CITATION:
Dyer, K. & das Nair, R. (2014). Talking about sex after traumatic brain injury: Perceptions and experiences of multidisciplinary rehabilitation professionals. Disability and Rehabilitation, 36(17), 1431-1438. doi:10.3109/09638288.2013.859747
SUMMARY:
Disruption to sexuality is a common occurrence among individuals with traumatic brain injury (TBI). Unfortunately, issues surrounding sexuality are often inadequately addressed in TBI rehabilitation, even though the literature has found that many individuals with TBI and their family members would be interested in discussing this topic. Furthermore, previous research has illuminated the disparity between healthcare professionals’ perception of sexuality after TBI as an important rehabilitation topic, yet there is lack of regularity in actually addressing it. This study aimed to identify and expand upon rehabilitation professionals’ attitudes on discussing sexuality after TBI by utilizing a qualitative design. Four focus groups (group size ranged from four to eight participants) with teams of interdisciplinary rehabilitation professionals (i.e., occupational therapists, support workers, psychological therapists, physiotherapists, case managers, a medical doctor, and “other” therapists) were utilized to explore themes associated with attitudes toward discussing sexuality after TBI with service-users (i.e., TBI survivors and their family members).
The authors identified and expanded upon six primary themes related to attitudes toward addressing sexuality after TBI. The first theme addresses the perception of sexuality after TBI as being a specialist issue, in which hesitance toward addressing this topic often stem from perceived or actual lack of knowledge, skills, and expertise. The second theme identified sexuality as a sensitive subject, and participants raised concerns about offending service-users. The third theme discussed practicalities of how, when, and where to discuss sexuality after TBI, as well as a tendency toward taking a reactive (i.e., waiting until the service-user raises it first) versus proactive approach to discussing this topic. The fourth theme of roles and responsibilities raised the dilemma of which healthcare discipline would take on the role of discussing sexual issues with service-users. The fifth theme identified concerns regarding risks and vulnerabilities related to discussing sexual issues with service-users, including risks associated with sexual exploration, hypersexuality, and vulnerability of survivors to abuse and exploitation. The final theme addressed organizational and structural issues related to discussing sexuality after TBI, in which sexuality is not typically prioritized in various rehabilitation settings.
This study supports prior research regarding attitudes that rehabilitation professionals have about addressing sexuality after TBI, while also expanding upon these ideas by utilizing a qualitative approach. Implications for practice, policy, and training were also explored, such as implementing routine assessment of sexuality after TBI and interventional approaches to addressing this issue. The authors recommend the use of the PLISSIT model to address the sexual wellbeing of individuals with acquired disability and chronic illness, including TBI. The PLISSIT model identifies four levels of intervention in discussing this topic: Permission to discuss sexuality, provision of Limited Information regarding sexuality, Specific Suggestions regarding the person’s sexual issues, and Intensive Therapy with a expert when needed.
I chose this article because it reminds me that TBI rehabilitation is multifaceted and should address many integral aspects of adjustment to disability beyond physical, occupational, and cognitive functioning, and a lack of discussion about sexuality after TBI may be a disservice to survivors and their family members. Normalizing the importance of sexual functioning as part of the human experience may allow for more open discussions regarding sexuality after TBI, which may then promote other aspects of psychosocial recovery, including interpersonal and romantic relationships, community reintegration, and quality of life.
THIS REHABILITATION SCIENCE SPOTLIGHT was chosen by:
Willa P. Vo, PsyD
Assistant Professor
Department of Physical Medicine & Rehabilitation
Division of Rehabilitation Psychology
University of Texas Southwestern Medical Center