1. Sexual Issues in Families Pam Schultz: January 2013

2. Aims of the session  What do we mean by sexuality?  Re-visit some key terminology from the social sciences applicable to theories of sexuality  Explore some practice examples to aid practitioners in supporting families with sexual difficulties  Where to look for material? 

4. Sex & sexuality  Talk together for about 5 minutes and discuss definitions and concepts of human ‘sexuality’.

5. Sexuality  1. the state or quality of being sexual  2. preoccupation with or involvement in sexual matters  3. the possession of sexual potency (Collins English dictionary, 2009)  In addition:- Do you think it is a uniquely human trait?  More than just mating rituals as we see in the animal kingdom

6. Sex & sexuality  Ingram-Fogel (1990) ‘Elements of Sexuality’-  Enabling a link with the future through children  Togetherness  A means of physical release and sexual pleasure  The communication of intense, subtle feelings  A feeling of self-worth when sexual experiences are positive  The development of ‘self’ or individual identity

7. Sexuality Sex/Sexual Practice Self Image Social relationships SensualityEmotions Spirituality Political factors With oneself With partner(s) of the same/other gender Celibacy Body image Self-esteem Looks Size Monogamy Family Partnerships Non-monogamy Food Music Dancing Smells Exercise Touch Love Desire Pleasure Joy Anger Intimacy Jealousy Sense of deeper self Closeness to nature Feelings of oneness Deep bonding Discrimination STIs Oppression Prejudice HIV Painter, 2005

8. Sex and Gender  "Sex" refers to the biological and physiological characteristics that define men and women.  "Gender" refers to the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women.  To put it another way:  "Male" and "female" are sex categories, while "masculine" and "feminine" are gender categories.

9. Stigma The term stigma conventionally refers to any attribute, trait or disorder that marks an individual as being unacceptably different from the ‘norm’ and which elicits some form of community sanction Goffman (1963)

10. Stigma ‘Enacted stigma’ - involves actual public discrimination or unacceptability ‘Felt stigma’ - refers to the fear of such discrimination or unacceptability Scambler (1989) The level of stigma attached to a particular condition is both historical and cultural and as such is not fixed for example differences of societal response to homosexuality, mental health & Disability

11. Stereotyping  Definition: A stereotype is “...a fixed, over generalised belief about a particular group or class of people.” (Cardwell, 1996).  For example, a “hells angel” biker dresses in leather.  All sex workers enjoy sex  In gay relationships one partner assumes the husband role and the other the wife.  Certain racial and religious groups are more prudish about sexual issues.

12. Stereotyping http://www.simplypsychology.org  One advantage of a stereotype is that it enables us to respond rapidly to situations because we may have had had a similar experience before.  One disadvantage is that it makes us ignore differences between individuals; therefore we think things about people that might not be true (i.e. make generalisations).

13. Prejudice & Discrimination  Prejudice is an extreme form of stereotype  According to Allport (1954) starts with dislike (which is the cognitive component)  Five Behavioural stages: 1) Anti-locution, could be nasty comments, gossip 2) Avoidance 3) Discrimination: when the object of stereotype is excluded from certain rights. 4) physical attack 5) extermination  It is unusual in this country to see as far as 5, but sometimes all the others, for example Honour-based violence and Homophobic attack

14. Cultural Differences  This can affect all aspects of sex & sexuality:-  Attitudes towards women in some cultures sexual “violence” is accepted  Honour-based violence.  Consider arranged or forced marriages  Whether sex is openly discussed, or private and hidden (though again be careful about stereotyping!)  Changes over time.

15. The Kinsey Institute  The Kinsey Institute  http://www.kinseyinstitute.org/ http://www.kinseyinstitute.org/

16. The Kinsey Scale

17. The Heterosexual-Homosexual Rating Scale, sometimes referred to as the “Kinsey Scale,” was developed by Alfred Kinsey and his colleagues Wardell Pomeroy and Clyde Martin in 1948, in order to account for research findings that showed people did not fit into neat and exclusive heterosexual or homosexual categories. Interviewing people about their sexual histories, the Kinsey team found that, for many people, sexual behaviour, thoughts and feelings towards the same or opposite sex was not always consistent across time. Though the majority of men and women reported being exclusively heterosexual, and a percentage reported exclusively homosexual behaviour and attractions, many individuals disclosed behaviours or thoughts somewhere in between.

18. The Kinsey Studies..  “ Sexual Behaviour in the Human Male” (1948)  “Males do not represent two discrete populations, heterosexual and homosexual. The world is not to be divided into sheep and goats…The living world is a continuum in each and every one of its aspects  “Sexual Behaviour of the Human Female “(1953)  “It is a characteristic of the human mind that tries to dichotomize in its classification of phenomena….Sexual behaviour is either normal or abnormal, socially acceptable or unacceptable, heterosexual or homosexual; and many persons do not want to believe that there are gradations in these matters from one to the other extreme.”

19. Kinsey Institute  http://www.iub.edu/~kinsey/publications/ki-pubs.html http://www.iub.edu/~kinsey/publications/ki-pubs.html  The Kinsey Institute References

20. Sex Differences  http://www.foreverpleasure.com/catalog/ask-the-sex- doc-t-4.html http://www.foreverpleasure.com/catalog/ask-the-sex- doc-t-4.html  The above is not a scholarly web-site but may provide information re: terms or “Jargon” you may hear in the community.

21. Health Visitors & School Nurses  We will meet all types:-  Heterosexual, Homosexual, bi-sexual, transsexual and every other variety.  Sex Workers, promiscuity, sexual naiveté, frigidity, under-age sex and older age sexual relationships.  To understand we need ourselves to have knowledge beyond the stereotype…we are NOT immune to wider societal beliefs & prejudices.

22. GLBT (or LGB???)

23. How to talk about sex…..adopt ….  A non-judgemental attitude  The ability to discuss matters of a sexual nature in a frank and open manner  An awareness of the complexities of human relationships  The ability to develop an effective practitioner-patient relationship  In other words draw upon all the advanced communication skills you have developed.

24. Advanced Communication Skills  Basic Theory of communication, Shannon & Weaver, 1949.  More complex than this: think about non verbal cues and communication  Think about shared meanings  “Effective Communication: A guide for the People Professions” (2011). Neil Thompson.

25. Young People & Sexuality  Popular website for teens  http://www.seventeen.com http://www.seventeen.com  Heather Corinna, (2007) “SEX” Perseus Publishing,.  Elizabeth Burtney and May Duffy. (2004) Young people and sexual health: individual, social and policy contexts

26. Communication with Children & Young People  All your skills and more (Thompson, 2011)  Being able to recognise child or young persons level of development.  Being very flexible and adaptable: change style as needed.  Not being drawn into being like them if they are being challenging or testing you out. Lead by example even though it might not be easy.  Use a wide range of communication methods play, hands on activities, use different methods to produce a “connection”  Observation and reflection upon what we see,

27. Explore Relate website  http://www.relate.org.uk/sex-therapy/index.html http://www.relate.org.uk/sex-therapy/index.html

28. Relate Website  http://www.relate.org.uk/common-problem- details/5/index.html http://www.relate.org.uk/common-problem- details/5/index.html  If someone has had an affair.

29. Sexual Abuse  Sadly more common than you might expect…..however societal attitudes have changed.  Often accompanies other domestic violence  Marital and “date rape”  Non consensual sex for example when one partner is intoxicated or under the influence of drugs  Honour-based violence

30. Sex addiction. http://www.bbc.co.uk/news/magazine-16469222  Sex therapists would argue it is a real addiction with serious consequences  But others in psychiatry and psychotherapy argue it is not comparable to substance addiction and should not be classed as such  Addiction can start with viewing online porn for a few hours a day and can then escalate  "It's a way of escaping from low self-esteem, feelings of anger and insecurity," says sexual relationship counsellor Paula Hall. "It's not really about sex. It's driven by shame.“  Watch out for Steve McQueen's film “Shame”

31. Sydney Morning Herald January 30 th, 2012 “When in comes to sex women want quality not quantity”. Large study looking at mismatch in expectations.

32. Some other issues….  Sex issues & Disability (either personal issues, but more often Stigma and/or discrimination  Effects of prostitution on the family  Open Marriages  Sado-masochism

33. Class work…..  Case studies ……

34. Journals & References  Archives of Sexual Behaviour  Behaviour Research & Therapy  Child Abuse & Neglect  Journal of Sex & Marital Therapy  http://www.tandf.co.uk/journals/titles/0092623X.asp http://www.tandf.co.uk/journals/titles/0092623X.asp  Journal of Marriage and the Family  Journal of Consulting & Clinical Psychology  Journal of Social & Personal Relationships  Journal of Personality & Social Psychology  Psychological Bulletin  Women & Health

35. References Bornovalova, M.A, Gwadz, M, Kahler, C, et al. (2008). Sensation seeking and risk taking propensity as mediators in the relationship between childhood abuse and HIV-related risk behaviour. Child Abuse 7 Neglect, 32, 99-109. Ellis, E, Atkeson, B & Calhoun K (1981). An assessment of long-term reaction to rape. Journal of Abnormal psychology, 90, 263-266. French (2007) BASHH 2006 National Guidelines--consultations requiring sexual history-taking. Int J STD AIDS18(1) 17-22 Goffman, E (1963) Stigma: the management of spoiled identity. Harmondsworth, Penguin Goldsmith, M (1992) cited in Promoting sexual health. British Medical Association Foundation for AIDS, London Health Protection Agency (2008) Sexually transmitted infections and young people in the UK. HPA, London Health Protection Agency (2007) Continued increase in sexually transmitted infections: An analysis of data from UK genitourinary medicine clinics up to 2007. HPA, London Hendricks, A (1992) cited in Promoting sexual health. British Medical Association Foundation for AIDS, Londonb

36. Health Protection Agency (2008) Sexually transmitted infections and young people in the UK. HPA, London Health Protection Agency (2007) Continued increase in sexually transmitted infections: An analysis of data from UK genitourinary medicine clinics up to 2007. HPA, London Hendricks, A (1992) cited in Promoting sexual health. British Medical Association Foundation for AIDS, London  Macleod, S. A. (2008). Simply Psychology;. Retrieved 1 February 2012, from http://www.simplypsychology.org/katz-braly.html  Rellini, A.H, Ellinson, et al (2011). The effect of pre-existing affect on the sexual responses of women with and without a hisotry of Childhood Sexual Abuse. Archives of Sexual Bejaviour, DOI, 10.1007/s10508-011-9772-y Scambler G. (1989) Epilepsy. London,Tavistock Society of Sexual Health Advisors (2004) The manual for sexual health advisors SSHA, London Tomlinson, J. (1998) Taking a sexual history. BMJ 3171573-1576 World Health Organisation: http://www.who.int/gender/whatisgender/en/ (accessed 31 st January, 2012.http://www.who.int/gender/whatisgender/en/