When we work with people, we strive to pay attention to people as holistically and customer oriented as possible. These two words often form a strong foundation for the social and health care profession and ethical guidelines. Still, to speak about sexuality as part of rehabilitation seems to be a challenging thing still nowadays. Sexuality is a very sensitive topic for both clients and professionals, so very often it is not really known how the topic should be approached or how it should be talked about. Avoidance of the topic increases if the client has an illness, disability, or trait that makes it difficult to approach sexual issues. But what if there are not any words to be available? Image communication is familiar to professionals working with speech-impaired people, but the images of sexuality have been missing.
Sexuality is a strongly experiential and individual thing that we cannot define on behalf of anyone else. Nor can sexuality be inferred or compartmentalized because of an existing illness, injury, or trait, even if we ourselves have some prejudices. We always encounter people through our own tools, but the principle and basis of the social and health sector is that the client by oneself defines important things in his or her life, sets goals for rehabilitation and is actively involved in planning his or her care and services. Among other things, the change in the rehabilitation paradigm puts more and more clients and their network at the centre of rehabilitation. The only professional way to meet a person is to genuinely hear what he or she is saying and what things are important to him or her. This also includes that we have to hear the humans and their own ideas and questions which are relating to sexuality, which are important things.
Rehabilitation in particular is comprehensive support for human survival and participation, despite an injury, illness, or feature. Sexuality issues are difficult to separate from humanity and therefore their consideration should go hand in hand as part of the various aspects of rehabilitation.
People with disabilities and the chronically ill must also have the right to a relationship, sexuality, intimacy, and sex. There are still strong fears, attitudes, and myths that sexuality does not belong to certain groups of people, that they do not have sexuality or there will be no need for discussing it. However, sexuality is such an experiential thing that an injury, illness, or trait rarely excludes sexuality, desires, or relationships altogether away. Every human being is an individual and therefore the experiences of sexuality are also individual. However, in different ways, people with disabilities often receive non-verbal messages about the negativity of the topic or its rejection. Most special groups are left without any support or information in these areas.
It is also important to note what we mean by sexuality. All too often, we get stuck with the idea that sexuality is sex and sex is between vaginal-penis intercourse. As we broaden our understanding, it is also easier to notice the presence of sexuality in all people. Even if there is no possibility of “traditional sexual intercourse,” sexuality can also mean erotic thoughts, solo sex, or just being close to another person in people’s lives. Sexuality can be expressed not only through the having sex (there are also many kinds of sex), but also through dress and self-expression. Sexual education and sexuality also essentially involve learning how to interact — what can be done to me, which places I can be touched and how I can behave in the company of others.
When, there is no speech at all.
Communicating with other people is the cornerstone of our being. Language and words define a lot of our interactions with others, but more important to the functioning and success of the interaction is that the person feels that he or she can become understood. If a person has severe speech and communication problems, they often find it difficult to be genuinely heard. It may be that their contribution to the interaction is not considered as valuable as the others. Therefore, in support of social survival, it would be very important to use all possible methods to support the success of interaction and communication. The most familiar of these methods are certainly the signs, body language, objects, and images. Image-communication enables a person to receive and express information and thoughts in accordance with international human rights treaties With the help of image communication, a person can feel that they are being understood and the receiving of information is secured. Image communication can also be used as a form of speech replacement or supportive communication depending on the need of the person. In most cases, people who need special support, such as people with autism spectrum disorders or people with intellectual disabilities, benefit from visual support in addition to speech, even if they do not have an actual speech disorder.
In the parts of areas of sexuality, the existence of images, and their use, is equally important. On the topic of sexuality, we need to be especially aware that the images and means of communication we choose automatically limit a person’s ability to tell as broadly and freely as possible about their own self and desires. So, with our own image choices, we may narrow out some topics or possibilities if we are not willing to discuss them ourselves. Critical self-reflection is one of the most important tools for a professional also at this point. If a person has been given images only of the presumed woman and man, how can the customer tell if he or she does not feel that either of the given options is correct? The importance of the diversity and breadth of all images used in communication is the foundation for enabling communication.
Diversities of gender or sexual orientation are visible all over the world — including people´s within disabilities and in special groups. These groups of people are in no way excluded from these deliberations. Exploring one’s own self, pondering likes and wondering all preferences affects all people, and these reflections should be given an opportunity, too, for those who are unable to automatically ask help with their speech.
However, not all rehabilitation and health care professionals need to be interested in their own or the client’s sexuality. Nevertheless, each of us should know what we think about sexuality issues and where the boundaries of our own activities go. This helps us so that we dare to face the customer in the vicinity of the customer’s topic and then guide him or her forward. We cannot leave the client alone with the topic, nor can we ignore the client’s need to become heard and to become understood. This is a real way of professionalism — we hear and help people to move forward. We are looking for either person, a colleague or a professional who can help and guide us with the topic. Also, dare to ask for help for yourself and your work community if you want tips or training on the subjects.