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Discussing intimacy is relevant to care and recovery

Systemic reluctance to talk about sexuality ignores the therapeutic value of intimate relationships, says Beth Stranks

Systemic reluctance to talk about sexuality ignores the therapeutic value of intimate relationships, says Beth Stranks


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During my first placement as a nursing student, I observed a patient’s expression of the need for intimacy being labelled as ‘bad behaviour’ and resulting in sanctions.

It appeared that the therapeutic value of intimate relationships was being ignored. At the time, I recognised only some of the complexity of this issue but the infringement of an individual’s human rights spurred me to investigate further.

I have since explored the research literature, had many discussions with a wide range of nurses and struggled with this issue in my own practice.

‘Think as broadly as possible’

My discovery that this experience is not exclusive to me reinforced my view that practitioners, researchers and policymakers need to explore the inherent difficulties over sexuality in mental health practice.

Let’s be clear what we mean by sexuality. People often first think about preferences of sexual attraction. In this discussion, I invite you to think as broadly as possible.

I came into mental health nursing from a role supporting young people to make informed choices on topics including sexual health. Coming from a family where talking about sex was not the norm, I struggled to overcome embarrassment.

Relevant sexuality topics

But the breadth of sexuality topics relevant to mental health nursing is much broader and poses a greater challenge. The embarrassment passed with time as my determination to develop my practice grew.

‘I hadn’t acknowledged aspects of my clients’ sexuality as relevant for their recovery because of the vulnerability that it triggered in me’

Despite this I was blind to my shortcomings. The truth was uncovered by a painful process of reflection supported by clinical supervision. I hadn’t acknowledged aspects of my clients’ sexuality as relevant for their recovery because of the vulnerability that it triggered in me.

I knew from my research the rationale that my clients’ most intimate thoughts were relevant to their care. However, my values screamed: ‘You discuss this only with your most trusted friends.'

Uncomfortable, embarrassed and scared

The uncomfortable feeling resulted from my perception that professional boundaries were being blurred.

With this improved self-understanding and the knowledge that I will feel uncomfortable, embarrassed and scared, I continue to take up the fight. I am mindful that I need to protect service users, and have a responsibility to keep us both safe and maintain professional boundaries.

‘I have been privileged to hear individuals’ stories, including how formative sexual experiences have affected their mental health and recovery’

Looking to explore these issues in a collaborative way, I have found several strategies, such as softening my approach by using broad questions initially and then funnelling down to more specific issues, and empowering clients by giving them control of what and how much they share, helpful.

These strategies also include keeping us both safe by explicit acknowledgement of the effect on professional boundaries and agreeing ways to maintain them, and normalising the effect of sexuality issues by acknowledging the emotional difficulties for us both.

Emotional intelligence

I have been privileged to hear individuals’ stories, including how formative sexual experiences have affected their mental health and recovery.

These conversations have had the most positive effect on my therapeutic relationships with clients. However, the personal battle is not won, and reflection and supervision are crucial to my continued professional development in this area.

There are some studies in this field (Higgins et al 2008, Quinn et al 2011) but not many, which, with a lack of policy guidance, suggests that fear and avoidance are not personal to me but systemic and need to be tackled at all levels. Making sexuality a routine part of multidisciplinary discussions is paramount to maintaining safety, and identifying avoidance and integration into practice.

This complex and challenging issue needs to be addressed within nurse education to help nurses develop the emotional intelligence required to make informed clinical decisions necessary to maintain boundaries for safe practice.


Beth Stranks is a mental health nurse at ²gether NHS Foundation Trust, Gloucester

 

 

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