13 Questions to Guide You During an Eval
The number one mistake I see OT/OTAs (OTs) make when they address sex with clients is that they don’t ask enough questions during the evaluation process, throughout intervention, and in follow ups after clients have “tried out” the OTs recommendations.
This is because our patients can quite often be a bit tightlipped when discussing sex. They may answer verbosely, but not really answer the question, or they might answer the question with as few words as possible. OTs can interpret their patients' hesitancy as either discomfort or perhaps a nonverbal boundary that they don’t want to discuss more.
What is more often the case, is that our patients have never EVER EVER been asked or been in a position to answer these questions before. It’s like the wild wild west to them. They might not know how to answer them, they might not know the answer to them, or worry how much they can say before they “offend” us. I’ve had patients say, ‘ok, can I speak freely in here? I don’t want to offend you Dr. Ellis.”
As OTs do, we always have a comparison to toileting right around the corner… think about how we ask our clients, “do you wipe from front to back or back to front?” If someone asked me this, I genuinely might furrow my eyebrows, tilt my head, have to think about, and then give the answer.
Thank you ADL-Toileting, back to sex. If we don’t have the full scope of information we need, we can’t do an activity analysis, we can’t identify barriers, and we can’t help our patients. Remember, all of these questions are coming AFTER you’ve established permission with the client to talk about sex and educated the client that if they don’t want to answer a question of your, they don’t have to.
So here’s a list of questions that always help me gather more information:
Who do you have sex with?
Who initiates sex and how?
When you have sex, what do you do? In awkward explicit detail, tell me what activities you do.
Do you enjoy _______ activity?
When you’re sexual, what feels the most pleasurable?
When do you typically have sex and where?
Do you orgasm and how?
About how long goes by before you: lose your erection, orgasm, give up, stop?
When does the anxiety kick in and what exactly is it that you’re worried about?
When does the pain start and in what position?
When you felt desire that one time, can you think of anything that happened prior that could have had a positive impact?
What are your goals around sex? What would better look like?
If you were to start anywhere to help you work towards your goals, where do you think you would feel comfortable starting?
These are just a few of the questions that can help OTs paint a full picture of the occupation while considering patterns, sequences, expectations, and activity demands and support us in working our special kind of OT magic!
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