How to Overcome Unconscious Sexual Bias

If you have a brain, you have a bias. Confronting our own biases is uncomfortable, but it is our ethical responsibility as occupational therapy professionals.  Considering how paramount reconciling our biases are to enhancing the therapeutic relationship and treatment efficacy, and reducing patient harm and health disparities...

Many of us weren't taught this in school.  

Welp, add it to the list of uncomfortable yet essential topics that were and are omitted from OT curriculum !  And it's a double whammy omission-effect when we combine this with sexuality. 

So what does this mean for OT professionals? 

We need to do the work to acknowledge our bias and make sure to include sexuality when doing so.  This is exactly my motivation behind my favorite CEU offering, "Guided Self-Reflection of Sexuality Values, Beliefs, Attitudes, and Biases" (see below section for more info).  We're all sexual beings with our own experiences and beliefs around sexuality that unless explicitly self-analyzed this will impact the therapeutic relationship and have the potential to cause harm.  Let's take this scenario for example, many of us received messaging growing up around who is desirable and sexual.  This was a very strict and narrow standard typically centered around combinations of thinness or fitness, whiteness, youthfulness, and/or being straight, neurotypical, and nondisabled.  Additionally, many of us learned that we shouldn't talk about sex... with anyone!  Then this message is reinforced in OT where sexuality is most often omitted from curriculum.  So imagine an occupational therapist who received all of these messages and might not address sexuality with someone with an intellectual disability because 1) they believe sex isn't ok to talk about, and 2) they might view the individuals as asexual or not interested in sex.  What's the impact?  Well we know that individuals with intellectual disabilities are less likely to get sexual health education and more likely to experience sexual assault.  So the impact is very grave.  OT intervention centered around accessible sexual health information could have had a significant impact on this reality.

Or what about an OT who thinks, "I can't talk about sex at my hospital because I live in a conservative area." Do "conservative people" not have sex????  What about the individual (conservative or not) who dislocates their hip replacement having sex because they were never educated on positions that follow hip precautions.   

And these are just some of the messages we might have received and integrated as beliefs.  Something that has been particularly helpful for me is to normalize having biases.  This has held me accountable to look for and recognize them, do the work to deprogram them, and keep it moving until I notice the next bias I have!   

I was inspired to write about this topic for our newsletter after reading Sheela Ivlev's article "Racism in Healthcare and What To Do About it."  Sheela is another badass OT who is bringing the OT profession back to it's root mission of community, equity, and health through occupation (which it's never really quite achieved yet, but the vision is as old as the profession).  Drop everything and read her article or time block when you're going to read it in your calendar NOW.  Set aside about an hour for the article, test, and videos.  Pay attention to the action items to promote change in your practice.  The Harvard Implicit Association Test and UCLA Video Series on Implicit Bias are very educational and bring awareness to implicit bias. BUT!  Acknowledging your bias is only the first step and not nearly the most significant - real impact comes when we can reconcile the bias, replace our stereotypes, stop clinical decisions informed by cognitive short-cut thoughts, and make a change in our clinical practice to welcome and be inclusive for people we differ from... remember we differ from all of our patients and the influence of our own norms can negatively impacts all of our clients. 

To support you in your anti-bias work, Sheela and fellow OT Disruptors are planning a "Disrupt OT Community Summit"  for August 7-8th.  This is a free, two-day, live, virtual event with opportunities to learn alongside occupational therapy activists who will focus discussion on healing, returning to community, anti-racism, decolonization, and gender, sexuality, and mental health.