by Jeremy Irvin, LMSW, M.Ed., and Kimberly McKay, Ph.D.
Rainbow Heart
Social work programs throughout the country help prepare you for many of the challenging content areas that you will face throughout your career. The topic of human sexuality, however, is typically glossed over, despite the fact that it is an important part of life that many of your clients may struggle with at some level during their lives. This article is designed to serve as a brief introduction to the vast and fascinating world of human sexuality.
1. Biological sex, gender identity, and gender expression are all different.
The concepts of biological sex, gender identity, and gender expression are often used synonymously, despite the fact that they are vastly different. Sex, or biological sex, refers to the identity that was assigned to you at birth by others (e.g., doctors and other adults) based on your external sexual organs you were born with (e.g., penis, scrotum, vulva, clitoris, or any naturally occurring biological variation). This determination may or may not fit the way you think about yourself. Gender identity refers to how you internally perceive yourself. Gender expression is how you present yourself to the world. More simply put, your biological sex (e.g., male, female, intersex) is dependent on your physical body, whereas your gender identity (e.g,, man, woman, trans*, genderqueer, agender) is determined by the ways in which you view yourself, and gender expression (e.g., masculine, feminine) is how you present yourself to the world. Although our culture tends to think about these categories in a binary way (only male or only female), the human experience is not binary in nature.
2. Gender expression is a social construct.
As a result of the norms and expectations of the culture you live in, gender expression is socially constructed. Think about this for a moment: are young girls inherently born loving the color pink and wanting to play with dolls? Many would argue “no.” They are taught these things by interacting with the world around them. A person learns what behavior (gender expression) is socially acceptable for a woman or a man (meaning gender identity) by way of observing and emulating the actions of others in society. The standard that people are often encouraged to follow is that women have long hair and wear dresses, and men have short hair and wear pants, for example. Those who do not follow these standards can be seen as transgressive. By acknowledging that these standards are created by society, we can learn to accept people who express themselves differently from the standard.
3. There is more diversity than LGBT.
As social workers, we pride ourselves on being culturally competent and inclusive, but when it comes to human sexuality, we do not always recognize the great diversity that exists in our world. For example, the acronym LGBT (lesbian, gay, bisexual, and transgender) is often used in social work when we are trying to be inclusive of sexual and gender minorities. However, this acronym does not adequately represent the sexual and gender diversity that is found within society. A better acronym that members of the social work community could be using to be more inclusive is LGBTQIA (lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual). This is still an underwhelming acronym to represent the broad spectrum of attraction, identity, and behaviors related to human sexuality. As a field, we must continually strive to increase our understanding of the diversity found within society, to better serve our clients.
4. Do not assume anything about your clients based on their sexual orientation.
Many people within American society believe a person’s sexual behaviors, thoughts, and desires should be consistent at all times with their self-identified sexual orientation. For example, we expect a lesbian woman to only think about having sex with women, only want to have sex with women, and only choose to engage in sexual activities with women. However, humans are not so easily divided into distinct categories. Sure, there are people whose behaviors, thoughts, and desires are aligned, but there are also many individuals for whom this does not apply. For instance, there are self-identified lesbian women who marry men, self-identified straight men married to women who fantasize about having sex with men, and self-identified bisexual individuals who experience a greater attraction toward one sex over another. It is important for social workers to ask clients how they identify, and then to ask them to explain what that identity means to them. This can help social workers to avoid making assumptions about clients’ behaviors, thoughts, and desires based on their identity. By getting a better picture of who the client is by way of asking respectful, clarifying questions, you can gain a better understanding of who the client is, not who you think the client is.
5. We are all sexual beings.
As humans, we are all inherently sexual beings. This is true regardless of whether an individual is gay or straight, gender conforming or gender nonconforming, sexual or asexual, able bodied or differently abled, neurotypical or neuroatypical. We all have some capacity to experience sexual pleasure. Many people who may look, act, or function differently from what is perceived to be the norm of society are often looked at as being non-sexual, but this is not the case. Social workers must strive to advocate for each individual’s right to choose if, when, and how they will engage in sexual activities of their choosing. We also have an obligation to educate those with various privileges about the unique challenges certain minority populations face in their attempt to have their sexual needs met.
6. Just because you may choose not to do it does not mean it is wrong.
In our own personal lives, we may judge a specific sexual behavior based on our own personal beliefs. These beliefs are formed by our lived experiences and colored by our worldviews. While our own beliefs may be perfect for us, they may not always be appropriate for others. As social workers, we have a moral and ethical obligation to empower our clients to arrive at the best solutions for them, free from our own personal values and biases.
The following working definition within the field of sexology can be utilized by social workers as a guideline: Any sexual activity out of sight and sound of an unwilling observer that is mutually agreed upon by all partners and is not harmful or coerced and is among consenting adults should be considered normal, whether or not we ourselves choose to engage in it. If all these conditions have been met, it is most likely that this behavior should be considered healthy. There is a caveat: even if it meets these conditions, if the client reports a marked level of distress, it is likely that the social worker will need to help the client explore the issue in greater detail to understand the distress.
7. Using inclusive language matters.
Social workers strive to create an inclusive and welcoming environment, regardless of the type of population we may serve. By using a more inclusive vocabulary, especially in regard to sexual and gender minorities, we can better foster a safe and therapeutic environment for all individuals. But what kind of an impact is our current vocabulary having on the sexual and gender minority clients we serve?
For instance, take the intake form. When viewed from the perspective of a sexual or gender minority, the language we use may be more limiting than we realize. Does the form incorrectly ask for gender when it is referring to sex? Does the form assume that there are only two sexes? How many gender options are included on the form? When asking about relationship status, does the form use the term “married” or “partnered” (a more inclusive term that would include anyone in a committed romantic relationship)? When asking about sexual abuse, is the wording of the question “victim of abuse” or “survivor of abuse” (a more empowering reframing)?
As social workers, we need to have an awareness of what kind of messages our language is sending to our clients. Looking at all of these questions may seem overwhelming, but implementing a few small changes now may have a very positive impact on your clients moving forward.
8. Sexuality encompasses more than just problem areas.
Social workers are trained in strengths-focused methods of working with and empowering clients. Yet, when social workers think about sexuality, they often only think about problem areas that can negatively affect clients’ lives, such as teenage pregnancy, LGBTQIA bullying, sexually transmitted infections (STIs), and sexual abuse. It is important that social workers learn to be more sex-positive and willing to discuss all topics of sexuality with their clients, even the things that are going well. For example, when helping clients to work through sexually related trauma, it is also important to help the client explore the positive aspects of sexuality that were not taken away as a result of the trauma they experienced.
9. Create a comfortable and safe environment
Topics around sexuality can often be awkward for social workers and clients to discuss with one another because of potential cultural, personal, and religious taboos that both parties experience. It is important to remember that your personal comfort is not more important than your client’s comfort. Even if sexuality topics are personally uncomfortable for you, it is your professional responsibility to create an environment in which your clients feel safe to bring up concerns and presenting issues. If these topics are awkward for you, find trusted colleagues with whom you can practice discussing sexuality topics that could possibly affect your client population. Do research regarding the large spectrum of normative sexual behavior to help you be aware and be prepared.
10. Stay calm when you don’t know the answer.
So, what should you do when a client asks you a question about sexuality that you do not know the answer to? First, stay present in the moment, and try to remain calm. You don’t want to respond quickly with an uninformed and thoughtless response, as this can do irreparable damage to the client and the therapeutic relationship. Second, remain cognizant of your body language. If your body language changes, the client may feel rejected. Next, thank the client for feeling comfortable enough within the therapeutic relationship to bring up such a personal, and often difficult, topic. Then, reassure the client you are comfortable and happy to discuss the issue, but rather than responding quickly to this important question or concern, you would like time to do some research and find the best informed response possible. This type of response often can help strengthen the therapeutic relationship, as it can make the client feel truly valued and validated. Additionally, by responding in this way, you have now given yourself more time to do research and consult with colleagues about what is the most appropriate response.
As you can probably tell, the topic of human sexuality may be much more complex than you initially thought. We hope you will use these 10 guidelines as a stepping-stone that can help you on your way to exploring many of these important topics in greater detail.
Additional Resources
American Association of Sexuality
Educators Counselors and Therapists
http://www.aasect.org/
Sexuality Information and Education Council of the United States.
http://www.siecus.org/
Jeremy Irvin, LMSW, M.Ed. in human sexuality, is a mental health clinician working in the state of Idaho. His professional interests include helping to improve human sexuality education in the field of social work, as well as working with transgender and sexual minority populations, both within the criminal justice system and society as a whole.
Kimberly McKay, Ph.D., is an assistant professor of instruction at Temple University. Her dissertation topic was sexuality education within master’s of social work programs. Her professional interests include helping to improve human sexuality education in the field of social work, sexual wellness across the lifespan, sexual minority populations, juvenile criminal justice, and mental health of children/adolescents.