Social Work Spotlight - Episode 45: Candice & Arlyn (1)

Episode Date: December 10, 2021

In this episode I speak with Candice and Arlyn, who run the Sexuality Service at Royal Rehab, providing personalised support including one-on-one and couples counselling, and educational courses to empower people with illness, injury or disability, their family and carers as well as professionals assisting them to create a meaningful, pleasurable, and rewarding sex life. This is episode one in a two-part series. The first episode will focus on Candice and Arlyn’s professional backgrounds in social work and nursing and their further training to become psychosexual therapists, with the second episode going more into the practicalities of running such a service.Links to resources mentioned in this week’s episode:Training dates for 2022 NDIS Sexuality Training & Education For Clinicians In Sydney - https://royalrehab.com.au/sexuality-training-and-education-for-cliniciansJoan Price books on Amazon - https://www.amazon.com/Joan-Price/e/B001JRXBHW%3Fref=dbs_a_mng_rwt_scns_shareComprehensive list of sex-positive social media resources created by Royal Rehab - https://drive.google.com/file/d/1ifuOi7jZ99i0vLh9KJtPYtIlLssNS3CF/view?usp=sharingShane Clifton’s memoir ‘Husbands Should Not Break’ - https://www.goodreads.com/en/book/show/26763199-husbands-should-not-breakLeigh Sales’ ‘Any Ordinary Day’ - https://www.penguin.com.au/books/any-ordinary-day-9781760893637Sam Bloom’s ‘Heartache & Birdsong’ - http://www.penguinbloom.comAlex McKinnon’s ‘Unbroken’ - https://www.betterreading.com.au/book/unbroken/Mount Sinai Enhancement of Social Work Leadership Program - https://www.aasw.asn.au/document/item/11806Royal Rehab, Sydney - https://royalrehab.com.auStrength2Strength program, Royal Rehab - https://royalrehab.com.au/event/strength2strength-program-for-brain-injury-2Candice’s ResearchGate page - https://www.researchgate.net/profile/Candice_Care-UngerThis episode's transcript can be viewed here:https://docs.google.com/document/d/1qSrR68yrEB5r7prxn2gFUKoOlBi7q9Vbj7qqQcGqho4/edit?usp=sharingThanks to Kevin Macleod of incompetech.com for our theme music.

Hi and welcome to Social Work Spotlight where I showcase different areas of the profession each episode. I'm your host, Yasmin McKee Wright, and today's guests are Candice and Arlen, who run the Sexuality Service at Royal Rehab, providing personalized support, including one-on-one and couples counseling and educational courses to empower people with a disability, their families, and carers, as well as professionals assisting them to create a meaningful, pleasurable, and rewarding sex life. This is episode one in a two-part series. This first episode will focus on Candace and Arlen's professional backgrounds in social work and nursing and their further training to become psychosexual therapists.

And in the second episode, we go more into the practicalities of running such a service. Candice is passionate about ongoing learning and improving outcomes and opportunities for people with a disability. Candice is the professional leader of social work at Royal Rehab and their inaugural sexuality Services team leader. In addition to her social work bachelor's degree, Candace has completed a master's in public health and postgraduate studies in sexual health and reproduction, specifically psychosexual therapy. Arlen has been the clinical nurse consultant and psychosexual therapist at Royal Rehab's Sexuality Service since its inception in January 2021. He holds a master's degree in psychosexual therapy and is currently studying broader psychotherapy training.

His nursing background includes primary care and outreach, sexual health and critical care settings. Prior to becoming a registered nurse, he worked for four years as a disability support worker, primarily for folks with acquired neurological disabilities. He is passionate about holistic and person-centered healthcare, nursing philosophy, sex positivity, harm reduction and human rights. Thanks so much, Candace and Arlen for coming on to the podcast very excited to to have two people as well as an interdisciplinary focus for today's episode. And I'll start with why you chose this profession. So Candace, social work and Arlen, nursing. What brought you to the profession in the first place? Why did you choose to study? Nursing. That's back in my early 20s.

I wanted to study and I like working with people. So my mum's a nurse. So I grew up with my mother as a nurse, I looked at all sorts of things. I looked at counseling and I looked at massage and I looked at physio and I looked at all these different things and I didn't even consider nursing and my mom said, why don't you do nursing? Because there's so many different options you can do in nursing. Oh, okay. So I just sort of on a whim I went, yep, signed up to it. And then I loved it.

I loved studying nursing. Yeah, I sort of realized I loved it once I started studying it. But yeah, it came from a suggestion from my, my mum, the nurse. And was there a point at which you decided either your experience or something you were interested in that made you want to do extra study after that? Yeah, so I had all of my experience in sort of critical care areas in a major hospital in Sydney. And I was shift working and quite burnt out and stressed out

and sort of frustrated with the bureaucracy of the system. and also from what I'd learned in my nursing degree around sort of nursing philosophy and person-centered nurse and holistic care and things like that. And I didn't really feel like my values as a nurse were mandated by my job. They were more like a garnish that made my care special for the clients. And so I wanted to gain a bit of freedom and pursue some of my own interests and wanted to essentially leave the health system. And so I started my masters in psychosexual therapy to become a sex therapist. At the time, I wanted to quit nursing because I found it sort of too hard, not because I didn't believe in nursing, but because I felt that the system kind of limited us as a profession.

And so I gave up on it. But a few years later, as I ended up working in primary health care and in sexual health nursing towards the end of my masters. And the nurses and doctors and the service I worked in was really inspiring. And I went, hey, look, we can be really holistic and person-centered as nurses. So I decided I wanted to keep that hat and wear at the time I was going to wear two hats, the sex therapist hat and the nurse hat. But since this service started with Candace in January, it's one hat. I'm a nurse consultant in psychosexual therapy.

Sounds like it's perfect to blend those two together. Yeah, sort of fell in my lap in a way. I think it's a good reminder of you study to pursue the things you're interested in and the careers evolve, workforce change, the needs of the community change and jobs that didn't exist when you started studying exist a couple years later. But it's sort of about getting yourself ready. so that way when the jobs that you want and that you dream about when they can come together, you're able to be part of it.

Yeah, I sort of found that like towards the end of my master's, I was trying to reconcile the differences. And so most sex therapists, they're counsellors or psychs or doctors or social workers. And there's a few sex therapists that used to be nurses, but they quit nursing in order to become a sex therapist, which was what my original path was. but I felt this real affinity with the values and philosophy of nursing that I really didn't want to let it go. And so I really sort of struggled with coming to terms with that.

But then this service started and sort of allows me to keep my nursing hat on. And Candace? I came into social work as a school leaver. I actually used to work in a chicken shop as a teenager. And there was a girl who was in the chicken shop with me who had enrolled in social work. And I remember asking, oh, what's that? And she kind of explained what it was. And I was like, oh, that sounds pretty cool.

So I went home and changed all my preferences from primary school teaching, which is a terrible idea. I would have been a terrible teacher. Yeah, social work was the right way. I mean, she ended up changing and becoming a geologist. But I stayed in social work. So that was sort of my entry. And it was, you know, the right job at the right time, at the right divine intervention,

if that's what one believes in. But I just feel like it was a bit of a kind of calling job. So I have happily had a 16. year career in the social work area, but went back to do my postgrad in psychosexual therapy in 2019. And maybe for different reasons to Arlen, that was more around, I guess, the clients that I was working with at the time in rehab, having lots of sex questions and not so feeling that well equipped to be able to support them in the way that I wanted to support them. And then like looking within the industry, realizing, you know, there was this big gap for people with

acquired disability and, you know, lived experience of disability and sort of being able to access, you know, real comprehensive sexuality support. So I guess that was part of my motivation for going back and retraining. I probably wasn't and isn't the path that I thought I would be taking when I started as a social worker. I probably, I did have ambitions on child protection social work. And after my placement, that stopped that pretty quickly. It just, it wasn't for me. But health has always been a good fit for me. And then this was just, I see it as a specialisation of social work. It's just being able to have those really, you know, kind of taboo topic conversations, respectful, supportive in a way that, you know, our clients want and need.

So, you know, that was how I came into it. What was your experience of having those taboo topics in the health system? Oh, I've always loved taboo topics. They're like, the more socially outrageous or, yeah, taboo the more I'm in there. And like, as you know from the previous podcast that we recorded last year, spirituality was something that I was very comfortable talking about, happy to talk about existential crisis, you know, happy to talk about mental health, suicidality.

Like these are all taboo topics and sex is just another one. So I kind of, you know, religion, spirituality, sex, I'm happy, I'm there. And I think part of it is because I know that these are topics that people can't have with everybody. You know, these aren't conversations that society allows us to talk easily about. Yeah, so it's an area where there's a clear need, but often ignored or pushed under the table. And you saw an opportunity to then fill that gap. Yeah, I kind of like talking about the things they're not meant to talk about. Yep. Arlen, was that much of a focus for either your training or the practice of nursing? Taboos, yeah. I think in terms of my values, like I really resonated.

with the nursing philosophy around holistic work and embodiment and person-centeredness and things like that. I guess in my personal life, I was also always sort of, like that was one of the things I thought of studying was anthropology. I just fascinated by the way people are and the diversity and variation in how people live. And I think that's beautiful and that should be supported. And I like taboo because it makes people uncomfortable. It really sort of, if you bring up a taboo subject, it can really sort of poke someone somewhere deep, which is, I guess, why it's so difficult for a lot of people,

a lot of clinicians to really address. I really enjoy it. You can really find a lot out about people by boring it. I think growth happens when we're uncomfortable. Did you find that that's unusual, though, for the profession, and whether people tend to shy away from it as we tend to see in social work, unfortunately. Yeah, I mean, I guess the thing that sort of my big criticism in nursing was, was that the values and all of that of nursing of being person-centered

was kind of built into this structure of the health system of a lot of ticking boxes, especially if you're working on the ward and things like that, like you've got a lot of jobs to do and you have to get them all done. Whereas the sort of the art of nursing is how you do those jobs and how you do those things. But they're not particularly written into the policy. We're not necessarily paid for that. We do the job, we can get through. And it's up to the individual whether we really make it a sort of a healing experience for people.

I think most nurses have that within them, definitely. But when you're so busy, it's very hard to bring that aspect in. Within nursing and in the hospital, like one really big taboo thing, thing which I always considered going to work in was palliative care. So working with death. And within sort of the hospital system especially, there's this big focus on fixing things, fixing things, fixing things, healing things, curing things, surgery, all this sort of thing. And what I really resonated within pallative care and the people I knew that worked in PAL care was it all flipped. Like the whole goal of care changed to one of providing care.

And often it was a really difficult decision for families and patients, but also for often for many doctors to kind of let go of intervention to change the focus to, okay, well, like we're not actively making this person die, but we're withdrawing all these treatments which are not helping their quality of life and they're not, they're not going to get rid of their illness and disease. But we're going to really focus on making. making a person comfortable and happy for their sort of end of life period. And I think the value change into that specialty is really interesting. It's interesting you talk about anthropology. There was an episode 25. I spoke with Belinda and Rabina. And Belinda had worked as an anthropologist and an academic for many years. And she was really focused on eco-social work.

They're both working now in the disability and sexual violence team at the New South Wales Health Education Centre Against Violence, ECHAV. But yeah, just interesting, you mentioned that from different approaches, different ways of tackling the healthcare system and approaches within that. So yeah, it's definitely something that's becoming a little bit more apparent or focused on, which is good. Yeah, there's kind of a belief in the, this is how you do health, this is how you get better, whatever, you take this medication, you do this exercise, you eat this food,

and it's all very prescriptive. and like when you bring in spirituality and culture and things like that, it's very different for a lot of different people. And a lot of people that don't fit into that sort of normative box in their culture and their community, it can be really alienating in the Western health system for a lot of people. Yeah. So tell me about your current program, what the roles are and what populations you support. So Alan and I both work for the Royal Rehab.

sexuality service, which is based in Sydney, but we'll, thanks to telehealth service pretty much anyone in Australia. And our, I guess, focus area is for people living with injury, illness and disability who have a sex, sexuality relationship concern that they might like to engage in some support around. So both Arlen and I work in that service in the capacity of psychosexual therapists, another fancy word for sex therapist. So we provide, it's like a specialised counselling to do with. sex and sexuality concerns. And in the context of where we are, we tend to see a lot of people

with neurological injuries or acquired disabilities, maybe from an accident or an injury. And mostly we see people in the community, but obviously being based at a hospital, we'll provide an inpatient consultation. But it's one of those things people will actually know that we're there and we'll kind of dive a little bit deeper into when they're home and They've got, you know, the space and the time and the priorities shift when people are home. So, yeah, most of the time we're seeing people either at the moment, thanks to COVID, online. But otherwise, we also have like a clinic at all rehab that people would come in to see us. And otherwise, we'd do a home visit.

So that's where we are right now in terms of services that we provide. It's still kind of new. We're nine months in. Probably seeing a little bit over 70 people in that nine months, which is good. You know, we're kind of able to service that number. We're not being flooded, but at the same time, we still got the space to take in more people as well.

I think the thing that we've been learning as we're learning as we go is probably the main point. We're learning the types of issues that people are presenting with. And because there's not a lot of research in this space, some of it's trial and error. And so we are trialing things that we know work in the able-bodied community and we put our rehab hats on and make a few adaptions and tweak a couple of interventions and just see how they go in the community that we're working with now.

It's really interesting sort of working in a health service and doing sex therapy. Generally you see most sex therapists, they work privately. And the clients we see, we're sort of embedded in a rehab disability service. So our clients have, aside from complex, sort of psychological, needs and sexual needs, they've got a lot of medical stuff going on. And so we're really building sex therapy as part of a multidisciplinary team. And so along with that, it comes a lot of case management staff, writing reports and all sorts of things like that, which you wouldn't necessarily see in private practicing sex therapy where it's a lot more of an ongoing counseling,

maybe they'll refer to a doctor or things like that if there's a physical problem. Yeah, it's a lot it's a lot more sort of fits into MDT. Yeah, the interdisciplinary practice of having everybody there in the one spot's pretty cool. Like if we need to work with a speech path, well, we've got a speech path. We call her our sex path. But at the same time, it's, you know,

all of that's under the one roof. And we can talk to each other. It makes for much more holistic integrated care than, you know, the traditional private practice models where people are seeing different people and different services and have to take multiple appointments. across different organisations that may or may not communicate with each other, whereas that's probably one of the major highlights of being integrated into a health

service or a disability and rehabilitation service is that we're all under the one roof and we can share knowledge with each other. And we might not even necessarily see a client as a consult. We might just give our colleagues some advice. They might ask us for some supervision or some kind of ideas and tips that they might be able to do. So with that, we're kind of building and contributing to capacity. across the entire workforce of, you know, sex is on the radar,

sexuality issues are on the radar for everyone. Yeah, that's a huge part of what we're doing is, like, we don't want to be the only ones that talk about sex. Like, we can do the intensive counselling and education and, you know, consultation and things like that. But what we're really trying to do in being interdisciplinary is trying to get everyone to talk about sex and realize that within everyone's specialty,

there's something that you can do around sex. say if you're a physio, you might, you know, at the pointy end, do stuff with pelvic floor things and, you know, sexual function related to pelvic health, but also stuff around, I know a physio who's, who's written a sex-specific exercise program for our client, which is like things about getting up and down off the floor, off the bed, upper body strength to actually strengthen their body in order to have intercourse with the partner or, you know, OTs, for example, like equipment and things like that, they can actually facilitate sex or speech paths around communication, around kissing. So they're not necessarily doing intensive sex therapy,

but there are aspects of that profession which relate to sex and trying to get people in all professions to think about it. And just contributing to the client goal ultimately with each of us have a lot to contribute in helping people achieve their goals. Yeah. No, it's obviously so important. And it would seem like a really good or a rich learning environment as well for a student. I know you have a student at the moment, Candace, but I feel like that's because social work student placements do have the capacity for a little bit more flexibility. I'm wondering if, because nursing placements tend to be very clinical, would that ever work for a nursing placement, do you think?

That's a good question. I guess it's an interesting sort of area because like when we think of sex with nursing, we think of sexual health here. And they kind of call it sexual health here because they want it to be holistic. But again, we sort of fall into that medical model of STI prevention, HIV, you know, dermatology and disease and medication and testing, pathology, things like that. where like in the UK they'll call it gum clinics genitory medicine so it's got a medical vibe in the name but

what often happens in sexual health clinics is clients will have conversations with nurses about their sexuality but that's not on the surface as what happens in your head you think okay I'm going to get an STI test or I've got some symptoms I'm going to get treated and this was the thing about nursing I found was like that conversation that talking about sex was kind of the garnish and what made it a nice visit for a person, but it's not so much expected overtly of nurses in that setting. I guess bringing a student into sexual health is tricky because it's a sensitive area, the sexual health clinics. I worked in, we didn't take students. And in sex therapy, it's tricky again to, you know, so we're

working in therapy. We're one and one in a room. So how can we bring in a nursing student into the room to do that? Like when I was finishing my master's, I tried to get a bit of observation or something like that with a lot of sex therapists and they said, no, my clients wouldn't want it. They wouldn't want me there. So it's tricky. Yeah. I think that's one of the unique things of our service is because they are predominantly used to a multispronee team. They've got it's a quiet injury, they're used to teams working together. And the clients that we've had so far that we've said, you know, is it okay if our student observes our case conference?

They're like, oh, yeah, cool. Like, you know, they've got to learn somewhere. May I may as well learn here. Like our clients have been so generous in sharing their lived experience to be able to help kind of break down taboos, break down any sort of, you know, learning barriers. So we really do thank our clients for being willing and open and generous. And I do wonder a little bit if it's a little bit. to do with the setting, like that when people come into a health kind of setting, you know,

you walk through the doors at Royal Rehab and it's a busy place and it's kind of maybe got the energy and the vibe of it's nothing to be ashamed of. We don't need to be hidden in a room just with two people. Like it's a taboo topic because society made it taboo. It's a sensitive topic because it's intimate and it's personal. But it's the type of thing that through talking about we can find solutions for, we can improve outcomes. And if there's a student, who needs to learn along the way. And my observation is that our community like to be part of the teaching. You know, they kind of want to make sure that if that student's going to learn something

and I taught them something, well, that'll be good for the next person as well. So there is a kind of generosity. But this is the first student that we've had. The service has only been around for officially in this capacity, this kind of full-time capacity for the last nine months. So to be able to be in the place to take a student already is pretty awesome. And her student placement is from home. it's online.

So that is well, like you can say, would you mind if my student was to observe? Like to join a telehealth session is maybe a little less intimidating as well. I don't know. But so far, we're making lemonade out of what is the lemon situation of COVID-19. Did you find there was any hesitancy

or difficulty with arguing for a placement in the setting you're in? Did the university have any concerns? No, not at all. I mean, let's be honest. us, the universities are gagging for placements. It's so hard to support this generation through, you know, good quality, supported learning opportunities, particularly in its environment with so many placements have had to discontinue. And so I feel like for us, it was a research placement

initially. That's how it started out. We had a research project that we thought would be good for a student. It's an interesting area of clinical practice. And then as time's gone on, and because so many of the other placements have wound up. We've been able to kind of bring in some of the other social workers from the wider hospital, kind of make the placement a lot more robust by learning more about, you know, brain injury and inpatient social work and community social work and really shape that the social work identity whilst also drilling down to the specialisation of sexuality, disability, and what a unique opportunity to be able to have some rigorous education

during your like undergrad because I don't remember having a huge component of human sexuality in my undergrad and I know Arlen didn't really in his nursing training. Yeah, I got one one hour lecture at the very end of my Bachelor of Nursing. I was waiting and waiting and then I saw it come up in the unit outline for this final pathophysiology unit, reproductive system. Yes, I was so keen for it. There was a one-hour lecture of medical diagrams of genitals and our lecture are giggling all the way through it and in the accompanying tutorial.

We didn't even talk about it. We talked about an assignment that we were all working on. So we got one hour where we just looked at a bit of anatomy. You know, maybe they probably didn't even talk about the clitoris, for example, which we don't really see on a lot of medical diagrams, for example. And so it was kind of a side. thing was sexuality and when we kind of think of moving as a nurse into sexual health nursing there's often the question of oh are you going to de-skill you're going to lose your skills and i think

what we're going to stop doing you know using vents and using doing iv antibiotics and you know all that sort of thing yeah but we're going to gain a whole lot of other skills and this is what i sort of was talking about with that nursing belief was that, you know, things like critical care, emergency, you know, complex medical nursing, surgical nursing gets kind of glorified a little bit. And you see that a lot in placement. Students really want to gain skills. And there's a lot of skills in those areas. You know, nurses that work in the hospital are highly skilled. But more sort of skills that you might get in the community or in primary health care, in sexual health nursing, they're all. also very skilled nurses. It's just a different type of skills. And so a lot of people are hesitant

to move out of the hospital and move into community-based specialties. You know, you can have an amazing career outside there. I know one nurse who left uni and went straight into sort of practice nursing in a GP clinic and doing a lot of primary health care. And he loved it. And he's amazing and so knowledgeable. So, you know, those outside of the hospital nursing specialties should really be promoted as incredibly valuable. Yeah, I've been watching actually there's a show on Channel 7 at the moment called Nurses and it's based at St Vincent's Hospital and I have a connection to the hospital. So I was particularly interested, especially because I know most of the people working in the show. But what I was happy to see is recently they showcased maybe a third of

the episode was looking at this new program that's being trialled that puts a nurse, a mental health nurse in with the police. And so they respond to concerns of mental health crises. And they featured this nurse who said, I could never work in a hospital. I don't have the right training or the registration. But this is where I do have an impact. I have the capacity to not have someone do something that would be harmful for them or for others and also perhaps not get them in trouble with the police, but having an opportunity for someone to come to police if they're afraid because they know how have someone that will listen to them. So I thought that was really important to highlight that, yes, you might not have those skills of intubating someone,

but you do have something else that's really important to offer. Totally. And sometimes that stuff's more difficult. Like I've worked in ICU. I've worked in coronary care. I've done critical care. I've, you know, attended many arrest calls, zapped people and whatever. But those skills, they're practical skills. You learn with your hands. You learn how to do it. You learn the algorithms and you get very good at it. And it's almost like an automatic body thing, like just jump on someone's chest up doing CPR because you know that you have to do it. It becomes second nature. But then that's sort of outside stuff like with mental health, nursing and other broader stuff, there's a lot more talking and assessment that needs to be done.

And there's kind of a high value placed on the things you do with your hands. What's that whole like hard and soft skills, right? Like you can move into these nurturing roles that maybe some nurses would leave and go, actually, you know what, the calling for me was social work. Or the calling for me was in the talk therapies. And it wasn't that their identity as a nurse could be transitioned into. to, you know, being able to actually have a community-based, meaningful career. It's just different skills.

But the same for social work, you know, like we do assessment. Psychosocial assessment is the bread and butter of what it is that we do. But now we do psychosexual assessment. It's a psychosocial assessment with some sex questions. It's really very, very similar. I feel like coming through the postgraduate study, like, there was no magic answer at the other end of that. Like, I thought I was going to come out with, like, some fans. fancy, uh-huh, like here's the silver answer that nobody had told me beforehand. And then I came

through all that training. I was like, it was just a psychosocial assessment with more sex questions. I already, I could do that. That was, I mean, but I kind of needed to know what was involved to realize, oh, I actually already have all those skills. Yeah, to develop the confidence. Exactly. So when I talk to other social workers, it's like, well, what sex got to do with social work? It's more about just going that little bit deeper into an intimate area of somebody's life. but if you understand the amount of distress sexual problems can cause people, the impact it has on their mental health, there was a guy I worked with a long time ago who had a lower back injury.

It was like a work injury. It was a lower back injury. He had a lot of pain. And from the pain, he then developed an erectile dysfunction. It was a kind of combination. It wasn't a spinal injury, but it was this whole combination between pain medication induced erectile dysfunction. They're massively impacted on his understanding of masculinity, manhood,

what it meant to be a husband. And at the time he wasn't able to work, so he wasn't providing. Like it kind of really, all these things that he believed made him a good husband were off the table. And that the kind of amount that, you know, sexual performance is linked to masculinity is huge. And I didn't understand any of that before.

And ultimately, it was like the combination of his erectile dysfunction, his pain and his lack of employment that led to his significantly poor mental health and then ultimately his suicide attempt, which then resulted in, you know, complicated spinal injuries and brain injuries, and that's kind of where I get to come into the story as a rehab social worker.

And it was like, wow, imagine if good quality sex education and intervention had happened back at his back injury. Like, it could have changed the trajectory. And so instead, now we've got all these complex injuries and now we're talking about, who said that having a firm erection, that was the kind of equivalent to all of your manhood, like, what is it that you bring to a relationship

and trying to unpack that sense of, it's a self-worth piece of what do you bring to relationships, what can you offer, and where did you learn that penetrative sex was the gold standard for all kind of sexual activity and trying to just help him through his acceptance of that internalised ableism. Anyway, there's a bit of a random tangent. Sorry, Yasmin. That's all good. So your experience as a rehab social worker, then obviously you saw a need and you were working as a professional to address this in your everyday work and encouraging your colleagues too. But how did the program come about in the first place?

And what supports did you need to make it a reality? What people, what funding, what resources? So I had been dabbling in the area. So we have had a sexuality service for years. Like this is back in the 90s, early 2000s. And it was a wonderful CNC. So he'd go back to the nursing role. You know, the CNC was doing the sexuality education.

And I think within the acquired injury, the nurses have taken this space. Like North Shore's sexuality clinic was run by a CNC. Ours was run by a CNC. So the nurses had a big role here. And it was definitely. function-based, like in terms of erectile function was a major component of it and fertility focused. And it was one person in amongst a very busy caseload that they would see in the clinic,

you know, I think it was like one day a week or one day a fortnight. And it was just kind of, it was well before the end areas. And I feel like what has happened in the last few years is that society, there's a sex positive kind of wave that society has accepted that, you know what, is kind of important. It's a kind of aspect to just being human. And with that, there was a realization and more discussion. Like you look at the last 30 years of literature and it all talks about how sex is a under addressed issue within rehabilitation, but it's still a major, it's of importance to the patients. So here we go. We've got the patient saying it's important, as important as it was before my injury. And then we've got, you know, less than sort of 20% of clinicians saying, oh, I feel

confident to do that. So then you have this big gap of the patient saying, it's this big part of my rehab that's not really addressed. So I think that the combination of just the awareness of this is a big problem. It's not well addressed. We actually need to put some dedicated resources into addressing it. What would addressing it even look like? So, you know, that's like a business case. This is months worth of conversations with champions who want to do better. And I think Royal Rehab has a culture of stepping into new. spaces and doing things that maybe haven't been done before, whether that's in sport and rec or whether it's in sex, you know, we've kind of just got these fringe issues that people

think, oh, that's important, but it's not like, New South Wales Health hasn't funded it. So maybe we can't do it. And I think role rehab is in that unique position to be able to say, well, let's do it. Like, let's make a way. Let's find a way. And to be honest, it was a business case, some very supportive executive and very supportive CEO and I don't know how he sold it to the board because he did a good job. I wasn't in the room for that conversation. But I imagine it was probably on lines of if we're living our values and

if we say that what we want to do is empower people to live their best lives, well, that includes sex. So let's get on board. Also, it makes good business sense too, you know, like if there's a need that's not met in the community and we can do it, well, let's do it. So I think that's kind of sort of how it came about. Obviously, going and retraining and kind of having the skills to be able to say, this is what it would look like. You know, there's a vision there. And being able to sell the vision is an important part of being able to get something

over the line, being able to recruit someone like Arlen, who comes with the sexual health skills, the psychosexual therapy. I mean, here's my little unicorn. And I kind of have said that a few times. And to have had a nursing student kind of casual job or part-time job as a disability support worker for people with spinal injury and brain injury. It was like, here you go, this is your return home. But I do feel like, you know, when you put, it's like the list, when you write the list of what it is that you want and you put it out to the universe, then sometimes it will come and land in your lap. And that's good.

So manifesting. manifesting yes exactly right so we we dreamed a dream and we put it out there and then we found ourselves and alan so lucky us but i do believe that there's also been a huge amount of uptake from the rest of the clinicians who have i think one of the things we used to hear was people would say i don't want to open up pandora's box because i don't know what to do with it and if you know that you've got a service that you can refer them to everyone's happy to open the lid it's like oh i could talk about sex if i know what to do with it but i don't want to open up something i don't know what to do with and then be left with this awful kind of, oh man, there's a problem and we don't want to do anything about it.

That's a horrible feeling for any clinician. So I think even just having the service allowed people to have a pathway of opening up the conversation, discovering an issue, working out what the person wants to even do with that issue, would they just like to talk about it? Because people are happy to listen. But if they want to do something, kind of gets more into that specific suggestions or that intensive therapy, they're like, okay, look, here's a sexuality service. You could go there.

And then everyone feels better. They feel like they've done something for their client. The client feels like there's a potential pathway. And then I think it just sort of, it massively changes the culture of an organisation and a service and it. And for us a rehab area where you go, okay, if we open up the Handeras box, we've got something to offer. Having that sort of specialty service there of psychosexual therapy service, sort of it gives that backup to people that clinicians across the board, especially if they have an interest in it, can bring it up and talk about it. If they start to feel like they're out of their depth, then they can refer. Like if I use the example of PALCare, all clinicians can talk to their clients about end of life

and just sort of encouraged to bring it up. And then they can, from there, they can say, would you like to be referred to PALCare? The specialist can then talk to you even deeper. And that's sort of what happens with sexuality. Like we, I mean, in sexual health clinics, you've usually got counselors and social workers that work within sex. sexual health clinics, a nurse that might be sort of have an interest and have a knowledge, might start a conversation in an STI screen, but then might say, look, do you want to go see the counsellor and talk about this further? So there's kind of a bit of an option there, but

it's a bit limited. They'll only see clients within their service that are engaged or within nursing in different specialties, like oncology is a huge one. Like a lot of oncology nurses are interested in sexuality because it's a huge part of it. But that's kind of where it stops. Like it comes down to the clinician's interest and they might open it up. But again, it's just sort of part of what they do rather than a specialty. And having that specialty there gives a lot more weight to the importance of it, where they can take further than just a conversation in between their femur or whatever.

I think having worked in spinal injury for a long time, Our patients have always demanded it from us. So I feel like when you look at the field of rehab, we've been talking about sex forever. You know, there's decades worth of people who have been doing this work. There's loads of really good quality education resources. There's amazing patient resources,

online content, videos, self-directed webinars. Like the spinal community's got so much emphasis and time and effort has gone into understanding sex post-spinal cord injury for men and for women. And when you then look at other parts of rehab, brain injury, acquired brain injury, stroke, you go, oh, it's not, it's talked about over here. Why isn't it? It's talked about it over here.

And it's because the patients have demanded it in the spinal space. And I feel like maybe the kind of culture of working in spinal injury probably set me up to be more comfortable talking about it because even as a new grad, I was, you know, on the initial assessment, kind of going back to the systems that help you and support you to talk about it. Have you got enough information about, you know, sex post injury? Do you have any questions about sex post injury? That was on the initial assessment. So as a new grad, I had this, like, scripted language of what it was that I needed to be asking about. And then it was kind of clear about, okay, there's this issue. I'll bring it back to the doctors or the nurses or the team and we sort of

talk about what to do with it. But it was outside of spine up and injury that you went, oh, that's not the same culture. Like, it's not as widely addressed. So I think maybe you could bring some of the things that we were doing within the spinal rehab and there's a depth of knowledge across the spinal community and then transfer some of that knowledge into other areas which is why the clinic is for people with injury illness or disability really broad and whilst we still see you know probably about 40 percent have a spinal injury the other 60 percent more in that like acquired brain injury we see a lot of folks you know amputations other injuries other neurological conditions Parkinson's MS and then more and more the intellectual disability.

community are coming into the service. So I don't know, we'll just, we'll go with what the patients need. Arlen and I are kind of addicted learners. So we will upskill and learn and read and find out what we need to find out to be able to help the people that come across our desk. That's kind of with my value with nursing as well, is that like, what ties nurses together across the board is their values and their literacy and their understanding of the health system and ability to translate health information to clients and patients. And I always say, like, I'm a nurse. I might not know the answer if you ask me,

but I know where to find the answer. I'll go and find it. And I think that's something for all clinicians to think about is you don't have to know the answer, but have an interest and learn. And if something that comes up that you don't know about, like go find it, bring it back to your client. Because we know how to, for example,

like Dr. Google, like we know that there's a lot of misinformation on the internet. And as health workers, we know how to sift through that and find what's real, whereas our clients might not. Yeah, that was actually going to be my next question. The way that your service works is you're working as therapists, not as a nurse or a social worker necessarily. That's not the way you're advertising yourself. But obviously you've got those skills and that background.

It's great that people have the opportunity to see a guy or a gal, if that's their preference. How do you think your nursing or social work experience or skills or knowledge add to the value of the service? What makes it uniquely a nursing-led service or a social work-led? That's a good question. Yeah, so, yeah, it's a tricky sort of question and sort of trying to figure out what is nursing, what have I done? What do I do? I think probably for Candace's social work as well is working in the health system, you see and you've done and experienced a lot of things, which someone that might be in private practice as a sex therapist has never seen or done. And so having worked in the hospital and

worked with the medical system, you kind of have a bit of an understanding of what the client might have gone through, how to communicate in a multidisciplinary way, because we're kind of, as professionals, we're socialised to refer to other people and have case conferences and have, you know, things like that. So that background experience of how disability works and how health and illness works within the health system can really inform a bit of understanding with what the clients in disability are going through. In terms of that, what do we bring? I've really tried hard to be able to articulate this over the last few months too because I guess at the moment the process is someone's referred I do a bit of a

triage and if it's as simple as they want to talk to a guy or a girl then that's a easy you know just go okay we here go he's Alan he's Kenneth but there is something in it something in the triage you go this is not for you this is not for me and it does come a little bit into like our interest areas as well like you know Arlen he's got a lot of strengths in kinks and fetishes and I think because we have advertised that this is a strength of our service we've been getting those types of referrals. So straight away you can go, all right, well, this is something that is going to be something that Ireland's going to be able to really help here.

And then we also get some that have complex people are still in out of home care and they've got, you know, big alcohol syndrome as well. And they've got complex psychosocial trauma, big sexual assault background. And sometimes some of those, I'm like, oh, yeah, you know, there's like a lot of social work skills that I can bring to this. So a little bit is just case by case. I think the psychosocial complexity is something that social work can bring to it. Alan sometimes says, look, there's nothing I won't touch so long as I'm wearing gloves.

But I think that that is definitely got like a threshold that's different to mine. And that there's just something that you go, okay, this is what makes it a nursing led psychosexual therapy. I'm only going to talk for social work because I haven't quite been able to articulate what it is for Arlen. But for me, I think psychosocial complexity, how is it affecting their intimate relationships? How is the person making meaning of this? Particularly in the grief and loss component of acquired injury, you know, that's all, I'm comfortable in all that space. I'm doing that for a long time. You know, grief and loss shows up in all kinds of ways. And when you look at, you know, intimate relationships, well, what did sex mean for them before their injury?

and what does it mean now and what role did it play in their relationship, particularly around things like communication? Is it how they said, I'm sorry, I forgive you? Is it how they kind of knew that things were all right again? Because if that's not working the way it worked before, then how are you now in relationships communicating forgiveness and accepting that apology? I think it's interesting to understand what role, sex, masturbation plays for people

in terms of their stress management and their self-esteem. And so if people pre-injury were, you know, highly sexual, when you really understand people's sexual behaviours, nothing will surprise you because some people will use it to go to sleep every night. And if that's off the table, what's that now meaning for their slate routines and how are they managing stress? And do people feel just like anxious? And kind of how do they manage their anxiety before?

So I feel like understanding the pre-injury sexual activities in the context of their disability, and what they're able to do now or not able to do now or whatever's going on. For me, it's a social work lens. It affects all domains of their life if you're kind of able to tap into that issue. In terms of nursing, what would you say is different? I mean, this kind of comes into the biomedical side of what nurses experience. So maybe if there's a lot of physiological problems or if there's medication issues

and things like that, stuff around safety, STI prevention and behavior and things like that, health literacy that someone might need help with. I'm also finding the more I get into therapy, the more I'm starting to look at systems and move, like sometimes I'm like Candace has called me like a bit of a learning student social worker because I'm expanding into that area. But within social work, there's all that case management, working with NDIS and all that sort of stuff,

which is all new to me having been a hospital nurse previously. And I'm sort of learning that. I think the other aspect that comes into it between the two of us is our own personal interests and kind of what we've learned about and what we're interested in. So I'm really interested in sort of stuff outside the mainstream into LGBTQIA folks, into monogamy, into kinks and fetishes and all sorts of things. Like I'll see everyone, but that's kind of my personal interest, which is applied to my little anthropological interest in people.

You know, like one example of something that often happens with Canada, as if we get like religious clients or stuff around spirituality. Like that's not so much. Yeah, I'm happy in that space. But Candace has a great knowledge around that. So she'll work around that. So there's kind of our professional background and what we've seen, what we've experienced, but also our interests.

So my clinical backgrounds might inform it. Like I've worked in harm reduction and things like that. So for example, if someone comes up with chemsex or things like that, there's a lot of substance use around sex. I'm interested in that because I have experience working in harm reduction. So, yeah, sort of our clinical background might inform what type of clients we see if there's some similarity with clients we've seen in those past areas. And then sometimes it's just who's next available.

Yeah. You know, if someone wants to be seen next week, we'll flip a coin. Depends who's got time. Yeah. If one of us is really overloaded, the other will take a client. Yeah. happens to. Sounds like a good balance, though.

It's been working well. Thanks for joining me this week. If you would like to continue this discussion or ask anything of either myself or Candace and Arland, please visit my anchor page at anchor.fm slash social work spotlight. You can find me on Facebook, Instagram and Twitter, or you can email SW Spotlight Podcast at gmail.com. I'd love to hear from you.

Please also let me know if there is a particular topic you'd like discussed or if you or another person you know would like to be featured on the show. Next episode, I will continue the discussion with Candace and Arlen as they provide more specific information about the sexuality service, the types of clients who access the service, common concerns that people seek support for, and their approaches to enhancing psychosexual health for people with a disability. These two sessions are being released at the same time,

so you can listen to this right now. And if you haven't already, you may like to go back and listen to episode, where I first interviewed Candice and we go into more detail around her many roles as a mother, a wife, a netballer and pastor of a congregation with Community of Christ. We talk about social work, rehabilitation, sexuality, spirituality and Candice's passion for ongoing learning and improving outcomes and opportunities for people living with a disability. See you next time.