Social Work Spotlight - Episode 46: Candice & Arlyn (2)

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 two in a two-part series. The first episode focused on Candice and Arlyn’s professional backgrounds in social work and nursing and their further training to become psychosexual therapists, with this 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-UngerWorld Association for Sexual Health - https://worldsexualhealth.net/This episode's transcript can be viewed here:https://docs.google.com/document/d/1sPq-2Sq2cAEVUuDDQ3zlIvTLgPsDNu3kUAR0n8u1Kl4/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 family and carers, as well as professionals assisting them to make a meaningful, pleasurable and rewarding sex life. regular listeners of the podcast will remember my discussion with Candace for episode 20 Candice is passionate about ongoing learning and improving outcomes and opportunities for people

living 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, Candice 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 note,

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. This is episode two in a two-part series, and if you haven't listened to the first part, I would recommend pausing now and going back to listen to that episode first. The first episode focused on Candace and Arland's professional backgrounds in social work and nursing and their further training to become psychosexual therapists, with this second

episode going more into the practicalities of running such a service. You've already mentioned the type of clients you see in terms of the breakdown, for instance, spinal cord injury or acquired brain injury, but what are the most common issues that you see to do with sexual health or sexuality? And what's your approach to trying to resolve some of those concerns. I feel like we've had a run of requests for dating post-injury wanting to find a partner. So both establishing and then maintaining a relationship post-injury, particularly if someone's got a cognitive impairment, maybe some of that social cognition's impaired, being able to develop the relationships, whether it's just to help with online dating or even just trying

to get the confidence to approach somebody so that I feel like that has become a bit of a theme lately. finding and maintaining a relationship. And so that would fall into psychological therapy, but it's more in the dating skills. And so because of that, we're now writing content for like a dating workshop because I think,

there's enough people here that maybe we can do some group work. And I think sometimes by doing group work, it can normalise an issue that you're not the only person struggling to find somebody. And you know what? People who don't even have a quiet injury struggle to find partners.

I think kind of just bringing in some of the skills that we know will help in the social settings, which is why we're partnering with like speech therapy and groups like that, because that discipline has a lot to offer. Obviously, we'll see all the DSM-5 type criteria, which Arlen can talk to in a second, and we will provide all of the biomedical, as well as the psychosexual interventions for that. Because we are all under the one roof, we can easily link people back into rehab doctors, or we've got some great relationships with sexual health physicians and urologists, and it just depends on what the issue is as to who it is that,

we usually recommend that they follow up with if it needs another kind of medical pair of eyes on the issue. What else do we see, Alan? I guess those physiological changes. Like we, primarily our clients have all had a traumatic injury, neurological injury or an acquired neurological disability. And so in a way, they've got a traumatic or acquired sexual dysfunction that's happened as a result. So they, you know, with DSM stuff, there's, If you've got a penis, there's erectile dysfunction, there's premature or delayed ejaculation, there's sexual pain, there might be issues around desire. Disinhibition sort of comes in as well, but that's more of a neuropsych thing and behaviour

support. And so often these dysfunctions, to use that term, it's started at the time of their disability has been acquired. So there's some very real physiological things that are going on and changed for people. So we really, we work with a lot of that stuff. A lot of education. Help people understand what's happened. A lot of like sexual health literacy. So just sort of improving, you know, what people know, what they don't know, kind of filling in the gaps. And then normalising their experience to help them put in context, what role the injury has played in their concerns. For example, that's why in oncology, a lot of nurses are interested in sexuality because the side effect of the medications can cause a lot of sexual problems.

And that happens here with us as well. So when you compare in private working with able-bodied people, the vast majority of sexual dysfunctions are psychosexual. They're related to the person's mind and their relationships and what's happening. So there's a lot of counseling that needs to go on. But here, there's often a very real physical cause to it. And in private practice with able blood people, you know, for example, erectile dysfunction might be an early sign of diabetes or heart disease and things like that.

So often clients might need to get assessed to go see their GP as well. But in disability and in acquired disability, something has happened to their brain or their spinal cord or their nervous system or whatever and actually caused a problem that we might not actually be able to get past, but we need to really sort of try to look at what sex is again and develop a new, new sex life and sort of find some sort of functioning which is satisfying for people. Called this sexual scripts. So when we say that we're widening people's sexual scripts post-injury, it's through the process of counselling where you talk about people's beliefs and

understandings and practices pre-injury and moving, if you think a script as like a story script, You know, this is how things happen. And then post injury, it needs to be reinvented. Things need to be adapted and changed. And part of that will be education about what options are out there. I'll be linking them to great videos and peer stories because it's that whole, if you can't see it, you can't be it. So if you kind of understand what sex post injury looks like for other people,

then sometimes you can be like, oh, I can understand how that wedge will help me get into that position or that sling might support my weight to do whatever. So some of it's like physical kind of positioning stuff. some of it is like rethinking what is sex because pre-injury it was just like penetration and that was the end of the story whereas now I'm kind of like learning all these other sexual skills so we do do the sexual skills component and then there's just the whole introduction to sex tech which is a whole other area but the adaptive equipment that's available for people if they experimented pre-injury then the transition post-injury is very easily if they've never done it any sort of experimentation pre-injury then you know we've got a pretty impressive library at the moment that we're able to sort of, I guess, demonstrate, show people like, this is kind of what this does, this is what its purpose is. You can kind of assess some things a bit functionally, like can you even hold it with your hand function?

And then people aren't wasting money and time on things that won't work. And we can provide some advice and education about the types of things that might work based on their clinical presentation. And sometimes it's a bit of a cheerleader role, you know, just talking about sex post-injury still seeing that person as a sexual being, being in their corner to kind of help them as they explore their sexual life, particularly if they're single and they're looking to expand on it. Like I think sometimes we have these conversations where people are like, oh, this person's in our relationships, we're going to refer them to you.

It's like, well, don't forget out the single people. Just because you're not in a relationship doesn't mean this still isn't a problem, or it isn't still something that people want help with. I'm wondering, let's say for someone who's either a newer clinician or they don't ask the question very often or even just the general population, it's good stuff to be talking about as part of your psychosocial assessment. How would you suggest someone brings up the conversation in an assessment or in a therapeutic approach? So I'll take this one first and then Alan can add to it. So we suggest you can kind of approach it as two different ways. You've either got the declarative

where you just put it out there. So in the quiet injury space, we would say something like we know after traumatic injury, people experience themselves differently and that includes sexually. Have you noticed there to be an issue for yourself? Is it something you'd like to talk to me about or talk to somebody else about because I can always link you up? So that's just sort of putting it out there. Like we know that this is an issue. And then the other option is more like a question. So something like we know after spinal injury, traumatic brain injury, insert whatever injury, that people can experience, you know, challenges with their sexual function or with you know, the intimate relationships, have you noticed this to be a problem for you?

Then they would answer that. And if you have, is that something you'd like to discuss further with me? Or would you like to discuss it further with somebody else? And I can refer you. So I think by just tackling it like a declarative statement, you normalise it. It's just something that is part of your routine. And if you're doing it in your assessment, like we talk about how to bow, skin, sexual function.

It's just really normalized. It's just something that we just talk about as another body. bodily function. It's just an important part of how the body works. Then that can take a lot of shame and stigma and awkwardness out of the conversation. And I think as long as you have like a really confident opening line. So if you as the clinician fumble around and can't quite find your words, then it kind of can appear a bit awkward and a bit like you're not very comfortable. But if you're comfortable, if you're just and all you really need is a good opening line to start it. The same is like how do you ask someone about their income? Like we don't say how much do you earn

every year. We would find some language that would say, you know, do you have any financial stresses at the moment? Do you feel financially stressed? Has there been an impact on your income since this accident? Like, you know, we don't hit it just straight with what's your income. So I feel like we do have the skills to gently introduce sensitive topics and we just bring it into the sexuality too. So declarative, we know what happens or a question. Do you have a problem, would you like to talk to me about it? Yeah, and I think sort of clinically, like when we're looking at multidisciplinary and our whole goal of getting everyone to talk about sex is sort of finding within your

assessments and your daily work questions you might drop in and to kind of give a bit of an opener to that. Like, we always talk about speech paths who would be like, so can you kiss? Like, how's your kissing going? Like, is that a problem? And, you know, that might open a conversation broader about, like, oh, well, I've got no one to kiss and I'm really lonely. I don't know, something like that might happen.

Or, you know, I know a few GPs who've talked to me about when they're doing pap smears, cervical smears on clients, they often, while they're doing it, they're doing this really invasive examination on someone's generals. And the really great GPs are like, you know, so how is your sex life? Are you sexually active? What's going on? So there's a lot of little catalysts within our assessment or a nurse. you might be doing catheter care.

You know, I always found it funny how every single day when a nurse in a ward is doing their obs, they go, have you had your bowels open today? We just ask that. Like, it's just part of what we do. And really, that's kind of a confronting thing to ask someone. But it's just normalized. And so, you know, we might bring in a question, say, if we're doing managing someone's long-term catheter care, We might say, you know, is this affecting your sex life?

Or an OT might be ordering a bed and say, are you going to be sharing the bed with anyone? Do you need a double bed? Just to bring in these little questions that are pointing at sex, but maybe not directly about sex, as a bit of an opener. Can we talk about equipment very briefly? Sure. Obviously, you've got many different facets to your approach. You've mentioned education, and that's a big component, and there'd be a pharmacotherapy approach as well. that you'd obviously work closely with the doctors around.

But the tools and equipment is really interesting as well, whether it's something that is adaptive equipment or perhaps it's just mainstream equipment that can be easily adapted to a particular person's concern. So what are some common things that you recommend or trial with people? Yeah, just while Candace was speaking just then, I was thinking of wheelchairs, and we sort of understand wheelchairs,

and they're a great new pair of legs. So if someone really loses their mobility, their ability to walk for a lot of people. A wheelchair is a fine pair of legs and they can get around with a wheelchair. So it's a functional thing. And when we think of sex, if they've had a real functional change, whether in their body or just or actually in their sexual function, using products and things like that can actually help facilitate people to have a rewarding sex life. So equipment is a huge part of what we look at.

We call them all sexual aids to use a bit of rehab language. And, you know, there's medical devices. Like you've got Fibrex and 30 CARs that help people ejaculate. A slinglifter is potentially a sex toy. You know, if you're looking kink, you know, you've got big leather slings, sex swings and things like that. Like, not that far to look at a sling lifter and go, oh, you can have sex in that.

Yeah. Or wedges and positioning devices that you might need to, help manage someone's positioning around spasms or things like that. And so you can use these things that they're really functional aids that can make sex possible for people. So there's like liberator wedges and things like that. But we also look at vibrators that are just not medical devices, but some really fantastic products out there from, you know, cop rings to vibrators to masturbation sleeves and dildos. All that sort of stuff can really be used and even adapted, you know, say for people with hand function issues and things.

So that's a huge part of what we look at. Yeah. I'm also curious about how this is or this type of therapy is received by funding bodies. I know that there's an increase in support for this through NDIS and I care. What sort of challenges have you come across or have you found it pretty easy to navigate the systems? I think at the moment it's been pretty easy to navigate the systems because people know that it's a problem and they want to do something about it. There's probably also a little bit that people don't really understand what all the options are. There's not a lot of evidence-based literature out there for us to reference.

And maybe that's like the advocacy side of, you know, the social work skills coming out where like sometimes these are low-cost items. It's low risk. We've got to try something and this works in able-bodied property. based on the clinical presentation. We've done an assessment based on, you know, whatever sensory impairment they might have. There's a lot of practice wisdom here. And so I think sometimes we can just articulate the practice wisdom

as to justify why it is it we're recommending a particular product or what it is that we're suggesting a particular intervention whilst there maybe isn't a peer-reviewed paper to go with it. So far, it's been quite well received. Not yet. No yet. Yeah, exactly. And there is like, there's a lot of work in the sparnicle injury space.

So we know that, you know, vibrating cock rings help with that sort of reflex pathway. We know that the vibrate works, the Ferdicare works, like these medical grade products have been well and truly researched internationally. And I guess the thinking behind, okay, well, how do we? And there's lots of books, not peer-reviewed books, but like, you know, books, the old-fashioned paper. from lived experience where people talk about what it is that they did to kind of help with their sexual rehabilitation. I love Joan Price's stuff.

She talks about like aging in sex and how our sensations change, our sexual function, like our recovery period slows down as we age. And so there does become a certain point where the ability to manually provide the amount of stimulation somebody needs to complete a sexual response cycle. tricky but you add in a vibrator and suddenly arthritis isn't playing up and your hands aren't cramping and it can be pleasurable and rewarding and fun all over again and so I feel like reading her literature really kind of helped me understand okay this is the role that sex tech plays and has a really important role for managing sensation changes or upper limb function so whilst I haven't found

her stuff in peer review published I found her books to be really really helpful for conceptualizing what role, what help some adaptive equipment can play. Some of the providers, like in terms of equipment providers, they will make their equipment with the disabled community in mind. There's this German company that all of their products have is hook at the end, like a little whole hook. And that's just so clever. And one little thing, a little holly hook.

And he's go, oh, even like a finger can just slide through. You don't have to have a particularly strong Tiena D system. You have to hold on to it. it's just, yeah, it's smart. But it's also an off-the-shelf product that has a really smart handle. Yeah. And we've sort of looked at it and wondered whether that was a consideration when they designed the product or did they just make it?

They just thought that was a nice idea and it was ergonomic. And we found with our clients that product is almost like it was made by an OT. Probably wasn't. But the Germans, they're just smart. We look at them and go, hey, that, that would really work for people. Yeah. Or you do some testing with your clients and they give you feedback.

That was rubbish. I'm like, okay, cool. Scratch that off the list. Or they'll say, that was awesome. So the next person you see is a similar type of injuries. This works for them. It might work for you. Like, there's just kind of that knowledge that's being shared amongst the community.

Yeah. There's a lot of hypothesizing and experimenting and that gaining of wisdom. And as we learn what's out there, we start to get things that people tend to like and become our favorite products. Yeah. I know you're big into research. I know that's definitely something you enjoy and gives a lot of value also to what you're doing and to justify and to gain support. But what are some unmet needs still for you, having had some experience now running the program? What are some areas where you wish there were more services available or more research funds could be focused? We could have a full-time research assistant. No, I'm just like, this is such green pastures.

The reality is we could have a full-time research assistant in our team, if not too, there's enough projects and ideas to. Yeah, there's sort of, you know, we always talk about in our research meetings of these green pastures and how there's heaps of research that says that it's a problem or that clinicians have trouble talking about it and something needs to be done. But then when you look for what's actually been done, there's a lot less stuff. So it's well known that it's not addressed well, but we need to sort of start researching interventions and researching treatments. Like the outcomes. Yeah. There's a combination of satisfaction with the intervention as well as did it actually change anything.

I'm trying to answer this without giving away all of our research ideas in one go and then like, you know, somebody who listens to this then steals them all. We've obviously got a few on the go. We've got, you know, three or four. projects at the moment, sort of looking at, like we're even just doing a review of the first 100 patients that come through the service, just a clinical profile. You know, that's a starting point of just understanding the types of issues at people with a disability report and then looking at our interventions in terms of just, and what do we do about them? So if these are the common issues, then what are the common interventions based on like a data mining, just going back through the files, which is why, you know, right from the very beginning, we knew that evaluating the service

was really important and we've tried to set up some structures within how we started the service to be able to pull this information back out again because obviously data mining projects are only as good as what's in the files and that's really for the purpose of learning about common problems, common interventions and then the next step for that will be on what are the outcomes of those interventions like we might keep doing these things but are they really working what is really working even mean because there's so much of this stuff is very subjective even within the able-body population, orgasm is a very subjective report.

Like, sure, we could maybe measure people's blood pressures and heart rates and there's like a physiological component to it, but it's the intensity or the pleasure or, you know, like how that's sort of reported is very individual. So it kind of depends what the goal is. And that's why I ask people things like, oh, how was your sexual function before injury? Like, oh, sure, no problems.

I said, all right, was that like 100 out of 100? Yep, okay, so what would you rate it now? and they'll be like, oh, maybe like a 70, okay, all right, so tell me what's happening. So we want to understand what's happening about 30%. And we might try some interventions, like a cockering or a non-medical interventions, some breath and energy work or like some pleasure-based, some mindfulness work. And then ask them again, you know, what do you think it is? And they might be like, oh, it's like an 85.

But I mean, that's all subjective, right? Like, I'm not in there measuring anything. It's just self-reported. Qualitative stuff is really, really hit. Like when you look at a lot of sexuality, sort of literature, they talk about sexual satisfaction because sex is not a homogeneous measure of whether someone's sex life is good. You can only really rely on someone's degree of satisfaction. And so we want to get to the bottom of what would be possible and what would improve someone's

degree of satisfaction with their sexuality and their sex life. And if someone's goal was to find a partner, well, you know, if we're doing an intervention that's around their dating skills, is the goal how many dates have been on, or is the outcome measure, like how many dates have gone on, how many second dates have come from that, if they've, you know, been able to maintain a relationship. I mean, some of that is a little bit outside of the scope of our control. Like finding the right person for anybody is a bit of luck, a bit of timing. But it's more about, you know, how much is this person engaged in their community?

is their self-esteem high. Do they feel like they've got something to bring to a relationship? So when they meet someone that they're interested in getting to know a bit better, they've got the confidence and the skills to be able to ask them, I like to get to know you, be madder, do want to do something? And I guess giving people the best skills to be able to make the most of opportunities when they come about. There's so many things to be looking at in this service from, yep, sure there's functional things,

but there's also the emotional relational components as well. and sort of the quality of relationships, people are feeling more connected. But I think that's one of the cool things about what we're doing at the moment. No one person is the same. So when people say, you know, we're the most common things you see. It's like, well, we've seen a little over 70 people

and probably seen 70 different things. So we're not quite at the point yet where we're starting to see lots and lots of repetition of the same issues over and over again. It's so important that you've brought it back to the goals and what that individual person wants to be working on rather than having functional goals because having penetrative sex might not be a test of their sexual satisfaction.

So, yeah, bringing it right back to the small steps of what do you want to be achieving within this space, what is realistic, and then how do you bring those two together? This is the pleasure focus that we have. You know, how much pleasure do you have rather than what goals can you achieve, like goals in terms of orgasm or have a big heart erection or whatever. It's how much pleasure can you feel and experience alone and all with a partner? And there's a lot of different ways to have pleasure. And I can imagine the research that you do would have the opportunity for an expanded audience, which is really good. So you could present to conferences or you could write in journals that are

rehab focused and therefore interdisciplinary, or you could write an article that would be relevant for both nurses and social workers so it could potentially be accepted into two different journals, but it's the same thing. So I think that's a really interesting way of bringing together the two levels of experience and yeah, just having that wider audience is really good because the more you can get the word out there, the better. And there's one other bit, which is Alan and I are both members of the Society of Australian Sexologists. So part of it is bringing the sexologists on the disability journey to be that, you know what, 15, 20% of the population have a disability. So they're more confident we are as sexologists working with people with acquired disability or

with congenital disability, the better options and services available for the disabled community. So we've done some training with, so SAS is the Society of Australian Sexologists, it's our peak national body for education training of the sexology discipline. And even being actively involved with the SAS community and dropping the disability needs where we get the opportunity to influence. And there's a huge world association for sexology. There's that intersection between sex and disability. It's really important that the sexologists in the community understand about

acquired disability as much as it is about the rehab clinicians understanding about sex. So I probably think that that is the unique thing about the service. It's this marriage of sexual health and rehab all on the one spot. But, you know, Alan and I can't see everybody. So we really do kind of hope that the service will, I guess, create and be able to. or the capacity within both the sexology and rehab communities to better support people. Yeah. I've also spoken with social workers who are teaching at university,

but they're not teaching in the social work faculty. So they're teaching in public health or they're teaching a disability module somewhere else, which is great. But bring that back to social work and bring that into nursing, because that's obviously where it's needed as well. Yeah, I definitely think human sexuality could find its way into both of our curriculum. that would be amazing to have that more than one hour, you know. Disability should be in everything because it's such a huge part of the population

and sex should be in everything. I've had clients come to me who've said they've gone through a couple therapy and sex was not once discussed or maybe it was briefly mentioned and you go like you're doing relationship therapy but you're not talking about sex or sex is everywhere. Like it's tied to our sense of ourselves and our bodies and it's a very personal experience for each person. And it should just be accepted as being an aspect of every person in one way or another. Yeah.

We end up with some people having five or six clinicians involved because this person will only talk about their like mental health. And this person will only talk about their relationship. And this person, like nobody will talk about sex. And then it's going to ask for sex. We're like, are you serious? You've already got three or four. mental health professionals involved and now there is such a thing as too many cooks in the kitchen. Like we need to make sure that we're kind of integrating sexuality is part of all of our

interventions because if you just slice it off and say, oh no, I don't talk about sex. I think you've sort of missed a massive part of what's going on for the client. Well, and that person might not feel comfortable talking to you about other things if they know that that's off the table. Correct. You get really deep once you start talking about sex very quickly. Yeah. Yeah.

When we spoke last year, Candice, you provided some really great resources that I put up on the show notes, including Shane Clifton's memoir. There was Lee Sales Any Ordinary Day. There was Sam Bloom's Heartache and Birdsong, Alex McKinnon's Unbroken. I want to put those back on the show notes, but are there any other resources that you would recommend for listeners in the sexuality field or psychosexual therapy if people wanted to know more about these topics or areas of. either social work or nursing. I'd recommend Esther Perel's Where Should We Begin? Podcast. I love her.

She's amazing. Probably Joan Price's books, Sex After 50, Sex After 60, Sex After 70, She's got like a whole three series. I mean, we've got a whole social media list like Andrew Goerser's stuff. He's a disability educator. He's got cerebral palsy himself. Social media is a huge thing. There's a lot of sort of sex positive, disabled folks who are,

sort of influences and educators, and they're brilliant. Sort of it's engaging with that content of normalising it. There's a few brands that are starting to work on developing some sex products, sex toys, especially for people with disabilities like handy. We've talked to quite a bit and did a little bit of work with, and they're developing a product. How about we email you a list? because we have a social media list of people with a disability

who provides some pretty good sex positive content. Because I think that's the important piece too, is you want to find sex positive content. We don't need any more shame and blame and negative Nelly stuff anymore. Like, we're past that. So I'll just email you some things that you can just add to the show notes. Thank you. There's also some really good stuff on YouTube that I've been aware of.

There's Ojoi Sex Toy, which is they do a lot of reviews, but they also have guest comics. and it's very easy content to digest. There's another YouTube. The channel is called Sexplanations, but it's Lindsay Doe, who's a sexologist herself. Lacey Green is really accessible as well. But I love that a lot of these are very trans-friendly

and kink-friendly and inclusive Evie Lupine. Again, I'll put it in the show notes, but she does sort of kink deep dives. And so just really good resources to normalize a lot of those things. which is really good. Yeah. Once you start getting into this stuff of sex positivity and then you start looking at different communities

like disabled folks, you start looking at human rights and intersectionality and things like that. Once you start looking at sex, it suddenly starts becoming about a lot more than just sex. Humanity, freedom and self-expression. Like there's a lot of documentaries as well. I love Crip Camp, if you've seen that.

And there is quite a discussion about sex. sexuality within that documentary, and that was about the disability rights movement in the 60s and 70s in America. And so sort of learning up on the history of activism around sort of sexuality and disability and things as well can really teach you a lot. I attended a conference last night. It was about sexual justice. And, you know, we're in September of 2021. And things that are happening in Tunisia are horrendous. like, you know, three-year imprisonment for being homosexual. And people have, you know, special task force where they go on grinder and, you know,

lure people out, like what we would do in Australia to find pedophiles. And then the abortion laws in Poland, like absolutely horrendous. And then Texas, just in this last month. Like, when you start looking at sexual health, sexual well-being, sexual justice, yep, sure, Arlon and I predominantly focus. at the moment in the disability community, but you can't just do this work and not think about all that other stuff.

It really, it all interacts, it all interplays. And, you know, Australia in some ways is very progressive, but it's not, what happens here doesn't happen everywhere. And I think that the sexuality service at Wobbe for that reason is world bleeding. Like, there's nothing else like it to have this integrated sexual world. The literature talks about having sex therapists provide education and rehabilitation. And I know of like two other facilities that are in Canada that have dedicated sexual health

specialist as part of the rehab team. And then obviously our former C&C colleague who used to work at Royal Rehab. I don't know of any other places that have these integrated services. And yet we talk about it as being the preferred model of care. So it would be great if also you could talk very briefly about the training sessions you provide for professionals who are working with this population. Yeah, sure. Yeah, so they're fun. They're a lot of fun. They're fun to teach and all our feedback has been that they're fun to attend. So they're kind of crash courses in sex positivity and sexuality and really trying to get people to engage in what they think about sex and then we do that through a disability lens. So currently we have two all-day seminars that sort of build on each other but you can attend them separately. And so the first one is a lot around inclusive rehab and diverse sexualities and gender identities and sort of being

inclusive and just awareness of all of that. And then also linking that with disability and where those intersect. And then we start looking at how to talk about sex, how to bring it up, how to manage it if someone does bring up a sexual problem with you as a clinician. And there's lots of role plays and discussion and things like that. The second one, we go a little bit more. more in-depth and we start looking at things like sexual safety and consent, working with families, because often family is very involved in a person's life with a disability, and going a little bit deeper interventions, getting history, sexual health history, and things like that. And then that kind of prepares people, ideally, to have some conversations and use their knowledge. And we

kind of want to inspire people to read up more on it and develop a special interest. And so they start just talking about sex in their clinical practice. And then we're there to then refer on to once that first sort of opening up conversation has had. Yeah. Were you attended? What did you think? Yeah.

Incredible. Just opening up in terms of, I think the role play was probably one of the things I got most out of it in terms of just, yes, it's great to ask the questions, but what do you do when the answer comes back? So just again, that confidence of I feel more comfortable asking. the question and opening up that dialogue so that then people will feel comfortable to discuss things with me and then I feel equipped to then direct someone towards the right resources. So really that's what it's about.

It's an education thing, but it's also about equipping us as professionals. I love the names of the training, first base and second base. I haven't had an opportunity to attend second base yet, but very much looking forward to that. I should also ask, is that going online? Well, that's the plan. So at the moment, they're live. And we've got dates for March and April next year, which will be 22 when people are listening to this, which are advertised on the Royal Rehab website, which is Royalrehab.com.com.

That's our little plug. There's a whole sexuality platform there, which has the training, the service, the clinic. We do couples retreats over at Sargood as well, but thanks to COVID, we've had to cancel those until April, which hopefully they'll be able to run again. If people were interested, then, yeah, you can come into the website to find them. And then the plan is to roll some training into online platforms because I think it also allows, you know, regional folks to connect and people outside of Sydney to connect. So we've got plans, but haven't quite got the technology platform to make it all happen

just yet. But hopefully in the next couple of months. There's a lot that's outside of your control at the land as well. Is there anything else before we finish up that you wanted to mention about the program or about your approaches, the work you do? Maybe building on sort of what I was saying about the purpose of our training workshops and talking about how we think everyone in every specialty should work with it. And that was the major part of Candace and Lyme's training was examining our own thoughts and

our own beliefs and attitudes around sex, learning some information and reintegrating that and kind of opening, it's a lot of mind opening, really. That's something that I encourage everyone to do. Any listeners and any other clinicians out there is to engage with sex positive content, read books about sexuality, have conversations with your friends and family, and just normalise it within your own life and really think about an unpack sexuality for yourself. That's really the vital component to being comfortable talking with your clients about sex. It's being aware of your feelings about it and sort of maybe questioning them a little bit and actively engaging with it. Yeah. I think my only other bit to add would just be that

if you had an interest in sex and you've been working in the disability space or you're interested in this sort of intersection, I would encourage you to pursue further study in this area. human sexuality. Alan and I both attended the Sydney University, sexual health and reproductive post-grad, but there's one also over in Western Australia as well. So it's just the two in Australia. But this is a meaningful career pathway. There are jobs available in the industry. And if you were really keen and wanted to reach out, both Arlen and I provide supervision as well. So if there was a component to people wanting to upskill more or expand the skills and we're just kind of wanting to connect you're absolutely more

and welcome to touch base. Brilliant. Yeah, I think that your desire for that holistic care at the beginning of your careers led you to study and work in psychosexual therapy and it's also great that there's been a greater understanding of the importance of sexual health than sexual activities for both health and mental health outcomes, but specifically for the, the populations that functionally might have a lot of difficulty in that area and your approach in terms of encouraging communication and awareness and meeting the needs of someone. And the fact that now is the time, it's always the time, but there's been a lot of progress in terms of the sexuality movement. So there's a lot of talk about it and it's a good opportunity to bring that up with people

in that context and responding to those identified needs. So you've got the capacity for expanding your service, given that it's a new service, and you can constantly adjust if you need to, if you're finding that new things are coming up, and really just bringing your professional background and your experience as both nurses and a social worker, but also your interests. So it's not just about your professional experience. It's about what you individually find most interesting about this field of work. And what you feel is the best way for you to deliver that information because it's not just about having the information, it's how are you going to deliver it. So hopefully more people will be interested in reaching out and asking more questions,

whether that's students who are looking for supervision or professionals who are looking for supervision, as you were saying. I just don't think it's talked about enough and I think it's great that we have the opportunity to chat with you both today just to talk about, firstly, bringing up the questions and feeling more comfortable asking people and looking at that holistic approach to, yes, post-disability or someone with a lifelong disability, how is this part of your life being addressed? And what are your priorities? What are your goals? How do we start the conversation? I agree. Thank you. Yeah. I very much appreciated the opportunity. I love having two people on. It's the second time I've had the opportunity to interview two people at same time,

but first time we've had an interdisciplinary chat. So yeah, very much appreciate the energy that you've put into this and the work that you're doing. It's so important. And thank you so much. I hope people get a lot out of me. Thank you. Thanks for joining me this week.

If you would like to continue this discussion or ask anything of either myself or Candice and Arlen, 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 esther, 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. And if you haven't already, you may like to go back and listen to episode 20, where I first interviewed Candace, 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 Candace's passion for ongoing learning and improving outcomes and opportunities for people living with a disability. Next episode's guest is Madison, a proud Wiradjury woman from Central Western New South Wales and a newly graduated social worker. Madison currently works in acute mental health and within the General Hospital in Orange, providing support to patients within the Rehabilitation Unit and ED. She is passionate about general health. health for individuals in rural areas, domestic violence and Aboriginal and Torres

Strait Islanders well-being. I release a new episode every two weeks. Please subscribe to my podcast so you'll notified when this next episode is available. See you next time.