Disability, Intimacy, and Sexual Health: A Social Work Perspective

This slim volume is a much-needed addition to the minimal social work literature on the intersection of disability and sexuality. The book reports on the authors’ own research in the United States, qualitative interviews conducted primarily with social workers (42) involved in a range of roles working with disabled people at different points in the life course, but also with several disabled people themselves (8). A particular strength of the book is its grounding in the research data with participants’ quotes highlighting a host of important sexual health issues and practice considerations. Relevant literature is employed to expand the discussion and implications for social work practice are explored.

An introductory chapter presents the authors’ research methods and then discusses social work education’s minimal inclusion of disability and sexuality, structural factors that constrain disabled people’s intimacy and sexual health needs, terminological debates (disabled people or people with disabilities), the social model of disability and crip theory. The second chapter focuses on the restrictive policy history of sexual and reproductive rights for disabled people in the United States, their exclusion from sexual citizenship and sexual exploitation and the gradual enactment of laws and Acts following deinstitutionalisation that aimed to protect disabled people from discrimination in areas such as education, employment, and public settings. The authors emphasise, however, that control of disabled people’s sexual lives followed them into the community with an unbalanced focus on victimisation and protection. This whirlwind discussion of disability history, policy and theory, and their relation to disabled people’s sexual health is very brief, but functions well enough in setting the context for the substantive chapters to follow.

The remaining chapters report on the research results and engage with their relevance for social work practice. A life course model broadly organises the sequence of chapters, highlighting issues related to sexual health that social workers in their particular roles working with disabled people might encounter: development of self-esteem, forging peer relationships, development of gender identity and sense of sexual orientation, negotiating and establishing romantic relationships in adolescence and young adulthood, sexual vulnerability and victimisation, cohabitation and marriage, pregnancy and parenting, and intimate relationships in older adulthood, among others. Individual chapters are subdivided into sections according to ecological environmental systems (micro, meso, exo and macro). Because of the greater number of social workers interviewed in the study, their voices predominate across the chapters of the book, discussing the sexual health issues and needs of their clients, and their responses or interventions. Each chapter also has a section toward the end that succinctly outlines implications for social work practice, albeit in several chapters these sections could reasonably be expanded. As a way of organising and presenting the data and relevant literature, this strategy of using the life course and different ecological environmental systems to highlight important issues is very effective.

Social workers new to the disability sector and long-time practitioners who for one reason or another may have been reticent to engage with disabled peoples’ sexual health will especially find the focus on the provision of direct support for clients valuable. Most social workers interviewed in the study were adept at coming up with adaptive strategies such as helping disabled youth develop self-esteem and cultivate peer relationships. Given that social work practitioners work within institutions and systems whose policies often constrain or restrict disabled people’s sexual determination, the authors draw out possibilities for empowering clients, providing advocacy and challenging sexually oppressive policies and practices. For example, how a social worker might challenge institutional reports of abuse when older adults within nursing homes are seen holding hands or kissing. The authors also highlight some of the ethical tensions that social workers experience when working in disability contexts such as balancing the promotion of wellbeing of their clients, including prevention of sexual victimisation and abuse, with their sexual self-determination.

The strategy of staying close to the data employed by the authors was not always effective and sometimes seemed to limit delving into contentious issues and best practices beyond what participants brought up. For example, the authors cursorily mentioned sexual surrogacy, but there was no discussion of disability support workers or other caregivers providing “sexual facilitation” to clients as an accommodation for sexual self-expression or partnered sexual intimacy between two disabled people, which might arguably be of more use to those with severe mobility limitations (e.g., Mona, 2003). While social workers in Denmark play a key role in coordinating and providing this service (Kulick & Rydstrom, 2015), disability policy and support services in countries such as the US and Australia remain mostly silent on the issue. How might advocacy efforts by social workers in these latter countries contribute to ethical and progressive policy development in this area?

The authors also sometimes appear too eager to confirm claims based on relatively few references. A case in point is that young disabled people “engage in dating and sexual activity at a similar or higher rate as other adolescents” (p. 55). This is a misleading claim when the research on this issue has been inconsistent. Much depends on the type and degree of impairments (e.g., Wienholz, Anja Seidel, & Michel, 2016). While the social workers interviewed worked with people with a range of impairments, the authors confess that those most commonly discussed by participants were intellectual and developmental. To the authors’ credit, they do attempt to include social workers’ discussion of issues relating to people with the various impairments represented in their sample. Despite acknowledging this diversity, the authors can occasionally slip into using the generic term “adolescents” or “adults with disabilities” when more specificity is required.

Nevertheless, Disability, Intimacy and Sexual Health: A Social Work Perspective brings to the fore important issues, practice considerations and ethical concerns that social workers confront in a range of practice settings when supporting disabled people’s sexual health. It offers important recommendations for direct practice in this area. In beginning to address the issue of how social workers might challenge the structures and policies that continue to constrain and restrict disabled people from achieving full sexual citizenship, this volume takes a step toward developing a critical approach for social workers in this area. Overall, the book provides a useful reference to this neglected area of social work practice and research.