Social workers and social care practitioners are increasingly required to engage directly with matters relating to sex and sexuality in their everyday work. Policies and guidance on how to approach these sensitive areas are emerging.
This book provides busy practitioners with a ready reference for the day-to-day problems that they are likely to face in key areas of engagement, such as promoting sexual health, preventing sexual violence, working with those subjected to sexual abuse, and engaging with the complexities of contemporary sexualities. The book:
· reviews current policy in each area;
· outlines the relevant guidance;
· and provides links to further reading and other helpful sources of information.
Concise but comprehensive, practical and accessible, the book is realistic in terms of what services practitioners can provide.
“Sexual issues in social work” is essential reading for anyone who works with others where sex and sexuality have become part of the practice concerns.
As we use language to describe and make sense of the world, it is useful to start by outlining some of the meanings attached to our use of the terms ‘sex’ and ‘sexualities’. There is room for confusion here, as the terms can have slightly (or greatly) different meanings depending on who is using them, where, when and how. So sex may mean the biological gender of a person or sexual activities. Often when completing forms or surveys, a question will be asked about your sex, meaning whether you are male or female. Yet a sex survey in a popular magazine will probably be more interested in the sexual attitudes and activities of readers. Sexuality tends to mean the sexual attitudes, expressions and practices of the person, yet this can also have different boundaries drawn around it (Saraga, 1998). It can be a category (‘What is his sexuality? He is gay’), or an action (‘She is expressing her sexuality’). It can be limited to specific sexual activities, or broadened to include many aspects of a person’s life including fertility, dress and friendships.
Within this range of meanings there are some (often obscured) value judgements made about sex and sexualities. Not least is the idea that there are norms of sex and sexuality that are the preferred and privileged ways of being in our society, leading to assumptions about people that can be unhelpful. The idea that people have a fixed sexuality, for example, is very strong, with particular performances attached to these. Consider the notion of our heterosexual man.
So far this book has outlined some of the biological ideas that inform our understanding of sex and sexuality. This chapter looks at how ideas have developed from the rather polarised debates about the influence of nature or nurture into ways that question the need to understand sex and sexuality through creating categories in which to place people. Some of the ways in which these ideas have been rethought are through the application of social constructionist and discourse theorising, recognising that how we talk and make sense of particular issues changes over time and that certain ways of talking and understanding are privileged over others. This has consequences for people’s identities around sex, sexuality and gender, as we must ask questions about the truths we hold dear about the categories created by these ideas. Weeks (2003) has comprehensively outlined the range of theoretical understandings of sexuality, identifying that this is an area of competing knowledge that has changed and that at different times particular approaches have been favoured and/or marginalised. Power is central to this thinking – the power to define and allow what is known about a subject. Hicks (2005a, p 142) has outlined some of the key elements of this thinking with specific reference to sexuality and social work. As he states:
The very term ‘sexuality’ is itself problematic because it is usually taken to refer to something possessed by a person, as in, ‘what is your sexuality?’. This, of course, relies upon a way of thinking which divides bodies, desires, actions into a series of discrete ‘types’ such as ‘the lesbian’, ‘the gay man’, ‘the bisexual’, or ‘the heterosexual’.
Social workers operate within a context of state policies that heavily influence what is allowed to be done, with whom, where and when. Welfare policies are structured in ways that can appear to be benign and neutral, yet they have implicit and explicit assumptions about sex and sexuality that permeate the ways in which social work practice is undertaken. Carabine (2004, p 2) points out that ‘… social policy does not have to be specifically concerned with sexuality for it to “speak” of sexuality and for it to regulate sexual relations and behaviour’. Chapter Two has identified how heterosexuality is institutionalised and this chapter now turns to some of the ways in which our social policies suggest, insinuate and demand that there are only certain types of sex and sexuality that should be favoured.
The prime location of this institutionalisation is within the family, or a specific notion of what a family should be. Legal, cultural and social privilege is given to supporting (heterosexual) marriage and the production and nurturing of children, with the nuclear family viewed as the basic element of society. In the UK, but also in many other countries, this support for a particular social institution has a history that has left a legacy that we still engage with today. Doolittle (2004) outlines the historical development of this in a clear way, bringing feminist perspectives to illuminate the ways in which gender has been conceptualised in policies. The very construction of the welfare state was premised on the husband as financial provider and the wife as an adjunct to him, with tax and benefit incentives to marry and to produce (legitimate) children, as well as assuming that women would be dependent on their husbands’ welfare contributions.
Government guidance increasingly links emotional and sexual well-being, thereby expanding the social work role. Two major concerns put the sexual health of the nation on the government agenda: the increased rates of sexually transmitted diseases, particularly HIV, and the rising rate of unintended pregnancies, particularly in young, unmarried women. But sexual health is not just concerned with the prevention of disease and pregnancy, as the Department of Health recognises:
Sexual health is an important part of physical and mental health. It is a key part of our identity as human beings together with the fundamental rights to privacy, a family life and living free from discrimination. Essential elements of good sexual health are equitable relationships and sexual fulfilment with access to information and services to avoid the risk of unintended pregnancy, illness or disease. (DH, 2001a, para 1.2)
Nusbaum and Rosenfeld (2004) identify the benefits of good sexual health as:
a link with the future through procreation;
a means of pleasure and procreation;
a sense of connection with others;
a form of gentle, subtle or intense communication;
enhanced feelings of self-worth;
a contribution to self-identity.
Frequent and enjoyable sexual intercourse is a significant predictor for longevity (Palmore, 1982) but, paradoxically, people need to be physically and emotionally healthy to enjoy this important component of well-being. Sexual activity is denied many people on the grounds of their inability to sustain relationships or the unavailability of opportunity to make intimate relationships. Even for those in loving t can be disturbed by psychosocial issues, injury, illness, loss, medication or drug use.
Initiatives aimed at safeguarding the sexual well-being of children proliferated in the 1980s following an increased awareness of the incidence, and damaging effects, of child sexual abuse. Early prevention programmes were targeted at helping children become aware of ‘stranger danger’ (see, for example, Elliott, 1985) and were considered largely the province of teaching (see, for example, Milner and Blyth, 1989). Since then, sexual safety teaching has been largely incorporated into Personal, Social and Health Education lessons in schools, although keeping safe programmes are often delivered by visiting specialists, as teachers often fear that pupils may make false allegations if they introduce such topics. Government-issued guidance to safeguard teachers (Responding to Allegations Against Teachers, DfES, 2004a, and Safeguarding Children in Education, DfES, 2004b) establishes the need to make arrangements to take all reasonable measures to ensure that the risk of harm to children and young people is minimised and sets out the need to ensure that induction and follow-up training is provided for all school staff to enable them to fulfil their responsibilities effectively in respect of child protection. The guidance recommends that the management of sexualised behaviour in schools be approached on a whole-school as well as classroom/curriculum and individual level. Thus not only are children taught how to protect themselves but school staff are also trained to recognise and respond to sexualised behaviour.
Keeping safe work does not necessarily require specialist skills and knowledge as long as the worker is well prepared.
Talking to adults about sexuality is not usually high on the social work agenda, except where the issue is problem sex. This chapter suggests situations where social workers may be inhibited about discussing sex and sexuality with adult service users, and also circumstances where social workers raise issues of sex and sexuality perhaps inappropriately. How adult sexuality becomes the focus of social work assessments is discussed, using a range of vulnerable situations in which adults come into contact with social workers.
The link between parenting and sexuality is so evident that, apart from the odd query from young children about where babies come from, sexual activity is rarely talked about with parents. This is despite the difficulties in adapting to changing nuances of sexual activity: the shift from romance, excitement and experimentation (which is explicitly sexual), to domesticity and parenting (which becomes implicitly non-sexual). When a child is lost, whether through stillbirth, sudden infant death, accident, illness, murder or adoption, the effect of the subsequent grief on sexuality is well documented in the social work literature. For example, Murray Parkes (1986) noted that sexuality diminishes for many people in the early stages of grief, although Swigar et al (1976) found that some people’s need for someone to cling on to might lead to increased sexual activity. Losing a child is so awful an event that a tendency to deny the fact by replacement pregnancies has been noted for many years (see, for example, Lewis, 1976), and can interrupt grieving to such an extent that shadow grief plagues some parents for the rest of their lives.
Government guidance for social workers dealing with sexual violence is not as straightforward as that on sexual health. The latter emerged from a clear sequence of events: first, a concern was raised, in this instance the health risks resulting from teenage pregnancies and sexually transmitted infections; second, the people most at risk were identified; and finally a plan was put forward to prevent these risks, in this instance by improving the sexual health of all people. A similar process is evident with regard to sexual violence but, because sexual violence is so varied in terms of both victims and offenders, settings and effects, the guidance has emerged piecemeal. Historically, concerns were raised first about rape and then about child sexual abuse. Despite commonalities, especially the difficulties in establishing incidence because of under-reporting, these were researched discretely. As a result, the research literature is preoccupied with the effects of different types of abuse on victims. From this knowledge base, policies and practices were promoted in guidance from different government departments; for example, the Home Office published most of the early guidance on serious sexual assault and the Department of Health that on child sexual abuse, although the former issued guidance on offenders until it became clear that many sexual offenders were children themselves. Making sense of the knowledge base on which government guidance developed was problematic for social workers. Estimates of incidence did little but demonstrate that sexual violence is widespread and under-reported – for example, recorded crime figures reflect only about 15% of all adult sexual violence (Home Office, 2005) – although the feminist emphasis in the early research tended to obscure the fact that sexual violence is also experienced by males.
Sexual offending has become increasingly recognised as a harmful, damaging and common behaviour that crosses boundaries of race, class, age, ability and gender. Nash (1999, p 1) described the 1990s as ‘the decade of the predatory sex offender, at least in terms of constructing a demon. Across the world a range of legislation has been set in place which seeks to single out this group of offenders for greater punishment, fewer rights and potential exclusion from society’. Debates abound about the prevalence and nature of this behaviour, with clarion calls for action that have included castration, incarceration and exclusion. ‘Paedophile’ has become a playground term of abuse, constructing a new folk-devil that can generate huge anxiety, anger and retributive action that is unique to this offending. Sexual offences cover a vast range of behaviours that are defined within their time and culture, with different behaviours being illegal in different countries and developments in legislation to reflect changing social attitudes. For example, despite popular images of the Victorian era as being sexually prudish, the age of consent to sexual intercourse for girls was 12 for most of the 19th century until the Criminal Law Amendment Act of 1885 raised it to 16.
Thomas (2005) provides a comprehensive outline of the development of policy and legislative responses to sex crime in the UK, highlighting the increased concern about sexual misbehaviour and the ways in which governments have attempted to deal with changing public and professional understandings of this. Legislation had been piecemeal and somewhat fragmented until the Sexual Offences Act of 2003 reviewed and codified much of the previous relevant law to bring it into line with current socially acceptable mores.
Given the current anxieties about sexual offenders, attempting to work in ways that are creative and meaningful can be limited. Assessment and practices that are dominated by presumptions of cognitive deficits are of limited demonstrated effectiveness, despite claims to the contrary. The authors have worked with children, young people and adults using the following assessment and intervention approaches for people who have harmful sexual behaviours. These are considered to be useful and effective alternative ways of working.
Assessment underpinned by solution-focused (De Shazer, 1988) and narrative (White and Epston, 1990) principles and practices has been found to be useful in producing a good understanding of sexual offenders and the ways in which they can be assisted in developing lives that are free of the problematic sexual behaviour. The aim of the assessment is to determine the level of intervention required to assist the person in maintaining a future that is free of sexually concerning or harmful behaviour. The following goals have been developed by The Junction, a Barnardo’s children’s service:
To be specific about the detail of the alleged sexually harmful behaviour.
To clarify what everyone understands about the behaviour and their individual levels of concern (offender, family, victim, agency).
To consider how the behaviour has already been responded to.
To identify what works in assisting the offender to avoid the sexually concerning behaviour.
To agree a strategy for maintaining a problem-free future and to develop safety.
To establish the motivation and ability of participants to work towards safety.
Referring agencies to Barnardo’s The Junction service include the courts (often for psychiatric and psychological assessment), social services, the probation service and youth offending teams.