164 PARTICIPANT 2:
To be honest she reacted exactly how I expected her to and gave me the answer I had expected. Even though she (the client) had mentioned that she had been sexually abused as a child, when we got to that section of the interview she answered I knew there would be minimal response and it was a minimal response.
INTERVIEWER:
Do you think knowing that there is a history of sexual abuse, and the fact that she glossed over that and just gave you the bare minimum, do you think that that there needs further looking at …
PARTICIPANT 2:
Definitely I mean she has had sexual abuse and sexual history so it has to be important surely? I feel like, I mean if you think about it logically…..And although she has had sexual abuse it is very hard to see how that affected her from there to now? And I still don’t know how to bring it up, like current life, childhood, how that affects sexual life and if it did……
INTERVIEWER:
It's difficult because I would feel uncertain : do you want to revisit this thing, is it important to bring it up or not? Do we need to look at current sexual functioning? Does current sexual functioning link to that?
What to bring up first? It's tricky. What would you do differently with a new client?
PARTICIPANT 2:
II have to be more comfortable with being able to ask about sexual health and their experiences INTERVIEWER:
What do feel would be helpful in better equipping you with dealing with this topic?
PARTICIPANT 2:
Definitely one or two seminars on the topic and gender stuff of being able to talk to male and female colleagues, text books or articles, something about talking about the subject because I haven't read anything useful
165 Yes, so that was actually difficult to try and fit that all in and bring her back to more structured questions and contain her at the same time.
Interviewer:
So did you go through a process of orienting your client to the whole initial intake, what it’s going to entail specifically regarding sensitive topics?
Participant 3:
I just said that some of the questions might seem irrelevant or might seem strange, I didn’t use the word ‘sensitive’ at all.
Interviewer:
So that was your way of making the client aware that you were going to gather a whole range of information?
Participant 3:
So I think ‘strange’ was probably the word I used.
Interviewer:
So in your mind was that an umbrella the sensitive topics you would have to cover ? Participant 3:
When I look at it now, probably not, when I look at sensitive topics now perhaps I should have added the word ‘sensitive’ as well.
Interviewer 3:
So do you think you were adequately prepared for that initial interview with gathering all information?
Participant 3:
I do have to stay that I have worked before in crisis counselling but this was very different because there it was more a sexual assault unit so it was very different, it was a more structured questionnaire. I don’t think you are every adequately prepared or feel confident enough so at the back of your mind you’re always thinking I have to remember to ask certain questions so you lose focus a bit.
Interviewer:
So did you feel you had familiarity with the process of what you needed to say?
Participant 3:
Yes absolutely!
Interviewer:
Your own personal challenges around the topic of sexuality, sexual functioning, sexual history, how does that come into play when and if you asked?
Participant 3:
I think it was really easy for me to ask because I have worked in the sexual assault unit so it’s no longer a sensitive topic for me so it’s something I just would have asked. In saying that when I did ask the question I did notice that the client was taken aback, which did make me think that this was probably sensitive.
Interviewer:
So how did you introduce your client to the topic of sexual health during the first interview?
Participant 3:
I just went through the process of the questionnaire almost like being step 1, step 2, step 3.
Interviewer:
So for you is there an understanding of why you need to gather information around sexual health, sexual functioning and sexual history?
Participant 3:
166 Absolutely I think that it’s really important because for example a client would be going through a difficult relationship so then it shows that she’s lost interest, but she’s the same also, she is post diagnosis for PTSD so it was quite important……. lack of interest, so it gives an indication of how they deal with relationships.
Interviewer:
So those kind of questions gives you more insight as to how that person is in their relationships?
Participant 3:
Yes absolutely.
Interviewer:
So you said there was a moment you noticed when you asked, can you tell me about that moment of what you perceived in your client.
Participant 3:
I think it was unexpected, then saying that she was taken aback but then she was happy to answer but it did take a moment.
Interviewer:
So there was a pause but then she went on to answer, what was her discomfort like, was there any?
Participant 3:
No not at all I think it just was the initial surprise.
Interviewer:
For you, in relation to things like culture, gender, language differences and age tell me a little bit about those things. Do you think they affect whether you are able to ask questions around sexual history and sexual functioning or not?
Participant 3:
I think it might be quite awkward, if I was dealing with a young girl she might think I’m being a bit judgemental, so that maybe a bit difficult.
Interviewer:
And a person in their mid twenties, thirties?
Participant 3:
It wouldn’t be awkward for me, so if it’s not awkward for me and I ask it in such a way that it may come across as just part of the questionnaire which I have done before, so if I’m awkward about it that would have an adverse reaction, for example the client even though she was of a similar age to me she felt good because the questionnaire followed structure it became less awkward, I was thinking that she felt let’s just continue answering the questions so I think that makes a different because if it’s in a structure.
If I had to zone in on it, it would make it more sensitive, I presume, I’m just guessing now.
Interviewer:
And in your mind with culture and gender, what would it be like dealing with people of different culture or gender?
Participant 3:
There again I think the more I keep it as a structured format the less sensitive it is to talk about, so there again I think it just becomes part of the questionnaire so I think if you make it something sensitive then it will become sensitive.
Interviewer:
Do you think that your age makes a difference?
Participant 3:
167 I think it definitely does as I’ve probably been around and seen everything and heard everything especially having children that have gone through different experiences and now are older and having been through their sexual education, I definitely think it does.
Interviewer:
So that also sounds like it has a lot to do with experience, having conversations, because you have not only had conversations with your own children but conversations whilst working at the crisis centre, so this conversation is not a sensitive conversation for you it’s a conversation you’ve been having for years.
Participant 3:
Yes definitely, and because my goal is ultimately to work with offenders I need to be able to talk about really sensitive topics. I have attended courses and workshops on sexual assault and there they almost get you to talk about sex in a different way, they say you cannot work in a sexual assault unit unless you can call things by certain names so you cannot get all silly about it. You have to be able to talk about that. You have to be able to listen to somebody who perhaps has had some really weird experiences.
Interviewer:
So there again it’s familiarity with language, familiarity with the topic, the understanding with why it’s important? These are the things I’m picking up from you: that it’s not this taboo subject any more.
However what’s interesting is that perhaps for you it’s not but for clients it maybe, as you said there was that moment of her not expecting that?
Participant 3:
I think as you become aware of that, I didn’t expect that reaction but I think the client realised it was not uncomfortable for me she was able to carry on which is very important.
Interviewer:
Yes because you walked into the room and it was very normal to ask what you were asking, yes very important. So asking around sexual history, sexual functioning, sexuality do you feel it’s an invasion of privacy or not? is it part of just gathering a full history? What are your feelings about that being part of the intake.
Participant 3:
I think it’s absolutely essential, when I spoke to this particular client, I felt like the total lack of interest and also to do with relationships, I think it’s essential and very very important.
Interviewer:
As you said you weren’t aware as to where the alliance changed at all after questioning but I think that’s the way you broached the subject?
Participant 3:
I don’t think it would bother me if it was a male either to be quite honest, because if somebody asked
‘why do you need to know that’ I would just say: to understand you better. So no it would not bother me.
Interviewer:
And any cultural differences?
Participant 3:
I think what maybe concerns me, which I haven’t come across, not cultural differences but more power differences. Perhaps if I had a male that used sex as a means of power I think I might find that difficult, the only reason I would find that difficult is because I worked in the sexual assault unit.
Interviewer:
So it’s not the actual topic of sex per say, it’s the power and the abuse.
Participant 3:
168 Yes I think that’s the difference, I’m not talking about in a particular culture, just if there was a power dynamic came into it. Not that it would bother me, I’m just imagining that it could possibly bother me.
Interviewer:
So what strategies would you say you employ to help deal with covering sensitive topics: knowledge, experience, normalising, theoretical?
Participant 3:
I think it’s having understanding of what the process is about, of understanding of why you are getting the information. Knowledge and training as well, not in particular sensitive topics. I looked at some of the questions I felt that some were a bit odd, not sensitive questions. So once we did the role- play and got into it, I think you have to be quite fluent in the way you ask the questions. I think if you start stuttering around it so you have to ask it in a way that is quite straight forward, so the moment you actually bring in your awareness of it being a sensitive topic, I think that could be tricky, so I just think you must make sure of the way you questioning it is important.
Interviewer:
And fluency you only really gain from being able to say the words, that you are able to talk about this, it’s familiar.
And in your family when you were growing up the topic of sexual health, was that ever discussed, or not?
Participant 3:
Yes it was discussed, it was more in the way of ‘let’s discuss this book’, it wasn’t very open it was all a matter of fact. There was one instance reading a newspaper about an incidence of rape and I asked my mother ‘what is rape’ and she said to me ‘where did you get that word from’. I can’t remember how she explained it but she wasn’t freaked out about it I only remember asking her what it meant.
Interviewer:
So it wasn’t really a taboo topic?
Participant 3:
No not at all.
Interviewer:
So your expectations when covering a sensitive topics, it sounds like it was just part of the whole process, there wasn’t any huge anxiety around thinking what I’ve got to do, what I’ve got to ask?
Participant 3:
No I didn’t even think twice about it to be honest. I didn’t even look at the question and feel: oh my gosh how am I going to ask this? No it was just part of the questioning, it’s just part of functioning, so no not at all.
Interviewer:
Very often it’s not seen as part of functioning, it’s in a little box that just sits there, so for me my own personal feeling is that’s where the issue is, always a taboo.
What do think would have been helpful in training to assist with equipping M1 students? Specifically regarding sex?
Participant 3:
I was thinking maybe to explain why it’s necessary? I don’t think we actually spoke about that. Perhaps because the people who train us they don’t put that part in a box so they may presume that we in fact wouldn’t do that. I think perhaps it should be explained as to why we should be doing that, what are the reasons behind asking the questions on sex.
Interviewer:
When you did your role- plays did you ask about sexual history and sexual functioning?
169 Participant 3:
No we actually didn’t.