Jodi - you did just great!

You gave two important pieces of information, one that was
true from a medical point of view, and one that was from your
heart. And you did it in a humorous way - showing, that it was
OK to ask and that you were not easily embarressed. To put
it inside the PLISSIT:

You gave "P" (permission) - or may already have done so in
the past by your whole attitude, since he dared to ask you.

You gave "LI" (limited information), about having sex with his
condition.

You even gave "SS" (specific suggestions) - and you chose
them so wisely, that they made the "LI" more acceptable
for the SO.

I'm quite sure you didn't stop them from asking again - that
is if I got the right feeling about the situation. One thing
though:

Could your client be experiencing anything like difficulties
with erection or ejaculation? This would certainly contribute
to his grief about losses. Might help him to be able to speak
about it - and it might even have to do with some medication
that could be changed, now or later.

I think I would address that - e.g. tell him that it happens some-
times, and then ask - for once without the SO in the room!

But besides that, I don't think I'd take it any further - no "IT"
(intensive therapy) on sexual grounds. But maybe on others,
like their losses, grieving, anger, changed roles, if you see
a need.

If possible, offer both a chance to speak to you alone. Not
as IT, but so questions can be asked and problems
layed out in the open. Nobody can replace you there really,
as only you have that much knowledge about both his
condition and him/them.

Any peer support available in the area? Else there are
some great groups online - though I'll have to check
about CVA.

susanne

----- Original Message -----
From: <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Thursday, May 30, 2002 8:09 PM
Subject: OT and sexuality


> This doesn't come up too often in my practice - but it did recently.
The
> home health client , 70some male, suffered a CVA two months ago.  SO
50 yr
> old female, seems to have shifted her role from partner to caregiver.
He
> started asking me about sex, she's standing behind him shaking her
head.  She
> wants me to tell him not safe for his heart.  That isn't true of
course.  He
> is difficult for her, will not follow through with PT and OT
suggestions
> between visits, refuses to bathe unless I am there ( Could do with her
asst,
> needs only CGA) and by both of their reports he has even hit her ( no
> physical harm caused) calls for help in the night to use urinal which
he
> could do I, got mad and went to front door one day and just fell out
of the
> door down the stairs - only way he could leave house alone.  So, what
I said
> ( go ahead and beat me up, this is really out of my area of
expertise ) It's
> not dangerous for him to have sex, and  maybe if someone would shave
and
> bathe and be nice and cooperate, he might get some.  SO was OK with
that
> response.  Patient agreed verbally, but continues to be cantankerous.
They
> haven't brought up sex anymore with me - ( probably due to my royal
failure
> in this area).  On my last visit SO told me his daughter needs to find
> someone to stay with him some, she needs to stay at her own  house
some,so it
> seems the relationship might be unraveling some.  I'm sure he is in a
lot of
> grief over his losses due to this CVA, and try to address that grief,
but he
> is just really kind of mean to the SO -- Jody
>

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