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Travis Sky Ingersoll, PH.D., MSW, M.ED.

Social Work & Sexual Health Education/Consulting/Research

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Epilogue from Like an Egg in a Bowl of Cherries

Posted on June 3, 2020 at 3:04 PM Comments comments (1)

From my book – Like an Egg in a Bowl of Cherries
A Year of Adventures, SARS, Wet-Markets, and Profound Realizations
While Teaching in China
Epilogue (2020)
As a college professor, I've been teaching a course titled “Race Relations” for close to a decade now. In that course, I revisit many of my past experiences in China to provide examples of cultural differences, cultural similarities, and to illuminate the many connections that humans have with one other. I also use my experiences to talk about discrimination. In particular racial/ethnic discrimination. As a cisgender heterosexual Caucasian man, I am born with a lot of privileges that I would not readily recognize, if not for the quality education and diverse international experiences I have had.
I share with my students how, while living in China, it was common for Chinese men to become aggressive with me whenever I was walking with a Chinese woman, how groups of men tried to start physical fights with me, spat at my feet, or yelled at me to “go back home to where you come from” to my face. It was also common for me to be followed throughout stores. When this first happened, I thought it was because people were just curious, and wanted to take a look at the strange foreigner walking aimlessly in their store. But after talking to my Chinese friends, I was informed that they were following me because they didn’t trust foreigners and wanted to make sure I didn’t steal anything!
Those experiences gave me a first-hand glimpse at what it might be like for many Black or Latinx men in the United States. To have people assume that you're stealing something when you're just shopping, or to have people suspect that you've committed a crime when all you are doing is going for a jog around the neighborhood, or to experience how certain men become threatened and aggressive whenever they notice you spending time with one of “their” women, can feel downright abusive and depressingly dehumanizing.  
Please don’t get me wrong – I love my country’s people – but I also have love for all my fellow human beings, regardless of who they are and where they live.  People often mistakenly believe that the politicians and other “elites” that make up a geographical area’s (e.g., country, state, colony, etc.) ruling class, fully represent all of the human beings within the places they exert their power and control.  Since many places on our planet are controlled by minority rule (i.e., those at the highest levels of wealth in any given place), this false belief couldn’t be further from the truth. 
Wherever I’ve traveled to, I’ve noticed the same disturbing trend that I first became aware of in my own country; that those who hoard massive amounts of money and wealth often use it to exert a disproportionate amount of power and control over the people within the areas that they live.  Everywhere I’ve been – 24 countries so far – I’ve seen the same divisive techniques being used.  People are always forced into one of two boxes and programmed to narrowly think within an “us vs. them” paradigm.  A land’s ruling elite, who are often leaders of large corporations and religious institutions, have been using such divisive tactics for hundreds (if not thousands) of years.
We are socialized from birth to separate into distinct socially hierarchical categories, where we always have people above us to envy and revere, and people below us to pity and loathe.  Humans throughout our planet are programmed to divide ourselves from one another based on our skin color, our gender, or sexuality, our spiritual faith (or for not having one), the color of our eyes, the texture of our hair, the way we speak our language, physical dimensions of our bodies, the kind of pets we prefer, the kind of cars we drive, the kind of food we eat, and recently in my own country (during a devastating pandemic), whether or not we wear a potentially life-saving face mask in public places.  In order to begin to correct this massive social injustice that has been perpetrated on a global scale, we need true democracy.
A true democracy is one where every person counts, where instead of voter-suppression there is voter-promotion, where those with wealth are stripped of their ability to have a grossly disproportionate influence on the lives of those who represent the majority, where quality education, healthcare, and the means to meet one’s basic needs are guaranteed rights for all. 
I’m not saying that people shouldn’t be allowed to amass great fortunes due to their hard work, I just believe that the more you make, the more you should be required to give.  No one gets rich in a vacuum.  Without people to work, create, and consume, no wealth can be generated.  Like it or not, when you break it all down, we humans are all family. And as fellow family members, we have a duty to support one another, to strive for that which promotes the health and well-being of us all, regardless of our differences.
One of the most important lessons I have learned from my travels, is that no matter how different you think people around the world are, when you get a chance to meet them, spend time with them, share a meal with them, and truly get to know them, you realize that the vast majority of Earth’s people are a lot like you.  We all create, have pride in our work, laugh, love, have our heart’s broken, and grieve for those we’ve lost.  We love our families, our friends, our neighbors, our communities, our animal companions, and the land on which we live. We fret over the safety of our children, the health of our elderly, the well-being of our first responders and everyone else on the front lines who bring knowledge, compassion, and positive change to the world around us.
No matter what our beliefs are, regardless of our superficial physical and psychosexual differences, or what ruling structures govern and control us, the overwhelming majority of humans across the planet are good people. Please remember this fact the next time you are subjected to divisive messaging, for there is nothing the ruling “haves” fear more, than unity among the “have-nots.”  Human beings are amazing, and we deserve far better than to be controlled, manipulated, and divided at the expense of our physical, mental and spiritual well-beings; so that the ruling-class elites, often spanning multiple generations, can maintain dictated status quos that have perpetuated and exasperated the many social inequalities plaguing our world. You, dear reader, deserve better!

Like an Egg in a Bowl of Cherries

Posted on June 1, 2020 at 12:17 PM Comments comments (0)
After 16 years, I've finally published a memoir about my experiences living and teaching for a year in Dalian China.

My book can be found on Kindle and on Amazon = ISBN: 979649443777

Like an Egg in a Bowl of Cherries is a memoir that will appeal to those with a lust for life and a passion for exploration. Drawing from hand-written journal entries and emails sent home while living and working for a year in Dalian, China (2002-2003), readers are taken on an entertaining ride filled with humor, sarcasm, and irreverence.

With topics ranging from the challenges and rewards of teaching in China, to dog restaurants, wet-markets, and the SARS Pandemic, the stories within this book will expose readers to a world of interconnections, surprising parallels, contrasts, similarities, and at times, profound realizations.

Table of Contents
Note from the Author (2020)
Preface (2004)
Arrived and Unpacked
Trimming Hedges, The Hard Way
Downtown Branch School Orientation
First Day of Class at the Branch School
Full Moon Festival
The Bookstore Gig
A Place to Call Home
Trip to the Countryside & Visiting Farmhouses
English Corners, Tutoring, and Ancient Rocks
Three Months of Teaching Under My Belt
Common Courtesy?
Communal Snow Removal
Six Months In = The Halfway Point
Dog Food & Wet Markets
Tiger Beach
Spring Festival
Adventures in Beijing
The Great Wall
The Mongolian Incident
The Machete Man
Yantai by Boat
Exploring an Ancient Taoist Monastery
A Run-In with The Puff-Coat Mafia
Street Food and Cosmic Connections
A Harrowing Boat Ride Home
Politics of Teaching
The Fading Dreams of My Students
I Try to Remain Positive But…
Kung Fu-ish
The Foreigners
Being Here Can Be Really Challenging at Times
Returning Home
Epilogue (2020)

Racial Preferences in Dating? Part 3

Posted on December 16, 2019 at 11:10 PM Comments comments (0)
To encourage critical thinking and competitiveness, I hold up a prize (usually candy or gift cards) that they will receive if they can tell me ONE such "preference." I've never had to give away anything since I started teaching my Race Relations class close to 8 years ago, and I let my students know that fact. We then discuss "preferences" as a class. I provide examples of true dating preferences as characteristics that cannot be solely attributed to a particular race. Examples I give are skin color (dark skin can be found among Black Americans, Aboriginal Australians, Cambodians, etc.), height, eye color, hair color, and body shape, all of which vary more greatly within ethnic/racial groups than in comparison with other groups.

I then bring up a slide that highlights the Zealot/Defensive Stage of the Majority Identity Development Model. It describes this stage in detail by explaining that the Zealot/Defensive Stage ranges between two extreme reactions: Become a zealot for "minority" causes or become defensive about "majority" views, and perhaps, even withdraw from finding out about multicultural views altogether. In becoming a zealot, the person is often reacting to their own, or to the majority culture's collective guilt. Cultural appropriations and/or over-identification of the identified "other" are common manifestations of this reaction. In becoming defensive, the person either attempts to maintain exclusive contact with majority culture individuals, or they try to defend majority values by pointing out all of the "concessions" made by the majority culture for minority cultures (e.g., Affirmative Action, Marriage Equality, etc.).

The final slide asks only one important question: "What do you think such 'racial preferences' in dating is all about?" Students begin to draw connections, including how it can be a manifestation of the zealot end of the Zealot/Defensive stage of the Majority Identity Development Model. When providing other possible motivations for such behavior, students have given potential motivations such as feeling guilty about their own privileged "majority" status; as an act of defiance against a racist and/or bigoted family system; the possibility that it's an act of revenge against an ex who was overtly racist against a specific group; or in cases where people won't date members of their own race - that it's a symptom of internalized racism, prejudice, and/or hatred.

To conclude this often challenging introspective and thought-provoking  exercise, I make sure to emphasize an important personal viewpoint with my students. I let them know that the activity they just participated in is not, in any way, designed to deter mixed "race" dating, and that in fat, I endorse and am fully supportive of everyone forming intimate relationships (or not) with whomever they have a connection to. However, I feel that we should all do so for the right reasons (e.g., connection, attraction, etc.), and not because we are dealing with our own reactions to the uncomfortable realization that we have been (as Caucasian, heterosexual, cisgender, and other identified "majority" group members) benefiting from a racist and heterosexist system of oppression, or that (as member of groups other than Caucasian, heterosexual, cisgender, etc.) have internalized the destructive racist, heterosexist, and/or oppressive messages we have been forced to consume throughout our lives that have made us wrongly believe the lie that we are in some way inferior.

Racial Preferences in Dating? Part 2

Posted on December 5, 2019 at 2:40 PM Comments comments (0)
The Zealot/Defensive Stage of the Majority Identity Development Model is what I choose to focus on during this activity.  Here's how the activity progresses. First, I let students know that we're about to talk about racial preferences in dating. I then ask them to not "out" themselves in any way during the activity and instead to speak ab out people they know who engage in any of the behaviors, give any of the justifications, or think any of the thoughts that they will discuss within their small groups.  Once students have been assigned to small discussion groups (three to five students each), the Power Point presentation begins by having the students discuss in their groups the following questions: Do you know anyone who either only dates members of a specific "race" other than their own and/or will not date members of their own race?  After they talk among themselves for three to five minutes, the next slide states, "Often people who only date members of a 'race' not their own tend to 'prefer' one 'race' in particular," and follows up with "What are some of the reasons they typically mention?" Once again after three to five minutes of discussion I move onto the next slide.

It's important to mention that I do not call on students or have the small discussion groups share what they've been talking about to the entire class until the very end of the activity. The next slide asks the groups to think about the following: "If their reasons included a rationale of 'preferences' connected to the race they will only date, what were they?" They are then instructed to generate lists of those stated "preferences." Finally, I have the groups of students look over those "preferences" lists and circle any items that are not connected to RACIAL STEREOTYPES.

Racial Preferences in Dating? Part 1

Posted on December 1, 2019 at 3:30 PM Comments comments (0)
At the university where I work, I am the lead instructor for a course titled "Race Relations."  I've been teaching the course for over 7 years, and it's one of the most impactful classes I teach (both personally and for many of my students). One of the lesson plans I created on was an introspective activity titled "Racial Preferences in Dating?"  With trial-and-error experiences, this activity, using a PowerPoint presentation as a guide and small discussion groups to process, was found best to be introduced beyond the half-way point in any semester. Not only does the later-in-the-semester timing of this activity ensure that the students have had ample time to get to know one another better, it also gives adequate class time to develop a safe learning environment, and to teach students about the various racial identity development models and theories that may help to explain the phenomenon being examined by the activity.

At the time that I introduce my students to this activity, they've already learned about the biological/genetic (un)reality of race, intersectionality, cultural competency versus cultural humility, the multiple dimensions of privilege, critical race theory, Helm's White Racial Identity Model, Chestang's Character Development, Poston's Biracial Identity Development Model, Root's Multiracial/Ethnic Identity Model, and much more. The "Racial Preferences" activity I introduce focuses on one stage of what's been titled the "Majority Identity Development Model." I love to use this model because it's applicable everywhere in the world where there exists any form of ethnic "majority" and "minority" identification status among its people. There are four stages in this model: (1) pre-exposure stage - where little thought has been given to multicultural issues or to one's own role as a majority group member in a racist and oppressive society; (2) exposure stage - where the individual is confronted with the realities of racism and prejudice and is forced to examine their own role as a majority group member; (3) zealot/defensive stage - where people dealing with the cognitive dissonance of the exposure stage tend to initially retreat to one of two extreme reactions: become defensive or become a zealot; and (4) integration stage - where the overly reactive feelings of the zealot/defensive stage subside, making room for a more balanced view to take its place.

Fathers and Their Daughters

Posted on February 19, 2019 at 2:58 PM Comments comments (0)
The following is one of the new author "Rants" that will be included in the 2nd edition of Sexuality Concepts for Social Workers - due in the fall of 2019.

Fathers and Their Daughters
I remember being an undergraduate Psychology major when the question “Why do fathers begin to distance themselves from their daughters when they begin to exhibit secondary sex characteristics (e.g., breast growth)?” was discussed in my developmental psychology class. I was one of three self-identified males in the class.  What the professor and my female peers seemed to be suggesting was that their daughter’s budding breasts and developing sexuality engendered a distancing response from fathers based on the repression of their incestual desires.  I remember thinking – “What? Are you serious? That can’t be what’s going on!” Now that I’m a father of an adorable little girl, I’ve revisited that conversation many times and have thought about it more critically and introspectively.
One conclusion I came to is regarding the way I intend to be a good father for my daughter; I will not withdraw my physical affection when she begins to go through puberty, nor will I do so at any point in her life.  I will however, completely respect her independence, her need to differentiate from her mother and I, and encourage her sense of self-agency and empowerment by requiring her enthusiastic consent before giving her a big hug or cuddling on the couch watching movies together.  She may, at some point, tell me I don’t need to ask for consent for such displays of affection, but that will be up to her.
Another aspect of her healthy development that I want to do everything I can to support, is regarding her sexual and spiritual growth.  As a sexuality scholar and educator, I’m sure I’m going to be embarrassing to her at times, especially during her teen years, but I can’t let that discourage me from being persistent in giving her consistently positive messages about sexuality in general, and towards her personal sexual and/or spiritual development specifically.  I want my daughter to have an amazing sex life, one that is full of joy, pleasure, connection, and personal growth.  I want all of her sexual experiences to be positive and enthusiastically consensual.  I also want to make sure she knows how to be as safe as possible (i.e., contraceptive choices; STI awareness; knowing how to communicate with partners about sex, etc.), and to assure her that she will be loved and respected by me no matter what she does, who she loves, or how her sexual path develops. 
However, there is a grim reality to contend with.  The reality I’m speaking of is the fact that she will be growing up in a culture that encourages men to be persistent when seeking sexual experiences with women; that every “no” is just a step closer to a “yes.”  We have a culture that raises males to disregard their own emotions, unless it’s anger and/or callousness, and to view all other emotions as feminine, therefore weak and something to be ashamed of.  In fact, when males express other emotions besides those often associated with the term “Toxic Masculinity,” they open themselves up to ridicule (by males and females) for being too “feminine,” less of a “man,” or even to be accused of being “gay,” which isn’t anything to be ashamed of or to be used as a weapon of insult in the first place, but also calls attention to our culture’s collective mental illness connected to gender ideologies and delusional heterosexist hierarchies.
My daughter will unfortunately grow up in a rape culture, one that accepts that sexual assault is an everyday occurrence. With some even believing that rape is a male prerogative.  We see this acceptance of rape in the way police are often apathetic and/or victim blaming when handling rape cases.  We see it in the well-founded fears of stigmatization suffered by rape victims and their families.  And most recently we see it in our society’s implicit acceptance of rape culture through the election of a President who openly admitted sexual assault on an audio recording prior to winning office, and also with a Supreme Court Justice fast-tracked into a permanent and powerful position while concurrently being investigated as a possible rapist.  And during these very high profile events, the media showed us groups of women who were standing up for the admitted and accused sexual predators, by stating things like “boys will be boys,” and “that’s just a part of growing up.” What! Really? Rape is just a part of doing what boys are expected to do, and what girls are expected to experience?  How sad and embarrassing that is to the human race in general, and to the people of our country specifically.
To return to the question I began this rant with… why do fathers tend to distance themselves from their daughters when their daughters begin to develop sexually?  Perhaps it has nothing to do with repressed incestual longings.  What if, instead, it has to do with the gut-wrenching reality that all fathers with daughters have to confront, which is the sickening fact that due to our culture’s soul-less commitment to patriarchy, sexism, heterosexism, and the like, all of our daughters are likely to be regularly sexually harassed and have to confront a high probability of being sexually assaulted at some point in their lives.  And if they are sexually assaulted, our daughters may then have to confront victim blaming and stigmatization by a society that instills the message that women are of less value than men. 
So perhaps it’s not their daughter’s developing bodies and sexuality that fathers are distancing themselves from, but instead is the painful prospect of being powerless to protect their daughters from a sexist and rape-prone society.  Maybe it’s this unfortunate reality that causes some fathers to distance themselves from their daughters; not due to repressed sexual desires, but as a way to try to protect themselves from the possibility of experiencing deep emotional and spiritual pain resulting from their daughters being hurt in such ways?  All I know for sure is that this is the source of fear I personally have for my little girl’s future.  And trying to be the best father I can be is why I’ll never distance myself from her in any way.  

Sex Positivity and Sexual Consent

Posted on March 27, 2018 at 9:58 PM Comments comments (0)
Although sexual activity is one of the most natural aspects of being human and sexual dysfunction can affect a significant amount of the U.S. population, practicing social workers continue to be uncomfortable approaching issues of sexuality and sexuality social justice (Ballan, 2008; Diaz & Kelley, 1991; Galarza, J., & Anthony, B., 2015; Ng, 2007; Strawgate-Kanefsky, 2000). Sex positivity is embodied by individuals and communities that emphasize openness, nonjudgmental views, freedom, and liberation from anti-sex (or sex-negative) attitudes.  Sex positivity can further be understood as a stance towards human sexuality that regards all consensual sexual activities as fundamentally healthy and pleasurable, and encourages sexual pleasure and experimentation.  The term sex positivity has become a framework that integrates the emotional, intellectual, physical, social, and spiritual aspects of sexual being and sexual practice in healthy, positive and enriching ways (Burnes, Singh, & Witherspoon, 2017; Syme, Mona, & Camerone, 2013). 

The World Health Organization has consistently asserted that within a sex positive framework, a person’s sexual orientation, eroticism, and orientation are considered to enhance their personality, communication, and expressions of love. Furthermore, sexual health is not merely the absence of dysfunction and disease, but requires a respectful and positive approach to sexual relationships, as well as the possibility of having safe and pleasurable sexual experiences, free of discrimination, coercion and violence.  In order for the attainment and maintenance of sexual health to be possible, the sexual rights of everyone must be respected and protected (WHO, 2002).

Related to sexual rights and sexual oppression, consent is a significant and integral part of sex positivity.  Sexual consent is a direct and unequivocal agreement to participate in a sexual activity with others, and is characterized by an absence of any form in inherent power-imbalances.   Before being sexual with someone, it is important to be honest about what you both want and don’t want, and that you know for absolute certainty that the person you desire to be sexual with, wants to be sexual with you too. Consenting and asking for consent are all about setting personal boundaries and respecting the boundaries of your partner. Beyond just “respecting” their boundaries, it’s equally important that you genuinely care about them as a fellow human being.

Without being granted consent, all forms of sexual activity (e.g., oral sex, genital touching, vaginal and anal penetration) are sexual assault.  According to Planned Parenthood (2018) there are five basic components of sexual consent.  Consent is (F.R.I.E.S.):

Freely given. Consenting is a choice one makes without manipulation, pressure, or when under the influence of alcohol and other drugs.

Reversible. Regardless of the situation, anyone can change their mind about what sensual/sexual activity they want to participate in at any time, even while in the middle of the act itself. 

Informed. You can only consent when your partner “keeps it 100%” and is honest with you.  For example, if your partner tells you that they have and will use a condom, and then they don’t, that is not full consent.

Enthusiastic.  When it comes to engaging in sexual activity, people should only engage in behaviors that they truly want to, not things that they feel they’re expected to do.

Specific.  Saying yes to one form of sensual and/or sexual activity (e.g., lying in bed while making out and kissing each other’s necks), does not mean that you consent to any other activity (e.g., engaging in oral, vaginal or anal sex).

It doesn’t matter if you and your partner have done it before.  It doesn’t matter if you are both lying naked in bed.  You (and your partner) get the final say regarding what happens with your bodies.  You and your partner are allowed to say “stop” at any time, and you both need to respect that.  As previously stated, sex positivity cannot exist without mutual and honest sexual consent.  It ensures that sexual experiences are approved and desired by everyone involved. Mutual and enthusiastic consent is very, very sexy!


Ballan, M. S. (2008).  Disability and sexuality within social work education in the USA and Canada: The social model of disability as a lens for practice. Social Work Education, 27(2), 194-202.

Burnes, T. R., Singh, A. A., & Witherspoon, R. G. (2017).  Graduate counseling psychology training in sex and sexuality: An exploratory analysis. The Counseling Psychologist, 45, 504-527. doi: 10.1177/0011000017714765

Diaz, Y., & Kelly, J. (1991).  AIDS-related training in US schools of social work. Social Work, 36(1), 38-42.

Galarza, J.,& Anthony, B. (2015).  Sexuality Social Justice and Social Work: Implications for Social Work Education. The Journal of Baccalaureate Social Work, 20, 27-41.

NG, J. S. C. (2007).  Sexuality and psychotherapy: An exploratory study of the subjectivities of
psychotherapists with experience and expertise in working with sexuality (Doctoral Dissertation).  Available from ProQuest Dissertations and Theses database. (9B-1).

Planned Parenthood (2018).

Strawgate-Kanefsky, L. (2000).  A national survey of clinical social workers’ knowledge, attitudes, and practices regarding sexuality. New York, NY: New York University.

Syme, M. L., Mona, L. R., & Cameron, R. P. (2013).  Sexual health and well-being after cancer: Applying  the sexual health model. The Counseling Psychologist, 5, 67-72.

World Health Organization (January, 2002).  Defining sexual health.  Report of a technical consultation on sexual health, Geneva,  p. 38-31.

Older Adult Survivors of Sexual Abuse

Posted on February 10, 2017 at 4:11 PM Comments comments (1)
This is an excerpt my chapter (Ch.6) titled "Intimate Relationships" in the new textbook Healthy Ageing and Aged Care (Edited by Maree Bernoth & Denise Winkler) published by Oxford University Press.  

Adult Survivors Of Sexual Abuse

One of the most neglected issues in discussions regarding older adult care is the impact of past childhood or adolescent sexual abuse. Statistics reveal that between 12% and 40% of adults have experienced some form of abuse in their past (Walker, Torkelson, Katon & Koss, 1993). On average one in five women experience rape at some point in their lives, and among girls who became sexually active before the age of 13, 22% reported that it was involuntary. Given the reluctance of many older adults to disclose private matters or to pursue counseling for their history of sexual abuse, many more unreported cases are likely to exist. Stigma and shame act as effective barriers, keeping many people from revealing problems related to abusive experiences from their past (Doll, 2012; Fouche & Walker-Williams, 2015). 

Although attention has been given to the prevalence of sexual abuse experienced by older adults, research lacks information about the possible factors that influence sexual expression in people with dementia, which may include a history of sexual abuse (Burgess, 2006). Studies have tried to link types of dementia with uninhibited or intrusive sexual activity, but produced inconclusive results (Nagarantam & Gayagay, 2002; Miller, Darby, Swart, Yener & Menea, 1995).  However, there is one study involving 20 assisted living residents, where all subjects who exhibited intimacy-seeking behaviors were found to have Alzheimer's disease, and the older adults with a form of dementia unrelated to Alzheimer's disease all displayed uninhibited sexual behaviors (de Medeiros, Rosenberg, Baker & Onyike, 2008). 

Think about how many of the behavior problems experienced in nursing homes and other elder care setting may be attributed to a history of sexual abuse. Imagine the potential implications for the following actions: A nurse or social worker quietly enters into a darkened room to conduct a bed-check; people entering without warning into a room where an older adult is getting dressed, disrobing or getting dressed; home health-aids, sometimes of the opposite sex, disrobing residents for bathing purposes.  Such experiences could mirror childhood experiences of sexual abuse. And for a person with dementia, such memories many not be experienced according to the confines of their chronological age. Social workers, nurses, and other providers of care to older adults should always be sensitive to such possibilities (Doll, 2012). 

*The excerpt above came from the book: Healthy Ageing and Aged Care (2017). Edited by Maree Bernoth & Denise Winkler. Oxford University Press: Australia & New Zealand. ISBN: 9780195597585


Burgess, A.W. (2006). Sexual abuse, trauma and dementia in the elderly: A retrospective study of 284 cases. Victims & Offenders, 1(2), 193-204.

de Medeiros, K., Rosenberg, P.B., Baker, A.S., & Onyike, C. U. (2008). Improper sexual behaviors in elders with dementia living in residential care. Dementia and Geriatric Cognitive Disorders, 26(4), 370-377.

Doll, G.A. (2012). Sexuality and Long Term Care: Understanding and Supporting the Needs of Older Adults. Baltimore, MD: Health Professional Press.

Fouche, A., & Walker-Williams, H. (2015). A group intervention programme for adult survivors of childhood sexual abuse. Social Work/Maatskaplike, 52(4), 525-545.

Miller, B., Darby, A., Swartz, J., Yener, G., & Mena, I. (1995). Dietary changes, compulsions and sexual behavior in frontotemporal degeneration. Dementia, 6, 195-199.

Nagarantam, N., & Gayagay, G. (2002).  Hypersexuality in nursing care facilities: A descriptive study. Archives of Gerontology and Geriatrics, 35, 195-203.

Walker, E., Torkelson, N., Katon, W., & Koss, M. (1993).  The prevalence rate of sexual trauma in a primary care clinic. Journal of the American Board of Family Practice, 6, 465-471.

Useful Educational Models to Help Cancer Patients Address Sexuality Concerns

Posted on June 2, 2016 at 7:29 AM Comments comments (1)
The information below will soon be added to Chapter 11 (Special Topics: Illness, Disability and Sexuality) in my textbook "Sexuality Concepts for Social Workers."  

Cancer patients and their significant others would undeniably benefit from counseling and comprehensive discourse pertaining to the challenges facing their sexuality. To meet these important needs, there exists a variety of curriculum available for social workers and health care professionals to utilize. The ALARM, PLEASURE, PLISSIT, and BETTER educational models can all be extremely useful to health care providers when confronted with the sexual health concerns of their patients. Common themes incorporated within these models include; bringing up and giving patients permission to discuss sexuality; explaining sexuality as an integral aspect of healthy living; communicating that issues surrounding sexuality can be brought up at any time; reviewing and combating the sexual side effects of treatment, and referring patients to sex therapists.

Useful Models for Sexual Health Assessment


The ALARM model (Anderson, 1990), which appears to incorporate and expand on Kaplan’s (1979, 1995) triphasic model of sexual response, is one useful model of communication and assessment regarding sex and the sexual activities of clients. ALARM inquires about each stage of sexual activity along with the client’s medical history. ALARM stands for Activity, Libido (desire), Arousal, Resolution, and Medical Information. The social worker (or other human service professional) begins by assessing the client’s sexual activity level prior to the point at which the identified problem or medical illness began, following up with an evaluation of changes in libido that may be causing, prolonging, or exacerbating the sexual problem the client is experiencing. Because this approach focusses primarily on the behavioral and physical aspects of sexuality, it may overlook other important domains, such as intimacy, sexual anxiety, emotional connection, and self-image (Hordern, 2008).


The PLEASURE model includes the assessment and evaluation of sexual attitudes, emotions, and activities; level of energy; current treatment and disease side effects; and incorporates the client’s understanding of actual and potential sexual dysfunctions and issues related to reproduction. Specifically, the PLEASURE model assesses the following topics and develops interventions based on identified issues and concerns: Partner, Lovemaking, Emotions, Attitudes, Symptoms, Understanding, Reproduction, and Energy (Schain, 1988).


The PLISSIT Model was designed by Annon (1976) as a step-by-step method for gathering sexual health information. PLISSIT stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. This model has been recommended as a useful template for the assessment of sexuality and sexual health in palliative care settings (Cort, Monroe, & Oliviere, 2004; Stausmire, 2004); and Claiborne and Rizzo (2006) have asserted that PLISSIT is particularly suited for social workers. The model provides the practitioner with a general framework on how to initiate a dialogue about sexual issues and hot to continue the discussion if warranted. This approach is versatile and can be applied to a wide range of illnesses, situations, and settings – both outpatient and inpatient. According to this model, the latter levels of treatment build upon the previous ones. However, the social worker (or other human service professional) can move back and forth between the levels of treatment based on the client’s needs. The PLISSIT levels progress as follows:

  1. Permission - Permission can be interpreted to mean either asking for permission to evaluate or giving the person permission to discuss sexuality. “Would it be all right if I asked you about your sexual history?” “Is it ok if I asked you some questions about how your medication(s) has affected your sexual health?” Asking permission puts the individual in control. Such questions should be followed with a series of open-ended questions specific to sexual health: What concerns do you have? What changes have you had in your feelings about sexuality? In relation to your sexual health, what are things you’d like to have change for the better? The assessor might ask permission to have the person’s spouse or partner join the discussion as well. By doing this, social workers are offering clients and partners permission to both have and discuss sexual concerns. Giving permission not only provides opportunities for people to voice sexual concerns, it also validates and normalizes their desire to engage in, or refrain from, sexual activity (Annon, 1976).
  2. Limited Information - This step involves providing brief education to clients and partners regarding common sexual side effects associated with an illness and its treatment, including etiology, pathology, and complications. This information may be given in a short period of time or over several brief meetings to share accurate and relevant information about client and partner concerns. The health and human service professional can also provide the individual with current and accurate information regarding the factors that may be affecting their sexuality.
  3. Specific Suggestions - Based on the individual’s responses to open-ended questions the social worker or other health care professional can then make suggestions for a plan of care. For example, clients are provided with concrete suggestions on how to cope with changes in sexual function due to an illness or surgery. If a client is partnered, it may be best to see the couple together to understand the causes and dynamics of the problem and then explore possible solutions (Monturo, Rogers, Coleman, Robinson, & Pickett, 2001). Social workers may also benefit from examining how the client explored or expressed their sexuality prior to the diagnosis or presenting problem, and how sexual pleasure was achieved. Some clients or their partners may express feelings of guilt, grief, resentment, or anger resulting from the inability to achieve the level of sexual pleasure they would like to experience (Claiborne & Rizzo, 2006). This is particularly applicable during advanced disease and at the end of one’s life, as patients’ losses and recognitions of changes in their sexual selves may by exacerbated by the physical deterioration and alienation they may be experiencing.
  4. Intensive Therapy - This final level addresses ongoing concerns and may necessitate a referral to a sex therapist or relationship counselor. A small minority of cases may require this type of intervention. For example, it has been estimated that only 30 percent of people will need this last level of the PLISSIT model, since the majority of sexual function problems are resolved by providing permission, limited information, and specific suggestions (Derogatis & Kourlesis, 1981).

More recently, Tayor and Davis (2006) modified Annon’s (1976) through the development of the extended PLISSIT model (or Ex-PLISSIT). The Ex-PLISSIT model suggests that the “permission” level should involve requesting permission to discuss sexual issues as well as providing permission for a person to be a sexual being, and this should be incorporated into each level of the model (Taylor & Davis, 2006). Therefore, when assessing a client, a social worker would offer permission in conjunction with limited information, specific suggestions, and a referral to intensive therapy. Another useful application of the Ex-PLISSIT model is its integration of reflection and review by the social worker (or health care professional) after every interaction with the client. 

This step holds the practitioner accountable for their own interactions, biases, and reactions to the client. It also encourages the client to provide continual feedback and review. Incorporating these two additional steps of permission giving into each level of the PLISSIT model and designating time for reflection and review allow for practitioner accountability during a patient-centered assessment of sexual health needs.


BETTER is an acronym for Bringing up the topic of sexuality; Explaining to the client or partner that sexuality is a part of quality of life; Telling the client about resources available to them (as well as gauging the social worker’s ability and willingness to assist in addressing questions and concerns); Timing the discussion to when the patient would prefer, not only when it’s convenient for the human service practitioner; and Recording that the conversation took place and any follow-up plans to further address client concerns or questions (Mick & Cohen, 2003; Mick, Hughes, & Cohen, 2004). However, this approach may not adequately emphasize the need for psychotherapeutic interventions or referrals to specialists (e.g., Sex Therapists, Urologists, Family and Marriage Therapists, etc.).


Anderson, B. L. (1990). How cancer affects sexual functioning. Oncology, 4(6), 81-88.

Annon, J. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioral
treatment of sexual problems. Journal of Sex Education and Therapy, 2(2), 1-15.

Claiborne, N., & Rizzo, V. M. (2006). Addressing sexual issues in individuals with chronic health conditions [Practice Forum]. Health & Social Work, 31, 221-224.

Cort, E., Monroe, B., & Oliviere, D. (2004). Couples in palliative care. Sexual and Relationship Therapy, 19, 337-354.

Derogatis, L, & Kourlesis, S. (1981). An approach to evaluation of sexual problems in the cancer patient. CA: A Cancer Journal for Clinicians, 31, 45-50.

Horndern, A. (2008). Intimacy and sexuality after cancer: A critical review of the literature. Cancer Nursing, 31(2), E9-E17.

Kaplan, H. S. (1979). The disorders of sexual desire. New York: Brunner/Mazel.

Kaplan, H. S. (1995). The sexual desire disorders: Dysfunctional regulation of sexual motivation. New York: Routledge.

Mick, J., & Cohen, M. Z. (2003). Sexuality and cancer: A BETTER approach to nursing
assessment of patient’s sexuality concerns. Hematology Oncology News and Issues, 2(10), 30-31.

Mick, J. A., Hughes, M., & Cohen, M. Z. (2004). Using the BETTER model to assess sexuality. Clinical Journal of Oncology Nursing, 8, 84-86.

Monturo, C. A., Rogers, P. D., Coleman, M., Robinson, J. P., & Pickett, M. (2001). Beyond sexual assessment: Lessons learned from couples post-radical prostatectomy. Journal of the American Academy of Nurse Practitioners, 13, 511-516.

Schain, W. (1988). A sexual interview is a sexual intervention. Innovative Oncological Nursing, 4(2-3), 15.

Stausmire, J. M. (2004). Sexuality at the end of life. Journal of Hospice and Palliative Care, 21, 33-39.
Taylor, B., & Davis, S. (2006). Using the extended PLISSIT model to address sexual health care needs. Nursing Standard, 21(11), 35-40.

Great Resources for Sexuality and Social Work Educators

Posted on February 6, 2016 at 12:44 PM Comments comments (0)
As an educator, I'm always looking for new ways to engage and inform my students. When I came across the Flipboard, an on-line platform where people can create and customize their own e-magazines, I immediately recognized its potential as a teaching aid.  No matter what topic you teach, you can create a Flipboard magazine full of information connected to the material you cover in class.

I have spent more than a year populating my e-magazines on Flipboard with a wide variety of relevant news articles, research reports, and opinion pieces.  Here are three that I created for the Social Work and Sexuality courses I teach:

Sexuality and Social Work

Sexuality Concepts for Social Workers is the textbook I co-authored (available at,, and Our textbook is full of QR codes that take you to similar articles as the one's you'll find in this Flipboard e-magazine. I teach Sexuality and Social Work courses at West Chester University and Widener University. The articles in this e-magazine are meant to aid in classroom instruction and discussion.

Race, Ethnicity and Culture

I teach a Race Relations class at West Chester University. The articles I collect for this magazine are chosen in order to help students learn more about issues of diversity, and to aid in class instruction and discussion.

Policy, Poverty & Social Work

This is a collection of media resources focusing on policies and issues related to poverty and social inequalities.