6.3 Communication

i) Recognise verbal and non-verbal components of communication about sexuality

Communication is both verbal and non-verbal. People with head injury can retain the ability to respond to tone of voice even when understanding of the meaning of words is lost. Even when there is no loss of understanding, people who have had head injuries may respond to tone of voice instead of the actual words.

Emotion is commonly revealed in tone of voice. In dealing with clients' sexual issues, workers' emotions (such as embarrassment or anger) can show in the tone of voice, even when the words used are appropriate for the situation. As workers, we need to listen to how we talk and we need to be able to speak unemotionally when that is necessary.

Body language also provides important clues in communication, for example gesture is often used with people who have aphasia and no longer understand the meaning of words.

Emotion is also revealed in body language. For example, when someone is angry he or she may move more quickly than when calm, or someone who is embarrassed may break eye contact and look away.

Clothing also provides information in an interaction between people. If we are working with someone who has problems with disinhibition and control, our "don't touch" message will work better if we are not wearing sexy clothes.

Matching verbal and non-verbal communication to get a message across effectively

Strategies for matching modes of communication include checking that words, tone of voice, facial expression, body language, eye contact, clothes (where appropriate) are all saying the same thing and that there is no confusion between different parts of the message.

If the verbal message is "Masturbate in the bedroom, not the lounge" and the non-verbal message is disapproval, the client will conclude either that he/she is in trouble, or that masturbation is disgusting, or that the worker does not like him or her. The intention of confining sexual activities to private instead of public space may be missed altogether.



ii) Clients special needs in verbal communication

Clients who have had a head injury have special needs in verbal communication about sexuality. Common needs are:

  • more time than the average person to take in information
  • more time to process information
  • more time to respond
  • more repetition
  • small chunks of information at a time
  • external limit-setting or prompts about appropriate behaviour

People who have had TBI often get easily overloaded with too much information delivered too fast. People who have memory problems need a lot of repetition and reminders.

Taking time to plan how best to deal with a client's sexual issues saves time in the long term. The longer an undesirable behaviour continues, the harder it is to change. There will be a short term increase in work to tackle the problem, but a decrease in effort in the future once it is resolved.

Inappropriate sexual behaviour is not personal. The client is not doing it to intentionally upset the worker. He or she is acting out the effects of the TBI while the worker is present. Keeping the focus on the behaviour that needs to be addressed rather than feeling personally involved helps to maintain distance between the worker and the client's behaviour.

iii) Our responses

It is normal to feel emotional discomfort in response to socially and sexually inappropriate behaviour. Our own memories of experiences with sexual connotations colour how we respond to similar encounters with other people, including people who have had head injuries.

Have there been situations where you have felt uncomfortable?

Ways of dealing with our feelings include:

  • talking about what has happened and how we feel to other workers or a supervisor
  • giving ourselves permission to feel what we feel, i.e. saying to ourselves, “I feel quite shaky after what happened,” rather than saying, “I shouldn’t feel this way, he/she can’t help behaving like that” or “I’m a professional, I shouldn’t get upset”
  • remembering that feelings do not have to be acted out, eg. we can feel angry but may decide not to show the anger to the client if the anger would be unhelpful
  • remembering not to take it personally
  • saying something to reassure ourselves, eg. “It’s over now”
  • using a quick relaxation procedure to help ourselves calm down, so that one upsetting event does not contaminate the whole day. A few slow, deep breaths are useful for calming down quickly.



iv) Interviewing about sexuality - making a very normal response

“When a client discloses that they have a sexual health concern, we need to make sure that we respond in a positive way so that the issue can be addressed effectively. We need to make a response that comprises three elements.

This can be called a ‘Very Normal Response’:


We need to validate the client’s concerns. We can do this by saying “It is important that we address the issue that you have raised.”


We need to normalise the issue. We can do this by saying “Many people with brain injuries have had the same problem.”


If we do not have the knowledge or skills to address the issue, we need to organise a referral for the person. We can do this by saying “I do not have the expertise to help you with this issue. But I would like to find someone that can. Would you be happy for me to do this? Would you feel more comfortable speaking with a man or a woman?”

Interviewing about sexuality – possible questions to ask

The following is a set of general interview questions that a person with TBI could be asked about their sexuality to help identify problems to be solved.

Have you noticed any changes in your sexuality since the brain injury?

Is sexuality an important issue for you at this time?

If you are not having sex, do you think ...

– erotic magazines – sex videos – sex workers – masturbation – phone sex lines ... will help to meet your sexual needs?

If you have been sexually active with another person/other people:

– was it good or not so good? – why? – did you take any safe sex precautions, eg. contraception? – did you experience erectile difficulties? – difficulties with ejaculation? – problems with orgasm? – was intercourse painful?

Have you noticed a change in your sex drive?

Do you think you are as sexually attractive as before the injury?

What sort of rules/values do you think are important in sexual relationships?

Where do you think sex should be placed in a relationship?

Since the injury, have you been taken advantage of or abused sexually?

Have you had any interactions with your family about sexuality issues?

What issues do you think arise for staff in relation to your sexuality? Have you had any interactions with your staff about sexuality issues?

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If, during some interaction with a client, they say that they have a sexual concern, how would you respond to this situation? what sort of a response could you make? what other action might you take?