Supporting Clients with Spinal Injuries

A Sexual Rehabilitation Service for Spinal Cord Injury Patients

Michelle Donald PG Dip.PST
Psychosexual Therapist

COSRT Accredited

I am a Psychosexual Therapist and Relationship Counsellor, with expertise in the areas of sexual issues related to spinal cord injury, relationship issues, and issues with daily living. My long-term aim is focused on the development of a functional sexual rehabilitation programme within hospital spinal units nationwide.

I believe it is necessary to address the issue of how important sexuality is after a spinal cord injury, believing that this aspect of the relationship shared by a couple, is often neglected, with the focus being on the physical dysfunction. I am involved in research to encourage spinal units to help incorporate ideas for change and presenting this information to all the staff to allow them to think about what is achievable within the short space of time that patients are in spinal centres and how sexual rehabilitation can be effectively integrated during that period.

I have undertaken a Post Graduate Diploma in Psychosexual Therapy and as an accredited member of the College Of Sex and Relationship Therapists, bound by it’s code of ethics and principles of good practice for members and subject to it’s complains procedure.

I am a professional speaker having spoken at many conferences and delivered workshops nationwide.

I am a director of I-SAID, Informing on sexuality after Illness and disability, delivering high quality training around sexuality and relationships, illness, disability and carer support to relevant groups and institutions across the UK.

In addition to consulting at the National Spinal Injuries Centre in Stoke Mandeville, The North West Regional Centre for Spinal Cord Injuries in Southport, Stanmore Spinal Centre and Belfast Spinal Centre, I am a mentor and group leader for ‘The Back Up Trust’ . This is a national charity that runs a range of services for people with spinal cord injury that actively encourages personal challenge, as well as helping to build confidence, motivation, and independence.

I also work with private clients, clients from Warrington Disability Partnership (WDP) and Case managers.

Spinal cord injury (SCI) has a major impact on sexual function. Intimate relationships, social life, bladder management, physical well-being, mental well-being and body image. After spinal cord injury, people have a choice to be sexually active or not. As Health care professionals, it is our role to ensure that they have accurate information about sexuality and the emotional support to make that decision.

The importance of this area has been recognised by many spinal centres nationwide, many of whom are working closely with Michelle Donald, psychosexual therapist.

As a result of my own spinal injury and personal experience I decided to train as a relationship counsellor and then specialise as a psychosexual therapist with the objective of helping people like myself. I work with both able and clients with neurological issues. It is critical to the process of renewing the sexual experience that clients accept that their sexual experience is now going to be different.

Some Sex Therapy Interventions may include:-

  • Helping a patient develop realistic and appropriate goals. Patients regularly need help understanding female and male sexual response and what is arousing for them as individuals. They may not have explored their sexual responses since their SCI, they may be pretending to have orgasms, they may be anxious or inhibited about their sexuality, or they may engage in a set pattern of sexual activity that is now not arousing or satisfying to them. Exploration of wants, needs and sexual turn ons or turn offs may also be used. Education about a sexual problem is often the first step in the treatment process and helps the patient better define their needs, goals, and expectations.

  • Identifying contextual catalysts for sexual activity. Review of the context in which sexual activity typically—i.e. the sexual script—including the time of day, the interval between sexual encounters, and the way a partner indicates his/her desire for intimacy can be used to make recommendations about how to increase desire for sex, arousal, and satisfaction.

  • Cueing exercises. These exercises are designed to help a patient remember instances in their lives when they felt sexy and had a good and satisfactory level of sexual desire. The patient is instructed to recall the setting, the smells in the air, the music and use these as “cues” for feeling sexual now.

  • Assigning sensate focus exercises. These behavioural exercises involve a couple taking turns pleasuring one another so each person has a heightened awareness of what types of strokes and caresses are most arousing and can convey that information to his/her partner. Sensate focusing can be both genital and non-genital in nature. It often begins with limited sensual massage of the face, hands and neck and progresses over time to include sexual intercourse. In fact, to reduce “performance anxiety” and help the couple establish emotional intimacy, the exercises are not goal-oriented (i.e., tied to intercourse) and intercourse is initially discouraged.

The area of sexual functioning and intimacy reaches far beyond the often narrowly defined purely physical experience of sexuality or sexual intercourse. It is experienced in a much more holistic way and encompasses a huge spectrum of lived experiences. Sexuality and intimacy, in whatever form they are practiced, often form the glue, which strengthens couple bonds and enhances an individual’s ability to move forward in all relationships.

More specifically, sexuality and intimacy can help to fulfil a range of fundamental human needs, many of which are more acutely felt by individuals and couples navigating the challenges brought on by a SCI. These include the need for touch, physical closeness and pleasure, the need to feel “normal”, to console and comfort and to be consoled and comforted and to feel wanted, accepted, loved and “whole”. It leads to increases in a person’s self esteem as well as in their gender specific sense of femininity or masculinity. Sex can also be a way of coping with anger and confusion, sticking to life and saying farewell. Its significance is felt most acutely when circumstances outside of a couple’s control lead to a reduction in or complete cessation of previous levels or types of sexual expression.

Screening and timely intervention can prevent many difficulties from developing and avoid an aggravation of difficulties later on. Combined psychosexual and biomedical treatment approaches are able to help the vast majority of patients and can encourage adjustment and facilitate optimal sexual functioning even when all medical approaches have been exhausted.

For more information, contact Michelle (including I-SAID): –

Email: michelle.donald@nhs.net

Telephone: 07775 927 533

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