We look at the world of Psychosexual Therapy when working with disabled clients. The wonderful Michelle Donald trained to be a Psychosexual Therapist, specialising in working with disabled clients, after she had a spinal injury in 1996.
Michelle's warmth and passion for the subject comes pouring out in this fabulous podcast. Jennie & Emily invite her to share the actual process involved for the client in this type of therapy. What is it that happens in the room?
Does her disability help or hinder her clients?
We look at the world of Psychosexual Therapy when working with disabled clients. The wonderful Michelle Donald trained to be a Psychosexual Therapist, specialising in working with disabled clients, after she had a spinal injury in 1996.
Michelle's warmth and passion for the subject comes pouring out in this fabulous podcast. Jennie & Emily invite her to share the actual process involved for the client in this type of therapy. What is it that happens in the room?
Does her disability help or hinder her clients?
Welcome to Enhance the UK's Undressing Disability Podcast, where we strip back all things taboo on sex and disability.
Emily Yates:Hello and welcome to the Undressing Disability podcast. We've got a really fascinating episode in store for you today. Whether we're disabled or not, we might want to enlist the help of a sex therapist at some point in our lives, be it to find solutions to physical issues or to gain some emotional support from a professional.
Jennie Williams:And today, we have the wonderful Michelle Donald. So, Michelle, welcome and thank you for coming to join us. Michelle, you are a friend of Enhance the UK, we've known each other for quite a long time now. And Michelle is a hugely well known psychosexual therapist, who has personally experienced a disability and specialises in providing therapy to those who may be experiencing sexual issues relating to spinal cord injury or neurological disorders. In addition to this, she delivers training around sexuality, relationships, illness, disability, and career support to relevant groups and institutions nationwide. So Michelle, thank you for joining us today.
Michelle Donald:Thank you so much. It's such a pleasure. And that was a that was a lovely introduction. Thank you.
Jennie Williams:Well, we spent hours writing that Michelle. So before we delve a little bit deeper into what you do, could you please start by telling us what is psychosexual therapy and how does it work?
Michelle Donald:Okay, it is a frightening title to a lot of people because it's such a such a big title. But at the end of the day, psychosexual is what it says - it's about what's going on in our heads, because it's all right giving somebody a tablet, or saying there's an aid. But actually, if our heads haven't dealt with how our bodies have changed, there lies the difficulty. So the work that I do is enabling people to be able to communicate really well. And I give them tasks to do. So it's a lot of cognitive behavioural therapy. So people go away, I get to know them quite well, then I speak to them. And we talk about what's gone before what their sex lives were like before possibly their injury, or what their sex lives have been like in their life. And then we just work from there. So it's very unique to each person or couple, I can be working with just one person. And then we work on sensation, we work on thoughts, we work on looking at automatic behaviours, and trying to change them if they're unhelpful. Within a couple, obviously, I work with a couple relationship a lot to start with -let's have a look at how that relationship functions, the patterns that have maybe got embedded that sometimes are unhelpful, and then when a neurological issue presents itself. So like I said before, the majority of my work is done with spinal cord injury, and MS. I've just signed a new contract to be working with Sue Ryder locally. So that's fantastic in that we've been looking at their policies. So again, the psychosexual work stretches such a long way. But mainly it's Cognitive Behavioural Therapy. People get a task. So initially, it takes away what you would call a genital focus, we have some lovely phrases for our work, so it's genital focus and self focus. So we take away genital focus to start with, and we take it back to basics. Let's look at touch, let's look at sensation, how does it feel? Let's look at communication. Let's look at how we move around each other's bodies now. How is that different? What does that feel like? And then I will take feedback from those sessions. So you'll go away and do those sessions yourself. I'll take the feedback. And then from that, I'll then really tailor a programme to that particular couple because as we know, everyone's absolutely different. And then we'll take that further. And then later so we'll go with genital focus, touch and sensation. And then after touch and sensation, we'll talk about our play. So we add in things like you know people have brought back sponges and a brace and things to scrub pans with that they touch each other's bodies with, sort of talk to them about being really playful, let's find things that you can touch each other's bodies with, what does that feel like? How does it feel? And then after that we'll start to look at. So that's sensation, then we'll start to look at arousal. And at that point, when we start to look at arousal, sometimes that's when some of the blocks come in for people. So they really kind of worry, or sometimes can get really imaginative about what's next. So we bring in what's called genital focus. So at that point, we'll start looking at what happens to the genitalia when when it's touched, how does the reflex erection work, I will have gone into the education around reflex erections. So kind of the erections or the lubrication that we get when we're sleeping that our body gives us as an automatic response to keep our genitalia healthy. So we'll talk about that. We'll talk about how to enhance it, if that's changed. If there is no feeling there, we'll talk about how that can be looked at and changed and other parts of the body. And so really start to look at what sort of what skin changes are happening. So if the testes are touched, what happens? Do they move? Do they engorge with blood? Do they stay the same? Do they drop? How does it feel? How does the testes feel but also genitalia for women- look at the labia when you touch the labia? What happens? So even though maybe some of the people are not feeling it, the partner gets to know what that looks like and communicate to their partner what's happening, how that's changed. So it's so much about communication. And I know this is quite a long answer. I'm very aware of that. But there is so much involved in psychosexual therapy. So the easiest answer is yes, it's Cognitive Behavioural Therapy. I give tasks, people come back, give me feedback, and then I tailor tasks that I give them after that. And then later down the line, obviously, after touch and then we do genital sensation. After the genital sensations some people might want to add things such as PDE 5 inhibitors such as Viagra, Levitra, Cialis, people might use prompts, people might use different things, but we'll bring them in so they're friendly, so that people get used to them, having those things around. I call penis pumps sort of physio for the penis, they're the really healthy things to have around and clitoral pumps as well to engorge the clitoris with blood. So it's quite I think I get really excited about it, because it's so different for everyone. And I just love the work that I do, because it just brings people so much closer. Don't get me wrong. It's it's hard for a lot of people. And it's a process. And sometimes it's a process of grief that people are going through at a time. But actually, somebody contacted me last night actually by email saying 'We set up a task. And we're going to do this tonight and I'm really excited. But it's a heterosexual couple and she said 'but I'm really worried because he's not initiated yet. Should should I nudge him, should I should I talk to him?' So we talked about initiation and things like that. And I'm always there in the background. People send me emails just to go actually, are we doing this right? we doing this wrong? What can I do? And it's all about them. So yeah, I'll leave that there. Sorry, that did go on for a while.
Jennie Williams:Michelle, hearing you speak, it just reminds me of when I met you 10 years ago, and how excited I was right at the start of my journey for this. And I met you and I just thought this lady wows me. And I've always held you in such high regard, as I still do now. And all the work that I've been trying to do with Enhance for all these years. So much of that is focused around the conversation that you and I had all those years ago, and I saw this enthusiasm, passion come from you. And I just thought I get it. I get it and how do we make that mainstream? How do we get people talking and knowing about what it is that you do? And it's so, it's incredibly exciting the work you do and incredibly important and your passion comes through so well which is amazing. Which makes you such a good therapist.
Emily Yates:Yeah, it totally does. That was really great to listen to. And just great to hear a little bit about really the the mechanics and the logistics of sex and everything that goes into it. You know, when we think about sex so often or the way that it's portrayed in the media, it really just is seen as this one act of penetration. But it really is everything in the way that we identify as human beings, isn't it which is basically what you've just said. So that was really interesting. Thank you. And from our point of view, it will be really brilliant to know more about you as well and how you got into this. Was it always something you wanted to do or did your personal experiences and perhaps even your experience of disability sway you towards it, or bring a certain exciting element to it?
Michelle Donald:Absolutely. Originally in my, I call it my previous life, so I was paralysed in 1996, from T12, which is my waist down and a complete injury. And before that in my previous life as I call it, I was a Travel Agent.
Emily Yates:Wow.
Michelle Donald:It was really something that I had never thought of. And then I went to see my psychologist at the spinal unit that I was at, who was amazing but it was an able bodied man. And I struggled, I struggled to talk to him. And then my partner and I had only been in a relationship four months before the injury. And we had the injury together, so to speak, where I was on the back of his motorbike, and he wasn't injured. And I was obviously, and so we have this new relationship that for us at the time, was highly sexual. And then all of a sudden, I was in a spinal unit for five months. At the time, it was a bit less, you know, you could actually, he could sit in my bed and kiss me and things like that. But, you know, there's no way you would be getting sexual in the hospital or I wasn't. Because I've just felt no, I couldn't possibly do that. So talking to my psychologist at the hospital just made me think, Wow, who can you speak to? and I started to search out sex therapists. I could find them. But nobody was, was comfortable, shall we say, with spinal cord injury, not only not comfortable, I couldn't get in anywhere. And I know this was 1996. And so we ended up seeing a relationship counsellor just because I could get into the therapy room, and there was just one step. And the issue I found with that was she she used to say and kind of pat me on the head and say, oh, Isn't it lovely he looks after you. And I was like, Oh my goodness, oh my goodness people, counsellors and psychosexual therapists really need to start thinking about disability. And I just could not find anyone. So I thought, right, that's it. I didn't like my job much before. So I thought, right. That's it. I'm so into my local Relate, and said, Look, I've got my British Airways exams, I've got everything you need in travel, but I really don't have a degree. And they said, Okay, well, you need a degree. Right? What do I do? So they, Relate Lancashire, took me on, and I started doing relationship counselling, which is absolutely the backbone to the work because obviously it is it is about a relationship. It's about what's going on. It's about how we form relationships, if we're not in them, how does that happen? You know, if we, you know, if we're in a relationship for nine months, and the next relationship's nine months, what's the pattern what's going on there? So that was the backbone of the work, so to speak, which is quite strange talking about spinal cord injury, but it was the backbone of the work that I do. And so I did that for three years to get my qualification with my diploma because I had to do voluntary work. And then I put myself through the Post Graduate Diploma to do psychosexual therapy after that, and when I put myself through the psychosexual therapy side of it, that's when it got quite interesting because I knew I wanted to work with disability, but I hadn't, I thought it was going to take quite a long time to establish, and then a consultant at one of the spinal units came over to me and with their head psychologist and said, We need you.. You're the only accredited psychosexual therapist with a spinal cord injury, and we really want you in our centre. So that's kind of how I became sort of specialist in spinal cord injury. So I did the kind of normal, if you can say that, work to get my psychosexual degree. And then after that, straightaway, I started specialising in spinal cord injury. So that was, that was a really big step for me and the spinal injury centre was a long way away from my home address, and then after that, it became a roller coaster because then one spinal centre said, Well, actually, can we have you and can we have you? So yeah, so from then on, so yes, to answer the question, absolutely. It was straight off the back of my disability because I found it really difficult to get help. And I do find that a lot of patients and clients come in and go, because sometimes they don't necessarily know or haven't read my background. They just know I specialise in a particular area and they go oh my god, you're in a wheelchair. And then sometimes that takes away. One guy, more than one guy, people have said to me, you know, it takes away the stress of having to talk about and tell you about our bowels and bladder, having to explain all my medications, having to explain hypersensitivity and what that feels like, having to explain spasms, shooting pains, all the different things that come with different neurological issues. And they're like, Oh, I'm so glad, you can see the relief on their face when they actually see my chair. Now, working on Zoom is very different. Because I'm used to that response. And people automatically seeing my chair, working on Zoom obviously it's my head and shoulders. So I've tried to find a way around that to enable people to know without actually having to say the words sometimes. So often, if I'll often leave my office door open. And when I get onto the zoom call, I'll say I'll just shut my door, so they can see I wheel to my door and close it. You know, it might not be that important. But I know for some people it is. So yeah, absolutely. It was my disability that led me down this path.
Jennie Williams:That's it. I mean, that's a massive thing for acquiring a disability and kind of going through that journey so quickly. Are there many other You's out there?
Michelle Donald:No, I'm, I'm just really, really trying to talk to people about do this, you know, I've hit my 50s and I'm going can we have some more people, please, because I kind of really want to retire in a few years. So no, not that specialising in the neurological side of things. There are able bodied people. And there are other companies. So, for instance, Spokez are amazing, and they have fantastic counsellors. They have so many people with so much experience about disability. So yes, there are people out there, but it's like having to come through Enhance and finding that because otherwise, how do you find it? If you go on the COSRAT website, which is the College of sex and relationship therapists, quite often I'm challenging this at the moment, quite often it doesn't specifically say what people specialise in. There are specialisms. But it's hard. And then it's harder to find that with people's places of work are accessible, which is so much better now, because of being able to do virtual calls. So a lot of people are doing this. I have a colleague, who actually now lives in France. And since COVID, and she does a lot of work with oncology. So as an oncology nurse, she's a sex therapist. So she's taken on some of my my overflow work. So Sue is getting a lot more work with spinal cord injury. And then obviously that that helps, because then she gets to know everything. And I'm, you know, I've taken on some of the oncology work with Sue. And so I asked her questions, and so we kind of get to know each other specialisms. There's a lady down in Brighton, who's amazing. And she's taken on some of my some of the tetraplegia clients that had when they wanted to see someone face to face. So she now has a little bit more expertise. So there are pockets of people that are picking up this expertise. But I would love, obviously a lot of these people, all of them are able bodied. I'm sorry, I hate the term but I'd really love the different people with different neurological issues could do this work. And I'm pushing it so much. So anybody who's out there that wants to do this, and you've already got a degree, go out and do it. It's two years psychosexual therapy course, especially if you're already in healthcare, and it's fabulous. There's about three different places you can actually do the qualification.
Jennie Williams:Em, don't think about it. You've got, I know! I can read your read your mind. Em's thinking oh, I've got a bit of spare time. At three o'clock in the morning on a Thursday for four hours. You have not got time to do this yet.
Emily Yates:Sounds so great, though doesnt it
Jennie Williams:You'd be brilliant at it Emily, to be fair, but not not yet.
Emily Yates:No, Yeah, you're right. You're right. Maybe in a few years, I'll I'll definitely hit you up Michelle, when the time comes.
Michelle Donald:You will be doing this.
Emily Yates:So I wanted to talk to you a little bit about this idea of therapy and vulnerability, shall we say? I think the two, when you think about therapy and this idea of baring all, I think this idea of vulnerability comes into the, into question if you like, and, and maybe worries people a little bit. And I thought it might be useful if you could take us through the process almost of what to expect as a client of yours. Is vulnerability the key to getting the best results? Or is it just really about learning more about yourself through the process, that is everything you need?
Michelle Donald:Wow, that's an absolutely fantastic question. Absolutely. vulnerability. And vulnerability is often where people start. And anybody that before the video calls, or anybody that came through my door, was was feeling embarrassed, vulnerable, scared. This is something that as culturally for many cultures, who, we don't often talk to our best friends about our sex life, nevermind a stranger. So I think it isn't just about the neurological side of things people going 'actually, because of this, I'm feeling more vulnerable.' I think as a whole. And not just as a nation, I think most people are feeling quite vulnerable when they when they enter that room, or they just make that phone call. So Wow, what a big step for so many people to enter that room. And I just admire and I think that's one of the most amazing things about the work is I admire, everyone that makes that call that walks through that door, wheels through that door, is just incredible. And so I know people are starting from a point of vulnerability more often than not, and if it's not one part of the couple, if the coin is a couple of it's not one part of the couple, it's the other. Someone's been dragged in, you're coming with me, we're going to do this. You know, I've just had, in fact, this week, I just had somebody who said right, he finds it really difficult to talk, I can't get him to open up on the spinal unit and said, Yeah, you might find it quite difficult to get some conversation, he's really quiet. Obviously, he finds it difficult to get word the words out anyway. And so it was quite beautiful. Because last night, I had a conversation with a couple. And she'd already said this, this can be hard. And so I said, Who initiates, who used to initiate before the issue that you have now, who used to initiate? And so I said his name, so he knew exactly who I was talking to, and said, and did you you know, what was it like when you initiate and when you initiated? What did you notice your wife doing? How did you know that she was receptive to that? And he said, bless him, he's fabulous. He said, Well, I'd take my trousers off and shake my willy at her. And she always said yes. How wonderful is that? And for somebody that had been described to me as somebody that didn't open up, how beautiful that was to have that description, and she just burst out laughing in the background. But okay, we know when we're going with this now, this is, this is straightforward. Erm, so yes, so there's, there's always that vulnerability in that. And sometimes when we talk about transference in counselling, sometimes you can really feel it when clients are absolutely terrified. And I think sometimes that vulnerability enables them to move forward with the work and hopefully I enable them to feel relaxed. I hope that and that's why I like to speak to people via a video platform, because I think it's important still to get that body language. What's happening for them, where's their smile. I often when I first started therapy, I used to have a thing on my wall that I'd look up and it would say smile, even in my like my educational things. Because I remember watching a lady at COSRAT at the College of sex and relationship therapist is one of my teachers and she used to smile all the time. And it just warmed me and I was like, oh, and so I think it's so powerful, being able to see people. And when they can see me and hear me I hope I don't you know I've always made it an absolute of mine never to have a desk between us. Never to have a pen and paper between us this is this is something that's intimate for them. And actually, if I'm going to start putting boundaries in our way, what does that say to them? So I think it's really important to be open with your clients. Now, some of my supervisors have challenged me on how open I am with my clients. And so you might ask about my vulnerability, I suppose. Where does it leave me being slightly open? But I found through experience, that if people ask me a personal question about my sex life, that I feel is acceptable, I mean, sometimes they might not be acceptable. There's that there's a line here,
Jennie Williams:We've been there Michelle, working with Enhance, trust us.
Michelle Donald:But I think I will disclose some personal information. And I will always have a rationale for why I'm disclosing that and how helpful it is to them. I won't disclose things that I, you know, just feel I'm disclosing for the sake of it. So after each session, for my own vulnerability, I will check in on myself, and I have a peer supervisor and a supervisor. So I will speak to them. And if they think I've gone too far, they will tell me, but I think now, after over 10 years of doing therapy, I feel quite competent in being able to open up, but some things still still might make my eyes well. And when people come into my room with that vulnerability, you know, some of the stories that people are telling me are so powerful. And I won't excuse myself, so to speak, if my eyes well up, I now say, don't worry about me, this is just me, this is sometimes what I do. So don't worry about me. But Wow. Because at the end of the day, we're human and it's about connection.
Jennie Williams:Well, you know, you've kind of inspired me, you're just talking about disclosing, and you've kind of inspired me to say something to you as well, when actually hopefully, our listeners can take on, I've actually recently been diagnosed with something called lichen sclerosis, which is an auto immune disease, but it's affected my my vagina. And it's changed dramatically the architecture of my vagina. And to the point where, I'm in a lot of pain. And I don't know if I'll ever happen to, we're at that point at the moment. And I'm going through this big process. And bear in mind, I work with Enhance the UK, I set up 10 years ago, this is what I do for a living. Yet, i am very much going through this kind of grieving process. I don't know whether I'm grieving it, because I don't know what the end journey is. But then, because I'm a proactive person, trying to do all the things. It's all the people, change all the cleaning products in my house, do everything that I can be, actually I'm leaving my partner 10 miles behind, because he's trying to catch up getting his head around this. And actually, it was today where I said to him, I think that we need to go to some counselling together. I think we need to do this together, because we apparently are miles apart in this journey. And I think, it's a really, really, big deal to make that decision to go because it's kind of admitting that you need that help. And it's not just about you, it's about your partner, and what you said about dragging someone in. I don't think I have to drag him kicking and screaming, but he's not holding my hand equally saying Come on, let's go through the door. But I've really made this big decision this week that I'm going. Nobody likes talking on a public forum about their vaginas or their penises, generally speaking, but actually, I feel like I need to take that responsibility. Start talking about it, because I am I'm at a stage where I feel really lost at the moment. And I would love to have somebody like you, Michelle, to know, you know, you said about seeing somebody else who's a wheelchair user, oh, my goodness, if I could find a therapist who also had Lycan sclerosis that could inspire me as well, and talk through, that would be an amazing, amazing thing. And maybe we can talk about it, off the podcast about how you could help point me in the right direction. But I think this it's amazing listening to you to speak out this and it always has been but now even more I'm so more so much more personally invested in it. So, but just to kind of wrap this podcast up really. Is there any kind of like final words of wisdom from you? That you could you could share with our listeners and us
Michelle Donald:Well as you just said, It's powerful. You've spoken to your partner. And often we're in different places at different times. But when we're in a relationship, it's about that other person as well as us. And we have to remember that they're going through it, as well. So it's so important to keep it couple based. It isn't anyone's fault. And I think that's what people come in to the room with. It's his fault. It's her fault, it's their fault. And I think one of the biggest things for me is keeping that equal for them as a couple. And for people that are coming to me on their own, and enabling them to have confidence, to be able to have conversations about things. And it is about and as you've just said, there, I think the biggest thing is communication. And sometimes we are in our patterns, we're already in those patterns. And sometimes that works for us, and sometimes it doesn't. So it's so powerful to go and see another person because a professional can elp us, to get out of that. It d esn't have to be a professional does it you know, with peers nd mentors, you know, they're so important. Like at the spina units and other neurologica centres, peers are just so important. And then they're the nes that will then talk to you. And if they feel that actuall, if you need more professional help then push it forward. So it is about finding someone, it's not about necessarily just goi g right, I need to find a pro essional, it's about finding som one that that has similar ssues. And as you said, not n cessarily the same issues, just omeone that might be able to ave an idea about what you're alking about. So for instance I've just started going through the menopause. And it's re lly made me reflect on th work that I've done before, an how, how, maybe when I was much younger, not having the same emp thy for the ladies that were going through their menopause, hat I have now. So I'm not say ng you have to have the same have been through the same thi g. But actually, it's reall important to find someone hat you feel you can relate to. So if you go and see someone, if you're not relating to them, end it there and then find som one else. Because you're spend ng your money on this, or y u're the NHS is spending mon y on it, or whoever it is that s ending money on it, you nee to know if you're not conn cting with that person, it's not going to magically happen.
Jennie Williams:That's really good advice. I mean, I know in the past, I've tried to find counsellors for various different different things, it's taken me quite a long time to find that right person, you know, and it might take 3,4,5,6 goes until you actually find that person. And my last question really is where, is there a certain website that you would advise people to go?
Michelle Donald:So the first place I advise people to go is the Enhance Love Lounge.
Emily Yates:Yay
Michelle Donald:but as in talking to people that that are similar to them, Backup mentors are amazing for spinally injured people. And there's different things for people with MS. So there's lots of different places that people with different neurological issues can go to, but the biggest places are COSRAT, the College of sex and relationship therapists. And so you can go through that website, it's quite easy to navigate to find a therapist in your area or a therapist that will do this online. And it does, they do have sections that they specialise in. There's also the Spokz site where they have counsellors but I think the COSRAT website would probably be the first place to look for your actual qualified psychosexual therapist. Yeah, otherwise, it's those specialist areas.
Jennie Williams:If there's anyone out there who is struggling and can't can't find a therapist, then please do get in touch with us. And we will maybe put you in touch with Michelle and we'll help guide you along your journey and try and hopefully match you up to the right person. But, EmI don't know if you've got any, any last words of wisdom on this as well?
Emily Yates:Just to say thank you so much to you, Michelle, that was so so insightful and so interesting. And you know, we joke about my interest in getting involved in absolutely everything but I think one thing that hopefully this podcast episode will have done is, not just help people who may be going through those struggles themselves, but hopefully people who want to also assist and help out and support in the best way possible. So, thank you. That was so great.
Jennie Williams:You're not allowed to retire yet Michelle. I'm sorry. We've got to squeeze a few more years out of you yet, you know, but thank you so much. Hopefully this won't be the last of our conversations on the podcast and we'll continue to have these conversations. And honestly without sounding ridiculously cheesy, Thank you for being my inspiration 10 years ago, you know, I've held you in such high regard and like I said, as I do continue to, it's absolutely true as all my all my team will tell you it's absolutely true. So, we will speak to you and see you again soon. Hopefully have a drink when we're all allowed.
Emily Yates:Thanks for listening. For more information or to have a chat with us, please visit enhancetheuk.org. From there, you can also sign up to our Undressing Dsxisability hub, a platform for professionals to connect and collaborate in the arena of sex and disability.