Trigger warning for conversations around consent, including minor consent violations

Sexual Behaviorism

My work as a sexual behavior specialist for adults with intellectual disabilities. That means that I work with clients to help them make healthy behavior changes within the realm of sexual needs.

Okay, so…what does that mean?

Behaviorists believe that every behavior has a cause. No action appears out of the blue. We can’t change people’s behaviors just by teaching them to do things differently, or by punishing/rewarding various behaviors. We have to change the events that lead to a behavior. Only then will the behavior change on its own (or with some retraining).

So how does behaviorism tie in to sexual needs?

Well, ‘sexual needs’ is a pretty big umbrella! My clients may need help with forming or keeping romantic relationships, processing sexual trauma, or healthily expressing sexual needs or desires. They may exhibit unsafe sexual behaviors or be resistant to health care. Some of my clients throw tantrums or flip chairs when their friends don’t pay attention to them. Some of them are cruel to their staff, and some obsess over their romantic partners. Any unsafe or unhealthy behavior that relates to social interactions or sex are behaviors that I can help them with.

Most of my clients live in homes with staff members or family who care for them. They’re independent to some extent but wouldn’t be able to live fulfilling lives as adults without support. Even still, about half of my clients either have or want romantic or sexual partners.

Intellectual Disabilities and Consent

One question that a lot of people ask me is “how do people with intellectual disabilities consent to sex?”

We know that all consent must be FRIES:

freely given,

revocable,

informed,

enthusiastic, and

specific.

How can people consent to sex if their cognitive ability presents them from being entirely informed about risks and consequences? What if they have difficulties communicating, and don’t have the ability to verbalize what kinds of sex they’re consenting to?

The lens we need to look through is that all consent must be FRIES to the best of our ability.

If L knowingly lies about their STI status to a partner, the partner may say yes to sex without barriers. The ‘informed’ quality of FRIES consent has not been met. They are not informed about all the factors of the sex that they consented to. L is violating their partner’s consent. But if someone has an STI and doesn’t know about it – maybe it’s too early for it to have shown up on a blood test, or another partner lied to them about test results – and they tell their partner that they don’t have an STI, then they have met FRIES consent to the best of their ability. That’s the most we can generally look for.

My clients may be cognitively unable to remember all the safer sex information that I’d consider ‘the bare minimum’ to practice safer sex. They might not have the communication tools to look for specific consent. But, as long as their consent is enthusiastic (or explicit), freely given, and revocable, then the ‘specific’ and ‘informed’ factors, both of which rely on cognitive ability that my clients may not have, don’t signal sex as a deal breaker.

Okay, now I’m going to pull back from the academic and get to the concrete:

Just because my clients have cognitive delays does not mean that we, their staff, can forbid them from accessing their sexuality. That access is one of their human rights.

If my clients want to have sex with someone else, and that someone else wants to have sex with my client, then we have (almost) no right to forbid them from having sex with each other.

The purpose of FRIES consent is to make sure that all participants in a sexual encounter want to be having exactly the sex that they are having. If my clients, to the best of the cognitive and verbal ability, tell me that they want to have sex with someone, I have to honor that. They have the right to have sex, if they want to.

What Can I Do?

Now, I’m a sexuality specialist. I’m certainly not going to just give them the thumbs up and shoo them off to the bedroom. If my client tells me that they want to have sex, I’m going to come in and have a meeting before their planned date. Maybe several meetings.

I might advise them to not quickly jump into bed with a new partner – but I will remind them, repeatedly and clearly, that they are adults and get to make their own choices – I’m just here to help.

Or I might teach them about over-the-counter contraceptive methods or get their house manager to set up a doctor’s appointment for prescription contraceptives.

I might ask them why they want to have sex with their partner.

I’ll discuss STI prevention.

We’ll talk about communicating verbal and non-verbal consent with their partner (Like, “if he moves away from you, you should stop touching him and ask what he wants”).

I will do my best to get them to a point where they have more information than they did previously.

Sometimes, I’ll meet with a client and their partner at the same time. These meetings are usually less productive because they are embarrassed to be talking explicitly about sex in front of each other. They can handle it with a stranger (me), but there’s something horribly intimate about talking about sex that even most people with typical cognitive development can’t handle. It takes self-control to make yourself talk about things like STIs and consent with a partner, and my clients don’t always have that ability.

If my clients have had sex in the past, I’ll ask them if they liked it, and what they liked about it. I’ll try to prepare them to replicate the parts that they liked, and how to not repeat the parts that they didn’t like.

If my clients say anything that indicates to me that their interest in sex is non-enthusiastic or that they were badgered or coerced, I’ll have a meeting with my client and their house manager and work out an action plan. Usually, my client will ask staff to make it so they’re never alone with their partner which is easy enough to arrange. We can’t force them to break up with their partners. Many of them like the dating experience but aren’t confident that they could resist sexual pressure in person.

So whether I have a client who wants to have sex or is already having sex, I just do the best that I can do to make sure that they’re prepared for the risks of sex, and that they want to be having the sex that they’re having.

When Consent Isn’t Consensual

Occasionally the consent of one of my clients is called into question if they’re dating someone who does not have an intellectual disability. Because my clients may be easy to manipulate, we need to make sure that (if their partner isn’t diagnosed with an intellectual disability) that they aren’t being manipulated into having sex by someone who only wants to be with them for sex or power (as opposed to a healthy relationship). What I’ve found in these circumstances is that my clients’ partners often also operate with cognitive delays, but not severely enough to be labeled with a diagnosis of ID, or likely were never tested for ID. They have a lot in common with my clients and enjoy the relationship for similar reasons, like companionship, intimacy, and affection. When this happens, I don’t feel concerned that they’re being taken advantage of for sex or power.

The one situation in which caretakers can forbid adults with intellectual disabilities from having sex is if those adults were declared mentally incompetent/incapacitated by the legal system. It’s a very high bar. An evaluation would need to show that the person is entirely unable to participate in their own care and well-being. If a person’s cognitive ability is such that they are declared mentally incompetent, it’s common that they are also unable to meaningfully consent to sex. They may have partners and go on dates, but any activity that involves genitals is beyond their ability to consent to and is therefore off the table.

One residential facility where I worked had a ‘sexual consent test’ of sorts. Upon admission to the facility, individuals would be asked a series of questions such as,

• How do you prevent pregnancy?
• What parts of the body do you use to have sex?
• Can you name a sexually transmitted disease?
• Can you name the body parts on this figure?

From that test, it was determined whether or not this individual could meaningfully consent to sex. When two people were deemed able to consent, they could have sex with each other. Any other relationships could not involve sex.

The folks who can’t answer the questions don’t generally understand exactly what sex is. We focus more on what behaviors are appropriate for public and private, how to treat other people in positive ways, and how to stay safe around strangers. If we discuss masturbation, it is always in positive terms that emphasize the enjoyment and privacy aspects of masturbation. But, most folks that I work with who don’t know how sex works are also uncomfortable at the idea of touching their own genitals for anything other than hygiene. It’s undoubtedly bourn from having parents or guardians with terrifiedly sex-negative perspectives.

I believe that a handful of the folks who don’t have enough information to pass a ‘sexual consent test’ could be given tailored sex-education lessons. There, they can learn more about the risks and factors involved in sex, and be able to someday meaningfully consent to sex. The rest, however, don’t have the cognitive ability to retain information about something so complicated as sex.

That’s not the most common kind of client that I have. Most of my clients can consent to sex. It may not be the exact kind of consent that I look for in my clients with typical cognitive development. But, they make clear that they want to be having the sex that they’re having. They are enthusiastic and uncoerced and very specific about what they want. From there, I can support them and educate them and process with them. I can help them to live their most successful and healthy sexual lives.

Galia Godel is a Philadelphia-based sex educator and behaviorist. She has an M.Ed in Human Sexuality and works as a sexual behavior specialist for adults with intellectual disabilities. Galia also works as a communication coach and focuses on explicit verbal communication and structured conversations. She lives in a medium-sized house with her five-person polycule, two cats, and one dog. You can read more of her writing at her site, Cerebral Sexuality, and follow her on Twitter.