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The researcher’s personal experience, combined with the identification of the

occupational therapy profession’s past and present lack of attention to the


issue of sexual orientation, stimulated the decision to undertake this research,
which aimed to explore and understand the lived occupational experiences of
gay men and women. A qualitative approach was used, working within the
tradition of phenomenology. Five gay men and women participated in
unstructured interviews.
This research generated five themes, which provided insight into how sexual
orientation can affect the occupations and the environment that a person chooses
to engage in through heterosexism and fear of discrimination, prejudice and even
physical attack. In turn, this influenced where and to whom people ‘came out’
and where and with whom people socialised, and possibly prevented them
from engaging in occupations that they might either wish or feel they biologically
need to do. This could lead to increased stress, depression, reduced support
and occupational deprivation and alienation (Wilcock 1998), which may have a
further impact on occupational participation.
Research into how sexual orientation affects all client groups in differing
cultures is recommended. A focus on occupational deprivation and alienation
in gay people’s lives, including occupations such as parenting, could also be
further investigated, as could issues about socialising, discrimination, prejudice,
family dynamics and support. Therapists therefore need to have the awareness,
the willingness and the opportunity to consider sexual orientation within the
remit of occupational therapy theory and practice.

Sexual Orientation and Occupation:


Gay Men and Women’s Lived Experiences
of Occupational Participation
Rebecca Bergan-Gander and Heidi von Kürthy

Introduction individual places on his or her sexual orientation also varies


greatly. Just as people are individual, so is their sexual
Wilcock (1998) suggested that the term ‘occupation’ refers orientation. However, many definitions focus on the
to all purposeful human activity and that occupation is sexual activity component of sexual orientation, therefore
inextricably linked to health. Moreover, she suggested that overlooking its complexity (Jackson 1995).
occupation is essential to human life, that occupation has a Jackson (1995) highlighted the importance of sexual
positive influence on health and that occupational therapy orientation for the occupational therapy profession,
has the potential to be a health-promoting profession. asserting that sexual orientation is integral to the study of
Occupation is further understood to have various dimensions, occupations, has a place in occupational therapy and is a
including physical, social, contextual, spiritual (American core theme that affects occupations, their meaning and the
Occupational Therapy Association 1995) and sexual environmental opportunities and constraints for
(Couldrick 2005). Occupational participation occurs when participation in occupations.
individuals engage in these dimensions of occupation, which Planning effective, client-centred intervention requires
make up their daily lives (Townsend and Wilcock 2004). therapists to consider the many factors in people’s lives
Sexual orientation is also a complex phenomenon that contribute to who they are, what they like to do and
(Stronski Huwiler and Remafedi 1998). Its meaning is what they actually do. One such factor is sexual orientation.
culturally specific, context specific and, most importantly, Nevertheless, the profession is deficient in literature and
specific to the individual. Sexual orientation is not obvious research regarding sexual orientation (Kingsley and
or observable, unless disclosed by the individuals themselves Molineux 2000, Williamson 2000), whether heterosexual,
(Wilton 2000). The meaning, value and significance an gay, lesbian, transgender or bisexual.

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The noticeable lack of occupational therapy literature maintain the profession’s core philosophy through
regarding sexual orientation poses a problem if understanding how and why sexual orientation is important
occupational therapists are committed to providing to the study of occupation. This study further suggested
non-discriminatory, client-centred services (College of that various factors exist that can prevent the practice of
Occupational Therapists 2005). It certainly raises ‘authentic occupational therapy’ (Yerxa 1967, p1): the gap
concerns about the profession’s efforts to ensure in knowledge regarding sexual orientation, the lack of
occupational justice, where everyone has access to and relevant literature, the prevalence of heterosexist
is enabled to participate in meaningful occupations assumptions and the lack of understanding about the
(Townsend and Wilcock 2004). It could be argued that complex nature of occupation. In addition, the study
if gay people are deprived of or prevented from engaging asserted the need for further research: ‘Occupational
in occupations owing to their sexual orientation, they therapy as a profession must increase its understanding
are experiencing occupational injustice. Without the of the relationship between sexual orientation and
knowledge about how gay people experience occupation’ (Kingsley and Molineux 2000, p209).
occupational justice or injustice, occupational therapists The aims of the present study were:
are not in a position to work with them to promote 1. To explore participants’ experience of participation
health and wellbeing. in occupation
This qualitative study explored the lived experiences 2. To explore how participants felt that participation in
of five gay men and women’s participation in occupation. occupation might be affected by their sexual orientation.

Literature review Method


In a systematic review, Jackson (1995) highlighted that A qualitative paradigm based on the phenomenological
identifying oneself as being gay affects the kinds of tradition was employed to describe and analyse the
opportunities available in people’s communities. Despite individual’s life-world from the individual’s perspective
concerns about generalising findings to all gay people, the (Abercrombie et al 1994, Bannigan 2004). The use of
suggestion that occupational scientists must understand phenomenology, with its assumption that human
‘how certain … contexts enable or constrain persons … experience is complex and multifaceted (Hammell 2001)
in their attempts to pursue daily activities in the context and needs to be studied holistically and realistically
of their homosexuality’ (Jackson 1995, p672) is (Bannigan 2004), was considered to support the practice
particularly significant. Jackson (1995) also emphasised of client-centred occupational therapy and the very
how occupational therapists must recognise their clients’ essence of this research.
sexual orientation, if they are truly to understand their
nature as occupational beings. Participants
More recently, Jackson (2000) explored the perspectives Participants were selected purposely because they would
of lesbian occupational therapists working within be talking from personal experience about a topic that
non-inclusive occupational therapy clinics, which she they knew well and, therefore, would be motivated with
suggested created and maintained heterosexism through an incentive to participate (Morgan 1998).
heterosexual discourse, homophobic comments, assumed The snowball sampling method was used, whereby the
heterosexuality and perceived stereotypes. Jackson (2000) first participant was identified through a contact within
proposed that if these factors were more explicit, people the university and was asked to identify other potential
would be able to choose whether or not to participate in participants. Although this can provide an unrepresentative
this heterosexism, which she suggested affected both sample, it is especially advantageous when participants
therapists and clients. Again not generalisable, the wish not to be identified (Taylor et al 1996).
findings certainly prompt therapists to consider whether Five people – who identified themselves as being gay –
heterosexism exists within their work environments. As attended one interview each, lasting between 25 minutes
such, Jackson’s (2000) work justifies the need for an and 1 hour 15 minutes. Prior to the interview, willing
understanding of the actual, lived experiences of gay participants were sent a participant information sheet and
people, who may experience heterosexism. a consent form to sign. Participation was voluntary and the
Of considerable significance to this research was participants were told that they could withdraw from the
Kingsley and Molineux’s (2000) study, which used study at any point.
semi-structured interviews to explore the opinions of six
basic grade occupational therapists on working with Ethical considerations and consent
lesbian, gay or bisexual clients. The study emphasised the Given the topic, this study contained some potentially difficult
particular significance of sexual orientation as one of ethical issues. Various methods were used in an attempt to
many other significant factors that can influence what ensure that all participants would remain anonymous, that
people choose to do. Kingsley and Molineux (2000) confidentiality was maintained and that participants and
proposed that occupational therapists can help to researcher were safe throughout their participation.

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The School Ethics Panel recommended the use of the Ensuring rigour and trustworthiness
snowballing method; it was considered safer for the The researcher remained aware of the very strong risk of
researcher than the suggested use of an advertisement. research bias due to her personal experience. In order to
Prior to their providing written consent, an information minimise researcher bias, improve credibility and promote
sheet was sent to potential participants which outlined the trustworthiness, the researcher used the following: a reflexive
possible disadvantages and risks of taking part. The risks diary, to self-reflect continually and evaluate in order to
were considered to be minimal and related to the possibility validate the data (Lee 1993) and achieve credibility
of participants becoming distressed when talking about (Krefting 1991); supervision, to provide the opportunity
their own occupational experiences. Because of this, the for further reflection and non-biased critique of the research
participants were over the age of 18 years and were during each stage and to ensure that the data were reported
considered able to provide their informed consent; accurately; and member checking, where the participants
participation was also voluntary and could be terminated were given a transcript of their interview to confirm that
at the request of the participant. The people who agreed to this was an accurate representation of their views.
participate were provided with a written version of the first Triangulation of the data would have been ideal;
question, which was open-ended and intended to initiate the however, it was not possible owing to time constraints.
interview discussion. This presented the topic of discussion
in order that each participant had a clear understanding Data analysis
of what he or she would be required to talk about. Phenomenological thematic data analysis was deemed the
All data from the study were treated as confidential. most suitable method to analyse the meaning of the lived
The interview tapes were transcribed by the researcher experience of the participants. This method understands,
and both the tapes and the transcripts kept in a locked interprets and explains data through the process of
drawer, accessible only to her. Anonymity was ensured deconstruction, which reveals the meanings of the
throughout, with the use of identification numbers for phenomenon (Thomas 2000).
each participant. No demographic information (such as An eclectic approach to thematic analysis was taken as
age or income) was collected and any personally identifiable follows. The interviews were recorded on an audiocassette
information that might have indicated identity (such as tape and transcribed verbatim by the researcher. The
workplace) was omitted from the data. The raw data were participants were sent a copy of their transcript to confirm
destroyed after the completion of the research and all the accuracy. No changes were made as a result of this. The
data on computer file were deleted. transcripts were read several times while listening to
Finally, the study was reviewed and approved by the the tape to ensure accuracy, allowing the researcher to
University of Brighton’s School Ethics Panel. Ethical become immersed in the data and to gain a clear and
considerations were guided by the Department of Health’s deep understanding of each participant’s lived experience.
(2004) Research Governance Framework. Pertinent statements were highlighted on the transcripts
(Van Manen 1990). The highlighted text was compiled
Interview procedure and analysed to uncover meanings. The data were
The interviews were guided by a predetermined interview checked with the participants, who each confirmed
schedule and were introduced with the following question: these to be accurate.
■ I would like you to tell me about what you do in your The data were studied for commonalities and
everyday life. So for instance, in your work, your home differences in order to identify those elements that best
and your social life and how you feel that they are portrayed and described the participants’ experiences.
influenced by your sexual orientation. Themes were identified and these are presented as
The main body of the interview followed, during which the subheadings within the next section. It was intended to
researcher used prompts when the discussion decelerated, use member checking once the themes had been
for example, ‘You mentioned earlier … why is that?’ The identified, in an attempt to improve credibility. However,
researcher also prompted participants using more specific, owing to time constraints this was not achieved.
open-ended questions related to their occupational
participation. Some sample questions were:
– Have you experienced any difficulty in your everyday Findings and discussion
life because of your sexual orientation?
– Have you ever experienced a situation where you Five themes emerged from the data: socialising; needing to
wanted to do something but felt that you could not be, coming and being ‘out’; heterosexism; discrimination;
because of your sexual orientation? If so, please can and personal relationships. These are presented through
you describe it and say why you felt this way? the use of direct quotations (pseudonyms are used) and
– Have you ever felt that you needed to hide your sexual supportive interpretation.
orientation? If so, can you tell me about the last (or
most recent) time you did this? Socialising
– Is there anything else you would like to share regarding The aim of this research was to identify whether sexual
what has been discussed? orientation affected participation in occupation. Within

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this theme, evidence exists that sexual orientation has a of homophobia, Nicole mentioned that she herself
significant effect on participation in socialising. could be homophobic:
All the participants expressed that their sexual
I’m homophobic in that I just don’t like being in big
orientation influenced their participation in leisure and
crowds … when I’ve been in [place name] I’ve had
social occupations, particularly where they socialised and
aggravation from straight people outside, coming out of
with whom. Leo commented:
venues, and from people inside, and even from gay people
… Sometimes we will go to one or two of the local gay themselves. It’s just been … quite difficult I think, when
pubs. But we do mix with quite a varied group of people, I was coming out, and I think maybe I brought that sort
however … most commonly with gay couples. of with me.

When discussing the gay social scene, all the participants Such an experience is explained by Herek et al
mentioned that they had been or went to pubs and /or (1998), who argued that individuals can grow up
clubs intended predominantly for gay customers. internalising the heterosexism that permeates society.
Consequently, during the process of coming out, gay
Needing to be, coming and being ‘out’ people can experience negative feelings towards
This was a particularly significant theme discussed by all themselves or other gay people, termed ‘internalised
the participants. They had a mutual need to be ‘out’ and homophobia’ (Herek et al 1998). This can hinder
accepted, while simultaneously having a great awareness self-acceptance (Lesbian /Gay Community Service Center
of other people’s comfort with their sexual orientation: of Greater Cleveland 2004), causing higher levels of
depression, lower levels of self-esteem and less of a
I was reserved because I was unsure of how I would be
tendency to self-disclose sexual orientation (Cruise 2004).
accepted … through my life I suppose being gay has, that has
Emotional changes, such as depression, have been found
been difficult, being accepted has not been easy. (Libby.)
to have an impact upon occupational performance
I was out to my Area Manager, only because I knew that he (George et al 2001); depression can impair cognitive
was gay as well. (Alistair.) function, which contributes towards people’s competent
and satisfactory functional ability (Gardner 2002).
Coming out is a process that occurs in stages, whereby
an individual accepts his or her sexual orientation,
Heterosexism
consequently develops a sexual identity and sense-of-self
Three of the five participants experienced heterosexism,
(MacEwan and Kinder 1991) and then reveals this to
where it was assumed that they were heterosexual.
others (Rankow 1997). The participants’ descriptions of
Cate remarked:
the process, experience and consequences of coming out
were very similar; four of them described it as being either People tend to make assumptions that you’re straight, unless
‘difficult’ or ‘hard’: you tell them otherwise.

I did have a hard time sort of coming out; a lot of my friends Alistair described three separate occasions when he
were straight and they just did not want to know, and I lost a experienced heterosexism: once while he was at university
lot of friends. (Nicole.) and twice while he was at work:
There was a little bit of distance between us, when they first I used to work with clients and their families, you know?
realised, or found out, that I was gay. That made things And a lot of the parents, they often automatically assumed
difficult … (Cate.) that I was with a girl. And you know, why shouldn’t they?
You know? Or possibly engaged, or possibly married …
Herek and Capitanio (1996) explained that the need to
come out occurs because the process of coming out to friends Alistair went on to describe his experience of heterosexism
and family appears to reduce prejudice, as highlighted by at work or productivity as making him feel:
the following quote:
… out on a limb … a bit strange … (and) a bit odd.
I feel really quite secure within my own role here …
Enduring heterosexism can lead to psychological
everyone knows that I am a gay woman and they’re really,
distress, including decreased self-esteem (Garnets et al
really happy for me, for my life sort of thing, which I am
2003). Garnets et al (2003) recommended coming out as a
grateful for … I find that makes work a little bit more easy
means of overcoming any such threats to psychological
and, I’m sure if it would be the other way round, difficulties
wellbeing. Arguably, in doing so, further stress may be
would arise; I’m not sure I would feel so, so great about
created and consequently experienced by gay people, due
coming to work, and enjoy my work. (Nicole.)
to constantly having to reveal their sexual orientation to
Sherrod and Nardi (1998) also inferred that coming others (Rankow 1997) as they participate in work or
out was necessary to reduce the prevalence of heterosexism leisure activities. Straight occupational therapists need to
and homophobia within society. However, for Nicole, be aware of their own assumptions with regard to sexual
being out contributed to her experience of homophobia. orientation in order to prevent heterosexist behaviour
As the only participant specifically to report the experience with both colleagues and clients.

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Discrimination might get going to school … other children and parents
The impact of the concerns about discrimination, prejudice finding out that the child has two mothers and came from a
or a lack of understanding, related directly to the participants’ gay family. So, it’s made us think very carefully about what
sexual orientation, was frequently reported: we do and whether we should do it … it’s made it quite
difficult for us to actually make a choice, because there’s so
… having to you know sort of deal with other people’s
many different things to consider.
prejudices and how I fitted into that … that made quite
an impact on how confident I felt… I held back because Here the concern is not only the possible prejudice of the
I didn’t want any more prejudice. (Libby.) medical profession, but also the future stigma for the
child. Throughout history, women have traditionally
I feel quite different … there are some quite deep-set
followed child-raising occupations (Wilcock 1998).
negative views, which can take a great deal of time to
By not doing so owing to cultural constraints
dispel. I hear the term ‘homosexual’ rather than ‘gay’ a
occupational deprivation may occur, which could in
great deal at work, which seems a good way to illustrate
turn result in ill-health (Wilcock 1998). Additionally,
me the rather ‘clinical’ way that people perceive, what
social values that suggest that gay women should not
they might see, as my ‘problem’. (Leo.)
have children may promote the women to feel estranged
Every participant mentioned his or her work from the nature of the human species and this, in turn,
colleagues’ potential and /or actual attitudes and reactions may result in feelings of alienation towards self and
to his or her disclosed sexual orientation. In Alistair’s case, others (Wilcock 1998).
his manager explicitly warned him that it would limit his
career progression:
Personal relationships
I mean it was her opinion that it wouldn’t necessarily help me All the participants commented on how they felt that
as a professional if I was to progress further … I shouldn’t, for their sexual orientation had an impact upon relationships
instance, disclose things like that … she actually thought that with friends and particularly with family. Moreover,
I shouldn’t put things on [an application form] like working the attitudes and acceptance of parents regarding them
on [a] Gay Switchboard, you know? Because it might have and their sexual orientation appeared to have a
implications in terms of who reads my application form. significant effect:
Prejudice linked with the first theme regarding social I don’t even think my parents knew I was gay at that point.
occupations. Here Nicole reports her experience of a pub So it was very sort of, you know, sort of, I didn’t have the
in a geographical area where she asserted that she would same support. (Libby.)
never disclose her sexual orientation for fear of being
My whole family is very straight basically, which has been
physically attacked:
quite hard, in that respect. (Nicole.)
… the homosexual factor: they’ve stuck it in the furthest
Loss or withdrawal from pre-existing relationships
pub they could find … So, you go there for a few beers, you
denies people access to the support and reassurance that
can’t drive obviously, so you’ve got to get a taxi; and the taxi
they can potentially provide. Kavey (2004) reported
man gives you loads of hell because you must be queer,
that the consequence of a gay person’s family relating to
because you’ve gone to this only gay pub.
him or her with fear, silence and /or denial is that he
These limiting and detrimental effects of both perceived or she may experience pain and alienation. This
and actual prejudice and discrimination in relation to sexual experience has implications for client /family-centred
orientation are of vital interest to health care professionals occupational therapy, which values the importance of the
(O’Rourke et al 2002). Finding that the participants have opinions of the client /family, the client’s right to
concerns about discrimination and prejudice, and that this occupational choice (Law et al 1995) and the impact of
affects their participation in occupation, further demonstrates the client’s environment upon his or her occupational
their experience of occupational injustice, which Townsend performance (Rebeiro 2001, Hoppes et al 2003).
and Wilcock (2004) suggested researchers should explore. Therapists need to be aware that people may not have
Townsend and Wilcock found that occupational justice social or familial support and the associated result of
was understood as ‘no discrimination based on ability, age, this when engaging in occupations (Kielhofner et al
or other factors’ (2004, p78). Therefore, the participants’ 2002). That said, both Cate and Alistair commented
experience of discrimination based on their sexual that their relationships with their families had improved
orientation is understood to be an occupational injustice. with time and growing acceptance. Additionally, Alistair
A further example of perceived discrimination follows, said that this had had an impact upon his relationship
where a participant felt that her sexual orientation directly with his partner:
influenced her choice of becoming a mother:
Our families … have all been very supportive. Obviously, a
… we’ve considered having children … but there’s various bit difficult at first, as always … both families have been very,
things to consider … the way the medical profession might very positive about us and … that’s helped a lot, helped our
assist us and react to us, and also the reaction that children relationship with them, and each other.

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Limitations of the study Future research priorities
The rationale for this study stemmed primarily from the The occupational therapy profession would benefit
researcher’s personal experience. As a gay woman, she from continued research into how sexual orientation
believes that her sexual orientation has directly affected affects occupational participation with all client groups,
her experience of, and participation in, occupation: a core including bisexual, straight, gay (men and women),
aspect of people’s experience and existence (Wilcock transgender, older people, child and adolescent. Such
1998, Foster 2002). This established the study’s three evidence would challenge constructively the therapists
core domains of inquiry: occupation, participation and who perhaps do not consider sexual orientation to be
sexual orientation. within the domain of occupational therapy.
Despite lengths taken to improve the trustworthiness Nationwide and worldwide research of the
of this study, researcher bias has had a significant impact experiences of gay men, gay women, and transgender
on the method and results of this study, particularly in and bisexual people should continue to highlight
relation to the difficulties associated with being gay and important occupational issues that they may experience
engaging in occupations. Certainly, first-hand experience – as a result of their sexual orientation – in different
influenced the opening interview question. It is therefore geographical areas or cultures.
acknowledged that the five identified themes may not Research could focus on the issues highlighted about
have emerged if this had not been asked so directly. occupational deprivation and alienation in gay people’s
Additionally, the research would have benefited from lives, including occupations such as parenting. The issues
more stringent member checking, peer review and about socialising, discrimination, prejudice, family dynamics
triangulation of data, possibly using focus groups. and support could also be investigated further.
In an attempt to anonymise participants, no descriptive
information was collected; for example, age, ethnicity,
employment or hobbies. It is recognised that these data Conclusion
may have enhanced the results. However, perhaps future
research of a more quantitative nature could collect this This research has generated insight into how sexual
type of information; certainly, anonymity would be more orientation can affect the occupations and the environment
easily protected in a larger study. that a person chooses to engage in through heterosexism
and the fear of discrimination, prejudice and even physical
Recommendations attack. In turn, this influences where and to whom people
The findings of this research introduce the importance of come out and where and with whom people socialise,
sexual orientation to occupation and, therefore, to and possibly prevents them from engaging in occupations
occupational therapy professional practice. The findings that they may either wish or feel they biologically need to
therefore urge occupational therapists to be aware of a do. This could lead to increased stress, depression,
client’s sexual orientation, how this affords and restricts reduced support and occupational deprivation and
his or her occupational behaviour and how this in turn alienation (Wilcock 1998), which may have a further
affects him or her as an occupational being. This will impact on occupational participation.
require occupational therapists to ask clients about their The participants’ evident awareness of the above portrays
sexual orientation – where appropriate – and how this them as very aware occupational beings. This demonstrates
affects their participation in occupation. Occupational the potential for a truly beneficial client-centred and
therapy interviews and assessments also need to contain therapeutic relationship, where clients can be encouraged
questions about sexual orientation and occupation. This is to identify their occupational needs and injustices with a
in order that therapists can work with their clients to well-informed and understanding therapist. Therapists
enable and empower them, to identify potential barriers therefore need to have the willingness and the opportunity
that affect their occupational behaviour, through an to consider sexual orientation within the remit of
understanding about the impact of sexual orientation occupational therapy theory and practice.
on occupation. Importantly, therapists should be aware
that gay sexual orientation and sexuality can promote Acknowledgements
many feelings that inhibit or restrict occupational This study was undertaken in part fulfilment of an MSc in Health Through
behaviour and that, through their understanding of the Occupation at the University of Brighton in 2005. The researcher would
effect of occupational deprivation and alienation, they especially like to thank the five people who participated in this research
can work with clients to remediate this. and who gave their time to talk about their experiences. She also wishes to
Certainly, as this research recognises, the degree of express her thanks and appreciation to Dr Gaynor Sadlo; to the two
importance that sexual orientation has for people varies anonymous BJOT article reviewers; and, of course, to Louise. The second
greatly. Thus, to perform this duty, therapists must author would like to thank David Haines for his interest and advice.
understand sexual orientation as one of many factors
contributing to people as occupational beings that References
may affect their lived experience of participation Abercrombie N, Hill S, Turner BS (1994) The Penguin dictionary of sociology.
in occupation. 3rd ed. London: Penguin.

British Journal of Occupational Therapy September 2006 69(9) 407

Downloaded from bjo.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 4, 2015


American Occupational Therapy Association (1995) American Occupational Krefting L (1991) Rigor in qualitative research: the assessment of
Therapy Association: Position paper: Occupation. American Journal of trustworthiness. American Journal of Occupational Therapy, 45(3),
Occupational Therapy, 49(10), 1015-18. 214-22.
Bannigan K (2004) Finding meaning (or what is qualitative data?) Mental Law M, Baptiste S, Mills J (1995) Client-centred practice: what does it mean
Health Occupational Therapy, 9(2), 55-56. and does it make a difference? Canadian Journal of Occupational
College of Occupational Therapists (2005) College of Occupational Therapy, 62(5), 250-57.
Therapists: Code of ethics and professional conduct. London: COT. Lee RM (1993) Doing research on sensitive topics. London: Sage.
Couldrick L (2005) Sexual expression and occupational therapy. British Lesbian/Gay Community Service Center of Greater Cleveland (2004)
Journal of Occupational Therapy, 68(7), 315-18. Internalized homophobia. Cleveland, OH: The Lesbian/Gay
Cruise K (2004) Effects of age of self-identification, age of disclosure of Community Service Center of Greater Cleveland. Available at:
sexual orientation, and perceived social support on self-esteem in gay http://www.lgcsc.org/internalized.html Accessed on 28.07.05.
and lesbian youth. Journal of Young Investigators, 10(1). Available at: MacEwan I, Kinder P (1991) Making visible: improving services for lesbians
http://www.jyi.org/volumes/volume10/issue1/articles/cruise.html and gay men in alcohol and drug treatment and health promotion.
Accessed on 27.07.05. Wellington, NZ: Alcoholic Liquor Advisory Council.
Department of Health (2004) Policy and guidance: Research governance. Morgan D (1998) Planning focus groups: focus group kit 2. London: Sage.
Available at: http://www.dh.gov.uk/PolicyAndGuidance/ResearchAnd O’Rourke A,Adams N, Middleton R,Wishart G (2002) Evaluating the integration
Development/ResearchAndDevelopmentAZ/ResearchGovernance/fs/en of values into practice. Available at: http://www.dementiaplus.org.uk/
Accessed on 09.01.05. library/regionalpapers/valuesprojectreport.htm Accessed on 29.07.05.
Foster M (2002) Theoretical frameworks. In: Turner A, Foster M, Johnson SE, Rankow EJ (1997) Primary medical care of the gay or lesbian patient.
eds. Occupational therapy and physical dysfunction: principles, skills North Carolina Medical Journal, 58(2), 92-96.
and practice. Edinburgh: Churchill Livingstone, 47-81. Rebeiro KL (2001) Enabling occupation: the importance of an affirming
Gardner M (2002) Cognitive approaches. In: J Creek, ed. Occupational therapy environment. Canadian Journal of Occupational Therapy, 68(2), 80-89.
and mental health. 3rd ed. London: Churchill Livingstone, 227-44. Sherrod D, Nardi PM (1998) Homophobia in the courtroom: an assessment
Garnets LD, Herek GM, Levy B (2003) Violence and victimisation of lesbians of biases against gay men and lesbians in a multiethnic sample of
and gay men: mental health consequences. In: LD Garnets, DC Kimmel, potential jurors. In: GM Herek, ed. Stigma and sexual orientation:
eds. Psychological perspectives on lesbian, gay, and bisexual experiences. understanding prejudice against lesbians, gay men, and bisexuals:
2nd ed. New York: Columbia University Press, 188-206. psychological perspectives on lesbian and gay issues. Volume 4.
George S, Wilcock AA, Stanley M (2001) Depression and lability: the London: Sage.
effects on occupation following stroke. British Journal of Occupational Stronski Huwiler SM, Remafedi G (1998) Adolescent homosexuality.
Therapy, 64(9), 455-61. Advances in Pediatrics, 45, 107-44.
Hammell KW (2001) Using qualitative research to inform the client-centred Taylor P, Richardson J, Yeo A, Marsh I, Trobe K, Pilkington A (1996)
evidence-based practice of occupational therapy. British Journal of Sociology in focus. Ormskirk, Lancs: Causeway Press.
Occupational Therapy, 64(5), 228-34. Thomas DR (2000) Collecting and analysing qualitative data. Auckland, NZ:
Herek GM, Capitanio JP (1996) ‘Some of my best friends’: Intergroup contact, University of Auckland. Available at: www.health.auckland.ac.nz/hrmas/
concealable stigma, and heterosexuals’ attitudes toward gay men and collectingdata.htm Accessed on 17.11.04.
lesbians. Personality and Social Psychology Bulletin, 22(4), 412-24. Townsend E, Wilcock AA (2004) Occupational justice and client-centred
Herek GM, Cogan JC, Gillis JR, Glunt EK (1998) Correlates of internalised practice: a dialogue in progress. Canadian Journal of Occupational
homophobia in a community sample of lesbians and gay men. Journal Therapy, 71(2), 75-87.
of the Gay and Lesbian Medical Association, 2(1), 17-25. Van Manen M (1990) Researching lived experience: human science for an
Hoppes S, Davis LA, Thompson D (2003) Environmental effects on the action sensitive pedagogy. London: Althouse Press.
assessment of people with dementia: a pilot study. American Journal Wilcock AA (1998) An occupational perspective of health. Thorofare, NJ: Slack.
of Occupational Therapy, 57(4), 396-402. Williamson P (2000) Football and tin cans: a model of identity formation
Jackson J (1995) Sexual orientation: its relevance to occupational science based on sexual orientation expressed through engagement in occupation.
and the practice of occupational therapy. American Journal of British Journal of Occupational Therapy, 63(9), 432-39.
Occupational Therapy, 49(7), 669-79. Wilton T (2000) Sexualities in health and social care: a textbook.
Jackson J (2000) Understanding the experience of noninclusive occupational Buckingham: Open University Press.
therapy clinics: lesbians’ perspectives. American Journal of Occupational Yerxa E (1967) Authentic occupational therapy. American Journal of
Therapy, 54(1), 26-35. Occupational Therapy, 21(1), 1-9.
Kavey KE (2004) What we wish we had known: breaking the silence,
moving toward understanding: a resource for individuals and families. Authors
5th ed. New York: Presbyterian Church of Mount Kisco. Rebecca Bergan-Gander, BSc(Hons), MSc, Occupational Therapist,
Kielhofner G, Borell L, Freidheim L, Goldstein K, Helfrich C, Jonsson H, South Downs Health NHS Trust, Occupational Therapy Department,
Josephsson S, Mallinson T, Nygård L (2002) Crafting occupational life. Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE.
In: G Kielhofner, ed. Model of human occupation: theory and application. Email: rebecca.bergangander@southdowns.nhs.uk
3rd ed. Philadelphia: Lippincott Williams and Wilkins, 124-44. Heidi von Kürthy, Senior Lecturer/Admissions Tutor, MSc Health
Kingsley P, Molineux M (2000) True to our philosophy? Sexual orientation Through Occupation, University of Brighton, Robert Dodd
and occupation. British Journal of Occupational Therapy, 63(5), Building, 49 Darley Road, Eastbourne BN20 7UR.
205-10. Email: h.vonkurthy@brighton.ac.uk

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