Aptitudes and Attitudes among Licensed Professional Counselors Regarding Human Sexuality and Sexual Counseling in Puerto Rico: An Exploratory Study A Dissertation Submitted to the Faculty of The American Academy of Clinical Sexologists In Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy Clinical Sexology By Orlando García Colón, MPH, MFC, LPC Orlando, Florida May 2017 I © Copyright by Orlando García Colón, MPH, MFC, LPC. 2017 All Rights Reserved II III Abstract The purpose of this study was to explore the aptitude and attitude exhibited by a group of Licensed Professional Counselors in Puerto Rico regarding human sexuality and sex counseling. Descriptive data was gathered by a self-administrated questionnaire. Out of the 100 counselors that were invited to participate, 64 accepted the invitation. The sample group (N=64) was recruited according to their availability. Due to the size of the sample the results do not reflect the reality of all professional counselors in Puerto Rico. The participants were asked to answered basic socio-demographic questions. Almost half of the sample group was composed by Guidance Counselors. Majority of the participants were women with more than 15 years of experience in the field and who worked in the public education system. The level of knowledge was measured by two factors; previous education on sexuality and by the results obtained on a self-evaluation exercise using a Likert scale. The instrument included 22 basic concepts related to sexuality. More than half of the respondents (56%) answered they had taken a course on human sexuality. The present results indicated that 49% of the sample considered that they had a high or very high level of knowledge concerning human sexuality. In this study attitude was defined as a learned manner or disposition to approach and evaluate a situation or a subject. In this case, 83% of the sample was willing to improve their education on human sexuality and 56% was willing to intervene on cases involving sex counseling. Therefore, the investigator concluded that in general, professional counselors in Puerto Rico exhibit a positive attitude toward human sexuality and sex counseling. IV It was also found that the most common topics that counselors were willing to intervene included; contraceptive methods, female and male reproductive systems and sexually transmitted infections. All these subjects are commonly found in medical books rather than in counseling books. On the contrary, some of the topics they were most likely to refer were; psychogenic female and male sexual dysfunctions, fetishes and paraphilias. These subjects are usually found in counseling books. These results combined with the fact that almost one-half of the participants (47%) studied human sexuality at bachelor’s degree level, suggests that the type of knowledge that they demonstrated was must likely learned in sex health classes rather than sexuality counseling courses. This finding suggests that the knowledge participants reported was learned from a biology point of view rather than from a counseling perpective. Further investigations are therefore recommended. V Vita Orlando García, MPH, MFC, is a licensed professional marriage and family counselor, a certified sex educator and sex therapist in Puerto Rico. He completed his Master’s Degree in Public Health at the Graduate School of Public Health, Medical Science Campus of the University of Puerto Rico. He obtained his human sexuality education certification from the Professional Studies Division of the University of Puerto Rico. He earned his second Master’s Degree in Marriage and Family Counseling at the Central University of Bayamon, P.R. and later attained a sex therapist certification from the Carlos Albizu University, San Juan Campus. Currently, he is a candidate for the degree of Doctor of Philosophy in Clinical Sexology from the American Academy of Clinical Sexologists. His professional history includes working for the Puerto Rico Health Department Ryan White II Program, San Juan, P.R. as a program evaluator. He has also worked as a research interviewer on various investigations at the Behavioral Science Research Institute, Medical Science Campus of the University of Puerto Rico. Currently, he is an adjunct professor of professional counseling and human sexuality at Central University of Bayamon, P.R. and active member of the Asociación Puertorriqueña de Educadores, Consejeros y Terapeutas Sexuales (AsPECTS) (Puerto Rican Asociation of Sex Educators, Counselors, and Therapists). VI Dedication To all licensed professional counselors who dedicate their lives to promoting good mental health in Puerto Rico. But specially to those who always aspire more, those who seek growth as professionals and as individuals. But especially to those counselors who demonstrate interest in human sexuality and sex counseling. VII Acknowledgements I would like to extend my deepest appreciation to all the people that in one way or another contributed to making this study possible. And I would like to give special thanks to my Dissertation Committee; Dr. Carmen Várcarcel-Mercado, Dr. William Granzig and Dr. Karla Narvaez, for their guidance, support and trust. I am especially grateful to Dr. Várcarcel-Mercado for accepting being chairperson of my committee, and for her time and encouragement. I would also like to acknowledge and thank the people who helped me validate my research instrument. Dr. Waldo Sánchez, Dr. Myrian Guadalupe, Dr. Karla Narvaez, Dr. Agnes Ferrer and Ms. Yamilet Arroyo and to Dr. Idania Rodríguez for her contribution to the SPSS data program and analysis. Also, I would like to thank Mr. Cutberto Camacho and Ms. Amnerys Colón for their technical assistance and the five graduate counseling students who anonymously participated in the pilot test to validate the questionnaire. I would also like to recognize and thank the participants. Without their willingness and thirst for knowledge this investigation would have never been possible. Thank you all. VIII List of Tables Table 1 – Socio-demographic Characteristics of Professional Counselors …………………….42 Table 2 – Knowledge and Willingness to Have Further Studies in Human Sexuality …………43 Table 3 – Level of Knowledge About Human Sexuality Concepts …………………………….44 Table 4 – Intention to Refer or Intervene on Cases Regarding Human Sexuality ……………...48 Table 5 – Intention to Receive Training Regarding Human Sexuality …………………………51 Table 6 – Chi Square Test of Level of Knowledge Among Counselors by Selected Characteristics ……………………………………………………………………….56 Table 7 - Chi Square Test of Level of Knowledge Among Counselors by Years of Experience ………………………………………………………………………...…57 Table 8 – Chi Square Test Willingness to Refer or Intervene in Cases Among Counselors by Selected Characteristics ……………………………………………...58 Table 9 – Chi Square of Interest in Receiving Training About Human Sexuality Concepts Among Counselors by Years of Experience ………………………………59 Table 10 – Chi Square Test of Interest of Counselors for Hours of Training by Category of Interest to Take a Full Course in Counseling on Human Sexuality ……………………………………………………………………………..60 Table 11 – Chi Square Test of Interest of Counselors for Hour of training by Category of Interest to Take a Certificate on Human Sexuality …………………….61 Table 12 -Chi Square of Interest of Training by Category of Interest to Obtain an Academic Degree on Human Sexuality ……………………………………………....61 Table 13 – T-test results of Selected Categories and Concepts ………………………………..62 IX Table of Content Copyright Page ……………………………………………………………………………III Abstract …………………………………………………………………………………...IV Vita ………………………………………………………………………………………..VI Dedication ………………………………………………………………………………..VII Acknowledgments ………………………………………………………………………VIII List of Tables …………………………………………………………………………….IX Chapter One: The Problem ………………………………………………………………..1 Introduction ……………………………………………………………………….1 Rationale and Purpose of the Study ………………………………………………3 Research Questions ……………………………………………………………….3 Limitations / Delimitations ……………………………………………………….4 Operational Definitions …………………………………………………………..5 Chapter Two: Literature Review …………………………………………………………6 Introduction ………………………………………………………………………6 Gender Identity ………………………………………………………………….13 Sexual Orientation ………………………………………………………………14 Classification of Sexual Orientation ……………………………………………14 X Transgender ……………………………………………………………………15 Intersexuality …………………………………………………………………..16 Eroticism ………………………………………………………………………17 Sexual Dysfunction ……………………………………………………………18 Hypoactive Sexual Desire Disorder …………………………………………...18 Sexual Arousal Disorder ………………………………………………………18 Orgasmic Disorder …………………………………………………………….19 Sexual Pain Disorder…………………………………………………………...19 Erectile Dysfunction …………………………………………………………...20 Orgasm and Ejaculation Disorders in Men ……………………………………20 Delayed Ejaculation, Anejaculation and Male Anorgasmia …………………..20 Female Reproductive System ………………………………………………….21 Male Reproductive System ……………………………………………………21 Sexually Transmitted Infections ………………………………………………23 Sexuality in People with Disabilities …………………………………………24 Sexual Abuse ………………………………………………………………….25 Sexual Harassment ……………………………………………………………27 Sexual Taboos ………………………………………………………………...27 XI Sexual Myths ………………………………………………………………….28 Paraphilias …………………………………………………………………….28 Fetishism ……………………………………………………………………...30 LGTTBIQ Issues ……………………………………………………………...31 Sexual Response Cycle ……………………………………………………….32 Contraceptive Methods ……………………………………………………….33 Cybersex ………………………………………………………………………34