The literature on older adults and sexuality suggests that culturally sensitive counseling may give older adults an opportunity to express sexual concerns and promote healthier attitudes toward sexuality. Guidelines for counseling older adults who self-identify with ethnic minority groups or as gay, lesbian, or bisexual are given, with recommendations for training, practice, and research.
As members of the baby boomer generation move beyond 65, much of what mental health professionals "know" about how to treat their concerns will become obsolete (American Psychological Association [APA], 2003; Langer, 2009). In this article the term "older adults" will be used, referring specifically to adults 65 and above (as Libman, 1989, defined "old age"). Older adults constitute the fastest-growing segment of the American population: There are currently 35 million older adults in the United States and it is expected that there will be over 53 million by 2020 and 70 million by 2030 (DeLamater & Sill, 2005; Sue & Sue, 2008). Langer (2009) suggested that the "greater sexual freedom" found among baby boomers encourages an emphasis on maintaining sexual activity throughout the lifespan (p. 756), and Jacoby (2005) asserted that this generation of older adults is revolutionizing sexuality by focusing on overcoming the physical limitations that accompany age.
Although "the majority of older adults are engaged in spousal or other intimate relationships and regard sexuality as an important part of life" (Langer, 2009, p. 772), negative stereotypes abound in American culture influencing how older adults are perceived by others and how they perceive themselves (Lindau et al., 2007; Watters& Boyd, 2009). A survey by the APA (2004) found that almost 70% of psychologists work with adults over 65, but only 30% received any graduate training about them and only 20% worked with older adults in a practicum or internship setting. Mental health counselors have a responsibility to acknowledge the stereotypes and validate older adults' experiences, but they must also be able to give them accurate information about normative development so that older adults can base their self-assessments on facts rather than myths or unrealistic expectations (Watters & Boyd, 2009).
The APA's (2003) Guidelines for Multicultural Practice consider age as much a vital part of an individual's identity as gender, race, ethnicity, socioeconomic status, sexual orientation, and religious/spiritual affiliation. Thus, it is important that early-career counselors have training in this area so that they are less likely to alienate or offend older clients. Besides fulfilling our responsibility to acknowledge all aspects of our clients' cultural identities, it is essential to consider older adults' needs and desires in all areas of functioning--physical, emotional, and social/interpersonal. Often overlooked in the literature pertaining to older adults is sexuality. The goal of this discussion is to examine how counseling can be used to promote healthy sexuality and sexual expression among older adults, especially members of ethnic or sexual minority groups.
WHY DISCUSS OLDER ADULT SEXUALITY?
Sexual thoughts, feelings, and activity are a vital part of the human experience (Langer, 2009; Watters & Boyd, 2009). DeLamater and Sill (2005) have described sexual desire as "an innate motivational force" (p. 139) akin to hunger or thirst. The desire to express oneself sexually does not decrease with age (Langer, 2009; Watters& Boyd, 2009). The spectrum of activity ranges from "sexual intercourse, oral sex, masturbation [and] sexual conversation" to "loving words, kissing and hugging" (Walker, Osgood, Richardson, & Ephross, 1998, p. 472). Even without sexual activity, sexuality in its psychological and social aspects can be a means of communicating intimacy, affection, and esteem (DeLamater & Sill, 2005; Pangman & Seguire, 2000; Watters & Boyd, 2009). …