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What Do(n’t) American Undergraduate Social Work Students Learn About Sex? A Content Analysis of Sex Positivity and Diversity in Five Popular HBSE Textbooks


Emily E. Prior1,2, D J Williams1,3, Tina Zavala3, & Jessica Milford4

1Center for Positive Sexuality (Los Angeles); 2College of the Canyons; 3Idaho State University; 4University of Utah


Author Note

Acknowledgement: This study was funded via a research grant from the Idaho State University College of Arts and Letters.


Despite an emphasis within American social work to operationalize important professional values, such as embracing human diversity and promoting social justice, it is not clear how this may or may not occur with respect to human sexuality and sexual practices. In considering this issue, the present study employed a thorough content analysis of undergraduate level Human Behavior and the Social Environment (HBSE) textbooks in order to explore how human sexuality and sexual practices are presented to undergraduate college students. Specifically, this study focused on the extent that texts in the sample reflect sexual diversity and sex positivity, which are consistent with key social work values, and thus how such texts may shape students’ professional views of sexuality. Findings suggest that the educational presentation of sexuality and sexual practices varies across HBSE texts in terms of embracing sexual diversity and promoting sex-positivity. 

Keywords: diversity, sex positive, HBSE, social work, sexual identity, sexuality


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Introduction and Background

Although social work education emphasizes strong professional values, such as human diversity, empowerment, and social justice, it is debatable how well such values are taught and practiced concerning sexuality. In a recent issue of Critical Social Work, Fantus (2013) pointed out problems that have occurred from the construction of sexuality into dichotomous categories, including that such divisions may prevent people from questioning or exploring their own sexualities. Dunk (2007) pointed out that knowledge of sexuality is vital to social work practice, yet there has been relatively little attention given to this topic across social work curricula. A recent study that assessed BSW students’ (N=170) perceptions of preparedness to handle issues of sexuality among clients found that a majority felt unprepared in dealing with such issues, despite that sexuality is a salient part clients’ identities (Laverman & Skiba, 2012).

A critical study that analyzed discourses of sexuality in social work found that knowledge about sexuality seemed to be limited and operated alongside “systems of ignorance”— ways of not knowing important aspects of sexuality — which then serve to marginalize some behaviors and groups of people (Jeyasingham, 2008, p. 138). Indeed, Johnston (2002) observed that the history of social work education in advocating for sexual minorities’ rights has been erratic. Perhaps because of such inconsistency and ignorance, scholars have called for the need to address several deficiencies in social work education, including continually addressing the needs and issues of lesbian, gay, bisexual, and transgendered people (i.e., Fredricksen-Goldsen, Luke, Woodford, & Gutierrez, 2011; Hafford-Letchfield, 2010; Johnston, 2002; Raiz & Saltzburg, 2007; Swank & Raiz, 2007; Wall, 2013), the sexuality and needs of people with disabilities (Ballan, 2008), and people with various alternative sexualities and identities (Williams, 2013; Williams, Prior, & Wegner, 2013). While there remains a strong need for social work to address the sexual needs and issues of specific minorities, there are also common macro-level problems associated with sexuality, such as teen pregnancy and sexual violence, which are frequently addressed by the social work profession.   

A Sex-Positive Framework

Drawing from classic work by the sexologist Vern Bullough (1976), Williams, Prior, and Wegner (2013) cite widespread societal sex-negativity as the cultural climate that facilitates the privileging of specific (traditional) forms of sexuality, gender, and sexual behavior, while fostering marginalization of people who do not fit such expectations. In a largely sex-negative climate, interpretations of sexuality and sexual practices are often taken at face value and are not critically explored. In such social climates, sex is talked about in whispers or hushed tones (or avoided), sexual and gender diversity is greatly restricted, sex is flavored as adversarial, and discussion is focused on problems associated with sexuality (i.e., sexually transmitted diseases).

In contrast, a more sex-positive climate encourages open discussion of sexuality (as with any other topic), communication and consent are emphasized, both benefits and risks are acknowledged, and sexual and gender diversity are embraced (Tobin, 1997; Williams, et al., 2013). Moreover, each individual is assumed to possess inherent sexuality across the lifespan, and sexuality may be quite fluid (see Diamond, 2014; Fantus, 2013). Such a view is consistent with the World Health Organization (WHO, 2004) position that sexuality is unique for each person and is shaped by biological, psychological, cultural, social, economic, political, legal, ethical, historical, and religious and spiritual factors. As such, a multidisciplinary framework of positive sexuality has been recently proposed that includes the above views of consent; communication; individuality, diversity, and fluidity; as well as the additional dimensions of incorporating knowledge from multiple disciplines; focusing on the ethics already in place through various professions; humanizing and inclusive language and practices; peacemaking that values healing; and a multi-level application across all social structures (Williams, et al., 2015). This framework suggests that sex-positivity is inclusive of sexual diversity (differing orientations, identities, and practices) while also promoting the additional dimensions mentioned above.

In contrast to sex-negativity, a sex-positive macro approach may help reduce marginalization and oppression of people who do not conform to dominant social discourses concerning sexuality and gender, eliminate inequalities that are unintentionally reinforced through standard school sex education programs and lower incidences of sexual violence and crime (see Glickman, 2000; Williams, et al., 2013). Williams, Thomas, and Prior (2015) found that a sex positive model, when applied to current U.S. sex offender policies, could improve the effectiveness of these policies for offenders and survivors alike, including reducing and even preventing sexual crimes.

Indeed, sex-positivity reflects important values and standards of the social work profession, and may help address deficiencies and problems in social work education regarding sexuality that have been identified and discussed by scholars. Much of American society, with its ubiquitous media messages associated with sexuality, seems to reflect considerable sex-negativity. Therefore, the purpose of the present study was to analyze popular, American BSW-level textbooks to assess the degree to which these books were consistent with sex-positivity. Our research question inquired about the degree to which a sex-positive perspective is reflected in such texts, which likely shape students’ understandings and interpretations of sexuality in the context of social work practice.    


HBSE Focus

Although content on human sexuality potentially could, and probably should, occur anywhere across social work curricula, it is directly addressed in HBSE courses. HBSE is where students gain foundational knowledge about human sexuality, which may then shape their developing professional attitudes toward sexuality of future clients. The application of knowledge of HBSE is one of the 10 Core Competencies in social work curricula that has been established by the Council on Social Work Education (CSWE, 2008). For these reasons, we selected undergraduate level HBSE textbooks as the focus for obtaining and analyzing data.

Textbook Selection

Criteria that were considered in textbook selection included popularity, familiarity with the book by the second author (who regularly teaches HBSE), and informal discussions with several other social work professors who have taught HBSE. Publishers were also contacted and asked which HBSE textbooks were most popular based on sales. Other researchers (see Gallegos, Tindall, & Gallegos, 2008; Macgillivray & Jennings, 2008) have utilized these criteria for textbook selection in similar content analyses.

A significant amount of research related to sexual diversity has occurred within the past decade, and commonly accepted educational standards require that textbook content should be reasonably current. Therefore, an additional criterion for textbook selection was publication date of 2010 or later. Finally, because sexual diversity and sex-positivity are often promoted among critical theoretical perspectives in other relevant disciplines, textbooks that promoted a critical approach were given additional consideration. In other words, it is perhaps more likely that sexual diversity and sex-positivity would be included in books that take a critical approach to HBSE. Based on the above criteria, we selected five HBSE textbooks for analysis. We will now identify and briefly discuss each text. 

Human behavior theory and applications: A critical thinking approach (2012) by Elizabeth DePoy and Stephen French-Gilson includes 21 chapters that are organized according to various theories. This textbook (372 pages) introduces theory and its roles (Chapters 1-2), discusses several diverse groups of theories (Chapters 3-14), and shows how theories are connected to values, ethics and practice (Chapters 15-21).

Essentials of human behavior: Integrating person, environment and the life course (2013) by Elizabeth D. Hutchison is a comprehensive text (855 pages) that combines and synthesizes to some degree her previous very popular Dimensions of human behavior two-book series that focus on “person and environment” and “the changing life course,” respectively. Hutchison’s work is widely used in HBSE courses.

Human behavior and the social environment: Theory and practice (2011) by Joan Granucci Lesser and Donna Saia Pope is now in its second edition. The book (598 pages) is organized into five sections that are divided into 18 chapters. Sections focus on conceptual issues, individual development, sociocultural contexts of development, the human life cycle, and policy.

Contemporary human behavior theory: A critical perspective for social work (2012) by Susan P. Robbins, Pranab Chatterjee, and Edward R. Canda is now published in its third edition. This book is comprised of 14 chapters that discuss a diverse array of behavioral and social theories and their application to social work.

The fifth textbook selected was the very popular Understanding human behavior and the social environment (2013), now in its ninth edition, by Charles H. Zastrow and Karen K. Kirst-Ashman. The book (766 pages) is divided into 16 chapters and takes a biopsychosocial approach across the lifespan. Similar to the other textbooks selected, the latest edition of this book was printed recently. (At the time of publication of this article, they were published recently.)

Content Analysis Procedures

Our main research question focused on the extent to which HBSE textbooks take a sex-positive approach; directly related to this question is how open to sexual diversity such texts seem to be. Specifically we looked for words, images, and other data related to concepts of sexual diversity (e.g., gay, lesbian, BDSM, polyamory, etc.) and the context in which these data were portrayed (sex-negative: framed around shame, illness, secrecy, etc. versus sex-positive: framed around open communication, acceptance, humanizing language/images, etc.). Because research on sex-positivity is almost nonexistent, it was important to use a flexible, yet rigorous, content analysis procedure. Our critical analysis process was primarily qualitative, but we also included a tabulation of numerous terms associated with sex-positivity. This approach gave a broader assessment for sex-positivity. We generally followed the three phases outlined by Elo and Kyngas (2007): preparation, organizing, and reporting.

Similar to the critical analysis of LGBT content in education textbooks by Macgillivray and Jennings (2008), we made an exhaustive list of terms commonly associated with both sexual diversity and sex-positivity in the preparation phase. Based on the terms from the Macgillivray and Jennings (2008) study, our list consisted of the following: BDSM, fetishes, kink-aware, leather, nonmonogamy, polyamory, pornography, prostitution, sadomasochism, sexual behavior, sex positive, sexual diversity, sex education, sex work, sexual freedom, sexual health, sexual identity, sexual minorities, swinging, sexual orientation, homosexual, gay, lesbian, bisexual, pansexual, erotic(a), pleasure, queer, transgender, gender fluid, transsexual, recreational, asexual, consensual/consent, negotiation, communication, alternative, arousal, desire, fantasy, and masturbation. We also looked for various forms of these terms when appropriate (i.e., homosexual, homosexuality, etc.) Later, those terms were searched in the index of each book to see if and where the term and its associated discussion occurred. We also scanned the Table of Contents of each book to further identify where, and in what context, discussion of sexuality occurred. Further, a line-by-line search for the terms was conducted through each textbook to ensure that nothing of import would be overlooked.

In the organizing phase, we separately analyzed specific discussions of sexuality line by line using open coding. We identified which sexual topics were included (and excluded), what general discourses seemed to inform those topics, and finally how various topics were positioned within the text (in other words, where is the discussion located in the text and what topics immediately precede and follow each topic?). A tabulation of frequency was created to allow us to see how often a particular term was used in any given textbook and across all textbooks. We also included analysis of any photographs, tables, and case studies associated with topics. Throughout the process, we also sought to identify important latent content in each text.

While initial analyses occurred separately from three of the four authors, we then collaboratively applied a constant comparative process similar to that used by Macgillivray and Jennings (2008) to clarify our initial interpretations and construct categories as themes emerged. The first author directed and generated this process among the research team based on reviewing and comparing independent analyses. Throughout the comparative process, or reporting phase, we could begin to confidently assess the extent to which sexual diversity and sex positivity are included within texts. At the same time, such critical content analysis could also uncover hidden assumptions and biases within social work education (specifically HBSE) that unknowingly and perhaps unintentionally marginalize and oppress (see Myerson, Crawley, Anstey, Kessler, & Okopny, 2007).


This study has several limitations. First, similar to content analyses of other topics in social work (i.e., Council on Social Work Education, 2009; Gallegos et al., 2008) only a small number of textbooks were analyzed. However, these textbooks were chosen based on popularity of use within the classroom across the United States. This creates a smaller number of HBSE books analyzed compared to the total number of possible textbooks available, yet this small number seems to reach a large audience of students. Second, textbooks were selected nonrandomly and according to specific criteria, and we acknowledge that these findings cannot be fully generalized. Despite the limitations, this study utilized appropriate methods. It also generates new and valuable knowledge for the social work profession. As discussed in the results, calculating the frequency with which terms are being used and in what context, helps to elucidate how diverse these texts actually are. For example, it is important to explore in popular textbooks whether specific sexual minorities or identities may be unfairly excluded or marginalized, or if heterosexism or mononormativity are privileged. Since teaching diversity is a cornerstone of social work curricula this is an important contribution to, and possibly critique of, the field.

Comprehensive Results

Quantitative Findings          

The quantitative data from this study are in the form of frequency tabulations. The researchers counted how many terms from the original word list were found within each book, as well as how frequently each individual term occurred within each specific textbook. Of the 41 original terms, 25 of these terms were actually located somewhere in one or more of the textbooks. The following terms were not found: kink, leather, nonmonogamy, pornography, sex-positive, sexual diversity, sex work, sexual freedom, sexual health, swinging, pansexual, gender fluid, recreational, asexual, negotiation, and communication. The omission of these words across textbooks suggests that there may be a strong need for social work education to embrace sex positivity.

Figure 1. Word Cloud Pictograph

Of the remaining terms, the range of frequency was from 1 to 75 times. The Word Cloud Pictograph (see Figure 1.) represents the frequency with which specific terms occurred across all texts. The smallest words, shown in 8-point font, only occurred once. Each increment higher than one is shown in an increase of one font point per increment, so the larger a word appears, the greater frequency with which it occurred across all textbooks combined. Some terms only occurred in one or two books, whereas other terms occurred with approximately equal frequency across all texts. Other terms seemed to be found with much more frequency in only one or two of the books when compared to the remaining texts. For example, the term “gay” was found an average of 10.5 times across four of the texts, but occurred 33 times within the Lesser and Pope (2011) book. The term “lesbian” was found an average of 3.25 times across four of the texts, but was found 14 times within the Robbins, Chatterjee, and Canda (2012) text. The term “gay” was the most frequently used term from our search list, occurring 75 times, followed by “sexual orientation” at 58 times.

While searching for the terms from our original list, we found several additional terms that seemed to stand out, either because these were terms that perhaps could have been included in the original search list but were not identified a priori, like intersex, sexual intimacy, gender identity, sexual identity, and similar terms that may denote a sex-positive perspective; were terms that denote a mainly medical, biological, or neutral perspective, such as childbirth, pregnancy, and conception; were terms that primarily denote a sex-negative perspective, like sexually transmitted disease (STD or STI), rape, and incest; or were terms that were somewhat surprising to find, like berdache, bisensual, polyfidelity, and power exchange. All additional terms that were noted across the coding team were thus added to the Word Cloud Pictograph (see Figure 1.).

The only terms that have been grouped together as being similar enough for this study, and are therefore represented by one major term, are specified as “BDSM+” and “GLBTQI+.” The first grouping includes all references to BDSM, in part or its entirety, as well as any related word that is typically associated with this acronym (e.g., bondage, discipline, submission, dominance, sadism, masochism, sadomasochism). The second grouping includes all references to some or the entire LGBTQIA acronym. Singular words associated with this acronym are displayed separately since their individual frequencies varied so much from one another and the acronym.

Analysis of Photographs      

In the analysis of images within the textbooks, only three of the five books had images or illustrations to analyze. The Hutchinson (2013) text included three basic diagrams of male and female reproductive organs and some photographs. The Zastrow and Kirts-Ashman (2013) text included nine relevant photographs, and the Lesser and Pope (2011) text included seven photographs of note.

Within the Hutchinson (2013) text, the illustrations of male and female reproductive organs were found to have captions that were somewhat contextually different from one another. While the male reproductive organs were labeled as “reproduction system” (p. 101), the female reproductive organs were labeled as “sex organs” (p. 103). On the surface, these labels may not seem to be particularly dissimilar, but for some readers there is a semantic difference between what organs are considered for reproductive use versus sex use. Because of this, some students may not understand that such a similarity is implied, if in fact it is. In addition, all photographs of teen or adult couples or families depict heterosexual couples or a group of mothers with young children. There are no photographs depicting non-heterosexual couples. The photographs also imply monogamy.

The Lesser and Pope (2011) text contains several photographs that are meant to depict diversity based on the context of the headings and subjects discussed in the accompanying text, yet only one of the seven photographs actually depicts anyone outside of a heteronormative context. Within this particular photograph, there are two men with two young children representing gay parenting (p.156). The caption describes increasing numbers of gay and lesbian parents and the various means that are used by gays and lesbians to become parents.

The Zastrow and Kirst-Ashman (2013) text has the most sex-positive images of all of the books. Some of these images include a group of men rallying against Proposition 8 (p. 578), a gay male couple kissing (p. 592), a Gay Pride Parade (p. 594), a lesbian couple with a marriage certificate (p. 596), a Gay Straight Alliance march (p. 602), a gay male couple with children (p. 606), and a gay male couple kissing (p. 657). These images indicate a more diverse group (or at least homosexuality) as being acceptable within the context of this book, although it is important to note that all photographs in other chapters that show couples only show heterosexual couples.

None of the books portrayed sexual diversity beyond homosexuality, and heterosexuality and monogamy were clearly the norm. There were no photographs depicting BDSM, polyamory, or other diverse orientations, sexual identities, or sexual practices. As such, all of the textbooks fall short of portraying sexual diversity, much less sex positivity, when analyzing the photographs.

Results of Analysis for Books Separately

Human behavior theory and applications: A critical thinking approach (Depoy & French-Gilson, 2012)

An analysis of the Table of Contents for this text yields no clear mention of sexuality until subheadings under Chapter 11 that include Sex and Gender, Sexual Orientation, Feminisms, and Queer Theory. Although the authors mention a few times that this book is taking a diverse approach to the discussion of sexuality and human behavior (i.e., p. 200), there is little evidence to support this statement. The sections that could be considered sex-positive, or more accurately neutral or not clearly sex-negative, are described below.

In Chapter 8, the section on Social Role Theory (pp. 142-144) provides a brief discussion of the theory and how it can be used to discuss gender roles, among other social roles. This is a good, short, discussion on this topic. However, current standard verbiage regarding gender roles uses masculine and feminine to define gender, not male and female, which denote sex. In this way, this text is interchanging sex with gender. The interchange of these terms occurs throughout the book, and later the authors state that they will not take a position regarding whether or not sex and gender are distinct from one another or are synonymous (p. 197).

In Chapter 11, Table 11.1: Descriptive Definitions of Gender Terminology (p. 198) offers descriptions of currently accepted terms for some specific gender categories. This is an acceptable start, but an inclusion of a growing number of terms, descriptors, and identities that are outside the scope of this list should be noted. Queer identity and queer theory are discussed in this chapter, which are consistent with sexual diversity and sex positivity.

The most sex-positive portion of this book does not occur until Chapter 19, which is near the end of the book. In this chapter, two sections use case examples of gay people coming out to their families, issues of gay marriage, and how systems theories may be applied in these cases.

Unfortunately, much of this book is either neutral or sex-negative, possibly providing a biased perspective regarding individuals and relationships outside of heteronormativity. In many cases, terms or ideas are presented without a clear context or discussion that might further confuse students rather than instruct. For example, in Chapter 4, Freud’s Stages of Psychosexual Development are discussed (pp. 49-50). Although it is important for these theories to be provided within a book on the development of human behavior, ideas such as heterosexuality being the normative behavior and homosexuality being a behavior that one must overcome have been widely discredited. Within this text, these ideas are not discussed further nor are an alternative view presented. If these remain unchallenged or are not sufficiently discussed with current findings and theories, then the connotation is clear that these are negative, unwanted outcomes. There is some concern that without clarification by the authors or an instructor, students who have no previous exposure to opposing theories or ideas may continue to perpetuate these clearly sex-negative ideas. This particular textbook seems to be uneven in its handling of sexuality topics. In some sections, it seems rather antiquated or not cognizant of current trends and theories regarding sexuality, yet other sections address some types of sexuality openly and with an eye towards sex-positive identities.

Essentials of human behavior: Integrating person, environment, and the life course (Hutchinson, 2013)

An analysis of the Table of Contents for this text provides a clear indication that sexuality is discussed across almost all chapters throughout the book. This book offers several neutral to sex positive discussions throughout, although there is still a primary focus on heterosexuality and heteronormative behaviors being the “norm” and possibly preferred. The first indication of a more neutral to positive tone occurs in Chapter 3 with a case study of a couple raised with strict religious beliefs within a larger educational community that did not provide sex education (p. 80). This discussion illustrates the difficulties that youth and young adults encounter when they have not been provided with information necessary to aid their sexual and overall well-being. Later in Chapter 3, in a discussion of the reproductive system, explanations of various sexual and gender orientations are provided (pp. 99-104). This section is excellent in clarifying that it is specifically focused on heterosexuality rather than making this the “default” focus without stating a bias. This section also briefly discusses other possible sexualities, and admits that discussing them in detail is beyond the scope of this section.

Chapter 5 provides case examples of people confronting a conflict between personal and family religious beliefs and the individual’s sexual orientation (pp. 157, 184-186). This is an accurate description of what many people experience when trying to reconcile their faith and their sexual orientation. This section provides a good discussion of problems that can be faced when religious/spiritual beliefs clash with sexual orientation. Resources are listed that advocate for tolerance. In addition, readers of this text are reminded that the NASW Code of Ethics requires workers not to be judgmental regarding sexual orientation when working with clients.

Chapter 9 discusses small groups and family systems using a case example of a woman realizing her sexual identity and coming out to her family (pp. 329-330). This is a good example of the process that many people come to recognize their sexual identity and orientation. Additionally, some typically uncommon language (for an HBSE text), such as “baby dyke” (p. 330) is used, providing a more sex-positive and realistic perspective.

Overall, this book uses several non-traditional case studies to discuss examples of clients who are not heteronormative, thus providing a much more diverse and sex positive view. However, there are areas in which heterosexuality is mentioned as “normal” (p. 57, for example) with no alternatives presented. More frequently, discussions of a binary gender system and development are given. In Chapter 12, a section on early childhood gender identity and sexual interests upholds beliefs about biological sex and gender differences in areas of performance, such as toy choice etc., even though recent evidence does not support this behavior as biologically inherent but socially constructed (i.e., Butler, 1990, West & Zimmerman, 1987). This alternate epistemological approach is mentioned briefly in a few sentences at the end of several paragraphs to the contrary (pp. 477-479). In addition, this book does not address transgender development at all, while stressing that girls and boys develop along socially acceptable feminine and masculine lines (pp. 521-522).

Human behavior and the social environment: Theory and practice, 2nd ed. (Lesser & Pope, 2011)

An analysis of the Table of Contents for this text provides several sex-positive terms as subheadings under Chapter 4: Identity Development. Some of these terms are included again as subheadings for Chapters 13, 14, and 15. This book discusses a wide range of sexual, gender identities throughout the text, and poses several possible developmental theories that might explain this variety. Generally, this text is quite sex positive, and it includes several neutral discussions. Only a few topics seem to be sex-negative or possibly not discussed in sufficient depth to be classified as neutral or sex-positive.

Discussions of sexual identity development begin early in this book starting in Chapter 4, where alternatives to Freudian psychosexual development theory are offered, including Queer Theory and Feminist perspectives (pp. 105-117). This chapter also addresses transgender and intersex development without describing these in pejorative terms or as being abnormal (p. 108). The text also offers nonjudgmental definitions for terms like queer, bisexual, lesbian, gay, and more (p. 110). Various models of homosexual identity development are offered within this chapter as well, which includes both negative and positive self-perspectives regarding coming out. The text also mentions some of the problems with linear models of coming out and identity development (pp. 114-117). Specifically, this chapter does a very good job of positioning homosexuality and queer identities within the scope of heterosexism. It is also significant that readers are asked to challenge the use of Gender Identity Disorder (GID) and Transvestic Fetishism as valid psychiatric diagnoses (pp. 116-117).

In Chapter 5, family systems are discussed. This section is inclusive of non-heteronormative individuals and families. The chapter describes the social, legal, and political difficulties inherent with families where the parents are of the same sex. It is also suggested that comparing with heterosexual parenting systems might not be nearly as useful as comparing lesbian and gay parenting systems to one another (pp. 153-156).

Chapter 7 focuses on communities and organizations. One of the practice examples includes a discussion of SOY, a grassroots program that serves gay, lesbian, bisexual, trans, and queer youth in Toronto as an example of community building (pp. 212-214). Using this particular organization and its target population as an example of community building and grassroots organizing is very helpful, and such inclusion is sensitive to current community needs.

Although much of this book seems to project a sense of “normalcy” around topics of non-heteronormative identities, relationships, and practices, there are a few issues that are noteworthy. For example, AIDS is mentioned throughout the book across several chapters, but it is not until Chapter 15, almost the end of the book, where demographics other than gay men are mentioned in relation to HIV/AIDS. The most thorough discussion on this topic becomes evident by Chapter 17, yet this discussion is not referenced earlier in the book. If instructors do not completely finish the book in the one or perhaps two semesters that an undergraduate HBSE course is taught, then students may get the impression that AIDS significantly affects only gay men.

Other problematic issues include a discussion of possible relationship styles in Chapter 13, wherein only monogamous relationships are presented as likely to be preferred and/or lived by young to middle-age adults (pp. 340-341). Furthermore, a brief mention of the terms “eroticization” and “sadistic sexual activity” (p. 425), which based on the surrounding text and chapter heading, clearly positions these terms and ideas within a framework of trauma and maladaptive behaviors. However, most of this book is quite diverse in its discussion of various topics; therefore, these exceptions seem to be relatively minor issues.

Contemporary human behavior theory: A critical perspective for social work, 3rd ed. (Robbins, Chatterjee, & Canda, 2012)

An analysis of the Table of Contents for this text indicates sex-positive terms as subheadings under Chapter 4: Theories of Empowerment and Chapter 8: Theories of Life Span Development. This book is progressive and generally reflects sex-positivity in how it portrays various topics related to sexuality. This text discusses many perspectives of Freudian psychoanalytic theory, including some of the problematic conclusions and repercussions of depending too strongly on these theories to define or describe "normal" sexual development and behavior. Several perspectives are offered as alternatives to the basic Freudian psychosexual stages of development, including specific feminist perspectives that are often ignored. In fact, there are sufficient examples of thorough sex positive discussions in this book but only a few will be pointed out here.

First, this book is rare in that it implies that children are normally sexual in nature and that sexual development begins early in childhood, not just at puberty (pp. 2, 204-211). The book also references terms like gender, sexual orientation, gay, lesbian, bisexual, transgender, queer, questioning, and intersexed throughout the overall text as well as part of a specific subheading within a chapter. It is clear that these identities are being included in discussions on systems theories, conflict theories, empowerment theories, feminist theories, and other topics. In-depth discussion is given to non-heteronormative sexual and gender identities and orientations across the entire book, including a discussion on how terms like LGBTQI can be problematic in many ways.

This text also includes sex-positive terms that are not found in almost all of the other books. Such terms include drag queen, androgyne, MTF, FTM, sexually variant orientations, erotic power exchange, BDSM, bondage/discipline, domination/submission, sadism/masochism, and others. Within a discussion of clients who may identify with some of these terms, or who may be having issues with being labeled as deviant based on these identities and others, the authors point out that an interactionist perspective may be particularly useful (p. 314). Such discussion is frequently absent in many texts about these identities.

While this book is overwhelmingly sex-positive in many respects, a few noteworthy issues can be critiqued. For example, in the discussion of Freudian psychosexual stages of development, the topic of vaginal orgasm being more mature or desired for women is portrayed without being challenged (pp. 173-175). In Chapter 8, there is a discussion that some theories of development show a tendency towards a “more androgynous gender identity” in midlife for many adults (p. 224). Unfortunately, this statement is not well contextualized or defined. Such a statement could be connected to a discussion regarding how this concept should be temporally and culturally defined, but no such parameters are offered.

Finally, the authors use the terms “opposite sex” and “other sex” interchangeably. This is not necessarily incorrect, but it is not consistent. Some current texts use “other sex” to denote a known difference between males and females without asserting an opposing difference between the sexes (i.e., Crooks & Baur, 2014).

Understanding Human Behavior and the Social Environment, 9th ed. (Zastrow & Kirst-Ashman, 2013)

An analysis of the Table of Contents for this text suggests that sexuality and related topics will be discussed throughout the book, but only subheadings for Chapter 13: Sexual Orientation and Chapter 15: Psychological Aspects of Later Adulthood reflect topics that may be specifically sex-positive. Although the chapter subheadings in the Table of Contents indicate that there may be only a few sex-positive sections of the book, this text is overwhelmingly sex positive. There is a continuing discussion of sexual diversity and inclusion throughout the book, and the authors offer several perspectives of topics that are often controversial and not always discussed openly, such as abortion, masturbation, non-marital sexual relationships, intersex conditions, and others. This book offers numerous examples of basic sex-positive discussions, but only a few will be illustrated below.

The topic of abortion is discussed at length in this book, most particularly in Chapter 2 (pp. 77-92), and arguments for and against abortion is presented. The authors provide an even-handed discussion of this topic, yet clearly state that social workers are obligated to work on behalf of their clients’ best interests and not necessarily from the worker’s personal belief system.

Masturbation is also discussed in detail in Chapter 6 (pp. 287-288), and the text emphasizes the normalcy of this sexual activity, especially for adolescents. A highlighted passage on this topic is provided that includes slang terms used to describe masturbation, a detailed description of masturbation and subsequent benefits. Such thorough discussion on this topic is usually not included in texts that are not specifically focused on human sexuality. This is especially informative to readers, considering that the text focuses more on commonality and benefits of masturbation rather than guilt and shame.

This book also provides a thorough discussion and comparison of comprehensive and abstinence-only sex education programs. Citing scientific evidence, the authors point out the fallacies of abstinence-only programs compared to the demonstrated effectiveness of comprehensive sex education (pp. 292-295).

A section of the book focusing on non-heteronormative gender and sexual identities, such as transgender, transsexual, transvestites, drag queens and kings, and others is provided (i.e., p. 403). These identities are defined and discussed with nonjudgmental and even supportive language, implying that gender expression of all kinds can be healthy.

In several areas in the book discussions of healthy sexual functioning are paired with orgasm for males and females, open communication, differing relationship styles, and other topics (pp. 457-458, 523) offering a range of possible positive outcomes for different types of individuals.

Although this book is generally sex-positive throughout, a critique is warranted in some areas. In some places the authors interchange the terms “sex” and “gender” as if they were synonymous (i.e., p.61-62). Given how well written and researched this book is, the authors should be more careful to avoid such interchangeability of terms. In several areas there seems to be an implication that having multiple sex partners or being in a relationship that is not designated as “marriage” is somehow detrimental, negative, or perhaps wrong (i.e., pp. 354, 457-458, 518-521). This is, of course, very problematic. In a section on extramarital sex and affairs, “mate swapping” (p. 459) is offered as an alternative to cheating. However, other consensual possibilities, such as polyamory or open relationships, are not discussed. However, this book seems to be considerably sex positive despite a few exceptions, and it addresses a wide range of subjects and perspectives on human sexuality.

Summary and Conclusion

The scholarship concerning understanding human sexuality and gender is rapidly increasing and changing. Despite rapid advancement in sexuality studies, American social work education currently does not require any formal training on this topic. It seems to be commonly assumed that social work students will obtain sufficient knowledge about sexuality from their other courses, especially HBSE. Nevertheless, it is likely that widespread cultural sex-negativity severely restricts awareness of sexual diversity and reduces the effectiveness of social work education and practice.

Indeed, if we are to truly understand and empower our clients, practice with cultural competence, advocate for social justice, prevent and reduce sexual harm, and increase the quality of life for all people across society, then social work education and training must become more sex-positive in its approach, while keeping pace with human sexuality scholarship. However, social work continues to show weakness regarding the inclusion of recent important scholarship on sexuality. For example, while it is estimated that up to 10% of the general population is involved in some form of consensual BDSM (Moser & Kleinplatz, 2006) and numerous studies have discredited common assumptions that such behavior is rooted in psychopathology (for reviews, see Powls & Davies, 2012; Weinberg, 2006; Williams, 2006), this topic is virtually absent in the field of social work. Similarly, the field of social work has lagged in its acknowledgment of alternative (nonmonogamous) relationship structures, yet such relationships are not uncommon in mainstream society (Sheff, 2013). Unfortunately, untrained clinicians may unintentionally inflict serious harm to clients who prefer alternative lifestyles and relationships (Graham, 2014). Indeed, there is little doubt that more sex-positivity in social work could be helpful for many of our clients.        

Overall, when considering how sexuality is presented in these five HBSE textbooks based on quantitative and qualitative (including the examination of photographs in texts) analysis, the authors could make improvements in their presentations of sexuality. Such modifications will be more critical as time progresses, given that the science of understanding sex and gender diversity and mutability is increasing rapidly (Fausto-Sterling, 2014). Currently, there seems to be considerable variations in how sexuality is approached and presented to American undergraduate social work students, which is similar to research by Jeyasingham (2008).

Of the five books analyzed, one stood out as clearly not sex-positive (Depoy & French-Gilson, 2012). The handling of the material related to sexuality within this book is uneven in its stance. Although the authors used the term “diversity” to explain the focus of the text, the actual verbiage and discussions provided throughout the book give a much more neutral to possibly sex-negative impression to the reader. This could lead instructors, students, and professionals to perpetuate beliefs that are problematic and detrimental to clients during actual practice.

The Hutchinson (2013) book, while having several sex-positive discussions and an overall tone of being sex-positive, maintains a mostly heteronormative perspective. A binary gender system is maintained throughout the text, offering no alternatives and no discussions of genders that are not primarily feminine female or masculine male. Some areas of the book are more sex-positive in that non-heteronormative case studies are used as examples in some areas, but the remainder of the surrounding text still gives one the impression that these situations are not “normal.” This is problematic, and could lead instructors, students, and professionals to some confusion about what, or whom is “normal,” and would therefore adversely affect client well-being.

The remaining books offer a much broader spectrum of sex-positive to neutral information and verbiage (Lesser & Pope, 2011; Robbins, Chatterjee, & Canda, 2012; Zastrow & Kirst-Ashman, 2013). Although there are a few areas in each of these books that could use work to make them more sex-positive, the overall tone, examples, case studies, and discussions provided demonstrate a wider range of perspectives and topics for instructors and students when compared to the other books. These three books each have a slightly different approach, focus, and depth of information on sexuality topics in particular. As such, it may be useful for instructors to review each of them to determine which would best suit the needs of their students.

Perhaps most importantly, instructors should increase their own awareness of research pertaining to the range of diverse sexual identities and practices. Instructors are encouraged to seek out academic articles and books that may provide more in-depth and sex positive information to further their own education, and therefore become more comfortable and prepared when teaching about sexuality to students. Based on our findings herein, it is highly recommended that instructors also provide additional current reading materials to their students in order to help students learn specific information that a particular HBSE textbook lacks.

For future consideration, HBSE textbook authors and editors should be more inclusive and provide information on sexual orientations beyond homosexual and heterosexual, on relationship styles beyond single, married, and monogamy, on gender presentations beyond a binary of masculine-male/feminine-female, as well as other information that could be useful to students entering the helping professions. For these textbooks to become more sex positive, sexuality needs to be portrayed as diverse and as a healthy, humanizing part of our development and well-being.


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