INAPPROPRIATE SEXUAL BEHAVIOURS EXPERIENCED BY SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS IN SOUTH AFRICA

The experience o f inappropriate sexual behaviours (ISB) by healthcare professionals has been identified internationally as a serious is­ sue. This study investigated the extent o f ISB directed towards speech-language pathologists and/or audiologists (SLP/As) in South A f­ rica. as well as the sources and the effects o f ISB, the responses o f the SLP/As, and the perceptions o f the SLP/As with regard to their abilitv to manage ISB experiences. F ifty-six qualified SLP/As and 62 student SLP/As completed a questionnaire based on sim ilar studies conducted in Canada and New Zealand. M ost o f the respondents had experienced ISB, mostly o f a m ild to moderate nature, at som e point in their careers, and som e had experienced severe ISB in the workplace. ISB occurred in a variety o f work contexts. The sources o f ISB included clients and/or their fa m ily members, as well as colleagues and employers. A range o fpersona l and work-related effects resulted and the respondents took the least assertive strategy' in the management o f their ISB experiences. The results reflected that SLP/As in South Africa are poorly informed with regard to their legal rights and responsibilities, as well as strategies to deal with unwanted sexu­ ally related experiences. ISB ought to be recognised as a serious issue in clinical practice in South Africa by SLP/As, professional bodies as well as training institutions. The results are in line with previous research on ISB experiences by SLP/As and other healthcare pro fes­ sionals.


INAPPROPRIATE SEXUAL BEHAVIOURS EXPERIENCED BY SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS IN SOUTH
The experience o f inappropriate sexual behaviours (ISB) by healthcare p rofessionals has been identified internationally as a serious is sue.This study investigated the extent o f ISB directed tow ards speech-language p athologists and/or audiologists (SLP/As) in South A f rica.as well as the sources a nd the effects o f ISB, the responses o f the SLP/As, a n d the p erceptions o f the SLP/As with regard to their abilitv to m anage ISB experiences.F ifty-six qualified SLP/As and 62 student SLP/As com pleted a questionnaire based on sim ilar studies conducted in Canada a nd N ew Zealand.M ost o f the respondents had experienced ISB, m ostly o f a m ild to m oderate nature, at so m e p o in t in their careers, and som e had experienced severe ISB in the workplace.ISB o ccurred in a variety o f w ork contexts.The sources o f ISB included clients and/or their fa m ily members, as well as colleagues and employers.A range o fp e rso n a l and w ork-related effects resulted a nd the respondents took the least assertive strategy' in the m anagem ent o f their ISB experiences.The results reflected that SLP /A s in South A frica are p o o rly inform ed with regard to their legal rights and responsibilities, as w ell as strategies to deal with unw anted sexu ally related experiences.ISB ought to be recognised as a serious issue in clinical p ra ctice in South Africa by SLP/As, p ro fessio n a l bodies as well as training institutions.The results are in line with previous research on ISB experiences by SLP/As a n d other healthcare p ro fe s sionals.
Key words: sexual harassm ent; speech pathology and audiology; professional-patient relationships

IN TR O D U C TIO N
Sexual harassm ent is a ubiquitous phenom enon that per vades all levels o f society.N otw ithstanding w ide ranging debates on sexual harassm ent, the definition is broad and controversial because the experience is personal and individualised.The South A frican L abour R elations A ct o f 1995, section 203(2) o f the D e partm ent o f L abour (1995) defines sexual harassm ent as un wanted conduct o f a sexual nature w hich is persistent (although a single incident o f harassm ent can constitute sexual harassm ent).A ccording to the A ct, the behaviour can only be deem ed as har assm ent if the recipient has m ade it clear that the behaviour is considered offensive.In addition, central to the A ct is the condi tion that the peipetrator should have know n that the behaviour is regarded as unacceptable.In contrast, the U nited States Equal Em ploym ent O pportunity C om m ission (1980) w ithin the Civil Rights A ct o f 1964 (EEO C) recognises that the perpetrator may be com pletely unaw are that his or her behaviour is offensive or constitutes sexual harassm ent or m ay be com pletely unaw are that his or her actions could be unlaw ful, and furtherm ore, the EEOC recognises that it m ay not be possible for the recipient to express in any w ay that the behaviours are unw elcom e.
As well as the difficulties inherent in form alised defini tions o f sexual harassm ent, blurring o f boundaries occurs in p er sonal experience and perceptions in that unw anted sexual behav iours are not always construed by the recipient as being o f a h ar assing nature (W illiam s, de Seriere & B odington, 1999).In rec ognition o f the alienating and judgem ental im plications o f the term 'harassm ent', M cC om as, H erbert, G iacom in, K aplan & Dulberg (1993) used the term 'inappropriate patient sexual behav iours' in their investigation o f the experience o f inappropriate sexual behaviours (ISB) by physiotherapists in Canada.Their findings, as w ell as those o f W illiam s et al. (1999) in N ew Z ea land w ho identified the experience o f ISB by speech-language pathologists, confirm ed that rehabilitation therapists do not al w ays construe the experience o f ISB as sexual harassm ent.The absence o f a universal definition is evident in the vast literature that debates term inology and sem antics in sexual harassm ent and also in international legal texts and depositions w hich lack con sistency and agreem ent.
In the absence o f a universal definition, m odels o f sexual harassm ent can help to clarify the boundaries betw een what is acceptable and w hat is unacceptable, w hich helps to determ ine perceptions o f harassm ent (M cC om as et al., 1993).O ne o f the m ost com m only used m odels differentiates 'quid pro quo harass m en t' from 'hostile environm ent harassm ent'.Quid pro quo har assm ent involves a person in a superior position using sexual harassm ent as an expression o f pow er to achieve his or her aims.In contrast, hostile environm ent harassm ent occurs w hen an equal peer engages in sexual behaviours that create a hostile environ ment.This differentiation is reflected in the definitions provided by the South A frican Labour R elations A ct (D epartm ent o f L a bour, 1995), the EEOC (1980), as w ell as the Com m onw ealth Sexual D iscrim ination A ct (1984) w hich constitutes federal law in A ustralia.
M cC om as et al. (1993) m ade use o f a sim ilar model in their study in Canada w hich exam ined the extent and nature o f ISB directed at physiotherapists.T hey concluded that m ost ISB w'as directed by equal peers, or non-superiors, and thus fell into the category o f hostile environm ent harassm ent.H ow ever, their respondents did not identify-their experiences o f ISB as harass ment.The experience o f both quid pro quo harassm ent as well as hostile environm ent harassm ent has been reported w idely by healthcare professionals internationally, such as nurses (H enderson, 2003;M adison & M inichiello, 2001;Tang, Yik, Cheung, Choi & Au, 1996); physiotherapists (M cC om as et al., 1993;O 'Sullivan & W eerakoon, 1999); pharm acists (B roedel-Zaugg, Shaffer, M aw er & Sullivan, 1999); and m edical doctors (R ecupero, H eru, Price, & A lves, 2004;V ukovich, 1996).R e searchers estim ate that alm ost one in every two w om en experi The South African Journal o f Communication Disorders, Vol. 53, 2006 Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.)ence ISB at some point in their working lives (Fitzgerald, 1993;Gutek, 1985).A study conducted by the Institute o f Directors in 1992 estimated that 76% o f South African women experience ISB in the workplace (Vetten, 2001).Therefore the professions o speech pathology and audiology, which are predominantly ema e professions in South Africa, cannot ignore ISB as a professiona issue because the experience o f ISB poses a serious n sk to both the emotional and physical well-being o f a person (Schneider Swann & Fitzgerald, 1997).However, despite the femin.sation of some professions such as speech pathology and audiology Rothstein (1993) in his commentary on McComas et al. s (1993) study argued that ISB should be viewed as a professional issue, and cited Bruckner (1993) who argued that ISB is not primarily a women's issue.
The experience o f ISB is a serious professional issue be cause o f the extent o f the harm that it can cause (McComas et al., 1993).Some theorists, particularly within the psychological as opposed to the legal paradigm, argue that the consequences, rather than the intentions, are the determining factors in the defi nition o f harassment (Fitzgerald, 1993;Gutek & Koss, 1993;M adison & Minichiello, 2001).The consequences o f the experi ence o f ISB, whether the person defines the experience as harass ment or not, include a range o f negative effects in the workplace, such as decreased morale, increased absenteeism, decreased job satisfaction, job loss, and deteriorating relationships with co workers (Schneider et al., 1997).Furthermore, the experience o f ISB often has a serious effect on people's physical and emotional health and the more severe the ISB the more severe the reactions (Gutek & Koss, 1993;Schneider et al., 1997).The reactions re ported by both men and women who have been the recipients of ISB include anxiety, depression, sleep disturbance, weight loss or gain, loss o f appetite, headaches, feelings o f frustration, fear, an ger, embarrassment, shock, alienation, and loss o f self-esteem (McComas et al., 1993;Schneider et al., 1997).According to Schneider et al. (1997), ISB may lead to symptoms o f posttraumatic stress disorder.They wrote that people who experience sexual harassment exhibit similar psychological effects as victims o f trauma.Furthermore, people who have experienced ISB in the workplace are likely to experience it on an on-going basis rather than as an isolated incident.Rothstein's (1993) view o f ISB as a professional issue provided a lens through which the management o f the experience o f ISB may be viewed.The healthcare practitioner's experience of ISB results from multifaceted interactions o f a complex array o f factors including personal, environmental, and societal influ ences, underscored by their role as professionals.This role begins in education and a num ber o f studies have shown that student health care professionals are at risk for experiencing high levels o f ISB (McComas et al., 1993;Recupero et al., 2004;Vukovich, 1996;Williams et al., 1999).ISB that is experienced in the work place o f the healthcare professional may be influenced by the setting, the nature o f the work, as well as the clients.The settings in which healthcare professionals' work place them at risk for the experience o f ISB, are places such as consulting rooms, quiet audiology booths, and hospital wards.Close physical contact is necessary in many aspects o f healthcare.Healthcare workers may provide-a sympathetic ear to clients and/or their caregivers and family members, and transference is a well-documented phe nomenon in healthcare provision.Sexual control problems may be experienced by the clients served by healthcare professionals, such as patients with brain injury (Bezeau, Bogod & Mateer, 2004;Lawrie & Jillings, 2004;Philips & Schneider, 1993), and severe learning disabilities (Murphy, 2003).Recently, models for effective management o f ISB with people who have sexual behav iour control issues have been described in the literature (Bezeau et al., 2004;Lawrie & Jillings, 2004).
ISB was identified as a serious professional issue in speech-language pathology by Williams et al. (1999) who investi gated the experiences o f ISB by members o f the New Zealand Speech-Language Therapists' Association as well as third and fourth year students studying speech-language pathology.Wil liams et al. did not include audiologists in their study.More than two-thirds o f the students and almost 85% o f the qualified speechlanguage pathologists reported at least one experience o f ISB.The current study was designed to determine the experiences o f ISB directed to SLP/As in South Africa because variables that impinge on professional practice may differ in different geo-political con texts.

Aims
The primary aim o f this study was to investigate the extent and nature o f the experience o f ISB by qualified speech-language pathologists and audiologists (SLP/A) as well as students studying speech-language pathology and/or audiology in South Africa

Research design
This study took the form o f a postal survey research design because the aim was to partially replicate the study conducted by Williams et a l.(l999) in New Zealand who adapted a question naire developed by MComas et al. (1993).A survey design was appropriate for this study because it allowed the researchers to access a large sample.The anonymity assured by the design gave the respondents more opportunity to answer honestly questions which related to very personal information on a sensitive topic (Babbie, 1995).One o f the disadvantages o f survey research is that the answers may be unreliable as a result o f misunderstanding o f the question or the irrelevance o f the question to the respon dents.Furthermore, the researcher has little control over when and where the questionnaire is answered.The respondents may leave questions unanswered, not understand questions or not answer the questionnaire in privacy.
However, the survey had been used successfully by McComas et al. (1993) as well as Williams et al. (1999).

Ethical considerations
The researchers were granted permission to conduct this research by the Ethics Committee (Humanities) o f the University o f the Witwatersrand.Because o f the sensitive nature o f some of the questions that could evoke difficulties for the respondents, a list o f available counselling services was attached to the question naire.Included in the information letter that was attached to each questionnaire was an assurance o f confidentiality and anonymity o f the participants.The participants were informed that participa tion in this study was voluntary and that their completion o f the Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.)questionnaire was interpreted as their consent to participate in the study.They were asked to avoid including any identifying infor mation in the questionnaire, and were asked to mail the responses in a sealed envelope directly to the researchers.

Participant Selection Criteria
Participants were required to be SLP/As working in South Africa or SLP/A students at South African universities.The students were required to be in their third or fourth year of study because they would have had contact with clinical work by this level o f study.

Sampling
Qualified SLP/As.A mailing list o f all registered SLP/As was obtained through the South African Speech Language and Hearing Association (SASLHA).Systematic sampling was used to gain a representative sample from the larger population.This requires less time, and is cheaper and more practical than simple random sampling.However, it is not as accurate as simple ran dom sampling and it may result in a cyclical order o f sampling, which may result in a biased sample (Babbie, 1995).Although this method o f sampling results in a sample o f convenience, the researchers were intent on surveying SLP/As nationally.The questionnaire was mailed to 78 qualified SLP/As.
Student SLP/As.The questionnaire was distributed to 262 students in the third and fourth year o f study at all South African universities that train SLP/As.

Response rate
Qualified SLP/As.According to Babbie (1995), a 50% response rate for postal surveys allows for adequate analysis and provides an accurate representation o f the subjects.Fifty-six questionnaires were returned by qualified SLP/As, which yielded a response rate o f 71.7%.This high response rate implies that the respondents had an interest in this topic and alludes to the impor tance o f the experience o f ISB in clinical practice in South Africa.All o f the responses received were from female SLP/As.It is pos sible that no male SLP/As received a questionnaire as a result of the sampling procedure which did not take into account the few male SLP/As in South Africa.The lack o f information with re gard to the experiences o f male SLP/As in South Africa is an important limitation o f this study, given the number o f studies that have demonstrated that male health care workers experience ISB (Broedel-Zaugg et al., 1999;M adison & Minichiello, 2001;McComas et al., 1993).
; Student SLP/As.Sixty-two questionnaires were returned by student SLP/As which yields a response rate o f 23.6 %.All the universities that were included in the survey were represented in the sample.The low return rate renders the data unrepresenta tive o f the student population and therefore leads to difficulties in the interpretation o f the results.It is possible that the students had not been exposed to any o f the behaviours targeted in this study.Alternatively, perhaps the poor response rate was due to the fact that the survey was conducted at a particular time o f year in the university timetable which included examinations followed by a vacation period.The researchers acknowledge that this poor return rate is a limitation o f the study, and that the generalisability o f the results to the general student population is restricted.As with the qualified SLP/As all the respondents were female and thus the results can only be generalised to the female population o f student SLP/As.I

Description o f participants
Fifty-six qualified SLP/As and 62 student SLP/As partici pated in the study.The demographic data o f the qualified SLP/As are summarised in Table 1.The qualified SLP/As ranged in age from 20-65 years, and in experience from new graduates to clini cians with more than 20 years experience.The participants worked in a variety o f settings.The sampling method might have been inappropriate to some extent in that work contexts were not necessarily represented fairly.For example, only one respondent worked in a university setting.Fifty-seven o f the student SLP/As ranged in age from 20-24 years and five were between 26 and 30 years o f age.Sixteen students were in third year and 46 students were in fourth year.Although the researchers were aware that English is not the home language o f all SLP/As in the country, the questionnaire was produced in English only and home language was not a con sideration in the participant selection criteria.The reasons for this limitation were the time and financial constraints imposed by the study.However, most o f the professional literature that is con sulted by SLP/As is in English, and therefore SLP/As are pre sumed to have a fairly good reading comprehension level o f Eng lish.O f note is that five completed questionnaires had comments written in Afrikaans in the open-ended sections.The researchers The South African Journal o f Communication Disorders, Vol. 53, 2006 Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.)acknowledge that the language o f the questionnaire might have limited the number and/or quality o f the responses.
The information letter that was attached to the question naire emphasised that the questionnaire pertained to the experi ence o f ISB in the workplace only.The questionnaire was pre sented with the topic o f the research as 'The Experience o f Inap propriate Sexual Behaviour in the W orkplace', which served to remind the respondents that the survey was focussed on the workplace.
The questionnaire consisted o f a total o f five sections, which included both open and closed type questions.Nonexhaustive categories were added to ensure that all possible re sponses were catered for (Babbie, 1995).This took the form o f "other" and "add any comments".
The first section consisted o f a set o f questions to deter mine the biographical data o f the respondents.The information that was sought included gender, age, years o f experience or year o f study (for students) and place o f work.No information was sought with regard to variables such as home language, cultural background, gender identity, race, or ethnicity because o f the scope o f the study.However, this information might have con tributed to the depth o f the analyses and the information that was obtained.The second section consisted o f a set o f questions to determine the types o f ISB experienced by the participants.These took the form o f yes/no questions.This section was based on the questions published by Williams et al. (1999), which de scribed and classified ISB as mild, moderate, or severe.The third section consisted o f a set o f questions to determine from whom the ISB was experienced as well as in which contexts it was ex perienced

Distribution o f Questionnaire
Qualified SLP/As.M ost o f the questionnaires were sent by mail.Twenty questionnaires were hand delivered to the par ticipants to reduce the postage costs.To ensure the participants' confidentiality, the completed questionnaires were not personally collected by the researchers but were returned by mail.All ques tionnaires included a stamped, addressed return envelope.
Student SLP/As.Questionnaires, along with the covering letters, were distributed to the SLP/A students at the University o f the W itwatersrand in their private mailing boxes at the univer sity by the researchers.The students were asked in the informa tion letter that was attached to the questionnaire to place their sealed and completed questionnaires in a box allocated for this purpose.To ensure anonymity, they were asked to place the completed questionnaire in the envelope with which they had been provided and to seal it.For the students at the other univer sities, each head o f department was mailed a batch o f question naires, with a letter requesting that the questionnaires be distrib uted to all third and fourth year students.The information letter to all students requested that the questionnaires should be mailed directly to the researchers in the stamped return envelope which was attached to the questionnaire.
The questionnaire was analysed using descriptive statistics to summarise, organise and describe the data.Frequency counts were completed for each section o f the questionnaire, resulting in descriptive data that accounted for the frequency o f occurrence of ISB, the effects o f the ISB, the contexts in which ISB was experi enced as well as the management strategies that were employed.A broad thematic analysis was completed on the open-ended re sponses in line with the aims o f the study and the themes that were identified, as well as personal stories, were analysed to comple ment the quantitative data (Pidgeon & Henwood, 1996).McComas et al. (1993)

Reliability and validity
In order to control for the threat o f researcher bias and to enhance the reliability o f the analyses, a. second rater was em ployed to analyse the responses (Babbie, 1995).The rater, a quali fied SLP/A, was familiar with the research topic, as well as the Williams et al. (1999) study.The rater was given access to the raw data first and subsequently read the researchers' analyses o f the data.M ost o f the data was analysed quantitatively and was there fore indisputable.However the qualitative data, generated by the open-ended questions and comments that were made by the re spondents, were open to interpreter bias (Babbie, 1995).Further more, the qualitative data were used to support the interpretation of the quantitative data.In order to control for researcher bias the rater and the researchers discussed how best to represent the re sults and write up the findings (Pidgeon & Henwood, 1996).

RESULTS
The results are presented in five sections as per the aims o f the study.
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Severity and frequency o f the experience o f ISB I
The experiences o f ISB were categorised as mild, moderate or severe as per McComas et al. (1993).The data revealed that 55% o f the qualified SLP/As and 45% o f the student SLP/As had experienced ISB at least once in their professional lives.Tlie types and severity o f ISB experiences are reflected in Table 2.
M ild ISB was experienced by 55% o f the qualified SLP/As and 42% o f the student SLP/As.Williams et al. (1999) reported that mild ISBs were underreported because the SLPs did not con sider mild behaviours to be offensive.It is possible that under reporting occurred in the present study.Moderate ISB was experi enced by 41% o f the qualified SLP/As and 16% o f the student SLP/As.Severe ISB was reported by 26% o f the qualified SLP/As and 8% o f the student SLP/As.
The classification o f severity is an arbitrary one and in a way minimises the experiences in the mild category and draws attention to those in the severe category.The questionnaire did not ask the respondents to rate the severity; perhaps this is a limitation o f the categorisation strategy employed by McComas et al.

Analysis o f Data
Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.)

Question
Qualified Student

M ild ISB
Have suggestive stories ever been told to you?
Has an offensive joke ever been told to you?
Have flattering remarks about your appearance that made you uncomfortable ever been made?Have you been stared at in a way that made you uncomfortable?
Have you ever been asked for a date?
Has anyone suggested that you 'get together' for a drink?

Moderate ISB
Have crude sexual remarks been made to you?
Have any attempts been made to draw you into a discussion about your private sexual matters?
Have you ever been propositioned (e.g.asked you to have sex with him or her)?
Have you ever been deliberately touched (laid a hand on your bare arm or put an arm around your shoul ders) in a way that made you feel uncomfortable?

Severe ISB
Have you had genitals exposed to you?
Have 3.2

The effects o f ISB
The respondents experienced a variety o f physical and emo tional reactions to their experiences o f ISB as well as consequences in the work-setting.M ost o f the consequences that were reported were psychological, although the respondents experienced physical symp toms as well.Some o f the consequences that were reported to have affected work performance were' serious, such as the resignation o f four SLP/As from their jobs.The; study did not determine whether the effects were long-lasting or not.I The frequency and nature o f these effects are presented in Table 3. j

Sources o f ISB
The findings showed that 35% o f the qualified SLP/As and 30% o f the student SLP/As reported that ISB was predominantly di rected by clients, and o f these respondents, 28% o f the qualified SLP/ As and 30% o f the student SLP/As perceived that the perpetrators might be expected to have sexual control difficulties due to their un derlying pathology.Other sources o f ISB included the parents, spouses, and children o f the clients.Patient's caregivers were reported to be the perpetrators o f ISB by 4.8% o f the student SLP/As.ISB was reported to have been perpetrated by employers and colleagues in senior positions by 8.9% o f the qualified SLP/As, and 5.3% o f the qualified SLP/As had experiences o f severe ISB directed at them by hospital porters.None o f the student SLP/As reported having experi enced ISB from faculty workers or supervisors.Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.) i<?R was e x p e r i e n c e d by the respondents in a variety o f i«-Jttin e s ISB was e x p e r i e n c e d by 0.8% o f the student SLP/ A s tn d 20% o f the q u a l i f i e d SLP/As in hospital settings.Simi larly ISB was e x p e r i e n c e d by 3.2% o f the qualified SLP/As and 3 6% o f the student SLP/As in rehabilitation centres.ISB was e x p e r i e n c e d in nursing homes by 4.8% o f the qualified SLP/As and 5.3% o f the student SLP/As.
ISB experience was reported in school settings by 8.1% o f the qualified SLP/As and 1.7% o f the student SLP/A, all o f whom experienced ISB from their colleagues.Unfortunately, the questionnaire did not determine whether the perpetrators were superiors in the work-setting, although two o f the respondents who described their experiences in the open section o f the ques tionnaire reported that their ISB experiences were directed by their school principals.
ISB was experienced in private practice by 16.1% o f the qualified SLP/As and by 1.6% o f the qualified SLP/As in the industrial audiology setting, and was experienced in speechlanguage and/or hearing clinics attached to universities by 40% o f the qualified SLP/As and 17% o f the student SLP/As.ISB was experienced in rural settings by 4.8% o f the student SLP/As.

M ethods o f dealing with ISB
The experience o f ISB was ignored by 30.3% o f the qualified SLP/s and 38.7% o f the student SLP/As.One o f the strategies that were employed by 19.6% o f the qualified SLP/As was to discuss the ISB with their clients, and 14.2% discussed the experience o f ISB with their supervisors.Similarly, 11.2% of the student SLP/As chose to talk to their clinical tutors about the ISB, and 6.4% o f the student SLP/As spoke to the clients.Call ing on co-professionals to manage ISB within the team o f health care professionals was employed by 3.6% o f the qualified SLP/ As.Termination o f intervention with a client as a result o f ISB was reported by 1.7% o f the qualified SLP/As.These findings are similar to those o f W illiams et al. (1999).

Perceptions with regard to preparedness to deal with ISB in the professional setting .
Although 37% o f the qualified SLP/As and 37% o f the student SLP/As felt that they had handled the situation effec tively, 82% o f the qualified SLP/As and 58% o f the student SLP/ As believed that specific training in the management o f ISB would be beneficial.Moreover, 64% o f the qualified SLP/As and 34% o f the student SLP/As indicated that they had not re ceived any training at any point in their careers with reference to the management o f ISB in clinical practice.This finding was also evident in W illiams et al. (1999) andMcComas et al. (1993), who found similar trends with regard to SLPs and physiotherapists.
The respondents identified specific topics that they felt would be beneficial to include in a training programme.Quali fied SLP/As and student SLP/As suggested similar topics such as assertiveness training, how to define ISB, deal with ISB, respond effectively to ISB, as well as procedures to report ISB.In addi tion, 85% o f the qualified SLP/As and 58% o f the student SLP/ As indicated that they were not familiar with the South African laws pertaining to ISB, and suggested that this aspect be in cluded in training courses.

W ork settings in which ISB was experienced
The results o f this study showed that SLP/As in South Af rica are vulnerable to the experience o f ISB in their work settings.The high response rate, as well as the results o f the study, con firms that the experience o f ISB in the workplace is a serious pro fessional issue.At least half o f the respondents reported having experienced ISB at least once, and although the majority o f these experiences were mild, m any o f the respondents had had to deal with the experience o f severe ISB.The findings are similar to those established by W illiams et al. (1999) although qualified SLP/As in South Africa reported more experiences with severe ISB.McComas et al. (1993) reported that half o f their qualified physiotherapy respondents and a third o f their students had ex perienced severe ISB.Despite the difficulties with explaining why the experience o f severe ISB by the respondents was common, the results o f the current study reveal that SLP/As in South Africa are vulnerable to severe personal harm, the most serious o f which comprised violent encounters with co-workers, but also extended to experiences o f ISB that the respondents did not know how to resolve and which led to remarkable life changes such as chang ing career direction and interest.
The value o f examining the experience o f ISB as a profes sional issue is warranted by the finding that the majority o f ISB was directed by clients, their caregivers, or family members.M any theorists have attempted to provide a classification or a typology o f the person who directs ISB.For example, Madison & M inichiello (2001) described harassers in terms such as 'the con fidante', 'one-of-the-gang', and 'the bully' among many others, which describe the wide variety o f behaviours as well as inten tions that characterise harassers.However, clients and their care givers cannot be viewed as members o f the typical workplace and therefore the typology o f harassers does not necessarily translate into healthcare settings; indeed, the healthcare context is not nec essarily comparable to commercial work environments, nor is there a set o f features that defines healthcare contexts.However, clients who present with communication disorders and/or their caregivers can be viewed, in many cases, as vulnerable and fragile members within the healthcare context.W hile transference is a well recognised notion in the psychology o f healthcare (Hall, 2001) the behaviours that result from transference and countertransference have not traditionally been labelled as harassment although they fit the definitions o f harassment provided by the South African Labour Relations Act (Department o f Labour, 1995) as well as that o f the EEOC (1980).In most cases, the ex perience o f ISB by the client is blamed on the healthcare profes sional's breach o f the fiduciary relationship (Hall, 2001).Simi larly, the person with a communication disorder who finds the SLP to be empathic and sensitive to his or her emotional needs might not be cognisant o f the need, or have the skills, to maintain and limit their relationship boundaries such as role, space, lan guage or physical contact (Hall, 2001).In a similar vein, it is well recognised that people who have sustained head injuries have problems with inhibition and the control over their sexual behav iours (Bezeau, et al., 2004).In line with this, ISB was identified as a symptom o f the client's condition by most o f the respondents in the current study.The South African Act (Department o f Labour, 1995) specifies that the perpetrator is aware o f his or her behav iour and knows that it could be unacceptable, but there is ample evidence that clients who have sustained head injuries have im paired executive function and reduced awareness and are thus not able to judge the appropriacy o f their behaviours (Lawrie and Jillings, 2004).It is unfortunate that the questionnaire did not de-

DISCUSSION
Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.)termine the type and severity o f the disorders with which the cli ents presented.
The majority o f respondents in the current study did not perceive the behaviours o f clients and/or their caregivers as unac ceptable or as harassing, although at least 10% o f respondents classified their client's behaviours as harassment.This finding mirrors those o f McComas et al. (1993) andW illiams et al. (1999).Williams et al. posited that to label ISB as harassment implies that the healthcare professional has to apportion blame on the perpetrator, but victims o f harassment prefer to apportion blame to themselves or to circumstances.
In the present study, the consequences did not necessarily determine whether the respondents perceived ISB to be harass ment.One o f the respondents resigned from her job because she could not cope with ISB directed by clients in a nursing home, but she did not perceive the ISB to be harassment.Rothstein (1993) suggested that healthcare professionals might be desensitised to the brutality o f sexual harassment by the extent o f violence and related sexual behaviours which are prevalent in m odem society, and that the abuse might begin in student years.He wrote, "Perhaps shock gives way to coping in a perversion o f the right of passage into professionalism" (p.739).Rothstein did not take into account the nature o f people who elect to enter the profession of SLP/A, nor the behaviours that are taught to SLP/As as they de velop into clinicians.Although the literature is very sparse in the field o f education o f SLP/As, there is some evidence that suggests that SLP/As are taught to be accepting, unconditional, and empathic (Goldberg, 1997) but these attributes, if not moderated, could result in SLP/As being susceptible to abuse.Further re search may help to explain why SLP/As did not view ISB directed by clients to be harassment even if the consequences were severe.
Not unlike the participants in the study conducted by W il liams et al. (1999), respondents in the current study reported the experience o f ISB directed by co-workers and colleagues.W il liams et al. reported that more severe ISB was directed by clients but the current study did not concur.The most serious report in the current study was a violent encounter o f a qualified SLP/A with a hospital porter who hurt the; respondent physically although actual sexual penetration did not occur.
None o f the student S L P /^s reported having experienced ISB from faculty workers or supervisors which was somewhat unexpected, given the figures that' have demonstrated that ISB in educational settings remains a significant problem on campuses across the globe (Recupero et al!, 2004).It is possible that the poor response rate o f the student SLP/As had an effect on the re sults.On the other hand, it is possible that in a predominantly female profession taught predominantly by women, that the chances o f ISB are greatly reduced.
In contrast, ISB was experienced by the respondents in this study in most work settings.Kamel and Hajjar (2004) described the intense burden for nursing home staff created by ISB, which was true for the SLP/As in the current study.The hospital envi ronment is a significantly risky environment as demonstrated by the results o f the current study which is supported by the large body o f research on ISB that is experienced by healthcare profes sionals in hospital settings (Phillips and Schneider, 1993;Recu pero et al., 2004).In private practice, SLP/As may work alone or with a limited number o f other SLP/As which leaves them rela tively powerless and an easy target for an ISB experience.Addi tionally, SLP/As may meet with a client's parent or caregiver in the early mornings or evening, times which once again provide an opportunity for ISB to take place.| SLP/As also work often behind closed doors, a situation that creates vulnerability for them.The experience o f ISB in rural settings is an important finding when considering the fairly recently introduced period o f Community Service for newly qualified South African SLP/As, many of whom are placed in rural settings.In the main, new graduates are young, inexperienced in the work place, are in the earliest stages o f independence and their dissociation from their clinical super visors in the university setting.These variables place the new graduate at risk for ISB.Finally, the silence and isolation o f audi ology test environments places audiologists at risk for ISB.
M ost o f the respondents adopted the least assertive strate gies to manage the experience o f ISB, which was similar to the findings o f W illiams et al. (1999) and by researchers in allied healthcare professions (Schneider et al., 1997).For example, Sandberg, McNiel and Binder (2002) found that although nurses experience very high levels o f quid pro quo sexual and hostile environment harassment, very few cases had been reported by the nurses that they studied.McComas et al. (1993) discussed re search that has indicated that healthcare practitioners may not be prepared for the experience o f ISB which then contributes to its reoccurrence.Ferns (2006) related her findings with regard to the actions taken by nurses to manage ISB to their gender, their ex posure to violence in society, the status o f their profession, as well as beaurocratic structures.The SLP/As in the current study chose to ignore ISB much o f the time, but also chose to confront their clients and/or caregivers, or their colleagues.In line with the findings by W illiams et al. (1999), most o f the respondents per ceived their actions to have been successful although most of them indicated that in-service training as well as training at the undergraduate levels would be beneficial.Students reacted in similar ways to qualified SLP/As although they reported that they avoided confrontation with the perpetrator o f the ISB.
The experience o f ISB is a serious issue, and yet not one respondent was aware o f the laws in South Africa pertaining to sexual harassment.South Africa is one o f few countries to pro hibit sexual harassment directly through legislation.The Labour Relations Act o f 1995, section 203 (1) includes the 'Code O f Good Practice On The Handling O f Sexual Harassment C ases' (Department o f Labour, 1995).It is incumbent on SLP/As who are employers, managers, or employees, to be cognizant o f the requirements o f the Act.For example, the Act specifies that managers are responsible for ensuring that the workplace is free o f sexual discrimination; that policy statements on sexual harass ment should be communicated effectively to all employees; that employers should develop clear procedures to deal with sexual harassment; and that employers and employer organisations should include the issue o f sexual harassment in their orientation, education and training programmes o f employees.

CONCLUSION
This study o f South African SLP/As revealed that more than half o f the respondents had some degree o f experience with ISB directed by their clients or their caregivers, and colleagues in their professional lives.Most experiences were mild to moderate, although severe experiences were reported, and the consequences o f the ISB experiences ranged from feeling mild anxiety to re signing from the job.ISB was experienced in a number o f work settings including schools, hospitals, private practices and univer sities.In general, the respondents adopted the most nonconfrontational and least assertive strategies to manage their ex periences o f ISB.Most o f the time, the respondents did not per ceive ISB to be o f a harassing nature, even those experiences that resulted in significant consequences.
The South African Journal o f Communication Disorders, Vol. 53, 2006 Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.)The experience of ISB is an infringement of human rights, no matter if the recipient perceives the ISB not to be harassing.More than half of the respondents in the current study reported that they had experienced ISB, and although most of them did not label the experiences as harassment, they reported a range of con sequences which could be classified as hostile environment har assment and to a lesser extent, quid pro quo harassment.If the ex perience of ISB is acknowledged to be a professional issue, then it warrants a number of questions to be researched and debated.SLP/As need to exam ine the implications of the high incidence of ISB, the perceptions of acceptability of ISB, and the management strategies that are used.For example, Rothstein (1993) asked whether professionals are in fact doing their clients an injustice by allowing their clients to behave inappropriately.Rothstein's ques tion is just one of the questions that challenge professional mores in SLP/A.This is not a case of apportioning blam e because ISB is an extremely complex phenomenon, but could rather be viewed as responsible appraisal o f the values and the nature of the healthcare professions and its professionals to determine whether existing practices either encourage or do little to discourage ISB.The pro fessionals might question whether they communicate effectively and explicitly to their clients and their caregivers as well as col leagues apropos the boundaries that they wish to maintain.The professions might need to determine whether clinical interven tions recognise and manage adequately transference and counter transference, and furthermore, whether ISB is promoted by pro fessional behaviours that are considered by healthcare profession als to be appropriate and integral to optimal programme efficacy.The professionals may investigate the personality traits of those attracted to the professions and might determine at which point these traits and/or behaviours become abused.Research might address issues surrounding intimacy in the professions.For exam ple, SLP/As engage with emotional intimacy by virtue of their involvement with communication.In addition, SLP/As connect intimately on a physical basis such as in their management o f cli ents in acute care settings, in areas such as dysphagia, and in vari ous aspects of audiology where the audiologist is required to be in close physical proximity to the client.Assertiveness is one of the traits that deter harassment.SLP/As might reflect on whether they assert themselves as a profession and as professionals.
The successful management of ISB is dependent on the cooperation of stakeholders at a number of levels when consider ing that sexual harassment is an individual human rights issue, a professional issue, as well as a societal issue (Rothstein, 1993).The current study showed that 80% of the respondents agreed that SLP/As in South Africa should receive training in the manage ment of ISB at the undergraduate level.The results of this study, not unlike those of W illiam et al. (1999), suggest that, for various reasons, SLP/As who participated in this study may have allowed ISB to occur.They were not necessarily passive recipients of ISB in that many of them did take action and most of them expressed that they would recommend both under-graduate preparation for and post-graduate training in managing ISB.Furthermore, the study revealed that SLP/As did not perceive ISB in the clinical setting to be harassment although the consequences were often harmful.The results of the study highlighted that the experience o f ISB by SLP/As is common in South Africa and that knowledge and skills are lacking with regard to the prevention of ISB as well as the recognition and management of ISB.Hence, the responsi bility of training institutions, as well as employing bodies, is inarguable; however, individuals have to take responsibility for their own safety and well-being and have to be proactive in seeking information including their legal rights and responsibilities.
The vast literature on sexual harassment in the workplace has shown the complexity and pervasiveness of this world-wide phenomenon.Sexual harassment results from interactions be tween gender, race, and class on the power dynamics at the organ isational, socio-cultural, interpersonal or individual levels.The current study did not collect race data and only women were sur veyed.In addition, limited information was obtained with regard to the organisational structure of the work settings, the socio cultural status of the respondents, and their location in organisa tional hierarchies.However, the results of this study showed clearly the high frequency of ISB experiences by SLP/As in South Africa which calls for further research.It is recommended that further studies investigate ISB experiences within a broader framework taking cognisance particularly of the convolutions of South African history in which discrimination and power laid the foundations for current socially constructed systems.As in other geo-political contexts, social interactions, including ISB, have been carefully bred within race-gender constructions in South Af rica.Future research which will inform professionals with regard to the prevention, recognition and management of ISB might ad dress how the socially constructed systems within which SLP/As function are organized around characteristics such as race, gender, class, ethnicity, and sexuality, and how these identity systems in teract and mutually shape and reinforce each other.In addition, research might examine the nature of power in the workplace of the SLP/A and its role in maintaining structures of inequality that affect individual and group identities and experiences.
As professions develop and change, so they need to exam ine their professional and ethical foundations.The study revealed that ISB is a common experience of SLP/As in South Africa.It is therefore incumbent on educational institutions, professional bod ies, and individuals to recognise that the experience of ISB is a significant issue in professional practice in South Africa, and to put into place mechanisms for research and analysis, reflections on professional practice, and advocacy and protection of SLP/As in the workplace.Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.)Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012.) . The study aimed to determine (a) the extent o f SLP/As experience with ISB; (b) the type o f ISB encountered; (c) the sources o f ISB in their workplace (d) SLP/As perceptions o f the consequences of their ISB experiences, (e) the strategies employed by SLP/As to manage their ISB experiences, and (f) SLP/As perceptions with regard to their preparedness to deal with ISB in the professional setting.
et al. (1999) adapted a questionnaire developed by McComas et al. (1993) who investigated ISB directed at physiotherapists in Canada.Neither McComas et al. nor Williams et al. published their questionnaires, and thus the present re searchers developed a questionnaire based on the reports o f W il liams et al. and McComas et al.Workplace settings were defined as they exist in South Africa as well as to accommodate audiolo gists who were not surveyed by W illiams et al.Additionally, the participants were asked to indicate whether they perceived the behaviour to be symptomatic o f the client's condition.Hence, the current study was a partial replication o f W illiams et al.The re searchers acknowledge the limitations implied by a lack o f pilot ing the questionnaire which was the result o f time pressure to complete the study.
. The fourth section consisted o f a set o f open-ended questions to determine the effects on the participants as a result o f the experience o f ISB.The final section consisted o f a set o f closed-ended and open-ended questions to determine the various ways in which ISB was managed and what the respondents felt about training at an undergraduate level.One closed-ended ques tion asked respondents whether they had knowledge about the law in South Africa regarding ISB.Respondents were invited to add any extra comments.(See appendix for copy o f the question naire).
categorised the severity o f ISB which resulted in their division o f the questions that they posed to their respondents into mild, moderate and severe categories.Because the questions that were employed in the current study were almost identical to those used by McComas et al., severity o f the ISB was analysed as per their categories.The results o f the qualified SLP/As and student SLP/As were analysed separately because o f their possible differ ences with regard to age as well as clinical experience.
Please describe the effects that the experience of inappropriate sexual behaviour had on you.Did it affect your work perform ance, decrease your work productivity, motivation , time off, requests to change work placement etc.? Did it increase your physical stress (e.g.insomnia, headaches, weight gain, fatigue, pains and digestive problems)?Did it increase your emotional stress (e.g.guilt, depression, nervousness)?Other effects?Please describe how you responded to the inappropriate sexual behaviour (please tick).that you were adequately trained during your undergraduate degree on how to handle such behaviours?Do you feel that it would benefit future therapists if training was provided by the university at the undergraduate level?________________ I _____________________________________________________________________ I If so, what topics do you feel should be discussed?Do you know the South African laws regarding inappropriate sexual behaviour?___________________________________Please try to estimate how many experiences of inappropriate sexual behaviours you have had in your professional life Please provide any comments Thank you fo r participating in the study.Your involvement is appreciated.I The South African Journal o f Communication Disorders, Vol.53, 2006

Table 3 : Respondents Reported Effects o f the Experience o f ISB Effects of ISB Qualified SLP/As Student SLP/As W ork Performance
The South African Journal o f Communication Disorders,Vol.53, 2006