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NACS - Nordic Association for Clinical Sexology
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Consensus on
NORDIC SEXOLOGY EDUCATION AND AUTHORISATION
By Fugl-Meyer K S (SE), Almås E (N), Benestad E (N), Dahlöf L-G (SE), van Deurs S (DK), Johansen B D (DK), Kaimola K (FI), Kristensen E (DK), Kontula O (FI), Langfeldt T (N), Sjögren B (SE), Valkama S (FI)
Representatives from DK) Denmark, FI) Finland, N) Norway, SE) Sweden.
Introduction
The Nordic Association for Clinical Sexology (NACS) was established 1978 by representatives from Denmark, Norway and Sweden. Some years later Iceland (1986) and quite reasonly Finland (1998) joined the association. The members of the Scandinavian sexological associations were - and are - mainly professionals within different fields of health-care. The national Nordic sexology associations have during more than 20 years developed their own and specific profiles. The domains of sexological knowledge have, however, always been mutual and have for example been elaborated further during annual Nordic meetings. One important spinoff is the Scandinavian Journal of Sexology, an English-language quarterly which emerged in 1998 after 15 years publication of a Scandinavian-language journal called "Nordisk Sexologi".
Educational questions and strategies have always been a subject of priority and both formal and informal educational co-operations have been widely used. Some of the countries have established postgraduate sexological education, mainly directed towards post-graduate students within healthcare (such as midwifes, nurses, occupational therapists, physicians, physiotherapists, psychologists, social workers). Several textbooks have been written (Hertoft, 1976; 1987; Langfeldt 1993; Lundberg, 1994; Almaas, Benestad, 1997; Lottes, Kontula 2000); each of them mirrors the Nordic sexological distinctive character as well as the mutual Nordic culture.
The different Nordic educational programs have, so far, heterogeneous curriculae. This has been true concerning the different countries but also within each of the countries. The need for inter-Nordic complements of educational programs has been evident and a coordination is judged to increase both quality and quantity as well as to stimulate research within the field. After several years of educational discussions, the general assembly of the NACS, therefore, in September 1997 appointed a committee of three representatives from each of the countries Denmark, Norway and Sweden to work with a Nordic educational project. The purposes were:
to design and offer qualitatively high-standing educational programs structured into different levels and comparable between the different Nordic countries and, to provide regulations for sexological authorisation and act for authorisation of those who are clinically active within the field of sexology.
Quite soon (May 1998) the Finns joined the committee. Unfortunately, the Icelandic sexological organisation did not respond to several invitations to join the committee; although they gave an early positive support. The Nordic Council ("Nordplus") supported the project financially.
During the period 1997 to 2000 the committee - which per se regarded itself as a network - met ten times. Analyses of the current sexolgocial educational situation in the Nordic countries as well as in other European countries and the United States were performed. Thereafter, analyses of expected requirements, seen from the viewpoints of the prospective students of each country, the different countries and the NACS followed. Consensus of Nordic educational programs for clinical sexologists took shape. These programs (see below) were, in 1999, approved by the NACS Annual Meeting, Grimstad, Norway ("Sexological Education and Authorization of Clinical Sexology", NACS, 1999; Almås et al, 2000).
In order to secure the (basic) quality of the sexological education and clinical practise of sexologists the NACS Annual General Meeting in 2000 (Helsinki, Finland) approved the authorisation procedure (see below) ("Authorization procedure for sexologists - based on the Nordic Assiciation of Clinical Sexology education requirements". 2000).
Ethics. Provisional ethical guidelines has been recommended by the NACS Annual General Meeting in 2000 ("Code of ethics for members of organizations of NACS working as sexologists". 2000).
Programs:
The program has three levels and is regarded as mutual for the member societies of NACS. The progran starts with a part (I) termed basic sexology. It then continues along two lines. One termed Clinical sexology, the other termed Educational and Scientific sexology. Each line encompasses 80 points1 (including the mutual part I, Basic sexology). Each country will have possibilities for designing their own profiles and special courses of sexology. Within the different Nordic countries it is also possible for each university (or equivalent) to develop its own special clinical and research directions (paradigms). Thus, the students to be will to a certain extent have opportunities to focus upon their own aims and directions and they also have possibilities to "criss-cross" their education over the borders of the countries. Hence, keeping in mind that sexology is interdiciplinary.
The Nordic working committee has underlined the students´ graduate education as an important basis for this post-graduate program; governing the structure of sexology education programs. Therefore, after authorisation each subject is expected to state her/his graduate education/profession together with the sexological post-graduate authorisation.

The program
Sexology I: Basic sexology (20 points)
Goals: Knowledge and understanding of human sexuality and expressions of sexuality. Knowledge and understanding of sexual concepts and gender roles within different cultures, communities and orientations. Ability to critically and ethically evaluate the different expressions of sexuality. Acquirement of basic knowledge that may be used for further studies in sexual counselling, therapy and education and/or research.
Requirements: Students at university level and/or students/professionals in the fields of social and health care or education.
Duration:1 year half time (totalling 800 hours).
Contents: Human sexuality in its historical, cultural, sociological and religious contexts. Basic concepts and ethics in sexology and in clinical sexology. Reproduction and sexual wellbeing. Sexual development (including medical, social and psychological aspects). Sexual anatomy and physiology. Sexuality during the life span. Male and female sexuality, gender roles. Body awareness, sensuality, eroticism and love. Sexual identity and orientation. Sexual diversities. Sexual harassment and abuse. Sexuality in the medias and commercial sex
Training: With teacher: (5 points) 200 hours. Without teacher: (10 points) 400 hours including group work 200 hours and literature studies.
Literature: 2000 pages. Mainly non-fiction including textbooks, scientific papers and other relevant literature.
Final paper: 200 hours (5 points). Final paper can be an oral or a written presentation, brochure or video.
Examination: Written/oral. Approved final paper and participation in at least 80% of the training/course.
Certificate: Only according to local rules (no authorisation).
Sexology II: Clinical sexology: Sexological counselling (20 points)
Goals: Extended knowledge of theoretical and practical methods of sexological investigations and treatments. The training aims to enable the participants to competently deal with the sexological problems they may meet in their professional capacity and to make them able to cover the three first levels of the PLISSIT-model (permission, limited information and specific suggestions). Ability to confront and process own sexuality and attitudes.
Requirements: Three years of basic graduate education within a clinically relevant field.Minimum 6 months clinical experience. Approved basic sexology (Sexology I) or the equivalent. Clinically sexologically relevant work during the program.
Duration: 1 year half time (totalling 800 hours). Not less than one year and not more than three years.
Contents: Human sexuality in historical, cultural, sociological and religious perspectives. Sexual development (including medical, social and psychological aspects). Sexual anatomy and physiology. Bio-psycho-social knowledge and understanding. The professional encounter with the clients. Case-history and assessments. Body awareness, sensuality, eroticism and love. Life crises and sexuality. Sexual identity and orientation. Sexual diversities and paraphilias. Sexual harassment and abuse. Sexuality, diseases and disabilities. Sexual dysfunctions and sexual problems. Clinical examinations and treatment methods. Sexual counselling - methods and training. Sexual Self Acknowledgement (SSA). Ethics. Supervision.
Training: With teacher: (5 points) 200 hours. Including supervison 75 hours in group or 50 hours individual. Also including individual work with own sexuality for instance as SSA (Sexual Self Acknowledgement) 25 hours continuos setting for example during one weekend. Without teacher: (10 points) 400 hours individual or group activities. Including: 1) counselling clients 100 hours (preferably 15 hours of these as telephone or internet/magazine counselling) 2) peer supervision 36 hours and 3) literature studies.
Literature: 2000 pages. Mainly non-fiction including textbooks, scientific papers, and other relevant literature.
Final paper: 200 hours (5points). Written or other relevant project at scientific level.
Examination: Written/oral. Approved final paper and participation in at least 80% of the training/course.
Certificate:Yes.
Sexology III: Clinical Sexology: Specialist in clinical sexology (40 points)
Goals: Extended knowledge of theoretical and practical methods of sexological examinations and treatments. The training aims to enable the participants to deal competently with sexological problems they meet in their professional capacity and to make them able to cover the fourth level of the PLISSIT-model (Intensive therapy). Competent in supervision and lecturing in sexology.
Requirements: At least 4 years clinical professional graduate education. Approved one year basic (Sexology I) and counselling (Sexology II) or the equivalent training. Minimum 1 years clinical work including supervision/education. Minimum 2 years clinically sexologically relevant work. Clinically sexologically relevant work during the program. Documentation of authorisation for individual clinical work must be in accordance with rules and requirements in the country one shall practice.
Duration: 2 years half time (totalling 1600 hours).
Contents: Sexual development (including medical, social and psychological aspects). Bio-psycho-social knowledge and understanding. The professional encounter with clients. Case-history and assessments. Body awareness, sensuality, eroticism and love. Sexual anatomy and physiology. Current knowledge of medical and pharmacological aspects of sexual function. Training in therapeutic methods, including the theoretical frames of reference. Individual, couple and group treatment/therapy. Assessments , diagnostics and treatments of: a) Sexual dysfunctions and problems b) Sexual complications of diseases, disabilities and their treatment c) Sexual diversities and paraphilias d) Sexual offenders and sexual victims e) Sexual identity problems f) Gender identity problem. Sexual Self Acknowledgement (SSA). Ethics. Supervision.
Training: With teacher: (10 points) 400 hours. Including individual work with own sexuality, for instance as SSA (5 days), plus individual integration work (self therapy) 48 hours (for example 2 hours per month in 24 months). Also including supervision 120 hours in a group or 80 hours individual. Without teacher: (10 points) 1200 hours individual or group activities. Including clinical sexological work 200 hours.
Literature: 4000 pages (10 points): Mainly non-fiction including textbooks, scientific papers and other relevant literature.
Final paper: 400 hours (10 points). Written or other relevant project at a scientific level. For example aiming to be published in Scandinavian Journal of Sexology and/or presented at Nordic or international conferences.
Examination: Written/oral. Approved final paper and participation in at least 80% of the training/course.
Certificate: Yes.
Sexology II: Education and Scientific Sexology (20 points)
Goals: Extended knowledge, understanding and practical skills in scientific sexological analyses and methodologies and in sexological educational target framing, planning, development and carrying out lectures, seminars and other relevant educational activities.
Requirements: At least three years of basic graduate education within a relevant field. Approved Sexology I (basic).
Duration: 1 year half time (totalling 800 hours). Not less than one year and not more than three years.
Training: With teacher: (5 points) 200 hours.
Literature: 2000 pages. Mainly non-fiction incl textbooks, scientific papers and other relevant literature.
Final paper: 200 hours (5 points). Written or other relevant project at scientific level.
Examination: Written and oral. Approved final paper and participation in at least 80% of the training/course.
Certificate: Yes.
Sexology III: Scientific Sexology (40 points)
Goals: Proficiency in designing and performing scientific investigations in sexology and to write manuscripts intended for publication in scientific journals.
Requirements: At least three years of basic graduate education within relevant field.
Approved Sexology I (basic) and Sexology II (clinical or education and scientific).
Duration: 1 to 3 years.
Contents: Specific courses (preferable on 5 points (200 hours) levels) may be included, for example in statistics or other relevant methods ( at the individual level).
Literature: 4000 pages. Mainly including textbooks, scientific papers and other relevant literature.
Final paper: The written paper equals 15 points.

Sexology I (basic) is meant to be given at several places and universities in the different countries. Sexology II probably at one or two localities in each country. Sexology III can possibly be given jointly to students for the different countries - across the national borders (at least during the first years of the program).
The points given refer to the Swedish system: one point equals one full-time week and 40 points equals one full-time year of studies. Hence, 20 points equal one year half-time participation in the program. In this context it can be mentioned that 120 points in Sweden gives a bachelor´s and 160 points a master´s degree provided that at least 80 points of studies are within the specific area and that a total volume of 20 points is a written project/report.

REFERENCES
Almaas E, Benestad E. Sexologi i praksis. (in Norwegian) Oslo: Tano Aschehoug 1997.
Almås E, van Deurs S, Johansen B D, Kristensen E, Kaimola K, Kontula O, Valkama S, Benestad E, Langfeldt T, Dahlöf L-G, Sjögren B, Fugl-Meyer KS. Sexological education and authorization in the Nordic countries. European Federation of Sexology, Berlin 2000.
"Authorization procedure for sexologists - based on the Nordic Association of Clinical Sexology education requirements". In Sexologinytt 2000; 3: 14-15.
"Code of ethics for members of organizations of NACS working as sexologists". Scand. J. Sexol. 2000; 4: 151-152.
Hertoft P. Klinisk sexologi. (in Danish). Copenhagen: Munksgaard 1976. Third edition 1987.
Langfeldt T. Sexologi. (in Norwegian). Oslo: Ad Notam, Gyldendal 1993.
Lottes I, Kontula, O. New views on sexual health: The case of Finland. Helsinki: The Population Research Institute, D37/2000, The Family federation of Finland. Helsinki 2000.
Lundberg PO (ed). Sexologi. (in Swedish). Stockholm: Almqvist och Wiksell Medicin, Liber 1994.
Nordisk Sexologi, Copenhgen: Munksgaard; later Dansk Psykologsisk Forlag 1983-1997.
Scandinavian Journal of Sexology. Copenhagen: Dansk Psykologskt Forlag 1998 - .
"Sexological education and authorization of clinical sexology", NACS. In Sexologinytt 1999; 2: 14-20.