Abstract
Sexual harassment is pervasive in academic health fields. Although a predominantly female profession, early career academics and trainees in occupational therapy (OT) remain vulnerable to sexual harassment. We aimed to describe experiences of sexual harassment of female-identifying academic OT practitioners. We conducted surveys and interviews using Interpretive Phenomenological Analysis to examine participants’ experiences. Ten participants completed the survey and/or interview. Experiences ranged from inappropriate comments to persistent sexual assault. Four themes (blurred lines, unbalanced consequences, “how did I get here?” and “we don’t talk about it”) were generated based on participant responses. Power dynamics and the cultures and values of the OT profession were underlying elements of all themes. The consequences of sexual harassment were severe and affected personal and professional growth. For OT research and education to thrive, stronger support for victims and consistent, appropriate consequences for perpetrators are necessary to minimize negative outcomes for victims.
Introduction
Sexual harassment against women is gaining recognition as a pervasive and serious issue. Emerging evidence suggests women in academia experience widespread sexual harassment. Specific figures vary greatly, with estimates ranging from 11% to 73% in higher education (Bondestam & Lundqvist, 2020). Women with research-focused higher education careers may experience greater levels of sexual harassment with 27% of women at the National Institutes of Health (ICF Next, National Institutes of Health, 2020), 30% of career development grant awardees (Jagsi et al., 2016), and 83% of women in academic medicine (Vargas et al., 2020).
According to the National Academy of Sciences, Engineering and Medicine (National Academies of Sciences, Engineering, and Medicine [NASEM], 2018), sexual harassment is a form of discrimination with three categories of behavior (pp. 24–29). The first category is gender harassment, defined as “verbal and nonverbal behaviors that convey hostility, objectification, exclusion, or second-class status about members of one gender.” The second category is unwanted sexual attention, defined as “verbal or physical unwelcome sexual advances, including assault.” The third category is sexual coercion, defined as “when favorable professional or education treatment is conditioned on sexual activity.” Sexual harassment can be direct or ambient. Gender harassment is the most common type, with the purpose “to put people down and push them out, not pull them into sexual activity” (Cortina & Areguin, 2021).
Predictors of sexual harassment occur at individual and organizational levels. At the individual level, sexual harassment is more likely to happen to people who are women, sexual minorities, and younger in age (ICF Next, National Institutes of Health, 2020). The strongest predictors, however, are organizational in nature (NASEM, 2018, p. 46). Sexual harassment is more likely to occur in environments where men outnumber women, leadership is male-dominated, or in occupations considered less traditional for women (NASEM, 2018, p. 46).
Because contextual factors are the strongest predictors of sexual harassment, it is important to understand sexual harassment across contexts. The factors and context characterizing sexual harassment are consistent with the organizational theory of sexual harassment. This theory suggests that the purpose of sexual harassment is power, and the intention is to sustain patriarchal relations (Kapila, 2017). Specific to academic contexts, the theory indicates that structures of organization hierarchy imbue specific individuals with power leading to an environment prime for abuse.
Most of the work in this area has focused either on women in academia broadly or those in academic medicine. Research published in the last decade is either broad in scope (Anitha et al., 2020) or focused on a specific subfield (e.g., physics; Aycock et al., 2019). Little to no research has occurred in other academic health disciplines, including the allied health professions (Castner, 2019). Most research related to sexual harassment in the allied health professions is focused on the sexual harassment of practitioners by clients (Schneider et al., 1999). Sexual harassment issues are likely to be present within academic occupational therapy (OT), although the profession of OT is predominantly female. OT practitioners are more than 90% female with approximately 7% of OT practitioners working in an academic setting (American Occupational Therapy Association, 2019). Academic OT has a high percentage of early career faculty, with only 39% of faculty having obtained tenure (American Occupational Therapy Association, 2019). In an academic setting, OT departments are embedded within larger colleges of medicine, rehabilitation science, or education, leading to frequent collaborations in male-dominated fields. There are many factors that make academic OT practitioners vulnerable to sexual harassment.
The purpose of this study is to better understand sexual harassment as it is occurring in academic OT. Due to the lack of published evidence on the topic, we began the line of inquiry using a qualitative approach. Specifically, this study explored two research questions:
Method
Phenomenological methods, in particular Interpretative Phenomenological Analysis (IPA), can be used to generate an understanding of how individuals perceive and make sense of a phenomenon (Pietkiewicz & Smith, 2014; Wright-St. Clair, 2016). Researchers work to understand participants’ lived experiences and the meaning they derive from these experiences through semi-structured interviewing, reflection, and storytelling (Cuthbertson et al., 2020; Pietkiewicz & Smith, 2014). The result is a rich description and interpretation of the phenomenon through the development of associated themes (Smith et al., 2009).
In this study, we sought to generate a shared understanding with participants of the experience of enduring sexual harassment as an early-career academic or academic trainee in OT. We conducted semi-structured interviews, guided by the research questions stated above (see Appendix A).
Participants
A convenience sample of participants were recruited via emails to personal contacts, social media posts, and related professional groups. Participants were included if they: (a) were older than the age of 18, (b) identified as female, (c) worked or trained in the OT field, (d) worked or trained (professional degrees beyond undergraduate) in an academic setting, and (e) had experienced what they considered to be sexual harassment during their time in academia. Procedures were followed in accordance with the ethical standards of the revised (2000) Helsinki Declaration, and the research protocol was approved by the first authors’ institutional review board. In phenomenological research, recruitment typically occurs on a rolling basis until the data set reaches saturation, and no novel ideas are generated by participants (Wright-St. Clair, 2016). The study team anticipated that saturation would be achieved with a combination of approximately 12 interviews or statements as this number captures approximately 92% of all themes (Francis et al., 2010). Recruitment concluded when sufficient data were collected to support each research question and no new ideas arose.
Ethics
Because of the sensitive nature of this research, we took extra steps to ensure participant confidentiality. We distributed an internet-based screening method and participants could access the link to initiate the screening process and complete the survey anonymously (See Appendix B). Participants who chose to could generate an anonymous email address to schedule a follow-up Zoom interview to discuss survey responses in depth. In these cases, no personal information was collected, and recordings were destroyed as soon as a transcript was generated. All identifying information was removed from transcripts for the protection and privacy of the participant. Only two members of the research team conducted and transcribed the interviews to limit the number of people who would be able to recognize participants based on their voices. While this process was necessary to protect the identities of our participants, it limited our ability to conduct member checking.
Instrumentation
Interested individuals completed a REDCap (Harris et al., 2019) survey to determine eligibility and indicate the extent of their participation. Eligible individuals could submit a written statement describing the sexual harassment experience, upload a file describing the experience, and/or participate in an interview with the research team. In alignment with the Interpretive Phenomenological tradition (Pietkiewicz & Smith, 2014), interview questions were asked in a variable order based on the direction and flow of the conversation, and therefore each interview differed slightly in length and content. As unanticipated topics or experiences arose, researchers included additional questions to expand on participant responses (Pietkiewicz & Smith, 2014). Interviews were conducted via Zoom video-conferencing software (Zoom Video Communications, 2022). Interviewers completed a reflective memo after all interviews were finished.
Positionality
The research team identifies as female, early career academic OT practitioners, or trainees. Many of the research team members have personal experiences with sexual harassment, which influenced their academic and professional trajectories. Thus, we have a vested interest in highlighting the topic of sexual harassment in academic OT and in seeing it eliminated. We feel a responsibility to provide an open accounting of these experiences and its impact on the individuals and the profession. As future leaders in the field, we aim to create a safe and inclusive profession for ourselves and those who follow.
Analysis
Interview transcripts were auto-generated by Zoom video-conferencing platform, de-identified, and checked for accuracy with audio recordings. Cleaned transcripts were uploaded to NVivo qualitative analysis software (released in March 2020) for visualization and coding (QSR International Pty Ltd, 2020).
The authors adapted the six-phase process described by Braun and Clarke (2021) to structure the analysis. For Step 1 (data familiarization), each written statement and interview transcript was read by all members of the research team. Step 2 (systematic data coding) was completed by two team members using simultaneous initial coding. Coders compared initial open codes to generate focused categories based on conceptual similarities. Coded data were then re-reviewed by all authors. Each author made analytical memos on how the codes were clustered to complete Step 3 individually (generating initial themes). We consolidated focused codes into axial codes before sharing initial themes with the group and working to further collapse/combine themes as appropriate in Step 4 (developing and reviewing themes). During the group discussion, authors worked to refine, define, and name the themes (Step 5), selecting terms and phrases that most closely reflected participants’ experiences. Initial themes were transformed into visual representations and superordinate themes (explanatory phrases), followed by group refinement and synthesis with theoretical models. When possible, we used participants’ own words to enhance trustworthiness (e.g., “blurred lines” and “how did I get here?”). As report writing (Step 6) commenced, authors worked to give voice to the lived experiences of the participants (Cuthbertson et al., 2020; Pietkiewicz & Smith, 2014) and also to consider the themes in terms of their broader meaning and implications, per the recommendations of Braun and Clarke (2006).
Results
The interest survey was initiated by 23 individuals. Eight individuals were not included in the data analysis or findings presented in this article: ineligible (n = 4); no sexual harassment (n = 2); and male-identifying (n = 2). Demographic information presented in Table 1 is inclusive of five individuals who completed the survey indicating that they experienced sexual harassment but did not provide text, upload text, or participate in a Zoom interview. Ten participants entered text, uploaded text, and/or completed Zoom interviews, some participating in multiple ways, resulting in 13 transcripts for analysis. Zoom interviews (n = 6) ranged from 26 to 88 min (M = 51.67 min). Participant demographics are presented in Table 1. As noted in Table 1, most participants identified as cis-heterosexual females and described perpetrators as male. A few participants experienced same-sex harassment, but these are not explicitly separated within the themes described herein.
Demographic Characteristics of MeTooOT Study Participants (N = 15).
Participants reported a range of experiences with sexual harassment and its effects on their personal and professional lives. Experiences ranged from inappropriate comments and microaggressions to coercion, sexual assault, and stalking. Participants reported not attending conferences to avoid specific perpetrators, having work intentionally delayed or stolen by the perpetrator, and leaving their jobs altogether. Four superordinate themes (Figure 1) were generated to describe these experiences: (a) Blurred lines, (b) Unbalanced consequences, (c) How did I get here?, and (d) We don’t talk about it.
Themes.
Blurred Lines
In many cases, participants learned that their sexual harassers wanted more of a relationship beyond what would be expected based on their professional roles (mentor/mentee, colleague, and teacher/student). Participants noted that lines were also blurred due to the nature of academia (Figure 1a). Some participants recalled specific tactics that the perpetrators used to create blurred lines. One participant noted: “. . .he started off with like he, he really wanted his students to feel like they were almost more like peers ” (TRANSCRIPT 22).
Participants reported that actions they took as part of their usual roles as a mentee, student, or colleague (e.g., attending office hours) were viewed by the perpetrator as opening the door for further harassment. As one participant stated: “. . . turns out it was just fueling the fire. . .” (TRANSCRIPT 10). Such actions implied permission and led to more explicit crossing of boundaries.
When participants actively set boundaries with their perpetrator, this usually led to anger and backlash from the perpetrator, including negative consequences for the participant. One participant described, I basically said, you know, “Leave me alone. . . We can be advisor advisee but like that is it and, like this other stuff is not going to happen anymore.” And, and he did not like that. He started stalking me, harassing me. (TRANSCRIPT 22)
Unbalanced Consequences
Participants reported numerous personal and professional consequences related to their sexual harassment. They reported their consequences felt more severe than those of the perpetrator. Personal consequences included depression, anxiety, eating disorders, and nightmares. Participants spoke about the long-term consequences, including prolonged shame, disengagement from success, and imposter syndrome (Figure 1b). For example, one participant reflected on her career thus far, stating, I looked at my CV and saw his name on half the lines. I can’t even like look at my CV anymore and feel pride about any of it . . . I am anxious. I am filled with self-doubt . . . would I have gotten to where I am in my career if not for this? (TRANSCRIPT 10)
Study participants shared a variety of methods for coping with the consequences such as therapy/counseling, moving away from their perpetrator, avoiding interactions and social events, journaling, and medication.
Participants also reported professional consequences and a loss of productivity due to those consequences: I had to put my research project, with which he was helping me complete, on hold so I could identify a new biostatistician to collaborate with. He put me in a very uncomfortable position and delayed my research timeline because he would not stop asking me to spend time with him outside of work. (TRANSCRIPT 6)
In addition to loss of productivity, participants reported a loss of opportunities. In some cases, loss of opportunity was imposed on victims by the perpetrator in retaliation. However, others reported choosing to continue interactions with their perpetrators as the only way to preserve their careers: It can also be very detrimental to your research. Like, you know, if I had dropped him as a mentor completely you know, like, I spent four years collecting this data. That would make it impossible to see it through and to publish it under my name. (TRANSCRIPT 8)
Participants reported adjustments to their behavior and career path years after the experience. In the most extreme examples, participants reported dropping out of PhD programs, moving to a new state, or leaving the profession entirely. The effects of these professional consequences included a reduction in the productivity of OT practitioners in academia. These effects were described by one participant: “You know, there might be just a little drop in, maybe not what we’re able to achieve, but what we do achieve” (TRANSCRIPT 10).
When discussing consequences for the perpetrator, most participants perceived the consequences to be minimal. Many perpetrators appear to still supervise students, advance in their careers, and expanded their research teams. Some participants reported that current academic systems favor the perpetrator: “We [participant and peers] went to talk to his boss, and his boss’s boss and we were told. . . that ‘he’s a rising star..’ . . I was also told directly, ‘be careful’ because he can have a retaliatory personality” (TRANSCRIPT 8).
“How Did I Get Here?”
Throughout the statements and interviews, participants reflected on their sexual harassment experiences with feelings of incredulity about how they had come to be in a circumstance of abuse. Many of the participants reported experiencing audacious comments and behaviors in professional settings. Others reported a gradual increase in harassment experiences from their perpetrator, beginning with microaggressions or mild comments that at first did not feel particularly harmful (Figure 1c). However, these experiences persisted into more dangerous and damaging behavior, following a similar process to grooming (manipulative behaviors that perpetrators use to gain access to a potential victim [RAINN, 2022]): It was definitely a very gradual kind of process like how they talk about like the grooming process. I didn’t obviously realize it was happening at the time, but you know hindsight is 20:20. I look back and definitely see that that was what was happening. (TRANSCRIPT 22)
Many such feelings were woven into accounts of the sexual harassment incident(s), and at other times, participants reflected on what happened after the harassment experience, sharing similar notions. From these reflections, two distinct subthemes were generated, relating to the ideas of audacity and disbelief.
Audacity is defined as “the quality or state of being audacious: such as a. intrepid boldness, b. bold or arrogant disregard of normal restraints” (Merriam-Webster, n.d.). Participants provided statements that elicited this theme such as: “How in the world is that appropriate right now?” (TRANSCRIPT 12) and “. . . How did this turn from us talking shop?” (TRANSCRIPT 12) Audacity was interwoven with statements of emotion and lack of reason. One participant shared: “When you’re in that moment of like ‘I feel scared,’ we just don’t always do things that are necessarily the most logical because we just are reacting out of, out of self-preservation” (TRANSCRIPT 10).
Others told of feelings of disbelief, internal conflict, denial, and self-doubt, which may have been attempts at self-preservation. Time and distance (physical, emotional) from the sexual harassment experience allowed many participants to actively reflect. As one participant stated: “At the time, I just thought, well, that’s inappropriate. That’s not professional. But I never identified it necessarily as sexual harassment. But now I’m like, oh, my gosh, ‘young [self], that was sexual harassment!” (TRANSCRIPT 12)
“We Don’t Talk About It”
The final theme refers to the lack of procedures in place to report sexual harassment, lack of support received from colleagues, and efforts to sweep sexual harassment under the rug. In addition, participants discussed a lack of preparation related to sexual harassment, and the limited or convoluted systems in place in academia for reporting it. Participants recounted the unspoken expectation that if they spoke up about sexual harassment, they would be treated differently. Many described the reporting process as confusing, multilayered, and emotionally taxing. Some only learned about the reporting process after the fact, while others stated that they declined to report the experience because they had no support or training on how to do so. Still others reported fear of retribution or damage to their career (Figure 1d). As one participant stated: “I thought I would get kicked out of the program.” (TRANSCRIPT 22) Another shared, “I’m still early in my career and reputation means a lot in our field and so you don’t necessarily want to get a reputation for anything other than succeeding academically, right?” (TRANSCRIPT 11).
Furthermore, those who attempted to confide in senior colleagues or mentors were often “brushed off” or minimized. Others felt that colleagues were sympathetic but unable to provide support. “I spoke with a female member of the research staff to determine a course of action. She was sympathetic, understood my discomfort, but also understood how impossible it would be for me to say anything.” (TRANSCRIPT 3).
OT is a relatively small field (estimated ~ 128,000 practitioners) with less than 10% of the professionals working in academia (AOTA Workforce survey, 2019). One participant stated: “I did not feel I could speak up given the small community” (TRANSCRIPT 3). Because of this, participants remaining in research and academia felt unlikely to be able to completely distance themselves from the perpetrator, the institution, and colleagues involved in the situation.
Synthesis
We presented the four themes in a specific order; however, these experiences may not follow a linear pathway or have a consistent outcome. Across the themes, power dynamics inherent in the harassment experiences were a constant, underlying thread running. Power dynamics were well-described by one participant, who stated: “In research, your career is so dependent on other people lifting you up” (TRANSCRIPT 8).
Participants shared that success and promotion in OT academia and research were intimately tied to cultivating and maintaining a network for career advancement. The need for a good reputation and strong connections for a successful research career leave many early career researchers feeling powerless and without options. We envision that power dynamics as the thread connecting each of the themes, and that the backing, which underlies all these experiences, is the context of OT (Figure 2).
Integration of Themes and Visualization as a Quilt
We must be very clear that the participants in this study were victims and in no way responsible for their abuse. However, as the research team met to consider the words of the participants and develop the resulting themes, a consistent undercurrent to the harassment was identified. Participants made mention of dynamics that may have, in some part, been related to the values, ethics, and personality of those drawn to helping professions. Participants shared a sense not only of professional obligation to their perpetrator, but a desire to help care for them.
The compulsion to relieve suffering and assist is one of the most admirable qualities of health professionals. OT practitioners are trained to be “client-centered,” sometimes to the detriment of their own comfort. Another participant reflected, “You know, I switched into what we, as, as OTs do so well. . . listen, empathize, validate their emotions” (TRANSCRIPT 10). It can be difficult for OT practitioners to “switch off” this part of themselves.
We contend that while many of our thematic findings are likely shared with other victims of sexual harassment, the way these incidents played out was also influenced by the specific context of OT (see Table 2 for additional quotes). As a participant mused, “Sometimes people, because they’re used to systems and they know the way a system works, they unintentionally follow these patterns, because that’s part of the way you’re supposed to act” (TRANSCRIPT 16). Through this experience, the victims were able to use themselves as a therapeutic modality to create connection and relieve discomfort. Yet it is fair to say that there may be some vulnerability to harassment inherent in relationships with unbalanced power in our field. We must take a critical look at this possibility and be thoughtful about how we might work to counteract this imbalance as a profession.
Additional Participant Quotes Organized by Theme.
Discussion
Sexual harassment of female OT academics is an ongoing problem and is damaging to short- and long-term personal and professional growth. As a relatively young field with a documented shortage of qualified candidates for teaching and research positions, OT cannot risk losing individuals with post-professional doctoral and/or research training. The loss of an academic OT practitioner can amount to hundreds of thousands of dollars of institutional loss drawn from graduate student stipends, faculty mentorship hours, benefits, and training. The loss of these individuals is a loss to the integrity of the profession, a loss to the contributions of the field’s scientific growth, and a loss of academic rigor.
Our analysis revealed four interwoven themes: (a) Blurred lines, (b) Unbalanced consequences, (c) How did I get here?, and (d) We don’t talk about it. These themes parallel reported experiences of female physicians who were sexually harassed by fellow doctors. Stone and colleagues (2019) described this trajectory of sexual harassment experience as: (a) Prelude, (b) Assault and Limbo, (c) Exposure, and (d) Aftermath. We use these dimensions to anchor our findings, distinguish unique applications related to the field of OT, and provide targeted interventions to address sexual harassment moving forward (Table 3).
Recommended Interventions by Stone et al. (2019) “Dimensions of Sexual Harassment.”.
Note. AOTA = American Occupational Therapy Association.
Implementation of organizational policies should primarily focus on the culture of the organization (Bondestam & Lundqvist, 2020). The policy should protect the rights for self-determination and non-discrimination for both individuals and groups, be implemented from the bottom-up, and have strong support from senior leaders who ensure adequate resources and facilitation from engaged and legitimate case managers. However, the policy needs to be supplemented with a positive organizational culture where workers feel safe to speak up and report instances of sexual harassment (Bondestam & Lundqvist, 2020). No participants directly described using Title IX support at their institution, which we expect is because these processes are often unclear and linked to other HR and internal procedures. We suspect this lack of connection may be related to the fact that Title IX in graduate programs is focused on school-based procedures (Title IX of the Education Amendments Act of 1972, 2018) rather than support for the individual and most reports are deemed unactionable (Cipriano et al., 2022; Lorenz et al., 2022). Title IX requires schools that receive federal assistance to collect and share complaints of sex discrimination, including harassment and violence. Title IX does not require ongoing interaction or follow-up with the individual who reported. Furthermore, participants explicitly described not wanting to report because of fear of retaliation, getting a bad reputation within our small field, and/or fear that reporting would not change their situation. Thus, Title IX may not be an effective protection if it cannot confidently be used and trusted. Rather, we suggest that the focus of eliminating sexual harassment must include improving organizational culture, awareness, expectations, re-establishing norms, and supporting victims’ safety in all realms: physical, mental, and professional.
We acknowledge this study had several limitations, particularly our use of convenience sampling, which limits generalizability. Participants were mostly white cis-gender females with only a few participants outside of this demographic group. It is important to note that there are many types of harassment, including sexual harassment, and that members of minority groups may experience these at higher rates which were not captured in this study. We only included participants who were willing to speak up about their experiences and are most likely missing other incidents which may have occurred within this population. Most participants belonged to a younger cohort and may not represent the experiences or perspectives of others with different levels of professional experience. Finally, we acknowledge that sexual harassment is widespread; however, organizational and individual understanding is ambiguous, and the true scope of sexual harassment needs to be more adequately quantified for further research and action.
Conclusion
Female-identifying academic OT practitioners are experiencing sexual harassment. Four themes were identified: (a) Blurred lines, (b) Unbalanced consequences, (c) “How did I get here?” and (d) “We don’t talk about it.” Within each of these themes, power dynamics were at play, and the culture of OT provided a foundation for the form and scope of the abuse. This is a problem that reflects academic culture but poses a unique threat to the OT field. The severity of the effects of abuse, including the loss of OT researchers and educators, have the potential to trickle-down to clinical practice and the quality of care that clients receive. There is a strong, urgent need to create greater support for victims of sexual harassment in female-dominant health care professions such as OT and nursing science. In addition, we contend that more consistent and appropriate consequences for perpetrators may ultimately serve to help eliminate sexual harassment in these fields.
Supplemental Material
sj-docx-1-otj-10.1177_15394492231153120 – Supplemental material for MeTooOT: Sexual Harassment Experiences of Occupational Therapy Academics and Recommendations for Systemic Change
Supplemental material, sj-docx-1-otj-10.1177_15394492231153120 for MeTooOT: Sexual Harassment Experiences of Occupational Therapy Academics and Recommendations for Systemic Change by Rachel Proffitt, Bridget Kraus, Amanda C. Jozkowski, Samantha Shea Lemoins, Jessica Kersey, Rachelle Brick, Jaclyn K. Schwartz and Catherine R. Hoyt in OTJR: Occupational Therapy Journal of Research
Footnotes
Research Ethics Section and Patient Consent
The study was approved as exempt by the Institutional Review Board at the University of Missouri (IRB #2059263).
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Rachelle Brick is funded in part by the Cancer Prevention Fellowship Program in the Division of Cancer Prevention at the National Cancer Institute. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health.
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References
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