Sexuality is an integral part of human life, affecting our physical and emotional well-being. However, for many individuals, discussing sexual issues can be difficult and uncomfortable. The PLISSIT model is a well-known and effective approach to sex therapy that provides a structured framework for professionals to address sexual concerns with their patients. Developed by Dr. Jack Annon in 1976, the PLISSIT model has since become a cornerstone in the field of sex therapy, guiding practitioners in providing sensitive and supportive care. In this blog post, we will explore the components of the PLISSIT model and its significance in empowering individuals to address and resolve sexual concerns.
"PLISSIT" is an acronym that stands for "Permission," "Limited Information," "Specific Suggestions," and "Intensive Therapy." It is a tiered approach that tailors interventions based on the individual's needs and comfort level. Each level provides progressively more focused and comprehensive support, allowing therapists to address sexual concerns in a gradual and sensitive manner.
The first "P" in the PLISSIT model refers to the initial stage of therapy where the therapist creates a safe and non-judgmental space for patients to discuss their sexual concerns. Many individuals carry feelings of shame or embarrassment about their sexual issues, and the permission stage aims to alleviate these feelings by normalizing their experiences. By providing a supportive environment, therapists encourage open dialogue, making it easier for clients to share their feelings and experiences. This stage literally begins with asking permission of the patient to discuss their sexual health. "Is it ok if I ask you abut some of the sexual concerns you've been having?" This question explicitly informs the individual that therapy is an appropriate place to discuss these matters. Even if the individual is not comfortable discussing their concerns at that time, the message that therapy is a safe space to discuss sexuality and sexual function is clearly established. This normalizes the conversation about sex and sexuality and establishes the therapist as an avenue of support.
The "LI", or "limited information" in the PLISSIT model represents the second stage, wherein the therapist offers basic information about sexual matters. This information should be relevant to the client's specific concerns and presented in a straightforward and understandable manner. The goal is to empower the client with accurate knowledge, which can be instrumental in addressing misconceptions and myths surrounding sexual health. In many cases, the primary concern an individual has is related to these misconception. The "limited information" stage might only involve a few sessions focused on psychoeducation surrounding sex and sexuality. Unfortunately, there is an abundance of misinformation about this topic that individuals learn from pornography, movies, television, or social media that can negatively impact sexual function or perceptions of sexuality. The "limited information" stage is focused on reinforcing accurate sexual health information.
The "SS" in PLISSIT, or the "specific suggestions" stage, involves providing tailored suggestions and guidance to address the client's sexual concerns. These suggestions may include practical techniques, exercises, or communication strategies to enhance sexual satisfaction and intimacy. Some tools that might be included in the "specific suggestion" stage may include mindfulness, behavioral relaxation, cognitive restructuring, assertiveness training, intimacy enhancing skills or discussion surrounding the sexual excitation and sexual inhibition systems. The therapist works collaboratively with the client to identify and implement strategies that align with their preferences and values. As this level of intervention is more involved than simply sharing accurate sexual health information, individuals who are in need of this level of intervention generally require a a moderate duration of therapy.
The final stage of the PLISSIT model, represented by the "IT," or "intensive therapy" stage, is reserved for clients with more complex or deeply rooted sexual issues. At this level, the therapy becomes more specialized, and the therapist may delve into deeper psychological and emotional aspects of the client's concerns. This might be related to trauma, concurrent medical or psychiatric issues, or significant influence of the sexological worldview (an upcoming blog post on this!), which relates to factors that influence thoughts or feelings about sex or sexuality. There may be a greater emphasis placed on exploring relational, developmental, or cognitive processes, depending on the clinician's clinical approach to case conceptualization and therapy. This stage often requires additional training and expertise in sex therapy and may involve longer-term therapy.
The PLISSIT model's significance lies in its practical and client-centered approach to sex therapy. By breaking down the assessment and treatment process into distinct stages, it helps therapists address sexual concerns with sensitivity and precision. The gradual progression from permission to intensive therapy ensures that clients are not overwhelmed and can approach the therapeutic process at their own pace.
This approach recognizes and reinforces that not all clients require intensive therapy for their sexual concerns. Many individuals can find relief and resolution through permission and limited information alone, without needing to invest the time or money into a deeper dive into other aspects of their sexual lives. This approach reduces the stigma around sexual concerns and empowers individuals to seek help without fear of judgment.
The PLISSIT model stands as a beacon of hope for individuals struggling with sexual concerns. By creating a supportive and structured environment, therapists can help clients navigate their sexual issues with confidence and knowledge. As we continue to promote sexual health and well-being, the PLISSIT model remains an essential tool in the arsenal of sex therapists worldwide, making a positive impact on the lives of countless individuals seeking guidance on their sexual journey.