As you may recall from a previous post, the PLISSIT Model is an approach used by sex therapists to facilitate case conceptualization and treatment planning for issues related to sexual health. In this approach, there is a gradually increasing level of intervention, focused on addressing the underlying needs of an individual or couple. Developed by Jack Annon in 1976, this trusty acronym stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. My next four blog posts will be focused on increasing an understanding about the stages in the PLISSIT model, but today, in what is arguably the most critical part of the sex therapy process, we begin with the first: Permission.
Why begin with permission? And why is it the most important stage of this model?
Picture this: You welcome a client or a couple into your office for an initial session. You invite them sit down on the couch, you introduce yourself, and you follow up with, "So, tell me about the last time you had sex". You are met with a blank stare and an awkward silence. They may not quite know what to say or how to react. You sit there patiently while your client or the couple squirms uncomfortably in their seat, not realizing that this very private part of their lives would come barging out in such an obvious way. Feel uncomfortable? It's because that's a pretty uncomfortable way to introduce this topic.
Sex and sexuality are among the most personal and vulnerable parts of the human experience. Even from a purely physiological perspective, the act of sex involves the intertwining of two individuals in a vulnerable and intimate way. Using William Shakespeare's proverbial "beast with two backs" euphemistic metaphor, you can also see the physiological vulnerability associated with sex and intercourse. One of the individuals has their back exposed during sex and therefore vulnerable to danger. Its a part of why safety is such a core part to our evolutionary drive for sex.
So what does asking permission do here? Asking permission allows for a patient to be consensual to a conversation and to maintain control over the nature of the disclosure in session. Just like we have expectations that all sexual activity be fully consensual, we similarly need to get consent from a patient before we ask very personal and private questions about their intimate lives.
The patient doesn't just give permission; the therapist is also tasked with creating a vibe, an atmosphere, where discussing sex and sexuality is accessible. Think, “I’ve heard it all before, and no, I’m not judging you for anything you might share.”
In therapy, this might sound like:
“A lot of people feel unsure about this topic—it's okay to explore it here.”
“There’s no right or wrong way to feel about this.”
“We can talk about anything on your mind, even if it feels a bit uncomfortable.”
Let’s say a patient hesitates, their words halting as if they’re not quite sure how to proceed. The permission stage is not about forcing or imposing questions on a patient in which they feel they are forced to answer. Instead, it’s about fostering an environment that naturally invites openness. Here’s how it might sound:
“A lot of people feel unsure about bringing up this kind of topic—it’s totally normal.”
“This is a space where we can talk about anything on your mind.”
“You don’t have to rush into anything, but if there’s something you want to explore, I’m here for it.”
"If you'd rather wait to discuss this a different time, that's completely ok."
These words aren’t magic, but they carry something even more important: intention. They create a space where the other person knows they’re free to speak without fear of embarrassment or shame.
The Permission stage isn’t a one-time thing. It’s an ongoing practice woven into every interaction. Some people may need a reminder that the door is still open, especially if they’re venturing into topics they’ve been taught to keep private.
For example, someone might share a little, then hesitate, or verbally or non-verbally indicate discomfort. That’s your cue to offer another invitation, saying something like, “Thank you for sharing that—it’s a really important thing to talk about. If there’s more you’d like to explore, we can”, or, "Is it ok if I ask you more about that experience?" This keeps the door open without pushing, letting the person set the pace.
When someone feels they have permission to speak, the results can be transformative. Permission plants the seed of trust, helping someone realize that their story, their feelings, and their fears all have a place. The beauty of the permission stage is that it doesn’t demand solutions or immediate action. It simply says: I am here for you if you are open to sharing. And in a world where so many of us feel the need to edit ourselves before speaking, that welcome can feel like a breath of fresh air. In this way, the Permission stage of the PLISSIT model can actually be deeply therapeutic, even if there is no "intervention" being done.
The Permission stage of the PLISSIT model is more than a step—it’s a philosophy. It’s about creating a space where people feel seen, heard, and valued, without conditions or expectations. Whether you’re a therapist, a friend, or just someone trying to help another person open up, remember this: Sometimes, the most powerful thing you can say isn’t an answer or a solution. It’s simply, “You’re allowed to talk about this.”
In my next blog post I will share insights from the second stage of the PLISSIT model, the Limited Information stage.
Permission: The Most Important Stage in the PLISSIT Model
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