Sex Therapy Counselling and the PLISSIT Model
Updated: Jul 24
Sex can be a difficult thing to talk about, especially sex therapy counselling. This awkwardness created by the discussion of sex can lead to people avoiding conversations concerning sexual health with medical professionals. Ignoring sex-related problems does not make them go away and can worsen the issue while also amplifying feelings of shame and embarrassment. Promoting a healthy sex life is important to not only our sexual health but our mental and physical health as well. Sex therapy is a form of psychotherapy devoted to addressing issues surrounding sexual health, satisfaction, and sexual well-being.
The realm of sexual health can be wide-ranging; therefore, sex therapists can help both individuals and couples with a broad spectrum of issues including, but not limited to:
sexual function/dysfunction (pain, desire level, arousal, orgasm)
sexual orientation and identity
compulsive sexual behaviours or sex addiction
past childhood sexual abuse
issues related to infertility, childbirth, post-partum
sexuality and ageing
healthy sexual development and expression
sexuality and spirituality
Many of us are uncomfortable with the idea of talking to a stranger about our sexual problems. Like mentioned early, tackling these sorts of issues can bring up lots of awkwardness, embarrassment and self-consciousness in patients seeking help (and sometimes doctors trying to help).
Jack Annon, a sex therapist, developed a counselling model to approach the discomfort of addressing sexual health in a clinical setting. He called it the PLISSIT Model consisting of four levels of intervention. Picture an upside-down pyramid with four tiers
Permission is the first and largest level of intervention, meaning that most people's sexual health concerns can be solved at this tier. Here is where therapists must gather information about the patients' sexual, personal, medical, and relationship history, as well as aspects of their specific sexual health concern to uncover when and how the problem first developed. After getting to know their patients a bit and understanding their problems a little more, therapists can give their patients permission. This could simply be giving them permission to stay the same, to change, or to seek help.
There can be a lot of negative emotions that can influence how we feel about sex. Guilt, shame, anxiety and embarrassment towards sexual fantasies, sexual desires, sexual feelings, or sexual behaviours can inhibit our ability to address our specific issues. Because sex is often not talked about openly, sometimes getting permission to masturbate, to grieve, to feel sexual feelings, to engage in sexual experiences etc. from a medical professional can enhance sexual satisfaction.
It can even just significantly change the comfortability of these types of issues. Having the permission to talk openly about sex, not only to a therapist but to sexual partners as well, can be the key to confronting the initial sexual problem.
After the permission tier, half of patients will require to move to the second level of intervention, limited information. Limited in this context means specific, which is to say that this level of intervention involves presenting information that specifically pertains to the patient and what is most relevant to them at this moment. This could include showing them statistics, vocabulary, and anatomy drawings, or books, magazines, and videos on the subject. Providing proper sex education can disprove common misinformation about the specific problem at hand and eliminate false beliefs that may have developed in the past.
The goal of this level is to provide facts and resources to educate patients about what is normal. Many sexual problems are often much more common than you'd think and hearing specific data and information may help destigmatize the issue.
Even fewer people (approx. 20% of patients) will end up at the third level, specific suggestion.
Here is where patients may require explicit instruction on what to do. This would include giving patients home assignments or assigning specific exercises to do in-between therapy sessions. Some tasks that are commonly recommended are self-masturbation, sensate focus exercises, and stop-start techniques. However, the assigned activities are typically up to the discretion of the therapist who considers what is most useful to the patient.
Looking for couples therapy? Can Dan and Lisa at Nomina to see how we can help.