One of the first things you learn in sex therapy training is the PLISSIT model. This is a tiered model of how we assess and intervene with our patients. I think the framing can be helpful to understand going into the sex therapy process, so you know what to expect. Your sex therapist has a reason for the pace at which they begin your treatment, and PLISSIT is likely the guide!
PLISSIT is an acronym introduced in 1976 by Jack Annon to help clinicians determine the appropriate level of intervention with a patient. Let’s break the acronym down.
LI Limited Information
SS Specific Suggestions
IT Intensive Therapy
Permission can be interpreted a couple of different ways. First, I like to think about getting permission, or consent, from a patient as we begin our work together. I also like to give them permission to revoke consent at any time! I will ask very personal questions about a patient’s sex life, identity, sexual and trauma history, and maybe anatomy depending on the issue at hand. I tell every patient that it takes time to build trust with me, and I don’t expect them to feel comfortable telling me everything on the first day. Or ever. It is up to them. I need to get permission to ask, and they have permission to refuse.
Secondly, permission refers to giving our patient permission to change, or to stay the same. A good number of sex therapy patients really just need validation that what they desire is normal. Another good chunk just want permission to make a change. Having a professional to validate this, explain how normal they are, and create a container to explore their needs may be all the therapy the person needs.
Limited Information ensures a patient gets what they need, and not a lot of extraneous information. In order to provide this, sex therapists complete thorough intake assessments with clients. Here’s an example. I have a lot of training on pelvic pain. The etiology of pelvic pain can be so many things, and different origin points might lead to different treatment plans. Because I want to give my patient limited information versus an overload, I’ll want to find out about their trauma history, any medical conditions, if the pain is global or situational (all the time or just in some circumstances), primary or acquired (it has always been the case, or it started later in life), and some other assessments too as indicated. Based on that, I might give my patient information on assistive sexual devices to help with pain during intercourse. Or maybe how trauma impacts our musculature. Perhaps some education on estrogen cream, or a pelvic floor physical therapy to treat hypertonicity. We want the laser focus here on what education a patient actually needs; not a firehose of data on every single potential that doesn’t apply directly to their case.
Specific Suggestions are the “what to do next” pieces of sex therapy. What interventions might help this person? This is the “therapy homework” for the patient, and also potential referrals to other sexual health professionals. We will develop a treatment plan together, often with specific goals so we know if these suggestions are working. This level of intervention can be thought of as behavioral changes that will, we hope, ultimately change a person’s sexual experience into a more enjoyable and aligned version.
Intensive Therapy is exactly what it sounds like. This might include treatment for past sexual trauma, anxiety, depression, and other mental health and wellbeing concerns that specific modalities of mental health therapy treat. Different therapists are trained in different modalities, but some of the popular ones include Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Exposure and Response Prevention, Acceptance and Commitment Therapy, and Internal Family Systems. Intensive therapy can be done with an individual, or multiple people in a relationship, depending on the issue at hand.
Sex therapists are trained to manage and facilitate each stage of the PLISSIT model. If you are interviewing potential sex therapists, asking them about their comfort level with each stage can help you understand their training and competency–remember, “sex therapist” is not a protected term! Anyone can call themselves one, even without training and certification. It is important to look for the initials “CST” after your therapist’s name, which means they are a “certified sex therapist,” or assurance that the therapist is currently in training toward their CST credential.
Mary-Margaret Sweeney, MSW, LCSW, CST is a certified sex therapist licensed and practicing in the state of Indiana. You can read more about her practice and reach out about working together here.