The PLISSIT model, first proposed by Jack Annon in 1976, provides a hierarchy for intervention in the case of sexual dysfunction. The assumption underlying the PLISSIT model is that there are varying degrees of need for intervention - most people who are dissatisfied with their sex life do not need intensive sexual therapy. The model is primarily intended for use by health care professionals who are not trained as sexual therapists (nurses, physicians, counselors, and the like), although most sexual therapists follow a similar methodology when first treating a patient. PLISSIT is an acronym formed from the different levels of intervention required, ranked in order of increasing intensity: Permission, Limited Information, Specific Suggestion, and Intensive Therapy.
Permission (P): Sex, particularly sexual problems, is an uncomfortable topic for many people. Often, a person will consciously or subconsciously seek permission to feel the way they are feeling. Sometimes, the patient is seeking permission not to feel "wrong" or "dirty" because they need to discuss a sexual problem that will require greater intervention to actually resolve. In other cases, granting this permission is the only form of therapy that the patient needs.
Example: Mary is a young woman who recently became engaged to be married. She is perfectly happy with her relationship with her fiance, but she still feels sexually attracted to other men. Even though she would never think of being unfaithful to her fiance, Mary is afraid that her feelings are an indication of a sexual problem. Mary needs to be told that it is normal and acceptable to find other men attractive; it only becomes a problem if she feels compelled to act on these desires.
Limited Information (LI): Once someone feels comfortable discussing their problem, they want answers to their questions, which may be as specific as "Will I be able to maintain an erection after prostate surgery?" or as broad as "What's happening to me?" Despite the fact that sexual dysfunction has developed a high profile in recent years due to pharmaceutical advertising campaigns for drugs like Viagra, the etiology of sexual dysfunction, especially related to female sexuality, remains a mystery to most of the general public. Chances are that the patient has already sought out information through other sources of varying reliability, such as the internet, friends, and self-help books. It is the responsibility of the caregiver to provide the patient with honest, informative, accurate answers to their questions. If this is not possible, the caregiver must be able to point the patient towards reputable sources that provide the necessary information.
Example: Mike is a 16 year old boy who has always considered himself to be a heterosexual, but a few nights ago, he had a sexual dream about another boy in one of his classes. Mike is afraid and anxious because he thinks the dream may mean that he is homosexual. Mike's fear could be alleviated by the knowledge that homoerotic dreams are really quite common and not necessarily indicative of homosexual tendencies. Ideally, Mike would also learn that homosexuality is not a sexual dysfunction, and ultimately, he would become more comfortable with his own sexuality as well as alternate expressions of sexuality. However, this kind of lesson is probably too much for Mike to absorb all at once; the caregiver should be aware of the patient's level of receptivity and should limit their answer to each patient's particular needs (hence the term "limited information").
Specific Suggestion (SS): After the patient is well informed about the cause of their condition, they naturally would like a solution to their problem. In many cases, there are specific techniques that can address the problem without the need to go through true sexual therapy. In order to adequately master this level of intervention, the caregiver should have supplementary training and education in sexual dysfunction, but not so much as to preclude a general health care professional from dispensing useful suggestions to patients.
Example: Pat and Chris have been in a monogamous relationship for several years. In the beginning, the sex was great, but now it has become mechanical and boring. They do not need sex therapy, but rather some suggestions specific to their situation. Suggestions might include positioning, the use of erotica and sex toys, or roleplaying.
Intensive Therapy (IT): When all else fails, there's intensive therapy. Unlike the other levels of the PLISSIT model, intensive therapy should only be carried out by a trained sexual therapist. Although some might consider it treatment of a medical problem, sexual therapy is rarely covered by insurance and can be quite expensive. Therefore, it should be considered a last resort, reserved for patients with severe sexual dysfunctions, such as anorgasmia, inhibited sexual desire, vaginismus, dyspareunia, erectile inhibition, and retarded ejaculation. The different approaches to sexual therapy are numerous, sometimes conflicting, and definitely beyond the scope of this writeup.
Example: Robert and Jennifer have been married for 2 years, and are extremely dissatisfied with their sex life. Jennifer told her doctor that she suffers pain whenever the couple attempts sexual intercourse, and asked why this might be so. Her physician referred her to a gynecologist, who found during an examination that Jennifer suffers from vaginismus, and in fact, still has an intact hymen. Robert and Jennifer begin seeing a sexual therapist on a regular basis. The therapist prescribes dilators for Jennifer (a set of progressively thicker rods that Jennifer inserts into her vagina to acclimate her to the feeling of sexual penetration), and teaches the couple several exercises to make both of them more comfortable and less frustrated during sexual encounters.
It is very important to note that the PLISSIT model does not fully address all causes and complications of sexual dysfunction. Sexual problems can be the symptom of a more deeply rooted physical or psychological problem. About 10-20% of sexual dysfunctions are organic in origin, and many of these can be treated medically. The rest of sexual dysfunctions are psychogenic and may require psychotherapy in addition to sexual therapy.
Sources:
Sawyer, Robin. Lecture notes for HLTH377: Human Sexuality. University of Maryland, College Park.
http://www.onlinece.net/courses.asp?course=55&action=view
http://www.rehabpub.com/features/42002/7.asp