The PLISSIT Model
PermissionLimited InformationSpecific SuggestionsIntensive Therapy
This refers to the professional (you) giving the client permission to feel comfortable about a topic or permission to change their lifestyle or to get medical assistance. This level was created because many clients only require permission to speak and voice their concerns about sexual issues in order to understand and move past them, often without needing the other levels of the model.Communicate willingness to discuss sexually related topics.Might begin by saying, “Those in similar situations have expressed concerns about intimacy and sex. What concerns are you having?”
On this level the client is supplied with limited and specific information on the topics of discussion. Because there is a significant amount of information available, the professional must learn what sexual topics the client wishes to discuss, so that information, organizations and support groups for those specific subjects can be provided.Provide educationUse clear, nontechnical language and avoid medical jargon.Address myths and misconceptions
On this level the professional gives the client suggestions related to the specific situations and assignments to do in order to help the client fix the psychological or health problem. Can include information on how to deal with sex related diseases or how to better achieve sexual satisfaction by the changing of sexual behavior.Concrete suggestions on coping with the effects of the illness: 1)pleasuring 2)altering positions 3) dealing with emotions 4)medication.If partnered it is usually best to see the couple together.
The fourth and final level is where the professional refers the client to other mental and medical professionals that can help the client deal with deeper underlying issues and concerns being expressed. This has limited use at the end-of-life. However, with the advent of the internet that can be used for online resources that can be helpful and private.
Developed in 2006 by Davis and Taylor because of their concern that professionals were by-passing permission giving and going straight to providing information without giving clients the opportunity to express any concerns they might have.This model has permission giving as its core. It also requires review where the professional asks the client to review the interaction and give the opportunity to express any further worries or concerns.It also requires the professional to reflect on their interactions, challenging assumptions and extending their knowledge
Some Common Concerns
Body image and self-concept (wasting, air loss, disfigurement, odors, swelling, incontinence, bedsores)Changes in sexual functioning/desire(explore alt. means of sexual expression, possible meds, align expectations w/reality)Social and relational concerns(relshipscan strengthen at EOL, facilitate social connections, “Living yet to do” rather than “dying.” respect privacy intimacy)Systemic barriers (change policies & institutional rules/practices that impede sexual expression: e.g. wait for permission before entering room, “privacy please” signs, hospital beds for 2)Staff in-service on patient right/intimacy needs
Post-mastectomyViagra requestNew girlfriend in NHTeen ager wants to experience sex before he diesDon’t neglect the intimacy/sexual need of family members
The clinical/professional relationship and rapport building are important. SWs should always maintain:Clear professional boundariesHigh ethical standardsA patient-family directed approachAsk your supervisor or team for help when needed.
Sexuality/intimacy are important at EOLProfessionals in hospice and PC should pay attention to this issue including beginning the conversation.Clear communication is most important.The PLISSIT and Ex-PLISSIT models can be helpful in providing a framework for addressing these issues.
Melanie G. Ramey3240 University Avenue, Ste 2Madison, WI 53705608-235-5349 or 608-467-2044www.melanieramey.com