PLISSIT

Domain V · Systemic, relational, group & community · Jack S. Annon · 1974 · Honolulu, USA

What it is

PLISSIT is a conceptual framework for grading sexual-health interventions, not a single therapy. Its name lists four levels of increasing depth: Permission, Limited Information, Specific Suggestions, Intensive Therapy. Each level requires more knowledge, confidence and skill from the clinician. Its…

Format

• PLISSIT has levels, not timed phases. In Annon's conception the first three levels are brief therapy of one to a few sessions; no source gives Annon's own time estimates or a fixed session count. Published nurse-led programmes ran four or five sessions (see the group and couple formats below).
• Group and couple formats (published operationalisations, not Annon's). A Brazilian nurse-and-sexologist programme for breast-cancer survivors ran five weekly group sessions of about two hours: session 1 permission, 2 limited information, 3 specific suggestions, 4 integration of the first three…

Who practises it, and how they are trained or regulated

• Original vs extended versions. In original PLISSIT the levels are a stepped sequence: problems not resolved at the first three levels go on to IT. Ex-PLISSIT keeps the four levels but (1) makes explicit permission-giving a core feature of each of the other stages rather than a one-off first step, (2) requires review of all interactions with the client, and (3) uses reflection to build the practitioner's…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Staying within training; seek supervision.
• Comfort; offer printed versions to take away.
• Reduced self-blame; openness to a combined plan.
• Anxiety in rehearsal; grade the task down if needed.
• Whether the client attends; check at the next contact.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.