Transform the Reluctant Client’s Therapeutic Experience with PLISSIT: From Pointless to Meaningful
When potential clients are ambivalent about starting therapy, clinicians may instinctively push back. Ely Peralta, LCSW-C, suggests gentle engagement using the PLISSIT model instead.
I’m going to use my really lame superpower (educated guessing) to take a shot in the dark. If you’re a mental health provider you’ve probably heard new clients say something along the lines of “There’s no reason for me to be here.” “This is pointless.” Or perhaps the dreaded, “I don’t have anything to discuss.” For me, hearing a phrase like those conjures images of suddenly hitting a brick wall, one that stands between me helping a client take something worthwhile from the session which I have found to be crucial in determining whether they come back and see you again.
If we think of that metaphorical wall that those statements create, our instincts as humans, even as trained professionals, may be to take a sledgehammer to it by forcefully pointing out the ways therapy could help a client. I think that such an approach is ultimately counterproductive as it centers the perspective of the therapist and does not allow for the client to have agency.
When clients make statements like those, I find the function is that generally they are asking “Why should I come back? What’s in this for me?”
The answer to that question depends on that client’s unique values. Unless you have psychic powers and know the perfect answer to that question, taking clients through the PLISSIT framework is the next best solution I’ve found to discover what those values are and propose a therapeutic relationship intended to help them get in touch with and live a life that is more aligned with them.
The PLISSIT model, which stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy, was developed by clinical psychologist Jack Annon in 1971. While often associated with sexual health and education, its principles can be applied to secure clients’ buy-in.
PLISSIT becomes a chisel which clinicians can use to gently loosen a single brick in the wall and invite clients to pull it out from their end. This opening is the beginning of fostering trust and openness and building the therapeutic relationship that is crucial across all modalities.
Permission is the first step in recognizing the client’s autonomy and comfort. Therapists create a safe space by inviting clients to share their thoughts at their own pace. This foundational aspect reduces pressure, allowing individuals to feel empowered to express their feelings without judgment.
A simple “You are in the driver's seat here, and you get to decide what we do or don’t talk about, and you are always welcome to change your mind” even saying “you can choose to leave at any time” can significantly enhance a client’s sense of safety and trust.
Limited Information involves providing clients with essential knowledge about the therapeutic process. Many clients may have preconceived notions about therapy that cultural values, pop culture, or personal experiences have shaped. Clients tend to feel more at ease once they know that the therapist isn’t going to be doing their best Freud impression or that the therapist isn’t going to spill all a teenager’s innermost thoughts to their parent. Also, normalizing their experience can go a long way in helping them feel comfortable
“A lot of people I meet with have questions about how to navigate the workplace or “People are curious about how to handle relationship conflicts”
Clarifying what therapy entails demystifies the process. This transparency can make the environment less intimidating and encourage clients to engage more openly.
Specific Suggestions come into play when clients express uncertainty about what to bring up in sessions. Therapists can provide gentle prompts or topics for discussion, allowing clients to explore areas they might not have considered.
Questions like: “what’s important to you?” or, “what would it look like if you were living life according to your values?” can guide the conversation in a meaningful way.
It may also be helpful to offer options by indicating ways therapy could be of value by asking, “Is the way you are handling the situation right now working?’ “Are you willing to try something different?” can help clients feel that they truly are in the driver’s seat of this experience.
My role isn’t to be some all-knowing expert handing out commands or instructions, I’m a navigator who’s willing to sit in the passenger seat and help collaboratively create a map to get them closer to where they would like to go as long as they would like me to.
Intensive Therapy represents the more profound work you can do once the client has a sense of their values. This is the stage where you can outline concrete benefits for them to an ongoing relationship. “
If I see you regularly, we could work to find tools for you to help improve your relationship with Mom and Dad since it sounds like that’s important to you.”
“If you were to come back, we could work on processing those feelings you have a hard time dealing with so you are able to be more present with your wife like you talked about.”
The integration of the PLISSIT into therapy breaks down barriers and fosters an environment of trust. It empowers clients to openly engage in their therapeutic journey by emphasizing autonomy, providing guidance, offering gentle suggestions, and offering to dive deeper. For clients, this framework can transform how therapy is experienced, making it a profound space for connection and healing. Therapists can help clients feel safe and valued as trust builds, clients cultivate the courage to share their experiences, paving the way for profound healing and growth. This reiteration of the transformative potential of the PLISSIT model can make therapists feel more optimistic about their practice.
Reference
Davis, S. (2006). Rehabilitation: The use of theories and models in practice. Chapter 6.
Doe, L. [@sexplanations]. (2013, September 1). The PLISSIT Model [Video]. YouTube.
Taylor, Bridget & Davis, Sally. (2007). The Extended PLISSIT Model for Addressing the Sexual Wellbeing of Individuals with an Acquired Disability or Chronic Illness. Sexuality and Disability. 25. 135-139. 10.1007/s11195-007-9044-x.
Ely Peralta, LCSW-C
Ely Peralta, LCSW-C’s passion is for helping people engage in self-discovery. He specializes in working with LGBTQ+, neurodiverse, disabled individuals and their loved ones. Ely earned a Master of Social Work degree from the University of Maryland Baltimore. His therapeutic approach draws from elements of ACT, relational therapy, narrative therapy, dialectical behavior therapy and mindfulness; Ely is currently training to be an AASECT certified sex therapist. Request a free, brief consultation by clicking the “Request an Appointment” button on Ely’s bio.
