In this post, I will discuss how to decide when to treat sexual issues and when to refer out.
As with any other counseling issue, you should not attempt to treat a sexual issue if you are unqualified to do so. Sometimes, this decision is clear-cut and sometimes it isn’t. For example, it should be obvious that if a client calls to make an appointment to address their erectile dysfunction, unless you are a sex therapist or have other specialized training in this area you will need to refer them out. But what about when clients start talking about sexual issues after you’ve already started to treat them for something else? If you aren’t a sex therapist should you refer out every time a sexual issue comes up?
If you did you probably wouldn’t have any clients. And you wouldn’t be practicing ethically.
Sexual topics come up frequently, especially when you are treating couples. Often, people need to get to know you a little bit before they will start to open up about their sexual problems. Therein lies your dilemma: you cannot practice outside the scope of your knowledge, yet you cannot abandon your client, either.
In my last post, I discussed how to establish proper boundaries during sexual conversations with clients. Before you proceed, you want to make sure the client is bringing up the topic because it’s really an issue and not just because they want to see you blush. (Yes, this happens!) Assuming it’s really an issue, I suggest you use the PLISSIT model to guide your discussions.
The PLISSIT Model
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- “P” stands for Permission. First, you give the client permission to talk about the sexual issue. This can be done in a number of ways:
- Display a few books about sexual topics on your bookshelf.
- Ask them about their sex life (if therapeutically appropriate.)
- Mention sexual issues on your website.
- Include resources on sexuality under the “Resources” section of your website.
- “LI” stands for Limited Information. Depending on your knowledge base, you can easily provide clients with some psychoeducation. Because many clients are not educated properly on sexuality, sometimes just giving them the correct information is enough. Do not make the assumption that clients already have basic sexual knowledge. Instead, ask them! Then, you can fill in the blanks. Alternatively, tell them to stop you if they already know the information you are giving them. (Not once has a client stopped me.)
- “SS” stands for Specific Suggestions. If providing the information didn’t address the problem, and you are comfortable doing so, you can make suggestions to clients. Often, this will dovetail nicely with the information you have just given them. However, if you aren’t sure what to suggest, explain to the client that this area is outside of your expertise, and you’ll either need to consult with an expert (a sex therapist or other counselor experienced in sexual issues) or refer them out. Clients will appreciate you looking out for their welfare. After all, you wouldn’t want to suggest something and then have it backfire.
- “IT” stands for Intensive Therapy. If the specific suggestion did not address the problem, the next step is intensive therapy. Unless you have specialized training, you will not be able to assist the client at this level. This is where you would need to refer them to a sex therapist.
- “P” stands for Permission. First, you give the client permission to talk about the sexual issue. This can be done in a number of ways:
Yours in the Joy of Knowledge,
Dr. Barbara LoFrisco
