by Isadora Alman, MFT
Most of the clients I see in my counseling and psychotherapy practice meet with me only a few times, sometimes only once or twice. The work I do generally and in sex therapy follows the PLISSIT Model developed by Jack Annon and his colleagues in the 1970's. Specifically, I normalize my clients feelings and behavior (give Permission), offer Limited Information, make Specific Suggestions, and finally, if warranted, do Intensive Therapy. Seldom is the latter what people want when they consult me.
If a woman comes in because she has difficulty reaching orgasm, a man because he is afraid to ask for what he wants, or a couple hoping to get along better without as many quarrels I see no need to do family of origin investigation or spend several sessions taking a detailed sexual history. They come with a specific problem. It is our job, working together, to arrive at a specific solution, or a selection of possibilities. Should the presenting issue be more complicated than the client or I originally thought, that can be explained and explored as well.
I work in 90 minute sessions. I begin the first session with "housekeeping rules" such as the bathroom location, assurances of privacy with legal exceptions, that I will give a 20 minute announcement when we near the end so that we can wrap up gracefully, the rules of discourse ("Feel free to speak directly to each other rather than through me" and "If I ask a question you do not wish to answer please say so and I will back off") and I end this with "Now, how can I be of help?".
The reason I begin with my two minute or so housekeeping spiel is only partly to convey the information. It is also for the client to become a bit more comfortable with the surroundings and with me personally -- what I look and sound like and, I hope, the warmth and lack of judgment I project. It's difficult enough for some to decide and locate a therapist, make an appointment, enlist any partners to accompany them, and to get themselves finally to my office. How much more so to launch into their most intimate concerns with a stranger.
When my daughter was little and first learning the facts of sex she would ask wide-eyed and horrified "Do you and Daddy do that?' My answer then was always "What Daddy and I do is private but most adults do it and enjoy it."
My clients are all adults, not innocent six year olds. While I am certainly entitled to keep my private life private and psychotherapists are, in fact, enjoined to do so, judicious disclosure on my part goes a long way to both normalize clients' thoughts and feelings and establish our rapport. Often I will present stories of anonymous other clients for the same effect, but I find that sharing some of the misconceptions I personally also had about female anatomy for example does just that more effectively and allows us to laugh together.
I have clients that come in periodically with new life challenges over the years. While I am flattered that many quote something I said years ago, or say when stuck they try to imagine what I might tell them, several have recalled some personal sharing of mine to be what was most helpful.
Because I encourage clients to record our sessions for their use later, I am aware that bits and pieces of my own history are out there all over the place. Yet in more than 26 years of counseling, I have yet to have this come back to haunt me in any way. To the contrary, I have been told many times how meaningful my personal disclosures have been to them. They have served not only as illustrations of coping strategies but as models of how to take risks and the value of being open with others.
Isadora Alman, MFT has a private practice in Alameda. She has authored multiple books and currently writes a blog for Psychology Today titled "Sex and Sociability" http://www.psychologytoday.com/blog/sex-sociability . Isadora will be presenting at this month's Berkeley CEU workshop titled "Honey, Let's Talk," on Sept 10th. Visit Isadora at www.askisadora.com.
This article first appeared in Psychology Today.com.
