Permission–Again and Again: The PLISSIT Framework as the Foundation of Kink/BDSM Affirming Clinical Practices
The PLISSIT framework, originally created in 1976 by Jack S. Annon, is one of the primary frameworks utilized in the fields of sex therapy, as well as sexuality counseling and education. The letters of this acronym—permission(P), limited information (LI), specific suggestions (SS), and intensive therapy (IT)—refer to four differing levels of interaction and intervention related to the kind and degree of support needed. The varying levels revolve around what the client is looking for and how comfortable they are in collaboratively discussing sexuality and sexual health, in general, and in this training, more specifically, in discussing erotic orientations, identities, backgrounds, and/or experiences. In 2006, the PLISSIT framework was extended by Davis and Taylor–out of concern that providers often bypass permission-giving and go to the providing information level without giving people a real opportunity to express their own sexual concerns. This extended model places permission-giving at the core and any information that follows is then specific to the needs of that person. This EX-PLISSIT framing is grounded in being intentionally more collaborative, particularly in that it also requires further permission-giving in the form of ‘review,’ and this framing also requires the provider to reflect on their own side of interactions—whereby the provider does their own self-of-therapist work in challenging their own assumptions and extending their own knowledge. Considering a solid working alliance is one of the key common factors of therapeutic effectiveness (Sprenkle & Blow, 2004)–frameworks that help to build and foster such an alliance are essential—the PLISSIT and EX-PLISSIT framework is designed to do just this. Relatedly, in this training, Dr. Markie Twist will provide an overview of the PLISSIT and EX-PLISSIT framework. Dr. Twist will then review the clinical microskills that comprise kink/BDSM-affirming practices (Twist et al., 2021) and share how this framework can be applied in the context of fostering said affirming clinical practices (Pilliai-Friedman et al., 2015). The training will close with offering the opportunity to apply the framework, in real-time, through discussion via a provided kink/BDSM-based case scenario.
At the conclusion of this training, attendees will be able to...
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define and describe the PLISSIT and EX-PLISSIT framework
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review and apply the PLISSIT and EX-PLISSIT framework to Kink/BDSM-Affirming clinical practices
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discuss application of PLISSIT and EX-PLISSIT framework through provided Kink/BDSM case scenario example
Our Presenter: Markie L. C. Twist, PhD, MA, MEd, BS, LMFT, LMHC, CSE, CSE-S, RegCOSRT
Markie L. C. Twist, PhD, MA, MEd, BS, LMFT, LMHC, CSE, CSE-S, RegCOSRT (she/they) (dr. Markie) was born in Alaxsxaq (Alaska), grew up in a small village on the road-system and is Teaching Faculty and Graduate Student Research Chairperson in Doctoral and Masters Couple and Family Therapy (CFT) programs, and Interim Program Coordinator of the Sexuality Studies Certificate in Relational Therapy Division at Antioch University (New England and Seattle campuses) in Graduate School of Counseling, Therapy, and Psychology. She is Session Instructor in the University of Guelph Professional Sexuality Practices Clinical Training Program in Guelph, Ontario, Canada. dr. Markie is a registered member of College of Sexual and Relationship Therapists (COSRT), licensed marriage and family therapist (IA, NV) and mental health counselor (IA), clinical fellow and approved supervisor of American Association for Marriage and Family Therapy (AAMFT), and certified sexuality educator and supervisor through American Association of Sexuality Educators, Counselors, and Therapists (AASECT). They are co-author of the books, The Internet Family: Technology in Couple and Family Relationships andThe Couple and Family Technology Framework: Intimate Relationships in a Digital Age. dr. Markie serves as Editor-in-Chief of Sexual and Relationship Therapy and is coeditor of the book, Eco-Informed Practice: Family Therapy in an Age of Ecological Peril. dr. Markie was the 2025 American Association of Sexuality Educators, Counselors, and Therapists (AASECT) Sexuality Educator Award. You can learn more at drmarkie.com and follow them on IG/Threads @dr_markie, FB @DRMARKIETWIST, and LinkedIn: Markie Twist.
Continuing Education Credit
The complete event of 3 hours is eligible for 3 APA and 3 AASECT CE units.
American Psychological Association continuing education credit
TASHRA is approved by the American Psychological Association to sponsor continuing education for psychologists. TASHRA maintains responsibility for this program and its content.
Many states honor APA CE credits for other licensed health professionals, please check with your own state licensing board.
This program addresses Curriculum Content standard 1.1,
Program content focuses on application of psychological assessment and/or intervention methods that have overall consistent and credible empirical support in the contemporary peer reviewed scientific literature beyond those publications and other types of communications devoted primarily to the promotion of the approach;
American Association for Sexuality Educators, Counselors and Therapists continuing education credit
This program meets the requirements of the American Association of Sexuality Educators, Counselors and Therapists (AASECT) and is approved for 3 CE credits. These CE credits may be applied toward AASECT certification and renewal of certification. Completion of this program does not ensure or guarantee AASECT certification. For further information please contact [email protected].
The Core Knowledge Area addressed in this webinar is:
Diversities in sexual expression and lifestyles, i.e. polyamory, swinging, BDSM, tantra
Health/medical factors that may influence sexuality i.e. illness, disability, mental health, safer sex
Group Rates and Scholarships
Group Discount Rate:
Tiered
minimum group size: 4
Group size: 4-9 10% off registration for each person
Group size: 10 or more, 15% off registration for each person
For more info or to ask questions, please contact Zita at [email protected]
Scholarship
Application: https://docs.google.com/forms/d/e/1FAIpQLSer0jnLFpFLHv8U0Ysfy6Z2dtlSpBTmWDe8c-IAPlwE2B-eUg/viewform
Why do you want a scholarship for this training?
Do you currently work with kinky clients/patients?
Do you intend to specialize in serving the kink community?
Scholarship covers 50% of registration
Clinical Training Team approves 3-6 scholarships per training depending on level of registration and the types of tickets being requested.
Deadline for applying is one week before training
Only one scholarship per calendar year per participant
Scholarship prices are sent as invoices via PayPal, not as discount codes on the website. These should be sent 1-week before the training begins.
Cancellation Policy and Grievance Policy
Cancellation Policy
You may cancel up to ten days before a scheduled workshop without penalty and receive a credit for another workshop or a refund minus $7 for processing costs. If you cancel less than ten days before, you will be responsible for payment. TASHRA reserves the right to cancel any event that does not meet our minimum registration within 4 business days of the class. If TASHRA cancels an educational event, you will receive a credit toward another workshop.
TASHRA Grievance and Complaint Policy
TASHRA is committed to conducting all activities in compliance with the American Psychological Association’s (APA) Ethical Principles of Psychologists and the American Association of Sexuality Educators, Counselors and Therapists (AASECT) Code of Conduct. TASHRA will adhere to all legal and ethical responsibilities to be nondiscriminatory in promotional activities, program content, and the treatment of program participants. Monitoring and assessment of these standards will be the responsibility of the TASHRA Clinical Training Team ([email protected]).
While TASHRA makes every attempt to assure fair treatment for all participants, occasionally complaints will arise about continuing education programs. This does not include complaints or comments received on course evaluations.
The person with a grievance will first try to informally resolve their grievance by contacting TASHRA with the issue concerning the training, its delivery, the evaluation method, technological issue, other attendee(s), and/or any other concern.
When a participant files a complaint, either orally or in written format, and expects action on the complaint, the following actions and procedures will be taken:
- If the grievance concerns a speaker, the content presented by the speaker, or the style of presentation, the individual making the complaint will be asked to put his/her comments in written format. The Professional Development Services Manager will then pass the comments on to the speaker, assuring the confidentiality of the complainant.
- If the complaint concerns a workshop offering, its content, level of presentation, or the facilities in which the workshop was offered, Professional Development Services Manager will mediate and attempt to resolve the complaint promptly. If the participant requests action, the Professional Development Services Manager is empowered to:
- Attempt to move the participant to another workshop, or
- Provide a credit for a subsequent year’s workshop, or
- Provide a partial or full refund of the workshop fee.
- Actions 2b and 2c will require a written note, documenting the grievance, for record keeping purposes. The note need not be signed by the grieved individual.
- If the complaint is made after the program has occurred or concerns the TASHRA CE programming more generally, the Professional Development Services Manager will address it as follows:
- Request that the complainant submit a written complaint and propose an appropriate remedy.
- Provide the instructor(s) with the opportunity to respond to the complaint and propose an appropriate remedy,
- Review these documents, make a final determination, and decide on any remedy.
- TASHRA’s Clinical Training Committee will then consult regarding this grievance in an effort to find fair methods of resolving the grievance.
- If the aggrieved person is not satisfied with the solutions put forth, then they may put their grievance in writing and contact the American Association of Sexuality Educator, Counselors, and Therapists (AASECT). The appropriate AASECT personnel can be reached at [email protected].
- TASHRA will abide by any decisions made by the APA or AASECT regarding resolution of the grievance.
For further information, contact Zita at [email protected]