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PSYCHO SEXUAL COUNSELING Many people think of counselling as giving or offering solutions to the problem. However, counselling is neither of these. When the client comes for help with a problem he has to change something in himself to solve it. This may be a change of attitude, of perception of self or of others, of habit or a change of behavior. Counselling is teaching the client ‘life-coping skills’. Goals : To help reduce the level of anxiety when confronted with a stressful situation To help bring about a meaningful change in the client and function more successfully To facilitate client’s decision-making process To help client to plan his solution for his problem using his value system Essentials: Listen actively, and question effectively Accept the client , respect him, his ideas and feelings Show empathy ( recongnition of another’s feelings)and warmth Be honest and non-judgmental Counter the myths and misconceptions Maintain confidentiality Counselling can never be hurried (average time: 30 min) Hold the counselling session in a private place. PLISSIT Model: Sexual problem, where there is no organic cause, can be effectively tackled by the use of PLISSIT model of sexual counseling. This is behavior treatment for sexual problems. This is based on the belief that human behavior is a learned process. Maladaptive behavior can be unlearned and positive behavior can be substituted. PLISSIT Model was formulated john anon in 1976 .this model suggests therapeutic interventions 4 levels: Treatment level I P: Permission: The counsellor asks questions about client sexuality e.g. sexual thoughts, fantasies, dreams, feeling, sexual arousal, masturbation, nocturnal emission etc. The counsellor assures the client that he is O.K. and to continue doing what has been doing. Level II : LI: limited information ; At this level the counsellor explains why the client is O.K. the counselor counters myths and misconceptions related to his sexual problem and provides scientific information on the concerned topic e.g. masturbation, oral sex, breast and genital size during menstruation/ pregnancy etc. Level III : SS : Specific Suggestion: At this level the counsellor provides alternative explanation for the problem (learning & conditioning) and offers specific suggestions to the client to manage the sexual situation e.g. specific coital position during pregnancy; sensate focus; Kegel exercise. Level IV: IT: Intensive therapy: At this level analysis and treatment of attitude, reinforcing and discriminative function of stimuli that elicit inappropriate emotional responses are required. Paraphilia, marital discord, substance abuse required this level of therapeutic intervention. Additional instruction to the client : 1. Tobacco : To stop smoking or any other use of tobacco. Nicotine in tobacco causes vasoconstriction and enhances atherosclerosis. 2. Balance diet : To avoid excessive consumption of fats, sugars and salts and to take plenty of proteins ( egg white, pulses, fish, skimmed milk) , green vegetables and fruits. Udid contains natural testosterone and soyabean contains natural estrogen. Idli made from udid and rice is a nutritious food item. Vegetarian and non-vegetarian diet are equally good provided extra milk is consumed by vegetarians. Balance diet provides enough energy for sexual activity. 3. Exercise : The aim is to achieve physical fitness and not the body building. Exercise should be done on empty stomach. It should be gradual. If pain occurs in the chest during the exercise, it should be discontinued immediately and seek physician’s advice. The four components of physical fitness are: (a) Cardio-respiratory efficiency : Running, swimming, fast walking, cycling or spot running, , minimum for 20 min and at least for 5 days in a week. The pulse rate should be 220- age *4/5 (b) Flexibility : Yogasnas. Each asana should be done for 2 min. Difficult and painful asanas need not be done. (c) Endurance : sit ups, push ups (d) Strength: Wait lifting, bulwarker. 4. Body weight: Excessive body weight may cause difficulties in the sexual activities. Optimum body weight is calculated by the formula of body mass Index (BMI) B.M.I. – Body weight in kg/ ( Height in meters) 2 The resultant Should be 25. Both, Dieting and exercise are necessary for the weight reduction.