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Sensate Focus in Sex Therapy: The Illustrated Manual

The Book Brigade talks to therapists Linda Weiner and Constance Avery-Clark

Used with permission of authors Linda Weiner and Constance Avery-Clark
Source: Used with permission of authors Linda Weiner and Constance Avery-Clark

For many people, problems with sexual response reflect the intrusion of their conscious, goal-oriented mind into an activity of the body that goes awry from psychological pressure. Sensate focus is a technique that helps partners learn to enjoy touch for the sheer pleasure of it.

To whom is the book targeted?

Sensate Focus is intended for sex educators, sex therapists, relationship counselors and therapists, pastoral counselors, physicians and physician assistants and, to a degree, the general public. There has never been a publication on the specifics of how to use sensate focus touching to recover desire, reconnect with a partner, or address sexual dysfunctions. The manual also offers explanations for the reasons sensate focus works. The book has visual depictions so everyone may see the positions.

Who uses sensate focus and what training is needed to use it?

Sensate focus was developed by Virginia Johnson Masters and William Masters in the 1960s and formed the foundation of sex therapy with sexual dysfunctions. Sex therapists, as well as other therapists, continue to use it and consider it highly effective. Since the late 1980s, it has been difficult to get training in the use of sensate focus. At that time, Masters and Johnson stopped offering their popular weeklong seminars. There are only a handful of published articles and portions of book chapters that provide information about sensate focus. We decided to publish the book to honor Masters and Johnson’s unfulfilled pledge to write down the specifics of how to use this powerful technique. We updated it, incorporating modifications for diverse populations suggested by many talented sex therapists.

Sensate focus is about touch. Why do couples need to learn about touch, and what about it do they most need to learn?

Touch is the most primal sensation and need. The first thing children do is to explore through touch out of a sense of curiosity. By the time we are young adults, touch is often paired with sexuality, and expectations about sexual touch abound. People need to relearn the importance of touching for its own sake, touching mindfully. Re-experiencing the sensation of touch, without the pressure to like it, to be aroused by it, or to simultaneously arouse the partner, helps create a connection to oneself and/or to the partner. When the conscious mind gets out of the way of the body, the body may respond on its own, building up a simmering charge.

Couples need to learn how to refocus on touch sensations to deal with negative thoughts that interfere with sexual interest or responsiveness. “Will my body work?" "Will my partner like what I’m doing?” If you are thinking these thoughts, it is difficult to become absorbed in touch sensations leading to sexual responsiveness. Couples learn to be in their body, focus on their own experience, and turn off unhelpful ruminations and distractions. This is the magic formula

When sexuality is mixed in with touch, touch may become a mere prelude to sexual activity. Touch is then paired with pressure, and the attitude of non-demand touch needs to be relearned.

For what kinds of problems is sensate focus therapy appropriate?

Sensate focus is not just a therapeutic technique. It may provide valuable diagnostic information in vivo unattainable through interview. Sensate focus may be used individually or with a partner to: Increase body awareness and comfort; build trust and emotional closeness; slow down the sexual interaction for the partner(s) who may need it; increase sexual desire; and, where there is a psychosocial component to the sexual difficulty, sensate focus may serve as the foundation for the treatment of the sexual concern.

How common are the problems at which this treatment is directed?

Sexual dysfunctions appear to be among the more common psychological difficulties in the general population. The prevalence is most likely between approximately 10-50 percent among men and 25-60 percent among women.

What does sex therapy consist of, and what is its goal?

The goal of sex therapy is teaching people how to get their conscious, goal-oriented mind out of the way and return sex to its natural state. In a culture that places a high value on intentionality and hard work, sex is one thing that never works when you are working hard at it! Sexual response is about turning off the conscious mind and tuning into the body in a here-and-now way. Evaluations, expectations, and judgments must be managed so as not to get in the way of natural responsiveness.

Another component of sex therapy is education. Through therapy, people discover themselves and their bodies, and they communicate their discoveries to their partners. This may ultimately lead to a decrease in inhibition and an increased likelihood of genuinely transcendent experiences.

For couples with a more complex history, say, of emotional abuse in the family of origin and/or with current relationship dynamics that include intense and ongoing conflict, the initial goal might be helping them tackle barriers to being vulnerable outside of the bedroom before sensate focus is introduced. While sensate focus remains the focal point, skills for managing communication and relationship skills, in general, may have to come first.

How do therapists know when it is appropriate to use this method?

Sensate focus suggestions are almost always appropriate, even with people who have no sexual difficulties but want to optimize their intimate connection. By improving their sense of physical intimacy, the small irritations that occur outside the bedroom are often neutralized. After the touching, people frequently report feeling closer to their partner and more hopeful of gaining greater emotional intimacy.

How do you distinguish between couple problems that are more physical-sexual (and thus suited for sexual therapy) and those whose problems are more emotional?

There are three types of sexual problems: medically related, emotional, or a combination of the two. Sometimes it is difficult to distinguish the causal factors involved, but by using sensate focus techniques regardless of etiology, the elements begin to evidence themselves. For example, one client had prostate cancer surgery twice. After the first, he was able to recover his erections. Following the second surgery, he reported no progress regaining his erections. This appeared to be a medically induced case of erectile dysfunction.

However, by using sensate focus touching suggestions paired with fantasy work and relationship therapy, he was able to regain sexual functioning once again. There was clearly a psycho-social component. Even when the etiology is purely medical, sex therapy and sensate focus may help people discover what does work, rather than focusing on what has been lost.

Does sensate focus have any impact on psychological and emotional aspects of relationships?

Absolutely! Many clients report being somewhat apprehensive before the touching but they feel relaxed and emotionally connected to their partner afterward. Touching and being touched without pressure to do anything to or for anyone often produces the feel-good chemicals in the brain that create bonds and increase overall couple satisfaction.

What misunderstandings do therapists have about this treatment?

The most common misunderstanding has to do with the focus and intent of the touching. Most therapists have been trained to suggest that clients touch each other to give themselves or their partner’s pleasure. Sensate focus was, in fact, initially described by Masters and Johnson this way in Human Sexual Inadequacy. However, by the time Constance and I trained at the Institute, the emphasis was on touching for self-interest (focusing on touch sensations) without regard for one’s own or the partner’s pleasure. The pressure for producing pleasure is removed. This is Sensate Focus 1. In Sensate Focus 2, when there is no longer a sexual difficulty, couples do more sharing and providing feedback in terms of what they might prefer.

What misunderstandings do patients have about the treatment?

It’s interesting how many people ask if we will be observing them doing the touching suggestions! No! They carry out the suggestions in privacy. It is in the therapy session that we then verbally process the details of the touching sessions.

Your book has a chapter on what sensate focus is not. Why? And what is it not?

This chapter is there to emphasize the most commonly held misunderstandings by therapists about the focus and intent of sensate focus. Many have believed, and understandably so, that sensate focus is about arousing and pleasuring especially the partner. But sensate focus is intended to remove all the pressure. Can you imagine if the expectations are that sensate focus is aimed at making arousal and pleasure happen, especially for the other person? Wow! Talk about pressure!

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Sensate Focus in Sex Therapy: The Illustrated Manual

Used with permission of authors Linda Weiner and Constance Avery-Clark
Source: Used with permission of authors Linda Weiner and Constance Avery-Clark