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Section 7: Using Sensate Focus

As we have noted earlier, most current approaches to sex therapy involve a complex set of intervention strategies. Rather than seeing the problem as strictly a performance issue involving just one individual separate from his/her surround, the strategies seek to extend the understanding - and the fixes - to include the whole person in real sexual relationships in real time. This is in line with the New View Campaign to re-envision sexuality away from a primarily medical model.

The New View states, “Professionals are sought as helpers in unlearning sexual myths, learning facts, providing options for sexual expression, helping men and women to improve their communication skills around sexual issues, guiding men and women to explore the underlying causes of their emotions, anticipating teachable moments during times of intimate care, spelling out the benefits of a more flexible gender role, teaching men and women to focus on pleasure and intimacy.”

As we noted earlier, the New View nomenclature considers 4 categories of causes of sexual problems in order of likely prevalence and suggests that interventions be considered in this order as well, ensuring that educational interventions are always considered.

1. Sexual problems due to sociocultural, political, or economic factors
2. Sexual problems due to partner and relationship
3. Sexual problems due to psychological factors
4. Sexual problems due to physiological or medical factors

There are considerations that must be addressed in taking this approach. One of the basic principles of sex therapy is that both partners share in the responsibility for the problem and the solution. Often clients do not make a connection between the problem and their contribution, and blaming the partner is a very common issue.

Working with these individuals can be challenging for the therapist. However, defensiveness, resistance to accepting responsibility and attempts to blame one’s partner for relationship problems are common to many problems in couple’s counseling, not just the sexual problems.

Establishing a therapeutic relationship with clients, exploring their points of view about the problem that is being defined as the partner’s, and beginning to incorporate psycho-educational information as to the mutual and reciprocal nature of these issues can be helpful in engaging many clients in the process.

Encouraging and supporting clients in viewing the problem as something both of them are going to address together rather than trying to “fix” one person can be helpful in reducing ongoing blame.

A more positive process and outcome can often be created by establishing a desired relational outcome as the focus of treatment.

Ultimately, however, if the blaming partner is unwilling to join in the process and be a “part of the solution,” it becomes difficult to move relational approaches forward. In such cases, the clinician must pursue other options in order to work on the sexual problem.

In some instances, a clinician may attempt to work with one or the other of the partners individually regarding his/her options in attempting to establish a satisfying sexual relationship. (Donahey & Miller, 2001) It may be necessary to create some other kinds of changes in the relationship – or in one or both partners – before they can come back together to work on the sexual side of their relationship.

In some of these cases, the inability of the couple to address the sexual problems will be connected to deeper obstacles to closeness and intimacy: attachment concerns, object relations problems, and other serious kinds of psychological difficulties brought into the relationship by one or both partners. In such instances, sexual healing will usually advance hand in hand with remedying the underlying causes of the other rifts in closeness and intimacy – if the couple can be held together long enough for improvements to occur.

These cases will not be addressed in this section or in this course. However, there are two topics that are more appropriately discussed here. While they are separate, they can often be utilized together to support one another and create better and faster outcomes. The first of these kinds of approaches to addressing sexual concerns, and one that bridges the more traditional and post-modern approaches quite well, is the approach called Sensate Focus. This is an intervention that can be learned relatively quickly by mental health clinicians and incorporated into their work.

The second area of study will form the content of the next section in this course, examining how to address Unconscious Sexual Saboteurs.

Sensate Focus Exercises were developed by sex researchers Drs. William Masters and Virginia Johnson (1970) as a treatment approach for erection problems stemming from anxiety. The goal was to create a safe setting for intimate partner-to-partner touching and communication that minimized or eliminated performance anxiety.

The process involves a step-by-step process of touching, beginning with the first step, which is non-genital touching, to be accompanied by a focus on the pleasures of touching and being touched, and communicating with one another. Partners take turns being the giver and the receiver. Sexual intercourse in the beginning steps is generally discouraged so that performance anxiety is not an issue.

When both partners are comfortable with the first step - which may take several sessions, they can move to the second step which is similar to the first, but now incorporates touching of the breasts and genitals. After comfort is achieved with this step, partners may move to the third step, which incorporates caressing of the breasts and genitals and can include intercourse (Metz & McCarthy, 2004).

The use of Sensate Focus has now been expanded as an intervention for other types of sexual disorders in which anxiety plays a role, such as with premature ejaculation or in situations where couples are beginning sexual contact for the first time and have anxiety or lack of knowledge.

Also for sexually experienced couples who have been focused on the American idea of sex (i.e. the goal-oriented stair step progression that leads to the “mythical” multiorgasmic simultaneous orgasms in intercourse for both partners) and who have “forgotten” the joys of non-demand touching and communication, Sensate Focus can add a new dimension of loving and intimacy to their relationships. Sensate Focus is also valuable for couples who are not engaging in sexual intercourse, regardless of the reason.

In order for clinicians to operate with confidence in using Sensate Focus approaches, it may be helpful to pursue some additional learning in this area. There are internet based resources that will provide additional detail and instruction in the use of Sensate Focus techniques. Links for this are provided below.

It may also be helpful for clinicians to engage in some of these steps in their own romantic/sensual relationships, in order to understand what a client is likely to experience during the process of Sensate Focus. Because it is an approach that is designed to enhance relationships and improve the sensual experience of giving and receiving positive tactile stimulation, there is little risk for clinicians in incorporating these techniques into their own relationships.

There are a number of videos available on the internet that explain and demonstrate sensate focus. A link to one of these videos is presented here:

You may also download descriptions of the six stages of sensate focus here:

Guidelines, limitations, contraindications: Sensate Focus is generally considered a low-risk approach to improving closeness and intimacy within a relationship. However, the use of Sensate Focus Exercises will usually quickly reveal whether there are deeply rooted intrapsychic or relationship problems that stand in the way of establishing a measure of safety for the exchange of pleasurable touching behaviors. If the exercises are sabotaged, then the focus can be removed from the exercises and refocused on the other personal or relationship forces that are causing the sabotage.

This technique can be used by clinicians who are not sex therapy specialists with a moderate amount of study and preparation for use. A clinician wishing to use this approach should know the different stages of sensate focus, how to integrate it into the overall treatment approach, and when to discontinue its use due to problems on the part of one or both partners that would preclude its use.