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Sensate
focus
Sensate focus
is a series of specific exercises for couples which encourages each
partner to take turns paying increased attention to their own senses.
These exercises were originally developed by Masters
and Johnson to assist couples experiencing sexual problems, but can
be used for variety and to heighten personal awareness with any couple.
When used in the treatment setting, sensate focus is done in several
stages over the course of therapy. The first stage usually begins around
the third therapy session, after the nature of the sexual problem has
been discussed and the couple has a clear understanding of the rationale
for the treatment. In the first stage, the couple has two sessions in
which they take turns touching each other's body, but with the
breasts
and genitals
off limits. The purpose of the touching is not to be sexual but to
establish an awareness of sensations by noticing textures, temperatures
and contours while doing the touching, or to simply be aware of the
sensations of being touched by their partner. The person doing the
touching is told to do so on the basis of what interests them, not on
any guesses about what their partner likes or doesn't like. The couple
is instructed that if sexual arousal does occur, they are not to proceed
to intercourse. Masters and Johnson recommend that the initial sessions
of sensate focus be as silent as possible because talking can detract
from the awareness of physical sensations. Of course, the partner being
touched must let his or her partner know, either verbally or
nonverbally, if any touch is uncomfortable.
In the next stage of
sensate focus, touching is expanded to include the breasts and genitals.
The person doing the touching is instructed to begin with general body
touching, not to immediately move to the genitals or breasts. Again the
emphasis is on awareness of physical sensations and not the expectation
of a sexual response, and intercourse and orgasm are still prohibited.
The couple is asked to take turns trying a "hand riding"
technique as a means of nonverbal communication. By placing one hand on
top of the partner's hand while being touched, one can indicate if he or
she would like more or less pressure, a faster or slower pace, or a
change to a different spot. Masters and Johnson caution that these
nonverbal messages should be conveyed in such a way that the person
being touched does not take over full control, but simply adds some
additional input to the touching, which is still primarily done based on
the interests of the toucher.
In the next phase of
sensate focus, instead of taking turns touching each other, the couple
is asked to try some mutual touching. The purpose of this exercise is to
practice a more natural or real life form of physical interaction
(people don't usually take turns touching and being touched), and to
help each partner shift attention to a portion of his or her partner's
body and away from watching his or her own response. Couples are
reminded that no matter how sexually aroused they feel, intercourse is
still off limits.
The next stages of
sensate focus are to continue with the mutual touching, then at some
point to move into the female-on-top
position without attempting insertion of the penis into the vagina.
In this position, the woman can rub the penis against her clitoral
region, vulva and vaginal
opening regardless of whether or not there is an
erection.
In a subsequent session, she may progress to putting the tip of the
penis into the vagina if there is an erection, all the while focusing on
the physical sensations and stopping or moving back to non-genital
touching if either partner becomes orgasm oriented or anxious. After
completing a session or two at this level, couples are usually
comfortable enough to proceed to full intercourse without difficulty.
These fairly simple
techniques are used as part of a comprehensive program of
psychotherapy
and can have a dramatic effect, even in cases where severe sexual
dysfunction has been present for many years. Professionals generally
agree that there are various dynamics to account for the profound
effects of these seemingly simple exercises. For one, sensate focus
exercises are a form of invivo desensitization whereby a feared
situation is gradually mastered by breaking it into discrete steps that
are experienced under safe conditions. Furthermore, the explicit
instruction against sexual arousal and orgasm frees each partner of the
pressure to produce an adequate sexual response in him- or her- self or
in his or her partner. It is also important that they are given
permission to experience pleasure. Thus, sensate focus is a learning
experience whereby pleasurable responses are reinforced and sexual
anxiety is diminished because the fear
of failure is removed.
An additional therapeutic
feature of sensate focus relates to the psychodynamics of the couple's
psychosexual problems. Masters and Johnson, along with renowned sex
therapist Helen Singer Kaplan, noted that in gently caressing each
other, the couple may be confronted with one or both partners' anxiety
about physical intimacy. Both the anxiety that is aroused and the
defenses this anxiety elicits become important avenues for
psychotherapeutic exploration, and can be very important in
understanding and improving a couple's relationship in general, which
most likely will have a significant influence on their sexual
functioning.
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Sex
