How is Sensate Focus Used in Sex Therapy?

Before I discuss how Sensate Focus is used in sex therapy, I want to define what sex therapy is because there are many misconceptions about sex therapy in the general public and even among psychotherapists who don't practice sex therapy.

What is Sex Therapy?

Sex therapy is a specific type of psychotherapy for individuals and couples to address sexual problems (see my article: What is Sex Therapy?).

Sensate Focus is a Component of Sex Therapy

There is no physical touch, physical exam, sex or nudity during sex therapy sessions.  Everyone in the room remains fully clothed just like they would in any other type of talk therapy session (see my article: What Are Common Misconceptions About Sex Therapy?

Sex therapy addresses physical, emotional and psychological factors that might be getting in the way of sexual fulfillment.

As a sex therapist, I help clients with a variety of sexual problems, including:

• Low Libido/Sexual Arousal/Sexual Desire
  

• Mismatched Sexual Desire Between Individuals in a Relationship

• Sexual Communication

• Sexual Boredom

• Erectile Problems

• Sexual Performance Anxiety
  

• Painful Sex

• Orgasm Problems
  

• Sexual Guilt and Shame
  

• Sexual Self Esteem

• The Sex Script of a Couple

• Sexual Abuse/Trauma

• Age-Related Sexual Problems

• Body Image

• The Unconscious Meaning of Sexual Fantasies

• Kink, BDSM , Eroticized Power Play 

• Transgender Issues

• Consensual Nonmonogamy
  

• Compulsive Use of Pornography or Out of Control Sexual Behavior

As well as other sex-related issues (see my article: What Kinds of Problems Are Addressed in Sex Therapy?).

A sex therapist might refer a client to various other health care practitioners to either rule out or overcome related medical or physical issues that could be part of the problem.  

For instance, if a man is experiencing erectile problems, a sex therapist often refers the client to a medical doctor who specializes in erectile problems to determine if the problem is medical.  Once a medical problem has been ruled out or addressed, a sex therapist can help the client with the emotional or psychological issues involved.

Another example of a possible referral is if a woman is experiencing pain during intercourse. A sex therapist often refers the client to a gynecologist who specializes in painful sex problems to either rule out or address the problem. Subsequently, a sex therapist can also refer the client to a physical therapist who is a pelvic floor specialist while the sex therapist simultaneously helps the client with the emotional or psychological issues involved.

What is Sensate Focus?

Sensate Focus is one component of sex therapy among many.

Sensate Focus is a behavioral technique that was originally developed by Masters and Johnson. 

Sensate Focus is a Component of Sex Therapy

Sensate Focus involves a series of behavioral exercises that a couple does together to help them to enhance their emotional and sexual connection.

The behavioral exercises are done as part of sex therapy homework in the privacy of their home.  They are not done in front of the sex therapist.

When I work with couples who want to improve their emotional and sexual connection, I provide them with psychoeducation about Sensate Focus and how it can be helpful.  Then, I tailor the homework to the needs of the particular clients. 

For instance, if they are in a long term relationship where there has been either infrequent or no sex for a while and they are apprehensive about Sensate Focus, I collaborate with the clients to see where they each feel relatively comfortable to begin.  

I stress to couples that Sensate Focus is a behavioral mindfulness technique and, as such, it's a non-demand exercise. 

The non-demand aspect of Sensate Focus means there is no expectation of sex. 

In fact, the exercise won't go beyond what has been agreed upon in advance by each member of the couple.

Sensate Focus is a Component of Sex Therapy

For example, with couples who haven't touched each other in a while, I might ask them to start by setting aside two times between weekly sex therapy sessions where they each take turns touching the other partner's hands for 2-5 minutes without any talking (this is to avoid the possibility of criticism which could make one or both people want to stop).  

During initial Sensate Focus exercises, I usually recommend that the couple is fully clothed when they do their homework assignment and that they do the exercise with lights on. There is no music or anything else that would indicate the expectation of sex.

By starting at a point where both people feel comfortable, Sensate Focus helps to remove stressful aspects of sexual and emotional connection that the couple might be struggling with. In fact, most people find Sensate Focus relaxing.

Sensate Focus is a Component of Sex Therapy

If one of the partners is uncomfortable with how the other partner is touching them, they can show them by lifting the partner's hand and demonstrating how they would like to be touched.

When the couple returns to their next sex therapy session, assuming they did the exercise, they each talk about their individual experience with the exercise.  

If they didn't do the exercise, I facilitate a discussion as to what got in the way of doing it.  Beyond giving reasons that they were busy or tired, this helps the couple to explore and understand unconscious issues involved with why they might have avoided doing the Sensate Focus exercise and how they can overcome these issues.

Overcoming obstacles to Sensate Focus also reinforces the idea that there is mutual responsibility for sexual and emotional connection. 

In other words, it's not the job of any particular person to be "in charge" of the exercises, so I usually recommend that each individual take turns reminding the other partner about the exercise and initiating.  

So, if Person A is the reminder and initiator on Day 1, Person B is the reminder and initiator on Day 2.

From there, I continue to collaborate with the couple on how to proceed to the next step in Sensate Focus. 

Based on the clients' mutual agreement, Sensate Focus progresses to include different types of touch as the exercises progress.  Once again, the exercises are highly individualized for the particular couple.

What is the Foundation of Sensate Focus?

There are several elements that serve as the foundation of Sensate Focus, including:

• Providing sexual information and education to both partners about sexual function and activities

• Establishing mutual responsibility between partners for addressing sexual communication, sexual needs and concerns of each partner

• Helping couples to communicate effectively about sex without guilt or shame

• Being willing to change sexual attitudes that are getting in the way of sexual fulfillment

• Overcoming sexual performance anxiety, including guilt and shame

• Overcoming issues related to sexual roles in the relationship

• Giving behavioral homework assignments for couples to improve their sexual and emotional relationship

When is Sensate Focus Used?

Sensate Focus is used for a variety of sex-related problems, including but not limited to:

• Sexual Arousal Problems

• Sexual Desire Problems

• Erectile Problems, including premature ejaculation, delayed ejaculation, erectile unpredictability

• Painful Sex

• Sexual Anxiety

• Other Sex-Related Problems

Conclusion

Sensate Focus is a well-researched, effective component of sex therapy.

Sensate Focus helps to enhance emotional and sexual intimacy with behavioral exercises for couples to do privately as part of their homework.

Sensate Focus is beneficial for couples of any age, race, gender or sexual orientation, including heterosexual couples or LGBTQ+ couples.

Getting Help in Sex Therapy

Sex therapy is a form of talk therapy for individual adults and couples.

If you're struggling with sexual issues, you could benefit from working with a skilled sex therapist.

Rather than struggling on your own, seek help from a sex therapist so you can lead a more fulfilling sex life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex-positive therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Keeping Sex Alive in Your Relationship is a Team Effort Between You and Your Partner

In her book, Sex Talks, Sex Therapist Vanessa Marin describes sex as a team sport in a relationship--meaning that both people are responsible for their sex life.

This is similar to how Barry McCarthy describes successful sexual dynamics in a relationship in his book Rekindling Desire, which he also says is a team effort between the two people in the relationship (see my article: Keeping the Spark Alive in Your Relationship).

Keeping Sex Alive in Your Relationship is a Team Sport

In other words, it's not up to just one person to keep things going sexually.  

For instance, in a heterosexual couple it's not just up to the woman to get dressed up in a sexy night gown to seduce the man.  Similarly, it's not just up to the man to always initiate sex, which is based on the fallacy that men always want sex.  

How Do Both People in a Relationship Take Responsibility For Keeping Sex Alive

In Sex Educator Dr. Emily Nagoski's book, Come As You Are, she discusses "turning on the ons and turning off the offs."  

What Does "Turning On the Ons and Turning Off the Offs" Mean?

To put it succinctly, it means knowing your own and your partner's sexual turn-ons and turn-offs and working on reducing what turns each of you off and increasing what turns each of you on.

Dr. Nagoksi recommends starting with focusing on the turn-offs first because it's often easier for people to identify what they don't like before they can identify what they like.  

In an earlier article, I discussed the Dual Control Model of sexual brakes and accelerators (see my article: Getting to Know Your Own and Your Partner's Sexual Accelerators and Brakes).

To recap briefly: Sexual brakes are things or situations that turn you off. Conversely, sexual accelerators are things or situations that turn you on.

Common Sexual Brakes

Some of the common sexual brakes referred to in the prior article:

• Stress
• Lack of privacy
• A negative body image (see my article: Is a Negative Body Image Ruining Your Sex Life?)
• Anxiety about sexual performance (see my articles: What is Sexual Anxiety? and What is Performative Sex?)

Common Sexual Accelerators

Some common sexual accelerators referred in the prior article include:

• Establishing an emotional connection between partners
• Sexual fantasies you explore on your own
• Exploring Sexual Fantasies With Your Partner
  
• Talking about peak erotic experiences in your relationship

Focusing on eliminating or reducing sexual brakes is the place to start for most couples, as per Dr. Nagoksi.

You can't completely eliminate every stressor in your life, but you can take steps to develop healthy coping strategies to reduce your stress: 

• Doing breathing exercises, 
• Doing mindfulness meditation
• Exercising
• Walking in nature

Clinical Scenario

The following clinical vignette, which is a composite of many cases to protect confidentiality, illustrates how sex therapy can help a couple to come together as a sexual team to improve their sex life.

Bob and June

After 10 years of marriage, Bob and June sought help in sex therapy because they basically stopped having sex.  In the last 12 months leading up to sex therapy they had sex twice (a no sex couple is considered a couple who has had sex less than 10 times in the prior 12 months).

Keeping Sex Alive in Your Relationship is a Team Sport

Both of them felt sad and frustrated about their sex life, but whenever they tried to talk about it on their own, their discussion ended in an argument, so they weren't getting anywhere on their own.

Bob was the one who contacted the sex therapist because he was at his wit's end.  Initially, June was opposed to the idea of seeing a sex therapist because she felt self conscious about talking to a stranger about their sex life.

Their sex therapist normalized their experience and told them that the dynamic in their relationship wasn't unusual for a long term relationship. 

So, after a few sex therapy sessions, they both felt more comfortable talking about sex with each other in the sex therapy sessions and with their sex therapist.

When they discussed their sexual accelerators and brakes, Bob said he wasn't aware of any sexual brakes. For him, it didn't matter if he was relaxed or stressed, whether they had complete privacy (in fact, he was turned on by the possibility of being observed by neighbors if he and June didn't complete pull down the bedroom shade) and he wasn't concerned about sexual performance.

June said she couldn't get sexually turned on if she was under more stress than usual.  She also felt self conscious that she had gained 15 pounds over the last few years, so she had a negative body image that interfered with her libido.  

In addition, on those rare occasions when they had sex, she was self conscious about whether she was taking too long to have an orgasm which created anxiety for her and became an obstacle to enjoying sex.

So, like many couples, June and Bob were very different with regard to their sexual accelerators and brakes.

It also became clear to the sex therapist that Bob was the pursuer when it came to sex and June was the withdrawer.  And, in terms of their emotional relationship, June was the pursuer and Bob was the withdrawer.

According to Bob, whenever he attempted to have sex with June, he felt rejected by her. And according to June, whenever she tried to strengthen their emotional connection, she felt rejected by Bob.  

When Bob heard June talk about trying to strengthen their emotional connection, he said, "In order for me to feel an emotional connection with you, I need to have sex first."

Hearing this, June said, "But in order for me to feel sexually connected to you, I need to feel an emotional connection first."

Both of them agreed that this is where they got stuck each time, and they couldn't see a way to overcome this sexual connection/emotional connection dilemma (see my article: Whereas Women Often Need Emotional Connection to Get Sexually Turned On, Men Often Need Sex to Connect Emotionally).

(As an aside: The dynamic described above for men and women is a generalization. There are many men who need emotional connection to get sexually turned on and many women who need sex to feel emotionally connected.  For instance, in her book, Sex Talks, Vanessa Marin discusses how she needs sex to feel emotionally connected and her husband, Zander, needs emotional connection to feel sexually connected.  So, be aware there are exceptions and whichever way the dynamic goes, it's all normal.)

Since they were both emotionally and sexually disconnected from each other, Bob and June decided that their priority at the start of sex therapy was to feel more emotionally connected first, so they made this their initial goal.

Their sex therapist explained the concept of Senate Focus, which was originally developed by Masters and Johnson in the 1960s and updated by contemporary sex therapists, including Linda Weiner and Constance Avery-Clark in their book, Sensate Focus in Sex Therapy - The Illustrated Manual.

The sex therapist explained to June and Bob that the basic premise of Sensate Focus, which is also called Mindful Touching, is that a couple improve their emotional intimacy and communication through non-sexual touching.  

She advised June and Bob that they start slowly and, in order to focus on emotional connection first, that they not have sex after they practiced Sensate Focus touching--even if they felt sexually turned on.  She explained that by eliminating the expectation of sex while they were engaged in non-sexual touching, they could both relax and focus on becoming more emotionally connected without the pressure of sex.

After practicing Sensate Focus for a few weeks, Bob and June were feeling a lot closer emotionally.  They also both accepted that they were in it together when it came to improving their emotional and sexual connection, so they accepted the idea that it was a team effort between them.

As a next step, once Bob and June were feeling more emotionally connected and June was more open to connecting sexually, they focused on eliminating or reducing June's sexual brakes.  

June worked on developing a more positive body image.  Over time, she gradually learned to accept her body.  And Bob talked to June about how turned on he was by her body--regardless of the fact that she gained weight.  He said he didn't care that she gained weight at all.  He loved her regardless.

To reduce stress, Bob gave June massages to help her to relax. He also took over many of the every day chores that were on June's to do list, so she didn't feel so burdened by so many chores, which allowed her to relax even more.

After they worked on reducing the sexual brakes, they focused on both of their sexual accelerators, including discussing sexual fantasies and their peak erotic experiences from earlier in their relationship.

By then, June and Bob both felt more sexually alive and ready to have sex again on a regular basis.  Bob learned to focus more on June's sexual pleasure at first rather than focusing only his own.  

Based on what he learned in sex therapy, he focused on cunnilingus (oral sex) and fingering June's clitoris instead of relying solely on sexual intercourse. He also assured June that he was not in any hurry for her to have an orgasm, so she could relax.

June also learned not to focus so much on whether or not she had an orgasm.  As a result, without that stress, she was able to relax and she had orgasms more frequently because she didn't feel pressured.

Both Bob and June also learned to focus more on the quality of their sex rather than the quantity.  

Keeping Sex Alive in Your Relationship is a Team Sport

As they continued to work on their sex life together in sex therapy, they told their therapist that they were enjoying sex more than ever.

Conclusion

It's not unusual for couples to go through different sexual and emotional stages in their relationship, especially in long term relationships.

Developing and maintaining a fulfilling sex life is the responsibility of both people in the relationship. 

Even though the particular vignette in this article is about a heterosexual couple, the idea of sex as a team effort is for everyone regardless of age, gender or sexual orientation.

Getting to know and work on each person's sexual accelerators and brakes is an important part of rekindling sexual desire.

Sensate Focus or Mindful Touch is helpful to many couples who need to re-establish an emotional connection before they rekindle sexual desire.  

Getting Help in Sex Therapy

Many individual adults and couples seek help in sex therapy for a variety of reasons to overcome obstacles in their sex life (see my articles:  What is Sex Therapy?  and  What Are Common Issues Discussed in Sex Therapy?)

Sex therapy is a form of talk therapy where there is no physical exam, no nudity or sex during therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?

Sex therapists usually give homework, like practicing Sensate Focus and other exercises, for couples to work on individually or together between sex therapy sessions.

If you're having sexual problems, rather than struggling on your own, seek help in sex therapy so you can have a more fulfilling sex life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Sexual Wellness: Savoring Pleasure

Just like a delicious meal is best appreciated by savoring it, slow intense sex is much more pleasurable than rushed sex (see my articles: Mindful Sex and What is Rec-Relational Sex?).

Savoring Pleasure

Although there's a time and place for fun quickies, a longer sexual buildup adds to pleasure and can lead to more intense orgasms (see my articles: Rethinking Foreplay as Just a Prelude to Intercourse and Closing the Orgasm Gap Between Women and Men - Part 1 and Part 2).

Savoring Pleasure

When it comes to pleasurable experiences, delicious food and good sex have a lot in common. With delicious food, you might think of it as starting with a much-anticipated reservation at your favorite restaurant.  

The pleasure of this experience begins after you've gotten the reservation and you're thinking about what you'll wear, how you'll slowly sip your favorite wine before appetizers arrive, being made to feel special by your server, the ambiance, choosing your favorite food, enjoying every tasty morsel, and pacing your experience to enjoy every moment.

Many individuals and couples who come to see me in my psychotherapy private practice in New York City tell me that they don't have time for sex and, even when they have time, they're too exhausted.  

Others say that the thought of scheduling a time for sex feels unnatural and they think it should happen spontaneously. But when they try to be more spontaneous, it doesn't happen--except, maybe, when they're on vacation.

Scheduling time to have sex might feel counterintuitive at first, but when you know you have the time and privacy to enjoy sexual pleasure, you can relax more and give yourself over to a pleasurable experience.  You'll enjoy sex so much more when you're free of your usual responsibilities.

In addition, scheduling time for sex often increases the anticipation and buildup of sexual pleasure. 

For instance, if you and your partner plan to have sex on a Saturday night while your children are staying with your parents, you and your partner can fantasize about what you want to do together, which massage oil and sex toys you'll use, and which sexual positions will be most fun (see my articles: Accessing Your Sexual Energy, Discovering Your Peak Sexual Experiences and Reviving Your Sex Life With Your Peak Sexual Experiences).

Other couples, who have been together for a long time, complain in couples therapy that they've become so bored with their sex life that they've just stopped having sex (see my articles: Improving Sexual Intimacy in a Long Term Relationship and Overcoming Sexual Boredom in a Long Term Relationship).

Changing Your Sex Script

It's easy to get into a sexual rut where you're doing the same things and deriving less pleasure from them (see my articles: Changing Your Sex Script - Part 1: Sexual Arousal, Part 2: The Beginning Phase, Part 3: Understanding Sexual Motivation).

When you have time to be sexually intimate, you want to pace yourself in much the same way you would pace yourself when you're enjoying a special delicious meal.  

You can enhance your experience by using Sensate Focus techniques, which were originally developed by Masters and Johnson:

• Taking Turns With Hand-riding: Hand-riding begins with non-genital touch. The partner being touched places a hand on top of the hand of the partner who is touching and gently guides them on how they like to be touched--where, how much pressure, etc. 

• Adding Lotion or Massage Oil: According to Masters and Johnson, one way to increase pleasure is to change the medium of touch.  So, adding lotion or oil can add a new dimension to make touch more pleasurable.

• Mutual Touch: Using hands, lips and tongue, you explore each other's bodies at the same time (rather than taking turns during the initial stage of Sensate Focus with hand-riding).

• Sensual Intercourse: Masters and Johnson emphasized sensuality, so they used the phrase "sensual intercourse" instead of "sexual intercourse."  Rather than beginning with sexual thrusting, sensual intercourse focuses on first experiencing the sensations of warmth and touch, like brushing genitals against each other.

Savoring Pleasure During Solo Sex

Savoring sexual pleasure isn't just for couples.  

Whether you're in a relationship or not, as I mentioned in my article Sexual Pleasure and Developing the Erotic Self, you can also enjoy solo sex by taking the time to discover what's pleasurable to you.  Knowing what you enjoy sexually can also enhance partnered sex.

Getting Help in Therapy

Many individuals and couples need help to establish or revive their sex life, but they feel too ashamed to seek help (see my article: Why It's Important to Talk to Your Therapist About Problems With Sex).

A skilled psychotherapist can help you to overcome the barriers that keep you from having a more fulfilling life, so rather than struggling on your own, seek help.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Certified Sex Therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.