Sensate Focus: An Introduction

About this resource

Sensate focus was developed by Masters and Johnson as the core behavioural component of sex therapy and remains the foundation of treatment for a wide range of sexual difficulties, including low desire, arousal and erectile problems, pain, and the avoidance of intimacy that follows any of these. It works on the same principle as graded exposure: performance anxiety and avoidance maintain sexual difficulty, and a hierarchy of touching exercises with intercourse explicitly off the table allows the couple to re-approach physical contact without the pressure that has come to surround it. The instruction to attend to sensation rather than to arousal, the partner's response or any outcome is what makes the exercise different from foreplay.

This resource introduces the first stage only: taking turns to touch and be touched on non-genital areas, with breasts and genitals excluded, for a fixed time, with attention on temperature, texture and pressure rather than on pleasure or arousal. Later stages, which gradually include genital touch and eventually intercourse, are introduced by the therapist only once this stage is comfortable. The description here follows the contemporary manualised approach of Weiner and Avery-Clark, in which the touching partner touches for their own interest rather than to please the other, which further removes the pressure to perform.

The professional version adds guidance on setting the stage boundaries, on the common ways couples drift from the instructions (rushing, turning it into sex, one partner giving feedback throughout), on managing anxiety and dissociation during the exercise, and on when a history of sexual trauma means the pacing or the exercise itself needs adapting.

How to use it

1. Assess first: medical contributors, pain, trauma history, relationship safety and current alcohol or substance use. Sensate focus is not appropriate where there is coercion or ongoing relationship violence, and needs careful adaptation where there is a trauma history.
2. Explain the rationale in session: pressure and avoidance keep the difficulty going, and this exercise removes both. Be explicit that intercourse and orgasm are off the table for now, for both partners, and that this is a rule rather than a suggestion.
3. Go through the instructions together, including the boundaries on which areas are touched. Ask each partner to say back the instructions in their own words so you can correct misunderstandings before they practise.
4. Prescribe two or three sessions of the exercise between appointments, each of fifteen to twenty minutes per partner. Ask them to complete the practice log after each one.
5. Review the logs in detail at the next session. Difficulties are information, not failure. Do not move to the next stage until both partners report the first stage as comfortable and unpressured.

References

• Masters, W. H., & Johnson, V. E. (1970). Human Sexual Inadequacy. Little, Brown.
• Weiner, L., & Avery-Clark, C. (2017). Sensate Focus in Sex Therapy: The Illustrated Manual. Routledge.
• Leiblum, S. R. (Ed.). (2007). Principles and Practice of Sex Therapy (4th ed.). Guilford Press.