Sex Therapy With Sensate Focus

councillor looking at couple on the sofa
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Sex therapy is a form of psychotherapy that is used to help individuals and couples address sexual problems. Sex therapy is talk therapy, not hands on therapy. In a sex therapy session, everyone in the room remains fully clothed, and there is no touching. Sex therapists may recommend getting physical exams in order to rule out medical causes of sexual problems. Some may also encourage the use of sexual surrogates for individuals who are working on sexual problems and do not have a partner to practice with.

However, sex therapists do not perform medical exams on, or have sexual interactions with, their clients.

What Is Sensate Focus?

The technique of sensate focus was initially developed as a sex therapy technique by Masters and Johnson in the 1960s. It involves a series of behavioral exercises that couples do together in order to enhance their intimacy and connection.

There are seven elements that serve as the foundation of sensate focus. These are: 

  1. Mutual responsibility between partners for addressing sexual needs and concerns
  2. Information and education about sexual function and sexual activity
  3. Willingness to change attitudes about sex
  4. Getting rid of sexual performance anxiety
  5. Helping couples improve communication around sex and sexual techniques
  6. Reducing problematic behaviors and sex roles in the relationship
  7. Homework to help couples change their sexual relationship for the better

Two of the most important elements in the success of sensate focus are an acceptance of mutual responsibility and a willingness to do homework as prescribed by the sex therapist.

Mutual responsibility is critical because it frames sexual difficulties as a problem of the couple instead of a problem of the person who has been identified as "the patient". Structured homework assignments are the component that separates sensate focus from other behavioral techniques.

The hallmark of sensate focus is that it temporarily takes stressful behaviors off a couple’s sexual menu.

Then, with the sources of stress removed, the therapist prescribes a specific recipe of steps to follow to improve the couple's sexual lives.

What Is Sensate Focus Like?

Two of the principal goals of sensate focus are reducing performance anxiety and improving communication. A typical early homework assignment for a couple where one partner is experiencing erectile dysfunction might go something like this:

I want you two to find two nights over the next week where you can spend at least an hour together. One of you will arrange the date on the first night, the other on the second. Whomever is arranging the date will set up the bedroom with clean sheets, nice light, and pleasant music that you two find relaxing.

Before your date, you'll each take a warm shower to relax. Since you've told me you'd prefer to be wearing underwear for this first exercise, you'll do that. Then, the person setting up the date will help their partner get comfortable on the bed. They'll then spend half an hour exploring and enjoying the sensation of touching their partner's body. For now, we're going to avoid touching genitals, as we want to keep this experience low stress.

After a half an hour, you will switch. Then the other partner will have a chance to do the same type of exploration. The goal of this homework is not to give your partner a massage. Instead, it's to find enjoyment in touching, and being touched, without any expectations. That's why it's important to communicate throughout this date. Tell your partner what you like and what you don't like. Let them know what feels good, and if there's anything that makes you uncomfortable or that you'd like them to stop.  

What Conditions Is Sensate Focus Used For?

As a component of sex therapy, sensate focus  has been shown to be effective at treating a number of different types of sexual dysfunction in women and men, including

Sensate focus is a couples based intervention. It can be used for couples of all different ages, gender identities, and sexual orientations. Much of the research has been for heterosexual couples. Still, many therapists have adopted it for same sex and diverse orientation couples.

Is Sensate Focus Effective?

There is a lot of research examining the use of sensate focus, alone or in combination with other techniques, to improve couples’ sexual satisfaction.

Studies suggest that sensate focus is useful not just for addressing specific sexual problems but also for helping to improve sexual satisfaction in couples with more general dissatisfaction. The technique has also been used as a component of sex therapy for people dealing with sexual difficulties as a result of medical conditions, such as breast cancer.

Sensate focus is well-accepted by sex-therapists and other physicians working with sexual dysfunction. That's particularly true when it is used in combination with good education about sexual performance and function. Sensate focus is a very safe technique, and most individuals find it easy to follow. That is, in large part, because sensate focus is specifically designed as a slow and gentle process of reducing performance anxiety and stress around sexual activity.

Many sex therapists report that sensate focus is a straightforward and effective way to increase intimacy and connection among couples, same-sex and opposite-sex alike. However, not all couples or individual therapists are comfortable using sensate focus. It's a technique that requires a great deal of comfort with discussion of explicit sexual topics. That's not something everyone has.

How Can I Find a Sex Therapist?

There are several ways to go about finding a sex therapist. The most affordable is often to search the provider list for your insurance company. Look for a behavioral health practitioner who specializes in sex therapy. You can also search therapist listings, like Psychology Today, for sex therapists and cross reference that with your insurance list. Finally, the American Association of Sexuality Educators, Counselors, and Therapists maintains a list of sex therapists on their website at AASECT.org. AASECT certified sex therapists are required to undergo both training and clinical supervision in sexual health and therapy techniques.

Be aware that not all sex therapists take insurance. The cost of sex therapy is likely to vary depending on where you live. That said, sex therapy is often time-limited. Pure sex therapy is generally expected to last no more than 10-12 sessions. However, the number of sessions you need will vary depending on the problems you are looking to address and whether you are seeing a sex therapist for general therapy as well.

Sources:

Albaugh JA, Kellogg-Spadt S. Sensate focus and its role in treating sexual dysfunction. Urol Nurs. 2002 Dec;22(6):402-3.

Carr A.. The evidence base for couple therapy, family therapy and systemic interventions for adult-focused problems. Journal of Family Therapy. 2014 35:159-194  doi: 10.1111/1467-6427.12033.

Ratner ES, Erekson EA, Minkin MJ, Foran-Tuller KA. Sexual satisfaction in the elderly female population: A special focus on women with gynecologic pathology. Maturitas. 2011 Nov;70(3):210-5. doi: 10.1016/j.maturitas.2011.07.015.

Sarwer DB, Durlak JA. A field trial of the effectiveness of behavioral treatment for sexual dysfunctions. J Sex Marital Ther. 1997 Summer;23(2):87-97.

Wylie K. Assessment & management of sexual problems in women. J R Soc Med. 2007 Dec;100(12):547-50.

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