Sensate Focus in Sex Therapy

The Illustrated Manual

Linda Weiner, Constance Avery-Clark

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317245810
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoterapia

Sensate Focus in Sex Therapy: The Illustrated Manual is an illustrated manual that provides health professionals with specific information on the use of the structured touching opportunities used regularly by Sexologists to address their clients' sexual difficulties (Sensate Focus 1) and enhance intimate relationships (Sensate Focus 2). This book is the only one to: vividly describe and illustrate the specific steps of, activities involved in, and positions associated with Sensate Focus; emphasize the purpose of Sensate Focus as a mindfulness-based practice; and distinguish between the purposes of Sensate Focus 1 and Sensate Focus 2. Through the use of artful drawings and descriptive text, this manual engages mental health and medical professionals and their clients by appealing to both the visual and the analytical. It discusses how modifications to Sensate Focus can be applied to diverse populations, such as LGBTQ clients, the elderly, the disabled, trauma survivors, and those with challenges such as Autism Spectrum, anxiety, and depression. The book also offers suggestions for dealing with common client difficulties such as avoidance, confusion, and goal directed attitudes. This comprehensive approach to Sensate Focus will remind readers of the beauty and power of touch while offering suggestions for moving from avoidance to sensory transcendence.

Chapter 1:Introduction

“Sexuality is not mere instinctuality; it is an indisputably creative power.”

(Jung, 1966, para. 107)

Sex. So much has changed in the last 50 years since the publication of Masters and Johnson’s Human Sexual Response (1966) and Human Sexual Inadequacy (1970). And so much has not. So much is easier. And so much is more complicated than ever.

Brief Overview of the Field of Sex Therapy

Thanks to the contributions of many different clinicians, researchers, and sexologists working with many more diverse populations than Masters and Johnson, we know a lot more about the physiological bases of sexuality and the biomedical sources of sexual concerns. We also know much more about psychological, relational, lifestyle, and cultural factors that contribute to sexual problems. Thanks to these same professionals, we know a lot more about ways to treat sexual distress and to improve sexual satisfaction across many populations, often requiring modifications in the original Masters and Johnson sex therapy and Sensate Focus protocols.

However, we are also aware that sexual functioning and its meaningfulness are so multidimensional that understanding just the physiology or just the psychology or just the cultural factors is not enough to explain many sexual problems and dissatisfactions. To add to the complexity, we also know that treating sexual concerns and dissatisfactions is not a simple matter of using this approach or that. We also know that many people are often still too uncomfortable to talk about their sexual concerns and to seek out professionals who can help them. This is unfortunate because we definitely know that sexuality specialists today have more tools to help individuals and couples experiencing sexual dysfunctions.

Why Are We Writing This Manual?

We hope that Sensate Focus in Sex Therapy: The Illustrated Manual will help health professionals become more comfortable with and knowledgeable about how, when, and why to use the power of Sensate Focus. We anticipate that by making this manual available to clinicians and their potential clients, we will lessen the discomfort of people thinking about meeting with a health professional.

We are particularly excited about two additional and specific reasons for writing this manual. The first is clarifying Sensate Focus, both in theory and practical application. This is something that has never been done before. The second is shining the spotlight back on the whole person. The field of sex therapy appears to be gravitating towards what we believe is an overemphasis on the biological view, and we want to keep the psychological, relational, cultural, and spiritual work integrated with the biological.

Clarifying Sensate Focus

While there are many excellent publications on how to do sex therapy, there is nothing that has been published in any depth about the foundational centerpiece of sex therapy that is Sensate Focus. The main reason we want to publish this manual is to clarify one of the most powerful approaches to resolving sexual dysfunctions that is already in the hands of clinicians and has been for nearly 50 years. This deceptively simple, straightforward series of touching opportunities developed by William Masters and Virginia Johnson (1970) can have a profound impact on resolving sexual dysfunctions. It may also optimize the intimate and sexual relationship specifically, and enhance the overall relationship generally.

However, despite its power and the fact that Sensate Focus continues to be widely used by sex therapists (Weiner & Stiritz, 2014), and after more than three and a half decades of our practicing, presenting, and publishing on Sensate Focus, we realize this time-honored foundation of sex therapy remains confusing to many. It is often applied differently than what we believe makes it most effective practically, and differently than what makes its application consistent with its theoretical underpinnings. This has resulted in misunderstandings over the purpose, value, and procedures of Sensate Focus.

Witkin … reflects the widespread objection to the Masters and Johnson [Sensate Focus] assignments – that they block spontaneity. Ironically, this is precisely their objective. The fact that this is not generally known arises from Masters and Johnson’s way of presenting their work. Outside of participation in their full-time training program or attendance at their training seminars there is no way to become familiar with many of the essentials of their model …

Not only has their model yet to be completely presented in published form, its deceptive simplicity has made it seem limited at best. This is a crucial misunderstanding. Masters and Johnson’s therapy is a revolutionary departure, even from subsequently established approaches that are thought to be based on it and simply to go beyond it.

(Apfelbaum, 1995, pp. 23–24)

On this basis, we have decided that a more complete, detailed, yet reader-friendly published manual on Sensate Focus is long overdue. That is the primary purpose of this Illustrated Manual. We are intending to cover all aspects of Sensate Focus, including both the practical details of its application so clinicians will know how to use it, and also its theoretical underpinnings in order to clear up any misunderstandings about its purpose. We hope that by including both the practical and the conceptual we will appeal to a variety of readers. New clinicians will find it helpful in the real world of therapy. More seasoned therapists may be intrigued with the historical perspective and become more confident about adding sexuality interventions into their practice. Sexuality professionals and other practitioners will find helpful suggestions for working with a wider variety of clients than was the case in the days of Masters and Johnson.

In doing this we hope to clarify how to apply Sensate Focus in a manner we believe to be most effective in the treatment setting. This is based on the more than 60 years of experience we have between the two of us. However, we are also hoping this manual will stimulate more research that will empirically and more rigorously validate our experience than has been the case up until now.

Addressing both the application and conceptual foundation of Sensate Focus is probably a reflection of the differences between the authors. Linda tends to look at sexual problems from a more practical perspective: “What do I need to suggest to clients to help them right now, and how can I put it in terms they will immediately understand?” This most likely comes from her educational and professional background as a systemic-oriented social worker and trainer. Constance often emphasizes the theoretical: “How can I help the clients understand the larger context of their concerns so they will become more interested in them, more motivated to work on them, and more motivated to continue with their progress?” This is probably associated with her education and training as a more depth- and Jungian-oriented clinical psychologist. Clearly both viewpoints are critical, and we hope that by working together we offer a comprehensive overview of Sensate Focus that will be both helpful and interesting.

Defining Sensate Focus and its Purpose

Sensate Focus is a set of touching suggestions that serves as a powerful therapeutic approach for helping people experiencing sexual concerns. While we will be focusing mainly on Sensate Focus with sexual dysfunctions, we will also be describing to a limited degree some of the effects Sensate Focus can have on greatly improving sexual intimacy and overall relationship satisfaction. We refer to the concepts and techniques for resolving sexual dysfunctions as Sensate Focus 1. We refer to concepts and techniques for enhancing intimacy and relationship satisfaction as Sensate Focus 2. We will discuss Sensate Focus 2 in more detail subsequently and we will distinguish Sensate Focus 1 and Sensate Focus 2 throughout this manual.

Detailing Instructions and Offering Illustrations

While Masters and Johnson acknowledged the lack of specific information on the use of Sensate Focus, they never published a precise description of the instructions. This manual will do just that. However, perhaps its most important contribution will be providing not just written instructions but also visual illustrations about how to use Sensate Focus. We have taken our inspiration from The Illustrated Manual of Sex Therapy (1975; 1987) by Helen Singer Kaplan. In it, Dr. Kaplan made a point of writing in a less academic style so her work would be more accessible to clinicians and laypersons alike. Perhaps even more significantly, she provided illustrations to both clarify the positions and activities used in sex therapy techniques and also to suggest “the beauty and humanity of sex”:

In the past … I have had to rely on my verbal descriptions. Often these do not convey the various positions with sufficient clarity and I have had to make sketches to illustrate what I was asking them to do. On some occasions members of the staff have actually had to demonstrate some of the more difficult positions … It is the objective of the drawings … to provide clear illustrations for commonly suggested positions … The drawings will, apart from merely illustrating specific positions, also, I hope, convey the beauty and humanity of sex, fundamentals to successful sex therapy.

(Kaplan, 1987, p. 5)

1.1The Beauty and Humanity of Sex

Shining the Spotlight Back on the Whole Person

Another reason we decided to publish this Illustrated Manual is to emphasize the need for a refocusing on the entirety of each client’s experience. We do this by raising awareness of the history of Sensate Focus and the advances in modifications for more diverse populations. We are going to describe using Sensate Focus with people experiencing a variety of sexual dysfunctions, physical challenges, psychological concerns, relationship dynamics, lifestyle stressors, and value systems.

The field of sexology has become increasingly medicalized over the past several decades. It began with the contributions of Helen Singer Kaplan in the mid-1970s, and has been both helpful and not so helpful. There is no question that one of the most important advances in the sexuality field has been the development of medications and procedures to address sexual dysfunctions. We now have increasingly accurate medical assessments and interventions to help people who are experiencing hormonal, cardiovascular, neurological, anatomical, and illness-related problems affecting their sexual functioning.

However, we need a wake-up call because this same emphasis may demote sex therapists to a secondary rather than a collaborative role, or to no role at all. This is a big problem. While medical interventions are most useful for those clients who are experiencing medical or mixed etiologies, they do not address the psychosocial difficulties that arise even in cases where the primary etiology is medical. Many clinicians tell us, “Sexual dysfunction is inevitably complicated. It is multi-causal (biopsychosocial), multidimensional (psychological and interactional), and has multiple effects on the person, the partner, and their relationship” (Metz & McCarthy, 2012, p. 213). Despite this, eminently respected sex therapist and psychologist Michael Perelman notes,

Regrettably and more rapidly than any sex therapist could imagine, the exaggerated mid-century notion that psychological problems caused most sexual dysfunctions was replaced by a media-fueled equally fallacious argument that sexual problems were almost exclusively the result of organic causes. Dismissed from the public discourse and all but forgotten was the truism that every sexual disorder, regardless of the severity of its organic etiology, also has a psychosocial component – if not causative, then certainly consequential.

(Perelman, 2016, p. 40)

Nowhere is the influence of this emphasis on medicine and biology more evident than in the recent publication of the controversial Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2015). In this bible of clinical diagnoses, the psychological, relationship, lifestyle, and social contributions to sexual dysfunctions have been relegated to “associated features”: “One new exclusion criterion was added: the disorder should not be better explained by a ‘nonsexual mental disorder, a consequence of severe relationship distress (e.g., partner violence) or other significant stressors’” (IsHak & Tobia, 2013, p. 2). This suggests that, according to the DSM-5, an individual’s psychological disorders, a couple’s significant relationship problems, or other significant lifestyle concerns may not be the primary diagnosable cause of sexual dysfunctions.

It is a rare case in which there is solely a medical component to a sexual dysfunction. Even if physiological problems contribute to the onset of the dysfunction, individual, relationship, and other psychosocial factors also often play a significant role in the origin of a sexual concern, and a much more significant role in maintaining the problem. For example, Perelman’s (2009) Sexual Tipping Point® model reminds us of the mind–body connection.

The Sexual Tipping Point® model depicts the continuously dynamic and variable nature of an individual’s sexual response on a distribution curve … [It] easily illuminates the mind–body concept that mental factors can “turn you on” as well as “turn you off”; the same is true of the physical factors. Therefore, an individual’s Sexual Tipping Point represents the cumulative impact of the interaction of a constitutionally established capacity to express a sexual response elicited by different types of stimulation as dynamically impacted by various psychosocial-behavioral and cultural factors. An individual’s threshold will vary somewhat from one sexual experience to another based on the proportional effect of all the different factors that determine their tipping po...