Sensate Focus in Sex Therapy: The Illustrated Manual reconnects the reader with one of the hallmarks of the pioneering days of sex therapy: Sensate Focus. At its most basic, Sensate Focus is a technique to minimize performance anxiety and “spectatoring.” It may be counter-intuitive to some on first consideration, but the very success of sexual pharmaceuticals, and their impact on sexual health delivery world-wide, makes this book a must-read for any healthcare professional assisting people suffering from sexual disorders and concerns. Why? Medical approaches to sexual disorders are optimized when medical interventions are integrated with counseling. Understanding the rationale for non-demand experimentation and the basics of Sensate Focus can be a powerful weapon for anyone attempting to assist those who suffer, whether a sex educator nurse practitioner, physician, or psychotherapist. Sexual disorders and concerns are multi-determined by a host of varied biological and psychosocial-behavioral and cultural factors. Yet, those who suffer from sexual disorders all have an underlying concern and anxiety about disappointing themselves and their partner. Sensate Focus techniques can help a person learn how to manage those issues and that is the focus of this volume.
I was honored when Linda Weiner and Constance Avery-Clark, earlier this year, expressed their eagerness for me to write a foreword for this volume, that was inspired by the work of my former mentor and colleague Helen Kaplan, and my friends Bill Masters and Gini Johnson. All three of them did so much for our profession and society in general. I certainly owe my own career of over 40 years to them. This is a book whose time has come. How might that be? In Masters and Johnson’s preface to the 1970 landmark, Human Sexual Inadequacy (a book that launched sex therapy and introduced the world to Sensate Focus) they wrote: “It is to be hoped that human sexual inadequacy, both the entity and this book would be rendered obsolete in the next decade” (Masters & Johnson, 1970, pp. v). Despite the tremendous progress that has been made over ensuing decades, their hopes could not have been more unrealized as the parade of distressed individuals seeking assistance daily all over the world for relief from the suffering caused by their sexual problems continues to this day. Of course there is no one cure, but Sensate Focus in Sex Therapy: The Illustrated Manual provides a guide to familiarize (re-introduce) novice sex therapists and experienced master clinicians, as well as the public at large, to a technique that has universal application in almost every case where sexual symptoms exist.
This book has a number of strengths, but I want to highlight a few for the reader. Most important to the professionals reading this book, the authors advocate for and practice a type of communication that is key to good diagnosis and treatment. First quoting Marcel Proust, “Be precise, my dear, be precise,” the authors elaborate: “As therapists we must be Proustian in our measured attention to the details of sensation descriptions so that our clients will want to divulge everything down to minute details.” The key to a good sex status (focused sex history) is obtaining the details, and that can be part of almost every consultation. For the novice therapist in particular, explicit and elaborate explanations of the why and how to give instructions for Sensate Focus is quite useful. The authors explore the theory behind reducing performance anxiety. This is a common cause of sexual disorders and one that is almost always a factor in the maintenance of sexual disorders regardless of whether a pharmaceutical and/or sexual counseling has been initiated. Both the why and the how to initiate Sensate Focus instructions are provided, with sensitive consideration for diverse patient populations and varying overlapping disorders. Again, the emphasis on providing precise and vivid descriptions and seeking the same back from clients is something we all must be reminded to do continuously.
For novice and experienced clinicians alike, Weiner and Avery-Clark explore the management of common problems and resistance to both the outcome and process of Sensate Focus. That in-depth discussion includes, but is not limited to, non-compliance, boredom, lack of spontaneity, ticklishness, feeling nothing, sexual frustration, confusion about, and difficulties with either/or Sensate Focus concepts and instructions. In almost all cases the process involves the clients learning to recognize and acknowledge their anxiety, communicate it, but then move beyond it by refocusing their attention productively. All are also reminded of the importance of patience when seeking change and of the necessity to appreciate systematic approximation and embracing how small iterative steps can lead to longer lasting confidence and success. Explanation of how to manage distractions through cognitive-behavioral mindfulness techniques should especially appeal to those practicing this currently popular approach with its many adherents.
Of course the illustrations themselves, like those in Helen Kaplan’s The Illustrated Manual of Sex Therapy (1975; 1987), help inspire this current book and offer so much to both the public and professionals alike. However, unlike Helen’s own pioneering work, the interpretive non-traditional illustrations illuminate a broader application of Sensate Focus to a larger group of sexual concerns and a more diverse audience. That varied range is recognizable among the participants who are illustrated within themes that recognize aging, loss (mastectomy, leg prosthesis), and race. This naturally broadens the audience of the book’s utility for use by professionals and those seeking self-help alike.
What all cognitive-behaviorally-oriented therapists know is that helping someone behave themselves into a new way of thinking and feeling is possible and rewarding for both clinician and client/patient. Weiner and Avery-Clark conclude their book with an acknowledgment of the primary nature of touch. What I have always loved about sex therapy is the fact that “mother nature” is on my side – that is always a good thing. All who read this book will benefit and find useful guidance in their efforts to make sex a positive force in both their personal and professional lives.
Michael A. Perelman, Ph.D.
Co-Director, Human Sexuality Program
Clinical Professor Emeritus of Psychology in Psychiatry
Former Clinical Professor of Reproductive Medicine & Urology
Weill Cornell Medicine | NewYork-Presbyterian