William Masters and Virginia Johnson (1966; 1970) will be remembered for their landmark successes identifying and cataloging scientific data on human sexual response, and pioneering the first short-term treatment for sexual dysfunctions and distress. However, their most important contribution to the field of sex therapy may have been the creation and development of Sensate Focus touching experiences for identifying and resolving sexual difficulties and, ultimately, fostering and optimizing intimacy.
The elegantly simple and straightforward technique of Sensate Focus is a radical departure from our cultural scripts about how sex happens. We are taught that to be a good lover you have to skillfully turn on your partner and your partner has to skillfully turn you on. Additionally, you have to do this by what amounts to reading your partner’s mind and knowing what your partner will enjoy without your partner’s having to share anything. All you have to do is look at the magazines at your local grocery store check-out line to learn Ten Easy Steps for Turning on Your Boyfriend or How to Make Your Wife Horny.
The way sex actually works is just the opposite. It is all about zeroing in on sensations for yourself in the moment and without expectations for any particular response. If you focus on sensations for yourself, sex will happen naturally. Sensate Focus teaches you how to do just that, how to reconnect to the sensory roots of sexuality when you have become lost.
Sensate Focus is a series of structured touching and discovery suggestions that provides opportunities for experiencing your own and your partner’s bodies in a non-demand, exploratory way without having to read each other’s minds. Non-demand exploration is defined as touching for your own interest without regard for trying to make sexual response, pleasure, enjoyment or relaxation happen for yourself or your partner, or prevent them from happening. Touching for your own interest is further defined as focusing on the touch sensations of temperature, pressure, and texture. Temperature, pressure, and texture are even more specifically defined as cool or warm, hard or soft (firm or light), and smooth or rough.
Sensate Focus works because arousal, pleasure, enjoyment, and relaxation are emotions, and emotions are physiologically-based natural functions that, by definition, are not under direct voluntary control. Trying to make them happen, or trying to prevent them from happening, is the single most common psychological cause of sexual dysfunction. Sensate Focus helps people learn to stop trying to directly control the natural function of sexual responsiveness in order to allow it to happen on its own. The Sensate Focus attitude of touching for interest gets your conscious mind out of the way, clearing the path for the body to respond naturally.
During Sensate Focus, when people focus on anything other than touch sensations, they are encouraged to treat these other thoughts and feelings as distractions, and to refocus on the dependable, touch sensations in a mindful way and as often as necessary. This is identical to mindfulness practice. It also involves the focusing principle of the cognitive and behavioral techniques of systematic desensitization and relaxation training, namely, that you cannot pay attention to two things at the same moment in time. Focusing on touching for your interest reduces performance anxiety (often caused by expectations to respond sexually) because you cannot zero in simultaneously on both tactile sensations and anxiety-producing thoughts.
Practitioners use Sensate Focus for many reasons. One is identifying the psychological, relationship, lifestyle, and sociocultural issues that contribute to sexual difficulties. Other reasons include teaching new skills to remediate sexual issues, and also eventually facilitating more satisfying and meaningful sexual intimacy.
Why is Sensate Focus Based on Touch?
Why touch sensations? “If words are the currency of poetry, and color is the currency of art, touch is the currency of sex” (Masters, Johnson, and Kolodny, 1995, p. 358). “The sense of touch is the special sense most used in sexual interchange” (Masters & Johnson, 1986, p. 8). In fact, what led to the development of Sensate Focus in the first place was Virginia Johnson’s reflection on the memory of her mother’s comforting “facial tracing” during her childhood (Maier, 2009, p. 182). She was not the first to recognize the power of touch.
(Aanstoos, 2012, p. 51)
Over the centuries, literary masters have also reflected on the power of touch:
(Shakespeare, Romeo and Juliet)
Philosophers suggest that skin-to-skin contact is the gateway to the “openness of the body … [to] our deepest relational intertwining with the flesh of the world” (Aanstoos, 2012, p. 57).
Scientific research suggests as much. Touch is the first sensation we experience before and immediately after birth. It often remains the most emotionally significant sense throughout our lives. It alters our biochemistry, our neurology, our feelings, thoughts, and behaviors, our ability to socialize and have intimate relationships, our ability to heal, thrive, and survive. In fact, touch may determine whether an infant lives or dies. Neurobiologists and psychiatrists have discovered that children whose senses are intact and who are provided with food and shelter but who do not receive and give touch suffer physically and psychologically. Researchers have shown that elderly people whose other senses are failing function better physically and psychologically when they can give and receive touch, and function much less well if they cannot (Konnikova, 2015). Helen Keller is a remarkable example of someone who, deprived of the sense of sight and hearing, was able to lead a healthy and deeply meaningful life in large measure because of the power of touch. It is this power that Masters and Johnson originally harnessed when they developed Sensate Focus.
Use of the common denominator of sensory experience is employed in reversal of the presenting sexual distress … Communication intended to give comfort or solace, convey reassurance, show devotion, describe love or physical need is expressed first by touch. Olfactory, visual, or auditory communication generally serves as a reinforcement of the experience … Touch … becomes the primary medium of exchange …
(Masters & Johnson, 1970, p. 66)
The purpose of Sensate Focus is and always has been to help sexually distressed individuals resolve their concerns by grounding them in touch sensations in the moment.
Why Does Focusing on Touch Sensations Help with Sexual Dysfunctions?
It is clear why touch is so powerful. But why would focusing on touch sensations help sexually distressed people with their problems? Three reasons.
First, as clinicians, if we suggest to our clients that they stop focusing on their conscious anxiety about sexual responsiveness (“Will I get an erection?” “Will I be orgasmic?”) we have to give them something else on which to focus instead. Turning your attention to sensations is a reliable, neutral, and tangible alternative to focusing on the worrisome thoughts and feelings that are often powerful contributors to sexual problems. Sensations give you something dependable on which to focus because sensations are always there. You cannot reliably get rid of performance thoughts and feelings about what has happened in the past, what may happen in the future, or what is or is not happening in the present moment. But you can always turn your attention to the tangible sensations of temperature, pressure, and texture.
Second, it also happens that turning your attention to touch sensations is often the most powerful portal into sexual responsiveness. Focus on tactile sensations, get the conscious mind out of the way, and the body knows what to do. The benefits of this include decreased blood pressure, the release of oxytocin (the bonding hormone), and blood flow to the pelvis that serves as the foundation of sexual interest and sexual arousal. Your conscious attention then moves beyond being aware of even the sensations, and you become absorbed in the flow of the sexual experience. This is the ultimate aim of Sensate Focus.
The Gateway to Relating Sexually
Finally, focusing on the touch sensations not only leads to your own arousal but also to your partner’s. William Masters often said that the main sources of sexual stimulation are threefold: your touching; your being touched; and your partner’s arousal. Each person’s arousal becomes part of an ongoing, positive feedback loop that serves as another gateway into the other person’s arousal. This loop moves the partners beyond merely self-focused touching into sexual relatedness and enhancement.
The Main Concept Underlying Sensate Focus: Sex is a Natural Function
An understanding of the reliability and power of mindful touch leads into an understanding of the most important idea underlying Sensate Focus, namely, that sex is a natural function. This is central to appreciating how and why Sensate Focus works.
All natural functions have three characteristics in common.
We Are Born With Natural Functions
First, and barring major organic pathology, all natural functions are wired into us from before birth. This includes vegetative functions like breathing or digesting food, and emotional responses like pleasure, relaxation, and enjoyment. The same is true with sexual responsiveness. We are born with the ability to respond sexually. Baby boys have erections in utero, and newborn girls are known to lubricate. Are these reactions all there is to sexuality? Obviously not. But they do suggest a natural, physiological readiness to respond in ways that are later considered sexual.
We Cannot Be Taught Natural Functions
Second, we do not have to be taught, nor can we be taught, these natural responses. While we can teach people to do things to increase the chances that these natural responses will occur (this is what therapists do all the time), we cannot directly teach the natural functions themselves. Just as the notion of instructing someone to sleep or to feel joyful seems nonsensical, similarly the notion that you can be taught to feel sexually desirous, have an erection, lubricate, or be orgasmic is preposterous. People can be encouraged to engage in doing things that increase the likelihood that the natural function of sexual responsiveness will occur (this is the essence of Sensate Focus), but even the most skilled practitioner cannot instill in a client the ability to respond sexually if the natural function is not wired in to begin with or if it is disrupted by medical or psychological problems or other factors.
We Do Not Have Direct Control Over Natural Functions
Finally, although we do have some ability to control our natural functions (you can hold your breath), we do not have the ability to intentionally make these functions happen or keep them from happening. For example, you can only hold your breath for so long. Another illustration involves producing a urine specimen when you visit the doctor. Have you noticed how the harder you try, the more difficult it becomes? Conscious demand to directly control a natural function creates anxiety, and anxiety interferes with the expression of any natural function.
The Paradox of Sexual Responsiveness
The same is true with sexual functioning. The paradox of sexual desire, arousal, and orgasm is that the harder you consciously try to make them happen, the less likely they are to happen, and the more intent you are on trying to keep them from happening, the more likely they are to happen. Conscious intentionality produces tremendous anxiety because you simply do not have direct, voluntary control over making yourself, or someone else, sexually aroused. The anxiety associated with trying to turn on yourself or your partner is at the heart of many non-medically based sexual dysfunctions and disorders. In a world in which most successful people have been rewarded for working hard for results, this paradox is very different from the usual manner in which we approach tasks.
The Formula for Implementing Sensate Focus Using Research-Based Techniques
Understanding and taking advantage of the concept and paradox of sex as a natural function, Masters and Johnson began helping people with sexual problems. They discovered that our romantic ideals of creating sexual responsiveness directly in ourselves and our partners, as well as the admonition we have received not to be self-focused in sexual encounters, are all wrong. What they realized through their laboratory and interview research is that people who are functioning well sexually practice three skills that honor sex as a paradoxical natural function: (1) while touching their partners, they touch for themselves rather than for their partners; (2) while touching or being touched, they focus on touching for their own interest, curiosity, or exploration (defined as focusing on tactile sensations) rather than for arousal, pleasure, relaxation, enjoyment, or any other emotion; and (3) they redirect their attention back to sensations when they are distracted. An understanding of the role of natural function and these three attitudinal skill sets are the foundation of Sensate Focus. Let’s examine them in more detail.
Touching for Self vs. Touching for the Partner
Keeping the principle of sex as a natural function in mind, the first critical aspect of using Sensate Focus is the attitude of touching for self. The Masters and Johnson approach of touching for self was entirely new when it was developed. It put forth the radical idea that sexual responsiveness is essentially self-focused. This means that in order to become sexually responsive, you have to focus mainly on your own experience rather than on your partner’s. This is different from being selfish where you are only focused on yourself. During Sensate Focus, the partner’s experience is not ignored as will be described in more detail subsequently. The problem is that in our culture, we have been taught that being self-focused is the same as being selfish. However, in order for any natural function to express itself, a person must be absorbed in his or her own sensory experience. Everyone has to know how to tune into his or her own sensory experience in order to allow sexual responses to happen naturally. Let’s put it this way: About whom are you thinking when you are orgasmic? You cannot be orgasmic and focused on your partner’s experience at that same moment in time.
This is where focusing on the partner becomes a problem in the initial stages of Sensate Focus. It follows that if you cannot directly control natural functions for yourself, how are you going to make them happen or keep them from happening for someone else? We know this when it comes to other natural functions. Do you ever think that you can digest food for someone else? Or cry for them? Sexual responsiveness is no different. It requires a self-focused attitude. Touching for the partner generally doesn’t work because you are out of your own experience. Not only that, but if the partner senses you are touching for them in order to turn them on, the pressure on the partner to respond sexually creates anxiety in them as well. This becomes a negative rather than a positive feedback loop for both participants.
Instead, Masters and Johnson suggested that what really happens in good sex is that each person becomes involved in touching for his or her own interest, using the partner’s body as one source of absorption and stimulation in a mutually agreed upon lend lease proposition. This, then, creates a positive feedback loop that eventually is more likely to lead to arousal for both partners.
Touching for Interest by Focusing on Sensations vs. Touching for Pleasure or Arousal
The attitude of touching for yourself without judgments, expectations, and evaluations about arousal, pleasure, and the like is easier said than done. It is accomplished by the second critical attitude of Sensate Focus, touching for interest rather than for arousal or pleasure. Clients are encouraged to move away from judgments, expectations, and evaluations about arousal and pleasure because doing so leads to a demanding, performance-oriented mindset: “Am I doing a good job?” “Am I succeeding?” “Am I touching the right way?”
However, it is impossible not to attend to these judgments, expectations, and evaluations without something else on which to focus instead. Sensate Focus provides just this, a dependable alternative to anxious thoughts in the form of concrete, tangible, touch sensations in the here-and-now. These touch sensations are identified for clients as temperature, pressure, and texture, and even more concretely as cool or warm, firm (hard) or light (soft), and smooth or rough so that there is no confusion about what they may focus on instead of judgments, expectations, and evaluations.
Identifying and Managing Distractions
The third aspect of implementing Sensate Focus is identifying and managing distractions, especially those having to do with demands for the natural responses of arousal, pleasure, relaxation, and enjoyment. Clients are encouraged to identify anything other than temperature, texture, and pressure as a distraction. Distractions besides anxiety about performance may include thoughts about things left undone at home or at work, worrying about someone’s knocking on the door, or negative feelings about yourself or your partner, among many others.
In the beginning of therapy, suggestions are extreme. Even positive thoughts like “I am having such a wonderful time” are treated as distractions in order to drive home the point that focusing on anything other than touch sensations is a distraction and is best managed by refocusing on the touch sensations. Again, this takes advantage of the main principle of the behavioral treatment techniques known as systematic desensitization and relaxation training, namely, that you cannot focus on distracting and anxiety-producing thoughts and experiences and, at the exact same time, attend to something else. In this case the something else is touch.
The Purpose of Sensate Focus: Mindfully Touching for Your Interest
The primary purpose of Sensate Focus can be summarized in this way: “Each partner touches for self and focuses on his or her own sensory experience without regard for the partner’s or one’s own pleasure” (Weiner & Avery-Clark, 2013). This is the same as what has come to be known as the practice of mindfulness. “Mindfulness practice is an ancient tradition in Eastern philosophy that forms the basis for meditation, and it is increasingly making its way into Western approaches to health care” (Brotto & Heiman, 2007, p. 3). Mindfulness is an attitude of here-and-now, self-focused awareness during which each sensation, emotion, intuition, thought, and feeling that captures your attention is acknowledged and accepted just as it is without judgment or evaluation.
We have been to conferences where, and read publications in which, Sensate Focus is described as similar to mindfulness practice. Our opinion is that Sensate Focus is mindfulness practice. Just as meditation, yoga, hypnosis, guided imagery, and deep breathing training aid clients with managing stress and debilitating moods by redirecting distractions and focusing on some type of sensory information, so Sensate Focus helps clients turn their attention from disconcerting experiences onto neutral, reliable tactile sensations. In the case of meditation, the sensory information may be auditory in the form of a mantra. In yoga it is kinesthetic in the form of physical sensations in different positions. In hypnosis it may be visual stimuli on which your eyes focus either outside of yourself or inside your head. In the case of guided imagery it may also be visual imagery. With deep breathing training it is the auditory sound and kinesthetic feel of your body inhaling and exhaling. In the case of Sensate Focus, it is the sensations of touch. All of these increase the likelihood that future-oriented anxiety will lessen and a desired natural response in the present will be more likely to happen.
The Difference Between Sensate Focus 1 and Sensate Focus 2
Although we have been using the general term Sensate Focus to identify the hierarchical touching suggestions, we make a distinction between two phases of Sensate Focus, as we have suggested. What we have been describing thus far is more accurately referred to as Sensate Focus 1. However, there is also another phase that we call Sensate Focus 2. This is because just as there is more to sex than natural responses, so there is more to Sensate Focus than touching for your interest.
While we will be discussing Sensate Focus 2 in more detail at the end of this manual, we are emphasizing the components of Sensate Focus 1 in order to underscore the importance of mastering sex as a natural function, and mastering its attitudinal and practical applications of touching for your own interest, before moving on to Sensate Focus 2. Sensate Focus 1 involves mastering skills for people who are having sexual difficulties. Sensate Focus 2 is for people who are not having difficulties, or who have resolved their difficulties, and who want to enhance sexual satisfaction. The difference between Sensate Focus 1 and Sensate Focus 2 is similar to the difference between a child who is under the age of two years and one who is over the age of two. The reason the first two years of life are often referred to as the sensori-motor period is that children must learn how to take in sensory experience and navigate around their small worlds before they can form concepts from these sensations and move on to learning how to relate to others according to complex social guidelines, all of which represents the operational years of development. In the case of Sensate Focus, formal sexual dysfunctions need to be resolved first in Sensate Focus 1 before clients can move on to that for which many people really come to sex therapy, namely, cultivating more sexually relational and optimal experiences that are romantic, pleasurable, arousing, relaxing, and even transcendent. This is Sensate Focus 2.