Chapter 3:What Sensate Focus is Not: A Little Bit of History About the Confusions

Sensate Focus seems pretty straightforward, doesn’t it? Unfortunately, that hasn’t always been the case. This next chapter covers a bit of the history of Sensate Focus in order to clarify the confusions about how Sensate Focus is understood and implemented. If you are not a history buff, you can move to the next chapter without missing much of the practical information. However, this history clarifies why we spend so much time emphasizing the critical importance of both appreciating sex as a natural function and also the attitude of touching for your own interest when it comes to using Sensate Focus effectively. The history also indicates the power of the words that are chosen for Sensate Focus suggestions, and these words may hinder or facilitate therapeutic progress.

Almost from the moment Human Sexual Inadequacy (Masters & Johnson, 1970) was published, there was confusion about what Sensate Focus was all about and how to use it. Even as talented clinicians training under Masters and Johnson enlarged the sex therapy field from its original and medically based, psycho-educational model, the original purpose of Sensate Focus was either poorly communicated in their publications or never published at all. Masters and Johnson were aware of their role in these misunderstandings, and they acknowledged that Human Sexual Inadequacy does not accurately portray the intention of Sensate Focus.

Confusion About the Concept of Sex as a Natural Function

The confusion about the main idea underlying Sensate Focus, that sex is a natural function, has to do not so much with the concept itself but more with a lack of appreciation for its profound significance. We don’t know of one sex therapist who wouldn’t agree with the notion that sexual responsiveness is something with which we are all born, that we cannot be taught, and that is under some limited but not direct voluntary control. And most people who are not even sex therapists would also nod heads in agreement.

But do any of us really live sex as a natural function? While we know that we do not have direct, ongoing control over other natural functions like sleep, food digestion, or our emotions, we live in a culture that treats sexual responsiveness as something different, as if it were under our direct control.

Another confusion has to do with recognizing the meaning of sex as a natural function. Some sexologists have suggested that viewing sex as a natural function is an inaccurate oversimplification of sex, one that is based only on biology (Tiefer, 1991). The first sexologists who would agree that there is more to sex than biology would be Masters and Johnson themselves. They clearly recognized that sex is more than anatomy, biochemistry, physiology, neurology, and endocrinology. Their emphasis on sex as a natural function does not exclude psychological, interpersonal, social, and even spiritual dimensions. However, by emphasizing sex as a natural, psychophysiological process, Masters and Johnson were reminding us that it is all too easy to forget that the natural processes of sexuality are its bedrock, and that it is often necessary to focus on this physical bedrock before attending to other factors when treating sexual dysfunctions. This is true not only in sex therapy but also in life in general. The famous psychologist Abraham Maslow (1954) suggests exactly this same principle in his well-known hierarchy of needs when he stresses that the basic physiological needs must be met before all others can be pursued.

Confusions About Sensate Focus Suggestions: The Importance of Touch for Mindful Self-Focus

Confusion about the full conceptual measure of sex as a natural function has often translated into misunderstandings about the words that are used to convey Sensate Focus instructions. This is particularly true for initial Sensate Focus suggestions.

Some would contend that the words we use are not particularly significant and that to quibble over them is to play semantics. Others suggest that words are at best inadequate: “The human tongue is like a cracked cauldron on which we beat out tunes to set a bear dancing when we would make the stars weep with our melodies” (Flaubert, 1965, p. 138). We are going to suggest that, at least for the purposes of accurately conveying and processing the concepts and suggestions associated with Sensate Focus 1, the words therapists and clients choose are of paramount importance. Words have the power to convey attitudes that help the clients moderate pressure, or attitudes that can add to the pressure. Much as cognitive-behavior therapy practitioners advise, the verbal narratives we tell ourselves make all the difference in the world in terms of: our emotions; our ability to cope with disruptive ones by cultivating productive attitudes; and our ability to translate these into more effective behavior patterns (Ellis, 2000).

The confusions over the concept of sex as a natural function, and the practical Sensate Focus suggestions that come out of this concept, are perfect examples of the power of language to shape emotions, attitudes, and even behavior. They began with Masters and Johnson’s own and unfortunate choice of words when initially describing Sensate Focus. Masters and Johnson seem to have accurately conveyed the idea that sexual responsivity could not be produced on demand. They did this by avoiding using phrases like make yourself sexually aroused when offering the Sensate Focus instructions. However, they did use words that implied a demand for other natural, emotional responses, most notably, pleasure. They also used language that emphasized creating these natural responses for the partner.

The partner who is pleasuring is committed first to do just that: give pleasure. At a second level in the experience, the giver is to explore his or her own … personal pleasure in doing the touching to experience and appreciate … the somewhat indescribable aura of physical receptivity expressed by the partner being pleasured. After a reasonable time … the … partners are to exchange roles of pleasuring (giving) and being pleasured (getting).

(Masters & Johnson, 1970, p. 68)

It is this emphasis on producing pleasure, especially the partner’s pleasure, that resulted in major confusion when it comes to implementing Sensate Focus suggestions. Apfelbaum (2012) correctly describes how, as a result, many professionals have interpreted the first phase of Sensate Focus as non-demand pleasuring of the partner.

Thus, understandably, the purpose of Sensate Focus often has been presented in the professional literature as emphasizing the goals of creating enjoyable, relaxing, romantic, or pleasurable emotions particularly for the partner but even for oneself. Inadvertently, this wording pressures clients to make these emotions happen for each other and for themselves. This is not only a double whammy but also the incorrect use of Sensate Focus that may have negative therapeutic consequences. In fact, clinicians lament, “In clinical supervision, we often hear reports that therapeutic disasters resulted from incorrect usage of sensate focus” (Weeks & Gambescia, 2009, p. 360). One of the most common forms of incorrect use is incorrect wording. This is also one of the most significant contributors to resistance on the part of clients to participate in Sensate Focus.

The Problem with Using “Touching for Pleasure” Words

All of this suggests the need for clinicians to be careful when choosing the words for initial Sensate Focus directions. Directions that incorporate phrases like “focus on sensations” and “pay attention to temperature, pressure, and texture” are much more therapeutic than ones like “give pleasure,” “try to relax,” or “enjoy being touched.”

The word “feeling” should be avoided. Clinicians will say, “Pay attention to what you are feeling.” Since people often think of “feeling” as synonymous with the words “emotion” and “sensation,” it is better to stay away from this word altogether. If clients interpret “feeling” as meaning “emotion,” they are likely to pressure themselves to experience arousal, pleasure, or relaxation, experiences they cannot make happen. This is counterproductive to the therapeutic goals of non-demand touching for self-focused interest.

Other tricky words are “sensual” and “sensuality.” Our suggestion is that clinicians avoid using these words because clients are likely to interpret them as meaning “sexual” and they may, therefore, pressure themselves to become aroused. This is one of the reasons we stress using the word “sensation” in this manual. Focusing on sensations is quite a different experience from sensuality and sexuality, both of which have a more goal-oriented connotation. Even the word “sensation” requires clear definition as “temperature, pressure, and texture.”

The Problem with Using “Touching for Partner” Words

Using phrases that encourage clients to pleasure the partner puts them in a doubly pressuring situation to produce not just their own natural response but also a natural response for someone else. It is helpful to avoid words like “giving” or “receiving,” or identifying the person touching as “the giver” and the person being touched as the “receiver.” This is why we will refer to the partners as “the Toucher” and “the Touchee.” Words like “massage” or “back rub” can also trigger clients to fall back into a partner-oriented approach to touching and should be avoided.

The Ramifications of, and Resolutions to, the Confusions

It is unclear why Masters and Johnson’s original Sensate Focus suggestions were not consistent with the notion of natural functions. Perhaps Masters and Johnson did not appreciate the importance of the words they used (phrases like “touching for pleasure” as opposed to “touching for interest,” “attend to what you are feeling” rather than “focus on sensations”). Perhaps they did not appreciate the effect these words would have on the interpretation of Sensate Focus instructions by future clinicians. Perhaps they actually changed their suggestions once they understood how counter their original instructions were to the approach they hoped to convey.

The good news is that by the 1983 training program in which we participated, Masters and Johnson had changed the wording of the instructions. On February 21, 1983, during the Sensate Focus component of the post-doctoral training program in sex therapy at the Masters & Johnson Institute (that initiated our five years of clinical and research work at the Institute), Robert Kolodny, Masters and Johnson’s associate and third author on many publications, outlined the following:

Purpose of Sensate Focus/Process of Sensate Focus

•to get in touch with senses

•to reduce spectatoring → goal orientation – i.e., to get at neutrality …

•to get at self-representation and responsibility

•to get at the neutrality – staying in here-and-now

(Avery-Clark, 1983, p. 1)

Throughout the 1983 postgraduate training at the Institute, the aims of Sensate Focus were clearly delineated as “the toucher is to touch for themselves [sic] – trace … with intention of taking in sensations. Don’t evaluate – just experience – stay in neutrality,” and “Encourage exploration, experimentation,” “Touching for self – focus on your partner’s body for your own self, own interest, what’s going on with you – not a massage to please them, not a turn on to please them,” and “Touching for Self … It’s not something you do – it’s an attitude.” It is evident that Sensate Focus was, by that point, described in sensory-oriented, non-demand, touching for your interest terms, terms that we believe may be more conducive to therapeutic progress.