Chapter 6:Processing Sensate Focus 1 Instructions
When the couple returns to the therapist’s office for the next scheduled session, each partner’s experience is processed according to some helpful guidelines. This ensures that the therapist has a concrete sense of the clients’ subjective experiences and an ongoing window into their individual and relationship dynamics. While therapy sessions emphasize the specifics of Sensate Focus, they may also include an overview of the clients’ general life experiences, stresses, and relationship and communication skills, challenges, and successes since the last therapy session. As it is the intent of this manual to discuss the specifics of the touching sessions, we will leave it to others and to later publications to elucidate the details of any individual and/or relationship therapy that may accompany sex therapy.
In terms of processing the Sensate Focus suggestions, it usually works best to have one partner describe his or her experience first while the other is encouraged to listen, if only for the practical reason that it is difficult for the therapist to attend to two people’s experience at once. It is helpful to alternate who begins talking first in subsequent sessions. This structure affords clients an opportunity to really attend to what the partner experienced during the session, something that many partners have had little chance to do. It is remarkable how differently the Sensate Focus sessions may be experienced by the partners. Often they are confused by these differences, often they are intrigued, and often the therapist learns much about the couple’s dynamics, observing how they relate and communicate about these differences in the session. All this helps the therapist steer Sensate Focus, specifically, and sex therapy, generally, in the most productive direction.
Throughout the processing of Sensate Focus opportunities, the therapist listens for whether clients have been able to touch or be touched for themselves rather than for their partner, and whether the clients have been able to touch or be touched for their own interest (focusing on sensations) rather than in service to expectations for arousal or pleasure. The distractions experienced and their handling of them inside and outside the bedroom are also included in the processing.
Touching for Self by Describing One’s Experience vs. Focusing on the Partner
The attitude of touching for self is usually evident in two ways. These include the words that are used to describe the touching, and the nature of the distractions.
Words and Their Influence on Attitudes
As we have noted, words can have a powerful influence on the emotions and attitudes clients are experiencing, and whether these emotions and attitudes are more or less productive for resolving the clients’ sexual dysfunction. When it comes to processing Sensate Focus suggestions, and when participants use evaluative or partner-oriented expressions like, “It didn’t go well because I didn’t get an erection,” “She seemed to be having a good time,” or “He massaged me like he knows I like it,” you can be reasonably assured that they are focused on the partner’s response during the touching rather than on their own experience in the moment. Attending to the wording is critical in order to catch when clients are expressing this goal- and partner-oriented focus.
Clients may voice frustration in the beginning as the therapist respectfully suggests using different words when describing the Sensate Focus opportunities: “Rather than telling me how you touched him where he likes to be touched, can you describe the sensations you experienced when and where you were touching him?” With more practice most clients will soon appreciate the significance of the words and how these words influence their touching attitudes during the actual Sensate Focus sessions.
The second way partner focus shows up is by the words the clients choose to describe the distractions they had during the touching sessions. It is important for the therapist to listen for how frequently the clients’ minds wander to the other person as they describe what captured their attention other than the sensations. This is true for both the Touchee as well as the Toucher.
Touching for Interest by Describing Sensations vs. Touching for Pleasure by Describing Judgments and Emotions
With regard to assessing participants’ ability to focus for interest rather than on pleasure or arousal, the therapist may listen for how precisely and vividly the clients describe sensations, and they can also listen for the use of judgmental and emotion-oriented words.
A useful question with which to begin is, “Who initiated the session and tell me where you began touching first?” This can be followed up with, “Tell me what sensations you were able to focus in on while you were touching there.” The importance of the precision with which clients describe their attention to sensory information cannot be overemphasized. There is a lovely paragraph in Alain de Botton’s How Proust Can Change Your Life in which the renowned author Marcel Proust has asked a new acquaintance to describe how certain committees work. The acquaintance begins with, “Well we generally meet at 10:00, there are secretaries behind …” and Proust stops him.
“Mais non, mais non, vous allez trop vite … Vous montez l’escalier. Vous entrez dans la salle … Précisez, mon cher, précisez. [But no, but no, you go too quickly … You climb the stairs. You enter the room … Be precise, my dear, be precise].” So I tell him everything … the rustle of the papers; the tea in the next room; the macaroons.
(de Botton, 1998, p. 46)
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. This is in service not only to the therapist’s knowing exactly what suggestions to make but also to the clients’ learning a new way of thinking about mindful touching. Although as children we could focus in this here-and-now fashion, most of us as adults have neurologically moved, and have been socialized to move, away from being present in the moment as our brains developed to think more abstractly. While conceptual thinking is beneficial in just about everything else we do as adults, it works against us when it comes to attending to present sensations in such a way as to allow the natural function of sexual responsiveness to express itself. The more intellectually sophisticated the clients, the more difficult this might be for them. Sensate Focus is not actually about teaching people something new so much as it is about helping them re-access aspects of themselves with which they were once in touch and that serve as portals into the natural function of sexual responses.
Given these issues, it is of paramount importance that the therapist vigilantly yet gently keeps redirecting the clients back to descriptions of sensations. “Mais non, mais non, vous allez trop vite. Tell me when you were touching her arm, where on her arm were you touching? Where did you start touching first? And what sensations did you notice? Was that part of her arm cool or warm? Rough or smooth? Where did you touch next? What was the temperature there? Were you aware of pressure? Hardness? Softness? And tell me about the textures in that area.” Soon, the participants will become more adept at this mindfulness language and will have less difficulty providing the therapist (as well as themselves) with the sensory information needed to know how to move forward.
Judgmental and Emotion-Oriented Words
The second indicator of the degree to which participants are able to focus for their own interest is the extent to which they use evaluative and emotional language. Listen for words like “good” or “bad,” “fine” or “not so great,” “pleasurable” or “frustrating,” “arousing” or “boring,” “relaxing” or “anxiety-provoking,” “sensual” or “irritating.” These usually suggest clients are touching in order to produce some kind of arousing, pleasurable, relaxing, or enjoyable emotion, or to generate some kind of good or correct experience, and are expecting to be able to produce emotions and feelings of this nature. Depending on having a specific emotion or feeling sets up more pressure and that is exactly the opposite of what Sensate Focus is all about.
While the therapist is not trying to make things uncomfortable for the clients, the therapist is not particularly interested at this point in whether the Sensate Focus session was enjoyable or not, or whether it was good or not. Instead, what the therapist is interested in is the clients’ descriptions of sensation-oriented words like “cool, warm,” “hard, soft,” and “rough, smooth” to convey their experiences, and the therapist is also interested in the nature of the distractions and how they were handled.
The next line of discovery in processing the Sensate Focus sessions has to do with distractions. A useful questions is, “What else were you thinking about while you were doing the Sensate Focus exercise?” Not infrequently clients will say, “I wasn’t thinking about anything.” This, of course, is impossible. It is easy for clients to consider themselves as having failed at the exercises when they think about anything other than tactile sensations. They must be reassured that not only is it natural to have distractions but also that the distractions provide an opportunity for practicing refocusing on sensations. It may be helpful to remind them that it is human nature to pay attention to a large number of things in rapid succession, so quickly that it seems as if they are concentrating on more than one thing at the same time. For example, one study suggests that the human eyeball processes a couple of hundred bits of information within the first few seconds of entering a new room. And that is just the eyeball! Not only can distractions not be eliminated, they cannot be avoided.
Clients may also respond to questions about distractions with a judgment that their distractions are wrong. “I know I shouldn’t have been thinking about this, but I started wondering if I shouldn’t be getting aroused.” Clients often interpret the information that it is not the purpose of Sensate Focus to get arousal or feel pleasured as meaning that if they think about pleasure or find themselves getting aroused they are somehow not following the instructions. They may need to be reassured that, in general, they cannot prevent or eliminate distractions, and also that they cannot experience a “wrong” distraction. Just as teachers of meditation, yoga, and other mindfulness practices remind us, distractions are not bad or wrong; they simply are. If eliminating distractions is impossible, trying to prevent them is also a waste of time. More specifically, when it comes to Sensate Focus, the purpose is not to eliminate distractions such as performance-oriented thoughts, but to work with them regardless of their content, taking note of them as apertures into whether the person is touching for his or her own interest, and then redirecting attention onto sensations.
The next line of processing is asking clients what they did during the sessions when they noticed themselves becoming (unavoidably) distracted. It is important not to accept broad or vague statements like, “I did what you suggested,” “I managed them well,” or “I focused on how I was feeling.” The first is general; the second is judgmental; and the third is emotion-oriented. While reminding them that distractions are to be accepted, clients are encouraged to return the focus of their attention to touch sensations. This is just about always the answer to their questions having to do with, “What do I do if … ”
One set of instructions that is sometimes confusing involves interpreting and managing positive emotions as distractions. Clients sometimes have difficulty understanding why they are being guided away from focusing on enjoyment, relaxation, and arousal and back onto sensations. A useful way of handling this is to remind them that there is nothing problematic with these distractions per se; the issue is that they cannot focus simultaneously, at that precise second in time, on both the positive emotions and the tactile sensations. The presence of positive emotions is not dependable while the presence of sensations is, and these sensations serve as the reliable gateway into the natural function of the positive emotions. They are not discouraged from savoring their relaxation, pleasure, or arousal. However, since these emotions often lead to expectations that they should feel more of them as the touching progresses, they are encouraged to refocus on the sensations as the trustworthy segue into more sustained positive experiences that eventually transform focus on sensations into experiences of being in sensations without conscious awareness.
Moving the Toucher’s Hand (Handriding and Positive Handriding)
Some of the most important questions to ask couples when processing Sensate Focus are whether or not the Touchee non-verbally moved the partner’s hand away or used handriding at any time during the session and, as Sensate Focus progresses, whether the Touchee used positive handriding. Participants will often have either forgotten these directions or will have interpreted them as suggestions to be used only if they are feeling physically uncomfortable or ticklish during the touching opportunity. While this is the ultimate use for handriding and positive handriding, it is helpful in the early stages of Sensate Focus to have the Touchees practice moving the Toucher’s hand away and using positive handriding whether the Touchees need these or not so that it becomes second nature for Touchees to do this. If people being touched do not practice moving the Toucher’s hand even when unnecessary during initial sessions, they are unlikely to remember to use it when they really need or want it.