Appendix C:Sensate Focus Special Instructions and Modifications for Different Dysfunctions©
Along with addressing the specific dysfunction concerns delineated below, it is presumed that the therapist will also focus on any relevant, individual or relationship issues throughout treatment. What follows is an outline of significant modifications and special instructions for varied sexual dysfunctions.
I.Male Hypoactive Sexual Desire Disorder (HSDD)
A.More mental and physical erotic stimulation alone (self-Sensate Focus and self-stimulation)
B.The couple creates more mental and physical erotic stimulation together
C.Cultivating fantasies
D.Reading erotic, romantic, and/or informational material
E.Viewing erotic, romantic, and/or informational material
II.Female Sexual Interest/Arousal Disorder (FSIAD)
A.Self-Sensate Focus and self-stimulation
B.Sensory-oriented bath or shower
C.Tune into the body in other than sexual ways, e.g., physical exercise, mindfulness exercises, meditation, yoga, etc.
D.Vibrator exploration alone
E.Vibrator exploration with partner
F.Education about the fact that for women sexual interest/desire may not precede sexual activity but may evolve after sensory, sensual, or sexual activity begins
G.Manage negative cognitions, especially about body image
H.Cultivate fantasies
I.Read erotic, romantic, and/or informational material
J.View erotic, romantic, and/or informational material
III.Erectile Disorder (ED)
A.When genital touching becomes part of the homework, the partner is initially recommended to move away from an engorged penis and touch elsewhere until engorgement subsides (gaining and losing engorgement on purpose)
B.Manage spectatoring using a code word; both partners change physical position and activity, and continue with the touching rather than stop
C.Recommend client begins using PDE-5 inhibitors, like Viagra, Cialis, Levitra, etc.
D.Recommend client continues use of PDE-5 inhibitors, like Viagra, Cialis, Levitra, etc.
E.Recommend client immediately discontinues use of PDE-5 inhibitors, like Viagra, Cialis, Levitra, etc.
F.Recommend client eventually attempts to discontinue use of PDE-5 inhibitors, like Viagra, Cialis, Levitra, etc.
G.Client and partner decide on their goals regarding use of PDE-5 inhibitors, like Viagra, Cialis, Levitra, etc.
IV.Delayed Ejaculation (DE)
A.Either reduce or eliminate self-stimulation to orgasm
B.Relearning techniques for idiosyncratic masturbatory patterns that cannot be duplicated with partner stimulation
C.Sexual fantasy techniques
D.Include self stimulation exercises without partner and with or without sexually explicit material
E.PC muscle awareness exercises
F.Relaxation training
G.Use of vibrator with self-stimulation
H.Use of vibrator stimulation by partner
I.Education about the two stage model of ejaculation
J.Alternating partner stimulation with self-stimulation by any means
K.Self-stimulation or partner stimulation to high plateau level and then insertion close to the time of ejaculation
V.Rapid, Early, or Premature Ejaculation (PE)
A.Education about the two-stage ejaculatory process
B.Coronal Squeeze technique
C.Basilar Squeeze technique
D.Stop-Start exercises without partner present
E.Use of lotion or oil with self-stimulation
F.Use of masturbatory sleeve, such as Fleshlight
G.Stop-Start exercises along with partner manual stimulation
H.Use of breath to let go of tension
I.Other relaxation techniques
J.PC Muscle awareness exercises
K.Insertion with no movement
L.Insertion along with the techniques of Stop-Start communication between partners
M.Use of an SSRI as an adjunct to therapy
VI.Female Orgasmic Disorder (FOD)
A.Self-exploration and self-stimulation homework without vibrator
B.Use of vibrator for stimulation
C.Development of sexual fantasies
D.Reading erotica
E.Viewing erotic visual material
F.Reading romance novels
G.Viewing educational visual material demonstrating masturbation techniques
H.Connecting to and letting go of PC muscles (Kegels)
I.Female astride position with partner
J.Acting “as if” being orgasmic, using pelvic movement and vocalization
VII.Genital Pain (Dyspareunia)/Penetration Disorder (Vaginismus)
A.Confirm accurate diagnosis of Dyspareunia or Vaginismus with a physician
B.Ensure client is in full control of all touching and physical activities, including insertion
C.Accurate education about the cause and nature of Dyspareunia or Vaginismus, that it cannot be thought through voluntarily
D.Frequent use of handriding and positive handriding
E.Connect to and let go of PC muscles (Kegels)
F.Experiment with different positions
G.Use of graduated dilators while alone
H.Couple utilizes dilators together
I.Partner assists with arousal and/or orgasm prior to using dilators together or separately
J.View a video on Dyspareunia or Vaginismus alone or with a partner
K.Join an online Dyspareunia or Vaginismus support group
L.PC muscle exercises
M.Use of lubricant
N.Utilize visualization techniques
O.Use of Botox as an adjunct to other therapies
P.Refer client with Dyspareunia or Vaginismus to a physical therapist as an adjunct therapy
Q.Refer client with Dyspareunia or Vaginismus to a physical therapist for primary dilator work
VIII.Sexual Trauma
A.Process sexual trauma before Sensate Focus homework for the couple
B.Intermix trauma processing and Sensate Focus homework for the couple
C.Use a variety of techniques to reduce anxiety and increase relaxation
D.Refer to a physician for anxiety reduction medication
E.The survivor engages in Sensate Focus him or herself before homework as a couple
F.Use handriding to allow survivor to experience control
G.The survivor initiates
H.The survivor plans and controls the advancement of the Sensate Focus hierarchy suggestions
I.The survivor identifies triggers and learns management techniques
J.The survivor learns to deal with dissociation and its management
K.The couple engages in relearning touch techniques, such as the “magic pen” (Maltz, 2012)
L.The couple create new rituals that celebrate or mark the sacredness or specialness of their sexuality
© These instructions and modifications are the copyrighted material of Linda Weiner, MSW, and Constance Avery-Clark, PhD. There is no reproduction or use of these materials without written permission from the authors.