The Uses and Benefits of "Sensate Focus" Exercises

The Uses and Benefits of
"Sensate Focus" Exercises
By Linda De Villers, PhD and Heather Turgeon
Editor's note:
Updates of Clinical
and Educational
Sexology are intended to provide stateof-the-art education
for AASECT members and other professionals on matters relevant to the
practice of sexuality
education, counseling and therapy. At
the direction of
AASECTs Professional Education
Committee, and
witb tbe oversight
of AASECT's president, executive
director and Board
of Directors, these
Updates will offer
Prior to the
Masters and
Johnson approach,
the most common
approach to sexual
disorders entailed
a long-term psychoanalytic
approach that
focused on resolving the unconscious conflicts
believed to underlie the symptoms,
rather than directly addressing the
symptoms themselves. Consequently, this new
approach (Masters
&: Johnson, 1970)
^vas hailed as a
Heather Turgeon
Linda De Villers, PhD
readers who fulfill certain designated criteria an opportunity
to receive AASECT Continuing Education credits relevant
to AASECT certification procedures.
We publish Updates on a bi-monthly basis as a special feature of Contemporary Sexuality.
SENSATE FOCUS:
revolutionary, contemporary one that put behavioral techniques at the forefront of treating specific sexual complaints and helping couples to enhance emotional and sexual intimacy. Masters and
Johnson's "sensate focus exercises" launched the field of
modern sex therapy. In current parlance, the terms "caressing exercises" or "sensual exercises" are often used because
they offer a more descriptive, accessible term and better
capture the sensual and relational spirit of sensate focus
(Kennedy &C Dean, 1988; De Villers, 1997; 2004).
A DEFINITION AND HISTORY
PRINCIPLES OF SENSATX FOCUS
S
ensate focus is the term used to describe a series of
non-demand pleasuring exercises first introduced by
Masters and Johnson (1970) to facilitate the resolution
of sexual problems such as erectile difficulties, rapid ejaculation and orgasmic problems. The term is used to highlight
that the "focus" is on "sensations." It represents a psychoeducational approach derived from the extensive, direct
observation research conducted in St. Louis by William
Masters, a gynecologist, and his research associate Virginia
Johnson, on the nature and physiology of the human sexual
response cycle (Masters 6c Johnson, 1966).
Sensate focus is intended to be an experience in itself, not a
prelude to "sex" or a form of foreplay. The couple in treatment is usually instructed to refrain from having intercourse, focusing instead on the range of physical sensations
that can be elicited by touch. By removing the "goal" of
sexual encounters, the couple learns to heighten their
awareness of a broader range of stimuli that include all of
the senses. Masters and Johnson (1970) proposed that the
removing intercourse would alleviate the performance anxiety and cognitive distractions that are characteristic of many
sexual difficulties. They used the term "spectatoring" to
Contemporary Sexuality
Vol. 39, No. 11 November 2005
Updates of Clinical and Educational Sexology
describe a person's tendency to see himself or herself in the
therapist often suggests that they agree on a pre-arranged
third person during sexual activity—becoming an outside
time for their sessions, lasting at least 30 minutes.
observer and evaluator of the sexual encounter, rather than
Alternating, lovers take turns giving and receiving touch to
focusing on the body's sensations. The ban on intercourse
enjoy the physical contact and the sensations it produces
was designed to create a non-goal oriented context that
without attempting to elicit a sexual response; breasts and
simultaneously decreased spectatoring and increased pleasgenitalia are usually off limits in the first few sessions.
ure (Masters & Johnson, 1986).
Verbal communication is limited durCompleting a series of sensate focus
ing the exercises unless needed to stop
Sensate
focus
is
intended
exercises often led to the resolution of
uncomfortable or painful touching. In
to be an experience in
sexual difficulties. Results of a study
all cases, verbal feedback and dialog
of 365 couples treated in an outpaitself, not a preiude to
after an exercise is over is encouraged.
tient clinic for a range of sexual problems supported this thesis. Researchers "sex" or a form of foreplay
In later stages, the couple is encourfound that the amount of sensate
... By removing the "goai" aged to try a "hand-riding" technique
focus completed in the final week of
in which the receiver puts his or her
of sexuai encounters, the
treatment was the best predictor of
hand on top of the giver's hand to
success (Sarwer 6c Durlak, 1997).
couple learns to heighten
guide the touch during exercises that
their awareness of a
do include the genitals (Blonna &
FEATURES AND PROCEDURES
Levitan, 2005). Masters and Johnson
broader range of stimuli
OF SENSATE FOCUS
set strict guidelines for clients to folthat include all of the
low during the graduated assignments,
but many therapists make adjustments
Specific Sensate Focus instructions can senses.
to these guidelines based on their clinibe found following the conclusion of
cal judgment. Eor example, verbal communication might be
this article. Several features of sensate focus help to account
for its effectiveness. As a "baby-step" (or successive approxi- limited during the "first round" of a particular exercise, but
might be encouraged when repeating the exercise on a submation) approach, it parallels a form of systematic desensitisequent occasion (De Villers, 2004).
zation that gradually proceeds through an anxiety hierarchy.
It is often very reassuring to clients to know that the
approach is gradual. Sensate focus also breaks set; it invites
Another variant is offered by Hall (2001) in her work with
participants to alter their beliefs and assumptions about
lesbian women; she alters the assignment by having the
rewarding sexual interaction. In more theoretical terms.
giver provide the kind of touch that she herself likes during
Eraser and Solovey (2004) suggest that sensate focus proone half of the touching, and the type she anticipates her
vides an opportunity to bring about "second-order change."
partner would prefer during the other half. She also sugThe exercises, with their emphasis on experiencing pleasurgests doing this in no particular order and having the parting throughout the body, literally from head to toe, enable
ner later guess which half was which.
many couples to acquire a new mind-set that sigtiificantly
expands their capacity to experience erotic pleasure. This
During the course of treatment, the therapist helps the couincludes helping the couple learn to slow down instead of
ple process their experience with the exercises and uses this
rushing through a sexual experience.
information to inform further treatment decisions.
When the couple is assigned a sensate focus exercise, the
GUIDELINES EOR SUCCESSEULLY INTEGRATING SENSATE FOCUS
INTO SEX
Linda De Villers, PhD is a licensed psychologist and
AASECT Certified Diplomate in Sex Therapy. She is an
Adjunct Professor in the Graduate School of Psychology
and Education at Pepperdine University and maintains a
private practice. Her website is www.Ioveskills.com; the
working title of her next book is: "Beyond the Food: A
Sex Therapist's Rx for Aphrodisiac Meals."
Heather Turgeon is a graduate student in psychology at
Pepperdine University. She practices as an intern at the
Women's Clinic & Eamily Counseling Center in Beverly
Hills, California.
Contemporary Sexuality
www.aasect.org
THERAPY
Sensate focus is generally not adequate as a stand alone
treatment, and its use in therapy, particularly in instances of
low desire, may not be curative. Instead, these exercises
serve as "an elegant diagnostic and exploratory device"
(Apfelbaum, 1995, p. 39). Most experienced sex therapists
share and make use of this technique. Therapists also work
with clients in each session to process the thoughts, emotions, and behaviors that have come up during outside
homework assignments. Working with this information and
addressing the underlying issues brought out by the sensate
focus exercises can be the most powerful part of treatment
(Levine, 2000).
The Uses and Benefits of "Sensate Focus" Exercises
One fairly common response to sensate focus exercises is an in the dark, in bed, with both partners dressed in pajamas.
Others may start by taking a bubble bath and washing each
increase in anxiety rather than a decrease. For some, the
other's backs" (p. 269).
ban on intercourse creates anxiety, especially if the ban is
prescribed for an extended period. Some therapists put a
more positive spin on the ban by using the term "interIn that spirit, the following "caressing" exercises have been
course free" (Metz 8c Weiss, 1992). In other cases, anxiety
excerpted from Love Skills (De Villers, 2004). They offer a
arises during the exercise. LoPiccolo
sampling of contemporary extensions
refers to this as "metaperformance
In designing sensate focus of the original sensate focus format
anxiety," providing this example from
and are useful adjuncts as one part of
a male client: "'...Fm not supposed to exercises, the therapist
an integrated approach to resolving
get an erection, and we're not allowed must be both creative and
sexual difficulties and also in sexual
to have intercourse even if I do get
enrichment programs. Neither of these
sensitive to both partners' is included in Masters and Johnson
one. So now that all the pressure is
anxieties regarding sexual (1970), or in Kaplan (1974), whose
off, why am I not getting an erection?...'" (cited in Rosen, 2000, p.
book. The New Sex Therapy, became
intimacy.
287). This latter point highlights that
the "bible" of sex therapy throughout
sensate focus does not inevitably have the anticipated
the 1970s. Variants of both of the exercises below appear in
results; the well-trained sex therapist should anticipate this
a book co-authored in the 1980s by a well-known and highpossibility.
ly regarded surrogate partner of the era, Adele Kennedy
(Kennedy & Dean, 1988). Kennedy indicates that in her
experience,
of all the sensate focus exercises, the "hand
Both the timing and the "content" of the specific exercises
caress"
below
is the single most important step. For a full
affect the probability of their usefulness. Most often, the
roster
of
sensate
focus exercises in the context of a complete
risks of sensate focus are related to their use in "cookbook
program,
see
Love
Skills.
fashion." This can range from failing to adapt them to the
specific needs of the clients, to inappropriate timing, to the
assumption that they are inevitably called for at all. A failure to engage the couple in a collaborative, decision-making
process can also lead to disappointing results (Wincze &c
Carey, 1991). In some cases, the exercises are inadequately
described. Clinical errors in this regard can be damaging
and exacerbate problems as well as yield no amelioration of
the presenting difficulty.
Some have challenged the "heterosexist" bias of such exercises when their primary aim appears to be successful
coition (Tiefer, 1995). Interestingly, however, both
McWhirter and Mattison (1980) in their sex therapy with
gay couples, and Hall (2001) in her work with lesbian couples, endorse their merits. Dodson (1996) provides a number of sensual exercises that are autoerotic only and with no
ultimate coital goal.
CONCLUSION
Though the use of sensate focus can be debated, it is clear
that the technique is effective for certain clinical cases. As a
source of enrichment exercises for non-distressed couples, it
is even more likely to yield positive results. The therapist's
skill at incorporating the exercises into therapy will often
determine their treatment value.
Althof (2000) highlights this point: "In designing sensate
focus exercises, the therapist must be both creative and sensitive to both partners' anxieties regarding sexual intimacy.
It may be necessary for the clinician to have couples begin
the exercises at a rudimentary level, such as holding hands
CARESSING EXERCISE: HANDS, FEET AND FACE
(ADAPTED EROM DE VILLERS, 2004)
For your first sensuous touching session, set aside up to an
hour. Begin slowly, and take turns. For the first half of the
session, one of you should be the giver and the other the
receiver. Then switch.
Sensuous stroking is the key to sensual LoveTouch. Once
you feel comfortable with sensuous stroking, you can move
on into more advanced exercises during later sessions.
Keep in mind that sensual LoveTouch requires a light touch
— it is caressing, not massage. The pressure of massage can
actually numb the skin. Caressing is a special kind of intimate sharing, communicating your desire to give her or him
pleasure. Light stroking produces a far greater richness of
sensation because it activates nerve tissue, not muscle tissue.
As a giver, you may find you need to change your position
from time to time so you won't become uncomfortable.
That's okay, but make it a point to maintain body contact
throughout when you change positions or replenish oil. (If
you are using oil, simply turn one hand over, palm up, continuing to touch your lover. Use the other to pour oil into
your palm.)
Let the receiver pick which part—hands, face, or feet he or
she wants to have caressed. For the face, allow about ten
minutes. For hands or feet, allow about fifteen minutes
each.
Contemporary Sexuality Vol. 39, No. 11 November 2005
iii
Updates of Clinical and Educationai Sexology
The hand caress: Select a position that is comfortable for
then begin stroking. Beginning with the lower leg area, use
you both. Many people like to sit facing one another. If you both hands to stroke downward onto the upper and lower
are the receiver, allow your hand to remain limp and passive surface of the foot to relax it. Then move from the base of
throughout the session. If you are the giver, pick up one of
the toes toward the ankle, making circular motions with
your partner's hands and do not let go until you are ready
your thumb. Repeat several times. Try using the heels of
to move on to the other hand. Use your entire hand, the
your hands, or several fingers together. Stroke every toe
back, palm, and your fingers to
over its entire length, using your
explore your partner's hand. Lightly
thumb and finger, and run your little
stroke with your thumb and forefinBeing ticklish [on your feet] finger slowly between each toe. Pay
ger, making gentle, circular motions.
attention to the pad on the
(or anywhere else), may be particular
As the giver, notice everything about
bottom of the big toe.
your partner's hand — its texture, its your psyche's defense
folds, its creases, its shape, its thickagainst their potential as a Vary the speed of your stroking. If
ness in various parts. Notice each finyour partner can accept the touching
source of enormous
ger as well as the fingernails. Once
without being ticklish, try light feathyou sense that you are both comfort- sensual pleasure. Being
ery strokes and use your fingernails as
able, you will find the experience
well to caress. If your partner is tickmore intense if you close your eyes as ticklish allows you to avoid lish anywhere, try using a slightly
you continue stroking. Whether giving being touched and inhibits firmer touching in that area initially,
or receiving, do your best to concenand see if you can later return to it
sensations that might
trate fully on the sensations in your
with a softer touch. After ten or fifhands and the feelings evoked by these become sexual.
teen minutes, conclude by cupping
sensations. As the giver, linger a bit
your partner's foot between your
after you are finished with each hand. Try holding your
hands for a moment, then gently remove them. Proceed to
partner's hand, palm downward, between yours a few
caress
your partner's other foot in the same manner. If you
moments before putting it down and moving on to the
decide
to switch roles, with the receiver becoming the giver
other.
and vice versa, take about five minutes to share your feelings and reactions before starting the second session.
The foot caress: Begin by bathing your partner's feet. If you
are going to take turns, you will need six bath towels and
If your feet are ticklish, you can try to overcome it by
enough soap, oil, lotion, or powder for both of you. Next,
desensitizing your feet. Being ticklish there (or anywhere
fill two buckets or small tubs with warm (not hot), softened else), may be your psyche's defense against their potential as
water. (The addition of a softener provides a wonderful fra- a source of enormous sensual pleasure. Being ticklish allows
grance and sensuously enhances the texture of the water.)
you to avoid being touched and inhibits sensations that
You will use one bucket for washing and the other for rinsmight become sexual. To desensitize the soles of your feet,
ing. Gather all these supplies together in advance so you
go barefoot as often as you can. Walk on a variety of surwon't have to interrupt the session once you have begun.
faces: cool tile, hardwood floors, grass, carpeting, sand,
concrete, fabrics. This will also be a form of sensual awareness for your feet. It may sound silly, but your feet are richSit on a comfortable chair with the wash bucket between
ly endowed with nerve endings which, when stimulated, can
your legs. Gently place one of your partner's feet into the
produce
extraorditiary levels of pleasure.
tub of water. Slowly wash the foot with soap. Leave it in
the water as you move on to the next foot, repeating the
process. After you have given each foot an initial washing,
The face caress: Having your face caressed is surprisingly
place a towel over one of your thighs, lift the first foot from relaxing and arousing. If you are a man, do not worry
the water and place it on the towel. Re-lather the foot genabout being clean shaven; actually, whiskers' varied textures
erously and then place it in the rinsing tub. Repeat this pro- provide added interest. If you wear makeup, remove it. If
cedure with the second foot. Remove each foot from the
either of you wear contact lenses, it is best to remove them,
rinse water and wrap each completely in a dry towel. Push
too. Get into a comfortable position that provides access to
the buckets of water aside, unwrap one of the feet and
your partner's face. Sit with back support and a pillow in
slowly and thoroughly dry it. Be sure you dry carefully
your lap, while your partner stretches out and places her
between the toes. Do the same thing with the other foot. Oil head on the pillow. Or stand behind your partner while she
or powder them both.
is seated in a chair. Close your eyes if you are receiving. But
keep your eyes open if you are the giver, at least until you
Place the heel of one foot on your thigh so that you can eas- have become thoroughly familiar with your partner's face.
Remember as you are giving to stay focused on your partily touch both the sole and upper surface. Cradle the foot
ner's face and on the sensations you experience as the giver.
between your hands for a few moments to warm it, and
IV
Contemporary Sexuality www.aasect.org
The Uses and Benefits of "Sensate Focus" Exercises
You can experiment with both your fingertips and the
palms of your hands. If you want to use a lubricant, a
lotion is preferable to an oil; however, many people dispense with this entirely for this part of the body — especially around the eyes.
Begin by cradling your partner's face for a moment between
your hands. Then glide your hands slowly upward through
the hair and over the scalp. Move to the forehead area.
Using your thumbs or your fingers, stroke from the center
of the forehead outward toward the temples. Repeat several
times. As you move downward, stroke the eyebrows, then,
ever so delicately, the lids and eyelashes. Do that several
times, too. (Be sure to keep any lubricant away from the
eyes.) Pause for a bit with your fingertips gently resting on
your partner's eyes. Next continue down the face to the
nose and cheeks. Use your thumbs to stroke downward on
the sides of the nose and then outward just under the cheekbones. Glide your fingers upward through the hair before
returning your thumbs to the nose. Then use gentle, circular
motions with your fingertips on the cheeks, or experiment
with the palms of your hands. As you move toward the
mouth, stroke the area above the lip for a bit and then trace
around the edges of the lips with your fingertips, following
her or his contours. Then caress the lips themselves. As you
proceed to the chin, try feathery downward strokes while
continuing to move upward along the jaw line. Then move
to the neck, continuing to stroke upward toward the jaw
line as well. Continue to your partner's ears, using your fingers and thumbs to explore all over them, but do not probe
inside them. Use both your hands to carefully lift and turn
the head, allowing it to now rest in the palm of one hand.
Use your other hand to stroke the exposed side of your
partner's neck. After a while, turn and rest the head in your
other palm and caress the other side of the neck. Finally,
run your fingers through your partner's hair. Then bring
your hands to rest gently on the face for a minute before
releasing them. After you are done, share your experience
with your partner.
Repeat these exercises as often as you like — at least as
often as is necessary for both of you to feel thoroughly
comfortable and enjoy it as an end in itself. Only after this
should you begin to use these exercises as a prelude to sexual activity.
you a chance to mentally anticipate the next wave of pleasure, highlighting the classic adage that the brain is your
most important sex organ.
Slowing down also makes for better sex. Nerve endings can
"numb out" when over-stimulated by intense, rapid movement. Not surprisingly, the message of How to Satisfy a
Woman Every Time and Have Her Begging for More was sl-o-w d-o-w-n.
The following exercise will help you slow down, while
heightening your lover's anticipation of your touch and
bringing her to exquisite levels of sensory awareness and
pleasure.
1. Take off your clothing and He down somewhere comfortable with your lover.
2. Ask your lover to try to anticipate where you are going
touch him or her next as you do the exercise.
3. Begin by holding your hands just above your lover's skin
for a minute or two. Hold them close enough to allow
your lover to sense the heat generated by your hands
onto the skin.
4. Place your hands down gently on the same spot.
5. Lift them up again and pick a near-by area. Again, hold
your hands above it for a minute before placing them on
your lover.
6. Repeat until you've covered many different areas on
your lover's body. Here's a hint: You're not restricted to
just your hands. Feel free to place other parts of your
body above your lover. Now, take this technique one
step further.
7. Rest your hands lightly on your lover's body for a while.
8. Tell your lover you are about to remove your hands. Ask
him to try and hold on to the memory of your touch.
9. Lift your hands v-e-r-y slowly.
10.Give your lover a chance to really savor the sensation by
waiting a bit before you place your hands down again.
CARESSING ExERcrsE:
CREATING ANTICIPATION, YEARNING AND DESIRE
Enhance sexual touching with anticipation and ensure your
lover's continuing desire during sex. Keeping the spark alive
means creating a sense of yearning and anticipation before
and during sexual activity.
With practice, your lover may not realize that you are
no longer in contact for up to a minute or two after the
hands are lifted!
11. After you have finished, share your experience with
your lover.
One of the best ways to produce that sense of longing is to
slow down. When you slow down your movements, it gives
Contemporary Sexuality Vol. 39, No. 11 November 2005
v
Updates of Clinical and Educational Sexology
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