Masters and Johnson’s Model
Following the publication of Human Sexual Inadequacy (1970), Masters and Johnson will be remembered for creating Sensate Focus as the foundation of sex therapy. Their most significant contributions to the field of sex therapy may be the creation and development of Sensate Focus exercises for in vivo understand and resolution of sexual difficulties, and the definition and understanding of sex as a natural function that underlies these exercises.
They said, Sex is a natural function: “Sexual functioning is a natural physiological process. . .[like] respiratory, bladder, or bowel function” (Masters & Johnson, 1970 p. 9).
Natural functions include vegetative processes (e.g., breathing, sleeping, etc.) and emotional responses (sexual responsiveness, pleasure; rage, fear).
Natural functions as neurophysiological processes:
- with which one is born;
- that cannot be taught;
- that are not under immediate voluntary control.
Natural functions are part and parcel of the autonomic nervous system ANS, and while they can be somewhat influenced by conscious direction with disciplined practice over time, they are essentially never under instant control.
Emotions differ from sensations and feelings as follows:
- Sensations are descriptive data informing us about developments inside and outside of our bodies to which we need to attend;
- Emotions are involuntary physiological responses to these data, motivating us towards (e.g., eat, mate, fight) or away from (e.g., sleep, flee) the developments; and
- Feelings are qualitative analyses that assist our judging these emotions (e.g., right, good; wrong, bad) usually according to socially constructed values.
Feelings are closely connected with learning, and consciously controllable to a much greater degree than emotions, because they involve higher, voluntary brain processes in larger measure.
Emotions and other natural functions can be influenced by voluntary factors but only over a lengthy period of time of disciplined training (e.g., meditation) and only to a limited degree because they involve neurochemical activation originating in lower, limbic substrates of the brain not under voluntary direction.
The natural processes of sexual arousal include erection, lubrication, orgasm, and, ultimately, desire. One cannot make these happen any more than one can, on demand, keep them from happening. Trying to consciously control them is a major psychological source of sexual difficulties.
Why Sensate Focus Is Used
As a component of sex therapy, sensate focus has been shown to be effective at treating a number of different types of sexual dysfunction in women and men, including:
- Pain during sex
- Premature ejaculation
- Erectile dysfunction
- Arousal disorders
- Desire disorders
When clients are having difficulty responding sexually, they are provided with something reliable on which they can focus (sensations) as well as an activity over which they have direct control (redirection of attention), rather than depending on something unreliable (emotions) and trying to force a response over which they do not have direct voluntary control (sexual arousal).
The person touching (the toucher) focuses on touching the partner head to toe, front to back, avoiding the breast, chest, and genital areas. This is referred to as breasts and genitals off limits. This non-verbal touching involves only the use of hands and fingers but not full body contact or kissing. These suggestions are aimed at reducing any expectation that this is a romantic encounter.
The toucher focuses on two things. The first are tactile sensations descriptively defined as temperature (cool or warm), pressure (hard or soft), and texture (smooth or rough). The toucher focuses on managing distractions that are defined as anything other than that on which the toucher is to be focused (i.e., the tactile sensations). Distractions include but are not limited to: emotions, including pleasure, enjoyment, relaxation, arousal, etc.; feelings, or the evaluations of emotions as good or bad; the partner’s responses; and/or outside disturbances. Participants manage these by refocusing onto tactile sensations.
The person being touched (the touchee) focuses on two things: the temperature, pressure, and texture wherever he/she is being touched; and non-verbally communicating by moving the toucher’s hand away if some area is experienced as physically uncomfortable or ticklish. Moving the toucher’s hand away eliminates common distractions such protecting or pleasuring the touchee. The toucher is then free to touch for his or her own interest, trusting that the touchee will convey any discomfort.
The toucher touches long enough to become adept at refocusing on sensations, but not so long that he/she gets bored or tired. Initially, no specific time is suggested because the length of time clients touch is diagnostic. If participants touch for only a few minutes or more than 30, they can be encouraged to lengthen or shorten the time, but they are discouraged from watching the clock.
Once the toucher is finished, he/she says, “Switch,” partners exchange positions, the second partner touches as the first has already done, and the first partner becomes the touchee.
The second partner completes his or her touching exercise by saying, “Stop.” Participants are encouraged to get up, get dressed, and write down what they have experienced in terms of: the sensations on which they focused; whether they were able to return the focus of their attention to these sensations; and the nature of any distractions.
All this information is diagnostic of both the individual and also the couple dynamics, and offers opportunities for teaching therapeutic skills and interventions.
The ability of the therapist is to create a tailored program (homework) that the clients have to follow that becomes the core to rebuild the lost sexual bond.