Sensate focus is a series of specific exercises for couples which encourage each partner to take turns paying increased attention to their own senses. These exercises were originally developed by Masters and Johnson to assist couples experiencing sexual problems, but can be used for variety and to heighten personal awareness with any couple. When used in the treatment setting, sensate focus is done in several stages over the course of therapy. The first stage usually begins around the third therapy session, after the nature of the sexual problem has been discussed and the couple has a clear understanding of the rationale for the treatment. In the first stage, the couple has two sessions in which they take turns touching each other's body, but with the breasts and genitals off limits. The purpose of the touching is not to be sexual but to establish an awareness of sensations by noticing textures, temperatures and contours while doing the touching, or to simply be aware of the sensations of being touched by their partner. The person doing the touching is told to do so on the basis of what interests them, not on any guesses about what their partner likes or doesn't like. The couple is instructed that if sexual arousal does occur, they are not to proceed to intercourse. Masters and Johnson recommend that the initial sessions of sensate focus be as silent as possible because talking can detract from the awareness of physical sensations. Of course, the partner being touched must let his or her partner know, either verbally or nonverbally, if any touch is uncomfortable.
In the next stage of sensate focus, touching is expanded to include the breasts and genitals. The person doing the touching is instructed to begin with general body touching, not to immediately move to the genitals or breasts. Again the emphasis is on awareness of physical sensations and not the expectation of a sexual response, and intercourse and orgasm are still prohibited. The couple is asked to take turns trying a "hand riding" technique as a means of nonverbal communication. By placing one hand on top of the partner's hand while being touched, one can indicate if he or she would like more or less pressure, a faster or slower pace, or a change to a different spot. Masters and Johnson caution that these nonverbal messages should be conveyed in such a way that the person being touched does not take over full control, but simply adds some additional input to the touching, which is still primarily done based on the interests of the toucher.
In the next phase of sensate focus, instead of taking turns touching each other, the couple is asked to try some mutual touching. The purpose of this exercise is to practice a more natural or real life form of physical interaction (people don't usually take turns touching and being touched), and to help each partner shift attention to a portion of his or her partner's body and away from watching his or her own response. Couples are reminded that no matter how sexually aroused they feel, intercourse is still off limits.
The next stages of sensate focus are to continue with the mutual touching, then at some point to move into the female-on-top position without attempting insertion of the penis into the vagina. In this position, the woman can rub the penis against her clitoral region, vulva and vaginal opening regardless of whether or not there is an erection. In a subsequent session, she may progress to putting the tip of the penis into the vagina if there is an erection, all the while focusing on the physical sensations and stopping or moving back to non-genital touching if either partner becomes orgasm oriented or anxious. After completing a session or two at this level, couples are usually comfortable enough to proceed to full intercourse without difficulty.
These fairly simple techniques are used as part of a comprehensive program of psychotherapy and can have a dramatic effect, even in cases where severe sexual dysfunction has been present for many years. Professionals generally agree that there are various dynamics to account for the profound effects of these seemingly simple exercises. For one, sensate focus exercises are a form of invivo desensitization whereby a feared situation is gradually mastered by breaking it into discrete steps that are experienced under safe conditions. Furthermore, the explicit instruction against sexual arousal and orgasm frees each partner of the pressure to produce an adequate sexual response in him- or her- self or in his or her partner. It is also important that they are given permission to experience pleasure. Thus, sensate focus is a learning experience whereby pleasurable responses are reinforced and sexual anxiety is diminished because the fear of failure is removed.
An additional therapeutic feature of sensate focus relates to the psychodynamics of the couple's psychosexual problems. Masters and Johnson, along with renowned sex therapist Helen Singer Kaplan, noted that in gently caressing each other, the couple may be confronted with one or both partners' anxiety about physical intimacy. Both the anxiety that is aroused and the defenses this anxiety elicits become important avenues for psychotherapeutic exploration, and can be very important in understanding and improving a couple's relationship in general, which most likely will have a significant influence on their sexual functioning.