Sexual and Relationship Therapy, 2014

http://dx.doi.org/10.1080/14681994.2014.892920

Sensate Focus: clarifying the Masters and Johnsons model

Linda Weinera and Constance Avery-Clarkb*
a

Washington University Brown School, St Louis, MO, USA; bPsychological Associates, Masters &
Johnson Institute, Boca Raton, FL, USA
(Received 1 August 2013; accepted 5 February 2014)
While Masters and Johnson will be remembered for creating Sensate Focus as the
foundation of sex therapy, confusion still abounds about its implementation and about
the conceptualization of sex as a natural function that underlies it. Sensate Focus and
sex as a natural function are clarified and explored. The crucial difference between the
intended aim of non-demand touching for ones own interest and the misleading
interpretation of non-demand pleasuring of the partner is emphasized. By mindfully
being present to sensations in the moment, and refraining from forcing pleasure and
arousal, clients can move towards the optimal intimacy they desire.
Keywords: sex therapy; Sensate Focus; sexual function; Masters and Johnson; sexual
psychology

Introduction
Masters and Johnson (1966, 1970) will be remembered for their landmark successes identifying and cataloging scientific data on the human sexual response, and pioneering the
first short-term treatment program for sexual dysfunctions. However, their most significant contributions to the field of sex therapy may be the creation and development of Sensate Focus exercises for in vivo diagnosis and resolution of sexual difficulties, and the
definition and understanding of sex as a natural function that underlies these exercises.
Following the publication of Human Sexual Inadequacy (1970), the sex therapy field
grew richer as a variety of talented clinicians trained with Masters and Johnson. They
expanded the medically based, psycho-educational approach that served as Masters and
Johnsons original therapeutic model. While these sexologists contributed to the field,
much of what Masters and Johnson originally conceptualized and implemented, and
much of what they developed subsequent to 1970, was either poorly communicated in
their publications or never formally published at all. A significant amount of information
on what they intended sex therapy to be, and a significant amount of information on what
evolved from 25 years of experience, was communicated almost exclusively to participants at professional conferences, to attendees at the Institutes workshops, and to the
clinical staff at Masters & Johnson Institute that included the authors (Weiner & AveryClark, personal communication, 29 April 2011). This dearth of well-formulated publications, correcting misinterpretations of Sensate Focus and elaborating on the evolved
thinking, has resulted in misinformation about polished conceptualization and implementation. This confusion is particularly true with the initial Sensate Focus client suggestions,
and it is not surprising because, as David Schnarch notes,
*Corresponding author. Email: caveryclark@me.com
2014 College of Sexual and Relationship Therapists

L. Weiner and C. Avery-Clark

The actual clinical and conceptual processes of the leaders in the sex therapy field have been
available only to the small group of clinicians who interact directly with them on an ongoing
basis. For example, William Masters has said on many occasions that Human Sexual Inadequacy does not accurately depict the Masters and Johnson treatment approach. However,
interpretation of this publication constitutes the sum total of most therapists knowledge of
their clinical work. (Schnarch, 1991, p. 145)

The goal of this paper is to identify, clarify, and promulgate Masters and Johnsons
application of the initial phase of Sensate Focus, as well as their conceptualization of sex
as a natural function that underlies Sensate Focus, in a way that more accurately depicts
both their treatment as it was practiced at the Institute and also the potential power of Sensate Focus to promote meaningful intimacy. Both authors are graduates of the Institutes
six-month intensive training program and subsequently served as Research and Clinical
Associates for five years.

Confusions over the definitions and implementation of Sensate Focus

Origin and use
Sensate Focus is a hierarchy of invariant, structured touching and discovery suggestions
created by Virginia Johnson as she reflected on the memory of facial tracing by her
mother during her childhood (Maier, 2009, p. 182). It is a diagnostic and a therapeutic
tool for identifying psychological and relationship factors that contribute to sexual difficulties, and for teaching new skills to overcome these problems and to foster more meaningful sexual intimacy. Sensate Focus is the centerpiece of Masters and Johnsons
therapeutic work, and continues to be utilized by sex therapy professionals. The preliminary results of an ongoing investigation being conducted through Surveymonkey and
involving 94 sexologists to date indicate that 41.54% of clinicians surveyed often use
Sensate Focus with a multitude of clients, and an additional 43.08% use the techniques
sometimes, with a total of 84.62% of respondents using Sensate Focus in some fashion
(Weiner & Stiritz, 2014). However, misconceptions about its purpose and use abound,
particularly when it comes to initial Sensate Focus and the way this is implemented.

Masters and Johnsons concepts and techniques

Confusion about Masters and Johnsons conceptualization and implementation of Sensate Focus, and their precept of sex as a natural function that is its underpinning, developed almost immediately after the publication of Human Sexual Inadequacy.
Perturbation was twofold: the significance of emotions (such as sexual arousal and pleasure) as natural functions; and emphasis on the partners experience. We will define
what Masters and Johnson meant by sex as a natural function as the foundation of Sensate Focus. We will then delineate both what they intended the initial Sensate Focus attitude to be and also how they implemented it. We will follow this with some of the
concerns that other professionals in the field have expressed with regard to Masters and
Johnsons medically based approach to sex as a natural function and to the implementation of Sensate Focus. This will provide a baseline for understanding the conceptual and
practical confusion that developed as compared to the way Masters and Johnson intended
the concept of sexual function, and the associated implementation of Sensate Focus, to be
understood.

Sexual and Relationship Therapy

Conceptualization: natural functions

An appreciation for what Masters and Johnson meant by sex as a natural function is
critical for understanding the purpose of Sensate Focus. They posited a medically based
approach, and are famous for their assertion that sex is a natural function: Sexual
functioning is a natural physiological process. . .[like] respiratory, bladder, or bowel
function (Masters & Johnson, 1970, p. 9). This precept has become the cornerstone
of sex therapy in spite of long-continued opposition from the medical community
(Masters & Johnson, 1986, p. 2). Masters and Johnson define natural functions as
neurophysiological processes: (1) with which one is born; (2) that cannot be taught;
and (3) that are not under immediate voluntary control. Natural functions are part and
parcel of the autonomic nervous system, and while they can be somewhat influenced by
conscious direction with disciplined practice over time, they are essentially never under
instant control.
Natural functions include vegetative processes (e.g., breathing, sleeping, etc.) and
emotional responses (sexual responsiveness, pleasure; rage, fear). 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.
Implementation: initial Sensate Focus (Sensate Focus Phase 1) suggestions
Because their original research focused on discovering the natural, physiological
aspects of sexual responsiveness, Masters and Johnson naturally emphasized treatment
for disturbances of natural functions including erection, lubrication, orgasm, and, eventually, desire. Clients suffering from sexual problems were trying to make sex happen,
or trying to keep it from happening, by touching for their and/or their partners arousal
or pleasure and, therefore, generating performance anxieties. The initial goal of treatment is to neutralize these untenable pressures. Clients have to learn to focus on that
over which they do have voluntary control. These include activities involving higher,
neocortical brain functions such as redirecting attention onto sensory experience and
engaging in voluntary behaviors, thereby allowing the natural functions to occur on
their own.
Masters and Johnson discovered this sensory redirection approach while working with
their laboratory subjects. Subjects who responded with sexual ease reported doing three
things: (1) they touched for their own involvement as opposed to their partners; (2) they
defined touching as focusing on sensations, especially tactile sensations, rather than on
trying to make themselves or their partners aroused; and (3) they redirected attention

L. Weiner and C. Avery-Clark

back to sensations when their mind was distracted. When engaged in these activities, cultivating an attitude of touching for ones own interest, or touching for ones self, their
bodies were much more likely to respond.
Touching for ones interest is what we refer to as Sensate Focus Phase 1 (Weiner,
2011; Weiner & Avery-Clark, 2013). It is not so much any behavior as it is a focusing
attention attitude: Are clients able to zero in on their own sensory experience? Are they
more concerned with the partners experience? The advantage of this attitude is that
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). Paradoxically, the most likely way to experience sexual arousal and pleasure is secondarily, through redirection of voluntary attention away
from trying to make the involuntary response happen, and onto sensory experience.
Therefore, initial Sensate Focus suggestions stress descriptive, sensory involvement to
neutralize evaluative expectations that create anxiety and that, in turn, interfere with
sexual functioning.
Although being present to immediate sensory experience allows natural emotional
responsiveness to occur, the tendency for attention to shift to neocortical, analytical processes (e.g., evaluations such as I hope it feels pleasurable for my partner, I wonder if
Im doing this right) is almost irresistible. This is particularly the case for clients early in
therapy and with higher levels anxiety levels. Unfortunately, shifting from sensory experience to evaluative interpretation works against the expression of natural functions
because clients try to voluntarily force the natural function they judge as nice, right,
or good. Thus, the initial instructions encourage clients to focus in the short-run on the
sensory level of experience that is the gateway to their long-term goals of sexual arousal,
pleasure, and intimacy.
Mindfulness
The attitude of Sensate Focus Phase 1 is what is currently referred to as mindfulness.
Mindfulness practice is an ancient tradition in Eastern philosophy that forms the basis
for meditation, and it is increasingly making its way into Western approaches to health
care (Brotto & Heiman, 2007, p. 3). When mindful instructions for Sensate Focus are
followed, focusing on sensations becomes the avenue into arousal and pleasure because
the autonomic nervous system is allowed to do its job, and these natural experiences are
no longer the primary, conscious goal.
The confusions
As noted, confusion about Masters and Johnsons conceptualization of sex as a natural
function, and of Sensate Focus as the sensorial redirection of attention, began almost
immediately after the publication of Human Sexual Inadequacy. It manifests as both
misinterpretation of the conceptualization of sexual difficulties and also as misunderstanding about the implementation of treatment for these difficulties. This is particularly
the case with the initial patient suggestions that are the focus of this paper. The confusion over initial suggestions is twofold and includes failure to appreciate emotions
(such as sexual arousal and pleasure) as natural functions, and emphasis on the
partners experience.

Sexual and Relationship Therapy

Conceptualization confusion: sex as a natural function

One of the primary points of confusion has been the conceptualization of sex as a natural
function. Tiefer (1991), associated with the New View of sexuality, suggests that sex is
not so much a natural function as a socially constructed phenomenon, and also contends
that characterizing sex as a natural function is an oversimplified inaccuracy excluding
this social constructionist perspective. The first sexologists who would agree would be
Masters and Johnson, confirming that sexuality is more than anatomy, biochemistry,
physiology, neurology, and endocrinology. Their assertion that sex is a natural function
does not exclude other aspects of sexuality including interrelated social, psychological,
interpersonal, and metaphysical processes. Sex is not a modernistic, either/or dichotomy,
but rather a post-modernistic, both/and complexity.
What Masters and Johnson did emphasize is that it is all too easy to forget that the
bedrock of sex is natural functioning that includes anatomy, biochemistry, physiology,
and other such processes. They noted in their 25th anniversary address that their first precept was
That it would be easier to develop far more effective therapeutic techniques to deal with sexual dysfunctions or disorders, if prior investigative effort had separated the physiologic verities of sexual function from the myths and misconceptions that had been accepted as dogma
by both the culture and the medical community. Thus, the Institutes research program was
initially geared to follow the long-established medical dictum that when you know little of
the anatomy, biochemistry, physiology, neurology, or endocrinology of a natural function,
the investigators should move first to the basic science laboratories. (Masters and MastersJohnson, 1986, p. 1)

Natural functioning, much like the foundation of Maslows (1954) hierarchy of needs,
must be addressed in therapy and in life before the social, psychological, and spiritual levels of human experience can be attended to and realized.

Implementation confusion: initial Sensate Focus (Sensate Focus Phase 1) suggestions

The most significant confusion pertains to the aim of Sensate Focus suggestions, particularly the initial ones. Apfelbaum notes, Masters and Johnsons (1970) sensate focus
assignments have been widely misunderstood as practice in focusing on the sensations
that please ones partner. . .. It actually refers to exactly the opposite: avoiding any effort
to please ones partner (Apfelbaum, 2012, p. 6) and, we would add, avoiding any effort
to please ones self.
It is not so much any misunderstanding about focusing on conscious demands for sexual arousal that has contributed to the confusion. Professionals have correctly understood
that initial Sensate Focus suggestions are aimed at moving away from anxiety-producing
expectations about sexual responsiveness. Kaplan notes that the primary attitude of the
initial suggestions is to shift
the couples objective away from the achievement of a [sexual] response to the giving and
receiving of pleasure. [Clients] attention is diverted from erection and orgasm and focused
instead on the experience of erotic feeling. . .. the famous sensate focus and mutual nondemand pleasuring experiences. (Kaplan, 1974, p. 202)

Despite her understanding of the need to redirect pressure for sexual excitation,
Kaplan promulgates the interpretation that initial Sensate Focus instructions are aimed at

L. Weiner and C. Avery-Clark

generating pleasure. It is this emphasis on pleasure, particularly when it comes to the

partners pleasure that represents the primary difficulty. Apfelbaum (2012) correctly
describes how many professionals have interpreted the first phase of Sensate Focus as
non-demand pleasuring of the partner. The confusion is most likely due to Masters and
Johnsons own misleading description of the intention of initial Sensate Focus
procedures:
The partner who is pleasuring is committed first to do just that: give pleasure. At a second
level in the experience, the giver is to explore his or her own component of personal pleasure
in doing the touching-to experience and appreciate the sensuous dimensions of hard and soft,
smooth and rough, warm and cool, qualities of texture and, finally, the somewhat indescribable aura of physical receptivity expressed by the partner being pleasured. After a reasonable
time. . . the marital partners are to exchange roles of pleasuring (giving) and being pleasured
(getting). (Masters & Johnson, 1970, p. 68).

Experts immediately seized upon, and continue to use, the notion of non-demand
pleasuring and focusing on the partner. This pleasuring and partner language can be subtle, signaled only by a word such as relax or enjoy: Alternating, lovers take turns giving
and receiving touch to enjoy the physical contact (De Villers & Turgeon, 2005, p. ii). It
can be more overt where clients are instructed to
Take turns touching each other in a sensual manner. The touch can resemble a gentle
massage. . .. You will succeed to the extent that you are able to give each other and
yourself pleasurable sensual feelings. . .. The intent is to help the couple enjoy sexual stimulation as a goal in itself within an anxiety-free environment. (Weeks & Gambescia, 2008,
pp. 357, 359)

Masters and Johnson recognized that their originally circulated Sensate Focus suggestions included the misleading, impossible, and ostensibly unintended suggestions to produce personal and partner pleasure antithetical to the fundamental intention of the
therapeutic opportunities. They refined their instructions as reflected in 1980s training
materials in which they stipulated two critical alterations reflecting not so much changes
their original thinking but in the wording they used to convey their thinking. One
involved shifting from an attitude of pleasuring to touching, and the other from attending
to the partners experience to ones own experience. By 21 February 1983, Robert
Kolodny, Masters and Johnsons esteemed associate and third author on many publications, outlined the following during the Institutes post-graduate training program:
I. Purpose of Sensate Focus/Process of Sensate Focus
to get in touch with senses
to reduce spectatoring ! goal orientation i.e., to get at neutrality. . . .
to get at self representation and responsibility
to get at the neutrality staying in here and now. (Kolodny, 1983)

The aims of Sensate Focus were clearly delineated as the toucher is to touch for
themselves [sic] trace. . .with intention of taking in sensations. Dont evaluate just
experience stay in neutrality, and Encourage exploration, experimentation,
Touching for self focus on your partners body for your own self, own interest, whats
going on with you not a massage to please them, not a turn on to please them, and

Sexual and Relationship Therapy

Touching for Self. . .. Its not something you do its an attitude. This emphasis on the
initial part of Sensate Focuss being a psychological attitude rather than a specific behavior is very important. Masters and Johnsons conceptualization and implementation had
been reconsidered in attitudinal terms we summarize as follows: Each partner touches
for self and focuses on his or her own sensual experience without regard for the partners
or ones own pleasure. In later phases information about pleasure is shared between
partners (Weiner & Avery-Clark, 2013). This crucial shift moves Sensate Focus from
non-demand partner pleasuring to non-demand touching for self.
By the time Masters and Johnson disseminated the corrected wording for the initial
Sensate Focus suggestions, the damage had been done with regard to the suggestions
being interpreted as non-demand pleasuring and partner pleasuring. Even as they revised
their misleading published material, they continued to train professionals using a mixture
of the old and the reassessed suggestions. In the outline for Sensate Focus Strategies:
General Purposes and Principles at the Postgraduate Workshop on Human Sexual Function and Dysfunction, Sensate Focus was defined as the use of the dimension of touch to
provide sensory experiences in reconstituting natural responsivity to sexual stimuli
(Meyners, 1981). This reflected the reconsidered perspective. However, in the same outline, the goals of Sensate Focus were additionally described as non-demand, non-goal-oriented teasing, supporting, pleasuring, playing, and touching. During their presentation at
the 25th anniversary celebration, while they were clear that the aim of Sensate Focus was
each persons focus on his or her own experience, they asserted, the individual touches
his or her undressed partner for the individuals, not the partners, interest or pleasure
(Masters & Johnson, 1986, p. 8, italics ours). Professionals exposed to the amended suggestions have been interweaving non-demand touching for self with non-demand self and
partner pleasuring ever since.
The individual partners are directed to focus on their own pleasurable sensual experience. . ..
By taking turns you will be able to focus on either what you are feeling or what the person
would like to receive from you. . .. During the initial steps or progressions of sensual pleasuring, the giver chooses the type of touch while the receiver takes in as much pleasurable sensation as possible and concentrates on what is feeling good. Then the receiver becomes an
active participant directing the giver by communicating what is enjoyable to maintain pleasurable sensations. . .. The receiver is not to worry about the giver but to focus on the self
when on the receiving end. (Weeks & Gambescia, 2008, pp. 357, 359)

Clients are thus confronted with two untenable conflicts possibly raising, rather than
lowering, their anxiety: the impossible demand to create pleasure and eroticism at will
for themselves and their partners; and the impossible demand to make pleasure happen
and simultaneously focus away from making pleasure happen. The initial Sensate Focus
non-demand attitude of touching for self is combined with the premature inclusion of
suggestions more appropriate for later aspects of Sensate Focus, namely, focusing on
responding to partner communication about pleasurable and erotic emotional
experiences.

The problem with non-demand pleasuring of the partner

The problem with cultivating an attitude of non-demand pleasuring of the partner and/or
ones self, often misunderstood as the purpose of the initial Sensate Focus instructions, is
that it does not honor the fact that pleasure, like all emotions, is a natural function. As has
been suggested previously, and as will be discussed in more detail subsequently, natural

L. Weiner and C. Avery-Clark

functions are not under direct voluntary control. The significance of this with regard to initial Sensate Focus suggestions is that defining Sensate Focus as non-demand pleasuring is
both oxymoronic and impossible: if one is positing the goal of pleasuring, one is not only
making a conscious demand but one is also making a conscious demand for something that
is impossible to achieve through conscious demand, namely, the generation of an involuntary natural function. Additionally, defining Sensate Focus as non-demand pleasuring of
the partner is doubly impossible: if one cannot order up pleasure or any other emotion at
will for ones self, one most certainly cannot order it up for another person.
Sensate Focus Phase 2
As suggested, Masters and Johnson have been criticized for over emphasizing neurophysiology at the expense of the relational, communicational, and even spiritual aspects of
sexuality. Because of their accentuation of the often neglected medical underpinnings of
sex, and because of their accentuation of the touching-for-self attitude that aims at alleviating disturbances of these underpinnings, they did not emphasize in the initial Sensate
Focus implementation an attitude of receptivity to partner feedback and to emotional
experiences of arousal and pleasure. While they did honor communicational significance
in the initial Sensate Focus suggestions, as will be described in greater detail in the discussion on non-verbal feedback, this was still with the intention of fostering the Sensate
Focus Phase 1 attitude of touching for ones self.
Nonetheless, just as sex as a natural function is not all there is to sexuality, the initial
Sensate Focus suggestions are not all there is to treating sexual concerns. Not only have
other sexologists made rich, therapeutic contributions, but Masters and Johnson evolved
their own thinking. For example, in their 25th anniversary address, they note
The fifth precept [of sex therapy is] that mutually satisfactory sexual interaction in a committed relationship is one of the better, if not the best means of nonverbal communication. It
was also presumed that if there is lack of effective nonverbal communication in the bedrooms
of sexually dysfunctional couples, there probably are difficulties with verbal communication
outside of the bedroom. Therefore it was deemed incumbent upon sex therapists to teach the
arts of verbal and nonverbal communication to sexually dysfunctional couples as an integral
part of the therapeutic format. (Masters & Johnson, 1986, p. 7)

Masters and Johnson expanded their treatment approach to increasingly cultivate an

attitude of partner and emotional sensitivity, interweaving the attitude of touching for self
with what we distinguish as the Sensate Focus Phase 2 attitude of greater responsivity to
partner feedback and to emotional experience. Sensate Focus Phase 2 more actively
accentuates partner communication about emotional experiences, and these are obviously
critical to the longer-term goals of intimacy and optimal sexuality.
However, the focus of this paper is on Sensate Focus Phase 1 because the concepts and
techniques are easily overlooked, much as it is easy to overlook the ground stage of
Maslows hierarchy of needs. Most therapists already emphasize the Sensate Focus Phase 2
attitude of sensitivity to partner and emotional experience. The significance of this Phase 1
attitude of touching for self, and the need for mastering Phase 1 skills prior to moving on to
cultivating the Phase 2 attitude that emphasizes partner, pleasuring, and communication,
may impede positive outcome because clients have not yet learned the foundational skills to
manage distractions and anxieties that affect natural sexual functioning by redirecting their
attention back to sensations. We will be addressing issues of Sensate Focus Phase 2 in subsequent articles.

Sexual and Relationship Therapy

Resolving the confusion over Sensate Focus

Sensate Focus instructions: non-demand touching for ones own interest
One way to illustrate how Sensate Focus Phase 1 operates to put natural responses and
voluntary behaviors in their proper perspective and relationship by stressing touching for
ones interest is to detail initial Sensate Focus suggestions implemented at Masters &
Johnson Institute. To the best of our knowledge, and after a thorough review of the literature, these suggestions do not appear to have been formally or widely published.

Preliminaries
Many therapists emphasize creating a relaxing and intimate atmosphere before engaging
in Sensate Focus. However, this can inadvertently contribute to avoidance of the exercises: We were too stressed this week. I just didnt feel like it. Clients need to be
assured they do not have to experience any particular emotion in order to engage in
Sensate Focus. Again, this is because it is not possible to create any specific emotion or
atmosphere at will. Clients can be encouraged to arrange the Sensate Focus setting so
they might increase the possibility of feeling relaxed, but insisting that they be relaxed
may place undue expectations that are contrary to the non-demand goals of Sensate Focus
Phase 1.
The touching opportunities should be as simple as possible in terms of the sensations
on which the clients focus and the behaviors in which they engage. This is to avert any
concern participants may have that they will fail. They do not have to want to do it and
they do not have to like it, but they need to believe that they are capable of following the
suggestions. This is possible and, in fact, they more likely to succeed, if evaluative
expectations for specific emotions are removed from therapeutic suggestions. Participants
are also instructed that they can always stop an activity or do less than has been suggested. However, they are encouraged not to proceed beyond the instructions to avert a
goal-oriented mindset antithetical to the non-demand purpose of Sensate Focus. This is
the paradox of being present to immediate sensations rather than trying to make happen
or keep from happening any particular emotion: clients can only succeed.

Specific suggestions
Sensate Focus is most effective if sessions take place on the average of every 48 to
72 hours. This keeps the physiology associated with sexual arousal percolating. An hour
is set aside during which partners are least likely to be disturbed (i.e., all electronic devices turned off, no pets in the room, etc.). Clients are also encouraged to: have a comfortable room temperature; have some light on; preferably remove all their own clothing or
as much as they feel comfortable removing; open or close their eyes depending on which
helps them focus; avoid talking or music to exclude auditory stimulation; and refrain
from using candles, lotions, or other accouterments that reinforce the expectation of pleasure or relaxation in these initial stages.
Participants begin by assuming any physically comfortable position together. 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.

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L. Weiner and C. Avery-Clark

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 partners
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 touchers hand away if some area is experienced as physically uncomfortable
or ticklish. Moving the touchers 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.
At Masters & Johnson Institute, we saw couples daily for two consecutive weeks. Not
only did they benefit from the accrual of neurophysiological tension associated with frequent tactile contact, but they could more easily refrain from sexual activity until suggested since the time in treatment was so concentrated. Although it is not the purpose of
this paper to focus on modifications of the original Masters and Johnsons model, many
therapists have adapted their suggestions around weekly sessions. A recent study (Weiner
& Stiritz, 2014) suggests that clinicians increasingly tailor their approaches in other
ways as well, for example, who initiates the session, and the sequence and pacing of suggestions. Althof offers one illustration of modifications when noting, in designing sensate focus exercises. . .it may be necessary to have couples begin the exercises at a
rudimentary level, such as holding hands in the dark, in bed, with both partners dressed in
pajamas (Althof, 2000, p. 242).
Hierarchy
Sensate Focus Phase 1 moves through an invariant and structured hierarchy of behavioral
activities designed to foster the attitude of touching for ones self. It begins with breasts
and genitals off limits and progresses to breasts and genitals on limits, mutual touching
lying together, partner astride, and insertion as therapeutically appropriate. Sensate
Focus Phase 1 serves as a means for diagnosing difficulties as well as for practicing
touching for ones own interest, and this, in turn, systematically desensitizes participants
anxiety and neutralizes their evaluating their experiences as successful or otherwise. As

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11

progress is made, additional sensations and behaviors can be included. In the later Sensate
Focus Phase 2 of therapy, where partner communication is stressed, participants exchange
non-verbal and verbal information about emotional desires, and respond to feedback from
the partner. This often renders them more vulnerable, exploratory, spontaneous, and intimate in their touching. However, this is not the goal of the initial phases because, at the
beginning of therapy, patients have too much difficulty slipping into the aforementioned
goal-oriented mindset of trying to make erotic connection happen.
The paradox of powerful presence
In Masters and Johnsons clarified instructions, the toucher is not only no longer required
to experience pleasure, increase sexual responsiveness, or prevent these natural responses,
but is also directed away from emotions altogether. Clients allow the emotional responses
to occur on their own rather than forcing them. The toucher is encouraged to focus on
tasks that are under his or her voluntary control, namely, engaging in touching exercises
and refocusing on sensations. Additionally, the toucher touches for himself or herself.
The reason tactile sensations are emphasized is twofold. First, the sense of touch is
the special sense most used in sexual interchange (Masters & Johnson, 1986, p. 8).
Temperature, texture, and pressure are particularly powerful potential portals into neurochemical activation of the longed for emotions of pleasure and arousal. Second, tactile
sensations are reliable. One can always turn ones focus to temperature, pressure, and texture. The same cannot be said about a specific emotion like sexual arousal or pleasure. As
noted, the paradox is that the only way to experience desired emotions like arousal or
pleasure is indirectly by voluntary redirecting attention away from consciously forcing
these emotions.
The profundity of this shift from trying to control sexual and pleasurable responses to
honoring them as natural functions by redirecting attention in a mindful way onto present
sensations for ones own interest cannot be overstated. It represents moving away from
conceptualizing and implementing Sensate Focus in a manner antithetical to patient progress, and moving towards conceptualizing and implementing so as to alleviate pressure
and expectations. This increases the likelihood off resolving psychologically induced sexual difficulties, and ultimately may foster optimal intimacy.
Conclusion: what Sensate Focus is and is not
Sensate Focus in its initial phase is a set of clinical exercises intended to cultivate an attitude of non-demand touching for ones own interest. Its aim for the clinician is providing
invaluable diagnostic and therapeutic information about the clients. Its aim for the clients
is learning about their physical responses by tuning into sensations and refocusing away
from evaluation expectations of the experience. Clients simply do not have conscious
control over making pleasure and sexual arousal happen even though these are their longterm goals. What they do have short-term control over is redirecting their attention onto
tactile sensations while engaging in touching activities. This gets consciousness out of
the way of natural functions that is the primary goal of Sensate Focus Phase 1.
Sensate Focus in its initial phases is not an attitude of non-demand pleasuring for the
partner or for ones self. It is not aimed at enjoyment or relaxation. It is not aimed at being
a massage or an erotic encounter. Sensate Focus is not touching for the other person. Sensate Focus is not touching to sexually arouse ones self or ones partner. It is is intended
to be an experience in itself, not a prelude to sex or a form of foreplay (De Villers &

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L. Weiner and C. Avery-Clark

Turgeon, 2005, p. i). It is the paradox of pleasure and sexual responsiveness that being
present to conscious sensory experience, rather than trying to make these natural emotions happen, is what promotes them.
If the attentional redirection and behavioral engagements that are the initial components of Sensate Focus are practiced, they may serve as powerful portals into the subsequent, Phase 2, segments associated with the very emotions that patients are yearning to
experience but cannot make happen. These include the deep connection to which Kleinplatz refers as optimal sexual experience (Kleinplatz & Menard, 2007, p. 74) during
which sexual energy mixes with the sacred, one having the potential for activating the
other. The effect can be numinous. (Avery-Clark, 2012, p. 90). If couples initiate their
engagement in Sensate Focus in the non-demand touching manner that Masters and Johnson intended, they increase the likelihood of having the opportunity to experience how
intimate connection can arise spontaneously and meaningfully so as to optimizes the
erotic closeness they so desire.

Acknowledgements
The authors would like to thank Barry McCarthy, PhD, and Michael Plaut, PhD, for their invaluable
support and suggestions with regard to this article.

Notes on contributors
Linda Weiner, MSW, LCSW, is a Sexology Diplomate, American Board of Sexology; a Clinical
Social Work Diplomate, NASW; an AASECT Diplomate in Sex Therapy; former Research and
Clinical Associate at Masters & Johnson Institute, and holds a Social Work Masters. She teaches
Human Sexuality at Washington University and is co-authoring articles on Sensate Focus.
Constance Avery-Clark, PhD, is a Diplomate in Sexology, American Board of Sexology; an
AASECT-certified Sex Therapist; former Research and Clinical Associate at Masters & Johnson
Institute, and holds a doctorate in Clinical Psychology from USC. She is in private practice, specializing in sex-related issues, and is co-authoring articles on Sensate Focus.

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