Sensate Focus Therapy for sexual health & intimacy

Sensate Focus Therapy (SFT) can be a powerful and effective approach to support individuals and those in relationships to address sexual concerns including sexual pain and erectile difficulties. It can also improve the quality of sexual and intimate experiences. SFT involves a series of structured touching exercises that offer the opportunity to reshape your relationship with touch and sex.

You may have heard about SFT from a health care provider or through your own search for a supportive practice. I hope that this blog can be a resource to help understand the purpose and rationale for this approach as well as to provide some guidance on ways to implement it in your life.

While Sensate Therapy is structured, it is most effective when it takes into account, and is customised according to, your individual needs and circumstances. Accommodations for a range of considerations have been developed including for neurodiversity, gender diversity as well as for age, illness and disability. Some accommodations are described in this blog but it’s by no means an exhaustive list.

While this guide could help you plan and implement SFT in your life, further support and information from a trained practitioner might be important to consider - including the Sexual Health Psychologists at SHIPS.

What is Sensate Focus Therapy?

Developed in the 1970s, Sensate Therapy is a series of structured touching exercises that provide opportunities for experiencing your own or your partner’s body in an exploratory, curious and open manner.

As embodied beings, touch is a powerful and important sensory element that influences how we experience the world and our sense of self. Throughout our lives, touch has the ability to “[alter] our biochemistry, neurology, feelings, thoughts and behaviours, our ability to socialise and have intimate relationships, our ability to heal, thrive and survive” (Weiner & Avery-Clark, 2017, p.10). From birth, touch helps babies to physically and psychologically thrive and develop healthy and safe attachments to caregivers. Even in late life, psychological and physical functioning are improved when the ability to touch and be touched are preserved.

In intimacy and sex, touch is seen as the window to sexual responsiveness, increasing blood flow to the pelvis, triggering the release of oxytocin (bonding hormone) and decreasing blood pressure. The use of touch makes sense for working with sexual health concerns, as the quality of our experience with touch can give us important insight into what might be contributing to difficulties. Coming back to mindful touch can then assist in healing and strengthening our ability to be emotionally and physically attuned to our sexual selves and bodies.

Sensate Therapy can be helpful for working through a range of sexual health concerns. This includes recovering from sexual trauma, sexual pain (vaginismus, vulvodynia), sexual anxiety, performance anxiety, erectile dysfunction, pornography addiction, and arousal/ orgasm difficulties to name a few.

What are the aims of SFT and how are they achieved?

One of the underlying premises of SFT is that sex is a physiological function guided by our autonomic nervous systems. Much like sleep or breathing, sex can be influenced by various factors from medication and hormone changes through to psychological factors like stress, anxiety or distraction. Just as there are factors that allow for greater quality of sleep to unfold, the actual stages of sleep are automatically and unconsciously regulated by our nervous system. Fears and worries about sex can also interfere via the sexual inhibition system when a survival response is triggered.

Mindful awareness

Through drawing on mindful awareness, SFT allows us to become aware of the barriers to safer and more pleasurable sex. We learn to be more embodied and accepting of the sensations we experience during sex. Additionally, when our thoughts impact sexual experience, touch and sensation are also a reliable and tangible alternative for where we focus our awareness.

Touch without the expectation of sex

Sensate touching exercises draw on mindful awareness to focus attention on tactile sensations of skin temperature, texture, and varying pressures of firmness and lightness with no aim for orgasm, pleasure, enjoyment or relaxation. This might sound counterintuitive, however, the premise of this is that expectations that sensual touch should lead to sex or that there is a correct sequence or sensory experience could also be contributing to sexual health concerns and so Sensate Therapy creates a space to deliberately focus on being able to attend to your embodied experience without judgement or pressure to arrive at an outcome. More generally, being able to be connected to and respectful of our bodies also involves being able to accept that intimacy and sex are not the same thing and that sex may not occur or be what we want or need in a given moment.

Assessment and pattern recognition

One of the aims of SFT is for assessment and pattern recognition. Paying mindful attention to the thoughts, feelings and sensations that arise during physical intimacy can help us gather data about the factors that could be contributing to or maintaining sexual health concerns. For example, someone might notice aversive responses to being touched in a particular way. Noticing this might then help them understand what their current trauma triggers are in sexual situations and guide safer and more responsive engagement in sex going forward.

It might also help us recognize the implicit expectations, beliefs and assumptions we can all hold about sex based on our history, education, values and schemas which our nervous systems may be responding to. For example, a self-sacrificing schema may mean that it is anxiety provoking to assertively discuss our sexual needs and boundaries, which could contribute to or maintain sexual pain.

Enhancing the quality of physical intimacy

Another purpose for Sensate Therapy is to improve the quality of physical intimacy. Over the life of a relationship our experience of sex and physical intimacy can change, influenced by various factors such as life stage, age, infidelity, pregnancy, the addition of children, physical health concerns or injuries, disabilities and trauma to name a few. Sensate Therapy can give those in a relationship the space to explore barriers and also come back to a state of curiosity and intentionality with touch and one another’s bodies, potentially enriching this experience again and facilitating healthy conversations about sex. Additionally, when embodiment and pleasure are witnessed in another, it can also increase our own arousal creating a positive feedback loop in response to touch.

What does it look like in practice?

For a detailed description of each step of Sensate Focus, there is a handout listed in the references. It is important to note that SFT can be adapted and tailored to suit individual presentations and concerns, for example, taking into account neurodiversity needs, factors to support chronic illness and pain, challenges related to age or disability and so on. This can be supported with the help of a healthcare provider trained in Sensate Therapy and there is also a list of suggestions further below.

Here is a brief description of the steps:

Phase 1
Develop a plan with your partner and practitioner that is tailored to your individual needs and circumstances.

Without judgement or expectation, engage in mindful touching of a pre-determined part of your partner’s body. This occurs for a set period of time eg. 10 minutes. Then swap - the toucher becomes the touchee.
The aim is to practice skills of awareness and attunement to bodily sensations for curiosity rather than for a goal.
Handriding can be introduced, so that if a sensation is uncomfortable emotionally or physically, or if an area is ticklish, the person being touched can move the hand of the person touching away or hover their hand over the toucher’s hand to indicate a pause would be helpful. It is important not to push through any uncomfortable sensations, however, this might be important to make a note of when gathering data about your sexual health concern.

Phase 2 - Same as phase 1 but including genitals, chest and breasts once you are able to touch for interest rather than being outcome focused. Do you feel able to focus on sensations and bring your mind back from anxiety-provoking distractions and expectations? The amount of time spent on the touching session might increase.

Phase 3 - Engage in mutual touching, kissing and stroking of each other’s bodies simultaneously. Start with phase 1 and progress to phase 2. At first avoiding chest, breast and genitals as before, and then when you are able to stay with or return to sensations confidently, add these back in.

Positive handriding can take place, where hands are guided not only away from discomfort but towards areas of interest to explore texture, temperature, pressure and movement rather than for a goal e.g. pleasure.

Phase 4 - Proceed through stages 1 - 3 then genital-to-genital contact can occur, without penetration (if practiced). This can be modified according to preference and need; differences in height, for example.

Arousal may occur and allowing for the gaining, losing and regaining of arousal can be challenging, e.g. in the case of performance anxiety. Discussion and acceptance of this as normal can allay fears about arousal needing to be connected to any conditions such as erection for those with pensises.

After this, and in relationships where this is practiced, penetration could be added without movement. It’s important to attend to sensations without a goal-oriented focus, judgements about whether or not it feels good or if arousal is present or not. Movement can be added later, and again focused on curiosity about sensation rather than being goal or outcome-focused.

A Sensate session can stop any time. A period of time together afterwards is encouraged, being present with the other without the pressures of a particular goal. It can also be a time to debrief on things that were noticed.

Adaptations when engaging in Sensate Therapy

SFT can be adapted to meet a variety of different needs for those who have experienced sexual assault; those who are neurodivergent or gender diverse; trans populations; and for those who due to age, illness or disability may benefit from some physical accommodations.

Sexual assault: Clear communication both before, during and after Sensate Therapy can help set up a space that feels safer and more contained.

Make sure consent is prioritised and is an ongoing discussion during each session.
A conversation around known triggers and signs of dissociation can help you feel like there is a plan in place for how to respond in the moment.
During Sensate Therapy, and at least initially, it might feel more approachable for the trauma survivor to be in the role of toucher first or to proactively use handriding techniques to provide in-the-moment feedback and direction on any potential discomfort.
Signals such as ‘red light, amber light and green light’ could also support communication in the moment around comfort, uncertainty and discomfort. Red light might indicate discomfort, amber light to slow down and proceed cautiously - checking in if discomfort arises - and green light to continue as planned.
Taking an opportunity to reflect on what helped support safety and what could be improved afterwards can also be supportive.

Neurodivergent individuals:

It can be helpful to normalise the potential for distractibility during Sensate Therapy, for example with ADHD. Distraction might also occur more in response to sensory processing differences including tendencies for under or oversensitivity with both ADHD and Autism. Does there need to be less stimulating factors, or more, and in response to which sensory modalities; tactile, auditory, olfactory/ smell and so on? Clothing could initially be worn for example, for overstimulation tendencies. You could also reduce the length of touching sessions.
Using a map of the body might also be a tool that can support discussion and reflection on the body to identify areas of greater sensitivity.
The act of recognising when distraction has occurred and, with intention, returning your focus to bodily sensations is a part of the practice of building mindful awareness as well.
Structure and routine can be helpful to consider. Creating a tailored plan week to week around how to set up the environment and how to respond in moments of overwhelm could increase confidence with Senate Therapy.

Gender diverse and trans individuals:

Consider in advance the potential impact of discussion of different body parts and dysphoria. Note down potential triggers for dysphoria and what language/ terms might increase safety.
Experiment with new sensations, positions and new ways of interacting with the body that reduces dysphoria.
‘Red light, amber light and green light’ as previously mentioned could also be helpful as a communication tool around potential discomfort in the moment and debriefing later.

Disability, illness and ageing:

Minimising pain and maximising comfort and mobility where possible is important, but so too is the acknowledgement of potentially limiting beliefs about sex and disability, illness and ageing. It is not uncommon for beliefs around there being a ‘right way to engage in sex’ which can limit the exploration of ways that your body can experience intimacy and connection. In addition, challenging the ideal that sex does not always need to be spontaneous if you think about the care and love towards self or other that comes from valuing needs.
Supportive equipment including furniture, pillows and wedges can provide additional comfort with physical pain or mobility concerns. Toys including vibrators and dildos can increase stimulation, for example, with those who have neurological conditions. Lubricants and gels can increase comfort for older individuals.
Different positions can also be adapted where, for example, those with hip difficulties may prefer lying on their side. Optimising the environment including lighting and temperature to better support your needs will improve your ability to focus on touching exercises.
Where body image may be a source of distress, underwear or even some clothing can be worn during exercises to increase comfort and reduce distraction around body image.
The timing of engaging in Sensate Therapy could also be helpful, particularly if there are times of the day or days of the week when you are less fatigued or experience reduced pain.

Other helpful considerations

Staying focused on bodily sensations can be challenging and managing distractions is an important part of the process. Thoughts, goals, worries and expectations - whether judgemental or positive - take us away from the core purpose of Sensate touch. Anxieties about engaging in Sensate Therapy correctly or worries about how much sensation is experienced are common examples of this. Recognising this, normalising that this will happen and practicing and strengthening your ability to redirect your focus back to bodily sensations is a part of the process.

Mindfulness itself is often important to conceptualise in the practice of Sensate Therapy. Generally mindfulness can be defined as “the awareness that arises when we intentionally pay attention in a kind, open and discerning way”. Many people engage in mindfulness because they are suffering and are seeking a way to change or escape their lived experience. While mindfulness can act as a respite at times, the practice does not necessarily change our experience but our relationship to what is occurring in the moment, so that we can respond consciously and skillfully in challenging and painful circumstances - rather than through automatic and implicit reactions.

The field of neuroplasticity demonstrates that our repeated experiences shape our brain functioning. Over time and practice, mindfulness can build our mind’s ability to know our experience as it arises and passes. We may not have control over all circumstances in our lives but we can learn to shape our relationship to and responses to those experiences, reducing what is called secondary suffering over time.

There are three broad components to mindfulness practice: Intention, Attention and Attitude (IAA);

Being intentional about why we are choosing to engage in mindfulness is important. We need to understand for example how mindfulness will be in service of what is important to us or our direction for life (values). Perhaps you want to improve your acceptance of all your emotions or you want to deepen your ability to be present and attuned to those you love. Knowing this will also help you maintain a new behaviour or habit.
Mindfulness also requires a commitment to attend to not only your surrounding environment but your internal world, moment by moment, in a non-reactive way even if it is painful or difficult. This might be very different to our usual responses to challenging emotions.
Finally, our attitude to mindfulness will also affect the quality of our attention. A kind, open, discerning attitude is important to keep in mind. Without this we may end up falling back on old patterns of judgement or criticism of our internal experience.

Starting Sensate Therapy can feel daunting. Start with where you are at if you don’t feel confident with mindful awareness. Even 5 minutes is great so you can start from there. Making a plan for regular and consistent engagement with sensate touch is ideal and it is recommended to create opportunities daily.

Environmental factors can also have an impact on our ability to stay present. Some things might be in our control to change and reducing distraction where possible is a part of setting up for the practice. Creating a quiet and private environment, a comfortable temperature and to have unpressured time together before and after to reflect on what was noticed/ learnt can be helpful.

If mindfulness is challenging, whether due to little experience with it or if there are factors that impact on attention, information processing or interoception, working on mindful touch individually (‘solo sensate’) for a period of time might be a part of the process. Solo sensate can support the development of a more positive relationship to one’s own sexual self. Also, if there is initially too much fear or distress with partnered exercises e.g. as a result of trauma, this can be a helpful starting point.

If self-criticism and judgement is a theme you notice, self-compassion can also be a supportive practice to engage in to strengthen your ability to be open and curious instead.

Although Sensate Therapy may be suggested as part of an individual treatment plan, it is important that the responsibility for working through a sexual concern is shared. A sexual response represents a dynamic shared between people and there will be elements and behaviours that each person is responding to that shape the sexual experiences they have. For example, one partner may experience erectile difficulties however their partner may internalise this experience as a part of their own relationship to their body - this needs to be acknowledged too. Sensate Therapy is a chance for all parties in a relationship to learn about how they contribute to concerns and actively work together as a team to heal.

Sensate Therapy invites us to focus on the sensations of touching and being touched which for some could be challenging, e.g. those who have learnt to prioritise another person’s pleasure. The focus of touch is on interest and curiosity rather than arousal and pleasure, as the latter could be experienced as pressure, internally or externally, on particular expectations and goals.

Arousal as a biological process is not under our conscious control but is paradoxically more likely to arise when we attend to our sensory experiences without pressure to make it happen. Noticing and understanding the context and history that might contribute to this is a helpful first step.

Some questions that might be helpful to reflect on:

What emotions are coming up for me and where am I feeling these in my body? Be curious, even sensations like ticklishness could at times be indicative of some anticipatory anxiety.
What is my first instinct in responding to these feelings? E.g. wanting detach emotionally or physically withdraw.
Is this a familiar or a new feeling for me?
If familiar, what previous experiences might this remind me of and how did this help me cope or survive then?
Does this still make sense in my current circumstances and why/ why not?
How would I like to be able to respond, including to myself?
What might this be like to act on and what might get in the way?
Having someone else to explore this with, including a partner, close friend or even a therapist might be supportive too.

Arousal may occur during Sensate Therapy and knowing how to respond to this is helpful. If arousal arises try to attend to the sensation and come back from any goals or expectations associated if possible. If this becomes uncomfortable or distracting, or is experienced as goal-oriented, closing one’s eyes or focusing on another part of the body can be helpful. In the same way that we cannot force an orgasm, it may occur spontaneously and we cannot prevent it. As long as it wasn't the goal or intention, it can be seen as a neutral and natural function and Sensate Therapy can continue. Stopping after orgasm or ejaculation could reinforce the sense of there being a correct way or sequence to have sex.

Consider logistics. Timing, and planning your physical space, are both very important. Make sure you have enough spoons or physical and/ or emotional capacity to engage in Sensate Therapy and still be aware of and respond effectively to worries or distractions. Other things to consider are whether to engage in Sensate Therapy when medications have positive effects, when less fatigued or in greater physical pain. Or if you or a partner are neurodivergent, consider whether any sensory preferences and needs might be helpful to plan around. With sensory needs, it might even be helpful to create a body map of areas of the body with lowered or heightened sensitivity to avoid overstimulation.

Final thoughts

Sensate Therapy can be an incredibly powerful tool in not only understanding what may be contributing to sexual health concerns but also to reinvigorate or strengthen our ability to be intimate with our bodies individually and in connection with others. It honours the shared dynamic that contributes to sexual health concerns and reduces the sense of isolation and shame that can be a part of living with these issues. We are embodied beings and through touch we can find our way back to a positive and safe connection with our bodies and sexuality.

This blog post is a brief exploration of this topic and does not replace therapy. At SHIPS, we have practitioners that are knowledgeable and skilled in a variety of areas including sex therapy, relationships and more. If you may benefit from some support, please check out our website resources or contact us.

We are also always happy to hear feedback about our blog articles. If you would like to share your experience or feel we may have missed something on this topic, please contact us to let us know.

Resources:

Sensate Homework Guide
Solo Touching Exercise - by Dr Sarah Ashton (9:13 minutes)