Sex therapy and sensate focus

Domain V · Systemic, relational, group & community · Masters and Johnson · 1970 · St Louis, USA

What it is

Sex therapy in this tradition is a brief, structured, couple-focused, behavioural-educational treatment for sexual dysfunctions (erectile difficulties, early ejaculation, delayed ejaculation, orgasm difficulties, vaginismus/penetration difficulties, low arousal or desire). Its core idea of change:…

Format

• Original Masters and Johnson format (St Louis, 1960s–70s)
• Intensive two-week programme with daily sessions (weekends included), couple away from home and treated as guests in residence.

Who practises it, and how they are trained or regulated

• Weekly (or fortnightly) conjoint sessions with a single therapist; LoPiccolo & Stock report single therapists did as well as dual-sex teams in one study. Co-therapy is now mostly used in training or complex systemic cases (Wylie).

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• embarrassment preventing practice; respect refusal.
• the receiver feeling they must please the toucher with feedback.
• one partner taking over or reverting to a habitual sexual routine.
• rushing to orgasm; anxiety returning at penetration (go back a step).
• aversion to wetness or mess (explore; may link to body image or disgust).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.