Episode Transcript
[00:00:00] Speaker A: Are you struggling to overcome a sexual difficulty, like an elusive orgasm or loss of an erection? Or maybe you're feeling sexually disconnected from your partner and want a strategy to reintegrate sex without it feeling awkward and uncomfortable? Perhaps you're a cancer survivor and need help reawakening the pleasure pathways in your body. One sexual intervention is tried and true.
[00:00:23] Speaker B: Sensate focus, which is the topic of today's episode.
[00:00:27] Speaker A: About halfway through recording, I realized that I opened nearly every sentence with one thing I love about Sensaid, and that's.
[00:00:34] Speaker B: Because there is a lot to love.
[00:00:36] Speaker A: Linda Weiner wrote the book on it, and we are going to break it.
[00:00:39] Speaker B: Down for you today.
[00:00:41] Speaker A: Let's meet our guest. Linda Weiner is a certified diplomat in sex therapy supervisor in sex therapy. She earned a BA in psychology from American University and an MSW from the University of Missouri. Linda was trained and employed at Masters and Johnson Institute and served as the director of the Child Sexual Abuse Treatment Program and as a research and clinical associate. She evolved into private clinical practice as a therapist specializing in sexuality and relationships while also serving as an adjunct professor at the Brown School, Washington University in St. Louis. Linda later began publishing on Sensate Focus, mindfulness and somatic touch techniques with co author doctor Constance Avery Clark. Following a publication of a number of journal articles and a book chapter, their book, Sensate Focus and Sex therapy, was finally published in 2017. Linda has presented nationally and internationally internationally, and has been interviewed by a number of media outlets, including the New York Times, CNN, and Vice. Her current interest is in transmitting information about the use of sensate focus techniques to physicians and allied health professionals who represent the first contact with people struggling with sexual problems. Let's dive in.
[00:01:56] Speaker B: Linda, welcome to the show.
[00:01:59] Speaker C: Emily, thank you. Thanks so much. It's good to be here.
[00:02:02] Speaker B: I know. It is so great to connect with you. We were talking before we started recording that. It's just been a long time since we've been bumped into each other at like an ASEC conference or something. And that's one of the things I love about doing this podcast, is I get to see all these old faces that I wouldn't have probably seen otherwise. So thank you for joining me today.
[00:02:21] Speaker C: Absolutely.
[00:02:23] Speaker B: And we are going to talk all about sensate focus, which is such an important sex therapy intervention, and I have so many questions about it. But before we dive in, I'd love for you to tell our listeners a little bit about you and how you got into the field and just how you began focusing on sensate focus because you've written a whole book about it.
[00:02:45] Speaker C: Okay. Yes. Well, I think, Emily, it started out with being born with the last name being pronounced Weiner. Weiner. And, you know, I became desensitized early to jokes about male anatomy and the Oscar Mayer jingle and all of that. So when I went off to school, college, I changed the pronunciation to whiner, but it already had its effect. So I think that has to be mentioned as a precursor. But I guess I've also always been fascinated by people and their story. And sexuality was coming into fruition for women in the seventies when I went off to college. And it was, for the first time, the 1950s spell of, you know, the chaste woman. And there were sexuality courses and workshops, and it was just the time I had the name, I had the interest, and that's how I got into it.
[00:03:47] Speaker B: I love that. That's awesome. All the pieces of the puzzle just came right together. Yeah. Yeah, I. Well, okay, let's dive into sensate focus, because it is one of the first interventions that any sex therapist learns, and that is because it is tried and true and backed up by a lot of research. So what is sensate focus? How do you define it?
[00:04:10] Speaker C: Yeah. Okay, so sensate focus. Sensate from the word sensation. Okay, so focus on sensation. So basically, masters and Johnson had done research. Those are the people that invented modern sex therapy. Before them, you had to lie on a couch for a couple days a week, and maybe your sexual problem would dissipate if it was related to childhood issues.
But what Masterson Johnson discovered is that a lot of time, it's associated with anxiety, and it's associated with what they called spectator or watching yourself. So they knew that anxiety was a cause of anxiety, and they knew that touch was a way to moderate anxiety.
Generally speaking, when you're touched or rubbed or you relax. And so they invented this step by step hierarchy of touching exercises, starting with something that wasn't real stressful. It could be touching. Your turn, my turn, everywhere. But breasts and genitals could be with clothes on. If that's your first step, that's what you do. But the idea is, as you are exposed to touch, you begin to relax after the first time or two. And then when you're relaxing with no breasts and genitals, then you add breasts and or breasts in genital touching. And what it does is it helps people learn to relax, learn to turn off the front part of your brain, because sex happens back here.
So this is what's getting in the way anxiety and thinking and watching and evaluating. So they focus. You manage anxiety, then you move on to the next step, which might be then genital to genital touching. So at each step, you manage anxiety. You also manage whatever dynamics are going on between the couple. If you're working with a couple where one might be evaluating or pushing the other, so you get to intervene. So it is a hierarchy of touching experiences that moderates anxiety, teaches you something to do with your brain. So rather than saying, how's this going?
Am I getting soft? Am I getting aroused? You're thinking about temperature, texture, and pressure, the sensations. So every time your mind goes to something else, okay, how warm is my partner here, where I'm touching? What is the feel of the skin? Because you can't turn off the thinking brain, but you can turn it to something neutral so that the anxiety or the cortisol doesn't get released, which shuts down relaxation and sexual function.
Such a simple thing, but it works so amazingly well.
[00:07:02] Speaker B: I know, I know. And so for people listening, you mentioned spectatoring, and basically, that is, is when you feel like you're watching yourself from the third person, which, you know, historically, I think happened a lot with people who were worried about getting an erection or women who were worried about whether or not they would have an orgasm or people who felt concerned about the appearance of their body. And I think this day and age, in addition to spectatoring, we just have this, like, never ending chitter chatter in our heads because of our fast paced lives and the fact, you know, I always tell people, you cannot expect to multitask all day long, which we do now more than ever, to switch gears with the flip of the switch and focus on the singular act of sex and the sensations that it's giving you. And so I have always loved sensate focus, but I think it comes into play even more now just to quiet down the brain, which is busier than it ever has been. And, you know, this is going to be an audio recording. And so I know y'all couldn't see Linda folk, you know, pointing to the front part of her brain and the back part of the brain. She said, sex doesn't happen here, pointing to the front part of her brain. And that's the prefrontal cortex. That's where our rational thinking, decision making, planning, it's where the chitter chatter is happening constantly. And. And then you said, sex happens here, pointing more towards the back part of the brain. Our, you know, it's. It's nervous system, kind of this balance of activation and deactivation. It's that balance of calm and arousal that the chitter chatter really gets in the way of. And so sensate focus is such a valuable tool at helping quiet down the mind?
[00:08:43] Speaker C: Yes, actually, it's been seen as a form of mindfulness practice. And mindfulness practice is very big now because of just what you said, how chitter chattery and multitasking our life is. So consequently, we are more and more turning to ways to quiet the mind. And mindfulness practice, as well as meditation, are two that are very popular now. But mindfulness practice might be, or meditation might be focused on a sound, like a gong, or focused on something visual, like a flame. This is focused on sensation. Every time your mind wanders, you bring it back to sensation rather than to a sound. So it is a form of mindfulness practice meant to relax the body by getting the mind shut down, so that it's a nice, even non distractable, non evaluative tool. The idea is to turn off the mind and tune into the box.
[00:09:41] Speaker B: Exactly, exactly. And this is a process. I mean, I write about it a lot in this book I have coming out. I have a whole chapter on sensuality, and I really think sensate focus gives people the opportunity to take mindfulness a step further. So the way I think about it, you know, when you're practicing mindfulness, there's this awareness of the thoughts that may be trying to distract you, but you respond to them without judgment and let them pass and then draw your attention back to the sensations that you're experiencing. And I teach people not just to focus on touch, but even to lean in and take in their partner's smell or place their head on their chest and just listen to the sound of their breath or the beat of their heart. I mean, our bodies are this whole, like, you know, instrumental that's always playing. And so I think it, you know, does a lot to tune into that. But I think once you practice that, then you can switch to more embodied sex, which is when the mind doesn't really. It's not this bounce between the mind and body. It's more this fully embodied experience. And that's when the mind really, really goes quiet. And so I think sensate is an excellent tool at helping people move past mindfulness to get deeper into embodied sex.
[00:10:58] Speaker C: I like to say it's when I give people the initial instructions. I like to say to them, what we're looking for is a state of being in which your mind is turned off and you're totally in the flow of the experience. Similar to, and this is an example I use that people generally relate to, similar to, if you turn on the shower and you get the water just the right temperature, you lean your head back into it and you just kind of go, oh, yeah. Where you are not thinking. You are purely in the experience of that feeling in the moment without evaluation. And so that is the state of being that the mindfulness practice will hopefully bring you to that place where your mind is shut off completely. Because when, for example, you're having an orgasm, that's the state in which you are right. You're not thinking about, oh, I love my partner, about, gosh, this feels good. You're just experiencing.
[00:11:58] Speaker B: You're in it. There's a sense of merger. It's like you are the orgasm.
[00:12:02] Speaker C: Exactly. Yes.
[00:12:04] Speaker B: Yes.
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[00:12:53] Speaker B: Yeah. So what kinds of issues do you think sensate focus is most effective in treating? And what kinds of people do you think would benefit most from practicing it?
[00:13:04] Speaker C: So, you know, that's a good question. The number one problem in our culture right now for both men and women is the lack of sexual desire or interest, especially in long term partnered relationships. And I think that is because of the complications of life and social media and the attention it draws.
I think most of the people that I see come in because of a difference in level of desire or a lack of desire causing some stress in the relationship. But it's also great just for couples who want to rebond and slow down the experience and create more, because it does build up sexual tension. It's not entre per se, but it does. If you do this touching without having to move on to be sexual, it stores sexual tension so that when there is a release, it's more awesome, shall we say?
[00:14:06] Speaker B: Exactly.
[00:14:07] Speaker C: Also, it helps people who have had cancer or body image issues, people that have been sexually traumatized. It's a really exceptional tool to help them be in charge and re enter their body and have a new lived experience of pleasure in their body. So.
[00:14:25] Speaker B: And why. Why do you think that is that sensate focus in particular is so beneficial for people who have experienced either sexual trauma or just gone through the trauma of cancer? What do you think it is about sensate that helps them?
[00:14:38] Speaker C: I think what helps them is, like for a person who's a cancer survivor, the focus on making peace with your body, self acceptance, and that it still works and that other places that you might discover that are very sensitive, if, for example, you've lost the sensitivity in your nipples. So it can be very helpful in that way. For sexual trauma survivors, it's very helpful because they're relearning touch and they're relearning to honor their sexuality instead of finding it a frightening or triggering experience because they are totally in charge of. Of pacing and what happens and when it happens and they practice saying no, you know, for example, they got points for just getting through it. No, I don't give them points for just getting through it. No.
Right, right.
[00:15:32] Speaker B: Yeah.
Right.
Exactly. Yeah. Because I am of the mind that, you know, humans are hardwired, not of the mind. I mean, this is backed up in research that humans are hardwired for touch. And, you know, for people who have experienced touch in a traumatic way, I think sensate focus gives them the opportunity and the blueprint to rewire their body so that they can learn, again, how to have touch in a way that feels safe and gives them an opportunity for connection. I think especially for people who've been traumatized, there's so much disassociation that happens and you kind of leave your body because that's what you had to do to. To make sense or survive whatever it was that happened to you. And so this, I think, gives people the opportunity to really reconnect and ignite those pleasure pathways in a way that's safe and makes you feel comfortable and ultimately starts to build that arousal.
[00:16:32] Speaker C: Yes, I was going to say that even for couples, or might have said it, I don't know, even for couples who are seeking reconnection and don't have a sexual problem or trauma that they want to work through, maybe they've just simply drifted apartheid. And I guess I did say it, but anyway, I'm saying it again because it's an important point, very easy and very powerful experience.
[00:16:56] Speaker B: Absolutely. Absolutely. I love that. And the other thing I love about sensate is that it slows you down. You know, I think people hop into bed and they expect arousal to build within a matter of seconds, and then they feel frustrated when they're struggling to focus on sex or they're struggling to have an orgasm. I don't think we have sex for a long enough time to make it really good. You know, I draw a lot from flow state science, and flow is broken into four different stages, and the first stage is the struggle phase. It's where you're trying to focus. You might be flooded with a little bit of cortisol and stress hormones because you're making the transition from whatever it was that you were doing prior to trying to focus on this thing that, you know is going to be enjoyable. But I think when it comes to sex, that where a lot of people give up. And what I love about sensate is that we elongate the experience, and it gives people the time and space to move past the struggle phase and into the next stage, which is release, and then hopefully eventually into flow as. As you get more skilled in doing it.
[00:18:07] Speaker C: Beautifully said. Beautifully said.
[00:18:09] Speaker B: Yeah, yeah. So when I'm assigning sensate focus, a lot of times I will tell people not to talk or unless something is uncomfortable. And I'd love your take on that. Cause I think that people struggle to stay quiet when it comes to sex. And so what do you advise?
[00:18:26] Speaker C: Well, you know, if talking is evocative for people, you know, talk dirty to me or such like that, then that's it helps produce and build on arousal. But for most people, the talking is because they're nervous. So they might be giggling. Things are ticklish, they're talking and making jokes to create distraction because they're anxious.
And when you're talking, you're in the prefrontal cortex, not the part of the brain where sex happens, the primal part of the brain, which is the brain stem. So we want to be in the brain stem. Talking is going to get us. Now, if in the moment after there's a sexual problem that's resolved and you're starting to give each other information about what you do. Like, so, yeah, then, like, oh, I like that. Stay with that a little faster. You know, whatever gets your point across or your interest across, in sense. Eight, focus. One where we're trying to resolve a sexual difficulty, generally we don't want talking because that is a distraction. And often, as I said, a reflection of anxiety.
[00:19:38] Speaker B: Yeah, yeah. And I totally agree. I mean, I always tell people, just try to stay quiet unless something feels uncomfortable, then obviously speak up. And then, of course, course, you can debrief after the experience. But the other thing I love about quieting down is that it gives people the opportunity to start focusing on each other's nonverbal cues, which I don't think we do enough. I think that there is such an emphasis on communication skills, like verbal communication and sexual communication, and that's important. Don't get me wrong, I think that's a good first step. But I think everybody eventually would like to get to the point where they can move in synchrony and almost as one being, which doesn't happen when you're stopping to talk about every little thing.
[00:20:22] Speaker C: Yes, yes. In a sense, in focus, we do emphasize moving the partner's hand initially away from any place that's psychologically or physically uncomfortable. And the second phase is moving their hand to a place you'd like to explore.
And then the final phase is, oh, yeah, let me show you how I self stimulate or how, what I like, and you show me what you do and how you like it. And then we'll talk about it and we'll practice.
[00:20:52] Speaker B: Yes, yes. And I think what's awesome about that, too, is that it gives people the opportunity to discover new erogenous zones. I think so many couples, without realizing it, are guilty of just jumping straight to the genitals. When we have this, like, entire body that's covered in nerve endings. And, you know, when you start exploring it and learn to touch it in a way that feels good to your partner, you're doing a lot to build sexual arousal. And so it, it behooves people, I think, to just take a moment to slow down and explore the entire body.
[00:21:25] Speaker C: Indeed, I did want to get back to the idea that you had brought up that taking your time with sensate focus really helps couples, particularly females, because males are visually stimulated and all they might need to see is an orb, you know, even covered by clothing, and they start to become interested. I don't always say they get an erection. It depends on the age of the person and their medical condition. But psychological arousal happens for female bodied people. It often takes 20 minutes of tactile touch before they are. My saying is it takes 20 minutes of tactile touch. Misses Smith. Not misses Smith, but it takes 20 minutes of tactile touch before you are at a place where he is at the drop of a bra.
[00:22:22] Speaker B: Right at the drop of a bra. I love that.
[00:22:25] Speaker C: So it really is a helpful intervention with especially heterosexual couples.
[00:22:34] Speaker B: Exactly, exactly. The whole men are a microwave. Women are an oven it's true. Women just take a little longer to build arousal. And I think what I love about sensate is that there's some massage that's built into it. Of course, you can experiment with different kinds of touch, but most women like that. It helps them relax. I think women, you know, we were talking about the chitter chatter in the head. Women carry so much mental load that men. And again, we're talking about heterosexual couples here. So much mental load that men are not even aware of. And so it gives them the opportunity to move away from, you know, did I register my son for summer camp or did I sign my daughter up for ballet class and gives them an opportunity to start moving away from those thoughts that are constantly occupying the head and get them into their body. And so for any heterosexual couple listening, spend some time just massaging your partner and helping her relax, because she carries a lot all day long and needs your help in quieting down the mind.
[00:23:38] Speaker C: Absolutely.
[00:23:39] Speaker A: Yeah.
[00:23:40] Speaker B: Yeah. What is typical touch hierarchy? So what, what steps do you give people when they're working through sensaic?
[00:23:47] Speaker C: Okay, well, let me say that, you know, first you have to have a reasonable relationship together.
[00:23:53] Speaker B: That's important. We didn't talk about that, but, yeah.
[00:23:56] Speaker C: Where it feels safe enough. And sometimes a little couple's therapy around communication and fair fighting and all of that is necessary because what, the living room impacts the bedroom? The bedroom impacts the living room. So we have to say, you have to have not a perfect, of course, but see each other as on the same team.
[00:24:17] Speaker B: Okay.
[00:24:18] Speaker C: Rather than as opposing forces. So the first step depends on where, you know, what their history is and where they're at. Sometimes the first step is just lying together and cuddling. Yeah, sometimes the first step is a hand caress where you're in the living room so you don't have the bedroom issues or triggers. For people who have had some serious issues sexually, the bedroom can connote all kinds of things that we don't want to associate. But in general, they start with being nude together and using their hands and fingers, touching without breasts and genitals, every other part of the body except breasts and genitals, and making sure not to play brinksmanship, which tells you if we're playing brinkmanship with the breasts or genitals, then we have a couple dynamics that we have to stop and talk about and address. But in general, it takes about two sessions of your turn. My turn. I'm going to touch and be touched, focusing on temperature, texture and pressure in my body, both when I'm being touched. And when I'm touching and I'm going to practice bringing my attention back to my body, and my mind goes off to something else. And it generally takes a couple of times before the anxiety of that first step, which is kind of weird. People don't do that.
And the second step would be breasts and genitals get included as any other part of the body. It's not like, oh, now we're on the good stuff, and we're just going and work on the other person to get them aroused. Like our old way of interacting.
Then mutual touching, where you touch without breast and genitals touch mutually instead of your turn, my turn, but includes your turn, my turn. And then mutual touching first without breast and genitals. Then we include breasts and genitals again as any other part of the body.
Then generally, if the couple does practice insertion, we move first to genital to genital contact. And then if they practice insertion, we move to insertion, but in a slow, low, just feeling it. No urgency. No race to get to.
No worry about losing erection. No. You know, just enjoying. No, not enjoying. Experiencing. Okay. Enjoying is an evaluation. We want to get away from evaluations. So just experiencing what, for example, vaginal containment feels like and not moving. And then experiment with movement. First one and then the other, and then both. And beginning to communicate to one another. And the information that the 11th commandment, once the penis goes in the vagina, it has to stay there. It is. I don't abide the 11th command.
We can play around in other ways and then start again. That part of it is what triggers orgasm is stimulation from two places, at least two places at the same time with something novel happening. So like a different movement or a word in the ear or a change in position.
[00:27:46] Speaker B: Yeah, yeah. What is your advice for people who are hearing this and thinking, this sounds so awkward, I would never do it.
[00:27:54] Speaker C: I want to tell you that whatever you do that's different for the first time feels really awkward.
[00:28:00] Speaker B: Amen.
[00:28:03] Speaker C: And that, you know, here's the deal. Awkwardness passes amazingly.
[00:28:08] Speaker B: Amen.
[00:28:10] Speaker C: So the hardest thing for a sex therapist is having clients do the first touching. And the reason is that it's very awkward. They managed to avoid it for a long period of time, quite often, and they're very practiced at avoiding. And so. So it takes a bit of encouragement to have people give it a try.
[00:28:30] Speaker B: Yes, yes, I. Same to all of that. I mean, because I get that remark all the time, and I'm like, you go into it expecting it to feel awkward because I'm instructing you to interact in a way that you either have never done before or that you haven't done in a long time. And I love giving, like, a snow skiing analogy. I grew up skiing, but then, like, I don't know, ten years had gone by since I had skied. And I remember the first time I put my ski boots on, I was like, like, clunking around, feeling so awkward. I was nervous the first time I got on the chairlift. You know, everything felt uncomfortable. But I didn't let that stop me because I knew eventually the fun would kick in, and it did. And the same applies to sex. This is gonna feel a little bit awkward or, you know, know that if you start laughing or get giggly, it's probably just nervous energy leaving the system and to focus back on the breath and let it pass. And that's where the mindfulness, I think, comes in, too. Just noticing it without judgment or reaction and then tuning back into the body and continuing the process.
[00:29:33] Speaker C: Yes, because we all get distracted and we all have difficulty. I liken it to the difficulty we sometimes have getting to sleep. You know, that we all go through phases of sleeping more deeply. Some people are lucky, and I know some people don't get very deeply most of the time. There's variation in our sleep that we accept, but our ability to tune in and tune out the brain and tune into the body does vary from occasion.
[00:30:06] Speaker B: To occasion totally, and through just different seasons in life. You know, I think for couples who have young kids at home or when careers really take over, it's hard to shut all of that out in a way that really gives you the opportunity to fully concentrate and immerse yourself in the experience. And sensate is, you know, it's not just for people who are experiencing ed or difficulty with orgasm or some kind of, you know, sexual difficulty.
[00:30:33] Speaker C: It's.
[00:30:33] Speaker B: It's really, I think, a great reset. Like you were saying, for couples who have disconnected and need to learn to tune back into one another when you.
[00:30:42] Speaker C: Have a three month old and a three year old. Right.
[00:30:47] Speaker B: Yeah.
[00:30:49] Speaker C: It does take some doing to plan the time when you can do this. And so fun things some couples do that have the resources to do it is go to a hotel, get a babysitter, and go to a hotel.
[00:31:04] Speaker B: Staycation. Yes, that's right.
[00:31:07] Speaker C: I love those.
[00:31:07] Speaker B: I love those. Well, Linda, thank you so much for joining me today. It's so nice connecting with you, as always. Where can people learn more about you and find your book about sensate?
[00:31:18] Speaker C: Okay. Well, my book is called Sensate Focus and sex therapy, the illustrated manual, and it goes through the steps of sense aid focus that I've described for various sexual difficulties and different populations, including how it might be modified for LGBTQI couples. So my website, www. Dot sexterapist St. Louis, that's stlouis.com, is also a great resource and I have some blogs there that people might find of interest.
[00:31:55] Speaker B: Awesome. Awesome. Well, I will be sure to link everything in the show notes so it's easy to find. Again, thank you for joining me and I hope we can reconnect again soon.
[00:32:04] Speaker C: Okay, thank you very much. Bye now.
[00:32:06] Speaker B: Bye.
[00:32:07] Speaker D: Thanks again for listening to love in Libido with me, your host, doctor Emily Jamia. If you enjoyed today's episode, be sure to subscribe and drop me a five five star review. Positive ratings help keep the show going. Don't forget to visit mlajamia.com to see how you can access dozens of free bonuses when you purchase my new book, Anatomy of Desire, currently available everywhere books are sold. Additionally, you can follow me across all the social media channels at Dremelie Jamia. Thank you for listening.
