An investigation into psychodynamic couple psychotherapists' theories of 'sensate focus' in clinical practice

Abstract

Since 1948, psychodynamic couple psychotherapy has treated sexual problems through the mind by using psychoanalytic, principally Kleinian theory to interpret partners' unconscious interaction. By contrast psychosexual therapy attempts to improve sexual relationships through the body, often using a behavioural programme of touching exercises known as “sensate focus” (Masters and Johnson, 1970b, p. 67). Remarkably a number of psychodynamic couple psychotherapists now incorporate sensate focus in their clinical work, combining these two seemingly incompatible approaches. Little is known about how these ‘dual’ psychotherapists think about integrating the two paradigms. This study sought to understand how these practitioners theorise their use of the exercise programme in couple work and thereby address this gap in the current field of knowledge. A qualitative methodology, including data analysis through interpretative phenomenological analysis (IPA), was completed with 10 participants in order to explore this under-researched area. Four superordinate themes with 14 subordinate themes were generated. Superordinate themes were: accessing anxieties about sexuality; facilitating couple development; working with possible manifestations of aggression; and challenging couple psychotherapists. The discussion of the results highlights psychoanalytic theories, mostly Winnicottian, informing participants’ perceptions of couples’ responses to sensate focus, the value that this intervention adds to the talking therapy, and participants’ assessments of contraindications for its use. The question as to whether there might be a ‘home’ for sensate focus within psychoanalysis is debated. It is proposed that the bodily intervention might be viewed as “interpretive action” (Ogden, 1994, p. 220). The study also indicated that participants had significant concerns about the inadequacies of professional trainings. These concerns included the avoidance of sex in psychotherapy and the teaching of sensate focus as a predominantly behavioural programme, universally applied to clients without due regard to its emotional-relational impact on partners. Finally, the study’s limitations are discussed and recommendations for action are offered.