Sensory Focus in Integrated Occupational Therapy
Integrated Mansionale Therapy (TMI), through the application by patients of the tasks prescribed by the therapist, allows to face the problems, resistances and beliefs that can give rise to the different dysfunctions of sexual behavior and offers the possibility to discuss and evaluate the improvements and targets achieved.
Arianna Ferretti – OPEN SCHOOL, Cognitive Studies Modena
The term “sexual duties” refers to specific techniques relating to Integrated Occupational Therapy (IMT). These are, in principle, prescriptions of sexual behavior which represent one of the fundamental points in sexual therapy and which can be assimilated to real homework. In fact, through the application, by the patients, of the tasks prescribed by the therapist it is possible to understand and have the opportunity to face the problems, resistances and beliefs that can give rise to the different dysfunctions of sexual behavior and also offers the possibility to discuss and evaluate the improvements and targets achieved. It is not, therefore, spontaneous acts of the couple,
A sexual task is composed of micro-objectives agreed with the patient, is proposed and built with the patients themselves according to the reported problem and the therapeutic objectives stipulated. The aim is not to provoke sexual pleasure, even if it can happen, but to encourage the therapeutic process (Fenelli and Lorenzini, 2014) and to create the conditions to guide the couple towards the exploration of sexuality.
The prescription, therefore, is made at the end of the session and it is necessary that it is clear and that it is explained, spontaneously and in detail, to the couple. It is therefore necessary that the therapist is not afraid or prejudiced or has outstanding accounts with his sexuality (Kaplan, 1976). Once explained, the couple is asked if there are questions or unclear aspects, their real feasibility is checked and possible difficulties are analyzed. It can be a more or less flexible prescription. For Masters and Johnson (1970) it was usual to apply sexual duties in a rigid and protocolary way, while Kaplan (1976) began to flexibilize and make more dynamic the various steps of the occupational therapies according to the characteristics of the patients, the phase of therapy and the agreed goals.
Each sexual therapy is characterized by the presence of four fundamental phases, which act as a “compass” also within the occupational techniques prescribed by the therapist:
Each of these phases takes into account the behavioral, cognitive and relational component:
Table 1. The four phases of behavioral, cognitive and relational sexual therapy
So it is essential to work, in the first instance, on the hardships and resources of the individual and then gradually focus on the couple. Often patients show a tendency to want to speed up this process by taking for granted aspects that, during the session, are necessary for a deeper study and which aim at increasing the awareness of the patient.
Among the most well-known job theories and used in therapy is Sensory Focus invented by Master and Johnson in 1970 on the occasion of their numerous and precious studies on sexuality and sexual therapy. Some therapists prefer the term “pleasuring” which has also been used by the Masters and Johnson themselves in the scientific literature on the subject. In the sensory focus, the couple decides to give up having sexual intercourse, and consequently orgasm, for days and weeks. This sexual task is prescribed by the therapist after an accurate medical history, the definition of the problem in the sexological field and the stipulation of the therapeutic objectives. This prescription is made only when it is specifically indicated in the treatment of sexual dysfunctions found. It is a particularly suitable and effective technique in male and female arousal disorder and for male and female orgasm inhibitions (Seal & Meston, 2018). The mechanism of action of the sensory focus is based on the reduction of tension that occurs during sexual intercourse. Ultimately the partners free themselves from beliefs and deviations that can compromise the quality of sex. A typical example of thinking that does not help the man with erection maintenance problems can be “This time I have to do it”, while a typical woman’s thought can be “I have to commit myself to being able to keep him erect”. Through sensory focus, neither of them has an obligation or duty to maintain and / or cause an erection and there is no type of pressure or anxiety. If we take learning theory into consideration, it is understandable how this presupposition can create the roots for the extinction of emotions, such as anxiety, which disadvantage sexual intercourse. With this job technique, a sense of relaxation and looseness is favored in men and women, which gradually decrease and dissipate the anticipatory anxiety that often acts as a warning of a possible failure. Consequently, the positive sensations and emotions aroused by the various steps that characterize the sensorial focus, act as real reinforcements and impact on sexual well-being. There are two types of sensory focus: I and II.
In this phase the therapist, with clear and precise prescriptions, asks the couple not to have any type of sexual relationship and makes sure of the patients’ point of view before closing the session. He therefore asks the couple to look for a suitable time and space and, after trying to let go of any kind of concern other than sexual matters, gives them the indication to take a shower and go to sleep without clothes on. He also requests that they caress each other, defining in session who will start first, and specifying that it is essential that the erogenous and / or genital areas are not touched and / or caressed. Caresses it is important that they are as gentle and tender as possible and that they go to explore each other’s areas of the partner’s body: starting from the nape of the neck, to go from the back to the feet. The partner who receives the caresses has the task of placing awareness solely on their feelings. It is important that you do not worry, for example, that your wife may get tired or bored and that you “get lost” on your bodily sensations. It is essential that the partners communicate any annoyances or excitement points discovered during the job, so that they can understand what the other likes so that they can replicate it in subsequent sessions and outside therapy. Sensory focus I ends when the partners feel totally satisfied. that the wife can get tired or bored and that she “gets lost” on her own bodily sensations. It is essential that the partners communicate any annoyances or excitement points discovered during the job, so that they can understand what the other likes so that they can replicate it in subsequent sessions and outside therapy. Sensory focus I ends when the partners feel totally satisfied. that the wife can get tired or bored and that she “gets lost” on her own bodily sensations. It is essential that the partners communicate any annoyances or excitement points discovered during the job, so that they can understand what the other likes so that they can replicate it in subsequent sessions and outside therapy. Sensory focus I ends when the partners feel totally satisfied.
Sensory focusing II is usually subsequent to sensory focusing I, although in some cases treatment can begin by assigning this task already. The therapist in this phase gives precise and detailed instructions regarding the bond of genital pleasure and specifies that the goal is not to reach orgasm, but to produce excitement. Ultimately the prescription is to caress the partner’s body all over the place with the specific intent of bringing it to excitement. The couple are asked to observe the interaction between the two and all the same indications of sensory focus I are provided (awareness of bodily sensations and not of performance). For example, in the specific case of an erection deficit,
At the end of focus I and II, the therapist will ask the patients for the details of every aspect encountered during the job. This aspect is crucial since it encompasses both the positive aspects, which can act as positive reinforcement for subsequent sessions, and the negative ones which, consequently, can allow you to make the necessary changes to be applied during the course of therapy.