Create a presentation that highlights some of the basics of sex therapy. Be sure to gear this presentation toward MFT internship students that are thinking about increasing their skills and understanding of sex therapy.
Be sure to address the following key points in your PowerPoint:
Describe sex therapy.
Define at least four sex therapy models or approaches and describe how these can be applied when working with relationships.
Discuss how one MFT model could address sex therapy.
Sage Reference
The SAGE Encyclopedia of Marriage, Family, and
Couples Counseling
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Author: Quintin A. Hunt, Matthew Nelson
Pub. Date: 2016
Product: Sage Reference
DOI: https://doi.org/10.4135/9781483369532
Keywords: touch, sexual dysfunctions, sensation, anxiety, breast, sex, equal time
Disciplines: Counseling & Psychotherapy, Counseling Setting / Client Groups, Theory & Approaches,
Relationship Counseling, Family Therapy
Access Date: July 28, 2023
Publishing Company: SAGE Publications, Inc
City: Thousand Oaks
Online ISBN: 9781483369532
© 2016 SAGE Publications, Inc All Rights Reserved.
Sage
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© 2017 by SAGE Publications, Inc.
Sensate focus refers to a technique therapists and counselors employ to help couples experiencing certain
types of sexual dysfunction build trust and reduce their anxiety. It involves nondemand touch (touch that is not
meant to be sexual or produce orgasm). Many people struggling with sexual issues in their relationship will
have experienced numerous failed sexual experiences over time, and each of these creates anxiety. Such
anxiety can interfere with the sexual relationship and the ability to become aroused or achieve orgasm. Sensate focus exercises are meant to pair touch, and eventually sexual behaviors, with relaxation rather than
anxiety. The exercise involves couples taking turns touching and massaging each other, without having the
pressure of being sexual or having an orgasm. In the beginning stages they are not allowed to touch breasts
or genitals, and the goal is to relax and communicate to the partner what feels good or does not feel good.
Over time the couple builds up to more sexual touch.
The aim of sensate focus is to build trust between couples, allowing them to explore giving and receiving pleasure. The emphasis is on positive emotions, feelings, and sensations while reducing any negative responses.
The technique allows for feedback from each person in the couple and allows for a great deal of flexibility
in how it is presented and when a couple moves through the various stages. The stages themselves can be
modified as needed to adapt to the needs of each couple. In the sections that follow, the history and rationale
for sensate focus, the process of sensate focus, and possible challenges are discussed. The entry concludes
with a discussion of the elements necessary for success in sensate focus and the benefits of the technique.
Origin of Sensate Focus
The sensate focus technique originated from work by William Masters and Virginia Johnson in the 1960s and
1970s. Their technique was further refined by Helen Singer Kaplan, a sex therapist and professor of psychiatry who held doctorates in both medicine and psychology. Over time this process has evolved and has
become a standard practice for those practicing sex therapy. Originally Masters and Johnson would focus
on the individual patient who was presenting with the sexual dysfunction and using the partner as a type of
cotherapist at home to process the dysfunction. Systemically it is helpful to work with both partners equally,
as both are influenced by problems in the sexual relationship and the other partner may have developed behaviors and beliefs that feed into sexual problems.
The Concept of Sensate Focus
The idea behind sensate focus is that underlying anxiety prevents couples from experiencing arousal and
orgasm with one another. Basically, anxiety interferes with sexual functioning and sexual pleasure with a partPage 2 of 7
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ner. It is not uncommon that partners experiencing these sexual difficulties will have little problem performing or enjoying sexual experiences either alone or outside of the marriage—but by no means is this always
the case. The purpose of sensate focus is to help couples enjoy touching one another without the anxiety
response that has been conditioned into their pattern and interferes with their sex life. Sensate focus is commonly used to treat issues of deficient sexual desire, difficulty in achieving sexual arousal or erectile dysfunction, and difficulty in reaching orgasm.
Therapeutic Use of Sensate Focus
Many therapists enjoy assigning homework, but for homework to be successful it should make sense to the
couple and be clearly explained. If poorly explained and executed, the incorporation of sensate focus into couples’ treatment can appear as a pointless assignment or do harm to the couple’s relationship. Poorly preparing and assigning sensate focus to clients may reinforce the conditioned anxiety. Clients typically respond
well when the purpose and point of sensate focus are explained to them. The purpose is to enjoy touching
one another, not orgasm. Once couples enjoy touching and being touched by one another, the orgasm will
occur in later stages.
There is no one right way to introduce or to implement sensate focus. Some clients will move through the
steps with ease, while others will have anxiety triggered by the mere thought or discussion of sensate focus
exercises. Generally, there are two major sections of this process: sensual and sexual. The assignments,
however, should be gradual and require satisfactory completion of each step before moving to the next step.
This helps to ensure the clients’ comfort level and allows the clinician to assess for sexual anxiety.
Pressure and anxiety are two roadblocks to successful sexual encounters for many couples. The process of
sensate focus should allow those feelings to be lowered, and an atmosphere of comfort and trust should be
created. The point of the exercise is not to have sexual orgasm as the goal; it is to be aware of sensations
that occur when being touched. Not infrequently couples report failing the assignment as they proceeded to
intercourse or orgasm rather than waiting. Each of these responses, as well as any others, can be used to
further understand and focus further treatment.
Typically, couples are encouraged to participate in the activities two to three times a week as time permits.
Each sensate focus session should include uninterrupted time that is disconnected from electronics, pets,
children, or other distractions. Each partner should have equal time as the partner touching and the partner
being touched. The amount of time is dependent on how much time is available but should be somewhere
between 10 minutes and 1 hour, based on availability of each partner. At the start of each turn a timer should
be set so that there is no subjective interpretation of how much time has passed.
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The couple take turns touching and caressing one another; they can alternate who initiates the touch. The
couple should have a space that is pleasantly lighted and at a comfortable temperature, as the clients will
remove as much clothing as they feel comfortable with. Here is another area where flexibility is important, as
some individuals may have body image issues that they are working to overcome. Alcohol and recreational
drugs should be avoided before and during the activity because they are likely to interfere with the process of
feeling sensations. In general, there are five stages to sensate focus practice:
1. Touching and caressing with no breast touching
2. Touching and caressing including breasts but no genitals
3. Touching and caressing including genitals
4. Mutual touching including insertion (fingers or toys) but no intercourse
5. Intercourse but not orgasm
The clinician explains at the onset of the intervention that sexual intercourse and sexual activity should be
avoided. The rationale is that by removing sexual activity performance, pressure is removed, and a nondemand atmosphere is created, and each person can feel more relaxed. The pressure to have sex can deter
from the process and is often the root of much of the anxiety experienced. The initial stage has the couple
find a comfortable place to engage in the touch exercise. They avoid touching the breasts and genitals and
focus on the feeling, pressure, and temperature. This touching should be done by the hands and fingers only,
with no kissing or full body contact. All areas of the body, except those off limits, should be explored. The
focus should be on the sensations of touch, pressure, and temperature. If anxiety arises, the individual should
refocus on the touch sensations and move on to a new part of the body. The touch should be long enough
that the awkwardness is overcome but short enough that the partners do not get bored or tired. Each partner takes turns throughout the session performing both roles of toucher and being touched. If the one being
touched feels physically uncomfortable, he or she can redirect the partner away nonverbally or by placing a
hand over or under the partner’s hand and guiding to a new area.
Steps one through three focus on the sensual nature of touch, while the last two gear more toward sexual
touch. It is important to remember through each step that sexual intercourse and orgasm are not the goal;
rather the goal is to increase understanding and awareness of one’s own body and sensations.
How to Have Success With Sensate Focus
The important keys of having success with sensate focus revolve around the level of comfort the couple are
able to experience. The more that the clinician is able to explain the process and allow the clients to feel comfortable, the more likely success will happen. The clinician also needs to be aware of the level of readiness
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of the clients. A thorough assessment of the couple’s skills and levels of communication will be helpful, as
any perceived failure with sensate focus will impact the couple’s level of marital satisfaction. As part of the
exercise, it can be helpful for the clients to have sofa sessions. These consist of a debriefing of sorts for the
couple to share their experiences and to listen to their partner’s experiences. The clients expand their communication about what they are feeling and respond to their partner.
It is essential that each partner have equal time in each role. When being touched, the partner being touched
should focus on the experience and being mindful of how things feel. The partner being touched is not in
control of the experience but is encouraged to express what is enjoyed. A prepared list of basic expressions
can be provided to the couple to assist in directing the touching partner: yes, no, harder, softer. These expressions are best delivered after completing the activity in the debriefing time. This allows for questions in
a nonjudgmental way. The strength of sensate focus lies with the openness of the concept. Clients are able
to stretch their comfort zones and learn to explore pleasure in a nonperformance demanding way. In the later
stages as the couple has progressed, the clinician may suggest adding lotion or other objects to change the
touch dynamics. A few of these might include feathers, ice cubes, or soft fabrics. This is dependent upon the
couple’s level of comfort and the ultimate goal of the relationship.
Benefits of Sensate Focus
Sensate focus is a directly applicable intervention that can help couples reduce their anxiety with one another
and help couples learn to communicate about their wants and desires in a nondemanding way. The patterns
of communication in failed sexual experiences are extremely predictive of the patterns of communication that
couples experience when in distress.
Sensate focus can be used as a diagnostic tool to determine a couple’s readiness to commit to therapy and
their levels of communication outside the therapy room. Many people are uncomfortable saying what they
want or like from their partner, both in and out of the bedroom. Sensate focus helps the couple learn reciprocal connection that is focused on pleasing each other. These skills can directly be applied to much more than
just the bedroom, but like sensate focus, they work well only when each partner works to please the other.
Sensate focus is not just an intervention used by couples that are struggling to enjoy sensual and sexual experience with one another, it can also teach couples how to do foreplay. Sex is not simply a matter of getting
to orgasm as quickly as possible; it can also be about pleasure and enjoying being pleasured sensually and
sexually.
Quintin A. Hunt and Matthew Nelson
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See alsoAnxiety; Couples and Marriage Counseling; Homework Assignments in Therapy; Mindfulness; Sex
Therapy; Sexual Enhancement, Sexual Toys; Sexual Intimacy; Sexuality Education
Further Readings
Coren, C. M., Nath, S. R., & Prout, M. (2009). Computer-assisted sensate focus: Integrating technology
with sex therapy practice. Journal of Technology in Human Services, 27(4), 273–286. doi:10.1080/
15228830903329823
De Villers, L. (2014). Getting in touch with touch: A use of caressing exercises to enrich sensual connection
and evoke ecstatic experience in couples. Sexual and Relationship Therapy, 29(1), 87–97. doi:10.1080/
14681994.2013.870336
Gupta, P., Banerjee, G., & Nandi, D. N. (1989). Modified Masters Johnson technique in the treatment of sexual
inadequacy in males. Indian Journal of Psychiatry, 31(1), 63–69.
Joanning, H., & Keoughan, P. (2005). Enhancing marital sexuality. The Family Journal, 13(3), 351–355.
doi:10.1177/1066480705276194
Kaplan, H. S. (1974). The new sex therapy. New York: Brunner/Mazel.
Masters, W. H., & Johnson, V. (1970). Human sexual inadequacy. Boston: Little, Brown.
McAnulty, R. D., & Kazdin, A. E. (2000). Sex therapy. In Encyclopedia of psychology (Vol. 7, pp. 328–241).
New York: Oxford University Press.
Regev, L. G., & Schmidt, J. (2008). Sensate focus. In W. T. O’Donohue & J. E. Fisher (Eds.), Cognitive behavior therapy: Applying empirically supported techniques in your practice (pp. 486–492). Hoboken, NJ: Wiley.
Van Hasselt, V. B., & Hersen, M. (1996). Sourcebook of psychological treatment manuals for adult disorders.
New York: Plenum Press.
Weeks, G. R., & Gambescia, N. (2009). A systemic approach to sensate focus. In K. M. Hertlein, G. R. Weeks,
& N. Gamescia (Eds.), Systemic sex therapy (pp. 341–362). New York: Routledge.
Weiner, L., & Avery-Clark, C. (2014). Sensate focus: Clarifying the Masters and Johnson’s model. Sexual and
Relationship Therapy, 29(3), 307–319. doi:10.1080/14681994.2014.892920
Wiederman, M. W. (2001). “Don’t look now”: The role of self-focus in sexual dysfunction. The Family Journal,
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© 2017 by SAGE Publications, Inc.
9(2), 210–214. doi:10.1177/1066480701092020
• touch
• sexual dysfunctions
• sensation
• anxiety
• breast
• sex
• equal time
Quintin A. HuntMatthew Nelson
https://doi.org/10.4135/9781483369532
Page 7 of 7
The SAGE Encyclopedia of Marriage, Family, and Couples Counseling
International Journal of Transpersonal Studies
Volume 38
Issue 1
Article 14
9-1-2019
Erotic Mindfulness: A Core Educational and Therapeutic Strategy
in Somatic Sexology Practices
Marie I. Thouin-Savard
California Institute of Integral Studies, San Francisco, California, USA
Follow this and additional works at: https://digitalcommons.ciis.edu/ijts-transpersonalstudies
Part of the Other Feminist, Gender, and Sexuality Studies Commons, Philosophy Commons,
Psychology Commons, and the Religion Commons
Recommended Citation
Thouin-Savard, M. I. (2019). Erotic mindfulness: A core educational and therapeutic strategy in somatic
sexology practices. International Journal of Transpersonal Studies, 38 (1). http://dx.doi.org/
https://doi.org/10.24972/ijts.2019.38.1.203
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This Special Topic Article is brought to you for free and open access by International Journal of Transpersonal
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administrator. For more information, please contact the editors.
Erotic Mindfulness:
A Core Educational and Therapeutic Strategy
in Somatic Sexology Practices
Marie I. Thouin-Savard
California Institute of Integral Studies
San Francisco, CA, USA
Somatic sexology modalities such as sexual surrogacy, sexological bodywork,
masturbation coaching, and orgasmic meditation have shown significant potential
for helping individuals transcend sexual difficulties and grow into more fulfilling
erotic lives. The use of an embodied state of consciousness similar to neo-traditional
forms of mindfulness meditation may be a common factor contributing to therapeutic
efficacy in a variety of somatic sexology methods. Comparing the structure of
three somatic sexology modalities—sexual surrogacy, masturbation coaching, and
orgasmic meditation—with recent evidence supporting the efficacy of neo-traditional
mindfulness practices in promoting women’s sexual wellbeing reveals that somatic
sexology practitioners use embodied mindfulness as a strategy to set aside mental
activity and invite their clients to feel, act, and interact with their sexuality from an
embodied state of attention. This embodied state, when focused on one’s eroticism
and sexuality, will be referred to as erotic mindfulness. The paper closes with a
commentary on the potentially significant impact of using erotic mindfulness in sex
therapy and education, and suggests avenues for further research.
Keywords: Holistic sexuality, somatic sexology, embodied mindfulness,
erotic mindfulness, sexual surrogacy, masturbation coaching, orgasmic
meditation, sexological bodywork
I
s there a place for the body in sex therapy? This
question titled a 2011 editorial of the Sexual
and Relationship Therapy journal, as its editorin-chief Alex Iantaffi pleaded with sex therapists
and educators to explore and expand the research
evidence for bringing embodied practices back into
the therapy room. As he explained,
I have been struck by the possibilities that being
present to the body can open up within the
therapy room, especially when dealing with
sexuality and relational issues. Yet, most of the
current literature does not seem to address the
applicability of sensorimotor therapy or somatic
healing to sex therapy. (Iantaffi, 2011, p. 1)
His voice echoed many others (e.g., Barratt, 2010;
Kleinplatz, 1996; Tiefer, 2006; Ventegodt & Struck,
2009) asking that clinical sexology’s “resistance to the
humanistic programme [be] addressed” (Tiefer, 2006,
p. 371), both in order for somatic and experiential
modalities to reclaim the space they once held, and
for them to resume their development within the field.
Indeed, in the 1970s, the popularity
of humanistic psychology brought forward
great interest in “new forms of psychotherapy
(e.g., Rogerian, existential, Gestalt, body- and
movement-centered) that focused on growth and
fulfillment, unconditional positive regard, staying
in the present, feelings and consciousness, and a
holistic body-mind view” (Tiefer, 2006, p. 362).
This movement supported the advent of many
somatic sexology modalities, or teaching by doing
approaches, such as orgone Reichian therapy
(Nelson, 1976), the use of surrogate partners (Wolfe,
1978), and the practices of nudism, body imagery
work, and sexual contact with clients (Hartman &
Fithian, 1974). These practices involved a spectrum
of experiential activities from using nudity to teach
Erotic
Mindfulness
International
Journal of Transpersonal Studies, 38(1), 203–219
International Journal of Transpersonal Studies 203
https://doi.org/10.24972/ijts.2019.38.1.203
self-acceptance, masturbation coaching, one-way
touch from therapist to client, and two-way touch.
The main premise for using somatic modalities
in therapeutic settings is that powerful emotions such
as shame, guilt, disgust, anger, helplessness, and fear
are in some sense stored within the body, particularly
in the tissues of pelvic and sexual organs as tension
and pain (e.g., Ventegodt, Morad, Hyam, & Merrick,
2004) and therefore often remain out of reach for
pharmaceutically oriented cures and talk therapy.
Sex therapist Jack Morin (2006) observed, “Some of
my clients’ issues would take years or might never
be resolved by standard non-touching therapy.”
The therapeutic efficacy of somatic modalities, in
contrast, seems to reside in the process of attunement
and presence with the body itself; in a safe and
ethical context, this process appears to support
the release and integration of painful emotions and
trauma (Moore, 2017; Ventegodt, Clausen, Omar, &
Merrick, 2006). Furthermore, the direct experience of
one’s eroticism outside of performance expectations
and relational narratives habitually associated with
sexual contact (e.g., striving to perform specific
roles or activities in order to satisfy someone else)
can, in itself, be a source of deep freedom, selfdiscovery, and empowerment (Jesse, 2017). Somatic
sex educator Cassie Moore (2017) exemplified this
through her own experience of somatic healing with
a sexological bodywork practitioner:
I experienced trauma in my early childhood, and
despite extensive counseling and a lifetime of
attempts to move towards health, I still carried
a deep sense of sorrow and brokenness in my
body, and a profound sense of shame. . . .
Through guided touch, words and presence, I felt
a huge, unexpected sense of release of sorrow
and shame, and a shifting toward safety and
wholeness. . . . I experienced my voiced needs
being acknowledged, honored and met, and it
was deeply restorative and transformative for
me. I know that this level of change would not
have occurred in a more traditional therapeutic
container. The element of compassionate, safe
touch that included my sexual body, guided fully
by me, provided a unique and powerful context
for repair. (Moore, 2017, pp. 3–4)
204 International Journal of Transpersonal Studies
This testimonial, along with many others, portrays
the non-judgmental witnessing and validation of
someone’s unscripted erotic expression as key to
the therapeutic alliance between somatic sexology
educators and clients.
As with most healing modalities involving
a strong relational and even spiritual component
(e.g., Reiki), somatic sexology practices challenge
the general classification and validation structures
of the current scientific model. They blur the lines
habitually drawn between therapy, education,
and spiritual practice by addressing eroticism
as a holistic phenomenon, instead of a purely
physiological, cognitive, and behavioral one. Also,
the experiential and often multifaceted nature
of those methods (blending emotional, physical,
and spiritual dimensions into erotically-focused
practices) challenges the binary between sexual
function and dysfunction, which is foundational to
the field of sexology (see Masters & Johnson, 1970).
Often, clients seek out experiential methods not only
to remedy their sexual problems, but also to explore
their erotic potentials (Kleinplatz, 1996) and unravel
transformation into various aspects of their life, such
as improvements in physical health and relationship
satisfaction (Resnick, 2004). The fact that somatic
sexology modalities are holistic in nature and thus
function outside the mainstream medical model
of sexual health has resulted in a lack of empirical
research in these areas. This, along with the ethical
and legal risks associated with sexually-oriented
touch (see Tiefer, 2006), brought the American
Association of Sexuality Educators, Counselors and
Therapists (AASECT) to explicitly ban touching or
nudity in treatment in 1978, and professional sex
therapy became limited to talk therapy, along with
pharmaceutical and behavioral approaches.
However, nudity and touch in sexual
therapy and education never entirely disappeared.
Today, such practices still exist, however within an
ambiguous legal and professional framework. For
example, sexual surrogacy, sex and masturbation
coaching, and various erotic embodiment workshops remain available to the public, though they
are not reimbursed by medical insurance plans
as their pharmaceutical and cognitive-behavioral
counterparts often are—thereby restricting their
Thouin-Savard
reach to small, economically privileged audiences.
Therefore, there is a compelling need to look at
somatic sexology through an expanded scientific
lens that privileges therapeutic efficacy over
culturally based assumptions around sexuality.
Modes of sexual therapy and education vary
widely across nations and cultures (e.g., Wylie &
Weerakoon 2010), and there is much to learn from
countries where certain somatic modalities are more
commonly viewed as legitimate practices, such as
Israel, where sexual surrogacy is legal and accepted
(Rosenbaum, Aloni, & Heruti, 2014). Additionally,
while empirical research on somatic sexology
modalities is sparse in the United States at this time,
there is a growing body of scientific literature from
Denmark supporting the use of those modalities to
address a wide range of sexual problems in clinical
settings. Practices involving genital touch from
practitioners, such as acceptance through touch
and vaginal acupressure, have been shown to help
patient with sexual pain disorders, vulvar vestibulitis
syndrome, vaginismus, and dyspareunia (Ventegodt
et al., 2006; Ventegodt & Struck, 2009), vulvodynia
(Ventegodt et al., 2004), and even severe anxiety
linked to sexual abuse in childhood (Ventegodt,
Clausen, & Merrick, 2006). Additionally, Danish
researchers have found masturbation coaching to be
highly efficacious in helping women suffering from
anorgasmia. In a study conducted with a sample
of 500 anorgasmic women in Denmark, 93% of
participants experienced success in achieving
orgasm through masturbation coaching (see more
detailed presentation of the study on p. 8; Struck &
Ventegodt, 2008).
Understanding what makes such practices
potentially healing and transformative may support
further research in these areas. A nascent strand
of empirical research on embodied mindfulness,
including a series of studies connecting mindfulness
practice with sexual satisfaction in women, suggests
that the state of attention associated with the
practice of embodied mindfulness might be the core
experience that yields efficacy to somatic sexology
methods in fostering transformation and healing.
Juxtaposing recent evidence of the efficacy of
neo-traditional mindfulness-based stress reduction
techniques (MBSR; e.g., Kabat-Zinn, 2003a, 2003b)
Erotic Mindfulness
in controlled clinical studies with the structure of
several somatic sexology practices (including nonclinical ones), it appears that somatic sexology
practitioners use a process similar to embodied
mindfulness as a strategy to set aside mental activity
and invite their clients to feel, act, and interact with
their sexuality from an embodied state of attention
that can be described as erotic mindfulness.
In the following section, pertinent literature
on the effects of embodied mindfulness practice is
reviewed, including that which relates specifically
to sexual function and arousal. Then, three
categories of somatic sexology practices—sexual
surrogacy, masturbation coaching, and orgasmic
meditation—are described and shown to rely on
the working principle of erotic mindfulness.
Embodied mindfulness
any definitions of the terms embodiment and
mindfulness exist in the psychological literature (e.g., Glenberg, 2010; Schubert & Semin, 2009).
In this paper, embodied mindfulness is defined
from the perspective of somatic phenomenology.
Somatic phenomenology as described by Hartelius
(2007, 2015) has depicted states of consciousness
in relation to one’s attentional posture—referring
to where the attention is felt to be coming from
within the body of the subject (i.e., their egocenter),
rather than what the subject’s attention is pointing
at. The premise is that one’s state of consciousness
is affected by where one’s attention is coming
from (e.g., the head, the heart, or the lower belly)
as well as by other dimensions of their attentional
stance (e.g., whether diffused or focused) in the
body. Thus, the definition of embodiment used in
this paper refers to a state where one’s attentional
activity originates from the core of the body,
rather than from the forehead—or in Hartelius and
Goleman’s (2016) words,
M
those states of consciousness in which the
attention that normally arises from the head is
now deployed from the central structures of
the body—as if the self that is conventionally
centered in the head is now located in the
trunk of the body. (p. 167)
The aforementioned principles are then used
International Journal of Transpersonal Studies 205
to distinguish between two varieties of mindfulness
practices (Hartelius, 2015): cognitive-behavioral (e.g.,
Hayes, Strosahl, & Wilson 2011) and neo-traditional,
exemplified by Kabat-Zinn’s (2003a, 2003b)
mindfulness-based stress reduction (MBSR). The
former reflects a state of awareness where the mind
harnesses its attention to promote a disidentification
from mental contents while the egocenter remains
seated in the head, using strategies based on
language, thought, and perspective taking (Hartelius,
2015), and the latter reflects a radically embodied
stance (Hartelius & Goleman, 2016), where a
consciousness shift occurs by shifting the egocenter
downward so that attention is experienced as coming
from the belly and/or the trunk of the body instead of
from the head. The working principle of embodied
mindfulness (which is used interchangeably with the
term neo-traditional mindfulness) is thus a shift of
consciousness where
the observer of thoughts, emotions, and
sensations is not the familiar ego but a momentto-moment awareness focused on the experience
that is present to the senses (cf. Kabat-Zinn
1990) rather than the conventional narrative of a
historical self. In this state, insight arises not from
cognitive reflection but from non-conceptual
noticing. (Hartelius, 2015, p. 1273)
Lauche, Paul, & Dobos, 2012; Hofmann, Sawyer,
Witt, & Oh, 2010), the physical and psychological
support of patients struggling with chronic pain
(Teixeira, 2008), and the stress management of
healthy people (Chiesa & Serretti, 2009).
These desirable effects could be attributed,
at least in part, to mindfulness’ positive impact on
empathic response and presence. In 2007, BlockLerner and her colleagues demonstrated that MBSR
approaches can play a role in the cultivation of
empathy, arguing that non-judgmental, presentmoment awareness increases the capacity for
perspective-taking and empathic concern (BlockLerner, Adair, Plumb, Rhatigan, & Orsillo, 2007).
They explained:
As individuals are more mindfully attentive
to the thoughts and feelings they and others
experience in the present moment, they are
more likely to find common ground and
greater intimacy in their relationships, engage
in higher levels of valued action, and increase
their overall quality of life in the process—one
moment at a time. (p. 513)
The effects of embodied mindfulness
Embodied mindfulness has been the recent
subject of much empirical study. Over the last few
decades mindfulness has been increasingly viewed
as a central process in therapeutic change (Baer,
2003; Grossman, Niemann, Schmidt, & Walach,
2004; Martin, 1997). More specifically, therapies
based on MBSR have been shown to be helpful in
the treatment of many medical, psychological, and
behavioral ailments (Grossman et al., 2004; Merkes,
2010) as well as positively affect physiological health
(e.g., Teixeira, 2008) and epigenetic changes (Bhasin
et al., 2013; Kaliman et al., 2014; see also Brotto &
Basson, 2014). Indeed, several meta-analyses have
shown MBSR-based practices having a positive impact
in a range of clinical and non-clinical interventions,
such as the treatment of depression and anxiety
across populations with a chronic medical disease
(Bohlmeijer, Prenger, Taal, & Cuijpers, 2010; Cramer,
Indeed, it appears that exercising a more embodied
attentional posture, characteristic of a state of
embodied mindfulness, may facilitate a quality of inthe-moment presence that, in turn, enhances one’s
ability for empathic resonance and attunement.
Predictably, research also shows that MBSRinspired embodied mindfulness practices can
improve one’s sexual functioning. Brotto and Basson
(2014) investigated the effects of a mindfulnessbased cognitive behavioral sex therapy (MBCST)
training on women (N = 115) seeking treatment
for distressingly low or absent sexual desire and/or
sexual arousal. In their study, women participated in
group sessions that included mindfulness meditation,
cognitive therapy, and psychosexual education. The
treatment also included many somatic practices,
either performed on site or as homework, that were
strikingly akin to the humanistic somatic sexology
modalities developed in the 1960s. Each treatment
session included a mindfulness practice component.
In session 1, mindfulness was introduced through a
body scan, a practice where participants were guided
to notice different parts of the body while tuning into
206 International Journal of Transpersonal Studies
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the sensations without attempting to change them.
In Session 2, the body scan was repeated, this time
with attention on the genital areas. Women were
invited to use a hand-held mirror to look at their
own genitals as part of the practice, and reminded
to remain in a state of embodied, non-judgmental
attention. In session 3, women were encouraged to
repeat the body scan that included genital focus,
but this time incorporating some light touch to focus
on the sensations that arise with touch. This was
framed as a “non-masturbatory exercise designed
to continue the mindfulness and non-judgmental
awareness of the genitals and not meant to elicit
sexual arousal” (Brotto & Bason, 2014, p. 46). In
the final (4th) session, therapists introduced the
practice of sensate focus (see Masters & Johnson,
1966, 1970) to be used at home with a partner, or
in a visualization of how they might use sensate
focus with a future partner (Brotto & Bason, 2014).
This treatment significantly improved sexual desire,
sexual arousal, lubrication, sexual satisfaction, and
overall sexual functioning in the women participants
(Brotto & Basson, 2014).
Building on previous findings suggesting
that mindfulness could promote a more direct
access to body sensations by training attention and
reducing negative self-evaluation (Brotto, 2013;
de Jong, 2009), the authors had hypothesized
that “mindfulness practices can not only increase
awareness of sexual responses unfolding moment
by moment, but also lessen judgment that the
latter are insufficiently intense or in some way
sub-standard” (Brotto & Basson, 2014, p. 44)—a
proposition that was confirmed in their results. Also,
they found that women practicing non-judgment in
a sexual context experienced less self-judgment as
well as higher acceptance of the partner and sexual
context, which are all positive predictors for desire
and arousal. Additionally, this study suggested
that mindfulness training may have “tempered the
anxiety, guilt, self-criticism, and frustration that may
preclude women’s arousal from sexual stimuli”
(Brotto & Basson, 2014, p. 51).
Those findings corroborate the growing
empirical literature showing the beneficial effects of
mindfulness-based treatment for sexual difficulties
in women (e.g., Gunst et al., 2018; Velten, Margraf,
Chivers, & Brotto, 2018; see Stephenson & Kerth,
2017 for a meta-analytic review and endnote 1
for a more comprehensive list)1, in men (Bossio,
Basson, Driscoll, Correia, & Brotto, 2018), and in
both men and women (Kimmes, Mallory, Cameron,
& Köse, 2015; Sommers, 2013). While those
approaches do not involve touch between patients
and practitioners, they bring scientific support and
legitimacy to the use of somatic and experiential
approaches in addressing sexual difficulties by virtue
of successfully employing erotic mindfulness as a
core principle of sexual healing and transformation.
Further corroborating the clinical evidence
for mindfulness practice’s enduring benefits on
cognition and behavior are neuroscientific studies
showing brain changes in individuals who practice
mindfulness meditation. Mindful presence has been
shown to have effects on a person’s brain activity
that leads not only to temporary, limited behavioral
change, but also to larger and multifaceted change
(Baldini, Parker, Nelson, & Siegel, 2014). It is
known from studies in neuroplasticity that how
one learns to focus the mind can alter the structure
of the brain (Siegel, 2009). Siegel (2010a, 2010b)
demonstrated that clinicians can promote their
clients’ wellbeing by supporting neural integration
through the practice of mindfulness. Mindfulness
has been shown to effectively alter the top-down
habitual activity of the brain cortex’s upper layers
by allowing the ongoing sensory experiences
flowing from its lower layers to take charge of one’s
attention. While upper layers 1, 2, and 3 represent
the conceptual and linguistic mental categories that
one constructs from past experiences, lower layers
6, 5, and 4 bring up fresh, unscripted, and nonjudged sensory information to awareness (Siegel,
2009). The upper layers’ role in interpreting and
categorizing fresh input from the bottom layers is
undeniably useful in everyday adult functioning,
but it also constrains and deprives the mind from
its natural sense of liveliness, vitality, and freedom
that is typically experienced in both infancy and in
genuinely surprising or novel situations. Thus, the
habitual intrapersonal cortical oppression of layers
1, 2, and 3 can leave one’s awareness “imprisoned
by prior learning” and adults feeling “dead inside”
(Siegel, 2009, p. 154), while on the other hand,
Erotic Mindfulness
International Journal of Transpersonal Studies 207
mindfulness practice brings “a breath of fresh air. . .
into our lives” (Siegel, 2009, p. 154).
More recently, Tang, Hölzel, and Posner
(2015) conducted a meta-analysis of the previous
two decades of mindfulness literature to describe to
what extent previous research had revealed changes
in brain activity and brain structure following
mindfulness meditation training. Because the
studies reviewed varied in terms of research design,
measurement and type of mindfulness meditation
used, the locations of reported effects varied across
multiple regions in the brain. Further, effects were
reported in multiple brain regions at once, suggesting
that the effects of mindfulness might involve largescale brain networks. Nevertheless, eight brain
regions were found to be consistently altered in
meditators. To demonstrate this, Fox et al. (2014)
reviewed and meta-analyzed 123 brain morphology
differences from 21 neuroimaging studies, reflecting
a total sample size of approximately 300 meditation
practitioners. They found increases in structures of
the following regions: the frontopolar cortex, which is
suggested to be related to enhanced meta-awareness
following meditation practice; the sensory cortices
and insula, areas that have been related to body
awareness; the hippocampus, a region that has been
related to memory processes; the anterior cingulate
cortex (ACC), mid-cingulate cortex and orbitofrontal
cortex, areas known to be related to self and
emotion regulation; and the superior longitudinal
fasciculus and corpus callosum, areas involved in
intra- and inter-hemispherical communication (Fox
et al., 2014).
The connection between brain maturation
(observed as structural increases of brain regions) and
cognitive development is well established, and there
is robust evidence in favor of the brain structurefunction connection in human neuroimaging.
This points to the idea that mindfulness practice
promotes healthier brain function by reinforcing the
structures of the eight brain regions listed above.
However, it bears mentioning that the morphometric
neuroimaging field as a whole, and the smaller realm
involving meditation practitioners in particular, is
as yet in early stages of understanding the specific
meaning of brain structure differences. Low
replication rates also point to the need for further
208 International Journal of Transpersonal Studies
research to corroborate those preliminary findings.
Nevertheless, the authors suggested that “brain
structure increases related to meditative practice
might provide at least a partial neural explanation
of the numerous cognitive and emotional benefits
associated with meditation” (Fox et al., 2014, p. 52).
This preliminary evidence, while still
nascent, supports anecdotal data arguing that
somatic sexology modalities may create lasting and
positive changes in a person’s wellbeing. If those
modalities evoke a state of embodied mindfulness
in individuals who practice them, it would likely
follow that those practices alter not only their brain
activity in the moment, but also affect their brain
structure of in lasting and desirable ways.
Somatic-Experiential Therapies
omatic sexology modalities, as well as at the
somatic components of Brotto and Basson’s
(2014) mindfulness-based cognitive behavioral sex
therapy (MBCST), are both structurally akin to the
practice of embodied mindfulness—and seem to
yield results similar in nature to those that mindfulness
brings in non-sexual therapeutic settings such as
the ability to experience increased in-the-moment
presence, non-judgmental awareness, as well as
empathic resonance and attunement. Indeed, sexual
arousal as a portal for pleasure is a compelling draw
to stay present in the moment: Erotic sensations
provide a fitting basis for the practice of embodied
mindfulness, and reclaiming a more unhindered
connection to the cortical bottom-up information
flow appears to enhance erotic sensation (Sommers,
2013)—thus offering a way for somatic sexology to
naturally promote vitality and wellbeing in the sexual
arena. This will be exemplified with the analysis of
three somatic sexology modalities: surrogate partner
therapy, masturbation coaching, and orgasmic
meditation.
Surrogate Partner Therapy
Surrogate partner therapy is far from a new
technology, as it reflects in many ways the work
of sacred prostitutes in ancient cultures (QuallsCorbett, 1988) of engaging in two-way sensual touch
for the purpose of somatic, emotional, and sexual
healing. The term surrogate partner was coined
in the late 1960s and early 1970s by sex therapy
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pioneers Masters and Johnson (1966, 1970), who
introduced volunteer partner surrogate therapy into
their work as a way to help their single patients with
sexual dysfunctions calm debilitating performance
pressures (Morin, 1995). As the practice grew in
popularity, many surrogate volunteers were trained,
all of whom were licensed professionals: it was these
professionals who later formed the International
Professional Surrogates Association (IPSA) and
developed a detailed code of ethics for members, in
order to compensate for their ambiguous legal status
(Bullough & Bullough, 1994).
Guided by these ethics, certified surrogates
must be supervised by a therapist, as part of a threeway therapeutic team, in order to work with a client
(Poelzl, 2011). A sexual surrogate is a practitioner
“with whom the client practices, role-plays, and
rehearses skills taught by the therapist during their
sessions. The surrogate provides feedback to the
client on their behaviors while the [surrogacy] session
is in progress” (Rosenbaum et al., 2014, p. 323). The
role of surrogates is to somatically guide clients to
experience a fuller range of sexual expression using
sensate present moment awareness, with goals
ranging from curing specific sexual dysfunction, to
enhancing relational intimacy, to exploring uncharted
erotic potentials (Poelzl, 2011). During the therapy
process, a weekly meeting is held between the
therapist and the client, between the therapist and
the surrogate and, only then, between the surrogate
and the client. At the end of the therapy process the
relationship between the client and the surrogate is
completely terminated (Aloni & Heruite, 2009).
In addition to its use as adjunct to sex therapy,
sexual surrogacy is increasingly seen as a way to
help people with disabilities live sexually vibrant
lives and build sexual self-esteem (Shapiro, 2002).
Indeed, cultural perceptions of sexual attractiveness
and desirability, often combined with other barriers
such as physical limitations, can make sexual access
to intimate partners through traditional routes highly
challenging for disabled people (Shuttleworth &
Mona, 2002). As health professional and activists
are increasingly recognizing the inherent sexuality
of disabled persons and attempting to find ways
to accommodate their needs (Appel, 2010),
professionally facilitated intimacy can be an integral
Erotic Mindfulness
part of a whole-person framework of patientcentered care (Earle, 2002). Sexual intercourse is
said to have a “minimal presence in the types of
sexual services normally provided to the patient”
(Shapiro, 2002, p. 76), and the goal of the practice
is not exclusively to achieve climax. Instead, “the
ultimate benefit of this type of therapy is to increase
the sexual self-esteem of the disabled person
through the physical pleasure of non-penetrative
bodily contact and to help the disabled person learn
about their own body” (Shapiro, 2002, p. 76).
The backbone of a surrogate partner’s
practice, developed by Masters and Johnson (1966,
1970), is called the sensate focus method of sensual
touch with verbal feedback. This method can be
defined as the surrogate directing the client’s attention
away from their heads and into the concrete world
of the senses (Morin, 1995). This also contributes to
moving a client away from spectatoring—described
by Masters and Johnson (1970) as a person focusing
on himself or herself from a third person perspective
during sexual activity, rather than focusing on one’s
sensations and/or sexual partner—a cognitive
distraction that could increase performance fears and
cause deleterious effects on sexual performance (see
Trapnell, Meston, & Gorzalka, 1997). Thus, sensate
focus is more of an attitude about touch rather
than a specific behavior, where partners remain in
a neutral state of exploration and experimentation
while giving and receiving touch (Weiner & AveryClark, 2014).
Brotto and Basson (2014) argued that the
sensate focus method was in fact a variety of
embodied mindfulness practice:
In their description of the causes of sexual
dysfunction, Masters and Johnson (1970)
believed that anxiety and spectatoring played
a major role for both women and men, and
developed sensate focus as a core aspect of
therapy. Sensate focus involved the structured
and progressive touching by one partner to the
other as a means of improving concentration
on the sensual aspects of touch and to reduce
anxiety. Although Masters and Johnson did not
use the term mindfulness, in part, cultivating
mindfulness [sic]. However, rather than any
International Journal of Transpersonal Studies 209
focus on acceptance of the present moment,
during sensate focus each partner is encouraged
to give on-going feedback and guidance so as to
find the optimal type of stimulation. (p. 44)
Sensate focus was also said to be an especially
helpful tool for enjoying a sexual experience when
one would be “in the gray zone, unsure of what
to do next” (Morin, 1995, p. 245). Thus, it seems
that sensate focus is, at core, a form of embodied
mindfulness practice focused on erotic content.
Masturbation Coaching
Masturbation coaching, or directed masturbation, is a form of therapy that was developed in
the early 1970s as a behavioral treatment for female
orgasmic disorder (Both & Laan, 2008). Based on the
concept of sensate focus introduced by Masters and
Johnson (1966, 1970), LoPicollo and Lobitz (1972)
were the first to design a multi-step masturbation
program for anorgasmic women, which included
both partners of a couple. This program consisted
of education, self-exploration and body awareness,
directed masturbation, and sensate focus. Later,
Barbach (1974, 1975) transformed the masturbation
program to a format for group treatment for
women without their partners. More recently, Betty
Dodson (1996, 2002), a well-known sex coach and
educator, became famous as a masturbation coach
working with clients individually as well as in group
experiential workshops for women called Bodysex™
(Britton & Bright, 2014). Bodysex™ consists of a
two-day workshop, five hours each on a Saturday
and Sunday afternoon, where about ten women are
in attendance and participate in nude group sessions
throughout the entire workshop (Meyers, 2015).
Dodson (2005) described her methods:
During a sex coaching session, we view her
genitals under a bright light naming all the parts
and locating the clitoris. She takes her first
steps in developing positive genital self-esteem.
She locates and feels the pubococcygeal (PC)
muscle with her finger inside her vagina. Lying
down, she experiences slow vaginal penetration
under her control while using a well-lubricated
resistance device. While she squeezes and
releases the PC muscle she adds pelvic rocking
210 International Journal of Transpersonal Studies
and coordinates her breathing. Next she uses
different methods of stimulating her clitoris:
manual masturbation, a small battery vibrator
and two electric vibrators of varying intensities.
While she masturbates, I observe and
encourage her to go beyond current boundaries
of tolerating intense pleasurable sensations. Sex
coaching heals her confusion about orgasm.
(p. 43)
Two studies have investigated the
effectiveness of Betty Dodson’s methods of
masturbation coaching. One study was conducted in
Denmark with a sample of 500 anorgasmic women,
between 18 and 88 years of age (mean of 35 years)
with chronic anorgasmia (for 12 years on average).
Of the participants, 17% claimed that they had been
sexually abused in childhood, and 25% had never
experienced an orgasm. They participated in the
“orgasm course for anorgasmic women” (p. 886),
which included three therapy sessions of five hours
each. The sessions used the tools of reparenting,
genital acceptance, acceptance through touch, and
direct sexual clitoral stimulation aiming to entice
sexual and existential healing (salutogenesis). The
treatment included patient masturbation under
supervision and instruction using a clitoral vibrator
after initial digital stimulation. The therapist,
Pia Struck, co-chair of the Danish Association
for Sexology, was trained in psychodynamic
psychotherapy and had 10 years of professional
experience with the treatment of sexual
dysfunctions at the time of the study. Her training
was also supplemented with personal sexological
training by Betty Dodson in 2001. Of the patients,
50 were treated individually (one-on-one) because
they felt uncomfortable participating in the group
sessions. Results showed that 465 patients (93%)
had an orgasm during therapy, witnessed by the
therapist, and 35 patients (7%) did not. No patients
had detectable negative side effects or adverse
effects (Struck & Ventegodt, 2008).
Meyers (2015) also studied the impacts of
masturbation coaching by assessing the impact
of participation in Betty Dodson’s Bodysex™
workshops in women, on different aspects of their
sexuality: sisterhood, masturbation, orgasm, sexual
Thouin-Savard
To what does directed masturbation owe
its efficacy? Once again, it appears that erotic
mindfulness lies at the core of the practice:
self-schema, body esteem, and female genital selfimage. She used a mixed-method research design
to find “to what degree and in what ways does
change result” from participation in Bodysex™
workshops (Meyers, 2015, p. x). Surveys from 63
prior participants provided quantitative data while
individual interviews with a volunteer sample of 15
of those women provided qualitative data. Thirteen
women also participated in pre/post surveys. The
exploratory design of this study went beyond the
binary purpose of assessing the achievement
of climax (or not), and rather focused on the
participants’ perceptions of their transformative
experiences resulting from the workshop. The
study thus yielded nuanced and detailed results,
and readers are referred to the original text
(Meyers, 2015) to fully grasp the complexity of the
three participant pools’ responses. Nevertheless,
statistically significant changes regarding genital
self-image, sexual efficacy, and sexual satisfaction
were found from quantitative data, and four main
themes emerged from the qualitative interviews
and open-ended survey questions: (a) Experience of
sisterhood: described as bonding/connection, and
female connections at home; (b) Feeling more normal
as related particularly with: nudity, their genitals,
their sexual satisfaction and sexual-esteem, and
common struggles; (c) Feeling empowered: through
increased knowledge and competency and selfpermission to pursue life changes in their primary
relationships; (d) Healing: emotional healing from
past trauma, shame, and guilt and physical healing
from specific conditions (Meyers, 2015, p. 97).
Directed masturbation is one of the only
somatic sexology modalities to have remained
recognized and endorsed by mainstream clinical
science, partly because it is used to target a specific
type of sexual dysfunction, described in the DSMIV as female anorgasmia, and partly because it
has the ethical advantage of not necessitating the
touch of a therapist. Both and Laan (2008) assessed
that “reviews of treatments for sexual dysfunctions
in women that follow the criteria for validated or
evidence-based practice (APA, 1995) conclude
that directed masturbation treatments for primary
anorgasmia fulfill the criteria of ‘well established,’ or
at least ‘probably efficacious’” (p. 159).
This treatment description is strongly
reminiscent of Brotto and Basson’s (2014) sexual
mindfulness treatment. In both cases, sensate
focus—or the focused attention gradually placed
towards bodily sensations—is the main working
principle. Both methods address negative scripts
and emotions around sexuality using additional
cognitive-narrative avenues, but these appear
to fulfill a supportive role: the crux of these
practices is experiential sensate awareness, which
ultimately aims to disentangle sexual pleasure from
judgmental and narrative content. This is performed
by encouraging participants to shift into a state
of presence within their bodies, and to immerse
themselves into erotic sensations.
While directed masturbation methods
were developed specifically to address anorgasmia
in women, masturbation coaching is also used
with men. In those cases, the focus is usually not
on achieving climax, but rather on feeling more
pleasure, accessing altered states of consciousness,
gaining enhanced orgasmic and ejaculatory control,
and weaving the heart to the genitals (OrgasmicYoga.
com). Joseph Kramer, who founded the Body
Electric School and the New School of Erotic Touch,
employs masturbation coaching extensively as a
Erotic Mindfulness
International Journal of Transpersonal Studies 211
The exercises [prescribed in directed
masturbation] focus initially on body awareness
and body acceptance, and on visual and tactile
exploration of the body. Second, women are
encouraged to discover the areas of the body
that produce pleasure when touched. After
that, women are instructed in techniques of
masturbation, and to use fantasy and imaging to
increase sexual excitement. The use of topical
lubricants, vibrators, and erotic literature or
videotapes is often recommended. Frequently,
Kegel exercises (contraction and relaxation
of the pelvic floor muscles; Kegel, 1952) are
prescribed, since they may increase women’s
awareness of sensations in the genitals and
because that may enhance sexual arousal. (Both
& Laan, 2008, p. 159)
form of erotic mindfulness training in his programs.
Specifically, his Orgasmic Yoga Institute (an offshoot
of the New School of Erotic Touch) includes a
Mindful Masturbation program for men that offers
“clear and simple instructions to escape from habit
and enjoy embodied masturbation” (OrgasmicYoga.
com). Unfortunately, no peer-reviewed literature
addresses this specific practice as yet; however, its
practices are coherent with the principle of erotic
mindfulness.
Orgasmic Meditation
Orgasmic Meditation (OM) is a sexual
mindfulness practice where a partner of either
gender gently strokes a woman’s clitoris for 15
minutes with no other goal other than to feel,
connect, and be present (OneTaste, 2019). OM was
popularized by Nicole Daedone, who founded the
OneTaste organization and conducted workshops
based on the practice in several cities around the
United States (Snyder, 2013). In Slow Sex: The Art
and Craft of the Female Orgasm, Daedone (2011)
explained:
In Orgasmic Meditation we learn to shift our
focus from thinking to feeling, from a goal
orientation to an experience orientation. This
shift turns all our expectations about sex on
their head, exchanging “faster” and “harder”
for “slower” and “more connected.” (Kindle
location 171)
The practice of cultivating embodied attention
using the contact between finger and clitoris as a
focal point is very much akin to other mindfulness
practices, both sexual and non-sexual. By isolating
focus on the sensation, orgasmic meditators
disassociate sexual pleasure from traditional
performance goals and show confidence in the
ultimate wisdom of the body (Snyder, 2013).
Orgasmic meditation is said to enhance
practitioners’ sense of vitality in the rest of their
lives, including their day-to-day sex lives by inducing
a deeper sense of intimacy and an attention to
the foundation of pleasure, free from agendas or
relational expectations (Daedone, 2011). Millar
(2015), a coach for OneTaste, conducted a survey
for her master’s thesis exploring the demographics
of people who practice OM and the reported
212 International Journal of Transpersonal Studies
benefits. For this survey, 419 participants were
split nearly evenly between male and female with
five responding as transgender or other. Ages
ranged from 18 to over 75. Millar asked them to
rate the effect of OM on their intimate romantic
partnerships, familial relationships, friendships,
health, mental health, professional life and spiritual/
religious life. In terms of their intimate partnerships,
both men and women generally reported that
the practice of OM resulted in “improvements
of their sex lives, communication, awareness of
others, as well as increased their sensation and
ability to feel, and self-confidence” (pp. 31–32).
Millar’s position as an organization insider as well
as her convenience sampling method may have
affected her research results. It is likely that her
recruiting and interviewing processes offered cues
to participants about what the researcher hoped to
hear, so the results should be interpreted critically.
However, OM’s similarity in structure to
other sensory-based mindfulness meditations is
so striking that similar beneficial effects should
naturally be expected. OM is fundamentally a
specialized version of the sensate focus method
developed by Masters and Johnson (1970): it
shifts the attention away from mental activity and
performance expectations, and turns it towards
the body’s moment-to-moment sensation for
both stroker and strokee. As such, the practice
exemplifies the core principle of erotic mindfulness.
Discussion
here are additional somatic sexology modalities
that could have been included in this short
review of clinical applications of erotic mindfulness,
but the focus here is on examining what makes
those practices effective. Just as neo-traditional
or embodied forms of mindfulness have shown
durable efficacy in helping practitioners move
beyond trauma to more fulfilling lives (e.g., Siegel,
2009), erotic mindfulness may catalyze the healing
journeys of individuals facing a wide spectrum of
sexual concerns and trauma, as well as enrich the
lives of those who are seeking a more expansive,
embodied, and empowering relationship with
their sexual and erotic nature. There is abundant
anecdotal evidence (e.g., Blackburn, 2011;
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Jesse, 2017; Moore, 2017) and growing empirical
evidence (e.g., Meyers, 2015; Struck & Ventegodt,
2008) that characterizes the field of somatic
sexology as a highly promising avenue of practice
for sexual education and healing. The limitations
of talk therapy and medication for treatment of
psychologically related sexual challenges are well
documented (Moore, 2017; Morin, 2006; Resnick,
2004; Tiefer, 2006), and it appears that somatic
and experiential modalities could be instrumental
to the progress of the sexology field.
While the ethics of touch are complex, and
thus difficult to regulate (Barratt, 2010; Ventegodt
& Struck, 2009), this alone should not stop the
scientific community from investigating these
avenues. For one, the attitudes of the scientific
and therapeutic communities are contingent on
larger cultural assumptions and value orientations
towards sexuality itself. While collective attitudes
and assumptions around the topic of sexuality
tend to transform slowly, there is opportunity
for practitioners in the field of sexology to
incorporate erotic mindfulness as a potential
common mechanism within promising therapeutic
approaches. Tiefer’s (2006) plea is still pertinent
over a decade later:
initially be associated with painful emotions
(Morin, 1995)—causing a person to want to flee
sensation. Individuals who display resistance to
embodiment might be better served by preparatory
psychotherapy to support further healing (Barratt
& Rand, 2003). Nevertheless, there are situations
where somatic practices can be an effective way
to address sexual trauma. Pioneering somatic sex
educator Caffyn Jesse (2017) discussed this topic:
For survivors of sexual abuse and violence,
navigating desire and communicating choice
in highly-charged sexual exchanges can feel
impossible. Somatic sex education provides
an arena in which people receiving touch can
stay safe and focused. They are encouraged
to breathe into body sensation and decide,
moment to moment, what their body wants. . . .
The clear boundaries and ethics of professional
practice create a container for healing. (Jesse,
2017, p. 9)
Of course, diving into a sensate experience
is not always desirable, or even possible. In
cases where a person carries prominent sexual
trauma, sexual arousal and pleasure might
As with traditional modalities, what constitutes
an appropriate intervention or practice for each
individual must be assessed carefully from both
the practitioner’s and the client’s perspectives.
This further highlights the need for science-based
protocols to be developed in support of those
practices, as well as established professional
frameworks.
To fill this need, professional associations
have been put in place to provide training programs,
standards of certification, and a clear code of ethics
to practitioners. For example, the International
Professional Surrogates Association offers training
and certification for sexual surrogates, as well a code
of ethics. The Association of Certified Sexological
Bodyworkers fulfils a similar purpose when it comes
to sexological bodywork, although there are now
several different training organizations that provide
education in this modality—the Institute for the
Study of Somatic Sexology, the Sea School of
Embodiment, and the Institute of Somatic Sexology
being some of the most well-known. The Somatic
Sex Educators Association and the Association
of Somatic & Integrative Sexologists also work to
provide training, certification, community, and
ethical standards to practitioners.
Erotic Mindfulness
International Journal of Transpersonal Studies 213
[I]t seems likely that resistances to the use of
bodywork or group-work or political action
on the part of sexologists arose from the
desire to adhere to the most respectable
approaches so as to establish the legitimacy of
the profession. This in turn may have arisen out
of embarrassment about sex itself, especially
about the respectability of sexual pleasure
rather than sexual function as a focus for
work. But in 2006 it is no longer acceptable
for professionals in the field of sex education,
research and therapy to fear being tainted by
the subject matter. Our role is to advocate
sexual authenticity and sexual entitlement
without hiding behind the medical model of
sexual ‘health’ and ‘normality.’ (p. 371)
While these organizations are steadily
shaping and strengthening the future of the somatic
sexology field, more evidence-based research is
needed for those practices to be understood more
deeply and become accessible to all the individuals
who can reap their benefits. Considering the
multifaceted and often central role sexuality plays
in people’s identity development, relationships,
and health, the quest to understand and promote
sexual wellbeing cannot be reduced to a single field
of inquiry. Elucidating and mapping the emerging
field of somatic sexology will require researchers
and practitioners alike to adopt a holistic lens that
honors the complexities of the lived experience
of sexuality and holds space for the potential of
healing and transformation. To this aim, scholars
from the fields of whole-person psychology (such
as somatic, transpersonal, and humanistic), sex
science and therapy, medicine and neuroscience
need to work collaboratively rather than in
isolation—a proposition that has the potential to
deepen the understanding of human embodiment
as well as cultivate growth and healing in countless
lives.
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About the Author
Marie I. Thouin-Savard, MBA is a PhD candidate
in the East-West Psychology department at the
California Institute of Integral Studies, and an
Editor at the International Journal of Transpersonal
Studies. Her doctoral research focuses on the
experience of compersion in consensually
nonmonogamous relationships, which she
discusses
at
www.whatiscompersion.com.
Her research interests include transformative
experience and the intersection of transpersonal
studies and human sexuality.
About the Journal
The International Journal of Transpersonal Studies
is a is a peer-reviewed academic journal in print
since 1981. It is spnsored by the California Institute
of Integral Studies, published by Floraglades
Foundation, and serves as the official publication
of the International Transpersonal Association.
The journal is available online at www.
transpersonalstudies.org, and in print through
www. lulu.com (search for IJTS).
International Journal of Transpersonal Studies 219
Contemporary Family Therapy (2019) 41:368–383
https://doi.org/10.1007/s10591-019-09504-x
ORIGINAL PAPER
A Hold Me Tight Workshop for Couple Attachment and Sexual Intimacy
Brianna L. Morgis1
Ruth Jampol2
· E. Stephanie Krauthamer Ewing1 · Ting Liu2 · Jaime Slaughter‑Acey3 · Kathleen Fisher1 ·
Published online: 8 August 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
There is an abundance of research demonstrating significant relationships between romantic attachment and sexual intimacy,
which in this study refers to sexual communication and sexual satisfaction. However, not many interventions specifically and
simultaneously target these two important aspects of romantic relationships. Furthermore, there are a lack of affordable and
accessible psychoeducational interventions that provide opportunities for couples to gain basic knowledge about romantic
attachment and sexual intimacy. To fill this gap, the authors of the current study took a 10-week, eight-session attachmentfocused intervention (The Hold Me Tight Program: Seven Conversations for Connection), adapted it into a 1-day workshop,
and focused on the role that attachment plays in sexual intimacy. Pilot data was collected to examine treatment feasibility,
acceptability, and knowledge acquisition. In addition, exploratory efficacy data was analyzed with respect to changes in
couple attachment patterns, sexual communication and satisfaction, and overall relationship satisfaction. Quantitative results
revealed that participating couples showed increases in perceived knowledge acquisition and actual knowledge acquisition
about concepts related to attachment and sexual intimacy. Qualitative and quantitative pilot data suggested movement in the
expected direction for improvements in couples’ romantic attachment patterns, sexual satisfaction, sexual communication,
and relationship satisfaction with a trend towards a statistically significant increase in sexual satisfaction.
Keywords Couples therapy · EFT · Romantic attachment · Hold me tight
Introduction
* Brianna L. Morgis
Blb5242@gmail.com
E. Stephanie Krauthamer Ewing
Ek469@drexel.edu
Ting Liu
Tingliu.lmft@gmail.com
Jaime Slaughter‑Acey
jslaught@umn.edu
Kathleen Fisher
Kmf43@drexel.edu
Ruth Jampol
Ruth.jampol@gmail.com
1
Drexel University, Philadelphia, USA
2
Philadelphia Center for Emotionally Focused Therapy,
Lafayette Hill, USA
3
University of Minnesota, Minneapolis, USA
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Romantic relationship satisfaction and stability are important to healthy adult functioning, but many factors can make
achieving and maintaining relationship satisfaction difficult.
Research has shown that couples report sexual satisfaction as
an indicator of relationship satisfaction, and that when they
are unhappy with their sex lives, they are unhappy in their
relationships (Soleimani et al. 2015; Štulhofer et al. 2010).
In fact, McCarthy (2003) found that unhappy couples attribute 50–70% of their relationship distress to sexual issues.
For many couples, it proves challenging to talk about sexual intimacy. Instead of openly communicating about sexual
likes, dislikes or needs, many couples rely upon stereotypes
to guide their awareness of their partners’ sexual preferences
(Byers 2011). According to MacNeil and Byers (2009), only
26% of couples have clear understanding of their partners’
concerns regarding their sexual relationships. This is problematic because effective sexual communication is a significant predictor of sexual wellbeing (Byers 2011; Khoury and
Findlay 2014). Despite the importance of sexual satisfaction
Contemporary Family Therapy (2019) 41:368–383
in romantic relationships, partners often struggle to openly
address their sexual issues with one another because of the
vulnerability, trust, emotional closeness and effective communication it requires. However, when partners are able to
develop a strong and secure romantic attachment bond with
one another, built on mutual vulnerability, emotional safety
and security they are better able to communicate their sexual
concerns and needs (Johnson and Zuccarini 2010). In turn,
they tend to have a better chance at a more satisfying sex life
and relationship as a whole.
Romantic Attachment and Sexual Intimacy
Romantic attachment style has been linked to sexual intimacy, such that attachment styles influence how people
make sense of their intimate relationships (Johnson and
Zuccarini 2010; Khoury and Findlay 2014). In the scope
of this article, sexual intimacy refers specifically to both
sexual communication and sexual satisfaction. Modern
adult romantic attachment theory, heavily influenced by
John Bowlby’s theory of parent–child attachment, has been
identified as the most promising theory of adult love with
substantial empirical support (Hazan and Shaver 1987).
According to attachment theory, all human beings form
internal working models based on their early experiences
with their primary caregivers, which inform one’s self-worth
and expectations for love, care and protection in close relationships (Bowlby 1973; Verschueren et al. 1996). It is these
early experiences that influence beliefs about the availability
and responsiveness of significant others, including romantic partners, in times of distress or need (Burgess Moser
et al. 2015). Later work by Bowlby and one of his students
and colleagues, Mary Ainsworth, identified three major patterns of early childhood attachment: (1) secure, (2) insecureanxious/ambivalent, and (3) insecure-avoidant (Ainsworth
et al. 1978). While secure attachment patterns were marked
by infant expectations for caregivers to be responsive and
meet their needs, anxious/ambivalent and avoidant patterns
were not. Anxious/ambivalent infants tend to have expectations that they will receive inconsistent support from their
caregivers and will often display hyperactive expressions
of distress. Avoidant infants may be faced with caregiver
rejection, which often leads to the suppressing of emotion in
interactions with caregivers (Ainsworth et al. 1978; Burgess
Moser et al. 2015). This categorization of attachment style
was then expanded to include insecure-disorganized/disoriented attachment, which manifests as fearful, conflicted,
or disoriented behavior by infants towards their caregivers
(Main and Solomon 1986). Though there may be many reasons for infants to display disorganized/disoriented behaviors, it is often noted that these infants experience their caregivers as a source of alarm of threat.
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In later work, Bowlby theorized that early infant-caregiver attachment patterns may impact interactions later
in development with romantic partners (Bowlby 1988). He
hypothesized that early experiences and expectations for
being cared for play a significant role in organizing positive
internal working models of self-worth and love, expectations
for care, comfort and security in close romantic relationships
later in life. Secure internal working models are thought to
help manage relationship tension and uncertainty, maintain
accurate perceptions of desired closeness, and balance closeness with independence in romantic relationships. A number of empirical studies have provided evidence for these
hypotheses (Burgess Moser et al. 2015; Greenman and Johnson 2013; Halchuk et al. 2010; Mikulincer and Shaver 2010;
Tilden and Dattilio 2005). For example, Zayas et al. (2011)
found a significant association between retrospective recollections of early insecure caregiver attachment and reports
of insecure attachment bonds with adult romantic partners.
Stemming from this body of work, Hazan and Shaver
(1987) proposed an attachment-based theory of romantic
love. They applied Ainsworth’s original three-category
attachment classification system to a study on romantic
love, and they proposed that adult lovers form attachment
bonds in similar ways that young children and caregivers
do (Hazan and Shaver 1987). Hazan and Shaver qualified
the analogy by noting that while the romantic attachment
and early attachment processes and patterns may share some
similarities, adult relationships are certainly more reciprocal
and balanced in nature compared to parent–child relationships. What they suggested, however, was that the ranges in
romantic love patterns can be theorized and conceptualized
in a similar way to the patterns developed by Ainsworth
and colleagues, in terms of secure vs. insecure expectations
for care, comfort and safety in the relationship (1978). In
sum, when a couple’s emotional attachment bond is healthy
and each partner feels safe and emotionally connected to the
other, their relationship fosters a sense of security. When
the attachment bond is weak, withdrawal, anger, anxiety,
and jealousy are commonly evoked when the relationship is
threatened (Bowlby 1988; Johnson 2004; Wood et al. 2012).
Recent studies have also explored the connection between
romantic attachment and sexual intimacy. For example, studies have found that partners with weak or insecure attachment bonds often struggle to effectively communicate and
express their needs for emotional and sexual closeness (Banmen and Vogel 1985; Susan Johnson and Zuccarini 2010;
Soleimani et al. 2015; Theiss 2011). This leads to greater
disconnection and dissatisfaction in the relationship and
ultimately further bolsters the patterns of insecure attachment in the dyad (Susan Johnson and Zuccarini 2010). On
the other hand, secure attachment between partners often
fosters successful communication regarding sexual matters.
This pattern of communication can help partners better
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understand one another’s likes and dislikes, resulting in the
couple engaging “in a sexual script that includes more pleasing and fewer displeasing activities” (Byers 2011, p. 22).
Butzer and Campbell (2008) support this association
between better attachment and improved sexual satisfaction and communication. In their study of 116 married
couples, they used the Experiences in Close Relationships
Questionnaire-Revised (Fraley and Shaver 2000) to measure attachment avoidance and anxiety, the ENRICH Sexual
Relationship Subscale (Fournier et al. 1983) to me…
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