Often both husband and wife find that partial or complete penile erection develops when they are merely following directions to pursue alternative sensate patterns of "pleasuring" one another without direct physical approach to the pelvic areas.
Whether a full erection develops during the first days of concentration on sensate focus is of little moment.
What is important, erection or not, is for cotherapists to take advantage of the marital-unit's newfound means of physical communication, that of providing mutually for each other's sensate pleasure, in order to describe in detail the concept of erection as a natural physiological reaction.
Again and again therapists should hammer at the basic principle that erective attainment, like breathing or bowel or bladder function, is a capacity men are born with, not a function they must be trained to accomplish.
Husband and wife are assured and reassured that no man can will an erection and that the only thing accomplished by such attempts is blocking of sensate input from his sexual partner.
The concept of the biophysical and psychosocial systems of influence aids immeasurably in marital comprehension of the previously inexplicable results accrued from blocking of sensate input.
There are other advantages to the members of the sexually dysfunctional couple than absorption of the pleasures of sensate focus during the first two or three days after the roundtable discussion.
This is a necessary period of mental and physical relaxation from the high tension levels inherent in the strain of cooperating with the detailed personal evaluations scheduled during the first three days of participation in the program.
This respite also provides for release of nervous tensions accumulated during the last few days or weeks before husband and wifes move to meet scheduled appearance dates at the Foundation.
Finally, there is mutual opportunity to reestablish lines of communication of both verbal and nonverbal variety.
These lines of communication have been markedly inhibited or essentially destroyed by the physical tensions and the psychic trauma developing directly from and/or secondary to their sexually dysfunctional status.
On the second day, after the roundtable discussion, the program moves toward coordinating the theoretical discussions between cotherapists and the couple, described above, and the specific functional directions to be followed by husband and wife in the privacy of their bedroom.
Instructions are given to return to sensate focus procedures during the subsequent 24 hours.
Direct approach to the male and female external genitalia, including the female breast, is encouraged. Underscored positively is the instruction that there is no concern for the amount of vaginal lubrication nor the effectiveness of the penile erection or, for that matter, whether or not there is any lubrication or an erection.
The essence of the directions is that each individual take advantage of this non demanding opportunity to show what most pleases him or her in any overt sexual approach to the pelvic organs.
When the husband is to excite his wife, it is suggested that they, rather than he, participate in her pleasuring and at her direction. After a comfortable period of sensate stroking of her total body area, the approach to the pelvic area should be under her control.
The wife's hand should be placed on her husband's to guide and to show him what really pleases her in terms of manual positioning, pressure, direction, or rapidity of stroking. There is positive reinforcement for any man learning what really pleases the women of his choice by having her quietly show him the specifics of her sensual interest.
Then the husband must, in return, provide educative opportunity for his wife. When his wife, after tracing his face, rubbing his back, or playing with his fingers, approaches his pelvic area, his hand should be on hers.
In this most effective form of nonverbal communication, he must indicate which of the multiple varieties of pelvic approach provides the most pleasure for him.
The particular areas of the penis:
are the most sensitive, the comfortable degree of manual constriction of the penile shaft, and the desired rapidity and tension of penile stroking are basic information that a wife wants to learn from her husband.
Anything that husband or wife might have learned from prior masturbatory experience that would tend to increase the levels of sensate pleasure should be shared freely with the marital partner. Often this material can only be elicited at the direction of the cotherapist.
At this time, authority should strongly emphasize in joint session that acquiring mechanical or technical skill is not a major focus of therapy.
It is important for a husband to know how to approach the clitoral area when stimulating his wife, but therapists should point out that a physical approach that is exciting for the wife today may be relatively non stimulative or even irritating tomorrow.
Attaining skill at physical stimulation is of minor moment compared to the comprehension that this is but another, most effective means of marital-unit communication.
It should be underscored constantly that what really is happening in their private sessions of physical expression is that a man and a woman committed to each other are learning to communicate their physical pleasures and their physical irritations in an area that heretofore in our culture has been denied the dignity of freedom of communication.
What better level of nonverbal communication can be attained between the impotent man and his wife than, when placing his hand on hers, he teaches her what really pleases him in penile stimulation.
With cotherapists constantly emphasizing the demand to open the lines of communication within the sexually traumatized couple, and husband and wife establishing their nonverbal communication at the most important of all communicative levels, that of the marriage bed, the marital couple is really doing its own therapy.
They are teaching each other specifically what pleases. Although they frequently do not realize it at this stage in their therapy, husband and wife are focusing their attention on each other rather than involuntarily assuming roles as spectators to physical response and thus perpetuating their mutual fears for his performance.