Somatic murmurs: a narrative inquiry into how women with low libido in long-term relationships experience sensate focus

Female Sexual Interest/Arousal Disorder (FSIAD – DSM 5) or lack or loss of sexual desire (ICD 11) is regularly cited as the most common and complex of sexual dysfunctions (Brotto, 2017), with treatment options being either: medical and/or pharmacological intervention/s, education or individual and/or couple therapy (Wiederman, 2001; Almås and Landmark, 2010; Brotto et al., 2017). Sensate Focus, a mainstay of sex therapy, originally developed by Masters and Johnson (1966), is a structured-touch treatment programme used to treat FSIAD. The therapeutic process involves working through sequential stages of increasing intimate contact and culminates in sexual intercourse.

Positioning the research within social constructionism, a methodological approach of narrative inquiry was used to explore how three women in long-term relationships, who had undertaken sex therapy to resolve their ‘low’ sexual desire, experienced sensate focus. Two narrative interviews were conducted with each participant. Three in depth individual narratives were produced from their accounts using dialogic/performance analysis.

The research highlights the evolution of psychotherapy in relation to psychiatry and challenges the change in emphasis from mutuality, contextual understandings and social responsibility to explorations of individualistic, objective, scientific facts and processes.

It places the experience of sensate focus centre-stage and offers a more contextually embedded narrative of how the process is experienced by women with low libido and what they internalise from the process. The women’s accounts highlight the pervasive role of implicit interpersonal processes in their experiences of sexual desire and show how the negotiation of the sensate tasks may be used to expose recurrent and entrenched relational dynamics which ultimately undermine sexual desire. While my research endorses the primacy of emotional connection in female sexual relating, it also highlights women’s struggle with an inner objectifying voyeur that mirrors societal attitudes toward their bodies, sexuality and aging - all of which can be sexually undermining. The primacy of intercourse in sex is also considered.

The implications for psychotherapy are that the foregrounding of sexual performance, or the lack of it, in the absence of relational factors will inevitably pathologise diminishing sexual desire. Therefore, right from the beginning of the programme, the negotiation of boundaries in the sensate tasks offers a vehicle for exploring interpersonal dynamics and exposing relational difficulties. Furthermore conversation, being listened to and taken seriously, mirrored by the therapist, all contribute to the creation of an emotional connection vital for intimate relating.