What training protocols do sex therapists use to teach the stop‑start and squeeze techniques in couple therapy?
Executive summary
Sex therapists teach the stop‑start (pause) and squeeze techniques as structured behavioral exercises embedded in a broader sex‑therapy protocol—usually beginning with psychoeducation and sensate‑focus, progressing through graded solo and partnered practice, and often delivered across multiple sessions with follow‑ups [1] [2] [3]. Randomized and controlled trials are small but suggest modest gains in intravaginal ejaculatory latency time (IELT) when these techniques are taught within comprehensive therapy rather than as unsupported self‑help [4] [5].
1. What the stop‑start and squeeze techniques actually are
The stop‑start method asks the man (or couple) to build sexual stimulation up to near the “point of no return” and then stop stimulation until the urgency abates; the squeeze technique adds a firm manual compression of the penis at the glans just below the head to blunt the ejaculatory reflex before resuming activity [6] [7]. Masters and Johnson and later sex‑therapy manuals codified these as behavioral skills intended to teach awareness of arousal phases and voluntary modulation of orgasm timing [1] [8].
2. How therapists introduce the practices: psychoeducation and sensate focus
Clinicians typically begin with education about sexual response, normal variability in latency, and the role of performance anxiety, then move to sensate‑focus exercises (non‑goal oriented touching) so partners relearn pleasurable sensation without pressure to perform; the stop‑start/squeeze techniques are introduced during or after genital sensate focus once relaxation and communication skills are underway [1] [2] [8].
3. Typical session structure and home‑practice prescriptions
Protocols in the literature describe multi‑session behavioral programs—commonly 4–6 or more therapy visits of roughly 45 minutes spaced across weeks—combined with daily or twice‑weekly home exercises that begin with solo practice (masturbation) and progress to partnered practice and intercourse after initial sessions; instructional materials frequently include demonstrations, videos or visuals and explicit guidance on frequency and when intercourse is permitted in the program timeline [3] [9] [10].
4. Partner role, pelvic‑floor and cognitive elements
Therapists teach partners how to perform the squeeze safely and compassionately and often pair behavioral drills with communication training, breathing, pelvic‑floor or sphincter control exercises, and cognitive work to address dysfunctional beliefs and performance anxiety—studies report greater effects when stop‑start is combined with sphincter control or broader psychosexual education [7] [3] [8].
5. Evidence, outcomes and limitations of the protocols
Systematic reviews and trials show modest benefits: small RCTs report increased IELT by a few minutes after about 12 weeks when behavioral techniques are taught within sex therapy, and some studies report improved sexual satisfaction when sensate focus plus stop‑start/squeeze are used versus waitlist; however, trials are small (often <40 participants per arm) and heterogeneous, so effect sizes and long‑term durability remain uncertain [4] [5] [11]. Clinical guidance therefore treats behavioral approaches as first‑line, but emphasizes combination with psychotherapy or pharmacotherapy for many men [1] [5].
6. Practical, ethical and clinical considerations
Best practice in couple therapy emphasizes informed consent, explicit rehearsal of techniques outside surprise sexual moments, stepwise progression from non‑genital to genital exercises, and therapist attention to relationship strain or trauma that might make exercises inappropriate; commercial self‑help versions exist, but the evidence base supports higher effectiveness when techniques are clinically supervised and integrated into couple‑centered therapy [10] [5] [8].