William H. Masters and Virginia E. Johnson, human sexuality researchers, first introduced the idea of sex surrogate therapy in their 1970 book Human Sexuality Inadequacy. Their belief was that people could only learn about sexual intimacy experientially. Over the course of their research, couples explored sexual intimacy exercises together; however, the single people in the study were paired off with surrogates in lieu of a committed romantic partner. The surrogates worked closely with therapists to act as a mentor or coach to the clients. A therapist will first have talk therapy sessions with a client. They’ll work to develop a treatment plan to help with physical and sexual healing and intimacy, which may involve introducing work with a sex surrogate. Sex surrogates work in close collaboration with a therapist and a client. Surrogates are trained to help clients with treatment goals, which may include becoming more comfortable with their body, developing emotional and physical skills for intimacy, building sexual confidence, and addressing issues like shame that occur with intimacy and sexuality.
Techniques
One of the misconceptions about this type of therapy might be that it’s just sex. If it were just sex, there wouldn’t be a therapeutic component—which there is. Sex surrogates can help a client understand the giving and receiving of different types of touch (such as friendly, affectionate, comforting, healing, sensual, erotic, or sexual touch). A surrogate may also help a client practice the development of social and sexual skills, and support the client in healing. For example, a client who is a survivor of sexual abuse or assault may recoil from touch, and a sex surrogate can help the client learn how to differentiate between safe, consensual, and caring touch versus aggressive and harmful touch. In the International Professional Surrogates Association’s code of ethics, it states the term “surrogate partner” can only apply in a therapeutic situation that includes a client, surrogate and supervising therapist, usually a sex therapist. There is a protocol that practitioners of this therapy follow, which follows four different steps or phases.
Emotional Connection
Like other, more traditional therapy, the basis of the beginning of the work in sex surrogate therapy is building rapport, or, emotional connection. While this is key in any therapeutic relationship, it is imperative in this type of therapy that may also involve more direct physical, intimate, or sexual interaction.
Sensuality
Next, you will begin to become intimate with touch. A technique often used is sensate focus, which involves touching mindfully. Sensate focus involves participants focusing on their own feelings, experiences, and sensory perceptions during touch instead of focusing on the other person’s experience, genitals, or goal-oriented behavior such as orgasm. The focus is meant to be on the sensation and experience of the touch being given and received.
Sexuality
Although the therapy is sometimes called sex surrogate therapy, that may be a bit of a misnomer. One study looked at the percentage breakdown of activities surrogates engaged in, and sexual activities—including fellatio, cunnilingus, and sexual intercourse—only comprised 12% of the activities.
Closure
From the beginning of their work with a sex surrogate, clients are informed that they will be engaging in a professional and therapeutic relationship, not a romantic relationship. During the course of their therapeutic work with a sex surrogate, the client will talk, process, and integrate their feelings and experience with both their therapist and surrogate.
What Sex Surrogate Therapy Can Help With
Sex surrogate therapy is said to help a number of physical conditions including:
Anorgasmia (inability or difficulty orgasming) Erectile dysfunction Sexual pain Vaginismus (tightening of vaginal muscles that prevents penetration)
Sex surrogate therapy can also help mental health conditions including post-traumatic stress disorder (PTSD) and anxiety. Working with a therapist and sex surrogate may also be helpful for those who’ve survived sexual abuse or assault. Working with a sex surrogate can be helpful for trauma survivors or transgender patients following surgery to increase comfort with their bodies. It can also be helpful for those living with paralysis or brain trauma or who have autism or schizophrenia.
Benefits
Though not much research exists on this field to validate the benefits, several small studies have found that it may help alleviate physical symptoms such as vaginismus or erectile dysfunction. It also is believed to lead to more meaningful and satisfying relationships for those who are partnered.
Effectiveness
Research shows that sex surrogate therapy has helped clients with disabilities overcome obstacles they faced with sexual functioning. One paper discusses how a bisexual woman was able to uncover and appreciate her sexual identity with sex surrogate therapy. One study notes that a man who began inappropriately touching people as a result of a traumatic brain injury showed improvements in his behaviors after 16 weeks of sex surrogate therapy, as he learned about boundaries and what constitutes appropriate sexual behavior. A group study of 16 women experiencing vaginismus who participated in this type of therapy had a 100% success rate in treating the condition when compared to treating it with couples therapy.
Things to Consider
Although sex surrogate therapy has some demonstrated benefits and success, it is still wildly controversial, especially considering that sexual contact between psychotherapists and their clients is unethical and illegal by most professional organizations’ and state licensing boards’ standards. However, the sex surrogate is typically not a psychotherapist and, if they are, by IPSA’s standards, their primary role is as a sex surrogate. While the state doesn’t provide any definite protections for these types of practices, California also hasn’t outlawed the practice. Many have concerns over the ethics of the practice, including complications in feelings of attachment, particularly in a population already vulnerable to that. Criticism of the research that does exist is that it typically excludes discussion of the psychological effects, focusing more on the physical benefits. Additionally, some say that this type of paid relationship doesn’t help clients out in the “real world.”
Caution
Sex surrogate therapy work is not recommended for individuals who are inclined to form extreme and intense emotional attachment in relationships, individuals already in committed partner relationships, or individuals who have a history or suspected history of psychiatric instability. It is also not recommended for those who believe that sex surrogate therapy is an opportunity to experience sex in a “risk-free” environment.
How to Get Started
If you are interested in pursuing sex surrogate therapy services, the best place to start is with your existing therapist, if you are seeing one. They can tell you if they think it will be appropriate for you given your treatment goals and if they would feel comfortable with processing this type of work with you. If you’re not already in therapy, a sex therapist is a great place to start. They can help you unpack the issues leading you to seek this kind of therapy and may be able make recommendations or referrals to a sex surrogate. The American Association of Sexuality Educators, Counselors, and Therapists has a directory of sex therapists on their website. When looking for a sex surrogate, the primary thing to ask yourself is if you feel comfortable and safe with this person. This is an incredibly vulnerable type of work, so you want to be sure this is someone you can trust. This type of therapy may happen in a few ways: intensively, over the period of about two weeks, where you would meet with the surrogate and the therapist daily or over the course of months or even years. This work is likely undoing years of programming, so it is best to be patient.
Other Options
Because surrogate partner therapy can be so deeply personal, it may be too much for you, and that is totally fine. But if you are looking to heal sexually in a less hands-on way, somatic sex education and sexological body work might be for you. The two modalities have much overlap, but encompass education in breath work, body awareness and communication skills. The biggest difference is that any touch is one way–that is, only the client is the one being touched, and there is never intercourse.
A Word From Verywell
Because this is a controversial and minimally-regulated field, you will want to be very thorough in your research before embarking on this type of therapy. If anything doesn’t feel right, trust your gut.
