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Sex surrogates, sometimes referred to as surrogate partners, are practitioners trained in addressing issues of intimacy and sexuality. A surrogate partner works in collaboration with a talk therapist to meet the goals of their client. This triadic model, composed of the client, talk therapist, and surrogate partner therapist is used to dually support the client and the surrogate partner therapist. The client engages with the surrogate partner therapist in experiential exercises and builds a relationship with their surrogate partner therapist while processing and integrating their experiences with their talk therapist or clinician.
The modality in which surrogate partners work is called surrogate partner therapy. This modality is used to address obstacles to physical and emotional intimacy that a client is unable to resolve through traditional therapy and requires the involvement of a partner. Clients’ presenting issues have commonly included sexual dysfunctions, lack of healthy intimate experiences, or traumatic history.
Masters and Johnson introduced the practice in their book Human Sexual Inadequacy, published in 1970. They believed that people could learn about sexual intimacy only by experiencing it. In their research, subjects that were partnered used these partners to aid in a series of exercises designed to help overcome sexual dysfunction. Unpartnered subjects were paired with "surrogates" who would take the place of a partner, work under the direction of a trained therapist, and act as a form of mentor for the client. In their research, all of the surrogates were women who were assigned to work with single men. Today, most surrogates are women, but a few are men. [1] The practice of Surrogate Partner Therapy reached its peak in the early 1980s with a few hundred surrogate partners practicing in the U.S. Since then, Surrogate Partner Therapy's popularity declined but reentered social consciousness after the 2012 film The Sessions , which depicts one surrogate partner's work with a disabled man. As of 2014, those practicing Surrogate Partner Therapy were still very few in number. [2]
Patients frequently present with these specific problems: [3] [4]
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There are people who have experienced a change in sexual lifestyle due to an acquired disability (accident, paralysis, disease, trauma), and a surrogate can help them explore and develop sexual potential. [5] The causes of sexual concerns are numerous and the methods a surrogate might use to help improve a client's sexual life are varied.
The course of this therapy involves continued communication with both the talk therapist and the Surrogate Partner Therapist. The talk therapist is responsible for addressing the client's concerns and helping them explore ways to overcome their sexual problems through talk therapy. If the therapist and client deem it necessary that they need additional assistance, they can explore the option of working with a Surrogate Partner Therapist. Talk therapists are limited only to talk therapy, which is why a Surrogate Partner Therapist can be beneficial in helping address the client's concerns through exposure therapy, without the same limitations on touch. The talk therapist is responsible for relaying critical information and treatment goals to the Surrogate Partner Therapist for the meeting with the client, so that they may fully address their concerns during the interaction. The therapist, surrogate partner, and client work together to create their course of a treatment plan, the interaction between the client and the Surrogate Partner is essentially for the client to practice what they've learned with their therapist through talk therapy.
The methodology of this therapy is described to have four phases to achieve a successful treatment:
The first step in Surrogate Partner Therapy is for the surrogate to verbally create an emotional connection and bond with the client, to create a safe environment and address any boundaries and expectations. During this step, the surrogate and client can get to know each other as individuals and create a meaningful relationship. This first step is essential in making the client feel comfortable in pursuing this new type of therapy and laying a good foundation for practicing emotional intimacy.
The next step involves exploring the client's sensuality. This step may involve physical touch and nudity to help the client overcome their sexual concerns, but would not involve sexual arousal or interaction between one another. In this step, the surrogate partner therapist may work on exercises with the client to help them feel more comfortable in their own body and near someone else's body, this may involve hugging, or cuddling.
In the third step, which more often than not completed as it is not necessary to achieve the therapeutic goals, the surrogate partner therapist and client focus on sexuality, this may involve:
The fourth step is universal to all therapy and is closure, to close out the therapy once all parties are satisfied with the results.
Since sexual problems are often psychological rather than physical[ citation needed ], communication plays a key role in the therapeutic process between a patient and the surrogate partner therapist, as well as between the surrogate partner therapist and the talk therapist. Surrogate partners offer therapeutic exercises to help the patient. These may include, but are not limited to relaxation techniques, sensate focusing, communication, establishing healthy body image, teaching social skills, sex education, as well as sensual and some sexual touching. Surrogate partner therapy begins with a meeting between the client, talk therapist, and surrogate partner therapist in which the goals of the client are discussed and the scope and arch of the therapy are established. Throughout the process, communication between surrogate partner therapist-client, client-talk therapist, and surrogate partner therapist-talk therapist is maintained. [6]
By definition, Surrogate Partner therapy is solely performed with single (unpartnered) persons. The surrogate partner therapist engages in education, often intimate physical contact, and only very rarely sexual activity with clients to achieve a therapeutic goal. [7] Some surrogates work at counseling centers, while others have their own offices. [8]
The 2003 Salon.com article "I was a middle-aged virgin", by Michael Castleman, discusses a middle-aged American virgin (Roger Andrews) and his therapy with the surrogate partner therapist Vena Blanchard. [9]
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Vaginismus is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. This often results in pain with attempts at sex. Often it begins when vaginal intercourse is first attempted.
Hypoactive sexual desire disorder (HSDD), hyposexuality or inhibited sexual desire (ISD) is sometimes considered a sexual dysfunction, and is characterized as a lack or absence of sexual fantasies and desire for sexual activity, as judged by a clinician. For this to be regarded as a disorder, it must cause marked distress or interpersonal difficulties and not be better accounted for by another mental disorder, a drug, or some other medical condition. A person with ISD will not start, or respond to their partner's desire for, sexual activity. HSDD affects approximately 10% of all pre-menopausal women in the United States, or about 6 million women.
Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.
Sex therapy is a therapeutic strategy for the improvement of sexual function and treatment of sexual dysfunction. This includes dysfunctions such as premature ejaculation and delayed ejaculation, erectile dysfunction, lack of sexual interest or arousal, and painful sex ; as well as problems imposed by atypical sexual interests (paraphilias), gender dysphoria, highly overactive libido or hypersexuality, a lack of sexual confidence, and recovering from sexual abuse ; and also includes sexual issues related to aging, illness, or disability.
Couples therapy attempts to improve romantic relationships and resolve interpersonal conflicts.
Sensate focus is a sex therapy technique introduced by the Masters and Johnson team. It works by refocusing the participants on their own sensory perceptions and sensuality, instead of goal-oriented behavior focused on the genitals and penetrative sex. Sensate focus has been used to treat problems with body image, erectile dysfunction, orgasm disorders, and lack of sexual arousal.
Feminist therapy is a set of related therapies arising from what proponents see as a disparity between the origin of most psychological theories and the majority of people seeking counseling being female. It focuses on societal, cultural, and political causes and solutions to issues faced in the counseling process. It openly encourages the client to participate in the world in a more social and political way.
The term emotional affair describes a type of relationship between people. The term often describes a bond between two people that mimics or matches the closeness and emotional intimacy of a romantic relationship while not being physically consummated. An emotional affair is sometimes referred to as an affair of the heart. An emotional affair may emerge from a friendship, and progress toward greater levels of personal intimacy and attachment.
Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.
Gay affirmative psychotherapy is a form of psychotherapy for non-heterosexual people, specifically gay and lesbian clients, which focuses on client comfort in working towards authenticity and self-acceptance regarding sexual orientation, and does not attempt to "change" them to heterosexual, or to "eliminate or diminish" same-sex "desires and behaviors". The American Psychological Association (APA) offers guidelines and materials for gay affirmative psychotherapy. Affirmative psychotherapy affirms that homosexuality or bisexuality is not a mental disorder, in accordance with global scientific consensus. In fact, embracing and affirming gay identity can be a key component to recovery from other mental illnesses or substance abuse. Clients whose religious beliefs are interpreted as teaching against homosexual behavior may require some other method of integration of their possibly conflicting religious and sexual selves.
Private Practices: The Story of a Sex Surrogate is a 1985 US documentary film directed by Kirby Dick about the interaction between a sex surrogate and her clients - Dick's first documentary film.
Joe Kort is an American psychotherapist, clinical social worker, board-certified clinical sexologist, author, lecturer and facilitator of therapeutic workshops. He works as Clinical Director and founder of The Center for Relationship and Sexual Health in Royal Oak, Michigan.
The American Association of Sexuality Educators, Counselors and Therapists (AASECT) is a professional organization for sexuality educators, sexuality counselors and sex therapists.
Certified Sex Therapists (CST) have graduate degrees in a clinical mental health field and have obtained advanced training in sex therapy from a credentialed training body, resulting in certification. One of the largest such bodies is the American Association of Sexuality Educators, Counselors and Therapists (AASECT).
The Sessions is a 2012 American drama film written and directed by Ben Lewin. It is based on the 1990 article "On Seeing a Sex Surrogate" by Mark O'Brien, a poet paralyzed from the neck down due to polio, who hired a sex surrogate to lose his virginity. John Hawkes and Helen Hunt star as O'Brien and sex surrogate Cheryl Cohen-Greene, respectively.
Cheryl Cohen-Greene is an American sexual surrogate partner, speaker, and author, known for her work with American poet Mark O'Brien in 1986, before his death in 1999. She was portrayed in the film The Sessions by Helen Hunt, who received an Academy Award nomination for her performance. In 2012, Cohen-Greene released her memoire, titled An Intimate Life: Sex, Love, and My Journey as a Surrogate Partner.
Center for Healthy Sex is a community therapy center in Los Angeles that specializes in the treatment of sexual dysfunction, sexual anorexia, sex addiction, and love addiction. The Center is located on Santa Monica Boulevard near Overland Avenue bordering the neighborhoods of Century City and Westwood.
Wendy Maltz is an American sex therapist, psychotherapist, author, educator, and clinical social worker. She is an expert on the sexual repercussions of sexual abuse, understanding women's sexual fantasies, treating pornography-related problems, and promoting healthy sexuality. She has taught at the University of Oregon and, up until her retirement in 2016 from providing counseling services, was co-director with her husband, Larry Maltz, of Maltz Counseling Associates therapy practice in Eugene, Oregon.
Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.
Many health organizations around the world have denounced and criticized sexual orientation and gender identity change efforts. National health organizations in the United States have announced that there has been no scientific demonstration of conversion therapy's efficacy in the last forty years. They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the Hippocratic oath to do no harm and to refrain from attempts at conversion therapy.