Here's An Inside Look At The Therapists Who F#ck Clients
Let's talk about crippling sexual dysfunction, baby. For years, people suffering from sexual disorders have sought the help of psychiatrists and sex therapists, but there's a big difference between learning the theory of riding a bike and going out there and getting on one. That's why a sex therapist might give a patient an eyebrow-raising prescription: a sexual surrogate.
In brief, a sexual surrogate is someone who helps a patient overcome a sexual problem through therapy and physical exercises that can, and generally do, include intercourse. You might call them medicinal sex workers. While researching his new book, Robert Evans talked with two of these workers, as well as a therapist who works with one of them, to learn more about their work.
It's Totally Legal, Under Specific Circumstances
As a general rule, when you pay money to have sex with someone else, John Law starts trotting out all kinds of fancy law words like "solicitation" and "illegal." But since 2003, sexual surrogacy has been essentially legal, though very much unregulated (the practice, of course, existed long before then). California's state attorney general summed the rules up as, "If it's between consensual adults and referred by licensed therapists and doesn't involve minors, then it's not illegal."
Since no arm of the U.S. government has made it their job to regulate this practice, the International Professional Surrogates Association (IPSA) has taken it upon themselves to make sure sexual surrogacy doesn't go the way of medical marijuana and become an excuse for people to get around inconvenient laws. Shai Rotem, who has been a sex surrogate for more than a decade, works with the IPSA. He also works with a number of clothed therapists, including Shemena, as the law requires.
Shemena explains that the process usually begins with Shai contacting her and walking her through his notes on a client's sexual background, "and then, I will meet with the individual and do my own assessment." Shai and Shemena then take turns visiting with the client over a period of weeks or months. "We keep each other in the loop in regards to any impasses that are occurring," Shemena says, noting that "The client is fully aware of our engagement."
Essentially, it's two medicals professional coordinating care, like an oncologist would with a general physician, rather than a nod-and-wink license to hump. In fact ...
Actual Intercourse Is A Small Part of It
When Shai first meets with a client, he doesn't simply drop trou and get down to business. In fact, he explains that "non-painful penetration" would be "one indication for success" for about 99 percent of his clients -- meaning that it's the end goal, not the starting kick. You work up to it slowly, starting with nonsexual contact and rounding the bases at a pace even an asthmatic T-baller would scoff at. "The average client needs about 40 hours from a surrogate partner," Shai says. "That's 20 sessions. And some people with more issues ... may need more than that." That's at least an entire work week of mostly not boning.
Remember, these aren't just people who need to get laid -- we'll talk about those in a moment. Shai's patients are struggling with real issues, from painful physical conditions like vaginismus (an involuntary nervous clenching of the vaginal muscles) to sexual trauma. Shai talks about one client: "I felt that she was pushing the therapy process too fast, wanting to get naked on the third session. I had to explain, 'No, we're not going to do that.' And by processing with the therapist and myself, she was able to understand that she felt so uncomfortable at the stage where we were just holding hands and talking she was powerless, and she wanted to gain power by having sex with me."
In that case, the surrogate's job is to help their client learn how and when to say no, too. For clients who have been sexually assaulted, a lot of the therapy is "about trusting men," Shai explains. "Because these people, their private space and body were brutally violated ... many of them don't have a healthy sense of boundaries. Many women I worked with don't know they're allowed to say 'No,' or 'I don't like that.'"
The Training Process Includes An Internship
Another difference between a sexual surrogate and a prostitute is that the former will usually have some education under their belts, while the latter is more of an on-the-job training kind of deal. Shai and his colleagues at the IPSA administer a one-year internship to would-be surrogates, which includes lectures, required reading, and "hands-on exercises." No, not that kind.
"We teach and educate the candidates of very specific breathing and relaxation exercises, focus exercises," Shai says. "These help people get in touch with their body, sensuality, senses. And then we teach about human sexuality. They have to be very knowledgeable about sexual dysfunction. We teach them some clinical practices about how to work with clients." Once they've gone through their training, interns start working with clients and therapists under the supervision of the experienced surrogate who's been teaching them. And yes, we realize that even though we are using very clinical language, half of you still spent that last sentence picturing an Eyes Wide Shut situation. "So she tells us what to do, and then watches us from the shadows? And the whole thing is in some kind of ... dungeon, I assume?" No. Or at least, that's not how the ones we spoke to do it.
"They see the therapist separately once a week, and then they come to my office," Shai says. "They have a 30-minute check-in conversation with me, we review the past week and all the experiences they had in the last session, and prepare the client for today's session with the partner ... and then I leave the therapy room, and they go ahead and see the surrogate partner for a two-hour session ... I go back and process the experience and talk with them, and give them homework to exercise until next week."
Shai normally works with one intern at a time, but so far, he's trained more than 20 of what we're going to go ahead and call "erotic padawans," because someone's got to use that term before the fanfiction community takes it.
A Lot Of Women Go Untreated
The man who refuses to go to the doctor until at least one appendage is actively falling off is a well-worn stereotype, but when it comes to sex therapy, the opposite is true. Whatever stigma men may feel for seeking treatment for sexual dysfunction is usually overcome by sheer urgency. As Shai says, men are generally programmed to feel that "when something doesn't work for them sexually, they lose a major component of their identity." Our culture insists that a man who can't bone isn't a "real man" at all. Lots of men who'd let a suspicious lump go for years will quickly make a call when things stop working downstairs.
Women, on the other hand, are more reluctant. A woman who, say, cannot achieve orgasm will be less likely to seek help than a man with the same problem -- hence why 10-15 percent of women have never orgasmed. It's tragic, because when a woman overcomes the stigma of sexual treatment, her odds of success are overwhelming. According to one study, surrogacy was the most effective method of treating vaginismus. The surrogate patients succeeded in penile-vaginal intercourse 100 percent of the time, compared to 75 percent of patients working with their romantic partners.
That last part touches on a question lots of you probably had: "Isn't it creepy doin' it with a clinical professional you feel nothing for, rather than a real partner? Wouldn't that make a nervous person even more nervous?" But it turns out that's actually a major advantage of surrogate therapy. Relationships are stressful enough as it is. Do you seriously want to add being responsible for the operation of your partner's vag-valve to everything else?
Most people think it ruins the mood to constantly stop and update each other in cold, clinical language, since that never happens in movies. ("Okay, the beach setting is romantic, but this is hurting my hips and I now have a surprising amount of sand in my anus.") When you can strip away the pretense and be frank about what you're feeling, years of dysfunction can be overcome in weeks. And remember that they lead up to it slowly -- there's none of the unspoken pressure to perform or resist. Everything is discussed, everyone is clear on what should happen next.
"But," you are probably wondering, "don't these people wind up falling in love with their surrogate, the handsome stranger who literally navigated them through a sensuous sexual awakening?" Yep! But ...
A Healthy Breakup Is Part Of The Therapy
"In our work in surrogate therapy, we encourage clients to feel. This is the very first thing we encourage," Shai says. "All clients, at some point in this process, form a relationship with the surrogate, and that is healthy." But this one is unlikely to end in wedding bells, and it would probably be super unethical if it did. So "in surrogate relationships, we give our client the ability to end the relationship with a form of graduation."
Shemena acknowledges that terminating the relationship is the hardest part, but it's also helpful. Part of her job is to "help the client unpack what it is they're truly looking for. Usually it's a fantasy ... 'I want a friend. I'm lonely. I wish I had someone in my life who is similar to Shai.'" That's useful knowledge when the time comes to go out and find an unpaid partner, as well as the skills to cope if that partner turns out to be an asshat.
As Shai points out, "Many clients either never had any romantic relationship, or never had any successful relationship." So this is kind of like a dry run, with "a therapist who sees them every week and talks to them about their emotional attachment" to guide them through the process. Honestly, that's a service that could benefit even the healthiest person. Wouldn't it have been great if, before that first heartbreak socked you in the gut and force-fed you several gallons of ice cream, you'd had a practice breakup?
There's A Blurry Line Between Medicinal And Recreational Sex Work
Alright, so let's say that your equipment works fine, but you are sexually dysfunctional purely in the sense that you don't have anyone to have sex with. You're objectively suffering from an involuntary lack of sex (most humans need that kind of intimacy), and it can easily be cured by somebody letting you do sex at them. You don't need classes or therapy; you need a partner. But if such a partner comes along and that's the only service they offer, both of you can go to jail if you get caught (depending on the state). Because that's called "prostitution."
The only legal dividing line between surrogacy and prostitution is that surrogacy is done with a therapist for a therapeutic purpose, but it must have been close to lunchtime when it came to defining what counts as therapy. It seems easy to prove that the lack of a sex partner can be emotionally damaging, but surrogates aren't allowed to play that role. Shai says it's always about equipping his client to seek out sexual relationships on their own.
But we did find another surrogate -- one who isn't certified and doesn't work with IPSA -- who feels differently. We'll call her "K." One K client "had Muscular Dystrophy, and he was told he wouldn't live past 20. Around age 21, they told him he had a different type of MD ... so when he was 25, he decided he wanted to know sex. His therapist connected us. I've been seeing him for months." He and many clients have no expectation to ever have a nonprofessional sexual relationship, but K believes they benefit anyway. As she put it, "He's not gone off and gotten married, but it's expanded his horizons." Another man "had spina bifida and craved human touch" she says. "I was able to meet with him weekly and shower him with female energy. I met with him for about a year. And then one day, he died of a heart attack. But he got to be intimate with somebody who cared."
That's the single most heartwarming thing we've ever heard, but is it therapy? There's a documentary about this called Scarlet Road, which follows an Australian sex worker named Rachel Wotton who exclusively services the physically disabled. We asked Shai about the practice, and he was quite adamant that, "This is not surrogate partner therapy per se ... the touching and cuddling and being in this place of intimacy with a person has a healing effect on anyone, but you can't call it therapy, and you can't call it surrogate partner therapy. It's a different service."
An illegal one for the vast majority of you. Still, tell us that you don't know at least one person who would greatly benefit from such a service ("Now there's a guy who needs to be showered in female energy.")
For more insider perspectives, check out 5 Things You Learn About Sex As A Sex Therapist and Abortion On Request: 5 Facts Of Life As A Surrogate Mom.
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