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 sex therapist to meet the goals of their client. This triadic model is used to dually support the client: the client engages in experiential exercises and builds a relationship with their surrogate partner while processing and integrating their experiences with their 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. 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.
Patients frequently present with these specific problems:
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. 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 therapist and the Surrogate Partner. The 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 Sexual Surrogate Partner. Therapists are limited only to talk therapy, which is why a Surrogate Partner can be beneficial in helping address the client's concerns through exposure therapy, with no limitations of touch. The therapist is responsible for relaying critical information and treatment goals to the Surrogate Partner 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 sexuality. This step can 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 can work on exercises with the client to feel comfortable in their own body and next to someone else's body, this can involve hugging, or cuddling.
In the third step, the surrogate and client focus on sexuality, this can involve:
The fourth step is closure, to close out the therapy once all parties are satisfied with the results.
Since sexual problems are often psychological rather than physical, communication plays a key role in the therapeutic process between a patient and the surrogate partner, as well as between the surrogate partner and the 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, therapist, and surrogate partner in which the goals of the client are discussed and the scope/duration of the therapy are established. Throughout the process, communication between surrogate partner-client, client-therapist, and surrogate partner-therapist is maintained.
Some couples attend surrogate partner therapy sessions together, while some people (either single or in a couple) attend them alone. The surrogate engages in education and often intimate physical contact and/or sexual activity with clients to achieve a therapeutic goal. Some surrogates work at counseling centers, while others have their own offices.
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 sex surrogate Vena Blanchard.