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My Real Life "Sessions." How a Sex Therapist Learned About the Limits of Talk Therapy by Margie Nichols

Monday, October 8th, 2012

  Recently I was interviewed by Newsweek for an article anticipating the release of the film “The Sessions.”  I didn’t make the final cut, but I’m pleased that Lizzie Crocker wrote a pretty balanced article about the controversy over the use of sex surrogates, or surrogate partners as they are now called.  Vena Blanchard, the head of IPSA, the International Professional Surrogates Association, was sympathetically portrayed and cogently quoted.

      But I was disappointed that the only comments from a sex therapist in the article were from David Schnarch. Schnarch is well known and highly regarded, an acknowledged expert in sex therapy with couples.  But he represents the conservative wing of sex therapy, at least on this issue.  He made surrogacy sound a little smarmy, and implied incompetency on the part of any therapist who would have to ‘resort’ (his word) to using one.

      But there are sex therapists who find surrogates helpful, even though they are often reluctant to speak publicly about this, because Schnarch’s perspective dominates the field.  In fact, earlier this year the discussion of surrogacy on the listserv of a prominent sexology organization was disrupted by a participant who threatened to sue any therapist who admitted to the use of surrogates.  So it’s not surprising that no one is stepping forward to defend their use.  But even though there is some potential risk here,  I think it’s important for me to go on record about my experience collaborating with a surrogate to help a client I’d been seeing in talk therapy for a couple of years.

    As Crocker describes, the use of surrogates has a venerable history: they were used by William Masters and Virginia Johnson in their ground-breaking behavioral therapy for people with sexual dysfunction.  Most sex therapy, almost by definition, ultimately revolves around sexual contact with a partner, and the doctors used surrogates to take the place of a partner for single patients.  Since sex therapists don’t actually observe their clients having sex, the most important part of  therapy often happens at home with behavioral homework assignments.   The protocols for many sexual problems – e.g., erectile dysfunction, rapid ejaculation, some types of orgasm difficulties - start with masturbation exercises done at home, but there comes a time where therapy must halt without a partner.  Surrogates, from the first, were more teachers, more emotional and physical healers than sex workers, although knowledge of sexual technique and extreme comfort with sex was obviously a prerequisite.  Think ‘physical therapist’ with a lot of intimacy, sensuality, and possibly orgasms.

     Since M & J, however, surrogates have fallen out of use.  In part they became victims of the general backlash against sex that blossomed in the ‘80’s and still dominates our hypocritical Puritan culture today.  But some of the decline is attributable to sex therapists themselves.  Masters and Johnson pulled off the use of surrogates because, in their white lab coats, they appeared professional and pretty asexual.   But sex therapists who followed M & J  have always wanted, and sometimes needed, to distinguish themselves from a public  that regarded them with suspicion and conflated them with sex for hire.  To this day, I get my share of whack-off calls, usually guys who think listing myself as a sex therapist is code for phone sex, if not more.  So sex therapists have distanced themselves from surrogate partners in order to gain credibility and respectability.  And now, few sex therapists are even educated about their use, so I hope my story will give some insight to those of my colleagues who are open minded but uninformed.    

            I’d practiced for over 25 years as a sex therapist without using a surrogate.  I’d been told – erroneously, as it turns out – that therapists could get arrested for ‘solicitation’ for referring to a sex surrogate.  I’m on the East Coast, where the use of surrogates is less common- California remains the source of most surrogate referrals.  So I never knew anyone who used one, and after a while, I forgot about using them.

     Then last year two things happened at once.  I had a young male client with one of the above sexual problems who had gone as far as he could with in depth talk therapy, EMDR, and solo behavioral exercises.  His dysfunction turned out, unsurprisingly, to be intertwined with other problems of self-esteem and social anxiety.  But it wasn’t just about that, and he was at the point where he really needed a partner to go further.  About the same time, I was part of an online conversation about the use of surrogates- the one that ended in flames - and learned that in over 40 years of existence, IPSA has not one recorded instance of a therapist being disciplined or arrested for using a surrogate. 

   The next week my client told me he had hired an expensive escort, and that it had helped a little.  A lightbulb went off in my head, and I explained what a surrogate was (or rather, what I thought it was – I turned out to be wrong).   I asked if he would be interested – he was, and it was arranged.  It was what IPSA calls an ‘intensive’ – over two weeks of the surrogate and my client spending six hours a day together.  And every day the client, the surrogate and I de-briefed by phone, Skype, or in person.

    My expectations of what would happen were shattered.  I thought she would complete the set of behavioral exercises my client had started solo.  That was the LAST item on the agenda – and the least important.

     Without getting into details, this is what I saw happen over those 12 or so days:

I observed a surrogate partner who was one of the most loving beings I’ve ever seen, who regards her healing efforts as a vocation, not a job;

Who genuinely cared for and appreciated my client, and was able to convey this to him;

A skilled therapist who created an absolutely safe space for an anxious young man;

A playful sexual being who was able to educate and teach our mutual client to be the same, able to get him to appreciate his own body, have confidence in his skills to please a woman, recognize his own desires and ask for them respectfully, and ultimately please himself.

She also gave him a model of safe and loving intimacy that he can carry in his head when he looks for a partner himself.

And in the process, especially through sensual touch, his body released memories of childhood that then became important focuses of my talk therapy with him.

Oh, and btw – there was very little genital sex, only towards the very end.

     So I ask you – what’s bad about any of that?  I certainly couldn’t have done those things. Sex therapists, like all mental health practicioners, are prohibited from intimate contact with clients – and that prohibition is essential to creating a safe space for the type of therapy we do.  But surrogates can heal what we can’t.  Could a terrific girlfriend have done the same?  Absolutely, and someday I hope some awesome woman will take my client to the next level.  But the problem is he lacked the self-confidence to approach women, and possibly the skills to discern a ‘good fit’ and then to keep her.  That’s changed now. 

   These situations don’t come up often.  Most sex therapy clients will never use a surrogate, even some who probably should.  But the alternative should exist, and more therapists should educate themselves about their use.  If we are truly sex-positive, we need to acknowledge the ability of sex – and touch – to heal.  We can’t do it, but we can help make that healing happen – like in ‘The Sessions,’ like this moving video of a woman whose use of a surrogate helped her overcome early abuse trauma – and like what happened for my young client.

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