Sex Surrogate Therapy: What It Is & How It Works

What Is Sex Surrogate Therapy?

Sex surrogate therapy, also known as surrogate partner therapy, aims to assist the client with overcoming barriers they may have regarding sexual functioning, emotional intimacy, and or physical intimacy. Ideally, the treatment will improve the client’s ability to form healthy sexual relationships with others. The treatment involves a three-person team, the practitioner, the client, and the surrogate partner.²

Sex surrogate therapy was founded by William H. Masters, a physician specializing in gynecological medicine, and Virginia E. Johnson, an American sexologist. Masters and Johnson headed the Masters and Johnson research team, which was devoted to researching human sexual responses, sexual disorders, and or dysfunctions. The team also organized training workshops for researchers, educators, and therapists.¹

Sex Surrogate Therapy Vs. Sex Therapy

Sex surrogate therapy may be confused with sex therapy, as both treatment practices are intended to assist clients with overcoming sexual or intimate concerns. However, they differ outside the counseling setting; sex therapy may involve solo-activity “homework” for the client to complete, such as masturbatory exercises, while sex surrogate therapy involves partnered activity with the surrogate partner.

Sex Surrogate Therapy Vs. Sex Workers

While sex surrogate therapy may seem similar to sex work, as both involve sexual acts, the goals of each practice are different. Sex workers are individuals who accept payment as compensation for sexual services. Sex surrogate therapy provides a client with a surrogate partner who will work in a comfortable, safe environment to explore physical and emotional intimacy to overcome established concerns.

What Sex Surrogate Therapy Can Help With

Sex surrogate therapy is aimed at addressing the client’s trauma, fears, or anxieties regarding physical or emotional intimacy. Sex Surrogate Therapy can be compared to exposure therapy, as both involve a gradual increase in exposure to an item of concern in a safe, structured environment.

The goals of sex surrogate therapy may not always concern sexual acts or sexual intercourse. Due to different types of trauma, clients may have difficulty with identifying platonic or sexual intentions from others and with identifying different types of displays of affection. Clients may work with their surrogate partner to address difficulty with physical touch with others and identify differences between different types of physical contact.

Sexual surrogate therapy can be used to treat the following:

• Erectile dysfunction
• Delayed ejaculation
• Anorgasmia
• Vaginismus
• Sexual pain
• Sexual trauma
• Emotional trauma
• Post-Traumatic Stress disorder
• Anxiety regarding sexual intercourse or other sexual acts
• Body dysmorphic disorder

Is Sex Surrogate Therapy Legal?

Considering that some people may hold the misconception that sex surrogate therapy is similar to sex work, it’s understandable that some may question the legality of the practice. While receiving monetary compensation for sex work is illegal in most of the United States, sex surrogate therapy may fall into an undetermined category of legality, as the goal of such is not simply sexual pleasure.

The therapeutic intentions behind sex surrogate therapy have prevented it thus far from receiving any legal backlash. Keep in mind that the sexual component of sex surrogate therapy is entirely optional, as some clients may engage in the practice to address other areas of intimacy.² The IPSA, the certifying body of the surrogate partners, has not faced any legal issues since its establishment in 1973.

Sex Surrogate Training & Certification

Surrogate partners are certified through the International Professional Surrogates Association (IPSA). Surrogate partners will complete 100 hours of courses covering human sexuality, sex therapy, and surrogate partner therapy. After completing their coursework, surrogates will complete a multi-year, multi-client supervised internship under a licensed clinician until they have demonstrated that they can function independently as a competent surrogate partner.³

Surrogate partners are also committed to a Code of Ethics through the IPSA. The IPSA Code of Ethics establishes guidelines for the partners to follow through their work as surrogate partners. The guidelines address the levels of communication required between the three-person team, the parameters of the therapeutic relationship between parties, and the boundaries to be maintained between the surrogate partner and client.⁴

How Does Sex Surrogate Therapy Work?

Sex surrogate therapy entails both a therapist and a surrogate partner. It begins with the client coming in for a counseling session with the therapist. Based on the presenting concerns, the therapist will create a treatment plan. The therapist will then recommend a surrogate partner for the client to work with to address their specific concerns. With the surrogate’s assistance between sessions, the practitioner will work with the client to discuss their work with the surrogate.

The four phases of sexual surrogate therapy include:⁵

1. Emotional Connection

As in most types of “traditional” therapeutic practices, the first phase in sex surrogate therapy is to establish trust and emotional connection between client and practitioner. The work done during sex surrogate therapy is incredibly intimate. As such, it’s imperative that the client feels comfortable with their practitioner. A trusting emotional relationship will ideally assist the client with being more open and honest with the practitioner during treatment.

2. Sensuality

The second phase in sex surrogate therapy involves the client growing more comfortable with physical touch. The technique utilized during this phase is sensate focus therapy, which consists of a series of touching exercises completed in sequence. The goal of the exercise is for the client to focus on the sensory aspects of touch rather than the expectations of how things “should” feel.⁶

3. Sexuality

The third phase of sex surrogate therapy involves sexual acts. The third phase, as well as the title of the therapeutic modality, may be moderately misleading, as only 12% of clients in sex surrogate therapy will engage in sexual activities with their surrogate partner.⁷ The modality is predominantly directed at assisting clients with becoming more comfortable with different types of physical touch.

4. Closure

The final phase of sex surrogate therapy involves maintaining boundaries between clients and their surrogates. Clients are informed at the start of the relationship with their surrogate that it is professional and not romantic. Throughout the client’s work with their surrogate, clients will discuss their feelings, processing, and success or difficulty maintaining boundaries with the licensed counseling practitioner.

Is Sex Surrogate Therapy Effective?

Since its inception, the efficacy of sex surrogate therapy has been questioned. Researchers have attempted to identify the efficacy of the practice through various studies utilizing different populations. In one study conducted in 2011, a woman could identify and come to terms with her bisexual orientation through assistance from sex surrogate therapy.⁵

In another study, 489 heterosexual male participants reported suffering from sexual dysfunction. 97% of said 489 participants sought sex surrogate therapy after trying “traditional” therapy. After three months and a 6% drop-out rate due to financial constraints, 89.78% of the remaining participants reported success in overcoming their dysfunction with the assistance of a surrogate partner.⁵

Things to Consider About Sex Surrogate Therapy

As sex surrogate therapy is an atypical and somewhat controversial practice, it is important to note that it is not appropriate for every client experiencing intimacy issues. For instance, individuals who are likely to form an emotional attachment to their surrogate partner, as identified through attachment trauma in their past, should avoid the modality.

Things to consider before beginning sex surrogate therapy include:

• Surrogate partners are not psychotherapists: Although the certified sex surrogate may possess another licensure, as per the IPSA Code of Ethics, the individual’s role in the sex surrogate relationship is to function as the surrogate and not the therapist.⁴
• You may develop feelings: As the activities performed during sex surrogate therapy are largely intimate practices, platonic or otherwise, some individuals may become attached to their sex surrogate partner. This inherent risk is why honest communication with the therapeutic provider is paramount to the modality’s success. Inappropriate attachment to the surrogate partner may disrupt the efficacy of the practice.
• Research is limited: Research on the efficacy of the treatment focuses on the physical benefits of treatment. There is little research that regards the long-lasting psychological effects of the treatment on clients.

How to Find a Sex Surrogate

A client seeking sex surrogate therapy must first seek out a licensed psychotherapist for therapy. Ideally, said provider will be a certified sex therapist. The provider can then seek a surrogate partner for the client through a professional network. The client may also seek out a surrogate partner directly through IPSA’s list of surrogate partners or one of IPSA’s referral coordinators.

Potential clients seeking sex surrogate therapy should first seek a licensed professional specializing in sex therapy. An online therapist directory is a great place to find assistance connecting to a licensed provider with a specialization in sex therapy.

In My Experience

Most people, aside from those identifying as aromantic or asexual, desire emotional and physical intimacy with others. Barriers in the way of achieving said intimate connections can be incredibly frustrating to deal with. Clients struggling with emotional or physical intimacy are under intense pressure to remedy their concerns; however, before seeking support through sex surrogate therapy, I would suggest seeking out traditional talk therapy with a licensed professional. Finding a provider who is a certified sex therapist can be additionally supportive. If traditional talk-therapy practices are ineffective at addressing your specific concerns, then it may be worthwhile to seek out alternative treatment methods, including sex surrogate therapy.