Sexual surrogate partners are women and men with professional training who function in place of an individual's nonexistent sexual partner in the course of sex therapy using a short-duration, delimited-boundaries, psychosocial/behavioral therapy model. As specified in the code of ethics of the International Professional Surrogates Association (IPSA), typically a surrogate partner will work with a client who is simultaneously being seen by a therapist, who directs the therapy as one member of the therapeutic triad of the client, therapist, and surrogate. As such, the therapist and surrogate consult prior to the surrogate's work with the client, and again later, as the surrogate is able to bring insights to the therapist for processing with the client following their social and/or sexual interaction. Those surrogates who work with clients without the supervision of a therapist are generally considered disreputable and outside contemporary professional standards for this type of therapy. Typically, also, for legal, ethical, or therapeutic reasons, therapists will not use sex surrogate therapy with clients who are married or have a regular sexual partner. At the beginning of the twenty-first century, sexual surrogacy remains a controversial practice in the United States, with complex legal, moral, ethical, professional, and clinical implications. Yet it continues to be of interest to many potential surrogate practitioners and clients.
Therapists and surrogates will work with clients of any sexual orientation for a variety of sexual dysfunctions or other sex-related emotional and social problems. Some surrogates specialize in working with persons specially challenged by various physical or psychosocial limitations; in some environments, these persons are prevented from having social interactions in which to meet potential partners, which sometimes limits their social or sexual skills. Vena Blanchard, president of the IPSA, highlights some of the populations found to benefit from this type of therapy:
The most common client referred to [surrogate partner therapy] is a heterosexual male with a combination of sexual and emotional inhibitions or dysfunctions that have delayed or inhibited his entry or re-entry into physically and emotionally intimate relationships—this includes mid-life virgins, men abused as children, and men troubled by rapid ejaculation, inhibited ejaculation, and erection difficulties. Female clients are referred to [surrogate partner therapy] to resolve debilitating negative body image, anorgasmia, vaginismus, mid-life virginity, sexual shyness, and sequelae of childhood abuse.
(Personal communication, June 5, 2006)
Although surrogate partner therapy has been found to be a highly effective adjunctive therapy model for resolving such issues, the use of this type of therapy appears to have been steadily declining since its introduction by William Masters and Virginia Johnson in 1970 (following a decade of experience developing it) and its peak in the early 1980s. Some of this decline, which began in the mid-1980s and persisted for about a decade, can be attributed to the fears surrounding AIDS that began to surface at the time, as noted by Raymond J. Noonan (1995, 2004). Despite signs that this decline was reversing by the close of the millennium, the introduction of Viagra, and the concomitant "medicalization" of sex therapy with various other drugs designed to enhance sexual performance for both women and men, have since accelerated the decline. This reflects, in part, the simultaneous decline in the use of traditional forms of sex therapy overall in favor of pharmaceutical solutions. Julian Slowinski, William R. Stayton, and Robert W. Hatfield (2004) note the criticism of these quick-fix solutions and the discovery by many couples and individuals that mere sexual functioning often does not address the complex emotional and interpersonal problems that can disrupt and destroy intimate relationships—the very issues on which sexual surrogate therapy tends to focus. Many surrogates and therapists believe that the healing process inherent in surrogacy is because of two factors: on the emotional level, the psychological processes of transference and counter-transference provide experiential material that the therapist can address, while the teaching and learning of sexual and relationship skills provide the behavioral component.
Both prospective clients and the general public often ask the question, what do sex surrogates actually do? Within the context of surrogate therapy, Noonan (1995, 2004) found in a 1984 survey of sex surrogates that they provided more than just sexual service for their clients, spending about 87 percent of their professional time doing nonsexual activities. In addition to functioning as a sexual intimate—which, in its various manifestations, involved only about 13 percent of their therapy time—the surrogate functioned as educator, counselor, and cotherapist, providing sex education, sex counseling, social-skills education, coping-skills counseling, emotional support, sensuality and relaxation education and coaching, and self-awareness education. The results indicated that most of the surrogate-client interaction was spent outside of the sexual realm, suggesting further that surrogate therapy employs a more holistic methodological approach than previous writings, both professional and lay, would seem to indicate. Clearly, the sex surrogate functions far beyond the realm of the prostitute, a common misconception among some members of the public—and some professionals and politicians—that still persists.
In 1988 Dean C. Dauw noted that little in-depth research had been conducted about surrogates, their effectiveness, or their appropriateness in working with specific sexual dysfunctions, a situation that has persisted into the twenty-first century. A number of other research questions exist that also need to be answered about surrogate practice in light of the various changes that have occurred with respect to sexual health issues in the four decades since surrogacy's inception. The reasons for this lack of research are unclear. Perhaps it has as much to do with the general antisexualism that remains a part of American culture as it has to do with the litigiousness that has become a predominant focus of American life, and the reach of managed healthcare provisions that tend to foster simplistic pharmacological remedies for what are often larger biopsychosocial sexual problems. Further, the fact that sexual partner surrogates are themselves a relatively small group of individuals, with many not affiliated with established professional sexuality organizations or networks or possibly trained in idiosyncratic therapeutic protocols, may also serve as an impediment to such research. Although anecdotal reports exist for heterosexual male clients' work with surrogates, little is known about heterosexual female clients' or both female and male gay clients' experience with surrogates.
Dauw, Dean C. 1988. "Evaluating the Effectiveness of the SECS' Surrogate-Assisted Sex Therapy Model." Journal of Sex Research 24: 269-275.
International Professional Surrogates Association (IPSA). 2006a. "Code of Ethics." Available from http://www.surrogatetherapy.org.
International Professional Surrogates Association (IPSA). 2006b. "Surrogate Partner Therapy." Available from http://www.surrogatetherapy.org.
Masters, William H., and Virginia E. Johnson. 1970. Human Sexual Inadequacy. Boston: Little Brown.
Noonan, Raymond J. 1995. "Sex Surrogates: A Clarification of Their Functions." Available from http://www.SexQuest.com/surrogate.htm.
Noonan, Raymond J. 2004. "Sex Surrogates: The Continuing Controversy." In Continuum Complete International Encyclopedia of Sexuality, ed. Robert T. Francoeur and Raymond J. Noonan. New York: Continuum. Available from http://www.kinseyinstitute.org/ccies/us.php#surrogates.
Slowinski, Julian; William R. Stayton; and Robert W. Hatfield. 2004. "The Medicalization of Sex Therapy." In Continuum Complete International Encyclopedia of Sexuality, ed. Robert T. Francoeur and Raymond J. Noonan. New York: Continuum. Available from http://www.kinseyinstitute.org/ccies/us.php#medicalization.
Raymond J. Noonan