Sexual healing

OK, let’s get the salacious stuff out of the way fast. This is not about paying someone to get you laid and then sticking your company’s health insurance with the bill. It is not about porn stars granting private sessions for a fee and calling it therapy. It’s not about prostitution, but it is about people allowed by the law to have sex for money. Welcome to the world of sex surrogates.

Surrogates are always interested in having threesomes, just not the type you’re used to. According to the International Professional Surrogates Association (IPSA) Web site (www.surrogatetherapy.org), “a surrogate partner is a member of a three-way therapeutic team consisting of therapist, client and surrogate partner. … The involvement of the team therapist, a licensed and/or certified professional with an advanced degree, is a cornerstone of this therapy process. Sessions with the therapist are interwoven with the surrogate-client sessions.”

Surrogate partners (as they prefer to be called) have been around for decades, but their heyday was in the 1970s and 1980s. These days, only about 30 surrogates are members of IPSA. Most are in California. Others are in states like Florida and Idaho. There are none in the Northeast. These 30 men and women provide sexual healing to men (98 percent of the clients are male) across the United States.

Pam, Sacramento’s lone surrogate, covers a territory from Fresno up to Oregon. Her primary office is in an outlying city of Sacramento. In her mid 30s, she’s been a surrogate for three years, although she’s known she wanted to be one since she was 15.

“I’ve been drawn to this work ever since I was a teenager. Sometimes, you just know something. I used to watch surrogates on [The Phil Donahue Show] with my mother,” said Pam. “At 15, I told my mom that’s what I want to do. Mom has been very supportive, and she’s a very open person.”

Pam has had a full life. She’s been married, had children, owned a business with 20 employees and been involved in healing work in one capacity or another for a long time.

About three years ago, she took the 60-hour IPSA training. “What drew me to it is that it is not really about the act at all,” said Pam. “It is about intimacy with yourself and how you learn to share that with another. It is different from how society sees intimacy.”

The intensive three-week training includes lectures on the emotional and psychological aspects of sex, as well as homework on anatomy, physiology, prevention of sexually transmitted diseases, and the effect of certain drugs on sexual function.

According to Vena Blanchard, president of IPSA, surrogates are “men and women in their middle years, generally with college education, often with a history of working in the helping professions—nurses, teachers, massage therapists, people studying to be a psychologist. They are often in relationships, some married and some divorced,” said Blanchard. “I’m not aware of any of our surrogates divorcing in 25 years.”

“Despite what you think, we’re not glamour girls. Not one of us. We’re all very human,” said Blanchard, laughing.

Clients come primarily from referrals from qualified therapists. They screen patients for physiological, pharmacological and other easily treatable conditions for sexual dysfunction.

“I will not work with anyone in this capacity if there is not a therapist in the process,” said Pam. “That’s because I’m not a therapist—don’t want to be one. This is a therapeutic process that requires somewhere where they can process what’s going on so they can better integrate it. If you just do exercises with someone, and they go away, there is no integration. The therapist is crucial for giving me guidance. We always have the communication between us.”

Surrogacy takes two forms: open-ended long-term with weekly visits (with prices in the range of $100 to $200 an hour, depending on the rate therapists get in the area) or—if weekly visits are a geographic impossibility—a one-week intensive session (18 hours with a surrogate and seven hours with a therapist for $2,850) or two-week intensive session (38 hours with the surrogate and 14 hours with a therapist for $5,500). All that money comes from the client; insurance will not pay for it.

To be crass, why isn’t a person who takes money for sexual encounters a prostitute?

“My understanding is that in California, it depends on the intent. The intent is therapeutic, and so I am not a prostitute. To be honest with you, if I was a prostitute, I’d be making a hell of a lot more money than $100 an hour,” said Pam.

According to IPSA, surrogacy has never gone to court. In the mid-1980s, a clinic in Los Angeles was investigated after a neighbor complained. The police did an undercover investigation but found that the intent was therapeutic, so no charges were filed.

“When we do hand caresses, I’m not getting paid for the hand caress. They pay for the therapy,” said Blanchard. “The touch is a tool that is necessary, but it is one of the many tools. They also get my intellect. The touching is one of the tools to help them, but it is not what they are contracting for. There is never a guarantee for sexuality.”

Erotic touching and sex are sometimes a part of the experience. “On some small portion of cases, we have genital touch or erotic feeling. I would say that’s only 5 percent to 10 percent of the total therapy experience and only if it makes sense clinically and is acceptable to client and surrogate.”

Despite our fevered imaginings, nudity may not be part of a session for weeks or months, if it ever is. The first session is a lengthy interview. The next session will involve verbal exercises, in which the client asks for what he wants.

“The idea is for people to verbalize. If they have a huge fear of rejection, even to get it out of their mouth is a victory,” said Pam. “They get to ask for what they want without the intent of it getting carried through, just to ask for what they want and to hear yes.

“Physical exercises start very slowly. We retrain the way we touch. Often, so much is outwardly focused on the other person, fantasizing and not being present,” said Pam. “All the exercises are about retraining someone to get out of their head and be more present with the other person.”

The touching exercise is called sensate focus. “When they touch me, they feel what it is like in their fingertips, not focused on bringing pleasure to the other person, but bringing pleasure to themselves,” said Pam. “That’s a completely different perspective than, ‘What will the other person be thinking of [me]?’ The person who is being touched is to fully feel and to let the other person know how we like being touched. Not everyone likes being touched in the same way. It is about building trust and communication skills.”

The slow pace may seem frustrating, but it is part of the process. “It takes literally months, and it may never happen that you get naked. Even getting naked doesn’t mean that there’s much touch in the beginning. For any kind of real change to happen that’s going to be long-lasting, it has to occur slowly,” said Pam. “It is really important for us as surrogate partners and their therapists to be with people until they go through all of those cycles, until true change is really ingrained in the person. People have the conception that it is much more than it is in terms of the physicality. It is more about creating a model relationship.”

Traditional surrogate-partner therapy is available to male and female clients of all sexual orientations with surrogate partners of either gender. It may be appropriate for some clients with issues of inexperience or negative body image or with histories of trauma, to work with a same-sex surrogate who participates as a role model rather than as a sexually intimate partner.

Most of Pam’s clients are single men; more than 50 percent come to see her because they consider themselves premature ejaculators. “With some, if you even brush close to them, they would ejaculate,” said Pam. “It is exacerbated if they haven’t had a partner in a long time. It involves not feeling comfortable or safe somehow.” Treatment involves a lot of Kegel exercises (tightening the muscles used to stop urination), yoga breathing and stretching exercises.

The other big group Pam sees are middle-aged virgins. She does some work with couples, but her one condition is that she’ll only work with a married or committed client if the partner knows about it. “Because a married relationship is best healed through complete openness and honesty,” said Pam. When working with couples together, she’s more of a coach than a participant.

Women, she said, don’t seek out surrogacy as much, but when they do, they generally fall into two camps: those who have trouble reaching orgasm or those who have difficulty with physical intimacy.

The biggest taboo in the world of therapy is that no patient should have sex with the therapist. Isn’t the surrogate, by definition, violating that precept?

Not according to Blanchard. “From the beginning, [surrogacy] is about fostering the client’s goals, not to satisfy the surrogate’s needs. [Surrogates] exist because it is not appropriate having a client looking out to the therapist for these needs,” said Blanchard.

A big problem for therapists is transference (the client projecting feelings about someone or something else onto the therapist) and counter-transference (where the therapist does the same to the client). But with surrogacy, transference is to be embraced.

“What the client in surrogacy gets that the client in psychotherapy doesn’t is the potential for physical touch, potential for eroticism,” said Blanchard. “The idea, the possibility of the intimacy puts pressure on the client in a clinically useful way. Their issues with eroticism emerge in a way that can be seen and resolved.”

“If buttons aren’t being pushed here and there, then the real work is not getting done,” said Pam. “Many therapists don’t feel they’ve made progress until [their clients] get pissed off at them. When that person accesses that rage, they know they’ve had a breakthrough. Is it rainbows and bunnies? No. But relationships are that way.”

Blanchard sees surrogacy as a branch of behavioral psychology. “We use it to re-establish more-effective patterns of behavior or patterns of thinking. It is cognitive behavioral retraining for some clients.”

For example, there was a male client who had been molested as a child. In the course of therapy, every time he experienced any real emotional content, he’d get angry. He became aware that it was left over from childhood and not appropriate to the surrogate. He had a moment in which he realized he was keeping intimacy at a distance. For this client, change started from the ground up, literally.

“[Sensate] touching his feet was a revelation [to him],” said Blanchard. “His feet were untainted, they were not part of the molest. It was pure, comfortable and relaxation that was not tangled up with guilt, shame and pleasure.” Over time, this client was able to tolerate emotional and physical intimacy without falling into the childhood anger.

Another client, a man in his 50s, had never been naked with anyone else. “He had a powerful experience looking in the mirror with me,” said Blanchard. “He realized that people do this, couples do this. It is OK that he had a tummy. He said at the end of the session, ‘I feel like I’m more part of the human race for having done this.’”

The decision to end therapy is made mutually between client, therapist and surrogate partner when the goals of therapy are met. “Then, there is closure in the relationship. You talk about the things that worked, things that were a challenge. Trying to model an ideal relationship, you’ve got a mediator who is the therapist,” said Blanchard.

“The relationship with the surrogate partner is a model for the outside world,” she added. “It is not the skill of physical technique but the skill of being emotionally mature in intimate encounters.”

Do surrogates ever fall for their clients? “Attraction to patients happens no more frequently than any other helping professional,” said Blanchard. “Whatever our feelings are, our commitment is fostering their growth and to have them leave us. We’re like a parent. We love them while they are here, care about their future, but our job is to let them go.”