Gary Schubach, Ed.D., A.C.S. – Comprehensive Exam Question Response
Discuss the pros and cons of working
with a “surrogate” in sex therapy.
To begin with, it is necessary to define terms. A sex surrogate is someone, male or female, who serves as a sex partner to the client as part of a sex therapy team that includes the client and the therapist. The surrogate’s purpose is to teach and aid a client with no partner to work with, to achieve emotional and physical intimacy by using experiential exercises designed to build those skills. This can involve exercises in the areas of social skill training, communication, relaxation techniques and sensual and sexual touching. It also may involve, when appropriate, genital-genital contact but that is a minor portion of the total time spent in the process and usually takes place close to the end of the process after the necessary interpersonal and body sensitivity lessons are learned.
The qualities that are important in sex surrogates would include warmth, caring, empathy, comfort with their own sexuality and body, good interpersonal communication skills, and trustworthiness. It is also important that they have nonjudgmental attitudes towards choice of lifestyle, sexual activity and sexual partners. It is essential that they be emotionally mature and able to effectively cope with intimate situations.
So under what conditions would the use of a sex surrogate be appropriate? Until about 1970, the treatment of sexual dysfunctions usually involved the traditional model of a therapist working one on one with a client in an attempt to understand the deep-seated psychological roots of the problem and to resolve them through verbal therapy. Then came new viewpoints by such people as Masters and Johnson, Helen Singer Kaplan and Hartman and Fithian suggesting that in addition to a psychological causation, it was also possible that there was an educational deficit that might be addressed in a focused sort of way. Many people simply did not possess the interpersonal communication and tactile skills necessary to create an environment where they would feel relaxed and comfortable enough to enjoy sex without the anxiety that can cause dysfunction. New approaches were developed that saw sexual dysfunction not as a “problem” of one partner or the other in a relationship but as a joint relationship issue to be addressed by both partners. Intensive strategies were developed to re-educate both partners as to normal sexual function, communications and relaxation techniques. Sensate focus exercises were developed. In these exercises, according to Masters and Johnson, “The purpose of the touching is not to be sexual but to establish an awareness of touch sensations by noticing textures, contours, temperatures, and contrasts (while doing the touching) or to simply be aware of the sensations of being touched by their partner. The person doing the touching is told to do so on the basis of what interests them, not on any guesses about what their partner likes or doesn’t like.”
The problem is that these promising therapies were designed for couples, and really need to be done with a partner. What about cases where there is no partner or if there is a partner, he or she are unwilling to participate? It was in response to this question that the role of sex surrogate was conceived.
Outcome statistics for this type of therapy, utilizing a surrogate, have not really been kept and its popularity has faded some since its inception in the 1970’s. A more sexually repressive period has brought out concerns by therapists about the confusion of surrogacy with prostitution, as well as the fears of therapist liability in a litigious environment. Concerns about AIDS and other STD’s are an additional factor. Also, while a trained surrogate knows how to deal with transference issues, there is always the possibility that the client will become emotionally attached to the sex surrogate which can create problems for the client, the therapist, and the sex surrogate.
However, I have had experience with this type of therapy and I clearly believe in its effectiveness if used with the appropriate client. My experience has been that the client must not have too many deep-seated anxieties around sex so that it is impossible to surrender to the exercises and the process. However, before I would even make a referral to a sex surrogate, it is important that I would have already established rapport and a sense of trust with the client. Also, I would have already introduced the client to relaxation techniques that might include self-hypnosis, breathing exercise and guided imagery. If the client is resistant to these exercises, then they are probably not a good candidate for the type of sex therapy that would involve using a surrogate.
The client that I would find appropriate for this type of therapy would be one who is open, willing and even eager to learn new skills and to have a joyful and loving sex life. For that person, sex therapy utilizing a surrogate can be a rewarding and enriching experience.
©1997 by Gary Schubach, Ed.D., A.C.S.