Surrogate Partner Therapy Creates Transformational Intimacy
Emile, a gay man in his early 30s, grew tired of having casual sex. Hooking up with men he met at bars was exciting at first, but over time the sex was less than fulfilling. In fact, he began having trouble reaching orgasm and struggled with intimacy issues and erectile dysfunction (ED).
He yearned for a committed relationship, so he sought a unique, somewhat controversial therapeutic practice known as sex surrogate therapy, a hands-on treatment designed to help a client feel more comfortable with sex, their body and intimacy. Emile (whose real name has been withheld due to patient confidentiality) saw surrogate partner Mark Shattuck and explained that he didn't think he could get an erection.
"He didn't know how to address how to be close to someone," said Shattuck, who practices in San Francisco and is certified by the International Professional Surrogates Association (IPSA), a nonprofit organization providing surrogate training, certification and referrals. (Shattuck, as well as IPSA, prefers to drop the "sexual" part of his practice and refers to it as "surrogate partner therapy" because sex is involved in only about 20 percent of his cases.)
Shattuck and Emile started slow, with no expectations of getting an erection. Over multiple 90-minute sessions, they built intimacy to the point where they were naked together and creating a relationship. They touched each other, and Shattuck gave Emile tips on how to stay mentally present.
"There's no expectation of a goal in mind," Shattuck said. "Sure enough, when you relax and be in the moment, that can be very successful."
Surrogate partner therapy can help people overcome intimacy issues, improve their social skills and learn how to date.
The sessions with Shattuck resolved Emile's sexual dysfunction and intimacy issues, and when the therapy was complete, he met a gay man with whom he enjoys a long-term, monogamous relationship.
Shattuck sees surrogate partner therapy—first introduced in the 1960s by pioneering sex researchers William Masters and Virginia Johnson—as an adjunct to talk therapy. The IPSA-certified model always involves a triadic relationship where a talk therapist, a client and a surrogate work together toward the goals of the client.
Surrogate partner therapy can help people overcome intimacy issues, improve their social skills and learn how to date. Shattuck explained he helps his clients figure out "a lot of the things that are arriving around sex," which may or may not include sexual touching and intercourse.
Phases of surrogate partner therapy
Surrogate partner therapy consists of four main phases, according to Vena Blanchard, D.H.S., the IPSA president and a surrogate therapist herself.
The first phase deals with building familiarity and trust, and teaching the client basic skills like relaxation, self-awareness and communication with a partner. There is some exposure to sensate focus, which are touch exercises that build intimacy and connection.
"In the first phase, the touch is nurturing touch: soothing, comforting, relaxing," Blanchard explained. "This phase is very much about learning to be comfortable as a foundation with each other and inside themselves and building some skills that the client will need for the later phases of the work."
The second phase is about whole-body acceptance, body image work and whole-body sensuality.
"It's not about being explicitly sexual," Blanchard continued. "It's about allowing oneself to touch and be touched in a sensual, pleasurable way and continuing the relaxation practices, the self-awareness, the communication."
Shattuck noted this phase helps the client feel more comfortable being naked around another person in a safe environment.
"On the fourth or fifth session, we do a mirror exercise where you disrobe to your level of comfort, and for most surrogate partners, that's completely naked," he said. "We stand in front of a mirror. I'm a 60-year-old guy with a beerish belly and a round, middle-aged man spread just like any normal, average guy. I talk about myself from the tip of my head to the tips of my toes. I talk about the things I like and what I don't like.
"Hopefully, [the client] can do the same thing and see that we're all people," he explained.
While the first two phases are similar for most clients, some have a greater inhibition about touch or nudity, and the work might slow down to accommodate the client's pace, Blanchard explained.
In the third phase, she said the client's specific sexual difficulties are addressed. For example, a female client with vaginismus—a condition involving the spastic contraction of vaginal muscles—would work on getting comfortable touching her own genitals and, eventually, letting a surrogate guide her in touching herself. The idea is that after the therapy, she will be able to guide a partner in touching her in a way that feels safe and comfortable to her.
The fourth phase is the closure phase, where clients wrap up the work with the surrogate.
"They learn some things about how to say goodbye at the end of a relationship gracefully," Blanchard said. "Sometimes, because this is the first deeply connected relationship they've ever had, you want to be slow and gentle with them in that part of the process."
Blanchard emphasized that everything the surrogate and client do is diagnostic, which includes how the client responds to the surrogate's exercises. This way, their reactions reveal insights about the client in ways they may not be able to express verbally to the talk therapist.
"Every part of the work with the surrogate is also a model for how they can create relationships in the future, including how to work through difficulties if they emerge, whether they're sexual difficulties or emotional difficulties," she said.
What's the difference between sex surrogacy and sex work?
Stephanie Wadell, M.A., a surrogate partner and the director of the Bay Area Surrogate Association (BASA) in San Francisco, said the BASA method, while similar to IPSA's, is geared more toward behavior modification. BASA involves relearning or learning ways to relax in the bedroom, have a conversation and engage with a partner, she explained. She disagrees with the movement to remove "sexual" from the name of the therapy.
"Sexual surrogate partner therapy is about people who don't have a sex life and don't know how to connect with the opposite gender or the same gender," Wadell said. "We are substitute teachers. That's what we are. We're teaching them. It's a misrepresentation of what our therapy is."
In recent years, many of Wadell's clients have been men in their 30s and 40s who have been viewing online pornography for years and struggle with intimacy when they're with a partner.
"A 37-year-old man is writing to me that he's been on porn for 20 years and he can't perform in the bedroom because he can't get his fantasies out of his mind," Wadell said. "I tell them those aren't fantasies, those are all porn images and he doesn't even know the difference. But do you think he's going to work with me if we're not going to have intercourse? No. Who's the client who's going to work with a sexual surrogate partner and not have intercourse?"
The simplest distinction between a surrogate and a sex worker is the surrogate's intent is to teach.
A common myth surrounding this type of therapy is that it's a form of prostitution. The simplest distinction between a surrogate and a sex worker is the surrogate's intent is to teach, according to Michael Perry, Ph.D., a sex therapist in Bakersfield, California, who has both trained surrogates and referred clients to surrogates.
"[Our] intent is to try to help somebody overcome the sexual problem," he said. "A prostitute's intent is to get you off."
Perry thinks a hands-on approach is invaluable.
"I'd hate to see someone try to teach someone to swim and they never get in the water with them," he said. "I think [surrogate therapy] is an extremely valuable and useful way of getting someone to overcome whatever difficulty they may have.
"It's going to last only 10 or 12 sessions, and you know it's supposed to come to an end, but it is a real relationship," he added. "You're reeducating somebody's mind and their body, or maybe educating them for the first time. There really are 40-year-old virgins out there who've never had a sexual experience in their life, both male and female. They've come to me, and I've hooked them up with a surrogate. By and large, it's been very successful."
Blanchard said when surrogate therapy is successful, "transformational intimacy" happens between surrogate and client.
"They become a new person with new awareness and new skills and just a new sense of themselves," she explained. "So while the relationship is temporary, a lot of those changes are permanent."