Masters and Johnson developed sexual surrogacy in America in the early 1960s as a new type of sexual therapy (Runciman 1975). Other terms most commonly used now include “surrogate partner therapy” and “surrogate partnership” to describe the therapy, and “sex surrogate,” “sexual surrogate” or “partner surrogate” to describe the person who has physical, intimate contact with the client. Masters and Johnson opened their first sex therapy clinic in 1964 and continued to operate until 1994.This therapy, introduced within their second book, Human Sexual Inadequacy (1970), was deemed revolutionary at the time, and it remains a contentious therapy option, even today.
Sexual surrogacy recently enjoyed mainstream media attention since the release of the Hollywood film, The Sessions (2012). Based on the true story of Mark O’Brien, a man who contracted polio as a child and spent most of his life in an iron lung due to complications from the disease, he hired a sexual surrogate to help him lose his virginity and enjoy sexual contact with a woman. Written observations from both O’Brien and the sexual surrogate, Cheryl Green, have been published, outlining their experiences working with each other and were used to develop the screenplay (Cohen-Greene and Garano 2012; O’Brien 1990; Saratogian News 2012). With The Sessions being based in the USA, where sex work is predominately illegal, seeing something like this on the “big screen” was an eye-opening moment for people, especially as it was screened at the Sundance Film Festival. Additionally, with highly respected actors, such as Helen Hunt and William H Macy, taking on pivotal roles, those working in the surrogacy field hoped to gain increased credibility and professional respect in what they do, drawing away from the perception that it was a form of sex work.
Services are provided, according to what the therapist believes will best assist with the development of the client’s physical and emotional personal growth. Specially trained sexual surrogates are employed to follow these directions and provide hands-on, tactile services to the client. This can include sexual and non-sexual, clothed or naked services, but neither the client nor the surrogate goes beyond the directives outlined by the therapist. While intercourse may eventually occur during a session, it is not the final or only activity that is focused on. Feedback from both the surrogate and the client are given to the therapist, who then, in conjunction with further sessions with the client, will formulate what the surrogate should focus on next time they meet their client. Overall, this therapy is structured to be both short- and long-term goal-orientated, with the client always moving forward in their development and learning curve. Essentially, each session will address new and different activities and issues, with constant revision of previous learnt skills. Although this triangulated model of therapy, with therapist, client and surrogate working together, is the best-known framework, there are also surrogates who, after their training—or drawing upon training from similar modalities—work more independently, advertising for clients themselves and structure the sessions according to what they professionally believe would be best for their client.
Sexual surrogacy predominantly operates in the USA and Israel, but has also been practiced to varying degrees in the UK, Australia and different parts of Europe (Colley 2018; Freckelton 2013). Whereas still operating in a quasi-legal “grey zone” within the USA (often being condated with sex work, which is illegal everywhere, except for a handful of brothels operating in certain counties within the state of Nevada), in Israel it enjoys the full support of the Government. This was primarily due to Governmental guilt in sending so many abled-bodied men to war and having a massive increase in permanently injured soldiers returning home.
Sexual surrogacy was initially designed to be provided at a specific therapy centre and, though this still occurs in Israel, other countries, such as the USA, often allow for surrogates and clients to meet elsewhere. This could include the clients home or the workplace of the sexual surrogate.
The sexual surrogate is paid a fixed amount each session, regardless of what activities occur. When working in a triangulated model, the rate is determined by the organisation or the specific therapist, not the sexual surrogate (Ridley 2012). Only if the surrogate were working and advertising independently would they set their own pricing structure.
Service aims and objectives and client motivation
Clients first work with therapists to deal with specific problems, anxieties or issues they wish to address. If they need specific “hands-on” practice to achieve their learning goals, then the use of sexual surrogate services would then be introduced into the therapy schedule. Vena Blanchard, president of the International Professional Surrogates Association (IPSA), describes it as “a therapeutic treatment that combines psychotherapy with experiential learning ... it’s a programme designed for people who struggle with anxiety, panic, and past trauma—things that can distort a person’s experience in the moment” (Savage 2018). Overall, surrogacy aims to create a safe learning environment that simulates real-life experiences that the client has been too afraid or nervous to pursue.
Availability and eligibility of both the service provider and the client
Unlike sex work, a surrogacy client doesn’t normally get to individually choose the surrogate with whom they will be working but is assigned one, based on a range of demographics and availability (Rosenbaum et al. 2014).The clients often work with a therapist before being introduced to a surrogate. Clients who simply want to experience sexual and compassionate touch or to lose their virginity straight away are generally ineligible. Clients normally need to travel to a specific location, so anyone whose disability precludes them from doing this will be automatically excluded. In fact, Israeli representatives at the 2014 1st Global Conference: Sexualities and Disabilities, in Lisbon, Portugal were very clear during a Q&A that they would not send a surrogate out to the home of a person with disability, even if that potential client were unable to access their specific therapy rooms.
Organisations who may facilitate training
The International Professional Surrogacy Association (IPSA 2018a) is based in San Diego, America, and operates the best-known well-established training course designed specifically for sexual surrogates. Whereas surrogacy sessions generally remain a private interaction, one educational documentary, Beruf: Berührerin, encompasses the discussions and work of three sexual surrogates in Austria, Germany and Switzerland. Due to the sensitive nature of the work, this film is not available online (Dworschak and Müller 2012). In 2018, IPSA also released Surrogate Partners:
Intimate Profiles, also not permitted to be uploaded online. This 23-minute documentary features interviews with therapists, clients and surrogates, as well as footage of surrogates and clients doing experiential activities that form the basis of their Surrogate Partner Therapy (IPSA 2018b).
In Israel, the Dr Ronit Aloni Clinic is the only major centre providing sexual surrogacy and has been operating since the late 1980s, when Dr Aloni brought her formal surrogacy training back from the USA (Kolirin 2017). This centre provides training for their surrogates and receives referrals, from the sex therapy clinic at Tel Aviv’s Ichilov Hospital, as well as from other sex therapists working from other clinics and hospitals across Israel.