Surrogate Partner Therapy: A Sex Therapist-Guided Approach To Intimacy

Content Warning: Please be advised that the article below might mention trauma-related topics that include abuse, which could be triggering to the reader. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Note: Licensed therapists should not and do not partake in sexual or romantic intimacy with clients. Surrogate partner therapy involves support from an outside third-party surrogate worker who is not a therapist. The therapist typically does not participate in or watch the activities between a surrogate and a client.

Surrogate partner therapy is a therapeutic approach in which a client, a licensed sex or relationship therapist, and a trained surrogate partner work together to address concerns related to sexual intimacy, emotional closeness, and relationships. Developed by Masters and Johnson, this method creates a triadic setting where individuals can explore healthy interactions in a structured, professional environment. Below, explore what surrogate partner therapy involves, who may benefit from it, how sessions work, and options for finding support.

What is surrogate partner therapy?

Surrogate partner therapy is a type of therapy involving a partner surrogate. It is a three-way partnership between a client, a licensed therapist, and a surrogate partner. Surrogate partners are professionally trained in surrogate therapy and offer services to those seeking support with relationships, intimacy, safety, and sexual concerns. This approach differs from sex work in that it occurs within a therapeutic framework with specific treatment goals and professional oversight.

Healthy relationships can be essential for physical and mental health, and many individuals may struggle to find satisfying relationships and connections in their lives. For this reason, a sexual or romantic surrogate can offer company, guidance, and a safe space to explore healthy interactions. Anyone of any gender and sexuality can partake in surrogate therapy with surrogates.

History of surrogate partner therapy

Surrogate partner therapy, also known as sexual surrogacy, was developed by William Masters and Virginia Johnson and introduced to the public in their 1970 book, Human Sexual Inadequacy. At its inception, surrogate partner therapy focused primarily on addressing sexual dysfunction for male clients. Today, the approach has evolved to be more inclusive, helping people of all backgrounds and gender identitiesdevelop relationship skills and address a wide range of intimacy concerns.

Goals of surrogate partner therapy

People may pursue surrogate partner therapy for various reasons, and the goals can be tailored to individual needs. Common objectives may include:

• Increased confidence in sexual ability
• Healing from emotional or physical trauma or adverse sexual experiences
• Connection with another person
• Increasing self-confidence
• Coping with physical challenges or sexual dysfunction
• Learning what one likes with a partner
• Learning about consent and healthy relationships

Understanding the legitimacy and ethical framework of this approach can help individuals make informed decisions about whether it might be right for them.

Is surrogate partner therapy legal and ethical?

According to the Surrogate Partner Collective, surrogate partner therapy is legal and ethical. Before a client is paired with a surrogate partner outside of a therapeutic session, therapists ensure they would be a healthy candidate. If the client does not understand consent, the purpose of the therapy, or is looking only for sex with a sex worker, they could be disqualified for the treatment.

One of the ethical rules outlined by the International Professional Surrogates Association (IPSA) is that the surrogate's relationship with the client is temporary and professional and is strictly a therapeutic relationship. Consistent communication can also be important. The framework also involves boundaries, therapeutic methods, and contraception. Surrogates must test for sexually transmitted infections (STIs)) and stay healthy. Clients may also be required to test for STIs and ensure protection is used.

Common myths about sexual surrogacy

Because surrogate partner therapy involves physical intimacy, misconceptions about its nature are common. Understanding what this therapy actually involves can help clarify its therapeutic goals. Here are some important clarifications:

• Surrogate partner therapy is not prostitution or sex work; it occurs within a therapeutic framework with specific treatment objectives.
• The focus is on therapeutic progress and skill-building, not sexual gratification.
• A licensed therapist typically oversees the process and creates the treatment plan.
• Activities require informed consent from both the client and the surrogate.
• Surrogates follow a professional code of ethics established by organizations like IPSA.

With these distinctions in mind, it can be helpful to explore who might benefit from this type of therapeutic support.

Who may benefit from surrogate partner therapy?

Often, those who seek surrogate therapy may have difficulties with effective communication and find it difficult to maintain relationships or find physical and emotional intimacy in their lives, which can occur for various reasons. For example, they may live with an anxiety disorder like social anxiety or have a physical disability that causes difficulties in dating. They also might have trouble being comfortable in their own body.

Common challenges addressed in surrogate partner therapy

Individuals might benefit from surrogate therapy if they experience any of the following:

• A physical disability
• A lack of romantic or sexual history
• A lack of relationship skills
• Confusion about their sexual orientation (lack of clarity regarding sexual identity)
• Painful emotions, memories, or symptoms from trauma or abuse
• A terminal illness
• Specific sexual dysfunction, such as erectile dysfunction or erection difficulties
• Difficulty achieving orgasm or orgasming too quickly
• Genital or pelvic pain (including vaginismus, contraction of the vaginal muscles)
• Mental health conditions, such as anxiety or depression
• Concerns with libido
• Avoidance of relationships
• Shame or guilt
• Body image issues or negative body image
• Mobility concerns

Anyone can seek surrogate therapy with a certified professional surrogate partner for any reason. However, it may be beneficial to go into the treatment seeking a healthy learning experience. Surrogates are trained as therapeutic professionals rather than sex workers or romantic partners for clients. They are temporary professional support workers who may or may not engage in sexual intimacy with individuals.

How to choose a surrogate partner

A surrogate partner may be referred to you during sex therapy with the goal of surrogacy. However, you may have a choice in the gender and age of your surrogate. You might also find a surrogate via their online social media platforms. The International Professional Surrogates Association (IPSA) suggests that you should not choose a provider you feel immensely attracted to, to ensure the therapeutic purpose of the treatment. Clients can also choose between an intern or a certified surrogate partner. These professional partner surrogates work with organizations like IPSA.

IPSA offers a list of registered surrogate partners throughout the US and worldwide. Once you have chosen a surrogate partner, you can choose a therapist and get connected for your first session.

Factors to consider when selecting a surrogate

When choosing a surrogate partner, several factors may help ensure a good therapeutic fit. Consider the following:

• The surrogate's sexual orientation and whether it aligns with your comfort level
• Their character traits and communication style
• Their specialty areas and training background
• Whether they have experience working with others who share your condition, concerns, or goals
• Their availability and location
• Whether they are an intern or a fully certified surrogate partner

Once you have identified potential surrogates, understanding how the therapy process unfolds can help you prepare for what to expect.

How surrogate partner therapy sessions work with a sex therapist

During these therapeutic experiences, clients will meet with their sex therapists when they first come in for surrogate therapy. The therapist is a licensed professional in counseling, social work, or psychology, and they may have further education or training in sex therapy. The client and therapist can first devise a treatment plan identifying the client's treatment goals. Sometimes the treatment involves homework, like watching certain materials or self-exploration.

Afterward, the therapist may invite the client's surrogate to sessions, and the three can discuss their goals and potential activities for the client and surrogate. Afterward, the client and surrogate can schedule sessions to participate in the activities or treatment goals outlined.

The role of the sex therapist

The licensed sex therapist plays a central role in surrogate partner therapy, though they typically do not participate in or observe activities between the client and surrogate. The therapist creates the treatment plan, determines appropriate activities based on the client's goals, and provides ongoing talk therapy throughout the process. They may use modalities like cognitive-behavioral therapy (CBT) to address concerns surrounding sex, intimacy, and emotional closeness with others. The therapist also ensures that both the client and surrogate maintain appropriate boundaries and that the therapy remains focused on therapeutic objectives.

Phases of surrogate partner therapy

1. Early phase: This stage focuses on building rapport, establishing trust, and setting clear boundaries. The client, therapist, and surrogate discuss goals, consent, and expectations for the therapeutic relationship.

2. Middle phase: During this phase, the client and surrogate engage in activities outlined in the treatment plan. These may range from non-sexual exercises like communication practice to more intimate activities, depending on the client's goals.

3. Termination phase: As the client achieves their therapeutic goals, the relationship with the surrogate concludes. A closure session allows both parties to discuss their experiences and process the ending of the therapeutic relationship.

Activities and exercises in surrogate therapy

The specific activities in surrogate partner therapy vary based on individual goals and treatment plans. These activities might include the following:

• Discussions about types of touching, such as friendly, sexual, romantic, or comforting touches
• Discussions about consent, boundaries, and areas the client doesn't want to be touched
• Discussions about the surrogate's boundaries and needs during the session
• Sexual touching, such as genital contact
• Sensual touching, such as cuddling
• Emotional connection activities
• Mindfulness touching
• Discussing interests and desires
• Normalizing bodies
• Roleplaying a relationship dynamic

Depending on the client's goals, the professional surrogate-partner relationship may last a few weeks, months, or years. The therapy process varies depending on the client's needs. Although many individuals may refer to this process as "sex surrogacy," it does not always involve sexual intercourse or touching. Instead, it is a type of therapy unique to each client. Some clients may come to treatment seeking cuddling, communication skills practice, and education about their bodies.

When surrogate partner therapy may be considered successful

The time it takes for surrogacy therapy to be successful and conclude depends on each client. For some, successful surrogate partner therapy might occur when they can reduce pain during sex or improve their sexual functioning. For others, it might occur when they experience healthy closure from past sexual traumas. After the sessions are concluded with the surrogate, the individual and the surrogate can meet for a closure session to discuss their experiences. The client may continue to visit with a sex therapist for talk therapy after the surrogacy has ended. Clients experiencing residual emotional attachment with their surrogates can discuss these thoughts and feelings in a safe environment with their therapist.

How sessions maintain professional boundaries

Although clients may develop emotional connections or sexual attraction for their surrogate partner, the surrogate is trained to handle these concerns and to follow a code of ethics. The surrogate's relationship with the client is temporary and professional and is strictly a therapeutic relationship. Consistent communication can also be important. The framework also involves boundaries, therapeutic methods, and contraception. If a client violates a surrogate's boundaries, they may be banned from further sessions.

Effectiveness of surrogate partner therapy

Although there are limited studies on the effectiveness of surrogate partner therapy, a few studies have found favorable results. One study found that the form of treatment was effective for treating vaginal pain during penile-vaginal intercourse for 100% of clients enrolled in partner surrogacy therapy, compared to 75% of clients who participated in the activities with a current partner. More research is needed to fully understand the effectiveness of this approach across different populations and concerns.

Cost and accessibility of surrogate partner therapy

If you're considering surrogate partner therapy, you can reach out to IPSA to find a surrogate partner in your area or seek a sex therapist in your area who is linked with surrogate partner programs. Note that coverage for these services varies by plan, and surrogate partner therapy can cost around $75 to $200 per hour. Many sessions last from one to two hours.

The total cost of treatment varies depending on how long the therapeutic relationship lasts, which can range from a few weeks to several months or longer. Because coverage for these services may vary, some providers may offer payment on a sliding scale based on financial need.

Online therapy as an alternative for intimacy and relationship support

If you cannot afford surrogate partner therapy, or it is unavailable in your area, you can also consider online sex or relationship therapy, which typically costs around $70-100 per week compared to $100-350 per in-person session. However, online services are not connected with surrogates. A sex therapist can address many similar concerns through talk therapy, including social skills training and more. Note that online therapy does not involve a sexual or romantic relationship between the therapist and the client. BetterHelp also offers psychiatry services through Uplift as an additional care option alongside therapy. Psychiatry services may include medication management when clinically appropriate, based on a full evaluation by a licensed psychiatric provider.

Some providers on BetterHelp may be in-network with certain health plans. You can check whether a provider is in-network for your plan through BetterHelp. Learn more about insurance coverage. The cost of online therapy via BetterHelp ranges from $70 to $100 per week, billed weekly or monthly, with costs based on your location, referral source, preferences, any applicable non-insurance discounts, and therapist availability. Coverage varies by plan, provider, and therapist availability.

Benefits of online therapy for relationship concerns

Online therapy can offer several advantages for those seeking support with intimacy and relationship concerns. The ability to connect with a therapist from home may make it easier to discuss sensitive topics in a comfortable environment. The flexibility of scheduling can also help those with busy lives or mobility concerns access consistent support.

How online therapy may support intimacy concerns

For people seeking support with intimacy, relationships, or emotional closeness, online therapy may offer meaningful guidance even when surrogate partner therapy is not available. Studies show that video-based therapy is an effective alternative to in-person therapy for intimacy concerns, and many individuals report satisfactory outcomes.This is also reflected in BetterHelp outcomes data, where 72% of BetterHelp users experienced a reduction in symptoms in 12 weeks, with a 4.9 out of 5 average rating for live sessions from over 1.7 million client ratings.

When using insurance, certain BetterHelp features may be limited or unavailable, including chat-based sessions, groups/classes, and select self-help tools.