The main application for sexual surrogacy therapy is to help clients overcome issues of sexual dysfunction and performance; clients not only talk to their sexual surrogates about their concerns, but act out and engage in sexual situations with the surrogates, who use clinical training to guide clients through the spectrum of responses to sexual contact. The interactions are purely professional in nature. Rosie Garelick, a writer in Salon magazine confesses that she did not know the name or number of the male sex surrogate she worked with for five months, and he did not have her information either. The clinic that set up the appointments handled all issues of payment, so there was never any suggestion of a “cash for sex” arrangement.1
After every session between Rosie and her surrogate, they would both individually report to the head of the clinic; Rosie’s report would be the subject of her sessions with her talk therapist, who formed the “therapeutic team” to help the writer through her problems.
For Rosie, sexual surrogacy therapy was a double-edged sword. Her work with her partner helped her appreciate her physical body and her sexual identity, and being appropriately touched by other people (even the simple act of holding hands was part of her therapy). When Rosie confessed to the clinic administrator and her talk therapist that she was (perhaps inevitably) developing feelings for her sexual surrogate, they encouraged her to go with the flow; experiencing the relationship to its fullest, even at the risk of blurring the lines between a personal and professional circle, would suggest that the therapy was working, that Rosie was learning to love again. If she ended up with a broken heart when the relationship reached its inevitable end, that would mean she was emotionally healed.
Sexual surrogacy therapy takes a lot of people by surprise, but those who practice it are very serious about what they do. When Rosie and her surrogate had their first sexual encounter (a full 20 sessions into the program), the moment had been meticulously planned out by her therapeutic team; even the positions of intercourse had been scripted.
Ten sessions later, Rosie and her surrogate parted ways, with him making it clear that there would be no further contact between them.
In cases where such abuse has happened, sexual surrogacy therapy allows clients – mostly female – to learn how they can trust themselves and trust male partners again. Victims of rape or abuse have had their private space and body violated, says one surrogate therapist, which robbed them of a healthy sense of boundaries. Some women close off entirely, whereas others turn to using sex as a means of controlling their partners, to ensure the assault never happens again. Sexual surrogacy therapy is a means to let these women (as well as men) understand the complexities and nuances of human interaction, in a healthy, controlled, and safe environment.
This rise has coincided with a better understanding of human psychology and development, especially in the areas of therapy, treatment, and rehabilitation. For that reason, providers of sexual surrogate therapy take their work very seriously. Speaking to ABC News, a former sex surrogate banishes the idea that treating clients through sexual intercourse is all fun and no work; part of the mission is to “retrain” their sexual ability and the plethora of thoughts and responses that come with the expression of human sexuality. It is far more than simply having sex with clients; the act of sex (which can come after months of other therapy) is a form of treatment in itself, one that is then used to unlock other doors that the client’s mental state has forced shut.4
For that reason, sexual surrogate therapy is serious business. Practitioners charge a comparable rate to that of other therapists, with one saying that “you can get a prostitute for way less.” One client paid $125 an hour for therapy, which included weeks of relatively smaller exercises, such as simply developing the skills and strength to hold hands or hug.
The exchange of money is one of the elements of sexual surrogacy therapy that makes it a questionable practice for a lot of people. A sociology professor at the University of Washington explains that the confluence of clients paying money to have sex does raise questions over how similar the practice is to prostitution, a view held by many who oppose the use of sexual surrogacy therapy as a way of helping clients with mental health concerns.
But the rejoinder that follows is that the sexual surrogates are specifically trained for their role, where the sexual contact is seen as part of a larger treatment paradigm, and not the four issues by which most jurisdictions outlaw prostitution:
- Victimization of the individual offering the service (in relation to human trafficking)
- Freedom of the individual offering the service
- General harm to society
While it could be argued that sexual surrogates are not the victims of trafficking, and that they make the choice to offer sex as therapy of their own free will, the questions of morality and general harm to society are much harder to answer, perpetuating the debate.
Sex surrogacy has been “essentially legal, though very much unregulated,” says Cracked.com.5 As far back as 1997, the future California attorney general said that sexual surrogacy therapy would not be considered illegal “if it’s between consensual adults and referred by licensed therapists and doesn’t involve minors.”6
In order to avoid any controversy, some sex therapists do not work with surrogates, says FOX News. A couples and sex therapist in New York City chooses not to send patients to practitioners of sexual surrogacy therapy, because there is yet to be a legal distinction between the work of sexual surrogacy and prostitution. She also expressed reservations about the methodology of sexual surrogacy, claiming that simply “curing” a patient through sex does little to address the deeper social, behavioral, or mental health issues that gave rise to the overall problem.7
Sexual surrogacy therapy raises a lot of eyebrows, but it has nothing on the reception that nude psychotherapy usually gets. As the name suggests, both therapist and client are in the nude, with no suggestion of sexual overtones, in order to improve the client’s psychological health. The theory is that the mutual disrobing helps facilitate a therapeutic environment that is more trusting, honest, and intimate than standard therapy.
While the idea of therapy sessions being conducted in the nude would be a source of surprise (and skepticism) on its own, one particular extension of that has proven quite controversial. Psychology Today writes of Sarah White, a woman who provides one-on-one talk therapy sessions with men via video chat over Skype. What sets White’s methods apart is that she takes her clothes off during the one-hour conversations; her client is allowed to similarly strip, if he feels comfortable. If White feels that the act would be psychologically beneficial, he is allowed to masturbate during the therapy session.8
Channeling Sexual Arousal
Speaking to Australia’s news.com.au, White explains that men are often told to keep their sexual arousal on a leash, and that this is unhealthy for male cognition and identity.10 Men are facing a mental health crisis that is being ignored, says The Telegraph, and White believes that her services and methodology address that crisis.11 Sexual arousal is a “vital part of thinking,” says White, and it is often thought of an expression of a deeper desire. But White feels that men need to claim their arousal – that with her supervision, the excitement can be used to gleam “unique, powerful, relevant insights.”
On that note, the Vice writer observed that it was very helpful to be naked, and to be sexually aroused, when talking about the anxieties that can affect sex and relationships. One session with White, he says, effectively addressed many of the problems he would have been too embarrassed to disclose to anyone else. White’s channeling of arousal outside the boundaries of traditional physical contact was the therapeutic key the writer needed.
Male Acceptance and Sexuality
Even though what White does has very strong sexual overtones to it, she insists that “there is a world of difference” between her Naked Therapy and pornography. Pornography, White tells Psychology Today, is merely indulging in sexual desires; Naked Therapy, on the other hand, actively and clinically uses sexual arousal as a means to access the underlying feelings and problems that her clients have.
The idea of men finding a degree of psychological freedom in a sexually charged environment is not a novel one. A cultural anthropologist, sex researcher, and former exotic dancer says that strip clubs give men a safe space to express their sexuality, and thus encourage them to behave naturally (within appropriate limits). Taken to another level, “strip clubs save marriages,” the Daily Mail quoted her as saying.12
By disrobing (and even touching herself on camera, in view of her clients), White feels that she can circumvent the barriers that the male psyche can erect. For men, White’s school of thought says, issues of acceptance are intrinsically linked to their sexual identity; by allowing them to explore that sexuality (with her clinical guidance), her clients rediscover themselves and are thus empowered to address other issues in their lives.
Many of those issues deal with images and conceptions of masculinity, which is typically reduced to basic, stereotypical concepts that categorize men as being subservient to their sexual desires (or the sexual desires of a partner). As a result, a number of men are unable to put their feelings into words (a situation that Scientific American explains called “alexithymia,” a form of “emotional blindness”), which might turn them off the idea of talking to a person to seek help for their problems.13 This, in turn, makes men resistant to the idea of going to therapy, even becoming inappropriate and aggressive toward female therapists. Little is known, writes a researcher at New York University’s Online Publication of Undergraduate Studies, about “the male experience in psychotherapy,” and how “the pressures and confines of masculinity affect the clinical process.”14
To that effect, the writer in Vice magazine mentions some of Sarah White’s own research on the subject, which highlights that despite the majority of men experiencing mental health crises and disorders, most of them do not seek treatment, primarily because they are afraid that acknowledging a problem (and a psychological problem, at that) is emasculating. The Vice writer struggled with depression, and what contributed to the problem was difficulty in “swallowing [his] ego and admitting that [he] needed help.”
Sarah White’s approach to men taking ahold of themselves – in the most literal manner imaginable – is her solution to this problem. White told Psychology Today that her male clients work with her because they’re not compelled by an angry partner or a judge to seek counseling. The men she sees are very much able to identify and express their feelings, but they don’t know how. By entering into mutually agreed nudity with her, by engaging their sexuality, and by paying $250 for a 60-minute Skype chat, their journey begins.
White makes no claims that she is a therapist and offers a disclaimer on her website that the services she offers are more informational than therapeutic. Nonetheless, she argues that the services she provides are therapeutic in nature and generally helpful; for legal reasons, however, she is very clear that she is not licensed to offer mental healthcare to clients. If people come to her with problems beyond her purview, she refers them to professional clinicians.
The Naked Therapy approach of Sarah White (a pseudonym) falls under the same umbrella as sexual surrogacy therapy or so-called “cuddle therapy”; tactile or sexual contact is the means to expressing repressed thoughts and feelings in a healthy and supportive way. Not all nude therapy involves touching; sometimes the sessions are exactly like standard talk therapy meetings, except that both clinicians and clients are naked (and there are no sexual overtones, as with White’s service). Psychology Today explains that contemporary therapists appreciate that sessions conducted in the nude might be especially useful for clients suffering from body image disorders.
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Naked therapy and sexual surrogate therapy exist on the fringes of public familiarity, but dozens of other forms of therapy (of varying effectiveness and scientific validity) have made significant splashes in mainstream culture. Flooding therapy, for example, will see a client being forcefully and repeatedly exposed to the stimulus that causes them trauma and distress until the stimulus has no more power.16 Someone afraid of dogs, for example, will be left in a room full of (domesticated) dogs until that person overcomes the fear of dogs (cynophobia). A client with obsessive-compulsive disorder might be exposed to the trigger that causes an OCD reaction and then denied the means to carry out their compulsion (also known as response prevention therapy).
Concerns around flooding therapy center around the method exacerbating the pre-existing trauma; even with a clinician guiding the client through the process of literally facing the fears, it might be too much, too soon for a psychologically vulnerable person to deal with. The Cognitive and Behavioral Practice journal asks if flooding therapy is “the cruelest cure,” noting that it is imperative for the therapist to create “an adequately safe and professional context” to ensure that no harm is done to the client via iatrogenesis (damage caused by a medical intervention; i.e., making a pre-existing trauma worse by exposing the client to more of the same, in order to help the client overcome the trigger).17
Critical Incident Stress Debriefing
The human mind is a delicate thing, says The Guardian, and even some of the best-intentioned and well-thought-out therapies can offset a precarious balance.18 Critical incident stress debriefing, for example, is often offered to survivors of a violently traumatic incident, such as a plane crash or terrorist attack. Theoretically, it allows the survivors to bond together as a group, and under the guidance of a therapist, the aftereffects of the event can be healthily and positively dealt with.19
But a professor of psychology at Emory University warns that since critical incident stress debriefing (also known as crisis debriefing) is usually done as a group, individual needs can often go unmet. This could even cause a person’s trauma (which might manifest as post-traumatic stress disorder) to get worse.
The out-there and bizarre therapies discussed above run the gamut from the unconventional to the mostly harmless. But one of the most controversial forms of therapy that ever made its way to the mainstream was once thought to help people who survived traumatic or severely distressing events. Victims were usually of a very young age when the events took place, and the nature of the events were so threatening to their wellbeing that they involuntarily suppressed the memories of what happened to them. Now widely discredited, recovered-memory therapy (also known as RMT) is actually an umbrella term for different kinds of therapy that seek to recall memories that the client has suppressed, primarily because those memories are of the traumatic event. Individual therapies that fall under this category include:
- Guided-image therapy
- Application of sedative-hypnotic drugs
During the heyday of RMT, advocates (some with “varying degrees of training”) claimed that by a client recalling the memories, the negative effects on current behavior can be addressed and treated, possibly extending to solving crimes and apprehending perpetrators.20 However, established mental health associations have sounded alarm bells of the potential damage RMT can do to clients, because the accuracy of the memories may be compromised by the trauma. Trauma can, in fact, distort memory to the point where the client might “remember” events that never happened. In 1994, for example, Gary Ramona was awarded $500,000 in damages after a jury found that his daughter’s therapist had implanted false memories of abuse in the child, the first such finding in the United States.
Implanting Memories in Vulnerable Minds
According to the Los Angeles Times, a “cadre of expert witnesses” who testified on behalf of Ramona, said that one of the psychiatrists who treated his daughter, Holly, “implanted the memories in a vulnerable girl’s mind,” with the aid of sodium amytal “to prove to her that the images were true.” During therapy sessions, Holly recalled numerous times her father abused her, “although her descriptions were sketchy.” It was enough for her therapeutic team to report the crime of rape.
A forensic psychiatrist hired by Gary Ramona testified that methods like recovered-memory therapy have the potential of “wreaking havoc with patients’ minds or memory,” and accused Holly’s therapeutic team of violating acceptable standards for mental health care.21
Four years after the Ramona verdict, the British Journal of Psychiatry warned that “there is vast literature” on the idea of repressed-memory therapy, “but little acceptable research,” and opinions in favor of the practice are “often unsupported by evidence.”22
‘The Most Dangerous Idea in Mental Health’
In the spectrum of bizarre and out-there therapies, RMT stands out. While covering another story of apparent sexual abuse that turned out to be a case of implanted memories implicating an innocent man, Pacific Standardmagazine called recovered-memory therapy “the most dangerous idea in mental health,” with the director of clinical training at Harvard University’s Department of Psychology dismissing it as “folklore” that has “infected” psychology and psychiatry.23 Psychiatric Times was far blunter, saying that the rise of RMT was “the most acrimonious, vicious and hurtful” controversy that modern psychiatry ever faced. It stoked panic and appealed to fear and biases, tarnishing clinical mental healthcare and ruining lives in the process24.
RMT has been widely discredited by the medical and judicial communities, but it persists in sensationalized media and pseudoscience. “Hollywood keeps the myth alive,” says Scientific American, even as recently as 2015, when a movie that used the concept of repressed memories (and the drama of recovering them) launched a new wave of questions about the practice.25 Such is the extent of the problem of RMT, that foundations have been set up to help the “thousands of adults” who have been falsely accused of abuse as a result of fabricated memories divulged by children who were undergoing recovered-memory therapy.26
One of those adults is “Tom Mitchell,” the pseudonym given by Pacific Standard to a man who was accused of raping his daughter. Despite being cleared of all charges when the presiding judge ruled that his daughter’s testimony was “too inconsistent [and] too contradictory,” as a result of the recovered memory therapy she received, Mitchell’s family life was over (as was Gary Ramona’s, even after winning his case against his daughter’s therapists). For Tom Mitchell, victory in court against the treatment center that subjected his daughter to RMT meant little; respecting the wishes of his ex-wife, he no longer has contact with his daughter.
“What I Learned from a Male Sex Surrogate.” (March 2015). Salon. Accessed September 30, 2016.
“Sexual Surrogates Help Many Who Suffer Alone.” (May 2013). Psychology Today. Accessed September 30, 2016.
“The Sex Freak-out of the 1970s.” (July 2015). CNN. Accessed October 1, 2016.
“Sex Surrogates Seem Like Prostitutes But Are Helping Hands.” (August 2011). ABC News. Accessed October 1, 2016.
“Here’s an Inside Look at the Therapists Who F#ck Clients.” (May 2016). Cracked. Accessed October 1, 2016.
“To Refer or Not to Refer — Surrogate Partner Therapy.” (n.d.) Zur Institute. Accessed October 1, 2016.
“Use of Surrogate Sex Partners Rising Among Women.” (September 2011). FOX News. Accessed October 1, 2016.
“Naked Therapy.” (September 2014). Psychology Today. Accessed October 1, 2016.
“I Went to Naked Therapy™.” (August 2014). Vice. Accessed October 1, 2016.
“Meet Sarah White, the Naked Therapist.” (September 2014). News.com.au. Accessed October 1, 2016.
“The Male Mental Health Crisis Is Real — So Why Is It Still Being Ignored?” (February 2016). The Telegraph. Accessed October 1, 2016.
”Strip Clubs Save Marriages”: Anthropologist Who Spent Six Years as a Stripper Researching a Book (But Still Wouldn’t Want HER Husband Visiting One…)” (August 2013). The Daily Mail. Accessed October 1, 2016.
“The Emotional Blindness of Alexithymia.” (April 2014). Scientific American. Accessed October 1, 2016.
- “The Masculine Experience in Psychotherapy: An Examination of Clinical Processes and Outcomes.” (Fall 2011). New York University. Accessed October 1, 2016.
“Birthday-Suit Therapist Sarah White Conducts Naked Therapy Sessions For Troubled New Yorkers.” (March 2011). New York Daily News.Accessed October 1, 2016.
“Flooding.” (n.d.) Psychologist World. Accessed October 1, 2016.
- “The Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments.” (May 2009). Cognitive and Behavioral Practice. Accessed October 1, 2016.
“Critical Incident Stress Debriefing From a Traumatic Event.” (February 2013). Psychology Today. Accessed October 2, 2016.
“Recovered Memory Therapy, Evangelical Abuse, And The Mystery of What Happened to One Michigan Family.” (January 2016). Medical Daily. Accessed October 2, 2016.
“Father Wins Suit in “False Memory Case.”” (May 1994). Los Angeles Times. Accessed October 2, 2016.
- “Recovered Memories of Childhood Sexual Abuse. Implications for Clinical Practice.” (April 1998). British Journal of Psychiatry. Accessed October 2, 2016.
“The Most Dangerous Idea in Mental Health.” (November 2014). Pacific Standard. Accessed October 2, 2016.
“Ground Lost: The False Memory/Recovered Memory Therapy Debate.”(November 1999). Psychiatric Times. Accessed October 2, 2016.
“Memory Mondays: “Regression Therapy” Isn’t Real, but Hollywood Keeps the Myth Alive.” (November 2015). Scientific American. Accessed October 2, 2016.
“Remember, Remember…” (April 2003). The Guardian. Accessed October 2, 2016.