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Notes for reviewers and moderators of The Sessions

 by IPSA President, Vena Blanchard

The Sessions is a film about personal courage, self-acceptance, and love. The screenplay is based on two articles written by Mark O’Brien, a profoundly disabled man, about his 1986 experience of exploring his sexual potential, losing his virginity, and embracing himself through his work with surrogate partner (“sex surrogate”), Cheryl Cohen Greene. Although Mark’s brave life, touching poems and essays provide the voice and sweet heart of this film, it’s important to remember that this is NOT a documentary about Mark, Cheryl, sex therapy or surrogate partner therapy.

When reviewing and discussing this film, keep in mind:

  •  Some of the specifics of Mark’s therapy (e.g. six session limit, sessions at a friend’s house, etc) were accommodations made by the therapist and surrogate partner in consideration of Mark’s lack of funds and extremely limited mobility. Although the specifics of his therapy as depicted in the film are not typical of surrogate partner therapy (then or now), concerns about cost and access ARE still common obstacles to romance and sexuality for people with disabilities.
  • There are currently only a few dozen surrogates in the entire United States, and only a few clinics that offer surrogate partner therapy outside the US (most notably in Israel and England).
  •  Back in 1970, researchers William Masters and Virginia Johnson reported great success for single clients in sex therapy who worked with “partner surrogates.”  Someone shortened “sex therapy partner surrogate” to “sex surrogate” and for a time that was the common term. But the term sex surrogates was always a misnomer, and is now just an outdated misnomer. The correct term is Surrogate Partner (or Professional Surrogate Partner).
  •  A professional surrogate partner works in close partnership with referring therapists and clients who need a caring, trained, ethical partner to assist them in understanding and resolving a broad range of interconnected social, emotional, psychological, and sexual concerns.
  •  The terms sex therapist and sex surrogate (aka surrogate partner) are NOT now and nor have they ever been synonymous. Sex therapists TALK with clients and give experiential homework assignments that are done outside the presence of the therapist. Some of those assignments require a partner. In addition to the talking with clients, surrogate partners engage clients in experiential learning – practicing relaxation, mindfulness, communication and sensual and sexual touch. Sex Therapists are all talk. Surrogate Partners are talk and touch.
  •  The involvement of an engaged supervising therapist is central to surrogate partner therapy (SPT). Clients are generally in therapy for some time before their therapists suggest the possibility of adding a surrogate partner. Clients continue to see their therapists, usually on a weekly basis, and see the surrogate partner separately. Therapist and surrogate consult with each other (usually by phone), after every session. These consultations center on the client’s response to the relationship and activities with the surrogate partner, discussion of client psychology, and session planning.
  •  Clients typically work with the surrogate partner for 6 months or longer, in addition to months of work with their therapists prior to, during and after the SPT.  It is not uncommon for a client to need 1-2 years to recover from sexual assault or remedy long term sexual dysfunctions. As noted on the IPSA website, most clients find they need more than the 12+ hours Cheryl spent with Mark.
  •  The surrogate and client relationship is an extremely valuable learning environment. The right combination of structured and unstructured interactions, compassion, authenticity, and self-examination trigger anxieties, insights, old shame, new courage, and untapped strengths. As a result, clients learn and grow as whole people. They eventually become more comfortable with themselves.  At some point the therapist, surrogate and client reach the conclusion that the work is complete and it is time to bring the surrogate and client relationship to a close. The process of closure is considered the final stage of the work, and is not done without careful consideration and care for the feelings of all participants. Clients generally continue to see their therapists well beyond the SPT.
  • In every human sphere there are some people who are less than ethical. This is also true of some people associated with surrogate partner therapy. Some people claim to be certified or trained even though they are neither. (Anyone can use the term surrogate partner or sex surrogate.) An add in a  free paper in NY used to offer “45 minute cure with sex surrogate.”  I would bet real money that this was not a genuine offer of genuine therapy.) The only way to be sure one is not getting snared by con artists is to get referrals and verification of credentials from IPSA.

Surrogate Partner Therapy is based on highly effective, well tested principles of cognitive behavioral therapy (CBT), such as successive approximation, systematic desensitization; and the well tested principles of modern sex therapy. It is part of the sex therapy tool box. It is not an alternative to therapy. It is therapy.

Every legitimate SPT program includes an actively involved therapist, an appropriate client, and a trained, ethical professional surrogate partner.

After an initial phase of trust building, relaxation and communication skill building, and beginning Sensate Focus exercises, the surrogate and client may be ready to gradually move into the second phase of SPT, which is more about whole body sensuality and emotional risk taking. In this second phase the therapy focuses on body image issues, attachment issues, and establishing a deeper level of trust and self-acceptance. Exercises might include partial or total disrobing; mirror work; caressing the whole back side of the body for sensual (not sexual) pleasure; sharing deeper feelings; learning about conflict resolution and partner communication.

The surrogate-client-therapist team has been solidifying for months (sometimes years) before considering entering a third stage of SPT, which might include eroticism and direct work on sexual dysfunctions. Some clients never need this stage. Others may have found a personal partner with whom they wish to proceed. Some do not have issues that are amenable to experiential work. That is determined, on a case by case basis, by the therapeutic triad over the course of the therapy.

Starting therapy is never a contract for sex. Neither surrogate nor client is ever required to do anything with which they do not feel personally comfortable. But, for some clients the only way to resolve their difficulties is to work on them directly in therapy. Take for instance female and male clients with phobias about penetration (perhaps due to rape experiences). In the early stages of the surrogate partner therapy, they will learn to establish trust, manage anxiety, and take baby steps that produce positive, reparative intimacy experiences. Yet, they may still need the safety of the therapeutic environment to tolerate the testing their emotional stability in intercourse. They are terrified to risk this outside of therapy, and without the therapeutic experience they avoid all relationships that offer (threaten) this sort of challenging intimacy. They genuinely require the safety and support of therapy in order to brave the third stage.

SPT is a diagnostic tool, a skill building environment, a model for healthy relationships and an opportunity for transformational intimacy. It is often difficult, powerful, tender, and at its best, it is a sophisticated therapy. It isn’t prostitution. It isn’t mechanistic. It isn’t illegal. It is exactly as challenging and rewarding as any emotionally honest relationship. In fact, emotional honesty is the hallmark of this treatment method.

Because the goal is to move clients into their futures, they all eventually leave SPT the way a child leaves its parents – with our heartfelt blessings and the tools they need to create new friendships and families of their own.