Anita Rao
All the conditions seemed right. We'd had a really nice day together exploring the city, capped off with dinner out and a not-too-stressful subway ride home. But once all the outside noise was shut out, and we were cuddled up on the couch, all of my own stuff started to get really loud: The white stretch marks in the inside of my thigh that I happen to notice in the bathroom. The text that popped up on my phone from a co-worker, reminding me that the project I thought we'd finished was now back in purgatory.
It's taken me years of ongoing work, many good books and lots of conversations with my now-partner to start to unravel the obstacles I encounter to physical intimacy. But what if you're in a place where those barriers feel really insurmountable, and you need help building a healthy sexuality? One option: surrogate partner therapy.
This is Embodied. I'm Anita Rao.
It's almost easier to describe what surrogate partner therapy isn't than what it is. It's different from sex therapy and sex work. It combines skills training, communication and sometimes sensual and sexual touch to help people working through barriers to physical and emotional intimacy. I first heard about it in the 2012 movie "The Sessions," starring Helen Hunt and John Hawkes. The film was based on the real life story of the late Mark O'Brien, a journalist and poet who used an iron lung for decades due to complications from polio. He sought out the services of a surrogate partner to explore his sexuality.
John Hawkes in "The Sessions"
This therapist suggested I could work with a sexual specialist — have sex with a person known as a sex surrogate who would be sensitive to my unusual needs.
Anita Rao
That's actor John Hawkes as Mark O'Brien. On brand with many Hollywood depictions of sex and intimacy work, this film didn't get everything right. One big thing it got wrong was conflating the work of surrogate partners with sex therapists. Some sex therapists occasionally work with surrogate partners as we'll talk more about later, but the two professions are very different. "The Sessions" did, however, introduce the concept of surrogate partner therapy to a much wider audience.
Surrogate partner therapy has actually been around since the 1960s and owes its origins to human sexuality pioneers William Masters and Virginia Johnson. Their work on what they called "sexual inadequacies" brought them to the belief that while talk therapy is crucial, it's missing an aspect of embodiment. Many of the mostly white, cisgender men they were working with were married with romantic and sexual partners. But for those who were unpartnered, they were given access to a trained professional — or surrogate — who could help them. The practice has evolved a lot since then, but the stigma around it has lingered. And that's due in part to the many misconceptions about the work. First and foremost? That surrogate partner therapy is all about sex.
Jeannie Miller
This is Jeannie Miller. I'm a trans woman. I often work with trans and queer clients. Over some months, I saw one client who had been afraid of intimacy for decades, start to smile and joke easily, to weep openly, to take emotional chances that seemed unthinkable. One of the most striking things was when she showed up one day and said, "I told my therapist that when I saw you last, I thought about when I could kiss you." And the therapist asked, "Well, do you want to ask her?" So the client said to me "I was afraid to, but I'm telling you now." And I said to the client, "That's great. How does it feel to share that?" She said, "It feels fine." And then she didn't even ask if she could kiss me. She asked if we could try something else. We tried this particular kind of touch. And then she said, "That's it. And I'm so amazed that I'm not afraid. Thank you so much." And I reminded her, "You are doing all the heavy emotional lifting here. You worked for it. You take it into the rest of your life."
Anita Rao
Jeannie is one of dozens of surrogate partners working in the U.S. She and the person you're about to meet went through training with the International Professional Surrogates Association. It's an organization that has established a code of ethics and professional standards for this field. And what's key to understand about this work is that it's a relationship among three people: a client, a licensed clinical therapist and a surrogate partner. And the client isn't the only connective tissue between the two professionals. They work very closely together to coordinate the care that they're providing and make sure that they're on the same page. The best way to think about this is kind of like a triangle, where everyone is connected to one another. And all those connections have to be strong to make it work.
Brian Gibney
The work is part science, and it's part art.
Anita Rao
That's Brian Gibney. He's been a surrogate partner since 2016. And if you were to look at his resume, you might be confused as to how he ended up in this work. His first career was as a research scientist working in molecular biology. He then was a professional jeweler for about 10 years before spending seven years as a circus performer. So what's the through line from all of that to surrogate partner therapy? His answer: analytical thinking combined with embodiment. Surrogate partner therapeutic relationships also rely on a lot of mutual trust and relationship-building.
Brian Gibney
First off, I want to make sure that a client is working with a therapist. If they're not working with a therapist, I usually refer them to a therapist, because this work is intensely relational and because it often pokes some really tender spots that clients have in their history. It's really important to have a separate third party outside of the client-surrogate dyad that helps them process these things. The other thing I do is I talk to a client about what their goals are, what their visions are for what healthy relationships, what healthy sexuality would look like for them. On the other end of this work, some folks come to the work and they feel like they need more experience. Some folks come to the work and they feel like they have some severe obstacles to physical and emotional intimacy. And for me, those are the folks that I really like to work with. But I do want to clarify that, like, this is not magic. You know, this is not you go through the process, we wave a magic wand and you're going to be somehow magically cured. Like, this serves as a really great controlled, compassionate and therapeutic way of looking at some of the stories that we have about our sexuality and our relationships.
Anita Rao
So I want to ask you about one of the things that I mentioned early on, which is distinguishing this work from sex therapy, in particular. How does having physical intimacy and touch on the table as part of the relationship serve the clients in a different way than going to more traditional sex therapy?
Brian Gibney
Yeah, yeah, yeah, it is a huge difference. So sex therapists, part of the clinical container, part of the professional container for them is that they don't have erotic contact, they typically do not have physical contact with clients. But also they're there to maintain objective and clinical standpoint in the work. Our position in the relationship is really different. Not only do clients walk into the room with us, and there's this erotic potential — they think, "Oh, wow, I could possibly be having sex with this person at some point in time" — but we also show up as ourselves, or you know, our human selves, where we get to say, "This is what Brian is like. And this is what Brian the person's experience of you is." Which is very different from what therapy looks like.
Anita Rao
It's described as kind of a temporary relationship. You are bringing your full self into the interaction and into the exchange. And while physical intimacy is on the table, it's definitely not where things start. So take me to day one, maybe for example — and I know there's a satellite exercise that you use to guide people through kind of orienting to this work. So talk to me about this exercise.
Brian Gibney
Yeah, so I typically work with folks that — cis females, folks that have — are nonbinary folks that have been socialized female. One of the things that I want to do from the very beginning in the work is create safety in the container of our work. That means really making space for the client's feelings of discomfort or want. So when we're doing satellite, what I often do is I ask the client to sit in the middle of the room and move me around in the room. Tell me to come closer, tell me to move further away, move around them kind of in a — in a circle. And let me know what is their feeling of comfort, of safety, based on my position. They get to move me around in that space. So if I'm in a place where they feel uncomfortable, they get to say, "Please move back. Please move into my field of view." And we start to create this language, this dance around two things. One is the client's own self-awareness of their experience. And two is how they communicate that experience to me.
Anita Rao
Surrogate partner therapy work has specific and distinct phases. The first part is that emotional connection and communication skills piece that Brian just talked about. That comes before any body work or sensual or sexual touch enters the picture. It's a careful dance and different person to person. Arianna Fernandez is another surrogate partner doing this work. Arianna is based in Los Angeles, and their work is trauma-informed, polyamory-friendly and kink-aware. Arianna uses he/they/she pronouns interchangeably.
Arianna Fernandez
I identify as genderqueer. And I do think that an affirming nonjudgmental space is easier to develop if you understand the experience of the person you're working with. So I have started working with more trans and nonbinary clients as I've also gone through my gender journey. It is a uniquely supportive space, I think, because our training is to create genuine, authentic connections. They have just needed a person who can sit with them, and listen to their lived experience and their feelings of being other. And that's really reflected in the first time I did a body image exercise with a trans client. Because dysphoria often also comes with body dysmorphia, it is very difficult for trans and nonbinary clients to do body image exercises in the mirror, where we talk about our bodies without feeling triggered and feeling more sensitive than perhaps another person might be. And it's just important that we be mindful of these differences that might show up in the room and rely on that relationship that we've built to support them and to, you know, really see them in a way that not everybody does, in the way that they see themselves on the inside.
Anita Rao
That's a really helpful example. And I think points to the fact that what Brian referenced earlier is that you are bringing your full self into the room. And a lot of this work is about the two-way relationship, back and forth, versus a lot of other ways that people work with intimacy coaches, or other kinds of support in this field that's a little bit more one directional. Talk to me a bit about the two way piece, and — and how that really shapes how the relationship evolves.
Arianna Fernandez
Sure, from the very beginning I tell clients that I am going to be available to tell them details about myself. So because it is an attempt to heal through connection, to heal through attachment, we have to share more about ourselves and we can't be objective. That means that sometimes clients do have a hard time connecting to us if we don't have a lot in common outside of the room. But that's all grist for the proverbial mill in their therapy. If they're having a hard time with us, they go back to their therapist and can process with their therapist before communicating directly, hopefully with us. And all of these things, these possible differences, possible conflicts are a good example of what's going to show up for them in other relationships possibly and giving them good experience so that they have something to draw from when they're trying to repeat the results a little bit, whatever successes they find in the room. Then they can have some confidence that they could go do that outside in the wider world.
Anita Rao
Listening to you talk about this, as someone who has been in more traditional kinds of therapy for a long time, there are these like alarm bells going off for me in terms of boundaries. Like I feel like I'm so schooled in thinking about a therapeutic relationship with, like, very clear boundaries. I don't know anything about my therapist, and like, even though I'm really curious, I'm not supposed to ask, like, I shouldn't know. And so I'm curious about how you think about and describe boundaries in this work, like, how do you figure out what to keep in the container and what to keep out? And how does that more blurred line serve the work that is happening?
Arianna Fernandez
Yes, what's very important is that the client and the surrogate partners are not spending time together outside of the sessions. That container, the room that we're doing our sessions in, is the only place we really see each other. That we only talk outside of our sessions in order to schedule sessions. If there's conflict that we address it in the room, and we involve the therapists. And if there are changes to those agreements that we have, these fundamental things that maintain the space as limited, that we are only renegotiating with the therapists' involvement. So if a client wants to have longer sessions with me, if they think it would be helpful because they're taking a while to get settled in, they're still anxious in the beginning and need a little longer to talk and to get more comfortable, for example, then we would need to talk to the therapist and make sure that they agree that that's actually going to be clinically useful. Now there's room for negotiation, but changes in things like the cost of sessions should also be reflected in that relationship with the therapist. Anything where our major agreements would be changing, we can't do that alone. Because the client is in a unique position where they're very vulnerable with us. And we are seen, even though it's a peer relationship, as leading a little bit, right? So while we are proposing exercises, and they get to say yes or no, there's explicit consent asked and given, we still involve that other person in that triadic relationship so that we know that we are doing things ethically and based on those clinical goals that we set out at the beginning.
Anita Rao
I told y'all earlier that surrogate partner work is comprised of a few distinct phases. And just as important as those beginning ones of laying the groundwork for communication and connection, is how this relationship ends, which surrogate partners call closure. Before talking to Brian, I listened to some interviews that he did on other podcasts, and one of the moments that really stood out to me was when a podcast host posed him a listener question that said, "How do you prevent clients from falling in love with you?" And Brian's answer was, "I don't."
Brian Gibney
This is one that definitely elicits strong reactions. The surrogate partner therapy is predominantly an attachment-based, relationally-based work. So we don't shy away from emotional connection. There's a lot of safety and security that comes with that attachment. Even if there is grief at the end, but that grief is part of the work. So sometimes we get to the end of the work, and they look at me with tears in their eyes. And they say, "I think I'm done. I think I've accomplished everything that I could accomplish with you. And that makes me really sad and happy and excited and nervous for the future." And we get to sit with them and say, "Yeah, it's all those things." And often I cry with them, right? Like I'm gonna miss them too. Our work, the relationship that we have that is in service to the client's work, has to end so their broader work can continue.
Anita Rao
I know that every surrogate partner has a different set of parameters around the work that they do. Arianna, I'd love to hear a bit about your parameters, especially around the physical component of the work and how you've come to define those and how those have evolved for you over time.
Arianna Fernandez
Yeah, great questions. So I personally do not do genital touch with clients at this point in my career. And that has been confusing for a good many people lately, because the old term that was sort of popularized for surrogate partner therapy was "sex surrogates." Which I think was always a misnomer. But what's really happened with this field is that it has evolved over time to include a lot more than the original Masters and Johnson work. And because it is about developing this authentic relationship, there was a point at which I had to question whether or not I was actually still comfortable doing genital touch with clients. And the answer was that I wasn't. It was no longer something that I felt aligned with. So while we work on nurturing and sensual touch and sex education and dating advice, not every surrogate partner is doing genital touch. Or maybe some people will do genital touch but are not comfortable having in intercourse, everybody works a little bit differently. And I think it is better for the client to know what we're genuinely okay with and what we're not feeling aligned with, because then they can be assured that when we show up in the room, we are giving them 100% honest representations of ourselves.
Michelle Renee
My name is Michelle Renee, and I'm surrogate partner in San Diego, California. A moment that really sticks with me is a client who had come to me to explore her sexuality as a trans woman. There was a moment where we had explored some of her sexual interests that were a little outside of mainstream. And with my help, and my background in kink and BDSM, we were able to safely explore this interest of hers. This work is important. This is not something the client could have explored simply in talk therapy. This is not something that I would want to send a client out into the regular world to explore on their own. In surrogate partner therapy we're able to keep a safer container than the clients would have out on the street.
Anita Rao
Up until this point we've talked a lot about the role of the surrogate partner, but what about the therapist? Meet Deva Segal.
Deva Segal
Where I come in in the model is to first of all make sure that they don't have other areas of their life that probably need to be prioritized before they decide to pursue a relationship with a surrogate partner, engage in surrogate partner therapy.
Anita Rao
Deva is a licensed marriage and family therapist and certified sex therapist based in San Francisco. Recently, she started incorporating surrogate partner work into her practice.
Deva Segal
The people who make the best candidates for surrogate partner therapy are, they are single, have had not a lot of relationship experience and or they have a certain part of their experiences that they have not been able to express, get to, for a number of reasons. It could be because of ability, it could be because of neurodiversity, it could be because of sexual interest, it could be because of trauma, it could be with difficulties with attachment. So the folks that make the best candidates for that realize that they have a part of themselves that may be getting in the way, or they have experiences that are making it difficult for them to have real world experiences. And they want to find a safe place to find out more about that.
Anita Rao
So this kind of therapy has been around for a long time, but it is not as popular in the U.S. as maybe you would expect given the length of time that it has been around. So I'd love to kind of better understand maybe some of the misconceptions that you think exist about surrogate partner therapy in the field of sex therapy, or what some of the reservations are — why it's not more widely adopted?
Deva Segal
Oh, gosh, um, I think it's, you know, for a number of reasons. I think that even with other therapists that I've talked to, their first question is, "How is this different than full service sex work?" And, you know, there's a number of reasons that it's not, but again, therapists' education, honestly, trying to help folks understand why this would be needed at all —which I think also goes back to just the public at large, really thinking of sex as this very specific thing and not thinking about it in the larger context of what it means to be in a relationship. And sex is not just about the act, it's about intimacy, it's about comfort. And then finally, I would say access. You're working with two different providers simultaneously. Therapy is reimbursable. Psychotherapy is reimbursable by insurance. Surrogate partner therapy is not. So you do need to have, you know, at minimum those financial means to access that. And then also, the number of surrogate partners that are available. Obviously, I think that that community is looking to grow and expand. But we're, you know, talking about access just in terms of numbers, and then also financially. Yeah, I think that those are probably the largest issues, is just misunderstanding about what it's for, and then how to actually do it and get it.
Anita Rao
So tell me a bit about your own process of deciding to add this element into your practice. What brought it to your attention, and what pushed you over the line of deciding that you really wanted to start working in this model?
Deva Segal
There has been moments that I've been in the therapy room with particular clients that have particular needs, and I'm like, "Yeah, spidey senses going off." That it's like, yeah, this person would really benefit from somebody that can do this work in real life with them. I'm clear with my clients about what the limits of psychotherapy can be. And part of that is that we're not going to be in a touch-based relationship. And so it just made sense. It just made sense that this is something that I want to be able to lead my clients to if they're appropriate for it. And if they're appropriate for it, then they need somebody, you know, on their team to help figure it out because it's a delicate process. Takes a lot of bravery, takes a lot of focus and it takes commitment.
Anita Rao
On your website, where you outline the range of services you provide and a bit about your experience, you also write about your philosophical approach to the work. And there's a line that you wrote on there that stood out to me, which was that you said, "When you want change, the irony is, the slower we unwind your thoughts and feelings, the more bang for your buck you get." And it really reminded me of some of the things that the surrogate partners said of how, you know, despite the fact that some people might walk in and think like, "Okay, we're gonna have sex like day one, let's do this, I've been waiting for an opportunity to have someone really support me through this." Like, that's not how it goes, it's much slower. It's about this very slow build, to unravel and really understand. I'd love to know about the pacing piece and a bit more about, I guess, if you could elaborate a bit more on that part of your philosophy and how it connects to surrogate partner work.
Deva Segal
It's so funny hearing you say my website back I'm like, "Oh, really I did say that, huh?" [Laughs]
Anita Rao
[Laughs]
Deva Segal
Yeah, I think that — I will say this to clients in a number of different contexts and I think this is just as applicable to as surrogate partner therapy clients as well — which is, the frustration is real, but honestly, this is the shortcut. And it means that you're in a conflict with wanting something and then not being able to access it for a number of different reasons, some of them very, very understandable and legitimate. And it's about giving yourself the opportunity to observe, and try to make meaning of those observations, rather than just doing and having and getting. It's a very human thing to not be happy with what you don't have and what you, you know, think that is going to fix it. And we don't know what we don't know. And allowing some of that — those observations to really be more like mystery. And really to be more like curiosity. And holding that near stillness, or just slowing down the process to such a degree that you're really having to pay attention to — to nuance. It opens up the field way more than, "Well, when I just get this thing, this is what's going to make it happen." And dealing with that kind of frustration in a number of different contexts is very normal and very human. And that's why I'm there.
Anita Rao
We've said it before here on Embodied, and trust me that I will keep saying it until someone takes my microphone away: shout out to therapy! It is never easy, but it is so worth it. As we've been noting throughout this episode, the number of surrogate partners and the number of sex therapists who work with surrogate partners is very small. Some therapists and sex therapists have misgivings about this work, and others don't even know that it exists. But surrogate partners like Brian and Arianna will tell you that they've seen this work bring about powerful transformations for people. And they also acknowledge that it's shaped how they show up in their own lives.
Arianna Fernandez
It's definitely made me a better communicator. I have been able to understand, be more emotionally aware and understand my needs better. And communicate more directly what those are and by extension get more of what I want in those relationships. It has helped me to accept the impermanence of some loving relationships, and to just value connection regardless of how long we have the person.
Anita Rao
Embodied is a production of North Carolina Public Radio-WUNC, a listener-supported station. If you want to lend your support to this podcast, consider a contribution at wunc.org now.
This episode is produced by Paige Perez and edited by Amanda Magnus. Kaia Findlay, Paige Miranda and Gabriela Glueck also produce for our show. Skylar Chadwick is our intern and Jenni Lawson is our sound engineer. Quilla wrote our theme music.
And this is actually Paige Perez's last episode with us. Paige came to Embodied for a short stint earlier this year, and we liked her so much that we made her stay for as long as we could. Paige is the genius behind so many great shows from the past six months, including what's become our most listened to episode ever: "Isolated," about male infertility. Paige, we are going to miss your incredible warmth, your very affirming slack messages and your humor. Don't be a stranger.
We also want to give a special thanks to surrogate partners Jeannie Miller and Michelle Renee for their contributions to this week's show. A big thanks also to Krista Nabar, a licensed psychologist and the executive director of the Carolina Sexual Wellness Center.
If you want to stay up-to-date on new episodes, or weigh in on the conversation, give us a follow on Instagram and X, formerly known as Twitter. Our handle is @embodiedwunc. If you're more of a thinking-out-loud person, we'd love for you to leave us a message with your stories, thoughts and ideas at our virtual mailbox, SpeakPipe. You can find the link in the show notes.
Thank you so much for listening to Embodied and if you liked the show, please spread the word in your own networks. Tell a friend about it. Word of mouth recommendations are the best way to support this podcast.
Until next time, I'm Anita Rao, taking on the taboo with you.