Among American taboos, sex work has remained one of the most morally contested, despite our hypersexual culture. Surrogate partner therapy is the process of treating clients who struggle with emotional and sexual intimacy through sessions that, at times, include sexual acts. “But that,” said surrogate partner pioneer Dr. Susan Kaye, “is the least of it,” quoting one of her colleague’s books.
“In our culture, whenever people hear the word sex, they immediately go to genitals banging together,” Kaye said. “There is just so much more our sensual life can give us. Sex is 10 percent of what (surrogate partners) look at. The other 90 percent of the emotional connection of intimacy is way more important.”
Andrew Heartman has been a professional surrogate partner in San Francisco for almost nine years. He has another part-time job, which he said is important for male surrogates to maintain.
“It’s a temporary relationship, and I don’t want to be dependent on income from surrogacy clients,” he said. “I don’t want to feel conflict about ending the therapy at the end of its natural course.”
Heartman is one of six International Professional Surrogate Association certrified male surrogates. Helping women learn about their own boundaries, and teaching them about consent, has become one of his passions.
Early on in his career, through a surprising discovery with one of his patients, Heartman learned what’s on someone’s surface doesn’t always imitate what’s underneath. He asked a client early on in their professional relationship if she was comfortable with him giving her a hug. She responded yes. He later found out that this was not the case, but she didn’t feel comfortable telling him no.
“That totally changed the way that I work because it made me aware that so many women have so much of their attention on other people and what other people want from them, that they are not in touch with what they want, and might not be comfortable communicating that,” he said.
He now uses the ABCs (awareness, boundaries, and communication) of SPT as the foundation that needs to be established before any physical connection.
While he makes a disclaimer about gender generalizations, Heartman said one commonality between many of his clients is they are people-pleasers. For Kaye, who has been a surrogate partner since the ’80s and trained directly with sexual research team Bill Masters and Virginia Johnson, commonalities in her male clients shifted with modernity. In the beginning, a third of her clients were adult virgins or people with some sexual history who experienced trauma.
“In today’s world, I see more people with a lack of self-confidence,” she said. “They are trained by pornography because pornography is everywhere. They model themselves to how it looks for the porn stars.”
Surrogate partners do not work with people in relationships. Other types of treatment that includes both people are suggested for couples. The surrogate’s job is to be close to their clients, to build trust that allows for intimacy at the client’s pace. Nothing happens spontaneously and the exercises are customized for each individual. As an example, Heartman will stand in different locations around one of his clients and ask her level of comfort or discomfort on a scale. If she is uncomfortable making eye contact, this gives Heartman some insight on how to proceed.
An activity is only included in the therapy only if it’s been established as corrective (rather than a repetition of habits that already aren’t working well). This means barriers such as communication skills, self-awareness, body image, overcoming shame, and cultural conditioning are addressed before intercourse is even an option. As the client-surrogate relationship grows, this may gradually lead up to intercourse if it is determined to be benificial. This creates a delicate professional boundary, which is why a three-person team – the surrogate, the client, and a licensed therapist – is necessary.
“The sex therapist sits in the office and does the psychological work, and the surrogate partner does the hands-on work. They work in cooperation with each other,” said Boulder-area sex therapist Dr. Tara Galeano.
Galeano’s practice, Boulder Sex Therapy, occasionally utilizes surrogate partner therapy. She usually lets her clients approach her with the idea, but she occasionally suggests SPT for her single male clients with prostate cancer.
“If (a patient) had prostate cancer, it’s really about ‘use it or lose it,’ so you really want to help get those erections going immediately,” Galeano said.
Galeano admits that part of the reason she doesn’t commonly suggest SPT is that it is not endorsed by regulatory agencies.
“It’s not something that is legislated here in Colorado. It’s not something you can say is absolutely legal. It’s not something you can say is absolutely illegal. I usually err on the side of caution,” Galeano said.
Galeano is prudent, but believes people should be able to seek the care they want or need.
“If (prostate cancer patients) want to be able to understand how to function better and get erections and don’t have a partner, I don’t think they should be shamed or put out,” Galeano said. “There is a flaw in the system, and some type of morality is constraining it.”
From Heartman’s experience, the therapy plays a much bigger role than sexual function alone.
A client once told him he was the only man to treat her with respect. He responded, “I’m honored to have been the first man, but I know I won’t be the last.”