The New Male Sexuality (71 page)

By fulfilling your conditions, by having sex only when you desire it and are aroused, by making sure you are relaxed, and by getting the kinds of stimulation you like, you are ensuring that your penis will function most of the time you want it to. And when it doesn’t meet your expectations or
when an erection goes away at an inopportune moment, you no longer have to worry about it. You are prepared to have a good time no matter what your penis does.

As time goes on and your sexual confidence continues to develop, you will not need to be as careful about your conditions. Just don’t forget about them altogether. If you should find yourself backsliding, if you notice you’re tense in sex or find that sex isn’t as satisfying as it is now, give more attention to conditions, arousal, relaxation, and stimulation, and it probably won’t be too long before the situation improves again.

CHAPTER TWENTY-THREE

Surrogate Partner Therapy

For men who have any sex problem—shyness, lack of experience, lack of interest, erections, rapid ejaculation, or inability to ejaculate with a partner—and don’t have a regular sex partner and aren’t likely to get one until the problem is resolved, the most effective and certainly the most controversial treatment is what’s called surrogate therapy. The word
surrogate
means “substitute” and was chosen by Masters and Johnson to refer to a woman associate who did the sexual exercises that ordinarily a man would do with his partner.

Despite lots of publicity about surrogate therapy in the media, there is still much confusion about it. Some people think that a surrogate is nothing more than a prostitute because she has sex for money. It’s true that surrogates—just like therapists, lawyers, and physicians—like to get paid for their work. But the similarity ends there. A prostitute’s job is to give her customers a good time and get them off, usually as quickly as possible.

A surrogate’s role is different. Her job is to teach clients skills they need to be more effective socially and sexually. Reputable surrogates work with therapists—that is, the client has a session with the surrogate and then goes to see the therapist, with or without the surrogate—and function more as the therapist’s associate rather than as a wife substitute. The surrogate’s job is not getting the man off or giving him a good time. Rather, it is working with the therapist to diagnose and treat the client’s problem.

A lot of the time the man spends with the surrogate is devoted to the development of social skills and talking, which in itself is different from what happens with a prostitute. Talking usually takes up most of the first session, followed by a relaxation exercise or two and perhaps some light touching with both surrogate and client fully dressed. In subsequent sessions, there is a progression to communication exercises, nudity, sensual touching, and finally more direct sexual activity. The physical/sexual activities they engage in, often called body work, are similar to the partner exercises given in this book. Depending on the surrogate, therapist, and the nature of the problem, there may or may not be much intercourse. In almost all cases, a large amount of time is spent by the surrogate helping the client to learn ways to reduce the anxiety he feels in sex and to increase his confidence.

Surrogate partner therapy is extremely beneficial to men of all ages who have little or no sexual experience and who are shy and fearful. I have worked with virgins or near-virgins as young as eighteen and as old as fifty-seven. Enrico is an example. He was forty-three when he came to see me. He had several experiences with prostitutes when in the army, and a number of hand jobs at massage parlors since then, but never sex that hadn’t been paid for. He’d never had a date. Needless to say, he was painfully shy, fearful of both rejection and acceptance.

It took several sessions with me before he was even willing to meet the surrogate. For the first ten sessions with her, he kept his clothes on and the work focused on overcoming his social anxiety. I did a number of confidence-building and fear-reduction techniques with him, and he practiced talking to the surrogate and then role-playing meeting her in various places and initiating conversations. This progressed to getting her phone number and asking for a date.

He and the surrogate then went on simulated dates. They actually went for walks and to coffee shops. Then we got to initiating physical contact and, finally, to sexual contact. An essential element in every step was practicing talking with the surrogate; for example, in explaining why he wanted to proceed gradually in sex instead of rushing into bed on the second date.

The work with Enrico took a number of months because of his extreme shyness and fear. But in the end it was successful. He started dating and after a while met a woman he fell in love with. Now, some years later, he is happily married and a father.

You may be surprised by all the work we did with Enrico on social skills and communication, yet this is a common and crucial feature of surrogate
partner therapy. We have had a number of clients who were taking penile injections for their erection problems, and now Viagra or antidepressants for their quick ejaculations, but who still wanted help to reduce their anxiety and to learn skills to become more confident and satisfying lovers. There is a lot more talking and relating in surrogate therapy than most clients and even referring therapists and physicians realize.

There is an exception to my earlier statement that surrogate work is only for men without partners. I have also worked with some men who had partners who absolutely refused to participate in any way in the treatment; they wouldn’t even talk to me on the phone. Some of these women have themselves suggested a surrogate; they wanted their men to “get the problem fixed” or learn better lovemaking skills, but they didn’t want to have anything to do with it. I have always had mixed feelings about doing surrogate work with these men, even when their partners are the ones pushing the idea. I haven’t liked helping them have sex with a woman other than their mates. But given that the partners either wanted this solution or wouldn’t cooperate in helping the men with their problems, there didn’t seem to be much choice. Some of these cases have worked out, by which I mean the man overcame a problem by learning better skills with the surrogate and was able to transfer the learning to sex with his partner. But in a significant number of these cases the result was that the man left his partner. This isn’t surprising, because her refusal to participate in treatment is a definite sign that the relationship was not in good shape. I don’t exactly know how to categorize these cases—can a divorce ever be considered a success?—but without exception the men reported that the therapy was very helpful. Several of them even said that going into therapy with the surrogate and me was the smartest decision they had ever made.

Surrogate therapy at its best involves the therapist and surrogate working toward a common goal, with each contributing his or her own expertise. For example, the surrogate may tell me that our client is fine with sex play as long as there’s no thought of intercourse. When intercourse is a possibility, he immediately tenses up and loses his erection. To help prepare him for intercourse, I may do some relaxation work with him followed by processes to reduce the specific fears. Then we have him imagine moving toward intercourse in a positive way. What I do with him in his imagination, she does in reality.

The main advantage of surrogate therapy is that it is highly effective.
Other therapists I know who do this kind of work agree with me in thinking it is the most effective therapy for men without regular sex partners. It has been almost 100 percent effective with male virgins of all ages. Usually
these men have failed with several women and been so humiliated that they refuse to try again until they feel their problem is resolved.

Some people make the assumption that while surrogate work will help the client function with the surrogate, it won’t carry over to other partners. Fortunately, this assumption is incorrect. The surrogates I’ve worked with and I are very much aware of the issue and direct our efforts to resolving it. We would view it as an unmitigated failure if a man could function with the surrogate but not with real-life partners. So we are always focused on the partner(s) he doesn’t yet have. Say a client is able to do something today with the surrogate that he’s never been able to do before. When we ask him why, he usually gives credit to the surrogate: “She made me feel so relaxed (or confident) by saying X or doing Y.” Then we ask the crucial question: Suppose you’re with a woman who doesn’t say X or do Y? What could
you
do to feel as relaxed (or confident)? And then we work on what he needs to be able to do, often involving role-playing with the surrogate and the therapist. In the many cases I’ve worked with, the ability to function as well with a real-life partner as with a surrogate is over 90 percent.

Surrogate therapy is hard work for the client. The work causes his problems to surface, and then he has to learn and perfect the skills necessary to resolve or handle them. In many ways the therapy is more difficult than real life. Many clients have told us long after the therapy, after they have dated one or more women and are involved in a relationship, “After what I went through with you, everything is easy.”

Surrogate treatment also has disadvantages. First, it is applicable only for a small segment of the population: those men with sex problems who don’t have a regular sex partner and who probably won’t find one until their problem is resolved. Second, it is expensive, because two people are being paid. Surrogates generally charge less per hour than therapists but their sessions are longer, usually an hour and a half or two hours. Third,
this kind of therapy is not widely available. As far as I know, the main places to find reputable surrogate therapy are in the large metropolitan centers on the East Coast and in California, especially Los Angeles and the San Francisco Bay area. In my practice, we have had clients from all over the country and abroad come to us for treatment because surrogate therapy wasn’t available closer to home. This means that men living elsewhere may have to consider coming to one of these cities for two weeks or so of intensive therapy, which of course involves the additional expenses of travel and lodging.

An important question has to do with sexually transmitted diseases. After
all, surrogates have sex with many partners and seem like prime candidates for contracting one or more of the many common diseases. The fear of spreading or getting AIDS, or of being sued for transmitting it, has caused some therapists to stop doing surrogate therapy.

The surrogates I have worked with are extremely careful about disease and were this way before the advent of AIDS. As far as I know, not one has ever had a sexually transmitted disease. The surrogate I now work with gets an HIV antibody test every six months and demands two negative test results from every new client. Safe sex is the name of the game, and it is played compulsively. Clients learn far more about safe sex than they want to know.

If you’re interested in this kind of therapy, I have a few suggestions.

1. Work only with a surrogate-therapist team, not a surrogate alone
. You see both of them and they keep in touch about you. In my own work, I call the surrogate after every session I have with the client to go over what came up and how that affects our work. She does the same after every session she has with the client. The therapist is a crucial element in the therapy. Surrogates are trained in sexuality and surrogate work, but they are not trained psychotherapists. Besides, as many surrogates will be the first to admit, it’s often hard to be objective when you’re doing body work with someone. Some therapists refer clients to surrogates and then have nothing further to do with the case. This is not a good idea and I caution against it. Both client and surrogate need support and assistance from an experienced therapist.

Speaking of which, it is important that your therapist be experienced in working with a surrogate. Most therapists, even most sex therapists, do not have this experience. If your therapist does not, ask for a referral to someone who does.