“Helen Hunt was nominated for an Oscar this year?” a man asked his companion as the bus jostled passengers side-to-side.  “Yeah, she played some sex worker helping some famous disabled poet,” was the reply.

Overhearing this conversation on my way home, I guessed they were discussing the film, The Sessions; but the reference was only partly correct.

The film depicts the true story of writer-poet Mark O’Brien (John Hawkes) losing his virginity at the ripe age of 38, with the support of his priest/confidant Father Brendan (William H. Macy), to certified sexual surrogate Cheryl Cohen-Greene (Helen Hunt).

A far cry from the synopsis I overheard on public transit.  Yes the character does work in the field of sex, and yes, she helped a well-known writer, but there are differences between surrogates and sex workers that go beyond the labels.

Surrogate clients typically suffer from specific problems, some physiological, but mostly psychological.  They range from lacking confidence and trouble with intimacy to erectile dysfunction and premature ejaculation.  Many are middle-aged virgins who know little about women and sexuality.

Former sex surrogate Rebecca Torosian recalls her shift in perspective as she describes one client:  “I was astonished to find that men like him existed.  I always thought men were born with an innate understanding of how to have sex.  But what I discovered over the years was just how wrong I was.”

Arising perhaps from our preconceived notions of male sexual competence, we label such men as “johns” rather than patients, despite problems like physical disabilities, psychological traumas stemming from sexual abuse, or histories of sexual shame or embarrassment.

Sexual surrogacy clients, consist mostly of men, although some are women.  They generally do not find sex enjoyable and their anxiety over sexual performance is often crippling.  They may feel isolated and stuck in a perpetual cycle of sexual failures.  Lack of confidence results in shortened romantic endeavours and the prospect of loneliness, with the sexual surrogate providing their last hope.

Surrogates also describe the ways in which their motivations distinguish them.  Prostitution is oriented toward return business, sexual surrogacy is not.  Rather, there is a predetermined number of sessions, with some flexibility depending on the client’s problem, along with treatment schedules akin to those of other mental health professionals.

Credentialing  makes a difference as well.  The real Cheryl Cohen-Greene is part of the International Professional Surrogates Association (IPSA).  Started  in 1971, ‘the organization maintains professional and ethical standards, and helps sex therapists, those who provide talk therapy for the clients’ sexual problems, find trained surrogates who can provide the “hands-on” treatment a traditional therapist cannot.

Surrogates work on relaxation, communication, and other behavioural therapy techniques.  In 1970, sex therapy and surrogacy vanguards William Masters and Virginia Johnson developed the standard training program based on the “sensate focus” method of sensual touch with verbal feedback.

Surrogates are included as part of treatment, often working alongside a sex therapist.  In an interview with The Daily Beast, Executive Director of the Institute for Personal Growth and certified sex therapist Margie Nichols explains that there are advantages in using both talk therapy and surrogacy when helping clients.  There is a difference between talking about sex and actually having it.

IPSA’s mission statement captures the purpose of the profession:  “As members of IPSA, we are committed to promoting healthy attitudes toward sexuality and intimacy in our clients and in the community.  To further our work and our own emotional well-being, we join together to provide support and assistance to each other in these endeavours.”

The Sessions and sexual surrogacy are partly about sex.  But human sexuality is complex, and to the extent that it is, surrogacy is more essentially about helping others find a way to express their love for another human being.

-Justin Garzon, Contributing Writer