Surrogate Partner Therapy in the United States: Ethical and Legal
The surrogate partner therapy modality was developed in St. Louis in the 1960s by human sexuality pioneers Masters and Johnson.
Surrogate partner therapy programs are undertaken in a collaborative format known as the Triadic Model, with the collaborating triad consisting of the client, the psychotherapist, and the surrogate partner. Before starting, the therapist evaluates whether the client is an appropriate candidate for this type of therapy. The therapist and surrogate partner collaborate on a treatment plan to meet the therapeutic goals of the client.
The client works with the surrogate partner on specific issues that cannot be resolved through talk therapy alone. The surrogate partner and the client form a temporary relationship so that the client can learn social, emotional, and physical intimacy skills within a real-life environment. The therapist continues to support the client before, during, and after the program.
Surrogate partner clients typically have no existing partner and no realistic ability to enter into an intimate relationship on their own. Some clients have high levels of social anxiety or histories of trauma or abuse, some have disabilities, and some have other concerns that prevent them from believing they can enter into a successful intimate relationship without therapeutic support.
The surrogate partner supplements the client’s support team temporarily. During surrogate partner therapy, the therapist and surrogate partner collaborate to help the client achieve specific goals. After the client completes their program with the surrogate partner, the client typically continues work with their therapist to help generalize their experience and integrate their new skills into their daily life.
The work of surrogate partners is often misunderstood to center around explicit sexual contact and intercourse. In reality, the therapy supports the client in building a foundation of self-awareness, healthy boundaries, good communication, relaxation, and positive body image before more deeply intimate contact is even considered.
Surrogate Partner Collective (SPC) certified surrogate partners continually assess the readiness of the client to engage in therapeutically relevant activity using the following criteria: (1) the activity is relevant to the therapeutic goals of the client, and (2) the surrogate, therapist, and client all agree that a foundation has been established, based on what has been done previously, that would allow that behavior to be corrective and therapeutic. An activity is included in the surrogate partner therapy program only if the aforementioned criteria are met.
Surrogate partner therapy is not, and has never been, illegal. There are no laws that prevent clients from seeking surrogate partners, prevent surrogate partners from practicing, or prevent therapists from collaborating with surrogate partners.
Claims otherwise are rooted more in fear than fact, as the surrogate partner process has not been immune from the deeply-rooted fear, shame, and judgment around sexuality that has thrived in our culture.
No statute prohibits the practice. After extensive research, we have not been able to find evidence of any case in which a surrogate partner or a collaborating therapist has been prosecuted for violating a criminal law or held liable for violating a civil law.
We invite information relating to any case we may have overlooked. If you believe such a case exists, we ask that you provide us with concrete information about the case, preferably including a court and case number, so that we can review case documents, determine the validity of the claim, and further our collective professional understanding.
In 1997, Kamala Harris, Vice President of the United States, former United States Senator, and former California Attorney General, stated:
“If it's between consensual adults and referred by licensed therapists and doesn't involve minors, then it's not illegal.” (1)
Professional Ethics and Therapeutic Licensing
Psychologists strive to benefit those with whom they work and take care to do no harm. (2)
Many clients struggle for years or decades attempting to overcome their obstacles to emotional and physical intimacy. While talk therapy may be sufficient for some, for others it may not be.
In some cases, the most ethical course of action would be to refer the client to another practitioner who can collaborate with the therapist to provide the highest likelihood of success for the client.
When it comes to licensure, we can not find documentation of any case in any state or jurisdiction where a therapist’s license has been put in jeopardy because they collaborated with a surrogate partner. As with the lack of court cases mentioned above, we invite documentation of any case we may have overlooked.
In fact, licensed therapists are encouraged to refer their client to an outside professional if they determine that it would benefit the client. The American Association of Sex Educators, Counselors, and Therapists (AASECT) code of ethics states:
When the certified member’s level of competence does not afford optimal benefits to the consumer, the Certified member shall, in a timely and efficient manner, recommend referral to better-qualified sources. (3)
Similarly, the American Psychological Association (APA) requires:
Psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work.(4)
Clearly, organizational codes advocate the use of professionals, such as certified surrogate partners, when therapeutically relevant. Licensing regulations are in harmony with the ethical duty that a therapist refer to an outside source when it is in the best interest of their client.
While it is true that therapists are prohibited from entering into intimate relationships with their clients, this prohibition does not extend to the surrogate partner. When a client requires relational experience that a therapist is prohibited from providing, a surrogate partner is an appropriate option for referral.
The surrogate partner modality is viable, if often misunderstood. It is a time-tested and proven benefit to many clients. It is a legal modality that is appropriate to consider for certain clients.
The surrogate partner program presents us with an opportunity for a paradigm shift. A shift away from shame and narrow ideas of intimacy. A shift to more healthy, well rounded, skillful, and loving human relationships.
We, as experts in our field, invite therapists to join us in asserting our commitment to client care and expansion of broader societal sexual health by actively integrating somatic, intellectual, and emotional well-being.
1. Nhu, T.T. (1997, October 4). Her Mission: Sexual Empowerment. San Jose Mercury News. 4B.
2. American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct; Principle A: Beneficence and Nonmaleficence. Retrieved from https://www.apa.org/ethics/code/principles.pdf
3. American Association of Sex Educators Counselors and Therapists. (2014). Code of Ethics & Conduct for AASECT Certified Members; Article VI: Code Of Conduct; Principle One: Competence and Integrity. Retrieved from https://www.aasect.org/sites/default/files/documents/Code%20of%20Ethics%20and%20Conduct_0.pdf
4. American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct; Principle B: Fidelity and Responsibility. Retrieved from https://www.apa.org/ethics/code/principles.pdf
For more information about our code of conduct, please visit Surrogate Partner Collective Code of Conduct at https://www.surrogatepartnercollective.org/code-of-conduct.
Authored by River Roaring, Brian Gibney, Nicole Ananda, and Andrew Heartman