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The Evolution of Surrogate Partner Therapy

Updated: Jan 6

Not Your Grandmother's SPT

The practice of Surrogate Partner Therapy was pioneered by Masters and Johnson starting in 1959 and was introduced to the world with the publication of their book “Human Sexual Inadequacy” in 1970. More than half a century has passed since then, and the practice of Surrogate Partner Therapy has changed and evolved during that time. I spend a lot of time talking with people about the practice, and I’m often surprised at how many of the ideas that people currently hold relate to the way it was practiced at its inception, rather than the way it's practiced today. Even though the practice has changed, many of the conceptions about it have not.

As a result, I believe it’s important to point out the ways the profession has changed over the years. In the same way that the work of an information technology professional was very different in the 60s than it is now, the work of a surrogate partner is also different, and it’s important to recognize those differences and to get clear, when we talk about Surrogate Partner Therapy, whether we are talking about the practice as it was originally conceived back in the 1960s, or about the way it’s practiced in the present day.

I’ll be speaking about general trends in how Surrogate Partner Therapy has evolved. Because different surrogate partners practice and conceive the work in different ways, there are, of course, exceptions to the general trends in any time period. Nonetheless, the practice itself has changed over time in five observable ways, which are summarized in the table below.

​Masters & Johnson (c. 1970’s)

​Present Day


​Address sexual dysfunction

​Improve relationship skills


​P/V intercourse

​Reach therapeutic goals


​Partner surrogate

Sex(ual) surrogate

​Surrogate partner

​Time Period

​2 weeks




​All, LGBTQIA+-Affirming

Intention: Not Just for Sexual Dysfunction Anymore

Surrogate Partner Therapy was introduced to the world with the publication of the book “Human Sexual Inadequacy” by Masters and Johnson. Their focus was “the treatment of men and women distressed by some form of sexual dysfunction.”(1) This was made abundantly clear, not only by the title of the book, but by the titles of the chapters, which include: “Premature Ejaculation,” “Ejaculatory Incompetence,” “Primary Impotence,” “Secondary Impotence,” “Orgasmic Dysfunction,” “Vaginismus,” “Dyspareunia,” “Sexual Inadequacy in the Aging Male,” and “Sexual Inadequacy in the Aging Female.” The vast majority of other articles and videos during the 1970s and 1980s describe the primary focus and intention of SPT in the same way.

Some of the clients who needed help with sexual dysfunction did not have a partner. Masters and Johnson conceived of the idea of providing a substitute (surrogate) partner to work with them to help them overcome sexual difficulties. As they write, “It would have been inexcusable to accept referral of unmarried men and women and then give them statistically less than 25 percent chance of reversal of their dysfunctional status by treating them as individuals without partners.”(2) This approach apparently was quite successful. “In view of the statistics there is no question that the decision to provide partner surrogates for sexually incompetent unmarried man has been one of the most effective clinical decisions made during the past 11 years devoted to the development of treatment for sexual inadequacy.”(3)