How Therapists Can Support Their Sex Worker Clients

Image by 13smok from Pixabay

Source: Image by 13smok from Pixabay

The sex work industry today contains many different types of sex workers, and a much greater variety than before. Unlike in the past, when sex work was only seen as “street prostitution”, today there are many different forms of sex work And the availability of these forms of work has broadened access across communities and demographics.

In the past, few therapists, outside of those serving homeless populations, specialized in working with sex workers, or really even focused on these issues. Now, even therapists in rural communities may now find themselves working with people who do web cams, who only have fans, or who travel to Nevada to work stints in legal Nevada brothels.

Therapists serving college populations may find themselves treating exotic dancers, or women involved in sugar dating or escort work. They may find themselves caring for a couple that produces and distributes their own pornography, and travel to create content with other performers. A therapist may treat a professional dominant who does not have personal contact with his clients, or who only engages in non-sexual contact.

As our society has become more open to discussions of sexual diversity, and more averse to sexual shame and stigma, more people are opening up to their therapists about their secret sexual lives and interests, including their past or present involvement in sex work. Unfortunately, many therapists find themselves unprepared to effectively support their patients on these issues, and they may harm or stigmatize working patients of their own gender.

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Common mistakes when working with sex workers

When I treated sex workers, and trained and accompanied therapists around these issues, I saw a number of common dilemmas and mistakes emerge, in therapists who had little training on sex work. Some of them include:

  • Therapists often assume that everyone who engages in sex work is doing so against their will and that the therapist should rescue them. While some people involved in sex work are at risk of exploitation, many make independent choices considering their options, opportunities and needs. Caregivers should be curious and withhold judgment until they hear from their patient about their self-identified needs.
  • Involvement in sex work is No An inherent sign of pathology, attachment disorder, substance abuse, or other problems. Many sex workers choose to work in the industry for a variety of reasons, including financial independence and sexual exploration.
  • The role of a sex worker is not necessarily the reason why the sex worker comes to treatment. They seek support for the same range of reasons that everyone else does – relationship problems, depression, anxiety or personal struggles not caused by their work. I have seen therapists tell patients that they will not work on any other topic until the sex worker stops engaging in sex work, or they have made sex work the main focus of the treatment. Both reflect judgment and assumptions on the part of the therapist.
  • Not all sex workers are victims of childhood sexual abuse, and for those who are, their abuse may not be directly related to their work in the sex industry. This is a version of the “defective goods hypothesis,” where research shows that sex offenders are no more likely to have a history of sexual abuse than any other woman (unfortunately, too many women in general have been sexually abused).
  • Sex workers can include women, men, trans and non-binary people whose sex, gender and sexual orientation may or may not be part of their sex work. I have seen many people who identify as gay or straight in their personal lives but engage in other forms of sex in their professional sex work.
  • Many therapists assume they have never treated any sex workers, when in fact they have, but their patients choose not to disclose for fear of stigma, judgment, and shame.
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A complicated issue that many sex workers face is in their personal relationships. They may have spouses or partners who are not in the sex industry and who may struggle to integrate their partner’s sex work into their relationship. Therapists may be helpful to the sex worker or couple by helping them frame the relationship as a form of consensual non-monogamy, and helping them explore and identify boundaries, communication and agreements, from a place of love, respect and mutual respect. .

What therapists can do to improve skills in working with sex workers

Rachel is a Black queer nanny and sex worker who specializes in working with sex workers. She notes that sex workers can be anyone of any race, gender, sex, and socioeconomic background and that ignorance and bias often lead to a therapist assuming that only certain “types” of people are sex workers. She encourages therapists to do their own work, outside of the therapist’s office, on what they think sex work is, and examine where they got these ideas and values—whether they were from social media, literature, or anti-sex propaganda. In her words, “Therapists need to unload their feeds, and in the office, let the client lead the conversation.”

Therapists who work with sex workers of any kind must do their own work, around the therapists’ own sexuality, their sexual values ​​and attitudes, and their beliefs about sex work and sex worker clients. Working with a sex worker in therapy is No Time for a therapist to realize they need better skills to deal with erotic countertransference or confront their own biases about why people engage in sex work.

Therapists who want to do this personal work, expand their knowledge, and improve their skills to support sex workers can find a growing variety of resources, including training and certification programs, online and in-unit workshops, and conferences.


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