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How Therapists Can Support Their Sex Worker Clients

As the field of sex work broadens, many therapists are navigating new issues.

Key points

  • As the field of sex work expands, more therapists are encountering sex workers seeking therapy.
  • A common mistaken assumption is that sex workers need the therapist to rescue them—they don't!
  • Therapists working with sex workers are best when they approach their patients with nonjudgmental, affirmative curiosity.
  • Therapists can, and should, seek professional education about sex work, in order to provide effective and non-discriminatory treatment.
Image by 13smok from Pixabay
Source: Image by 13smok from Pixabay

The sex work industry now contains many different types of sex workers, and a far greater range than once existed. In contrast to times past, when sex work was seen merely as “street prostitution,” there are now many different forms of sex work and the availability of these forms of work has expanded 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 find themselves now working with individuals who do webcamming, have Onlyfans, or who travel to Nevada to work for periods of time in legalized 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 treating a couple who produce and distribute their own pornography, and travel to make content with other performers. A therapist may treat a professional dominant who has no in-person contact with their 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 ill-prepared to effectively support their patients on these issues, and they may unintentionally harm or stigmatize their sex-working patients.

Common Mistakes When Working with Sex Workers

As I’ve treated sex workers, and trained and supervised therapists around these issues, I’ve seen a number of common dilemmas and mistakes come up, in therapists who’ve had little training on sex work. A few of these include:

  • Therapists often assume that anyone involved in sex work is doing so against their will and that the therapist needs to rescue them. While some people involved in sex work are at risk of exploitation, a great many are making independent choices as they weigh their options, opportunities, and needs. Therapists should be curious and withhold judgment until they hear from their patient about what their self-identified needs are.
  • Involvement in sex work is not an inherent sign of pathology, attachment disturbance, substance abuse, or other problems. Many sex workers choose to engage in the industry for a variety of reasons, including economic independence and sexual exploration.
  • A sex worker’s job is not necessarily the reason the sex worker is coming to therapy. They seek support for the same range of reasons that anyone else does—relationship problems, depression, anxiety, or personal struggles that are not caused by their work. I’ve seen therapists who told patients they wouldn’t work on any other issues until the sex worker stopped engaging in sex work, or who made the sex work the central focus of the therapy. Both reflect judgment and assumptions on the part of the therapist.
  • Not all sex workers are the victims of childhood sexual abuse, and for those who are, their abuse may have no direct relationship to their work in the sex industry. This a version of the “damaged goods hypothesis,” where research finds that sex performers are no more likely to have a history of sexual abuse than any other women (sadly, far too many women in general have experienced sexual abuse).
  • Sex workers can include females, males, trans, and nonbinary individuals whose sex, gender and sexual orientations may or may not be a part of their sex work. I've 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’ve never treated any sex workers, when in fact they have, but their patients chose not to disclose for fear of stigma, judgment, and shame.

A complicated issue many sex workers struggle with is in their personal relationships. They may have spouses or partners who are not in the sex industry and who may struggle to incorporate their partner’s sex work into their relationship. Therapists may be helpful to the sex worker or the couple by helping them to frame the relationship as a form of consensual nonmonogamy, and to help them explore and identify boundaries, communication, and agreements, from a place of love, dignity, and mutual respect.

Image by Gerd Altmann from Pixabay
Source: Image by Gerd Altmann from Pixabay

What Therapists Can Do to Improve Skills for Working with Sex Workers

Raquel is a Black queer therapist and sex worker who specializes in working with sex workers. She notes that sex workers can be anyone of any race, gender, sex, and socio-economic background and that it is generally ignorance and bias that leads to a therapist assuming that only certain “types” of people are sex workers. She encourages therapists to do their own work, outside of the therapy office, on what they think sex work is, and to examine where they got these ideas and values—whether they were from social media, fiction, or anti-sex propaganda. In her words, “therapists need to unpack their whorephobia, 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 workers’ clients. Working with a sex worker in therapy is not the time for a therapist to realize they need better skills to deal with erotic countertransference or to confront their own biases about the reasons people engage in sex work.

Therapists interested in doing this personal work, expanding their knowledge, and improving their skills to support sex workers can find an increasing array of resources, including training and certification programs, online and in-person workshops, and conferences.

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