Vena Blanchard Interview

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Vena Blanchard has been a professional surrogate partner (and advocate for ethical surrogate practice) for the last 20 years. She is the current president of the International Professional Surrogates Association (IPSA) and is also their senior trainer. She has written and spoken extensively about sex therapy, surrogate partner therapy, and the dynamics of sexuality and change.

We conducted this interview with her on 2/1/99 via telephone to her home in Los Angeles. The complete interview transcript is followed by a resource listing, a set of handouts and slides prepared by Vena Blanchard, Vena's C.V., and the IPSA Code of Ethics.

Interview Transcript

SHS: For the sake of people who have never heard of it before, what is surrogate partner therapy?

It's a form of therapy in which the therapist refers the client to work with a surrogate partner. The client and surrogate build a relationship, and in the context of that budding relationship they learn about the clients strengths and difficulties in physical and emotional intimacy. The clients develop emotional skills, and have a chance to experience themselves and relationships in new ways. The surrogate and the client share all that information with the client's therapist so that the therapist can facilitate further growth and change. This is a "triadic" form of therapy; it always involves three people: client, therapist, and surrogate.

SHS: How long has surrogate partner therapy been around, and who first developed it? Masters and Johnson?

Yes, we do count Masters and Johnson as our grandparents. The term "surrogate partner" was first used by Masters and Johnson in 1970 when they published Human Sexual Inadequacy. They were having a great deal of success working with couples, and in order to be able to work with single people who were experiencing sexual dysfunction they trained and hired women to "substitute for" the wife of a client, in a program that was identical (or very similar) to their couples treatment program.

SHS: Had anyone even proposed it before 1970?

Not as far as we know. There are certainly people who suggest it has precedents: specifically, in temple prostitutes or certain tribal cultures where an experienced person trains or helps an inexperienced or unwell person. But honestly I think those are leaps. There is no precedent in a psychotherapeutic context with a triangular relationship between client, therapist, and trained "helping other." There are certainly similar models involving psychotherapist and physician therapist, involving physician and physical therapist, or in education when someone other than the instructor tutors a student.

SHS: How effective is surrogate partner therapy, in comparison to "pure talk" therapies involving only the client and his or her therapist?

There have unfortunately been no well-crafted research projects on this subject. But what we do have is the anecdotal evidence of a variety of therapists (who have no contact with each other) saying over and over again, "This process seems to work for many clients, especially ones who are socially inhibited or 'late-life-virgins.'" I'd say I have a 98%-99% success rate with premature ejaculators, which I think is probably going to be true across the board.

I think we all agree that surrogate partner therapy can be extremely effective in working with naive and inhibited clients, as well as with clients who have experienced physical or emotional trauma. Generally, I think we can categorize the kinds of client concerns that are appropriate and/or amenable to surrogate partner therapy as being those in which the client is having difficulty with physical and/or emotional intimacy, and needs the assistance of a caring partner to help them resolve that difficulty. These difficulties could be the result of self-consciousness, or of having developed some unfortunate patterns in their history. They could be either social concerns or sexual concerns.

SHS: What misconceptions do clients typically have about surrogate therapy, if any?

Let's start with the common misconceptions that people have about surrogate partner therapy, because by the time the client gets to the surrogate partner hopefully his therapist has already answered a lot of those questions.

One common misconception is that it is a mechanical or rote process; in reality, it is most effective when it is developed specifically to address the client's concerns, and the therapist, client, and surrogate together are constantly re-evaluating what's the most useful and appropriate. Another misconception is that it's all about sex, and specifically all about intercourse; in reality, only the smallest part of the process might involve explicit sexuality, and intercourse may never be a part of the process - it's only included if it is clinically appropriate and therapeutically in the client's best interest.

Yet another misconception is that it's about "having a good time." Because it's therapy it tends to be rewarding and meaningful, but not necessarily focused on short term pleasure; in fact, there are some parts of the work for every client that are particularly difficult and challenging, because they are struggling with difficult/ancient material and developing new skills that initially feel awkward and uncomfortable. They are also facing the part of their life about which they often feel the most self critical and the most ashamed.

A final misconception is that surrogates are all highly sexual and always sexy (all you have to do is know us to know that's not always true) and that this is somehow necessary or relevant (which it isn't, not any more than it's necessary for your physician to be sexy). The public seems to imagine that surrogates are wild women or men, when in fact the vast majority of us are just regular-looking people with a lot of compassion and an interest in helping others resolve their concerns so they can move on to have healthy and happy lives.

SHS: What misconceptions do therapists sometimes have?

One is that the surrogate is a tool for them to use, when in fact the surrogate is a para-professional, with a clinical judgment of her own, and is a human being with feelings. Another is that the point of being with a surrogate partner is for the client to have a one-shot learning experience.

Occasionally, a therapist will imagine that the process can work effectively without their own involvement, and that they can just refer the client to the surrogate and then simply abandon the case. That ultimately is not in the client's best interest; the client needs the therapist as an advocate for their interest, as well as a person with whom they can process their feelings. Often clients are not willing to tell their friends and family that they are working with a surrogate partner, and so their therapist is the only person outside of their relationship with the surrogate who can help them have perspective and process some of the emotional and therapeutic issues that arise in the surrogate partner therapy.

Another misconception is that the surrogate needs to be the client's ideal body type.

SHS: How should the therapist respond if a client begins to focus on the surrogate's body type as being relevant, before even meeting him or her?

I think that's a huge challenge in this culture, and the therapist may need to work through his or her own issues about how primary visual stimuli ought to be in the arousal process. I would hope the therapist could help the client see that they have some learning to do: that the surrogate partner is not their life partner and they can later choose the partner of their choice, but that the surrogate partner has other things to offer. The therapist could help the client develop a more mature attitude about sensuality and sexuality, which moves beyond being purely visual. I would hope that the therapist would look at this as information about what's getting in their client's way: that the client is essentially telling the therapist that this is part of their problem.

Now obviously no one want to be intimate with someone who repulses them, but if the client is focused on superficial aspects, then that's information about how this client is stuck and where he needs development. Hopefully the therapist recognizes that and has the skills to facilitate client growth in this arena. I talked a great deal about this when I presented at the World Pornography Conference in August of 1998 - about how difficult it is for some people to get beyond the superficial and into something more profound and meaningful. For some clients it is like a fetish; they are so narrowly fixated on one body type, and on the visual, that they aren't able to appreciate anything else about themselves or their partner other than the visual. People like that are often not capable of having partners, because nobody is ever perfect enough for them in real life. These clients also tend to be very critical of themselves as well. This doesn't mean they're beautiful people; quite often it's the exact opposite, and it seems to be some sort of compensation.

I personally think of it as immaturity. This is not to say that you can't love and appreciate the aesthetic beauty of someone without being immature, but rather that having such a narrowly-defined sexuality and/or relationship interest may be a sign of not having developed. By the way, I don't mean "immature" in a perjorative sense, I just mean that they're very young emotionally.

SHS: Are there particular types of talk therapy which you find surrogate therapy meshes best with, or is it flexible enough to work with most types of talk therapy?

It is extremely flexible. Any therapist who is comfortable with change processes, and has a language they can use for talking about and understanding meaningful change, can work with surrogate partners. I do think there are some modalities that are fabulous: Humanistic, Existential, and Object-relation therapies are very compatible.

Lots of sex therapists use the cognitive-behavioral therapeutic model. Although there is a core philosophy within the surrogate partner therapy process that is cognitive-behavioral, strictly behavioral therapists tend to ignore a lot of the emotional content of the process; clients, although they might resolve their sexual dysfunction in that context, don't get the support they need for the complex emotions that come up. Analysts in general tend to be disapproving, although when I have worked with analysts they have been able to make very good use of the material that came up in the client's work with me - even if they didn't approve of the client working with me. I think it's useful for them because they are used to processing counter-transference, and they can make make good use of the counter-transference material that comes up in the surrogate-client relationship.

SHS: Has the underlying philosophy of surrogate partner therapy evolved since Masters and Johnson, and if so how?

I think it really has evolved. As our view of relationships and women and sexuality has evolved, so has surrogate partner therapy; it's much more focused on the relationship than it was in the early days. I went back and reread Masters and Johnson's section on surrogate partners in Human Sexual Inadequacy recently, and what they said about their work with surrogate partners does not sound at all foreign or unfamiliar; but my understanding is that what happened in practice was much more behavioral, much less relationship-focused, and much less about the evolving relationship. Masters and Johnson put couples and surrogates and clients through a fairly rigid program, and each session was mapped out even before the arrival of the client.

Today, clients and surrogates typically work in an open-ended process rather than a rigidly-structured program, and the emotional content, the level of client comfort, and the client's skills or difficulties at each session are used to determine the most useful next step. It used to be that surrogate partners worked only in clinics under the direct supervision - though not necessarily "in the room" supervision - with the therapist. Now most surrogates work in private practice with a variety of therapists rather than just one therapist. It's also true that in the beginning, surrogates were trained (if they were trained at all) by therapists; surrogates these days are most commonly trained by experienced surrogates in conjunction with experienced therapists.

And finally, as sex therapy has grown beyond a simple behavioral orientation and more therapists with sophisticated training in psychodynamics (and even psychoanalysts) have begun to do sex therapy, they've brought in more sophisticated ideas about the surrogate-client relationship; surrogates then carry those ideas into every other case they work on. I think surrogates have become more sophisticated over the years, having been trained by experienced surrogates who have lots of years working with lots of therapists from lots of different therapeutic orientations, and surrogates these days are much more likely to actively engage in clinical decision-making with the therapist. It's less of a hierarchical relationship than it used to be.

SHS: As the level of sophistication and training of surrogate partners increases, can you imagine any scenarios in which (at least for some types of simple dysfunction) the therapist could simply refer the case to the surrogate and move on?

People have tried that in the past, and I think we all agree that it's in the client's best interest for it to be a triadic relationship. Because the surrogate and client get so close and do not have the traditional therapeutic boundaries, and because there is the threat of sexuality which stirs up such a large number of difficult emotional issues for these particular clients, it is important that there be someone outside of that dyad to help keep track of what is effective with this client, what is working well, and where the client is stirred up and potentially resistant. When we get very close to the most difficult change issues for the client their resistance gets amplified, and because the surrogate is so close it can be difficult for the surrogate to keep track of exactly where they were in the process and what it is that's stirring up the client; it's typical at the crux of the therapy for the client to basically hunker down and refuse to change, and it's the therapist's perspective outside of that relationship which helps to keep the surrogate and client on-track.

Additionally, because we're working in such an intimate arena, surrogates' personal issues can get stirred up; one of the therapist's jobs is to help sort through how much of this is specific to this client (in other words, how much of whatever issues are being stirred up for the surrogate are the kinds of things that this client will stir up in other people), and how much of this is just the surrogate's stuff which he or she needs to deal with in their own personal therapy or in a professional supervision group. So the therapist is an advocate and for the clients as they engage some difficult learning and a professional ally for the surrogate in a complicated and valuable clinical process.

There are also a lot of clinical reasons why it's sometimes better for the therapist to make certain suggestions, or for the therapist to process certain issues, and try to keep those issues out of the surrogate partner therapy (even though they have to be processed in order for the client to make progress with the surrogate). As an example, I have a client at present who has a lot of complicated things going on with other women in his life, and he has always got some sort of chaos and uproar going on in his dating life. He will talk about those struggles as a way of avoiding being present, avoiding the difficult work he needs to do with me. In fact that's what he does in every other relationship in his life: he talks about his work struggles when he on a date, and he talks about his personal problems when he's supposed to be working. So its valuable for the therapist and I both to be say to him, "You can talk about all those other relationship with the therapist, but it's not useful for you to talk about them with Vena, because it's your way of avoiding other more powerful work." He needs to deal with these issues because they're related to his sexual and relationship difficulties, which he came into therapy to address, and I wouldn't be able to not deal with them if there weren't a therapist involved.

SHS: Tell me a little bit about IPSA. What are its functions, and how long has it been around?

IPSA was founded in 1973 (just three years after Masters and Johnson first proposed the idea of surrogate partner therapy), by a group of surrogates who created it as a support group for themselves. Within five years it had expanded to become a professional body, with a code of ethics, which was conducting trainings and setting some standards for the developing profession. IPSA is the only functioning organization for surrogates, and really has been the only functioning organization for surrogates throughout its history. There have been some other people who have tried to form groups, and were able to form support groups, but never maintained any ongoing presence as a professional organization. We're a California non-profit education corporation, and so we have a bunch of goals that have to do with educating the public and the therapeutic communities, and providing ongoing education for surrogate partners (whether they're members of IPSA or not). Another one of our goals is to stay abreast of relevant legislation and new information in the field that relates to surrogate partner therapy and the treatment of the kinds of concerns our clients have. It doesn't happen very often, but occassionally we also have to review complaints from the public or from therapeutic communities about either a therapist or a surrogate.

So, IPSA continues to mostly be about information referrals and education, and because surrogate partners are not licensed or certified by any other body, it is a focal point for discussions about what is ethical and responsible practice for surrogate partners (as well as for the therapists who work with surrogate partners and the people who want to train surrogate partners). This involves being involved with other organizations, like SSSS and AASECT, and having our own ethics committee.

SHS: How long have you been the IPSA president?

For about the last three years. I've been a member of IPSA since about 1981, and have served on the board in some capacity or another almost every year since then.

SHS: Is there anything in particular that you'd like to see IPSA accomplish in the next ten years? My big goal a couple years ago was to create a web site, which I just completed. Other than that I think our goals remain primarily to train surrogate partners, to train therapists to work with surrogates, and to make sure that clients who need this kind of therapy can find it somewhere in the world. More recently we've begun to have contact with clinics and therapists who work with surrogates around the world, and I'm hoping that we will once again be a functioning international body; for the last number of years it's really just been limited to the United States.

SHS: As people go through the surrogate training program that IPSA offers, what sort of personal issues have come up for them that ended up being "deal-breakers" as regards their continuing?

One of the issues that ends up being a deal-breaker for some folks is that they realize they haven't worked through enough of their own issues to really be available to someone who's learning. A number of people realize that it's very difficult work, and that they don't really want to make so much of their whole selves available to wounded other people; it takes a great deal of maturity to be available to people who are so uncomfortable with themselves.

We talked earlier about the clients who are fixated on appearances; it also takes a lot of maturity to be able to work with someone who is frequently saying, verbally or with their behavior, "I'm not sure I want to trust you or be close to you," or "you aren't my type." One has to remember that is the client's issue and to have compassion for them about how they are limiting themselves, rather than to get personally wounded and withdraw from that client. It's often the client's way of manifesting their resistance that a great deal of patience. One of the skills that's required of a surrogate partner is an intellectual capacity to hold a lot of clinical and philosophical information and still be present and available for emotional contact - to be both the partner and the clinician at the same time, to not let one's clinical task turn one into a distant observer with a clipboard, and to not let one's personal feelings so overwhelm the moment that one loses clinical perspective and makes poor choices on the client's behalf. It's not uncommon for people to realize that it's just a lot more complicated than they thought, and that simply having compassion and liking sex isn't enough.

SHS: So, what personal characteristics would you identify as the most important for a surrogate partner to have?

I'd say compassion, intelligence, a sex-positive attitude, and being non-judgmental about consensual lifestyles and sexual orientations. You have to be brave enough to be non-conventional because there is so much question, even within the therapeutic communities, about the legitimacy of this work. One has to be comfortable being a pioneer, and sometimes going without societal approval.

SHS: How could someone know that they might benefit from surrogate therapy? In other words, as they're thinking about their problems or working with a traditional "talk" therapist, what would ideally be the triggers for them to begin looking into surrogate partner therapy?

That's a good question. Basically, they might consider looking into surrogate partner therapy if their concerns have to do with physical and/or emotional intimacy, and especially if they additionally find they are not able or willing to get into a relationship in which they could work on these issues. I actually think that's the primary one: that they are not letting themselves be in a relationship because of their problems, yet they need a relationship to resolve it. Of course, some people don't want relationships, and that's OK; it's when they want to be in a relationship but aren't willing or able to do so, that working with a surrogate can be really useful. The IPSA brochure "Surrogate Partner Therapy" says it pretty well... Let me just quote from it for a moment:

The concerns that motivate clients to seek surrogate partner therapy often range from general social anxieties to specific sexual dysfunctions. Some common sexual concerns for male clients involve dissatisfaction with orgasm, ejaculation, and/or erection difficulties. Female clients' sexual issues might involve difficulties with orgasmic release or with penetration. Clients of either gender may seek therapy to address problems relating to lack of experience; fear of intimacy; shame or anxiety regarding sex; low-level of arousal; lack of sexual desire.

Concerns for either gender might result from one of the following: medical conditions, negative body image or physical disfigurement; physical disabilities; issues of sexual, physical, or emotional abuse and/or trauma (rape or incest, for instance); confusion about sexual orientation; lack of sexual or social self-confidence.

SHS: In general, what's the easiest way for a potential client to locate a therapist who works with surrogates? Should they contact IPSA?

If they're in California, they should contact IPSA. If they're not in California but are in the United States, it's probably best for them to contact AASECT and ask for a list of sex therapists in their area, and then to ask those sex therapists whether they work with surrogates or if they know others who do. There are surrogates in only a few places in the world. For most people this means they will have to travel some distance to work with surrogates.

SHS: New York or California, basically?

California. The problem in New York is that prostitutes also advertise themselves as sex surrogates, and so it can be very difficult to determine who is a legitimate surrogate and who is not.

SHS: What prevents that from happening in California? Is it just not part of the culture?

That's correct, it's just not part of the culture. However, there are some people in California who call themselves surrogates and work independently of therapists; often it turns out they really haven't been trained. If the client is in California or is able to come to California, contacting IPSA is definitely the best way.

SHS: Is there anything else you'd like to say about IPSA before we move on?

Let me give just a tiny bit of information that isn't on the IPSA web site. There are three categories of membership in IPSA. We have full members, who are working surrogate partners who have agreed to honor this IPSA code of ethics; we have associate members, who are mostly retired surrogates, but who might also be surrogate partners that for some reason are not willing to make the commitment to honor the IPSA code of ethics; the other category of membership is for therapists who work with surrogate partners.

SHS: What aspects of your job do you find the most satisfying, and which the most frustrating?

I find the clients, and the generosity of therapists (their willingness to share information and expertise about and with me and with their clients), to be very satisfying. I also love training surrogates. For me, the most frustrating parts are having to continually explain what surrogate partner therapy is not, and (even in the sex therapy field) having to justify it.

SHS: How would you like to see the surrogate partner profession grow or change in the next ten years?

I would like to see more people train as surrogate partners, and I would like to see more therapists trained to work with surrogates. I think that as more therapists really understand what the work is and educate their clients about it, that more of their clients will be able to access this treatment modality. I would also like to see a lot more people join IPSA and do the organizational work, so I don't have to do it all!

SHS: I can certainly relate to that sentiment... Ms. Blanchard, you're in an excellent position to observe our culture's impact on sexuality; I'm curious if any themes have come up in your work with your clients, common misconceptions about sexuality or particular dysfunctions?

Absolutely. Common myths are that a proficient sexual partner knows it all without talking or asking, that superficialities (whether it's the appearance of partners or oneself) are all-important, and that technique is more important than contact and communication. Additionally, my understanding is that men lie to each other about sex, perpetuating myths about male sexuality, and that it's very difficult for men to get a sense of their acceptability as sex partners.

One thing that's very difficult for many of my male clients is the societally-imposed responsibility to take the lead in initiating relationships and sexuality; there's a great deal of distress they feel because they're afraid that their interest will be either misperceived as sexual harassment, or because they feel like the entire responsibility is on them. For lots of my clients their validity and acceptability as people seems, in their minds, to be tied to their proficiency at sexuality, and because they feel uncomfortable (and that is not part of the culture's ideas about men) they feel like they aren't proper men. If our culture were to shift a little and acknowledge that men, like other human beings, can be scared and still be men, or can be shy and still be men, then they wouldn't doubt themselves as thoroughly and wouldn't have to hide the information that they're nervous or scared or inexperienced. They end up having to work with me when they're ashamed of their lack of experience or their lack of comfort - not because they actually need some unique skills that I offer, but because they need the safety of knowing that they won't be treated badly.

I have heard from a lot of men recently that they feel increased pressure from younger women to perform for them without feelings, and they find more mature women more accepting and more tolerant. So I do have a little concern about what's coming in the future. I don't think that younger women have always been intolerant, I wonder if it's something about the current culture of young adults. If you watch "Loveline" - Dr. Drew and Adam - Adam's brusque orientation and lack of compassion may be a reflection of an attitude particular to that generation. Or anyway, that's what my clients are reporting...

In general, what I have discovered for myself and my clients is that trust, comfort, and loving are the best foundation for healthy and happy sexuality. It takes a lot of reprogramming for people to pay attention to that rather than to all the superficial things which ultimately don't lead to happiness or sexual health.

SHS: What percentage of your clients are late-life male virgins?

About 50%

SHS: This would seem to put you in a good position to answer a question I've had for quite a while. I'm curious about the extent to which, in the absence of better information, people actually believe the misconceptions about sexuality that are portrayed in mainstream video pornography.

To start with, virgins are not the only ones who have those misconceptions; my experience is that even people who have had real-life sexual experiences with another person still imagine that they're inadequate because they don't perform like the guys in porn. I would say, and this was part of my WPC presentation back in August, that this is the most common effect of pornography: the generation of misconception. One misconception is the belief that you're supposed to thrust constantly, and the other is that you're supposed to like every single activity - the raunchier the better. It's not that these people think they like those things, it's that they keep trying to do them and they don't know why it's not satisfying.

But the fact is that not everyone believes these misconceptions, and one of the things I was trying to decipher was why some people believe them and others don't. I think the primary difference is in how much they've matured as individuals and learned to trust themselves about anything. If they trust their own feelings about other things, then they often trust their feelings to be good guides in sex. I think this is one of the reasons that some fundamentalist religions tend to breed more sexual dysfunction: because the locus of control and knowing is outside one's self, individuals who don't trust their own feelings will get porn and think that's the measure of reality. But almost all my clients believe porn to some extent, whether it's about cock size, or about what really turned on women look like, or about what the sounds of sex are. Certainly it's true that the less experience one has, the more one is looking outside one's self for information about what is normal. But even people with experience still rely on it to a certain extent; most of us don't get the chance to watch other people be sexual, and pornography is one way that people try to get a sense of what is normal, or who they are, or where they fit on the continuum of sexual activity.

SHS: Do you often find yourself having to do basic sex education? Do today's clients tend to think that women typically reach orgasm just through intercourse, do they not know where or what the clitoris is, etc.?

Whether clients have watched a lot of pornography or not, sex education is a normal part of my work with most of them. Some people only need a little bit, and some people need more. I have a library that I loan to clients for additional information.

SHS: Just out of curiosity, what books do you tend to recommend?

I recommend Bernie Zilbergild's The New Male Sexuality,and Marty Klein's Ask Me Anything. Those two books I recommend right off the bat, even before they begin therapy. I also recommend Adele Kennedy's book Touching for Pleasure; this book now seems to be out of print, but I do know some people who have stockpiled it because it's so fabulous. If I work with a woman, I might recommend Lonnie Barbach's For Yourself (though if I'm working with a male client who has ejaculatory inhibition I might recommend this book too) and possibly Joann Loulan's book Lesbian Sexuality.

SHS: Do you ever encounter clients who have had their only sexual experiences with sex workers, and if so what issues tend to come up for them as a result?

Many of these clients have been wounded or shamed, although occasionally it was a positive experience for them.

SHS: For those who experienced this wounding or shame, what was the source of it?

There are two sources, really. One source is when the experience was something initiated by somebody else - their father, their brother, their friends, or their army buddies - and they were expected to perform sexually in some non-private situation (or when it wasn't really of their own choosing) but they were too embarrassed to say, "I don't want to do this." The other source is a callous attitude on the part of the sex worker which manifested as either verbal criticism, or an attitude of disdain or impatience.

SHS: But there have been clients for whom it was a positive experience...

Yes. It depends on the interaction and the person and culture from which the client came. Where prostitutes are not treated so badly by their culture, they don't tend to treat their clients as badly.

SHS: When you work with therapists, is the client typically given a formal diagnosis before the therapy commences?

That depends on the therapist and it depends on whether or not there's insurance, because they're required to do that for insurance purposes. Typically the therapist has worked with the client for anywhere from several sessions to several years, and has a pretty good sense of the client's mental health, but often does not understand exactly what is going wrong for the client in the sexual or relationship arena.

SHS: This actually leads me to my next question... I'm curious about whether you would encourage someone to enter surrogate partner therapy who DOESN'T have any specific dysfunction, and may actually have a healthy and happy sex life, but who just wants to learn more or have an opportunity for personal growth.

Not really; I think there are workshops and other places for people to get that instead. I actually think that's a really valuable question to ask, even though the answer is mostly "no," because so many people wonder if they couldn't just learn to be better lovers with surrogates. It's true that they could learn to be better lovers with surrogates, but they could also just take classes from the Human Awareness Institute or take a seminar on Tantra...

SHS: Which might be less expensive and more efficient...

Yes, and then they also get a chance to meet people and partners who are learning the same things. Surrogacy would be much more expensive, and is really designed for people who have bigger issues. Additionally, people who are looking for enhancement are also looking for fun, and surrogacy work isn't exactly about that...

SHS: What are your thoughts on people who have surrogacy training but who aren't working in a surrogate partner context (i.e. they're calling themselves, say, "Intimacy Coaches," and working with individuals and couples without a therapist)? I agree with you about the workshops, but if people still want one-on-one work and their concerns aren't so emotionally intense to where a therapist is necessary, then the skills that surrogates possess would seem to be ideal.

This has definitely been done. Former surrogates have conducted couples workshops, and there's one surrogate who runs workshops for people interested in learning what we know who don't necessarily need to do it in the context of therapy.

IPSA allows people to take the training who aren't specifically interested in becoming surrogate partners; sometimes they want to learn more just for themselves, and it becomes a source of profound personal growth for them. In that sense what surrogates have to teach they can certainly teach outside the context of therapy.

But this question does bring us into a complicated arena of politics... Technically, the term "surrogate partner," by definition, applies only to a triadic relationship involving client, surrogate, and therapist. We might say that surrogate partners have skills that can be used in other arenas, like sexuality education or in some sort of coaching capacity, but if I were not personally receiving the referral from a therapist and it looked like we would be doing traditional surrogate partner therapy, the client would still have to find a therapist to work with. There are some circumstances in which some surrogates offer themselves to work with certain kinds of clients without a therapist involved, and hopefully they're calling it something other than surrogate partner therapy.

SHS: I'm curious if any of the distinction between surrogate and sex worker, at least in California, hinges on the fact that the surrogate's relationship to the client is triadic? In other words, if no therapist were involved, would you be in more danger of falling under the prostitution laws?

It depends. In the state of California, prostitution laws are written with a focus on the intention of exchanging sex for money; if I'm working dyadically they could question whether or not my intent is therapeutic, but anyone who has actually worked with me or observed my work would know that it is.

SHS: I was intrigued by a comment in one of the IPSA brochures, which mentioned that some (presumably heterosexual) clients might be better served by a same-sex surrogate who is acting as a sort of "role model" rather than as a surrogate per se. When is this most appropriate?

Sometimes, people who have been molested or who have profound body-image issues need a safe environment in which to do their initial exploration: to learn to relax, in the context of another person, but not necessarily in a context in which they feel the greatest sexual threat. For some heterosexual clients, a same-sex partner might feel safer. I've worked with a couple of heterosexual women who were married, where it was basically for sexuality education. It wasn't that I showed them how to masturbate, but we talked about masturbation, we talked about some of the complexities of heterosexual relationship, and I taught them the concept of sensate focus: doing non-sexual touching. Once they owned that for themselves they could take that information back to their relationship and explore and touch for their own pleasure, rather than simply doing what their husband wants them to do it.

SHS: I'm curious, in this context, what works well for people who have body image issues.

Unfortunately, due to homophobia many people aren't more comfortable in the presence of a same-sex person, but let's say for an obese woman who is working on feeling OK with herself and her body, working with a heterosexual female surrogate partner might help her allow herself to be touched on the hands, the face, and the feet. She might even disrobe. It would be about getting comfortable with herself and getting honest feedback from her partner about what it feels like to have a hug or sit close. People with weight issues sometimes have body-odor concerns or logistical concerns about how to negotiate their bodies with partners.

Transsexuals (male-to-female) have also successfully worked short-term with heterosexual female surrogates, to discuss the female body and female sexuality. In this case it's more of a sexuality education process.

SHS: There's been a lot of dialog recently, among sex workers and in the writings of people like Dr. Carol Queen, about the archetype of "Sacred Whore" or "Temple Prostitute." I'm curious what you think about this whole idea.

I haven't examined the anthropological basis for the dialog. At the very least, it's a useful Jungian archetype.

SHS: I'm interested in your opinion on this subject because, even though the "Sacred Whore"'s relationship to the "Customer" is not triadic, the intent does have to do with sexual healing and growth. Given your perspective, I'm curious if you've thought of any ways (for example) that they could introduce some sort of triadic element, and whether this would even make sense for them to do?

As far as I know, within that model there IS no triad, and the power rests entirely with the woman. That's the appeal of the archetype: that there's this all-knowing, all-nurturing sexual Goddess or her representative. I suppose if a person is sufficiently flexible in the way they conceptualize it, however, then the team of therapist and surrogate, together, could be seen as the one nurturing, healing, representation of the Goddess...

Some of the concerns I have about the Sacred Whore model have to do with the power residing in the healer rather than in the healed. From my point of view, what makes the healing more permanent and lifelong for my clients is not that I was loving with them once, but that they learned how to be loving with themselves and with others. My focus is almost entirely on how they can mature and develop, so they can have relationships in the future with people other than me.

Perhaps other people are more magical than I am, and can heal in that one-time, one-shot, single experience, but frankly I need a few months and a lot of thinking (as well as some interpersonal magic) to be able to really help my clients. Again, this is because my goal is not just for them to feel a moment of magic, but rather for them to learn how to create that feeling for the rest of their lives. It's the old "feed 'em, or teach 'em how to fish" saying...

SHS: Can you think of any way in which the structure of this relationship could be changed so that more power would rest with the healed?

Many people are working on that, and there's a book coming out shortly: Linda Savage has a book coming out this spring on female sexuality that interlinks modern sex therapy and the ancient archetypes. And, within the students of the Quodoushka tradition there are some people who are doing similar work; although they like the archetype of the sexual healer, they have broadened it to include a responsibility to the long-term well-being of the client, and not just to the short-term experience. For instance, rather than healing the client with a one-time experience they are constructing learning experiences for the client over a series of sessions, which should help the client to develop new skills; they do that from the point-of-view that as a sexual healer they should help the client develop more of themselves. I don't know too many people doing that, to tell you the truth, but this may just be the limitation of my circle of friends....

SHS: So these folks, in some cases coming from traditional sex work backgrounds, have managed to latch onto what they find to be a very powerful and empowering archetype. Is there any similarly empowering archetype for the triadic client/therapist/surrogate relationship, or any precedent for such a thing in history?

Good question. I haven't heard anybody talk about this sort of thing with a focus on the triadic relationship. There are some surrogates who are very attached to this Sacred Sexual Healer archetype, and they see it as having a relationship to the work that they do. But strangely enough, I think parenting comes the closest, where two people have a third person's interests at heart and the three of them work together to develop that third person, with the idea that this third person will grow, mature, and eventually leave them. That's certainly one model, and it's not uncommon, to tell you the truth, for clients to say that they are aware of this dynamic and feel a little bit like the therapist is a parent and they are growing up through therapy.

But honestly I think of it more as a healing community, because therapists and surrogates tend to rely on a whole body of knowledge: the books I bring in, the videotapes the therapist might show, the therapist and surrogate and client together as a team.

SHS: Which I imagine is psychologically comforting in and of itself.

Yes, because now the client has a whole community that supports them. We eventually refer clients to workshops and dating groups and such, which lends even more of a sense of having entered an accepting healing, community.

SHS: Thank you so much!

Thank you! It was a pleasure.

Resource Listing

Resources Mentioned During the Interview

Surrogate Partner Therapy Handouts and Slides

Handouts and Slides by Vena Blanchard


Effective surrogate partner therapy illuminates the client's physical and emotional patterns, skills and difficulties, as well as highlighting developmental issues, and defensive and characterological structures. We use the emerging transference, projective identification, counter-transference, experiences of anxiety, intimacy, arousal, anger, success, failure, etc. to inform client, therapist and surrogate about the roots and branches of the client's problems and means of learning, and about his history and his unfolding new self. For this aspect of the work to be effective, surrogate and therapist need to maintain consistent, high quality, and professional communication.

Skill Building

Simultaneous structured and non-structured experiential processes provides opportunities for clients to develop new patterns of behavior and develop new emotional skills through exposure and repetition in the areas of:


Whether intended or not, because they are seen as experts by the client, Therapist and Surrogate are always modeling a value system. In effective surrogate partner therapy, this is a conscious part of the treatment, an integrated aspect of the therapeutic context which therapist and surrogate manage on behalf of the clients' learning. The client learns from what he sees and experiences with the therapist and surrogate partner, as well as from what they suggest and assign.


The unique relationship between surrogate and client can be an arena of profound healing and transformation. As the relationship moves from the first hello to the final farewell it develops client emotional maturity, heals the insidious effects of severe trauma, and repairs the client's damaged relationship with sexuality and sense of self-worth. Although the relationship is relatively temporary, the experiences of genuine, loving, intimacy and authenticity remain forever as touchstones in the clients' inner world.

Overview of Surrogate Partner Therapy

  1. Surrogate Partners engage with clients in emotionally and physically intimate experiences that are simultaneously diagnostic, skill building and transformational.
  2. Theoretically this therapy integrates cognitive, behavioral, dynamic, humanistic, existential and transformational treatment approaches.
    1. The relationship serves as a unique diagnostic tool (a microcosm)
      1. via the exercises: relaxation, communication, sensate focus
      2. at each stage of the developing relationship
        1. transference, counter-transference, projective identification
        2. obstacles and strengths
        3. response to nurturing, intimacy, risk taking, boundary setting
    2. The relationship serves as field in which client can practice:
      1. new/different cognitive and behaviors patterns
      2. new emotional experiences
      3. new relationship style
    3. Modeling attitudes, values, behaviors and relationship
      1. the structure of the therapy as model
      2. S-C relationship as model for building and conducting relationships
      3. Surrogate Partner and Therapist transmit values and attitudes
      4. conscious integration of values into the process:
        1. Micro - baseline interaction: in the moment, in the relationship
        2. Macro - communicated verbally as a value
        3. Meta - in the structure, underlying all communication
    4. Transformation: S-C relationship has the potential to be provide opportunity for profound healing and transformation.

Structure of the Therapy

  1. Therapist and Client establish relationship.
  2. Therapist and Surrogate Partner consult re: the case.
  3. Three-way meeting between Therapist, Surrogate and Client.
  4. Client continues to work with Therapist while working with Surrogate Partner.
  5. Therapist and Surrogate consult regarding the on-going progress of the case.
  6. Periodic three-way meetings between Therapist, Surrogate and Client.
  7. Surrogate and Client close their relationship.
  8. Therapist and Client continue to work on generalizing the learning and improving Client's life.

Structure of Surrogate-Client Relationship

  1. Initial meeting(s)
    1. Emotional contact
    2. History taking
    3. Agreements and contracts
    4. Informed consent
  2. Nurturing and Building the Foundation
    1. Relationship: developing trust, familiarity, and comfort
    2. Communication: developing a common language for the therapy
    3. Initial Experiential Work:
      1. Relaxation
      2. Introduction to Sensate Focus
      3. Re-integration of body/mind one body part at a time
    4. Initial Assessments via:
      1. Exercises
      2. Client and Surrogate personal responses to each other
      3. Client reactions to structure of therapy and relationship
    5. Communication: introspection, communication of feelings
  3. Body Image Work: desensitization re: nudity, sexuality, intimacy
  4. Gradually Increasing Levels of Physical and Emotional Intimacy
    1. Generalization of previous learning (client specific)
    2. Communication:
      1. Introspection and communication, Risk Taking
      2. Permission Giving and Getting
    3. Structured and Non-Structured Experientials, add:
      1. Paying attention to own feelings and the relationship (the context)
      2. Sensate focus exercises involving the whole body (sensuality)
      3. Client taking more responsibility
      4. Client-specific work (e.g. social skills training, resolution of dysfunctions)
    4. Acceptance of physical and emotional feelings and responses
  5. Sex Education (How to Talk About Sex)
  6. Sexuality
    1. Resolution of Sexual Dysfunctions
    2. Mutuality, Desire, Initiation
    3. Re-integration of whole body with whole self
    4. Client-specific learning re: communication, relaxation, introspection, communication, eroticism, relationship issues, dysfunctions, generalization, etc.
  7. Closure

Structure of Surrogate-Client Sessions

  1. Greetings and conversation about previous sessions and homework
  2. Structured and non-structured experiential learning
  3. Discussion about progress and new homework
  4. Consultation with Therapist

Sensate Focus With a Surrogate Partner

  1. Anxiety Reduction
  2. Repeated Exposure
  3. Relaxation practice
  4. Developing healthy behaviors and thoughts
  5. Here and Now Focus
  6. Body Focused/Touching for Pleasure
  7. Identification of behavioral, psychological and historical roots of dysfunction
  8. Re-integration of Mind and Body

Vena Blanchard's Curriculum Vitae

Personal Information

Name:   Vena Ellen Blanchard
Titles:   Sex Educator; Professional Surrogate Partner
Office Phone:   (310) 836-1662

Professional Experience

Professional Surrogate Partner

1981 - Present   Full-time Private Practice, Southern California. Working in partnership with licensed private practice clinicians of every theoretical orientation, assisting adult clients in resolving difficulties with physical and emotional intimacy. Specializing in social phobias and inhibition, sexual dysfunction, and post traumatic stress.
1981 - 1985 Surrogate Partner, Center for Marital and Sexual Studies, Long Beach, California. William Hartman, Ph.D. and Marilyn Fithian.
1979 - 1984 Surrogate Partner, Center for Social and Sensory Learning, Los Angeles and Encino, California. Barbara Roberts, MA.
1977 - 1978 Surrogate Partner Internship.

Surrogate Partner Trainer, International Professional Surrogates Association (IPSA)

1985 - Present   Senior Trainer. Responsibility for training surrogate partners (including lecturing on human sexuality, sex therapy, professional ethics, and clinical issues); counseling trainees; training new trainers; supervising trainer and trainee internships.
1987 - Present   Worked intermittently as IPSA Training Coordinator. Administrative responsibility for IPSA training program including screening applicants, coordinating speakers, scheduling trainings, updating training materials.
1984 Junior Trainer.
1983 Training Internship.

Editorial Assistant

1997 - 1998   Marty Klein, Ph.D. and Associates. Projects related to human sexuality, relationships, clinical issues and sex therapy.

Guest Lecturer

1982 - Present
  • University of California, Los Angeles (UCLA), Dept. of Psychology
  • UCLA Neuropsychiatric Institute
  • UCLA School of Medicine
  • University of Southern California (USC) graduate and undergraduate
  • California School of Professional Psychology, Los Angeles
  • California State University, Domingus Hills
  • California State University, Northridge
  • Antioch University, Los Angeles campus
  • Pepperdine University
  • California Graduate Institute, Los Angeles
  • Ryokan College
  • Institute for the Advanced Study of Human Sexuality, San Francisco
  • Various Southern California Community Colleges (list available)

Related Education

Surrogate Partner Training
  • Center for Social and Sensory Learning, 1977
Advanced Seminars in Sex Therapy
  • Center for Social and Sensory Learning, 1978-1979
Surrogate Master Class
  • International Professional Surrogates Association (IPSA), 1983
Sociology and Psychology
  • Los Angeles Harbor College, California, 1977-1978
  • El Camino College, California, 1979-1981, 1992-1994
  • Antioch University, Los Angeles, California, 1985-1986
Human Sexuality
  • University of California, Los Angeles (UCLA), 1981
  • Los Angeles Sex Information Helpline Training, (LASIH) 1988
  • Professional Meetings, Conferences, and Workshops and Courses: APA, SSSS, AASECT, AHP, San Diego Society for Sex Therapy and Education, LA Sex Information Helpline, IPSA.
Clinical Issues Seminars
  • David Johnston, Ph.D. (weekly supervision group), 1985-1990
Child Development
  • Santa Rosa Junior College, 1976 (ECE Certificate)

Professional Affiliations

Other Contributions to the Field

Media Projects

Interviewed, quoted, and consulted by numerous publications, news shows, free-lance writers, and documentarians. List of appearances and projects available upon request.

IPSA Code of Ethics

Each member of IPSA, when acting as a surrogate, shall adhere to the following ethical standards:

  1. The designation "surrogate partner" shall apply only in a therapeutic situation comprised of client, surrogate, and supervising therapist. A surrogate partner may be designated to act primarily as either a substitute partner or a co-therapist depending upon the agreement between the surrogate and the therapist.

  2. The surrogate is responsible for fostering effective communication with the supervising therapist and the client.

  3. The surrogate's primary responsibility is to the therapeutic situation of which she [note: the feminine pronoun is used here to refer to the surrogate, and the masculine pronoun to refer to the client, although both surrogate and client may be of either gender], the client, and the supervising therapist(s) are integral parts. Within this situation, the chief focus and primary ethical responsibility is for the client's welfare.

  4. The objectives and parameters of the therapeutic relationship shall be discussed with the client by the supervising therapist and the surrogate so that the client may make informed decisions.

  5. The surrogate's relationship with the client is temporary, always within the context of the therapeutic situation, and with the supervision of the therapist.

  6. The surrogate shall recognize the boundaries and limitations of her competence. She will not attempt to use methods outside the range of her training and experience. Should she think that the client may benefit from such methods, she will communicate this to the supervising therapist.

  7. If a surrogate has a professional degree, certificate, license, or accreditation which applies to other than surrogate work, the function of "surrogate partner" shall be primary while she is working as a surrogate. However, if there is agreement between the surrogate and the supervising therapist that other methods and techniques, within her competence, are appropriate for the welfare of the client, the surrogate may use these additional skills.

  8. If a supervising therapist is not available and a situation arises which would normally require consultation with the therapist, the surrogate is responsible for taking appropriate action for the welfare of the client.

  9. The surrogate's responsibility for the welfare of the client continues until it is terminated by mutual agreement among client, surrogate, and the therapist, or the client voluntarily terminates the therapy.

  10. The identity of a client, and all information received from or about him in the therapeutic situation, shall not be communicated outside the therapeutic triangle without the client's expressed permission. The following are exceptions:
    1. when there is a clear and imminent danger to individuals or society, and then only to appropriate professional colleagues or public authorities;
    2. for the purposes of professional consultation with appropriate colleagues;
    3. for presentation of information to professional or lay groups, but always with identities of individuals disguised.

  11. Surrogates shall be responsible for adequate precautionary measures against the transmission of communicable diseases and infections. It is the surrogate's responsibility to determine that the client has taken similar precautions.

  12. It is the surrogate's responsibility to ensure protection against conception.

  13. Surrogates shall recognize that effectiveness in the therapeutic situation depends, in part, upon the surrogate maintaining independent, personally fulfilling social and sexual relationships.

  14. In order to maintain optimum professionalism, surrogates are responsible for:
    1. obtaining relevant continuing education,
    2. seeking prompt and effective help when personal problems arise,
    3. receiving adequate supervision for cases.

  15. Each member of IPSA who imparts information either publicly or privately about surrogate work or the organization shall indicate clearly whether the statements represent official IPSA policy or are personal opinions.

  16. Members shall be aware that they may be regarded as representative of all surrogates or of IPSA members even at times when they are not acting in these capacities. Therefore, their personal conduct should be such as to uphold the professional reputation of surrogates and of IPSA.

  17. Announcements of surrogate services to the therapeutic community shall be limited to a simple statement of name, training, credentials and experience, address, phone number, a brief statement of methods used and times available. Current and former supervising therapists shall be identified only with their explicit permission.

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