by Heather Woodford, LCSW, SFSI-certified sex educator
Sexuality professionals who provide direct 1 on 1 client services can include: sexological body workers, sex work, sexual surrogates, sex therapists, and coaches and more. A student asked about the distinctions between these after class tonight so I thought I'd write something up to clarify. Feel free to comment, and/or contact me at sexpositivesacramento@gmail.com to add your thoughts.
Some of these professionals’ work is explicitly considered illegal, or in a legal gray area. So if you know someone who exchanges erotic labor for money or goods, please ASK them before outing them! They may have to intentionally be discreet to protect themselves.
Sex work is a broad umbrella term for anyone who exchanges erotic labor for funds or resources. This can include escorts, people who do cam work (i.e., online live nude or erotic webcam shows/private sessions), pornography performers, prostitutes, exotic dancers, phone sex operators, professional Dominants/Dominatrixes, and others. Some folks would also include go-go dancers, cocktail waitresses and others whose income is specifically linked to using or playing up their sexuality. There are certainly others I'm not including here, but you get the picture. Sex workers' work mainly centers around sexual pleasure. They will often use genital-focused touch, including and up to penetrative sex, and often the goal of their work is to help the client experience sexual stimulation and pleasure, sensory rich experiences, up to and including orgasm. They may have other goals such as helping people have new or different experiences; find connection/intimacy; touch that does not result in orgasm; and even emotional intimacy. Many sex workers will say that much of their labor is emotional rather than purely physical. However, this is often a "hidden" goal or outcome, and the stated goal is usually related to erotic/physical experiences.
Sexological body work focuses on helping people find personal growth and healing around their own sexuality. While no "official" (i.e., legal) body oversees their work, sexological body workers are usually well trained through organized programs, even as a component or extension of some PhD programs! They are likely to be certified through the Association of Sexological Body Workers. They often curate and provide group or individual experiences to help people work through their own sexual blocks and even trauma. While they may touch their clients' bodies, it can also be focused on guided touch or imagery with the client's own body.
Sex surrogates are professionals who step in in the role of sexual partner in the absence of a relationship or sexual partner. They are likely to work with their clients in a structured, goal-oriented way. They may work with people with disabilities. Surrogates often create a treatment plan with a limited number of sessions, and an intentional end to the work together. They usually use erotic touch, up to and including penetrative sex. For an example of this, watch the 2012 film The Sessions with Helen Hunt.
Sex coaches may work with individuals and/or people in relationships to help them resolve sexuality related issues. They can provide a combination of strategic and experiential guided interventions, similar to sexological body workers. They may also help clients think or talk through problems through in a more strategy-based way. They do not treat deeply entrenched mental illness or trauma in the way a therapist would. They may use touch, but typically as a supplemental or guided experience, rather than purely for experience or pleasure.
Sex therapists are mental health professionals, who have a master's degree through an accredited higher education program in clinical work. By the time a person is using the title of sex therapist, they are usually either licensed or well into their pre-license hours. Sex therapists are overseen by regulatory licensing bodies - in California it's the Board of Behavioral Sciences. While there is no law that actually provides title protection AGAINST any licensed therapist calling themself a "sex therapist" - ethically any person calling themself a sex therapist SHOULD have at least a minimum of master's level or post graduate experience and training in sexuality. Usually this is through a specialized health education or sex education program such as Widener University or a sex therapy certification program such as AASECT (American Association of Sexuality Educators, Counselors & Teachers), which includes a minimum number of supervised hours from a certified sex therapist. I don't technically call myself a "sex therapist" for a few different technical reasons - partly because I didn't complete a program specifically for sex therapy. I call myself a sex-positive therapist and sex educator because those things are true, and more specifically documentable (I have a license in clinical social work, and I completed a sexuality educator certificate program through San Francisco Sex Information).
Sex educators and sexual health educators teach people directly about sex, sexuality and related topics. They provide information, teach workshops, help people learn to access reliable and nonjudgmental information about sex. They may use a variety of forums to do this - classrooms, online discussion boards, YouTube channels, the Sex & Gender Hotline, etc. Their goal is not to treat or diagnose, but to inform, and refer people to resources to help them find further information or treatment. For both better and worse, this is also not a protected title, and as such, literally anyone can claim the title of sex educator.
If you're wondering which of these fall under the umbrella of sex worker, I think a strong argument could be made that sex surrogates, sex coaches, sexological bodyworkers and obviously sex workers fall into this category, whereas sex therapists strictly DO NOT, and sex educators alone (who don't also provide other services) usually don't either. I would say the defining line is the presence or absence of touch. A therapist or educator would not touch their clients in a sexual way (in fact, the BBS strongly prohibits this). Neither would they likely lead their client through an erotic exercise that would have the client touch themself during session - although sex therapists often give their clients homework that involves erotic experiences and sexual touch, either alone or with another person.
I do not draw this distinction to distance myself from sex work, as I believe erotic labor is a wonderful resource that everyone should be able to avail themself of. I truly believe that sexual healing, erotic experiences, learning, sexual exploration, and pleasure in all forms are (to quote Good Vibrations founder Joani Blank) the birthright of every human. I do not draw this distinction to distance myself from sex workers. I deeply respect sex workers. I just happened to take a path that led me elsewhere. I have, and will continue to, refer people to sex workers of all kinds.
Some ethical issues:
A sex therapist should never receive kickbacks from ANY service provider, as this creates a conflict of interest.
Ask me sometime about my opinions about the Board of Behavioral Sciences' publication "Professional Therapy Never Involves Sex" - that's a whole different article.
People who do not have the training or experience in any of the professional realm that includes specialized knowledge - including any healing-oriented sexual profession - should never pass themselves off as if they do. Pretending to have more competence than one does could cause serious harm to clients.
There are a multitude of other professional or volunteer roles that may use knowledge of human sexuality in direct work with people, whom I'm not including here, such as rape crisis hotline worker, pelvic floor therapist, nurse, and so forth. Feel free to share about those in the comments.
To find a sexuality professional locally, check out this listing: http://tinyurl.com/sptherapistlist