Surrogate partner therapy, an emerging treatment that involves physical touch, could help those with an intense fear of intimacy

• Surrogate partner therapy (SPT) is a new way to address struggles with trauma and sexuality.
• Unlike traditional talk therapy, SPT involves working hands-on with a surrogate on trust- and boundary-setting exercises.

Justin knew therapy was working when he could hug Michelle and feel her physical warmth.

Before that, the 38-year-old said that receiving hugs felt odd, like his body was covered in layers of bath towels. He knew he was meant to savor embraces from loved ones, but their hugs felt like physical pressure, just a weight atop Justin's towel-like layers. They didn't come with feelings of pleasure or comfort he knew other people experienced, Justin told Insider.

Throughout his thirties, Justin pushed himself to spend time out with friends, but felt like his body consistently protested his desire for fun and companionship. Justin wanted to enjoy himself at familiar spots like his local pub, but his body said something else: Stay hypervigilant. Violence could strike at any time.

He told Insider he began to feel this way after he cut off contact with his parents, who he said sexually abused him as a child. He managed to move away and live a safe and normal life, but traumatic memories and feelings that didn't impact Justin in his twenties came flooding back in his thirties, so he sought therapy.

"I never got to learn what it feels like to be comfortable or safe around somebody," Justin, who lives in Maryland and asked not to use his last name for privacy reasons, told Insider. But after eight years of weekly therapy sessions where he talked through his trauma, Justin said he still felt stuck.

That's how he ended up hugging Michelle, a woman who wasn't his therapist, but a trained professional known as a surrogate, who works alongside a licensed therapist. Together, a surrogate and a therapist can execute surrogate partner therapy, an emerging practice that could help those like Justin who say talk therapy falls short of their needs.

For six months starting in March 2021, Justin met weekly with sex therapist Lee Phillips and also had separate weekly in-person sessions with Michelle Renee, an intimacy coach and surrogate. Insider interviewed Justin, Phillips, and Renee separately to understand how surrogate therapy works – and how it can fill in gaps that some say traditional talk therapy leaves in their healing process.

Traditional talk therapy has limits

Surrogate partner therapy first came onto the psychology scene in 1970, when pioneering researchers William H. Masters and Virginia E. Johnson wrote about the concept, the New York Times reported.

Masters previously coined the term "sex therapy" in 1958, but the practice is distinct from surrogate therapy. Sex therapists like Phillips won't touch their clients due to the potential legal ramifications and for ethical reasons.

But for people with intense trauma, disabilities or chronic illness, or those who have never had sex before, a hands-on approach to sex therapy can help them overcome fear, confusion, and anxiety about their physicality, Phillips, a sex therapist of six years, told Insider.

"They want to experience what pleasure feels like and to get more in touch with their body," Phillips said.

That's where a surrogate can be beneficial.

Trained to help clients overcome deep-rooted challenges with emotional and physical intimacy, surrogates use a series of repeated exercises to boost clients' ability to relax, lean into physical sensations, and communicate about their feelings and needs. There's not a singular path to becoming a surrogate, but many get certified through the International Professional Surrogates Association.

Justin said he learned about surrogate partner therapy through a friend of a friend, who connected him with Brian Gibney, an intimacy coach and surrogate partner who has built a network of surrogates and therapists who work together along the East Coast.

Gibney then connected Justin with Renee, who asked Phillips if he wanted to act as a therapist for Justin, and he agreed.

In March 2021, Justin met virtually with Phillips and Renee to discuss his goal of enjoying himself and feeling safe while in crowded spaces, kicking off six months of work that would change Justin's life forever, he told Insider.

For him, that meant learning how to feel physically safe around others. He said talk therapy helped him understand why he felt unsafe and why certain environments and types of touch made him feel post-traumatic stress. But he still couldn't figure out how to feel safe in places or situations that made him think of his childhood, even subconsciously.

Unlike traditional talk therapy where a client and a therapist use conversation to uncover and heal emotional wounds, surrogate partner therapy employs additional elements of touch-focused and boundary-setting exercises, allowing clients to notice physical sensations in their bodies, whether that's through saying "no" to a request, experiencing a light touch on the arm, or sex.

How surrogate therapy works

Before surrogate partner therapy, Justin said he had an "ever-present anxiety and tension" in his body that made any other physical sensations, even pleasant ones, feel dull to him.

When a friend would stand close or hug him, he knew he should feel their body heat, and the care he knew they had for him. Instead, all of those feel-good sensations were dampened by his raging anxiety.

He pushed himself to go out with his closest friends, like to his local pub's trivia nights, but always found himself double- and triple-checking where he was in relation to everyone else in the bar.

And being on high alert all of the time, he also said he had no energy.

But after six months of working with Phillips and Renee, Justin said he could notice the warmth of Renee's hand when she lightly touched his arm for comfort.

"I can literally feel more," Justin said.

To get there, Renee said she and Justin did a progression of exercises to explore his relationship to physical sensations and trust.

Justin said that one exercise, where Renee provided a basket of fidget objects and toys that he would pick up one-by-one, was especially challenging for him. With each object, he has to describe what it physically felt like to hold it, instead of blocking those sensations out as he normally would.

For another exercise, they stood at opposite ends of Justin's living room, he said. As Renee slowly moved towards Justin, he had to tell her when he felt uncomfortable and if she should stop. And when she did stop, Justin had to lean into what it was like to have his request upheld, instead of numbing himself out of anxiety.

After every hands-on session with Renee, Justin said he met with Phillips to discuss how he reacted to certain exercises and make sense of any challenging moments.

Physical touch, like hugs or sex, can lead to therapeutic breakthroughs

Though some surrogates will have sex with their clients, it's a misconception that always happens, or is the purpose, of surrogate therapy. Justin said that he and Renee never had sex because he didn't think that would help him nor did he have a desire to.

But physical intimacy was still important to their work, and towards the end of their six months together, Justin said he was able to hug Renee and feel the warmth, care, and comfort, that used to be foreign to him.

Less fear, more living

When Justin was about halfway through surrogate therapy, he said he decided to go out for a drink, when an old friend approached him. "You look like a completely different person," Justin recalled him saying. And he felt like one too.

He said that he's had two successful romantic relationships since completing his work with Renee, including one that he's currently in, and his friendships feel deeper and more fulfilling.

"I cannot overstate the impact this has had on my life. And most people don't have as much trauma as I do," Justin said. He said that he'd recommend the experience to anyone who feels like they've reached an impasse in regular therapy.

Surrogate therapy is not yet widely available. And because touching therapy clients is still considered taboo, some therapists are wary of partnering with surrogates, Gibney told Insider. Justin, for example, said he ended up working with Phillips because his existing therapist was unable to participate, due to legal precautions at the practice where she works.

But Gibney thinks more therapists are recognizing that talk therapy isn't always enough, and additional tools can help clients heal in ways that were previously inaccessible.

Before Justin was in his current relationship, he said that he did something he never fathomed possible: He went, by himself, to a dating mixer. He didn't know anyone else there.

Instead of feeling too tense to move and thinking that anyone there could be a threat to his safety, Justin had another thought: This is easy. This is fun.