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"He was already self-conscious and scared being in that situation," Catherine says, "and now you have a hooker telling you that you smell bad. The poor thing. He went 20 years before he could even talk to a woman."
Picket-fence America wasn't ready for the concept of sexual surrogates when the therapy was developed in 1959 in St. Louis at the Reproductive Biology Research Foundation, later renamed the Masters and Johnson Institute. Respectable folks didn't discuss such matters. Masters and his research assistant turned wife, Johnson, were the first American academics to examine human sexuality since Alfred Kinsey's groundbreaking work at the University of Indiana. They created a broad program that involved everything from interviewing volunteers about their sexual histories to observing couples having sex in the laboratory. Their findings are still the basis for most research in the field of sexology, according to Dr. James Walker, president of the American Board of Sexology, a national quality assurance and certification organization that oversees sex therapists. "There have been new models for study and treatment and obviously with pharmaceuticals," he says, "but everything people are doing really comes from adaptations of this original way of looking at sex."
Masters and Johnson developed new methods to treat married couples with sexual dysfunctions, conditions they described with terms such as ejaculatory incompetence and orgasmic dysfunction in women. The solution, as they saw it, combined psychological approaches with practice at home. The exercises were based on trust and acceptance, with couples and therapists working as a team.
But this posed a problem for unmarried men and women, who were often the most severe cases. Their sexual problems, in fact, were precisely the reason they didn't have a partner. It was a twisted social paradox: can't work on the problem without a partner; can't get a partner before working on the problem.
So Masters and Johnson trained the first surrogates. For the study, 13 women were selected as surrogates from 31 volunteers. They worked with 41 single men. After 11 years, in 1970, Masters and Johnson published Human Sexual Inadequacy, a book about their research. It became a best seller and has since been translated into 30 languages. The book, written in intentionally dry, clinical language, has a chapter dedicated to the work of the original group of women, whom they called partner surrogates.
An optimal partner surrogate, they explained, was, for the patient, "someone to hold on to, talk to, work with, learn from, be a part of, and above all else, give to and get from."
Masters and Johnson believed that without two people present to explore the nature of the dysfunction, there was no chance of recovery. With an emotional connection, they said, the treatment can bring healing, in some cases overriding the original trauma and replacing it with a positive association.
The original surrogates came into the program with some traumatic stories of their own. Three of the 13 women had been married to men with sexual dysfunctions. One man killed himself. Another husband, unable to deal with his dysfunction, became an alcoholic and eventually divorced. But the women all had their own reasons for wanting to participate in the program.
If someone wants to conquer a fear of flying, at some point he must ride in a plane. If someone wants to conquer a fear of intimacy, at some point he also has to board the plane. The way Volker looks at it, to be a surrogate, you have to like being the plane — the one who eases the pain, no matter how physically or emotionally handicapped the patient may be.
Volker is sometimes called the Dr. Ruth of South Florida. She used to host a call-in radio show called Sex with Marilyn. She also teaches graduate classes at Florida International University, Barry University, and St. Thomas University. She's the type of grandmother who gives her grandkids books about sex every year.
Volker does at least four or five "talk therapy" sessions before she introduces a patient to the surrogate. If the patient is struggling with problems such as addiction, anger management, or depression, or even if there's a medical issue such as high blood pressure, these must be addressed before beginning therapy with a surrogate. "We can't have anything else getting in the way of those true, intense emotional feelings," she says.
The first sessions are a screening process. Because patients often work with surrogates in the surrogates' home or alone in hotel rooms, she has to make sure she isn't putting the surrogate in danger. They use protection if there is intercourse.
If the patient seems like an appropriate candidate, the three parties — Volker, Catherine, and the patient — meet in the Hollywood office. "The first step is everyone getting to feel comfortable with one another," Volker says. "Surrogates aren't prostitutes — not that there is anything wrong with prostitution. It isn't 'Here's 50 bucks; give me a blowjob.' A lot of times, there isn't even intercourse. It's mostly talking."
She says if a patient asks what the surrogate looks like, "that's an immediate red flag. I know right there that's not the type of person who would benefit from working with a surrogate."