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If the meet-and-greet goes well, the therapy begins with what Volker calls body mapping — the surrogate and patient going over the patient's body together, determining what's comfortable (or functional) and what's not.
Then comes an exchange of touches: first observational, then playful, then nurturing, and, finally, sexual touching, which may or may not lead to intercourse.
The process is often done slowly, with weekly meetings over a number of years. "For people who have done surrogate work," Volker says, "their rituals of moving with regard to closeness will be very different from what's on adult films. Their ritual of what we call foreplay — I call it 'outercourse.' They get to genitals in very different ways. Because for many people, if it were done like on adult films, it could be triggering, and the body could shut down. Because it is like reenacting the traumatic experience."
Volker recalls the case of a man who'd been injured in a car accident at 18. Before the accident, the man was sexually active; he was engaged, in fact. But the crash left him a quadriplegic, unable to speak. After ten years of rehab, he was living in a nursing home. His psychologist asked Volker to see the patient. "This man was very angry, hostile," she explains. "He was making — I suppose clinically it'd be called 'lascivious tongue movements' at women."
He also managed to swing his arm, hitting people near him.
Volker established a communication system so the patient could answer yes or no questions. "I wanted to see what was important to this young man. He was very interested in the sexuality part. He was very angry that there was no way to express this. Here he was in a Catholic nursing home, which was great for helping him in all the rest of his life, but the sexuality was very overlooked."
When she brought in pictures, she learned he liked blonds — blonds with large breasts. As it turns out, his fiancée who left him after the accident ("and one could hardly blame her," Volker adds) fit that picture.
Volker said she'd bring in a surrogate to work with him but only if he agreed to stop the tongue movements and hitting.
Catherine quickly figured out what he could feel and what he couldn't, what worked and what didn't. As it turned out, the patient could get erections and ejaculate (the limbic system, which controls sexual impulses, had not been affected by the accident), but he couldn't reach himself to masturbate. He had gone ten years unable to tell anyone.
The climax of the treatment came when they arranged for Catherine to come to the nursing home one night. It was Volker's idea. "We set up a step-by-step 'date' of watching a movie together, eating some food or drinking something together, then a massage with what we might call a happy ending."
There's no way of knowing exactly what percentage of the populace might be candidates for surrogate therapy. Volker suspects that the percentage of "sexual anorexics and phobics" who actually come in for therapy is small. There are many others out there who would be right for the treatment but can't afford it or are too embarrassed.
David Yoblick is no longer embarrassed about the time he spent with a sexual surrogate. It was 30 years ago. Yoblick, then 37, had just divorced his second wife, and he wanted help with delayed ejaculation. "This was before we had Viagra," he says. "There wasn't much a man could do, but I tried it all: eating certain things, not eating certain things, vitamins, minerals, exercises, whatever I thought might work."
Yoblick says the problem began with his first sexual experience, when he was 12. "It was in a public park in Philadelphia, and, well, I ejaculated very rapidly." He had sex in high school, but it was always brief, and there were long stretches when he couldn't perform. It was the same when he got married. He was always tired from working two full-time jobs, causing a strain on the marriage. In his second marriage, sex wasn't as big an issue, but it still didn't work out.
Yoblick's lack of sexual confidence was a huge issue, he says. "The first thing I thought about whenever I shook a woman's hand and introduced myself was, 'Will I be able to get an erection?' Men think if they don't get erections, they are in some way less of a person."
In the late '70s, Volker was finishing her graduate work in sexual behavior at the University of Miami. She was at a party with one of her mentors when a psychologist was talking about a patient who needed someone with knowledge of sexology to work as a surrogate with him. Inspired by the moment — and a recent divorce — she volunteered her services.
She worked with the therapist and the patient, following the traditional Masters and Johnson steps, making emotional connections, then physical. "There's nothing like seeing a person discover their own sexuality — seeing the moment they feel free from some trauma or the moment they learn they are just as capable of having sex as anyone else." She gets a knot in her throat as she talks. "It's just overwhelming. What people are capable of is amazing."