But I never seriously considered developing a stable of surrogates.
At first I used prostitutes. I felt on a much sounder ethical footing this way. There is certainly a difference between employing a prostitute who has already functioned in that occupation and recruiting a girl as a de facto novice in the profession. There is also the security of knowing that she has done this before and has been able to handle the role emotionally to a greater or lesser extent.
But there was still so much wrong with this method. The motivation on the female’s part, for example. It’s entirely financial, and as carefully as you try to screen potential surrogates, you still wind up looking for the mythical whore with the heart of gold. If she exists outside of melodrama, I’m afraid I haven’t yet met her. In my experience, the average prostitute is a severely disturbed woman with an unresolved Oedipal conflict, an inability to postpone immediate satisfaction for the sake of long term benefit, and a neurotic emotional cripple. And those relatively few prostitutes who are well-adjusted are still women who want to make as much money as possible in as little time as possible with as little effort as possible, either to live luxuriously and effortlessly or, more rarely, with the hope of retiring as soon as they can to a better way of life.
Thus there’s an incredible degree of unreality here. A couple on the Masters and Johnson plan are working together toward a common goal that will benefit them both. A man with a professional sexual surrogate is receiving treatment from her for which she in turn receives financial compensation. They inevitably relate to one another in this light. If, for his own benefit in terms of the therapy, the man tries to regard his partner as something other than what she is, as a love-object, he is simply deluding himself. And, when his course of treatment has been completed, he has not learned how to make love to a woman. He has only learned how to achieve satisfaction with a prostitute.
Given these reservations—and they are considerable—I still achieved some favorable results in this manner. But I was never satisfied with it, not entirely. And it did absolutely nothing for women in the same position. I never even considered going out and finding male prostitutes to service them, nor could I imagine such an approach having any useful results. I simply had to assume that the Masters and Johnson approach to female sexual inadequacy was not applicable to single women.
When it first occurred to me that two patients could serve each other as surrogates, I rejected the idea out of hand. It goes against the grain, you know. Even in group therapy, which is predicated upon the idea that patients can help each other through emotional interaction, there’s the absolute premise that such interaction should take place only within the group, that the patients should not know one another’s last names, and that they should have no social contact on their own.
Now this is easier said than done. Whatever the ideals of group therapy, whatever rules one sets up in advance, the patients manage to work things out as they see fit. It is a practical impossibility to prevent two adults from exchanging telephone numbers if that’s what they’ve decided they want to do. And it constantly happens that they want to do this, to see each other outside of the group situation. Sometimes, especially when you’re dealing with people in an urban locale, they have few real acquaintances outside the group. It’s no more than natural that they’ll want to heighten these relationships.
Periodically I would discover that two members of a group I was running were having an affair. Once this happens there’s not a hell of a lot you can do about it. If you discourage the affair, all you usually accomplish is to drive the persons involved away from the group. These affairs would have a bad effect upon the group because they would alter its emotional makeup in certain ways, and would prevent the persons involved in the affair from playing their roles in the group as freely as they might have done otherwise.
Yet it was my experience that such affairs were not necessarily bad for the two people involved. It was quite often just what the doctor ordered—except that in this case the doctor in question had ordered the opposite. While the affair might adversely affect the way the two functioned in the group, it often seemed to improve the way they functioned in other areas of life.
This led me to conclude that, while it was undesirable in certain ways for members of a group to have an affair, it was not perforce undesirable for two patients to have an affair with one another.
I then began to consider anew the prospect of two patients serving one another as sexual surrogates. As I saw it, this would amount to creating a therapy group composed of two persons and specifically encouraging their interaction, interaction on a sexual level. They would be able to utilize Masters and Johnson techniques in dealing with one another’s problems, and they would approach each other as equals, similarly motivated and drawn together for their collective good. They would not have the advantage of married couples. They would not love each other and would not have a common goal to the same extent. But it seemed to me that their relationship would have to have greater validity than that of prostitute and client.
My ideas on the subject remained highly theoretical for some time after I had clarified them because the right patients did not materialize. I continued to treat single subjects as best I could. I modified the treatment of premature ejaculation, for example, by having single male patients employ the M & J technique by themselves in the course of masturbation. This works to a certain extent, in that the mind and body learn to defer orgasm. There’s an argument that premature ejaculation represents a problem originally learned through masturbation, that adolescent masturbators often attempt to bring themselves off as quickly as they possibly can and that this sets a pattern of future sexual response. I’m not sure how valid this is, but it’s been my experience that men who learn to prolong masturbation can more easily learn to prolong intercourse.
It didn’t work as well as it might have, though, because it couldn’t go far enough. A man might train himself from a physiological standpoint to postpone orgasm, but this interaction between his penis and his hand would hardly give him confidence when he was with a woman. His concern over the possibility of failure could serve to guarantee failure, as is so often the case with sexual difficulties.
Ultimately, I found myself in the position of having two individuals as patients whom I felt could very likely help one another. The female patient was a young woman of twenty-four who had been recently divorced. Her husband had left her for another woman. Their sexual relationship, never entirely satisfactory, had deteriorated considerably in the months before the divorce. Since then she had had sexual relations on several occasions with several partners and had found herself incapable of response, although she had responded sexually in the early years of her marriage and had frequently reached orgasm then.
The male patient was approximately the same age. His problem, really, was sexual insecurity as much as anything else. He had never been married and had never had a long-term sexual relationship. On the few occasions when he had had sex, he had been impotent to a greater or lesser extent most of the time. Occasionally he was unable to get an erection in the first place, occasionally he reached orgasm immediately upon intromission, occasionally he sustained intercourse for a long enough period of time but subsequently lost his erection without having reached a climax. Because he was not confident of his ability to perform adequately, he tended to avoid situations in which he would be called upon to perform at all. He was socially unaggressive, dated infrequently, and found it excessively easy to accept when a woman rebuffed his attempts at seduction.
It struck me that these two might be very good for each other. I also was able to determine that neither was likely to do the other any serious harm. These two were not extreme neurotics and their personalities were such that they would not attempt to hurt one another or use one another improperly.
I brought the two of them together, explaining that I wanted to experiment with a form of group therapy involving two persons instead of the traditional larger g
roup. In this way they were able to get to know each other and discuss their problems without the pressure of an incipient sexual relationship, and at the same time I was able to observe how they related to one another. My impression that they would be good for each other was reinforced.
I met with them separately and established that each found the other sexually attractive. I then discussed with them—separately, again—the idea of the two of them working together to improve their respective sexual performance. I explained how the Masters and Johnson system worked for married couples and how I would be inclined to modify it for their special circumstances.
While each was somewhat hesitant, both of them agreed to try working together as what you might describe as an ad hoc couple.
The program I established for them ran along the following lines: Three nights a week, they would have dinner together. They would then return to the young woman’s apartment where they would become increasingly intimate with one another along the M & J lines. At first they were to practice giving one another pleasure in ways that were not specifically sexual, caressing one another on the arms and face, giving each other back rubs, etc. Then they would remove their clothes and pet. Ultimately they had sexual relations, employing the techniques I had explained to them to deal with sexual problems.
At the same time, I was seeing them both together and individually several times a week. I would discuss with them the progress they were making and their emotional reactions to what was taking place. There were certain problems. Each of them was holding back to a degree at the beginning out of a fear of being hurt. Each felt the possibility of falling in love with the other and worried that this love would not be reciprocated since they were basically involved in an affaire de convenience, so to speak. Each simultaneously feared that the partner would be the one to fall in love. My method of coping with this consisted largely of inculcating them with the idea that, in a contrived situation of this sort, love was a legitimate option which could be regarded as a nonpermanent thing. Don’t try to make too much sense of that statement; it was more pragmatic gobbledygook than anything else, a line of argument simply designed to allay fears.
In a matter of weeks they were functioning more than adequately. The fact that each was helping the other was enormously important. In dealing with married couples, Masters and Johnson have confirmed that one problem lies in a tendency to regard a shared problem as the particular problem of one of the partners. In other words, if the man’s impotent, both the husband and the wife tend to think it’s his problem and she’s helping him solve it, when actually it’s their problem and they damned well better work it out together. With my two single people, both of them knew they had a problem and that the partner had a problem, so this made things easier in that respect.
Before very long, the man was learning to take for granted his ability to get an erection, keep it as long as was desirable, and reach a strong climax. The woman was learning to relax with a lover, respond to sexual stimulation, and reach orgasm either in intercourse or in non-coital love play.
I had been fairly certain that this would happen. What concerned me more was what would happen next. There was the chance that they would worry about their ability to function as well as other partners. There was the chance one would want to continue the relationship and the other would have to choose between prolonging an undesired affair or rejecting and hurting the partner. It was the possible denouement of the whole thing which had concerned me most at the beginning, and the better the two of them were together, the more anxious I grew about it.
I wondered just how they would work it out. Would they both begin dating other persons at about the same time? Would severe depression be a problem for the rejected partner? Or would the ego boost of sexual success be sufficient to lead the rejected individual to form meaningful sexual relationships on his own initiative?
In this case, I got no answers, because my two guinea pigs were too well suited to one another. Perhaps my intuition in selecting the two of them had been particularly keen. Perhaps the sharing of this triumph created a bond of particular strength. Whatever the cause, their relationship simply did not break up. They continued having an affair, neither of them desirous of ending it, and they began living together, and at the present time they are married and awaiting the birth of their first child.
At the time I regarded this as an extraordinary development. I have since ceased to be surprised when affairs which I have arranged lead to long-term alliances, if not to marriage per se. One must appreciate that two persons who know each other through shared therapy, and subsequently through shared sexual therapy, almost inevitably construct a very strong basis for a continuing relationship. They know each other better than most people do at the onset of a marriage. They have conscientiously exposed themselves to one another. And they were emotionally compatible in the first place, since I had established this compatibility long before suggesting that they treat each other’s sexual ills. And they’ve developed a sexual relationship which has been more satisfying for both of them than either has managed in the past, and have done so in an emotionally candid fashion. Why then should it be surprising for them to conclude that they’ve got a good thing going, and that they want to hang onto it?
In instances when the two persons did not remain in a long-term monogamous relationship, the results have been almost entirely favorable. Again, let me emphasize two things. First, the persons involved were not severely disturbed to begin with. They were emotionally stable and intelligent. Secondly, I was meeting with them regularly, and was able to prepare them for changes in the nature of their relationship, and to offer some support when it was needed.
Affairs that did not continue resolved themselves in a variety of ways. In one case, for example, both of the parties felt that sexual relations of a casual nature were quite legitimate. When they ceased seeing each other in their therapeutic relationship, both of them began seeing other persons and had successful sexual relations with a variety of partners. Periodically they would get together with each other in order to have sexual relations and enjoy one another’s company. They have been able to do this without any unpleasant effects on either side.
In other instances, both persons have agreed in the course of therapy that they feel it necessary to rule out seeing one another at all after therapy had been concluded. For example, I put two people together in a successful therapeutic relationship and, good as they were in bed together, their backgrounds and interests were such that they recognized it would be impossible for them to make a success of a marriage, nor did they feel themselves to be in love in any sort of permanent fashion. Their orientation was such that they only approved of sexual intimacy in the context of a serious relationship—with the exception of their own relationship created for therapeutic purposes, which they were able to accept in that respect. Therefore they agreed from the start that the relationship would never be more than a mutually therapeutic one, and neither appeared to desire to change this agreement at any stage.
I can’t claim one hundred percent success. I doubt any matchmaker can, whether he’s aiming at temporary sexual harmony or permanent marital bliss. In many cases the two people simply don’t take to each other. Their personalities clash or they fail to find each other sexually appealing. Most of the time, this comes out long before I’m likely to suggest that they go to bed together, so there’s no harm done; I simply discontinue seeing them together and, if the prospects are right, pair them up with other partners. A few times they began the therapy process before discovering that they could not function together for one reason or another. Again, no real harm was done.
I’ve lately come to the conclusion that it’s not absolutely essential that both of the parties have a problem of sexual dysfunction as such. For example, I’ve paired an impotent man with a woman whose major problem was general anxiety and low estimate of self. I felt that the experience of sexual interaction of this sort would be beneficial to her and that she w
ould be a useful partner for the man in question. I’ve also done the reverse, paired a man with more general problems with a woman with problems of sexual inadequacy. The procedure has had good effects on both parties, perhaps because anyone is going to benefit by having good healthy sex on a regular basis, whatever the nature of his or her basic difficulties.
Paradoxically, the chief difficulty I face at the present time is that patients have been coming to me lately with an understanding of the course of treatment I employ. They’ve talked to former patients of mine and know in advance that I’m likely to pair them off with other patients. This makes it difficult for them to approach their prospective partners in the right frame of mind, as they are apt to erect defenses immediately because they are thinking in sexual terms. Also, when I do pair them tentatively and things don’t work out, they can hardly avoid interpreting this as rejection, whereas they would not know they had been rejected if they had not known that a sexual pairing was in process. This has been a problem, but even so the results have been significantly more favorable than unfavorable.
Years ago I read a mystery novel by Fredric Brown called The Screaming Mimi. One of the characters was a lunatic psychiatrist who had created a certain amount of frenzy at a mental hospital which had employed him by taking a satyr and a nymphomaniac and locking them in a room together until they either killed or cured each other. Sometimes I feel as though the role I’ve played of late is not all that different from that of the fictional psychiatrist. I know a great many persons in the field would tend to regard what I do as either unethical or dangerous or both. I can only say that it seems to work, and that whatever dangers it may have do not seem to have materialized.
If the best way to treat persons is to let them treat each other, I can’t see any valid objection.
In Praise of the
Electric Toothbrush
The Sex Therapists: What They Can Do and How They Do It (John Warren Wells on Sexual Behavior Book 15) Page 15