Sex Therapy Surrogate Partners for Individuals with Very Limited Functional Ability Following Traumatic Brain Injury

Abstract

The use of surrogate sex therapists for survivors after Traumatic Brain Injury (TBI) who have Very Limited Functional Ability (VLFA) is discussed. It includes the rationale of using surrogate therapy with this population as well as some of the professional and ethical issues that such therapy can evoke. It is suggested that surrogate therapy can provide satisfaction and positive experiences to the restricted lives of some of the VLFA-TBI survivors. The use of surrogate therapy is viewed as a part of the integral rehabilitation process aimed at improving the quality of life and the fulfillment of basic human intimacy needs. Often requiring help in this important area of life, they are not always able to initiate and control emotional behaviors to promote healthy sexual relationship and activity. Surrogate therapy is an activity that can help survivors with TBI monitor and initiate feelings, reactions and motivation in intimate relationships, as well as provide a certain amount of control over their lives. A case study is presented to illustrate the process of sex therapy with a surrogate partner for a VLFA-TBI survivor.

Remediating Serious Inappropriate Sexual Behavior in a Male with Severe Acquired Brain Injury

“…Aloni et al [3] highlight the possible role of sex workers (''call girls'') as being able to continue a program established by a sex therapist and surrogate for addressing the sexual needs of people with ABI with severe disability. However, no surrogates could be identified in the state of Victoria by the treating team.…”

“…At a broader level, Wolf [43] suggests that one dimension of the social validity of an intervention is the 'acceptability of treatment'. There are several countries or states in which either surrogacy is permitted or sex work is legal and accessed by people with disabilities including Israel [3], Denmark [44], Norway [44], and some states of Australia [23,25,37]. However, in countries such as the United Kingdom, the legalities of facilitated sex, particularly as it applies to personal care attendants, are much more problematic [37].…”

“…However, psychosocial factors (psychological or environmental) may also contribute to the genesis, exacerbation or maintenance of ISBs [3]. Furthermore, ISBs are often part of a broader syndrome of behavioral dysregulation including aggressive behaviors, as well as cognitive deficits [9].…”

“…Furthermore, ISBs are often part of a broader syndrome of behavioral dysregulation including aggressive behaviors, as well as cognitive deficits [9]. Therefore, treatment efforts are often complicated by need to address both ISBs and comorbid aggression within the context of other impairments such as memory problems and reduced executive functioning (e.g., lack of self-awareness, limited self-monitoring, poor planning skills) [3,10].…”

“…This important principle has been discussed within the intellectual disability literature since the early 1970s [18]. Pioneering such an approach in the field of ABI, Aloni et al [3] have facilitated sexual adjustment using collaboration among rehabilitation service providers, sex therapists and surrogates.…”