Surrogate partnership

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As a surrogate partners are sexual assistants referred to in a therapeutic context, the sexual acts perform. They are therapeutic substitute partners who are supposed to temporarily replace the actual sexual partner as part of sex therapy . The method is controversial.

In a modification of the classic prostitution, they are intended to offer the client, above all, mental and emotional attention when performing sexual acts . The sex or oral sex is thereby not necessarily practiced. The therapeutic context makes the guidance and supervision of a psychotherapist mandatory, who does not take part in any erotic contacts. Active surrogate partnerships are punishable for doctors and psychological psychotherapists or nurses in Germany , while passive partnerships are sometimes permitted, but ethically controversial. There are no reliable figures on the spread of these practices in German-speaking countries due to the problematic demarcation from the prohibition in dependency relationships.

In Germany, surrogate partnerships are offered especially for work with disabled people by the Institute for Self-Determination of the Disabled . The concept developed by the psychologist Lothar Sandfort is, however, open to anyone seeking advice. This practice for disabled people is criticized, among other things, because the voluntariness on the part of these clients is not always easy to determine and abuse is therefore possible. The practice among non-ill people in the context of the requested help from self-determined persons who are not psychologically or physically dependent on the surrogate partner is not covered by German criminal law.

Terminology

The term surrogate partnership comes from surrogatum = the substitute , past participle passive of the Latin verb surrogare = sub-rogare = to choose someone instead of someone else . A distinction is made between two types: on the one hand, according to the degree of assistance in active and passive, on the other hand, according to the goal in sex therapy or sexual participation of the disabled.

Active and passive sexual assistance

Passive sexual assistance involves procuring sexual references (eg, condoms, vibrator, sex film), sexual counseling, manufacturing (of contacts (partners, sexual assistants, prostitutes), preparatory activities transport to a prostitute, Undressing a couple for the sexual contact, protection from foreign domination and structural violence ). It can include actions like stroking, hugging, holding, and caressing, which makes a strict separation from active sexual assistance difficult.

Active sexual assistance includes sexual massage, hand satisfaction and sexual intercourse, i.e. prostitution if paid . In particular, it should be about helping people to help themselves, i.e. about masturbation, sexual and contact advice.

Differentiation of sexual assistance and therapeutic surrogate partnership

Sex assistance for disabled people differs from therapeutic surrogate partnerships and sexual accompaniment in that sexual assistance does not treat any emotional disorders with a disease value and is usually not therapeutically trained.

Medical therapists are forbidden to enter into sexual contact with addicts themselves ; this includes all patients, clients and those seeking advice in their treatment. In surrogate therapy, you therefore work with sexual companions.

Criminal liability and legal situation in Germany

The right to sexual self-determination is guaranteed in Art. 2 GG . This also includes the right to protection against abuse and the right to choose any sexual partner who can help to overcome one's own deficits or unwanted own chastity due to the lack of opportunities to develop a healthy sexuality. Another problem is structural violence , i.e. even further unauthorized limitation of self-determination, for example through house rules in care facilities (prohibition of visits for prostitutes), through social control (constant supervision by care staff) or lack of intimacy due to a lack of single rooms or alternative rooms (love rooms). On the one hand, the nursing staff should enable the clients to live a life worth living; on the other hand, there is a risk that the nursing staff abusively or with good intentions exceed limits.

Outside of care facilities, in the private context and in the context of non-medical life support in the sexual context of advice from alternative practitioners or healers, the performance of voluntary, self-determined sexual acts by others than one's own or a steady sexual partner due to the right to sexual self-determination does not represent a legal problem Active sexual assistance is prohibited according to §§ 174 ff. StGB in dependent relationships .

However, passive sexual assistance is always possible as long as it is not practiced on addicts, as the commercial offering of sexual services is no longer punishable in Germany. The Prostitution Act ( law regulating the legal relationships of prostitutes - ProstG) regulates the legal status of prostitution as a service since 2001. At the same time, the penal code in § 180a ( exploitation of prostitutes ) and § 181a ( pimping ) were changed to the effect that creating an appropriate working environment is no longer punishable as long as prostitutes are not exploited. For people who otherwise have no care relationship with the person concerned, the criminal liability according to Sections 174, 174a and 174c StGB does not apply. That is why sexual assistants are used. Nursing staff often practice sexual assistance secretly or veiled (washing intimate parts, bathing, applying lotion).

Pro Familia came to the conclusion: "There is no simple legal legal basis from which a state duty could be derived to institutionally support providers of paid sexual assistance and sexual accompaniment for people with disabilities." assumed constitutional obligation and considered the forcible withholding of possibly paid sexual contacts as structural violence.

Sex therapy - therapeutic surrogate partnership

Origin and development of surrogate therapy

Therapeutic sexual assistance (sexual surrogate) as a specific form of sex therapy was introduced in the USA by Masters and Johnson . Today it represents a rare and atypical technique there and meets with ethical and legal concerns.

In Germany in the 1960s and 1970s, surrogate therapy was carried out for a while by the Munich sexologist Götz Kockott . In the course of the increasing fear of AIDS , however, this form of therapy has not established itself and is now becoming better known in Europe.

The therapist as a surrogate

Due to ethical, legal and professional regulations, licensed psychotherapists never act as substitute partners themselves. Specialized prostitutes who are trained as sex therapists and z. B. Acquiring a permit for professional practice of medicine without appointment ( alternative practitioner ) can act as a surrogate in their therapeutic work without restriction and with a corresponding declaration of intent between patient and practitioner.

The role of the auxiliary therapist

The sex therapists Masters and Johnson , instead of proceeding analytically, use the partner of a client without manifest symptom formation as an auxiliary therapist. The advocates of a systemic view, on the other hand, understand the client's sexual problem more as a disorder that manifests itself in the relationship of the respective couple, even if the manifestation of symptoms is only present in one partner.

The psychotherapeutic work here is therefore usually experience-oriented, so that the couple is instructed to organize physical-sexual interaction with their partner, but also with themselves, according to certain rules at home. Against this background, some sex therapists and professionally qualified prostitutes have begun to instrumentalise the role of substitute partner for therapeutic settings across disciplines.

Sex therapy approaches, which mostly contain integrating methods of behavior therapy , cognitive therapy and psychoanalysis , currently have a much higher priority in the USA than in Germany. Based on the conviction that the therapy of sexual problems can only be successful if both erectile dysfunction and the partnership itself are treated, extensive therapy programs have now developed there.

requirements

A therapeutic surrogate partnership is used, for example, when a somatically (physically) healthy client shows impaired access to their own or shared sexuality with their partner. Above all, it is about erectile dysfunction (potency disorders) due to impairments of sexuality through conflicts in everyday life and delayed or premature orgasms in men (ejaculatio praecox). Erectile dysfunction or lack of orgasm ( anorgasmia ), the loss or general decrease in sexual desire ( impaired appetite and frigidity ) can be treated more successfully if a sexual partner is available to implement the changes discussed. If this is missing, some therapists use a surrogate partner. This can be the case in particular if the disorder prevents the establishment of a sustainable intimate relationship in the first place. If the therapeutic discrimination shows such a problem, a surrogate partner may be used. Sexual disorders can only be recorded to a certain extent by classic therapy. Depth psychological procedures are based on the actual cause of the impaired sexuality (often experiences of abuse, early childhood disorders, trauma-induced defense mechanisms, etc.). By resolving the pre-conflict and developing the ability to relate, the patient can develop or deepen new or existing love relationships over time and build a relationship-centered sexuality. For this, a surrogate partnership would not only be unnecessary, but clearly contraindicated.

Since the psychological causes of atraumatic sexual disorders are largely gender-neutral in the respective role understanding and social self-esteem, emotional affection and expectation-free encounters represent the therapeutic basis for surrogate therapy for clients of both sexes. In this mood of extensive confidence-building, the client is more likely to succeed in their own sexuality than As in a normal sexual relationship, he would have to simultaneously fulfill relationship-relevant expectations, expectations of fitness , thoughts about contraception or the desired child , in relation to the socialization of the sexual partner or his own role as a partner, breadwinner or provider. Likewise, a male surrogate partner can encounter a corresponding anorgasmia in female clients. Because sociological and material ulterior motives on the part of the sexual partner are eliminated and certain expectations of a perfect body or a certain stamina are not even made during the act and the client knows, not least, that his surrogate partner, unlike a regular prostitute, is himself also gets involved with him humanly, the actual problem of disturbed sexuality can be better dealt with.

Sex therapy, in which a client's fear of sexual intercourse is relieved by using a “surrogate”, physically replaces the actual desired partner with a substitute. Such a therapy can only work if the therapeutic setting at the beginning of the treatment clearly locates both sides in their temporary emotional role as sexual partners. The surrogate therapy is mainly accused of promoting prostitution in the classic sense due to ignorance of this conversational therapy preparation and follow-up. In fact, the sexual act itself and sexual practices are not in themselves the focus of a therapeutic surrogate partner's work. Rather, he fulfills the role of an empathetic companion who first builds the client's actual readiness for their own sexuality and, if necessary, resolves any affective disorders in a supportive manner.

In the case of traumatic sexual disorders, a correspondingly longer preliminary phase in conversation therapy is regularly indicated. The surrogate partner speaks with the client in detail about their feelings and, if necessary, works with a psychotherapist on trauma treatment . Ideally, he is trained in it himself, e.g. B. to work with non-direct conversation . After a meeting with a surrogate partner, stress patients, depending on the diagnosis displayed, are followed by a talk-therapeutic unit and the request to find new sexual partners themselves.

The frequency and duration of encounters with a surrogate partner vary greatly. A one-time treatment will be the exception here, as will a comparatively long-term therapy, as is common in the field of psychoanalysis . Since in Europe only scientifically recognized procedures can be carried out at the expense of the health insurance company , surrogate partners are only used as privately financed co-therapists in the context of psychotherapy .

education

The activity of a surrogate partner is not trained by the state or mediated by a provider of vocational institutions. There is no association or professional representation of sexual assistants, sexual companions and surrogate partners with the possibility of a professional exchange or quality assurance in Europe.

A further education and supervision for sexual accompaniment for the disabled has been offered for the first time in Europe in Trebel / East Lower Saxony since 1997 by the systemically trained psychologist Lothar Sandfort at the "Institute for Self-Determination of the Disabled" (ISBB). The methodology shows parallels to neotantra and body therapy . In 2004 the well-known Dutch sexual companion Nina de Vries trained four men and six women; she did this on behalf of the Department for Disability and Sexuality - Against Sexualized Violence , founded by Aiha Zemp . Psychological psychotherapists and doctors with specialist training in psychotherapy are professionally committed not to enter into an intimate relationship with a patient . A violation of these ethical rules would result in the withdrawal of the insurance license . For sex therapists there is on the one hand medical training, but also non-medical professional fields, e.g. B. for alternative practitioners or psychological counselors. Access to work as a surrogate partner is therefore primarily available to practitioners from the field of Tantra with a naturopathic license or prostitutes with a degree in psychology or correspondingly trained skills.

Sexual assistance to the disabled

Sexual assistance tries to give disabled people access to sexuality as it is practiced by non-disabled people.

A sexual companion seeks those who are not or no longer able to convey an erotic-sensual experience themselves. It should be about closeness and security, but also about sex and sexual satisfaction. Sexual accompaniment wants to help disabled people to have their first sexual experiences.

Nursing staff are not allowed to sexually assist the disabled person who is dependent on them. Since sexual assistance for the staff is excluded in many house rules with reference to sexual abuse or the relevant criminal regulations, contact is established through relatives or nursing staff.

Development of sexual assistance

In Switzerland, the organization for the disabled, Pro Infirmis, planned the first training course in 2003. Hard resistance from the public, combined with a decline in donations, led to the establishment of the Disability and Sexuality Unit , which began training in 2004 under the new name of "Sexual Assistants". In Switzerland there is currently an opening of the training offer in the direction of sexual intercourse and also for homosexual clients.

In the field of handicapped assistance, Nina de Vries, together with Dipl.-Psych. Lothar Sandfort offered sexual accompaniment for the first time in the mid-1990s. Pro Familia explains : "There are recognizable professionalization efforts and voices that only want to call those sexual companions who - comparable to a protected job description - have special training and professional qualifications."

criticism

The sexual accompaniment or surrogate partnership is often accused not only by conservative circles, that they are only euphemisms for a form of prostitution. Such prostitution is a taboo for churches and conservative circles. Health insurance companies and many psychologists are very critical of sexual accompaniment. In the case of the sex therapy surrogate partnership, they lack reliable evidence of effectiveness. It should also be noted that the possible reasons for sexual withdrawal by the patient are not discussed. Most of these causes (be it difficulties in finding roles or trauma experiences) are clear contraindications for a therapeutic surrogate partnership.

The basic therapeutic rule of abstinence is diametrically opposed to surrogate therapy . The vast majority of sex therapists consider the danger of not being able to dissociate sufficiently to be an insurmountable obstacle to this therapy. Sexual assistance is therefore rejected in terms of sexual ethics . In order to avoid criminal liability and this rejection, close partnerships have sometimes been established between therapists who do not enter into sexual contact with those seeking advice and surrogate partners. Due to the threat of punishment, there is hardly any concession in practical implementation in care facilities. Most care services do not take any precautions in terms of space or content, so sexual assistance is almost exclusively carried out in private.

In 2010, with the support of the Community Aid Association and the "Church Collection of the Bible and Confession in Bavaria" (KSBB), in an open letter to President Nikolaus Schneider , the chairman of the EKD Council , Diakoniememet were criticized for the propagation of the surrogate partnership in the Orientation , a specialist journal im Field of work for disabled people. It has been propagated in a campaign that has been going on since 2003, especially in the 02/2003 and 02/2009 issues "Prostitution [as] a 'sacred act on behalf of the goddess'" and as a "Christian' profession". Such practices are incompatible with Protestant sexual ethics and punishable under § 174 and § 179 StGB.

See also

  • Tantra or Neotantra focuses the work on energetic aspects with a spiritual and esoteric background. Surrogate partners are also used here, but mainly out of the endeavor to re-experience one's own sexuality less selfishly or bound by expectations towards a single partner. The aim is to work meditatively and contemplatively with the aim of understanding one's own sexuality as a source of strength for connection with God or the world. Todothis, so-called chakras are activated (see Kundalini ) and, in contrast to sexual assistance and surrogate partnerships, the goal is not to achieve a possible climax or to overcome the consequences of a disability. A climax is sometimes even perceived as an obstacle, but not dogmatically rejected. There is no scientific evidence for the existence of chakras.
Wiktionary: surrogate  - explanations of meanings, word origins, synonyms, translations

Working on the topic in fiction and film

  • Yazgülü Aldoga: Kiralik Adam . Alfa Yainlari Verlag, Istanbul 2009. German: The accompaniment . binoki, Berlin 2012.
  • Ben Lewin: The Sessions . German: The Sessions - When Words Touch 2012.
  • Kirby Dick : Private Practices: The Story of a Sex Surrogate . 1986.

literature

Books

  • Mirjam Mirwald: Sexual accompaniment for people with learning difficulties. Discourse analysis and documentary film “Die Heide ruft”. Shaker, Aachen 2009, ISBN 978-3-8322-8810-5 (also diploma thesis at the Humboldt University Berlin, 2008).
  • Ilse Achilles et al. a .; Joachim Walter (Ed.): Sexual accompaniment and sexual assistance for people with disabilities. In: Edition S. Winter, Heidelberg 2004, ISBN 3-8253-8314-8 .
  • Monika Krenner: Sexual accompaniment for people with intellectual disabilities. Marburg 2003, ISBN 3-8288-8541-1 .
  • U. Krahmer, R. Richter: Home law. Teaching and practice commentary (LPK-HeimG). Baden-Baden 2003.
  • Jörg M. Fegert , M. Wolff (eds.): Sexual abuse by professionals in institutions, prevention and intervention. A work book. In: Votum. 2nd updated edition. Juventa, Weinheim / Munich 2006, ISBN 3-7799-1816-1 .
  • Lothar Sandfort: Right to lovesickness. Emancipatory sexual counseling for the disabled. published by xinxii.com , 2010.
  • Heinrich W. Ahlemeyer: Prostitutive intimate communication. On the microsociology of heterosexual prostitution. Thieme, 1996, ISBN 3-432-27171-9 . ( New edition: Money-controlled intimate communication. Psychosozial-Verlag, Gießen 2002, ISBN 3-89806-088-8 .)
  • Kurt Marc Bachmann, Wolfgang Böker (Hrsg.): Sexual abuse in psychotherapy and psychiatry. Huber, Bern / Göttingen / Toronto / Seattle 1994, ISBN 3-456-82485-8 .
  • Julia Zinsmeister: Multi-dimensional discrimination. The right of disabled women to equality and its guarantee through Art. 3 GG and simple law. Nomos, Baden-Baden 2006, ISBN 3-8329-2009-9 (also dissertation at the Johann Wolfgang Goethe University Frankfurt am Main 2006)

Essays

  • Reschke, Kranich: Sexual Feelings and Fantasies in Psychotherapy. An anonymous questionnaire survey among Saxon psychotherapists. In: Behavioral Therapy and Psychosocial Practice. 1996, Vol. 28 (2), pp. 251-271.
  • A. Bergmann: The legal relationship between prostitute and suitor - the Prostitution Act from a civil law perspective. In: JR. 2003, pp. 270-276.
  • W. Commander, K. Krott: Lend a hand? In: Orientation. 2/2003 p. 25.
  • M. Crossmker: Behind Locked Doors: Institutional Sexual Abuse. In: Sexuality and Disability. 9 (3), 1991, p. 167 ff.
  • Bernard Apfelbaum: The Myth of the Surrogate. In: The Journal of Sex Research. Taylor & Francis, Vol. 13, No. 4 (Nov. 1977), pp. 238-249. (Preview)

Web links

Individual evidence

  1. ↑ Sexuality and physical disability as a challenge in social work . (PDF; 824 kB) from p. 51; Retrieved January 1, 2012
  2. ↑ Expert opinion on the legal requirements and limits of sexual assistance and sexual accompaniment (PDF; 484 kB) profamilia.de, 2005, p. 58 with further references.
  3. ↑ Gerald P. Koocher, Patricia Keith-Spiegel: Ethics in psychology: professional standards and cases. McGraw-Hill, 1985, ISBN 0-07-554879-8 , p. 103.
  4. ↑ Model professional regulations for psychological psychotherapists and child and adolescent psychotherapists (as of 2014) ( Memento from June 25, 2014 in the Internet Archive ) (PDF; 95 kB)
  5. ↑ Institute for Self-Determination of the Disabled
  6. ↑ Sex companions for the disabled - sex is part of everyone . In: taz , September 22, 2009.
  7. ^ Pro Familia in an expert report on sexual assistance for women and men with disabilities.
  8. ^ Surrogatpart Partnerschaft.blogspot.com , accessed April 19, 2010.
  9. ^ ISBB Trebel
  10. ↑ repealed with effect from November 10, 2016, Art. 1 No. 8 of the law of November 4, 2016 ( BGBl. I p. 2460 )
  11. ↑ Kurt J. Heinz: Sexual abuse or "sacred act on behalf of the goddess"? - Paid services in the Diakonisches Werk der EKD: "I masturbate him until he has an ejaculation" . In: Medrum, April 15, 2010, Archived by WebCite ( April 16, 2010 memento on WebCite ).