While developing therapy concepts and procedural patterns at onset of the clinical investigative approach to sexual dysfunction in 1959, there were many severe problems to be faced. One of the most prominent concerns was the demand to develop a psychosocial rationale for therapeutic control of unmarried men and women that might be referred for treatment.
During 11 years of treatment, 54 men and 3 women were unmarried when referred by their local authority with complaints of sexual dysfunction. In a statistical breakdown relative to intake diagnosis, 16 men were premature ejaculators, one was an incompetent ejaculator, 21 were primarily impotent, and 16 were secondarily impotent.
The three women were orgasmically dysfunctional, one primarily and two situationally (coital orgasmic inadequacy).
The immediate problem to be faced was the obvious clinical demand for a female partner a partner to share the patient's concerns for successful treatment, to cooperate in developing physically the suggestions presented during sessions in therapy, and most important, to exemplify for the male various levels of female responsivity.
All of these factors are essential, if effective sexual functioning is to be returned to the sexually inadequate man. In brief, someone to hold on to, talk to, work with, learn from, be a part of, and above all else, give to and get from during the sexually dysfunctional male's two weeks in the acute phase of therapy.
The term replacement partner is used to describe the partner of his or her choice brought by a sexually inadequate unmarried man or woman to share the experiences and the education of the clinical therapy program.
Partner surrogate has been reserved to indicate the partner provided by the cotherapists for an unmarried man referred for treatment who has no one to provide psychological and physiological support during the acute phase of the therapy.
The final listing, that of marital partners, includes not only husband and wife units, but also former husbands and wives, divorced or legally separated, who choose to join each other in mutual hope of a reversal of the sexual dysfunction that was a major contributor to the legal dissolution of the marriage.
Nine such units legally separated at intake have been seen in therapy in the last 11 years. Statistically, these units have not been treated separately from the legally married units referred for therapy.
Thirteen of the 54 non married men brought replacement partners of choice who were most willing to cooperate with the therapists to enable their sexually dysfunctional men to establish effective sexual performance. The three unmarried women also brought replacement partners of their choice to participate in therapy.
These replacement partners were men with whom they had established relationships of significant duration, as well as the personal warmth and security that develops from free exchange of vulnerability and affection.
Partner surrogates have been made available for 41 men during the 11 years. This situation has involved basic administrative and procedural decisions. Should the best possible climate for full return of therapeutic effort be created for the incredibly vulnerable unmarried males referred for constitution or reconstitution of sexual functioning, or should there be professional concession to the mores of society, with full knowledge that if a decision to dodge the issue was made, a significant increase in percentage of therapeutic failure must be anticipated?
Whose dysfunctional status could be reversed to allow assumption of effective roles in society would continue sexually incompetent. From a clinical point of view there really was only one alternative. Either the best possible individual return from therapeutic effort must be guaranteed the patient, or the Foundation must refuse to treat unmarried men or women for the symptoms of sexual inadequacy.
Either every effort must be made to meet the professional responsibility of accepting referrals of severely dysfunctional men and women from authority everywhere in or out of the country, or admission to clinical procedure must be denied. It would have been inexcusable to accept referral of unmarried men and women and then give them statistically less than 25 percent chance of reversal of their dysfunctional status by treating them as individuals without partners.
This figure has been reached by culling the literature for material published from other centers, since it is against Foundation policy to treat the sexually dysfunction individual as a single entity. If the concept that therapy of both partners for sexual inadequacy has great advantage over prior clinical limitations to treatment of the sexually dysfunctional individual without support of marital partner, then partners must be available.
Statistically there no longer is any question about the advantage of educating and treating men and women together when attacking the clinical concerns of male or female sexual inadequacy.
For these reasons the therapeutic technique of replacement partners and partner surrogates will continue as Foundation policy:
It should be emphasized that no thought was ever given to employing the prostitute population. For reasons that will become obvious as the contributions of the replacement-partner and partner-surrogate populations are described, so much more is needed and demanded from a substitute partner than effectiveness of purely physical sexual performance that to use prostitutes would have been at best clinically unsuccessful and at worst psychologically disastrous.