“Sex Worker or Therapist?” was censored by Psychology Today in 2012 and never appeared online.

Several years ago, a 62-year-old man had a consultation with me a few months after good friends had conducted, let’s say, an intervention on his behalf. Andrew was a pediatrician who had worked nearly his whole life in rural Vietnam, a demanding job that caused him to sideline other important parts of his life. Now that he had retired, his friends decided Andrew needed help building a sex life. He accepted their rather unconventional assistance.

Andrew told me he always knew he was gay even though until recently he had never had sex with anyone. “For the first time in my life,” he said. “I’ve developed an intense excitement about having sex with men and perhaps even a loving relationship.”

I asked him about the recent sexual experience arranged by his friends.

“They found an escort for me. It was a little like you see in the movies — the father taking his virgin son to see a prostitute to initiate him into manhood. Having done their research, my friends chose well. The young man understood that I was a virgin and was extraordinarily kind, loving and generous with me. I was terrified and overexcited. He handled me perfectly,” Andrew said. “Since then, I’ve seen Peter weekly. It’s been the most amazing experience. I am learning to appreciate my body as old as it is and I’m also learning the mechanics of sex which I had only occasionally seen in porn movies. My whole attitude has changed. I feel much more confident about myself and I’ve started to date. I’m so grateful to Peter for what he is giving to me.”

Another patient Judith reported that in the past she had seen a male escort who helped her with a deep fear. Judith had several disturbing childhood experiences with an uncle who fondled her, sometimes masturbating while he touched her prepubescent breast.

Judith had consequently developed a lifelong fear of physical contact with men and although she had fantasized regularly about having sex, when she expressed her fears to the men she dated, they inevitably left her. “Too much baggage,” she said. “As it turned out the right man for me was an escort.”

“I confided my fears in my closest girlfriend,” she continued. “She made the suggestion that I try an escort. I thought she was nuts at first, but it was absolutely the right thing. I found an escort service online and called. Dan was sweet, tender and gentle. He knew exactly how to touch me. He had a lot of patience that guys I dated didn’t have. I saw him about four or five times and while I am not entirely cured, I am on the way. I’m no longer afraid the way I was. I’m making better choices with men now because of Dan.” Later, she said, ”It didn’t matter at all that I was paying him. I’ve paid more to therapists over the years and I didn’t get anywhere.” She added one more thought. “I got attached to him, maybe I even felt a kind of love. But, I got over it quickly. I put it in it’s place. Yet I have to say that it opened my heart to other men in a way I couldn’t before.” Like Andrew, time with a sex worker prepared Judith to go out into the world with experience, self-confidence and a positive attitude toward sex. She felt she could finally have a sexual relationship.

Every escort might not have the same talents to heal and while some do exploit their clients, the sex workers I spoke with, as well as some I have been with, share many of the same positive values and ethics as therapists. Both psychotherapists and sex workers have guided me, at different times in my life, to a deeper understanding of my true desires, partly by challenging me to confront shame.

Of course, a sex worker’s profession is illegal in most states.

In the 1970s, sex researchers Masters and Johnson introduced the idea of using sexual surrogates with patients to engage in intimate sexual relations to achieve a therapeutic goal. The idea caught on for a short time. Sex surrogates were eventually certified to use a combination of techniques — talking, listening and performing to help resolve a patient’s sexual issue. Psychotherapists referred patients to surrogates who had problems with self-confidence, sexual anxiety, premature ejaculation, vaginismus, sexual inhibition and erectile dysfunction.

Despite the high success rate of surrogate programs, complicated legal issues, along with intense criticism from both the far right and feminist organizations, arose. Few states allow sexual surrogates to practice these days.

The sex worker industry, on the other hand, will never disappear. And while therapists cannot refer patients to them, they are working with mental health professionals to help patients explore and develop their sexual potential.

Of course, communication plays a key role in the success of these sexual exchanges as it does in therapy since so many sexual issues are psychological. I have heard of sex workers who use relaxation techniques, intimate verbal communication, non-genital contact, sexual touching as well as intercourse.

Because of negative attitudes associated with prostitution we think of it as lacking humanity. After all, it’s an activity engaged in mostly by strangers with an exchange of money. Therefore, we make the wrong assumption that both parties are entering into a very intimate encounter with a total detachment.

But this wasn’t the case with my patients nor with some of the sex workers I interviewed.

“I’ve had such positive experiences with hookers,” one straight patient told me. “The best experiences have been the conversations. Some are better educated than I am. They seem to genuinely enjoy their work and care about their clients. We are no different. We’re all people. I’m sure their relationships are just as fraught with complications as mine. The only shame I have about it is what society places on me. I wouldn’t talk about it with my friends, even though I’ve learned so much about sex and myself through these experiences. My guy friends would think that I’m not cool enough to find and keep a girlfriend and my female friends would be totally creeped out. I wish I could openly recommend it to my friends, but I can’t.

I wanted to learn more about the views of escorts.

“I introduce guys to their bodies,” one woman I met online told me. “Most of the men I meet are pretty out of touch with themselves physically. They think they want to just fuck. I teach them that sex isn’t all about fucking. I relax them first with conversation, then sensual touching I teach them what women need. The connection is important. “Sometimes I’ll ask a client about his fantasies if I feel comfortable enough with him. They don’t always know I coax it out of them If we’re sexually compatible, then we will go ahead and try to play his fantasies out. There are times I’m just not into what a guy wants and will politely tell him that he would have a better experience with someone who enjoys what he does. I do it without shaming him.

“Don’t get me wrong. I’m not entirely a missionary. I enjoy the money. There is something erotic about getting paid. It’s as much a turn-on as anything else. It satisfies a deep need of mine to be admired.”

I spoke with Devon Hunter, a gay man who has a decade of experience in the adult entertainment industry and who became a sex worker, or courtesan, as he prefers to call himself, after years of deliberation.

“What motivates me is the desire to create an experience that awakens kindness and compassion in my clients. Most of my clients are not coming to have intercourse. The great majority seek intimacy and affection I create a boyfriend experience in which we get acquainted through conversation, touch, perhaps tender kissing. We might go out to dinner then come home and have sex, but just as often not. Together, we establish a romanticized, or idealized version of what every man hopes for. In part, I accomplish this by focusing my attention with deep compassion and empathy for what it is someone needs. Whatever they look like, act like or fantasize. I suspend all judgements. My goal is to affirm people.

“Some of these men come from relationships that are dysfunctional or co-dependent where there has been sacrifice. Our experience acts as a counterpoint. It’s healing in that my client internalizes the kindness, compassion and tenderness we exchange then takes that into his own life and propagates it. Although I am not trained as a therapist, I always hope that the experience is a therapeutic one for my client. That doesn’t mean that it’s not sexy.

“I develop a bond with clients as regularly as might happen in real life and it’s as authentic as any that would happen outside of the situation. It grows from the cycle of freely giving and receiving that I work to establish. Being a man is demanding. Men have to prove they are men usually through aggressive behavior. When we are together, we can suspend that performance. Often I teach a client to receive. To let me take care of them. Most realize that intercourse is not what they want Affection and sensuality is what’s most meaningful to them. Kissing achieves that.

“Unfortunately, sex workers are marginalized and demonized on all fronts. I understand there are people who are hustlers — ‘gay for pay.’ They are often men who are self-loathing, emotionally inauthentic and inaccessible. Those kind of people exist in every profession. Some men are sadly attracted to the danger and potential self-destructiveness of encounters with these men.

“I want to bring attention to the fact that while sex workers have to constantly deal with society’s demonization of them, many are not self-hating. Personally, such ostracism reminds me to act with greater kindness and empathy towards everyone.”

It’s difficult not to continue the comparison between the goals and techniques of these sex workers and of psychotherapists — empathy, compassion, communication and connection, self-knowledge, affirmation and a corrective experience. Both experiences take place within a suspended reality where the relationship is limited to a prescribed time and place.

I remember sitting in the lobby of an office suite I once shared. Several patients sat on either side of me and I imagined what it would be like for them waiting for their session to start. My watch read 12:50 P.M. Suddenly, the doors of a dozen consultation rooms flung open. It was the end of the patients’ fifty-minute session. They were followed a minute later by nearly twelve therapists who came out for a stretch or bathroom break

The image of sex workers standing outside their doors waiting for their next client in Amsterdam’s red-light district instantly came to mind.