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The Sessions

Is there a difference?

            The Sessions is a very fine movie about a remarkable man who has since died, but who made sure his life was meaningful, despite a profound disability of being paralyzed from the neck down as a result of polio at age six.  He spent most of his life in an iron lung, but when the technology allowed him to venture out on an electric gurney, he maintained his own apartment and attended classes at UC Berkeley, making the most of it.  The film presents one aspect of his life (his encounters with a sex surrogate); a 1996 Oscar-winning documentary by Jessica Yu (Breathing Lessons:  The Life and Work of Mark O’Brien) covers his life as a whole. 

            My first reaction to The Sessions was very positive; it is gripping in a quiet way, and the script and direction by Ben Lewin and acting by Helen Hunt, John Hawkes, and William H. Macy are top notch.  It is noteworthy that Lewin is a polio survivor himself, and the inspiration of Mark O’Brien’s writing (“On Seeing a Sex Surrogate”) on the internet led him to make this movie. 

My second reaction was related to professional issues.  It is fundamental in the mental health professions that therapists do not have sex with their patients.  “Certified sex therapists do not have sexual contact with clients, in the office or anywhere else.  Sexual coaching that involves physical contact isn’t considered part of mainstream sex therapy” (  Does this apply to sexual surrogates, though?  Unfortunately, The Sessions does not maintain a clear distinction between Cheryl (Helen Hunt) as a counselor versus Cheryl as a surrogate.  When the film opened at the Sundance Film Festival, it was entitled The Surrogate; but, unfortunately, this was later changed to The Sessions, suggesting counseling rather than surrogacy. 

            In the film, when Cheryl introduces herself to Mark, it is as a “sexual counselor”, and she explains that she is different from a friend; there will be boundaries such as time-limited six sessions, and her personal life will not be discussed.  Mark is the focus of their work together.  This is representative of what a therapist would say.  Unfortunately, the script—which should have labeled her as a surrogate all the way through and never presented her as a counselor/therapist—departs from that stance.  As a counselor/therapist, Cheryl makes errors in terms of boundaries and proper termination of a patient/client.  First of all, she becomes personally involved by having a social coffee with Mark, and, more seriously, begins to develop a loving attachment to him and to think about him romantically between sessions.  Eventually, she panics, and abruptly ends the sessions after four meetings, another grave error in the practice of psychotherapy/counseling (e.g., improper termination is a serious ethics violation).  [In Mark O’Brien’s actual life, the surrogate did see him for six sessions and maintained proper boundaries, and after the lessons ended they remained “friends” until his death in 1999.]

Surrogates—not actually being certified counselors/psychotherapists—are probably not bound by the same rules as certified/licensed counselors, although this is a murky issue.  According to Mark’s actual surrogate, Cheryl Cohen Greene, a member of the International Professional Surrogates Association, this organization has a code of ethics and will make referrals for surrogates to psychotherapists.  Edward Guthmann’s interview of her is at (  She says that many surrogate partners are trained by the International Professional Surrogates Association in Los Angeles, which has a code of ethics and will provide psychotherapists with referrals for surrogates.  Guthmann quotes at least one Berkeley psychotherapist, Rob Hopcke, as saying that referring a patient/client to a surrogate is very common among those who work as sexual counselors.

Nevertheless, Brian Alexander, contributor, who explored the issue in depth reports that some practitioners have used sex surrogates, but because of possible legal issues and fear of eroding respectability for organizations like the American Association of Sexuality Educators, they are not used much nowadays by licensed professionals (  It is likely that opinions differ greatly, depending on the state in which one resides.

Most professional sex therapists still use regular talk therapy to discuss an individuals/couple’s relevant history and psychological issues.  “Sensate focus” exercises may be prescribed, but the therapist does not touch the clients; couples are to use the exercises at home.  As noted by Carol Boulware, MFT, Ph.D., a sex therapist certified by the American Board of Sexology and clinical fellow of the American Academy of Clinical Sexologists, the therapist uses “talk therapy” and functions as an “educator, providing accurate information about anatomy and physical responses” specific to individual clients (  He/she may recommend books and videos, but does not use physical touch.

As I watched The Sessions, I began to feel that the film overstepped boundaries by implying that therapists having sex with patients is the norm; whereas it clearly is not.  Granted, most of what is written about this film refers to Cheryl as a surrogate, not a counselor, but that is not how the character presents herself.

Therapist-patient sexual involvement occurs so frequently in films in general, I have to think it has something to do with the filmmakers’ (many of whom have been in therapy) fantasies toward their own therapists, rather than being based on reality.  The boards for psychiatry, psychology, social work, and other counselors strictly forbid it, and it has ethical and sometimes legal consequences if it occurs.

            My third reaction came when I read about the real Mark O’Brian’s life.  His experience with the surrogate, Cheryl Cohen Greene, seemed to have turned out very well, although it was made clear that she was a surrogate, not a “sexual counselor”, and they discontinued sexual activity after six sessions, although they did remain friends, and she was at his bedside just before he died.  After seeing the whole issue from the perspective of someone in his circumstance, I became entirely convinced that he deserved being able to have what most of us consider a personal right, so his employing a surrogate seems justified to me.  I do think that optimally, a surrogate would be in regular contact with a licensed therapist to help maintain proper boundaries and assure that the therapy is for the benefit of the client. 

So, in the end, if Helen Hunt’s character is seen as a surrogate—not a certified/licensed counselor—this film can be viewed as a valuable aid in serving the interests of those who are disabled and understandably wish to have normal life experiences.