How Therapists Don't Learn About Sex Workers

raquel savage therapy

Originally published at

I love my therapist. In 2018, I decided to give therapy another try. I was done feeling dysregulated and desperately wanted to work to change that for myself. Immediately, something about my therapist felt different from previous experiences, of which I’ve had MANY. In elementary school after my parent’s divorce, I saw a therapist who gave me playdough and toys. During sessions, she observed me playing but never asked me meaningful questions, which meant she overlooked that I was feeling overwhelmed at school, totally unrelated to the divorce. In high school, there was an elder Black woman therapist I saw. She had this way about her, she’d pause and look at me before responding which felt more like judgment than thoughtfulness. She diagnosed me with bipolar disorder after only two sessions – how could she know that about me so soon? Then there was the white woman therapist I saw after a sexual assault who, during our first session, asked me, “what lesson did you learned by being assaulted?” I walked out.

But this new therapist was different. She made me feel calm. Just sitting across from her, in silence, modeling her breathing, attuning my body to hers, made me leave the session feeling safe. I disclosed that I was a sex worker, in passing, and was sure to scan her face and body language to gauge her reaction. Would her head cock? Would her eye twitch? Would her breathing shift? Would her smile drop? She didn’t miss a beat. She smiled and responded to the parts of the story that I highlighted as important, and being a sex worker wasn’t one of them.

As I continued to mention my sex work, I started adding more detail. Eventually, I even shared how being a sex worker made me feel proud, how it’s allowed me autonomy, how it’s part of my identity and central to the professional work I do (like my non-profit, Zepp Wellness. Or the Equitable Care Certification, a training program for clinicians to learn how to work with sex workers as therapy clients). She smiled, warmly, sharing in my joy. Never with hesitation and never with suspicion that she carried any disdain or disgust for my job.

I love my therapist.

But I’m lucky. This is not the norm, she is the exception.

When I was in my second year of graduate school, studying to become a therapist, we had yet to discuss sex work. I had taken ethical issues, human sexuality, multicultural considerations… But, nothing. I wasn’t out as a sex worker in school but waited each semester for an opening to engage in dialogue, if for nothing else than to advocate for us as deserving of care. And then, in crisis intervention, on the day we were to talk about sexual assault, my professor invited a speaker (who was also the human sexuality teacher!!!) from Kristi House, an anti-trafficking organization in south Florida. You know where this is going.

The speaker stated that porn and sex work (prostitution, specifically) lead to child sex trafficking. In shock, I raised my hand: “What’s the difference between sex work and trafficking?”, “What informed that idea that one causes the other?”, “How does criminalization lead to trafficking?”, “What do you know about decriminalization?” Noticing the speaker’s difficulty in navigating my questions, the professor asked that we move on. I knew, then, that I was going to center my therapeutic work around sex workers, not only by creating healing space but also by training clinicians to work with us as therapy clients and as people.

I knew, then, that I was going to center my therapeutic work around sex workers.

The unfortunate truth is that graduate school and academia, while touted as spaces of learning and thought provocation, are institutions aimed at de-radicalizing and homogenizing therapists (and everyone else). Graduate schools are systems and tools of oppression, full stop. And the mental health and social work field, broadly, are informed by a legacy of racism, ableism, colonialism, etc. So, it should come as no surprise that therapists are both actively taught harmful ideology and miss topics that would actually be important for effectively helping their clients, sex workers included.

In the average graduate counseling program, therapists aren’t even taught what a system of oppression is. Most therapists have no sense that occupying a marginalized identity comes with lived experiences that are more than just people “being mean” or feeling excluded. They aren’t given the language to understand power and how it’s wielded unethically and asymmetrically, that it does not work in reverse. Which means they also aren’t taught that, as therapists, they inherently uphold systems of power. That they are extensions and agents of the state. What’s worse, because the social work and mental health field is predominantly occupied by white women, there is the inherent belief that all the work therapists do is morally “good.” Pure. Innocent. Helpful. Saviorism in mental health means there is no space for critique and that decisions around how assistance looks, is facilitated by therapists positioned as the authority, rather than by communities directly.

We see how harmful saviorism is through policies like mandated reporting where therapists are cops, by proxy if nothing else. They police individuals and families through surveillance, forced separation and involuntary hospitalization and treatment. Again, under the guise of doing good. When I asked my graduate counseling students, “what happens after you make a call to the child policing system (CPS)?” Guess what they said? “I DON’T KNOW.” All they know is that it’s something they must do under certain circumstances informed by their own sense of suspicion. Terrifying. Particularly with the knowledge that the child policing system started as a mechanism to remove Indigenous children from their families, often give them to white families, and is still perpetuating that same goal – disrupting Black, brown, and indigenous families – and destabilizing marginalized communities.

These practices, gaps in knowledge and carceral power disproportionately impact sex workers and their families.

When therapists aren’t taught about sex workers, criminalization, stigmatization, etc. and aren’t taught about systems of oppression, there is no room to acknowledge that, under capitalism, we are all engaged in survival labor. There is no room to discuss that being “sad” and “miserable” (a student’s words re: “stereotypes about sex workers”) in sex work is hardly different from being sad and miserable in hospitality. There is no space for nuance, like that we all exist on a spectrum of survival labor by proxy of our identities, families, financial status, etc. – that some of us have less or more autonomy around choosing how we generate income. Because sex is culturally bad, so is sex work. And that’s where the conversation ends.

When therapists aren’t creating space to unpack their whorephobia, they never get the chance to learn the beauty and expansiveness of sex worker identities. They don’t get to hear about our joy. How we keep each other safe and care for each other. How we feel powerful with cash in our hands or proud when we make a deposit. They don’t get to hear about mutual aid and sex worker organizing. They don’t get to see our families, chosen or otherwise. How our children benefit from our sex worker identities. And they can’t hold space for the nuance of our hard days, shitty clients and sore bodies. Because instead of being met with understanding and care, we’re met only with encouragement to leave the work.

When therapists aren’t taught about sex workers, they only see us as whores, when we ARE that and many other things, too.

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