The Work is Not the Problem, It's the Whorephobia

As therapists, we are often trained to be allies to marginalized communities. And yet, sex workers frequently report that therapists are among the least trustworthy professionals they encounter. Why?

There are three primary reasons:

1. Second wave feminism and it’s influence on cultural and ideological narratives about sex work,
   
   
2. Systemic oppression within the mental health profession itself, and
   
   
3. Widespread sexual shame and repression.
   
   

1. Pathologizing Narratives and Rescue Frameworks

Therapists—often unintentionally—default to a “rescue” narrative when working with sex workers: How do we get you out? How can we protect you? These questions, rooted in second-wave feminist ideology and sociopolitical messaging around exploitation, can invalidate a client’s autonomy and lived experience. While intended to be protective, such framing reinforces a cultural narrative that commodifying one’s body is inherently harmful or immoral. It also isolates sex workers from activist and therapeutic spaces, denying them community and solidarity. 

Rather than assuming harm, therapists must recognize the diversity within sex work and engage with curiosity and respect. Many sex workers report agency, empowerment, and fulfillment in their work, and our role is not to override their reality with our own moral frameworks.

2. Systemic Biases in Mental Health

The mental health system has a deeply problematic history of oppression rooted in white supremacy, patriarchal values, sexism, homophobia, transphobia, ableism and kink shaming. Sex work often appeals to individuals with multiple marginalized identities due to its accessibility, flexibility, independence and variety of iterations possible. Sex workers—many of whom hold multiple intersecting marginalized identities—face additional stigmatization. Yet mainstream clinical education still fails to address sex work as a legitimate identity or experience. There is a notable absence of guidance in textbooks, training programs, and ethical standards.

In the absence of structured education, therapists often rely on personal or sociocultural values when supporting sex-working clients, which can lead to re-traumatization. Whorephobia—the fear, hatred, or judgment of sex workers—shows up frequently in clinical spaces, even if subtly.

3. Sexual Shame and Cultural Control

Sex work continues to be framed as the ultimate threat to normative sexuality. Sex workers symbolize a challenge to patriarchal, religious, and moral control over sexuality—especially when they openly own and profit from their erotic labor. This triggers deeply ingrained cultural shame.

Sexual oppression—also known as sex negativity—stigmatizes sexual diversity, autonomy, and expression. Those who defy these norms (including sex workers, queer and trans people, kink practitioners, and polyamorous individuals) are often marginalized, not for harm they cause, but for the threat they pose to dominant narratives. Yet sex workers have always been at the forefront of sexual liberation movements—pushing for safer sex practices, bodily autonomy, and freedom from shame.

Instead of listening to and learning from their wisdom, society frequently responds with dehumanization, criminalization, and violence. How deep is your sexual shame, that you must oppress those who represent expression and liberation? How might we repair and create safer clinical spaces for them?

A Call to Clinical Self-Reflection

Therapists must reflect on their own biases and positioning. Consider the following questions as a self-assessment:

• Do you consume pornography? Is it ethical, performer-centered content? If not, why? What beliefs or assumptions do you hold about porn and those who create it?
  
  
• Do you personally know any sex workers? If yes, do you place limits on your relationship with them based on their profession? If not, why is that?
  
  
• Where are you in your own sexual journey? Do you know what you like and have you healed areas of harm or shame? Can you talk openly about your sexuality with others besides your partner? Do you require alcohol or other substances to access your sexuality or sexual conversations?
  
  
• Would you support a partner or friend seeking the services of a sex worker? If not, why? Would your views change in a non-monogamous context?
  
  
• How have your religious, cultural, or moral backgrounds shaped your views on sex work? What work are you doing to unlearn inherited stigma?
  
  
• Are there forms of sex work you view as more “acceptable” than others? (e.g., digital vs. street-based)? What might help you understand the full spectrum of sex work more empathetically?
  
  
• Does your practice or organization offer services specifically for sex workers? Is sex work acknowledged as a marginalized identity in your framework of care?
  
  

Sex workers are not the problem. The issue lies in our collective discomfort with sexuality, our unexamined moral judgments, and the institutional systems that uphold these. As mental health professionals, we are ethically obligated to confront our biases, expand our competencies, and commit to harm reduction—not harm by omission or assumption.

Sex workers have always modeled resilience, collectivity, and liberation. The future of inclusive, ethical mental health care must include them—not as cases to be fixed, but as communities to be respected, centered, and supported.