FAQ from

A Surrogate Partner's Perspective on Therapist Involvement

By Andrew Heartman

Surrogate Partner Therapy (SPT) is always a collaboration between a therapist, a surrogate partner, and a client all working as a team to help the client reach their goals. I have learned first-hand the importance of the therapist in SPT. I would never see a client without it. Even if it weren't required by my training and my Code of Ethics, I would still never see a client without it for the following reasons:

1. Some clients are not appropriate for SPT or are not likely to benefit from it. I do not have the expertise to identify contraindicating conditions and to make that assessment. Therefore, I depend on the therapist’s clinical assessment of the client’s overall mental health and their determination of whether this client is appropriate and likely to benefit from SPT.

2. Many clients feel ashamed or embarrassed about whatever issue causes them to be in SPT or even that they are in SPT at all. They may not feel comfortable telling any of their friends and family that they are doing it. Consequently, they may not have access to their normal support structure. It is therefore absolutely essential that they have the support and expertise of the therapist to discuss, process, and integrate whatever happens in the experiential work. The therapist is the client’s primary ally and support throughout the process.

3. The expertise of the therapist is critical to help the client acquire the cognitive underpinnings that allow the new experiences to be fully integrated as new ways of being, thinking, and living. The therapist helps the client to generalize the experiences to future relationships.

4. Most clients seek SPT because they have not been able to resolve their issue(s) through their own life experiences or through verbal therapy. Most likely, they have patterns of thinking, communicating, or behaving that are not conducive to maintaining fulfilling relationships. As I form a relationship with the client, these patterns show up in her relationship with me. This is an important part of the therapy because it allows any issues with intimacy and relationships to be seen and resolved.

There are, however, times when these ineffective relationship patterns can interfere with therapeutic progress. The client may find it difficult to be honest with me because of the role I am playing in her life and her habitual ways of relating to men in that role. In this case, the therapist can say, "Why don't you tell Andrew what you just told me?" Similarly, the client may be able to hear suggestions or information from the therapist that she would be resistant to hearing from someone with whom she's forming a relationship. I have experienced situations where the involvement of the therapist was crucial to getting the therapy back on track to a successful completion.

These are my personal reasons why the involvement of a therapist is better not only for the client, but for me as a surrogate. They all hinge on the idea that I want the client to benefit from the work, and that is more likely to happen when the therapist is actively involved in the case.

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