The Importance Of Sex Workers' Mental Health

By: Tyler Rizzo, LSW at Perez Therapy, LLC.

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Before I decided to become a therapist, I knew I wanted my work to center the care and well being of sex workers. As a former sex worker myself, I learned firsthand how challenging it was to find a therapist versed in supporting folks with experiences like mine. Unfortunately, many in the mental health field have a long way to go to address their own misconceptions and stigma, and become truly safe spaces where sex workers can feel comfortable accessing care.

What is sex worker affirming therapy?

In a world that can be deeply unkind and hostile towards sex workers, as therapists we have a responsibility to unlearn harmful stereotypes and cultivate a deeper understanding of the issues sex workers face. To that aim, sex worker affirming therapists:

• regard sex workers as the expert in their own experiences, practicing non judgment and humility

• recognize that each person has their own unique relationship to sex work, which may be positive, negative, or somewhere in between

• respect the choices that clients  make about their bodies and how they make a living

• hold space for clients to explore self-identified therapy goals, without imposing any agenda or ulterior motive.

How can therapy support sex workers?

No one should have to struggle with their mental health alone, and therapy can support sex workers facing difficulty coping with a number of issues, including:

• Setting and maintaining healthy boundaries - in personal relationships and with clients

• Processing bad dates and/or sexual trauma 

• Self esteem or body image issues

• Feelings of isolation and loneliness

• Experiences of judgment and stigma from family, friends, and partners

• Harassment & discrimination in non-sex work related employment

• Coming out as a sex worker to folks 

• Navigating parenting as a sex worker

• Unpacking internalized stigma: self-judgment, fear of rejection, shame

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Sex worker affirming therapy also recognizes that folks come to therapy seeking support around many issues, many of which may not revolve around their experience in sex work. For example, if you’re looking to heal from trauma or learn ways to cope with anxiety, a sex worker affirming therapist won’t assume that these issues stem from sex work. We’ll hold space for you to process your experiences on your own terms– no judgment, pathologizing, or assumptions. Plus, knowing your therapist won’t overly fixate on the role sex work plays in your life can make it feel more freeing to bring it up when it does feel relevant.

Seeing a sex worker affirming therapist can help take the pressure off you to educate them on the basics of the industry and common issues sex workers face– opening up more space to focus on what’s most important to you. If you’re ready to start therapy and looking for a sex worker affirming clinician, here are some helpful things to keep in mind in the process!

1. Search for therapist profiles with key words like ‘sex worker allied,’ ‘sex work/sex worker affirming’, and ‘sex positive.’ Some folks who have been trained as sex therapists also have experience providing therapy to sex workers. Making a list of these therapists with links to their profiles can be a helpful starting place.

2. Consider any other factors that are important to you in a therapist: are you seeking a therapist who’s a person of color? Do you want to work with someone who has experience with grief and loss? Reflect on what brings you to therapy and narrow your list down to a few therapists who feel like a better fit for your preferences and needs.

3. Request an initial consultation. Most therapists offer a free 15-minute consultation, in which you can ask any questions you may have about their approach to therapy and realm of expertise. If you’re comfortable bringing up the subject early on, this could be a good opportunity to ask questions that will help you gauge if this therapist will be a good fit for you, such as:

   • What does it mean to you to provide culturally competent care? 

   • What is your comfort level and experience in talking about sex work?

   • How would you describe your experience in providing care to folks who are sex workers?

   • What is your position on sex work? How do you work with clients who are former sex workers or who currently do sex work?

   • How would you describe your knowledge of stereotypes and/or misconceptions about sex work?

4. Trust your gut: if you’re not comfortable asking the therapist about sex work when you first meet, that’s okay! It’s your choice what to share and when. If after the initial consultation you’re unsure it’d be a good fit, take some time to think on it - and schedule some consultations with the rest of the clinicians on your list. 

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You deserve a therapist who leads with compassion and non-judgment, who recognizes that sex work is real work and respects your choices and autonomy. A sex worker affirming therapist will cultivate understanding of the issues sex workers face and create a safe space to show up as you are. Through these practices, therapy can support sex workers in finding the healing, connection and joy we all deserve. 

If you’re interested in starting therapy with a clinician who has lived experience with sex work, I hope you’ll reach out and connect! I’m currently accepting new clients, and you can learn more about me from my profile here.