Therapy for a sex worker

This article first appeared in the September 2022 issue of University & College Counselling, published by the British Association for Counselling and Psychotherapy. ©BACP 2022

Veronica Smith* challenges therapists not to perpetuate society’s stigma about sex workers, and, if they want to support this community, to see beyond the job, and value their clients as complete human being

About me

I’ve been a sex worker for five years –and I’m currently training as a therapist. As part of my training, I’m required to be in weekly personal therapy and attend supervision, so I have a lot of personal experience navigating sex work in a therapeutic context. In the former, I’m ‘out’ as a sex worker, but I don’t always feel comfortable disclosing this to supervision groups because of the stigma surrounding sex work, from both peers and tutors.

My current therapist is great, but I’ve had some bad experiences with previous practitioners, who’ve made assumptions about what I need therapeutically as a sex worker and how I feel about my work. This is one reason I’m training to be a therapist: I feel that the context of sex work in the UK is deeply misunderstood. The slogan, ‘Sex work is work’ doesn’t mean that sex work is a job like any other. Rather, it means that sex workers are workers and, as such, deserve labour rights. Sex workers need access to high-quality, informed therapy from people making efforts to understand the industry, while also being willing to learn and meet clients where they are, rather than trying to impose a particular outcome on them, such as exiting sex work.

I wish to share some lessons from my experience, both as a sex worker in therapy and as a therapist-in-training.

Don’t make assumptions about how people feel regarding their job

Like most people, sex workers have a range of feelings about their work: positive, negative and ambivalent. I know few people who love the work – we don’t do sex work because it’s empowering or exciting, but because it pays the bills. As someone training to be a therapist, this is particularly important, as training is expensive! Some sex workers may hate their job, but don’t want to stop because it’s the best choice they currently have.

Assuming all sex workers either love or hate what they do doesn’t allow for nuance, undermining therapists’ facilitation of a robust working alliance. Therapists need to walk a challenging line between taking responsibility for keeping themselves informed, and remaining open to trusting in the expertise of their clients regarding their positionality and feelings about this. I feel therapeutic disciplines have yet to realise the potential – inherent in concepts like countertransference, projective process and enactment – to explore how societal stigma and our responses to it emerge in our work. Even a well-meaning desire for a ‘good’, objective position on sex work perpetuates conditions where the therapeutic profession doesn’t truly have to ‘see’ or engage with clients who sell sex in their complexity. The safety of a ‘position’ appears preferable to contact. From personal experience, I feel this preference is evident to clients, either through a clear therapeutic agenda, pushing them to ‘exit’ work, or the non-verbal communication of therapists’ discomfort with exploring together. The message is clear: ‘We don’t go here’.

Don’t try and persuade us to stop

One of my previous therapists couldn’t understand that while I didn’t really enjoy my job, it worked for me and supported other things I liked to do. They kept trying to persuade me to stop working, and whenever I tried to explore other problems in my life, they would always relate them back to my job. This was very painful for me, and in the end, I had to stop seeing them.

 It also made it very difficult for me to discuss any trauma I had experienced at work, because they assumed the job itself was traumatising – they viewed all the sex I had at work as unwanted, and couldn’t understand the complex nature of consent within

this type of work’s context. This denied space for the instances of real harm I’ve suffered in my job, and ultimately was detrimental to the therapeutic process. Therapists shouldn’t be approaching clients with an agenda, and working with sex workers is no different. Increasingly, I wonder whether therapists doing so project their feelings of fear and anxiety, preventing engagement with clients’ resilience and resources that makes this work possible.

 Not everything is about our jobs

I eventually felt as if I was only seen through the lens of my work, rather than in a well-rounded way, as a complete human being. My job is a part of my life, but by the therapist solely focusing on it, other aspects of my experience were left out – for instance, I couldn’t discuss relationships without my therapist asking what the person I was in relationship with thought about my job. This made the therapy feel narrow and ultimately unhelpful. In my training, we have been taught that therapists’ open and warm curiosity is the basis for ‘meeting’ a client at relational depth, and this is

what felt lacking. Their curiosity was limited to one thread. This made me feel objectified and prevented me from experiencing the therapy as a supportive relational space.


It is undeniable that sex work can be a difficult topic for people to approach, on both sides of the therapeutic relationship. I believe that therapists who want to do meaningful work with sex workers need to be able to work through whatever they notice is arising for them in working with sex workers, so it can be processed and not interfere with the work. Whether the therapist feels shocked or saddened, or curious in a way that feels prurient, they should be able to reflect on what is coming up for them, because their clients will feel it in the transference, and this experience can easily mirror society’s stigmatising view of sex work. I feel my experiences are reflective of precisely such processes. Therapists’ attitudes about my work have been projected onto my lived experience; my autonomy and agency regarding my work have been defocused in favour of my therapists’ beliefs; and, ultimately, I could not bring important material outside of this area.

It is also important that therapists educate themselves on the topic, ideally from learning from the wealth of resources created by sex workers themselves, without relying on their clients to do this work. Therapists should also look at their reactions,

biases and beliefs concerning bodies, sex and consent more generally, as these are all areas that can be touched upon when working with sex work. Through further training and education, we can develop our capacity to notice our supervisors’ blind spots in this area, and potential parallel processes. Supervision is both a site of personal reflection and one where we as practitioners, when safe, can advocate against stigma. This is why I would also suggest that therapists who work with sex workers look out for supervisors with specialist awareness around the topic. Finally,

I feel therapists need to be aware of the limits of their competence around working with sex workers, which is an ethical requirement across specialisations.

* Veronica Smith is a pseudonym


Veronica Smith* is a sex worker, a trainee therapist, and a member of SWARM, a sex workers’ rights collective, founded and led by sex workers who believe in self-determination, solidarity and co-operation for this community.

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