What Sex Workers Want their Therapist to Know About Their Profession

When you see or hear “sex work” or “sex worker,” what are your automatic assumptions and beliefs?

Sex work is one of the oldest known careers, yet it has been stigmatized and discredited by mental health practitioners and other professionals for decades. Here are just a few points that I and others have put together to shed light on some of the myths and misconceptions when working with sex workers in therapy and other mental health settings. 

1. Sex work isn’t something to be “saved” from. Some providers, even the most well-intentioned, may comment on how sex work isn’t necessarily “real work” and believe that it is a last resort for a job. As a result, they may try to help the client choose another career path when the job isn’t the problem they may be coming in for. “There are some of us who actually enjoy the job!” Kristen, a friend, and former sex worker stated when asked what they wish mental health therapists knew about the work. “Not every sex worker needs an intervention or to be saved. Sex work can be a high-paying, long-lasting career with the right person and setting.”

2. Just because there is sex work doesn’t mean there is a history of trauma (aka “daddy issues”). People get into sex work for different reasons, including the ability to have a flexible schedule and income. The myth that all sex workers have “daddy issues” and trauma only further stigmatizes the work, making others, including mental health professionals, believe that there must be something “wrong” with the person who chooses to go into sex work. The reality is that there are many reasons folks decide to go into sex work, including the freedom to choose their schedule and payment as well as dress and convenience of where to work.

3. There is a lot of independence and autonomy within the scope of sex work. Many sex workers enjoy making their own schedules, choosing their own job responsibilities and dress, and the high pay for working part-time. They can travel when they want, take time off when they want, and choose whom they work with. That kind of freedom in work can allow them time for other pursuits, such as family, hobbies, or different career aspirations. Natalie, a friend, and current sex worker states, “There is actually a lot I enjoy about my job. The preservation of time is the first. This job allows me to make in a few hours what a $20-an-hour side job would take me more than a week to earn. Since I already have a full-time job, this saves me countless hours working an underpaid second job. I get paid for my time, and having someone value me feels really good.”

4. It is a skilled profession requiring emotional intelligence and motivation.  “It requires much self-motivation and emotional work,” says Sabrina, a friend, and current sex worker. “…being a sex worker doesn’t mean that we don’t have to worry about money…we experience a huge fluctuation in our income from day-to-day.” Because sex workers are independent contractors, there is no salary or general steady base you get paid for working. In addition, it can be emotionally draining work that can bring up differing feelings ranging from “paranoia” to “body dysmorphia,” says Alexis, a friend, and former sex worker.  “Although I like the people I work for, there is definitely a mindset I have to put myself into, and that can be mentally taxing,” says Natalie. Sexual assault can also happen, so having a solid support system, emotional intelligence, and ways to cope with the emotional burden of the work is a must. 

5. Just because they are sex workers doesn’t mean they are being coerced or trafficked. Yes, some people take advantage of others within the industry. However, the automatic assumption that sex workers are all coerced or part of criminal activity is false. Sabrina says, “Sometimes I feel that if certain people hear me complain about my job, they will start to wonder if I’m a sex worker who is being coerced or trafficked, which they could report. I make sure to emphasize from the first mention of it that I am very happy and feel safe….” Natalie also emphasizes the assumption that coercion into sex work is damaging and can leave folks feeling ashamed and fearful. “This isn’t something I was trafficked into. I am not looking to stop or leave so please try to normalize talking about it.” Natalie adds when considering what she wants mental health professionals to know about her work. She writes, “Sometimes we are scared and afraid that if something negative were to happen, we would be judged because we put ourselves in that position, so we keep our fears to ourselves. That can be super burdening to feel like you can’t share and open up with anyone and have to carry that alone.”

6. That more therapists need to be sex-worker allied. Sabrina believes that if more therapists identified as sex workers allied as they do with other communities, such as the LQBTQA community, there would be more sex workers in therapy. But, she adds, “I’ve heard so many other sex workers say that they want to find a therapist but are scared of being judged.” 

As therapists and mental health providers, we must do our best to look at the whole individual coming into treatment. Because of the psychological and physical demands that sex workers experience daily, we have got to step up, learn more about the work through individuals with lived experience, and be willing to leave the myths and biases we carry into the work at the door to help these folks adequately. 


Shelby Milhoan, LCPC