For Therapists: Working with Sex Workers

GoodTherapy | For Therapists: Working with Sex Workers

by Dr. Denise Renye, Licensed Clinical Psychologist and Sex Therapist, MEd, MA, PsyD in San Francisco, CA

Working with Sex Workers

Sex workers (sworkers). They are arguably the crux of most cultures, offering a service that is uniquely intimate. They are a part of every sociocultural makeup, yet denied, sometimes as existing, and sometimes as deserving, especially as deserving basic worker rights. International Sex Workers’ Day, or International Whore’s Day, was on June 2. This day of recognition, established in 1975 by a group of French sex workers, brings attention to the inhumane working conditions for people in this profession. (Read more about the history of the fight for sex-worker rights.)

I’m defining sex workers as people who have sex for money, those who have private websites, work in porn stores, operate phone sex lines, do erotic bodywork and massage, do tantra work, work in sex clubs, provide girlfriend/boyfriend/friend experiences, work for porn companies on or off camera, and/or have figured out other creative means to work in this industry not listed here.

My Own Experience Working with Sex Workers

I’ve worked in a variety of capacities with sworkers over the past two decades. It’s been important, deeply transformative work ranging from outreach to counseling. The counseling was sometimes directly related to the job, just like with anyone else I’ve counseled. Sometimes the concern or issue will be work-related, and sometimes it won’t be in the same way that a doctor I may counsel doesn’t talk about her patients or co-workers all the time.

Voluntary Sex Work Shouldn’t Be Lumped in with Sex Trafficking

It would be remiss for me not to mention the complications with sex work: for some, it’s involuntary, and for others, it’s a chosen profession. There is a big difference between voluntary sex work and sex trafficking. Politically, the powers that be want to merge these two categories together to demonize sex workers along with the sex trafficking world. Some individuals are sex trafficked and induced by force, fraud, or coercion to engage in a commercial sexual act — a terrible problem we are facing in modern society. Sex trafficking is a product of the patriarchy just as much as the merging of it with sex work is. They are very different.

Laws Affecting Sex Workers — and Their Effects

A pair of laws were passed in 2018 to combat sex trafficking: The “Allow States and Victims to Fight Online Sex Trafficking Act” (FOSTA) and the “Stop Enabling Sex Traffickers Act” (SESTA). The bills were an attempt to shut down websites that facilitate sex trafficking, but also harmed at-will sworkers and their ability to work by hindering their online infrastructure. FOSTA-SESTA made websites legally liable for any content that helped facilitate sex trafficking or prostitution, even if it was consensual, according to a PBS/NPR article.

The American Civil Liberties Union (ACLU) notes human trafficking persists because workers employed in certain professions are excluded from some labor and employment laws, sex work included. International Sex Workers’ Day seeks to highlight the exploitative and risky elements of the industry and promote justice for these workers.

As a result of FOSTA-SESTA’s passage, not only has the financial stability of sworkers decreased, but also sex workers have been pushed back into the streets. This has pushed some back into the stronghold of pimps, patriarichal danger at its finest — the gaslighting promise of safety, but typically that safety from outsiders comes with an absence of safety from the pimp themself. Furthermore, there’s an increase in sworkers’ exposure to violence because prescreening clients could no longer occur.

Sex work has been thriving for all of time, and that’s not changing. People choose sex work as a job for as many different reasons as people choose to be plumbers, Wall Street execs, and teachers. There can be flexibility, ability to earn higher wages, and a creative edge to the work.

Providing Mental Health Services to Sex Workers

Having access to health services — physical and mental — are imperative for folx in this industry just like anyone else. I used to work at St. James Infirmary in San Francisco, a clinic where sex workers obtain health services, as well as social services and food and clothing as needed. I provided counseling and coordinated services and saw how essential such a place was to the well-being of many.

I also ran mindfulness groups and smoking cessation groups for sex workers through the Masoni Center in Philadelphia, teaching basic mindfulness skills that could be used on the job and in rest of life. Mindfulness provides a pause from automatic behaviors and thought patterns, offering space to pay attention to the present moment without judgment. The group continues to have an online meetup space.

Changing Our Perspective

The work of sworkers has mostly lived in the shadows. This socioculturally mirrors where we hold sexualness and the expression thereof — in the shadows. Giving basic and rightful support to sworkers is just the correct action to take (just as we give that support to nurses, therapists, and performance artists), but that will require people to take a look at and assimilate their own sexual needs, selves and proclivities. And we don’t live in a world that seems to be ready to own and celebrate that. Denying sworkers accessibility and rights denies the collective. There are very real issues specific to sex workers, and I don’t think the psychological community does a good job of addressing them. Empowerment by way of accessibility is essential.

If you’d like some more info about this and other topics such as somatics, psychology, spirituality, and psychedelic integration, let’s keep in touch.

If you’re a therapist who’d like to share what you’ve learned about practicing psychotherapy, know that GoodTherapy members are invited to submit articles for our blog! Instructions about submitting an article are available in your Member’s Area dashboard. Not a member yet? Check out our therapist membership options to get in on digital marketing, CE events, publishing opportunities, and so much more!


American Civil Liberties Union. (n.d.). Human Trafficking: Modern Enslavement of Immigrant Women in the United States. American Civil Liberties Union.,as%20a%20result%20of%20trafficking.&text=The%20U.S.%20Department%20of%20State,the%20United%20States%20each%20year. Accessed June 2, 2021.

International Labor Organization. “A Global Alliance Against Forced Labour, 93rd Sess.,” Report I(B) at 10 (2005) [hereinafter ILO Global Alliance].

Tung, L. (2020, July 10). FOSTA-SESTA was supposed to thwart sex trafficking. Instead, it’s sparked a movement. WHYY. Accessed June 10, 2021.

© Copyright 2021 All rights reserved. Permission to publish granted by Dr. Denise Renye, Licensed Clinical Psychologist and Sex Therapist, MEd, MA, PsyD in San Francisco, CA

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

Leave a Comment

By commenting you acknowledge acceptance of's Terms and Conditions of Use.


* Indicates required field.

GoodTherapy uses cookies to personalize content and ads to provide better services for our users and to analyze our traffic. By continuing to use this site you consent to our cookies.