Minority Stress and Sex Work: Understanding Stress and Internalized Stigma

This post was originally shared by the Sex Workers Outreach Project - USA: http://www.new.swopusa.org/wp-content/uploads/2017/02/FACTSHEET-MINORITYSTRESSANDSEXWORK-SWOPUSA-1.pdf

What is a sexual minority?

  • An individual whose sexual identity, orientation, or sexual practices differ from the majority of the surrounding society (Meyer, 2003).

  • Stressors facing sexual minorities are unique, chronic, and socially based.

  • Historically this concept has been used to describe stress LGBTQ+ individuals face due to homophobia/transphobia. (Sullivan, 2003).

  • Sexual minority health disparities can be explained in large part by stressors experienced by these populations which are induced by a hostile, homophobic/transphobic (whorephobic) culture. This culture often results in a lifetime of harassment, maltreatment, discrimination and victimization (Meyer, 2003) and may ultimately impact access to care for gender and sexual minorities.

  • Sex work is a concealable stigma, meaning it must be explicitly (or implicitly) disclosed in order to be visible. This type of stigma is under-researched and less understood compared to visible stigmas.

  • Anticipated stigma, cultural stigma, and the distress relating to stigma all directly relate to chronic health issues and mental health symptoms.

  • Stigma also profoundly impacts the identity and relationships sex workers have.

Applying the minority stress model to sex workers:

  • As sex workers do not conform to societal sexual norms (by selling sexual services), applying the Minority Stress Model to those engaged in sex work is useful for understanding this lived experience.

  • Sex workers are subjected to high rates of discrimination, violence, and rejection related to their work (Deering et al., 2014), and receive more victim blame (and less empathy) after experiencing a sexual assault (Sprankle, Bloomquist, Butcher, Gleason, & Schaefer, 2016).

  • Just as an LGB person’s general psychological processes are “likely to reflect the way in which s/he manages prejudice, stigma, internalized homophobia, and concealment/disclosure” (Hatzenbuehler, 2009), sex workers struggle with managing stigma, internalized whorephobia, concealment/disclosure issues, employment discrimination (especially if an arrest occurs), as well as navigating legal systems (arrest, police violence, etc.).

There are three main internal stressors which can occur from experiences with rejection, prejudice, & discrimination (Meyer, 2003) applied to sex workers:

1. Identity concealment: passing as non-sex worker, concealing job from friends, family

2. Internalized stigma: internalized whorephobia, believing sex work is not “real” work

3. Expectation of rejection: anticipation which results in fewer close bonds with people, difficulty making new friends, isolation, being guarded or defensive, etc Internal psychological stress may be a result of sex work stigma. Chronic stress can lead to adverse mental and physical health outcomes. It is important for sex workers to engage in self-care practices (which look different for everyone) to mitigate this stress and prevent burnout and compassion fatigue.

Suggestions for mitigating minority stress (adopted from Pachankis, 2014):

  • Normalize mental health consequences of minority stress: Given the relevance of minority stress to sex workers’ mental health, it is imperative that anxiety, depression, and other adverse mental health outcomes are viewed as an understandable minority stress response.

  • Rework negative cognitions stemming from ongoing minority stress experiences: Ongoing discriminatory and prejudicial experiences may communicate to sex workers that they are deviant, deficient, inferior, or impaired in some way. These message may be internalized and become ingrained (albeit untrue) ways that sex workers view themselves. Seeking a sex work positive therapist may be beneficial to help combat these negative internal thoughts.

  • Communicate openly and assertively across contexts when possible: Minority stress may operate in a way that diminishes sex workers’ ability to communicate openly and assertively (due to having to conceal their work, fear of rejection, etc.). Minority stress experiences may lead to sex workers to feel as if their own needs and desires are invalid (the stigma that all sex workers are somehow pathological) which may undermine the ability to articulate needs relationally. Working on assertiveness skills training to explore and express needs may help empower sex workers and foster their existing agency and autonomy.

  • Validate sex workers unique strengths: Sex workers are a powerfully resilient group of people who cope with the challenges of stigma and discrimination in a myriad of ways including (but not limited to): demonstrating pride in their identity, sexual creativity, openness, and acceptance, social activism, and community building, and community outreach. These strengths (and many others) can be used to facilitate resilience in the face of ongoing minority stress.

  • Affirm healthy, rewarding expressions of sexuality: Sex workers may internalize ideas about themselves that they are “undateable,” shameful, undesirable and/or incapable of forming loving relationships due to their work. These ideas could prevent individuals from engaging in sex outside of their work, which might be unhealthy for some. Examining communication styles and the role sexual expression plays in the lives of sex workers may be useful to think about other types of healthy expressions of sexuality.

  • Facilitate Supportive Relationships: Sex workers who engage in selective disclosure regarding their work report greater access to social support & sex workers who conceal their work from most people report feeling lonely and socially isolated. Stigma coping strategies may have significant impact on social relationships & access to social support. (Koken, 2012). Because minority stress can give sex workers a sense of exclusion, they may also struggle to develop close relationships and form strong communities. It is important for many sex workers to form supportive relationships within the sex work community.

Self-care suggestions to prevent burn out and compassion fatigue:

In addition to the above suggestions for mitigating the effects of minority stress, below are some resources for self-care that sex workers may find useful:

134 Self-Care Activities

Self-Care Advice for Caring Professionals

Find a sex-positive therapist

Find a local SWOP chapter

Read articles by and for sex workers

#minoritystressofsexwork #stigma #sexwork #therapywithsexworkers