Therapy for sex workers, with no need to edit your story
Confidential, sex worker-affirming therapy and psychiatric care in New York for dancers, full-service providers, online creators, performers, companions and anyone who trades sexual or intimate labour.
Your work is work. You deserve mental health care from someone who will not flinch, moralise or assume you need rescuing. I offer a discreet, unhurried space where you can talk about everything, including the parts of your job you cannot mention elsewhere. Support may include trauma-informed talk therapy, somatic practice, medication or simply quiet room to think.
“You are the expert on your own life and work. My job is not to judge your choices but to help you look after yourself within them.”
That respect for autonomy runs through everything we do together, from the first call onwards.
Why sex workers need therapists who actually get it
Many sex workers avoid mental health care altogether, or hide their work from providers, because they expect judgement. That expectation is often based on real experience.
Sex workers frequently describe therapists who assumed their work was the root of every problem, pushed them to quit, or became so curious about the details that the session stopped being about them. Others have worried about how their work might appear in records or affect their safety. When you have to filter every story, therapy loses much of its value, and you are left managing the clinician's comfort instead of your own needs.
Sex worker-affirming therapy starts from a different place. Your work is understood as labour, with all the variety that implies: rewarding days and draining ones, clients you enjoy and clients you endure, autonomy and constraint, money and the pressures that come with it. Like any job, it can affect your mental health, and like anyone, you may come to therapy for reasons that have nothing to do with work at all.
My clinical history includes years as an LGBTQIA+ primary care provider and HIV specialist, and I have worked with people across many parts of the industry. Sexual health, stigma, criminalisation and the emotional skill your work requires are familiar territory. You will not need to explain the basics, and you will not be treated as a case study.
Emotional labour, boundaries and the work persona
Many people in sex work become remarkably skilled at reading others, holding boundaries and performing warmth on demand. Those skills are real assets, and they can also be tiring. Over time some people notice it becomes harder to switch off, to feel desire in their personal lives or to tell where the work persona ends. We can explore that gently, without suggesting there is anything wrong with having a professional self.
Stigma, secrecy and safety
Keeping your work hidden from family, friends, partners or other providers can create isolation and constant low-level stress. Fear of exposure, legal risk, platform changes and difficult clients add further pressure. We can look at how these forces affect your nervous system and relationships, and build strategies for safety, support and rest that fit your circumstances.
Trauma, without assumptions
Some sex workers carry trauma, from work, from childhood or from other parts of life, and some do not. I never assume your work is traumatic, and I never dismiss harm when it has happened. If you have experienced violence or exploitation, we can work through it at your pace, with care and without blame.
Reasons sex workers reach out
Every person's reasons for starting therapy are different. Some people want help with something specific to the work; others simply want a therapist they do not have to hide from. Here are some of the experiences people bring, and you are welcome to arrive with something else entirely.
- Anxiety or low mood
- Burnout and emotional fatigue
- Difficulty switching off after work
- Stigma from family or partners
- Isolation from keeping secrets
- Safety fears or difficult clients
- Past trauma or violence
- Money stress and instability
- Changes in desire or intimacy
- Thinking about a career change
Trauma-informed care that respects your autonomy
I bring psychotherapy, somatic practice, mindfulness and psychiatric care together in one confidential relationship. You choose what we focus on, and nothing is offered with an agenda about your work.
Honest, unfiltered talk
You can describe your work, your clients and your feelings in your own language. We focus on what you want to explore, using psychoanalytic, feminist and relational approaches to understand patterns and meaning, never to moralise.
Somatic practice
Bodywork-heavy jobs and emotional labour can leave you tense, numb or on high alert. Gentle somatic exploration helps you reconnect with your own sensations, separate your body at work from your body at rest, and find ways to settle.
Medication support
If anxiety, depression, ADHD or sleep difficulties are affecting you, I can assess and prescribe. We talk openly about side effects, including sexual ones, and any changes are gradual, collaborative and monitored.
Boundaries and safety
We think practically about protecting your energy, managing difficult clients, handling disclosure and building support networks. DBT-informed skills can help with stress in the moment and recovery afterwards.
Relationships and intimacy
Work can shape how you experience closeness, desire and trust in your personal life. We can explore this with curiosity, including how to talk with partners about your work if and when you choose.
Rest and restoration
Irregular hours and constant availability can erode sleep and recovery. We look at sleep, nourishment and downtime, and supplements may support resilience, always reviewed for safety alongside any medication.
Affirming therapy versus rescue-focused care
The difference between being respected and being managed shapes whether therapy can help.
Rescue-focused approach
- Work seen as the core problem
- Pressure to exit the industry
- Curiosity driven by the clinician
- Trauma assumed
- Autonomy questioned
Sex worker-affirming approach
- Work understood as labour
- Your goals guide the sessions
- Focus kept on your wellbeing
- Experiences taken as you describe them
- Autonomy respected
Starting therapy as a sex worker
A discreet, straightforward process, with your privacy considered at every step.
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1
Free consultation 15 minutes
A confidential call where you can share as much or as little as you like about your work and what you need. You can ask about privacy, records and how I work with people in the industry before deciding anything.
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2
First full session
We take time to understand your life, history, health and what brings you to therapy now. You decide what to disclose and when. If medication might help, I begin a careful psychiatric assessment.
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3
Building your plan
Together we agree on priorities and approach, whether talk therapy, somatic work, skills, medication or a mix. The plan reflects your goals, not assumptions about your work, and can change at any time.
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4
Ongoing sessions
We meet regularly for 60 or 90 minutes, with flexibility around demanding schedules where possible. Many clients value having one space where they can be completely honest and feel genuinely understood.
Francesca Rome-Marie, PMHNP-BC
I bring together psychiatry, psychotherapy, somatic work and whole-body health, informed by years in primary care and further study in gender theory, feminist thought, culture and visual art.
I keep a deliberately small caseload so that every client receives consistent, unhurried and genuinely attentive care, held within one relationship rather than split across several providers.
Clear, upfront rates
I don't accept insurance. Modern Holistic Psychiatry is an out-of-network provider, so sessions are paid for directly. Depending on your plan, you may be able to claim reimbursement through your out-of-network benefits.
Find out how much your insurance may coverNeed urgent support? If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Therapy for Sex Workers FAQs
Do you offer sex worker-affirming therapy in New York?
Yes. I provide confidential, sex worker-affirming therapy and psychiatric care across New York State for people in all areas of the industry, including dancers, full-service providers, online creators, performers, cam workers, sugar dating and companionship. You will be met without judgement, and your work will never be treated as a problem to fix unless you want to explore changing it.
Will you try to get me to stop doing sex work?
No. Your decisions about your work are yours. If you want to think about changing your job, reducing hours or leaving, I will support that exploration. If you want to stay, I will support you in looking after yourself within the work. Either way, my role is to follow your goals, not impose mine.
How is my confidentiality protected?
Confidentiality is central to my practice. What you share is protected within the legal and ethical limits that apply to all health care, and I explain those clearly at the beginning. You can ask any questions about records and privacy during your free consultation, and we can talk about what feels safe for you to disclose.
Do I have to talk about my work in therapy?
Only if you want to. Some clients come to work through childhood experiences, grief, anxiety or relationships, and their job is simply one part of their life. Knowing you do not have to hide it can be what makes therapy feel safe, even when it is not the focus.
Can you help with trauma from work or elsewhere?
Yes. I offer trauma-informed therapy, including somatic approaches, for people who have experienced violence, coercion or other harm, whether through work or in other parts of life. I never assume your work is inherently traumatic, and I never minimise harm when it has happened. We go at a pace that feels safe for you.
Can you prescribe medication and talk openly about sexual side effects?
Yes. As a board-certified psychiatric nurse practitioner, I can assess, diagnose and prescribe. Sexual side effects can matter a great deal, personally and professionally, and we can discuss them frankly. Any decisions are made together, with gradual changes and careful monitoring.
What if I am in crisis or feel unsafe right now?
If you are in immediate danger, please call 911. If you are struggling with thoughts of suicide or self-harm, you can call or text 988 at any time to reach the Suicide and Crisis Lifeline. Once you are safe, I am here to help you work through what happened.
Care without judgement
Book a free 15-minute consultation and talk with someone who respects your work and your choices. Share only what you want to.