Out On The Couch
The popularity and public visibility of consensual non-monogamy (CNM) continues to grow. Since Buzzfeed first reported on the phenomenon back in 2015, interest in this relationship style has been expanding. A recent study by Schechinger et al. (2018) found that four to five percent of the general population is currently engaged in an open relationship and that 33% have been involved in one at some point in their lives. In other words, one in five people experience non-exclusive relationships.
Many therapists pride themselves on the breadth of clientele with whom they can effectively work. You may have heard someone say, or thought to yourself, “Of course I can work with anyone! I’m a trained therapist with X number of years in the biz, I got this!” And maybe you do…
But here are seven reasons to seriously consider pursuing specific training in CNM *before* you start working with these clients:
- Monogamy–or a lifestyle of long-term, committed, sexually and romantically exclusive relationships–dominates our culture and our assumptions about healthy relationships. This “mononormativity,” like heteronormativity, impacts your CNM clients in multiple ways, both in their day-to-day lives and in the consulting room. Consider your intake paperwork; the options for relationship status probably include only “single,” “married,” “divorced,” or “widowed.” Since an entry for “polyamorous” or “consensually non-monogamous” is unlikely to appear, your paperwork perpetrates a microaggression, a small oversight that conveys to your CNM clients that their relationship style is weird, invalid, or of no concern to you. Furthermore, consider that some of your clients may have more than one person in their life whom they consider emergency contacts, and make space for them on your intake form!
In addition to the small ways in which your intake process may marginalize CNM folks, CNM clients are dealing with minority stress, and they may not realize it. Minority stress means that these clients, like LGBTQIA+ folks and people of color, face disproportionate exposure to discriminination, victimization, and rejection, which creates a more hostile social environment that leads to increased mental health problems. So these clients may be more likely to seek therapy not because they are intrinsically pathological, but because they are struggling with minority stress. As Schechinger et al. (2018) state, “Monogamous privilege and CNM stigma are so pervasive that the effects may not be evident to the client” (p. 22); a key task of therapy with these folks is increasing their ability to combat internalized mononormativity. You will be better equipped to do this if you understand the basics of this relationship style. Not only does your training itself convey validation to the client, it provides you an opportunity to challenge your own internalized mononormativity.
2. Intentionally learning about CNM among your peers, instead of from your clients, provides you a chance to uncover and challenge your own biases. This aspect of education is critical since therapists who are unaware of their biases impede their clients’ progress in therapy. You remain vulnerable to accidentally conveying judgement of your clients’ relationship styles, assuming the “real” problem is the relationship style, or dismissing their partners’ importance and impact in their lives. By learning about CNM outside of the client session, you have an opportunity to reflect on your own perspective and explore your biases with your peers. Dismantling your biases helps ensure your clients stay in therapy with you.
3. Appropriate practices with these clients prevents premature termination of therapy. Schechinger et al. (2018) surveyed 249 individuals engaged in CNM relationships across the U.S. and Canada. Their research showed that therapists perceived to be using inappropriate practices were substantially more likely to lose clients early in therapy: “For every increase in one standardized latent unit of inappropriate practices, participants’ probability of prematurely terminating increased by 87.6%” (Schechinger, 2018, p. 16). Themes of inappropriate practices can include being judgemental, pathologizing clients, demonstrating a lack of knowledge, and being dismissive or overly focused on the relationship. Specific examples include “indicating that CNM was the cause or result of another problem, lacking or refusing to gather information about CNM, being generally judgemental toward CNM, indicating CNM was wrong or not ideal and putting pressure on the client to end a relationship or ‘come out’” (Schechinger, 2018, p. 19). Inappropriate or unhelpful practices by clinicians also increase the community’s negative perceptions of therapists and increase barriers to seeking help. After all, clients are seeking to be understood by you, their therapist.
4. According to the APA, clients working with an effective therapist feel understood, trust the therapist, and believe that the therapist can help them. Early in therapy, clients are closely attuning to indicators of “acceptance, understanding and expertise” (Wampold, 2019, p. 3). You can imagine how hard it must be for a client to trust a therapist who is learning about CNM, let alone to believe that a therapist can help them, while in the process of trying to forge a therapeutic alliance. Effective training in CNM will enhance your therapeutic relationship and efficacy.
5. Another basic element for effective therapy, according to the APA, is the ability to provide “an acceptable and adaptive explanation for a client’s distress” (Wampold, 2019, p. 3). While you may be well-versed in codependency, trauma, dysfunctional family dynamics, or addiction, if you cannot apply that knowledge to a CNM context, then you will struggle to provide an acceptable explanation for your client’s distress. Training will enhance your knowledge of how the community itself understands the challenges inherent in CNM, and it will enable you to provide acceptable and adaptive explanations. For example, you might reduce the distress of an individual in a newly formed quad (a four-member relationship pod in which all individuals are equally romantically and/or sexually involved) by pointing out that there are actually nine new relationship configurations that all deserve their own privacy and opportunity to develop independently. You can validate the client’s distress by demonstrating your understanding of the inherent complexity involved.
6. Clients expect their therapist to have a basic understanding of their characteristics and context, allowing them to hone an individual understanding of their particular struggles. Despite the increased visibility of CNM, you live in a content-rich environment, so it is relatively unlikely that you will casually attain knowledge about the CNM context. Schechinger et al. found that only a third of clinicians were rated as “very knowledgeable” by the participants in their survey. Too many CNM clients end up using their session time to educate their therapist about the basics of their context, limiting the time they have to build the individual understanding they’re seeking.
7. Finally, effective therapists are aware of the best research evidence for clients’ problems, according to the APA. And the research for working with couples in general may not extrapolate to the CNM context. Many practical interventions seem useful for working with any relationship style, like the Gottman Stress-Reducing Conversation, a tool for teaching individuals a ritual for holding space for each other’s distress. However, the tool needs to be adapted to suit the needs of CNM clients. For example, a triad may need to engage in a round-robin version of the Stress-Reduction Conversation. For more examples of how to apply existing relationship intervention with CNM clients, I recommend taking my course, The Healing Power of Open Relationships. According to Schechinger et al, clients find knowledgeable, nonjudgmental clinicians to be the most helpful.
Another aspect to consider, especially if you identify as consensually non-monogamous yourself, is the benefit of recognizing your own blind spots. There are so many diverse relationship experiences within CNM! So get out there and get some training!
Schechinger, H. A., Sakaluk, J. K., & Moors, A. C. (2018). Harmful and helpful therapy practices with consensually non-monogamous clients: Toward an inclusive framework. Journal of Consulting and Clinical Psychology, 86(11), 879-891. doi: 10.1037/ccp0000349
Wampold, B. (2019). Qualities and Actions of Effective Therapists. American Psychological Association Education Directorate [White paper]. Retrieved from https://www.apa.org/education/ce/effective-therapists.pdf
The Affirmative Couch has courses on clinical work with consensual non-monogamy:
Polyamorous Clients in Therapy: What You Didn’t Know You Needed to Know
Taught by Stephanie M. Sullivan, MS, LLMFT
Healing Power of Open Relationships
Taught by Kathy G. Slaughter, LCSW
Multiplicities of Desire: Intersection of Bisexuality and Polyamory
Taught by Stephanie M. Sullivan, MS, LLMFT
Feminist Structural Family Therapy with Polyamorous Clients
Taught by Stephanie M. Sullivan, MS, LLMFT and John Wall, MS, AMFT