Out On The Couch

How to make your practice more CNM affirmative

Posted: 8-10-22 | Andrew Kravig

Four young companions lying on the floor with hands behind heads. The photo represents the idea that consensual non monogamy can be a happy and healthy relationship style.

As a young therapist intern, I once had a supervisor ask me what the difference was between “an open relationship and just screwin’ around.” I had to spend almost the full two hours of that group supervision meeting educating my supervisor and fellow interns about the nuances of consensual non-monogamy (CNM). I argued that  an understanding of these nuances is important for therapeutic practice. 

While it was a pleasure and an honor for me to advocate on behalf of CNM relationships in my internship, as a therapist, I feel it is important to ensure the burden of education is never placed on my clients. Therapists  may be happily monogamous or a member of a beautiful polycule themselves– either way, ensuring that CNM clients feel safe and seen is an important step towards inclusion and understanding. 

What is CNM and why does inclusion matter? 

CNM comes in a variety of forms you may have heard of, including swinging, polygamy, open relationships, polyamory, monogamish relationships, and relationship anarchy. According to recent studies, approximately 4-5% of the US population is engaged in some form of CNM relationship (Rubin et al., 2014), a number which has been increasing every year since 2006 (Moors, 2017). And while that may sound like a small number of people, it’s important to remember that it is larger than the combined bisexual, lesbian, and gay populations. 

The CNM Community

It’s currently estimated that 32 percent of men have engaged in CNM in their lives (Levine et al., 2018). Many factors, primarily social stigma, cause under-reporting of CNM experiences in social data collection (Van de Mortel, 2008). Whether the individual is intentionally engaged in a polyamorous relationship (or “polycule”),or they just happened to experiment with threesomes in college, consensual non-monogamy will show up in your client population.

Public interest in non-monogamous relationship options is increasing (Moors, 2017). For therapists, now is the time to educate ourselves, update our best practices, and perform an honest assessment of how welcoming our therapy practices may be t for CNM clients. Here are a few simple ways to ensure your practice is a CNM-friendly environment. 

Update Your Paperwork & Software

One of the first things to consider when making your practice more CNM-affirming is your intake paperwork. This is one of the first moments of contact you will have with your clients, and it will set the tone for your work going forward. If clients in CNM relationships struggle to fill out your forms because your terminology is exclusionary or limiting, the therapeutic alliance will be damaged right from the start. Just like learning to use the right pronouns with your transgender and gender non-binary (TGNB) clients, providing space for clients to describe their romantic attachments accurately will help you develop rapport and prove yourself to be a safe person for polyamorous clients. 

Creating a CNM friendly environment 

The space you utilize for client sessions will be an important piece of establishing safety and respect for your consensually non-monogamous clients as well. If your sessions are online, can your telehealth software accommodate sessions with multiple clients in a polycule? Can your office space accommodate in-person polycule sessions with three or more partners? In addition to the space, when you are in session, are you struggling to remember each member’s attachments, or sexual and romantic orientations? Fumbling the facts of clients’ connections to each other may be a hindrance to rapport-building and create an unsafe environment for therapeutic work. Never underestimate the value of putting careful thought and intention into your CNM inclusivity — it will only elevate your practice! 

 Training & Hiring 

When considering new hires in your practice, whether it be interns, associate therapists, licensed clinicians, or administrative staff, think intentionally about what they may bring to the practice. This may include their education, experience, exposure to the CNM community, and willingness to be trained on the subject, as well as their own identities or positionalities.  It’s important to make sure that your new hires share in your commitment to creating a welcoming environment for all forms of love and relationship in your practice. It will then be important to provide adequate training so that your practice has a consistent and competent approach to treatment with CNM folks. Remember that education doesn’t end after the first training. Continuing education will be essential for keeping pace with the shifting landscape of modern relationship structures.

 Be Self-Reflective

Once you understand the necessary terminology and feel comfortable navigating the terrain of CNM relationship structures, it will be important to consider your own personal biases on the subject. Much like internalized homophobia or racism, an unconscious bias towards CNM can result in microaggressions and negatively impact your rapport with clients. You may not be conscious of how these microaggressions manifest, but your CNM clients will sniff them out very quickly and erect defensive barriers to treatment (if they remain in treatment with you at all). 

Normalizing CNM Relationships

Personal and/or therapeutic biases show up in many forms. Working to identify and overcome them will take time and work. There are many courses and trainings you can take to help with the process. You can start by considering a few simple facts:

  •  CNM people come in all ages, bodies, identities, and sexual orientations (including asexuality!). 
  • CNM is not cheating. There are many ways to practice consensual non-monogamy, and they all require honesty, respect, consent, and open communication. 
  • CNM isn’t about escaping an unhappy relationship. For many people, CNM is about expanding and deepening the ways you can love, and acknowledging the truth that one person is incapable of meeting all of your needs all of the time.  
  • Sometimes CNM is “just sex,” and sometimes is it much, much more. Always ask your client what it means to them and how their relationships are meeting their personal needs. 
  • Practicing CNM does not mean your partner will leave you for someone else. Most polycules maintain multiple intimate connections with trust and deep commitment. 
  • Folks in CNM relationships experience jealousy. Encountering insecurities in your relationships is to be expected, and can be an opportunity to grow as an individual as well as in your relationship. CNM requires that you “do the work” with consistency and honesty. 
  • CNM is neither better nor worse than monogamy. It is just one more beautiful way that an individual can love and be loved. And just because it works well for one person does not mean it will work well for another. 

If any of these facts surprised you, or raised more questions in your mind, it’s time to dig in and do some work to educate yourself on the subject. Your CNM clients will thank you for putting in the work!  

Recognize Potential

A final thought to consider when creating a CNM-friendly practice is the therapeutic value of understanding CNM, a factor that is often overlooked. These relationships can teach us so much about intimacy, communication, trust, boundaries, family structures, and personal growth. As a clinician, it will be important to understand your clients’ approach to agreements, rules, and boundaries, and how these may differ between members of a polycule. This understanding will help you identify when other clients might be using rules in their relationship to avoid navigating their feelings or setting healthy boundaries, as well as to understand their relationship dynamic as a whole.

Educating yourself, removing barriers to treatment, and pursuing a continuing education will not solve all of the problems facing the CNM community, but they are critical steps forward. By emphasizing the presence of consent and the absence of distress as hallmarks of sexual/romantic health, rather than normalcy or conformity to cultural expectations, we can challenge mononormative assumptions promoting limited, uniform models of relating. As a CNM-friendly clinician, you will gain a deeper understanding of your clients by seeing them through the eyes of multiple partners and romantic experiences, which will deepen and expand your clinical knowledge. Research shows us that CNM opens up beautiful opportunities for growth and healing, which can be applied to and affect your work with couples of all types (Finn et al., 2012). Each client and relationship is an opportunity for understanding and growth, if only you can embrace it. 

Learn more from our CE courses

 Text: Psychodynamic Therapy and Polyamory presented by Ryan G. Witherspoon, PhD, 3 CE course under the animated image of three clients on a sofa working out a conflict with a therapist seated to the left of them.Text “Polyamorous Clients in Therapy: What you Didn’t Know You Needed to Know Presented by Stephanie M. Sullivan, MS, LLMFT 3 CE Course” underneath an image of a geometric heart with an infinity symbol depicting polyamorous relationships        Text: “The Healing Power of Open Relationships presented by Kathy Slaughter, LCSW 4 CE Course” under an image of a mobile of different colored hearts to represent how early childhood attachment can influence adult relationships and how open relationships can be healing of attachment wounds.      


Finn, M. D., Tunariu, A. D., & Lee, K. C. (2012). A critical analysis of affirmative therapeutic engagements with consensual non-monogamy. Sexual and Relationship Therapy, 27(3), 205-216. https://doi.org/10.1080/14681994.2012.702893

Levine, E.C., Herbenick, D., Martinez, O. et al. Open Relationships, Nonconsensual Nonmonogamy, and Monogamy Among U.S. Adults: Findings from the 2012 National Survey of Sexual Health and Behavior. Arch Sex Behav 47, 1439–1450 (2018). https://doi.org/10.1007/s10508-018-1178-7

 Moors, A. C. (2017). Has the American public’s interest in information related to relationships beyond “the couple” increased over time?. The Journal of Sex Research, 54(6), 677-684.https://doi.org/10.1080/00224499.2016.1178208

Rubin, J. D., Moors, A. C., Matsick, J. L., Ziegler, A., & Conley, T. D. (2014). On the margins: Considering diversity among consensually non-monogamous relationships. https://journal-fuer-psychologie.de/article/view/324

 Van de Mortel, T. F. (2008). Faking it: social desirability response bias in self-report research. Australian Journal of Advanced Nursing, The, 25(4), 40-48.


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