Out On The Couch
As the mental health field makes inroads toward inclusive and equitable practice, efforts to understand the needs of polyamorous people are expanding beyond the basics (Johnson, 2013). Moreover, it is important to ensure polyamorous therapists are included in that discussion. As practitioners, we are examining ourselves for opportunities to better meet the needs of diverse people, including both the people we serve in a treatment capacity and ourselves. Therefore, polyamorous self disclosure is one part of these considerations.
When considering personal definitions of polyamory, most people emphasize ethics, emotional involvement, and sexuality in their relationship structures and practices (Cardoso et al.i, 2021). Therefore, definitions of polyamory are as diverse as the people who identify with consensual non-monogamy. More than 20 percent of adults have identified as practicing some form of consensual non-monogamy (Haupert et al., 2017), and around four out of 10 polyamorous people have experienced some form of discrimination related to their relationship orientation/style (Fleckenstein et al., 2012). Many mental health providers (MHP) practice polyamory in their own lives, and though their profession aspires to greater inclusivity, they are unlikely to be exempt from discrimination merely by virtue of assumed professional ethics of their peers.
Need for Inclusive Guidance and Practice for Polyamorous Therapists
Given the negative effects of minority stress experienced by marginalized groups (Meyer, 2003), it behooves the field to provide guidance on community-specific clinical and ethical dilemmas. Firstly, this will support the capacity of individuals with diverse relationship structures and practices to be able to provide and receive mental health services for the long haul. Secondly, this is especially important as the next generation of practitioners gains competency in affirming identities of the people they serve (Buche et al., 2017). Similar to how individuals within the LGBTQIA+ community are “deeply stigmatized and often invisible to outsiders” (Gibson, 2012), polyamorous therapists and the clients they serve may also benefit from proactive and thoughtful therapist self-disclosure.
Certainly, polyamorous therapists deserve support in navigating dating in the online age, especially given their unique needs as a smaller community. Since the onset of the COVID-19 pandemic, more dating is taking place online (Kluck et al., 2021). The virtual forum allows for safe distancing, speedy reviews of profiles, and informed consent before meeting in person. With such a small number of potential paramours making up the polyamorous community relative to their monogamous counterparts, there is likely to be overlap between polyamorous therapists and the people they serve, especially in online spaces. For the benefit of both therapist and client, it is worth considering whether to proactively address this issue in the therapeutic space through self-disclosure, or to address a potential encounter after the fact.
Therapist Self-Disclosure and Protecting Clients from Harmful Multiple Relationships
Therapist self-disclosure has been a hotly debated topic for some time, with so much of the conversation hinging on the particular therapist’s theoretical orientation (Levesque, 2018; Miller & McNaught, 2018). Some therapeutic approaches, such as the traditional psychodynamic lens, emphasize the therapist as a blank slate upon which the person receiving services projects their inner world (Dixon et al., 2001; Gibson, 2012; Sparks, 2009). As a result, these therapists also view self-disclosure of personal information as a limitation to projection. However, most contemporary psychoanalytic theory does not emphasis the blank slate as it is often experiences as cold or distant by the client (C. Cathers, personal communication).
Other approaches to treatment, such as the feminist-relational lens, take on a more egalitarian lens in which the therapist may disclose pieces about themself to normalize common human struggles and subvert the traditional power dynamic of therapist as expert (Gibson, 2012; Hill &Knox, 2002). Still others, such as cognitive behavioral therapy, de-emphasize the content of therapist self-disclosure and are more geared toward modeling the use of coping skills (Dixon et al., 2001). Regardless of a therapist’s orientation to treatment, there are certain pieces of information that go on display inadvertently. For example, details of the therapist’s personal life might become available to the client during encounters outside of the therapy room.
Insights Regarding Multiple Relationships for Polyamorous Therapists from Rural Providers
For the polyamorous therapist working with a polyamorous client, this poses a challenging situation where the probability of encountering one another outside the therapeutic space may obscure the boundaries. MHPs practicing in rural communities may have helpful insights to offer, as they too are likely to encounter the people they serve outside the therapy room given the smaller size and insular nature of the community (Boilen, 2021; Schank, 1998). Rural psychologist Dr. Sara Boilen urges practitioners to consider whether entering into a dual relationship will impair the therapist’s ability to provide adequate treatment, exploit the person receiving services, or cause harm to the client (2021). That is to say, in working with the polyamorous community, polyamorous therapists are ethically obligated to be proactive in navigating potential for multiple relationships. Many rural psychologists recommend viewing overlapping social spheres as inevitable and addressing this at the outset (Boilen, 2021; McDermott, 2007).
Challenges Unique to the Polyamorous Therapists
Certainly, the unique nature of the dual relationship for polyamorous providers and clients is likely to bring up ethical challenges related to sexual intimacy. Most ethical codes of conduct for mental health professionals specifically indicate that sexual intimacy between a therapist and client currently in treatment is never appropriate (American Association for Marriage and Family Therapy, 2015). Some professions may even provide guidelines as to how many degrees of separation away a therapist should remain in relationships with individuals associated with or related to their clients (American Counseling Association, 2014; American Psychological Association, 2016).
In all cases, our profession encourages therapists to reflect on their motivations for potential boundary-crossing, consider whether their actions will promote the well-being of the client, and consult with colleagues when their objectivity is compromised (Barnett & Hynes, 2015). Still, there is little guidance that directly addresses the concerns of polyamorous therapists who could end up seated in front of a client who is interested in dating one of the therapist’s partners.
Proactive Strategies for The Polyamorous Therapist’s Personal Life
One option for polyamorous therapists is to discuss a “veto” rule with their paramours to address these situations that pose a risk for boundary-crossing. As Franklin Veaux* and Eve Rickert explain in their practical guide to ethical polyamory, More than Two, a veto is an agreed-upon rule where one partner has the right to tell another partner to end a relationship (2014). To clarify, implementing this strategy in advance of encountering a potential conflict may provide the partner who is a therapist with the opportunity to circumvent the need for therapist self-disclosure. A veto rule can also reduce the risk of compromising confidentiality of the client with the therapist’s partner, while still communicating that the client is not an acceptable dating option.
However, the presence of a veto clause will inherently alter egalitarian power distribution in the dynamics of the therapist’s relationship structures. Many polyamorous folx do not practice vetos because they believe it can create coercion in the relationship. As a result, it may be necessary to make sure that the therapist discusses their professional ethics with each of their partners to reach a shared understanding, if using a veto strategy is not a good fit. These preemptive strategies will not prevent the therapist from encountering the client (and their previously prospective paramour) in a public setting, so it may be important to have this conversation regardless.
Polyamorous Therapist Self-Disclosure
Similarly, professionals in other fields disclose potential conflicts of interest at the outset of a professional engagement, therapists can use this lens with clients. One option would be to include language addressing relationship style in one’s intake documents, such as informed consent to treatment and in the demographic information completed by the client. Eliciting relationship statuses and structures in a client’s intake paperwork is both an inclusive practice that all therapists are encouraged to consider and may also help the polyamorous therapist to head off potential challenges before beginning treatment. The APA Division 44’s resource, “Inclusive Medical and Mental Health Care for People Engaged in Consensual Non-Monogamy,” provides guidance on inclusive paperwork practices (2019).
It is also important to consider that because the therapist has more power in the therapeutic relationship, the onus is on them to name and resolve the conflict. For example, a therapist might have to discontinue a relationship due to a potential overlap in the client’s network of relationships. Additionally, there may be a time where the therapist has to directly address the client attempting to start a relationship with one of the therapist’s paramours. This is where a veto-based arrangement may come in. Or a signed authorization to release information to the paramour, depending on the client’s preference, comfort level, and possibly clinically-relevant issues, such as social anxiety or attachment style. Above all, it is important to remember that the client’s wellbeing is at the core of each of these interventions.
Rife with Clinical and Emotional Richness
While all of these considerations may sound intensely complicated, polyamorous folx, especially polyamorous therapists, are no strangers to the rich dynamics of emotional intimacy and direct communication. In fact, these qualities are intrinsic to both polyamory and psychotherapy. Subsequently, these complexities need not have the aura of doom and gloom that many therapists experience when contemplating ethical dilemmas. Therapist self-disclosure can play an important role in developing trust, modeling vulnerability, normalizing diverse identity statuses, deepening the therapeutic alliance, and can constitute a culturally-responsive intervention in and of itself (Bitar et al., 2014; Levitt et al., 2016; Solomonov & Barber, 2019; Sparks, 2009), especially for polyamorous clients.
Though it is impractical to anticipate all possible dynamics, the research tells one story over and over again: that the therapeutic relationship is the foundation on which everything else stands (Asay & Lambert, 1999). In order to foster the working alliance, some guidelines for therapist self-disclosure have been proposed (Henretty & Levitt, 2010; Hill & Knox, 2002). For instance, including timing, depth of content, low frequency, and checking in after the disclosure has been made to explore how the client received the information to refocus the session on the client’s experiences. Therapists are encouraged to examine the function of their intended self-disclosure, especially if it is experienced with urgency, as the goal of treatment should never be solely based on meeting the therapist’s needs (Hill & Knox, 2002).
Looking to the Future
To sum up, the aim of this article is to arm polyamorous therapists with practical tools for negotiating the intersection of personal and therapeutic dynamics, knowing that this in no way will address every possible scenario the therapist will encounter. As sources of information and guidance for polyamorous mental health providers and clients emerge, some organizations and resources to keep an eye on include the American Psychological Association’s Division 44 Consensual Non-Monogamy Task Force and the Institute for Relational Intimacy’s recent publication, Polyamory: A Clinical Toolkit for Therapists (and Their Clients), by Martha Kauppi. As with much of the norms and knowledge for polyamorous people, wisdom emerged from within the community. Additionally, polyamorous therapists are encouraged to find or form consultation groups with colleagues who share their experiences of consensual non-monogamy in order to discuss ethical and clinical dilemmas as they arise.
*Please note that we do not condone or support abusive or coercive behaviors alleged by victims of abuse.
Learn more about working with polyamorous clients
American Association for Marriage and Family Therapy. (2015). Code of ethics. Retrieved November 8, 2021 from: https://aamft.org/Legal_Ethics/Code_of_Ethics.aspx.
American Counseling Association. (2014). Code of ethics. Retrieved November 22, 2021 from https://www.counseling.org/docs/default-source/default-document-library/2014-code-of-ethics-finaladdress.pdf?sfvrsn=96b532c_2
American Psychological Association Division 44 Committee on Consensual Non-Monogamy. (2019). Inclusive medical and mental healthcare for people engaged in consensual non-monogamy. Retrieved December 13, 2021 from http://bit.ly/CNM-InclusiveHealthcare.
American Psychological Association. (2016). Ethical principles of psychologists and code of conduct. Retrieved November 8, 2021 from: https://www.apa.org/ethics/code?item=13#1006.
Asay, T. P. & Lambert, M. J. (1999). The empirical case for the common factors in therapy: Quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 23-55). Washington, D.C.: American Psychological Association.
Barnett, J. E., & Hynes, K. C. (July, 2015). Boundaries and multiple relationships in psychotherapy: Recommendations for ethical practice. [Web article]. Retrieved from http://www.societyforpsychotherapy.org/boundaries-and-multiple-relationships-in-psychotherapy-recommendations-for-ethical-practice
Bitar, G. W., Kimball, T., Bermúdez, J. M., & Drew, C. (2014). Therapist self-disclosure and culturally competent care with Mexican–American court mandated clients: A phenomenological study. Contemporary Family Therapy: An International Journal, 36(3), 417-425. http://dx.doi.org/10.1007/s10591-014-9308-4
Boilen, S. (2021). Dual roles, multiple relationships: No one is a stranger here. In S. Boilen, Ethics in Rural Psychology: Case Studies and Guidance for Practice (pp. 107-120). Routledge.
Buche, J., Beck, A. J., & Singer, P. M. (2017, February). Factors impacting the development of a diverse behavioral health workforce. Behavioral Health Workforce Research Center. School of Public Health, University of MIchigan. Retrieved November 26, 2021 from https://www.behavioralhealthworkforce.org/wp-content/uploads/2017/05/FA2P1_Workforce-Diversity_Final-Report.pdf
Cardoso, D., Pascoal, P. M., & Maiochi, F. H. (2021) Defining polyamory: A thematic analysis of lay people’s definitions. Archive of Sexual Behavior, 50(4). Retrieved November 1, 2021: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321986/
Dixon, L, Adler, D., Braun, D., Dulit, R., Goldman, B., Siris, S., Sonis, W., Bank, P., Hermann, R., Fornari, V., & Grant, J. (2001). Reexamination of therapist self-disclosure. Psychiatric Services, 51(11), 1489-1493.
Fleckenstein, J., Bergstrand, C. R., & Cox, D. W. (2012). What do polys want?: An overview of the 2012 Loving More survey. Retrieved November 8, 2021 from https://www.lovingmorenonprofit.org/polyamory-articles/2012-lovingmore-polyamory-survey/
Gibson, M. F. (2012). Opening up: Therapist self-disclosure in theory, research, and practice. Journal of Clinical Social Work, 40, 287-296. Retrieved November 26, 2021 from: https://www.researchgate.net/publication/257553161_Opening_Up_Therapist_Self-Disclosure_in_Theory_Research_and_Practice.
Haupert, M. L; Gesselman, A. N.; Moors, A. C.; Fisher, H. E.; Garcia, J. R. (2017). Prevalence of experiences with consensual nonmonogamous relationships: Findings from two national samples of single Americans. Journal of Sex and Marital Therapy, 4(43). Retrieved November 1, 2021: https://pubmed.ncbi.nlm.nih.gov/27096488/
Henretty, J. R., & Levitt, H. M. (2010). The role of therapist self-disclosure in psychotherapy: A qualitative review. Clinical Psychology Review, 30(1), 63–77. https://doi.org/10.1016/j.cpr.2009.09.004
Hill, C. E. & Knox, S. (2002). Self-Disclosure. In J. C. Norcross (Ed.). Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients (1st ed., pp. 255-265). New York: Oxford University Press.
Johnson, A. L. (2013). Counseling the polyamorous client: Implications for competent practice. Vistas. American Counseling Association. Retrieved November 8, 2021 from https://www.counseling.org/docs/default-source/vistas/counseling-the-polyamorous-client-implications.pdf?sfvrsn=9.
Kluck, J. P., Stoyanova, F., & Krämer, N. C. (2021) Putting the social back into physical distancing: The role of digital connections in a pandemic crisis. International Journal of Psychology, 56(4): 594-606. Retrieved November 8, 2021 from https://pubmed.ncbi.nlm.nih.gov/33615476/.
Levesque, R. J. (2018). Self Disclosure. In R. J. R. Levesque, Encyclopedia of adolescence (2nd ed.). Springer Science
Levitt, H. M., Minami, T., Greenspan, S. B., Puckett, J. A., Henretty, J. R., Reich, C. M., & Berman, J. S. (2016). How therapist self-disclosure relates to alliance and outcomes: A naturalistic study. Counselling Psychology Quarterly, 29(1), 7-28. http://dx.doi.org/10.1080/09515070.2015.1090396
McDermott, D. S. (2007). Rural psychologists’ responses to multiple-role relationship ethical dilemmas and their perceptions of job burnout. [Doctoral dissertation, Iowa State University]. Digital Repository. Retrieved November 26, 2021 from https://doi.org/10.31274/rtd-180813-17185
Meyer I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Miller (nee Johnston), E., & McNaught, A. (2018). Exploring decision making around therapist self‐disclosure in cognitive behavioural therapy. Australian Psychologist, 53(1), 33-39. http://dx.doi.org/10.1111/ap.12260
Reed, S. M. (2021) How therapists decide to self-disclose to their clients: A grounded theory study. [Unpublished master’s thesis]. Abilene Christian University.
Schank, J. A. (1998). Ethical Issues in Rural Counselling Practice. Canadian Journal of Counseling, 32(4). Retrieved November 8, 2021 from https://files.eric.ed.gov/fulltext/EJ581163.pdf.
Sparks, E. (2009). Learning to be authentic with clients: The untold journey of a relational practitioner. In Bloomgarden, A. & Menuti, R. B. (Eds.), Psychotherapist Revealed: Therapists Speak about Self-disclosure in Psychotherapy, 163-179. New York, NY: Routledge.
Solomonov, N., & Barber, J. P. (2019). Conducting psychotherapy in the Trump era: Therapists’ perspectives on political self‐disclosure, the therapeutic alliance, and politics in the therapy room. Journal of Clinical Psychology, 75(9), 1508-1518. http://dx.doi.org/10.1002/jclp.22801