What Therapists Need to Know About Consensual Non-monogamy
Too many clients who are in consensual non-monogamous (CNM) relationships have to educate their therapists. Too many of them discontinue therapy because their therapist judged them, didn’t know enough about CNM to be helpful, or worse, makes actively stigmatizing comments such as “polyamory isn’t stable,” “women can’t do non-monogamy,” or “we can’t accept you to our therapy group as you’re non-monogamous — you wouldn’t fit in.” These are real quotes from a study about the experiences of CNM clients in therapy a couple of colleagues and I recently had accepted for publication in Journal for Clinical and Consulting Psychology.
We believe our results clearly highlight how we need to start taking the mental health needs of the CNM community seriously. For context, around 4–5% of people in the United States report that they are in CNM relationships, a comparable number to how many people identify as lesbian, gay, bisexual, and transgender. More than one in five adults have also tried CNM at some point, which is not far off from how many people own a cat. We also know that interest and awareness of CNM, especially open relationships and polyamory, is on the rise, despite evidence of blatant stigma directed toward this population.
It is still rare, however, for mental and medical health professionals to receive training on how to effectively support people who are engaging in or exploring consensual non-monogamy. Given what we know about minority stress causing additional mental health burdens, I am concerned about the lack of support this community is receiving.
As co-chair of the American Psychological Association’s Division 44 Consensual Non-monogamy Task Force, I’m calling for my colleagues to thoughtfully examine our assumptions around monogamy, pursue and promote education about relationship diversity, and approach this issue with the same level of respect and care that we do with other marginalized communities.
Results, Implications, and Calls to Action
In our study, Drs. John Sakaluk, Amy Moors, and I asked 249 people engaged in CNM about their experiences in therapy, making it the largest study to date on this topic. Significantly, the study was accepted at a top-tier, mainstream clinical journal, signaling that the field of psychology is starting to recognize the importance of addressing relationship diversity.
Monogamy is privileged. It is the unquestioned status quo, prompting many therapists to assume by default that their clients are monogamous, or even, for some, that their clients should be. The publication of this paper means that mainstream psychologists may read about and subsequently treat the needs of the consensual non-monogamy community with an elevated level of respect. The article also calls on mental health researchers and providers to examine our biases and take a nonjudgemental posture toward clients engaged in consensual non-monogamy — just as we would with LGBTQ clients.
We asked participants in structured and open formats what their therapist did (or did not do) that they found to be helpful and unhelpful, allowing us to generate broad and specific practice recommendations and calls to action.
One of the most prominent themes in our data was the importance of educating therapists about CNM. For example, our participants rated therapists as being more helpful when their therapists: (1) educated themselves about CNM issues; (2) held affirming, nonjudgmental attitudes toward CNM; (3) helped them feel good about being CNM; and (4) were open to discussing issues related to a client’s relationship structure. By contrast, CNM clients rated therapists as less helpful and were more likely to prematurely discontinue therapy when their therapist: (1) lacked or refused to gather information about CNM, (2) held judgmental, (3) pathologizing, and/or (4) dismissive attitudes toward CNM.
One-fifth of our participants also reported that their therapist lacked the basic knowledge of consensual non-monogamy issues necessary to be an effective therapist, and/or had to be constantly educated about CNM issues.
That is not to say all therapists were unaware of CNM. One-third of therapists in our study were described by CNM clients as quite knowledgeable of CNM communities and resources. We also asked in an open format what our participants’ therapists did that they found particularly unhelpful. One in five of those responding mentioned their therapist lacking or refusing to gather info about CNM.
It is important to note that our results may be inflated positively as nearly half of our participants reported intentionally seeking a therapist who was affirming toward CNM. Results were generally worse among those who did not search for a CNM-affirming therapist.
These results in conjunction with the size and stigma directed toward the CNM population has led me to conclude that educating therapists needs to be addressed at the highest levels of the mental health profession. It is time to include CNM in therapist training and continuing education programs, and I am calling on my colleagues to join me in advocating for this change.
Removing Barriers to Treatment
Being able to find a therapist who is educated and affirming of CNM is also a critical issue. CNM therapy clients who screened for a CNM-affirming therapist reported better treatment outcomes. They experienced more “exemplary” and fewer “inappropriate” therapy practices by their therapists, and they rated their therapists as being more helpful than those who did not search for a CNM-affirming therapist.
I am also requesting my colleagues advocate for CNM to be included as a search term on therapist locator websites (such as Psychology Today and APA Psychologist Locator) to help remove barriers to the CNM community accessing culturally competent care.
This is a step that I am pleased to announce that APA Psychologist Locator has agreed to take. We are currently in dialog with them about adding ‘Consensual Non-monogamy’ and ‘Kink/Diverse Sexualities’ as searchable categories, with the changes (hopefully) set to go live in November/December 2018. We hope Psychology Today and other therapist locators will follow suit.
Blaming Problems on Relationship Style
Over half of participants indicated their therapists held judgmental or pathologizing beliefs towards consensual non-monogamy. The most common way this judgement appeared to manifest was in attributing clients’ problems to CNM.
For example, when a monogamous couple is having problems we typically don’t assume it’s because they’re monogamous. We also don’t assume a monogamous client is depressed or anxious because they are “attempting monogamy.” Without adequate education and exposure, even well-meaning therapists may engage in these and other types of biased, unhelpful practices.
It is important to note that there are multiple peer-reviewed studies that have compared data on monogamous and CNM relationships with regard to participants’ relationship quality and personal well-being. Their results consistently suggest CNM is a viable alternative to monogamy, at least among those who self-select into CNM.
Compared to monogamous relationships, CNM relationships appear to exhibit approximately equal levels of commitment, longevity, satisfaction, passion, and love. The research also indicates that CNM relationships enjoy advantages of greater levels of trust and lower jealousy.
The collective scholarship demonstrates that relationship structure (e.g., monogamy or CNM) is not an effective predictor of psychological well-being (e.g., depression, happiness) or relationship well-being (e.g., satisfaction, commitment, longevity). There is also substantial overlap in the perceived benefits of monogamy and consensual non-monogamy.
In other words, therapists’ comments about CNM relationships not lasting or causing problems for clients have more to do with therapists’ pre-existing biases than they do with CNM. These biased attitudes are informed by our mononormative culture, not empirical data.
Assessing Relationship Style on Demographic Forms
Another way stigma shows up in therapy is assuming clients are monogamous. This was one of the most common mistakes made by therapists with over one-third of our sample indicating that this happened to them. The hopeful news is that this practice is easily preventable — we just have to ask. I wrote a post for the APA Division 44 newsletter highlighting reasons therapists should ask about relationship style on intake demographic forms.
This step has been embraced by an increasing number of mental and medical health centers, including all ten University of California counseling centers.
Where do we go from here?
Given the size of the CNM population, the pervasive stigma they experience, and the lack of therapist training, I believe the mental health field has an ethical imperative to improve how we address the needs of the CNM population. Some professional organizations are beginning to respond to the growing awareness of relationship diversity. In January 2018, the Executive Committee of APA Division 44 unanimously approved a proposal for the first task force within the APA dedicated to promoting awareness and inclusivity about consensual non-monogamy and diverse expressions of intimate relationships.
Dr. Amy Moors and I are serving as co-chairs of the APA Division 44 Consensual Non-monogamy Task Force and are currently overseeing initiatives on a number of topics such as including CNM as a protected legal status, educating therapists, making it easier to find CNM-affirming therapists, and promoting awareness of issues facing individuals engaged in CNM with multiple marginalized identities.
We believe this task force is a significant sign of how far the non-monogamy movement has come and suggests there is hope that the world will become safer for people in CNM relationships.
While I strongly advocate for the changes to our field I’ve suggested in this post, I also believe we need additional studies regarding their efficacy. It is important to be sure that these measures actually foster the inclusivity for CNM clients that is intend.
Guidelines & Getting Involved
One of our initiatives is to advocate for the eventual creation of practice guidelines, similar to those that were created by the American Psychological Association for working with lesbian, gay, and bisexual therapy clients as well as transgender and gender nonconforming therapy clients.
In an effort to progress toward practice guidelines, I developed empirically-informed benchmarks that can be used to assess practices at the institutional and individual levels as well as sample language for assessing relationship style on demographic forms. Dr. Michelle Vaughan also led the charge in creating informational brochures that people engaged in CNM can provide to their medical and mental health provider(s).
You can access these resources when you join the APA Division 44 Consensual Non-monogamy mailing list or sign our petition to support relationship diversity in mental health, medical health, and the legal profession.
These resources and this post can be shared freely with your network as well as your current medical and mental health providers.
In addition to signing our petition and/or joining our mailing list, we would like to invite you to follow us on Facebook and Twitter, where we will be posting updates. I will also be making updates on my Twitter, Facebook, and Linkedin accounts.
Educating therapists, removing barriers to accessing treatment, asking about relationship status on demographic forms, setting benchmarks, and signing petitions will not eliminate the judgment and discrimination experienced by the CNM community — but we believe these are all important steps forward. With education and exposure we can challenge the mononormative assumptions promoting a one-size-fits all model of relating — in the same way we challenge assumptions about sexual orientation and gender diversity.
Just as monogamy is not right for everyone, neither is consensual non-monogamy. It’s not about what’s right for all, but what’s right sized for the individual.
Heath Schechinger, Ph.D., is a licensed counseling psychologist at the University of California, Berkeley, and Co-chair of the American Psychological Association Division 44 Consensual Non-monogamy Task Force. His private practice specializes in providing support to the CNM, kink, queer, and gender non-conforming communities.