Making Therapy Safer for Non-Monogamous Clients: A Comprehensive Guide to Inclusive Practice
- Sarah Wolfer, LICSW
- Aug 2
- 12 min read
By Sarah Wolfer, LICSW
Courageous You Founder
Mental health professionals have an urgent opportunity (and responsibility) to transform how they serve non-monogamous clients. The research is clear: the majority of people in non-monogamous (NM) relationships are receiving inadequate, and often harmful mental health care. With approximately 4-5% of Americans currently engaged in NM relationships and 21% of Americans having participated in a non-monogamous relationship at some point in their life, the time for change is now.
The statistics paint a sobering picture. In a study of 249 non-monogamous clients, a staggering 65% reported dissatisfaction with their therapeutic treatment, with 11% categorizing their experiences as destructive, 15% as unhelpful, and 29% reporting that their therapists lacked basic knowledge about non-monogamy. Even more concerning, 11% of these clients terminated therapy prematurely because of negative interactions with their therapist regarding their relationship structure. This represents a profound failure of our mental health system to serve a significant and vulnerable population.
The harm extends beyond individual disappointment. Research consistently shows that NM individuals face minority stress (chronic, socially-based stress that stems from stigma and discrimination). When therapists perpetuate this stigma through pathologizing attitudes, lack of knowledge, or overt bias, they compound the very stress that often brings clients to therapy in the first place.
Yet there is hope. Studies demonstrate that therapists with greater NM knowledge and multicultural competence show significantly more favorable attitudes toward non-monogamous clients. This suggests that with proper education and self-reflection, mental health professionals can become powerful allies in creating affirming therapeutic spaces.
This guide serves as a gentle jumping-off point for mental health professionals beginning their journey toward non-monogamy affirming practice. While comprehensive, it cannot capture every nuance of working with this diverse population; consider it a foundation rather than a complete blueprint. The landscape of non-monogamous relationships is rich, complex, and continuously evolving, requiring ongoing learning, self-reflection, and community engagement. As you read through these recommendations, remember that developing true competency takes time, practice, and often the guidance of experienced mentors. For therapists seeking deeper understanding, I offer specialized training, consultation, and clinical supervision focused on serving non-monogamous clients with skill and authenticity.
The Current Landscape: Understanding the Harm
Before exploring solutions, we must confront the scope of the problem. A 2024 qualitative study of 31 NM individuals in the UK found that over half had experienced pathologization of their relationship style, with therapists reducing or mistaking NM practice as signifying mental illness. One participant captured this perfectly: "Sometimes, people can have mental health issues AND be non-monogamous, and the two things can be completely unrelated."
The fear of judgment runs so deep that many NM clients begin therapy with preconceived anxieties about how they'll be received. They worry about pathologization, religious or moral judgments, and even legal consequences such as custody issues. This anticipatory stress creates a barrier to authentic therapeutic engagement before the first session even begins.
Perhaps most troubling is the pattern of therapist reactions that clients report: shock, surprise, avoidance, and silence when NM is mentioned. Some clients have experienced practitioners who "might be surprised because I seem normal," while others face complete avoidance, with therapists showing discomfort and "moving on" when the subject is raised. These reactions communicate volumes about the therapist's underlying assumptions and biases.
The Foundation: Understanding Non-Monogamy
To serve NM clients effectively, therapists must first understand the diversity of non-monogamous relationship structures. Non-monogamy exists on a spectrum, encompassing various approaches to love, commitment, and intimacy.
Polyamory involves having multiple romantic and often sexual relationships with the knowledge and consent of all involved. Within polyamory, there are further distinctions: hierarchical polyamory typically involves a primary partner with secondary relationships, while non-hierarchical polyamory treats all relationships as equally valid without ranking.
Kitchen table polyamory describes situations where all partners in a network get along well enough to metaphorically sit around a kitchen table together, fostering a family-like atmosphere. In contrast, parallel polyamory maintains separate relationships with minimal interaction between metamours (your partner's other partners).
Relationship anarchy rejects predetermined relationship structures entirely, with partners creating their own definitions and agreements without societal labels or hierarchies. Open relationships typically involve a primary partnership with sexual or romantic relationships outside that partnership, while swinging focuses primarily on sexual experiences with other couples.
Understanding key terminology is essential. A metamour is your partner's partner with whom you don't have a romantic relationship. Compersion refers to feeling joy in your partner's happiness with others (often described as the opposite of jealousy, though there’s a lot more to it than that). These concepts represent sophisticated emotional and relational frameworks that require respect and understanding, not pathologization.
If you want a quick start to understanding this, I have a free guide called "What Non-Monogamy Style is Right for You" available on my website that goes into a bit more detail of each of the most common styles of non-monogamy that you might encounter in your therapy office.
The Research Foundation: What We Know Works
The minority stress model provides a crucial framework for understanding NM clients' experiences. Originally developed to explain health disparities in sexual and gender minorities, this model applies powerfully to NM populations. Non-monogamous individuals face enacted stigma (direct discrimination), anticipated stigma (expecting negative reactions), and internalized stigma (applying negative societal attitudes to themselves).
A 2021 study of 1,176 polyamorous adults found that NM-related minority stress was positively associated with increased psychological distress, including higher rates of depression and anxiety. However, the research also identified protective factors: mindfulness and cognitive flexibility served as resilience resources that could buffer against the negative impacts of minority stress.
Crucially, when NM individuals find themselves in supportive environments, their mental health improves dramatically. A 2024 study of LGBTQ+ youth found that while 16.7% identified as polyamorous or ambiamorous and initially showed higher depressive symptoms, all participants, regardless of relationship orientation, showed significant improvement in mental health after spending time in an accepting environment.
The Comprehensive Checklist: Creating Inclusive Practice
Language and Intake Materials: Setting the Foundation
The journey toward inclusive practice begins before the client even enters your office. Traditional intake forms that assume monogamous structures immediately signal whether your practice is welcoming or exclusionary.
Replace "marital status" with "relationship structure" to acknowledge the variety of valid relationship configurations. Use open-ended language such as "Tell me about your important relationships" rather than asking about "your partner" or "your spouse". This simple shift allows clients to define their relationships without being forced into inadequate categories.
Create space on intake forms for multiple partners' names and pronouns. Avoid assuming that one relationship is primary or that any particular person is the most important. This seemingly small accommodation can prevent immediate feelings of invisibility or invalidation.
Website and Marketing: Authentic Representation
Your online presence should explicitly welcome NM clients. List "non-monogamy," "polyamory," or "relationship diversity" clearly on your website and professional directories rather than using vague terms like "alternative relationships". Clients seeking affirming care want clarity, not coded language that might mean nothing.
Include NM among your listed specialties so that potential clients can immediately identify your practice as appropriate for their needs. Use inclusive imagery and language throughout your marketing materials that reflects relationship diversity. This isn't about performative inclusion, it's about genuine welcome.
Clinical Knowledge: Beyond the Basics
Effective NM therapy requires more than surface-level awareness. Develop familiarity with different relationship structures, understanding that polyamory, relationship anarchy, swinging, and open relationships each have distinct characteristics and challenges.
Learn essential terminology naturally used within NM communities. Understanding concepts like metamours, compersion, New Relationship Energy (NRE), and the distinction between hierarchical and non-hierarchical structures allows for more nuanced clinical work. When you speak the language of your clients' experiences, you demonstrate respect and competence.
Critically, never pathologize NM as inherently problematic or as a trauma response by default. While some individuals may explore non-monogamy as a way of avoiding intimacy or working through trauma (as with any relationship structure), many actually adopt these relationship styles from places of health, growth, and authentic self-expression. Assess holistically, recognizing that minority stress, not the relationship structure itself, often underlies presenting concerns.
Stay current with NM research. The field is rapidly evolving, with new studies consistently showing that people in NM relationships report relationship satisfaction, trust, commitment, and psychological health levels equal to those in monogamous relationships. In fact, NM individuals often report higher levels of communication skills, sexual satisfaction, and personal growth compared to monogamous counterparts.
Clinical Attitudes: The Heart of Affirming Practice
Perhaps most crucial is the stance you bring to NM disclosures. Approach these conversations with what I call "grounded curiosity" or genuine interest without judgment, allowing clients to define what their relationships mean to them.
Resist the urge to attribute relationship challenges to the non-monogamous structure itself. Jealousy, communication issues, and relationship transitions occur in all relationship types and are not evidence that "non-monogamy is the problem". Instead, explore these issues with the same clinical sophistication you would bring to any relationship concern.
Support client autonomy by validating that NM is a healthy relationship orientation for many people. This doesn't mean encouraging every client toward non-monogamy, but rather recognizing it as one of many valid ways to structure intimate relationships. Engage in ongoing self-reflection about internalized mononormativity (the assumption that monogamy is inherently superior or more natural than other relationship structures). This bias is so deeply embedded in Western culture that it often operates unconsciously, even among well-intentioned professionals.
Ethical Boundaries: Navigating Complex Systems
Working with NM clients requires careful attention to ethical boundaries, particularly around confidentiality and multiple relationships within your practice. Early in treatment, clarify who your client is, individual, couple, or polycule, and obtain informed consent accordingly.
Be explicit about confidentiality policies when seeing multiple partners from the same network. Document disclosures and boundaries carefully, and revisit these agreements as relationship dynamics shift over time. The complexity of NM relationships doesn't change ethical obligations, but it does require more nuanced thinking about their application.
Avoid triangulating or playing "referee" between partners while maintaining appropriate relational neutrality. This balance requires skill in holding multiple perspectives simultaneously while attending to each person's individual needs and the health of the overall system.
Acknowledge the limits of your competence honestly. Refer or seek consultation when working beyond your expertise, and don't expect clients to serve as your educators about their own communities.
Community and Continuing Education: Lifelong Learning
Competent NM practice requires ongoing education. Attend non-monogamy specific trainings and webinars to deepen your understanding and maintain clinical humility. The landscape of non-monogamy continues to evolve, with new research, terminology, and community practices emerging regularly.
Read broadly from both classic texts like The Ethical Slut and contemporary clinical guides such as Jessica Fern's Polysecure, which applies attachment theory to non-monogamous relationships through the HEARTS model (Here, Expressed, Attuned, Responsive, Turned toward, Secure). Stay current with peer-reviewed research appearing regularly in journals focused on sexuality and relationships.
Follow NM-affirming professionals on social media, podcasts, and blogs to remain connected to evolving language and community discourse (for example, me!). However, never rely solely on clients to educate you about their communities. Seek formal consultation or mentorship when working in unfamiliar territory.
Intersectional Competency: Multiple Marginalities
Non-monogamous identity rarely exists in isolation. The 2024 OPEN survey found that only 33% of non-monogamous respondents identified as heterosexual, highlighting the significant overlap between non-monogamous and LGBTQIA+ identities. NM also often intersects with neurodivergence, kink identity, and various racial, cultural, and socioeconomic backgrounds.
Avoid centering white, cisgender, heterosexual, affluent, able-bodied versions of NM as "typical". Instead, understand how multiple marginalized identities compound stress and shape individual experiences. For example, NM individuals who are also LGBTQIA+ may face layered discrimination, while those from cultural backgrounds with strong monogamous traditions may experience additional family rejection.
Consider how systemic oppression and legal invisibility compound relational stress. NM individuals face potential employment discrimination, housing challenges, and custody battles with no legal protections. Validate these layered experiences while supporting client resilience and resistance strategies.
Apply an anti-oppressive lens throughout assessment and treatment planning, recognizing that individual distress often reflects broader social inequities rather than personal pathology.
Safer Therapy for Non-Monogamous Clients: Daily Implementation
In session, let clients define their important relationships and support systems without imposing nuclear family assumptions. Never suggest that monogamy is "more mature" or push clients toward monogamy as a solution to relationship challenges as this represents a fundamental misunderstanding of relationship orientation.
Mirror client language by asking "What term do you use for your relationship structure?" and following their lead consistently. This simple act of linguistic respect can profoundly impact the therapeutic alliance.
Actively affirm client strengths commonly found in NM communities: consent literacy, advanced communication skills, emotional flexibility, and sophisticated care ethics. Our communities have developed remarkable tools for navigating complex emotional terrain that can benefit clients far beyond their romantic relationships.
Help clients strategize around systems that may invalidate them, such as healthcare settings, legal issues, workplace challenges, or unsupportive family dynamics. This support for navigating minority stress can be as therapeutically valuable as traditional insight-oriented work.
The Path Forward: Implementation and Impact
Creating inclusive practice requires systemic change beyond individual awareness. Training programs must integrate NM competency into core curricula rather than treating it as an optional specialty. Continuing education requirements should include non-monogamous modules, and professional organizations should develop specific practice guidelines similar to those established for working with LGBTQ+ clients.
The potential impact of these changes extends far beyond the NM community. The skills required for NM-affirmative practice, sophisticated communication techniques, comfort with relationship diversity, anti-oppressive perspectives, and advanced consent literacy, enhance therapeutic effectiveness across all populations.
Research consistently shows that when NM individuals receive affirming care, they experience the same positive therapeutic outcomes as any other population. Moreover, the communication skills, emotional intelligence, and relationship sophistication common in NM communities often accelerate therapeutic progress when properly supported.
Conclusion: Beyond Tolerance to Transformation
Making therapy safer for non-monogamous clients isn't simply about avoiding harm; it's about creating spaces where all clients can explore their authentic selves and relationships without fear of judgment or pathologization. The research demonstrates both the urgent need for change and the clear pathway toward improvement.
As mental health professionals, we have the opportunity to be part of the solution. By developing NM competency, examining our biases, and creating genuinely inclusive practices, we can ensure that the 4-5% of Americans in non-monogamous relationships receive the quality care they deserve.
The clients are already in our offices, often hiding parts of their identities to avoid anticipated judgment. With intention, education, and commitment to growth, we can create therapeutic spaces where all forms of consensual, loving relationships are welcomed and supported. The question isn't whether we're ready to serve this population, it's whether we're willing to do the work necessary to serve them well.
The future of mental health practice must be radically inclusive, recognizing the beautiful diversity of human relationships and the courage it takes to live authentically in a world that often demands conformity. Non-monogamous clients don't need us to become experts overnight, but they do need us to respect their truth and commit to doing better. That commitment starts with this checklist, and continues with every interaction, every session, and every opportunity to choose affirmation over judgment.
Take Action: Deepen Your Learning and Transform Your Practice
If this guide has sparked your commitment to serving non-monogamous clients more effectively, I invite you to take the next step in your professional development. On October 17th from 11am-2pm PST, I'm partnering with Affirm Mental Health to offer "Liberated Love: A Therapist's Guide to Non-Monogamous Dynamics," a comprehensive 3-hour virtual training designed specifically for mental health professionals. This interactive course will deepen your understanding of non-monogamous relationship structures, provide practical clinical interventions, and help you develop the confidence to create truly affirming therapeutic spaces.
Beyond this training, I offer ongoing consultation and clinical supervision for therapists committed to growing their competency with non-monogamous clients. Whether you're just beginning to explore this work or seeking to refine your existing skills, individualized support can accelerate your learning while ensuring your clients receive the quality care they deserve. The non-monogamous community has waited too long for mental health professionals who truly understand their experiences; let's work together to ensure you can be part of the solution. Your willingness to grow and learn doesn't just benefit your practice; it helps create a world where all forms of consensual love are celebrated and supported.
References
Room for Growth: A Qualitative Study into the Therapeutic Experiences of Consensually Non-Monogamous Clients. (2024, April 2). Journal of Sex & Marital Therapy.
Polyamory among youth: New research highlights stigma and depressive symptoms. (2024, May 22). PsyPost.
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.
Polyamorous youth report facing stigma, heightened levels of depression. (2024, April 29). Washington State University.
Witherspoon, R. G., & Theodore, S. (2021). Exploring Minority Stress and Resilience in a Polyamorous Sample. Archives of Sexual Behavior, 50(4), 1545-1560.
OPEN's 2024 Community Survey Provides Comprehensive Insights into Non-Monogamous Lives. (2024, August 7).
Stigma Toward Consensual Non-Monogamy: Thematic Analysis and Scale Development. (2024, April 25). Archives of Sexual Behavior.
Internalized Consensual Non-Monogamy Negativity and Wellbeing. (2021, July 6). Chapman University Digital Commons.
Fern, J. (2020). Polysecure: Attachment, Trauma and Consensual Nonmonogamy. Thorntree Press.
Consensual Non-monogamy Fact Sheet. American Psychological Association Division 44.
Assessing therapists' attitudes toward consensually non-monogamous clients. (2020, July 28). Eastern Michigan University Digital Commons.
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