Assessing Relationship Structure on Demographic Forms

One of the first steps to providing culturally competent care is amending client-history and intake forms to assure that they are inclusive toward marginalized populations. An increasing number of mental and medical health centers are taking steps to be inclusive of relationship structure diversity. The following language provided by the APA Division 44 Consensual Non-monogamy Task Force is considered one of many inclusive ways to assessing relationship structure. The language was originally created by Dr. Heath Schechinger with feedback from a diverse group of consensual non-monogamy researchers and community leaders.

For additional background, please consult Harmful and helpful therapy practices with consensually non-monogamous clients: Toward an inclusive framework (Schechinger, Sakaluk, & Moors, 2018).

A pdf version of this resource can be found here.

Two options for assessing relationship structure/style:

When it comes to relationships, I think of myself or identify as:
-Non-monogamous (Polyamorous, Open Relationship, etc.)
-Monogamous
-Questioning/Exploring
-Prefer not to answer
-Other relationship structure/orientation ____________

I describe my relationship structure as:
-Monogamous
-Open
-Polyamorous
-Swinger
-Relationship Anarchy
-Monogamish
-Questioning/Exploring
-Something else: ____________________
-Prefer not to answer


Language for assessing comfort being public (or out) about relationship structure/style:

How comfortable are you being public (or out) about your relationship structure?
-not at all
-a little
-somewhat
-moderately
-strongly