I created these empirically-informed benchmarks in my role as the co-chair of the APA Division 44 Consensual Non-monogamy Task Force to highlight inclusive clinical practices and procedures for working with people engaged in consensual non-monogamy (CNM), a relationship arrangement in which all partners involved consent to extradyadic sexual and/or romantic relationships. This includes but are not limited to: people who practice polyamory, open relationships, swinging, relationship anarchy and other types of ethical non-monogamous relationships.
Organizations such as the American Psychological Association have approved professional practice guidelines in areas such as multicultural practice and working with lesbian, gay, and bisexual clients. The Human Rights Campaign also has created the Healthcare Equality Index, a tool that evaluates healthcare facilities' policies and practices related to the equity and inclusion of their LGBTQ patients, visitors, and employees. This document is intended to expand this work for individuals engaged in consensual non-monogamy, and is separated into three sections. For additional background, please consult Schechinger, Sakaluk, & Moors, (2018) and Vaughan, Jones, Taylor, & Roush, (2019).
I would like to thank Drs. Amy Moors and Rachel Anne Kieran for their contributions to later versions of this resource. A downloadable pdf version of this document can be found here.
Mental Health: Individual
Inclusive language: When discussing past or current relationships, do you clarify that you are supportive of all forms of relationships and use inclusive, CNM-affirming language (e.g., using partner or partners and avoiding husband, wife, couple, spouse, etc. unless the client uses these terms first)? Do you address relationship structure similar to how you would other marginalized identities (e.g., sexual orientation and gender diversity)? Does your website make it clear that you are CNM-affirming?
Inclusive symbols: Are there symbols (e.g., relationship anarchy symbol, polyamory pride flag, infinity heart symbol) in your office to indicate that it is a CNM-affirming space?
Assuming monogamy: When discussing past or current relationships, are you being mindful to avoid assuming clients are monogamous? Do you ask if clients identify as monogamous/CNM and/or if a relationship is open or closed when it is unclear? Do you intentionally normalize the desire for multiple sexual and/or romantic partners when relevant topics are discussed?
Clarifying agreements & terms: When discussing past or current relationships with all clients, are you asking about relationship agreements and preferred relationship terms?
Affairs: Are you mindful to direct the focus away from shaming sexual behavior and/or normalizing the desire for multiple partners when addressing relationship agreement violations? Are you open to seeing clients who are currently engaged in relationship agreement violations?
Blaming non-monogamy: Are you refraining from making suggestions or giving indications that consensual non-monogamy is the cause or symptom of the client’s presenting concern(s)?
Biased or judgmental: Are you being mindful to avoid coming across as having a favorable bias toward traditional/monogamous relationships and/or portraying concern or judgment (verbal or nonverbal) toward consensual forms of non-monogamy? Are you practicing in a way that affirms monogamy and consensual non-monogamy as equally viable options? Are you introducing consensual non-monogamy as a viable option in relevant cases? While being thoughtful of the therapeutic relationship, are you normalizing the desire for multi-partner relationships when a client expresses judgment towards this inclination?
Contextualized case conceptualization: Does your case conceptualization account for how societal stigma toward consensual non-monogamy may be causing and/or amplifying a client’s distress? Does your case conceptualization and/or treatment planning include exploring diverse relationship structures (in relevant cases)?
Proactive education: Are you seeking relevant information about consensual non-monogamy on your own to avoid asking a client to educate you in session?
Pressure: Are you avoiding putting pressure (explicit or implicit) on your clients to come out or end a consensually non-monogamous relationship?
Fixation on sexual activity: Are you making sure your questions about sexual activities are clinically relevant?
Mental Health: Institution
Groups: Do you offer support group(s) that assists individuals in the process of exploring, acknowledging, navigating, and/or coming out about consensual non-monogamy?
Inclusive forms: Do you offer the option to self-identify relationship style on intake/demographic forms? Are your office documents and website explicitly inclusive of consensual non-monogamy (e.g., mentioning CNM in your non-discrimination statement, using “partner(s)” instead of “spouse”)?
Affirming setting & structure: Do you have enough space/chairs to accommodate multiple partners? Are you able to offer longer appointments when working with more than two partners (similar to how you might for families)?
Annual trainings: Do you provide annual trainings for staff to increase their awareness of and sensitivity to the needs of the consensual non-monogamy community?
Recruitment: Do you actively seek to recruit consensually non-monogamous staff, similar to other targeted populations (e.g., staff of color, LGBT staff, international staff)?
CNM-affirming therapy: Do you offer CNM-affirming counseling services, with a staff that is knowledgeable of the needs and experiences of these identities and their related concerns?
Insurance: Do you offer a health insurance policy that covers ongoing counseling services for consensually non-monogamous clients who need such counseling?
Educational programs: Do you offer specific awareness and educational programs for consensual non-monogamy populations directed toward any of the following issues: healthy multi-partner relationships, exploring CNM, coming out as CNM, opening a relationship, coping with CNM stigma, raising children in a CNM household, or safer sex practices?
Sexual health resources: Do you actively distribute condoms, dental dams, and information on HIV/STI services and resources?
STI testing access: Do you offer free, anonymous, easily accessible, and comprehensive HIV/STI testing on a regular basis?
Partner access: Does your system make it easy for patients to share their STI results with their partner(s)?
Inclusive forms Do you ask about relationship structure on your intake and sexual health forms? Do you offer the option to designate more than one emergency contact on intake/demographic forms? Are your sexual health and STI screening/self-testing materials CNM-inclusive (e.g., are sex positive and promote risk-informed sexual practices as opposed to promoting monogamy)?
Inclusive protocols: Have you reviewed your STI testing protocols/recommendations (that may be normed for monogamous populations) for any ways they may put the consensually non-monogamous population at risk (e.g., only offering HPV vaccinations to those under 26, barriers to routine STI testing)? Do you recognize multiple, non-legal “spouses” in health care decisions? Do you permit multiple partners to be present with your patients?
Sex-positive evaluations: Are you/your staff portraying open, affirming attitude towards sex and sexuality when discussing sexual practices with your patients? Are you/your staff being mindful to be avoid judgmental and affirming toward patients with multiple partners when engaging with them about sexual health and wellbeing?
Education: Do you train your staff on how to conduct sex-positive, CNM-affirming, sexual screening risk evaluations?