Harmful and Helpful Therapy Practices With Consensually Non-Monogamous Clients: Toward an Inclusive Framework

J Consult Clin Psychol. 2018 Nov;86(11):879-891. doi: 10.1037/ccp0000349.


Objective: Drawing on minority stress perspectives, we investigated the therapy experiences of individuals in consensually nonmonogamous (CNM) relationships.

Method: We recruited a community sample of 249 individuals engaged in CNM relationships across the U.S. and Canada. Confirmatory factor analysis structural equation modeling was used to analyze client perceptions of therapist practices in a number of exemplary practices (affirming of CNM) or inappropriate practices (biased, inadequate, or not affirming of CNM), and their associations with evaluations of therapy. Open-end responses about what clients found very helpful and very unhelpful were also analyzed.

Results: Exemplary and inappropriate practices constituted separate but related patterns of therapist conduct. As expected, perceptions of exemplary and inappropriate practices predicted therapist helpfulness ratings and whether participants prematurely terminated their therapeutic relationships. Qualitative results point toward the importance of having/pursuing knowledge about CNM and using affirming, nonjudgmental practices.

Conclusions: Therapists are positioned to either combat or perpetuate the minority stress faced by individuals engaged in CNM. The results of this study highlight the need for additional research, training, and guidelines regarding CNM clients and their therapy experiences. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

MeSH terms

  • Adult
  • Couples Therapy / methods*
  • Extramarital Relations / psychology*
  • Female
  • Humans
  • Male
  • Marriage*
  • Middle Aged
  • Patient Dropouts / psychology
  • Patient Satisfaction
  • Professional-Patient Relations
  • Referral and Consultation*
  • Sexual Partners / psychology*
  • Sexual and Gender Minorities / psychology*
  • Stress, Psychological / complications
  • Therapeutic Alliance