Schechinger Et Al (2018)

Journal of Consulting and Clinical Psychology
© 2018 American Psychological Association 2018, Vol. 86, No. 11, 879 – 891
0022-006X/18/$12.00 http://dx.doi.org/10.1037/ccp0000349
Harmful and Helpful Therapy Practices With Consensually

Non-Monogamous Clients: Toward an Inclusive Framework
Heath A. Schechinger John Kitchener Sakaluk

University of California, Berkeley University of Victoria
Amy C. Moors
Chapman University and Indiana University
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Objective: Drawing on minority stress perspectives, we investigated the therapy experiences of

individuals in consensually nonmonogamous (CNM) relationships. Method: We recruited a com-
munity 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.
What is the public health significance of this article?

This study highlights how certain therapist practices relate to the experiences of clients who are in
consensually nonmonogamous (CNM) relationships. The results identify practices that are perceived
as generally helpful or unhelpful, and point to the need for additional research, training, and
guidelines to bridge therapists’ knowledge gap regarding CNM.
Keywords: consensual nonmonogamy, minority stress, therapy, sexuality
Public interest—and participation—in consensual nonmono- Veaux & Rickert, 2014), and elevating rates of Internet searches
gamy (CNM; relationship arrangements in which all the partners (Moors, 2017). In the field of psychology, Division 44 of the
involved agree to extradyadic sexual and/or romantic relation- American Psychological Association also recently approved the
ships) are on the rise. This is evidenced by media coverage (e.g., first Consensual Non-Monogamy Task Force to promote aware-
CNN, Scientific American, New York Times), increased scientific ness and inclusivity about CNM relationships.
inquiry (see Conley, Matsick, Valentine, Moors, & Ziegler, 2017; The number of people who have or are currently engaged in
Conley, Ziegler, Moors, Matsick, & Valentine, 2013; Rubel & CNM relationships is also not as small as one might expect.
Bogaert, 2015, for reviews), popular books (e.g., Sheff, 2015; Twenty-two percent of Americans have been involved in a CNM
relationship at some point during their life (Haupert, Gesselman,
Moors, Fisher, & Garcia, 2017; Haupert, Moors, Gesselman, &
Heath A. Schechinger, University Health Services, University of Cali- Garcia, 2017), with approximately 4%–5% currently engaged in a
fornia, Berkeley; John Kitchener Sakaluk, Department of Psychology, CNM relationship (Levine, Herbenick, Martinez, Fu, & Dodge,
University of Victoria; Amy C. Moors, Department of Psychology, Chap- 2018; Rubin, Moors, Matsick, Ziegler, & Conley, 2014). Despite
man University, and The Kinsey Institute, Indiana University. the prevalence and increasing public discourse on CNM relation-
The authors wish to acknowledge Barbara Kerr and Kristen Sager for
ships, U.S. culture still strongly privileges monogamous relation-
their feedback on early drafts of this article.
Correspondence concerning this article should be addressed to Heath A.
ships in a number of ways— both subtle and overt—and freq-
Schechinger, University Health Services, University of California, Berke- uently fails to acknowledge consensual multi-partner relationships
ley, 2222 Bancroft Way, Berkeley, CA 94720. E-mail: heathschechinger@ (Moors & Schechinger, 2014). CNM relationships, for example,
berkeley.edu are stigmatized as promoting a host of negative outcomes (from
879
880 SCHECHINGER, SAKALUK, AND MOORS
relationship dissatisfaction to spreading sexually transmitted infec- we broadly conceptualize individuals engaged in CNM as sexual
tions), and individuals in CNM relationships are viewed as pos- minorities. As such, we draw on the body of sexual minority stress
sessing numerous undesirable qualities (in comparison to monog- literature as a theoretical framework. Additional research is
amous relationships; Conley, Moors, Matsick, & Ziegler, 2013; needed, however, to clarify specific points of convergence and
Grunt-Mejer & Campbell, 2016; Moors, Matsick, Ziegler, Rubin, divergence with other sexual minority populations. The terms used
& Conley, 2013; Thompson, Bagley, & Moore, 2018). However, a in this article are not intended to endorse a particular position
small but growing body of empirical evidence suggests the con- about how CNM should be conceptualized.
trary and also supports the notion that CNM relationships are
equally viable options to monogamy (see Brewster et al., 2017;
Minority Stress
Conley et al., 2017; Moors, Matsick, & Schechinger, 2017; Rubel
& Bogaert, 2015; Wood, Desmarais, Burleigh, & Milhausen, 2018 Individuals from sexual minority groups are disproportionately
for reviews and meta-analyses). Across several studies, researchers exposed to discrimination, victimization, and rejection compared
have found that people engaged in CNM and monogamy report to heterosexual individuals (Balsam, Rothblum, & Beauchaine,
similar levels of satisfaction, trust, commitment, and mental sta- 2005; Meyer, 2003). As a consequence, sexual minorities experi-
bility (e.g., Conley et al., 2017; Rubel & Bogaert, 2015). ence additional mental health burdens (Cochran, 2001) and utilize
Mental health professionals have historically played a critical mental health services more frequently than heterosexual individ-
role in providing support for marginalized populations, but without uals (Cochran, Sullivan, & Mays, 2003). This process, by which
adequate education and training, they are subject to holding CNM- stigma and discrimination create a more hostile social environment
stigmatizing attitudes, and (unintentionally) using biased, inappro- leading to mental health problems, is known as minority stress
priate, or harmful practices with their CNM clients. To date, there (Meyer, 2003; see also Diplacido, 1998). Hatzenbuehler (2009)
is a dearth of research on the therapeutic experiences of CNM posited that cognitive, affective, and interpersonal pathways me-
clients, and limited resources to guide clinical practice (see Gra- diate the relationship between exposure to minority stressors and
ham, 2014; Weitzman, 2006; and Weitzman, Davidson, & Phillips, mental health. These mechanisms emerge early in sexual minority
2012). We therefore aimed to conduct the first systemic investi- individuals’ lifetimes and lead to psychosocial vulnerabilities and
gation of CNM client reports of therapist practices. mental health issues (Eisenberg & Resnick, 2006; Safren & Heim-
berg, 1999).
Minority stress is not necessarily exclusively negative, however.
CNM and Sexual Minority Communities
Resilience is also an inherent aspect of minority stress theory, as
The movement that started with promoting the rights of indi- the presence of stress also tends to bolster one’s capacity to cope
viduals identifying as gay or lesbian has become increasingly more (Meyer, 2015). Minority stress theory thereby provides a frame-
mobilized, visible, and vocal about issues of equality. The larger work for understanding how stigma experienced by people en-
sexual minority community has come to include additional sub- gaged in CNM may be linked with mental health issues, as well as
cultures, such as the bisexual, gender nonconfirming, transⴱ, queer, resilience.
intersex, asexual, alt-sex, dominant—submissive sex, kink, and
consensual nonmonogamy communities (Nichols & Shernoff,
Therapeutic Alliances and CNM Minority Stress
2007). There are clear and distinct differences that make each
community unique, as well as overlapping experiences that are Sexual minorities receiving counseling services have been
broadly shared between these subcultures (e.g., societal stigma, found to experience numerous benefits, including forming a pos-
general minority stress). Consensual nonmonogamy (and critiques itive identity, learning the effects of stigma, and developing strat-
of compulsory monogamy) has been found to resonate broadly in egies for coping (Browning, Reynolds, & Dworkin, 1991;
many nonconforming cultures, including feminist, leftist, lesbian, Eubanks-Carter, Burckell, & Goldfried, 2005; Perez, Debord, &
gay, bisexual, transgender, BDSM, and queer activists (Klesse, Bieschke, 2000). Clinical research has also consistently demon-
2011). Yet how to conceptualize CNM, as well as how it fits strated that safety in a therapeutic relationship is critical for pos-
within the sexual minority community, is largely unchartered itive change (Levitt & Williams, 2010). Mental health providers
empirical and legal territory. are uniquely positioned to help their clients feel safe by seeking to
Scholars have discussed the biological, psychological, and so- recognize and mitigate the effects of stigma experienced by their
cial influences shaping whether CNM should be considered a CNM clients. If a client does not feel safe or hold a secure bond
sexual orientation (Klesse, 2011; Tweedy, 2011), relationship with their therapist, they are more likely to prematurely terminate
practice (Lano & Parry-Lano, 1995), theory, (Emens, 2004), iden- therapy, which has been found to dramatically reduce efficacy of
tity (Barker, 2005), or relationship orientation (Anapol, 2010). therapeutic interventions (Heilbrun, 1982; Pekarik, 1992). In light
There are also diverse perspectives about whether, how, and/or of this, many consider the therapeutic alliance— defined broadly
when to include CNM in the larger LGBTQ community. Accord- as the collaborative and affective bond between therapist and
ing to Warner (1999), if there is a political divide, it is between client—an essential element of effective psychotherapy (Horvath
those who emphasize inclusiveness and assimilation, and those & Luborsky, 1993; Martin, Garske, & Davis, 2000).
who promote the importance of separatism and fostering differ- Therapists typically do not receive training on issues facing the
ences. CNM community (Weitzman, 2006), and available guidance is
Given the convergence in reported experiences between the limited (e.g., McCoy, Stinson, Ross, & Hjelmstad, 2015). This
CNM and other sexual minority communities (e.g., discrimination leaves people engaged in CNM seeking mental health services
based on sexual identity/practices, coming out/visibility concerns), tasked with finding culturally competent care within a mental
THERAPY WITH CONSENSUALLY NON-MONOGAMOUS CLIENTS 881
health system that is not adequately prepared to address their “monogamy” was included as a relationship structure option, none
concerns. Moreover, the dearth of CNM-related training renders of our participants selected this option. Rather than specifically
therapists susceptible to causing harm to their clients (Mikalson, recruiting for people who were actively seeking mental health
Pardo, & Green, 2012; Xavier, 2000), by creating or perpetuating services, we minimized selection bias by obtaining a community
minority stress, which could undermine their abilities to assist sample of individuals engaged in CNM, and used a subsample of
CNM clients. Therapists who are unaware of their own values and these individuals who had seen a therapist and indicated romantic
biases are susceptible to impeding progress in therapy (Corey, relationship(s) was a topic of conversation in therapy. Thus, par-
Schneider-Corey, & Callanan, 1993). When same-sex attraction is ticipants were eligible to take part in the present research if they
viewed negatively, for example, therapists are more likely to view were currently engaged in a CNM relationship, had discussed
the client’s sexual orientation as a poignant source of the client’s (their) romantic relationship with a therapist, and were at least 18
psychological difficulties, even when it has not presented as a years old. The present study was approved by the first and third
problem (Garnets, Hancock, Cochran, Goodchilds, & Peplau, authors’ Institutional Review Boards.
1991; Liddle, 1996). We anticipate that therapists’ explicit or A strategy similar to that used by Liddle (1996) was incorpo-
implicit negative attitudes and non-affirming practices can ad- rated in the present study. Specifically, participants were asked to
versely impact treatment with CNM as it does with other sexual describe their experiences with up to four different therapists: (a)
(and gender) minority populations, and that guidelines created for their current/most recent therapist, (b) their first therapist, (c) their
these populations (see American Psychological Association, 2012; most helpful therapist, and (d) their worst or most harmful thera-
American Psychological Association, 2015) may also be warranted pist. For each therapist, participants indicated whether their ther-
to protect and adequately support CNM clients. apist engaged in a list of 13 observable practices/behaviors (i.e.,
“Please put the number ‘1’ in each box if your therapist engaged
The Present Study in the corresponding practice.”), rated how helpful their therapist
was, and indicated if they prematurely terminated because of a
People engaged in CNM continue to face considerable prejudice negative CNM-related interaction. Participants also provided
and discrimination (Conley, Moors, et al., 2013; Cox, Flecken- open-ended responses and were asked to describe what their ther-
stein, & Bergstrand, 2013; Hutzler, Giuliano, Herselman, & John- apist(s) did (regarding their relationship orientation/structure) that
son, 2016). Although therapists can support people in CNM rela- they found to be (a) very helpful, as well as what they found to be
tionships, their ability to do so may hinge on using affirming (b) very unhelpful.
practices to build positive therapeutic relationships (cf. Corey et We focused on participants’ reports of experiences with their
al., 1993; Levitt & Williams, 2010). The current literature guiding most recent (or current) therapist, as a means of reducing recall
therapy with individuals in CNM relationships relies on first- bias. Of the 577 participants who completed the survey, 428 (74%)
person experiences and small samples (e.g., Bairstow, 2017; Gi- had at least one therapy session, and 249 (43% our final sample)
rard & Brownlee, 2015; Weitzman, 2006; Weitzman et al., 2012; indicated that their romantic relationship(s) was/were a topic of
Zimmerman, 2012). To provide a broader understanding of ther- conversation in therapy (see Table 1). Nine percent of our partic-
apist practices with CNM therapy clients, we designed the first ipants indicated they had 1 to 4 sessions of counseling or psycho-
mixed-method (quantitative and qualitative) study to systemically therapy, 30% had 5 to 20 sessions, and 61% had more than 20
explore what CNM therapy clients perceive to be helpful and sessions.
unhelpful therapy practices.
In the present study, we examined CNM therapy client percep-
tions to pursue four empirical goals. We first determined an initial Measures
set of therapeutic practices that would likely affirm or compromise CNM therapeutic practices. In her pioneering work, Liddle
the therapeutic relationship between CNM clients and their ther- (1996) distilled suggested practices for working with LGB clients
apists. Next, we estimated the frequency with which therapists offered by the American Psychological Association (APA; see
engage in exemplary and inappropriate behaviors with their CNM Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991) into 13
clients. Then, we tested the association between the frequency of items reflecting therapist behavior that could be observed by a
exemplary and inappropriate behaviors and therapeutic outcomes. client. These 13 items reflected two subscales: biased, inadequate,
Finally, we thematically coded open-ended responses to identify or inappropriate practices and exemplary practices. For our in-
what therapeutic practices CNM clients found to be very helpful or vestigation, the items created by Liddle (1996) were modified to
unhelpful. apply to people engaged in CNM relationships (see Table 2).
Language referring to sexual orientation (i.e., heterosexual, homo-
Method sexual) was replaced to refer to relationship orientation/structure
(i.e., monogamous, consensually nonmonogamous). Furthermore,
Participants and Procedure we revised one of the exemplary practices items so it would not
read as a double negative (i.e., “your therapist never made an issue
Volunteer participants engaged in CNM were recruited online of your sexual orientation when it was not relevant” was revised to
via listservs, organizations, and social groups focused on CNM “your therapist made an issue of your sexual orientation when it
relationships (e.g., National Coalition of Sexual Freedom; reddit: was not relevant”). As a result, the item became reflective of an
polyamory) to take part in a 30-min study about their relationship inappropriate practice, rendering an exemplary practices subscale
experiences. Participants were asked to indicate their age, gender, consisting of 3 items (␣ ⫽ .67), and an inappropriate practices
sexual orientation, race/ethnicity, and relationship structure. While subscale consisting of 10 items (␣ ⫽ .79). The modifications were
Table 1 evaluate the latent structure of exemplary and inappropriate prac-

Demographics of Final Sample tices and (2) test the contributions of exemplary and inappropriate
practices for predicting ratings of therapist helpfulness as well as
Demographic information % or M (SD) premature termination of the therapeutic relationship. CFA and
Age 36.62 (10.40) SEM models were fit using the lavaan() package (Rosseel, 2012),
Gender reliability of latent factors were estimated using the semTools()
Woman 62.25% package (semTools Contributors, 2016), and plots were created
Man 24.90% using the ggplot2() package (Wickham, 2009).
Another term best described gender identity (e.g.,
gender queer, trans) 10.04% Modeling the structure of individual exemplary and inap-
Sexual orientation propriate practices. We fit 1- and 2-factor models to the indi-
Bisexual 43.37% vidual practice items, in order to determine whether distinguishing
Straight 25.70% between the two valences (i.e., exemplary and inappropriate) was
Gay or lesbian 1.20%
necessary, or rather, whether a singleton factor would be sufficient.
Pansexual/omnisexual/queer 26.91%
Race/Ethnicity We identified both models using a fixed-factor scale-setting ap-

African American/Black 1.20% proach (i.e., fixing latent variances to 1 and estimating all factor
Asian American .04% loadings) and used a robust categorical estimator (diagonal
European American/White 82.73% weighted least squares, DWLS), given the dichotomous nature of
Latino/Latina .08%
Native American .04% the practice items. We then evaluated the plausibility of both the
Multi-racial 6.02% 1-factor and 2-factor models by interpreting both an absolute
Another term best described racial–ethnic identity 5.62% (RMSEA) and relative (CFI) index of model fit (see Hu & Bentler,
Relationship type 1999), as well as using a scaled and adjusted likelihood ratio test
Open relationship/marriage 8.43%
(Satorra, 2000) in order to directly compare the fit of both models.
Swinging/In the “Lifestyle” 1.20%
Polyamory 78.71% Recent simulation research on model fit indexes (see McNeish, An,
Another term best described consensually non- & Hancock, 2018), however, has revealed that universal application
monogamous arrangement (e.g., monogamish) of the Hu and Bentler (1999) cutoff values (RMSEA ⬍ ⫽ .06,
or specifically non-labeled 11.65% CFI ⬎ ⫽ .95) is not recommended, because these cutoffs biasedly
penalize well-fitting models with highly reliable factors, while
biasedly accommodating poor-fitting models with less reliable
initially made by two of the authors. Once the authors reached factors—a pattern termed the “reliability paradox” of model fit
agreement, the modified scale was reviewed by six experts (two (Hancock & Mueller, 2011). Whereas the Hu and Bentler (1999)
professors and four doctoral candidates) in the field of romantic cutoff values are appropriate to apply to models with standardized
relationship and sexuality science as well as several individuals factor loading values that are comparable to those specified in Hu
engaged in the CNM community. and Bentler’s (1999) simulations (M ⫽ .75), McNeish et al. (2018)
Therapist helpfulness. Following Liddle (1996), we assessed argue that more appropriately liberal cutoff values ought to be used
global therapist helpfulness using a single item (Brooks, 1981; 1 ⫽ (e.g., RMSEA ⬍ ⫽ .20, CFI ⬎ ⫽ .775) when standardized
destructive; 4 ⫽ very helpful). Using a single-item measure is a loadings for a given model are higher than those specified in Hu
common practice to investigate client perceptions of therapy (e.g., and Bentler’s (1999) simulation (e.g., M ⫽ .90). When appraising
Fridman, 2010; Fuller & Hill, 1985; Horvath, Marx, & Kamann, the fit of our specified models, we therefore report and interpret the
1990), with face-valid items typically yielding high levels of level of measurement reliability, in order to determine reasonable
predictive validity (Hoyt, 2002). Single-item measures of helpful- cutoff values.
ness are also known to be stable over time, consistent between Predicting therapist helpfulness and early termination from
clients and therapists, and predictive of session outcome measures the use of exemplary and inappropriate practices. We fit a
(Hill et al., 1994). They are also commonly used as a treatment structural model in order to predict helpfulness scores as well as
outcome (e.g., Elliott, 1985; Hill et al., 1994; Liddle, 1996) and whether participants prematurely terminated their therapeutic re-
have been found to hold concurrent validity with clients’ overall lationship, using the latent factors of exemplary and inappropriate
satisfaction with their therapist (Conte, Buckley, Picard, & Kara- practice. Advantages of this SEM approach include (1) estimating
su’s, 1994). larger effects with random error and measurement error removed
Premature termination. For each therapist, participants were from the true construct variance of the latent exemplary and
asked to report (0 ⫽ no, 1 ⫽ yes) if they had terminated therapy inappropriate practice factors and (2) simultaneously estimating
because of a negative experience with their therapist that was two latent regression pathways in a single model, for predicting
based on their CNM relationship orientation/structure. helpfulness scores (a continuous outcome) and premature termi-
nation (a categorical outcome). Effects for the dichotomous out-
come of premature termination are probit-linked.
Data Analysis Strategy
Thematic analysis of open-ended helpful and harmful the-
Statistical analyses were conducted using R (R Core Team, rapy practices. Participants’ open-ended responses to the two
2016). We first calculated frequencies of the individual exemplary questions asking if their therapist(s) did or said anything pertaining
and inappropriate practices. We then used confirmatory factor to their consensually nonmonogamous relationship orientation/
analysis (CFA) and structural equation modeling (SEM) tech- structure that they found to be “very helpful” or “very unhelpful”
niques (Beaujean, 2014; Brown, 2015; Little, 2013) in order to (1) were analyzed with Braun and Clarke’s (2006) epistemological
Table 2
Exemplary and Inappropriate Therapeutic Practices Descriptions and Frequencies Among CNM Clients (Adapted From Liddle, 1996)
and Their Loadings From a Confirmatory Two-Factor Solution
Practice Factor Item label Loading (␭)
Your therapist was quite knowledgeable about consensual non-monogamy

communities and other resources (so that he or she could have put you
in touch with useful books or important community resources). Exemplary CNMKnowledge .72
Your therapist was not afraid to deal with your relationship orientation
when it was relevant. Exemplary NotAfraidOfCNM .93
Your therapist helped you feel good about yourself as a consensually
non-monogamous person. Exemplary HelpedFeelGoodAboutCNM .84
Your therapist gave some indication that he or she had assumed you were
monogamous, before you indicated your relationship orientation. Inappropriate AssumeMono .72
Your therapist indicated that he or she believed that non-monogamy is
bad, sick, or inferior. Inappropriate CNMBad 1.00

Your therapist discounted, argued against, or pushed you to renounce

your non-monogamous lifestyle/identity. Inappropriate DemandRenounceCNM .94
Your therapist blamed your problems on your relationship orientation or
insisted on focusing on your relationship orientation without evidence
that your relationship orientation was relevant to your problems. Inappropriate BlamedCNM .97
Your therapist suddenly refused to see you any more after you disclosed
your relationship orientation. (Do not include cases where your
therapist made a sensitive and appropriate referral to a therapist who
was especially skilled in your expressed area of concern). Inappropriate RefusedTreatment .35
Your therapist lacked the basic knowledge of consensual non-monogamy
issues necessary to be an effective therapist for you and/or you had to
be constantly educating him or her about these issues. Inappropriate LackedCNMKnowledge .86
Your therapist pressured or advised you to come out to someone in spite
of the fact that you believed it was too risky. Inappropriate PressuredToComeOut .33
Your therapist did not recognize the importance of consensual non-
monogamous relationships and/or did not appropriately support these
relationships. Inappropriate NotSupportCNM .91
Your therapist did not understand the problems of societal prejudice
against consensually non-monogamous individuals. Inappropriate NotUnderstandCNMPredj .73
Your therapist made an issue of your relationships orientation even when
it was not relevant. Inappropriate MadeIssueOfCNM .92
Note. CNM ⫽ Consensually nonmonogamous. All factor loadings significant at the p ⬍ .001 level.
approach to thematic analysis to identify the major and minor relationship orientation. However, only roughly one third of recent
themes for each category. All responses were read through three therapists were described as quite knowledgeable of CNM com-
times by the lead author, a psychology faculty member, and a munities and resources. Rates of recent therapists perceived as
trained psychology doctoral student. Each reader independently engaging in inappropriate practices were generally much lower,
created a list of major and minor themes. The major and minor although many were described as presuming a monogamous ori-
themes were then reviewed, discussed, and combined based on entation from their clients and lacking basic knowledge of CNM
consensus. Each participants’ responses were then coded as “1” if issues—the remaining inappropriate practices were experienced
the theme was present and “0” if the theme was not present by two less frequently.
reviewers, with discrepancies decided by a third reviewer. The
endorsements were then added (including the sum and percent-
CFA of Exemplary and Inappropriate Practices
ages) for each of the major and minor themes.
We then used CFA to determine whether distinguishing between
Results exemplary and inappropriate practices was empirically supported.
The 2-factor model yielded highly reliable factors (␻3 ⫽ 0.81)
Frequencies of Exemplary and Inappropriate Practices with standardized loadings values that were higher (M ⫽ .79,
Mdn ⫽ .86) than those specified in Hu and Bentler’s (1999)
Rates of individual exemplary and inappropriate practices used simulation (M ⫽ .75), suggesting that their recommended cutoff
by current/most recent therapists among people engaged in CNM values would be overly conservative for appraising the fit of this
relationships are presented in Figure 1. In terms of exemplary model. We therefore determined that the fit of the 2-factor model
practices, a large majority of people engaged in CNM perceived was acceptable, as the relative index (CFI) and absolute index
that their recent therapist was unafraid to address their relationship (RMSEA) were well within levels of model fit for more reliable
orientations when it was, in fact, relevant to the issue(s) motivating factor solutions, as described by McNeish et al. (2018), ␹2(64) ⫽
them to seek services. A small majority of participants perceived 229.75, p ⬍ .001, CFI ⫽ .93, RMSEA ⫽ .10 (90% CI [.09, .12]).
their therapists as also helping them feel good about their CNM As expected, the factor for perceived exemplary practice was
Figure 1. Frequency of perceived exemplary and inappropriate therapeutic practices used by most recent
therapists, as reported by clients engaged in a consensually nonmonogamous (CNM) relationship.
strongly and negatively correlated with factor for perceived inap- participants’ probability of prematurely terminating increased by
propriate practice1, r ⫽ ⫺.78, p ⬍ .001. The single-factor solution 87.60%. Exemplary practices were unassociated with premature
was descriptively comparable to the two-factor solution in terms of termination rates, b ⫽ 0.28, p ⫽ .34.
relative and absolute fit, ␹2(65) ⫽ 242.22, p ⬍ .001, CFI ⫽ .93, We then performed an exploratory analysis of the moderating
RMSEA ⫽ .11 (90% CI [.09, .12]). However, a likelihood ratio characteristics of participants’ therapeutic experiences2, to deter-
test comparing these nested models revealed that the two-factor mine if they differed depending on whether participants searched
model of distinct, but strongly correlated perceptions of exemplary for a therapist who was affirming toward CNM relationships (n ⫽
and inappropriate practices were better supported by the data, 114) or not (n ⫽ 135), as those who screened their therapist rated
⌬␹2(1) ⫽ 11.78, p ⬍ .001 (see Table 2 for factor loadings). their therapist as more helpful (M ⫽ 3.61, SD ⫽ 0.63) than those
who did not screen their therapist (M ⫽ 3.27, SD ⫽ 0.83),
SEM Predicting Therapist Helpfulness and Premature t(244.41) ⫽ ⫺3.52, p ⬍ .001, d ⫽ 0.41. We began by testing
Termination whether our two-factor measurement model of exemplary and
We then fit a structural equation model predicting ratings of inappropriate therapeutic practices was invariant between these
therapist helpfulness as well as whether participants prematurely two screening groups, as invariance is a necessary precondition for
terminated their therapeutic relationship, using the latent exem- validly comparing groups on structural portions of a model (see
plary and inappropriate practice factors. The full structural model Vandenberg & Lance, 2000, for a review). We first fit a config-
fit the data acceptably well given the high degree of factor reli- urally invariant model, forcing the same general pattern of factors
ability, ␹2(86) ⫽ 281.36, p ⬍ .001, CFI ⫽ .93, RMSEA ⫽ .10 and loadings between groups, and evaluated its fit using the same
(90% CI [.08, .11]). criteria as our initial two-factor model (Hu & Bentler, 1999), while
Taken together, perceptions of exemplary and inappropriate being mindful of the reliability paradox (McNeish et al., 2018). We
practice both significantly and uniquely contributed to the predic- then tested weak invariance (i.e., factor loading equivalency, nec-
tion of ratings of therapist helpfulness. Therapists who were per-
ceived as using more exemplary practices were rated as more 1
Unlike the exemplary practices (which are relatively homogenous in
helpful, b ⫽ 0.27, p ⫽ .02, whereas therapists perceived as using their factor loadings), the inappropriate practices varied in terms of their
more inappropriate practices were rated as less helpful, b ⫽ ⫺0.30, strength of association to the underlying latent Inappropriate Practice
p ⫽ .001. Moreover, therapists perceived as using a greater num- factor. An earlier IRT analysis (not described in detail here) revealed that
ber of inappropriate practices were significantly more likely to constraining loadings to equality across inappropriate items lead to wors-
ened fit (p ⬍ .001).
have clients engaged in CNM prematurely terminate their thera- 2
We thank an anonymous reviewer for the suggestion to consider
peutic relationship, b ⫽ 1.16, p ⬍ .001; specifically, for every moderators of our effects pertaining to other aspects of the therapeutic
increase in one standardized latent unit of inappropriate practices, context.
essary for valid between-groups comparisons of latent correlations that they found very helpful, while 38% provided responses to
and regression paths) and strong invariance (i.e., intercept equiv- what they found very unhelpful. Those participating identified, on
alency, necessary for valid between-groups comparisons of latent average, 1.44 very helpful practices and 1.28 very unhelpful prac-
means) by constraining parameter estimates to equivalence be- tices, respectively. Coders had agreement on 94% of the cases
tween groups and evaluating to what extent that degraded the fit of when independently classifying major/minor theme responses.
the model. Simulation research by Cheung and Rensvold (2002) Percentages reported for major/minor themes do not total 100%
suggests that traditional ⌬␹2 difference-tests are too liberal for because many respondents mentioned more than one practice in
rejecting invariance, and that examining differences in CFI be- their response (e.g., “accepted my lifestyle and offered practical
tween models is a more reasonable approach. They suggest that advice”).
⌬CFI in excess of .01 suggests that a set of invariance constraints The very helpful practices were coded into four major themes
are untenable. Model fit indexes from our three levels of invari- (Affirming, Helpful Techniques, Nonjudgmental, and Knowledge-
ance testing are presented in Table 3. In summary, all three levels able) and 23 minor themes (see Table 4), while the very unhelpful
of invariance appeared to be supported, thereby enabling us to practices were coded into five major themes (Judgmental,
proceed to comparing latent regression slopes and means between Pathologize, Knowledge, Dismissive, Focus) and 19 minor themes
screening groups. (see Table 5). The major themes represent broad categories, while
Screening moderated which types of practices were more the minor themes represent more specific practices. The most
strongly associated with ratings of helpfulness, as constraining frequently endorsed helpful practices were (1) supporting the cli-
slopes to equivalency between screening groups significantly re- ents’ identity/decisions regarding CNM, (2) acting nonjudgmental
duced model fit (see Table 3). Specifically, among those who did toward the client about CNM, (3) normalizing/not overreacting
not screen therapists, the presence of more frequent exemplary about CNM, (4) prioritizing the client’s needs/goals/values, and
practices was associated with higher ratings of therapist helpful- (5) asking helpful questions. The most frequently endorsed un-
ness, b ⫽ 0.51, p ⫽ .002, whereas among those who did screen helpful practices were (1) indicating that CNM was the cause or
therapists, the presence of exemplary practices was not uniquely result of another problem, (2) lacking or refusing to gather infor-
associated with ratings of therapist helpfulness, b ⫽ 0.06, p ⫽ .54. mation about CNM, (3) being generally judgmental toward CNM,
Conversely, the presence of inappropriate practices was not asso- (4) indicating that CNM was wrong or not ideal, and (5) putting
ciated with ratings of therapist helpfulness for those who did not pressure on a client to end a relationship or come out.
screen their therapists, b ⫽ ⫺0.16, p ⫽ .28, whereas for those who
did screen therapists, the presence of inappropriate practices was Discussion
uniquely associated with reduced ratings of therapist helpfulness,
b ⫽ ⫺0.28, p ⫽ .008. Given the stigma directed toward CNM (Conley, Moors, et al.,
Unlike ratings of therapist helpfulness, screening had no mod- 2013), as well as the public’s (growing) interest in these relation-
erating effect on the associations between therapeutic practices and ships (Haupert, Gesselman, et al., 2017; Moors, 2017), the present
premature termination (see also Table 3). However, screening study examined CNM client perceptions of general practices—
groups experienced exemplary and inappropriate practices to a some exemplary, some inappropriate—that therapists adopt when
significantly different degree. Specifically, those who screened interacting with CNM clients. Our descriptive data suggest cause
found therapists who used exemplary practices more frequently, for cautious optimism, as exemplary practices were more com-
␣ ⫽ 0.99, p ⬍ .001, and inappropriate practices less frequently, monly reported than inappropriate practices, although there is clear
␣ ⫽ ⫺0.73, p ⫽ .001, compared to therapists who were not room for improvement in both areas.
screened. We also tested a model grounded in a minority stress perspec-
tive, which examined the extent to which CNM clients’ experi-
Thematic Analysis of Helpful and Harmful ences with therapists using exemplary and/or inappropriate prac-
tices were linked to important therapeutic outcomes. As expected,
Therapeutic Practices
CNM clients interacting with therapists who frequently engaged in
Sixty percent of the participants provided responses to our inappropriate practices felt worse about their therapy experience,
invitation to describe (in an open format) what their therapist did while interacting with a therapist who used more exemplary prac-
Table 3
Fit Indexes From Measurement Invariance and Structural Models Comparing Participants Who
Did (n ⫽ 114) and Did Not (n ⫽ 135) Screen Prospective Therapists for CNM Competency
Model ␹2 df ⌬␹2 (⌬df) RMSEA CFI ⌬CFI
Configural invariance 177.81ⴱ 146 — .04 .989 —

Weak invariance 215.05ⴱⴱ 158 10.88ⴱ (2.95) .05 .980 .009
Strong invariance 208.48ⴱⴱ 157 6.78 (4.13) .05 .982 ⫺.002
Equated latent slopes: Helpfulness 226.62ⴱⴱⴱ 160 8.69ⴱⴱ (1.38) .06 .976 .004
Equated latent slopes: Termination 211.27ⴱⴱ 160 .06 (.65) .05 .982 ⫺.002
Equated latent means 259.83ⴱⴱⴱ 159 18.13ⴱⴱⴱ (1.14) .07 .964 .018
Note. CNM ⫽ Consensually nonmonogamous.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.
Table 4
Very Helpful Practices: Major/Minor Themes for Qualitative Data and Percentages
Major themes % Example responses Minor themes %
Affirming 49 “Supportive of polyamory.” Supported CNM identity/decision 18

“Focused on my needs, not who met them.” Prioritized client’s needs/goals/values 10
“Said CNM was valid.” Acknowledged CNM as valid 9
“Trusted my decisions.” Validated/trusted clients’ decisions 8
“Supportive of my developing bisexuality.” Queer/kink affirming 3
Acknowledged societal stigma 1
Helpful techniques 43 “Asked relevant questions.” Asked helpful questions 10
“Offered practical advice.” Provided helpful advice 7
“Helped us develop parameters.” Helped to improve/navigate relationships 7
Listened effectively 7
“Treated each relationship separately/respectfully.” Valued relationships individually 6
Helped explore/manage emotions 5

Didn’t avoid or fixate on CNM 1

Nonjudgmental 36 “No judgments.” Was nonjudgmental 11
“Not making a big deal out of non-monogamy.” Normalized/didn’t over-react 11
Was accepting 8
“Apologized for making assumptions.” Acknowledged bias 3
“Didn’t think my issues were because I’m poly.” Didn’t pathologize/blame CNM for Problems 2
Remained neutral 1
Knowledge 17 “Being familiar with non-monogamous issues.” Had basic knowledge of CNM 7
Open to learn 5
“Researched non-monogamy on her own.” Sought outside information 3
Provided CNM resources 2
Note. CNM ⫽ Consensually nonmonogamous. % of participants ⫽ % of those who wrote responses that endorsed the theme.
tices was associated with CNM clients reporting that their therapy therapist is educated about and/or willing to gather information
experience was helpful. Clients who screened their therapists also about CNM. Conversely, many CNM clients found it especially
reported experiencing more exemplary and fewer inappropriate unhelpful when their therapists lacked knowledge about CNM and
therapy practices, and rated their therapists as more helpful. held judgmental, pathologizing, or dismissive attitudes toward
Screening, however, was also associated with higher expectations CNM.
of therapist conduct and greater disappointment if these expecta- Taken together, the therapists whom CNM clients find helpful
tions were violated. and maintain a therapeutic relationships with tend to be those who
Finally, open-ended responses revealed that CNM therapy cli- (1) educate themselves about CNM issues; (2) hold affirming,
ents find it particularly helpful when their therapist takes an nonjudgmental attitudes toward CNM; (3) help their clients feel
affirming and nonjudgmental posture toward CNM and when their good about being CNM; (4) remain open to discussing issues
Table 5
Very Unhelpful Practices: Major/Minor Themes for Qualitative Data and Percentages
Major themes % Example responses Minor themes %
Judgmental 48 “Judging and moralizing.” Generally judgmental 11

“That it was unnatural.” CNM is wrong or not ideal 10
“Bringing up religion.” Emphasized religion/traditional values 7
“Judging with facial Expressions.” Nonverbal judgment/discomfort 7
Felt unsafe discussing CNM 4
“Had obvious issues with bisexuals and CNM.” Queer critical (e.g., kink, bisexuality) 3
“Called me a whore.” Criticized/shamed for being CNM 3
Pathologize 38 “Equating CNM to a commitment problem.” CNM is the cause or result of another problem 27
CNM harms relationships 6
“Insisting ‘real’ women want monogamy.” CNM is not good for women 4
Knowledge 19 “Failing to research CNM.” Lacked/refused to gather information about CNM 12
“Didn’t really understand non-monogamy.” Not listening/grasping CNM concerns 4
“Expected me to educate them on my dollar.” Expected client to educate therapist 3
Dismissive 18 “Suggested I leave my bf because he’s poly.” Pressured to end a relationship or come out 10
“Refused to entertain CNM as an option.” Dismissed CNM 4
“Assumed I am into monogamy.” Assumed monogamy 2
Refused service 2
Focus 5 “Far too interested in sexual details of poly.” Focused on CNM too much 3
Avoided CNM 2
Note. CNM ⫽ Consensually nonmonogamous. % of participants ⫽ % of those who wrote responses that endorsed the theme.
related to a client’s relationship structure when brought up by their mononormativity is a topic that remains largely unexplored and
client, and (5) use helpful techniques that align with their CNM merits further investigation.
clients’ goals. Therapists whom CNM clients perceive as unhelpful
and tend to dissolve the therapeutic relationship early are those
Improving Therapist Education and Training
who (1) lack or refuse to gather information about CNM, and/or
hold (2) judgmental, (3) pathologizing, and/or (4) dismissive atti- The results from our investigation highlight the importance of
tudes toward CNM. Although an initial glimpse of CNM clients’ therapists holding affirming, nonjudgmental attitudes toward
experiences in the therapeutic context, we believe that results of CNM as well as the need for additional education and training for
our investigation provide important implications for research re- therapists. Although exemplary practices were the most commonly
lated to sexual minority stress and diverse intimate partnerships. reported, our data suggest there remains room to increase the
The current study also highlights promising avenues for improving frequency of these practices. Moreover, our results show that
therapist education and training, as well as future research on the inappropriate practices—reported in as many as one third of cas-
therapy experiences of people who do not adhere to the societal es— uniquely drive premature termination of therapeutic relation-
ideals of monogamy. ships, but, these inappropriate practices appear to be more heter-
ogeneous in their relationship to their underlying latent factor.

The three most commonly reported inappropriate practices in
Implications for Minority Stress
our quantitative data (mistakenly assuming a client is monoga-
The minority stress framework posits that unique stigma-related mous, lacking CNM knowledge, and not being supportive of
stress renders sexual minorities more vulnerable to general psy- CNM), in particular, have notably high rates of occurrence. Fur-
chological processes that are known to predict mental health issues thermore, the latter two inappropriate practices are especially
(Hatzenbuehler, 2009). Therapists can either serve their CNM strong indicators of generally unhelpful—and potentially iatrogen-
clients as bulwarks of support or, conversely, (in)advertently sub- ic—therapy practices. Routinely including CNM in continuing
ject their CNM clients to stigma and discrimination. In the latter education and training programs would directly address the first
case, our data collectively suggests that therapist-perpetuated two inappropriate practices by increasing awareness of CNM and
CNM stigma may be damaging the therapeutic alliance and jeop- providing helpful information needed to support CNM clients.
ardizing the longevity of the therapeutic relationship for a number This information would also likely combat (some of) the stigma-
of CNM therapy clients, both of which are well-established cor- tizing attitudes and/or lack of information prompting therapists to
relates of poor mental health outcomes (Horvath & Luborsky, be unsupportive. The need for therapist education/training about
1993; Martin et al., 2000). CNM was also reinforced in our qualitative data. Nearly one in
Given the uniquely privileged access therapists have to clients’ five participants (who chose to respond to these questions) com-
moments of vulnerability, psychotherapy might be an especially mented on how helpful it was when their therapist was educated
important context for studying minority stress processes. Indeed, about CNM. One in five also mentioned how unhelpful it was that
research on the basic need of belonging (see Baumeister & Leary, their therapist lacked education about CNM. In light of these
1995; MacDonald & Leary, 2005) suggests that rejection is often findings, therapists could seek further education on CNM and
most painful coming from sources with whom an individual is display symbols of CNM affirmation (akin to showing support for
emotionally close (Kross, Berman, Mischel, Smith, & Wager, LGBT identities). In addition, therapists could check in with CNM
2011). People engaged in CNM—who already face considerable clients about their prior experiences with mental health systems,
stigma and discrimination—may therefore be particularly vulner- given how frequently CNM clients have negative experiences with
able to (un)supportive therapy practices. therapists.
One of the most notable and concerning findings of the current Moving toward an inclusive model of sexuality and therapist
study is how frequently clients perceived their therapists to be practice, we should reflect on why so few therapists are receiving
suggesting or implying that CNM was the cause or result of CNM training on relationship diversity issues, as well as the impact of
clients’ presenting concern. This appears to be a clear example of this therapist knowledge gap. Several strides have been made to
how therapists’ lack of education or awareness of their bias ap- provide therapists evidence-based resources for working with CNM
pears to be harming CNM therapy clients. Rather than acknowl- clients (e.g., Schechinger, 2017a; Weitzman et al., 2012). Further
edging how societal stigma may be causing or amplifying the support by national organizations may be helpful to mobilize these
problem, some therapists appear to be implying that CNM is the efforts. As one example, the newly formed American Psychological
problem. Given this finding, we encourage therapists to examine Association Division 44 Consensual Non-Monogamy Task Force
how individuals engaging in CNM relationships are often forced to aims to develop resources and training to promote awareness and
negotiate monocentric systems (e.g., societal monogamy ideals, inclusion of CNM relationships.
institution of marriage) that pathologize them, which may be Finally, future research and advocacy initiatives should consider
generating or contributing to their distress. Monogamous privilege improving access to CNM-affirming therapists. Nearly half of our
and CNM stigma are also so pervasive that the effects may not be sample tried to find a therapist who was educated about CNM.
evident to the client. CNM and monogamous therapy clients alike Those who screened for a CNM-affirming therapist had better
are expected to hold varying degrees of internalized mononorma- treatment outcomes, as they reported experiencing more exem-
tivity (internalization of negative messages about nonmonogamy; plary and fewer inappropriate therapy practices, and found their
Klesse, 2011), and therapists would ideally be prepared to help therapists to be more helpful than those who did not screen. This
clients recognize the impact of mononormativity on their own finding highlights the importance of therapist education and cre-
attitudes toward their nonmonogamous inclinations. Internalized ating avenues for CNM clients to find therapists who have been
adequately educated about CNM. One way to improve visibility of ent’s experience/identity; and (6) raise awareness among staff and
therapists who are knowledgeable and affirming of CNM is to non-CNM clients (Schechinger, 2017b). As awareness of CNM
allow therapists to indicate consensual nonmonogamy (polyamory, grows, we anticipate that an increasing number of therapists and
open relationships) as a population they specialize in on popular mental health care organizations will demonstrate greater inclu-
therapist locator websites (e.g., Psychology Today and APA Psy- sivity of relationship diversity by inquiring about relationship
chologist Locator) structure—a step recently taken by all 10 of the counseling centers
in the University of California system.3
Future Research
Replication of our observed effects using high-powered longi- Limitations
tudinal designs would be helpful to address concerns of the ro- Our study was limited in several key respects. First, our cross-
bustness of our findings (see Tackett et al., 2017). Assessments of sectional retrospective design required all participants to recall
within-therapist variability as well as predictors of within-therapist their therapeutic experiences. Although we focused our analyses
and between-therapist variability in practice usage with CNM on participants’ remembrances of their most recent therapist in
clients are also a critical next step in determining the scope of order to reduce possible recall bias, future research would benefit
needed training reform. The current study also focused on global from a more intensive daily design, in which participants could
therapist helpfulness, and exploring with more nuanced measures report on their therapeutic experiences with less opportunity to
of therapist helpfulness over time is another needed step for later forget important details or (re)construct a different sense of
moving research in this domain forward. Additional studies inves- meaning from therapeutic sessions.
tigating the impact of CNM stigma and therapy practices on Our study was also limited in the use of a single-item indicator
mental health and motivation for (current and future) treatment are of perceived therapist helpfulness. While our chosen single item
also needed. Collectively, this research would help build the sci- measure is a face valid indicator of client’s experience in therapy,
entific foundation needed to create empirically informed guide- moving forward it would be beneficial to use a more nuanced
lines for psychological practice with clients engaged in CNM. multidimensional measure of participant’s affective experiences in
Guidelines for psychological practice. Understanding the therapy, in order to identify, specifically, what features of
differences and similarities among people engaging in a variety of therapist-perception are influenced by exemplary and inappropri-
stigmatized relationships, identities, and practices could also help ate practices.
uncover additional exemplary (and inappropriate) therapy prac- The current study also was not a random or representative
tices. Further research into points of convergence and divergence sample. Moreover, compared to other CNM studies, the current
with the CNM and LGB populations is warranted given the many study appears to have higher representation from individuals iden-
forms of convergence shared between these communities. For tifying as bisexual and pansexual/omnisexual/queer and lower
example, both communities appear to experience coming out/ representation from individuals identifying as lesbian or gay. This
visibility management, marital/adoption/custody/parental partici- may be due (in part) to providing pansexual/omnisexual/queer as
pation issues, moral ground discrimination, extended family con- an identification option. The generalizability of our study is also
sequences, negative internalizations from minority stress, limited by the fact that our sample was drawn primarily from those
difficulty finding community/fitting in, and housing/workplace who are/were involved in online forums/communities for CNM
discrimination. The treatment guidelines created for LGB clients relationships. While we asked participants to respond regarding
(American Psychological Association, 2012) therefore may help their relationship structure/orientation, we do not address the ex-
inform practices guidelines for working with CNM clients. Sepa- tent their experiences may have been moderated by other aspects
rate practice guidelines are needed, however, to address the issues of their identity (e.g., race, sexual orientation, gender). We also did
that are unique to CNM. Issues related to jealousy management not collect data directly from therapists, but given that nearly half
and integrating new partners, for example, are likely to be more of our participants (48%) screened for CNM-affirming therapists,
salient for the CNM community. Certain processes are also likely we therefore think that if anything, our sample may be underre-
to be experienced quite differently (e.g., coming out as nonmo- porting rates of non-affirming practices.
nogamous is different than coming out as lesbian, bi, gay, queer, Another limitation of the current study is the targeted recruit-
etc.). The current article highlights the need and provides an ment strategy, which focused on the CNM community as a whole
empirical foundation for CNM clinical practice guidelines. (as opposed to specific CNM practices, agreements, or labels such
Include relationship structure on demographic forms. In as polyamorous, open, swinging). Thus, it remains possible that
light of the frequency that CNM therapy clients were incorrectly certain effects might be moderated by CNM relationship “sub-
assumed to be monogamous, it is recommended that mental health types” or therapy modality. For example, Matsick and colleagues
professionals/organizations inquire about relationship structure on (2014) found that polyamorous relationships are perceived more
their demographic form. In addition to reducing the frequency of favorably than swinging and open relationships. We also did not
mis-identifying CNM therapy clients, asking clients to disclose specify the type of therapy participants were receiving (e.g., indi-
their relationship structure on demographic forms is encouraged
because doing so may (1) provide data to determine how well
3
therapists are serving their CNM clients and how professional The following item, created in conjunction with national CNM experts
and community leaders, was added to the standardized questionnaire: When
conduct might be improved; (2) create a safer avenue for disclo- it comes to relationships, I think of myself or identify as: Non-monogamous
sure; (3) signal that a site/clinician is at least aware of CNM; (4) (Polyamory, Open relationship, etc.); Monogamous; Questioning; Other;
promote in-session discussion/disclosure; (5) validate CNM cli- Prefer not to answer
vidual or couples/partners therapy), which also could serve as a Brown, T. A. (2015). Confirmatory factor analysis for applied research
moderator for given effects. (2nd ed.). New York, NY: Guilford Press.
Browning, C., Reynolds, A. L., & Dworkin, S. H. (1991). Affirmative
psychotherapy for lesbian women. The Counseling Psychologist, 19,
Conclusion 177–196. http://dx.doi.org/10.1177/0011000091192004
Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit
People engaged in polyamory, swinging, open, and non-labeled
indexes for testing measurement invariance. Structural Equation Mod-
CNM relationships represent a growing and, potentially, undera-
eling, 9, 233–255. http://dx.doi.org/10.1207/S15328007SEM0902_5
ppreciated population accessing therapy. Similar to people in mo- Cochran, S. D. (2001). Emerging issues in research on lesbians’ and gay
nogamous relationships, people in CNM relationships may seek men’s mental health: Does sexual orientation really matter? American
out clinical services to gain support in navigating their romantic Psychologist, 56, 931–947. http://dx.doi.org/10.1037/0003-066X.56.11
and sexual relationships. Or, like members of other sexual and .931
gender minority groups, people in CNM relationships may seek Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of
out mental health services to endure the stigma and discrimination mental disorders, psychological distress, and mental health services use
that they face. Mental health providers are, therefore, are posi- among lesbian, gay, and bisexual adults in the United States. Journal of
tioned to serve a valuable role in promoting the well-being of these Consulting and Clinical Psychology, 71, 53– 61. http://dx.doi.org/10
individuals. However, our research suggests that therapists are not .1037/0022-006X.71.1.53
sufficiently knowledgeable about CNM relationships, and that this Conley, T. D., Matsick, J. L., Moors, A. C., & Ziegler, A. (2017).
lack of knowledge—and possible prejudices held toward individ- Investigation of consensually nonmonogamous relationships: Theories,
uals in CNM relationships— can add to the minority stress expe- methods, and new directions. Perspectives on Psychological Science, 12,
205–232. http://dx.doi.org/10.1177/1745691616667925
rienced by these clients. We encourage additional research, train-
Conley, T. D., Matsick, J., Valentine, B., Moors, A. C., & Ziegler, A.
ing, and the development of standardized guidelines for
(2017). Investigation of consensually nonmonogamous relationships:
psychological treatment of individuals in CNM relationships to
Theories, methods and new directions. Perspectives on Psychological
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fewer the merrier: Assessing stigma surrounding consensually non-
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Journal of Consulting and Clinical Psychology

Harmful and Helpful Therapy Practices With Consensually

Heath A. Schechinger John Kitchener Sakaluk

Objective: Drawing on minority stress perspectives, we investigated the therapy experiences of

What is the public health significance of this article?

Keywords: consensual nonmonogamy, minority stress, therapy, sexuality

Table 1 evaluate the latent structure of exemplary and inappropriate prac-

Race/Ethnicity We identified both models using a fixed-factor scale-setting ap-

Practice Factor Item label Loading (␭)

Your therapist was quite knowledgeable about consensual non-monogamy

bad, sick, or inferior. Inappropriate CNMBad 1.00

Your therapist discounted, argued against, or pushed you to renounce

Model ␹2 df ⌬␹2 (⌬df) RMSEA CFI ⌬CFI

Configural invariance 177.81ⴱ 146 — .04 .989 —

Major themes % Example responses Minor themes %

Affirming 49 “Supportive of polyamory.” Supported CNM identity/decision 18

Helped explore/manage emotions 5

Didn’t avoid or fixate on CNM 1

Major themes % Example responses Minor themes %

Judgmental 48 “Judging and moralizing.” Generally judgmental 11

ogeneous in their relationship to their underlying latent factor.

Pekarik, G. (1992). Relationship of clients’ reasons for dropping out of

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