Working With ENM Clients
This blog was written as a supplement to the lecture presented on November 18, 2021 at the Alliance of Sexual + Reproductive Justice (ASRJ) at Washington University in St. Louis. It’s meant to provide an introductory guide to working with ethically non-monogamy (ENM) clients for grad students who aspire to be sex therapists and educators.
As a polyamorous, gay, kinky, genderfluid person it's been challenging to find affirming therapists, and I understand why. Having finished a master's program in psychology in 2018 from NYU, it's easy to see how a lot of therapists aren't receiving the proper training to support clients with non-normative relational, sexual, and gender identities. Unfortunately, many of these programs (and I'd even argue the mental health field in general) reinforce normative thinking rather than opening space for challenging preconceived societal agreements. Often, the focus is on treating abnormal individuals not sick societies. I was frequently reminded in grad school that “things are the way they are”, researchers are only here to observe, quantify, and report to clinicians, who then create standards and manuals, to evaluate, devise plans, and correct abnormalities. But what happens when we pathologize and try to treat things that are simply different, like ethical non-monogamy or queerness?
Normative Therapeutic Models
We often mistakenly believe social norms derive from universal absolutes. Humans behave this way because it's in our nature. Psychology arose as a scientific field loosely based on this assumption. But it's beneficial to view norms as a set of limited/restricted options among many. Monogamy, for example, is a norm, but it's no more natural or unnatural than other relationship structures, it's merely the compulsory option. Further, we confound normal with moral, because we assume that the "majority" must be right. When in reality, the "majority" subscribe to that option because it's the only one that was presented. We're taught from a young age that resisting the dominant culture is wrong, so there's shame involved with seeking alternative options, such as polyamory. We take cultural norms for granted because they are the patterns we learned, and therefore feel comfortable. We become oblivious to our cultural norms when we aren't shown viable alternatives. So we collectively fail to recognize how much normative thinking clouds our understanding of the world. And our oblivion works to replicate and strengthen those very norms. It's a vicious cycle.
When we're presented with only one valid option, say monogamy, we feel pressure to conform. Humans after all adapt to strengthen their social relations. We end up adhering to and upholding norms because everyone else does, not because it's necessarily the best thing for us individually. We mistake norms as the "right" way of existing rather than understanding them as one of many options available. Ultimately, our collective adherence homogenizes people and benefits those who are able to capitalize on hegemony. Elites in dominant groups, who best fit the norms, benefit at the expense of those in groups who seek alternatives. Institutions that refuse to critically examine who benefits from standardization, and subsequently dismantle social norms, inevitably reproduce oppressive conditions.
Let's not forget that "normativity" is a construct, as well as a hierarchy. Humans decide what is good and what is bad. Adherence to norms is equated with goodness, while deviation becomes bad. This process creates hierarchies that are used to justify punishment. Adherence creates industry and punishment is profitable. If everyone is expected to follow an action, say getting married, you can create an industry around that norm; those who don't want to get married, are told they are deficient and pressured by their families to go to therapy, which is also profitable.
Therapy has long been an avenue of enforcing norms at the client's expense. The field continues to insist on universal absolutes and seeks to correct those who do not align. We need to be honest about the reality that therapy is often oppressive, discriminatory, and harmful for folks who are outside of the dominant culture. Queers, polyamorous couples, and kinky folks are repeatedly told that their behavior is deviant, abnormal, and ultimately needs fixing. I hear from my clients all the time that their therapist told them the solution to quotidian polyamory problems is to go back to monogamy. You certainly don't need to pay a couple of hundred dollars an hour to licensed professionals for advice that amounts to what your mom and aunt have already told you a dozen times. Needless to say, this is still not addressing the issue that polyam clients needed help with in the first place. An industry built on making folks feel broken may be profitable, but is certainly not "helping".
Common Problems ENM Clients Face In Therapy
Clients have to teach clinicians about ENM
I'll speak from my experience first, when I came out as gay and opened my relationship one therapist told me I should work harder to continue having sex with my husband regardless so he wouldn't leave, and the other therapist knew exactly as much about polyamory as I did, which was nothing. I ended up having to give book recommendations to the latter therapist and defend my sexuality to the first, and I'd walk out of both wondering who'd benefited most from the session. Unfortunately, I hear this over and over and over and over again. Most clinicians simply don't have enough education about consensually alternative relationship structures or queer relationships. As a result, clients are often putting in labor to educate their therapist in the hope of them offering better help. This is a weird dynamic, and certainly not the client's responsibility.
Clinicians approach polyam issues from a monogamous framework
This is probably the most prevalent issue. Compulsory monogamy is the term that describes the only valid model of relationships as being long-term emotionally and sexually exclusive romantic dyadic. Most people never examine how deeply rooted their compmono beliefs are since they never depart from monogamy. Attempting to use monogamous frameworks with their polyam clients absolutely does not work. There are fundamental philosophical differences between compulsory monogamy and ethical non-monogamy which makes it impossible to provide accurate or helpful support without the correct framework. Clinicians who've never examined their own compmono beliefs certainly are unable to help clients deconstruct theirs. Rather than supporting patients in developing tools to navigate non-monogamy, based on non-monogamous theory, therapists often discredit, invalidate, and shame folks because their relationships don't follow the escalator script or seem less committed.
Clinicians pathologize their client's reasons for being polyam
One of my biggest pet peeves is when clients tell me that their therapist diagnosed them with XYZ or pointed to insecure attachment styles for wanting to be ethically non-monogamous. Clients who are told they're "abnormal" simply for wanting to practice ethical non-monogamy struggle as a result. Rather than recognizing that secure attachments can absolutely form in multiple relationships, and addressing the ways that polycules can play pivotal roles in supporting folks with mental illnesses, clinicians make clients feel broken. Subsequently, clients begin to mistake quotidian struggle with their own deficiency. Not helpful.
Clinicians contribute to the shame/stigma associated with practicing polyam
I can't tell you the number of folks who tell me "I can't tell my therapist I'm ENM." This is a giant problem. Beyond a lack of understanding, therapeutic settings and models that shame clients need to be critically examined. If your practice is so inflexible that it adds to the negative self-image clients have, we've got a problem. Even therapists who ARE affirming may fail to notice how much cultural shame is associated with alternative relationships, sexuality, and gender if they haven't experienced it firsthand. A huge hurdle for newly open couples to overcome is feeling confident in their choices to be open.
Clinicians rely on external or systemic indicators to create relationship attachments
One client recently told me that she was dealing with insecurity about her nesting partner's new pal. She'd brought up her issue with her therapist who suggested she and her partner get married to make her feel more secure. This is bananas, but it does illuminate a common issue, polyam folks often can't access social benefits and familial/community support due to the stigma of ethical non-monogamy. Any kind of support that relies on external indicators or systems (marriage, adoption, etc) can create more problems.
Peer Support
I'm a sex educator and peer mentor. I work primarily as an additional support resource for folks who have therapists that aren't versed in consensually alternative relationship structures. The scope of my practice only deals with what I call "quotidian issues" around polyamory, queerness, and sexuality due to my state's laws. Meaning I don't deal with complex trauma or mental health issues since I'm an MA, not a licensed clinician. I cover three recurring topics with my ethically non-monogamous clients: jealousy management/ distress tolerance, BAES (boundaries, agreements, expectations, and support), and safer intimacy practices.
In the support work I do, I don't assume authority, I am a peer. Whenever I slip into vertical (hierarchical) thinking, I catch myself and return to a horizontal role. We are equals, I am responsible for myself, and the other person is responsible for themselves. I do not claim to know what's best for them. I am not speaking from a place of authority. I don't evaluate clients and devise "treatment" plans to correct them back into normalcy. To me, that is absolutely nonsensical, if not unethical. Rather, the first thing I tell folks is that they are the experts in their lives, they are in charge of telling me what does and doesn't work for them, and they are the ones who have the ability to dream up the life and conditions that best suit them. All solutions must, therefore, be created to facilitate the achievement of their goal, rather than adhering to some normalized way of existing.
I operate from a free-choice model. I view my job as presenting and expanding the available options for my clients to choose from. We don't rule out possibilities just because they are unusual. We don't subscribe to the idea that any given option can be beneficial for everyone. And thus, we don't distinguish between "normal" and "abnormal" options; some are just better suited depending on the person. Most importantly, I don't present norms as the only choice. I certainly don't presume to know what's best for anyone but myself. I seek to understand people's values and co-create tools and frameworks that allow them to be aligned with their own sense of integrity. I speak from my personal experience because it illuminates our commonality. It allows me to learn about the other person based on how their experience deviates or aligns with mine. Since there are infinite ways to address a certain issue, speaking about my precedents merely offers an example, rather than a correct answer. This is the model I use for all of my sessions.
How To Support ENM Clients
Question norms
Empirical evidence applied to human experience will be flawed. We LOVE standardization, especially in a field that's long been fighting to be accepted as "real" science. However, humans are not singular. Trying to make overarching claims or standardize models often comes at the cost of nuance and therefore deep understanding. If the goal of therapy is to homogenize the population and eradicate differences, is that an industry you want to be contributing to? For me, the answer was no. (If your answer is yes, that's also fine, since I respect your choice!) My goal was, and is, to understand people and come up with ways to increase the joy in their relations with others. Even if it looks completely incoherent to those on the outside. Oftentimes, supporting people means eviscerating norms. I ask, "why?"
Learn more about ENM, queerness, kink
You fundamentally cannot help your clients if you don't understand what they need. Strive to close the education gap. Even if you're not willing to practice ENM, it's useful to play out scenarios with your partner to understand how these dynamics shift. Read up about ENM, especially first-hand accounts. Broaden your scope of understanding past normative experiences. Again, unless you have a robust understanding of ethical non-monogamy theory, and are able to deconstruct compulsory monogamy, you really shouldn't be working with these clients. Honestly, sometimes no therapy is better than therapy that views your choices as broken due to lack of education. It's also important to recognize that ENM, queerness, and kink are inseparable for a huge chunk of the community. Learning about one subject without being versed in the others doesn't provide a comprehensive lens.
Seek to understand your client's values and relationship ethics
For whatever reason, none of the therapists I've worked with to date have asked about my values, I think that's a shame. The better we understand what our clients want out of their consensually alternative relationship structures, the easier it is for us to facilitate. One of the biggest challenges working with ENM clients is that their relationships vary widely from couple to couple and even within their polycule. There's no singular script or guidelines for navigating polyam, which means we can't rely on generic romantic assumptions. It's only by diving into our client's values that we can understand what sustainable ethical non-monogamy looks like for THEM. And subsequently, create plans to help them get closer to their value alignment.
Help clients develop emotional distress resiliency and jealousy management tools
People starting with polyam generally experience an enormous range of distressing emotions and don't know what to do with them. CBT, DBT, and EMDR can all be applied to help clients learn how to manage. This is where therapy IS necessary. Further, loads of folks do bring complex trauma, mental illness, and insecure attachments into their polyamorous relationships. Being able to help clients navigate these challenges is important, but again, must be done through a polyam-affirming lens.
Illustrate concrete boundary setting
Most of my clients don't have a fucking clue what a boundary is. I have to repeatedly remind them to look at what they can do, what they can ask their partner to do, and how they want situations to resolve. Relationships will not unfold in therapeutic spaces so clients need practical ways to navigate outside of your office. I problem-solve with clients using a lot of very easy and repetitive tools that they can rehearse beyond our calls. My ability to demonstrate clear boundaries and explain in laymen's terms how to address conflict is entirely necessary for their success. Unfortunately, a lot of therapy relies on an authority model which strips client's agency to problem solve on their own.
At the end of the day, compassion and a willingness to embrace expansive views on relationships, sexuality, and gender make great therapists and mental health providers.
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