What is Therapeutic Bias?
The American Psychological Association identifies therapist biases as problematic because they can impact the process of psychotherapy. “Therapists’ attitudes include beliefs reflected in emotional responses and behavior, as well as cognitions.” In relationship to consensual non-monogamy (CNM), bias is the assumption of pathology inherent in CNM. Psychological judgment against unconventional relationships has a long history, from Freud who thought that all bisexuals were immature and stuck in a developmental phase to conversion therapies that attempt to “cure” gays and lesbians. The Diagnostic and Statistical Manual (DSM)—a very influential book that defines diagnostic criteria for mental illnesses—finally caught up with the rise in sexual diversity as a result of several sexual revolutions and the advent of Internet communications. DSM5, the most recent edition, emphasizes the presence of consent and the absence of distress as hallmarks of sexual health, rather than normalcy or fit with cultural expectations. Even so, bias against non-monogamy and in favor of monogamy is deeply rooted in society and therapeutic training programs.
It is important to note that I am not saying that all polyamorous relationships are models of healthy perfection and that any therapist with red flags about a consensually non-monogamous situation is only reacting negatively because of bias. On the contrary—some CNM relationships are seriously messed up and should be raising red flags for counselors. However, my 15-year study of polyamorous families with children indicates that many CNM relationships are happy, healthy, and deal with issues similar to monogamous relationships. Assuming they are all definitionally pathological simply because of the presence of non-monogamy is inappropriate and evidence of bias.
Reinforced in Traditional Therapists’ Training
With growing legal and social recognition of same-sex relationships, monogamy remains one of the last unquestioned bastions of relational legitimacy—at least in the minds of many couples’ or marriage therapists. Pro-monogamy bias in therapists is not an accident—in the majority of conventional counseling programs, therapists-in-training are taught that monogamy is important and should be protected. Conversely, non-monogamy is cast as a sign of a problem, something that should be solved instead of celebrated or explored.
Active vs. Passive Bias
Some therapists either don’t know about or can’t wrap their head’s around consensual non-monogamy, and thus exert a passive bias based on lack of knowledge, experience, and understanding. Other therapists are actively hostile to any form of non-monogamy—consensual or not—and treat it as the ultimate breach the couple must resolve before anything else can happen.
How Does Bias Affect Polys and CNM Folks?
In a culture that is already bent on shaming and humiliating sex and gender minorities, the last thing polyamorous and other CNM folks need is therapists who react negatively to their non-monogamous relationships. Such adverse reactions only reinforce the shame and self-loathing most unconventional clients will have to grapple with because of their inability or unwillingness to fit in to social norms.
Using bias to make clinical decisions – consciously or not – is poor clinical practice because it overlooks other important relationship issues that should be addressed. When therapists focus on consensual non-monogamy as the only issue worthy of discussion, at the exclusion of other issues the clients identify as important, then they are allowing bias to interfere with effective counseling.
Harmful to Clients
Rami Henrich and Cindy Trawinski, the Chicago-area owners of Lifeworks Psychotherapy who have been counseling polyamorists individually and in groups for the past 20 years, have found that many of their research respondents and clients had extremely negative interactions with therapists who failed or refused to acknowledge their biases. In their forthcoming article, Henrich and Trawinski state that: “Our data clearly indicate that anti-poly bias has a demonstrated pernicious effect on polyamorous clients who seek counseling. Psychotherapists serving polyamorous clients must guard against the potential for their own biases against polyamory or in favor of monogamy to harm clients.”
In my next blog I discuss ways that therapists can combat therapeutic bias.
 Henrich, R. & Trawinski, C. Forthcoming. “Social and Therapeutic Challenges Facing Polyamorous Clients” Sexual and Relationship Therapy.