Alternatives to monogamy are viable configurations that clients need culturally competent clinicians to address with them. This chapter prepares clinicians to work with clients considering or in consensual non-monogamous or polyamorous relationships. Readers will be introduced to terminology and consider transference and countertransference relevant to work with polyamorous clients. Understanding compersion, polyfidelity, contracts, configurations and minority stress are keys to this comprehension. Ethical self-examination is stressed as essential for clinicians to work with cultural humility and a social justice lens that supports consensual non-monogamy as a variation from mononormative traditions. Therapists’ own identities and relational statuses can impact how one listens to and conceptualizes clients. Being attuned to unconscious biases and habits or preferencing monogamous status in our language, behavior and even office décor and making inclusive modifications are suggested to improve one’s cultural competence.