From One Therapist to Another: Clients Lie in Psychotherapy! What?!?
Updated: Oct 29, 2020
That sounds so rude and harsh to say but Barry Farber, Ph.D., editor of the Journal of Clinical Psychology: In Session, and his colleagues have been researching this phenomena for over a decade. In one study, they surveyed 547 psychotherapy clients and found the following:
93% admitted to consciously lying to their therapist (doesn’t include those who aren’t aware of distorted perceptions/old narrative)
84% admitted lying on a regular basis
Only 3.5% of clients owned up eventually
Only 9% of therapists uncovered the truth eventually
So what do our clients lie about?
How bad I really feel 54%
The severity of my symptoms 39%
My thoughts about suicide 31%
My insecurities and doubts about myself 31%
Pretending to like my therapist's comments 29%
My use of drugs or alcohol 29%
Why I missed appointments or was late 29%
Pretending to find therapy more helpful than I do 29%
Pretending to be more hopeful than I am 27%
Things I have done or regret 26%
Farber and his colleagues summarized the literature on lying in psychotherapy in their book Secrets and Lies in Psychotherapy (Farber, et. al., 2019). In it they make the point that they aren't talking about when a client isn't ready to talk about something (an act of omission) but actually are dishonest (an act of commission). They described the reasons that our clients aren't honest with us as the following:
Don’t want to upset the therapist
Don’t want to be seen as a complainer
Belief that talking about how bad it is will make it more real
Fear of consequences
Fear being hospitalized if suicidal
Fear of being judged or misunderstood
Notice that many of these reasons are interpersonal in nature. I have written and given dozens of workshops on the idea that people have distorted perceptions and narratives which they then project onto current situations and I have been known to say, somewhat irreverently (but with compassion for those we treat) that "you can't believe what you hear." And yet these numbers still surprised me.
So, is it the client who is at fault or the therapist when this occurs?
I think that it is a dialectic in that it is 100% the client's responsibility and somehow it is also 100% the therapist's responsibility to prevent this from occurring.
But if dishonesty in psychotherapy is that pervasive, what can we do? If you remember from my last post, I talked about considering tenets from systems therapy when doing individual therapy. Well, the client/therapist relationship is also a system and if clients aren't comfortable being completely honest, some of that is on us.
It's sad to think that many clients hide some of who
they are in psychotherapy due to shame.
So when I say part of the responsibility regarding this phenomena lies in us, I am referring to the fact that it might be hard for many of us to have conversations about dishonesty in sessions. I suggest that we educate our clients early in the therapeutic process that this is a common occurrence. Maybe even refer to the above referenced research. I think it's much better to do this up front rather than wait until we suspect that we aren't getting the whole story. At that point it can be very hard or awkward for many of us to suggest that our client is being less than honest. Most of us are sensitive, empathetic, caring people and, according to the above survey, 91 percent of us either don't catch on or don't want to confront!
Be proactive! If you bring up the possibility that your client might hesitate to be completely honest early, you normalize this as part of the process and can have a conversation about what types of things the individual might have trouble sharing. It can start as hypothetical but can become a very powerful and preventive discussion. These conversations can enable the client to explore fears about the therapeutic process as well as hear your reassurance that you won't judge. It also allows for misconceptions, such as regarding suicidal ideation, to be discussed proactively. Some people in the research reportedly believed that if they brought up the fact that they periodically had suicidal ideation, that the therapist would send them to the hospital or not want to talk about anything else. It can be easy for us to forget that there may be many aspects of therapy, that clients new to the process, don't yet know or fully understand.
In my opinion, it can be a caring and professional gesture to
explain to your clients that you know there could be times when
it will be hard for them to be completely open with you.
Clearly when clients hesitate to be open in psychotherapy, they are struggling with ambivalence. I have written an article on Understanding Ambivalence which you can give directly to your client. It is a free download when you subscribe to this website (scroll to the bottom of the home page) but if you previously subscribed and didn't get it, you can email me through the website and I will be happy to send it to you.
My book A Clinician’s Guide to Pathological Ambivalence: How to Be on Your Client’s Side Without Taking a Side can help you learn how to enable clients to resolve their ambivalence and rewrite narratives. I would love to hear from you. Please scroll down to the bottom of this page (past the banner of recent posts) to leave a comment.