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Lying in Therapy: When, Why, and What to Do About It

Lying, distortions, and fibbing are complex human behaviors known to exist within a number of interpersonal contexts, but therapists often underestimate the degree to which dishonesty presents in therapy.

Psychotherapists assume a general level of honest exchange in treatment and aim to develop mutual goals in service of therapeutic progress; however, there is extensive evidence to suggest that dishonesty actually impacts clinical work at a much more frequent and more significant level than is often assumed.

Given that the therapeutic relationship is assumed to be based on authentic connection, therapists are surprised when a significant deception, distortion, or omission is revealed. Despite therapists being well-versed in understanding human behavior and trained in orienting carefully to non-verbal cues, they can still be blindsided and baffled when lying presents in a treatment relationship.

Our current climate of “fake news” and culture of digitally altered images serves as a backdrop for how honesty is currently managed in our world.  We have rising levels of distrust and skepticism, and we have more vulnerability and isolation among individuals.

Some of these issues can lead to exacerbation of the mental health issues that contribute to someone seeking out therapy, though this crumbling of moral health clearly impacts all individuals.  Despite that fact that our current world of technological advances may make lying appear more rampant, seminal dishonesty writer Bella DePaulo notes that most every culture throughout history has lamented about liars and lying.

There has been increasing exploration and significant research findings about dishonesty over the recent decades, and incorporating this information into the context of our work enlightens the impact upon the therapeutic process and provides strategies for coping with lying more effectively.

The field of dishonesty exploration has become quite expansive, but some highlights into this interesting arena of study can assist in our appreciation for this multifaceted area. This complex arena can be managed more effectively when therapists become more informed about the when, the why, and the what to do about the lies that do present quite regularly in (and outside) of therapy.

When Do People Lie?

Children are born as truth-tellers but learn to lie in the two to five-year-old range, though some studies have documented much younger children being able to engage in fake crying and laughing.  Developmental psychologists reference lying as a way that the child learning to test out their independence, boundaries, power, and identities.

Kohlberg’s stages of moral development highlight different ways in which truth-telling is approached, with estimations suggesting that only 10-15% of adults actually get to the postconventional stages of understanding right from wrong.

Despite parents often addressing the importance of honesty, there are often other messages teaching children to conceal their true emotions or to squelch their requests.  As children age, their secrets and lying about possessions move to lies about activities or peers.  By the time most reach adulthood, there is a fair amount of distortion and deception going on fairly regularly.

Although the majority of individuals lie only a little, the frequency of humans lying in some form or another is fairly high.  As Dan Ariely, prominent researcher in the field of dishonesty and developer of the documentary film (Dis)Honesty, notes eloquently, “Lying is not evil, it is human.”

Ariely and his team have dozens of creative experiments showing the multifaceted way in which humans can rationalize, avoid, distance from the lying and deception that goes on in even the most minor of circumstances.  Even Charles Darwin wrote about how lying is part of how our species survived, and the feigning and faking responses can be observed in many animal and plant species.

There are various types of reasons why individuals hold lies and secrets, and the scenarios vary wildly.  While secrets are considered to be the omissions, lies are identified as the direct commission. Lies can be divided into various categories, such as verbal vs. non-verbal, intended vs. unintended, white lies vs. whoppers, and self-protective vs. self-serving.

There have also been divisions focused more on the causal factors: manipulative lies (driven by self-focused and self-serving motives), melodramatic lies (with goal of being center of attention), grandiose lies (because of deep need to win the constant approval of others), evasive lies (to avoid trouble or shift blame), or guilty secrets (related most often to shame or fear of disapproval).

We lie about a number of different issues, but avoidance of shame and embarrassment seems to be one of the most common underlying causes. Most individuals who lie are not pathological or prolific liars but rather those with generally more normalized experiences of living in our culture.  There are some individuals, many of whom are often highlighted in cinematic series and movies, who may have personality disorders that influence their behavior overall. Research does show, however, that frequent lying makes subsequent lying easier.

Why Do Clients Lie in Therapy?

Within the context of therapy, the reasons for lying take on some extra layers of complexity. Van der Kolk, Pat Ogden, Diana Fosha, and others have helped therapists to be more aware of the secrets held in the body that are deeply rooted in past trauma and often not within a client’s consciousness.

But the impact of direct, conscious lying in therapy can range from distracting to derailing, and so therapists being more informed about this important arena is valuable.  In their seminal book entitled, “Secrets & Lies in Psychotherapy,” Farber, Blanchard & Love (2019) have pulled together some of the most significant research in the realm of lying in psychotherapy.

Some of the noteworthy highlights of the therapy lying underscore fascinating truths. It turns out that lying is quite ubiquitous in therapy, with 93 percent saying they consciously lied at least once to their therapist and 84 percent saying they lie regularly.

Only 3.5 percent owned up to their lies to their therapist voluntarily and only 9 percent were uncovered by therapists. Patients report that most lies are spontaneous and unplanned, coming up as early as the first session.

Lying was found to not differ significantly by demographic factors, with the exception of the fact that younger clients are on average more dishonest than older clients.  Bottom line conclusions: we won’t ever know everything going on for our patients.

There are some topics that seemed to be lied about more often, primarily in the realm of minimizing psychological distress and severity of symptoms.  On a list of top 10 lies, the number one item (endorsed by 54 percent) was the “how bad I really feel” item. Worry about being judged or criticized seems to be prominent.

Patients lie about things like why they missed an appointment and hide their doubts about whether therapy is effective, but even more concerning is how Farber’s team found that about 31 percent report concealing thoughts about suicide.  Fortunately, it seems that increased psychoeducation around how suicidal thoughts are handled could significantly decrease the deception around this often misunderstood topic.

When clients do lie in therapy, many do apparently feel guilty or conflicted about doing so; others reported feeling more safe and in control by lying because it allows them to have power with important information that feels risky if discussed.

Therapists apparently do sometimes have suspicions but hesitate to make a false assumption and damage the relationship, and this leads to more cover-up of topics that might otherwise be addressed more directly. Therapists, too, have a series of topics about which they sometimes lie, and this is another area of important study (Jackson, Crumb & Farber, 2018).

What To Do About Lies?

Specific interventions for lies and secrecy range from informed observation to direct confrontation.  Although each case is naturally unique, there are some general guidelines which can be considered in therapeutic situations to allow potentially more effective, informed and authentic interpersonal interactions which can enhance therapeutic progress.

Prevention of lying in therapy is naturally best accomplished early on, and the intake process would be an ideal time to reference the notions of someone getting more out of therapy if they remain open and honest.  Validating avoidance urges and normalizing cover up tendencies in a natural way can be helpful.  Being clear about confidentiality limits and what would trigger a hospitalization can also assist in a client not having to guess at how information would be managed.

Addressing a lie is like so many other areas of mental health: awareness is the first step for effective coping. Attunement to dishonesty in clients and ourselves can enlighten the therapeutic process and provide a base for effective interventions.

Often patience is required, sometimes in part to see if the dishonesty is an ongoing pattern that definitely needs to be addressed or if was more of a single instance that might be less significant.

Therapists can always address dishonesty more gently with “Can we talk about why it’s hard to talk about?” approach.  Farber, Blanchard & Love (2019) also provide a series of questions that might assist in opening up a topic of hypothesized deception, including “I am wondering if I am missing something?” or “I wonder if there are other parts of what you are talking about that are painful or hard to talk about?” We naturally can positively reinforce times when difficult disclosures are made but maintain a balance between being unaffected versus over-eager.

There will be times when we may also need to maintain respect how there are benefits of some lying and secret-keeping for some people, especially as we take into account just how normative it is for humans. In a Carl Rogers type of way, we can sometimes support individuals by approaching them in a non-judgmental and fully accepting way.

We might sometimes need to slowly incorporate ways of creating more effective narratives for themselves and improve their sense of self over time, but it is generally the patient who needs to lead the if and the when.  We know that significant self-delusion cannot lead to true happiness but shades of grey abound.

Sometimes, we may need to take a confrontational approach, especially when dangerous or self-harming behaviors are involved; yet, therapists still have to balance being compassionate with being somewhat skeptical of material presented.  We are not seeking truth in the way a lawyer might be seeking truth, but we are aware that more direct dealing of some difficulties is likely to lead to more productive processing.

We can continue to provide the awareness that there is a natural reluctance in terms of sharing that is self-protective and allows for impression management, and we, as therapists, do need to maintain deference for this function.

Lying is a complex topic deserving further study. Fibbing and falsifications alters interpersonal and intrapersonal experiences, in and outside of therapy, and ongoing learning in this fascinating field will help to bring out more moral health and happiness for our clients and ourselves.

Resources:

Ariely, D. (2013). The (Honest) Truth About Dishonesty:  How We Lie to Everyone – Especially Ourselves.  New York:  HarperCollins.

Blanchard, M. & Farber, B. (2016). Lying in psychotherapy: Why and what clients don’t tell their therapist about therapy and their relationship. Counselling Psychology Quarterly, 29:1, 90-112.

DePaulo, B. (2018). The Psychology of Lying and Detecting Lies.  Amazon Digital Services: USA.

Evans, J. R., Michael, S. W., Meissner, C. A., & Brandon, S. E. (2013). Validating a new assessment method for deception detection: Introducing a Psychologically Based Credibility Assessment Tool. Journal Of Applied Research In Memory And Cognition, 2(1), 33-41.

Farber, B, Blanchard, M. & Love, M. (2019). Secrets and Lies in Psychotherapy.  APA: Washington DC.

Garrett, N., Lazzaro, S., Ariely, D., & Sharot, T. (2016).  The brain adapts to dishonesty.  Nature Neuroscience,  19,  1727–1732.

Halevy, R., Shalvi, S. & Verschuere, B. (2014). Being honest about dishonesty: Correlating self-reports and actual lying. Human Communication Research, 40 (1), 54–72.

Jackson, D., Crumb, C., & Farber, B. (2018). Therapist dishonesty and its association with levels of clinical experience. Psychotherapy Bulletin, 53(4), 24-28.

Kottler, J. (2010).  The Assassin and the Therapist: An Exploration of Truth in Psychotherapy and in Life.  London: Routledge.

Merchant R. & Asch D. (2018).  Protecting the value of medical science in the age of social media and “fake news.” JAMA, 320(23), 2415–2416.

 

Lying in Therapy: When, Why, and What to Do About It


 

APA Reference
Wartski,, S. (2019). Lying in Therapy: When, Why, and What to Do About It. Psych Central. Retrieved on December 9, 2019, from https://pro.psychcentral.com/lying-in-therapy-when-why-and-what-to-do-about-it/

 

Scientifically Reviewed
Last updated: 12 Nov 2019
Last reviewed: By John M. Grohol, Psy.D. on 12 Nov 2019
Published on PsychCentral.com. All rights reserved.