Most of us do it: We lie, equivocate, fudge, withhold the truth and bend reality to suit our purposes. Given the ubiquity of such behavior, it isn't surprising it should arise regularly in therapy as well.
"A large part of what we do in psychotherapy is to try and understand people's motivations for distorting reality," says APA's Director of Ethics Stephen Behnke, PhD, JD.
"In fact, you could say it is psychologists' stock in trade."
Indeed, a survey by University of Minnesota-Twin Cities psychologist Caroline Burke, PhD, found that all 52 psychotherapists surveyed had either been lied to by clients, or suspected they had been lied to.
Clients' reasons for lying vary from wanting to avoid painful consequences to feeling too ashamed to share the truth, finds another study by Leslie Martin, PhD, of Wake Forest University's counseling center. In surveying 109 psychology graduate students currently or previously in therapy, Martin found that of the 37 percent who reported lying, most did so "to protect themselves in some way-mostly to avoid shame or embarrassment, to avoid painful emotions and to avoid being judged or rejected by the therapist," she says.
Many such behaviors have their roots in early experiences, notes Melba Vasquez, PhD, an independent practitioner in Austin, Texas, and co-author with therapy researcher Kenneth Pope, PhD, of "How to Survive and Thrive as a Therapist" (APA, 2005) and "Ethics in Psychotherapy and Counseling: A Practical Guide" (3rd edition, Jossey-Bass, 2007).
"The ability to be honest requires either good modeling in families or having developed good mental health," she says.
Those who haven't learned this strength may use lying to cope with life's difficulties; others may use it to fortify a shaky self-image, she notes.
Deception tends to arise more in some therapy contexts than others, adds Jane Brodie, PhD, a private practitioner in St. Paul, Minn. In her experience, clients tend to prevaricate about substance abuse and marital affairs, especially when they are in marital therapy with their spouse. Some also withhold information about childhood sexual abuse or embarrassing feelings about other deep-seated issues, she and colleagues have found.
What therapists can do
Fortunately, practitioners can help clients edge toward the truth.
For one, it is important to establish a safe, respectful environment that allows people to reveal difficult information, says Vasquez. She recommends doing this explicitly: "Early on, you can tell people they'll get more out of therapy the more authentically genuine they can be about their life," she says.
To aid this process, she tries to model honesty herself. For instance, one day she was running late for a session and found her client waiting at her office. When the client asked if the traffic was bad, she answered with the truth: "No, I just didn't plan my morning well enough," she admitted. She also likes to inject a sense of humor when possible, especially in benign areas where people may find it easy to equivocate, such as whether they've done their therapy homework or not.
Martin works gently with clients to discuss the truth when they are ready, and not before.
"I don't want them to feel they've dug themselves a hole by lying about something that's really important to them, that it will later be important to be honest about," she says. She also sets a tone of unconditional positive regard: "I want them to know I'll still accept and care about them no matter what they have to tell me," she notes.
Into the thicket
Cases of long-standing deception or suspected deception, such as affairs or substance abuse, require more delicate footwork, Brodie notes.
If she senses such a secret, she might comment to clients that therapy feels bogged down, and that maybe it's because something important isn't being discussed.
If a secret emerges at someone else's hand-for example, if someone has found an incriminating object that leads them to think their spouse is cheating on them-Brodie will wait and see if the spouse admits it. If not, she will ask the suspicious party how they feel about their discovery.
"At that point the person may still try to cover it up," she says, "but often they know it's something that needs to be addressed, and they'll start to talk about it."
When major secrets do erupt, it can be painful but also a huge relief, Brodie adds. For example, when a client was able to confront a parent who sexually abused her as a child, Brodie was astounded by how quickly the parent broke down and admitted guilt. Such admissions can lead the way to healing for the client and the perpetrator, she says.
Such revelations can catalyze further therapeutic change as well, says Brodie. "What is really helpful about exposing a lie is getting the person whatever extra help they may need," she says, whether it's a recovery program, more intensive therapy or other interventions.
Indeed, a survey of 21 therapy clients in the August 2006 issue of Psychotherapy Research (Vol. 16, No. 4, pages 463-469), by Columbia University psychology professor Barry Farber, PhD, and colleagues, found that clients report clear benefits from finally revealing difficult material.
"Whereas distressful feelings such as shame often precede and accompany self-disclosure," the authors write, "positive feelings such as relief and pride tend to predominate during and after disclosure."
Potential blind spots
Of course, therapists bring their own issues into therapy as well, including whatever experiences they have had withholding the truth.
In fact, to keep compassion at the forefront, it is instructive for therapists to remember how hard it may have been to reveal embarrassing information to supervisors while in graduate school, says Pope, who has investigated how psychologists handle their own difficult material such as anger, hate, fear and suicidal impulses. An article on therapists' own experiences in therapy by Pope and Barbara Tabachnick, PhD, in Professional Psychology: Research and Practice (Vol. 25, No. 3, pages 247-258), found that about a fifth of 800 therapists surveyed admitted there was something important they had kept secret in therapy. In most cases it involved sexual issues.
Indeed, therapist factors appear to play a role in why people lie in therapy, Martin found in her study. There was a highly significant relationship between those who reported such deceptions and those who reported poorer relationships with their therapists, she found. Those unhappy with their therapists cited issues such as not trusting the therapist, feeling their boundaries were being violated and feeling that the therapist didn't care about them, she notes.
While that finding could as easily signal a problem on the part of the client as on the part of the therapist, it's wise to keep alert to countertransference issues you may notice in yourself around lying, and to get therapy in that area if you feel it's an issue for you, Brodie says.
"I really believe it can do nothing but increase your own effectiveness, because it puts you in touch with your own issues," she says. "I also think it helps you understand how important it is for a therapist to be there with clients when they have difficulty expressing something because of shame or other issues."
Tori DeAngelis is a writer in Syracuse, N.Y.