In May of 2020 I got a call from a former client.
I was surprised because she and her long time fiancé had dropped out of therapy in 2019.
In 2019, when I'd called for a follow up to see why they'd dropped out, I never got a response, just the answering machine. It was a complete and utter ghosting.
So in May of 2020, she called me up wanting individual therapy.
As we talked my curiosity grew. Why had she ghosted me? Eventually I couldn't help but ask, "I'm sorry. I'm just a little confused. You dropped out of therapy last time, so I'm surprised you're wanting me to see you again. I thought maybe I'd offended you or something?"
"Oh, no." She said. "I wanted to see you because I don't want to go through my whole story again. Besides, we dropped out last time because he was cheating on me.[1]"
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Clinically we know clients deceive their therapists.
About once a year I get some version of the above revelation: A client I'd thought I'd failed, actually failed because there was a secret affair.
I see about 33 couples a year, so that means 1 in 33 couples I see has a secret affair. And those are just the ones I find out about. The actual numbers of clients hiding things, big things, therapy-destroying things, has to be much higher.
It really makes you wonder how many of treatment failures are due to clients lying?
The research is clear. Clients lie about important information.
In the literature, the idea that clients hide things from their therapist is well studied. This form of deception is called Concealment.
One team reports:
...current estimates suggest that between 40 and 93% of clients conceal or withhold personal details, keep secrets, or lie while in treatment ...[2]
That's a lot of concealment.
Now to be fair, much of that probably doesn't impact therapy much. Clients tell white lies as much as we do. But some of those lies, probably more than we'd like to think, are things which get in the way of successful therapy.
Why clients lie.
Paul Ekman is the world's leading deception detection expert. He's done extensive research on lying and deception. He's come up with various reasons why people lie. The top reasons are :
Avoiding punishment.
Concealing a benefit received by lying.
Protecting someone else from harm.
Self protection.
Maintaining privacy.
The thrill.
Avoiding embarrassment.
and Being polite
Some of these reasons are pretty innocent. If you ask me an inappropriate question, say about my sex life, I'm going to lie to maintain my privacy. And if you invite me to dinner and cook a meal I don't like, say salmon, I'll smile and say something polite, because I don't want to hurt your feelings.
But the other reasons, avoiding embarrassment, self protection, avoiding punishment, have obvious connections to shame. Which leads to the simple fact that unless you're dealing with a compulsive liar, most of the reasons people lie can be traced back to one simple fact:
People lie because the shame of discovery is too painful.
How to deal with client lying.
So what do we do about it?
First, we have to make therapy a safe place for clients. That goes without saying.
Second, we have to ask the question. I do "pit stops" about every 10 sessions, which is my version of treatment plan reviews. During treatment plan reviews I've started asking clients, "Is there anything else you haven't told me?"
Sometimes, not always, but sometimes, clients will muster the courage to divulge a hidden secret.
I think it's important in these moments to shower the clients with praise and validation. To face the shame of disclosure is hard. They need to be rewarded for their efforts.
Third, we have to realize our limitations. One therapist to another, let me just remind you, do your best, but remember if clients don't have the courage to speak the truth it's not your fault. We can't be expected to read minds.
It hurts to be lied to. Let's honor that.
My first response when I learned of client lying was anger.
I mean, I used to be obsessed with fixing clients' problems. I bent myself into pretzels to help clients. So to learn that at a minimum 1 in 33 was actively working against me felt like betrayal.
My second response was to try harder.
Maybe like me you think, "surely if you learned the right things, asked the right questions, learned to read body language you wouldn't get duped by clients' lies. Right?"
If you really feel that's what you need to do, then do it. You have my full support. A good place to start is Paul Ekman's book Telling Lies. If you don't want a full book, check out his blog (he's got a great article on pathological liars), or if you want a video check out Pamela Myer's Ted Talk.
But let's also address the elephant in the room. It hurts to be lied to. We hope that if we learn enough and gain enough skills we won't have to feel that pain again. So we go to drastic measures. We read all the books. We listen to all the podcasts. We attend more trainings.
The problem is, if we just work harder instead of attending to our own hearts then we're guaranteed to burn out.
So if you're hurting, I honor your strength and grieve what it has cost you.
-Fin-
[1] All stories about clients are mixes of various clients with identifying details changed. No identifying client information is revealed in these stories.
[2] Drinane, Joanna & Owen, Jesse & Tao, Karen. (2018). Cultural concealment and therapy outcomes. Journal of Counseling Psychology. 65. 239-246. 10.1037/cou0000246. Feel free to email me for a copy.
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