Lying in Therapy

for Social Workers, Therapists, Psychologists and Psychiatrists

Creating confidential “safe spaces” where mental health patients can confront their anxieties and past traumas and achieve a degree of self-actualization is the goal of any social worker, psychologist or mental health counselor. Indeed, most therapists have the best intentions and work to help their patients overcome self-defeating behaviors that may be holding them back at work, in relationships, and in life. With that goal in mind and with reserves of empathy and patience at the ready, how then to reconcile with the idea that many, if not all patients in therapeutic practice are actually lying to their therapists, at one point or another?

One study found 93% of patients lie to their therapist. Deception is not necessarily harmful to treatment. Trust is a long term slow motion dynamic that builds in micro-steps and ebbs and flows over time. What we choose to lie about speaks volumes about our interior monologue, about our fantasies and about the gaps between how we wish our world to be, and what it’s really like. Many experienced practitioners view lying as a mile marker in the long process of sharing and revelation which becomes more open and effective as the patient and therapist work as a team to reserve judgment and remove the blocks that get in the way of self-defeating urges, thoughts and actions. That said, it is crucial that mental health professionals learn to recognize signs of deceit regardless of whether they choose to confront their client about their hunches. Some therapists report waiting years before bringing up issues they’ve known all along their clients were dodging through omission, obfuscation, denial or outright conscious lying.

Five Reasons Why Your Client Is Lying To You

Patients may find it expedient to embroider their recollections, shade their memories towards a sunnier outcome, or even outright lie for any number of reasons. Although this phenomenon is to be expected, it can pose challenges for therapists and mental health professionals who are trying to help their patients heal and grow.

Here are five reasons why patients lie to their therapists and social workers and what can be done to address this issue.

Shame and guilt

Patients may lie to their therapists and social workers out of a sense of shame or guilt. They may be ashamed of their behavior or feel guilty about past actions, and as a result, they may withhold information or present a filtered version of themselves. In some cases, patients may fear being judged or criticized, which can lead to a lack of transparency in sessions. It’s essential for therapists to create a safe and non-judgmental environment where patients can feel comfortable sharing their thoughts and experiences.

Self-protection

Another reason why patients may lie to their therapists and social workers is self-protection. Patients may feel vulnerable and exposed during therapy sessions, and as a result, they may withhold information to protect themselves from further emotional pain or discomfort. They may also be concerned about the potential consequences of sharing certain information, such as legal or employment-related issues.

Impression management

Some patients lie to their therapists and social workers as a form of impression management. They may want to present a version of themself that is more positive or aspirational than their actual reality. This behavior is often driven by a desire to be perceived as competent, successful, or desirable. While it’s understandable why some patients may engage in impression management, it’s important for therapists to help patients recognize the importance of being honest and authentic in therapy sessions.

Trauma and PTSD

Patients who have experienced trauma or PTSD may also be more likely to lie to their therapists and social workers. They may be struggling to come to terms with their experiences and may not be ready to share details or memories. In some cases, patients may fear that sharing certain information will trigger a traumatic response, and as a result, they may withhold information or present a sanitized version of their experiences. For example some patients may be wrestling with lingering PTSD or so-called “moral injuries” which may have arisen out of the failure to prevent the injury or death of a fellow soldier, in recent war zones such as Iraq or Afghanistan. A lie or a misdirection during an early therapy session may allow a solider to have some distance to further process his or her experience until they are ready to share what happened.

Addiction and substance abuse

Patients who are struggling with addiction or substance abuse may also be more likely to lie to their therapists and social workers. They may be ashamed of their behavior or fear the consequences of sharing information about their substance use. It’s important for therapists to recognize the signs of addiction and substance abuse, such as secrecy, evasiveness, and defensive behavior, and to approach these issues with empathy and understanding.

Five types of lies you might hear in the therapy room

Outright lies:

The patient, John, tells his therapist that he was an Olympic athlete and won several medals, but when asked for details about his training, competition, and teammates, he struggles to provide any coherent answers. It turns out that John has never been involved in sports at a competitive level and is lying to impress the therapist and cover up his insecurities about his career and relationships. Another patient, Sally might tell an outright lie with no foundation in reality such as claiming that their father was an airline pilot (and as a result was absent from the household) when the father may have been a binge drinker who disappeared for days at a time as a result of blackouts.

Omission:

The patient, Maria, shares with her therapist that she had a difficult childhood and often felt neglected by her parents. However, she leaves out the fact that she was physically and emotionally abused by her older brother, which has left deep scars on her psyche. Maria is afraid that revealing this painful truth would make her seem weak,vulnerable and re-triggered, so she avoids talking about it even though it’s a critical piece of her story.

Minimization:

The patient, Tom, admits to his therapist that he has a drinking problem and often gets blackout drunk, but he downplays the severity of his behavior by claiming that he only drinks on weekends and never drives under the influence. In reality, Tom has been struggling with alcoholism for years and has lost jobs, friends, and family members as a result of his addiction. Patients often minimize the importance of certain mitigating factors in order to dial-down the more judgmental aspects of the difficult subject or experience. Similar to Tom, another patient might mention that they had an incident of infidelity but fail to add that it was part of an ongoing infidelity that took place over several years.

Half-truths:

The patient, let’s call her Lisa, tells her therapist that she has been taking medication for depression and anxiety as prescribed, but fails to mention that she has also been self-medicating with alcohol and sleeping pills to cope with her emotional pain. Lisa is ashamed of her substance abuse and fears that the therapist will judge her or possibly take action to report it, if she admits to it.

Exaggeration:

The patient, Mike, recounts a dramatic story to his therapist about how he narrowly escaped death during a car accident that left him with multiple injuries and permanent disabilities. However, when the therapist asks for medical records or contact information for witnesses, Mike becomes evasive and defensive. It turns out that Mike was involved in a minor fender-bender and has been embellishing the details to gain sympathy and attention. Mike may also exaggerate details of other events to amplify the emotional resonance of the story or simply because it may make for a better attention- provoking moment when recounted.

Three Skills Therapists Use to Spot Lies and Encourage the Truth

Identifying falsehood can help therapists and other trained mental health professionals take crucial steps toward breaking through early smokescreens or defense mechanisms during treatment. Yet most therapists are not trained in identifying deception or in understanding the role that cognitive load plays in the leakage of deceptive tells. The science of lying is a soft science; deceptive cues expressed via facial micro-expressions, body language and story structure can serve as helpful signposts for further examination rather than proof of deception. In the same way that the weatherman can not predict with certainty the arrival of a thunderstorm, a trained lie detector can at best identify cues to deception or red flags —-and artfully ask questions that get to the truth. Lie detection for therapists requires three key skills: Detecting and raising cognitive load, identifying verbal and non-verbal deceptive cues, and understanding the difference between deceptive and honest story structures:

Cognitive Load Manipulation:

Deceptive tells leak when cognitive load is high: when the client is thinking what to say, asked to tell a story in reverse chronological order or attempting to act composed. When cognitive load is high blink rates shift and subjects shift from their baseline postural norms, cadence and vocal tones. Talented therapists raise and lower the cognitive load on their subjects artfully, and then observe behavioral cues that leak. They take note of their client’s baseline behaviors: the tone and cadence of their laugh, their posture, their and leg gestures such as foot tapping. When the load is high their client will be likely to display a shift from baseline and several deceptive cues if lying

Identification of Deceptive Cues:

While it takes extensive training to accurately observe verbal and non- verbal cues to deceit, most patients will flash facial micro-expressions of contempt and duping delight (unconscious smiling) when lying. As well they might lower their voice, slouch further into a chair and unconsciously point feet toward the exit. They may provide conflicting signals between their body language and statements, or rely on protest statements “ why would I do that? That’s a crazy question to ask” to avoid hard questions. Therapists can be trained to look for clusters of deceptive cues: two to three verbal indicators and two to three nonverbal indicators. While a single indicator may be related to anxiety –an anxious foot tapper might normally tap throughout a session—its significant if a patient questions-the -question, flashes an expression of contempt, reaches for a blanket, and slumps in posture and vocal tone all at once.

Story Structure Analysis:

Truthful and deceptive stories are usually structured differently. Liars tend to gloss over the “main event” and pepper their stories with unnecessary detail. Truth tellers tend to add 4 more emotional content into their stories, telling them out of chronological order, with the most emotional moments, most prominent in their rendition. Therapists can be trained to analyze story structure as part of their observational training –as much of their work involves the telling and retelling of crucial personal stories and narratives.

The Complex Dance Between Therapist and Client

Lies provide a window into a patient’s psyche. They signal surrounding landmines that bear addressing– as might Google Maps when presenting a route. This is part of the “dance” that therapists and patients do as they learn to work together – a dance that includes appreciating the richness of fantasy, the insights that deception provides as well as the hurdles it can present. Training in deception detection can be a crucial skill for those in the helping professions—social workers, therapists, psychologists and psychiatrists who navigate blind alleys daily, and can benefit enormously from tools that accelerate an embrace of objective truth and put the patient on a stable path toward self-actualization. For Training in Deception Detection and Getting to the Truth, Pamela Meyer offers courses specifically designed for those in the helping professions: If you are a member of NASW, or NYSED you can also earn CEU’s when taking her live, virtual and pre-recorded courses that offer advanced certification in spotting deception. For her masterclass in deception detection that is a pre-recorded self paced course for social workers, you can earn 11-13 CEU’s.