The therapeutic relationship is built on good faith. Clients share deeply personal information about their emotional and relationship struggles in hopes that their therapist can help them. Clinicians aren’t supposed to be fact-checkers. Unless we have reason to believe otherwise, we generally assume that what our clients say is true—or at least that it reflects the client’s subjective experiences.
Understanding why some people lie in therapy and what they lie about can help therapists better understand their client’s experience—and potentially reduce the need for their clients to lie to them in the future.
What Clients Lie About
As it turns out, almost all clients lie to their therapists. A study done in 2016 surveyed more than 500 clients and asked about 58 different topics they could have lied to their therapists about. Almost all of them—93% to be exact—acknowledged that they lied about at least one of the topics.
Some of the lies were mundane. Clients would lie about why they missed, or were late to, an appointment. But many lies were directly related to topics that therapists would want the client to be open about. More than half of clients minimized how badly they really felt. In that same study, 39% reported minimizing the severity of their symptoms. Almost a third reported lying about suicidal thoughts, and 29% lied about their drug or alcohol use.
Why Some People Lie in Therapy
Many of the lies reported by clients in this study might have been driven by embarrassment or shame. For example, almost half of the clients surveyed reported lying about at least one sex-related topic. But a surprising number of lies focused on therapy or the therapist themselves, and suggested that clients didn’t want to create conflict with their therapist.
One of the most common lies respondents confessed to was “pretending to like my therapist’s comments or suggestions.” Another was “pretending to find therapy more effective than I do.” Each of those was acknowledged by 29% of respondents. Just over a quarter of respondents said they had pretended to do homework or take other actions suggested by the therapist.
Therapists recognize the importance of the therapeutic relationship in facilitating healing, and often work to intentionally build that relationship. In doing so, we may not realize all of the work our client is doing—including lying—to build and maintain a positive relationship with us. We might prefer that they see those lies as unnecessary—that our clients feel free to disagree with us or to be honest when they haven’t followed our suggestions. But the findings from this study suggest that clients may not see therapists as being meaningfully different from any other person with whom they want to build and keep a positive, accepting relationship.
What Therapists Can Do
Clients appear to make many of the same moral choices about lying to therapists as they would about lying to anyone else. That is, a desire to tell the truth might be outweighed by other considerations, like protecting oneself from embarrassment or avoiding conflict. So framing these lies as bad or hurtful acts seems unlikely to help. It denies their positive motivations, and may only deteriorate the relationship by leading clients to feel bad about lying.
Lying is, of course, just one way that the therapeutic relationship might be based on incomplete or incorrect information. And clients aren’t the only ones who lie or withhold information—therapists do it too, often for fully defensible reasons.
But there are a number of positive steps that therapists can take to make assessment more accurate, to reduce client fears, and to encourage accurate feedback about how the client really thinks therapy is going.
To make assessment more accurate, you can use assessment instruments alongside clinical interviews. Clients are sometimes more willing to be truthful on a pen-and-paper or online assessment than they would be in direct conversation, where they may be more embarrassed. You can also, with your client’s permission, interview third parties—like family members—to get their perspectives on your client’s struggles.
And you can set a framework for assessment by reminding clients that the therapy room is designed as a safe and confidential space where they can share anything they would like to. Let them know that as a therapist you’ve seen and heard it all before, and aren’t going to become overwhelmed or judgmental if your client is honest about the depth of their suffering.
To reduce client fears, it can be helpful to give your clients occasional reminders of the confidential nature of therapy. You can gently inquire about whether your client’s emotional suffering, symptoms, suicidal thoughts, or drug and alcohol use are more severe than what they initially acknowledged. Empathizing with the desire to minimize these issues also can help clients feel comfortable sharing their true experiences.
Encourage Feedback From Your Clients
In order to encourage accurate feedback about the process, routine outcome monitoring may be helpful. This is a formal process of gathering data at regular intervals—perhaps even each session—about the client’s perception of the therapy process and how well the process is moving toward the client’s goals. Routine outcome monitoring provides a safe avenue for clients to express concerns or dissatisfaction with treatment, and appears on its own to create small but meaningful improvements in outcomes.
Ultimately, client lies aren’t something to be feared or judged. Given how common they are, they’re to be expected and empathized with. Doing so won’t eliminate them entirely, but it can help clients see that when they’re ready, they can tell you the whole truth about their experiences.