Many of us associate therapy with a safe place for honest discussion in a judgment-free zone. While lying to a therapist might seem counterintuitive, two eye-opening studies conducted in Matthew Blanchard, Melanie Love and Barry Farber’s new book, Secrets and Lies in Psychotherapy reveal we’re struggling more than you might think with being truthful in therapy.
In study one, researchers asked 547 psychotherapy clients if they had ever lied to their therapist about 58 different topics. An overwhelming 93% admitted to telling at least one lie in therapy, while 6% lied about over 20 of the 58 topics. Participants most commonly lied about how bad they felt (54%), followed by the severity of their symptoms (39%). Lying about suicidal thoughts or their own insecurities were both the third most common untruth (31%).
Study two looked at ongoing lying and avoidance, as opposed to one-off lies. This time, 798 psychotherapy clients were asked how honest they were when discussing a range of 33 topics. Eighty-four percent lied or avoided discussing at least one of the topics with their therapist on an ongoing basis. Ongoing deceit about clients' sexual desires and fantasies came top of the list at 34%, narrowly followed by 33% routinely concealing the details of their sex life. This was succeeded by ongoing deceit about suicidal thoughts (21%) and clients' genuine reactions to their therapist’s comments (20%).
Both studies were conducted in the US, using a range of participants aged 18 to 80, with the clients being disproportionately female (78%). While there isn’t much comparable data from UK-based studies, speaking to a range of psychotherapy clients from diverse backgrounds and drawing from personal experience, we can see similar patterns emerge.
After a decade of deflecting my mental health problems, I was reluctant to let my defences down. In therapy I would downplay low points too painful to relive; say I was 'fine' when I woke up feeling too depressed to get out of bed; minimise my weekend bingeing habits to seem less chaotic. I desperately tried to create tidy parameters for 'socially acceptable' behaviour, dissociating myself from more erratic tendencies. The walls I built were the only things masking my vulnerabilities and shame; I felt too scared to relinquish control. With time, as I began to trust my therapist and find CBT effective, I found myself becoming more honest. Initially, I withheld information for self-preservation but being truthful was an even bigger relief. I thought only pain would come from revealing my deepest insecurities, but sharing them gave me an opportunity to heal.
Sometimes I would go in acting all happy, telling her I had done the tasks and they went really well. But really, I felt stressed because nothing had changed.
For PA Amy*, 25, being more truthful in therapy was a gradual process. "I’ve lied to my therapist about doing the homework for my sessions and how useful I found it. Sometimes I would go in acting all happy, telling her I had done the tasks and they went really well. But really, I felt stressed because nothing had changed. Mid-session I’d start feeling weird about lying so would tell her the truth – that I had been feeling crap and hadn’t got around to doing it. Afterwards, I would feel a lot better for being honest. It seemed a waste of a session, lying to someone trying to help me." With 26% of psychotherapy clients in study one lying about doing their homework or taking suggested actions from their therapist, experiences like Amy’s are far from uncommon.
Still, therapy can sometimes feel like getting naked in front of a stranger: weird, uncomfortable and awkward. But often it’s the truths we would rather keep hidden that we should be addressing.
Production manager Chloe*, 26, can relate to this. "I’ve definitely withheld the truth when I’m talking about stuff I don’t want to reveal, like how I really feel about myself," she says. "Or something which maybe isn’t a huge piece of information, but one of the smaller bits which stick in your mind, that seem too stupid, embarrassing or irrelevant to say. Although all the little stuff helps the therapist build a big picture of you, so it’s important to try being honest about everything, whether it’s big or small."
Oxford-based hypno-psychotherapist Zayna Ratty of ZR Therapy believes cultivating a nonjudgmental space helps encourage more honest discussions. "Clients need to learn that they can trust us. Before they tell us what they really want to talk about, we are taught early on in practice that the presenting issue isn't always the issue. A client may conceal if they feel their concerns might be gaslighted, minimised or othered by their therapist. We need to be aware of our cognitive and unconscious bias as this can lead clients to sense they might not be in a space where they can be completely open. One of the most common is surrounding the risk of client suicidal ideation."
Zayna thinks that in most cases, clients' deceit and concealment "is a complex combination of embarrassment, denial, distortion, dissociation – fearing what the therapist might do. It might be the way the client has learned to cope with their life and so the behaviour continues in session. These layers of truth can eventually be peeled away like an onion but can take time."
Lying can hinder this process, so Zayna advises against it. "Your therapist will be less able to facilitate long-lasting change if you are using falsification or concealment of a vital piece of information. By creating a filtered version of yourself, you are preventing the building of a true, lasting rapport, for the basis of process will be based on a fabric of untruths and ultimately, you are being false with yourself."
I've lied in therapy when really sensitive or intimate things come up; things you wouldn't admit to yourself out loud.
Sometimes discussing topics which give rise to uncomfortable emotions can prompt us to lie. This is something writer Isla*, 24, acknowledges. "I’ve lied in therapy when really sensitive or intimate things come up; things you wouldn’t admit to yourself out loud," she says. "I’m more open about general things. It’s awkward things, like how I feel about myself or my relationships which go too deep into my personal insecurities, or things like disordered eating, which feel uncomfortable discussing with a stranger. For me, I think it’s less about lying and more about watering down the truth, because it feels too unnatural to say."
On the rare occasions secondary school teacher Carmen*, 31, lies, it’s about her availability. "Sometimes when my therapist and I are both going away on holiday and scheduling our next appointment, I’ll lie and say I can’t make that week. Because sometimes I want three weeks, not two weeks off from her. I want a break, as does my bank account." Carmen says she conceals information, rather than lying to her therapist: "I don’t really lie to my therapist in therapy but I do withhold the truth. I’m careful about what I tell her, especially if it’s something I feel she doesn’t have to know. I don’t tell her anything to do with sexy stuff, because I don’t want her to think I’m a slag, sex addict or maniac – I keep it PG."
Zayna sheds more light on this stigma. "The concealment of sexuality, gender or relationship diversity can occur if a client feels a therapist might pathologise an element of their identity. No one wants a diagnosis of being a sex addict, or accused of being a sexual fetishist, yet clients who visit some therapists are still pathologised by outdated assessment models. Even before you enter the therapeutic setting, you bring with you the shame of inhabiting a sex negative culture that disregards expressions of sexuality, gender and relationship diversity. We are centred on very binary thinking throughout our lives which excludes those relationships, orientations and diverse lifestyles which sit outside of the heteronormative norm. Concealment is one of the number one causes of psychological distress among these minority groups." To overcome such taboos, Zayna says it is vital to understand how a client’s background, language, terminology, ethnicity, belief system and orientation, alongside a therapist’s own culture, influence the client/therapist relationship.
Variables such as our relationship with our therapist, our receptiveness to the form of therapy and where we are in our mental health journey can dictate how honest we feel we can be. It's clear that shame and embarrassment cause us to lie as a defence mechanism, as we struggle to address our deepest insecurities aloud. Ongoing deception regarding how we feel about ourselves and minimising our feelings is very commonplace and we can only endeavour to have more honest discussions about these topics to help break the taboo. While seeking professional help can be daunting and mentally draining, it can also be an incredibly enriching and cathartic experience.
Zayna believes compassion, transparency and trust are key for future-proofing a more honest environment. "Clients must know that a therapist is impartial, self-aware of their own triggers, and able to sit congruently with a client on their journey. The therapist can lay open the boundaries around what the expectation of therapy is, how therapy is not always easy, the challenges and how bravery and courage are required. By the admittance that we are all human, we all make mistakes; flaws are as important an exploratory tool in therapy as our successes. It is never too late to start again."
*Some names have been changed