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Lying in psychotherapy: Why and what clients don’t tell their therapist about therapy and their relationship

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Objectives: The primary aim of this study was to investigate one facet of a survey of client lying in psychotherapy, that which focused on the nature, motivation, and extent of client dishonesty related to psychotherapy and the therapeutic relationship. Method: A total of 547 adult psychotherapy patients reported via an online survey, incorporating both quantitative and qualitative methodologies, what topics they were dishonest about in therapy, and the extent of and reasons for their dishonesty. Results: Ninety-three percent of respondents reported having lied to their therapist, and 72.6% reported lying about at least one therapy-related topic. Common therapy-related lies included clients’ pretending to like their therapist’s comments, dissembling about why they were late or missed sessions, and pretending to find therapy effective. Most extreme in their extent of dishonesty were lies regarding romantic or sexual feelings about one’s therapist, and not admitting to wanting to end therapy. Typical motives for therapy-related lies included, “I wanted to be polite,” “I wanted to avoid upsetting my therapist,” and “this topic was uncomfortable for me.” Conclusions: Clients reported concealing and lying about therapy-relevant material at higher rates than previous research has indicated. These results suggest the need for greater therapist attention to issues of client trust and safety.
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Counselling Psychology Quarterly
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Lying in psychotherapy: Why and what clients
don’t tell their therapist about therapy and their
relationship
Matt Blanchard & Barry A. Farber
To cite this article: Matt Blanchard & Barry A. Farber (2016) Lying in psychotherapy: Why and
what clients don’t tell their therapist about therapy and their relationship, Counselling Psychology
Quarterly, 29:1, 90-112, DOI: 10.1080/09515070.2015.1085365
To link to this article: http://dx.doi.org/10.1080/09515070.2015.1085365
Published online: 23 Sep 2015.
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Lying in psychotherapy: Why and what clients dont tell their
therapist about therapy and their relationship
Matt Blanchard*and Barry A. Farber
Teachers College, Columbia University, New York, NY, USA
(Received 2 May 2015; accepted 18 August 2015)
Objectives: The primary aim of this study was to investigate one facet of a
survey of client lying in psychotherapy, that which focused on the nature,
motivation, and extent of client dishonesty related to psychotherapy and the
therapeutic relationship. Method: A total of 547 adult psychotherapy patients
reported via an online survey, incorporating both quantitative and qualitative
methodologies, what topics they were dishonest about in therapy, and the
extent of and reasons for their dishonesty. Results: Ninety-three percent of
respondents reported having lied to their therapist, and 72.6% reported lying
about at least one therapy-related topic. Common therapy-related lies included
clientspretending to like their therapists comments, dissembling about why
they were late or missed sessions, and pretending to nd therapy effective.
Most extreme in their extent of dishonesty were lies regarding romantic or
sexual feelings about ones therapist, and not admitting to wanting to end ther-
apy. Typical motives for therapy-related lies included, I wanted to be polite,
I wanted to avoid upsetting my therapist,and this topic was uncomfortable
for me.Conclusions: Clients reported concealing and lying about therapy-
relevant material at higher rates than previous research has indicated. These
results suggest the need for greater therapist attention to issues of client trust
and safety.
Keywords: self-disclosure; psychotherapy process; psychotherapy relation-
ship; client variables; therapist training; lying
Seldom, very seldom, does complete truth belong to any human disclosure; seldom can it
happen that something is not a little disguised or a little mistaken. (Emma, Jane Austen)
Client honesty has been central to psychotherapy since Freud set out his fundamental
rule”–that the client should reveal everything that came to mind, as it came to mind,
as honestly as possible. More generally, clientsdisclosure of thoughts and feelings con-
stitute the primary source material with which therapists work (Stiles, 1995). Neverthe-
less, as Freud and many other subsequent theorists and researchers found, clients are
not always honest. They keep secrets (Kelly, 1998), hide their negative reactions to
clinical interventions (Hill, Thompson, Cogar, & Denman, 1993), minimize discussion
*Corresponding author. Email: mpb2160@tc.columbia.edu
Portions of this paper are based on a presentation at the Annual Meeting of the American
Psychological Association, Washington, DC August, 2014.
© 2015 Taylor & Francis
Counselling Psychology Quarterly, 2016
Vol. 29, No. 1, 90112, http://dx.doi.org/10.1080/09515070.2015.1085365
of personally salient topics (Farber & Sohn, 2007), and sometimes spin elaborate
outright lies (Gediman & Lieberman, 1996). Researchers have tried to quantify the
prevalence of dishonesty in psychotherapy, arriving at estimates between 20 and 46%
of clients admitting to secret-keepingin therapy (Hill et al., 1993; Kelly, 1998; Pope
& Tabachnick, 1994). A broader denition of dishonesty that includes twisting the facts,
minimizing or exaggerating, omitting, or pretending to agree with the therapist would
probably nd that client dishonesty is almost universal. Dened in this manner, dishon-
esty is likely to be present to some extent in virtually all human interaction (DePaulo &
Kashy, 1998; DePaulo, Kashy, Kirkendol, Wyer, & Epstein, 1996; Jellison, 1977). For
purpose of this study, and reective of the ways in which clients themselves view their
lying in therapy (Blanchard & Farber, 2015), our focus is not just on overt distortions
of facts but includes as well instances of concealment.
The question for clinicians, then, may not be who lies in therapy?,but rather
what do clients lie about, and why?The study of client dishonesty can highlight
problem areas in psychotherapeutic treatment, alerting therapists to topics about which
they may not have sufcient accurate information to know how to proceed clinically.
Although clients lie about a great many matters, including the extent to which they
experience distressing and even suicidal thoughts (Blanchard & Farber, 2015), in this
paper, we focus on one specic category of client lie, one with signicant implications
for the therapeutic process: client dishonesty about therapy itself or their feelings about
their therapist.
Most every contemporary psychotherapy, even those seen as primarily manual-driven
and symptom oriented, endorses the central importance of the therapeutic relationship. It
is widely considered a common element across therapeutic approaches (e.g. Norcross,
2011). Some orientations (e.g. Person Centered) hold the relationship as primary, as the
essential healing force underlying therapeutic progress; others (e.g. CBT) view it as the
foundation for effective interventions, and still others (e.g. relationally oriented
psychodynamic psychotherapy) see the therapeutic relationship as both healing in its
own right as well as the basis for understanding other prior and current interpersonal rela-
tionships. Extensive research on the signicant positive relationship between treatment
outcome and an effective therapeutic alliance (e.g. Horvath, Del Re, Fluckiger, &
Symonds, 2011) as well as effective resolution of alliance ruptures (e.g. Safran, Muran,
& Eubanks-Carter, 2011) provide further evidence of the importance of a good and pre-
sumably trusting and honest therapistclient relationship. Some theorists (e.g. Cabaniss,
2011) have even suggested that trust is at the heart of the therapeutic relationship. Thus,
client concealment of salient information and/or outright lies may be seen as threats to
the integrity and mutative potential of the clienttherapist relationship. This is especially
the case, given the evidence that therapists are typically unable to detect hidden client
reactions and things left unsaid during sessions (Hill et al., 1993).
As noted above, we dene client lying and dishonesty broadly as any decision by
the client to not be honest with their therapist about relevant information. This
denition assumes both the intent to conceal or deceive, and a conscious awareness of
the falsity. In keeping with previous work in this area, the denition excludes delusions,
rationalization, repression, denial, or other forms of unconscious self-deception. While
some authors have focused on specic types of dishonesty (e.g. secrets, etc.), we
believe client dishonesty is best assessed as an all-encompassing phenomenon.
Investigating any one portion of the dishonesty spectrum, such as secret keeping or
Counselling Psychology Quarterly 91
extent of self-disclosure, is likely to offer only a partial view of the underlying clinical
situation, and may fail at Platos classic injunction to carve nature at its joints.When
clients decide not to be honest with their therapist, they can choose from a range of
strategies, from subtle avoidance and evasion to wild fabrications. The choice of strat-
egy, while clinically interesting and perhaps diagnostic, is arguably less important than
the underlying decision to be dishonest, which typically has signicant implications for
the therapeutic process.
The clinical and research scholarship on client dishonesty, though modest, addresses
three major areas: (a) the types of and motives for dishonesty, (b) topics about which
clients are dishonest, and (c) the consequences of dishonesty for therapy. We review
these studies with a particular focus on the extent to which they have shed light on
client dishonesty about therapy per se or the therapeutic relationship.
Types and motives
Several authors have sought to delineate types of dishonesty encountered in therapy,
and in most cases, the notion of typeencompasses both the strategy used and the
clients motive for lying or concealing information. This approach has produced several
taxonomies of clinical lying, with Gediman and Lieberman (1996), Ford (1996), and
Grohol (2008), each proposing lists with more than a dozen separate types of client dis-
honesty. Gediman and Leibermans taxonomy is the most comprehensive, consisting of
13 categories, including white lies (told for reasons of politeness), gratuitous lies (told
to establish psychological distance), omissions, secrets (a subtype of omissions that is
conscious), outright lies (told deliberately to mislead), and pseudologia fantastica
(pathological lying) and delusions. Their list is meant to capture all varieties of decep-
tion in the analytic dyad(p. 15), with each associated with a motive. Thus, the white
lie is thought to be motivated by politeness, whereas true delusions are considered the
product of psychotic retreat from reality. By contrast, Newman and Strauss (2003) argue
that non-delusional clinical lies fall into just two important categories: lies wherein the
motive is fear and shame (i.e. the client is ashamed or afraid of the truth), and
calculated lies where the motive is to achieve some conscious purpose (e.g. the client
wants to escape responsibilities, get a prescription, or win a legal case).
Hill et al. (1993) distinguished between three types of covert processesengaged
in by clients: hidden reactionsto therapist interventions; things left unsaidin regard
to their thoughts and feelings; and secretsabout major facts or feelings outside ther-
apy. Several studies by Hill and colleagues (Hill, Thompson, & Corbett, 1992;Hill
et al., 1993; Thompson & Hill, 1991) found that clients hide negative reactions to thera-
pist interactions far more often than they hide positive reactions, in both short and
long-term therapy. Hill et al. (1993) suggested that, when clients feel scared, stuck,
lacking in direction, confused or misunderstood, they do not want their therapists to
know(p. 285). Hill et al. (1993) also reported that about half the instances of secret
keeping were motivated by shame and embarrassment, and that the most common
motive for leaving things unsaid was the clients desire to avoid an overwhelming emo-
tion. Respondents reported a belief that the therapist couldnt handleor wouldnt
understandthe truth. Similarly, a study of secret keeping (Kelly, 1998) found the most
common motive was the clients fear of expressing feelings, followed by shame/embar-
rassment, and fear of showing how little progress had been made in therapy.
92 M. Blanchard and B.A. Farber
In a related vein, Rennie (1994) documented a strong tendency of clients to be
deferential. Participants in his qualitative studies reported a reluctance to express nega-
tive feelings, with many believing it was not their place to challenge their therapists
opinions, that criticizing their therapist might imperil the relationship, or that it was
simply unfair to express discontent when therapy was, all-in-all, helping them feel
better.
Topics lied about in therapy
A second line of inquiry has focused on topics, the subjects about which clients are
likely to be dishonest in therapy. Again, our focus here is quite broad; that is, we are
including in this section studies not only of overt lies, but of secrets and other forms as
concealment as well. Hill et al. (1993) tallied the kinds of secrets kept by 26 clients in
individual therapy, nding that sex was the dominant topic (27% of all secrets), fol-
lowed by feelings of failure (7%), and mental health (7%). Pope and Tabachnick (1994)
asked respondents (476 clients who were therapists themselves) if there was something
important they had kept secret and refused to disclose to any therapist(p. 251). The
highest percentage of reported secrets included sexual issues (51%), feelings about the
therapist (10%), personal history of abuse (8%), and substance abuse (6%). Martins
(2006) survey of 109 psychology graduate students who had been in therapy indicated
that the most prevalent lies were about relationships (13% of the total lies reported),
substance use (11%), symptom severity (9%), and sexual behavior (7%); feelings or
thoughts about the therapist constituted 4% of the lies reported in this study.
Farber and Halls(
2002) study of topics least discussed in therapyprovides a
somewhat different perspective on this general subject. According to their respondents
(not restricted to mental health professionals), the least discussed topics in therapy
include My sexual feelings toward or sexual fantasies about my therapist,and My
interest in pornographic books, magazines, movies, videos, etc.A related study (Farber
& Sohn, 2007) identied topics for which there were signicant discrepancies between
clientsself-perceived extent of disclosure and their ratings of the topics importance to
them. The greatest discrepancies were found for topics related to sex (concerns about
my sexual performance;the nature of my sexual experiences), inadequacy (my feel-
ings of inadequacy or failure), and abuse (my experiences of being sexually abused
as a child).
Consequences of dishonesty
Despite the widespread assumption that client honesty and forthright self-disclosure are
essential to positive therapy outcomes an assumption implicitly supported by studies
of the therapeutic alliance the empirical research is inconclusive. There is substantial
evidence that disclosure through writing is helpful in dealing with trauma (e.g.
Pennebaker, 1997). However, the link between extent of client disclosure and outcome
in the context of face-to-face psychotherapy is more tenuous, at least in part because of
the likelihood that more disturbed and harder-to-treat individuals (e.g. those with a his-
tory of trauma) disclose signicant clinical material more intensely and repeatedly
(Stiles, 1987). Kellys(1998) study found that the tendency to keep relevant secrets
from ones therapist was a signicant predictor of having fewer symptoms of
Counselling Psychology Quarterly 93
psychological distress. This nding led to Kellys(2000)self-presentational viewof
psychotherapy, suggesting that the choice to not disclose negative personal information
allows clients to construct and strengthen positive identities. Kellys view is, however,
controversial (Hill, Gelso, & Mohr, 2000) and runs counter to other studies indicating
signicant positive associations between client disclosure and therapeutic outcome (e.g.
Farber, 2006; Farber & Sohn, 2007; Sloan & Kahn, 2005).
Clients themselves tend to be primarily positive about the immediate consequences
of their disclosures; they also tend to believe that withholding clinical material nega-
tively affects the process of therapy (Farber, Berano, & Capobianco, 2004). In fact, the
post-disclosure emotions rated most highly by interviewed clients included relieved,
authentic,and safe, at the same time, vulnerablewas also a highly rated emotion.
Existing research paints an intriguing but contradictory picture of client dishonesty
about therapy itself, and the motives behind it. Detailed, small-sample studies (e.g. Hill
et al., 1992,1993; Rennie, 1994) suggest client deference toward the therapist plays a
role, and that much of what is hidden by clients does indeed involve the experience of
therapy. Yet large-sample surveys suggest that dishonesty about therapy is rare, reported
by only 1% of the sample in Pope and Tabachnick (1994) and 4% in Martin (2006).
Lack of a common denition of lying and/or concealment, use of overlapping terms
(including lying,”“secret keeping,”“non-disclosure,and hidden reactions), and the
adoption of highly divergent methodologies, all contribute to the apparent inconsisten-
cies. For example, the seemingly low rates of dishonesty about therapy reported by
Pope and Tabachnick and Martin may reect a specic feature of their methodology.
That is, both surveys asked an initial question to the effect of, Have you ever lied to
your therapist?Answering such a question accurately would require a mental review
of months or even years of therapy, a cognitive burden likely beyond the commitment
level of most survey participants. Most respondents are likely to require more prompt-
ing to recall such instances. By contrast, the results of smaller sample qualitative studies
are often confounded by the limitation of allowing therapists to recruit clients used in
the study, a problem which Rennie (1994) has noted may result in the recruitment of a
group of clients characterized by relatively good working alliances( p. 434). This may
result in the unintended exclusion of clients with greater therapy-related dissatisfactions
to conceal. Arguably, both large-scale quantitative approaches and smaller scale
qualitative approaches have produced underestimates of the general rate of dishonesty
in psychotherapy, including rates of dishonesty specically related to therapy or the
therapeutic relationship.
The present study
In keeping with our denition of client dishonesty, this study queried psychotherapy
clients about the entire spectrum of conscious dishonesty, including times when they
may have lied to their therapist, minimized, exaggerated, made up facts, concealed, or
found it hard to tell the whole truth. No specic hypotheses were formulated. However,
this study did have several specic aims. The rst was to gage the prevalence of client
dishonesty (broadly dened) in a large sample of psychotherapy clients. Our second
aim was to determine the general prevalence of dishonesty about therapy-related topics.
Our third, related, aim was to gage the relative frequency of specic types of therapy-
related dishonesty. Our fourth aim was to assess clientsself-perceived motivations for
94 M. Blanchard and B.A. Farber
their dishonesty about therapy-related topics. Our nal aim was to provide personal
accounts of client dishonesty that could add narrative richness to the numbers.
Method
Participants
The study included 547 respondents (111 men, 427 women, 9 other; age range
1880 years, M= 34.8, SD =13.4) who are currently or were previously in psychother-
apy. Marital status was reported as single or never married by 336 respondents (61.5%).
Participants self-identied as Caucasian (80%), African-American (3.1%), Asian and
Asian-American (4.6%), Latino (2.4%), and Native American (.7%); the sample also
included 50 respondents who reported being biracial or other(9.2%). This was a
well-educated sample with 59% reporting a bachelors or higher degree; 22.5% of the
sample reporting being in or training for a mental health profession.
These demographics can be compared to the therapy-using population reported by
the National Survey on Drug Use and Health (2012). While the current sample is some-
what younger and contains a greater proportion of college graduates, the two samples
are similar in terms of gender and ethnicity. Thus, although the present study used a
convenience sampling method, the demographics bear a good overall resemblance to a
national therapy-using population.
The median number of therapy sessions for clients in the present sample was 51
over the lifespan, and 20 with their current or most recent therapist; 71% of participants
were currently (or most recently) working with female therapists, and 29% with male
therapists. The theoretical orientation of these therapists, as reported by respondents,
included cognitive-behavioral (35.4%), psychodynamic (18%), addiction counseling
(4%), as well as a range of eclectic, gestalt, humanistic, and other therapies (8.3%).
Nearly a third of the sample did not know their therapists orientation. The most com-
monly reported reasons for these clients entering therapy included depression (64%),
anxiety (49%), stress (40%), personal growth (31%), relationship problems (30%), and
traumatic experiences (25%).
Measures
The Columbia survey on disclosure and lying in psychotherapy
This is an online, self-report instrument, designed with the Qualtrics survey software,
incorporating both quantitative and qualitative methodologies. The entire survey takes
respondents an average of 20 min to complete. In order to help respondents access
memories of dishonesty, the survey part of this instrument provides a list of 58 topics
about which they may have been dishonest. The topic list was adapted from the Disclo-
sure to Therapist Inventory IV (DTI-IV; Pattee & Farber, 2008), with items modied or
discarded in keeping with the previous literature on lying and concealment. Two rounds
of pilot studies were conducted to ensure no major topic areas were missed (i.e. no new
topics were suggested by participants). The nal version included a wide range of
possible topics for dishonesty, such as my use of drugs or alcohol,”“my desire for
revenge,and pretending to like my therapists comments or suggestions.The list
Counselling Psychology Quarterly 95
was designed to include situations previously described as secretsas well as hidden
reactionsand things left unsaid(Hill et al., 1993).
Respondents could browse the list and select topics on which they recalled being
dishonest. Further, they had the option to indicate that they had never been dishonest
with their therapist, or to volunteer an additional topic not covered in the list. Respon-
dents who selected one or more topics were then presented with the list of topics they
had chosen and asked to rate the extent to which they were dishonest about each one
on a 5-point Likert scale (1 = a tiny bit,5=totally or extremely).
A second section of the survey asked respondents to choose one lie about which
they would be willing to answer a series of additional questions about the circumstances
and perceived consequences of their dishonesty. This section included a set of open-
ended questions (e.g. Why did you lie to your therapist about this topic?”“Can you
tell us more about it?) in response to which respondents could type in narrative
answers of any length. This section also included a 28-item inventory of possible
motives, allowing participants to click multiple options that they felt described their rea-
sons for being dishonest about a specic topic. A preliminary list of such motives was
compiled based on previous research suggesting that clients may be dishonest for rea-
sons of impression management (Goffman, 1959), in order to avoid offending the thera-
pist (Rennie, 1994), to control the conversation (Regan & Hill, 1992), to avoid shame
(Hill et al., 1993), and to meet the psychological needs of self and other (DePaulo
et al., 1996), as well as for purely practical reasons, such as avoiding legal conse-
quences (Newman & Strauss, 2003). Six graduate research assistants were then asked
to record motives for lies they told in therapy over a three-week period, and later, a
pilot study collected more motives for dishonesty from a sample of 25 respondents. Fol-
lowing a review by the research team (the two authors and six assistants) of the
research literature and the new accumulated data, the nal list of 28 possible motives
were selected to be used in the survey instrument (e.g. This topic was uncomfortable
to me;I wanted to avoid shame;|I wasnt ready to discuss the topic;I wanted to
avoid my therapists disapproval;I wanted to make a good impression;I was
concerned with legal consequences). Respondents could also type in additional
motivations if they did not see theirs on the list.
Self-concealment scale (Larson & Chastain, 1990)
The self-concealment scale (SCS) is a 10-item measure of a subjects tendency to
actively conceal personal information from others that one perceives as distressing or
negative. It uses a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Internal consistency (Cronbachs alpha) for the SCS was .83 in Cramer and Barry
(1999), and .89 in the present study. The SCS was administered as a validity check; it
was expected that respondents who reported lying about more topics would have, on
average, higher self-concealment scores.
Procedure
Participants were recruited through postings to Craigslist sites serving 13 large
metropolitan areas of the United States. The posting message invited them to participate
in a survey on psychotherapy,and contained a link to the survey. All respondents
96 M. Blanchard and B.A. Farber
were entered into a drawing to win one of six $50 Amazon gift cards. There were no
signicant demographic differences in comparing completers of the survey (N= 547)
and drop-outs (N= 150), with the exception of gender: the completer group had a
higher proportion of women (78.1% female) than did the dropout group (69% female),
χ
2
= 5.7, p< .05. Dropouts were dened as those completing less than 80% of the
survey questions.
Results
Overall client dishonesty
A very high percentage (93%) of the sample reported lying to their therapists, with a
total of 4616 lies reported by the 547 participants. The mean number of topics
respondents reported lying about was 8.4 (SD =6.6), with no signicant differences as
a function of client gender, client income or education levels, therapist gender, and
therapistclient gender match. There was a signicant correlation between number of
topics lied about and respondent age (r=.16, p< .001), with younger clients likely to
report a greater number of topics lied about. A one-way ANOVA also indicated that
therapist age group signicantly affected the number of lies reported, F(5, 456) = 3.57,
p= .04: post hoc t-tests indicated that clients with therapists between the (estimated)
ages of 6069 reported fewer lies than clients with therapists in younger age brackets
(2229; 3039; 4049; 5059) as well as the older age bracket (70 and above). In addi-
tion, an independent samples t-test showed that clients who are a different race from
their therapist reported an average of 1.7 more topics lied about (M= 9.66) than clients
who are the same race as their therapist (M= 7.96), t(460) = 2.49, p= .013.
A signicant correlation was obtained between the number of topics lied about and
the SCS, r= .45, p< .001, indicating, as expected, that those who clicked a higher
number of lies were also likely to report a stronger general tendency to conceal negative
personal information.
Only 37 respondents (6.8%) reported having told zero lies in therapy. This group
was on average 6.2 years older than the rest of the sample, t(545) = 2.6, p< .05, and
contained a larger proportion of women than the rest of the sample (86% vs. 71%,
χ
2
= 4.1, p< .05). The remaining 510 respondents (93.2%) reported dishonesty on one
or more topics (see Table 1), with some topics endorsed by as much as 54% of the
sample (i.e. How bad I really feel I minimized) and several other topics endorsed
by more than 25% of the sample, including My thoughts about suicide,”“My insecuri-
ties about myself,and My use of drugs or alcohol.The majority of topics were
selected by between 5 and 25% of respondents, including lies about eating habits, self-
harm, indelity, violent fantasies, experiences of physical or sexual abuse, and religious
beliefs.
A principal components analysis (PCA), with direct oblimin rotation was run on
data generated from all 58 topics included in the full survey. A seven-factor solution
was obtained that explained 42% of the total variance. One of these factors pertained to
therapy-related topics; a therapy factor that explained 5% of the total variance and was
comprised of ve items: pretending to like my therapists comments or suggestions; my
real opinion of therapist; not saying I want to end therapy; that my therapist makes me
feel weird or uncomfortable; and pretending to nd therapy more effective than I really
Counselling Psychology Quarterly 97
Table 1. Topics of lies reported by therapy clients.
Topic N
Percent reporting
dishonesty (%)
1. How bad I really feel I minimized 295 54
2. The severity of my symptoms I minimized 212 39
3. My thoughts about suicide 172 31
4. My insecurities and doubts about myself 167 31
5. Pretending to like my therapists comments or suggestions 161 29
6. My use of drugs or alcohol 159 29
7. Why I missed appointments or was late 157 29
8. Pretending to nd therapy more effective than I do 156 29
9. Pretending to be more hopeful than I really am 145 27
10. Things I have done that I regret 141 26
11. Pretending I did homework or took other actions
suggested by my therapist
140 26
12. My sexual history 119 22
13. My eating habits 113 21
14. My real opinion of my therapist 100 18
15. My feelings about my body 99 18
16. My sexual fantasies or desires 93 17
17. Not saying that I want to end therapy 86 16
18. Self-harm I have done (cutting, etc.) 85 16
19. What I really want for myself 83 15
20. Things I have done that were illegal 81 15
21. Things my parents did that affected me 81 15
22. Secrets in my family 75 14
23. How I really act outside of therapy 73 13
24. The state of my sex life these days 72 13
25. Basic facts about my life 71 13
26. My real feelings about my parents 71 13
27. My masturbation habits 69 13
28. That my therapist makes me feel weird or uncomfortable 67 12
29. How I really act in relationships 62 11
30. The way I give in to othersdemands 61 11
31. Experiences of sexual abuse or trauma 56 10
32. My attempts to commit suicide 55 10
33. My real feelings about my friends 55 10
34. My desire for revenge 54 10
35. How I am mistreated by others 54 10
36. A sexual problem I have had 53 10
37. My real feelings about my spouse or partner 53 10
38. Times I cheated on my spouse or partner 52 10
39. Violent fantasies I have had 51 9
40. My use of pornography 50 9
41. How I really act with my friends 45 8
42. What I can afford to pay for therapy 45 8
43. Placing blame on others when much of it lies with me 44 8
44. My accomplishments (academic, professional, etc.) 39 7
45. Unusual experiences (ex: seeing things, hearing voices) 39 7
46. Experiences of physical abuse or trauma 35 6
47. How bad I really feel I exaggerated 34 6
48. Religious or mystical beliefs that I hold 33 6
(Continued)
98 M. Blanchard and B.A. Farber
do. However, because factor analysis, including PCA, is a somewhat problematic and
controversial procedure when used with binary data (Collins, Dasgupta, & Schapire,
2001), and because we view this study as primarily exploratory, we will present results
(including narrative accounts) for each of the 10 therapy-related topics.
Prevalence of dishonesty about therapy and the therapeutic relationship
The survey included 10 possible lies about therapy and the therapist (see Table 2)
mixed in with the other 48 possible lies about all other topics. Taken together, 72.6%
of clients reported lying about at least one of these therapy-related topics. By compar-
ison, only 46.8% of respondents reported one of seven sex-related lies included in the
survey. Four of the 10 therapy-related topics were each reported by more than a quarter
of the sample, making them among the most widely endorsed items on the survey.
These included Pretending to like my therapists comments or suggestions(29%),
Why I missed therapy appointments or was late(29%), Pretending to nd therapy
more effective than I do(28%), and Pretending I did homework or took other actions
suggested by my therapist(26%). By comparison, the most commonly reported sex-
related lie, My sexual history,was reported by only 23% of respondents.
Another three of the therapy-related topics were moderately common, including
My real opinion of my therapist(19%), Not saying I want to end therapy(16%),
and That my therapist makes me feel weird or uncomfortable(13%). The remaining
three topics were comparatively rare in this sample, including What I can afford to
pay for therapy(8%), My romantic or sexual feelings about my therapist(5%), and
Not saying I am seeing another therapist(3%).
No signicant differences were observed between men and women in likelihood of
reporting at least one therapy-related lie (χ
2
= 1.1, ns). Similarly, no differences were
observed across age differences between client and therapist (χ
2
= 1.4, ns), racial or eth-
nic differences (χ
2
= 2.4, ns), or gender differences (χ
2
= 2.7, ns). Furthermore, number
of therapy sessions attended was not signicantly correlated with the number of ther-
apy-related topics lied about (r= .02, p= .63). Those reporting at least one therapy-
related lie were on average 4.7 years younger than those who did not (M= 33.4 years
Table 1. (Continued).
Topic N
Percent reporting
dishonesty (%)
49. The severity of my symptoms I exaggerated 33 6
50. My romantic or sexual feelings about my therapist 27 5
51. Lies to get a certain prescription 26 5
52. Cruel things I have done to people or animals 25 5
53. Racist feelings I have had 25 5
54. Not saying that I am seeing another therapist 16 3
55. Political beliefs that I hold 15 3
56. Lies to get a certain diagnosis 15 3
57. The way I treat my children sometimes 12 2
58. My real feelings about my children 9 2
Note: N= 547.
Counselling Psychology Quarterly 99
Table 2. Therapy-related topics that are most frequently lied about in psychotherapy.
Topic NPercent reporting dishonesty
Extent of
dishonesty
M(SD)
1. Pretending to like my therapists comments or suggestions 161 29 3.1 (1.1)
2. Why I missed therapy appointments or was late 157 29 2.8 (1.2)
3. Pretending to nd therapy more effective than I do 156 29 3.5 (1.1)
4. Pretending to do homework or take other actions suggested by my therapist 140 26 3.0 (1.1)
5. My real opinion of my therapist 100 18 3.6 (1.1)
6. Not saying I want to end therapy 86 16 3.7 (1.3)
7. That my therapist makes me feel uncomfortable 67 12 3.3 (1.4)
8. What I can afford to pay for therapy 45 8 2.8 (1.4)
9. My romantic or sexual feelings about my therapist 27 5 3.7 (1.6)
10. Not saying I am seeing another therapist 16 3 2.9 (1.6)
Notes: Extent of dishonesty was rated on a 5-point scale where 1 = very little, 3 = a moderate amount, 5 = totally or extremely; these means are based only on the scores
of those individuals who reported they were dishonest about this topic. N= 547.
100 M. Blanchard and B.A. Farber
vs. M= 38.1, t= 3.5, p< .01), and a signicant negative correlation was observed
between client age and the number of therapy-related lies reported (r=.18, p< .01).
Extent of dishonesty about therapy and the therapeutic relationship
In addition to prevalence, the extent of dishonesty was measured for each topic on a
ve-point Likert scale. As Table 2indicates, among the ten therapy-related topics, seven
had mean scores of 3.0 or higher. Topics with the highest mean score on this scale were
My romantic or sexual feelings about my therapist,”“Not saying I want to end
therapy,and My real opinion of my therapist.Notably, the mean extent of reported
dishonesty for these three items was higher than those calculated for extent of dishon-
esty with regard to sexual abuse, physical abuse, and suicide attempts. Furthermore,
across all 58 topics on the survey, these three topics were most likely to occasion the
most extreme degree of dishonesty (i.e. generated the highest proportion of clients who
rated the extent of their lies on these topics as 5, corresponding to totally or
extremely). Lies about therapy, then, were not only among the most commonly
reported lies even more common as a category than lies about sex but they also
comprised a disproportionate percentage of those lies that were extreme in their degree
of perceived dishonesty.
Motivations for therapy-related dishonesty
As noted earlier, motivations for dishonesty were assessed with a clickablechecklist
of 28 possible motives. As shown in Table 3, the most common motives selected for all
instances of therapy-related dishonesty were, I wanted to be polite,”“I wanted to avoid
upsetting my therapist,”“This topic was uncomfortable for me,and I wanted to avoid
my therapists disapproval.These four motives can also be compared to the most
common motives reported for all other, non-therapy lies. As Table 3indicates, this
topic is uncomfortable to meis on both lists, but the remaining motives ( for non ther-
apy-related lies) are different, including: I didnt want to look bad,and I wanted to
avoid shame.
Table 3. Common motives for therapy-related vs. all other lies.
Reported motive NPercent reporting
For therapy-related lies (n= 106)
a
I wanted to be polite 57 54
I wanted to avoid upsetting my therapist 44 42
This topic was uncomfortable for me 36 34
I wanted to avoid my therapists disapproval 35 33
For all other lies (n= 325)
b
This topic was uncomfortable for me 162 50
I didnt want to look bad 148 46
I wanted to avoid shame 143 44
I wasnt ready to discuss the topic 122 38
a
Represents 106 respondents (out of the total 547) who provided motives for any of the 10 therapy-related
topics.
b
Represents 325 respondents (out of the total 547) who provided motives for any of the 48 topics which were
not directly related to therapy.
Counselling Psychology Quarterly 101
Specic lies about therapy and the therapeutic relationship: primary motivations and
narrative accounts
The following section provides more information about nine of the ten therapy-related
lies, including (a) the primary motives (selected from a checklist) associated with each
lie; and (b) clinical examples of each lie, drawn from the set of open-ended text-entry
questions to which respondents could provide short narratives explaining their
dishonesty in their own words. For purposes of clarity, we report the checklist data as
motivesand refer to the open-text data as narratives.The one exception here is
about the tenth topic, Not saying Im seeing another therapist,a lie about which no
respondent provided a clinical example.
Pretending to like my therapists comments or suggestions
As Table 2indicates, this was one of the three most common therapy-related lies,
reported by 29% of our sample. The extent of lying on this topic was generally moder-
ate, as the overall mean was in the mid-range of the scale; moreover, only 8% of those
who reported this lie indicated total dishonesty (i.e. chose 5on the 5-point Likert
scale).
As for motives, 10 out of the 14 respondents who elected to provide further details
about this lie selected I wanted to be politefrom the 28-item checklist. This
politeness motive could also be gleaned from respondentsnarrative accounts. As one
client explained:
I just wanted to make sure the therapist felt like she was helping me, even when her
comments did not help, or maybe made things worse. I was already feeling so bad about
myself, that I didnt want the guilt of making someone feel bad at their job.
This lie appeared to carry serious consequences for therapy, as 6 of the 14 narratives
contained direct references to termination or a failure to progress in therapy, such as It
had the effect of totally neutralizing my progressand I was always unhappy when I
left her ofce.The client quoted above, who wanted to make her therapist feel helpful,
remarked:
I ended up leaving therapy It was a waste of time and money to continue to see her as I
pretended to respond positively to her suggestions and observations.
Why I missed therapy appointments or was late
This lie was also among the three most common, admitted to by 29% of our sample.
The extent of lying reported on this topic was modest, with an overall mean slightly
below the mid-point on the 5-point scale; only 11% of those reporting this lie indicated
total dishonesty (i.e. selected 5on the 5-point scale), motives for this lie were diverse.
Six the 14 respondents who provided more details about this indicated a desire to avoid
embarrassment (I didnt want to look bad), with smaller numbers reporting a desire to
avoid my therapists disapprovalor simplify the conversation.
The 14 respondents who elected to provide narrative details about this lie tended to
ascribe their dishonesty to a variety of seemingly mundane circumstances. Some
102 M. Blanchard and B.A. Farber
overslept. Others forgot. Others contended they could not pay for the session. The most
common explanation for this lie revolved around clientssense that they were in no
condition to undertake therapy that day, often due to the very symptoms that brought
them to therapy. As one patient explained: There are times where I dont leave my
apartment for days. I would lie and tell my therapist that I was physically ill (u, etc.),
though in reality, I was avoiding interacting with anyone, especially my therapist.Most
said this lie had little effect on their therapy, although two respondents noted that it
seemed to feed a tendency to lie about other topics.
Pretending to nd therapy effective
Closely related to pretending to like my therapists comments or suggestionsis the
dishonesty related to pretending to nd therapy more effective than I do”–also
endorsed by 29% of the sample. The average extent of dishonesty about this topic
(M= 3.5) was above the mid-point of the scale; 21% of those who reported this lie
indicated total dishonesty about it. The motives for those respondents who provided fur-
ther information on this topic (n= 20) included a desire to be polite (16 respondents)
and a wish to avoid upsetting their therapist (12 respondents).
Consistent with these data, the narrative accounts of respondents indicated a strong
desire not to make the clinician feel bad. An example:
I told my therapist that it was very helpful for me because she seemed to think it was help-
ful. I would have felt bad if I told her it really hadnt helped me. It affected therapy
because if I had said this method wasnt working, I could have been helped more. I felt
like I was getting worse but didnt say anything.
A second client acknowledged that this lie led to signicant implications for her:
When I was in short-term intensive dynamic psychotherapy, I was not happy with the out-
comes. It was making me more anxious about seeing my family, and my mental state was
increasingly worse. My therapist kept saying how much this therapy helps and can cure
people, but I wasnt believing him. After I stopped seeing him, I became suicidal. Since I
did not believe in the therapy when I said I did, I lied to him and myself. Thus, it made
my mental state much worse.
Clients described the consequences of pretending to nd therapy effective in two main
ways: whereas three respondents reported no impact, ten directly referenced signicant
impacts, such as It made it uselessand I never dealt with my core issues.
Pretending to do homework or take other actions suggested by my therapist
More than a quarter (26%) of the total samples respondents admitted pretending they
had done homework or carried out other promised therapy-related actions when they
had not; 62.5% of those who reported this lie indicated they were in treatment with a
CBT therapist. The average extent of dishonesty about this topic was exactly at the
mid-point of the scale, with only 9% of those reporting this lie indicating total
dishonesty about it.
Counselling Psychology Quarterly 103
Respondents who answered follow-up questions (n= 15) were most commonly
motivated by a desire to make a good impressionand avoid my therapists disap-
proval.In their personal narratives, they described pretending to keep a journal, pre-
tending to have practiced meditation, and pretending to have studied a book on anxiety
management. Some also reported being in secret revoltagainst their therapist, as one
male CBT client explained:
I want advice from a therapist, not a complete takeover of my life. She is asking me to let
go of all my life issuesand just ll out a stupid form whenever I have a feeling, or when
I eat, drink, pee, or even pleasure myself. I pretend to ll those sheets she gave me, to
make it seem that I am improving.
Asked how this form of dishonesty affected their therapy, several respondents noted
feelings of guilt, a failure to make progress, or a sense of disconnection from their
therapist.
My real opinion of my therapist
A total of 18% of the sample acknowledged this form of therapy-related dishonesty. As
Table 1indicates, ratings of the extent of dishonesty on this topic exceeded the mid-
point of the scale; moreover, as noted above, this was among the topics with the highest
proportion of total or extremedishonesty (27%). Respondents who offered more
details about this lie (n= 15) described therapists who talk too much, seem too cultur-
ally different, are intimidating, give ridiculousadvice, fall asleep, seem too support-
ive, or seem not supportive enough. As for motives: Thirteen of the 15 attributed their
dishonesty to politeness.
Their narratives suggested that many were eager to protect their therapists feelings,
As one respondent explained:
She asked me if there was some feeling that this wasnt working, and I lied and said that it
wasnt about her. I didnt want to have deal with her feelings or my own about what it
means for me to not particularly like her style.
Another client described the trap hed fallen into as he desperately tried to conceal his
real feelings about his therapist:
I dont like the guy The sessions are horribly awkward and I dont feel like Im
representing myself accurately and I know he doesnt have a clear picture of what Im
really like. I cant think straight when Im there so I over- and under-exaggerate all the
time.
While three respondents reported little or no impact on therapy of this lie, nine
explicitly referenced negative outcomes, such as termination or lack of progress.
Not saying I want to end therapy
A (non-communicated) desire to terminate was another common focus of client
dishonesty, reported by 16% of the sample. The mean extent of dishonesty on this topic
104 M. Blanchard and B.A. Farber
(3.7) was among the two highest of all therapy-related topics, with 37% of respondents
who acknowledged this form of dishonesty reporting total dishonesty.
Six out of the eight respondents who reported motives said they wanted to be
polite,four wished to avoid upsetting my therapist,and three reported a fear that
they would look badif they were honest about wanting to end therapy. As one
respondent explained in her narrative account, I couldnt bring myself to tell my thera-
pist I no longer wanted to continue sessions because I was afraid she would disagree or
take it personally.The reported consequences of not being honest involved wasted
money, early termination, and a lack of progress. In the words of one young client, the
dishonesty prevented me from getting closure and guring out what it was about
therapy that did or didnt help me in my life.
My therapist makes me uncomfortable
Although a relatively uncommon lie (12% of sample), about a quarter of respondents
who selected this topic rated the extent of their dishonesty to be total or extreme.
Respondents who elected to provide details of this lie (n= 6) indicated that their choice
to dissemble or remain silent was motivated, not only by a desire to avoid upsetting
their therapist (5 respondents) and to be polite (4 respondents), but also by their own
discomfort (5 respondents). One female respondent explained:
I brought up some sex-related anxieties and he asked LOTS of detailed questions and I got
uncomfortable so I gave really vague answers and havent brought up sex in sessions with
him since. I dont know if Im being overly paranoid or if he was actually being creepy.
Another woman wrote about being disturbed by her therapists response to a social
encounter before treatment began:
I allowed my therapist to save face by not fully exploring an experience in which he admit-
ted that he felt personally rejected by me when, prior to our therapeutic relationship begin-
ning, we had met briey in a social situation Though we acted as if it was water under
the bridge, I believe it created the undercurrent that ultimately contributed to the relation-
ships demise.
Respondents were evenly split on the impact of this lie, with three reporting negative
outcomes (e.g. It makes me not want to go to therapy) and three reporting minimal
impact.
What I can afford to pay for therapy
Payment issues are a common point of dispute and negotiation in therapy (Schonbar,
1967), and in some (primarily psychodynamic) modalities may be used to facilitate dis-
cussions of the clients interpersonal dynamics. Dishonesty about what I can afford to
pay for therapywas uncommon in the survey (8% of the sample), and the mean extent
of dishonesty was among the lowest of the therapy-related lies; 13% of those reporting
this lie rated their dishonesty as total or extreme.
Only three respondents elected to tell us more about this particular topic, and none
ever admitted it to their therapist. An example: a man in his mid-30s started lying about
Counselling Psychology Quarterly 105
his ability to pay only after more than a year of therapy and only after he had spent
most of his life savings:
In the last two years I have lost my job due to my mental health issue. At the time I started
seeing my therapist I did not have insurance and had to pay out of pocket. In the past two
years I have spent over $17,000 (almost all of my life savings). I dont think the therapy
has helped but Im very attached to my therapist. A few months ago I told my therapist I
could no longer afford to see her because of the cost. My therapist agreed to reduce her
fee. The truth is my parents help me with my bills, so I can afford to continue seeing her,
I just dont think the therapy is worth what she is charging, because I havent made any
progress.
My romantic or sexual feelings about my therapist
While only 5% of the sample reported lying about romantic or sexual feelings about
their therapist, this topic, along with Not saying I want to end therapy,elicited the
highest mean extent of lying score. Moreover, among all the therapy-related lies, it eli-
cited the highest proportion of respondents indicating that this lie was total or extreme
(46%). The most common motives were I wanted to avoid shameand The topic was
uncomfortable for me.Looking to the narrative accounts provided by six respondents,
there was an evident concern that acknowledging the truth would change the therapeutic
relationship or possibly end it. As one woman explained:
I never told him how obsessed I became the rst few years of therapy. I think he knew but
we never talked about it. It was painful and I missed him between sessions and thought
about him constantly. Even found out where he lived and drove past his house sometimes,
hoping to see him I was afraid he would stop seeing me.
Of the 26 respondents who lied about this topic, 11 acknowledged concealing attraction
to a therapist of the same sex (9 woman-to-woman, 2 man-to-man). Notably, one young
woman described her romantic feelings for a female therapist as ultimately quite helpful
and something she hid for practical reasons:
Being able to see her while Im attracted to her is benecial to me, since it makes me want
to always be on time for all my sessions and try very hard to not slip-up or relapse in order
to impress her. If the lie got out, I would likely be transferred or treated differently, so
there is a bit of stress and anxiety about not revealing it.
Discussion
Overall, this study was an attempt to map the terrain of client dishonesty by surveying
a large number of psychotherapy clients about a wide spectrum of possible topics about
which they were dishonest with their therapist, through the use of any strategy from
subtle omissions to outright fabrications. We found that a high percentage of clients
(93%) reported lying, in one fashion or another, to their therapist, and that, for the most
part, this occurs across all types of clients across all types of psychotherapies.
The percentage of reported lying in the current study is substantially higher than
previous estimates of between 20 and 53% of clients admitting to secret-keepingin
therapy (Baumann & Hill, 2015; Farber, 2006; Hill et al., 1993; Kelly, 1998; Pope &
Tabachnick, 1994), and 37% reporting having liedto their therapist (Martin, 2006).
106 M. Blanchard and B.A. Farber
We attribute most of this difference to our approach, which relied on cued memory
(selecting from a list), rather than free recall (open-ended question). Our gure is closer
to some estimates of lying in everyday social life, which suggest a prevalence rate near
95% over the course of a single week, at an average rate of 12 lies per day (DePaulo
et al., 1996; DePaulo & Kashy, 1998).
Younger clients were more likely to report that they had lied about more topics. In
addition, clients whose therapists were of a different ethnicity than themselves reported
more topics lied about. These ndings underscore the need for open discussion of such
differences and their implications for the clinical process, a point of increasing emphasis
for many professional training programs in psychology (e.g. Sue & Sue, 2012). Still,
the prevalence of lying across our sample, as well as the lack of signicant differences
observed across many other demographic variables (e.g. gender) dening the client, the
therapist, or the dyad, suggests that lying in therapy is nearly universal and that its
occurrence needs to be understood not in terms of individual ethics or pathology, but
rather in terms of the structure and demands of the psychotherapeutic situation.
That is, the expectation of revealing ones most profound thoughts and feelings in
time-limited segments to a typically high-status, non-reciprocally disclosing other, even
in a context where condentiality is almost unconditional and ones therapist is likely
to be accepting and empathic, may inexorably lead to moments or instances of conceal-
ment and dishonesty. It is at times, all too much; self-judgment and/or assumed external
judgment leads most all therapy clients to less-than-honest expressions of the truth
about many topics, including their experiences of therapy itself and/or the therapeutic
relationship.
Our focus on therapy-related lies produced several notable ndings. First, we found
the proportion of clients who report lying about therapy-related topics lies about the
therapist or therapy per se to be over 70%, making this domain of dishonesty far
more prevalent in this study than even lies about sex, the topic which has often been
found in previous studies of therapy clients to be the most commonly concealed type of
material. The prevalence of therapy-related dishonesty appears to have been overlooked
by many previous studies, partly because secrets have been dened as events occurring
outside therapy (Baumann & Hill, 2015) or because these topics have been omitted or
minimized in survey research (e.g. Farber & Hall, 2002). Our operationalization of ther-
apy-related lies is closer to Hill et al.s(
1993) notion of things left unsaid,a study in
which the prevalence of this type of secret or lie was a roughly similar 65%.
Second, we found that some therapy-related topics occasion more extreme degrees
of dishonesty than almost any other subject. Three topics romantic feelings about the
therapist, the desire to end therapy, and the clientsreal opinionof their therapist
elicited total or extremedishonesty at a higher rate than any of the other 55 topics on
the survey. Discussing here-and-now feelings, especially feelings that may be consid-
ered off-limits or impolite, demands more intimacy and courage than many therapy
clients can muster. We suspect that difculties in discussing this cluster and other
related items are a major factor underlying the tendency of great numbers of clients to
terminate therapy without involving the therapist in the decision.
Third, we found that clientsmotivations for therapy-related dishonesty are different
from motives associated with other subjects of dishonesty. Whereas shame and
embarrassment may motivate secret keeping on many topics brought into therapy,
therapy-related dishonesty is more often motivated by other-orientedpsychological
Counselling Psychology Quarterly 107
concerns (DePaulo, 1996), such as a desire to be polite, to avoid upsetting the therapist,
and to minimize the possibility of provoking the therapists disapproval. This nding
could be seen as lending more empirical support to Rennies(
1994) argument that
clientsfears of criticizing their therapist, their eagerness to meet their therapists
expectations, and their attempts to avoid threatening their therapists self-esteem are part
of an overall pattern of deference to the clinician.
While some lies are clearly motivated by the tendency for clients to be deferential,
other lies seem triggered primarily by a poor therapeutic relationship that is, by
clientsdislike and/or distrust of their therapist, leading to their sense that honesty
would be pointless. Although it may be difcult on a priori basis to determine the
elements of an effective therapeutic match,the data documenting the importance of a
positive therapeutic alliance by the third session (e.g. Horvath et al., 2011) point to the
fact that some therapeutic dyads simply do not work well from the very beginning,
providing a too-easy context for dishonesty.
Limitations
Our efforts to take a different methodological tack based on cuing the respondents
memory introduced two important limitations. First, the survey title included the words
lying in psychotherapy.Individuals agreeing to complete such a survey were arguably
more likely to remember having lied to their therapist, undermining the generalizability
of the high proportion of therapy liarsin this study. In a related vein, the focus of this
survey on lying (to the exclusion of instances of truth-telling) may have led to an over-
estimation on the part of respondents of the extent and salience of instances of their dis-
honesty. Second, this study provided a list of 58 possible topics from which
respondents could choose. While this list served to trigger memories that might other-
wise have been forgotten, this set of topics cannot presume to capture all experiences
of dishonesty in psychotherapy. In this regard, a notable absence was possible dishon-
esty regarding ones sexual orientation, although space was provided for users to write
in new topics, topics not on the list may have been under-reported.
Another notable limitation was the absence of data on when participants who were
no longer in therapy had terminated treatment. The passage of time may have an impact
on what is remembered, in terms of the valued aspects of the treatment as well as those
less positive, more problematic aspects.
Clinical and research implications
That so many clients seem to struggle with being honest with their therapists about their
therapeutic experiences, including their relationship, is perhaps both inevitable and trou-
bling. It is inevitable, in the sense that people are rarely fully honest or fully disclosing
in any interpersonal situation. As Goffman (1959) noted so aptly, we are constantly
doing the work of impression management, of attempting to nd a balance between
wanting to be genuine in our expression of self and wanting to sellsome not quite
accurate sense of who we are in an effort to t othersexpectations and judgments.
Furthermore, per Goffman, people conceal aspects of themselves in order to mitigate
inner feelings of fear, guilt, or shame. The results of the present study, consistent with
the work of others who have studied similar processes, attest to the applicability of
108 M. Blanchard and B.A. Farber
Goffmans observations even in the sanctityand presumed safety of a therapists
ofce. As noted above, we are perhaps never entirely free of the fear that others espe-
cially highly esteemed others will judge us harshly, or even think less well of us.
And so, clients dissemble to protect themselves from their therapistsjudgments and
presumed subsequent reactions, and to guard and preserve their own often idealized and
sometimes fragile sense of whom they should be and how they should act.
But this is a troubling state of affairs as well. In some sense, these ndings suggest
that, as a profession, we are failing to provide a sufciently safe place for our client to
disclose some quite signicant clinical information. While therapy is a somewhat safe
place, a place where most clients do reveal a good deal of their innermost thoughts and
feelings (Farber, 2006), it appears as if there are true limitations. In fact, despite the
trend toward relationally oriented practices across multiple theoretical orientations (e.g.
Norcross, 2011), many clients are still struggling mightily to discuss honestly the very
nature of their thoughts about the therapeutic relationship and therapeutic process. Not
doing so not discussing the ways in which therapy is helping or the ways in which it
is disappointing surely has consequences for the client (including his or her commit-
ment to therapy and self-image), the therapist (including his or her morale and feelings
of self-efcacy), the therapeutic alliance, the likelihood of premature termination, and
of course, the probability of positive therapeutic outcomes.
We believe, however, that there are ways in which clinicians can increase the likeli-
hood that clients will disclose signicant material, including that related to the process
of psychotherapy and the nature of the therapeutic relationship. While client honesty
will never be totally unbounded, clinicians who address issues of emotional safety, trust,
condentiality, and disclosure in the earliest stages of therapy and who revisit these
issues periodically throughout treatment, are likely to encounter more open and engaged
clients (e.g. McWilliams, 2004). In a related vein, while most clinicians are aware of
the importance of such relational elements as empathy and positive regard, some would
undoubtedly prot from more focused attention on the dynamics of the relationship per
se. We would also argue for the need for increased therapist training in identifying and
resolving therapeutic ruptures as a means to attenuate client inclinations toward dishon-
esty in the room. Lastly, we believe that renewed attention to the possibilities and bene-
ts of pre-therapy client role induction(e.g. (Patterson, Anderson, & Wei, 2014)
could sensitize clients to expectations regarding therapeutic tasks, including disclosure
about the relationship itself. As Yalom (2002) writes, the therapist should carefully
prepare new patients by informing them about psychotherapy its basic assumptions,
rationale, and what each client can do to maximize his or her own progress(p. 86).
Future research on client dishonesty is needed, especially in the possibly related
areas of client minimization of emotional distress and client avoidance of discussions of
the current state of the therapeutic relationship. The groundbreaking work of Hill et al.
(1993)onthings left unsaidand by Safran and Muran (2000) on the identication
and repair of therapeutic ruptures are excellent examples of research that has begun to
move the eld to a greater awareness of the clinical implications of client dishonesty or
reluctance to disclose signicant clinical material. Still, more is needed to further iden-
tify those specic therapeutic practices that increase or decrease the probability of client
dishonesty. As we understand more about the processes that inhibit or facilitate client
disclosure, we are likely to be in a better position to help our clients heal.
Counselling Psychology Quarterly 109
Acknowledgments
We gratefully acknowledge the contributions of excellent research assistants Melanie Love.
Laura Curren, Lauren Grabowski, Mona Khaled, Lama Khouri, Veronica Ozog, and Katelyn
Zmigrodski.
Disclosure statement
No potential conict of interest was reported by the authors.
Notes on contributors
Matt Blanchard is a fourth-year doctoral student in clinical psychology at Teachers College,
Columbia University. He is currently writing a book with Dr Barry A Farber entitled Secrets and
Lies in Psychotherapy.
Barry A. Farber is the director of Clinical Training and professor of Psychology and Education
in the clinical psychology program at Teachers College, Columbia University. His work focuses
on disclosure and non-disclosure in therapist and clients; he is the author of Self-disclosure in
Psychotherapy (2006, Guilford Publications).
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