Question from Erika: How do therapists/shrinks tell if a patient is lying to them, and how do they deal with it, in terms of getting the patient the immediate care they need, as well as in terms of fostering the honesty necessary to the patient’s real long term healing?

Your question is interesting and challenging to answer. First, How do we tell? The straight truth is that every therapist has a unique set of skills and techniques that they use, but none of us can tell all of the time when others are lying to us. On the other hand, a lot of us can pick out deception frequently, sometimes in a heartbeat. For people that aren’t very skilled at deception, their lies can be obvious. When we’ve worked with those skilled at deception, we can just tell, or just feel it in the gut. Current theory is that we pick up subtle clues from peoples’ faces, eyes, voices, and bodies, in which their bodies tell the truth and we sense a mismatch. Human beings are rather marvelous. We can pick up a mountain of information through our senses, get a small percent into conciousness, and our unconscious supercomputer calculates information that we never noticed and sends us back a gut signal that says something like, “This is bunk.” A lot of our clients are just as good or better at doing this than we are, which motivates us to learn to be honest with them, too :).

Second, How do we deal with it in order to help the client get immediate care, and also foster long term healing? Because there are so many varying factors in clients, therapists, and circumstances, I am choosing to answer this question with some musings and observations. A lot of the work of therapy is about honesty. About facing and accepting the truth. More precisely, its about choosing to face and accept the truth. The therapist can encourage the client to make this choice, and make this choice more comfortable and safe for the client, but the client still gets to make a free choice. The lies that mess up our lives can go very deep. Our whole lives can revolve around them until they look like the truth from every angle to us. We humans can live a life based on lies and when we tell our life story to ourselves we think it’s the truth. When our lives are based on lies, we believe these lies ourselves. We tell these lies to others fully believing them, and without any intent to lie. We might inherit these lies from our parents, and then pass them on to our children, and create a new generation of lost souls who can’t find happiness. The job of the therapist is to somehow help the client see the truth.

Let me give an example. Since I’m the narrator of the story, I get to know everything about my client’s life and thoughts, but remember that in real life the truth unfolds in little glimpses. Maybe I get a woman in my office who experienced physical and sexual abuse in childhood. She’s been in several unhappy relationships. She experiences a lot of unpleasant emotions and uses substances to cope. Now she’s sitting in my office trying to tell me her story, trying to find a happier life. She’s not likely to tell me her whole story right off. It’s hard to do that anyway, but she’s fighting against a lot of lies. While she tells her story, she’s looking nervous. Why? Because she has a swarm of lies stinging her the whole time. They’re like thoughts and feelings that zip about so fast that she doesn’t really catch them and notice them. They say stinging things like, “This is a man I’m talking to. Men are jerks. Men don’t understand. They only think of themselves. He can’t be trusted. He can’t understand. He’ll just make fun of me and put me down and judge me. I’ve got to be on my guard so he doesn’t try to make a move on me. He’ll figure out that I’m a nobody that’s only good for one thing–to be used and then thrown out like trash. That’s what I am, trash. My life isn’t even worth coming to therapy to save. I need a drink.” There might be many more bees in that hive of lies. All these lies seem true because of what she’s been through. And they help contribute to her blindness to find a happy life. Because she thinks she’s worthless, she doesn’t think she deserves a shining prince,and keeps kissing frogs. When someone gives her a compliment, she discounts it thinking that they obviously don’t know the real her, or else that it doesn’t count because of all the bad things about her. In this way, even when faced with the truth of her worth as a person, her lies win out in her. I might be inwardly admiring her valiant fight to tell her story while being assaulted by her inner bees, but because she has been put down so much, when I compassionately say, “This is really hard for you,” she interprets it as me thinking judgmentally, “You’re an idiot who can’t even put two coherent sentences together.” So her lies perpetuate themselves and hide the truth from her. My job is to give her a new experience and a safe place to look at the truth. If we have luck, we can fast forward to a time when she can recognize that she is a worthwhile person with a life worth living and something to offer the world besides sex. She will know that she doesn’t need to self medicate because she knows other ways to manage tough emotions and besides, without those bees stinging her all the time, she feels a lot less miserable. And she will know that some men can be compassionate, kind, and can love her for the person she is inside, not just for her body. And when she goes out to look for a new relationship, she’ll be more likely to spot the kind of man with whom she can have a happy relationship, and be more likely to feel worthy of such a man and such a relationship. And if she can’t find a man like that, she will be more likely to feel good about herself anyway, because she is a worthwhile person with or without a man. (Yes, this applies to you.) And that’s the truth about finding the truth in therapy, the best that I can tell it today.