Apr 14

Lying in Therapy Is a Researched Thing

The topic of secrets and lying in therapy is just one aspect of research at The Psychotherapy, Technology, & Disclosure Laboratory at Teachers College, Columbia University. Dr. Barry A. Farber is the lab’s leader, while doctoral students Matt Blanchard and Melanie Love run the Lying in Psychotherapy element.

From the latter’s online description:

Client dishonesty is a broader category of non-disclosure that includes distorting and fabricating as well as omission, avoidance, secret-keeping, etc. Our initial survey of 547 psychotherapy clients showed large percentages of clients concealing therapy-relevant information, such as suicidal thoughts. We are now preparing a follow-up survey to replicate our initial findings, conducting interviews with clients, and developing a related survey for therapists.

According to the abstract of an article by Blanchard and Farber, the vast majority of clients (93%) admitted to lying in therapy.

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.’

Ryan Howes, Psychology Today, interviewed Blanchard about the research, and some of the more interesting excerpts from their exchange are presented below verbatim:

  • Omission is about 3.5 times more likely than fabrication. Similarly, clients report minimizing the truth about 6 times more commonly than they report exaggerating.
  • …(M)ost demographic factors—gender, ethnicity, education, income—had no relationship to dishonesty in therapy.
  • …(Y)ounger clients reported more lying. Those who lied about one or more topics were on average 4-to-7 years younger than those who reported total honesty. This finding matches findings about lying in everyday life outside of therapy, too.
  • Most commonly, clients lie to avoid the shame and embarrassment they feel even in the confidential, protected space of the therapy room.
  • One of the last questions we ask clients is: “How could your therapist help you be more honest?” We imagined that clients would want more warmth or skill from their therapist, or to know their therapist shared their problems, or understood their culture or class. On the contrary, the dominant response was, “If my therapist asked me directly.” So one simple takeaway from our work is: Just ask.

A “spinoff” of the Lying Lab is called Therapists’ Lies & Detection of Lies, run by doctoral student Devlin Hughes. “Specifically, the lab is exploring how therapists respond when they believe a client is being dishonest with them…”

Tori DeAngelis, not a representative of the above resources but a journalist, has compiled her own suggestions for therapists (APA) to minimize lying in therapy. Some examples paraphrased from her article:

  • Establish a safe space for clients; convey a nonjudgmental attitude.
  • Model the practice of honesty.
  • When possible use humor and acceptance regarding omissions and lies.
  • Tread more lightly regarding possible secret-keeping of a more sensitive nature, but do consider how to reach that material, as clients usually benefit.
  • Keep in mind that you as a therapist may have also had difficulty admitting the truth in therapy. One study “found that about a fifth of 800 therapists surveyed admitted there was something important they had kept secret in therapy. In most cases it involved sexual issues.”
Mar 31

“Big Little Lies”: Domestic Violence Therapy

The current and highly rated HBO comedy/drama mini-series Big Little Lies, a suburban murder mystery starring such notables as Nicole Kidman, Reese Witherspoon, Shailene Woodley, Laura Dern, Alexander Skarsgård, and Adam Scott, is based on Liane Moriarty‘s 2014 bestselling novel.

The Washington Post said of the book, “Big Little Lies tolls a warning bell about the big little lies we tell in order to survive. It takes a powerful stand against domestic violence…”

One way the TV series differs from the book is that creator David E. Kelley has placed more emphasis on a certain delicate and challenging situation being addressed in therapy. According to Carolyn L. Todd, Refinery29, the series in this way helps “make a very unlikable character more sympathetic.”

That character is Celeste (Kidman), an abused spouse. Although she first enters therapy with husband Perry (Skarsgård), this changes when he has to go out of town.

But in the book, Celeste sees the therapist alone from the get-go. Having Perry participate in therapy makes him seem like a better guy: he’s a domestic abuser, yes, but he knows he has a problem and is willing to work on it. It indicates he knows his behavior is unacceptable and wants to change. Celeste and Perry seem like more of a team. Plus, the tense dynamic of the therapy sessions is riveting, as is watching the pair negotiate in the moment how much truth about their marriage they want to share with the counselor.

Although therapists on TV are often portrayed sketchily or negatively or unfairly, there’s a general consensus that this isn’t so in Big Little Lies:

Caitlin Flynn, Bustle: “Therapy isn’t often depicted on TV and, when it is, the scenes tend to be brief and lack depth. The therapy sessions on Big Little Lies don’t just break that mold — they shatter it.”

Maria Elena Fernandez, Vulture: “Dr. Amanda Reisman (Robin Weigert) and Celeste and Perry Wright (Nicole Kidman and Alexander Skarsgård) are so realistic they’re draining.”

Melissa Dahl, New York Magazine: “And you know who else loves the therapist on Big Little Lies? Actual therapists.” Some of the highlighted factors: the realism, Dr. Reisman’s apparently advanced knowledge regarding domestic abuse, and her astute ability to pick up on subtle cues from the client.

Regarding the advisability of seeing Celeste alone considering that it was supposed to be marital therapy, it’s the existence of domestic violence that allows for this. For the optimal care of the victim, an experienced therapist is aware of the need to further assess the circumstances without the direct participation of the abuser.

Flynn expands on how the therapy in Big Little Lies proceeds:

It was only when Celeste began seeing Dr. Reisman on her own that she very, very slowly began to shed her facade. These scenes hit the nail on the head because Dr. Reisman successfully strikes a balance between needling the truth of Celeste without pushing her too hard, which could cause her to shut down and never come to another appointment. The scenes are lengthy, which allows Big Little Lies to flesh out what therapy really looks like — especially for abuse victims. Celeste can’t bear to speak the truth out loud, and her strongest moments in these scenes are conveyed through facial expressions, body language, and eye contact.

By the way, the seventh and final episode airs on Sunday. Time sums up the arc: “…The dreamy miniseries opened on a mysterious murder at the most glamorous trivia night ever. But six episodes in, we still don’t know who died and who the killer is.”

Mar 08

Homophobic Therapist Dads, Gay Activist Sons in “When We Rise”

Last week’s miniseries When We Rise revealed, among many other things, two different unflattering portraits of real-life homophobic therapist dads reacting to their gay sons.

The first such pair we meet is Cleve Jones, the author of last year’s memoir When We Rise: My Life in the Movement, and his father (played by David Hyde Pierce), a psychologist who believes being gay is a sickness to be treated with electroshock or other brain-changing practices.

In the first episode Jones is an adolescent struggling with his budding identity. Now 62, he recently told Terry Gross, NPR, about his despair: “I was planning to kill myself when I was 15 because I thought I was the only queer in the world, and I didn’t want to live that way. And I didn’t want to be ashamed and beaten up, and then I read about gay liberation in Life magazine. And I decided not to kill myself, and I flushed the pills down the toilet.”

As Cleve had feared, his coming out to his parents several years later didn’t go so well. Having purposely waited until he was old enough, he then went off to San Francisco, where he eventually became a well-known activist.

Cleve says he had little contact with his father for at least a couple years after that. Tim Teeman, The Daily Beast: “His mother, a former dancer who taught dance well into her 70s, and he had a much closer relationship. His relationship with his father got close again after Jones was diagnosed HIV-positive and became sick. ‘Both of them were quite perfect in every way. They went to quilt displays and marches and became activists. There was a rapprochement’.”

Jones actually wants to write his next book about his father.

Another key but lesser figure in the mini-series is Richard Socarides, who was an adviser to President Bill Clinton. His father was psychiatrist Charles Socarides (1922-2005), founder of NARTH, the National Association for Research & Therapy of Homosexuality.

In When We Rise Richard (played by his actual younger brother Charles Socarides) is being tapped to aid Clinton on gay and lesbian issues when he has a significant exchange with Cleve Jones. “…Jones (played by Guy Pearce) confronts Richard and asks if he’s related to ‘that homophobe shrink who damned my entire generation.’ Richard turns around and politely says, ‘He’s my father; have a good day'” (Theater Mania).

Father Socarides, in fact, had pioneered conversion therapy, and Richard had yet to reveal to him his own sexual orientation. Influenced eventually by Cleve’s strong opinions, however, Richard decides to come out with it. Adam Nagourney, New York Times, recently got the real scoop from Richard about this scene shown in When We Rise:

‘In that interaction with my father, my father takes out a gun and puts it to his head and threatens to shoot himself,’ Mr. Socarides said. ‘Which actually happened. No one ever knew about it. It was really intense. I hadn’t told anybody that ever, because I was trying to protect him, or I guess in some way I was embarrassed or ashamed of myself. I felt enough time had passed.’

ABC News quotes additional info from Richard about this: “I knew that the gun probably was not loaded, I knew he wasn’t going to fire it. But it was very emotional and I probably did not react in real life as calmly as Charlie does in the film.”

But Charlie told Theater Mania: “Richard’s strength is his ability to remain composed and productive under pressure and not let these personal demons eat at him too much.”

Richard himself to The New Yorker in 2013: I don’t think my coming out to my dad was harder or easier than anyone else’s. I didn’t come out to the founder of conversion therapy. I came out to my father.”

Mar 03

Hardest Part of Being a Therapist (“7 Questions Project”)

Being a therapist: what’s it really like?

Several years ago psychologist Ryan Howes conducted The Seven Questions Project in which he asked “big names in the world of psychotherapy” a series of pertinent questions. Although not everyone answered his request to participate, the ones who did were thoughtful in their responses.

When I recently found his series of Psychology Today blog posts about this and reviewed his queries, the one I found most interesting was the fifth: What’s the toughest part of being a therapist? (For the others, click on the link provided above.) And then I read Howes’s own conclusion regarding the project, which included the following:

“Best Question: I thought it would be questions one, four or seven, but question five (the toughest part of being a therapist) turned out to be the most revealing.”

Below are selected excerpts of some of the therapists’ answers to this specific question.

Thomas Szasz (1920-2012)

Individual psychotherapy — that is, engaging a distressed fellow human in a disciplined conversation and human relationship – requires that the therapist have the proper temperament and philosophy of life for such work. By that I mean that the therapist must be patient, modest, and a perceptive listener, rather than a talker and advice-giver…

Even if the foregoing conditions are satisfied, the therapist’s task may not be easy or enviable, as he may be required to be passive in the face of the client’s self-destructive behavior and tolerate the client’s choosing to stick to his familiar, self-limiting life strategies and not risk entering on the path of liberation.

Harriet Lerner

The toughest part of being a therapist is that you constantly run up against your limitations.

Jeffrey Barnett 

One major challenge of being a psychotherapist is to pay attention to our own functioning, monitor our effectiveness, and to practice ongoing self-care…Just like our clients we must deal with life’s challenges and stresses.

Nada Stotland

Perhaps the most difficult aspect of doing psychotherapy is listening to and absorbing patients’ psychic pain.

Irvin Yalom

Well, I think it’s just holding so much pain at times. Worrying about my patients. Seeing some people that I really can’t help, who in some ways are beyond help. Or seeing a sociopath knowing I can’t really do anything for him or can’t reach him. Or watching some people who are throwing their lives away on drugs and there’s so little you can do about it.

James H. Bray

Not taking client’s problems home with you. Many people come for psychotherapy with significant emotional distress and pain. It is important to leave that with the client and not take it home with you.

John Gray

…Whenever I even start to notice a sense of frustration within myself I recognize that I’m not giving a very good message to my client. Whenever you’re frustrated with someone you’re telling them, “you’re not enough, you’re not doing it right, you’re not living up to my expectations.” That’s not helping the client, it’s not helping yourself.

Glen O. Gabbard

The toughest part of being a therapist is being truly “present” with the patient. The demands placed on a therapist in a typical day of psychotherapy are truly extraordinary. The therapist must be present in a way that allows the patient to feel heard, validated, and understood.

Donald Meichenbaum

The toughest part of being a therapist is how NOT to get caught up with all of the questionable psychotherapeutic “BULLSHIT” that pervades the field.

David D. Burns  

…Learning to accept failure on multiple levels is, to my way of thinking, the key to become a world-class therapist. But that means humility, and setting your ego aside, while you develop superb new technical skills.

Jan 16

“Citizen Therapists for Democracy” Newly Forming

Several months ago I posted about Citizen Therapists Against Trumpism, an organization founded by psychologist Bill Doherty during the presidential campaign. Now Doherty has announced the formation of its replacement, Citizen Therapists for Democracy, an international dues-paying association dedicated to newly evolving goals.

As Doherty stated in his launch-related email, goals of Citizen Therapists for Democracy include the following:

  • Learning and spreading transformative ways to practice therapy with a public dimension
  • Rebuilding democratic capacity in communities
  • Resisting anti-democratic ideologies and practice

Some excerpted points from the Citizen Therapists FAQ section:

If it’s partisan politics (vote for my candidate or party), then it doesn’t have a place in therapy. But if politics broadly means how people with different views figure out how to live together and govern themselves—and then the policies that emerge from this process—then it’s game for conversation in therapy.

To be quite concrete, if you treat anxious or depressed Latino or Muslim clients who are frightened about Trumpism (and anti-Semitism is on the rise), is your job only to treat their symptoms or to also oppose the public xenophobia? We believe the nature of our work inherently combines public and private.

Keep in mind that Citizen Therapists for Democracy is not an “anti” movement. We are promoting democracy and public mental health, and in those contexts will oppose threats from any quarter. Further, there is collective power when members of a healing profession engage the public domain in their role as professionals.

On the matter of the blank slate, it’s really a myth in therapy. If a client learns that his/her therapist is in an organization that opposes aspects of Trumpism, well, that’s probably not going to be such a big surprise based on lots of assumptions the client has already made (you drive a Prius and have the New Yorker magazine in the waiting room). In the same way, if a client worries out loud about family members being rounded up and deported, and the therapist agrees that this is a scary public policy, is this not a validation rather than a misuse of therapist power?

The social forces that allowed Donald Trump the man to become President, and that are rising around the world, are so much bigger than his personality that focusing on a diagnosis risks marginalizing the contributions of therapists. Once mental health professionals took a diagnostic position during the campaign, that’s all the media wanted to know from them—before the media moved on to more interesting topics.

Refer to this link for additional reasons that you might be interested in joining Citizen Therapists.

On the other hand, “You’re probably NOT a good fit if any of the following is a big ‘yes’ for you” (from the same link):

  • Your main focus for action now is making sure Trump is a one-term President with a Democratic Congress after two years.
  • You think that therapists must continue to beat the drum that Trump has a personality disorder that makes him unfit to be President.
  • Your main approach to Trump supporters in the White working class is help them see how they’ve been duped.
  • You believe that Progressive politics has most of the answers to our nation’s problems, with Conservatives having little or nothing to offer.
  • It would feel weird to have Conservative therapists share a social change organization with you.