Jackson, D., Farber, B.A., & Mandavia, A. (2021): The nature, motives, and perceived consequences of therapist dishonesty. Psychotherapy Research, DOI: 10.1080/10503307.2021.1933241
There is very little research or writing about therapist dishonesty with clients. Psychotherapy relies on clients to be honest to establish a therapeutic alliance – but what about therapists? Honesty is different from therapist self-disclosure. Self-disclosure refers to private information that therapists may or may not choose to share about themselves. Dishonesty, on the other hand are words or behaviors that are meant to deceive or mislead. Dishonesty can be covert (implying something that was not completely true) or overt (deliberately providing misleading information). Therapists might justify dishonesty as being carried out to protect their clients from harmful information, although some lying might be done by therapists to protect their own self esteem. In this survey of over 400 psychotherapists, Jackson and colleagues examined the topics, frequency, and some reasons why therapists were dishonest with clients. The therapists who responded to the survey had similar demographics to those practicing in the United States. They were on average 46.25 (SD = 15.59) years old, female (72.8%), mostly White (83.3%), working in private practice (62.6%), with an average of 16.48 (SD = 12.66) years of experience, and working from a range of theoretical orientations. The top reasons for therapist covert dishonesty included lying about feeling emotionally or physically unwell, feeling frustrated or bored with the client, or liking the client. The top reasons for therapist overt dishonesty included lying about feeling emotionally unwell, not remembering something a client said in a previous session, appointment availability, not having had conversations about the client with others, and not paying attention during a session. Over 91% of therapists indicated that they at least once gave the impression of paying attention when they were not, 88% implied they were not available for a session when they were, over 85% gave the impression that a client was making progress when they were not, 84% indicated they gave the false impression about a reason for being late to a session, and 65% at least once explicitly told a client something untrue about their own mental health history. Less than 1% of therapists reported that they were never dishonest with a client. Despite almost all therapists reporting being dishonest on occasion, therapist dishonesty tends to be relatively infrequent.
Most of the time, if a therapist is dishonest with a client it is motivated by the consideration of a client’s best interest. On the one hand, therapists should be tactful by keeping in mind the needs and wellbeing of each client when considering what to disclose. However, research on therapist self-disclosure indicates that clients are more likely to disclose information if the therapist is honest about themselves. And some clinical writers suggest that therapists’ attempts to conceal negative feelings is an unproductive strategy that steers therapists and clients away from difficult conversations that might deepen the therapeutic relationship. As a general principle, therapists must consider whether the covert or overt dishonesty is truly in the service of the client or whether it is to protect the therapist’s self-esteem by not acknowledging their own missteps or limitations.