Mental Health Tip of the Week

4 Untruths to Avoid Telling Your Therapist

It's natural to hide things from your therapist, but to what end?

By: Jean Kim M.D

In a previous post, I discussed the natural difficulty in opening to another person about sensitive and difficult topics in one's life, and the importance of doing so in order to begin the process of healing and growth in therapy. Here I discuss the challenging, but more than understandable ways people avoid telling the truth to their therapists, given the anxiety and fear that often surrounds confrontation of painful truths. The point here is not to judge or blame people for turning to these types of avoidance and defense, but to gently highlight ways in which we do so in order to protect ourselves that may sometimes be counterproductive to progress in therapy.

Untruths to Avoid

Everything Is Fine." Minimization is a common way that patients avoid painful topics and detach from intolerable feelings. Sometimes these coping mechanisms veer into frank dissociation, where a horrific trauma elicits a person escaping into amnesia. The key is to maintain a sense of safety and gradually follow the crumbs of one’s story towards the fragmented remnants of a painful memory. Only then can the pieces be put back together to move past them.

Exaggerating Events. 

While it’s probably more common to minimize or hide significant events from your therapist, there are occasions where some people cope with anxiety by veering off into distraction narratives. But a step beyond that understandable defense mechanism is frank exaggeration of past stories, not unlike a squid spraying ink to hide their true whereabouts or destination. In extreme and rare cases, people may turn to a phenomenon called pseudologica fantastica, a form of pathological lying and compulsive exaggeration. These tall tales are often not consciously intentional and are driven by intense fear of underlying anger or emotion connected to past traumas. A skilled therapist will be able to sift past the “ink” and uncover the pain lurking beneath; but it will take more time in such cases.

Crying Wolf. 

A variant of telling dramatically heightened versions of real-life events, these behaviors involve getting a rise out of the therapist to provoke a sense of concern that the patient may have never received due to neglect, or received too often in the form of abusive attention that is compulsively sought. Sometimes it can be expressing dangerous thoughts or self-injury, or physical problems that have no medical basis. It is crucial to take all such thoughts at face value first, but after everything else is ruled out and certain patterns of behavior become apparent, it will take time to address the real underlying feelings of hurt and terror that cause these behaviors to happen.

Hidden Medications and Substance Abuse.

 It’s important to be open to your therapist about all active conditions ongoing, especially any medical issues and any alcohol or drug use. Psychiatrists may need to prescribe medications that can react poorly with unreported issues like other medications or ongoing alcohol or drugs. Other times symptoms may mainly be resulting from primary use of illicit substances. There are a host of targeted treatments for substance use disorder that can better target those issues and give a patient their best chance of feeling better.

Overall, the relationship between a therapist and a patient is a unique space, designed to explore difficult and painful issues in order to help a patient heal and move past them. Trust is of the essence for both parties, as is a dedication to moving forward in a comfortable, safe, tolerant manner. There is no need to be judgmental or punitive about the defenses and roadblocks that may crop up in the nuanced mission of approaching trauma or life stressors; these protections, even if they become maladaptive, are understandable responses to pain, suffering, and fear. The key is to recognize them as they occur, and to make a mutual commitment to continue towards a healing path.