Ideally, psychotherapy offers people the opportunity to be completely honest about their lives, with little risk of being judged and plenty of opportunities to heal. But how honest are clients, really, in their sessions with their therapists?

In a new book, Secrets and Lies in Psychotherapy, Barry A. Farber, Matt Blanchard, and Melanie Love describe the results of what are perhaps the two most important studies ever conducted on lying in therapy. In the first study, 547 psychotherapy clients were shown a list of 58 topics and asked, for each one, if they had ever lied about it to their therapist. In the second, 798 therapy clients indicated whether they had engaged in more routine, ongoing deception about each of 33 topics.

The overall rates of lying were stunningly high. In the first study, 93% of the clients told at least one lie to their therapist. In the second, 83% of the clients said that they routinely lied about at least one topic, or actively avoided discussing it.

But why? Why would people go into therapy and then lie to their therapist?

In the second study, clients were asked to explain, in their own words, what made it hard for them to be honest about the topics they were lying about on an ongoing basis. Here are their answers:

Clients Lying to their Therapists: Most Commonly Reported Motives for Ongoing Dishonesty

61% Embarrassment or shame

27% I didn’t want this to distract from other topics

24% I doubt my therapist can help or understand

19% Practical consequences (e.g., legal problems, hospitalization)

18% It would bring up overwhelming emotions for me

16% My therapist would be upset, hurt, or disappointed

The results reveal the power of shame. The most important reason, by far, why clients routinely lied to their therapist about a particular topic was that they felt too embarrassed or too ashamed to tell the truth. Because of those painful feelings, clients continued to lie, over and over again, or else they just avoided the topic altogether.

Feelings of embarrassment or shame motivated ongoing dishonesty in therapy more than twice as often as the next most important reason: Clients did not want the topic they were lying about or avoiding to distract from other topics.

Two of these top 6 reasons why clients routinely deceived their therapist were about the therapist. One was damning: the clients doubted their therapist’s ability to help or understand. The other suggested compassion, however misplaced: the clients worried that if they were honest, their therapist would be upset or hurt or disappointed.

Clients also lied to protect themselves. Nearly one in five (18%) feared that talking honestly about a particular topic would unleash overwhelming emotions.

They also worried about the practical consequences. If they confessed to a crime, would their therapist be obligated to report them? If they were completely honest about how they were feeling or what they were doing or thinking of doing, would their therapist hospitalize them against their will?

What were those clients concealing? Here are the answers, from the 127 clients who were worried about practical consequences of being honest:

39% suicidal thoughts or behaviors

13% drugs or alcohol

8% eating disorder

7% homicidal thoughts

Fewer than 7%: self-harm, being the victim of sexual abuse

What I have summarized here is just a sampling of what Secrets and Lies in Psychotherapy has to offer about the psychology of telling lies and keeping secrets in psychotherapy. I’ll be writing a review of this scholarly book for Psych Central, but I did not want to wait to give you this preview. (And yes, the theme of deception is off-topic for me. It used to be my main area of expertise, but now almost all of my writings are about single life.)

Photo by Fabrizio Morando