Clients often find it difficult to open up in the initial sessions of therapy. This results in withholding of information which can have an impact on progress.
Therapy is a dynamic process—clients often change their understanding of themselves and the world around them as they go through multiple sessions. During this period, it is important to recognize that a client may not fully disclose information about themselves in the beginning. They may also intentionally fabricate information, which can be considered as lying in therapy. This might include not sharing vital information about their mental health history or significant events that contributed to the state of their health; habits such as substance use; and other factors like suicidal ideation that can be dangerous to themselves and those around them.
It is common for clients in therapy to find it difficult to be honest. Psychiatrist Dr Divya Nallur says, “A therapist takes it for granted that they may not get full information from clients in the first few sessions.” In 2015, a study exploring the nature, motivation, and extent of clients lying in psychotherapy found that 93% of people reported having lied during therapy while 72.6% reported lying about at least one therapy-related topic.
What keeps clients from being entirely honest?
There are many reasons that may cause a client to not be completely honest in therapy.
The rapport-building phase: Most people take time to disclose personal information in the initial sessions of therapy. Clients spend the first few sessions—that form the rapport-building phase—understanding the therapist, seeing if they are someone they will feel comfortable opening up to. They reveal information based on how much they trust the therapy process as a safe, non-judgmental space. Talking about specific topics can be difficult for clients if they are not emotionally ready to address them.
Omission over commission: In many cases, information can go undisclosed as a result of omission. The client may not always make a conscious decision to ‘lie’ about a particular matter.
Mandatory referral to mental health services: Another cause for hesitating to share information can come from the fear of being forced to access professional help. This is a valid fear as this is commonly seen among clients who are referred to a mental health professional while undergoing treatment for a physical illness.
Impact of the family: A client’s family can also have an impact on how open they choose to be or can be during therapy. Sometimes members of the family insist on accompanying clients to their therapy sessions to remain privy to the information shared. The discomfort arising from such situations discourages clients from being fully honest with the therapist.
What kind of information do clients generally keep to themselves?
What a person chooses to not share in therapy is specific and personal to them. Clients also restrict themselves from talking about something that is very central to their sense of self, that makes them feel vulnerable and causes them shame.
Clinical psychologist Dr Rathna Isaac says, “It depends on where your (client’s) wounds are and what you are ashamed of.” In matters of family, “secrets” that guard a family’s honor are not discussed even if it is vital to the therapeutic process. Survivors of abuse often withhold information related to the incident as it can be difficult to relive the experience in therapy.
How does not sharing information affect the therapy process?
The information revealed by a client during therapy has an impact on the therapeutic relationship (therapist-client relationship). Dr Ashlesha Bagadia, a psychiatrist and psychotherapist says, “The therapeutic relationship is a controlled setting of a client’s relationships with others.” A person accessing therapy is not obliged to bare it all in the initial sessions, but they must work towards revealing more information as time passes.
Not giving the full picture to the therapist works as a disadvantage to the client who isn’t able to make full use of the service. It halts their progress towards wellbeing; without accurate information to work with the therapist’s ability to aid the client is restricted.
How does a therapist intervene?
A therapist must work on gaining a client’s trust in the initial sessions of therapy. A clear explanation of the treatment process; what the client can expect; rules of confidentiality and boundary setting go a long way in putting a client at ease. The therapist must explain to the client that the information discussed in therapy is confidential unless the client is at risk of harming themselves or others. The clients must be made aware that in case of such situations the therapist is obliged to alert an external party with the required information to assist them.
Following the initial rapport-building sessions, therapists begin to expect increased transparency in communication from clients. In its absence the therapist usually alerts the client if they sense there is relevant information—that is vital to areas addressed in the session — missing from what has been shared with them. This is done in a non-judgemental manner.
This article was written with inputs from Dr Rathna Isaac, clinical psychologist, Dr Divya Nallur, psychiatrist, and Dr Ashlesha Bagadia, psychiatrist and psychotherapist.