A majority of the participants had been deceptive in therapy, and a majority were willing to be deceptive in future therapeutic contexts; participants were more likely to use white lies than other forms of deception in therapy

Deception in psychotherapy: Frequency, typology and relationship. Drew A. Curtis, Christian L. Hart. Counselling and Psychotherapy Research, September 9 2019. https://doi.org/10.1002/capr.12263

Abstract: Deception in therapy has been documented anecdotally through various narratives of therapists. The investigation of its occurrence within therapy has largely been overlooked. We explored the reported frequency of deception within psychotherapy, the types of deception used within therapy, the likelihood of people lying to a therapist compared to other groups of people, and client perceptions of the types of deception that therapists use. Ninety‐one participants were provided with a series of deception examples, asked questions about the use of these types of deception within therapy, and asked generally about their use of deception in therapy. We found that a majority of the participants had been deceptive in therapy, and a majority were willing to be deceptive in future therapeutic contexts. Participants were more likely to use white lies than other forms of deception in therapy. Lastly, participants were less likely to lie to therapists compared to strangers and acquaintances. Implications for research and practice are discussed.

1 INTRODUCTION

When people communicate with each other, there is typically a presumption of honesty; however, people lie (Levine, 2014). In classic diary studies, people report lying, on average, twice a day (DePaulo & Bell, 1996; DePaulo & Kashy, 1998; Kashy & DePaulo, 1996). However, recent research indicates that the distribution of lies is positively skewed, with a small set of people telling many lies and most people telling fewer than two lies per day (Serota & Levine, 2015). Deception takes on a variety of forms such as outright lies, exaggerations, omissions and subtle lies (DePaulo, Kashy, Kirkendol, Wyer, & Epstein, 1996; Vrij, 2000). While there are numerous forms of human deception, the common thread that ties them together is an intent to mislead others. Vrij (2008) discussed various definitions of deception that had been used in the past, noting their shortcomings. He ultimately submitted that deception is “a successful or unsuccessful deliberate attempt, without forewarning, to create in another a belief which the communicator considers to be untrue” (p. 15).
1.1 Background

Over the past several decades, there has been a tremendous amount of basic research investigating human deception (see Vrij, 2008). This research has examined deception in a variety of contexts including intimate relationships (Cole, 2001; Peterson, 1996), in the workplace (Hart, Hudson, Fillmore, & Griffith, 2006; Shulman, 2011) and in forensic areas (Granhag & Strömwall, 2004). However, the prevalence of deception within psychotherapeutic settings has been mostly overlooked. In fact, it has been suggested that “surprisingly little has been written in the counseling journals on the topic of lying” (Miller, 1992, p. 25).

While psychotherapy involves an exchange between a therapist and a client, often perceived as honest (Curtis & Hart, 2015; Kottler & Carlson, 2011), deception is occasionally found woven into components of practice. Deceitfulness is one of the criteria for antisocial personality disorder (301.7) found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5; American Psychiatric Association; APA, 2013). The DSM‐5 also terms lying, motivated by external incentive, as malingering (V65.2). Within psychometrics, deception has been documented as a measure or scale in some assessments (e.g. Greene, 2000; Guenther & Otto, 2010). The Minnesota Multiphasic Personality Inventory‐II (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 2001) contains scales that reveal if a client is attempting to lie or be deceptive in different manners (Greene, 2000). The scant research investigating deception in therapy has focused on psychologists’ ability to detect deception, finding that counsellors and psychologists achieve 62%–85% accuracy rates when attempting to discern lies from truths, where 50% would represent chance levels of accuracy (e.g. Briggs, 1992; Ekman, O'Sullivan, & Frank, 1999). However, meta‐analyses and other literature suggest that accuracy for detecting deception is not much higher than chance for laypeople (54%) and law enforcement professionals (56%; Bond & DePaulo, 2006; Vrij, 2000).

More recently, there has been a re‐emergence of research and literature regarding deception in therapy. One study investigated therapists’ beliefs and attitudes towards client deception (Curtis & Hart, 2015). Curtis and Hart (2015) recruited 112 therapists and asked them to identify their beliefs about indicators of deception and subsequently identify their attitudes towards clients who lie. The results found that therapists possessed a number of inaccurate beliefs about actual indicators of deception (e.g. eye gaze aversion when lying), held a number of negative attitudes towards client deception (e.g. liking the client less) and lied to their clients in therapy.

While investigating psychologists’ ability to detect deception and their beliefs and attitudes towards client deception are worthwhile pursuits, the prevalence of client deception within psychotherapy has remained largely unstudied. Some literature has referenced pathological aspects of lying, termed pseudologia phantastica (e.g. Garlipp, 2017; Muzinic, Kozaric‐Kovacic, & Marinic, 2016). Additionally, in their book, Duped, Kottler and Carlson (2011) documented a number of anecdotal accounts of psychotherapists discovering that their clients had lied in therapy. Some of these reports included fabricating an entire therapy experience (Grzegorek, 2011) and intentionally omitting information about having a terminal illness (Rochlan, 2011). Thus, there is clear evidence that some clients do deceive their therapists.

Even though psychologists’ stories provide anecdotal evidence for the presence of deception within psychotherapy, there remains a dearth of empirical investigation. One recent study explored the occurrence of lying in psychotherapy, finding that 93% of 547 psychotherapy patients reported having lied to a therapist (Blanchard & Farber, 2016). Due to the present study having been conducted prior to the Blanchard and Farber (2016) study, it was not designed as a replication or intended for direct comparison.

In the current study, we sought to broaden the understanding of deception in therapy. We collected empirical data on the frequency of deception in therapy, the types of deception used and the influence of relational roles on deception. Given the previously noted research showing that many people report lying in their close relationships and in therapy, we predicted that the majority (>50%) of participants who had been in therapy would report that they had been deceptive within therapy at least once. Further, we predicted that the use of white lies and omissions would be more prevalent than other types of deception. Previous studies have found that people tell fewer lies to people with whom they are in emotionally close relationships (Vrij, 2008). Based on those findings, we predicted that participants would report being more likely to lie to a therapist than a significant other and family member, and we predicted that they would be less likely to lie to a therapist than social acquaintances and complete strangers. Based on the findings of Curtis (2013) that therapists believe clients are more likely to lie in earlier compared to later sessions, we predicted that people would report more willingness to lie to a therapist during the first session compared to subsequent sessions, due to the lack of emotional connection early in the relationship. Lastly, we predicted that people would be more likely to lie to a therapist that they did not like compared to a therapist they did like.