My Clients Are Liars

By Sharon Livingstone (with Tim Clark)

I’d been treating Colin (not his real name) every week for nearly 2 months when he walked into the treatment room, sagged onto the treatment table and, avoiding eye contact, said that he hadn’t been honest with me.

And, hoo boy, was it a doozy.

I’ve been treating his wife for a few years but until 2 months ago, I’d never met Colin or even knew his name.

Colin was making great progress. He was motivated, doing all the homework I set and had taken tentative steps to returning to sport – which was his goal when he started treatment.

I kept my face composed as Colin sat on my treatment table to explain that he is undergoing treatment for cancer and that the area he’s been struggling with was not actually a muscle tear as he’d told me on intake but a site of metastases.

My face lied. I was not composed. Our treatment sessions had to change. Our goals had to be reset. I had so many questions, and it was clear he really didn’t want to dwell on the answers.

After Colin left, I re-read the intake form he’d completed. My intake form specifically asks about cancer and there wasn’t even a contemplative blue dot on that part of the form to show that he was wavering in his decision to not disclose his complete health history.

Why had my client lied?

All Clients Are Liars

Let’s clear a few things up.

First, everyone fibs. We have our reasons for our fibs – we may get ourselves (or someone else) into trouble if we are honest, we want to win the poker game, the surprise party will be ruined, don’t want the kids to know that Santa is a fraud just yet … Sometimes a lie is kinder than the truth.

Second, I expect a certain level of dishonesty in the clinic room, e.g.:

Me: Have you been doing those stretches/exercises I suggested?

Client: Why, yes, all of them, every day.

Third, while I have my expectations of the treatment, they are not necessarily the client’s expectations. I know that if I have all the information available, I can create a treatment plan that will benefit my client. My client does not know which information is important and doesn’t know how a non-disclosure may impact their treatment.

Fourth, all massage therapists are liars. There are things we don’t tell our clients for whatever reason – it’s too personal, it may be nocebo, we don’t want to admit that our clinic diary is a bit sparse. It doesn’t mean we’re bad people. Massage therapists work by the principle of “do no harm”, so if our fibs are not harmful to our clients, we will continue to fib.

When I reopened my clinic after the first shutdown, I asked clients to fill in a health declaration form which asked specific questions about their health and the health of their close contacts. It quickly became apparent that my clients weren’t honest when they filled that form in. If I ever wanted a lesson in rapid fire risk management and crisis decision-making, my clients made sure I received it.

All clients lie. They even lie to their favourite massage therapist.

Why Do Clients Lie?

Lies take a lot of forms – kindness, malice, avoidance, selfishness.

I don’t believe Colin lied out of malice or intent to deceive. His demeanour made it clear he was uncomfortable talking about his cancer and his cancer treatment. He redirected or shut down my questions. He’d been dealing with – or enduring – it for a significant time before he entered my treatment room. It is possible all Colin wanted was to feel better and get back to sport.

Tim Clark, our favourite massage therapist/psychotherapist combo, offered his thoughts on clients lying.

Our clients are allowed to lie. When they do, it doesn’t necessarily mean a thing about us. If it leads us to reflect on how we might have inhibited their behaviour in some way – made them think they had to lie to us to stay in our good books – then okay. So be it. Might be useful reflection.

But the real responsibility for the lie rests with the client. Why they lie will be a confluence of all sorts of experiences and ingrained beliefs that have nothing to do with us. It’s up to us to give them an experience of feeling free to be honest.

Is Our Relationship Conditional or Unconditional?

Why did Colin’s lie bother me so much? Aside from having to re-draw his treatment plan and determine whether any part of our previous sessions might have caused harm to Colin, I was essentially unaffected by the lie.

Tim suggested I read a chapter on “Unconditional Positive Regard: Constituent Activities” by James R. Iberg. Unconditional Positive Regard (UPR) is a concept put forward by Carl R. Rogers. You can read a reprint of Carl R. Rogers’ original 1957 article from the Journal of Consulting Psychology here. Tim says:

Look at Rogers’ explanation of UPR: “It means a caring for the client as a separate person, with permission to have his own feelings, his own experiences.”

The important thing about UPR is that (Rogers says, and Iberg quotes) it “is a quality of the therapist’s experience toward the client”. In a Rogerian framework, it’s part of the therapist’s responsibility to provide UPR, to put judgement aside as much as possible and give the client an experience of acceptance no matter how grave their confession (or lie, for that matter). Rogers is realistic about UPR, saying it probably wavers at times, but puts it forward as an ideal to strive for. It’s rare to experience UPR in day-to-day life, which is why it can be so transformative in therapy. This is where the therapist’s self-regard comes into it. If the therapist sees themselves as beholden to conditions (‘rules’) that govern their own worth, or is excessively self-punitive, they’re likely to extend the same rules and expectations to others, consciously or not.

Can a massage therapist regard their client with an unconditional positive regard or is there always a condition? Is the massage therapist’s self-image or ego putting a condition on the relationship with their client? Hmm, something else to reflect on.

Massage therapists see themselves as an authority figure, a person of trust and with a lot of relevant knowledge. We see ourselves as trustworthy and deserving of receiving honesty, so when a client lies, it feels personal.

Tim says, “our own self-regard can limit our capacity to offer others positive regard. If we’re inclined to be harsh on ourselves for lying, then we’ll view others negatively for lying too, rather than seeing ‘incomplete/imperfect truth’ as one of the givens of existence.”

If we see ourselves as someone who deserves honesty and full disclosure, is it really that inconceivable that we’re hurt when our self-styled designation as a trustworthy expert is disregarded?

Tim points out that Colin choosing to admit his deception should be seen positively. “Look at the good work you’ve done that has allowed him to feel comfortable enough to come clean with you. That’s huge! You can look at that as PART OF (not contrary to) your treatment. Yes, he was deceptive, but now a barrier has been broken down and you’re able to make decisions from a baseline of truth.”

Perhaps his positive regard for me grew during our 2 months working together to the point where he trusted me and regarded me in such a positive way that he felt induced to come clean? Or maybe his wife berated him when he admitted to her that he hadn’t told me about his cancer. I don’t know – I never asked.

The Truth About Lies

There has been surprisingly little research done on lying by patients. In this research, there is some support for therapists (in this case, physiotherapists) undertaking specific education in patient deception to understand why patients lie and to not harbour ill feeling towards a patient who lies. Would massage therapists benefit from similar education around patient deception?

This paucity of research may be because lying is regarded as normal behaviour instead of extraordinary behaviour.

Tim shared his thoughts:

“I feel like accepting that clients will not (cannot?) always tell the truth – and not punishing them for it – is essential. Clients who lie may already have an excessively self-punitive internal dialogue (the gift of punitive parents) and further punishment will only leave them feeling deflated. Instead, getting closer to the reason they lied to you in the first place, and letting them know that they don’t need to do that with you, can offer them a healing relationship. And a lie like the one made by your client might be based on misinformation too. Maybe he thought cancer treatment meant no massage ever?”

I’m a terrible liar. It’s not that I can’t make stuff up and make it plausible. It’s that I can’t remember what I said in my lie and always seem to get caught out. Perhaps that’s a reason why I dislike lies – I’m jealous that people can sustain their lie. I also expect people to tell me the truth. I guess I’m gullible like that. Yes, I’m one of those people who thought my pet dog really did go to live on a farm (he went to a farm all right, just not to live there). Not to mention that for years, I thought my pet chook went to live with my sister-in-law’s mother instead of her actual fate of failing to get out of the way of my sister-in-law’s foot. This might simply be a lesson in not becoming one of my pets.

We Shall Go On

I asked Tim if there was something we therapists can do to minimise the gaps in information provided by clients.

“I suspect the short answer is no – if someone’s not comfortable sharing something with you, they won’t. But the long answer is, yes, it’s possible – by earning their trust, so they can feel safe sharing information that they feel renders them immoral/undesirable/unlikeable etc.”

If we accept that we aren’t necessarily getting the full answer from our clients, we can still find a way to achieve progress with our treatments and provide support and help to our clients..

In the meantime, Colin continues to experience improvement and has recommenced his favourite sport, albeit not quite at full throttle yet.

Further Reading

https://www.theschooloflife.com/thebookoflife/why-were-all-liars/

https://www.theschooloflife.com/thebookoflife/honesty/

https://www.psychologytoday.com/us/articles/199705/the-truth-about-lying

https://www.psychologytoday.com/us/blog/the-nature-deception/201905/what-is-lie

References

1. Patient Deception in Health Care: Physical Therapy Education, Beliefs, and Attitudes (Curtis, Huang and Nicks), IJHSE Vol. 5, Iss. 1, December 2018

2. The Necessary And Sufficient Conditions Of Therapeutic Personality Change (Rogers) Journal of Consulting Psychology, 1957, Vol. 21, No. 2, 95–103

3. Psychotherapy: Theory, Research, Practice, Training 2007, Vol. 44, No. 3, 240 –248

About the Author(s)

Sharon Livingstone is a massage therapist in Sydney, NSW. She has a size US6 foot but wears a size UK6 hiking shoe in an ever-decreasing radius from her home.

Tim Clark is a massage therapist and psychotherapist in Melbourne, Victoria. He does not enjoy writing his bio for blog articles.

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