Thursday, December 2, 2010

The truth and the whole truth

Many clients don’t tell me the truth and the whole truth, its part of the job. I do not take offence at such a thing and realise that it is easy for me as the therapist and much more difficult for the client to talk about the things which they talk about.

Most often when they are not being fully candid it involves something which they are embarrassed about. That usually involves something sexual, or they may have done something illegal and done prison time, treated someone else very poorly or it involves something like self harming or an eating disorder which some people tend to be quite secretive about. These are to be expected and just a part of normal human behaviour which clients like every one else exhibits.

Woman and truck

However on occasions one gets another circumstance which intrigues me. It happens when a client with holds a piece of information that significantly alters the therapy. I had been seeing this man for about two years. Not once a week type of thing but usually a number of sessions in a row, then he would stop for a while and then start again.

He did some good therapy particularly about his early relationships with mother and his siblings. Then after two years he informed me that he had known for a number of years that he was going to have to have a heart lung transplant which the doctors had told him he could die from. He stated that he was told he had a 50% chance of survival from the operation and the longer he waited the worse the prognosis. He always had breathing problems which he mentioned on many occasions and I observed but he never mentioned his dire physical circumstances. He had always passed it off as asthma.

If you are working with a client who may soon die and the longer he did not have the operation the more likely he would die then the goals and process of therapy change significantly. For two years he had worked with me and paid his hard earned money to me and the ‘success’ of the therapy had been significantly hampered by this non disclosure.


I understand he did not want to tell me and he is under no obligation to tell me. The outcome of therapy and his value for money would have significantly increased if he had told me. It’s like going to the doctor to have your bursitis treated and not mentioning that you have cancer. For two years they work on the bursitis so by the end of it you are completely bursitis free but then you die from the cancer.

The other problem this creates is that once a falsehood of this significance and type (ie not embarrassment based) is disclosed then I don’t know if what is now being disclosed to me is yet another falsehood or at least partial falsehood.

Therapists obviously can ever only work with what they are told be the client. Most falsehoods do not significantly change the therapy as described above. When they do it leaves me wondering a bit about the point of it all. Why would a client spend all that time and effort and money engaging in an exercise where the gain is going to be limited. And yes I understand it may be very difficult for a client to discuss such things. It’s just something that I, as a client, would not do and just another odd permutation of the human psyche which clients are for ever presenting to me.



  1. I totally get why he didn't tell you! Of course he wouldn't tell you. He didn't want his illness to affect his therapy. He wanted to be a "regular" person. He wanted to work through his issues, his childhood, his mother and siblings, without you focusing on the fact that he could die soon. Perhaps you would veer the therapy in a direction that you thought it should go, based on the fact that he could die, and he didn't want that to happen. As for spending his hard earned money on something that you don't think is as important as his impending death, well that is his choice to make, no?

    How do you think his therapy would have gone if he had disclosed this fact at the beginning?

    Why was he waiting for the surgery - there was not a suitable organ available, or he was stalling? If the former, than really there was nothing he could do. And perhaps he wanted to live as normal a life as possible while he waited. If he was stalling, then I agree that therapy could perhaps have helped him make the decision to have the surgery sooner.

    I don't necessarily agree that if he had told you sooner the outcome of therapy would have been increased. If he kept coming to you he obviously was finding value in your work together. Value is subjective and it sounds like you are projecting your ideas of what successful therapy is onto him.

    But I am sorry that his lack of disclosure led to distrust on your part. That could definitely impact therapy, in a negative way.

    It sounds like you were a great help to him, despite your doubts about the whole thing.

  2. Probably dealt with a heap of stuff... enough so that he could come out to you like that.

    I am not well but i'm frightened to go the doctors. They use needles and stuff... DELIBERATELY even!!!

    Every one who knows is annoying the BAGS out of me. I'm frightened Tony.

    Honesly... I wouldn't have told you either - no matter how silly it seems you may never have found out unless we worked through some personal stuff first.

    I'm so glad you're home again. Cheers!

  3. Hello Harriet,

    thanks for your comments and i think you make some good points. It raises a good issue about contracting and would I agree to assist him if he did not discuss his state of health.

    Regarding your comment about distrust on my behalf again makes me think. Did I distrust him from that point. I expected him to behave in a consistent pattern and is that the same as distrust? It seems I have more questions from your comments.

    I will probably do another post about some of this


  4. Hello Roses,

    and it is nice to be home.

    thanks for being candid about your state of health and I feel for your sense of fright.

    For me the choice to get medical help is yours and yours alone. If you choose not to and that has major consequences then I would fully support you in making that decision.

    On the other hand I can understand why your close loved ones want you to go to the doctor.

    hugs to you Roses


  5. He didn't want you to directly influence him or pressure him on his decision?

  6. Also maybe a trust thing or intimacy thing? In holding back that info he can also think to himself that you don't actually know him.