Dishonesty dialogues I

I have provided these slightly edited dialogues is for the purpose of illustrating how people constantly provide partial truths, outright lies, and simple or complex distortions in order to present themselves as they want to be seen. The lies of commission and omission stabilize a partial or distorted self-concept, even though it is understood that the focus of therapy is about making changes in oneself. For the most part, the lies are so habitual and practiced that the patient has limited awareness of his/her behavior. The rules of polite, social conversation usually preclude probing questions, because such questions make us uncomfortable and move us too close to unpredictability in casual relationships. The social lies are the “grease” that make polite conversation as shallow and deceptive as we need it to be, and even in the therapy situation people rarely understand that the rules of discourse are different.

So here you will see the usual lies we all tell, and hopefully we can see what the patient is trying to “sell”. Usually what the patient is trying to present is the person s/he wants to be, not the person s/he fears s/he is. It seems to me, however, that changing our self starts with who we are, not who we ought to be or want to be. This follows from the previous discussion of the effects of lying or truth-telling on outcomes in relationships.

There are many ways of handling dishonesty. Every competent therapist, consciously and deliberately or not, has learned how to detect and deal with such lies. It’s my belief that this approach, that of confronting dishonesty, lies at the heart of every effective therapy. I would like to direct your attention to the patient’s style of dishonesty, rather than the therapist’s style of confrontation, which is probably not as important and is certainly idiosyncratic.

Much of the following material was originally presented at the International Society for the Study of Personality Disorders, in Vienna, 1995.

A. Smoking

Pt: I really want to stop smoking (looking directly and sincerely at the therapist).
Ther: (After a pause) And?
Pt: What? What do you want me to say?
Ther: I’m not understanding. There must be more to it than that.
Pt: What do you mean?
Ther: If wanting to stop smoking were all there is to it, you’d have already stopped.
Pt: (long pause) OK, I really want to stop smoking, but I guess I want to keep on smoking more.
Ther: You “guess”?
Pt: (irritated) All right, all right! I want to smoke more than I want to quit.
Ther: I understand you now. So when we started this conversation, what did you have in mind when you told me only part of the truth?
Pt: Well, I guess that’s what I should say… I mean, it’s what I ought to do.
Ther: You didn’t want to say the part about wanting to keep on smoking?
Pt: No.
Ther: Because…
Pt: Well, that makes it look like I don’t want to stop.. or that I don’t want to try to stop, and I do.
Ther: So… if you were going to say the whole thing in one sentence, how would you say it?
Pt: I’d come in and say… “I want you to know I really want to stop smoking, and I don’t want to say that I really also want to keep on smoking, because I think you wouldn’t like that… that’s not the sort of person I want…. Ought to be.
Ther: OK, that makes sense.
Pt: So. Now what?
Ther: I’m sorry. What are you asking?
Pt: How is that supposed to help me?
Ther: I’m not sure. But I do know that dishonesty hasn’t and can’t help you, and if you intend to change something it’s going to start with where you are and who you are, not where or who you ought to be.

I hope the dialogue begins to clarify the patient’s struggle to have a more positive if less honest self presentation. I might add the patient was unusually cooperative and intelligent.