A Therapist’s Dilemma: Telling the Whole Truth vs. Healing the Wound

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Does anyone tell the “whole truth” all the time? No one, I suspect. There is a difference between answering direct questions honestly and offering opinions not requested. The therapist lives in the space between. He does not tell his patient everything he thinks about him.

This is no surprise. His job is to heal, not harm. Our best friends, for example, are careful not to say too much unless the information is essential. Indeed, many people will not offer any hard “truth” ever. Some are afraid of hurting the friend even if the buddy’s mate is having an affair of which he is unaware. As Shakespeare’s Othello says when he is led to believe his wife is sleeping with Cassio:

What sense had I of her stolen hours of lust? I saw ‘t not, thought it not, it harmed me not. I slept the next night well, fed well, was free and merry; I found not Cassio’s kisses on her lips. He that is robbed, not wanting what is stolen, let him not know ‘t and he’s not robbed at all.

Simply put, ignorance of the offense is bliss. Othello maintains the injury is not so much the infidelity, but the knowledge of betrayal. This is doubly true in his case, since the report of his wife’s affair is false.

To the extent a therapist is viewed as an authority, his opinion carries particular weight. Patients will, on occasion, request reassurance or ask what his assessment of them is. The counselor’s answer might be any of the following:

  • “Why are you asking?” The healer attempts to turn the conversation to the client’s motives.
  • “My opinion isn’t the one that counts.” The doc deflects the question, pointing out the need for self-esteem independent of anyone else’s viewpoint.
  • The shrink offers a few positives and tactful negatives (not couched as weaknesses or personality flaws), thus addressing the request as a diplomat might.

What if the therapist is in a position to provide information crucial to the patient’s well-being that he might not otherwise receive? For example, let’s say the client has body odor of which he is unaware. I suspect some therapists would shy away from anything as personal as this, but I recall an occasion with a supervisee when I dealt with it head on.

The trainee in her late-20s appeared well-groomed, but the scent always trailed her. Indeed, others on the hospital staff suggested I address the problem for the individual’s good, as well as to make contact with her less noxious.

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Making matters even more delicate was the gender difference between this lady and me. Still, it was essential my supervisee be informed how others reacted to her. I was not eager to impart the information, but my responsibility was clear. This decent and intelligent young clinician could serve her patients well only if she knew what was common knowledge. Failure to inform her would have been a disservice.

Now imagine she’d been a patient in treatment because of dating failures and loneliness. Would it have been responsible to shy away from any mention of a body odor?

A very different situation is more typical. I treated many middle-aged people who were concerned about how an adult child, now out of the home, turned out. Some of these parents felt rejected by an offspring, were depressed, or angry at the child or former spouse to whom they assigned responsibility. Often these folks found little fault in their own errant parenting.

If the patient wanted to improve his relationship with his adult child, the conversation would then involve what he might do differently now. If the offspring blamed the parent for historical wrongs, then self-reflection would be grist for the mill. But what if the relationship was over? Would the patient profit from awareness of his imperfect parenting? What gain might follow from a fresh and excruciating knowledge of the irreparable harm he’d done? Most therapists, I suspect, would allow the person’s rationalizations about his behavior to go unchallenged.

A therapist is not a palace guard barring the way to some heavenly reward, weighing the good and evil in any life, opening or closing the door to the pearly gates. He is not a moral arbiter. The job of harvesting or harrowing souls is left to “fire and brimstone” preachers and others who claim a divine purity far above the counselor’s pay grade.

The healer must keep in mind what the client came for. Most likely he did not ask for administration of an ethical purgative designed to expunge imperfection and cleanse his soul of sins past and present. If the counselor does not remember that, then the therapist, not the patient, has lost his way.

The top photo is called The Mouth of Truth, located near Lipnice nad Sazavou in the Czech Republic. The author is Jarda 75. The second image shows “Michele Linger, left, Sexual Assault Response Coordinator (SARC), lending an ear to a Joint Task Force Guantanamo service member during a counseling session at Guantanamo Bay, Cuba, March 25, 2010.” It is the work of Army Spc. Juanita Philip. Both photos are sourced from Wikimedia Commons.

13 thoughts on “A Therapist’s Dilemma: Telling the Whole Truth vs. Healing the Wound

  1. This is a really hard one – and I don’t envy therapists having to walk this extraordinarily difficult tightrope. I have just been through (and come out of – intact! 😉 ) a week of what I have been calling very ‘tough love’ by my therapist. A few home truths, a kick up the backside, a few comparisons with War and Peace! It hurt – a lot; it was a massive shock; but it worked. On the one hand I feel bad and frustrated that it takes something like this to make me see sense and to effect a change – I sort of feel as though I should be able to change anyway, that I should be less intransigent. But at least, I suppose, some things do have an impact, and I do respond to challenge in the end, even if it has to be fairly hard hitting to get through…or maybe it _feels_ more hard-hitting than it is, I don’t know….
    That aside, I am also often conscious of the fact that I interpret lots of things from what my therapist doesn’t say or half-says, as well as from what she does. In that sense I allow myself to believe things that may not be strictly true, and she doesn’t disabuse me of those notions. That concept does bother me, because I don’t like the thought of believing a lie, but I can see the dangers, as you describe them, of being ‘unnecessarily honest’ where no useful purpose is served, and possibly the opposite may occur. When we were going through these difficult times recently, I did try and press her, repeatedly, to tell me how she was feeling. I know that some therapists are much more open about their counter-transference – but she was firm in stating that her feelings and reactions were for her to manage and deal with, and I suppose that is another sort of instance of not telling too much of the truth, as it may burden or be unhelpful to the client.
    Thank you for another fantastic, interesting, and thought provoking post 🙂

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    • I’m glad you passed through the trial. Treatment is hard on both sides, but tougher (for sure) on the patient’s end. Your therapist seems to be helping you and you are helping yourself. That is the best measure of success.

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  2. Yes, its one of the things that makes the therapy relationship so unique and unlike any other. Not friendship or family like you can ask them “does my butt look big in these jeans” and you’re going to get an honest answer. What I find hard is managing real or perceived ruptures, sometimes after, you just need reassurance that he still cares but that is a very dicey answer to give. That happened once with my T and it was quite a dance for the both of us to get it out without upsetting the boundaries and without him directly saying how he felt but still convey some reassurance, what told the truth for me was not his answer but that he asked ‘is that ok?’ he would only check with me if he cared I think. On the whole I dont put that pressure on him to be constantly giving me reassurance, although I would like to get constant reassurance I think it would just get in the way of the work that needs to be done to help me heal so instead when I need to know how he feels I read therapy blogs such as yours Gerald, because I think he would have much the same response as other caring therapists such as yourself who can write it down in blogs without upsetting any therapy boundaries. I hope you understand what a really important contribution you give to others, well me specifically in coping with my own therapy journey otherwise going through it would be that much harder. Thanks again for another great blog.

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    • I’m glad this is helpful to you, Claire. Thanks for saying so. The dedication you show to your own betterment is a thing no one can give you, but therapists are grateful for. It’s presence is a quality without which progress is usually impossible.

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  3. All I feel qualified to say is that your work as a therapist is complicated. There appear to be many dances that a therapist must learn to do and it all takes time. I can’t imagine being a novice in the field. Perhaps the best thing about being a novice (if you are the least bit aware) is that you don’t really know yet how much you don’t know. It’s when you get going in the profession that the full scope might really hit you. Maybe that’s the way it always is when you work with human beings and not widgets…..

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    • “Perhaps the best thing about being a novice (if you are the least bit aware) is that you don’t really know yet how much you don’t know.” Exactly, JT! If you could communicate to any newborn all the challenges he would face in life, he’d crawl back in the womb!

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  4. Well said Claire, completely agree! 🙂 it’s an important contribution but also very carefully and considerately made, with much care and respect, it seems to me, both for past clients and current clients though not his own, as well as for non clients alike!

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  5. Thanks for sharing, Dr. Stein. I sure don’t envy the role of the therapist in recovery and healing!

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  6. It makes for a very interesting life, Rosaliene. Most of the human race spends lots of time thinking about others, but few get paid for it!

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  7. Oh boy…I’ll take sugar-coated ignorance, thank you! Lol. I’m hard enough on myself as it is.

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  8. “A deception that elevates us is dearer than a host of low truths.”
    Marina Tsvetaeva

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