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

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.

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.

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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.