Is Lying to a Patient Good Therapy?

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Reader’s Question

When is it okay to lie to a patient? I have a friend who has a three-year-old son with a woman whom he dated very briefly. For 3 1/2 years she tried to make him marry her. She lied to everyone, pretending that they were together, deluding herself and others; she attempted to manipulate him into not dating anyone else by threatening to stop him from ever seeing his child. She has caused significant emotional and physical harm to herself and her child throughout the years. She has not abused the child physically, but has drugged him, neglected him, and twice been caught DUI with him in the car. She is a prescription drug addict, and has not been able to let go of the delusion that someday they will be together. The man, in order to have a relationship with his child, has kept his dating life secret.

In the meantime, my friend has fallen in love with a stable, wonderful woman whom he has been dating for two years. While trying to impress upon the mother that there is no future for them as a couple, he has continued to keep his dating information from her, for the reason mentioned above and also because she has been in and out of rehab several times, and he didn’t want to be the cause of a relapse. After her third overdose in three years, she is now back in rehab and seems to be doing somewhat better.

The man has just been granted custody of the child. He and the woman he has been seeing really want to move in together, but the mother’s psychologist has recommended to him that he (and the psychologist) keep lying for as long as it takes for the mother to get healthy. For now, the psychologist recommends saying that he is ‘dating’ but not anyone in particular.

I’m just wondering — is lying really the best approach here?

Logic would seem to suggest that lies are what got them all into trouble in the first place and that part of the mother’s recovery is facing all these lies in a safe and nurturing environment, like rehab. She has long suspected that he was seeing other people and when the truth does come out eventually, she will discover that she has been lied to for all this time anyway. Won’t that endanger any progress that this suggested ‘lying’ is meant to foster?

I have been to psychologists on and off for years and for the most part, all of mine have advocated facing truths and coming to terms with them. So this course of treatment seems somewhat alarming to me.

Psychologist’s Reply

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As mental health professionals, our first duty is to do no harm. This does not mean that we tell our patients what they want to hear, but instead challenge and support them in getting better. This often involves confronting patients with painful realities so that they can work through them and move forward. You are correct in that rehab can be a good place in which to do this.

While there may be some instances in which lying to a patient is beneficial, this doesn’t seem to be one of them. It sounds like this woman does need to hear the plain, unvarnished truth in order for her to move forward with her life. And you are correct that lying now may end up hurting her later. This might be especially true because she would probably feel betrayed and then would have to deal with the betrayal on top of the lies. Thus, in this instance, “do no harm” would certainly mean confronting her now with the truth.

However, unless you were present in the room when the psychologist recommended lying, don’t be certain that is what was said. One of the things I’ve learned in private practice is that people often hear what they want to hear. There have been times in which patients of mine have told me that I’ve recommended certain courses of action when in fact I did no such thing. They weren’t being purposely deceptive but their frame of reference skewed my words into something that fit for them. That may be the case here as well.

Addiction is a very complicated illness, a significant aspect of which is that other people are significantly affected. They frequently don’t know what to do and, especially when children are involved, they tend to do what is easiest. Instead of setting clear boundaries and enacting reasonable consequences, they may excuse the addicted person’s behavior and/or lie about their own. Thus, in letting the mother of his child down gently by not telling her he is involved with someone else, your friend may actually have been sending mixed messages about their future. Moreover, by letting the mother dictate his romantic future, he is giving her power that is not hers to have and she may misinterpret this.

It sounds like your friend is a very caring person who wants to do what is right. Toward that end, it may be helpful to him to attend some Al-Anon meetings. Al-Anon is a group specifically for people with loved ones struggling with addiction. They can help people understand the process of addiction, their role in it and how they can handle it differently. If there is not an Al-Anon group around or if your friend prefers one-on-one interaction, seeing a counselor who specializes in addiction could be helpful as well. Whatever he chooses, it is important that your friend learn more about addiction because his son will need this information too. Addiction is a family illness and the sooner the father starts dealing with this, the better off the son will be.

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