Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Monday, November 07, 2011
Is it Ever Okay to Lie?
We've been having a great discussion over on the post Tell Me.... An Ethical Dilemma. The post talks about a young man who wants to know if he can check "no" to a question about whether he has a psychiatric disorder if his illness is not relevant to the situation. The comments have been fascinating -- do read them-- and very thought-provoking.
One reader asked, " If a patient asked if they were boring you, and they were, would you say yes?"
This is a great question, and of course the right thing to do is to explore with the patient what meaning the concern has to him. But is that all? I'm not very good at doing the old psychoanalyst thing of deflecting all questions, and mostly I do answer questions when they are asked of me. This can present a really sticky situation because one can not think of any clinical scenario in which it would be therapeutic to have a therapist tell a patient, 'Yes, you're boring, OMG are you boring,' or 'No, in fact, I don't like you.' And not answering could be viewed as negative response by the patient --if you liked me, you'd tell me, so clearly you don't like me. So if the exploration of the question doesn't take care of the issue, and the patient continues to ask, what's a shrink to do?
I'm not in favor of lying to patients, therapy is about having an honest relationship, but our readers have given some great examples. If a gunman asks for your money, is it okay to lie and say you have none? Is it okay to lie about whether you've been the victim of sexual abuse on a job application (one reader saw this!). Just because someone asks, do you need to answer truthfully? Of course, you can be truthful and say you don't plan to answer that question, but so many times, the assumption is that the answer must be Yes because if not, you'd have nothing to hide.
Psychiatrists don't owe it to their patients to be totally transparent. Shrinks have the right to their privacy, and professional boundaries dictate that it's wrong to share your problems with your patients (even if they ask).
That being said, it still can feel very uncomfortable on the shrink side of a couch when a boring patient asks if they are boring. What would you say?
Posted by Dinah on Monday, November 07, 2011
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Sadly, despite the fact that I take a deontologic viewpoint on ethics, I find lying to be on a continuum. Today, I lied about something very small because to not do so, would have been a bad thing for all involved. But on some recent issues, lying (not done by me) was a big big deal and was definitely in the infinitely morally wrong category.
I'm no consequentialist - I don't think the ends justify the means - EVER, but in terms of lying - jeez... I guess it's not as simple as right or wrong. A purer subscriber to Kantian ethics would probably just say it is wrong, pure and simple. Thou shalt not, and all that..
I don't know where psychiatry/therapy falls on that continuum. I suspect my psychiatrist holds back on a lot of things - I never asked him if he finds me boring. Often he'll answer my question after he explores what it means. Despite the fact that sometimes talking about my own issues seems narcissistic, I am pretty sure that my stories are usually not boring - I've gotten the sense over time that he is more interested when I go into the real issue and not talk around it. Sometimes easier said than done. Not today - he's probably never heard me swear so much in an appt ever - all because somebody really important to my life lied to me. ;)
Dinah, I am so glad that you liked my latest question since you took me to task for asking what might happen if your iphone fell into the wrong hands.
Anon: given that my laptop was recently stolen, asking about my iphone getting in to the wrong hands just reawakens a huge amount of PTLTD (post traumatic lost technology disorder). Let's not even go there.
(oy, I was futzing with our media website and I seem to have made myself into the Shrink Rappers)
When I'm feeling really insecure I ask my therapist, "Are you going to get tired of me", or I state, "I'm afraid you are going to get sick of me and kick me out", stuff like that.
He usually looks at me kindly and reassures me that No he's not doing that, isn't going to do that (well, that's how I interpret his brief but kind-seeming responses to those types of things). And then we often talk about why i'm feeling that way. Actually always, after something like that.
But there's a nagging little corner inside me that says, "But if he really was getting sick of you, therapeutically it'd be damaging to tell you that, so . . . ". Which I suppose I ought to tell him THAT fear too.
And since you say in your next to last sentence that it can be uncomfortable when a boring patient asks if they are boring, it makes me think that therapists can and do feel bored or sick of their patients and that they wouldn't say so so how could a patient trust any answer to this? Oy, now I'm worried. Sorry.
wv = rareart It's a rare art to balance all this crap in therapy.
i sometimes amuse myself by saying unexpected things. i like making my therapist laugh - though not sure that it's anything more then just making her laugh, rather then some secret freudian reassurance i'm not boring.
i've had therapists who i felt i was boring with - just didn't have anything i wanted to say with them. i sometimes wondered if they were bored, but then usually lost myself in thinking ahead to my plans for the day or work the next day -- pretty much what I assume she was thinking about across the room.
You did point out that you do not feel it would be therapeutic to come out and say that a patient was boring you to tears, something I knew already from my own training in the art of wriggling out of sticky situations like that, as well as something I have long felt as a patient to be true about therapists: they don't tell the whole truth. Not telling the whole truth could be construed as a lie, yet sometimes that lie is the best thing they can or should come up with. Of course, patients, many of them, have a very good sense of when they are being "handled". Some years ago, I read one of irving Yalom's books. This was back when bookstores began installing Starbucks and offered up cozy chairs. It was a great place to escape from kids at the end of a long, long day. One of the stories was called Fat Lady and detailed a therapy with an overweight woman, delving into some of the countertransference issues; Yalom was repulsed by fat women. More interesting than his particular issues was the fact that Yalom discovered towards the end of the therapy that the woman had picked up right away on his true feelings, something she let him know after allowing him to treat her without even being able to look at her for the longest time.
I know that therapists get bored, they get frustrated when patients do not seem to be getting any better, they do find some patients more difficult for all sorts of reasons and they do feel some sense of relief when a patient like this cancels a session. I know from the cigarette breaks in the stairwells and from the staff room and I knew from watching my own doctor's micro-expressions and sometimes grimaces, folding of the arms, defensive moves when answering a question.
It is okay to lie but expect to be called on it when you do lie. The therapist is entitled to privacy. Don't answer what feels like something that has nothing to do with the patient if you do not want to but when it does relate to the patient be prepared to be challenged. Not all people in therapy are fascinating. Boredom is an occupational hazard. So is lying or truth stretching and molding.
I love when I am witty, or on one at an appointment and can make my psychiatrist or therapist laugh that day. Being able to connect on that level, is great. Even if they may think you are boring and whiny on some level, I find I have made a breakthrough connection when I can get a chuckle out of them.
I have asked my therapist before if they are tired of me yet. they looked like they were about to smack me upside the head for even asking the question.
And in general, not a huge fan of people lying to me. I HAD a husband who lied constantly big lies and small insignificant lies. When he was caught in a lie, instead of admitting wrongdoing, he lied again.... grr.
I had an eye-opening experience with a therapist.
He found me interesting, my views, experiences and opinions. And in turn, I experienced a surge in my interactions in the 'outside' world. I suddenly developed a social life at work, started making new friends. It was great.
Then the relationship fell apart, and so did my budding extroversion.
I can't imagine what it would feel like to sit across from someone who was bored by me, week after week, and I don't want to try imagining what that would do to my social life.
So - do I feel that honesty is always the right answer? No. If you ask me a question I felt you had no business asking, I'd lie without blinking. But in all other circumstances, I'd tell the truth.
Because the truth allows us to move on.
If that guy is boring you, how do you think his other social relations are going? And if that guy is boring a hypothetical you because you have heard it all before, maybe it's time to switch track. With what we know about microexpressions these days, there's a fair chance you are doing more harm than good, unless he has the social sensitivity of a brick wall (and I've met people like that).
Finally, telling the truth need not equal being rude. And what may be small to you, may be a big deal to me.
There are two aspects to Dinah's question: that of the patient's communication to the therapist, and that of the therapist, whether it be his reaction to the communication or his experience of the patient.
If a patient asks whether he is boring the therapist, or just is boring in general, one should approach that as one does any communication. What is the overall context of the question? What has the patient been discussing? Is the question a reaction (a defence) to something on the patient's mind? Is this a patient who is critical of himself and feels he needs to please others?
So to simply "answer the question" without regard to issues such as these loses the chance to unearth and work on these things. Often it is a side remark, an apology, a self-deprecating comment, that opens up important areas to be explored.
The part of the psychiatrist finding the patient boring is an equally complex arena. The psychiatrist needs to look at himself and ask the same types of questions noted above for the patient. In psychotherapy there are no two patients who are the same; global issues reoccur but each person is unique.
Is it ever okay to lie?
Out of context: yes; In context: it depends.
wv = subrosms; climaxes that don't exactly put the lights out. Ladies, I think you know what I mean.
I am a shrink and I have been shrunk. I can say that I say that I have never been bored by a patient and, in fact, in the beginning, I struggled to not be upset by what patients (AKA people) were saying to me all day.
But I have learned how to find the right people to bring in to my office every day by careful phone screening. Any shrink who doesn't do this is foolhardy or works for an HMO....
In the time it took me to find my password, etc., Jesse, articulated a mature version of what I wanted to say. This rarely happens with such a quick turn around. But there you have it. I blame it on the East Coast/West Coast 3 hour time difference/lag, but ya gotta gave hang your failings on something....
So it's wrong to share your problems with the patient even if he or she asks. That leaves you with one less out, then. If you could share your problems, to the boring patient you could say, "Oh it is not you, I am very anxious right now about my son, Sam and how he will answer a personal question on an application..."
You could say that the real reason you are fidgeting is because you cannot wait for the session to end so you can check to see if anyone has called your iphone to report that your laptop has been found, or someone has called your laptop to report that your iphone has been found in the bar you went to three nights ago to drown your sorrows.
There's something else about what I posted above, that I sort of feel on the fringes of when I worry about that, that I thought more concretely on after posting.
It's that after he answers the question, sometimes I wonder if he has to "re-frame" me before he answers; think about me as the person who was abused from a variety of sources as a child, to add to the sincerity of his words and expression; that his possibly being bored is recognized by him as a temporary state and that the more important thing is to answer with what is true overall, in the whole scope of our therapeutic relationship . . . so yeah that's alot of "mind-reading" on my part of him, but like I say it was only half-formed before my other post . . . and so now that it's more consciously defined, it may be fodder for therapy exploration.
But anyway, even if I wonder about any states of boredness or getting tired of me, when he answers with a reassuring answer, I can fall back on my thoughts about him answering for the overall benefit of the therapeutic relationship, and that I trust that he means THAT, even if there's temporary boredness or fed-upness.
wv = sateri = a transposed satire
I don't think anyone has ever asked if they were boring me.
Sarebear, I don't know you in person, but years of blog response... I just can't imagine that you're boring!
Jesse: When can I be as wise as you?
Dinah, you set Jesse up. How is he supposed to answer your question? "Dinah, you are already as wise as I am, in different ways. Your experiences have shaped your wisdom ,as my own have mine. Delight in your own unique wisdom" OR: "Dinah, you have many strengths, wisdom...., well you need to work on your impuslivity before you will ever be able to develop true wisdom." OR, "Wisdom, what's it good for?"
You don't have to answer but is Charlie Miller a relation? http://www.forbes.com/sites/andygreenberg/2011/11/07/iphone-security-bug-lets-innocent-looking-apps-go-bad/
I have the opposite problem in that treating professionals are TOO interested in me, it seems to me. When a treating professional seems TOO interested, it creeps me out and I find another one. It feels like a boundary violation to me.
When I am really depressed, I worry if my mental health professionals hate me, one of my issues (I worry about everyone, not just providers). My therapist told me that she "fires" patients that she dislikes. Is it true that therapists do that? Or is that a white lie?
I think it is ok to lie if you are doing it for the benefit of the other person. I don't white lie often, because it smooths things over in the short run, but in the long run, the other person cannot trust your praise if it is genuine.
I also think it is ok to lie if the other person is violating boundaries or being somehow wrong is asking you about something. I try to deflect, but if that will not work or I cannot figure out how to do that, I will lie. Sometimes the other person is violating my privacy by accident, like asking "what do you do for a living?" Well, I am disabled by bipolar disorder, and the person had no idea he/she was violating my privacy by asking a usually neutral question, and it isn't appropriate to dump all my disability issues on a stranger, and also this is a question like "how are you today?" and they do not really want to know all my medical problems. It is small talk.
People who think it is NOT ok to lie to smooth social interactions, if someone asks you "how are you today?" do you TELL them you are feeling crappy? I would tell a family member, but not everybody.
Off topic, but I noticed someone said they felt narcissistic talking about their problems in sessions. I feel like that too and I RARELY talk about my problems with anyone other than my spouse in everyday life. I wonder if treating professionals get the idea that their patients are all narcissists, when in fact, they are at the appointment in order to get help, and uncharacteristically talking about themselves?
Patients are not seeking help to entertain psychiatrists.
That would be weird.
"I wonder if treating professionals get the idea that their patients are all narcissists, when in fact, they are at the appointment in order to get help, and uncharacteristically talking about themselves?"
I have wondered this very same thing myself, CatLover. I have met one where I was absolutely convinced he thought I was a narcissist (I only saw him once).
You know...if a shrink is getting bored, he or she ought to wonder why. I would really hope the shrink would be problem solving and using full mental capacities throughout the appointment. Shrink's are expensive and patients wanna get their moneys worth. Especially for a med management purist who doesn't even spend more than 20 minutes with a patient. If a shrink is bored, this may be a sign that the way therapy is being conducted should be reevaluated.
Rob's definition: wv = subrosms; climaxes that don't exactly put the lights out. Ladies, I think you know what I mean.
Men know what that means too! Plenty of men fake sexual pleasure. I read that on Yahoo years ago. Though I noticed there were only two reasons the men gave: marathon sex throughout the night, and they were really tired of sex (but not the idea of having sex). Or they were injured in some way but felt like they still needed to perform and so it wasn't that good.
I know what you're trying to get at, obviously, but....Is it EVER okay to lie? Really? Is it EVER okay to hit? Well, what about in self-defense? Is it EVER okay to steal? What if you're starving...the list goes on indefinitely.
Let's not pretend therapists stick to a black and white definition of ethics! (Though god, it would be nice if they did....)
I can't resist answering A above: so you are in 1939, in Germany, and the Gestapo knocks on the door and asks if there are any Jews in the house. Yes, in fact you are hiding one in the attic. Your answer, A?
This is the problem with absolutes. One needs to extrapolate to the extremes to get at underlying principles.
Perhaps I misunderstood A. He might have been making the same point I just did.
Rereading, I definitely misunderstood A. Sorry, A, apologies are warranted.
German Jews were stripped of most of their rights by 1939 ,but mass deportation of Jews from Germany did not begin until post 1939.
Anon #3, who wrote about Yolam, got it right. Honesty certainly may not be therapeutic, but I also think a lot of patients sense when the truth is being side-stepped, softened or reframed. Personally, I stopped worrying about whether my therapist thinks I'm boring years ago because, well, I can be boring. That said, the first psychiatrist I worked with once told me he didn't want to be patronizing or insincere when I asked him why he rarely pointed out any of my strengths when I was so hard on myself. Seriously, one of the few nice things he ever said was "at least you're not fat". It didn't sound much better in context either, but at least I can laugh about it now.
Sarebear: I am another person who never finds you boring.
I remember being concerned at one point because I felt like a "broken record" in therapy sessions in that what I said seemed to be similar to what I had said the week before and the week before that. I think I was getting bored with myself or at least impatient with my slowness to change. I told my psychiatrist at that time, that I seemed to be slow at making "progress" and perhaps his time would be better spent with someone else who I imagined might make more rapid progress. My psychiatrist laughed and asked me in turn something like, who do you think I ought to replace you with, Michelle Pfeiffer? I really thought at that point, that there might be someone more "worthy" of my psychiatrist's time than I was. I think the question was a reflection of my feelings of inadequate self-worth. I think it would have reinforced my feelings of inadequacy if my psychiatrist had said "You really are a broken record and I think you are right that you are wasting my time when there are lots of more worthy patients waiting for my services." I don't think he had to lie to answer my question as he did and the effect was that he did make me feel "wanted" as a patient.
I'm not sure that I follow your answer. The question originally posed implies that the patient is boring - otherwise there wouldn't be an ethical dilemma involved.
The overall context of the question might be a fine thing to explore, but I'd easily get the impression that the true answer was being avoided. I agree that the framework needs to be worked with, but I think it is equally important, if not more so, to answer the question truthfully, and work from there.
For the record, I've never worried if I bored my therapists. But I know that I've antagonized and frustrated them, sometimes on purpose, and I've seen them be unwilling to admit to these feelings.
(Granted, it's hard to answer truthfully about things you don't realize yourself. But isn't a certain form of self-awareness was implied in the job-description?)
@Rob : I have never lied to my now husband in that regard. It took us some years to figure out what worked, and I can't guarantee that his self-esteem didn't get bruised in the process, but in the end we had a great sex-life. So great, in fact, that we got kid, and now we have to start all over again :)
And from my observations (n=1), I find that it is true that men can have differing organisms, just like women.
Sometimes I bore myself when I see my psychiatrist. I know he is bored and cannot think of anything to say. If I asked him if he was bored he would deny it vehemently, even though it was obvious he was struggling. So I would never ask him.
It's a matter of duties - when most people believe that lying is wrong, but there are some times that you WOULD lie - then what are you upholding that is so powerful you'd allow it to trump a lie?
In the Nazi example, protecting life is a higher duty than being honest. It still doesn't make lying "right", but when duties conflict, one is going to trump the other one at some level.
wv = hurthe; lying hurthe
I think that with the Gestapo question we have an answer: Yes, there are times it's not only okay to lie, but it's wrong not to.
Maybe it's misguided that it's been so hammered in to us that it's wrong to lie, and yet we are never taught that it's wrong, or unethical, to ask intrusive questions. Of course you can say "That's none of your business" (which is considered rude), or "I don't wish to answer that" but then there is the assumption that the answer is "yes," because why wouldn't someone simply say 'no' to a question like, "Have you sexually abused your cat?" If we anything, we hear messages like, "there's no stupid questions..."
While patients don't generally ask if they are boring, this fear of seeming narcissistic or self-centered is common, and a great topic for it's own post.
I think some of our commenters are not happy with the idea that a psychiatrist might be bored. Ah, if only we were people who had been ordered a from a catalogue. I'm also not aware that 'self-awareness' is in the job description to treat psychiatric disorders, except for psychoanalysts who must undergo analysis first and I've never been impressed that this process turns them in to better people.
I do think there is some therapeutic value to answering these questions (especially if the answer is honestly "you're not boring at all"). There sometimes feels like once there's been some exploration, that to leave the question unanswered and leave the patient uncomfortable and wondering, also loses the opportunity to correct negative assumptions the patient makes and the "why do you always see yourself in a negative light" issue.
Maybe I will be as wise as Jesse when I'm less impulsive.
I love Dinah’s approach to responding to inappropriate questions. See also Penelope Trunk on lying in response to questions it’s illegal to ask: http://blog.penelopetrunk.com/2009/05/11/three-times-you-should-lie-at-work/
Another way to think about Carrie’s musing on conflicting duties is Sartre’s existentialism: choose to act, then deal with the consequences. The example he gives is also from World War II: a student, now an only child, who must choose between joining the Resistance to avenge his brother killed in the German offensive of 1940, or staying with his mother at home. Neither choice can be justified through any system of reasoning because they each cause a wrong of similar weight. The student just has to choose, that’s all. So choose, and live with the choice.
"Choose to act , then deal with the consequences."
So if a person is comfortable with the consequences (jail) they should choose to commit murder? The other limitation inherent in this is that it is not always the case that the actor has to deal with the consequences. Consider suicide. That is an act, the consequences of which are not dealt with by the person who chooses it.
@A Girl: A patient says to a psychiatrist “do you find me boring?” What is the overall context? Perhaps the psychiatrist has been distracted by some personal concern, and the patient frames his observation of that by asking if in fact he, the patient, were boring to the doctor. It could be that the patient has frequently thought he was boring to others. Perhaps a woman patient had been talking about a problem at work, speaking in a monotone, but by doing that she was avoiding talking about her conflicted feelings about a sexual matter.
There are near infinite possibilities. If the therapist “answers the question” without having thought about the context, history, diagnosis, etc. he may be steering the question away from the important underlying problem and into a safe surface issue.
Yes, there are times when one does answer a question simply and directly, then looks at the underlying issues. Therapy is hard work, requiring one to think and feel on several levels at once. Just as in the best of modern design, the simplest answer may cloak the most sophisticated analysis.
To frame this another way, imagine a woman patient asking a male therapist “do you think I am attractive?” That question contains so much! Would you think it should be directly answered, rather than that the therapist should consider what generated it and the ramifications of the answer?
"...this fear of seeming narcissistic or self-centered is common, and a great topic for it's own post."
I'd enjoy reading about this, Dinah. And I meant to type Yalom not Yolam in my previous comment.
Thank you for your well thought out reply. I do agree with you, and I think that perhaps we are working from two similar but not identical angels.
I agree with you that just thoughtlessly blurting out the truth may not be the best course of action.
F.ex. in your first example, the therapist might answer quite truthfully that the patient was not boring him. This would risk invalidating the patients observation ("Your attention is elsewhere") without offering an explanation. Or the therapist can turn the question around - Why do you ask? - thereby putting the patient on the defensive ("I don't know, it's just a hunch, and now that you ask, I don't have the words to tell you, I'm just going to crawl back into myself and talk about something else"). Either way, the results could potentially destroy the therapeutic relationship, and the therapist might never figure out why. After all, the whole interaction seemed utterly harmless to him/her.
So yes, here I'd maintain that the best answer would be to tell the whole truth, namely that they were distracted. Who knows, a patient with low self-esteem might even get a huge kick out of playing a therapist to the therapist :)
Your other scenario is much worse - "Do you find me attractive?" That question can potentially be used to manipulate, and even if it is asked in all innocence, it's still hard to find a good answer.
On the other hand - my mum used to ask me that, a hundred times every time we met. In the end, I got so fed up, that I told her the truth: she is well past her seventies, has led a hard life, been a heavy smoker all her life, and has not had the money for relaxing spas and plastic surgery. Attractive just isn't in the ballpark anymore. From now on, she needed to work with phrases like dignified, and gracious. It was rather rude of me, but surprizingly, she gave me a happy smile, and stopped asking (quite so much anyway).
I'm not religious in any way, but I do believe that the truth can set you free - as long as it is used wisely.
@ Jesse - yup, you got it right the second time. :)
@A Girl, yes, as you note, the second example is very tricky, and my point in using it was to show that simply answering a question can be a landmine. There are many other such examples, though not as dramatic. Very often I find that just as in mathematics one can test an hypothesis by taking it to the limit. I think it is important to try to look beneath any rule or example to find the underlying principle.
Being boring (or being bored) is not a quality, like having red hair, that is objective. I can imagine a doctor who repeatedly does the same procedure over and over getting bored with his work, but in dynamic or analytic psychotherapy we never encounter exactly the same situation twice. If we are bored there is almost always some problem that we need to confront.
The psychiatrists I know truly like people. There are many fields in which one can excel without liking people, but psychotherapy is not one of them.
I'm a teacher, and if a kid ever asked me if I liked him, or if I was bored reading his paper, it's not likely that I'd say I didn't like him at all and was bored silly by his paper.
I'd likely try to tactfully encourage him to use x, y, z, strategies to strengthen his paper...but I'd certainly never say, I don't like you, even if he was the most disagreeable child I've ever met. There's something to be said for a therapeutic alliance, whether in therapy or not. Or perhaps it's more the old adage - you catch more honey with flies then with vinegar.....
Providers of any care must assume that they will face dilemmas where their own personal experiences or relationships will be invariably unjustly investigated by a patient or another person in their lives.
One must possess the skills of reorganizing a situation so that it is positive both to yourself and the person who is pursuing a realm of your relationship that is off limits.
It is not ethical or proper to lie on a form of employment or other inquiry of personal data as suggested by the patient. We are all in situations we may not enjoy and there are always realizations that a lifestyle or other experience we may wish to pursue may not be to our success as we may have a true limitation or a legal situation that does not fit with the choices of the reviewing authorities for which we are applying or situating our own interests.
If there is a legal reason why some information is not to be shared, such as a health condition to a new employer per se, that is to be explored with your physician and or legal help if necessary.
In the case you cited where the patient wants to know if you liked him or not, a more intelligent reply for a professional is to comment on the positive qualities of the patient and indicate whether or not you are able to continue to provide the care or services that the patient necessitates.
No health provider or other professional for that part can be preferential in a integration of his or her own feelings towards one patient or another. To do so, in my beliefs is essentially unprofessional and thus crosses the line to a situation where you are simply playing to favorites and not ethically practicing your profession.
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