Sometimes clients come into a first session with amazing stories. Knowing whether a story is real or false can make the difference between notifying authorities, making false accusations, referring the client, or pursuing other treatment options. I had two clients such clients.

Client A told me a story of witnessing child abuse done by a neighbor with bizarre details so I interrupted her story to ask a specific question. She lost her train of thought for a moment, became agitated, and quickly answered the question but then had a difficult time returning back to her story. She repeated a previous statement to regain her storyline and then proceeded to finish. I let the story rest and then in the middle of a discussion unrelated to the story, I asked another random question about the abuse. She looked troubled and then contradicted a previous statement. Yet there was something familiar about the story she told me. So I searched the internet and found an almost identical story in a newspaper that happened only a few months, not years ago. I concluded that this client was not being honest during our session.

Client B told me a story of her sexual childhood abuse with minimal details. I interrupted her story to ask a specific question. She thought about it for a moment, answered the question, and easily returned back without any indication that she was frustrated by the questioning. We let the story rest for a while and discussed something else. Randomly, I returned to the abuse to ask another question. She was unable to answer it but was willing to think about it and get back to me later. I then asked her to complete an abuse assessment which specifies the seven different ways a person can be abused. She completed the list with multiple examples of abuse, not just the sexual abuse she reported. I concluded that this client was being honest in our session.

Here are a few things to keep in mind when trying to discern if a memory is real or false:

  1. One job of a therapist is to provide an environment where a client feels safe enough to disclose the thoughts, feeling or memories that maybe troubling them. With that in mind, it is best to come from a perspective of belief rather than unbelief. A sample question demonstrating trust is, Wow, that sounds awful, how did it that make you feel? As opposed to a distrusting statement of, Wow, that is hard to believe, Ive never heard of that happening to anyone.
  2. While a client is speaking, a therapist needs to check their emotional triggers. Some clients are very cunning and feed off a therapists reactions. Certain personality disorders like to create an atmosphere of chaos even when it is unnecessary because they function better in that environment. The therapist needs to keep their emotional responses in check so as not to encourage further dysfunction.
  3. Just because a client is saying a story passionately, does not mean it is true. Interrupting the flow of a story is one good way to see if it has been rehearsed. Look for body language signs, changes in voice tone or quality, increased agitation or anxiety, or other hand gestures that may indicate an untruthful story. Make sure any significant changes are double checked with other control stories to see this is their normal behavioral response or an indication of dishonesty.
  4. Therapists should try to avoid suggestive questions such as, You seem as if you have been abused before, when were you sexually abused? A more open-ended, non-leading question is, Have you experienced any abuse in your past? Keep in mind that it is not the responsibility of the therapist to investigate so questions that are interrogative are not appropriate.
  5. Returning back to the story at a later time can catch a client off guard so that a more accurate portrait can be revealed. A person being truthful will willingly readdress, clarify, or assess additional comments. A person being insincere will become frustrated. However, if the client has been traumatized by numerous people not believing them, they might become frustrated even if they are telling the truth. So addressing their emotional response is as important as obtaining any additional information.

After several sessions, Client A was diagnosed with a personality disorder that is known for deceptive behavior as part of a manifestation of the disorder. Whereas Client B was honest about multiple forms of abuse.