All patients are unreliable narrators in that their narratives change as their treatment deepens. Free association, the analysis of dreams and enactments in the transference all affect the patient's understanding and memory of past events. The lapses in memory or affect-laden versions of events are not conscious. However, some patients are not unreliable narrators because of unconscious lapses in memory or understanding — some patients intentionally lie.

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I am not talking about sociopaths who do not experience guilt, but rather about patients who lie to preserve their narcissism or to avoid punishment for something they perceive as wrong. Sometimes people lie because they have an intense sense of shame or they have an overly strong superego rather than a weak one.

Children usually begin to tell lies in their preschool years, between the ages of 2-4 years of age. They are imaginative and often fabricate stories as part of playing. Children also lie as a tool to preserve their self-esteem among those who matter to them — parents, friends and teachers. And children also lie to avoid punishment. Lying is a normal part of child development, but when it is treated harshly, the impulse to lie is reinforced and can continue into adulthood.

In some families, lying is encouraged because of a chronically stressful family situation such as alcoholism and/or abuse. If the impulse to lie is pronounced, it can result in the development of a “false self.” In its most pathological form, the false self is set up as real, and everyone thinks that it is the real self. In friendships and work relationships, observers think the false self is the real person.

Persistent lying becomes a maladaptive coping strategy, because covering up a lie is a significant stressor. Since lying is itself stressful, it creates a downward spiral: lying, covering-up, guilt, anxiety, more lying.

My patient Patrick is stuck in a dysfunctional loop that he has been repeating since he was a little boy. He often lies to women to protect them from disappointment or rejection by him, and to protect himself from their angry response. Then he avoids the person he has lied to because he feels guilty. This dynamic gets acted out most frequently in treatment regarding coming to session and paying on time. Almost from the beginning of treatment, he came late to the sessions and paid late. When there was a lull in the session, I brought up the payment of my bill.

“By the way, you have not paid me for last month,” I said.

“Yes, I did. I sent a check to you,” he replied.

“When was that?”

“You think I'm lying to you, don't you?”

“Why would I think that?” I asked.

“I'm furious that you don't believe me,” he said with his jaws tight.

“When did you send the check to me?” I asked calmly.


“I...did it this morning before I came here...That's why I came late, because I thought you'd be angry that I hadn't paid you.”

The dynamic began with Patrick’s having anxiety about not paying me on time. Indeed, our agreement was that he give me the check the session after I give him the bill. He knew he did something wrong, but he could not face it. He tried to avoid it by coming late. Then he got angry at me because he projected his own guilt and expected me to be angry at him both for not paying me and for being late. He felt he couldn't deal with my reaction to his transgression, so he regressed to an immature state in which he feared punishment and then coped with the stress by lying.

It has taken many years of analysis to get to the point where Patrick and I can discuss this downward spiral. In the past, each time I uncovered a lie, he responded with narcissistic rage, and it took several sessions to work through. Sometimes, he threatened to quit treatment. Now we can deal with it in a single session. Part of the problem was that I did get angry at him when he was telling me an obvious lie.

“You're angry at me, why don't you admit it?!” he yelled. “What's the point of coming here and talking to you if you are going to get angry?”

“If you don't pay me and then lie about it, I am going to have a negative reaction,” I responded.

“You are not supposed to have an emotional reaction. You're supposed to be a therapist,” he said.

“You mean you can treat me any way you want to, and I'm not supposed to have a reaction?”

“Yes, I think another therapist would be more helpful.”

“So, the problem is not that you haven't paid me and told me that you did. The problem is that I have a reaction to your not telling me the truth?”


Eventually we developed a more effective way of dealing with it.

“You haven't paid me for last month,” I said toward the end of a session to which he had come late.

“I know. That's why I came late. I expected you to get angry. But you don't seem angry. I know I've done something wrong and then I tried to avoid it by coming late...,” he said.

“What do you make of that?”

“I do something wrong, then I try to avoid the consequence and come late, but that makes it worse,” he said.


“I provoke you and then I get angry if you get provoked,” he said.

“Yes,” I said.

“The question is: why don't I pay you when you give me the bill?” he said.

“And then what makes it so difficult to own doing something wrong?” I asked.

“I don't know why I don't pay you on time.”

“But that's a separate question from why you need to avoid me or lie to me as a result,” I said.

“Yes, I see, there are two issues.”


Patrick and I are getting better at deconstructing these episodes. He has developed an observing ego, and when he comes late, he usually knows he's avoiding something that he's ashamed or guilty about. Together, we scan what's gone on in the recent past to find something he did or didn't do that he feels bad about. Usually he has either overtly lied to me about it or lied by omission. Once we identify what he feels bad about, we are usually able to see a conflict he had/has and identify that as the beginning of the downward spiral.

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