Once upon a time and many years ago when I was a very new therapist, I worked with a client who had completely made herself up.

A lot of things never added up with her. For starters, there was her presenting problem. Some days she would report a diet of jelly beans (not many) and carrots, and yet she was never low weight. But since clients with eating disorders are so often metabolically out of sync, it didn’t seem completely unbelievable either. And her restricting and purging progressed in fits and starts, with days of nearly normal intake.

So I’ve often wondered, did the lies start from the very first moments of treatment, or even before she entered my office, or did they start later? When exactly, and why? She told me she was singing lead vocals with a band. She brought me flyers, with dates and locations on them. Then she met a young man, an up-and-coming actor. One day she came in with an engagement ring. There was a lot of drama in their relationship, and a few months later they broke up. Throughout, she stoutly refused family therapy with the parents she continued to live with. Should that have been a clue? Over time, her story got somewhat wilder. Her former fiancé had an affair with a girlfriend of hers and the girlfriend became pregnant. When the baby was born, he had a heart defect, and my client became a significant source of support to the child and her mother. She denied conflicted feelings. The child was near death.

I started my private practice in a different state and my client transferred to another therapist, a friend of mine. A couple of years later she transferred to someone else for a similar reason. Occasionally, my former client would call me with brief updates about her life and progress. The last time she called me, it was to confess that none of what she had told me or her other therapists was true. As part of her ongoing therapy, and to her lasting credit, she wanted to apologize. The baby who died so tragically had never existed. There was never a fiancé. The engagement ring was a cubic zirconia she bought at the mall. There was never a band. I was shocked into speechlessness and had little to say or to ask.

Initially, my sense of shame and betrayal was so intense that I could barely think about her. As I told the story over in my mind, it became more and more absurd, an obvious lie. Although I eventually remembered that in the 15 years since I worked with her, I have heard many stranger truths than the lies she told me, at the time I felt a total fool, shamed before myself and (it is some comfort to say) my also-fooled colleagues.

For years, now, though, I have wondered. I have remembered the times when she wept, or when her face turned bright red with sudden anger or shame. Was she simply an extraordinary actress, playing her heart out to an audience of one? Picasso famously said, “Art is a lie that makes us realize the truth.” Lying, it seems, was her art, but what truth did it reveal? Could she possibly have benefitted in any way from our therapy? How did she see me? Bumbling, naïve—a confidence woman’s mark? Or possibly idealized—too good and too perfect in her eyes to be sullied with the probably more boring and more awful truth? How much did I participate in maintaining her fantasy? Surely it was not possible for me to be taken in without some collusion on my part. Did she stroke my ego? Fan my insecurities? I don’t recall at all.

And what, after all, is true in therapy? We know we are shown the distorted perspective of one person as seen through the distorted lens of ourselves. Dreams and fantasies contain truths as genuine as what we call conscious realities. Sometimes the” lies” are the most revealing part of the story, pointing like a flashing neon arrow to the place we need to go: “I don’t blame my mother,” “I’m not afraid to live alone,” “It’s only a diet,” “I just don’t think about sex anymore.” And of course, even with the best of faith, memory always lies.

But still…there are lies, and there are lies. The therapy relationship relies on our clients mostly telling us their truth. I think of my former client often. Hers is a cautionary tale, but in some ways I choose not to heed the caution. The therapy relationship also relies on who I am, and though I make an effort not to be naïve or foolish, I cannot strive toward the openness, honesty, and awareness that makes for an effective therapy when I am harboring too much distrust or suspicion. And although it took a long time and several therapists, my former client did after all find her way to honesty, and that is a good ending and a good beginning.

File under: The Art of Psychotherapy