Counseling clients with intellectual and developmental disabilities means that I often get to collaborate with my clients’ parents. This is true even if (or maybe especially if) my clients are adults. One common question that I get from parents is “will you believe everything my special needs child says in therapy?”

I understand why you’re asking.

Adults with disabilities may lack the insight and language skills to accurately describe their abilities or their history

Describing wants as certainties

They may describe their wishes as facts. This may be because they believe that their wishes will one day be reality. It might be because my clients, like most people, have a hard time talking about things they’d love to do but maybe never will.

Examples include telling me about their plans to:

• get married
• move to another state
• go to college
• drive
• get an apartment.

They may share their short term timetable for when these things will happen. Or they may discuss them as though they have already happened, when in reality they have not.

Having trouble with time

Many of my clients do not have a strong concept of time. I find that dates, ages, years, and other time related facts are often skewed when a client is filling me in on something.

Examples include telling me that something that actually happened 10 years ago happened ‘last month’.

Relying on the movies

Sometimes it’s easier to describe your feelings in relation to something you’ve seen in a movie. It’s not uncommon during sessions for clients to quote movies rather than use their own words.

Too many examples to name. I’ve been treated to monologues and quips from On the Waterfront to Guardians of the Galaxy and everything in between.

I do my best stay current on the Marvel Cinematic Universe and other popular action/sci-fi films. This way I can spot when my clients are speaking for themselves, and when they’re borrowing a catchphrase from a film.

Telling white lies to impress the therapist

Occasionally clients will expand the truth just to try to impress me.

This often happens with younger male clients. Examples include telling me how strong they are by saying they can bench press 300 lbs. Or sometimes clients will try to indicate that they have something in common with me. For instance, some clients will see my diplomas on the wall and tell me that they, too, attended UNC-Chapel Hill.

Making up stories that could have happened to cover up declining memory

Some adults with Down syndrome may have early signs of dementia, and may confabulate. This is a fancy psychiatric term for positing fiction as fact to cover for memory loss.

Examples might be a client with Down syndrome and Alzheimer’s dementia telling me that they spent the weekend “at home, just hanging out”, when I know from talking with their family that they were at a family event out of town.

In short, when counseling clients with disabilities, there are many ways in which the truth can be misrepresented.

Why parents worry if it seems like a therapist is taking everything their child says as fact

It can be frustrating to feel that the therapist is taking everything your child says at face value.

You might be worried that you’re wasting your time and money having your child talk to someone who is being ‘taken in’ by your child.

Probably you are hoping for some big changes for your child and improvements in responsibility because of counseling. It can be disheartening to feel that the therapist you worked so hard to find is falling for your child’s old tricks. You might believe that there’s no way your child can change if their therapist isn’t going to challenge them to be honest. Isn’t honesty the foundation of counseling?

If that’s where you’re at, I hope you’ll talk with the therapist before deciding that therapy isn’t working, or that your child “isn’t cut out for therapy”.

Especially if the therapist is one like me, who is very familiar with people with disabilities, odds are that they are very intentionally NOT calling your child out for their tall tales.

This can be hard for some parents to accept. But know that there are actually some pretty compelling reasons why a therapist might allow a client to say things that are patently false without telling them that they are wrong.

Why I allow my clients to speak untruths in therapy

Because understanding why a client tells me something untrue helps me to achieve a deeper understanding of them.

What is truly important to them? How is the life they’d most like to be living different from the one they have? What is so meaningful to them that it might be helpful to motivate change? How can I adjust my language and understanding to match theirs, so that they know that I am truly working my hardest to ‘get’ them.

People, regardless of their IQ or language skills, don’t make change because they are forced to.

Not real change, anyway.

Real change happens when we believe we are capable. When another person is fully committed to hearing our story and communicates that our actions and beliefs are understandable to them, we no longer feel so alone. Feeling understood is what gives us the power to move forward and break out of unhelpful habits and routines.

I allow my clients to say things that aren’t true, and I don’t challenge them on it, because it communicates that I take them seriously.

How I break the cycle and establish truthful communication

Over time, a client will trust that I’m on their side, that I have their best interest as my goal.

Generally speaking, once this belief is established, the lying ends.

When it doesn’t, it becomes a focus of clinical intervention

Confabulation?

I can refer out for appropriate screenings.

Suppose a client is saying something untrue to hide the fact that their memory is declining. I can coordinate for them to begin receiving regular Dementia screenings.

Telling lies to impress the therapist?

I can counter by validating the underlying fear that they’re not enough, and can coach them on healthier relationship building skills.

If the client is lying to impress me, I can gently question whether this is what they’re doing. I can suggest that it must be hard, feeling that they must be perfect, strong, or otherwise exceptional to have relationships.

Challenging the fear behind their desire to impress might sound like: “I wonder if you’re afraid that no one will like the real you?”

Having had their fears validated they can move forward in finding healthier ways to establish and maintain relationships.

Stuck reciting movie monologues?

I can help them find balance between the comfortable fantasy of movies and the more uncomfortable reality of expressing their feelings in their own words.

Maybe a client is lying because they don’t know how to communicate what they’re feeling. They find it easier to use words from a movie to express their feelings.

I can point out that I see them doing this. I can give them a new script that will let them reference the movie while still expressing their emotional experience. It might sound like this:

“Luke felt shocked and angry and scared when he heard Darth Vader say “No, I am your father”. When you said that I must go to a new school next year, I felt the same way. I wanted yell ‘No!’ just like Luke.”

The most common reason for stretching the truth? Being afraid that reality will never live up to their hopes and dreams.

Usually though, a client is lying because they desperately want to achieve their dreams but they worry that they won’t.

In these cases, I can validate that their dreams are worth having. While I do this, I can kindly differentiate between what is a want and what is reality. If I client tells me they are getting married soon, but I know that they are not, I can say:

“I hear you. You love your girlfriend so much, you’d marry her today if you could. I imagine its really tough to feel that strongly, but to not know when or if you can get married”.

It is truly powerful to have your deepest emotions validated. It almost always gives my client the confidence to talk about their fears that what they want may never happen.

OK, but what if I really think my child is really just duping their therapist?

Hopefully I’ve shown you that it may be clinically sound for your child’s therapist to allow them to say untrue things.

You may still worry that the therapist is going to believe everything your special needs child says in therapy. You might worry that they won’t understand that your child isn’t being truthful. This can be especially worrying if you fear that your child is coming across as more capable than they actually are.

Worried that the therapist won’t ever question or challenge your child? Here’s what you can do about it.

Before entering therapy, use the intake form to communicate your concerns and your child’s tendencies. Your adult child should complete their own intake form prior to starting therapy. Request that the therapist also send you an intake form to complete. If your child is their own guardian they’ll just need to sign a release form allowing the therapist to discuss their treatment with you.

Be upfront about how often you would like to connect with the therapist. A therapist who doesn’t usually treat clients with disabilities may not understand why this will be necessary. Help them to understand how your child may misrepresent the truth as a function of their disability.

Ask the therapist how they treat instances where your child isn’t fully truthful. If you’re still not sure that the therapist is believing everything your child says without a plan to address it, you may want to consider whether a therapist who has a better understanding of your child’s diagnosis might be a better fit. Please  check out my post on finding a therapist for your special needs child if that’s the case.

If your child might benefit from working with a counselor who understands their disability and the role that lying plays in how they communicate, I invite you to schedule an appointment with me.

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