Working with clients who embellish

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lakeland
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Working with clients who embellish

Post by lakeland » Fri Apr 12, 2019 1:41 pm

Just typing up some session notes and it's pretty clear that the person I'm working with has reported some things that aren't true, and I could easily verify. He's 17, difficult background including trauma and adoption. I'm curious really on whether or not people challenge these types of lies in therapy. I fully understand the function of the behaviour, but I don't if I should be saying to him that I don't believe him and whether that matters.

Interested to hear from others who may have been in a similar situation. I think because he's a child I'm a little less comfortable pointing it out than I might be in (for example) an adult offender setting.

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hawke
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Re: Working with clients who embellish

Post by hawke » Fri Apr 12, 2019 3:25 pm

I worked with a young teenager from a similar background who also used to embellish. It was a secondary school setting, rather than a therapy setting.
I never directly challenged him - I went with a behavioural approach and tried to think in terms of reinforcement. His lies were generally about fake achievements, and we formulated that he was after the "wow that's amazing" reaction from us. So if he told me something I already knew or strongly suspected was a lie, I would just politely acknowledge it but not give praise or ask questions about it. Instead, we tried to up the praise and interest for his normal day-to-day life activities, and boost his self-esteem and interpersonal skills in other ways. It did work to some extent with him and I, although I noticed over time he stopped seeking me out to talk to so much. And of course, being in a secondary school, there were hundreds of other people he could get reinforcement from. The kids were much more confrontational that I dared to be, and some would openly call him out on lying, which usually resulted in a lot of tears and fights. Looking back with a bit more experience now, I think I would probably have tried to make more use of these experiences to explore with him the effect his obvious lies were having on his relationships.

I think the answer depends on a few factors. Is the embellishment specific to you, or do they do it all the time? Are you trying to form a relationship, or do you already have one that could withstand something a bit more challenging? Does it form a main part of the problem, or is it a side issue? But I guess your formulation would be the best guide about whether a gentle challenge is a suitable intervention. I seem to remember reading an interview from a researcher in this area who said often the best way forward is to ask directly, but I can't remember any details to back myself up here!

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miriam
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Re: Working with clients who embellish

Post by miriam » Fri Apr 12, 2019 5:21 pm

I think I'd be curious about why they were telling me stuff I knew from other sources not to be true. I might even ask them about that, or make a guess out loud about what function it serves, if I could do so whilst holding empathy and preserving the relationship. But then, I am quite Dan Hughes influenced with this client group.
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lakeland
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Re: Working with clients who embellish

Post by lakeland » Mon Apr 15, 2019 8:58 am

Thanks both. He embellishes with parents as well and I can understand why - there are sibling issues and he has had a period living in care before being returned home recently. There's also a strong peer influence.

I've said to him that our work needs to focus a little more on feelings than behaviours, so I'm hoping that might be the way in. I don't think his lies are hurting anyone at the moment but similarly I don't want to just ignore them.

I'll give it some more thought in supervision next month. Downside of being a solo clinician is that you don't have any of the informal peer support you get in teams.

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workingmama
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Re: Working with clients who embellish

Post by workingmama » Sat May 04, 2019 6:20 pm

I'd also think of the function of the lies and think possibly from a narrative P.O.V. about the story he holds of himself or is trying to present to you about him. You could also think from a psychodynamic p.o.v about what he is trying to defend himself from by telling such tales (the unbearable pain of perceiving himself to be inferior?). I wouldn't challenge because I'd be thinking in Dan Hughes terms of the shield of shame, and about whether he could tolerate the feelings resulting from being 'found out', assuming that (because he's lying) he isn't in the place that he could trust that you would be holding his lies with compassion and understanding. I'd probably keep working without challenging those things and hope that over the months and years he came to trust that he was worthy of caring without having to brag.
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