When the Patient Does Not Tell the Truth

Abstract

After the premature conclusion of a long-term psychotherapy with a patient suffering from a traumatogenic psychotic disorder, it was serendipitously discovered that much of what the patient talked about was not true; yet the patient's mood and functioning appeared to significantly improve over the course of the therapy. In attempting to understand how this could occur, the therapeutic value of believing the patient is explained, utilizing Otto Fenichel's concept of pseudologia phantastica, or pathological lying. It is concluded that sometimes believing the patient is more important than knowing whether what the patient is saying is true.