I just straight up lied to my CBT therapist once or twice. One of the big techniques CBT uses is goal-setting wrt areas you want to address in your therapy. So you can say "I aim to do X, Z amount of times between now and the next appointment," and discuss the success/failure thereof at the next appointment.
clients lie all the time to their therapists! All the time! How much they drink, what they said, did, etc, how they feel. We don't have a truthometer--we take their word for it, because the outcome is their (client) wellbeing, so if they're lying...not likely to improve. with mandated treatment, ie third party referral (CPS, parole, sometimes employer),it's a little different bc the client may not want to be there anyway. I could write you a book on how to engage clients who don't wish to engage, but in the case of that type of treatment, there could be a consequence for not engaging (lose job, don't get kid, spend a weekend in jail) because it can be interpreted as client is unmotivated to change. Again, specifics are rarely discussed but overall, client in working in therapy, certainly can be (with a release)
Since my issues were centered around agoraphobia, I'd say something like I wanted to go for a 20 minute walk, by myself, three times a week (specificity of the goal is encouraged). On a couple of occasions, for various reasons, I said I'd achieved the goal even when I hadn't. Therapist then asked how it made me feel, what techniques helped me, where I wanted to go from there etc., and basically the answer is whatever they want to hear in order to assume you're getting something out of it all. "Yeah, it was a little stressful at first but I did the breathing exercises we talked about in earlier sessions and that helped a lot." "It was okay, but I learned something-or-other, and next time I could also try this-or-that which might make it better." And so on.
And again, most therapists are going to think great, s/he's feeling better--good ones tend to be able to suss out the "oh I'm just great" folks who make unrealistic progress--and leave it there. If, in fact, you were not feeling better and not telling your therapist, then...not much a therapist can do. Engaged clients who are committed to feeling better will tell their therapists - this isn't working! I don't want to do this! Can we talk about something else?
If there are specific things your character's employer
has decided they need to address in relation to their behavior,bolding mine (and this applies only to the US) So an employer can refer a client for some issue (anger, usually, because there has been a behavioral problem) but they DO NOT set treatment goals. That's between the client and the therapist. A therapist (with an ROI) could say that treatment goals are relvant to the referred issue but no third party actually sets goals (in my experience anyway) and if the goals involved could be situations that rely on self-reporting that can't be contradicted
and again, at least in the US, we don't follow clients around to monitor compliance! OTHERS can do that--say a parole officer busts a client for drinking--and tell us we need to address the infraction, but we don't play policeman. If I think a client is drinking, I'll ask them about it. , they could always just pretend to go along with it if that's plausible for them. Just like they could lie on questionnaires or quizzes their therapist might ask them to take.
Hahahahaha, clients always think they can hoodwink us on these, and on some testing batteries, the face valid ones, they try. But on several common testing batteries, we have profiles that tell us-the client is exaggerating in one way or another, is NOT responding to the content of the questions, or whatever. Very helpful (questions are NOT face valid) VERY hard to fake those (we pick those up)
In my experience, CBT tends to be quite patient/client-driven in the sense that you set the pace and the direction. I realize that might be different for your character if outside influences are directing things, but in general patients/clients have a huge amount of control in 1-on-1 therapy sessions when it comes to what they want to work on. So in that respect, your character could lead the therapist in a merry dance by making up issues they wanted to pretend to work on, and make it seem like they were accomplishing a lot when in reality they weren't.
And in that case, a decent therapist will notice. "A merry dance" can look like unrealistic progress, too many unrealistic goals, etc. Again, with no mandate, the therapist may just let it go--the client's the one paying, or may ask the client about it, but it's all on the client.
I was self-employed at the time of my therapy, so employer confidentiality wasn't an issue. What was made very clear to me, right at the beginning of my treatment, was that everything that was said during the sessions was absolutely confidential. Only the police with a court order could learn what had been discussed, in the unlikely event that ever became necessary or relevant (such as me being a danger to myself or others, or in
the course of a criminal investigation)
not exactly. Confidentiality is a little more complex. What Cornflake said ---> criminal investigations don't trump confidentiality unless a court issues a subpoena (and even then, sometimes they're contested) Certainly if a client is a danger to self or others (more complex than it looks), if a child or vulnerable adult is in danger/being abused, for billling purposes, some people have it so for emergency care limited info can be shared. When there is a third party, this gets more complex--ROIs are tailored for this. And again, when a client is showing up with a third party, they WANT you to tell the referrant they are doing well. If they don't, they don't show up. Also a client can quash an ROI whenever they want and a therapist can't reveal anything further (but may have already) Then the therapist just tells the referrant they cna't discuss anything further (and usually that referrant takes it up with the client) Again, this can look straightforward but can be quite complicated. I've had get legal consult on stuff with third parties (who gets an assessment, who can release it, and so on) If the therapist isn't somehow colluding with the employer or the employer's doctor -- or unless the client
explicitly consents to a certain amount of info sharing with certain parties -- then as others have said, that confidentiality overrides everything else
Most things, but again, with an employer, the client has two choices. They either a) show up and sign releases or b) don't sign releases. If a) the therapist can share certain info with employer. If b) the therapist can't share shit (so the employer will assume the client is not compliant and will terminate) But there is a LOT of grey area here. And some employers have their own therapists and confidentiality iis NOT assumed (police, in some cases) any time you have a third party paying, you get issues of who the client actually is a and it's complicated.
(You've probably run across all of these before, but if your character has been referred via an EAP, they have
guidelines regarding ethics and confidentiality, both in terms of employers and clients. There's also the
BACP's ethics framework, and the
BABCP's standards of conduct, which might be of some help. And there's
this info from a privately practicing counsellor that could be useful too.)