What motivates patients to withhold certain aspects of their lives during therapy? What defense mechanisms are behind this? How can the concealment of information become an obstacle to effective treatment, and what can the therapist do to uncover and overcome these defense mechanisms?

These aspects will be discussed below.

Withholding, a variant of dishonesty, must be addressed as a direct threat to the treatment. In terms of the dynamics involved, dishonesty and withholding can be equally motivated by a destructive internal part of the self resisting the treatment process in order to protect itself from scrutiny and maintain the splitting that organizes the patient’s experience. 

Evidence of withholding may come from discrepancies between what the patient reports and other sources of information, for example, information from third parties, etc.

In addressing the lapse or failure of honest and full communication, the therapist may distinguish between occasional suppression and ongoing suppression. 

Occasional suppression is the conscious withholding of information with respect to a circumscribed area. In general, the patient will be tempted to suppress what is most conflictual, but the positive motivation of the patient will overcome this temptation. 

Ongoing suppression is the patient’s systematic, conscious withholding of material over extended periods of time or the prolonged refusal to speak during most of the session over one or more sessions. Ongoing suppression may reflect:

- efforts to control the treatment (or therapist), 

- active competitiveness with the therapist, 

- severe paranoid fears (as seen in psychopathic or paranoid transferences of a pervasive kind), 

- guilt over certain behaviors. 

When the patient acknowledges that there is something difficult to talk about, the therapist should seek clarification, exploring the patient’s assumptions about the consequences of revealing the secrets before dealing with the specific content being withheld. 

In addition to exploring the patient’s fantasies, the therapist should confront and explore the conflict between the patient’s agreeing to the ground rules of open communication and then withholding or lying. 

The meaning of the behavior toward the therapist may add a different level of understanding to the patient’s assumptions about the therapist (e.g., the patient may assume that the therapist would react in an angry, critical way but, by withholding, the patient behaves in a way that is geared to provoke anger and criticism). 

Very often the competitiveness, fears, or guilt behind the withholding can be worked through only over an extended period of time.

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(c) Yuliia Holopiorova,

Ukrainian Association of Transference-Focused Psychotherapy

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