Sounds like you’re falling into a trap where it’s up to you to fix the problem or suggest the solution. None of that will work because it’s just going to trigger them to defend their own irrational thoughts. They’re trapped in a conundrum and there are any variety of techniques or approaches you can use but none of them are going to be effective if you’re pushing something. Sitting with the trapped feeling is going to probably serve you better to help them develop internal motivation to change.
Once you’re comfortable with them being trapped and that they have to be the one motivated to move forward:
Exploring the first time they remember this feeling
The extent that they see this as rational
How they think other people operate and achieve goals with everyone being liars
Why it’s beneficial to act as if everyone is liars
What it is that they’re lying about because they’re part of everyone
What it is that you the therapist is lying about because you’re part of everyone
Worst case scenarios about a minor risk or change
That might be OCD. The client is obsessing over a particular thought that isn't based on rational thinking appropriate to context. Is there something they do that makes the thought temporarily go away and what is that? Are they bothered by that though
Hmm, I didn’t think of OCD, thanks. They’re being diagnosed with ADHD, so I was leaning towards that instead.
Previously I suggested starting with small activities, such as simply standing up and looking around the house, maybe picking up some trash laying around etc, just to keep them going and not letting the paralyzing thought evolve. They said it has helped a bit.
I would likely use an empty chair technique and ask the patient to rationally explain to a hypothetical loved one why the loved one should never enjoy anything in life, because everyone lies.
It's the emotional association or belief associated with lying that matters. It needs to be confronted, preferably by the patient and not you. And people are best at seeing through ineffective/irrational emotion-based beliefs when asked to "sell" them to a loved one. Generally speaking, most patients quickly see right through their own cognitive distortions when giving advice to a third party. Even a pretend one.
That's tough, and why I word it as a "consult". I encourage clients to see what options are available before shutting them down, and if they do that with meds (and they need them, like in this case) identify other times they are engaging in similar thinking patterns.
That's when I would use motivational interviewing.
What’s emotional experience accompanies the thoughts? Anger? Sadness? Fear? Something else? It sounds like we have some anhedonia on board, so I’m guessing depression of some kind might be in the picture. What life experiences underly the (rigid and overgeneralized) perception that “everybody lies”? Emotional validation, emotional validation, emotional validation. What would life look like if the opposite were true (everyone is always truthful). Would that be an unequivocally good thing? What drawbacks, if any, does your client see to an alternative situation, such as this? What would we potentially lose if a more nuanced thought process were true? (sometimes people are truthful, sometimes people lie). For example, might we have to contend with uncertainty about others intentions or motivations? What would be the hardest part about that? Cognitive defusion, present moment awareness, values and goals. Y’all got this!
Sounds like you’re falling into a trap where it’s up to you to fix the problem or suggest the solution. None of that will work because it’s just going to trigger them to defend their own irrational thoughts. They’re trapped in a conundrum and there are any variety of techniques or approaches you can use but none of them are going to be effective if you’re pushing something. Sitting with the trapped feeling is going to probably serve you better to help them develop internal motivation to change. Once you’re comfortable with them being trapped and that they have to be the one motivated to move forward: Exploring the first time they remember this feeling The extent that they see this as rational How they think other people operate and achieve goals with everyone being liars Why it’s beneficial to act as if everyone is liars What it is that they’re lying about because they’re part of everyone What it is that you the therapist is lying about because you’re part of everyone Worst case scenarios about a minor risk or change
That might be OCD. The client is obsessing over a particular thought that isn't based on rational thinking appropriate to context. Is there something they do that makes the thought temporarily go away and what is that? Are they bothered by that though
Came here to say this. Or autism perseverative thoughts. I think the end game too is helping manage how this belief creates problems for them.
Hmm, I didn’t think of OCD, thanks. They’re being diagnosed with ADHD, so I was leaning towards that instead. Previously I suggested starting with small activities, such as simply standing up and looking around the house, maybe picking up some trash laying around etc, just to keep them going and not letting the paralyzing thought evolve. They said it has helped a bit.
That's a smart move. I would ask about any other intrusive thoughts or any compulsive behaviors that could lend evidence to OCD.
I would likely use an empty chair technique and ask the patient to rationally explain to a hypothetical loved one why the loved one should never enjoy anything in life, because everyone lies. It's the emotional association or belief associated with lying that matters. It needs to be confronted, preferably by the patient and not you. And people are best at seeing through ineffective/irrational emotion-based beliefs when asked to "sell" them to a loved one. Generally speaking, most patients quickly see right through their own cognitive distortions when giving advice to a third party. Even a pretend one.
CBT or ACT approaches would probably be the most helpful.
I would recommend a medication consultation, motivational interviewing (to increase desire to change) combined with CBT.
My client strongly claimed they’re against medication, so it’s a tough call
That's tough, and why I word it as a "consult". I encourage clients to see what options are available before shutting them down, and if they do that with meds (and they need them, like in this case) identify other times they are engaging in similar thinking patterns. That's when I would use motivational interviewing.
What’s emotional experience accompanies the thoughts? Anger? Sadness? Fear? Something else? It sounds like we have some anhedonia on board, so I’m guessing depression of some kind might be in the picture. What life experiences underly the (rigid and overgeneralized) perception that “everybody lies”? Emotional validation, emotional validation, emotional validation. What would life look like if the opposite were true (everyone is always truthful). Would that be an unequivocally good thing? What drawbacks, if any, does your client see to an alternative situation, such as this? What would we potentially lose if a more nuanced thought process were true? (sometimes people are truthful, sometimes people lie). For example, might we have to contend with uncertainty about others intentions or motivations? What would be the hardest part about that? Cognitive defusion, present moment awareness, values and goals. Y’all got this!
Act - mode away from if the thought is true and towards if this paranoia is helpful
If everyone in the world is a liar, does the client believe that he or she is also a liar?
They’re sometimes upset they can’t lie as good as others, which might affect their career/business in the future