It's not unusual for patients in my therapy office to lie to me. Sometimes, they lie because they're embarrassed. At other times, they're afraid they're somehow going to "get into trouble" if they tell me the truth.

Sometimes the truth comes out after a few sessions.

A patient who finally decides to trust me after several months of work together might say, "There's something I need to tell you. I haven't told you the whole story." She then might reveal she's having an affair or that she is taking drugs.

At other times, patients may deny the facts that are presented to them. A patient who reeks of alcohol may insist he hasn't had a drop of alcohol in months. Or, after failing a drug test, he might insist that he had to have been "framed" because he doesn't use drugs.

Stretching the truth, leaving out important details, and telling outright lies in therapy are a fairly common phenomenon. In fact, 93% of people reported lying to their therapist in a 2015 survey conducted by Columbia University.

Why Patients Lie

It's important for therapists to provide a safe space where patients feel comfortable telling the truth. But sometimes, they don't take enough time to develop a healthy therapeutic alliance before diving into deep topics. At other times, they don't show enough empathy or compassion--and patients don't feel comfortable sharing.

Lying may also be a symptom of a bigger problem--like low self-esteem. At other times, lying is the problem.

Here are the top seven reasons why patients lie to therapists:

1. They want to be polite.

When the therapist asks, "Is therapy helpful?" it's tough to say, "No, therapy isn't working." Quite often, in an effort to be kind, patients say what they think the therapist wants to hear.

2. They don't want to upset the therapist.

It's hard to admit things like, "I didn't try the homework you suggested," or "I did the exact opposite of what we talked about last week." In an effort to please the therapist or to avoid any consequences, it's common for patients to lie about the work they're doing.

3. The topic is uncomfortable.  

It's hard to talk about uncomfortable issues. Talking about a traumatic event or describing some poor choices you made is tough to do. It's often easier to divert the conversation or deny any problems exist.

4. They are lying to themselves.

Sometimes, patients just aren't ready to admit the truth to themselves. So they minimize how much time they spend on social media or deny that their substance use creates problems for them because they don't want to face the truth.

5. They feel ashamed.

It's tough to talk about things that stir up shame. In an effort to protect themselves, many patients deny circumstances or behavior that causes them to feel ashamed.

6. They want to be liked.

Announcing your failures, shortcomings, and setbacks each week might cause you to feel like a loser. In an effort to be liked by the therapist, many patients only talk about the good things they're doing.

7. They aren't ready to talk about it.

Sometimes patients don't feel equipped to handle the distress that an uncomfortable subject will stir up. Or, they fear that the therapist will tell them to give up a coping skill--like smoking or eating junk food--and they won't have anything to replace it with.

The Perils of Dishonesty

Telling your therapist the truth can be tough. But dishonesty isn't a good solution.

You might waste a lot of time and money on therapy if you are lying to your therapist. It's impossible to work through issues if you aren't acknowledging them.

If for some reason, you don't feel comfortable telling your therapist the truth, consider why not. You may need to dig deep and find the courage to talk more openly. You might even need to bring up with your therapist the fact that you feel compelled to paint yourself in the best light possible--it's a great topic for therapy.

Or, you might find that you and your therapist aren't a good match. And changing to a new therapist might help you feel more comfortable. But if you decide to go that route and switch therapists, just make sure you are doing it so you can be more honest, not because you're trying to avoid getting to the deeper issues.