Honesty in psychotherapy: Results of an online survey comparing high vs. low self-concealers.

Objectives: This study sought to investigate client dishonesty in psychotherapy through the trait of self-concealment. We hypothesized that comparing low and high self-concealers would yield clinically significant differences in the nature, motives, and perceived consequences of client dishonesty. Method: A total of 572 respondents, self-reported as psychotherapy clients, reported about their experience of being dishonest in therapy via a multi-part online survey. Concealment status was assessed using the Self-Concealment to Therapist Scale, an adaptation of the Self-Concealment Scale. Results: Eighty-four percent of respondents reported having been dishonest about one or more topics in therapy, most often "details of my sex life" and "suicidal thoughts." High self-concealers reported more relationally oriented motives for dishonesty and acknowledged more negative effects on therapy than low self-concealers. In contrast, low self-concealers were more likely to report that non-disclosure was based on motives of practicality (e.g., managing therapy time), and that they would be willing to disclose if the therapist asked directly. Conclusions: Low and high self-concealers showed distinct patterns of motives, perceived consequences, and attitudes about facilitating disclosure in therapy. This suggests that self-concealment may be an important variable in tailoring treatment to foster greater and more honest disclosure. Clinical or Methodological Significance of this article: This article adds to the burgeoning literature on dishonesty in psychotherapy and presents a novel exploration of how self-concealment can be used to individually tailor treatment to facilitate increased levels of honest disclosure. High levels of self-concealment, or the trait-like tendency to conceal negative or distressing personal information from others, have been associated with deleterious long-term health and interpersonal effects. By exploring clients' motives for being dishonest, as well as their perception of how it impacted therapy and their self-identified techniques for how therapists can foster more honest, we provide specific clinical recommendations to increase disclosure in psychotherapy.

Let's not talk about sex.

This article uses both a case illustration and data from a large-scale survey of outpatient clients (N = 798) to understand the client's perspective about avoiding or being dishonest with his or her therapist about sexual topics. The case study, of a gay young man working with a heterosexual female therapist, explores this client's experience of what happens when it feels impossible to be forthcoming about sex and sexuality. Based on the findings of our study, we note clients' motives for avoiding these intimate yet important areas (e.g., shame), their perception of how this impacts the therapy process (e.g., impedes clinical progress), and their sense of therapist responses and attitudes that could increase their ability to be more honest ("just ask"). We discuss ways in which therapists can facilitate a more open dialogue about sexual material while attending to clients' concerns about doing so.

Forgiveness in psychotherapy: the key to healing.

The process of forgiveness in psychotherapy involves both letting go of resentment toward the offender and replacing the resentment with mindful awareness and empathy. By reconceptualizing past transgressions with a kinder, more equivocal outlook, clients attain a shift in perspective that is spiritual and cognitive in nature, thereby reducing symptomology and enhancing their quality of life. Such insights bring clients toward their inner Buddha nature, which transcends the suffering associated with clinging to past hurts and resentment. This process is facilitated by techniques such as concentrative meditation and identifying with transgressors through perspective taking. Forgiveness therapy improves clients' sense of well-being by promoting feelings of peacefullness toward oneself as well as others.

Clinical outcomes, predictors of prognosis and health economics consequences in IBD patients after discontinuation of the first biological therapy.

BACKGROUND: In real-world clinical practice, biologics in inflammatory bowel diseases (IBD) may be discontinued for a variety of reasons, including discontinuation initiated by gastroenterologists. The aims of the study are to report outcomes after discontinuation and predictors of prognosis after a minimum follow-up of 24 months; outcomes of gastroenterologist-initiated discontinuation with resulting direct cost implications on the health system were also studied. METHODS: IBD patients who discontinued their first-use biologics between January 2013 and December 2016 were identified at our tertiary centre. Reasons for discontinuation and pre-defined adverse outcomes (AO) were recorded. Data were analysed using univariable and multivariable logistic regressions within a machine learning technique to predict AO. Gastroenterologist-initiated discontinuations were analysed separately, and Kaplan-Meier survival analysis performed; direct costs of AO due to discontinuation were assessed. RESULTS: A total of 147 patients discontinued biologics (M = 74; median age 39 years; Crohn's Disease = 110) with median follow-up of 40 months (range 24-60 months). In the total cohort, there were fewer AO among gastroenterologist-initiated discontinuations compared with patient-initiated; 54% (of the total group) had AO within 6 months. Among 59 gastroenterologist-initiated discontinuations, 23 (40%) had IBD-related AO within 6 months and 53 (90%) patients had AO by end of follow-up. Some 44 (75%) patients needed to restart biologics during follow-up, and direct costs due to AO and restart of biologics were high. CONCLUSIONS: The proportion of patients who have AO following discontinuation of biologics is high; clinicians need to carefully consider predictors of poor prognosis and high relapse rates when discussing discontinuation. The direct costs of managing AO probably offset theoretical economic gains, especially in the era where cost of biologics is reducing. Biologics should probably be continued without interruptions in most patients who have achieved remission for the duration these remain effective and safe.

Understanding of chemoprophylaxis and concordance in inflammatory bowel disease.

AIM: To assess patients' understanding for the reasons for taking 5-aminosalicylic acid or ursodeoxycholic acid as chemoprophylaxis against colorectal carcinoma associated with inflammatory bowel disease (IBD). METHODS: A questionnaire-based study using a 5-point opinion scale was performed. One hundred and ninety-two patients with colitis only and 74 patients with primary sclerosing cholangitis and IBD were invited to take part. RESULTS: Overall response rate was 58%. Sixty-four percent of patients claimed full concordance with chemoprophylaxis for maintenance of remission. Eighty-four percent of patients considered daily concordance during remission to be very important. Seventy-five percent stated they understood the reasons for taking the drugs. However, only 50% of the patients were aware of any link of their condition to bowel cancer. Seventy-nine percent of patients felt their concordance and understanding would be improved if they were informed of the chemoprophylactic potential of the medication. CONCLUSION: Despite good self-reported concordance, half of the patients were unaware of an association between colitis and bowel cancer. Explaining the potential chemoprophylactic benefits may enhance patients' overall concordance to 5-aminosalicylic acid and ursodeoxycholic acid and help maintain remission.