Feigning in Therapy: The Unspoken Challenge Therapists Must Address

Image: Britannica Dictionary

In the realm of mental health counseling, one of the most overlooked yet critical issues is the presence of feigning—clients who consciously or unconsciously exaggerate, fabricate, or prolong psychological distress. This isn’t a comfortable topic, and many therapists avoid addressing it out of fear of appearing insensitive or lacking compassion. However, ignoring this reality can lead to the implementation of ineffective or even harmful therapeutic techniques.

While the field of psychotherapy largely assumes good faith on the part of clients seeking care, research suggests that a portion of individuals engage in symptom exaggeration or fabrication for various reasons. Clinicians tend to overestimate their ability to detect feigning behaviors, which has serious implications for therapy outcomes (van der Heide et al., 2020). This reality is further complicated by societal narratives that encourage self-diagnosis and identity formation around mental health conditions, leading some clients to seek therapy not for relief but for validation of perceived struggles. This phenomenon raises ethical concerns about the integrity of the therapeutic process and the potential consequences of enabling feigned symptoms.

Not All Clients Purposefully Feign: The Importance of Honest Self-Assessment

It is essential to acknowledge that not all clients who exhibit signs of feigning do so purposefully or with deceitful intent. Many individuals may unknowingly exaggerate their symptoms due to external influences, societal narratives, or a lack of personal insight. Some may feel that having a mental health label validates their struggles or gives them a sense of community, while others may genuinely misinterpret normal emotional distress as a disorder.

For clients reading this, my goal is not to shame or dismiss your experiences but to encourage an honest self-assessment of your needs. Counseling is often marketed as the ultimate solution to life’s difficulties, but in doing so, it can sometimes diminish personal agency. The idea that therapy alone will “fix” feelings and behaviors can inadvertently strip individuals of their own power to change. While therapy is a powerful tool, it is just that—a tool. True transformation requires active engagement, self-reflection, and a willingness to take ownership of one’s growth outside the therapy room.

Recently, a client mentioned that she was putting her daughter in therapy. When I asked why, she struggled to articulate a clear reason beyond feeling overwhelmed as a parent. I then discussed with her the key indicators that would suggest a genuine need for therapy, such as persistent distress, functional impairment, or behaviors that indicate deeper psychological struggles—none of which her daughter exhibited. Through our conversation, I encouraged her to step into the discomfort of parenting rather than outsourcing it to a therapist. While it is tempting to relinquish control to a professional, doing so unnecessarily not only weakens a child’s ability to develop resilience but also disempowers the parent’s role in guiding them through life’s challenges.

Therapy should not be a replacement for active participation in one’s own—or one’s child’s—personal development. Instead, it should complement the natural responsibilities of self-reflection, problem-solving, and community involvement. The key is recognizing when professional intervention is truly warranted versus when discomfort is simply a part of life that must be faced and navigated with personal accountability.

Understanding Feigning in Clinical Settings

Feigning encompasses behaviors such as malingering (intentionally faking symptoms for external gain) and factitious disorders (self-imposed suffering for validation). Although historically associated with high-stakes legal settings, recent studies indicate that feigning behaviors are increasingly appearing in clinical and outpatient therapeutic settings (Rogers et al., 2014). A study by van der Heide et al. (2020) highlighted how undetected malingering resulted in harmful treatment interventions, emphasizing the risks of overlooking feigning behaviors in therapy.

Clients engaging in feigning may do so for various reasons, including obtaining financial benefits, avoiding responsibilities, or solidifying a personal identity centered around illness. Others may unconsciously exaggerate symptoms due to external reinforcement from social media communities or well-intentioned but misguided support groups. The rise of online mental health discourse has contributed to a surge in individuals adopting diagnostic labels without a thorough clinical evaluation, leading to self-perpetuating cycles of distress.

The Role of Diagnostic Tools

The reliance on certain diagnostic tools can contribute to misidentification of feigned symptoms. The Structured Inventory of Malingered Symptomatology (SIMS) is one such tool that has been scrutinized for its low specificity. Studies have shown that using the recommended cut-off scores can lead to a high rate of false positives, where genuinely distressed patients are mislabeled as malingerers. This misclassification can delay necessary treatment and exacerbate the patient's condition (van Impelen et al., 2014).

A systematic review of malingering assessments emphasizes the need for multiple sources of corroborating data rather than a singular reliance on screening tools (van der Heide et al., 2020). Beyond the use of structured screening tools, clinicians must also employ careful clinical judgment, corroborate symptom reports with objective behavioral observations, and remain mindful of inconsistencies in symptom presentation.

In my practice, I use assessments as an avenue not to pathologize clients but to inform treatment and identify inconsistencies in symptom presentation. Some tools are effective, while others are not, and their use should always be in service of the broader therapeutic goals rather than as a means of labeling a client. Diagnostic tools should be seen as one component of a comprehensive approach—just one of many that therapists should utilize in forming an accurate understanding of a client’s needs and ensuring appropriate intervention.

Iatrogenic Harm: An Unintended Consequence

Iatrogenic harm refers to adverse effects resulting from medical treatment or advice. In psychotherapy, this can occur when therapists, aiming to uncover repressed memories or hidden traumas, inadvertently implant false memories or reinforce maladaptive behaviors. Clinicians who fail to address feigning risk providing ineffective or even harmful treatment strategies, as research suggests that failure to recognize feigning may result in therapies that do more harm than good (van der Heide et al., 2020).

Therapeutic approaches that lack structured goal-setting or promote indefinite treatment without clear outcomes may also contribute to iatrogenic harm. When clients are encouraged to dwell on distress without active intervention strategies, therapy can reinforce dysfunction rather than resolve it. Moreover, excessive validation of unverified trauma narratives—particularly in the absence of corroborating evidence—can unintentionally deepen psychological distress rather than facilitate healing.

Another growing concern is the shift away from communal support systems. Instead of engaging in community, fostering friendships, or building resilience through social bonds, many turn to therapists to fill an emotional void. While therapists provide empathy and professional guidance, they are not substitutes for meaningful personal relationships. The tendency to seek therapy as a form of paid companionship rather than a structured intervention diminishes the profession’s credibility and effectiveness.

The Outcomes of Confronting Feigning in Therapy

When feigning is confronted in therapy, clients may respond in one of two ways: some will have the openness to explore what truly ails them—loneliness, low self-worth, lack of direction—while others will displace responsibility, blame, or even attack the therapist. Regardless of the response, it is crucial for clinicians to understand that neither reaction is a reflection of their professionalism or "lack " of empathy.

Clinicians must recognize that the reluctance to confront feigning often stems from their own fears—how they are perceived, whether they will be seen as harsh, or whether the client will retaliate. However, our role is not to ensure comfort but to facilitate meaningful change. We must remind ourselves that we are not responsible for how a client integrates information. If they respond with anger or defensiveness, it is often a reflection of their own struggles with accountability, not a failure on the therapist’s part.

For clinicians facing these challenges, consultation with peers or supervisors can be invaluable. Seeking consultation helps to maintain objectivity, refine interventions, and provide support when dealing with difficult client reactions. Setting firm, evidence-based expectations for treatment and holding the line on accountability ensures that therapy remains a space for genuine growth rather than symptom reinforcement. Wrapping Up

Addressing feigning in therapy is a complex but necessary endeavor. By acknowledging its existence, utilizing reliable diagnostic tools, being vigilant about the potential for iatrogenic harm, and implementing structured treatment plans, therapists can enhance the efficacy of their interventions and safeguard the well-being of their clients. However, it is equally important to recognize that not all clients feign symptoms intentionally, and that therapy is not a replacement for personal accountability.

A critical component of therapy is providing evidence against a client’s perceived issues rather than simply offering the tools they deem necessary. Although counseling is rooted in empathy, true empathy is not about coddling or softening our approach. Often, the most compassionate and effective intervention is direct confrontation—challenging distorted perceptions and opening the client’s eyes to new ways of thinking. Too much of the industry has shifted toward affirming symptoms rather than guiding clients toward personal accountability and the development of new life skills.

True healing requires a shift away from distress and grievances toward actionable change and resilience.