Is it a psychologist’s job to address false beliefs?

By Catherine Robertson Souter
February 3rd, 2022
Rebba Schwartz-Mette, Ph.D, associate professor of psychology, University of Maine.
Rebba Schwartz-Mette, Ph.D, associate professor of psychology, University of Maine.

With the massive amount of disinformation floating around, from political to medical, most therapists will come face-to-face with questionable beliefs spouted by patients.

One client may insist that COVID is no more serious than the flu and the reports of the dead are grossly inflated. Another may claim that the vaccines are not safe, not effective or necessary. And then there are political conspiracies, from claims of massive voter fraud to beliefs in the existence of a highly-connected child sex trafficking ring.

While it is in everyone’s best interest during a pandemic to insist on masking, distancing or remote therapy, at what point is a therapist responsible for educating a client on information that has no basis in scientific fact?

It is a tricky question, of course, and one with no easy answer. Beyond safety concerns, for the patient or others, is it a therapist’s job to disabuse clients of false beliefs?

“Setting aside the topic of the sincerely-held, but false, beliefs for a moment,” said Rebba Schwartz-Mette, Ph.D, associate professor of psychology at the University of Maine and past chair of the American Psychological Association Ethics Committee. “I think, at the outset, our responsibility, when our services are requested, is to properly assess the client’s presenting concerns and goals for clinical services.”

“If a client reports a firm grip on false beliefs and a desire to examine them in assessment or treatment, our responsibility would be to assess whether the false beliefs are a pattern, or are occurring in isolation, around one particular issue." -- Rebba Schwartz-Mette, Ph.D, associate professor of psychology, University of Maine

The therapist, in other words, should follow the client’s lead.

“If a client reports a firm grip on false beliefs and a desire to examine them in assessment or treatment, our responsibility would be to assess whether the false beliefs are a pattern, or are occurring in isolation, around one particular issue,” she added.

The next question would be whether the false beliefs add to a client’s mental health concerns, even if not directly.

“Additional considerations involve whether the belief is causing problems (distress, impairment) for the individual or those around them, and just how aberrant the beliefs may be,” said Schwartz-Mette.

What if a client brings up a topic, like a QAnon belief that Tom Hanks is part lizard, that is not directly related to their main concern? According to Schwartz-Mette, if brought up in therapy, it may need to be explored, to see if there is a “larger process at work” that could lead to problems.

“One key piece to keep in mind is whether the client is asking for help with this belief or not,” she said. “If there was no significant impairment or distress or risk associated with a false belief, and the client wasn’t asking me to change the belief, then I would imagine that any motivation on the part of the psychologist to ‘treat’ that belief could potentially (even if unintentionally) stem from the psychologist’s personal convictions.”

“It would behoove a psychologist in that situation,” she added, “to reach out for consultation so as to be sure that any clinical decisions were driven by clinical necessity and scientific judgment, not personal values.”

How you talk to a client about their beliefs is important as well. For instance, when talking to a patient about the science behind vaccine safety or efficacy, any temptation to preach may not be the best approach. When Hartford Health Care required vaccines for all employees, they spent a lot of time working to understand and communicate with those who were reluctant.

“We got into conversations about how to support people who are late adopters,” said James O’Dea, Ph.D, senior vice president of the group’s Behavioral Health Network. “I do believe mental health professionals can offer a lot to that conversation; we have the training to better understand how people change.”

Applying the Prochaska Stages of Change model may help to most effectively address the client’s concerns, he explained.

“When doctors or clinicians advocate an action-oriented step to a person in the pre- or contemplative stage, we know what happens,” he said. “Some may say nothing happens but, worse than that, the person ends up doubling down on their resistance.”

“Our job is to understand whether a person is in a pre-contemplative place or a consideration of whether they might take an action step,” O’Dea added. “I look at addressing vaccine hesitancy through empathy. Talk more and listen more with a genuine sense of curiosity, a radical curiosity, about why people have gotten to the position that they are in.”

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