To Avoid Bullshitting in Psychotherapy We Must Mentalize

If a distinguished Princeton philosopher can write a (small) treatise on it, I think we clinicians are entitled to use the word “bullshit” as a technical term rather than relegating it to the bin of vulgarities. Harry Frankfurt’s book, On Bullshit, is a gem. We can understand bullshitting best by contrasting it with lying. Lying requires a keen concern for the truth; to pull off a lie, you must be aware of the other person’s factual knowledge and tailor your lie accordingly. Bullshitting is marked by a lack of concern with truth—spinning a yarn for the sake of spinning a yarn, without concern about concealing or revealing anything real.

 

Here’s what grabbed my attention. Frankfurt pointed out that politicians often are at risk for bullshitting, because they are asked a wide range of questions to which they could not possibly have all the answers. I immediately realized that the same is true for psychotherapists:

Therapists who strive to answer such questions with any sense of certainty put themselves at risk for bullshitting.

 

But patients as well as therapists are liable to bullshit in psychotherapy—to their own detriment. For example, avoiding painful experiences and conflicts, patients may talk in elaborate detail about relatively minor or peripheral concerns. Or they may gloss over serious problems such as self-destructive behavior with flippant remarks. More rarely, patients may strive to entertain therapists with their exploits.

 

Here we need to bring in the concept of mentalizing, that is, being aware of mental states such as thoughts, feelings, and desires in yourself and others—and interpreting behavior accordingly. If you were sitting with a friend at a coffee shop and she suddenly bolted out of her chair, you couldn’t help mentalizing because you’d immediately start trying to figure out what’s going on in her mind.
 

Mentalizing involves empathy, not only for others but also for oneself. And what makes mentalizing “real” is emotional authenticity, a feeling of conviction, anchored in reality. Our colleague, British psychoanalyst and attachment researcher Peter Fonagy, PhD, pioneered our understanding of mentalizing. He distinguishes the “mentalizing mode” of functioning from the “pretend mode,” where ideas are no longer grounded in reality—reality doesn’t matter. After reading Frankfurt’s little book, it occurred to me that “bullshitting” is plainer language for the pretend mode as it pertains to psychotherapy. For this reason, we put a section on bullshitting in our book, Mentalizing in Clinical Practice, which I am reiterating here for a more general audience.
 

Here’s my worry about psychotherapy: we can engage in bullshitting without being aware of it. All of us, patients and therapists, can engage in “psychobabble,” that is, using jargon and well-worn clichés. We have psychology texts and self-help books filling shelf after shelf, and we can easily parrot concepts and lines from these. “I have a self-esteem problem.” “My inner child is feeling abandoned.” And we can use diagnostic terms in the same way: “What else would you expect me to do in that situation? Don’t you know I’m borderline?!”
 

Blatant psychobabble isn’t a major problem, because it’s easy to detect. A more significant problem is bullshitting and not knowing that you’re doing it. Detecting bullshitting, in oneself or another person, requires mentalizing: Is what we’re talking about sincere, real, significant, authentic? Most important, will this conversation make any difference? Bullshitting in psychotherapy in any form risks wasting time and money, where the patient and the therapist have the illusion of doing real work and yet nothing changes.
 

Frankfurt makes a final point about bullshitting that is worthy of a Zen master. We call mentalizing a not-knowing stance. That is, we can never know with any certainty what’s in another person’s mind. Moreover, we cannot know with certainty what’s in our own mind. Our conscious experience is a mere glimpse of the working of our mind—often enough, we speculate about the reasons for our actions. Thus I leave you to ponder Frankfurt’s paradox and its implication for detecting bullshitting: to quote him, “Sincerity itself is bullshit.”