Re:When behavior is motivated by revenge.

Yes it is risky on several levels. But worth a try. I like the idea of the question "is that true?" This patient lives by the motto, "I am on top when I trick you into believing I am a good guy." So, this method feeds into his pattern. He is not quick to catch on to sarcasm. To deal with this I planned to progressively build my story little by little until denied part of the story. Then I would backtrack through the story testing the details of the report. I developed a ridiculous story of good deeds done by writing letters of commendation to hospital administration regarding those the patient formerly slandered. I figured he would affirm the story immediately. He did. I then kept embellishing the story until he could no longer affirm it. For the rest of the session, little by little he denied the hole thing. No shame. He said in the end that what he was trying to say was that he is getting along with these people now. I will continue using this technique. The benefit is both in the paradoxical effect of encouraging the good behavior and in the way that I am in complete control of the facts. I know when he is telling the truth completely and when he is feeding me a line. This is very useful in developing a treatment plan for pathological lying. My hope is that as time goes on he will deny that my story is true earlier and earlier in the session. For now I plan to only use it when he tells me that things are going just fine for him. Thank you Dr. Stein for one more arrow in my therapeutic quiver.

Craig

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