Therapists' Loss of Reality - Causes, Dynamics, and Consequences

Abstract
Psychotherapists and psychiatrists are in close contact with mentally ill people every day, whose subjective experiences often deviate significantly from objective reality. In this situation, in which strategic lying and emotional manipulation also occur, there is an underestimated danger: the gradual loss of reality on the part of the therapists themselves. This article analyzes the structural, psychodynamic, and social conditions under which professionals can fall into a state of cognitive distortion that undermines their professional judgment. Particular attention is paid to the psychological mechanisms of action, the social isolation phenomena in old age, and the risk of a self-reinforcing lie structure in the therapeutic system.

1. Introduction

Psychotherapists and psychiatrists are considered a professionally reflective, psychologically stable, and largely resilient group of people. Nevertheless, reports of creeping disorientation, distorted perceptions, and even the internalization of patient truths by the practitioners themselves are increasing in professional circles and from practical observations. What appears to be a paradoxical phenomenon is in fact a complex interplay of structural overload, psychological projection, social isolation, and professional tunnel vision.

2. Therapeutic Interaction as a Stage for Strategic Truth

A central problem lies in the nature of mental illness itself: Many clinical pictures – such as borderline personality disorder, narcissistic or histrionic personality disorders, paranoid schizophrenia, or addiction disorders – are accompanied by a distorted perception of reality, manipulative behavior, or deliberate lying. From the patient's perspective, lying can be a survival mechanism – for example, to avoid coercive measures, to maintain autonomy, or to construct a more stable self-image.

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Therapists are faced with the difficult task of distinguishing between conscious deception, unconscious projection, and illness-related distortion of reality. If this distinction becomes a daily challenge over the years, there is a risk of so-called cognitive osmosis, in which alien constructs of reality creep into professional perception. In extreme cases, this can lead to "co-induction"—an unconscious adoption of psychotic interpretive patterns by the person conducting the treatment.

3. Loss of Reality Due to Professionalization and Habituation

The longer therapists practice, the more they tend to persist in their interpretive structures. This professional habituation promotes selective perception, in which only information that corresponds to their own theories, solidified over the years, is integrated into the worldview. The constant handling of "subjective truth" This imperceptibly weakens the therapist's own ability to differentiate between reality and construction.

Furthermore, there is an increasing merging of role identities: The therapist increasingly sees themselves as an authority on truth, which can lead to increased resistance to criticism and narcissistic consolidation. The loss of reality then manifests itself not through psychotic experiences, but through epistemic arrogance – the conviction that one can always correctly interpret subjective narratives.

4. The Influence of Social Isolation and Presbyopia

With increasing age, therapists' social circles often shrink, especially if their professional ethos leads them to discreet reserve and emotional distance. What is beneficial in the therapeutic relationship can lead to loneliness in the private sphere—especially if professional contacts are not complemented by personal networks.

This social shrinkage, combined with cognitive inflexibility—for example, due to age-related neurodegeneration or a reluctance to embrace new scientific findings—can lead to a closed worldview. In extreme cases, a "therapeutic echo chamber" is created in which only confirmation circulates, but no more corrective impulses from aexternal effect.

5. The Self-Reinforcing Cycle of Lies

In practice, not only patients become the source of untruths – therapists can also begin to deceive themselves: for example, by retrospectively rationalizing their own misinterpretations out of fear of mistakes, criticism, or loss of reputation. This becomes particularly dangerous when several colleagues work in similar circles and implicitly agree not to ask uncomfortable questions – be it out of loyalty, fear, or systemic constraints.

This creates a cycle of lies in which not only patients but also therapists begin to fill gaps in reality with plausible fictions. In such cases, the loss of reality is not abrupt, but gradual—a process of erosion.

6. Preventive and structural countermeasures

To counteract these developments, targeted measures are needed:

7. Conclusion

The loss of reality among therapists is a real risk, the extent of which has so far been barely systematically researched. Particularly in the border areas between truth, lies, and construction, highly sensitive self-monitoring is required, supported by social, professional, and ethical mechanisms. It is time to revise the myth of the unassailable professional and speak openly about cognitive, social, and emotional vulnerabilities in psychotherapeutic professions.

References (selection)

Author: Thomas Jan Poschadel

Medicines