Just want to be clear: I don't have any specific insight, so I'm trying to relate to something similar.

I don't have a substance abuse issue. But I do take benzo's for anxiety. I took an Ativan one time before therapy because I knew it was going to be a difficult session. My T noticed the difference. She said I was too mellow and nonreactive, and asked me not to take any anxiety meds before therapy...I can take it after if I need to. The problem with being on the medication was that I wasn't fully experiencing and processing the situation, my thoughts, my emotions. Part of therapy is getting to the core of you, and being under the influence is being the superficial you.

Another thing... I consider my SI an addiction. It would not be appropriate to SI right before therapy. I don't quite know how to explain why. I guess it's like binge eating before you go get weighed? Or getting drunk before an AA meeting?

And why does your T care when it's your time and money? Because it's his time and ethics. He wants to do his job. He actually cares? That's why Ts have a right/obligation to refer you out if they don't feel they can help you.