You are right Stopdog - the therapist isn't there to control you. However, as a therapist I would hold a boundary that you can take whatever substances/alcohol you like, but not be under the influence when you come to the therapy room. That is my boundary. To turn a blind eye to the state the client arrives in and allow their substance abuse to wreck their therapy, just as it wrecks their life outside the therapy room, would be to collude with their self abuse. It's not about control, it's about a healthy boundary. My clients actually like it and feel safe with it. Yes, if they are sent away they are often angry and there is often much testing of the bounday(and that's also important), but getting in touch with that anger and us both surviving it, is the start if their being able to manage powerful and painful feelings without using harmful substances. For many of us, the therapist is the first person to offer something safe, and boundaries are about being safe. Of course, for many, boundaries equate to being controlled - that is part of the work - to understand what healthy boundary means, especially if our boundaries have been violated. In therapy we can learn that boundaries mean safety

As a therapist, I am firm with this boundary, and will often show an anger that shows I care and want the client to be safe. I never attack with my anger. It shows I am willing to fight for my clients, and when that is internalised, the client can start to take greater care if self. It's all about healthy attachment, the blueprint for self care.