[alk2601]

So this is my first post in these forums, although I've been coming here occasionally to read others' posts. I suffer from depression and have a substance abuse problem as a result. The other day I went to my therapy session. I've been to this therapist for about 9 months, and have been hungover multiple times in therapy. This time I had done a particular drug (nothing illegal) the night before and was still slightly affected by the "afterglow" the next day. I was honest with my therapist and told him what happened...and he sort of blew up at me. It wasn't uncontrolled anger, but he was clearly upset and sternly told me that I was "crossing boundaries" and wasn't allowed to come to sessions while under the influence. I was stunned, the "afterglow" didn't seem to be affecting me more than a caffeine buzz would, and I had been hungover in his office so many times before that I didn't think this was an issue (more than once I have gone to sessions early in the morning after staying up all night drinking, and was still slightly intoxicated).

I feel like this post is getting long-winded, but my point was that I am going to therapy in part because of my substance abuse issues, so I feel like it's a little unreasonable for my therapist to demand for me to be completely sober in all of his sessions. I feel a little hurt and confused by his reaction during the last appointment. Is this a normal reaction for therapists? Why would he be upset with me? I mean, I get that therapy isn't that effective for someone who is high/drunk, but I'm the one paying for it! Do I need to look for someone who is a little more understanding? Or am I asking too much from him?

[Leah123]

Originally Posted by alk2601

So this is my first post in these forums, although I've been coming here occasionally to read others' posts. I suffer from depression and have a substance abuse problem as a result. The other day I went to my therapy session. I've been to this therapist for about 9 months, and have been hungover multiple times in therapy. This time I had done a particular drug (nothing illegal) the night before and was still slightly affected by the "afterglow" the next day. I was honest with my therapist and told him what happened...and he sort of blew up at me. It wasn't uncontrolled anger, but he was clearly upset and sternly told me that I was "crossing boundaries" and wasn't allowed to come to sessions while under the influence. I was stunned, the "afterglow" didn't seem to be affecting me more than a caffeine buzz would, and I had been hungover in his office so many times before that I didn't think this was an issue (more than once I have gone to sessions early in the morning after staying up all night drinking, and was still slightly intoxicated).

I feel like this post is getting long-winded, but my point was that I am going to therapy in part because of my substance abuse issues, so I feel like it's a little unreasonable for my therapist to demand for me to be completely sober in all of his sessions. I feel a little hurt and confused by his reaction during the last appointment. Is this a normal reaction for therapists? Why would he be upset with me? I mean, I get that therapy isn't that effective for someone who is high/drunk, but I'm the one paying for it! Do I need to look for someone who is a little more understanding? Or am I asking too much from him?

Welcome to the forum! I hope you find it helpful.

I have to say, I don't think his feelings or reaction are unreasonable, as long as he's expressing his concerns professionally. I am guessing your therapist wants you to be as committed to your well being as he is. Coming to session under the influence may well seem disrespectful, and even if not, as you say, it certainly seems counter-productive. And as far as his boundaries, yes, in my experience, it's a norm that clients are expected to be sober during session.

I think... more than asking too much or little of him, perhaps you are asking too little of yourself? I think it's important to try and raise your standards for yourself- if you've come to multiple sessions intoxicated and hungover... it is definitely concerning. Do you two have a workable plan in place to address your substance use and are you invested in it?

This isn't to say you're the only one who's ever done such a thing, and of course you can spend your money however you like, and of course you can change therapists.

Just need to decide what the best use of your time and money is.

I'd feel differently if you explained you were working really hard in therapy and having trouble kicking this addiction, but the way you're presenting it, you're irritated at him for having boundaries and not wanting you there under the influence and you're complaining that you can spend your money however you like, so I wonder if you're feeling defensive, or really just not thinking this is a big deal, or what?

[Petra5ed]

Well, I'm intrigued and trying to figure out what you were on... ?? Lol.

I think it's poor form for a therapist to ever get mad at a client. Like you said, we pay them for their time and substance abuse is a common problem. On the other hand therapists are human, obviously you touched a nerve somehow. I would really recommend you discuss it next session. Maybe you didn't judge your Ts reaction perfectly and they weren't that mad. Maybe it was paranoia?

Also I would say if your T has asked before that you not come in like that and you keep doing it that might be the cause of frustration. Then it's like you're not respecting their wishes, and honestly a therapist can't work with someone on being sober when they're not sober. So for what it's worth you can't keep coming in under the influence and think its therapy and that your T can miraculously heal you while your **** faced. It doesn't sound like you think that, but just sayin .

[Debbie07]

Most places that focus on substance abuse have clauses that if you show up under the influence of anything, even alcohol, you will not be seen that day.

[ScarletPimpernel]

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.

[stopdog]

The one I see says people come to therapy stoned or otherwise all the time. She made it sound like no big deal to her.
I would not continue to see one who acted all upset at me about anything I did. They do not get to lecture me. Not their place to do so in my opinion. Also, I interviewed over 30 of them in the last 4 years. I have not had any of them show me any clause about coming in impaired (which is not a deal for me because I do not, as a general rule, go anywhere near a therapist not in full control of my faculties) - but as a matter of principle - I would have left any of them who told me such a thing. I also only see those who work alone, so maybe that has something to do with it too.

[anilam]

Welcome to PC
Yes, lecturing wouldn't sit well with me too. But did this T lecture alk2601? I didn't get the sense he did...
T can set up his/hers boundaries- like not going to session under influence and tell the client what will happen if they do- Not see you/terminate you if frequent...if he really "demands" you to be sober and feels he cannot work with you otherwise and you feel you can be 100% sober yet maybe it's time for a new T. But I think most Ts would be open to some sort of compromising here...I'd be very surprised if your T wouldn't...

[Debbie07]

From a random certification ethics guidelines:

i. have the right to refuse and/or terminate the service to a client who is abusive or under the influence of alcohol, drugs, or any illegal substance

It's not unethical to refuse service if the client is under the influence, in no way make the therapist a bad or unqualified therapist.

[stopdog]

Drugs or alcohol are not issues I have, but I still would not see a therapist who thought they got to dictate how I came to appointments or if they got upset over anything at me. Sh, sui or anything really. It is simply not their place. The only result I can see from what the op's therapist did, would cause a client to lie rather than not. Further, the therapist is being paid. I do not believe a client can waste a therapist's time. A client can waste their own time or money, but not he time of the therapist.
See whatever therapist you wish, I simply would not. The therapist does not get to control me.

[silver tree]

I do struggle with the hypocrisy with the drugs issue. Basically it's whatever mind altering, cognitive impairing, addictive, organ damaging & emotion numbing drugs, with awful side effects, that a psych prescribes is considered good and the right course of treatment. But anything you take, even if you feel it helps to some degree, is considered bad and means your therapy will be ineffective. But how can that actually be a definite and medical fact? or even logical?

Having said that, turning up to your appointments hung over or worse, actually high, does you no good. And I would want my T to be angry at that tbh. Especially if that helped with abstinence of a substance that was negatively affecting my progression in therapy and I had expressed a desire to stop. He is, after all, being paid to do the best to help you out of the state you are in and not just sit there watching you destroy yourself and pocket the cheques.

Do you think the drugs and alcohol help with getting in touch with yourself or are they just pain relievers? because the latter is not helpful at all when seeking therapy, imo.

If you are paying for it and don't feel ready to delve deeper, then that is your choice ultimately. but you need to explain that to your therapist and request that they don't push you maybe? I think his expression of annoyance was a way of encouraging you to stop or a least dig deeper into why you don't stop, and testament to his respect for the money you are paying and concern for your welfare imo. He sounds alright to me, just on a different stage of your development and understandably pushy. He is not threatening to terminate the therapy though, is he?

All that Ts are is your "mirror, mirror on the wall." They are there to reflect the YOU that you need to be looking at, the events that are relevant and challenge what you wont/can't/don't want to. Once you can finally see these issues and life patterns for yourself, they are then there to help you let go of the issues and change the patterns. If you aren't ready, then you aren't ready- simple as.

I do understand. It is a horrible journey, and after all the small brakedowns and reluctance to deal with things, you eventually take the mirror and look for yourself....... from there is like the labour/birth experience (better not to tell people) probably not as bad as you fear, worth it for the feelings you get, but far from over either.

I hope you eventually get to where you need and want to be. I am sure you therapist is just trying to help so maybe talk about the pace you would perfer to take x

[moonlitsky]

Originally Posted by stopdog

Drugs or alcohol are not issues I have, but I still would not see a therapist who thought they got to dictate how I came to appointments or if they got upset over anything at me. Sh, sui or anything really. It is simply not their place. The only result I can see from what the op's therapist did, would cause a client to lie rather than not. Further, the therapist is being paid. I do not believe a client can waste a therapist's time. A client can waste their own time or money, but not he time of the therapist.
See whatever therapist you wish, I simply would not. The therapist does not get to control me.

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 and care.

alk2601 - I think that being sober for one hour a week in therapy is a reasonable request. Can you do that for yourself I wonder? Can you stay sober the night before therapy and notice how that feels, and take the feelings into the therapy room?
Part of the healing is about YOU taking responsibility, not the therapist. You can choose to turn up drunk each session if you wish, but part of the healing is in knowing there is a healthy boundary in place, and that means you may be told to leave, and come back next time sober. That's how you can start to take back YOUR control. Hopefully, it can be the start of many more hours a week where you can be in a better place to heal.

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.

I wish you well in your therapy and your journey to self care and reaching your potential.

Moon

[stopdog]

Originally Posted by moonlitsky

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.

If it works for the people who continue to pay you, then good. I would not continue to see you or feel safe and I sure as all get out don't want one of you therapists showing anger or pretending to show anger at me for any reason. I do not need a therapist to care about me. I just wanted the OP to know there are therapists out there who do not act the way you describe. I see two of them. As a client, my boundary is to not pay therapists who act in the manner as you describe.

[healed84]

My T and I just had this conversation.. He said, he won't do therapy (that session) if he has a client show up and is under the influence. It doesn't accomplish anything. I don't think your T should be mad at you per se, but I do think it he has every right to tell you, you come to therapy in your right mind (as far as drugs go).

[stopdog]

I do not disagree that one therapist can tell a client whatever. But the client has options too. I am not as much concerned about whether a therapist will not hold an appointment with someone actively drunk or high,(I of course I would not see a therapist who felt that way, but there seem to be a mix of them ) but that the therapist got or pretended to get upset. Eff that - it is my boundary. And there are therapists to be found who won't pretend to be and who won't get all up about how much their pretend anger or upsettedness means they care. And if it is not pretend or play acting, then I think the therapist needs to get their own therapy and a client should get far away from that therapist until that therapist comes to understand it is not their place to do so.

[RedSun]

My T gets a bit upset when I SI. Also I I share something sad or difficult she may get a bit emotional. Because she is tuning in to how I feel, and because I believe she cares, within reason. In many, but by no means all, forms of therapy, the focus is on the relationship between client and T as a vehicle of healing. This needs the T to show some parts of themselves, including their genuine responses and emotions. I guess your T was showing their frustration. It doesn't work for everyone. Personally, I couldn't work any other way.

[Can't Stop Crying]

Maybe it's time to wait for some feedback from the OP

I once said to T "I sometimes think I should have a beer before coming here, to help me talk". T laughed and said "Feel free, as long as you are not falling-down drunk." (Background information: I don't get drunk, ever - I hate the feeling of being out of control, and T knew that. I do like beer however, and have a fairly high tolerance, so one pint is not going to affect me very much in terms of how well I think or communicate.)

But since I always see T at the start of my working day, it wouldn't be an option, and I would not feel comfortable doing it in any case. But it certainly wouldn't be an indication of not being committed to my therapy - rather the opposite - if I did show up very slightly intoxicated, and I'm glad my T is relaxed enough to know that.

I've been reading all of this with quite some interest.

After years of therapy, I've not only come to realize, but to also accept responsibility for:

MY OWN SELF SABOTAGING BEHAVIORS!

If I'd have been some of my therapists, I'd have been pissed off at me too!

So, all I've got to offer is this ...

You want to disrespect yourself, your therapist and your process?

And then expect them to NOT get upset about it?

Really?

Wow!

Just, Wow!

[stopdog]

Originally Posted by Mastodon

I once said to T "I sometimes think I should have a beer before coming here, to help me talk". T laughed and said "Feel free, as long as you are not falling-down drunk." (Background information: I don't get drunk, ever - I hate the feeling of being out of control, and T knew that. I do like beer however, and have a fairly high tolerance, so one pint is not going to affect me very much in terms of how well I think or communicate.)

But since I always see T at the start of my working day, it wouldn't be an option, and I would not feel comfortable doing it in any case. But it certainly wouldn't be an indication of not being committed to my therapy - rather the opposite - if I did show up very slightly intoxicated, and I'm glad my T is relaxed enough to know that.

Yes, it is sort of like the ones I see who have actually suggested I try having a drink before coming to the appointment to see if it would help quell some of the anxiety.

I can't imagine my therapist, or the last one, being upset like that. Instead, I'd think he'd ask about my feelings behind it. It would be a good opportunity to address why you are doing this. For example, it could be self-sabatoge, like Pfrog said. On the contrary, it could be that you have an "attachment" to alcohol as opposed to a person. This, I believe, explains most substance abuse...

Working through this issue doesn't seem any different than working through other issues that include acting out, resistance, etc. Maybe your therapist was upset at himself that he didn't realize you were under the influence all of this time? That could be part of it.

Whatever the reason, he likely was shocked, so give him some slack about his reaction. Wait to see how it goes before you make decisions about continuing. You want someone to help you, right? Then don't run.

[stopdog]

Originally Posted by skies_

Whatever the reason, he likely was shocked, so give him some slack about his reaction. Wait to see how it goes before you make decisions about continuing. You want someone to help you, right? Then don't run.

I think you pay a therapist to control their reactions. The therapist surely has had other clients and should not, in my opinion, get shocked that a client may use substances. Leaving a therapist who is not right or who has incompatible stances is not, in my opinion, running in the bad sense. It would be running for the right reasons.
If it works for the op, or anyone, okay.

Originally Posted by stopdog

I think you pay a therapist to control their reactions. The therapist surely has had other clients and should not, in my opinion, get shocked that a client may use substances. Leaving a therapist who is not right or who has incompatible stances is not, in my opinion, running in the bad sense. It would be running for the right reasons.
If it works for the op, or anyone, okay.

Yes, I know....

I just wonder if it's a one-time thing with this therapist, which is why I was thinking 'wait to see how it goes'. I think anyone would be shocked to find out they were 'blind' for xxx times. Shock is difficult to contain for even a therapist....

For some reason I got the impression it was about running...it's natural among people I knew who have had SA issues. Just a guess and of course I could be as wrong as anyone's assumption.

If we expect to go into therapy ... An interaction with another human being ... and have them to not respond with any feelings or emotions when we've done something harmful to ourselves and/or others and/or our own process ... Then what's the point of even being there?

I'm sorry, but I simply don't get or understand this line of supposed reasoning.

It seems quite preposterous (to me) for anyone to expect another human being to "control" what would seem to be a normal reaction (getting upset) to something that caused them concern about another human being they are connected with whether on a personal or professional level.

[JaiBird]

So, I would talk to him about it. Although he might feel that he cannot work with you on sobriety if you don't make an effort to stay sober, it is your choice. He might not be the therapist for you. It is a partnership, and you two have to be on the same level.

[JustShakey]

To the OP: it sounds to me like your T just wants you to be responsible, but I'm not so sure if I agree with his method.

Therapists really need to be careful when using anger IMNSHO. I don't have substance abuse problems, but I do have issues with emotional intimacy and being used as a 'sink' for others' anger and painful emotions. My previous T tried to get me to respond through using anger and all she ended up doing was reinforcing the belief that I was difficult to deal with and that I do nothing but upset people when I try to get my needs met and that I have absolutely no right to be angry.
So, I'm touchy on the whole anger thing, pretend or otherwise. It's like fighting fire with fire. You (therapists) really need to know what you're doing if you choose to go there.