Drinks + therapy???

The difference between an Rx and alcohol.

An Rx: Prescribed for debilitating symptoms that make it difficult, if not impossible, for one to function in certain situations.

Alcohol: To drink in order to "open up" more in therapy.

Big difference there. I worked my *** off for almost three years to be able to be as honest and open with my T as I am now. I would find it almost offensive that someone takes a couple drinks in order to the same thing that I have worked so hard to do.

As far as taking my Rx before therapy-- Like I said before, by my ninth year of taking it, it's not changing my personality, believe me. I take an Rx because I have debilitating panic symptoms. Not because I want to be more open.

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I've spent LOTS AND LOTS of time talking about things while I was drunk

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This is a good point. Although I have never had a serious problem with substance abuse, I have used other means of avoiding my issues. I think part of the therapy process for me is learning how to speak and say stuff even though it is really difficult for me.

Using alcohol or an Rx may help me relax and may help me to actually disclose my true feelings and not screen them so much. However, the new found relaxation in therapy would not be transferable to everyday situations.

Although I've thought of drinking before therapy, I haven't done it and probably won't. My progress in therapy has been slow, but everything I've learned, I've been able to apply to other relationships.

I don't think the issue SHOULD be what substance is used, I think whether it is OK or not should be more about how the need for a anti anxiety intervention is determined. If it is through a systematic evaluation and diagnosis process, then whatever is used is probably OK. If the need is determined without this type of assessment , then it is probably not OK.

Just for the record, I don't believe that seeing a doctor who spends 5 minutes talking to you and then simply writes a Rx meets the systematic evaluation criteria any more than a patient who decides on their own to take something.

This is such an interesting discussion. I can totally identify with the original post. For me, I often wonder what its going to take for me to just bring the issues on my mind out on the table during session. There are times when I am in session saying over and over in my head "just say it" or "just do it'. I just can't. The therapeutic process alone causes me SO much anxiety. I also don't want to take medication daily because, for me, it hinders my progress. I do wish sometimes that I could take something to take the edge off - but only when I need it.
I want to make the struggle easier but I also want to be able to own the outcome.

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pinksoil said:
I worked my *** off for almost three years to be able to be as honest and open with my T as I am now. I would find it almost offensive that someone takes a couple drinks in order to the same thing that I have worked so hard to do.

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Why is it necessary that someone work their *** of if that person can achieve the same result without working their *** off. I'm saying that alcohol would necessarily work. It may result in state dependent learning. But I think the concept that an achievement has to require you to work your *** of to be worthwhile is a bit irrational.

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I worked my *** off for almost three years to be able to be as honest and open with my T as I am now. I would find it almost offensive that someone takes a couple drinks in order to the same thing that I have worked so hard to do.

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I also have a problem with this. So should I be offended that I have pounded my way through therapy all these months totally unaided, while other people take anti-anxiety Rxs? Likewise, if I were training to be a therapist and/or had posted extensively on my own less-than-ideal coping mechanisms, I think I would try to be a little more compassionate. Trivializing other people's anxiety just because they haven't jumped on the Rx bandwagon yet is a little unfair.

But that's all a side note. I'm glad this topic is interesting to other people as well. As I said before, I know it's not ideal and it's probably not something I will ever do again. But we all have to find our own path, and to me, moving forward, even by a baby step, was preferable to more being stuck.

I've been working as hard as I possibly can for two years and I still do not feel comfortable enough to raise some issues. This is despite having an excellent psychiatrist who is totally committed to my healing.
So, if there is something that may aid me in raising those tough issues - I think why not try it? I wouldn't hide it from him or anything and I don't think he would terminate the session because I had a glass of wine before arriving.
Pinksoil - you're lucky that your hard work has paid off in that way. My hard work hasn't. I see nothing wrong with a little liquid courage if it would produce some progress.

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notme9 said:
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I worked my *** off for almost three years to be able to be as honest and open with my T as I am now. I would find it almost offensive that someone takes a couple drinks in order to the same thing that I have worked so hard to do.

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I also have a problem with this. So should I be offended that I have pounded my way through therapy all these months totally unaided, while other people take anti-anxiety Rxs? Likewise, if I were training to be a therapist and/or had posted extensively on my own less-than-ideal coping mechanisms, I think I would try to be a little more compassionate. Trivializing other people's anxiety just because they haven't jumped on the Rx bandwagon yet is a little unfair.

But that's all a side note. I'm glad this topic is interesting to other people as well. As I said before, I know it's not ideal and it's probably not something I will ever do again. But we all have to find our own path, and to me, moving forward, even by a baby step, was preferable to more being stuck.

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If you read my other posts you would see that I have been on anti-anxiety medications for 9 years. They do not aid me in opening up in therapy.

I am prescribed to take my Klonopin the morning. This is sometimes before therapy, sometimes not, depending on the time of my appointment. It doesn't alter my personality the way alcohol would. All it does is downplay some of my anxiety symptoms, which can be quite debilitating at times. Going to therapy is about presenting all parts of your true self in that room, however resistant, open, pain-filled, angry, willing, childish, mature, etc. Alcohol would pretty much %#@&amp;#! that concept up.

I know that the few times I have had any alcohol in the past few years, I got silly, open, and sort of on the happy side. I did not feel traces of dark parts of me that I can get in touch with by just being myself in therapy. To get in touch with that pain in therapy and to allow someone else to share it is a brave and difficult experience-- one that I do not believe can be accomplished by drinking alcohol beforehand.

Interesting topic to debate.

Wow, some of this sounds heated!

I would think anything that lowers anxiety would make it easier to open up in therapy. At least it would for me. I experimented the one time and it didn't turn out that well. But I don't feel bad about the experiment. I'd feel bad if it became a permanent crutch or resulted in state-dependent learning.

I won't knock anyone for using medicinal support for anxiety, depression, etc. But I will respectfully disagree that it's somehow innately different from using any other substance that would achieve similar results for that person. Drugs affect people differently. Alcohol lowers anxiety for me, but there are folks out there who get really angry when they drink. Same thing with prescriptions. One anti-anxiety medication will work for one person and cause horrible reactions in another. The reactions to various substances are physiological and dependent on each person's body/mind. I do believe there are inherent problems with self-medicating (the dosage bit that I mentioned before) and certainly there are problems with using addictive substances. So I suspect it's better to have prescriptions written any time it's an ongoing problem. But using alcohol to occasionally get "unstuck" doesn't seem somehow worse to me than occasional use of an anti-anxiety med. The case that comes to mind for me now is flying: I'm nervous about flying so I usually have a drink or two on the plane. I could also get a prescription medication for the same thing. Would that be somehow innately better? The end result is the same.

Interesting to think about. I'll add a trigger to this post just in case.....

sidony

sidony, I tend to agree with you, responses to this question are going to be very individual, depending for example on that person's response to alcohol and drugs/meds. For some people, an anti-anxiety med (or antidepressant or whatever) may not change their personality or behavior, but this is not the case for everyone. For me, alcohol is very predictable. I know what dose produces what effect in me. I've been taking this substance for decades (occasional, recreational use), and I know it well. My anti-anxiety med, on the other hand, was a curious beast and very unpredictable initially. It made me very talkative, and even hyper. It made me impatient with people. I was never sure the dose was right--and the doctor sees me once every 3 months so how could the dose be adjusted without my own experimentation, which I didn't do? I accidentally took the anti-anxiety med a couple of times right before therapy (just the regular dosing schedule) and I didn't like those sessions. My thoughts were racing, I couldn't settle on a topic. Since my therapist was not part of my meds prescription, he wouldn't know I was taking this drug, same as he wouldn't know if I had had a drink, unless I chose to tell him. Anyway, after these experiences, I made sure not to take my med right before therapy as I didn't like the effect. Psychoactive meds are powerful stuff! I also wouldn't want a drink if it might interfere with therapy, so I wouldn't do that either. I like to "just be me" at therapy, drug/med and alcohol free, but I realize it could be different for other people.

When, in the depths of my depression, I was seeing my first therapist, and I was so non-functional, I mentioned the possibility of going on antidepressants. I really felt like I needed something to help me get through life. I was not functioning well at home or work. She did not react well and basically told me she would not work with me if I took drugs. That made me feel really bad (weak, ashamed, like I had commited a faux pas for asking), and I was new to therapy and didn't know whether you could do drugs at the same time. I regretted bringing it up, as it seemed like it triggered her, she got kind of mad at me. So I never mentioned getting meds to help me again and she continued to see me for a while. I was just too weak and miserable to go against her (I would have had to find a new T) and didn't realize it was common for people to take antidepressants and go to psychotherapy (I knew nothing!).

Anyway, this therapist had strong beliefs that you should not do meds if going to therapy with her. I wonder why? Is it because she wanted the real person to be more accessible somehow when not under chemical influence? About 5 months later, when I had worked hard in therapy with her (CBT) to lessen some of my symptoms (and thought I had made some progress!), she told me that I needed antidepressants and gave me the business card of a psychiatrist. What?? When I was miserable and at the bottom and not coping and everyday was hell, she wouldn't let me have meds, and then when I was doing a bit better, able to sleep better, and was a little peppier, she tells me to get meds? This made me feel awful, like she had no recognition of my progress. I was so angry at her, but of course, being me, I didn't know it. I remember taking the card but not commenting on it and putting it away and never looking at it again. Damned if I was going to do the meds NOW after all my efforts to get better without them. Later I left her and found my current T, and my remaining depression was "cured" after just a few sessions with him. So I didn't need the meds for my depression after all, first therapist was right, but sheeesh, she put me through a lot with her no-then-yes dance with meds.

At some point in my therapy with my current T, I have asked him about his view on meds, and he is very non-judgmental about them and does not mind if his clients take them. If he has that view, I'm wondering if he would really mind if a client had a drink before session. He seems accepting. I don't know.

Hey Sunrise,

What an awful experience. I don't understand the black-and-white thinking about medications, and I'm sorry if a T made you feel like that was never an option. Although I'd agree that a person is more truly themselves without medication -- there are many many instances in which I'd think medication was the best thing. I know several people in my group therapy use antidepressants, and T doesn't frown on that. Once, when I was severely depressed, he even suggested that I at least keep in mind that that's an option in life.

But I guess we're going a little off-topic here. It's interesting that alcohol was totally predictable for you whereas the anti-anxiety medicine was not. Certainly validates my point that it's different for everyone. I won't agree with generalizing that alcohol has one effect and prescription meds another. Depends on the person. Sometimes they're the same.

In general (this is directed to the overall thread as opposed to my remarks to Sunrise), I'd say if you were thinking of taking a drink before therapy, why not tell T about it? Tell him you need something to get over the hump? Because it sucks to never be able to get unstuck. T might have some other suggestions I don't know. Sometimes you have to go with what works.

Sidony

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notme9 said:
OK, I'm sure no one will think this is ideal, but I'm curious what the thoughts are on going to therapy with a little buzz. I could see the plus side: you could get things out that you have always held back due to self-consciousness. Then once they're out, they could be discussed in later sessions. I'm not talking about sloppy drunk, just a drink or two to relax and decrease inhibitions (think happy hour chattiness). I'm sure there are lots of cons too, but I'm just curious what people/Ts would think about this...

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<font color="blue">LOL--- oh man, don't do it. It's not a good idea; you never know what your going to say, and you never know, you could say something mean or hurtful. Secondly--- you aren't planning on DRIVING to your T appt., are you? </font>

back in the early 70's (for 3 years) and even in the early 90's (one year) when I have been in therapy, one was not permitted to smoke cigarettes or alter their minds during or before therapy sessions.

reason: no artificial stimulants allowed.

so, with the wide spread use of medications today, and the large number of patients taking anti-depressant and anti-anxiety medications daily, that would be present in patients systems during their therapy sessions ... it is probably harder to define why alcohol and nicotine are discouraged, basically prohibited ... yet I think it should still be.

this way you are fully present in the state of mind you function most in.

some of these medications are important to the state of mind patients function in.

nicotine and alcohol are not, in my opinion, for that matter, they are used to eleviate the state of mind one is in, right? escape? or let inhibitions loose? in an artificial way?

anyway, great conversation.

Weighing in on this.

I've been reading through some of these posts and a few things jump out at me. First of all I do not think it's a good idea to go to therapy with a "buzz." If you've drunk enough alcohol to get a buzz then you probably will NOT get what you need out of the therapy. Also, why wouldn't you tell your T this? It feels dishonest and that would effect the trust in the relationship.

Next, as to medications. Of course this is an individual decision. However, if you have thyroid disease would you stop taking your meds before session? If you have a broken leg would you take off your cast?

The point I am making is that medications allow people to function. If someone is on anti depressants that does not mean they don't feel things. Perhaps it is what allows them to get up and out of the house and go to work. Psychiatric meds do not necessarily change who you are nor do they stop you from feeling.

The older medications that were used might be guilty but the newer medications that are available have provided relief for people where no relief was possible before.

Peace

I'd definitely agree that a "buzz" is not a good idea! I think the debate's more reasonable (and far less black and white!) when it's about using a low level of alcohol to reduce anxiety. Anxiety can really be inhibiting. I don't think it's a good idea myself in the case of therapy. I'd argue for the natural approach and taking a lot longer to reveal in therapy. However, in lots of cases, the natural approach doesn't work. People end up needing anti-anxiety medicines to function reasonably in the world or get through a period of depression -- and then that of course leads to the question of whether self-medicating with alcohol is innately different/worse than using prescription medications. I think there are definite problems with self-medicating (inability to choose your own dosage for one, using addictive substances for another), but I don't think it's an innately different beast. I think it's frowned on because of the assumption that a doctor is necessary to validate someone's need for help with anxiety (as well as the other things I mentioned). And I think people can judge that for themselves. I like the natural approach where at all possible. Easy for me to say since my anxiety has not been so debilitating to prevent me from accomplishing anything in therapy! But I have a lot of compassion for others whose anxiety is causing a block. I'd recommend talking about it with T and trying to figure out ways around it!

This is a convoluted subject, so the thread really interests me.

Sidony

There's something I'm struggling with here. I think there is a perception that people should be able to manage their own mental illness (anxiety, depression, or other illnesses) rather than seek professional help.

Personally, I believe mind and body are one. I also don't think it's true that you "have to" use a doctor to cure a cold anymore than you "have to" use a doctor to get a prescription for anti-anxiety meds.

However, if the cold turns into strep, or bronchitis then you need a doctor's rx to get the right antibiotic to beat the infection. Or you may use homeopathy or other natural remedies. The doctor or practitioner is an expert consultant you hire in order to help you figure out the best route. You may choose whether or not to take his/her advice.

The same holds true for mental illness. If your anxiety or depression gets in the way of healthy functioning you consult with a professional. I don't think it's a case of "have to" but rather an alliance similar to the therapeutic alliance. It's done out of choice. Sometimes that professional is a pdoc and you choose medication.

As each of us travel our journey we use professionals to help us in many ways and we tackle those things ourselves that we feel able to.

I suffer from anxiety and depression. They are organic illness exacerbated by life circumstances beyond my control. I choose to consult with professionals who help me. I choose to use medication right now. It doesn't interfere with my psychotherapy, which I also choose as a path.

I guess I'm saying that I don't think there is one answer here for all.

But I do think it's a mistake to use alcohol to loosen up for therapy.
It's such an addictive substance and I wonder whether the benefits outweigh the risks.

The work of therapy is serious and using alcohol to loosen up seems to diminish the importance of the work.

That's interesting MissCharlotte.

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I think there is a perception that people should be able to manage their own mental illness (anxiety, depression, or other illnesses) rather than seek professional help.

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I certainly don't feel that way about anyone else's choice. For myself, I feel like I am seeking professional help in the form of therapy. From my limited experience with medications in this arena, I am not convinced that the "professionals" necessarily have the answers for me.

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But I do think it's a mistake to use alcohol to loosen up for therapy.

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If you just freeze and can't feel anything and can't emotionally connect session after session, I think a desire to change that goes beyond a desire to simply "loosen up." I can see both sides of the argument that having a drink to change that is a mistake. The biggest con that I see so far is the dishonesty issue. I'm less concerned about that because I am certain that I will disclose this at some point and we'll discuss why I felt it was necessary, what I hoped to achieve, etc. This thread has already helped me verbalize some of those things. Likewise, if you felt that you might start to use it repeatedly as a crutch, I could see a concern there. For a variety of reasons, I'm not too concerned about that for myself.

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It's such an addictive substance and I wonder whether the benefits outweigh the risks.

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For me, I feel like I know what the risk/benefit issues are for alcohol, and I feel a lot more nervous with regard to medications (specifically, the long term effects of these relatively new substances used on a daily basis). But of course everyone has to weigh these things for themselves, and I may change my calculation at some point in the future too if I feel the situation warrants it.

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The work of therapy is serious and using alcohol to loosen up seems to diminish the importance of the work.

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I get the impression that a lot of people feel that way, that it's "cheating" or something. That is still curious to me, especially given the apparent acceptance of use of other substances to manage anxiety, so long as they come from the drug store. And if it helps, I have lots of difficult, anxiety-filled therapy sessions ahead, just like everybody else. This in no way resolves that and I certainly agree it wouldn't be a good long term solution.

I see it more as an experiment, as allowing me to try out connecting and feeling something during the session, as well as getting certain things out there for future discussion. Ultimately, of course, one of my goals would be to be able to get there on a regular basis and unaided by any substances, prescribed or otherwise.

Thanks again for the thoughts everyone, I've really enjoyed the discussion.

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MissCharlotte said:
There's something I'm struggling with here. I think there is a perception that people should be able to manage their own mental illness (anxiety, depression, or other illnesses) rather than seek professional help.

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Did you mean in society in general? I hope my own posts weren't interpreted that way. I definitely think it's great that there is good professional help available. But some folks are only going to choose to self-medicate. Lots of inherent risks in that so I don't think it's a great idea. But I do think using any type of substance can have similar effects depending on the person. For me, I could relieve my anxiety with alcohol or I could go and have something prescribed for it. But my anxieties are not at such a level that I need to do either for therapy (I definitely need some anxiety relief for flying though!). But I can certainly relate to the desire to have a drink prior to therapy and therefore be less anxious! It's just got too many drawbacks. Alcohol definitely has huge risk factors. No one's suggesting going to therapy drunk! Even a buzz is a really bad idea.

In talking about this, I can sort of see why some therapists don't want their clients on any medication. I don't agree with that myself, but I sort of see the point of view (I'm adding the trigger now because I know that point of view is so inflammatory -- even my saying I disagree with it is still mentioning a triggering subject). But I get the idea that any medicinewould alter a person's personality. If a prescribed med is relieving anxiety, then that's similar to having anxiety relieved by an unprescribed med. It's all a change. But sometimes I think change is absolutely the best and healthiest thing.

Sidony

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sidony said:
It's just got too many drawbacks. Alcohol definitely has huge risk factors.

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And when I say things like that, that's just a general statement. Obviously there are plenty of folks for whom alcohol won't be problematic (not everyone becomes addicted or overuses etc.). But I wanted to make it known I'm not recommending it across the board for anxiety relief!

That's just a side note I wanted to clarify.

Sidony

Hi Sidony, Notme,

Umm I wasn't necessarily thinking of a particular person so I suppose I notice a general point of view that meds are bad or a sign of weakness.

I can only share my experience. I have been in therapy with and without meds. I can tell you that I did not choose to take meds because of an inability to connect in therapy. In fact, if I could go to therapy 4 times a week I could probably give up my meds. I connect real well with T but it took me a looooooong time and a lot of work to get to this point. I use meds because my depression and anxiety threaten my well being outside of therapy. I am a mother and I have responsibilities. The medication I use allows me to function at the level I am accustomed to and the level I need to.

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But I get the idea that any medicine would alter a person's personality

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Again, in my case that is not true. My personality has not changed.
I am still me.

The original post suggested a "little buzz" to cope with therapy. I still think it is very different from medication and a bad idea. This is NOT because medication is prescribed and alcohol isn't. It is because medication is usually an ongoing solution to an ongoing MEDICAL problem and once the levels are balanced out in your system, they are not providing a lift above normal but bringing you to a more even, normal place.

The occasional use of alcohol for therapy is situational. There would be no difference here than smoking a joint or popping a street drug.

Using substances to change your mood for a given situation is a sign of a possible substance abuse issue.

There is a big difference here.

The work of therapy is compromised by a casual attitude. I think that it's worth struggling through those sessions where you are anxious or disconnected. Therapy IS hard. Just my thoughts.

Peace

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MissCharlotte said:
Hi Sidony, Notme,

Umm I wasn't necessarily thinking of a particular person so I suppose I notice a general point of view that meds are bad or a sign of weakness.

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Oh good! I really really really wasn't trying to imply that! And definitely wouldn't consider it to be true.

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In fact, if I could go to therapy 4 times a week I could probably give up my meds.

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Alkthough I'm not on meds, I think that would likewise eliminate any pervasive anxieties that I have.

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But I get the idea that any medicine would alter a person's personality

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Again, in my case that is not true. My personality has not changed.
I am still me.

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And I guess this is partially colored by a point of view: In my opinion, anxiety / depression / obsessiveness, etc. is part of a person's personality. So if medications are reducing anxiety or alleviating symptoms of depression, etc., then they're changing the personality in my opinion. But you could also argue that those traits don't constitute parts of the personality. I don't share that point of view, but it's just a different way of looking at the intangible concept of personality.

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It is because medication is usually an ongoing solution to an ongoing MEDICAL problem and once the levels are balanced out in your system, they are not providing a lift above normal but bringing you to a more even, normal place.

The occasional use of alcohol for therapy is situational.

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But medication can also be a temporary solution for a short-term problem. Many people choose antidepressants to go through short periods of depression and then go back off them completely.

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There would be no difference here than smoking a joint or popping a street drug.

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Only if smoking a joint or popping a street drug has the same effect. I suspect they don't for most people. A small amount of alcohol lowers anxiety for me, whereas smoking a joint entirely alters my perceptions of reality. Can't speak for everyone on that! But drugs (prescribed or not) affect people differently.

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Using substances to change your mood for a given situation is a sign of a possible substance abuse issue.

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I'd agree that that is true some of the time, but not at others. That would be my airplane analogy again: If a person occasionally uses medicine or alcohol to avoid anxiety while flying (me for example) is that a sign of possible substance abuse? I would say no.

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There is a big difference here.

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I'd agree that sometimes there is a big difference and other times not.

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The work of therapy is compromised by a casual attitude.

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I absolutely agree with this statement!!! I think it's very serious and hopefully ultimately very meaningful.

Sidony

Here's a bit of another perspective. I've been using St. John's Wort for five years now to manage depression. I wasn't ever not depressed before SJW, and I didn't function very well. I go off of it every once in a while, and I return to a state of depression that impairs my ability to function and live my life. For a long time, I assumed that my T probably wouldn't approve of my dependence on SJW, and would think that using it is cheating and I ought to learn to cope all on my own. I stopped taking it for a couple of days before therapy most weeks, so that I would be in a more natural state at therapy. Bad idea. I don't function without it, and didn't work well in therapy either. I don't do good work in therapy while I'm badly depressed. When I finally did ask T what she really thought about using SJW, she was fine with it, just like other antidepressants. Some people need it and I'm one of them.

I don't think that it would be helpful to alter your mental state before therapy sessions, either by taking something that you don't usually, or by not taking something that you do need to function on a regular basis. Therapy is to help you learn to be your best in your life outside of therapy. If you are different when you go to therapy, it's probably not going to help as much.

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Rapunzel said:
I don't think that it would be helpful to alter your mental state before therapy sessions, either by taking something that you don't usually, or by not taking something that you do need to function on a regular basis. Therapy is to help you learn to be your best in your life outside of therapy. If you are different when you go to therapy, it's probably not going to help as much.

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I really like this statement!!!

Sidony

Hi! Just wanted to update as I promised to after disclosing to T that I had made use of alcohol before the session.

I told her by email that I had (yes, I waited a while)...and she was totally cool about it! I was worried about how she'd take it cause some of the other posts made it sound like it was a huge offense.

I explained in the email why (anxiety) and that it was not about acting out/being difficult, and said I was sorry if she thought it was disrespectful or something. She wasn't upset. She didn't say don't do it again, or anything like that. She said it "made total sense" to her and just suggested that we try some relaxation exercises that "might help too." So basically she understood exactly why I had and wanted to address that, rather than getting fixated on the idea that alcohol is inherently bad or something. I really like and respect my T. She's so professional and insightful and I'm glad I get to work with her!

Anyway, I just thought I'd share how it played out, since I know I like hearing about other people's therapy experiences.

Nome9, I hope you don't mine that I brought this thread back. I'm wrestling with the Medicated/Don't Medicate before therapy issue again. Everytime I consider this different rationale and arguments surface.

My last therapy session was a bit tough. Something had happen the week before that made me feel like talking about my past... more directly... was very important. So, before my session... I sent my T a messages basically saying...I need to go [here] during our session this week. I knew when I sent that message, that my T would carry out my directive and that I would NOT like the session at all. Well, that day as the session approached, I felt my anxiety start to elevate. Fearing that it would get the best of me and impede my ability to function during the session...I medicated before the session. I've mentioned that my doctor gave me an Rx to use for situations like this.

I guess the issue that is rattling around in my head today is...should I have told my T that I took medication before the session? Since I didn't, should I tell her now? I know I am the only one who can answer these questions, I want some help debating the issue.

I think it's a good idea to settle this so it doesn't weigh on your mind with all the other stuff causing the anxiety. Your T has an obligation to treat you in your present state and if they are unable or unwilling to do so, they have an obligation to refer you to another provider.

Is it a good idea to continue to let clients come to therapy directly from a bar? Well, it depends on whether or not that's the behavior that brought them to therapy. There are so many moral gray areas and associated health concerns that it's really tricky to address in a therapeutic relationship where substance abuse is not the main issue.

As a clinician, it isn't my job to fix anything for the client. It isn't my job to lecture them on poor choices. I provide information, lead skill building activities, and suggest ways things might be easier for the client to get along in life. If their drinking/medicating is limiting their ability to progress or disrupting my office, it's an issue for me, if not, it's an issue for them b/c of the aforementioned moral/health issues. As such, I'd probably direct a short exchange on the consequences of self-medication and use it as a tool to teach some supplemental activity that offered the same result.

My convoluted, tired, and rambling point is this... your clinician should be able to use this as a teaching tool. There's a chance they will view taking an rx right before session as immoral or weakness as discussed before... but if so, that's a flaw within your clinician... not within you. The equal chance that this could lead to a new tool that helps you overcome this anxious reaction is probably worth the risk that your therapist won't respond well.

Clinicians treat clients under the influence ALLLLLLLLL the time. Whether it's prescribed meds, caffeine, nicotine, alcohol, or crack... it happens and you can't just turn them away everytime or some people would never receive treatment. There are groups and individual therapy sessions where it's appropriate to agree that you will not receive treatment if you show up under the influence but that is only ethical if that is discussed explicitly at the beginning of treatment. Otherwise, it's up to the individual clinician to determine if someone is limiting their ability to participate (or even endangering their life by mixing meds/alcohol/nicotine/drugs) and to act accordingly in the best interest of that client.