Dozing doc

May 4, 2007 4:42 PM

My therapist has started to nod off during our last few sessions.

Some background: I have been seeing him for about 3 months (my former therapist moved, and I needed to find another one) All sessions with him, up to this point, have been very productive. Prior to the first occurence, he mentioned that he was having some back issues, a pinched nerve, and I thought that maybe he might have taken some pain killers, causing the drowsiness. I ignored the eyes rolling in the back of the head at first and didn't mention it. However, he is no longer having his back issues (I asked) and the almost dozing continues. How to handle? Confront him? Just call and discontinue our sessions? Has anyone else experienced this odd behaviour? Is this some weird way of him trying to get a reaction out of me? Or is he just that rude?

posted by anonymous to human relations (35 comments total)

Yes, confront him (tell him you've noticed he's falling asleep during session and you're upset by this). Then judge by his response whether to 'fire' him or not.
posted by LadyBonita at 4:49 PM on May 4, 2007

I would call and discontinue, but that's just me.
posted by milarepa at 4:52 PM on May 4, 2007

Yeah, his nodding off might be understandable, but not acceptable from a therapy stand point. Ask for a referral, and if he ask why, tell him the truth.
posted by YoBananaBoy at 4:55 PM on May 4, 2007 [1 favorite]

Is this some weird way of him trying to get a reaction out of me? Or is he just that rude?

Or maybe there's a third scenario that doesn't paint him as manipulative or insensitive. I know a guy with narcolepsy who falls asleep at the dinner table, mid-conversation. Now, this friend is not malicious, but I wouldn't have him for my therapist, either. (Or chauffeur.) If you like the guy, just tell him. It doesn't have to be a "confrontation."

"Hey, we seemed to be productive in the first few months, but lately I've noticed you've been falling asleep during our sessions. I'd really like to regain that productivity, but if that's not possible I need to see someone else."
posted by desjardins at 5:07 PM on May 4, 2007

Sneak out the next time he does it. When he wakes up, and eventually finds you sitting in the waiting room reading the Reader's Digest, you'll all have a good laugh.
posted by found missing at 5:10 PM on May 4, 2007

Productive therapists don't grow on trees. Can you change the time of day of your appointment -- maybe he is less dozy before lunch, for example.
posted by Rumple at 5:13 PM on May 4, 2007

It's unprofessional behavior. It sounds as if you're not overwhelmingly interested in finding a new therapist, but it's something you should consider.

But, if you want to try to continue with him, make note of the dates on which it happened. Then, as soon as possible--and preferably, not on time reserved for your therapy--tell him

You've fallen asleep during our last # sessions. It's unprofessional of you, no matter what the reason. I just need to know whether you anticipate this continuing, because if it happens again, I will need to see another therapist.

It doesn't matter why he has fallen asleep, because there are all kinds of understandable, human reasons to do so. But part of the job is staying awake. You need someone who can do the job.
posted by nita at 6:00 PM on May 4, 2007

Let him know that you feel uncomfortable paying for sessions in which he nods off. If he has a problem with this it is time to find a new person. The thing about therapists is that almost all of them need therapy more than you do, unless you have already contemplated shooting the president, and even then I am not so sure.
posted by caddis at 6:05 PM on May 4, 2007 [1 favorite]

Many of these suggestions seem surprisingly hostile to me.I would approach this as an information-gathering conversation rather than 'I'm not paying' or 'you're unprofessional.' There's obviously some information here that you don't have, and you might be surprised to learn his take on things. I would just start the next session by saying, "Before we start, I wanted to ask you about something. It seems to me that you have been falling asleep during our last few sessions. Are you?"

He might say, "Oh, I'm really sorry--I tend to close my eyes when I'm concentrating. But I'll make sure not to do that." Or he might say, "You're right, my new baby is keeping me up at all hours. I should have some coffee next time." You need to learn more before making a decision.
posted by underwater at 6:19 PM on May 4, 2007

surprisingly hostile to me

yeah, you are paying somebody close to $100 per hour to fall asleep on you and you have no problem with that? I have a bridge you might be interested in.
posted by caddis at 6:33 PM on May 4, 2007 [1 favorite]

It's not hostile to call a therapist who falls asleep during sessions unprofessional. It is unprofessional. If there's something that can account for his behavior he should have told you that.

If you like the guy have a talk with him, if not, this is reason enough to fire him.

I'm a therapist.
posted by OmieWise at 6:44 PM on May 4, 2007 [2 favorites]

Oh, I meant to say that there's no technical reason why he would be doing this. There are no recognized techniques in which this behavior is used to elicit a reaction.
posted by OmieWise at 6:45 PM on May 4, 2007

That is completely rude; I would discontinue the sessions and find a new therapist. I would not have a discussion or confrontation because, personally, I would not care what reasons he had for falling asleep during sessions. I think I could excuse it if it happened and he recognized it and apologized/explained over the phone or at the next session. Unless he's developed sudden narcolepsy, he has to know his attention hasn't been up to snuff. His failure to acknowledge and make up for it seems to indicate that he either does not believe it is unacceptable behavior or isn't aware that it is unacceptable behavior. Either way, that alone would compromise my trust in him as a therapist, and (imho) a client-therapist relationship requires a lot of trust.

Because I wouldn't be interested in the reasons for the behavior, if I were in your position, I would simply cancel future appointments. Confronting the therapist or telling him how unprofessional it is to fall asleep in a session would be stressful and uncomfortable for me, and I wouldn't find it necessary. Also unnecessary would be passive aggressive behavior like asking for a referral. Finding a new therapist and moving on would be the best option for me, YMMV
posted by necessitas at 7:51 PM on May 4, 2007

I'd feel good that he's so comfortable and probably nod off myself.

If you're still having productive sessions even with nap time, why bother turning it into a cost/value or manners issue? Why do you feel wronged? Like Rumple said, if you really jive with him don't worry about it.
posted by cowbellemoo at 7:59 PM on May 4, 2007

My great-aunt was a Superior Court judge and developed minor narcolepsy as she got on in years. Her mind was still "on", it just looked like she was sleeping. It didn't compromise her effectiveness as a judge one bit. My dad told me a great story where once an attorney said something about it because he was speaking and thought she'd nodded off and she grumbled "I'm not asleep, keep talking."

Next time it happens I'd just ask him if he's all right. If he's a normal human he'll explain himself.
posted by crinklebat at 8:12 PM on May 4, 2007

He might say, "Oh, I'm really sorry--I tend to close my eyes when I'm concentrating. But I'll make sure not to do that." Or he might say, "You're right, my new baby is keeping me up at all hours. I should have some coffee next time." You need to learn more before making a decision.

If someone knows they close their eyes when they concentrate, it is up to them to either break themselves of this habit or inform their clients that they have such a habit. I refuse to believe that anon is the first person to be annoyed by this. Waiting for a client to bring it up implies that they assume their clients would instinctively know that this is simply a peculiar habit and not offensive behavior; who would want a therapist with such an out-of-touch concept of interpersonal relations? Similarly, if the therapist is over-tired from dealing with a newborn, they know they are dozing and just phoning it in with their clients the next day. Waiting for their client to confront them about is rude and shows a complete lack of professionalism and decency.

I realize these are just examples, but my point is that the actual behavior isn't as telling as the lack of owning up to the behavior in a proactive fashion.
posted by necessitas at 8:22 PM on May 4, 2007

I would most certainly talk to the therapist and here's why:

A major theraputic element of therapy is the interaction that you have with your therapist. You are basically doing many of the things in therapy that you do elsewhere. If nothing else, telling your therapist that he's been nodding off and that you're bummed about that will help you practice standing up for yourself and expressing your feelings. It also, if you choose to stay with this therapist, gives you the opportunity to explore with him how you feel when someone you are depending on disapoints you.

Personally, I would probably tell him and quit seeing him, unless he was otherwise completely outstanding. But it's worth telling him either way.
posted by serazin at 9:38 PM on May 4, 2007 [1 favorite]

I think you should just scream really loudly when the therapist next falls asleep. When they jerk awake just continue as normal. That'll teach them.

I, personally, would suspect painkiller use (or abuse). But then again I am a cynical little cynic when it comes to that, the "oh, I hurt my back" explanantion being something I have heard before. Having said that I have a very good friend who is a wnderful therapist and is also narcolepetic and I know she doesn't even realize when she starts to drift off.

If you like them as a therapist then this is worth working through. Remember the whole point is that YOU benefit. I would talk to them. it'll be awkward and horrible but hopefully it'll lead to a brighter future. That's what I always tell myself when I have to have an awkward and horrible conversation with someone.
posted by fshgrl at 10:41 PM on May 4, 2007

Whatever this issue, I would refuse to pay for those sessions and if he has a problem with that then mediate the issue through the board of professional responsibilities.
posted by caddis at 12:59 AM on May 5, 2007 [1 favorite]

What caddis say. Ask for your money back for those sessions.
posted by zia at 1:14 AM on May 5, 2007

If you've got a good therapist, who you really like, I would advise you to at least talk to him about it and see if there's a reasonable explanation. People get sleepy sometimes, maybe he just needs a kick to grab that second cup of coffee before your session. I guess I've seen more than my share of therapists, and I can tell you that a good one is not something that's easy to find. (But you probably already knew that).
posted by !Jim at 1:18 AM on May 5, 2007

underwater: "Many of these suggestions seem surprisingly hostile to me.I would approach this as an information-gathering conversation rather than 'I'm not paying' or 'you're unprofessional.' There's obviously some information here that you don't have, and you might be surprised to learn his take on things. "

I wholeheartedly agree. And if I put myself in the therapist's shoes, I would want someone to talk to me directly as well if they had an issue like this.
posted by loiseau at 2:51 AM on May 5, 2007

Who cares why he's falling asleep?
If I hired a plumber by the hour to fix my bathroom and found him nodding off on the toilet, would I try to nurture that situation to find out why he's so sleepy?

I can't think of ANY profession where this type of behavior is acceptable. And I don't think you necessarily need to confront him. How can he possibly remember enough details about his patients and their problems when he's SLEEPING THROUGH HIS APPOINTMENTS?

We all bring enough problems into our therapists' offices, without having to deal with the frustration, resentment, and broken trust that comes along with not being listened to, valued, and heard.

I can't believe that your therapist has not taken responsibility or acknowledged that this has happened. And it's happened more than once! You deserve better. Hope you are able to find it quickly! Good luck to yoU!
posted by iamkimiam at 2:57 AM on May 5, 2007 [1 favorite]

What serazin and Rumple say. Good therapists are really hard to find. So if you like this one, speak up.

No, there is no special therapeutic technique of falling asleep. But therapy can often be about discussing feelings about things happening in therapy, or feelings about expressing your feelings. Once you speak up I'm sure you could have lots of great therapy talking about why you didn't speak up right away.

Therapists aren't perfect. Fortunately they don't have to be to be useful.

If you don't get anywhere, then you might decide to fire him. But speak up first, see if the appointment can be rescheduled for his awake time and see where that gets you.
posted by kika at 3:48 AM on May 5, 2007

Who cares why he's falling asleep?
If I hired a plumber by the hour to fix my bathroom and found him nodding off on the toilet, would I try to nurture that situation to find out why he's so sleepy?

I'd care why he's falling asleep, and yeah, I'd try to find out why he was so sleepy. Would it kill you to start off by treating someone like a human being instead of only caring about what it might cost you? Jeebus some of you people are hostile, jumping straight to the "who cares, smack 'im around!" level instead of just, you know, asking about it.

I agree with the suggestions to bring it up in your next session. If you don't get an answer that works for you, then start thinking about your next step, but this may have a very simple explanation and resolution, and as has been mentioned, addressing a problem like this is probably a good experience for you anyway.
posted by biscotti at 8:44 AM on May 5, 2007

The firing suggestions are rash, in my opinion. If this guy has been helping you, believe me, that's a lot harder to find than a doctor that doesn't snooze. Also, you have three months of history with him. Before you fire him and have to rebuild that history with another doctor, I would try to fix the problem.

Tell him, and then ask what you can do about it. Does he need more time between your session and the one before? Should you both take a break in the middle of a session? Is there a better time? Coffee?

Don't take it personally. Sitting and listening and really concentrating on what people are saying is tiring - even when you are 100% invested and interested in what the other person is saying. If you don't believe me try sitting down with your wife or whomever and have them talk to you for an hour or so without you saying anything while you really, really listen. I guarantee you will be absolutely exhausted by the end of the experience.

So - no, it isn't cool he's falling asleep, and, yes, it's unprofessional behavior. On the other hand, it doesn't mean he isn't a great therapist who's really invested in you. He's certainly not being rude on purpose. If he's been helping you, and you've put in time, I would try working out a solution to the problem. In this profession, I would expect this kind of thing (getting really tired) to happen. Not every session, but I wouldn't expect it to never happen again.
posted by xammerboy at 9:24 AM on May 5, 2007

I didn't mean to sound insensitive earlier with my reply. I would imagine though that if I were in that situation, I would find it totally disrespectful and alarming. Especially given that this would happen repeatedly, and my therapist wouldn't address it, prevent it, and I would have to be the one to bring it to his attention. I just don't see how being a good therapist and not being alert and "available" at your appointments can be two mutually exclusive things.

Obviously it's up to the OP to decide if it's worth it to him/her to continue therapy with this person, based on his/her estimation of the value (relationship AND cost) that he/she receives from the sessions. Personally, I would probably find the REPEATED behavior so disrespectful and hurtful (regardless if it was personal or intentional) that I would likely not bother any more.

Why, oh why, have we not settled on a gender neutral third person pronoun in English yet!?! Apologies for the overkill on the pronouns up there.
posted by iamkimiam at 9:56 AM on May 5, 2007 [1 favorite]

Wow, I had no idea that therapists get to have different standards of professionalism and that we all need to be understanding. All of these (well-meaning) suggestions about basically paying him to work through his issues are amazing.

But that's not why you should find another therapist. I would contend that he isn't a good therapist for you: otherwise, why are you posting an anon question about this? (Also, saying he's a good therapist when he's awake is like saying, "Oh, he's a good employee when he shows up.") This has obviously been bothering you a lot and it sounds like the trust relationship has been broken. Even if you did get an explanation, it's possible you may be always watching/waiting for him to doze off, which wouldn't be productive. (Or, potentially, start saying things so he won't doze off.) The end result makes him the center of your therapy. Not good.
posted by sfkiddo at 10:07 AM on May 5, 2007 [1 favorite]

I know I posted before, and I'm posting again.

I'm a therapist. I see patients, sometimes all day every day. It is unprofessional to fall asleep in sessions. There is no good excuse for it. Of course that doesn't mean that it's a firing offense, but if it happens repeatedly it's certainly something to be upset about and to require to change. It doesn't matter why the guy is falling asleep, it isn't something any patient should have to discuss with their therapist beyond saying: if you fall asleep again, you're fired.

Look, I'm a therapist who explicitly works with the transference that my patients have to me. I expect to have conversations about things, real or imagined, that they have issues with in the therapy and in our relationship. I welcome it. But because I expect those conversations, part of my responsibility is to be as professional as possible so that the discussion we have are about the patient and not about my bad behavior. Falling asleep is a boundary violation on the part of the therapist. The problem is precisely that it obscures the roles in the therapy and it puts the patient into an awful position: either accept the unprofessional behavior or terminate the therapy. This is all the more true as many people feel strongly and positively about their therapist and don't want to fire them, and because research indicates that the relationship between therapist and patient is the single greatest contributor to patient improvement.

I'm troubled, frankly, that so many patients (or what I take to be patients) here would excuse the behavior. Yes, a good therapist might be difficult to find, but therapy isn't magic, it's a professional discipline in which many people are trained. I'm pretty much a Freudian, and I think the most deplorable aspect of what I think is a misreading of Freud's work is that in which the therapy somehow becomes limned with fairy dust and the patient has to take the hit every time something goes wrong or changes. "Don't like what your therapist is doing--it's because you're resistant." Bullshit.

None of which is to say that anon should necessarily fire this therapist. Maybe they talk, briefly, and anon lets the guy know he's fucking up, and that's the end of it. They move on. But it's not all unreasonable to treat this as a major breach of your professional contract with this employee.
posted by OmieWise at 3:42 PM on May 5, 2007 [3 favorites]

As a therapist I say - Just ask him. Say - "I notice you've been nodding off during my sessions - what's up?" Then listen. If he invites a discussion - talk about it - then assess what you've learned. If he seems to be having medical problems and/or doesn't answer the question openly and with concern for your experience - go find a new therapist. There are many good ones out there.
posted by trii at 6:43 PM on May 5, 2007

Wow, with all the different viewpoints on how bring up or not bring up the issue, I'm suprised no one has suggested counseling to work through how you feel about your therapist.

It seems to me that in most personal services, falling asleep is considered unprofessional. This behavior would not be acceptable for a personal trainer, waiter, dentist, or cabdriver. I don't see that it is any less professional for a therapist, and I wouldn't be paying a hundred and hour to discuss how I feel about the therapist's behavior either.
posted by yohko at 6:46 PM on May 5, 2007

This is entirely unacceptable behavior in any profession, and there is no reason you should have to understand, compensate for or otherwise "understand" this person's inability to conduct themselves professionally.

In fact, it's arguable that this therapist has in fact caused further damage through this behavior, because you're now faced with more anxiety about his behavior than, one assumes, the issues which you should be discussing.

I am frankly astounded at the responses that urge you to overlook this behavior on the basis that "good therapists are hard to find". Horseshit. Good therapists are no harder to find than any other good healthcare professional: it simply takes a willingness to try several different people to find the best fit.

Follow OmieWise's advice: it's the best you've gotten in this thread.
posted by scrump at 3:34 PM on May 7, 2007

I am frankly astounded at the responses that urge you to overlook this behavior on the basis that "good therapists are hard to find". Horseshit. Good therapists are no harder to find than any other good healthcare professional: it simply takes a willingness to try several different people to find the best fit.

No one is excusing the therapist, but neither are they saying it is immediate, definite cause to terminate the relationship. In fact, good health professionals are hard to find, and mental health professionals doubly so. Nothing "simple" about it - the idea that is a simple matter is, indeed, horseshit.

If the OP switches, she is likely to be making multiple appointments (get multiple referrals) probably spread over a multi-week, multi-month period as she shops for a new shrink, followed by several months of getting caught up to the point she is at now. Or, she can raise the issue with the current shrink and perhaps move onwards.

It certainly seems to me that one would want to look into option 2 before blowing up the bridges and going straight to option 1. That is all anyone is advising - not overlooking, but dealing. I note even Omiewise, who did indeed give an excellent answer as you note, is advising exploring the options with the current shrink before moving on.
posted by Rumple at 5:45 PM on May 7, 2007

Next time he does it just pour a glass of water onto his crotch and then quickly go back to whatever it is you were doing. Warm water preferably.
posted by lemonfridge at 4:13 AM on May 8, 2007

As a data point, there's an essay by the psychoanalyst Adam Phillips about sessions with one client where Phillips falls asleep - as I recall he suggests that this is a response to the client's unconscious desire to bore him. As I remember, Phillips expresses a lot of shame about it. Not suggesting that this is what's happening here, just that Phillips frames it as unprofessional on his part.
posted by paduasoy at 2:15 PM on May 9, 2007