Tom, he is being manipulative. And he's supposed to be helping you; you don't need to push aside your mental health needs in order to help him. Do what's best for you. Offer sympathy and be as kind as you can without hurting yourself.

There's no way he should be calling you back the way he did. That's not professional.

This.

And what is making this so difficult for me is that I am completely unable to discern what is and isn't abuse.

I understand how that complicates things. I really, really do, and it fucking sucks.

But I'm going to echo Dana and say that, in this scenario, you don't have to determine if your therapist is being abusive or not. If (for the sake of argument) he's not abusive, you still aren't ever obligated to remain his client. You can just stop because it's not working for you any more.

Teppy and Dana are wise. Therapy is about you and your needs not your therapist.

Or just because you would feel more comfortable with another therapist, regardless of results with this one. The "and another thing" call strikes me as crossing a line, and one thing a therapist should definitely be mindful of is maintaining healthy boundaries.

IIRC, he's a traditional Freudian analyst, and you've been seeing him twice a week for a decade?

I wanted to go back to this, too. It really might be time for a different therapeutic modality. Sensorimotor psychotherapy can be very effective for trauma. (It can be a rough process, because I'd still rather repress everything and not acknowledge my shit [hey, I am what I am], but I cannot deny that it's helped me a lot.)

And also, my brother has had a lot of success with ketamine-assisted psychotherapy for his C-PTSD. (So much so that he's getting trained to administer ketamine-assisted psychotherapy, because there are very few providers in Colorado who do that right now.)

you don't have to determine if your therapist is being abusive or not. If (for the sake of argument) he's not abusive, you still aren't ever obligated to remain his client. You can just stop because it's not working for you any more

This. Hell, I’d want him to refund me for any session where he fell asleep but whatever. Find a new therapist.

I'm going to echo Dana and say that, in this scenario, you don't have to determine if your therapist is being abusive or not. If (for the sake of argument) he's not abusive, you still aren't ever obligated to remain his client. You can just stop because it's not working for you any more.

Thirding this - the line for "should I continue paying this professional for his services" can be set way, way lower than manipulation/abuse. If he's falling asleep during sessions, he's not providing the service you're paying for, and you, the client, can end that relationship for that reason alone.

And what is making this so difficult for me is that I am completely unable to discern what is and isn't abuse.

Tom, I'm so sorry you're going through this. I agree with Jessica, Teppy, and Dana. You don't have to discern whether or not this is abuse. Not all unsatisfactory treatment is abuse. It does not have to amount to abuse for you to decide you deserve better (and you do).

Your reasons for ending this professional relationship are based on evidence that he is not up to the job. If a barber, pharmacist, waiter, or M.D. fell asleep when I was engaging their professional services, I would no longer do so. The same holds true for a therapist, regardless of his personal health concerns. He cannot do the job when he is asleep.

For the sake of argument, let's assume the therapist is telling the absolute truth about the reasons he fell asleep. How are you supposed to keep your mind on the work you are doing in therapy, if you're wondering if the therapist is even conscious? How are you supposed to do your part, if you can't trust him to do his (even if the sleeping can be blamed on an illness)?

I know to a hammer, everything looks like a nail, but when you mentioned he'd gotten bad news about a medical test, I fully expected you to then say he then confessed he had a drink (or took medication) to calm himself down, and that made him drowsy.

I'm the adult child (hammer) of an alcoholic (nail), which is why I thought this story was going to be that kind of story. Even after your account didn't end that way though, AND after I realized why *my* brain was inclined to go there, I still thought it a possibility (between the previous sleeping episode, and the times you realized he didn't seem to be all there). I thought it, because he has excuses at the ready.

BUT, even if I'm wrong, and this isn't a nail, it is some other sort of health problem which, while sympathetic, is rendering him unable to do his job. I would feel bad for the cabbie with narcolepsy, but I'd avoid his cab.

I would feel bad for the cabbie with narcolepsy, but I'd avoid his cab.

Wow. YES. You are eminently wise, Cindy.