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.

Oh, Tom, how awful! I agree with everyone else - dump him pronto. You can work on how cutting him off affects you with someone else who will stay awake and be present during sessions. I don't see how staying with him will help you (or would help anyone) at all.

Yeah, I'm side-eying the dude real hard.

Back from the vet.

Marcie shrieked and squeed and made a fuss over every little touch of the stethoscope and got called a drama queen by the vet. She's perfectly fine.

Prubs behaved well, but her lump is a non-malignant mammary tumor. It just needs to be monitored now but we'll probably do surgery to have it removed in the new year.

They are both chombly but not remarkably so.

They were both declared to be "so cute" - which is a true fact.

Oh Tom, this is way too much. I'm sorry.

Tom I think the most important thing is that you don't feel comfortable with your therapist and for good reason. He's shown poor judgement before you talked to him- he feel asleep, he was disinterested etc, and then after he showed even worse judgement by not really taking responsibility and then giving you way too much info about his health and then EVEN WORSE judgement by calling you later and saying more.

Those are all very good reasons to fire your therapist and find another one.

And here is another one: you don't feel comfortable with him and if you don't feel comfortable with your therapist and don't trust them then therapy doesn't work.

There are lots of different types of therapy and lots of different therapists and there is nothing wrong with firing your therapist and finding a therapist/therapy type that works for you. (especially when the therapist has shown such poor judgement).