Triggered in session due to therapist behavior

[scold_hands]

Last week I had a regularly scheduled telehealth with my T. I logged on with plenty of time, my little bowl of dinner next to me while I waited. 10 minutes went by and she still hadn't logged on. I was about to text to see if we needed to reschedule when she said that the internet was messed up and she would try to connect another way. Finally, she logged on and immediately I knew something was off. From her mannerisms, speech, and physical movements it was staring at someone drunk. Fun fact: the majority of my sessions are spent going over the behavior of my adult parent's current struggle with alcoholism. She was distracted as my dog shook his collar and by a car driving fast on her road. It was exactly like looking at my mother on the screen. Instead of small talk or discussing how the month has been, she went straight into "So you're going to your parents for Thanksgiving, how do you think that is going to go?" I couldn't manage to actually answer that I was nervous about the holiday exchange, because the person talking to me looked to be in the exact state I would be trying to avoid. She did not have any advice or actual discussion to provide, just agreeing with me and nodding off if I went on too long. When we started to discuss anxiety towards a new issue in my relationship she just said "But you're doing good now". Lastly, what would have been a normal exchange discussing a rate increase, was a rambling mess about "I have to do the things" and "other therapists charge even more than this".

I was frozen and in shock the entire time. We closed out the session and I couldn't believe that was the session we just had. She texted me after to confirm our next session with 3 different dates and times all different from what we picked. She included grammatical and spelling errors and sprinkled in heart emojis throughout. I have had this therapist for years without issue, in person and telehealth. I did text her the next day (once the shock wore off) to say that I wanted to make sure she was feeling ok because the session felt very off. She initially said that she was sorry that the session felt off but that everything was ok, and that I could schedule a call to talk about it. I didn't answer right away and then the next day she texted back saying she had thought about it and she actually had a reaction to a steroid and that was why her face looked the way it did. I am to the point where I don't know if I can trust her. I have discussed this with another therapist and showed her the videos of the behavior I witnessed. She was shocked and said that she had no idea how she even had a session that day. I have not heard of a steroid causing someone to act drunk (let me know if it's a thing).

So here's my conundrum. Do I schedule a phone call and try to discuss how inappropriate I felt that session to be? That the person on screen was a mirror image of my mother in a drunken state. How she double-backed on saying everything was fine to oh it was a medical issue. Is this just me overthinking or transference?

 

[Teamwork]

Depends on how long she was taking it for. I’m on a heavy duty one and much of my life has changed while I struggle to get to remission. Memory is huge, as in I can’t recall things I should automatically know and much worse than that. I have a lot of side effects. But I have no choice but to muddle through. Simple steroids like you use for a week to clear up a bad cough are crazy hard on the body. That being said, I’m not responsible for managing someone’s appointment during the course of my treatment. With the stuff I’m on if I was, I’d have to take sick leave. At the very least she should have straight told you and offered to rebook-given she would know how difficult this would be for you. On the other hand if she had to do a short acting course of steroids then she wouldn’t be thinking straight. You know her and if this is a complete one off, give her that. You also would know if she has ever lied. She may not of offered an explanation straight away if she felt awkward a few days later when you asked. All told, it’s up to you which way to go. If it is a break in trust and a trigger, try the conversation and see if she is who you’ve thought she is all along. My therapist makes one accidental tigger and he is quite apologetic-meaning it was random, he missed it and owns it.

 

[Charbella]

. I have not heard of a steroid causing someone to act drunk

Me either BUT my aunt acted completely drunk on Advil. There is absolutely no way she was intoxicated and yet there she was acting it on Advil. High dose but I can take three times the amount and never have an issue, so it’s hard to say.

It sounds like she acknowledged her face looked different, not that she’s acting different so yes you should ask because she should know. Besides if you don’t ask it will just continue to bug you.

 

[Starfire]

Your T is suppose to be in a charge of leading your session to your benefit. Doesn't seem she was capable of doing that. To be crass, she couldn't do the job you paid her to do.

At the very least she should have cancelled the session for medical reasons or just plain not feeling well. Definitely not modeling good behavior.

If this is a one off, I'd say you did the absolute right thing by checking out your feelings, concerns and verifying your perceptions. Steroids can cause 'weird' reactions. Still you are not suppose to be taking care of your T. Since she brought the issue into your session, I would want to know if this is going to be of continued concern. Normally I'd think my Ts medical problems are none of my business. Perhaps set up procedures if she's again not feeling well. Gee, I sound like my T in the early days of my therapy!!!!

If it is a one off, she deserves understanding. Perhaps she was taken by surprise at her body's reaction. See how the feeling of sitting across from a mirror image of your mother, can help you. You know, make lemonade.

 

[Movingforward10]

How long have you been working with her? If this is a one off, it’s worth doing the call to say all you need to, ask all the questions you need, and take it from there? It could be resolved.

however, if you ask all the questions and still don’t feel safe, then…..

therapists do make mistakes. It could be a genuine mistake and she didn’t realise she wasn’t in a healthy state to take the session if she just took new medication and it didn’t agree with her. Hear her out? It’s unfortunate her presentation was a trigger For you and you now see her as unsafe.

 

[No More]

whatever caused it, your therapist should have known better than to try and have a session while in that state. If she’s previously been good, I would suggest you take her up on the offer of a call and lay it all out to her.


Aside from that, (and weirdly despite the fact I can use elephant sized doses of various substances) certain medications do make me slur, forgetful, act like I’m drunk in really small quantities. There’s one I’m prescribed to take as/when for a certain medical condition and I learnt the hard way I cannot take it and work, despite the fact I should be fine to do so, because I look like I’ve had 10 pints.

 

[Muttly]

Sure, it could be a reaction to the med and she didn't realize how badly it was effecting her. She may not have realized it was effecting her so much, although I find it concerning she still didn't realize after the fact.

Talking to her about this is going to be important and it could be super healing. It's going to depend on how both of you handle it. It could be really healing for you if she takes responsibility and models healthy responses to the situation.

 

[Friday]

I have not heard of a steroid causing someone to act drunk (let me know if it's a thing).

Oooooh, yeah. It’s a BIG thing with children (Google desperate parents of asthmatic children attempting to cope with steroids, for far more detail discussed openly), and a significant thing wih adults (although whilst adults with chronic conditions usually have their steroid of choice? If you can’t get into see YOUR doc, you’re left wih whatever madness pill Urgent Care will Rx. Meanwhile adults new to steroids are left to deal with all new kinds of crazy).

Steroids? Including corticosteroids, which are what are prescribed for breathing and massive inflammatory response (as opposed to “roid-rage” anabolic steroids that weightlifters use… are HORMONES. Think “crazy pregnant lady” hormones. Think the worst PMS ever. Then? Add a factor of x10 or x100.

Very VERY common side effects of steroids?


Drunk / Stoned / Delirious
Rage Explosion
Manic Racing
Paranoid fear & fight/flight
Insomnia for days
Nodding off
Blacking out
Nada. No mental/emotional side effects, whatsoever. But? ALL kinds of physical side effects.
Nada. No mental/emotional/physical side effects, whatsoever.
50/50. At first? Zero side effects. Then? Career/relationship/life ending side effects.

- All KINDS of keeeeerazy out of character behaviour. VERY expected on steroids.
- ZERO kinds of side effects? VERY expected on steroids.
It’s a coin flip.
They’ll f*ck you sideways, or not. No way to know, without taking them.

But? They also keep you alive. The whole breathing thing, being necessary for life. So they always get prescribed. Unless? The whole shutting down your immune system thing is more relevant.

Hormones? Are hardball. Full stop.

How she double-backed on saying everything was fine to oh it was a medical issue. Is this just me overthinking or transference?

She didn’t think she had a session that day, thought she was fine, and then? In retrospect? OFF meds? Realized her medication had f*cked her six ways from Sunday, and that she’s blacked out, yep. That’s a LEGIT medical issue, right there.

Does that mean you “should” continue on with her?

Nope.

Does that mean you “should” fire her?

Nope.

Keep her, fire her, both are totally fine/reasonable options. It’s completely up to you, what you do next.

 

[Freddyt]

Drunk / Stoned / Delirious
Rage Explosion
Manic Racing
Paranoid fear & fight/flight
Insomnia for days
Nodding off
Blacking out
Nada. No mental/emotional side effects, whatsoever. But? ALL kinds of physical side effects.
Nada. No mental/emotional/physical side effects, whatsoever.
50/50. At first? Zero side effects. Then? Career/relationship/life ending side effects.

- All KINDS of keeeeerazy out of character behaviour. VERY expected on steroids.
- ZERO kinds of side effects? VERY expected on steroids.
It’s a coin flip.
They’ll f*ck you sideways, or not. No way to know, without taking them.

Yum,,,,take them everyday.....to stay alive. #Addisons Life

Explains part of why I'm so screwed up!! But totally correct.....and with PTSD too.....a huge part of why we didn't spot one from the other because....well.....do any of those symptoms match PTSD?

And the changes when you start taking them? Everything. For me it goes from the eyes on down. Not fun until you learn to regulate them properly (we could go into the whole take two pills thing but....) and that's a learning curve too, because for me - I can have all the bad symptoms listed if I don't have enough meds - and you can add delirious rambling to the list.

It takes a while to sort it all out - I remember going to my doc the first time I got the flu thinking something was really really wrong. It was just that my body needs more meds when I get sick and feeling your way through that - leaves your Endo with that look on their face when you tell them how much you took. But when you know when you are about to hit the wall......it avoids a trip to urgent care.....

 

[Hedge]

I feel that she should have contacted you and explained that she had to take a course of medication (Steroids) and given their possible side effects (surely her doctor would have told her something of this), she would need to reschedule your appointment. It does sound like it was an honest error of judgment on her side. However, I do feel that she has a need to know how her behavior affected you. At least this way, she will become aware of how her actions caused you a lot of pain and triggering issues and, given that you are her client, your feelings are what are important here. As an aside, I take an antidepressant and one day, it just affected me big time. I arrived at work after a giddy trip on the tram going to work. When I reached work, I was feeling very light headed, shaking a lot, a bit nauseous for when I walked I felt like I was continuously walking to one side, and it felt like everything that I looked at was surrounded by a blinding light. I am indeed surprised that the security guard let me on site and believe he only did so as everyone knows me and knows that I do not drink alcohol or take drugs

 

[Weemie]

If it were me I'd do a debriefing to make sure she was OK and wipe this session from the books. Everything we said and did in that session, boop, doesn't matter. Reschedule the schedules, recount the payment increase etc now that she's in a sober mindstate.

I'd extend compassion to her and let her know it's OK that she had a f*ck-up, life happens. Let's pick up, fix everything, sort it all out. Then we can deal with how it felt related to mom, etc. Might even be a way to get some good therapy out of this.

She's human. You've known her for years. She had a bad reaction to heavy-duty meds. Now you're triggered, because her demeanor reminds you of your mom. It's regrettable, but no one did anything wrong, here. It was an accident and we can fix it up.

That's what I would do. I can't say what you should do, just offering a perspective.