Thursday, August 2, 2012

Prozac Never Sleeps

Despite all the bad rap heaped on psychopharmacotherapy (psych meds) lately, neither does any other drug. If it's in your brain, it's doin' it's thain. Not so psychotherapists. They (alright, we) do occasionally fall asleep on the job.

Patients: What do you do when your psychotherapist nods off in the middle of a session? How do you feel about that, and do you ever feel safe telling the psychotherapist how you feel about it? Does she ask? Do you start talking louder in the hope it will wake her up? Give her a little nudge? Walk out of the session? Do you blame yourself: "I must be boring her." Does she blame you: "You must be angry." Does she apologize? Do you ever see the eyelids start to droop and do something to try to increase sleep latency? How would you want your psychotherapist to handle the situation when she awakens?

Psychotherapists: Be honest. How often have you nodded off mid-session? What do you do when you feel it coming on? What would you want your patient to do or say? What have your patients done or said? Do you blame the patient or yourself? Do you apologize? Do you educate the patient in advance or wait for it to happen? Sleep latency supposedly reaches a minimum in early afternoon. Do you have any strategies for staying awake then? Ever pinched yourself? Ever refund the patient's fee? How much of a session can you sleep through and still claim reimbursement from a payer?

One of my favorite supervisors for group psychotherapy, a rather brilliant psychologist, used a novel approach. When he sensed the group avoiding significant material he would gradually slouch in his chair. If he did eventually fall asleep, and awaken before the end of the session, he would, he claimed, share his dreams therapeutically with the group.


  1. Fortunately, I've been spared "resting my eyes" syndrome. I've a policy of not charging for a session if I felt I was not "on" for whatever reason. Patients are very surprised by seem to appreciate the gesture.

    Research on circadian and ultradian rhythms indicate a "lull" that tends to set in around 3 pm. It's rare I'd schedule anyone for that hour.

    I've heard the tales re therapists--including luminaries in the field--nodding off and claiming to have useful feedback to offer patients when they awaken. Sure, anything is possible. That said, it doesn't sound credible.

    Seriously, imagine being interviewed by a national newspaper or tv reporter, sharing the "sleeping luminary" story.

    Public reaction ?

  2. In a time when so many are trying to figure out ways to charge patients/clients extra your policy is truly laudable. Good on ya!