Question

Why would a therapist not be willing to see a PTSD patient if they disclose they use substances *outside* of the therapy hour? I figure being open about light psychedelic use would be ok to share but she said no more therapy if I use any substances.

Answer 1

There could be several reasons why a therapist might have concerns about working with a patient who uses substances, even if it's outside of therapy hours:

1. Therapeutic approach: Some therapists may have a specific therapeutic approach or philosophy that prohibits working with clients who use substances. This could be due to concerns about how substance use might impact the therapeutic process, hinder progress, or even pose safety risks.

2. Ethical considerations: Therapists are bound by ethical guidelines that prioritize the well-being and safety of their clients. If a therapist believes that a client's substance use could compromise their emotional or physical health, they may decide it's best not to continue the therapeutic relationship.

3. Effectiveness of therapy: Substance use can sometimes interfere with therapy outcomes, making it difficult to address underlying issues effectively. Therapists might worry that progress in therapy could be hindered if a client continues to engage in substance use.

4. Liability concerns: Therapists may also be concerned about potential legal and liability issues associated with clients who use substances, especially if they provide counseling or support during periods when the client might be under the influence.

5. Safety and responsibility: Depending on the type and extent of substance use, there may be safety concerns for the client, the therapist, or both. A therapist might feel they are not equipped to provide the necessary support or intervention in case of substance-related emergencies.

6. Personal boundaries: Therapists have their own boundaries and comfort levels when it comes to working with clients who use substances. Some may prefer not to work with such clients for personal reasons.

It's essential to remember that therapists have a duty to prioritize the welfare of their clients and may make decisions based on their professional judgment. If your therapist has set this boundary, it's important to respect it and have an open conversation about your feelings and concerns regarding the matter. If you believe that the therapist's decision is hindering your progress or you feel it's not in line with your needs, you may consider seeking a second opinion from another therapist who may have a different perspective on substance use and therapy.