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The Question

On several occasions my psychotherapist has fallen asleep during our session. I see him nodding off, watch his eyes narrow to slits, see his neck hang back and his mouth flop open, and finally, hear him snore for up to a minute. There is no doubt he is asleep. When he snaps back into consciousness, he looks bewildered, and starts to spout gibberish about a topic unrelated to anything we have ever discussed. Then he tells me that we are out of time. Is he getting paid for napping on the job? Do I shake him to wake him? Do I call his secretary in? Is it ethical for me to take a video? I am sure that it would go "viral" but I really don't want to hurt his reputation. I am too embarrassed to confront him about this. Please help.

The Answer

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Taking a video of your snoozing psychotherapist would definitely go viral if you posted it on the Internet and it would do nothing to enhance the therapeutic relationship. Remember that video of the sleeping Toronto Transit Commission worker? Turns out he was on meds that made him drowsy. After that video, he went on medical leave, then died some 10 months later of a stroke. It just goes to show that we don't always know what is going on in another person's life.

Even so, your doctor's behaviour is unacceptable and unprofessional. And yes, he's likely billing the public health-care system for these cat naps. Don't shake him, wake him, tape him or call in his secretary. I'm going to suggest you do something far more difficult: confront him. It will be excruciatingly embarrassing for the two of you but the doctor's reaction will be very instructive on whether you want to stay with him.

Tina Chadda, chair of the Ontario Psychiatric Association's psychotherapy section, suggested you raise the issue first thing next session.

Start by saying you need to speak to him about something you find very difficult to discuss. That's his cue to prompt you to expand on your comments. It will also help prime him for what's coming. Then tell him he sometimes falls asleep during your session.

"The doctor may be embarrassed but they can certainly work through it in a respectful way," said Dr. Chadda, noting that patients sometimes fall asleep too. "I don't see it as the end of the relationship."

Most likely, the doctor will apologize, be embarrassed and want to explore how this has impacted the relationship. He will also need to look at reasons why he is nodding off. Is it the time of day? The sedentary profession? He will likely need to seek strategies to stay awake and may enlist you to tell him the next time he nods off.

"It's important to talk about it without shame, to not be defensive," said Dr. Chadda.

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This is likely not a one-off conversation; it may come up again if he dozes off. But how he reacts and how you feel about the talk afterward will inform your decision of whether to stay with him or find another therapist.

The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.

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