When Jason sought out therapy three years ago, he wanted to speak to a professional about what he thought was a negative pot habit. To his surprise, multiple counselors were hesitant to tell him to quit, which he found “morbidly amusing.” Eventually, the 40-year-old visual artist started taking a few hits off of his wax pen prior to sessions, and then after switching to teletherapy when COVID hit, occasionally smoked at home — not to raise alarms about his use, but because he didn’t think it was a big deal anymore.
“When I’d get high before a session, I tended to be more florid in my speech, reaching for grandiose metaphors for my actions and reactions,” Jason tells me. He would always disclose to his therapist that he was high, because he didn’t want to waste his time and energy on therapy by not being honest. He does admit that his sober sessions tend to be more efficient because he’s “not hiding behind poetry,” but will still toke here and there, mostly to try to see his challenges from a different perspective. (A growing amount of research has demonstrated how weed can be helpful for treating social anxiety, short-term depression and eating disorders; the same thing cannot be said, however, for chronic depression and suicidal ideation.)
Although it’s probably not helpful for counselors to shame clients for having a session before a session, it also makes sense why therapists like Andrea Dindinger discourage it. “When you smoke weed before therapy, you’re numbing out your feelings and likely quieting your thoughts, which is going to be wasting your time and money,” she warns. When her clients come in high, she doesn’t jump on their case about it, but she asks questions to uncover whatever feelings they might be trying to numb. When it’s an ongoing pattern, she will ask them to refrain from smoking before and after their sessions.
“This allows the client to have and feel their feelings and gives them the time in therapy to practice dealing with those feelings in a safe and supportive environment,” Dindinger explains. Basically, feeling your feelings is a big part of therapy, so you shouldn’t smoke something that makes you feel happier, sillier or more relaxed than you genuinely are. Not giving into this temptation “builds strength, maturity and self-confidence, the very tools you enter therapy to find and grow within yourself.”
That said, Dindinger acknowledges that in some cases, “a habitual weed smoker may need weed as a temporary crutch to even begin talking through their stuff,” but eventually, that needs to be addressed. If not, “the downside of showing up to therapy high outweighs the benefits, especially if it’s something you’re hiding and not being open and transparent about with your therapist,” she says.
Not every expert takes such a hard line against combining therapy and cannabis, though, especially if it’s intentionally incorporated into the process with clinical guidance. In fact, psychotherapist and psychologist Alison Draisin provides what’s known as cannabis-assisted psychotherapy, or CAP, to clients at the Seattle-based AIMS Institute. “We’ve all sat on a couch with our friends and smoked a joint and gone to that place where you talk about things you don’t always talk about. We just transfer that in a therapeutic sense,” Draisin tells me. “But it’s not like the dime bags you would buy off the street.”
At her practice, clients come in for an initial consultation, where they go over their mental-health history, substance-use habits and general relationship with weed as well as outline their treatment goals. They’re then referred to SMJ Consulting, a medical clinic partnered with the AIMS Institute, where consultants use Draisin’s assessment to recommend a strain. Next, they pick up a gram at an approved local dispensary, and bring it into their next 90-minute session to consume through a vaporizer. (She uses a volcano.) Sometimes the goal is to make them anxious in order to work through such anxiety, in which case clients might smoke something more sativa-leaning. In other instances, the goal may be to relax their “ego defenses” and open up.
Of course, not every smoker is going to be able to find a therapist with weed expertise like Draisin, who started her own edible company in 2009 after witnessing how cannabis helped a neighbor with prostate cancer. For many years, she hid being a psychologist when she judged on panels and spoke at cannabis events because she didn’t want there to “be a weird power differential.” But then, in 2018, physician and eventual AIMS Institute co-founder Sunil Aggarwal approached her at HempFest and told her about the clinic he was starting, which gave her a chance to merge together both sides of her double-life.
Today, she sees cannabis and psychedelic-assisted therapy as critical to her practice. “They’re the best tools in my toolbox,” Draisin says. “I’ve been practicing psychotherapy for 30 years, and I won’t see any other type of client at this point because of the value of using these tools.”
Yet, for guys like Hunter, a 26-year-old music teacher, using weed as a therapeutic tool has been more of a mixed bag. As with Jason, he started going to therapy because he was concerned about his use, particularly after watching his dad self-medicate his own depression for most of Hunter’s childhood. “I always felt vaguely guilty when I started smoking. It also didn’t really help my anxiety,” Hunter admits, but he kept smoking because it helped him focus and practice playing guitar.
His therapist was more or less ambivalent about his weed use, until about a year into his treatment, when Hunter got high before an appointment. He disclosed this to his therapist, who thanked him for being honest, and noticed the same benefits of inducing anxiety in a session that Draisin described above. Overall, “we could talk more directly about the anxiety I have, as I was feeling it during the session. So that led down a couple of helpful paths,” Hunter recalls. But because he was making up his own therapeutic weed regimen without much professional guidance, he quickly started experiencing diminishing returns. “It wasn’t really helpful after the first two high sessions,” he says. “I was really defensive and didn’t trust my therapist much.”
For his part, Jason continues to freestyle his own cannabis-assisted therapy here and there. He’s just sure to never violate the golden rule he’s set for himself: “If you’re getting high to avoid accountability in therapy or because you need an excuse to not take it seriously, then you need to reevaluate why you’re there in the first place.”