What should a therapist do under the following circumstances?
A 40 year old patient male) comes for initial consultation because he is unhappy with his life situation in regard to relationships and his career. There is no evidence of psychosis, severe depression or suicidal ideation. The patient has mild obsessive symptoms and there are various personality traits related to his family experiences. The patient is well motivated for psychotherapy and appears to have capacity for good insight.
The patient has occasional drink on weekends and no drug issues EXCEPT that he smokes marijuana most evenings and enjoys the experience. He also acknowledges that he does “ drive stoned” but he believes he is a good driver and has never had an accident. When this is explored further he acknowledges that he understands that his reaction time might be minutely slowed but he knows he is a better driver than most people. He expects to come for weekly psychotherapy and will drive about ½ hour to my office for an evening appointment. He also drives to work daily for about 45 minutes and sometimes will have joint before he drives home.
1- Would you insist that you cannot treat him if he is engaging in dangerous behavior by driving stoned? Explain
2- Would you make this a high priority issues to work on in therapy whether the patient bring it up or not ? Explain
3-Would you deal with this issue as you would any other topic depending on his associations and current conflicts as well as transference issues?
4- Would the answer to any of the above question be different if the patient were a moderate drinker and frequently drives while “buzzed“ or intoxicated?