President Declares Opioid Crisis a Public Health Emergency

Tym Rourke and the NH Union Leader respond to the President’s declaration last week:

NH speaks: How to win the opioid fight

New Hampshire Sunday News
October 28. 2017 11:47PM

There’s been a lot of national attention on the opioid crisis, culminating in the President’s declaration last week of a national public health emergency. And that may mean more funding is coming to New Hampshire.

But where should that money go? What’s the fix?

We asked folks who have been on the front lines of the epidemic here for years for solutions. Here’s what they offered.

Unfettered access’

Rourke Tym Rourke (left) has chaired the Governor’s Commission on Alcohol & Drug Abuse Prevention, Intervention and Treatment for eight years. He said he hopes the President’s declaration will bring more flexibility and funding to the table.

“Regardless of what part of the continuum you want to think about – more prevention, more treatment, more recovery – it’s about making sure that any individual has immediate, unfettered access to the things they need,” he said.

However, Rourke said, “None of this matters unless we can finally as a nation approach this disease just like we approach every other one. And the way we do that is people have insurance cards and they work.”

If people can’t access services, nothing will change, Rourke said. “Quite frankly, addiction (treatment) should not be paid for by grant,” he said.

Recovery housing

Patriquin Bryan Patriquin (left, showing his tattoos that read, “To thine own self be true”), 27, of Manchester has been in recovery from heroin addiction for nearly six years. A senior at Southern New Hampshire University, he has his own business and plans to pursue graduate school in clinical mental health counseling.

Patriquin says the greatest need for those new to recovery is safe housing. “When an individual gets out of treatment, very rarely does that person have a job waiting for them. Very rarely does that person have loved ones that are happy to see them,” he said. “Where does that individual go?”

Too often, he said, they end up back in their old environments and fall back into addiction.

Investing in recovery housing doesn’t get a lot of attention, Patriquin said. “But it’s going to save lives.”

Markevitz Susan Markievitz (left) of Windham lost her 25-year-old son Chad to an overdose in 2014; she has another son in recovery. She now runs a support group for parents like her in Derry.

If she had the ear of the President, she’d urge him to fund sober living programs that offer education and job search skills to help people get back on their feet after treatment. “Not only are they fighting their addiction, but their minds are also swirling: ‘Where am I going to get a job? How can I work?'”

Full-service recovery 

MarstonDonna Marston (left) became an unwilling expert on opioid addiction when her son became addicted. Since then, she’s created support groups for parents, written two books about her family’s journey, and started a scholarship program to help those in recovery with expenses. She also hosts an online support group that draws members from all over the country.

Marston said if she had a million dollars, she would build a full-service campus to bring people through detox, inpatient treatment and recovery. “The program would fill in the gaps that people often fall through when they are in early recovery such as day care, transportation, how to live a life without drama, chaos and lying,” she said.

It also would provide parents and other family members support services. 

Insurance coverage

Freeman Sarah Freeman (left) is executive director of New Hampshire Providers Association, which represents prevention, treatment and recovery providers. She said in the view of providers, two of the biggest barriers are financial uncertainty and workforce shortages.

She said it’s difficult for providers to expand services when they don’t know if programs such as Medicaid expansion will even be there; it’s currently due to sunset at the end of 2018. “If we’re not going to have a way to pay providers who treat those folks, there’s no safety net,” she said.

Merritt Michele Merritt (left), senior vice president and policy director at New Futures, said making sure that Medicaid and private insurance cover treatment and recovery is critical. “If we’re going to make a dent in the opioid crisis, the things we should be doing are ensuring that people have access to affordable health coverage, and once they have that coverage, that they can actually use it.”

Merritt said New Hampshire has been able to increase investment in recovery support services and prevention only because Medicaid expansion covers the cost of treatment for thousands of state residents.

Mentor the youth

Canfield Laconia Police Chief Matthew Canfield (left) says it will take a multi-pronged approach to address the crisis, including treatment, law enforcement and drug courts.

But Canfield said what’s often overlooked is prevention.

His idea is to have police officers serve as mentors to middle-school students, and have students do their own research about the devastating effects of drugs and then teach their peers.

“Because once somebody is addicted to heroin, it takes such a strong hold on them,” he said. “Even if they get treatment and they become sober, it’s a lifelong struggle.

“So let’s put more time and effort and resources into prevention before people have the opportunity to try this stuff,” he said.

Cut the strings

Crews Melissa Crews (left) serves on the board of Hope for New Hampshire Recovery. A successful business owner, she’s been in recovery for 24 years.

She wants to see more funding for accredited peer support programs “without burdensome strings or mandating billing system requirements.”

And it’s the same for recovery housing, she said. “Push National Addiction Recovery Residence accreditation and let that be enough to help these houses get up and running.”

Crews said it’s critical to have services available immediately. “It takes guts and courage to ask for help,” she said. “When you are turned away, it is devastating.”

Higher reimbursement

SpoffordEric Spofford (left) is founder and CEO of Salem-based Granite Recovery Centers, which has five facilities in New Hampshire that provide the full range of services from medical detox to sober living.

Spofford is a recovering heroin addict; he’ll celebrate 11 years of sobriety in December.

He said one needed fix is an increase in Medicaid reimbursement rates for inpatient residential treatment, currently $162 a day. He said that is a fraction of what private insurance will reimburse for such treatment, and doesn’t cover his operating costs.

Merritt from New Futures said reimbursement rates for substance use disorder services are “chronically low, which makes it really difficult to attract clinicians to serve this population.”

“An incentive in the form of enhanced reimbursement would make a world of difference,” she said.

And Freeman from N.H. Providers Association proposes the state adopt loan forgiveness programs for young people who go into the treatment field, especially in underserved areas where they’re needed.

If Donna Marston could ask one thing of the President about opioid addiction, she said, “It would be to educate people that this is a brain disease.”

“They’re good people who are sick,” she said. “They’ve got a hole in their soul and they’re looking to fill it. And they fill it with drugs.”

Marston said she’s one of the “lucky ones.”

Her son has been in recovery for more than 9 years; he has a “beautiful wife,” she said. And their first child, a son, was born on Friday.

“So blessings come out of this nightmare,” she said.


Full article can be found here:

Job Posting Part Time – Triangle Club Dover

The Triangle Club is hiring a part-time woman to be an Associate Recovery Coordinator with at least 6 months of continuous sobriety. We’re looking for a start date of December 1. Download Job Description Associate Coordinator Triangle Club


Associate Recovery Coordinator

Triangle Club – Dover, NH 03821

Part-time (up to 20 hours per week)

Club hours of operation are 9 a.m. to 8 p.m. M-F and 10-3 Sat/Sun. We are seeking individuals who can provide evening and weekend coverage. Additional hours will be on an as needed basis.

Essential Position Objectives

The Associate Coordinator of the Triangle Club will work under the direct leadership of the Primary Coordinator.

Position Qualifications:

  • Extensive and active experience with 12-Step meetings.
  • Working knowledge of a variety of addiction recovery modalities and the ability to oversee the successful implementation of all in-house recovery efforts.
  • Ability to work a flexible schedule including evenings and weekends.
  • Maintains the confidentiality of sensitive information.
  • Superior phone and people skills.
  • At least 1 year of continuous sobriety



  • Be a continual presence in the facility and be available to answer all phone calls.
  • Deal with patrons in a compassionate yet professional manner at all times.
  • Oversee and maintain when necessary, a level of cleanliness of the facility, through light but regular cleaning and through the engagement of volunteers.
  • Take direction at all times from primary coordinator.
  • Complete all tasks as assigned.

Interested individuals should contact Mark Lefebvre (, 603-502-8900) for more details


Harbor Homes Nashua Hiring Peer Support Workers

Harbor Homes (Nashua) is hiring. It’s the Mobile Crisis Response Team and a 24/7 program, which has openings in all shifts. A high school diploma and background in some human service-related field is required, but other than that each peer support worker is trained within their first 6 months of being hired within the mental health side of peer recovery work. If you have had students in the past who may be interested, they can go online and follow the directions to apply with HR. They can also email a resume to my clinical director, Rob Sibley at


Recovery Bill of Rights

Friend from Malden Overcoming Addiction (MOA) shared this wonderful flyer with me today. Thanks MOA!

It is from Faces and Voices of Recovery, a national advocacy group for substance use & recovery; website,

Here’s the image and a downloadable legal size poster.

Please share with those who can promote this information and benefit from it.


Recovery Bill of Rights

Inspiration for your day

“Anything that annoys you is for teaching you patience.
Anyone who abandons you is for
teaching you how to stand up
on your own two feet.
Anything that angers you is for teaching you forgiveness and compassion.
Anything that has power over you is for teaching you how to take your power back.
Anything you hate is for
teaching you unconditional love.
Anything you fear is for
teaching you courage to
overcome your fear.
Anything you can’t control is for teaching you how to let go and trust the Universe”

Jackson Kiddard

NH Recovery Month Celebrations!

Last Chance to register for Ethics for Recovery Support Workers – Registration deadline is Friday.

Ethics for Recovery Support Workers: Monday & Tuesday, Sept. 18th & 19th at Marion Gerrish Community Center, 39 West Broadway, Derry, NH. 8:30AM – 5:15PM each day. Cost is $60.00 to attend and manuals will be provided. 14 CEs will be awarded. Visit to register. Space is limited so register early.

HIV/AIDS – Derry, NH. Oct. 5th, 2017 at the Marion Gerrish Community Center, 39 West Broadway, Derry, NH. 6 CEs will be awarded. This class is pre approved by the NH Licensing Board for Alcohol & Other Drugs. To register visit are limited so register soon.

Welcome to National Recovery Month!Recovery Month began in 1989 as Treatment Works! Month, which honored the work of substance use treatment professionals in the field. The observance evolved into National Alcohol and Drug Addiction Recovery Month in 1998, when it expanded to include celebrating the accomplishment of individuals in recovery from substance use disorders. The observance evolved once again in 2011 to National Recovery Month (Recovery Month) to include all aspects of behavioral health. Read more at According to the theme for 2017 is Join the Voices for Recovery: Strengthen Families and Communities.

Events happening in New Hampshire

Restore Your Spirit Celebration & Vigil, Sept. 9th, 2017. 1:00PM to 5:00PM, White Park, Concord, NH; Food, silent auction, live entertainment. Special guest, Poet Mc-Matt Ganem. Download flyer here. All proceeds go to STARS. Read more about STARS Program here.

Rally for Recovery NH, September 16th, 2017, 9:00 am to 4:00 pm, Veterans Memorial Park, Manchester NH; The Rally is a family-friendly event seeking to educate and raise awareness about addiction and the journey to recovery.  HOPE for NH Recovery will be joining with other community partners to host this event.  Family members, friends, and advocates of recovery will come out to celebrate the commitment we all share in this recovery movement. Volunteer and Sponsorship Opportunities available! Download flyer here. For more information visit here.
3rd Annual Take A Walk In Our Shoes, Sunday Sept. 17th, 10AM to 3PM, North Conway, NH; Hosted by MWV Supports Recovery. Prefer to ride? Join the County Motorcycle ride that begins at 10AM.
Or join Family Friendly Recovery Rally at Schouler Park to include a BBQ, live entertainment, raffles, kids activities, quest speakers, resource tables and much more. Visit for all the details.

Keene Hates Heroin (KHH), 2nd Annual Live Free Rally here in Keene on Sept 16 at the Keene Recreation Center from 11AM to 5PM; Live Bands: The High Vultage Project, Zach Benton, and Rick and The Redhead; The Pit Stop is catering; inside there will be a health and wellness fair including yoga, meditation mapping, free massage & chiropractic services; live demonstrations from Shaolin Studios and more. Guest speakers and feature presentations about addiction and recovery as well as a resource room where services from the Continuum of Care (Prevention, Treatment and Recovery) are welcome to have a table. No charge to attend (food will be sold at event). Any donations/proceeds will be used in KHH scholarship form to help persons in recovery gain access to treatment resources (medical clearance appts, MAT assistance, transportation, copays, etc. Rain or shine. Indoors and outdoors. Child and family friendly. Playground on site (parents responsible for their children). Volunteers needed! Resource tables welcome. Contact Jessica White at or visit facebook here.

Super Sober Dance, Saturday, Sept. 23rd, 2017, 6PM-10PM. Hope for NH – Franklin Center, 175 Central Street, Franklin, NH. More information to follow, or contact Carolee Longely @ 603.934.1496.

Spotting Emotional Eating

Many times, overeating can accompany addiction. Overeating is similar to drug or alcohol misuse in many ways. As a recovery coach, you can further support your recoverees if you know what to ask. Here’s a good article on “How to Spot Emotional Eating.” I hope you read and gain some knowledge to further help your recoverees!

Hi Ginger,

I attended the World Athletics Championships in London the other week. It was truly awesome. 70,000 people cheering, roaring sometimes, with raw emotion. The power of collective emotion seems almost a magical force. I swear there were points in which athletes were willed on, almost psychically, by the focused masses.

The power of feeling it seems can practically move mountains. So, what we attach our feelings to is vital to how we live. We eat to live, to fuel our bodies and to socialize too sometimes.

But for many eating is a way of trying to deal with strong feelings. So called “comfort eating” or, what psychologists like to call, “emotional eating.”

In this week’s piece I talk about how and why it happens and how we might stop our clients from being consumed by their feelings to the extent that they literally try to consume their feelings.

I hope you enjoy this piece,


How to Spot and Treat Emotional Eating
5 uncommon strategies to help your clients break the comfort eating pattern

“After the break-up I just hid under the duvet and ate ice cream!”

“After a bad day at work I hole up in front of the TV and eat pizza and French fries!”

“When I feel depressed I binge on chocolate!”

I have heard endless variations on the above over nearly 25 years of practice.

Recently I had a question on our monthly Q&A: Could a client be overeating crisps as a way of feeling close to her father, who had committed suicide? The father also used to eat crisps in the evenings. (If you’re a member you can listen to the recording of this Q&A from 20th July 2017 here, once you log in to Uncommon U).

This set me thinking more generally about comfort eating, or what some psychologists call ’emotional eating’.

Why do we do it?

Whenever we eat when we’re not hungry, that is, when we don’t need to refuel, we do so for one or more of the following reasons:

*We eat for social reasons. It’s polite to eat. It’s expected that we eat.

*We eat habitually. We become conditioned to down chocolate or chips every time a certain TV show comes on, like a Pavlov’s dog automatically salivating to the sound of a bell. One pattern becomes intrinsically linked to another pattern.

*We eat unpalatable food try to deal with unpalatable emotions – otherwise known as comfort eating.

Comfort eating is not in the league of full-blown eating disorders such as bulimia. But for some, regular comfort eating can cause grievous health issues.

But first, let’s be clear: it’s not hard to eat food that will wreck us.

Addictively palatable food, deeply encoded desire

For comfort eating to exist, there needs to be plenty of addictively palatable resources available, which is why it tends to be a first-world affliction. It’s easy to overeat and snack on anti-nutritional ‘foods’, because these substances are designed to be addictively palatable.

In nature, we will always go for what gives us the most energy in the least time. When we hunted for our food (energetically, not in Tesco), there was no guarantee of when we’d next eat. Imagine this:

Your prehistoric buff body is becoming flat-out exhausted from hours of climbing and sometimes sprinting after uncooperative prey. You’ve got nothing. You’re burning energy fast, but you’ve nothing to refuel with. You’ve burnt most of what you last ate, maybe 24 hours ago. But then, something wonderful…

You discover a supply of honey! Don’t ask me how you extract it without getting stung, but you do. Maybe you’ve watched Bare Grills, or whatever his name is.

Anyway, you’ve hit the energy jackpot. All that energy in one hit! The sugar in that honey might just give you the energy to run down that deer so you can eat properly. That natural sugary snack, so high on the glycaemic index, has saved your life.

A nasty case of The Human Condition

So next time someone despondently cries, “I don’t know why I grab the ice cream/cookies/bread when I’m not hungry! What’s wrong with me!?”, you can tell them they have a nasty case of The Human Condition. We evolved to take on huge amounts of carbohydrate when we could get hold of it (which was hardly ever back then).

Yes, we’re hardwired to consume fast-energy-releasing foods. But this is not an excuse, because if we really listen to our instincts we will be able to discern our true requirements for food.

And of course, not having these honey traps (see what I did there?) around is a great idea. If it’s not in the house, it’s not in the mouth. If we let sugary foods be nearby, it’s not so much ‘weakness’ as it is simply being human that drives us to consume them.

Your survival instinct doesn’t care whether you look great on the beach. It will have you reaching for the fastest form of energy to get you sprinting after wildebeest (or, in modern life, settling back on the couch to enable all that insulin to store fat).

But palates and preferences can be retrained. One client filmed in Uncommon Practitioners TV over four sessions, describes how what used to seem alluring no longer does. She starts to see the old ‘comfort foods’ differently – and loses about 70 pounds in the process.

But comfort eating goes well beyond simply getting cheap, short bursts of energy.

Dealing with indigestible feelings

When we feel bad, we are driven to change our state. Alcohol and other drugs do this, but so do chocolate and other refined carbohydrate foods.

Many adults (and children) turn to comfort eating during times of stress or sadness as a way of trying to deal with the difficult feelings. Thirty-eight percent of American adults admit to turning to food when they feel stressed or sad.[1]

But the ‘solution’ is no solution, and in fact becomes a problem in its own right. Chronic comfort eating has consequences for health, fitness, looks and self-esteem.

We describe this behaviour as ‘comfort eating’, but does it actually work? Does eating bad food actually provide comfort for the upset eater?

A road to nowhere

We are, ahem, fed the message that food is a comforter as well as a fuel. And of course if we are hungry, really hungry, then refuelling is comforting, because it means more life! But that’s not the situation we’re talking about.

My client Elaine, also filmed in UPTV, began eating chocolate at night after a break-up with her boyfriend a year before. She describes feeling worse after comfort eating. And her case isn’t at all unusual.

Research carried out back in 2014 found that 81% of people believe comfort eating actually provides comfort by improving a low mood.[2] But researchers found that people’s mood improved just as fast when they ate neutral foods such as salad, or, in fact, no food at all.

So it seems comfort eating doesn’t improve mood or provide comfort, but I suspect it does provide a kind of numbness whilst the person is doing it. I suspect what comfort eating does produce for many is a kind of distracted trance state.

Hundreds of millions follow the siren call into a fat, unhealthy and (more) unhappy state, being led in a kind of mesmerized stupor.

So many clients describe a kind of trance state in which time seems to disappear and they, for a little while, feel switched off from their daily life. But once the eating episode is finished, often it’s as though they reawaken to the reality of what they’ve been doing and often feel worse than they did before.

So as it turns out, comfort eating isn’t much better at improving mood than it is at improving health, at least not beyond the first few initial mouthfuls.

Early (mis)Learning

I think some of the association between self-soothing and food is cultural, and commercials are a big part of that culture. But so are parents.

You might think parents already have quite enough reasons to feel guilty (for which some can turn to secret cream donut trysts), but it does seem that many adult comfort eaters learn this self-sabotaging pattern from the way they are fed as a child.

Researchers have found that emotional eating is:

*not genetic, but learned (from studies of identical twins)[3], and
*often learned in childhood.[4]

Not that it should be a massive shock, but it seems ’emotional feeding’ – giving your child ice cream when they fall over, packing them full of Cheerios when they didn’t get that party invite, or otherwise smothering their body with calories when they feel emotional emptiness – conditions the child to use food as an attempt at feeling better.

And this can persist into adulthood.

If we link comfort eating to unmet emotional needs, then we can see how cramming bad food in can seem like a way of filling a gap.

The Tin Man from The Wizard of Oz was hollow. He needed to feel love again, and for that he needed real experiences that could actually fulfil him – not just fill him.

As a reminder, we all need:

*to give and receive attention
*to feel safe and secure
*to heed the mind–body connection
*to have a sense of purpose and meaning
*to feel a sense of connection to community and of making a difference
*to be stretched, to be creative, and to face manageable challenges
*to experience intimacy
*to feel a sense of control
*to feel a sense of status; to feel valued, appreciated, and respected.

We can see how any of our common human needs could become subverted in an attempt to meet them in ways that don’t really fulfil them, but just seem like some kind of solution.

When people eat though boredom, for example, they might really need to be giving and getting attention, or to pursue greater meaning in their life, or to be challenged creatively.

Of course, what can be learned can also be unlearned.

Some clients use food as an attempted solution to bad feelings so often that they have forgotten what real hunger, a real need to refuel, even feels like. And they may have also forgotten that there are authentic ways of meeting the needs they are grasping for.

Obviously, we can ask our clients to what extent they feel they comfort eat. And about their history of doing so.

But here are a few other ideas.

1. Forget dieting, forget ‘losing’ weight

A diet is like a valley on a hike. You pass through it, but you’re not going to live in it. And that’s the problem.

People see diets as temporary, hard, and full of deprivation.

Generally healthier habits as an ongoing way of living seem to be the way to go. By getting stronger and healthier, we gain our real shape. We don’t have to think about losing anything.

In my work with ‘weight loss’ clients in UPTV, I don’t talk the language of loss much to them. I talk of gaining slimness (or their ‘real shape’), of getting healthy or having the freedom to move the way they are meant to.

Excessive consumption of addictively palatable foods isn’t healthy for anyone, whatever their weight. Gaining independence from the tyranny of compulsion isn’t a diet, it’s part of the process of becoming more fully human.

So unless the client insists on referring to dieting or ‘losing weight’, we can focus with them on increased health, fitness, and control of their own mind and body.

But we need to get more specific.

2. Find the triggers to find the need

Much of life can be a desperate distraction.

We might fill our time with empty experiences in order to feel ‘full’. But unless these experiences genuinely meet our needs for connection to others, for a sense of greater meaning and purpose, for intimacy or challenge, or for feeling safe and secure, then we will be left feeling ‘hungry’.

Often, triggers for comfort eating arise when there is a lull in the distracting noise of the day. We are suddenly confronted with our emptiness. (Because we are not meeting our needs, not because life is essentially meaningless. Don’t worry, I’m not about to put on a turtleneck and a beret and recite bleak poetry.)

We may desperately try to fill this emptiness any way we can. And in our culture this is easily done through, well, any number of self-harming ways, but certainly through food.

“I feel empty in some way, so I will fill up in the easiest way!” would be fine if it actually worked. We could have filled up the hollow tin man with concrete. But it wouldn’t have been a very satisfying ending to the movie.

One man, Neil, whose therapy is soon to appear in UPTV, tells how he works all day with barely a moment for lunch. He takes work home with him and works weekends. But he describes a kind of emotional crisis. Late at night, when the not-so-merry-go-round finally halts, he gorges himself.

Neil wasn’t meeting his needs for fun or intimacy. Life was feeling like an endless, meaningless treadmill. And he was becoming obese.

His trigger was situational. These late evening times. Suddenly the day had ended and there he was, no distractions, only a sense of “I need something!”

Other people may find any difficult interaction, or sense of rejection, or feeling of being unfairly treated, may tip them into comfort eating.

We can find the pattern by finding the triggers. We can also explore some real solutions to our clients’ real needs.

3. Meet their real needs

As the great Persian poet Rumi said, “Fool’s gold exists because there is real gold.”

When we discover what tends to trigger emotional eating, be it fear, exhaustion, loneliness, feelings of rejection, anger, or anything else, then we can find the real need that isn’t being met.

Emotions are signals either that a need has been met (satisfaction, love, enjoyment) or that a need hasn’t been met (fear, anger, despair). Signals can get crossed of course, but emotions are still a good guide to what is lacking in a person’s life.

We can work hard to identify the missing need. We can also develop strategies to be clearer about what the client may really need and start to create the kind of life that genuinely meets those needs. In this way, the life blood of the filling-a-gap behaviour dries up and can begin to naturally be discarded.

But we may still have to deal with the ingrained habit.

4. Access and retrain the trigger feeling

In my UPTV session with Elaine, I ask her to access the steps of the comfort eating. I suggest she access the feeling of really wanting to go to the fridge and get the chocolate out. Because she has ‘practised’ this experience so often, it’s easy for her to access the trigger feeling.

We then rehearse going from the feeling of wanting the chocolate directly to the uncomfortable feeling afterwards of really wishing she hadn’t eaten it.

This isn’t a state of mind and body normally associated with the very first step. But I am, if you like, helping to bring the unpleasant bit right up to the front of the experience so she has a chance to feel the reality of where this path will go if she follows it.

This is an hypnotic technique called scrambling. We begin to scramble or disrupt the old pattern so that it no longer runs so easily if at all.

Most people when comfort eating, or engaging in any addictive focus, will have temporary amnesia of the reality of the feeling of having just gorged or gambled or drank too much. I want the reality to be really there from the very beginning.

We can also mentally rehearse, while the client is deeply relaxed, ‘forgetting’ to emotionally eat, and engaging in healthier behaviours. And by healthier, I mean more likely to meet real needs for the client.

Finally, throughout our work with comfort eating we can do something we also do with smokers or, in fact, anyone besieged by a compulsion or problematic emotional pattern.

5. Externalize and reframe

I’ve written about the dangers of building one’s identity around a problem state. If you believe you are the problem, then getting rid of the problem is akin to getting rid of you. No wonder some smokers look terrified when they realize they might have to stop.

Of course, it’s a cliché to talk in terms of “you are not the depression” or “you are not the anorexia” (although much of modern psychiatry seeks to do the opposite), but we can be much more subtle than that.

When we defamiliarize a pattern, it becomes easier to separate from it. We can defamiliarize it by describing it in metaphorical terms.

I teach practitioners to talk to smokers in parallel, so rather than talking about ‘smoking’ to a smoker (a familiar associative word), we can liken smoking to an abusive relationship. One they need to see for what it is and break free from. I talk about ‘becoming free’ and ‘escaping’, not ‘quitting’ or ‘stopping’.

Then we can continue to talk in this metaphorical way. There’s a UPTV video of me treating a 20-a-day smoker who had smoked for 30 years. I talk very little about ‘smoking’, but I am talking about smoking.

I talk about “it trying to con her back” and how she can “stand up to it” and how “its voice will sound weak and pathetic”. Notice how this externalizes the behaviour and reframes it. It’s very different from saying, “You may get withdrawal symptoms, which you can work to resist!” I make it outside of her so she can separate from it.

We can do this with comfort eating, too. When working with Jane (in UPTV) I talk to her about how ‘it’ (the unhealthy food) tries to kid her that she needs to have anything to do with it.

I describe it as ‘conning’ and ‘manipulative’, trying to take advantage of her when she feels stressed and vulnerable. Pretty soon she stands up to it and finds she can handle the stresses of life without being pushed around by the old unhealthy foods.

The more we can cast off what is not so good about ourselves, the freer we become.

And anything we are able to cast off isn’t central to who we really are anyway

Mark Tyrrell

Uncommon Knowledge
Psychology trainers since 1995