Practices

Set small rewards for staying off it and let them grow the longer you go, so the next one is always near and a slip costs something you can feel.

A vague future benefit competes badly with something available right now. A jar you add to daily, a treat at day three and a bigger one at day ten, a…

If cutting down has failed over and over, that is information rather than a verdict on you. For some people the workable goal turns out to be none rather than less.

Starting young makes this more likely, and the earlier the heavy use began the harder the road back to casual use tends to be. Nobody enjoys hearing…

If the language of a recovery group puts you off, that is a reason to look for a different group, not a reason to decide that help is not for you.

Programmes vary a lot in how they talk. Some lean on surrender to a higher power, others are built around self-management and practical tools, and…

The useful part is not the chart on the wall. It is that the person could think of things to do instead, and that took months of quiet work to arrive at.

Someone else's list of alternatives will not hold, because they thought of theirs and you did not. Build yours slowly, adding what has genuinely…

If you are pulled towards risk, you will do better giving that pull somewhere with a floor under it than trying to switch it off. Fast, high, cold, loud: choose the planned version rather than the one that turns up at two in the morning.

Work out what the appeal actually is. Speed, height, cold water, a crowd, the edge of fear. Then find the form of it that has brakes: a climbing wall…

Some of what feels like a flaw in your character is really a job that can be handed to something outside your head: a calendar, a list on the wall, a person who helps you lay out the week.

Coaching for attention difficulties is mostly this, and nothing more mysterious. Someone sits with you, builds the week, works out what comes first,…

When a young person is struggling to launch into adult life, it is usually two things at once: the practical scaffolding, and the social side. Work on one only and the other tends to pull it down.

Calendars, laundry and deadlines are the visible half. The harder half is friendship, saying no, asking for something, being alone in a room full of…

If you have been the one holding someone's schedule, meals and reminders together, do not put all of it down on the day they leave. Pass it over a piece at a time, each with a date on it.

Write out what you are actually doing for them: waking, appointments, repeat prescriptions, food, deadlines, forms. Most families are surprised by…

Medication can make the learning possible. It does not do the learning. If no tools get built while things are steadier, there is nothing standing there when the dose wears off.

A common disappointment runs like this: the medication helps, then it seems not to be enough, then it gets stopped. Often what happened is that…

A bridge year can be a deferred place, a course at the local college, a job, or a stretch of genuinely doing very little. That last one is a real option and not a refusal to choose.

For someone who has just come apart, a fresh demand can restart the same collapse, so a few months with nothing scheduled is sometimes the…

The next step has to be theirs. A job that looks like nothing to you might be the first thing in two years they chose without being pushed, and that is exactly why it holds.

Parents tend to want the step that recovers the lost ground. The young person needs the step they can actually take on Monday. Shifts in a shop, one…

When someone has shut down, pressure to get moving usually pushes them further in. Safety first and activity afterwards, even when the whole household is desperate for a sign of life.

Safety here is ordinary and physical. Food that turns up without being asked for. A room nobody is inspecting. Conversation that is not a progress…

If most of the difficulty is happening at home, most of the work needs to happen with the household in the room. Otherwise the hour of good conversation gets quietly undone by Tuesday.

In a settled stretch, seeing the young person on their own with occasional family time is fine. In a crisis, turn it round: everyone together,…

Sorting goes better fast than carefully. If every item stalls you, ask someone to sit in the room while you work, not to help but to keep the pace up.

A person nearby changes what the hour feels like, and they can be reading their own book the whole time. What they supply is momentum, which is…

Often the most useful thing a clinician does is not delivered by the clinician. It is delivered by the teacher, or the parent, after a conversation you had with them.

Taking that seriously changes how the hour gets spent, towards talking with the school, coaching the parents and designing the arrangement, and away…