This patient is in her twenties and comes in for a routine visit. Review of her chart shows that she is on Methadone for treatment of addiction. It is also noted that she smokes cigarettes.

During the course of the examination she is asked “Why does she smoke?”

Her reply is that it is because of stress. I proceed to discuss the perception of whether a glass is half-empty or half-full. I ask for her perception which she replies is that a glass is half-empty. I then point out that the half state is neutral and that in the moment of her perception it becomes what she perceives, and from that point she will experience it in that way. I point out that from this perspective stress does not occur but rather is chosen. She agrees.

I then ask her again why she smokes. Her reply this time is that she smokes because she wants to and I reply that this is exactly so. Any experience she is having, she is having because she wants to. She wants to have this experience because she chose it. In fact, she is pregnant because she wants to be. She is with her partner, because she wants to and chooses to be with him. She is on methadone because she wants to be. She will continue to have these experiences until she does not want to have them anymore. Her partner sitting in the corner smiles, and says yes in agreement, as if the conversation is not new. She exudes dissatisfaction with this perspective, though she does not become angry. She does not want to be reminded she is having this experience by choice and not by circumstance.

The insight here is that no one wants to be responsible for the outcomes they are having, if they perceive them to be negative. They would like to blame this on another source. The fact here is, however, she has chosen to respond to an external event and stimulus by incorporating a stress response and then tying the reduction of this to another stimulus or event, that of smoking. This is done rather than dealing with the consequences of the original stimulus or event.