My accountant showed me a breakdown of the costs of our recent building project at The Recovery Centre. Over 20% of the costs – a lot of money that had to be found from somewhere – was not anticipated in advance even by the quantity surveyor. I suppose it isn’t really his job to know about Estate Duty Land Tax, the Bank’s legal fees and the concerns of the Healthcare Commission that patients might lock themselves in their rooms (so the doors have special hinges to open both ways) or might string themselves up from the fire escape (which had to be enclosed) – but someone has to pay. Guess who?

The five of us who went from PROMIS to the conference had a wonderful time together, discussing ideas. We now have even more in common than we did before. That is why, in my view, PROMIS is unequalled: we look for new ideas and we work together rather than against each other.

Aaron Beck, another keynote speaker at the conference, said ‘if it works it’s Cognitive Behavioural Therapy’. What wonderful self-confidence! (He speaks as one of the founders of CBT). I understand his point that there are many ways of getting to the same end result of patients changing their behaviour because they get better ideas – but I think his statement is too all-encompassing. Some of us are motivated more by our feelings than by rational argument. For all its protestations to the contrary (and likewise for the Rational Emotive Behaviour Therapy of Albert Ellis), CBT is basically a head trip. Despite that misgiving, I loved hearing Aaron Beck, as I did five years ago, because he is a lovely man. I suspect that is what gets his patients better.

I know Patch (who gave a keynote speech at the psychotherapy conference) insofar as I sat next to him at supper on one occasion twenty years ago and have kept in touch with him sporadically ever since. I don’t think the eponymous film about him has done him any good. Naturally I do not support his enthusiasm for free medical care and I am concerned that this particular crusade has gone to his head. I preferred him at our first meeting when, as a clown (in which role he has considerable talent and a great deal to offer to patients), the thing on his head was a pair of underpants.

One of the secondary presenters at the psychotherapy conference was Anthony Robbins, the pop motivator or, as he describes himself, the ‘why?’ man. He is an extremely effective salesman, to be sure, but it would be wrong to underestimate the value of his psychological messages. He is no fool at all.

I absolutely loved my time at The Milton H Erikson Evolution of Psychotherapy Conference in Anaheim, California, the week before last. Thirty lectures and demonstrations in five days was a feast. Even more, the humility, compassion and humour of the top men and women in their field in the world (the conference is held only once every five years so that they can all be together in the same place at the same time) was astounding.

The mother of a compulsive gambler patient of mine insisted that he should consult an eminent consultant psychiatrist. I was perfectly happy with that. I don’t own my patients. The boy reported back to me that he has been told to get a job in MacDonald’s and that he should take Prozac rather than go to Gamblers Anonymous. That’s odd: by following our recommendations he hasn’t gambled at all for the last 145 days. I wonder why the consultant psychiatrist – and his mother – feel so threatened by our ideas when they have manifestly worked so well in practice. Still, it doesn’t surprise me.

Another patient of ours, the wife of a consultant physician, is now totally abstinent from alcohol for over a year and goes regularly to Alcoholics Anonymous. Her divorce is getting ugly.

What is it with these doctors and what is it with these particular family members when they resent an idea that works?

I have missed only two weekends work in The Recovery Centre in the last year, one when I was in Hungary and one when I was in America. Meg wasn’t with me in Hungary so she has missed only one. What we have tried to do is to give to other addicts and their families the understanding that was given to us and it has made such a difference to our lives. Without the personal commitment of the families who reached out to help us, we would have been in a mess.

I have worked seven weeks and eight weekends without a day off and I am tired. That’s okay: I can cope with that. In one previous year I worked thirteen consecutive weeks and that was too long.

‘I am told I’m like you were twenty years ago’. Poor man. I am not sure that he realised that this might not altogether have been a compliment. I hope that twenty one years of application of the Twelve Step programme, first formulated by Alcoholics Anonymous, has changed me quite a bit and that almost twenty years of running The PROMIS Recovery Centre has given me a level of professional experience. Still, it’s nice for me to have people remember my determination.