TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
THERAPIST: Hi, come on in.
CLIENT: Oh, you got my e-mail from my insurance company?
THERAPIST: Yes I did. I looked over it very quickly. I didn't but thank you.
CLIENT: Maybe it would be easier if we did one session at a time and I mailed that claim over to them because it seems like now they owe money and they're taking longer like before only one every two weeks so -
THERAPIST: I may at some point soon be able to figure out how to submit to them directly.
CLIENT: Okay.
THERAPIST: Hopefully in the next month. So once that happens that would make it even easier.
CLIENT: Yeah, it's kind of stressful.
THERAPIST: Well, I appreciate you're looking into it. I can follow up, too.
CLIENT: I'm not trying to not pay you. I just want to -
THERAPIST: Oh no, no. I understand all that. I absolutely understand that. Insurance companies can be very frustrating. I totally understand how (inaudible). I'm just making sure. Were you worried that that's what I thought?
CLIENT: I don't know. Yeah.
CLIENT: It's a lot and it's been a long time, so I was getting frustrated so I thought -
THERAPIST: Why would I think you'd not want to pay me?
CLIENT: Oh I don't know. Just me. I wasn't thinking clear.
THERAPIST: Okay. Well, thank you.
CLIENT: You're welcome.
CLIENT: I'm here. And I'm on time. Yeah, Steve drove me and we got here two hours early.
THERAPIST: Two hours early?
CLIENT: Yes. And I (inaudible). So that was good. Where should we start? Probably everything like I told you last time, I think, I don't whether I should start with that.
THERAPIST: Well, there's no right place to start.
CLIENT: Do you have any questions at all? Do I understand all of that?
THERAPIST: Understand eating disorders in general, or eating disorders in particular?
CLIENT: Yeah. How have you helped have you helped anybody with an eating disorder?
THERAPIST: Sure.
CLIENT: How do you go about doing that?
THERAPIST: The general idea is trying to understand the meaning of it and what it's helping you with. No one does anything that is completely self-sabotaging.
CLIENT: Right.
THERAPIST: There may be self-sabotaging features to it they're doing it for other reasons that are helping them in some way. So in a very general sense, that's how I think about it. That's how I help people. You know work with them by thinking about what it could mean for them.
CLIENT: Have you ever heard of it as being like a mental issue and not only a medical issue as opposed to like getting something out of it? Like there's a reason why it happens? Like a chemical imbalance or hormone imbalance?
THERAPIST: Well, hormonal imbalances don't make you do specific behaviors. They may make you more likely to do something or another, but there's no like gene that tells you to be for example, you may feel upset and that what leads to it, but people have said they can do lots of things with it, so it'
CLIENT: Yeah. That makes sense.
THERAPIST: Are you thinking it's more because you said it's around your periods so -?
CLIENT: Yeah.
THERAPIST: So, that's what your thoughts were about, being a hormonal issue?
CLIENT: Yeah. Because it is like yeah, like I feel (unclear) and stressed. And then if I haven't eaten in a while, I'll eat a lot, then I think I feel guilty that I've overeaten but I always like have had to control my weight because I was heavy as a kid, so that I could eat part of so that I could find a different way to control it.
THERAPIST: Were you teased?
CLIENT: Oh yeah. For a long time. I mean, that just comes with it.
THERAPIST: Were you I mean, especially these days, kids are there are a lot of kids who are not thin.
CLIENT: Right.
THERAPIST: So it's usually one of those it's if you're one of the heavier kids versus just being a little overweight.
CLIENT: Oh, no. It was like 160 lbs, you know, in elementary school. But I was this height.
THERAPIST: Oh really?
CLIENT: I was very tall.
THERAPIST: Wow.
CLIENT: Yeah. I grew up really fast.
THERAPIST: In elementary school. How? So you didn't, even after, even after you hit puberty you mean you didn't grow anymore?
CLIENT: I grew like one inch. I hit puberty really early. I had like breasts in the fourth grade, pretty much.
THERAPIST: Did people tease you for that?
CLIENT: I don't remember that. I remember always trying to hide them. I don't think people teased me though.
THERAPIST: Do you think you were the first developed girl?
CLIENT: Yeah, I'm sure.
THERAPIST: Did you feel kind of exposed, like maybe stuck out or -
CLIENT: No. I think it was more like the weight issue. It was that issue. Yeah. And I went into I lost weight really fast, like I went from 6th grade to 7th grade I dropped like 40 lbs in a summer.
THERAPIST: Wow.
CLIENT: So I was like a different person going into like junior high, which was a different school. And that was just from not eating. Because I went from like just kind of like eating a small meal but I wasn't bulimic when I lost the weight.
THERAPIST: When you lost that weight, were you then underweight? Or were you more of a normal weight then?
CLIENT: I was at a normal weight.
THERAPIST: And then what happened?
CLIENT: I just always felt bad. I think that's what it was. Like I was normal weight but I always felt heavier than everybody else.
THERAPIST: And when did you start losing more weight?
CLIENT: I think I always have stayed like in the same weight category. One time I was really, really thin but like with my last relationship I lost like 30 lbs like in the summer. That was because of stress. I was so stressed. I think you're body works in overdrive when you're stressed. I lost a lot of weight.
THERAPIST: You were stressed about how he was treating you?
CLIENT: It was like hopeless. It was just transition to college and going to school and all that.
THERAPIST: Did your parents notice when you lost all that weight?
CLIENT: Oh yeah.
THERAPIST: What did they comment on?
CLIENT: Oh well, they knew I was going through when I broke up with my boyfriend. Like I had major (unclear) depression and I didn't sleep for a month so they had to give me medication to sleep. It was very stressful. But my mother was there like throughout the whole thing for me. I kind of just did what I had to do. I picked up like three jobs and I just worked and didn't think about things.
THERAPIST: Was it more or less stressful after you left the relationship and broke up with him?
CLIENT: I think it was more after because like everything kind of (unclear) it was like a loss. It was more like I had all my eggs in one basket, you know. Like that. I did everything for the relationship. So.
THERAPIST: The way you at times feel about Steve.
CLIENT: Right. I think that's like my problem. Like I didn't have a relationship without giving my whole self to a person. I feel like I should be able to balance that. I'm starting to realize that.
(Pause): [00:09:08 00:09:12]
CLIENT: Like I'm not a piece in our relationship where I'm comfortable in that. I have to work on that. Like if I don't have all my attention towards the relationship, he's not going to leave me. That's (unclear) thing.
THERAPIST: And so when you say, "your whole self," is it your attention that you're referring to primarily?
CLIENT: My attention, financially I did that with both relationships. And like I instead of putting more focus on school, I did more focus on them, which I regret. I got angry with them. I'm still here. I can still go back to school.
THERAPIST: You are still here and you can go back to school actually at any age, but you're still here.
CLIENT: Yeah.
THERAPIST: You mentioned (unclear) individually that you were thinking about that. Are you still thinking about that?
CLIENT: Oh yeah. But it's just a process with education programs. There's always process. It takes years.
THERAPIST: Even the process to get in?
CLIENT: Yeah.
THERAPIST: Because you need all sorts of prerequisites, right?
CLIENT: Right. Because mine are too old. They have to be less than five years. So it's like you have to start all over with them. But it's what I want. So now I'm in the process of doing that, seeing if I can get back into my old program and, if not, taking two of my classes that I need that are in an online program but then they switched the prereqs so now I have to go back and take other classes, which they'll always do that. There's going to always be a catch like with the online schools and with any (unclear) program. I just have to do it before they change something else.
THERAPIST: You seem at the moment kind of choked up.
CLIENT: Yeah.
THERAPIST: I know you're choked up a lot but what do you think at the moment it's about?
CLIENT: My disappointment. I was like disappointed like in high school.
THERAPIST: From what?
CLIENT: Just like my choices that I make. (inaudible).
(Pause): [00:11:42 00:12:02]
CLIENT: Like I feel like I give so much to my job and my boyfriend and everybody else and there is like no more time for me. (Crying) So that's like I don't know how to do that for myself.
THERAPIST: Yeah, I guess that sort of relates to my next question what would a time for you look like?
CLIENT: Like school. Like being able to go to the gym to work out and just like maybe have a social life. I don't have that.
THERAPIST: Because of sort of limitations outside or limitations or constraints you put on yourself?
CLIENT: Like work. I actually pay the bills. I think financially I'm the only provider. So I pick up extra hours and I just get really burnt out.
(Pause): [00:13:12 00:13:16]
CLIENT: I think if I go back to school and (unclear) my education I feel like probably but like if I'm upset about something like if I'm stressed, like I just think I don't know how to get around it. You know, like I don't have those skills. I just like kind of like sit and try to focus on the negatives. And I just feel stuck. And so I just keep going. And it's like I procrastinate on uncomfortable stuff and with like all kinds of stuff.
(Pause): [00:14:03 00:14:09]
THERAPIST: What uncomfortable kind of stuff?
CLIENT: I don't know. Like I don't know. It's like I've generalized for it and I don't even know what I'm afraid of, but like I don't do anything until the last minute because I have to think about it and over-analyze it, so it's the same with school, like I'm so worried I'm (crying) going to go back and like there's going to be a stressful situation and I'm just going to fail out, you know?
THERAPIST: Why would you fail out?
CLIENT: Because that's happened twice.
THERAPIST: And how did that happen? What happened?
CLIENT: (Crying) I was just over my relationship the last time. I think it was my last relationship and then Steve's dad died and my grandmother died and it was just like (unclear) and I just couldn't (inaudible) and other things, so it's like I feel like I can only focus on one thing at a time.
THERAPIST: Because otherwise you get distracted?
CLIENT: Yeah, like emotionally, like worried about something else instead of like worrying about myself and my education. That's what happened last time. And I feel like now like I do have a stronger support system where I could go back to school and I don't have to worry like Steve leaving me but other things can happen if I just don't get distracted. You know, I'm still going to have to work.
(Pause): [00:16:13 00:16:21]
THERAPIST: Well it sounds like it's not only the time that your obligations take up but the burden that they feel burdensome and that takes up energy as well.
(Pause): [00:16:32 00:16:37]
CLIENT: It's like developing skills to manage my stress.
THERAPIST: Okay.
CLIENT: I definitely need that.
THERAPIST: Are there things you do now?
CLIENT: Like exercise always has been a way to like I would run or I would kayak. That's about it. But even that takes me a while to get emotionally (unclear).
THERAPIST: Well there are two, probably at least two ways of dealing with stress, broadly. One is the getting help the getting tools to deal with the immediate feeling and the other is to sort of pick apart and look at what's causing so much stress and anxiety, you know, is the source of it. And I think it's a combination I don't expect you to have an immediate answer to it. I think that's a complicated question.
CLIENT: Yeah.
THERAPIST: Really complicated. When you were a kid and you were heavy, you know some kids are just heavy. You have a different metabolism and so forth. Were you overeating as a kid?
CLIENT: I just don't think like we ever ate the right things as a kid. And yeah, I probably did overeat as a kid.
THERAPIST: We being your family?
CLIENT: They never taught anything like you know, about nutrition or eating right, so yeah, I probably overate as a kid.
THERAPIST: So like in terms of meals, meals weren't particularly that your parents made weren't particularly healthy or helpful.
CLIENT: (Chuckles)
THERAPIST: Like were they like ice cream for an appetizer.
CLIENT: Right. It was an Italian family and they liked spaghetti and meat balls and pasta and you know, macaroni and cheese and all that, and if you have a slow metabolism as my family seems to, there's a lot of heavy people in my family, it's not going to help.
THERAPIST: Were there a lot of certain junk food around as well?
CLIENT: Not really.
THERAPIST: Mostly just the cuisine.
CLIENT: Yeah. It wasn't any they (inaudible) demands, just not healthy to eat.
THERAPIST: Did anyone else in your family have weight issues?
CLIENT: Yeah, my brother does.
THERAPIST: Your parents?
CLIENT: Um hmm [yes].
THERAPIST: Both of them?
CLIENT: I mean they're not like, thin, but my dad was very active and my mother has diabetes so it's kind of hard for her. She's, I mean, I guess they're both overweight, they are obese.
THERAPIST: Do they tend to be high strung?
CLIENT: Oh yeah.
THERAPIST: Both of them?
CLIENT: Oh yeah, both of them, yeah.
THERAPIST: What do they do in their high strungness? How do they act?
CLIENT: My dad, like will yell and then my mom will yell. And that's pretty much it. It's like I guess (unclear) when they're upset and they cool off.
THERAPIST: What do they yell about?
CLIENT: Any stressful event. It was like, you did something wrong, like if I got in a car accident I would get screamed at instead of like, 'are you okay?' You get like reprimanded. Because for some reason it was how my father dealt with fear he'd get angry.
THERAPIST: That's an interesting observation.
CLIENT: Yeah. Thanks (inaudible).
THERAPIST: How long has it been since you've understood that? I think that's very perceptive. Did you always have that sense or just in hindsight?
CLIENT: I think in high school, I could see that, and like I went to a therapist and she told me the best thing I could do was move out of the house and I would have a better relationship with my parents.
THERAPIST: Was this around the time you moved out or before?
CLIENT: Before.
THERAPIST: What did you have to see her for, initially?
CLIENT: Stress management. I've been a couple of times.
THERAPIST: And she saw a link between your living there and your being stressed.
CLIENT: Yeah. They're not easy people. I mean I have a very nice family but they're very high strung so hard to be around.
THERAPIST: Were they high strung with each other?
CLIENT: Yeah.
THERAPIST: Would they yell at each other a lot?
CLIENT: Yeah. But even like when they're happy, they were yelling, like feeling was very loud. Sometimes very quiet, if I'm excited and I'm loud he really thinks I'm yelling. He was brought up in a quiet household.
(Pause): [00:22:12 00:22:28]
THERAPIST: I know it's sort of aligned with your period, but when you overeat now are you, do you use that because you're feeling stressed?
CLIENT: Yeah, because I'm always stressed out.
THERAPIST: And do you are you like, are you stressed out about particular things or is it just sort of a general feeling of being overwhelmed?
CLIENT: Like work. I get stressed out about the house, like if it's messy, like that really stresses me out. And finances and just like responsibilities. Even if I'm like in a social environment. I get stressed out about that and like being in traffic, really like in traffic I've experienced being stressed out. For me it's just I've just gotten to the point that it's a lot of things.
(Pause): [00:23:22 00:23:29]
CLIENT: And I'm just like I normally keep it inside. It's not like I explode. That's not good.
THERAPIST: Where does it go inside?
CLIENT: I feel like I just like stop breathing sometimes. I feel like I don't breathe correctly. I like hold my breath.
(Pause): [00:23:50 00:24:03]
CLIENT: And like (inaudible). And to (unclear) all my problems so I can better deal with it. And I don't know how to deal with it. (Pause) But I feel like the larger situation is like, I mean if it were an emergency or something, something I should be stressed about, I'm not stressed. Like I can react normally whereas it's just little things. THERAPIST: Little things on the outside, maybe. It's something big on the inside. Did you get a sense that either of your parents felt burdened, just in general in their lives?
CLIENT: No, I don't think so.
(Pause): [00:24:55 00:25:06]
CLIENT: They didn't seem burdened. I mean, Father was always stressed about work.
THERAPIST: What, in particular?
CLIENT: Oh, he just worked for like a (unclear) company. He was never like around. He was always working.
(Pause): [00:25:25 00:25:32]
THERAPIST: And now he continues to do that.
CLIENT: Yeah.
THERAPIST: He doesn't take vacations. I remember you talking about that.
CLIENT: Yeah. He likes to work. I was like that for a little bit.
THERAPIST: Does it seem kind of obsessive to you?
CLIENT: Oh yeah. He gets obsessive about things like it's that and then he gets obsessive about things like his weight, too, like exercising. Like he over-exercises. So it's a little like I would see my parents like be away and my father would be trying to lose weight and he would starve himself. That's what I saw growing up. I try to teach them now how to eat healthy. Not to lose weight but like eat the right things. So I teach them (unclear).
THERAPIST: How do you feel about doing it?
CLIENT: I like it. Like it and my father's interested in it but he like will never spend the money and buy healthy food. Like he won't go over his budget and (sirens outside) spend like $80, $60 for groceries for the week.
THERAPIST: For himself? Or for him and your mom?
CLIENT: I don't remember.
THERAPIST: Wow. Is your mom okay with it?
CLIENT: No. But she doesn't really have a say. His hobby is like water sports.
THERAPIST: That can be shared, too. A couple can see it as their money even if one person is (cross talk).
CLIENT: I know. It's my dad's money.
THERAPIST: Oh. Does she feel resentful?
CLIENT: Oh, I'm sure. It's been like that their whole relationship.
THERAPIST: Does she express that?
CLIENT: Yeah. She gets upset about it. She does things like she'll she has like charge cards and she will pay them off but she knows that if she ever gets into financial trouble he's going to have to help her which is her way of going around it.
THERAPIST: So does she charge them for that purpose?
CLIENT: No. She still pays them herself but I think that's her backup. I don't think a lot of her spending is to enjoy his hard work. He's a very interesting person.
THERAPIST: How do you mean?
CLIENT: It's just that I've never met anyone like him, who seems to work that hard and save everything for nothing. It's not like he even puts it into investments or anything.
THERAPIST: It's a version of hoarding, it sounds like. And there's that obsessiveness that he has with exercise, too.
CLIENT: Man.
THERAPIST: I could imagine being in your mom's position and maybe this is how you would feel being his daughter feeling kind of deprived, like not taken care of. You'd want your husband to want to give you the opportunity to eat healthy and feel good.
CLIENT: Yeah. She's just like that selfless person. She doesn't think about herself. Like, I mean, it bothers her but I don't know not to the extent where like it ruins her day, every day. I don't know. They just have a bizarre relationship.
THERAPIST: You don't think she minds? Or she minds but she doesn't say anything?
CLIENT: No, I just think she's so used to it. It's like he's paid for the house and everything else, like he just bought her a car, so it's like she doesn't have to worry about that. She doesn't have to worry about the bills, you know. He takes care of that. It's like luxury when you don't have them. But that's fine with her. She's a very simple person. I guess it's debatable whether healthy food is luxury. I mean you get old and it does seem luxurious.
THERAPIST: Yeah. I mean luxury is defined differently by different people.
CLIENT: Right. But she doesn't I mean she works like at like a kitchen, so she can get food any time.
THERAPIST: Does she? Is she like -?
CLIENT: She's like a diet aide (ph).
THERAPIST: Ha.
CLIENT: So he's depriving himself.
THERAPIST: Did you feel that deprivation in the family home?
CLIENT: I don't know, I never really thought about it. I mean, we always like I worked my whole life. I worked in high school, I worked in junior high. I had a paper route, so you know, I probably had like $20 so far. I provided for myself. They weren't going to give me money and provide me with nice clothes. I was going to do it for myself. I mean, it's a good experience, I have working skills. I don't have things handed to me, you know.
THERAPIST: Well, it's nice to feel self-sufficient, but it's also nice to feel taken care of.
CLIENT: Yeah.
THERAPIST: And certainly one of your complaints when we were working as couples was you didn't feel taken care of enough by Steve.
CLIENT: Right. He likes to be taken care of. Today's my birthday so he's taking -
THERAPIST: Happy birthday.
CLIENT: Thank you. I think eventually our relationship will be different. I have a lot of faith in him.
THERAPIST: What do you imagine it will be like?
CLIENT: He's such a smart person and I think gradually I'll like get his education and think I can work like part time and have a family. Like I see that with us. That would be nice.
THERAPIST: Do you feel like he feels more comfortable about being taken care of than you do?
CLIENT: Oh yeah, probably. (Chuckles) We got together with his whole family they just they baby him, they worry about him. And you know, like his mother says things like, "Steve doesn't cook. Steve cooks?" Like she's babied him his whole life you know (unclear). The "only child syndrome," I'm thinking. He's still like mentally like a 24-year old, I think.
THERAPIST: Twenty-four.
CLIENT: Yeah, 24, 25. Still young, a little immature.
THERAPIST: You think so?
CLIENT: Probably in some ways, I'm sure. Like we've been having like good weeks, like I started the pill and I just feel like I'm (unclear). So that's when I have an issue with him and am able to talk to him about it and tell him I'm not really attacking him, like I just have these feelings and I needed to let him know. It works better than yelling at somebody. That doesn't work. And yeah, I need someone (inaudible) doesn't work either.
THERAPIST: No. (Unclear) doesn't work, too.
CLIENT: Right. I'm just like, I just feel like (unclear) I just tell their aunt to give them a call. Give them some advice where I can't. You know they want to see him doing better than he is.
THERAPIST: In terms of -
CLIENT: Like education because he doesn't have a GED and is going to school. They're all nurses and they feel like he has like ADHD or ADD and felt like he's always had that. So like I just told them they should talk to him about it like I can't. I've tried.
THERAPIST: He's more in touch with that part of him that likes being taken care of and you're more in touch with that part of you that likes to be self-sufficient. But there are times I think that you feel kind of alone in that and then you feel alone like, 'oh my God, everything's up to me," and I imagine that's part of the stress you feel.
CLIENT: Yes. You start talking to everybody else and they look at your situation and tell you like, 'that's not right.' Like my co-workers and stuff. Like they don't think it's right that I pay the (unclear) car bills. It's not (unclear) and somewhat that I don't like it either. But that's just where we are right now.
(Pause): [00:35:42 [00:35:49]
THERAPIST: When they express that, is that validating or does that just make you feel like kind of more helpless with what you're supposed to do? Does it make you feel good?
CLIENT: Yeah. And when I got home I'm like, I like resent him.
(Pause): [00:35:49 00:36:15]
CLIENT: I don't think it's going to be like this forever. I think beyond the struggle, in the beginning it is.
(Pause): [00:36:22 00:36:30]
THERAPIST: Well like in a sense, to talk about luxury it sounds like he has a luxury that you feel you don't have, like in terms of being able to rely on you and not having to earn enough to live off of. Like he has that luxury and you don't have that luxury.
CLIENT: I think he's always had that luxury. His mother pays for everything for him, too. I don't think I ever wanted that, though. I mean, sometimes it's nice but I like being self-sufficient. I never I dated guys that had money and had it all together and like that did not turn me on. I felt like they were buying me. So it didn't work out. I don't like when like people pay for me all the time. I just like the evenness of it, like, 'I have your back, you have my back.'
THERAPIST: Well, I wonder if in some parts of your parents' relationship, like the money represented power. Like you dad makes the money so he gets to call the shots which is not true in every family and in some families one person makes the money and the other person calls all the shots or they equally call the shots, but it sounds like your dad's attitude is more like, 'this is my money, I'll say what I'll do with it rather than what you'll do with it.'
CLIENT: Right. (Pause): [00:37:52 00:37:59]
CLIENT: I just like, I don't know, I just like only have, like I just pay the bills and hope that one day he'll like help out a little more. I'm like, marriage is (unclear).
THERAPIST: Yeah, I certainly don't think you feel that way in your position. I was wondering in the position where the guy has all the money, whether you feel like that could be a potential where you're disempowered somehow because you're bringing in the money, like he's buying you off, (inaudible), he can do just whatever he wants and if you were with anyone else or doing for anyone else, (unclear) -
CLIENT: I think that's why, exactly why I never went out with those guys. Some sort of insecurity. But my mother always said to me, 'oh you'll meet somebody who will lie to your back and cheat on you,' and stuff like that. And like (unclear) and everything.
THERAPIST: I see. I wasn't sure about that. Yeah.
CLIENT: I think, and my mom, she's a very insecure person, really, I don't know. She would just say, she always like nagged at my father about stuff like that but it like another woman or watching a woman on TV. And I feel like that's like inbred in me now, like I feel insecure like that.
THERAPIST: Like in public and even at home. In public would she comment like if she -
CLIENT: Oh yeah, just make out like with a flirt, like he goes out and get some attention, like he would just like kind of tease my mom more to just like get a reaction not to hurt her feelings, but I think it did hurt her feelings.
(Pause): [00:39:47 00:39:55]
THERAPIST: Wow, I'm just wondering what, I mean you're telling this story through adult eyes, but as a kid I wonder what that was like.
CLIENT: I wasn't a happy kid.
THERAPIST: Because of what was going on at home?
CLIENT: I don't know. I just I always talked with my mother and like I always talked with my dad because I didn't agree with whatever he said because he didn't make sense to me. My mother was really the passive one who did whatever he wanted and would do it behind his back because I would tell her what I believed and what I got was like real and I would tell them like they were wrong.
THERAPIST: About?
CLIENT: Anything. Religion. School. Even about going out on a date. Like about everything like everything was fake. Like, 'something's going to happen to you,' like you had to come home at a certain time, even like I wanted to go to travel, my parents would never let me do that. They would never and I had opportunities, because they couldn't watch over me. I wasn't I tried to do what I wanted to (unclear) a fight.
THERAPIST: I don't know if this is true. It just came to mind, that part of your anxieties about the fear that you actually do need their protection and now you're no longer under their roof?
CLIENT: No. I don't I think like, I don't know, I definitely think it's like how I manage stress and I do get over (unclear) because I like burn myself out and I know that I don't sleep very well and I just like do too much. I don't fear, like I'm not protecting it.
THERAPIST: Do you have the feeling that you do that just to distract yourself?
CLIENT: I think so.
THERAPIST: Sort of fill the time with activity?
CLIENT: Um hmm [yes].
THERAPIST: What do you think you might be distracting yourself from?
CLIENT: I just get so depressed sometimes, for no reason.
THERAPIST: I don't think anybody gets depressed for no reason. You may get depressed for reasons that are not obvious to you.
CLIENT: Yeah, I know. (Crying) (?) I don't know, I just feel sometimes, really down and that's a distraction, you know? Like you don't want to do what you need to do. You know you don't want to be out (inaudible), you know.
THERAPIST: Do you think that food helps you with the depression, too, when you eat?
CLIENT: When I eat healthy, I feel happy. Yeah. Like I diet reflects energy. Yeah. So I'm not quite sure about the media. I just don't get it myself. And when I'm on this medication I don't have that urge to be -
THERAPIST: The pill?
CLIENT: The pill it's my (unclear).
THERAPIST: And that's you know I owe you a referral for some. Really, I thought I had done that and I realize I was going to right after our session. Normally I do it right after the session. I was going to e-mail to some colleagues to help you with that. That would be good to have that.
CLIENT: Yeah.
THERAPIST: We're going to need just a minute or so. I was thinking about what you were saying earlier on about the insurance and you have been processing it and I was thinking about this issue of trust again. Like, we talked about it very early on and also that comes up between you and Steve a lot.
CLIENT: Yeah.
THERAPIST: And you know, just trust, to feel a basic trust in each other like do I trust you that you're doing the best you can with that? And fearing that I don't trust you somehow.
CLIENT: Yeah.
THERAPIST: I think, you know I think it's something for us to think about. I think it's really important because it's very impractical to live in the world when you feel that you can't trust people and other people don't trust you. You know it's hard to feel sort of safe and at ease, not stressed.
CLIENT: Yeah.
THERAPIST: So, yeah, we can think about that. And in terms of the time, I just wanted to make the cancellation policy (cross talk) so yeah, I don't want you, even if it's your birthday to cry and so forth on your birthday, but maybe it's cathartic, too. But yeah, I do I treat the times that I save for you pretty seriously, but then turn away other people who want those times and I only do get so if I save the times for you I do need you to use it. If you in advance tell me, that's fine, but I do am pretty protective of that. That's sort of helped me think about it.
CLIENT: Okay.
THERAPIST: Does that make sense?
CLIENT: Yes.
THERAPIST: Yeah, no I know. I just wanted to sort of explain the rationale so it doesn't seem sort of, you know, contrary.
CLIENT: No, I know, in know. I understand.
THERAPIST: And I can offer you this time as an ongoing time, this afternoon time.
CLIENT: All right. I'll have to e-mail you over the next week because I'm back to work and it looks like they have me working a lot and a lot of nights and a lot of -
THERAPIST: And on Tuesdays.
CLIENT: Tuesday I'm working nights. I'm not sure, like I'm going back in, that's the only thing is that I have to go in at 7 p.m. That means I won't sleep before coming here.
THERAPIST: Right. So if you picked a time earlier like I could potentially do 2:30. Does that help you far enough 2:30 does that help you at all or that doesn't matter as much?
CLIENT: Sure. I might have to bring my schedule, too, so I can look at that.
THERAPIST: Well, why don't I also have other times during the week. During the day I usually have some more flexibility but if this time is yours. If you don't want this time, I know someone else will. It's yours first.
CLIENT: All right.
THERAPIST: But if you do want another time -
CLIENT: I could even do, like I was thinking on the Tuesdays, which is like about me and Steve, it would be a different day.
THERAPIST: Do you have a sense of day might work? Or do you need to check your schedule?
CLIENT: I need to check my schedule.
THERAPIST: Why don't you e-mail and let me know and we can figure it out seeing what works for you? Okay?
CLIENT: Okay.
THERAPIST: Okay. Very good. So I will see you oh, wait to hear from you about next week.
CLIENT: Okay.
THERAPIST: Okay. Great. Take care!
CLIENT: You too.
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