TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

[00:00:00 00:10:06]

CLIENT: Hi.

THERAPIST: Hi.

(Pause): [00:10:07 00:10:19]

CLIENT: How are you?

THERAPIST: Good, thank you.

CLIENT: (inaudible) running late (Pause). How are you?

THERAPIST: Good, thank you.

CLIENT: Where should I start off?

THERAPIST: With the stress?

CLIENT: Stress? All right.

THERAPIST: You said you thought it was more stressful coming here.

CLIENT: Oh, it's stressful driving here. Like nonstop, like stop traffic all the way here. It's like an hour and 45, two hours of traffic.

THERAPIST: Do you want to find someone closer to your home?

CLIENT: I might. I may. Yeah. You mean someone that's covered by my insurance? Because, I don't know. I'm having trouble with the insurance.

THERAPIST: Well, we'll figure something out.

CLIENT: Yeah. I'll have I'm having (unclear) who can do it.

THERAPIST: Yeah, I have a paper that said they're writing me to say that the claim is taking more than 30 days and they apologize.

CLIENT: If someone is taking your insurance, you're going to have the same problem with your insurance company. That doesn't matter. Well, no, like if it's a preferred provider -

THERAPIST: Right. There are plenty of preferred providers who don't get paid.

CLIENT: Oh really?

THERAPIST: It's not an issue of whether they're in-network or not. People in-network have plenty of problems getting paid by the insurance companies.

CLIENT: Oh, they do?

THERAPIST: So that's not the issue. Is frustrating, but -

CLIENT: Yeah. As long as you're okay with that.

THERAPIST: Yeah, I understand it's taking awhile. At least they're keeping you in the loop and I'm going to figure out how to do electronic submission at some point. But it sounds like you're frustrated and -

CLIENT: I've just never had troubles like this before. Pay a co-pay and that's it. So but then I've got (unclear) is that what you're saying? No matter what.

THERAPIST: Yeah. Well, not no matter what but sometimes this does happen.

CLIENT: That's horrible.

THERAPIST: I mean that's why I'm going to try to submit them electronically. Actually, I told Betty not to bother to send you the statement for the insurance piece so you could try to submit them directly. Did she send you -? We're also going to try to submit directly and send that notice.

CLIENT: Okay. All right. So we can start off with I had a good week this week because I went back to work. I had a vacation for two weeks and one I was with Steve we had a vacation together and we had like a good vacation. And being by myself for the second week was like hard for me because I just like pretty much sat by myself. I wasn't like motivated to do anything and I'm like always someone who needs to be busy. So that's why I work a lot, so -

THERAPIST: Why do you think?

CLIENT: I don't know.

(Pause): [00:13:34 00:13:39]

CLIENT: It's like I can't get out of my own way kind of thing when I'm by myself. Where if I'm like productive I'm fine, but like self-productively not so good. And just like it takes me a while to get going. So I sat there until going back to work.

THERAPIST: What happens when you're by yourself? What do you think about?

CLIENT: Everything I should be doing and it like overwhelms me. I think that's what it is and it's like I don't know where to start. So I kind of don't start until like last minute. It's like if I have stress on me like I'll get to it last minute. But if I have plenty of time I get I don't know. It's like overwhelming. It's weird. So I just was like depressed all weekend which (unclear) I wouldn't have taken a week off. (inaudible) Then as far as my eating that was fine. I didn't have any problems. So I was just trying to be active and eat healthy. But the whole being alone thing, I don't know. I've always been able to be by myself. I've always been by myself. I'm very independent but I think where like me and Steve have problems because like when he's around I want to be with him all the time because I don't know, if it's a distraction or not.

THERAPIST: A distraction from what, do you think?

CLIENT: I don't know. Like, myself, pretty much if I focus on something else other than myself. I just have a lot of negativity towards myself and I just, I don't know, stress myself out for no reason.

THERAPIST: What kind of negativity?

CLIENT: I like was like bummed because we had like planned a huge party for like his birthday and like a lot of people didn't show up and I went out of my way to like cook everything and get ready and everybody like cancelled on the day, so I spent all this time and all this money so I was kind of bumming about that. For one, it took me about four days to plan the party and like everybody said they were coming and I spent a lot and no one showed up. So then I was kind of like I didn't want to do anything with anybody on my vacation. I was kind of angry with them.

THERAPIST: You felt abandoned?

CLIENT: Yeah. You go out of your way for everybody else and it's like not worth it in the end. That's people.

THERAPIST: Everybody?

CLIENT: You know, things happen. I mean it's horrible, but it happened, people cancel at the last minute and it's hard now that we're adults and have our own lives and (unclear) get together. But, I was unhappy about that.

(Pause): [00:17:40 00:17:51]

CLIENT: (Unclear) more related, I'm back at work. Once I like get back into the schedule they change my schedule so much like I'm days and then I'm nights and I think I'm going to try like pick up a (unclear) class and I don't know where to begin with that because I've never done it but that should be fun. And I looked into like once a month there's like a I think in Providence, they have a meeting for like people with eating disorders and they meet once a month, the first Saturday in the month and I think I'll go to that. It's like a support group.

THERAPIST: Do you know who it's through or is it just an independent group?

CLIENT: It is through something. Providence Eating Disorder Center. There's no (inaudible).

THERAPIST: I thought it might be part of Providence Eating Disorder Center I think that's what it is.

CLIENT: Yeah.

THERAPIST: In the Square? I mean there are other -

CLIENT: Yeah. I'm going to go to that next month and (unclear) and see how people overcome their eating disorder. And I think it's something that if I can manage my stress I can manage my diet.

THERAPIST: Did you get my e-mail about the referral?

CLIENT: Um hmm [yes]. Yeah. And that's (unclear) to plan that. It's just sitting down to make those appointments and having my schedule on there and it's just hard sometimes without the education schedule. Like if you work and you're out a week and you have one particular day off and that like the weekends you can't get anything done to make appointments. So I will, definitely, thank you.

THERAPIST: Sure.

CLIENT: Yeah, if it's close enough. Everything else is good. Me and Steve are good.

THERAPIST: What's changed?

CLIENT: We had a talk. We're trying to have some communication but I don't know, we just kind of avoid fights pretty much stupid, little fights like I just avoid them. And I think that makes him happier. And I give him his (unclear). More like he's listening more instead of like getting defensive. So that's changed. It's more loving.

THERAPIST: Very good.

CLIENT: Yeah. We just have to I just like focus on the relationship and I blame my unhappiness on the relationship but that's not all of my unhappiness. I need to stop blaming him. That's the problem. He's just I mean I have to like love him for who he is. He's never going to change. It's just probably that person and I can just like give him, I can encourage him if I wanted to do something instead of like, picking on him. If I do that it seems to go in a better direction. We had like a family party for his birthday. Those aunts, grandparents, his mother like they all talked about like how they're frustrated with him and how they're so sad that he hasn't found his way because they're all engineers and like nurses and they just pretty much look down on him. So it's kind of sad. And like I don't think you should be talking to me about this. And they put it on me to like get him to go back to school. They think I should be able to change him. And I'm like, no, (unclear) can do it on his own. And he knows how his family is. It's kind of frustrating to him, too.

THERAPIST: It's not very supportive.

CLIENT: No. And it's like, if you really want to encourage him to do that, you should like sit down and show him a plan or help him financially which they all could, but they don't chose to. So that's sad. But yeah, stress management, yeah, I'm trying that. It's just funny, like if I, when I'm at work, it's just such a stressful environment but like I do fine. Like everybody else is stressed around me but I don't like education doesn't stress me out at all.

THERAPIST: I imagine the structure, purpose, direction.

CLIENT: Yeah. And it's like you kind of put like your problems aside and you see like there's worse out there. Like that. That's like me I have to work on myself and that's hard to do.

THERAPIST: It seems like you need help in being more at peace with yourself.

CLIENT: Yeah. I guess. I should probably be starting that.

THERAPIST: Well, you're starting by talking about it but it definitely is a process.

CLIENT: Yeah.

THERAPIST: I mean, a way to frame that differently, to turn it on its head is you know what makes it hard for you to be at peace with yourself, to know one of the feelings or thoughts that don't allow you to do that.

CLIENT: I think like for me it's like I'm very insecure and like being heavy as a kid and I lost all that weight and I was like active and very in shape and now that I haven't been doing that I feel self-conscious and that bothers me so I'm like working to get back into shape. And I think that puts a role, it affects my relationship with my boyfriend because I feel like we were not intimate in the past due to me, like he doesn't find me attractive so that's restraining. And then frustrated about school, but it's like I say frustrated but I can't like get myself to sit down and focus on it.

THERAPIST: You're frustrated about not re-enrolling in school?

CLIENT: I'm frustrated with the process. Like I was waiting for my license to come back, because I need to get a copy and I have to write a letter but it's like I have to be patient for my license to come back so I feel like that took a month and I just wanted to have the answer, as I'm not patient to see where I should begin and hopefully once I write this letter I'll determine what I need to do to get (unclear) at school. But it's frustrating that it's such a process. It's not like I can just take the class, because you don't know which class to take because nobody will sit down and like tell you. You have to like wait and make appointments and everything.

THERAPIST: And what does that waiting feel like?

CLIENT: Wasting time. Yeah. It's like, once I get into the program like it's going to be a cup of tea, in the same amount of time I just feel like it's putting me behind, like I want to like get my degree and be like more financially stable and like hopefully like me and Steve in the future will be married and having our family. I just see I can't do that until I get my degree, you know?

(Pause): [00:27:05 00:27:14]

CLIENT: That's frustrating.

THERAPIST: Do things feel like if they don't happen now, they'll never happen?

CLIENT: I guess like not that they'll never happen, I just feel like I'm behind and I don't want to be like 40 going back to school for education. Because I'm already doing it but I'm just not getting paid very well for what I'm doing. You know (inaudible) like I always thought I'd have my bachelors at least that, by now. And that's frustrating. I think when I get it I'll feel much better.

(Pause): [00:28:16 00:28:27]

THERAPIST: But it seems like you have this feeling that what you need you don't have now.

CLIENT: Yeah, I just feel like financially it would be easier to live. Like it's just like renting and it's just tough. Definitely. And Steve doesn't make anything so I'm the only person providing.

(Pause): [00:29:00 00:29:07]

CLIENT: Maybe we should move into a smaller place and it would probably be easier.

(Pause): [00:29:11 00:29:14]

THERAPIST: Well it sounds like you feel both burdened and helpless.

CLIENT: Yeah. Sometimes. I just try to ignore it. You know and just keep going.

THERAPIST: Except when you're off for a week and alone and then those feelings come and thoughts come in but they're harder to ignore it seems.

CLIENT: Yeah. Absolutely.

(Pause): [00:29:40 00:29:56]

CLIENT: But let's just see how (unclear) will be in the future worth waiting for, I guess. I just want to be like productive towards it, you know? And I think I'd be happier doing something for my future. So it's not like such a struggle.

(Pause): [00:30:15 00:30:24]

CLIENT: That makes sense, right?

THERAPIST: Um hmm [yes].

(Pause): [00:30:28 00:30:31]

CLIENT: It's like the more I talk about it, I don't know if it makes me feel better. I don't know if it makes me feel better talking about it or if it's easier just to like distract myself from it.

(Pause): [00:30:44 00:30:56]

THERAPIST: That's the basic choice you have.

CLIENT: Yeah. Is that healthy?

THERAPIST: Depends on how you define health.

CLIENT: I know it's not going to hurt me in the end.

THERAPIST: Ignoring? Well, for one thing, it sounds like it doesn't always work so that's whether it's a good way or a bad way, if it doesn't always work, that's probably the most obvious problem. But you know, I mean I'm biased insofar as I think when people can kind of look at their feelings and thoughts and not be afraid of them or overwrought by them, maybe upset by them, but not overwrought, that usually people's quality of life is better so that's sort of how I think about things so I guess I have that bias.

CLIENT: I did start a kind of journal of my feelings and I wrote them all down. And I felt better after. Like I was really feeling down and wrote down everything.

THERAPIST: That was last week or -?

CLIENT: Yeah, it was like that was the day I was going back to work and I was so stressed out and like I was stressed about going back to work because I wasn't there for so long and I just wrote down everything and felt really good. So it's good to keep a journal of (unclear) emotions. I guess a couple of doctor's appointments to see how like they go up and down.

THERAPIST: Well, I do, I guess I wouldn't have agreed or certainly agreed and recommended us meeting or your continuing in your therapy if I didn't feel like it could be helpful and beneficial to you. And I do, the insurance piece, I as much it's important for us to think about how you're frustrated and I understand it's frustrating. I will take a look at that piece and submit electronically and hoping they have that done in the next week or so. Anyway, so that will be off your plate, although I know it's part of a larger issue. You're just feeling frustrated that things are just not getting done and you're not even sure how they're supposed to get done. It's just very frustrating and insurance companies are frustrating.

CLIENT: I just (unclear) you and I really feel bad.

THERAPIST: I see.

CLIENT: Yeah.

THERAPIST: Because I would feel bad, or what?

CLIENT: That you should be getting paid.

THERAPIST: Well, that's true but why would you feel bad?

CLIENT: I feel like I owe you that money, you know? So you don't have to like -

THERAPIST: So you feel l would be impatient?

CLIENT: No. It's not like the bill's already been paid right away.

THERAPIST: Many bills (inaudible).

CLIENT: As long as you're understanding about it, I feel better about that.

THERAPIST: Do you feel I would blame you for it?

CLIENT: I don't know. I just feel responsible, you know?

(Pause): [00:34:20 00:34:30]

CLIENT: I just, you know, you really don't really have to (unclear). You know, I (unclear) the claim so like I didn't see how these insurance companies take time, I know that. (inaudible) so that's nice to know.

THERAPIST: I do give the (unclear) separate people who, and you know, there are several people who I just sort of just take insurance and take their co-pay versus having to pay up front for people who are just sort of starting out. Where was I going with that? That I do give the added step although I'm now changing of having (unclear) as an added step. I'm changing that for a variety of reasons one of which is they're hard to track and I won't be able to track them. But that was not the point I was going to make. Well maybe, it felt both like a burden and a sense like you owe me and somehow I would be unhappy about that or hold you responsible.

CLIENT: Yeah. Because I pay our bills and sometimes I don't always pay them on time, so I don't want this to be another bill I haven't paid on time. But as long as I'm doing what I can and you're not frustrated, that's fine. It makes me feel better.

THERAPIST: This is your responsibility and obligation and people falling short of it I mean that's something you think a lot about and distresses you at times. It certainly, at least it's (unclear) distressed you with Steve in feeling that you're giving and people aren't sort of giving in return, whether it be out of a sense of obligation or just responsiveness to you.

CLIENT: I had all our (inaudible) who are no longer friends because the people just used me for like money and like I had a car. We were like friends for 10 years growing up and I really didn't recognize it so that changed my way of like thinking about people. And I went to like this girl I grew up with, this candle party and bought like $200 worth of candles and I never got them. She said, like she lost them. And I'm like, wow, that really shows her character and she didn't do anything to like refund my money and I spent probably like 18 years of my life but she was always like that, like my friends always steal from me and everything. So and there's this police officer (unclear) who like, 'who you surround yourself with.' I guess I haven't had good experiences.

THERAPIST: It doesn't sound like it. It sounds like you were really badly burnt.

CLIENT: Yeah. By multiple people. But it is that just because I'm overly sensitive, I'm going to (inaudible) everybody?

(Pause): [00:38:00 00:38:05]

CLIENT: (Unclear) someone who's sensitive.

THERAPIST: You're asking is it them or me?

CLIENT: Yeah.

THERAPIST: It's confusing.

CLIENT: Yeah. And that's like with Steve's fights Steve and my fights. And I can never tell, like is it me or is it him sometimes? Because I'll overreact and then it just looks like I'm the person at fault and so I pretty much just blame myself.

THERAPIST: There's a lot more to talk about in this and I'm sort of using this as a segue I mean there's really a lot more to talk about. I know how hard it's been for you to get here for a variety of reasons, but mostly the travel time. I would be delighted to continue working with you and I'd like to see you in some therapy. However, I think it's more important that you're in some therapy that you can get to, comfortable and not overly sacrificing away. So I want to put that out there. If you feel that you can make it out here (unclear) I would be delighted to continue with you, but if you really feel it's going to be a challenge, would be much happier seeing you see someone who you feel you can sort of meet with more consistently or for the full amount of time.

CLIENT: Well, when I leave I feel good (unclear).

THERAPIST: Oh, I understand that. It's not I'm not really questioning you're how you feel about the (unclear) per se, it's logistically I want to be sensitive to the fact that you need to be meeting with someone for the full amount of time and it sounds like it really can be a disaster getting here so you honestly don't have to answer me today, but if you want to think about it, because I think we're meeting is simply so important that I want to be sensitive to the fact that you're driving a long way and traffic is unpredictable. You want to like we'll see each other next week and you can think more about it?

CLIENT: Yeah.

THERAPIST: Okay. And next week we can plan a regular time.

CLIENT: Yeah.

THERAPIST: Next week I can meet why don't you I have someone at this time for next week.

CLIENT: Do you want me to do early?

THERAPIST: I could do a 2:30. I could do -

CLIENT: Do you have anything earlier than a 2:30?

THERAPIST: Let's see.

(Pause): [00:40:46 00:40:54]

THERAPIST: I could do actually I could do 10.

CLIENT: All right.

THERAPIST: You want to do 10?

CLIENT: I will do 10.

THERAPIST: Okay. So I'll see you at 10 o'clock next Tuesday, then.

CLIENT: Okay. I have I'll write you a check.

THERAPIST: Okay. And it can't hurt for you to send in the June statement. And we're going to start doing electronically once that gets underway. I mean it doesn't hurt to send it in twice, basically. But once I get underway, then I won't be sending you that part anymore.

CLIENT: All right.

(Pause): [00:41:27 00:41:43]

CLIENT: It is, M-E-N, or -?

THERAPIST: M-A-N.

(Pause): [00:41:45 00:42:13]

CLIENT: Okay.

THERAPIST: Thank you very much.

CLIENT: Thanks so much. (Pause) It's cooled down.

THERAPIST: Yeah. It did. (Unclear).

CLIENT: Okay have a (inaudible).

THERAPIST: See you next week. Bye.

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