TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi, Marlene.

CLIENT: Hi.

THERAPIST: I'll be with you in just a moment, okay? (Pause) [0:01:00] [Hi, do go on in] (ph, I'm just going to grab some water.

CLIENT: Okay. 2 [0:01:00] (Pause)

THERAPIST: Oh, thank you.

CLIENT: You're welcome. Did you get my message?

THERAPIST: I got your e-mail message, and you said that you were looking into it. Did you find out what happened?

CLIENT: She said that they sent it to the provider, and somebody cashed it, and they're looking into it.

THERAPIST: They sent it... thank you for this. They sent it to the provider. I'm sorry, I did get your e-mail message, but I thought (ph) it said you were looking into it. And so I didn't... I was waiting to hear back from you.

CLIENT: Well, I was in between conversations with them.

THERAPIST: So they... ah, well, what a bizarre... that's so totally (crosstalk)...

CLIENT: Yeah, and they said, oh, we don't do things that way. You need to send it to us, and then we'll send you a check.

THERAPIST: Yeah, so it doesn't make... why would...? They said they didn't send it to me, so it's so bizarre.

CLIENT: But they did this time, and they were looking into it. That's something that they didn't catch. [0:02:59]

THERAPIST: I know.

CLIENT: I was like, oh my God, I hope she doesn't think I cashed it (chuckling). I'm like, I didn't cash it.

THERAPIST: No, I assumed you cashed... you were going to send me a check, so I didn't realize that...

CLIENT: Yeah, no.

THERAPIST: Well, boy. I...

CLIENT: Yeah, I hope they didn't send it to me or something and somebody got it through the mail and cashed it.

THERAPIST: Well, that's unlikely. They're usually pretty good about that.

CLIENT: Yeah, so...

THERAPIST: Oh well.

CLIENT: Okay, then...

THERAPIST: They're following up. My assistant is away, but she can follow up with it, too.

CLIENT: Okay. Good. Great. So (chuckling)... so how was your vacation?

THERAPIST: Good, thank you.

CLIENT: Good. Did you do anything special?

THERAPIST: Just spent some time with family.

CLIENT: Good.

THERAPIST: How are you doing?

CLIENT: I've been better.

THERAPIST: Yeah? What's been going on?

CLIENT: (Voice shaking) Well, me and Steve got in a fight on the 14th, and after that things kind of spiraled down. [0:03:59] It was a very intense fight, and he threatened to leave. He called me crazy (chuckling), and he left that day. So I went to my mother's house. I called her. I told her to [come in and work] (ph) because I was feeling kind of suicidal, and I needed somebody there. And she came home. And she was very supportive and there for me. And while this was all going on Steve didn't want to talk to me. But we were kind of texting each other, and pretty much he left. He left with his laundry (chuckling), his dirty laundry, and that's about it. [0:04:59] And it was... I took it as an extreme. He only left because he was upset. It was... it seemed like he wasn't going to come back. But that day we went back home, and I pretty much... we had a conversation and I said that I need to get stuff better with our relationship and with me so I can have a better relationship with him. And I promised him that we'd never have a fight like that again. So... I fully take responsibility for that fight.

THERAPIST: What happened?

CLIENT: Nothing. I was just... I worked on Tuesday, and he was home. And I just asked him to cook dinner. He's never cooked dinner. [0:05:57] And I thought it would be all prepared when I got home. When I got home, he was still making it and still had questioned about how to make it (sniffing). And... but throughout the day I was texting him, and I wouldn't leave him alone. So when I got home that he was kind of pissed off. And we were like... we didn't talk. He just watched TV, and he kind of distanced himself from me. (Voice shaking) So we got in a whole big fight because I make everything so dramatic, that pretty much he's not showing that he cares about me. And we fought all night, and what he does is (sniffing)... I'll cry, he'll distance himself, I'll storm around and be angry, and he'll just ignore me (chuckling). [0:07:00] And then I'll finally go to bed, whatever.

But then I started in the morning with him, wanting to talk about whatever happened the night before. And he kind of just snapped, so I kind of... I feel really bad. (Pause) (Sniffing) So that happened on the 14th. Since then, we've had a week without any fighting. I kind of just looked into everything. I got a couple anxiety, depression books and ways to become happier. [0:07:59] And I just was looking into stuff (sniffing). And I stopped picking on little things with us and just let things flow naturally, which they have been. But I just... I noticed that. I kind of self-diagnosed myself (chuckling) with borderline personality disorder. It just makes sense. It... you know?

THERAPIST: Well, it seems too bad that you're coming to a therapist and you're the one who's all alone to diagnose yourself.

CLIENT: (Chuckling)

THERAPIST: It doesn't sound like you're getting the help you need.

CLIENT: (Voice shaking) Well, that's why I'm coming to you, and I called the psychiatrist. I'm waiting for her to get back to me. [0:08:59] Actually, I just called her in the car today.

THERAPIST: The one that I had...?

CLIENT: Yeah. So it could be... I need to be on a different medication definitely. I need something more... a mood stabilizer, so... (Crying) I seem unhappy right now because I'm just emotional. I'm actually very happy, and I have a sense of peace now because everything just makes sense. And I feel hopeful now that I know these thoughts I have are wrong, you know? And it's easy when you know what's causing them to differentiate reality and just your thoughts. [0:09:59] So it's been easier. (Chuckling) But on the other hand (exhaling), in trusting my mother and whatnot, she was upset. She didn't act upset. She acted pretty strong. But then she went and told everybody in my family about this. And we had a bride... a baby shower (sniffing). And everybody was... you just could tell they were looking at me weird (crying)? And I didn't know if she told anybody, but I just knew the way they were coming up to me. So that was uncomfortable. And then the day of the baby shower, my parents just came over unannounced. My mother was kind of yelling at me. [0:10:59] And I told her to calm down, and I told her I was going to reach out and get help. But it was like I had to console her, you know? I'm like, that's not fair that I have to console you.

THERAPIST: What was she so upset about?

CLIENT: More (ph) that I said that I wanted to hurt myself and that she thinks it's the relationship or whatever. And I know it's not the relationship. It's just... I know it's me.

THERAPIST: Did you feel that you couldn't call me?

CLIENT: I don't know. I felt like I had better control over...

THERAPIST: But I mean when you went to her to talk about these feelings, did you feel you couldn't call me?

CLIENT: Well, I feel like these sessions are where I can talk to you. [0:11:57] I'm not going to do that to somebody. (Crying) I would never hurt myself because (sniffing)... I'd never kill myself because I have a strong religious belief?

THERAPIST: Oh, I wasn't suggesting you should call me because you were going to kill yourself...

CLIENT: Yeah.

THERAPIST: But call me because you were so distressed.

CLIENT: Yeah. No. At the time, I couldn't think of anything. I just needed somebody to watch me right then. And I know my mother would be there for that. (Crying) And I just... or... I don't know. This is where I'm at right now.

THERAPIST: But I wonder if it speaks to how alone you feel, that you have a therapist, and in a time of crisis you feel you couldn't call me or ask to come in or whatever. [0:12:57]

CLIENT: It's embarrassing.

THERAPIST: You feel embarrassed to call me?

CLIENT: I feel embarrassed to talk to anybody (crying, sniffing). (Pause) It's... [I don't know] (ph). (Pause) See, like this. Like, I don't want to be crying right now. I wish I could just express my feelings and... without this, without crying, you know? It's like I'm so disconnected (sniffing). Like, I don't know. It just... it makes sense. My whole... it's been... since I've been a teenager I've had a rocky relationship with my parents, and I've always been really emotional. [0:14:02] And in relationships with friends and family I have had a hard time. And I just always thought it was somebody else. But now I can reflect and see that it's just not, it's not, it's not good behavior to be so emotional. Like, I feel agitated and angry. I go through... I'm just enraged by stupid stuff that provokes it. (Crying) And I go to sadness, and I feel guilty. And it's hard to have a relationship when you're always feeling abandoned for no reason, you know? [0:14:59]

THERAPIST: Well, no one has no reason to feel the way they do. Feelings are based on something, even if it's not what's actually happening at that very moment. They come from somewhere.

CLIENT: But I've always felt like that. (Pause) And Steve doesn't abandon me, so I've just always have abandonment issues and trust issues. I guess that's just how I dealt with things growing up, and now it's just a pattern. I don't need to feel abandoned. It's just... I just can't... I don't know, I just can't trust for some reason. (Pause) So I'm getting some help. I'm hoping to get help (chuckling). [0:15:56]

THERAPIST: I've seen you go through these cycles before...

CLIENT: Yeah.

THERAPIST: Where you go, this is all me, I need to just get control of it. And then I don't know what happens, but it's sort of... they're cycles you go through. I'm not sure I understand the cycles.

CLIENT: Yeah. (Sniffing) I would say when everything's good, everything's good. But when it's bad it's horrible. There's no in between. And I've had teachers, I've had my mother, I've had everybody say there's... you see things black and white. Like, pretty much they're really, really good, or they're horrible, you know? I don't have judgment factors (ph), where I think the worst out of a situation instead of, oh, okay. This is how it is, it's not a big deal, let's just keep going. I'm just like, oh my God. That's my first reaction, is horrible. I don't do it at work. [0:16:59] I... this is... it's weird, because it's only my personal relationships. With work I'm just so professional and goal-directed. Nothing really affects me at work. (Pause) I used to say that... the school, I played soccer. Whenever I played soccer, I just felt at peace, like I had something to work on. (Pause)

THERAPIST: Well, I'm... a few thoughts. The one thought I already shared with you is... we should talk about the embarrassed piece, but usually when people feel acutely distressed that's when it's really actually very good to have a therapist and be able to talk. [0:17:58] So I'm sort of struck by the fact that you felt you couldn't reach out to me.

CLIENT: Yeah, [I agree] (ph). (Sniffing) I don't think I was thinking (chuckling). I was just like, oh my God. He left, and I just needed to be somebody... with somebody. And my mother was there. She's so close, and she's been there for me before. She made me feel a lot better. (Crying) But then after that I just felt betrayed because she went to my aunts. And, [if I want to go to my aunts] (ph), speak... they're not my parents. Why are you talking to my aunts? She's going for help to my aunts (sniffing). So [it just made me] (ph) really angry. [0:18:58] (Chuckling) And how my dad dealt with it (sniffing). He came over and weed-whacked the yard (chuckling). I've been asking him to do that, I don't know, three weeks. (Crying) But instead of talking to me he weed-whacked my yard. He thinks that's something he could do because he emotionally can't speak with me this way, which is really funny (chuckling). (Pause)

THERAPIST: Well, what do you think...? It sounded like you were upset all day before you got home. You said you kept texting Steve.

CLIENT: Yeah, because I was just like, oh my God, he's doing something. He has a day off without me. What is he doing?

THERAPIST: But that happens every Tuesday, so what do you think was different about that particular...?

CLIENT: Because I wasn't there. Every Tuesday we're together.

THERAPIST: I see, so this is the first Tuesday in a while that you haven't been there. And that was what's different. I see.

CLIENT: Yeah (sniffing). It's so wrong (crying). He's not doing anything wrong, but I'm just around a lot of girls. [0:20:01] And all their boyfriends are cheating on them. Everybody I speak with, it's like their husband or significant other has cheated on them. And when I say I trust my boyfriend, they're like, oh yeah (chuckling). I'm like, oh, you know? But he's a very loyal person. He's never given me a reason to feel this way. It's something within me.

THERAPIST: But something got to you that day.

CLIENT: No, nothing (inaudible at 0:20:38). It was just the fact that he was home without me...

THERAPIST: I see.

CLIENT: And I had no idea what he was doing. That's it. And when he's at work he texts me all the time. He'll say hi (inaudible at 0:20:56) even if I don't text him back because I'm always busy (sniffing). [0:21:01] He didn't text me at all, so I was like, oh, this is different. Usually I look at my phone, and I have a message. But not enough to make him feel bad about it. It's not fair. He has one day off a week for me to constantly be bugging him. (Pause) And... yeah. That was the simplest thing, it just escalated because I was feeling needy (chuckling), you know? And I wanted attention from him, and he was already annoyed with me. But he doesn't discuss being annoyed. He just shuts off? And that really made me upset. [0:21:59] (Pause)

But (inaudible at 0:22:15) been doing really well (sniffing). And I'm writing down... trying to write down my feelings when this happens because I forget. It's like, when everything's good, I forget I behave this way, and I forget what I promise. (Crying) So if I'm able to look back on that day and see how I was feeling, I always think it's so silly afterwards (sniffing). And last night, Steve came... I worked nights, so I slept the whole day. And Steve came home, and he was exhausted, and he fell asleep. And he kept giving me his phone, and I didn't know why. And he was half asleep, and I'm like, don't give me your phone. [0:22:59] This is... I want to look through your phone. (Crying) I want you not to give me the phone (sniffing). So I kept giving it back to him (chuckling). And then finally I took it, and I just put it aside. But I wanted to look through that phone for some reason. It made me so anxious, but I didn't. And I woke up, and I was fine. I was able to control that, because, if I'd found just the littlest thing that meant nothing, I would make it into something really big. So to be able to control that, I think that's a good step. I just have to repeat it, so...

THERAPIST: What did you write down?

CLIENT: Oh, nothing yet (chuckling). (Sniffing) I wrote down... just on the 14th I wrote down, I almost lost my boyfriend today, and I promise myself to change. So I don't forget the promises that you make, so I don't repeat my behavior. [0:24:07] So (sniffing)... and I wrote down what I wanted to talk to you about because sometimes I just get here and I feel like I never say what I really wanted to say? (Sniffing) I'm starting school again. And I took a... I'm taking a class, just a class I've already taken, but it's been five years. So it's an education class I have to retake. And the money's up front on the first. And I asked my dad if I could borrow some, and he said no (chuckling). So I was kind of upset about that. It's fine. [0:24:58]

THERAPIST: Really? That's fine? It doesn't look fine.

CLIENT: (Crying) I don't get why he won't try to help. Even when I'm going to pay him back, he... I feel like he just watches us struggle. (Pause) I don't get it. It's really odd. Is that expecting too much from somebody? You know? (Sniffing) He thinks, because I moved out, he could have helped me stay home and allowing me to seethe (ph). (Crying) But I couldn't live there any more. It was so unstable. [0:25:59] I had to move out because him and his yelling and everything... it's not a big deal because it's not anything horrible. (Crying) But that was just his behavior if anything went wrong. He would yell at you. I just couldn't deal with it. He'd yell at my mom for something really stupid. I just couldn't deal with that, couldn't deal living with that. So I wish I could stay and save money and not have to struggle, but I couldn't... I had to make that decision to move out. (Pause) (Sniffing) So yeah, I am pretty much all on my own. [0:26:56] I don't think it will always be like that, but (crying) just right now. (Pause)

THERAPIST: It sounds like you... even though you know who your dad is, you still feel hurt and angry at him.

CLIENT: Yeah. I don't think I'll ever have a relationship with my father, even though my parents are together, whatnot. Never. He'll never change. He's... he is who he is. He's less angry, but... I don't know. He has a really... he has a problem opening up. Damn it, your daughter was thinking about hurting herself, and you weed-whack her yard? [0:27:57] Isn't that odd, instead of talking to her? (Pause) (Crying) And my aunts are the third party parent. That's why she went to them. I've always went to my aunts, and they're very helpful. They're a lesbian couple. They're married. And my aunt is very smart. She was going to be a psychologist, so when I talk to her I feel better about things.

THERAPIST: This is your mom's sister?

CLIENT: No, my dad's sister.

THERAPIST: Your dad's sister.

CLIENT: So she understands how my father is and how my mother is. So it's easy to go to her, but she kind of... she never had children, so she kind of cares for everybody. [0:29:01] So I don't want to burden somebody with this. (Crying) I want to be an adult, be able to deal with this myself (sniffing). But I went... after the fight and stuff, the next day I went over there. I didn't really tell her about the whole fight, but I was just feeling really down. So to go over there was nice. And I told her about going to a psychologist and just speaking, and she said, oh, I bet you your psychologist thinks your family's pretty interesting (chuckling). That's what she said, the dynamics. And I'm like, I don't know. Probably, but, I mean, it's seen. It doesn't go unnoticed. [0:29:56]

THERAPIST: Do... was she referring to anything in particular do you think, like your dad...?

CLIENT: My dad and my mom's dynamic.

THERAPIST: I see.

CLIENT: Yeah. I'm like, yep, probably. I don't think anybody gets it (chuckling, sniffing). (Pause) So... but for my mom to go to them without consulting me, that just makes me upset. (Crying) I can understand she didn't know what to do. She could talk with me first. I told her everything was better. I told her I was doing better, you know? (Pause) I feel like I'm doing better (sniffing). (Pause) So I hope to get the appointment with the psychiatrist, but it sounds like she's not taking patients for a couple months? [0:31:02] That's what it said...

THERAPIST: That's what she said on the voice-mail?

CLIENT: Yeah.

THERAPIST: I see. Well, then you should probably find you someone else.

CLIENT: Yeah, okay (sniffing). So if I could... I think the medication I'm on helps. I don't feel...

THERAPIST: What are you taking again? Is it (crosstalk)?

CLIENT: Wellbutrin?

THERAPIST: (inaudible at 0:31:19)

CLIENT: And Celexa together. And when I was just on Celexa I felt anxious and hyper. I'm... I felt happier, but the anxiety... it gave me so much anxiety. And with the Wellbutrin it would calm me down. And my doctor said that it's supposed to give you energy. And it's like, no, it calms me down. It kind of just balances me? But I definitely feel like when it comes to extreme measures it's not very helpful. [0:31:57] If... I don't know if that's... the medication's causing that or not? So I feel better when I'm on it, because I've gone... I've taken myself off and been like, I just can't function. And I'm just an anxious person and very irritable. And they've tried me on Zoloft and Prozac. But Prozac just made me wicked weepy all the time. And the Zoloft just didn't seem like it was enough, so...

THERAPIST: Who was it who prescribed you initially?

CLIENT: My doctor, my just general physician. She's a good doctor. She tries to take on everything, though, instead of being... sending you to a specialist? She'd try to treat everything. But I wasn't good about following up because I was... I'm still in denial about everything. [0:32:58]

THERAPIST: Well, I was thinking that I had given you the referral I think a few months ago. And it seems like you go back and forth. Is it that you feel you don't need it, or you're not sure what you need? Is that part of it?

CLIENT: I put a lot of stuff up because I just go. If you see my schedule, I work 60 hours a week. And I just go. I don't plan for things. (Crying) It's in the back of my mind, believe me. Just getting my contact, I have one contact right now. So today I need that... try to make that appointment, an appointment for the ophthalmologist. But it's like... I just function because I have to work so much. It's... and then I'm exhausted, so I sleep. So it's just, that's all I can do is sleep and work (chuckling). So (sniffing) I have to take time to do what's good for me.

THERAPIST: Because this psychiatrist isn't taking patients for a couple months, that's not a good situation for you. [0:34:00]

CLIENT: No, I was just... calling her was a big step for me.

THERAPIST: (Crosstalk)

CLIENT: If you could find somebody else, that's fine.

THERAPIST: Yes, I mean, that sounds like it would be a good plan.

CLIENT: Mm-hmm. I just... I felt... yeah, you're right (ph), I go back and forth. But right now I really... I'm for getting help. I understand it's a problem. I don't want to ruin another relationship. I was like this in my last relationship, but, I mean, he was no angel either (chuckling). We probably were going through the same thing together, so...

THERAPIST: I am curious about the back and forth, because I remember when I gave you the name of the psychiatrist you were going to call right away. You really wanted to call. So something happens for you.

CLIENT: I get distracted. I just... it's not like I don't want to call. It's just work and then... I mean, if you know my job, I stay up for two or three hours sometimes over [than what I'm doing] to finish my notes, which I don't get paid for. [0:35:11] So by the time I get home you're exhausted. There's not much you can do (sniffing). I talked... there're a couple of my friends, they're teachers, too. They can't believe how much I work because they all work three days a week. They get... they [do 12s] (ph).

THERAPIST: How many shifts do you take?

CLIENT: I normally have four, but I take on more. I'll do overtime. But sometimes they have me straight for, like, six shifts in a row? So there's no in between. Then you have a couple days. I'm always, on my days off, picking up where I... what I'm missing. Like, I have to pick up the house, try to pay the bills and stuff, but... I was... yeah, I wanted to see a psychiatrist. [0:36:09] It's just procrastination (sniffing). (Pause) So it's just getting organized for me. I'm very disorganized (chuckling).

THERAPIST: Well, it seems like things either feel like they're sort of pushed away or out of mind, or they're sort of overwhelming.

CLIENT: Yeah.

THERAPIST: They're like two modes.

CLIENT: Yeah. I definitely push things away. And when it gets to that point where, times up, it is overwhelming for me. I get things done when I'm stressed out (chuckling, sniffing). I function a lot better, but it's not a good way to do anything. [0:36:58] Even with exams, I would wait until the last minute and just kind of binge study for days. It didn't help me much (chuckling).

THERAPIST: It's an interesting way of describing it, binge studying.

CLIENT: Yeah. But I used to, for three days, stress out and just study. And that's when I got my best studying in, is when I was under a lot of stress. Not healthy (chuckling).

THERAPIST: Or... well, to put it in the... sort of the digestion metaphor...

CLIENT: (Laughing)

THERAPIST: When you sort of learn sort of a little bit over time, you get to metabolize it, versus, if you take so much in, you might be able to sort of regurgitate it, but there's nothing that's really metabolized.

CLIENT: Right. It's just there for that exam. It's not there to help me for the rest of the semester, just to get things done. (Sniffing) Yeah. [0:37:59] I'm just looking to turn around my life. I'm looking to be happier and no blame everything on my relationship. We could have a great relationship if I could just not get so emotional and extreme. That's hard for anybody to deal with somebody like that. So I definitely can look... if it was the other way around and I was with somebody that acted this way, I would not stay with them either, so I understand how much stress Steve's under, where I just blamed it on him. So I feel better about the relationship when I take responsibility. [0:38:58] And, like you said, when I act more relaxed and happy around him, he... [the big stuff] (ph), he's more relaxed and happier (inaudible at 0:39:08), and our relationship just works.

And it was really sad when he moved. He took off that day. He said, you can go to your parents' house, but I have no place to go. I'm like, oh, that's really sad, because that's true. He doesn't reach out to anybody. His mother's there, but he would never be like, I'm moving back home. She would never allow that. And he told me... I was like, this is my low right now. This is the lowest it goes. I'm like, what was your low? And he's like, well, there was a time when I was homeless for five months, living out of my buddy's basement. And he said all he'd do was drink. He'd work, drink, and sleep out of this guy's basement. [0:39:57] And one day his friend had his girlfriend over, so he locked the basement. So Steve couldn't get in, and he slept under the house because it was raining (chuckling). I'm like, yeah, that's pretty low. It's like, how did you get there (chuckling), you know, at that point (sniffing)? And he could have always called me. We were always friends throughout the years. He doesn't have anybody to talk to either (ph). (Pause) I'm kind of encouraging him to get friends, hang out with people more, because I think he'd be happier. Before... I mean, part of me doesn't want him to go out because I have those thoughts, like, what are you doing? But I know it's healthy for him. [0:40:59] (Pause) So that's a lot (chuckling). (Pause) Could you see how all of this could relate to that diagnosis?

THERAPIST: Borderline? Yeah, I don't love that diagnosis for you. I mean, a lot of people have some features of it. And I appreciate it sort of spoke to you. It sounds like it spoke to you.

CLIENT: Yeah.

THERAPIST: Do you know what in particular did? What in particular about it?

CLIENT: (Crying) The emotional instability, being overly upset, sensitive about things? The self-harm, and... that's what I did with the bulimia. That was obviously self-harm. And the anxiety, depression, and seeing things in black and white, and the problems with relationships and trust. That's a lot. [0:42:05] Is there more than that to that disorder?

THERAPIST: Well, what you describe could be a lot of different things. That's why... yeah, that's characteristic of that. But there's other things it could be characteristic of. I would really like to see you get a good sort of medication evaluation. I don't think you're bipolar. But what you struggle with... and this is both a biochemical issue and also just sort of a psychologic issue that... psychological issue that psychotherapy can help with, is just regulating your emotion, which is what you're talking about, feeling like these extremes and feeling at times this intensity of emotion and not knowing what to do with it, which is part of what binge eating is about.

CLIENT: Yeah.

THERAPIST: So there are medications that are used for bipolar patients but not... people don't necessarily have to be bipolar, but it sort of evens out your mood a little bit. [0:43:02] I think something like that is what's something that would help you. So I'm not a physician myself...

CLIENT: Right.

THERAPIST: So that's... with that very important caveat. But I think that that, in terms of medication approach... that could be something that could be useful for you. So that's what I see, but...

CLIENT: Yeah. Do you think I'm bipolar?

THERAPIST: I don't think you're bipolar.

CLIENT: Yeah?

THERAPIST: No.

CLIENT: I don't have the manic. I don't feel like I [have the manic] (ph).

THERAPIST: There... yeah, I mean, you... there's something called bipolar two, and again these are... it's like with a cardia... if you have clogged arteries or some cardiological problem, it's... this is sort of a clear... you look inside, you see the clogged arteries and so forth. The DSM, which is mental diagnoses, they're more descriptive. It's not like you have these symptoms, and this is this disease. They're more descriptions.

CLIENT: Right.

THERAPIST: So it's not sort of how you think about it in terms of medicine, in terms of your field.

CLIENT: Right. [0:44:03]

THERAPIST: But there's something called bipolar two, which doesn't have a manic... it's not like a full-blown mania, but it's more of an irritability? So that probably would fit you, but I wouldn't call you bipolar. I wouldn't give that as a diagnosis per se. But something... but I do think that something that would help you sort of even out the moods would be very... would be very helpful for you.

CLIENT: Yeah. What kind of medication do you know? Do they...?

THERAPIST: There's a few. I definitely don't want to go in that... down that road. That is really not my area of expertise.

CLIENT: Yeah. But you don't think... like, I would never take lithium?

THERAPIST: No. Oh, I... there's not... there's plenty of other medications that are not lithium. Lithium is a very old school drug.

CLIENT: Yeah.

THERAPIST: Did you...? Do you know what your mom takes?

CLIENT: (Chuckling) She takes Zoloft.

THERAPIST: She takes Zoloft. I mean, some SSRIs have the evening... [0:44:55]

CLIENT: I don't think that's enough.

THERAPIST: You don't think it helps her?

CLIENT: I don't think it helps me. I've been on Zoloft.

THERAPIST: I see, yeah. No, that's... yeah. So no, there's plenty of mediations that help both sort of evening out someone's mood that's not... that is not lithium. Lithium's a pretty old school drug.

CLIENT: Yeah.

THERAPIST: The one thing I was going to ask you, I know there's an issue of convenience, too. There's someone I know here I really like in Providence. And you don't really have to see this person very frequently. If you were able to get an appointment with her and I could try to see you on the same day that week, would you be open to seeing her, just for convenience's sake, so you don't have to keep coming back and forth?

CLIENT: What kind of therapy does she do?

THERAPIST: The... for medication.

CLIENT: Ah.

THERAPIST: So in other words I only... I don't really know medication people down there. I had to get someone through a colleague...

CLIENT: Yeah.

THERAPIST: So, if she's not available, I don't even know where else to send you.

CLIENT: Well, that makes sense. I have Tuesdays off, and I will be having more Tuesdays off because I'm going to be taking my class that night.

THERAPIST: Okay, so I will e-mail her and make sure that she's seeing new people, get that off the bat. [0:46:01] And then I will give you her contact information. She... just to let you know, a lot of my colleagues are away in August. So in case I don't hear back from her I'll let you... I should hear back from her in a week, probably this week, but...

CLIENT: Yeah, that's fine.

THERAPIST: Okay?

CLIENT: Yeah.

THERAPIST: I will see you next week then.

CLIENT: Sounds good.

THERAPIST: Take care, Marlene.

CLIENT: Thank you.

THERAPIST: Okay, bye bye.

CLIENT: [I'll give you this] (ph).

THERAPIST: Oh, thank you very much, I appreciate it.

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