TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

[beginning at 2:30]

CLIENT: How are you?

THERAPIST: Good, thank you.

CLIENT: I went to the psychiatrist.

THERAPIST: Mm hm. Do you want a pillow for the back?

CLIENT: No, I'm okay. Uh, that went well. She put me on two new medications. Sorry, I was running. And I feel like a lot calmer, and happier. So after that I [unclear 3:09]. Been a busy week. You know, not any issues at all. So that's good. Did she tell you what she prescribed?

THERAPIST: She may-she touched base with me and just said-she e-mailed and let me know that she did meet with you and that she felt you were essentially under-medicated and that medication could be of a help to you.

CLIENT: Yeah.

THERAPIST: I don't know she had-what did she prescribe?

CLIENT: Prozac. She asked what I would prefer. I was on Celexa and I didn't like Celexa, and it was 20 milligrams. But I'd been on it before and it was always like a low dose, and it always like caused me to be like weepy, but not this time. And Klonopin to sleep. And it's probably the first I've ever really slept for like I would say years.

THERAPIST: Had you never been on like Klonopin or Xanex before?

CLIENT: Just I was prescribed Trazadone once, and Ativan I think once, but I wasn't fond of the Ativan, it made me really tired when I woke up. But not really, like I never like continued to take it, it was only like if I needed it. But I just-I can't believe the difference. So I like don't wake up at all until I have to go to work now. So to feel like well rested is just amazing.

THERAPIST: So I'm glad to hear it helps.

CLIENT: Yeah, me too. I didn't believe it would. [5:00]

THERAPIST: Why not?

CLIENT: I don't know, I just thought I'd be sedated, and when I woke up I'd be sleepy. But I'm not. So that works. Like if I dream I don't remember my dreams. Normally I could write a story about my dreams.

THERAPIST: Do you remember any of them?

CLIENT: Oh yeah, for years I would remember. They're very vivid. I wasn't sure if that was because of the Wellbutrin, so it's a side effect, so. But just the last dream I had I was like sitting up, and like I think I was doing something at work. And it's because my assistant manager, I was teaching one of my students how to like drain a drain. And I was-in my dream I was sitting up and I was like alcohol wiping a catheter, and that's-I was like up and doing that. And Steve was like, "What are you doing?" And I'm like, "I'm just dreaming." But I would fully sit up and just be like reenacting things.

THERAPIST: So that was in the dream, or that was-

CLIENT: Oh, that was in my dream. And I'd be sitting up in bed. Very bizarre. So it's kind of like I slept well after, didn't go anywhere.

THERAPIST: Mm hm.

CLIENT: I have dreams I'm-like I'd wake up and I'd be laughing in my sleep, and wake him up. And I'd have dreams about like-I hate 'em-all the time I'd have a dream that like we weren't together and I was trying to find him, and like-

THERAPIST: [sneezes] Excuse me. [7:00]

CLIENT: Bless you. -things would always get in the way. So. And then I'd just have dreams that wouldn't make any sense. But I'm not dreaming, so.

THERAPIST: [sneezes] Excuse me.

CLIENT: Bless you. Did you get your flu shot?

THERAPIST: Should I have?

CLIENT: I don't know. I didn't last year and I didn't get sick. But when you're in a hospital they kinda hunch down and make sure you get one. But everybody since they've gotten the flu shot has a cold right now.

THERAPIST: I didn't-I'm going to just grab a tissue. I think it's actually allergies and not from anything else.

CLIENT: Yeah.

THERAPIST: I'm not too worried.

CLIENT: But yeah, on the Prozac I thought-like we talked about like my mother's history and how like I was afraid that I was manic depressive. And she told me the symptoms of that, and so to like make her aware. And I definitely don't feel hyper or all over the place. So I'm happy about that. And it hasn't affected my appetite, so that's good. So we'll see. It's only been a week. But like I had immediate relief taking the Prozac that day. Do you feel like-can that happen, can you have immediate relief like that?

THERAPIST: Well, you did, so do you feel it's something besides the medication then?

CLIENT: No. No, I really feel I got immediate relief. I was like stressed about going to see the psychiatrist, and I was stressed because I couldn't find her. And then I was stressed because of parking. And then I was like stressed on the way home after it all. But when I got the-took the medication I just I wasn't like weepy like I normally am. So. [9:00]

THERAPIST: That sounds like a big difference.

CLIENT: Yeah, it is. I'm even like able to relate to people at work. As opposed to like-I mean, I'll usually like keep to myself, do my own stuff, but now I'm more like social. I'm never like that. So that was my week. I don't think anything bugged me at all. So it's a good week.

THERAPIST: Yeah, it's a big change.

CLIENT: Yeah. I hope it like continues. Like with the Wellbutrin, I mean, I would like start the medication and I'd feel good, and then after a couple of months I'd feel like it would wear off. So I hope that doesn't happen this time. And like during our interview, her exam with me, she just like brought up things that made sense, that it just seems like the anxiety is taking over my life and it's really been an issue. So to have that relief feels good.

THERAPIST: I agree with that assessment.

CLIENT: Yeah. So yeah, it feels good.

THERAPIST: Mm hm.

CLIENT: So I feel like-how would I put this? I feel like I have an interest in things, so I'm excited about that. Like I used to love to run, and I feel like I want to do that again. And I live on a lake and I have a kayak, and I used to kayak, and that's how I would like relieve stress. And this whole year I didn't. I had no interest in doing that. And I just want to get right out there and do that. So. I mean, it's such a big difference. [11:15]

But I'd say also I've been like relating to the girls at work too. It's just like our environment, we're just high stress all the time. And when we go home it's just really hard to like relax. And there's another girl I talk to and she's the same way, she says, "Since I started this job-I was always such a happy person, and since I started like I'm just nasty. I'm like nasty to my boyfriend, every little thing bugs me, and it's like you can't enjoy life." And that's the truth. Like our job really like impacts our life. Where it's like you're just constantly, you can't take breaks, you're like-it's definitely like a selfless job. So.

I think since I started from like-I worked Falmouth, which was a slower pace, it was long-term, and like you got to have a lot more time with students, a lot more fun with the students. And now like on an acute care it's just like you constantly go, and it's pretty much like life or death if you miss anything. And you're that-the communicator for the families, the doctors. And you have to teach the interns, you have to teach the students. And you just have a lot of responsibility. And when you go home it's like you're on edge. So it's nice to talk to like the other girls that feel the same way, you know. So. [13:15]

THERAPIST: It makes you feel less alone?

CLIENT: Yeah. Because like that's how I was feeling, I was like I don't think anybody else like feels this way, they seem to like pull it all together. But it's not true. Like I see it all the time in front of me. Like like I said, with that manager, the assistant manager that I had problems with. She goes to work and she's just like a big ball of stress. And she tells us that like, "Oh, how I deal with my stress is I just let it out. It doesn't affect my family at all." But it's like, yeah, but you let it out at us. You might go home and you have that good family life. But like she takes it out on us and that's her way. And everybody sees that, but that's her way of dealing-handling stress I guess.

But yeah, it's nice to relate. It's hard to talk to people, you know, about anxiety. Because even though I am in the education field, it's such a stigma, you know, everybody is judgmental about mental problems. Which is not the case for me. I'm like able to relate to my students knowing that like I understand what they're going through. And I think I've helped a lot of people get help. So it's, yeah, something to be proud of. [15:00]

So I feel like I have more hope in my life than I did before. But even like struggling with this, the psychiatrist said like, "How do you see yourself in the future?" I never said that I-I told her, I was like, "I feel hopeful still, even though with like what I'm struggling with. I feel like I'm going to have, you know, that future that I want. And it's just-it's nice to get help." So I don't know what else to say. What do you think?

THERAPIST: Well, it sounds good.

CLIENT: Yeah. And I think-yeah, hopefully the medication will help. But there will always be times, you know, that I'll need extra support. And I didn't reach out to anybody, and I think that's, you know, the worst thing you can do.

THERAPIST: Why do you think it took so long to get to her?

CLIENT: I think with my-I was thinking it was hormone-like hormonal. When I was a teenager I was thinking it's hormone. And then with the bulimia I was thinking it was just bulimia, you know. I never understood that that was like a symptom. And then I took an abnormal psychology class, and I was like-I think that's when I started to like see it, like understanding. And I was like, "Yeah." I just felt like maybe everybody goes through this. And then with the breakup with my last relationship, and like not being able to cope, I reached out, because I needed that, like right then and there. But, you know, when you feel good some days and you don't-like other days you feel like, you know, tomorrow's going to be a better day. That was kind of the attitude I had, that I could handle this on my own. Which wasn't true.

THERAPIST: So I remember, I think I first gave you a referral like six months ago-

CLIENT: Yeah.

THERAPIST: -to someone near you. And it does-like it does seem like when things are good they seem fine-

CLIENT: Right.

THERAPIST: -when things are bad they seem kind of catastrophic. [18:00]

CLIENT: Right. And it's all like if I have no stress in my life, yeah, it's fine. There's, you know, stimulus or stimuli, like it was hard for me to cope. So that confused me, you know. And I have a lot of people saying like in my life, like my mother, "Just go to church, you'll be fine." Or my boyfriend saying like he doesn't understand depression, he doesn't understand anxiety, and just saying like, "We can work on this together." So that's why it took me so long. There's, you know, a lot of people that don't believe in getting help, they feel like it's more-I think they thought it was more behavioral and I had to stop the way I was behaving. And that's how I felt. [19:00]

And then like the work schedule definitely plays a part. Like I work so much that it's like to fit in an appointment, to even think about an appointment, to even get an appointment, I would need to get a break at work. So I said to her, because-you know, I was like, "I can't play telephone tag, you're going to have to e-mail me. I can't talk to you while I'm at work." And that worked for us. I think that's-if it wasn't the whole like communicating on the phone when I worked, that the e-mail was easier for me. So I also like the convenience of things. For me it's the same for everything. Like eye appointments and doctor's appointments, where they just don't have the time, I really have to like set aside time. That's how demanding my schedule is. [20:00]

And maybe on my part it's organization, but I kinda just go. Like I know I have to be at work at this time. And then, you know, I look for my day off, but my day off it's usually I have to like unwind and like clean, and like do the dishes, or go grocery shopping. So it's like I'm at the minimum of free time. My twelve hours turn into like sixteen hours. So if I work-you know, if I get at work at 7:30, and then if I'm supposed to be out at 8:00, I get out at 10:00, I get home at 11:00. It's hard to like plan anything. It's difficult. So that's pretty much like why it took me so long. And the flip-flop of my schedule too, like nights and days. That's hard.

THERAPIST: So it felt like practical obstacles.

CLIENT: Absolutely. I told her, and I'm like, you know, like making that appointment and going there I sacrificed a lot of things that I had to get done like that day. I had to study. And getting there, like getting stuck in traffic, it really limited the time I could like study for school. And so, you know, organization is always a problem with me. I'm very disorganized with my schedule. It takes me a little bit-like a couple weeks to-like if I have anything in my life it takes me a little bit to like get it set so I can do the things I need to do in a week. [22:15]

THERAPIST: Well, it sounds you can feel very kind of just sort of overwhelmed by the demands on your day or your week.

CLIENT: It's funny, because I do it to myself, you know. Like the girls at work, they were all wanting to go out. And I knew that was good for me, like to get out with people. But I had to work an overnight shift the day before. And then what happened was I got floated to a different floor and it was a really hard floor, and it had a really bad night, and it was only for four hours. And then I went back to my floor and had a really hard night. So I ended up getting out at 10:00. And then I drove home and I passed out at like a gas station for two hours, and then when I got home I couldn't sleep. And then I had to be-the next day in the morning I had to work a day shift. So I was-you know, you plan on things but stuff happens. And I wasn't able to go out. I was really disappointed about that, but there was nothing I could do. That's how demanding like my job, my life is.

THERAPIST: How many shifts a week do you work?

CLIENT: I pick up a lot of overtime. So it's supposed to be two twelves, two eights. I'll do overtime, and you know, I always spend like maybe like two hours extra each shift. Because it's overwhelming, and you have to like document any-what happens is you end up not able to document in your shift, so when it comes to like giving a report to the next teacher. I'm there for like two hours after like writing my notes. And sometimes like they'll ask me to cover, so I'll do another shift. And then I have a per diem job that like asks me to pick up. So some weeks I work like 70 hours a week. That's a lot. [24:30]

THERAPIST: Well, and you said that some of it you do to yourself.

CLIENT: Yeah, because I don't say no. You feel-with the per diem job I feel obligated, you know, because I'm not there all the time. And then with my job you kinda get cornered into doing it. It's hard to say no, because they make you feel guilty if you don't pick up. And I'm like burning the candle at both ends, so to speak.

THERAPIST: Well, guilt is something you're familiar with in your family.

CLIENT: Yeah. But I mean, the extra money does help. I would say if I didn't need to work like that I wouldn't. It helps. I'm trying to balance everything. Which I think I'll get there. And if I get my degree, you know, then I'll be-it'll be a little easier, and I'll feel much better about myself. That's my goal.

THERAPIST: How so, how can your degree make you feel better?

CLIENT: Because it's like to me it feels impossible, but I know I can do it. And that's just like a goal I set for myself.

THERAPIST: What about it feels impossible?

CLIENT: I've tried twice and failed. So. It's just it's hard. Like I have documented like learning disabilities. But I've never like-when I go to school I never like bring that up into school. I had like dyslexia as a child and was put into like special needs and everything. [becoming progressively more emotional, fighting tears] But I tested out of it. So I just have to work a lot harder. Which is fine. I just don't want to fail again. [27:00]

THERAPIST: When were you diagnosed with the learning disabilities?

CLIENT: Um, first grade.

THERAPIST: And was it primarily dyslexia, or was it other things as well?

CLIENT: Um, that was my diagnosis, was dyslexia. I was more reading comprehension too with that. And I stayed back.

THERAPIST: In first grade?

CLIENT: Yeah.

THERAPIST: Do you remember-I mean, you were so young, but do you remember having a hard time?

CLIENT: I was-I don't rem-I know I had a hard time in school, but I feel like it was more like social. Like I was very nervous. And like when I was younger I had anxiety, like I couldn't eat like with the other kids. Like during lunch or whatever I'd go in the bathroom I'd be so nervous. I don't know why.

THERAPIST: Do you know what you were nervous about?

CLIENT: No. I have no idea. It was very odd. And like I do remember like being like at the lunch table and have like one of like the lunch ladies like telling me I needed to eat. But I was so nervous I'd throw up all over. I used to when I was little, I got so nervous I would throw up. And I had like as a kid, if my mother like left me, I mean anywhere, I would just be upset the whole time. So. I feel like maybe I had learning disabilities, but it was more like social. [29:00]

THERAPIST: You were nervous around other kids. Did you have friends?

CLIENT: Yeah.

THERAPIST: Were you okay around your friends?

CLIENT: Yeah, I was fine around them. I had a lot of friends. But my way of making friends was, you know, different. I would always like give something of mine to make a friend, which is weird. Like I would save up all my lunch money and like give it to somebody. That's how I made friends.

THERAPIST: Did you feel like that was the only way someone would be your friend?

CLIENT: I think so. And then being heavy like in elementary school, like that was hard. So. I didn't start making like really good friends until like high school year. And it was like I made them outside of school. It was-I didn't really get with any of the girls I went to school with. Like I was friends with them, but I never trusted them. Because they were-my school was-kids in my grade, or that high school, they were very stuck up, they were very-they were into like partying and drugs and boys, and I just like didn't relate to that. I don't know. So instead I went to work like at an early age, I made friends through work. And [I wish? 30:52] I had these friends like to this day, you know? [31:00]

THERAPIST: Did it get better after first grade, the nervousness?

CLIENT: No. I think I was-I mean, it was my whole life, until I would say 16 when I met Steve. Like I wouldn't even talk to him. We would go out on dates and I would just like nod my head, I wouldn't be able to even have a conversation. After we broke up like I was like really hurt by that. I went the total opposite way and I just kinda forced myself to like be somebody I wasn't, but to like go to parties and like be social, even though it would like stress me out. So that kinda-I don't know, it helped me. [32:00]

And I worked at like in an outlet job, and that's when I built up like more like social skills. Because I had to, like dealing with customers and everything. I think that's when like I really like started to relate to people.

THERAPIST: Did your dad have social anxiety?

CLIENT: Yeah.

THERAPIST: Because you had described him as very anxious.

CLIENT: Yeah, he does. He can't-he's fine if he has like a drink. He can't-you have to force him to go anywhere, and it takes a while. He doesn't like to go out. But when he gets out he's very social.

THERAPIST: He doesn't like to go out. Meaning he doesn't like to leave the house? Or he just doesn't like to go-

CLIENT: No, like a social setting. Like a wedding, or like going out with friends, he doesn't like doing that. But once he's out he's very social. And, you know, I'm the same way definitely, but I force myself. But it takes me like-to get ready it takes me like hours to feel like I'm okay to go out. And my last relationship, he was a football player and he was so social, and we had to go everywhere. And I would have like panic attacks all the time, because we'd be in large groups, and he'd like leave my side, and it just like was way too much for me. But I never like realized that that's what it was, you know, social anxiety, I just thought that was just me. [unclear 34:00] And I mean, it's not as bad as it was, I've grown a lot. But I had to force myself.

THERAPIST: Do you feel like being-that part of the anxiety comes from sort of having the anxiety-your dad's anxiety rub off on you, just being around someone who's so anxious? Or less so?

CLIENT: I don't know. I mean, my mother has social anxiety too. She says like with the-we just went to a wedding, she said, "I took a full Zoloft so I could go to this wedding." I'm like, okay. But she even around her family is so anxious. But she ends up having a good time, it's just like getting there. [35:00]

THERAPIST: I would think with both of your parents being like this it would be hard for them to motivate each other to get out. Like it's no wonder they get out.

CLIENT: My mother is the motivator, so. She knows she's anxious but she's-she knows that like it's worth it. You know, she likes to have a good time.

THERAPIST: Do you know what makes her so nervous about going out?

CLIENT: I would say she has a lot of insecurities. I mean, her family is kinda mean. There's just-you know, there's a lot there that I would understand. I mean, she's a little overweight, and... It's like she never has like a good outfit, or she doesn't really feel good about going out. She doesn't have like-she wouldn't get to get her hair done or something like that, she doesn't have the funds to do that. [36:00]

THERAPIST: Because your dad doesn't give her money?

CLIENT: No, none at all.

THERAPIST: But that's why she doesn't have the funds? I mean, is it that your parents don't have the money, or she doesn't have the money because your dad doesn't give it to her?

CLIENT: Yeah.

THERAPIST: I thought she works.

CLIENT: She does.

THERAPIST: But she doesn't make a lot of money.

CLIENT: No, she probably makes like twelve bucks an hour.

THERAPIST: What does she do?

CLIENT: She's a diet aid in like a nursing home. And like if she had it her way she would just go to part time, but he wants her to work full time.

THERAPIST: Do you know why she puts up with it? Him meaning.

CLIENT: I have no idea. I had had a conversation with my brother about this, he told me that she probably loves him for the man he is, not for who he isn't. You know.

THERAPIST: What did you take from that? That's interesting. [37:00]

CLIENT: That's what he told me to do. He's very loyal, he provides, you know, the house, the electricity, and all of that. You know, she doesn't have to worry about it, mom.

THERAPIST: But that's as if she's a tenant.

CLIENT: [unclear 37:22]

THERAPIST: Not quite, but it's-

CLIENT: I don't know if she-

THERAPIST: -that's certainly not sharing.

CLIENT: I think she is the one that needs to love somebody. That works for her. And he's cute with her, I mean, they're cute together. They have an odd relationship, but where it comes to like being neglected she doesn't like that. She would never leave him. Never. She prays that one day he'll change. I've heard this for my whole life.

THERAPIST: And how do you think she wants him to change?

CLIENT: It would be-I think she wants to be able to travel, for him to be a little generous. You know, just share. He's just-he had a hard upbringing too. He had a father that was like a volcano, you know. His father like had his own business, and that's all he cared about was his business.

THERAPIST: And not his son.

CLIENT: Right. And then his father cheated on his mother, and that broke his heart. And I don't think they ever had a good relationship, they were just not emotional people. So I think that's what he took from his family. So my mom brings the good out of him in a way. It's just he has some obsession about his money. It's very odd. Like his sister was dying and she asked for help and he did not help her. I don't know.

THERAPIST: What-like do you feel he doesn't care, or he's so anxious himself about not having money? Or he feels like he's going to be exploited, or...

CLIENT: Probably. Maybe it's a trust thing. That's what he said to me, he said, "I'm not going to help you with school, I've already helped you with school. Why should I give you money, you failed before."

THERAPIST: Quite cold.

CLIENT: I guess. I understand.

THERAPIST: Well, I don't know about the sentiment. The way you said it, the tone. [40:00]

CLIENT: That's how he said it to me. And I was like, "All right." Then I was like, "Well, what if I don't fail? And I pay for this myself and I struggle?" And he's like, "Then you did it for yourself, and that's good." I was like, "Okay." See, my mother goes around it by getting credit cards and hides that from him, and she'll help us, me and my brother, and she'll help me with school. But then she struggles to pay for her credit card.

THERAPIST: I was going to say, how does she get the money for the credit card then?

CLIENT: Because she has good credit.

THERAPIST: But I mean, I imagine she has to find the money to pay it, so-

CLIENT: She does, and that's what her little paycheck pays for, her credit card bills. And she like enjoys helping. So my hope then, it's like to get my degree, you know, get on my feet and help her pay off those credit cards. Because she helps me and my brother so much.

THERAPIST: Do you think your father knows?

CLIENT: About the credit cards? Yeah.

THERAPIST: I guess I didn't understand the credit card, because if she's paying off the credit card anyway she could just get her own account. I guess that's why I didn't understand the credit card piece.

CLIENT: Mm. She has money to spend, you know, with the credit card. And then she pays it off like in payments. So that's how she gets around it. And she said, "Well, if anything ever happens he would have to pay them." And he would if it was, you know, that extreme. He would be there for us if it was an extreme case.

THERAPIST: So is she in debt with them, or-

CLIENT: I would say so, yeah. Like she's not in like debt likeI'd say she's in like thirteen. But she's not any-nothing compared to college. So. [42:10]

THERAPIST: Is it something that your dad could pay off easily if he wanted to?

CLIENT: Oh yeah. Yeah, he has lots of money in the bank. And with no like will or anything. So it just sits there.

THERAPIST: It sounds like in some ways he doesn't appreciate that you guys are family. You know, it's almost like you're very separate from him.

CLIENT: Yeah. I don't get it. I don't think he knows how to be that person. Which is sad.

THERAPIST: Mm hm. It is for you guys and for him.

CLIENT: Yeah.

THERAPIST: He could get a lot of joy out of helping you guys out by-

CLIENT: But sometimes he's like impulsive and he'll like surprise you with-like I think it was one Christmas he like gave us all like 300 bucks, and that for him was-that was a surprise. And then it was the rule of the house that he would pay for the wedding, like if I got married he'll pay for my wedding. And he bought both my brother and me a new car when we were in high school. And he paid for school. That was the things that he would do. So it's just very odd. I mean, it's not like he doesn't, he just does it in his own way. [pause] It's interesting. I don't know. I just hope, you know, that one day like he'll be able to when he retires enjoy it with my mother. And maybe that's what he's waiting for.

THERAPIST: Marlene, we're going to need to stop for today, okay?

CLIENT: Okay.

THERAPIST: I'm glad the medication is working out so well for you.

CLIENT: Thank you.

THERAPIST: I'm glad about that.

CLIENT: I know. Like I didn't want to be teary-eyed, but-I think it helps when I'm not like crying throughout the whole session.

THERAPIST: It's okay to cry. I'll see you next week.

CLIENT: All right. What is next week? [unclear] [45:00]

THERAPIST: It's the 7th I think.

CLIENT: Okay.

THERAPIST: So okay, great. And you just want to push it, great.

CLIENT: Thank you.

THERAPIST: Sure.

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