TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Session four... Monday, the 21st of October, 2013. Hello Jessa.

CLIENT: Hi, how are you?

THERAPIST: Very well, thank you. So you said you had a question for me?

CLIENT: I do. So I guess I was wondering, I'm finding it very, very difficult with being in level ten pain at this point...

THERAPIST: Physical pain?

CLIENT: Physical, physical, yes exactly...It's very easy for me to do the A, the B, the C but I find myself in so much physical pain that it's actually very challenging for me to get, when I get to the disputing piece of it and the rational thoughts, I feel so physically in pain that I feel that's actually affecting me very negatively with my thoughts and I wonder if there's a...not a different way to do it but, if that makes sense, in other words it's just everything kind of seems a little life is just a lot more challenging right at this particular juncture because the pain is so extreme. [00:01:23] I'm just trying to get through each day, that's kind of how I feel at this point, to be completely and utterly honest.

THERAPIST: I do understand being in physical pain can make things seem much more difficult. I think that your continuing to go to work and do activity though you're in extreme pain at times is helpful to you , though difficult. If you took days off it would be understandable however, and I'm sure you wouldn't run out of all your savings and have to stop paying rent and then be evicted if you take some extra sick days off work but you're choosing to carry on and go to work and do everything that you put your mind to. I'm applauding your tenacity...

CLIENT: Thank you.

THERAPIST: And your resilience, so well done Jessa ! And I do empathize physical pain as you're experiencing can be an immense distraction from the things we do in life.

CLIENT: Right.

THERAPIST: What interests me about your question which I haven't yet answered is that despite being in the pain, you're telling me that it's not difficult for you to do the A, B, C.

CLIENT: (laughter)

THERAPIST: But doing the D and E steps, you find them difficult? How does the pain affect the doing of them?

CLIENT: Yeah it does...

THERAPIST: So why do you think the doing of the A, B, C is not affected by the physical pain?

CLIENT: Do you want to know my scientific answer?

THERAPIST: I want to know any answer you give me [00:03:02]

CLIENT: My scientific answer is because I feel when the brain sends signals when there's something wrong and then the body's not right in whatever way, whether you have the flu, whether you have a cold, whether you just had surgery or something else bigger going on, and so I think that when the brain is sending those types of signals, this is just jabber talking not anything that I've read or whatever, but I believe that when the brain is sending, when you're in a lot of physical pain and you're not feeling well and something feels off or not right physically that you're brain sends these signals where it's a little bit more challenging to get to a happy place or a positive place or a rational place because the signals can be so strong depending on the level of pain. I mean if you just get a little cut then no I don't think so, but if we're talking excruciating, which in my case it 100% is, I feel like it's a bigger challenge. I'm not saying it can't be done, I just feel the signals are a little off (chuckles), I'm a little off right now. [00:04:15] I just want to be able to...for me getting up and going to work is like, "You did it Jessa!" It's not like "let's have a happy moment!" I do have happy moments in the day with my kids and they can distract me but I'm more tired easily, there's a lot that goes along with the physical pain. That's kind of what I'm saying so I think I'm probably angry a lot of the time too just because I'm in pain so that's why I think A and B and all that is easier and then when I start to have to dispute it it's like I'm so frustrated with this pain and my frustration tolerance is lower, that's my analysis on it. I could be wrong and maybe it would be just as hard but I never applied REBT when I wasn't in this kind of pain, so I don't know how it would be. We're trying it for the first time and I'm just going through all of this, so it could've been a completely different experience but maybe it would have been the same, I don't know.

THERAPIST: It's interesting that you find it easier to do the B step than the D and the E. I don't find irrational beliefs. The A (activating event) is often quite easy for many people, as it is for you. In it you're simply describing what appears to have been the event that set the ball rolling on this journey which had the outcome of the particular disturbed emotion that you want to change. [00:05:50] So A is not a difficult step for many of us. For a lot of people it's also not too complicated much of the time to identify the B's and the resultant C (Consequences) specifically the unhealthy, negative emotions and any unhealthy resultant behaviors there as well. Especially for people new to REBT, which you say you are, doing the detective work of identifying the irrational beliefs can be challenging and yet you find that it is not too challenging which is terrific and I'm looking forward to hearing about your homework. I don't know of any scientific research that talks about the contribution of physical pain to the doing of the "D" disputing and "E" effective new philosophy parts of the process...

CLIENT: If I can mention your husband (Dr. Albert Ellis) in this situation. I know that he was in physical pain when he was younger...

THERAPIST: And throughout his whole life.

CLIENT: Throughout his entire life?

THERAPIST: He was a brittle diabetic.

CLIENT: All his life?

THERAPIST: It was diagnosed when he was forty but he probably had it earlier and he monitored his own blood sugar levels and was constantly pricking himself and testing his blood sugar levels even when he was working with clients, or during his seminars.

CLIENT: All because he had to.

THERAPIST: Because he had to. And having orange juice present to drink if the blood sugar was low and having insulin on hand which he would inject into his leg or arm if the level was too high...he was remarkable in the way he monitored and took care of his blood sugar levels and other aspects of his health. In his final decades he often suffered extreme pain from arthritis, and other health issues, But he bravely carried on doing his work regardless...it is do-able to choose to attend to physical ailments and challenges, as best as possible, and to continue to put in effort to do one's chosen work. Now back to your situation.

CLIENT: No that's, I love this kind of stuff because it's so interesting to hear from the person who....you don't know someone until you, even if he developed it, until you walk in someone else's shoes, it helps me a little bit to know there was some type of, that he wasn't completely healthy. [00:07:58] He lived to a ripe old age but he wasn't 100% healthy.

THERAPIST: Far from it, far from it.

CLIENT: I don't know why that inspires me even more to cope with my pain.

THERAPIST: Do you need to know why he inspires you? Be inspired ! ...

CLIENT: No I know he did a lot to inspire.

THERAPIST: Good. The fact of the matter is now you are suffering physical pain so...

CLIENT: I have been for a number of years.

THERAPIST: Yes.

CLIENT: This isn't.......this isn't new.

THERAPIST: So contemplating the capacity to cope of another human being who carried on despite and including being in a lot of physical pain at times, that can be helpful. Many people in pain might choose to catastrophize, especially perfectionists, they think they have to operate at a certain level and then can think "when I'm in pain I can't and that's awful, terrible" instead of disputing and eliminating that ridiculously high ideal, to think instead: "Well, I have this pain now, in all probability it's not forever, I'm doing what I can to alleviate and I choose not to let it stop me from doing much, if not all, of what I choose to do most of the time." [00:09:15] So let Albert Ellis be your model in that regard. With or without him as your model, you are doing very well in coping with, and being in, physical pain.

CLIENT: Thank you.

THERAPIST: Going back to what we were looking at earlier Interesting that you find the D and E more challenging than A, B and C, it partly may be the familiarity and practice with those 3 ...

CLIENT: Is that typical though? I just always like to know about when other people are new to REBT, is that a common thing to struggle with, the D and E? I guess I don't have to know ...

THERAPIST: Everyone is different. Others may take some time getting more comfortable, and others take to it very quickly, and so what ! Where you are at, and how you improve in areas in which you wish to become more proficient is the most important thing for you to consider isn't it?

CLIENT: (chuckles) Yeah that's true. I could care less at this point. I was more interested than anything else, whether REBT is seen just as a philosophy, not as if it's something that people just take to easily, so if you're asking the general population how it is for them "Oh this is easy!" but you can't do that because there's gonna be...everyone's different.

THERAPIST: Yes indeed.

CLIENT: I just answered my own question. (chuckles)

THERAPIST: Do you have any other questions before...?

CLIENT: No that was my main question because it has affected me a lot.

THERAPIST: I see it has been on your mind.

CLIENT: I've definitely been feeling...maybe now this is the time to do the REBT because there are definitely times where I'm in such bad pain that I'm going "This isn't working, this doesn't work..." it's frustrating just trying to get to that place.

THERAPIST: You frustrate yourself because you're telling yourself what? [00:11:08]

CLIENT: I'm in so much pain that no matter how I try to work on things the pain is still there. I talked about this, I hope it's okay but I spoke with one of my close friends and she said, by the way she's full of wisdom and has some chronic pain issues herself, and she said "Pain is hard, that's a tricky one," and I'm like, well I guess I said what I think, this was my answer, "Yeah, but I guess the way that REBT might try to flip it a little bit if you were doing true REBT is that the pain is there regardless, it's what can you do, what's your attitude gonna be because if it's there regardless and you're trying to work on, trying to figure it out and that takes some time, there's not always an easy answer, then what's your attitude going to be throughout when you're actually experiencing the pain?" It's there no matter what. I'm just saying that but...is that kind of what, does that seem the thinking behind it or...?

THERAPIST: The thinking behind REBT? You tell me. What is your answer to that question.

CLIENT: I think so, I think I'm getting it, I think that's what it is.

THERAPIST: In REBT we're encouraged to do what we can to change adverse circumstances, which you are working on doing right now, you have one doctor's opinion about your shoulder pain, you're getting a second opinion which I think is very wise from another doctor, and so it does encourage you to do what you can and ALSO in the meantime REBT encourages you to monitor your thoughts and your attitude so that you don't exacerbate an unfortunate situation by creating unhealthy emotions. [00:12:44]

CLIENT: Okay.

THERAPIST: So yes, I think what you said to your girlfriend is quite accurate.

CLIENT: She rarely gets quiet and she was like super quiet after I said that, she's like "I could see that." (chuckles). She was really quiet and I was like "Alright, now I just have to believe it myself but it sounds good".

THERAPIST: We've spoken about briefly, in one of your earlier sessions, nothing detailed and it's something we may look at more with a magnifying glass on another occasion, about what you shared with me about your tendency to perfectionism, and we've used the following words a few times: catastrophisizing, horribilizing, and awfulizing... I'm just wondering Jessa whether in the past week or longer you've observed yourself either noticing more when you are being perfectionistic and/or awfulizing, and if so whether you are noticing whether you do anything different at that point from what you used to? [00:13:59] Are you noticing yourself giving yourself even a little bit of permission not to be a hundred million percent perfect, as seemed to be your tendency?

CLIENT: Yes, I am, and I did notice all that. Actually there is a second question because I did notice that.

THERAPIST: Before your second question, please can you reflect on my questions to you, and answer more fully and give me examples? Let's keep focused on completing one thing at a time here.

CLIENT: Sure, sure. Okay so...

THERAPIST: Your mind, which is a highly intelligent mind, and please tell me if I'm wrong here: does your mind have the tendency to jump from this to that to this to that?

CLIENT: Yeah.

THERAPIST: It's something I've observed. (client laughter) At times I've got to drag you back in to stick with one thing before going onto the next, do you see that !, do you see the benefit in doing that?

CLIENT: Yes.

THERAPIST: I do it with two intentions. One is to get the answer to my question, which I think will serve you and the process we're doing very well, and secondly to help you to work on increasing your awareness of what you do to yourself, how you think helpfully and non-helpfully, in order that you can then be better able to have clearer choice about how you think and therefore what you feel : the emotion you create according to what you are telling yourself. [00:15:14]

CLIENT: Your telling me to slow down you mean, a little bit?

THERAPIST: When I recommend what I have just said the point is not necessarily 'slow down', though that could be helpful to you, but to encourage you to focus on and complete as possible one thing at a time. I'm not telling you, for instance, not to multitask in your life or to stop thinking about more than one thing at a time all the time. However when I ask you a question as I did a few minutes ago I'm likely to persist until I get an answer to that. And after doing that it is a better time to hear your question number two.

CLIENT: Gotcha.

THERAPIST: So now, do you remember my question?

CLIENT: Yeah, so how do I see myself, do I observe myself being catastrophic or perfectionistic? I definitely have observed that. The piano recitals are a perfect example. It really is. Before the recital, leading up to it and even during it, some of my close friends were like "My goodness, you look so serious like you couldn't even smile for one second," and then one of my close friends who was at the performance, she was like "Most performers smile," and I was like "I'm not a performer, I'm sorry, I'm not Fiona Apple, I'm not just gonna sit there at the piano, I don't do that as a full time job so it was more intense," but I said that as a cover, because really the truth is inside, in my head, I needed it to be perfect and if I did screw up in any way it was going to be very hard. I observe that in myself, everything was planned out, the songs, what was coming next, so if I messed up in any way I messed up but I just noticed that little frustration tolerance that if there were to be any errors in the music, especially because I have a very good ear and I could hear music and it bothers me, it actually annoys me to hear something sound off.

THERAPIST: You annoy yourself? [00:17:15]

CLIENT: (chuckles) I'm sorry. (laughter). So...(laughter) it's actually funny.

THERAPIST: Good, good. Humor gives a wonderful perspective to things much of the time.

CLIENT: I laugh a lot, that I have to say, no trouble laughing but that is funny. Yes I annoy myself when I hear music that doesn't sound totally in tune and so the thought of anyone hearing me play like a note or two that's off key, that it came from my piano, is like totally detrimental especially because it was for the PTA, it was my principal and she asked me to do this. What I noticed is that during the performance my principal walked over while I was actually playing and I seek approval and I seek, this was something I was always aware of but I think I was even more aware of, hyper-sensitive to or because of what we're doing with the REBT more aware than before of doing it and she walked over to me and she was like "You are amazing, you are so good," and someone else as I was playing, "This is so impressive." I need that, I fixate on that. So then I repeat it, such a reaction...

THERAPIST: Repeat what?

CLIENT: What they say.

THERAPIST: In your head?

CLIENT: Yeah. [00:18:40] If nobody said anything, let's say the performance happened and that did happen, a couple of people didn't say a word, people who know me and know that the performance was a huge thing for me, that I need them to say but then I obsess over the fact that they didn't say anything and I'll obsess over the fact that they...I'll do both. it's almost like I, what's that word I'm looking for, I ruminate over people's opinions and approval, all that kind of stuff so I don't know if that answers your question, but I was very much aware of that when I was performing as well because I was so nervous to get the whole thing perfect, the whole performance and that wasn't even possible because I was playing with my painful shoulder condition and my neck issue for 35 minutes, so it's almost impossible to be completely perfect as it without pain, let alone adding everything else that's going on. The scary thing is that it was pretty close to perfect because...

THERAPIST: That's very scary isn't it ... (exaggerating and dramatizing)

CLIENT: It is, because I tried so hard, that's what I'm saying, it's exhausting. I would rather just be relaxed, it would probably come out better and then people might even say "Oh you performed and you were smiling..." but I'm so intense sometimes about doing everything a certain way to get the approval but yeah I notice it then. [00:20:02] To be, you know, thought in high regard, that's like very important to me.

THERAPIST: Where is getting you to have this dire need for approval?

CLIENT: I mean the only thing I can say is I like it, when people give me praise.

THERAPIST: Liking it when people give you praise is very different from needing their approval. So my question is: where does it get you to have this dire need? I think it gets you somewhere...

CLIENT: Oh, I don't know.

THERAPIST: But where? Anywhere helpful?

CLIENT: Where do you think it gets me? I'm lost. I don't know myself. It gets me tired.

THERAPIST: You get yourself tired. You yourself use the word obsess. You yourself indicated that if, even if people didn't disapprove but they did or said nothing, you might have the tendency then to exaggerate that into inferring that they didn't approve or think you were good enough. It seems to me from what you say that by hanging on to this need for approval, which is different from liking it (and that's a healthy like) but needing it and then you don't get it...results in most cases in a whole different emotion than if you simply like or want it, then you don't get it.

CLIENT: Exactly. [00:21:40]

THERAPIST: One leads to anguish, the other simply to healthy disappointment. I wonder whether you're willing to make the effort to change that need into wanting or liking.

CLIENT: I am definitely willing to do that, but one of the things I was definitely aware of, can I give an example?

THERAPIST: Yes.

CLIENT: Okay, was yesterday, my parents actually came in to do...this is a good example for REBT, I didn't put it in my journal, they came in to the city to do a breast cancer walk with my cousin who had arranged the whole walk and so it was family, a lot of family was there and my closest friend also did the walk as well so it was her, myself and then my parents who met us. I think I mentioned in earlier sessions that I was criticized constantly when I was younger and it was pretty much non-stop, the criticisms in different ways and then they would throw in lots of praise. It was praise and then criticism and it was unpredictable and so yesterday I realized at this age that it's still happening and even though I don't live with my immediate family anymore, I'm on my own and I've been on my own, I'm still so affected by them.

THERAPIST: You allow yourself to be affected.

CLIENT: I allow myself, I do. I was very much aware of that, I allow it, yes. I am aware that I allow it. What happened was yesterday to be specific was that we were walking and the way that the breast cancer walk was, I don't know if you've ever done a walk before, like a big walk where it's for a big cause, there was, I don't even know, it was like thousands of people in the park, more than thousands I would say like maybe 20,000 people, it was loaded with people, it was a little overwhelming actually but what happened was we ended up starting off and because of everything that's been going on physically with me I did the walk because I wanted to participate and I wanted to challenge myself but at the same time...I also wanted to be a part of the whole thing but I also knew that it was probably going to be a little bit harder for me to just do it maybe the way the rest of the people were walking. There were probably breast cancer survivors, maybe they had trouble too, I don't know. For my own self I knew it was going to be hard and so my parents were walking ahead and what I noticed was that my friend was walking next to me, and she has pain as well, and we were walking together and what I noticed was that it started off for about two hours of just waiting for the walk to actually begin so we were just standing around which was annoying. I allowed myself to be annoyed and then it was also frustrating, that I allowed myself to get frustrated by, it takes longer to say...was the fact that when we started to walk we were walking in a pack with like everybody so basically walking so slowly which maybe on any given day wouldn't have been a big deal, but because I was in a lot of pain I was getting more frustrated. [00:24:53] I was feeling frustrated and I wanted to walk fast. Long story, the short version was that I said to my mom: "my friend and I are going to go walk separately, we're still going to participate but we're going to walk ...." ...and my mother "Do what you want! Do what you want! I signed up for this!" I said "What are you going to do?" because my father suffers from spinal stenosis and you could see him aching and pulling his leg and this and that, and I said "Maybe you want to walk off to the side with us, then we'll go a little faster?" She said "No! Do what you want. I signed up for this walk and I'm gonna continue with it!" I said "Okay," and I acted as though it didn't affect me or I didn't allow it to affect me, I acted in that way but really deep down I was torn up because the guilt that I put upon myself, I don't want to say that they put it on me but the reaction of now thinking I signed up for the walk too...

THERAPIST: Wait! What were you telling yourself to make yourself feel guilty when your mother did her "poor me'' performance? [00:25:57]

CLIENT: (chuckles) What was I telling myself? Oh boy, I didn't even think about this, it was a 'should'.

THERAPIST: You don't say? Jessa, come on now, tell me what you were thinking!

CLIENT: (inaudible) I like it but I hate it.

THERAPIST: What do you hate?

CLIENT: It's like I don't really...I hate when I don't know something that I didn't realize...

THERAPIST: You're learning now, that's why we're here.

CLIENT: Okay, alright.

THERAPIST: So you discovered what?

CLIENT: I said to myself: I should walk with everybody else. Everybody else signed up just like I did and nobody else, it's very general, is doing what I'm doing. They're all walking with the pack, my parents are too, just like they should. I recognize that.

THERAPIST: Dispute that right now!

CLIENT: This is where I have trouble, okay...

THERAPIST: Take your time.

CLIENT: (pause) I don't know. Maybe if you can help me out I can finish it but I just need a starting point.

THERAPIST: Start with: Why should I ........

CLIENT: Why should I walk with the rest of the group when I'm a little more incapacitated than I typically am, it's not as though I'm not participating, I'm just modifying the walk that I'm doing. [00:27:31]

THERAPIST: And you could add: "Where is it written that just because my mother wants to do it the prescribed way that I should?" Continue in that vein ...

CLIENT: Where is it written that just because my mother wants to do it the prescribed way that I have to go along with that?

THERAPIST: Ask and complete: "How does it make me awful to..."

CLIENT: How does it make me awful to (pause)...

THERAPIST: Awful here meaning worthy of guilt?

CLIENT: To participate in...to do it differently, to do something differently that's still a good cause and that I am passionate and excited about doing but not in the exact same way as how she would do it or how my father would do it. What works for them doesn't necessarily work for me, doesn't have to work for me.

THERAPIST: Even though I'd love to keep up, if I don't, it isn't awful is it ? Nor are you awful ...

CLIENT: The joke of it is we saw other people doing the exact same thing as me ....

THERAPIST: That aside, let us say no one else was doing the same as you were doing, do you not have the right to choose to do what's more comfortable for you in this instance?

CLIENT: This is where I struggle. [00:28:55]

THERAPIST: Is it?

CLIENT: You don't want to hear that (chuckles).

THERAPIST: I do want to hear whatever you want to tell me.

CLIENT: It's panicky for me.

THERAPIST: You create the panic by insisting one "should" or another. That's why we're doing what we're doing. Think about it.

CLIENT: I'm sorry.

THERAPIST: Still in the disputing phase let us continue: "Even though I would like my mother to empathize and support me, where is it written that I can't stand it and I'm shameful when she doesn't?" Elaborate on that disputing question ...

CLIENT: (pause) I really need more time with this.

THERAPIST: Take your time.

CLIENT: I'm not sure what to say because...I'm being, the thoughts in my head are not going to match up to...I can't....

THERAPIST: Focus on the task. We're disputing irrational thoughts that, when you think them, create your guilt. So what we're doing now is disputing them in order to come up with different beliefs that will not create guilt.

CLIENT: Gotcha. When you said to elaborate, elaborate on the walk piece or just my mother? What you said about, like where is it written that if I don't get my mother's approval...

THERAPIST: Continue looking at Even though it would be nice to have approval...[00:30:45] that not keeping up and getting it makes you shameful in some way...

CLIENT: It's not written anywhere. Unfortunately I'm a feelings oriented person so the feeling is a poor feeling but it's not written anywhere. In fact I'd like to be able to not be so affected and to allow myself to be less upset, I wish that I...I feel like I try, like I was thinking the entire walk and in fact we spent 15 minutes, my friend and I, talking about everything and she said the same things that you said. Not in the same language or jargon but it was basically the same, like you don't have to do this... Can I just say one little piece? In my head I was concerned, we were going for brunch afterward and I was concerned for how they were going to be after the walk, and it was, that's where I struggled because there was commentary, there was a lot of commentary about breaking off and walking separately.

THERAPIST: Wow, how unusual, right?!!! I'm being humorous.

CLIENT: Please do be humorous. because it was upsetting. I upset myself.

THERAPIST: You did because...

CLIENT: I reacted to it, and I thought of you and was like "Just laugh, just laugh," and I got so involved in it that I went back to how I get when I'm around them which is...

THERAPIST: How you allow yourself to get when you are around them, by needing to be approved of, by needing to fit in, by needing to be perfectly the good daughter...

CLIENT: Exactly.

THERAPIST: ....and by thinking you are needing perfect harmony, or else you're doing something wrong it seems to you. You are responsible for the creation of the emotion which is the good news because given that you create these emotions you can uncreate them when you notice they are unhealthy, and create new healthy ones. That's one of the things we're looking at with REBT, the how-to's of doing that.

CLIENT: There were many other comments that were made throughout the day by them to me, so I feel like it's a quick punch and you gotta keep up with it and that's why I felt it was a challenge because I felt like "Okay, we handled that one but let's wait for the next blow to the..." you know?

THERAPIST: So you were continuing to take their criticism seriously. [00:33:01]

CLIENT: Yes.

THERAPIST: It's up to you. You can continue to do that for the rest of your life. Do you want to?

CLIENT: No.

THERAPIST: So what's the solution?

CLIENT: Change my thoughts.

THERAPIST: Yes. Right. So when in real time you feel the guilt grip, you feel the emotion, remember the mantra I shared with you, "What am I, Jessa, telling myself to make myself feel this way?" You'll find a should, a must, an insistence somewhere, a need, an unhealthy need for their approval and so then you dispute such beliefs, then come up with healthy new thoughts, healthy new beliefs. Then to maintain relief, and healthy emotions, it takes ongoing awareness and application. That is why in the times we have together I leave you with homework, and when we stop doing sessions, I'm hoping you will continue to be watchful and aware, and catch yourself when you think in unhealthy ways, and take action in addition to contemplation. Also looking back to what we were looking at here, might it have been possible in the light of you being very familiar with your parents tendencies to criticize, to prepare yourself for their worst possible behavior with the conscious intention and determination to take it lightly if they did so?

CLIENT: Yes, I thought I did and that was the thing, I thought I had done that and...

THERAPIST: How? What did you think you did that would have helped?

CLIENT: I thought that before they had gotten there, they were running late and so I had about an hour (chuckles) to prep so I was thinking...I mean I guess I'm not as familiar yet still and I've been having some difficultly with the elaboration, the part...in my mind ....I was hopeful I was doing a good job with it, not a good job but that I was succeeding and effective in changing the thought. [00:35:14] I think where I do struggle is that the emotion takes over and so in my mind I was like, they were late, so they said "We'll be there soon," I said "Oh where are you?" and then I got yelled at so it was like "We'll be there in a second! Just relax!" or something and I said "Okay. That's fine," so once that conversation happened where I sort of lost it a little bit, this whole thing is that I then try to refocus myself to get back to it but I'm an emotional...I allow myself to be emotional. I'm sensitive, can I say I'm a sensitive person? Can I?

THERAPIST: You're very, very sensitive. That doesn't mean you can't train yourself to be very rigorous at monitoring your thinking with the awareness that you have been for many years in that habit of succumbing to "good little girly'' mode, and of succumbing to believing the criticisms and then instead of objectively assessing that some of their demands are really over the top, finding it easier to put yourself down instead.

CLIENT: Exactly. [00:36:43]

THERAPIST: With regard to this tendency of yours to think those irrational thoughts and then feel deeply upset if one of your students who you work with and counsel came to you and was doing the same or similar thing as you you would do your best to encourage them to change, wouldn't you?

CLIENT: Of course.

THERAPIST: So as I've probably asked before in similar or different language, are you willing to be as kind to yourself as you are very easily and authentically able to be with others?

CLIENT: Yes. I am willing to do that, but it's harder than I thought.

THERAPIST: So right now it might be harder than you thought. I suspect that when you started learning piano it wasn't as easy at first as you might have preferred it to be. Or is that a bad example?

CLIENT: It's a bad example.

THERAPIST: You're a prodigy, okay!

CLIENT: (Laughter) No I'm not a prodigy but I was always musical, that's not a...

THERAPIST: Do you get my point, the point I was attempting to present to you?

CLIENT: I do, I get it. I totally get it. There's a lot of things I didn't feel were easy but...

THERAPIST: So you persist and they become easier and in time the stinking, hurt, harmful habits of thinking are increasingly replaced with the healthy ones, and at the very least, prior to that change, you're more quickly aware that you're doing self-harm with irrational thinking, and you more quickly attend to it.

CLIENT: Right. [00:38:15]

THERAPIST: So, sounds like you gave yourself a really hard time.

CLIENT: Yesterday at the walk, yes, it was bad.

THERAPIST: So what could you do differently if it were to happen tomorrow, another such walk, and everyone who acted the way they acted yesterday, acted the same way, what could or would you do differently so that you didn't feel agitated, wrong, ashamed, guilty, and all that other stuff that robs you from experiencing more joy on a sunny Sunday afternoon in a beautiful city?

CLIENT: Exactly.

THERAPIST: Tell me what could you have done differently, and what you would do differently, with the circumstances being just the same?

CLIENT: Probably just...number one tell myself that what is, what works for both my mother and father doesn't necessarily work or have to work for me, that's number one. And number two, that I came here to participate and to contribute and however I'm gonna do that and however that works for me and whatever that looks like, at the end of the day is a contribution nonetheless and I'm here giving my time up at 7:30 on a Sunday morning to participate and to be helpful.

THERAPIST: Oh, so you're doing it to be helpful not to get mommy's and daddy's approval?

CLIENT: Actually I wasn't doing it for them to tell you the truth. I would have done that walk regardless.

THERAPIST: If you were more solidly aware of that yesterday, maybe you would have felt less guilty when your mother gave her caustic kinds of comments...is that becoming more clear to you?

CLIENT: That sounds like I am a martyr, that's a negative thought. [00:40:28] Can I compliment myself and say that I'm not a martyr?

THERAPIST: I would love to hear you compliment yourself.

CLIENT: Alright, I'm not a martyr. If I'm in pain and I'm uncomfortable with something I'm not just going to stand in a line or herd of people and continue to be in pain and hold my side and ache and complain to everybody around me, I'm going to do something about it. I'm going to get out of line and walk.

THERAPIST: How refreshing to hear you say that?

CLIENT: Which is what I did.

THERAPIST: It would be nice if you would do that without creating guilt.

CLIENT: Right, exactly. That's funny I just looked down at my journal here, and I don't even know what or why this is, but the word "guilt" is there with an exclamation point. Right, and then also kind of just pre-empting, knowing that we were going to go to brunch, maybe to say: "Oh they can be so ridiculous with their little ways but that's just them". Just letting that go and almost being able to look back at it and almost laugh at the silliness of how ridiculous it is that I completed a walk, I got to the finish line, I walked five miles. Who cares if I walked on the hill, if I walked...

THERAPIST: On water?

CLIENT: (chuckles) If I took a bus, I don't care how I got there. The fact is that I crossed the finish line and that's the bottom line and however they decided to get there in their neurotic, ridiculous way is up to them but I chose to do it differently. [00:41:55] I'm not going to lose them as my parents just because I didn't do exactly what...I think that's the ultimate fear.

THERAPIST: Like it or not, forever they are your biological parents.

CLIENT: Exactly. I guess I have this fear of disownment if I don't do exactly what they want me to do and they're not just (inaudible), they need me probably even more than I need them in a lot of ways. I don't want to say that, I'm just saying in other words I'm constantly at their...

THERAPIST: Because you put yourself in that position, do you not?

CLIENT: I do.

THERAPIST: And you have choices. I think it could be very helpful to look at the sentence that you just spoke about your fear of disownment (pause). Even though you just said to me "Oh but it's not gonna happen, they need me more than I need them", nonetheless you've admitted the fear that you said you've held and may still hold. So may I ask you Jessa, now imagine a worst case scenario: you're living your life, you're not abusing anyone, you're not murdering anyone, you're not raping anyone, you're not bullying anyone, you're choosing to do what you as a young adult woman choose to do and imagine now, that you are doing some of the things which they disapprove of...

CLIENT: Okay.

THERAPIST: And they disown you and say: "I don't want to see you again Jessa, I don't want to hear from you, you're out of our will..."

CLIENT: (laughter) You're joking, okay. (laughter)

THERAPIST: Imagine this worst case scenario, Jessa, and that it happens. [00:43:57] It wouldn't be pleasant but could you really not stand it? (pause)

CLIENT: I don't know, it hasn't happened.

THERAPIST: Think about it. You're choosing to live your life, you're an adult woman, you don't need them to put food in your mouth or wipe your bum anymore.

CLIENT: Right.

THERAPIST: Right? You are able to take care of yourself, you're no longer an infant. Okay? For most humans it's preferable to feel loved and approved of by parents and unfortunately for many humans it doesn't quite happen as much as they would like it to happen. I'm suggesting we just explore worst case scenario of the fear that you've been holding even though at the same time you share that fear with me you say that it's not going to happen! You fear something that you think is not going to happen!

CLIENT: Right.

THERAPIST: Let's just run with that, let's look at that fear. So let's say that worst case scenario happened, and it seems to me that the fear of it happening may even, on an unconscious level, influence your ways of thinking.

CLIENT: Yeah.

THERAPIST: So let's say that happens, first of all, will the earth explode and the world come to an end?

CLIENT: No.

THERAPIST: Will you explode and die?

CLIENT: No.

THERAPIST: Would it be, though certainly not pleasant, but would it be the worst thing in your world and could you never be happy again?

CLIENT: No.

THERAPIST: You say that to me clearly and with conviction and I want to believe you. [00:45:41] Do you believe you?

CLIENT: No. (laughter)

THERAPIST: Can you explain...did you just tell me the answers you thought I wanted to hear?

CLIENT: No, when you asked me if I believed it, I guess, because when you asked me if believe me I said, when I actually thought about it it felt, you know, I guess it's hard for me to think about something that hasn't actually come to be.

THERAPIST: You can extrapolate in your mind, can you not? You seem to do that often.

CLIENT: Yes. I do, but I guess it's something I didn't really want to think about as a possibility, do you know what I mean? But maybe I should.

THERAPIST: There's no should. It could be very beneficial, because hanging on to that fear increases the likelihood in all probability that you will act in submissive ways and feel guilty if you don't.

CLIENT: That's true.

THERAPIST: That's why I am encouraging you to look at it.

CLIENT: Okay.

THERAPIST: Not to torture you. There's just a little bit of that !(said jokingly).

CLIENT: Okay.

THERAPIST: I'm joking, it's not my goal to torture, it's my goal to help you empower yourself!

CLIENT: Yes.

THERAPIST: By seeing what you're doing that hurts you and therefore with awareness, to catch yourself and work on changing that.

CLIENT: I think the illusion I held over the years was their transmitting you must need us, you must come to us, you must bow down...

THERAPIST: You're still wanting to be submissive?

CLIENT: No!

THERAPIST: So ...

CLIENT: No, I get it, I get it rationally.

THERAPIST: That's a good start.

CLIENT: I do get it rationally, I'm just...I'm always submissive, I submit to my own feeling. If I get a feeling of panic or anxiety I submit to that as opposed to disputing it.

THERAPIST: Isn't that why we're having sessions?

CLIENT: Yes! (laughter) [00:47:25] I'm so happy we are.

THERAPIST: So Jessa, I think it would be helpful if you were tougher with yourself in self-protection and proactive in thinking healthy thoughts, and I'm going to keep encouraging you to do that.

CLIENT: Okay. This is all new for me so I think...

THERAPIST: Congratulations it is new. So was walking once upon a time new to you. (laughter from client). You learned to walk and now you don't need your parents to walk with you, and you can learn to approve of yourself without having your parents approval because from what you tell me it's unlikely that they will approve of all you do all of the time. They may approve of some things but it's unlikely they'll approve of everything that you choose.

CLIENT: No, they don't approve of much.

THERAPIST: Demanding that they change it's a waste of energy.

CLIENT: Right, it's a waste, it's a waste of energy.

THERAPIST: So what are you going to do about that?

CLIENT: REBT.

THERAPIST: Specifically.

CLIENT: Specifically?

THERAPIST: Let's take the example of your feeling guilt. Mom's criticized you. You're feeling guilty, what are you going to do?

CLIENT: Dispute it.

THERAPIST: Dispute what?

CLIENT: Dispute the guilty feeling and don't allow...

THERAPIST: You don't dispute a guilty feeling, what do you dispute?

CLIENT: Dispute the thoughts that I'm having. [00:48:59]

THERAPIST: Yes. You dispute the thoughts that are creating your guilty feeling.

CLIENT: Creating the guilt, okay. I get it. Also maybe try to look at different angles of the situation rather than...

THERAPIST: Keep it simple, dispute the b.s. the thoughts that have no logical basis, no basis in reality and have no evidence supporting them.

CLIENT: Okay (laughs).

THERAPIST: Then come up with healthy new beliefs about that situation. Then using these healthy new understandings as affirmations, you might want to think of it as healthy training or healthy brainwashing, and every day after having written them down, and have the list of them by your bed, have them in your purse, anywhere else, and read them throughout the day to put these healthy thoughts such as "I don't need the approval of my parents even if I like it". "I have the right to take care of myself whether or not they agree with my choices" ... that kind of thing. You've said a few times tonight "It's new, it's new, it's new," and it will get less new the more often you take action and do it.

CLIENT: Of course and I understand that. I just think that you don't realize how you speak to yourself...

THERAPIST: You haven't realized how much you...

CLIENT: No I haven't and it's all about taking the control, not the control but the empowering piece you described I don't think I've really ever empowered myself which...

THERAPIST: What a useful recognition to have isn't it? Then you can change it.

CLIENT: No, it's...I feel upset about that.

THERAPIST: What do you mean by upset? [00:50:42]

CLIENT: Because...well upset meaning that I just feel like maybe some things were, you know, like a waste.

THERAPIST: But here we are here right now. You can begin to think and act differently. What are you going to do about it and prevent it from continuing? Can you change the past? No!

CLIENT: No I'm saying there's nothing I can do about the past.

THERAPIST: About the past, right can't change that but you have many years ahead of you, is my hunch. (laughter from client) And how exciting to know that you can create something magnificent every day in the many years to come..

CLIENT: That's true.

THERAPIST: From now onwards. Even when you have pain in your shoulder.

CLIENT: Well that I'd like to minimize.

THERAPIST: You're working on that.

CLIENT: Yes, exactly.

THERAPIST: You're working on that.

CLIENT: Thank you.

THERAPIST: You're very welcome. I haven't forgotten that you told me you had a second question.

CLIENT: Oh my god!

THERAPIST: (laughter) If you can't remember what it was, don't worry about it. We've just been a little bit free flowing, using what happened yesterday and your parents' attitude as kind of the basis for exploration and identifying some strong irrational beliefs. Also you told me you're not very familiar with disputing so I've been helping you with that. and you've been doing quite well yourself and so what we haven't yet gotten to in this kind of free flowing session today, can be part of your homework.

CLIENT: On the specific issue?

THERAPIST: On what happened yesterday. Do the ABC and D and E's of it!

CLIENT: Okay.

THERAPIST: But while we're somewhat free flowing in this session, and because we've only got a few more minutes of this session, I want to give a sense of completion to the dance we've been dancing.

CLIENT: Sure.

THERAPIST: Number one, number two. Number one, are there any additional disputes in addition to the ones we already did to irrational beliefs about needing your parents' approval and the others that we talked about? And question number two, effective new philosophies, I want to hear them from you. [00:53:15]

CLIENT: Okay.

THERAPIST: So number one, any more disputing or do you feel we've covered most of them?

CLIENT: No I think we definitely covered most of the disputing.

THERAPIST: Number 2, effective new philosophies?

CLIENT: I'm doing the sheet....that, okay so...this I find easier for whatever reason.

THERAPIST: Hooray you find it easier but I haven't heard what you find easier yet! Carry on! (laughter)

CLIENT: We'll use my parents as an example, that there are going to be situations, a few if not many, if not most situations, that my wonderful and beloved parents are not going to approve of or agree with, and that I can stand it and that I will survive and that I'm not going to blow up or explode just based on the fact that they don't agree and in fact, actually I'm going to extrapolate even more, I think that what I upset myself more with rather than that is the fact, the guilt feelings and all of that, that I think is more detrimental than...

THERAPIST: Tell me Effective new philosophies to prevent guilt.

CLIENT: Okay, sorry. Effective new philosophy to prevent guilt...that I'm not doing anything terrible, I'm not hurting anybody, I'm only helping people, that's what I do for my job, that's what I do with my friends, I care about people around me so if there's something to feel guilty about it shouldn't be...I'm sorry...help me ....

THERAPIST: You could think I do my best to care for others, to do the right thing and if I, Jessa, as a fallible human unintentionally or even intentionally make a mistake, say a sensitive thing...

CLIENT: I'm human.

THERAPIST: I'm a fallible human, humans make mistakes, I still have worth even if I screw up occasionally.

CLIENT: Okay I like that one. [00:55:36]

THERAPIST: I accept myself, I choose to accept myself unconditionally as a fallible, yet worthwhile, human being.

CLIENT: I know we have to end but can I get the pen?

THERAPIST: Yes, you can get the pen.

CLIENT: It's helpful to write it down and to reflect. Just that last part about the unconditional, I liked that last part that if I...

THERAPIST: Even if I intentionally or unintentionally screw up, make a mistake, say the 'wrong' thing I choose to unconditionally accept myself as a fallible, worthwhile human being who sometimes may make mistakes. (pause)

CLIENT: As a fallible...(writing notes)

THERAPIST: Worthwhile, both. Fallible, we make mistakes, worthwhile, you have worth just because you're alive, whether you do brilliantly or you do really poorly, you have an equal worth as a human being. [00:57:01] (pause) Just because you are alive.

CLIENT: I think this is the...

THERAPIST: One of...

CLIENT: If there's themes in people's lives, this is thematic for me.

THERAPIST: One of the big things for you.

CLIENT: The biggest. (over talking)

THERAPIST: There's many more.

CLIENT: This is a big one.

THERAPIST: Yes, it is. It's very significant and really terrific that you're open to recognizing...

CLIENT: I have to be open if I want to live my life...

THERAPIST: You don't have to be.

CLIENT: I don't have to be...I have a choice.

THERAPIST: Right. Contingent on your choice to live a happier life.

CLIENT: I'd like to live a happier life.

THERAPIST: Exactly, it's a healthy want. I encourage it. (laughter from client) Unconditional acceptance. Are there additional effective new philosophies that you can think of now?

CLIENT: Let me try to do one last one on my own and then I know we have to wrap up. What was the example, oh with the physical pain, let me try one with that.

THERAPIST: Stick with the situation.

CLIENT: Stick with the situation? Oh, okay. Well there was the guilt, still accepting myself as a worthwhile human being despite how my parents may or may not respond to me and then...what else?

THERAPIST: How about, "I can stand what I don't like. I just don't like it." That's very good for increasing...

CLIENT: Were you ever on TV?

THERAPIST: Tolerance...

CLIENT: No, were you really?

THERAPIST: Why do you ask that?

CLIENT: Because one time there was a show where the host had like a priest and he was doing things like this...

THERAPIST: Do I look like a priest?

CLIENT: (laughter) No, nothing like that! But he was using things like this, he just sat there with a pen and she went "Oh my god! Oh my god!" like every time he would do a different one she's like "Let me get that down, let me get that down!"

THERAPIST: I don't think I...

CLIENT: I think that thought is highly effective. "I can stand what I don't like. I don't have to like it"

THERAPIST: "I just don't like it."

CLIENT: "I just don't like it."

THERAPIST: That's a good preventative against catastrophizing.

CLIENT: That's good, that's a really helpful one for my physical...

THERAPIST: You don't say?!!!

CLIENT: I think that one I've actually used myself with the resilience I've had over the past six months. I stood it.

THERAPIST: So there's your evidence.

CLIENT: I do, I don't like my situation, but I'm standing it.

THERAPIST: It's healthy not to like it. It wouldn't be very functional to like it really.

CLIENT: (laughter)

THERAPIST: So Jessa, given the effective new philosophies we've just come up with, if you did integrate them more in your attitudes and philosophy, honestly do you think you would create the guilt and frustration like that which you felt yesterday?

CLIENT: No, absolutely not. [01:00:28] Absolutely not. Hindsight is 20/20 because I did not know this yesterday. I think the more we meet, I know I have homework and I have to be...

THERAPIST: The more we meet and the more you do your homework...

CLIENT: That's what I said, yeah. I did say that, I said "And the homework."

THERAPIST: Oh and the homework.

CLIENT: Yes, I said the more we meet and the more I do my homework.

THERAPIST: Your effort.

CLIENT: My effort is...

THERAPIST: To reinforce.

CLIENT: Absolutely.

THERAPIST: Okay, so...

CLIENT: What I'm saying is that it's finally starting to come together. I don't really know if I got it as much before. You can do homework, if a teacher gives you homework, but if you're not getting the concept then you can sit there and do the homework but then you need to go over extra help so this is my extra help because now I get it.

THERAPIST: Last week the homework was...

CLIENT: You wanted me to do a bunch of those ABC's. Which I did.

THERAPIST: Which you did up until the D?

CLIENT: No I did the D.

THERAPIST: The week before.

CLIENT: Oh the week before?

THERAPIST: Remember you told me in the past, and even tonight, you said that you get stuck with the D and E, that for you it's not as easy to do them.

CLIENT: I did them, I just wasn't...sure ....

THERAPIST: Being aware of what's more difficult for you is very useful and thenlooking at how or why you make it more difficult for yourself, and then despite and including that, making more effort can help tremendously. You are making effort but it seems to me in our session just now you've had some newer realizations that can be very helpful.

CLIENT: I did, I had a lot, yeah.

THERAPIST: And now it's up to you to maintain your remembrance of that. [01:02:07]

CLIENT: Okay.

THERAPIST: Now are you feeling any different now? When I say feeling I'm talking about the emotion?

CLIENT: I am.

THERAPIST: How do you feel differently from what you felt fifty minutes ago?

CLIENT: Oh my god! Ten times different.

THERAPIST: Why do you think that is?

CLIENT: Because I feel empowered and I feel like I don't have to succumb to things and events and incidents and people and responses and things around me, that I can change, I don't have to love it but I can stand it and I'm not going to die and I'll just figure out in my own mind maybe how to look at it more rationally and calmly instead of catastrophizing about whatever it is that's happening. There's always going to be an incident, I mean you can't stay in bed all day and not deal with life

THERAPIST: There will still be an incident?

CLIENT: There will still be an incident. That's true. (laughter) But if I don't want to look at it or stay in dream land then it's, I have that choice.

THERAPIST: So now you feel...give me a word for the emotion you feel now?

CLIENT: Calmer.

THERAPIST: A calmer form of what?

CLIENT: Less guilty than I felt.

THERAPIST: Less guilty or not guilty?

CLIENT: Less, I'm not going to say not. I'm not going to say not because that wouldn't be totally accurate.

THERAPIST: So you feel different, there's positive change right... so there's change because you're thinking about it differently is the bottom line.

CLIENT: Yes.

THERAPIST: Well done. The proof is in the pudding, right, and the pudding is you right now... You've proven to yourself that by thinking differently, you can change your feelings.

CLIENT: Yes.

THERAPIST: I'll suggest homework now, and see if you agree. I don't say with bossiness: "This is what you will do". I want to hear if you agree if my suggestions seem appropriate to you, but first do you have any comments or questions before we choose your homework?

CLIENT: NO. Isn't that amazing?

THERAPIST: Well done.

CLIENT: No questions.

THERAPIST: So your homework is...

CLIENT: Hold on. (pause) Okay.

THERAPIST: What do you think would be useful homework?

CLIENT: Instead of jumping around and looking a bunch of different activating events, taking that one event that occurred yesterday since it represents, it's a very good representation, it has a lot in it, to just take that one and just go with writing down on my own, without you here guiding me, to take that day and really relive it and do a bunch of A, B, C, D, E's with that whole day, from the morning with getting there and disputing every...there was so much, so much, I didn't give you the whole...my brain and everything that went through it from...

THERAPIST: Perhaps we will look at the other things next week.

CLIENT: Yeah we'll do it next week but is that alright for homework ABCDEs on yesterday?

THERAPIST: Yes, I think that's a good idea. Write it down and go all the way.

CLIENT: Breast cancer walks will never be the same! Oh my god!

THERAPIST: Perhaps next year your mother might be as much or even more critical to give you an opportunity to see how far you've come in not letting yourself feel guilty let's hope she gives you the chance! (Laughter). It may not be as far as next year, it might be another situation, that let's you practice what you are learning.

CLIENT: Maybe later tonight when we speak on the phone.

THERAPIST: It may be.

CLIENT: Okay.

THERAPIST: Okay, so write your homework down and go all the way when doing it meaning the Disputes and Effective new philosophies, and if the thought comes up "Oh this is hard, this is challenging, my shoulder hurts," -acknowledge that and do the homework anyway.

CLIENT: Okay.

THERAPIST: Do-able?

CLIENT: Do-able. Totally do-able.

THERAPIST: In addition to that what I invite you to do, tonight if you can at some point and it will just take a few minutes, is to write down at least two of the E's that we came up with that you appeared to love. "I can stand what I don't like, I just don't like it. I'm a fallible, yet worthwhile human," You could design a pretty looking page of these effective new philosophies that really seems like a balm to your oversensitivity when you look at it. I encourage you to see them as mantras, affirmations, whatever you want to call it.

CLIENT: Okay.

THERAPIST: To reflect on them at night before you go to sleep, in the morning, through the day, maybe put them on your desk.

CLIENT: It's good for my students too.

THERAPIST: You don't say? (laughter) Really so many humans would benefit if students as children got these lessons. I'm very confident as you continue to progress you'll be sharing certain things...

CLIENT: About the kids.

THERAPIST: With them.

CLIENT: I've done it already, I've been doing it already.

THERAPIST: I have no doubt, helping them even more than the work you already have been doing.

CLIENT: Okay sounds good.

THERAPIST: So you have two forms of homework.

CLIENT: Okay.

THERAPIST: Well done! Well done!

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