TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: This is session number nine with Jessa on Thursday December 5, 2013.

THERAPIST: Hi! Jessa, how are you doing?

CLIENT: Hi Debbie, good how are you?

THERAPIST: Good. Before I ask you about your homework and anything else, I just want to mention something in relation to a confusion you’ve shared you feel, something you are confused about that you brought up last session but also during previous times we have talked. You have expressed that you’re not sure about the difference between a feeling and a thought. (Jessa agrees) That is at times you say “I’m think that …” and other times you say “I feel that …”, because it’s a common use of our language to say “It feels to me that …”.

CLIENT: Yes, exactly.

THERAPIST: Generally speaking, using the word feeling refers to emotions like anger, shame, guilt, fury, what’s another hot one on your list? Oh yes, anxiety.

CLIENT: How do you say that in a sentence? My emotion is… I don’t know.

THERAPIST: “I feel angry” and so forth. But when describing your contemplations – “I think that his means …”, instead of “I feel that it means…”.

CLIENT: Oh I see, ok.

THERAPIST: So let’s see if we can clarify that as we go along. [00:02:24]

CLIENT: Ok.

THERAPIST: In general, the words emotion and feeling can be interchangeable but if you’re confusing yourself about is this a feeling/emotion I’m having or just a thought – remember “I feel...” refers to emotions. Incidentally, when I say “just a thought” I don’t mean that thoughts are any less significant. Not at all. (Jessa says yes, agrees in background).

CLIENT: It does clarify a little but not really. Because I’m thinking about like what about when people say, not when people say, but when I have more of a gut instinct, what’s a gut instinct vs. a thought? I don’t even know necessarily that there is, I mean there could be a thought like, “hmm that’s not a good idea, don’t do that, and don’t go there”. That might be the thought that you have, but yet sometimes there’s something in your actual gut It’s like a guttural response that you don’t even think about, and I feel like I have a lot of those. I feel, that’s where I get into some trouble because, I feel like or I think that ….

THERAPIST: “I think”.

CLIENT: I “think” yeah, I caught it!

CLIENT: I think in a way that I tend to run with my emotions as opposed to thinking, and then reacting. And so that is why I think I get confused about sometimes, when you’ll say, “sit down”, I think the reason why the homework is difficult is because sometimes I don’t even necessarily know what I’m thinking/feeling. For me, it’s probably more thinking because the feeling part would come thereafter. You could probably be a little clearer on what you were feeling if you knew what you were thinking. [00:04:04]

Now I’m confusing myself. In other words, I think that sometimes I’m doing things throughout the day and I’m not really thinking, the thought, it’s probably subconscious so I can’t really get it out to know exactly what the (in the back ground she says something inaudible) [00:04:27]

Now I just lost my train of thought? Oh! That at times I’ll have a thought throughout the day, I’ll have a feeling throughout the day but it’s hard for me to stop and even know what the thinking is behind it. So, and then that’s the other thing, that sometimes there’s many, many, many thoughts, and I think that’s where it gets difficult because you’ll say well “what is it that your thinking?” but there’s like 16, 17 maybe even 100 thoughts that go at one point. So that’s why it’s hard to always know and I don’t know if you have any advice for that?

THERAPIST: Well, my advice is careful that you don’t get hung up with the need for certainty. Careful that you don’t think that I need to know exactly and perfectly: “what is IT that I’m thinking that is creating this, or what are the 7 thoughts I am thinking that are creating this emotion?” As if there is a certain right answer.

CLIENT: Oh.

THERAPIST: At times when you experience an intense emotion, and it’s not clear exactly what you are thinking, in all likelihood you still will be able to identify that you are on your way to creating panic, that you feel anxiety.

CLIENT: Exactly, exactly.

THERAPIST: Then what I recommend you do is to hypothesize…

CLIENT: About?

THERAPIST: Think to yourself something like: “In all probability, I’m telling myself, my mother shouldn’t treat me like an imbecile” or any other probable “shoulds” that you are thinking. Even though specific thoughts aren’t clearly identifiable by you, as related to your “panic”, you can usefully hypothesize.

CLIENT: Exactly, ok, I see what you mean. Have fun with it I guess, right? [00:06:23]

THERAPIST: Well if you can have fun, have fun. The important thing is to identify the probable irrational ideas.

CLIENT: I’ve had some fun with some of the identifying. [00:06:28]

THERAPIST: Well that’s great! Very good!

CLIENT: Even with the homework, I was like oh boy, here we go and the “should’s” and yeah.

THERAPIST: Good, very good.

THERAPIST: Good because your saying that you had fun indicates that you might be taking it less seriously, which we’ve discussed and if that is so could be very helpful.

CLIENT: I see good positive results.

THERAPIST: I’m looking forward to hearing about those positive results. I’ve observed some also. I want to hear what your experience is, but first does our conversation so far today clarify the confusion somewhat for you? Don’t expect any “perfect” thought matched with your emotion when you are looking for the irrational beliefs, just do the best you can.

CLIENT: The best you can, yeah.

THERAPIST: And a word that might be good for you to use more frequently is “imperfectly”.

CLIENT: Imperfectly

THERAPIST: You don’t have to do anything perfectly, whatever that is.

CLIENT: Right, right.

THERAPIST: Enough to be useful is sometimes enough.

CLIENT: Exactly.

THERAPIST: Enough to be useful.

CLIENT: I think it’s interesting because I think the more that I do these sessions with you, I just don’t think I realized how hard I was or am, am, not was, because I still do it; on myself. I don’t think it even ever occurred to me consciously maybe I knew it on some level but I don’t think you realize it until you break down the thought or demystify what the actual thought is and that you don’t have to have that thought, like it’s empowering to realize that ok, you don’t actually have to have that thought. [00:07:50]

THERAPIST: And also that the thought that you’ve held for decades may not have any truth to it – which you can only discover by thinking about that thought !...

CLIENT: Well that’s the other piece to. That it might not actually be true. My belief though always before, was that sometimes you’ll have a thought but it could be a cover up for another thought. I don’t know if that makes any sense, but to me it does. Because I think that there are thoughts that we don’t always want to look at. It’s like what’s the underlying thing behind the thought that you think that you’re upset about or you’re upsetting yourself with.

THERAPIST: That’s more useful language. And hence the benefit of taking time regularly when you’re experiencing unhealthy emotions to sit and contemplate and preferably in the early stages, write down the answers to – “What am I telling myself, thinking that is, to make myself feel the emotion I want to change?”.

CLIENT: Before I get, I thought you were going to say before it gets really bad.

THERAPIST: Well, certainly before the unhealthy emotion escalates. [00:08:46]

CLIENT: I’ve used a lot of this stuff in my sessions but I used the horse example the other day.

THERAPIST: Ah.

CLIENT: The horse is running free.

THERAPIST: Which sessions, with your students?

CLIENT: Yeah, yeah I used what you said.

THERAPIST: Good!

CLIENT: I compared it to the horses running free

THERAPIST: And wild!

CLIENT: And wild! Yeah.

THERAPIST: Yes.

CLIENT: Anyway, I don’t want to go off on a tangent.

THERAPIST: Alright, no that’s fine. So, does that help a little bit?

CLIENT: A little bit, yeah. I think I’m always gonna have my curiosity.

THERAPIST: Curiousity is fine, healthy, as long as it doesn’t become obsessive and unproductive. Just watch your language when you think, and when you’re saying “it “feels” to me like…” – change it to “ I think that…”

CLIENT: Yeah.

THERAPIST: And regarding the question that you asked a few minutes ago, about having a gut feeling and you asked – “What do I call that?”

CLIENT: Oh yeah, right.

THERAPIST: Call it a gut feeling! What do you call your gut instinct? Call it your gut instinct!

CLIENT :(Laughter) I get it. [00:09:37]

THERAPIST: And, can you not distinguish between gut instinct and anxiety?

CLIENT: Those are two different things.

THERAPIST: Are they not?

CLIENT: No, they are yeah.

THERAPIST: Gut instinct and panic?

CLIENT: Yeah.

THERAPIST: Gut instinct can at best inform you. It may be accurate, it may not, but it can be perceived as offering information. It need not be disabling. Anxiety and panic are crippling at worst.

CLIENT: Um, Yeah!

THERAPIST: And even when anxiety is feeling less extreme, it doesn’t contribute anything positive really – does it? I mean one can say there is healthy fear, such as one can feel if there’s a poisonous snake nearby, and there’s a certain amount of fear, although in our REBT approach’s [00:10:24] terms, concern would be the most helpful experience to have emotionally because with concern you’re still alert, your adrenaline runs, you are more likely to take effective action but you’re not going to be paralyzed as panic can allow.

CLIENT: Right, right, right.

THERAPIST: You THEN, feeling healthy concern, can still be motivated to move your ass! Get out of the snake’s line! Whereas if you experience fear or panic some people just freeze and the snake might say : “ Hello dinner”!

CLIENT: Right! Exactly!

THERAPIST: You see?

CLIENT: It’s very; I just have to share my feeling, oops, I mean, my opinion, not my feeling.

THERAPIST: Ah! See you caught yourself! Good!

CLIENT: I know, I know, but it’s -I’m not used to it so.

THERAPIST: No you’re not, and you often say that. It is accurate – you are not used to thinking in this way. So expect, without judging it as bad, to not to be used to it. Till – after some time – you may become used to it.

CLIENT: But it’s like I’m trying right now, really hard to like say the right thing.

THERAPIST: Careful about “right” – about NEEDING to say the right thing. Better try to say the beneficial thing for your process and development. [00:11:18]

CLIENT: Ok, right, so the beneficial thing, cause it’s yours but it’s not my feeling but I think that just as the brain is so complex this is really multi layered REBT, only because, I’m thinking about what you just said, but then I’m thinking about at the same time, I’m thinking that the need for approval that people have, and then I’m thinking – well wait, if you think about the need for approval, in other words there are so many thoughts right? So then if somebody has a need for approval, then you go back and then you reflect well, wait, it’s a “should” and then it goes back to a “should” but then it could be something else. So it’s like, just life and then REBT, I’m not making sense but I’m making sense in my own head. (laughs) In other words, I feel like, how do I explain it all, it’s complex, I don’t think it’s as simple as, I don’t really think it’s simple at all, basically.

THERAPIST: I think of it differently. I…

CLIENT: Yes, please share it with me. I want to be able to see it in a different way.

THERAPIST: You have told me that you are experiencing benefits when you watch your thoughts, and catch the unhelpful ones so you can change them. You said you feel you are benefitting and that’s the proof the proof is in the pudding as they say.

CLIENT: That’s true.

THERAPIST: We have a semantics thing going on here, but I feel that the REBT approach can be described as simple, because you don’t need to have a massive intellect to understand how to apply the tools, do you?

CLIENT: I guess not, I don’t know (quietly)

THERAPIST: It seems to me that you’ve comprehended the difference between demanding and preferring, the “should’s” vs. the “I wants and preferences” – haven’t you?

CLIENT: No, I, I get it.

THERAPIST: And so, if on some level if you don’t like the word “simple”, fine but it’s not a complicated theory. Now, I think I understand what you’re saying, that if someone is using REBT as you have been, it would be good for them to be willing to investigate thoughts as one might peel the layers of the onion.

CLIENT: That’s what I mean, layers, lots of layers. [00:13:27]

THERAPIST: Not all people see layers of thoughts – they think of different thoughts. If you want to use the word complex, okay, or you could use the word substantial. What REBT is not, is superficial, which some critics have called REBT. It’s certainly I think can be called a depth therapy, because it really does invite one to do that. To think about their thinking. But I think at this point we are getting into talking too much about the theory and I want to hear about you now. Last session we didn’t really have time to talk about the homework of the previous session which you said you did, which was doing the ABC’s, and at the end of last session you thought, and I agreed, that a useful homework might be for you just to focus on one self-help form thoroughly on your ABC’s. That was the main homework and also the recommendation to not only do as homework now, but for the rest of your lifeto really have the intention to practice more compassion for yourself, in your life. There also was the suggestion that if you can find a photo of yourself as a child to frame it and have it around for you to look at as a reminder. Especially any time you are being tough and rough on yourself to remind yourself: well if I was dealing with a child in this case, I would be softer, kinder, gentler and more compassionate. [00:15:00]

CLIENT: I did do my homework.

THERAPIST: So, tell me about your homework, and also when we first met tonight you also said you wanted to tell me some additional things. But first your homework.

CLIENT: I did. Ok – so well I did a piece of the homework, but I didn’t do all the homework I was really looking forward to doing the one that I was going to reflect on, and I think that today it is a little bit of a better day. The past two days since I’ve seen you have not really been that wonderful, pain wise. It’s misery; I’m not going to lie. My pain level was through the roof, absolutely through the roof. I don’t think I have ever had so much physical pain since I can remember, and so I was really having a hard time with just sort of even being like I couldn’t settle in, I wasn’t sleeping. I was up till three a.m. one of the nights, just tossing and turning, not being able to find a comfortable position. Because as I mentioned earlier, I had shoulder surgery so I can’t lean on my shoulder. I have this neck issue going on, and so just to even get comfortable was really hard. [00:16:18] So, the past two days have been really, really challenging for me, the good news is that though I haven’t really done much of the writing, I’ve done a lot of thinking and just really working on just perspective taking and trying to keep a better perspective and be kinder to myself, I watched a video of myself because I don’t have any pictures from when I was younger, but I do have videos.

THERAPIST: You don’t have ANY photos anywhere?

CLIENT: Not here. Not from when I was little, no. Not HERE, I mean at my parents’ house maybe.

THERAPIST: Perhaps you could ask your mother to send you a photo? We can go back to that. Keep talking.

CLIENT: So (small laugh)

THERAPIST: You don’t look thrilled about it (getting a photo from your parents).

CLIENT: NO, I’m not thrilled about that suggestion.

THERAPIST: Which might make it good homework for you to push yourself to do.

CLIENT: Ok, so what I did instead was I watched, a video of myself that I have here that was from when I was about nine and it helped a lot actually just to watch the video and to actually see myself. It’s not just a picture, I was actually watching myself live, and what I was doing and saying and it was good to, because I observed different things that I didn’t as a child, you don’t say back. You know my parents were on the video and so you don’t say anything back as a young child but I was thinking oh, I could also when I watched it I remembered, if you can believe this, I remember all my thoughts, when those things were happening and what was happening in the video, I could remember what I was feeling and I empathized with myself. [00:17:57] I don’t know if that’s what you wanted, I had compassion for what I experienced as a young child as opposed to not, and kind of sat and had a little chat with myself and said, Wow Jessa, you are really a survivor! (laughs) because it was a lot, it was a lot, and it was subtle. It was really subtle of what occurred in my home because there was so much love. But there were some subtleties that occurred, that I think were, really, really, nestled in and hard to unearth, and so I was proud of myself for taking this step because I said you could have just lived a life and just continued like what I saw in the video, which is was a vulnerable, very, very vulnerable, scared really scared little girl who just wanted to please mommy and daddy and didn’t want to, didn’t want to say anything that was gonna rock the boat in any way. But there was some commentary that was put on the video and it was just the subtleties and the commentary, and I said wow! That is like amazing, that is it right there! That’s it!

THERAPIST: Give me an example.

CLIENT: Oh, here I have, not “perfect” example but a good example. (laughs) No, I was joking, I was gonna watch it!

THERAPIST: Good!

CLIENT: My, father, I was actually at camp, I was actually at a summer camp and my parents came up to see me for visiting day, which is what they have in these camps that they do. They came up to see me and he was taping me pretty much from the second they got there and everything. Hi Jessa, how are you, and then my father says, I can’t see this because I’m now in the bunk so I didn’t hear it but it was on the tape, He said Marge to my mother Don’t look in the cubbies, you know it’s not a good idea! And I was like laughing about it because it was so at the time, I felt it was just so damaging because…

THERAPIST: Hang on; hang on, your laughing about it, it is not clear about what… [00:19:57]

CLIENT: Well, I wasn’t full laughing. At first I saw it and I said, Oh boy, I said this is it, because those critical comments were persistent and you know it was relentless, those comments were relentless, the commentary, so I didn’t hear that particular comment because I was in the bunk, but then the actually went into the bunk and it was a lot of, maybe I’ll share the video with you one day, but it was a lot of criticism you know, with “we know best” and here it was visiting day and it was a month, and you only see your children one time in that summer and I didn’t really, I felt that I was slightly ignored to be honest, in a way, my feelings were ignored, this is really hard to say by the way, for me, it’s really, really hard to acknowledge it. Anyway, I just think that it was really nice cause you see a video and you see oh they were taking a video and it’s what the family does, but I don’t think that they ever really stopped to listen to my opinion, to what I felt, I think it was theirs rammed down my throat, and it’s still that, it still goes that way. [00:21:12]

So I can look at it and take a step back now a little bit differently, in fact they just called right before our session, and you know they were sharing their thoughts with me or opinions with me about something and I said Ok, I’ll take that into consideration and was really able to be calm about it, instead of getting that AHHH.. which is why I think I personally get very confused with feelings vs. thoughts because I just jump to feeling as opposed to thought because when it was coming time for me to share my opinion it was generally tended to be not really heard very well, and that was kind of common in my house growing. So, I am recognizing a lot of different things and I am coming to terms with a lot of things that parents aren’t perfect and that they do the best that they can do and

THERAPIST: SOME do the best that they can do.

CLIENT: Yes, some do. Mine did. Mine definitely did. But you know I think that the REBT has helped me to take a step back and to be able to see that I can empower myself, I don’t have to listen to everything that they say, that what they say is not the be all, end all and in fact I know a lot of things and I think I never believed that I was smart, and it was hard too, because I my teachers would always tell me, you know you’re really bright, I would get that a lot, but I would go home and I would never ever, ever believe that I was intelligent because really my opinions were not really warranted in my house. It was just my parents conveying “we know best”. So I just thought well I have some really smart parents but they created a dumb kid, that was, and I knew that that wasn’t really the case but after a while that started to become the way that I spoke to myself; was you just don’t know, you just don’t know. [00:22:56] So, it’s the language that I use with myself, which I understand now and it’s been some really, really, harsh language that I have used over the years with myself of attempting to be a perfectionist and there’s no such thing. I am seeing that as well, that we make mistakes.

THERAPIST: No such thing as perfection.

CLIENT: Perfection, perfection, yeah. In fact, its making me question so much that I am like well if I have to have this neck surgery, Shit! I wish there was such a thing as perfection! (laughing) If somebody’s going to operate on my neck – I want that surgeon to be perfect, but then this is the way I thought about it. There’s expertise and then there’s perfection, and they’re two different things and there is no such thing as perfection but there is such a thing as expertise.

THERAPIST: And striving for excellence. Yes.

CLIENT: That was how I tried to break it down in my head.

THERAPIST: That makes good sense to me.

CLIENT: Alright, it seemed logical and comforting to my own self at the time and I was watching a surgery on the video, going you might be getting this so, you know, and I wanted to face it forward and just really see what were the possibilities in front of me and doing my own research and all that kind of stuff, so it has been empowering in a sense and obviously nobody wants to have these ailments and these issues but I’ve been taking it upon myself to do my own research, to look into different options, to see what’s out there for me and I’ve never really done anything like that. I’ve always done, ““Mom”, “Dad”, what do you think? What’s your thought?” (in a high voice) and they don’t have any thoughts this time around so it’s actually better, in a sense that I can do it and I don’t need their approval. [00:24:33]

THERAPIST: That’s a major change, isn’t it?

CLIENT: It is, it is. There’s definitely been, and I continue to tell myself that this is a life long journey, it doesn’t end with, you know because those thoughts creep in throughout the day, it’s not like I am sitting here like Jessa had a perfect day, with the perfect health and back, I’m not sitting here saying that I didn’t have that, but it’s putting them into perspective and being able to check the thoughts I guess when they creep up but the past two days have definitely been you know a really big struggle. The interesting thing is that at work, I think some of the students; I’m getting even better responses than I thought that I would get. Well, in some ways yes and in some ways no, I think that some of the students have noticed that there are little small changes besides the fact that I am in pain so I’m probably more of a bitch. Can I say that on tape? I am a bitch, like I don’t have the same tolerance that I had last year or the year before. My pain tolerance is not, you lose a little bit when you’re in chronic pain. I don’t know if you’ve ever had chronic pain and I don’t wish that on anybody, but from a chronic patient to another they can look and say are a little more of a bitch, you’re a little more on edge, you’re a little less kind, and I’m a bubbly personality, I’m a lot less bubbly. So I think that they might be noticing a little bit of that, but I think it’s more than that. I think it’s me actually being a little clearer and today one of my students said something where they picked up a table and I was like ABSOLUTELY NOT, and I said, “you might not have your strength, but you have your brain”, he was angry, he was very, very angry and I said, “you DO NOT do that in my office”. I said there’s no way! And I said because of that you will not be invited back for two weeks to group. I said you will sit and reflect and think about it. [00:26:33]

CLIENT: And this kid has anger, like a whole lot if you can imagine. He got angry at another student and that was in the group and it was my job to protect the other kids, but I felt a lot of that had to do with REBT, because in the past, I might have said to myself, “you shouldn’t have told him that he can’t come to the group, that’s not right. I didn’t do any of that. I was like; you’re not coming back to my group, for two weeks.

THERAPIST: Well, that sounds very constructive. It sounds very appropriate to me. You are teaching the child there are consequences to actions. I didn’t hear you putting him down. You just said no, absolutely not little man, and presenting appropriate boundaries. Now I want to ask you about your evaluation of yourself as a bitch. [00:27:21]

CLIENT: Oh, why am I evaluating myself as a bitch?

THERAPIST: Why did you label yourself in that way?

CLIENT: Well because I just feel I don’t have the same tolerance I think for things. So is that equated as a bitch? I’m not a bitch. I know I’m not a bitch.

THERAPIST: The example you just gave me of the way you behaved with this boy who was acting out in anger …. CLIENT: (inserts) Right

THERAPIST: …didn’t sound bitchy to me, it sounded clear and definite and appropriate.

CLIENT: Yeah it was.

THERAPIST: Because of your role as counselor with children frankly I would feel very concerned, which I don’t at this stage, if I thought that you were allowing yourself to act towards them based on unhealthy emotions. Which I’m not getting that you are, but I didn’t want to let go this opportunity to look at your use of the word “bitch”, which was your self-evaluation. A harsh one. Earlier in our conversation you were telling me about, and giving me an example of, your being clear, and definite in setting boundaries, and not giving yourself a guilt trip afterwards and not giving yourself a lengthy postmortem of should I or shouldn’t I. Now, I would hope if you had let’s say, smacked the boy, which would be highly inappropriate, unethical and illegal, if you had really acted out inappropriately in anger with him, I would hope that you would do a lengthy self-evaluation of your inappropriate “behavior” and take appropriate action following that to prevent your doing that mistaken behavior again. [00:28:58]

CLIENT: You know where I think the bitch thing came from? I think sometimes it (laughing) I’m not gonna say it.

THERAPIST: Please say it.

CLIENT: MMM. I don’t know if it’s really, I don’t (stumbling) Just say it? I think my mom’s a bitch sometimes though and probably when I feel myself saying something or doing something I think it brings up maybe, Oh shit, your acting like your bitchy mother right now, because that’s what I think I sometimes sound like. So that’s why I’m saying it’s a little more complex because I want to say, you’re being a bitch and I feel I can’t say that to her.

THERAPIST: Well, if you did say that to her, there would be consequences, and then it’s for you to evaluate. Are you willing to take them or not? And -

CLIENT: No! (laughing)

THERAPIST: By the way, no one is ever “a” bitch. Someone may act …

CLIENT: Like a bitch?

THERAPIST: Yes they may be superbly talented at acting in bitchy ways. Just as no one is good or bad or evil 100%, no one is 100% a bitch. Maybe 99.9999999% (joking) but again with the REBT rational ways of thinking, we watch out for absolutes. Saying that someone “is” an anything means, they are that and only ever that. Which is not humanly possible.

CLIENT: Can I say nasty though? I feel that about her.

THERAPIST: She acts nastily.

CLIENT: Right, so sometimes, so saying acting, right, I mean

THERAPIST: Acting in certain ways, or saying they are behaving in such ways, as opposed to saying they are being those ways, which is a statement about their personhood, when you say they are something (nasty or a bitch)…

CLIENT: No I get it. I get it. I understand.

THERAPIST: A good habit to get into, to distinguish, to separate the behaviors of a person from their worth – and that applies to you

CLIENT: (cuts into therapist’s sentence) because you can accept people more and yourself

THERAPIST: And yourself. Unconditional self-acceptance.

CLIENT: Yeah, no absolutely. Yeah, I agree with that, and I get it. I just think that, I was angry at my mom the other night and so that’s why it’s coming up for me a little bit now. I was REALLY angry the other night.

THERAPIST: You mean that you felt angry?

CLIENT: Yeah, I felt really, really angry at her. Can I just share it for a second? I was angry, so that’s why I’m saying it might be coming up a little bit for me right now but, I was on the phone with her and something came up about the fact that she had reached out to me, I’ve been really trying hard, NOT to call her because I don’t want to deal with her, by the time I get home, Oh my God, I’m like, I haven’t been like this. Sorry, so by the time I get home I happened to be having a good night right now, because I came from physical therapy, but I’m usually not in the best of moods, because I’m not feeling well, because I’m not feeling that great by the time I get home, and so I avoid making phone calls to very many people because I just know that I don’t always have so many wonderful things to say, except that I’m in a lot of pain. That’s kind of what I’ve been feeling lately. So when I was talking to my mom, she said How was your day or something and I said, I’m in a lot of pain, it’s really not a great day and I said I was trying to get a hold of dad, to ask my father a question about something and she said, she said, I don’t really want to hear about your pain she said, you have your girlfriend to talk to about that. [00:32:33]

CLIENT: And I was like, you are a bitch. That was the word that came to my mind. And I was like this! And I said, ok, have a good night – see you later. So that was what you know, really, thanks for the unconditional care, because I don’t really say it to her that much and so that was, that has nothing to do with this boy and yet you know there’s a part of me that feels I was still unconditionally accepting him despite, despite his poor behavior, and I made that very clear to him, but I think because it’s something again that’s still new, it’s even for myself. I’m a little bit more inclined to say, Oh, your father’s in town, and you don’t see him very often and it must be really hard, you just threw a table but you know, that must be really hard. And now I’m seeing the effects.

THERAPIST: How would THAT help him?

CLIENT: It wouldn’t. It would not. And I don’t generally tend to do that and children don’t generally tend to pick up tables in my office either. This happened to be a more unique situation today. But, it was a challenge for me to learn how to approach it, because I know that I’m his guidance counselor and I know that I’m there to help him with his feelings but at the same time I know that that behavior is inappropriate and makes other people feel, it creates an unsettling feeling with other children in the room. [00:33:52]

THERAPIST: Right. Didn’t you handle it well in retrospect?

CLIENT: I think so, I do, I do.

THERAPIST: Did you handle it in a bitchy way? Get clear here about your self-evaluation.

CLIENT: No.

THERAPIST: And yet, your self-evaluation to me said unthinkingly minutes ago almost was, “Oh, I’m like a bitch, my tolerance is low, my frustration tolerance is low”. I think that the way you said you handled it, sounds like a very healthy appropriate way to handle it. The reason I’m stopping on this situation is to have you see how quickly you evaluated yourself negatively, and inaccurately. With awareness can come change. Also, the nature of your mother’s response to you on the phone does not, it seems to me, seem similar to the way you responded to the boy today. Does it? You indicated that you wanted to say to her “you’re a bitch” after she told you to tell your girlfriends about your pain.

CLIENT: I did say it, I went like that (gestures).

THERAPIST: She can’t see you give her the finger over the phone. I see you do it here, but she couldn’t see it. But you expressed for yourself. You were likening your behavior today, to that of your mother’s, calling the behavior of your mother “bitch”-like and saying that you were acting like a bitch with the boy. But now, as we stop and observe, as we reflect back: Did you behave like a bitch towards the boy?

CLIENT: No, I didn’t.

THERAPIST: Right. Ok, so notice how quickly you did that, and the reason I point that out is not to reprimand you, but to have you stop , to watch your thinking and irrational ideas therein – and if you’re willing to continue to be watchful and to catch yourself if you are being cruel to yourself then you have an opportunity to stop it. Make sense?

CLIENT: Yes.

THERAPIST: See how you were being kinder to the boy than you have tended to be towards yourself.

CLIENT: Kinder to him? I don’t know that I was kind. [00:36:13]

THERAPIST: Alright, let’s use the word appropriate.

CLIENT: Yeah.

THERAPIST: See, how you were more appropriate with him than you are to yourself when you call yourself a bitch.

CLIENT: Right.

THERAPIST: So how about a little democracy here when we’re able to use it? Make sense?

CLIENT: (laughing) You’re a character. Yes it does. You make me laugh!

THERAPIST: Good! Good! I hope you can at times appropriately make yourself laugh about the foibles of human nature and our tendencies. (laughing in background) [00:37:02]

THERAPIST: So back to homework, which, I’m not getting a clear message about whether you did it or didn’t do it?

CLIENT: I didn’t do it; I didn’t do it (Laughing)

THERAPIST: I thought I that you said that you did one part of it, and watched the video of you as a child.

CLIENT: Oh that part. My time has really been usurped with just basically getting up, going to work and coming back and doing a lot of research for, I’ve been researching surgeons, I’ve been researching and so not to say that I didn’t have time, because I’m sure that that we can always find time, but I really did not, I’m being completely honest, I didn’t sit down to do it. I’ve been just trying to remind myself. I’ve been using the, I have you in my head and I have the different thoughts that I have and I’m trying to stop and think and I was doing it at work today. Even after the kid left, I said, because the “should” started creeping in so I said, Jessa, sit down, reflect, so I mean, if that you know is, which I do all the time, but I think I REALLY calmed myself to do it today, with this particular situation.

THERAPIST: I think you did very well today. And yes it’s very good to think more and contemplate more and reflect more and catch the “should’s”, to use the more accurate language. So that’s one thing and well done.

CLIENT: But I did not sit down to do the homework, and I beat myself up about it too, that I knew I was seeing you tonight.

THERAPIST: How does that help, to beat yourself up?

CLIENT: Um, it doesn’t.

THERAPIST: What were you telling yourself in terms of beating yourself up? [00:38:48]

CLIENT: Oh, my goodness it’s a lot. Jessa, I told myself, you didn’t do the homework, and I have a session with Debbie tonight. That was really lazy, you had time even though you were looking for surgeons, I don’t know if I’d use the word lazy with myself, I said you are avoiding, that’s what I was saying. And then I was saying I can’t believe that you did that. Other people would have had the homework done.

THERAPIST: Other people, the royal superiors; meaning everyone else but you?

CLIENT: Yeah, everybody else but me would have had it done, Debbie’s not going to be happy with you, she’s

THERAPIST: (In exaggerated and joking form) Oh no! I’m depressed, I’m horribly depressed!

CLIENT: I told myself You said you would do it, you even came up with the homework assignment yourself. How stupid that you made the homework assignment and then you don’t even do it. That looks ridiculous.

THERAPIST: OK! So?

CLIENT: That was a lot!

THERAPIST: Yes, it was a lot.

CLIENT: Oh and I was coming home from physical therapy, and then I thought about well, it’s late and then I started getting angry with myself. I said it’s late, why would you

THERAPIST: You got angry? NO. You made yourself angry , because you were thinking what ?

CLIENT: Because I was thinking that I made this time for us tonight but that there really wasn’t a lot of, oh because that was the other thought that I had. I said to myself Jessa you asked Debbie for a session soon, to do it now before the next time because you needed it and then I thought how selfish that you know you were wasting time.

THERAPIST: Hmm. I’ve just heard all of this self damning talk, but a few of the comments may have been accurate. [00:40:16] Some of what you thought is descriptive. You could say to yourself that’s not a self damning comment. It’s actually accurate; but then when you put in the other ones, those that then lead to your feeling guilt or shame and all that. They are self damning. Why do that to yourself?

CLIENT: Punishment.

THERAPIST: Well yes. Unconditional self-acceptance doesn’t mean allowing yourself to work against your interests and be a lazy one at catching yourself thinking in harmful ways. That’s not the goal of it.

CLIENT: No, I feel like it actually probably does the opposite.

THERAPIST: Unconditional self-acceptance

CLIENT: Yeah, I feel like it probably encourages you to be less of that, because if you’re sitting there and you’re beating yourself up, chances are you’re doing the, it’s the self-fulfilling prophecy and then you’re gonna screw up even more, in some way. You may not screw it up to the outside world, but eventually that’s going to catch up to you and you’re going to screw it up another way. So,

THERAPIST: Yes, that’s highly probable.

CLIENT: I think you become a more effective person when you don’t self-damn.

THERAPIST: When you said become a more effective person, a preferable way of expressing that is that one can function more effectively.

CLIENT: Yeah, function.

THERAPIST: Remember, not to confuse your worth with your performance, good or bad.

CLIENT: Gotcha.

THERAPIST: So, you’re still a worth-while human despite the fact that you didn’t do what you committed to do. Not for my sake but for your own sake.

CLIENT: Yeah, I know. [00:42:06]

THERAPIST: So, given that and

CLIENT: Oh, one last thing though. I did have thoughts about which one I was gonna do. And I had a problem with that as well because I was trying to be perfect, I’m sure, yeah.

THERAPIST: Caught yourself, good. It’s good that you caught yourself.

CLIENT: (damn, damn, quietly in the background)

THERAPIST: So, alright. So on the one hand [00:42:32]

CLIENT: I always get tired after, not in a bad way, after we do this -

THERAPIST: Well its healthy brain exercise. None the less, On the one hand, you didn’t do your homework, does it make you a louse? Does it make you a low-life? That was a question. (Jessa giggling in background)

CLIENT: No.

THERAPIST: No! It simply makes you someone who didn’t do what she intended to do with the goal of positive self-enhancement in recent days.

THERAPIST: On the other hand, you’re not doing some healthy things that might be very helpful. And this isn’t the first time you haven’t done the ABC homework, and in past sessions we’ve explored one possible reason that you proposed is you just didn’t feel you understood the disputing part of it or that you could do it well enough.

CLIENT: I didn’t.

THERAPIST: Ok.

CLIENT: That was the truth, I don’t, I was confused about it.

THERAPIST: Are you less confused about it.

CLIENT: Yeah! Now I’m not confused!

THERAPIST: Ok, so you simply didn’t do it. Watch out for any tendency of having to find the perfect issue to do the ABC form about.

CLIENT: Yeah, but I’m less confused about what to do, if I do sit down to do the exercise, I’m not confused anymore in terms of like the dispute. Like, I get what you’ve explained and I’ve read, and I feel like I get it now

THERAPIST: So, why do you think you didn’t do your homework this time?

CLIENT: (sigh) I think for all of the reasons I said. I think I’ve been a little overwhelmed.

THERAPIST: But you told me a few minutes ago, that you probably could have done it if you set your mind to it. So what did you possibly, probably tell yourself?

CLIENT: I really just told myself I wasn’t I really haven’t been feeling well.

THERAPIST: You didn’t feel like it?

CLIENT: No, didn’t feel well.

THERAPIST: But you still did the research for the surgery.

CLIENT: Well because I feel like my, that’s where my

THERAPIST: priorities -

CLIENT: priorities are, right now.

THERAPIST: And I’m not disputing the value of researching doctors and the like that right now. If it had to be either or, I think you were wise to choose researching your medical issues. My question is was it really an either/or? Or could you not have done, even imperfectly for 10 minutes, a little bit of the ABC form? Could you not have?

CLIENT: Oh, I guess I could have. I just thought we had said a ½ an hour.

THERAPIST: So there was that need to do it perfectly?

CLIENT: Perfectly.

THERAPIST: Perfectly or close to it. [00:45:29]

THERAPIST: Ok, so the good news is, I’m going to suggest that you do that homework again, and see how you go. Either you are going to do it, or, if you don’t do it, it will be interesting to hear what excuses you’ll come up with then. (laughing) This is time for you to deepen your acceptance of yourself, your awareness of yourself, which clearly you’re making progress with. To enhance your life and the first clear stated goal, way back when we started, was around the anxiety issue, but this approach applies to many other issues as you’ll discover. Now, was there any anxiety you felt in recent days?

CLIENT: LOTS! I told you I didn’t sleep.

THERAPIST: Yesso did you do anything differently than you might have done three months ago?

CLIENT: When I had the anxiety?

THERAPIST: When you experienced the anxiety as a result of

CLIENT: I did, I was up and I was tossing and turning a lot because like I said, I couldn’t get comfortable. It was really hard to just settle in and just relax and so I so I, what I did tell myself ?, because I have tended to have anxiety with, surrounding sleep.

THERAPIST: To feel anxious. [00:47:06]

CLIENT: Oh, what did I say?

THERAPIST: What did you tell yourself which created the feeling of anxiety?

CLIENT: Ok, (laughing), I’m tired Debbie. (laughing)

THERAPIST: Just a little more torture, come on. What did you do in the early hours of the morning when instead of sleeping, which you tell yourself you should be doing, you are awake and uncomfortable … and I’m not meaning to sound like I’m trivializing your pain. I do know it is very difficult.

CLIENT: That’s good, because my mom trivialized it.

THERAPIST: If that is so, let us for now leave discussing that. I’ve acknowledged you before, for your courage and carrying on as you endure intense physical pain.

CLIENT: Intense way beyond belief.

THERAPIST: I believe you.

CLIENT: Alright, I’m glad you do. Because when you look good, I don’t look sick, someone said to me recently you look good, and I was thinking like you have no idea.

THERAPIST: Why don’t you start, when you see that person next, you could let saliva dribble down and out of your mouth, and stagger along, put fake blood on your chin

CLIENT: Well actually I said, next time I’m gonna wear pajamas

THERAPIST: Tell that person – “Look at me, this is how I feel!” (laughing) Don’t forget to let the saliva dribble! That has good dramatic affect. (both laughing)

CLIENT: But people DON’T know what they see. Sometimes, not all the times, but sometimes I think that when people see an image, it’s confusing because you know, I do put myself together well for the most part, that’s what actually keeps me going throughout the day. Well I say I have a nice outfit, pretty jewelry, my makeup is on, but I feel like crap! (laughing) [00:49:01]

THERAPIST: But you carry on regardless.

CLIENT: Exactly. So I think that people see that sometimes and they don’t understand.

THERAPIST: So, they might not. Is that so awful? NO.

CLIENT: But any way, why did I bring that up? OH! because I was really having a hard time settling in and then I started in with telling myself: you should be asleep, you need 7 hours, you need 8 hours, if you don’t get 8 hours your gonna be a mess, if you’re a mess this is what’s gonna happen and it was like the next and the next until I did lie there till three a.m. I eventually was able to sort of self soothe I guess, and I don’t remember what I was telling myself, because it was a long time of the worry.

THERAPIST: What might it have been that you told yourself to self-soothe?

CLIENT: You will eventually fall asleep because you’ll be really, really tired, what’s the worst thing that can happen.

THERAPIST: Good, good.

CLIENT: I was you know, so you’ll lose a little bit of sleep, you’re not going to die, you know, the walls aren’t going to come crashing down. What I actually did do was I put on an inspirational video, just because I was lying in bed, so I wasn’t going to get up and do anything, so big and significant like run a marathon, but I put on a video that I would like to share with you at some point just because the girl in it she was one of my students actually who just recently passed away in July of cancer, she was so positive, so spunky, just had such a way of being positive she would be a really good if she had survived and carried on with her life, I feel like she encouraged a lot of people to be inspirational too and despite what you’re feeling, physically or whatever it is to carry on and so I put her video on. I watched her – it was about a 10 minute video and I felt her with me and I was like that’s it, I said to her, “you’re amazing”, and then I fell asleep so I don’t remember anything after that till I woke up. [00:51:13] So I feel that a part of that had to do with everything, I’m sort of, because I was able to really listen to what she was really saying as opposed to just watching this cute little bubbly girl and saying oh she’s so bubbly, she’s so great, I really heard her in what she was saying and the things she was saying and she was expressing like ok I got basically a death sentence from the Dr.’s. They told her she had such sentence from the cancer, and she said But I’m not listening to those Dr.’s she said, I’m still here and she was, oh she’s adorable, so, it was really, really inspirational for me to watch that at that moment. And also to know that she suffered from some really serious physical pain which no child needs to go through.

THERAPIST: Yes. Well done Jessa. To choose to think about inspiring things, not about not sleeping.

CLIENT: I think so. (laughing)

THERAPIST: What you did was change your thinking from oh no and won’t it be awful if I don’t get enough sleep etc. to a healthier perspective of so if I don’t get much sleep, I don’t. So I will be a bit tired, I will be a bit weary. Then you watched an inspirational video which, one of the things it possibly did, was remind you, as you mentioned a few months ago, it could be worse, you were in pain, but so was she and yet, not only is she a great model for you, in terms of carrying on regardless, but you don’t have that same illness. You have an issue that’s in all probability can be helped to some degree. And certainly not like cancer.

CLIENT: Right.

THERAPIST: And you’re investigating possible best solutions or treatment, which is a pain in the neck! LITERALLY!

CLIENT: Literally.

THERAPIST: But productive. And yet also what you did successfully was to put things in perspective and the result was, you did fall asleep. And if you had not slept all night, it would not be as you said, have been the end of the world and the walls wouldn’t have fallen down and so forth.

CLIENT: Do people get that around sleep? With the, are there a lot of issues surrounding REBT and sleep and how it can help you to get to relax.

THERAPIST: Oh yes!

CLIENT: Really?

THERAPIST: And as you know CBT was derived from REBT and in the news recently, I think only two weeks ago, the New York Times, twice featured an article

CLIENT: I just saw one too!

THERAPIST: Yes.

CLIENT: In my physical therapist office, I saw something

THERAPIST: About CBT helping with sleep issues and so you know one of the things that people in this program, I think it’s connected with Columbia Presbyterian Weill Cornell hospital (that could be the longest name of a hospital !!!), in New York City, are given behavioral strategies and guidelines for what to do if they do not fall asleep when they want to, and with recommendations of what NOT to do before sleep time, and then if they don’t sleep or if they wake up and can’t get back to sleep, they are guided to write down what they are telling themselves and then to put it into perspective. You pretty much did that part of it – distract yourself, and see your awakeness from a less catastrophizing perspective. [00:54:44]

CLIENT: Oh my goodness! No, no, I’m sorry, it just dawned on me, and you just reminded me of the dream that I had that night that I finally fell asleep. I got shot twice in the arm and I said I’m fine it’s just my arm and I can still use the rest of my body.

THERAPIST: Oh well, looky here!

CLIENT: I just, it just dawned on me!!

THERAPIST: You were even thinking in healthy ways while in your sleep!! (both women exclaiming)

CLIENT: I did, because I realized, I said, that was, I don’t have dreams like that normally and it was boom, boom, right in my arm two booms right in the arm, I mean right in the shoulder where I had the surgery and I got up and I said alright, I’m not happy about this and it’s not the best thing but I’m gonna get up and stand up anyway.

THERAPIST: Well ! I can understand why you would want to sleep more often, you are very rational in your dreams!

(laughing) [00:55:27]

CLIENT: It just reminded me when you said that!

THERAPIST: Very good, very good. Well done Jessa. Time moving, we’re winding down now, we’ve only got a few more minutes for our session. I would just like to share something with you. Disclose something with you in relation to what we’re talking about and about the importance of maintaining a healthy perspective, and then let’s talk about homework that you will or won’t do (laughing) before we next meet.

There no doubt is a biological reason for why humans do better with a certain amount of sleep. I mean it’s a provable scientific fact that there are circadian rhythms and so forth. On the other hand, humans are very resilient, we’re very adaptable. We can go through traumatic times and recover and heal and start again in a healthy way, and what can hold us back from recovering more quickly is catastrophizing, and what can make times that are filled with traumatic situations easier is keeping a healthy perspective. So, my personal disclosure, that I want to share with you is the fact that for the last 15 months of my husband’s life he was in hospital, and then rehab with a hope of getting better and going home, but then there would be a relapse and it was back to hospital and then back to rehab, and so it was for 15 months it was in and out of hospital and rehab, and then only as he was dying in his final weeks did we get to go home, because I didn’t want him in a hospital environment in the end. And so wherever he was, so was I. So when he was in a hospital they let me set up a cot next to him, I would sleep there. Sleep: Hardly. And then when he was in rehab there was in his room a recliner chair that became my bed. I’m highly sensitive to noise, a light sleeper, and was aware of people around us in that place, and very much attuned to my beloved husband and what he was feeling and going through. And so for 15 months I doubt that there was even one night in which I got more than 45 minutes sleep before being woken up. By a nurse coming in, by Al’s saying “water, water”, or groaning in pain. And if there was something I could do, I would get up and do it. I might get up and stroke Al’s head till he seemed to relax. Then I would just allow myself to just go back to sleep. Al was in a lot of pain, I mean really most of the time. And I would get up and I would stand by his hospital bed and he would love his head being just gently touched and stroked and I would do that and sometimes I would fall asleep, literally standing up. I don’t know if it was for five seconds or five minutes, but I would wake up and there I was, with my hand kind of on his head, I had been asleep. Standing. It appears that my brain was forcing me to sleep. Or could no longer keep me awake. My point being, for a very long period of time, I didn’t get enough sleep. And I survived, I got by. It may have affected short term memory awhile, but not in any significant way. At times from sleep deprivation I was probably a little foggy, but I got by. Now before that had happened, if any had said to me: “you know, I’m a psychic and for the next year and a half you will get hardly ANY sleep”, I could have easily created anxiety within myself thinking it was going to kill me. I am telling you this six and ½ years after the fact. So there have been no apparent long term consequences. [00:59:55] If there were, I would probably know them by now. So, I shared this with you to give you the message that we humans are resilient (and I could give you very many other examples of people in more dire straits than I was in). My situation was not exceptional. It was damn hard. A lot of people don’t go through such hardships, but a lot of people do go through such dire events and worse. My point being for you, in the context of what we were talking about, that we can handle a lot, we humans, and if we tell ourselves we can’t and when we think in awfulizing ways, then we really limit our enjoyment and capacity to cope with hardship, and we are telling ourselves something that usually is false anyway.

CLIENT: And thank you for sharing that because it, it’s, I mean it was a nice picture for me to see in many ways about the sleep but also to just hear about Al and also somebody who I know, you know, to see him as human in a way I guess, even though he did, obviously he was the one who came up, devised this whole concept of REBT, but you know he, he was human as well and, and had experienced pain and physical pain you know.

THERAPIST: Oh, very intense and agonizing physical pain.

CLIENT: And I understand that and I think right now, maybe pain looks different for everybody but you know pain has been a part of my life for months and months without a break from it really, without really saying oh I feel great, you know so, It’s really just interesting how you were able to sort of able to keep things in perspective because he was the patient but you, I don’t think people always take into consideration the one whose caring. No, no, no I mean I am saying it in a way that it makes it, it makes me, and it makes it easier for me not to beat myself up so much that I am in pain. I’m in pain that’s not fun, nobody wants to be in, yeah but I know, but I don’t know if I’m being clear, but it’s clear in my head and I’m gonna use it and also with what you said about the sleep that you survived it, that was whole point of your story, was that nothing so bad happened.

THERAPIST: Worst case, you’re foggy the next day.

CLIENT: Well that was what happened, because sleeping from 3 a.m. to you know 7 is not a good thing.

THERAPIST: It is probably not life threatening.

CLIENT: It’s not life threatening.

THERAPIST: Unless you walk in front of a bus.

CLIENT: Then of course it is! Yes, I think the funny thing is though that the body, and know we are wrapping it up nowend of session but the body does have a way, if somebody goes for like a day or so, your body can just sleep, like you don’t, like I’ve had the thoughts before, oh if you don’t sleep, then what happens if it’s like two days and then three days but I think you sometimes, just, you are human like you said.

THERAPIST: There are mothers who have screaming, crying babies, who also get extremely little sleep.

CLIENT: Exactly! That’s what I thought!

THERAPIST: So anyway, you did well,

CLIENT: Thank you. Sorry, I’m getting tired myself now.

THERAPIST: No, no need to apologize.

CLIENT: But thank you for sharing, I appreciate it.

THERAPIST: Alright, no problem and in Al’s biography and in a few of his books, you can read that he was very ill and in pain throughout his life, but he did not catastrophize about that.

CLIENT: Yeah I know, I read that.

THERAPIST: One of the issues was he would have debilitating headaches especially as a boy and teenager, and young man. Before he was diagnosed as a diabetic he probably had issues that contributed to migraine, and sometimes as many migrainesufferers share, the pain is so intense they want to die. I mean they think in those moments that they would rather die than bear the pain. The good news is that core part of the carries on because they remind themselves that the pain will pass.

CLIENT: Exactly! [01:03:59]

THERAPIST: And let’s not forget that persistence which you’ve been practicing. Jessa . I think it’s an easy question, but what do you think would be good homework for you to do?

CLIENT: The homework I didn’t do before!

THERAPIST: That might be a good idea. Between now and the next time I see you.

CLIENT: Yeah, I’ll have a little more down time; um you know, to do it.

THERAPIST: I would still want to give you that homework even if you had less down time.

CLIENT: I’m sure you would, I have no doubt.

THERAPIST: That is your homework; any comments or questions before we finish?

CLIENT: No, nothing.

THERAPIST: Ok, Good job,

CLIENT: Thank you.

END TRANSCRIPT