TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Ok, this is session 10: Monday the sixth of January, 2014.

THERAPIST: Hi Jessa.

CLIENT: Hi Debbie.

THERAPIST: So it’s been a few weeks since we met. Our last session was last year !!!, meaning December, prior to this holiday period. When we finished off in our last session, your homework was to be a completed self-help form rather than more than one form. You said that you would do one ABC form thoroughly and mindfully and so …. (pause) you look a bit emotional at the moment…

CLIENT: I do?

THERAPIST: Yes, you’re not? Your eyes seemed to …

CLIENT: It’s my eye makeup running

THERAPIST: So is that what it is?

CLIENT: Maybe, probably.

THERAPIST: So that was the homework and another task was for you to find a photo of yourself as a child and …

CLIENT: It found me

THERAPIST: It found you? I’m really looking forward to hearing about that. The main tasks were your doing the ABC form, thoroughly, mindfully, not just getting it done and over with because it was homework, and to find the photo of you as a child so you could mindfully consider having an attitude to yourself, now, these days with these challenges that you’re enduring, which can remind you to be as gentle to yourself at present as you would be to a child. To remain mindful and keep things in perspective. Another of the things that we were talking about in one of the later sessions of last year was the wise thing that you did one night when you couldn’t sleep. Instead of lying there stewing and thinking over and over, “I can’t sleep, I can’t sleep”... you looked at a video of a friend of yours who passed away from cancer, you said you did so because the video of her shows life and spirit and upliftment. That’s a brief recapping of recent sessions and the homework tasks that we had spoken about. So, please if you would tell me how much, or little, or not all, you did you did of the homeworks and anything else you want to say to bring us up to date. [00:02:44]

CLIENT: Sure. Sure. So the first thing in terms of the homework, I did a little bit on my computer and I did some in my notebook. I did a lot in my notebook actually and I am very, I am a little disgruntled right now because I went to my girlfriends for the holiday and I have a feeling an inkling that it might be there. But I’m not 100 % sure only because she had a suitcase, because she only comes every other week, I started to do it on the computer the other night when I realize I didn’t have it and totally forgot to ask her if she had seen it but now thinking back she still has one suitcase in her car from the week before and I believe it might be in there. The notebook, which I would be upset if I don’t have because I wrote A LOT in there. That’s just a side note. That has nothing to do with the homework not being done, because I can tell you right now I did do the homework and in fact some today that I did thoroughly. So it’s not about not doing the homework, it’s about the fact that I wrote some really personal things in there (laughing) and I don’t know where that note book is at the moment. So, I could pull up the computer, but I don’t think it’s really totally necessary because I did attack one, one activating event very thoroughly, if that helps. [00:04:00]

THERAPIST: Yes, okay, so did you find that you did successfully apply yourself, particularly to the area that in the past that you have said was not all that comfortable for you – the disputing. Did you do that?

CLIENT: Yes, so here’s what’s interesting, I don’t think that in my life I ever really been challenged in the way that I’ve been challenged more recently, which I have mentioned, I don’t have to get into it again, with just having to make this big decision about surgery and it’s up to me, that there’s lots of pain, and it’s a lifestyle decision, that the surgeons would operate, but that it so something that is lifestyle. And I think that growing up, and I do have to go back to that only because I sort of have been in this little bubble of not really having to challenge or thinking that I had to challenge anything that was said to me in my past from my parents. And so growing up in that sort of fashion, yes I have a job now, and yes I do all these things, but I didn’t have the opportunities to dispute. [00:05:11]

In all honesty up until quite recently, like I would say more in the last few times of doing the homework, it did come more naturally; like wait a second – you actually can dispute, you don’t just have to jump to the anxious feeling, I hate to be so dramatic or extreme, but that is what I really have tended to do, without realizing it. Without knowing, so to answer your question, I don’t think it very naturally came to me to dispute at all and I would sit there and it was almost like, something that is so not natural, anything that you do in life that doesn’t feel right because it’s not coming to you automatically or easily. A homework assignment, when you’re little and your teacher gives you homework, and they are saying like go home and do this calculus assignment and you can’t do it and you’re like no matter what I do I cannot do it. And then finally after trying and trying and trying the light bulb goes off – wait a second I can do it. And then it starts to come more naturally and of course you still have to practice it, but at least that thought of ‘wait a second I can actually do this without somebody guiding me and sitting on top of me, 24/7’ : that piece of it then starts to come. Then you can pass the test, and then you can maybe even start to get a 100. [00:06:29]

So I almost feel like I haven’t been able to do that up until the more recent times. It felt a little forced, NOW it doesn’t, if that makes sense.

THERAPIST: It makes sense and it’s good to hear of that change, that progress you are making over time. But it sounds to me like you might have held a very unrealistic expectation, and I hope as your therapist, I didn’t misguide you in any way, to think that the changes would or could come naturally. Of course …

CLIENT: I thought that that did come naturally. Well because I was in therapy. So I thought.

THERAPIST: You refer to the therapy with someone else, in the past?

CLIENT: In the past yes. And I’m a guidance counselor. So again it goes back to my expectations, but I thought if I had counseling in the past, if I was in a master’s program to get counseling, because we had to do that in order to get our degree, and then I was thinking if I do counseling all day long with students how is it that this work on my stuff would be so difficult? That was the expectation. That it wouldn’t.

THERAPIST: And what’s the answer now?

CLIENT: The answer is that this is something that I never did before.

THERAPIST: Right!

CLIENT: So why would it be easy?

THERAPIST: Yes, why would it feel “natural” to do things differently – to use the word you used before.

CLIENT: Yeah, right. But that wasn’t the expectation. You’re right the expectation, was no, this should be something that I should know how to do. It was all about the “should’s”.

THERAPIST: The should were in your own head, and you put them there.

CLIENT: In my own head and I was confused. But I was genuinely confused. Genuinely confused as to why something therapeutic, that I ALWAYS, there I’m quoting that word because it is so extreme. Something that always came so naturally to me in school and my class when I graduated top of the class, no I’m joking! (laughing) and all my teachers loved me and said you’re going to be an amazing counselor, I thought these weeks, how can I not even get these REBT concepts? That was sort of what I was thinking in my head. I no longer think that, But I DID think that when we first began. [00:08:30] So, that’s not what I have now, at all, this is a completely different, it might be within the therapeutic umbrella but it’s a very different, it’s like being trained in something that I was never trained in before.

THERAPIST: Correct!

CLIENT: So, I’m enjoying it now instead of being hard on myself when I do it.

THERAPIST: Or feeling you need to do it perfectly well, or not at all. So that’s interesting for us to view as we look in the rear vision mirror the way you imposed on yourself that expectation of it needing to come naturally, and I am pretty certain that I would not have said to you “Jessa do this a few times and it will feel natural”. I don’t believe I did that !

CLIENT: No, you never said that.

THERAPIST: So, I am not being critical of you here. We’re just viewing what had been your experience, and what you’ve just shared, and it’s good for us to put the magnifying glass on it, because if you are aware of the tendencies that can come easily because you’ve practiced them unchecked for many, many years – it makes it easier to change them if you so choose. Knowing that that tendency to think that if you have done well at things before, it will feel natural to change behavior sooner. No. With practice, the changes can feel more NATURAL!! Over time. Though it’s not natural, it can feel more familiar with more practice. You can either do preventative work or catch unhelpful thoughts sooner and dispute and then change them. [00:10:01]

So, it is good to be aware of how even with REBT, and even with the probability that I shared with you that over time change can happer, this is something unfamiliar.

CLIENT: Unfamiliar, exactly.

THERAPIST: It will require work and practice, disputing your NEED to do it right, to do it perfectly, even given the fact that you are extremely bright and have been very successful in many things. Those needs are inhibitors. And the good news is your telling me that’s no longer the case that you unthinkingly succumb. Well done. So, we’re fast forwarding to 2014, YAY! Happy New Year!

CLIENT: Yes, Happy New Year!

THERAPIST: And so you did the ABC form, and you feel more comfort in the disputing?

CLIENT: I do, I do. I have one question that I think is important. Because where I’m still struggling and we can talk about the ABC’s, is I do get and again this might not be related to REBT specifically, but I get chest pain at times, like the free floating anxiety.

THERAPIST: I was about to say what corner of the room is it on right now, has it “floated” to the ceiling? (Joking tone).

CLIENT: (Laughter).Well I call it free floating only because I have tried when I have those moments, and a lot of times its more at night where I’ll get anxious, just more at night I would say, not, but maybe it’s during the day, and I might not be as aware of it, but when its dark and its late and I’m by myself [00:11:59]

THERAPIST: Less distraction at night.

CLIENT: Less distracted, exactly, exactly – less distracted. I’ll get that. So, with that said, I’ve tried to, I’ve actually thought what are the “should’s”? I’ve done that, I’ve actually done that, where I’ll swear I’m struggling and I would love to get help with this, is that once I sometimes get I’m going to call it anxiety because that really is what it is, it’s a …

THERAPIST: When you feel anxiety…

CLIENT: Feel anxiety, yeah, oh not “get” anxiety. Oh, when I FEEL anxiety because the feeling is so powerful. To me it is when my heart is racing and I’m having difficulty breathing and all of that and that when that feeling of panic sets in, what I find difficult, is once that feeling sort of sets in, or all the symptoms, let’s call them the symptoms. The difficulty breathing, the chest pains, chest tightness all of that, I then have a very difficult time even being, like what’s the, then my mind I feel like is going here and here and here, once that feeling actually comes on and so to calm my body down, I feel like I need to do that first before I then look at what the thoughts are because the feeling, I don’t, I’m a (stumbles) And then I’m sounding like I’m trying to be a, to connect neurons and (sigh) …

THERAPIST: No, No, No, I don’t recommend you do that if you are experiencing those physical symptoms, just as if someone creates rage within themselves it would be a most unrealistic expectation to suggest to them when they’re in the peak intensity and heat of the rage, to ask themselves “so now what am I telling myself to make myself enraged?”.

CLIENT: Right!

THERAPIST: So, it’s a very helpful rational strategy to calm yourself, to calm your breathing, relax your body... before identifying the thoughts. [00:14:00]

CLIENT: I don’t know how to though, that’s the problem. I don’t want to cut you off, but that’s the issue I’m having.

THERAPIST: Well then we’ll talk about it now, the How-to calm yourself, so that you get yourself to the place of doing the cognitive investigation. So …

CLIENT: So in other words you can’t ever be expected to do the investigation, you’re agreeing that when you’re in that sort of symptomatic state with all the you know, the breathing issues and all that, it’s very hard to

THERAPIST: I would not say, never, as there may be some people who get to the point after a long time of practicing REBT where by just remembering “oh, I have this tool that’s helped me so much in the past – what am I telling myself…” , it might work for some.

CLIENT: Ok.

THERAPIST: However, I can totally understand that in these early days for you of applying REBT, it’s not working like that and so I fully encourage you to do something healthy to calm yourself and your body. I say healthy, as opposed to someone doing something like having a drink or doing something else to distract themselves that really isn’t therapeutic or healthy, that isn’t for their well-being, it’s JUST a distraction. But you know, I’ll throw out a few healthy things that could be done, and you tell me which, if any of them might work for you.

CLIENT: Sure. [00:15:16]

THERAPIST: When you are in the grip of that physical sensation of shortness of breath and tightness or pain in the chest and so forth, one reminder to yourself might be thinking:” I’ve gone through this before, and I’m going get through it again. And I’m going to calm myself down because whatever is going on it isn’t the end of the world”. Tell yourself soothing thoughts, “This too will pass, I can endure this” in other words, and tell yourself: “In some moments when I’ve calmed down, I’m going figure out what I thought to contribute to the anxiety”. Calm yourself. Calm. Just as you would encourage a child who’s afraid. So, no reprimanding yourself No thinking: “OH God, I’m doing this again, no, no, no or I can’t stand it! Oh I’ll never feel better, it’s like Oh! Oh here I am again!!!” – Soothe yourself, remind yourself it’s going to be all right. “I’ve gotten through this before and when I’ve calmed down I’ll feel better and steady”.

CLIENT: I like that, the reason that doesn’t completely resonate is because of what I’ve decided is that this a lot of this all surrounds sleep. It all surrounds sleep. I don’t really get that panicky, in other words my, what I tell myself is if you don’t get enough sleep, something very bad is going to happen to you. This is what I, I don’t say this when I’m being rational during the day, it’s at night because I would go nights sometimes, being awake, awake, awake and not getting sleep and then it affects me the next day, how I work, my mood and then it becomes like almost like cyclical. [00:16:52]

THERAPIST: Now we’ve talked about this before,

CLIENT: I know we did.

THERAPIST: You tended to catastrophize about it.

CLIENT: I do, I know.

THERAPIST: And then you feel anxious about the anxiety.

CLIENT: Exactly anxiety, it’s about the anxiety.

THERAPIST: And that gets you nowhere. And the alternative is being kindly firm with yourself.

CLIENT: Ok.

THERAPIST: And refusing to let yourself believe that if you don’t get any sleep, it’s going to be terrible tomorrow. The reality is, it may be more of a struggle than if you had gotten a good night’s sleep, but can you get NO productive work done even with little sleep? I doubt it. You may not enjoy the day as much, but you know what? Worst case scenario, so, you don’t have a great day, just like you don’t if you get the influenza virus, you know it doesn’t mean for the rest of your life you’re doomed ! It may be a negative outcome as a result of insufficient sleep. But telling ourselves, we’re not going to cope or “it’s terrible”, exacerbates the situation.

CLIENT: Makes it worse I know! That much I know!

THERAPIST: Yes! And you know I think

CLIENT: It’s a punishment, I feel like it, I mean I don’t know if that’s ..

THERAPIST: What’s a punishment?

CLIENT: That is my punishment, in other words when guilt sets in about something I feel that in turn I am deprived of sleep

THERAPIST: Guilt doesn’t set in –you create it.

CLIENT: Ok.

THERAPIST: You create it by telling yourself what? [00:18:13]

CLIENT: By telling myself that I did something wrong, by not accepting myself unconditionally.

THERAPIST: And saying that you should have …

CLIENT: That if I made a mistake that it was not ok that I made a mistake – instead of thinking that whatever it was I’m human and humans do make mistakes and that’s ok. Instead of going over and rehashing everything I’ve did or didn’t do, right or wrong in my life. In fact what’s important to mention here is I did go back to my diary – I had a consistent diary that I kept when I lived abroad over a decade ago. And it was just interesting to go back and read it because it was consistent, it was pretty much every day where I wrote in a diary and it was ALL the complete opposite of what we do with REBT. It was very much the “should’s” with me not knowing it, and I read it and I said WOW, this is 15 years ago and that was how I was thinking and it came up in every, it was good to see the consistency because it wasn’t like I just had a bad day and I thought in that way, it was pretty much my way of thinking all the time.

THERAPIST: Your habit; your habitual way of thinking.

CLIENT: I only brought that up because I thought that was important.

THERAPIST: Right!

THERAPIST: You don’t have to justify it. Notice that you are, however back to the recent question I asked (client talking in background), which was how do you create your guilt? So you see, it’s by you damning yourself for not doing what you tell yourself that you “should” be doing according to the gospel of Jessa.

CLIENT: Yep!

THERAPIST: So you see how self-defeating that is.

CLIENT: It is, it is, it’s completely debilitating.

THERAPIST: And you’re willing to keep working at changing it?

CLIENT: Yes!

THERAPIST: Preventing it?

CLIENT: Yes, yes I am very much. Yes absolutely.

THERAPIST: Good ! So – I want us to complete, before going on to anything else, discussing a strategy that you can use if you find that you’ve created anxiety and panic about not sleeping enough, or about anything in fact. Choosing a strategy that you can be conscious of, and apply.

CLIENT: I would love that!

THERAPIST: To address that panic at the time you feel it, so you can lessen it to the degree that you can then apply REBT to further lessen it. SO, that’s what I want to discuss in a moment, after that let’s go back to talking about your homework, the example of the ABC that you’ve got today.

CLIENT: Ok, ok.

THERAPIST: SO – tell me if you can what you think would work for a small child in your care who was, let us say, sleeping over at your home, who came to you heart racing and breathing quickly and saying “I’m so nervous, I’m so afraid, I’m so anxious Jessa What, what can I do?” How might you soothe that child?

CLIENT: It’s exactly what I tell the students that come to me when they are anxious during the day. Not necessarily when they are anxious at night. What I generally tell them is that, because what I see is that they’re putting pressures in some way, or expectations on themselves, when they’re in that state.

THERAPIST: You wouldn’t tell the child that.

CLIENT: No, no, no, no, no, No I don’t tell them that.

THERAPIST: What would you tell the child?

CLIENT: I’m saying, what I NOTICE in them, so then what I say to them, whether it works or not and they seem to like it, is I say how old are you? And then they’ll tell me, because I only work with kids up to 5 -10, in the range of 5-10, so they’ll usually say their age is 5,6 7, 8, 9 or 10 and then I’ll say you’ve only been on the planet for what, like eight years? or whatever it is, and they’ll say yeah, and I’ll say in those eight years what did you do so wrong that you need to beat yourself up? I like make it light with them and they say, nothing, and I say that’s exactly right, you’re a child and you don’t have to worry, you don’t have to have those worries and you can just be a kid. Whatever I say, they seem to relax after coming in all frazzled.

THERAPIST: What do you think it is in what you said to them that when they believe it allows them to relax?

CLIENT: Because I think that they put it into perspective, that it isn’t really them to blame if their parents are let’s say fighting all the time or if their homework isn’t done exactly how their teacher wanted it or if they spoke in class out of turn or whatever is that they have done . And I show them that now what they are doing to themselves by torturing themselves basically if that’s what it is, is not matching up to whatever the action was that they did.

THERAPIST: It’s disproportionate.

CLIENT: It’s disproportionate to whatever the action was or wasn’t and then the other thing is, what I do tell them, is they’re a child and that they’re learning. If they do make a mistake they have the ability to be able to reflect on it. I’m not as nice as that to myself, I don’t feel [00:23:19]

THERAPIST: Oh, you don’t say! (laughing)

CLIENT: (Laughing) You know you’re an adult, you are responsible for all those adult things, and it’s the children I feel I need to protect. That’s kind of how, you know, I know that if I can’t help myself I can’t help them, but …

THERAPIST: That’s not true, because you do help them.

CLIENT: I do help them, I don’t know how that happens, I don’t, but yes, I help them a lot. No I’m saying because I don’t know, because usually people say if you are very kind to yourself you help them.

THERAPIST: Oh! People ! “Usually people say …” There you go paying attention to the opinions of the masses! Ok, let’s come back here now!

CLIENT: Alright, we’ll come back, but that’s what I do, and then they relax, I could see their bodies relax and there are times where I wish I could do the same things that I do for them, for me!

THERAPIST: Well that’s what I’m suggesting you do! (laughing)

THERAPIST: Funny thing that! (laughing)

THERAPIST: So, can you now, just reflect, just slow down and reflect.

CLIENT: It makes me emotional or I get emotional, I don’t want to say it ‘makes me’, when you say that, because when I think, I was like, am I gonna cry today?

THERAPIST: Is there a problem with your crying for you? Because it isn’t any problem for me.

CLIENT: Ok, thank you Debbie.

THERAPIST: I invite you to feel what you feel, and we can talk about it.

CLIENT: Ok, I unfortunately, I don’t think that I really, realized how much whether it was in a loving way or not, how much I was continually criticized for just anything and everything that was done or not done and I don’t want to go back, I don’t want to go back but every time that we get to that point where you say just think for a minute and be that child or whatever it is that you’re telling me try to switch the page a little bit and think about it. It’s like my immediate go-to is Jessa you did something wrong, and I know or I want to say that I know that that’s not possible that I did all these things wrong, but my beautiful, wonderful parents shared all the time that I did, but it’s really, really challenging for me to get out of that chorus of voices that constantly just comes up, you did something wrong, you did something wrong, you did something wrong. Because even when I looked back in my journal, that is what it always was. I was always told YOU DID SOMETHING WRONG. Whether it was something right or something wrong or there wasn’t even a right or wrong in that situation, it wasn’t let’s sit down and talk about it, it was you did something wrong. So, looking at these children I work with, and being able to help them as much as I do, I sometimes think that I’m able to do that as well as I do and I feel confident that I can help the kids because I treat them how I wish, I WISH, I definitely feel like I am getting upset but, I feel like I treat the young children that I work with the way that I just wish somebody would have treated me, and I don’t feel like I ever go that, like (starting to cry) that experience. [00:26:21]

THERAPIST: You didn’t, from what you tell me, you didn’t get that experience, that’s the reality.

CLIENT: But I STILL don’t!

THERAPIST: Then you STILL don’t from them.

CLIENT: I get it from others, I know I do but its not the same as from parents.

THERAPIST: And even when you get the support from others, I wouldn’t want you to rely on that in order for you to feel good enough. The thing you seem to me skipping around now, and I’ll keep coming back to it to remind you when helpful, you appear to want to avoid looking at it because you are reluctant to feel emotion, according to you – that is what you said, and I actually welcome you to feel your feelings.

CLIENT: Because when I cried, I got in trouble for it so …

THERAPIST: Oh! When was the last time I beat you up for emotion?

CLIENT: You didn’t,

THERAPIST: No, I didn’t

(Small pause)

CLIENT: It doesn’t affect you the same way I guess it affects my mom or my dad when I’ve, If I cry and they’ve, you know, that’s how I look at it, it might not be the case but that’s how I’ve looked at it. That I am now ruining everything, that, their day because I had an emotion you know.

THERAPIST: Well now, using the perspective of REBT, please can you step out of the role you play in the family scenario, be an observer, and see they ruined their own day with their particular, peculiar way of thinking. YOU didn’t ruin it. We are not here to spend time now figuring them out, we’re looking at them in relation to how YOU are allowing the behavior they did in the past, and still can tend to do, to affect you NOW. [00:27:55]

CLIENT: I know.

THERAPIST: And really it is up to you to work on not letting it affect you.

CLIENT: I really wish that wasn’t the case Debbie, I really, that’s why I want help.

THERAPIST: You wish that what wasn’t the case?

CLIENT: That I DIDN”T allow them to affect me the way that they do. I do, I mean I know I do.

THERAPIST: Well, that is what you are here to do. You are not a failure because you haven’t done it yet. You can never be a failure. You can fail at some things but until recently from what you’re telling me you haven’t even thought about some of the things that our sessions have brought to light, have brought to your awareness. So, its early days of your use of REBT. I might say to you Jessa, just as you would say to one of your students, how long have you been in this REBT world? And you might say two months (both laughing) … I might be saying, well little baby girl (laughing) how could you be expected to do it perfectly? You couldn’t. And by the way, I’ve had some clients who have come over a period of years and made steady progress. But it’s not the case that overnight there was a massive transformation in them. AND I have also had clients who have made massive transformations in a short time. It’s different for each one of us, and what I am NOT willing to do is to say that there is a certain time period by which you should achieve so and so. Steady progress is good, and right now we’re bringing to light something that has been an obstacle for you – which is very helpful. With awareness, you can change it.

CLIENT: It’s an obstacle yes.

THERAPIST: And, your habitual tendency to be rougher on yourself than you are to practically anyone else in your life – that is helpful to observe. So what’s the action required unless you want to keep living in this pain?

CLIENT: No, I don’t, no I don’t. I don’t want the pain.

THERAPIST: Is the remedy for you having willingness to be kinder to yourself and to soothe yourself

CLIENT: Exactly.

THERAPIST: In the way you do with others.

CLIENT: Yes, exactly

THERAPIST: And then after you have done that, calmed yourself, you can get your detective hat out and say “Well look how I created this anxiety”, identify the irrational beliefs, and get to disputing them. So there’s a solution if you’re willing to be easy on yourself. What’s happening right now for you?

CLIENT: I’m just listening to you and I appreciate it because I do see the connection, and I see that unfortunately I think where it’s more of an obstacle is that I am close with my family and that I do want that relationship with them but yet I find it challenging because what I’ve tried to do is back away a little bit when I know that they are criticizing me, and I see that doesn’t really work.

THERAPIST: You mean you tried seeing them less?

CLIENT: Either see them less, you know – stay over less. I haven’t really gone there in a while but like when I did I used to think “Oh go and sleep over” and you know do all that and I would get excited, I don’t know, and you know just have less or talk to them less about different things and I just don’t, those haven’t really, those solutions haven’t, they haven’t been solutions.

THERAPIST: Why? It is good for us to look at that. Why haven’t they worked? Let’s get clear about why they haven’t worked so we can get clear on what can work.

CLIENT: Sure, sure, sure. So, should I use an example maybe, and figure it out that way? Because I don’t know that. I would say the reason is, because no matter what … no I know why, I don’t have to use an example. Because no matter what I do, my parents and the way that they are is that their tendency is to be more, more up and then they can be down. A little bit this and then that, sometimes they’re in a good mood and I get a good reaction out of them, sometimes they’re in a bad mood and I get a bad reaction. So it’s a little

THERAPIST: So are you basing your comfort on their moods?

CLIENT: Well that’s what I was gonna, that was what I was gonna say. So let me say that because that’s what I think it is. So what happens in turn is that I base whatever if they say, ooo my little pooboo, my little, which happens, they say right my special angel who is so wonderful, how are you feeling today? And then I would walk away and I’d say W E L L my parents think I am okay. Wow. I’m 35 and I’m still looking for that approval, and I love it – that approval and it feels great! And they love me and how great how I feel. Within 20 minutes I could get another phone call “Jessa” – and say something like:” not now this is ridiculous, I don’t even know why you’ve asked me this question, I don’t even know why you care, you’re ridiculous and I don’t have the time for this”. Ok. So that can all happen within 20 minutes, it’s like living with an alcoholic. And they’re both kind of seemingly like that in their own way, both mom and dad. So, what I, what my tendency is, I get that from them – changeability and all.

THERAPIST: You mean, what your tendency has been till now.

CLIENT: Has been, that I get THAT reaction and then I take it on. So, instead of saying “oh that’s them” and that’s you know, how they’re being and they’re in a bad mood because of XYZ and that has nothing to do with me, or you know, what have you, I then in turn reflect it 100% on me, not even 90% , and think I have done something wrong or not well enough.

THERAPIST: You are blaming yourself.

CLIENT: Well I blame myself for it. And then I feel guilty for inconveniencing them because they don’t want to hear it at that moment. So I will then in turn torture myself just based on their reaction, whereas if I have a very positive you know, you know situation, for instance you know, and they cute talk to me my little, my little booboo where are you? I love you I can’t stop thinking about you sending you love”. Sounds a little crazy and cuckoo but that is what I get from them, right. OH – wow I’m so emotional I have been trying, it’s like a tight rope, after I tried to balance my emotional sort of temperature so that I don’t get affected by that text message or phone call from them, but then, and I can do that when it’s the I love you’s and not get so affected, but then when it’s the opposite, I have a hard time with that. [00:33:45] So, I’ve gotten to the point where I don’t get so, taken by those types of comments from them, you know, “oh you’re my baby and my special one”, and I have been able to distance from that and take the emotion out of it but I’m having a very hard time doing it when it’s the opposite, when its beating me up over this or that. Why, probably, because that happens more. This probably happens a lot more than, AND it’s not rational. I mean there’s nothing rational about it.

THERAPIST: BUT you’re acting as if it is, you’re taking it seriously

CLIENT: Yes. Because they’re educated people who actually, I BELIEVE know what they’re talking about. I’m starting to see Debbie and that has given me hope, I’ve had a lot of progress with this – I see that they don’t know all and I don’t look now at them as the perfect people I thought they were when we started REBT. So I see there has been a lot of growth and there has been a lot of change, I just think that as humans things are complicated and it doesn’t always come so (snaps her fingers) like that. So quickly. You know, I don’t think it happens so quickly.

THERAPIST: Yes! Good Jessa. Well said. But notice that, though you’re saying that now, earlier in the session when we were talking, you were, sharing how hard you are on yourself

CLIENT: Because I just got off the phone with them right before the session. That’s why.

THERAPIST: We were talking about your saying that you were not feeling familiar with, or comfortable with, the process of disputing.

CLIENT: No I, no, no, No I was, NO I said earlier, I said that it WAS getting, getting better for me.

THERAPIST: When we were talking about your giving yourself a hard time, last year,

CLIENT: Oh, yes, – I got you, I get it.

THERAPIST: It seems there has been progress with regard to your taking your parents off the platform of deities, and you are willing to start to see them as humans, fallible humans, as each one of us is. [00:35:30]

CLIENT: Fallible, yeah no absolutely, I see growth and progress within myself, I think where, where, where I still continue to struggle is, is that, I think two sessions ago, not like the last session we had but maybe it was the one we had before, we did talk about sleep and I remember that you know, you had said that if you don’t sleep or you even said it today, that it is not the end of the world. But I guess I look differently at, at sleep, because I feel like sleep is the best gift that we can ever, I feel like it’s a present, so then I feel like I’m taking it away, the gift, when I don’t sleep enough. I truly, if I think about any gift we’re given that’s a NATURAL gift, like a natural born gift, is that we all have the ability to sleep and so, when I don’t …

THERAPIST: But if we all had the ability to sleep then we’d all sleep! You’re telling me there are nights you don’t!

CLIENT: Exactly

THERAPIST: Yes.

CLIENT: But I feel like I’m the only one! The only one who just lies awake, that’s the thing. All the people I associate with they’re like oh I just go to bed, I’m like, my best friend, my girlfriend, their like: “I just go to sleep”. And I’m like no! That’s not fair. I have trouble!

THERAPIST: Would you, would you dare to believe me if I told you your well-sleeping girlfriend does not represent every human being on the planet?

CLIENT: … and my best friend, and other best friend, the two people that are like the closest people to me …

THERAPIST: OH TWO more people who sleep! Oh alright, well (both laughing) they happen to be able to sleep easily and well. You know there are sleep clinics, there are people who, there are a lot of people who have trouble sleeping. If you were the only one with sleep difficulties, such clinics would not exist!

CLIENT: That’s true.

THERAPIST: The people who sleep best are probably, I hypothesize here, people who if they don’t get enough sleep according to their preference they don’t make a big deal of it!

CLIENT: Exactly, exactly!

THERAPIST: They don’t catastrophize about it.

CLIENT: I know that! I know that! I know that’s what it is!

THERAPIST: And I shared with you, I think a session or two ago about the period In my life when my husband was ill for over 15 months and I would sleep, well – hardly sleep, I would stay with him, wherever he was: be it in the hospital or the rehab. I can’t remember a single night during that period in which I didn’t get woken up by his groans rom feeling pain, or his needing something. I might have slept 45 minutes then woken, then I would try to soothe him or stroke him gently or give him something, and then I would lie down again. The fact of the matter is, I wouldn’t recommend it, not getting a full night’s sleep undisturbed for 15 months, it wasn’t healthy however my choice at that time was to put up with the sleep deprivation as best that I could, or not STAY with him. I chose to be with him. I would not have wanted it differently – I chose to be with him. And you know what? I survived. Even if I’m somewhat functional now (laughing) maybe I would be a girl genius if I had gotten more sleep but I don’t think so! [00:38:14] Point is – I got by.

CLIENT: Right, right.

THERAPIST: I survived and so can you. You can choose to convince yourself that you MUST have enough sleep or you just will not function well and that is awful, or you can go with the flow more, do what you can to improve your sleep, but if or when you don’t sleep well – to NOT catastrophize, to accept. Your choice.

CLIENT: You are so amazing Debbie! You really are and I’m not putting you on a pedestal when I say it, I just think that the way you present things to me has been so helpful. I feel empowered! I do, I definitely do, I haven’t felt like this, or I haven’t thought like this! (laughing)

THERAPIST: Thank you, that’s very nice of you to say but

CLIENT: But it’s the truth.

THERAPIST: Thank you, But now I want you to express to me in your own words, what you are prepared to tell yourself if you wake up at some ungodly hour and there’s a feeling of panic.

CLIENT: Exactly.

THERAPIST: What will you tell yourself to soothe yourself?

CLIENT: Well, I would say that I would acknowledge the fact that I was awake, (laughing) I would say ok I’m up now because it happened the other night, there were some loud noises, and I got woken up at 4-o’clock in the morning and then I wasn’t able to go back to sleep. So in looking back at it I actually did not catastrophize that time around, I said ok, well now I’m awake and it’s very hard for me to go back to sleep and I’m going to watch something on video, I put that on and I haven’t been watching T.V. So what I would say to myself is it’s unfortunate that I’ve woken up, I wish that wasn’t the case but I will survive regardless of not getting the full eight hours, the perfect eight hours that they talk about in magazines and in Dr.’s offices , (laughing) and that I won’t even, or do I dare?!!! throw in that my mother would constantly say to me you need eight hours!!

THERAPIST: It appears that you dared to throw it in!!!

CLIENT: Ya, Ya, I had to – but I’m laughing at it!

THERAPIST: That’s fine!

CLIENT: And I will refuse to allow my parents voices from what I heard as a child that “you know you are messing up if you don’t do XYZ”, I will take that out, because I don’t think I realize how much that comes in when I’m awake at 4-o’clock, 5-o’clock, whatever time it is that I’m up, when I “shouldn’t” be up, and I put that in quotes ... (laughing) but you know, I think that if the dialog happens and if I can’t calm down or if I don’t calm down, or if I have that feeling: that’s that panic stricken feeling that I will work on doing some of the things that you said to do earlier, but I also think I will talk to myself and say you know what, what would you say to one of your students right now? But really truly say that, instead of pretending like I’m just going to do it to do it. If I really want that help and I want to be able to go back to sleep I would say what would you tell one of your students and the other thing is – it’s not all about me, cause I think sometimes what happens is, I get into this state where I feel like the next day everybody is going to be knocking on my door, which they do at work. That’s ok because I have the right to have a boundary and to be able to help people as best as I can, I don’t have to help the world every single day of the year. [00:41:41]

THERAPIST: And do you have to do perfectly, wonderfully at work every day when you have a slightly off afternoon !!!(said in jest).

CLIENT: Yes, yes and I will ALLOW myself to do that, and especially in 2014 – have boundaries.

THERAPIST: YAY!

CLIENT: The more I allow myself to do that – I think the better days I’ll actually have in fact I feel like my sessions have been even better.

THERAPIST: Because?

CLIENT: Because I’m not beating myself up this much, as much.

THERAPIST: As much.

CLIENT: As much yes, I still do …

THERAPIST: Let’s be real here.

CLIENT: Yes, let’s be realistic. NOT as much and I’m using a lot of the REBT techniques with the students and they benefit.

THERAPIST: Which, reinforces REBT for you by the way, when you share it with others.

CLIENT: It totally reinforces it And it’s funny because they’ll look at me and I’ll say, what are you telling yourself?…

THERAPIST: You tell them that? Very good!

CLIENT: I say what are you telling yourself? and I get more of an answer from them when I ask them that, as opposed to any other questions, because it makes them stop and think, or it allows them, I don’t want to say makes them, but it allows them, it opens up the gates to actually stop and say wait a second, what am I telling myself, and kids are so great like that, because they are very fresh and so they do give me answers.

THERAPIST: You help them realize they’re creating their thoughts and they can create different ones.

CLIENT: It’s empowering to them. I had some really great sessions today, and if I didn’t have a great session it was fine, I mean it wasn’t, you know the end of the world, if it wasn’t perfect. I think I’ve tried to be this this perfect entity and it’s just not realistic.

THERAPIST: That idea, where did you get that expectation? Where did you learn that?

CLIENT: Is that a trick question?

THERAPIST: No.

CLIENT: Oh, you really want to know? My parents

THERAPIST: From believing what you heard from them. You now, at the age of 35, have the choice of maintaining or rejecting any irrational ideas.

CLIENT: I know… Well, I’m going to work on not allowing that (inaudible) [00:43:30] that’s the whole point, is that I can’t say that when I do have that recognition, I will ok, you know, put it into perspective and, you know, be able to I think the missing piece was that I was always looking to others to be soothed and in reading Albert Ellis’s and your book, I feel like he had a little bit of that flavor as well and then he went walking in the park and was in love with Kathy, and I don’t remember if that was her name …

THERAPIST: Karyl.

CLIENT: Karyl. When he said wait a second, I have this like it was this epiphany that you know that it would be nice if, sorry to bring up Karyl, (laughing)

THERAPIST: It’s fine. No you’re not hurting anyone.

CLIENT: So, I was reading that and you know sometimes when you read things, I don’t know If this ever happens to you but you read something and you can read it and just read it. Like if you were doing something, if you could remember when you were doing your studies. Right, this is how I would do it; I would read it to memorize, just to do well on the test. That was how I learned. I would say ok, so the Indians, Pocahontas and I wouldn’t read it and that’s what’s bothersome to me about sometimes how I was in schools.

THERAPIST: Ok, get back to Karyl, and get back to you.

CLIENT: Ok, sorry, this is what I do. Ok. I don’t DO this but I’m a little, I’m excited! So getting back to Martha and Al so depressed she rejected him and then what he said was it would be nice for her to love him the way he loved her, but because he didn’t NEED –just wanted, he didn’t NEED her love and approval but that it would nice and he would still go home at the end of his walk and still appreciate it if she loved him more, if it happened and enjoy it if that happened but if it didn’t, HIS self-worth wasn’t dependent on her loving him, and he didn’t, he wasn’t crumbling basically if he wasn’t getting that from her and he felt quite annoyed that he said something like the garbage he was putting up with, he didn’t use that word exactly but it was something like that.

THERAPIST: Oh he might have!

CLIENT: Something like, the crap that he was putting up with all along

THERAPIST: How do you relate that story to your life now?

CLIENT: So, I think at work I have been seeking out and looking for people to say, Oh Jessa , you know, you poor thing, with what you’re going through and you know, and there are a lot of people at work, they just go to work and they are in their own worlds and they are caring or not. Whether I felt before they were very compassionate human beings with me or not, before this whole thing with my pain and neck trouble, with what’s been going on, that we’ve mentioned many times with my neck, and so I think that what’s been helpful in a way for me in going through this big challenge, huge challenge, is that I’ve realized that you’re not always going to get what you want from people necessarily and that’s not awful, and I don’t have to then be dependent upon them, I don’t need that. Would it be nice if somebody came over and said how are you? would I take it graciously if they said how are you doing? Are you ok? I’ve been thinking about you. I’ll welcome that in, 100% I would, and say wow, that’s very thoughtful and very kind and I’ll appreciate it. But if it doesn’t happen, I’m not going to then let that affect my day.

THERAPIST: Or make yourself feel devastated …

CLIENT: Or be devastated by the fact that it didn’t happen. What I find happens more, is when you let that go a little bit, it comes even a little bit more, because I guess people can pick up, I don’t know.

THERAPIST: Well, when you lose your desperation, more people may respond.

CLIENT: Yeah, it’s almost like desperate, but is that “Desperately Seeking Susan”? Remember that movie?

THERAPIST: Not really.

CLIENT: “Desperately Seeking Susan” was a movie, you know when your longing, the desperation comes out of your pores, (laughing) even if you don’t say it, well that’s what I think, that’s my hypothesis.

THERAPIST: So, people can pick up on it.

CLIENT: They can pick up on it or they don’t know, or my other hypothesis is that some people don’t really know how to respond when they see somebody like me who is generally bubbly and happy, who then is coming in and is in a lot of pain and that’s ok, that’s ok, that’s not for them, that might be their deficit, and that might not be my deficit or maybe I’m not picking up on something that somebody else is going through so, you know that’s the way it is.

THERAPIST: Over what do you have power?

CLIENT: The power is in what I tell myself and how I say that it would be you know, not the end of the world, if the expectation wasn’t met.

THERAPIST: Exactly.

CLIENT: Or not even to put the expectation there because people do have lives and you know people get into their own life and things and they don’t always stop to think about others, how I am, and that’s being human.

THERAPIST: Correct

CLIENT: That’s a little less obsessive when you’re waiting for attention from others, you know with baited breath, and it really, the people can disappoint you.

THERAPIST: Where does it get you to wait for anything from someone else with baited breath? Where does it get you?

CLIENT: Absolutely nowhere. THERAPIST: Nowhere good!

CLIENT: And circles, it just goes in circles.

THERAPIST: And it can be self-defeating.

CLIENT: And self-defeating, yeah.

THERAPIST: So, if you wake or are awoken before you’re ready, before you’ve had enough sleep and if you catch your thoughts, and you are feeling anxiety and having the physical symptoms. What will you tell yourself to soothe yourself?

(Pause)

CLIENT: I’m not trying to think of the perfect answer, I’m just trying …

THERAPIST: You’re NOT trying to?

CLIENT: Yeah, I said I’m not trying to.

THERAPIST: Good.

CLIENT: I’m just kind of thinking about it, because I think, what I will tell myself is that actually I think it’s pretty simple as you don’t have to be, I know this might sound,

THERAPIST: Just say it.

CLIENT: you don’t have to be perfect.

THERAPIST: Hello!?

CLIENT: I will tell myself You don’t have to be perfect and, and, I don’t want to say there is no such thing as perfect because, in other words.

THERAPIST: Too much intellectualizing for 2:30 a.m.!!!

CLIENT: That’s what I’m saying!! That’s what I’m saying, exactly!

THERAPIST: What are you going to tell yourself?

CLIENT: You don’t have to be perfect so that in your mind if you’re thinking that getting

THERAPIST: In MY mind Jessa ?

CLIENT: In MY mind Right in MY mind, if I think that getting eight hours of sleep is the best thing for me or the perfect thing for me, that is BS because there might be nights where I do get awoken and that’s ok and I could maybe take a couple of deep breathes I could say Jessaeverything is going to be fine, I could say you are somebody who’s been through a lot and you’ve survived you’ve made it, you did have sleepless nights before you never did die, you know you woke up the next day.

THERAPIST: (Joking) You only murdered one or two, not 10 people…

CLIENT: YEAH, mentally murdered (laughing). You might be crabby the next day, that’s fine too. You might be crabby even if you do get eight hours of sleep, you know, so just sort of talking to myself and being kind to myself and saying, let’s not, you didn’t do anything so terribly wrong, because I look at it as that’s a good way of punishing..

THERAPIST: In the PAST you’ve looked at it

CLIENT: In the past I’ve looked at it as a way

THERAPIST: SO now you’re determined to do what ?

CLIENT: To be kinder to myself and …

THERAPIST: As you would be to a child

CLIENT: As I am with the kids that I work with, students yeah.

THERAPIST: After our session today, would you be willing to write down some of the things that were meaningful from our session.

CLIENT: Absolutely.

THERAPIST: Particularly write down what you will say to yourself more or less, not verbatim. If you are experiencing those panic symptoms, be it from insufficient sleep, or you are awake or for any other reasons, write down the thoughts connected to it. Sometimes you felt panic, according to what you’ve told me in the past, not related to that …

CLIENT: Not related to what? Oh Sleep?

THERAPIST: Insufficient sleep

CLIENT: Yeah A lot of it is, a lot of it is.

THERAPIST: So, would you write it down, especially emphasizing your healthy attitude of acceptance and non-awfulizing, and read it every day till we see each other next time, just to get it into your mind, more consciously, more substantially.

CLIENT: Sure, sure, sure, yeah! I would be happy to do that.

THERAPIST: Ok. So, we don’t have a lot of time left in this session, but do you feel complete with what we looked at?

CLIENT: I do, I do.

THERAPIST: Step one: Soothing yourself and talking yourself out of panic, and then applying the REBT steps, disputing and replacing irrational thoughts. This relates to what you shared before, and thinking that you can’t adequately do the REBT when feeling panicked, and I agreed that may at times be the case. Not necessarily that you can’t do it, but that it may be more difficult to go through the first steps with yourself till you have calmed yourself.

CLIENT: Got it.

THERAPIST: Alright,

CLIENT: Yeah, they’re easy to do. Not very easy but, I’ll do it.

THERAPIST: Even if now it is not very easy but – is it do-able for you?

CLIENT: It’s do-able

THERAPIST: And the more you do it, the easier it will become.

CLIENT: Ok. (laughing)

THERAPIST: But, I’m not going say how soon it becomes easy, it is different for each person, you can tell me how it becomes easier as you keep on making effort.

CLIENT: Of course! Of course, I’ll let you know.

THERAPIST: As time rolls on. Ok so the second thing we were going to look at was the ABC.

CLIENT: I’m excited to share it because I feel like this was the first time I was able to dispute and dispute and dispute. I used to get stuck! In the past I would get stuck at that, I wrote down the A, would love writing down all the B’s(making a sound) irrational beliefs. I didn’t have the paper with me, so I didn’t remember what that was called but I knew it was that C were the consequences when I tell myself all that, but that was the irrational belief. And then I would get to the disputing and I would feel stuck. Today that was NOT the case when I did it, so I was excited and happy that that I felt like I crossed a new, went over to a new side. Ok. So, should I share? (clearing throat)

THERAPIST: Please: share. (no shoulds !)

CLIENT: So the activating event is I am in a tremendous amount of pain, I have been. And have been seeking to find appropriate medical professionals for months. I finally found one surgeon who I liked and was ready to schedule the surgery when some of the pain decreased and things weren’t as inflamed. Its nerve pain, so some went down. And I have been keeping a journal and you just don’t know when it’s going to be. The consequences because of that; here I am ready to schedule surgery with this surgeon, fear, anxiety, worries of pre-regret, I haven’t even had the surgery yet and I’m already thinking that I’m going to regret the surgery. And concerned about making a mistake, if I go ahead and do it, looking back and saying why did I do it?

THERAPIST: Fear and anxiety are the unhealthy negative emotions. Concern is actually a healthy negative emotion.

CLIENT: Oh, so there you go, healthy is my constant hardly..

THERAPIST: But it’s important that you distinguish between healthy and unhealthy emotions. REBT does not aim to create apathy – it wants us to feel healthy emotions.

CLIENT: I understand that!

THERAPIST: We want healthy emotions! Feeling concern motivates you to keep alert, to take action. Anxiety can paralyze or create panic attack symptoms.

CLIENT: Exactly.

THERAPIST: So, Ok carry on.

CLIENT: So, here’s how I did it. The way I set it up was I would do, I wrote down all the, the ones, all the irrational beliefs, but then I did, I would take one and then do the dispute.

THERAPIST: Perfect!

CLIENT: So what I’m going to do ..

THERAPIST: I said “Perfect”! You didn’t catch me!

CLIENT: I did catch it, I got that you were being funny … So what is the way I’m going to do it?

THERAPIST: Give me each irrational belief.

CLIENT: And then the dispute, just that way. So the first irrational belief is: If I make a mistake and screw up, I will feel regret for my whole life; very irrational.

THERAPIST: What’s irrational about that? Which part of it? Just specifically which part of that sentence irrational, because not all of it is irrational necessarily. Which part of it?

CLIENT: Whole life

THERAPIST: Yes.

THERAPIST: That kind of prediction has no basis. Can you predicting the future, and what will happen for the rest of your life !

CLIENT: Whole, whole is irrational .

THERAPIST: And that kind of negative prediction that” I’ll regret it for all of my life”.

CLIENT: Ok, so then the way that I disputed was: If I make a mistake life will go on. I am human, all humans make mistakes. I do not have all the answers and there is no such thing as the absolute. And there is no such absolute answer especially with something like this.

THERAPIST: Very good.

Ok, two: Others will think I am dumb, impulsive and not thorough if I get the surgery now.

THERAPIST: Ok, that, as you’ve written and stated it, is not necessarily irrational

CLIENT: Oh, that’s more of a statement?

THERAPIST: Well, others may think that.

CLIENT: Well, can I say how I disputed that?

THERAPIST: First tell me what you think would make that irrational?

CLIENT: If I allow it to affect me

THERAPIST: By adding to what you wrote by thinking that “it would be awful” or “I couldn’t stand that”.

CLIENT: Oh! oh, oh ok! That, I didn’t put that in there, but that was what, that was THE irrational. Ok – I just want to add that in (turning page – writing)

THERAPIST: Please add that in…

CLIENT: And I can look back at that?

THERAPIST: Yes. Because even if others may think you’re out of your mind, some people just won’t care, those musings are not irrational, but when you add to them – “and I couldn’t stand it if …and that they shouldn’t ….” – then it becomes an irrational thought or thoughts.

CLIENT: You know what’s really funny though? When I was writing it, I didn’t think, I wrote that just now but when I was actually writing it I was thinking alright and then this is how I dispute it. Others can think what they want, that’s their opinion. It’s my body and I will decide what’s right for me and nobody else can do that. I really truly believed that when I wrote it. (laughing) I don’t think I believed that before. Cause in the past I would think – “mom, dad, what should I do? What should I do”?

THERAPIST: You have the RIGHT to make choices, and experiment – try this and try that.

CLIENT: Oh! Oh ok, ok, ok

THERAPIST: Because to have an expectation that you can know what’s right for you already, will add pressure to you.

CLIENT: I get it

THERAPIST: Remember, one of your goals is to be kinder to yourself.

CLIENT: Number three was: If I get surgery it can make things worse. Now I know you’re going to say that’s not irrational, that’s a possibility. For it to be irrational I would have to add” and that would be awful”. Did put that in on paper? No but that is really what I think.

THERAPIST: Hang on, what were you going to say that I was going to say?

CLIENT: YOU were going to say that! (stumbles) That it could make things worse! But I didn’t put it in that way

THERAPIST: It may or may not make things worse.

CLIENT: May or may not, but I didn’t put in “and that would be awful”, which is what makes it irrational, which is what creates anxiety.

CLIENT: So, oh I got it. So three was I said if I am already in a lot of pain and if things get worse, that was the risk I took. Oh see, now no, no, no, hmm, I don’t know if that’s, now I’m looking at it differently but that’s fine. I thought it based on what I felt was needed at the time.

THERAPIST: Thought, not felt, was needed at the time.

CLIENT: Oh, thought, ok. (writing) And then I added a little spiritual thing. I said God can help me here with knowing all the paths, knowing the course of things happening for a reason, and all will be ok. Because I think what I’m having a hard time with is just feeling like this has been going on for a long time and that I don’t have an answer to which way to go and so that’s where I put it on God.

THERAPIST: And you don’t have an answer.

CLIENT: And I don’t, so I said – God will you help me out here a little bit?

THERAPIST: Well you don’t have an answer that is certain and brings guarantees. There are probabilities.

CLIENT: Exactly, it’s rolling the dice.

THERAPIST: Which is part of the human experience. Trying, experimenting, taking healthy risks.

CLIENT: Ok, four was: I’m in so much pain and I fear it will not go away without surgery. And that would be a catastrophe.

THERAPIST: Is that what you believe?

CLIENT: Yes

THERAPIST: Ok, so that end sentence is what makes it irrational, do you see that Jessa ?

CLIENT: Oh, I understand, ok. Ok, I’m still, I’m learning.

THERAPIST: You are learning, very good.

THERAPIST: Why is it hard to write that part though, if that’s what I’m thinking then I guess putting down on paper seems …um….

THERAPIST: You don’t want to set it in concrete?

CLIENT: I guess not.

THERAPIST: Guess what? Paper can be burned. And ideas can be changed and even concrete can be smashed. So get bold, look at your assumptions and irrational thinking, so you can clearly dispute and destroy those unhelpful or debilitating thoughts.

CLIENT: Excellent.

THERAPIST: Glad you think so !

CLIENT: So next was: I don’t have to decide anything at this exact moment in time; slow and steady wins the race. I will document my pain level each day in a journal and try to look for patterns. If each day is good for a solid two weeks I will proceed accordingly thereafter.

THERAPIST: Which is a very good practical strategy, however, you neglected to address specifically the thought we identified: ”and that would be awful”.

CLIENT: Wait, in just that second part of it?

THERAPIST: Yes, remember you added it just now.

CLIENT: I did add that, right!

THERAPIST: “And that would be awful” – That is the part you had better, if you want success in disputation, breakdown.

CLIENT: Ok.

THERAPIST: So, could you dispute “and that would be awful”.

CLIENT: Oh, I see what you’re saying, um

THERAPIST: In addition to what you said, I mean it’s good to give yourself healthy, rational information, when disputing the nonsensical ideas.

CLIENT: I didn’t think I was able to do that before so I was excited about that.

THERAPIST: No, it’s very good!

CLIENT: Instead of catastrophizing, oh no wait a minute – here I go, I can say you have options, you can delay it, you don’t have to decide, no one’s coming in with like a gun telling you, you have to get surgery tomorrow.

THERAPIST: That is a healthy part of putting it in healthy perspective. Very good! So I’m not saying that the first part is wrong, but keep investigating and identify the thoughts that make ideas irrational.

CLIENT: No I know, add to it – make it more

THERAPIST: Address the awfulizing, don’t neglect that. So now would you please address the awfulizing?

CLIENT: So, um – what was my thing again? (looking back, recites #4 option)

THERAPIST: Address that, dispute it now.

CLIENT: Ok.

THERAPIST: How would it not be awful, even worse case scenario, how would that not be awful – with “awful”meaning: the worst it could be.

CLIENT: How would it not be the worst that it could be? That it would be possibly uncomfortable, not ideal, not really what I would aspire to have in my day, however I could still go on as I have been doing and survive, and not just survive I might even be able to have enjoyment despite having the pain. I could do things and maybe be distracted from the pain by some things.

THERAPIST: AND keep looking for other solutions!

CLIENT: And keep looking for other options.

THERAPIST: Where there is life, there is hope. And have hope, continue to have hope.

THERAPIST: Important, so you are clear on how that is a solid part of the disputation.

CLIENT: Yes, I am very clear on that. One recommendation that I do have, I would love a book that has just a list of like lots of example of irrational beliefs and then, you know when I’ve tried to (stumbling badly) (laughing)

THERAPIST: I’ll complete it in 2015 !

CLIENT: I will do all the irrational beliefs, and I would love that!

CLIENT: Ok next I’m afraid to bother the surgeons with my neurotic inquiries; they’re too busy for me. That was what it was. You know, asking questions as follow up even though I’ve already had my appointments, is that wrong?

THERAPIST: Too make it easier, phrase your irrational belief clearly and concisely, and the more effective you can be at disputing it. So, say that again.

CLIENT: I’m afraid to bother the surgeons with my neurotic inquiries.

THERAPIST: Aren’t you thinking something like: I shouldn’t bother them?

CLIENT: Yes.

THERAPIST: And that way you’ve got a “should” to tear apart.

CLIENT: Ok, ok, got ya.

THERAPIST: You see, it just makes the disputing more straightforward to do.

CLIENT: Oh and one more thing to add to that and I don’t want to be VIEWED as a neurotic individual, because that would be awful.

THERAPIST: It would be awful to be viewed as a neurotic individual – that makes disputation easier when you phrase it that way? You see, so think about the way you phrase your irrational beliefs, makes sense?

CLIENT: Yep

THERAPIST: It makes the disputation easier when you identify the shoulds and find the musts, and the oughts, and the awfulizing.

CLIENT: Got it, got it, got it.

THERAPIST: I believe you did!

CLIENT: So the way I disputed that one, this one I thought was kind of funny. The surgeons do this for a living, they chose this profession and I deal with neurotic people all day. I will accept myself regardless of my neuroses, besides REBT has helped me to be less neurotic. I don’t know that that was so much disputing.

THERAPIST: Right, it’s not exactly so – it is more rationalizing.

CLIENT: I had a little bit of fun with it though,

THERAPIST: Good!

CLIENT: Because I actually felt like wait a second Jessa, you are worried about calling these surgeons and asking these questions, but you get phone calls all day long form parents that are so neurotic and you don’t judge them. I’m thinking this is what I do, I’m getting paid to do it and they are getting A LOT more salary than I am. So I was just kind of laughing with that one.

THERAPIST: Which by the way is a helpful perspective, to have a sense of humor.

CLIENT: I said I had fun with that one.

THERAPIST: That was effective, however in addition you could be more precise in the way that we have discussed. [01:05:37]

THERAPIST: All right, moving along, anything else?

CLIENT: Ok next was: It’s a lifestyle surgery, if I get the surgery, its being called a lifestyle surgery because of the amount of pain. It’s not life or death basically and I hate that grey area. Because it should be more clear. And when it’s not clear I can’t stand it. So, hold on. Life has lots of grey areas, but we forge ahead.

THERAPIST: We can forge ahead. And watch out for the shoulds.

CLIENT: Can, can choose to.

THERAPIST: Some people,

CLIENT: I don’t know where I wrote the rest of that one, maybe it’s not there but we can choose like it’s a choice to forge ahead, what else are you doing if you’re not forging ahead? (laughing)

THERAPIST: Staying stuck and believing nonsense.

CLIENT: Oh, ok (laughing)

CLIENT: Next was: I want people to believe me and I think they never do and because of that, that’s awful.

THERAPIST: Because they never do as they should? Be specific. Cherchez le Should. It helps the process.

CLIENT: Well it’s going to be good when I go back and look at it, again. Because I don’t think I have ever actually enjoyed doing my homework, as much as I have.

THERAPIST: Why should you enjoy doing it?!!!

CLIENT: I DO though now!

THERAPIST: That’s, good! But watch that you don’t feel discouraged if one day you’re doing it and you’re not enjoying it!

CLIENT: Oh yeah, that could happen.

THERAPIST: But when you do enjoy it, that’s a great bonus!

CLIENT: Today I enjoyed it! It got me to get, I was a little clearer and empowered.

THERAPIST: I think that if you contemplate the way being more precise can help dispute more effectively can ..

CLIENT: Help me even more! [01:07:33]

THERAPIST: Indeed, It can help you to help yourself. Go ahead.

CLIENT: Next dispute of irrational idea was: Some people will validate me during this time, and others may not. It would be nice to have more compassionate people in my life during this challenging time but I don’t need it. My worth and value as a person does not depend upon others being compassionate, I’m very grateful though to those people who are.

THERAPIST: Nice.

CLIENT: Eight was: I would have to be out of work and it’s unfair to my students. This one I struggled with.

THERAPIST: Would you add – “ life should be fair or I should be fair”? Stick in the “should’s” when they exist. I want to check – am I putting words into your mouth do you understand?

CLIENT: NO, NO, no you’re not, it resonates, otherwise I wouldn’t write it down. I would say NO Debbie, I don’t think so. Ok. Now eight was: Oh I guess I started to dispute eight and then I stopped. I don’t know why, but I did. Unless it’s on here. I don’t know, I did stop, but I can do it now. I can dispute it now; about the students. If I were to be out of work during the surgery, what I was going to say, people would survive. Life would go on and that it may not be the ideal situation to you know for the kids that I work with because I do know that they benefit from my service, but I will be hopeful when I resume my duties at work that we continue where we left off and that if I think that what I worry about is that they will be mad at me as they shouldn’t be.

THERAPIST: Ok, what you haven’t addressed is the issue of its not fair. I want to hear you dispute that.

CLIENT: Well because I can hear them saying it. I can hear the kids say it. So I could just say

THERAPIST: Be the wiser one! Come on Jessa help out.

CLIENT: Oh, Ok, your right, it isn’t fair,

THERAPIST: It isn’t fair!

CLIENT: It isn’t fair, why should it be? And I would allow, maybe I’m thinking, what would I say? Because if I don’t know what to say that would be, when I return, that would be awful and we could explore it.

THERAPIST: Come back. You haven’t addressed “life should be fair”. Focus. You are jumping.

CLIENT: Oh, ok.

THERAPIST: Dispute that, that’s important. You can do it, you can do it.

CLIENT: So, life shouldn’t be fair, it would

THERAPIST: I’ll help you It would be nice…

CLIENT: It would be nice if life were fair.

THERAPIST: Sometimes it is! However, sometimes…

CLIENT: Sometimes it’s not, sometimes it is and sometimes it’s not, sorry! (laughing frustrated)

THERAPIST: …And if my students

CLIENT: And if my students just demonstrate anger and frustration and sadness over …

THERAPIST: Stick with the if the situation is unfair for the students, if it is, and by the way that’s a big IF

CLIENT: Well, I think it is a little unfair to them if they need it…

THERAPIST: THEN, IF they need it THEN?

CLIENT: Ok so if it is unfair to my students, um.. (thinking) If you had a ticker across my head right now it is so many “should’s” and so many “must’s” I’m working on that! And then it has you saying, and can I say what I am saying in my head right now? Debbie would say, “just say it, it doesn’t have to be the perfect answer!” I know! I do! I have it in my head! I don’t have something ready and I think this is interesting because it does have a lot to do with the words, it’s all about the words and not, and I can’t find them right now so just hold on!

THERAPIST: Ok, patiently, that’s fine..

CLIENT: So it may be unfair and it may seem wrong

THERAPIST: Maybe or maybe unfairness is a part of life? Can your students really not survive a situation that appears unfair? That would be the dispute. Make sense?

CLIENT: Oh, ok, ok, could they survive something like that.

THERAPIST: You may at times Jessa be looking for the genius insights that can enlighten the world, when you dispute instead of just keeping it simple! Start with that and then later in your spare time find the words to enlighten the planet.(Jokes) Start small!

CLIENT: I love that one! Could they survive what’s unfair?

THERAPIST: I mean what can they expect throughout their life?

CLIENT: Disappointment.

THERAPIST: Yes – at times. It is unlikely that anyone will get everything that they want, when they want it? Children, who are spoiled in certain ways, can end up being adults who feel entitled, how does that help them in the bigger picture? Usually not and it can be hard for them to face facts and reality. I’ve worked with some people who are suffering distress after not having everything they wanted when they wanted it. So, if your students … CLIENT: have something they don’t want to deal with, such as their favorite counselor being absent for a few weeks, people might argue that’s not even unfair, but if you’re going to perceive it in that way, it can be healthy to dispute the shoulds. And, I think I am going to miss them too!

THERAPIST: That’s a whole other area to explore around the idea of “I wish I could be with them”…

CLIENT: Oh I see, that one has nothing to do with the other.

THERAPIST: No, no, get clear, thinking I wish is healthy , thinking I should… is a demand – not healthy to do that …

CLIENT: Oh! ok, ok, ok, got ya!

THERAPIST: So you did the disputing, did you get around to your effective new philosophy, as in E as in ABCDE.

CLIENT: Well, because of the time issue -

CLIENT: I didn’t have my paper with me and to be honest with you, I forgot about that part.

THERAPIST: You did?

CLIENT: I really did, and I was like it’s the ABC and I just forgot about the E.

THERAPIST: The good news is, right now, you are smiling and I’m not getting too much that you are beating yourself up! Even though you didn’t complete your homework.

CLIENT: I’m not! (laughing)

THERAPIST: Well that’s progress isn’t it!

CLIENT: I just forgot!

THERAPIST: Even though this is your 10th session of REBT!! (laughing) How are you not making yourself guilty?

CLIENT: I just think it’s so – cause I was laughing, cause I was like Jessa – telling myself how many times have you been doing it and you forgot? Ok, it just shows how much I wasn’t doing it before for me. Now I am doing it for me.

THERAPIST: And you also are using your sense of humor at this moment. So your homework for this week is to write down the effective new philosophies of what we went over now and the other homework that I gave you earlier. Write down self-soothing conversations that you will use if you feel symptoms of panic and extreme anxiety. I ask you to do with those two homework’s, so that you can really give yourself the opportunity to really focus and do them thoroughly. I’m already predicting in all probability next time I see you I might invite you to do a very full and thorough ABCDE.

THERAPIST: For now, two homework’s, and we will start next week with those and you can tell me what you did and didn’t do!

THERAPIST: Any final comments or questions before we complete this session?

CLIENT: No, just a comment, I have noticed a change in myself and it’s not I know that this stuff takes work, I am very aware of that.

THERAPIST: What change and progress doesn’t take work or effort by the way?

CLIENT: Nothing, anything worthwhile in the end comes without work, I guess. But what I am saying is it takes work, but the beautiful part of today, is that in this state of panic with something very big happening, I was able to stop, and think wait a second, you have options, you have choices… and I was able to have conversations with myself. And it can be overwhelming in a good way. Anything that is new is a risk, I personally think this was a big risk that I took by doing it and I am very thankful that I did. That’s what I have to say. It’s a continuing part of my journey, to be able to apply this stuff to every day life, not just to the big challenges.

THERAPIST: Keep on, Keep on Jessa. The more you make effort and are mindful, the more you can notice changes. Good job Jessa ! See you next session.

END TRANSCRIPT