TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: So this is session 12 with J.M. on Monday, the 13th of January, 2014. Hello Jessa.

CLIENT: Hi, Debbie.

THERAPIST: So, you told me, when we first said, “Hello,” this evening that you’re physically not in great shape.

CLIENT: No, no, no – not in good shape.

THERAPIST: What’s going on?

CLIENT: So, the same thing that’s been going on since we started the sessions, which is the stuff with my neck. So, I actually decided—I mean, today, it got to the point—I was at work and stress in any kind of way doesn’t help and work – as much as I like my job – is stress. And with having to get ready for a leave, because I did decide that I’m going to be having surgery next Thursday, there’s a lot to get done.

THERAPIST: When you say, “Next Thursday,” in three days or Thursday of next week?

CLIENT: No, Thursday of next week is when I’m scheduled to have surgery. So I still have some days left to get prepared for a leave. But it’s a big leave. It’s like a period of six to eight weeks. I was concerned about I had to get medical forms in, I had to get coverage, I had to get—you name it. And then, in the meantime, seeing—I have pretty much like an 80-child caseload of mandates, so students that I work with, I was trying to make sure that I was able to see my students. And, of course, knowing in my mind that—and writing a letter that—to say good-bye for the period of time.

So, needless to say, it’s been very, very challenging. And, today, just my pain and I don’t know whether it was fully related, because on Saturday, I wasn’t as stressed about—like how I was in school today. It was just a nice. I went to the movies and I was in incredible pain. So because it is nerve pain, there’s not always a rhyme or a reason. I could have an okay day and then I can have a horrific day and there’s no explanation as to why. [00:02:05] You could say stress could make it worse but sometimes it is that and sometimes it isn’t.

So needless to say, I was at work and there’s a couch at my job. And I literally just—I was dealing with some really intense cases today. And I just lay down at the end of the day, closed the door, and just really felt that I needed to leave. [laughs]

But then I got myself together and I realized that the pain had gotten a little bit better and subsided somewhat. So I went down to continue what I’d been doing, work and everything, and trying to manage the fact that I don’t have a whole lot of time left before I take my leave. And so I’m in a little bit of a—in limbo right now, in terms of trying to get everything done, knowing that it’s not going to be perfect. [laughs]

THERAPIST: Well, if you truly accept that it’s not going to be perfect, and if you accept the likelihood of your not getting everything done that you want to get done, how are you in limbo? [00:03:13]

CLIENT: I’m really not. I’m in a lot of pain and so I think that I’m a little bit—probably the—I have accepted that. I think that what I’m probably having a harder time accepting is just the pain level and how it does stop me from doing the things that I want to do. I think that’s where I am having a more difficult time.

THERAPIST: Well, wait. It stops you doing a number of things you like to do, but not everything that you like to. I want you to notice the way I’m listening to your words.

CLIENT: Okay.

THERAPIST: And I’m not just taking as gospel everything you say. You’re not in limbo. It doesn’t stop you doing what you like to do. It stops you doing some things you like to do.

CLIENT: Well, working. [00:04:01] It’s stopping me from working right now. I mean, I’m getting the surgery.

THERAPIST: Your words were, “It does stop me doing what I like to do.”

CLIENT: Okay, let me—

THERAPIST: No, no, no, let me.

CLIENT: Oh, sorry, sorry.

THERAPIST: That’s all right.

CLIENT: Okay.

THERAPIST: I’m being bold.

CLIENT: Okay.

THERAPIST: Because I want to model for you, now, the way I want you to think. Because thinking in such ways will help you.

CLIENT: Okay.

THERAPIST: The way I want you to continue to work on using your awareness to think about your thinking. And then, in your own way, to do what I’m doing – which is to not take your initial words or thoughts as Gospel truth. If you stop and separate from your thoughts, and take a few moments to assess the validity of them and, really, that relates to one of the issues from our last session, which was interesting and informative and, at times, hysterically funny, if you remember. [00:05:09] But you agreed with me, and with my observation, that your –at times – racing mind doesn’t serve you well in all instances and in many instances.

Al used to say, very frequently – when he and I would give presentations and talks and workshops – that unlike other animals, who also think—

CLIENT: [giggles]

THERAPIST: as far as we know, humans are the only species who can choose to think about their thinking. So, in this session, let’s both focus on what you say, in terms of sticking to your answering the question that I might ask, or sticking with the issue that we’re looking at, focusing on any catastrophizing and should-ing that might spill out. [00:06:13] And to catch it, not just letting it go. Okay? So, if I am at times – going to interrupt tonight, it’s with that purpose. Is that agreeable to you?

CLIENT: Yeah. Yes.

THERAPIST: Good. Good, good, good. And since we’re pausing here, I also want to ask: remember at the beginning of our last session, our attempts to do a relaxation?

CLIENT: Yes, I do.

THERAPIST: Which ended up, I think, no further than below the neck.

CLIENT: [laughs]

THERAPIST: Starting from the top of the head and peals of laughter, which – in its own way – was therapeutic, in a sense. However, I’m not going to attempt to do it now, with you.

CLIENT: [chuckles]

THERAPIST: But a suggestion for you to keep in mind, particularly before and after your surgery – which is coming up – and for your use in the rest of your life—

CLIENT: Mm-hmm.

THERAPIST: that something that many people do, which they find helpful, is a progressive body relaxation.

CLIENT: Okay.

THERAPIST: When there’s some stress or tension in the body, or the mind is too active, you can apply it. And you do that very simply by suggesting to yourself what I suggested. You, yourself, would direct your attention to the top of your head and—

CLIENT: Good.

THERAPIST: let that part of you relax and then go down to the forehead, the ears, the brain, the face, every muscle, and every cell—and consciously relax it. Feel the kind of warm, easy, heaviness in a positive sense – a dropping of tension, in other words – in every part that you focus on. And some people who are visually inclined also do it that way or prefer doing it in this following way: where they first identify a color that they find soothing and healing. [00:08:15]

CLIENT: Okay.

THERAPIST: And they imagine that color at the top of their head—

CLIENT: Okay.

THERAPIST: and that it slowly enters through the skull and relaxes and fills every cell, every tissue, every bone, every part, and let it work down. A lot of people who do this, may not get past the nose or the neck or the belly button—

CLIENT: Because they’re so relaxed, by the time—

THERAPIST: And they might fall asleep.

CLIENT: Yeah, okay.

THERAPIST: So keep that in mind, in your toolkit.

CLIENT: Okay.

THERAPIST: Okay? All right. And then, so the homework that we decided that you might try was . . .?

CLIENT: Well, so, we did—I’ll tell you the homework. I didn’t cut corners this time. [00:09:01] [chuckles] But not only did I do the homework, but something actually occurred that I’d like to share.

THERAPIST: Tell me the homework.

CLIENT: Oh, tell you the homework first? Oh, yeah, sure. It was just to go over, to read again the effective new philosophies on all of the A, B, C, D, and E’s. But really hone in on the effective new philosophies, because that was where I was tending to struggle a little bit more and had sort of left out the last time. So it was just to do that and just to do one thorough – if possible, more – A, B, C, D, E, all the way until the end, yeah. The whole enchilada: A, B, C, D, E.

THERAPIST: Right. Right. So how about you tell me about that now, and then tell me whatever it was you were starting to tell me.

CLIENT: Well, the reason why I don’t want to do in that order – if it’s okay – is because what happens relates to why I chose to do this particularly—why I chose this A, B, C—this activating event. [00:10:06] Does that make sense?

THERAPIST: Yes, it does.

CLIENT: So, I think—

THERAPIST: First of all, first of all, did you do the homework reading?

CLIENT: Yeah, of course.

THERAPIST: Okay.

CLIENT: Absolutely.

THERAPIST: All right. So, then tell me as you prefer.

CLIENT: Just, oh, okay. So, well, I think it’s very interesting, what happened, because I sort of used—I don’t want to say I was “forced to” use REBT, but I found it very beneficial to use REBT in a moment that happened in my family last week, after—our session? I’m trying to think. Oh.

THERAPIST: When—

CLIENT: So—when did I see you, Monday—

THERAPIST: Wednesday.

CLIENT: Thursday.

THERAPIST: Not Thursday.

CLIENT: Wait, I saw you Wednesday? I did? Wednesday?

THERAPIST: Yes, you did.

CLIENT: I’m so confused because—

THERAPIST: Mm-hmm.

CLIENT: Oh!

THERAPIST: No, Wednesday.

CLIENT: Because this happened Thursday, that’s why.

THERAPIST: Okay.

CLIENT: This incident happened Thursday. So basically, I think it’s really important because I could’ve allowed it to affect me differently. [00:11:01] But what ended up happening, the gist of it was that my – as I’ve mentioned before – my parents tendencies when I was growing up and the way that they raised me were very, very controlling and sort of created dependent children as opposed to creating independent children, and that’s inclusive of myself and my brother.

And what happened was on Thursday evening – so it was the night after our session and everything’s very fresh from our last session – my mom and I were on the telephone and my brother’s—an ex who’s now a friend of my brother’s had called in. And she has a drinking issue. And so, she had called in and she was actually drunk and was calling my parents—

THERAPIST: Your friend?

CLIENT: My brother’s ex—this was an ex-girlfriend who’s still friends with my brother. They still continue to be friends even though they’ve been no longer as an item for a number of years now, two or three years.

So she’s been close with my family and so, she reached out to my family to say that she was very—she was so worried about my brother and even alluded to – I mean, I think it’s important to say this here, because instead of making things fluffy – that she thought he was going to hurt—maybe commit—saying it in this way because my brother is so—she was drunk, and so things were—but my brother’s friend happened to call. [00:12:23]

He called her, the ex-girlfriend, to let her know that he was all—everybody was in hysterics because Jeff – that’s my brother – was so, so, so down because he doesn’t have a job. And he hasn’t had a—I don’t know if I’ve mentioned in the past, but he’s had a couple of jobs. It’s been about 10 years or 11 years since he’s been out of college. And he’s had jobs—he’ll have a job and then he’ll even have it for maybe a couple of months and then he would lose it. Then he would go for like a year and he wouldn’t have a job. My parents would pay the bills, do all that. Then he would get another job, then he would lose it. He would have it for a few months then it would be same thing, he wouldn’t have a job. So you get the gist.

So this has been a pattern. This has been going on for years and years and years. And it’s nothing new or surprising to me anymore when either my brother calls or my parents call and say, “Jeff lost his job.” Or they’ll call and say, “Your brother is so down. He’s looking for a job.” So that’s where we’re at right now.

And so what happened was my mom had—when I was on the phone and I’d found out what had happened, that this ex had called my parents and was concerned, my mom said to me, she said, “Jessa,” she said, “I can’t stand this.” She said, “I’m so down, and I—” – and this is typical conversation, by the way – she said, “And I’ll only be happy when he gets a job.”

Now, mind you, I’ve been hearing this same kind of lingo for ten years. So I took the opportunity to say, “What are you telling yourself right now, when you are saying that you’ll only be happy when he gets a job?” And it was really interesting to see sort of the way that it took, because she said, “I’m not eating over this and I’m so down and I can’t stand it, I can’t take it and he needs a job desperately.” And I said, “Well—”

THERAPIST: So she didn’t answer your question.

CLIENT: No, no, she did, actually. Because when I said, “What are you telling yourself?” she said, “I blame myself.” She did, for the first time—I forgot to mention that, because she hasn’t really ever said fully that or taken any bit of ownership. It’s more just like, “I need him to get a job.”

Then she started to say, she said, “I blame myself.” And I said, “Well, is that helping you?” I [laughs] and then I’m like, “Oh God, look at what I said !”

THERAPIST: I’ll give you an REBT certificate.

CLIENT: Yeah, oh, I did. I said that. I said, “Really, the REBT that I’ve been doing,” I hope it’s okay that I mention it, I said, “with Debbie,” I said, “has been really beneficial because it teaches the ways that you think and how a certain way of thinking can be very unproductive and not really get you anywhere.” I said, “And so, I’m not saying it point fingers or say, ‘You did this,’ or, ‘Jeff did this,’ or anybody did this.” I said, “It’s more to help the situation.” I said, “And so, I keep seeing a pattern. And I see that this has been going on for a number of years and that nothing’s really changing.” And then she said, “You’re so negative.”

And I didn’t say anything in that moment, but I’m thinking, “Well, actually, no.” No, I did say it, I said, “No, I’m realistic.” I said, “I’m being realistic.” I said, “I’m just looking at what the situation is and how it’s been.”

And then she insisted on saying, as always – I’m going to say “always” because that’s her tendency – is, when I was—

THERAPIST: No, instead of saying “always” you can say “as has been the case till now.”

CLIENT: Has been her tendency, not always but tends to be what she says is, “This brings me back to when my father (meaning her father, my grandfather) always lost a job and blah, blah, blah, blah, blah.” And I said, “Well, this isn’t your father. This is a different situation.” I said, “And if you want to continue to go over that,” I said, “you will have every reason to do that. But,” I said, “I don’t know how beneficial that’s going to be.” I said, “Because it’s now 40-something years later, maybe more.” I said, “So you can choose to do that if you want,” I said, “or you can—” and then I pushed it a little bit, I said, “Or you can be,” because what tends to happen is that they collude with each other. [00:16:10] So my brother will call, “Ma, Ma, Ma,” she’ll run to his rescue. I said, “You can continue to do that,” I said, “if you want. Or you can say to Jeff, ‘You know what? I’m not your therapist.’ I am going to call up every REBT therapist that I know, and,” I said, “and possibly bring it—walk him over,” I said. “And be supportive. That’s not having him be dependent,” I said. “You’re actually encouraging him that there are opportunities to make a better life.”

So she heard me. She definitely heard me. And then I found out, the next day, that she took a Xanax and half a glass of wine and put herself to sleep and did okay. That was her coping strategy. [laughs] But she definitely sounded to me, the next day, like she was not as distraught over the situation and she wasn’t saying, like, “I’m so down,” how she may have typically done in the past. Because I think she realized that she couldn’t pull that with me, because that wouldn’t really get her anywhere to do that. So.

THERAPIST: Well, well, well.

CLIENT: Yeah, so, I think—my homework, then, was based on—I took that opportunity to then read the effective new philosophies. And what I’ve started to notice and then I get a little bit hard on myself and I realize that it’s okay is that I’m going to back to my tendencies, because this has only been 12 sessions and my life has been 30-something years of thinking the other ways.

THERAPIST: 12 sessions, indeed.

CLIENT: 12 so far, and my life has been 30-something years of habits. And so I will easily go back. But that’s—

THERAPIST: You may easily go back. The way you said it means you are psychic !How can you predict the future?

CLIENT: Um . . .

THERAPIST: I said you may easily go back.

CLIENT: Okay.

THERAPIST: You may tend to. But if you use the words you used, you’re making an absolutistic prediction.

CLIENT: Because I’m trying to break a habit, so I guess I thought habits don’t break easily and that’s the reality. Okay, I got you.

THERAPIST: See, I was catching you thinking in unhelpful ways.

CLIENT: Okay, okay.

THERAPIST: I recommend that you do what I’m doing.

CLIENT: Okay.

THERAPIST: I want you to think about your thinking—do you see what I mean?

CLIENT: Yeah. [chuckles]

THERAPIST: And to literally watch your language! [chuckles]

CLIENT: I got it. No, I do.

THERAPIST: You see?

CLIENT: Yeah. So, I think that what I’m also getting at is that I think what I’m realizing, actually, I should say, is that it takes a lot of work. And it’s work that I’m willing—

THERAPIST: Ongoing effort, yes. (And careful of using “shoulds” ! )

CLIENT: yeah, so and that’s okay. I’m fine with that. But I think that as long as the ultimate goal is for it to be something positive, then the goal is worth it. I think when you’re working, working—well, in the very beginning of our sessions, I was working just to work. Now, I’m working because I want—I’m seeing that it’s—I didn’t know the difference. I really didn’t know. I was working to please you. And to do the—

THERAPIST: Didn’t you bring up the issue of anxiety—

CLIENT: There was that—

THERAPIST: as being something that you wanted to lessen?

CLIENT: I did, but I didn’t realize that—I wasn’t able to catch myself in what I was—in other words, I was working—sorry, let me rephrase, to do the homework piece. I was doing it to get the right answer, to do the right thing, or to make it perfect, whereas—

THERAPIST: And then you noticed that you were doing that.

CLIENT: Yes. Right.

THERAPIST: We noticed.

CLIENT: And so now, I’m realizing that I was thinking in unhelpful ways -

THERAPIST: And then we thought, “Enough of that crap.”

CLIENT: Yeah.

THERAPIST: Because was thinking in those ways helping you?

CLIENT: No.

THERAPIST: A little bit at times, maybe certain thoughts were not unrealistic, but not in the—

CLIENT: Not in the bigger picture, not in the grand scheme and I think I’m at a—

THERAPIST: Exactly. Not in a substantial way.

CLIENT: Well, here’s the thing. I think that life has a funny way of working out, because right now, I’m in a true crisis, just physically. I’m looking at this as it’s very unfortunate that I’m going through what I am and that I need a lot of help.

THERAPIST: What’s your definition of “crisis”?

CLIENT: Horrible, horrible pain that’s incapacitating.

THERAPIST: So now you’re in very restrictive pain.

CLIENT: So change the language there, too? [laughs]

THERAPIST: Well, you can walk. You’re in pain, not denying that. However it could be worse. You’re able to feed yourself and your cats. You’re still able to.

CLIENT: Barely. Barely.

THERAPIST: You’re making a lot of sense as we speak. But at times the horribilizing comes through. So I’m just taking—

CLIENT: I know, I know.

THERAPIST: it a notch down from “crisis.”

CLIENT: Okay, okay.

THERAPIST: “Crisis” might be – heaven forbid – an amputation—

CLIENT: [laughs]

THERAPIST: or you damage your brain, and have irreparable damage.

CLIENT: I think the pain—so then—no, you’re right.

THERAPIST: So let’s not catastrophize. Again, this is me—

CLIENT: I know. I know you’re catching me.

THERAPIST: catching your language.

CLIENT: So maybe then, and what I need help with then, is when pain gets unbearable and really, the pain. I’m separating my thoughts now from the actual physical pain. And I was working on trying to separate that. But it was really getting in the way.

THERAPIST: And look, I empathize and I do understand, and I also applaud you for carrying on despite the immense pain. I do. The fact that here we are looking at the issues, you didn’t cancel this session, which was an option.

CLIENT: Because I know we need it. I know we need it.

THERAPIST: Well, it benefits you—

CLIENT: Yes, it benefits me.

THERAPIST: It wouldn’t have been the end of the world to cancel. But you made a choice, that you’re functional enough—despite the pain. Well done.

CLIENT: I did.

THERAPIST: And good on you. You see, you’re demonstrating – to both of us but most importantly, to yourself – that when you use your willpower, you can choose a constructive behavior, even though you may not be in your optimal state of being pain free.

CLIENT: Exactly.

THERAPIST: And you can still benefit.

CLIENT: Which is why I said in the very beginning that I was separating that I was happy to see you, but not in a happy state—

THERAPIST: Yes, excellent. You showed us that you can choose a healthy path, even when in pain.

CLIENT: So I think that’s always been—I get very extreme, and it’s like, “Oh my God,” and I was so excited to see—and I realized that I can feel that but still feel that my situation is not good.

THERAPIST: Still recognize that your situation isn’t good—

CLIENT: Okay.

THERAPIST: while feeling some physical pain —

CLIENT: Am I going to get a copy of this?

THERAPIST: still you can create a positive emotion.

CLIENT: Yeah.

THERAPIST: I want to finish—

CLIENT: Okay.

THERAPIST: looking at your homework.

CLIENT: Okay.

THERAPIST: Which is where we started.

CLIENT: Well, I have it in my head, but I also can pull it up on my Word document. Or I could just say what I wrote.

THERAPIST: Well, start by saying what you recall.

CLIENT: Okay.

THERAPIST: and if you need to look at your computer, you can—

CLIENT: Okay.

THERAPIST: So, you were saying the situation with your mother and brother is what you chose to do the A, B, C on? Is that what you’re saying?

CLIENT: Sort of, because it was a little bit more on a personal level of more how I felt, that I thought that it affected me. It wasn’t so much on my brother but it was the situation that I thought affected—

THERAPIST: I’m not clear did you do the homework on that?

CLIENT: Yeah, it was basically on that.

THERAPIST: Okay.

CLIENT: It was basically on that. It wasn’t specifically on my brother.

THERAPIST: So let’s hear it.

CLIENT: Okay. I might just need to look at my computer just to—and then I also had a separate one that I did—

THERAPIST: Fine. Focus. One thing at a time.

CLIENT: I did a separate homework, because I had a fight or conflict with a friend and I used it to help myself, to soothe myself after the conflict occurred. [00:23:01] So we can—

THERAPIST: Well done, Jessa. For someone in crisis (jesting), you’re doing quite well!

CLIENT: [chuckles] I feel like it’s what’s helping me to get by, to tell you the truth.

THERAPIST: Sounds like it is, that you’re helping yourself get by by using it. Well done.

CLIENT: Yeah.

THERAPIST: You have been helping yourself when you apply this approach. Pause. Can you take that in?

CLIENT: Yeah, I’ll take it—I’m proud of myself that I have—

THERAPIST: Proud of what you’re doing.

CLIENT: Yes, yeah.

THERAPIST: Good.

CLIENT: Okay. Hold on. All right, so the activating event, I said, “I was thinking about REBT and how amazing the concept is. But in reading the books, I started to get,” this was like a few days later, “I started to get—”

THERAPIST: Wait, is this the one about your mother-brother?

CLIENT: It is, it is.

THERAPIST: Oh, okay.

CLIENT: You’ll see how it—

THERAPIST: All right.

CLIENT: You’ll hear. So, oh, “Thinking how amazing the concept is but in reading the books, started to get to thinking that my type of person is not one who can keep at such a successful pace while reading—”

THERAPIST: Slow, slow, slow. Talk more slowly now, so I can better keep up with you.

CLIENT: “while reading, I started comparing myself to others who’ve been extremely successful with REBT, and had the thought that they were better than me.” What I didn’t say here was, “Due to,” so that was the—I guess that was the one missing piece was, “Due to my dependence on my parents growing up,” basically. [00:24:09] So—

THERAPIST: Who do you know who’s been successful with REBT?

CLIENT: Who do I know personally?

THERAPIST: Isn’t that what you implied – as you compared yourself to others.

CLIENT: Yeah.

THERAPIST: You know others?

CLIENT: Uh huh.

THERAPIST: Mm-hmm.

CLIENT: Who do I know?

THERAPIST: You don’t have to mentioned names, but—

CLIENT: Oh, I thought you would—

THERAPIST: you know people who have used REBT?

CLIENT: yeah, no, you had told me when we were doing it that you said there’s been people that have been very successful—

THERAPIST: Oh, so it’s no one you know personally.

CLIENT: I don’t know them—no, no.

THERAPIST: So you know that people have benefitted.

CLIENT: Yes. Exactly.

THERAPIST: All right.

CLIENT: Yeah. So my thought process here was that it wasn’t going to work for me, because—after the conversation I had with my mom, even though I was – I think – successful at sort of talking her down a little bit, when I hung up I felt great sadness that this was still a pattern within my family and that it was—I felt a little bit stuck, like I didn’t know how I was going to get out. And that I didn’t know if I would be able to keep up with being successful at REBT due to—I was blaming, basically, the situation that I had with my family.Does that make sense?

THERAPIST: Okay. Yes. So now, are you saying that the emotion, the C, the emotional consequence, was extreme sadness?

CLIENT: Well, I have it right here. So the consequence was sadness, frustration, anger, anxiety, uselessness, worthlessness, and crappy.

THERAPIST: Okay. A little mini test, here. Which of those emotional responses to adversity are not unhealthy, negative emotions?

CLIENT: Frustration.

THERAPIST: Depending on the degree, yes. What else?

CLIENT: Sadness was—sadness is.

THERAPIST: Sadness can be a healthy emotion.

CLIENT: Yeah.

THERAPIST: Feeling sad in response to adversity, in many cases, is a healthy response, is it not?

CLIENT: Yeah, no, that is. But the other ones—

THERAPIST: What are the unhealthy ones?

CLIENT: Anxiety, uselessness, worthlessness, crappiness, and anger. I don’t know if anger really is that productive.

THERAPIST: It depends on the degree of anger—

CLIENT: Yeah, it was out of control.

THERAPIST: Debilitating.

CLIENT: It was out of control, it was out of control.

THERAPIST: So that would imply—maybe you could call it rage? [00:26:02]

CLIENT: Rage. Okay, sure. We could change it to that.

THERAPIST: Rage is an unhealthy response, that’s most definitely an unhealthy, negative emotion in REBT language.

CLIENT: Yeah.

THERAPIST: And in life. And then the crappiness and the other thing you worded, they’re all under the umbrella of self-damning, are they not?

CLIENT: Exactly.

THERAPIST: Which is lack of what?

CLIENT: Self-worth.

THERAPIST: And lack of unconditional—lack of—

CLIENT: Unconditional self-acceptance.

THERAPIST: Unconditional self-acceptance. All right. Back to the A B C D E. So tell me, not looking at your written stuff, there—

CLIENT: Uh huh.

THERAPIST: briefly and succinctly – briefly – the A the activating event.

CLIENT: The phone call with my mom.

THERAPIST: Yes. And then enlarging it a bit, one or two sentences maximum, “The phone call with my mom in which . . . ?”

CLIENT: In which I based my success with REBT on my phone call with—the themes in my life. No, I don’t . . . the . . . phone call with my mom was the activating event, and then the—what I told myself, the—

THERAPIST: No, no, no, I’d stick with that. “The phone call with my mom in which she said,” or, “I said,” or I thought— finish the sentence …

CLIENT: Oh, in which she—

THERAPIST: just make that more complete.

CLIENT: Oh, sure. In which she said that she won’t be happy until my brother gets a job.

THERAPIST: “And I . . . “?

CLIENT: And I felt, or thought—

THERAPIST: Thought.

CLIENT: that it was—I’ve never actually said this. That I felt—I thought that it was—well, I didn’t say this before, should I say it now?

THERAPIST: Yes, yes.

CLIENT: I thought it was not going to happen until they—I felt rage. I felt rage, because I—I don’t know.

THERAPIST: Finish the sentence about—

CLIENT: Because blamed them—

THERAPIST: You blamed what she said. [00:28:03]

CLIENT: Oh, there’s so much, though, in this.

THERAPIST: Keep it succinct. That’s a challenge to you.

CLIENT: Yeah.

THERAPIST: A challenge to you. But well worth working on.

CLIENT: No, I know. I know. I have a hard time at that. Wait.

THERAPIST: Pretend you’re a video camera and the director says, “I want you to shoot the crucial scene in 30 seconds.”

CLIENT: Okay.

THERAPIST: “Get the main images.”

CLIENT: [chuckles]

THERAPIST: So you’re a camera. That means objective. You’re not emotionalizing, you’re not coloring—

CLIENT: Got you.

THERAPIST: you’re describing what is.

CLIENT: Got you, got you, got you.

THERAPIST: So, you have got 30 seconds or less.

CLIENT: Okay.

THERAPIST: 30 seconds.

CLIENT: I get it.

THERAPIST: I’m doing it for the purpose of what we’re doing now—

CLIENT: Sure.

THERAPIST: encouraging you to practice being succinct—

CLIENT: Exactly.

THERAPIST: in this moment.

CLIENT: Okay.

THERAPIST: So you’re the camera. You got 30 seconds—

CLIENT: Okay, okay.

THERAPIST: Tell me only the activating event. Not the consequence yet, not the beliefs. What happened?

CLIENT: Okay. The activating event was my mom made a phone—my mother and I had a phone call. We exchanged information where my mom said that she wouldn’t be happy unless my brother had a job. I mean, that was—

THERAPIST: Consequence?

CLIENT: The consequence was…

THERAPIST: The emotional one.

CLIENT: from my perspective ?

THERAPIST: Yes yours, we’re exploring your situation.

CLIENT: It is rage.

THERAPIST: Mm-hmm.

CLIENT: rage, anxiety, anger—oh, no, anger is rage. Frustration, sadness—but that’s a healthy one—

THERAPIST: Didn’t you say self-damning?

CLIENT: Self-damning, yep. Worthlessness. I don’t know what the word would be for somebody that feels like they can’t fix something, so I guess—

THERAPIST: Incompetent.

CLIENT: Incompetent. Like I—

THERAPIST: That’s all related to the lack of unconditional what?

CLIENT: Self-acceptance.

THERAPIST: Okay. All right. Were there any behavioral consequences? There may or may not have been.

CLIENT: For me?

THERAPIST: We’re talking about you and this instance.

CLIENT: Yeah, yeah, yeah. No, no, no, there was. I then could not sleep for a while after the phone call had ended.

THERAPIST: So overactive mind?

CLIENT: Mm-hmm.

THERAPIST: Mm-hmm. All right. So, now, detective work. What comes next?

CLIENT: Then there’s the irrational beliefs.

THERAPIST: Right.

CLIENT: Okay. So I talked to myself and I said, “Jessa, you are not,” well, remember, this is about REBT, so, “you are not diligent enough to really be good at a new concept like this in my life, because you’re too dependent on your parents.”

THERAPIST: Can I just point out that there’s a mixture in that sentence of “you,” “my,” as if there are two people here. So how about you keep consistent with the “you.”

CLIENT: Yeah, no, I know.

THERAPIST: If you’re going to do “me,” be consistent with the “me.”

CLIENT: Right, yeah. I’m sorry about that. So—

THERAPIST: Or you might confuse yourself in the doing of the process.

CLIENT: “Jessa, you’re not diligent enough to be good at a new concept like this to help your life, because you’re dependent on your parents and it shouldn’t be that way. You must separate from them in order to be perfect in life.” [00:31:04]

THERAPIST: We just want the irrational beliefs.

CLIENT: Oh, okay. So that was it.

THERAPIST: Is that clear?

CLIENT: So, yeah, so, “You are not diligent enough to really be good at a new concept like this to help you in your life, because you’re too dependent on your parents and it shouldn’t be that way.” That was irrational enough for me.

THERAPIST: Yes, but you haven’t really clarified some of the self-damning statements, have you?

CLIENT: Not in that one, no.

THERAPIST: Would you like to do so now do it?

CLIENT: Sure. So . . .

(pause)

CLIENT: I need a little help with that one. Just if you can just get me help to get me back on track with it, because I forget sometimes.

THERAPIST: Try and think—you said, a few minutes ago, “worthlessness.”

CLIENT: Yeah, I felt all that.

THERAPIST: Mm-hmm. So what irrational belief might create this worthlessness?

CLIENT: That I can’t do anything to fix this problem. And that—

THERAPIST: “As I . . . “?

CLIENT: as I should be able to. Yeah.

THERAPIST: Is that relevant?

CLIENT: Mm-hmm. Yes. And that, “Can’t do anything to fix the problem as I should,” and, “My parents won’t—” “My brother will continue to be—” “My mother will continue to feel the way that she does and I can’t stand that.” [00:33:03] I can’t stand when she calls me and says that she’s depressed or upset or bothered over the fact that my brother doesn’t have a job because I think—because I tend to blame them and—wait, hold on, I know the—and it must—

THERAPIST: You could have put a full stop in a few words ago, okay? Slow down !

CLIENT: Oh, okay.

THERAPIST: All right. And now?

CLIENT: And now what? Second one?

THERAPIST: Continue, yes.

CLIENT: Oh, okay. Okay, “Other people I know would be able to do this type of therapy because they would put in more effort than I would. I should do more. And when I don’t, I’m a lazy, ineffective human being and I can’t stand to think about myself that way.” Anyway, right, myself, so—okay, I had written the wrong thing there. Next one?

THERAPIST: Oh, we’re still on the irrational beliefs?

CLIENT: Yeah.

THERAPIST: Yes continue, continue.

CLIENT: “My parents raised me where they took control” – now, I know this as a fact, I’m getting the difference – but then I put in, “They took control over literally almost everything I did. I could do nothing for myself. It must be my fault that they did this, since they must have noticed I was ineffective as a child and them thinking about me in this way is unbearable and I can’t stand it.”

THERAPIST: And, “They shouldn’t have done that”?

CLIENT: Uh huh, sure.

THERAPIST: Is that what you believe?

CLIENT: Yes.

THERAPIST: Then, “They shouldn’t have done that.” “They should have been perfect parents,” is the implication, right?

CLIENT: I guess. Or that I should have been a perfect kid. I think it’s— I put it on me that I should have—in other words, that they looked at me as an ineffective. If I was more effective, they wouldn’t have done that.

THERAPIST: So it’s a separate—

CLIENT: Oh, okay.

THERAPIST: irrational belief, isn’t it?

CLIENT: Mm-hmm.

THERAPIST: “They shouldn’t have done what they did,” and “I should have been better than I am.”

CLIENT: Yeah, that’s separate.

THERAPIST: Mm-hmm. See, the clearer you are in separating them—

CLIENT: reflection, which—

THERAPIST: then, with disputing, you can be more precise, and then zap, zap, zap. Disputing can be easier.

CLIENT: Okay. The next one is, “I’m angry at my—” well, I should say “rageful.” Rageful. And [in a rage] …

THERAPIST: You should say “rageful”?

CLIENT: Well, I’d like to say “rageful,” “rage,” I’m in a rage that my—

THERAPIST: What would be more accurate?

CLIENT: No, it can be “rage.”

THERAPIST: Okay. I was just picking up on your “should” language.

CLIENT: Yeah, no, it definitely can get to that point. “I feel rage,” or, “experience rage that my parents raised me this way. And it’s awful that I feel as angry as I do at them and I can’t stand this feeling.”

THERAPIST: So what is that an example of?

CLIENT: Low frustration tolerance?

THERAPIST: It is, and also, in REBT, we call it a secondary disturbance.

CLIENT: Oh, anxieties about the anxiety.

THERAPIST: Rage about the rage.

CLIENT: Oh, rage about the rage.

THERAPIST: Yes.

CLIENT: Okay.

THERAPIST: So then I’m inserting a little theory, here.

CLIENT: Okay. Then I just went and disputed each one by one, so—

THERAPIST: That’s the goal. So they’re your—

CLIENT: Those are the irrational beliefs about that, yeah.

THERAPIST: Very good. Okay. So time to zap them.

CLIENT: Okay. So the first one, “Jessa, that you’re not diligent to do a concept—”

THERAPIST: Slowly, can you talk more slowly?

CLIENT: Sure, sure, sorry. Okay. So the one about—the first one about – just to refresh – about the not being diligent enough to—that other people—comparing myself, basically, and saying that I’m worthless and this and that.

So what I said to that and how I disputed was, “I may not have the most diligence of all people, but despite this, I am still a worthwhile human being who tries hard to be successful and does the best I can at the time. It may be true that I am dependent on my parents in some ways, but that does not make me a loser. [chuckles] It’s unfortunate that my parents raised me this way, but they probably did not know any different and they are fallible human beings who do make mistakes. I can live with the fact that this is what happened and work on changing some of the bad habits that were instilled in me as a child.” [00:37:17]

THERAPIST: That’s very well said, but it’s a combination of disputing and effective new philosophies.

CLIENT: I thought that might—yeah. I think I’m still struggling a little bit with the difference between those two—

THERAPIST: You’re still learning.

CLIENT: Okay. Okay.

THERAPIST: That’s a better way of putting it, isn’t it?

CLIENT: Yes.

THERAPIST: You caught my jumping on the “struggle” word?

CLIENT: Can I ask a brief question? And if it’s not a brief answer, we can just go to it later or at another point. But, no, I won’t. It’s fine. It’ll get answered, somehow. Should I go to dispute number two?

THERAPIST: Ask the question. [laughs]

CLIENT: [laughs] [I know] (ph), I’m just trying to stay on track.

THERAPIST: Is the question off track?

CLIENT: Well, I feel like I’ve been thinking about this question a lot.

THERAPIST: Okay, but if it’s slightly off-track, please try to remember it for when we finish what we’re doing.

CLIENT: Got you. I’m going to go back to it, yeah.

THERAPIST: All right. If it was related to this, I would welcome it now.

CLIENT: It’s not related to this at this moment, so no.

THERAPIST: Okay. Carry on, then.

CLIENT: Okay.

THERAPIST: Disputing hones in on the “shoulds” and “musts” and the “I can’t stands.”

CLIENT: Exactly.

THERAPIST: The effective new philosophy is an effective new philosophy. It’s that gentle stroke that says, “even if,” “you can still,” “I can still,” “I have resilience”.

CLIENT: Exactly.

THERAPIST: Can you notice how the so-called dispute you just shared is a mixture of both?

CLIENT: Yes, I do.

THERAPIST: Now, is that better than not doing anything? Most definitely it is.

CLIENT: Okay.

THERAPIST: However, it’s to your benefit—

CLIENT: To separate it.

THERAPIST: to keep practicing more precision.

CLIENT: Okay.

THERAPIST: All right? It seems to me, from your face, you’re really clear on that.

CLIENT: I am clear.

THERAPIST: So that’s good.

CLIENT: Yeah.

THERAPIST: And between now and next time I see you, I’ll suggest you do another one and we’ll really pay attention to A, B, C, D, E. But really look at how well you – between now and next session—

CLIENT: Oh, yeah.

THERAPIST: make the D more clearly D, and the E more clearly E. Make sense?

CLIENT: Yeah. It does make sense. I think it’s clearly for me now, when you put it that way.

THERAPIST: Good.

CLIENT: You may have put it that way before, but now that I’m getting things more, it makes more sense that—yeah. It’s more structured.

THERAPIST: And may I hypothesize? Certainly, my observation is, as I’m sitting with you now and we’re talking, you seem more focused on the task we’re doing. And I’m not getting any evidence that you’re – somewhere in your head – thinking, “Oh, can I really?” or, “I don’t know if I’ll do it good enough,” or, “Need to please Debbie,” or—

CLIENT: Yeah.

THERAPIST: You seem to be really on-track and more involved saying, “Oh, this is interesting,” and, “Yes, that’s right,” and you seem to be in un-anxious learning mode, which is different from your attitude at times in the past. And just having that, I think, is making the learning more accessible to you.

CLIENT: It is. It is.

THERAPIST: That’s my observation. You agree?

CLIENT: I do. I do. Yeah, I do.

THERAPIST: Good thing.

CLIENT: [giggles]

THERAPIST: Keep it up.

CLIENT: You’re so funny, Debbie.

THERAPIST: Well, I’m glad you think I’m funny. I actually wasn’t joking there.

CLIENT: I know you’re not, but you’re just a character. Okay. I mean, you’re Debbie, but you just have personality. [chuckles] Some people are boring.

All right. So number two was, “Other people would be able to do this—” wait, hold on. Did I do two? Oh, no, I did—

THERAPIST: We really were, one, looking at your marriage of D and E rather than clear D.

CLIENT: Right.

THERAPIST: And that it will serve you to be more aware of that tendency, and to distinguish between the two. So keep going and let’s see—

CLIENT: And then it might come up, they might be married together again.

THERAPIST: It might. And we’ll point to that. And this will be good exercise to help you, perhaps, get better at the task in the days ahead.

CLIENT: Yeah. I’m seeing it even as I’m looking a little bit forward.

THERAPIST: Okay. So go ahead. Next one, two.

CLIENT: Oh, right, which was the second—

THERAPIST: [laughs] – dispute.

CLIENT: sorry, was, “Other people know you’ll be able to do this,” hold on, hold on, “because I should,” oh, “I should—”

THERAPIST: Slowly, slowly.

CLIENT: “I should be able to do this type of therapy because,” like, a better job, basically, “and when I’m not, I think of myself as a lazy, ineffective human being. And I can’t stand to think about myself this way.”

THERAPIST: That’s an irrational belief.

CLIENT: Yes. So then the dispute is, “It is possible that some people have an easier time doing this type of therapy. But even still, I can keep at it and continue to practice to the best of my ability, for my benefit, to just help myself give—to give myself a better perspective.” [00:42:04]

THERAPIST: Okay. So that was, I would say, largely E.

CLIENT: Yeah.

THERAPIST: And disputing would have been jumping on the “should.” Think of disputing as zapping the irrational elements. So in this case, “Why should I be better? Why shouldn’t they be better?” “Where is it written?”You question the assumption.

CLIENT: Okay.

THERAPIST: Do you see what I mean?

CLIENT: “Why shouldn’t they”? Yeah.

THERAPIST: Yes. “So they are. So I may not.” Do you see what I mean?

CLIENT: I do.

THERAPIST: You jump on the irrational elements in the D stage.

CLIENT: I’m going to ask my question now, if I can. Because I do think it actually applies to it and I think it’ll help me more to understand.

I think where I have a difficult time with the—I don’t want to say “I have a difficult time.” [00:43:00] What I want some clarification on with REBT is when there’s subconscious thoughts, because I think I have many. It’s, for me, when I do the REBT, it’s sometimes—like, you’re talking about precision. Sometimes I think my—and we’ve talked about this many times in the past—but to make it easier.

Is there way to be able to hone in a little bit more on the underlying thoughts? Is there a way to get to those underlying thoughts? Because sometimes I think that I’m not even aware of the underlying thoughts. And then it makes it more difficult to be precise. If that makes sense. It’s like I stay right at the superficial level of the thought, because I don’t—or I don’t even know, necessarily, what it is because there’s so many. I think that’s the issue that I have, is that just there’s so many. So I don’t know what’s there.

THERAPIST: Well, if they’re subconscious, you don’t know.

CLIENT: Or maybe I shouldn’t even say “subconscious.” They’re not subconscious. There’s just the phone call with my mom, there were so many irrational beliefs that there was so much dispute that I don’t know how to prioritize. And then it gets a little scatter-y when I sit down to do it, so . . . [00:44:04]

THERAPIST: Well, if you can remember it, it’s significant enough. Don’t worry about trying to elevate what’s subconscious into consciousness.

CLIENT: Okay.

THERAPIST: Just take the time to write down all the thoughts that you do remember.

CLIENT: Okay.

THERAPIST: Keep it simple.

CLIENT: Right.

THERAPIST: If you’re busy that day, do a little bit here and a little bit there. You don’t have to finish it perfectly all in one—

CLIENT: Okay.

THERAPIST: shot.

CLIENT: Okay.

THERAPIST: Does that answer your question?

CLIENT: Yes, it does. Sorry, I’m just—had a little bit of shaking, it’s—

THERAPIST: Bit of a physical spasm?

CLIENT: Yeah.

THERAPIST: Do you want to shift your posture?

CLIENT: No, that’s all—I’m good. But thank you, though.

Okay. So, hold on. So that was—

THERAPIST: So the second irrational belief, say it again. And dispute it now, off the top of your head, not looking at the notes.

CLIENT: Okay. So the second one was that I think of myself as a lazy, ineffective, worthless human being when I think that other people – [chuckles] it’s so nice – when I think that other people would be able to do this type of therapy and be more successful at it than I am.

And to dispute that, I would say, “Well, why shouldn’t they be more—who’s to say that they wouldn’t be more effective or—”

THERAPIST: “And why should I . . . “?

CLIENT: And why should I have—be top of REBT of Albert Ellis? [laughs]

THERAPIST: [chuckles] Yes. All the time.

CLIENT: Yeah.

THERAPIST: Also—

CLIENT: Or write a—I mean, I go really far with it, with the irrational and then I could—if I could just get a little more rational right now—I’m not—”Other people write books. Where’s my book on this?” meanwhile (ph), I just started. I could take it really far.

So then I would have to take a step back and dispute and say—

THERAPIST: You wouldn’t have to, but it would help you. [00:46:04]

CLIENT: It would help me.

THERAPIST: Yes. Also, a good line to remember during the disputation phase is, “Where is the evidence?”

CLIENT: Okay.

THERAPIST: “Where is the evidence that everyone does it better than me? Or that, “Others do it better than me in a way I never could?”

CLIENT: But I provide evidence for myself. That’s what I do in my irrational belief.

THERAPIST: Do you have any data that is proof?

CLIENT: False.

THERAPIST: of consistency and excellence of these other people? Do you?

CLIENT: No.

THERAPIST: You’re assuming that—

CLIENT: A lot of assumptions.

THERAPIST: Yes. And you forgot the fact that these are early REBT days for you.

CLIENT: [laughs]

THERAPIST: No?

CLIENT: [laughs]

THERAPIST: Yes? No? What’s giggly about that?

CLIENT: [laughs] Oh !

THERAPIST: Tell me in Words !

CLIENT: No, you’re so funny, because it’s true. It’s true. It’s so early. I don’t know where this—all right, who cares where it came it. Doesn’t matter.

THERAPIST: It came from your head, expecting yourself to be perfect within 12 sessions.

CLIENT: [laughs] Oh my God, I’m so hard on myself. I know this.

THERAPIST: Say that again.

CLIENT: I’m so hard on myself.

THERAPIST: When you let yourself be. When are you going to stop that?

CLIENT: Yeah, no, I really would like to, because I think it—I’m actually more effective when I’m not.

THERAPIST: Oh, you don’t say !

CLIENT: No, I know. In fact, I wrote that here. Oh, no, I didn’t. That was something different. I wrote, “Having a harder time with something does not make me an inadequate” – that was marrying the two but I still said, “Does not make me an inadequate human being. It just makes something harder.” That was an effective new philosophy. But I kind of thought that was a little bit of disputing, because it just make it harder.

In other words, it might be hard but that doesn’t make me ineffective just because something is harder for me. Separate. Does that . . . ?

THERAPIST: Yes.

CLIENT: Okay.

THERAPIST: Good catch.

CLIENT: Okay. I’m going to jump to the next one, if I may. I’m not going to say, “Am I allowed?” “My parents raised me where they took control over literally everything so I did—could really do nothing for myself. It must be my fault,” blah, blah, blah. I don’t have to go over that again. “They shouldn’t have done this, I should’ve been better. I can’t stand that they could’ve looked at me as ineffective.”

THERAPIST: And by the way, you’re calling that the next “one,” that’s the next four! You’ve just told me three or four implicit and overt “musts” and “shoulds !”

CLIENT: No, that was one irrational belief! That was in one. I labeled them, with the numbers.

THERAPIST: Yes, but in that sentence—

CLIENT: Oh, yeah.

THERAPIST: there’s a “should” and a “must” and a “must” and a “should.” An “I can’t stand “…

CLIENT: I got them all in.

THERAPIST: Do you see?

CLIENT: Yeah.

THERAPIST: Yes, so it’ll be simpler for you to dispute if you break them down.

CLIENT: Condensed it a little.

THERAPIST: No, clarified.

CLIENT: Oh.

THERAPIST: “Condense” is different.

CLIENT: Break each one down, I see what you’re saying.

THERAPIST: Yes, the “should” about you, the “should” about your parents—

CLIENT: Okay.

THERAPIST: the “should” about dut-dut-dut-dut. You see what I mean? Whatever it is you have demands about.

CLIENT: I do see. It cleans it up like a . . .

THERAPIST: Then you’ve identified the “shoulds” clearly and distinctly it’s easier to target them in your disputing phase.

CLIENT: Got you.

THERAPIST: You see? When you got four in one sentence, then that invites your already racing mind to go, “Whoa-ho!” [laughs]

CLIENT: I understand, yeah. [laughs] Okay. By the way, I did just have an irrational thought, but I changed it. I mean, I disputed it. In that two seconds, that happened. I said, “The poor transcriber is going to have to deal with my fast talking,” this is what I said. And then I said, “That was his job, that he’s going to do [laughs] and it’s okay that,” no, I mean—

THERAPIST: The transcriber may be a she.

CLIENT: Oh. Sorry, transcriber! No offense, but good luck to you. And I’m not damning myself, I’m a fast talker and I know that.

Okay, so. Hold on, wait. Oh! So what I dispute for that one—

THERAPIST: Slow down.

CLIENT: Okay.

THERAPIST: Have compassion. [laughs]

CLIENT: Okay. Okay. So—

THERAPIST: And by the way, it’s good for you to slow down too —

CLIENT: Yes, I—

THERAPIST: as well as for our transcriber. Go ahead.

CLIENT: Okay. So then I said, “My parents have tendencies for the need to be in control. That was what happened when I was younger and I survived.” Oh, wait. This is probably—is that a dispute? I think that’s—I disputed it because I said, “I did survive it.” It’s not really a philosophy.

THERAPIST: It’s a little bit of additional commentary, actually.

CLIENT: Okay.

THERAPIST: Cherchez “le should”! Cherchez “le must”!

CLIENT: Okay.

THERAPIST: Hone in for the self-damning, tear it apart—

CLIENT: Well, okay—

THERAPIST: Dispute the irrational thinking that’s the enemy, here.

CLIENT: Okay. So I said, “I will continue to forge ahead,” oh, that’s the E – effective new philosophy. And then I said—wait, “forge and accept that my parents are fallible human beings who struggle, as we all do. No human is—” this is, I’m sure, the E – effective new philosophy…“No human is perfect and I can stand that my parents make mistakes. I do not have to continue to whine about it.”

THERAPIST: Mm-hmm.

CLIENT: Yeah, that’s—

THERAPIST: from what you’re telling me now, in this real moment time, that you’re already getting—

CLIENT: I’m getting that, yeah.

THERAPIST: more clearly what an effective new philosophy is versus disputing. Now, there will sometimes be some overlap.

CLIENT: Yeah.

THERAPIST: So watch it that you don’t get obsessive perfectionistic about it.

CLIENT: Okay, got you.

THERAPIST: However, there has been an overload of intrusion of Es into Ds in this instance, tonight. So let this session be helpful as training for your getting better at it as time goes on.

CLIENT: Yeah, that makes sense.

Okay, so then the next one. I’m just going to find the “cherchez ‘le should’” in number four, because I think I probably did do effective new philosophies, the one where I said, “I’m angry at my parents, I’m rage—” I changed it to rage. “I’m rageful that my parents raised me this way. It’s awful that I feel as angry as I do and I can’t stand that feeling.” So I’m just going to do it now, because I don’t—I think [that it’s] (ph) effective new philosophies.

So to dispute that . . .

THERAPIST: Ask: “What’s so awful about . . . ?” [00:52:03]

CLIENT: What’s so awful about feeling as angry as I do?

THERAPIST: And about . . . ?

CLIENT: The way they raised me.

THERAPIST: This is another instance of how it’d be easier for you to have had two or three different sentences, here.

CLIENT: Right.

THERAPIST: So you see—

CLIENT: So just one, “I am rageful at my parents that they raised me this way.” Period. Now l’d dispute it.

THERAPIST: Aren’t you also implying “They raised me as they shouldn’t have.”

CLIENT: As they shouldn’t have.

THERAPIST: Stick in the “should” when you write the thoughts down it’ll help you—

CLIENT: Okay.

THERAPIST: dispute.

CLIENT: Okay.

THERAPIST: Okay.

CLIENT: “I’m rageful that they raised me this way, as they shouldn’t have.” Who’s to say that the way they raised me was ineffective? I’m not going to dispute that there were some really great things about my childhood. And then there were some unfortunate—or tendencies or habits that were sort of instilled that . . .

(pause)

THERAPIST: Repeat the “should” statement again.

CLIENT: “I am in a rage,” I’ll just say that, “My parents raised me this way as they shouldn’t have.”

THERAPIST: Okay, so you’re focusing on the “shouldn’t have had.”

CLIENT: Who’s to say that they shouldn’t have raised me that way?

THERAPIST: When they did raise me that way!

CLIENT: What do you mean?

THERAPIST: Because they did!

CLIENT: Right, right… they did.

THERAPIST: They did. Even though it may have been preferable if they had not. And then your bit about how awful—

CLIENT: “It’s awful that I feel as angry as I do at them, and I can’t stand that feeling.” What’s so awful about feeling as angry as I do? I can accept that I have some anger. And I can deal with the fact that I have not the happiest of feelings that some things have occurred. But that doesn’t mean that I can’t live with that or that I can’t deal or cope with the fact that it wasn’t exactly how I wanted it to be.

THERAPIST: Full stop, at the end of disputing. And then, in the effective new philosophy related to that, “I can stand what I don’t like, ” “I just don’t like it.”

CLIENT: I just want to see what I told myself for—I said, “If I keep telling—” oh, this was my—for the dispute that I had. Because I just made that up just now, the other one. “If I keep telling myself how angry I am, I will continue to think in angry ways. I can feel—” no, that was probably a little—

THERAPIST: “To think in ways that create anger.”

CLIENT: That create anger, okay. “I can feel disappointed and occasional frustration. Despite my parents’ tendencies, I’m a worthwhile human being who makes mistakes—”

THERAPIST: Slowly, slowly.

CLIENT: Oh. “Despite my parents’ tendencies in raising me, I am a worthwhile human being who makes mistakes, who also accepts myself unconditionally despite these mistakes.”

I just want to put in what you said, though, for my own benefit. “I keep—” wait, “If I keep telling myself how angry I am, I will continue to think in ways that will create anger”? Is that what you said to—is better?

THERAPIST: “If I keep thinking in ways that create anger—”

CLIENT: Angry feelings. Angry emotions.

THERAPIST: “That create anger.”

CLIENT: Okay. And then I said, “I can feel—I can accept that I have disappointment and occasional frustration.” So I think it’s that accepting it? The disputing piece?

THERAPIST: And disappointment and appropriate frustration is not unhealthy.

CLIENT: Right. It’s the unhealthy versus—yeah.

THERAPIST: Rage— is unhealthy.

CLIENT: Right.

THERAPIST: It is unhealthy because it—

CLIENT: It doesn’t get me—

THERAPIST: debilitates.

CLIENT: Right.

THERAPIST: Yes. All right.

CLIENT: So now I did effective new philosophies. And I kind of just did—I didn’t do them according to the—I just said a bunch of philosophies after—I didn’t know if that was the way, but I just did it where after I did all my irrational and then disputing, I said, “Well, now, I’m going to look at things differently.”

And so I said, “Life is not always fair. There are wonderful aspects of life and parts of life that sometimes just stink. I can accept that bad things happen to good people.”

THERAPIST: Slowly!

CLIENT: Okay. “I can accept that bad things happen to good people and that there’s not always an explanation for why people do the things they do and why things happen the way they do.”

“No matter how dependent I am on my parents at times, I am not a worthless person. Just a person who can be dependent at times. My parents may make mistakes as well as I do, but they are fallible human beings and I can accept that they do not have all the answers.”

“Although I have felt sadness about my past, my life as a whole has been overall happy. And I have had really amazing experiences and will continue to have them. Just because negative situations have occurred in my life does not make my whole life a bad life.”

“Physical pain,” and then I got into this because I was feeling pain but I continued to write. “Physical pain is not fun and I’m not happy that I’m in severe pain at the moment, but I will forge ahead the best I can. I’ll appreciate the good days because nothing lasts forever and neither will the pain.”

THERAPIST: Yes, true. But the last couple of sentences don’t relate to the activating event.

CLIENT: Yeah, I know. That’s because I went back to it later and felt different—was doing effective new philosophies on the pain because I was really feeling it, so it was before you came and I just added in. Oh, I see. I didn’t dispute it. I didn’t do anything with it.

THERAPIST: We were talking about the phone call.

CLIENT: Right. [laughs]

THERAPIST: So you extrapolated here, right? Pointing that out. Now How did you feel differently after doing this, if you felt differently? Did you feel the same rage, anxiety, frustration, and self-damning?

CLIENT: Not as much with this particular one. It was more with—

THERAPIST: That was the question. How was it with this?

CLIENT: Not as much with this one as the one I did with my—when I had with an actual fight, conflict with a friend. And I did in the moment. But I didn’t do this one in the moment. Let me just explain: the phone call happened and I waited. I didn’t do it right after the phone call happened. So I think what I’m—but I had a conflict with a friend and I did it in the moment, because I was in such a state of panic. And that actually helped and I was able to go to sleep. That was the next night. And so I realized then. But I had to really push through to do it, I was so—the one with my friend. But that was so beneficial.

THERAPIST: Well, I hypothesize if you had not pushed through and done it and changed your emotion, you may not have gotten back to sleep.

CLIENT: Probably not.

THERAPIST: according to what you’ve told me about your past tendencies.

CLIENT: Yeah, absolutely.

THERAPIST: So that sounds like a real success story. But focusing back on what—

CLIENT: This one wasn’t as successful, unfortunately, because I didn’t do in the moment after the phone call. I was spent. I was in physical pain. And I didn’t do the homework then. I waited. So it didn’t have as much effect, because the feelings and the—I probably sat there and had more irrational thoughts than—even though I was successful, I think, with helping my mom in some way, it didn’t matter. The irrational thoughts were still really running through my head that night, after the call. Waited and did the homework a night later.

THERAPIST: But when you recalled the activating event, did you still feel rage?

CLIENT: No, I guess not.

THERAPIST: And anxiety?

CLIENT: No, probably not as much. I mean, I think, in the past—

THERAPIST: Okay.

CLIENT: it would have been a lot worse.

THERAPIST: You mean, the day before, it would have felt worse?

CLIENT: No, no, no. In the past, when phone calls like this have happened.

CLIENT: This is not the first phone call—

THERAPIST: Do you think that in some ways, a change in your attitude lessened the emotions, the negative ones?

CLIENT: Yeah. Absolutely.

THERAPIST: Changed the harmful negative emotions in a constructive way—

CLIENT: I think so.

THERAPIST: which is why there wasn’t, in this exercise, a sharp contrast between how you reported feeling after the event and how you felt after doing the E section.

CLIENT: Exactly.

THERAPIST: Because you’d already kind of talked yourself out of some of the thoughts that created the extreme.

CLIENT: Yeah.

THERAPIST: So you’re having success, aren’t you?

CLIENT: I am, yeah. Definitely. I’m having a hard time at this particular moment in time, at this very moment—

THERAPIST: A hard time with . . . ?

CLIENT: With my irrational thoughts. I’m in so much pain and I’m having a lot of irrational thoughts about that, about that it shouldn’t be this way. That I shouldn’t be in this much pain. And it’s not fair and this—I don’t—and I’m taking it—but I want to use that right now, because it’s so relevant. But I think what I’ve noticed is that I tend to, my tendencies are that I take it to that I’m going to be in pain for every single day for the rest of my life. And I do reflect on the fact that I’ve been in pain every day for seven months, which I think has been that I haven’t had a pain-free day. Literally, not one pain free day. There’s been glimmers of – if that’s a word – of glimpses of less pain on certain days, but when it’s heightened, it just continues to hang out around me. It’s difficult.

THERAPIST: So it sounds like, the reality is that, pain has been a daily occurrence to greater and lesser degrees.

CLIENT: Mm-hmm.

THERAPIST: But at the same time, I have witnessed you laughing with mirth. I’ve witnessed you—or I’ve heard you tell me of some enjoyable things you did with your friends and your girlfriend. And so, the reality is not every moment of the last seven months have been dominated by pain, even if that’s been a regular visitor.

CLIENT: Okay.

THERAPIST: It’s been, in an overall sense, a very difficult time for you.

CLIENT: [crying] I’m sorry.

THERAPIST: And all things considered, how are you doing? How are you coping with this?

CLIENT: I can’t wait for the surgery. [giggles] I’m trying to be realistic about that, as well, without—just knowing that it’s surgery and that it’s—you don’t just jump off the table and pop up and start.

THERAPIST: Whoa! Pulling you back to the present moment. Could you give yourself credit, now, for how well you’ve done in the last seven months despite – and including – the pain? Tell me, I want to hear it.

CLIENT: I think I’ve done a remarkable job. I don’t know how—I mean, I found strength somehow, within me, to be able to forge ahead and be able to just move along and go to work and function, despite being in this amount of pain

I think that people are going to be possibly confused as to – I’m talking about the students – as to—well, I’m not going to share with them how much pain I’m in – but they might—in other words, I’ve forged ahead so much and enjoyed my times with them – I’d like to concentrate on that – so that I think they would even be surprised to know that I would need—

THERAPIST: I don’t care about their states right now Jessa. I want to hear how well you’ve done. I’m honing you in, now.

CLIENT: Okay.

THERAPIST: You’re not off off track. You’re getting off track. I want to hear how—

CLIENT: Really, really—

THERAPIST: I want to hear how well you’ve done.

CLIENT: Really well.

THERAPIST: Yes! Yes! Yes! Yes! Hooray! Hooray. And there are tears because . . . ?

CLIENT: I’m in so much pain physically. It’s just my whole body, from my head to toes, and it’s really just hard to concentrate on things right now. Nothing really relieves it.

THERAPIST: Well, we’ll start winding up our session now.

CLIENT: [sighs]

THERAPIST: And again, given that you are in that pain, good on you for carrying on and for being engaged in our conversation. I definitely observed and heard that you were with me for the most part while—

CLIENT: Yeah, [I know].

THERAPIST: and with yourself, more importantly, in thinking about the things we discussed, and now, you’re feeling the pain again. And I have a hunch that maybe some of the tears that you’re shedding now may also come from compassion for yourself. Yes?

CLIENT: Yes.

THERAPIST: Yes. You are recognizing how well you’ve done despite such a great amount of pain—

CLIENT: Yeah.

THERAPIST: over seven months. So it’s good to have compassion for yourself. You deserve that. You’ve done really well. You are doing really well.

CLIENT: Thanks, Debbie.

THERAPIST: You are.

CLIENT: [sighs]

THERAPIST: So let’s start our concluding the session

CLIENT: Okay.

THERAPIST: and then you can go to bed or relax or do what you find helpful to do to relieve the physical pain.

CLIENT: I have to go feed my friend’s cats. [laughs]

THERAPIST: So just completing that A, B, C, in conclusion, quite well done. It’ll be more helpful to keep working on more precisely separating the D and the E.

CLIENT: Okay.

THERAPIST: And also, you didn’t feel a huge change in the emotion after doing the D and the E because you reported to me that already there was a change in your emotion by the time you sat down to do it.

CLIENT: I mean, yeah, but I definitely less rage.

THERAPIST: Yes, but let me—

CLIENT: Oh, sorry.

THERAPIST: ask you—

CLIENT: Yeah.

THERAPIST: the change in emotion, was that because you had a different attitude between the time it happened and the time you sat down to—

CLIENT: I’m sorry, I lost you , which one are we talking about it? The one—

THERAPIST: That one that your—

CLIENT: this one, here?

THERAPIST: mother’s—

CLIENT: Yeah, there had been a—yeah, I was—

THERAPIST: So you had talked yourself out of the extreme unhealthy ideas?

CLIENT: Yeah, by that point.

THERAPIST: By that point.

CLIENT: So it didn’t feel as bad —I had already kind of done that.

THERAPIST: Yes!

CLIENT: The one that was really effective, which – maybe in the next session or whatever, I can share – was with my friend, because I felt that I was able to recognize ways of my thinking and the self-damning and blaming and things like that when we were in this conflict and I was able to get—talk myself down by using REBT. And then, it ended up being effective.

And then it had a good turnout, too, because the next day, she apologized. Whereas I was all set and ready to blame myself and say, “I’m so sorry,” which is what had been my tendencies – not always, but sometimes I can be stubborn – but I was ready to do that and she was apologetic even before. So it had a good outcome.

THERAPIST: What if she had not apologized? Would you have put yourself down?

CLIENT: No. No. I wouldn’t have. No. I did the work and was able to recognize that it wasn’t anything—it was a circumstance and it wasn’t anything to do—putting myself down was not a necessary in this—it wasn’t going to benefit me, so I wouldn’t have continued to do that.

THERAPIST: Would have hurt you to put yourself down?

CLIENT: Yeah.

THERAPIST: So, good job.

CLIENT: Thanks.

THERAPIST: You’re feeling pain. I can see. We will finish up now.

CLIENT: [crying] I’m sorry. I mean, I feel like it’s related but—

THERAPIST: Related to what?

CLIENT: Because I don’t know what to tell myself right now to [laughs] to not feel such physical pain. I don’t know how to get out of it, so . . .

THERAPIST: Well, okay. First practical possibilities The physical pain, is there a—you used to have a pillow you warmed up to put on—

CLIENT: Yeah.

THERAPIST: might that help?

CLIENT: I burned it.

THERAPIST: You burned it ?!!

CLIENT: I’ve used it so often [laughs]

THERAPIST: [laughs] At least it wasn’t in a voodoo ritual or in a fit of rage.

CLIENT: [laughs] No, I used it every day—

THERAPIST: Then you had an accident with it?

CLIENT: I warmed it for six months or so, in the microwave, four times a day—

THERAPIST: Oh.

CLIENT: so it’s pretty much—

THERAPIST: Oatmeal.

CLIENT: [laughs] It stinks when I use it but I don’t get as exciting about using it because it has a burned smell. So I could use it right now but I’d have to probably go out and get another one, if I want to enjoy using a heating pad again. [laughs]

THERAPIST: Why don’t you put that on your shopping list to get a new one when you can?

CLIENT: Yeah, I looked it up last night and they don’t have the ones, this is a special one [laughs]

THERAPIST: Could you get a less special one?

CLIENT: Yeah.

THERAPIST: Which would be better than the one you’ve got, even though not as great as this one was in its infancy?

CLIENT: [laughs]

THERAPIST: A hot bath or shower, will that possibly soothe you?

CLIENT: Maybe. Maybe.

THERAPIST: Will you do that?

CLIENT: It’s possible.

THERAPIST: try that after you’ve finished—

CLIENT: Yeah.

THERAPIST: your cat duties? And do things to nurture yourself tonight.

CLIENT: Yeah. [crying] Sorry.

THERAPIST: Why are you sorry? What are you apologizing for? There is no need for apology. Why are you apologizing? Or , what are you apologizing about?

CLIENT: I’m not sure. I just feel bad that in this session, and I’m in so much pain. I feel like it’s something—

THERAPIST: Oh. So you should never—

CLIENT: [laughs]

THERAPIST: be in pain or cry when you’re my regal company— !!!

CLIENT: [laughs]

THERAPIST: is that what you’re telling yourself? And what are you going to do with that “should”?

CLIENT: [laughs]

THERAPIST: What would Albert Ellis say?

CLIENT: Well, I know he had physical pain, too, so he would probably—he would, I’m sure, have something to say to that.

THERAPIST: Yes, he would. My question was: What would he say you could do with that “should”? Where might it be . . . ?

CLIENT: Stick it some—I don’t know.

THERAPIST: Well, actually, it’s funny you should say that. He, to some people, would say, “Why don’t you stick that ‘should’ where the sun doesn’t shine?” [laughs]

CLIENT: [laughs]

THERAPIST: But my husband had a way about him when speaking humorously, and the way he said those things. In any case, point being—

CLIENT: I feel like I know him now. Anyway. [giggles]

THERAPIST: Well worth knowing.

CLIENT: Yeah.

THERAPIST: Yes. So it’s highly possible that your discomfort in showing tears in my company is a close first cousin to your having insufficient compassion on yourself when you’re feeling vulnerable and—

CLIENT: Well, I don’t want to have that compassion because I don’t want to keep crying. I don’t mean to—

THERAPIST: Two separate things.

CLIENT: Yeah, but I just don’t want to—I just want to be able—to be okay.

THERAPIST: All right, so—

CLIENT: You’re probably right.

THERAPIST: Jessa: Consider a child comes to you who’s crying. Do you do your best to soothe the child? Or do you say, “I don’t want to pander to this crying so-and-so”?

CLIENT: [laughs]

THERAPIST: “ – because I don’t want to encourage it.” What would you do with your crying student?

CLIENT: No, we’ve gone over this.

THERAPIST: Yes, we have! I’m seeing your impatience with yourself and a reluctance to have compassion on yourself, which is—I don’t care if we’ve gone over it before, I’m seeing you not exercising— and that doesn’t help you.

CLIENT: I don’t like seeing myself like this. I’m sorry.

THERAPIST: So if you ignore this, do you think that will be of greater success—

CLIENT: No.

THERAPIST: than if you have compassion for yourself? So how’s about a little kindness?

CLIENT: Okay, yeah. [crying]

(pause)

CLIENT: [sighs]

THERAPIST: You see how tough you can be on yourself?

CLIENT: Yeah. I’m just concerned. I have just concerns. I guess healthy concerns that it’s—I have to work another week and I know I got through today and it’s Monday, but it’s just getting harder and harder. Just getting harder to be there and to be effective, let’s just say. I mean, I feel like I’m …

THERAPIST: No. No. Stop, stop, stop. Right now—

CLIENT: Okay.

THERAPIST: At this moment it’s early evening. You’re not at work. You’re predicting it’s going to get harder.

CLIENT: Sure.

THERAPIST: Fact: it may. And I predict you’ll cope if it is.

CLIENT: Okay.

THERAPIST: Fact number two: it may NOT be as hard as you’re sitting here thinking it will be. So what is the point of letting yourself think—

CLIENT: There isn’t.

THERAPIST: There isn’t. Can you focus in on more on the present time? It’s early evening. You’re going to feed your friend’s cats after our session. You’re going to feed your own cats. You’re going to hopefully put some warmth where the pain is. And have a decent night’s sleep.

CLIENT: Okay.

THERAPIST: Okay? Gentle, gentle. So, between now and next time I see you, what might be doable and useful homework?

CLIENT: Probably something to do with the pain. Like an A B C on the pain and then doing the disputing—well, I don’t know. All my philosophy’s about the pain. Because pain is pain, but then it’s where I have the choices to catastrophize it or—

THERAPIST: Can we be more precise and focus on compassion for yourself?

CLIENT: Sure.

THERAPIST: The pain – hopefully – you will lessen through warmth and showers and whatever. But what became apparent a few minutes ago was the awkwardness or resistance to having compassion for yourself. USA: unconditional self-acceptance.

CLIENT: Okay.

THERAPIST: So you were reading the book by my husband, “The Myth of Self-Esteem,” and that certainly has some exercises in it—

CLIENT: Okay.

THERAPIST: which attend to lack of self-acceptance. So are you comfortable, between now and next time, to make your focus increasing unconditional self-acceptance? And then when I see you, you’ll tell me what you did and—

CLIENT: Okay.

THERAPIST: how you did.

CLIENT: Okay.

THERAPIST: And additionally, I encourage you to keep doing the best you can – given the difficult time – to watch your thinking. As I was doing – particularly earlier in the session – and—

CLIENT: Okay.

THERAPIST: catching the unhelpful thoughts—

CLIENT: Okay.

THERAPIST: and disputing them away and just—with the goal of gentle, gentle on yourself.

CLIENT: Okay.

THERAPIST: Okay? Well done.

CLIENT: [chuckles]

THERAPIST: Well done.

CLIENT: Thanks.

THERAPIST: Good job.

CLIENT: Thank you.

END TRANSCRIPT