Client "K", Session December 21, 2012: Client discusses boyfriend's ongoing medical condition and care. Therapist helps client with breathing and calming exercises. trial
TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
THERAPIST: So where are you?
CLIENT: It’s not been the best week. I’m trying to remember when I last saw you.
THERAPIST: You were having a good week.
CLIENT: I was having a good week. I think I told you it was like yoga.
THERAPIST: Yes, I recall that.
CLIENT: I’ve changed my mind about that. (sniggers)
THERAPIST: Ten days ago.
CLIENT: Ten days ago. Josh had his procedure.
THERAPIST: Was that just this morning?
CLIENT: That was Wednesday. Gosh, what do I want to tell you? (chuckles) I was kind of [ ] (inaudible at 00:00:34). I had made two appointments this week. Whenever school ends, I’m always in trouble. I’m always in trouble all throughout college. I’ll come home the day after finals and generally freak out because, all of a sudden, I have nothing to do.
THERAPIST: It’s a huge release.
CLIENT: Oh, my gosh. And I generally start having [ ] (inaudible at 00:00:57) my father so I almost always make my little brother go and take a walk around the lake. I would freak out to him for about an hour. He’d tell me I was crazy and then we’d go have ice cream. [00:01:07]
THERAPIST: What would you freak out about to him?
CLIENT: I’d just be really frustrated. I wouldn’t know what to do with myself and I’d be frustrated with my father for whatever. I don’t know. Just talk, talk, talk for an hour about whatever is going on. It would take me a day or two to unwind. But I don’t know, I had really started feeling all of that. All my friends were going away. We had a couple of holiday parties which were kind of stressful and not super fun, everyone left, and Josh started getting really worried about his procedure. We went to the gym on Saturday morning. This is like a week ago. I was feeling kind of icky and he was feeling kind of icky. I started having a crying fit at the gym and then walked out. We were going to go shopping afterwards so I walked over to the store, which is just around the corner; and I proceeded to have this mental breakdown in the middle of the store, which was really embarrassing. I was hysterically crying. Josh came and found me. [00:02:17]
THERAPIST: What were the tears expressing? Were you angry, sad, frustrated?
CLIENT: Well, I mean quite often we go to the gym and lately it’s been great because we’ve gone with somebody else. He doesn’t feel good and I try not to let it bother me too much. He just does whatever he needs to do, whatever he feels like doing or goes home. For some reason I just couldn’t handle it because my friends are all gone. The guy I go to the gym with won’t be back until like February.
THERAPIST: You were disappointed in the workout or the experience of going to the gym.
CLIENT: I knew if I could just do my own thing I would feel better because that always happens. I just couldn’t handle it. I just got all wrapped up in how it was going to be like last year all over again. My family just left, so nobody was around except Josh’s mother, who has been really strange and I’m really angry at her or her not being helpful. I don’t know. I just got really worried that the school thing was not going to work out. [00:03:18]
THERAPIST: So feeling kind of abandoned and scared.
CLIENT: Yep.
THERAPIST: It sounds like fear was a big piece of that because as I said that your eyes got wide. There’s a lot to be fearful of. You don’t know how things – you certainly didn’t know how things were going to go Saturday.
CLIENT: Yeah, I feel like there’s something else happening. I don’t know. My mom called me. I feel really bad. She has guilt, I think from not knowing what was going on for so long, and I think she feels really bad that I have to handle the stuff with Josh anyway. She called me like six times when he was in the hospital. They’re in Washington visiting my grandma, which makes me feel bad. I mean I’m sleeping now. I’m not totally miserable. [00:04:05]
THERAPIST: You feel badly that you didn’t go?
CLIENT: No. I don’t feel badly that I didn’t go, I feel badly that she feels bad that she’s not here. They had the trip planned. They left the day before – so maybe she was around. I don’t remember exactly what the timing is. They were gone before his surgery. Anyway, then I got over it and it was fine. Josh was very good. He came and found me and said it was going to be fine. We just ended up – I’m not sure what we did. We just did some fun things that day. It was so fine. Then the day before his surgery, first of all, his mom hadn’t asked anything or said anything about it. I wasn’t feeling very confrontational, so I didn’t say much to her about it. The morning of, we were up at 5:00 AM to get him to the hospital really early. [00:05:03] She woke up because the dogs were going nuts and she starts asking me for the jumper cables in the car because she’s leaving for Milwaukee Thursday. I’m like you’ve got to be kidding me? We’re going to the hospital and I’m finding the jumper cables. I was just steaming because it took us a half an hour to get ready and she was just putzing around making coffee.(chuckles) I go, “Well, wish us luck.” She’s like, “Good luck.” I was furious. At least she can take care of the dogs all day and I don’t have to come back, although in retrospect it would have been nice because then I would have had an excuse to leave the hospital. I’ve just been furious all day.
THERAPIST: You really want her priorities to be more aligned with what you feel like.
CLIENT: Or just say something.
THERAPIST: Acknowledge what’s going on.
CLIENT: “Make you dinner when you get back,” or just anything. Give her son a hug – whatever. I think she’s really scared. She once told me in the car, which was really uncomfortable, how her other son who’s a drug addict and in jail, I think, and if he died she would be sad; but if Josh died, she wouldn’t be able to go on. [00:06:10] So I know she cares. She just shows it less when it’s needed than even regularly. So I was just still so mad at her. Anyway, the procedure went well as a procedure, but when they went in there, his heart hasn’t been healing at all. He finally came out of it and I saw him and everything was so much better than before. He didn’t get super sick or – like he wouldn’t stop bleeding last time. Everything went fine. They went in there hoping that his heart – it’s enlarged – hoping that it had shrunk by this time and it hasn’t, so they did what they could but the doctor came to and told us, basically, that it’s just going to have to be managed, probably. He’ll probably need more procedures. Who knows. We didn’t talk excessively about it, but he left the hospital. Actually, they got him into rhythm by the end of the procedure, which is good. [00:07:09] I was hanging out with him. We were sitting watching some TV and he had his dinner, and then he started bleeding all over, which was really traumatizing. He had all the nurses running, freaking out because he wouldn’t stop bleeding, and then he went back out of rhythm because his blood pressure dropped. He didn’t even notice. He was oozing blood all over the place. It was really gross.
THERAPIST: That must have been really scary to see.
CLIENT: I don’t do well with blood. I’m usually the one bleeding, for some reason. He takes care of things. He’s fine. Yeah, the world’s not good. So then I left him and . . .
THERAPIST: How long was he in the hospital?
CLIENT: He had to stay overnight instead of coming home the night because of that, (chuckles) which was good because if it had happened at home it would have been ten times worse.
THERAPIST: Yeah, you feel a little safer. He was there with people who can respond immediately.
CLIENT: Yeah, other than that, though, he bounced back much quicker than last time. He’s trying really hard to show me how much happier and better he is, but I’m really struggling . . . [00:08:10]
THERAPIST: That causes uncertainty because his heart stops.
CLIENT: Yes. His doctor said this is just going to go on and on. If his heart hasn’t tripped by now, it’s just probably not going to. He’ll just have to deal with it for the rest of his life, which is kind of the worst-case scenario, besides something horrible happening and him needing something really serious like a transplant or something really terrible. This is kind of the worst-case scenario out of this procedure that could happen.
THERAPIST: I’m so sorry.
CLIENT: We haven’t really talked about that part. He asked me about it a whole bunch of times. He was like, “Are you really sad about what the doctor said?” I wasn’t going to start bringing it up that I was sad. I don’t want him to worry about it, I think maybe a little bit.
THERAPIST: It’s a lot to take on.
CLIENT: So then we got home and I got home really late. His mom actually texted me once or twice while I was at the hospital asking if everything was okay. I was really happy. [00:09:08] I was like, “Okay, she realized what’s going on.” I texted her back and said this is what happened and then I told her again he wasn’t coming home. Then I didn’t get home until kind of late and she appeared to be asleep. I went to bed and I heard her getting up so I went out and called her name. Then she appeared to be asleep again and I wondered if she was avoiding me. The next morning, she was gone for work at 7:30 AM and didn’t answer my call. I called her.
THERAPIST: It does feel like she’s avoiding you.
CLIENT: I could be reading into it, but it felt like she was avoiding me. Then she came home around 3:00 to get ready to go to Milwaukee and I was exhausted. I was lying on the couch and she asked me if I was okay. She didn’t say anything about Josh. Oh, my gosh. I almost just lost it, but I didn’t. [00:09:58] Later I was making dinner and she came in and said something about Josh and how if he had just been taking care of himself this wouldn’t be happening; so it was his fault. Maybe the things he did led to this happening, but he’s not doing anything wrong right now. It’s not his fault. And then she said something like, “Well, at least you know it’s not genetic.” I’m like, “What are you saying here? Are you saying, ‘Please don’t leave him’? What are you saying?” “It’s not my fault,” I think is what she was saying. “It’s not my fault.” Of course, his dad died of – his heart exploded they said because of a cocaine overdose, which generally doesn’t happen so I would say there’s definitely – not last year, but the history before was – I don’t know. I don’t know what’s going on with her. I didn’t want to totally look for bad. Our living situation is really incorrigible, but now I think she’s gone until New Years so I’m stuck again caring for him and he’s being so sweet. He’s like, “oh, don’t do this” and “don’t do that”, but he can’t lift anything or take care of the dogs or do anything. I’m not going to have him bleeding out all over the house just because he wants to help and not make me feel bad. [00:11:12]
THERAPIST: What are his restrictions?
CLIENT: He has to let his wound heal, so he can’t do any vigorous activity. That’s all. I dealt with the fact that this is now like a – he’ll never get another one of these procedures. He wouldn’t do this again, but it will either be something worse or they’ll shock him back into rhythm every month or whatever, however often it’s needed.
THERAPIST: It’s something that goes from being something that felt potentially curable to being a chronic, manageable issue.
CLIENT: Who knows – we were going to plan a vacation. We can’t really plan a vacation until they figure out what’s going to happen. Maybe we’ll never be able to plan a vacation. [00:12:02] Who knows. We’ll have to talk to the doctor in a month because he can’t go on like this actually forever because the drugs he’s on are toxic, which is the point of this procedure. I don’t know. I don’t know what they’re going to say. I’m going to be dreading it all month, I’m sure and I’m sure he will be, too.
THERAPIST: I know that you were really counting on having some support and not having to handle all of these questions and all the care all by yourself, having his mom around thinking she would shoulder some of this.
CLIENT: Yeah, and I mean my mom will when she gets back. Maybe I could figure out a way to confront his mom and be like, “Look, you need to do something with this. Anything.” I had dinner with a friend of mine the night before, which was really good. I almost canceled on her so I could just sort of pull out, but I didn’t. She actually works over at the hospital in a different unit. [00:12:59] She sent me some messages that day and a lot of people – I decided I was just going to email all of his friends. He told me that was okay, so I emailed all of his friends and there were messages from some of them.
THERAPIST: That’s wonderful.
CLIENT: That was actually amazing. I didn’t think it would be, but then I was sitting there and getting random messages from people saying “good luck”. It was really nice.
THERAPIST: I think that show of support is really wonderful. It’s nice to also be reminded that your expectations are normal and that his mom is not meeting kind of the typical expectations. Having everyone else remember and keep it in mind and offer support kind of reminds you that yeah, she should be doing those things, too.
CLIENT: Well, I got a message from her as if she was just another one of my friends that knew about it. That’s his mother. I’m okay if you’re terrified. She’s 60 years old. I mean, come on. She had a lot of stuff happen to her. I would think she’d be able to deal with it by now, especially for her son. Even if she is terrified, how can she watch me do all this without offering to help. She laughs when we asked her to ship some boxes for us. You’ve got to be kidding me. Who are you? [00:14:08]
THERAPIST: How does he respond to this?
CLIENT: Not as angrily as I would have thought. He’s just like, “Oh, whatever.”
THERAPIST: He’s not surprised by it.
CLIENT: He’s not surprised.
THERAPIST: It’s a combination for you of being surprised and angry, whereas I wonder if this is somewhat in line with how she’s responded to different things throughout his life.
CLIENT: I think she thinks this is all his fault and she doesn’t want to take any responsibility for it. He told me when he got his first ever procedure, cardioversion, to get him back into rhythm the very first time when he was living with her, she was at a training and he took a cab to the hospital and back. (chuckling) That’s awful. I was just going on and on to him. What would you do if I wasn’t here and she was? He was like, “Well, I’d take a cab. That’s what I did before.” Unbelievable. [00:15:03]
THERAPIST: Wow. He’s had to be really independent.
CLIENT: Yeah, so I think he just doesn’t expect anything from her, nor has he. She’s done a lot of bad things to him and I’m confused by his feelings towards her because he was happy to have her live here. He seems to care about her and wants to help her. I don’t understand. He has feelings like that towards his stepfather, who was abusive. He says lots of things about how he helped him and how he wants to be like him in some ways and then never wants to see him again. He appreciates what he learned from him, and yet he also kind of ruined his life in a way. It’s really confusing. His mom did kind of the same thing in a way, less seriously. I don’t get it.
THERAPIST: It’s really hard to understand how someone can have such conflicted feelings. [00:16:02]
CLIENT: I don’t know if it’s conflicted or if he just somehow manages to separate the two or if it’s a problem. I don’t know. I have no idea. (pause)
THERAPIST: So how have you been holding up in the wake of all of this?
CLIENT: It’s so much better than last time and I guess I haven’t dealt with what might come yet . . .
THERAPIST: Well you can’t. Part of that is dealing day by day.
CLIENT: I mean, today was the first day I sort of got myself going. Yesterday I spent most of the day on the couch with him, which I’m not sure was the best plan. (laughs) I’m feeling clearer.
THERAPIST: Thank goodness you got here by 9:30, which was actually a good thing. (laughs)
CLIENT: Good. Got to go home, give the dogs a bath . . . [00:17:04]
THERAPIST: Maybe we should do that all the time.
CLIENT: No, really. I’m used to going back to school, regardless of vacation. I wish it wasn’t vacation. I don’t do well with vacations.
THERAPIST: It’s hard to go from having such structure to not having structure; and the structure really does provide a good distraction.
CLIENT: Yeah, I mean I used to know what was going to happen and what was expected.
THERAPIST: Because you didn’t have the typical exams-type thing, right?
CLIENT: Right.
THERAPIST: Is this the first time you haven’t had classes?
CLIENT: Well, no. Last year, this didn’t happen because I was such a mess to begin with. Then it got worse, for sure, over the break because I was feeling more isolated and more upset that I was having nothing to do and yet not sleeping. [00:18:00]
THERAPIST: Maybe we could spend some time thinking about what can be the structure, since you don’t have the typical expectations. You can certainly fill some stuff in – it doesn’t have to all be work – to give yourself some structure so you do get up and going, that you still have flexibility to take care of Josh when he recovers. What would you like it to look like?
CLIENT: If I can just go to school every day. I just need something to get me started and that’s not . . . [ ] (inaudible at 00:18:36)
THERAPIST: Have some [ ] (inaudible at 00:18:41) scheduled.
CLIENT: Schedule things. I scheduled a whole bunch of social things this week, which was great. I canceled some of them because of the overnight in the hospital.
THERAPIST: These are things you scheduled to make up for stuff that you canceled, or are you canceling stuff now? [00:18:58]
CLIENT: [ ] (inaudible at 00:18:59) I had planned on until the hospital, and then I canceled every class, which is fine. I don’t know. There is some sort of fine line between trying to do too much and sort of wallowing, which is definitely the past few days. Gosh, I just think about if I was still working what I would have done. In grad school I can sort of pretend I’m not doing anything as long as no one notices. That’s probably good and bad for me.
THERAPIST: Do you feel like you’re doing nothing? Well, for three days.
CLIENT: Yeah. (laughs) No, I mean, I’m helping Josh. I’m not overstressing myself, I guess.
THERAPIST: You’re taking some sick time for family leave. You’re allowed to use your sick time for family. You don’t punch a clock, but that’s sort of the idea of taking some time off to help your boyfriend. [00:20:04]
CLIENT: I had to read a paper for my advisor and mail it back and tell him I can’t get to it for three days because I’ll have to [ ] (inaudible at 00:20:14) my work and I haven’t gotten a response from him. Hopefully I’ll get a response from him.
THERAPIST: Can you focus on work? If you were to try to read that paper today, would you be able to do it?
CLIENT: Today? Probably. Yeah.
THERAPIST: How has your sleep been? Has that been affected by this?
CLIENT: I don’t know. I mean, last night I had horrible dreams and woke up in the middle of the night.
THERAPIST: Do you remember any of them?
CLIENT: Yeah. Oh, my God. I woke up in a panic. (chuckles) I think I was at Berkeley, where I lived for a summer and Josh was taking me to some – this is so embarrassing – to some meeting of supernatural creatures or something. I was the only one who wasn’t . . . (sniggers) They went around in a circle and asked everyone what their supernatural power was. They made me go home because . . . [00:21:13]
THERAPIST: Because you didn’t have one.
CLIENT: Yeah. And so Josh had to drive me home.
THERAPIST: He was needed.
CLIENT: He wanted to get back before they left to see whatever they were doing. And then he dropped me off and then I got lost and tried to find the rest of the way back home. I ended up in some scary neighborhood. I remember – I forget exactly what happened, but I woke up in a sweat, just terrified.
THERAPIST: What were you terrified of? Because you were lost and couldn’t find your way home?
CLIENT: Yeah, I’ve had dreams before of getting lost in some terrible part of town or something. Then I woke up and it was like 4:00 AM and Josh had apparently gotten up half an hour before to watch TV on the couch, which is so disconcerting because he couldn’t sleep.
THERAPIST: Does he often have trouble sleeping? [00:21:59]
CLIENT: Yeah, he had a small bit of trouble sleeping right before the procedure. If he’s really stressed he’ll wake up really early. He had taken a whole lot of drugs last night. It probably just caused him to wake up early.
THERAPIST: I think it makes sense before procedures to be really anxious about it. That seems within the realm of normal.
CLIENT: Actually, it was really nice. While I was waiting to see him in his hospital room, I was waiting with this family. This was sad. It was six family members waiting for the grandfather, who was getting some horrible quadruple bypass or something. (chuckles) But they come from all over and I was like where are my six family members? One of the women was telling me how she’s been having the same symptoms of her father and how she really hopes it’s just anxiety. “Yes, it’s just anxiety,” although she had some weird diseases. Anyway, it was nice to talk to them. They invited me to have dinner with them and everything. So that was nice. [00:23:07] (chuckles) Happens to other people, I guess. Even really old people with really old parents have the same troubles.
THERAPIST: It would be really nice to feel like you had people rally around you the way they had each other. It highlights the role that his mom is not taking.
CLIENT: Yeah. I mean it was nice just having my mother call me. And now I feel bad that she’s guilty. I know that this time she would have been there, probably driving me crazy all day asking me tons of questions. It was nice. She knew this time.
THERAPIST: Yeah, it makes a big difference being able to get those supportive emails and phone calls. Someone can help take care of you while you take care of him.
CLIENT: Yep. And they will eventually. [00:23:59]
THERAPIST: I wonder in what ways you feel lost in your real life, since it seems to be that this is a scary theme in your nightmares. This isn’t the first time you’ve been lost in a nightmare.
CLIENT: I don’t know. I mean I couldn’t go back to sleep either for a little while just thinking about him and the doctor, his mom. I would really like to figure out what to say to her because I can’t just . . . I need to say something to her, but I also don’t want to cause [ ] (inaudible at 00:24:34) tension in the house, either.
THERAPIST: It seems like there is some tension in the house if she’s avoiding you, pretending to be asleep.
CLIENT: I could have just made that all up, but my mom wouldn’t have let me go to sleep if she heard me get up. She’d be like, “What happened?” (chuckles) And maybe she just wanted to leave me pee. She was walking out the door finally to go to Milwaukee and she said to Josh without even looking at him, “Take care of yourself. I love you,” as she was walking out the door. There’s definitely something. I don’t think I’m making it up. I’m pretty sure there’s something happening. [00:25:15]
THERAPIST: So maybe you feel kind of lost in your relationship with her, like what is your role really supposed to be between her and Josh? It’s a little bit confusing.
CLIENT: Yeah, like what am I doing with this guy who’s got this family? I love him so much, but this is just so much.
THERAPIST: It doesn’t fit into the expectation of what you had of what it would be like.
CLIENT: I was just thinking how sad it is that we haven’t had any fun for a really long time. I really hope that we can eventually, sometime, some day.
THERAPIST: You want to have some normalcy.
CLIENT: Yeah. I got pretty upset at the last holiday party we went to for my department. Josh knows a bunch of people. Everyone is making all of these plans, inviting us to stuff. My department is sometimes really clicky, almost like middle-schooly, which I guess happens at work, too. I couldn’t really handle it. (chuckles) I was starting to feel like a completely separate, kind of like how I felt all last year. Everyone is making all their pretty holiday happy plans and I come up blah.
THERAPIST: You’re having a very different experience.
CLIENT: Yeah, I mean I spent a little time talking to a friend about a project I’m going to take on, which I’m really excited about. Josh wandered off and didn’t come back. He just clearly didn’t want to participate and couldn’t . . . like being social is just too much, I guess. So I don’t know. I don’t know where I’m going with this exactly, but it’s too much. [00:27:05]
THERAPIST: Yeah, it sounds like really what you’re talking about is different ways in which you feel like things just aren’t going the way you envisioned. You envisioned being one of those people in the lab, being able to make your holiday plans, plan vacations, be able to look forward with some sense of certainty to what you could expect, have a family and potential in-laws that worked in a way that was something similar to what you know about family. It is so different from your family, so different from what you wish your family would be when you think about a more perfect version. There are just so many ways in which things aren’t the way you envisioned. [00:27:49]
CLIENT: Yep. Yep. Oh, my gosh. Maybe it was this morning I started going, “How am I ever going to have a family with Josh?” We can’t really do anything in case he has to go to the hospital. How can we ever really build a life? Maybe it’s not going to be this bad and the doctor will tell us that it won’t be that terrible [ ] (inaudible at 00:28:14) and it probably won’t be.
THERAPIST: It’s hard to wait until that appointment time to feel like you have some answers, until you find out what you’re allowed to hope for. Do you question whether you want to stay with him? Or is it just a question of what staying with him looks like?
CLIENT: Gosh, I don’t know. I don’t want to leave at the moment, which is confusing because what am I going to do – just take care of him for the rest of our lives?
THERAPIST: You could.
CLIENT: Yeah, I could. I don’t know. That just seems crazy. (pause) [00:29:00] I don’t know. (pause) It may be worth it. I don’t know.
THERAPIST: It’s an option. Also leaving is an option.
CLIENT: Yep. (pause)
THERAPIST: They’re both hard. I wish you had an easier decision to make.
CLIENT: He was freaking about again about his mother and her finances a little while ago and he said something about how she probably won’t have to worry too much about retirement because she’s probably not going to live that long anyway. He’s worried about his grandma, her mom, died in her 70’s because she was obese and didn’t take care of herself and was really unhealthy. I’m pretty sure her problems run in the family. I’m pretty sure. That’s horrible, which is part of why I want to get her this gym membership, which is not going to work I’m sure. I’m sure it’s not going to work, at least given my family’s experiences trying to get someone to do stuff like that. [00:30:09]
THERAPIST: It’s very hard trying to make people do things that you want them to do. Even change.
CLIENT: I’m like how long is he going to live? He’s going to die on me of something, probably in his 60’s. Gosh, I just wish I could get some time alone with the doctor to be like . . . Oh, my gosh. And I almost lost it, too, with the doctor, who is really nice and amazing. He doesn’t usually pay too much attention to me during these things. He includes me but he was like patting my arm and just being a little . . .
THERAPIST: Getting to know you.
CLIENT: Well, I was like are you trying to tell me something here? Do you feel really bad for me? I probably read into it a little too much, but it was just really surprising. A few times he gave me a little back rub or something. (laughs) [00:30:57]
THERAPIST: Do you know what rights you have to talk to a doctor or get access as a girlfriend?
CLIENT: I don’t. Probably none. Do you know?
THERAPIST: It’s a little bit different in mental health than in medical health. The laws are more stringent in mental health with regard to rights to privacy and confidentiality. Since you are really primary caretaker here, I don’t know if there is something that Josh can sign so you can get more information. And it’s not that you want information about whether or not how to make a decision about how to envision the future, but you’re also the person that takes care of him at home, helps him make decisions, will probably be involved in making treatment decisions, things like that.
CLIENT: Yeah. They gave him a health care proxy form so that if he’s a vegetable I can make decisions for him. He wanted me to be on that, not his mother. [00:31:58]
THERAPIST: That makes sense. You’re the person there at the hospital with him.
CLIENT: Yep.
THERAPIST: If you were married you would be his health care proxy. That’s typically the way it goes. [00:32:08]
CLIENT: I don’t even know if they have his mother’s number. I get the phone calls.
THERAPIST: And it’s not so that you can make decisions for him. Really what you want to do is sit down and have a conversation with him so that he’s made the decisions now and you just have to follow them, carry them out, because it’s really hard to make those decisions for somebody else. And it doesn’t have to be such an extreme circumstance. Unable to respond to stimuli in a coma is the worst-case scenario, obviously, but there may also be times when they go in and see that his heart is enlarged and it’s a question about making a decision about this way or that way. Before you’re the proxy sit down and have some of those conversations with what are his wishes? What would he like? So that you know you’re making the choices to the best of your ability that he would make. Take some of the pressure off of you. [00:33:07]
CLIENT: We haven’t had that conversation.
THERAPIST: Most people your age are not having to make these kinds of decisions and have these kinds of conversations.
CLIENT: Yep. I think I can say in front of him to the doctor at the appointment, “What do you expect his life to be like?” as long as I warn Josh before. I think the fact that he’s trying to be really happy . . . I don’t know how happy he really is, but he’s not super good at hiding that kind of thing. I think it will be okay.
THERAPIST: It seems like a really good question. What is the expected prognosis? What is the course of this illness and the course of treatments and managing it look like? It seems like a really good question. Doctors don’t have a crystal ball, either, so they have trouble predicting and the predictions might not be right, but maybe a little bit more informed than what you’re imagining on your own. I would hope they’re more informed. [00:34:12]
CLIENT: This procedure stinks. They’ve only been doing it for like 30 years.
THERAPIST: So they don’t have a ton of information.
CLIENT: I don’t know. I don’t know. (pause)
THERAPIST: It seems like you’re actually holding up pretty well in the face of what you had to deal with this week.
CLIENT: I mean I don’t know why taking care of yourself is so difficult, but I’m trying to do a better job. I’m definitely doing a better job than before. I don’t know why it’s so hard. Even in normal life it’s so hard. You think it would be easier.
THERAPIST: What do you think makes it hard for you to do the things that are taking care of you? [00:34:59]
CLIENT: I don’t know exactly. I don’t know why exactly it’s easier not to.
THERAPIST: You’ve had a lot of experience meeting other people’s expectations, doing the assignments that are made in school, getting good grades in high school and college. There haven’t been a lot of times where you’ve been the one to decide what’s important about you. You’ve been meeting all those external expectations.
CLIENT: Yeah, I guess.
THERAPIST: In light of taking care of you, maybe we should do some relaxation. It’s probably something you haven’t made time for.
CLIENT: Well, unless you count napping on the couch all day.
THERAPIST: Different. (laughs) There’s actually a difference between relaxing and sleeping. Sleeping is very important, but giving you a chance to be awake and calm is important, too. So let’s do that so you get a chance to do that. I think we were scheduled for next week at 9:30.
CLIENT: [ ] (inaudible at 00:36:18) my calendar.
THERAPIST: (laughs) It didn’t cost me anything, even though I had to walk in the rain twice. I saw your number and I was like, “Shit. Did I do something?” I looked at my calendar and, no, I’m where I’m supposed to be according to my calendar. I wish it was a nicer day for you to have to do extra walking. So next Friday, 9:30. [00:36:54]
Let yourself close your eyes. Find a pace for breathing that feels comfortable for you. Let your body relax and settle into the chair in a comfortable position. (pause) As you begin to get relaxed and calm down, let your breathing slow down, extending your inhales and your exhales just a little bit so it still feels comfortable and allows you to be even more relaxed. (pause) Work at your own pace, matching movements to your breath. Whenever you’re ready to inhale squeeze your eyes tightly shut, noticing where that brings tension to your face. When you’re ready to exhale relax your eyes, letting them stay gently closed, repeating that as you inhale squeezing your eyes tightly shut. And as you exhale relax your eyes, letting them be gently closed. On your next breath in you’re going to squeeze your teeth tightly together, clenching your jaw, noticing where that brings tension to your jaw, your neck and your face. When you’re ready to exhale you’re going to drop your jaw, letting your teeth come apart, repeating that, clenching your jaw as you inhale and releasing as you exhale. [00:38:45]
On your next breath in you’re going to drop your chin towards your chest, noticing where that brings tension on your neck and your throat. When you’re ready to exhale you’re going to let your head float up to a neutral position, bowing forward as you inhale and letting your head float up as you exhale. Tipping your head over to one side, era towards your shoulder notice the tension in your neck and then let your head float up to a neutral position as you exhale, tipping your head the other way as you inhale slowly and lifting it up as you exhale. In hale and shrug your shoulders up towards your ears, noticing the tension in your shoulders, neck and back; and releasing them all the way down as you exhale, repeating as you shrug them off as you inhale and releasing as you exhale. [00:39:55]
On your next breath in you’re going to bend your arms bringing your hands towards your shoulders, noticing the tension in your biceps. Exhale and let your hands drop all the way to your waist. Inhale and bend up. Exhale and release. Inhale and squeeze tight fists, noticing the tension in your hands and forearms. Exhale and release. Inhale and squeeze. Exhale and release. On your next breath in tighten your abdominal wall, bringing your belly button towards your spine. As you exhale release your muscles. Let yourself take a full, deep breath, belly soft. Inhale and squeeze. Exhale and release. On your next breath in you squeeze your knees tightly together, feeling tension in your inner thighs. Exhale and release, letting your legs come apart. Inhale and squeeze your knees together as hard as you can. Exhale and release all the way. [00:41:13]
On your next breath in straighten your legs, bringing your feet up off the floor, noticing tension in your thighs or your hips. When you’re ready to exhale drop your feet down, letting your legs relax. Inhale, lift and straighten. Exhale, release. Inhale and flex your feet so your toes come up off the floor, feeling tension in your shins and your ankles. When you’re ready to exhale let your feet relax. Inhale and flex, bringing your toes back towards you. Exhale, release. Reversing that as you inhale pressing your toes down into the floor, feeling tension in your calves. Exhale, release, let your toes drop down. Inhale, point those toes down as hard as you can. Exhale and release, letting your feet relax. Inhale and scan your body, noticing any place where tension has crept back. Think about squeezing that space tight and then exhale, release, letting your body relax just a little bit more, repeating that as many times as you need to, noticing the places where you’ve brought tension back into your body. Notice it without judgment and then let it go with your breath, letting your body be relaxed. [00:42:49]
Also notice the thoughts that have stuck in your head. Acknowledge them without any judgment, just like you’re saying hi to them and then let them go. Thoughts can come back to you and you can acknowledge them and let them go, giving yourself the peaceful space for now. (pause) Let yourself take a few more deep breaths at your own pace, almost memorizing this feeling of being relaxed so that you can come back to it at any time by taking a deep breath. Whenever you feel ready, let yourself come back to the room at your own pace. (pause) Hold onto that for as long as you can and then I’ll see you next Friday.
CLIENT: 9:30
THERAPIST: 9:30
CLIENT: And then I don’t know what the next week looks like. We can decide that next week.
THERAPIST: We can pick a day if you’d like.
CLIENT: Okay.
THERAPIST: I’m not going to be in most of the week, but I’m in on Friday again. We can do an 11:30 on the fourth. Does that work?
CLIENT: Yeah.
THERAPIST: Would you like a card?
CLIENT: Yes, please.
THERAPIST: You can’t have my free Starbucks coffee then.
CLIENT: I think I might have taken it last time. All the electronic calendars I have, there’s just nothing quite . . .
THERAPIST: Clearly I agree with you because I’ve stuck with paper calendars far longer than most people. It works for me.
CLIENT: My phone, in fact, recently shut itself off and deleted all of my applications.
THERAPIST: That’s what I’m terrified of.
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