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CLIENT: (Unclear) culminating in the night before New Year's Eve when my family and Josh and a friend of ours were going skiing and the night before I didn't sleep like at all (laughs) which was terrible because we were about to go country skiing Josh's favorite thing and one of my favorite things, too, and we just taught my friend who now thinks it was the best thing ever. So everyone was excited and the reason I couldn't sleep was because I was excited and this like night after night of bad sleep and then really not sleeping. So I was having a really hard time -

THERAPIST: And it's been a while since you've had that pattern.

CLIENT: Yeah, this was the worse I've felt since (inaudible). Luckily I had a lot of distractions so I didn't have time to wallow and get super upset about it but I had crazy dreams the whole week after night after night of waking up at like 3 a.m. So anyways I was kind of upset about going away right back to because we were staying at this lodge with bunk beds so this meant my entire family was in the room. [00:00:47]

THERAPIST: Were you nervous about that?

CLIENT: It occurred to me that I'd like bring earplugs and stuff, but normally I'd been sleeping so well so it wasn't something I don't know exactly what caused me to sleep so badly. It was the week before I got my period so like I was being extreme hormones but maybe something's wearing off, the effect of one of the drugs. I don't know. I was really upset so I took a and this is New Year's Eve I felt so terrible, to go skiing. Luckily my friend can't really ski well and Josh is in atrial something fibrillation or whatever, so neither of them really particularly (unclear) which kind of plodded along but I could barely ski, I was exhausted. I felt like I was going to fall over. I feel like I broke something. I don't know. I was just a mess. So that night it's New Year's Eve, there's like a Midnight Session, all sorts of silly things happening at the lodge and I just like fell apart at like 10 o'clock and had to go to sleep and took a sleeping pill for the first time in like ages and ages just in case. If I didn't sleep then it was just like ruin my vacation. [00:01:58]

THERAPIST: When you say you fell apart, what do you mean?

CLIENT: My friend had brought champagne, my family was playing games and like they'll sleep on the couch and it was like involuntary, like be excited to stay up like and I turned into like a mean person and had to go to bed. And I was trying not to like make a big deal out of it because my parents were like confused like why was I behaving this way? I tried to apologize to my friend but I guess, I don't know.

THERAPIST: You were miserable.

CLIENT: I wasn't even miserable. Well I was confused because I was so I'd been exhausted all week and I would fall asleep right away and then wake up at 3 a.m. and I did not want that to happen again, so I took a sleeping pill. But -

THERAPIST: And it is a good idea. When you start to get into, when you have a couple of nights in a row that are not good, taking a sleeping pill to break that pattern is one way to kind of get back to what you can do.

CLIENT: Every once in a while for the past month I'll wake up in the middle of the night and fall back to sleep probably at certain times of the month and that's fine but this feels really bad. So, yeah, so then I slept and I was perfectly happy. And I fell asleep ever since. I mean this week could have been really stressful. This friend I brought skiing I helped her out the day before and she's moving on Monday and she decided that she was going to stay with someone else but we decided to keep her, to have her stay with us. She's a really good friend so now there's -

THERAPIST: A lot of people.

CLIENT: (Cross talk) two dogs in my house (Laughter). But it's been really fun. So, actually Josh is going to get his heart shocked back into rhythm on Tuesday and he's trying not to like freak out a little bit about it and it was such a nice thing to have her there I guess. She's an unusual friend. Josh really likes her and she's a good distraction. Yeah, skiing really depressed him because he really felt terrible.

THERAPIST: It really shows what he can and can't do right now.

CLIENT: Yeah, I mean Josh (unclear sentence) [00:04:49] And another thing I didn't realize like it was like 10 degrees up there and he has really poor circulation and he couldn't stand to be out there very long because there's like no blood coming to his fingers. His heart's just not pumping it around. Which I hadn't even thought about and I don't think he did either. He was like (cross talk) with his hands. I was like, ‘why are your hands so cold?' Well, obviously he has no circulation.

THERAPIST: It's disappointing to realize the different effects that it has, he didn't have to confront before.

CLIENT: Yeah. And my parents have not really witnessed him, have never seen it before and they got really upset which was probably good in a way, because they've probably never seen that, but they got kind of upset and gave about a half hour lecture about how he should take care of himself and my friend's here witnessing all this. It was crazy.

THERAPIST: I'm sorry it didn't go the way you wanted.

CLIENT: It was actually an it was an amazing weekend. He managed to not sink too deep into like being upset and the next day after I'd slept I had a great time with my friend, unfortunately not with Josh, but -

THERAPIST: But he can't do that.

CLIENT: I mean and it was good we were with my family, it was good to (unclear) because he likes my family, playing games with my mom in the lodge. That was good. I mean it goes to show how much better it is to have people around then if there's just the two of us alone. He's not so good, even worse right now. [00:06:10]

THERAPIST: Being able to rely on your support system and thinking I know you at some point have had a conversation with the doctors about what might the future hold, but part of what, if, he's going to continue to have these kind of problems and if you're going to stay with him thinking about how you build your life -

CLIENT: Yes.

THERAPIST: so you'd love to be able to do these things with him. Being active together is part of what brought you together, but if he can't do those kinds of things how do you build your life so you can be with him but also have these other needs met. And part of that is kind of figuring out, well, maybe it's taking trips together with other people so that he can participate in what he can do. He has someone to go back to the lodge with and it doesn't feel limiting to you. You can go and do a harder run or a longer ski or something, whatever, a more challenging bike ride with someone else.

CLIENT: Yeah.

THERAPIST: It's not the way you'd hoped.

CLIENT: And I think he loves me having this friend, too and so it's so sad she's leaving. It's going to be a real big bummer. She leaves on Monday which is the day we go to the doctor to get his opinion on what is the future of all this.

THERAPIST: Sounds like a very hard day.

CLIENT: Yep.

(Pause): [00:07:54 00:08:03]

CLIENT: (inaudible) parents (inaudible). I actually asked my brother on the little family trip we took last Friday what he would do if his girlfriend were he's been with his girlfriend for I don't even know how long, not 10 years but since they were like freshmen (inaudible) so you know, if she really, like, got cut off or whatever, and he said it would depend on her attitude about it, whether he would care about it or not. And I mean that really is the problem like Josh because he gets really down, he's like overly jealous if you're skiing and I'm never getting better again and you know there's nothing good happening to me anymore, my life is over, and then he kind of starts to sink down in this spot and if there's no one else around this is when we start to have problems and I get really upset and he gets upset. Like we're supposed to go he bought me did I tell you this? a ski weekend for Christmas.

THERAPIST: No, no.

CLIENT: Which I've always wanted to do since we got to know each other, but never have because of his heart problem but he decided it would be a good idea. They have this romantic weekend at a little lodge. And I had like the energy and you're like forcing him not to make it for like the week after he gets shocked back (inaudible) [00:09:31] It's such a terrible idea but I can imagine how this weekend could be just a total disaster, just the two of us.

THERAPIST: It's hard to predict where he'll be. What would make it successful, obviously feeling up to everything and anything? That would be great.

CLIENT: If he kept a good attitude about it and didn't get upset about having this feeling. He's got at least a normal heart rhythm to keep his fingers warm (laughs). I don't know. Maybe I should bring my parents along. (Laughs)

THERAPIST: For your romantic ski weekend? (Laughter)

CLIENT: Maybe.

THERAPIST: Have you talked to him about what the emotional aspect is like?

CLIENT: Yeah I mean this has been a problem for a long time. I think I told you about the time he took me skiing last year and like some other (unintelligible) [00:10:30] and I completely lost it. I told him about that and how that made me feel, how when he like when I come back from doing whatever I've done with a friend or alone and he tells me how sad he is he couldn't come and how and he starts going off into a deep (unclear) how it makes me feel, but I mean, at some point he's allowed also to feel that way.

THERAPIST: Ah. So where's the balance?

CLIENT: Yeah, I don't know.

THERAPIST: For him being able to express sadness without making you feel terrible and you being able to express excitement and enjoyment of what you've been able to do without making him feel terrible. You both need to be allowed to have your range of emotions and we need to kind of set some boundaries I guess around where it has become too hard to tolerate the other person's experience.

CLIENT: Yeah. I mean as long as I can sleep. I wish I knew. I almost want to go back to a doctor of some sort and be like, what is you know. Because I think I told you once I asked a gynecologist like can you test my hormones to tell me if there's something super wrong? And that's really all this is and I don't need to worry about anything except to keep my hormones normal and he told me that they couldn't do that.

THERAPIST: Yeah, there's no way to measure that.

CLIENT: I don't know, I don't know if I'm doing something wrong.

THERAPIST: You're back to okay, right?

CLIENT: Well, even if I had a week like last week every month that would be like a real bummer.

THERAPIST: A real bummer, but if you know that it's going to be one week and that it's not going to be beyond that it's -

CLIENT: I guess. But that means having to take sleeping pills once a month and that kind of just makes me feel like an old person who just can't function anymore. Is that really how to be normal?

THERAPIST: Taking a sleep pill once a month or a couple of nights in a row every month is not not functioning. It's doing what you need to do to function. What makes that feel so daunting?

CLIENT: It doesn't feel daunting, it just I mean, I guess it's upsetting about medication is I'd just be like off the deep end.

THERAPIST: Well it sounds like you have some days that you feel off the deep end.

CLIENT: Yeah, like I could barely do school. Like it was just no good. If I hadn't taken a sleeping pill I don't know what would have happened. Maybe I would have ended up being fine and maybe not. It seemed like it was completely out of my control. (inaudible) [00:13:21]

THERAPIST: Yeah, it might be part of the hormonal cycle for you because this is now; I mean I don't know if it was last month or if it was the cycle before that but that you noticed a big shift right before your period.

CLIENT: Yeah, definitely.

THERAPIST: So it's not foolproof yet, but there's some evidence here that it is more difficult for you to regulate your emotions which I think impacts your sleep the week before your period and so it might be that we need to figure out what do you do that week so that you can function and if you did take a sleeping pill would it have regulated you know once you got your period? Maybe. Maybe we don't need to know that. Maybe knowing that you take a sleeping pill kind of short circuits that pattern and that gets you through it.

CLIENT: Yeah, I was even at school and I tried to like because I just couldn't concentrate and I tried to like listen to like a meditation but you know if I'm already feeling yucky just to like trying to like calm down and focus I'm like nothing, it just makes me feel worse.

THERAPIST: Yeah, it's a really hard time to do that. It's easier to do that when you're feeling good or a little, you know, starting to feel badly. You can kind of circumvent it. But once you're already feeling really low it's hard to move into a new space.

CLIENT: Yeah.

(Pause): [00:14:53 [00:14:57]

CLIENT: Yeah, and now I'm fine. Now I can sleep. So, who knows? This is the second night. Last New Year's I had a kind of flu thing.

THERAPIST: It's not a good holiday for you.

CLIENT: Not really. Oh, no last New Year's was two night's before Josh's first ablation. It was two New Year's ago which is like there's no hope for New Year's.

THERAPIST: Maybe you could celebrate like February 28th instead. Pick a different month to celebrate the end of it's really just a random day.

CLIENT: My friend suggested trying a different like Chinese New Year's.

THERAPIST: Sure. Go for it. It's really a very random day. We end the month every month. Why do we have to make sure a big deal about ending December?

CLIENT: Because just Christmas is too sad. I don't know. We need more holidays.

THERAPIST: Well, I'm sorry that they've not been what you want them to be. It does seem unfortunate.

CLIENT: I mean we were in a lodge playing anagrams and I couldn't even (laughs) (inaudible) [00:16:17]

THERAPIST: And I know you want to be able to handle that and more.

CLIENT: I would not, at least not had a crushing exhaustion.

THERAPIST: Any night. I know there have been other activities where you felt like you were missing out and didn't want to miss out because you felt so exhausted.

CLIENT: Yeah, I mean because the next day we were skiing and I had such a good ski and was really amped up and really happy and my friend was just like, ‘what happened to you?' and I'm like (laughs) which was sort of sad.

THERAPIST: Yeah, you have these really intense swings.

CLIENT: Yeah, I taught my mom how to ski. Managed not to kill my dad. It was great. (Laughs)

THERAPIST: With the skiing or was he doing things that made you want to kill him?

CLIENT: I mean he was trying to race me and he was on [inaudible] (ph) which is faster, apparently faster then regular cross country skiing because that's what Josh taught me to do and (unclear), whatever. Not important. So he was trying to race me and there's no (unclear) and I was teasing him about how not to I told you about the bike ride where he pulled over and basically had a panic attack of some kind, you know, and he was starting to act kind of like the same way he did on that bike ride, kind of acting exhausted and then trying to race me again and I was like, oh my gosh, it's 10 degrees out. I can't pull over and (unclear) make sure you don't have a heart attack (unclear) I was definitely worried about him. I don't know exactly where I'm going with this. [00:17:17]

THERAPIST: Well, you said you managed not to kill your dad so I asked what was going on.

CLIENT: I was real happy regardless with him. (Laughs)

THERAPIST: And you wouldn't let anything sort of get in the way of that happiness. It feels hard to come by sometimes.

CLIENT: Yeah, I mean the cold. Usually I hate the cold and the fact that it was 10 degrees and biting winds really didn't bother me. It was awesome.

THERAPIST: What was protecting you from that? Emotionally.

CLIENT: I don't know exactly.

THERAPIST: I get that you were probably wearing winter clothes but what allowed you to have a good time despite the weather, your dad?

CLIENT: Well, the fact that I had other people around like my friend, Anna, was staying with us and the things we liked, the silly things we do, she would think of like it was so amazing, she's like so happy to be staying with us and so that makes me look at things differently. You know, her being so excited to be with my family at the lodge skiing, (unclear) makes me happier about it. Her being near makes me happier. [00:18:59]

THERAPIST: Yeah, it sounds like it allows you to see it through a different perspective and be grateful for some of the stuff that your family and your situation bring even though there's other things that can be frustrating about it. So I wonder how you can hold onto some of Anna's perspective even when she moves away, like being able to see things through that lens of appreciation that she seems to have.

CLIENT: Yeah, I would definitely want to keep a close contact with her. Even Josh makes me appreciate my family more. He seems to he's always willing to do things with them not like other people except for Anna. She's willing to do things (unclear) [00:19:45] and you know he not complaining about my father, he loves my father, he loves my grandfather, both my parents. He's helpful when he's not being unhelpful about his condition. I don't know, I wish I had [mean friends quite so much] (ph) I really do, I'll have to find another one. (Unclear) [00:20:18]

THERAPIST: Have some backups. Do you wish you didn't need them so much? What's wrong with needing your friends?

CLIENT: Well, because if they're not around like if effects my mental states like so much. It's almost scary, like -

THERAPIST: You feel dependent.

CLIENT: Yeah. Yeah, especially like, which is, and Josh effect my mental state probably more than he should or is normal, I don't know exactly.

(Pause): [00:20:45 00:20:52]

THERAPIST: What do you feel like you can hold onto independent of others? What can you rely on yourself for?

CLIENT: Well, I mean if I'm slipping and like already in a bad spot, I generally can be my own friend in a way, can motivate myself to do things, like even this past week no one's been in school, no one comes back to school for another week and go in there and there's no one around and I have a harder time concentrating like I just can't work as well. It's frustrating. Yeah, some people would kill. Like some people would kill, like Josh would kill for an empty building to go to work, but I can't do it. It should feel a lot better next week when people are back at school and I know there are some people are around.

THERAPIST: What have you accomplished this week without people around at school?

CLIENT: Actually yesterday I decided to walk from home with Anna and Josh and it was great. The day before I went to school I made it like a half a day with nobody around.

THERAPIST: You have a higher need for affiliation, just to be around in the presence of others. And it might work for you to think about, ‘well, this is what I'm like and do better around people,' whether it just be having coworkers around or spending lots of time with friends and family. Think about how to make it work for you rather than wishing it away.

CLIENT: (Chuckle) Well I don't wish it away except that it's hard to have that all the time. I mean right now I feel like a live-in friend for a week, which is perfect.

THERAPIST: Yeah.

CLIENT: But obviously that's not reality.

THERAPIST: But you can so you can't necessarily always prefer having a friend living with you, but you can set up lots of meet me for coffee, come walk the dogs with me. Sometimes you retreat because you're afraid you're not going to be energized to do things and it sounds like actually being around people feeds you and sometimes gives you the energy and that's when you're most up, you know, when you go to a party and you find yourself really amped, so I think working with what you know you're like and being really active in scheduling not really big activities but scheduling so you know those people are going to be around more often than not and not leaving it up to chance.

CLIENT: Yeah, I mean it's hard to find friends who like to do the things that I like to do or want to do.

THERAPIST: Spreading them out or sometimes you might find someone who matches up on one interest. You've got some bike friends. You're making you may teach somebody else how to cross country ski. Recruit the next person.

CLIENT: Yeah, he finds a friend like this girl who would basically do anything that we're doing and thinks it's great is basically magical. She has to (unclear) figures. [00:24:03]

THERAPIST: It's unfortunate.

CLIENT: Yeah. I mean I have found other people like that before. It just takes a long time to find them.

THERAPIST: Yeah. It's easier to kind of piece them together and it's okay to have friends that introduces the friend that you do this kind of thing with and this is the friend you do this other thing with.

CLIENT: Yeah, I mean she was my friend before she was living there. (inaudible)

(Pause): [00:24:42 00:24:58]

CLIENT: She's a good [talker] (ph) for Pat, too, Josh's mom.

THERAPIST: How is his mom? Things were really tense between the two of you when I saw you last because of how she sort of failed to respond to his procedure.

CLIENT: Yeah, I mean I've kind of (unclear). Josh was asking me the other day actually how I wanted to live and I kind of want it to come from him, he's not really good at that, so, we have a really -

THERAPIST: What would dealing with it mean?

CLIENT: I don't know, I guess sitting down and talking about how and I know it seems like a really deep subject to get into as to why she doesn't seem to want to be involved in her son's health problems. She also, there's so much (unclear) she doesn't give us rent money.

THERAPIST: Oh, really?

CLIENT: Which Josh is really upset about.

THERAPIST: And the agreement is that she would.

CLIENT: Yeah, I mean after a few months we figured she'd better get her act together with whatever (unclear) she had and start (unclear) buy some groceries. Yeah, the agreement was that she would give Josh rent money that he needs to help me get rent money and (unclear). I was actually like really happy she got us really cute Christmas presents, the two of us. They were (unclear) mostly like, not useless junk, but like thoughtful things that we definitely need, but that are a warm shirt because I'm always cool, you know. And Josh got really upset and was like, ‘why does she buy' she does she's very giving like she wants to and she sent boxes and boxes to like all of her friends which was nice but [00:26:21]

THERAPIST: But didn't have money the money to give you rent, or didn't -

CLIENT: Yeah, and rather than being for the Christmas presents (unclear) about it. [00:26:58]

THERAPIST: So which conversation like you said, ‘there's a lot of things,' so there's the conversation about the rent, there's the big conversation about that she seems so hesitant to be involved in his care two very big issues probably not to be tackled in one conversation. What feels more important to you? What would make a bigger difference to you to have a conversation about?

CLIENT: They're both really uncomfortable. And I mean her actions are completely confusing to me and it's a little scary to think about what she'll say about either of them. So, I feel equally strong about them.

THERAPIST: I know you said they're hard conversations for Josh to have, too. Do you know what feels more important to him?

CLIENT: Oh, well rent. He doesn't care that his mom that's not true he did get a little upset when she didn't even ask him how he was feeling that first day and she actually asked me how I was feeling. I was really furious about that, too. I don't know. From what he's told me, she's never really been involved ever.

THERAPIST: Yeah, that's not new to him. And the money feels like a more direct impact. I wonder how you can support him and to have that conversation. It does seem like a conversation he does need to have with her.

CLIENT: Well I told him we should go out to dinner with the purpose of having that conversation so (unclear) somewhere in public where it can't be a super big scene. I know that's a terrible idea or good idea? About my -

THERAPIST: Well, it does set some boundaries to have it at a neutral place, not the house, and it does, having it in a public setting puts a check on everybody's volume and intensity. I think it's fair to let her know the purpose of the conversation that you're going to have over dinner rather than feeling like otherwise she might feel ambushed, like here I'm out at dinner, The two of you knew we were going to have this conversation and I didn't she may feel kind of trapped.

CLIENT: That's true.

THERAPIST: So I think you're saying, ‘we'd like to have a conversation with you about some important stuff. Can we all go out together so we can sit and talk and you know you don't need to say exactly, but I think giving her somewhat of a heads up or a warning so she doesn't feel attacked -

CLIENT: That almost makes it worse to invite her out for dinner to talk about that, makes it worse. Yeah, that's a bad idea.

THERAPIST: I mean if you let her know what it is and it's honest and up front.

CLIENT: Yeah. When she first moved in with us I had just, I think it was too clear that we moved in with my mom for a week and (unclear) leaving Josh when all this went on and I actually talked to her about it. She asked me a little bit about it and I actually thought she would be supportive. She told me some of her life story in which she made bad choices and regretted some of her decisions and all this sort of thing. I don't know it's confusing why she would sometimes open up and talk to me about things and then completely be not present at all. In fact I was thinking about that lately because I was almost upset that I did talk to her about stuff before and now she's completely I don't know if she's shut off or what exactly. Because at the time I was just starting to talk to anyone about it and I didn't really know her.

THERAPIST: Yeah, you were really helpful about this arrangement when it started, that it was going to provide an opportunity for him to be closer to his mom. He was going to help. I remember hearing you talk about how it would be helpful with finances and him getting back on track and paying down some of the debt. (Cross talk)

CLIENT: (Unclear) highlights the problems and worries about (unclear) [00:31:28]

THERAPIST: It certainly helps you understand where it comes from.

CLIENT: And it's always painful to watch her go over her life sometimes.

THERAPIST: Yeah, it feels unfair.

(Pause): [00:31:47 00:31:51]

CLIENT: I mean in some ways I really resent her and like the stuff she's done to Josh and like the lack of support she's given him and then as his mother I didn't want to help her (unclear). Josh also is really confusing about her. Sometimes he wants to help her out and sometimes he gets really upset with her, too. I can never quite decide how he feels about her. Kind of similar to how he talks about his stepfather who he alternately tells these stories about all the things he taught him and that he also abused him and he never wants to talk to him ever again. So he has this really strange [00:31:58]

THERAPIST: It must be confusing for him too to have such conflicted emotions.

CLIENT: He likes to tell stories. They're really funny, crazy stories he'll tell about his father and he tells like how he was telling how like these crazy camping trips his father would take them on and my mom, she you know, came from a stable family, she asked him, ‘oh, you really don't ever want to talk to him again? You really think that you never want to contact him?' No, not really. She was clearly like really confused by that.

THERAPIST: It's hard to understand if you haven't been through a situation like what he's been through.

CLIENT: Well, and she doesn't know about (unclear) he doesn't really talk about the other parts with.

THERAPIST: Hmm.

CLIENT: He's only told me some of it once and will never talk about it again. (Laughs) Even my parents with Pat, they don't really understand anyway, so my friend

Anna has a very strange family, with a stepfather and a real father and stepsister and all kinds of strange family relationships that are not necessarily normal and each parent lives in like a different continent and her trying to explain it to my mom and my mom was like not really understanding. Not that she wasn't understanding I don't know where I'm going with this.

THERAPIST: Well, it seems like you're trying to wrap your head around different people's family experiences and the conflicted feeling that you have for Josh's mom. You haven't had that with your family and such mixed emotions because even in your frustrations with your parents they're very consistent and it sounds like the inconsistency that Josh experienced with his mom and with his dad, her friend with her parents, it leads to very conflicted emotions, holding to separate things at the same time.

CLIENT: I've been thinking about this probably too much because Anna gave me this book, "Social Animal." Have you ever read it?

THERAPIST: I don't think I have read that one.

CLIENT: It's basically about how we learn and form relationships through a story of two hypothetical people and it talked about everything like how these are attachments and what that says about your future spouses and life to like why poor kids have trouble succeeding because of like this all this I don't even know.

THERAPIST: Like object relations type stuff like good mom/bad mom?

CLIENT: I don't know about that. (Laughter)

THERAPIST: I don't know if they even use that language. It sounds -

CLIENT: No, no, no. I mean it's a story told (unclear). Basically how your family and relationships (unclear) to you make your success in life and your relationships with other people. In fact it starts out with a chapter on love and how it said all these things about who people fall in love with is really predictable when you look at it, it's not magical. [00:35:20]

THERAPIST: Take all the fun and romance right out of it, huh?

CLIENT: Yeah, that's how they start off the book.

THERAPIST: So, what's it been like for you to read about it?

CLIENT: Oh my gosh, it's terrible. It makes me just over think everything about my life and why what's been going on. In fact, when I was with my dad I kind of tweaked my shoulder skiing and my dad has had like some pain in his arm for like weeks and weeks and was going on and on about it and then I was telling him tweaked my shoulder too and then instead of like trying to think about it he like, go ask my mom, see where this comes from, or something (laughs). I think my dad in fact, the whole family, has a tendency to go on about problems, and be hypochondriacs and all that sort of thing, and I find myself wondering if I'm just being a hypochondriac quite often, yeah, like I want to complain, and then for him to say that to me was, oh, my gosh, cause I mean he'll go on and on about how he like checks his blood pressure every day. (Cross talk) [00:36:56]

THERAPIST: He's very worried about himself.

CLIENT: Yeah, in fact he recently tried to give me some like tape he listens to to lower your blood pressure or something.

THERAPIST: Have you ever had high blood pressure?

CLIENT: No, I have really low blood pressure.

THERAPIST: Okay.

CLIENT: It runs in his family (inaudible). He has attempted a few times to try to commiserate with Josh and he also takes some blood pressure medication, which has not gone over well. [00:37:14]

THERAPIST: The scale feels off.

CLIENT: Yeah. He could also just exercise a little more and probably be fine. Stop eating so much cheese. I don't know.

THERAPIST: Well, I do believe that our early experiences obviously have an impact on how you develop and how you see things but I also believe in some plasticity. You know these things are not fully determined.

CLIENT: This is not 100 percent.

THERAPIST: Well, and I think being aware of what impacts you gives you some ability to choose how to respond to things. So without awareness, we react and probably pretty predictable ways. We tend to react the same way every time to the same thing unless you're really aware of what you're doing and you make an active choice to do something differently if you're natural response isn't working for you. I think that's really what the process is about, it's becoming more aware of how you're impacted by things; what your responses are and looking at ‘are my automatic responses working for me?' Usually we have that response because it worked at some point, but then sometimes the circumstances change and your automatic response doesn't work as well in the new environment. You know what you're doing right now is kind of looking at, ‘well how am I thinking about these things? Does thinking about it this way work for me or do I choose a new way to think about it? Does responding to when I have a bad night's sleep and I start thinking about it would be like if I never slept again, does that work for me or is there something I can do differently?' So, you in choosing to do therapy you're choosing to have a more active role in shaping how you respond to things and choices you make. I think that's what gives us power to have the ability to make changes.

CLIENT: Yeah, I guess I feel like I've worked on a lot of things, but maybe I still react the same way.

THERAPIST: Well, recognizing is the first step.

CLIENT: I still feel like I really know how to react better. I mean even if I can recognize that I'm (unclear) or whatever that whole list of things that you gave me, I still can't fix it. Sure, I can recognize it but I still feel the same way.

THERAPIST: You stay feel the same way and the feelings will change when you can create new thoughts about it. So, the first step is recognizing what you're doing because there's a lot of times when you thought that way you had an emotional reaction to the way you were thinking and you didn't know why you were feeling the way you were. Now, you know, ‘yep, I'm jumping to conclusions about that,' or, sometimes you have the all or nothing thinking. So, right now the part you're working on is, ‘okay, so I'm recognizing I'm doing it, how can I remember to come up with an alternate thought?' That's the phase you're in. And that's still really tricky.

CLIENT: I really hope that we can get some sort of, something I can grab onto with his health because I feel like I'll feel a lot better when I know that this is the reality that we have to live with. It's really hard to -

THERAPIST: Having those unknowns is really hard.

CLIENT: Yeah. I need to have some sort of like, ‘okay, he's going to be this sick forever,' (unclear) as opposed to having a constant unknown. [00:40:55]

THERAPIST: I'm hoping you will get some answers on Monday.

CLIENT: I mean I kind of think don't think we will. We continue to not so why would we now, you know? It's like, ‘okay, we'll keep watching you and hope for the best.' Because, like that's what's going to happen. And that would be tough.

THERAPIST: So, if that's the answer you get, what will be your follow up question?

CLIENT: I don't know, I mean actually the worse case scenario is that they tell him he needs to get a pacemaker because he can't stand we have to have some sort of a solution, because he can't stay on these toxic drugs forever or they'll say, ‘stay on these toxic drugs until they start to cause your kidneys to fail or whatever he's going to end up doing eventually and then we'll deal with it then. Or they'll say you really have to get a pacemaker.

THERAPIST: So you may want to prompt some of these, you know, I'm sure, in reality there are some unknowns. They can't predict with 100 percent certainty what's going to happen but you can, rather than let it if that's the answer, you get one of those vague, ‘we're going to watch and see, we don't know what's going to happen,' you can say, ‘I know that we can't predict with 100 percent certainty what's going to happen, but I need to know some parameters. What's the worst-case scenario? When would we do a pacemaker? How long can he stay on these medications?' So having these specific questions it sounds like you know enough to be able to formulate some of those more specific questions so they can then at least give you answers well, he can stay on these drugs for 10 years, or, give you something.

CLIENT: Yeah. That's really hard being at those doctors with Josh because he really shuts down and he wants to come off like he's fine and everything's all fine, he'll even sometimes not tell the doctors how bad he's feeling or whatever, and so now I'm like, ‘yeah, actually that did happen to you yesterday or last week. Don't you remember, you -

THERAPIST: It's important for you to give the information because he can't.

CLIENT: Yeah, but his tendency is to say, ‘no I'm fine, I'll be fine.' I mean I've told him to ask some of these questions, I keep telling him (unclear), I mean the few discussions I've heard them have about pacemakers he can barely even talk about it, he gets so upset. [00:43:23]

THERAPIST: And you can acknowledge that though it's really hard to talk about these things but I need to be part of the plan. I mean you are his main support. You're the person who does a lot of the care taking and you're making decisions. You need information to do that. It's a really important, significant role.

(Pause): [00:43:54 00:44:02]

CLIENT: Yeah.

THERAPIST: I do hope it goes as best as it possibly can for you guys.

CLIENT: Yeah, I hope so too. If we have any kind of stability, like he just hasn't had a stable health in a long time.

THERAPIST: Yeah, yeah.

CLIENT: I'm amazed he's not just completely a mess, like I would be. And he just applied to a university last week and basically we (unclear) [00:44:32] all day. He wouldn't even apply when he decided to follow me to the east coast. He wouldn't even apply. Like who cares, I applied for the heck of it, just because I never thought I'd get in and it worked out for some weird reason. So why not? And of course he got in everywhere he applied but he refused to apply because if he got rejected he'd feel too bad. So had he applied, I know like if he doesn't get into grad school first of all it'll be fine (unclear) but that's like a whole other level of stress. I mean grad school alone caused me plenty of stress. [00:45:03]

THERAPIST: Yeah, grad school plus his medications. It's a very difficult process both the applications and the work.

CLIENT: Yeah. Even this morning he completely snapped at me out of the blue which he really only does when he is acting really stressed and I started snapping back at him and I was like pretty sure this is just the procedure (unclear) grad school (unclear). I also didn't want to have a huge fight in front of my friend. But like that's what comes out when he is really, really stressed. I'll ask him a question and he'll just (unclear) [00:45:35]

THERAPIST: That's hard to sit with.

(Pause): [00:45:49 00:45:54]

CLIENT: Yeah, and then I have this whole like battle of drawing it out of him and I don't want to get mad at him because if I've been sleeping and happy and I don't get mad at him, that's fine. But if I haven't been sleeping I can't take it and I feel like a (unclear) and I have to handle all of this for him (unclear). But of course that keeps me from having a friend and other things too and -

THERAPIST: Yeah, finding support some place else.

CLIENT: Yeah.

THERAPIST: So, if you're not getting all the strength you need from being well rested you suck it up from other places and it's beneficial, it's okay to have those sort of multiple places where you get different types of support and you gain your inner resources and strength from them.

CLIENT: Yeah. Both of us were even just nervous about January because last January was the worst ever and until, I think actually until he went skiing he was like, ‘well at least we're not as bad as last year.' He was actually really (unclear). [00:46:53]

THERAPIST: Well, there's lots of January left and you could have some good things.

CLIENT: Yeah, yeah, it could happen.

THERAPIST: Speaking of resources, since it's going to be a new semester, new groups will start at UHS again so I don't know if that's something you're interested in trying again. That look on your face was ‘not so much.'

CLIENT: I mean I'm trying to recall how low I was (unclear) when I went but it was such a I don't know if it was a [native] (sp) experience but I mean I guess I could try it again. [00:47:25]

THERAPIST: Well, you might want to look and see what they're offering. I saw I happened to be there the other day and I saw they had some of the new group lists coming out so you can see what they're offering, see if something feels like it might be a good fit. You know I know the experience was not all that you wanted it to be last time. It's not necessarily the same thing again. But if it's not something you feel like you need I'm not saying it's something you have to do. Just -

CLIENT: I mean I really -

THERAPIST: It wasn't what you wanted it to be. I'm wondering if you could have something closer to what you wanted it to be.

CLIENT: It was really because of the other people in the room.

THERAPIST: Yeah. And that's, you know, with a group it's partly what the facilitator's envisioning and partly determined by who shows up.

CLIENT: I mean I feel so removed from people at school most of the time and I would anyway just, I mean, I don't always think I am and then someone will say something about how I live with three people and two dogs and (inaudible) [00:48:25]

THERAPIST: And it's a different experience. I didn't even think about how different it is but with just all the things that are going on in my life I (unclear) occasionally feel like I can't connect with other people in that room. I had a really hard time following it's just going to be more students (unclear) test anxiety. I don't think I can handle being in that room with those people. Which is probably just fine, perfectly legitimate but I don't -

CLIENT: You want to have right, if you're going to be in a group experience you want to make sure that it's an experience with people who you can empathize with and who can empathize with you, have some more similarity in a situation. One of the I don't know if you did this last time but sometimes they do a pre-group screening where you can talk to the facilitator. I did, yeah. I did. (Laughs) Poor, it's [Rugles] (ph) do you know her? [00:49:16]

THERAPIST: Yes.

CLIENT: I've talked to her like three times about joining the group (laughs) and I finally joined and then dropped out. So, hopefully she will let me come in if I decide to go.

THERAPIST: Oh, so she runs some, but then other people run other groups as well. I saw that there's one on relationships which that might be a potential fit for you because so much of what you are struggling with is your relationship and then the group you did was more of the DBT skills type of group. And they're running those as well but I saw some other things on the list that I can't remember, but -

CLIENT: Yeah, I don't know. I mean more and more I feel like the problems with me and Josh they're not even problems. Most of the time I feel like we're doing really well. It's my own needs that I'm not dealing with properly, that are causing the problems. Maybe that's not true. I don't know.

THERAPIST: There's a lot of uncertainty which is really hard for you to (unclear) creates a lot of anxiety.

CLIENT: Maybe I've just been dealing with his heart problem for so long that it doesn't feel like -

THERAPIST: It doesn't feel new any well, it's not new anymore.

CLIENT: Maybe if I had a new boyfriend without a heart problem I would realize how much trouble (unclear). [00:50:26]

THERAPIST: That's a pretty scary thing.

CLIENT: That's a horrible thing to say. Besides the fact that, you know, he couldn't ski. If we had if he was in a good mood and feeling like hopeful about the future we'll have a very romantic, wonderful weekend.

THERAPIST: Well, I hope you do.

CLIENT: I hope we do.

THERAPIST: We should probably stop for today. And, when are we meeting next? Okay, so let's -

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