TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Flexibility is allowing me to cancel at the last minute. So how are you?

CLIENT: Last week was actually pretty terrible. Not for me really but for Josh. He's feeling really dragging lately. Just really tired and I thought he was just kind of down and I don't know, sinking into his own kind of hole of you know, whatever, being upset over things. But it turned out he had developed a thyroid problem. So he was cold, he was tired, he was sleeping a lot. All that sort of thing and I was (unintelligible) (laughs). In fact I feel terrible because last week I was and still am really, really tired, I think it's hormones or something, I don't know. I think there was a week I told you about that I just watched a lot of TV and read and curl up with chocolate like every day. It's like a month ago. It appears to be a monthly occurrence. So anyway I was really frustrated and tired and especially with him for being so tired but then it turns out he has an under active thyroid. He got a blood test on Friday or something. [00:00:42]

THERAPIST: Is this a recent, I mean there's no doubt about it but I think that this is connected (cross talk)

CLIENT: Oh, no, no. It's because of his medications.

THERAPIST: It is. Okay.

CLIENT: Something that's -

THERAPIST: Because when I saw you last a couple of weeks ago you were actually quite surprised at how well he was doing given the news that he had been sort of dealing with.

CLIENT: Yeah, yeah, and I thought his behavior given the fact that he does have a heart condition was great. But he was just acting so tired I thought it was just because he was not happy [as yet] (ph). [00:01:47]

THERAPIST: But he's really hypothyroid.

CLIENT: So I feel bad because he had so much trouble with either a hypochondria or getting people to believe him (chuckles) it's always one or the other like he always thinks that you know he actually was going on and on, he thought this one drug he's on that for his heart rate. It's called Amiodarone and it can cause lung problems. It can cause organ problems of all kinds. It actually is causing the thyroid problem, this particular drug, but he thought he was getting lung problems because it can cause this cough. But he didn't have any of these things and in fact he talked to the doctor about it and the doctor said you're fine, you're fine, you're fine, but it turns out there was something wrong -

THERAPIST: (Cross talk)

CLIENT: which is actually much more reasonable than the lung thing, but it was kind of distracting, not something silly, but not probable. I mean he knew something he just -

THERAPIST: That he couldn't really, he couldn't really pinpoint what it was.

CLIENT: I mean the whole story of his illness is like people either not believing him or trying to be a hypochondriac. It's really tough.

THERAPIST: It's really hard.

CLIENT: So yeah, this is really -

THERAPIST: And it's hard to continually advocate for yourself in the face of not being believed or -

CLIENT: Right. Well, and then quite often he does get overly worked up over things that are nothing. Maybe they weren't. I don't know. So, anyway, he's pretty upset about this. Because this is bad news and he can't go off the drug.

THERAPIST: No. So it's adding on another set of drugs on top of -

CLIENT: Yeah, and I mean he is cold all the time and now he's freaking out that he's going to gain a ton of weight because he has issues with that because he can't exercise. He's tired because his heart so he sort of thinks he's like deteriorating.

THERAPIST: Can they give him the typical things they would give you for hypothyroid to balance out his levels or is he kind of stuck?

CLIENT: I mean, right now he's just waiting to see the doctor again to have a look at (unclear). Unfortunately they called him, the doctor called him with the test results like a Saturday afternoon, so [00:03:57]

THERAPIST: So you just have to sit with these results and not know what you can do about it.

CLIENT: Yeah. I mean they said they'll put him on a hypothyroid drug and there's like special things that you do for heart problems. If he goes off the drug it will go away, so they say. But -

THERAPIST: But he can't go off the drug.

CLIENT: He can't go off the drugs for right now the hope is that if he's chilled out for like three years the heart will shrink. And the doctor we asked wouldn't give me a straight answer of what the likelihood of that was, and if not, I don't know. It could be a mess. If that doesn't happen he's going to be on thyroid drugs and heart drugs and who knows, maybe he'll have lung problems next and this would end up causing like organ failure.

THERAPIST: That's so scary.

CLIENT: It is scary. And I seem to not know what to do about it. So yeah, this week was terrible. I was exhausted. He was exhausted. I was trying to keep him from totally freaking out and I don't know, I haven't told anyone else about the thyroid problem although his mom knows and she seems more concerned than she has in the past, which is good.

THERAPIST: At least he has someone else working with you a little bit, if she's reacting in a similar way.

CLIENT: Yeah. I'm afraid to tell my parents until we know more because I think that they'll just freak out. I don't know what they'll say exactly.

THERAPIST: How are you feeling? Are you freaking out?

CLIENT: I'm trying not to. Mostly, I'm so tired and I think it's unrelated to this. But, I'm stressing over that as well.

THERAPIST: How are you sleeping?

CLIENT: So much. I'll have crazy dreams every night.

THERAPIST: So it's not very restful sleep then.

CLIENT: I don't know if I have crazy dreams or if I'm just more anxious because I don't know. I don't know what happens that makes me so tired. I fell asleep on the couch yesterday like (cross talk) [00:06:13] school last week.

THERAPIST: And you're tired before you're getting your period. You don't have your period yet.

CLIENT: No. Well, I should. But like -

THERAPIST: You should, but you don't.

CLIENT: I mean again, my boobs are killing me. I don't know. I had a (unclear) pill. I don't know if maybe the combination of going off the pill is too much. [00:06:31]

THERAPIST: Are your breasts tender all the time or is this like, this is build up?

CLIENT: Okay.

THERAPIST: So I think we can pretty reliably say you're period is coming.

CLIENT: Yeah, but I mean one week or more every month the exhaustion.

THERAPIST: Is too intense.

CLIENT: And I didn't deal with it well last week at all because Josh was so tired and I was frustrated like I skipped school half the week and I just disintegrated a little bit. I kept trying, like take the dogs for a jog or something. But it had no effect. Like I would just come home exhausted. So that was frustrating. I have had several cups of coffee today and (unclear) [00:07:09], so I don't know.

THERAPIST: Yeah, to me it sounds like this was a couple of months in a row where it is a pretty consistent pattern, but it feels like even though you know why, it's sort of scary because it does seem there seem to be some signs here that it's all related. It's too intense for you to tolerate every month.

CLIENT: Yeah, I mean I was on this pill for years, so I'm hoping that it will settle, but now it's just a bad combination of events last week. Especially because I don't want to like whine and complain in crisis like complaining that I was mad at him and he turns out having this problem. I've been like making fun of him for being so cold because our car broke.

THERAPIST: I remember you mentioned it when you were skiing that he like couldn't stay outside.

CLIENT: I know it sounded reasonable because it was like 10 degrees and he doesn't have much circulation but it was more than that. So yeah, our car broke and we were walking to the movies because the car's in the shop and he couldn't handle walking back to call his mom for a ride home which was like a half a mile and it was like 20 degrees and then he got like all -

THERAPIST: Yeah, but most people feel miserable but can handle it. I mean it would be logical to be outside in 20-degree weather but it's different for him right now.

CLIENT: And he was trying really hard to get us out because I've been we call our couch like the couch of death because it's become this place where we go when we like, we end up (unclear) or something, have way to much time on this couch and (unclear) people. I would go there in the middle of the night when I would wake up and couldn't sleep. We really need to get off that couch. But anyway, when things stop deteriorating. He was trying to get us off the couch and ended up just like resulting in my crying at the movie theater because he was such a mess. I don't know, I guess I realized how upset he was and how much of a problem it really was for him. I was like, ‘can't we please just walk home? I just want to get home. Like I really (unclear) because I hate having his mom pick us up. I don't know. It's just it's not great.

THERAPIST: It sounds like it's been really a hard time.

CLIENT: Yeah. Yeah. And it's weird because I don't even feel anxious about it.

THERAPIST: It sounds like you feel beaten down. You're worn out from having to cope and having to readjust and readjust.

CLIENT: Yeah, and we always have to keep waiting and waiting and waiting as things gets slowly, painfully worse.

(Pause): [00:09:52 00:09:58]

CLIENT: And I've tried to like talk to a few people about it because again my friend who (unclear) and don't get great responses. I don't have anyone else, really. This is some stuff to talk about.

THERAPIST: Yeah. Is Josh on your insurance?

CLIENT: He's on has his own insurance, too.

THERAPIST: I wonder if he's eligible they're running a group for students with chronic health issues that you may I don't know if he can go as a partner.

CLIENT: That would be interesting. Actually, because all that reading what do you do when you have an under active thyroid?

THERAPIST: I don't know.

CLIENT: (Unintelligible) [00:10:35] all this stuff and managing stress and I was like (unclear) of course I had talked about taking him to yoga and I can't get him to go and he just feels so crappy. I actually went and it was great. (Laughs) But I can't get him to go.

THERAPIST: I'm glad you were able to take advantage of it.

CLIENT: I have a friend who goes every week. Sometimes I go with her. Unfortunately it's high yoga which he's not allowed to go to.

THERAPIST: But for your well being they may know what would also be great for him to be able to do something but you also need to focus on how you manage your stress in dealing with this.

CLIENT: He just seems to be trapped. He's just trapped.

THERAPIST: Yeah, I think a support group of some type would probably be really good for him. Just to have someone else who might understand a little bit of what it's like to go through what he's going through and to face these uncertain diagnoses.

CLIENT: Yeah, it seems great. He did go to therapy last, the fall that he moved here and he still biked and things. He went for about a month and really hated it. I'm sorry, I tried I talked to him last week about going. He was just out of it saying he didn't need to go. Maybe he does. Maybe he his brain doesn't go round and round like mine does. Maybe he can handle it, but I don't know. It would be nice for me if he would go.

THERAPIST: If he could talk to someone else.

CLIENT: It might help me more than him which is not really fair. So, I'll see, I'll see. I'll bet he can't go.

THERAPIST: Yeah, I don't know if it's open. I saw that it was advertised but I don't know how the rules work about partners. If you were married and on the same insurance I think he would definitely have access, but I don't know.

CLIENT: Even if we were married. I don't know, it (ph) doesn't seem to have the same sort of service center that the university does. Or maybe they do and he just doesn't know.

THERAPIST: You could call there too.

CLIENT: I have actually. They don't even have a health clinic like we do. They have like an associate off-site clinic that people go to.

(Pause): [00:12:52 00:13:02]

CLIENT: He rarely goes to campus this semester anyway. He's just started writing his thesis. He probably wouldn't go on campus anyway. He could come to the school.

THERAPIST: Well, give them a call, see if they and if not, see if they know of anything in the area they might recommend, like a hospital that might have some sort of support group or something like that that (unclear) the addition of new complications, some kind of support group for people. You know it doesn't have to be a matching diagnosis, but some kind of chronic illness that needs to be managed because it does seem like that's where he's going to be at least for the next year.

CLIENT: Yeah, it's just awful because we have no idea. We're at this like some weird place in between being active that drop dead while playing sports that you hear about in the news and like actual heart failure because is this weird thing (unclear) [00:13:56] we didn't but then there's not many patients like him. There's nothing out there you can find about what usually happens. What the usual course of things is.

THERAPIST: It's not usual.

CLIENT: Yeah. When you google having a thyroid problem and having a heart problem you get wildly unhelpful stuff. Add to the fact that it's really tough to talk about with people -

THERAPIST: People are scared.

CLIENT: It's a scary thing to talk about and it's confusing and complicated. I mean it would almost be better if we were having weird relationship issues. I don't know anything.

THERAPIST: I think people have no frame of reference, (cross talk)

CLIENT: Yeah, there's no frame of reference.

THERAPIST: You've really been thrown into this world.

CLIENT: Oh my gosh, and the doctors I didn't quite realize how if he pushes himself it's making things worse. When we first started dating he was getting over the first diagnosis for the first time and basically everything we did the first year, we shouldn't have done it. Like all the adventures and going out to hang out at his friends and going on bike rides with his friends and basically like keeping him sick and so makes the whole beginning of our relationship which was at least the good part, like actually the bad part.

THERAPIST: You didn't realize.

CLIENT: Yeah, I never, and neither did he. But it's really obvious in retrospect.

THERAPIST: You have a lot more information now than you had then.

CLIENT: Yeah. He didn't have a doctor who was making it really clear what was happening. And I mean, a lot of what they do is they say, ‘if do you feel good, fine,' regardless of what the tests say. But basically, his heart was enlarged and he continued to push it and push it so it wasn't shrinking.

(Pause): [00:15:59 00:16:04]

CLIENT: So I didn't quite realize that until this past week that that's what had been happening. And that's why there's hope that if he does nothing for a while not nothing but takes it easy for a while, that it will shrink now. It's just such a mess. And it's ironic, too, because I guess one of the first things he had was the thyroid problem way back when and they never checked his heart at the time, of course, and now he has both.

THERAPIST: I'm sorry for both of you.

(Pause): [00:16:33 00:16:45]

THERAPIST: Who could you talk to when you say it's hard to talk about and it's scary to talk about, but you need to talk to people?

CLIENT: Yeah, I keep trying to talk to people like right around and people who love me. I'm not sure, she's just not the opening up type so I tell her things and she doesn't react at all or well. And I mean maybe it's fine and she's just a hard to (inaudible) person.

THERAPIST: Have you talked to the person who moved back to New Mexico?

CLIENT: Yeah, I mean we go back and forth but it's just not quite the same.

THERAPIST: Could you call?

CLIENT: I'm not sure.

THERAPIST: I mean on the telephone?

CLIENT: Yeah, I mean -

THERAPIST: Have an actual conversation?

CLIENT: It's tough to get people on the phone with the time difference. But, yeah, yeah, like an actual phone conversation.

THERAPIST: You might find that that's a little bit more supportive. I know it's hard to navigate with your schedule and her schedule and the time difference but I wonder if setting up a time to actually have an actual live conversation she has been somebody in the past that's been able to handle hearing this kind of stuff.

CLIENT: Yeah, I mean a lot of my other close friends who I would want to talk to about this aren't here for college right now, high school or whatever, they're not around and they only know me as they don't know us, they only know me and so they'd take the side what are you doing? Why which makes me like nervous about talking to her not nervous but less comfortable I guess.

THERAPIST: How do you respond to people who give you that response?

CLIENT: Well, you know it used to really bother me. Like, especially people who'd never really met him or maybe who I hadn't talked to in a long time and I guess the first they're hearing about him it sounds nuts, what I'm doing from their perspective.

THERAPIST: Does it feel nuts to you?

CLIENT: Not any more. It used to. I mean the thought I mean I'm just (unclear) unless I just lose it again which I don't think, feel, I will which is also really depressing because I can't leave, don't want to leave, yet maybe he will just deteriorate for the next few years and then die. I don't know. Like who knows and then that would be awful. So it is crazy, isn't it? But I'm going to do it anyway, I guess. [00:18:50]

THERAPIST: Well, you know where you are.

(Pause): [00:19:19 00:19:23]

CLIENT: So I don't know how you get someone to support you in that. When I first told my college roommate about this she had just been talking to you and that a friend of ours from college who I wasn't friends of but she was because they were in the rode in together, who had gotten married and then moved with her husband to start a new job for her husband and then he had gotten testicular cancer, I might have told you this I guess this happens to young men from time to time, I don't know. So she had just like gotten off the phone I guess with this girl and I kept thinking about this girl and I wished that I was friends with her would love to talk to her about this.

(Pause): [00:20:01 00:20:09]

CLIENT: I think that's all (unclear) But there are other people I've heard of or know of who aren't close friends but have had things happen to them. Maybe a group like this could (inaudible) [00:20:18]

THERAPIST: Yeah. I'm wondering, I just remember seeing the posting. I'm wondering now if it's if you would be eligible, you know is it only for the actual person with the diagnosis or is it for people who are also affected by chronic -

CLIENT: Actually it would be awesome if it was if it was, like they'd let me go but I didn't actually have the problem, diagnosis.

THERAPIST: Maybe, I don't know if it's geared toward you know who it's geared toward.

CLIENT: Yeah, yeah, yeah.

(Pause): [00:20:42 00:20:48]

THERAPIST: But I bet there are things out there for partners or family members of people who are diagnosed with a chronic illness because it does have a it's a profoundly difficult experience to be the one who's going through it along side somebody. Your experiences are different but they're both really profound.

(Pause): [00:21:10 00:21:18]

CLIENT: Yeah, I don't know. I mean it's awful like when I heard about this thyroid thing I was like, ‘well you know, you can rest, it'll be fine, I'll take care of him and I'll just do my own thing,' you know. I'll go to school, I'll work hard. But it's just hard, I mean it takes so much energy. Something's sapping all my energy. Just the fact that he's there and he's sick is exhausting.

THERAPIST: Yeah, because he can't give back to you in the same way that he could when he was healthy.

CLIENT: Right, but I mean even if I just let him be and try to just do whatever I'm going to do and let him be, it just doesn't work that way, I guess. He's been so much more supportive this time around and hasn't been sort of pulling at me, I guess.

THERAPIST: Which is also not being fun with him. When he's healthy the relationship feeds you. It gives you back energy because you enjoy one another and you're able to do things that you enjoy together and that circles back.

CLIENT: And I generally know he's at home miserable.

THERAPIST: Yeah, and that's (cross talk)

CLIENT: Just out of love he's -

THERAPIST: On your mind.

CLIENT: Yeah. So I'm going to (cross talk)

THERAPIST: It's hard to let go.

CLIENT: Yeah.

THERAPIST: Of that. In order to really enjoy what it is that you're out doing which the instinct to do that, you do need to take care of yourself and you do need to pursue your own things, too. But yet it's not the same, you going off and having time with your friends knowing he's off having fun with his friends is different than knowing he's home and not feeling well.

CLIENT: I mean he's home because he likes to play video games which is what he likes to do, but I know he's also miserable.

(Pause): [00:23:11 00:23:16]

CLIENT: I mean I know when I'm upset he's worried about it too. That's reasonable.

THERAPIST: Yeah, it's reasonable. That makes sense. I don't think that there's anything wrong with you, but that doesn't make it an easy path to follow right now.

CLIENT: Yeah. If it's all in my head that's exhaustion or the drugs or combinations of drugs.

THERAPIST: It's in your head, it's in your bones.

CLIENT: I was reading about how, I guess, hormonal troubles peak in like your late 20s or something, early 30s or something.

THERAPIST: Oh, I didn't know that actually.

CLIENT: I'm sure it's not true. I spend too much time (inaudible) [00:24:03] my woman's' magazines always that's where all the answers have an article about this, about googling your health symptoms. (Laughs)

THERAPIST: Do they tell you you shouldn't do it?

CLIENT: Well, and how if you're into it just looking at it like you know, Mayo Clinic and age and all that because I forget where I read that.

THERAPIST: Checking your cycle is very important.

CLIENT: I mean I even asked my lab mate, I was like ‘has this ever happened to you?' and she maybe I asked her badly, I don't know, she got kind of quiet and didn't want to say much about that.

(Pause): [00:24:38 00:24:42]

THERAPIST: She's not very open.

CLIENT: Maybe coming to college with a bunch of girls, I don't know, questions like that were not like crazy.

THERAPIST: I don't think it's a crazy question. Some people are much more closed off.

CLIENT: It's a very personal question. But (unclear) every day, so I don't know (laugh).

(Pause): [00:25:07 00:25:16]

THERAPIST: I'm sorry you've had such a hard couple of weeks.

CLIENT: Then I keep thinking that like, ‘oh, we'll know something better by this time (unclear)." It's nice to have a point in time but it keeps getting pushed out, pushed out, pushed out.

(Pause): [00:25:33 00:25:36]

THERAPIST: It's very hard to wait for some good news finally.

CLIENT: Or just, I mean, like I said before I just want him to have some sort of stability even if it's in a crappy spot so we can deal with it.

THERAPIST: Something to get used to.

CLIENT: But things keep getting right exactly. But things keep getting worse, basically. Or we think they're getting better and seem to be but then they get worse.

THERAPIST: So when does he talk to the doctor about the thyroid stuff?

CLIENT: In two weeks I think because we'll do another test just to be sure. They did a test and they see wrong, then they did another test and it was for sure that and then they said a few more weeks and do another test just to be sure.

THERAPIST: That's a long to wait and to feel so crappy.

CLIENT: It is. I mean to make (unclear) all the time feeling crappy, just to be sure to see if things stay bad or whatever.

THERAPIST: Any the depression mimics hypothyroidism? So I mean it's not just the physical stuff that you're seeing that's related to that. The feeling cold, the feeling tired? But feeling bad, feeling down, depressed is also a symptom of hypothyroidism.

CLIENT: I thought he was depressed.

THERAPIST: Which in some ways is good news? If they can regulate his levels then some of what you're seeing as depression is probably related to the hypothyroid and that's an easier fix. You know, if they can do it the same way that they would manage it if it wasn't caused by meds. I don't know.

CLIENT: It might not be as bad and he's taking it that way because not only does he think of himself for one, think of himself as an athlete with something making him chilling out even harder. I think I may have told you that his father used to poke and humiliate him for being a chubby kid.

THERAPIST: Oh, no. Yeah, I think you did mention that.

CLIENT: And used to only give him praise for being athletic.

THERAPIST: So that avenue of feeling good about himself is gone.

CLIENT: Yeah, I mean it's a big problem, like in cycling they basically become; I mean they develop these eating disorders like they were in ballet or something. It's a kind of ugly (unclear) hanging out with a bunch of cyclists who are really, really serious about it. So, that fed that. And he's gotten over most of it.

THERAPIST: But now this is very scary to him.

CLIENT: Yeah, it's really (unclear). His mom was telling about that and about his childhood again. [00:28:20]

THERAPIST: And how it really sticks with you. Your core fears.

CLIENT: Yeah. I mean his confidence in other parts of himself is like he's [feels clear right now in some way, I'm not sure where's it's happening, but he's really holding on to that other part]. (ph) [00:28:20]

THERAPIST: It's like your role can be reminding him of the things that you like about him that are not related to his ability to be active.

CLIENT: I do, for sure. But then, the minute I go off on a bike ride with some of my friends or go to yoga with the friend he's kind of down.

(Pause): [00:29:09 00:29:15]

CLIENT: I mean right now he can't even like walk down the street to the movies and I also don't know like with this thyroid problem -

THERAPIST: He must feel really trapped.

CLIENT: Yeah. I don't know if he can push that or he just feels crappy, a whole other thing to figure out with what you're supposed to do.

THERAPIST: How does it affect your intimacy? Does he have any interest in sex? Can you guys -

CLIENT: Well, there's been all kinds of problems, but I mean, besides just surgery, one of the they didn't tell him this one of the pills he was on to help his heart, it was supposed to be like a water retention pill that actually they found out is not as effective for beneficial effects on the heart, they just know nothing about how these drugs work, but whatever, they just give it to him. They didn't tell us it has like estrogenic effects.

THERAPIST: Oh.

CLIENT: And he didn't tell me that for like a few weeks. It was like secret (unclear) than sex which is weird because I think he's all about like make up stuff sort of like if he feels the kind of relationship is like going badly or something. [00:30:12]

THERAPIST: That's one way to commit.

CLIENT: Actually he has a lot of confidence in himself. If nothing else he feels like he can do the job. So, yeah, it's been bad. Which has been fine up until recently. I don't know why, making him more sad lately.

THERAPIST: Sad that he has no interest.

CLIENT: Well no, we're selfish (unclear) (Laughs) I guess that as I feel better and better I wish that I mean it really has been a long, long time now that he's been having multiple unrelated troubles in that area. So the minute we get him off that estrogenic pill and on something else because of this I guess insurance won't let you switch until you have side effects or something ridiculous like that, so anyway. And he gets off that and (unclear) and then he gets his thyroid pills. [00:30:55]

THERAPIST: Which also lowers his libido.

CLIENT: Yeah. He just has no energy. So yeah, it's bad. Or it's not bad, it's just -

THERAPIST: It is. It's a problem; I mean it's okay for that, to feel like that's a problem in the relationship. It is a problem.

CLIENT: I mean we're super affectionate and we talk about it. He tells me how much he'd really like to. It's just (unclear). So I don't know what I'll do exactly, but at least continue to like (inaudible). [00:31:57]

(Pause): [00:32:07 [00:32:12]

CLIENT: I mean it's spoiling the good part.

THERAPIST: The relationship. Yeah. It's an important piece. It's finding a way to stay connected and finding a way for you to feel satisfied. Getting creative.

(Pause): [00:32:21 00:32:33]

CLIENT: I guess he likes being in control and not that he likes to be controlling, I mean this seems to be sort of a mild problem which I would talk to him about and tease him about but he not ever not ever but he would rarely let me like start things.

THERAPIST: Oh.

CLIENT: Actually, we used to fight about, not fight about, but talk a lot about because it would drive me crazy -

THERAPIST: What was that about?

CLIENT: I don't know exactly. He likes warnings and I had (unclear) [00:33:12]

THERAPIST: So if you want to initiate you weren't initiating at the time he would normally want to be -

CLIENT: I guess. He just had a lot of, sort of moments where it wouldn't work for him it had to be like a certain time. I'm not explaining this very well.

THERAPIST: So if it wasn't how he wanted it could he not actually perform?

CLIENT: No, he could.

THERAPIST: But he just didn't like it that way.

CLIENT: Yeah, I mean, or if I would like try to start things he would feel uncomfortable or embarrassed I guess, I don't know.

THERAPIST: Is that continuing? Or are you just not initiating?

CLIENT: No, I mean I do. I mean there really has been no sex.

THERAPIST: For how long?

CLIENT: Wait. Maybe a few times since his surgery, so a few times since December? So, not much. (Laughs)

(Pause): [00:34:11 00:34:24]

CLIENT: And I feel like I'm making our sex life sound really bad, like it's mostly been amazing.

THERAPIST: Because he's taking all the medications.

(Pause): [00:34:25 00:34:42]

CLIENT: Yes, well it could be another thing like to do a better job with.

THERAPIST: And figure out how to make that work. What feels right for you guys right now? And how to deal with it as an imbalance which, I mean it sounds like there's going to be because there's nothing effecting your sex drive and there's a number of things effecting his.

(Pause): [00:35:02 00:35:09]

CLIENT: Yep. I feel like not only this past week because I've been exhausted and had my (unclear) telling me that I don't really want him to have sex which is just another -

THERAPIST: Which is another sign that it's really time for your period.

CLIENT: Which is not only kind of embarrassing but also because there's nothing I can do about my (unclear) if there is, I don't know what to do about them. And I mean, for hormones, not only do they put you on a pill, they put you on things like Zoloft I think, I googled which (inaudible) which is another reason I was wondering maybe I sleep too much. [00:35:30]

THERAPIST: Sometimes an SSRI (ph) can help with some of the signs of premenstrual disorder and so it sounds like what you're having is really exaggerated PMS and I don't know whether you've talked to Linda about it or not, but sometimes they do you SSRI's to help combat some of those effects. It's not going to change the increase in libido near your period. That's totally normal. That's nature's way of saying, ‘quick, get pregnant before the cycle's over.'

CLIENT: Right, right.

THERAPIST: Whether or not you want to.

CLIENT: No, I have mentioned things related to the pill and we talked about it.

THERAPIST: And she says she's shying away from it.

CLIENT: Yeah.

THERAPIST: I would talk to your (unclear-ologist).

CLIENT: But then when I talk to them about hormones they're like, ‘well, you can't really test for it,' or ‘you can try them pills if you want.' (Laughs) They're not helpful. I mean I want (unclear) to test my mom and they said it was (unclear). [00:36:35]

THERAPIST: Yeah. I don't think there's really an objective way to look at it. But the symptoms that you're describing are certainly something that you're recognizing and experiencing in a patterned way.

CLIENT: Yeah, and the most frustrating thing is you google and then like, ‘eat well and exercise.' And I try not to eat (unclear) and chocolate and try to take my dog for jogs and its just exhausting. Everything's exhausting. And I mean, I don't know if I just kind of like let it go to far. I have things due for school and I have hardly finished them. I just, I don't know, I didn't put up much of a fight I guess. [00:37:00]

THERAPIST: Well, you've got a lot working against you. You're not just experiencing hormonal shifts. I think it's also partly you know you're doing that in the context of your boyfriend getting his news. Your boyfriend feeling horrible at home. It sounds like your sleep has been interrupted so you are depleted of good restorative sleep.

CLIENT: For sure if you have crazy dreams it means you're sleeping is not ideal.

THERAPIST: Yes. Because only remember our dreams if we are somewhat aroused during it, so there's lots of different sort of levels of sleep and you don't have to be all the way awake to be sort of out of the deepest sleep waves, the longest sleep waves. So, if you're remembering these crazy dreams that means that you are somewhat being aroused out of your good, deep restorative sleep during the night. And if you are remembering multiple crazy dreams then you're probably being awoken to some degree multiple times. And so does that mean you're not sleeping at all? No. I mean you're clearly sleeping, but we go through sleep cycles during the night. There are these 90-minute sleep cycles and you keep going through them. If they're interrupted then you're not getting some of the restorative sleep. You are supposed to go through the REM phase, you're supposed to go through a deeper, more restorative phase. So you're getting woken up during them, they're getting interrupted and you're not getting that good restful sleep that you have when you go to sleep at night and wake up in the morning and don't realize anything's happened in between. That's different for your body.

CLIENT: I wonder how much more I can relax. I don't know what else to do about it exactly.

THERAPIST: I think, not try. You know, sometimes the more you try to relax the more frustrated you get and the harder it is.

CLIENT: Even yesterday like I had this great yoga class and I downloaded a silly book by Tina Fey and we ate dinner and I was exhausted. I don't know what else -

THERAPIST: I think you did lots of healthy good things and we need to ride this out because it sounds like a lot of what's affecting you is your menstrual cycle and you can't do anything about that one right now and it sounds like you made some really good, healthy choices about the things that you can control.

CLIENT: Yeah, I've just been like something I googled yesterday was like this shouldn't last more than three days or something.

THERAPIST: How many days do you feel like it does, the most intense part is for you?

CLIENT: It's usually just a solid week. Usually I snap out of it, I mean because it's a pill back down. Usually I snap out of it on a Monday, only it's not working this Monday, maybe tomorrow. But everything happens in weeklong cycles. So, I was actually really bummed out today (cross talk)

THERAPIST: When it wasn't the same or it was the same. It wasn't what you were hoping for.

CLIENT: It's also incredible how I'll sleep eight hours to like the minute. I went to bed at 11 on Saturday night, so I woke up at 7. I went to bed at 10 last night and woke up at 6. It's just bizarre.

THERAPIST: But that's actually good for you.

CLIENT: Yeah. No, that seems good but if I'm still exhausted and people say, ‘oh, (inaudible) [00:41:20]

THERAPIST: I know. You're body doesn't like to do that but that catch up can actually mess up your circadian rhythm.

CLIENT: So google also says. (Laughs)

THERAPIST: Google and I agree for a change. Well, let's check our schedule and maybe do ten minutes of relaxation and get you some, maybe not sleep, but it is relaxing and restorative and see if I can't help you get through the rest of your day. I know I switched one thing on you and did we not have, I don't see you in my book. Is that because we didn't put you in?

CLIENT: I thought we had just said, ‘okay, (unclear). [00:42:06]

THERAPIST: Okay. I do still have, I have your 3:30 spots held for you on Tuesdays if that's good.

CLIENT: Okay.

THERAPIST: All right. I didn't know if we had (turning pages) [00:42:29] I think I had done them all the way through January and had not looked for it in February, but they're there and they're yours.

CLIENT: Thanks.

THERAPIST: I did notice we're getting very close to the 24 that Blue Cross allows you for the academic year, so after that it goes up to the one in 40.

CLIENT: (Unclear) [00:42:50]

THERAPIST: Okay so we need to talk about this. So you get 24 sessions covered per academic year on your Blue Cross. You knew that.

CLIENT: Yes.

THERAPIST: So my full fee is $165. But since you do the recording, we can knock some of that off just like we knock off some of the co-pay and usually I think that puts you up $140 per session so I don't know if you need to juggle that into your -

CLIENT: Yeah, if we could do maybe every other week and the co-pay will help -

THERAPIST: All right, so I think that's -

CLIENT: But next time.

THERAPIST: I don't think it's next time but it's kind of what's coming up. I know you've had to miss some sessions so it kind of bought you some time into the semester but I will double check where you are.

CLIENT: Okay, yeah, or I could, I probably could.

THERAPIST: You can. You can call Blue Cross and what they'll do is they'll tell you what they've paid for thus far and they're going to be a little bit behind because they haven't probably processed you know, the end of December. They haven't processed January for sure. And so you can get a really close gauge from that and just add on.

CLIENT: Yeah, when I used to work and go to any doctor I would still get a statement. You should get something back from them once they've paid me.

THERAPIST: They should be sending you something called an explanation of benefits.

CLIENT: Yeah, yeah.

THERAPIST: You don't get them?

CLIENT: No. Maybe I should get them.

THERAPIST: That's weird. Do you have like an office address at school that you never check your mail at?

CLIENT: I do, but I wouldn't, I've never given it to anyone.

THERAPIST: It might be on file with the school though.

CLIENT: That's interesting.

THERAPIST: I've had clients who have been like, ‘so I just looked in my office at school and there's a thing for November of last year that said,' so you could check that mailbox because that might be what's on file at school and your Blue Cross is through school, so. But that's going to be behind, even. So call the member services number on the back of the card or drop in next time you're at the member services office on the first floor and they can tell you everything that Blue Cross is paid thus far. But I'd also do a I'd keep a record on my computer as well.

CLIENT: I'm sure I could figure it out, too.

THERAPIST: Well, I'll tell you next week.

CLIENT: Okay.

THERAPIST: All right. Let's let you do some deep breathing and relaxation. So close your eyes. Let yourself take some full deep breaths and your natural pace and then please scan your body. Notice any place that feels tight or uncomfortable, mean while breathing into that space with a full deep inhale and then as you exhale let go of the tension that you feel. Let your body relax. Let your mind empty. Notice that your breath will slow down as you let go of the tension letting your inhales be as long as your exhales. Working with your own rhythm whenever you're ready to inhale then squeeze your eyes tightly shut and then when you're ready to exhale you can relax that letting your eyes stay gently closed. On the next breath in you can clench your jaw, squeezing your teeth together and then when you're ready to exhale relax your jaw, let your teeth come apart, let all that tension in your face drain away. On your next breath in shrug your shoulders toward your ears noticing when that brings tension to your neck and your back, then when you're ready to exhale let your shoulders fall and the tension drain out of your arms and your chest and your shoulders. On the next inhale squeeze your hands into tight fists noticing where that brings tension to your hands and your forearms and when you're ready to exhale, let your hands relax, let the tension drip out of your fingers. On the next inhale, bend in your elbows bringing your hands towards your shoulders, noticing where that brings tension to your biceps, hands and shoulders and when you're ready to exhale let your hands fall and the tension drip out of your arms. On your next breath in, squeezing your knees tightly together noticing where this brings tension to your inner thighs and then when you're ready to exhale, let your legs relax, let your knees come apart and let your body relax into the chair. Next breath in, think about tightening your abdominal wall by pulling your belly button in toward your spine. Notice where this brings tension to your torso and your hips and when you are ready to exhale, let your belly relax taking full deep breaths.

(Pause): [00:48:28 00:48:35]

THERAPIST: On your next breath in, thinking of flexing your feet, pull your toes back up off the floor noticing where this brings tension to your lower legs and when you're ready to exhale let your toes relax, let your feet fall flat.

(Pause): [00:48:48 00:48:53]

THERAPIST: On your next breath in reverse that movement by pointing your toes down toward the floor noticing the tension in your calves and your ankles and when you're ready to exhale let your feet relax letting them fall against the floor.

(Pause): [00:49:06 00:49:11]

THERAPIST: Continuing to breath at a relaxed pace, scanning your body once again, noticing where you've held onto tension or where it's crept back, thinking about breathing into that space, tightening it even more and as you exhale let go of all the tension letting your body fully relax.

(Pause): [00:49:30 00:49:35]

THERAPIST: On taking a breath to notice what thoughts have crept into your head, acknowledge them without any judgment and as you exhale letting your mind empty for a moment, feeling that other thoughts can come back to you if you need them to, but for now can be empty.

(Pause): [00:49:52 00:50:00]

THERAPIST: And let yourself count out a few more breaths letting yourself hold onto the relaxation you've gained as you come back to the room at your own pace.

(Pause): [00:50:10 00:50:39]

THERAPIST: Look at your hands.

CLIENT: (Laughs)

THERAPIST: Holding I was just noticing that when you were pretty relaxed your hands were holding on with those fists, so just sometime during the day today, make a fist and let it go because it seems that you were holding a little bit there. Okay? I will see you next week.

CLIENT: Okay.

END TRANSCRIPT