TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: So did he come home?

CLIENT: He did come home.

THERAPIST: He did?

CLIENT: And maybe it was a bad idea to come see you today. (LAUGHTER) I’m so overwhelmed. I don’t even know what to even think. I’m like still half way in my pajamas from this morning. (LAUGHTER) He got home but it was an all-day production that just continued until, today will probably continue until things settle down next week. (PAUSE)

THERAPIST: Well, it’s okay to be overwhelmed and half in your pajamas and whatever else you are in here.

CLIENT: (LAUGHTER) (PAUSE) I haven’t been to school in like probably a week. So I’m going to go today after (inaudible at 00:00:53) the visiting nurse, he showed up this morning like halfway through what she was doing. So... (LAUGHTER) (PAUSE) [00:01:00]

(PAUSE) (LAUGHTER)

THERAPIST: It’s okay. Just start in the middle, wherever you are.

CLIENT: I’m exhausted. I think I told you last week I was going away last weekend which, in fact, was causing me a lot of stress and did cause me a lot of stress and was a pretty stressful weekend.

THERAPIST: So you did go?

CLIENT: I did go. Actually, I went late because Josh (ph) was bleeding on Friday.

THERAPIST: Oh no.

CLIENT: But no one seemed to think much of it. So once he got past the stress of freaking out about it which took him pretty much all day until someone told us it was not a problem, I had decided not to go to the party, the bachelorette weekend until the next day. But then two days of it was plenty for me. It was exhausting. [00:02:01]

THERAPIST: I’m sorry it didn’t turn out to be a good sort of get away and distraction.

CLIENT: Well, it was good. It just caused me a whole heck of a lot of stress also. I mean, I didn’t sleep (PAUSE) did things that I wouldn’t normally do. (LAUGHTER) (PAUSE)

THERAPIST: That were fun or were uncomfortable or...

CLIENT: They were fun. I mean, there was dancing and I slipped away to go skiing. But it was just the opposite of relaxing, I guess. (PAUSE) You know, it was fun to get dressed up and dance, I guess. But... (PAUSE) I don’t even know. (PAUSE) It was also... I mean, this girl I was always pretty much jealous of my entire life. She’s my next door neighbor. And her family had a lot more money and they were always... And she was much more confident than me. [00:03:03]

Her mom would like tell her like, would show her how to do her nails or... I don’t know. She was just always... She was just popular and pretty and all this and whatnot. And I don’t know. Especially in middle school I was getting made fun of by people too because my mom didn’t tell me to wear deodorant or... I don’t know. Whatever. So there was like middle school baggage brought up and like... (LAUGHTER) This girl and all her friends (inaudible at 00:03:33) always wanted to be more like her when I was little. I don’t know. That just fed into my stress, I guess, about the whole weekend of feeling like I needed to keep up, I guess. They’re not people I’m super comfortable with, I guess, despite the fact that we’re really good friends. (PAUSE) Taking (inaudible). I don’t know what I’m trying to say. [00:03:57]

THERAPIST: You clearly felt uncomfortable and like you couldn’t really be yourself and relaxed.

CLIENT: I mean, I was myself. I just wasn’t relaxed about it. (PAUSE) It made me feel a little crazy.

THERAPIST: Yeah.

CLIENT: It felt so different.

THERAPIST: Yeah. You felt like you didn’t quite fit with the group.

CLIENT: Right. And I didn’t quite expect to. But it was still just really stressful. (PAUSE) So... Okay. Something I’ve been thinking about since last time is when I was telling you about feeling panicked. And you had said, “Well, a panic attack is such and such and such.” And I don’t know if I’ve ever actually really had a panic attack. I was trying to think about it based on those criteria. It just sort of this knot of anxiety that goes up...

THERAPIST: And down and never really goes away.

CLIENT: ...or down. (PAUSE)

THERAPIST: Does it ever go away?

CLIENT: I don’t know. I mean, I guess not. (PAUSE) Depends how much anxiety (inaudible at 00:04:59) personality that I want to have or not. (LAUGHTER) I mean, I guess I can think of times where it’s been pretty low. (PAUSE) [00:05:11]

THERAPIST: How much does it matter to you whether it truly qualifies as a panic attack or whether it’s just heightened anxiety that goes up or down? (PAUSE)

CLIENT: (SIGH) Well, panic attack, I guess you were saying, is more like a defined episode that ends.

THERAPIST: Yeah. And yours never... Does it end? Well...

CLIENT: Well, sure. I mean, if it’s like levels. It goes up and down for sure and at some points it’s a problem and at some points it’s not a problem. (PAUSE) I guess it’s a problem when I feel like I can’t handle the current situation. [00:05:55]

THERAPIST: So in terms of like... If we think of anxiety as like a family of disorders... But we don’t really say disorders because we have diagnoses for them. Right? So... So there’s a big heading of anxiety and there’s all different forms that anxiety can take. Panic disorder is considered one of the types of anxiety disorders. You’re allowed to have as many different anxiety disorders as fit. It’s not like you get one or the other, you know, can’t go together. So, you know, really the only... Diagnosis is helpful in helping you to sort of understand... It gives me a way of being able to kind of quickly think about what your situation is like. But, other than that, I mean, it doesn’t really change... I mean, whether we say, yes, there are true panic attacks happening superimposed on general levels of anxiety or not, that doesn’t really change so much kind of... It doesn’t change at all what’s going on in your life and it doesn’t change so much the treatment that you’re getting because you already have, you know, medication for anxiety and Joan (ph) gave you stuff to take sort of PRM. [00:07:11]

You know, if something gets more intense, you could have something that you take as needed. So, you know, whether that’s heightened anxiety or panic attack, it doesn’t so much matter. But for your own sense of sort of, you know, clarity about what might be going on for you, a panic attack is generally, if it’s going to go by the book, is going to be a discrete episode that has a start and a stop and the feelings during that episode tend to be physical in addition to the sort of worried thoughts that you sort of kind of carry with you a lot.

CLIENT: Well, right. They go... I mean, you can’t separate the thoughts and the physical. At least I can’t. But it doesn’t feel like the physical discrete episode.

THERAPIST: Okay. [00:07:57]

CLIENT: I mean, I guess like last night... The reason I was thinking about this is because if it feels like a knob, all the things I do to cope...

THERAPIST: Turn it down a little bit.

CLIENT: ...turn it down a little bit as opposed to ever making something stop.

THERAPIST: Right.

CLIENT: (LAUGHTER) So Josh has been, since he got home, has been obsessed with planning our wedding. (LAUGHTER) I’m not sure why. But I’m letting him go with it because he’s latched onto it so much it seems to help him. I don’t know. (PAUSE) It’s helping him (LAUGHTER) even though I think it’s a little crazy.

THERAPIST: It gives him something happy to focus on and something that gives him some control in a way he can’t...

CLIENT: He’s gone crazy. I saw him... He was about to send an e-mail to his two best friends telling them about how we were getting married in October. I was like, “Whoa. Please don’t tell anyone anything. (LAUGHTER) Holy crap.” But...

THERAPIST: Are you getting married in October? [00:08:59]

CLIENT: I don’t know. (LAUGHTER)

THERAPIST: Okay.

CLIENT: (LAUGHTER) (PAUSE) He... I was making him dinner last night in kind of a state in trying to get him in order while he was going on and on about florists or something. (LAUGHTER) And he said something about how he wanted to give me his heart in October but hopefully it would be a different heart, not his heart. And I just started crying. In fact, I’m crying just thinking about it. Sorry. (CRYING)

THERAPIST: That’s okay.

CLIENT: For no reason, just because I’m so tired and... (PAUSE) This is exactly what happened. I can’t even say it. (PAUSE) Why am I telling you this story? I guess it’s just boiling over. (PAUSE) And he’s been doing the same thing too. [00:10:01]

We walked in yesterday and our dogs weren’t there, which he knew, but he just lost it. It’s like...

THERAPIST: Like the reality...

CLIENT: Yeah.

THERAPIST: ...kind of hits you at different moments. So it’s... I mean, it sounds like that comment that, “I want to give you my heart but it’s hopefully not going to be mine,” it’s like reality that you’re waiting for a new heart for him. And not having your dogs at home is a reminder of how difficult and intense it’s been that you, you know, placed them for foster care right now.

CLIENT: Or, I guess... I mean, thinking about our wedding, that’s about... Everything is like “your heart this,” “love that.” It’s all going to be based on... I don’t know. It’s just going to have so much more... I don’t want to say meaning. It’s not meaning. It’s just... (PAUSE) It’s like a really loaded thing to say. [00:10:59]

THERAPIST: Yeah. (PAUSE) But suddenly, the meaning of it kind of changes. It’s... (PAUSE)

CLIENT: Yeah. We’re both sort of just hanging by a thread. (PAUSE) (SIGH) And, I mean, little things have been setting him off all over the place. (PAUSE) I need to go... I guess he’s coping by planning our wedding.

THERAPIST: How are you coping?

CLIENT: I’m not sure I’ve had a chance yet, really. There’s been no time to cope. Well, I guess I’m coping in spending the day planning how I can go for a run before I go home because Josh’s mom isn’t home and I need to talk to her when I get home and do a whole lot more stuff. There will be no relaxing once I get home. [00:12:01]

And I haven’t had a chance to do anything for myself yet. I feel like if I don’t go find a way to run, I’m going to lose my mind. So the thought of having to do that all day has been coping, I guess.

THERAPIST: It sounds like it’s been really hard. What have you been doing? What has the actually having him home been like?

CLIENT: Well, it’s been about twenty four hours now and it’s been exhausting just getting him set up. I mean, all the sudden it’s hard. I mean, we walked into the house with all this stuff, got him sort of situated and he needed to go to the bathroom and he couldn’t sit all the way down to the toilet because it was so low. And he’s got these pumps that won’t allow... I mean, I wasn’t... I’m still not sure if it’s pain or physically not possible, one of the two. And then he just lost it. [00:12:59]

He started having like a... It didn’t last very long. But, I mean... (LAUGHTER) He had a moment because he couldn’t sit on the toilet. So then I had to go to CVS. I had to go to CVS to get his medication and a raised up toilet seat and his medication lists didn’t match up. I had two of them and they didn’t match up with what the pharmacy got or each other. So then I spent an hour on the phone paging doctors at the hospital. And then some of... The pharmacy didn’t even have one of his drugs. So... (PAUSE) (LAUGHTER) We got home and it was suddenly just like an eruption of problems. And I’m still...

THERAPIST: Yeah. As much as prepared as you try to be, there’s these things that like nobody thought or told you about. Like no one at the hospital prepped you that he would need a raised toilet seat. I’m sure there’s a host of other things sort of that can be adapted maybe that you don’t realize until you get there and see what the challenges are for him. [00:14:01]

CLIENT: Yeah. (PAUSE) I mean, he’s barely had a chance to like be in the house. (PAUSE) And now I’m afraid to go home and see what happened. And this morning, I mean, this morning... So not only did he go home with these pumps that have to have the dressing changed all the time, he had to go home with... We got this all thrown at us yesterday. This antibiotic... Two antibiotic in his arm. One needs to be changed every day. They both need to be changed every day. (LAUGHTER) So they run us off all these med lists, which of course I didn’t notice at the time didn’t match and then spent an hour and a half training us on how to change these IVs. (LAUGHTER)

THERAPIST: Wow. [00:14:53]

CLIENT: It’s just really overwhelming. For these antibiotics that, I mean, if we do it wrong, could either give him another infection or not give him the antibiotics that are keeping the infection at bay. So...

THERAPIST: Scary.

CLIENT: It was just... (LAUGHTER) It wasn’t even scary. It was just a lot. No one told us about this. We’re supposed to leave at three o’clock and the nurse comes in at one o’clock with this box of refrigerated antibiotics and goes through. (PAUSE)

THERAPIST: That’s a lot of responsibility.

CLIENT: It’s a lot to get right. And people keep saying...

THERAPIST: Yeah.

CLIENT: Like ten different people said, “And don’t forget about this and don’t forget about this.” I’m like, “Can you write this all down?” They’re like, “Sure.” And things don’t match up and... It’s just incredible to me how carefully things were... Well, okay. Things were (inaudible at 00:15:45) at the hospital but more carefully than... (PAUSE) And then we rush out. (LAUGHTER)

THERAPIST: And they were sort of giving it to you... Right.

CLIENT: And so... (PAUSE) [00:16:00]

THERAPIST: It is a lot to take on.

CLIENT: It is. This morning I spent several hours just changing all his dressings and antibiotics and things and trying not to contaminate him all on the couch. You know, the hospital, you just throw things on the floor. Someone cleans it up later. They have a medical waste bin. You’ve got a trash can, several of them. (PAUSE) And then, all the while, Josh is bugging me to get our dogs home. How on earth are they going to be able to come home? (PAUSE)

THERAPIST: Yeah. That’s a tough environment for them.

CLIENT: And I’m sure we’ll figure it out how to make it work for him. But I think we both had some fantasy that him coming home would be better. I don’t know.

THERAPIST: It’s going to take some adjustment. (PAUSE) [00:17:00]

(PAUSE)

CLIENT: And also, right before... A few days before he left, there was a girl actually named Katie (ph) who had the same device who was somewhat our age who had been discharged and then she showed up back at the hospital with a bleed from her stomach.

THERAPIST: Oh no.

CLIENT: So, I mean, it just... (PAUSE) I’m almost convinced that something’s going to happen. He’s going to end up back in the hospital it seems like, especially the way they just sort of send you home with all this stuff.

THERAPIST: It’s a lot to take on. (PAUSE)

CLIENT: Yeah.

THERAPIST: Yeah. I mean, he never really feels that stable. (PAUSE)

CLIENT: Yeah. I mean, and they tell us... First, there was this nurse, this lady with this VAD (ph) who has four kids running around. I have no idea how she could be possibly doing that. I mean, every time Josh moves, he’s like basically bleeding or something’s falling off or... (LAUGHTER)

THERAPIST: Gosh. [00:18:03]

CLIENT: I mean, he’s got this bag of antibiotics. It’s just... It’s almost ridiculous. It’s almost so ridiculous it’s funny. (PAUSE)

THERAPIST: It might be funny if it were a TV show.

CLIENT: If I could not think about the fact that it could kill him at any moment, it’s kind of funny. (PAUSE) (SIGH) (PAUSE) Oh. Also, this morning he was bleeding even from like, his gums were bleeding. And he made the visiting nurse take the blood thinner... And it was like way higher than it should have been. So we noticed... Who forgot to do something or what happened?

THERAPIST: Right.

CLIENT: I don’t even know if that got resolved or not. (PAUSE)

THERAPIST: How often does the visiting nurse come?

CLIENT: Every day.

THERAPIST: Oh good. [00:19:01]

CLIENT: For two weeks. Yeah. But (inaudible at 00:19:05) just in case the nurses at the hospital don’t get them and they want to know. I don’t know. Just... (PAUSE) It’s incredible to me how disorganized everything has become all of the sudden.

THERAPIST: Yeah. And there’s really no... You end up as the point person for trying to organize it all and trying to communicate between the nurse and the hospital and Josh.

CLIENT: Yeah. I mean, if I had to be at school today or if I was going to drop out if I didn’t show up at school at like eleven... But I could... I mean, I could still be doing things at home I’m sure. I mean, I don’t know how it’s going to work out. (LAUGHTER) [00:20:03]

And, I mean, I know I told you that my advisor is fine with whatever I do. But I’ve got so many other people that rely on me that... They’ve been asking me for things and it almost doesn’t matter at this point. (PAUSE)

THERAPIST: Do you want to take the semester off or is that still an option? Do you feel like you need that?

CLIENT: No, I don’t. It’s just that... It’s just leading to my, I mean, adding to my exhaustion, I guess.

THERAPIST: Yeah. This is another role that you want to fill. (PAUSE) It sounds like fitting in that run is pretty important.

CLIENT: Fitting in?

THERAPIST: That run for yourself. [00:20:59]

CLIENT: Yeah. I mean... Okay. I start panicking thinking about it all day (inaudible at 00:21:07).

THERAPIST: Right.

CLIENT: It’s like how am I going to do that without going home first? (LAUGHTER) It’s been taking up way to much energy which is really frustrating. I wish I could just relax. But I can’t.

THERAPIST: Well, you have a pair of sneakers.

CLIENT: Yeah. (LAUGHTER)

THERAPIST: That’s all you need.

CLIENT: Yeah. It makes me... Also, while I’m thinking about this, I don’t know but it seems crazy...

THERAPIST: A pair of shorts and a road.

CLIENT: Well, I guess, you know, I’m a little nuts. I just bought a pair on the way over here.

THERAPIST: Perfect.

CLIENT: It feels nuts. It feels completely nuts. And I also probably won’t tell Josh that I’ve done that because he will not understand. (LAUGHTER)

THERAPIST: Yeah. But you need it. You need to have something that’s for you that helps to discharge some of your anxiety and lets you clear your head and just be in the zone for a little bit. [00:22:05]

And you are holding together a lot of pieces and so making sure that you do something for you is really important because you can’t hold together all these pieces for everybody else if you’re not okay. And this... It sounds like, one, being able to think about the fact that you’re going to go take some time for yourself allowed you to get through the other parts of your day and it keeps you just sane enough to be able to do it.

CLIENT: I guess, I mean, it’s also incredible energy. It’s still like anxious thinking, I guess. I mean, even when I was at this bachelorette party, I had missed the day when they all went downhill skiing and I had my ski stuff in the car and we had just been out drinking all night. [00:22:57]

And then they were going to sit around drinking in all day. And the thought of that caused me so much stress that...

THERAPIST: It’s really not where you wanted to be.

CLIENT: Yeah. (LAUGHTER) That I spend probably hours stressing over whether I should go home, use Josh as an excuse... Well, he’s not an excuse. Decide that I should go and leave.

THERAPIST: Right.

CLIENT: Or go skiing which is exhausting. The thought of it was so exhausting. But the thought of staying was impossible which also made me feel insane. So I went skiing and it was... (PAUSE) It helped. But it was also exhausting. I wish there was something I could do. I did try to take an Ativan. I think it helped some tiny little percent. But it was like just sitting and relaxing was not possible. (PAUSE) Which I probably could have used. (LAUGHTER) I don’t know. Hopefully all of this...

THERAPIST: Well, it’s...

CLIENT: ...coping is not going to like make everything worse. [00:24:03]

THERAPIST: It’s not going to make everything worse. (PAUSE) It’s hard to tell yourself to relax. You’re obviously really tense and keyed up and worried. I mean, it’s reverberating off you.

CLIENT: (SIGH) (inaudible at 00:24:25)

THERAPIST: So, I mean, to say, “I’m going sit and relax and hang out and drink with these girls,” I mean, it’s an unrealistic expectation that you’re going to be able to slip into that mode. It’s not where your life is right now.

CLIENT: Well, and one of them... So my friend is a social worker who is having the bachelorette party. And one of them... So half of them are social workers from her grad program. One of them was a (inaudible) social worker from Mass General (ph). (LAUGHTER) And I couldn’t stop thinking of things I wanted to ask her yet I did not want to talk about all of this stuff.

THERAPIST: Right. [00:25:01]

CLIENT: Which also made me just want to go.

THERAPIST: Yeah. I could... That’s a really odd situation to be in.

CLIENT: Every time I sat and talked to her... And she was mostly, the whole weekend, you know, talking about (inaudible at 00:25:15). And I’d start thinking about things I wanted to ask her. You know, it was definitely an odd situation.

THERAPIST: Did they know sort of what was going on with Josh at all?

CLIENT: Yeah. Every one of them knew, in fact. And we talked for a little bit. Another girl... I mean, another girl had just had a baby and her baby had just been in the ER the night before and was freaking out about that. And she kept thinking about whether she should leave or not. But no one else felt the need to run out and go skiing.

THERAPIST: Well, they had already gone.

CLIENT: Everyone else was sort of being too relaxed (inaudible at 00:25:55) made me feel nuts. (PAUSE) [00:26:00]

(PAUSE) It was a little bit like other times I’ve been away where being with other people made me so self-conscious of also my anxiety because also I was sleeping in a room with four girls. And the second night, I lost my ear plugs which were really good. And I could hear everything and I couldn’t handle it. And in the middle of the night I had to like find some quieter corner to hide out in where I finally went to sleep. But that was also just so embarrassing. And it’s not the first time it’s happened to me being away with other people.

THERAPIST: Yeah.

CLIENT: It wasn’t as bad as some other times.

THERAPIST: I know it’s been a really challenging piece to try to find a space that sort of fits your requirements to be able to sleep and not having control over the situation is really hard. I don’t think you’re crazy. But I do think that you’re really anxious. And you have a lot of good reasons to be really anxious right now. [00:27:05]

You know, combined with the fact that you tend to run at a higher anxiety state than, you know, what most people’s baseline is. So the combination of already being pretty up there sometimes and then having all of these really good reasons to be anxious, places you pretty close to panicking. And maybe not in the typical sort of panic attack mode because, like you said, there isn’t really this start and then release that a panic attack tends to have. That tends to be a discrete period. But I think you’re panicking which is exhausting.

CLIENT: It is exhausting.

THERAPIST: I mean, to be running the level of intensity that it requires to be this anxious for this long, it’s an enormous amount of energy you’re using up. And so I think that you know, feeling exhausting and overwhelmed and drained makes sense. [00:28:05]

CLIENT: And I’ve had like four cups of coffee today and it’s had like no impact, no (inaudible) (LAUGHTER)

THERAPIST: I think it’s probably had an impact. It’s not making you less tired. It’s probably making you pretty edgy.

CLIENT: Probably. (PAUSE) I knew things were getting pretty bad last week when I tried... I forget why I took an Ambien last week. I think I was so stressed about going away. (PAUSE) I mean, even just about how I was going to clean the house and go grocery shopping before Josh came home, all of which I did yesterday morning before the day even became exhausting. (LAUGHTER) Like how I was going to do those things before the bachelorette party was causing me not to sleep. So I took one and then woke up at five AM. But then I was encouraged... By the next night, I decided to try an Ativan instead and I slept in until nine. And I’m sure Ativan could be helpful also in the future. Except this weekend there was too much alcohol involved. [00:29:03]

THERAPIST: Yeah. You don’t want to combine that much.

CLIENT: I forgot to take all medications today. I barely made it out of my pajamas. (LAUGHTER) So that probably didn’t help the situation either.

THERAPIST: Yeah. So I think figuring out how to make a small space for yourself so that you can do your, make sure you take care of you too. You get to take your meds. You get to have a half an hour to go do your own thing whether that be a little bit of yoga or a run or if you can find an hour, that’s great. But there needs to be some space to take care of you. You’re not going to be able to have, help anybody else if you’re completely exhausted. [00:30:03]

CLIENT: I for some reason thought that there would be more time for that when Josh was home because I wouldn’t be driving.

THERAPIST: It’s less commuting.

CLIENT: Yeah. Oh my gosh. I mean, I’m so happy not to have to drive to the hospital today. But, I mean, even just the fact that I’m going to have to interact with Josh’s mom causes me enough anxiety besides all the other stuff. (PAUSE) I don’t know. I mean, he can’t do anything at all for himself whatsoever.

THERAPIST: Maybe that will get a little bit better. This is the first day. There’s a lot of adjustment the first day home. So...

CLIENT: Yeah.

THERAPIST: Maybe holding out some hope that, you know, once you get some routines in place you’ll get more comfortable. This is the first day that you did the IV and the antibiotic and the, you know, all of that. When it’s the tenth day, it’s going to be a little bit easier for you. Those pieces will become less cumbersome. [00:31:01]

CLIENT: I don’t know. He needs to go to the doctor Friday and on Monday and on Tuesday (inaudible at 00:31:15).

THERAPIST: Well, I’m sorry it’s so hard. I wish that the homecoming felt better for you and for him. I’m sorry it’s been so hard.

CLIENT: Well, it was really great for like a little moment last night when we were both sitting on the couch and he was picking out his suit. (LAUGHTER) (PAUSE) I mean, that was nice, I guess. I wasn’t sitting on a hospital couch anticipating having to drive home and (inaudible) that’s a little nicer, I guess. [00:31:57]

THERAPIST: There will be lots more of those kinds of moments to balance out the other stuff. (PAUSE)

CLIENT: The next two weeks are going to be awful because he needs to be taken care of 24/7 basically.

THERAPIST: Who else can come help?

CLIENT: My dad, I think, can come help too and Josh’s mom.

THERAPIST: Is there a rotation set up?

CLIENT: We did. Not at the moment. Right now, his mom is just coming. (PAUSE) I barely have a chance to like (inaudible at 00:32:47) and fill him in on what’s going on because I didn’t even really believe he was coming over yesterday until, I guess, they let us go.

THERAPIST: Until you actually walked out? [00:32:59]

CLIENT: Yep. (PAUSE) I mean, other people can help. It’s great his mom is there. (PAUSE)

THERAPIST: Well, it’s great that someone is. But it also requires that you’re then kind of interacting with her more than you would like. And so maybe even having other people there as a buffer so that you’re not having to spend time with her.

CLIENT: I mean, unfortunately the people who cause me the most anxiety to interact with are my dad and his mom. I wish there was somebody else. But... I mean, unless there was Phil (ph). There’s nobody else. I mean, I almost killed him mom when she walked in and started complaining about how there was no parking. I was trying to get to school. (LAUGHTER) Oh, she had wanted me to leave the car, my car because Josh can’t get in her car because it’s a two door and there’s no way he can get in with his device and he’s not allowed to sit in the front seat anyway. [00:34:09]

But there was no way I was going to be able to leave the car there and make it to school on time. And so I snapped at her. Hopefully she wasn’t too offended. If there was an emergency, we’d call 911. She wouldn’t drive him. Or... I don’t know. If there was an emergency and she needed a car, we’ll drive him. There was just no way that was going to happen. I’m glad I didn’t have time to stay and argue about it. (PAUSE) (LAUGHTER)

THERAPIST: I think it’s a good plan. If there’s an emergency, you call 911. (PAUSE)

CLIENT: I mean, I wish I felt... She keeps asking me if I need anything. I wish I could be honest with her about what I need. [00:34:53]

THERAPIST: What would you say?

CLIENT: Well, it would be great if she would just come... I mean, I’ve been tempted to call her and ask if she would, you know, call her on the way home and ask her if she would go. I also don’t want to offend her. So I can go home and just relax, not have to talk to her and everything. (PAUSE) That also feels really selfish because I know Josh’s mom needs me to help support her too.

THERAPIST: That’s a lot. (PAUSE) Is there something in between that? Is there a way to make interacting with her easier when you get home and the transition between her being there and you being there? [00:35:55]

CLIENT: Yeah. If I go run first. (LAUGHTER) So that’s my plan.

THERAPIST: And then I wonder if sort of making your interaction with her really specific... You know, what do you need to know about how the time went or anything that happened during the time so that maybe that would make the conversation easier.

CLIENT: I don’t know.

THERAPIST: You know?

CLIENT: It’s just the way she is and it’s not her fault. I just... (PAUSE) I don’t know. Operate on different... It’s the same with my dad. But at least with my dad I could be blunt with him. My mom was trying to talk to me while... I had gone straight from the bachelorette to the hospital and my mom was there and she was coming and she wanted to talk to me. And I told her I couldn’t have her around because I hadn’t slept in like three days and had basically been drinking continuously for three days and skiing and freaking out. [00:37:01]

And she (inaudible at 00:37:03) mom. (PAUSE) I called her and apologized the next day. (LAUGHTER) (PAUSE) And both of them, both moms are exhausting also in that... I mean, yesterday Josh was having... Or on Sunday... Whatever day I was there with his mom, I mean my mom... Josh was having incredible back spasms. They were causing him so much pain he was just like groaning in the chair. My mom... I’m not sure she’s ever seen him quite like that. I certainly have. There was nothing I could do about it at the time. And they were having the pain people come in. Oh. And then Josh’s mom did show up and the two of them were just talking about how frustrated they were about it and what they could do about it. I forgot what I was saying here. [00:37:59]

THERAPIST: They were both really frustrating.

CLIENT: Oh. And I mean I’ve been getting e-mails and calls from my mom about his back and she’s trying to find a chair that would be more comfortable and all that sort of thing. And she also wouldn’t leave that day. He was sitting there in pain and I had to make her leave.

THERAPIST: So you feel like they just don’t get it?

CLIENT: No. It’s not that they don’t get it. It’s that they’re wanting to help is also stressful. I mean, he definitely does want a chair. But... (LAUGHTER) If they want to help and get him a chair, it just needs to... They can make it appear. I can’t participate. Participating in them finding solutions that they need need to happen is exhausting.

THERAPIST: It’s like another thing added to your list.

CLIENT: And this is... This happens with relatives all the time I feel like. They want to help. But they also... I mean, I have an aunt who wants to buy me a futon. But the amount of effort I had to put into helping her helping me was not worth it. [00:39:07]

THERAPIST: Yeah. I understand what you mean because it sounds like... Yeah. I would be great if the perfect chair appeared in your house. But you’re so busy doing, taking care of other things that need to get done as well that adding that on your list of things to pay attention to is not helpful. And if she’s sending you links of chairs to look at, it’s like you don’t have time to be looking at, you know, the nine different chairs she’s discovered.

CLIENT: Yeah. And, I mean, I want to make her less concerned because I know that she’s... I mean, I can see it in her face the other day when she was watching him groan and cry out in pain that like it was really making her upset. (PAUSE) [00:40:00]

Which is makes me feel like I can’t be upset. She’s upset.

THERAPIST: How come you can’t both be upset at the same time?

CLIENT: I don’t know. I don’t know exactly.

THERAPIST: Yeah. I think it’s okay for you to be upset together. And maybe if you could let yourself do that... It’s not your job to make everybody not upset. So if your mom is upset or his mom is upset, it doesn’t become your job to take away their distress. You can be upset too.

CLIENT: I mean, that’s always been something I’m not able to do is be upset. (LAUGHTER)

THERAPIST: Let other people have their own feelings. It doesn’t have to chance yours and you don’t have to take care of theirs. That might make it... If you can let go of that, let go of that desire or need to sort of take care of the other people, it might make it easier for you. (PAUSE) [00:40:55]

CLIENT: Well, I mean, to take care of them it just... They’re not helping me by being there and acting that way.

THERAPIST: Yeah.

CLIENT: They want to help. And, in fact... I had talked about this with the couple, the girl who had the heart transplant. I was actually surprised. The boyfriend had said he, at one point, had a social worker kick out her parents because all they were doing was hovering and worrying and it was making everyone more stressed out. And he had told... They had talked to the social worker about how upset it was making them to have their parents or her parents be doing that. And she said, “If you want me to, I’ll kick them out and tell them they can’t be here anymore. Or it would be better for everyone if they went home.” And I was really surprised. That’s...

THERAPIST: That’s exactly what you want.

CLIENT: That’s horrible. Yeah. I feel they don’t have the right to do that. Maybe I do. I don’t know.

THERAPIST: You certainly do in your own home.

CLIENT: Well, at home I can’t because it’s either I’m there or somebody else is. [00:42:01]

THERAPIST: Right. But you don’t... But you can kick out Pat (ph). Right? It’s her name? You can kick her out when you get home. (PAUSE)

CLIENT: I guess I wish I had a social worker there to... (LAUGHTER)

THERAPIST: It would be much easier. Yes. It would be really nice to have somebody else to do that. And you don’t have one there to say the words for you. But you can certainly invoke the social worker to say, “Get home. Alright. I’m home now. Thanks for taking care of Josh while I was gone. It’s better not to overwhelm him. So now that I’m home... The social worker said not to overwhelm him.”

CLIENT: (LAUGHTER)

THERAPIST: “So now that I’m home you can go and rest. And can you come back at whatever time tomorrow?”

CLIENT: I guess you know what else is different about it too is that Josh seems to look not like...

THERAPIST: He likes having her there.

CLIENT: I mean, yeah. He’s... He seems to like having my mom there worrying. Or at least, when I ask him, he doesn’t share my feelings about it. [00:42:59]

It just seems like the other couple...

THERAPIST: They were more aligned.

CLIENT: ...were aligned in that feeling.

THERAPIST: Yeah. And so... But you also count. So, you know, what’s useful for Josh and what’s good for him counts. But what’s good for you also counts. So, you know, he’s got, I think, balancing the care and the attention that he’s getting from having people there and the stress that you feel or you’re imaging you’re going to feel when she’s there, you know, you have to weigh that out. And if it’s causing you more stress... Sometimes you win too.

CLIENT: Yeah. I think we’re going to have to talk about this when I get home.

THERAPSIT: Yeah. See how it is. Maybe it won’t be... You know, it might... Maybe she’ll be easier to deal with this on one day that another.

CLIENT: And this has also made me think about the dogs, how I think I’m going to have to put my foot down because the thought of having to go home and take care of them...

THERAPIST: It’s too much for you. [00:43:57]

CLIENT: ...is too much no matter how much he cries, I guess, which is awful.

THERAPIST: Yeah. Because he can’t take care of him right now. And if they jumped on top of him... (PAUSE)

CLIENT: We... Yesterday the neighbor brought up her dog. So that was good. I don’t think they’re going to hurt him. I think that’s going to be fine.

THERAPIST: Okay.

CLIENT: No more than I will probably end up hurting him somehow. I mean... (PAUSE) Or he himself, hurting himself. Yeah. It’s just too much.

THERAPIST: Yeah. I think you have enough to take care of. I know it would be, in some ways, probably nice to have the dogs home. But they are other beings to take care of.

CLIENT: Well, it’s been... It’s just been such a constant battle ever since with Josh about that. And the lady who was training us yesterday on the antibiotics... I don’t remember why we mentioned dogs. [00:45:03]

Someone brought up our dogs. And Josh said something to her about how they were abandoned by their mother. (LAUGHTER) And she took that literally. She was like, “Oh, that’s terrible.” She thought we were taking care of...

THERAPIST: Right.

CLIENT: ...dogs or something. I had to set her straight. And like he says things like that sometimes just jokingly and then sometimes he starts crying and freaking out about them. And I hate to like take away more than he already has had taken away. But...

THERAPIST: Yeah. But it’s a lot of work.

CLIENT: But I don’t think we’re ever going to be able to understand each other on that. I think I’m just going to have to put my foot down.

THERAPIST: There is a very big difference between placing your dogs in good care when you’re not able to do it and abandoning them.

CLIENT: Well, I can’t make him...

THERAPIST: You can’t make him see that.

CLIENT: ...see that. Yeah. [00:45:59]

THERAPIST: Well, I think it’s important that you know that other people can see that. And that’s the choice you made.

CLIENT: Yeah. At the moment, I guess I’m just sort of surviving and I really don’t care if I go home and he’s crying about the dogs, at least right now. (LAUGHTER) But it’s like a constant decision I have to make (inaudible at 00:46:25).

THERAPIST: Yeah. That’s really hard. Well, go take your (inaudible). I think we’re scheduled for next Tuesday.

CLIENT: I feel like I just got here. (LAUGHTER) Oh... (SIGH)

THERAPIST: Do you want to come back sooner than next Tuesday? Does that make it harder or easier? (PAUSE) I just heard you say that you feel like you just got here. So if you need more time, we can schedule more time. But I don’t know if that... I don’t want to place a burden on you of coming extra.

CLIENT: I think next week is... Actually, I’m going to have to be at the hospital next Tuesday.

THERAPIST: Okay. [00:47:01]

CLIENT: But I don’t want to change anything now. I want to see if I can get Josh’s mom to do it.

THERAPIST: Okay, okay. And if you need to reschedule with me, we’ll...

CLIENT: I might.

THERAPIST: ...do that. So I have you for the 12:30 on Tuesday. But there are other spaces in my week. So if you need to...

CLIENT: You know what? His clinic... We’re going to have to (inaudible at 00:47:21) and I’m sure I’m not going to be able to get someone to take him every time or even if I can just in case, let’s move it. (LAUGHTER)

THERAPIST: Okay. Friday? I have to look at next week.

CLIENT: Is this a slot you have in general or is this just a random opening?

THERAPIST: I have this spot every other week but not every week. This is Wednesday at 3:30. Right? So I don’t have this next week. But I have it the week after. Next week I have a 9:30 on Tuesday or a 10:30 or 11:30 on Friday. (PAUSE) [00:47:59]

CLIENT: Okay. Maybe I can work out every other clinic week or something.

THERAPIST: Okay.

CLIENT: But also... I’m e-mail you.

THERAPIST: Okay. Do you want me to put you in for the next, next Wednesday would be 3:30? Do you want me to hold that for you?

CLIENT: Yes. That would be perfect. (PAUSE)

THERAPIST: And just e-mail me about next week.

CLIENT: Okay. (PAUSE)

END TRANSCRIPT