TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: How are you today?

CLIENT: Today, I’m good. (chuckles)

THERAPIST: You seem surprised.

CLIENT: No, I guess today I’m feeling sort of contemplative. I don’t know. I just had friends in town this weekend. And decided to ignore basically what I would do if they weren’t there to sleep and (chuckles) take care of myself. And just take the consequences.

THERAPIST: What were the consequences?

CLIENT: Oh, that I’m (chuckles) exhausted. Or I slept last night, but that I was really, really tired. I don’t know. Which, I guess, made me think a lot about whether all of my troubles are—sometimes they feel like bad habits. Sometimes, it feels like an illness, almost. [00:01:03] I don’t know. One of Josh’s friends who was here has a deformed foot and he’ll just never be able to run on it or—there’s a lot of things he—it’s a very clear limitation. No matter who’s doing what, he just cannot do some things. Or, I mean, sometimes, it really makes me think if I’m doing something wrong.

We were relaxing on Sunday. (chuckles) Meaning lying around on the couch. And I was having a lot of trouble just laying there. (chuckles)

THERAPIST: Not relaxing for you at all.

CLIENT: Well, I recognize that it should be. I was very tired. There wasn’t anything else I really wanted to be doing. I just was really –

THERAPIST: What do you feel when you do that?

CLIENT: My heart is pounding. I almost feel a little nauseous. And laying there is just really hard. And I was really tired, so, it wasn’t like I wanted to get up and go running or something. I was just still, I don’t know, worked-up from the weekend. [00:02:00] (sighs) I don’t know. I don’t know.

I mean, that happens a lot, where I’m—want to be laying there –

THERAPIST: Mmm, (crosstalk at 00:02:10).

CLIENT: relaxing, but I just can’t.

THERAPIST: And you’re so anxious that it’s not relaxing. Because the heart-pounding feeling is anxiety.

CLIENT: Yeah. And, I mean, there’s been a couple situations where I had no choice but to relax for like three or four days. And by the end of it, sometimes, my body will give up and actually relax. And it’s great, which makes me (crosstalk at 00:02:33).

THERAPIST: Did you try taking a Klonopin to see if you could actually allow your body to relax in that situation?

CLIENT: Yeah. So, last night, I took an Ativan. And, yeah, it really—well, so, the Zoloft helps. (chuckles) God, I mean, I hadn’t (inaudible at 00:02:51) it was awful. I’d been waiting for them to get up, because, of course, I wake up early and they (inaudible at 00:02:55) sleep until noon, because we’re tired. And that’s what people do when they’re tired is they sleep. [00:03:00] (chuckles) So, I’d been waiting for them to have brunch that I could have Zoloft. I don’t know. I just have always woken up so early whenever there’s a sleepover situation my whole life. And it always sucks in the morning. It always makes me feel like there’s something wrong with me. Especially since I wish I was sleeping.

So, anyway, so, the Zoloft, once I took it, helped a little. Not as much as Ativan does. So, yes, it does. It makes it go away. And then, I could just be—still sit there and it’s not a super-uncomfortable . . .

THERAPIST: It doesn’t feel like you’re being chained to the couch.

CLIENT: Yeah. But I don’t know why. If I’ve done something wrong, if it’s something inevitable, like a deformed ankle that I just can’t do anything about. Or if I live differently, would this happen? (chuckles) I don’t know. It’s just so frustrating to be relaxing when everyone else think they’re having a great, relaxing time, I’m suffering. [00:04:02]

THERAPIST: Right. And you’re like, “This sucks.” (chuckles)

CLIENT: To lay there. It happens a lot. Really a lot, so . . .

THERAPIST: What would feel better for you? I mean, like you said, you didn’t—it—you were tired, so it wasn’t like you wanted to go out and take a run or there was something else you were really wanting to do. But clearly, it wouldn’t be what you were doing if you were on your own. What would you have done?

CLIENT: I don’t know. I mean, I probably would’ve cleaned the house or something. (chuckles) I don’t know. I mean, the first morning, I made muffins, which was a little bit helpful. But I was really tired. And I could’ve just gone, laid on the couch while everyone was lying around. But I made muffins, instead, so . . . (chuckles)

THERAPIST: Mmm. Which feels less incongruent with what your body was doing, because you’re up and moving. It distracts you a little bit from –

CLIENT: Well, I’m sure if I laid back down in the middle of making muffins, I would’ve felt the same way. It’s just then I don’t have to think or listen it. [00:05:01] Or feel it.

THERAPIST: Right. It distracts you. Being busy distracts you from the tense feelings inside.

CLIENT: Yeah. I mean, it’s like when I come in here and I don’t even know, because I’ve been running around and then calmed down and realized that I was feeling that way. And it’s horrible, so . . . I don’t know.

THERAPIST: Yeah. I think I look at it as somewhere in between the physical limitation of having a disability, like a foot that’s not properly functioning, and lifestyle. You haven’t done something wrong. I think, in some ways, your body just does operate at a higher rev than –

CLIENT: Mm-hmm.

THERAPIST: maybe somebody else. So, when you try to be still, you notice that your notice that your engine is revving pretty high and you’re feeling really anxious. I think where the difference is if your bones are in a certain configuration, they’re in a certain configuration. [00:06:01] And that’s it. There’s not much you’re going to do short of a cast or surgery to change that.

CLIENT: Mm-hmm.

THERAPIST: With anxiety, it’s a little bit more malleable. So, you do have some control over slowing your heart rate down. Lowering your blood pressure. Things like deep breathing and yoga and even how you’re thinking can have some impact on those things. But are you going to be the most laid-back, chill person ever through use of those techniques?

CLIENT: (chuckles) No. Yeah.

THERAPIST: I don’t think so. (chuckles) I don’t think you have that much control. But I do think it is somewhat malleable. And lifestyle changes help you to adapt to it. And when somebody else comes in and you have visitors and they alter your schedule or the expectation of what a day looks like changes, that’s going to be hard for you.

CLIENT: Another thing that made me think about this is that the friends have been having a lot of a trouble having a baby. [00:07:04] And they had three miscarriages. (chuckles) And we stayed up—I was going to go to sleep earlier on Saturday night, and then, she just started telling us all this stuff about how traumatizing and awful it’s been until like 2:00 in the morning. And she was really worked-up and got really upset, which made me feel—we’re so worked-up and upset, because they—it’s something they’ve been hiding from everyone. I also know how much that stinks. (chuckles) And that almost kept me up when I went to sleep.

THERAPIST: Yeah, (crosstalk at 00:07:33).

CLIENT: Just feeling so anguished and, then, she sleeps until noon.

THERAPIST: Well, she unloaded.

CLIENT: (chuckles) Right. But even if I’d unloaded, it would still take me a while to calm down. That doesn’t happen to her. She just doesn’t have this response to these crazed—I mean, her—she was going a mile a minute.

THERAPIST: And then she just [was done] (ph).

CLIENT: How could you not be all worked-up? She was. Right. And she just went to sleep. (chuckles) And that makes me feel like I have a problem. [00:08:00] That’s something’s wrong. Why can she do that and I can’t? Especially with something that’s really awful. She was describing these three miscarriages. (inaudible at 00:08:14) have a baby, and all these tests that she’s been taking. She spent like $10,000 on all this stuff. I mean, that would cause me major trouble. (sighs) So . . .

THERAPIST: And then, she was able to turn it off. Yeah.

CLIENT: Yep.

THERAPIST: And in some ways, yes. I think it’s clear that you do have an anxiety disorder. And so, something is wrong. It’s not something that you’ve done wrong to respond that way. It’s not like you’re not—it’s not that you could change something that you’re doing and fix it completely. You have room to work with it. But, yeah, I mean, your body respond to anxiety different and holds lots of it than hers or maybe somebody else’s. [00:09:02] And it just part of something that you have to work around.

CLIENT: But when I work around it, do I think of it—so, it’s something I can never think about just getting rid of.

THERAPIST: I think there’s hope that you could have it so well-controlled that it wouldn’t interfere.

CLIENT: It’s always going to be managed.

THERAPIST: But it’s always going to—but you’re not going to be able to—I don’t think that it’s realistic that you can forget about it and not have any awareness of the choices that you’re making, because you’re—those choices will probably have an impact. But could it be—could you have it under such good control that it doesn’t interfere with your life? Yeah. But like with a diabetic, it doesn’t have to get in your way, but you can’t forget about it and eat all of your Halloween treats in one night if you’re a diabetic kid. Right?

CLIENT: (chuckles)

THERAPIST: You just can’t. That’s going to have a consequence. But does it have to get in the way of your life and make you think that you’re doing something wrong? No. But you’re going to have to space out your Halloween treats in a little bit of a different way. [00:10:03] Or take more insulin if you’re going to binge on candy. So, you are going to have to keep an awareness of, yes, staying up until 2:00 a.m. for you is probably going to throw off your sleep schedule. You might bounce back a little bit differently than someone who’s never had problems with sleep. And lying around on the couch until noon is probably going to feel different for you, maybe, than someone else.

CLIENT: Well, and especially things that, if I told someone, they’d be like, “That sounds great.” (chuckles) Most people think that sounds awesome.

THERAPIST: But it doesn’t. I mean, when you feel like you don’t have the choice. You’d like to be able to make the choice to totally have a chill day and be able to relax into it.

CLIENT: I guess I’ve never really—I don’t know. Acknowledged that I couldn’t make it go away somehow. [00:11:00] Although, when I think about it, my entire childhood –

THERAPIST: It’s been around for a very long time.

CLIENT: It’s been around. (chuckles) I don’t know. People’s, I guess, not like controlling needs or something, but—I don’t know. It’s not something that people talk about. So, who knows? Maybe my friend was also miserable with not being able to do what she wanted. I don’t know. She wouldn’t say so, probably.

THERAPIST: Yeah. People tend to be quieter about some things than others.

CLIENT: But I have had so many friends, like when I went to the bachelorette party, who I tell about how nervous I am about it. Because I know I’m going to have to really work hard to have fun. Just don’t. (chuckles) So taken aback.

THERAPIST: Mmm. Yeah, but that sounds different than what they think when they’re looking forward to a trip or –

CLIENT: Well, it’s certainly—definitely not a normal reaction. [00:12:03]

THERAPIST: How did this weekend feel? I mean, so, it was frustrating to notice that you were not enjoying a sleeping-in the way that they were. But the other time with them, did that feel like you were working hard to enjoy them or was it genuinely –

CLIENT: No. I mean, they made us –

THERAPIST: enjoyable?

CLIENT: They made us feel really taken care of. I mean, they had no expectations. They cooked for us. Just listening to Josh for a long time, talk about everything. And Josh’s friend sat and played video games with him like all day. And me and the girl went and took a walk. I mean, it was very enjoyable. Except for the—I couldn’t handle my schedule being thrown amok. (crosstalk at 00:12:56) –

THERAPIST: Mmm, right. So, do you notice the contrast (ph)?

CLIENT: (chuckles) I have a big problem. (chuckles) So, I mean, we were—it was a very uplifting thing. [00:13:02] Which is why I’m not—I’m not really upset about not having been able to sleep. It’s just sort of sad, because the weekend would’ve been a lot better had I been able to.

THERAPIST: What do you think it would’ve taken for you to be able to sleep in a scenario where your schedule is a little bit thrown off?

CLIENT: I don’t know. I don’t think there’s a—if I’m going to stay up until 2:00 a.m. listening to this girl’s problems, because we’re having a very support-each-other time. It is what it is. I don’t think there’s a way, unless I wake up in the middle of the night and take an Ambien at—no, I mean, I’ve done that, actually. At like 3:00 a.m. and it doesn’t make a difference. (chuckles) The only thing that’s gotten me to get any extra sleep is Ativan. So, maybe. But, still, it would just—it took me out for so long. (chuckles)

THERAPIST: I mean, you really didn’t feel like you could’ve put a boundary on that discussion. [00:14:00] And have it end sooner. It was really important to listen and be there. That that was (crosstalk at 00:14:05).

CLIENT: Yeah. I mean, it was worth it, for sure. (sighs)

THERAPIST: How long did it take you to fall asleep when—once the conversation was over?

CLIENT: I don’t know. A little while.

THERAPIST: Did you ever fall asleep?

CLIENT: I did. Yeah.

THERAPIST: Yeah? Okay.

CLIENT: But a while, because I just couldn’t—I—it was an intense conversation. (chuckles) Took a while to come down from—I don’t—yeah (inaudible at 00:14:27) clock. I don’t know. A little while. And I was really tired. And it always happens. I’ll be really tired, I’ll be like, “I can’t talk anymore.” And then, I’ll get in bed. And then, I’ll still just be as if I was still in the conversation for, I don’t know, half-an-hour, an hour.

THERAPIST: It feels like a long time when you’re lying there.

CLIENT: Well, I mean, that—I mean, I have definitely reconciled myself to the consequences. So, I wasn’t freaking out about that. I wasn’t going to sleep. I mean, it was also nice that (inaudible at 00:14:59) we had no expectations. [00:15:00]

THERAPIST: The next day. Yeah.

CLIENT: I mean, they’re a couple we used to go and sleep on their couch and go for bike rides. Five-hour bike rides. And then, go out to a bar or something. (chuckles) Somehow, I used to be able to do those things. And I would never sleep very much. I had more energy reserves. I don’t know. (chuckles)

Yeah. (inaudible at 00:15:26) stayed in our pajamas for like half a day, so, it didn’t matter. I just felt crappy. (inaudible at 00:15:34) my parents came over last night to drop off some things for Josh. And I was just non-functional. I couldn’t even answer their questions.

THERAPIST: Yeah. You were really wiped out.

CLIENT: To the point where, I mean, I was almost worried about driving my friends to the airport. (chuckles) I kept dropping things. I kept forgetting things. [00:16:00] I mean, there were definitely points when I hadn’t slept for like a whole week where I didn’t even want to bike to school, because I was afraid I would fall over. (chuckles)

THERAPIST: That feels scary when you feel that out of control.

CLIENT: Well, that’s when I know it’s a really bad point, when I’m not—clearly not functioning at all. Why would my body want this to happen

THERAPIST: Right. Well, it doesn’t.

CLIENT: And we were talking about why would your—when you get a new heart, your body could live forever if it just let it be there instead of attacking it. Anything. Any autoimmune disease or anything where your body just –

THERAPIST: Right. It doesn’t seem to make sense.

CLIENT: Right. Which also makes me think about why would my body want to do these things to me when it’s not helping anyone. It’s not making me healthier. It’s making me unhealthy. (sighs) Which, then, makes me feel like I have a disease. (chuckles)

THERAPIST: Mmm. Well, I think your body does it with more intention.

CLIENT: Sure. Right.

THERAPIST: Right? [00:17:00] I mean, there is intentionality in it, the thought process makes sense. But it doesn’t realize. I mean, what your body is doing, except it’s not in the right scenario. So, I mean, that heart-racing feeling makes a lot of sense. There is no threat that your body is responding to. And it’s when you’re anxious. It’s like your body is responding as the way it would as if there were some sort of threat.

CLIENT: Right.

THERAPIST: But, in the same way, just like an autoimmune disease. Right? Your body’s responding in the way that there’s some sort of bacteria or something that it’s gearing up to fight. But there’s no virus. There are no bacteria. It’s not fighting anything except itself. But it’s normal, typical responses, just at the wrong time.

CLIENT: I always think of the fight-or-flight thing that was something that’s quick. Because I could feel like that for days. I mean, why doesn’t it go away?

THERAPIST: Right. And it still is that fight-or-flight thing. It’s just that it’s doing that in a prolonged way. [00:18:02] And that’s part of why—and that’s why we say, okay, this is crossing the line from a normal anxiety response to calling it an anxiety disorder, because it’s continuing to prepare as if there’s some sort of ongoing threat. And there isn’t one. And there maybe never was even one. Sometimes, it’s set. You’re anxious about something that makes sense to be anxious about. But then, that kind of time goes away and the response doesn’t. And so, you’re left feeling anxious about something that you could’ve been done with days ago. Or you’re responding to nothing at all. You don’t even know why you’re feeling anxious, but your body is going through those motions.

And then, the exhaustion makes sense, because it’s the coming-down effect. But you’re having it in such an intense way that it feels like exhaustion rather than just coming down from that peak of anxiety. When your body shoots out all that cortisol and adrenaline and all of that that it uses when it gets revved up –

CLIENT: Mm-hmm. [00:19:01]

THERAPIST: and there’s—you have hormones that counter that, to help calm everything down. And that’s what makes you feel so exhausted. It’s too much of that stuff.

CLIENT: I feel like I may not have enough of that stuff.

THERAPIST: Mmm. In the first place.

CLIENT: Why do I have to try so hard to calm down? I have to work really hard. (chuckles) Even just to bring it down like a level. After, I think, (inaudible at 00:19:29) running, just sitting on the couch, I start to feel a little more comfortable. But it would take me like two seconds to go right back.

THERAPIST: Mmm. When you say you’re working really hard to bring it down, what do you—what is the—what’s the work? What do you do to get yourself that little bit of relief?

CLIENT: Well, not jumping up and freaking out. So, just trying to stay put, which is hard. (chuckles) (inaudible at 00:19:52) to do that. To try to breathe deeply and slowly. (sighs) I think that’s about all. Just trying to keep up breathe and stay put. [00:20:01]

THERAPIST: What if you fought it less? What if you got up and paced around?

CLIENT: Because I was so tired I just wanted to relax. Because I guess I was mad. I wanted to relax. (laughs)

THERAPIST: Anger doesn’t really help here. (chuckles)

CLIENT: Right, right. And that would make me feel crazy, if I got up and started pacing around. I didn’t want to be crazy. I wanted to relax. So, and I guess maybe I was just being a little irrational because I was so tired. (chuckles)

THERAPIST: Yeah. Well, it’s hard to think rationally when you’re tired. And it’s what you want—what you want to want is different than what you actually want.

CLIENT: Yes. For sure. I don’t know. I guess maybe I was being stubborn. (chuckles)

THERAPIST: Mmm. Yeah. I wonder if you compromised with yourself if you’d get to that place faster. So, if there was some compromise between getting up and racing around the house and cleaning, which may fit with the restlessness.

CLIENT: Mm-hmm.

THERAPIST: Something between that and forcing yourself to lie still on the couch. [00:21:03] And, “Damn it, I’m going to relax.”

CLIENT: Yeah.

THERAPIST: Which seems so not relaxing. Is there an in-between? Is there a gentle activity you could do?

CLIENT: Well, it’s hard when there are other people there.

THERAPIST: Can you sit and knit or cross-stitch or something that’s not racing around, but also not completely chilling. Crossword puzzles. Would that be enough of something to distract you a little bit, but still be calm?

CLIENT: I don’t know. Maybe.

THERAPIST: Would doing something like that feel—help you feel more in-line with other people?

CLIENT: Probably. I tried knitting once. I was really bad at it, but . . .

THERAPIST: But making a beautiful product would not be the point.

CLIENT: Sure. Right. [00:22:00] I mean, I was really bad at it because sitting and knitting is –

THERAPIST: (inaudible at 00:22:06) still. It was still too still.

CLIENT: Well, but maybe at that point, it would’ve been something good to do. I forgot about my Silly Putty, which I do have. I should’ve gotten my Silly Putty and . . .

THERAPIST: Yeah. Just having that. Allowing you to be restless in a little bit of a way.

CLIENT: Mm-hmm.

THERAPIST: Having something to play with with your hands. All of the things I suggested are all about a way to have something to do but still allows, for the most part, your body to be still. To me, it seems like that plays with the compromise of you clearly have this nervous energy going on, so, I feel like we need to be—to honor that. That’s there. We can’t fight it. But if the main goal is to be—feel like—emotionally feel like you’re fitting in with everybody else and physically actually giving your body, your gross motor, you’re giving it a rest. [00:23:00] Right? The big stuff. And you’d still be able to release some of the fidgety energy in smaller ways. By playing with Silly Putty, playing with a bouncy ball, or doing a crossword or Sudoku or . . .

CLIENT: Yeah. Those would’ve all been helpful. I’m still working on getting a piano. That might’ve been a little much for the moment.

THERAPIST: Yeah. A little harder to fit in with the other—with the group.

CLIENT: Right, right.

THERAPIST: But that’s not always . . .

CLIENT: But that (inaudible at 00:23:32) the same idea. I think I had knitting stuff from college. I just threw it away, I think.

THERAPIST: That’s okay.

CLIENT: It does seem like a good—it would’ve been a good thing to have yesterday.

THERAPIST: Mmm. Well, see what’s easiest of those types of things, so that you don’t have to invest in a whole new project. And maybe just seeing what it’s like to give yourself a small out. [00:24:04]

CLIENT: Yeah. It was really, hard, too, because Josh was saying how relaxed I look or looked or –

THERAPIST: Hmm. (inaudible at 00:24:14)

CLIENT: Because I was trying to close my eyes. And telling me how I was obviously asleep or something. (chuckles) I blew up at him. I was like, “I was dying. You don’t even know.” Oh, because I had asked him if—because I thought maybe watching a movie would be—I don’t know. It seemed like something (inaudible at 00:24:33) up. I don’t know. So, I had suggested that. And we all sat on the couch (inaudible at 00:24:38) hanging out. (sighs) And he was like, “That’s a terrible idea. That’s so isolating. We’re not talking to each other,” or something. I don’t know. It also led to a bit of my frustration. “What’s wrong with me?”

THERAPIST: Mmm. That doesn’t seem so crazy. People go to movies together. [00:25:00] Or rent movies together (crosstalk at 00:25:02).

CLIENT: (crosstalk at 00:25:01) yeah, I don’t know. I mean, I definitely didn’t get a lot of my own space this weekend. It was really about him and his friends. Making sure he was alive. Finding about their terrible troubles, so, it was really trying not to be a needy, crazy person.

THERAPIST: Mmm. But of course, you do have needs. And that doesn’t make you crazy. And even though it’s really nice to have friends come, it also is a disruption. And you do lose your space and your privacy and control of your schedule. That’s hard, especially when even a normal—in a normal week, you’re feeling very squeezed by other people’s needs. And you don’t have a ton of control over your schedule or your space.

CLIENT: Yeah. I mean, that’s the other thing I just sometimes get mad at is how much control I would love to have. It also stinks. Sometimes, I just get mad and refuse. [00:26:00] And then, take the consequences, I guess.

THERAPIST: Yeah. It’s hard to swing from extremes.

CLIENT: Mm-hmm. But if I give in completely, then, I just feel so—I don’t know. Abnormal, I guess. And, I mean, and the one thing I love about Josh is that, I mean, he’s not anxious like this. But, I mean, he likes his schedules. He likes control. For different reasons, which I’m still not entirely sure what they are. (chuckles) So, usually, that works really well, when it’s just us together.

THERAPIST: Mm-hmm. Yeah. You’ve figured out how you fit together. Even with some of his changing needs. And you throw another couple in the mix and that really upsets the balance. Because you don’t have a routine with them.

CLIENT: Yeah.

THERAPIST: You’re not used to sharing space with them in this way. [00:27:00]

CLIENT: Yeah. And, I mean, I was also feeling really sad, because, I mean, they’re Josh’s favorite people in the world and I—I mean, I also, have—the reason we’re not near them. So, a little bit of guilt over that, too. And, I mean, if they were next to us or living near us like they used to be, they would be so supportive and helpful. Come cook for us all the time. Walk our dogs and stuff, so . . .

THERAPIST: It would be nice to have close friends like that here. You don’t really have couples friends here.

CLIENT: No. Not like that. Especially since it’s pretty when I can’t get Josh (chuckles) out of the house to meet people, so . . . I don’t know. [00:28:00] I mean, I guess it’s good that this whole weekend made me just want to think this all through, as opposed to continue to be really anxious. Although, that was definitely helped by an Ativan, (chuckles) so . . .

THERAPIST: That’s okay. I mean, that’s why Joan felt it was an appropriate prescription.

CLIENT: Yeah. I definitely think it would have helped a lot a long time ago if I had agreed to it. She had one time prescribed me Klonopin and I was afraid of them, so I didn’t take them. (chuckles) I think they’re (crosstalk at 00:28:34).

THERAPIST: It’s very similar stuff. Yeah. And I will forget which one you’re taking all of the time. Just correct me.

CLIENT: They’re that similar?

THERAPIST: Yeah.

CLIENT: Okay.

THERAPIST: They tend to get prescribed for similar—I don’t know why a prescriber chooses one of over the other. They tend to get prescribed for the same types of things, in my experience. They seem to work in similar ways. [00:29:00]

CLIENT: Yeah. And I had sent her a bunch of questions. And she had said there’s no reason why the extra Zoloft would’ve made me feel like that. But of course, I can reduce it if I wanted. (inaudible at 00:29:14) I’ve been taking the extra anyway.

THERAPIST: Staying at the same. Yeah.

CLIENT: It’s still hard to say if it’s doing anything at night or not. But I’m also going to see her on Friday and ask her more clearly than over e-mail (inaudible at 00:29:32) about the whole thing, so—and she had also said—she also said it’s okay to take Ativan a few days in a row, I guess.

THERAPIST: Okay. Because I know taking it a couple times in a row for sleep was something you had wondered about. So, not every day in a row, but a few days is okay?

CLIENT: I think so. I’m still a little unclear (crosstalk at 00:29:54). (chuckles)

THERAPIST: Yeah. You can clarify in-person.

CLIENT: Yeah, yeah.

THERAPIST: But, for now, you’ve got a good working answer for the week. [00:30:00]

CLIENT: But I think I’m out of them (inaudible at 00:30:03), so . . . (chuckles)

THERAPIST: You should check that.

CLIENT: (chuckles)

THERAPIST: Yeah. If you are, call in your script ahead of time so that you can just pick it up when you’re there on Friday, rather than having to do a two-part trip. Because it does sound like it’s helpful to have them there.

CLIENT: Yep. Yeah. I mean, and Josh is on them, too. Sometimes it feels ridiculous we’re just so drugged just to get through every day.

THERAPIST: Mmm. Well, your situation is pretty extreme. There’s not a lot of—yeah. I’m sure when you’re on that transplant list, it seems like a long list. But in reality, it’s a pretty small percentage of people that ever have to deal with that type of situation.

CLIENT: Yeah. Yeah. Yeah. And I found myself looking up statistics again this morning, because they were—they made us really hopeful this weekend. And there’s a little bit of dreaming about what we’ll do together when it’s all done. [00:31:01]

THERAPIST: How did that feel?

CLIENT: It was good. In fact, I had to ask Josh not to tell the two of them about our dream wedding. And, of course, he told Greg. Greg is his friend. And I had to (inaudible at 00:31:18) because we were walking the dogs. And I forget what we were talking about. Oh, she said, “You seem a little bitter.” And we had gotten—I forget why she said I seemed like that. What I had been saying. So, then I told her about how we had dreamed this wedding in October. And then, realized that was probably too much of a risk. And we had come really close to paying for things and it was really close. We had taken the dream so far. It was a pretty big disappointment when we were like, “Oh, wait. We shouldn’t do this.” [00:32:00]

Oh. She was telling me I seemed bitter because I was trying to get Josh out of the house. To come out. And he wouldn’t do it. And I was really trying. (chuckles) And I was telling her I was afraid he would just sit in the house. Because he had said, before, he would just sit and wait for a transplant, however long it takes. Sit in the house. I don’t want that. That doesn’t seem like a healthy thing. He’s been dreaming and designing the mountain bike he’ll buy when he gets out and planning the trips we’ll take and all this stuff.

But, I mean, if he has to do that for a year, that—I can’t imagine he could keep that up with no real life happening at all. (chuckles) I couldn’t. Maybe he can. I don’t know.

THERAPIST: Mmm. But to have such a contrast in what you’re thinking about and what you’re doing –

CLIENT: Right.

THERAPIST: feels too hard.

CLIENT: Or it’s like it’s hard for me to watch. So, anyway, so, I told her about that. And then, I guess while we were gone, he was telling Greg, so (chuckles) we ended up talking about it. I forget why I started telling this.

THERAPIST: You were taking the dogs for a walk. [00:33:02]

CLIENT: Or maybe about dreaming? I don’t know. (laughs)

THERAPIST: I had asked how it felt to think about the future –

CLIENT: (sighs)

THERAPIST: because you told them you got really hopeful with them being here this weekend.

CLIENT: Oh. Right.

THERAPIST: Telling them what your plans are.

CLIENT: Right. I can’t. I still haven’t decided if it’s too much hope or (chuckles) just what we needed. I mean, it mostly feels good, as long as we stay realistic. But, again, yeah, this morning, I was looking at the transplant statistics, being like, “How long is it really going to be?” (chuckles) And I find myself thinking, “How many months has it been? Should I start to . . .” (sighs) I got a bunch of phone calls from random numbers this weekend, too, which I now have to answer no matter what. And every time, I’m like, “Oh, maybe I’ll (inaudible at 00:33:52) they’re here. Who’s this?” (inaudible at 00:33:54) [00:34:00]

THERAPIST: How do you know how much hope is too much hope?

CLIENT: I guess when we get disappointed so easily. And it feels so terrible. Or, at least, for me, that’s—I don’t know what it was about the day we went and they were like—someone said out loud, it could be a year or at least a year. I don’t know.

THERAPIST: And that felt crushing.

CLIENT: Yeah, because we’d just been making all these grand plans. Because I let myself like it must happen by the summer. (sighs) So, I don’t know. I don’t think that we’ve done that this time, though. A little nervous. (chuckles)

THERAPIST: Mmm. Yeah. I mean, using your internal sense of judgment. If dreaming and fantasizing and planning and hoping feels good, then, that’s good. [00:35:01] I think having hope is—does seem important, because you are waiting for something.

CLIENT: Right. Oh, we had talked about having my own dream last time. And I went home and told Josh about it. And I think I told you I had gotten rejected from going to this Philadelphia trip. And I went home and told Josh that I had. And I asked him. Because I was afraid he would want to live near Portsmouth and (inaudible at 00:35:28) for the rest of our life. And that’s the way he’s thinking right now. (chuckles) But he was like, “Sure. You could get a job there. We can go move down there.” Pretending it’s nice, (chuckles) whatever. And it was a big relief to hear him say that.

THERAPIST: Well, I’m so glad.

CLIENT: Which I don’t know why it surprised—it surprised me (inaudible at 00:35:46). (sighs)

THERAPIST: Yeah. So, he can imagine a time when he’ll feel less scared and less tied to this hospital, these doctors. So, then, you’re free to imagine that time, too. [00:36:00]

CLIENT: Well, and right now, he’s dreaming about can we ever move back to Washington to be near his friends. I don’t think any doctors are worth him moving back to Washington. (chuckles) Which I would do. It’d be great. That’s where most jobs are in what I do anyway. If they’re an FDA, so it was just a—yeah. Nice to dream to a little.

THERAPIST: Yea. I think it’s important. Dreaming and planning for your future is part of living. And it is hard when those dreams—when you get some news and those dreams are crushed for a little bit. So, figuring out the balance of tempering it with reality. But you don’t always know what reality is. So, you can’t stop yourself from thinking ahead and wondering just because there might—you don’t know exactly how long you’re going to be on the list. The reality is it could be tomorrow or it could be a year from now. [00:37:00] I mean, you just don’t know.

CLIENT: Yep. And I’ve been also dreaming about things like someday (inaudible at 00:37:10) require no planning. If there’s any planning, like for the wedding, attached to the dreaming, it becomes a big problem.

THERAPIST: Mmm. That’s when it gets trickier.

CLIENT: Yeah.

THERAPIST: Yeah. So, being able to think the someday. And you can think about someday—you can think about your wedding. Maybe it doesn’t make sense to put down deposits on things right now. But that doesn’t mean you can’t think about what you’d like and what it will feel like. Who you’ll want there. I think those things can be fantasized about.

CLIENT: I don’t know why last week, that felt really hard. So, it doesn’t feel as hard this week.

THERAPIST: Mmm. What’s the difference? What’s different about this week?

CLIENT: I don’t know. I mean, just telling Josh and him being able—because, I think I’ve told you before, I’ll often tell him terrible things I feel like I’m thinking. And he hasn’t (crosstalk at 00:38:00). [00:38:00]

THERAPIST: And wanting to work for the FDA is a terrible thing?

CLIENT: Well, that he won’t want to ever leave the Providence area. (chuckles) So, he could stay near these doctors. (inaudible at 00:38:11) thinking. Or just anything. He hasn’t really been able to my handle my deep, dark fears up until recently. Because he’ll start to cry or break down or . . .

THERAPIST: Sounds like he’s feeling a little bit stronger, too.

CLIENT: (sighs) A little bit. I mean, it’s hard, because it depends a lot on how much support he’s been getting. We managed to get him enough pain drugs to last him until this Thursday, when he has another appointment. And we would’ve had a whole different weekend. And I’d be in a whole lot—in a different state if we hadn’t. And that required spending hours on the phone with different doctors. (chuckles)

THERAPIST: And that’s hard.

CLIENT: (sighs) So, and, I mean, I really hope he doesn’t end up addicted to pain drugs. I don’t know. But the fact that he was not in pain this whole weekend allowed him to sleep, himself. [00:39:05] And be happy because his friends were there. And not be a miserable person and then, support me, so . . .

THERAPIST: I know last time I saw you, you guys were about to embark on him trying to sleep in the bed for the first night.

CLIENT: (chuckles)

THERAPIST: How did that go?

CLIENT: I mean, it took drugs and a fan and earplugs and everything. And a long time with me fighting to stay calm to fall asleep. But I guess he didn’t sleep well, because he got up in the middle of the night and was so worried that he was going to wake me. And he was so worried that I wasn’t actually sleeping that the next morning—I expected to wake up and him be like, “Oh, my gosh, that was wonderful.” And then, the next night, (inaudible at 00:39:49), “Don’t worry. That was fine. Don’t even worry.” I mean, I guess—I think he doesn’t believe me. We tried one more night and he was just like, “I can’t.”

THERAPIST: He couldn’t relax. [00:40:00] He was too worried about worrying you.

CLIENT: He was too worried.

THERAPIST: (chuckles)

CLIENT: I mean, it really does. It shakes the whole bed. Really loud. I don’t know if I could do it every night. I don’t seem to be able to get used to things. One would think that I’ll –

THERAPIST: Mmm. His pump shakes the bed just running? Or him getting in and out?

CLIENT: Yeah. I mean, I can feel the bed vibrating a little. (chuckles) (sighs) I don’t know. It’s an unresolved problem. And people tell me, “Oh, you’ll get used to it.” I don’t think I will. I think if I had the pump and it wasn’t him, I’d be in big trouble. Just for sleeping. I think I could get used to it. I don’t seem to have that ability. I mean, maybe, because, I mean, when (sighs) we first –

THERAPIST: Well, if it was constant, you’d habituate to it over time.

CLIENT: I hope so. When we first moved to our apartment, it’s on a pretty busy street. And I was having so much trouble sleeping, trying to fall asleep, that if an ambulance went by—and we live kind of near the hospital, in fact. [00:41:02] Or close enough that there’s ambulances that come by (chuckles) that it would cause me to freak out. But now that doesn’t bother me as much anymore. But I also have a fan going (sighs) to black out white noise. But that is not the same as a vibrating, beeping (chuckles) pump.

THERAPIST: Mmm. Pump right in bed with you.

CLIENT: Yeah. I don’t know.

THERAPIST: But part of what helps you to block things out is hearing them all of the time. Feeling them all of the time. So, one night in, one night out. A couple nights in, a couple nights away is—you lose the habituation. Right? Because it goes away. And you’re like, “Ah, back to normal.”

CLIENT: I know.

THERAPIST: So, I mean, if you want to learn to—if you want it to be something that you don’t pay attention to, then it has to be there all of the time. The same way that you don’t pay attention to—you don’t get distracted by the sound of your heart beating.

CLIENT: But I do sometimes.

THERAPIST: (chuckles)

CLIENT: (laughs)

THERAPIST: Oh, but it’s different. [00:42:00] Right? Or when it gets—when it’s racing, you notice it.

CLIENT: Right. Right. Right.

THERAPIST: But when it’s normal, you don’t. Yeah? So, whatever is your normal –

CLIENT: Mm-hmm.

THERAPIST: you can learn to block out. But if he can’t relax because he’s worried about you and doesn’t trust you when you said it was okay, that’s another hurdle, too. Might not be one worth fighting right now.

CLIENT: This morning, actually, though, he was being particularly sweet and—I don’t know. I guess he’s particularly hopeful, after this weekend. I asked if he could try to sleep in the bed again tonight. (chuckles) So, maybe we will try to fight. I don’t know. If I knew it would take a week –

THERAPIST: Right. Then, you could get through the week.

CLIENT: I could plan it. I wish I had some sense of how long it might take me to –

THERAPIST: Yeah. I don’t know what to predict. [00:43:00]

CLIENT: And I can function on the drug, mask, earplug thing enough. But going on long enough, it would definitely hurt, (chuckles) so (sighs) I don’t know.

THERAPIST: Does it help if you stagger? Like, if you fall asleep before he gets into bed? Or if he got into bed before you? Which might be easier.

CLIENT: (chuckles) I don’t know, because then, I would lay there and be like, “All right. I got to fall asleep so that he can go to bed.” (chuckles)

THERAPIST: (laughs) Yeah. That sounds like too much pressure.

CLIENT: It would feel like pressure. Yeah. That means he’s in the room. He’s making a lot of noise. He did tell me he got up in the middle of one of the nights and I definitely did not wake up.

THERAPIST: Mmm. Good for you.

CLIENT: But I was probably in the middle of an Ambien—I don’t know how it works, but I know there are two . . .

THERAPIST: Yeah. [00:44:07] If you were in a really deep sleep. Well, we’ll see how tonight goes. Use all your supports. Use your fan. Use your drugs. Use your mask, your earplugs. And see if you can have some success. If you can, then, he’ll feel a little bit more relaxed, which might make you feel a little bit less pressure to have it work.

CLIENT: (inaudible at 00:44:36) What was good, I guess, is that I didn’t end up kicking him in the middle of the night or . . .

THERAPIST: Mm-hmm. It doesn’t sound like it was a disaster.

CLIENT: (sighs) It wasn’t a disaster.

THERAPIST: Which, maybe for a first couple nights, that’s a huge win.

CLIENT: Yeah. I guess so.

THERAPIST: Well, why don’t we wrap up there for today? I think we’re on for Wednesday next time? Is that right?

CLIENT: Yes.

THERAPIST: (inaudible at 00:44:58) flip-flop (inaudible at 00:44:59).

CLIENT: Yeah. [00:45:00]

THERAPIST: Yeah. So, the 26th, at 3:30. I know we discussed this last time. It hasn’t changed.

CLIENT: If you do ever get the Monday open, I certainly would love it.

THERAPIST: I don’t think I had a cancellation next week. No, I didn’t. If I get a –

CLIENT: Well, in the future –

THERAPIST: Yeah. Did we not schedule beyond that—next Wednesday?

CLIENT: I don’t know.

THERAPIST: I don’t think we did. So, the Monday, the 31st, is open at 12:30.

CLIENT: Okay. Good.

(pause)

THERAPIST: And then, the next week, it would be on the 9th, which is the Wednesday. Yeah. So, we can do the 26th, and then the 31st, you can have the—a 12:30 on the 31st. [00:46:00] And then, it would have to be Wednesday, the 9th. What is that, 3:30 that you do on Wednesday?

CLIENT: Mm-hmm.

THERAPIST: 2:30? You have a choice, actually, on the 9th, of 2:30 or 3:30. Which would you like?

CLIENT: 3:30’s fine.

THERAPIST: Okay. All right. I’ll see you on the 26th. Thank you.

END TRANSCRIPT