TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: How are you?

CLIENT: Cold. (chuckles)

THERAPIST: (inaudible at 00:00:06) Disappointing, isn’t it? (chuckles)

CLIENT: (sighs) (inaudible at 00:00:10) disappointing. I don’t know. I’m tired. (chuckles) I think last time, I was still pretty worked up. I think. And it’s just sort of –

THERAPIST: You’re just coming off your weekend with friends.

CLIENT: Yeah, okay.

THERAPIST: So, restless but also tired.

CLIENT: And I’ve been having some really bad anxiety again. And it sort of slid into just exhaustion, I guess. I still haven’t recovered. (inaudible at 00:00:42) frustrating.

THERAPIST: In how many ways you feeling exhausted?

CLIENT: (sighs) What do you mean?

THERAPIST: Physically? Emotionally? Both? [00:01:00]

CLIENT: Yeah, both, I guess. Running has been feeling like so much work. I’m just a drag.

THERAPIST: Mmm. You were going to say “torture.” (inaudible at 00:01:11)

CLIENT: Well, it’s not torture.

THERAPIST: I heard you stop yourself. But a lot of work.

CLIENT: Yeah. It just doesn’t feel very good. And the thought of going to do things is just really a lot of work. And it might just be I’ve been spending too much time with Josh in the house (inaudible at 00:01:30). I don’t know. But it seems like if I’m not anxious and—I can’t seem to find someplace where it’s just calm.

THERAPIST: So, your only energy is the anxiety energy.

CLIENT: (crosstalk at 00:01:41) Yeah. And I think I’ve talked about this before. I’m not sure how to find motivation and (ph) energy without anxiety. And I still don’t know (inaudible at 00:01:49). (chuckles)

THERAPIST: Yeah, because it sounds like excitement or desire isn’t really there anymore. [00:02:00]

CLIENT: Yeah. And I mean, it seems to be so tied to what time of the month it is, too. Which makes me feel so helpless. (chuckles) I mean, these things seem to happen together, so I don’t know. Sometimes I just feel like I have no control at all. I don’t know if I do or not or (inaudible at 00:02:24). (chuckles)

THERAPIST: I mean, certainly there are hormonal fluctuations that happen over the course of the—your menstrual cycle. And you don’t have control over those. There may be some ways that you can manage your response to them. But I think there really is a difference in how your hormones affect you. What do you notice?

CLIENT: Well, I’ll always be more anxious the week before I get my period. And, then, feel kind of like this. [00:03:00] I mean, it’s varying –

THERAPIST: Really tired.

CLIENT: degrees, I guess. Or maybe I just pay too much attention now. I don’t know. (chuckles)

THERAPIST: So you feel when you actually—you have your period now? Or you (crosstalk at 00:03:13)?

CLIENT: No. This is the week after.

THERAPIST: Week after.

CLIENT: Yeah, yeah. So I guess my hormones are low. When they’re high, I guess I have more energy. But sometimes, that feels more (crosstalk at 00:03:23).

THERAPIST: But it feels like anxiety, rather than –

CLIENT: Well, no. It’s not always. And then, there’s generally a week or two in the middle where things are pretty good. I don’t know. (sighs) Makes it feel even harder to manage, I guess.

THERAPIST: Mmm, yeah. Like you said, it’s that not—it’s not really in your control.

CLIENT: And a lot of the times, I feel like I just work—I work better if I think less about how I’m feeling. Just do things that I know are good for me. And I think I’ve said this before, but lately, I’ve been just been thinking too much.

THERAPIST: Well, so, I think one of the things you said just before that was, “Am I just paying too much attention?” [00:04:02] And I think there is—right, what details make sense to pay attention to and what details aren’t useful to pay attention to? It’s an important skill of filtering out—right? Because we don’t want to pay attention to the static.

CLIENT: [Yes. Right] (ph).

THERAPIST: So, while paying attention to your mood and noticing what your anxiety is or noticing what you’re feeling is useful, there is a degree at which it becomes redundant. You already know there’s a pattern here. And if it’s not a symptom that you can necessarily do something about and it’s not dangerous to you, maybe we shouldn’t notice it.

CLIENT: Yeah. I mean, this past week, I’ve had no schedule of any kind. And that makes it worse because I have to decide –

THERAPIST: Right. That’s not good.

CLIENT: everything I do. And then I think about how I’m feeling and just—it’s not good. I mean, I had no meetings. Nothing getting me anywhere. [00:05:01] In fact, this was the reason (inaudible at 00:05:04) go to the house today. I mean, I made myself go (inaudible at 00:05:07) now, but –

THERAPIST: But knowing that you actually did have to be out probably helps you to do that.

CLIENT: Yeah. I mean, yesterday I decided to work from because no one was there to hang out with Josh. And he’s continuing to have a hard time. And it’s just not helpful. (chuckles) And that was like four days I spent with him, basically. Just us.

THERAPIST: In the house?

CLIENT: Well, we did go out. We went out to the mall, which was huge. On Saturday. But it was pretty exhausting. And we went so that I could buy really expensive noise-canceling (inaudible at 00:05:45) so that we could sleep next to each other. Which sort of worked. I mean, it’s kind of elaborate. The noise-canceling headphones plus a fan app plus a fan and I [could sleep] (ph). (chuckles) Probably plus an Ativan, depending on if I’m really worried (inaudible at 00:06:02). [00:06:02]

So, we left the house. But it was pretty stressful. (chuckles) And it was still just the two of us. (sighs) I don’t know. And I guess I’ve been thinking too much about why I’m feeling this way and trying to (crosstalk at 00:06:22).

THERAPIST: Uh huh. So that’s the other piece, right? So, if you’re noticing that you’re feeling something, it’s like—if sometimes is a really good indicator that you should pay attention to fix something?

CLIENT: Mm-hmm.

THERAPIST: If there’s a cut, you want to know so that you can fix it. But if it’s chronic pain and there isn’t necessarily anything to do. Old injury. Nothing to treat. Then, it doesn’t make any sense to pay attention to that pain signal. And I think for you, sometimes tiredness, sometimes anxiety falls into that chronic pain category, where –

CLIENT: (crosstalk at 00:07:00)

THERAPIST: there isn’t necessarily new information here or something specific you can do to alleviate it. [00:07:07] So, you want to ignore it. Not reinforce it.

CLIENT: Yeah. I was just being really hurt by having Josh be the way he is right now.

THERAPIST: Mm-hmm, right. Because he’s paying attention to all (inaudible at 00:07:21).

CLIENT: It’s really hard to ignore. Yeah.

THERAPIST: Yeah. He’s hard to ignore, but you are, too. Right? So, when your signals are going off, when you feel anxious or when you feel tired, it’s hard to ignore, as well. My sense would be that there’s this culture in your house right now of paying attention to symptoms.

CLIENT: Yeah. Well, and he’s not going to help me. (chuckles) I mean, a little bit, going out of the house is helpful, but—and I think I said this last time. If we go out and most of it is—there’s very little actual distraction, good stuff. And there are constant problems. [00:08:00] Pain. Troubles (ph). So, it’s good, but it’s not so good that it makes me forget about what’s going on.

THERAPIST: It’s a lot of work, too. To take him out.

CLIENT: Yeah. (sighs) It’s a lot of work. (chuckles) But I don’t know. So, I come here to talk about how I’m feeling. But I also shouldn’t think too much about it, which I’m having trouble reconciling.

THERAPIST: You come here to discern which feelings we pay attention to.

CLIENT: Okay.

THERAPIST: And which feelings it’s safe to ignore. Or not say ignore them, but move on with them. Right? Like that tiredness. If running is feeling like—you’re so tired and running is feeling like way more work than it is good? I think that’s important to pay attention to. And that doesn’t mean you don’t exercise, but it does mean you don’t go and push yourself on an incredible run. Maybe you do let your—cut your pace back so that you’re running at a more relaxed pace. [00:09:02] Or run for less time than you normally would. So that you still get the benefit of feeling like you did something that was good for you, but you’re honoring what your body is saying but not worrying about it.

CLIENT: Yeah. That’s really hard, because a lot of the times, I need to just do what I know will probably help and ignore my body. And sometimes, I need to listen. And that’s really hard.

THERAPIST: Right. And it’s hard to discern when—which signals mean what.

CLIENT: And then, I’m trying to discern that for Josh every day. Do I push him? Do I not? Is it a good idea (inaudible at 00:09:36)? Sometimes it’s good. And sometimes it’s bad. Or sometimes it’s both. Or it’s bad but it’s okay.

THERAPIST: Do you have any way of predicting which it is with him?

CLIENT: I don’t know. I don’t think so. I mean, he will sometimes just say no. And have a good reason. [00:10:01]. And (inaudible at 00:10:01). I won’t push, but . . .

THERAPIST: And any way to predict with yourself? Do you have a way of discerning, “What anxiety I should listen to.” “What tiredness I should listen to.” And which ones?

CLIENT: Well, this is why having a schedule, a more concrete schedule is great, because certain things that you have to do, will it be like a gauge? I don’t know if this makes any sense. If I get to a point where I’m doing the things that I have to do no matter what, without thinking about them, and I still feel crappy, then that probably –

THERAPIST: Mmm. Then, that’s something (crosstalk at 00:10:43).

CLIENT: Correct. Yeah, yeah. I seem to be unable to keep up anything. Any kind of a schedule. I feel so (inaudible at 00:10:56), I don’t know. (chuckles)

THERAPIST: What are the things that you were able to do the week before last, on your schedule? [00:11:04]

CLIENT: (sighs) I don’t know. I mean, I guess the fact that a lot of things I usually do are canceled.

THERAPIST: Oh, it was spring break that week.

CLIENT: Last week. Yeah. And people weren’t around. I mean, even just the fact that I went to the gym this morning. I made myself go, even though it was halfway through the morning already and I was—it was a huge struggle. There were people there doing all their (ph) things. Even just that was helpful.

THERAPIST: Mmm. How did your workout feel?

CLIENT: Eh, (inaudible at 00:11:35) slow and . . . I don’t know. I guess it was—I mean, it got me out of the house. It was nice to be somewhere where there are people. (chuckles)

THERAPIST: Doing similar things.

CLIENT: I guess. Yeah. (sighs) I’m not sure what I’m trying to say here, exactly. [00:12:00]

THERAPIST: Well, I had asked what things you were able to do without thinking. And it sounds like there aren’t really many.

CLIENT: Oh. Not many. Right, not many. Yes.

THERAPIST: So, according to your own rubric, then, that’s a thing you pay attention to.

CLIENT: Okay.

THERAPIST: So, does it feel different than—so, last time I talked to you, you had just come out that weekend. Your friends were visiting.

CLIENT: Mm-hmm.

THERAPIST: And one of the things that was making feel—wonder if you were crazy was they were able to lay around on the couch and enjoy relaxing and sleeping in and you were—felt like you were going crazy.

CLIENT: Mm-hmm.

THERAPIST: How’s that? How does that compare to what you’re feeling now?

CLIENT: Oh. The complete opposite. I just want to lay on the couch.

THERAPIST: Now you do. Would it be relaxing?

CLIENT: I think so. Yeah.

THERAPIST: So, how’d you get from one place—from such two different places? [00:13:03]

CLIENT: I have no idea. Hormones?

THERAPIST: Mmm. It could be.

CLIENT: I mean, I’ve always wanted to crash, like when I stay up and don’t sleep for a like a week at a time. (inaudible at 00:13:19) get really upset sometimes, reading romance novels or whatever I like to read, where something crazy happens and then they just crash. I’ve never been able to just do that. I’m wondering if I should be happy that I’m feeling this way, because maybe this is my body deciding it does need to rest, instead of just continuing to be . . .

THERAPIST: Yeah. Well, I think it is, probably, your body’s decision, telling you that you need to rest. Either from coming off of that week where you really felt really restless and keyed-up or maybe it is because of where you are in your cycle. And it’s a natural time for your body to crash. But I think the goal is so that you don’t have to have a week of feeling frenzied and restless and keyed-up and so anxious that you think you’re crazy. [00:14:04] And then, have the crash as relaxation, because I don’t think—crashing is not really relaxing.

CLIENT: No. I’ve been doing this a lot, up and down, up and down. And (inaudible at 00:14:18) normal.

THERAPIST: Yeah. And you think, really, our goal is to have a little bit more stability.

CLIENT: Yeah. I mean, I don’t know what I can hope for with Josh the way he is.

THERAPIST: Mmm. Yeah. What can you hope for you (inaudible at 00:14:30), and then, you’re not really on your own. He’s being in the system that you’re in also has a real impact.

CLIENT: Right. I mean, it would be hard enough to keep myself normal anyway. I know that’s pretty normal for most of my friends. Keeping yourself in a good place is just hard. (crosstalk at 00:15:00)

THERAPIST: Yeah. I think the consistency is hard. [00:15:01]

CLIENT: Mm-hmm.

THERAPIST: Yeah, I think being a graduate student, having a consistent schedule is challenging, because you don’t have a 9:00 to 5:00 thing that you show up on that ends. It’s very chaotic. And you can, right, not come in and work on your own?

CLIENT: Mm-hmm.

THERAPIST: And it makes it hard that there’s not a lot of external structure imposed upon you.

CLIENT: Ugh.

THERAPIST: And the structure is part of what keeps you consistent. Having that schedule.

CLIENT: I mean, even Josh’s mom coming to work at our place while I went to school has been sort of a schedule, in a way, because I know I can’t come home and give up at like 3:00 because (ph) she’ll be there and she—and it will mess up her day. And I’ve been a little bit frustrated, that I feel like –

THERAPIST: You can’t be in your own house.

CLIENT: I can’t come home when I want to. But then, it also keeps from giving up. [00:16:00] But she hasn’t been able to come in like a week. (chuckles) So, even an aggravating little—I mean, it’s been frustrating, but also helpful.

THERAPIST: Mmm. Yeah. The limitations (inaudible at 00:16:15) –

CLIENT: Yeah, yeah.

THERAPIST: it’s aggravating. But actually having that boundary is (ph) good for you.

CLIENT: Right. Right. Right. (crosstalk at 00:16:25)

THERAPIST: When might that be put back in place?

CLIENT: I don’t know. It sounds like something odd is going on. I have to talk to Josh more about it. I think she’s maybe starting to get some pushback from work or something. I’m not sure exactly. He hasn’t been super-talkative in the past few days, so I don’t know. (sighs)

THERAPIST: Are there other things that can put some external limits on you?

CLIENT: I don’t know.

THERAPIST: Or [can you] (ph) create them?

CLIENT: I’ve been thinking about what can I do. I don’t know exactly (ph). [00:17:00] It would probably require asking somebody who had some—ask my advisor or something for meetings. I don’t know.

THERAPIST: Can you get some stuff scheduled? Even if it’s a meeting with a peer.

CLIENT: Yeah. Well, and I usually do a morning (ph) schedule. It’s just a bad week. But it feels really sad that one quiet week, and I totally fall apart. (chuckles)

THERAPIST: It’s a pretty delicate balance right now.

CLIENT: Yeah. I mean, I have a lot of things to do that should be exciting enough (ph) to keep—to make me get out of the house. But I don’t know. It’s just a little extra excitement that could very easily (inaudible at 00:17:44), I guess, by Josh.

THERAPIST: Yeah. Yeah, by feeling pulled in the other direction.

CLIENT: Yeah. I mean, even working at home yesterday, he was constantly needing something. So I could never quite focus. And (inaudible at 00:18:01). [00:18:01] It was just really tiring, I guess.

THERAPIST: Yeah. It seems draining to constantly be pulled in two directions and responsible for such an important thing. I mean, your work is really important. And taking care of him is really important. And somehow, taking care of you needs to fit in there, too.

CLIENT: Yep.

THERAPIST: What does your structure look like the rest of this week?

CLIENT: (chuckles)

THERAPIST: The next couple days?

CLIENT: There’s something that gets me out of the house on both Thursday and Friday, so that’s good.

THERAPIST: That is good.

CLIENT: I don’t know. I mean, I guess I would ask Josh to help me, but I’m not sure he can at the moment. [00:19:00]

THERAPIST: What could you ask him for? What would help? If he could, what would you like him to do?

CLIENT: I don’t know. Tell me to go. (chuckles) (inaudible at 00:19:09)

THERAPIST: And he won’t?

CLIENT: Well, I know he really feels lonely and he wants someone to hang out with him all day. And doesn’t like being alone. I mean, I felt terrible yesterday. I had my noise-canceling headphones on and he was having muscle cramps and then freaking out. And I couldn’t hear him. He texted me. (chuckles) I felt my phone buzz so I could hear him. I mean, I don’t know. I mean, I feel mostly, I have to keep myself separate from him, because he’s got so much need that I can’t always –

THERAPIST: And you can’t fill that. Not and, right? You can’t fill all of that need and take care of yourself and provide for your work. [00:20:02]

CLIENT: Right. I mean, I think I’ve said this before, but it stinks that I need to just keep us separate in some way. Either if it’s just go to school every day or go out with my friends more often or what. Just really stinks, because most of the time that I spend with him is not—it’s just draining (ph).

THERAPIST: Right. You’re caretaking.

CLIENT: (sighs)

THERAPIST: Right now, he’s not in a place where the relationship really gives back to. And that’s, right, I mean part of a long-term relationship is sometimes, there are going to be times like that.

CLIENT: Mm-hmm.

THERAPIST: But I think it’s—the reality right now is that the relationship is not something that you’re getting stuff from. I mean, you love him, so you’re taking care of him. But that’s what it is.

CLIENT: Yeah. I mean, there are little tidbits here and there. But it’s not nearly enough. (sighs) And he’s back to dreaming our wedding again. And at the mall, we were—we went to the (inaudible at 00:20:56) and he’s like, “Let’s look at engagement rings.” (sighs) So, we went and looked at engagement rings. [00:21:01] And I don’t know.

THERAPIST: How did that feel for you?

CLIENT: I had a very strong negative reaction (laughs) to it (ph). The first place we went just a little bit of curiosity. And then, we chatted with some people. And that was it. And then, we went to another place and Josh wanted to talk specific diamonds with this guy. I don’t know. I had to leave.

THERAPIST: What were you (crosstalk at 00:21:25)? You had to leave because you were feeling . . .

CLIENT: I don’t know. Kind of nauseous. (chuckles) Putting it out there to a salesperson just felt so real. And our future’s –

THERAPIST: What was sickening about that?

CLIENT: I don’t know. I’m still trying not to think about it too much, because, I mean, I like our whole dream. I just feel like if we make it real right now, our life is so not-real. Like it’s we’re in some—he’s in pain world. (chuckles) And this can’t be real life. [00:22:01] Or, at least, not forever. This has to be a temporary situation, so (sighs) I don’t know.

THERAPIST: Does planning for your wedding make this seem more—this current life more permanent?

CLIENT: (chuckles) I don’t know. I mean, who knows when he’s going to get a heart transplant. And what that’s going to be like. I don’t know. I still don’t know exactly why I had to leave.

THERAPIST: Is the wedding dream contingent upon after-transplant? Or is that something that would happen before or after?

CLIENT: I mean, at first, it wasn’t, because—in fact, it was a before. And then, I don’t know. When we started actually dreaming about what it would be like, it would be a tragedy for him to be build a (inaudible at 00:22:58) would want to have our wedding. [00:23:00] And so, we decided it would be after. So, yeah, that makes a big difference in (inaudible at 00:23:09) think about it. Or how I do. Because it would be the beginning of something (inaudible at 00:23:15) better. (chuckles) (sighs) I don’t know. Luckily, Josh didn’t seem too upset by my reaction.

THERAPIST: Mmm. How upset were you by your reaction?

CLIENT: I don’t know. I’m still not sure it really means anything. Just a little overwhelming, maybe. I don’t know if that’s all. I forget why I started telling you this. Because you asked me…

THERAPIST: I don’t know what my original question was. (chuckles)

CLIENT: I don’t know. I guess I’m feeling a little hopeless about the whole thing right now.

THERAPIST: The whole thing. [00:24:00] The wedding fantasy? The relationship? Life? What’s the whole (crosstalk at 00:24:04)?

CLIENT: Life. I don’t know. Life.

THERAPIST: Yeah. It sounds like a—any thought that life might be like it is now long-term is pretty terrifying.

CLIENT: I mean, it’s not terrifying. I mean, it just makes me so (ph) tired, I guess. (chuckles) It’s depressing. And I don’t know.

THERAPIST: Yeah. Life is hard right now. You don’t want it to be hard forever. Being able to be hopeful about a better future is pretty important.

CLIENT: I mean, Josh also spends a whole lot of time dreaming about all the things he’s going to do once he gets his transplant. [00:25:00] (sighs) I don’t know. It’s hard to watch, I guess.

THERAPIST: What makes it hard for you to watch that?

CLIENT: I guess I can’t imagine—I think I said this before. I can’t imagine him keeping that up for six months or however –

THERAPIST: Dreaming about the future?

CLIENT: It’s a long time to dream.

THERAPIST: It is. I wonder if that’s what keeps him going, is being able to dream.

CLIENT: Probably. I mean, probably. For sure. He definitely does not react in any of the same ways that I do [to things] (ph). (chuckles)

THERAPIST: Mmm. Yeah. You have very different responses to thinking about the—a better future. I wonder what you response is about. What the nausea or the fear really means for you.

CLIENT: I don’t know. I guess the thought of walking around in an engagement ring, and then having everyone ask about how excited I am would just feel really false. [00:26:07] Because, I mean, even this morning, the people at the gym know Josh, because he used to go there. And he sold them the bikes. And one of them asked—people always ask in a relatively (ph) positive way. “So, is he getting better? Is he doing better? Is he getting stronger?” Which is different than, “How are you (ph) doing?” Which, then, I usually respond with, “He’s holding on,” or—I mean, he’s not doing great (chuckles) so . . .

THERAPIST: Right. Yeah. That feels like there’s a—those questions are hard, because there’s—people want to hear that he’s doing better. It’s clear with those kinds of questions.

CLIENT: Right. I mean, I don’t really want to—I don’t even want to really talk about the whole pain problem, which is probably [just going to be] (ph) problem forever. It doesn’t make sense to either of us. Just a really confusing, ongoing problem. [00:27:00] And it also stinks to tell someone, “Oh, well, he’s in a lot of pain.” (chuckles) I’m sorry.

THERAPIST: Because people don’t know how to respond.

CLIENT: Yeah. So, I guess if you add a ring on top of that and telling everybody about a wedding and planning a wedding, it’s just—I don’t know.

THERAPIST: What you’re experiencing is—you’re imagining that what you’d be experiencing is so different from what people are imagining or wanting you to experience. (inaudible at 00:27:23)

CLIENT: Yeah. I mean, it’s even like when people—when your [graduation’s coming up] (ph) and people are like, “Got a job yet?” or something. (chuckles) It’s the same kind of –

THERAPIST: Expectation.

CLIENT: Yeah.

THERAPIST: You’re not meeting people’s expectations, right?

CLIENT: Well, that’s what people do. I mean, I get asked questions and (inaudible at 00:27:38) kind all the time. I usually just ignore it. Brush it off (crosstalk at 00:27:43). Because I’m not sure I can do that at the moment.

THERAPIST: Yeah. I can see that there’s—imagining that if you were wearing a ring, that there’d be all these assumptions. Right? Pretty typical responses. [00:28:00] Asking about, “Oh, when’s the wedding? Have you set a date?”

CLIENT: Yeah. (sighs)

THERAPIST: “Are you so excited?”

CLIENT: Yeah. (chuckles)

THERAPIST: Those are pretty common responses to seeing somebody with a new engagement ring. And that would be a lot of assumption to (inaudible at 00:28:13) up to, because your own—what your experience of it might be very different than the typical engagement and wedding planning process.

CLIENT: Yeah. I mean, I guess it all feels so meaningless, too. I mean, this ring that’s supposed to be happy, but—we’re pretty committed. Putting a ring on top of it just feels faker or more false, for some reason, in a way. (chuckles)

THERAPIST: What feels false about it? (inaudible at 00:28:51)

CLIENT: I don’t know. It’s just such a—I don’t know. [00:29:00]

THERAPIST: Because it wouldn’t feel like a change to you in what your level of commitment is?

CLIENT: (inaudible at 00:29:08)

THERAPIST: You don’t know.

CLIENT: I don’t know. (chuckles) (inaudible at 00:29:13)

THERAPIST: Mmm. Sometimes it’s hard to put words to what you’re feeling.

CLIENT: Yep.

THERAPIST: Are there other places you feel false or is it only in regard to your relationship with Josh?

CLIENT: I didn’t know, I guess, because when people asked me, I’ve stopped saying anything. I’ll say whatever it is that’s happening. Which is nice. I mean, I still feel uncomfortable doing it. I don’t know. Last night, my brother and his friend came over to talk to Josh about medicinal marijuana. (chuckles) We just keep asking the doctors about it, because they keep trying to take him off drugs. They’re addictive. [00:30:01] Anyway, my brother just said he would come over because his friend has panic attacks, I guess. And has a medicinal marijuana card or whatever for it.

But anyway, so, I was talking. And I barely know my brother’s roommate. I mean, I know him a little bit. And we started talking about not Josh (chuckles) but about his major—I guess he (inaudible at 00:30:23) depression and anxiety and panic attacks. I know it sounds horrible, but I started just pouring out all this stuff to him. I don’t know. He seemed okay with, but it was –

THERAPIST: Mmm. How were (ph) you with it?

CLIENT: A little embarrassed. (chuckles) I mean, he seemed—yeah, he seemed fine. I mean, maybe he was—he left, and he was like, “Whoa.” Definitely felt a little inappropriate. It was really nice, though.

THERAPIST: Mmm. Ah. So, it felt nice to be able to be really honest and be open and not hold back. [00:30:23]

CLIENT: Yeah, (inaudible at 00:30:23) my brother—well, my brother finally, I don’t feel bad about just spilling out my guts to him. But his poor friend. I mean—I don’t know. (chuckles)

THERAPIST: Well, I think it speaks to how overwhelmed you feel. And the needs you have that aren’t being met. Right? Because when there was an opportunity to connect with someone and to unburden yourself a bit, it came really easily to do that. And there’s nothing wrong with that. But I do think that it’s telling that you did it with someone that you wouldn’t have chosen for it to be your brother’s roommate, who you don’t know really well. So, that’s a sign to pay attention to, right? That when you had an opportunity to relieve yourself in that way, you took it. And it’s because there’s not enough opportunity to do it in a place that you would feel even safer. [00:30:23] Or with a person with whom you felt really safe.

CLIENT: Mm-hmm. Yeah. I mean, I was actually dying to tell one of my friends at school today about the whole engagement ring thing. But that requires, I feel, a different—I don’t want to do that in my office (inaudible at 00:30:23).

THERAPIST: Yeah, so there’s (inaudible at 00:30:23).

CLIENT: (inaudible at 00:30:23) about that, yeah.

THERAPIST: It’s stuff you’re hanging onto that doesn’t (inaudible at 00:30:23) to go.

CLIENT: Mm-hmm.

THERAPIST: And I think because you don’t feel like Josh can help you with a lot of the stuff that you normally talk to him about, there’s more stuff built up that you’re hanging onto that doesn’t really have a place to go.

CLIENT: Right. And right now, it’s making very tired, as opposed to anxious. And I don’t know why that happens. But –

THERAPIST: I wonder if it’s just where the limit is. Right? Over a certain amount, it feels overwhelming and draining. And maybe before you hit that limit, it feels anxiety-producing in a more energizing way. [00:33:00] It could be about how much stuff, how long you’ve held onto it. Or it could be about—in a certain part of your cycle. The overwhelming feels energizing. And in another part of your cycle, it hits you differently. I don’t know which side it comes from.

CLIENT: Well, yeah. No, I guess it’s the heart transplant was so big that it wasn’t anxiety-producing anymore. It just shifted everything.

THERAPIST: Mmm. You get resigned to it.

CLIENT: Yeah. But, in a way, there are some good things about that. Too many little things are—what am I trying to say? I feel like I’ve said this before, but in a more positive way. It’s like having a problem that’s so big, you have to completely change everything. It can be (ph) better than having little problems that just cause some (ph) anxiety that’s not helping.

THERAPIST: Mm-hmm. (crosstalk at 00:33:55) spin your wheels.

CLIENT: Yeah.

THERAPIST: In an anxious way.

CLIENT: (crosstalk at 00:33:58)

THERAPIST: But when you move into crisis mode, it’s like you mobilize to cope with the crisis. [00:34:04] But when the crisis isn’t so overwhelming that you’re just in the moment, dealing with it, you get in your head. Which feels really uncomfortable for you, right? (inaudible at 00:34:15) in your head, worried about stuff feels worse for you than mobilized to deal in the moment.

CLIENT: Right. But if I’m not in my head worrying or mobilized, I’m just anxious.

THERAPIST: (inaudible at 00:34:28) often.

CLIENT: Yeah. I just don’t know what other path. There’s no other path I have.

THERAPIST: Yeah. So, it feels like those are your two modes. You can manage crisis, which you’re pretty good at.

CLIENT: Uh huh.

THERAPIST: Or you can be really anxious. And you don’t have something else.

CLIENT: Mm-hmm.

THERAPIST: You used to. What did your mode—what did your other mode used to be?

CLIENT: I don’t know. Autopilot, I guess. (chuckles) Just do (inaudible at 00:34:57) what’s the next step and just do it because it needs doing. [00:35:01] I don’t know.

THERAPIST: When you were on autopilot, what were you driving toward? Do you remember?

CLIENT: I don’t know.

THERAPIST: What was the point of it all?

CLIENT: I mean, I guess it would be succeeding at work. Or applying to grad school. Or some goal that I had to do certain things to get to.

THERAPIST: Do you feel like you still have goals? Is succeeding at work still a goal or is that –

CLIENT: Well, I mean, sometimes, I really could care less. (chuckles) I mean, it is, for sure, because I don’t want my life to completely fall apart. (crosstalk at 00:35:45)

THERAPIST: But that feels a little bit different—preventing your life from feeling—from falling completely apart sounds different than succeeding at work.

CLIENT: I guess I’ve spent a little too much time thinking about what I would do if I just dropped out. Or asked for a leave of absence (crosstalk at 00:35:56). (chuckles) Contemplating the end too much. [00:36:01] I don’t know. I mean, this is also another reason to have a schedule. Part of the goal, I guess.

THERAPIST: Is to give yourself some autopilot again.

CLIENT: Mm-hmm.

THERAPIST: Right? Because that mode feels better than crisis management or worrying.

CLIENT: Or giving up I guess is the current mode.

THERAPIST: Mmm. So, what would a reasonable goal for you be? What would be something to work toward, rather than—because it sounds like so much of life right now is about not failing. What would be something reasonable that you could work toward, rather than prevent?

CLIENT: (chuckles) I mean, every time I’ve said I’m going to implement a schedule, it hasn’t really worked out.

THERAPIST: Yeah. So, we need to not say that.

CLIENT: Right. But I don’t know what else to do. (inaudible at 00:36:56) going to go to school 9:00 every day. But inevitably, it just doesn’t –

THERAPIST: Yeah, that’s a little bit too –

CLIENT: work out. [00:37:02] (chuckles)

THERAPIST: So, I think something like that, the schedules that you’ve attempted to set up in the past are too stringent. Right? And then, if you said something like, “I’m going to go to the office every day,” you miss it once, and now your schedule has failed. So, what if we set something that was more doable? Like I’m going to get out of the house five times this week? Give yourself some structure, but a more flexible structure.

CLIENT: Yeah. And it makes me feel so bad about myself that I want someone to make me do things. It feels really sad. (chuckles) (inaudible at 00:37:43)

THERAPIST: You want to be internally motivated.

CLIENT: Right.

THERAPIST: If it works, it might get there. This might be a step toward that. My hope would be that if you can have someone to be accountable to and you can get out of the house and you can start interacting and having a little bit more consistency, it will feel good. [00:38:08]

CLIENT: Mm-hmm.

THERAPIST: And then, that feeling good will be the more internal motivation.

CLIENT: Mm-hmm.

THERAPIST: But we have to start somewhere. Or restart somewhere.

CLIENT: (chuckles) Yeah. Yeah. I don’t know. I mean, scheduling meetings with my advisor, it could be a good idea, except that he’s not consistently available, so –

THERAPIST: Right. So, he can’t be the only reason.

CLIENT: (crosstalk at 00:38:36).

THERAPIST: He can’t be the only person.

CLIENT: In fact, I had tried to schedule something with him on Monday. Which would’ve been good if it had happened. But he was out of town. I don’t know. I’ve thought about asking a friend or two at school, but none of the people I work directly near have any kind of a schedule, either, so (chuckles) . . .

THERAPIST: But could they have—so, they might not have a consistent schedule, but could you set up something like on Wednesday, let’s get together at such-and-such a time? [00:39:09]

CLIENT: Oh. Mm-hmm.

THERAPIST: And so have that be a one-day. And then, me be another day. And advisor maybe one day.

CLIENT: Yeah, that could be helpful (ph).

THERAPIST: And maybe that’s enough. What would be reasonable? Getting out three days a week? Getting out four? Getting out two?

CLIENT: (laughs)

THERAPIST: What’s reasonable? Because every day is not reasonable right now, I don’t think.

CLIENT: I don’t know. I mean, one day not leaving the house is almost already too much.

THERAPIST: (crosstalk at 00:39:46)

CLIENT: Maybe just one day a week where I don’t make it out is okay, but –

THERAPIST: Okay. But any more than that feels horrible.

CLIENT: Yeah. I used to kind of dread the weekends, because Pat would be there the whole weekend. [00:40:00] But I still kind of dread them, because there’s nowhere to be. (chuckles)

THERAPIST: Okay. So, then, it sounds like getting out six days a week, even if the getting out—it doesn’t necessarily all need to be work-related, but it needs to be getting out. Because it sounds like staying home is not good for you.

CLIENT: No. That’s the problem. (chuckles)

THERAPIST: Does getting out to do grocery shopping on your own, does that suffice for helping you to feel like part of the world and productive?

CLIENT: Yeah. Yeah. Josh, even one of the days when I was going to go grocery shopping, and then, he’s discovered an app where they’ll do grocery shopping for you. And all he does, basically, is cook, play his Xbox, and occasionally do a little bit of work. So, I don’t want to take his—he’s so excited to have control over groceries, because of this app. (chuckles) Anyway. [00:41:00]

THERAPIST: So, you don’t want to take that away. But another errand you could have. Because I think getting up—just scheduling it to be work six days a week I’m a little leery of.

CLIENT: (laughs) Yeah. I mean, I have to say, the dogs have been helpful to have (crosstalk at 00:41:17).

THERAPIST: Ah. They’re back home permanently?

CLIENT: Yeah. Because they always need to go out. And that’s always a reason to go outside, like you said.

THERAPIST: And take a walk.

CLIENT: It doesn’t always end up being very (inaudible at 00:41:28). (chuckles) Ugh. And also, I think that maybe right after I last saw you or towards the end of feeling really anxious and keyed-up, I also started to feel really angry. The same kind of—if I saw some—I would get into a fight in a parking lot or something.

(sighs) And then even just taking the dogs for a run, because it was so much work, made me so angry. So, it’s part of my wondering if my hormones are just uncontrollable. And I’m just not meant to function at all. [00:42:04]

THERAPIST: I don’t think many people are meant to function under these circumstances for very long. Or function without feeling badly. You’re functioning. There are some consequences to it. You don’t feel well a lot of the time. How’s the keyboard process going? You were in the process of seeing if that was something you could from (ph) mom.

CLIENT: Yeah, so, I can’t get one from her. But I have decided to sell a bunch of stuff to make space for it. So, I put some up on Craig’s List, which is really a disheartening thing to do because Craig’s List is really (chuckles) frustrating. Because I’m really excited to get rid of some stuff. Sell some things. Replace it with a keyboard.

THERAPIST: Because that might be a way of feeling—for times when you’re at home, I wonder if using that would be something that would help you feel productive. Give you an outlet for some of these feelings.

CLIENT: Yeah. (sighs) I mean, I think I was telling you a little bit my reckless spending. And then, Josh is also—we keep both trying to buy things that we think will help, like these noise-cancelling headphones. And he’s been buying all sorts of exercise contraptions to try to do a little bit of exercise at home.

THERAPIST: Yeah. Looking for something to fix some of what’s going on.

CLIENT: Yeah. And if I didn’t buy the really expensive headphones on Saturday, I might’ve just bought a keyboard, but that ended up coming first. Actually, that’s when I decided to sell some stuff. (crosstalk at 00:43:37) stop, just (sighs) I mean, this has always been something that—Josh would be any supplement he thought would help, really. (inaudible at 00:43:49) just to feel more harmful than helpful. I still think the keyboard’s really helpful (inaudible at 00:43:57). (chuckles) [00:44:00]

THERAPIST: You’re explaining why your process of selling to buy. Yeah. That’s going to make you feel like you’re doing something responsible. And that’s okay. I do think that the desire to want to buy something that’s going to fix is so understandable. Especially when you both feel so out-of-control and helpless to be able to control what’s going on with him.

CLIENT: Mm-hmm.

THERAPIST: And any behavior, doing things is going to be more helpful for you than stuff. Stuff isn’t going to fix it.

CLIENT: Mm-hmm.

THERAPIST: Playing music is a good coping technique.

CLIENT: (chuckles)

THERAPIST: You need something to play on. (chuckles)

CLIENT: Yes.

THERAPIST: So, figuring out a way to do that makes sense. But I think it’s not the buying that’s going to make you feel good. It’s having something as another outlet that’s going to, I think, be a positive impact on how you manage being limited. [00:45:03] It’s harder to go out and have a consistent schedule by having a lot of emotions that you can’t talk about him—you can’t talk about with him right now. Music can be a healthy outlet for that.

CLIENT: Yeah.

THERAPIST: And (inaudible at 00:45:24) the other thing we talked about was getting your Silly Putty or your Play-Doh out. It’s a way to . . .

CLIENT: Yeah. I mean, I guess not too long after I last talked to you, I needed a whole different set of coping mechanisms, because the anxiety went away and was replaced –

THERAPIST: (crosstalk at 00:45:39) tired –

CLIENT: more like this (ph).

THERAPIST: You might not need something to relieve your (inaudible at 00:45:46). Because I think it comes from the same place. My guess is, is that the feeling tired is hiding from being overwhelmed. And the anxiety is –

CLIENT: Mm-hmm.

THERAPIST: is just maybe a different way of experiencing it. [00:46:00] Because I think it is feeling overwhelmed with your responsibilities and somewhat helpless in being able to meet all of the different things that you’re being called to meet. Even though it feels really different, I’m not sure that the coping with it is necessarily that different. When you feel exhausted, it still might—I wonder what would happen if you took out the Silly Putty and played with it and broke it and smooshed it and formed it into things. How that would change what you’re feeling. It’s certainly not going to be harmful.

I think trying it out and seeing how it impacts your feelings, where it takes you to. The idea is just to move to a different place.

CLIENT: Mm-hmm.

THERAPIST: When you’re feeling really anxious, you want to move to a place where you feel calmer. When you’re feeling exhausted and drained, you want to move to a place where you feel more calm, right? Calm is different than exhausted. [00:47:00]

CLIENT: Yeah. (chuckles) Well, that is something else that I can be or—I don’t know about why that made me think of exercising. Or even I guess yoga can make me feel calm but not exhausted.

THERAPIST: Yeah. (inaudible at 00:47:18) I think the goal is always to find a way to help yourself manage whatever you’re feeling.

CLIENT: Mm-hmm.

THERAPIST: The goal is always for you to feel calm, grounded, good.

CLIENT: Mm-hmm.

THERAPIST: The same techniques might get you there, regardless of where you’re starting from. Let’s play with them. Wherever you are. (chuckles) And see how it helps you to move.

Anything else that we should’ve caught up on today that we didn’t? I think we had scheduled. So, next week, we’re on Monday.

CLIENT: Mm-hmm.

THERAPIST: And then, the following week, back to Wednesday. [00:48:00]

CLIENT: Yes.

THERAPIST: The 1st and the 9th. 31st and 9th, must be.

CLIENT: And then, the week after that –

THERAPIST: (inaudible at 00:48:08)

CLIENT: I will not be around anyway.

THERAPIST: Okay. I’m not either, actually.

CLIENT: Oh. Okay.

THERAPIST: I don’t know (inaudible at 00:48:13) schedule (inaudible at 00:48:15) back. All right. So, you’re not around—oh, I had you as a question mark for Monday, the 14th, but you’re not around that day. So, normally, we would reconvene on Wednesday, the 23rd, but I’m still out of the office that week.

CLIENT: Okay.

THERAPIST: So, can we do—oh, boy. I have you in my schedule with a question mark, which means I held a space and didn’t talk to you about it.

CLIENT: Okay.

THERAPIST: For Wednesday, the 30th, at 3:30.

CLIENT: Okay.

THERAPIST: But I would like to see you before then, because that’s a really long time.

CLIENT: Okay. [00:49:00]

THERAPIST: How would you feel about an 8:15 on Friday, the 25th? Is that way too early?

CLIENT: I mean, that could be helpful.

THERAPIST: 3:30 on the 25th?

CLIENT: What day of the week is it?

THERAPIST: That’s a Friday. It’s the first day I’m back in the office after being away.

CLIENT: I would think that you’d rather the (ph) 3:30 than –

THERAPIST: Either one. I’m probably going to end up seeing a client in both spots. Would you prefer the 3:30 over the 8:15?

CLIENT: Yes.

THERAPIST: Okay.

CLIENT: And I’m sorry, that was the 25th?

THERAPIST: So, that’s the 25th at, yeah, 3:30. And then, we’ll meet again Wednesday, the 30th, at 3:30, which would be your normal Wednesday.

CLIENT: Do you have Friday and then a Wednesday?

THERAPIST: Yeah. That’s okay, isn’t it? It’s the same as Wednesday to Monday. If you want to do the Friday, we don’t—we certainly don’t have to if that feels too close to you. It’s just a really long time—it seems like a really long time to me between the 9th and the 30th. [00:50:00] Three weeks.

CLIENT: It is a long time. I don’t know. (chuckles) Sure, we can just put—keep in the schedule.

THERAPIST: Okay.

CLIENT: So, I borrowed a check from my (inaudible at 00:50:16), so it has her name on it.

THERAPIST: Okay.

CLIENT: Because I misplaced my purse.

THERAPIST: (chuckles) Thank you.

CLIENT: Because I’m so tired. So, I don’t think my name is on there anywhere. (crosstalk at 00:50:26)

THERAPIST: I will remember that you paid me, though.

CLIENT: Okay.

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