TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: So, where are you?

CLIENT: Feeling a little crazy today, because I woke up late, which is so great.

THERAPIST: (laughs)

CLIENT: [I’m feeling] (ph) very happy today.

THERAPIST: Crazy and happy, huh?

CLIENT: Pretty much since I saw you, I’ve just still been really tired. Feeling just dragging.

THERAPIST: So, it was nice to be able to sleep today.

CLIENT: Well, so, I didn’t get to sleep until late, because I was working on something. And then, the dogs needed something. And I don’t know. I didn’t get to sleep until really late. And then, the dogs woke me up at—or Josh woke me up, because the dogs were freaking out at 4:00 a.m. (chuckles) I still don’t know why. They seemed fine. So, I take them out at 4:00 a.m. And I was just furious (chuckles) for no—I was just so mad to have been woken up and—I was just—I couldn’t go back to sleep. [00:01:00] And I just felt exhausted, but I was just so mad. (chuckles)

And Josh felt really bad, but—so, I took an Ativan. Because it seemed like a good use of it. And then, I slept until—for another few hours and felt really happy about that. Because otherwise, I would feel really miserable today and upset –

THERAPIST: Yeah. Well, it sounds like –

CLIENT: furious.

THERAPIST: it was actually a really horrible night of sleep.

CLIENT: Yeah. And it wasn’t that I couldn’t sleep because I was really anxious. I just (crosstalk at 00:01:31).

THERAPIST: Mmm. No, things started getting in the way. Work, and then, being angry. Right? I mean, when you’re feeling—when your blood is boiling because you’ve been awoken –

CLIENT: I had taken my dogs out like three times before I went to bed. I was just really mad at them. (chuckles)

So, I’m happy that it worked out. And I don’t know. I mean, even just the weather this past weekend has been really (crosstalk at 00:01:54).

THERAPIST: Mmm. Just really dismal for –

CLIENT: one thing too much. (chuckles) And I spent all of yesterday getting Josh sorted out with pain medication and a new doctor. [00:02:03]

THERAPIST: Yeah. I know you said you had a new appointment yesterday.

CLIENT: Right. Which turned out to be wonderful. The doctor assessed the situation exactly how Josh was feeling. Asked him how he was feeling. Who’s also a cyclist. Just a good personality for him, too, so . . .

THERAPIST: What specialty is this guy?

CLIENT: He’s just a primary care.

THERAPIST: Okay.

CLIENT: So, we needed a primary care –

THERAPIST: (crosstalk at 00:02:29) but you—that’s—I mean, you really need someone to be the point person. (chuckles) I mean, the primary care can be the someone who organizes all the other doctors.

CLIENT: Right. Well, it made it worse, because we had gotten—we—he had had one who was not wanting to deal with the pain problem. Not wanting to prescribe the narcotics. Not wanting to talk to him about it. Not responding to his calls. Just basically treating him like can addict and –

THERAPIST: That’s so unfortunate. [00:03:00]

CLIENT: Yeah. And, I mean, a—it was just—there was just no communication that was—it was making everyone upset. (chuckles) And Josh was trying to have the psychiatrist at Portsmouth, who was in charge of—I don’t even know what he was in charge of. The one who started with the pain drug but wasn’t supposed to continue them. I guess at Portsmouth, I guess they’re not supposed to prescribe, because I guess Providence has a huge drug problem. I don’t know. (chuckles) It’s just a mess.

So, (sighs) he has to go through a primary care. And then, he also needs a primary care. But we couldn’t have this primary care. So, we got another one. At least, we figure, we just go to the Portsmouth because they would at least have records. I mean, even just getting records back and forth to this doctor? No one was responding to phone calls. It was just a mess.

So, just by luck, we ended up with someone at least could talk to Josh. I mean, he talked to him like a person. [00:04:01] Talked to me like a person. (chuckles)

And gave him a pain plan that seems like a—is not something that they’re just throwing at him to get him out because they think he’s a junkie. So, that’s good. But then, I mean, even just getting these drugs is so hard. Had to get a piece of paper. Bring it to a CVS.

THERAPIST: (sighs) You need a written script.

CLIENT: Right. But then, what the doctor had put it in wrong. So, then, I had to go back, all the way back to Cheshire. Get another piece of paper. Got to the CVS. The CVS only had two (crosstalk at 00:04:40) –

THERAPIST: (inaudible at 00:04:40) wait 24 hours. Right?

CLIENT: I’ve never had to do that.

THERAPIST: They don’t (inaudible at 00:04:44). They don’t always have some stuff available.

CLIENT: Well, these are patches. They’re (inaudible at 00:04:51) patches, so, it’s like a morphine patch. And they didn’t have them in the CVS. And if they could order them. And they’re like, “We don’t usually do that.” I’m like, “Okay.” So, I have to go to another CVS. [00:05:00] And then, the insurance wouldn’t cover it. So, then, we’re still trying to get these patches.

This whole story, I guess, leads up to why I was feeling really frustrated. (laughs)

THERAPIST: (chuckles)

CLIENT: And I was just so tired.

THERAPIST: (inaudible at 00:05:12) rightly so.

CLIENT: So, I guess, last time, you had said that you think that my super-exhaustion is just anxiety in another form, which has been really helpful to think about, because, I mean, yesterday, I would’ve thought I would’ve been so worked-up that I would want to just go running or something. But instead, I just—all I wanted to do was just take a hot shower and put on pajamas. (chuckles) And I was trying not to feel bad about that, because it was kind of a confusing thing, but—and I basically spent the entire weekend tired and on the couch in my pajamas, as a result of other exhausting things. (chuckles)

THERAPIST: I mean, it sounds like yesterday was a really frustrating day. And to want to be done with the day and be with pajamas and take a hot shower and let go of the—let go of all that frustration, it seems normal. [00:06:12]

CLIENT: It was just not the way I usually feel.

THERAPIST: Yeah. It was surprising to you.

CLIENT: It was surprising. And I felt like (crosstalk at 00:06:17).

THERAPIST: Because normally, that stuff, you feel like would work—get you worked-up and angry and angsty.

CLIENT: Yeah. Even just having to drive back and forth across Providence (inaudible at 00:06:26) would usually get me furious. And instead, I mean, I just did it [to get] (ph) it done. It didn’t make me worked-up, (chuckles) which is good (ph).

THERAPIST: You were in crisis-solving mode, which you often feel more calm in the midst. Not necessarily crisis, because none of that stuff was a crisis, but it was like it needed to be faced and addressed right then.

CLIENT: No, I mean, this is definitely different than I usually would feel, so . . . it was good, but, I guess, if it’s also the anxiety, then, that I’m just exhausted, then, that’s not good. [00:07:02] I don’t know if it’s good or not, I guess. (chuckles)

THERAPIST: Mmm. Well, it’s how you felt. And it seems like it makes sense in that moment. Right? After having a day where you solved a lot of problems and ran back and forth a lot, to me, I mean, take anxiety out of it. It sounds like you were tired at the end of the day and wanted to relax.

CLIENT: (laughs)

THERAPIST: That doesn’t sound crazy. (chuckles)

CLIENT: Right. I mean, I did—I really did try not to think too much about it. I was feeling really frustrated the end of last week. I had one hour, I didn’t sleep very—really well. I’m not sure why. And Josh was having tons of trouble with his pain. And (sighs) doctors were driving everyone crazy. Oh, he also called my dad to ask if my dad any oxycodone left from his surgery. [00:08:00] And my parents are convinced that he is an addict. (chuckles) And they called me. And I was like, “I don’t know. I think he was in a lot of pain and just desperate.”

My brother’s friend does medical marijuana. I was trying to figure out how to get him a medical marijuana card. I mean, it was just all—it was “Twilight Zone.” Like, “Why can’t we get this fixed?”

So, on Friday night, my friend was having a party. And I didn’t ever intend to go. But I went out to dinner with a speaker who had come to Yale. And had a glass of wine, which basically just (chuckles)—and then I just was like, “Screw it. I’m just going to go crazy.”

THERAPIST: Having the glass of wine basically just—what was the end of that sentence?

CLIENT: I don’t know. Made me go from feeling, “I just want to give up and hide in the corner,” to, “I’m just going to do whatever I want,” which is go to that party, because that’s what everyone else is doing that I know. [00:09:03] And that’s what the normal thing to do is.

THERAPIST: Mmm. And you want to be normal.

CLIENT: Yeah. (chuckles) Yeah. And then, I went to this party (sighs) and just danced like a crazy person for like three hours, which was great.

THERAPIST: Why was it like a crazy person?

CLIENT: I don’t know. I just didn’t even care who was at the party or what was happening. I just wanted to do dance. Dragged a couple of my friends to dance. I haven’t done that in a really long time.

THERAPIST: It sounds like you were dancing like a young woman.

CLIENT: Right. I haven’t done that in a long time.

THERAPIST: That’s different than crazy. Just want (crosstalk at 00:09:40).

CLIENT: Well, and I really could care—who knows (chuckles) what—it’s (inaudible at 00:09:43) my department what they (inaudible at 00:09:46) (laughs) will say to me when I next see them. I mean, he was—it was –

THERAPIST: Out of character for you.

CLIENT: Yeah. It was. But it was really, really fun. I was exhausted. I knew I should’ve gone home to make sure Josh was okay. I called him a couple hours before. [00:10:01] I never intended to stay out all night dancing.

THERAPIST: Mmm. (crosstalk at 00:10:07)

CLIENT: Drunk enough that I didn’t care.

THERAPIST: Mmm. You were letting go.

CLIENT: Yes. And then, of course –

THERAPIST: And not being responsible for a little while.

CLIENT: Right. (inaudible at 00:10:18) and I keep doing this. (chuckles) This is not the first time this has happened. And then, I of course had paid for it a lot the entire rest of the weekend, which also didn’t help my exhaustion. It was like a—any energy, pent-up frustration I have was all let out in those two hours. And then, I went back to being exhausted.

THERAPIST: And then you were really exhausted. So, I guess, what we want to separate is –

CLIENT: (sighs)

THERAPIST: what feels like exhaustion that feels appropriate to the moment and hiding, withdrawing-type exhaustion that maybe is avoidance of anxiety, rather than truly just being tired and wanting to rest. I think that’s what we need to figure out a way to distinguish between, so that you know whether it’s, “Yeah, I’m tired after a long, frustrating day,” or, “I’m tired after not sleeping well at night,” versus, “I’m anxious and I’m channeling into, ‘I’m hiding from the world in my pajamas.’” [00:11:17] Right? It’s not always bad to want to hang out in your pajamas. But sometimes, it’s a signal that you’re actually avoiding stuff, rather than just responding to your normal physiological cues of being tired. We want to know when it’s one thing and when it’s the other. And it sounds like you have both.

CLIENT: Yeah. I guess it’s good that hiding used to be more like what I did most of the time. Or all the time. And now, I still kind of want to, but sometimes I fight it and go completely the opposite direction. (chuckles)

THERAPIST: Mmm. How in control do you feel of what you’re—how you’re responding to situations? [00:12:02]

CLIENT: Well, in general, I feel like I have to control my life so much to feel good that I—I don’t know. I just try to not—I don’t—I just chose to not control it or I don’t know. Maybe that is controlling. I don’t know.

THERAPIST: Mmm. Yeah. [In a sense] (ph) you feel like so much of your life has to be tightly controlled in order to be okay. And then, sometimes, you just do the opposite. Have to do the opposite.

CLIENT: Right.

THERAPIST: And not care at all.

CLIENT: Which is not something I used to do. (chuckles) And I think I said this last time I did this, I—there was huge consequences. I don’t sleep at all, generally, because I feel awful. I feel terrible for at least a day or two after. And it’s not even because I had too much to drink. It’s really just because I couldn’t sleep, because I was just—I don’t know. (sighs) (crosstalk at 00:12:59)

THERAPIST: When you get home from a night when you were dancing, what makes it hard to sleep? [00:13:05]

CLIENT: I don’t know. I guess I was so still worked-up and overly excited. Sometimes, I feel like a five-year-old that’s overstimulated. (chuckles) Or my dog when he’s up in the middle of the night for no reason and he looks at me at me, he’s like, “Oh, is it playtime?”

THERAPIST: Mm-hmm. Yeah, you’re so disoriented.

CLIENT: Yeah. And then, I’ll wake up every like two hours. (chuckles)

THERAPIST: Hmm. Well, did you take an Ativan that night, or no, because you had been drinking?

CLIENT: (inaudible at 00:13:32) That would’ve been great. If I could have, it would’ve really, really helped, I’m sure.

THERAPIST: Well, I wonder what would’ve happened if you had—you said you were waking up every two hours. What if you had taken one on one of those wake-ups when it would’ve been long enough after you had had that last drink?

CLIENT: Mm-hmm.

THERAPIST: Right? It’s an hour per drink to get out of your system.

CLIENT: Yeah. Yeah.

THERAPIST: So, I wonder if that would’ve helped to reset your clock. That might be a question for Joan.

CLIENT: (crosstalk at 00:13:58) (chuckles) [00:14:00] I don’t know what she’ll say to that. (laughs)

THERAPIST: (chuckles) Well, on nights when—I mean, I think—not that it’s the plan to figure out how much you can drink and how long and then how quickly you can take medicine after. But regulating your sleep is really important. And there’s so much of this stress of your life that’s out of—is out of your control. You can’t predict what’s going to happen with Josh. And if there’s going to be some sort of crisis. You can’t predict if your dogs are going to wake you up at 4:00 a.m. But being able to control—having as regular of a sleep pattern as possible without having to give up your socialization and your life completely. I mean, there’s a lot that you have had to give up. So, being able to go out and dance isn’t really hurting anybody, except if it then interferes with an entire weekend (inaudible at 00:14:58).

CLIENT: Yeah. (chuckles)

THERAPIST: So, if there’s a—if it—if there’s a safe way for you to be able to recoup some of the sleep loss faster . . . [00:15:05]

CLIENT: Yeah. (sighs)

THERAPIST: You’re not a junkie.

CLIENT: No, I know. She’s just always asking me about eating healthy and things, so . . . (chuckles)

THERAPIST: (chuckles) Are you?

CLIENT: Mm-hmm, yeah. I don’t know. In a way, the not being able to sleep, I mean, I was pretty angry on Saturday. And frustrated. And Josh was really excited to go to where he works. Or used to work. Or still kind of works. He hasn’t been there since he left. He hasn’t been there since he went to the hospital. And it was a big—it was super-sale at the shop. And so, he asked me if I would take him. And he wanted to get there like first thing in the morning. So, he basically dragged me out of the house. And I had to pull myself together. And then, we stayed at the bike shop. I (inaudible at 00:15:58) sit at the shop for like three hours while he talked to everyone who was there. And he’s trying to take back some of his work (crosstalk at 00:16:08).

Anyway. So, I just (crosstalk at 00:16:12) –

THERAPIST: Sort of connect with what feels like life to him—regular life to him.

CLIENT: Yeah. And then, so, we did all that. And then, he begged me to take him to the mall again, because he was still feeling good. I was like, “I can’t.” I don’t know. He’s feeling good. If I’m feeling like death, I don’t know. I didn’t want to make him go back home. (chuckles) So, I took him to the mall, where I just got more and more angry and frustrated. And anyway, all this leads up to us –

THERAPIST: Angry at—does it feel like it’s directed anywhere?

CLIENT: No. He can tell. He was—kept asking me if I was mad at him. And I was trying just to be quiet, so I didn’t just (chuckles) start screaming for no reason. So, no, it was just anger that I was—I had basically ruined what could’ve been a lovely day. [00:17:02] But I was also really happy about having danced all night.

THERAPIST: Mm-hmm. Yeah. So, (crosstalk at 00:17:10) –

CLIENT: (inaudible at 00:17:10) it could ruin my day, which would’ve been a lovely day. (chuckles)

THERAPIST: So, you want to find a way to—instead of swinging from one extreme to the other –

CLIENT: Uh huh.

THERAPIST: find a way to be able to have both. And I think some of that is figuring out when you can use things to help yourself.

CLIENT: Mm-hmm.

THERAPIST: And also figuring out how you can let go of control in a slightly controlled way. (chuckles) Realizing your limits, maybe. Right? So, being able to let go and dance and have a good time, but what would happen if you did it for two hours instead of three?

CLIENT: Oh. At the time, I didn’t want to.

THERAPIST: I know.

CLIENT: I just basically just danced until I was –

THERAPIST: Until you were so exhausted.

CLIENT: because now, I want to fall asleep, now. But anyway, it was a—it was okay, until I was really hungry. [00:18:01] And Josh had promised—he was looking at where we could go to dinner. And he seems really excited about it. And then, he started to have a lot of pain. And he started to get really upset. And I just didn’t have the energy to help, so I just figured I would go home. But I was going to cry. I was so tired and so hungry.

THERAPIST: Mmm. Disappointed.

CLIENT: And not even disappointed. I was just hungry. (chuckles) So, this all led—so, we got home, and I forget exactly how we ended finally having a huge fight. But, in a way, it was almost good. We haven’t really had a fight, just a silly fight, because (inaudible at 00:18:44) trying to be nice. (chuckles)

THERAPIST: Right. So, it actually felt a little bit more normal.

CLIENT: Yeah. So, anyway, this whole being reckless and being exhausted thing kept me from holding back, I guess. And we had a huge fight, which started out as something really stupid. [00:19:02] But then, we ended up actually talking about real things, so—and he seemed to be able to handle it.

THERAPIST: He may be not as fragile—I mean, you’ve been really working to control what you say, what he perceives, what you’re doing, to try to protect him and take care of him. And maybe there’s some ways in which he doesn’t need as much protection and taking care of.

CLIENT: (sighs) Yeah. I mean, (sighs) I definitely made him cry. He went into the bathroom and started crying for a minute.

THERAPIST: And that’s not (inaudible at 00:19:36). That’s okay.

CLIENT: But it’s not what he would normally do. And, in fact, we (inaudible at 00:19:45) the fight. We resolved it, sort of. We went to bed. And then, the next day, I don’t know if I didn’t sleep well or what. But the next day, those things were still kind of not so great. And then, we had another fight. (chuckles) [00:20:00] This time, about his mom. And I don’t know. This sounds weird. It felt so good. We went through all the rest of the stuff that we hadn’t—we were so tired, we didn’t go through. Yeah. And it felt really, really good.

THERAPIST: So, what is it that you’ve been holding back that you finally got to hash out with him?

CLIENT: (chuckles) On Saturday night, I had been furious for no reason, because he had insisted on getting this [meat share] (ph) that we used to get again, because he has determined he will support agriculture. And I was furious, because he’s not the one who ends up cooking it. He’s not really hungry. So, he doesn’t end up eating a lot of it. And it just feels like more work for me. And it feels like—I guess sometimes, I feel like he has dreams about how things can be better, about—considering how much work it is for other people. [00:21:00] I mean, he’s not really about the (inaudible at 00:21:02). And then, his mom would have to go pick up the [meat share] (ph). (sighs) I don’t know. I guess he asks so much of everybody sometimes without thinking about (chuckles) their feelings (inaudible at 00:21:17).

And this has kind of always been something that I’ve always pushed back. I mean, he used to forget his shoe when he went to work. When he biked to work or something. And ask me if I could come bring them to him. And this is back when I had a real job. (chuckles) As if it was no big deal. He’s like, “Oh, and you can come have lunch with me.” And I’m like, “I can’t go home and get your shoes and bring them to you and”—we’d get into a huge fight about it, because he wouldn’t understand, so—I mean, it wasn’t really about the [meat share] (ph), it was more about –

THERAPIST: Right. “Pay attention to what you’re asking of me.”

CLIENT: “Is it possible for me to have my feelings considered at this point, now that you’re not dying? Are you okay enough to have me be like, ‘No. You need to not ask this. This is too much.’?” [00:22:04] Which feels really nice.

THERAPIST: Yeah. To be able to put some limits on it. Right? If you rethink back to conversations we had months and months ago about setting limits. Right? When a lab mate asked a question or somebody wanted to talk to you and being able for you to determine, “This is a good time,” or, “This is not a good time.” Or, “This is how much time I can devote to this and how much I can’t.” For a while, now, it’s felt like it wasn’t okay to have any limits of how much you could take care of him and what you could do to making his life a little bit better. But to be able to have limits again?

CLIENT: Yeah. And be able to—I don’t want to say yell at him, but yell at him for –

THERAPIST: Being allowed to be angry at him.

CLIENT: Or a [meat share] (ph) is not drugs he needs. (chuckles) And, I mean, for him, it’s –

THERAPIST: At this point, it’s a luxury to be able to consider. [00:23:00]

CLIENT: Yeah. But for him, it’s –

THERAPIST: (crosstalk at 00:23:01)

CLIENT: normal life that he wants, and so –

THERAPIST: Right. He so wants to be able to do things the way he would if he were healthy. Right? And if he were really healthy or healthier than this right now –

CLIENT: Mm-hmm.

THERAPIST: then, setting that as a goal and keeping that as something that’s important would make sense.

CLIENT: And that, I mean—I also love this about him, because he has such dreams that I’m not always good at. And he has dreams that are—that will cause me some distress to even think about. (chuckles)

THERAPIST: (crosstalk at 00:23:32) picture a thing like that.

CLIENT: I mean, he’s much better at thinking of the fun things to do or—without stress, but then, when he asks—I don’t know. And sometimes, I get upset when he asks so much. When it’s not really necessary. I feel taken advantage of, I guess, so, it was nice to be able to yell at him.

The next thing we fought about, though, was that his mom keeps showing up at the house unannounced. [00:24:00] And I’m really trying to set up more boundaries there, because it’s really, really upsetting to me when it’s like a Sunday morning at 9:30 and I just woke up and she just walks in the door. And maybe Josh knew she might come, but, I mean, I would never show up without calling, even. (chuckles)

So, she does this on Sunday morning. And I’m in the kitchen. And I don’t come out and say, “Hi,” to her, because I hear her voice and I’m just furious. Suddenly, all of this anger, because I still haven’t had a good night’s sleep at this point. I was just furious.

(sighs) And then, she leaves. No one says anything to me. And then, Josh comes in. He’s like, “Why didn’t you come say, ‘Hi,’ to (inaudible at 00:24:44)?” I just lost it. Because I’ve asked him before to please ask her to call ahead. I don’t know. It hasn’t gotten through. I guess he doesn’t think it’s unreasonable and hasn’t quite said to her (crosstalk at 00:25:02) that makes her understand that it’s not a reasonable thing to do. [00:25:05] And I want to feel like I have my own house, so . . . (chuckles)

THERAPIST: Mm-hmm. Yeah. It sounds like you and Josh have different expectations of what’s considered reasonable for a family member to come by.

CLIENT: Well, if she was coming to –

THERAPIST: And you guys need to agree.

CLIENT: Yeah. She was coming to bring him things that he had asked for. And I also worry sometimes that he takes advantage of her, because she would’ve gone to get the [meat share] (ph) because he asked her to. And she wouldn’t have said no, (inaudible at 00:25:34) biggest problem. He’s probably been able to do this with her, so . . . (chuckles)

So, anyways. We had a huge fight about his mom, because—I don’t know. She’s been really, really helpful and wonderful. But at some point, there’s got to be—I have to be able to set—it’s really hard to set up a boundary when someone’s being wonderful. It’s a really difficult thing to do. [00:26:00]

THERAPIST: Yeah. And it’s a tricky situation, because you do—you need her help. And you need her presence right now. But you guys also need to be an independent, adult couple and have your private space respected.

CLIENT: Yeah. (chuckles)

THERAPIST: Getting on the same page with Josh about, so, what does that—what would the—what would it feel like to have your space as your home feel respected? And is that a 15-minute warning? Like, “Hey, I’m stopping by”? Or having her needing to call and say, “When would be a good time for me to drop this stuff off?” But clearly, it’s not okay for you to have her just drop in. Are there certain hours when that would be okay, but not before 10:00 on a Sunday and not after –

CLIENT: Yeah. It’s an apartment. There’s one room. Or two rooms and (sighs) I don’t know. It makes feel a little crazy. And, in fact, Josh has told me that I can be just really, really mean, sometimes. [00:27:01] (sighs) Which is something my mom has said to me, before. That I can be really, really mean.

THERAPIST: Do you recognize when you’re being what they’re calling really, really mean?

CLIENT: I mean, yeah. (chuckles) Yeah. I mean, I’m trying not to totally go in there and start screaming at his mom. So, I’m trying not to do what I really want to do, which would be awful. But it still ends up being mean or rude or (sighs) something like that. (sighs) And I think that’s because I’ve been sort of trying to be okay with something I’m not okay with (crosstalk at 00:27:39).

THERAPIST: You’re not okay, right. And you’re feeling really resentful.

CLIENT: Right. And then, but it would take a little bit of meanness or something to stop it right away and then, avoid future meanness.

THERAPIST: Well, it sounds like it’s going to take some straightforward discussions. [00:28:00]

CLIENT: Yeah. (sighs) Which is really hard, so—but anyway. It helps that I can do that with Josh, now.

THERAPIST: Mm-hmm. I think that’s the most important place to be able to do it.

CLIENT: Yeah. And, I mean, a lot of these things, we don’t agree about, especially with his mom and my parents. (chuckles) And if we can’t fight about it, if he’s in so much pain and miserable that he just starts crying the minute I need to talk about anything, even if it’s not about that? So, now we can. So, that’s really—feels really good, which –

THERAPIST: Or, at least there’ll be times when you can.

CLIENT: Right.

THERAPIST: And it may be that there’s still days when he can’t. But it sounds like there are definitely times when you can have these kinds of talks.

CLIENT: Yeah. I mean, he’s still definitely up and down. Sometimes, he’s just completely [in pain] (ph) world, but –

THERAPIST: Mmm. Right. And when he’s in pain world, you can’t have these kinds of conversations. It doesn’t mean you’re not allowed to have the feelings, but you can’t have those kinds of conversations when he’s in active pain. [00:29:04] Or figuring out what the level is that he can tolerate and still function in his way.

CLIENT: Mm-hmm.

THERAPIST: But I think you don’t have to agree on what’s reasonable and what’s not reasonable. What you do need to agree on is what are the rules of your house?

CLIENT: (chuckles)

THERAPIST: Because you may always have a different perspective on whether it’s reasonable for a mother, a mother-in-law type to stop by unannounced. He may always think that’s okay. That’s maybe the way he was brought up. And you may always think that’s completely unreasonable. What you need to agree is like, “Okay. What’s going to be—what’s our stance on what we can both tolerate?” And that’s going to have to be a compromise somewhere in the middle. I think staying away from words like, “right,” or “wrong,” and, “reasonable,” and “unreasonable,” makes it more helpful to—because those have such a sense of critique and evaluation in them. [00:30:02] But if you can keep it straightforward, like, “We need to (ph) set a rule for our house that we can both live with,” and it helps you to not feel so mean.

CLIENT: Yeah. I guess a lot of these (inaudible at 00:30:17) are very—are coming from very different places (inaudible at 00:30:21). I guess this is probably why my mom thinks I’m mean. I feel so strongly that it can’t, just can’t be the way it is, because I will just lose my mind. (chuckles)

THERAPIST: Well, and maybe it can’t. You can’t live with that. You can’t live with it being the expectation that she can show up whenever.

CLIENT: Right. And then, Josh gets really defensive, I guess. And I don’t feel like there’s a compromise. I can’t have it like that. And that’s probably why I end up being kind of mean. I mean, I don’t know if a compromise—I just need some kind of notice. Any. (chuckles)

THERAPIST: Right. And if you can separate, “I can’t tolerate that,” from, “That’s crazy that you think I should be able to tolerate it.” [00:31:02]

CLIENT: (chuckles) I do think it’s crazy. (laughs)

THERAPIST: Ah. Yeah. I totally understand that.

CLIENT: (chuckles)

THERAPIST: And you’re totally allowed to feel that, just as he’s allowed to feel like it’s a reasonable expectation that you should be comfortable with her just stopping by whenever. It’s just you come from very different places in your perspective. You’re both right in that regard. However, getting on the same time, what’s going to make it best for you guys as a couple? Clearly, this isn’t. You’re not going to all of the sudden decide that you’re totally cool with that. And he’s not going to totally decide that there should be three days of written notice before –

CLIENT: (chuckles)

THERAPIST: which might make you feel really comfortable.

CLIENT: Yeah.

THERAPIST: So, deciding that yeah, you’re both right, in terms of what your expectation is. But that expectation doesn’t—can’t coexist. So, can you set up an expectation that at least you can both count on? So, he can learn to expect that yep, Mom’s going to have to give some sort of notice. [00:32:03] You get clear with what kind of notice you’re getting.

CLIENT: Yeah. And these kinds of things take us a lot time to really get on the same page about. But I’m glad we can at least [talk about it] (ph). (chuckles)

THERAPIST: What do you think you would—what would you be able to tolerate?

CLIENT: Oh, from her? Yeah. It totally depends on my state of mind. I mean, if I wasn’t exhausted and in a terrible mood already, she could’ve shown up and I probably would’ve just—whatever, but . . .

THERAPIST: But she can’t know what mood you’re in.

CLIENT: Right. Yeah. I mean, I just asked Josh to please ask her to text (chuckles) five minutes before. It’d be fine.

THERAPIST: So, is it okay if she texts and says, “I’m five minutes away from your house. I’ll be there in five minutes”?

CLIENT: Or, “I’m stopping by.” Just anything, so I’m not –

THERAPIST: That would be okay?

CLIENT: I don’t just hear her voice and be like (chuckles)—I mean, she walked in one time, Josh and I—no, we weren’t fighting. [00:33:04] We were just in a heated discussion. I don’t know.

THERAPIST: Does she have a key?

CLIENT: Yeah.

THERAPIST: She can just let herself in (ph).

CLIENT: Well, because she comes –

THERAPIST: She comes to help him, yeah.

CLIENT: to help a couple days a week, yes. It’s just really helpful. I mean, she was there on Friday, or I would never have come out and done crazy things. (chuckles) She wasn’t there all night, but she was there, so that I knew that the dogs had gone out and Josh was alive and had whatever he needed.

So, she’s been really helpful for me, too. And she doesn’t seem to mind that I do these things. I don’t know. I guess I’ve never had someone—maybe other people are better at it or other people are equally as bad at setting boundaries. I’ve never had people say such strict (ph) things to me, like—I don’t know.

THERAPIST: What’s a way that you could soften it that you might be more comfortable? [00:34:02]

CLIENT: I don’t know. My communication with her is about as bad as it is with my dad. (chuckles) Worse than it is with my dad. I don’t know. Right now, I’m asking Josh to ask her. (chuckles)

Oh, okay. This was worse, because she had yelled at me for illegal parking. She was really upset that I had parked illegally, because I was dropping Josh off and she was afraid I was going to get towed. We’ve gotten towed so many times and she’s had to help us out. So, she was mad. And so, I told Josh. I was like, “She seemed awfully mad,” and he’s like, “Well, you know, we put her through a lot with towing cars.” (chuckles) And he had told her that I had said that she was mean. That was also part of the fight was that he thought he was explaining to her that it just—at the moment, it’s like he tells her—or, she tells him things, I tell him things. [00:35:06] And it’s a disaster.

THERAPIST: Mmm. And he gets stuck in the middle.

CLIENT: Yeah. Well, he is in the middle. Like I’m in the middle of my dad and him. But it’s making things worse. (chuckles) So, but I still haven’t been able to just talk to her directly. I mean, I’ve tried a couple times, and she just—about some serious things and she just shut down. And then, she’s not really good at it, either, so, I’m sure it’ll be an ongoing struggle forever and ever (chuckles) to talk to her, but point being that I can talk to Josh about it now, so, that’s a step, at least.

THERAPIST: Yeah, (crosstalk at 00:35:42). Yeah, it’s absolutely a step. And it feels good to be able to be honest with him. And not have to be so careful. I think if there are two themes of the day, it’s figuring out what your limits are and finding places where you can let go of a little bit of the control, to be a little bit more flexible or less limited. [00:36:03] And how careful and controlled you need to be, so that when you let go, it doesn’t need to feel so drastic. And not like you have to get out every ounce of freedom –

CLIENT: (chuckles)

THERAPIST: and ability to let go of some of the responsibilities, because you feel like it’ll—it’s like you’re binging on freedom when you let go.

CLIENT: Mm-hmm.

THERAPIST: Because you’re afraid that you’re never going to get it again.

CLIENT: Well, and Friday was also the day that my mom had called because she thought Josh was trying to get drugs from anywhere. And I just also just didn’t want to deal with it anymore. Well, I guess that’s the same thing as wanting (inaudible at 00:36:38).

THERAPIST: Mm-hmm. Yeah. You don’t want to have to have the responsibility, which makes sense. You have so much responsibility heaped on you right now. And sometimes, you’d like a huge break from it.

CLIENT: But again, last week, when you said the—it’s still anxiety if I’m—even if I cannot—it’s really helpful. [00:37:00] I don’t know.

THERAPIST: Well, if it’s useful framework to think about it –

CLIENT: (chuckles)

THERAPIST: hold onto it.

CLIENT: (crosstalk at 00:37:08)

THERAPIST: Yeah. I mean, because the point of me saying that was that some of the same things that feel helpful when you have that kind of vibrating anxiety could also still help you feel better.

CLIENT: Right, right.

THERAPIST: Right? That was my point. And, yeah, so, taking advantage of the techniques that work, I guess, to help you find equilibrium. Right?

CLIENT: Yeah. And I’m still not doing a good job with that. I’m still trying to get a piano. I still can’t seem to sell anything. (chuckles) I haven’t quite given up. But I haven’t been able to—this morning was the first time I’ve run in like a week. I couldn’t bring myself to do any exercise for days. I just didn’t care, I guess. And I was really tired and didn’t feel like trying. (chuckles) But I didn’t have anything else, really, to do.

THERAPIST: (inaudible at 00:37:58) as a replacement.

CLIENT: I mean, luckily, at work, it’s a distraction enough. [00:38:03] But it’d be nice if something else (inaudible at 00:38:07).

THERAPIST: When you don’t have the energy to run—I know the weather was really crappy last week, but it’s looking like it’s going to be better for a few days –

CLIENT: Uh huh.

THERAPIST: does taking a gentle walk outside or taking the dogs out for a walk, does that feel good or?

CLIENT: Oh, sure. And sometimes, the weather doesn’t get me down so much that I can’t go out to a yoga class or something. I don’t know. I didn’t feel the need to let anything go, which is why I usually need to exercise. And maybe it would’ve helped anyway, made me a little more energetic. But I just couldn’t even . . .

THERAPIST: Yeah. But, I mean, also listening to your body. When your body says, “I want to take a hot shower and lay on the couch”? You can do that. Trust in yourself a bit. If that’s what you’re feeling, then, that’s—a hot shower is definitely on the list of things that people recommend for dealing with anxiety. [00:39:06]

CLIENT: Is it? (chuckles)

THERAPIST: Yeah. (chuckles) Yeah, absolutely. Heat, warmth, very soothing. But it’s also a way just to transition. Right? We talked about just getting yourself to move from a place—that like if you’re feeling stuck in a mood, then, just doing anything to help you transition and move out of that to something else.

CLIENT: Mm-hmm.

THERAPIST: And a hot shower? Sometimes just even changing clothes? That can just be a way to transition. Like, “Okay. I’m getting myself unstuck.”

CLIENT: Mm-hmm. Yeah. Well, I guess, it’s when you said that the same things can help—I still—I’m lacking motivation sometimes when I don’t have anxiety. And I don’t want to just give up because I feel so tired. I don’t know what I’m trying to say, exactly. [00:40:01]

THERAPIST: But you can take a break when you feel so tired. And it’s not giving up. It doesn’t have to be permanent.

CLIENT: Well, it was good, in a way, that it didn’t cause me anxiety to be so tired (inaudible at 00:40:13). (chuckles)

THERAPIST: Mm-hmm, yeah. You don’t have to worry about it. And that’s when discerning whether it’s tired avoidance—right?—and maybe—and when you’re avoiding going out or going to work, then, you do want to push against that.

CLIENT: Mm-hmm.

THERAPIST: And being able to tell when it’s tired like, “I need a break and I’m going to honor my body’s signal of wanting to rest for a bit.” So, being able to see if you can sit with the feeling for long enough to discern which one it is. And then, respond appropriately. If you’re avoiding something, all right. Take some time to sit with that. And then, ask yourself to approach whatever it is that you’re avoiding. And if you’re tired, take some time to sit. And let yourself relax. And maybe you won’t be so tired after a little bit. [00:41:01]

CLIENT: Yeah. Actually, I haven’t panicked as much about anything since the bachelorette party. I was so anxious about going to it. I felt like I just wanted to stay home, because it was easier and it was definitely avoiding. But then, ever since that bachelorette party, I’ve been ignoring the consequences of acting a little crazy. (chuckles) Because I don’t even want to bother being anxious. I just want to—and it’s (inaudible at 00:41:38)—it’s always very spontaneous. I need to find some other way. (chuckles)

THERAPIST: Well, I think you want to find a way to be able to be spontaneous and let go. And recover a little bit faster, so it doesn’t feel like it—the—find ways to help yourself after, so that the consequences don’t feel so severe. My guess is most people at that party felt tired the next day. [00:42:01] It was probably more severe for you.

CLIENT: (sighs) Well, even at the bachelorette party, watching everyone sleep in. I was up like –

THERAPIST: Mm-hmm, right. That helps them recover.

CLIENT: (sighs) Ugh, it’s so frustrating. (sighs) So, I know that this is not something that’s good for me and everyone else can do this for obvious reasons. Because they can sleep in. Even if it’s just staying up too late and not even partying or doing anything else. (chuckles) But even just staying up too late last night, couple hours, was detrimental. And sometimes, I want to just rebel against that.

THERAPIST: I can understand that. Not want to have to be so tightly controlled.

CLIENT: But usually, it makes me hide. (chuckles) But I haven’t been, I guess, since the bachelorette party. I’ve just been accepting the consequences, I guess. I don’t know if that’s good or bad.

THERAPIST: Mmm. I think it’s part of the process. Right? Because what we want you to be able to do is live a—live your life and actually have some spontaneous and uncontrolled moments, because otherwise, it’s going to feel really boring. [00:43:05]

CLIENT: (chuckles)

THERAPIST: And figure out how to do that in a way that doesn’t have such drastic consequences for you.

CLIENT: Yeah. And I guess even getting back just a little piece of my boyfriend is helpful.

THERAPIST: Mm-hmm. Yeah. I mean, there’s not so much that you’re seeking.

CLIENT: Right.

THERAPIST: When you get back a little bit of him, it’s fewer limitations on you and I think some of what you’re looking for. Not to have to always be so in control and the one who’s responsible for everything. If he can be actually responsible for dealing with his feelings or his sadness or your anger at him, then you don’t have to.

CLIENT: Yeah. It’s terrible, but his two best friends, on Saturday, one of them broke his hip. [00:44:02] And the other one got caught by his wife—he’s apparently addicted to porn. Got caught by his wife. And so, his life—both of their lives basically went down the tubes. It was really nice to hear Josh on the phone talking to them both.

THERAPIST: Yeah. Being able to be there for them. You got to see him be stronger than he thought he was, huh?

CLIENT: Yeah.

THERAPIST: Or more himself.

CLIENT: Yeah. And that’s happening more lately. I don’t know what’s going on in the universe that both of his closest friends, the two people that he would go to a desert island with or whatever, their lives have just gone off the deep end. But, yeah, I was glad that he could handle it.

THERAPIST: Mm-hmm, yeah. And not have his world be totally about what’s going on. Yeah. I think when he went, found himself in the hospital in such dire straits, really, I mean, the whole world is revolving around Josh. [00:45:03] Rightly so.

CLIENT: Mm-hmm.

THERAPIST: And it sounds like in recognizing that his world doesn’t need to be revolving completely around his symptoms, his pain, his treatment right now, it—there’s actually room for his world to encompass his friends. Their lives. You. Your feelings. I think it’s evidence that he is—he really is recovering. That there’s room for this stuff again.

CLIENT: Yeah. I mean, and he’s been trying really hard (inaudible at 00:45:30) to give him some credit. I mean, it kind of started with an Xbox to distract himself from pain. But that’s evolved. And then, that evolves into the whole wedding planning thing, which caused me a lot of stress. He wanted to go to the mall so he could look at the suits, because he told me that when he looks at suits, he feels—he can forget about the rest of it. It’s like how can I not (chuckles) take him to look for suits? And then, actually being able to be there for his friends felt really, really nice.

THERAPIST: Mm-hmm, yeah. He is working hard. And you are, too. [00:46:00] Right? I mean, it’s not either/or.

CLIENT: Right. But now, being able to ask him for stuff from—for me was also really, really nice.

THERAPIST: Right. I’m glad that you were able to do that.

CLIENT: (sighs) I mean, it was (sighs) there was a lot more emotion than there would’ve been otherwise. And it in itself is completely exhausting. But it needs to happen.

THERAPIST: Mmm. It sounds like it was important. It needed to happen for both of you.

CLIENT: I don’t know if it was good for him. I hope so. (chuckles)

THERAPIST: I mean, I can’t be sure, but, I mean, it sounds like he’s really working to try to have some normalcy. And he’s looking for ways to do that.

CLIENT: Mm-hmm.

THERAPIST: And part of normalcy is being able to have a range of emotions with your girlfriend. That includes being mad at her or her being mad at you sometimes. I mean, it’s not fun. Nobody likes that feeling, but it’s part of the safety of a good relationship is that you’re allowed to feel everything.

CLIENT: Uh huh. [00:47:00] Right. Yep. Right. And when I’m taking him shopping, also, it’s so that he would be distracted from the pain of his whole life. And I feel like I really can, sometimes. Or in any of those situations. It’s supposed to be his therapy. Right? I feel like there isn’t quite room for me to completely blow up, which is why I eventually did later, because I was—it was building up and I –

THERAPIST: Right. You couldn’t do it then. But you also can’t be his—right?—you can help him get to some of his therapies, but you can’t be his therapist.

CLIENT: Right. And in fact, he doesn’t ask it of me as much as maybe I would like him to do. I don’t know. He does really try to protect me. (chuckles) I mean, he also just thought that we were having a great time and we just weren’t. (chuckles) Or, I wasn’t. I was having a terrible time. [00:48:00] Which, for him, would—made no sense.

THERAPIST: Right. And he didn’t know that because you didn’t tell him until (chuckles) until he finally found out.

Well, why don’t wrap up there for today? I think we’re scheduled for next time. Right?

CLIENT: I think so. This should’ve been yesterday, so, next Wednesday.

THERAPIST: Right. Yeah. So, the 9th, at 3:30. And the 25th at 3:30, because I go away. So, we have a weird –

CLIENT: Yeah. And I was going to say, the 25th is his next clinic appointment. We just got the schedule. But it’s at 10:00 a.m., so I should be able to make it. Unless you have the Tuesday on that week.

THERAPIST: I think I’m still away. I’m still away. So, I’m away from the 16th to the 24th. So, the 25th is my first day back.

CLIENT: 25th is a Wednesday?

THERAPIST: It’s a Friday. [00:49:00] So, our next appointment is Wednesday, the 9th. And then, we have Friday, the 25th, because I’m away.

CLIENT: Well, then, I must have something wrong, because I—he does—there’s no possible way to have the clinic on the 25th, but, I see the card (inaudible at 00:49:12). Anyway. I’ll figure it out.

THERAPIST: Well, I’ll see you on the 9th and we can (inaudible at 00:49:16).

CLIENT: Okay. (chuckles)

THERAPIST: We’ll figure out where we’re –

CLIENT: Thank you.

END TRANSCRIPT