TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: You let me know a little bit on your intake form about what you're looking for in therapy but maybe you want to sort of just continue on with this.

CLIENT: So what I'm looking for is to improve my relationship with food and with myself, I guess. So to give you a little bit of background from the beginning, my first memories in life have to do with food. So there's always been some kind of an association between different events and food for me and then a lot of it starts to get negative. So when I was about six I think, my mom threw all the sugar out of out of our house because she thought sugar was bad and I remember that because it was like my one treat that I was allowed to have was thrown out. So kind of the negative stuff started around then and got worse over time. So a lot of it has to do with like my mom and like putting me on diets and all that kind of stuff and I get a little emotional about it (crying).

So I can only remember a few times in my life where I've actually had a normal attitude towards food, towards eating, towards my body, and coincidentally there were a few times, a half dozen times when I didn't focus or fixate as much on food. So for me if I had to look at food I can calculate how many calories are in it. Or if I'm eating around other people I feel like they're watching me and I feel like they're kind of watching what eat and things like that. It's kind of been going on for a long time and I want to work on it so that if I have kids down the line I don't want to affect them in the same way and I want to work on it so I don't think about it all the time. But I think a lot of it goes back to family and stuff like that because when I'm with my family it's very negative and very stressful for me and I actually find myself eating more. They're in Pennsylvania but when I go to visit, when I'm around them, because -

THERAPIST: Six-three-one, right?

CLIENT: Yeah, New Jersey.

THERAPIST: That's in New Jersey. Not 561.

CLIENT: No 516. So when I'm with them it kind of triggers something in me that actually causes me to feel so stressed that I eat more. Of that they're watching me and it kind of makes sense because my family has a lot of issues with eating, too. So like I lost weight and kind of gained weight and the past couple of years I've kind of like avoided going to functions with my extended family because I don't want them to pass judgment on me so it's kind of like pervasive now. But like one of my cousins has anorexia. So there's a lot of eating. My grandmother doesn't eat. There's a lot of eating issues kind of on my mom's side of the family and there's a lot of focus on weight. So when someone says hi to you the first thing they notice is your weight, changes in your weight or what the change has been in your weight, what you're eating, what you're doing instead of the person. It's all about the weight.

THERAPIST: And what does the weight represent or mean about the person?

CLIENT: To me like, I feel like when they see me they think like she's not doing well because of her weight (crying) or that person's ugly, or they don't look good or that they look like really down or sloppy or things like that. So I feel like sorry, if I get it out (crying) it's like a really hard topic for me.

THERAPIST: Yeah, very emotional. That's what you're here to do so -

CLIENT: Yeah! So yeah, so to me I feel like when they say this person looks good they weigh less. Or this person looks bad because they weigh more. So for me I feel that the one I actually have a lot of good things going on in my life. I'm kind of a perfectionist so I beat myself up and focus on the weight and I can't see any of the other good and there are so many like good things but so, because I see myself that way I think other people see me that way so where other people may not notice so much, I think that they do. And when I see someone whom I haven't seen in a while I don't want to see them because they're going to realize the weight and other people are going to talk about it or talk about me and there's sort of like that aspect of it and there's the way that I relate to food because for me everything is either all good or all bad and so what I'll do is I try sometimes to eat all healthy but if I decide I'm going to be bad, then it's all bad. Or if I'm going to be good it has to be all good with food. There's no like moderation or in between or I can't have a little bit of something that I consider to be bad. It's going to be 'I'm going to be bad or I'm going all out,' or something. And a lot of that has to do with when I'm eating with other people because they might say girlfriends or family or whoever they might say, 'oh, I'm being bad today having this,' and you kind of go with them and you think about how it will reflect on you if you don't eat the way that they are so for me when I'm eating with other people there is a lot of stress. So there's a lot of like, 'are they watching me? Are they watching what I'm eating? Do they think that I shouldn't eat that because I'm so overweight that if I eat that they will think, 'well that's why she's fat because she eats that' so I kind of feel like it's hard for me to just be at peace when I eat, or eat mindfully or hear any like hunger, I mean, I hear hunger (unclear) in so many things but to really satisfied or actually enjoy the food for what it is. It's been really hard for me the past few years. I think it's gotten worse, probably. [00:08:06]

THERAPIST: Worse your preoccupation with it?

CLIENT: Yeah. I would say because when I did after I did lose weight I felt at peace and I felt that I wasn't preoccupied with it anymore and I sort of just put it out of my head and I actually don't have a lot of memories associated with food from like a few years ago when I lost weight. I feel like I was in a really good place but then I had someone from the gym who caused me to be focused on food again because she was talking about all these different kinds of eating and things and then I became preoccupied again and then I put a lot of weight on because I just got this obsession about it so I would like to get back to a place where it's just not this obsession anymore and just have a healthier outlook towards it and also where I don't start avoiding people because of the way I think of myself, like I'd like to think of myself and a little bit of in better ways of not avoiding family or I can learn how to deal with family maybe because they're not going to change really but I need to learn how to deal with their habits and things they say because they really are big triggers for me. [00:09:37]

THERAPIST: And so like you're obsession with gaining weight by obsession you mean the obsession with eating?

CLIENT: No, it's the way I think about it I think, so it's like the way I view things as good and bad instead of viewing it as delicious or food or this sustains you and this keeps you healthy. I look at it as 'I'm eating really well. Look at my plate compared to everybody else's. They're eating badly. My plate looks good.' Or, 'my plate looks bad. Everyone else is not eating well, so it's okay if I'm being bad.'

THERAPIST: So there's like a big comparative element to it.

CLIENT: Yeah, so there's a lot of comparison with other people or with how you are perceiving me or how they're looking at me and stuff and occasionally I think at home I do sometimes emotionally eat but it's not really I think the overeating isn't happening as much at home. It's actually more when I'm in a social setting with other people and it's just because of the stress and how I'm perceiving the situation I think. Because a friend of mine even called me and she said because it's not just me but a lot of my friends have this obsession with calories and weight and it becomes a big part of your conversation and so a friend of mine even mentioned to me a few months ago when we went away and she said, 'I feel like all anyone talked about on that trip was food.' Like, 'what are you eating?' And, 'what aren't you eating?' And it becomes this group mentality where other people kind of get into it too and I just don't want to fuel that conversation or be part of it either. But for me what I notice is really triggering it is just family and talking to my mom on the phone or anything like that. Anytime I see them then that seems to make the problem to exacerbate it, I guess. [00:12:09]

THERAPIST: This is sort of an odd way to phrase a question, but do you feel like you have a relationship with your mother outside of food? Or is that like your focus, focal point?

CLIENT: Well, I think it's a big focal point I would say, like I when I was in like sixth grade I think, in home ec, I was telling people about calories and telling them, you know, what it was and I had this Susan Powers boxed cassette tape set from a yard sale. Like I was put on diets from when I was really, really young, so and my mom would always, so what would happen is my mom would group she and I in the same group and then my dad and my sister in a different group so then she would say, 'your dad and your sister are naturally thin, they can eat whatever they want. You and I can't do that. We're different and we have to be on this diet or that diet, but your dad and Geraldine' that's my sister 'they can have whatever they want.' So my mom would get cookies for my sister and hide them from me so there was like I mean that's a big memory throughout my whole life so I think that a lot of our relationship has somehow been linked back to food or what's this person on and my mom's always told me what she ate or what plan she's doing or different things like that so I don't think that's our whole relationship because certainly, she asks me about school and different things. I think she does care but I think that's a really big part of our relationship because she's always put us as 'we're the same and we have the same issue and we have to deal with this issue together. We're different, we have a different metabolism,' and all this kind of stuff. So she'll talk about other family members and their weights and their weight changes so I think because she does that I think they all have to be talking about me because I hear her saying it about other people so then I think they must be talking about me, too. But I think it's a big part of their relationships as well like my mom and her sister seem to talk about food and diet a lot. So I think it's just something that maybe they were already doing and so she just thought it was okay and I've told her that I feel that she's sort of given me this sort of negative view of food and that I don't like it. And then she kind of pulls the whole guilt trip thing on me saying, 'well I'm going to a counselor for this and I'm sorry if I -' and she just gets this tone kind of -

THERAPIST: Defensive?

CLIENT: Yeah. She does that with a lot of stuff. There's a lot of guilt kind of stuff. I don't know if it's a New Jersey kind of thing or what. So there's a lot of guilt. Like 'you don't come home enough.' Or, 'you don't do this.' So she has this sort of defensive sort of guilt thing towards this situation as well. And so I really don't want to pass any of this on to my kids. I don't want them to see any of this and I don't want to say the things that said because I think just growing up like that, it would be hard to have a normal outlook towards food. So I'm just hoping I can change it now.

THERAPIST: Is there a reason at this time that you're thinking about kids and passing this down to kids?

CLIENT: So I've known my boyfriend for five years and obviously like marriage comes up and stuff and he sees marriage as kind of a religious thing and so his main reason to get married would be to have kids and we do want to have kids together, but he says that his reservation is that he thinks that I will pass these behaviors onto our children, so my (unclear) in all this stuff has been a really negative part of our relationship for the past three years (crying). So I've never really talked to anyone about this before.

THERAPIST: I'm glad you're talking to me about this now.

CLIENT: And I just feel like I really love him and I think he's a great guy and I really want our relationship to work and part of me doesn't think it's fair that he's putting all of this on me but I do recognize that I want to change and I want to feel better about myself because I recognize that obviously my moods are, the way I look at myself in the mirror and make negative faces or pinch fat and stuff like that, that obviously, that's going to affect the relationship or the mood so I want to change for that because I do want to stay with him and I do want to have kids with him and I want to have him think that I can change but it's been kind of stressful that he feels that way because of me and I'm trying to work on it but I think it's going to take some time.

THERAPIST: What in particular does he think are his worst concerns or what is -

CLIENT: And part of this I think is because his mom left his dad when he was one so I think that has something to do with it but he said that he doesn't want me to be standing in front of the mirror pinching my fat or talking about calories or food and have our kids come in and see that and he knows about this stuff with my mom and I think he just doesn't want to have his children, or our children, have to go through what I have gone through and so he just said all that and then he said I don't want to be a single dad at the end of it. So I mean, I think it's a mixed bag of different things but I understand that he's seeing what I'm going through and I can understand that he wouldn't want our kids to go through that so I think he's afraid that if they would see how I'm viewing myself negatively or things like that because kids pick up on all that stuff that all that stuff would affect them. [00:20:11]

THERAPIST: So his focus, as yours is, is about your future kids.

CLIENT: Yeah. I think that's more of his focus, but I think the other problem is that it's really a downer if I'm always down about myself. I think it's a downer for him and I think it's kind of like a downer for the relationship, like it kind of sucks a lot of the positive energy out if I'm having days where I'm depressed because I think I'm fat or talking about my weight or never thinking that I look good or just having issues when we go out with friends about food. I think that starts to kind of weigh on our relationship so I think that's the other aspect of it, too, as more in the immediate. If you always have a negative outlook about yourself it's hard for your partner to see and I think it's hard for them to view you in a really positive way if you're always putting yourself down.

THERAPIST: Do you feel like there's a time in your relationship when this was not a feature of it and it changed?

CLIENT: Yes. So I feel like when I was at I guess happier, so and that happened five years ago when I first started a job in finance and my job wasn't very stressful then and I felt I had a good weight and everything was great and then I gained a bit of weight but kind of lost it and still felt I was at a great weight and everything was good and then my job became more and more stressful and then I think it started becoming really the focus and it was more obvious and it was more so I think there was a time where because I was okay with my weight and with myself it wasn't really as much of a focal point and now because I think because I feel so negatively about myself I think it's more of a focal point so I would say it's more like the past few years or past couple of years it's been an issue.

THERAPIST: And it sounds like at least for the it sounds like this has been true for much of your life but why now in terms of seeking treatment versus a year ago versus like -

CLIENT: So I left my job hoping that that would make everything better and it did make me more fulfilled mentally and everything but I realized that there is still a problem and I did go to I think she was a social worker a couple of years ago and I talked about and there was a lot of work stuff going on then so that was a big part of it. But then I did kind of talk about the weight stuff but it just wasn't kind of addressed in the right way or it wasn't really the focal point or anything so that didn't really work that well for me but now I just feel like it's really become pervasive in my life and I recognize what's going on a lot more than maybe in the past I think I'm a lot more self-aware of the situation and I know I need help and can't do it on my own. So I think that's a big part of it.

THERAPIST: And you got to me through a dietician is what you said.

CLIENT: Yeah, at Brown Vanguard.

THERAPIST: I used to work there.

CLIENT: Okay, because she said she had met you so that's probably why. So I started seeing the dietician hoping that would help and I think she realized and I realized that there's a big psychological and emotional part of this because I'm very aware of what is and what is not healthy and what is the ideal place and it is more of the fact that I am saying it's all good or it's all bad and all this other stuff so she wants me to keep seeing her but she wants me to see you, obviously, to work through all this.

THERAPIST: Yeah, it's certainly not for a lack of knowledge you're not eating well. It's not for lack of knowledge. Maybe it's too much knowledge but certainly not no knowledge.

CLIENT: Yeah.

THERAPIST: You said that some of your first memories are food giving the example of your mom throwing out the sugar. Any other memories?

CLIENT: So my paternal grandfather died when I was three from heart disease and I think this is a real memory. I remember him coming in and bringing me like little bags of Wise potato chips and that's my only memory of him because he died when I was three and that must have been before he died. And I'm thinking that that really is a real memory but that's one and then when I was in pre-school we had some nut snack that I was passing out and I smelled it and got yelled at. And then I remember that my dad used to bring us every week as a treat we got a box of fruit snacks and we could have a package every day or whatever and that's what my mom threw out after she took this class. I distinctly remember sitting with my dad and her coming in and saying, 'no more sugar in this house,' and throwing it out and that's a very distinct memory for me. And then you know I remember a lot of food from family events and that makes me remember the family event and things like that. But then I also remember my mom hiding the food and I can remember trying to find it, to find like where it was and so I mean, I actually think more of the binge eating and things like that was more when I was a teenager because I was trying to find the food my mom hid and then I would just eat a lot of it because I found it. So I think that was a lot with eating was happening a lot of it, then. But even still, my mom says to me, 'you're an emotional eater, just like me. I come home and eat a row of cookies, or whatever.' And I actually don't do stuff like that. For me it's more like socially I overeat and different triggers like that it's not that you know I come home and eat a row of cookies. So she still thinks that we're the same but she's still trying to say that we have the same emotional eating stuff because she's still trying to group us in the same group or whatever. But I think it's a little bit different. [00:27:45]

THERAPIST: Well, it's so interesting. It seems like an important piece of this. You know, I don't know if you have thoughts about what need that fulfills for her, that you could see that it could potentially, and obviously that whole separate meaning of food but you could potentially see happening a lot of ways in which, or a lot of things your mom could graft it onto we have to be the same, you and me are the same. Have you thought about why she would need to think of you like that?

CLIENT: No. I'm not sure why she would need to, but she does it in other ways, too. Like I'm always helping, or very giving and she says that she's the same way she's very giving and sometimes it takes its toll on you and you get stressed, so. And she's say we're the same, like there's other areas where she says we're the same but I don't know why she like I don't know if so I know growing up she had like she is from nine kids but her mom was really sick when she was in high school so she took care of the kids a lot and -

THERAPIST: Was she the oldest?

CLIENT: No, she wasn't the oldest but she was the oldest one there at the time because everyone else left so she was (unclear) with us. But she went through a lot of emotional eating stuff then because she told me about it. Maybe she felt really alone because everybody else was having fun and kind of enjoying life and she had the responsibility of being the parent and taking care of them. So maybe she wanted to feel like she had someone else who was similar to her in me where we could do stuff together and be similar and like maybe she didn't have that connection with anybody else and so that's -

THERAPIST: It's such a particular way of relating to your daughter. Very particular and also not only are she and you alike in her mind but that she also distinguishes your father and your sister who are not like (unclear) each other which is sort of interesting, too.

CLIENT: Yeah, they are both very reserved and are both so they're always in this basket or they were allowed to eat doughnuts for breakfast because they had a good metabolism, so they were always in this one basket and we were in the other basket. [00:30:32]

THERAPIST: Yeah, it seems like a way to establish that kind of closeness or connection but in a way that's so limiting for you, that you sort of have to be like her in order to maintain it. And the ways she wants you to be like her are not like for the most part, 'aren't I a wonderful person, 'but in the ways that we have deficits, in a sense. And so there is a joining around that which is so confusing for a kid, just so confusing.

CLIENT: Yeah, it was always just like she would buy us matching clothes and stuff like that, too. Yeah. And she would always say, 'like I had to wear over-sized clothes because I had a big chest and my sister could wear clothes that were more form-fitting because she didn't.' And it was always just like I have to do this and have matching clothes with her and all this stuff and then you know my sister could wear whatever she wanted. There was always this very big distinction made.

THERAPIST: And was there did you feel that she was jealous or envious of your sister or was she trying to -

CLIENT: I think that that could have been because she was always envious of people who are naturally thin and my sister was always naturally sporty and didn't have to worry about what she ate and was a scrawny kind of kid and stuff and so it could be because she would always say that she and I were not naturally thin, but that my sister was and so my dad was, and so we were built differently. And so it could be that she was envious that she could kind of eat what she wanted and it didn't matter and she had to have someone else, like me, to say that we're the same and everything. Looking back, I mean, I wasn't overweight as a kid. That's the whole problem is that I was a little chunky but I wasn't actually overweight at all and so I was also very taunted by the other kids about my weight, too. And so I think that added to it and I think I would probably go to her for help or come home upset and then she would say, 'well, we'll go on this diet together. We'll do this together.' Stuff like that.

THERAPIST: Missing an important point that it's not about you needing to diet.

CLIENT: Yeah.

THERAPIST: What was your relationship with your sister growing up?

CLIENT: I think she was always kind of more popular than me and she never really had a hard time because I was sort of nerdier without a lot of self-esteem because people were constantly breaking it down whereas my sister never had to worry about that. So I think I was kind of envious of her in that way but I was always kind of trying to look out for her and she kind of didn't want to have anything to do with me. She was three years younger than I am. And so I think I may have been a little bit envious of her too, because she was a size 2 and could do all this stuff.

THERAPIST: Your mom is giving her all these things that she's depriving you of and telling you that she has all of these apparently good attributes that you don't have, or favorable genes or whatever, so it would be hard imagining you not being envious of her.

CLIENT: Yeah. But I think I was envious but I still wanted to be with her, hang out with her and she always thought that was kind of uncool. But and now we have a very strange relationship because my sister lives in Pennsylvania so she's closer to my parents, which has almost actually been really negative, I think for her because she has a lot of emotional attachment because she doesn't do a lot for herself and there's a lot of negative things that I see there but my sister almost speaks to me now the way my parents do. I almost hear the voice of my dad when she talks to me. She says, 'what are you doing that for? You don't need -' You know, she kind of talks down to me sometimes even though I'm older, so I try to reach out to her and have this relationship with her but I think she's spending so much time with my parents in that environment, going out on the weekends and stuff that talking to her is even really stressful and really negative for me because she gives me a lot of the same guilt that my parents give me so not just about food. Like she'll say, 'I don't visit my grandparents enough,' and I don't value them enough and different things like that but it's a lot of what my parents could be saying behind my back to her and she's saying it to me. I mean the relationship's changed a lot but not necessarily in a positive way.

THERAPIST: Where was your dad in all of this? Like did he know how your mom was talking to you? What would he do? [00:36:03]

CLIENT: He didn't really ever do anything about it. He's usually quieter and my mom is the one who calls the shots I guess a bit. And so I don't remember ever his stepping in. I remember he became more health conscious after he found out he had hereditary hypercholesterolemia so he got really health conscious about everything that he was eating so I can remember him making little remarks about certain foods being unhealthy and calories and different things like that but it was never to the same extent and he never stepped in or anything when my mom was saying or doing all this stuff. He just kind of went along with it. Because we would be on vacation driving in the car when my mom was younger and my mom would be reading to me from the blood-type diet and talked about what we were going to eat together on vacation and he would be driving and not really listening or not telling her that she shouldn't do that or anything like that. So I think he was kind of passive in the whole situation.

THERAPIST: Was this primarily what you and your mom talked about food?

CLIENT: I mean, yeah. But because she was like very conservative, very religious, very set in her ways, so the only other thing she ever said was don't do this or don't do that. There was not a lot of discussion or conversation about different things so a lot of it was centered around food and also around talking about other people which seems to still be a very big part of her way which is part of the reason that she tries to talk to me every day and I try to not always return her calls but then I feel guilty about that because I don't want to hear all these negative things about other people and I don't want to participate in that and I have worked really hard to try to not that I don't do that sometimes but to try to not do it as much because it's something I grew up with. So I have to try to work really hard to not do that and try to reverse that because that was really negative for me. But she still does it. Like that's the center of everything. She'll tell these stories about people that I couldn't care less if they're getting divorced or whatever. I don't care. But she's always having to talk about other people or tell stories about other people's life and usually negative things. It's usually not anything positive, it's always negative. So I would say that and food are two main topics of conversation.

THERAPIST: And when you think about it do you think it's a way of making her feel better about herself?

CLIENT: It could be. I think that's way I guess that's why people talk about other people but I don't know I almost feel at this point that she doesn't even realize what she's saying, because I think whereas I've been able to be really reflective my boyfriend's helped me a lot with noticing these things. Where I've been really able to be reflective about these things that I don't want to keep doing, I'm not sure that she has been able to have the time to think that through, so I'm not sure she realizes what she's doing anymore. Like I think it's so ingrained that she might not even know what she's doing.

THERAPIST: What you're describing people that usually refer use this term referring to thinking, but it sounds like the thinking is compulsive almost not obsessive. It's like a compulsive thinking. Like it's an activity.

CLIENT: Yeah.

THERAPIST: Obsessive seems almost like it has a slightly different meaning to me. I don't know if that's the word that came to my mind.

CLIENT: Yeah.

THERAPIST: Wow, this could be really crazy-making.

CLIENT: Yeah. It's just the whole environment. I don't think I realized how negative. I still try to look at it you know, my mom doing homework with me, you know, there were a lot of really good things too. But I think there's a lot of judging. It's not just all weight it's everything. I think coming from that environment where you know other people are being judged all the time, you just assume that you're being judged all the time, too. [00:41:08]

THERAPIST: When you were saying there's a lot of good things as well, it's like that's the hard part. Things just don't all go into a good or bad category. And there's a lot of pain, but that's the hard part in a sense.

CLIENT: Yeah. If my boyfriend makes comments about my childhood or sometimes he'll say he doesn't think my parents were very good parents, I get really defensive and I say, 'well, no, they did my homework with me and they did and they took me on all these educational trips and did all these things and helped me with college,' and so it's hard because I recognize that there were a lot of really destructive things that were happening and I don't want them to happen to anyone else but I also see that there was good there too and I get really defensive about it.

THERAPIST: I could see that. Well, I'm so glad you came.

CLIENT: I am too.

THERAPIST: I'm so glad you came. You've got a lot of things to talk about and work through. I'm very impressed with how you are very reflective and it's very clear you've tried to put things together for yourself so that you can kind of go to the next step of working through it. But you're clearly aware of a lot that goes on both inside yourself and sort of the things that have brought how you feel yourself how they've evolved. So that's clearly apparent. Outside of seeing the social worker for a few times, have you been in other therapy?

CLIENT: No.

THERAPIST: So this is really a new thing for you to do?

CLIENT: Yeah.

THERAPIST: It seems like you're serious about it.

CLIENT: Yeah.

THERAPIST: You're in grad school now. What do you study?

CLIENT: I'm actually studying history.

THERAPIST: You probably know a lot more than your classmates.

CLIENT: And a lot of it honestly comes from I want to do some work as a school historian and I just want kids to have a really great attitude towards food and I think a lot of it comes from me not wanting other kids because I don't think this just happened in my house. I know it happens in a lot of places, especially for young girls. So I think a lot of what drew me to it is just wanting kids to think about food in a really positive and great way where this is nourishing and healthy. So I actually think it's been pretty positive for me to be studying this because I am trying to look at it in a different way and so it's a little bit hard because there are a lot of people in the classes that are fairly obsessive and so sometimes it's hard to be around other people that are like that but I've tried to align myself with people who aren't you know, make friends with people who aren't.

THERAPIST: Did you instruct this year?

CLIENT: I started part time in January and full time this semester.

THERAPIST: Hence, leaving your job.

CLIENT: Yeah.

THERAPIST: That's not uncommon for people to come to therapy right after making a change they thought might help and they realize sort of like you're removing variables. Well let me remove this variable and see if that makes change. No. That variable I'm going to go on to the next. That's not at all uncommon. It's a good thought process trying to figure out what might be leading to what. So that makes sense. Do you have any questions for me so far?

CLIENT: No.

THERAPIST: Well I think that you I imagine that if today is representative of future sessions that you will take to this process very well because you have I know it's painful but you are able to talk about what your experience is so that will serve you very well.

CLIENT: Yeah, I think that will be good for me.

THERAPIST: Well, the invitation to ask questions is open. So you can feel free to ask any time.

CLIENT: Okay.

THERAPIST: Not just to start with but -

CLIENT: Okay.

THERAPIST: It sounds like you're good for now.

CLIENT: Yeah.

THERAPIST: So it sounds like the next logistical thing is scheduling.

CLIENT: Yeah.

THERAPIST: It sounds like your yeah, I want to make sure we find a time that works.

CLIENT: Okay.

THERAPIST: So do you want to take a look at that?

CLIENT: Yeah.

THERAPIST: Great.

(Pause): [00:45:33 00:45:43]

THERAPIST: Sometimes my schedule is a little more flexible than others. My schedule these last couple of months have tended to be a little tighter but I wanted to see what we can do. Where do you go to school?

CLIENT: In Framingham, so that's just kind of a (unclear) thing. And I'm taking a lot of science classes so I have labs in the afternoon and I've been working part time per diem at Watertown Hospital just to get some hours for school but that's pretty flexible so that's where I can kind of tell them I can't work this I mean it's not -

THERAPIST: Well let me here are some times I have available. I have a midmorning time on Tuesdays at 10:50. I have a Wednesday, not this coming week but generally in the 10:50 time on Wednesday as well. Those are two times I have.

CLIENT: Those are two times I'm definitely out at school during those two times.

THERAPIST: So Mondays I don't have anything. Those are the two times I have on Tuesday and Wednesday. Thursday I have an 11 o'clock that is my Thursday time. And I have one or two times on Friday morning. That's what I have so far. What were you -?

CLIENT: I'm usually in school pretty much all day on Mondays, Tuesdays and Thursdays because I have classes like in the morning and then I'll have the lab for about four hours in the afternoon. But Wednesday afternoon and Friday afternoon are when I don't have the lab.

THERAPIST: The time I have on Thursday but you said it didn't work so well for you is that 5:30 time on Thursday because I do have that as an evening time.

CLIENT: See that the hard thing is I have a lab and you can't predict how long it's going to go. So it could end at 4 and I could be able to make it or I could it's hard to predict.

THERAPIST: Because I don't have any that's my evening time right now.

CLIENT: Okay.

(PAUSE): [00:48:07 00:09:17]

THERAPIST: Do you switch schedules every semester or is this basically it?

CLIENT: Yeah, no I switch every semester.

THERAPIST: Because what I'm seeing is if we can patch something together for this semester and then to revisit in January. It does not sound like our schedules are coordinating.

CLIENT: No, and I think it will be better because I have only one class in January so I think my schedule will free up.

THERAPIST: I hate when someone I'd love to work with you when someone needs treatment and I'm not available. I hate it (cross talk).

CLIENT: My schedule's really hard this semester.

THERAPIST: Let me see. So you're really only looking -

CLIENT: Actually so I know there are certain weeks that I know I don't have class because of the holiday. So the week of October 14 I think that's Columbus Day, so I wouldn't have chemistry lab on the 17th on a Thursday.

THERAPIST: Oh, I see what you're saying in October.

CLIENT: Yeah.

THERAPIST: We can take a look at that. My main thing for you though is I really think it would be important to meet with someone weekly. You've got issues that you want to work through and sort of and so and that's my main thing that I don't want to be meeting every few weeks. I don't think that would be in your best interests.

CLIENT: Okay.

THERAPIST: What time on Wednesday? What's the earliest that you'd be done on Wednesday?

CLIENT: On Wednesday I have class until 12:30 and then I have to just drive back here. So like 1:30 usually or 2.

THERAPIST: Because that's one thing I could do. I know starting like December I won't be able to do this, but probably for October and November I could probably do a mid-afternoon on Wednesday.

CLIENT: Oh, that would be great.

THERAPIST: I just couldn't sort of when I get someone in a time I like to say this is your time period.

CLIENT: Right.

THERAPIST: That's not something that I could do. I could make that work for a little while.

CLIENT: Great.

THERAPIST: So let's do that. Let me just take a look.

(Pause): [00:50:12 00:50:23]

THERAPIST: Would 1:30 be possible?

CLIENT: Yeah. I could try -

THERAPIST: Would a better one be 1:45?

CLIENT: Yeah. That's probably better because of the traffic pretty unpredictable.

THERAPIST: Let's do why don't we do this I can do 2:45 for this coming Wednesday and then I can start 1:45 starting the 9th.

CLIENT: Perfect.

THERAPIST: So 2:45 on the 2nd and 1:45 starting the 9th.

CLIENT: Okay, perfect.

THERAPIST: Let's do that. That sounds good. And my assistant will e-mail you a consent form with information about my practice and also a statement. So we can talk about the insurance. They're not letting out of network providers submit anymore which would mean you would need to submit it.

CLIENT: Okay. I'll just mail it.

THERAPIST: Exactly. Pretty simple.

CLIENT: Okay.

THERAPIST: Okay, great. So I think I said it would be $125 for today and I think I told you the co-payment would be $40.

CLIENT: Okay.

THERAPIST: Okay so we'll keep it like that then.

CLIENT: Okay.

THERAPIST: Okay. Great.

CLIENT: So do I just give you my card here?

THERAPIST: Oh, do you want to use your card? That's all right. I can do that and then yeah. Usually for the first visit I usually the people pay me at the time of visit and then we just do it monthly. For co-pay you can do it at the end of the visit, that doesn't matter as much.

CLIENT: Okay.

THERAPIST: I just write it down, my (Unclear) system. That's pretty straight forward. Okay, great. I can even send you the health insurance link with the claim submission form.

CLIENT: Okay, perfect. So I just need a receipt and just mail it.

THERAPIST: Okay. So I will see you next Wednesday at 2:45.

CLIENT: Perfect. Thank you for everything.

THERAPIST: Nice meeting you. Take care.

END TRANSCRIPT