TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi, come on in. Hi.

CLIENT: Hi. So things have been kind lately. So I'm just busy, so. [laughs] I just had like a lot of stuff going on with school, and then like interviewing for the new job and stuff, so I kind of just have been going a lot for the past like week. So I haven't really had a chance to like have anything affect me [laughs] or think about anything because I've been so busy. And I got some grades that I didn't like, and dealt with them and life in an okay way.

THERAPIST: That's-

CLIENT: Good. I kind of freaked out a little bit at first, but then did like the kind of tried to rationalize in my mind and have [Carla?] involved to talk that through, which was good. So that's like weighing on me a little bit less, although I'm still just kind of like going, going, going with school and stuff. And my parents are actually coming to visit this weekend too, so that just kind of throws stuff into it. But what I notice I've been doing this week which I think has been effective is working on like taking more control of situation instead of being passive. So like if someone asks me to do something that I don't want to do I've actually said no. Which that's like really, really a big deal for me because I never-I can't do that usually. And even like with my parents' visit this weekend, usually they like to say like, "Here's everything we want to do while we're visiting," or some things. But I actually just took control of it and sent them a plan for what we were going to do instead. So I kind of changed the dynamic from what it usually is. [3:00]

And I realize that makes me feel really good, to actually like say my opinion, or do what I want to do, instead of feeling really like resentful I guess. Because a lot of times if someone asks me to do something that I don't want to do, but I have trouble saying no to them, I'll do it anyway, but I'll feel-like really resent them and have all this negativity the whole time. And so I haven't-I mean, I only did it like a few times this week, which is big for me, so I haven't done it in like every instance. But it feels really-I realize that it feels really good, it feels like freeing kind of. So I think that's helped this past week to be a little bit better too, because that is almost like taking back control, and it feels nice, and sometimes it couldSo what I'm realizing is it could create enemies for me, I could displease people and make people not happy by saying no or asserting myself. But I'm trying to just realize that that's okay.

THERAPIST: Well, making people unhappy and making enemies seem like two different things. I mean, these are not-

CLIENT: To me in my mind it's not. So in my mind-not an enemy, but-well, in my mind someone really wouldn't want to be like friendly with you or associated with you if you make them unhappy. But that sort of goes back to me always wanting to please people that are my friends, that I need to be pleasing them. But actually, like for tonight we're invited to something with our group of friends that I don't really want to see, and I actually said-I did say no to them. And I just said I can't, I have too much going on. And that was really hard for me, because I felt like they were going to be upset that I wasn't there. But I just had to say no. Like I was just like there's-you know, there's been too much going on, enough is enough, I only have limited free time and I need to spend my free time the way I want to spend it and not give it to other people. And then someone at work had asked me to drive her to some random T stop after work, and it was really hard for me to say no to that, but I just couldn't do it, and I just said no. And I don't think she liked that, but I had to do it, and I felt really like relieved almost in doing that. [6:00]

And I think-I mean, that's the hardest thing for me, is I feel like by saying no to people and turning them down that it goes from just saying no to like they're going to hate me forever. And it's why it's been so hard for me to say no to people. But trying it out and seeing how good it feels. And I think the only reason I've tried it out is because I'm so busy with school that I realize that I had to just start, you know, making my time my time. But once I did it and realized how good it feels I really want to keep doing it. But it is hard for me to get past that idea that like if I don't do this, or if I don't help this person, they're just really not going to like me, like I'm going to make enemies by doing that.

THERAPIST: Does it feel like that's why you do things for other people? Do you feel like-

CLIENT: Mm hm. I don'tI think there was some point in my life where I enjoyed doing things for other people. But that morphed into I have to just keep doing stuff for other people because it's going to keep things like even and make everybody happy. Like the little girl that I mentor, I really have a hard time fitting in seeing her once a month. And it's something I've really struggled with, but I feel like I need to keep helping her. I mean, in this case I feel more like it's kind of like an obligation, but I feel like I can't sever that or say no to that obligation, even though a lot of times I'm like, "I don't have time for this, I don't know how I'm going to do it." But I can't say no, and I keep this relationship, even though there is issues with like her mom asking me to do too much, and I don't say no to her, and there's all kinds of stuff. But I feel this like sense of obligation. [8:30]

So I think I feel a sense of obligation to just help other people and do these things, and I don't get any enjoyment out of it at all because I do it so much. I think initially I used to do a lot of volunteer stuff and everything when I was like 14, and I really like it because I liked helping other people and seeing their reactions and that was great. But somehow that morphed into like my identity, and then it became like a job, instead of, "Oh, I'm helping someone else because I like to see them smile, or I like-", you know. It became, I have to do this or everyone's going to be really upset. Because I actually still-I drive other people to a different subway stop still from work that I haven't been able to say no to because I feel bad for them, and I feel like, oh, because they have to take a bus and two trains to get home I have to drive them because I feel so bad for them and it's my obligation to drive them. And if I don't drive them they're going to be really upset and they're going to resent me because they're going to have to wait for the bus, and they don't have a ride. And so I should really just take them every time, because if I don't it's going to just upset the balance and it's going to be really bad.

THERAPIST: Upset what balance? [10:00]

CLIENT: I feel like-upset a balance like right now they like me, and if I say no they won't. That's kind of how I feel.

THERAPIST: So they only like you because of what you do for them?

CLIENT: And that's a lot of-a lot of times I think that my friends only like me because of all these things that I do for them, and that that's what I give to the relationship, and that if I stop doing things for them they won't like me anymore. And I don't know. And I think that goes back to like lifelong having trouble making friends and trying to do anything for people to like you. "I'll do it, I'll help you with this, I'll do this, I'll do anything." And then I think that I kind of carried that. So I'm always like sending cards to people, or sending people flowers, like doing all the friend stuff for people, and I feel like if I don't do it it will make them not like me. Or it will make them like talk about me or something.

THERAPIST: I think that's such a sad way to feel about yourself.

CLIENT: Yeah. Yeah, it's hard. You know, I think that-so I think that's part of like what I'm trying to do, because in saying no, and in kind of like asserting my authority and my own opinion again, it's like I feel kind of like I'm taking back my self-worth a little bit. Because I actually noticed that this week I wasn't really thinking a lot of negative thoughts about myself. Which was kind of remarkable, because that hasn't happened in a while, so I was like, "Whoa, what's going on?" I'm actually thinking positively about myself. And I wonder-I feel like that's tied into taking back control. And I don't necessarily know how, but it's kind of like I'm owning who I am without doing, you know, some of this other stuff. But I'm still doing a lot of it. [laughs] [12:30]

Like there's still a sense that I do need to keep doing all this stuff, and if I don't do it, like thatthat's still there. But I think trying to start saying no when other people request something is like the first step. But I'm still doing all these things for people that they don't ask for. And that's like a pat[tern]-that's just something that I kind of like naturally do and feel like it's an obligation. And that probably will be the hardest thing for me to stop doing. But the easiest thing is like if someone outright asks for something or requests something to say no to that. And just realizing that that made me feel so good, I realize that I think if I work on this more it might help me a lot. But I think it's hard for me to like stop doing the things that I do for other people that they don't ask for. Because that's just me putting that on myself. Like I'm telling myself that it's an obligation and that I have to do it, and that if I don't do it people will hate me basically.

THERAPIST: Hm.

CLIENT: Yeah, I think-because I missed-I used to send people cards for every holiday that there was, and I got too busy and kind of stopped doing that. And we got like a card from my boyfriend's family for something, and I was like, "Well, I didn't send them a card. I can't believe I didn't do that." That's the first thing I thought, instead of thinking like, "Oh, it's so nice that they send this," I was like, "I didn't do what I was supposed to do because I've been too busy." And like today I realized that it's, you know, someone's birthday tomorrow and I didn't send a card yet because I've been too busy and I forgot. And so to me I'm like, "Oh my god, I can't believe that I missed this obligation. This was something that I had to do, and I'm like slipping up on this a little bit."

And so I want to become more relaxed and all that kind of stuff and not-and maybe-and be doing it more out of I'm sending them a card because I care about them, not I'm sending them a card because it's my duty to do that. Because, I mean, I think it's fine to send someone a card, but it's just sort of changing the thinking about it, because all of these different things that I do I'm not doing them out of enjoyment, I'm doing them because it's almost like it's my job, it's my obligation, this is what I must do. [16:00]

THERAPIST: So you sort of connect saying no with valuing yourself more?

CLIENT: Yeah. I don't know what it is, but it was something-it's something that's so empowering about taking control and saying no and saying what I think, and I don't do that very often. And I think it felt so good that I just started seeing myself in a different light almost. And yeah, I mean, and it almost feels like relieving to say no, it's soAnd I don't know if those two things are really connected, like valuing myself and saying no, but it seemed like the relief and the sense of empowerment and like self-awareness that I got from it helped me to just feel a bit better. And I don't know if they're really related, but it definitely felt like relief kind of washed over me every time I said no, or just kind of put something off, or-it kind of, yeah, it felt good to-

THERAPIST: There's something about control. I think that's really-you gravitate toward, you know, take control.

CLIENT: Yeah. There's something about feeling in control overall that makes me feel good. And I don't know, I have no idea why. But there is something about feeling in control of my own actions. And like even in terms of stuff with weight, feeling like I am not heavy because someone did this to me, I'm in control and I can also change this, because I have control over what I eat and what physical activity I do, and I know what I need to do to change it because I'm in control. Because I think in the past I've felt a lot of times like a victim sort of. Like, why me, why am I not like this other person, why do I have to do this, why-you know. But there is something about taking control that helps me. If I look at a situation from that perspective I think it helps me a lot in terms of like my mood and how I feel.

THERAPIST: When I listen to you I think, this is woman who needs a plan.

CLIENT: Yeah. [laughs]

THERAPIST: You'd like to have a plan.

CLIENT: Yeah.

THERAPIST: No plans is no good for you. [19:30]

CLIENT: No. Yeah, no, I always have to, yeah, have a plan. Like I very structure my entire weekend [sic]. Like I have to. But then I feel really good when I have accomplished everything sort of in my plan. And yeah, I don't-I mean, I sort of need a plan more lately because of school and making the timesheet work and things like that. But overall I just feel better if I go into things with a plan, because I think it goes back to the whole control thing. It's just I feel better if I'm thinking things through and ahead of the game. And I think that's also why I freak out if I don't know something on an exam, or if something's hard for me, because it's like I need to know everything going in, and my plan is to do well, and I need to likeAnd so it's sort of the fear of the unknown I guess, or like it feels chaotic if I see something on an exam that I don't understand. I need everything to be like understood and very clear. [pause]

Yeah, but I just have realized though that I feel so much better if I make these plans and I stick to them. Like if I-you know, I've been like studying in the morning, and then I work out, and then I go to-and I feel really good if I stick to my plan or my schedule. And if I don't, it's sort of like I'm trying to be a little more relaxed about it, but I'm constantly like revising the plan in my head I guess.

THERAPIST: Well, maybe one of the ways of thinking about sort of your coming here and our task together is that you need other ways to feel good about yourself aside from this one. [21:50]

CLIENT: Mm hm. Yeah. Because I think this-it's like the control and the planning has been the main way that I can feel accomplished, or feel good. And I think working out has been another thing that's helped. But there is not-I'm not sure that I can identify anything else that makes me feel good about-or I guess like if my boyfriend compliments me and, you know, things like that, or notices that I'm like really happy and like-and different, that helps. So [preens? 22:31] from others obviously makes me feel good about myself, but I'm thinking more in terms of stuff I can actually do, and the only two things I can think of are being in control and kind of sticking to the plan. And then exercising, and when I get that-but that's part of the plan too, and then when I get that done I feel good. [pause]

THERAPIST: And it's a lot about doing, you're not being.

CLIENT: Yeah. Because I think that I feel like being, just being, is unproductive and-

THERAPIST: Right, I can see that you think being is not doing, that that's what being is.

CLIENT: Yeah. Yeah.

THERAPIST: Being is not some category.

CLIENT: No. Yeah. And so I don't see that as accomplishing anything, because I can't justify not-well, not doing an activity or something, just sitting calmly. So do you mean more in terms of like thinking of like mindfulness kind of techniques to feel better?

THERAPIST: It has nothing to do with techniques.

CLIENT: Oh. Okay. [24:00]

THERAPIST: No.

CLIENT: Just being happy with yourself, just...

THERAPIST: It's hard to escape it, right?

CLIENT: Yeah. [laughter]

THERAPIST: So the question is, how do you formulate being as a plan?

CLIENT: I don't know.

THERAPIST: Well, that's what I'm saying. That's sort of the problem you're trying to solve, which reiterates the problem in a sense.

CLIENT: Yeah. I mean, and I've always thought about putting like meditation or something into my day, but I don't know if that's kind of like another activity.

THERAPIST: Well, it's almost like you're talking about ways to get around how you feel about yourself.

CLIENT: Well... yeah. So I think I see it as like constructively doing things to help me to feel-to improve my feeling about myself, because I know that like at a baseline I don't feel very good about myself. And so then it's like starting from there I feel like I need to make a plan to do things to improve that feeling and keep that high level of, you know, feeling good. But I feel like if I stop doing those things it will go back.

THERAPIST: I mean, it's that baseline that I think we need to-

CLIENT: Mm hm.

THERAPIST: -talk about, think about. [26:00]

CLIENT: Yeah. Yeah. And I don't... Because I don't-I feel like mentally I can't understand changing that feeling without like doing stuff. Yeah, like I can't-I guess I can't understand changing that without having some kind of like a plan, or doing different things. Or like journaling, or, you know, having some techniques. I don't know how to just change it. Like I don't mentally understand how to do that.

THERAPIST: Well, I think in terms of changing it, the first thing is know it. Like it seems like there's a way in which you almost distract yourself from knowing how you feel. You're also trying to improve how you feel, so I understand it's not-it's a little [overtalk] in that.

CLIENT: Yeah. Mm hm.

THERAPIST: But it's also a distraction from knowing how you feel.

CLIENT: Mm hm. Yeah, probably, yes. And-well, I mean, but sometimes when I like check in I notice that I do feel better. Like this week when I sort of would check in or whatever I noticed, hey, I feel really good about myself this week. Even though, you know, bad stuff happened, but I'm still okay, and I noticed that change when I sort of like checked in. But do you mean more like just checking in more often how you feel? I don't know. [28:00]

THERAPIST: Well, I guess ultimately it's about not feeling like you need to do anything in particular-

CLIENT: Yeah.

THERAPIST: -to get people to like you or for you to like yourself.

CLIENT: Yeah. I mean, I think that I'm becoming more okay with myself, but I'm still allowing what I see as other people's perceptions to affect how I'm feeling. So I could-the way I'm feeling could be evolving, but I'm still letting external factors affect that. And so it's like trying to figure out how to block that, or not worry about it, or, you know, just worry about me. And that's really the challenge. Because it's like-I feel like it's a pattern of behavior that I've been doing for so many years that it's really hard to-I mean, so for me the first step is kind of like this my like mindfulness of what I'm doing, and saying no. But other than that it's like it's a really hard pattern to break. And it's almost like I don't know where to begin I guess.

THERAPIST: When you say other's perceptions, you mean your understanding of other people's perceptions, or... [29:50]

CLIENT: Yes. And-I mean, they might actually have a negative reaction, or they might not, and I might still think that it's going to-like ISo it's definitely my understanding, because for them it could go either way. But it's sort of just-it just comes down to not caring what other people think. And I've been caring about what other people think for so long that not caring is like-it's almost like I don't know how to do it basically.

THERAPIST: Well, it's not just simply caring, it's worrying that they think badly of you.

CLIENT: Yeah.

THERAPIST: It seems like caring about what other people think of you in general's not a bad thing.

CLIENT: Right.

THERAPIST: To be sort of attuned to that on some level.

CLIENT: Mm hm. Well, that's what-I mean, people always say, "Oh, you have so much empathy. You're really good at reading people. You can always kind of assess how someone else is feeling." But it's me assessing how I think someone else is feeling and then putting that back on myself that's like I-I'm always putting the blame on myself for how other people are feeling. I think that's, you know, part of the issue too, is that, well, if this person's angry or sad it must be because I didn't send them a card, or didn't do this, or didn't-it's all my fault for how they feel. I think that's kind of the overwhelming issue, and I sort of struggle with figuring out how to break that cycle of thinking.

THERAPIST: Well, it's a particular kind of vigilance too.

CLIENT: Mm hm.

THERAPIST: It's like a need to know.

CLIENT: Yeah.

THERAPIST: It's a vigilance. [32:00]

CLIENT: Yeah. Because I guess if I wasn't so aware-I don'tI mean, yeah. Because as soon as I do do something like say no, I'm like waiting for the reaction, and worried about the upset that I think will follow. Instead of just saying no and going about whatever I wanted to do, it's like that extra step I guess that's been there for me. But I need to try to not [inaudible].

THERAPIST: You're assessing the damage.

CLIENT: Mm hm. Yeah. Yeah, and I pretty much do that with everything. And so it's like-I think that's where a lot of the worry comes from, which I think contributes to the anxiety. So there is like this little anxiety, but then the overwhelming thing is like the worrying about what's going on with everybody else, and what I did to cause what's going on with everyone. That's-that kind of like-that's I think the main cause for the anxiety and the worry, because it literally is like carrying the weight of the world on your shoulders, because I feel so responsible for what's going on with so many people, and I'm not responsible for it.

THERAPIST: Well, and there's something about your own survival that's at stake too. [33:40]

CLIENT: Mm hm. Yeah, it's sortWell, yeah, because it's sort of my own well-being will be negatively affected if someone else is feeling negative about something and I think that I caused it. It sort of like eats away at me. So yeah, I mean, I think that's where a lot of the anxiety issues that I've been having have been coming from. And so, I meanSo I'm kind of-I'm aware of that, but when I quickly have these thoughts, like what's the other person thinking, I lose some of my awareness because I automatically just go into that thought pattern. Where, I mean, I think if I tried to be a little more mindful in those situations and change my think[ing]-like try to think about something else it would help. But I just-I almost don't know how to make that step. Like I almost don't know how to break that pattern, cycle.

THERAPIST: Well, you don't know, otherwise you'd be doing it.

CLIENT: [laughs] Yeah. Yeah.

THERAPIST: And it seems like it's so hard not to know how to fix something.

CLIENT: Yeah. Yeah. Because I like to have-it's like I like to have the answers, and it's really hard to not have the answers. So it's really frustrating, and it's also frustrating to be aware-I guess to be aware of the situation but not know what to do about it. Other than, okay, I know like saying no was a good, you know, first step, but I don't know where to go from there. I can try that more, but it-you know, there's other thoughts involved with saying no, like worrying about what the other people think when you do say no, even if you did. So it's like, how do you just stop those thoughts from happening? And I think that's another reason I try to keep really busy, is because if you're really busy then you can't think. [36:35]

THERAPIST: And just try to distract yourself.

CLIENT: Yeah.

THERAPIST: Well, this will definitely be one of the challenges of therapy for you, to be aware of things that will not have any clear cut answer, at least right away.

CLIENT: Yeah.

THERAPIST: I think it'll be hard.

CLIENT: Yeah. Yeah, it's hard. Yeah, because to me there always has to be like an answer or a solution for everything. Like, you know, if you have a really difficult chemistry problem or a medical question or something you can look it up and there's an answer for it. And so with something that's more mental, or say logical, and there's not really a necessary answer, that's really hard for me to deal with that more abstract kind of thinking. Yeah. But, I mean, I feel like what has been good though has been being more self-trying to be more self-aware, at least in certain moments. Because it doesn't happen all the time, but when I am able to realize like my thought patterns, or why I'm thinking something, or how I'm thinking about it, it is good because it helps me to kind of reflect and work on that a little bit. But it definitely doesn't happen all the time, because often I just get caught up in thinking the way I've thought forever. So it's hard. [38:20]

THERAPIST: And the thoughts are often products of feelings that you have that you may not understand or know what to do with or-you know.

CLIENT: Mm hm. Well that's-I mean, I think that I took a feeling of having low self-worth from when I was a kid, and I don't think I ever fixed that, and then that just kinda carried through. But like, you know, other things happen in between on top of that to change and have these ups and downs to that. The main issue that happened a long time ago that I think everything's probably stemming from was never addressed really. And so I've been coming to terms with-like I don't know if working through stuff that happened when I was a kid would help, but it might a little bit.

THERAPIST: I think that's a very accurate assessment.

CLIENT: Yeah.

THERAPIST: And I think working through some of those things will absolutely help. And they're not only in the past, they're a living present, they live inside you now.

CLIENT: Yeah.

THERAPIST: It's not only just going back to the past.

CLIENT: Yeah, for sure.

THERAPIST: It makes you sad to think about this. [39:40]

CLIENT: Yeah. [crying slightly] It makes me sad because I wish that-I wish I had taken care of it when I was younger. Like I wish someone had realized what was going on. But... Because I think that would have helped a lot. Yeah, it just makes me sad to think about like me having all these struggles and going through so much when I was younger, and like stuff that kids did to me. And it makes me like almost like sad, but also angry, that like no one did anything to recognize it or help me with it. Because it's sort of upsetting to have something that happened like years ago just kind of like stay with you and like-and negatively impact your self-worth and your adult life. So I think it makes me sad to think about. Because to me I'm in a much better place now then I was when I was a kid, and it makes me sad to think about how down I was and how much I was going through, and that no one like realized I guess.

THERAPIST: That is really sad.

CLIENT: Yeah. [pause] Yeah, because I mean, that's-it's definitely where everything comes from, and there's only so much-there are only so many negative things towards you that people can say before it starts to make you feel like that is your self-identity, especially when you're really young. And so I think that the self-identity that I created from all of that when I was a kid, even though now it's like I have all these friends and successful and all this stuff, I can't really see all of that because I still have that self-identity that I created when I was a kid based on stuff that other people were saying to me that was negative. [pause] Yeah. [42:30]

THERAPIST: Because that's clear, you not only try so hard with your self-improvement, but there's a way in which it seems like you have to do it on your own, like you're all alone in this.

CLIENT: Yeah. Because I think, you know, as a kid I did feel really alone. And oftentimes I was just alone in my room trying to write in my journal. And I remember like I think Oprah had a show about gratitude journaling, and I just started doing that like on my own when I was like 13 or 14. Like I would take all these different things and try to stand on my own, and cry or work through stuff orThere was a lot of-there was a lot of time spent on my own trying to come up with plans for how I could make things better, whether it was like lose weight, feel better about myself, or just how can I make friends and how can I get people to like me. And like one of those plans was when I decided to stop talking in class and stuff when I was like 14. [43:50]

So I would keep coming up with these plans of how can I get people to like me and how can I change. But everything was very much like me on my own, there wasn't, you knowAnd I would tell my parents, you know, "Someone said I was fat," or someone said this. They would just say, "You're beautiful." You know, obviously positive things, but they wouldn't really do anything else about it. So it really was just me against the world trying to figure out how to deal with it, and how to survive the social situations, and how to feel better about myself.

THERAPIST: That is the weight of the world on, you know, a kid's shoulder, a girl's shoulder.

CLIENT: Yeah. Yeah, so that's just how I felt then. And I think just all of those behaviors and the way that I felt about myself then, I just-I mean, I've just carried it through. So even if I have all these friends, I think a lot of times I'm also scared that they're not real friends. Because as a kid there would be friends that I had that were mean, they weren't real friends, and it was kind of like they wanted to poke fun at me or whatever. And so that mistrust in your friends, or that, "Why are they really friends with me? I need to do all this stuff to keep them as my friends." Even though I know that that's not still the case, and I know I don't need to do that, and I know that I've made friends with good people, I can't stop feeling that way. Because when I first made friends as a child these were the techniques that I used, and I can't-it's hard to stop those behaviors. [46:15]

THERAPIST: Well, your solving that in some ways is still a problem, but not really, it's a very different kind of problem because it's now an internalized problem, not a problem with you and your environment.

CLIENT: Yeah. That's-so that's the issue, it's almost like you've done this practice for so many years that it's all that you know. Like that's the only way that I know how to make friends or interact with friends. Or anyone I guess for that matter. And I don't know how to do things differently.

THERAPIST: Well, no, that's-I'll end on the note of that's why you're here.

CLIENT: Yeah. Yeah.

THERAPIST: We do need to stop [overtalk].

CLIENT: Okay.

THERAPIST: And so I will see you on Wednesday.

CLIENT: Yup.

THERAPIST: Okay.

CLIENT: Thank you.

THERAPIST: Sure.

CLIENT: Thanks for rescheduling this week too.

THERAPIST: Sure.

CLIENT: That was like a long time thing.

THERAPIST: Sure, glad it worked out.

CLIENT: Yeah, it did. [unclear]

THERAPIST: [unclear] it's awesome. Okay, take care.

CLIENT: Thanks, you too.

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