TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi, come on in.

CLIENT: Hi.

THERAPIST: Welcome back.

CLIENT: Thank you.

THERAPIST: So how are you doing?

CLIENT: I am okay. I was feeling really good after we met on Friday, but on Saturday I found out that like a friend was engaged, and I have really bad reactions to other people getting engaged, I have a lot of like jealousy and stuff about it. So I started feeling really, really, really down over it. And I noticed that that set off a chain of, you know, putting myself down, and sort of all of those behaviors, and it’s probably taken me until about this morning to like recover from that. So almost what happens is I feel so sad, and so down, and so jealous and angry, there’s all these kind of feelings that come up over it, that it takes me a long time to feel like I’m back in control of my feelings. So I definitely realize that that’s—it’s a trigger for me, that I notice that when something happens that’s almost a trigger it sort of sets off this reaction of like really putting myself down, and comparing myself to other people, and it takes me a while to sort of come out of it and talk myself back up into like a normal state. So I thought that would be good to talk about actually, because it’s obviously something that happens and I need to be able to deal with it.

THERAPIST: So what do you feel jealous about when you think about it? [2:45]

CLIENT: Well, so usually what initially happens is I feel like, oh well, either they’re younger than me, or they haven’t been with their boyfriend for as long, like all of this kind of stuff. And then, you know, with this particular friend I was like thinking, you know, she’s skinny, she’s perfect, she has it all, now she has this. I’m nothing, I look sloppy, I don’t look the same, and I’m not engaged. Like so I have everything wrong and she has everything right. So it’s like this comparison with other people, it’s like checking off these boxes kind of.

And then once that starts it’s not just even about the person that’s engaged, to like we’re at another friend’s for dinner and they have, you know, some new car, or she was doing some workout. It’s just comparing yourself to everybody in general. It sort of sets off this like checking off of boxes. “Well look, she has this, I don’t. She has—” You know. So it sort of starts with that, or with the idea of the engagement and feeling like that’s something I don’t have and they have it, and I should have had it before them. And then it goes into like appearance stuff, or just even like, you know, their house looks more in order than mine, it’s cleaner. Then it sort of spirals into like all kinds of comparisons.

THERAPIST: It sounds exhausting.

CLIENT: Yeah. And I feel like it really took me several days to come out of it. Because I’ll just feel really down and just be putting—I’ll look in the mirror and put myself down, and just putting myself down all the time. And like last night I was supposed to go out for an old coworker’s birthday, but I didn’t go because I didn’t want people to see what I looked like because I thought that I looked so bad. So it takes me— And then this morning I kinda like tried to make—if I make schedules for myself or do different things it helps me to come out of it because I feel more in control, so I tried to do that, and then I feel better and more positive. But it took several days to bring myself out of it. [5:30]

THERAPIST: No, I can imagine that there’s a lot of triggers then.

CLIENT: Mm hm. Yeah. I mean, I think a big trigger would be like other people either getting married or having babies. Like those are two things that makes me feel like I’m behind, or like I’m comparing myself to other people. And the whole like Facebook thing doesn’t really help because people are always posting all this different stuff about what they have or what they’re doing. So if you see that you’re saying, “Oh, now someone else got engaged. Yeah, someone else is doing this now.” And so it’s a lot of stuff like that where it kind of brings out these feelings that I’m having and makes me feel really like negative towards myself. And then it like—with the whole engagement thing it also makes me feel really angry towards my boyfriend, because—

THERAPIST: For not proposing?

CLIENT: Yeah. So it makes me feel like, “Look what you did, now there’s another person. And now if we even got engaged it wouldn’t be the same because it’s already all these other people did it.” So it’s kind of like I feel negative towards him for no—he didn’t do anything, it’s just because of someone else. So I want to be able to stop comparing myself to other people, because I think what it’s doing is just making me put myself down a lot, and making me set some like unrealistic expectations for myself too. And I like to be able to like not immediately sink into that really, really, really sad, jealous, angry place, I would like to be able to talk myself out of it. [7:40]

Because ideally I want to be happy for other people, but every single time I’m not. I mean, I can’t, I just sink into this— Like a couple—or I guess like a—a couple years ago? yeah—when my boyfriend’s sister got engaged, I was in my basement crying. Like it’s just every single time it’s happening. So I want to be able to just not have it happen anymore, just not go to that dark or—place.

THERAPIST: Well, I guess if it’s just—if everyone is on one ladder, one person up means that you’re one down.

CLIENT: Mm hm.

THERAPIST: It’s sort of like—

CLIENT: Yeah. Yeah.

THERAPIST: If that’s sort of the framework.

CLIENT: Yeah, I think that’s—even if I see someone that like lost weight or something. like that then it’s like they could do it but I can’t. It’s like always—there is always they’re up here and I’m, yeah, like down here basically.

THERAPIST: Well, it sounds like, if I understand correctly what you’re sort of describing, all the thoughts—

CLIENT: Yeah. [9:00]

THERAPIST: Is there’s both—you mostly feel—feeling down on yourself. But it seems like it starts to feel like, “I should have that.”

CLIENT: Mm hm. Yeah.

THERAPIST: And then it goes to, “I must be crap.”

CLIENT: Mm hm.

THERAPIST: “If I deserve that too, I must be crap.”

CLIENT: Yeah.

THERAPIST: So it’s sort of they’re both in the kind of—maybe like in dynamic tension with each other, I’m not sure.

CLIENT: Mm hm, yeah. That’s definitely what happens.

THERAPIST: Mm hm.

CLIENT: At first it’s, why don’t I have that, and then, here are all the reasons that I don’t have that. And in addition to me not having that, yeah, like here are all the problems. This person looks put together, I don’t. This person— You know, so it’s just this kinda whole thing.

THERAPIST: This might be a funny way of putting it, and I’m not implying that this would be intentional, but I’m wondering—like going to that place about like, “Oh, something must be wrong with me,” it distracts you from staying angry.

CLIENT: Mm hm.

THERAPIST: You know, and rather than being like, “I’m just so angry. I want that too.”

CLIENT: Yeah.

THERAPIST: Right. So it’s almost like then you’d be—you know, it moves you away from being angry—

CLIENT: Mm hm.

THERAPIST: —[overtalk] that’s part of the function. Like that maybe it’s even harder to just be angry.

CLIENT: Yeah, it could be. And I think a lot of it—well, I think of where it comes from too is like in the past when I’ve had these conversations with my boyfriend a lot of it is centered around reservations he has based on my behavior, or based on me. So I think every time it happens I think that could also be why I immediately turn to looking at myself, because of these conversations that we’ve had, and because I feel like, well, it must totally be on me, and if I was more together, or if I had it more together, then it could be me, but I don’t.

THERAPIST: So is it then a frustration with yourself, like why can’t I just be better? Whatever that means, I don’t know. Or like why can’t he give me what I want? Or…

CLIENT: It’s more—it’s become more why can’t I just be better. I think it used to be more of like why can’t he give me what I want, but now I think that I—I get a bit angry at him, but I almost do turn it around on myself, because I need to be in control of everything. And so even though it’s something that he would be doing, there must be a reason like that I am controlling that’s prohibiting him from doing it. Because I think I need to find blame or ways of controlling every situation, or—yeah, like basically blame myself for everything. So I think it’s a way of putting the blame back on myself. [12:00]

THERAPIST: Right, but if someone is to blame, yourself or anybody else, that implies that things could have been different or things could have been controlled. Versus like, no, there’s no one to blame, it is what it is.

CLIENT: Mm hm. Yeah.

THERAPIST: Yeah. What kinds of behaviors has he said gives him reservation?

CLIENT: So a lot of it has had to do with me being so down, and down on myself. So a lot of it has to do with, you know, coming in the door and immediately being negative about something that happened during the day. Or, you know, not being able to accept compliments, or like looking at myself and saying negative things. So it’s a lot of very negative behaviors that I’ve had because I don’t feel—I think don’t feel good about myself, or can’t always be very positive. And so that’s pretty much all of it. You know, he would say like he’ll come in the door from work, “and instead of saying something positive you always have something negative to say or a complaint.” Or, you know, “You’re just being so critical of yourself and putting yourself down and doing all this stuff.” And by me acting that way he says that it puts him in like a dark or more depressed—just not like a very happy place basically.

THERAPIST: And when he said that to you how do you feel?

CLIENT: I mean, I feel like—in a way I was glad that he pointed out certain things. Like, I mean, like coming in the door and being really negative, it’s something that you can just sort of be conscious of and just think like, no, you know like. So in a way it was good because it helped me to be more reflective, but in other ways I felt like, well, you’re supposed to kind of be there for me and help me through this and be understanding that I’m having a difficult time, and it’s hard that—it’s a lot of pressure to have to be up all the time to keep someone else up, even if maybe you’re just really not feeling great.

THERAPIST: I would think so.

CLIENT: Yeah.

THERAPIST: I mean, I would think so. If you’re having a hard time and your boyfriend says, “You’re really a downer for having a hard time. Can you not have a hard time?”

CLIENT: Yeah.

THERAPIST: I know I’m [overtalk].

CLIENT: No, but it’s—yeah, but it—

THERAPIST: Or a little bit maybe exaggerated. [15:00]

CLIENT: Mm hm. No, but it’s a lot of responsibility to feel like your mood is going to determine the other person’s mood. And I have been in—I’ve had more prolonged good moods I think since leaving my job, but there are still these times that I get into this darker place. And so it’s really stressful to think like, if I don’t bring myself out of this dark place then there goes all these months of positive feelings and we’re back to square one with the negative feelings, and now I have to wait another year to get— Like so that’s sort of how I feel like I can’t have these bad periods, because then it just tacks on more time. So it’s a lot of pressure I guess to try to hide when I’m not feeling great, but it’s kind of hard to do when you live with someone, so.

THERAPIST: I would imagine.

CLIENT: Yeah.

THERAPIST: Are there times where he soothes you or makes you feel better?

CLIENT: Yeah. I mean, but I think that he tries to. But also sometimes if I’m really being down he kind of walks away because he doesn’t know what to do. More out of frustration. Like he’ll say, “I don’t know what to do when you feel like this, I don’t know.” You know, kind of like throw your hands up, “I don’t know what to do anymore.” So I think also because if I’m crying he doesn’t like to see me cry, it’s too hard for him, and I think he doesn’t know how to handle it really. Yeah. So I don’t think there’s a lot of things he would do to comfort me more out of frustration than anything else I guess. [sic]

THERAPIST: What parts of your relationship work? Because this sounds like a part of your relationship that doesn’t work.

CLIENT: This is just, yeah, one part that doesn’t work. But then in general I would say everything else works. Like we have, you know, great conversation, we’re really on the same page about traveling and doing different things together, and we have a lot of fun together, and when we’re just having, you know, down time or cuddling and stuff like that, that’s really good. So when we are doing more of that stuff it’s really, really positive, and we’re in synch about how we feel about a lot of things. [18:00]

But the one area that we’re really not is just I guess me being down and my relationship with myself. And then the ideas about marriage. Because I believe in God and he doesn’t, and so the one area where that really comes into play is with marriage stuff, because he feels like you should just do it legally to have kids, and I feel like it’s a little bit more than that.

THERAPIST: Well, you would think you could not believe in God and still think that marriage is beyond a legal contract.

CLIENT: Yeah. I think that he thinks it’s a religious institution. So that’s why I don’t think—he says that, you know, “I wouldn’t be with you if I didn’t love you. And by being with you in this relationship, to me that’s how we show our commitment to each other.” And, I mean, his dad’s been married three times, so I understand where some of these reservations and some of these things are coming from. And his mom almost split up with her long-time partner a few years ago. There’s a lot of things that are telling him that marriage doesn’t work out I think.

THERAPIST: [sneezes] Excuse me, I’m just getting over a cold.

CLIENT: Oh, that’s okay.

THERAPIST: Sorry about that.

CLIENT: No, that’s okay. So yeah, I think there’s a lot of signals and different things that are telling him that marriage doesn’t work. And with his dad’s second wife, she kind of raised him, and she went into some kind of depression sort of crisis with herself and that’s what led to their divorce, and that really affected him. And I think part of him is saying well, if you’re doing this now, what are you going to do when you’re older, like what’s going to happen? So I think that’s a lot of it. But it’s still hard for me to feel like it’s all me.

THERAPIST: Well, I can certainly help you frame that part differently. I mean, of course it’s not all you, it’s about how your moods make him feel, and what he can and can’t do. So it’s a dynamic between the two of you, it’s not your fault.

CLIENT: Mm hm.

THERAPIST: But it sort of feeds into your feeling that it’s your fault. And I guess if it’s your fault it’s also maybe within your control, versus your moods and how he can and can’t manage them. There’s really no reason that someone’s mood necessarily affects another person.

CLIENT: Yeah.

THERAPIST: I mean, that’s not inevitable.

CLIENT: Right.

THERAPIST: Something’s going on inside of him.

CLIENT: Mm hm.

THERAPIST: I mean, he cares about you obviously—

CLIENT: Mm hm. [21:00]

THERAPIST: —but for those moods to be overwhelming and for him to feel like, “Well, you just can’t feel that way,” something is going on inside of him that he’s struggling with as well.

CLIENT: Mm hm. Oh yeah, yeah.

THERAPIST: And maybe you know that logically, but I guess emotionally it doesn’t feel that way.

CLIENT: Mm hm. Well, I definitely know that there are things going on inside of him that I’m sure he was affected by different things that happened in his childhood and has never really addressed them. So I know that a lot of actions or the things that he’s doing may be because of that, but he’s not willing to—you know, he says that his stance on marriage has nothing to do with his parents. So if someone isn’t willing to acknowledge that certain things might be affecting their behavior, or like they might have something going on, then you kind of just put it all on yourself. Because that’s the only thing that I feel like I can change, is me. And I feel like I can’t change a lot about his view of the world, because it is what it is. And in a lot of ways his view of the world works with mine and it’s fine, and it’s just this one area. And I don’t want to think that I can change him, because I know that I can’t. So I think that’s why I just keep looking at myself to figure out what I can change to make things work.

THERAPIST: That still doesn’t mean it’s all your fault.

CLIENT: Yeah, I know.

THERAPIST: I feel like there’s a big difference between sort of recognizing your partner’s limitations and realizing that if some dynamic is going to change you may need to be the one that makes the difference. Versus, well, this is all my fault—

CLIENT: Yeah. [23:00]

THERAPIST: —which is a very different kind of thing.

CLIENT: That’s true. Yeah.

THERAPIST: Do you feel like those things get lumped together for you?

CLIENT: Mm hm. Yeah, I mean, in almost every situation I think that things are my fault. So, you know, even in a work situation or anything I’m very overly critical of myself because I’m always willing to take the blame or think that something’s my fault, or think that I could have done something better.

THERAPIST: Like if only?

CLIENT: Mm hm. Yeah, there is a lot, there is a lot of that. But, I mean, that feeds into my weight and everything. Because I think, if only I hadn’t gained those first 10 lbs. then it wouldn’t have kept happening and then I wouldn’t be here. Or if only I hadn’t eaten cheeseburgers in college this wouldn’t have happened. So there is a lot of those kind of thoughts. Like I know that I need to move forward and deal with what’s already happened, but there is a lot of I could have done this better and then none of this would have happened, and then everything would be better and I would be more of this ideal person that I—or I would be just as good as everybody else is.

THERAPIST: There’s a term for it in the field which has a very—a pejorative term, but it’s called pathologic regret.

CLIENT: Mm hm.

THERAPIST: It sounds like a very—

CLIENT: Makes sense, yeah.

THERAPIST: It makes sense. It’s a very pejorative term.

CLIENT: Yeah.

THERAPIST: But this is—the sentiment is just like—in a sense like living in the past.

CLIENT: Mm hm, mm hm.

THERAPIST: Which is hard to kind of—there’s a feeling that you get of control over things, and I guess there’s a hopeful aspect of it in that sense, but it’s really kind of a position of despair. Like any change that could have happened you, you know, missed the boat.

CLIENT: Mm hm.

THERAPIST: So there’s not like a forward looking “let me see all the things that could be ahead of me that are really good.”

CLIENT: Mm hm. Yeah. And I think I’m trying to look forward in terms of career and all of that, but I think that in terms of like marriage and stuff I sort of have turned that off and stopped myself from looking forward, because I feel like that leads to disappointment. So there was a time where I would, you know, picture all this stuff, and plan different things, and now I just try to shut if off because I feel like it’ll almost like get my hopes up in terms of that. [26:00]

And then in terms of weight stuff, I try to look ahead, but then every time I come to a point where when I was looking ahead I should have already lost 10 lbs., or I should have done something. Then it’s sort of like, well, obviously it’s not going to happen, I shouldn’t set goals or look ahead or be optimistic about my weight because it’s not going to change, and if anything it’s going to get worse.

THERAPIST: Kind of this catastrophic—

CLIENT: Mm hm.

THERAPIST: —like it can only get worse, it can’t get better.

CLIENT: Mm hm. Yeah.

THERAPIST: Well, that’s not good.

CLIENT: No.

THERAPIST: We have to [overtalk] about that.

CLIENT: Yeah.

THERAPIST: Stop coming to therapy like that, be more positive!

CLIENT: Okay.

THERAPIST: I’m teasing, that was supposed to be a joke.

CLIENT: All right. [laughter]

THERAPIST: It’s only a joke. Please, please, that was a joke. [27:00]

CLIENT: Yeah, so… Yeah, I just want to like move past all of this negativity, and just I want to try to put all of those thoughts that I have, like sort of reverse them or turn them around, because it can ruin days at a time when I’m feeling so horribly about myself. And then the other thing too is a lot of times when I do feel badly about myself I will put on a little bit of weight. And I weigh myself a lot. And so I feel like seeing a bad number on the scale makes it even worse, like it triggers those thoughts even more. Whereas seeing a good number on the scale makes you feel more elated or happier.

Because I actually did go through a period where I tried not to weigh myself, because I felt like my mood was really tied to weight. But then during that period I actually gained weight because I wasn’t keeping track of it. So I need to work on finding the happy medium between, you know, weighing yourself for medical reasons, or just to keep track of it, and having your whole mood be tied to what’s on the scale. Because that definitely brings me like way down, and it makes me really, really critical.

THERAPIST: And do you gain weight when you feel badly, or are you just eating more like to comfort yourself?

CLIENT: Probably. Certainly I don’t think about food as much or in such a negative way when I’m feeling better. And like I noticed on Saturday, we were out for Mexican food and I was like—the chip basket. Like just that comfort because I was feeling so upset. So I think I sort of get completely out of control with everything. So I think it includes food, but it also just includes feeling like everything in my life is not in my control. So I get into a place where I’m not as aware of what I’m doing almost. So I think that’s what’s happening more with the food and the overeating when I’m feeling down, because I’m almost shutting off the awareness portion of my brain and I’m just not even paying attention to what I’m doing really.

THERAPIST: One thing—I can’t remember if we talked about this last time, in terms of medication, if you’ve ever been any anti-depressants or any [inaudible]. [30:00]

CLIENT: I haven’t, and I don’t want to be. I would like to be able to just like exercise, or positive thinking, or affirmation. Like something—I want to be able to use other reflective tools. Just because some of my friends have had really bad reactions to medication, so I want to try on my own, you know, to kinda deal with things. But I haven’t ever taken anything.

THERAPIST: That’s not surprising that you want to do it on your own.

CLIENT: Yeah.

THERAPIST: I do—you know, it’s very much of a chicken and egg problem. When people feel depressed they think very negatively.

CLIENT: Mm hm.

THERAPIST: But when people think very negatively they get—you know, you can feel depressed. And so, you know, what comes first [overtalk].

CLIENT: Right.

THERAPIST: But I would like to—I mean, I want to know—you know, I don’t think medication is the answer. If I did I’d be an M.D.—

CLIENT: Yeah.

THERAPIST: —which I don’t want to be doing. But in the last year or so I’ve thought about this more and more, about med—yeah, almost about medication as sort of treated—taking medication as you would a medical illness.

CLIENT: Mm hm.

THERAPIST: Not to say that I think you’re ill by any means.

CLIENT: Mm hm.

THERAPIST: But you’re depressed. You definitely have— And so I don’t like to see that untreated. I think psychotherapy is wonderful, and I think we could do a lot of work together, but I worry about this not getting treated and in a sense delaying your progress.

CLIENT: Mm hm.

THERAPIST: So I do want to put that out there.

CLIENT: Does the medication make you gain weight? Because a lot of my friends have gained a lot of weight.

THERAPIST: I figured that that would be one of the things that you would ask. And really I don’t like to talk too much about the specific medications because that’s why I refer someone to a consult, because it’s really not my area of expertise.

CLIENT: Oh, okay.

THERAPIST: But I’m happy to answer some of the questions. But, you know, I’m not a physician.

CLIENT: Okay.

THERAPIST: But that’s first of all not—there’s medication—like SSRIs, which a lot of people are on, Celexa, Prozac and so forth, people do gain weight. There are anti-depressants where people don’t gain weight. So it depends on the anti-depressant. The other thing is, when people feel less depressed they often—they can lose weight.

CLIENT: Yeah.

THERAPIST: If they’re feeling less depressed. So some medications do have the side effect of weight gain, but not all medications do.

CLIENT: Mm hm, okay.

THERAPIST: So that’s not—that wouldn’t be inevitable.

CLIENT: Mm hm. And do you feel like when someone’s on them they have to be on them forever though?

THERAPIST: No.

CLIENT: Okay. I just don’t—

THERAPIST: Well, that would be your concern?

CLIENT: Yeah, I just don’t want to have to be taking something forever. I want to be able to do this on my own and like come out of it sort of on my own and not have to rely on something else I guess for a really prolonged period of time.

THERAPIST: What does “on your own” mean? [33:00]

CLIENT: I guess like I want to be able to have different practices or different—change my way of thinking. Or maybe like have more of a schedule, or keep—I don’t know. I just want to be able to use different techniques that aren’t medicine and be able to I think practice those techniques forever I guess. And have that be something that I’m doing or that I’ve changed or that I’ve developed or fine tuned, rather than just taking medication forever I guess.

THERAPIST: Yeah, I don’t want you to feel like I’m pushing medication on you at this point.

CLIENT: No, no, no. Yeah.

THERAPIST: But it seems—like my thought in terms of what you were saying for that, and it really relates to one of the things you talk about, not everything is under our control.

CLIENT: Yeah.

THERAPIST: We have brain chemistry that is what it is.

CLIENT: That’s true.

THERAPIST: It’s not always under our control.

CLIENT: Mm hm. Yeah, that’s true. Because part of me does feel like there’s something going on with my brain chemistry. Because to suddenly just be able to feel so sad and so down like so quickly is kind of crazy, and to really have trouble bringing yourself back out of it. Like I don’t—I mean, I don’t think that’s the norm. I definitely have more highs than—a lot of highs and a lot of lows, and there’s not a lot of evenness.

THERAPIST: I mean, I will also say, it’s funny, I don’t—I will also say, first of all, people are certainly not on medication—I mean, I guess some people like to take it forever, but you’re not signing up for something for life. But I will say that when people feel a little bit better they’re more likely to change how they think about things.

CLIENT: Mm hm. That’s true.

THERAPIST: Then when you’re just feeling so badly it is much—it’s not impossible, but it’s much harder to get out of those thought patterns because it’s so self-reinforcing. When you’re feeling badly it’s very hard to think differently, you know.

CLIENT: Yeah, that’s true.

THERAPIST: And so—and I think part of the suggestion is coming from a place that I actually think that you’d—it would help you get to where you’re going.

CLIENT: Mm hm, yeah.

THERAPIST: That it would be sort of a vehicle for that and not just sort of a crutch, or a place—

CLIENT: Right.

THERAPIST: —where you were actually doing things differently in your life. Which is ultimately the goal.

CLIENT: Mm hm.

THERAPIST: I mean, the goal isn’t to take medication.

CLIENT: Right.

THERAPIST: The goal is to think about yourself differently. As you say, a different relationship to food and a different relationship to yourself and to the people around you, which are all related.

CLIENT: Right.

THERAPIST: That’s the goal.

CLIENT: Yeah, that makes sense to me.

THERAPIST: So yeah, I mean, I just encourage you to think about it. I think it might help, but— [36:00]

CLIENT: Does your primary care prescribe it then?

THERAPIST: Actually that—you can. I usually—I have one or two people that I refer to—

CLIENT: Okay.

THERAPIST: —who are psychiatrists, just because they just know—I mean, they know a lot more about this, this is their specialty.

CLIENT: Okay.

THERAPIST: So they can specifically address this medication is much less likely to produce weight gain, because you know, this is what they do.

CLIENT: Okay.

THERAPIST: They don’t do, you know—

CLIENT: Yeah.

THERAPIST: —primary care doctors do everything.

CLIENT: Right.

THERAPIST: So what I typically do is every couple people—the one person I refer to in general people love, because they feel very much like she’s a consultant and she doesn’t really have an opinion on what you should or shouldn’t take, she just supplies you with information.

CLIENT: Okay. That would be good.

THERAPIST: So yeah, I could definitely—let me see if she has—if you’re interested I’ll—

CLIENT: Mm hm.

THERAPIST: She’s in Cambridge as well.

CLIENT: Oh, okay.

THERAPIST: And I will check to see about her availability.

CLIENT: Okay. Great, thank you.

THERAPIST: Yeah, I mean, among—you’re feeling depressed.

CLIENT: Mm hm.

THERAPIST: And you’re not depressed all the time.

CLIENT: Yeah.

THERAPIST: And it’s clear that you’re able to be very sort of actively engaged in some of your endeavors for sure, but you’re describing feeling really down.

CLIENT: Mm hm. Yeah.

THERAPIST: And it spirals downward for you.

CLIENT: Mm hm. Yeah, that’s true. Mm hm.

THERAPIST: And it doesn’t make you bad or defective.

CLIENT: Yeah, I think that’s part of it. Like you don’t want to—I don’t want to have that stigma of someone that’s depressed. Because I feel like that’s a big—that has a lot of weight kind of with it. And so I think for me mentally I know that when I’m having these really down periods, and I don’t really want to do anything, and I can’t get myself together to do my school work or do different things, I know that that’s depression, but I don’t want to acknowledge it, because I feel like that’s just another thing that’s wrong with me.

THERAPIST: A personal defect.

CLIENT: Mm hm, yeah.

THERAPIST: Which just feeds the cycle.

CLIENT: Yeah. [laughs]

THERAPIST: You feel more depressed, and now you’re defective too.

CLIENT: Yeah, that’s basically what happens.

THERAPIST: Yeah, just sort of—

CLIENT: Yeah.

THERAPIST: —a very sort of cyclical nature and not a good cycle.

CLIENT: No. Yeah.

THERAPIST: And this particular way you were describing having a really tough relationship with yourself—

CLIENT: Mm hm.

THERAPIST: —that’s evolved over time and largely—you know, obviously a lot based on what you’ve so far described, and I’m sure there’s a lot more to learn, about your family.

CLIENT: Mm hm.

THERAPIST: And your mother’s views toward herself.

CLIENT: Yeah.

THERAPIST: And your mother’s views towards you as almost an extension of herself.

CLIENT: Mm hm.

THERAPIST: It’s very complicated.

CLIENT: Yeah. Yeah. And she actually sent me a card this week with a poem about Weight Watchers in it. [laughs]

THERAPIST: That she wrote? [39:00]

CLIENT: No, it was like one of her coworkers wrote a poem about counting points and Weight Watchers and she thought it was cute. And then I got a card from her that was saying, you know, “Good luck with your exams in school,” and stuff, and then inside was this poem about Weight Watchers that she had… So yeah, there’s definitely a lot of stuff there. I mean, I know that that’s where it came from. But then I feel like, well, I’m not around them all the time, and I’m not in that environment, why can’t I just, you know, get out of it on my own or—I don’t know. It’s kind of…

THERAPIST: Right. Which is just part of what keeps you in the cycle.

CLIENT: Mm hm. Yeah, I mean, I think that’s part of my personality is that I’m always—I’m always naturally kind of—I apologize all the time, and I’m always thinking that I’m to blame for everything that’s going on, or that I’m just not good enough.

THERAPIST: Did your mom feel that way about herself?

CLIENT: She definitely tries to do it all, to the point of getting very, very, very overwhelmed. Like she found out earlier this summer that she had breast cancer, but it’s the stage zero, so they just kinda took it out and different things. But she still kept going and trying to help everyone and do all this stuff without taking care of herself or acknowledging that she might need time to rest. So I feel like maybe the fact that she keeps trying to do it all—and I—it kind of reminds of the same thing—is sort of a sign that she feels like she’s responsible for a lot and she needs to be in control of it, and if she doesn’t do it no one else will. I mean, I definitely think we have very similar feelings in regards to that.

Like if I—she’s always cleaning her house before people come over, and I do the same thing. Like if it’s not clean then they’ll judge me. Or, you know, she’s always trying to help other people with stuff, and I’ll do that too, because if I don’t then who am I if I’m not someone to always be helping people, and always be going above and beyond. So I think that’s a lot of her identity, and it might come from needing to, you know, be in control of different situations. But I mean, we are similar sort of in that kind of way, but… [42:00]

THERAPIST: I imagine with the cleaning the house that it can have like the symbolic meaning of someone coming inside and seeing that not everything is tidy or straight.

CLIENT: Yeah. And my mom used to—when she would come to visit me when I first had an apartment here she would come, and I would have just cleaned the bathroom, but she would clean my bathroom. So in a way of trying to help I guess. But I think that’s also a little bit of a trigger. So now I feel like, well, there’s a speck here, and someone’s going to see it when they come in and they’re going to think that that’s disgusting. So I think a lot of that is coming from her probably. Because I definitely freak out before I have people over and want to have everything presented a certain way, because I feel like it’s a reflection of me and everything needs to be perfect, and if it’s not perfect then they’ll know that I’m not perfect.

THERAPIST: It just sounds so stressful.

CLIENT: Yeah, it is. Yeah. And that’s—I definitely freak—like for a while my boyfriend didn’t even want us to have people over because I was freaking out so badly. And now I try to plan more in advance so it’s not as chaotic, but I still kind of have that I want everything to be a certain way.

THERAPIST: What came to my mind is like almost this level of equivalence. Like your mom thinks, you know, you’re her and she’s you.

CLIENT: Yeah.

THERAPIST: Like you’re the bathroom and the bathroom is you. Like there’s sort of like a very strong identification with people and things.

CLIENT: Yeah. Yeah, there is.

THERAPIST: Like your home. I mean, I guess there’s some loose—you know, your home maybe is a reflection of you to some extent. [44:00]

CLIENT: Yeah.

THERAPIST: It reflects your style. But there seems like such an equivalence.

CLIENT: Yeah. And that’s like—I mean, growing up before we would have people over like she would always make us—my sister and I—help her clean, and she was always running around freaking out. And then I notice myself having similar freak outs and it’s kind of scary, because I don’t know how it happened. But she would always want—you know, this needs to get done, and you have to polish the furniture and do this and that and everything. So I think maybe her feelings on that, somehow just growing up with that I just sort of took those on, or decided that that’s what you need to do before people come to your house.

THERAPIST: Well, there’s certainly the issue of exposure, that that’s what you know.

CLIENT: Uh huh.

THERAPIST: Or have seen. And then there’s the issue of sort of always being told that the two of you are so similar.

CLIENT: Mm hm.

THERAPIST: And all that you take in based on that sort of repeated, you know, enforcements of that.

CLIENT: Yeah.

THERAPIST: But I think that’s very strong.

CLIENT: Mm hm.

THERAPIST: As much as like you do not want to be identical probably to anybody, especially your mom you know has her own struggles—

CLIENT: Yeah.

THERAPIST: —that don’t look very appealing to you.

CLIENT: No. And that’s a lot of it too, is like I don’t want to become the person that is never taking time for myself, or just constantly in this chaotic state kind of, and just trying to do all this stuff for other people, and then not even addressing my own issues. Like I don’t want that to be me at all. So there are a lot of aspects of obviously her behavior and the stuff she’s doing that I just really don’t want to be me. But what I had always taken as a positive was, “Oh, she does all this stuff, she volunteers and she tries to help other people,” and so that’s who I am and I’m going to have to help other people and do all this stuff.

But a lot of times I’m doing those things almost begrudgingly. Like sometimes I don’t even want to be doing them because I don’t have time necessarily. And so I think sometimes I’m overbooking myself basically, just because I’m trying to keep up this appearance that I can do it all and that I’m—you know, my house is clean, I’m cooking all this stuff when people come over, I can volunteer and go to school and just do all these different things. And somehow I think that doing all of that at least puts me like a little higher. But then it’s like the one bad thing is that I’m not engaged. And then I’m fat, and then I don’t look good. Like then there’s all these other things. [47:00]

THERAPIST: It cascades.

CLIENT: Yeah.

THERAPIST: I think we’re going to need to stop for today.

CLIENT: Okay.

THERAPIST: Okay?

CLIENT: Yeah.

THERAPIST: But I will see you next week. So 1:45.

CLIENT: 1:45. Yeah, that’s fine.

THERAPIST: And I would be willing in the next couple days I’m going to reach out to—actually there are two very good people. I’ll reach out to one of them in particular—

CLIENT: Okay.

THERAPIST: —and give you her information when I hear back from her.

CLIENT: Oh, perfect, that would be great. Thank you so much.

THERAPIST: Okay, take care. I will see you next week.

CLIENT: Okay.

THERAPIST: Bye bye.

END TRANSCRIPT