TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi! Come on in!

[pause 00:00:09 to 00:00:27]

CLIENT: So, I was thinking more this week about like, what we talked about last week, about kind of like, just working on like, being happy and content with yourself. But (sighs) I still feel like I need some kind of like, technique in order to be able to like, transition into doing that. I was reading an excerpt from a book that someone had written. I don’t know if this is like, a good technique or not, about taking sort of like, moments of happiness that you have in your life and “bottling” them and sort of like, remembering that feeling instead of taking negative stuff that happens, and “bottling” that and sort of remembering that, letting that kind of like permeate. [00:01:34]

I was thinking about that, because I feel like that’s what I do a lot of. I really dwell on everything that I perceive to be negative (that either happens, or that I perceive to be negative with myself) (therapist responds), instead of taking like, the good things that happen and focusing more on that. Like, that seems to be a big part of my behavior, is that I’m like, so fixated and looking for something to be wrong, that (sighs) it’s very... Some days, I find it easy to see good, but that’s like on a good day. But most like, on the average day, I fixate on the negative so much. I feel like that’s a big part of what is preventing me from like, moving forward, is just kind of like never being able to get over the negative. Instead of seeing something... [00:02:53]

Well, first of all, it’s seeing (chuckles), seeing things as negatives that might not be. Then it’s also, you know, when something negative happens, I carry that with me and punish myself for it continuously, instead of being able to like, move past it. I feel like that prev ... If something good happened like, say I weighed myself and thought that I weighed a lot. Then something like, really good happened right after that, the weight would affect my entire day or entire week, and it would prevent me from seeing anything else that’s good. So (sighs) I feel like if I could find a way to move past this fixation on negative (chuckles) things and change my thinking a bit, it would help me to be able to feel more positively about myself like, over time. [00:04:10]

THERAPIST: Well, I guess, in that light, I was thinking about expectations. (client responds) and sort of your expectations about how quickly you’re going to feel better (client affirms). I’m really appreciating and empathizing with the depth and the longevity of the problems that you have, and the difficulties.

CLIENT: Yeah, that’s true. (chuckles) Yeah, I mean... I think they’ve been going on for so long. But I’m just trying to think of ways that I can sort of develop habits and make small steps to try to just work through it, try to form new habits that can help me to get out of this negative (chuckles) thinking, because that’s... I mean, that’s a huge part of like, what makes me feel down, and what leads me to eat, I think sometimes, and it’s just this like, overwhelming sense of negativity and failure, because one thing might have happened. [00:05:29]

THERAPIST: Oh, I understand! (client affirms) I understand!

CLIENT: Yeah, and so, it’s just...

THERAPIST: I just hear you having expectations that I worry will set yourself up for failure.

CLIENT: Probably, yeah. (chuckles) Well, that’s what I always do. (chuckles)

THERAPIST: No, I meant that... You know, an interesting, in this... and I don’t know how you’ll feel about this. I want to talk about it. (client affirms) But in this vein, I was thinking that you’d be a great candidate, if we could figure out the logistics, of (client affirms) coming here twice a week.

CLIENT: Uh-huh. Yeah, that’s a, that will be hard (chuckles) logistically!

THERAPIST: I know, but let’s talk about what you need clinic , you know, what you need in terms of your treatment and then (client affirms)... I’d always rather do it that way, and then (client affirms) figure out how the logistics can be worked out. [00:06:10]

CLIENT: Uh-huh. Yeah, so, um... Yeah, I guess I just... it’s (sighs) as I’ve said many times before, it’s hard for me to... (sighs) It’s hard for me how, to figure out how to like, move forward or change unless I have behavior modi , or mental I guess behavior modifications to think about. Like, it’s hard for me to... to not have some kind of like, an action plan, because I always have to have a (chuckles) plan. But, and I am being more... I mean, I think I’ve been a lot more reflective lately of like, why I’m doing stuff and what’s going on; but then when I observe it, I need to have a plan for like, how to change it. [00:07:24]

THERAPIST: Why?

CLIENT: (pause) Because I know, so... Like, I know that thinking that way is leading to... I know that dwelling on the negative is leading to me feeling down, and not being able to see the good, and all different things like that. So, if it’s something, so that behavior is something that I perceive as bad, and I feel like anything bad has to be changed like, I have to have a way to change it.

THERAPIST: But if you did, you would have already. (client affirms) (inaudible).

CLIENT: Yeah, so I think... and that (sighs) I guess what I kind of don’t even, what I don’t necessarily understand is where to start, I guess. [00:08:30]

THERAPIST: Do you feel like you haven’t started?

CLIENT: A little bit. (therapist responds) Well (sighs) so, I feel like I’ve been a lot more aware of my actions, and more reflective on like, why I’m doing certain things. But then I feel like, “Okay, now I identified them. Time to start conquering.” Like (chuckles), and so... I guess, looking at it from a different perspective, I have done a lot, because I’ve been able to really figure out what’s driving things, and figure out why I’m behaving certain ways, but... For me, I always need to have like, action, plan, and (chuckles) and so I feel like, “Okay, well now I’m identifying all this stuff, but I know it’s bad and how do I fix it?” It’s... So it’s kind of like, it’s part of my always needing to have a plan for everything and always needing to have the answers. [00:09:54]

THERAPIST: Yeah, what if you just have no idea?

CLIENT: That’s, that feels really scary (therapist responds) to me. Like... I don’t know. It’s just, it’s sort of like... (pause) I kind of feel... It’s like if you don’t, if I don’t have the answers to something, I feel really lost, and really stressed, I’m really anxious, and really out of, like out of control. (therapist responds) Like... it’s sort of like, if I’m taking a test and there is one problem I don’t know, I start to unravel completely and feel totally out of control, because I don’t like not having the answers. [00:10:47]

So... it just, (sighs) it’s something about like... needing (sighs) to feel like, in control, to feel put together. Because if I feel out of control, I feel like I’m broken, or I’m like, ineffective, or like just not like, I’m not the person that I want to be. Because I need to always have everything together and be, and have like... Like, it goes back to like, me saying how I always have the house clean and I can’t. When it starts to get not clean and I don’t have time, I hate that. I have to clean, because I need to feel like everything is in its place and everything is like, where it needs to be. [00:11:48]

THERAPIST: So, in a sense, when we talk about breaking thought patterns, that would be one of the thought patterns you’d have to break.

CLIENT: (pause) Yeah. It’s a (chuckles), it’s...

THERAPIST: That is, that’s an act, right? In your way of thinking about it, that’s actually an anti-action plan.

CLIENT: Um-hmm. Yeah, yeah. So, yeah, it’s sort of like I (sighs), in almost every single area, I need to have the answers and I need to have control. The one place where I think I can let myself get out of control at times (or I have periods where I get out of control) would be like, with eating. That’s something that’s so... it’s so emotional and there is so much tied to it, that even my desire to control everything (chuckles) can’t totally like, come through in that area. Because that’s the one place where I sometimes feel like I allow myself to lose control. It’s like almost as like, an escape type of thing. [00:13:10]

THERAPIST: Which is a different sort of thing (client affirms) than tolerating uncertainty. (client affirms) Because what you’re describing is a kind of treat, not a going into the mess. (client affirms) It’s sort of going on the side of it.

CLIENT: Uh-hmm. Yeah, it’s just like... it’s sort of like... I stop thinking and obsessing for a minute and like, eat like, a few slices of pizza and just like... But when I’m doing it, I’m not even like, it’s like, my zone out, like I’m not even conscious of what I’m doing. But it’s the only... it’s like, the only time that I guess I have that zone out. Like, it’s the only action I can think of where I just, I’m not like, aware of what I’m doing. [00:14:21]

THERAPIST: It’s a reprieve (client responds) from the distress that you feel.

CLIENT: Yeah, yeah. But otherwise, I need in other, all other (chuckles) areas, I need to have the answers and I have to be in control. Everything has to go according to plan. Often it does not go (chuckles) according to plan, because that’s the way life is. Then, it’s almost like what you were saying like, me setting myself up for failure. So I like make these big elaborate plans, and then nothing really goes according to plan, and then everything is failure then. So, it’s like then everything is negative, everything is wrong, and nothing is good. [00:15:19]

THERAPIST: Yeah, I mean, I really want to try to prevent that happening in here. (client affirms) And so the analogy that came... I’m sorry; I didn’t mean to interrupt. The analogy that came to my mind, it’s not a great analogy, but it’s like, say you hurt your knee and you’re limping. Your type of solution is, “Let me figure out how not to limp”; not, “How do I fix my knee?”

CLIENT: Yeah, yeah (chuckles). Yeah, that’s sort of... I just need to like, fix the sort of like immediate (therapist responds) thing that’s happening, because I need to have all the answers and... And I kind of... What I want to be able to do is to just let go, because it’s so... because then I think I wouldn’t have to like, go to food as like, having the escape, because I would just let go, like all the time (chuckles). It would be great! But (sighs)... I don’t... I’m sort of scared of what would happen if I let go. (sniffles) [00:16:39]

THERAPIST: Because what could happen?

CLIENT: Chaos! (therapist responds) And like, I feel like if I just... stopped planning and feeling like I had all this stuff to do, that’s when I feel like, everybody would start getting mad at me, because I wasn’t doing all the great stuff. So like, I feel like if I let my house get messy, then if I had people over, they would judge me because of that. Like, I feel like if I didn’t, you know, send people cards and gifts and different things, they would not like me anymore, or think I wasn’t thinking of them enough. Or like I feel like if I don’t call my parents enough, then they think that I’m a bad child or like that I don’t care. [00:17:41]

So... I feel like I have to like, keep all of these things up. But then often, I’m doing all this stuff, and I’m sacrificing myself to do it. So I’m like, putting off a workout (that I may not really want to do, but that, you know, would be good for me to do), because I have to clean the house, and I have to do all these other things. Then the stuff that’s for me gets like, put to the side, because if I don’t do all this other stuff and keep it in order, then like, everything will fall apart in terms of my relationships with other people. (therapist responds) [00:18:38]

Then I feel like... because a lot of times, if I do kind of like, not keep up with people, I get messages like, “Where have you been? I miss you. We need to hang out.” Like (sighs), just... I feel like if I do try to let go or not keep up with all this stuff then, it’s like, I get all, my to-do list grows, because it’s like, everyone’s sending messages and saying all this stuff. So I feel like I just have to keep up with it and keep everything in order or like, it’s just... There is going to be too much to clean up, there is going to be like a mess that I have to clean up.

THERAPIST: Well, how do you feel... I want to make sure that... Well, I have a bunch of different thoughts in different areas, but then what, you know, how do you feel about coming more often? [00:19:39]

CLIENT: I would like to come more often, but my schedule is a lot! (ph) Peter (sp) is losing out/moving out (ph), actually right (chuckles) now. It’s a little bit crazy.

THERAPIST: Right. Which is itself... (client chuckles), finding the time to take for yourself.

CLIENT: Well, because... Yeah, because... if I start that new job in January, then that’s working like, three evenings a week, but it’s not... I don’t... but it’s at Walter Reed (ph), so it’s like further. Then I have a similar, a little bit of a similar schedule to this semester next semester, but not quite as bad. So it’s like, I feel like, I already feel like, “Okay, I have, like...” I already feel like I have no (chuckles) time! And so... it’s (sighs) it’s this issue, because coming here more often (and doing things like going to the gym, and doing these different things for myself) will be so good, but I put everything else in front of me. [00:20:55]

I mean, you know, school is important and the job is important, but I am trying to like, say no to people more, so that the time that I have in between school and work can be spent on me. I’m getting a little bit better at doing that, but then (chuckles) I’m feeling like, I have a ton of school work, and then the time that I’m spending not doing that, I’m spending apologizing to people for not seeing them, or for missing events because I’m so busy with like, work and school. So...

It’s (sighs) it’s hard because I feel... so (sighs) like, saying no to people is so stressful for me and so hard on me that (sighs) it’s like, almost, I almost feel like it’s like a side job. Like today, I took 30 minutes out of my day to send people birthday cards, and someone flowers for their birthday, and then respond to all these different messages I had from friends, because... I almost feel like it’s like, like another job that I have. It’s like, when I don’t see people, I have to carve out a half hour, (chuckles) like twice a week, to respond to all these people and all this stuff. Because if I don’t’ respond, then what if something happens and I need them and I have lost all of my friends, because I was too busy? Like (sighs), so... [00:22:51]

THERAPIST: I mean, it’s sort of, ironically, this is what you’re wanting help with, so you don’t have to do that anymore.

CLIENT: Yeah! That’s the whole, that’s the whole thing, is like... I know that it’s something that I need to do and make time for. And I want to, and it’s... I want to find a way to make more time for myself, in general, overall. But in the transition, I guess, it’s... I’m realizing that it’s like, so (chuckles) stressful for me, because... and I know it’s just like, a transition, you know? But it’s, I wish that, (chuckles) sometimes I just wish that people would like... leave me alone, but I know that it’s not them. [00:23:56]

It’s the way that I’m like, perceiving (chuckles) everything, because if I didn’t send people cards or flowers, I’m sure that it would be fine. (chuckles) But I feel this like, sense of obligation I’ve created for myself. If I don’t do it, then it’s like, I’ve failed, because I created this expectation for myself. I don’t think anyone else has the expectation of me. I created it, and I’m punishing myself for not meeting my own expectation. The other people are just like... there. (chuckles) But I am creating what I think that they’re doing or saying. [00:24:54]

THERAPIST: (pause) I really think this is important.

CLIENT: Yeah, yeah. No, I think I can find time for it like, I already, I know pretty much, just need to be told the three days that I’m going to be working, once like, some background check stuff and whatnot goes through. So... But I already know my schedule for next semester, too, so I kind of know, like schedule-wise, where I’m headed, so... Yeah. (pause) It would probably be good. (chuckles)

THERAPIST: Do you feel like I’m putting you in a position of saying yes or no to me?

CLIENT: Oh (chuckles)...

THERAPIST: I was wondering...

CLIENT: Well, I just feel like that with everything, though. It’s not, it’s...

THERAPIST: I’m not taking it personally. [00:25:56]

CLIENT: Okay. (chuckles) No, but I mean, that’s literally how I am with everything, it’s... Um... But... because another way that I would like to, I would like to... I told you, you know, working out makes me feel so good mentally, and it’s something I really need to also do as a “time for myself” thing. I’m finding myself like, put , you know, it just, anything that’s like really good for me or you know, just for me, I’m just always putting off and prioritizing other things in front of it. So I mean, especially as I, you know, have my new schedule, and know when I’m going to have free time, I want to be able to make a point to prioritize things like that. Like, coming here and just making sure that I carve out that time for myself because I’m just, otherwise I’m just not going to get it. [00:27:13]

THERAPIST: Well, I certainly want you to understand, even though you may not feel this way (client affirms), that you can absolutely say no. The only, the extent to which I’ll be disappointed is simply that I want to make sure that you have the best treatment that you can get. (client affirms) This is your treatment.

CLIENT: Yeah, no, I think that trying to like, work with the schedule and carve out will... will be really (sighs)... I think it will be really good for me, because like I said, I’m always putting everything in front of me. So it would be good if, at least twice a week, I could make time for myself and not put everything in front of that, because that’s pretty much like, how I... That’s like my survival mechanism, is that I’m putting everything else in front of me, because I need to keep all of that order and everything like, together. But it’s like... it’s almost like (sighs), kind of like a façade, like everything is not together, but I need to make it seem like everything is together. That’s like my survival. [00:28:50]

THERAPIST: Well, just like when you limp is to compensate or something. In that sense, it’s a limp.

CLIENT: Yeah, yeah, yeah that is, I mean... That is what it is, and it’s just trying to... I think the reason like, that I need to like, have all these things to do and keep it all together is because I’m so worried about what other people think of me that I want them to think that I have it all together. I want them to think that my like, house is in order and that I am in order. If they don’t think that, I’m so worried about what they’ll think that I just can’t, (sighs) that I just keep doing all (chuckles) this stuff so that never happens. But... [00:29:49]

THERAPIST: It’s a solution that prevents solution. (client affirms) (inaudible), just window dressing.

CLIENT: Yeah, that’s what it is. It’s just like, like a window dressing. Just and... I’ve done that with like, material stuff a lot like, always needing to like, have this or have that because I need people to look at me or look at my house and think a certain thing. So like, it’s just all these different things are just a way of like, like a distraction, like a way of making people not know that I’m, inside I’m feeling terrible about myself, or inside I’m judging myself against them, or I don’t think I’m good enough, or I don’t think I’m as good as them. But if I have the same handbag as them, then I am as good as them. So it’s like, I’ve always done all these different things to try to like, cover up people from seeing that I’m... or I think that (chuckles) I’m like, flawed. [00:31:09]

THERAPIST: There is so much hurt inside that needs to come out. (client affirms) And what you do is desperately try to cover it up. (client affirms) And it takes so much work.

CLIENT: Yeah, because it’s, and it’s to the point now where I’m just like, I... Like, I just really do just want to let it go, because... it’s... When you’re, you know, studying organic chemistry and on top of (chuckles) all of this other stuff that’s going on, it’s like, it’s just too much. I think... I always thought that by (sniffles) leaving my job, I would, everything would go away and be better. But, it’s like, I’m just finding new ways to stress myself out, basically. It’s kind of like I, you know, mentally enjoy what I’m doing (chuckles) more now; that’s not the issue. But I’m still finding ways to physically and mentally just completely wear myself out. (therapist responds) That has not gone away (chuckles) at all. It just, I’m just doing it in new ways now. [00:32:37] (therapist responds)

(pause) So I think that was like, the hardest thing to realize is that I made this change, but everything’s not, it didn’t fix (chuckles) everything. I think it was a good change, in terms of mental stimulation and interest, but it didn’t fix (chuckles) everything else. So, now it’s like, I’m just finding new ways to drive myself crazy, and feel anxiety, and have stress manifest itself, and put other things in front of me. Like I’m just finding new ways to do it.

(pause) So, yeah, it’s... I was just realizing that, because I’ve had all these like, really horrible like, physical stress symptoms and stuff. I was like, “I thought that when (chuckles) I left my previous job, those would go away,” but I just found new ways to put pressure and expectations (therapist responds) on myself. I like, can’t go on doing that anymore. I’m so (sniffles)... I just feel so like, worn and so tired from it, but... So I think feeling that worn is like... helpful and like, realizing that I need to like, give up (chuckles) these behaviors, but, um... I’m realizing that I can’t go on doing this to myself (sniffles), because it feels like it’s like... It just feels, it’s just really tiring. Like, I don’t have (chuckles) energy to do anything else for myself, because I’m juggling so much. (sniffles, takes tissues) [00:34:43]

(pause) But, and I wish I could like... I wish I could change... I wish I could actually not really have expectations for myself. Like (sniffles)... almost like start with like, a blank slate and almost... It’s almost like what I was telling you about, how I used to not think I was fat, because I didn’t really know what that was. It wasn’t until other people started saying all these different things that I decided that’s what I was. (therapist responds) It’s almost like (sighs), I wish I could like, just start from a clean state and not (sniffles)... not have all these preconceived notions and these expectations for myself. Like (sniffles), I wish I could just accept... my performance or accept my physical appearance; just be, like, just be. [00:36:12]

THERAPIST: And not feel so imprisoned by them.

CLIENT: Yeah. Yeah, because they just take, it just takes over everything and you could (sighs) I mean, I really do feel like, imprisoned by it. (therapist responds) It’s totally taking over everything that I do and all of my behavior. It’s just I’m constantly putting pressure on myself all the time in every area, in areas where you don’t even need to put pressure on yourself, I’m putting pressure on myself. I’m trying to set new goals for myself, and trying to do new things, and I just want to like, just give it all up.

THERAPIST: (pause) Do you imagine feeling free? [00:37:18]

CLIENT: Yeah. (therapist responds) Yeah. I think that if I... I think if I was just able to like, stop, I would just literally feel like a weight was lifted off my chest. I feel like I would feel free. And I like... and still, I feel like that’s not... As usual, I feel (chuckles) like that’s not something I could possibly achieve (sniffles), but I sort of dream of that, because I think it would be so amazing. (takes tissue)

THERAPIST: Because on the flip side, you fear chaos.

CLIENT: Yeah. I’m afraid of what will happen if I just... stop, but (sighs)... But if I didn’t, if I didn’t fear the chaos, or I didn’t... If I wasn’t worried about what was going to happen, or if I wasn’t worried about the negative, or what other people... The main thing is what other people would think of me. If I wasn’t worried about that, then that would be so... I would be so afraid, because the main issue is that I feel like I’m burdened by like, judgment from other people. But it’s really, it’s really me judging myself and deciding what I think other people are thinking or saying (which they may not be). (sniffles) So it’s really me putting judgment on myself, but using the words of others to do that to myself. But, if I could, if that all went away, that’s what would be so freeing like, it would just be (chuckles) great. [00:39:23]

(pause) And I think it’s... The main thing is recognizing that it’s not... I think I’m holding everything that people said when I was younger (and really did say), and assuming that everyone now would say the same things. (therapist responds) And (sighs) they probably won’t, but I just make it all up in my head. That’s what dictates my life, basically. (therapist responds) (sniffles)

(pause) So, I feel like... I feel like I understand more why I think everybody is like, out to get me or thinking negative things about me, but I don’t know... (pause) (sighs) I don’t know how to like, stop feeling attacked by other people without totally isolating myself. Like, I think I feel like, if I start (sighs)... making more time for myself (saying no to people and all that stuff), all the friends, that everyone will leave. Then I’ll be alone, and then... and I’ll have my family (because they’re family), and I’ll have my boyfriend (because I know he really loves me), but what if anything happened to any of those people? Then I don’t have any friends, because I’ve alienated them, lost all of them. (therapist responds) (pause) I rationally know that won’t happen (chuckles), but I... I think that’s what I think will happen if I just let go. [00:41:47]

THERAPIST: (pause) (inaudible) (client affirms) I can see that you feel that way, too. (client affirms) (inaudible) that I can see that.

CLIENT: No, that, well, that’s the thing is, the rational part of me knows that I’m manifesting all of this, and that I’m making up these extreme things, and that they won’t happen. But the rational like, the emotional part of me, and the frightened part of me, and part of me that’s thinking that everyone’s out to get me takes over. I can’t, the rational part can’t really win out, because... I think I’ve just, I’ve been feeling that way for so long that it’s like... it’s like second nature to feel that way. (therapist responds) [00:42:53]

(pause) And I’ve tried to like... I guess I’ve tried to... see like... I’ve tried to, um (sighs), I guess simplify, in a way, and tried to like, observe good things that were happening around me without me controlling something or buying something for someone or... Like, I’ve tried to see that. There is good, without me having to do different (chuckles) things to achieve it. But most of what I’ve been able to see has been like, I’ll notice like, really cute kids on the street, or strangers, or it’s a beautiful day, or different things like that, but it’s always something always kind of removed (therapist responds) from me. [00:44:14]

It’s never something... so, I really struggle seeing good in a situation without feeling like, I made it happen somehow, because of something I did and because of my control. So I think a big step for me would be just seeing that things can be good without me having to do anything, but, and things that are close to me, or really relevant to me can be good without me having to do anything. (therapist responds) But right now, the only place I’ve been able to see it has been in stuff that’s more like... removed.

THERAPIST: Well, it’s like, we’re going to need to stop in another minute. It’s like seeing the beauty in the world. (client affirms) That’s (inaudible) (blocked).

CLIENT: Yeah, like I see it in the world around me, but... not always with my friendships or things like that. Like, I feel like I have to give to receive. [00:45:20]

THERAPIST: So, we really need to stop. (inaudible) if you would like to go ahead and see, at some point, for us (client affirms) another session, let me... You know, we should probably (client affirms) (inaudible) (blocked)

CLIENT: Okay, let’s e-mail. Okay.

THERAPIST: Yeah, in terms of just the logistics or..

CLIENT: I can send you my schedule (therapist affirms), too, so that we can see like, because especially, I know you said we have to change for next year anyway, probably?

THERAPIST: Yeah, why, why don’t you e-mail... just, I will do my best to find the two times for (client affirms) us to meet (client affirms), so maybe (inaudible) (blocked). [00:45:49]

CLIENT: Okay. That sounds good. Okay! Thank you. Oh, and Thank , not next week, but Thanksgiving week, I might be away that week.

THERAPIST: That Wednesday?

CLIENT: Yeah. So I just, I’ll send you an e-mail, too, just to let you know (ph).

THERAPIST: Okay, just let me know. All right. Thank you!

CLIENT: Thank you!

THERAPIST: Thank you so much, and I’ll see you next Wednesday! Okay, take care!

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