TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi, come on in.

CLIENT: Did you get my e-mail?

THERAPIST: Yeah, I did. You know, I feel like I didn't respond to it.

CLIENT: Oh, that's okay.

THERAPIST: Sorry about that.

CLIENT: That's okay. I just didn't know what worked too for the week that's being moved this time.

THERAPIST: Yeah, I'm glad you did. Because I actually just sent you this letter. Oh, I never sent it to you.

CLIENT: That's okay.

THERAPIST: So I can have-you know, I was just looking at my calendar this morning. Because I think you said the day before New Years.

CLIENT: Yeah.

THERAPIST: Like that day is good for you in general.

CLIENT: The 31st, yeah. Yup.

THERAPIST: Because I have a decent amount of flexibility that day.

CLIENT: Oh, okay.

THERAPIST: I have a few openings.

CLIENT: I'm free the whole day, so.

THERAPIST: I have an 11:50 time, would that work?

CLIENT: Sure, yeah.

THERAPIST: Okay, so I definitely have that time, 11:50.

CLIENT: Okay, okay.

THERAPIST: So I'll put you in then for the 31st.

CLIENT: And then for the week after is it okay if I just do the 7:10 appointment?

THERAPIST: So did you want to do that just for that week?

CLIENT: Well, so the new boss is saying that my shift can start at 3:00. Like it's kind of like a variable thing on Thursdays, and so it's hard for me to have that before I know I'm going to get there on time. So I wanted to do the 7:10 only for like the first month or so while I see how everything goes. [2:00]

THERAPIST: Okay. I do right now have some slightly earlier afternoon time on Thursday as well, I have a 12:45 time.

CLIENT: That's-so I have school until like 1:30.

THERAPIST: I see, I see.

CLIENT: It's one of those days where it's-yeah.

THERAPIST: [overtalk]

CLIENT: Yeah. Okay, so the 31st.

THERAPIST: And one other scheduling thing. Would you mind-on the 1st and the 8th the first two weeks-

CLIENT: Yeah.

THERAPIST: -would you be able to do 8:10 rather than 7:10?

CLIENT: On the 8th? Yeah.

THERAPIST: On the 1st and the 8th. Oh no, the 1st we're not meeting.

CLIENT: Yeah. So on the 8th I can definitely do 8:10, that would be fine.

THERAPIST: Okay, so let's do that. That would just be for that week.

CLIENT: Yup, that's fine.

THERAPIST: Okay, I'll put you in then.

CLIENT: Because I don't think I'm scheduled to go to work until like 11:00.

THERAPIST: That's right, I keep forgetting. [3:00]

CLIENT: It's the-yeah. Okay. So I had another issue this week similar to like the picture issue, which is sitting getting my hair done having to look at myself for such a pro-it was like such a prolonged period of time. I was like really the whole time kind of like picking at different things that I saw. And that was-it was like a really similar experience to when I have the picture. So I was thinking that it's more of when I have this prolonged time to look at something, myself, and find the faults and find all-like it was very similar experience. And it was kind of like I was like I wonder if she notice-the hairdresser notices how like fat I am and how much weight I've gained, and all this stuff. And like it was just because of the experience of having to like look at myself for such a long period of time.

So I think a lot of times at home it doesn't happen as much, because either I'm only looking at myself like quickly, or a lot of times I shut the-like I shut the lights out sometimes when I brush my teeth and stuff because I don't want to look at myself. So I think it's more like when I have the opportunity and I have to look at myself for like a long period of time that's when I'm like finding all of these faults and everything. [5:00]

So I sort of am realizing that it's like-it's more than just the picture thing, and the fact that I-like I sort of forgot the fact that I like shut the lights off when I brush my teeth and wash my face and stuff, because I don't want to look at myself for that long like in the light. And so it seems like more often than not having to look at myself is problematic. Because it's like something that I can't face I think because I'm afraid that I'm going to see all of the faults. So sometimes I think I look at myself and think I look okay, but I think it's more of like a fleeting or like a quick kind of thing. But when I have the opportunity to like really look at myself for a long time that's when I focus on like picking everything apart. And in those instances when it's not the picture, it's like the hairdresser in the mirror, it's not necessarily just me thinking like that other people are thinking, in that case it's me knowing that I'm the one that's thinking it. [6:40]

So it's like I'm realizing more and more like I was saying last week that it is me. And I feel like it's not-it's manifesting itself as like me picking all this like superficial stuff about my appearance apart, but I don't think that's the issue, I think it's like me feeling like I'm really flawed in general. And I feel like in some ways I do feel that I'm making progress in that area. Because like this week I was really proud of myself because I, you know, got through my finals in a really like kind of calm way, and I looked back and I said, "Wow, this is a really great accomplishment and I'm really proud of myself for doing that." So for me like seeing that and being proud of myself, that was big. So I felt that in some ways I'm making progress, but there's obviously-I'm still feeling so flawed because I'm still having so much trouble with looking at myself and with my appearance. [8:15]

And I'm concerned about the holidays, because I know that there will be pictures, and I'll be with my mom, who's a trigger, and just like overall worrying about dealing with that situation. Because I don't want my time off work, vacation time, to be ruined by obsessing over my imperfections and the way that I look. And I just feel like there's going to be so many different instances where that could happen and could come up, and I'm worried about it, because when I do focus on that stuff for so long it just like it brings me down and it kind of erases the positive thoughts like I might have been actually have-like finally having about myself. [9:30]

So I just am worried about how to deal with all of that next week. Because I know that people are going to take pictures of me, and they might send them out in an e-mail or something after a family event, and I just don't want to see them. And I know that my mom probably sent a family Christmas card with some kind of a picture of me, and it might not be one that I like, and then I'm going to have to see that and know that she did that, and know that all these people are looking at it. [pause] [10:15]

So I just-I feel like this week I'm doing-I'm good, and I'm just so-I still don't want to-I want to keep-like I want to keep it that way, and I don't want to revert back to the really extreme negative feelings about myself. And I might just be doing good this week because I haven't seen any pictures of myself or anything. But I haven't, and because of that I'm, instead of necessarily just-besides the hair dresser thing-instead of just looking at my appearance, I'm focusing more on like the stuff that I have accomplished this week, and like over the past few months, and I'm feeling like really good about myself. I think that I really have done a lot. But it's not-that's like independent of my appearance, and I'm worried that if I'm put in a situation where the focus is put back-in my opinion is put back on my appearance that it's going to somehow like in my mind erase the good things I'm feeling this week, like that I've done and stuff. So I'm just worried about how I handle it.

THERAPIST: Well, it's a rational worry in so far as it happens for you.

CLIENT: Mm hm.

THERAPIST: So what's the worry? If it happens, then what? [12:00]

CLIENT: I mean, that's fine, but I don't like to-well, I don't like feeling that way. And I don't want to feel that way. And the lows that I can get from being critical of my appearance are so-could be so low, depending on the circumstances, and I hate feeling that way, I don't want to feel that way. And so that's the worry, is that I want to be happy, and I want to feel good, and I don't want to get into this funk where because something's triggered this, and because I saw a picture in that I look so bad, and all these things, it ruins like-because when that happens to me I can't see anything that's good.

And like we're planning on-my boyfriend and I are planning on going into like Philadelphia for a day to get away, and do like different fun kind of like independent stuff. And I don't want-like say on Christmas someone takes these pictures of me and shows them to me, or my mom makes some comment about how I look, or all these different things happen-I don't want my down feeling because of all that to ruin all the other good-you know, good stuff that's going to be happening, or all the other good moments. Because that's what happens to me.

THERAPIST: Right, I was going to say, but [overtalk 13:38].

CLIENT: Right. And that'sAnd I know what my-and I don't know why-I mean, I can't control it.

THERAPIST: No.

CLIENT: I can't. But it's sort of like I really don't want it to happen. So... Because I know when those things happen that I do have no control over it. And it takes a lot for me to come out of it. It's usually like completely removing myself from the situation, or changing the scenery, or, you know, different things like that could help. But it's like something probably could happen, and then I'm going to be around my mom for the rest of the week and she might make more comments and it could make it worse. And I wish that I had a better coping mechanism so that when these things-because right now I'm not to the point where I'm not going to think these things, and where appearance-wise I'm going to feel good about myself, because I'm not there. But I wish that I had a way to not make that like initial negative feeling and thoughts create this spiral that can ruin days or a week at a time. [15:30]

THERAPIST: Well, I guess in that sense-actually I don't fully understand why you wouldn't want to like do everything in your power to get here more often, given how important this is to you.

CLIENT: Well, so the other things that I have noticed have been helping me a bit have been like I started trying to do yoga once a week, and that's helping me. Like I want to try-I know that mind-body kind of stuff also has-like does help me a bit and has helped me in the past. So I'd like to do this once a week and then try to start some more of that again and see how that helps too. Because for me-and maybe it's superficial, but a way that I've been able to feel a little bit better about my body in the past has been through yoga or different physical things, because it helps me to see my body more as something powerful that can do these really great things. So I know that in the past that's been good for me mentally, and so I want to try to be able to fit that kind of stuff in too with my schedule and not get overwhelmed.

THERAPIST: Do you feel like you have a hard time trusting me, that I could actually lay out something that would be helpful for you? I mean, trust me, if I thought that yoga and this once a week was actually the recipe, I would tell you. [17:20]

CLIENT: No, it's not that. It's sometimes when I have too many things in my schedule it's really overwhelming for me. And so next semester with school and working, and then like having this scheduled in twice a week, I think initially it might be really overwhelming for me. Because for me, like having a lot of different appointments, or work over far away, and all this different stuff, it can sometimes be a little too much for me. And I want to try to do some classes at the gym more and be able to fit that into my schedule more too. Because I think it's going-I know in the past like-and maybe it has been superficial, but when I have consistently exercised it's been really good for me mentally in terms of the way that I feel about myself. And I don't think that that is actually addressing the core issues by any means, I think it's just endorphins and things. But I know that that's something that will make me feel good and make me a little bit healthier than I feel like I am now. [18:50]

So I don't want to overbook myself. Even though this is for me, I just don't want to overbook myself initially with my new schedule until I just get a better feel for how everything's going. Because that was one thing about this semester, is that the workload was really a lot with school, and I felt like I put certain things-like for me going to the gym is something that is for me, and I felt like I put that aside a lot so that I could do all the extra studying and things, and I didn't like the way I felt putting that aside. So it's more like I want to try to fit everything in and then see how everything works with my schedule.

THERAPIST: Aside from like the issue of how many times-

CLIENT: Yeah.

THERAPIST: -I do feel like there's almost like a control thing going on. Like you have an idea of how it's going to work best for you-

CLIENT: Yeah. [20:00]

THERAPIST: -but you're coming to seek out my expertise. But you'll take my expertise to the extent that it fits in with your idea of how-

CLIENT: Yeah, yeah.

THERAPIST: Which is actually wonderful, because it gives us an opportunity to look at what goes on for you.

CLIENT: Well, yeah. I mean, there is a big control thing.

THERAPIST: There's a way in which some-when something gets in your head about how something should go or what you feel [overtalk]-

CLIENT: Yeah.

THERAPIST: -there's no veering off, there's no like, "Okay, well let's try that."

CLIENT: Yeah.

THERAPIST: You get very kind of hunkered down in this way of thinking, and it's kind of a little bit hard to get you toSo aside from how many times you come-

CLIENT: Yeah.

THERAPIST: -I mean, this issue is really important.

CLIENT: Well, and I think I also have this idea that like it's better for me to come in the morning because then I don't have to like run from here to there. And so like morning is reallyLike I feel like ifFor some reason in my mind, if I was coming here two mornings, that would be like better in my mind than afternoon, because it's like running. Because even now having this, it's like school here, work. Like I-the feeling of like running around a little bit is always-it always makes me feel a little bit like stressed. And I think part of that too is that my mom is the type of person that's always running around from this appointment to this to that. And I don't like my days to be like that, because I just-I don't like that feeling. [21:45]

And so for me I always need to like, well, as you know, like plan or control or structure my days, because I don't want to feel like frazzled running around from here to here to here, I want to be like, "On this day this is the way I will do things." And so for me it's like for some reason doing the things for myself, like coming here or going to the gym, I need to do them in the morning. And I don't know why, and it's just like I have to do that in the morning and that's that time, and then the rest of the day I don't feel like I have to do those things because I've already done them. So it is part of the like control of how the day-how my day should be structured. And it's hard for me to have something else like-it's hard for me to have it go in a different way without feeling stressed out.

THERAPIST: Yeah. Yeah I see that. [23:00]

CLIENT: I think that's a lot of-because to me I'm like, okay, well, if I come in the morning that's really good, because I'm gonna come in the morning and do this and then I have the rest of the day to flow this way and I'm not like running from here to here to here to here, because that's like too much and I can't deal with it. But I think part of it also is not wanting to turn into that frazzled person. I need to keep like the flow or I feel really overwhelmed and out of control. So it's like just making myself like come here after school and then go to work and do it that way actually has been really uncomfortable. So that's been like big for me to be able to do it that way, because it doesn't go with the way I usually would see things going I guess.

THERAPIST: Well, that seems-I was going to say that seems paradoxical.

CLIENT: Yeah.

THERAPIST: Which is probably not the right word. I think that you will start to really get better when you really feel that what you're doing now really isn't working. Like because what you do is you try to do more of it.

CLIENT: Yeah.

THERAPIST: And it's sort of the hope of, "No, but if I really get a lot of control then it's really going to work."

CLIENT: Yeah.

THERAPIST: It's just that you need to have more control.

CLIENT: Yeah.

THERAPIST: And sort of you kind of do more of it-

CLIENT: Yeah.

THERAPIST: -to feeling like, "Well, that's gonna help."

CLIENT: Mm hm.

THERAPIST: And there isBut then you try to control the control in a sense.

CLIENT: Yeah.

THERAPIST: Rather than like, "We've got to go back to the drawing board, this isn't working." [25:00]

CLIENT: Yeah. I thinkYeah, because right now I don't-yeah, I don't-right now I don't feel like it's not working, and soBecause part of my thing too is like I feel like, okay, I'm done with finals now, now I get to start over and fix everything that I screwed up by like not going to the gym and not doing this schedule and not doing the things like the way that I should have. And so now I get to start over and try to make a new schedule for next semester. So in a way it's like this semester, in terms of like schedule and doing things, actually did feel kind of frazzled and like out of control. And so then in my mind I'm thinking, well, I'm going to fix that, and then next semester I'm going to start over and I'm going to have a better schedule that I can stick to. And so I think that's part of why I was like worried about-because I knew if I came here at 2:30 I wouldn't get to work in time, but also worried about like running around and different things. [26:30]

And the other too was I had to get an evaluation from the current hospital for my program, and because I didn't give them a lot of availability I guess, they put-so people evaluate me, I have to have everything be "excellent" or "very good," and if someone ever puts "good" to me that means like failure. And so they put "good" for flexibility because I wasn't available enough to work. And now I'm thinking with the new hospital I have to make sure that I am really flexible because then they might evaluate me badly and think that I'm not flexible, so I have to give them like all this availability. Because what if they put something that says that I'm just good? Because to me that's bad. [27:30]

So I think that's part of it too, is that I don't want-I feel like if I don't give the new hospital all this availability then they won't think that I'm like flexible or willing to work. So that's part of it too, because-it's weird, it's like if anyone ever gives me-well, it goes back to grades and all of that stuff. But if I ever have anything that's like average, to me that's failing. And I think that applies to like a lot of different things with me. It's just-it's like I need to keep all of the-everything going, and it has to keep going really well.

Like today when I was done with finals I made another list and started doing all the stuff that I felt like I needed to do, because I felt like I had neglected people because of school. When I probably should have just kept it the way that it actually was, because it was probably better. But I was like, "Oh no, now I have to catch up with everybody that there is because I was so busy with school that I neglected all of my obligations, so now I have to do all of this stuff." And so I went back to finding then new ways of stressing myself out. [laughs] [29:00]

THERAPIST: Yeah, I'm wondering if there's a way that we can help you step aside from yourself and think about your thinking. And I don't know if that makes sense.

CLIENT: No, it does. Like just looking at like an outsider's view on that?

THERAPIST: Well, you get stuck on this like view that the [overtalk].

CLIENT: Yeah.

THERAPIST: Like you get completely stuck on it. And it's hard for you to feel like in the end, you know, it actually doesn't matter how my workplace evaluates me. This really is not going to make or break me. Just let go.

CLIENT: Yeah.

THERAPIST: It's just not [overtalk].

CLIENT: Yeah. Well, sometimes I think of things that way. Like I'll think, okay, in the grand scheme of things I could always-like if I don't get into this program I can find another one. I could just not do this, I could pursue something else. Like there are many options for me, this will not like end my life. Like nothing big is going to happen because someone put "good" on this survey. So sometimes like I am able to see that, but that's like rare. Like I really have to force myself to think that way. And it's the same thing with like what other people think of me.

Because, for example, there's maybe like ten people that I decided not to send Christmas cards to this year, because I was like, "I'm just not going to send as many." But then I rationalize it by saying, "They don't care, no one cares. It's a card, whatever, it's fine." But then I couldn't like keep that thinking up, and a week later wound up sending them to all those people. Because I couldn't-I kept thinking, "Well, I really should do-" Like there was like two-it's like two different voices almost. It's like the one voice is trying to say like, "You're trying to think a different way. Be calmer about this. This isn't a big deal." And then it's like the other voice that says, "But isn't it easier if you just do all this stuff?"

I think that's the main thing, is like one side of me feels like, "But it's easier if I just do all this stuff, because if I do all of it then no one's going to think any badly, or nothing bad will happen." Because it's harder for me to not do anything and listen to the other voice and stay calm, because it's like, well, it's just easier if I just do it.

THERAPIST: Isn't it easier to check the stove ten times? At least I know it's checked.

CLIENT: Yeah. It's that. It's that sort of-

THERAPIST: [overtalk] but I don't know, maybe the stove is still on. [32:30]

CLIENT: Yeah. It's sort of like, "Well, it's easier to just e-mail all these people, or call all these friends and check in with them and do all this stuff, because I know then that I did it and it's done and they can't think that I was being a bad friend or something." As opposed to, "Why don't you just relax and take time for yourself? You're finally done with finals, you finally have like a minute to breathe and relax." But no, I had to go do all this stuff and check all the boxes. So it's like sometimes I am able to think that way, but that voice isn't able to win out yet.

THERAPIST: Well, I was thinking, and then the other suggestion that I have that you don't want is medication. I really do think you have some OCD. And I don't think will power is going to overcome it.

CLIENT: Yeah.

THERAPIST: And I think therapy over time can be very helpful.

CLIENT: Yeah.

THERAPIST: I do think medication would help.

CLIENT: Mm hm. But what kind of medications for OCD?

THERAPIST: Usually like Lexapro. Anti-depressants can also help-are often used. First of all, anti-depressants are often used as anti-anxiety pills. But certain medications in certain doses are supposed to help with obsessive thinking as well. [34:00]

CLIENT: Yeah, I think my friend Blair was taking Lexapro and liked it, like didn't feel any bad side effects or anything like that. I mean, so that just sort of changes the way stuff's going-happening in your brain?

THERAPIST: It just brings things down a bit. I mean, for-

CLIENT: So it's not as like I have to do this, I have to.

THERAPIST: I mean, people have dramatically different-and also I'm saying this with the huge caveat that I'm not an M.D.

CLIENT: Right, I have the information from you, yeah.

THERAPIST: But so different people-and people have very different reactions. But certainly the idea is that for people for whom it works, that sort of the thinking slows down, it's not as intense. From what you describe-and I mean, there are a lot of ways to address things.

CLIENT: Yeah.

THERAPIST: I always think, well, why don't you use all the ways you have?

CLIENT: Mm hm. All the tools, yeah.

THERAPIST: All the tools. But there's a way, when I see you get into these mind-frames where you start to think-

CLIENT: Yeah.

THERAPIST: -and I can see you cannot get off that wheel.

CLIENT: No.

THERAPIST: You're in that wheel, you cannot get off that wheel. [35:00]

CLIENT: Well, that's the problem, is like there is like the calm voice, and I see that, and it's like I want to be there. But like the other voice that's saying like that I have to do all this stuff kind of like wins out. Because when I'm being calm, or not doing as much, I feel like there's something wrong with that. Like it feels like it's just not-like it's not right to not be doing anything. And so-and I feel like I've kind-I mean, because of school and everything I've kind of been doing a little bit more of that side of it for the past month, but there is something that felt so wrong about it that I was like, "I can't wait till I can get back to doing all my stuff." But as soon as I kick back into that mode it didn't feel good. Like as soon as today I finished my final and like ran to do all these errands and do all this stuff and call these people, that didn't feel good. It felt like I don't want to be doing this.

THERAPIST: Frantic.

CLIENT: Yeah. And I felt-whereas previously like maybe that might have felt good to me, it didn't feel good to be having to do all this stuff. And it didn't even feel good when I was done with it, whereas it would have used to feel that way. But I think because for so long I've been like a little calmer with all of that stuff because I felt that I had school as an excuse, it didn't-it felt good to go back to like the old way of doing things. Because I liked the more relaxed way of feeling like, "Oh, I forgot to do that, but they'll understand because I have school." But now I feel like I have to do all this stuff because I'm done with school and no one will understand anymore. [37:30]

So it was like I was able to behave a certain way, but it was only because I felt like I had an excuse to behave that way. It wasn't because I was really able to convince myself to act that way, it's because I felt like I had an excuse. And then as soon as I felt like I didn't have that excuse anymore I had to go back to the old ways, but it didn't feel good.

THERAPIST: Well, the ways that you try to sort of sooth yourself-maybe sooth yourself isn't the right word, but take care of yourself [from?] the same things that actually drive you crazy. [38:00]

CLIENT: Yeah.

THERAPIST: I don't think it's your schedule.

CLIENT: Yeah. I mean, I don't think the schedule is good for me. Like-

THERAPIST: You might have a different schedule, and that's a way to make things easier.

CLIENT: Yeah.

THERAPIST: I understand that you sort of overbook yourself.

CLIENT: Yeah.

THERAPIST: So I appreciate that, I'm not saying you're faking that.

CLIENT: Yeah. Yeah.

THERAPIST: But it's the way that you're constantly on the go in your mind.

CLIENT: Yeah, that's what it is. It's just likeAnd that's sort of why like I don't like that like running around feeling, or like writing all these e-mails, or doing all this stuff, because it doesn't feel-that doesn't feel good to me.

THERAPIST: And I think it's so sort of ego-centonic, and so part of who you are.

CLIENT: Yeah.

THERAPIST: And it's hard for you to see that this is the way that you suffer.

CLIENT: No, I know. I know that it is. And it doesn't feelI thinkI mean, the other thing is I realized today it doesn't feel good. It doesn't make me feel like happy. Whereas before I think checking off a checklist, or doing all this stuff, would make me feel good. But it doesn't make me feel good, it makes me feel that like frazzled feeling again, and I don't like it. But it's like at the same time I still feel like there are certain things that I like have to do and have to fit in, like going to the gym. Which I feel like-I feel really guilty about not doing that enough. And I feel like I don't go enough, and that if I went more it would be like better for me mentally. But I don't know. It's sort of that's something that I like struggle with getting myself to do and motivating myself to do, and it's sort of always my like constant I have to do it, I have to do it. [40:30]

THERAPIST: You know, I can-and I think maybe it's hard for you, I don't know. But I really can envision you feeling better. I really can envision that.

CLIENT: Mm hm. [pause] Yeah.

THERAPIST: And I think there are a lot of different ways to get there. But I really can envision that.

CLIENT: Well, I feel like I can too, just with the different ways that I-the way I feel about certain things has changed. I mean, I think the fact that it doesn't feel good for me to like-I know it's not good for me to be as controlling. And sometimes I hear that other voice. So I feel like I can get there too, but breaking some of my patterns is really, really uncomfortable and really, really, really stressful for me.

THERAPIST: And to put it very bluntly, why should you trust anybody? You've had good reason not to.

CLIENT: Yeah.

THERAPIST: You have a really good reason not to.

CLIENT: Yeah. And it's just really uncomfortable for me to like do something that I think might stress me out in any kind of way. Like it's really hard for me to get myself to do it. Because like telling the new boss that I just, you know, can't work Thursdays at all, or whatever, that is so uncomfortable for me to do, because she knew from way back that I was going to have these like five afternoons of availability. It's so uncomfortable for me to do that, even though like I know that would be better. Like it's like I know something will help, but I just can't do it because it's so-it's so like internally stressful for me to do.

THERAPIST: And it breaks with some routine that you have in your mind about what-no order.

CLIENT: Yeah.

THERAPIST: [overtalk] [43:00]

CLIENT: Well, yeah. Because breaking-I think that's what's-breaking like the order and the way that I think things should be done is so, so, so uncomfortable for me. And it's like, but then once I do it it's okay. But it's just getting there that's really like there's debate inside my head and inside of me, like I know I should do this but I can't because it's too uncomfortable, it's too-like it's too stressful, and so there's like this struggle that goes on.

THERAPIST: I can see that.

CLIENT: Yeah. Yeah. So that's the real issue, is that. And then that sort of like rational, "No, you really need to do this," that voice just isn't really winning. I mean, sometimes it is, but a lot of times it's not. So that's sort of like the hard thing. But I think it was good that-in a way that I did all this stuff today and I didn't feel good or accomplished, I just felt kind of tired. So. And then I kind of realized like I didn't even give myself a break, I just did all this stuff, and I couldn't just give myself a break. I needed to say, "Starting tomorrow back at the gym." So like I needed to do all this stuff, why can't I just give myself a break? So it's also like-it's also feeling like I'm worth it enough to give myself these things, instead of giving to other people, or letting other like priorities in my mind win out. [45:00]

THERAPIST: You know, I think we are going to need to stop for today.

CLIENT: Okay. Okay.

THERAPIST: So I guess then I will see you in two-a week from this coming Tuesday.

CLIENT: Yeah. Mm hm, yeah.

THERAPIST: Okay, great.

CLIENT: Thank you. And if you-if there are other mornings that you have that open up.

THERAPIST: So that-so the mornings. Right now my morning-aside from the Wednesday morning everything's booked.

CLIENT: Okay.

THERAPIST: I actually have a morning time-I don't know if this will help-well, it's sort of on route to your school, but I have-on Friday mornings I'm in Amherst.

CLIENT: Oh.

THERAPIST: And I may have a morning time open up there. So I'm mostly here, but two half-days a week I'm in Amherst.

CLIENT: Oh. Okay. That might be-I have to look at what time all my stuff is on Friday, but that might actually be good, because that is on the way to Framingham.

THERAPIST: Okay. And just to also let you know that the time-I don't know if this makes much of a difference, but it's 2:10 the time I have on Thursday afternoons. And I don't know if that makes a difference.

CLIENT: I think because I have to be at school at 3:00 potentially, depending on what the shift is. But on-

THERAPIST: And I could potentially do 2:00 as well. I don't know if that helps you at all. Fifteen minutes is not going to be enough time to get over there.

CLIENT: But Fridays-let me just-I don't want to... Fridays I have a class from 8:30 till 10:30, and one from 11:30 to 12:30.

THERAPIST: So you wouldn't have a morning, you'd have an early afternoon.

CLIENT: Yeah.

THERAPIST: Let me take-I don't know how long I'll be, because I'm only-I usually have a space there for half a day.

CLIENT: Okay.

THERAPIST: But let me take a look at that.

CLIENT: Or-and I could always see after like the first week of school starts and stuff like I said and try to see how everything's shaping up.

THERAPIST: Okay.

CLIENT: Could I-I know I need to do the twice a week, it's just kind of-you know.

THERAPIST: Okay. Well, we'll figure it out.

CLIENT: Thank you, bye.

THERAPIST: Terrific. Okay, take care.

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