TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: Hi. Come on in.

(Pause): [00:00:06 00:00:23]

CLIENT: So I get here early so we can start on time. It's okay that you're -

THERAPIST: Oh that's okay. I just wanted to let you know -

CLIENT: I appreciate that. (Laughs) Okay. So can we talk about billing briefly? So, it's not like we're due the whole bill? Do you have a preferred due date?

THERAPIST: Yeah, usually just as within a few weeks. Sorry. I put that on like a treatment contract that was months ago.

CLIENT: Oh, okay. I'm sorry.

THERAPIST: Usually, no. I ask within a few weeks, you know if it's to the end of the following month that's okay, too.

CLIENT: Okay. Thanks.

THERAPIST: Sure.

CLIENT: Like I said, Tanya and I have been seeing you since November. We still have not gotten reimbursed from then from the insurance so we're -

THERAPIST: Are you serious?

CLIENT: Yeah. So eventually there will be more money coming in. So that's the question.

THERAPIST: Did you I know -

CLIENT: We submitted all the things.

THERAPIST: I know you guys are dealing with so much insurance crap, but have you called them because that's pretty unusual. They're usually actually the insurance company is pretty good.

CLIENT: Okay. So I called them it's probably a month ago now, but I can't quite remember when but it had been a month or month and a half since we had submitted a batch of a number of them and they said they were updating their computer system and that things were taking longer and we should just wait because they hadn't been processed yet. So, Tanya's going to call them today was the plan because of course we have the same issue her treatment with Chad so it's well, so he's just recently switched from being a provider to not and so -

THERAPIST: That's really because I haven't heard that but sometimes it goes in waves.

CLIENT: Okay.

THERAPIST: I know the first set I actually submitted for you and that's usually like three or four weeks (unclear). If for some reason you have any difficulty I have an assistant who can sometimes help out with insurance and find out what's going on. I'm sorry you're having trouble getting reimbursed.

CLIENT: Thank you.

THERAPIST: Yeah.

CLIENT: Okay. We'll call them and continue forward.

THERAPIST: They are required because once it's in the system like 30 to 45 days which they rarely take that long, but they are required once it's in the system to take that amount of time.

CLIENT: Right. So I think they get to define what counts as "in the system" so if they get the paperwork and don't type it in or whatever, I think that's what's going on with that.

THERAPIST: Right. Well, just let me know. At the very least, I can do it by phone. I can punch it in by phone, which is how I did your first one. At the very least I can redo that and then take there's a reference number and make sure I write that down so then that's you know but anyway, see what you can do and let me know.

CLIENT: Okay. Thank you. Thanks, that's helpful.

(Pause): [00:03:16 00:03:22]

CLIENT: So this has been a better week. Tanya's been doing better. She's been applying for jobs since last Tuesday, fairly consistently at her own I don't know, will or something. So that's a good thing. (Pause) It's made it easier for me to continue working and sort of begun to restore some normalcy to our lives just really good.

(Pause): [00:04:00 00:04:48]

CLIENT: So one of the reasons I wanted to start seeing you individually is the story I'm about to tell. I having a little hard time telling, but so (Pause) Tanya's a person who develops crushes on people easily. It's just kind of a thing about her. I find it endearing. I think it's a good thing by and large. So she started developing a crush on one of her professors at William & Mary while she was there I forget exactly when. And I'd known it for a long time and saw it happening. It's not a big deal. We were somewhere in there we got engaged -

(Pause): [00:05:31 [00:06:23]

CLIENT: The particular timeline doesn't matter but I think sometime after she graduated we got married about three months after that. But between those two events the professor indicated he had feelings for her also despite being married and having two children and wanted her to run away with him. She didn't but they from some point in that time period they carried on an emotional affair for some time. It never culminated in any real physical affair but that -

(Pause): [00:07:03 00:08:07]

CLIENT: It culminated I think that November which would have been 2010 and at a conference he wanted to take things further and I think she probably wanted to also but also didn't want to. So they ended up holding hands, which for her was crossing a line in her mind that was the moment that it crossed the line at the time. And so when she came back she told me that that had happened but didn't want to talk about the exchanging love letters.

(Pause): [00:08:40 00:08:50]

CLIENT: So the rest of it came out some time later. You know I it's one of those times when I could tell there was more to the story and left it alone for awhile waiting for the rest of it to come out. And eventually I asked about it again after a number of months. The rest came out and -

(Pause): [00:09:13 00:10:05]

CLIENT: So I forgave her really. I looked up the word to make sure I understood what I was saying. It still hurt. But I forgave her. I was probably a little bit angry with her but not very. Probably more angry with him.

(Pause): [00:10:33 00:10:42]

CLIENT: It was one of those things that I don't understand how it happened. Basically, I have very similar academic interests in a very narrow, specialty. So -

(Pause): [00:10:57 00:11:26]

CLIENT: I think the reason I'm more angry with him than with her is that I feel like he's violated some code of professional ethics also in addition to other ethical codes.

(Pause): [00:11:45 00:12:06]

CLIENT: So this still comes up. We like to watch TV shows together. We don't watch television proper much like a TV show sequence, like following the story. So, apparently it is a common thing-both the figures and suicide come up in a whole lot of media outlets since it's always sort of both hard to watch and painful and a good thing. You're articulating one of the purposes of therapy is helping to make sense of my experiences and I think there is a real sense of that is what that does also.

(Pause): [00:12:57 00:13:34]

THERAPIST: What do you think makes it so hard to talk about?

(Pause): [00:13:36 00:13:52]

CLIENT: It hurts.

(Pause): [00:13:52 00:13:58]

CLIENT: And I spend a lot of time not talking about it.

(Pause): [00:13:59 00:14:04]

CLIENT: Part of the -

(Pause): [00:14:04 00:14:18]

CLIENT: I still have this urge to protect Tanya, so I feel like this is one of those things that people get judged very harshly for in some circumstances. Not that I particularly think you are in that position. Just you only have to look at the national news to see that, right? Betrayals, (unclear), affairs, scandals they made headlines for a very long time. That should perhaps, but regardless like being part of the most complicated part of forgiveness is not seeking retribution not that I would want to but like that is what I have to say, I just said, okay?

(Pause): [00:15:19 00:15:24]

CLIENT: If I am the wronged party, I have absolved her, so telling people about it is in some way not meeting that criteria, which makes it a little hard to deal with.

(Pause): [00:15:33 00:15:57]

CLIENT: The other thing that makes it hard to say is that as I sit here I can kind of go through whatever details I have, but that's not really the hard part. The hard part was saying what happened. There's nothing much to say after that just that it hurts and the hurt continues to hurt.

(Pause): [00:16:21 00:16:25]

THERAPIST: That she could betray you?

(Pause): [00:16:30 00:16:49]

CLIENT: Yeah, yeah I guess so.

(Pause): [00:16:52 00:17:12]

CLIENT: I like to think of myself as a very loyal person so loyalty matters a lot to me this is a it's a violation of that. Yeah. I think in a lot of ways the harder thing to deal with for me has been the question of timing. So, she's not happy that she did this. I don't think she's forgiven herself and if you just match up timelines she we got married and then she went to Brown and then she's been depressed ever since, wanting to kill herself. I'm not sure she's forgiven herself for this, so it's not too hard to paint a story where -

(Pause): [00:18:03 00:18:26]

CLIENT: where a major exacerbating factor in the depression is her inability to forgive herself and deal with the guilt.

(Pause): [00:18:33 00:18:42]

CLIENT: Frankly, I'm very angry. Very angry. (Pause) Because then it's I'm not sure that that story is correct, but I think there is more than zero truth to it.

(Pause): [00:18:55 00:19:02]

CLIENT: Because then what she's doing may be in a way is just taking away my right to forgive her. Making that useless.

(Pause): [00:19:26 00:19:45]

CLIENT: You seem confused by that or something.

THERAPIST: No. I'm deep in thought.

CLIENT: Okay.

THERAPIST: I was just I was trying to -

CLIENT: Take your time. That's okay.

THERAPIST: Yeah. I guess I was just sort of formulating questions in my own mind and I guess one question I have for you is does that make you, then, forgive her less?

CLIENT: It's sort of like there's a new thing to have to forgive her for.

(Pause): [00:20:08 00:20:18]

CLIENT: I'm not sure that I have yet.

(Pause): [00:20:19 00:20:28]

CLIENT: But then we get very far into that discussion and we're talking about why is she sick and what does it mean to be mentally ill the way that she is and is it her fault or not. We've talked before about it not being her fault but -

(Pause): [00:20:49 00:21:22]

CLIENT: There's a sense in which regardless of the cause she's wanting to kill herself is giving up and -

(Pause): [00:21:32 00:21:46]

CLIENT: I think that makes me pretty angry.

(Pause): [00:21:47 00:22:17]

CLIENT: You know, it's okay to not have enough to deal with things. It's okay to drop the ball or whatever. For me to lie down to rest quitting is not okay.

(Pause): [00:22:38 00:22:51]

THERAPIST: You definitely don't strike me as a quitter.

CLIENT: Thanks.

(Pause): [00:22:55 00:23:10]

CLIENT: She's not going to die, either.

(Pause): [00:23:13 00:23:33]

THERAPIST: So then is it hard to make sense of what she's doing now?

CLIENT: Yeah. Yeah. And you know, if she is that's hard to make sense of, too. You know, if she -

(Pause): [00:23:47 00:23:51]

CLIENT: We had a conversation like a year and a half ago, or maybe a year ago, where I articulated something like that like, 'how can you give up?' She says, 'well, it's taken a year of intense pain but I'm tired,' or something like that, you know?

(Pause): [00:24:16 00:24:26]

CLIENT: There's some pieces of that that I understand but I can't (Pause) care if I don't know the whole thing. Just I can understand moments of wanting to give up. That's part of not giving up is wanting to sometimes. But it's never meaningful if you never want to give up and don't give up. Like what have you accomplished? You just continue to do like think there is something about continuing in the face of that feeling of adversity or whatever that is meaningful and hard. But maybe that's why it's meaningful. So I understand the wanting to and even understand the short periods of giving up, I guess -

(Pause): [00:25:29 00:25:45]

CLIENT: But I don't understand where she is or what she's doing other than at this point she's not like this is it, right? Like this conversation lags behind my experience by some period of time and part of that is because I can't always talk about all that's happening. And part of it is because all that's happening and just existing in the moment not thinking about some of these pieces.

THERAPIST: While it's happening. What's the it?

CLIENT: Oh sorry. Her wanting to kill herself so that she's not suicidal right now in the way that she has been for a long time. That's a good thing, really, I'm happy about that. But you know, I still have emotions and experiences to deal with from when she was there.

(Pause): [00:26:45 00:26:49]

THERAPIST: Well, I can see why you could feel on a number of times why it looks like she's given up and it seems like sort of her functioning decline some more gradually and then precipitously, it feels sort of like one thing after another of what she wasn't able to do anymore.

CLIENT: Yeah. Yeah, that's right.

THERAPIST: So it is sort of stripped to its bare essence of living.

CLIENT: Yeah. Yeah, I think that's right. Yeah.

(Pause): [00:27:28 00:28:38]

CLIENT: I'm sitting here thinking I'm not sure what else to say. That was all very helpful. I feel considerably better. I'm not sure where else to go.

(Pause): [00:28:47 00:28:52]

THERAPIST: Do you feel like you can ever tell her you're angry?

(Pause): [00:28:59 00:29:19]

CLIENT: Probably not. It's so, so -

(Pause): [00:29:22 00:29:44]

CLIENT: The whole affair/forgiveness thing came up during the television we were watching so we talked about it some. I did articulate that I felt like she was doing me wrong if she refused to forgive herself because it's to throw away the forgiveness that I'm that I have forgiven, taking away my right to forgive her for something which I think in British common law sense makes sense in the maybe it doesn't make sense in an emotional way like you know, her feelings are hers and they're about her feeling and that's it's own thing, but -

(Pause): [00:30:38 00:30:44]

CLIENT: So I could tell her that idea but did not tell her that I was angry enough that that I would be angry about that, or could be and I feel like there is not space for me to say that I am angry that she wants to kill herself. It is not a safe thing to say because one of the things she has a very hard time dealing with is me being angry, and particularly at her. So that's will I ever be able to say that I am or was angry about that? Maybe but not now.

(Pause): [00:31:42 00:31:51]

THERAPIST: I was thinking when you were saying about feeling your forgiveness was useless if she's not going to forgive herself. I was thinking how many different ways you can think about "useless" over the last several months if your desire to keep her alive has felt useless to some extent.

(Pause): [00:32:07 00:32:57]

CLIENT: Yeah, I think that's right.

(Pause): [00:33:04 00:33:35]

CLIENT: Not entirely useless, but not fully useful. Yeah.

(Pause): [00:33:46 00:34:02]

CLIENT: But that's an interesting connection.

THERAPIST: Well it made me think about your looking for jobs for her or even just refilling her medication or trying to get her medication and being frustrated that you couldn't do these things for her as much as you've tried.

(Pause): [00:34:24 00:34:47]

CLIENT: So that's complicated because I feel like the upshots of those conversations were that I was trying to do too much for her in the sense of -

(Pause): [00:34:59 00:35:11]

CLIENT: coddling her, taking away by helping her or preventing her from healing or regrowing or something. I'm not sure that is the case here also.

THERAPIST: Yeah, I wasn't initially drawing that analogy and maybe there's no analogy to be made but I was thinking more about sort of your frustration about not being feeling like in part what you were doing was in response to your own feelings of helplessness. And I guess that was the analogy I was making to the extent of feeling useless and feeling helpless were the same things.

CLIENT: It's a I, in general, haven't pressed very hard on the helpless description but it's a word I have trouble accepting which maybe makes sense but I feel like I am there are a lot of things out of my control but to be helpless is to have nothing under one's control to my mind. And that's never really the case. So I feel, I think I feel that if I accept that description which a number of people have tried to use that word as a way of like helping me deal with not being omnipotent or something if I accept that word then I am giving up controlling what you have left.

THERAPIST: That's really interesting.

(Pause): [00:37:17 00:37:22]

THERAPIST: Because then the opposite is that if you reject that word you actually have control that what you're actually doing is not simply describing something, but actually making it happen or not happen. That's very interesting. I'm not sure I agree with it.

CLIENT: (Laughing) Yeah, I guess yes, to say it is to perform an utterance, yeah.

THERAPIST: Versus, you know really descriptive.

CLIENT: Right.

THERAPIST: Where to call a thing a thing makes it real, whereas not to call it a thing because it's not real.

CLIENT: Hmm.

(Pause): [00:38:02 00:38:08]

CLIENT: Yeah, I'm not sure that I buy that, yet in some sense if not having a need for a thing doesn't make it not exist. Not being able to -

(Pause): [00:38:18 00:38:31]

THERAPIST: But this very much relates to the idea of giving up.

CLIENT: Yeah. Oh yeah. Yeah, which you said you didn't think I do, so you can understand how I might, if I think they're related, not want to take that word.

THERAPIST: Well, giving up is a response to feeling helpless and not synonymous and feeling helpless is still feeling and not an actuality. I don't think that people are helpless and I think also how you're defining helpless is much more globally than I mean it. I don't think of helplessness as a state of being. While it can be, I think people can also be helpless in a particular context. It depends on how you define the problem. Living Tanya's life for her that's a I think you'd be helpless in that but that's a very context I don't see it maybe global as you're defining it.

CLIENT: Humph. That's helpful.

(Pause): [00:39:29 00:39:55]

CLIENT: You don't think helplessness is also a state of being?

THERAPIST: It could be. But not necessarily.

CLIENT: Okay.

THERAPIST: You can be someone who just feels globally helpless. I don't think you could be.

CLIENT: (Laughing)

THERAPIST: Maybe we can all be in certain contexts. I'll have to think about that. But it can be but it doesn't have to be that.

CLIENT: Okay.

(Pause): [00:40:17 00:40:36]

THERAPIST: This issue of how much of Tanya's sort of behavior of being as a mental illness and it's out of her control, and how much she has responsibility and interest in taking responsibility for it, I think is a huge issue for you.

CLIENT: Yeah. Yeah, I don't have any answer on that front and it varies from day to day, more really from week to week and it's more or less stable from day to day but it kind of changes. I think it probably changes in response to how she's doing. I'm not sure that's really fair but is what happens.

THERAPIST: How did like if she's doing better how does that how does that change?

CLIENT: When she's doing better it has a hard time so she's doing fairly well right now but is still very sad. But -

(Pause): [00:41:34 00:41:39]

CLIENT: She keeps applying for jobs. That's good. What she also needs to do, must do, in applying while doing that is deal with the negative issues that that causes. It's very clear it causes negative emotions. Useless, helpless and worthless and all these things because she doesn't have a job immediately after applying for it and hasn't had a job for a while and has lost her kind of has lost her direction in some way. Not dealing with those feelings is a it's clear that that's what she needs to do is the thing that I have a hard time dealing with. It's I guess there's some preventability in it. When she gets really bad and wants to kill herself I there is something more of crisis in it and so it seems more (Pause) out of control, out of her control.

(Pause): [00:42:56 00:43:08]

CLIENT: I'm really all tangled up in this. I don't really know. But I think part of it has to do with when it seems like it would be little things that she could do that would make a difference. Those I feel like are clearly her responsibility and so (Pause) it's less clear how one should deal with feeling suicidal.

(Pause): [00:43:46 00:43:51]

CLIENT: That's just so big in some sense, and so unbearably large.

(Pause): [00:43:56 00:44:08]

CLIENT: But how do you deal with forgetting things? How would I deal with forgetting things? I would keep lists and calendars and write notes to myself. I would ask for help. It's a there are practical things one can do to respond to these essentially practical problems that are essentially practical for getting from one day to the next. Some things. And then the feelings of and so now we're back at helpless I think because I think she feels helpless in the face of some of the memory loss caused by ECT and she feels like a failure as a result. But she's not helpless in the sense of like -

(Pause): [00:44:58 00:45:11]

CLIENT: There are things that could be done and she has gotten better about just asking me where something is or where something came from or what happened on some time. And that's good. I think that's a good thing.

(Pause): [00:45:26 00:45:43]

CLIENT: I've started out answering questions and I've gotten tangled away from it but I feel like there's something in there.

THERAPIST: We're going to need to stop for today. Let me, when you do find out from the insurance what the story is, let me know if I can be of any help, okay?

CLIENT: Okay.

THERAPIST: If it's a matter of stuff that they say that they haven't received it I can at the very least phone everything in and have a confirmation number in which case there is a trail.

CLIENT: Right.

THERAPIST: Okay.

CLIENT: Thanks very much.

THERAPIST: Okay. I'll see you next week.

CLIENT: Okay.

THERAPIST: Okay, bye-bye.

CLIENT: Bye.

END TRANSCRIPT