TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: So I'm not actually sure what to talk about today. I guess start by telling you how I'm feeling about (inaudible). I guess I'm sad and probably a little bit angry but not at the moment. Just as a seems to be where I am right now.

(Pause): [00:01:01 00:01:08]

CLIENT: Tanya's been doing better in the last week. She continues to have better memory and seems to be more like "there" for lack of a better description, which is really good. She's decided not to do ECT anymore which I think is a good thing because it's given her a place like to direct some anger at her situation and like can be angry with them because they took away some portion of her memory.

(Pause): [00:01:36 [00:01:50

CLIENT: So I think that's good. She's continuing to apply for jobs, which is also a good thing. I think that that's going to be a helpful thing in the long run. She's having a hard time managing herself, which I think contributes to me being somewhat anxious.

(Pause): [00:02:11 00:02:27]

THERAPIST: Managing herself, how?

CLIENT: In terms of like she's very good at mentally flogging herself into doing things but maybe not so good at not flogging herself, so she's able to get things done but not as readily to take care of herself in like that's enough for today. I can now go sit and have a cup of tea and read a book, sort of way. But that's okay. I can help with that. It's not too hard to help with that especially if you've really done all of these things and they were hard. It's okay now.

(Pause): [00:03:14 [00:03:16]

CLIENT: That's a role I don't really mind and in the doing of it, I don't mind at all. I kind of like it. When I was captain of the volleyball team in college, that was kind of the coaching role, also. There's something I like about that. So, in a sense I'm just coaching her taking care of herself in this process for applying for jobs. I don't mind that. The stakes are a little high, but still in a sense, and there is still like you know, we would talk some about feeling powerless before, so this is a way of not feeling powerless because it's something that I can do. But there's also kind of this looming one of the keys about coaching people is that they have to listen. If they decide they don't want to hear what you're saying then you have no power over them any longer. Not that I want power over Tanya, but like -

(Pause): [00:04:33 00:04:45]

CLIENT: This looming kind of like if it gets bad enough to a certain point there will be nothing I can do again and it's just beyond coaching or talking or anything I can do and -

(Pause): [00:05:10 00:05:15]

CLIENT: And I guess describing that way I should be okay with it on some level but I'm not sure that I am.

THERAPIST: What part of it are you not okay with?

(Pause): [00:05:24 00:05:49]

CLIENT: I'm not exactly sure. Maybe the uncertainty. Maybe the -

(Pause): [00:05:51 00:05:58]

CLIENT: I don't really know what to prepare for. It would be nice to be able to live in a world where there wasn't this threat of like someday it might get really bad again and there's nothing to be done and who knows what will happen at that point. Yeah, I don't know exactly.

(Pause): [00:06:25 00:06:37]

CLIENT: I don't want to lose her and also there's also a sense in which like if it gets that bad again I will have lost her, but not permanently, necessarily, but she'll be gone again.

(Pause): [00:06:47 00:06:56]

THERAPIST: The uncertainty of it.

CLIENT: Maybe. It's certainly what it sounds like.

(Pause): [00:07:00 00:07:19]

CLIENT: You know, I guess I'm okay with the idea of not being able to know what the future holds. It's kind of fundamental to being human. So I think I'm just afraid it's going to be very bad again.

(Pause): [00:07:34 00:07:53]

CLIENT: Because at the moment it feels like things are going okay and she's still depressed but back in a like more normal range of depressed, in a sense. Which is a weird enough thing I guess. (Pause) Depressed but handling it. And so it feels like we can do the right things and have that be effective like she can take some time and take care of herself. Yesterday she decided to listen to her voice messages because I think that she had missed a call and thought she had a voice mail from her father and so she was trying to listen for that one. Of course, voice mailboxes are set up to like not useful. So she had to listen to all of the messages. She probably has a half dozen from the ambulance person who was trying to get her to pay them which is a situation that is under control. I mean, I'm handling that one. She doesn't remember that that's the case. She's been doing ECT and doesn't remember a large number of events so she has all this guilt from like, 'here's this thing I'm supposed to do that I didn't do, and no I owe money.' So it's like just different trigger. So she happened to do that when she was walking back from therapy I think. She got home and I reassured her that that was taken care of and this wasn't a thing but she was still very triggered so we sat and we talked for a while and I hugged her and told her it was okay and encouraged her to spend as much of the rest of the day as she needed to recover from that incident because it was traumatic in a sense and that takes time to work through, which she did. By the end of the day she felt better. So it feels like it's manageable right now and I'm scared that it's going to stop being manageable and the feeling like it's manageable right now and the fear is somehow associated with the idea like we will mismanage it and it will become unmanageable. Like we're sitting right at a balance point and so long as we keep handling it correctly or very close to correctly, it will be okay. But I'm not sure it's possible for an infinite amount of time, so I'm afraid we're going to tip back over I think.

(Pause): [00:11:12 00:11:29]

THERAPIST: Everything that's happened has really shaken you.

(Pause): [00:11:31 00:11:50]

CLIENT: I mean the events of yesterday didn't really shake me. That was not a big deal. But like the -

THERAPIST: (Unclear) of the last few months that was a lot of (inaudible).

CLIENT: Yes. Yes, it has. Yes, it has.

(Pause): [00:12:01 00:12:20]

CLIENT: Yeah, I think I'm still sad and probably angry although I don't feel angry at this moment. And it just -

(Pause): [00:12:29 00:12:48]

CLIENT: just hurt or something from all of that. Everything that's happened, it still, it takes time to recover from trauma and here's the threat of having it again. I think that's -

(Pause): [00:13:04 00:13:11]

CLIENT: I think that's part of what's going on.

THERAPIST: You started by mentioning sadness.

CLIENT: Um hmm [yes].

(Pause): [00:13:22 00:13:31]

CLIENT: Yeah, well sad but not sad about anything in particular, just -

(Pause): [00:13:32 00:13:53]

CLIENT: I don't have a particular single event to associate sadness with. I think it is a result of the series of events of the last months or weeks or days. But sort of cumulative rather than any specific saddening event.

(Pause): [00:14:12 00:14:34]

CLIENT: There's also this sense in which as Tanya gets better she wants to take care of me because like that's very important to her. I am important to her. That's good I think. It's nice except that I haven't really been able to rely on her for months so and also like -

(Pause): [00:15:00 00:15:11]

CLIENT: She's still pretty fragile. I know she's fragile so it's there's some sense in which I can't rely on her still but she's not as aware of that as I am or something. It's like I can't say no, I don't want to talk to you about being sad.

(Pause): [00:15:32 00:15:49]

CLIENT: I'm still not really sure where to go and what to do on that front of when or how do I trust her again. I think that there's a sense in which I just do it but -

(Pause): [00:16:05 00:16:16]

CLIENT: I think it's small steps so it's like she wants to help make dinner or wants to make dinner so I let her. Trust her to do that. Let her do that. Let her take care of herself and me and us in that way. I think that's a good thing.

(Pause): [00:16:37 00:17:27]

CLIENT: But it's hard, I mean, even ignoring the possibility of it hurting her for me to be sad or however I'm feeling at the moment. I'm not sure that I'm ready to trust her with that and that's hard. But I think I feel guilty about that, but -

(Pause): [00:17:46 00:17:53]

CLIENT: It's where I am, I guess.

THERAPIST: You don't trust her to (Pause) do you feel like she'll fall apart?

CLIENT: Maybe. Yeah.

(Pause): [00:18:05 00:18:41]

CLIENT: Yeah, I think that's got to be about it.

(Pause): [00:18:42 00:18:52]

CLIENT: Yeah. Something like that. Yeah.

(Pause): [00:18:53 00:18:58]

CLIENT: That like if she -

(Pause): [00:18:58 00:19:27]

CLIENT: Yeah, the feeling that I have is something like 'if I trust her, things will end up worse.' So yeah, I think it's that I'm anxious that she will fall apart or something like that. Although the feeling isn't quite as specific as that, I think that is the yeah.

(Pause): [00:19:46 00:20:33]

CLIENT: So, in that silence I thought about the other thing that I haven't mentioned yet which is my advisor told me at our meeting last week that he thought that I should finish writing up what I'm writing up and then we should measure my time to degree in months and the number should be small. Which is really good in some sense. And he was not expecting me to be pleased by this idea so I kind of he framed it in my this is not necessarily going to be the thesis that either of us wanted for you, but I feel like you would be an excellent representative of the department and so it's time to move on for all of us. Yet this is also tied to the sequestration because most of the funding is through a government agency and he's got a large grant under renewal and so part of the reason he's thinking about it is because there is the possibility that he'll end up suddenly having like a tenth of the funding that he had, or thought he had for this year. And so he's looking at how to see, in a sense, reduce his exposure. So I guess I have this fear, also that I'm going to talk to him this week and that's going to go away. Which sounds like I have trust issues this week. (Laughs)

THERAPIST: As in a way being the funding?

CLIENT: Not the funding, no. The 'let's get you out the door' is going to go away. That's going to get back entrenched in a degree that has been in a has been very frustrating. I've done a lot of things that have worked and it's just taking a very long time, or it's felt like a very long process during which very little has gotten done.

(Pause): [00:22:35 00:22:56]

CLIENT: So then I was trying to think of why I am I tagged for difficulty of trusting anything this week? I had mentioned before that there's kind of been a whole sequence of things that I've tasked that I've done that just haven't stayed done which is not a usual experience with me. Usually when I do something I do it right and it stays done and I move on. So there's that and like Tanya had been in and out of the hospital repeatedly this year, so every time it's kind of like, 'oh, maybe this time it's better, it's going to be okay.' And then it keeps not being okay and end up back (Pause) I think that' all related.

(Pause): [00:23:54 00:24:00]

THERAPIST: I was thinking of your thesis advisor saying, 'this is not the thesis people wanted it to be,' is the theme of your life right now.

CLIENT: (Laughs) Yeah. Yeah, I think that's right. Yeah. The theme in that sense, but the theme of the last several years of my life.

THERAPIST: Really.

CLIENT: Yeah, well you know, Tanya's been depressed for a long time. As I was saying, the last several years I've been working on this degree and just not getting anywhere in a meaningful sense. I mean, I got into research because it was just, it was a place could work at the edge of what was known and that was really kind of fascinating and interesting. When I was a freshman in college that seemed really cool. I was very frustrated with the education I was getting at the time, like I felt like my first year or two of college was mostly review of my high school time. It's not what I was hoping for or expecting and so this was kind of a nice outlet, doing research. I had a really good advisor who took good care of me. So I ended up publishing a lot of papers as an undergraduate, which was also cool. It was kind of nice. So I had this like, this was the same thing that I really liked and was good at, was successful at by any metric. And that sort of in some major way went away in graduate school.

(Pause): [00:25:42 00:25:47]

CLIENT: Yeah, so it's kind of been a theme for a while.

THERAPIST: So then, sort of a piece, or a part of that is disappointment and loss.

CLIENT: Yeah. Yeah and the sort of existential questions that come with both of those, particularly the disappointment of like who am I? Where am I? What am I doling? Yeah. And where did it go? Kind of the loss questions like how did this happen? Yeah, those make a pretty good parallel to my life with Tanya.

(Pause): [00:26:30 00:26:57]

CLIENT: The place they become parallel is kind of the, 'what am I going to do?' or, 'where are we going?' world. I could walk away from biomechanics. I'm not going to walk away from Tanya. I don't think I'm walking away from biomechanics either. But that's been on the table, that's been like that's not a real sense in which anyone needs a PhD. Like it's not a degree that you must have. So it's something that can be walked away from, though I'm not sure that I ever could actually have walked away from it because that would be quitting.

(Pause): [00:27:46 00:27:50]

CLIENT: So then there's been a lot of like questions of like, 'well, if walking away is actually sort of the best thing to do what's it okay to do?' Even though it is quitting. What's -

(Pause): [00:28:06 00:28:11]

CLIENT: That's been a question. I think I would have answered it in the affirmative if I had had a clear picture of something else that I wanted to do more.

(Pause): [00:28:19 00:28:24]

CLIENT: But I actually really liked biomechanics research, it's just been really frustrating and the further I go into graduate education, the more I know about the educational system and the grant system and the tangled bureaucracy as in funding streams and it's a mess. It's a mess and I think there are some real moral questions about whether it's okay to educate people to be scientists. So that's been a real struggle like the career paths that are open to me are in like industry or in government or in education and I'd prefer to be in education but then I'm teaching people to do biomechanics and the only career paths open to them are in industry or government or education.

(Pause): [00:29:28 00:29:37]

CLIENT: If I were to decide that neither industry nor government positions were morally acceptable to take it would be hard to take an education position where I trained people for those positions.

THERAPIST: Well, accept if the people, the students you had needs and values were different.

(Pause): [00:30:00 00:30:07]

THERAPIST: That assumes that they would feel the same way you would about those industries or sectors or -

CLIENT: Yeah.

(Pause): [00:30:18 00:30:23]

THERAPIST: You're not so sure.

CLIENT: I mean, in a sense you're right. There's also a sense in which like if I'm not sure that if it there's a sense in which I still haven't decided about moral absolutism, so. Like if I'm pretty sure what's wrong, can I be pretty sure that it's wrong -period? Or can I be sure that it's wrong for me? I still haven't quite figured out the answer to that. I think there are some things that are just wrong.

THERAPIST: What do you feel I understand the education part because you feel you're educating people to do things that are wrong. But what is the wrong in these other sectors?

(Pause): [00:31:09 00:32:22]

CLIENT: It's hard it's hard to speak in a really broad, general way and to get into any detailed way like I'd have to go through like specific industry but in the general sense it's like pollution, oppression of someone, exploitation for someone to make money at the expense of someone else while telling them that it's for their own good. So like the pharmaceutical industry is a decent example of that last one I a lot of ways. Although medicinal biomechanics and drugs are good and helpful things, the pharmaceutical industry is oriented towards finding the next billion-dollar drug, or multi-billion dollar drug. In order to do which they have to convince someone that you need a drug for some condition which sometimes is the case but for example, for statins for heart disease, there (chuckles) they treat high blood pressure the statins do but high blood pressure is only linked to heart disease it's not necessarily a cause of heart disease and so the most recent thing I've read about it is that setting an arbitrary limit for the highest high blood pressure means that one prescribes statins for people who have not increased risk of heart disease because a slightly elevated amount has not clinically demonstrated connection to heart disease. But if you try to change the recommendation of any agency that makes the recommendation of blood pressure, you'd have to deal with the several companies that market statins who also lobby all of the groups that would make the decision. So it would be is it the case that statins are helpful? Probably. And maybe I'm saying the wrong actually I've never heard it said. (Pause) Is there a great deal of, if not actual corruption or wrong doing? The appearance of it yes. And so an agent in that, if I were to do research for a company that was involved in making those, what would be my moral culpability for that sort of scenario particularly knowing that is how it's going to go. They're going to look for drugs that treat conditions that are widespread but don't have an easy remedy already and then they're going to attempt to market those, then attempt to enforce the need for them in some way. So it's just -

(Pause): [00:35:43 00:36:25]

CLIENT: It's a cycle where the (Pause) it's a cycle where the scientist ends up being typically, the scientist is just trying to help people make new medicines to cure people, but you have to believe that that system is actually doing that and the large scale studies indicate that despite spending several times more per person in health care, the U.S. does no better than anyone else and often worse. That says something about the system working or about the people who are working with so it's like there's a whole series of large-scale corporations where someone is taking advantage of ideological skilled workers. So like I can't see how I can train someone into that field. But I can also see how you've already in a sense like, is that person being exploited if they're okay with it? I don't know.

THERAPIST: They only are if they just don't know any better. That would be how they'd be exploited.

CLIENT: Right.

(Pause): [00:38:05 00:38:09]

THERAPIST: But then you'd have to assume that they're not competent to make their own decisions.

(Pause): [00:38:12 00:38:44]

CLIENT: Or that they don't have the information necessary to make their own decisions competently. But -

THERAPIST: Maybe, but then, you know it's -

CLIENT: Well, but then -

THERAPIST: people's responsibility to gather information so -

CLIENT: Sure.

THERAPIST: it's still a problem that they're not gathering the information they need..

CLIENT: But I know that people aren't gathering information they need because the academic community wouldn't be so cruel to it's own, to itself, if it gathered all the information it needed and (inaudible) I have a very good friend who just started working at Dow because despite being very good, he's a really good scientist, and he worked for a really good research group, such that he could have a career in academia. He knew what he was getting into and decided that he couldn't face another seven to ten years of grueling work all the time so he's not going into academia. Well, that's a real loss to the community like that. So -

(Pause): [00:39:54 00:40:05]

CLIENT: It's like the person who doesn't look at that and say, 'yeah, I'll do that because it's worth it,' he's just like, isn't there some level of punishment that's just not okay, even if the person is willing to take it on?

(Pause): [00:40:21 00:40:31]

THERAPIST: Well, I really see that you can be disappointed a lot. Human nature falls so short of these ideals, in general.

(Pause): [00:40:35 [00:40:45]

THERAPIST: I mean I can make a whole other argument which I feel at times is that if the focus was on lifestyle and getting rid of fast foods and diets and so forth, you wouldn't need most of these medications for heart disease. So (Chuckle) I mean, although some people just have genetic heart disease, so -

CLIENT: But you know, absolutely and they're digging up mummies and finding that they have hardened arteries and so there is some element in which like this is what happens to people. People age and then they die. Like, part of the whole industry is just being unwilling to accept the fact that we're mortal beings. I'm not sure that's a moral thing either. Like we're going to die. You know, we can work to make that happen later in life or something. Live our time better but I'm not sure we live our time better, like we just work to make it happen later, so.

THERAPIST: But maybe what's more pertinent was my comment of imagining that you could be pretty disappointed much of the time.

CLIENT: (Laughs) Yeah. Yeah, I think that's pretty pertinent.

(Pause): [00:41:55 00:41:58]

THERAPIST: Some people have a job mostly to get a paycheck.

(Pause): [00:41:59 00:42:03]

THERAPIST: To get home from work and spend time with their family or hobbies or whatever.

CLIENT: You know, there's a real sense in which I can think of for them, I'm not sure I can do that. Maybe I should strive for that but I haven't -

(Pause): [00:42:17 00:42:30]

CLIENT: Yeah, I'm not sure.

THERAPIST: Not sure. Yeah, I mean, but I can't imagine that you'd be the type of person who would want that.

CLIENT: (Laughs)

THERAPIST: You know it speaks to sort of are there relatives, thinking the opposite of absolutely relative values that might work for some people but that wouldn't work for you.

CLIENT: Yeah. It's sort of like, so this is the problem, right? So those people meet so I could train these people that if they had the value system that made it okay, but at some point like if the people who run most of the corporations have a value system that takes advantage of the majority of people having that value system and the structures that result and then punish people like me who don't want to just have a paycheck, my training more people to work in that corporate model, I'm making a world that I don't want to live in.

THERAPIST: Well, the piece of it is that you believe they're being taken advantage of. You're thinking about things in terms of power and control and I'm not questioning it, per se. I'm just sort of providing a framework for thinking about it.

CLIENT: That's a good question. I'm -

(Pause): [00:43:52 00:44:05]

THERAPIST: And I guess maybe the assumption that some people are more helpless than others -

(Pause): [00:44:09 00:44:19]

CLIENT: Yeah, that's a big I think we have to accept that's true like that there's some sense in which -

(Pause): [00:44:26 00:44:35]

CLIENT: despite some fundamental moral or political equality, I'm not sure people are practically equal. If one starts out in a very poor family or a very rich family, the outcomes are very different in a practical sense, despite anything we might desire otherwise. So there are people who are more powerless.

(Pause): [00:44:58 00:45:33]

THERAPIST: Luke, we're going to need to stop for today. Thank you for your flexibility today. I appreciate it.

CLIENT: Absolutely. I'm usually flexible so it's -

THERAPIST: Yeah, well I respect your time and our time. Okay. I'll see you next week.

CLIENT: Okay.

END TRANSCRIPT