TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi, come on in. [Do you want some water?] (ph).

CLIENT: (Pause), Hi. (Pause), (door closes), (pause). Need help?

THERAPIST: Thank you, thank you. (Pause).

CLIENT: So I'm not sure where we are this week. I guess left off you suggested that it would be you could see how it would be easy for me to be disappointed often, (pause), which I think is probably right, but (pause), yeah, I think that's right. [00:01:07]

(Pause), I haven't worked out any (pause), any detail of what that implies, if that makes sense. (Pause), could take the approach that that means that the worldview that I have is problematic, because it doesn't allow me to exist in the world that actually exists exist easily in the world that actually exists.

I don't know if that's true or not. I mean certainly, (pause), yeah, I'm not sure.

THERAPIST: [inaudible at 00:01:49], (pause).

CLIENT: So there's that, (pause), Tanya's been doing some tutoring, so she's found a couple of people that want her as a tutor, and she's doing that. That's good. I feel like she's also really struggling with the job search, in the emotions management portions of it.

Most jobs, you apply for them and there's some window, and after the window's over, they start evaluating applications. And I'm not sure she can handle the not hearing back, (pause), for several weeks part of it. [00:02:46]

THERAPIST: Oh.

CLIENT: (Pause), [inaudible at 00:02:52] have been getting harder for her over the last week, and (pause), if it gets too much harder, we're going to be in not a good place, so I don't know where that's going.

THERAPIST: And how do you mean?

CLIENT: (Pause), I think she's starting to have suicidal thoughts again, so I think that if it gets too much harder, she's going to spend most of her time in suicidal thoughts. And while she's survived that several times, that's not a place that I want to be or I want her to be because that would [inaudible at 00:03:39].

(Pause), it's one of those things where nothing's changed from last week to this week, except she's picked up another couple of students that she's tutoring. So in terms of progress on short-term jobs, things have gotten better. In terms of progress on long-term jobs, they haven't changed, and they shouldn't have changed because she's applied for jobs that those application windows are more or less to the end of March.

So in a very factual sense, things should be okay. (Pause), but in an emotional sense for her they are not okay. And I don't, (pause), I don't know exactly how to make sense of that. [00:04:50]

(Pause), because she's actually been unemployed or underemployed for six or nine months or something. So another week really is a marginal change of no significance, again, factually. But then to compare it to emotionally, she's doing worse this week than last week with handling it.

(Pause), and I definitely understand that sometimes the longer you carry something, the harder it gets to carry it. So I can see since we went to that adding another week is not just a marginal change. It's a, (pause), some other form of change. It just gets harder. [00:05:53]

But (pause), it's still hard to see exactly what to do, because I can't quite make sense of the apparent disconnect. (Pause).

THERAPIST: What to do? What you should do?

CLIENT: Yeah, yeah. I mean how what should I do? What should she do? What does she need to do? What can I help her do? What yeah.

THERAPIST: (Pause), yeah, (pause). It feels like something needs to be done?

CLIENT: (Pause), (crying), it feels like whatever strategy's being taken to manage, (pause), the whole thing is not quite coping, so yeah, I think something needs to be done. [00:07:10]

(Pause).

THERAPIST: What do you mean not quite coping?

CLIENT: So (pause), I feel like the (pause), the emotion management is not keeping up with the feelings.

THERAPIST: Okay, so?

CLIENT: So, so (pause), she is starting to get overwhelmed by her own feelings of inadequacy and failure, and whatever and whatever. And so yeah, I think something needs to change.

(Pause), you look somewhat confused or puzzled or ... [00:08:11]

THERAPIST: I am.

CLIENT: Okay.

THERAPIST: I don't think anything's changing. I mean over time the hope is that Tanya that these conflicts will be less disruptive to her life. I imagine they're always going to be with her, that they're there with the illness (ph).

But I don't think anything is changing in the short run. Hopefully she will be not in the hospital any more and not acutely suicidal, but even that it's unclear. (Pause). [00:09:59].

CLIENT: (Sniffs), I think what I'm trying to say is that things are changing for the worse. And if they can change for the worse, they can change for the better at the same rate, or they ought to be able to or they should at least be able to stay the same, if they're getting ...

THERAPIST: But what feels like it's getting worse? I mean it sounds like Tanya's doing better in many respects.

CLIENT: (Pause), I feel like she has been doing better and is starting to do worse again. (Pause), so her memory has started to be more whole from the ACT, and that's a really good thing. She's started to apply for jobs. She's been applying for jobs for several weeks now. (Pause). [00:11:15].

And there was a period of time in there where she wasn't anxious or on edge all the time. But she's starting to be on edge all the time, and that's (pause), it looks like we're heading back to those crisis nights, where (pause), leaving her alone would (pause), would give her an opportunity to attempt suicide.

So she's not there, (pause), but I feel like she's heading there. So (pause), that seems worse. (Pause) [00:13:07].

THERAPIST: What are you thinking about?

CLIENT: (Pause), I was thinking about different ways to interpret what you were saying. One way to interpret it is that this is not going away. There is no obvious solution to this. (Pause), (sigh), (pause), or there's not solution to this or something like that.

And (pause), and I'm trying to piece out whether it is that I'm just really tired or really like we've been doing this for a long time. It's hard. And it would be nice to have a break or to have things change. [00:14:08]

I'm trying to piece out where that hope or something, (pause) is where that is, and where (pause), where a realistic trajectory is. And (pause), you know one of the things that no one really talks about in the hospital is how you get better. There isn't there's no answer to that question.

There's kind of like, (pause), really half assed answers like, well you need to figure that out. That seems pretty unhelpful to someone who is suicidally depressed. So I'm trying to figure out, across that whole set of things, where what you're saying fits in. [00:15:22]

I feel like you're (pause), trying to help me find a realistic trajectory. (Pause), but I also feel like perhaps it's an area where the distribution of realistic trajectories is not very well known.

THERAPIST: Yeah, I think that's true too. I mean I guess I was when you were saying things were getting worse and you described what worse was, I was like well, actually it sounds like things are staying the same. I mean things are getting worse relative to a week ago. But -

CLIENT: Yeah. [00:16:14]

THERAPIST: In the grand scheme of things, things are basically the same.

CLIENT: Sure.

THERAPIST: Whereas Tanya is -

CLIENT: Okay. Okay.

THERAPIST: You know, dangling on suicidal thoughts. Moving away and toward them at times, but there.

CLIENT: Sure. You know that's right. Over the course of the time I've been seeing you, it's not any worse. But yeah, relative to last week and the week before, it's worse. That's concerning when it looked like things were getting a little better.

So I the other way to interpret what you've been saying is just, well you're the time scale on which determining (ph) things is not a very useful one. Things change. Things fluctuate across weeks in a way that does not mean very much.

THERAPIST: Well yeah. So many thoughts I feel like there's a couple of different conversations we could have.

CLIENT: (Laughs).

THERAPIST: That we should have but I guess, what is your vision for what you think would be possible for Tanya, or what you want, which also may be two different issues. [00:17:18]

CLIENT: I think it's probably two different issues.

THERAPIST: Well than you can feel free to go with either one.

CLIENT: (Pause), you know, what I want really is to have Tanya back. To have her be healthy and be able to live in the world again, to, (pause), have fulfilling work and enjoy life, and to be a partner to me, and (pause), that's what I really want.

What I think is a realistic trajectory for Tanya, I really don't know. (Pause), yeah actually, I thought I knew how to answer that, but I don't actually know. [00:18:30]

(Pause), the problem is that I think people are pretty powerful. And so I think that she could have that back, (pause), I really do. But I don't know if that's realistic or not.

The problem is that I've often found that people rise to what's expected of them, or are hoped for them sometimes. And so (pause), I don't know. Is it the same here or not? I don't know.

(Pause) [00:19:28].

THERAPIST: Well it seems like it's not clear where there are limits that you're hitting up on, or are they virtual or real.

CLIENT: Yeah, yeah. (Pause).

THERAPIST: Something that I thought about after, you know, what we talked about last week, are sort of limits in terms of what people do, do, creating organizations or structures or whatever, that are far from my deal. Are they virtual limits that can be worked through? Or are those just sort of the limits of human nature -

CLIENT: (Chuckles).

THERAPIST: That people -

CLIENT: Yeah.

THERAPIST: Tend to sort of look at their feet rather than around the world. How do I make a living and take care of my family versus how do I do things that are noble and are those is that just virtual limits that people could push beyond them if they wanted to. Or is it just endemic to human nature?

CLIENT: (Pause), yeah, I don't know the answer to that either, but it does tie in here doesn't it? [00:20:30]

THERAPIST: It does.

CLIENT: And I tend to think again that people are very powerful. that not in every moment can we break through those virtual limits, so they become real in some sense. But (pause), with sustained vision and effort, I think we can break through many of those virtual limits. And so if they were real boundaries, they I don't think they could be as frustrating for [a minute] (ph).

THERAPIST: Right, but it brings us back to the question of what's real or not.

CLIENT: Sure.

THERAPIST: Are they real or are they virtual?

CLIENT: You know you're right. That is a very begging (ph) question.

THERAPIST: That very much begs the question.

CLIENT: (Pause), yeah, just I really don't know. I it's one of these things. I feel like it's related to that, (pause), discussion we had about powerlessness. You said well no, it's a feeling. [00:21:45]

I said well I can I'm okay with describing the feeling, but someone says you are powerless, accepting that makes it so in some way. And so (sigh), I feel like that's tied up in this too. Don't ...

THERAPIST: It's so interesting, and I think you're right. And the question is, does it make it so? Or does it acknowledge something that's already there? I was thinking, if I told you here I tied a string to a 747 and I said pull this -

CLIENT: (Chuckles).

THERAPIST: A hundred yards. Now you're saying I'm powerless to do so. Is that making something real that wasn't already? Or are you just pointing out the obvious?

CLIENT: Fair enough.

THERAPIST: What's interesting about that example is there's a competition, I think in New Hampshire, where teams of people get together and pull I think it's 737s, and see how far you can pull it.

CLIENT: (Laughs).

THERAPIST: Or actually it's not that. In a given amount of time or no, no, no in a given amount of time, how far you can pull it something like that. So actually you can, if there's enough people maybe this goes to your point. If there's enough people you can actually you can pull a 737. They use FED EX planes for this competition. [00:22:53]

CLIENT: (Laughs).

THERAPIST: They call it a bizarre. But anyway ...

CLIENT: That's pretty cool though.

THERAPIST: It is very cool. You know, it's fun. It's a very good so this is not a serious professional sport. It's kind of a good sport -

CLIENT: (Laughs).

THERAPIST: Kind of a funny thing to do.

CLIENT: Yeah, (pause), yeah I feel like that's a good story. It gets, (pause), gets pretty far into the question. It is one of those questions that I don't have really good direct answers to, because stories are, (pause), a decent way of gesturing at it.

(Pause), in the case of pulling by yourself, I guess that, (pause), the question is what are you allowed to do? Do you have to just pick up the string and pull it? Because in that case, yeah, it's probably you're just probably pointing out a fact. You are not strong enough to pull that object. [00:23:58]

That's, (pause), but I feel like a lot of simple puzzles like that, not that this is what you're doing, but a lot of simple puzzles like that, (pause), in that case the virtual restrictions are not getting together a team of people, not getting a couple of trucks, that sort of thing. So you could move that 747 or 737.

THERAPIST: Right. It depends on what the question is.

CLIENT: Exactly.

THERAPIST: The question is can this be moved versus can you personally, on your own move right. It depends on how the situation is framed.

CLIENT: Right. Well even, can you personally, on your own, what does that mean? If I go and I ask enough people and I get them together to pull it, have I done that? Have I moved it on my own? [00:24:58]

In a sense I've moved it with the power of words or something like that. It's a stretch, but it maybe becomes more relevant to the rest of the world, in terms of with enough vision, and enough people maybe you can make things actually change. So (pause) ...

THERAPIST: This is a very far reaching and bold statement. But my first I'm not totally going (ph) into, but I'll put it out there. My first thought was, whatever amount of control you want over Tanya's illness, I guarantee you'll always have less than that.

CLIENT: (Laughs), (pause), you know, which I think is fine and with it comes the harder to accept whatever amount of control I want Tanya to have over her illness, she will always have less than that, I think might come with that. I'm not sure. [00:26:17]

THERAPIST: Well one interesting thing is that you there are two separate questions. They're equally important, but they're separate that I think sometimes get confused in your mind, because of how you think about it.

Even this, I'm formulating as I'm talking. There's what power you have and there's what power Tanya has. Those are two completely different things, right, because it's her life. But I think sometimes you see them as joint somehow, like maybe you can elicit that power in her in a certain way.

And I'm not saying that people don't influence each other, but there's a way, I think you want to have a lot of control over that piece. You want to have control over Tanya having control of what she does. [00:26:56]

(Pause), [00:27:57].

CLIENT: I probably still was just trying to get a grip on the question. (Pause), (sniffs), (pause), I'm still not sure I have a very good grip on it, so I don't want to go away from it. But I'm going to tell this short story because I think it might help.

[00:29:02]

So while fencing in college, I had this good friend who was really, really good. He was a few spaces on the list away from me, on the U.S. National team. And so we're fencing at our conference championships. He's in the individual rounds and he's fencing in this in the, I guess the gold metal bout so to win the individual conference championship.

So we're losing, (ph), and his left quadricep seized up. So he couldn't do most of the actions that are required to fence, because he'd have to do a whole lot of leg work. So I was there and I was coaching him from the sidelines. And I sort of gave him a series of pep talks along the lines of, I know it hurts. And it's going to be really hard, and it's going to keep hurting, but you can do this. You can still win this and he did. [00:30:04]

And (pause), and it was I think it was very clear, to both of us at the time, that it was something that he had done, that I had helped him do.

THERAPIST: What do you mean?

CLIENT: There is no way in which I could do anything on that strip. I can't interfere in any way, but I helped him find the reserves and strength that he had, and use them. So does that sound just as tangled up?

THERAPIST: Actually it's an interesting analogy for its similarities and its dissimilarities. Because in that case, I'm sure he wanted it as much for himself, or more so, than you wanted it for him. That's the very issue at hand with Tanya. [00:31:12]

CLIENT: Hmm, (pause), so what you're saying is if Tanya doesn't want it, I can't help her?

THERAPIST: Yeah. You can't make her want it. You can communicate her responsibility to you, but that's still her wanting to keep the responsibility to you and a commitment to you.

(Pause).

CLIENT: (Sniff).

(Pause), [00:32:46].

CLIENT: Yeah, I'm really not sure where that leaves me though. (Pause), yeah, at that moment that she wants to kill herself, (pause), there's nothing left. (Pause), which isn't really a revelation, but I think sheds some light on, (pause), why I'm concerned about it getting worse. [00:34:08]

THERAPIST: Well maybe on these days where she's doing slightly better, you have the illusion of control, so you want to sort of you get in there and work it as best as you can, until you feel like it's slipping away? But I think that it still is an illusion.

CLIENT: (Pause), control's kind of a slippery word. Do you have synonyms that fit you?

THERAPIST: I don't know. I like that word so much. It's -

CLIENT: (Laughs).

THERAPIST: Very difficult well, yeah. Let me hear more. Maybe I can find a synonym. (Pause), the power to affect change. [00:35:15]

CLIENT: Okay, okay.

THERAPIST: What didn't you like about control?

CLIENT: I don't want to control Tanya.

THERAPIST: Yeah.

CLIENT: If I were controlling her, like if I had control over her in kind of the, (pause), yeah that, I don't want that. That's not, (pause), (sniff), it's tied up in the wow, (ph) you know, world of controlling spouses and that's tied up in the, (pause), feminist ideals of oppression of women, so control is complicated in that way. Okay? [00:36:28]

(Pause), (sigh), (pause), it's pretty important to me most of the time for her to have control of her life and her actions, and for us to make decisions together that affect both of us. What jobs are we going to do and where are we going to do them? (Pause), [00:37:37].

THERAPIST: But her sort of will is that she doesn't want to have control. So therein lies the dilemma.

CLIENT: Can you say that again?

THERAPIST: She doesn't want the control. She's not wanting to take control of her life. She doesn't want that. Or at least that's not what she's doing.

CLIENT: Are you telling me what you think or are you telling me what I think right now?

THERAPIST: No I actually am feeling like I'm pointing out objective reality.

CLIENT: Okay.

THERAPIST: She's feeling I mean this gets into much deeper issues about what's illness and what's motivation, or what's but I mean there's she's not interested in having control over her life. I mean she's not that she's totally not interested in it, but it's not -

CLIENT: It's coming and going.

THERAPIST: It comes and goes. It's far more of a consistent interest to you than for her. There are far other things that are of interest to her than having control over her life that often does not take a very high priority. So that's what I mean by that. [00:38:40]

(Pause), I mean that's what upsets you so much.

CLIENT: Yeah, yeah, but you know it -

THERAPIST: I'm deeply sympathetic to it. I'm just saying -

CLIENT: (Chuckles).

THERAPIST: Is that when you say, well all I want is this, but you want control over that. You want control over Tanya taking control, if that makes sense. Maybe control isn't the right word.

CLIENT: But it's I think I get the point, I think. Again, I want her to want to be alive. I want her to want to have yeah, no, that's right. Because, yeah I think this really runs back into the real and virtual boundaries that the, (pause), the virtual boundaries are as real as you let them be, if they're virtual.

And (pause), I mean that is the definition of virtual in this context. So (pause), and in this context, that does get deep into the question what is illness and what is motivation? [00:39:47]

THERAPIST: Or as Freud really said, "Most mental illness is an illness of motivation. It's an illness of will."

CLIENT: (Pause), I mean I don't know whether it's true or not, but it certainly is a, (pause), is a fairly compelling description of what's happened to her over the last couple of years. She just had the will to keep fighting beaten out of her.

THERAPIST: (Pause), by whom?

CLIENT: (Sigh), yeah that's a really interesting question. I don't know. (Pause), you know, there's a sense in which it was her department at the school. There's a sense in which at the end of the day, (pause) by herself, I think. [00:40:52]

And (pause), it's sort of like how does someone else, (pause), I don't know. Yeah this is, (pause), how does someone else get to decide what motivation you have, which feels funny to have me say right now, given the conversation we've been having all day.

(Chuckles), but how does someone else get to decide the motivation you have? There's a I think what you've been arguing is fundamental that they don't. They can't. That is up to you, and I think that's right. But it can be influenced, I think. (Pause).

THERAPIST: Well and it's sort of one version of it is to what extent are you a victim of your circumstance versus responsible for your life? A victim of circumstance you let the circumstances be it an abusive childhood, or just a victim of having an illness, or however you define it. [00:42:06]

CLIENT: Right. (Pause), and I think you're always both. I mean, (pause), the circumstances are what they are. They I was born to the parents I was born to. That's never going to change. I have no control over that. I never will.

(Pause), but and so there's a sense in which everything that is past I have no control over. And it's or the circumstances I'm given at any given moment to deal with. And the question is whether I will or not.

That's where I think the personal responsibility comes in. But the problem is sometimes those circumstances include you have no motivation. So (pause) [00:43:20].

THERAPIST: I will say on a very practical level that has important emotional implications, or important sort of psychological factors for you is but sort of, I guess in some ways is advice. But sort of assessing Tanya's state on a day-to-day or even week-to-week basis, I think is not going to be productive for you.

Productive's an interesting I think it's going -

CLIENT: (Laughs).

THERAPIST: I think it's going to drive you crazy is maybe to make a little bit of sense.

CLIENT: (Laughs).

THERAPIST: Because when there's a particular and this is not my professional context but literally just kind of making you feel like you're banging your head against a wall. Because it comes with it a particular kind of either micromanagement or desire for management, and it's like you're holding on to something so tightly, and your hand is cramping. [00:44:23]

CLIENT: (Pause), (sniff), (pause), you made me think of the management styles of a couple of the professors at Illinois. One of them comes in and talks with the students every day all of the students every day.

He wanders through the lab, sees what they're doing, and suggests what they should do the next day. And if they don't do what he suggests, on a couple days scale, he gets pretty upset. [00:45:29]

And then my advisor meets with everyone in his group once a week. And kind of assesses where everything is, and makes some suggestions. But he views it, usually, as a [let's say], (ph), recommendations that we should, (pause), do with what we want.

It's advice more than anything else. Although that's not always clear to us when we start, but that, (pause), I think it's probably meaningful that most of my advisor's students end up in academia. And most of the other students end up in industry. (Pause), there's something, (pause), crippling about the everyday monitoring.

THERAPIST: That's something interesting for you to bring into your week this week, maybe your [inaudible at 00:46:22] thinking. It's a very interesting analogy, where you went with that. We do need to stop for today.

CLIENT: Okay.

THERAPIST: I will see you next week.

CLIENT: Okay.

THERAPIST: Okay, take care.

CLIENT: Thank you.

THERAPIST: Okay. Bye.

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