TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi. Come on in.

CLIENT: Good morning.

THERAPIST: Good morning.

CLIENT: So I think we left off last time with you questioning the assumptions that have brought me to Andover I think that's about right which is kind of a complicated knot of a problem because it gets into what are the appropriate roles of everyone involved in our lives and in this particular time in our lives. I don't really know what the answer is to that question. [00:01:01]

THERAPIST: Well "brought you" and "keeps you", I think those are two separate questions. (pause)

CLIENT: Yeah. Answering one is interesting and answering the other is, in a sense, essential for moving forward. We can answer why we're here, but that really might give us instructive lessons or help us learn something. Answering what keeps us here is essential to figuring out where we go at the moment. (long pause) [00:02:10] I think first and foremost what keeps us here is that Tanya has therapeutic relationships with Chad and with Dr. Hoffsteder (sp?) and she trusts those and does not want to leave them. To a large extent, that's what also brought me here. She, of course, came to school here and then stayed because she wanted to go back to school because she had these therapeutic relationships. Certainly that first piece is gone now, but she still does have the therapeutic relationships and is reluctant to abandon them, although not unwilling.

THERAPIST: Is she not thinking about ever reentering a program or is it just not on the horizon for now? [00:03:00]

CLIENT: She thinks that she does not want to go back to graduate school and that she wants to teach. Will she ever go back to school of any kind? I don't know. Perhaps, but I don't think she's going to go back for a PhD. I think in her mind the costs are too high and it takes too long with, in her field, no guaranteed prospects for a job at the end. Somewhere here priorities have changed so that getting a job at the end is important. (pause) [00:04:14] For me there is some question as to what I want to do next in my career and when my degree will finish and how it will finish. That would make it difficult to figure out where I should be next, and so there is a sense in which so long as Tanya can find a job and that could be a good thing, I don't know that it matters very much where I am other than I think it would be good to be close to our families or close to somewhere where we have any kind of real support network, which is basically just close to our families. [00:05:08] (pause)

You sort of asked last time this question of why she didn't go home when she got sick, when she became more sick, or whatever the correct line should be there. (pause) It's a very interesting question so (pause) [00:06:03] my best friend, Franco, was engaged to a woman that he had known since they were in high school. She was a couple of years younger than he was. They went to the same high school. She ended up coming to Texas A&M and Tanya, also, and they started dating somewhere around that time. They also went to graduate schools in separate cities because they both wanted to pursue academic careers. They also tried to end up in the same place. He went to graduate school a year before she did, so it was kind of like he was already in Denver so she was trying to come here also, but also trying to balance going to a program she wanted to go to; so she ended up at Ithaca and he was here. Franco has been a very good friend to me and to Tanya during this time, particularly starting a year ago while Tanya was at the hospital the first time in Denver. [00:07:10] I guess it's been a year and a half ago now. When I flew in I stayed with him rather than staying at Tanya's apartment, just because it was I don't know he was a friend and he was there and he wanted to take care of me and I wanted to let him. Tanya was at Englewood south of Denver which did find job stabilization, but at the time I didn't realize that that was their only goal, stabilization, and they weren't really interested in planning for recoveries; so Franco and I sort of did some thinking and did some reading and he talked to his mother, who is trained in psychology. [00:08:17] She sort of directed us in mind of what we were talking about to a thing called the Wellness Recovery Action Plan, or WRAP plan, which is a program developed by a woman who wanted to get better from whatever her particular illness was. I think it was depression, but I can't quite recall now. She kind of asked a whole lot of people how one gets better and there wasn't a very clear answer from almost anyone, so she kind of eventually assembled this practical guide to figure out what it looks like when you're doing well and when you're not doing well and kind of what are distinct steps along the way. What helps when you've been triggered. [00:09:09] It's a useful, very practical sort of thing. You can see how I would like a thing like that. As part of discharge planning for Tanya, Tanya went through and did it. She was enthusiastic about this. It's not like I pushed it on her. It was like, "Here is a thing that can maybe help," and so she was willing to do it. Part of getting in a crisis there was something like "What do you do?" and one of the suggestions was get out of the immediate surroundings you're in. Go to friends, go to that sort of thing. So she asked several friends in the area if she could stay with them when it got bad but it wasn't bad enough to be hospitalized yet. [00:10:06] (pause) She did consult with all of her medical professional staff while doing this. It's not like we were doing this completely off the radar or something. It's a legitimate thing. Franco was one of the people that she asked if she could go stay with him because they're good friends also and have been for a very long time. Like most of our friends in the last several years, he was like, "Anything I can do to help. Yeah, absolutely." Off and on, occasionally when this would happen, she would go and stay with him. [00:10:58]

I found out in September, about the time that I was moving here, that his fianc� was not okay with this and had not been okay with this for some time. This, coupled with whatever things were going on in their lives, had turned into a critical crisis point in their relationship. (pause) For whatever reason, they went to couples counseling and, obviously, they talked to each of their individual counselors. Whatever and whatever. Somehow it seemed best to both of them that neither of them talk to me about it because, I think in her mind, he couldn't talk to me about it because he wouldn't present a united front between them to the world and she couldn't talk to me about it because he figured I couldn't handle it or something. [00:12:11] I'm really not sure why. Anyway, they eventually decided to break that up and so she called me and come to find out she's angry with me and thinks that I should have moved to Denver after that first hospitalization a year and a half ago because, clearly, that was the thing to do. Since I was literally packing to move to Denver at the time, this was after Tanya was in near crisis mode again and I feel like I can't fulfill my obligations to my advisors and my work and my wife simultaneously. My advisors very graciously said, "You really need to do what you need to do. If that means take care of your wife, go do that. It's okay. We'll work it out." [00:13:06] (long pause) The net result being that I might be a little defensive about defending or explaining the decisions that have brought us to this point, even though you're suggesting, in a sense, the exact opposite of what she was suggesting.

THERAPIST: And so defensive about . . ?

CLIENT: Just . . . [00:14:04] (pause) she really wanted answers to why did we do what we did? How did we think that was okay? How did I think it was okay to abandon my duties to my wife and pass them off to my best friend, particularly send my suicidal wife to him? Ignoring the part where she wasn't actually going to stay with him when she was suicidal, this was the level up on the plan. (pause) I couldn't give her the answers. I could not explain to her, nine months removed from the decision, all of the details and parameters that led us to this point because we were making decisions that were fairly localized in space and time. [00:15:19] It was like given what everyone wanted at the time, this was the best decision that we could figure out how to make, but I can't always reconstruct what everyone wanted at the time nine months later, particularly after everything else that's been going on. It's been a series of ups and downs. (pause)

THERAPIST: If I didn't I should have made a slightly different point. It's actually very different, but I certainly was bringing up other options. I was wanting not to bring up "why didn't you do this?" and more pointing out that there are a lot of different options, which is a very different kind of point.

CLIENT: (chuckles) That's fine. [00:16:10]

THERAPIST: It's okay how you heard and thought about it. I'm curious about that, too. (pause)

CLIENT: I feel like it doesn't matter too much how you phrased it. It's sort of like rolling a ball across the floor that has a hole in it, but near the hole is kind of a funnel. If you roll the ball too near the edge of the funnel, it's going to go in the hole eventually. I think what I'm trying to say is that I have maybe a . . .

THERAPIST: A funnel?

CLIENT: Yeah. Yeah. (laughs) [00:17:00] That's the thought of "why didn't you do this?" because everyone wants to suggest some other option. It's not that that's not a helpful thing, it's that (pause) in order for that to be actually helpful, one has to have all of the relevant information. It's just not that useful to suggest that Tanya should go back to teaching when she's in her graduate program and really wants to do that now. It's not that helpful, if one is her father, to suggest that she was really happy when she was teaching. Well, she was also really happy when she was in graduate school for two years. (sniggers) She was also not married to me at the time, so maybe you should say she was really happy when she was single. These are just not . . . [00:18:01] (pause) I really don't think you have done any of those things, but I think that I have a . . .

THERAPIST: Do you think that you do that to yourself, too? Why didn't you do this or you could have done this?

CLIENT: Absolutely. Oh, no absolutely, but in a sense it's easy for me; I've figured out how to handle that problem more or less over time, and the way to handle it internally is make the best decisions I knew how to make at that time, given what I knew. I can't do any more than that. I cannot make the perfectly optimal decision in any circumstance because we don't have the resources to make the computation, nor do we have all of the information necessary to do it. [00:19:09] It's literally impossible, and so we just do the best we can. (pause) You sort of said last time that most people just are close with one sibling or another, so they just talk to that sibling.

THERAPIST: That I'll stick by. I'll stick by with that one. I did say that. [00:20:00]

CLIENT: (laughs) While that makes sense, my two sisters with whom I have been closest at different times are somewhat jealous of each other, and so I tend to be very careful to try to balance my relationships with them out of some sensitivity to their needs or issues or whatever the correct word is. That's not all of what's going on there, but that's sort of why my first impulse is this optimization thing. It's like I know something about where they are and want to take care of them also.

THERAPIST: Yes. You're not the kind of person who is like, "I'm not talking to whomever. I'm going to mostly talk to you because this is a crisis and you guys are going to have to suck it up and deal with this jealousy issue. I'm not attending to this right now." [00:21:12] (long pause)

CLIENT: I'm definitely enough that kind of person that would do that in the moment of a crisis, but I guess I would not call either of them first in a crisis; and so we get into extended crisis mode, then I step back from that position or something. [00:22:16]

THERAPIST: You wouldn't turn to them first in a crisis because you don't necessarily find them that helpful or . . ?

CLIENT: Yeah. I mean I assume you know to whom you would turn in a crisis in some place. I might turn to my mother first or I might turn to my friend, Franco, first, depending on whether I need something in this area or whether I need something else. At one point in time I would have turned to Tanya, but that's kind of not on the table right now. [00:23:00]

THERAPIST: Even though that's a parenthetical in what you're saying, it's not a parenthetical in general.

CLIENT: Yeah. Yeah. It may be easier to say it's a parenthetical to another statement because it's, in a sense, the defining thing of right now. And so if I couldn't turn to either of those people, I might turn to my father. If you go right down the list, I might turn to my sisters. It's not that they're not on the list, it's just that they're not at the very top of the list. I'm going to turn to the person that I think I don't know what the right word is. I turn to the person that I trust to be helpful in the crisis in the crisis. [00:24:12]

THERAPIST: I guess it begs the question of why talk to your sisters very much at all? That may be what your point was to begin with. I don't know. (long pause) [00:25:14]

CLIENT: Most of my siblings talk to my mother more than they talk to any one of my other siblings, so that's just kind of the way our family does things which, I have observed, is different from the way that a lot of other people's families work. It just is what happens and one of the results sometimes is that big things will happen in my siblings' lives and I won't find out about them until much later. The same thing happens to them, also, and so it's kind of a recurring theme of someone finding out that "X" has been going on for so and so. [00:26:00] (pause) I think that's why I talk to them at all at times. I do care about them and I do know they care about me and that carries some sort of I don't know obligations or something.

THERAPIST: Which is part of the heart of the matter, the extent to which relationships carry obligations and what obligations and whose responsibility is it.

CLIENT: And we could get to ignoring the obligations and responsibilities.

THERAPIST: Which is an interesting way of phrasing it, because that's one question. [00:27:01] There is ignoring the responsibilities and there are simply responsibilities that are not yours, which is different than ignoring. Ignoring implies that they're there, you're just not paying attention to them.

CLIENT: Sure. Sure. (pause) It sounds like you might be suggesting that some circumstances remove responsibilities or that the responsibilities people have are not the same in all circumstances.

THERAPIST: Maybe. I think I was making a more general point about who is to say what the responsibilities are to begin with? Sometimes crises actually outline or help us reframe what our responsibilities should be to begin with, which may be part of this. I don't know. It could be, for you. [00:28:02] (long pause)

CLIENT: I think I answer those questions differently than most people. (pause) I don't have the good sense of what the right answer is in relationships. [00:29:01] (pause)

THERAPIST: After her first hospitalization, did Tanya ask you to move up here?

CLIENT: No, I offered. I didn't remember this when I was talking to Sascha, Franco's ex-fianc�, but I offered and she said, "No. I want you to go back to school. I want you to finish your degree. We need to keep what we're doing," in a sense, but with some additional I don't know safeguards or something, support.

THERAPIST: I guess in a sense when I think about it it's because I also think responsibilities don't happen in a vacuum. If Tanya is begging you to move here and you said no, it's very different than she told you not to or it never came up. There are so many different scenarios. [00:30:01]

CLIENT: That's exactly right. I really do think that (pause) in the marriage relationship where it's a little more so sibling relationships are complicated, right? You can't undo the fact that you're siblings with someone. Certainly people disown people, but I'm not sure that's actually that meaningful. (sniggers) It's just declaring the responsibilities void or something. In a marriage relationship, both people have entered into it with some volition, at least in the United States (chuckles) . . .

THERAPIST: Good point.

CLIENT: I'm not sure whether that's a good thing or a bad thing. It seems that at least some arranged marriages are very happy and the U.S. does not have a very good success rate at marriage. [00:31:00] But at any rate, I believe and a lot of people don't agree wholly, but I do believe that the people entering into that marriage contract by and large get to set the responsibilities and obligations. This is one of the reasons that I try to make decisions with Tanya and why it's hard to make decisions about where we should go and things like that during a time in which she's not doing well because we don't have a clear norm for dealing with it or something. (pause) [00:32:06]

THERAPIST: It seems like, regardless of what I did say last week, your feeling was that it was actually the complete opposite of what Franco, especially what Franco's ex-fianc� said, but it sounds like, regardless, everyone seems to have opinions on these things.

CLIENT: I think everyone has an opinion on these things; but shouldn't everyone have an opinion on how their relationships work? It's just a matter of not always do the opinions line up.

THERAPIST: In terms of the opinion of what's the "right" thing to do, that implies a certain amount of certainty that, in so many situations, I'm not sure how you could have. [00:33:05] (long pause)

CLIENT: Most people seem to do what they want to do. They seem to think that's a good way to pick what to do, is do what you want to do. I want to do the optimal thing, so I have to figure out what the optimal thing is. That's, as you're suggesting, nearly impossible to determine in most real-world situations. [00:34:03] (long pause)

THERAPIST: What are you thinking about?

CLIENT: Just thinking that sort of raises the question of what else do you want? I want the optimal thing and that's not really obtainable or not discernable, then I have to figure out what to do some other way. [00:35:02] That brings back the question of what you want and I don't know. I just don't know. I typically want to take care of the people around me. I have a very strong sense of local community and obligation to the people with whom I'm in some sort of relationship. I've invested a lot of time in biomechanics and I'm quite good at it, but I'm not, necessarily any better at it than anything else that I would be at anything else that I invested this much time in; so it's like do I really want to continue doing this thing? (pause) Because I have this sense that, with a similar amount of effort, I could do many other things, so it's not like there is a whole lot of path dependence to most decisions. [00:36:08] It's like I've gotten to this point, and so the next point on this path is this thing. I have the sense that I could walk off the path fairly easily; there are not steep walls on it, so what do I want? I have no idea. That was what I was thinking.

THERAPIST: What does that feel like?

CLIENT: Usual. (chuckles) That's not a change from any time in the last several years when I have been somewhat disenchanted with biomechanics, with academia, and still not exactly sure what I want. (pause) [00:37:04] It's a little disorienting or it feels like waiting for something to become clear that just hasn't become clear. (long pause) It's sort of like, on the other hand, I don't not want biomechanics sufficiently to say that, clearly, I should stop doing it. [00:38:01] (pause)

THERAPIST: Have you always felt this way or is this more recent?

CLIENT: It comes and goes. The question of "what am I going to do next?" really heightens this sense that I really don't know what to do. [00:39:06] In the last couple of weeks, that's become the more relevant question, both professionally and in talking with you. I would say it's very new in the sense of our therapeutic relationship, but not new in the sense of been there before.

THERAPIST: This sounds like a trivial way of putting it, but do you like it here?

CLIENT: In Andover?

THERAPIST: Yes.

CLIENT: (pause) I don't hate it. I don't love it. I would prefer to be someplace where it was quiet, anywhere in walking distance. [00:40:02] (pause) It's not really a place I would come to for any happy reason. It's like if I had come to school here, that would be a different sort of context for having come to the place. As it is, it's a place that's seen maybe the worst six months of my life so I think that colors my feelings about the place.

THERAPIST: Do you and Tanya talk about what you're going to do next, just even in terms of where you live? [00:41:02]

CLIENT: Yeah, because she's been applying for jobs and so the question is where does she apply for jobs? Does she limit it to Andover or does she apply at other places? After talking, she's applying to places that are kind of between here and Georgia, on the east coast, which would, at least geographically, keep us closer to her treatment team here or to our families. (pause) The difficulty of going back to the San Antonio area where my family is and where the school that she used to teach in is, is that (pause) if we're to continue on an academic trajectory, there's not a lot of career options in San Antonio proper. [00:42:22] There are a couple of schools but doing a post-doc at either of the schools would narrow the range of schools that I could then work at to a very, very small number; so it's a career dead end, in a sense. Within an hour's driving distance there are larger schools where it would not be the same, but that brings us back to the question of what do I want? [00:43:01]

THERAPIST: Do you feel like there is any challenge for the two of you, for you and Tanya, talking about your future because there's so much uncertainty about her illness and the nature of it?

CLIENT: (pause) Yeah, that's definitely a real-world problem. I tend to get around it in the actual discussions by trying to focus on the question of where do we want to be? I do want to be close to my family, so that's at least one thing that I want. I want to be employed, I guess. She wants to be employed also and she wants to teach, and so that sort of constrains the search enough to keep moving forward. [00:44:04] (pause) For the most part, I ignore the question of is she actually well enough to teach? Is she well enough to have a job where she works five days a week or more?

THERAPIST: Why do you feel like you need to ignore that question? (pause)

CLIENT: Because I have no idea how to answer the question of what do I do if she isn't well enough? What do we do if she isn't well enough? I have no idea how to answer the question. [00:45:02] In hope that I don't have to, I'm ignoring it for now. (pause) On the tail end of it's bad enough that she can't hold down a job, et cetera, she's going to kill herself so I don't have to worry about that because that's fairly easy to handle. You just clean up and grieve and move on. (sniggers) That's . . .

THERAPIST: Practical and sort of morbid.

CLIENT: Yeah. Sorry.

THERAPIST: You don't have to apologize. You can be as morbid as you want.

CLIENT: Okay. Well, thanks. I still feel bad, for what that's worth.

THERAPIST: Feel bad about . . ? [00:46:01]

CLIENT: Saying that. It doesn't hurt Tanya at all. She's not here so I don't feel bad about that part, but you are here. You sort of have to deal with whatever I say. I have no idea how you do that, but I have to trust that you do. But that doesn't mean that I can ignore that it has to have some effect. You are listening. I recognize that I'm supposed to, for the most part, ignore that and let you take care of it but . . .

THERAPIST: But you worrying about it is part of who you are and part of what is causing the challenge, given the very profoundly challenging situation you're in.

CLIENT: Right.

THERAPIST: James, we're going to need to stop for today, okay?

CLIENT: Okay.

THERAPIST: I will see you next week. Okay. Very good. Take care.

CLIENT: You, too.

END TRANSCRIPT