TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Come on in. (Pause)

CLIENT: Someone vacuumed very prettily.

THERAPIST: Oh, yeah, I got my carpets shampooed, so...

CLIENT: Ah, okay. (Chuckling) Good morning.

THERAPIST: They make patterns.

CLIENT: Yeah. It's nice (chuckling).

THERAPIST: Thank you.

CLIENT: So I'm not sure where we are. I had thought that it might be good to sort of review where we are what we're doing?

THERAPIST: Mm-hmm.

CLIENT: But I hadn't thought much farther than that about what exactly what is it... I guess I don't know what is important to talk about or say. So help (chuckling)?

THERAPIST: Okay. Well, we talked last time about the process and your feelings about the process and your reactions to the process. [0:01:01] And I thought it was helpful. I certainly learned about what your experience is like. And then the question is... I think that I raised later in the session is, is your experience of the... or can your experience of this therapy process inform us about something else more general about you that can be useful for you to know.

CLIENT: Right. (Pause) And I think the answer to that question is yes. (Pause) The problem I think when generalizing is how to be sure when one is actually generalizing or making correct analogies and when one's not just making connections because they could be there or something. Does that make sense? So, like, you could generalize this to many relationships. [0:01:58] But I'm not sure that... (Pause) I'm not sure it's correct in all instances. But I'm not sure that that matters very much either.

THERAPIST: Yeah, I mean, I see your point. I guess you can make that statement about lots of things. How do you know? How do you know? There're so many things about one's emotional life that is not verifiable...

CLIENT: (Chuckling)

THERAPIST: And I feel like it's verifiable insofar as it rings true, and that's the best...

CLIENT: Okay.

THERAPIST: To me, that seems very important.

CLIENT: Okay. That's a helpful test. I mean, it doesn't have to be right every time, but it's helpful to have some guideline, if that makes sense.

THERAPIST: Yeah, I mean, I think about it I guess in terms of sort of, whether something's factually correct and more about whether it's meaningful in a useful framework to think about one's experience, which is really... there're so many things that are not factually verifiable when it comes to one's emotional life or even just the sort of the limitations of memory. [0:03:13]

CLIENT: Right. Yeah. I agree (chuckling). That makes sense. Okay. (Pause) [0:04:00] So I guess the two most obvious relationships that sort of have... that may have similar dynamics are my relationship with Tanya and my relationship with my advisor at Ohio. Obviously very different, but they... (Pause) But I guess the constant through all of them is me. So there's that. So... (Pause) [0:05:00] I think I said very quickly at the end last time that it's easy to sort of generalize to my relationship with Tanya where I do feel like I have to protect her. And... (Pause) Of course that relationship is why I'm here in the first place, so I guess I would hope that, whether the... my experiences with this process or this process in general, one of those two would help in dealing with that. (Pause) [0:06:00]

THERAPIST: What are you thinking about?

CLIENT: I was thinking about whether it was important to talk about my relationship with my advisor in this context. I mean, so I meet with him once a week also and have for the last four or five years, sort of the pattern that he sets. And the longer that I go through it, the better I understand what he comes to the table expecting. [0:06:59] But it's in some ways a very similar thing of, I come in, and he kind of looks at me and says, what's up? As if he didn't ask to meet with me every week, which obviously you didn't (chuckling) ask, it's the other way around. But it's sort of a... it's a strange greeting that puts the weight of talking on me immediately, too? But then he very clearly wants to talk about specific things once we get started talking and doesn't want to talk about others. And so there's this weird tension between him I think trying to give control of the interaction to the student and not being enormously good at it. (Pause) [0:07:58]

Yeah, I think in the ring true test, there're some real analogies about not... (Pause) I'm not particularly bothered by those... I don't know, pieces of my relationship with my advisor today. (Pause) [0:09:00] In that relationship I feel guilty about being here and not being there because he's still paying me. He's in a sense paying less than he would be because I'm not actually formally enrolled right now because there wasn't any need to be. And one of his particular difficulties is, he's very interested in a lot of different chemistry, and he's very good at a lot of different things. But he's not a brilliant fundraiser? And so he's... money is often tight (chuckling). And so I feel like I have these obligations to produce results. [0:09:59] And that's much more difficult from here than it was at Ohio, and so I think this is similar in that I think this is something that I'm bringing to the table. He, I do not think, feels this way, that I am a burden on him or anything like that. So... (Pause) I think that's all I've got.

THERAPIST: Well, with him it seems like he opens with you setting the agenda, but he kind of has an agenda.

CLIENT: Or he very much wants to steer the agenda once he has opened the door. [0:10:56] Like, here's something I think is important to talk about. And he'll sort of acknowledge it and then move on to the next agenda item, so... (Pause) And sometimes that's helpful as a way of figuring out what is important to consider or look at or which experiments are important to do. And then sometimes it's frustrating because it leaves questions somewhat unanswered and then I have to sort of insist on it. And it can be hard to insist on it in a way that he engage... to get him to engage with the problem fully? Yeah, yeah. (Chuckling) Everyone comes to every meeting with their own things going on anyway. [0:11:57] And so sometimes he's tired, or sometimes he's thinking about something else, or just doesn't really feel like thinking about a particular problem in a particular way that day. But... (Pause)

THERAPIST: Well, I imagine he came to mind for a reason, even though the reason isn't obvious. Well, it's obvious insofar as your relationship and your relationship with Tanya might reflect something about what we're talking about in here.

CLIENT: I didn't... I'm sorry, I didn't quite follow.

THERAPIST: Well, what I was saying is that, my first thought was it's not clear, your saying, I'm not sure what the implications of your relationship with him are, what it means. And then I sort of backed up and said, well, you were drawing an analogy. [0:12:58]

CLIENT: Right. (Pause) And I was drawing the analogy in response to the question, am I here just working on our therapeutic relationship (chuckling) or actually working on something else that's in some sense more fundamental to me or the way I approach relationships? (Pause)

THERAPIST: Here's a couple thoughts I had.

CLIENT: Yeah.

THERAPIST: Well, one is that, one of the things that we were talking about last year is how much of the structure of this relationship is sort of external, and how much of it is... are you bringing to it and sort of imposing your own sort of ideas about what should be happening to it that have nothing to do with what I'm asking for. [0:14:10]

CLIENT: (Chuckling) Right.

THERAPIST: And certainly I think that there are parallels that could be drawn in your life in a lot of ways. And I think sometimes it's unclear whether the situation is demanding this of you or you are choosing in some way, based on your own values, to participate. And I think it especially factors into your marriage. I was very struck by your trying to... one session you tried to compare what other people do with depressed significant others? And then you said, well, everyone broke up or left their depressed significant other (chuckling). So there's a, where does that leave you, on a lot of levels.

And I think it's unclear, is the situation... is your situation and your relationship with Tanya, is it controlled by her not wanting to take responsibility or more responsibility? [0:15:07] Is it controlled by her illness, which she can't control? Or is it controlled by you, but does you and your values about what the marriage means to you driving it? That's not something external. That's something internal. (Pause) Because it speaks to the very heart of control because, if it's something that you're bringing to the situation, sensibly you have more control over it. You have more choice than if it's something being imposed upon you. (Pause) [0:16:00] [0:17:00]

CLIENT: Yeah, I don't really know how to answer that. It wasn't exactly posed as a question, but it was... (Pause) Yeah, I think you have pointed to a very central question that I don't know how to answer. And in some ways the questions is, which parts of it are which of those different things? And I don't... (Pause) [0:18:00] I don't really know how to figure that out.

THERAPIST: Yeah, I mean, in a sense I think that was the point I was making...

CLIENT: (Chuckling) Okay.

THERAPIST: That it's unclear to you.

CLIENT: Yes. (Pause) But then we're back in that place where I don't know... (Pause) [0:19:00] I certainly don't know what's factually true, and I don't really have any useful models to impose on it. And so I don't know what to do in terms of... (Pause) I'm still sad and angry and hurt about this whole situation. And I just don't know what to do about any of this other than sort of try to cope with the feelings. But... (Pause)

THERAPIST: Well, maybe coping with them means expressing them more. (Pause) [0:20:00]

CLIENT: So I stopped... I don't know, some time ago, giving you kind of a weekly update as to where Tanya was. But that is relevant. (Chuckling) That happened about the time you suggested that maybe I should not monitor her wellbeing on a day to day basis because that was not going to be a useful time scale to monitor it over. But it's probably important (chuckling), because it's been so long, to tell you how she's doing. So she...

THERAPIST: I certainly wasn't wanting to discourage you from doing that. Maybe I was... I mean, if I think about it, maybe I was sort of applying the thought that... yeah, that in the long run it wouldn't be productive, even though it's important that you felt the need to do it. [0:21:06] But certainly... I certainly didn't want to discourage you from talking about it.

CLIENT: I appreciate that. I didn't feel discouraged from talking about it, just I think by virtue of attempting to step back and not monitor it so intensely... I don't know. Maybe I did get discouraged from talking about it, but I didn't... I don't think that's exactly what happened. I think it was just more that I stopped paying as close attention to it, and so I stopped talking about it quite as much. She's also been getting better, and she is... and I don't know (chuckling)... this is the other thing. [0:21:56] I don't know how to talk about how well she is because it's sort of a logarithmic scale. It's like, you move a little bit, and you've gone up by a factor of ten. And so... (Pause)

And somewhere in there, as she started to get better, she also I think stopped telling me how badly she was feeling at times because it... I'm not sure exactly why, but... so... (Pause) [0:22:59] And I guess I would say she's better than she's been in the last four months or so, five months, something like that? And seems to be feeling like she's making progress in therapy and dealing with the... both the depression and the life events that seem to have caused or triggered or played into the depression. So that's good. She's taken a job, so she's starting next week. So if that... so she feels better because she now feels like she is contributing to our lives again. (Pause)

And I started telling you all of this because you suggested that maybe I needed to talk about my feelings more in order to deal with them more. [0:24:08] And so part of that is to say that I have been talking about them more with Tanya because she has been better. And so for a long time there's... I couldn't talk about them, or I felt like I couldn't talk about them. I'm not sure which was really true because I felt like, me being upset was itself a strong trigger for Tanya. And Tanya was in such a bad place that being upset was potentially catastrophic. So... (Pause) [0:24:56] And the other thing is that as she gets better she wants to take care of me because that's part of who she is also. And so she wants to know how I'm doing and talk about it. And that's hard because I want to trust her. I want to be in a real relationship with her in which we can talk about things like this. But I also don't entirely because of where we've been for the last number of months (chuckling). And... (Pause) [0:26:00]

But I have told her that I am very glad she didn't kill herself but angry about the way that I feel like she used that threat to make life changes that she, for whatever reason, was unable to decide or admit she needed to make. (Pause) So I don't know. That was... yeah, maybe I should continue to talk about it. I think I probably should continue to talk about it, but I don't... I also don't know how to do that. What do I do? Get up every day and say I'm still angry about this thing? [0:26:58] I'm not sure that's particularly helpful for anyone really, but... (Pause)

THERAPIST: Well, you can talk about it with me.

CLIENT: I think the other piece of why we haven't been talking about that as much is that Tanya is not the only thing in my life. And I think I am angry in a lot of ways about the extent to which she has become the only thing in my life or was for a long time. And so I was, I think in some ways, trying to deal with some of the other issues in my life here also. Not sure that was really wise, but I think that was a part of what's been going on, too.

THERAPIST: Why not? Why wouldn't it be wise?

CLIENT: Well, it's sort of like, if I can't actually talk about being upset with Tanya with Tanya and I don't talk about it with you or I could talk about it, then I'm not talking about it. [0:27:59] That might not be such a good thing.

THERAPIST: It reminds me of what you were talking about last week in terms of conflicting priorities for your time (chuckling). (Pause)

CLIENT: Yeah, that sounds about right. (Pause)

THERAPIST: Do you worry that, even though things are better now, they could go back to bad? [0:28:56]

CLIENT: Yeah. The last two days Tanya has been a little bit worse than she had been last week. So is that the result of me telling her that I was upset? It could very well be. The time scale's about right. So... but it may be entirely unrelated. (Chuckling)This is why you suggested that maybe monitoring it on a day to day basis was not the most useful thing. So yeah, I very much worry that she could go back to that place, in part because every time she gets better... we've done this a few times now, every time she gets better she kind of goes through the same cycle where she decides she's not going to kill herself. And then she feels like that's a big realization or decision. And this time she doesn't, I think, remember that she's had that decision or realization before, which is its own huge complication of the whole situation, right? [0:29:58] Like, she can't really remember what the last several months have been like. So (chuckling) to what extent is she now even responsible for it? I still have to deal with it having happened, and she has to deal with the fact that she can't remember anything from this time period. And so...

THERAPIST: Is her memory almost completely gone?

CLIENT: It's hard for me to tell what exactly is not there, but she doesn't remember people visiting that visited for days. So...

THERAPIST: That's a lot not to remember.

CLIENT: Yeah. Yeah. And so... but... (Pause) Yeah. I mean, it doesn't just stay inside. The claim when she was starting was that it was going to stay inside the sort of time window in which she was doing it? [0:31:05] She might not remember things from then, but she'd remember everything around it once she stopped. But she's missing memories that go back much farther than starting the ECT also, so it seems to me like a disturbingly dangerous treatment that is done when people get to a certain point because... I don't know. At some point you have to decide what's... (Pause) What risks are acceptable in trying to save someone's life.

THERAPIST: Do you feel like it was worth it? (Pause) [0:31:59]

CLIENT: I don't really know. It's hard to assess whether it worked (chuckling). It certainly blasted her memory, but it didn't seem to really... and it did seem to stop the suicidal thinking for a while. But it certainly hasn't made the depression go away, and it has not (chuckling) helped the... some of the feelings she's had in terms of instability in her life. Not being able to remember seems like a pretty big instability, so (sighing) I think we made the best decision we knew how to make at the time? I'm not sure that we made the correct one or that it was worth it. But I don't know... it was not clear at the time what else could be done, and she really wanted something to be done. [0:32:54] (Pause) So... (Pause) [0:34:00]

THERAPIST: When you sort of go into your thoughts, which you do, like, just at this moment, do you want me to ask about it, or do you want me to sort of give you some space?

CLIENT: I don't know. It's a little different every time. And then often you'll ask me what I was thinking about, and that'll make me think of something else and not even know what to say in response (chuckling) because... but... and sometimes I'm trying to formulate the next thing I might say. And sometimes I'm just really not sure where we're going and thinking I'm not sure where we're going. And then the thoughts go from there. So this time I was... so I don't have a good answer to what I want you to do. Whatever you want to do is fine there. (Pause) [0:35:00] So this time I was thinking that... (Pause) (Chuckling) You mentioned my discussion of other people dealing with depressed significant others. And you mentioned it in the context of me suggesting that I might just stop coming because I couldn't deal with the dynamics of our relationship as I had imposed them on myself. So I feel like it may have occurred to you that those are connected things in some way.

THERAPIST: They actually didn't...

CLIENT: Oh, okay.

THERAPIST: (Crosstalk) I'm curious about what you're going to say. I was not drawing that connection consciously.

CLIENT: Sorry, okay.

THERAPIST: No, go for it. That's interesting.

CLIENT: So, if Tanya and I were dating, there is a... very likely that I would just walk away at this point, just... I'm worn out, and I feel like I'm being pulled in many, many directions. [0:36:01] And I can't find my way out of it. And so I think that's a sense in which there's a real parallel here. I sort of continue to do the thing until I can't, and then I just stop. So... yeah, it's not like any particular dynamic of our session. Two weeks ago was... I mean, so maybe it was a little worse on that day, me feeling trapped or whatever. But...

THERAPIST: You're usually not doing that with Tanya though.

CLIENT: No. So... right, I didn't make a vow to you that I would keep coming and doing this, but I did make that vow to Tanya. So...

THERAPIST: My thought is maybe... this is a version of what you're saying, it's like, better get out while I can. [0:37:02]

CLIENT: (Laughing)

THERAPIST: And I say that only in the context of, it feels like an obligation of sorts. As time goes by, one can feel that one's obligation to another person increases. I don't think that's inherently true, but... (Pause)

CLIENT: Yeah, I think I usually feel like my obligations to a person increase with time, just in terms of... I don't know, I care about the person more. And so... that sort of thing. I'm not sure that this particular... I don't know. [0:38:01] That might be correct, the better get out while I still can in terms of this therapeutic relation. But I don't think so. I think it was more like, there's some threshold of things with which I can deal, and, when we pass that, I want to leave. (Pause) Through a combination of their being real costs associated with coming here in terms of time and thought and energy and effort and financial and all of that. [0:39:04] And, if in some sense those are merited by the... by what we're doing, then good. Then we should keep doing it (chuckling). And then at some point, if it seems like they're not and I felt like we were going in a therapeutic direction that I didn't think was right and, as I said, I didn't think that I could change that. I didn't understand how to change that. Then it just seemed like a place that I was going to be trapped in, continuing to do this thing without any control over (pause) how we do it and with... (Pause) [0:40:15] It's a good question, I'm not sure I have a complete handle on the answer, though.

THERAPIST: And the idea of thresholds (inaudible at 0:40:25) going potentially way above the threshold and then below the threshold of what you can manage. You were saying if you hit the threshold that's a good time to leave, right? If you're below the threshold, that's manageable. Above the threshold is no longer manageable.

CLIENT: Right.

THERAPIST: One of my thought... I don't think this is all of it, but one of my thoughts is, just in terms of what you were saying earlier with Tanya, that in a sense dealing with her sapped you of your resources, certainly your time, and your emotional energy, to enjoy or pursue other parts of your life that are very important to you. [0:41:05] And that's what you were talking about last week, that this actually may be detracting from or taking away valuable resources that could be used other... in other ways.

CLIENT: Right. And I don't think that's actually true, but I thought it was true when I was saying it. But...

THERAPIST: Well, it felt... it was an emotional truth, certainly at that time.

CLIENT: Yeah, yeah. But I think that is certainly true of how I feel about my relationship with Tanya. (Pause) And without anything to show for it, I like to have some result for putting in time and effort. [0:41:59] Like, Tanya's still alive, but... (Pause)

THERAPIST: You're concerned it's maintenance and not growth. (Pause) You're saying Tanya's still alive... you were saying that, you know, what do you have to show for it? And when you say Tanya's still alive you're maintaining her...

CLIENT: Yeah, no, that's right.

THERAPIST: (Crosstalk) so there's a maintenance factor, but there's not necessarily a treatment factor or a progress factor or a growth factor, maybe not at least.

CLIENT: Right, and certainly she's better, but I'm not sure I have very much to do with that. So... (Pause)

THERAPIST: Well, that's interesting, because then you imagine that you can make things worse, but you can't make them better (chuckling).

CLIENT: Yeah, yeah. No, I think that's about... I mean, that's certainly how I feel. [0:42:57] I can't make them much better, or any better that I make them can be erased immediately or very close...

THERAPIST: But you could make them much worse.

CLIENT: I could... yeah, I feel that way. Now, whether that's true or not, I don't know. But certainly I feel that way.

THERAPIST: I'm not endorsing that (chuckling), just for the record...

CLIENT: Okay (chuckling).

THERAPIST: But I'm trying to articulate what you're feeling.

CLIENT: So you don't think that's true? Or you're not sure?

THERAPIST: I don't think that's true. But what is... how would one test that?

CLIENT: That's okay. I think it's sufficient that you don't think it's true or don't feel like it's true. It's very clear to me that you're not there with Tanya and I every day to tell whether it would be possible. But in a general sense you don't think that's really the way things work, so...

THERAPIST: Well, I would say in that way I think that you are a value to her, and to maintaining her, for being in her life is great. [0:44:02] (Pause) I wouldn't see it as an insignificant variable in this equation. And I imagine it's hard to feel that way when you see her spiraling and you feel helpless. And probably the feeling of helplessness does not... your next thought is, wow, I really provide value for this (chuckling).

CLIENT: (Chuckling)

THERAPIST: Feeling helpless.

CLIENT: Yeah, well, so say I provide value in that situation, but I don't provide enough value. So... but I don't have any more to provide.

THERAPIST: Well, how do you assess it's not enough value? Where does (crosstalk)?

CLIENT: Well, if she kills herself, then I will not have added enough value to prevent her from killing herself. So that's it, sort of. (Pause) Now, is that my responsibility? I... (Pause) I certainly don't want her to die. [0:45:01]

THERAPIST: But, I mean, I could make the argument that she hasn't killed herself. I understand you could then follow that with yet, but...

CLIENT: (Laughing) Yes.

THERAPIST: Hence my position could be true then.

CLIENT: Yeah, absolutely. Yeah, but I also feel like I have fewer resources now than I did three months ago. And so, if it spirals again, I don't know that I will have enough this time. (Pause)

THERAPIST: I could see how that's unsettling. (Pause)

CLIENT: Yeah. (Pause)

THERAPIST: I'm trying to make a very smooth transition to this very kind of profound moment...

CLIENT: (Laughing)

THERAPIST: Oh, by the way we have to go. I don't know, today I'm having a particularly difficult time making that transition...

CLIENT: Okay.

THERAPIST: But we have run out of time for today.

CLIENT: Okay.

THERAPIST: I will see you next week. [0:46:03]

CLIENT: All right. Thank you.

THERAPIST: Take care.

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