TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi. I'll be with you in just a second.

(long pause) [00:01:53]

THERAPIST: Hi.

CLIENT: Good morning.

THERAPIST: Good morning.

CLIENT: You doing okay?

THERAPIST: Yeah.

CLIENT: Okay. It's just very unusual for Time seems to be like the thing that you are always on top of.

THERAPIST: How do you mean?

CLIENT: Like you always start on time and end on time.

THERAPIST: And end on time. Yeah, you know I'm s Yeah.

CLIENT: It's okay.

THERAPIST: I'm s I didn't mean to -

CLIENT: I am really not upset about it. Just noting the unusualness of it.

THERAPIST: Oh good.

CLIENT: So I feel a little bit like I am coming here to ask for help and I don't exactly know what I want help with, if that makes sense. It's sort of like So maybe I'll just list some things that are going on in general, and then say, "Help."

THERAPIST: Okay.

CLIENT: (sigh) So I feel like I am angry a lot of the time. Not like outwardly angry necessarily, but just feel angry. I feel sad but that's less at the surface than angry. I feel a little bit lost in terms of like I lost of track of how to maybe even have desires, but like weigh them in a reasonable fashion against, particularly against Tanya's. [00:03:23]

But it is feeling more like a general problem of like not being sure how to find an optimal outcome or find an outcome that I would want. (pause) I feel like process things more slowly right now, so I feel like I'm thinking more slowly and less able to articulate what I want to say, in a general sense.

And I think that's related to having feelings that I'm just angry a lot of the time. And it's not hard to tap into that. And so the leaving that alone part and continuing to have another sort of conversation takes some effort that takes away from the actual conversation part, I think. (sigh) (pause) [00:05:00]

I think those are the main feeling parts of it in a sense. (pause) I'll probably finish my degree by the end of the year, which means I'm going to have to figure out what I'm going to next. Which is itself an optimization problem that has all of these other particular difficulties that I've just been talking about of like it's hard to think about.

I'm not exactly sure what I want. Not being exactly sure what I want in that career sense is not a new thing particularly. We've talked about it a little bit before.

THERAPIST: Mm hm.

CLIENT: But I guess I felt in the past like it's something I needed to deal with eventually. Eventually I'll need to figure out exactly what I'm doing next, but the time scale is longer. Now it's sort of like, well I really need to have some clear sense of what I want to do next. And probably after that, because the optimal next step depends on where I'm trying to go after that. [00:06:05]

THERAPIST: Mm hm.

CLIENT: But really I'm not well equipped to do it. That's a little bit of an overstatement because I feel like Tanya is doing better and quite well really. And I can talk to her about what she needs and wants and how we should balance her needs and mine. So we've had some of those conversations and they went surprisingly well.

THERAPIST: Mm.

CLIENT: I think another piece of it is I'm probably afraid somewhere in there that it's all going to happen again. Because there's no clear reason why it happened in the first place. Or that's not really fair. I can tell a lot of stories about why it happened, but I can't tell a story that's good enough to predict when it will happen again.

And so, in that sense, there's no clear reason why it happened. And so that's something that I feel like has to play into what I do next. Because it's not the case in all jobs that I can move across the country and stop doing some major portion of it so that I can take care of my ill spouse. It's just not how most of the world works. I'm very lucky to have been where I was when I was. [00:07:34]

THERAPIST: Mm hm.

CLIENT: Help. (laughs)

THERAPIST: Help knowing what to do with all these problems? Or where to even start? Decisions.

CLIENT: I feel like they're similar questions. Yeah.

THERAPIST: Yeah. What do feeling angry about? (pause)

CLIENT: That's a hard question because I can feel angry about almost anything, but it's not really like, I don't feel like it is in some sense the root cause of the anger. [00:08:34]

THERAPIST: Mm hm.

CLIENT: And that is a little bit harder for me to figure out. So it's like, you know, someone is driving very, very dangerously on the highway swerving in and out of traffic. I can be angry about that and more angry than I would normally be because I find endangering others to be not a nice thing.

THERAPIST: Mm hm.

CLIENT: But I feel like it's compounded by some other residual anger. So I feel like the question that you may really be asking is, "Why am I residually angry most of the time." And I'm less clear about that. I think it has to do with feeling betrayed and abandoned in this marriage. Feeling like she doesn't remember things and so it's [00:09:34]

I think I feel guilty about that because it happened while I was the only one of the two of us that was really aware of what was going on. I couldn't really have stopped it, I think that's pretty clear, but it happened. (pause)

You know I moved across the country in a sense because she kept wanting to kill herself. We kept making changes. Like, "I'll take an incomplete in this class and then take a little time and then finish it later in the summer." Well, "Take a leave of absence from your program." [00:10:34]

And then that really wasn't working. She couldn't find a job. She couldn't find a job that she wanted to do because, of course, they weren't going to cover her health care or pay her while she's taking a leave of absence. (pause)

I don't know that moving here made things any better. I don't know that they made it any worse either. But there's sort of this sense in which like I did this really big in heart thing and I'm not sure it was worth anything. But that hasn't stopped it from being hard.

And even if it was worth something, she's still withdrawn from her PhD program, can't remember why she did that, and upset about having done it. So ultimately that was probably the thing she needed to do most. So I guess that I should probably just be mostly happy about that. But (pause) So I feel like I haven't answered your question really. [00:11:58]

THERAPIST: I think you're doing fine -

CLIENT: Okay.

THERAPIST: with it. Well, you started what you just said, you prefaced it with saying, "I feel betrayed and abandoned in my marriage."

CLIENT: Yeah, that's probably right.

(long pause)

CLIENT: I've tried to tell some of my friends this because it seemed like a large enough thing like that I was angry in this position. It seemed like a large enough thing that I wasn't dealing with on my own very well. And that even talking with you was, in some sense, not acknowledging it enough or something like that. Or it seemed like it. [00:13:06]

I'm not sure that's correct, but that's how it seemed. It seems to be a hard thing to hear. And I'm not sure whether I just can't articulate it or whether I (pause) I think there's a sense in which if you're not in my position, Tanya being well again is just a really good thing. Full stop. And it is a really good thing but it -

THERAPIST: But it also isn't good that she was sick to begin with to be well from.

CLIENT: Yeah, that. And the -

THERAPIST: And who knows the pattern?

CLIENT: Sorry?

THERAPIST: The pattern, which is what you Who knows the pattern?

CLIENT: Yeah. And also like the way she was sick I guess I dealt with much more than anyone else. [00:14:12]

THERAPIST: Mm hm.

CLIENT: And so there's a sense in which that's like behind most people. It's sort of like, "Well, she's well again. We can leave that behind." I don't seem to be able to just leave it behind.

THERAPIST: Well how could you? It's left you with so many hurt feelings and lingering questions.

CLIENT: Yeah, that's right.

THERAPIST: I would be far more concerned if you left it behind.

CLIENT: (laughs) Okay.

THERAPIST: Because it would mean to me you weren't processing things. "Oh great, it's sunny today."

CLIENT: That is nice.

THERAPIST: But if you just went through a war, it's nice that it's sunny, but it doesn't erase everything. [00:15:11]

CLIENT: Okay. (pause) How does it get better? (pause) (laughs)

THERAPIST: (sigh) My very trite answer, it's really trite, is by doing this. I mean, in a sense, by processing it. Unpacking all the complexity of it both, you know, in terms of your feelings and in terms of your thoughts, and in terms of your thoughts about the future and what your future looks like. The meaning of it. It's right now really still something that happened to you. It's a little bit more than that, but mostly that. [00:16:10]

CLIENT: As opposed to?

THERAPIST: Sort of what it means. What the impact You know, sort of the, you know Yeah, the implications, the meanings, the feelings. It's just something that This is also not a great way of putting it, but it's sort of still a traumatic event that's not integrated. Because it just happened not because you're failing to integrate it.

CLIENT: Right. Okay.

THERAPIST: The identity of your marriage. You know? I mean (pause) I mean like when your house is burning down, which is kind of an interesting metaphor that I thought about this, you have to put the fire out. What you're going to do about the house, your attachment to the house, I mean that's not things you think about.

You've got to try to put the fire out so there's some semblance of a house left. But then there's all those other things to deal with. Do you recover? What can you recover from the house? What do you need to build anew? [00:17:19]

CLIENT: (laughs) Right. Right. (pause) Yeah, I think that's right. I feel like you understand where I am pretty well. So, thank you. (pause) Most of the, it may be trite, but the answer of about continuing to do this is a path forward.

THERAPIST: Mm hm.

CLIENT: It's a good, it's a helpful thing. [00:18:18]

THERAPIST: Mm hm. (pause) Yeah, maybe trite isn't Probably what I meant is it's not fully, it's not a full explanation of this but it's, you know, it's a little bit amorphous to describe it that way. I do believe that.

CLIENT: That's good. (laughs) (pause) Do you think people do your job that don't believe that?

THERAPIST: I don't know. (laughs) What are your ?

CLIENT: It would be interesting if you didn't believe it to be a way forward but we're doing it anyway.

THERAPIST: Hm.

CLIENT: Digression of I don't think any importance. [00:19:24]

THERAPIST: Mm. Well it is an interesting question of, do people do things they don't believe in?

CLIENT: Well, maybe that's the way in which it's not that far afield of what we're talking about. What do I have to do next?

THERAPIST: Mm hm. (pause)

CLIENT: Yeah, and so it's sort of like on top of all these other things in terms of feelings about my wife, the other major thing in my life is my career. Which is going well right now in the sense of I'm actually going to finish my degree. (laughs) That's a good thing. [00:20:41]

THERAPIST: That's a huge thing. When you say at the end of the year, are you meaning December?

CLIENT: Yeah.

THERAPIST: Not the academic year.

CLIENT: No. In between. But the next step in biomechanics is if I want a faculty job is to do a post doc. And those start in a sense randomly, but between semesters is as good a time as any.

THERAPIST: Mm hm.

CLIENT: But then the question is, do I actually want that career path? How do I feel about taking a job where someone else is going to take all of the credit and do very little of the work, but provide most of the funding. (pause) Uncomfortable, at best, but I've had other friends try to do other things besides a traditional academic post doc. [00:21:49]

And the one friend I'm thinking of is doing okay. He has a faculty job, it's just not at a very school and not with a lot of resources. And it's not where he wanted his career to be. But (long pause) [00:23:09]

CLIENT: I guess I feel like I'm in a place where the next steps, that I have to rebuild my marriage in some sense. It's just been shaky in a fundamental way. Tanya is turning back into the person that I married, but she's catching up to who she is faster than I am in some sense.

THERAPIST: Mm hm.

CLIENT: I'm still aware of who she's been recently. In a sense she's lucky because she doesn't. (laughs)

THERAPIST: Mm.

CLIENT: She doesn't feel lucky not to remember anything about the last several months and large pieces of the last couple of years. But (pause) they were not good times. They were bad enough that she wanted to kill herself. So maybe it's better she doesn't remember them. (sigh) [00:24:17]

THERAPIST: Mm hm. (pause)

CLIENT: So her responsibility is, of course, a weird thing in that world. Like if she doesn't have any real understanding of or consciousness of it, what responsibility does she bear for it now?

THERAPIST: Hm.

CLIENT: And (pause)

THERAPIST: Maybe she has a responsibility of knowing and bearing in mind what you're experience of that was. Appreciating the impact of it.

CLIENT: But knowing how much? [00:25:21]

THERAPIST: I'm sorry, knowing how much? Knowing refers to?

CLIENT: You said maybe she has the responsibility of knowing what she's done, what the impact has been on me. But at what level of detail?

THERAPIST: I see. (pause) At what level of detail should you share? Is that the question?

CLIENT: Yeah. And that's, you know, complicated by me still not entirely trusting her. Because I have this concern that if I share every level of detail, she will not be able to handle it. And then we'll be right back where we were when it was bad. Which is part of the trust problem. [00:26:26]

THERAPIST: Mm hm. (pause)

CLIENT: [I should] (ph) probably rephrase this. How do I have a relationship with someone I don't really trust? To which I would just respond, "I don't really want to have a relationship with someone I don't really trust." It's just not how I want to be in a relationship, but (pause) here I am. (sigh) (pause) [00:27:53]

You know I don't monitor almost every move she makes any more. So that's good.

(long pause) [00:29:06]

CLIENT: I don't make sure the knives are always washed and put away so that they aren't like out as a temptation anymore. (pause)

THERAPIST: Does she know you think about these things?

CLIENT: I don't know.

THERAPIST: Well if you don't tell her, she probably doesn't. I don't know, maybe that's not a good assumption.

CLIENT: No, it's probably right.

(long pause) [00:30:03]

CLIENT: But, you know, It's hard enough to say these things in your general direction when I know that you can handle them, more or less. And I'm really not sure about her. And they're hard for me to say. You know, I think you're right. I do need to say them to her, I guess.

But I think there's a part of me that's irritated that I have to rebuild trust or intimacy or something like that. It's a hard thing to do in the first place (pause) and now it's, in a sense, redoing it under duress. (pause) I don't have anything more to say at the moment, so if you have a thought. (sighs) [00:31:34]

THERAPIST: I was just making different analogies in my head and trying them on for size and then seeing if there's I was thinking about being married to someone with alcoholism. And at what point do you get rid of all the alcohol.

And then clearly probably, you know, getting drunk in front of your spouse who has an alcohol problem, that's probably not (laughs) advisable and probably irresponsible one might say. But then at what point do you extrapolate to, "It's your responsibility to have them not drink?"

CLIENT: Hm.

THERAPIST: Do you, maybe you get rid of all the alcohol in the house. Maybe you petition to have all the stores in your town not sell alcohol. (laughs)

CLIENT: (laughs)

THERAPIST: You know, you can sort of extrapolate out.

CLIENT: Right. Right.

THERAPIST: But you're describing these layers of burden. Just burden of bearing what happened. The burden of and the anxiety about sharing it with her. I mean, just like sort of layers of burden. And, you know, sort of what you were saying. [00:32:43]

I mean, I agree with you and I do have an opinion on that sharing with her, whatever the timeline is, the impact that her suicidality, multiple hospitalizations and ECT has had on you. I think without that I don't think you'll feel good in your marriage.

CLIENT: Hm. (pause) Okay. I think that's probably right. (pause) There's probably a sense in which I don't really want that to be the answer. I guess it would be nice if there was a, if it were easy in some sense. [00:33:53]

THERAPIST: Mm.

CLIENT: But -

THERAPIST: I mean this experience was deeply traumatizing. It was a traumatic experience in your life. And in some ways, not that I would want to put a quantitative mark on it, but in some ways more so than hers. If only because she doesn't remember a lot of it. I mean that itself is traumatic for her.

CLIENT: Yeah.

THERAPIST: So I don't want to minimize it. Maybe I don't even want to make it qualitative. It's just so different. It's just a very, being her and being you in this experience is just extremely different.

CLIENT: Yeah.

THERAPIST: But traumatic for you. Traumatic for anybody. I'm not saying this happened to have been traumatic for you. This is a traumatic event, series of events.

CLIENT: Yeah.

THERAPIST: Over time. (pause) [00:35:00]

And actually your process kind of very much is in line with how sort of people process trauma. That during the trauma you're more recounting what is happening, which is what you were doing. You were sort of recounting and recounting. You were sort of like going over the details, going over the facts.

Not that that's what you were only doing, but that's a big piece of it sort of while it's happening, is sort of shortly after. And then when you get a little bit more breathing room, a little bit more distance from it, that's when you can sort of understand the meaning and the feelings and so forth.

CLIENT: Hm. (pause) Yeah, it also has, having had traumatic experiences in my life before and we've talked about some, that there's a difference here in that there's no closure to the event. [00:36:05]

THERAPIST: Mm hm.

CLIENT: So it's not a thing to walk away from and make peace with over time.

THERAPIST: Mm hm.

CLIENT: It's a thing to continue to live in and make peace with over time. And I have a much less clear idea of how to do that. You know, my volleyball coach drove into a tree. Like I can be angry with him for driving into a tree, but I'm certainly not hurting him by being angry with him. (laughs)

THERAPIST: Mm hm.

CLIENT: You know. (sigh) (pause) I feel like this a more complex event to attempt to process.

THERAPIST: Mm.

CLIENT: Because, as you have been saying since before I was saying it, because of the implications for our future. [00:37:09]

THERAPIST: Mm hm. Mm hm. (pause) And the more immediate one that's coming up is sort of practically. I mean it has sort of emotional pieces to it, but in terms of what you're going to do next, keeping this mind as you were saying, there were certain situations where flying across the country would not have been an option.

CLIENT: Yeah. It's also like, it is in a sense a practical decision or other practical things of high importance to weigh in. Like there's a relatively small set of places that I could go that don't bound my career paths in some way. How far can we reasonably go from Or where can we reasonably go that Tanya will have the continuing care that she needs or wants or needs or wants. [00:38:13]

THERAPIST: There are a lot of places that you can go.

CLIENT: Right.

THERAPIST: I mean if you get an academic position in some place extremely rural, though it would be less so.

CLIENT: (laughs)

THERAPIST: But for the most part in the US there are a lot of places for that.

CLIENT: Okay. (pause) I feel like there are some entire states that have dramatically less good health care systems. We were in Ohio where she was hospitalized first. They said that she probably wouldn't be able to see someone for six months if she were just coming in under normal circumstances. So it seems like not great.

So fortunately I don't really want to go back to Ohio, so that's not an issue. But (pause) But yea, this is just in a sense the immediately appearing practical concern. It makes all of the feelings and difficulties about rebuilding and living forward come up. [00:39:34]

THERAPIST: Mm hm. You know one thing I was thinking about, and you probably know this anyway, but if you've ever felt that coming in an additional time a week for some period of time to help make sense of this and process this. If you felt that would be helpful like please let me know.

CLIENT: Okay. Thanks. I really want to have a clear sense of what would be helpful.

THERAPIST: Yeah. I've thought about it over the last month or so.

CLIENT: Okay.

THERAPIST: I sort of wondered whether that having an additional time each week to talk about these things, at least for some period of time, especially in the sort of midst of it. You're just so in the midst of processing what happened and making decisions about your future.

I mean that's an awful lot. And having, you know, an additional time and space each week could helpful. But I don't have any strong opinion on it but it's certainly been something I've thought about.

CLIENT: Okay. Thanks. I don't think I had thought about it very much.

THERAPIST: Mm hm.

CLIENT: So will think about it some. [00:40:34]

THERAPIST: Mm hm.

CLIENT: It's definitely helpful to be seeing you and to be coming here. So, yeah, I'll think about it.

THERAPIST: Mm hm. (pause)

CLIENT: Yeah, I'm not really sure where else to go at present or what else to say.

THERAPIST: Mm hm.

CLIENT: Or talk about. (pause)

THERAPIST: Well, let's see what comes up.

CLIENT: (laughs)

THERAPIST: Where your mind goes. (pause) [00:41:57]

CLIENT: (laughs) Unfortunately, the place that that goes is that I know that when Tanya comes to a moment in therapy where she's not sure what to talk about, Chad says, "What comes to mind?" Tanya has a hard time dealing with that question.

THERAPIST: Mm.

CLIENT: So (laughs) that (pause)

THERAPIST: Well I'm always sort of happy to chime in with something, you know, share my thoughts. Sometimes I like to let those moments go a little bit because you may be working on something you don't realize you're working on.

CLIENT: Fair enough.

THERAPIST: So I like to like, "Well let's see if something emerges." But I don't mean to be sort of mystical about it (laughs) or, you know.

CLIENT: (laughs)

THERAPIST: But that's sometimes why I don't chime in right away.

CLIENT: No. And I really appreciate it. And I am sure it's hard to tell from me sitting here staring at that wall whether I'm thinking about something or nothing at that moment. [00:42:58]

THERAPIST: Mm.

CLIENT: And sometimes it's one and sometimes it's the other, so I appreciate that. Today I don't really, I don't seem to be going anywhere in particular. So if you I mean, it's sort of like you have been saying things to me and I've been saying," Yes, that sounds about right."

THERAPIST: Mm hm.

CLIENT: Which itself is helpful because I feel like you're presenting it clearly and it helps to understand it or hold onto it.

THERAPIST: Mm hm.

CLIENT: And it's also helpful just to have a sense that, "reasonable" isn't the right word, but that like I'm on some sort of path that looks vaguely like what other people might have gone through under similar circumstances. If that makes sense. Sort of like (pause), in a sense, yes, these feelings are to be expected. [00:44:15]

What exactly they look like, that depends somewhat on me and somewhat on the circumstances. But it's not at all surprising that we are here at this moment because I think I feel like some of my friends and family are surprised that I would be not just happy now.

THERAPIST: Mm.

CLIENT: Not that they don't understand it quickly, I don't think, when I start explaining. But I don't think that it's like occurred to some of them that Tanya being better now isn't just Tanya being better. There's still everything else to deal with. (pause) [00:45:21]

THERAPIST: Well, to use the war analogy again. It's sort of like if you, you know, get to come home from Afghanistan, you were still in Afghanistan.

CLIENT: (laughs)

THERAPIST: You may not be there now.

CLIENT: (laughs)

THERAPIST: And then if there's the uncertainty, "Will I sent back again. I don't know." It's not fully comforting and settling and "yay" all roses.

CLIENT: Yeah. Yeah. And home looks like a different place.

THERAPIST: Mm.

CLIENT: I think is what a lot of people find.

THERAPIST: Mm hm.

CLIENT: Which is definitely where I am at present.

THERAPIST: Mm hm. (pause) [00:46:30]

CLIENT: A practical question. You've suggested that we should do couples counseling. On what time scale? Like when should we start?

THERAPIST: (cross talking at 00:46:45)

CLIENT: Is that something I should decide? Is that something we should decide together? I mean there's still that part of me that doesn't want to have to be rebuilding. Right?

THERAPIST: Right. So the question you're asking is an emotional question more than a practical question.

CLIENT: Maybe.

THERAPIST: Practically, whenever.

CLIENT: Okay.

THERAPIST: I mean, go next week.

CLIENT: (laughs)

THERAPIST: You know, I have a couple of great people I'd be happy to send you to.

CLIENT: Okay.

THERAPIST: By next week. But, right, you're talking about an emotional question, both about, you know, "Why do I have to be doing this?" And also, "How can I fully trust that Tanya's going to be able to hear what I have to say without falling apart?"

CLIENT: Right.

THERAPIST: Those are all I mean, I guess the latter can be somewhat of a practical question, but a practical question that really doesn't have any clear answers.

CLIENT: Fair enough. Fair enough.

THERAPIST: So my immediate response is, "Yeah, whenever."

CLIENT: (laughs) Okay.

THERAPIST: But maybe the ancillary question is you're feeling, "When will I be ready?" [00:47:46]

CLIENT: Yeah. I think that's the question I'm trying to ask. And is it okay if I'm not ready now?

THERAPIST: Mm hm.

CLIENT: Because it seems like part of the answer to the first two emotional questions you asked is well, "You just have to start doing it." Like, that's how trust works as far as I can tell. You just start doing it and then you build it over time. And so I feel like part of the purpose of the therapy is to of the couples counseling, couples therapy is to do that. The process is how it happens.

THERAPIST: Mm hm. I need to let you know, we need to stop for today.

CLIENT: Okay.

THERAPIST: Sorry about the lateness. I was going to ask. I can totally do the 10:45. For July and August it would work a little bit better if we could meet earlier. And if not, that's fine too.

CLIENT: No, we definitely can. That would be great.

THERAPIST: Okay. Well, if you can do the nine o'clock, my schedule shifts a little bit for the summer. But if you can nine o'clock that would be great. [00:48:49]

CLIENT: Okay.

THERAPIST: Is that good?

CLIENT: That would be fine.

THERAPIST: [Let's just keep it that.]

CLIENT: Okay, great. I'll see you next week then at nine. Okay. Bye bye.

CLIENT: Bye bye.

END TRANSCRIPT