TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi. Come on in.

CLIENT: Good morning.

THERAPIST: Good morning.

CLIENT: So we were talking last time about where my desire to be gone at the end. So I thought about that some and I think the answer breaks up into some of them never existed. Some of them lost track of and I think some of them I suppressed because I did not, I do not want to face them sometimes so there were times when I did not want to be in this marriage. I don't think it's really an overriding desire, but it's something I definitely think I have wanted during this time. And so, those are (Pause), that's a hard one, too, that we have to face, or something, and so I think that's where some of those went.

(Pause): [00:01:34 00:01:42]

THERAPIST: Um hmm [yes].

CLIENT: That's all I have on the subject, but even so, I thought I'd -

THERAPIST: There's a lot in that.

(Pause): [00:01:47 00:01:58]

CLIENT: Yeah, probably.

(Pause): [00:01:59 00:02:07]

THERAPIST: Well, you did start with the last one first. The question is, when you have desires that are not being met, what do you do? Do you just submerge the desires? Or, what does one do with that?

(Pause): [00:02:19 00:02:28]

CLIENT: And I guess part of that is what does one do when one has competing desires? Throughout all of that I had a stronger desire not to break up the house that I had made, the vow that I had made. But that doesn't make the other desire disappear. So -

(Pause): [00:02:50 00:03:01]

CLIENT: So some days the answer was to look at it and push away and some days the answer was just to push it away and not look at it.

THERAPIST: Um hmm [yes].

(Pause): [00:03:10 00:03:29]

CLIENT: I'm not sure how good either of this is. Eventually, it sits there but between the two of them I think the former was better to say, 'this is here. This is not what I'm going to do.' But I don't know.

THERAPIST: Um hmm [yes].

(Pause): [00:03:48 00:03:58]

THERAPIST: Well, it's especially difficult when there's an assumption that these desires are going to be met and then something completely derails that.

(Pause): [00:04:05 00:04:26]

CLIENT: Yeah, and there I feel like were beating someone into the (unclear) who just got lost because these are things I want and then they're we ended up in a very different world, than I feel like we'd set out to be in and -

(Pause): [00:04:43 00:04:59]

CLIENT: This is the part where it's hard to hold onto desires that I have that certainly are not possible in the present. I guess in a sense they're similar to the other ones. I desire other things, but I desire, in some sense, to take care of Tanya, more.

(Pause): [00:05:28 00:05:35]

CLIENT: The requirements of that have become overwhelming at times and hard to hold onto anything else in sight of that.

(Pause): [00:05:44 00:06:07]

THERAPIST: Well, this is, what I meant to say, all of it. But I do think a piece of it is that you have assumptions of what desires can be met without knowing. Like you have assumptions that you can't be forthcoming and honest about certain feelings you have about the marriage, about what happened, that may not be that may not be true that you can't do that. I'm not saying it's definitely not true, but you're making a lot of assumptions that may not be true.

(Pause): [00:06:36 00:07:32]

CLIENT: I mean in this talking about this and that specific desire (Pause), there's a sense which the narrative of the last several years is Tanya was abandoned by her parents and then got into graduate school and felt abandoned by the people who were supposed to be taking care of her in that circumstance. And so even the suggestion of I might not be there I'm not sure the assumption of that is a dangerous thing to voice. It's really an invalid one. (Pause) I agree, I am assuming it, but I think I have I don't think that's one that I have constructed entirely.

THERAPIST: I'm not at all suggesting that. I'm not at all suggesting that. And I'm not suggesting you might not be right.

CLIENT: Okay.

THERAPIST: I'm not suggesting either. I'm just saying that's not a certainty. And maybe I'm even as I'm thinking about it, certainly that's not all. I'm not making the claim that everything that you desire I mean, that you assume that you can't get that you desire, that all might not be true, that you're just making assumptions. Because there's a lot of desires that have already not been met.

CLIENT: Right.

THERAPIST: So, I'm thinking as I chose what to say, maybe I wasn't picking the most essential thing.

CLIENT: Well, I think you weren't picking the most essential thing of the specific desire not to be in that marriage while that was happening. I think it is probably an essential feature of other desires, that I do something similar. I actually think that is that. I think that my position is not too far off the mark in that circumstance. When she is suicidal saying, 'I don't want to be with you when you're like this,' is maybe not the thing to say when she has said that I am the only reason she is still alive. I don't really believe that I'm the only reason she is still alive, but she's holding onto telling the story of I am the thing she's holding onto, so to loosen that tie seems dangerous, but -

(Pause): [00:10:16 00:10:22]

CLIENT: That's not true in most of the other circumstances or all of the other so, I probably am making (Pause) similar assumptions or something like that, that is contributing to my own frustration or something like if -

(Pause): [00:10:43 00:10:49]

THERAPIST: I had a whole I hadn't remembered this in like 14 years or something. It was just sort of an I think often, I don't know what the context was, but I was in supervision once with a colleague. I was probably like a first or a second year grad student and he was talking about doing this assessment with this psychotic I mean, clearly, psychotic I mean, not like upset or something, she had some sort of psychosis and he met with her and the family first and this woman really seemed quite psychotic and off the wall and he met with her individually and she was still psychotic but much, much more organized. And the reason that I think that I thought of it and you can be completely right about Tanya, so please, like I'm not saying this is what's going on, but I think there are certain complex, sort of systems where behaviors enabled that might not otherwise happen. Like it could be the case, and just could be, please, like don't get me wrong that you know, if you were to say to Tanya, you know, 'actually, this isn't acceptable.' Maybe she'll rise to the task. I don't know that.

CLIENT: You know, that's a really interesting suggestion. She used to self-harm, to cut herself on her legs. I don't know if you knew that or not.

THERAPIST: I didn't know that, but -

CLIENT: It's not surprising given the other stuff.

THERAPIST: given the whole thing.

CLIENT: Right. So that's something I think she'd done when she was in high school, self-injury of some kind, I don't know exactly what. And then it would like come back as things got worse.

(Pause): [00:12:24 00:12:33]

CLIENT: It is something that I told her about that I did not think was okay but it wasn't I sort of didn't say it that strongly, but anyway she stopped after she visited, which one was it -?

(Pause): [00:12:48 00:12:51]

CLIENT: Mount Sinai up in Brooklyn. Or Brook-lyn, or however they say it over here. And the reason was one of the psychiatrists really thought something like that was going on to a large extent that like the type of psychotherapy she was doing was enabling her to spiral out of control emotionally, rather than helping her deal with it and so he essentially told her she just wasn't trying hard enough which was not really what she wanted to hear and maybe not helpful in a lot of ways, but I think to spite him, she decided to stop self-injuring. And it hasn't since. So -

(Pause): [00:13:40 00:13:47]

THERAPIST: But you were.

CLIENT: It's an interesting suggestion. I don't know that I could take the risk involved in saying it. Like, 'this is not acceptable.'

THERAPIST: What is that risk?

CLIENT: It feels like the risk is of pushing her over the edge. Saying, 'this is not acceptable,' in a time when she's (Pause): [00:14:14 00:14:28]

CLIENT: In a time when she's in a sense, out of control, or emotionally out of control. She -

THERAPIST: But here's a Catch-22. Part of the reason she's out of control is she's not being held accountable.

(Pause): [00:14:43 00:16:57]

THERAPIST: It looks like you've gone somewhere very deep.

CLIENT: Well, that's a pretty deep suggestion, isn't it?

THERAPIST: Yeah.

CLIENT: The first thought that came to mind is so the five year old she's watching a few weeks ago, started her morning by doing something deliberately that she had told him not to do. He'd kicked his sister and then she said, 'don't kick your sister.' So he'd look at her, kick his sister and then looks back at her like, 'what are you going to do?' So she sent him to his room and the rest of the day he'd be fine. So it seems like (Pause) he was in a sense, asking to be held accountable and I mean by being held accountable, everything was okay. So, certainly I just told you about the self-injury, I guess I -

(Pause): [00:18:01 00:18:32]

CLIENT: It's plausible. I don't know whether it's, I don't know. But I'm not certain as to who's supposed to hold her accountable? It's not a question I guess. Of course my first answer is, 'me.' I guess that's -

(Pause): [00:18:56 00:19:14]

THERAPIST: Your first answer is you. (Pause) Why is your first answer, you, that you're supposed to hold her accountable?

CLIENT: Well, I felt that that was part of what you were suggesting because we were having the discussion in the context that I didn't feel I could say these particular things but being as I don't know. I think part of that is just me, and part of that is certainly -

(Pause): [00:19:50 00:20:05]

CLIENT: I guess it's I'm married to her. I love her. Who else is supposed to hold her accountable in that circumstance? And that part of the (unclear) there are several other people who could reasonably hold her accountable, I guess. Her family is another set of people who fall into a similar category as me, untrained but love her and

(Pause): [00:20:37 00:20:48]

CLIENT: And then she's seen an entire slate of medical professionals and -

(Pause): [00:20:52 00:21:06]

CLIENT: So is it their job to hold her accountable? I don't have a very clear picture what some of the jobs are.

THERAPIST: Nor too much faith for so much of the time.

CLIENT: Yeah. And a lot of that's from the ill-defined nature of what they're doing. It's like if there's a clear sense of what they were doing I could assess whether they were doing it or not, but -

(Pause): [00:21:35 00:21:45]

THERAPIST: Or you could argue that it would be clear to you that they were doing something if it was clear to you.

(Pause): [00:21:50 00:21:58]

THERAPIST: But here's the issue about, 'ought you to hold her accountable.' Because I started to think as we are talking about this topic, I actually think it's really important, I thought diverging from what you were saying which is about you and your desires and the compromises that you've had to make maybe too many compromises so this there's the issue of holding her accountable for her own good for her good. And there's holding her accountable because it's what you need holding her accountable because you need a partner in marriage. And so when you said, 'who else?' it sounded like it was more because it was your responsibility to hold her accountable because you have to take care of her. Which, I mean, I'm not saying that's not true, but then what gets lost is you need to hold her accountable because you need a partner who can be accountable because that's what you need in a marriage.

(Pause): [00:22:57 00:23:08]

THERAPIST: I do think not being held accountable is a destructive thing in life in general. I started thinking about the story of her brother, about the graduation, of how he didn't seem like he was held accountable on any level even to the extent that his parents would check in with him, would be like, 'how are you doing your classes? Are you actually getting -?' He could lie. I'm not saying he wouldn't lie. But there's a lack of accountability there which seems like instead of being accommodating, but in the end being extremely neglectful of your son who clearly needed their help and needed their input and needed to be held accountable.

(Pause): [00:23:42 00:24:02]

CLIENT: Yeah, he sort of changed life plans in December and Jonah wanted to (unclear) by boat and no one said, 'what's wrong with you?' That's not a reasonable life plan. So, yeah, sure.

(Pause): [00:24:14 00:24:21]

THERAPIST: So I guess one of the things I'm thinking is that I'm kind of thinking out loud, is your feeling of what she needs and what you need as sort of conflicting isn't necessarily true.

(Pause): [00:24:31 00:25:25]

CLIENT: So on the other hand if she had cancer, it would not be reasonable to look at her and say, 'this is not acceptable. You cannot have cancer.'

THERAPIST: But it would be reasonable if she avoided treatment of it. The cancer isn't she can't but if she did have something that actually hastened her death with the cancer, or neglect her care, that you can hold her accountable to.

(Pause): [00:25:45 00:25:51]

CLIENT: Absolutely, So the line is clearer there than it is in the mental health case.

THERAPIST: Well, it's tricky because if the illness is not holding oneself accountable, how can expectation about being accountable that's part of the illness in a sense.

(Pause): [00:26:14 00:26:19]

THERAPIST: And so it becomes more complicated I agree.

(Pause): [00:26:20 00:26:26]

THERAPIST: But certainly the solution is not avoiding that issue and I know you're not because I mean, we're talking about it. But it's still there even if it's not clear what the answer is. I mean you can, to me I think actually a good analogy is alcoholism. I mean, for some people I mean their alcoholics. I mean it's in their I don't think this is true of everyone who has an alcohol problem. For some people it is in their genes. I mean this is a disease they have.

CLIENT: Right. Well, there's a spectrum of people and then that's one end of this.

THERAPIST: But say there's one end of it. Well, they can't help that. But they cannot go to bars.

CLIENT: Right.

THERAPIST: They may even have to not go to social situations that they want to go to but they be tempted, so they can't do anything about that but they can do things or even they know if they're depressed they're more likely to drink, well then they have to really take care of their depression, maybe even more quickly than many of us do where it's not going to lead to catastrophic results.

(Pause): [00:27:28 00:28:54]

CLIENT: So it's tough the suggestion that if enabled this horrific event it's -

THERAPIST: I'm not making that kind of claim.

CLIENT: Okay.

THERAPIST: I really am not, because I'm not I don't feel like you have that much responsibility.

CLIENT: Okay.

THERAPIST: You're enabling it sounds like you're doing something. Do you see what I'm saying?

CLIENT: Okay.

THERAPIST: It's a really important distinction.

(Pause): [00:29:24 00:29:37]

CLIENT: I'm a little stuck. I so -

(Pause): [00:29:44 00:29:50]

CLIENT: If me not holding her accountable contributed to where we are, then I mean, if like me holding her accountable for her well-being at some point we have avoided some of this, then -

THERAPIST: Let me be careful about some things. I want to think about that because I'm not, I'm realizing what my response is and then I'm thinking, well maybe what I'm saying isn't clear. Maybe what I'm saying to myself isn't clear. I don't think I'm not even making the claim that you hastened this. This could have happened without you. I don't know.

CLIENT: Fundamentally, I guess we can't know.

THERAPIST: We can't know, but I'm not making the claim that you hastened this.

CLIENT: Okay.

THERAPIST: What I am making the claim is, you're not holding her accountable isn't helping.

CLIENT: Okay.

THERAPIST: That's different than you're actually making it worse, not -; could you possibly make it better? Maybe. Could she possibly not tolerate that and have it, you know, be like so like not cutting. Her response would be, 'fine, I'll go commit suicide.' Maybe. I mean, I don't -

CLIENT: Yeah.

THERAPIST: Maybe. I mean I don't I'm not saying she'll do that. So I'm not saying I have the answer.

CLIENT: But you're not speaking to past events in the sense of like if I'd held her accountable you know, it's likely that things would have been better.

THERAPIST: No. First of all, I definitely don't think it's likely. It may have been possible, but no I'm not making that I'm making a statement in the here and now because that has been going along with your logic that somehow you had some responsibility in creating this. Even from a moral standpoint, I couldn't possibly take that position. I don't think it's your responsibility. Would it have helped? I don't know. I really don't. But you're feeling now that you can't do certain things because it's going to undermine her mental health, and I'm only making the claim that I don't think that that's true -

CLIENT: Yeah, that's true. Those assumptions are -

THERAPIST: I don't think -

CLIENT: Okay.

THERAPIST: those assumptions I actually -

CLIENT: I think you may be right in the here and now or at least (inaudible).

(Pause): [00:32:05 00:32:10]

CLIENT: I mean when she gets to a really bad place I don't know what the right answer is. That's part of the struggle. Who knows what's going to do what? But I do think she's a lot better now and I think telling her about the effect that her repeatedly wanting to kill herself has had on me has had an effect on her. I think there was some (unclear) but it wasn't I think that has been a motivating factor for her also because she does seem to want to take care of me still. So -

(Pause): [00:32:55 00:33:14]

CLIENT: Yeah, I can deal with that better. It's a lot of guilt otherwise.

THERAPIST: Your feeling you mean you feel -

CLIENT: Yeah. If I (Pause) if you were making the other claim that you are not making, that's a lot of guilt for me.

THERAPIST: Boy. I really have to watch what I say. I'm not I'm saying -

CLIENT: (inaudible).

THERAPIST: it tongue in cheek, I'm saying it very tongue in cheek.

CLIENT: Okay. All right.

THERAPIST: I'm saying that very tongue in cheek. But I can appreciate -

CLIENT: I really appreciate your saying these things, though. I think this has been a really interesting session and I think a good one and helpful even if I sat here in a place you really weren't trying to send me or steer me.

THERAPIST: Well, but it's well, I mean, you hear everything through the ears of your responsibility and sort of listening for, you're like listening have I lived up to my responsibility, have I failed in my responsibility? I mean that's the sort of the lens through which you hear 99% of things.

CLIENT: (Laughs)

THERAPIST: And so I understand certainly why you would hear that. I was also thinking I was thinking about the Brown students and taxes and I was thinking that on some level I imagine that it's probably more than just this, but you know, you have such an intense internal sense of accountability responsibility and accountability, which I think are they're separate they're not the same thing, there's overlap. People can feel responsible but not accountable.

CLIENT: Yeah, like a car accident, that something comes out of the blue. Yeah, a deer runs out and you hit it. You're responsible in some sense, but accountable or something.

THERAPIST: I have to think about that more.

CLIENT: I'm not very good at but I think I get the but I think I understand what you're saying, though.

THERAPIST: I actually have to think more about it, but Tanya doesn't operate that way. In some respects. Not in all respects. She knows that there are things that she shouldn't do, but she does them anyway. Just like you're saying that the Brown actually I was making the claim that the Brown students, like maybe they understand they do understand that they should pay taxes. Money doesn't miraculously come and not be taxed.

CLIENT: You can hope that that would be the case but you kind of know that that's really not the way the world works.

THERAPIST: But you do it anyway. You when you know there's something right to do you do it. There's probably not a nanosecond in your mind that goes by between those two things.

CLIENT: Well, there's that moment of hope where I if there's some way I cannot do this no this is really what you have to do. I understand that like not wanting to do some things that are particularly who wants to pay taxes? And like, actually that's not even fair. I am happy to pay taxes as part of like responsibilities to a collective state so that -

THERAPIST: We need our state taxes but I still can't believe someone comes and takes my garbage. That's so nice of them and that's great.

CLIENT: (Laughs)

THERAPIST: Can you imagine if we didn't have that service?

CLIENT: (Laughing) Yes!

THERAPIST: I think it's awesome.

CLIENT: Yeah and so you're probably happy to pay taxes, too.

THERAPIST: That's probably what 1% of my state taxes, probably not even that much, and even that service alone I love it.

CLIENT: (Laughing)

THERAPIST: Plow our street. We don't have to do it ourselves to get somewhere if it's ten blocks we don't actually have to plow those ten blocks someone does it for us. It's awesome. Anyway. So, you know -

CLIENT: I like that.

THERAPIST: There are so many cool things.

CLIENT: My dad's a director of public works so they were just visiting this week and they were kind of wandering around looking at all of the what are they doing here and it was fun.

THERAPIST: Andover I think is you know, I have no professional experience, but I think it does a good job in lots of things.

CLIENT: That was his view also, yeah. Well one of the questions how do they pay for all of this? Because everything's just very well kept for portions of Andover.

THERAPIST: They have tons of money they get from all these industries. There is almost no property tax here miniscule property tax.

CLIENT: Oh, okay.

THERAPIST: Almost nothing.

CLIENT: Business taxes?

THERAPIST: I'm sure. Actually property taxes are extremely low here. They're almost nonexistent. They're kind of a joke. So they aren't getting it from property taxes. I'm sure they're getting it from all the industry and businesses it has to be. I don't know how else they get it.

CLIENT: Okay.

THERAPIST: I don't know. Anyway. This is hardly my area of expertise and we were talking about accountability. Yeah, but so maybe, so in some general sense you understand that some people would rather have, you'd rather have more money than less money even though you're kind of like but I think when it comes to your health, I think like Tanya not getting her medication I mean, I think that seems less obvious.

CLIENT: Yeah, I understand. Like yeah, I can understand that I don't want to go do that errand feeling, but not the part where that stops you from doing the thing that you need to do. Does that make sense to you? But, anyway, that's a I feel like you were going somewhere I just -

THERAPIST: No, I'm sort of wanting to go back to the beginning because, again, I think this is really important, but I also would acknowledge the profound challenge and quandary you're in that at least some of you know I'm making the claim that some of the desires you have may not initially be thwarted. That doesn't mean others are. I don't want to -

CLIENT: Sure. Certainly some have been and the question is like we're now maybe in a position where they aren't but there is the question of which ones aren't. And some of them having been thwarted, I have lost track of them also.

(Pause): [00:39:13 00:39:22]

THERAPIST: Probably one of the more important ones is having a partner that you can rely on now in going forward and having some sense of security and trust that she'll be there for you. And you know, her mental illness aside, which is (unclear) you want to feel that she can be accountable to herself with all of her vulnerabilities and accountable to you.

CLIENT: And there is also there's some sense that there's nothing I can do about that like I can hold her accountable, but what will I do if she fails? I guess I don't see sometimes I don't see a meaningful way to hold her accountable if I'm not going to leave and I'm not going to leave, so (Pause) I'm not saying, 'oh, you didn't get milk. I'm out the door,' is a likely or reasonable response, but -

THERAPIST: That's an interesting way of thinking about it. Because what you're saying is that there is no consequence had you held her accountable. If there's no sending her to her room after she's kicked her sister, what's the point? But that's interesting in itself that the only way that that accountability is meaningful is if there's a consequence.

(Pause): [00:40:59 00:41:09]

CLIENT: Yeah, and I'm not sure I think that's true. It's just that it's clearer when there's a consequence that accountability has happened. I think that maybe part of why we have the criminal justice system we have, which is clearly problematic, but -

(Pause): [00:41:27 00:41:42]

CLIENT: So for a child, the consequence is the accountability I think. Or something like it. It's the physical manifestation of the accountability.

THERAPIST: Well, then a consequence like you're going to your room.

CLIENT: Yeah. Is there accountability without consequence? Is that even a meaningful thing?

THERAPIST: Well, that's what yeah, I guess that's the question we're looking at.

CLIENT: Okay.

THERAPIST: This is sort of going out on a limb a little bit so I really don't know if I believe this, but I do wonder, like 10'% of me, 5% of me wonders that if you held Tanya accountable and she failed, whether you'd be more open to consequences. You don't even get there. You're not even going there.

(Pause): 00:42:38 [00:42:46]

THERAPIST: That it's simply to say that you actually might feel differently if you whatever this looks like and then it didn't happen you might feel differently than you do now.

(Pause): [00:42:56 00:43:37]

CLIENT: I think part of this is that this is not the kind of relationship that I thought I was entering into so I know how to hold people accountable. I can do that, but I ran the fencing team for several years. I held them accountable, made them practice. I mean like but if -

(Pause): [00:44:02 00:44:19]

CLIENT: But I was elected to be in charge of the fencing team. Am I in charge of my marriage? Like am I -

(Pause): [00:44:25 00:44:41]

THERAPIST: Maybe we're talking about different kinds of accountability not that you and I are thinking about different but maybe if we think about it as different kinds of accountability, because when I brought up Tanya's brother, the accountability that a son to parents has, you know, that kind of relationship is different than in a marriage. I would argue that every marriage has, you know, two people are holding each other accountable, like always, like that's part of a marriage. What's different about your marriage is that doesn't feel implicit right now.

(Pause): [00:45:17 00:45:21]

THERAPIST: Maybe that's a way of looking at it. But I think you were but I understand what you were talking about.

CLIENT: Okay. And I'm not upset. I'm very interested in this line of discussion because I think it's getting at something very fundamental.

(Pause): [00:45:46 00:45:54]

CLIENT: There's something that I don't want to have to hold Tanya accountable to for her vows. Does that make sense like I feel like those are I am accountable and responsible for my vows but that is a thing that I should be doing, like maintaining.

THERAPIST: Well, I guess we're going to need to stop here. These are, you know I was thinking like we needed to analogize the Brown students like the Brown students might be paying their taxes. They should, but they're not. So what do you do? Do they not pay their taxes or do you come to them, 'look, you need to pay your taxes.' So I don't know if that's a perfect analogy, but if people aren't doing that then what do you do? And what you're saying is you didn't sign up for the, 'then what do you do?' But that's the position you're in.

CLIENT: Right. I didn't intentionally sign up for it, but it's yeah.

THERAPIST: We're going to stop on that note. So I will see you next week. Take care. Bye-bye.

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