TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: Hi. I'll be with you in a few minutes.

(Pause): [00:00:14 00:02:36]

CLIENT: Good morning.

THERAPIST: Morning.

CLIENT: So the 17th through the 31st I'm going to be in Ohio.

THERAPIST: Okay.

CLIENT: So I'm not able to be here.

THERAPIST: Okay. I'm going to mark that.

CLIENT: Okay.

THERAPIST: Summers are pretty complicated times for vacation.

CLIENT: Oh, for vacation.

THERAPIST: Yeah.

CLIENT: Yeah.

THERAPIST: I like to just keep track of it. Is the 17th a Wednesday?

CLIENT: It is a Wednesday, yeah.

THERAPIST: Okay. So you're not here the 17th and then through the 31st?

CLIENT: Right.

THERAPIST: So you're not here three Wednesdays. Is that correct?

CLIENT: That's right, yeah.

THERAPIST: Okay. And then I'm away the first week of August, which is the 5th. So I guess we'll that'll be four weeks.

CLIENT: Okay. (Laughs)

THERAPIST: I'm happy if you want if you're getting back on the 31st, I'm happy to oh no, I'm going to be gone. I may have time Thursday morning if you're interested in having a session during that long break. It's up to you.

CLIENT: I may be. I'm not sure at this moment whether I will be.

THERAPIST: No, yeah, no worries. Just to put that out there.

CLIENT: Thanks. I'm going back to work in the lab for a little while, so it'll be good.

(Pause): [00:03:50 00:04:01]

CLIENT: So I think that Tanya and I need to do couples' counseling which you've always suggested. I think support I still believe is the thing we need to do.

(Pause): [00:04:11 00:04:16]

CLIENT: I guess, one is do you have a recommendation of a counselor?

THERAPIST: Yeah, I have a couple of accredited people.

CLIENT: Great. So I would appreciate their names but I don't need that at the moment, I guess.

THERAPIST: Yeah, I'll definitely check. Some people are away and so forth, so I can see. I guess you'd wanted to start it after -

CLIENT: It seems silly to start it this week or next week and then be gone for three weeks. But I mean it's really two weeks but somehow it's three Wednesdays, so -

(Pause): [00:04:51 00:05:06]

THERAPIST: It does seem like on the forefront of your mind -

CLIENT: Yeah -

(Pause): [00:05:09 00:05:19]

CLIENT: Tanya and I had a, I guess a fight Friday evening or something like that which wasn't particularly pleasant but looking back on it, it's well we're both alive, so that's probably okay.

(Pause): [00:05:34 00:05:50]

CLIENT: So it was our I think it was last Wednesday was our third wedding anniversary, so it's a very small celebratory thing Wednesday evening. She was working Wednesday and Thursday and then Friday we sort of had the date night and it was good. So her family on birthdays like most people just say, "happy birthday," her family has this thing where they say, "I'm glad you were born." Which I think is a really nice sentiment. It's sounds a little funny but it's nice. And so for anniversaries, one of the things that she says is, "I'm glad I'm married to you," or, "I'm glad I married you." Well, that's not exactly a thing that I am sure that I can say truthfully at this point.

(Pause): [00:06:38 00:06:47]

CLIENT: And, if I were a different person I would, knowing that I'm not going to leave her and that we're going to continue to be married I would just say it back and because it would be expedient, but it's just not who I am or what I do or something. So,

(Pause): [00:07:06 00:07:43]

CLIENT: So after I didn't respond to it several times she asked if I was glad to be married to her and I don't remember exactly what I said. But I think it was something along the lines of what I just said in terms of like, 'I'm not going anywhere, but am I glad that my lives are where they are? No! And it seems a little unreasonable to expect me to be glad.' Yeah, I'm glad she's alive but -

(Pause): [00:08:15 00:08:21]

CLIENT: You know, we've had that conversation several times so I -

(Pause): [00:08:24 00:09:21]

CLIENT: So in general we're in this place where she doesn't really talk to me about her emotions anymore which in a sense is a sharp change. She doesn't talk about them much because I think, because I couldn't handle hearing about them when she was just coming back from having no memory. You know, she was not really she couldn't really remember the crisis and she couldn't really remember how we made all the decisions that we made and she couldn't remember almost anything about where she was or how she got there and so she was upset about these things and that's fine, but -

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

CLIENT: When we make our decisions they are rarely defensible, I find. Or I find it difficult to defend them down the road in light of later information and more knowledge, but that's not the situation in which you make the decision. You make the decision with what you have at the time, the resources, the whatever, and you do it. And so I don't think she was asking for an account of the decisions, but it felt like that was what she was asking for and I couldn't give it and I particularly couldn't give it at that time because we've talked about me sort of her getting better and me getting worse at the same time as part of the same thing in some way. So I'm not doing particularly well, or was not doing particularly well during those times and she was just you know, she was angry about the ECT and she (Pause) didn't know why she left Brown couldn't remember her time there really which is that's like two years' worth of time that should not be gone but was gone. And she's gotten some of that back now through reading journals but and so -

(Pause): [00:11:49 00:12:08]

CLIENT: Basically, I couldn't handle it. I told her I couldn't handle it and I asked her to talk to someone else about it because I couldn't do it then because I had very few reserves and I was apprehensive about the prospect of another crisis and about not having enough reserves for a crisis. Now I don't know that that was necessary or correct, but that was what happened.

(Pause): [00:12:33 00:12:58]

CLIENT: I don't really confide most of my feelings in her because I've thought for a long time that she can't handle it and that so that's a not great place for us to be in. That was all (unclear) besides there, but I'm not sure exactly where it was, trying to recount the essence of this conflict

(Pause): [00:13:27 00:13:45]

CLIENT: I think it comes down to something like I think that I feel angry about what's happened and she is proud she didn't kill herself.

(Pause): [00:13:54 00:14:15]

CLIENT: And I think she should be. But I also think that that is -

(Pause): [00:14:18 00:14:31]

THERAPIST: Tunnel vision?

CLIENT: Yeah. Yeah. Yeah. Neglects anything that anyone else has done around her deciding not to kill her as if it didn't matter. And in some sense it really didn't matter. I've said that to you before. If she decided to kill herself, I'm not sure that there was anything I could do to stop that within some margin of error. You know, if I'm there and she tries to kill herself there's something that I might be able to do but yeah, at some point it comes down to that but (Pause) but I'm upset that she got to the point where that was the battle she had to fight and I don't she does not think that that is her fault in some way. Or, perhaps in the process that she is in she cannot yet handle that being a thing that she could have done anything differently about. But here's the thing that I took away from that a day or two later that's not really the point. That doesn't really matter. That all happened. Nothing is going to undo it. It just happened. But there is life ahead and we can make different decisions moving forward but -

(Pause): [00:16:02 [00:16:11]

CLIENT: I think there is the sense in rehashing what happened with her repeatedly is not going to do either of us any good. I don't see what we're going to gain from it, so I'm not sure that that's the like -

(Pause): [00:16:24 00:16:39]

THERAPIST: How do you mean, "rehashing"?

(Pause): [00:16:40 00:17:11]

CLIENT: Going back through again and again trying to figure out how and why it happened, I think that's what I mean.

(Pause): [00:17:19 00:17:34]

THERAPIST: It doesn't seem that that's where you're focus is and your sort of "bone of contention," for a lack of better word, is. I think about our conversation between the difference between accountability and responsibility that even if Tanya wasn't responsible for what unfolded or the decision she did make, that you want her to feel a sense of accountability toward you and appreciate that what happened didn't happen in a vacuum.

(Pause): [00:18:06 00:18:15]

THERAPIST: And what you're describing this is sort of more extreme, more than I mean, but so I really can't find the right word, but sort of obliviousness on her part that there might be greater implications than simply whether she's alive or dead.

CLIENT: Yeah. And her response to that sort of feels that she didn't want to hurt me, she tried not to hurt me but she did anyway. (Pause) Which I hear and understand (Pause), on one level. I think that not hurting me was one way that she kept herself from killing herself. It was a tie that kept her here, that desire.

(Pause): [00:19:16 00:19:25]

CLIENT: But seriously, her mother has a history of suicidality and left her when she was eight. She understands what abandonment is. She knows how much it hurts. That's how she got here in some sense. Like, and that excuse sounds pretty flimsy on some level, like, 'I didn't know what I was doing,' is what it sounds like it reduces to to me, but, 'no you didn't care to know what you were doing. You didn't bother to know what you were doing or I let you do it by telling you I could take it in the view that you were doing the best you could.' But, I'm not sure that that's true now.

(Pause): [00:20:02 00:20:17]

CLIENT: But when someone says, 'that's the best I can do, is not kill myself, and I was barely able to do that,' what do you say? Not that that's what she said, but I feel like that's what in some sense it reduces to. Part of it's, 'I'm glad you're not dead.' That's good.

(Pause): [00:20:39 00:20:44]

THERAPIST: And as you say that, the implication is that seems like a fairly low bar.

CLIENT: Yeah. Yeah, I mean (Pause), I know it did not feel like a low bar to her at the time, so (Pause). See that's the thing, right? I was there. I remember it. I'm not relying on journals that I wrote sporadically. And when I was particularly bad, which she is, so she didn't have a clear sense of like anything other than (inaudible). So I guess she has a clear sense of what she felt when she was really not doing well, so hurray for keeping journals only when you're really depressed. That doesn't seem like the best recovery strategy on some level or this wasn't done with the intention of her referring back to them after she lost her memory. So -

(Pause): [00:21:43 00:22:10]

CLIENT: Well, I appreciate your listening. I didn't think I had that much to say on that subject.

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

CLIENT: I really do feel like -

(Pause): [00:22:22 00:22:35]

CLIENT: there's no useful I don't know what the right word is there may be useful conversations to have with Tanya on that subject, but they're going to be very difficult to have because we're both like in some sense, entrenched far apart. So I feel like a much more reasonable strategy for moving forward and rebuilding trust is to leave that piece alone somewhat and work to rebuild the trust in other places. Does that sound like the wrong way to handle it?

THERAPIST: I'm just not sure what that means.

CLIENT: Yeah.

(Pause): [00:23:17 00:23:42]

CLIENT: We still live together. We're both still alive. You know, we are more financially stable now than we've been for a while so that's you know, at least our lives are back to some sort of quasi-normalcy.

(Pause): [00:23:57 00:24:06]

CLIENT: So do we continue to live in the shadow of this event or series of events or do we do new things? You know, (unclear) new dates, have new discussions, have new conversations or do we keep reliving this one event, extended sequence of horrible events? That's not to say that like (Pause) we need to bury it or hide it or forget about it, but I'm not sure that like the best way to rebuild is by sifting through all of the ashes. Eventually, there's nothing left. You have to just start building something new.

THERAPIST: That sort of imagery of a shadow, I think is a good one because there's the thing that creates a shadow, but the shadow is still there even if the you know, so there's implications for the now about the past. And I see what you're saying. I think there is a difference between rehashing and talking about how the past has current and future implications because we've talked about and I can't imagine it's not on your mind, is what does this mean about the future? Are there going to be other instances like this. Is this really in the past?

CLIENT: Sure. But those are -

(Pause): [00:25:39 00:26:08]

CLIENT: Those aren't well-posed questions in the sense that there's no way to answer them.

THERAPIST: There is no way to answer them so it's not about the yeah, it's not about whether they have been, it's about current fears. You have planning we talked about planning a lot and you're interest in planning, but you know, there is some way in which one wants to know, could make commitments now because there are some assumptions about the future that can be greatly challenged and hopefully those plans are based on your past experience. And so asking those questions are important and having dialogues with them is important, it would seem to me.

(Pause): [00:26:49 00:26:53]

THERAPIST: Because they're current fears about potential future events that are grounded in something.

CLIENT: Yeah.

(Pause): [00:27:04 00:27:40] CLIENT: Yeah. (Pause) and I'm not sure I'm equipped to have those conversations unsupervised.

THERAPIST: That's a very interesting way not mediated, potentially but supervised.

CLIENT: I'm not sure if you can read too much into the language, but -

THERAPIST: Occupational hazard.

CLIENT: (Laughing) No, I think you're right. There's something in the language. I don't know that it's you know, I chose the word a little bit deliberately, so I don't know that -

(Pause): [00:28:27 00:28:39]

CLIENT: I think "mediated" might be a better word in actuality, but I do feel the need for some sort of reference or, or -

THERAPIST: Supervision among other things implies protection, right?

CLIENT: Yes.

THERAPIST: Supervision when sort of going out and doing something on your own that might not be safe and so you need some supervision to make sure that everything is kind of kept in check.

CLIENT: Yeah, that's good.

(Pause): [00:29:13 [00:29:23]

CLIENT: Yeah.

(Pause): [00:29:23 00:30:54]

CLIENT: Yeah, I'm not sure who I feel needs to be protected in that situation, but -

(Pause): [00:30:59 00:31:17]

CLIENT: Yeah, I think I I don't know.

(Pause): [00:31:18 00:31:25]

CLIENT: Ultimately I feel like if Tanya and I can have that conversation alone we'll continually have a very similar conversation and it's not going to productive so I feel the need for some assistance in steering the conversation in productive directions to, I guess, to transform it from rehashing into something useful.

(Pause): [00:31:53 00:32:16]

CLIENT: I've been reluctant to do so for a while which I mentioned here. Part of the reluctance was it just seems like a lot of work and I wasn't ready to do it. I think I'm ready to do it now. I think I need to do it. I think it needs to be done. The other part of it is that I am not sure that I can meet with you and do that once a week, both of them. So I guess from a scheduling point of view, I don't know that I can make the time to do that and do everything else that I need to do. Is it possible to meet with you less frequently?

THERAPIST: We could try it.

CLIENT: You don't think it's a good way to proceed.

THERAPIST: Oh, it's not typically well, it's not typically what people do. That's not to say that that's -

CLIENT: (Laughs)

THERAPIST: Usually people don't sort of cut down on one treatment to engage in another. I could see why from the time perspective but I think we could just, you know, if you want to try it to see how it goes, the concern would be that a lot will come up in there that will be important for us to process in here and vice versa.

CLIENT: Okay.

THERAPIST: But -

CLIENT: Well, so the other solution to the time problem the reason that I don't have enough time is that I have a certain amount of work that I need to do and want to do and that I am also doing a perhaps disproportionate share of the household chores, so you know, an alternative way to manage my time and maintain similar balances for Tanya to do more things which -

(Pause): [00:33:57 00:34:06]

CLIENT: is probably the more reasonable thing to ask anyway in some sense. So -

THERAPIST: You mean I'll put out the obvious. It's your choice you know,

CLIENT: (Laughs)

THERAPIST: (inaudible).

CLIENT: Well, thanks.

(Pause): [00:34:18 00:34:37]

THERAPIST: Do you worry that it will be too much emotionally, too?

(Pause): [00:34:40 00:34:50]

CLIENT: Not really but only because I don't have a clear sense of how to project how much it will be emotionally and so I haven't bothered to try very hard to project that.

(Pause): [00:35:02 00:35:07]

CLIENT: Yeah, I guess I'm aware of the possibility that there might be a lot emotionally and I think that may have been one of the I think I'm reluctant in the sense of thinking it would be too much, like it may be fairly clear that (inaudible) several weeks ago.

(Pause): [00:35:25 00:35:32]

THERAPIST: My main as I think about it, my main sort of practical recommendation would first be to see if you can sort of negotiate the time for both of them. I think that would be sort of the best just projecting my experience from the past. But I appreciate you have other things to do in your life like you have other things besides taking care of Tanya and you want to actively engage in the productive engagement of those things, so you know, I appreciate there is life outside of therapy. And so in that case, when you come to that decision, I guess my suggestion would be at least you did an initial several weeks for us to meet weekly to see how it goes and then if you feel that you know, the couples therapy sort of the couples therapy is productive, and you know, coming less faithfully here makes sense, then we could do that because that would be my sort next recommendation.

CLIENT: Okay. (Pause) Thanks. Well, it seems like your two recommendations converge, at least in the first several weeks.

THERAPIST: Yeah, I think so.

CLIENT: You know, I just sort of appreciate this as I do it more, I just sort of know kind of norms in terms of how people best use the treatment in a general sense, but also think people have very different needs and so I like to keep, you know, in mind, both of those things at once.

(Pause): [00:37:02 00:38:05]

CLIENT: I guess I'm sort of sitting here thinking about what accountability would look like if Tanya started to get much worse. And I don't -

(Pause): [00:38:13 00:38:34]

CLIENT: I mean you can ask a five-year old to give an account of integral calculus but I'm not sure it's a very meaningful exercise.

THERAPIST: Because the task outstrips their abilities.

CLIENT: Right. And then you can ask a 15-year old to give an account of integral calculus who's taken calculus, or a 19-year old it doesn't matter what age but someone who's you know, been exposed to it and has (unclear) and I think that it's not that they can't do it, then they can't do it but they won't. And -

(Pause): [00:39:25 00:39:35]

CLIENT: And asking for an account is then may very well be just as fruitless as asking the five-year old. But -

(Pause): [00:39:51 00:40:05]

CLIENT: It's not clear that one is a test of their abilities so much as their perception of their abilities. But at some point the distinction between those two things doesn't matter.

THERAPIST: Because they're still not doing calculus.

CLIENT: Um hmm [yes].

(Pause): [00:40:26 00:41:32]

CLIENT: You could teach them the calculus again, but that at some point there's that core decision of whether they decide if they can do it or not. I don't know. I'm not sure where that leads for the future.

THERAPIST: Um hmm [yes].

(Pause): [00:42:03 00:42:18]

CLIENT: The problem is to ask either of those two to check your math when you're designing a bridge. Not that I have any particular bridge in mind, just like you probably don't rely on that in a situation where it would be essential for them to remember the calculus or use it.

(Pause): [00:42:34 00:43:02]

THERAPIST: What are you thinking about?

CLIENT: I was hoping that would lead us somewhere, but I haven't found a place that's let us -

THERAPIST: Oh (unclear). I was thinking about the analogy of the bridge.

(Pause): [00:43:16 00:43:22]

THERAPIST: A bridge is something that you need to count on that in error is potentially fatal.

(Pause): [00:43:31 00:43:38]

THERAPIST: And that calculus might be something abstract, maybe, but building a bridge actually has presence in reality.

(Pause): [00:43:48 00:44:23] CLIENT: Yeah.

THERAPIST: I was just thinking that the bridge is "trust," too, because when a couple comes together and gets married, whatever, there is a leap of faith about who this person is, about what their future can be together, the expectations you have to be followed through on and so it's not necessarily solid ground. There's sort of, I don't know, to me it just seems like it represents trust and you want that bridge to be really solid. And if it's really solid it's almost like standing on solid ground.

(Pause): [00:44:57 00:45:13]

CLIENT: You've really fleshed that one out nicely.

THERAPIST: Thank you.

CLIENT: Thank you!

THERAPIST: I am going to have to leave you with those thoughts. We need to stop for today. So I'll see you next week.

CLIENT: Okay.

THERAPIST: I have one person in mind I think would be great as a couple's therapist. I don't know if she's away but what the story is, but I will certainly reach out to her and see if she has availability and if she's, when she's around.

CLIENT: Okay. Well, thanks very much.

THERAPIST: Absolutely. Take care. Have a good fourth.

CLIENT: Thank you. You too.

END TRANSCRIPT