TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi! Come on in!

CLIENT: (pause) Oh, these are for you.

THERAPIST: Oh, thank you.

CLIENT: The bank mailed me an overdraft statement, so I thought I’d give you a copy of it.

THERAPIST: Okay, but... here. (client affirms) I assume you... that is correct.

CLIENT: Okay, thanks.

THERAPIST: On the issue of trust.

CLIENT: (chuckles) (pause) So I... took Tanya to the ER yesterday, so she’s back in Frederick now. I walked with her, I didn’t make the decision, I just went with her. So... (pause) that’s happening.

(pause 00:01:03 to 00:01:56)

So it seems like this... that a string of episodes, episode, has been going on for a week and a half or so. She had been dealing with suicidality. She wasn’t working last week, because they were out of town, and so she had the week off (the family she nannies for). So she saw Chad every day. I feel like they were in, he was closely monitoring the situation, so... Monday of this week they... Is that the right day? Yeah, Monday of this week... Today is Wednesday. They... He decided that things were bad enough that he thought she needed to at least go to the ER, and be there for a while to be safe, and then have them assess her in a few hours, because these tend to get bad and then drop back off, and she’s okay again. That’s kind of the normal pattern. [00:03:13]

So we walked from his office in the Square to the Andover Hospital, just, not very far, but, you know, it takes 15 minutes or something so... By the time we got there, she... felt like going in was ridiculous, which was sort of, one of the metrics as to whether like, this is the, actually the right course of action. Like, if you’re there for a while, and then it starts to feel absurd that you’re there, then maybe it’s okay to not be there, or to not do the full hospitalization.

So she called him, they talked for a minute and... he said, “Okay, well, go on home, I’ll see you in the morning anyway,” because they had an appointment Tuesday morning. So they... So she... packed our filet knife with her in her bag, because she goes to work on Tuesday. So she was going to go see Chad, and then go to work, and afterwards, she was going to drive out somewhere and cut her wrists. So she ended up not doing that and instead, giving the knife to Chad. Then I walked her from there to the Andover Hospital. We sat in the ER for a while, and moved to the Psych ER, and then she’s at Frederick now, so... (pause) It seemed vaguely important to... give you the facts. So I did. [00:04:50]

THERAPIST: (pause) Well, that’s part of what happened, and then there is what’s happening in you.

(pause 00:05:12 to 00:06:00)

CLIENT: So I, we’ve done this a few times, and I sort of expected that to be, you know, your response would be somewhere in that line. So I was sort of wondering why I felt like starting with the facts was the important thing anyway. I still think it is. But... that came to mind, so...

(pause 00:06:23 to 00:06:58)

Anyway, so I’m sad today. Yesterday... was crisis day, right? So it’s, for me that’s the easy day. It’s easy to do what needs to be done, just continue on. What needed to be done there was go, and to be with her, and listen when she wanted to talk and... At this point there is not anything that she can say about suicide, I don’t know, that I haven’t heard from her already. It’s... (chuckles) it’s complicated, because she doesn’t remember... the worst of the suicidal events, because of the CT (ph), so she just like, we’re at Frederick and she hasn’t... (chuckles) it feels vaguely familiar to her, but... She spent about a month there, but doesn’t remember it at all. That’s weird. I remember it very clearly. So... [00:08:02]

It’s sort of like I know, more or less, exactly what her routine is going to be like from day to day, but she doesn’t know what it’s going to be like there, so it’s... But again, that’s easy, like that situation is easy for me. Today, you know, I’m sad.

(pause 00:08:31 to 00:08:59)

I haven’t really hit despair yet, at least not for any length of time.

(pause 00:09:05 to 00:09:27)

If I weren’t coming here, it would have been a lot harder to get up this morning. I would have, eventually, but...

(pause 00:09:35 to 00:10:20)

I’m also glad I’m here. I... (pause) I... Yeah, I feel safe here and I feel like you... already know most of my response to this, in some sense, and I know that whatever response I have is okay here. So, thank you.

THERAPIST: (pause) I’m sorry.

CLIENT: Thanks.

(pause 00:11:23 to 00:11:55) (sighs)

THERAPIST: I imagine this is upsetting and discouraging.

CLIENT: (pause) It’s definitely upsetting. Yeah, it’s... discouraging is probably right, but I, it’s like... this doesn’t seem... I mean, A) it doesn’t seem as bad as it’s been other times. It’s like she is more able to cope with the suicidal ideation and feelings and thoughts like, this is, it seems pretty clear that this is a place that she goes when she gets overwhelmed. But that... I think largely through some distance from some of the most acute original causes and some, and a whole lot of work and therapy with Chad, she is more able to cope with... with the stress or the whatever. [00:13:14]

But unlike, with any particular medication, where like, the claim is essentially like, your mood should be, our mood stabilizing needs to be (ph) compressed, such that you don’t have large swings in this direction. There is no particular claim in that direction with psychotherapy, right? Like, this is not, this is not overturning the theory of what’s going on in any way like, she’s overwhelmed. (pause) I feel like... you know, the way she describes it, she has to decide every... ten minutes, or hour, not to kill herself. That seems like it would be hard, and, if you’re doing that for a week, I feel like... it would be harder to keep making the same decision, so I don’t know. [00:14:15]

So in that sense, I’m not discouraged about like... I think that’s probably a part of... I don’t feel like the course of treatment that she’s on is ruined, or wrecked, or broken, or failing, even. It’s like, this is a bad thing that has happened, but it’s sort of in the range of expected values. The other side of that is like, you and I talk a lot about trust, and particularly in the last couple of months, we’ve talked a lot about it. So, you know, one of the themes we haven’t exactly sorted out is like, this sort of, you can trust anyone or you can trust no one. There is some space in the middle where it’s probably better to live, but... [00:15:15]

It seems to me like we’re agreed that there are people who are trustworthy, or there are things that are trustworthy. Maybe I misestimate what those are, but... it’s a lot harder to... (chuckles) It’s a lot harder to trust someone who doesn’t want to live, because fundamentally, we’re back in this place where like, I know she’s suicidal and so I trust her alone less. I trust her ability to deal with her own moods less, so I’m going to trust her with mine? That’s, you know, I wouldn’t say that’s (chuckles) the right response, but that’s certainly one I have, so...

THERAPIST: (pause) I guess I used the word “discouraging” because I think one is discouraged when one is expecting something to go in one direction and it goes in another direction. Maybe I’m... imputing that to the situation. Maybe you weren’t feeling that way. [00:16:35]

CLIENT: (pause) I think... (sighs) There has been a strange element this time around, where like, I have not felt like this is a thing in my control, and that’s been okay. Like... (pause) The phrase that’s kind of come to mind several times is that “this is not about me,” which is sort of a weird... phrase anyway, and a little weirder in this context. But it sort of gets at the... the feeling like... (pause) Yeah, I can’t fix her, I can’t fix this for her. There are some things I can do to help, and I’ve tried to do them. But... yeah. I don’t know, I guess I don’t... [00:18:00]

(pause) I feel like a year ago that I had a larger sense of like, “I have to do something about this,” or something, but I don’t have that sense now. I think that’s a good thing, and some of that I, it concerns me like, maybe I... I don’t care about her in some way, or something. I don’t think that’s really true, but that... I think for the most part, it’s mostly like, this is actually not a thing I can control, and so... wanting to control it is not really... (chuckles) helpful or useful.

THERAPIST: (pause) That is a big change.

(pause 00:19:05 to 00:19:56)

CLIENT: Yeah, I think it concerns me, because I think that there is a... there is a... part of me that... sort of feels like, “Well, at least if she killed herself, I could deal with that, and it would solve the problem of... do I leave her or do I stay in this particularly horrible situation that’s not always horrible, but is tough.” (chuckles) I’m not particularly happy about that part of me, but I sort of understand it, so... I actually think it’s a good thing to feel like this is not in my control, and that I shouldn’t be trying to control it. But that other piece, I don’t know. Seemed related and bothers me. [00:21:01]

THERAPIST: (pause) That you feel that way? (client affirms) (pause) Well, it speaks to... maybe a burden you feel about not knowing what to do and what this means.

(pause 00:21:47 to 00:22:07)

CLIENT: Yeah, I think that’s right, I think that’s right. Yeah. Because it’s sort of like, “Well, at least the burden would be gone, so...” Short way of saying it, yeah.

(pause 00:22:21 to 00:23:41)

Are you okay?

THERAPIST: Yeah. (chuckles) What was your concern?

CLIENT: Um, yeah, so (sighs), I, of course, would have the concern anyway, right? Because I feel like I have to take care of you. But I respond to that, “No, no, it’s okay. (chuckles) I don’t need to take care of you. I need to be here so that you can take care of me.” And thank you for that. But then you sighed, and so you’ve... You’ve sighed twice in this session, and you don’t usually sigh, so it was sort of a, you know... so I asked. Here we are.

THERAPIST: I feel sad about the situation, and I feel sad for you. I can feel with you. I can imagine, or try to imagine, the weight of that burden is. So I have all of those feelings, but I also feel okay, too. [00:24:37]

CLIENT: Hmm! Thank you. So why? (chuckles) Why would you imagine that? (pause) I understand why, but, and thank you for doing it, but that... that seems like a lot.

(pause 00:25:00 to 00:26:30)

So I... feel less sad than I did when I got here. Thank you. And we also have some more time, so I would be interested in talking about other things, if that seems okay to you.

THERAPIST: This is your space.

CLIENT: (chuckles) I don’t have any particular thing, you know. Just I feel like we have been... not on a perfectly linear path, we’re kind of following several themes for several weeks. I would prefer to hold onto that somewhat, if possible.

(pause) So I feel like we left off last week talking about, very briefly, raising the subject of like, my sensitivity to other people. (pause) I’ve also had this... sense in the last couple of sessions that, or feeling that... as if you have been trusting me more, which I thought it would be interesting to mention. [00:28:14]

THERAPIST: Trusting you in what ways?

CLIENT: I feel like you’ve been more open about what you’re thinking, or what you do or think about it. I don’t know that that’s actually accurate, but that’s how I, how I feel, so that seemed like... I actually think that some of the things you’ve said, you said before, so it’s not like... So, I... anyway, I don’t know exactly where the feeling comes from, but it seemed important to mention. (pause) I like it.

(pause 00:28:50 to 00:29:41)

It’s weird, it feels, you know... artificial, like I’m trying to force the conversation in a particular direction that’s not... (pause) And then I’m having a hard time adjusting that I...

THERAPIST: (pause) Well, do you feel like you’re trying to move away from the topic of Tanya being re-hospitalized?

CLIENT: I didn’t when I started doing it. I actually did feel better. It’s sort of like I, in trying to move away, I felt like it’s been harder to access the other space, or something like that. Yeah, so...

(pause 00:31:10 to 00:31:33)

Feels sort of like I’m trying to maintain something that’s... eclipsed right now. (pause) I keep trying anyway. So, one of the things that I did remember wondering, after we talked last week was, do you think of yourself as a scientist?

THERAPIST: Not really.

CLIENT: Do you think of yourself as a medical professional?

THERAPIST: No. Definitely not that.

CLIENT: Interesting. Okay. So the analogy that sort of came to mind last week, or afterwards, was that it was like you are a scientist whose instrument was herself, because you were talking sort of both feeling and watching yourself feel things, and using that as the... I thought that was very interesting. It seems really hard. [00:32:46]

THERAPIST: Yeah, I think this, you know, I don’t think of myself as a scientist, but I think in a very broad definition, sure. Like, that fits.

CLIENT: Yeah, I mean, I don’t particularly need you to be a scientist. I think you’re more of a wizard than a scientist, anyway, but... I just... that was the analogy that had been, sort of comes to me, because I know a lot of people who, you know, do one instrument or something, sort of get to know the instrument very well. So I was curious.

THERAPIST: And the medical professional part?

CLIENT: That was actually just, I don’t know. You said no to scientist and it, that question popped in my head, so I asked it.

(pause 00:33:32 to 00:34:12)

THERAPIST: But a wizard is something altogether different.

CLIENT: (pause) Yeah. You know, there is, there are all sorts of sort of pithy responses to that, right? The old, any sufficiently advanced technology is indistinguishable from magic, or... you know, the methods the alchemists followed were pretty similar to the methods that early chemists followed, or pretty similar to the ones we follow now. It’s just some information content difference. Yeah, it’s altogether different, but I feel like... people, and the things people do, and things we care about are kind of... more similar than we talk about, across time and professions. But yeah, it is an altogether different description, or way of conceptualizing, what you do. [00:35:30]

THERAPIST: Yeah, I mean, I don’t think of my primary care doctor as a wizard. (client chuckles) He can be very helpful. (client laughs)

(pause 00:35:45 to 00:36:21)

CLIENT: I don’t think of your primary care doctor as a wizard, either, but... We’ve talked about this before. It’s one of the... worse analogies that I’ve used, because it’s more opaque (ph) for you, I think, so it’s...

THERAPIST: Well, it certainly has a particular connotations, usually.

CLIENT: (chuckles) Yeah. I don’t think I need all of the connotations that it has, so... But...

THERAPIST: Well, is it, when I think of wizard, I think of magic, there is usually magic involved.

CLIENT: Sure, sure.

(pause 00:37:00 to 00:37:36)

Yeah, then we’re back to... magic being often things that are not well understood by the person who thinks they are magic. But, that’s not... that’s the less important part. I think the more important part is that like, for the person for whom the wizard is doing something that... there need not be any magic. There just, there is the... I don’t know... (pause) you know, even in a like, purely physical world, there is something going on in that interaction that is important. You know, it gets particularly problematic in the context of most magicians are also tricksters, which I don’t really, but that’s not an implication, because most magic isn’t actually magic. But... yeah, that’s also not really a piece that I meant there, so... Yeah, particularly poor, as analogies go.

(pause) Because I neither understand, nor need to understand, everything about what we do in order for it to be helpful or very real, so... (pause) I also would like to understand most of what we’re doing. [00:39:40]

THERAPIST: Because you’re a scientist?

CLIENT: Or maybe they both come from the same... piece of me. I am a scientist and I care about that, because of who I am, you know. (pause) See, I also don’t think of myself as a scientist, although I very much am, in terms of like...

(pause 00:40:01 to 00:40:57)

THERAPIST: What are you thinking?

CLIENT: Um, so initially I was expecting you to tell me the time was up, because I sort of thought that was a thing that you would respond to, because you went through several “Hmm’s.” Then we were looking at each other and you kept doing that.

THERAPIST: Time is almost up, but we still have like, a minute. (client chuckles) It wasn’t up at that point, actually. (client affirms)

(pause 00:41:24 to 00:41:52)

CLIENT: Yeah, so, anyway, so I have tried to follow the, some of the themes we were talking about. It’s really... I feel like, scattered to the wind a whole lot, but... Okay with it.

THERAPIST: There is a lot going on. (client affirms) Here is when we actually do need to stop. (client affirms) Okay, I’ll see you next week.

CLIENT: All right, thank you.

THERAPIST: Take care. Bye bye.

END TRANSCRIPT