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CLIENT: I don't know if I talked about this earlier, but I had seen Josie on Monday. I was walking to work, in a bad mood because I was walking to work, and my resting face is, apparently, really bitchy looking. I've had many people tell me that I look mad. So, whatever. I was just walking, not paying attention, and I see someone cut across the street right in front of me. I look up and it's her. [00:00:59] I do cross the street to avoid her. I've never seen her do that to me.

THERAPIST: Which is what she did? So she crossed?

CLIENT: Yeah. There were two things: One, I saw her doing it and I was like, "Huh, you crossed to avoid me." Also, I just didn't feel any longing for our relationship or thinking like, "Oh, it was so nice when things were going well." I wasn't thinking about that.

THERAPIST: I remember you saying something like that lately, but I don't remember anything about crossing the street, so I don't think you told me about that. I'm just trying to ferret out... [00:02:05]

CLIENT: Yeah. It also might have happened on Wednesday. So that happened and I was like "humph." I had seen her twice recently, like in the last three months, clearly on a date with a guy. One of the times I was kind of like "hmmm" and this time I was like "I don't want to be around you and I will cross the street. I no longer feel any [...] (inaudible at 00:02:34) feelings for you. Great." I ended up speaking, after therapy on Tuesday, I hopped on the bus and happened to be the same bus that Karl was on. He was socially raised by wolves and I have never, ever said why I have not wanted to talk to him or hang out at his house. [00:03:10] Eventually someone like Kate maybe sat him down and explained it.

THERAPIST: Okay, so this is Karl of Karl and Kate. Kate used to be involved with Josie; not Karl from work?

CLIENT: Yes. There are a lot of Karls, I guess, which is weird. Karl, for a year or two was like, "You should come over."

THERAPIST: Yeah, I remember this.

CLIENT: Yeah, and so we talked about his dog, which he loves. And that was completely fine. That was a nice interaction. I also was thinking of seeing Kate. [00:04:00] Kate works across the street so she's just around. She's just there. I probably see her like once or twice a month when I'm coming and going; and it always feels very uncomfortable to me in ways I don't totally... I guess what it is, is that I don't want to talk with her and I don't want to interact with her – and she still tries to make small talk sometimes and I don't want to. I recently remember about a month and a half ago I was standing and waiting for a friend to pick me up. Kate was walking and I was like, "Oh, I'm just going to turn the corner of this street abruptly for five minutes." [00:05:02] It was like a little um-hmm. It was annoying, but it wasn't horrible. I didn't feel [anything, like kind of good about that.] (ph?) Wednesday I wanted to go see a movie with some friends. We went and saw Fast and Furious, which is stupid and delightful. We had dinner. It was really great. I was having a good evening. We were getting out of the bus and the bus stop is right there. We were kind of talking and I see that Josie is there with a guy. She's on a date. [00:06:01] She has her arm in his and I just completely froze up and was just like, "I don't want to wait at the bus stop with you. I don't want to be on the bus with you because it's a long ride." I was like, "I can't; I can't; I can't," and I was with Ashby and I was with another friend of mine and Ashby knows what Josie looks like, but my other friend doesn't. So I was kind of like, "We have to walk over here now." She was like, "No, but the bus..." "We have to go." I kind of drive them across the street and then I manage to flail out, "I can't get on the bus. I don't know what else to do, but I can't get on the bus." Thankfully, my friends and I walked to another bus stop and took a totally different bus and checked to make sure that Josie wasn't on that bus before we got on it; and then kind of flailed home. [00:07:11] It was just (sighs) (pause)... I just felt really terrified of being on the bus with her. It wasn't anything about the bus – not the bus, but I would be in a close space. There was going to be no one on this bus really because it was about 10:00 PM or whatever. I don't want to wait for the bus.

THERAPIST: You can't leave when you want.

CLIENT: Yeah. And also I felt panicked like, "But how else will I get home?" And I'm dragging other people into this, but mostly I'm just like, "I can't get on the bus. I cannot get on the bus. I can't get on that bus." [00:08:10] That was super-stressful and upsetting. I got home, took Valium, sat on the sofa and was freaked out for a few hours and then managed to sleep. When I woke up on Thursday I was kind of like, "Yeah, I'm going to go to work. [...] (inaudible at 00:08:35) I'm sure I'll be fine," and I really wasn't and left at noon because I felt myself almost crying several times. [00:09:02] Mostly it was kind of like I'm typing an e-mail and suddenly I'm going to cry in four seconds. Once or twice someone said something that was the mildest of irritation and I just felt like I was going to fly off the handle and scream and cry.

THERAPIST: Sorry. Someone said something to you and they exhibited the mildest irritation?

CLIENT: Like they would say something that was mildly irritating to me.

THERAPIST: Okay. Got it. You felt like you were going to lose it.

CLIENT: Right, so I went off. It was just like, "I have to go. I have to get away."

THERAPIST: [...] (inaudible at 00:09:37)

CLIENT: Yeah. Also, as it turns out, I was running a fever, which I found out after I got home; so that didn't really help. I canceled my dinner plans. I canceled for Friday and was just like, "I'm out. I'm done. I can't." I ended up taking Friday off because Thursday I just felt so horrible. [00:10:04] The first thing I did was I actually tried to go to this craft studio and do some really simple, mindless sewing. It was kind of like, "Oh, I'm just sewing. I'm relaxing." It was okay-ish when I was doing it. [...] (inaudible at 00:10:33) as I should. That's good. When I left and I was actually getting home, I just felt more and more stressed and upset and not wanting to be around anyone and feeling very fragile. I also got home and was lying down in bed and just crying periodically. [00:11:06] After lying down for a while, I was like, "I can't go to work on Friday." I have sick time and I decided to use it. I can take a day off. I was still very upset and feeling freaked out. I had a hard time falling asleep and Saturday morning I woke up basically with night terrors, which I haven't had happen since I was a teenager.

THERAPIST: Wow. What did they involve?

CLIENT: What it involves for me is suddenly waking up terrified and I don't know why, so I don't remember. [00:12:10] I never remember the dream or what was scary at all. I just wake up really scared and feeling like someone jumped across me or is about to – usually it's kind of the feeling that someone just jumped at me and I [...] (inaudible at 00:12:38). It's a feeling that I just dodged something really scary and dangerous and woke up; but I don't remember it. I just wake up feeling terrified. [00:12:59] When I was a teenager I used to sometimes wake up sitting up in bed. I used to scream sometimes and just wake up screaming. It was very weird. That happened sometimes very frequently and sometimes not for about two years and then it stopped. There was nothing that...

THERAPIST: That obviously [...] (inaudible at 00:13:35)

CLIENT: Yeah. Nope.

THERAPIST: Did you go to the doctor at the time?

CLIENT: Weirdly, no. (chuckles)

THERAPIST: That's not really unusual for someone that is...

CLIENT: No, I have no idea why I didn't, actually, because I used to have a bedroom. At my parents' house the second floor had all the bedrooms – [my parents' ] (ph?) bedroom, [...]'s bedroom, my bedroom. [00:14:05] [This was also my first] (ph?) attic and I decided at some point when I was 14 or 15 that I wanted to sleep in the attic because I was a teenager, clearly, and wanted more privacy. That was also convenient when I was waking up freaked out, in that I didn't always wake up anyone else. I just woke up really, really scared and my parents would be like, "What's wrong? What happened?

THERAPIST: They knew about it?

CLIENT: They knew about it. Yeah, yeah, because I did wake them up a few times. If they came and were really worried I could never tell them what it was because I don't... [00:15:02]

THERAPIST: Yeah, you didn't know.

CLIENT: Yeah. I think my parents would be [...] (inaudible at 00:15:06) night terrors or someone and I would be like uhh. It was also a time in my life when I was having panic attacks for no reason. I had panic attacks for a while when I was working at [15 or something like that.] Not a lot. I think it didn't happen frequently enough that I really wanted to do anything and I couldn't really describe it. It wasn't until I was in my twenties that I was like, "Oh, I was having a panic attack," but they had already stopped. (chuckles) [00:16:02]

THERAPIST: It's possible – I don't remember a lot about night terrors – but it may be possible that the night terrors didn't have a psycho-social precipitant. [...] (inaudible at 00:16:18)

CLIENT: Yeah. In your teens it can just be that's the thing that happens.

THERAPIST: Or when you're little, too, I think.

CLIENT: Yeah. I've had sleeping problems since I was a kid. Some of them were just things like I used to crawl under my covers at the bottom of the bed or the bottom of the sleeping bag. My mom would sometimes be like, "Where is she? Oh, she's..." You know. Sometimes I was scared of the dark or whatever and I would have a hard time falling asleep. But it was kind of like, "Kid..." [00:17:02]

THERAPIST: Panic attacks, though, I associate them with precipitants; although unlike many other forms of anxiety, it's also very difficult to trace the connection between the trigger and the panic. Sometimes it's not.

CLIENT: What I think it was, and this is looking back, at the time it was just like I had no idea what was going on. It started when I was at an academic camp. [...] (inaudible at 00:17:48) with the youth and they did summer camp, like nerd programs.

THERAPIST: Did you say "nerd?"

CLIENT: Nerd. We called it nerd camp because you sat at the camp learning shit. [00:18:01] I did it once. Most people boarded, but you could do it as a day student. One summer I did it as a day student. A friend's mother would drive us. It was very stressful socially because I didn't know anyone and we were the only two day students. Everyone else knew people and I didn't. I didn't know where I was supposed to go on campus. One time I went to the wrong dining hall – they were right next to each other – and it was very, very stressful and miserable for me because I felt like I didn't know what I was doing the whole time. [00:19:06] A couple of times there were situations like one of them where I was trying to figure out where I was supposed to have lunch and they got really scared – pulse racing, sweating, dizzy, disoriented. I went and sat down for a while and they went away. That happened a couple of times. The next year I was able to convince my parents to let me board at the same camp and it was much better, but I still had one or two... I had a couple of incidents where I was stressed and I didn't know what I was supposed to do. I felt like it was that teenager like "what's this [band](ph?) supposed to do?" [00:20:02] It was like there was one thing you were supposed to do and everyone knows it but me. (pause)

THERAPIST: I'm struck by the confluence of three things you said to that. It was a sense of disorientation, particularly relative – like it is as though the people around help a lot to orient you. I don't mean by explicitly telling you stuff, but just what they're doing or how they're looking at things or what they know about the routine or something like that – being part of the social events – grounds and orients you. With what you just described, I'm thinking of Josie and the bus because you had this panic that moment that was partly, "Oh, my God. What am I going to do? [00:21:08] I can't get on this bus because she's getting on the bus and I have to get home – and that's the bus home." It sounds like the panic was related to those things.

CLIENT: That's the way to get home and I can't do it and I don't know what to do next.

THERAPIST: Right. And, in a much milder and more benign way, with me at the beginning of the hour – and I participated. We were trying to figure out what you had told me and what you hadn't and when this happened and when this happened and when that happened. I was sort of struck at the time about "why are we trying to...?" It's not a problem, you know? But it seemed like – and I was getting caught up in it, too. [00:21:58] We were both fussing a little bit over when stuff had happened, in a way that felt more like it was about orientation and grounding than it felt about conveying important information.

CLIENT: I guess I felt like it was more about avoidance, which was that I didn't want to talk about [Josie] (ph?) or any of that, in part because I have had these series of "yay." Especially Tuesday after therapy having this long bus ride with Karl. It was totally cool and I was completely not stressed. Then learning the next day that... And Saturday morning it was just so awful. I don't super-well remember the night terrors that I had as a teenager because they were a while ago. [00:23:11] I kept on trying to fall back asleep and there was that weird – you don't have a sense of time, but I felt like I would close my eyes and be filled with terror and then open them again and be like, "Okay, now I'm going to go back to sleep." I would try to and maybe I did; and then I was terrified again. So after a couple of rounds of that, I just got out of bed and watched cartoons because I couldn't do anything else and was really upset – both feeling them and super-upset and also just really (sighs) frustrated and angry that (pause) – I don't know. One of my friends, when I was first being like "we have to leave this spot," I was like "ex-girlfriend, blah, blah." The girl wasn't really coherent and one of my friends said, "But surely you see your ex everywhere," because we had been talking earlier about how there is this bubble where I just know everyone. I just see my friends there. [...] (inaudible at 00:25:00) why it's annoying. I couldn't convey that, no, no, no, this is not like my regular "Oh, yeah. I dated her." This is something more. (sighs) I didn't want it to be something more. I just wanted to see a movie and go home and have us mutually ignore each other and have that be okay. (sighs) I think what [...] (inaudible at 00:25:54) at the time is it's horrible. At some point I was just like, "Okay, but I'm really exhausted. I want to lie down." [00:26:04] I would be like that again and I was lying down and crying off and on and not really – like I knew I was crying, but I wasn't really super-aware of that, I guess. I was petting my cat and whatever, but I was mostly just lying in bed and I was really scared to close my eyes and try to sleep. I did manage to nap a little bit and woke up feeling disoriented and super-anxious, but not terrified. [00:27:03] (pause) And then was dragging myself to [...] (inaudible at 00:27:14).

THERAPIST: Sorry, then you...?

CLIENT: Taking Ambien and Valium.

THERAPIST: Did you say "dragging yourself to the [pills?]" (ph?)

CLIENT: Yeah. I was trying to take all the drugs because I can't.

THERAPIST: [I guess I'm more interested in hearing a little bit more again.] (ph?) When was that?

CLIENT: That was Saturday night. Saturday night I was just like...

THERAPIST: Right. You had the night terrors for the first time.

CLIENT: Saturday morning was the night terrors.

THERAPIST: Oh. I got it.

CLIENT: Right, Saturday morning. Although Friday night I took Ambien like I always do and the difference in what I was taking was that I take Ambien every night to sleep. I don't take Valium with Ambien because I feel like it's a gun to a knife fight. It's a lot (chuckles) of [...] (inaudible at 00:28:25). Occasionally I'll take Ativan a half-hour – like at 9:00, and Ambien at 9:30 – and then get into bed so I don't wander around aimlessly. [...] (inaudible at 00:28:49) it said you can do that occasionally. Okay, I try not to because it feels really weird and also I feel like I should just be in bed the entire time. Then I just woke up early and didn't have the night-terror freak-out, but I wasn't rested at all. I didn't sleep well last night either and maybe didn't fall asleep until after 2:00. I was trying to fall asleep starting at about 10:30 and as part of good sleep, I get up at a certain point and get out of bed, blah, blah. I did that twice. [...] (inaudible at 00:29:40) sleep something-something (sighs). [00:30:01] (pause) I guess I really, really don't want to have more night terrors and I don't feel like it's under my control at all – and that's really scary. I feel like somehow like three years of therapy was just undone and now... I don't know. I just feel like, "But I was doing all this stuff in therapy so that this wouldn't be my reaction. I thought it wasn't going to be my reaction anymore. I felt like I was doing good and then, holy shit, no." [00:31:07]

THERAPIST: Um. (pause) Maybe this is wrong, but my hunch is that you thought that more of the affect that went along with that thought was anxiety, like you felt anxious thinking about that – more so than angry and disappointed. Is that true?

CLIENT: Yes.

THERAPIST: Okay. So I wonder if a lot of that anxiety that you're referring to comes from feeling essentially separated from people or from home– like if, in a way, it's like a sort of separation anxiety that, at this point, isn't more – you see it in kids, usually. A major component is actual physical separation. But I wonder if what you're referring to is more feeling a psychological distance from home. [00:33:07]

CLIENT: Like from my sense of home.

THERAPIST: Yeah. Literally you were worried about being able to get home. That was part of it. Also, I think, in a way, from me, inasmuch as "there goes three years of therapy." I think part of that sense of increased solidity, I guess, I imagine is sort of bound up with that sense of relationship with me.

CLIENT: Yeah. I just... (pause) [00:34:03] Also it makes me think of – I don't know. Sometime in May both Ashby and I were having a lot of fun – a mental health stress extravaganza – and I was really freaked out and...

THERAPIST: I have more, but I'll let you...

CLIENT: It was like, "Ashby, here's the thing. I'm having a nervous breakdown." She was like, "Yeah, okay." I'm like, "No, no, no. But Ashby, for real. I think I'm having a nervous breakdown." She was like, "Well, okay. I'm having one, too." I was like, "Okay, but I just wanted to let you know that that's what I'm doing right now." What I sort of meant by it was – I mean, there were a lot of things – but I felt like (sighs) we have both talked about this. [00:35:13] Both of us have the ability to leave the house, get to work, feed ourselves, basically pay the bills, et cetera. We can make it seem to a lot of people that we're both okay when that's not true. I think I was feeling very intense and was like, "I am not feeling okay and I don't know how to convey this because having a nervous breakdown is not a [living] (ph?) thing; it's a Victorian novel thing." [00:35:58] [...] (inaudible at 00:36:00) That wasn't really what I was saying. What I was mostly saying was that I'm not feeling super-good right now and I'm really sorry, but I am not, at this moment, totally up to all my adult responsibilities, as it were. Part of that was a lead-up to, basically what I was kind of stressed-out about was my parents, kind of like all of that. I haven't really lost that feeling since my parents visited. [...] (inaudible at 00:36:57) [00:37:06]I guess I feel like the other shoe hasn't dropped. I feel like something else is going to happen or something worse is going to happen or something. I don't know what it is. (long pause) [00:38:52]

THERAPIST: I feel like you're saying that you feel in terrible danger.

CLIENT: Yeah. (pause) Yep.

THERAPIST: And I think [it often escapes you] (ph?) what from. (pause) [00:40:08] Maybe I can back up on some of the other things. I feel like I'm having this sort of an epiphany about you and separation. I think it's so much about that for you, something that I completely haven't seen before – like with work. The part you do talk about a lot is the many, many, awful, terrible things that happen. And we talk some about leaving, but that usually crashes and burns pretty quickly, usually around how unfit you are for any other job. [00:41:02] But maybe what it is, is that you're terrified to think of leaving. Maybe that is a lot of what it is when you were with Josie, it was so hard to see at the time how badly you were being treated in certain ways. I mean some of it I know she was manipulative and all of that. I'm not trying to take that off her and put it on you, [but things we have wondered about and want to know why,] (ph?) is what made it hard for you to see some of that. Maybe it was because you were really scared to leave her. Night terrors in adolescence may be that a lot of it had to do with [tearing away from your parents] (ph?). [00:42:11] It seems to me like it all went along with what was going on around that time.

CLIENT: Being a teenager.

THERAPIST: Yeah. And you felt it in terms of being separate from the other kids at this camp, which I know was literally true; but what was mysterious was why feeling more disconnected from them would have had such a strong effect. I mean, it sucks, but why so anxious? And maybe it was displacement of feeling more separate from your parents or it was kind of related in that this is who you were supposed to be hanging with now because clearly you were not going to hang with your parents. [00:43:00]

CLIENT: Yeah. And the other thing which was sort of also related to the boarding movement – day-camping versus boarding – is that, not surprisingly, parents who can afford to send their kids to nerd camp or whatever it was at the time, usually have some money. Being a boarding student rather than not boarding, people were kind of like "what's wrong with you?" almost. I lived 25 minutes away. It seemed kind of dumb, but it felt like that barrier of money and class I didn't really get yet, but I was kind of like... [00:44:06] I don't know. It was like an early understanding of like people I knew would do things like go to Club Med on vacation and my family did not. We usually went camping. It took me a while to get that it wasn't just that we liked camping, although that's still also true, but we could not afford to go to Club Med. (pause) It's weird because when I think about how I felt grew up, I feel like I was average. I didn't particularly feel like my parents didn't [...] (inaudible at 00:45:15) the summer and did stuff. It is true that we didn't do some because they were expensive, but mostly my parents didn't want to talk about that. "We're just going camping." I'm like, "Okay." That camp, in particular that program, you get in, I think, based on your P-SATs so suddenly all the people I knew, like in my Honors classes or whatever, were talking about it and going, which meant you could go to different places. I'm like, "Where are you going?" [00:46:07] You come back with nerd-camp friends and all these things. It felt like the year that I day-camped I just felt very separate from everyone. I felt like I was, not the weirdo, but like...

THERAPIST: Alienated.

CLIENT: Yeah.

THERAPIST: We should stop. I do think this is sort of probably ties back around to incidents from the past, which seems less immediate, but I think it probably ties back to why you're so anxious now. I'm not sure if it's feeling that another slide and shift with your parents after what happened around the bombings or in some other things as well, but [we can talk about that tomorrow.] (ph?)

CLIENT: Okay.

THERAPIST: [...] (inaudible at 00:47:43)

CLIENT: Thank you. Have a good weekend.

THERAPIST: Yeah.

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