TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

(Conversation coming into session)

THERAPIST: One of us messed it up. I’m glad...

CLIENT: Thanks a bunch. (chuckle)

THERAPIST: Sorry. (chuckle)

CLIENT: Did you by chance get contacted by anyone?

THERAPIST: I did not get contacted by anyone, but I knew that you had seen someone so I brought over a release. Did you sign one there as well?

CLIENT: Yes, I did. It was a weird form. It didn’t ask for your phone number. It asked for your address, so maybe you’ll get (inaudible phrase at (00:00:27) in the mail.

THERAPIST: Oh, okay.

CLIENT: Yeah, so I was there on Wednesday.

THERAPIST: How did it go?

CLIENT: I’m not quite sure.

(16 second pause)

Highly qualified, I’m sure, but some of the decisions she made seemed kind of strange and weren’t communicated very well to me and then were not communicated at all to the pharmacist. [00:01:13]

THERAPIST: Okay, start from the beginning. What happened?

CLIENT: She said, “Okay, we’re going to change this medication down, and we’re going to increase this one and then switch the one at the end of the day from 300 400 (inaudible at (00:01:31).” That one, I sleep just fine on the 300 a day. I got put down to 200 in the morning from 300, because “we want to make you less sleepy.”

I left there and went to CVS because I got the text that it was filled, and there was only one prescription. It was the 400. So I called them back and said, “Can you just go over with me what the changes are because I want to make sure this makes sense.” [00:02:05]

“Yeah, that’s it.”

“Is there something I should take in the morning?”

“Nope.”

I got a call back an hour later, “Actually, you are supposed to take 200 mg of this in the morning and we’ve called it in to CVS.”

It’s not a big deal, but I felt a little bit annoyed. I’m actually not taking the 400 mg at night, I’m still taking the 300 because I have a large quantity left and I sleep just fine into the night and...

THERAPIST: Have you switched to taking the lower dose in the morning?

CLIENT: Yeah.

THERAPIST: Is this Wellbutrin?

CLIENT: No, this one is Pregabalin (ph). Wellbutrin I’m cutting down 400 to 300, increasing Setraline (ph) from 200 to 250 and then... [00:02:58]

THERAPIST: Did those make sense to you?

CLIENT: Yeah, I wanted to get off the Wellbutrin. It’s such a high dosage. It’s the maximum you can take, 450, and the insurance company wasn’t happy about it, anyway, and I don’t want to be on all these drugs. It’s kind of funny because every time I go to the psychiatrist, a new one, my wife says, “Ask them to put you on Lithium because it was excellent for me.” She’s (ph) not bipolar, but for her it took care of all these symptoms that I apparently share and so she gets frustrated when I don’t insist. I mean, it’s a first appointment, I’m not going to say, “Do this,” without any kind of understanding of where I’ve been. [00:03:56]

I was encouraged because she said she was going to talk to you and talk to my primary care and check the blood work that I had done in November. That’s fine. Again, it just takes so long to move forward.

THERAPIST: When is your next follow-up?

CLIENT: February 7th.

I’ll go in and say, “Well, you know, I didn’t follow your instructions exactly, but...” At the same time it seems like I always feel agitated anyway, so what’s the worst that can happen unless it gives me stomach cramps or something like that. [00:04:49]

THERAPIST: Well, I think the important thing to do is know what you are doing and over the next couple weeks see if you can do some tracking of what your symptoms are, how your sleep is, how energetic you feel, if there’s a change in the sense of motivation that you have to follow through on things. So you can go in with some information about like, “Here’s what I actually did.” Regardless of whether it’s exactly what she said or not, but so she knows what you are doing, what you are taking, and if that has a noticeable impact on any of the target symptoms anxiety or lethargy, etc., so she’s got real information to go on.

CLIENT: That’s a good idea, because it seems like, “How have I been over the past month?” I can’t remember how I felt the past week. [00:05:44]

THERAPIST: Right. It’s really hard to do self report on past feelings and behaviors is not very reliable. It’s much more reliable if you kind of take notes on yourself in the moment, because it’s really hard to go back and think well, “How did I feel last week?” It gets lost and it gets washed away by what you’re feeling now. If you can just jot down in your calendar, “feeling really, really anxious today” or “feeling really lethargic in the morning”. These are things that are going to be a little bit more reliable.

CLIENT: Yeah, I’ll definitely have to make a point of doing that.

Those changes are now in place and I guess I don’t feel all that different. I didn’t expect a change.

THERAPIST: Right, certainly not within two days. But, you’ve now sort of embarked on the process of establishing a relationship with somebody who can more closely track because you hadn’t been able to do that for a long time. [00:06:53]

CLIENT: Yeah, and not having to dish out like $300 to do it. It’s awesome. It’s a plus.

THERAPIST: Yes, it makes you a little bit more likely to go back for frequent follow up.

CLIENT: I don’t really know what the coverage is really, but she does accept my insurance (ph). But apparently the changes in the healthcare law are now going to allow me to change to something else. I assume she takes other things as well. I don’t know what they offer yet. It’s weird (ph) that the question I asked you a couple weeks ago as far as (inaudible phrase at [00:07:40]).

THERAPIST: Keep me posted and if we can get you covered by insurance, we will.

CLIENT: Alright. [00:07:49]

I went up to Vermont. I did not go ice fishing. I helped build sleeping lofts which was good, I guess. I was kind of nervous about bringing my dog up there because she’s been kind of needy. [This guy] (ph) said, “I tell you what. It’s going to be raining up there and my wife and daughter don’t want to go up so they said why don’t they take Sparky(sp) while you and I go up to (the big mountain) (ph).” I thought, “Wow that’s a great idea,” because I really needed a vacation from that dog! (chuckle) I’ve been taking care of her myself the past three weeks. [00:08:49]

THERAPIST: You were a little bit anxious, too, about being in that family dynamic with the kid and —

CLIENT: It’s not just the family dynamic as much as it is any kind of social gathering. I don’t know, but it was interesting because I’ve never spent time alone — actually, that’s not true. I went fishing with him once with myself, but that was just a few hours. This was an entire Friday to Sunday and it was great. I’ve always known him to be an easy-going guy, but there’s just no pre-tense at all. He is just so down to earth. He’s this five foot, barely, Asian guy from Maine, I’ve known for a while. He just looks like a boy. He’s really slight, and yet he works for State Street Investments. It’s just a huge...it hasn’t changed him at all. He’s very well off, and yet he still likes to go to garage sales. He still likes to go fishing. It’s like these things that are —[00:10:28]

THERAPIST: He knows who he is. He’s comfortable with who he is.

CLIENT: Exactly. It’s inspiring in a way. I don’t know how I can get there, necessarily, but it was just nice to be around somebody who was like that. It was a good time.

THERAPIST: What was the best part and what was the worst part?

CLIENT: Probably the same event. On Saturday morning we were going to get lumber and it was like a skating rink and he’d hooked up his trailer and he went to this first (bump he heard) (ph) [00:11:40] and he pulled in. It was kind of a slope going down, like that, and he said, “Oh, I think they’re closed.” I said, “I’m not sure how far in you want to keep going.” And we just sort of started sliding down, just uncontrolled. It was horrible because I didn’t think we were going to get out of there. He had one thing of kitty litter. I got out and just started dishing it out around and he’d just go little by little by little, and finally he got up all the way and we were just laughing our heads off. We had this vision of stopping a truck to pull us out. That kind of set the bar real low. [00:12:32]

THERAPIST: (chuckle) For the rest of the weekend.

CLIENT: It was kind of hilarious.

THERAPIST: That really does pull you into the moment. There can’t be anything but the moment right then.

CLIENT: Yeah, exactly. Your senses just focus on not falling down or —

THERAPIST: — getting caught under the wheel of a skidding truck. (chuckle) Sometimes it can be nice to have a very singular focus.

CLIENT: It was up there toward the top and the bottom. Not getting out (ph) fast enough was at the bottom, but I was laughing my head off when I got back in the car.

THERAPIST: Feels good to laugh. [00:13:28]

CLIENT: It was interesting. Yesterday I was listening to a show that I hate Providence Public Radio on GPH and it’s these two people that I just can’t stand. Anyway, one segment was on this report that suggests that men don’t have enough friends, male friends, and they were talking about the stigma of appearing gay if you’re (with your guy) (ph at 00:14:11). And they said, “Guys do stuff together like go the bar, watch a game, do sports or whatever, but unlike women who typically talk to other women more intimately and more frequently, men don’t really have that kind of relationship with other men — typically.”

And I started thinking about my dad, again—

(10 second pause)

— and myself and I was trying to identify those relationships I have that are intimate or just with other males. I do. I think my brother is one of those who I can talk to about anything. I don’t know that I have a lot of others, especially out here, with that same kind of connection. Anyway, it wasn’t really not (inaudible phrase) earth-shattering, but it did give me pause to consider my own situation. [00:15:50]

THERAPIST: Do you feel you have female friend with whom you can talk?

CLIENT: I do, to a point, but the female friend dynamic is more difficult for me. I think we’ve talked about that. What does it mean to be friends with me? I have a hard time understanding why anyone would be friends with me male or female. Therefore, a female wanting to be friends with me must be interested in me, or something like that. But somewhat related to that, I had this moment up in Vermont when I caught myself looking around, seeing what the place might need, that I could give him. That I could — [00:17:00]

THERAPIST: Kind of to sort of ingratiate yourself, you think?

CLIENT: Yeah, exactly, and I said to myself, “You know, you really don’t need to do this.”

THERAPIST: He’s already invited you up.

CLIENT: And I’ve already helped him build six more sleeping areas for this place and so it was somewhat obligatory that I caught myself doing that and noticing that I’ve done it in the past without even stopping to think about it.

THERAPIST: Well, I remember before you went to France you were talking about doing that with a woman with whom you were staying?

CLIENT: Yes.

THERAPIST: Finding ways to be useful.

CLIENT: Yes, but I think that was a little bit different only because I was so appreciative of her letting me stay there without paying for a month.

THERAPIST: Well, it felt more justified. I think it’s a similar process, because she wasn’t asking for... [00:18:02]

CLIENT: No, I think that relationship was easy to adapt to because I’m malleable in that way. I can show my gratitude or show how worthy a friend I am by what I can do, what I can provide, how conscientious I can be, how thoughtful and considerate.

THERAPIST: Because you don’t trust that your friendship is valuable enough in itself. Without knowing this guy, I can imagine the reason he was interested in you coming up with him was probably not primarily for your building skills, but (cross-talk at [00:18:56]) I’m guessing primarily for your companionship and this was also the thing that he wanted to get done in the house that weekend and you weren’t going to sit and watch.

CLIENT: No, I’ve offered to help him with projects in the past. [00:19:11]

THERAPIST: But he could have hired a contractor if he wanted to get it done really fast.

CLIENT: Yes.

THERAPIST: So, trusting your companionship, that you as a person are valuable to your friends…

CLIENT: And so I guess I struggle with that. I see what I tend to do now, at least.

THERAPIST: Catching yourself in the moment and being able to choose another course is a really significant step in being able to change that pattern. You have to do that again and again, but you can do it.

CLIENT: I seem to also do it out of guilt, because of the people back in Maine, my friend Chris, for example. He’s done so much for me over the years. He’s such a giving person and he’s around a lot of taking people and he’s probably my closest friend and…

(13 second pause)

I went out to see them two or three times not solely to see them, but to have to go back to Maine for various reasons and I felt bad about telling him that I was going to come out in January and then telling him that I won’t be coming out in January. And that’s kind of wrapped up in the fact that I rarely acknowledge his kids’ birthdays. I guess I just forget, or I’m just completely oblivious to them. He was telling me four weeks ago about how they would win this LEGO robot thing, and you’ve had to experience those yourself (chuckle). [00:21:26]

THERAPIST: I’m quite skilled at LEGOs, yes. (chuckle)

CLIENT: Well, it’s robotics that...

THERAPIST: They have moveable pieces that they’re engineering.

CLIENT: Yeah, that they can control with remote-control and stuff. (chuckle) You seem like you’re thrilled about this!

THERAPIST: LEGOs are a fabulous educational tool. I think LEGOs are wonderful, actually. They happen to be all over my house. (chuckle)

CLIENT: (chuckle) Yes, I seem to remember that, especially those small ones with just the caps.

THERAPIST: Yes.

CLIENT: Well, he was telling me how they were doing this weekend competition and so on and so forth and I started thinking, “Oh, I can do something with that.” So, I was able to find this kit which is a next step up from that and so I got that for Christmas. I felt like that was good because it was something they would really actually use and enjoy and learn, but it also kind of took me out of myself. [00:22:40]

THERAPIST: Yes, you were thinking about others.

CLIENT: I think that, thinking about myself a bit, which has been so —

THERAPIST: And that felt good, to be taken out of yourself.

CLIENT: Yes, it’s primary impulse to just be in my own head it’s something that because of that, I also really felt guilty that I haven’t really been nurturing the relationships of those who I care about. So, I guess this all comes back to (I’m not being present) (ph), but I suppose I can be present without remembering somebody’s birthday.

THERAPIST: Yes. There are lots of ways to be present in a relationship, I think. And events anniversaries, birthdays, etc. are not necessarily actually even the best indicator of how attuned you are to somebody. With Facebook, anybody can send you a birthday message on your birthday. It doesn’t require much thought or connection at all, right? But remembering a piece of a conversation that, oh, they went to this thing and his kids are into LEGO engineering or LEGO robotics, that actually shows much more connection.

I think the really interesting piece of this story is you only let yourself feel good for a short while before you flipped it into feeling guilty that you hadn’t done it more. [00:24:18]

CLIENT: Well, yes, that was my point, though, was the friendship feeling that I needed to go over the top to make up for it or that my friendship isn’t valuable and I guess that I’m recognizing it but I would like to try to find ways to kind of celebrate those relationships pro-actively as opposed to reactively based on guilt.

THERAPIST: Yeah, I’d like to see you be able to celebrate them not with the things that you can do but in a way that you can be. [00:25:20]

CLIENT: Yeah, I get that.

THERAPIST: I think this past weekend when you spent so much time with this friend and, yeah, you were doing something valuable, helping him to get a project done on his house it’s a big project. But I imagine there was time in between where you were just being, just providing companionship.

CLIENT: That’s true.

THERAPIST: And then being able to see that that in itself is really valuable. Being able to enjoy that and giving yourself credit for it. I think that’s the piece to practice.

CLIENT: I hear you and I think it was a bit easier for me because I’ve been a little bit more attuned to my anxieties about those kinds of things and I think it was also helped by the fact that it was just him and me. [00:26:20]

THERAPIST: Yes, not having to manage a group dynamic on top of these other things that you’re paying attention to.

CLIENT: I think one of the issues I have with people back in Maine is that I really don’t miss any of them and I don’t really want to go back there. Certain people I do miss.

THERAPIST: Those are the relationships to pay attention to. Relationships with people who you don’t miss, you can let them go. It’s okay for not every relationship to be a forever friendship, but picking some people with whom you really do want to maintain a relationship, whether it be somebody from Maine or somebody here, you’re going to have a lot more success if your desire to be in a relationship is genuine in being able to actually stay engaged and be there and present in a relationship. A relationship that you’re maintaining out of a sense of guilt is not going to be one that you’re going to be able to be really present for. [00:27:28]

CLIENT: Yes. You know there’s this thing on Facebook. It’s “37 Things You Will Regret When You Are Old” or something like that.

THERAPIST: Hmm, that’s lovely. (chuckle) What was meaningful for you in there?

CLIENT: Well, there was a lot and it wasn’t because I’m not doing them. I am doing these things that it’s saying you really should be doing so you don’t regret having not done these things when you grow old. I felt really good about a lot of them. One of them, though, that kind of struck me was “Say good-bye to — Friendships are not forever.” Some will pass and that’s okay to let them go.

(23 second pause) [00:28:54]

The other thing that the psychiatrist suggested is that I need more structure in my day. I’ve actually built a schedule now, depending on the day. So, Monday, Wednesday, Friday, I do this and Tuesday, Thursday, I do this. The real difference is just going to the gym. I’ve been to the gym six times in the past two weeks and I feel good about that. I’m also being reminded of the whole Jung’s(sp) thing and I don’t have to do everything all at once. I don’t have to do it correctly or successfully every single time. Things we talked about last week. I’m still working on those. [00:30:12]

THERAPIST: It’s a practice.

CLIENT: Yes. The other thing she said was— I didn’t get anything into my work with you at all, except she says, “CBT?”

I said, “Yes, I guess.”

She said, “The one thing I’d recommend is for people to not dwell in the past.” This woman’s real Romanian and she has a very thick accent. She comes off as very authoritarian, but it’s just kind of —

THERAPIST: Directive.

CLIENT: Directive. Anyway, I’m taking those to heart. It’s really uncomfortable with these things.

THERAPIST: It’s sounds like there’s some overlap in our perspective which is helpful that we’re picking (ph) on the same team. [00:31:10]

CLIENT: Exactly. So, there’s that. I’m still working on it and... I don’t know what else.

(16 second pause)

I was at the gym yesterday and I was at the end of my workout, this yoga routine on the floor. There was a TV up on the wall. Typically I just have my headphones in and I’m kind of [set up] (ph) to yoga music that helps me to relax. Anyway, there was this commercial on and it was this crazy car commercial. And you know how they usually say at the bottom “closed course, professional driver”? [00:32:11]

THERAPIST: (chuckle) Yes, do not attempt.

CLIENT: Yes. This one was a little bit more comical and it said, “This is a fantasy, do not attempt. Cars cannot ride (ph) on trains. This is still a fantasy, do not attempt.” Things like that.

It struck me, the whole fantasy thing, “do not attempt”.

(12 second pause)

And that fantasy, in and of itself as a mechanism I’m starting to warm to the idea that it’s okay and that it’s healthy. It’s a reaction to something else. I guess I’m starting to look at it more as be not concerned or feel guilty or bad about the fantasy, just concerned or attentive to the need to enter into the fantasy.

I feel like there’s been a lot of self-awareness that’s been developing lately for me and I’m not sure what to attribute it to. If it’s the fact that my wife’s in France for a month, or that I’ve got time to myself to reflect on things, if it’s the exercise, or the structure that I’m starting to develop. I don’t know what it is but...I guess that’s about all I was going to say about that. [00:34:31]

THERAPIST: There’s two things to pay attention to so that the idea, the what is it that prompts you to enter into the fantasy, but on the other end that the separation you also make even without the commercial telling you that this is a fantasy, don’t actually attempt it. That’s where your conscious choice comes in. You make a choice to leave it as a fantasy and not to attempt it. Whether it be driving your car on a train or engaging in behavior with me. You do. You make a conscious choice to leave it as fantasy and I think there’s a piece where you can give yourself some credit. I know you often experience a lot of guilt about what the fantasy is, but giving yourself some credit for leaving it, appropriately, as a fantasy, can be added on to the idea of also letting go of the guilt and instead wondering what is it that makes it necessary? [00:35:27]

CLIENT: Yeah.

(12 second pause)

I think it’s been, for me, a bit of a struggle with what I can control and feel guilty for things that I can’t. That’s something that I feel like I should be able to control. In the past I felt bad that even though you tell me that developing an attraction to a therapist is normal, it can happen, then it almost gives me license to exploit that.

THERAPIST: What do you mean by exploit?

CLIENT: Well, knowing that it’s “normal”. To not be very motivated to not enter into it. Do you know what I mean? [00:36:48]

THERAPIST: Do you feel like you’re supposed to be fighting against it?

CLIENT: Well, I think that I have felt that. For me to sit here and to look at you and fantasize or get excited or whatever is… (7 second pause). Because I know it’s normal makes it okay for me to do that.

I can’t remember where I am now...

THERAPIST: Letting go of the guilt because it’s a common experience.

CLIENT: Yes, yes. I guess then getting back to what I can control and what I can’t control. Being something I choose not to control because I enjoy it. [00:37:50]

THERAPIST: I guess there’s so many different layers of where you actually do have control and where you can try to have control. I think for me there’s a separation between attraction, fantasy, and behavior. Attraction is a feeling and I think we have very little control over that’s a reaction. There’s some layer of control over the thoughts, right? So, fantasy involves not just that reaction or emotion, but it also involves a lot of thought and scenarios that you might create in your head. A layer on top of that is actual behavior, acting out on that thought. I think you have very little control over the attraction, which is just a natural feeling that you have and who knows where that comes from. You do have control over how far you let those thoughts go, where you stop them from circling, and probably even more control over the behavior. [00:39:04]

CLIENT: Yes.

(10 second pause)

The other thing about that attraction is it’s so deeply seated in this need for approval and it’s almost like if I knew that you were attracted to me or whatever... It’s almost like, “Okay, I can move on.” Or if I got feedback from someone else and I— That is still a struggle that I then go someplace else to try to figure out. It has nothing to do with you. [00:40:06]

THERAPIST: Yes, that’s where the work is, right? That’s the meat of the work.

CLIENT: And we’ve talked about this a lot before. What is happening at that moment that I seek into my need for acceptance? I think that’s one of those things, on the weekend when I caught myself from trying to make myself “Super Bryce” it was the same impulse, I guess. I also thought at one point… I applied for some job and it’s like what behaviors do I want to curtail when and if I go back into a work environment? On that thing I made myself essential, essential, essential. And that’s what I typically do. [00:41:13]

THERAPIST: That’s somewhat adaptive in a work place.

CLIENT: It is, but I think it’s also a bit unhealthy. It can be.

THERAPIST: You need to set some limits. Making yourself valuable and essential in a workplace is adaptive, smart, good business sense, but you don’t want to do that at the expense of all your other relationships and time and hobbies.

CLIENT: Yes, I think that’s the difference. In the past, my plugging into work has known no bounds. And so I think my worth in various arenas is being questioned, is being devalued. So, anyway... (sigh and 30 second pause) [00:42:17]

THERAPIST: How is the relaxation, progressive muscle stuff going?

CLIENT: It’s not.

THERAPIST: It’s not. Do you want to practice? You’ve got five minutes, do you want to practice in here or do you want to leave that off?

CLIENT: I think I’m going to add it to the documenting how my emotions are throughout the day (chuckle).

THERAPIST: Okay. [00:43:12]

CLIENT: I think part of the structure that I’m trying to put in my day is also having the time. I know you said don’t do this right before bed. That’s not my plan, but to have at least a half hour to an hour to, kind of, reflect on the day and do things that can kind of bring me into closure for the day.

THERAPIST: It’s not a “don’t do it before bed”, it’s an “it doesn’t always have to be done before bed”, so that you can learn to relax and to fall asleep. You want to learn to do both. Certainly it makes sense as a way to close your day, to let go of some stresses, when you become really proficient being able to do that at different times as well, is ideal. But, like you said, things need to be worked on in process. It doesn’t have to be ideal all of the time. [00:44:22]

CLIENT: Falling asleep hasn’t really been a challenge. I think the Pregabalin seems to be doing its job, too.

THERAPIST: Well, let’s take a minute to schedule some follow-ups.

CLIENT: Okay.

END TRANSCRIPT