TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi. Come on in. I'm just going to get some water. (pause) I'm really sorry about that. I mixed up the weeks. So I apologize.

CLIENT: It's really okay. I just went and got groceries. I usually do that afterwards. Doing it before was not a problem.

THERAPIST: Okay.

CLIENT: But thank you.

THERAPIST: Sure.

CLIENT: So Tanya is back in the hospital. I guess I haven't seen you while she was out because she got out last Thursday afternoon. Her sister was in town from Tuesday through Sunday. So that was good.[00:01:17]

THERAPIST: Mm hm.

CLIENT: (pause) We talked with the ECT doctor yesterday after her, I guess, seventh round of the ECT. And he said that it was not that unusual to have a patient seem like the ECT was working inpatient and then leave the hospital and it seemed to sort of stop working. Which has sort of been the case here.

And he seemed to think that was often due to uncontrolled background stressors of one kind or another. In the hospital you can protect someone from most anything coming on. Outside of the hospital it's a lot harder.

THERAPIST: Mm hm.

CLIENT: I think that's probably about right. Certainly her mood is still very reactive. So Thursday, the first day she was out for a whole day, she was supposed to go see her outpatient psychiatrist who ended up having the flu. But she, and her sister escorted her, went out to the office and no one was there. [00:02:32]

THERAPIST: Mm.

CLIENT: And that was not particularly good for her emotionally. And she didn't really recover Thursday. I mean she was stable but very, very sad for the rest of the day really. Then had another round of the ECT Friday morning and was better. So then her mood kind of dropped off over the weekend and it was a long weekend.

So when we went to do the ECT on Tuesday the hope was that it would kind of jolt her out of things and didn't seem to. So the best course seemed then to take her back in. I mean take her upstairs. We were already at Frederick doing the ECT. (pause)

The other course that the ECT doctor suggested as a possibility was to just bring her back today for another round of ECT. He said he didn't usually at this point in the treatment like to do that back-to-back because of memory loss issues, but that sometimes that worked also. [00:03:45]

So I don't know whether they will do that inpatient or not. Monday was bad enough that it seemed like spending another day or night like that was not a good idea.

THERAPIST: What happened that Monday?

CLIENT: I guess Sunday her sister left and then some time in the evening, her sister left round noon, and then some time in the evening she just started to get very depressed and somewhat suicidal. So she eventually called Chad.

THERAPIST: Mm.

CLIENT: They talked for a little while. They made an appointment for Monday morning with a kind of "I'll be safe until this point," plan that we had talked about before. Went to that meeting, still was not doing very well. Basically sat in a chair all day Monday. [00:04:50]

THERAPIST: Mm.

CLIENT: Alternately staring into space and reading a book. So in a sense she was safe. But she's alive now, so I guess she was safe. But it was (pause) not an ideal circumstance, I don't think.

THERAPIST: Where were you while she was doing that?

CLIENT: In the apartment, around. Her sister helped us move our remaining items out of storage so everything is in our apartment now. But some of it needs to be put away. So I was just putting things away, unpacking.

THERAPIST: Mm. Do you read during that time? Do you work? What do you do while she's like that?

CLIENT: It varies. Sometimes I just sit with her just to be present. Not that I can really hold her hand or something. Not that I can really share her pain, but I can at least be there. Sometimes I read. It's hard to work during that time. It's just (pause) her being in acute distress sort of makes it hard focus enough to do work for any period of time. [00:06:20]

THERAPIST: What does it feel like when you sit with her?

(very long pause) [00:07:52]

CLIENT: I'm not sure I have the right words. It feels like she's monumentally sad and there's nothing I can do about it, but at least I'm there. (pause) I guess I'm sad that she is sad and I'm sad there's nothing else I can do. (sigh, pause) But I don't know that I'm really thinking about those in the moment. (pause) I don't know. I'm kind of there. (long pause) [00:09:42]

Yeah, I tell her I love her, because I do and it seems important. She tells me she loves me, which I know. Sometimes she says she's sorry. And I try to tell her that I don't think it's her fault (laughs) that this is where we are. But that doesn't get through very well.

THERAPIST: You know, one thing I think we haven't talked about very much is how you think about her depression. Whether you think about it as a disease. Yeah, how do you think about it?

CLIENT: That's a good question. I do think of it as an illness.

THERAPIST: Mm hm.

CLIENT: (pause) Disease has a complicated range of connotations. I don't know that I would usually think about it in that term, but definitely illness. [00:10:59]

THERAPIST: Mm hm.

CLIENT: We have a couple of times, you and I, have talked about the situation by analogy to other illnesses, particularly of a chronic nature.

THERAPIST: Mm.

CLIENT: And that's something that I have done for some time as a way of trying to find some perspective on where I am and where she is. If you had this instead of depression, we would do this. So we should look for something similar in terms of what we do. The roadmap just seems more clear for cancer somehow. I'm not sure that's actually true but it seems like it from where I sit.

Yeah, I definitely think of it in terms of illness. But it's (pause) Yeah, and in some ways it's like an infection. It has it's own self preserving tendencies. [00:12:17]

THERAPIST: Mm.

CLIENT: That use her and use her mental processes, but are in a sense self preserving for the depression, not for her.

THERAPIST: Mm. (long pause) What are you thinking about?

CLIENT: I'm thinking about whether that was a complete answer to the question or not. (laughs)

THERAPIST: Mm.

CLIENT: And I'm not sure that it is. I also think about what are the causes, because in the illness world there is more or less a cause for things. Cancer being an interesting parallel because we don't have very clear You know, the state of Louisiana knows a lot of things cause cancer, but it's not really clear what caused any specific cancer in any specific person, most of the time. Maybe smoking, lung cancer is clear. [00:13:28]

But on some level it seems like in the depression world, it comes from somewhere. And so if we could find all of the causes it would help to move forward somehow. Just I think one of the reasons that she's still in psychotherapy. I think that's kind of the But maybe I have a misunderstanding of psychotherapy. So it seems to me like a large piece of the puzzle is childhood trauma.

THERAPIST: Mm.

CLIENT: A lot of yelling in her childhood. A lot of instability. Her mother leaving. That left, in a sense, a real vulnerability that has been played upon heavily in recent years. And then here we are. [00:14:41]

THERAPIST: Mm hm. Do you see her as powerless over this?

CLIENT: (pause) No, I really don't. I think she sees herself as powerless over it in a lot of ways, but I really don't.

THERAPIST: I guess with that do you feel that she could be doing something more?

CLIENT: (sigh, pause) This week, no. (laughs) I have definitely felt that way before. I think it's not an uncommon way to, having talked with other people who have family members who are depressed, I think it's not an uncommon reaction to it. [00:15:38]

THERAPIST: Mm hm.

CLIENT: Because it just seems like, "Well if you would just do this different thing." But not in the last week, no. I really think that (sigh, pause) Like still her outpatient psychiatrist did contact her by e-mail and by phone before the appointment last Thursday. But our phone was still off because she had been in the hospital up until the day before and so she hadn't turned it on because there hadn't been any obvious need to and he hadn't checked her e-mail.

And so, you know, do I think that she should have done something differently there? Absolutely not. Do I think the psychiatrist should have done something differently? Not really. So it's just kind of a really terrible situation.

So in a large way, yeah, I think Tanya was powerless in that. And given that it happened and given where she was, what happened was more or less inevitable. So, yeah, I don't feel like there's anything really that she could have done differently in the last week to make things different. [00:16:58]

Going back to the beginning of this calendar year when she was first hospitalized. Do I think she could have done something differently? I don't know. There's a sense in which I still don't understand exactly what happened, so I don't really know -

THERAPIST: Mm hm.

CLIENT: what she could've done. I think that fundamental idea behind all of these coping skills and CBT and DBT methods is that you can do something though.

THERAPIST: Mm hm.

CLIENT: So if that's not true then we're just filling our mental health patients with a whole lot of fluff and setting them up to failure. So I don't believe that.

THERAPIST: Mm hm.

CLIENT: And I don't think So I guess But then I ask this question of like, what does it mean that there is something more that you could have done? Does that mean that you are responsible for not having done it? Or does that just mean that there is another thing that you can try another time? [00:18:07]

I don't have a great answer to that, but sometimes I think it means you should've done something differently. But illness involving the mind is really hard to piece out in this responsibility or powerlessness thing. (pause)

Yeah, I don't have a firm hold on the end point and I'm kind of okay with that. The end point of, who's fault is any specific thing? Or, should you have done something differently? At this point, at least, I feel like, "Well, here we are."

THERAPIST: And it sounds like at times you have felt frustrated with her.

CLIENT: Oh sure. Yeah. Yeah. Particularly when I don't understand what's going on. You know, in the Fall there was a time that she just didn't go to work because she couldn't face it for reasons which never really became clear to me. It just was overwhelming or her somehow. [00:19:40]

It was very frustrating because it's (pause), because that was very self defeating, you know, in a major way. Not going to work at a place that reserves the right to fire you if you don't show up. I mean when you're really upset about, when you're really concerned about continuing to stay employed is really not, the pieces don't all add up.

THERAPIST: Mm hm.

And the missing piece, I think, is that she really wanted to quit but didn't think she could, or something. And so this was kind of a result of that. But, yeah, it's very frustrating because if she really wanted to quit we just needed to have a conversation in which she said she really wanted to quit. Which we eventually did and then she did. [00:20:41]

So I, yeah, there have definitely been times that it's been frustrating. (pause) I don't have any other examples off hand.

THERAPIST: You said this week was different in terms of that in particular.

CLIENT: In terms of like how I felt at least. I didn't feel like I guess there's two ways in which it was different. One, I wasn't surprised to see her mood decline over the course of the weekend. Yeah, her mood had declined over the course of the previous weekend between two ECT treatments. So Saturday of last week, not a couple of days ago but the previous week, she had been more or less okay and then Sunday just not really that good. Not doing very well. [00:21:50]

Then ECT Monday and she was better. And ECT Wednesday and she was better. After ECT on Monday she was really ready to go home and I was really confused. I talked about this song about us living in different worlds because she didn't really remember being not that well on Sunday. But I remember, so this week I was not that surprised to see it go this way.

So in that sense in which I am more prepared for it in some way. And so it's easier to deal with. And then there's also the sense in which like (pause) it's much more clear to me how her psychiatrist not showing up would rattle anybody, but would particularly rattle her. I'm not sure if I told you, her inpatient psychiatrist wanted to push for a borderline personality disorder diagnosis. [00:22:56]

THERAPIST: Mm hm.

CLIENT: Which I don't think is correct. But I don't think it's correct because she doesn't meet the criteria in the DSM for a personality disorder. She has like six or seven of the symptoms for borderline personality disorder. But you have to, as I understand it, you have to meet the personality disorder requirement first and then you can diagnose down. She doesn't meet that.

But Chad's view was that she has (laughs) a lot of the symptoms of borderline but does not have borderline. For whatever any of that is worth. I trust him. But that's a whole lot of things. But at any rate, so given that she has those sorts of symptoms and reactivities, a caregiver not showing up really ought to set her off in some sense. Like these are the symptoms. This trigger is clearly going to be a trigger and it's just, it just is. I don't know. [00:23:56]

THERAPIST: I was going to ask. That was one of my questions about what you imagine was so devastating for her in him not coming?

CLIENT: It is a her.

THERAPIST: Her not coming. Sorry.

CLIENT: What I imagine, although I really haven't actually gotten much out of Tanya about it, is that it just, it's very much like when as a child her father would just show up late for picking her up for something. Or her mother left. It's kind of in that same vain of. "Here's someone that I need to rely on not being there. And I really need them right now."

That might not be correct. It might just be, "Here was a plan and the plan has been abandoned." But I feel like it's somewhere on the (inaudible at 00:24:28) like this.

THERAPIST: I think that would probably be more your feeling. Like, in knowing you.

CLIENT: (laughs)

THERAPIST: That that would be a way that you thought about it.

CLIENT: Fair enough. (laughs) But I think there is a reason that Tanya and I have gotten along well though. I think there is a sense in which she does also need a plan, more than she admits.

THERAPIST: Mm.

CLIENT: She grew up in this family like, I was talking with her sister, and her sister said, "Yeah, no, the plans never go through. Nothing ever is going to happen." Which I think is somewhat of a conversation you and I had about how I was dealing with this. And I think that was hard for Tanya as a youth and I think still as a young adult when I met her. [00:25:40]

And so, me wanting to have plans and stick to them and kind of doing that I think was a sort of stability in her life that was good. So, yeah, that's definitely a kind of my interpretation of events. But I think there is some, I guess, truth to it for Tanya also. I'm not sure though.

THERAPIST: In reading over the criteria for borderline personality disorder and seeing some of the characteristics, you know, what are your thoughts about that or feeling about that?

CLIENT: Well my first feeling was that Frederick really likes ECT and diagnosing BPD. Because she did (laughs) an outpatient program at Frederick after her second hospitalization so, I don't know, fourteen months ago, and the psychiatrist there wanted to diagnose her with BPD. At the time her response was just, "No, I don't have any of these emptiness feelings ever." But that's kind of one of the characteristic traits. It's really not. [00:26:54]

So I guess it's like, I've seen these before. I think more of them fit her this year than did last year, which is interesting and in some ways consistent with the diagnosis because the symptom is supposed to grow for some period of time and then diminish as you get into middle age. Or something like that. (pause)

The first time I read through I sort of had this feeling of, "Yeah, a lot of these really do fit Tanya." But I left it alone for a day and came back to it and I read them, and they don't fit quite as well as they seem like they did yesterday. Then I guess I kind of came back to it a third time, or a few hours later, and I feel like there are a number of them that are pretty good descriptors of her symptoms.

I think she was really concerned about the diagnosis of BPD. In part because her mother has it, or has been diagnosed that way. And she really does not want to have so much in common with her mother. [00:27:58]

THERAPIST: Mm.

CLIENT: She sees her mother as a very broken and draining person and she doesn't want to be that person. I didn't have any of Like I don't have any stigma of that kind or of any other attached to it. I don't know.

My response then and to her was just that if it's helpful in the sense of this describes your symptoms and this gives us a way to kind of treat you better, then it's helpful. If it doesn't do that, then it's not helpful and it's not very meaningful. And that's, I guess I don't have any really stronger feelings than that.

It seems to me like a classification system. And if it doesn't classify well, it's not very useful. If it classifies and does nothing more than that, it's still not very useful. So it's only really important if it gives us some direction to move in. [00:29:02]

THERAPIST: Mm hm. (pause) I was thinking of something you said a few weeks ago. I think I just pointed out that you were sort of hopeful that, you know, providing her with structure or a job would make a difference. And this sort of calls into question that, in the sense that it just seems like her functioning is so poor right now that it's unclear what kind of structure at least would help right now.

CLIENT: (laughs) Right.

THERAPIST: And you had said, yeah, I mean, you know you wanted he to apply for jobs and if you could find a way to apply for a job with her, for her, you would do it. Although you couldn't really figure that out. And I was thinking about that sense of responsibility for her. Like in your thinking that you wished you could apply for jobs for her. [00:29:58]

CLIENT: (long pause) Yeah. So I care about her a lot, so that gives, in my mind, that carries some obligations. I also made a set of vows to her that also carry some obligations. And so, yeah, I do think I have responsibilities to and for her. [00:30:51]

(long pause) [00:32:00]

We talked some, I think it was last week, about me being concerned that I had to be very careful in managing her, particularly her inpatient care. But kind of her discharge and those things because there wasn't necessarily looking in the right place, particularly not the inpatient people. (pause)

Yeah, what I'm trying to separate out here in my own mind, and I'm not exactly how well I'm doing it, is the sense in which I have responsibilities to Tanya that become very consuming in some way. In a sense, but I guess what I'm trying to separate out is like the part of that is about Tanya and the part about that that's more about me and how I respond to responsibilities that I see that I think are important but that no one is handling. [00:33:20]

THERAPIST: Mm.

CLIENT: So I was co-captain of the volleyball team in college, and by the time I graduated (laughs) I ended up having most of the officer positions in the organization. I didn't want most of them but I would sort of start doing pieces of them as other people dropped them. And then I would end up with the whole roll.

So there's some element in which I feel like there's something consistent in me that's doing this also, in addition to like Tanya just being ill. So I don't know.

THERAPIST: That's really an interesting parallel analogy or just sort of thought. Huh. Do you think in that case, was it sort of anxiety that you led you to do that? [00:34:20]

CLIENT: No.

THERAPIST: Like that I need to do this otherwise they're not going to get done?

CLIENT: (sigh) Hm. (pause) Maybe. (pause) Yeah, maybe. There was also a real sense in which (pause) there was kind of a set number of things that needed to get done in that case, and that no one (laughs) really wanted to do. So if (pause) Yeah, so there were definitely cases where if I didn't do it, it didn't happen. [00:35:46]

And there were kind of a, this is a club thing that everyone is doing in their spare time. And so (pause) I think for many people the commitment to the organization was rightfully less important than their commitment to their classes. And so if something had to slide it was, "Well, I just won't do that thing that I was supposed to do for the volleyball team."

Which is just fine, but it leaves that organization somewhat lurching when the funding from the school is connected to whether we do certain things or not.

CLIENT: Yeah, maybe there was some anxiety there. There was also a sense in which (sigh, pause) Yeah, so there was some anxiety about giving up some of the roles, I think, in that I thought that if I gave them up the next person would not do the job as well. [00:37:01]

Which was indeed the case when I did give up all of the jobs. But that's not very helpful. And so having not giving up one or two of them, it sort of cascaded somehow into like they all came towards me. I'm not exactly sure how that ended up.

THERAPIST: Mm. (pause)

CLIENT: Yeah. I'm not sure. I need to think about that more, I think. In that sense though, I'm not sure where the analogy would go. [00:38:20]

THERAPIST: Mm hm.

CLIENT: Because there my concern would be towards kind of the functioning of the organization.

THERAPIST: Oh I think the analogy is a perfect one.

CLIENT: Okay. (sigh)

THERAPIST: You know, this concern may be, like the worst case scenario is everything would fall apart. The organization would cease to be. (laughs) I think there's a lot of analogy. Like Tanya (inaudible 00:38:42).

CLIENT: (laughs) Fair enough. Okay.

THERAPIST: Things falling apart. Who is going to be able to pick up the responsibility if you aren't? (long pause)

CLIENT: Now I feel like have to tell you the rest of that story, because So I graduated in 2007, and then I stayed for another year to do a degree because I was doing research with a guy that I really liked. And in that year our 87 year old volleyball coach drove into a tree killing himself and one of the players on the way to a volleyball meet.

Yeah, this was not a good time. I guess, yeah, I was driving in a fifteen passenger van with the rest of the team right behind them while they did it, while he did it. [00:39:57]

THERAPIST: So you saw?

CLIENT: Oh yeah. Yeah.

THERAPIST: Oh.

CLIENT: Yeah, that was not a good time. It was not a good time. (sigh) But since the coach had been doing a whole lot of the other important things for the team and then there was obviously this very large hole. Things had fallen apart in some sense. So, you know, after several months of kind of just limping along, I sat down with the officers of the team then. Because I had no actual responsibilities then.

I was actually only driving the van because I was the only person still certified to drive the van because the person who came after me hadn't done the responsibilities that they were supposed to do. (laughs)

So I was there in like a volunteer capacity. Anyway, so I wrote them a constitution that broke up everything that the coach had done, and that I had done when I was doing everything, into like eight different people's jobs. And I kept them very separate in a sort of constitutional sense. [00:41:15]

Because I could see that it was not healthy either for the organization or for me or for the person who would be me, to have been doing all of these things. And that's worked well. I mean we're five years on from that and they continue to function, if modified, since then.

THERAPIST: Oh my God! What was that like to see that?

CLIENT: Oh. (laughs) I'm sorry. (pause) It's horrifying. There's this person that I loved very dearly and a car full of freshmen in college who are riding with him. And they were just driving along on a road that I've driven, I don't know, several hundred times because it was close to my house. When he just kind of veered off the road into a tree at seventy miles an hour, seventy-five. [00:42:24]

And, you know, I thought they were all dead. Two of them survived and are just fine. But (pause) yeah that was really hard for a long time. (long pause) Yeah. (pause) [00:43:39]

THERAPIST: What were you thinking?

CLIENT: I was thinking that it took a lot of, in some ways, similar roles then to what I do now in terms of there are a whole lot of people who wanted to know what was going on, how the boys in the hospital were doing. So I ended up doing a lot of those communication roles in that time. Which is something I do a lot of now of communicating, "How is Tanya today? Where are we?" I don't really know where that analogy goes. But a lot of similar roles.

THERAPIST: Yeah. One thought, sort of on a practical level, but sort of, you know, this more sort of deeper level is, you know Tanya's parents in this. Like are they taking on some roles? Where are they in this? [00:44:36]

CLIENT: (sigh) Um. (pause) So if I weren't involved I think Tanya's mother, I don't know what she would do. But Tanya's father and one or both of her siblings would be here like all the time. (pause) Tanya thinks she doesn't want that. (pause) Yeah, that's right. Tanya thinks she doesn't want that and so I end up more in the role of interfacing with them to communicate what's going on and So her father came up fourteen months ago and during that visit, that was good. [00:45:37]

But Tanya really doesn't want that now. And so it's kind of like he's in the position of being powerless. He really wants to do something, but he (pause), I think in some sense he sees it as my role as husband to supervise some of these things and to communicate what we need and want.

And he wants to do anything that he can, but he also thinks it's important to keep the right roles for people. He does not want to, I think in his mind, he does not want to trample on our marriage. He has a very religious sort of, they leave their father and mother and cleave onto each other, interpretation of marriage, I think. Such that like he wants to keep that boundary. Which I think is, in some sense, sacred for him in tact. [00:46:51]

THERAPIST: Well, you just told me what Tanya wants and you told me what Tanya's father wants. What do you need?

CLIENT: (sigh) Well the thing that I need is for Tanya to be well. And so I can't really have that. So I don't know that I have any other like, I'm not sure that I have another want here other than to take care of Tanya as best I can and function for the things that I have to do as best as I can. I don't mean that I can never have Tanya being well, I just mean that like right now that is not the case and is not going to be the case for some time.

So, do I want him to come up? Um. I don't have any particular need to see him. (laughs) I have a fine relationship with him. I like him very much, but it's not helpful to me for him to be around. [00:47:54]

THERAPIST: That was more my question.

CLIENT: Yeah. It would be helpful if Tanya wanted to see him, you know, forty percent as much as she wanted to see me. It would be helpful in the sense that I just wouldn't visit on some days. But that's not really the case.

THERAPIST: Well this is a continuing sort of conversation between us that has both sort of my advice giving -

CLIENT: Yeah.

THERAPIST: and also these deeper issues. I think the deeper issue is you're wondering what does it mean to be devoted? What do marriage vows mean? Are there limits to it? What does it mean to be devoted to another person? What point are you betraying that devotion? You know, in micro ways or macro ways. I think these are really sort of deep questions.

I think on a practical level, I think it's very important to keep in mind what Tanya needs and what you need. If you need someone around more, you need to take that into consideration. I'm not saying you should go ahead and do it, but you need to take that into consideration. [00:49:05]

CLIENT: Yeah.

THERAPIST: You're not the only one with profound needs right now. I mean that's interesting that I said that.

CLIENT: (laughs)

THERAPIST: I think in part because the two of you are aligned in a certain way. I think sometimes I get confused in my mind. Obviously you're not. You're in very different places. But sometimes I think there's a little bit of interchange. But Tanya is not the only one with profound needs right now.

CLIENT: (laughs) It is interesting that you said the other.

THERAPIST: I know. What did you think of that?

CLIENT: Uh.

THERAPIST: Maybe that's how you feel?

CLIENT: No. No, I do feel that way some. I do feel like her family and my family have profound needs to take care of us, and there's nothing they can do on some level. But that's also just a mirror of like there's not much I can do either. And so we're all in this position of wanting things to be better and not having anything to do. Given the flow of what you were saying, I thought you misspoke. [00:50:10]

THERAPIST: I did misspeak. You know, James, we are going to need to stop for today. So you know, I have you guys, you and you guys as 10:45, just to clarify the time.

CLIENT: Okay.

THERAPIST: I don't know if that was today.

CLIENT: Okay. Alright.

THERAPIST: I kind of went back and forth. I have it as 10:45 though.

CLIENT: Okay.

THERAPIST: If that's okay.

CLIENT: That is just fine. I had thought it was 10:40 and so 10:45 is, yeah, that's fine.

THERAPIST: Okay.

CLIENT: It's good to know.

THERAPIST: Okay. So I guess let's do a wait and see again.

CLIENT: James.

THERAPIST: I will see. This time is here.

CLIENT: Okay.

THERAPIST: And one or both of you will be coming.

CLIENT: Do you want it to be a different time next week?

THERAPIST: Oh, that's fine. No it's not a problem at all.

CLIENT: Okay.

THERAPIST: It was just something idiosyncratic today and I mixed up the weeks.

CLIENT: Okay.

THERAPIST: It's fine. Let's keep it this.

CLIENT: Alright. Alright.

THERAPIST: Okay. Very good. I'll see you next week.

CLIENT: Alright. Thank you.

THERAPIST: Okay.

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