TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: So where do you want to start today?

CLIENT: I'm still having the panic attacks. It's really, really hard to like focus and think, this is just a feeling, though it's not going to do any damage or stuff because the thing is, it's like it still feels uncomfortable and still hurts and that's a thought that always goes against it and yeah, like on Tuesday afternoon, evening, I was [like shopping] (ph) [00:00:35] after I got done seeing you and then there I was fighting the urge to flee which I really couldn't do since I was on the job. I was talking to Thomas online about how I was packing and so he actually agreed to meet me before rehearsal so we went to rehearsal together which was really good because when I had parked the car and was walking down the hall I was fighting the urge to run back to the car and drive away and go home. I knew that once I got to rehearsal I'd be fine because that was what happened every other time but the getting there part was like -

THERAPIST: Hard.

CLIENT: Yeah.

THERAPIST: And like you said it's really uncomfortable. It is, that's true. Panicking is really uncomfortable.

CLIENT: And when it happens so constantly and stuff it's like once I actually ended up missing rehearsal but that was because I panicked and I called Sydney and we got into a little bit of a fight and then he panicked and then I ended up going home so I could, because he needed me and he was totally fine with that. And I did go to rehearsal and Thursday and Friday we didn't have rehearsal and then I was panicking Saturday night, too, and I was panicking Sunday right before I got to like call for the show and then last night I was okay and I was okay during the show, was okay during the after party. I was starting to panic a little bit like when I was making myself dinner and then I went to bed and woke up and I was panicky. And I had moved on they're supposed to be -

THERAPIST: They're very frequent.

CLIENT: Yeah. They're supposed to be a week like taking the Klonopin in the morning and at night and I decided to try it a little bit earlier like starting yesterday instead of starting tomorrow with going down to 300 mg of Wellbutrin which -

THERAPIST: So this was all happening on the increased Klonopin?

CLIENT: This was all happening on the increased Klonopin. You know I was like it was sort of okay -

THERAPIST: Not the expected result.

CLIENT: No. I don't think it was worse from the increased Klonopin, it just I don't know, maybe if I work it down into smaller pieces I could ask her if I could do that and take one, like half in the morning and another half in the afternoon to space it out, but I'm not sure if that would actually work.

THERAPIST: That's a psychiatrist question.

CLIENT: Yeah, and I mean, step two is reduce the Wellbutrin which hasn't seemed to have any it hasn't had any ill effect either though.

THERAPIST: And what day was our ending set when did you step down on the

Wellbutrin?

CLIENT: Yesterday morning was the first day that I took 300 instead of 450.

So, yeah, it wasn't so far nothing bad has come of it, but -

THERAPIST: But also nothing good yet. But it's early on in that process.

CLIENT: It's just really hard to wait a whole week feeling like this before I even you know, and I may not be seeing her until the 19th and that would be when I would start the (unclear) which would be the other antidepressant that works like Wellbutrin whose name I never remember.

THERAPIST: That's okay. As long as the psychiatrist remembers.

CLIENT: Yeah.

THERAPIST: And I know this is kind of a multi-part plan and it's important to give each step a chance. And it is hard to wait, especially when you're feeling so tense.

CLIENT: Yeah. Maybe it will take a while for like the Wellbutrin to get out of my for the extra benefit to get out of my system. I'm not sure, but -

THERAPIST: So let's think about what are you doing to sooth yourself? Instead of focusing on the panic, let's focus on the soothing.

CLIENT: When I can distract myself by going to rehearsal or something, I can do that. It was okay Thursday evening when I was working on the yarning stuff and so if I can do something that takes up most of my mental energy it works. If I'm just on my laptop like doing nothing, you know, playing [my catch] (ph) [00:05:14] or whatever, that's not really enough.

THERAPIST: And how much of your day do you feel like you're doing nothing?

CLIENT: Depends on the day. Tuesday I was running around. Wednesday I was cooking dinner though I got a late start. So in the morning I felt like I was doing nothing and, so it depends on the day. I guess it's going to happen especially with [tech] (ph) [00:05:45] week I had to do lots of running around and singing, but still a good portion of it which maybe having a job would be better than sort of afraid if I had a job I'd panic at that, but I mean I guess it would depend on what the job was and how much energy it took.

THERAPIST: How often did you panic at school?

CLIENT: I didn't but these panic attacks didn't really start until a month ago. Like these really intense ones. I think if I was at school like did I ever, maybe a couple of times were, I think the only time I was really panicking at school was like the last semester when I had broken up with Jonas. I was like a wreak. But the rest of the time I was fine and might be a little bit here or there but might last for 10, 20 minutes or something. It wasn't something like ongoing. And it was never to the point where I had to leave school.

THERAPIST: Yeah, it may have been that part of this is the structure of school, being involved in something is actually good for you. I know you're worried that, what if this happened while you were at a job would it get in the way of the job? But, I guess based on your history I'm more inclined to believe that you'd do better with a job. I mean I know you want one.

CLIENT: Yeah. I guess the question would be getting an interview in the first place and not panicking at the interview. And maybe, I usually don't panic at interviews though I haven't done any interview well enough to like get the job, so I finally, I did send out a job application on Friday that was like really panic inducing because it was like for a (unclear) Smithsonian that they have like some astronomy, observatory thingy, but you had to apply through USA JOBS which you had to create an account and the e-mail got delayed and it was getting close to Shabbat and I was like, ‘oh, no.' It didn't even require a cover letter but it said, ‘if you are qualified through education,' which I'm not sure I was because I also had all the job experience, that you needed your transcripts and I only found out about the job on Thursday and the deadline for it was Friday and of course, I'm not going to have my transcripts, like they take you know, five to seven business days, at least. So, I didn't attach any transcripts because I didn't have any and since then I ordered the school ones and I'm going to figure out to order the worksite one, the other one and then I'm going to so in the future I can like two copies of each one being a sealed copy and one being one that I can like open up and copy fast. So, is it okay if I -

THERAPIST: Absolutely.

CLIENT: (Unclear) so whatever. It's probably going to he'll leave a message. Sorry, (unclear) to do that before. But yeah, so and then I was freaking out because it's like okay, I spent the past few hours doing all this work to try to ‘cause you couldn't upload a resume, you had to use their resume builder and put in all your job experience and all that and with all that I, you know, will they even look at my thing. You know, because part of it is like, can you follow directions and I can follow directions but if the direction is give us this document that you don't have, then I can't so I'm not sure whether or not I even have like a little bit of a chance or if I'd just wasted like four hours of my day working on it. And I'm inclined to think the latter. [00:09:03]

THERAPIST: You can only do what you can do.

CLIENT: Yeah. Maybe I shouldn't have applied at all.

THERAPIST: Why?

CLIENT: Because then I would not have wasted all the time not having my transcripts.

THERAPIST: What would you have done instead with that time?

CLIENT: Not panicked about not having my transcripts for one thing. I don't know, because it wasn't until Thursday that I was like relaxing that I needed it bad, so I guess I wouldn't have done much but maybe it would have saved me some anxiety but most jobs don't require transcripts. It's just all government jobs.

THERAPIST: And now you have them because you went through that experience, now you've done the legwork of having them in case it's necessary for the next time.

CLIENT: I've done one third of the legwork. I still need to get from the others. I only ordered the ones from school because I could do that online. I have to call the others and -

THERAPIST: So maybe that should be on the list for this afternoon.

CLIENT: Yeah.

(Pause): [00:11:03 00:11:10]

CLIENT: He's trying me again. Is it okay if I -

THERAPIST: It's up to you. It's your time.

(Pause): [00:11:10] cell phone conversation [00:11:54]

CLIENT: He forgot that I was in therapy. That's why he called the second time after I hadn't answered.

THERAPIST: How often does he call you in a panic?

CLIENT: Not that often. Usually he gets panicky if he has to do something like in this case he had to get down to therapy and I like I called him right before my appointment to say like, because I asked him to let me know either way because if he was coming down then I could get a ride from him and if he wasn't I would take the bus back because his appointment starts a half hour after mine. But, yeah, so it doesn't happen that often.

THERAPIST: How does it affect you?

CLIENT: I mean right now I'm kind of like a little bit annoyed with that, like it would have been really nice to have a ride home especially because I'm just like so tired and out of it, but I'm okay about it, a little bit worried but like then again he panics a lot and like it's like he has a hard time getting to his appointments so I hope that he can get it together enough to have a phone session at least but then he always like feels guilty about that. It's not (unclear) but it's better then nothing, so yeah, a little bit of annoyance.

THERAPIST: So, a little annoyed, a little worried.

CLIENT: Yeah. But it depends on the situation.

(Pause): [00:13:30 00:13:38]

THERAPIST: I think both of you are having a rough time of it.

CLIENT: I don't know what to do. He knows I'm in therapy now. Oh, that's a different number. Okay. Like you said, I don't have to answer at all. Okay. But yeah, and like it's also hard like when I'm panicking. Like he's gotten a lot better about this, why I've been having these crazy panic attacks without being comforting, but sometimes I panic and then he panics and then our life it totally like I know it's irrational and like I'm the one who was panicking first. I don't have the ability to comfort you. You should be comforting me. ‘Cause like when he panics first, I comfort him, but like it's really annoying to like get upset about something and then have to be the one to like be less upset even though you're more upset.

THERAPIST: When else can you get comfort from him?

CLIENT: What do you mean?

THERAPIST: Well, you can get comfort from him sometimes if you're panicking and I'm wondering what other times is he able to comfort you?

CLIENT: Usually it's only the panicking that's needing the comforting. I mean I'm depressed also but usually everything bad that's happened lately has been manifesting itself in the form of panic.

THERAPIST: When else do you get a lot of attention or more affection?

CLIENT: (Unclear) when we're around each other. You know, like if which is a lot of the time considering we're both still unemployed. But like he also does ask me for hugs and I'll ask him for hugs and that to me at any point is also, most of the time yeah, it's not like he's ignoring me, right? It's never like he's ignoring me or anything. It's just like his needs become more apparently urgent than mine do even though like I was the one who was panicking first. So -

THERAPIST: Well, I know sometimes we've talked about feeling like your needs are going unmet with regard to affection or intimacy and I'm wondering if maybe this is sort of another way, which sometimes you feel like your needs aren't being paid attention to -

CLIENT: Yeah, it is. I mean it's good he's getting better about it, but like it sometimes happens that he'll get upset and I'm like, wait, you're getting upset because I'm getting upset. So yeah, right. I mean I'm also like shifting my expectations and stuff which was why I was like, okay, let me know whether or not you're coming in. If you're having a phone session I'll take the bus home rather than (unclear) [00:16:37] get a ride back and I'm like still is he really tired from last night and like I was really hungry this morning. I had lunch before coming here and was still like feeling a little bit of pain in my stomach for having not eaten for so long, so like I can probably drive myself back up to you. It will just be annoying and part of me is thinking, ‘maybe I should just spring for a cab' even though that would use up like a good portion of the money that I just earned from (unclear) [00:17:13] this morning. Maybe I could like you know, I'm finally like done with the stuff with the historical society for the grant. I actually got the last check. It came yesterday night or I guess it would have come Saturday and then I cashed it today but I'm pretty sure Tara would probably be fine with me, either coming out and doing more like voluntary stuff or coming out there just hanging out and being social and doing job application-y things, ‘cause yeah, she's very supportive. She's like, ‘oh, if there's anyone you want me to introduce you to that I know, and I'll be happy to write you a letter of recommendation and all that, so -

THERAPIST: That's great.

CLIENT: It is. That would be a great place to escape to like and there have been times that I've been panicking before going to work there and being fine once I got there, so. In most cases I probably could do going to the job will stop me panicking except for when that job is (unclear) and not just sitting around being Jewish.

THERAPIST: But that's not as engaging. It doesn't give you a focus the same way that doing a project gives you a focus.

CLIENT: Yeah.

THERAPIST: It sounds like maybe keeping yourself on somewhat of a schedule to go in and volunteer would be useful for you in a couple of ways. It gives you that structure, a place to go, or escape, something to focus on. It also keeps you connected to that world. Tara is supportive. It's great to have somebody who's supportive in your corner and if she's willing to introduce you to people she knows, maybe she meets somebody new, keep you in that loop. It sounds like that would be a really positive thing to keep as part of your week.

CLIENT: Yeah, and now I'm going to have even less structure, well, I have a couple more rehearsals because we have another event next week but (unclear) but I guess we're also, over winter break recording some songs, so I guess I will still have that structure, kind of. And that's also at night and like doesn't really help take [00:19:35]

THERAPIST: Doesn't really help take up part of your day.

CLIENT: Yeah. So, I still need stuff to do during the day, but -

THERAPIST: Is there anything going on with the temp agency process?

CLIENT: I actually talked to a human being on Friday.

THERAPIST: Oh, wonderful. How did that go?

CLIENT: Well, so I sent her the resume and she did remember me. She had forwarded my resume to one of her colleagues and then I guess, you know, the week of Thanksgiving everyone was they were short staffed because everyone was out, but she was going to tell the colleague that I was like in touch again and if I didn't hear back from them by Monday, which would be today, to call again. So -

THERAPIST: That needs to be on your list if you haven't heard from them by the end today -

CLIENT: Which I'm sort of expecting a lot, so -

THERAPIST: Maybe think about making a plan to call them by 4 or something like that.

CLIENT: Yeah.

THERAPIST: Because a lot of the time, a lot of the data get to you but not waiting until the very end of the day when they'll probably be gone.

CLIENT: Oh, I mean when I talked to her on Friday it was towards the very end of the day, so that actually worked out better than I thought it would, so yeah. And that would at least give me something to do and get me out of the house.

THERAPIST: It seems like that could be really useful.

CLIENT: Yeah.

THERAPIST: Help you feel productive.

CLIENT: And financially independent.

THERAPIST: It takes away one of the stressors.

CLIENT: Really, somewhat like I don't even know like what they pay us (unclear) [00:21:28] probably depends on what temp job you're doing.

THERAPIST: Yeah, but more than you're making now, currently.

CLIENT: Yeah. But like not necessarily enough to be financially independent (unclear) with job search. [00:21:46]

(Pause): [00:21:42 00:21:56]

CLIENT: And then, of course, my mom will have to send me another e-mail (unclear) here's this job which is this job at the university which is just like an administrative assistant position and I'm like, ‘that's not (unclear) I'm trying to go like there is the e-temp side and the (unclear) side. I'm not going to also do another like third job search for administrative assistant positions but I can't tell my mom to stop sending me job stuff. I mean I could, I just don't feel like having that discussion with her.

(Pause): [00:22:23 00:22:31]

THERAPIST: That feels nagging.

CLIENT: Yeah, and it's just like you're not being helpful. It's not like I'll even be considered for those jobs anyway, but it's like because there are people who have much more experience being in that position and I don't, I just have lots of fancy degrees so. And like the ones that I did apply for, it's not like I ever heard back from any of them, not that there were that many, but you know, I think I'd have better luck with the archive stuff.

THERAPIST: You have had better luck with the archive stuff because you've at least gotten something you can use even though they haven't resulted in a job offer yet.

CLIENT: Yeah, that's true.

THERAPIST: Getting further in the process when it's more within your field.

CLIENT: Better to do that.

THERAPIST: Give all your energy to that.

CLIENT: Yeah. And it's also hard having all that energy when I'm panicking like the times I was able to do that you know, because it was just like (unclear) [00:23:28] I mean the jobs today are like, ‘wow, that looks really cool.' And like, ‘oh, wow, the deadline's tomorrow.' Okay, I'll do this and I made myself do it.

THERAPIST: And that was a lead you can take.

CLIENT: Yeah, she said that to me. She sent me some other ones too but I was a lot less motivated at that point for those. But, I should check back with those to see if any of those are still open. Probably not at this point, but yeah.

THERAPIST: Would today be a day where it feels useful to make a list because you've put a couple of things on that list in your head.

CLIENT: Possibly. My laptop's good. I could put a list on it.

(Pause): [00:24:18 00:24:24]

THERAPIST: I know we did that recently. Was it useful?

CLIENT: Kind of. I mean look how those that was the list that I made and then I got really, really ill and almost nothing on that list got accomplished.

(Pause): [00:24:33 00:25:05]

CLIENT: Okay, I have a document up and I can turn it into a list now.

THERAPIST: So, you had mentioned calling back the temp agency if you haven't heard from them today. And then you just mentioned checking back in with those leads that Tara had sent you that you didn't follow up with.

CLIENT: And then tomorrow going down and going clothing shopping with my mom to pick up the sweater the online sale go applicably with the you know (unclear) they're all lightweight and I'm like ‘those aren't sweaters, those are (unclear) knitted shirts that you're calling sweaters.' So, (inaudible) [00:26:18] big ones, like -

THERAPIST: Well, I think the idea of this is to keep it reasonable.

CLIENT: And I can't put ‘don't panic' on the list because it's not really -

THERAPIST: You can't. You can put on things that tend to combat panic, so like I'm thinking about tomorrow if tomorrow you're going shopping with you mom that's typically a somewhat stressful experience for you. What are some things you can put I around that to maybe ease some of the stress?

CLIENT: I'm not sure.

THERAPIST: What usually makes you feel better?

CLIENT: (Unclear) alcoholics. I'm thinking of driving down with the because I realized if I took the train then I have to carry my clothing home, so I can't have a drink because I'd be driving. I think what makes me feel better after that is getting away from my parents and like keeping it at a limited attraction.

THERAPIST: So since you're driving you're not going to have the bus schedule or train schedule to limit your visit. So how about setting a time, letting your mom know what time you need to be back in town or something like that so that you know what the time limit is going to be.

CLIENT: You know I do need to be back in town because I do have a rehearsal that night but it's not until 9:30 and I thought it was at 7 originally. I guess if I like did need clothing right away I'll probably call my mom after this mostly to see if, like if she was willing to like ship everything to me then I could do the train which -

THERAPIST: Would you prefer the train?

CLIENT: I think so, especially because then I don't have to deal with rush hour. Like, I like the autonomy of having the car on the other hand, yeah. The train would limit the time and necessitate getting back by a certain point.

THERAPIST: So, yeah, if you could do that, that might minimize the stress of traffic, the timing issue.

CLIENT: Yeah.

THERAPIST: It also lets you bring something to read or knit, or other to occupy yourself where you obviously can't do those things when you're driving.

CLIENT: Yeah, if I had enough, like if I use Sydney's computer we could theoretically burn some (unclear) [00:29:02] onto CDs and I could listen to those but it's not quite the same though it is better than nothing.

THERAPIST: Yeah, so if you're going to drive that might be an idea to do that, but if not -

CLIENT: Yeah.

THERAPIST: But if not I'm sure you'll bring a knitting project and book.

CLIENT: Knitting and probably a disc is never a problem, I always have at least 12 with me at all times.

THERAPIST: How is been able getting some exercise in your day been going?

CLIENT: I don't have that much of I mean today like did a little, walked to the bus and stuff and I'll be walking back from the bus but that's only like walking I did a little bit of walking on Saturday.

THERAPIST: And how's that been on your back?

CLIENT: It's been okay. Like, (unclear) night was actually like the rehearsals like just the whole standing like my feet were getting really sore just from standing even like though these shoes are comfortable it was even worse when I had to like change for the concert into like less comfortable, but more formal shoes, but so if I wear sneakers it's not too bad. My lower back might hurt a little bit but I can deal with it and if I'm not carrying anything, then that's really fine. But yeah, it wasn't really like dying, carrying my backpack with my laptop to (unclear) [00:30:34] this morning so I can do it.

(Pause): [00:30:35 00:30:44]

CLIENT: And I probably should do it more.

THERAPIST: Well, I think it certainly can help. Exercise is really a good way of combating some anxiety and contributing to a positive mood. I know it's one of your goals has been to have more activity and trying to control your weight.

CLIENT: But if I'm panicking at midnight which happens a lot.

THERAPIST: It's not necessarily something the impact of exercise has on mood isn't just instantaneous. It's actually if you exercise on a regular basis it changes mood on a more global level. It's not something that if you're panicking, go take a walk and you'll feel better. That actually works sometimes just to get you out of the situation, but the point of exercise is not to do in the moment that's something you can just incorporate into your day and it actually creates an overall shift. So I am absolutely not suggesting that you get up at midnight and go take a walk outside.

CLIENT: I mean if Sydney came along with me I could do it. But, I'm not going to do it by myself.

THERAPIST: You don't have to. That's not that's not the only way that it can be useful in terms of helping to manage the anxiety. It can also be used as more of a preventative measure, not just an overall wellness -

CLIENT: I mean Sydney is like in touch with a personal trainer and he needs to call him back, so -

THERAPIST: Is that something for both of you? To do as a couple?

CLIENT: Because I do like small classes of two to four people so -

THERAPIST: You guys can do that as a very small group.

CLIENT: Exactly. It's less (unclear) [00:32:28]. His insurance pays for part of his and I don't know, my insurance might pay for part of mine. I don't know. (Unclear) my parents would pay for it. But I haven't told them. I don't want to tell them about it until it's actually (unclear) because they'd get all I don't like talking to them about weight stuff because then I feel like I'm accountable to them or something. And in this case, I'd be spending their money on it but that's the only reason why I would tell them because in that case spending their money on it kind of does make it their business even if otherwise but they were willing to pay for a gym membership so I think this would be a -

THERAPIST: Yeah, they've been fairly supportive with things that are healthy for you.

CLIENT: In terms of paying for them. You know. In terms of not being judgmental or nagging and that's less than true. They financially yeah, it will be financial support. But that's, yeah. It still means I want to avoid talking to them about that at all costs.

(Pause): [00:33:35 00:33:49]

CLIENT: I guess I am panicking right now if you're wondering.

THERAPIST: When did that start in session?

CLIENT: I think it started before session actually. I think I've been panicking this whole time. I've been panicking this morning, took a little nap (unclear) by accident but yeah. I don't even know when it started. I think it started before session but at this point I can't (unclear). [00:34:21]

THERAPIST: How intense is it right now?

CLIENT: It's like low level in intensity. Possibly could be still working it's way up.

THERAPIST: Is talking about it making it worse?

CLIENT: Possibly. But it's like I can't not talk about it. That's not going to make it go away.

(Pause): [00:34:40 00:34:47]

CLIENT: So, yeah it's not really one of those things that you can ignore and make it go away. It stays no matter what.

THERAPIST: I know it's really uncomfortable.

CLIENT: Yeah. Like I'm still like feeling like I want to hurt myself, or feeling suicidal sometimes like you know, like that hasn't gone away either.

THERAPIST: Is there change in your thinking about a plan for how to hurt yourself or intent to actually follow through on those ideas.

CLIENT: No.

THERAPIST: So it's still a fleeting thought that comes up, something that you don't think you'd do.

CLIENT: By fleeting, you mean it sticks around for at least a couple of minutes, or is it just like there and gone?

THERAPIST: And that's how long you feel like it sticks around for a couple of minutes?

CLIENT: I think. It's like it really (unclear) [00:35:40]

THERAPIST: These things are always kind of hard to, no one's clocking it.

CLIENT: Yeah.

THERAPIST: Trust your judgment to your experience.

CLIENT: Yeah. Like definitely more than a few seconds.

THERAPIST: Would you like to try a breathing exercise right now? See if that's something that might be useful?

CLIENT: Sure.

THERAPIST: So, close your eyes and I'm going to close mine, too. You're not being watched. See if you can try to extend your breath so you're taking a slightly longer time as you inhale and exhaling in that same amount of time, matching your inhales to your exhales.

(Pause): [00:36:24 00:36:36]

THERAPIST: I'm going to give you some movements to do and you just want to work at your own pace matching the movement to your breath or whatever feels comfortable so whenever you're ready to inhale and your next inhale I want you to make a tight fist with your hands. And when you're ready to exhale, let that fist go.

(Pause): [00:36:56 00:37:07]

THERAPIST: On your next breath as you inhale you're going to bend your elbows bringing your hands towards your shoulders. And when you're ready to exhale you can let your hands fall all the way down letting the tension go. On your next breath in whenever you're ready, shrug your shoulders up to your ears and as you exhale let your shoulders fall all the way down. On the next breath in, whenever you're ready, drop your head forward so your chin comes towards your chest. Then as you exhale, whenever you're ready, let your head float up to a natural position.

(Pause): [00:37:59 00:38:05]

THERAPIST: On your next breath in give yourself a hug, grabbing your hands around the front of your body, crossing your arms and then whenever you're ready to exhale, let that go letting your hands come to a natural position, wherever feels comfortable.

(Pause): [00:38:20 -[00:38:27]

THERAPIST: Next breath in squeeze your legs tightly together and whenever you're ready to exhale let your legs go letting you relax.

(Pause): [00:38:38 00:38:46]

THERAPIST: Your next breath in you're going to take your toes and you're going to flex them up toward the ceiling and as you exhale whenever you're ready, let them flop back down to a comfortable position.

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

THERAPIST: And then just breathe and let your body be as comfortable and relaxed as you can.

(Pause): [00:39:11 00:39:21]

THERAPIST: You might want to think about something that feels comforting, whether that be remembering a place where you felt really comfortable or thinking about wrapping up in your favorite soft blanket, something to associate with a comfortable feeling. Imagine yourself being in that space, be in your warm bed or some place else wrapped up and safe and comfortable.

(Pause: [00:39:49 00:40:02]

THERAPIST: Then when you're ready let yourself come back to the room. Let your breathing return back to normal, your body in a comfortable position. What was that like to be led through those movements?

CLIENT: It was sort of relaxing and then there was sort of panic on the side that was still there like it didn't go away.

THERAPIST: It didn't go away. Sort of relaxing, you said. So let's focus on the parts that were different than what it would have been like if you were doing nothing else. What was sort of relaxing?

CLIENT: Just trying to focus on something specific like relaxing my muscles and all that.

THERAPIST: And that was a real quicky. That was maybe four minutes and if I were doing a full body relaxation with you, it would take about 15 minutes to do that, but I wanted to kind of check in with you part way through because sometimes people can find it really uncomfortable and I wanted to check in to make sure you weren't having a sort of a worse experience. So since that's something that sort of works, that's something we can practice in here doing a little more of and building on that and that's something you can do on your own. It doesn't matter what order you go in. I just kind of picked an order that I remember in my head. But that's something you can try to get yourself because what it does, it gives you a body sensation different than what typically happens when you panic and you described kind of feeling pressure, you know, kind of jittery, so doing those other movements is something different, a different body sensation than one that is typically panicky for you. And that's all you want to do, is you want to experience something different even if it just takes the edge off a little bit. So maybe we'll, since the panic has been coming up more frequently recently we can take five or 10 minutes in sessions to practice this and give you a little bit of a different experience and something to practice at home.

(Pause): [00:42:10 00:42:19]

CLIENT: I can feel the panic like fighting against me even there. It's just like (unclear) just really, really tiring and maybe I should just let it take over because there's like so far I haven't found anything like permanently gets rid of it.

THERAPIST: Well, I think part of that is because panic is a natural reaction. It's that fight or flight reaction that all beings have and you're having what's a really normal response in abnormal situations, right? You're not having a panic response in reaction to a life threatening danger, but you're not going to ever get rid of the panic, because your body needs it in case you are ever in a life threatening dangerous situation. At that point your body needs that adrenalin and it needs that response to actually make you super alert and to be able to charge down the mountain. What we want to do is make sure you're having those reactions when they're absolutely appropriate. So, right now it's combating it because they're popping up when they're not supposed to.

CLIENT: Does adrenalin, does it sort of turn off like higher levels of thinking?

THERAPIST: In the moment.

CLIENT: In the moment like permanently, but like while you're panicking.

THERAPIST: It can get in the way of rational thought because it tends to the panic experience tends to make people pretty narrow in their focus which in a life-threatening situation makes sense. Right? You only want to focus on exactly what it is that you're facing. You don't really want to be contemplating what you're going to have for dinner at that moment or some deep psychological question. So it narrows the focus and it can become a little bit irrational in that it's so narrowed. So sometimes that's why people get pretty circular in their thoughts and to have one train of thought going over and over and over again, and so that's pretty illogical. It's not when you do your best thinking but that wears off as soon as the adrenalin wears off. And there does there's always is going to follow that peak and then coming back down. It's never going to go up and stay up at that high level forever. Always going to have an end point, no matter what you do. So we can try to short circuit it and make that end point come sooner or you can do nothing and it will take over and it will still follow that pattern of coming to a peak and then dropping off. So, regardless of what you do, even if it takes over, it's not going to take over forever.

CLIENT: I don't know if it's just like in my head but there's part of me that feels like my brain was like getting slower and I have like less ability to think than I normally do and I could be completely and totally making this up.

THERAPIST: Well, I think you're exhausted because you've been having lots of panic attacks but your brain's not being permanently altered. Your ability to think complexly and about difficult things is not going away, but I do think you're exhausted and fighting this. And you're getting stuck thinking about the panic instead of thinking about other things and my guess is that that's what's going on right now.

CLIENT: It's really annoying because there's nothing that makes it permanently go away, but makes it temporarily go away. And that's it.

THERAPIST: Well, you're still working on some good plans with your psychiatrist. You're not done with that. You just started step two of the plan to see if you can get some better medical control over the panic that's going on right now. So let's not give up on that. Let's stop there for today.

CLIENT: Okay.

THERAPIST: Take a regular time next week?

CLIENT: By the way, did you call them and see what you're supposed to do with -

THERAPIST: I'm going to send in the referral information with your billing.

CLIENT: Okay. Hopefully, they'll decide to pay for some of it.

THERAPIST: Yeah, we'll follow up from the communication after that. All right?

CLIENT: Yeah.

THERAPIST: Hang in there.

CLIENT: Okay.

(Pause): [00:46:51 00:47:04]

THERAPIST: I see you have your stuffed animal in there.

CLIENT: Yeah.

THERAPIST: Yeah? That's another good, having something soft, comforting, a texture, another way to soothe yourself so good call.

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