TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Where are you today?

CLIENT: Still panicking.

THERAPIST: I'm sorry to hear that.

CLIENT: I have an appointment at least now, for Thursday.

THERAPIST: So you got that moved up, which is great.

CLIENT: Yeah. Of course I, like yeah, I also asked her about, like, if I can split the Klonopin and she said I could. So I tried doing that today but it doesn't really seem to have any effect, as far as I know. Like, I was OK this morning and then I started being panicky. And then I took the second half of the Klonopin, like, a little bit before coming here and it didn't seem to do anything.

THERAPIST: What are you feeling right now?

CLIENT: Anxious.

THERAPIST: Is that anxious separate from panicky or mean the same thing to you?

CLIENT: No, it's the same thing. I mean, some of it might be triggered by the whole I was running late because Sydney was giving me a ride and he was getting caught up with something on his computer and we ended up leaving later than I would have liked.

THERAPIST: Yeah, it sounds like you rushed in (ph).

CLIENT: Yeah, and I had to, like, go in the back of the car and get the umbrella because it started pouring out (ph). And the umbrella was stuck of course but now I have the umbrella. But I was, like, even before coming...

THERAPIST: Even before that happened...

(crosstalk)

THERAPIST: ...continuant (ph) or exacerbated feeling, like you were rushed. [00:01:37]

CLIENT: Yeah. And I ended up on Saturday, like, telling my mom about the fact that I had been feeling this bad and more (ph) suicidal and stuff. So yeah, she was like, "[Get as many appointments] (ph) as you need. We're happy to pay for it. We don't want to mess around with this." (inaudible at 01:53)

THERAPIST: What's it like to tell your mom about that?

CLIENT: Awkward. I usually don't tell her. I mean, like, when I had depression, when it started in college, like, you know. I mean, granted I was all the way in Ohio but, like, you know, it was a good, like, few weeks before I told my parents. It didn't even occur to me till someone else was like, "You should probably tell your parents." I was like, "Oh, I guess you're right."

THERAPIST: So you felt like this was something you should tell her or did you tell her so that you could feel free to schedule extra sessions? What was your motivation?

CLIENT: I was more talking I sort of, like, was on the fence and I asked Sydney if I shouldn't. He said that I probably should, that they'd probably want to know. And part of it was being able to the whole scheduling extra sessions and stuff. So, yeah. And luckily she wasn't like, "Oh, why don't you find a new psychiatrist [who's on the plan] (ph)," because yeah, I'm not doing that again. Especially when, like, she seems like she knows a lot more than other psychiatrists in terms of, like especially with the whole, like, fact that I take, like, 90 percent of the antidepressants out there.

THERAPIST: Yeah, it seems like you feel like you've met a good match and she's had some good plans and availability to be able to come in and have, you know, extra sessions or more urgent sessions. Seems like a good match for you.

CLIENT: Before (inaudible at 03:33) I was getting really bad and it was, like, you know, I was thinking maybe I should be looking into, like, what if I have to go to a mental hospital or something if I, like, start losing control of myself, you know, and I don't know anything about the mental hospitals around here.

THERAPIST: Well, I mean, one thing that we've done each time you've come in is sort of check what are, you know, those suicidal thoughts. What are they like? What are the limits on them? And up until this point and I'll ask you again today it seems like you think about it but you're not in danger of acting on those thoughts, that you don't have a specific plan. You haven't let yourself create a specific plan.

CLIENT: I mean, I have a non-specific plan, but I don't have a specific plan.

THERAPIST: What's the non-specific plan?

CLIENT: I mean, the non-specific plan is that, like, I assume if my body is this allergic to serotonin if I, like, you know, took (inaudible at 04:38) that probably would (inaudible at 04:42) cause lots of problems for him and I'd feel bad taking his stuff.

THERAPIST: You had an idea?

CLIENT: So it was this big idea.

THERAPIST: Is that something that you would plan on doing or have plans to do?

CLIENT: No. It was, like, it crossed my mind and then I sort of ruled it out.

THERAPIST: OK. So, you know, I think we should maybe create some guidelines for you so that you don't have to wonder. "Should I call a hospital? Is this something that I need to do?" With a non-specific plan like that therapists would call that an idea rather than a plan, because that's not something you are actively thinking you'd actually do right now. So that generally is not thought of as hospitalizable, certainly not against your will. You can always volunteer to go to the hospital, whether or not they'll admit you and insurance will cover it. You have to sort of meet criteria. Right now it seems like outpatient is really the best match for you because although you're really uncomfortable and these thoughts cross your mind, you're keeping yourself safe, which of course is where I want you to stay, keeping yourself safe. Having, like, ideas like that shows that you're really distressed but ruling them out shows that you can keep yourself safe.

CLIENT: Yeah. It's also harder, like, when it's been, like, when I've been really (inaudible at 06:16) by myself. Like, you know, Sydney is asleep or something. You know, he said I can wake him up whenever but, like, whether or not I can actually succeed at waking him up is, like, a different matter in that I'm like [no I really need you] (ph) right now and, you know, that's when I start to get really, really scared. And, like, even, like, Saturday night, after (inaudible at 06:40) I went over to my place because we were at Sydney' place. I left Sydney at his place because I had to do yarn things (ph) and, like, I was fine for most of it and then at the end I was, like is that true or was I panicking the entire time while I was doing yarn things (ph)? I'm not sure. But definitely by the end I was, like, really, really panicking. Like, when I was, like, before I got over Sydney' place.

THERAPIST: Well maybe we could come up with a plan for what you do when you're really, really panicking, so that you're not left considering these thoughts that are not safe or productive for you. What would you like the plan to be? What would feel comforting, safe?

CLIENT: Well, it really would be nice if there were, like, sedatives (ph) or something. I could take them. Like, except I can't take the Xanax and the Klonopin at the same time. But I feel especially if I'm in a situation where it's like, you know, I'm not doing anything urgent, I don't need to be somewhere, I'm at my house or whatever then, like, something I could take to calm myself down. But I don't know... [00:07:57]

THERAPIST: And Klonopin you feel like doesn't work or certainly doesn't work in the dosage that you have a prescription for, to do that.

CLIENT: Yeah.

THERAPIST: So that's one thing to talk on your Thursday appointment. Thursday is that what you said it was?

CLIENT: Yeah.

THERAPIST: On your Thursday appointment, is to talk about saying that taking a half a pill doesn't work to calm you down in the moment when you're having a panic attack. Is it OK? You know, finding out if it's OK to increase that or is there something else you can take in the moment.

CLIENT: Yeah. Like, you know, I can't mix Klonopin and Xanax.

(crosstalk)

CLIENT: Yeah, the other thing I'm going to ask her about is, like, sleep medications because, like, last night I was feeling really panicky before I went to bed. I actually was able to get to bed and then I woke up at seven o'clock in the morning feeling panicky.

THERAPIST: What time did you go to sleep? How many hours of sleep did you get?

CLIENT: I went to bed at 1:30 and my alarm was set for 8:45.

THERAPIST: And you woke up early?

CLIENT: Yeah. I went back to sleep but, like, it was like, you know, I would have liked to have not woken up in the first place. And, like, you know, there are other times that I've, like, woken up many times in the same night. And so something that will allow me to sleep through the night. Because, like, you know, this is usually never a problem. Usually once I go to sleep I'm asleep, you know. And, like... [00:09:21]

THERAPIST: But this has been popping up and it's been popping up at night.

CLIENT: Yeah. And, like, I'm still having the nightmares and stuff. And so which I'm not sure if that's been waking me up, but, like...

THERAPIST: What are your nightmares?

CLIENT: I mean, all sorts of crazy things. Like, there's this really weird one where, like, (inaudible at 09:42) that Sydney was cheating on me, like, in the same bed as me. Like, right next to me. Which, you know, would never ever ever happen but it was, like, really disturbing. And then I was trying to tell Sydney about it, which actually was also inside the dream too, I realized after. And he wasn't really (inaudible at 10:02) because that was still I woke up, but I didn't really wake up I only dreamed that I was waking up. So that one was, like, from, like, two night ago and was really upsetting.

THERAPIST: Yeah, because that would be a horrible nightmare to have come true.

CLIENT: Yeah, so...

THERAPIST: In your waking life are you worried about him cheating on you?

CLIENT: No, it was just that dream and...

THERAPIST: It's a horrible feeling (inaudible at 10:31)

CLIENT: Yeah. And also he wouldn't be that much of an idiot. Like, anyone who cheats on someone like, no one cheats on someone, like, in the same room. Like, I don't think anyone is that stupid. But...

THERAPIST: Often times the content of our dreams is not very realistic, but the feelings are very real.

CLIENT: I mean, I'm not concerned about it in real life, so it was just like...

THERAPIST: [Really disturbing] (ph).

CLIENT: Yeah. But it wasn't yeah, so I don't know. Like, I mean, I guess I want to be able to stop panicking when I panic and, like, unfortunately I haven't really found a way to do that.

THERAPIST: Well it sounds like reaching out to Sydney feels comforting.

CLIENT: Yeah, if he can hug me and stuff but, like, if he's not there then, like, I don't really have a backup plan.

THERAPIST: I know sometimes you carry a stuffed animal that's comforting.

CLIENT: Yeah.

THERAPIST: Does that help at all, the texture or the...

CLIENT: Maybe a tiny little bit but not enough to actually calm me down. So, yeah. Definitely not enough to calm me down. And even Sydney helping (ph) me, like, doesn't completely calm me down. It makes me feel better than I was but not 100 percent better, you know. And, like, I don't have anything to distract myself, like, 100 percent. Like, it needs to be something to take up all my energy and I don't have anything like that yet. So, yeah.

THERAPIST: You know we tried that breathing technique last time and you tried the sort of progressive muscle relaxation the time before that? Were you able to try those on your own at home?

CLIENT: I was able to do it, like, try it on my own once. But, like...

THERAPIST: What happened when you did that?

CLIENT: I was still panicking and I wasn't really able to, like, go through with it. So I was too panicky to do that.

THERAPIST: How far did you get? Which one were you trying?

CLIENT: I was trying the one where I was, like, breathing in and then holding my breath for four whatever and then breathing out. But, yeah, you know, I was, like, too keyed up to, like, do it. But at least I thought of doing it. Like, also not enough to actually relax me. [00:13:14]

THERAPIST: So you said you felt too keyed up to do it? So take me through what happened. You started to try it and then what did you do instead when you felt too keyed up?

CLIENT: I abandoned it.

THERAPIST: And did what instead?

CLIENT: Went back to thinking panicky thoughts. Like, I didn't really do much of anything.

THERAPIST: How long did that last before the panic subsided?

CLIENT: I don't even know because that was, like, yesterday and then I was, like, in the car and, like, I was doing it before. And then I had gotten into the car before I actually got to driving. And, you know, then I was still driving while panicking. It lasted at least, like, the 15 minutes of the car ride and then probably more than that. So...

THERAPIST: So it sounds like you went on to somewhat focus on the driving, at least enough to drive.

CLIENT: But I was still panicking while I was driving and I was still panicking when I got to Sydney' place. So, yeah. [00:14:18]

THERAPIST: And when did you noticed that the panic had subsided enough that you didn't call it panic anymore?

CLIENT: (inaudible at 14:27) for a while because I was panicking, like, then when we were sitting there. And, like, he made me noodles and stuff and I was panicking during that. So that would have been another ten minutes. And, you know, panicking while we were (pause) maybe there were lulls in it but really I think it lasted until I went to bed, pretty much.

THERAPIST: That's a long time.

CLIENT: Yeah. Like, it doesn't go away. Now I'm wondering maybe if it really isn't the anxiety and it's depression, but it feels more like anxiety.

THERAPIST: How do they feel different to you? How do you differentiate?

CLIENT: I guess, like, depression is more of a feeling of sadness and, like, I can't stop crying. Like, anxiety will sometimes makes me cry but it's not, like, constantly making me cry. They're, like, very similar but, like, they are somewhat different. But just, like, the anxiety should not be lasting that long. Like, there's no way. [00:15:34]

THERAPIST: Well, so this is sometimes how we distinguish between panic attacks and anxieties. Panic attacks by definition are more discreet. And because yours are extending and lasting so long, you kind of having lulls and coming back, it sounds more like high generalized anxiety because, you know, usually when people think about panic attacks they're thinking about feeling OK, having a very intense ten minutes or so with a discreet end, where they know it ends and it goes away. And they might worry about that coming back but it doesn't feel like they're panicking about it coming back. More of a, you know, like, "Oh gosh. I don't want to feel that again. That was horrible. I hope that doesn't return."

So a real worry in your head and the panic is more visceral in your body. But there's a discreet beginning and end. And it sounds like what you're experiencing feels so ongoing. It feels more chronic, where you're able to have it subside somewhat to be able to drive. And then maybe it comes back more when you're less distracted but then it's more soothed by some other form of distraction, but it's still there. The fact that it's still there and going on so long makes it sound more like a high generalized anxiety. And of course these things are related, right. I mean, panic and...

CLIENT: High generalized anxiety just keep on lasting for this long? [00:17:06]

THERAPIST: It can. There's no rule on how long anxiety can last.

CLIENT: Yeah. Well, but there might be a rule on how long my body can, like, keep this up before it, like, crashes or something, like, if this is adrenaline and stuff. How much adrenaline can my body possibly produce, you know? And the fact that I, like, wake up early, early in the morning and I'm awake.

THERAPIST: You're already keyed up, yeah.

CLIENT: Like, it shouldn't be this ongoing. And maybe some of this, like, later is being triggered like, because then we ended up ongoing on out for breakfast. Then I wanted ended up having because I was like, "Maybe I shouldn't have caffeine." So I had, like, half decaf coffee, because I wanted the (inaudible at 17:49) coffee, which was caffeinated, which in retrospect probably wasn't such a good idea, even with the half decaf. Like, that's not much caffeine. It was one cup of coffee. And, like, even if it caused this bad of panic it's not like all of the other times I wasn't drinking coffee.

THERAPIST: Yeah. I mean, this is not fabricated. I know that what you're feeling is real and it's uncomfortable. Did the caffeine exacerbate it maybe, or mimic it? It's possible because it's so closely linked the feelings of caffeine and the feelings of jitteriness and yeah, again, adrenaline. But, you know, having the coffee is not what started this. Maybe did it exacerbate what was going on today? Possibly. It's a good idea to stay away from it for now, especially because your sleep is being interrupted. But that's just one teeny little piece of what's going on. It's not everything. [00:18:53]

CLIENT: I'm trying to get enough sleep and usually I can get enough sleep but, like, if all of my or I guess the majority of my waking time is filled (ph) with this anxiety. And then I feel really, really tired and stuff. Like, I'm sure I'll hit that sometime today. Probably, like, during the middle of my performance or something. Because we're singing (inaudible at 19:19) tonight at MIT. So I bet I'll crash then. But, like, I can't feel like this forever, can I?

THERAPIST: No, you're not going to feel like this forever. What's, you know, a combination of figuring out the meds to help you through this really tough time and addressing what's causing it. I mean, we need to I think resolve some of the things that are going on and have been chronically going on in your life to resolve it. I really think that a lot of the anxiety that you're feeling now is your resources of coping with being unemployed, being frustrated somewhat in your relationship with Sydney, being resentful of the dependence you have on your parents. I think you're worn down from dealing with those things. I think we really need to address those problems so that you feel better about where your life is right now. I think if you felt more confident about where you are in your life your anxiety would be less. [00:20:34]

CLIENT: It just doesn't seem like even those four, like, things should be enough to cause this much anxiety for this many weeks. Because this started like, OK. There was, like, a time off but it originally started in the very end of October and, like, even if we (inaudible at 20:52) still been like two weeks, like, even since that last appointment that I had and, like, maybe five days. So it's (ph) been, like, two and a half weeks of pure panic.

THERAPIST: How distressed do you think you're allowed to be?

CLIENT: Not this distressed. Not distressed enough that I can't do anything about any of the things that would, like you know, not that I can do anything about all of the things but, like, you know. I went to the temp agency on Friday, though I was able to do that while panicking. But, like, I've been too panicky to write any cover letters. You know, maybe I could try to write on while [I'm in panic] (ph), but I've been trying to deal with the panic and it's just taken over everything. And, like, that, you know so the panic is preventing me from facing either the being unemployed or the being dependent on my parents.

THERAPIST: The panic is preventing you? [00:22:00]

CLIENT: Now it is. I mean, before the lack of motivation was preventing it but then I was, like, finally starting to get motivation and then (pause) I started feeling like this.

THERAPIST: If you can drive while panicked, what stopped you from being able to write when panicked?

CLIENT: Writing requires more intelligence than driving does? I mean, driving you have to be careful on the road and stuff and it's not necessarily the best thing that I'm doing. You have to be aware of your surroundings. But, like, writing cover letters, you really have to, like, think. And maybe...

THERAPIST: You've written a lot of cover letters. I think you're probably pretty good at it by now.

CLIENT: Or really bad at it because none of them have succeeded in getting me a job. Like, maybe I could copy and paste them. Maybe. But it's hard to, like, even focus on, like, you know, going to the Web site and, like, looking at the postings and finding one that would be a good fit and applying to it. [00:23:07]

THERAPIST: It's certainly a lot easier to do those things when you're not feeling anxious.

CLIENT: And also the difference is with driving, like, I have to. Like, I had to get back from rehearsal to get to Sydney' place. I had to. I couldn't just stay, like, in front of the university for the rest of the night. Whereas I don't have to immediately write a cover letter. I have to write them if I want to get a job, but...

THERAPIST: So do you want to get a job?

CLIENT: Yes, but that's not, like, as urgent as getting out of there.

THERAPIST: I think it is.

CLIENT: And I guess the other thing is also writing the cover letter doesn't also instantly get me a job the way that driving myself out of the school does.

THERAPIST: It doesn't have that very instant gratification of, "I've solved this problem," right. So when you're leaving rehearsal and you feel panic, forcing yourself to get in the car and drive home instantly solves the problem. You've gotten yourself home. You're no longer stuck at this place. And writing cover letters and looking at the Web sites and finding jobs doesn't give you that instant gratification because there's no guarantee that this is the cover letter that's going to get you a job. But I do think it's just as important, because if you can't yourself out of the situation where you feel stuck I don't think this is going to change much. There's nothing else that's different in your life and right now you're anxiety is worse than it's been in a really long time. And this is the, you know, I think being stuck in this situation is the thing that's so different from when you were in library school or when you were at divinity school. And the big difference is that you feel stuck unemployed for a long time now. [00:24:58]

CLIENT: I did go the temp agency [and they did] (ph).

THERAPIST: That's great. How did it go?

CLIENT: I mean, I think the interview went well. It's just they didn't have anything immediately for me but I now have a person who is my contact and, like, he said he'll be in contact with me, you know, every week. Like, we should, you know, see if, you know, if he has anything for me if I have, like, made any progress with the job search and stuff. And so now there's, like, something concrete there. And also he said that, like, some of his colleagues, you know, might contact me with opportunities. And usually they try to give at least one day leap (ph) time for things. And sometimes they can do more and sometimes they can't.

THERAPIST: So that's a great step, that you followed up on that and you did the interview.

CLIENT: Yeah, because the other thing was also Friday can be a really slow day. So, like, that's probably why they didn't have anything but, like, you know, I guess I can sit around and wait for them to, you know, get me something or call them this week. But it won't immediately (pause) I don't know if that will fix things. So I don't know if that actually is an excuse to not write cover letters but it's a lot easier than writing cover letters. And if I do get temp work then at least I have a place to go. [00:26:28]

THERAPIST: Yep, it solves some of the issues.

CLIENT: So, yeah. I've just been I don't know. Like, sometimes I can get things done and sometimes I just can't. But I'm panicking all the time, so...

THERAPIST: So if you're going to be panicking anyway, you might as well be panicking and getting things done and working toward getting yourself out of this situation.

CLIENT: Yeah, because I'm so convinced that, like, nothing I do will even do anything.

THERAPIST: Well, and that's a pretty hopeless position to believe yourself in.

CLIENT: I'm just, you know, because of all my experience and all the cover letters that I have written and stuff. And, like, you know, none of them... [00:27:32]

THERAPIST: There's lot of evidence you can look at that will point to the fact that doesn't work. Because you had all these you had written lots of cover letters and you've submitted lots of applications and it hasn't worked.

CLIENT: And I've gone on interviews.

THERAPIST: And it hasn't worked to get you a job thus yet. So there's lots of evidence built up in the direction.

CLIENT: Not even, like, a job that I'd, like, not like as much as another job or something. And still, like, there's really nothing I can (ph). So it's just, like, hard to get myself to write this cover letter while I'm panicking if the cover letter will just be one of many other cover letters that gets completely ignored.

THERAPIST: I can totally understand that argument.

CLIENT: But, like, I really want to get out of this situation. I really want to be able to start saving money so I can, like, you know, have my own place at some point.

THERAPIST: So you need to choose something to focus on that supports that wish. I really want to do something to get myself out of this situation, is what I just heard you say. You need to focus on, well, what are the actions that you would take if that's what you were thinking? Rather than, "What are the actions I would take if what I'm thinking is this situation is hopeless and nothing I do is going to change it." Because it sounds like those are the two things that are in your head. [00:28:56]

CLIENT: I feel like contacting the temp agency was probably the best thing I could do right now because then at least now it's their job to find me a job instead of my job to find me a job.

THERAPIST: So you've set that in motion and I think that is a really positive step to get them working on your behalf.

CLIENT: Yeah. I don't know if I should then talk to another temp agency or multiple temp agencies or if that would be too much too manage. Like, this one is, like, the largest, like, local temp agency, so...

THERAPIST: So it seems like a good one to have working for you.

CLIENT: Yeah. So, you know, they seemed enthusiastic about being able to get me something and again maybe they're always like this but I don't know.

THERAPIST: Well, it's their job to look for temporary positions, right? Work that's available.

CLIENT: Yeah. Because the thing is also they have temp to permanent and then also some places, like, outsource their permanent stuff to them. And also it turns out they do work with, like, four of the libraries at the university, so, like...

THERAPIST: Oh, awesome.

CLIENT: You know, it would be more possibly admin assistant stuff at a library but that would at least be, like, closer and then I'd be, like, you know, more likely candidate for that since I have, like, the library experience and could you know, that's the kind of thing that could in theory lead to something if any of the libraries were hiring for more than temp. But at least that's something, but I have to wait for those to open up again, because right now there's not anything that anyone's instantly working on. So, yeah, I just have to wait. And I don't know if, like, writing one cover letter a week will, like, actually be doing much to change my situation. But, like, you know, or if I should be trying to do more with stuff, like, not in my field, especially with the, like, whole I have not gotten a single response for any of the cover letters that I've written outside of my field.

THERAPIST: So maybe focusing on looking for things that are available in your field. So a temp agency is going to be looking for, you know, everything their jurisdiction. And maybe your leftover energy and taking whatever focus you can and putting that toward looking at permanent stuff in your field, narrowing a scope to just that to make it manageable.

CLIENT: Either that or (inaudible at 31:26) yarn because people actually are buying yarn from me, but not enough to get me out of this situation but, like, you know, I had, like, two sales on Thursday and another two sales on Friday.

THERAPIST: This is probably a good time of year for that.

CLIENT: Yeah, I guess some people are getting yarn to well, at this point it's starting to get really late if they're buying yarn to make Christmas presents. But I guess if they're I guess also right after Christmas when they get all the Christmas money will be a really good time, hopefully. But, yeah, like, I'm potentially what that package is, is a custom order of yarn that I have to send. But it's really nice to, like, have that little bit of money that gets added to my PayPal account, but it's not like, you know, it's not enough to...

THERAPIST: And it's also nice to know that people really like your stuff.

CLIENT: Yeah. You know, and if people, like if I had that many sales, like the sales that I got that day. Like, if I had those sales everyday then I might, you know, be making enough to cover rent. But still, it's not but it's never ever going to be that consistent.

THERAPIST: You need something else maybe to...

CLIENT: Like I need a real job. I guess I'd do fine with, like, the combination of yarn and temping. But, yeah, it's just not I just don't think I'm going to get a real job anytime soon in my field. I could write cover letters but, like, I don't know that that's actually addressing the I need to get out of this situation thing because, you know, if it's not doing anything, you know, I might as well be, like, sending my resumes in, like, formal paper (inaudible at 33:22) in different directions. And I might be getting just as much a response to that as I am to writing these cover letters for positions, considering the evidence. Just because it's, like, theoretically linked doesn't mean it's actually going to get me anywhere.

THERAPIST: Well, what will happen if you don't write any resumes or don't send any cover letters or applications?

CLIENT: Nothing. And what will happen if I do? Possibly nothing as well. And then I'll just have spent more time writing cover letters.

THERAPIST: It sounds like what you want me to say is, "Georgia just wait and don't do anything."

CLIENT: Or at least wait until my panic subsides to a point where I can actually get some stuff done without, like, having to fight against myself to do it. Like, when I'm fighting against myself it's really, really hard.

THERAPIST: What's going to make your panic subside? [00:34:27]

CLIENT: Hopefully the current drugs, maybe.

THERAPIST: They (ph) might help. Is that the only thing you think will work?

CLIENT: And if I get handed a job then that might work. But I don't know because, like, you know, what if that was, like, what triggered it and, like, what if I do get a job and that still doesn't make the panic go away? Like, I don't even know.

THERAPIST: What if what was what trigger?

CLIENT: What if, you know, what if all these things? Like, not having a job and being supported by my parents. What if that did trigger the panic but now that I'm panicking getting a job won't necessarily fix it?

THERAPIST: Is that what you're afraid of finding out, that if you get a job and it doesn't go away?

CLIENT: I mean, I'll still be happier because then at least I'll have a job and something to do. But, like, I am worried that that's what will happen.

THERAPIST: So I wonder if part of your resistance to continuing to kind of put in applications is not wanting to test that theory. [00:35:37]

CLIENT: Maybe. The reason why I'm not doing it is because I'm panicking and not because I'm not wanting to test this theory. Like, it just makes it really hard to focus on anything and, you know, I have a hard enough time doing some things I need to do and, like, even things like doing dishes after dinner and stuff. (inaudible at 36:10) and I still haven't, like I was supposed to clean the future at my, you know, house every other week or three weeks or whatever and I haven't done it in, like, a lot longer than that.

THERAPIST: I'm a little bit worried that you're convincing yourself that you're not capable of doing these things. And I've seen you do really complicated or have heard about you doing really complicated complex things. You were writing multiple pages of papers a week and handling lots of different classes and final papers and exams. Those are all things you're capable of doing.

CLIENT: Those are all easier because they, like well, A, I wasn't panicking while I was doing any of them and, B, like, I knew that they were, you know, there were consequences for me finishing them or not finishing them.

THERAPIST: But you could do it. It's not so the difference...

CLIENT: But I wasn't panicking.

THERAPIST: The difference is the consequence. The difference is not your capability. [00:37:14]

CLIENT: But I wasn't panicking.

THERAPIST: Well, I think they're linked.

CLIENT: Like, if I feel like I want to sit in a little ball and curl up it makes it very hard to get up and, like, do dishes and stuff. And (inaudible at 37:32) have these small bursts of, like, feeling like cleaning all the things but then, like, the rest of the time I don't have that.

THERAPIST: I believe you, that you're panicking. I believe that you're anxiety is really high and that you feel really distressed a lot of the time. You don't have to convince me. I also believe that you can do these things anyway and that you will feel better when you let yourself be more productive. You don't have to convince me that you feel horrible. But I think that part of the reason that you're really distressed is that you are living as if this is the only thing you can do. And I know that you can do more. I've seen you through those periods of your life where you have juggled a lot and worked really hard at things other than kind of fighting off your panic. I think if you were devoting your energy to doing some of these other things that you can do, you would have to devote less energy toward fighting off this anxiety. It would feed you back. I think that's some of what happened in school, is when you worked really hard at things and you got good results and you felt good about the work you were doing, that prevented some of the anxiety and some of the sadness. And right now you're not getting the benefit of that. [00:39:01]

CLIENT: Maybe I should enroll in another master's program or a PhD?

THERAPIST: I think you can move on to the next phase of your life and get those same benefits from something else.

CLIENT: If I can find a job.

THERAPIST: [If you can] (ph) find a job.

CLIENT: The thing is (inaudible at 39:16) the odds of getting into a well, I don't know about a PhD program because I'd have to deal with (inaudible at 39:22). But, like, if I were doing another master's, if I were trying to get into the Master's of Museum Studies, odds would be very, very high that I'd get into it. Also because, you know, they have, like, maybe not a zillion spots but they might have, like, 300 spots whereas, like, a job will have one spot.

THERAPIST: Jobs are really scarce that doesn't mean that you can't get one of them. People are getting jobs and eventually you will be one of the people that gets a job.

CLIENT: Well, a lot more people are getting into grad schools than are getting jobs right now, I think.

THERAPIST: Well, I mean, you can debate this with me but I don't think it's going to actually make you feel better.

CLIENT: (inaudible at 40:02) for another few years and, like, maybe the economy will be better by then and actually (inaudible at 40:10) something. I can't really think of what I should go to, like, what other degree (inaudible at 40:14) . Like, if I got into a PhD program then I'd be, like, having a stipend and I'd be fine but I can't really justify spending more money on education and that's what I would be doing if I were to get a third master's in something.

THERAPIST: But what you really want is a job.

CLIENT: Being a PhD student is kind of a job. You get paid.

THERAPIST: Do you want to get a doctorate in something?

CLIENT: I used to think I did now I'm not so sure.

THERAPIST: So it seems like, you know, if you want to get a doctorate in something then apply to a PhD program. If you want to be busier and be financially independent, do what you need to do to get a job.

CLIENT: It's just that the do what you need to do doesn't always get you a job in something, whereas do what you need to do to get into a PhD program, if you're smart enough, does. Like, I've never been rejected from an academic program in my entire life, ever. The odds are just so much higher than they are for getting a job. Because, like, you know, what if I wanted to, like, you know what if my career was, like, I want to be a rockstar or something, you know. How many people who want to be rockstars, like, what percentage of the people who want to be rockstars get to be rockstars? Probably, like... [00:41:37]

THERAPIST: Well certainly not the ones that aren't working on their music.

CLIENT: True. But even the ones who are working in the music industry. A whole lot of people. You know, they might, like, do small gigs and stuff but usually they'll have to get, like, another job to, like...

THERAPIST: You're doing the equivalent of that, right?

CLIENT: Except for the fact that I don't have this other job or anything.

THERAPIST: The fact that you went to the temp agency, that would be your backup job if you were going to be a rockstar.

CLIENT: But there are no longer all the backup jobs for anything anymore and, like, [I'm just saying] (ph) there are jobs.

THERAPIST: OK, so then I'll say what you want me to say. Don't do anything. Stay home and panic. That's what you want me to say?

CLIENT: Oh, I don't know.

THERAPIST: When I encourage you to do the things that will help you, you fight me.

CLIENT: Because I do them and then they don't help, you know.

THERAPIST: So then don't do anything.

CLIENT: I'm just, I don't know, waiting for someone to hand me a job. Because that seems like the only way that people get jobs.

THERAPIST: That's not going to happen. That is not how people get jobs.

CLIENT: That's how Rebecca got her job. She was, like, having to move because she, like, only could stay for, like, a year with her parents supporting her. She was, like, needing to find a job and couldn't find a job. And then (inaudible at 42:55), like, you know, maybe a week or two before she was going to have to leave, she mentioned this, and then there was a guy who actually had a job.

THERAPIST: She networked. She mentioned it.

CLIENT: In the right place at the right time.

THERAPIST: She asked somebody. That's what networking is. You have to go mention it. And this is another thing you've been really resistant to telling people, asking people, talking to people.

CLIENT: Because I (inaudible at 43:17) actually, like...

THERAPIST: Did Rebecca know that guy was going to hand her a job?

CLIENT: She at least knows people who are, like, adult people. All the people I hang out with are, like, my age. They don't have most of them are students.

THERAPIST: You've now talked yourself out of the possibility that anybody could ever help you. So you want someone to hand you a job but you don't want to talk to people and let them know that you need that.

CLIENT: I did some networking. It just didn't get me anywhere. Like, I talked to the woman at the (inaudible at 43:52) and that, you know. I got a very nice tour of the (inaudible at 43:58) and it was really cool meeting her but I didn't get that job that I applied for there. So, it only works for some people I guess. Like, I don't know anyone else that, like, is I don't know people who are, like, looking for people for jobs, at least around here. Like, maybe every so often, like, (inaudible at 44:27) the ones that will be posted about people, like, who have jobs that they're looking for people, except they're always, like, somewhere really, really far out there. Never, like, here. Or they're for, like, director of something, which I, you know, (inaudible at 44:45) experience of, like, you know, a five year (inaudible at 44:47) or any experience with, like, increasing responsibilities or something. I'm like...

THERAPIST: I want to help you and I want to be supportive but I don't want to fight with you. And that's what you want to do right now. You want to fight. And I understand that you're frustrated with the situation and frustrated with your anxiety but I'm not the person to fight against.

CLIENT: I could wait for my grandma to die in a few years and then I'll get half of her inheritance and Cullen will get the other half and then I'll be well off and I won't need a job.

THERAPIST: Sounds like a good plan.

CLIENT: Just requires (inaudible at 45:31) another ten I have no clue how long grandma will live. She's, like, 87.

THERAPIST: So if that's what you want your plan to be and you want me to support you in that then you can have that.

CLIENT: I'll probably die of boredom first.

THERAPIST: Maybe not the best plan for you. We do have to stop for today. We can pick up the debate next week.

CLIENT: OK.

THERAPIST: I hope your appointment on Thursday is helpful.

CLIENT: I hope so too.

END TRANSCRIPT