TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: I got the job.

THERAPIST: Congratulations.

CLIENT: Thanks.

THERAPIST: That's wonderful news.

CLIENT: Of course the day after I got the job I got a call back for an interview from another job I applied to but, like, yeah. (inaudible at 00:14) job it turns out it pays 13 an hour, which isn't great. [Still better than the] (ph) temp job. And I mean, for the type of work I'd be doing I think it's worth it, like, to be doing something I actually enjoy.

THERAPIST: That makes a big difference.

CLIENT: Yeah. And then the other one would have been paying, like, 800 to 900 a week and it would be more fulltime but not completely full like, it was still part time. (inaudible at 00:40) temp. Why did I say yes right away?

THERAPIST: Well you had been looking for a job for a long time.

CLIENT: I had.

THERAPIST: The timing is certainly I guess unusual or sort of ironic.

CLIENT: I mean, yeah. I also had gotten the call about the job in the first place the day that I got the job at the temp agency. So...

THERAPIST: There's no predicting these things sometimes.

CLIENT: Yeah.

THERAPIST: I think it's good news.

CLIENT: It is. I mean, it's just so I'm going to be working 24 hours a week, so that's sort of almost enough to live off of but not really. Like, it's enough to live off of if we don't count my medical expenses and...

THERAPIST: Are there benefits with it or no?

CLIENT: No, it's hourly. And it's only a year (inaudible at 01:31). So, I mean, I think at least on the plus side I calculated, like, if I do the 24 hours a week it'll be, what, 16,000. If I did the full 30 it would be about 20,000 and a few hundred, which is actually more than working 40 hours a week at the temp job per year.

THERAPIST: Plus it's in your field.

CLIENT: It's in my field.

THERAPIST: And it sounds like it (ph) would be interesting.

CLIENT: So it's like, you know, at the end of the year I'll have to look for something else but at least I have something now. I'll probably have, like, you know, be ahead since it's easier to find a job when you already have one.

THERAPIST: Well you certainly feel less stressed because you can start looking. You know when this job is going to end so you can start looking with that in mind.

CLIENT: Well, I approximately know because it's approximately a year, sort of based on how long the work lasts. But, yeah.

THERAPIST: So when do you start?

CLIENT: I start on Wednesday. And I guess the one thing I was a little bit terrified of is the drive but I kind of was a little bit scarred by the fact that, like, driving there and back there was the snow. [00:02:41]

THERAPIST: And that's not going to be the case all the time, plus you won't miss that exit all of the time.

CLIENT: Yeah, that's true. And be stuck on the bridge for ten minutes or right off the bridge waiting for the bridge.

THERAPIST: Yeah, you'll get used to it. I'm sure you'll get used to the drive. You'll get familiar with where you need to go.

CLIENT: If I wanted to, like, make it an even longer commute I could do it without driving because, like, a friend of mine commutes far but it's already, like, 100 minutes with the buses, like, to get there. I don't really feel like I want to wake up at, like you know, if it has to be six o'clock in the morning. So probably not worth it, probably.

THERAPIST: Well, you can try it one way, try it another way, figure out what works for you.

CLIENT: Yeah. I think if I'm awake enough it will be OK and I guess if I can (inaudible at 03:41), like, I'm not hitting all the traffic.

THERAPIST: Yeah, so you have some flexibility in your hours?

CLIENT: I have some flexibility, yeah. And the other thing is since I'm only working three days a week I can easily do it (inaudible at 03:50). If a certain day is going to be snow...

THERAPIST: You just go on a different day.

CLIENT: Yeah. So that's yeah. And then I started feeling like, I found out on Wednesday. And then there was a point I guess on Thursday when I found out about the other job. And then I was panicking like, "Oh my god, I must have made the wrong decision." And I called the other job. Because the other job called me twice because first they asked for a certain time to interview and then they were like, "Can we change [to the time] (ph) interview?" Then I had to call them back and be like, "Actually, I just accepted another position, like, the day before you called me." And so now it's (inaudible at 04:28) I guess, but I still feel kind of stupid and, like...

THERAPIST: Well how could you have known?

CLIENT: I couldn't have. And I mean, by the time I felt like once I said, especially since the other one was just an interview, not another offer. So I could have easily not gotten that one. That one was even more of a long shot, so I was sort of surprised because I'd been like, I had all the qualifications except for the, like, three years working in archives. Like, if you look at my resume and, like, chronologically it would be three years but it doesn't actually add up to a full three years, since most of that time I was in school and stuff, which is why I had sort of forgotten about them (ph). And that one, like, the drive is it's still out there but it's, like, a 45 minute drive instead of, like, an hour and a 15 minutes, hour and a half drive.

I'm, like, I don't know if I'm nervous about the job. And then, like, when I was in the city with Sydney there were a few times that, like, I was really afraid to be alone. Like, he was, like, going to take a nap or something, I was, like, getting uncomfortable and stuff and, like, panicky. And I'd (ph)...

THERAPIST: Is that unusual for you?

CLIENT: Yes, it is. Like, I'm not someone's who's all like, "Oh my god, I need all the alone time ever." But, like, when I have alone time, like, I can deal with it. I can do things (inaudible at 05:55) usually, you know, or if I'm at my place I can even sometimes be productive and (inaudible at 06:01) and stuff. But, like, that wasn't the case. And I think it was Friday night it was either Thursday night or Friday night that I had this, like, really, really bad nightmare. Like, woke me up and I was like super-duper panicky.

THERAPIST: What was the nightmare about?

CLIENT: It was about, like, being in a like, it started off being something completely different. And the part that was the nightmare was (pause) I was in this, like, house and, like, I had this in this dream I had two older brothers, you know. Neither of them were Cullen and Cullen is also younger than me. These two people who were fictional who were my older brothers who I've never met in real life ever. Like, one of them was abusive and, like, I'd have to hide and I was, like, trying to plan my escape out. And, like, I don't know if he could read my thoughts but, like, you know, I had to cover my tracks everywhere and I was (pause), you know, trying to escape. And, like, you know, every time it's like, you know. He would sometimes be sent away to, like, military camp or something but, like, for some reason nobody bothered to give me notice that he was coming back when he would come back.

And, like, if he saw me ever, like, out of room or something he would, like, beat me and was like, you know, each time if I messed up a little bit and like, "Oh fuck, I messed up," I had to go back to the beginning. So it kept on happening over and over and over again, like, trying to, like, be more sneaky. He was like you know, I don't know why in my dream I didn't, like, go to the police but I imagine it's because he somehow had, like, power over them because when I tried to write a letter he, like, got the information that I gave (ph) to the post office. You know, in real life there's no way this could have happened but it was like...

THERAPIST: Well, if we think about what the feelings are in the dream rather than what the content of the dream is, the feeling well, one of feeling kind of trapped, afraid that you may, you know, be penalized or punished for some kind of mistake, that I think speaks pretty closely to some of the fears you have in your waking one. You know, what if accepting the job was the wrong thing to do? Feeling trapped, like, you know, you've accepted and committed to this job, you know, for the length of time, for the...

CLIENT: Like, I don't think it's going to be a bad job. Like, I had a really good feeling about the place when I was there, like, and it was happy. And it's like..

THERAPIST: I don't think there's any reason to assume it's going to be bad.

CLIENT: It's just the whole, no I'm not going to be completely financially independent, but at least this way I can keep (inaudible at 08:44) I think. Like, I should see what limits are but, like and I should probably inform them, like or I guess maybe after I've been working for a month and know I'm staying. But, like, you know, tell them that I have a job now? Because...

THERAPIST: I don't know what the rules are on that.

CLIENT: I don't know either.

THERAPIST: You need to check with insurance. I don't know what the limits are.

CLIENT: (inaudible at 09:08)

THERAPIST: Well it sounds like your first job is to go to work on Wednesday and get comfortable and figure out what it's going to be like and (pause) it's making a transition. It makes sense that there would be some anxiety and come questions going into a transition but you can, you know, rather than look for and make assumptions about what might go wrong, you can let yourself be open to the experience and see how it is. You don't need to predict how it's going to go.

CLIENT: I don't know. And then, like, there was panic. And, like, I don't know if the panic had started before the dream or after I'd had that dream but...

THERAPIST: It sounds like a really scary dream.

CLIENT: It was, and I woke up and I was like, "I am afraid to go back to sleep." It also took me a moment to realize, "Wait, this is real (ph). I'm in out of town. I'm a hotel room. Sydney is right there and I can ask Sydney for a hug." And, like, Sydney didn't mind the fact that I woke it turned out it was, like, four o'clock in the morning or something ridiculous like that but he didn't mind me waking him up. He's I don't know. And I think I've been OK today but, like, even yesterday I was feeling kind of miserable at a certain point. And yesterday I was doing stuff most of the day because that was, like, the day we had the acapella festival that we were singing in and stuff. But, like, there was I think it was, like, after we had performed and, like, we were all going to go out for well, the people who were staying in New York were going to go out for dinner, though I ended up not. Because Sydney was not feeling well so instead, like, because I wanted to get together with Sarah. [00:11:04]

So she met me at the hotel and we hung out there for a while and so she could at least meet Sydney and then he went back up to the room. Like, I think it was between when, like, the concert got out and I was just, like, sitting there and I texted him asking how he was feeling and he wasn't feeling so well. And I'm like, "Oh, that's too bad because I could really use a hug right now." Actually, that might have been before the concert. Sometime yesterday.

THERAPIST: You said you were feeling miserable. What were you feeling?

CLIENT: I felt like I wanted to curl up in a ball and cry and I didn't know why.

THERAPIST: So that sad feeling.

CLIENT: Yeah. Like, you'd think by now I probably should have returned to normal if it were, like, something having to do with being off birth control for a week. Maybe.

THERAPIST: Well it sounds like you are a lot more back to normal because when you were talking about that that felt much while somewhat episodic, a lot more constant during the day. This sounds like it was one episode of that than some anxiety at night sparked and in-between that feeling OK at the concert. [00:12:23]

CLIENT: I was fine when we were singing but, yeah.

THERAPIST: Did you curl up in a ball and cry?

CLIENT: I couldn't. I was in the room with people. I curled up in a I sat down in a chair and was knitting (ph) while, like, other people were selling CDs. But I did not curl up in a ball and cry.

THERAPIST: How long did that feeling last you think? Minutes, hours?

CLIENT: Probably not for that long. It definitely wasn't hours. It probably was, like, minutes.

THERAPIST: That's pretty brief.

CLIENT: Yeah. I guess I'm doing better.

THERAPIST: Yeah, it does sound like you're doing better than what you described when I saw you last. I still feel sad for you that you had that moment, but it does sound like it's certainly less ongoing than it was.

CLIENT: It's (inaudible at 13:26) less ongoing than it was. I should be happy now, especially, you know, I'm only working three days a week. During the rest of the time I am definitely not working at all, like, because I'm pretty sure all the stuff that I have to do at work is, like, stuff that's, like, only on site that I by definition cannot do when I'm at home.

THERAPIST: And rather than thinking what you should be feeling I heard you saying, "I should be happy now" but are you feeling?

CLIENT: I'm still feeling a little bit anxious I guess, though not, like, as bad as it was.

THERAPIST: It sounds like you're a little bit apprehensive.

CLIENT: I'm also a little bit tired because we had to wake up at, like, 5:15 in the morning to get the seven o'clock train.

THERAPIST: And being sleep deprived, because that's really early for you to get up.

CLIENT: I mean, we went to bed at, like, 10:30 or something. So it wasn't like I almost got seven hours of sleep, you know. It wasn't as sleep deprived as I was on the way to the city when, like, we had to...

THERAPIST: But it's also somewhat cumulative, so...

CLIENT: I guess, though in between, like, I got extra sleep for, like, you know, Friday morning and Saturday morning. I didn't have to be anywhere at a specific time, so I got a lot of sleep then. [00:14:46]

THERAPIST: But you said you feel tired.

CLIENT: Yeah.

THERAPIST: So that means you are. When you add up the hours any certain way, if you feel tired then your body probably needs more sleep and when you're tired you tend to react more tensely to things. Your ability to kind of modulate your emotion is less when you're tired, so you might react more strongly to things. It sounds like you feel a little bit apprehensive.

CLIENT: I guess...

THERAPIST: While getting the job is good news, it's also a big change.

CLIENT: Yeah, I guess my real fear, besides the oh, well I'm not completely financially independent. But whatever, my parents are fine with that. At least I'm like...

THERAPIST: You're contributing a great deal.

CLIENT: I'm taking, you know, whatever, 16,000 dollars a year worth of burden off of them, even though that's, like, not that much. It's not nothing.

THERAPIST: Yeah, financially it's definitely something. You pursued a job in your field and got one and you're building towards something because, you know, one of the things that was hard about getting a job was feeling like in a lot of them you didn't have the experience that you needed. So this would be some experience, in archives. [00:16:01]

CLIENT: Yeah. (inaudible at 16:04) if there were, like, a commuter route that went all the way to there or something that would, like, solve everything. But there isn't.

THERAPIST: You have to be a little bit creative about the commute.

CLIENT: Yeah. I guess the thing I should probably do is e-mail them and ask if anyone else commutes because if I can carpool with someone, that would solve all their (ph) problems. Yeah, because it's also trying to figure out like, it turns out, like, if I work for a little bit over an hour will pay for that day's commute in gas. And so then I'm still getting, like, seven hours worth of pay every day. So, yeah. It's just the driving. I mean, Sydney said that he would burn, like, podcasts onto CDs for me so I could have them, because he has a bunch of podcasts on CDs in his car and at this point I've listened to all of them. So, I'll be probably going through a lot of CDs because you can only put, like, about an hour's worth of material. And if the drive is an hour each way plus some...

THERAPIST: Do you ever listen to books on CD? Can you take those up from the library?

CLIENT: I could.

THERAPIST: It might be another thing that you can do safely while commuting. You could so it feels like, you know, enjoyable time.

CLIENT: Yeah, I could probably do that. I hadn't even really thought about it. Like, I was thinking about audiobooks a little but I was like, "Wait. Like, those would be really long. How many CDs would that take up? But I guess if they're audiobooks that are already on CD as opposed to downloading, like, the mp3.

THERAPIST: Yeah. I mean, I think most libraries, you know, have some stuff. I don't know what the selection would be but it might be worth checking out, seeing what you can do to make the commute more enjoyable.

CLIENT: Of course I have no clue where my library card is. I might have to get a new one.

THERAPIST: I'm sure that's something you can rectify.

CLIENT: Yeah, I'm sure I can look up in the system if there are any books that I've been thinking of reading, whether or not any of them are on CD. They make them on CDs, right?

THERAPIST: Yes.

CLIENT: And then somehow, like, missed a step between, like, tape and mp3 or something.

THERAPIST: They definitely do have books on CD. (pause) I think let yourself do it a few days, you know. Do it the, you know, on Wednesday drive because you've done it once. You know the way now. When you get there, you know, you'll meet the other people. You can find out where people are coming from, what they do for commuting. And if there's somebody coming from, you know, your area or has a tip for you, you could pick that knowledge up. The first week is really about just go, let yourself have the experience. See what it's like. You don't need to figure out all the ideas for how you'll do it forever or for a year. You can develop the habits that work for you. [00:19:37]

It makes sense that you're a little bit apprehensive, because you don't know all the stuff yet. You don't know is it better to drive, is there someone to carpool with. Is there some combination of public transportation that would work. But this stuff will fall into place for you when you've done it for a little bit and you can play around with it.

CLIENT: (inaudible at 20:02) because, like, when I did it through the Web site they were like, "Sorry, we don't go within a mile of that location. Here's the closest that we can get you." But I guess if I tried (inaudible at 20:12) they might be able to, like, give it, had its own public transportation, which I don't think it does.

THERAPIST: Yeah, I don't know much about that area.

CLIENT: Yeah, so I...

THERAPIST: Yeah, you may end up driving or carpooling.

CLIENT: This also just feels kind of ironic that I'm, like, trying to you know, my work is to help climate change and that if I'm driving there every day for, like, an hour and 15, an hour and a half, like, all that gas that I'm wasting for no good reason other than it's the only way to get there.

THERAPIST: It's the only way to get there or it may be the only way to get there. And hopefully the work that you'll do and the information that you're gaining goes to the greater good.

CLIENT: Yeah. Can people get used to commutes or, like, used to them (ph)? Because the thing is if I could...

THERAPIST: Of course you can.

CLIENT: ...carpool or anything else, like, then I could be knitting or something. But, like, if I'm driving then I have to be, like, paying attention to the road, you know, all the time, because you can't really let your focus drift off because that's not (ph)...

THERAPIST: Of course you can get used to it. And it might be well worth it because it's very different to commute for something that you don't care about or don't like versus commuting to a job that is interesting and enjoyable and worthwhile to you, you know, which this very well may be. [00:21:43]

CLIENT: Yeah, I would have the option but I just...

THERAPIST: And there are lots of people that commute, you know, an hour each way, more than an hour each way. It's just very different for you. This is new to you.

CLIENT: Yeah, it is. (pause) I had something I was going to say and it sort of escaped my mind. It was about commuting or something like that but...

THERAPIST: When it comes back to you just share it with me.

CLIENT: Like, I used to like driving a lot. It's only, like, now that I'm sort of I was just, like, driving when I was, like, driving back from work, but I think that was the snow.

THERAPIST: That's more difficult driving condition.

CLIENT: And [I got] (ph) also panicky when I was driving back from home to or there. Both ways. And that was, like, due to not being on birth control and also driving. I mean, I used to drive...

THERAPIST: So you're starting to associate those specific negative experiences with driving.

CLIENT: Well, they happened because I was driving and had to, like, keep focus on the road. And there were winds and I had to keep the car from...

THERAPIST: But that's not all driving, right. I mean, those were those specific drives were anxiety producing for you.

CLIENT: OK. I mean, I think it's also the highway driving in general and I don't think there is a way I can get to work just taking back roads without, like, getting horribly lost or taking forever.

THERAPIST: What makes you nervous on the highway?

CLIENT: You're going faster.

THERAPIST: Yes you are.

CLIENT: And the faster makes me nervous, because if I did lose control, you know, then I would, you know an accident would be horrible. If you get into an accident when you're driving, like, five or ten miles an hour, like, it will suck but you probably won't get too injured. You know, having been in a car accident that we were going five or ten miles an hour. And it sucked but, like, I didn't even have any broken bones. I even delayed going to the hospital for a couple days. Like, yeah, there is but driving that fast is dangerous. Then you have all the other cars that are going fast too and then when [you're by] (ph) trucks. I really, really hate driving next to trucks. I assume everyone does because they can't see you. [00:24:33]

THERAPIST: So thinking about what can you do to feel safer. Because there are plenty, you know, plenty of times that you've driven on the highway and not been in an accident and you're not necessarily likely to get in an accident. Lots of people commute everyday safely.

CLIENT: I guess I just don't feel like I'm the world's best driver. I'm actually an OK driver apparently. I'm bad at parking but I'm fine at driving. So...

THERAPIST: And practice will give you the opportunity to feel a lot more comfortable with it. You know, maybe partly what has made you more anxious is that, you know, for a lot of your time you don't have to drive. But maybe getting used to it and to being in control of what you can be in control of. You know, if there's a big truck that's driving next to you, slow down and let the truck zoom ahead or switch lanes so that you're further away. You know, these are some of the things you can control. Can you control all of the traffic? Absolutely not. But you can position yourself so that you're more comfortable. [00:25:40]

And those are the things that I want you to focus on when you're driving. Rather than thinking about what could happen or, you know, what's the statistical probability of this thing or the other thing happening, focus on what you can do. You can pay attention to the road. You can make sure you're in your lane. You can be aware of your surroundings. You can switch lanes if you're feeling uncomfortable about the distance somebody's keeping from you. You can determine how much distance you want between you and the car in front of you. Focusing on what you can do to keep yourself as comfortable and safe as possible. (pause) And stopping some of those what-ifs, because they don't change the outcome they just make you nervous about a potential negative outcome.

CLIENT: I mean, it's not like when I'm driving I'm necessarily actively thinking I'm going to be in an accident, I'm going to be in an accident. What I am thinking is, "Oh my god, I'm going really fast. I have to keep control of this car and I'm, you know, if I'm tired or something and, like, I'm tired and I need to stay awake, I need to stay awake. Bad things will happen if I don't stay awake." And you just get tired when you've been driving for so long just because it's, like, it's mind-numbing. [00:26:59]

THERAPIST: Which is why you'll get some books on CD or download more podcasts or sing along to the radio. Practice your acapella music.

CLIENT: Well, I can only do that if I have it memorized because if not I'm going to be driving and reading -

THERAPIST: (inaudible at 27:17) singing the ones that you memorized. And these are the things you can do.

CLIENT: I just really wish I knew anyone else who, like, commuted, like, from here to there. But I feel like that's probably a commute that very few people too. It would usually be the other direction.

THERAPIST: Yeah, you are doing the reverse commute, which should make the traffic better.

CLIENT: Yeah, I mean, unless I were to, like, drive on the highway, like, 80 miles per hour, like, the entire way, I probably can't really make the time. Like, I think an hour and 15 minutes is probably the shortest I can do it in.

THERAPIST: The best you can do.

CLIENT: Yeah. I'll have to, like, leave the house at 7:45 or something and I guess I'll have to start going to bed at 10:00.

THERAPIST: Yeah, you'll have to adjust your schedule a little bit so that you feel well rested.

CLIENT: Yeah, and then it's (inaudible at 28:18) throughout the entire week. Well, I can't actually do that for the entire week because the key rehearsals are usually late at night, so...

THERAPIST: Well, so you'll have to have some variability, but it does help to try to be as routine as possible. But you can't control all the factors.

CLIENT: I don't know why I'm so anxious though. Like, it's a new job. I should be excited, not anxious, that's it's a new (ph) job.

THERAPIST: Excitement and anxiety are related so, you know, it's all if we look at what is arousal it's, you know, arousal and anxiety are very similar things. We call it anxiety when it doesn't feel so good and we call it excitement when it feels good, but it's a lot of the same things. You know, when we get really excited about something our heart races faster. Our muscles clench. Our pupils dilate. Palms get sweaty. Blood pressure goes up. You know, your breathing rate sometimes quickens. That's all the same stuff. When you attach negative thoughts or worries to it we call it anxiety. But a lot of what you're feeling might also be excitement. But because you start to attach these worries to it, it feels like anxiety. It feels bad. But physiologically it's the same thing. So if we can try to stop some of the negative thoughts and focus on the things that are good about it, it might feel more like excitement to you. [00:30:01]

CLIENT: Maybe (ph). If I can do that. I'm not sure I can necessarily retrain myself to think of it as excitement and not anxiety.

THERAPIST: Well, let's think about some of the good things.

CLIENT: OK.

THERAPIST: What's potentially good about starting a job on Wednesday?

CLIENT: I'll be able to look at, you know, work with really cool, like, sources and stuff. I'm pretty sure it's, like, going to be (pause) easy in terms of, like, something that will come to me quickly as opposed to, like, you know, trying to do things that are, you know, not, like, boring easy but, like, fun easy. I mean, well, at first I guess it won't be quite so easy because I'm going have to be able to decipher all that, like, cursive handwriting, which (inaudible at 30:52).

I know people write in cursive because it's faster but it makes it a zillion times harder to read. But, you know. No, they'll be actual intellectual work involved and then, you know, I'm getting paid. I'm getting out of the house. I'm not completely financially independent but I guess if I think of it mostly as, like, this is my spending money and my parents are paying for rent then at least I can, like, you know, not feel guilty about going out to restaurants and stuff. And, you know, also Sydney will be happy like, he'll have alone time too and that will be good for him.

THERAPIST: It may be good for your relationship.

CLIENT: Yeah. I guess the other good thing is that it is only three days a week, so I'll have four-day weekends, assuming I (ph) decide to stick with Tuesday, Wednesday, Thursday. So, I think all those things outweigh the commute and the it's-only-13-dollars-an-hour. I mean, that's, like, as much as they can afford to give me (inaudible at 31:57). It's not, like...

THERAPIST: Yeah, so there are a lot of good things. A challenge, something to learn, some financial independence, some regularity in your schedule.

CLIENT: The city is so expensive. We ended up staying an extra day and stuff. But I mean, Sydney got most of the food but, yeah, it was really so I'm sort of feeling guilty about spending all that money even though I shouldn't. Maybe (ph) I really shouldn't. you know, it was my birthday/Hanukkah fest combined. So...

THERAPIST: If it's a gift, it's a gift.

CLIENT: Yeah. I mean, that was the hotel room. Not even the I mean, the food and stuff that I did get on my own was, like...

THERAPIST: Did you enjoy yourself?

CLIENT: I did enjoy myself. [Even though] (ph) for a bit, you know, a good portion of it Sydney wasn't feeling so well, you know, during the point that I wasn't feeling so well. Like, Friday morning I was dizzy and I thought it was a lack of food, and then I had food and I was still dizzy. So probably, like, lack of sleep on Wednesday night and not (inaudible at 33:25). I took a nap and then I got better.

THERAPIST: Oh, good. I'm glad to hear that.

CLIENT: So I did enjoy it, even if we didn't quite get to do as much going out as we wanted to do. But, I mean, that was a I've been so many times. I've seen lots of shows. I don't need to see a show every time I go.

THERAPIST: And you got to see Sarah.

CLIENT: I got to see Sarah.

THERAPIST: So what are the things that you did do that you wanted to do?

CLIENT: Mostly, like, going out to really nice kosher (ph) restaurants and the acapella festival. Like, we didn't actually do any sort of choresy (ph) thing. I guess also that and seeing Sarah. But, yeah, there was lot of time spent hanging out in the hotel, which was fine because we got this really nice room, so yeah. I think it was worth it though.

THERAPIST: Well, it sounds like you did some things that you enjoy doing. You being able to go to those good restaurants and seeing a friend and gong to the acapella room and having a concert and having a nice hotel room. It sounds like a nice gift to yourself.

CLIENT: Yeah, it was.

THERAPIST: Then you're allowed to enjoy it. [00:34:44]

CLIENT: I don't know why I'm so anxious right now. (pause) (inaudible at 34:55) in the sense that I think I'm more anxious than I am excited. I don't know why.

THERAPIST: Well you don't have to question it either.

CLIENT: I want it go away though, though I don't know if my figuring out what's causing it would make it go away.

THERAPIST: Yeah, not necessarily. Sometimes questioning it feeds it because you're focusing on it. So you can accept it. This is what you're feeling. It doesn't necessarily need to make sense. And you can let it go. Let it pass by.

CLIENT: (inaudible at 35:39) I'm going to take a nap. Maybe it's, like, being tired is actually what's causing me anxiety.

THERAPIST: [And plus] (ph) it makes it harder to deal with.

CLIENT: Yeah, because even the walk from, like, the T to here felt kind of long. And I'm like, "This is nothing. Why am I feeling tired? This is not supposed to make me tired."

THERAPIST: Well, it's pretty cold out there today. It makes it sometimes harder to get a good deep breath.

CLIENT: That's true, yeah. It is really cold out. I guess that probably didn't help. I was, like, trying to get some sleep on the train before (ph) taking the bus because we were seated, like, the row, like, right near the door. At one point the door was open for a while because, like, the conductor or whoever was, like, getting the tickets, like, didn't close it and then, like, we couldn't close it on our own at first. The woman who was sitting across from us had to, like, flag the guy down and get him to close it. And even when it was closed it was still, like, pretty cold.

THERAPIST: Sounds uncomfortable. [00:36:38]

CLIENT: Yeah, so I didn't quite get the sleep that I would have liked.

THERAPIST: Yeah, sounds like catching up on sleep, allowing your body to rest and let your mind take a break from some of these questions.

CLIENT: I just feel so out of shape too and I don't know if that's just being tired. It might be because it wasn't like I was walking that far. I think normally I'm OK with walking that far.

THERAPIST: Well, you don't get out of shape in a week.

CLIENT: No, that's true.

THERAPIST: So, I mean, if it felt different today than it felt last time coming to your appointment that's just probably where you are today, you know, a change we had unusually warm weather for a while.

CLIENT: And it was, like, warmer there and then I came back here and it was, like, 23 degrees out or something.

THERAPIST: It's quite cold today and that can make it hard sometimes to when your muscles tighten up it's harder to get a deep breath. A lot of people react to the really cold weather.

CLIENT: But it's, like, I don't actually sense not getting a full breath. Like, I just sense the effects of it.

THERAPIST: Well that's often the case for you with your anxiety, right? When we talk about anxiety, you're most aware of the worries in your head. It doesn't mean the stuff in your body is not going on but where you tend to focus is what are the thoughts going on in your head. Getting out of your head a little bit is usually what helps you, right. Distraction, getting a hug and focusing on the support that you're getting. So your anxiety tends to be most noticeable in terms of what you're thinking the cognitive stuff and not necessarily the physical stuff. But they're connected, you know. Your head is connected to your body. [00:38:30]

CLIENT: Yeah, it is.

THERAPIST: For you, it might actually be helpful to be getting more in touch with what you're feeling in your body, rather than what you're feeling in your head because you might have more control over that. You know, it's really hard for you to redirect your thoughts sometimes.

CLIENT: That's true. And I'm just so, like, out of focus that I, you know, can't focus on that. Well, I can kind of focus but I definitely feel that, like, my mind is running more slowly than it normally would. It's a really unsettling feeling. I'm feeling that I'm getting stupider or something.

THERAPIST: Not being able to focus and being stupid are different things. It sounds like you're tired or distracted. [00:39:33]

CLIENT: Probably tired. And now I'm just, like, oh my god, taking the subway back is going to suck. Maybe I should pay for a cab because then I wouldn't have to take the subway and it would take me directly to where I need to go. It's, like, less than a five minute walk from the train station to Sydney' place.

THERAPIST: You can do that and the fresh air might actually even though it's cold and it's harder to walk, if you can not worry about the fact that it feels hard to walk or harder than it does on a nicer day and instead focus on getting fresh air, maybe letting that actually be a little bit rejuvenating, getting your body to move a little bit, those can be the positive parts of taking that little bit of a walk. If you're not in pain, then you can do it. And that exercise is good for you.

CLIENT: Yeah, I'm not in pain, so...

THERAPIST: And it doesn't look like you're carrying a real heavy bag today.

CLIENT: No, I just have my purse.

THERAPIST: So that usually feels good for you, when you get a little bit of movement. (inaudible at 40:40) deny yourself that you don't need to.

CLIENT: Maybe I feel that [I'll be] (ph) bad like, I don't think I'll be bad at my job.

THERAPIST: They certainly seem to think you'll be a good fit. They interviewed other people and they chose you.

CLIENT: That's true. They did.

THERAPIST: That's something to focus on. They know what they need. They meet the people who were qualified and they chose you.

CLIENT: Yeah. I never pretended to, like, know anything more than I did.

THERAPIST: Yeah, I think you could probably be great and it could be a really good fit for you. I hope it goes well. I'm excited to hear about it.

CLIENT: Thanks.

THERAPIST: Why don't we wrap up there and take a minute to do some scheduling. It sounds like our Monday at 2:30 probably works? [00:41:41]

CLIENT: It does, though if the Friday ever opens up to, like, having slots for, like, every week then I could, like, work Monday, Tuesday, Thursday basically because Wednesday is, as of now though I'm trying to change that is the day that I cook for my house. If I get out of work then I'm not going to have time to cook but if I I have a house meeting tomorrow so I'll see if I can change around the schedule.

THERAPIST: Well...

CLIENT: Right now I know that Friday is only every other week.

THERAPIST: Yeah. Well, Friday's sort of, like, all over the place right now. I'm looking at yeah, Friday's just really packed and inconsistent. So let's do for next week...

CLIENT: Yeah, next week we're already scheduled for 2:30.

THERAPIST: I can move you to earlier in the day, if that helps. Because, like, this Monday, even though we scheduled a 2:30 I also have a 10:30 that just opened up today. If you would prefer that you can move into that spot. [00:42:51]

CLIENT: I don't think it will actually change anything, like, what time I would be doing Mondays.

THERAPIST: OK, so let's stick with the 2:30 on Mondays for now because it is something we can do consistently. And if that becomes problematic for you, let me know. And there are no Mondays in March that my schedule should be different, except Passover starts the 25th. So that's probably going to be a day...

CLIENT: I mean, it starts at, yeah, that evening. But I'm OK with skipping that one.

THERAPIST: Yeah, I probably need to leave my office pretty early that day. Right now I have a 12:30 that I could do and keep with you on that day if you want.

CLIENT: OK, yeah.

THERAPIST: Well, we'll do the 12:30. I can keep that either way. I'm thinking where I go for Passover is actually closer to work than my house, so maybe I'll go straight from here.

CLIENT: I take it then that you're not, like, cooking for Passover?

THERAPIST: No, there still are enough people more senior than I in the family that I don't cook for Passover. I don't host I cook and bring, but...

CLIENT: But you aren't, like, cooking for, like, a few hours up to Passover trying frantically to get everything done on time?

THERAPIST: No, I do it ahead of time. (laughter)

CLIENT: (inaudible at 44:24)

THERAPIST: So, I do have a bill for you. I haven't billed you for a while. And that actually includes the three sessions that I billed insurance for, because they denied. I would encourage you to you can try to appeal to them but they did not cover those sessions that the referral...

CLIENT: Do you know anything about the appeal process?

THERAPIST: Not a bit. But usually there is some appeal process from insurance members, so you can try to do that if you want.

CLIENT: Did they give you, like, any sort of reason or just a denial? Because if it, you know I don't have anything to go on but...

THERAPIST: I can tell you what the code was. They're pretty generic. Claims denied, that's what it says. (laughter)

CLIENT: Oh, wow.

THERAPIST: That's even more generic than usual "service not authorized." 950c is their deny code.

CLIENT: OK, 950c. Whatever that means.

THERAPIST: They don't give you a lot of information.

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