TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: I don't need my [inaudible at 00:00:04]. My chair, this one's off (Ph). So where do you want to start?

CLIENT: So I had a bit of a freak-out on over Shabbat and stuff and I really don't know what triggered it. The only theory that I have is that maybe it was because I was getting sick but usually getting sick doesn't make me go crazy like that. But then Saturday I was no longer freaking out but then I was dizzy and then that continued through yesterday.

THERAPIST: How do you feel today?

CLIENT: I feel okay. I ended up going to bed at 9:00 last night and waking up at 7:30 this morning or whenever I woke up.

THERAPIST: That helped.

CLIENT: So the extra sleep I think did it.

THERAPIST: so you say you had a bit of a freak out, what -

CLIENT: I was panicking, I was feeling suicidal again, I and I don't know what it was because the thing is that I don't you know I was back on the birth control so it couldn't have been that and that's what I think caused my freak-outs last time. So I don't know if maybe the Desipramine (ph) isn't working as well as I thought it is or if it's just stress but I don't know where the stress is coming from.

THERAPIST: How long do those feelings last?

CLIENT: That is a good question. I can't really you know.

THERAPIST: Just a rough all day, a little bit of a day.

CLIENT: Definitely all day, like little bits, maybe they lasted for an hour or something. Like it's more than five or ten minutes I think and I guess, yes, it actually happened last night too now that I think about it. It was one of those not being able to fall asleep, panicking, and not wanting to be alone but Sydney was falling asleep. And he said that I could wake him up if I needed him but that only would be if he actually could wake up and I couldn't really prevent him from going to sleep because it would be wrong but I was freaking out at the same time, so. Yes, I don't know what the cause of these freaking out before going to bed panic things are. But, yes, I can't figure it out. [00:02:24]

THERAPIST: There may not always be a reason. Sometimes people do have free-floating anxiety that's not pinned to a particular event or a particular thought but it's there and it is very real. Those feelings of panic you have are real feelings, even if they don't have a reason.

CLIENT: The problem is at night I can't even do anything. I can't go and exercise or anything like that. It's like I'm about to go to sleep.

THERAPIST: You feel and I wonder if that, maybe just that, that feeling of being powerless to distract yourself or control it in any way is enough to actually exacerbate little feelings of anxiety, feeling kind of trapped by them.

CLIENT: I could've theoretically gotten dressed again and gone downstairs and Internetted or something.

THERAPIST: That's always an option.

CLIENT: But I didn't really think of it at the time. But in retrospect I could've done something like that. I didn't have to go to sleep when Sydney when to sleep. I just felt that I should because I was tired.

THERAPIST: So what stopped it?

CLIENT: I think eventually just falling asleep.

THERAPIST: And know it's really uncomfortable.

CLIENT: It's also hard to really figure out a way to lie down and be comfortable. It's like oh no, I'm going to have to sleep on the floor or go to the couch or something and for some reason it wasn't that I didn't want Sydney to be there but I kind of wanted more space on the bed and I couldn't really tell him to go away because that would leave him without a place. I guess theoretically he could have gone back to his place but it was already, we were both in pajamas and stuff, so. [00:04:18]

THERAPIST: So it would have been inconvenient.

CLIENT: Yes, it would have been inconvenient and mean and I wasn't going to do that to him.

THERAPIST: And how uncomfortable are you doing one of those other things like sleeping on the couch or?

CLIENT: It's not like I guess it wouldn't have been the most uncomfortable thing in the world. Yet the problem is the covers aren't the cleanest and I don't mind when I'm sitting on them but it really sets off my OCD tendencies if I'm sleeping. I really don't like it when Sydney wants to eat in the room on the bed because then I feel those crumbs underneath me when I'm sleeping so yes. That and then people would have been around when I was sleeping and stuff so I don't know if any of those that -

THERAPIST: Yes, and so you don't really feel like you have options when the bed isn't feeling comfortable or spacious enough.

CLIENT: Yes, so I can't really you know, this was really the first time I felt like that.

THERAPIST: But it I guess it reminds me of hearing you talk about not necessarily that particular scenario but when you feel like you don't have options, when you feel trapped, it tends to make you feel like it's the end of the world or the end of you wanting to that's sometimes where these suicidal thoughts of wanting to escape or just wanting it to be over kind of pop up, when you feel like you can't -

CLIENT: But I think the suicidal thing was more on Friday afternoon than I don't think I was feeling suicidal last night when I was trying to fall asleep.

THERAPIST: And so what was happening Friday afternoon when you were thinking that way? [00:06:08]

CLIENT: I don't even know. Like I said there was a little bit of a panic when, because we had gone over to Sydney' place before Shabbat to get a few things and then he said oh we'll get back before Shabbat and then all of the sudden he said what if we stayed here. And when he normally suggests something like that it normally means he can't do it, but this time he was legitimately making an exception. And I sort of freaked out a little because I said I didn't bring any clothing with me, you can't do this, what about Megillah reading and stuff, which was happening Saturday night. And we ended up getting back to my place on time but -

THERAPIST: But you were worried about that and maybe the plan shifting.

CLIENT: I think the suicidal feeling was either before that or after that and not during that. I don't think maybe they were linked but I don't think, because I was really panicky; I felt trapped there too because he didn't even tell me that this would be a possibility and I didn't bring a change of clothes or my medicine or anything. So it wasn't going to work. And, yes, I really don't know where these feelings were coming from.

THERAPIST: Were you mad at him?

CLIENT: I was a little annoyed that I thought he was going to trap me at his place and we got into a little bit of a fight because I couldn't take the car back and leave him there and I couldn't really take public transportation back for some reason I don't know why I never thought of that as an option. So it was either stay with him or leave with him and not me leave, you stay. Yes, I was annoyed. I wasn't super-duper mad at him but I was just oh no, not again. And granted he legitimately was just making a suggestion at that time and he didn't expect me to freak out but it's just that every other time he's made a suggestion [00:08:21]

THERAPIST: Yes, but you feel like it's not, it wasn't this one instance. It feels linked to all those other times where you felt disappointed that the plan got changed.

CLIENT: Or trapped.

THERAPIST: Or trapped. Yes, I think that trapped feeling for you is a big, it's a big feeling because it has echoes of all these other times when you've felt trapped like waiting for him to wake up for something, or expecting him to pick you up and not picking you up. Those are all different times that you've felt trapped.

CLIENT: Yes. I've usually been able to manage it now by not being reliant on him and I usually drive myself to rehearsal and stuff. But -

THERAPIST: But you felt reliant upon him at that moment.

CLIENT: Yes, because if it got too late I wasn't going to drive on Shabbat. I still I might be I'm using electricity on Shabbat but I do not drive on Shabbat and he knows that and if it got passed a certain point it would've if he couldn't drive I would've had to drive on Shabbat if he wasn't feeling up to driving.

THERAPIST: Do you feel okay with that other change, using electricity because that wasn't something you didn't used to do?

CLIENT: Yes, I've been doing it for the past month or so, so I feel a little bit weird. I mean now it's different because I actually am working so Shabbat is a day of rest because we're not working. Whereas before it was okay what makes it like Shabbat was not using the Internet and stuff because I do that every day, I sat down around the Internet. Now at least it makes sense.

THERAPIST: What prompted the shift?

CLIENT: Turns out actually a bit of history in that originally there were some Orthodox Jews that, groups of orthodox Jews that used electricity on Shabbat when electricity was first turned into a power for using things in the household. And then it was one Rabbi who did this whole campaign against using electricity on Shabbat and that Rabbi is the same Rabbi who is the [inaudible at 00:10:32] Rabbi who has since died and they still think is the Messiah coming back from the dead. And very anti-[inaudible at 00:10:37] about it and there wasn't actually a good reason in Jewish law not to use electricity on Shabbat depending on what you were using it for and it really was just people were doing it because the [inaudible at 00:10:53] Rabbi had promoted it as a thing. [00:10:57]

THERAPIST: So it no longer made sense for you?

CLIENT: Yes, so that is why I, yes, which I had not known about. And I guess the thing is most of the time I'm spending Shabbat with Sydney and not in a group of people who are also not using electricity. I mean my housemates for meals but most of the time I am just hanging out with Sydney. It was no longer I'm doing this to be part of a greater community or something. Certainly not.

THERAPIST: This was a difficult Shabbat?

CLIENT: Yes. That doesn't it's only Monday and it's already all blurred together and I can't remember what happened when, part of that was being sick and being dizzy. I ended up Saturday night not even going to Megillah reading at all and telling Lee that I wasn't going to be there since he was going to be there so he could tell the people that I wasn't going to be there to read the chapter, as opposed to reading it. On Sunday I made it to the reading because Sydney bribed me with going for pastries and, because he really, really wanted to go and then, but I told the people I couldn't stand up for a long period of time and therefore I couldn't do the reading and someone else did it so it was okay. Because there's someone who knows how to read every single chapter and can do that without any preparation and there are other chapters that [inaudible at 00:12:48] for Shabbat hadn't been signed up for. I didn't end up screwing anyone over but, yes [00:12:56]

THERAPIST: You didn't feel like you could do it.

CLIENT: No, I could barely even walk or anything and I would've had to stand up there for a good five minutes or something depending on how fast I read it. And I mean I couldn't even it was one that I've read a billion times except not last year because last year I was assigned to a different chapter so it had been two years since I've read it. And I, on Saturday when I was trying to go over it, I couldn't even focus on that or sit up or whatever and I just said okay I think I'm not going to be able to do this. I could've read it badly, maybe, except for the whole standing thing. Yes, there really was no way I could've done it and I really shouldn't have even been at shul but I just wanted to go because Sydney wanted to go and didn't feel comfortable going without me and I also felt like I should do something at least. But yes, because there's certain parts of the service where you're supposed to stand and I wasn't even standing during those, either.

THERAPIST: I'm sorry you felt so badly. [00:14:10]

CLIENT: It's okay. I'm getting better now. I don't know what caused it but I don't even have time to go to the doctor, so, and since it's mostly gone away by now I think just stay guarded (ph) and hope it was just a fluke. Also it turns out that Sydney sort of has serotonin (ph) syndrome too. We went to the emergency room on my birthday. He had a normal doctor's appointment as a follow-up for the one he had for his cold however many weeks ago it was and it turns out that when he was there his pulse was, and his blood pressure, were both really, really high. His pulse was 144 and that was after he had been in the ambulance. And so and the doctor had thought it might have been a reaction with his SSRIs.

And so they, yes, they called an ambulance and he wanted to and then he was freaking out because he said oh no I won't be able to go home, and I said but you really need to do this. And then they gave him an antibiotic then he calmed down a lot and then it was okay. But we were in the emergency room for three or four hours or something. The last hour was just waiting for the discharge papers but -

THERAPIST: Certainly not what you expected for your birthday.

CLIENT: No, I had to cancel my birthday party because I was going to be out in ER.

THERAPIST: So which day was that?

CLIENT: Tuesday.

THERAPIST: Tuesday?

CLIENT: That was Tuesday and now he's actually doing better. They took him off the because he had an appointment on Friday morning with his psychiatrist and he actually invited me to come along too. And so they took him off the Lexapro and he yes, all of those times that he's always tired and stuff, those were actually all related to the serotonin (ph). [00:16:21]

THERAPIST: So this might really be a change of what's been happening, then getting that figured out because that's been a big issue for you.

CLIENT: Yes, and I had just gotten so used to it being the status quo and then I forgot that it was actually a thing that was wrong. But yes, that was also why he couldn't drive on Friday and why I was going to have to be the one to drive home and would've been trapped if I had stayed past when Shabbat started.

THERAPIST: I wonder if these changes just have some impact on what your reaction was this weekend. A lot went differently than you expected. And then I'm also the other big thing obviously was you started work last week.

CLIENT: Yes. Except for that's been going well. You know, the work is interesting and I've actually even though I've only worked two days so far the commute wasn't the first day it took me a while because I got a little bit of a late start and I was in traffic for a really long time. But then Thursday I left at 7:00 in the morning and was able to get there at 9:00. So it really isn't as bad as I thought it was going to be. And the commute back also -

THERAPIST: It was two hours when you left at 7:00?

CLIENT: Maybe I left at 7:30. No, I oh, you know what happened? I was tired so I pulled over at a rest stop and got coffee and a donut and so -

THERAPIST: But I didn't think you expected it to take that long.

CLIENT: No it wasn't supposed to take that long so yes, I guess I took about a half-hour break to drink the coffee and eat the donut to make sure I wouldn't fall asleep on the road.

THERAPIST: Yes, so it was broken up for you.

CLIENT: Yes. In the future I probably don't want to take as long drinking coffee and eating donuts and maybe do that, go to the Dunkin Donuts in Davis instead. Do that before I head out. But yes I was so the commute wasn't bad and the commute all was fine. In the morning I just have to deal with the whole be tired and do something to wake me up because I haven't had to rely on caffeine until now. [00:18:46]

THERAPIST: Well maybe when you get more used to getting up in the morning, your body can adjust to that. Especially if you try to get up a little bit earlier even on the days you're not working, just trying to switch your schedule a little bit.

CLIENT: Yes, and today I woke up at 4:00-ish or 5:00-ish or whatever it was.

THERAPIST: Well I'm glad you find it interesting.

CLIENT: Yes. I don't have the feeling of dread in the morning when I'm going to work.

THERAPIST: Fabulous. That's a nice relief.

CLIENT: Yes and I guess maybe it's also because it is only three days a week so I'm not feeling like this is my entire life; all my freedom is gone.

THERAPIST: Yes. You were really resenting that sort of that impingement on any free time, being able to schedule things the way you wanted to with the data entry position or with the fulltime-ness of it. And so not feeling so limited.

CLIENT: Yes. It's still going to be a bit of a problem for Wednesdays because my Tuesday night rehearsals are still going to be 9:00 to 11:00, which -

THERAPIST: Not be able to get a really long sleep.

CLIENT: Yes. I guess I could get in later and stay later on Wednesday. Maybe if I -

THERAPIST: Maybe you could I don't know what the flexibility is but if you could drive in after commuting hour. You don't want to time it for commuting hour but depending on how much flexibility there is, that's another option. [00:20:21]

CLIENT: Yes it is and I left at 9:00 and drive in at 10:30 and stayed until 6:30 or something. Yes because there's less flexibility on the earlier end because the earliest people get in reliably is 8:45. So but usually Jim who's my supervisor he, I guess he really likes working or something I'm not sure why but he'll stay until last week he said he was staying until 7:00 or 8:00 or something. Usually he stays until at least 6:00. So, I think I need to be there when there are other people there since I don't have the keys to the building or anything like that but it might be a possibility.

THERAPIST: And how are the other people?

CLIENT: They're nice. Usually people go upstairs and eat lunch together and, yes, everybody's in a division (ph) and there are people who come in, researchers and stuff.

THERAPIST: Sounds like a much better environment for you.

CLIENT: It is. Though it's still a little bit uneasy about the fact that I'm not completely supporting myself but I can deal with that and if I like the work -

THERAPIST: You're supporting yourself a lot more than you were.

CLIENT: I am, that's true.

THERAPIST: You were persistent and got something in your field. [00:22:02]

CLIENT: Yes, and yes, that's just I don't know. I don't know why I was upset this weekend.

THERAPIST: Yes, it doesn't seem to have a clear trigger.

CLIENT: Maybe it was lack of sleep. I tried to go to bed early but like Wednesday I went to bed at 10:30 or 11:00 or something and still woke up at 6:00 in the morning on Thursday, so it wasn't quite enough sleep I think. And Friday I also had to wake up yes, because the appointment that we had with Sydney' psychiatrist was at 8:15 in the morning, which is really, really early. And I had my birthday party on Thursday since I couldn't have it on Tuesday and people stayed until I didn't go to bed until 1:00, so.

THERAPIST: So you were sleep-deprived but I think maybe it's something important for us to work on is what to do when you ‘re having these feelings. What to do when you're having panic, and what to do when suicidal thoughts pop up and it doesn't make any sense.

CLIENT: I really don't know -

THERAPIST: What if there isn't an answer for why you're feeling the way you're feeling but you are feeling that way and we need to find a way for you to move on from it because those aren't good feelings to sit with.

CLIENT: I don't know. Especially the ones where I'm all really ready for bed and we'll have to go through some effort before I can make myself clothed enough to leave the room and go to some other area of the house.

THERAPIST: Well what do you want to tell yourself? Maybe it's not a it may be a harder time to do something physical.

CLIENT: I kind of want to tell myself to go to sleep so I'll go to sleep but it doesn't seem to be working. [00:24:14]

THERAPIST: Well what did you say to yourself before you actually let's see what worked because you did eventually fall asleep you said and you woke up feeling better. What were the last thoughts you remember having before you fell asleep?

CLIENT: Probably I'm feeling like the last thoughts I was still having were panicky thoughts but I don't really remember because it's not like I ever remember when I fall asleep, I just remember some time before it.

THERAPIST: The last thing you remember is?

CLIENT: Feeling panicky slash turning around to try to find a comfortable position to sleep, which was really [inaudible at 00:25:00] to deal with. Before that it was Sydney just gave me some hugs and stuff but.

THERAPIST: Yes, [inaudible at 00:25:13] remember turning around to try to find a comfortable position to sleep, so it's almost like you decided to focus on what was going to happen next, falling asleep, rather than focusing on what was happening in your head at the moment, which was panicking. You kind of made this decision all right I'm going to go to sleep now.

CLIENT: But I made that decision for a while and I had to turn around a bunch of different times. Nothing was working. When I was lying on my back that's a usually I sleep on my side and when I turned away towards the door then my back is in the middle of the bed and for some reason something was tickling it. But if I turned the other way then it was like I felt sort of trapped in there. I didn't have enough foot space where I had if I had slept on my stomach. Then my hand was in a really uncomfortable position even with the wrist brace and it would start hurting in a few seconds and then okay that wouldn't work. I don't even know what I ended up deciding on. [00:26:22]

THERAPIST: Has your wrist been causing you a lot of pain?

CLIENT: A little bit, not that much. And usually if I sleep in a good position then it's fine but sometimes I don't sleep in a good position. And now, even if I take a three-hour or one-hour whatever nap in the middle of the day I need to put the wrist brace on because if I don't then it hurts. Yes, I didn't bring it out at work on Thursday. The thing is I'm not even tired that much.

THERAPIST: Because you didn't need it or because you didn't want them to see it?

CLIENT: No, I brought it out as in I put it on. Once I did need it Thursday I did and I think it was just I don't know because most of the time I'm reading. And then a lot basically what I'm doing amounts to reading these old file (ph) books and notating the page numbers of things that are interesting that happened so they can go into the finding huge words so people can just not have to read the whole thing and just go to the pages where the interesting stuff is happening so. Mostly but the book is big and I have to have it over here on the laptop. So sometimes yes, I don't know. I'm not even doing anything particularly [inaudible at 00:27:44] with my hands but for a while it was hurting. It was mostly after lunch so I might have hurt it while eating or something or just sleeping the night before.

Yes, it's not causing me too much pain but I have noticed some pain when I'm maybe it's the driving. I should probably wear it when I'm driving because I remember when I first had the wrist brace I always had to wear it when I drove. So this might maybe it's related to that because it's not like I up until now I had a reason to be driving for more than 15 minutes.

THERAPIST: Right, that's a big that's the one thing that's changed a lot. [00:28:22]

CLIENT: For the most part my wrist is behaving but, yes.

THERAPIST: I think it's sort of striking a balance between paying attention to these episodes and figuring out a way to kind of put them in their place. They're happening, they're not happening as much as they used to and they don't necessarily mean that something is wrong, like they don't necessarily mean that something specific happened that was wrong or that something is wrong with you. It's almost kind of like phantom pain, right? People feel it; it's really intense so it's real in that way but it's not an indicator that something's wrong. And I think you're having kind of the emotional equivalent of that.

You know, I don't think it's necessarily we'll track it that's why I want to pay attention to it but I also don't want to make more of a deal of it than we should. It doesn't necessarily mean that we need to change your meds. The change of meds that you went through with your psychiatrist helped when you were having really frequent panic attacks and longer episodes of suicidal thoughts. So I want to track it and I also want to find a way to be like okay this is the feeling I'm having and I'm going to let it go, so that you don't have to sit with it for longer. [00:30:05]

CLIENT: I'm still tempted to see if I can have an easier solution which would be at least at night if I could get a medication which is actually measured to putting me to sleep and take it so that way I don't have to deal with things. Especially if it's a matter of me getting whether or not, if it makes a difference between me getting enough and not getting enough sleep.

THERAPIST: Well I'm certainly not going to stop you from talking to your psychiatrist and asking that question.

CLIENT: I have an appointment tomorrow, so -

THERAPIST: Convenient enough.

CLIENT: I will ask her then.

THERAPIST: Yes, so I mean if that's an appropriate medication solution that's a decision you guys make together and you let me know about it.

CLIENT: I don't think I would use it it's not like every night I feel like that. It was just -

THERAPIST: No, you've never had a history of abusing your medication. I'm not worried about that.

CLIENT: That's true, so maybe that'll fix things. But that doesn't really help for the stuff during the day.

THERAPIST: Right, so we need to find a way for you to have some control over them. Acknowledging your feelings, noticing what they are, acknowledging them and finding a way to set them aside, the equivalent of that rolling over for the last time and deciding and putting the feelings to bed.

CLIENT: That's really distraction would be the easiest thing and I can do that without, if it's not when I'm trying to fall asleep, then I can much more easily distract myself.

THERAPIST: And when you're trying to fall asleep you can distract yourself with comforting thoughts.

CLIENT: I'm not very good at that. I need something to occupy my brain and take up the space.

THERAPIST: Well what fantasyland can you go to in your head to distract yourself?

CLIENT: I don't know. Not really used to going into fantasyland in my head. Sometimes I'll daydream and stuff but [00:32:11]

THERAPIST: What do you daydream about? Let's use what you can already do and build on it.

CLIENT: Usually that's when I'm getting bored with something and my thoughts just wander and I can't really come up with anything off the top of my head of where they go.

THERAPIST: All right. Let's see, what if you had an assignment you were telling me about that game you use on your phone. Can you create a scenario like that?

CLIENT: Probably not. Not really. I don't think so because the difference is it's on my phone and there and ooh I just got this item and stuff. It's an outside force that is running in and not just me running into my head.

THERAPIST: What are the places that you go to? Physically and where are they supposed to be virtually?

CLIENT: Oh, I mean they are virtually just portals at so and so place, like the one, the statue or usually works of art or things, so I'm not really just some of the items you get from them or things that either help build them up or help take down the empty (ph) ones. But they're all, the portals are the places that they are at. So they're not like this is a space station or something. They're all named after the places where they're supposed to be and sometimes it's off but, yes.

THERAPIST: All right, so you'll have to come up with a different idea because mine's not working.

CLIENT: I don't even know why. Maybe but someday having cats of my own that aren't evil and stuff if me and Sydney eventually get to have our own place or something like that.

THERAPIST: Could you so if you start to envision, could you use that fantasy or that hope for the future and then try to get detailed about it in your head? What would the place look like, what kind of cats would they be, what would you name them? Can you let yourself create details like that? [00:34:36]

CLIENT: Maybe. I'm not sure. I could try it; I'm not sure it will work but I can try it.

THERAPIST: Yes, sometimes giving yourself a task and then requiring yourself to be really detailed about it. If you are imagining a space, an apartment that you might share, trying to get really detailed about it. How would you decorate it, what would the rooms look like? What would as a way of getting your mind really involved and limiting the opportunity to question yourself. It doesn't have to be realistic. You don't have to work out how you would pay for the space. It's just a fantasy game of what you would do if you could. And the only point of it is occupying your brain in every corner so that there's no room for other stuff.

CLIENT: I guess it kind of makes sense. Problem is I'm just not as imaginative any more. It's just that I have less opportunity to daydream because I'm not getting bored in classes. Not that I always get bored in classes. At least in [inaudible at 00:36:11] school I was actually paying attention most of the time because I had really good classes and I guess my library school classes I would say 50-50 were interesting and worthwhile versus -

THERAPIST: Well it sounds like you spend a lot of your free time on the Internet and maybe that's not giving yourself time for your mind to wander because it's focused on whatever you're looking at? [00:36:39]

CLIENT: Yes.

THERAPIST: I find that sometimes when we talk you have a focus on wanting to be really logical. Fantasies are not logical a lot of the time and sometimes you'll talk yourself out of kind of a more fantastical thought with reality, you know, it can't be this way because of this, that, and the other thing. And sometimes you have to shut that off a little bit to let yourself fantasize. Fantasies aren't always realistic or practical or logical. They're not by definition and maybe giving yourself permission sometimes to let that stuff go. You don't have to be logical all of the time. You don't always have to be right. Sometimes you can let yourself be immersed in the dream that doesn't makes sense in some parts and that could be productive even though it's not -

CLIENT: I guess at this point I no longer have to worry about oh I'm not getting anything done most of the time because if I'm not at work -

THERAPIST: You don't have to be getting something done.

CLIENT: With the exception of cleaning.

THERAPIST: But there's probably time for you to be able to do that and give yourself free time to be in a dream world. You no longer have the I-should-be-applying-for-a-job hanging over your head.

CLIENT: It's really weird getting used to that. [00:38:09]

THERAPIST: You spent a long time feeling that pressure.

CLIENT: Yes. I mean today I actually did get things done because a bunch of people over the past week or so ordered [inaudible at 00:38:22] things for me and I had to send them out but -

THERAPIST: That's great.

CLIENT: Yes it is. I mean I guess there were things I could've cleaned today and I said screw it, I don't really care right now. Especially if it's in my room where no one else is being affected by it but Sydney. But I should be happier if I don't have all that pressure on me to apply for a job. I know I have this job for a year and at least until I don't know, September, November whatever I decide, I don't have to worry about applying for things. I really, really don't.

THERAPIST: So let yourself experience that relief.

CLIENT: I don't know if I really ever can. I was really happy when I found out and no longer freaking out about money.

THERAPIST: But you almost moved directly into worrying about the details of the commute and how would that work and should I have waited, because you got that other -

CLIENT: Because I got that other job?

THERAPIST: You sort of skipped right over feeling happy and relieved.

CLIENT: Because they called me the next day. I felt like I even had that much time to wonder about the other place and I mean I was worried about the commute at least until I've taken it and now okay, it's not as bad as I thought it was. And I thought parking was going to be an issue and then I, I guess someone had just left a couple of weeks ago and there's this parking garage a couple streets away that costs $10 a day but you can also get a pass and if you have a pass it's free. And so they gave me the pass and it works, so I don't even have to worry about paying for parking now. And it turns out I actually do get 30 miles a gallon if I'm doing highway driving. So if I work for a little bit over an hour a day, it makes back the day's commute in gas.

THERAPIST: So these are all worries that you don't have to have, you don't have to carry with you. [00:40:47]

CLIENT: Remember there's peace in not worrying.

THERAPIST: I don't think your brain is used to not worrying.

CLIENT: It always finds something either class or finding a relationship or something like that.

THERAPIST: And so this is why maybe practicing letting yourself fantasize a bit, give your brain an opportunity to do something different. You have to train your brain and you can. These are skills you have; they're rusty but you have them. You can remember times when you've used them when you used to daydream in class. So I think letting yourself kind of take that skill back out and practice it a bit so that you can have time off from thinking about the next thing to worry about.

CLIENT: It's so weird. I'm not used to this at all. Not even a little bit. I guess there's still stuff to worry about like Sydney finding a job but -

THERAPIST: You don't have to worry about that.

CLIENT: That's his worry.

THERAPIST: That's his worry, exactly. You don't have to take that on as the next thing to worry about. The next thing for your brain to do is take a break from worrying, take a break from feeling guilty.

CLIENT: It took a whole year for me to find a job. [00:42:07]

THERAPIST: It did but you found one in your field. That's what your goal was and you achieved your goal. Part-time because you didn't really want to work a fulltime schedule in your field. Let's let you be happy about that.

CLIENT: I can actually buy things now without feeling guilty and I haven't really started using that power (ph) I guess because I still have to -

THERAPIST: It's still pretty new.

CLIENT: It's still pretty new and I haven't had that income come in yet. Yes it's so weird.

THERAPIST: It's pretty good. I'm happy for you.

CLIENT: Yes. I just don't know how to be happy. That doesn't really make sense.

THERAPIST: Well it's different because you haven't let yourself be happy for a while, for a long while now, but that doesn't mean you can't do it. It might take some time to settle in and kind of believe it. And I wonder if some of the anxiety you felt is about that shift, kind of not knowing what to do with this new perspective of -

CLIENT: Possibly but it shouldn't have turned me suicidal. That makes no sense at all.

THERAPIST: Those thoughts are not new. They didn't turn you suicidal.

CLIENT: Yes, but I was -

THERAPIST: But they haven't completely disappeared from the place that your brain goes just because you have a job. Those are thoughts that come up for you pretty frequently unfortunately but they don't mean anything different. You've never created a plan, you've never had intent to follow through on these thoughts, they're uncomfortable thoughts that you have, right? Correct me if I'm wrong.

CLIENT: Define plan. [00:44:06]

THERAPIST: A plan. Ideas about how you would actually harm yourself. Ideas about how you would kill yourself.

CLIENT: Okay, then you're incorrect in that.

THERAPIST: Okay, so tell me what your plan is.

CLIENT: I mean, inasmuch as like I know that overdosing Desipramine (ph) could kill me and I have.

THERAPIST: You have a plan to overdose? Do you have intent to overdose?

CLIENT: I don't have any intent. It's just when I feel, in the back of my head when I've been feeling suicidal it's I could actually do this, there is Desipramine (ph)and I have a lot of it. So it's never gone to the point, at least as if the drug start working, that I've needed to ask Sydney to hold onto it for me or anything.

THERAPIST: Do you need to have as much Desipramine (ph)in the house as you have or do you have a stockpile?

CLIENT: I have a stockpile but it's in general I like having stockpiles of my meds so I don't run out.

THERAPIST: Do you feel safe having a stockpile or do you worry that you will take it?

CLIENT: I usually I feel safe. When I feel suicidal it isn't usually to the point that oh I should take that considering, there's just a knowledge that I do have this thing that I could in theory overdose on.

THERAPIST: So maybe it would make sense if you feel like you need to have more, if you feel like you need to have a stockpile of sorts to feel comfortable that you won't run out, maybe it would make sense to split it between the two households so that you don't have access to all of it at once, so you don't have to ask Sydney to take some when you're feeling unsafe. But split it up so that you would have to actively go get extra. That will safeguard you. It sounds like you have knowledge of how you could kill yourself, one step away maybe from planning to kill yourself, and I want to make it harder for you to get to that. [00:46:14]

CLIENT: Yes it's just I'd have to know how much an overdose would be and -

THERAPIST: Let's not figure it out.

CLIENT: Well if half of what I have is still enough for an overdose, then the plan of putting half of it in Sydney' way -

THERAPIST: Makes you safer.

CLIENT: I guess. I mean -

THERAPIST: Having less is -

CLIENT: overdose or I guess a smaller overdose is less likely to be lethal but I don't know if I'm safer knowing or not knowing what the amount is for a fatal overdose because say I take 75, well I take 85 milligrams a day. I have 75-milligram pills and the 10-milligram pills. I think 200 milligrams is the upper edge of a normal dose. That's only eight pills and I have of the 75-milligram pills a month's supply is 120, or was 120 of those pills when I was taking 100 and now I think they're giving me 90 pills to reflect the fact that I'm only taking 75 of the 25-milligram pills. But if 12 pills is enough to overdose on and I have 150, 200 pills splitting between mine and Sydney' place -

THERAPIST: Yes, I see your logic. How safe do you want to be?

CLIENT: I don't know because the thing is, you know, now that I have a job it's not like I have to have to go to CVS every single day and pick up four pills or whatever. So I can't really get to the point where I have no extra pills at all. That's just really, really impractical. And it hasn't even been that I've gone to my backpack and gotten it out to take it or anything, so I think I'm okay. I think I could split that half between my place and half between his place but that doesn't if I have 100 times more than I need for an overdose or even perhaps 30 times more than I need for an overdose, then having 15 times more than I need for an overdose won't make that much of a difference, which is [00:48:57]

THERAPIST: So I think your question, the question that you need to figure out for yourself is would having information about how many pills would actually be a lethal overdose would that make you less likely to overuse your medication or more likely?

CLIENT: The answer is I don't know.

THERAPIST: So something to think about and, you know, the same rules always apply. If at any time you feel like you're actually intending to take more medication than what's prescribed and therefore to harm yourself, then you call the ER. That rule always applies.

CLIENT: It's never got to that point though it was it did when I hurt myself but not kill myself at a certain point over the weekend and drove over my moms and I did tell Sydney that I might have to go to the emergency room and he said no you're fine and I was fine.

THERAPIST: Yes, and so at times like that reaching out to him -

CLIENT: I was sort of afraid that I was going to be trapped in the emergency room and I really didn't want to do that considering and considering how we spent a significant amount of time in the ER -

THERAPIST: The hospital already.

CLIENT: Yes, I was just -

THERAPIST: You'd had enough of hospitals. [00:50:10]

CLIENT: And at that point it was still before I had gotten sick so how am I supposed to read Megillah if I stayed too long -

THERAPIST: And when those concerns come that's actually a sign of health because you were at the same time that you were feeling like you wanted to hurt yourself, you were always thinking about but I have these responsibilities in the future that I don't really want to mess up. That's a sign of health. We hang onto those because you really didn't want to hurt yourself so badly that you couldn't do the thing you were supposed to do the next morning. So that's you know, hold onto those positive thoughts and reaching out to him to help you remind yourself of them is a way of keeping yourself healthy. Beyond just safe, really, keeping yourself in a healthier place. Well why don't we stop there for today and you can think about those questions. I know you said you had a meeting with your psychiatrist tomorrow, which is also a good place to talk about these questions. At least she's part of that team.

CLIENT: I'm not sure whether or not I should ask her what the amount is for an actual overdose or -

THERAPIST: Well if you're having thoughts of suicide she needs to know that.

CLIENT: Okay. You know, I wasn't planning on not telling her about my thoughts of suicide, but -

THERAPIST: So I think bringing that up and having the same conversation we had with her so that she knows exactly what your thought cycles are like and where the line, you know, help her be a part of the decision of what do we do to make sure you stay safe even when you're having those moments where you don't feel like being here. I think we're on for next week same time?

CLIENT: There's a chance so I'm going to Kentucky to meet Sydney' family. Our flight is supposed to get in at 11:00 a.m. on Monday, which should leave more than enough time for me to get here by 2:30 but if the flight gets delayed or something I won't know that until should we just move it or [00:52:14]

THERAPIST: I have Tuesday the fifth, I have an 11:30 or 12:30. Do you work -

CLIENT: I'd be working.

THERAPIST: Okay. Let's keep it. If you're delayed, I won't charge you if you're delayed, I won't charge you a no-show fee or a late cancellation fee because you don't really have control over the plane.

CLIENT: Yes, that's true.

THERAPIST: If you find out that your flight is changed or something ahead of time let me know but -

CLIENT: Okay, I'll do that.

THERAPIST: let's just plan that everything's going to work out. If not, you're absolved of the typical fee.

CLIENT: Okay that works.

THERAPIST: All right. [00:52:58]

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