Transcript of Audio File:

BEGIN TRANSCRIPT:

CLIENT: So for the past week I've been having a breakdown. I haven't been able to do any good stuff. And I can, you know, through bits and pieces if I occupy myself. Otherwise, sometimes I get my mind off of it. And it's like I ended having to, like I ended up not going to work at all last week. I mean I was going to go in on Tuesday. It was like snowing and stuff, but once I (inaudible at 00:00:34) I also didn't make it in either because I just couldn't.

And I've been having, I guess �Well last night was a Seder and I had alcohol and stuff, so I didn't have any trouble sleeping last night. But like the night before and I had trouble sleeping then. And just all this panic and I don't know where it's coming from and it won't go away. And I feel like my meds aren't working anymore. And I don't have any way to stop it.

THERAPIST: Well I know when we talked last week, the house stuff and the living situation was something that was a big deal and you think talking about it was important, but also brought up a lot of anxiety.

CLIENT: I mean except that from Monday evening on I spent the entire week at my house.

THERAPIST: How was that?

CLIENT: It was better. It was nice to have my own bed and stuff. [00:01:33]

THERAPIST: Mm.

CLIENT: And also I wasn't commuting so it wasn't like I could really see whether or not it was making a difference within (ph) me. I mean I knew I was going to be at my house anyways because my friend Nora was visiting.

THERAPIST: Mm.

CLIENT: So it would be weird to not be staying at my house when my friend was staying at my house.

THERAPIST: Mm.

CLIENT: So (pause) (sigh) So being at my house was better. But it didn't -

THERAPIST: How did it change things between you and your boyfriend?

CLIENT: Um. (sigh) I'd think it would be we're less tense, though then on Saturday we got into a really big fight and almost broke up. And then we -

THERAPIST: Mm.

CLIENT: (sigh) It's just so I couldn't -� I kept on getting �Like he was doing things that were making me angry and I got mad, and then he got mad, and he couldn't deal with my anger. And I was telling him that, you know, I was thinking that maybe we should break up. [00:02:30]

THERAPIST: Mm.

CLIENT: Like we both were thinking it and then we both decided that we want to stay with each other. I realize that I overreacted, even though originally I had thought I was right, I don't even remember what the issue was anymore.

THERAPIST: Hm.

CLIENT: But I had thought I was right. But then I was like, "Okay, this makes no sense. I shouldn't be reacting this way." And he was afraid that I had turned into this person who was always upset all the time and he wanted the real me back. (inaudible at 00:03:00), but it makes sense that I leave than having �We've been okay and only minor problems that we feel like we can resolve right away.

And I told him last night that I thought it would be helpful like if I'm upset, that will upset him. If he's upset, that'll upset me. But if we're like upset and not at each other and maybe telling each other, "It's not you." So that we'd be less likely to internalize it if, you know, it wasn't something that we were causing, and the other person was not mad at us. But (pause) I've still been breaking down.

THERAPIST: Mm.

CLIENT: And, I mean, I'm running a little bit low on sleep and I probably need to take a nap this afternoon to catch up. It's like Sunday night I got out of rehearsal at ten-thirty but I couldn't get to sleep until like three-thirty. [00:04:11]

THERAPIST: Wow.

CLIENT: And well first we had to do some Passover things, like the finding the chametz and stuff like that took a really long time. But then after that I just couldn't sleep. And, oh, also we had dropped on Friday the car. The bumper, there was this part. Like the bumper had been dented for a while, but there was a part underneath that started dragging on the ground and we couldn't drive the car like that.

THERAPIST: Mm.

CLIENT: So we put it into the shop, so that �There was a reason why I mentioned that.

THERAPIST: You were talking about the timing of why you went to bed so late and couldn't fall asleep?

CLIENT: Oh, because the next morning, we were renting a car because the car is going to be ready either this afternoon or tomorrow, so we were renting a car and we had to pick it up yesterday morning. And we had to do the Passover shopping. And so Sydney hadn't been clear about the fact, like I asked him if I needed to be along for the car and he said he would strongly prefer it. Which I thought meant he would strongly prefer it but it didn't mean that I actually had to be there. It was like, "Do I have to be there?"

THERAPIST: Mm.

CLIENT: And that he would have said, "Yes." And so then the next morning he was all like, "You have to be there." And I was like, "I asked you." [00:05:32]

THERAPIST: Mm.

CLIENT: So it turns out that "strongly prefer" actually means "yes." (sigh) I don't thing he's being �Like he thinks it's a politeness thing. I think it's like, if you don't say what you mean you are going to cause more problems to be, and then that's not really very polite at all.

THERAPIST: Mm.

CLIENT: But at least I got him say at least [for the most part of the time] (ph) if he is going to say, "strongly preferred," it does mean "Yes, you do have to do this," or whatever.

THERAPIST: Mm.

CLIENT: And he just doesn't want to come out and say it. At least if it's consistent I can deal with that. But, yeah, because we were going over the Haggadah and I probably would have tried harder to fall asleep if I knew that I wasn't going to have a chance to catch up on any of that sleep.

THERAPIST: Mm. So it wasn't that you were necessarily trying to go to sleep. (cross-talking at 00:06:21)

CLIENT: Well I was at first. We were both at first. And then we both couldn't sleep. And then we were like, "Okay, why don't we go over the Haggadah and stuff for your Seder."

THERAPIST: Mm.

CLIENT: We tried at first. So there was a period where I couldn't get to sleep.

THERAPIST: Mm.

CLIENT: So, yeah. Everything is a mess now. Like I'm worrying about all the days I've missed at work.

THERAPIST: Everything is a mess. What is all a mess?

CLIENT: Well the fact that I can't keep myself together. Like I barely made it to the services today. I had to be there because I was leading the service. You know, well I was fine while I was there but started panicking again as soon as I got out of services.

THERAPIST: Hm.

CLIENT: You know, and could barely get here. And Sydney dropped me off and Sydney is going to pick me up because I don't even think I can make it home on the T.

THERAPIST: What are you afraid would happen if you went home on the T?

CLIENT: (sigh) Well I'm just not sure that I'll have enough will to force myself to walk to the T station and get on and do all those things. Like those things all seem really, really hard to do right now. (crying) Like there's these tasks that I would take for granted as things I can normally do. [00:07:38]

THERAPIST: Mm.

CLIENT: Like there's no good reason why I shouldn't be able to walk over. It's not like I'm carrying lots of things or anything. Like there's no good reason why I couldn't take the T.

THERAPIST: Although it feels like it's something that is too hard right now.

CLIENT: (crying) Like even getting up off the couch an hour ago or something was too hard.

THERAPIST: How did you get yourself to do it?

CLIENT: Um. (sniffling) I don't even know. I think eventually Sydney was like, "We should go back upstairs." And I was like, "This is really hard." And he was like, "Do you want to come to the room or not." And I was like, "Okay, fine I'll come in." Then I just followed him and I don't really know what I did. (crying)

THERAPIST: Hm.

CLIENT: But it just feels like it's going to be so much mental energy to force myself to do all these different things.

THERAPIST: Mm.

CLIENT: Like we still have to cook for Sydney' Seder. And, I mean, he might be able to do it all without me, but I'm not sure. And, (pause) like �(sigh) [00:08:48]

THERAPIST: Mm. You say you've been panicking but in some ways it sounds more like a depression.

CLIENT: Yeah.

THERAPIST: Feeling like things are really hard and overwhelming.

CLIENT: (still sounds like crying) Yeah. I think it's both depression and anxiety right now. (pause) And I can't do anything. Because when I called the doctor (ph) and stuff, she called me back last Tuesday because I had called her on Monday to let her know about how I'm feeling with the drugs. But she said that I shouldn't have even gotten the serotonin reaction in the first place that I got. But I got it. And it happened. And also that I shouldn't have been feeling any withdrawal. But like -

THERAPIST: But you feel like you are.

CLIENT: But I feel like I am. Or maybe it's just coincidental timing and I was going to break down anyways.

THERAPIST: Mm.

CLIENT: But I can't even be on mood stabilizers. I can't cope on the Desipramine much because of the whole weird heart thing. [00:09:57]

THERAPIST: Mm.

CLIENT: So the metabolism or whatever [shots up] (ph). Like it gives me a certainly high level that I should not have been getting on such a low dose. And the Klonopin seems to be doing absolutely nothing. So I just feel like there's absolutely nothing I can do.

THERAPIST: Ah. So you're feeling like there's no possibilities anymore. I wonder if that's making you panic.

CLIENT: (sniffling) It might be. (crying) And I'm just like, you know, how am I going to go to work. I don't want to lose my job. I like my job.

THERAPIST: Mm hm.

CLIENT: I just am having trouble (crying) getting to it and stuff. I don't want to get there and have a breakdown either.

THERAPIST: Mm hm.

CLIENT: Maybe I'd be fine when I was there. (sniffling) I don't know. I don't want to operate a motor vehicle for, you know, three hours a day when I'm in a state or some times when I've been feeling all these suicidal thoughts and all this panic. That just isn't wise for me. [00:10:58]

THERAPIST: Mm.

CLIENT: You know? But I don't want to miss all the work either. (sniffling) And I feel like I can barely �Like I saw how I was able to yesterday, you know �Like yesterday I guess I wasn't that panicky as I am today.

THERAPIST: Mm.

CLIENT: I guess I was in this mindset of I just have to do everything. And so I did everything.

THERAPIST: Mm.

CLIENT: And I made the matzo ball soup, and the hummus and stuff. And so how I did all that? I don't know how I did it. And I don't think of capable of replicating it again today.

THERAPIST: Mm.

CLIENT: I don't even know if I'm at a point where I should go to the mental hospital. I'm not going to hurt myself but I'm also not functional either. And I don't want to be trapped there especially over Passover where there's no way I'd be able to get food that's Kosher for Passover.

THERAPIST: Mm hm.

CLIENT: Like I have no options. Like there's nothing I can do. (pause) [00:12:03]

THERAPIST: Let's look at sort of what functioning really means for the next couple of days. What do you need to do to function?

CLIENT: (sniffling) Somehow get back to Sydney' place for tomorrow or today. I need to. I might be able to get away with going back to sleep instead of helping cooking.

THERAPIST: Mm.

CLIENT: He thought that me getting sleep, catching up on sleep, would be a good idea.

THERAPIST: Mm hm. Okay, so he's going to pick you up. So he's going to pick you up and take you home back to his place.

CLIENT: Yeah. The problem is also we're waiting for, he ordered a Seder plate from Israel and it's being delivered today and he has to sign for it and he's not quite sure when it's coming. So I might have to wait awhile.

THERAPIST: Mm.

CLIENT: Well also keeping myself together enough to leave for him to pick me up whenever that is.

THERAPIST: Mm.

CLIENT: And then possibly cooking and then being at the Seder and helping him lead it because, I mean I guess I could, in theory, flee and hide in the room if I really, really have to. But I'd rather not go there. [00:13:19]

THERAPIST: Mm.

CLIENT: But if it becomes my only option then I'll do that. (sniffling) And, you know, also have to get myself to eat food. Well it wasn't a problem earlier, but I don't know if that will be a problem later.

THERAPIST: Okay. Why would it be a problem if it wasn't before?

CLIENT: Because I'm more panicky now, I think, than I was when I was making [matzoth pizza] (ph) earlier.

THERAPIST: Mm.

CLIENT: So there are like those things. I guess Wednesday, most of the day I could just stay at home and then after like the holiday ends I need to go to rehearsal.

THERAPIST: Let's take one day a time.

CLIENT: Okay. (sigh)

THERAPIST: And I know I said the next few days. But I think probably it makes sense to revise that and think about getting through one day at a time right now until some of this panic subsides.

CLIENT: (whisper, labored breathing) Okay.

THERAPIST: Panic is like a wave. It has a peak and it always comes back down. You don't know exactly how big that wave is going to be, but panic always does start to subside at some point. [00:14:31]

CLIENT: And probably I think I still would have a higher base line than normal. (crying) You know? And it will subside, but I don't know if it will subside enough.

THERAPIST: Enough for what?

CLIENT: (sniffling) Enough to not feel so uncomfortable all the time and wanting to hurt myself and stuff.

THERAPIST: Mm. You need to tell me about those thoughts of self harm.

CLIENT: I mean they don't happen that �Like it's usually only when it's really bad. Like right now it's just like how I was feeling. Well the Wellbutrin wasn't working where it was like this feeling is so uncomfortable there is no way to end it. I need to end it. (deep breath) You know, also starting to get hopeless with the whole like (deep breath) fear that I won't be able to function enough to work. (sigh) And not wanting to lose my job.

THERAPIST: Is there any indication that you are going to lose your job?

CLIENT: No. Well -

THERAPIST: When you didn't go to work, did they say that?

CLIENT: No. I mean I even sent an e-mail being like, "Hey I know that I missed a lot of days. I was thinking of coming in Fridays to make up for those days over, once Passover's over." And they were like, "Oh cool. Come in Fridays (laughs) if you want to." (sniffling) So �[00:15:53]

THERAPIST: Okay.

CLIENT: It's just sort of a fear that got planted into me with like originally Sydney and I were planning to do the trip right after Passover. My Mom was all like -� I called her and asked her about it because she has miles on Southwest that can be used towards those flights.

THERAPIST: Mm.

CLIENT: And she was all like, "Oh you're missing so much work." And like, "For Passover you can't just go and take a vacation like that." You know, even though I'd probably only be missing a day of work for the vacation.

THERAPIST: Mm.

CLIENT: Because I'd do it over, you know, if I have a four day weekend then I have a four day weekend. But, um, (pause) it means, but that sort of got me thinking, "Oh wow, I am missing a lot of work." And then I missed more work for being sick. And I've missed snow days. And also because my Mom was all like, for the snowstorm on Tuesday, I had originally planned to come in late when the report was just like, "Oh, it wall end by eleven." [00:16:56]

THERAPIST: Mm.

CLIENT: And then when they were like, "Oh it's actually going to start up again in the afternoon," you know I told work that I wasn't going to come in after all because I didn't want to risk my safety on the drive home either.

THERAPIST: Mm hm.

CLIENT: And but I had called my Mom because it was her birthday and I called [her out for it] (ph) and she was all like, "Oh, you're not at work." And I'm like, "No. The snowstorm got worse." And (inaudible 00:17:22) at she was that surprised about it. Like just reinforced the whole, I could lose my job if I'm not going to work all the time. Even though I have a really relaxed boss. And my job does not at all effect the running of the place.

THERAPIST: Mm. So you may have a better idea of work's response -

CLIENT: (cross talking) Yeah.

THERAPIST: �than your Mom.

CLIENT: Possibly. (ph) (sniffling) You know, it's not like I'm not a hard worker. It's just, it like really it's not like this project, it's more like (sniffling) this project will take about a year and the funding is, like I think, I guess the grant probably has to be finished by a certain point. But I think if goes a little bit over it's okay.

THERAPIST: Mm.

CLIENT: (sigh) And you know, I'm getting paid by the hour so I'm not costing them any money for the days I'm not coming in.

THERAPIST: Mm.

CLIENT: So I think it's all good. But now I don't know. And my Mom, has caused me to doubt that.

THERAPIST: Mm. And those doubts lead to anxiety.

CLIENT: Yeah. (sigh) I don't think that's the underlying cause of all of this anxiety though, because I was feeling anxious before that. [00:18:39]

THERAPIST: Mm hm. But it seems like it added to it.

CLIENT: Yeah.

THERAPIST: It gave you something to worry about that doesn't really have a clear answer.

CLIENT: True. Though I feel like eventually I would've on my own gotten to the point of worrying about missing so much work. You know I was okay with telling them all the days I'd miss for Passover and stuff.

THERAPIST: Mm.

CLIENT: But if I keep on having these sick days then I, you know. I don't want to lose my job. I wish, like if I could work from home, which -

THERAPIST: It's not a work from home job.

CLIENT: It's not a work from home job. It's one that could. I mean the thing is that they do have the PDF scans of the log books I'm working with. But sometimes things are hard to read and I need to look at the actual log book.

THERAPIST: Mm.

CLIENT: And it's better, it's easier, well it goes back and forth which one is easier to read depending on what page and how it go scanned.

THERAPIST: Mm.

CLIENT: But if I just work from the PDF I could still probably get it and then the software that I'm using for the, you know, writing the [finding in] (ph) to the software that I have.

THERAPIST: Mm.

CLIENT: So like I could, in theory, actually do some of the work from home if I were to set myself to (inaudible 00:20:01) and stuff. But, in general, it's (inaudible). Like I don't know if I could, especially because they're not going to be here to see me working and if I want to keep track of my hours and stuff.

THERAPIST: Mm.

CLIENT: I think it's easier just to go. But I �Yeah.

THERAPIST: So rather than focusing on how much time from work you might miss or whether or not you could create the ability to work from home, let's focus on getting you back to a place where you can go to work.

CLIENT: I just don't know how to do that.

THERAPIST: Mm.

CLIENT: (crying) I don't know that it's possible. And I had seen doctor Hoeg (ph) on Friday, so that, or a least soon, but -

THERAPIST: Mm hm. And when was the next day that you were scheduled to go in.

CLIENT: Thursday. (pause)

THERAPIST: Okay. Then it's very possible that you can take yourself to work on Thursday.

CLIENT: Yeah. (whisper) (sigh) Sydney doesn't have anything going on, but it would probably be unfair to ask him to drive me to work and hang around so I could be less -

THERAPIST: Mm. [Tomorrow maybe.] (ph)

CLIENT: Yeah. (sigh) So it's not completely outside the realm of possibility. But I think given his mental status, I'm not going to, like I wouldn't want to put that burden on him. [00:21:23]

THERAPIST: Mm.

CLIENT: But I don't know whether or not I can drive safely. (sniffling)

THERAPIST: Mm. Well, you'll know much more on Thursday.

CLIENT: Yeah.

THERAPIST: And it's hard to predict from today to Thursday. A lot could change by then.

CLIENT: It's true. I don't know if the -� I don't know and just don't want to be missing the work.

THERAPIST: You don't need to know now.

CLIENT: I guess I don't.

THERAPIST: I don't think you need to make a decision on Tuesday about what you're going to feel on Thursday.

CLIENT: Uh huh.

THERAPIST: You just don't know.

CLIENT: Yeah.

THERAPIST: Right now you take it one day at a time and do what we need to do to get you through the things on your list.

CLIENT: (sigh) Uh huh.

THERAPIST: Because it does, I think your experience is showing you that staying active and doing things usually does help you. Distraction is one of your best techniques for getting through the anxiety. [00:22:32]

CLIENT: It's just hard to even get myself into a distraction in the first place. I'm just not going to do it. And, you know, it has to be, you know, intellectually stimulating enough to make me, you know, get distracted.

THERAPIST: Mm.

CLIENT: But I'm also very wary of the whole being around large groups of people right now.

THERAPIST: Mm.

CLIENT: Like I'm kind of dreading the Seder.

THERAPIST: Who's going to be at the Seder?

CLIENT: Um, they are all of Sydney' friends and possibly some of the housemates.

THERAPIST: Mm.

CLIENT: I've met them all before.

THERAPIST: And how big of a group are you expecting?

CLIENT: I think we're expecting, including I think Sydney thinks there are thirteen people coming to the Seder, including me and him. So eleven other people.

THERAPIST: Mm. That's a pretty good size group.

CLIENT: Yeah. Which is why I am kind of wanting to hide and run (ph).

THERAPIST: Are there any things you like about Seder? Are the positive things you can focus on? Songs or foods or rituals.

CLIENT: At this point, in general, yes, there are things I like about Seders. Right now all the things I normally like about Seders would be (inaudible at 00:23:59) except for the food, which I'm kind of hoping I can eat. (inaudible) at the Seder then hide in Sydney' room and go to sleep.

THERAPIST: Mm.

CLIENT: But he wants me to help lead the Seder. Just I think leading is going to �Well at least he's �Well he was at a Seder last night, therefore, he (inaudible at 00:24:20) most things that I (inaudible). You know, we used the same goblets last night that we're using tonight. So there should be nothing in there that's a surprise to him. You know?

THERAPIST: So what do you feel like your responsibility is in helping him lead?

CLIENT: I guess it's just I'd like to be able to help him if I can. I really don't think I can though.

THERAPIST: Mm.

CLIENT: Like I really think the best thing for me would be to, you know, get a bowl of the lamb stew and stuff before people come over and just, you know, don't even hide, just go to bed early and skip the Seder altogether.

THERAPIST: Mm.

CLIENT: So that way I could not have to deal with lots of people and having to stay. Because it's also like once I'm there I feel like I'm stuck there and I can't get away.

THERAPIST: Ah. It seems like that's what you're afraid of.

CLIENT: Yeah.

THERAPIST: How are you stuck?

CLIENT: Well, for one thing, when you're trying to put thirteen people into this room, it's not the biggest room in the world, and for people to �Like the way we're going to have the tables I'm guessing it's going to be hard to just get up and leave at any point. I could get a seat closest to the door. [00:25:41]

THERAPIST: Mm hm.

CLIENT: But it would be awkward, I think, is the other thing.

THERAPIST: Mm. To excuse yourself?

CLIENT: Yeah. I mean I ended up doing it last at eleven. Last night it was -

THERAPIST: How did that go?

CLIENT: That went okay even though I was leaving the Seder I abdicated to Sydney. And I, because it was getting late and I had to wake up at eight thirty so I could get ready to [lead this off] (ph) today and just was falling asleep. And since I was operating on three hours of sleep, you know, everyone was fine about me leaving. I don't really have the same excuse tonight.

THERAPIST: But nobody necessarily needs to know that.

CLIENT: True.

THERAPIST: I wonder if you could plan with Sydney to do a compromise.

CLIENT: Uh huh.

THERAPIST: To seat yourself in a chair where you feel like you do have an easier path out. And to plan to help him get it going and get it started and to excuse yourself. To let people know that you �You know, you could say, "I got very little sleep. I'm really tired so I'm going to excuse myself for the remainder of the Seder." [00:26:54]

CLIENT: (sigh)

THERAPIST: It seems like part of what's escalating your anxiety is this fear. It's this feeling that it's all or nothing.

CLIENT: Uh huh.

THERAPIST: That you either have to be at the Seder and stay for the entire length of it no matter how long it goes and feel trapped or hide. And neither one of those really seems like a safe option. Feeling like you have to hide is not a good safe feeling, because you still feel trapped and you're stuck in your room the whole time.

CLIENT: I guess if I were going to be in my room, I think I'm tired enough that I'd really be sleeping for most of it.

THERAPIST: Mm.

CLIENT: So I don't think I'd be too trapped by that.

THERAPIST: Mm.

CLIENT: I think the Seder is definitely the more trapped option.

THERAPIST: Mm. So let's plan an out so that that way you have as many options available to you, as much freedom.

CLIENT: Uh huh.

THERAPIST: The freedom to be at the Seder or to go to sleep. You know, to put yourself at a place where you could be at the table and more easily exit, rather than feeling like you need to block into one thing or the other.

CLIENT: Uh huh.

THERAPIST: I mean giving yourself a lot of options gives more freedom, more space to breathe, less feeling like you have to do one thing or the other. [00:28:01]

CLIENT: Uh huh.

THERAPIST: And that feeling of having to, the shoulds of feeling blocked into an either/or.

CLIENT: Uh huh.

THERAPIST: Those things usually escalate your anxiety. And one plan to face your day in a way that you have as little things triggering your anxiety as possible. As few things triggering.

CLIENT: Then how do I deal with that when it's like work.

THERAPIST: Well at work you still have the option to exit. You know, if you're driving and you feel unsafe.

CLIENT: Uh huh.

THERAPIST: You always have the option to pull over to the side of the road. Even if you're on the highway there's usually an exit that you could take or, you know, a rest stop that you could pull over, or even making use of the breakdown lane.

CLIENT: Yeah.

THERAPIST: You're remembering to find the options. Or if you get to work and feel like you can't do a full day -

CLIENT: Uh huh.

THERAPIST: �you can leave early. Or you can go take a break someplace.

CLIENT: Uh huh.

THERAPIST: It might not be what you technically do, but I think reminding yourself that there are usually options if you remind yourself to look for, "What are the options here?" What might not be the normal path but is a possible path. [00:29:18]

CLIENT: Uh huh.

THERAPIST: That way you don't have to judge, you know, on Wednesday night whether you feel like you can do a whole regular work day on Thursday.

CLIENT: Uh huh.

THERAPIST: You can keep judging throughout the day.

CLIENT: Yeah. Because the other thing is if I do, you know if I am going to work, I always have to at least make the decision the night before to the extent of getting, going to bed at ten so I have the ability to get to work the next day.

THERAPIST: Mm hm. Yeah. So going to bed early gives you the option of going. Going gives you the option of working a certain number of hours or fewer.

CLIENT: Uh huh.

THERAPIST: This is about giving, letting yourself see where you have choices.

CLIENT: Uh huh. (pause) (sighs)

THERAPIST: It seems like, just as I pay attention to your breathing when you came in, your breathing was very short and shallow. And it's actually slowed down. I don't know if you feel that, but I can see it just from how you're sitting and from how your chest is moving, that it seems like you're able to take a deeper slower breath now. [00:30:28]

CLIENT: Uh huh. Yeah. I'm feeling less �Like, I mean, before I got here I was going back up to my room after we had made lunch. I was hyperventilating. So -

THERAPIST: That's a really uncomfortable feeling.

CLIENT: Yeah. (deep breath)

THERAPIST: It's not dangerous, but it is uncomfortable. I don't know what's allowing you take a slower deeper breath now, but being able to do that probably feels more comfortable.

CLIENT: Yeah.

THERAPIST: As we call attention to it it might actually (laughs) take away some of that feeling.

CLIENT: Uh huh. Yeah, I'm just (pause) (deep breathing) I don't know if it will stay like this. I still feel [I'm going to] (ph) gag.

THERAPIST: Mm.

CLIENT: I'm still completely nervous.

THERAPIST: Yeah?

CLIENT: And I don't know if I'll be �Like I'm just afraid that Sydney won't be able to do it all by himself and that he'll need to rely on me. [00:31:32]

THERAPIST: Mm.

CLIENT: And that I won't be able to do it because I can't.

THERAPIST: What happens if the Seder doesn't go the way he wants?

CLIENT: He gets disappointed and then I have to be sad because he's disappointed. And I don't want to see him disappointed.

THERAPIST: Mm.

CLIENT: Depending on which way it doesn't go right. You know, or deal with I'm panicking while he's trying to Kosher (ph) the oven at his place. And you know he's making his own matzo. And for some reason the matzo's the size of a pita bread or something. And that like for thirteen people he should make like forty matzos.

THERAPIST: Mm.

CLIENT: As like (inaudible 00:32:10).

THERAPIST: That's a lot of matzo.

CLIENT: That's a lot of matzo. (laughs)

THERAPIST: (laughs)

CLIENT: Nobody's going to want quite that much. I think, also three big ones for the Seder plate. It's often like I'm like, "No. You really don't need to make that many."

THERAPIST: Mm.

CLIENT: You know, especially because the amount of work that goes into making them. You know, it has to be done within the eighteen minutes. The surface has to be wiped down between each use of rolling out the towel and stuff. And so it's going to be really crazy.

THERAPIST: He's got some pretty high expectations.

CLIENT: Yeah, and so I'm just afraid everything �Because he was panicking about how he was going to get everything done. And I was telling him that it was going to be okay. But now I feel kind of like I really can't do anything to help it get done.

THERAPIST: Mm.

CLIENT: Like I just don't think I can. [Not in this span]. (ph) Like he still needs to buy some of the food for the Seder because he hasn't done that yet.

THERAPIST: Mm. It seems like a lot of your anxiety, you're sucking up some of Sydney' anxiety.

CLIENT: (sniffling)

THERAPIST: He's setting a really specific and high bar for how he wants the Seder to go.

CLIENT: Yeah.

THERAPIST: And hasn't left himself a lot of time to prepare. [00:33:27]

CLIENT: Yeah.

THERAPIST: And it seems like you're sucking up all of this anxiety for him. And worrying about him being very disappointed if it doesn't go a certain way.

CLIENT: Yeah. I told him he should send an e-mail to, you know, if it was like this morning and the Seder's today and everybody checks e-mail, I don't think it's that big a deal to be like, "Hey, we're pushing it back to eight." Which he should definitely do.

THERAPIST: Hm.

CLIENT: What would take some of this stuff of the list. You don't have to make all you're own matzo. He could make some.

THERAPIST: And we have boxes of �You know, I think if he just made the three big ones for the Seder plate.

THERAPIST: Mm. yeah.

CLIENT: And everybody, because -

THERAPIST: And use good ole boxed matzo for the rest.

CLIENT: Yeah.

THERAPIST: I mean I don't know if he will take you up on that suggestion.

CLIENT: Yeah.

THERAPIST: So you don't have control over what he decides. You can certainly make that suggestion. What you do have control over is his anxiety and his expectations get pushed back on him. You don't have to feel his anxiety for him.

CLIENT: Mm hm.

THERAPIST: And while I know you care about him, and obviously you don't want to see him disappointed. And you can feel sad for him if he does end up feeling disappointed. But you don't have to own or carry his feelings too. You have enough of your own feelings. And it doesn't mean that you're not feeling empathy for him.

CLIENT: Mm hm.

THERAPIST: But you don't have to take on his burden too. [00:34:55]

CLIENT: Mm.

THERAPIST: He's making some choices and he's having a reaction to those choices. And you can let those be his and you have yours.

CLIENT: Yeah. It's like I have to run two Seders.

THERAPIST: Yeah.

CLIENT: He helped a little bit with the cooking towards the very end for mine, but me and Aimee did the vast majority of things.

THERAPIST: Mm.

CLIENT: So I think it's only fair for me to -

THERAPIST: Yeah. You can be supportive without being it.

CLIENT: Yeah. So, but even I don't even think I want to be in the room when he's [making it.] (ph) Like I think I want to be in his room while he's in the kitchen making all the matzo. Even though he was in my room when I was in the kitchen making all of the soup yesterday.

THERAPIST: Mm.

CLIENT: So -

THERAPIST: It seems that some of this feels kind of like tit for tat.

CLIENT: Well, more like I feel more justified then in being a little bit less supportive than I would otherwise be.

THERAPIST: Mm. Yeah.

CLIENT: Because -

THERAPIST: You don't feel like you got that support.

CLIENT: Well not in that so much as like if you felt that panicked about it, he should understand why I'm feeling that panicked right now. [00:36:05]

THERAPIST: I see.

CLIENT: And therefore, you know, I'll do stuff if he really, really needs me to. Or at least I will try to and if I fail then that will at least be a good indicator that I can't do things. But I think when I get back I'm just going to hide in the room and not help out with things.

THERAPIST: Mm.

CLIENT: (sniffling) If he's okay with out. I mean it's also because he's, if the Seder plate didn't get there in the past hour, after he picks me up I think I'm going to stay while he goes shopping. And I at least I'll be there to get the Seder plate when it arrives.

THERAPIST: Mm.

CLIENT: If nothing else. I won't be completely useless, but I can't be as useful as I normally am. (strained voice) It's just everything has worn me out.

THERAPIST: Mm. Yeah, you seem really worn out. Anxiety is also very exhausting because your body goes through a lot to be this anxious. To ride these waves. [00:37:08]

CLIENT: So I really can't stop being anxious right now.

THERAPIST: But you actually have. You've taken the edge off. Even just in the past forty-five minutes.

CLIENT: Uh huh.

THERAPIST: You've been able to take some of the edge off. It hasn't taken away the anxiety, but you're not panicking the same way you were when you walked in the door.

CLIENT: Mm hm.

THERAPIST: And that's something that you did by being able to talk a little about it, slow your breathing down, focus on just one day rather than jumping ahead and imagining this week and next week. That helped you to take some of the edge off. And that's much more bearable than being at that really high intensity.

CLIENT: Yeah.

THERAPIST: And you can continue to do that outside of this room.

CLIENT: Yeah. You know, it's not like I have so much conscious control over it. [00:38:11]

THERAPIST: Mm hm. (pause) I think what you can do to grow (ph) into the control that you do have, is thinking about those options.

CLIENT: Right.

THERAPIST: What are your options for an alternate route? Just like we thought of, well, instead of the "either/or" box of hiding or doing the whole Seder.

CLIENT: Uh huh.

THERAPIST: Here are your options. There are options to exit the road on the way to work or to take a shorter day. I think if you can remember to look for options -

CLIENT: Uh huh.

THERAPIST: �that gives you some conscious control over it.

CLIENT: Uh huh.

THERAPIST: I think you can do that.

CLIENT: I will try. Though I don't �It's just so hard to just get control.

THERAPIST: It is hard. It's hard work.

CLIENT: (crying) I don't know if I have it in me. I already took a leave off but I feel like I need more breaks from the world.

THERAPIST: Mm.

CLIENT: I need to just hide away from everyone and I can't really.

THERAPIST: You can take breaks. That doesn't mean hiding away completely.

CLIENT: I can take breaks, but I really can't take time off, [per se.] (ph) [00:39:29]

THERAPIST: Mm.

CLIENT: Like maybe I have the option to not go to work on Thursday, but I really don't want to take the option because I think it'll make things worse later on.

THERAPIST: So think about breaks rather than thinking about the whole day off or the whole day working.

CLIENT: Uh huh.

THERAPIST: To make it manageable, do it in chunks. Do the Seder in chunks. And think where you can take the breaks that you feel like you need.

CLIENT: Uh huh. Yeah. Well I don't know if we have enough time to take breaks before the Seder.

THERAPIST: But you can. You might not take breaks �The Seder may not take breaks. But if you need to excuse yourself, you can.

CLIENT: Okay.

THERAPIST: There's no rule that says somebody can't get up and go to the bathroom.

CLIENT: No.

THERAPIST: Or even go lay down.

CLIENT: I mean it's like all the preparing for the Seder now, I don't think we have enough time before the Seder to start and to take breaks and not help with things. I think I feel trapped into that.

THERAPIST: Mm.

CLIENT: I don't think I have the option. Maybe I do. But I do not yet know whether or not I have the option to hopefully bow out of helping set up the Seder. [00:40:43]

THERAPIST: Mm. Allow what you can do to be ruled by what you can do.

CLIENT: Okay. (sigh)

THERAPIST: Not necessarily what somebody's asking.

CLIENT: (sigh)

THERAPIST: But what you can do.

CLIENT: But I always thought that if I push myself hard enough I can usually make myself do things even though I'm really uncomfortable doing them.

THERAPIST: Mm.

CLIENT: I just don't want to put in all that energy to push myself right now because I did that yesterday and this morning.

THERAPIST: Yeah. And so you want to find that limit of pushing yourself a little bit because sometimes that 's useful for you to be engaged.

CLIENT: Uh huh.

THERAPIST: But knowing where the limit is. Where it's hurting you versus helping you. I think pushing yourself a little bit helps you.

CLIENT: Uh huh.

THERAPIST: But when it's too much and you might be able to feel that in your body, where the anxiety is.

CLIENT: Uh huh.

THERAPIST: That's when you step back a bit.

CLIENT: Uh huh. (pause) Yeah. I really hope Sydney get it together. So what else it leaves is like making the chicken and stuff so I don't have, like Sydney isn't -� I think the big things that he has to do are the lamb stew and the matzos. [00:41:55]

THERAPIST: Mm.

CLIENT: And if I can convince him that he, you know, if he wants to make some matzos (ph) for everything, it's like one soft matzo per person, then you're only making thirteen.

THERAPIST: Mm.

CLIENT: And we got four boxes of matzo yesterday. Like there is no reason why -

THERAPIST: There's plenty to go around for at least for today.

CLIENT: Most people don't usually, you know -

THERAPIST: It sounds that there is going to be better things to eat.

CLIENT: Yeah. Most people don't eat all the matzo ever at a Seder. (sniffling) So maybe I can convince him to cut back on the amount he's planning on making.

THERAPIST: That will make it is easier for both of you. And remember to leave, if he chooses not to cut back, that's his choice.

CLIENT: Yeah.

THERAPIST: Not your stuff. Let those be separate.

CLIENT: Uh huh. Yeah.

THERAPIST: We stop there for today. And I'll plan to see you at our regular time next week. But you know you can call if you need to. [00:42:55]

CLIENT: Okay.

THERAPIST: And I know you see the doctor on Friday?

CLIENT: Yeah. And the week of the eighth is there any way we could move that to a different time, because I got an appointment to see the hand doctor and to get my new wrist brace. And that's at three-thirty up at Assembly Square.

THERAPIST: Oh. I have a 12:30 on the eighth.

CLIENT: Okay. Yeah, that can work. I'll just have to move around the �Lee's (ph) adopting a second child.

THERAPIST: Oh wow.

CLIENT: I might need to go get fingerprinted at this specific place. But I think if I cancel more than twenty-four hours in advance and reschedule and then that's fine.

THERAPIST: Okay.

CLIENT: It's at eleven thirty, so.

THERAPIST: Mm.

CLIENT: That shouldn't take an hour, right?

THERAPIST: Uh.

CLIENT: Though I guess paperwork is (cross talking at 00:43:52)

THERAPIST: I don't know how lines, and I don't know. The actual fingerprinting. I don't know.

CLIENT: Yeah, I'll probably move �Well the fact they make you have an appointment.

THERAPIST: Mm hm.

CLIENT: But, yeah, I'll move around the fingerprint date because therapy's more important than fingerprinting.

THERAPIST: So next week on the first we're at two-thirty and then the eighth at twelve-thirty.

CLIENT: Mm hm.

THERAPIST: Okay. I'll see you then.

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