TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: So where should we start today?

CLIENT: For one, I guess, it was this, no it was the Friday before-I guess I don't think I actually told you, but when I saw the other doctor, the 29th, she said that you should call her and talk to her.

THERAPIST: Okay. I will do that.

CLIENT: Okay. I'm feeling a little bit better. I don't know like, well over the weekend-starting out, like on Wednesday, Sydney got really sick and then I caught it on Thursday. And I'm not sure, it's like some of my depression was due to heading into this illness. But I have this really weird thing, one like, I was sick, you know it would be tired and dizziness like normal sickness. Except then it turned into panic. And like, I couldn't really find any trigger. I'm pretty sure the panic had to do with being sick. [0:01:10.9] And like, I'm like, oh, I don't feel that sick anymore but I feel panicky instead. And I've never seen that happen before. It happened like, quite a few times. And like, so quick that I was like, you know Sydney would be like, oh, do you want to watch a TV show. And I'm like, I don't want to watch a show because then I'm committing to watching something for like 40 minutes or whatever. Even the idea of you know, committing to watching TV seems overwhelming. Even the idea of committing to eat a sandwich for like 15 minutes seems overwhelming. I can't do anything. [0:01:42.7]

THERAPIST: That seems really extreme.

CLIENT: It does. (Chuckle) And I think it had to do with being sick but I don't know. And it was like at the time I felt kind of powerless to do anything about it.

THERAPIST: And that was how long ago?

CLIENT: Like this past Thursday and Friday mostly.

THERAPIST: It sounds like some of the symptoms of the illness feeling weak, feeling dizzy, sort of mimic what it feels like to have a panic attack.

CLIENT: Yeah but I don't usually feel weak and dizzy when I have a panic attack. I mean, maybe because they're not full-fledged whatever someone would label as a panic attack. But more bouts of panic that I experience. Like the heart racing thing is really the only thing that I would-

THERAPIST: Notice

CLIENT: Yeah. There's just this really strong feeling of not wanting to do it, and then like well. You know Sydney wanted to watch TV with me and like, I could go back into the room and you can watch TV and I can just Internet. But he was like, no, I want you there. You know, Sydney is like, his sickness was just being sick and he couldn't really understand I was panicking and I was like, I don't really understand it either, but it's happening. [0:03:07.2] You know, and then I eventually agreed to like, watch TV with him and it wasn't like, bad, but-

THERAPIST: What happened when you watched the show?

CLIENT: I think my panic lessoned a little because I had something to focus on. But, yeah. (Pause) It's one thing to feel trapped by not having enough free time or something but to like feel trapped just by the idea of watching a TV show, or even the idea of sitting down to eat, like that's bad.

THERAPIST: Because what would happen if you followed through on it? You said you didn't want to commit to 40 minutes. What would happen if after 10 minutes you didn't feel like watching TV was interesting, useful, good idea?

CLIENT: I'm not sure. I guess I could have gone back to the room. But like I don't, I sort of feel like once I start it I can't stop it. I mean like, luckily I didn't feel like I needed to stop it. But I sort of am more likely to go along with it once it's already happening. It wasn't like they were shows that I didn't like either. They were things I did like; it was just like, okay why don't we do this 20-minute show instead because it's shorter. [0:04:17.6] Instead of this 40 minute show.

THERAPIST: It seems like, you know we talked last time about you're feeling trapped. It seems like you're allowing yourself to feel trapped by things that don't necessarily need to be confining in any way. You know, if you start a show and don't want to finish it, there's nothing holding you to that. That's easy to amend. You can pause TV these days. (Chuckle)

CLIENT: Especially because most of the things that we're watching are like through the Roku box and are like therefore, like on Amazon. Or like something else through the Internet thing.

THERAPIST: So you may not be missing-I mean worst-case scenario in the olden days, would be if you didn't watch a show at the time it was on, you missed it. You don't live in that world.

CLIENT: I was in that world, like I do remember having to watch TV when it was on. [0:05:11.3]

THERAPIST: But it's not like that anymore, right? So, I think, I remember talking last time about the idea of trying to find your options. Rather than allowing yourself to feel like you don't have any options. That you are really trapped. Because a lot of times you are not. There's a lot of ways in which you can create another, you know a more flexible way of looking at something.

CLIENT: I guess there's also a sense, like Sydney was feeling sickly, he needed the TV to like, give him something else to focus on so he wouldn't be feeling as sick. You know, and I guess because he was in-you know if I was watching something by myself, sure I could just stop it. But like, in watching it with him, I have to like, you know, I guess I could always just stop paying attention to it. [0:05:57.9]

THERAPIST: Or you could let him watch by himself if you don't feel like it.

CLIENT: Yeah, but he wanted me to stay up in the living room with him. Yeah, I'm not sure. Like, I feel-

THERAPIST: Are you feeling trapped by him or by the TV?

CLIENT: Probably more trapped by the TV. But it was also that because of him it wouldn't even be an issue in the first place. Yeah, I really don't know why I had such a strong reaction. All I can think of was, it was because I was sick and like, I guess the sickness could be making my heart race. And my brain interpreted it as panic. And like, somehow I even ended up going out and walking like, on Friday morning and then again on Friday, but afternoon. And like on Saturday, and was a little bit dizzy. But like, you know, then I would come home and be like, okay need to drink like all the water or Powerade. But like, I didn't. And like sometime too on Saturday I was like a little bit hazy. [0:07:05.2]

THERAPIST: And how was your anxiety on Friday and Saturday, those days that you walked?

CLIENT: I think it was fine while I was outside. It was more when I was coming back in and being, the idea of being trapped by TV or something when-which I know, it's really ridiculous.

THERAPIST: But felt very real.

CLIENT: Yeah, and like it wasn't even like I had other things that I needed to do. It was like, there is no good reason why I should feel that way, because, unlike-there was nothing there. That like realistically should make me feel the way I was feeling. Like, I mean, like the only time restraints we really have are when we want to like go out and buy food before Shabbat started and we were able to do that. Or I was able to do that. Then Saturday Sydney was able to buy food. [0:08:09.0] So yeah, there was nothing there.

THERAPIST: Nothing logical.

CLIENT: Nothing logical, there was nothing-I didn't have to like-and it gets to a certain point like, because we had some dishes from (inaudible) at one point it was like, yeah, I'll do the dishes I have to do them. But Sydney ended up doing some of them I think. Like after I went to sAaronp. But that was like, like Saturday night when I was mostly bad. Yeah, like, there's nothing realistic, that I can think of. That would make me feel this way. [0:08:41.8] (Pause)

THERAPIST: How did you get past it?

CLIENT: By giving in and letting Sydney put on something on the TV and watching it. Though it was still after the show had ended I would be like, do you want to watch another. And been like, okay fine we can watch another. Because like, each time it would come up, I'd feel trapped again. [0:09:09.0]

THERAPIST: Each time the idea of watching the show-

CLIENT: Yeah or each time I had to make a decision. Each time I had to make a decision about it, I'd be like, no I don't want to. Even though it was like fine watching the previous show. It's not like I had a deadline, or we only have a few hours until we have to go axe. There was not axe. There was nothing. And like, like I've been better since then and like, because originally I was going to go off like the Seroquel and the Klonopin. And like it sort of ended up not. I guess the Klonopin I don't have to worry about it affecting me during the daytime. Like the entire, because the one day I did take it I was fine. But, Seroquel I then noticed the next morning when I was up around 4, that my heart was racing for like a little bit. Maybe that was also related to the sickness. So then I tried it for like a day or two and then like okay, whatever I'll just stay on the regular amount that I was on and not change any of my meds. Even though I could. [0:10:14.0] So yeah. It's all connected somehow and I can't really score it out, like what is the cause of what and what.

THERAPIST: I agree with you. I think that it's probably connected. I think that being sick has some physical symptoms that might mimic what can happen during a panic attack. Even though it sounds like you don't usually recognize those things. You don't notice that they happen. You notice more; you know the heart racing than the feeling of dizziness.

CLIENT: Usually I don't-

THERAPIST: Just feeling off maybe.

CLIENT: But like I shouldn't be having such an over-reaction to feeling off. It's just really frustrating. Normally what I feel is I can just feel sick and I'd be like, okay I can't do anything, I'm just useless. And sit in bed and like, you know, use the Internet and be fine. And not be going crazy about being sick.

THERAPIST: But Sydney was asking you to do things, and I wonder if that's partly what you are reacting to. Feeling like you were being asked to do things that although doesn't seem like they should feel taxing, like he wasn't asking you to-

CLIENT: Maybe. But we've been sick together before like when we had the norovirus. We were fine watching TV then. There I had to even cook-

THERAPIST: So what made this time different?

CLIENT: Yeah. Like, you know I didn't feel trapped when I was stuck in the ER with the IV in my hand waiting for all the food to drop in. Which took longer because I was using a pediatric needle. You know, I was there for like three hours or something and I didn't feel trapped by that. Yet, feeling trapped for watching 40 minutes of TV. [0:12:00.1]

THERAPIST: Yeah, seems illogical.

CLIENT: Maybe because I really had no choice with the ER?

THERAPIST: Yeah because in some ways I heard you say earlier, the anxiety of making a decision. Making a decision was hard. With the hospitalization, or the ER trip, there was no decision to be made.

CLIENT: Well there was, it was like, do I feel bad enough to go to the ER? Okay, I do. Okay, I'm going to drive myself there.

THERAPIST: But once you got there, they made decisions for you.

CLIENT: True. Once that I got there, they made, yeah. But afterwards it was-

THERAPIST: Do you typically feel anxious when you're making a decision? When asked to?

CLIENT: Not usually. I think it depends on the type of decision, but I guess if it's something that you know, sometimes I guess like, when I was feeling all panicky in the first place, and like, the anxiety about deciding whether or not I was going to take off from work those days. And I took off, and like was feeling anxious and doubting myself. And being like, maybe, like I'm just letting this get to me too much and I really should be working. Because I'm going to miss all this other time for Passover. [0:13:10.2]

THERAPIST: So you do tend to question yourself.

CLIENT: If it's something that will actually affect me. Like, you know that's something important. Keeping my job is important to me. And like looking like I am an actual dedicated worker and not just like slacking off. You know, and I'm like, I took this other sick day. And I left, I left work early on Thursday. Because I started, it's like five in the morning and then like sometimes a few hours in is when I started feeling sick and okay, I should probably go home while I can safely do so. Then it was like, great, now I'm taking off more sick time. When I had already had took off the week. That week in March where I missed time because I was feeling suicidal. So, I guess I question my judgment sometimes. I'm trying to think like, what would be slightly more important decisions than watching television, but would be less important than going to work. [0:14:20.7]

I guess it's when they have consequences is when I will usually question things. But if they don't have consequences then I'd-like once we've decided what we're going to do for dinner, then fine. Sometimes the up in the airness is hard. But I don't know, it's not like something that's so typical, maybe recently. But usually I can make-

THERAPIST: Yeah, this seems a little out of the norm for you.

CLIENT: Yeah. Maybe it's all also coming on the heels of the whole trying to decide whether or not I'm going to stay in my apartment.

THERAPIST: Yeah I wonder if it's less to do with what was actually happening right in that moment, or more to do with what bigger decisions you've been kind of carrying around with you. [0:15:14.0]

CLIENT: Because I'm still sort of like, I've been-we had also-he had e-mailed me and said we should talk because I have people who are interested in coming here in September. I was okay, if you're going to do that, you should probably build a wall in my room so it's not, if you're going to run (inaudible) next to it. But like, if I were to do the move, like, I could just wait til September to do that move and-

THERAPIST: Do that move? Moving to a new apartment?

CLIENT: Moving to a new apartment. But, I feel like, yeah.

THERAPIST: You feel like?

THERAPIST: Like it's definitely not something I can do. I mean I haven't even started looking at places. I feel like if I do find a place, I want a good month before I'd be making the move so that I can be packing everything up and not be rushed. And also give Sydney time to get his clavichord and the other things that he still has in my room out of my room. So I can more efficiently move then. And it would probably also wait until after, I'd wait til at least June. Because in May I have the (inaudible) concert and Tech week and stuff, so I don't want it to conflict with that either. And like, if there are going to be move places, if September is when more places open up, then I should just wait til September. In June I'm not going to find as much. [0:16:52.8] But, I guess, I mean when Sydney was trying to buy the place, especially when he was going back and forth between whether or not he wanted roommates, it was hard for him.

THERAPIST: So you are assuming it's going to be hard for you?

CLIENT: Yeah, I don't even know.

THERAPIST: I wonder if that's a rational assumption?

CLIENT: Well, and you don't even know what my limit is, but like, I'm not sure if it's because he had more limitations than I did. I don't think he did. It was just, there didn't seem-maybe because it was like, especially when he was looking for July. July is a weird time. Whereas June and September are less weird times. [0:17:48.1]

THERAPIST: Do you feel upset on moving? Is that a decision you've made?

CLIENT: I think so, I think because you know with Sydney-like I guess I'm not completely set because I'm still worried about the cost. But like, every other, if it wasn't the cost, you know. Or if I knew that like coming out of my job at the museum that I'd like be able to have something lined up for right afterwards. That paid me real money or wasn't really far away such that I wouldn't be relying on my parent's anymore. It would be okay. [0:18:21.5]

THERAPIST: Those are some pretty big unknown's right now.

CLIENT: Yeah. So, I mean I guess my parents are okay with supporting me through that. I still am convinced that the cost is going to go up at my place anyways when Carl and Larry move out. I just really, with a job so far away, it just makes it harder to do all those chores. I still haven't sent out the e-mail of being like, hey why don't we stop doing communal dinners since no ones coming to them. But it would just be really nice to have my own place again. And like, be able to have, cats and stuff. And I think it will be better for me and Sydney to because that way like-especially if I found a place that was near him. Then, yeah, it would probably be the best thing. It's just like; I'm scared about the process of moving and getting everything moved out. I don't want to be, you know, like Joan was and leave the room I'm moving out of a total mess. You know, the next person has to deal with, and just leave tons of stuff there. It just seems like, especially because I have things in multiple rooms, it's not just-you know I guess like, I don't even know 100 % which books are mine, that are like on the bookshelves. [0:19:49.4]

THERAPIST: I'm sure that is something you can sort out.

CLIENT: Possibly. Because I never actually labeled them. And like, Aaron has like, hundreds of books, and I have maybe throughout the house twenty books or something. So it's a little bit harder, especially if he's moved things around a lot and put things in boxes. So you know, I guess, like, I don't want to be like other people are and leave the books there. Derek left a bunch of books there and then it was like, oh, I'll just-you'll mail them to me. But I don't want to like go through all the boxes since Aaron's moved all the books around. [0:20:26.3]

THERAPIST: Well, you do the best you can. As I'm listening to the things that you are thinking about and the level of detail that you're putting into the thought.

CLIENT: When I haven't even found an apartment yet.

THERAPIST: Yeah. And you're letting yourself get worked up about these details, that; one, as you just noticed, you haven't found an apartment. You don't know yet whether if you should shot for June or September. Like you are going many steps beyond where you are right now. And two, you're talking about them in such a way, that you're building it up and you're minimizing the level of competence you have. These are things you can do. Is it pleasant to pack up all your stuff and move? No, I think there's probably very few people that love that chore. But is it something that people can do, including you? Yeah, it takes an effort. You gotta do it. It's not, you know, it's not a fun chore. But you can do it. You're perfectly competent. [0:21:30.5]

CLIENT: It's not that I'm not competent; it's that I don't have the space. Like, my room, like I've never had enough space for all my things. Therefore, like tons of things are on the desk, like falling off and like I have things in laundry baskets and stuff. And like, not-and therefore I guess the task of getting it all into boxes when I don't have a place to put the boxes. [0:21:57.3]

THERAPIST: Well you'd have to use the space that's in your house. I mean, you may not be able to contain yourself to just your room in the process of moving out.

CLIENT: That's true.

THERAPIST: People have to be accommodating to the fact that you are moving out. You may have to have some boxes for a short amount of time in a common area. This is part of the realities of people moving in and out of an apartment. [0:22:16.7]

CLIENT: This is true. I just wish there were a way-

THERAPIST: You may not, you know, other people moved out, left some stuff behind. Probably made a mess in the process. Made you a little uncomfortable. You'd rather you didn't have to deal with that. But you can. And you can make some allowances for them, and they'll make allowances for you when that time comes. You know, I'm noticing-rather than-I don't want to argue with you about the details, what I want to pay attention to is, what are the patterns in your thinking that serve to make you really anxious about this stuff. I think that these are some of the patterns. Kind of jumping way ahead, and kind of talking yourself almost out of things or talking yourself into fully believing that this is something either so overwhelming that it's going to be miserable. Or so difficult that you can't do it. [0:23:08.1]

CLIENT: I mean, it's also, I have concrete experience. Like, you know, I had to move Sydney when he got sick last summer. And it really sucked.

THERAPIST: And you did it. But then you were fine. It sucked but you were fine.

CLIENT: I had to get a bunch of friends over and those friends no longer live here. So I can't really, like Lucy and Bennett have moved out west.

THERAPIST: So but the takeaway is that you did what you needed to do to manage then. It might be different now; you won't necessarily come up with the same exact solutions now. Because maybe the same people aren't around to help. But you will do what you need to do to manage now. I think, what you've learned is that, or what you can-what you can chose to take away from it, is that you can do it, even when it's not the best of circumstances. You can handle things even when they're difficult. You can live through things that kind of suck. [0:24:01.5]

CLIENT: Yeah, I just, I wish, like, I wish it would be over with. That I could just find a place and just decide and once I've made the decision I think, you know that I can start putting things in boxes and stuff.

THERAPIST: And start taking action, rather than taking worries.

CLIENT: Yeah because right now, I guess there are small things I could possibly do. If I spent more time at my place, at least get rid of all the recycling stuff that's around. Like, perhaps put all the yarn in my store on sale, such that people will buy it and I have less to take with me. Like, I could -

THERAPIST: It seems like there is some stuff you could do, not necessarily (music plays) just-I'm sorry let me turn that thing off. (Pause) It sounds like there are some things you could do just to make life more comfortable now. Not even necessarily thinking about preparation for moving. You've talked before about feeling kind of bothered by the recycling or boxes that are around. There's no need to have those around right now. [0:25:11.3]

CLIENT: Yeah. Like, most, that's more Sydney's room than my room. The stuff, like in his side of my room and I could, I really just need a day where I can like, where I can dedicate to things. I think least once I'm done with (inaudible) I will have more Sunday time that I can devote to that and stuff. It's just like, even though I have four day weekends, it's just like, that isn't enough. [0:25:43.4]

THERAPIST: Where is that time going?

CLIENT: Well Saturday's mostly Shabbat and I'm not going to do moving related things on Shabbat. Friday's, I guess it depends. Friday's are possibly turning into not weekends. Because, I mean, this coming Friday, I'm not going to work. But like the following Friday and maybe the Friday after that, I want to work to make up for those days I missed. Like, but maybe, I don't have to. Guess you know, I mostly just have to get this project done within a year-ish. So if I'm getting faster at my work, which I am. Like I no longer struggling to figure out what the cursive writing means, even though it's a new author. [0:26:28.8]

THERAPIST: You're getting more used to looking at it.

CLIENT: Yeah, so I'm actually getting quite good at that. So, I mean I guess it would be mostly making up the lost income, but like, and also just not looking like I'm missing work here and there for no reason. (inaudible) I think if I end up staying late, all three days this week, that would probably be enough effort to show them that it's not like I don't care about missing work. I just really did have to miss it. And probably at this point I don't have to deal with more snow storms. [0:27:14.0]

THERAPIST: That's true.

CLIENT: At least until the winter.

THERAPIST: Which hopefully is a long time off from this spring.

CLIENT: Yeah.

THERAPIST: So even then, look, look. You're worrying about snow storms on April 9th.

CLIENT: I'm worried.

THERAPIST: Even in New England, you can pretty much feel comfortable that there's not going to be a storm for a while.

CLIENT: There was this April Fool's Day blizzard when I was in like middle school or elementary school.

THERAPIST: That was a long time ago. [0:27:36.9]

CLIENT: But we have global warming. I mean, last year we had the year without winter, so. At this point yeah, I probably can be safe from -

THERAPIST: Worrying about it does not impact it.

CLIENT: But it's like, I don't know. Do I have to make up that time, do I like-there's nothing. It's really because my mom was like, oh you are missing too much work, the horror's, the horror's. And everything like that.

THERAPIST: That's a discussion to have with the people you work with, not with your mom, not with me. Do they want you to, I mean, you can offer. You can come in on Friday's to make up that time the next few weeks.

CLIENT: I mean, start of the, the answer I was given was like, oh you are welcome to come in Friday's if you want to. Which doesn't mean like, oh they want me to (cross talk)

THERAPIST: Right, which isn't-

CLIENT: That's not an actual answer, that's a like, you can do it but we aren't going to tell you whether or not we want you to.

THERAPIST: Yeah, but they didn't say, you know that would be a really wonderful thing if you could do that.

CLIENT: That's true.

THERAPIST: Which would give you more of an inclination of, oh they'd like me to. Not just I can if I want. That sounds like they were pretty noncommittal either way.

CLIENT: Which yeah. I guess it's just the fact that my mom refuses to believe that my work place is in fact that chill. Means that-

THERAPIST: Mean's your mom doesn't work there.

CLIENT: Yes that's true, my mom doesn't work there. I work there.

THERAPIST: And you have to trust your gut.

CLIENT: Yeah, so I think I'll just like, so maybe if I don't turn Friday's into day's that I'm going to work then I can-

THERAPIST: You can use them to maybe ease the, either ease the transition if it becomes a transition, or just make yourself more comfortable. [0:29:09.7]

CLIENT: Or at least make my room better. And like, Sydney can stay at his place and, I mean other than-really the only things I need his help with at my place is getting out the things that he has there. Which there probably is a lot of work I can do without going to that point. I think I'd probably feel a lot better. Of course I can't even start doing it until next week. So until then I have to live with it.

THERAPIST: It will be interesting to see, that if you let yourself take action on some of these things that have been kind of hanging over you, how that impact's just kind of the baseline anxiety that you've been really struggling with the past couple of months. [0:29:53.9]

CLIENT: I should definitely send out the e-mail when I get home, asking people if they are interested in ending communal dinners since they're not very communal anymore.

THERAPIST: And that's something you can take action on right away.

CLIENT: Yeah.

THERAPIST: Is getting that ball rolling. Allowing yourself to feel competent to handle the things that have sort of been lurking. I imagine that would feel like a big relief to you. Seems to me that you've been carrying around a lot of these worries and resentments. Feeling a little bit resentful toward the house, feeling or the responsibilities associated with the house. Feeling resentful of Sydney and some of the demands that he is placing on you. To keep himself comfortable because his needs are really high right now. [0:30:45.3]

CLIENT: Like even yesterday it was like, Monday mornings are trash day in his neighborhood and it's like, can we put out the boxes tonight. Originally it was sure, and when I got back from rehearsal its was like, okay do you want to wait a week. Yes, I want to wait a week if you don't mind. And like okay, I have to be in (inaudible) with this boxes for at least another week. And it's like, okay -

THERAPIST: Or you say no.

CLIENT: Well, I could have, but then I would have to do it myself because he really wasn't up to it. And it was already like 11:30 at night and I had just gotten back from rehearsal. So I wasn't really keen on doing all the work for him. So I couldn't really say, you have to do this. Like, I could say okay let me take out a few things, which maybe would have made things better.

THERAPIST: Why? How come you can't say to him, no I'd really like to get it done this week and I need your help? Why is that not a possibility? [0:31:40.5]

CLIENT: Because it's his room and not mine. I am making-

THERAPIST: I'm sorry, I didn't realize you were talking about the boxes in his room. It sounds like there's also boxes in your room.

CLIENT: There are a few boxes in my room. There are massive, massive boxes in his room. So.

THERAPIST: I got confused which room you were in.

CLIENT: Yeah, if it's my room then okay, I can understand you know like, deciding, yes I'm doing it now, but if you don't want to help, whatever. But if it's his room I can't be like, I mean I could be like, yes I'm doing this now, and he would be okay with that. I wouldn't be okay with that. I'm not taking out all the boxes, I'll help him when he does it, but it's not my job. [0:32:19.5]

THERAPIST: I understand, I just, I got lost.

CLIENT: I really wish we had dumpsters or something that like we could, such that it wasn't so time based and we could take out all recycling whenever. Instead of like having it be a Sunday night where we're not busy. Because you know, I might feel, or he might feel up to it on a Wednesday afternoon or something. I mean I guess he could at least break those boxes down with a box cutter. Which would be better. But like, they are too big to fit into the recycling bin as is and need to be taken out when recycling can be collected. So that's kind of frustrating. It's just, it's hard to be okay with it by you know, just be like, okay it's his place.

THERAPIST: You're there so much.

CLIENT: Because they get in my way. What?

THERAPIST: Well, and you're there so much.

CLIENT: Yeah. Well, I'm there, more than I am at my own place. Like, there's really, at least we did laundry today. At least I'm going to have clean clothes for work. But like, I-

THERAPIST: That must feel like something accomplished. [0:33:30.4]

CLIENT: Yeah, like he even brought down laundry, and I put it in the washer and then I moved it to the dryer. But he carried it down and helped carry it back up. So.

THERAPIST: So what he does is not under your control. So I wonder if focusing on the things that are in your control. You know, I heard you say that Friday and Saturday you went out for walks. Which is something that is in your control that usually helps you feel better. How is the food going because that is in your control.

CLIENT: Food is going, I mean I guess I'm mostly making the effort to cut up cucumbers and stuff. Like on days that I have work, and therefore I'm not doing it on days that I don't have work. So I should, I guess also because I was, well I wasn't even eating that much when I was sick.

THERAPIST: That makes sense.

CLIENT: Because I wasn't like, oh I could totally go for a Hershey run right now. So like (pause) I guess I should probably buy more groceries today. But like when I have the materials to do it it's fine. And I have been feeling better and more full and stuff and it's good to have healthy things around. Yeah. [0:34:47.2]

THERAPIST: So you're not feeling deprived it sounds like.

CLIENT: Yeah, not feeling deprived.

THERAPIST: Not deprived.

CLIENT: I just need to do better.

THERAPIST: But you do feel like you're making healthier choices at least on work days.

CLIENT: Yeah. I guess I could also do like popcorn or something as like a snack if I you know-

THERAPIST: That's a healthy snack.

CLIENT: Especially if I don't put all the oil on it ever, like-

THERAPIST: Yeah, you need to leave it fairly natural. [0:35:09.9]

CLIENT: I guess I, I mean I have to do that anyways because like, otherwise if I'm gonna run, you know to the locker. Because it's a library, it's a research library, you can't have food in the library part. So the upstairs is like where we eat lunch and outside is where you like put your backpacks and stuff. And so in my locker is where I will like keep the snack so I can like run out and eat something. And like doing popcorn with oil then the oil could get on the stuff that I'm working with and that would be bad. So I would be pretty motivated to not make it oily. So yeah, that would be easy to prepare. Yeah I guess it's mostly just figuring the breakfast. Because like eating cereal takes too much time. Like I would have to wake up earlier if I wanted to eat cereal for breakfast. So I need like a better option. [0:35:59.9]

THERAPIST: What have you been coming up with?

CLIENT: There was one day when I didn't really eat breakfast. What did I do on that Wednesday? I think I ended up not eating breakfast. And the Thursday I stopped by Starbucks and got a Caramel Frappuccino and like this cinnamon chocolate bread thing that I think is marginally healthier than the doughnut. But the Caramel Frappuccino totally isn't. But I sort of decided that I needed to do something, and it was better than not having anything to eat. [0:36:41.6]

THERAPIST: Right, and breakfast is an important meal. A lot of the nutrition research shows that people who eat breakfast usually take in fewer calories over the course of the day. Not eating breakfast kind of sets you up to not over eat later. You know, so, I mean that was sort of your emergency stop it sounded like. But that's a pretty caloric breakfast that doesn't have a ton of nutrients in it. So it's not gonna want to be your go to. You have to find a go to that's filling, gets you more nutrients. [0:37:12.6]

CLIENT: Yeah, and I don't really have a good, especially just because the way I drive to work, like, the easiest place to swing by is Dunkin Donuts. But I don't want to, I don't mind getting coffee there. But I don't want to do the donut thing if I can think of.

THERAPIST: What about things that you could pre-make? Like hard boiled eggs, bananas, even taking a granola bar with you? Those things might, you know.

CLIENT: Granola bars would probably get all over the car. And traditionally have taken me a while to eat. Bananas could work if you know I would have to buy them every so often so they don't go bad. [0:37:54.5]

THERAPIST: Yeah but it sounds like you are going to the grocery store.

CLIENT: I guess I could get other fruit. Like, I think sometimes what I've ended up doing is have the bag of grapes that I brought for lunch and like munch on some of those and some of the cucumbers like while I'm driving. But I think that has to be paired with something more filling.

THERAPIST: Some sort of protein or carbohydrate.

CLIENT: And it's just like, that requires effort and like-

THERAPIST: Cheese sticks? A low fat cheese stick?

CLIENT: I probably would have to go to the butchery to get those kosher.

THERAPIST: Yeah, I don't know.

CLIENT: Yeah, because usually the only, the kinds of cheese that you can get kosher in grocery stores are usually things like ricotta and like things like the spreadable, well cream cheese or (inaudible) or like cottage cheese or not like mozzarella, so. [0:38:54.1]

THERAPIST: It makes it a little harder for you to get.

CLIENT: It would be, yeah. That would work, if it weren't for the whole kosher issue, that would be a good idea. But it's the oh, I have to go to the butcher to get this. I don't want to spend time going to the butchery. You know, and I would do that. And like I definitely wouldn't have time to do that today. I don't know, maybe like rice cakes or something. I mean they would probably be more filling if I put something on them, but.

THERAPIST: Yeah, you could spread it with peanut butter or cream cheese something. It would give you a combination.

CLIENT: And I could like, yeah that would be something that I could do like on my way out. So.

THERAPIST: And that's not too messy. It's pretty portable. And you can even, I mean I think combining things so that you can get some protein, some carbohydrate, a little bit of fat. That keeps you satisfied feeling. So even just, my kids do rice cakes with cream cheese sprinkled with raisins. We put them in happy faces. (Chuckle) You might not need to do that. But that gives you a combination of-raisins give you iron which is good for energy. You know, the rice cake is filling. If you put peanut butter or cream cheese you're getting a little bit of calcium, a little bit of protein. [0:40:16.9]

CLIENT: If raisins give you iron, do grapes give you iron? Or does it all come from like the dehydration process?

THERAPIST: I think it's the dehydration process. I don't know if grapes have as much iron as a raisin actually does. But I know that raisins are one of those key things that's not meat but can get you iron. And a lot of women are a little bit anemic, I mean I don't-you've had blood work done and it's not been a problem in the past but. But it's also just, then it becomes a more filling breakfast if you're trying to get something quick on the go. [0:40:53.1]

CLIENT: I mean, if I'm having meat for lunch, I'm not too worried.

THERAPIST: And you've been doing like deli sandwiches for lunch still?

CLIENT: Well I didn't do it the days I went to work last week, but before that. I still have deli meat and I bought bread a couple days ago so I could do that if I wanted to. So, yeah I can do that, it's not a problem to do. Yeah I guess I could do those things, yeah that'd probably, yeah. Then I guess it's just he caffeine issue. Because I do really need some sort of source of caffeine to.

THERAPIST: That's fine. Do you ever brew coffee at home?

CLIENT: No.

THERAPIST: But if you are having breakfast with you then you can just stop by and not feel as tempted at one of those other places. [0:41:42.5]

CLIENT: Yeah, and I can probably hold out at least til like the point of the drive where there's the rest stop. Which is like at about two thirds of the way through and get a coffee then. But it's better if I have it beforehand so I can like be awake.

THERAPIST: Yeah.

CLIENT: It depends on the day, but I usually feel awake, at least when I start, so. I really don't want to be dependent on caffeine though. It's kind of frustrating that I am. Because-

THERAPIST: How much caffeine do you use, take in in a day?

CLIENT: It'll just be really that one cup of coffee that I have on the way to work.

THERAPIST: That's pretty normal.

CLIENT: I don't need it for days that I don't have work. It's really just the whole waking up at 6 o'clock in the morning thing that's the issue. But, because it's just because then I have to take the time to stop at a place that has caffeine and stuff. Or, have a travel mug to brew the coffee in, which I don't think I-like I know in theory I own travel mugs and they are somewhere. [0:42:58.1]

THERAPIST: You'd have to locate it somewhere?

CLIENT: Yeah, so. Or buy a new one. Yeah I own travel mugs. Or maybe they're, they could be all gone. I have no idea. It's not something, and I guess it's just-well I guess it wouldn't take that long to brew coffee.

THERAPIST: It would just, if you got-it would be another part of the routine to adjust to. You know, yeah, you would have to-the time to set up the coffee maker, and doing it ahead enough, early enough in your morning routine so that it's ready when you go. So you're not waiting on it. In reality it doesn't take that long, but it would be part of the routine to adjust to. You could do that. Just like you've adjusted to cutting up you're, you know veggies. [0:43:42.0]

CLIENT: Yeah, but like I could cut a bunch of veggies at once for like a few days.

THERAPIST: Yeah you'd have to set up your coffee pot each day.

CLIENT: I think it might be worth the couple of dollars to have someone else brew coffee for me. But, (Pause) Or I could do tea or something, that would be less work.

THERAPIST: That's just heating up water.

CLIENT: Yeah. (Pause) But I'm real easy. I think the walk-like I'm no longer like having that pain in my lower back when I walk for like a few minutes.

THERAPIST: Oh that's fabulous. So you are really noticed a difference.

CLIENT: So I think I'm doing something right. I go for longer, I can go for multiple times a day when I have time in the day to do that so. Like, staircases aren't wearing me out as much as they used to. [0:44:35.5]

THERAPIST: I'm glad to hear that, it's nice to see those differences. These are the things to focus on. The things that you can do and the benefit that you're getting.

CLIENT: But I'm still not noticing, like even my clothes are like feeling looser or anything.

THERAPIST: It takes a long time. And I know that you anticipated that if you didn't see those kind of visual, visible results that you'd get frustrated with it. And you need to acknowledge that, that it's frustrating not to see those visible results. But you are seeing some results and that it's getting easier, the pain is reduced.

CLIENT: I mean I guess it's like, because I'm doing things that are enjoyable, like I get to eat fruits and vegetables and rice cakes. You know, and I'm less hungry. If it were a starvation diet, or a diet where I felt like I was getting you know, I mean I guess it's like, because I'm doing things that are enjoyable, like I get to eat fruits and vegetables and rice cakes. You know, and I'm less hungry. If it were a starvation diet, or a diet where I felt like I was getting you know, being hungry all the time that'd be frustrating.

THERAPIST: That's why those are not sustainable. [0:45:28.1]

CLIENT: Since I don't mind doing the walking either. So that's, I mean isn't, if I only do the walking, if I only do like an hour or so a day on the four days that I'm not working.

THERAPIST: Better than not doing any walking.

CLIENT: Like, I mean, I walk for maybe five minutes from the garage to the, to my work place, so it's not like I'm doing absolutely no walking.

THERAPIST: No, but you do less on the days that you work.

CLIENT: Yeah, just because I don't really-and then I get home and if I only have a few hours free time then I'm not going to-

THERAPIST: That's not what you want to spend it doing. Something is better than nothing. And you've made some changes in your week. What really counts is what's the overall, you know, you don't have to nit pick what happens on each day. Overall you are being more active than you were. It sounds like you are eating a wider variety of foods, and making some healthier choices. So let's look at those as positive steps. [0:46:27.2]

CLIENT: Okay.

THERAPIST: The more positive steps you can take, the more it's going to be engrained in your lifestyle. That's what you are working toward. But you know, the changes that you make, they need to be sustainable. That's why we didn't want you to do a starvation diet. I didn't want you to pick some sort of exercise goal that felt torturous. Because nobody sticks to torture. But doing things that feel good, and you will see things eventually, but it does take a while. But looking at things you do notice to keep you going. [0:47:06.3]

CLIENT: It would be nice for the clothes to be first.

THERAPIST: I hope that we'll get there. So that you can feel more comfortable in your clothes. And I would also, you know that in the same way that making some of these positive changes feels good to you, you know with regard to what you're doing; looking at the other things where you have control. Not necessarily just the food and exercise parts of your life. But like control over your-in your house or in your room, where you have the ability to have some impact or some control over your life might help reduce those feelings of anxiety and resentment that have been building. [0:47:43.8]

CLIENT: Yeah, yeah.

THERAPIST: You know, you mentioned earlier, maybe that next step is really sending off that e-mail about the communal dinners. That might be the next place where you have the ability to take some action.

CLIENT: Especially since (inaudible) are moving out in less than a month.

THERAPIST: It's timely.

CLIENT: It's timely and even before that, you know people come to Monday night dinners sometimes. But like, the other nights, like I don't go to any of the other ones. I think, and like people have said usually it's just like the person who's cooking that's there.

THERAPIST: So it's not much of a communal dinner then.

CLIENT: Yeah, so I think we would really all benefit by just-

THERAPIST: Making that a relaxed-

CLIENT: Be on your own and cook yourself something. You know we could still have the food be communal. Just, yeah like it would make my life easier. Then if I could change the day that I do dishes to like a day that I don't have work the next day.

THERAPIST: I think that would probably work better for you. It would give you more freedom. [0:48:49.0]

CLIENT: It would.

THERAPIST: Then that feeling of being trapped or overly committed might dissipate. Why don't we stop there for today. We're not meeting next week, the 15th. We're meeting the 22nd.

CLIENT: Oh, oh, are you gone the 15th or-

THERAPIST: Yeah, I'm not going to be in because of the holiday/marathon makes it really hard for me to get here.

CLIENT: Okay. So then the-

THERAPIST: So we're on for the, I believe we had scheduled for the 22nd.

CLIENT: The 22nd, yeah.

THERAPIST: (inaudible) Oh, you know, I may have scheduled it without really telling you. Saved your space on the 22nd because I have a question mark in here. So I've put you in for 2:30, if that works for you.

CLIENT: Oh, okay. Yeah that's fine.

THERAPIST: I just sort of penciled you in because we are getting to the end of the month I guess.

CLIENT: Okay.

THERAPIST: All right, I will see you then.

CLIENT: Okay.

END TRANSCRIPT