TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Is this fear the only thing keeping you from attempting?

CLIENT: Fear and inertia, I don’t know.

THERAPIST: When you’re…

CLIENT: It’s not something I think about all the time 24/7.

THERAPIST: How often do you think about it?

CLIENT: A couple of hours a day.

THERAPIST: And when you’re thinking those couple of hours, what are those thoughts like? If I were inside your head what would I be hearing?

CLIENT: It’s fearing that I might… I will never find a job. All these… applying to jobs are pointless. I’m never going to find anything, I’m never going to be able to support myself, and I’m a burden. And I don’t deserve anything so I deserve to die because I cost too much money and I’m a disappointment to everyone. And I’m not smart and I’m not good at anything. [crying] I’m fat. I’m ugly.

THERAPIST: Those sound like really harsh thoughts.

CLIENT: Well they’re true. (pause) Doesn’t matter whether or not they’re harsh; they’re true. [1:12] (pause)

THERAPIST: Would you think they were true if Sydney were saying them about himself?

CLIENT: But he doesn’t cost people money. He has the money to support himself.

THERAPIST: That’s only one part of what you’re saying though.

CLIENT: He’s not fat and ugly and he’s not… and he’s actually good at what he does. He has a field that actually has jobs in it and he’s going to amount to something.

THERAPIST: Does he… if you said that you were fat and ugly to him, does he believe those things?

CLIENT: No, but he’s the only one.

THERAPIST: Well it’s at least one.

CLIENT: Okay, so he’s the only person in the world who doesn’t think I’m fat and ugly. That doesn’t… and for all I know he might just be saying it. [2:14]

THERAPIST: He may very well not be the only one. I think some of these things that you feel are truth are very subjective, and very unknown. You’re projecting the future. I’m never going to get a job, I’m never going to do this or that.

CLIENT: Well it’s already too late, okay. If I get a job at age 50 what is that going to do me? I’m about to turn 30 next February and I’ve never had a real job in my life. That makes me a total failure.

THERAPIST: It does not make you a total failure.

CLIENT: Yes it does, and it means all the things that I did up to it have been no better because okay, so I could see people, if they… instead of going for a career they decided they wanted to be a stay at home parent or do something worthwhile, that there’s a reason why they don’t have a job. That’s one thing. But if you just sit around and don’t have a job for no good reason…

THERAPIST: I believe and understand that you feel like you’re failing. I completely understand your… the intensity of your feelings and how bad that feels.

CLIENT: What’s the point that I got… Cullen’s getting his PhD and I can’t even get a job. And he has this consulting thing that pays him $100 an hour and he gets to fly around everywhere and consult and not actually have to do any hard work. And he gets paid. And I…

THERAPIST: That’s really unfair.

CLIENT: And I have to drive an hour and a half each way to get to the zoo to get paid $13 an hour. [crying]

THERAPIST: That’s really nonsensical. [3:56]

CLIENT: And so I’m a failure. I mean just… I got these degrees and they didn’t do me anything, and now I’m stupid and I can’t get a job because I have no social skills and nobody would like me and I’m too [inaudible] And I’m too fat to be employed anyways. Of course I think that even if I got an interview, which I’m not going to get, nobody…

THERAPIST: What does your weight have to do with whether or not you can do a good job?

CLIENT: It doesn’t have to do with whether or not I can do a good job, it has to do whether or not… how I’m going to be perceived if I manage to get a job interview. People who are more attractive are more likely to get jobs. There’s [inaudible] on that.

THERAPIST: Yes, I know there is. There is definitely a stigma that you are up against.

CLIENT: I’d have to be really super overqualified to overcome that and I’m not super overqualified. I applied for two things on Friday. I did.

THERAPIST: Good for you. That’s a good step.

CLIENT: But I’m not going to hear back from them in time. I’m going to have to give up the apartment. And things aren’t stable enough with Sydney that I can move in with him and pay less money for a shared place. So I have to find a real job. And I’m going to have to move again and then I’ll have to move again and again and again. And I don’t want to move at home but… there are no opportunities in Connecticut. There’s nothing there. I don’t want to live there. [crying] I’m going to be so miserable. I don’t want it.

THERAPIST: You sound really scared.

CLIENT: I don’t want it. [5:38] But I’ll save them the cost of the food that I eat and whatever, health insurance.

THERAPIST: I would give them the choice first.

CLIENT: It’s not their choice; it’s my choice.

THERAPIST: So you’re talking about it because of their money.

CLIENT: It’s the only thing I can control in the situation. I can’t control anything else. I mean I can’t even control if I’m losing weight now because whatever I do isn’t enough, and I’m not losing any weight. I feel better walking around, and now what used to be a ten minute walk from the… my place to the T ended up, well, five minutes plus waiting forever for the pedestrian light but…

THERAPIST: Wow. So you’ve really been able to walk faster, just putting in some time into that.

CLIENT: It’s the longest, fastest I used to be able to walk.

THERAPIST: But you’re noticing a difference.

CLIENT: But I don’t look any different and I’m not fitting into my clothes any different. I’m still too fat for all my pants and I’m only wearing new skirts and feeling ridiculous for wearing skirts all the time, especially with T-shirts.

THERAPIST: I’m sorry you’re feeling ridiculous.

CLIENT: And then I can’t justify spending money on new clothes because that’s also my parents money and I need to stop being fat. I don’t deserve new clothes; I just need to stop being too fat to fit in the old ones. And I can’t.

THERAPIST: This word deserve, what you deserve, keeps coming up. Who determines what someone deserves? [7:18]

CLIENT: I do. I determine what I deserve based on societal feelings and stuff.

THERAPIST: What would you need to do to deserve to be happy in your view?

CLIENT: Get a job and actually be able to support myself.

THERAPIST: Let’s work toward that. Rather than thinking about how you can save your parents money by ending your life, which seems really extreme to me, let’s focus on getting healthier, getting more active, getting more in control. Those are things you can have some say over. You’ve dedicated some time to going swing dancing and walking and being more active, and you’re seeing a difference. Not in weight but you’re seeing a difference in your health. If you can walk the same distance faster than you used to be able to that’s an improvement in your health. [8:18] And it… and you said it feels good. These are important markers.

CLIENT: If I don’t lose weight I’m not going to stop being pre-diabetic.

THERAPIST: Not necessarily the case. Ask your doctor to show you the research on activity and its impact on diabetes.

CLIENT: [inaudible]

THERAPIST: You can be healthy, you can improve your health, at any size. Being active, having an active… having movement in your days, that’s healthy, no matter what the scale says. You have control over that. You have control over how active you are. You don’t have control over your weight. And what we know about diet and exercise programs is that most people tend to cycle. Some people lose weight on them; lots of people lost weight on them, some people…

CLIENT: And then as soon as they stop it comes back.

THERAPIST: May come back. But what we also know is that the more active you are, the healthier you are. Measure health not in terms of how many pounds somebody weighs but you measure health in terms if somebody’s insulin levels, insulin reactivity, blood pressure, VO2 max, which is how you measure how you’re using air. Those things are actually measures of health. [9:40] How much you weigh is only a measure of your size. So if we focus on bringing health into your life that usually improves mental health as well as your physical health. And if you want to see research on that stuff, because I know you like to know where your facts are coming from, you can look that stuff up. You can also ask your doctor about the impact of activity levels on diabetes and prediabetic states. There’s lots of stuff out there on that. The reason we want people to exercise is because it’s the exercise that’s actually good for you. Sometimes that results in lost weight, too, but it’s not… weight loss isn’t what makes you healthier. It’s the improved exercise that makes you healthier. And it’s good for depression, which clearly you’re really feeling because when the thoughts that you’re having seem really logical to you, that shows me that you’re pretty depressed.

CLIENT: Or maybe we just have to forget the definitions of logical.

THERAPIST: I’m willing to hear that.

CLIENT: It makes financial sense. Even if they had to pay for my funeral that would be less than two month’s rent.

THERAPIST: Life value is not measured in finances. If it was, nobody would ever have kids. Kids are very expensive. People go on…

CLIENT: Only… I mean if they were in a Gregorian [sp?] society or something they would have kids. [11:12]

THERAPIST: But we’re not, right. It doesn’t make financial self… sense to have children in today’s society for the majority of where people live in the United States. People in cities keep having children because they value life not just money. You’re somebody who… you don’t place a huge value on money. Look at the livelihood that you’re pursuing and the education that you’ve pursued. If money was your goal, lots and lots of money, you’ve said yourself you would have pursued other things. You don’t need a ton of money. You do want to be able to support yourself but you don’t need a ton of money. It’s not the only thing you value.

CLIENT: Okay, but stealing someone else’s retirement or something, if we’re valuing their ability to retire over my life than…

THERAPIST: It doesn’t necessarily need to be one or the other. The retirement is in the future. That’s not…

CLIENT: Not that far in the future. It’s in three years. That’s not that long. [crying]

THERAPIST: Let’s focus on what we can do now so that there’s choices that you and your parents can make in the future. [12:36] If you kill yourself then there’s no choices that anybody else gets to make. You don’t get to make any more choices in the future; they don’t have any say over it. But there may be ways that you and they both get choices. But you have to be able to keep yourself safe in order to give yourself other choices, and to give them choices about how they retire or when and how much they support you and how much they support themselves. What do you really want?

CLIENT: I don’t know. [crying] I don’t know. Maybe to have a job and be thin and pretty. And to not have to ever listen to my parents again. And to not feel like a complete and total failure all the time. [crying] It does feel like that, though, because I am a failure and I’m so stupid for choosing this field because there aren’t any jobs in it. And okay, I didn’t need something that pays $600,000 a year but I shouldn’t have chose something that wasn’t so oversaturated. [14:13] I mean I guess I didn’t realize how oversaturated it was when I went in but it’s so oversaturated that it’s just [inaudible] Now I can’t get another job as anything else or unless it’s something related.

THERAPIST: That’s feeling pretty hopeless.

CLIENT: Yeah. I think [inaudible] doing something that made $13 an hour [inaudible] be better but it wouldn’t be enough to pay my rent.

THERAPIST: And have your parents said that you need to be completely self-sufficient, be able to cover all your own expenses?

CLIENT: No, but they haven’t said that I don’t either. (pause) I just really don’t want to talk to them right now. I really don’t want to talk to them. [15:27] I’d like to avoid talking to them if at all possible.

THERAPIST: I can understand, after having a really unpleasant dinner with them.

CLIENT: Yeah, [inaudible] how bad it was. She was the one… she’s like you don’t have a job either. But I’ve already told you that. I told her that when I was… when we were down in Connecticut cat sitting. I told her that so many times. And then she has to be on and on and it doesn’t matter because she doesn’t remember it, but I remember it. [crying] I don’t want to be around my grandma ever again either. She’s too much of a pain.

THERAPIST: I’m sorry it was so hard.

CLIENT: I don’t want to keep on being judged. I’m sick of being judged. And if I die then I won’t be judged anymore. I mean I guess I will be judged but I won’t know about it anymore. I won’t have to deal with anyone’s judgmentalness ever again.

THERAPIST: How do you think your parents would feel?

CLIENT: I think they’d be relieved.

THERAPIST: That’s not a typical response.

CLIENT: I’m not a typical person. [16:56]

THERAPIST: Are they?

CLIENT: Maybe they think they’d be sad but I think part of them would also be relieved. Sad and relieved. And they won’t have to worry about me anymore. It’s not my fault they waited so long in their life before having me. They waited until they were married for ten years and in their thirties, so of course I’m totally going to be starting out when they’re getting towards retiring. And you used to be able to get all these jobs by just having a… actually if you were just having a high school degree, and now you have to do so much more to be successful so it takes longer. I don’t know anyone else who’s… okay, I know one other person who hit thirty without ever having a real job and that was Ivan. But Ivan wasn’t really trying to apply himself or anything and dropped out before his last semester of college because of money but… and never pursued trying to finish that degree by transferring to something like community college or something cheaper. And as far as I know now he’s still just living at his mom’s place and helping out on the farm. And writing a book.

THERAPIST: Does he deserve to live? [18:46]

CLIENT: Well he’s not costing his parents… his mom that much money because he’s living there so… maybe it is up to him and his mom. I think so. And people expected more of me and now I’m just dashing everybody’s expectations by being a complete failure.

THERAPIST: So you feel like you’re disappointing people.

CLIENT: Yeah. And it’s just [inaudible] so hard now to get a job that has health insurance and benefits because nobody wants to give out those jobs anymore. And people just want to make all the money and they don’t care about giving their workers a fair wage. No one cares. And it just seems so illicit [sp?] and… to get a job like that and I think I…

THERAPIST: What did you apply for on Friday?

CLIENT: I applied for one position at RPI that had been up for a month, but I checked the site and it was still there. I probably didn’t… and I actually had to… there was one… I was mostly qualified at some point in the questions. One of the qualifications was extensive knowledge in database software or something like that that I’m like well, I could learn that. [20:14] And for qualification it was fine except then they had a questionnaire. You had to answer these five questions and… do you have this degree and etc., etc. And the fifth question was do I have that knowledge that I don’t have that I figured if I answered no that would automatically screen me out so I answered yes to it. But I don’t, in my cover letter or resume, say that I have this experience so it will mean… that won’t get me into a lot of trouble. But so late in the game that they’re probably not going to do it. And do anything. And then the other thing I applied to was… there’s this architectural… actually the guy who built Yale Hillel is… built a lot of very, very beautiful and impractical buildings for Jewish agencies, but his architecture firm is looking for an employee who… to… I guess they have some collections. And again, I’m not sure that they’re bringing them here or something. I forget what it was but it was something that I was actually qualified for.

THERAPIST: Awesome.

CLIENT: So I applied for it and it had only been posted two days prior or something.

THERAPIST: Good for you for putting your name in and getting your stuff in.

CLIENT: I don’t think it’ll matter much, and I just… I don’t even have the space that I could be trying to dye yarn or something that I feel like getting some income in. There’s nothing I can do right now. [22:02] And I don’t think I’m going to get hired for retail without retail experience, or without…

THERAPIST: More recent…

CLIENT: More recent retail experience.

THERAPIST: Yeah, hard to know. Since you’ve been feeling so badly and I know Sydney is concerned, I certainly feel concerned after hearing what you’ve been feeling the past couple of days, I’d like to make some time to make some concrete plans about how you know you can keep yourself safe and I know you can keep yourself safe. And if we can’t do those things then I think we do need to, regardless of the cost, figure out where you can go to be safe. And you do have health insurance coverage. I don’t know exactly what the coverage is for either an intensive outpatient program or inpatient, but the priority really is you being safe so that you can go on to be healthier. I can’t allow the priority to be money savings. And I think if I were to have a conversation with your parents, which I won’t break your confidentiality in that way, I won’t do, but based on the way they’ve responded to other things, yes, money is a concern, but your life is worth more. There’s a big difference between them deciding to pay for an apartment and treatment. So if your health insurance coverage didn’t cover a treatment that you needed, my sense from previous experience is they would be willing to pay for that. But let’s think about how you can keep yourself safe and feel that Sydney, who’s with you a lot of the time, feels comfortable. Because it sounds like, from him telling you that you really need to talk about this today, it sounds like he felt uncomfortable. [23:58] So what are your… what do you think?

CLIENT: I have no idea what am I… I don’t think I’m going to hurt myself.

THERAPIST: How could you be sure of that? Can you be sure of that?

CLIENT: I think so.

THERAPIST: Do you have any access to something that would kill you at home? Any firearms?

CLIENT: I have no firearms. I mean you know that I have the Desipromine.

THERAPIST: I know that you have the meds, yeah. How much do you have at home right now?

CLIENT: One bottle that was recently filled, so probably more than 20 and less than 30 pills.

THERAPIST: Could you give some to Sydney to hold onto for you so that it’s split up?

CLIENT: Probably.

THERAPIST: Will you do that?

CLIENT: He probably would.

THERAPIST: That’s one step to keep yourself safer. I know that you sometimes… you didn’t report today that you thought about taking too many meds but sometimes you reported that in the past. Is that something that you’re thinking about?

CLIENT: Not right now.

THERAPIST: Okay. I’m glad to hear that. [25:27] Is there anything worth living for?

CLIENT: Maybe my kitten, but I feel like he’d be better off if he had a new home.

THERAPIST: Adjust to somebody new?

CLIENT: Yeah, but he has ringworm and I’m afraid that we’re not doing enough for him. And it’s my fault that it got worse. And if he were in someone else’s home they’d take care of it. It wouldn’t have spread all over his face.

THERAPIST: What would you need to do to take better care of him?

CLIENT: Well the thing is we washed the sheets and stuff but we haven’t sanitized every single thing in the house because… and I’m not sure if that really need to sanitize things is because of him getting more ringworm or if it’s because… I think the reason why is because the concern that I’ll get infected, which I feel like probably would’ve happened by now if it was going to happen. And I’m doing… taking some precautions but I don’t know if the ringworm spreading more is my fault or if it’s just that’s the way it’s going. I think the fact that it’s growing on his head is probably not from getting more reinfected or that would… you’d probably see it appear in other places too. That’s probably just the topical stuff isn’t strong enough for it. [26:55]

THERAPIST: Maybe a call to the vet will answer those questions.

CLIENT: Well I took him to the vet this morning.

THERAPIST: Oh, okay.

CLIENT: Yeah, we’re getting the… there’s an oral medication that we’re going to pick up sometime after five.

THERAPIST: Oh, so it sounds like you are taking steps to take care of your pet.

CLIENT: Yeah I am. I mean I took him to the vet on Thursday and that’s when I got the ringworm diagnosis and started with the topical stuff.

THERAPIST: Yeah, so it sounds like you are taking good care of him. He’s got this infection but you took him in, you took him back today, and he’s relying on you to take care of him.

CLIENT: Yeah, maybe someone else… and maybe a place where he had a second kitten to play with because he only has me and Sydney to play with right now.

THERAPIST: Lots of cats don’t have a cat friend.

CLIENT: It’s one thing if it’s an adult cat but when it’s a kitten it’s really cruel and selfish to adopt him by himself. But I didn’t have space for two cats, so I shouldn’t have adopted him in the first place.

THERAPIST: All cats should be adopted… all kittens should be adopted in pairs? Is that the recommendation?

CLIENT: Yeah, well or have another cat at home to play with. I don’t know if that’s the official recommendation but when I was at the pet store the day before I picked him up I was mentioning how… getting a new kitten, and the person there was all like oh you really should get two of them. One will wear you out and stuff. [28:38]

THERAPIST: Ah, one will wear you out.

CLIENT: Yeah I think [inaudible]

THERAPIST: She was trying to sell you a second cat.

CLIENT: Well I wasn’t buying it from her, I was… the pet shop had adult cats but she wasn’t trying to sell me one of her cats. She was trying to get me to adopt a second kitten, which I don’t have space for.

THERAPIST: Yeah, so you don’t have space for that. So it sounds like but what you do have is time to spend with the kitten. And you don’t have to get worn out and it doesn’t have to be alone for long portions of the day. You have time that you can spend. And it sounds like you’re being attentive. Maybe think about what you can do to be a really good pet owner rather than thinking about getting a different pet owner. Your job is to take care of you and to take care of this pet that relies on you right now. Why don’t we make an appointment for Wednesday because it seems like you’re having a really tough time right now and you’ve… you don’t have a plan to hurt yourself. It does sound like you’re having thoughts of lots of hopelessness. And if you can split up your meds so that next time Sydney goes home he takes home some of the extras that you don’t need in the next couple of days. It sounds like you can be safe at home, and I’d like to keep you that way and keep you working toward health. Taking advantage of this beautiful weather for some walks, maybe reaching out to a friend for some support, even if it’s just a phone call or texting back and forth, from people that are further away. Keep in contact with people that care about you and want you to be around. There are those people. [30:37]

CLIENT: I’m going to write you a check.

THERAPIST: Can you come back at 1:30 on Wednesday?

CLIENT: Yeah.

THERAPIST: I’d like to check in.

CLIENT: Okay.

THERAPIST: Let me put that in my folder.

CLIENT: Okay. So 1:30 pm on Wednesday you said or…

THERAPIST: Mm-hm.

CLIENT: Okay. Sorry.

THERAPIST: That’s okay.

CLIENT: I thought I had a pen but I can’t find it right now, so can I borrow yours? Thanks.

THERAPIST: Sure.

CLIENT: [inaudible]

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