TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Yeah, so it goes up and down in the sort of – in terms of how difficult it is and in terms of –

CLIENT: How much it bothers me.

THERAPIST: – how much it bothers you.

CLIENT: Yeah. I don't – I guess those things are correlated.

THERAPIST: Uh-huh.

CLIENT: I don't know why it's so difficult for me. I think it gets harder in the winter, for sure. But I just like get stuck and I don't have – I don't feel like I really have a reason to get out of bed, not because I'm upset, but because it's really comfortable, and warm, and like, I guess I'm not sleeping like the best ever right now in my life, so – with all the – with the active dreaming, so – like I always feel like I could sleep a lot more. But I'm getting eight, nine hours of sleep. And if I have something to show up to, I can make the – like an enormous effort one day and it will work. Or if I come to like a culminating point in my – like how bothered I am by it, like today, for example, then I can make a big effort and it works. But like yesterday, Jeremy's been waking up early at like 7:00 because he gets a ride at 7:30. And if I'm not – this is the first time that I've woken up with him and not gone back to sleep. So usually my – my alarm will go off like in the middle of the sleep cycle after he leaves. So I'll have woken up when he left and then be woken up by my alarm and like plan to wake up soon after I turn it off, but then like it's just so easy for me to go back to sleep. And then like the last two days, I've gotten into lab at noon, because I wake up at like 10:15. Like it's – it's hard for me to figure out how to make it work. And I – I think it is kind of debilitating. It's not really a problem that most people have, or if they have it, they just like suck it up. Or they like go into a profession or field where it doesn't really matter and – it doesn't really matter for me. But most of my lab – get there before noon. I think it's woven into – so one is like – uh, like I don't – I'm not hungry, I don't have to pee, like there's really no good reason for me to get out of this warm, comfortable space. Then there's like this whole construct of ‘If I sleep more, I'll be more' – like if I haven't gotten enough sleep, it's the worst, because it's like – well, there's a trade-off. Like I could wake up now and get in early and that feels great. It feels really good to get in early or to even be up early for me. Or if I sleep more then I have – then I won't be tired during the day. And I hate being tired. Or like today the dialogue was ‘If I wake up now, it's very possible that I won't have enough energy to go to jump rope class after work.' And I've been like thinking about it all day, like whether I have enough energy to go to jump rope class. And that is like totally not how I want to be spending my mental energy. But there's this anxiety there around like physical state, physical discomfort, not being able to finish the jump rope class because I'm too tired; like, being afraid of being tired at work. (pause) And it's easier for me to wake up on the weekends, when I don't have to go anywhere. [00:05:08]

THERAPIST: I was wondering, yeah.

CLIENT: Yeah, it's a lot easier. (pause) Yeah, it's something about like facing the day that's taking – taking a lot of like winding up to do. And I know that that is – that can be symptomatic of a lot of things including depression or a sleep disorder, or – or none of those things, and it could be just the way I am. I mean, it – I don't think it's a mood disorder because it's been with me for like – since I was like 12. Um – yeah. (pause)

THERAPIST: Tell me what comes to mind? [00:06:20]

CLIENT: I feel ashamed of it, because it seems to be like something most people have been able to overcome.

THERAPIST: Uh-huh.

CLIENT: And maybe it's like perceived as weakness or laziness. And I think I don't like those things. And I tried to explain it to Kelly once and I got like the worst reaction ever. She was like, ‘Huh, you really shouldn't be a doctor.' And she didn't smile and she was like totally like disgusted. And she's not the type of person who – who gives sympathy easily at all.

THERAPIST: Uh-huh.

CLIENT: So I don't know what I was expecting, but (pause) – but so I guess if I had some job or something to do where like it was just myself who knew when I – like when I showed up, I think it would still really bother me and it would still be really hard, but – I think I would – maybe I would have an easier time addressing it. Because it's kind of like a visible thing, when you show up. Not that visible. I mean, sometimes I can sneak in, but it makes me feel bad. And I associate like good – I don't know, a lot of people that I think are good in lots of different ways are early risers. I sort of respect that, I think. [00:08:37]

THERAPIST: Hmm. (pause)

CLIENT: So the last time this was bothering me a lot –

THERAPIST: Uh-huh.

CLIENT: – was at the beginning of this year, like in the winter. And Jeremy and I started this star chart for me, which was incredibly helpful.

THERAPIST: Hmm. [00:09:27]

CLIENT: It was my idea. And there were five different colored stars. Silver for getting in before 9:30, and then Jeremy moved it up to 9:15; gold for staying in lab for more than eight hours, and then I moved it up to nine hours; green for going in to the lab or library on the weekends, blue for doing the same thing on weeknights, going to the library on weeknights. And red was Jeremy's choice. And so I would be awarded these stars at the end of the day by Jeremy, on the calendar, and he made up this little ceremony, which involved him improvising a song that he would sing to me. And it was so helpful, like I had not gotten into lab that early that many times or anywhere in my whole life. And it lasted for about four months, and it's like totally silly and cute and I was – I mean, I was just aware of how funny it was the whole time, but once it started to be clear that that was really working for me, I was eager to share it with people and a couple of people in lab have – have started to do the same things for their own – their own lives.

THERAPIST: Why did you stop? [00:11:05]

CLIENT: The wedding sort of was taking over. I didn't – I also didn't feel like I needed the extra motivation of the stars. So it was actually quite positive when I stopped.

THERAPIST: Uh-huh.

CLIENT: It was like, ‘I'm working a lot.'

THERAPIST: Yep.

CLIENT: ‘And I'm happy about it and I don't need it.'

THERAPIST: Uh-huh.

CLIENT: Um –

THERAPIST: That it kind of served its purpose?

CLIENT: Yeah. But then – I haven't been able to – I have not been able to like imagine the star chart being helpful at all in the last six months. And I've thought about it a lot, like whether there are things for which I would like there to be a visual acknowledgement and a – like a nice acknowledgement from Jeremy. And (pause) I don't know why. I don't know why the star chart doesn't seem appealing. So yesterday when I got really upset about getting lab at noon for the second day in a row, I thought, ‘Well, maybe reinstating just the silver stars for getting in early actually is kind of appealing.' (pause)

THERAPIST: I wonder why – is there any more you can say about it not having been appealing? [00:013:29]

CLIENT: It's really bothersome to me that it doesn't appeal. I think it's like the emotional structure that it gave me before seems completely almost too like trivial or on the surf – or superficial. And I think there have been so – there's been so much emotional disregulation in the past several months that either I wouldn't derive any pleasure from being awarded the star, like I wouldn't care. So if Jeremy, for example –like thinks the star chart is dumb, for himself. We've talked about it a little bit, because he – he often says that he could use something like that, but he like really doesn't care if he gets a – a star on the calendar, so he tried for a little bit. He said he would – he would really benefit from like having some reward that he actually thought was a reward.

THERAPIST: Right.

CLIENT: So foot rubs were the reward that we thought of and we linked foot rubs to the certain number of stars and that seemed to work –

THERAPIST: Right.

CLIENT: Ok. So –

THERAPIST: Using standard stars (inaudible) a foot rub?

CLIENT: That's right. (laughs)

THERAPIST: Yeah. [00:15:03]

CLIENT: Yeah, so may – like I don't know. The stars were really helpful because it was sort of like this extra little treat that was kind of like – it was already a treat in itself to do all of those star things. But to – like to get in early or to stay in lab late or whatever, it was kind of like a small little acknowledgement of something that was already rewarding in itself. And it's almost like, recently – I don't know. I have like much simpler goals for the day. The goals are like sleeping well and like being aware of my emotions and if I feel anxious, like sort of sitting with it and being aware of it. And (pause) yeah. Because I guess for many of the last six months, there have been lots and lots of – I think lots of challenges. And I think the challenges are disappearing or they're changing, because this is the first time that a silver star seems to be at all appealing. But I did – this – the other thing that comes to mind is that Jeremy went to New York City this weekend.

THERAPIST: Uh-huh. [00:017:03]

CLIENT: And he hasn't left the apartment on a trip without –

THERAPIST: Uh-huh.

CLIENT: – me before. He's a homebody.

THERAPIST: Uh-huh.

CLIENT: So this was a – kind of a big deal for him.

THERAPIST: Yep.

CLIENT: And I was like totally felt turned upside down for the first 24 hours or so of that. And I was ok that he was leaving, but I sensed already that the black hole of the weekend that sometimes creeps up on me was like coming. And – but that like – I knew – like I know how to entertain myself, I know how to get pleasure out of time and space and other people. And it – it's just a matter of getting to a point where I can psych myself up for doing that. So the first evening – so I basically like made a million plans a day to – to cope. And the first night it was lovely and I think – when I woke up the next morning, I – I felt a lot of the sense – physical sensations that I had around my wedding.

THERAPIST: Hmm.

CLIENT: And I had a lot of – like kind of a lot of distance from them, like feeling dizzy. Like I haven't felt dizzy from anxiety too – I haven't really felt it too much. But around the time of my wedding it was happening multiple times a day.

THERAPIST: Uh-huh. [00:018:51]

CLIENT: Um –

THERAPIST: And you felt it that first morning that –

CLIENT: Yeah, I –

THERAPIST: – he was gone?

CLIENT: Yeah. And I felt kind of like this out of body, watching myself thing –

THERAPIST: Uh-huh.

CLIENT: – which was happening then, too.

THERAPIST: Uh-huh.

CLIENT: And felt like kind of really sad and –

THERAPIST: Yeah.

CLIENT: – and very scared.

THERAPIST: Hmm.

CLIENT: I went to the meditation center and sat for awhile, and – yeah, like I – I almost cried. I felt – I saw like a lot of – you know when you close your eyes really tightly?

THERAPIST: Uh-huh.

CLIENT: And you op – and you sort of like release the tension, like these colors appear?

THERAPIST: Yeah.

CLIENT: So I was seeing all of these colors like swirling around, like it was really interesting. But I was getting – at the most like panicked time, and I sat through it and it – it sort of went away. And I left the meditation center and I started to build – like actively build my confidence. Like, ‘This is going to be an awesome day.' That was a great feeling, going to a meditation center. Like, ‘You've had these feelings before and look how different it – it actually feels, like you're totally' –

THERAPIST: Do you sit at home? [00:20:39]

CLIENT: Uh, I have, like maybe the ratio is like five to one. (pause) It's nice to get separation, it's nice to go do the five-minute walk there and back, it's really nice to have the walk back to like transition back into all the stimuli. It's hard for me to imagine how to do that at home, though. I couldn't just walk around the room. We have a basically one-room apartment with the bedroom, so in general, the dynamic inner space is – is kind of like we're always together, which has been really hard, actually. And I – and the weekend ended up being actually amazing because it gave us this enforced space that I could really be at peace with because there was no chance of the space going away or coming back like it – I mean that – Jeremy coming back –

THERAPIST: Right.

CLIENT: – where as at home, there's always a possibility for me to reach out to him and it's –

THERAPIST: Right.

CLIENT: – it's very difficult for me to maintain that space when he's like right there.

THERAPIST: Yeah. [00:22:18]

CLIENT: So I – we were like blissfully, like totally so happy to see each other and so totally in love, and like – and feeling love from each other when he came back. And it's been a long time since we had that distance and we did it every two weeks for two years.

THERAPIST: Ok.

CLIENT: So that was lovely. But some of the aspects of the space that make it hard to communicate or not communicate for me also make it hard to meditate, because it's hard to – it's hard to disengage from the fact that I could be interacting with another person. Or like Jeremy. (laughs)

THERAPIST: In particular?

CLIENT: In particular.

THERAPIST: Yeah.

CLIENT: And I don't have like a cushion and it's kind of cold. (pause) There's – the spaces are all like occ – they all have like their meaning. I mean, there's like the bedroom, and there's my yoga mat, and there's – like the little Hindu shrine that all could be like approximately a meditation space, but they're not. They have these other purposes and I visit them every day at other – for other reasons. (pause) And it's nice to be with people who are meditating. I don't go at the people times any more. But it's just nice, I guess, to know that someone could be there. Do you have thoughts about sitting at home?

THERAPIST: Sure. (pause) Do you have particular questions, or do you mean just in general, in reaction to what you're saying? [00:24:55]

CLIENT: Yeah, like do you think there are – there are reasons to cultivate a home practice?

THERAPIST: The only thing I was wondering about is whether it might help to like get a – maybe if you got up around when Jeremy was leaving the apartment –

CLIENT: Uh-huh.

THERAPIST: – and sat for a little bit, whether that would make it easier to get out of bed.

CLIENT: I think so. If I could do something that would prevent me from falling asleep, like maybe go brush my teeth and like wash my face.

THERAPIST: Uh-huh. I think that would be enough for – well, for a few different reasons. One is it seems to be something you get a lot out of doing, and also something that's somewhere in between being in bed and facing the day.

CLIENT: Yeah. Sitting in bed seems blasphemous or something.

THERAPIST: Oh, sitting in – I wouldn't sit in bed –

CLIENT: Ok.

THERAPIST: – necessarily.

CLIENT: Yeah.

THERAPIST: Yeah.

CLIENT: And I don't know if blasphemous is the right word. Do you know what I mean? Like –

THERAPIST: Yeah. Yeah. I wouldn't probably sit in bed – I mean, I don't really know like –

CLIENT: Yeah, so my yoga mat is like next to my bed, so I could –

THERAPIST: I see.

CLIENT: – sit there and that's where I've tried to sit before in the past.

THERAPIST: Right.

CLIENT: And maybe I could turn the heat on higher in the morning and like use a blanket.

THERAPIST: Uh-huh. Yeah, it's kind of like, ‘Ah, do it anywhere.' I mean like –

CLIENT: Uh-huh.

THERAPIST: – you know, but then, of course, you'll probably find one or two places that you sort of get used to, but in my like – I don't – in my opinion, it doesn't really matter where –

CLIENT: No.

THERAPIST: – you sit, you know?

CLIENT: I don't think it matters either.

THERAPIST: Yeah.

CLIENT: Once – I think it's – it's once like I'm sitting, actually the meditation ends up being pretty much the same.

THERAPIST: Yeah.

CLIENT: It's more like – it's so – it feels so much more – it just feels better to go somewhere, but if I did it more at home –

THERAPIST: Yeah.

CLIENT: – maybe it would feel more natural.

THERAPIST: It would and it – it might be nice to have like a daily practice, at least during the week. [00:27:58]

CLIENT: Uh-huh.

THERAPIST: Where it was kind of part of – you know, sort of a regular part of your day like that.

CLIENT: Yeah.

THERAPIST: And – and a more (inaudible) thing, but –

CLIENT: I think I would love that.

THERAPIST: Yeah.

CLIENT: And I think the morning time is actually the – I mean, I think there's a general consensus that morning is the better time –

THERAPIST: Than evening?

CLIENT: – than evening to sit, and I – I've found that to be true for me, but I just – the thought of adding another thing to my morning seems (pause) for the – waking up at 10:15 morning, it's – it seems irresponsible.

THERAPIST: Uh-huh.

CLIENT: But actually maybe having that be a part of the morning will make – help me wake up.

THERAPIST: Right. I guess that was my thought, was that it would be something that you might look forward to.

CLIENT: Uh-huh.

THERAPIST: And it sounds like it could work out well with Jeremy leaving the apartment –

CLIENT: Uh-huh.

THERAPIST: – at 7:30.

CLIENT: Oh yeah, that's a good point. I'll try that. (pause)

THERAPIST: Find out what it's – it's nice to have a daily practice. [00:29:17]

CLIENT: It is. It's nice to feel like you've made the time, too. And actually having a daily practice is what I started with in July and August, and I think it was pretty – it was pretty different from now where I kind of have a spurt (inaudible) three or four times a week practice, but it's at different times and different places.

THERAPIST: Uh-huh. (pause)

CLIENT: I was surprised that I had those sensations on Saturday. And kind of disappointed and also kind of happy, because I had such a different relationship to them then I did earlier. But I was disappointed because – I don't know, they kind of suck. And I didn't want to have them.

THERAPIST: Right. [00:31:15]

CLIENT: And also like the prospect of having them again seemed kind of sad.

THERAPIST: I imagine you really didn't want to be that anxious that Jeremy was gone, that – that he took the trip then was –

CLIENT: Yeah, I –

THERAPIST: – gone and missing him, Ok, maybe. But anxious?

CLIENT: Yeah. Yeah, it did – it didn't feel right. (pause)

THERAPIST: Also, it sounds like sleeping may be related to – to the extent of the people –

CLIENT: Uh-huh.

THERAPIST: – you have and I – I guess part of what you're saying is that the star chart not being appealing in the way that it was before seems related to that. Like – it was kind of enough to buoy you then, but with there being kind of more of people and – maybe you're having more intense (inaudible) about getting out of bed than you used –

CLIENT: Yeah.

THERAPIST: – it maybe doesn't seem like enough or it even seems aversive –

CLIENT: It seems sort of wrong, actually. It feels sort of wrong.

THERAPIST: Yeah. Like a – (inaudible) when it feels like a – a bribe that's inappropriate for a problem that feels more serious.

CLIENT: Yeah. Yeah, exactly. It's kind of like putting a Band-Aid on something –

THERAPIST: Yeah.

CLIENT: – that actually needs to be open to the air for like a year or something. Jeremy asked me yesterday – I have to decide if I'm going to go on his insurance, too.

THERAPIST: Uh-huh. [00:33:45]

CLIENT: And I've been vacillating. And he asked me if I had a time frame for how long I might want to be in therapy, if I want to continue therapy, and I told him that that –that wasn't really a great question and I didn't think that I could answer it.

THERAPIST: Uh-huh.

CLIENT: But I thought that six months was like a reasonable order of magnitude.

THERAPIST: Uh-huh.

CLIENT: And I don't know where that came from. Because I'm still unclear about – I think one of the things that came up is like what is life like without therapy? And I – I don't know. I don't remember. (pause)

THERAPIST: Has it felt different transitioning to once a week from five?

CLIENT: Uh-huh. Yeah. It feels like there's a lot of sampling bias. [00:35:03]

THERAPIST: Uh-huh.

CLIENT: Like it's hard to really –

THERAPIST: Get more representative –

CLIENT: Yeah. Do justice to all the various things that come up.

THERAPIST: Uh-huh.

CLIENT: And I – you know, I do a pretty good job of like making mental notes about stuff that I might want to bring up. But I also – that feels kind of like I don't want to plan –

THERAPIST: Uh-huh.

CLIENT: – the session, so that has felt different. But it's not – but it hasn't been negative. I don't feel – I don't think that – I think it's nice, but it's not like urgent. (pause) But it is serving a purpose, but I just can't quite figure out what that is.

THERAPIST: You coming to therapy?

CLIENT: Uh-huh.

THERAPIST: What pops into your head? I mean, not necessarily as an answer, per se, but –

CLIENT: Um, well it's – it's nice to talk. (pause) It's nice to have really – to like go through the days knowing that there is some outlet, or like there is some help, maybe?

THERAPIST: Uh-huh. [00:36:50]

CLIENT: Not that – and in like kind of a way that isn't actually that helpful, but it's (laughs) – but it's like this nice sort of structure and have – having a listener is quite powerful.

THERAPIST: Uh-huh.

CLIENT: I think it is – it is actually very helpful, in a way. So it's nice to have – it's almost like a safety net.

THERAPIST: Yeah, I mean is this a reasonable – it's not especially instrumentally helpful.

CLIENT: Uh-huh.

THERAPIST: But it's sort of helpful or provides support in some kind of emotional way.

CLIENT: Yeah, I mean, some things are helpful. Like I thought –

THERAPIST: Uh-huh.

CLIENT: – I thought about my dad –

THERAPIST: Uh-huh.

CLIENT: – a lot after last week, and I didn't like really reach any place or come up with anything that – that's particularly different from it – what I had before. But it was nice to – like look at those dreams in a different way.

THERAPIST: Uh-huh. [00:38:01]

CLIENT: And to like interact with my dad with that –

THERAPIST: Uh-huh.

CLIENT: – with that perspective. So I – I do think it's helpful at – like it does change my behavior, but it's not – subtle.

THERAPIST: Uh-huh.

CLIENT: It is subtle. (pause)

THERAPIST: Yeah, it seems like (pause) – maybe one thing we're talking about is the way that – you know, we are in – sort of benefitting from certain emotional supports more than at times is clear like –

CLIENT: Uh-huh.

THERAPIST: – or as obvious.

CLIENT: Uh-huh.

THERAPIST: I'm not thinking of therapy as much as the chance to stay in bed or Jeremy being around.

CLIENT: Yeah.

THERAPIST: And I guess I – I think of us talking about the marriage and the way that that, too – you know, feeling further from your parents kind of has shaken you up more than you anticipated.

CLIENT: Uh-huh.

THERAPIST: And about other stuff, kind of like wake-up call sort of metaphor that I'm looking for – you know, that sort of ties together that and bed and Jeremy.

CLIENT: Hmm. Yeah, and things are kind of clunky. Jeremy's parents visited and –

THERAPIST: Uh-huh.

CLIENT: – Jeremy's mom is always so exploratory and observant –

THERAPIST: Hmm.

CLIENT: – and very – really likes to verbally process things if she has someone who wants to do it with her. So she was – visit – we were just talking about how their marriage is just like this little dance, it's this orchestrated dance where it's clear what their roles are, it's clear what – you know, they both sort of know what they are getting out of life. Like there isn't ton of uncertainty. I mean, of course, we're always asking lots of questions, but – and she – she just kind of did that back when she was first married, and they were – she was 21. And things were so clunky and I thought, ‘Well, that's really a good word to describe it.' And maybe part of what – why therapy is – feels nice or useful is that I don't have to worry about – I don't have to consider how my things that I'm talking about are effecting our relationship, or decisions that we're going to make together, or how you feel, or – yeah.

THERAPIST: Uh-huh. [00:41:40]

CLIENT: And I think the natural person to share these various concerns with would be Jeremy.

THERAPIST: Sure.

CLIENT: But there's still kind of a lot of like – just figuring things out and it's nice and it's slow. It's nice but it's slow. And I don't really wish for it to go any faster or happen any differently. I'm enjoying it, but it –

THERAPIST: Uh-huh.

CLIENT: – I think it makes him as an emotional support like not exactly that effective right now.

THERAPIST: Hmm.

CLIENT: Like talking about whether I want to continue therapy –

THERAPIST: Uh-huh.

CLIENT: – I read it as – as like a, ‘Can you please listen to me talk about this and' –

THERAPIST: Right. [00:42:38]

CLIENT: – ‘and tell me what you think?' And it turned into this like – talk – talk about like finances and I was crying because Jeremy was saying that he doesn't get so much out of therapy that he would pay $3,000. But that's not – he knows that that's not – that's him and that's not me. But it was just like this whole thing, I – all I wanted to do was kind of air out some of the –

THERAPIST: Right.

CLIENT: – options.

THERAPIST: Ok.

CLIENT: So.

THERAPIST: We should stop for now.

CLIENT: Ok.

THERAPIST: But we'll talk more in a couple of weeks.

CLIENT: Cool.

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