TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: But I'm on my fourth day of waking up at when Jeremy leaves and sitting.

THERAPIST: Uh-huh.

CLIENT: And it's so great.

THERAPIST: Sounds terrific.

CLIENT: It's really hard. Jeremy like has to really, really coax me out of bed, which is like what I've found all my life. But I somehow get out of bed and then it's fine.

THERAPIST: Uh-huh. That's good.

CLIENT: It's getting easier.

THERAPIST: Good.

CLIENT: I have a like a reward attached to it, which is a bird feeder. And I'm I'm hoping that I can keep it up after I get the bird feeder, because it is kind of a reward in itself.

THERAPIST: Uh-huh. [00:01:19]

CLIENT: And I got a meditation cushion, which has made everything so much better.

THERAPIST: Hmm.

CLIENT: And my sittings are like wildly different from each other. But they're there, which is great.

THERAPIST: Uh-huh. (pause) What are you doing the same practices each time?

CLIENT: Yeah, I think I'm still like figuring out what my practices I mean, I set a I have this app that like sounds a bell, so I set that. And it's been between 25 and 45 minutes. And when I just sit and I sort of like settle in and then I focus on my breath and I keep coming back to it. And sometimes I will like really, really not pay attention to thought.

THERAPIST: Uh-huh.

CLIENT: And sometimes I will and that will be the practice, or sometimes I will like feel like exploring, but not in a judgmental or attached way. Just sort of like, ‘What are all the different aspects of this thought?'

THERAPIST: Uh-huh. [00:03:05]

CLIENT: ‘Is there a feeling?'

THERAPIST: Uh-huh. Sort of examining them?

CLIENT: Yeah. And like maybe labeling them but you know that could like really quickly into a narrative -

THERAPIST: Uh-huh.

CLIENT: mode, which, I don't know. I could do that for like 45 minutes and not pay attention to even a single breath, so -

THERAPIST: Uh-huh.

CLIENT: I don't I don't want to do that. So I think the practice that I've been settle like that I've end up doing for most of the time is some combination of those two.

THERAPIST: Uh-huh.

CLIENT: Like alternating examining and just noticing, and then also like breathing.

THERAPIST: Uh-huh. Like focusing on using your breathing as kind of a support for your meditation (inaudible)?

CLIENT: Yeah. And then I sometimes I like will fall back on some Metta type phrases, but I don't know. Those are like sometimes really calming or sometimes they're sort of make me agitated. In general, I (pause) I think I'm like I don't know, less challenged by various different things, which is nice. But and I think I can attribute that to a lot of like concrete changes in my relationship with Kelly and lab work and like strengthening my sense of self in my relationship with Jeremy and our home. Meditation, medication, therapy. But I I definitely still have these like little cycles of anxiety and depression or depressed they're sort of like depressive low mood cycles. And they come I don't know, they come like every three or four days.

THERAPIST: Hmm. [00:05:51]

CLIENT: And last for like 15 minutes to a couple of hours. And like they're getting further and further apart, but they're still they're very interesting. And I don't know when I tried to describe them to Jeremy, he asked if they were if the cycles were like thoughts or if they were feelings. And I I don't know that I can tell the difference between the two at that like during the episode.

THERAPIST: Uh-huh.

CLIENT: It's kind of like what happened in the car in Vermont on the way to that wedding, which is like this it seems sudden, a sudden like sense of panic. And like, ‘Uh, do I really have to go on? Like, do I really have to keep on keeping on,' and it seems so long, it seems so tedious, so tiring. Like what is what are the good things, what are there any good things? And then like come and then like immediately like, ‘What is this? These are scary thoughts. These are scary scary feelings.' And then like I notice myself really trying to change it or to act on it or to figure out, ‘Ok, why now?' And I think my response to it is definitely changing and evolving, which is all I can do or all I feel that I want to do. But I wonder why it happens at all. (pause)

THERAPIST: What was going on last time it happened? [00:08:07]

CLIENT: Um um (pause) -

THERAPIST: Or I guess better yet, what was it about the car that seemed familiar about it?

CLIENT: I don't know, I guess I'm usually alone. It's usually some transition, like coming home from lab, or what this wasn't the last time it happened, but the time before that.

THERAPIST: Uh-huh.

CLIENT: I was driving to the dentist, and the day before Thanksgiving I think I was really nervous about going to the dentist, because I had I actually enjoyed getting my teeth cleaned, but I've had a lot of cavities over the last like four years, and never before that. So I was nervous about having more cavities. But I didn't really realize it until I left the dentist and I didn't have any cavities and it was a pleasant visit, and I felt like this great relief, and sort of like giddy with relief.

THERAPIST: Uh-huh.

CLIENT: But the thoughts or feelings didn't have anything to do with the dentist, it was just like almost like I was driving and I felt I just felt like really detached from where I was and what I was doing. And that didn't last very long because I was like had to talk to the dentist and stuff.

THERAPIST: Uh-huh. [00:09:52]

CLIENT: And usually that interacting with people changes my mood.

THERAPIST: Uh-huh.

CLIENT: The last time it happened I don't really remember anything about it except that I was coming home from lab and just sort of like feeling really ho-hum about everything. And not and actually what happens is that I'm not able to like focus. It's almost this like hyper hyperactive state. (pause) I don't feel physically hyper, but my mind is like maybe triggered by some sort of sad or bad feeling and then I can't like calm down. I can't like visually focus like like there's all these like different -

THERAPIST: Agitated?

CLIENT: Yeah. Agitated. [00:11:11]

THERAPIST: The word that I had in mind.

CLIENT: I don't and I think I was like pretty much permanently in that state around my wedding the time of my wedding.

THERAPIST: Uh-huh.

CLIENT: And I've been have like having dreams about my wedding. (pause)

THERAPIST: (inaudible) wedding?

CLIENT: Yeah, last night's dream was it was so vivid that I will look back at this time in my life and it it will be so interesting these how vivid my dreams have been.

THERAPIST: Uh-huh.

CLIENT: Because I've never never really had that window -

THERAPIST: Uh-huh.

CLIENT: before. So the dream was like everybody was at our house, except it wasn't really our house. And I was getting ready and get the like getting ready part of the all the different wedding events were like so long, and I know that I feel badly that I spent so long having to get ready, because like I really didn't care. And I just wanted to go and be with the people. So in this dream, basically, I missed like I delayed the wedding because I was getting ready and all these people all these women older women in my life were helping me. And I don't remember if my mom was there. My mom feels she says that her one regret about the whole thing is that she didn't spend any time with me while I was getting ready.

THERAPIST: Uh-huh. [00:13:09]

CLIENT: Right before the wedding. And I when she brings it up she's brought it up a couple of times and I my reaction is like, ‘What? That's dumb. Like you were doing such better stuff like greeting people and' but I just like I wonder why the getting ready part matters and if it has anything to do with that, of why it keeps coming up in the dreams. So I was wearing like these really elaborate there was like the wedding and then the reception, and a different sari for each one. And someone I knew very well was like wrapping the sari on me, whereas at my real wedding, it was sort of like a community woman who is very good at it and gets hired to do it, but I didn't know her very well. And so I was late to the wedding, and then I guess the wedding happened. I don't remember that part of the dream. And then I had to spend like even more time getting ready for the reception. And I like finally did and I was like loaded up with fabric, and we had to walk to the reception. And my cousins and my these like aunts and women in our family-friend circle were walking with me, and there was this like it had been raining. And the reception was like at the bottom of this hill and we had to like crabwalk like backwards crabwalk down the hill to get to the reception.

THERAPIST: You mean like on your hands and feet? [00:14:47]

CLIENT: Yeah.

THERAPIST: Uh-huh.

CLIENT: And everyone else was doing it everyone else was I don't know how they didn't get mud on their on themselves, but like I was the bride wearing like all of this jewelry and gorgeous fabric, and I was like crab walking down the hill. And the mud wasn't brown, it was like gray. And I remember like thinking like, ‘Oh, I'm not getting any mud on me. It's fine.' And then like I show up and I'm late to the reception, and my great friend (sp) is speaking, and Jeremy is like perched up on like this pedestal for like two people. And I'm like climbing this ladder to the pedestal with like mud on my sari, like most of the way through her speech. And that was the dream. (pause)

THERAPIST: Well, a couple of things that seem to recur involve your being on your way somewhere, right?

CLIENT: Uh-huh.

THERAPIST: Like in the dream, both before the wedding and the reception. And with the dentist and the wed the other wedding that you went to. [00:16:13]

CLIENT: Yeah.

THERAPIST: And I guess also being by yourself?

CLIENT: Uh-huh.

THERAPIST: Maybe not on the way to the wedding that you drove to -

CLIENT: Well, yeah. I mean, I was sitting in the backseat. Jeremy and his mom were talk chatting for a while -

THERAPIST: Yeah.

CLIENT: amongst themselves.

THERAPIST: Yeah. And (pause) I think some sense of anticipation or frustration.

CLIENT: Uh-huh. And also like a performative -

THERAPIST: Uh-huh.

CLIENT: quality to most of this.

THERAPIST: Um I wonder one thought that occurs to me is whether or a question. There's something going on with the way that maybe you're like some ambivalence about these events -

CLIENT: Uh-huh.

THERAPIST: got split in time, since that the bad feelings, which may may be less acceptable. Like it's ok to have come up on your way there, like like you know you feel mixed about the dentist, and like having to get your teeth cleaned. On the other hand, you're worried about having more cavities and whatever else. And you also know that once you get there, you're going to talk to the dentist and probably be nice to the dentist and hygienist or whoever.

CLIENT: Yes. [00:18:47]

THERAPIST: And so I wonder and the word I wonder is ‘crabby.' But the crabby (laughs) feelings kind of come out before.

CLIENT: Yeah, I mean, it's kind of like the first jazz rehearsal of the semester like -

THERAPIST: Uh-huh.

CLIENT: but not really being able to process the feelings and just like totally breaking down.

THERAPIST: Uh-huh. And when you get there I think both like kind of being pulled into things by the other people like by the social dimension of the situation -

CLIENT: Yeah.

THERAPIST: like I think probably for two reasons: one is like it's just kind of grounding to have the people around. And the other is I suspect it doesn't feel as ok to be cranky or unhappy about being there -

CLIENT: Yeah.

THERAPIST: in front of the other people, so you sort of shelve it a little bit. But it's also just generally kind of reassuring to or grounding to be around other -

CLIENT: I think I I'm really I've always been really worried or -

THERAPIST: Uh-huh.

CLIENT: placed a lot of importance on like showing up and doing a good job, or like, you know, giving it what I as much as I can give it or -

THERAPIST: Uh-huh.

CLIENT: I don't know. Like when I speak with people, I I think Jeremy's grandmother I might have brought this up. She called me like said my greatest achievement is in my inner personal relations and it made and it was in the context of how I'm a great achiever, but that to her -

THERAPIST: Uh-huh. What mattered most? [00:20:54]

CLIENT: Yeah, and it in some sense it made me think of, ‘Well, actually I'm like kind of an overachiever in in in my inner personal relations because I' I don't know. I'm sort of always like pushing and trying to connect and -

THERAPIST: Hmm.

CLIENT: like feel really unsatisfied if I like -

THERAPIST: Hmm.

CLIENT: haven't made a great effort to -

THERAPIST: You have almost like a very strong sort conscience or judgementalness or something -

CLIENT: Yeah.

THERAPIST: around how you're how much of an effort you're making, how much you're trying.

CLIENT: Yeah.

THERAPIST: Something like that.

CLIENT: Some of it I I've noticed because like I I scold Jeremy a lot for this these things that I consider my like I consider important to myself. Like early in our relationship I used to do it a lot, and it it's like totally a terrible thing to say to someone. And I think I really gave Jeremy a complex for a while, and maybe he still has it. I mean, I think he has it anyway, but he's sort of a like a social underachiever -

THERAPIST: Uh-huh.

CLIENT: in that like he doesn't really like people other people that much.

THERAPIST: Uh-huh.

CLIENT: Like he doesn't really look at strangers as an opportunity. He sort of sees them as kind of a burden. [00:22:44]

THERAPIST: Hmm.

CLIENT: Big family big gatherings in general are really intense and overwhelming for him.

THERAPIST: Uh-huh.

CLIENT: When he was getting to know my family, which by the way took such a long time, because he just like wouldn't speak. He would speak when spoken to, but wouldn't ask any questions.

THERAPIST: Uh-huh.

CLIENT: For years. And this was like such a point of shame for me that I was like bringing this guy into the house who already wasn't Indian, he already like took a year off from college, like he isn't he isn't like a stereotypical sort of achieving you know, he's not going to become a doctor or a lawyer or I don't know. Like school was hard for him, but also he like I his IQ is like in the genius range, so he has this like -

THERAPIST: Uh-huh.

CLIENT: and I just say that because because it is, I think and I think it's obvious, like when you speak with him, there's this incredibly smart person. But if you who's like functionality in the world is like a little bit off. So anyway, so I was aware of all of these things, and like on top of that, Jeremy just like wouldn't ask any questions. And my parents would would like notice it and say it to me, like ‘He didn't ask me a single question.' And that was so painful. And I would like I would like have it out with Jeremy, like ‘You have to ask questions.' And it was horrible. One thing that I real sort of realized over the break is that I have spent like seven years trying to like make Jeremy be acceptable to my family and trying to make him acceptable to me. And trying to make us, and our future, like possible, and like scheming and planning and hoping. And that's sort of like over. Like all that energy is maybe still there, but it's not really like being directed in a in the same way at least. I brought it up to Jeremy and we sort of talked about how we could keep the scheming and planning and hoping in my life. But towards things that are relevant now, like a healthy relation a healthy marriage, or like you know, things that we want to do and accomplish together. (pause)

THERAPIST: I wonder if you kind of maybe this isn't the way it was brought up, but whether the dynamic like between you, vis-à-vis your family, like the (inaudible) -

CLIENT: Uh-huh. [00:27:33]

THERAPIST: and finger-pointing and whatever -

CLIENT: Uh-huh.

THERAPIST: I think it's something that goes on more obviously within you. I mean, whether there's a part of you that kind of identifies with his I don't know how exactly to call it. Like it felt to you like kind of like lack of sociability -

CLIENT: Uh-huh.

THERAPIST: with your family. I don't necessarily mean for you with your family, specifically, but elsewhere, where it's not so easy for you, necessarily, or always so comfortable. You it sounds like you work hard at it.

CLIENT: Yeah, I do work hard at it.

THERAPIST: You make it happen, but you put quite a bit of pressure on yourself sometimes to do those things. But it sounds like sometimes it's not necessarily clear to you the ways in which it so it can be uncomfortable or difficult or really require effort. I think a part of you kind of identified with the way he was and was reacting to him in probably a pretty similar way to how you would react to yourself, like -

CLIENT: Yeah.

THERAPIST: ‘Come on. Like, get going. Let's do it. What the heck's going on? Like, get out there.'

CLIENT: Yeah. [00:29:22]

THERAPIST: ‘Just say it. You know that's the right thing to do. You've got to make a good impression.' And it's a little embarrassing not to do that -

CLIENT: Yeah.

THERAPIST: or whatever else.

CLIENT: I guess there's a lot of like I don't know, wanting like almost like I'm collecting their connections. Like it's sort of like a currency -

THERAPIST: Uh-huh.

CLIENT: that, for whatever reason, drives me either because it's like, I don't know some thing that I'm like forcing myself to do that, for some reason I keep doing.

THERAPIST: Uh-huh.

CLIENT: Or actually because it makes me feel good. And also there's I think I I mean, I want to make a good impression. (pause) And I think I can make a good impression. Like, I don't have any really like so when Jeremy talks about this, a lot of what he says is like, ‘Well, I really don't have anything to say, like I don't really know what to say, like it's stressful.' And I don't have any of those -

THERAPIST: Uh-huh.

CLIENT: challenges. (pause) But I do I do spend like time thinking of questions to ask people. Like you're don't I mean, I'm pretty naturally curious, but you don't just like deepen a relationship just like by like standing next to each other. I don't know, I'm always like thinking about where people are in their life and what they said yesterday and -

THERAPIST: Hmm.

CLIENT: but I like to, I really like that aspect. [00:31:42]

THERAPIST: Do you have a misanthropic heart?

CLIENT: What does misanthropic mean?

THERAPIST: Doesn't like people.

CLIENT: Oh.

THERAPIST: I haven't heard about it, but -

CLIENT: I love people. But it's hard to say, because it almost I love people and that's strong, but what's also strong is like that's who I am. I love people, and like I'm a people person, and these are the ways in which I've learned how to be great -

THERAPIST: I see. It's just more sort of the work it can take sometimes -

CLIENT: Yeah.

THERAPIST: the effort you put in. You're sort of conscious about it in a way. Stuff like that that is what can make it difficult, not that you're sort of contending with some part of you that really wants to be off by yourself in a cabin in the woods all day.

CLIENT: No. But I do have strong reactions to certain I don't know, like fat people. THERAPIST: Uh-huh.

CLIENT: I have a pretty strong reaction to obesity and overweightness in general.

THERAPIST: Uh-huh. [00:33:07]

CLIENT: And I don't know, like Jeremy's friend best friend, Nolan -

THERAPIST: Uh-huh.

CLIENT: like doesn't sit he doesn't sit well with me, and it's because he's like make he makes like really self-destructive decisions of him I get afraid that Jeremy will turn into Nolan. But actually it Nolan on his own as his own person, I don't have problem with.

THERAPIST: Uh-huh.

CLIENT: I don't know. I guess I have a I have some judgmental feelings about certain things that happen and people like not taking care of yourself, laziness, lack of will willpower. Less so then it used to be. I think it used to be pretty self-righteous, but now it's just like -

THERAPIST: Uh-huh.

CLIENT: I guess I just ignore it or don't -

THERAPIST: Yeah, it it sounds like this is maybe throwing some context for some of the agitation that you can feel on the way to some things, social or performative, in that it it's sort of like (pause) anticipating that you're, you know, like going to be putting yourself under some pressure and judging yourself, and then the other people, too. But I think a lot is self, about how you're feeling. [00:35:17]

CLIENT: Uh-huh.

THERAPIST: And I think that can make you can of anxious and weigh heavily on you.

CLIENT: I wonder where the -

THERAPIST: Uh-huh.

CLIENT: ambivalence or sadness comes from?

THERAPIST: Uh-huh.

CLIENT: The anxious feelings are pretty familiar.

THERAPIST: Uh-huh.

CLIENT: Like the sort of like can't sit still, gotta move, can't say no, can't focus, like THERAPIST: Those are (inaudible) -

CLIENT: scared, worried -

THERAPIST: like the agitated part as being a certain kind of fear like -

CLIENT: Yeah.

THERAPIST: obsessed with being trapped or anticipating feeling trapped.

CLIENT: But there's a quality of it that I've never experienced before -

THERAPIST: Uh-huh.

CLIENT: which is like not wanting to go on. Like not really in a in a physically harmful way, but just in a sort of like, ‘Uh, I've had enough.'

THERAPIST: Uh-huh.

CLIENT: Like -

THERAPIST: ‘I'm taking my plate and going home.'

CLIENT: Yeah. And like we I've had a good life, like -

THERAPIST: I see.

CLIENT: it's not like death isn't any part of it at all.

THERAPIST: Yeah.

CLIENT: And harming myself isn't any part of it, but it's sort of like, ‘Uh...'

THERAPIST: Throw in the towel? [00:36:41]

CLIENT: Yeah. What like what is what's left? There's not too much left. And then like when I bounce back like I mention, it only lasts for a couple of hours -

THERAPIST: Uh-huh.

CLIENT: it's usually like the thing that changes is that I can like see something or feel something that's worth -

THERAPIST: Uh-huh.

CLIENT: being around for. Not to say that like that thing made me come out of it, but that is that is a way to describe what it feels like when I come out of it.

THERAPIST: Right. Right.

CLIENT: Kind of like staying in bed in the morning. It's really similar to that feeling. Like I have no interest in -

THERAPIST: I see.

CLIENT: greeting the day, I don't want to do anything.

THERAPIST: Yeah. Life's pretty good here in bed and -

CLIENT: Yeah.

THERAPIST: and outside, maybe not so much.

CLIENT: Yeah.

THERAPIST: That's how it feels at that moment. Not that it doesn't feel differently once you're out of bed. [00:37:57]

CLIENT: Right.

THERAPIST: Yeah, I it seems like it might be a similar thing, where you anticipate, again, the kind of questions -

CLIENT: Uh-huh.

THERAPIST: and stresses. I think specifically that you put yourself under which may be closely related to maybe it's not a useful distinction. That's why I say different from what you get from other people or from work, per se, but (inaudible) like the heaviness of the pressure and the sense of being trapped, I think -

CLIENT: Yeah.

THERAPIST: by the responsibility that you have to do well and work hard and reach out.

CLIENT: But I wonder but I always like rise to the occasion.

THERAPIST: Uh-huh.

CLIENT: I'm wondering what it is that's -

THERAPIST: That doesn't mean it's easy.

CLIENT: Yeah, it's not easy. [00:38:55]

THERAPIST: When you say overachieving I mean, it sounds a little self-critical, but also it it makes me imagine that like you're really working pretty hard -

CLIENT: Uh-huh.

THERAPIST: and maybe wanting it to sort of look easy and probably coming across as though it's not so much work for you -

CLIENT: Right.

THERAPIST: but inside it is. It's a good call.

CLIENT: Did I talk about conserving social energy?

THERAPIST: No.

CLIENT: I it occurred to me -

THERAPIST: Ok. Ah, yeah.

CLIENT: Ok. Oh yeah.

THERAPIST: Ok. Well it sounds like it's sort of another topic?

CLIENT: Well it just occurred to me that -

THERAPIST: Yeah, sure -

CLIENT: like some people can go through the day and just be very sort of calculated and con conserving in the way they interact with the world, like Jeremy, and other introverted people. [00:39:58]

THERAPIST: Uh-huh.

CLIENT: And then they like can sort of be around and doing things for longer, and I think that I like really spend my last -

THERAPIST: Uh-huh.

CLIENT: like, you know, whatever the currency is. I'm out of juice.

THERAPIST: Put it all out on the table, yeah.

CLIENT: I'm out of juice by the end of every day.

THERAPIST: Yeah.

CLIENT: And so I was like I was just thinking for a while to myself and with Jeremy, like how can I just be less engaged?

THERAPIST: Uh-huh.

CLIENT: Would I necessarily like to?

THERAPIST: Uh-huh.

CLIENT: I think we're going to have two more sessions. [00:40:40]

THERAPIST: Ok.

CLIENT: And if you have anyone that you think would be good.

THERAPIST: Right, in the network?

CLIENT: The network.

THERAPIST: For Blue Cross?

CLIENT: For Blue Cross -

THERAPIST: Ok.

CLIENT: HMO.

THERAPIST: All right. Let me look around a little bit, and I'll let you know.

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