TRANSCRIPT OF AUDIO FILE:

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THERAPIST: How did things work out? I've got your message obviously after...

CLIENT: Mm hm. No you were very helpful. Thank you for taking time to call me.

THERAPIST: Sure.

CLIENT: So Ivan said he was fine that night, that he didn't need to go anywhere and that...so he didn't do anything further. He did say "I was hoping you wouldn't find that," so we did make the distinction that he was saving it actively.

THERAPIST: Yeah.

CLIENT: It wasn't something that he'd forgot about which I was really hoping it was because that's really common for him. But it wasn't and we saw Dr. Farrow (sp?) Friday obviously. It wasn't very helpful and I guess I...something I tried to convey to her which I'm not sure she understood...not communicating directively or maybe she doesn't understand, I feel like I need more help. I feel like I need...I don't know what form it should take, I don't know what it should look like but it's been...it's really become a lot to take care of him on some level and to be (pause) responsive to the way things are going with his depression and such without any additional help because I feel like it's really helpful to me with you but that's 45 minutes out of a week. [00:01:31] Then my sister is there, always listen but I feel bad like putting that on her cause then she's really worried. I don't like doing that and that's kind of where it ends because my parents aren't so able I guess and talking to Ivan's dad was a really bad experience so I guess...She's like "Do you need someone to come in and help you with the apartment?" I'm like "No!"

THERAPIST: Yeah I wonder what your picturing when you say "I need more help." What looks...what would help?

CLIENT: In theory I think it would come from our sets of parents. In theory it would be someone who could be calling him and checking up and finding out what's going on and be really like on board with his treatment plan and...I don't know if I should call it that but....Maybe for me somebody whose able to call and just "How's it going?" It seems pretty clear, it's not going to come from my parents, which is fine and Dr. Farrow said "Do not call his dad." I think it's more emotional support, I think it's more I'm having a really, really tough time. His mood swings seem to be...I don't know, more pronounced? [00:02:53]

THERAPIST: Mm hm.

CLIENT: He goes from like crying to really happy, hyper attentive towards me, he goes really back and forth, back and forth, which I understand is part of depression. I shouldn't expect it to be different, I'm not criticizing the fact that he's going through that but I'm just acknowledging it's really tough.

THERAPIST: It's a lot on you.

CLIENT: Right! I'm really worried about the threats and the note and I'm very worried about it obviously but I'm also again, it sounds horribly selfish but I've taken a moment and am realizing this is really tough to deal with. I'm not doing it completely alone obviously but it feels like that sometimes when I'm not here.

THERAPIST: Yeah.

CLIENT: I'm the only other person in the apartment and it's too much and its effecting me physically and its effecting me emotionally and I sometimes feel myself being really pulled down in his...when the moods are really depressive it's really hard to like try to bring him up because I'm like...so it's getting really difficult to manage.

THERAPIST: One of the dilemmas is that as you articulate what you wish you had that would helpful is a parent who is more supportive. Both of you. You wish not only for your own parents to be people who they are not but his parent sounds like that also is a piece of what we may have felt clearer after your exchange with Ivan's dad that he has tremendous deficits also as a parent. [00:04:40]

CLIENT: I don't know. I talked to my sister a little afterwards like the next couple days or whatever and I told her what had gone on and she's like "Well he's reacting like a Dad. He's emotional, he can't...it's unfortunate he couldn't step out to help you, but..." She felt like it went back to his...he and Ivan are more friends than anything which is...I don't know how I feel about that but I mean he was not at all able to be...it wasn't like an initial hysteria and then he calmed down, like had a plan. No...

THERAPIST: So he was hysterical on the phone?

CLIENT: He wasn't like sobbing and...but he was really emotional and he was very clear that he wanted me to call Dr. Bourd (sp?) and find out what I should be doing differently and how I should be taking care of it. He's like "Do not call and ask what Ivan needs to be doing. Find out what you need to be doing." I'm sure he meant...I'm sure it never occurred to him...

THERAPIST: Yeah, I'm not...

CLIENT: That sounded really accusing but... he said "I don't know if this is around the time you went home to get your car inspected but...I don't know if Ivan...if it sounded like you didn't want him to go. I don't want to get in the middle of that but..." So he just kind of let me know that he thought it was me kind of....it sounded accusatory to me and he called me back after a while cause he couldn't wait to hear if I had gotten hold of Dr. Bourd and he's telling me that Ivan has had some struggles with this before, he's like "Ivan doesn't know it but he wrote a poem in seventh grade and his teacher called me because it was dark..." and I wanted to say "Why didn't you do anything, why didn't you...?" But all I said was "I feel like clearly in grad school, even a little before, Ivan needed some help with this and he didn't get it." [00:06:34] There are some big things I'd like to know when really...see his struggle with attention or memory or he's like "No, that's all he's been there." They never...and I mentioned, I said someone, I didn't want to bring in that I'm seeing someone intimate but I said one of them said that it might be helpful for Ivan to get some kind of evaluation to find out what's going on and maybe even a pharmaceutical evaluation and just...I told him didn't know if he was aware but Ivan feels this is very stigmatized and he's very disappointed in himself if that would come up. He made that very clear. I said "I don't know if there's a way that you could somehow approach him and let him know that you guys support it and you don't...you know, there is no stigma and it's healthy and good..." He really couldn't get that maybe cause I'm like "I know you told Ivan at one point he needs to be on antidepressants," and I said "Maybe you don't do that?" [00:07:40] (laughs) I said "You know you're not really...it's not really your field and even if it was you are his dad and you are so close to this." He's like "Well I did take a lot of psychology courses," and I just...I'm sorry I can't get past that I'm so angry at him. He's a pastor, he went to seminary, like he's not...(laughs) major in psychology even. He has no...but he's honestly on the phone telling me how 20 years ago he took a couple classes and I'm just like...

THERAPIST: Did he call Ivan or did Ivan's mom call Ivan?

CLIENT: Huh uh.

THERAPIST: No one called him?

CLIENT: No everybody's acting like nothing ever happened and Martin was very clear on the phone, he's like "This conversation never happened, until you hear from Dr. Bourd." He said "I don't think you should confront Ivan." I told him I didn't know what to do here and I was hoping...he really just kind of told me to just...so it was unfortunate and he kind of gave me like a short list of what he needed and he never called me back, not even to check like "How's it going?" I think that's his way of...so I understand Ivan maybe avoids him sometimes and maybe he learned that a little bit at home.

THERAPIST: Yeah.

CLIENT: I don't know I'm just really...

THERAPIST: Well I think that could be one of the things that for you right now is most (pause) anxiety provoking about not only finding the note but then to discover in the whole system of your life, your shared life with Ivan that neither of you has a set of parents or even a single parent who you can turn to for some guidance and support through all this and that's devastating. [00:09:33]

CLIENT: Maybe...so my sister said "What about Julie? Maybe his mom is a bit more..." She's definitely a bit more less emotional and less mainly talking to her but the problem is I'm very intimidated by her so I'm kind of scared to call and I'm really worried that it can go as badly as it did with Ivan's dad or worse and I really, again this sounds really selfish but I really can't deal with her blaming me cause I already feel like they're...they've already suggested me saying "You need to have a job or you need to..." like that makes him feel worthless or that makes him feel...which is so difficult.

THERAPIST: Yeah. One of things that's hard, I mean Dr. Farrow said that she does experience the dynamic in the room gets so polarized where you're holding this kind of rage and criticism and he's holding all of the shame and kind of recoiling. I think that the thing I would be pushing you guys to start getting out there and understanding together is that I don't think you're the only one with rage and criticism in the room and I don't think he's the only one with shame in the room. And the anxiety.

CLIENT: No, no.

THERAPIST: I think you carry around tremendous shame about your own family, your own experiences. The problem is that you just both deal with it in opposite ways. He puts his head in the sand and you kind of do a very opposite obsessional, organizing, cleaning, organizing, cleaning, organizing, cleaning so you take it almost as a critical attack and he takes it with the withdrawal. The problem is that right now as long as you're in that place he's going to stay in this place, you know? [00:11:24] And if the couples work is going to help you it's going to be able to help you come back to not feeling as responsible for him, not feeling sort of letting go of your criticism for the time being and to him to start to grab some more of his own self-criticism in a productive way, his own agency, his own initiative. I think one of the problems in what's getting clearer in this family system though is that you both have had sets of parents who've kind of reinforced these ways of being in the world and to find that Ivan's dad for example, here's what his son wrote, a suicide letter, and doesn't want call him, that's how avoidant he is. That's how much he sticks his own head in the sand, you know? That's extraordinary, tells you not to confront him about it and this is how much things got pushed under the rug in this family and still to this day he can't be a responsible, appropriate parent around. An appropriate parent would have been to call him and say "I need to let you know I know this, I'm so concerned about you, what can we as parents do to help you with this?" And that's absent so it's all the more infuriating for you. [00:12:39] The problem is what if that's what's you're going to get? What if that's who they are?

CLIENT: I don't know, I really again I kept trying to emphasize to Dr. Farrow cause I feel like this has been really clear in me for quite a while is I really need something more and it's not...so she's like "Do you need to see Dr. McNally more? Do you need someone to help you clean the apartment? Do you need...?" I don't know that those are...and then she immediately from there went to separation which right now I don't feel good about and I don't want to do. But I don't know if it's apparent this is really difficult. Yesterday I had to listen to him tell me how it's inevitable we're going to get divorced. In couple's therapy I have to listen to him say this is hopeless, it's never going to get any better and I have to find a way to not only not get upset and not have any emotion surrounding that and not take a minute to go cry or call someone or take care of myself. I need to turn around and say like "What can we do to help you, tell me..." It's really, really difficult.

THERAPIST: And you have all this feeling that bubbles up about how he could do that from your own childhood. [00:13:54]

CLIENT: Yes!

THERAPIST: You've done that your whole life.

CLIENT: I'm tired and I don't know what...Dr. Farrow said she thought...it seemed like she perceived me as being almost like stuck in the nineties, like I'm really redoing it all over and it feels that way to an extent but honest to goodness it more...maybe this is just me not being aware but it really feels like I really did do it growing up and I really did do it even college, like every summer and now I really am doing it with my spouse and so...(sighs)

THERAPIST: Okay. So one of the things we have to I think get clear about in reality is his parents are not going to be parents to him in the way you want them to be.

CLIENT: Should I try to talk to Julie? Is that a...?

THERAPIST: That may be an option is to try it but and who knows? I don't know her, you know her better than I do for sure, I don't know what kind of response she'll have, that might be then the next step of something you could try, if you're being practical. But if she responds in a similar way it's that question then what? If there are not going to be parents who are going to help on either side. Will your parents?

CLIENT: My mom is apparently still not talking to me from two weeks ago when I asked about Easter so I'm not...sometimes she can be really helpful and other times her own, like she's really not. Not a good situation and my dad doesn't do any type of emotional discussion. [00:15:29]

THERAPIST: What would happen if you called him?

CLIENT: He would tell me "I'm really sorry to hear that, let me know if there's anything I can do." He would care but talking about feelings is not something he does and he would really take the, you know, "I'm really cross that Ivan didn't get a job" or "He needs to be working." He wouldn't take the very practical like...he's someone who doesn't take care of his own health so I mean he's worried about me. If anything he's pretty disappointed I think with the way Ivan has been.

THERAPIST: But what...so what's missing? He would have a response in the moment that was empathic, it sounds like he would say "I'm sorry," but he wouldn't be able to be...to offer more of something? Is that what you're looking for? Like somebody who's going to?

CLIENT: I don't know but I'm...

THERAPIST: Because nobody's going to be able to fix this situation. [00:16:24]

CLIENT: No, no and I'm not expecting a fix but what I'm saying is like I feel pretty overwhelmed and every day, truly yesterday he went from crying all the way through church, afterwards telling me how we're getting a divorce, then at lunch like nothing ever happened, happy and then later in the evening like crying a little bit again and then up again and down. It is so sharp and it's so and he's also doing...and again I can't even tell him this is going on or that I'm struggling with this because he's totally unaware. He's in his own...he's also doing a little bit of, it feels pretty manipulative and my sister said "That sounds really intentional." I don't know but he's doing things like "I will walk to my 4:30 a.m. shift at Starbucks." And I'm like "Why would you do that? Like that doesn't even make sense. Take the car, that's so silly, it's like a ten minute drive, why would you even?" He did the oh no, woe is me, pity party, so upset about it and of course I kept saying "No, of course not." I feel like those comments are meant to illicit a lot of sympathy which they do and then the next night when it was really snowing "Is it okay if I take the car tomorrow morning?" He's really doing that a lot. It's happening another..."I can go without health insurance for a couple months until it kicks in..." I'm like "Why are we even going to have this conversation?" It's so absurd and he knows it's absurd and I feel it's very clear that...he denies, he's like "I'm not manipulating you, I'm not trying to get any kind of sympathy." But he'll throw a pity party like that, like I don't need health insurance, I can walk, like really extreme...[00:18:09] Then of course I respond very warmly, lovingly, sympathetically and he wants that and its really frustrating because again I feel really alone in taking care of all this and it is a lot, all day every day and night, still breaking out in hives and the whole thing.

THERAPIST: So if you're not ready to get separated one of the things I think we really need to help you do more is to learn, for right now, to not be as responsible for him.

CLIENT: It's impossible.

THERAPIST: Cause as your language comes out Ramona, every single thing you're saying is that it's as though he's your parents and your saying (pause) "I have to take care of him and I have to be kind, then I have to coax him out of that, then I have to do this..." You sound like you need more protection right now from playing that role and anything and everything we can do to help you not play that role anymore. It doesn't mean being extremely angry but it just might mean saying...stepping out of scenarios in which you feel drawn in to take care of him just not doing that. [00:19:19]

CLIENT: It's impossible.

THERAPIST: What do you mean when you say it's impossible?

CLIENT: I don't think anyone gets what's going on because quite honestly he sits in couple's therapy and says "I can take care of myself, I've got it under control," and then Dr. Farrow turns to me and says "You need to start taking him at his word." No one understands that then we go home and Ivan continues to say he can take care of himself sometimes but he's not taking care of himself.

THERAPIST: When you say that, what's happening? Is he not getting to work?

CLIENT: Like he didn't have a schedule for this week. He didn't and I like "Okay, you need to call this morning and you need to get that."

THERAPIST: So that's what you need to not do anymore.

CLIENT: I can't.

THERAPIST: Well that's your responsibility though, that's not his responsibility, that's more a symptom.

CLIENT: But I can't, I cant. That is like the bare, him doing the work thing, that is the bare thing I need to happen from him right now.

THERAPIST: Okay but that's not your responsibility. What are you afraid of?

CLIENT: I need to be able to get groceries! I need to be able to pay the bills.

THERAPIST: So you don't believe he'll get to work if you don't get his schedule?

CLIENT: I don't know, I mean we had to have a pretty big fight before he would call for it for his very first week, like something is really seriously wrong when someone doesn't care if they have their work schedule or not.

THERAPIST: Actually I know a lot of people who call at the last minute, get their schedule and function just fine.

CLIENT: After a month of not having a job?

THERAPIST: Yes. I'm not saying that's ideal I'm totally with you on the way you're doing it is more appropriate but this is the kind of thing you...we need to help you, even for one month, not do. Your taking on being his mother. [00:20:55]

CLIENT: And he just keeps saying "I don't want that, I don't need that, I don't want that, I don't need that." No one is there to see that he can't do it on his own.

THERAPIST: But you don't let him try so we don't see what will happen if you don't do that. Do you know what I mean?

CLIENT: But I mean Tuesday morning I woke up and we had warm food because he couldn't remember to close the fridge. I mean we woke up and the car battery was dead because he couldn't remember to turn off the light. I mean he's been using shampoo to wash his body for over a month because he can't remember to take his new bar of soap into the shower. I mean things actually happen that affect me so it's not like we've been down the road, I can let it go, or I should let it go and it just falls on him and maybe he'll learn consequences, the whole...It doesn't happen. He doesn't get worked up about the consequences, I do and they affect me too.

THERAPIST: Yeah. So you sound like you're at your whit's end Ramona. If your saying you can't not let some of these things go for a month, do you know what I mean? That this is that important? For example, what if you were to separate? I don't mean divorce, I don't mean we're in a separation I just mean living...you went and lived with your sister for a month or something like that or he went and got his own apartment for a month?

CLIENT: It can't happen. [00:22:19]

THERAPIST: Why?

CLIENT: I don't...Dr. Farrow tried to say something like that, she got creative, I don't know if...I don't mean to say you're not aware but I can't just move in with my sister. She has a one room, like studio type thing on the top floor of a house and they don't turn on their heat and I have a cat and I go to school and she lives in Newton and I have stuff and I would have to be on their lease...

THERAPIST: When I say that I'm not suggesting that that might be the exact scenario.

CLIENT: But there is no...it would involve one of us finding another place probably unless I lived with my sister and there is no...I don't think anyone is hearing me, like I need him to get his schedule because I need to be able to pay our rent. We don't have money for another...

THERAPIST: I don't think you're hearing me that you're asking for something that can't happen in reality then.

CLIENT: Okay.

THERAPIST: Do you know what I mean? (pause) I hear you wanting something that's not going to exist for you.

CLIENT: Okay.

THERAPIST: So we have to work within the limits of what is possible in reality and figure out which option is best for you. Do you hear what I'm saying?

CLIENT: Mm hm.

THERAPIST: I hear how bad it is Ramona, I did a lot of talking to Dr. Farrow from your eyes so that she understands. It sounds like she doesn't quite understand how bad it is and I try to tell her these kinds of things. Do you tell her all of this?

CLIENT: It's really hard, I feel like she doesn't get it, I feel like she blames me, she criticizes me and I feel like she says we need to deal with your anger and resentment and we never talk about Ivan's depression, I feel like she tries to counsel us like we are both...I don't know how to say this. I feel like she tries to counsel us like Ivan isn't depressed and having mood swings and having problems with memory things like that never enters the room I feel. So it's like superfluous because you can't expect the same result.

THERAPIST: Yeah. [00:24:16]

CLIENT: I can't get...

THERAPIST: So maybe one of the things would be helpful is for me to talk to her again to clarify a little bit more, even you're adding these bullet points of things that are happening. To make sure she hears that loudly and clearly about just what continues to be going on. Things like the soap, that's minor in the grand scheme of things, like that would be the kind of thing I'd say to you "See if you can..."

CLIENT: It doesn't matter.

THERAPIST: Go buy another shampoo for a dollar, find a cheaper shampoo, you can buy it, hide it so he doesn't use that one and use that one yourself. The car, that's a different story, the fridge is a different story, these are things that start to up the level of impact in your daily life. His mood swings. This is where I also think like even if you're not going to separate spaces right now how to start develop some space for you even if you're going to be living in the same space. How to say you won't then spend the evening together, you know what I mean?

CLIENT: But it's not working because I have tried...we have basically two rooms, we have the bedroom, we have the living room/dining room, we have an open kitchen and the bathroom and the patio.

THERAPIST: So what do you want to happen then? What are you hoping someone will tell you to do?

CLIENT: I'm hoping that someone will...I don't know. All I know is I really need more help because it's really exhausting and really like...

THERAPIST: What is more help look like? What kind of help do you need? [00:25:48]

CLIENT: I need someone.

THERAPIST: To do what?

CLIENT: Maybe to listen, maybe to say at the end of the day say like "Oh your husband told you you're going to get a divorce, that's really..." (crying) I'm sorry, this is so stupid.

THERAPIST: It's not stupid Ramona.

CLIENT: It's not that big of deal I'm just a little...I guess I need someone to say "That's really difficult, I'm here for you." Just something or "it must be really tough to listen to him say how hopeless it is and keep going but I'm here for you and I hear that and you're not crazy and you're not making it up and it's okay to get upset about that or you found a suicide note today, oh my gosh let me listen or let me come over and just hang out with you." I don't know something, but quite frankly I have you and I have my sister and I'm even reluctant...I told her about the note and stuff which I didn't want to do but I really needed to have somebody...

THERAPIST: Of course you did. [00:26:54]

CLIENT: But like that's the best relationship I have and quite honestly she's been my caretaker when she was young because she's the oldest and I hate that she ends up...she goes and she's really worried about me and then she tries to help me out in ways but I don't want our relationship to become all about trouble in my marriage because she already listens to my mom about her troubles and her marriage and my poor sister is never going to get married and I don't know. I need somebody to...

THERAPIST: It sounds like you need someone in your life understanding what you're going through and how real and how horrible and how scary this is. Just even finding a suicide note Ramona is terribly, terribly scary and overwhelming. I don't know if it felt like that didn't get honored in the couple's session?

CLIENT: No we talked about it for like five minutes and then she's like "Let's move on to where we left off," and I'm like "No, you don't get it, I can't even talk about any of our problems in here because he's going to go write another note or he's going to make another threat or worse he's going to continue finding ways to hide them." She tried to tell him "You need to tell Dr. Bourd about these things. You need to promise that," and he's like "No, I don't want to tell anyone because I shouldn't be feeling this way." I don't even say that I'm angry when I'm angry because I should be better than that and it is obscure, it is so like (pause)...[00:28:26] I don't know, it's getting really, really difficult and I don't...

THERAPIST: You sound and I think one of the things that might help is identifying what your feeling is right now. The thing that comes out most is anger like even at me today, your affect towards me is anger. You sound though underneath that Ramona, terrified.

CLIENT: Because on the one hand I just cannot do this anymore, like I can't do this for five more seconds. On the other hand it's okay because I need to take care of him and he needs my help right now and he's my husband and he's really struggling but it's just like he won't get the help he needs.

THERAPIST: Actually Ramona, you're struggling too.

CLIENT: But it doesn't matter!

THERAPIST: It does to me.

CLIENT: But it doesn't even...

THERAPIST: Listen, it does to me. It does matter, it does matter.

CLIENT: I can't turn to my husband and say "I'm having a really rough time with your mood swings." I can't do that, I can't say "It really hurts me that you don't support me going to school." I can't do that. I can't...

THERAPIST: What if in a couple sessions you said "I'm terrified. I am absolutely terrified." [00:29:41]

CLIENT: He's going to get more depressed. I don't think anyone...I can't talk about anything that's going on that's wrong with his behavior or anything that hurts me because it sends him further into shame and guilt and depression.

THERAPIST: I'm not talking about wrong with his behavior, do you hear the words that I'm saying are "I'm terrified."

CLIENT: He'll feel horrible about that.

THERAPIST: That's his problem.

CLIENT: No it really does become my problem because I need to take care of him when he is writing notes and making threats and sobbing through church because we're going to get a divorce.

THERAPIST: How about you don't take care of him? You keep saying "I need to take care of him, I need to..."

CLIENT: Then whose going to?

THERAPIST: Not your problem.

CLIENT: Then I have no marriage left, I have no...Ivan is, things are going to get worse for him.

THERAPIST: I actually think you'd have more likely to have a marriage that would get saved if you could say "It's not my problem," more. Because he will also have more likely of a marriage he's going to save the more he can say "It's my problem, I got to do this, I got to own this." (pause)

CLIENT: But he's not going to, he's not willing to take the steps to...part of depression is he doesn't want help, he doesn't want to talk about it, he would rather slam something and yell then say "I'm angry," because he should be better than that, it's so extreme and even the suggestion...

THERAPIST: He has a very serious personality disorder. [00:31:08]

CLIENT: Is it that?

THERAPIST: Mm hm. On top of depression, he's depressed too but what it sounds like you're responding to are the layers of the way he regulates affect and respond interpersonally that can be manipulative, can be moving to extremes without being able to look at things in a more mature way, this is stuff in his personality that is in addition to being very depressed. So I think that's also part of what feels so frustrating right now is that a piece of what's getting attributed to depression actually has to do with being depressed and having a personality disorder at the same time.

CLIENT: Does he really have a personality disorder?

THERAPIST: I think so.

CLIENT: But what does that...I made the horrible mistake the other day saying "I feel like you're two people sometimes, like I feel it's a different personality some times." I made the horrible mistake of that and then days later he said "You called me schizophrenic." I'm like "I never used that word Ivan, like that is so..."

THERAPIST: Which is not...schizophrenic is very different than he would be two different people. That's totally different diagnoses. He's not schizophrenic I don't think.

CLIENT: So like I really want...this again sounds really horrible and it sounds really selfish but I really desperately want him to be evaluated and I want to find out what the heck quite frankly is going on because...and I want if he needs to be taking medication, if he needs to be seeing Dr. Bourd a couple sessions, twice...I don't know. I need to know and I need it to happen yesterday and he just tells me if anyone asked him to do any kind of evaluation he would feel so disappointed in himself and I get where that comes from because I'm talking to his dad who says if we screwed him up, we'll deal with that. [00:32:59] That's what he said to me! I'm like "What is wrong with you?" No wonder Ivan has a stigma with it, he hears his parents refer to it as screwed up.

THERAPIST: Yeah, yeah.

CLIENT: I don't...

THERAPIST: It's really hard that you're going through...

CLIENT: But is he going to be able to like, I have no clue what's going on with him. Is he going to be able to (pause) come out of it? Is he going to be able to...?

THERAPIST: I don't know for sure. I don't know him, I don't know what's going on with his treatment, what I do know from talking to both Dr. Farrow and Dr. Bourd that they both feel he's made quite a lot of progress so independently Dr. Bourd said he's opening up in a way he never did in the beginning, he finds more of his own feelings about actually being angry in the session, being upset rather than just kind of whipping himself shame that is a symptom that kind of covers up a whole lot of other stuff. Dr. Farrow said she also felt like he was really beginning to find a little bit more of a voice, she thought the two of you guys were making a lot of head way for a while when you were being seen twice a week for a little bit until she went away on vacation and she said she felt like everything fell apart and almost felt like none of the progress had ever happened. [00:34:26] She thought at that time, was feeling quite hopeful about where the two of you were beginning to head together. So I'm saying that now because I think just to know that their perspectives are that change is happening in him. It's not as fast maybe as you'd like it to happen but character change, personality change doesn't happen quickly. It takes years. So this is a new piece of the puzzle that Dr. Bourd didn't...he didn't know even that Ivan had made threats for example.

CLIENT: I know. I understand why Ivan wouldn't tell someone who...I can't understand...

THERAPIST: Maybe you can understand in that it took you awhile to tell me because you were so embarrassed about it. Do you remember?

CLIENT: I didn't want to...I hadn't looked at this note since I found it. I want it to all go away. (pause) The thing is things can go really well at home if I bring up no issues, if I instigate no arguments, no discussions about anything that's problematic. If I just cook dinner and we watch a movie and make a point of talking about things that...you know? He's not going to bring it up and then things are okay at home. But they're not okay so I don't know how to...I've honestly felt like saying last time that I don't want to go to anymore couples therapy because it so...it feels almost...(pause)

THERAPIST: You feel like you're getting blamed?

CLIENT: Yes. Yes, I feel like I'm getting blamed by his parents, I feel like I'm getting blamed by her, I feel like if I could just deal with the anger and the resentment and if I didn't speak up last time and say this is too much, I need help that she wouldn't have suggested us to separate probably. [00:36:21] So it's like the marriage can work if I just put it all in a drawer and I don't...I really just keep coming back like I want to know what's going on with him and I want to find a way to deal with it and I want to move on and I can't deal with the next five years being like this.

THERAPIST: So he's in good hands so this is more a piece of (pause) it takes time getting into a relationship with a therapist to begin to sort all of this out. Sometimes years. So that's kind of what you're up against in reality is that it can't go a lot faster even if Ivan were to go into the hospital for example, say he were to feel so suicidal again that Dr. Bourd...to me what feels hopeful about this is whether you and Ivan stay together or not, is Ivan is now, Dr. Bourd knows, he knows about the letter, he knows from me because you both gave me permission to talk to him a little bit more about these threats he was making, it's extremely helpful to him now that he knows this because it kind of fleshes out a little bit more about what's going on beneath the surface. This means that Ivan can now start to talk about some of this stuff for the first time in his life and my guess is stuff he's kept bottled up inside, mostly hasn't been put into words, will start getting put into words. That's all good stuff. Dr. Bourd is an excellent therapist, he's probably one of my top three therapists in the entire city who I would refer to. He's outstanding in his intuition about people. [00:37:56] It can't get much faster especially or example let's say Dr. Bourd says "Okay, Ramona wants you to get testing I'm going to come in and tell you you need to get tested." If he does that in that poorly timed way Ivan's going to say "What?" and never go back to see him again. So he's got to also pace himself even if he agrees with you that that's a really good idea and agrees with me even with psychopharm, these are things that...what I can do in my role is keep him informed of all of the pieces that you keep telling me to make sure he has a whole picture. I think that will help him and Ivan it even sounds like he's given me permission to do that. I think that will be helpful to Ivan, I don't think that's only in your best interest, I think that's in his best interest that people get the fullest picture faster. But Dr. Bourd's also going to have to find a way of bringing this up in ways that are palatable and manageable for him too and it might take some time to do that. So I might say to you if you can even, until we meet next, not bring anything up and I'm saying this, not going to work, your marriage is not going to work if that's what happens in the long run but even just to get a break right now. You are flooded with anxiety Ramona, you are flooded and you need a break from this. You need just some breathing room. The two of you need some breathing room. He needs some too but you especially. I'm in your corner about kind of thinking about what you need. [00:39:23] The break is not going to come from a parent right now saying "Let me come and visit," even I wish, maybe in my heart of hearts do I wish I could come and just descend in your life. Of course I can't do that so how else to we build in kind of quiet, internal parent that gives the both of you a little bit of breathing room in all of this as you start to sort it all out. I will also talk to Dr. Farrow and hammer home even more than I did already, what you're saying to me today because I think it's more of a perspective that she's not thinking of as much. I also would encourage you to go in and don't hold back, say what you said to me today to her, to Ivan, what you're feeling about the work and the feeling that maybe you can't get to any of this if you feel like you're not being understood or being heard in the work and that that's a piece of what when she's asking you "What do you need, what do you need, what do you need?" One of the things you're arriving at is "I need to feel like people really get what's happening and I don't quite feel like all of you are getting what's happening through my eyes." That's a piece of what has to happen in the couples work for you to feel like it has value to you. [00:40:30] Say that the next time your there but also know that I will have called both of them in the interim and left a little bit more information to make sure they're getting the whole picture of all this. If you continue to feel like Dr. Farrow's not getting it, like if you feel like it's biased and you've had a chance to talk about that then it's not working for you. That's important too and we'll kind of cross that bridge when we come to it but I think there's a little bit more that can get communicated both from you and from me before your at that place and that in the meantime you need a break right now. I would watch movies, I would cook dinner, I would try to keep it lighthearted for a little bit and know that you're going to keep coming back here and talking about it. He's going to be a very big turning point in his own therapy now that this is out there, it opens new doors into places that have never been looked at and if you can get back into the couples work in a way that feels safe and good for you I think that could be helpful to bring the things you talk about at home, bring it there. Try not to have those discussions at home. If you need to see her more often than see her more often. [00:41:38] Does that sound like a temporary plan?

CLIENT: I guess. It's my spring break so I'm home unless I spend my days I mean I could go to the library every day but...

THERAPIST: And he's at work?

CLIENT: He now, as of this morning, has a schedule for the next couple days.

THERAPIST: Okay. (pause) So you'll have some time then apart and the evenings together?

CLIENT: Hopefully.

THERAPIST: Any overture of something that's kind of like a little white flag or peace offering to just get a week of peace, I'm not talking about permanent "I'm going to placate and cow tow to you and to talk my needs in other..." No. Just talking about lets...can we take a hiatus from the intensity of this and try to have some light-heartedness together, no matter where your relationship is headed, you both could use that right now and I think anything that's kind of waving the peace flag for a little bit even if you say to him "let's take a little break, I'm not going to bring anything up." He's got a job right now, you're going to pay the bills this month, he doesn't go to his job one day that's a different story. Then we have something else to address but if things can kind of remain, kind of percolating along at the moment to take just a little bit of time right now to have some breathing room together I think is what you need so that the urgency can calm down some. [00:43:01]

CLIENT: Should I even try to call his mom?

THERAPIST: I think it would be helpful to you to try to see what happens.

CLIENT: Okay.

THERAPIST: Even if it's just to say "I feel like I'm holding a lot, I'm very worried about him, I wanted to see if it would be possible for you to check in with him yourself." See how she responds. I would not go into it with high hopes, in your own self-protection you might go into it assuming she's going to respond in a way that's not that productive but you're putting it out there to try to protect yourself and it's worth a shot. I think that's totally reasonable to do.

CLIENT: Okay.

THERAPIST: Okay? I'm out next week on vacation, I haven't said that for a little while but you may remember me saying that a few weeks ago.

CLIENT: I don't, I'm sorry. Okay.

THERAPIST: Did Thursday work at all?

CLIENT: I wasn't going to cause it's kind of like basically I'm going to therapy every day but yeah if you're not here next week then I should find a way to do it.

THERAPIST: Okay. I don't know if I had both times available Thursday morning in the e-mail but I mentioned 8:20 and 9:10.

CLIENT: That's what you have?

THERAPIST: Yes as of now I do.

CLIENT: Okay.

THERAPIST: Is either one better?

CLIENT: I'll do 9:10 I guess.

THERAPIST: Okay. And Thursday that works? That's when you don't have...? And I'm out of the office all of next week.

CLIENT: Okay. [00:44:29]

THERAPIST: (pause) I have you checked off on my list that I told you...

CLIENT: No I'm sure I forgot. I'm sorry.

THERAPIST: You have much bigger things on your mind.

CLIENT: Alright, thank you.

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