TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: You know like, will I repeat for me or will it say actually like this is what's going on with her, like who gets it and who does something about it and I can't lose that so please help me (inaudible, crying).

THERAPIST: I'm not going to make you switch. None of that's coming with me I'm asking you though if you feel like you want someone's who's even more directive than I am?

CLIENT: No, I don't...

THERAPIST: Who's going to give you homework assignments for example, that kind of thing. I want to help you find that and that doesn't mean we have to not meet again it could be a piece you could add adjunctively even or you could do that for a period of time, kind of similar to what you've done before.

CLIENT: Yeah, but quite honestly like having three therapists going on right now is way too much and something I'm very embarrassed about and something that feels like a project. It is a project (laughs) and I really can't have one more.

THERAPIST: Mm hm. You could have someone else instead of me for a little while and then switch back to me? No? Why?

CLIENT: (crying) Because you and Emma are like what I feel like I have so... [00:01:06]

THERAPIST: So there's something you're saying that feels helpful here? There's something and maybe it's hard to put into words what it is because it's not something I'm telling you to go do? Maybe it just feels like I know you somehow and I know what's going on?

CLIENT: Yeah. You spent a lot of time getting to know me which is valuable and I mean I've been here for months and you're very empathetic and you really...you've been able to connect when I've explained some things that I've never...like in the CBT work I've had before I'd never, I guess I was still a child so maybe there was nothing to...but I guess what I'm saying, like I feel like that understanding is very valuable but I'm not in a place where I can take that understanding and go out and do something where it lessens my depression or anxiety it just means I understand it a little better or I have a glimpse of what you understand.

THERAPIST: Yeah.

CLIENT: I'm still waiting for someone to like tell me what's going on (crying). [00:02:07]

THERAPIST: Well I told you what's going on but it sounds like....We've talked about a number of things that are going on but it sounds like you then get that but it doesn't help you feel any better.

CLIENT: Well I mean today you say severe depression so I didn't realize, I didn't know if it was mild or moderate or whatever the...So I don't...

THERAPIST: Yeah, so that's what...okay. Well let's do this one. Let's talk about the next couple weeks and how to set the stage in a way that might begin to get you back off to a better baseline for a while, okay? I think you need to be here, I'm so glad you came today. I think it was a very healthy decision because I think checking in here actually can help contain this in a different way over time. I think you have a pretty serious, I would even call it agitated depression, going on right now that's as a result of some things that are happening in your marriage that are very significant things that are very similar to your childhood background. There might even be things happening, I would give you, in my opinion, what you tell me what he's doing, what's in here, they are identical to your family background so it's not just that you're experiencing it as though it's this and it's not really that. The thing I would say is different than your family background is you are trying to see "Is Ivan exactly like my parents in that I will never get through to them?" [00:03:41] You tried and you tried and you tried and you tried and you tried and it did nothing. You're trying to this day and it does nothing. Or is Ivan different than your parents in that even though he's doing some of the same things, he has a different kind of openness and potential inside him to make some changes over time. Now I'm saying this with a question mark in my mind. I don't know, I don't think even Dr. Bourd (ph?) knows, I don't think Dr. Farrow (sp?) knows. What they do know, from their observations is that they feel he's ...things are starting to shift some. Just as Ivan apparently this week said to Dr. Bourd, he could feel you trying to make light of things in certain times during the week, you know we talked about kind of keeping things lighthearted? He felt that, he thought that was a change. He was very, very appreciative of that in you. But change is slow so its part how do we help you slow down on your internal process if you want to do this and still keep giving this a chance? I don't hear you ever saying you want to leave him tomorrow. [00:04:49]

CLIENT: Yeah but I don't know about that because I was doing well with the lighthearted thing and we were not talking about any of the issues because (coughs) that's what you said to do and that was working until Tuesday night? I'm working on a research study through school and it's at the ER which is fine and Ivan was supposed to pick me up at 9 and he...like this has happened so many times before, I'm not upset about the isolated incident, I'm upset because it is so...

THERAPIST: Because it's a pattern?

CLIENT: Yeah and it's been my parents and it's been him and I am just so tired of coming in absolute last, dead last, I mean...So he's supposed to pick me up at nine o'clock from the ER and I'm standing outside in the cold rain and I get a text from him "Oh I just woke up. Are you still done at 9?" Like this has happened so many times and...he couldn't set an alarm, he couldn't...you know? It just didn't matter and for some reason I just lost it and I just really cried on the way home because it was just like, I don't know. It was too much. [00:06:00] It was like and I told him "I'm not upset, I'm not that upset because I had to wait another twenty minutes and I still haven't eaten dinner and its cold and raining and..."

THERAPIST: Because you don't feel loveable if he's not keeping you in mind...

CLIENT: No he doesn't love me, I'm pretty sure. Maybe he never did and he really just needed somebody dependable, a hard worker who would take care of him. That's what he needed and that's I've been for him and so he's...that's fine but there's nothing in me that he feels anything towards anymore it feels and so I just lost it and I cried a lot. A lot Tuesday night and he just...he did nothing. He just never...

THERAPIST: Was this the night he came in and said "what was going on," that you wrote about?

CLIENT: I think so.

THERAPIST: I don't know the dates.

CLIENT: I think so.

THERAPIST: And you said "I just need some space," and then he just let you go.

CLIENT: He did leave me alone, I mean he had nothing...so I just didn't do dinner, didn't...I slept on the couch and just...you know and he just never...I mean we had words about it (laughs) I told him how upset I was and I told him how frustrated I was and I wasn't very nice and he just really didn't "Oh I'm really sorry that you let me down. You have a right to be disappointed," but I mean that's it. [00:07:24] I have heard that my whole life, you know the "I'm sorry, I'm trying, I'm working on it." I've heard it. I've heard it so much. "It's not that you're not important." It's crap. I'm sorry like it's just ridiculous. I've heard it so much and it was just too much for me and I just really cried and last night I cried again for like three or so hours in the evening. Slept again on the couch and he just like...his response was...he was in the bedroom, he's like doing his own thing and he comes out and he's like "Well, what can I do to help?" and he just like, no expression on his face, no emotion whatsoever, he's not concerned, he's not upset and I'm like "You know what, just go back and do your own thing." I hear the closet door in the bedroom and I have to go in and he's sitting in the closet with the door closed on the floor because this is rough for him because he needs space because it's disturbing for him, this is traumatic for him that I'm crying. So I say "Okay, get up off the floor, come on..." and then like a little later he's going to the gym. (pause) [00:08:36] He's like "Well what can I do?" He asked me maybe three times what he could do...

THERAPIST: He was trying...

CLIENT: But there's no...I mean he doesn't care it's completely out of obligation. He really...

THERAPIST: You don't believe then that he was sincere?

CLIENT: No, no I don't.

THERAPIST: That's so important.

CLIENT: But he doesn't. Like if I say that he'll "No, I do," but I'm crying and he can't even say like "I'm sorry you're having a rough night.."

THERAPIST: Or hug you, put an arm around you and say "I'm here. I love you."

CLIENT: I mean he sat on the couch and what can I do? He's not able to do anything and even in that moment it feels like I need to take care of him and say "Okay, when someone's crying, this is a good way to..." I can't, I just can't.

THERAPIST: Yeah.

CLIENT: So he went to the gym for two hours which is longer than he ever goes because I'm pretty sure he needs to take care of himself and I'm embarrassed to say it but I called him like as soon as he left because I didn't feel like I was okay alone and I was having some not so great thoughts and I felt like I needed somebody...anybody. I ended up talking to my sister cause I realized he didn't take his phone which is another sign of like...he's not going to deal with it, he's going to take care of himself like always and...he came back and he still had nothing . I really I told him. I said "I can't keep taking care of you. I really can't do this." I told him how angry I was that he couldn't say like one nice thing and he still hasn't...just like nothing. He's not concerned, he's not worried about me, he even just said "Well that's your depression." No...he really doesn't. [00:10:24]

THERAPIST: I would agree with him, you're depressed but I don't think that means that's the only reason you're feeling that towards him.

CLIENT: It doesn't matter. It really doesn't matter and it's not even something I can bring up in couples counseling because there is no room in the relationship for anything with me. It is all him, all the time. I need to take care of him because he is struggling and this is difficult for him and he's depressed and he's anxious and (pause)...

THERAPIST: So I actually had a thought after reading...I reread the first part this morning. You heard me starting to say this to you Monday. You may be saying to me and you can tell me this, you are done with couple's therapy, you're not feeling it with Dr. Farrow and so you're outta there. That's one thing. If your sticking it out for a little bit longer I wonder what it would feel like or if you'd ever be willing to share that with Dr. Farrow and with Ivan.

CLIENT: It doesn't matter.

THERAPIST: Have you tried it? You haven't tried it.

CLIENT: There's no space. I don't think you understand.

THERAPIST: I mean say "I was wondering if I could start off a session today by reading something."

CLIENT: Nope. Because what we're going to talk about...because on Friday I need to bring in his suicide letter and we're going to talk about that because that's what we talked about last session, that's what we're going to talk about on Friday. We need to take care of him. [00:11:47] I can't even remotely...

THERAPIST: Okay. Ramona, yes you can.

CLIENT: No!

THERAPIST: Yes you can!

CLIENT: No because he's going to write another note. No one understands. I'm afraid that he...like I was afraid to leave this morning, like the fact that I was sobbing for hours the past two nights and I told him how hurt I was that he couldn't say anything, couldn't do anything, like couldn't figure it out.

THERAPIST: Ramona, you're feeding into the enabling by not saying "I was wondering if we could talk a little bit about my experience right now." There's something to me in this that I think would be helpful to his suicidality. Not hurtful.

CLIENT: No you don't understand. I can't say anything.

THERAPIST: I do understand. I specialize in suicidality.

CLIENT: I can't say anything negative. He will write another note, he will do something else like...

THERAPIST: That's not your responsibility.

CLIENT: But it is!

THERAPIST: No it's not.

CLIENT: But everybody says "Just don't take care of him, it' s not you're..."

THERAPIST: It's not your responsibility. I'm telling you right now. Go in, maybe not this session, maybe next week's session. If there were space would you do it?

CLIENT: There will never be space.

THERAPIST: Okay. This is a flashback, that's not true. This is not what Dr. Farrow's saying about it.

CLIENT: But it is because I have to take care of him. [00:13:02] No one else is going to.

THERAPIST: If Dr. Farrow would ask you Ramona, that I want to hear about your experience, would you read this letter?

CLIENT: I really can't.

THERAPIST: Why not?

CLIENT: Because he is going to write another note.

THERAPIST: You're afraid you'll lose him then? Afraid he'll kill himself?

CLIENT: I don't think...I don't know that he would actually go through with it but I am very afraid because this is like the fourth thing he's done within the past number of months like threats, like verbal or...it's going to continue and I can't...it's...I can't...

THERAPIST: He's in Dr. Bourd's hands.

CLIENT: He's lying to Dr. Bourd and hiding things.

THERAPIST: It's not your responsibility. It's not your responsibility. Listen, even as a therapist working with somebody suicidal, if you feel it's your responsibility to keep someone alive, you're actually in a very negative space with them. It's not any single person's responsibility to keep any other single person alive and if you keep taking on that responsibility you are enabling him. (pause)

CLIENT: It's not just...I don't...I'm worried that he would hurt himself but I'm mostly...this is horrible. [00:14:23] I don't know how to keep dealing with the threats and with the...

THERAPIST: Maybe leave the relationship then?

CLIENT: I can't.

THERAPIST: Why not?

CLIENT: Because it's not him that has the problem, it's me. If I was different then he would love me. If I was different then he would be honest. If I was different he wouldn't need to look at a picture of a naked woman online.

THERAPIST: You think that's true?

CLIENT: Yes!

THERAPIST: Yeah?

CLIENT: Yes!

THERAPIST: I thought we established from his family background he was looking for someone his entire life who would take care of him?

CLIENT: Yeah but he didn't feeling anything beyond that to the extent that he lied about it, a huge chunk of his life so that I would marry him at the time I did. That is how much he does not love me!

THERAPIST: You are not responsible for that though Ramona. He did that!

CLIENT: But if I was more whatever...

THERAPIST: He wouldn't have lied?

CLIENT: He would've loved me enough to not. But he doesn't.

THERAPIST: This is your assumption from your childhood. That if you were more of something else your parents would've been better parents. It is not true about the world.

CLIENT: No!

THERAPIST: That is an assumption you can't carry around inside you.

CLIENT: I'm not saying it's true about the world, I'm saying it's true about Ivan. I'm saying the fact that I can cry for hours and he can't say one nice thing or even bring me some tissues or a glass of water, something you would do for anyone. [00:15:49]

THERAPIST: I don't think he's in a place where he would do that for anyone right now. He's profoundly depressed, filled with self-loathing, has no idea how to reach out to another person.

CLIENT: It doesn't matter.

THERAPIST: You take it though as a sign of your unloveability and I'm saying to you if you bring to the couple's session that you feel unlovable and bring it in this way. This is heartfelt, owning your own anxiety, your own shame, your own fears. What comes out from you is anger, kind of virulent aggressive anger. I don't know if you're aware of how aggressive you are. (pause) He backs away.

CLIENT: (crying)

THERAPIST: He backs away. You're not this way, you're scared in this letter and if he hears this I think he will want to come closer. Not go further away. He can connect to this and relate to this. (pause)

CLIENT: (sobbing)

THERAPIST: If you can say "I'm scared Ivan, I'm scared."

CLIENT: No!

THERAPIST: Okay. I don't know. We're at a standstill then. I'm telling you what I think would be helpful to you and you're telling me "I won't do it."

CLIENT: I know but you don't know Ivan and I'm telling you that any time I tell him something negative, even if it's like "I'm really hurt or I'm really upset or..." his response is to turn it like, into self-pity. Then he just retreats to how much it's his fault but then he doesn't do anything about it.

THERAPIST: Then what Dr. Farrow will do is if you say something from anxiety and shame and fear that is something people can connect with. [00:17:41] If people feel attacked they don't connect. Even Dr. Farrow won't connect with that, right, but if she hears you saying "I'm so scared, I love you and I am terribly afraid that something's going to happen to you." He will feel very differently in the relationship with you.

CLIENT: I've said it.

THERAPIST: Without anger? Because pretty much everything out of your mouth comes out in anger. Do you know what I mean? If you said it from your fear...

CLIENT: When I found the note I told him I was concerned about him and I wanted to know if he was going to be okay but then I made the calls, not because I wanted to shame him, I wasn't angry at him, and I wasn't upset so I did.

THERAPIST: And did it make things worse for him that night?

CLIENT: No he was fine, he was happy.

THERAPIST: So it helped? The way you were?

CLIENT: (crying) It didn't help me!

THERAPIST: It didn't make you feel less scared that you could actually have a conversation?

CLIENT: It made me feel less scared that he was going to like, that I knew he was okay for the night so that was helpful but nobody, truly I feel like nobody gets it. I can't be his mom anymore, I can't.

THERAPIST: I get that, you can't.

CLIENT: I can't (crying).

THERAPIST: Stop being his mom!

CLIENT: I just know and I can't get upset, I need to stay calm and go through the steps and make sure he's taken care of...like this is all I do. [00:19:01] I need to keep doing that and nobody can say "Wow your husband told you that it's inevitable that you're going to get divorced? That must be rough on you?" Nobody can say that.

THERAPIST: I have said that to you Ramona. I said that to you on the phone. I spent 45 minutes on the phone that night as I said that to you and helped you through the conversation. So when you're saying nobody...

CLIENT: No this happened after that.

THERAPIST: What do you mean after that?

CLIENT: When he cried through church. After church I was like "What's wrong, what's going on, what can I do to help?" He told me over and over how it is inevitable that we are going to get divorced.

THERAPIST: Yes, yes and I hear that.

CLIENT: And I can't get upset in that moment. I can't have any feelings. I have no value and no worth and no nothing.

THERAPIST: It sounds like you're just wanting me to know how stuck you feel? It feels like there's no way out, there's nothing you can do?

CLIENT: Nobody gets the mood swings he goes through, that he tells me how it's inevitable that we're going to get divorced and then we have a nice lunch where he's happy and then evening he tells me how hopeless the relationship is and how hopeless it all is. Nobody understands how difficult that is.

THERAPIST: I've worked with couples where that's happened before. I understand.

CLIENT: But there's no space for me to say that's really difficult for me because Ivan is the victim and Ivan is the one struggling with depression and Ivan is the one going through this big...so nobody cares that Ramona...that that feels really horrible and nobody's there for me and I can't even...

THERAPIST: I care! You're saying nobody, nobody, nobody, nobody. [00:20:31]

CLIENT: (crying) Because I can't even take a minute to like step outside and cry at that moment because I have to take care of him and I'm not this horrible person who doesn't want to take care of somebody who's struggling. I'm just saying I can't have any emotions.

THERAPIST: Ramona...I hear you. I hear you. You feel caught between a rock and a hard place. There's nothing you can do to get through to him that you need to share your experience...

CLIENT: He cant. He can't even say something nice when I'm crying for hours. He can't support me going to school, he can't do a card for my birthday, he just can't. He can't even remember like stuff that's going...I can write it in the biggest letters ever and he can't...he's just never going to be there for me and he does not care about me and I'm not saying it's all his fault. It's me. I am this aggressive, like critical, not very nice to be around person.

THERAPIST: You're aggressive and critical and it's not all your fault.

CLIENT: It doesn't matter whose fault it is.

THERAPIST: Do you hear how everything you say...you tell me it's wrong?

CLIENT: I'm sorry but this isn't going to help me (crying). I'm sorry. (pause) I'm sorry (crying). [00:22:00]

THERAPIST: Ramona you deserve so much better than what you're getting in this relationship. I hear you about the wide range of irresponsible, disconnected things he's doing over and over and over again.

CLIENT: (crying)

THERAPIST: And I hear what you're saying to me that you think it's important that I understand that this feels like there's nothing you can do about it because you have to take care of him. There's no choice in the matter.

CLIENT: That's what nobody, I don't feel like anybody ever got that because it was the same thing growing up. I didn't have to clean the house, I didn't have to cook dinner but I wanted a clean place to sit. If I wanted to....like I really did have to. People still tell me "Oh that's so wrong." The one counselor told me I was so wrong and I was so off and she's like "No that's not your job, it's that simple." Nobody understands...

THERAPIST: No Ramona, I mean I think it did become your job. If you didn't do it you wouldn't be able to live.

CLIENT: But that's part of how it is now. If I don't...

THERAPIST: I know, I get it. I get it. I get it. If you don't do it he doesn't do it either. [00:23:36] You don't have a partner who you can rely on in any way right now. Really in any way. I don't think I even knew things like birthday cards and Valentine's cards, not even in the heat of the moment he can at least pull it together.

CLIENT: He really doesn't...I don't think he loves me, I don't think he really...(pause). I think he needs me on some level but I really feel incredibly alone and that leaves me with nowhere to go.

THERAPIST: Yeah. (pause)

CLIENT: Maybe he would be nicer if I could...I don't know. Be less aggressive? Less critical and less...if I could fix...

THERAPIST: It doesn't mean that's what's causing him to do what he's doing. The only reason I raise that layer is that that is the only thing that's in your hands that might....How much do I think it's going to help? About this much because you are not causing his depression.

CLIENT: But I think I am.

THERAPIST: He has personality disorder. No, personality disorders aren't caused by spouses.

CLIENT: I don't think he...[00:24:55] Does he really have a personality disorder?

THERAPIST: Yes.

CLIENT: I'm...you're not working with him so I'm not questioning your judgment but is that Dr. Bourd's diagnosis?

THERAPIST: They both feel that there's...that that's a piece of what's going on.

CLIENT: But what does that mean?

THERAPIST: For example experiencing and processing your emotions by threatening suicide. That's a part of having a pretty significant disorder in the personality.

CLIENT: I thought that was just depression.

THERAPIST: No. Depression is somebody who actually does it. You know what I mean?

CLIENT: But people who are depressed like think about it and talk about it and write notes...I mean that's severe depression?

THERAPIST: Yes but they don't threaten it whenever they're going to be abandoned for the weekend. Abandoned. That's a personality issue. In other words he's using the threat of that as a way to keep you close.

CLIENT: But that's just emotional abuse isn't it? It's just...

THERAPIST: You can call it whatever you want to call it. I mean its...for example if you look up Borderline Personality Disorder, that's an...Fears of abandonment, extreme self-loathing, extreme shame, I think that's...would I give him the full blown criteria diagnosis? I don't know. I never really do that with personality disorders anyway but there's something that's going on in the nature of the way he regulates affect. There's something else than depression. [00:26:14] Living with that is extremely grueling and difficult.

CLIENT: But honestly if that's...I don't want to say all it is but...

THERAPIST: That's not all it is. He's very depressed too. He has depression as well. I'm not saying that...

CLIENT: No, no. I'm just saying that sounds like...I mean I could fit that. I have shame and I'm depressed and I am scared of being alone, I'm scared of being abandoned sometimes and when people...

THERAPIST: Yes, some, some but you haven't done the same thing. You've been asking for space for example, you haven't been so terrified of space that you're clinging to his leg saying "I'll kill myself if you leave."

CLIENT: But I think he has just attachment problems I think.

THERAPIST: Yes, that's another way of putting personality disorder.

CLIENT: I guess I'm trying to understand what it is because it's either this huge, scary, unknown thing that could take years and years for him to get through and he may never get through it and he may always be like this versus it's something going on with his depression and maybe if he got diagnosed and maybe if he needed medication or maybe...I'm really...

THERAPIST: How about if we put it like this? He has a significant attachment disorder that includes self-esteem problems as I think you do. In other words fears of being alone, fears of not being taken care of, very low self-esteem. You both have it and you're both depressed.

CLIENT: There's no hope for this relationship. [00:27:47] (pause)

THERAPIST: You may feel that way. (pause) So we got to stop. If I were you I would advise you when you're having intense feelings to write them down throughout the course of the next week and try your hardest to keep it lighthearted throughout the week and bring the intense feeling to Dr. Farrow. Okay?

The person who's covering for me for the next week is Tamara Feldman, who you've met with before so I'm wondering if you would like to see I assume somebody else rather than her for coverage?

CLIENT: No, I'm just not going to...I'll just wait two weeks.

THERAPIST: Do you want a different name? Just in case? [00:28:48] If you did want to see somebody and not her you could always call her and she knows our colleagues if there was somebody else you wanted to check with besides her. Okay? I'm sure even you could check in individually with Dr. Farrow. This is a terrible, terrible time for me to be away Ramona.

CLIENT: No, I understand.

THERAPIST: No, it's terrible. It's absolutely terrible. You need the session next week. Even though I feel like you think it would be a waste of your time?

CLIENT: No it's not, it's just I...it's me. (pause) Thank you.

THERAPIST: I'll see you in two weeks.

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