TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: How you doing?

CLIENT: Um, I guess a lot of ups and downs.

THERAPIST: I did get a chance to look over your-

CLIENT: Okay.

THERAPIST: -journals, both from last week and just continuing. It's really helpful to see kind of-

CLIENT: Okay.

THERAPIST: -keeping my fingers on the pulse of what's happening behind the scenes. The last week there's been a lot about you and Ivan. That's neither-it's not good or bad in a judgment kind of way, but just noticing how much of your thinking was revolving around you and him. Or your pain I guess was revolving around you and him.

CLIENT: I don't think that's new, but we don't always write about that.

THERAPIST: Yeah. It makes me wonder, Ramona, just as a question to take a step back and get a sense of things for where you are, a year and a half ago or so-how long have you been married?

CLIENT: Three years or so.

THERAPIST: Okay. So in the first six months of your marriage would you say, or in the year before you got married, how do you think your mood and anxiety were during that year, year and a half?

CLIENT: I think my mood was pretty good, except at like extreme points of stress. Looking back on some finals week, like it was really bad. I would think the anxiety was really chronic, or like the stress was really chronic, but quite frankly I was engaged and planning a wedding, I was graduating, and I decided I wanted to finish a chemistry minor on top of my other minors. I wanted to apply to grad school and then deal with acceptances and then choose which one I wanted to. And I also was going to move, and I also was going to find apartments in a new city.

THERAPIST: A lot of change. [2:00]

CLIENT: Yeah. Ivan was not-not that he wasn't onboard in actually wanting to do it or say anything, but he didn't really help it a lot. The parts that would involve him, like-

THERAPIST: You mean with packing and moving and that kind of thing? Or-

CLIENT: I mean, I pretty much did-like, we were going down to his parents and I was like, "Okay, we're going to go through your closet and we're going to-" But he really wouldn't help with the wedding stuff very much.

THERAPIST: Wouldn't-like you tried to get him to be involved and he would refuse, or-

CLIENT: Like setting up the website, which is like a template that takes like a couple hours to do total-

THERAPIST: Yeah, yeah.

CLIENT: -he waited 6 months to do it. Like he just wasn'tAnd knowing what I know now about what he was going through I completely understand why making a wedding website or even getting married would not be like something that he should have been-that he could have been taking on. I completely understand that now, but at the time it felt like, you know.

THERAPIST: At this point what did you think? So he's taking 6 months, what was.

CLIENT: Right, it was just-it was back to the-I mean, it's sort of similar to what happens now I guess, but like asking him, and like, "What's going on? Why don't you want to do it? Like I'm doing all this stuff and why are you helping with-" I mean, it was even something that he sort of showed some interest in doing, and it's such like-it's a ridiculously easy task. I mean, I can't evenAnd just no follow through that, and it felt maybe like he didn't care, maybe like he wasn't serious about it. And once again, like it was fine to talk about it, and it was fun to talk about it for him or whatever, but rolling up his sleeves wasn't something he was interested in, and that was aggravating to me. But I didn't have as much time to focus on it because I really was finishing college, arranging grad school, all of this other stuff.

THERAPIST: Yeah. Because it's interesting, it's sort of like that's there about where he was and what he was suffering with. And it happened before you got married, but it sounds like you're saying you were so busy with all this other stuff, it wasn't maybe taking up space in your mind? [4:00]

CLIENT: It wasn't as much. And I also had this perception that he was doing a similar thing with grad school.

THERAPIST: Yeah.

CLIENT: I mean, I knew he wasn't preparing for another program, and I knew he wasn'tHe was never as stressed, no matter what. He was never as stressed academically and he didn't take on as much. But I also did have this-like, he was doing something.

THERAPIST: You said he was in school.

CLIENT: He was doing something really important.

THERAPIST: Yeah, yeah.

CLIENT: And I also didn't see him, you know, except for weekends, so he wasn't in front of me all the time.

THERAPIST: Yeah, yeah. Yeah, it makes sense. I want to attend to our conversation from last week and just also start by saying where are you and what's on your mind? I mean, there's so many things I could ask you about reading it and reading the whole course of the journal entries over time. Where are things for you, and specifically we maybe could talk at some point even beyond the general about how things are going with what's working, what's not, journaling, what were successes, what's not working, where you need help, that kind of thing.

CLIENT: Mm hm.

THERAPIST: But generally speaking first, where are you? Where's your mind on things these days?

CLIENT: So yeah. So when I say highs and lows I think that's like the best way to capture it, because when I describe like last Sunday we went to dinner, which is something we haven't done since August, and it was just like-it was strange. It was strange. But it was so-it was nice. It was really weird but it was really nice. And I felt like, wow, we really-like things were going well in the couple days before it, and Ivan was pulling his weight in some areas, and I just felt like-felt some hope, and I felt some, okay, this feels like back to things that I really liked about my relationship with Ivan.

THERAPIST: That rings true, reading your summary of that day sounds like almost just uplifting.

CLIENT: It was, and honestly-

THERAPIST: And remembering what brought you together. [6:00]

CLIENT: It was like two and a half hours.

THERAPIST: Right.

CLIENT: It wasn't like this huge romantic gesture.

THERAPIST: No, no.

CLIENT: It really-we went like ten minutes away to Olive Garden, because he had a gift card from his aunt. But it was just really-it felt like big deal. So like that felt really, really good. And then two days later he's swearing at me and yelling and slamming the door and walking out. And I'm like how do we-and I really-it felt like the end of the world for me. And I guess that would be characteristic-something that I see in my own depression for me, it's really the black and white thinking, the all or nothing, like that really comes out. But at the same time if I tried to be objective I would say like having a nice dinner and going from that to two days later slamming the door and swearing, like that does feel extreme maybe regardless.

THERAPIST: Yeah, yeah.

CLIENT: So that felt really low. And then he did his typical like come back and he's sorry. But I am just getting to the-I'm like, what if we just keep going through this over and over and over? Because honestly, when he did that, when he slammed the door, I was like-in that moment I was ready to be done. I was ready to be like, I don't want to do this anymore.

THERAPIST: What stopped you from saying that?

CLIENT: The same thing that always does.

THERAPIST: Which is?

CLIENT: Getting a divorce isn't justified at this point. I think I'm-this makes me sound like a horrible person, maybe I am, but I'm almost waiting-like if he were to become physically abusive, or if-I don't know what would have to happen, because some of the things that are happening or that have happened I feel are pretty extreme, or I feel like are pretty difficult, maybe like anyone would say that's not okay, but I really don't know if I could-this [is/isn't?] the right thing, but I picture myself to someone why the relationship ended, and I see them saying, "He like yelled and walked out? Like you had a big fight? That happened a few times." Like everybody-I just-

THERAPIST: Yeah. [6:00]

CLIENT: I feel a lot of judgment and shame and guilt, and I feel a lot of responsibility. I'm becoming more and more aware lately of how responsible I feel for all of his stuff. And not just his, I've been tuning in a little bit recently to even friends if they are struggling with something, of it they're like even behind on something. Like I take it on and I'm like, "What can I do to help you?" And that's not maybe normal.

THERAPIST: Mm hm, no. Yeah.

CLIENT: So that's happening. And I don't know how to do it without getting like really off topic, but I recently had actually kind of a-I don't know if you'd call it a fight, but an argument with my mother in law. Because-so with the insurance reimbursement Ivan has been doing this thing week after week after week. Like, "I don't know what's going on now that I'm on my parents' coverage, I don't know how it works anymore." And every week I'm like, "Well, you know, you need to talk to your parents and find out what's going on."

THERAPIST: So that just ended. He's been on his parents' insurance for a while and it just ended?

CLIENT: So it was recently his 26th birthday. You can't be on your parents' plan after that unless you're a student and you have to meetLike, okay, so he's done.

THERAPIST: Yeah.

CLIENT: And next month he's supposed to be able to pick up Subway's. Which is good, but that leaves a month without. Anyway, regardless, like the reimbursement thing hasn't been happening, which considering the fact that we both see someone individually and we see a couples counselor, and I have been getting some dental work done that I really needed to get done, like it actually-we just don't haveAnd Ivan is only working part time. So it's like it's not an issue that we can just not talk about I feel because it's so critical to like getting through financially.

And anyway, the point is every week he's like saying, "Oh, I talked to my dad but my dad doesn't handle the insurance and he doesn't know, and he says he'll get back to me and we'll talk about-" And it's been like going on for a very long. And it usually takes at least like a month to get the reimbursement or so, and it's just like-it's been a mess pretty consistently. [10:00]

So I'm like, okay, you know what, I'm just going to send an e-mail to them so that we're all on the same page and just ask them really specific questions. And at the end of it I just said like, "You know, right now I need to get some dental work done and I'm told that it can't wait. And I'm wondering if I can file any of that in reimbursement under your family, but only if there is like an amount that would allow for it, and even if only part of it." Like I just wanted to ask, because otherwise I have to pay for it in my loans. So I feel like I can't be too proud to ask at this point.

Anyway, his mom wrote back and she's like, "Well, you've waited this long, these problems didn't just happen." She's like, "You're getting a new job in a month, hopefully really quickly, and don't let someone pressure you into something. They don't know the financial burden you are under." And she's like, "You need to seriously look at your household budget before you do something like you can't afford." She's like, "The only reason you should be going is if you are in pain or you have an infection." And it was just like-

THERAPIST: Not nice.

CLIENT: It was too-yeah. So, I mean, it was like really-I had Ivan read it because I was like so upset. And, I mean, his jaw dropped. And he's used to like-

THERAPIST: [unclear]

CLIENT: No, his mom is like very-she has five brothers and she's like very-she doesn't-she's not the maternal one, his dad is. That sounds odd, but she's like very-

THERAPIST: No, no, I totally get it.

CLIENT: She's very blunt and she's very forceful. And I mean, in her job she manages patient care, she's used to bossing people and telling-and it carries over in her family, which works out because Ivan's dad is like Ivan. But yeah, it was just like-

THERAPIST: It's like also just so not a loving response.

CLIENT: Well, and it was-

THERAPIST: There's a way you-if that's what she's thinking there's another different-other language you could use or ways of describing it. It's really harsh.

CLIENT: It was. And she like also included, she's like, "Well, you need to look into assistant plans, and you need to like consider other options." And I'm like, does she not know me well enough to know that the minute I got home from the consultation I looked into dental plans, because it's not included in my insurance, I called the dental school because students can go over there. I looked into Care Credit, which is like a credit card for healthcare. I at some point called my parents. So I mean, like I really did, like that's just how I-I wouldn't dream of just saying, "Well, I need to get it taken care of, I don't know if it's important, I'm just going to carelessly spend this money. And I wasn't getting my teeth whitened. Like I needSo anyway, it's just like[12:40]

THERAPIST: So even Ivan was-

CLIENT: Right, right.

THERAPIST: -surprised to hear this e-mail from her.

CLIENT: Yes. So it was like really, really bad. And I like called my mom and I was like hysterical and so upset, and I told her how worked up I was. And like does she even know that the only reason we have a budget is because I make one? Does she know that I pay for over half of the expenses consistently? Like does she know that I paid-like that same amount of money that I need to get fillings done I paid for Ivan's loans, because he didn't open his mail. For interest on loans for an education that he didn't get. Like does she really-it was just soMy mom's like, "I understand." Like, "I'm sorry, I need to get it out." Because if I didn't call her and do-and like-I was going to call Julie and it was going to be really bad. So later that evening Ivan's like, "I really just want to call her and deal with this." So he did and talked to her a little bit, and then I talked to her and I just told her like-because I didn't feel like it was okay or fair orAnd she's like, "Well, I know I don't have much tact, and that doesn't make it okay." Evidently I'm not the first person who's like ever said something. And I'm like, "I really-like it's been an ongoing thing and I've kept my mouth shut for almost seven years, that's how long Ivan and I have been together." And really trying to like let things go and just-

THERAPIST: Yeah, yeah.

CLIENT: But it was too much for me for whatever reason, and it was just like it's all I've been able to think about, I had a nightmare about it. Like, it was justI shouldn't feel guilty for getting my teeth taken care of, I've given up so many things since we got married, because he's just like-he's just really not pulling his weight. And so it's just-I guess bringing it back to how I feel about things in general, part of me is feeling like I felt this way a year ago, how many years is it okay to say like, "He's still struggling," or, "He's still not pulling his weight." How long do I want to do that? On top of which I'm having this overwhelming fear that as soon as I graduate there's going to be so much resentment and maybe I'm never going to be able to get over it. [14:40]

THERAPIST: Yeah.

CLIENT: I'm like literally-I haven't applied to any jobs I am so-which is-I mean, I've had a lot wrapping up like final projects and stuff, but it's not like me completely.

THERAPIST: Yeah, yeah.

CLIENT: I'm so anxious because I'm-

THERAPIST: I'm hearing you might be terrified.

CLIENT: I'm terrified that I won't get something, and then I'm going to be as bad as Ivan. Which my mom says, like, "No, he's been doing this for two years, you are not like him." And I'm terrified that I will get something good that pays that I am like okay. Because then I could see Ivan falling back more comfortably, and then he'd use that as the marital problems, like going away is I'm able toBecause in my mind the money's not the problem, but I'm not sure if he perceives it that way. And I just have this fear that I would resent him so much that I would never like-on top of which we're still not talking about grad school and stuff.

THERAPIST: Yeah, yeah.

CLIENT: It's just like-it's too much. And the other day he told me he can't ask about-like the reason he hasn't been asking about graduation is because he can't remember that I'm graduating. And I think, like he's serious?

THERAPIST: [overtalk]

CLIENT: He's serious? And I'm like-I don't think it occurs to him how that comes out. But it's just like it's too much for me. [16:00]

THERAPIST: Yeah, yeah. When you say something like, "I just don't know if I can take it anymore." You know, like, "I'm at my wits' end, I'm just about done," and then what stops you-I mean, I say, "Well, what stops you?" You say, "Well-" You allude to things like guilt, or what people would think, or I just-I understand how that would sound. Are you in a place where you're wishing someone would just say to you to just end it? Like is that a piece of what you're-

CLIENT: Sometimes. Sometimes I wish someone-like I wish my friends could know without me telling them, and I wish they would step in and say like-I wish someone could normalize or like validate. Because I've told one friend that my husband-that Ivan's like dealing with some depression, and she mostly-she's like, "So how's he doing?" And it's like a very compassionWhich is great, but I can't-I don't know how to even tell her like, "I don't know what to do. My husband won't-" And I guess another thing that just kind of put me over the edge is he's supposed to be doing these job meetings with his mom, like we're back to that. And he's doing them sometimes, but evidently she's been struggling with depression, and this is like really uncharacteristic of the woman who does it all. And she then like wants to quit her job, but she knows she'll get out of it. So she's not been asShe said she has trouble holding him accountable because now she has trouble doing those things herself.

And that's not the issue, the issue is I'm like, "So do you have like a list of jobs you're going to talk about with your mom this week?" And he's like, "Well, I've recorded some of them." Like we're still back to the same like-I feel like no matter how much we go through it's still going to be the same thing, and it's just likeSo yeah, and some points I just want to-especially when his parents were-like his mom responded that way to me, like getting my teeth taken care of, I felt like, I wish I could live on my own. I wish I could only deal with my money and my-because it feels like Ivan's not able to take care of me, it almost feels like he doesn't want to. And more and more and more I feel like I'm convincing myself that a huge-I'll be like maybe subconscious reason he married me was because he was really struggling and he really needed someone to take care of him. And in the weeks where he like didn't go to class and didn't turn in assignments he came to see me on the weekend and everything was fine. And why wouldn't you want more of that if that was pulling you out ofI'm not saying he's a horrible person, I think it makes sense. [18:45]

THERAPIST: Like he would see it almost more though as an avoidance of other parts of his life.

CLIENT: Or maybe-like I could see him really convincing himself, like the weekends are good, it's going to be more uplifting and I really am going to be able to pull it together.

THERAPIST: Yeah. Yeah. So, okay, your friends aside for a second, you know that I know a lot more about what's going on than your friends-

CLIENT: Yeah.

THERAPIST: -do sound like they do. Do you wish I would say that to you?

CLIENT: I don't know. What I really want is for somebody to tell me likeI don't know, it's tricky. Because if someone's in an abusive relationship you're not supposed to just tell them to leave, you're supposed to be supportive of whatever they want I guess. But I wish someone would define it in those terms or not. I wish someone would say like, "He's struggling with some mental health issues and he's going to need a lot of work, and you can expect this to go on for X number of years." Or maybe it's not all connected to that, maybe he's just-maybe this is how it's always going to be. But my mom's like, "I don't want you in ten more years to be saying the same thing." Like-

THERAPIST: Your mom said that?

CLIENT: Yeah. Because like a year ago I think I was saying like, "I can deal with it," if I have to look back, and the first year was really rough. [20:00]

THERAPIST: Yeah, yeah, yeah.

CLIENT: Now I'm going to say that about the first two years. I don't want to say that about the first five years.

THERAPIST: Yeah, yeah. Yeah. I mean, so my answer, and I think I have said to you before, is that I don't think I would characterize what he's doing with you as emotional abuse. I think there's a way though you both sometimes relate to each other that really escalates to unhealthy ways of communicating. And that can feel abusive. Like the way you can come at him critically could feel abusive to him, the way he yelling and screaming and swearing could feel abusive to you. It's not-in other words, those are-the way he's treating you in your journal entry is not appropriate behavior in a couple. The only problem with only painting even that is that he's coming from cowering in the corner [in a sheet? 21:10]. So the fact that he's letting something out to me, as horrible as it feels in the moment, is him making some form of progress. It's I would rather have him be angry than to just be, you know, whipping himself and whipping himself, and everything's my fault. Because you get nowhere with that.

CLIENT: Right.

THERAPIST: Right? There's no conversation, no communication.

CLIENT: Agreed.

THERAPIST: But I also get that you might want pretty quickly getting your couples therapy just to start setting some ground rules down about kinds of relatedness. Like sometimes-I don't know if this has ever come up in a session, but you could say, "Hey, don't curse at each other. Let's start right there, no curse words. That's disrespectful." Or try to find a tone of voice that is a communicative tone of voice rather than screaming, just as kind of setting some ground rules. That's new for him. Like he's not used to letting his anger come out. [22:00]

CLIENT: That's [overtalk].

THERAPIST: I also think, Ramona, a lot of his anger is not for you, it's for his own parents.

CLIENT: I don't know. That's what-I just keep feeling like I'm trying to figure out what the heck is going on, and it's impossible for me to step a hundred miles away and look at it and see. Like part of me feels like I should say, "I don't deserve-" Like I deserve better than this, and I should be able to step and work it out. But I'm not used to having that kind of attitude I guess. Or even if I have felt that way, like with my parents, abandoning them just isn't-like they're my parents, it just is what it is.

THERAPIST: Yeah, yeah, yeah. Yeah.

CLIENT: So there is that aspect. But then there's also the-like I really want it to work, and I really have-like there are moments, like when we go out to dinner, when I'm like I really want-you know, I really want all of that to happen and to work, and I want toSo it's hard, because I know I'm the one who's saying like, "Oh, he won't express himself, he won't like say that he's angry," which he's still not saying that he's angry. But I also don't want him to yell and swear. And like he's always like running out the door, which is bizarre to someone who like threatens to kill himself when I go somewhere. Like it's-I don't understand what's going on.

THERAPIST: That also could be something for the couples therapy, just to say, "Could you not storm out [overtalk]."

CLIENT: I've done it. I mean, I've done it at home. And I've also like no more lying, no moreBut it's like it doesn't work.

THERAPIST: Yeah, yeah.

CLIENT: So that's Ivan. But I also just want to-if I have any time I want to say I'm sometimes having these extreme lows, and typically when I'm by myself, which doesn't help. But yesterday I had a good hour where I just like sat on the floor and cried and had some really, really unhealthy thoughts. And I explored them sort of rationally mentally in a much more extensive way than I've done in a long time. And I'm not proud of it, I'm not like-but I'm concerned, and I just find myself in those moments like I hate myself, even though he's the one who's like yelling, or he's likeI feel like maybe there is some responsibility that does fall on him, but I feel so responsible. [24:15]

CLIENT: And I just-like I can't do anything in those moments. Like I-literally I have to try to pull it together. And I like feel like I'm completely relying on myself, there's no one there, there's no one-and to pull myself up and say like, "No, you're not going to do anything like that. You're going to-" And to just move on. And I can't tell anyone about it, there's no one, and it's justSo that's happening sometimes, and I know that that's bad, and severe depression, and I-

THERAPIST: Yeah. The thoughts are feeling suicidal?

CLIENT: Yes.

THERAPIST: And specific thoughts about it, things you're thinking about it? Fantasies?

CLIENT: Some. But it's more like I don't know how to get out of my situation. I really-I wish-it's such an idiotic like to view that as the way out. It's like I'm aware of how-whatever you want to call it. But at the sameYeah, but it's more like what would that do to everyone, and will that make it impossible for Ivan to get through his stuff, what that would put on my sister. And it's more that I-

THERAPIST: What killing yourself would do you mean?

CLIENT: Yes. And I don't want that for any of them.

THERAPIST: Well, good for you.

CLIENT: That's the thing, it doesn't reallyIt's obviously scary to think of not. But it's just sometimes it really does feel that and I really am having those times sometimes, and I know that's not good so I just want to check in with you and[26:00]

THERAPIST: I'm so glad you're telling me. One of the things that's very clear from your journal, even different places, even times where you've been in a better place about-with more perspective thinking about what's happening with Ivan, your knee jerk response is to move into when you get triggered, and when we talk about trauma, your own trauma of your own childhood, in that state you're like child part gets triggered, you move immediately, readily, quickly, uniformly back to tremendous self-loathing.

CLIENT: That's the-like, it feels horrible, it feelsThat's to put it-I mean, and you get the picture.

THERAPIST: Yeah.

CLIENT: But at the same time I don't like feeling that way. But if you took that away from me, and the self-criticism and the-I'd feel like I need it. I know that's really unhealthy, I'm not telling you I like that, I'm just-

THERAPIST: No, I think it's so great that you can acknowledge that there's something safe about those thoughts in a way.

CLIENT: So I obviously-I don't know, but that's probably a long-term goal I need to figure a way to substitute a different coping mechanism. But-

THERAPIST: Yeah. Yeah. It is very common in trauma, whether we're talking about emotional abuse and neglect, sexual abuse, physical abuse, all those kinds for the child to blame herself or himself. Because if you really are blaming the other person who's actually failing you then you're acknowledging how horrible your situation is. In a way to blame yourself, then it's in your control in fantasy, right. Then as long as you clean the house and make it spotless you're correcting-it's almost like the acting out of the cleansing of making the hateful parts good, making it good, making it good. It's an obsessive compulsive that started in you as a young child to cleanse yourself and the environment as much as possible of all this badness that is floating around. As long as you took it in yourself and then cleaned, and you were good and as good as possible, then you could sort of keep on top of those feelings. It's a massive defensive system. And that is the long-run work for us to begin to kind of dismantle that. Because I think when you think if the house is spotless then things will be better, it's not really true. [28:30]

CLIENT: I know, I know.

THERAPIST: And you know that, you know that, right.

CLIENT: But I can't not-

THERAPIST: But it feels that way, because that's what you did your whole life is to make-like clean that good. Clean that-she's good, my parents are good, I'm good, right, and it's a way of keeping it in your control. So, okay, we'll get-in the long run I think we have to get to all of that. I think it's awesome that you're able to recognize that this is a way of thinking that actually gives you a sense of safety.

This is what's so hard about my bringing up with you a few weeks ago, and then you got mad at me and really hurt and upset, when I said, "Look, do you realize how angry you are or aggressive you are?" Because I know you, Ramona, now that I know if I say something like that what you're going to do is, "Oh my god, how dare I think I had something to be mad at, it's all my fault," and you're going to move back to this place of it's all fault, it's all fault, it's all fault, it's all fault. That is not true.

CLIENT: But I don't know how to get the anger or the-like even if I feel really justified. Even with Ivan, something that's really currently happening, not a past trauma-

THERAPIST: Yup, yup.

CLIENT: I don't know how to deal with it, because if I criticize him it's shutting him down.

THERAPIST: Yup.

CLIENT: And it's like I'm actually getting less of what I want.

THERAPIST: Yes.

CLIENT: If I say nothing he's going to continue to avoid and I'm getting less of what I want.

THERAPIST: Yes.

CLIENT: And so if I turn it inwards I have control and I have responsibility and I have-like I can deal with it.

THERAPIST: Yeah. Yeah.

CLIENT: So yes, I need to get out of that. [30:00]

THERAPIST: So one set of skills we could actually work on is a set of skills called interpersonal effectiveness from DET. Have you ever heard of those skills? They're three acronyms that describe ways of trying to communicate one's feelings that do not evoke an escalation or defensiveness in the other person and actually help you get what you want. I think sometimes, a lot of the time, when I hear you describe the story-again, I'm just one person, so I could be wrong about this too, but my being outside of it and hearing the description, your feelings sound totally justified about things that are actually happening, right. It's not only that you're having a transference to Ivan. I think there's a piece of the feelings from your past because it is so much of a repetition that mean that Ivan then gets to be the person where all of the feeling from even the past goes. It's not just-you're not inventing it, it's actually happening with him, but now the feelings that come out of him, the criticism, is the mass of feelings that are both for him as well as for your own parents. Which in the current relationship with Ivan, the only piece that's unfair to him about that is that he's getting the onslaught of all the history you're feeling. I think he's doing the same thing with you, I think he needs to work on exactly the same thing. So when he's yelling and screaming at you right now, that's not meant for you. You didn't do enough to warrant that level of reaction in him. He might be mad at you for some things I would want him to talk to you about and actually find words, be calm and sit down and discuss that might be real, but not the level of what's happening. For example with him, you got a taste of what his mother feels like, the way she talked to you.

CLIENT: Yeah.

THERAPIST: What I can only imagine is that's how she was with him too as a child. It's very unloving, it's almost emotionally abusive. It's harsh, it's cutting down, it's how dare you want too much. It creates a sense of shame and hiding about one's own needs. There's already to me just in your description of that exchange that he had with you a lot that gives us information about what's happened to him in his own life. [32:15]

CLIENT: But if I-like I've tried to have that discussion with him on some level, which might be inappropriate.

THERAPIST: No. No, no.

CLIENT: But even the like, "Ivan, do you see like your mom really takes care of your dad, and it would probably really natural for you to look for a spouse who would maybe do that for you. Like why would-" I mean-

THERAPIST: Yeah.

CLIENT: And even to say like, "I get really upset when your parents say like you don't deserve loving parents when you tell them about grad school." Like to say like that's-you know, "What you did wasn't okay, but for them to shame you that deep-like that's not good for you either," he can't handle it, saying anything about his parents like negative, like he can't do it.

THERAPIST: Yeah. So it's not there yet.

CLIENT: I think he would feel too ashamed to say-I mean, like-and I really feel very strongly, because his dad was like his friend as opposed to his dad and they're like so close. Plus his dad is this tremendous authority figure in Ivan's eyes, especially being a pastor, like there's nothing more shaming than letting down-

THERAPIST: Yeah.

CLIENT: So I don't know what to do.

THERAPIST: Speaking to him again where interpersonal effectiveness would come into play is how can you say something in a way that just plants a seed, or that lets him knowLike I could see for example saying, "Don't you see how this feels and what they've done to you you're whole life?" And him going, you know, "Go away, that's way too critical of them." As opposed to saying, "Ivan, that was a hard conversation for me to have, it was really kind of hurtful, and it makes me have more empathy for you about even what some of your experiences have been." You know, he might be able to hear-do you see how it's the same thing, but said in two totally different ways, where your emphasis is on I feel for you. Because that's actually what you're trying to say to him, and you're having empathy for him. If it comes out as empathy instead of attacking his parents. If he hears attack of his parents he'll probably just, you know, recoil defensively. But if he hears, "Wow, Ivan, that was hard for me, I feel sorry for you right now too," he might hear something different. [34:30]

So I think maybe next time why don't I bring in-there are three interpersonal effectiveness skills that actually have acronyms. The first one we could work on is something called a DEAR MAN, that is guidelines for getting what you want while being interpersonally effective. I think Ivan needs these skills also. So it's basically a way of talking to another person to try to explain what you need from them, but keeping judgments out, criticism out, negative tones of voice out, and just getting into a cleaner line of clear communication that doesn't lead with criticism and judgment. The moment any of us, any one of us talking to each other with criticism and judgment as the tone, the other person automatically goes like this, and then might start throwing daggers back. The more you can try to think, "Okay, what do I need, what do I want from this conversation? How do I express that in a way that pulls judgment out of my tone of voice, that pulls criticism out of the tone of voice?" In DBT you literally have a bell, we call it the judgment bell, and whenever somebody in the room in a group therapy context says something that's judgmental you ring the bell just to remind everyone that the way that was expressed is a way that breeds defensiveness in the other person, and you try to find a different way of reframing it that expresses your own feelings, expresses empathy for the other person, expresses and reinforces what you could get if the other person does what you want, but pulls judgment out of it. I'm actually going to give you a worksheet on that next time if you want. [36:00]

CLIENT: I'd appreciate that.

THERAPIST: My other thought about a homework assignment between now and next time for your thoughts is that what I would do-how was journaling helping in general this week just getting your thoughts down in the circumstances? Did it help at all?

CLIENT: It's really-so I always-I don't know why, but I always feel this like resistance to do it. And you're like, "Try to see what time of day would work."

THERAPIST: Yup.

CLIENT: And I find like any time of day would be a time when I really-

THERAPIST: Hard.

CLIENT: Yeah. So that's not practical.

THERAPIST: Yeah, yeah.

CLIENT: But in theory I would think at the end of the day, but it's just like really hard to force myself to do it. But then once I do it I feel some relief, and I feel some almost like validation, and I also feel like I have-I can look back and sort of see what I went through over the week, or I canSo I feel like it's good, but I need to like force myself almost I feel to just do it.

THERAPIST: To do it, yeah. I would keep that up then. If you can keep forcing yourself to do a paragraph at least. It doesn't have to be a huge paragraph, you don't have time, but a paragraph to summarize what the day was like. Because I think just getting that container for the feelings for the day, and for the feelings for the week, and just even some space to watch progress happen or not happen is also going to be really important. If you look back and say, "Wow, we were here and now we're here." Sometimes when you're still in the thick of things it's hard to see the forest from the trees. Do you know what I mean?

CLIENT: Mm hm.

THERAPIST: So just even like saying, "Whoa, there's been some movement," or, "Oh my god, it's the same, it's Groundhog's Day, it's the same exact thing I was saying from day one," that will also I think help you get a sense of what you want to do in this marriage even over time. Just to know you have some time where you can look back and get some more perspective on it rather than the heat of the moment. Why I would ask you to add to that, and maybe even keep it a different-a separate journal if that's what makes more sense to you, is if there is a moment when you are having suicidal thoughts or feelings or urges or fantasies, if you could take a moment when that's happening to just jot down where you are, what just happened, just kind of-like what's the context, what the specific thoughts are if there's any specificity that's important. If it's the same thing that you've told me already that's fine, just say "suicidal thoughts," but if there's a specific thing that comes up that we haven't talked about say what it is. Say what the thoughts are besides I want to die. In other words, why you want to die, what is it? I hate myself. Is it this is all my fault. Is it if I were to die they would recognize how much pain I was in. You know, lots of different thoughts a person can have. [39:40]

CLIENT: I don't want to write that, because I don't-I can't tell anyone but you. It would kill my sister. Like it would be so painful for my sister. It would bring Ivan probably down more, it would bring my parents down more. I certainly couldn't tell my in laws, like I couldn't tell my friends. Like I just don't want anyone else to-

THERAPIST: To find it you mean?

CLIENT: Not because I'm like trying to hide plans, I just couldn't bear to like-the first time I've done that would be incredibly hurtful, and then for like Ivan it would be like-it would not help him make progress, it would not-like he would feel-it would just break him down more, which is not going to help me or him.

THERAPIST: Are you worried about him finding it, is that theLike what if you just e-mailed it to me for example?

CLIENT: I guess I can, I just kind-I could try.

THERAPIST: Maybe it's hard to make it real to you too.

CLIENT: Yeah.

THERAPIST: Yeah. Let me modify it I guess by also saying it doesn't have to only be when you're suicidal. Let's say you're just in a horrible, horrible place.

CLIENT: Okay.

THERAPIST: I know you're not always in that bad a place, but let's say zero to ten, ten is the extreme distress-self-loathing, hatred, depression, anxiety, whatever it is. Zero is no negative aspects, having a great day, in a good mood. So the times when it's eight, nine, ten, up at the upper end of the spectrum, whether it's I feel suicidal concretely, or I just feel so bad that I can't take it anymore. What are the thoughts in that place? You've done some of that by how much self-loathing there is. And then add another column of what a competing statement might be with that. Like if we start to recognize that those thoughts are irrational, what is the exact thought you're having about yourself or about your life or about Ivan, and what would be if you were in a different mind frame a rational competitive thought? In other words, what would you even tomorrow when you're in a better mood think about that statement right now. What is a way you can say something slightly different that actually is more grounded in reality than the thought that's coming up, and see if you can write out a competing thought. You don't have to do that every day. [40:55]

CLIENT: Okay.

THERAPIST: Even if it's only two or three examples, whenever it comes up that it's at its peek intensity we're going to try to find out what that thought is and help you find a competing thought. I'm adding competing thoughts right now because you've I think done this before.

CLIENT: Mm hm, mm hm.

THERAPIST: So there's some experience, you know what I'm talking about. Otherwise we'd just be doing the thoughts themselves. See if you can do that. And you could even write it on a piece of paper if you want and bring it in and I will shred it at the end of it. The point is just that we have it so we can look at it together, you don't have to save it.

CLIENT: Okay.

THERAPIST: I can put it in your file or something where no one will see it, you know.

CLIENT: Okay.

THERAPIST: Does that make sense?

CLIENT: It does.

THERAPIST: Okay. Just monitoring and seeing what you can do to challenge the thoughts as you go along. Okay?

CLIENT: Mm hm.

THERAPIST: To me, again, the more you can keep breathing, monitoring the relationship right now, keeping forward momentum going in here, you will over time, Ramona, sort out what you want to do with this. You said something I think really important, one year was one thing, two years is something else, you don't want to be at five years. You've already set up then a framework of time. You are not saying I want to leave him today. [42:00]

CLIENT: I really don't.

THERAPIST: Part of you does. But you haven't come in here and say all of me wants to.

CLIENT: Mm hm, mm hm.

THERAPIST: This is another I almost might call it a psychodynamic skill. That's an oxymoron. The more you can realize as the backdrop skill that you are in an ambivalent place about the marriage. Sometimes when people feel ambivalently about a person or a thing, or should I follow this profession or not, or whatever it is, the way we all struggle defensively around our ambivalence is that you project into another person one half of your ambivalence. So I want to leave the marriage but other people would judge it. Actually part of you wants to leave the marriage and a part of you would judge yourself for leaving the marriage.

CLIENT: Yeah. Oh yeah.

THERAPIST: And you know that.

CLIENT: Yeah.

THERAPIST: The more the ambivalence can get pulled back inside as yours-because I also hear you saying, "Part of me is done, but a part of me also feels like I want to give it some more time to see if there's any more room for change." I think that's not just me saying that to you, or Farrow saying that to you, or Ivan saying that to you, I think part of that is your own feeling about it too.

CLIENT: Mm hm.

THERAPIST: So the more you can say, "These are my thoughts and feelings, my ambivalence, and this scale's like this right now." If it goes like this you'll leave. It's not like this quite yet though.

CLIENT: But what I really don't want to do is what I've done with my parents, which is after seeing the same thing for, you know, over 20 years there's still a hope that like it'll all change, or it can all get better. And I don't want to put myself through that the rest of my life by choice.

THERAPIST: Yeah. I don't want that for you either. So we're totally on the same page. And to say, okay, you're actually not at 20 years yet. It's been a year, but it's been a short time that you've actually been really focused working on this together to see what can come out of it or not. If another year passes and you're in the same place, that's a lot of good information for you to know. If another year passes and you're in really a different place that's some good information to know. [44:20]

CLIENT: Okay.

THERAPIST: So the more you can keep saying, "Okay, I'm going to be trying to work on my part," knowing it's not all you and a lot of it's him, but what is your part, that's a piece I think even when people leave a relationship, if they feel like I did what I could do and that's as much as I can do, and I can't be responsible for yours, but I know I tried my hardest on my part of this, then the ending of the relationship is a more peaceful one. It's not filled with regret and uncertainty and, "Oh wait, did I do that impulsively and I didn't really work on it?" Do you know what I mean? That's also a piece of trying to just kind of know that's what you're doing right now. Know that's what he's trying to do, know that's what Dr. Farrow has in mind of just trying to kind of buy you guys some time to see what you want to do over this time, but we're in the meantime trying to work on helping you with your own inner life. Okay?

CLIENT: I did want to ask, do you have any other availability throughout the week? Just because Dr. Farrow is now-she's totally on vacation.

THERAPIST: Oh, she is.

CLIENT: And I don't have classes on Thursday because it's a Monday schedule, so that's a very rare-

THERAPIST: Let's see.

CLIENT: If you don't I understand, but-

THERAPIST: I do not. The reason being-I might have otherwise, but I'm not in tomorrow-

CLIENT: Okay.

THERAPIST: -and for the second half of the day today, so it's unusually tight. If something opens up Thursday do you want me to let you know as soon as I know.

CLIENT: Yeah. I mean, Wednesday, Thursday or Friday.

THERAPIST: Wednesday, Thursday or Friday.

CLIENT: Yeah, mostly Thursday or Friday I guess.

THERAPIST: Okay.

CLIENT: But yeah, no, I understand.

THERAPIST: Is Friday the whole day pretty flexible? [46:00]

CLIENT: Yes, I have nothing scheduled.

THERAPIST: Okay. I will make a note of that and call you if anything comes up.

CLIENT: Thank you.

THERAPIST: Cancellations do come up.

CLIENT: Thank you.

THERAPIST: Okay.

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