TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Glad this works.

CLIENT: Thank you.

THERAPIST: Were you nervous about yesterday or is there something else going on?

CLIENT: Well, when I was sending the e-mail, it was still at a point where I didn't know what was going...

THERAPIST: Yea, yea.

CLIENT: So it was like... and I didn't want to wait until after Saturday because I knew... but I will admit, I also just felt really bad having an appointment this week at all because so many people are having real problems. And I didn't want to... I don't know. I felt bad about that.

THERAPIST: That's really striking that you would feel guilty as though you're not having real problems yourself.

CLIENT: Well, it's not... yea, but it's like so insignificant in comparison. And I just feel kind of...

THERAPIST: I don't know. I actually don't think so. You have quite a history, Ramona (sp?). There's a way I think you don't know how hard your life has been. You're so used to telling yourself to kind of pull yourself up by your bootstraps and not make a big deal out of it. [00:01:02]

CLIENT: I mean, I guess I feel like nobody has a perfect or even an ideal...

THERAPIST: That's true.

CLIENT: ...childhood or... (chuckling)

THERAPIST: That's true.

CLIENT: And I wonder how many people have a completely healthy childhood, whatever that would look like. I don't know. (pause)

THERAPIST: Different degrees. (pause) How are you? How are things?

CLIENT: They're OK. It's kind of a range again. I feel like sometimes things are going really well and smooth. And then there are other times where I feel like it just all adds up and I'm like really agitated. Or I feel that agitation or irritability coming out and I just... in the one way it feels so frustrated and so real. And then if I step back on it, I'm like OK, it's just this short list of things. Take a deep breath. Get over it. Let go. [00:02:03] I guess it's not the individual things themselves. It's more like it's not going. I feels like it's constantly building up. And it feels like... so there's that. And I guess that's mostly with Ivan (sp?). And then there's... school is over next week. (chuckling)

THERAPIST: Yea.

CLIENT: Basically I have one more class after next week. So...

THERAPIST: Wow.

CLIENT: Yea.

THERAPIST: Oh my goodness.

CLIENT: It's like I don't even know. But I... so I have a final next week so I'm studying for the final. But I'm also applying for jobs and I'm finishing up my research hours for my actual course credit. I'll keep doing it after I graduate but I need so many hours for the credits. So pretty much whenever I apply to jobs, I feel really bad that I'm not studying for my final. And when I study for my final, I feel really bad that I'm applying to jobs. So...

THERAPIST: That's where we left off last time about what's to come for you in another set of changes.

CLIENT: Yea.

THERAPIST: You've already been through a really big set of changes that you're just trying to get your bearings around. [00:03:07] And yet it's going to change again. How are you doing with it all? It sounds like there's a lot of anxiety.

CLIENT: There is a lot of anxiety.

THERAPIST: Yea.

CLIENT: There is a lot of anxiety and there's frustration. I guess I feel... because I feel so... kind of feels like right now I can't do anything really right. Because like I said, when I'm doing the one, I feel bad when I'm not doing the other. And meanwhile, Ivan (sp?) is doing his thing. So that doesn't feel very good because it doesn't feel like even after I get done with a big chunk of studying, I don't feel that great about it because it's not done. I mean, because I wasn't working on the other thing. So yea, I guess...

THERAPIST: So there's a really good example of a very distorted thought that comes in your mind. I mean, it's so striking that you could be working hard on something and automatically feel guilty that you're not working hard on this thing. [00:04:03] Like if you did this...

CLIENT: Yea.

THERAPIST: ...you're not... you're just... it's never enough. There's never a way to say, "I'm doing a good enough job what I'm doing."

CLIENT: No. In fact, so this final is 20% of my grade and so far I have all A's in this class. And I just keep thinking to myself, if I don't get an A in this class, I'm going to be... like this is not going to be OK. It's not going to be OK. And it's just... so I...

THERAPIST: What's going to happen if you get an Aor a B+?

CLIENT: Oh, an Ais fine. I can live...

THERAPIST: OK.

CLIENT: That's fine because sometimes even an Ais a 93 or a 95. It depends on the class so I can live like that. But if I get a B, I'm just going to be really upset.

THERAPIST: To get a B, you'd have to get like a C-.

CLIENT: Maybe.

THERAPIST: I mean, if it's at 20%?

CLIENT: Yea, I mean, I haven't done the math to figure out because it's not that many questions. [00:05:01] But...

THERAPIST: You'd have to do pretty poorly...

CLIENT: I guess.

THERAPIST: ...to affect the rest of your performance...

CLIENT: I guess.

THERAPIST: ...in order to bring it down to a B. And then what? What if you get a B?

CLIENT: I wouldn't have all A's. I'm hoping to have all A's. Otherwise...

THERAPIST: This semester?

CLIENT: Mm-hmm.

THERAPIST: OK. So what if you have...

CLIENT: It'll be fine and I will get over it. I'll just be disappointed and upset about it. It's kind of like the job thing. I feel like... they told us we need to do 30 to 50 applications or get 30 to 50 resumes out there. Not counting the career fair, I guess.

THERAPIST: Thirty to fifty?

CLIENT: That's a lot. But they also said that 75% of people from the program have a job in their field within six months. So I guess, I mean, you have to really apply to do that. I'm sure not everybody does that but I feel like this tremendous pressure, unbelievable pressure. It is so daunting. [00:06:01]

THERAPIST: So I don't know if you had any opportunity this week to look at distortions cognitive distortions and then competing thoughts. Did that come up at all?

CLIENT: I didn't do any journaling.

THERAPIST: OK.

CLIENT: I didn't do any. What I did try to do... I don't know if it really helps. But Thursday I finally... I guess it was Thursday or Wednesday. I finally sat down and I'm like, I'm just going to look. And so I pulled out all my career stuff and all the listings that I knew about and all the employers that I had spoken with and the whole... and just started looking. And it felt really overwhelming because some of the jobs I'm just not qualified and some of them, I just... I really wouldn't want them at all. But I just kept going through. I was so anxious. And I found one at a research firm and I just applied to it. It wasn't like my perfect, ideal job. But I thought I'm just going to do my cover letter, do my resume...

THERAPIST: (inaudible at 0:06:55).

CLIENT: Do it. But I spent like two hours on it which is a long time to just add relevant course work and customize your cover letter. It was too long. But I did it and at the end... so when I started my list of jobs that I've applied to. So it was a start.

THERAPIST: That's huge.

CLIENT: So... and I've done a couple since then. But... so I did go from feeling over the top anxious, can't deal with it. It's going to be the end of the world if I don't get a perfect job that makes X number of dollars to it's OK if it's not my dream job. I'm just going to... so... in a way that there...

THERAPIST: So there's a good example of you finding a challenge to the distortion of it's going to be the end of the world if I don't find a perfect job. Then it would be the end of the world for every single person on the face of the Earth. There's no perfect job. (chuckling) Also that you can find something and that builds experience to get you maybe in somewhere that you'd like a little bit more there after this or some time to start building something up. There's not as that urgency... there's so much urgency it seems like you feel. [00:08:00]

CLIENT: It... Well, it really feels like... it's maybe not fair to say it but it really feels like it all falls on me. It really feels like Ivan (sp?) may or may not work full-time. He may or may not decide what he wants to do with his life. He might just be completely floundering for I don't even know.

THERAPIST: Yea.

CLIENT: So it feels like not only is there the normal pressure that I would put on myself to get a good job that had a good paycheck that I was interested in as well. There's like this really big... because I feel like I have to do it for both of us.

THERAPIST: Yea. And I totally get that. If we pulled him out of the equation for a second, though, my guess would be... let's say you had never met him and you were just... you were single, you were doing this on your own. You would still be feeling a lot of that urgent feeling and anxious. Like oh my God. It's life and death. And how am I going to get a job that's going to support myself? Like even if it were just you in isolation, I think the fact of the addition of him makes it that much more repetitive of your childhood because now it gets triggered that it's not just yourself. You're having to take care of... you're having to actually take care of a household in which you were the child. [00:09:08]

And you're having to sort of be the adult and pretend to be the adult and take care of things and take care of even adults that are suffering with depression. Your father, even in his own way, has this kind of avoidant depression. Something is going on with him. I don't... it's not totally clear. But there's something he's just staying away from the house for. And so Ivan (sp?) adds to that feeling that there's even more on your shoulders, more people to take care of besides just you. But my guess is, Ramona (sp?), that because of your history, you would even be feeling that just for you.

CLIENT: No, I...

THERAPIST: And that's important to us.

CLIENT: I feel like that's true. And I have... I've at least said to Ivan (sp?). Like, "Look, I think as soon as I start working, you need to separate half and half because I've been..." We just did the taxes. I know for a fact I paid more than half.

THERAPIST: Yea.

CLIENT: And most of that was loan money which is the worst idea ever. And I'm like so that needs to start happening. And I'm scared because I know that if he doesn't, what am I going to do? [00:10:04] I'm not going to let our rent go unpaid. I'm not going to make him call his parents. So even when I'm looking at jobs and I see that it's actually I've never had a real... I went straight from high school to college to grad school to... so I've never like... but they all pay plenty that I would be able to pay my half and more. I can probably pay all of our bills every month and still have some for the loan money to pay back loans.

THERAPIST: To pay back loans. Yea.

CLIENT: And I'm already thinking like, oh, how many loans can I pay off each year? And how many years can I do this in? It's just a lot and I've already been thinking about do I want to do another program? Do I want to do a Ph.D. at some point? Do I want... and what does it need to be in? And I feel like I have to have it all figured out now and I'm 26. And I'm just like... I feel so overwhelmed and I feel that I would feel this way regardless. But I do feel there's some extra pressure because Ivan (sp?) went from having a really... I don't know. [00:11:08] He had a pretty good plan for a real career and real... and now it's all...

THERAPIST: Yea.

CLIENT: So...

THERAPIST: So just so I get a sense of the actual logistics of this unfolding summer spring and summer. You have a final next... when are you done with everything at school?

CLIENT: I guess in two Thursdays.

THERAPIST: Two Thursdays will be your last exam.

CLIENT: The 9th. May 9th is like... no. The 2nd is my exam.

THERAPIST: OK.

CLIENT: And then the 9th I have just a class. She in fact...

THERAPIST: A class. (inaudible at 00:11:43)

CLIENT: Yea, she's like, "Bring resumes and we will take about like getting you jobs in this field."

THERAPIST: Oh, great, great.

CLIENT: So I really...

THERAPIST: So May 2nd. Once you're done on May 2nd, is your coursework done?

CLIENT: Yea.

THERAPIST: No more papers.

CLIENT: I should have my research hours done by then. But if I don't, it's literally me going into the hospital and putting in... I have 14 hours total left. So...

THERAPIST: It's not high stress?

CLIENT: No. [00:12:00]

THERAPIST: OK. So one thing I'm going to suggest to you. This might make you sound... feel a little crazy. May 2nd is not very far away.

CLIENT: I know. (chuckling)

THERAPIST: Right?

CLIENT: I know.

THERAPIST: It's a week and two days. Is that right?

CLIENT: Mm-hmm.

THERAPIST: So what if you just say, "Let's table job applications for..." OK, so there it goes. Why, mm-mmm right away?

CLIENT: Because I'm already terrified and panicked because I really do feel like I need to do 30 to 50. And I really want to get something that I care about and I'm interested in that I can stick with for like at least a year. I don't want to be in two months telling them...

THERAPIST: Yea.

CLIENT: "I finally did my job applications. I'm leaving."

THERAPIST: Yea.

CLIENT: And in order to do that, I also feel like I need to... so the more applications I get done, the more hope I have for interviews. And I really want to start work. I graduate on the 18th. I'd like to start on the 20th. But June 1st, ideally in a more realistic sense, I would like to have a real job started June 1st. [00:13:04]

THERAPIST: Wow. That seems really ambitious.

CLIENT: It probably is.

THERAPIST: But to me that seems really unlikely that you'll have a job. Even if you were the stellar applicant, that's really fast to get a job.

CLIENT: It probably is.

THERAPIST: For even the top qualified people, no. This job market is tough right now and so when you set yourself up for disappointment...

CLIENT: No, it's probably going to... I just don't... I'm going to feel horrible if I don't have something around then because then I'll feel like I'm doing what Ivan (sp?) has been doing. And then I won't be contributing to income and I won't... and it's going to be really bad. Plus his in-laws, all the... my in-laws, although they... to Ivan (sp?) they say like, "It is what it is. It's nobody's fault," in regards to his job situation which is so frustrating. They tell me like, "Hopefully you'll have a job really quickly after graduation." And they even told me where they wanted me to work. And I'm just like, it's too much. It's too much.

THERAPIST: It is too much. [00:14:00] And it's not realistic. I mean, I... even when you said to me a few weeks ago, "I really would ideally like... I want to make sure I get a job in fall." Even that I thought, OK, I hope it goes really well because these days highly qualified applicants, it usually takes about six months, on average, for them to find a job. So I really might want to work on shifting your expectations so that there's some room for you to not be so mad at yourself and beating yourself up. And almost expect that maybe in the meantime you'd be on the side looking for a summer job or something like that if you are worried about having a little bit of income working retail, working admin, whatever it is that could get... bring in some... a few hours. You could temp if you feel bad committing to a job. Go to a temp agency just to get some hours coming in of income that's a little bit.

As long as it reserves you some days to also work on your applications and just kind of get your mind a little bit more around the fact that this could take a while. If you're pleasantly surprised and it doesn't, that would be great. But it seems like you're asking yourself to be super human or to live in a different society to expect that you're going to have a job by July 1st. [00:15:11] Unless there's something I don't understand about the job market in public health.

CLIENT: It's not... I mean, the jobs aren't... some of them are lab jobs or research jobs, public health department jobs at the hospitals, research trials, things like that. So I mean I have some hope because my professors have a lot of connections.

THERAPIST: Because they have some openings for those...

CLIENT: Mm-hmm.

THERAPIST: OK. So that helps.

CLIENT: There are tons of openings. So I mean I'm applying.

THERAPIST: Can they also do summer June, July, August start dates?

CLIENT: Oh I mean they're open right now.

THERAPIST: Oh, OK.

CLIENT: Like open opportunities now. So I mean there are a lot out there that I haven't applied to. So that's something. And I do have a lot of professors who have a lot of connections because they actually do research or they practice medicine or they...

THERAPIST: Yea.

CLIENT: So I'm hopeful because I've already done a couple meetings. [00:16:02] But... and I have a couple more scheduled. I just... I can't go for... if I wasn't able to start until July, that would mean I had like I had a month and 10 days of no work. And I could work in retail. That's just very painful after all the money I've spent on this degree and all the work. And I mean I also have a college... I mean...

THERAPIST: But a lot of people do that.

CLIENT: ...I did retail in high school. (chuckling)

THERAPIST: Do you know what I mean? A lot of people do retail after they've graduated from a... or something that just fills in getting hours while you're waiting for your permanent job if you have to. If you don't have to financially, they you also don't need to. But that's a very common experience to be just filling in something while you're waiting for your real job to come around.

CLIENT: I might... I guess I might have to. It's just... it's overwhelming. And I can already hear my in-laws. It's just...

THERAPIST: Saying what?

CLIENT: Oh, my mother-in-law, like all she says. It's like she won't ask about how school goes. [00:17:01] She won't... she doesn't even ask about how I'm even doing. She won't. But she just keeps saying like, "You should work at the CDC. You should apply and you should work at the CDC." I don't know if that's the only agency that she's familiar with.

THERAPIST: CDC.

CLIENT: But she keeps saying it over and over which first of all, those fellowships are completely... like incredibly competitive. And usually they have opening the beginning of the year. So January, February. And I didn't apply and I didn't look at that time. And it's not the only good job out there.

THERAPIST: No, especially here.

CLIENT: It's just so frustrating. So like no matter what I do...

THERAPIST: Why is she (inaudible at 00:17:38) on that?

CLIENT: I have no idea.

THERAPIST: Does she know someone there or...

CLIENT: She's evidently told... no. She's evidently told everyone that she knows, "Maybe she'll work at the CDC. I really want her to work at..." And I'm just like... because... so now no matter what I do, she's going to be disappointed. And there will be some kind of like, "Oh, what are you doing?" (chuckling)

THERAPIST: That's just weird behavior. That doesn't make any sense.

CLIENT: No. Especially since their son is managing at Starbucks and that's fine. [00:18:05] There's nothing... I mean, he doesn't even need to... if he looks for jobs, fine. If he doesn't, fine. It's just...

THERAPIST: It's not the CDC. I don't know if you want to work there. Maybe you could apply for January. (inaudible at 00:18:16).

CLIENT: I could but it's just like right now there are a lot of opportunities and I'm really fresh out of school. And I don't know more like...

THERAPIST: Pressure.

CLIENT: Yea.

THERAPIST: What also is striking is she... I don't even hear her asking, "Would this be a good fit for you?" or "What are your interests?"

CLIENT: No. She doesn't even ask where I want to work.

THERAPIST: Yea. Who knows if you'd want to work at the CDC? (chuckling) I don't know whether you would or wouldn't or what that would entail or not. Do you know what you want to do? What's your sense about it? What's ideal for you at the next step?

CLIENT: I have an idea. I mean, I haven't been out there so I don't really know. But I'm working on research study right now and I really like it. And it's in a clinical setting. And I really like that so I'd like to do that in infectious disease epi. [00:18:59] It's what I've focused on and taken a lot of coursework that was optional. I've done that because it's just what I'm really interested in. It follows up with a lot of what I did in undergrad and so that's the field. And ideally I guess I'd like to do some research.

THERAPIST: So is this a laboratory setting?

CLIENT: No.

THERAPIST: No? No.

CLIENT: It's like research studies.

THERAPIST: OK.

CLIENT: So clinical trials.

THERAPIST: Clinical trials.

CLIENT: Things like that. Not just clinical trials. There are other studies. But that and I have applied to be a TA in the fall for the Intro Epi course because I tutored for that course already and I really liked it. I also talked to my advisor because they said I... they didn't have an Epi course this semester and I really missed it. And I debated if I wanted to get a Ph.D. in Epi but I really didn't know. And I was not going to commit to anything like that for at least a couple of years. But I'd want to think about it. And so she encouraged me to take the advanced Epi course for like just as a... once you graduate, you can take courses for like $300 or I mean, it's like... yea. I mean, it's not like you're... I don't think you get credit maybe, per se. I'm not sure. But either way...

THERAPIST: You can sit in it and take it. [00:20:03]

CLIENT: So she recommended that and I might do that. So I mean I have some plans, I have like thoughts and I know what field I definitely want to be in.

THERAPIST: Yea.

CLIENT: I want specific jobs I'm looking for so project managers, coordinators, things like that.

THERAPIST: And if you did a Ph.D?

CLIENT: Or I... so I... and that's a ways off. I don't need to...

THERAPIST: Two years, you were thinking?

CLIENT: Yea.

THERAPIST: It wouldn't be the beginning for this fall for the following year. OK.

CLIENT: No. I need some times of work and get my feet on the ground.

THERAPIST: Yea.

CLIENT: And pay off some loans and really think about it because it's a big commitment. It just feels like I need to have it all figured out now because I feel like...

THERAPIST: Yea. Where does that come from exactly?

CLIENT: Ivan (sp?) has nothing figured out. So it's like I know that's the all or nothing thinking that's unhealthy.

THERAPIST: Yea.

CLIENT: But that's what it is because Ivan (sp?) went from, "I'm going to teach with my master's and I'm going to get a Ph.D. and I'm going to teach and write and I'm going to publish and I'm going to do all these things. And we're going to have a house someday." [00:21:10] And this whole big plan that sounded really ambitious. But not like for somebody who was going to have a master's. It didn't sound crazy or undoable. So anyway, he went from that to no master's, working at a pet shop, living with his parents and now working at Starbucks. And I'm not ashamed that he's working at Starbucks. I don't know if anyone appreciates... like I've had to... I've had all these expectations and it's like the rug has been pulled out under... from under me.

THERAPIST: Oh, I do appreciate it's not what you thought you were signing up for in the partnership.

CLIENT: No. And I probably, to be honest, wouldn't have agreed to like... working part-time at Starbucks. Like there's nothing shameful or wrong with that. But that may be not be...

THERAPIST: But maybe not for you or your partner.

CLIENT: Maybe not and maybe that's not... I don't know. I feel horrible about that. But maybe it's also not like the ideal time to say I can't afford this city's standard of living. [00:22:07] It's so expensive to live here and I can't afford to be married and take on additional responsibilities.

THERAPIST: I hear the amount of overwhelm that that really puts on you. That he had this huge plan that ended up to not come to fruition at all.

CLIENT: Right.

THERAPIST: And your expectations just sort of plummet for what's actually happening with him and his career trajectory right now. It doesn't follow logically though, to me, that that would mean you, in your separate career separate from him have to have everything figured right now. In fact, if you were to try to pretend to figure everything out right now and come up with what is going to be your ten year plan, I think it would be a bad plan for you to try to do that because you'd be missing data that you will get if you wait five, six months getting into a job, for example, even a year so that you've had... maybe a year is a little far eight months where you have had the work experience under your belt, some time to pay off some loans. [00:23:17]

A sense of what is this like in working life now that I have my own job, I got my degree. To give yourself some information that you would then make a more educated decision about the next steps. Do you know what I mean? To actually decided, are you going to apply or not to a Ph.D.? And what degree are you going to do it in and where you're going to do it? That just sounds so... like it would be a bad decision to try to decide that right now.

CLIENT: Right. So that's why I'm not. But it's something I'm thinking about and I'm already planning steps on how to figure it out.

THERAPIST: Yea.

CLIENT: Because I feel...

THERAPIST: Anxious.

CLIENT: I'm unbelievable anxious and...

THERAPIST: Your anxiety is so high.

CLIENT: ...I originally had this plan that I was going to be done with all of my schooling before I was 30. And I was going to have a career before I was 30. Like a real... and it was just... I don't know. [00:24:03] I guess I feel... since Ivan (sp?) has sort of like... since he left grad school even before I knew that he'd lied about failing as opposed to just leaving out of principle, he's gone over... like he's suggested doing everything from an MBA to a master's in curating. There are degree programs in that, an archivist program. He wants to do a master's of Education.

The other day he came home and he said, "Yea, they want me to be a coffee master which is like a title that they know all about... and they taste and they..." He's like, "And at some point, I could travel. They send people all over the world to travel and taste and purchase coffees." And I'm like pick one. Do something. Have some passion and ambition and... because he really... I just feel like it's this roller coaster. And tomorrow if I came home and said, "I want to buy a house this week and I want to start a family," I think he would say, "Let's do it." And I'm just like... I'm terrified. [00:25:04] So I feel like it might not be fair to him. But I feel like I need to have everything figured out and none of it can go wrong. And I can't have any setbacks because there's no room for that.

THERAPIST: In a way it feels like there's time kind of slipping away from you. Was that...

CLIENT: Yea.

THERAPIST: There was something about you wanted to be a certain place by the time you were 30. Let's say a year or two ago, Ivan (sp?), when you were under the impression Ivan (sp?) got this master's or did it all but degree master's, left for principle, didn't know what you know now and was going to continue along in that pathway. Where did you picture yourself with him when you were 29, 30? Did you want to have a family at that point? Is that...

CLIENT: No.

THERAPIST: No.

CLIENT: No, but I thought we would both be done with our education by 30 or pretty... or like finishing up our final degrees or whatever. [00:26:00] And still working full-time. I thought we would have careers or very close to established careers. I thought that in our 30s we would have a house of some kind. Be in a position where we could have that kind of lifestyle. And that maybe... obviously mid-30s would be the last time to be thinking about did I want to have a family or not because that's just necessary at that point to decide.

THERAPIST: You weren't... you're not sure though that you wanted one.

CLIENT: (chuckling) I thought I did.

THERAPIST: And it was a year ago.

CLIENT: I thought so, yea. Now I feel like it's not even... I feel like Ivan (sp?) couldn't. I feel like Ivan couldn't do a house or a family. Or I feel like so many things that I just wanted for myself regardless of whom I married I feel like I can't anymore or only if things would change a lot. I guess I just feel like things are so unstable and so uncertain. And I don't... I even... I just don't feel supported at all. And I feel... I don't know. [00:27:06]

Ivan (sp?) still can't talk about graduation. He still won't. He's doing the like... first he said he couldn't like or the reason wasn't because he forgets that I'm graduating. And since then he just hasn't because he's ashamed that he didn't before. So now it's already ruined. So now he can't. And it's so frustrating and it's really hard to look at that and say, well, he's struggling with that, with everything. Not just me. It feels really unloving and really hurtful and really unsupportive. It feels like a slap in the face. It's so hard to separate those feelings from... and have some compassion for the fact that he's struggling with these things. I don't feel like I want to be very compassionate about it sometimes.

THERAPIST: Yea, yea. Yea, and what you're aiming to do right now is just trying to be patient and see what changes in him.

CLIENT: Which...

THERAPIST: Well, and what can change in you about helping your anxiety and feeling being responsible for everyone. [00:28:11] Calm down some so that it can get some space to think without it being urgently anxiety driven. But I hear that you don't feel a lot of empathy for what he's going through because it's been so long at this point?

CLIENT: Yea. It really... sometimes it feels like he's just openly defiant or it feels like he just doesn't care. And I honest to goodness and like I think I'm a pretty good person at reasoning out or I can be if I'm not doing the all or nothing thinking but I honestly can't figure out a lot of the time if it's he doesn't care or he's really... no, really he has trouble focusing his attention. He has ADHD or whatever. Or no, really he's struggling with shame and depression. It's not personal. Or maybe really he doesn't care very much about me and he really just needs me to take care... I have such a very long list of what so many things it could be about. [00:29:06]

And then sometimes it feels like it maybe doesn't even completely... like it matters but not completely because yesterday I came home and he picked me up from the train (ph) so he knew I was coming home. And I walked in and the TV is on. And the toaster which gets like crazy hot is still plugged in and I always... I made him put a little post-it by it to remind him to unplug it because it gets so hot and the wires are hot.

THERAPIST: So it stays on, you mean? You have to unplug it to turn it off?

CLIENT: No, it doesn't stay on. But once you use it, it's really hot. So I don't think it's a good idea to keep it plugged in if you're not... to let it cool down because I think it could be an electrical fire hazard. And we've agreed on this and he still like... and then he forgets. And the laundry is piled up and the trash is piled up and those are his only two chores. The other day I found... there's just like a pizza crust on the counter by the stove. And I'm like, why is there a pizza crust on the counter? "Oh, I tore it off before I sat down and ate my piece of pizza. I guess I left it there." [00:30:08]

I'm like... it really does feel like I don't... I know this makes me sound like the worst person in the world but it does feel like he's in a role of the kid sometimes. It really does feel like I mommy him. And I know that's my choice and I know that I'm choosing to do it. But it doesn't feel like I have a choice. So unless I want the TV to stay on and pay the electric bill and I want to deal with the plug is really hot or there's food on the counter or he's not going to do his chores, it feels like...

THERAPIST: Doing his chores. It is like he's your kid.

CLIENT: We each have chores, though. I mean, like we...

THERAPIST: You call it chores for you, too?

CLIENT: Yea, yea.

THERAPIST: Oh, OK.

CLIENT: So I do the dishes and I'm supposed to get the mail and clear off the dining table if stuff gets piled on it. And he's supposed to do laundry and trash. And it's... so I mean, those are... I feel like that's fair. [00:31:03] I feel like that was actually... that was your suggestion that we distribute some of the...

THERAPIST: Absolutely. Yea.

CLIENT: And that was like a great idea that nobody had ever suggested to me and that I don't see with my parents. And so that was good except...

THERAPIST: So he... what happens? He doesn't do his part?

CLIENT: No. He does it sometimes.

THERAPIST: Or it just takes a long time.

CLIENT: Yea. It's like the trash will get out really... we just have a small can. We don't have like a nice big can which is fine. But it needs to get taken out more often or it's like piled up and up. And...

THERAPIST: One of the things that's so tricky about this is that there are some things you're picking up on him that are really causing him problems in his life that are deficits, right organizational structural deficits, focusing in on something rather than avoiding it. Some other things... some... I mean, at a little bit less of an extreme might be simply individual differences. [00:32:03]

Some people if you say, "Would you like to do this task..." that's, say, an annoying task "...today or tomorrow?" It's a personality test, right? Some people will say, "Oh, do it today and get it out of the way." And some people will say, "I'll do it tomorrow. Put it off as long as you can." And then they'll do it tomorrow. And at the... by the deadline they'll both have it done but one got it done early and one waited until the very last minute. But people who operate getting it done early can't stand the people who wait until the last minute. And the people who wait until the last minute, I don't think it's that they're bothered as much by the people who get it done early because sometimes they make out because the other person would have done it first. (chuckling)

It's not as irksome to them except it is irksome to the degree that this person nags them and criticizes them for the fact that they can get it done early. But in the end, if they both get it done, there's actually not a problem with either style. So I think there's some of that that happens. Your anxiety is so high that you're driven to get it done, get it done, get it done, get it done. The way you're talking about with your planning right now, it's... you almost want to... if you could get things done a year... that are due a year from now, you would do it right now because it just feels better the more is in your control as soon as possible. [00:33:19]

That is what helps your anxiety. That's the way you manage your anxiety. Ivan (sp?) manages his anxiety by avoiding it for as long as possible until it's... he absolutely can't overlook the garbage pile that this high. And then he'll take it out. His style he pushes to an extreme sometimes and doesn't take it out. So it actually... he doesn't meet the deadline. I don't know if you set up a deadline, for example. Do you guys...

CLIENT: Yes.

THERAPIST: Yea?

CLIENT: So we tried. I'm like, "Why don't we do it Monday and Friday? It might be like a little much during the middle of the week but let's just do it Monday and Friday so that we can relax on the weekend and its..."

THERAPIST: Yea.

CLIENT: Yea. So he agreed to that at first. And then he said, "No, I don't want to have days set because I don't want it to be an excuse that I'm not taking it out other times it needs to be taken out." And like who I am, I said, "Wow, that's amazing. That's amazing."

THERAPIST: (chuckling) It sounds good. [00:34:09]

CLIENT: And then like the little kid again, he didn't do it at all. Because he didn't have days that he was supposed to do it so there was no point for me to say like, "You didn't do it Monday." And so Dr. Farrow (sp?) said try Dr. McNally's (sp?) strategy and you don't say anything even if the trash is to the ceiling and Ivan (sp?) does it. And so that worked a little bit on the first week. And now we're back to I don't say anything which he likes. And he avoids it and which drives me crazy.

THERAPIST: So I wonder about saying, "OK Ivan (sp?), that doesn't work for me. Not angry, but it's just not working. I think the garbage has to get taken out once a week. Is there a day that works better for you? Could we settle on a day? You pick a day if Monday and Friday don't work for you."

CLIENT: Yea. I even... I mean, but we've been through that and no.

THERAPIST: What will he say, though? Would he... he'll just say, "I won't pick a day." [00:35:04]

CLIENT: That's the... but I mean, when we talked about it in couple, he's like, "Yea, I know. I think I do need to schedule because the no schedule thing isn't working." And I'm like, "Well, we tried the schedule thing and you didn't want to do that." So now we went back to he would do it Monday and... I was like, "Why don't we try. You just do it two days. And if you feel like you can do it other days when you think it needs to be done, that's great and that's a bonus."

THERAPIST: And then see.

CLIENT: Yea, that's not happening. So I just... I guess when you said I needed to find... we talked about me finding a way other than criticizing to deal with it, I became acutely aware of how much I need that. Because the other day I really just like... I did. I heard myself. We got back from church and I heard myself like, "Ivan (sp?), you didn't take out the trash. Ivan (sp?), the laundry is piled high. Can you at least put in a load? Ivan (sp?), don't wear your good clothes to do those things." I really... like completely being his mom, completely criticizing. And he just yelled at me. And he's like, "Can you just say one thing that's not criticizing me?" [00:36:00]

And I felt really bad because I knew it was true that I was in that moment being really critical of him not doing his chores. But I also felt just so stuck and helpless because it's like if I say something, that's wrong. If I say nothing, he's avoiding so it's just like feeding into it. And I just feel like this isn't going to work for me. And I feel this. I'm terrified because what if it could take him years to develop?

THERAPIST: Yea. So here's a thought and I don't know if this is going to sound clear or not. I'll try my best. If what is coming out of you, of him, of anyone of us when we go, our angst is high, that your frustration, your anxiety is high and you criticize, right? The criticism comes out. It's usually done in a particular tone. It usually feels like for whoever the criticizer feels kind of like the mommy. [00:37:05] And the person who's on the receiving end kind of feels like the child.

Even if he's the one criticizing, if he's in that space, he's going to feel like the mommy or the daddy. It feels like a little bit talking down to that person. And one thing that happens when we criticize you didn't do this, you didn't do that, you didn't do that is that it reifies I'm up here, you're down here and kind of recreates this sense of mommy/child. I would want to help you find a way of having a voice in the relationship that is not mommy/child. But that also doesn't mean zipping your mouth shut either. Because I hear you saying, look, either I start criticizing him because... and I can't help it. Or my other option is that I keep my mouth shut and then I'm fuming inside because he's not doing anything.

We will trying to find and are trying to find what is a way that you can relate to him from your adult place and basically refuse to enter into mommy/child with him? [00:38:08] Refuse also to silence yourself because in a way that's your own kind of being the child. Letting the parents run the show and not having any voice but actually trying to find a voice that is a peer voice even if he can't do it yet.

So this to me might look something like this. "Ivan (sp?), I... one of the things that's important for me in the running of our household that feels safe and comfortable for me. Some of this I want to tell you about I manage my anxiety and I want to own that. But it's a fact about who I am. I don't live or function well when the garbage isn't taken out once a week. If it piles and piles and piles and piles, it just doesn't work for me. You might not like me, Ivan (sp?), because I'm a person like that. And I would give you room to have those feelings. [00:39:00] Like totally justifiable feelings if that bothers you. But what I'm saying to you is this is important enough to me that I feel like for this relationship to work, this is one of those things that has to happen. So if it's important enough to you that I'm saying this is important to me. I really want to ask is it possible for you to do this for me?"

CLIENT: Yea.

THERAPIST: Do you hear how that sounds not like a criticism?

CLIENT: Yea. I feel like I've tried to frame things positively before though. Like I think it would... I think he would feel... like he'll say something like, "Maybe I want to go to the gym. Or maybe..." "I think it would be really beneficial for you. I think that you really feel good if you did... like that sounds like a really good idea." And try to do that instead of...

THERAPIST: Yea.

CLIENT: "Yea, you need to. If you don't, like..."

THERAPIST: Yea, instead of all the negatives.

CLIENT: Right. Or, "You might feel really great. It would be great. It's really sunny. We can put some laundry on the patio. Like that would be really nice." Or... but it just doesn't. And so we actually talked about just the trash which is representative of all of these tasks. [00:40:01] And Ivan (sp?) described to me this like... literally like an existential crisis that he goes through when he sees the trash when it isn't taken out. He's like, "I feel ashamed because I didn't do it. And that must mean that I didn't want to do it so now what I want isn't important and isn't good. And I still can't take it out because then I'm reminding my..." And this is literally what he described to me that he goes through. And I'm completely freaked out and I can't quite tell him that but I'm freaked out because I'm like it's just trash. Just take it out. And I even...

THERAPIST: Yea, I hear you.

CLIENT: He is like... he'll go to these extreme lengths. And I'm like, "But don't you feel..." I'm like, "There's things like that for everybody." Like you put it off and you feel bad about it and it's like nagging you.

THERAPIST: Sure, sure, sure.

CLIENT: And I'm like, "But then once you finally do it, isn't there like that rush of relief and that, this is silly. Why didn't I just do it sooner?" He's like, "No, I never feel any relief." And so I don't know what to say to that because this is real for him and I don't want to belittle that experience or act like his problems are stupid. [00:41:04]

THERAPIST: Yea.

CLIENT: But at the same time I want to say like, "You're my husband. If you're going to take out the trash and I'm going to do the dishes, you've got to find..." I don't know. To me, it's just like overwhelming. I'm just like I cannot... I don't even know what to say to that.

THERAPIST: He doesn't feel like he's penetrable in that state it sounds like.

CLIENT: It's... well, he's... I mean, he's aware. I think we're pretty aware his shame is absolutely paralyzing to him.

THERAPIST: Yea.

CLIENT: It's unbelievably. But I don't know how to live with that because part of me really wants to be compassionate and supportive and helpful because I do think he can get through it. And he's recently agreed to talk to his mom. And then all of sudden he agreed he wanted to do a psych consult and medication if necessary.

THERAPIST: Wow.

CLIENT: I mean, he's deathly ashamed of it and he doesn't want anyone to know. But...

THERAPIST: That's something.

CLIENT: That's something.

THERAPIST: You know what that feels like when you're feeling it.

CLIENT: I do. And I...

THERAPIST: Yea. [00:42:01]

CLIENT: So...

THERAPIST: Yea, he's struggling. I mean, the way you described the amount of shame and how frozen he gets around it. It's hard to have a conversation with him that feels like you're in reality almost. So I mean, I keep thinking of the interpersonal effectiveness skills I'd mentioned. I can even give you a worksheet on that and we can talk about that next time. But on the other hand, one of the things you're describing is you may be as effective interpersonally as you possibly can and still it goes nowhere because of where he is. Do you know what I mean?

CLIENT: I mean, yea. I'm just really scared because like I said, I don't know. For... if I talk to my friends and I said, "Yea, my husband won't talk about graduation at all because he said he can't remember and now he's ashamed." Or, "My husband can't take out the trash because it's literally an existential... like it's literally a crisis for him." [00:43:01] I just don't even know like...

THERAPIST: It's heartbreaking, Ramona (sp?), for you. I hear it. I'm sad for you when you described that. If anything, for me, the part that is yours that I think might help your continued conversations in the couples therapy is the more you can find your calm, mature not anxiety driven but clear voice about what you need in a relationship not what has to happen or what he's doing wrong but just what works for you in a relationship. "I" statements I need this for my own anxiety. You might not need that but this is something I need in order for a relationship to work.

So I'm wondering if that's something you can work with me in providing some of... the more you can find that voice that is about speaking to your own experience and your own needs, I think he may not budge at all. [00:44:02] It may not get through to him. But one of the things it will do is get it clearer and clearer in the work that the problem around the relationship is more on him. Do you know what I mean?

CLIENT: I do but I feel horrible because, Ivan (sp?), I think he really does want to provide all those things. I think he hates himself. He tells me he hates himself like intensely because he doesn't and actually that hatred fuels not doing it more.

THERAPIST: OK. So I get all that but that's his problem. That's actually not your problem. And it is your problem but what I'm trying to say what would help the whole system right now is the clearer you can be about your best foot forward getting a foot forward in trying to negotiate this. The more it then becomes clearer I think to [Farrow] (ph) I think to even Dr. Bourd (sp?) when Ivan (sp?) is saying yes, she's being reasonable with me. She's been kind. She's speaking... she's using "I" statements. The things that like listening how the conversation is navigating and he can't tolerate his own self, I think that will help him get clearer and clearer about the work that's in front of him. Do you know what I mean? [00:45:15]

And even will help you. No, I did my best part I could imagine doing so that if we talked about two years go by and nothing has changed or a year goes by and nothing has changed. You will know I was as mature and as clear and as calm in my own communication. I've tried to facilitate the least amount of shame that I could imagine. Because in fact, what the way I keep describing these examples of how you might phrase something is not... it's not this. It's not a shaming statement. You're saying it in a non-shaming statement. And in fact, you're saying because of my anxiety, this is the way I operate. In fact, you're owning your stuff and it doesn't mean your stuff is bad. It just means like kind of ... all of us have stuff that because we're this way this is the way we feel safe in a relationship. Because someone else is this way, this is the way they feel safe in relationships. [00:46:09]

And it's not criticizing. It's just saying, "Could we work... would this work together? This is what I need. You need this. I need this. Can these blend or not?" It's the least shaming communication that's around. And I think who knows where that goes with him. He's going to feel shame no matter what you say. But I think there's a chance he feels less ashamed the more you are communicating in this kind of way. Does that make sense at all?

CLIENT: Yea. No, I...

THERAPIST: What are you thinking?

CLIENT: No, I want to. I don't know. I lost my thought but I want... I guess I really want to try that. I just... I guess part of it I recognize that it's partly me and it's partly me reacting to him not doing it for the millionth time. But sometimes also me reacting to every time I ask my parents to do it, every time I ask...

THERAPIST: Yea.

CLIENT: And it's like this is so reasonable. But I also feel like there really is me... I don't know but in my opinion, I guess I feel like out there in couples, there is an understanding that somebody... like it's totally reasonable and normal and there's an... like somebody does need to take out the trash. [00:47:14] Somebody does need to do the laundry.

THERAPIST: Totally.

CLIENT: Somebody does need... it's not just me being OCD or anxious or like...

THERAPIST: I totally, totally agree with you.

CLIENT: I think that adds to it but I think that it's normal.

THERAPIST: I totally agree with you. The only part... I don't think that expectation is you being out of line or your being OCD, right? There might be parts of that but if you're talking about daily functioning of the household that has to happen in normal couples, OK? The only part that we're talking about right now that might be yours is when you've described to me, for example, in your family the feeling of desperation that you would say, "Please. Can someone please clean... can somebody do something?" I feel this it's kind of palpable, desperate anxiety inside. And I think that is not going to get you anywhere with Ivan (sp?). [00:48:04]

So to the degree that we can find like that's your child self getting triggered, if it's coming from that, you don't understand how urgent this is. Right now it's only some stinky trash. It actually isn't life or death. It's really annoying and it's really important that you figure a way for him to take out the trash. But it's also not life and death. And I think the way... if you can find a way of feeling like this is a reasonable adult thing for an adult to ask another adult to do in a relationship. And let's figure a way through this without the desperate urgent life and death anxiety. I think that's the part that is yours that can contribute to it escalating to a place that is not good for either one of you.

It's a two way street. He does it too in his own way. His shame is what he escalates. He needs to stop being so ashamed. Do you know what I mean? Cut that part out. Your anxiety we're talking about. How do we bring that urgency back down? OK. It's trash. This is a reasonable thing for adults to figure out to get him we got to figure out a way. This is ridiculous. We got to figure a way for you to take out the trash from a confident, calmer place. [00:49:08] Do you know what I mean?

CLIENT: Yea. No, I do and I want... I just... it's not as easy to like get rid of the feeling.

THERAPIST: Totally.

CLIENT: And I will like I always feel that with my parents even to this day.

THERAPIST: Yea.

CLIENT: And even... and I understand... like even having the house clean or having them make a meal or show up wasn't a life or death thing. I could have survived if the house had never gotten cleaned. I don't know. It's just hard to...

THERAPIST: It's hard to put into action. I'm going to give you one of the skills to look over.

CLIENT: OK.

THERAPIST: We got to stop so we can go over this next time. But just to give you a copy so you can start looking at it. You said you had not seen the DEARMAN Interpersonal Effectiveness Skills in DBT before?

CLIENT: No.

THERAPIST: So I'll give you this and we can start here next time. (pause) Hopefully you can read that. It's a little dark on that side. So DEARMAN is what we call this skill. These are guidelines for getting what you want in a relationship while remaining as effective and as calm as possible. There are two other skills that have to do with different goals. This is goal is communicating in a way that gets you what you want. So in this case, getting the trash to get taken out.

CLIENT: OK.

THERAPIST: And we'll go over this next time. Having the skills doesn't mean it's not legitimate. [00:51:01] It actually says what you're asking for is really legitimate. Let's help you get it.

CLIENT: Thank you. (pause)

THERAPIST: See you Monday.

END TRANSCRIPT