TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi.

CLIENT: Yea.

THERAPIST: How are you?

CLIENT: OK.

THERAPIST: You got my e-mail about the...

CLIENT: I did. Thank you. I think... so I mentioned it to Ivan (sp?) just briefly and he said he thought that was the same person because Dr. Bourd (sp?) mentioned someone else about it.

THERAPIST: Oh, really?

CLIENT: Yea.

THERAPIST: Oh, that's funny.

CLIENT: Yea, so I think he may already have the name.

THERAPIST: OK.

CLIENT: But I do need to double check with him before he goes to the appointment tomorrow. But thank you. I really appreciate that.

THERAPIST: He's going to see her then?

CLIENT: No, he's going to see Dr. Bourd (sp?) tomorrow.

THERAPIST: OK.

CLIENT: So he doesn't have an appointment with anyone yet but it's in the works.

THERAPIST: Yea. How are you both feeling about that?

CLIENT: So I have told Ivan (sp?) I would be happy to go. Sit outside just so someone is there and be supportive because it is difficult. And he said he didn't want that. And he said he would feel even more ashamed or disappointed. Or it would be a reminder of... so I'm trying to maybe coax him a little bit. [00:01:02] I don't... I want what's comfortable for him. But at the same time I really feel like if wasn't this shameful secret, like if somebody else was there and knew and supported him doing it, maybe that would feel good in the end so we'll see what he wants.

THERAPIST: You're... what's nice is you're just trying to be supportive in whatever way supports him getting there.

CLIENT: Yea.

THERAPIST: Yea. (pause) So what's on your mind? How are things going?

CLIENT: So things are going, I guess, up and down again but... so Thursday is my last final ever.

THERAPIST: I remember. (chuckling)

CLIENT: Yep. But I...

THERAPIST: How is it going?

CLIENT: I worked incredibly hard last week. And so I finished my 33 pages of (inaudible at 00:01:47). I typed them all up.

THERAPIST: Wow.

CLIENT: And then another ten or so page study guide and then a couple dozen index cards...

THERAPIST: Oh my goodness.

CLIENT: ...which I know a chunk of them already. It's more than I think anyone else in my class is doing. (chuckling) But...

THERAPIST: It sounds like an enormous amount of work. [00:01:59]

CLIENT: It's... I think it's my like... I don't know. I always have this list of things I have to do before exams that I kind of make myself do. But in reality I've already memorized a chunk of the index cards. And I'm feeling pretty decent. So I realized actually studying for this exam and applying to jobs isn't so much to have on your... like if I think of it that way, it's not super crazy.

THERAPIST: What led to that change? Do you know?

CLIENT: Because I've thought of all the... I mean, looking for jobs is a really... it's a big thing, I guess. But then I thought of all the finals weeks where I've had multiple finals or...

THERAPIST: Right.

CLIENT: ...finals in really... like this isn't a class where I have difficulty understanding any of the material.

THERAPIST: Yea, yea.

CLIENT: Right. So I thought... and plus it's...

THERAPIST: Could be worse.

CLIENT: Right. And it's a fairly straightforward exam and it is only 20%. So even if I failed it, I would still get a B in the class which I'm not going to fail it. But... so I thought that's some perspective. And then I also... I had met with... we have a whole career services office at school or whatever just for our school. [00:03:06] And so I met with the dean of that and I had already gotten some support through that. But I was meeting with her because she said that she could help me a little bit in my search and the process. And she was really optimistic. And she told me how 90% of their graduates get a job in their field within six months.

THERAPIST: Wow.

CLIENT: So I thought that's really encouraging. And she, right off the bat, like volunteer... there's a recruiter that she knew personally. And she's like, "Well, if you want to apply for this job, I will also forward your resume with a note because I know her." And so people have like reached out to me and helped me on some level.

THERAPIST: That's great.

CLIENT: And she... yea, she's like, "Well, with finals it's realistic. Do what you can but then after that, you can do more." And she said she thought it was realistic to get something. Maybe even by mid late June. She's like, "That's not crazy."

THERAPIST: Wow. Oh my goodness.

CLIENT: Well, she's like April, May, June. That's... she's like, "You already know what you're applying for. You're not just looking."

THERAPIST: Yea. [00:04:03]

CLIENT: And obviously my resume and cover letter...

THERAPIST: You have a resume drawn up.

CLIENT: They've been done. I tailor them for each one but... so I decided to... like I couldn't not do anything with jobs. So I decided to do like two or three a day. And then I guess Saturday I didn't apply to any and I let it go.

THERAPIST: Good for you.

CLIENT: And I guess I applied to like one... was it yesterday... I applied to one recently. And I decided if I apply to one or two per day. If I don't, it's not the end of the world because Thursday is very close.

THERAPIST: Two days.

CLIENT: So... right.

THERAPIST: You could make up for those two days easily.

CLIENT: Right. Plus...

THERAPIST: Apply to five the next day and the next day.

CLIENT: Yea. So it was really good. And I set up a couple of meetings with people who, within the departments, that may have research opportunities just to feel out what they have or don't have. Or... so yea, I guess that was helpful. And it put it in perspective a little bit. [00:05:01]

THERAPIST: Yea.

CLIENT: So on the one hand, I've calmed down a little bit. On the other hand, it's like when I do calm down, I get to the point where I feel guilty or I feel like I'm being complacent. And then I like feel like I need to kick myself and get worked up. I... so it's hard to explain. I know it's unhealthy. I'm not defending it. But...

THERAPIST: No, no, no. Your describing the sequence is really helpful to hear.

CLIENT: I...

THERAPIST: (inaudible at 00:05:23). So I'm interested in that. What... so you start to feel guilty. And why? Because...

CLIENT: Because if I sat back and said, "You know what? I have read the majority of the textbook which almost no one else has done. I've typed up all these study guides. I've worked really hard. I have all A's in the class. It's going to be fine. I would feel really lousy about that. So I have this like I have to... even if I studied and I knew like I could take it now, I would still feel like I needed to get somewhat worked up because that's just part of... I think part is just what I do. But I also perceive that as being a healthy like I take this seriously. [00:06:02] And it's important that I'm a good student.

THERAPIST: It's almost like you've upheld doing it everything to the nth degree as the ideal. And if you're not doing that, you're doing less than.

CLIENT: Right. And it's hard for me to walk away with that. So even though I could stop studying now and say, "Well, I really need to get a job and I'm going to be OK in the class no matter what," I couldn't do that.

THERAPIST: Yea.

CLIENT: So...

THERAPIST: Again, because you said, "I view that as being really lousy."

CLIENT: It would be... yea. It would be like a failure. It would be a disappointment. It would be lazy. It would be settling. It would be... like I said, it probably relates to my all or nothing thinking but... so that's one.

THERAPIST: Again, just this (inaudible at 00:06:49). A failure it would be being a failure to decide I've studied enough for this (inaudible at 00:06:56) to something else. Like to almost to not do something every single part of something is being a failure.

CLIENT: Yea. And I guess I feel like when I look at my transcripts I can't say, "No Ramona (sp?), you could have... if you end up getting a B, you could have waited four more days to do more with the jobs." So it's like it's never... yea.

THERAPIST: It's never enough.

CLIENT: It's never enough. I did get my final grade in one of my classes already because I turned in my paper a little early and I volunteered to present first and whatever. And so I got an Ain the class which I was surprised because I thought that would be fine. But I was a little...

THERAPIST: Disappointed in an A-?

CLIENT: I was a little disappointed.

THERAPIST: Oh my goodness.

CLIENT: It's not like I... honestly I know I come off this way but I... if one of my friends got a B, I would not think any less of them. It's just I don't know why exactly. So no, that's OK. But on the other hand, I legitimately had a nightmare the other night about having a mistake on my resume. [00:08:02] And yep, so I... yea.

THERAPIST: What was the nightmare? Do you remember the...

CLIENT: Yea.

THERAPIST: ...exact content?

CLIENT: So I had met with my advisor and she was talking about I don't know the importance of tailoring your resume but really proofreading your resume. And she's had this talk with me for before. Not to me. She's says this, I think, to everyone, but how she had a student who wrote, "Attention to detail." This was a strength of theirs in their cover letter and they made a mistake. And she's like, "So you're telling me it's important that you're not making those." And she's like, "So just be really careful."

And so I had this nightmare where it happened to me. And the worst part is the next day I did this awesome... like for the woman who was going to send it to her friend for this position that was posted. I had this awesome cover letter and resume and she even gave me some extra tips that made it really much more polished. It made me sound good. And then I e-mailed it myself to apply and then I e-mailed it to her. And she's like, "You have an extra parenthesis around this one thing." And I had already e-mailed it to her. [00:09:03] (chuckling)

So it was like I had the nightmare and then it came true. And then I was worked up about it. I'm still a little worked up about it. But she will be forwarding her the corrected one. But I just like... so that was a little weird that I've got that worked out that I was having nightmares about it.

THERAPIST: So... and this may sound strange to you but do you remember what the exact nightmare was?

CLIENT: That's as much as I... yea, that I made a mistake.

THERAPIST: Like you don't even remember what word it was. It's just that you made a mistake and how you discovered it in the dream after you had sent it somewhere?

CLIENT: I guess. I just know that I ended up submitting... like that that really happened to me (inaudible at 00:09:39).

THERAPIST: Something that had a mistake in it. Yea.

CLIENT: So which I know is a little... but I guess I've been pretty worked up about that. And on top of which it's maybe silly but Thursday night which is like the end of a really... like a 12 hour day for me, I usually don't do any work school Thursday night. Anyway, my mother-in-law calls and she's like, "Yea, we're going to come for your graduation," which they mean so well. [00:10:06] They really... they meant so much thought but I was just like I can't. I was really getting to a point in the week from having done all that work. I was really into a point where I was I cannot plan one more thing, deal with one more thing, even talk about one more thing right now.

And so Ivan (sp?) gave me a... I forced him but while I listened to her voice about giving me heads up what was going on. But they already booked a room. They already took off of work. They took off work in January and decided to not tell anyone, they... yea, yea. So they like really... they meant really well and I'm sure it never occurred to them like, this is a stressful time. Maybe now is not the time to spring it on.

THERAPIST: When is your actual graduation?

CLIENT: It's the 23th.

THERAPIST: The 23th. OK.

CLIENT: Right. So I mean it's a ways away. But it was still like... and she wanted to know what time it was and she really... I will say she really made the effort to be, I guess, a little more sensitive than usual. [00:11:02] And she was asking really nice... like really... questions like she really cared and really wanted to know. So it was nice but it was just like an additional... it's like, oh, my in-laws are coming.

THERAPIST: Do you wish they weren't coming?

CLIENT: I thought they weren't which was fine. I wasn't offended. But I also was really looking forward to just a quiet weekend with just my parents and my sister and Ivan (sp?). Because that's so rare that we do that or see just them.

THERAPIST: Oh, I see. I see.

CLIENT: I mean dad is going to get coverage for at least 24 hours which is huge for him.

THERAPIST: Wow.

CLIENT: Just for emergencies obviously. But it's huge for him to do that.

THERAPIST: Yes it is. It's huge for you then.

CLIENT: Yea, it is. So it's like I really wish... but my mom was like, "You cannot be rude. At this point, they've already booked everything. And even if they should've asked, you need to..." So it's fine. It is what it is. But that was like... that was a lot for me. And then I got really worked up. I'm like, "What am I going to do? How are we going to coordinate all this? What about change..." [00:12:01]

So on top of which after I got off the phone with his mom, Ivan (sp?) is like, "Oh yea, we should buy your cap and gown or whatever. I think we should get on that." And it's just he... for him I guess it came across because he remembered it was going on. But for me it was like you won't talk about it. You won't acknowledge that it's happening until your parents are coming. So it felt like... yea.

THERAPIST: So that was the first time he actually was willing to talk about it after hearing they were coming.

CLIENT: No. Like I mean... yea, I mean, immediately after hearing they were coming the same day, he's like... then after I got off the phone with his mom, then it's important that I get my cap and gown. And up until them, like... so yea.

THERAPIST: There's so much on what you're (inaudible at 00:12:48).

CLIENT: It's OK. It's OK. But it's like... and I have... I guess I'm a little proud. I've let a bunch of things go.

THERAPIST: Yea.

CLIENT: I see like... I did the dishes because that's my chore. [00:13:00] And then I was like, well, the counter really needs to be wiped off. And I'm like I'm not doing it.

THERAPIST: Yay.

CLIENT: So it was like...

THERAPIST: Good for you.

CLIENT: ...oh, the counter really doesn't look good. But you know what? It can wait.

THERAPIST: That's good. Right.

CLIENT: So it's not the end of the world.

THERAPIST: And how did it feel then doing that?

CLIENT: It felt gross and I felt bad and then I felt lazy. But on the other day, I met myself half way. I was like, "You're not going to clean it. I know I can't clean the apartment right now. That's crazy. But I can... at least I'll just wipe down the bathroom counter. Wipe off the mirror. Like clean that up a little bit. And call it." And I did. I stopped there pretty much. So that was like compromise. So I have tried to let some things go which I feel good about. In reality, yea, as soon as the exam is over, I kind of want to clean the entire apartment. But I'm trying to let it go.

THERAPIST: (chuckling) It's something though if you can force yourself to try to look at while you need the time. It's not as interfering in your life if you want to do a big clean after you don't have other responsibilities as much. That's a different story. [00:14:05] But to make yourself be doing that right now, that's when it's becoming a pathology in you. Do you know what I mean?

CLIENT: Yes. And I thought... I even thought about it the other day. Like I could really... I could go through some things. I could deal with... and I thought that's just the way to deal with my anxiety and stress. I'm not going to do it and my sister... actually she knows me very well. (chuckling) She's like... she called me. She's like, "Well, I'm on my way over. We're going to go to the beach for a walk." I'm like, "Oh." She's like, "No, we're going to go."

THERAPIST: (chuckling) Oh.

CLIENT: So we just walked along the beaches. It's not a "beach" beach but it's like... there's space to walk. So it's just 15 minutes away or so. We just walked a couple miles, came back.

THERAPIST: Oh, that's lovely.

CLIENT: Yea, it was really, really good for me so... yea.

THERAPIST: It's a really good example the kinds of things that over time we can try to help you be able to do even for yourself more. How do you create spaces that are actually not frenzied, not cleaning and just... and have those be OK instead of something that makes you feel guilty. [00:15:10] Something that's rejuvenating instead of degrading of your sense of yourself that you took a break. It's hard for you to do.

CLIENT: It is. It is. And I'm finding sometimes when I'm still getting really... my chest feels like... feels really tight. It's hard to breathe.

THERAPIST: Yea.

CLIENT: I know that's the anxiety and the panic. But that's happening and it's just... sometimes I really I feel like I'm at the point where I could be the tiniest additional thing and it would be too much for me. So...

THERAPIST: There's so much anxiety and particularly a sort of strand of the anxiety is perfectionism. And I know you know this in a way. But one of the things I hear... I'm just going to put this a little bit more bluntly than you've been phrasing. It's as though if we walk through what the automatic thought and feeling is that comes up when you're looking at a dirty counter trying to get yourself not to clean it. It's as though that counter is a representation of your sense of yourself to you. [00:16:16]

Like a dirty counter means you're a bad person. You're a lousy person. You're a lazy person. You're not worth much. A clean counter makes you feel in the heat of the moment like you're a good person. You have things in order. You have things in control. That's just something we have to start kind of dismantling and teasing apart, breaking apart a little bit. Because if you actually think about it, all it is, is a dirty counter.

CLIENT: Yea.

THERAPIST: It's just a description of a counter with some coffee stains and crumbs on it. That's all it is. It's almost like people who are claustrophobic and you want to expose them to the types of situation just get them to know nothing happens. Like actually you're not going to die and you have a full blown panic attack. [00:17:01]

And they eventually learn, OK, I'm fine. So I'm a little squished but that's all it is. It's the same thing for you with the counter. It's like wanting to expose your brain to looking at it and just seeing describing it as a counter. This is mindfulness. What is the description of it without there being judgments of your sense of yourself? It has nothing to do with your sense of yourself. In your childhood, it did, right? You're... it... the lack of cleanliness of your household very much had to do with your parents selves and their pathologies. You're not them. You're not somebody who is so depressed she's not cleaning her house all the time. You're actually quite the opposite. So you're trying to sort of just break apart. It's just a dirty counter.

CLIENT: It's just... yea.

THERAPIST: Just let it be a counter. (chuckling) You'll clean it tomorrow. You're... you can't feel good enough about yourself without things being perfectly normal. And I think the same thing goes for studying. It's like, all right. So you'll let go of a chapter that you've already reviewed a little bit earlier in the semester. How do you feel good enough about yourself? [00:18:09] There's not a feeling of good enough-ness, right?

CLIENT: Right.

THERAPIST: It's perfect or bad.

CLIENT: I would agree. Yea, and I appreciate that that's the all or nothing. And it's so easy to label it as that but it's so hard to change that thinking.

THERAPIST: Yea.

CLIENT: So I feel bad if I have an A-. I feel bad if Ivan (sp?) forgets that I'm graduating. Even if it's truly... he really is forgetting, I feel... I internalize all of it into myself worth which I know is very unhealthy and which I would never do for someone else. If they got a Bor if their kitchen counter was dirty, I wouldn't judge them. So I know that's something I need to work on.

THERAPIST: You're so hard on yourself.

CLIENT: It feels like something that's stuck with me from last session was you said the more I can do the interpersonal skills and the less I can do the criticism, the more the problems whatever they are like real like they can be more... like they can eliminate my portion of it in part. [00:19:08]

THERAPIST: Yes.

CLIENT: But I thought... and so I thought about that. I've been thinking about that. And it's scary to me because then I lose control over it. I lose responsibility for it. I lose the ability to change it, fix it, make it my fault, feel bad about myself. Feel good about someone else because that feels better. That... if it's my fault that the counter is not clean, I just I clean the counter and then it's done. So it's like I know that might not make much sense but that's...

THERAPIST: It makes a ton of sense.

CLIENT: OK.

THERAPIST: I hear you. You're saying that you're aware and some way you have an investment in being the one who's making the mistake because then at least it's in your control. If you can be like... if this is what's not perfect about me, you go fix it. Then it's still you and your problem. It gives you something to do about it which is how you handle your anxiety by doing, doing, doing, doing, doing, doing, doing. [00:20:09]

It makes a ton of sense. I mean, I also realize thinking about the interpersonal effectiveness skills. For example, that I don't ever want you to get the message that this is... you just have to get more perfect at being interpersonally effective. Do you know what I mean? Because in a way you could also use that as, oh, OK. I'm not doing a good enough job here. And better learn this skill and go be perfect at this and perfect at that. It's not about being perfect. It's about finding ways that you can be driven more by what's good enough and not by the need to have yourself be perfect and you need Ivan (sp?) be perfect. I know Ivan (sp?) is far from perfect. But I think that the pressure the level of the criticism that comes at yourself and at him is about there's nothing less than perfect that's acceptable that's inside you. [00:21:05]

CLIENT: I don't know why. Like I said, if I went over to my friend's apartment... like I have went over to my friend's apartment and it's not spotless, I actually... this will sound maybe like I'm a horrible person. But I almost... I feel a little good because it's like they're not perfect. And I like that they're not perfect.

THERAPIST: Oh, so it's a relief almost.

CLIENT: It is.

THERAPIST: Yea.

CLIENT: And I don't judge them and say, "Oh, I wish you cleaned your apartment." Or, "This is gross." It makes me feel good. I mean, if it was filthy I would feel differently. But the fact that there's clutter and it's a little messy and whatever, it almost feels easier. Because sometimes if I perceive that they're perfect or everything... you got an A or it feels like something bad about me. Or it feels like... I don't know. Maybe it's easier to be friends with someone or have a relationship with someone who isn't so perfect all the time and who doesn't always have it together. [00:22:06] It feels like there's space for me to not have it all together.

THERAPIST: To be human.

CLIENT: Yea.

THERAPIST: (inaudible at 00:22:11) human. Yea, that makes a lot of sense. I mean, it's... you qualified it when you said, "If I go over and they have a little clutter. And you said, "I don't mean filthy but some clutter," that's an experience of something. The kind of what's good enough that you didn't get to have as a kid. It was filthy.

CLIENT: Yea.

THERAPIST: So it leaves you... when you're a kid growing up and especially you where your brain works about kind of order and organizing to manage your anxiety. You're growing up in filth. It's not that you grew up in a place where sometimes clutter gathered because people were busy leading their lives, right? It was really filthy.

CLIENT: Yea.

THERAPIST: So you don't have... you literally have black in your... like why do you have black and white? Because it was black. It wasn't grey. It wasn't... what's my parent cleaning from time to time. Getting it nice and clean and then it gets dirty again for a while and people, because we're busy going to lessons or having family night or whatever. [00:23:16] It was really, really filthy. So to have this experience of a friend have some clutter and kind of ordinary messiness, that's OK. And someone who you love or like or admire is really new. I also wonder, Ramona (sp?), as you're talking about this, there's so more, so much more for us to understand about how much self-loathing there is in you.

CLIENT: It's really... so I've done a little more journaling and it really does come out there. And I really feel bad about it. I understand that's really unhealthy. I understand it's very... it doesn't even help me maybe. Well, maybe it does help me deal with the problems but in a very unhealthy way. [00:24:09] And I'm almost like embarrassed to admit it because I don't want to be a martyr. I don't want people to feel sorry for me. I don't want... because it's my own doing. It's not like someone is telling me to hate me every day and I hate myself as a result. It's... I just... I don't know how to...

THERAPIST: Yea, but see, that's what I've read... what I have read. I know I didn't read this week but it feels so important and clarifying to me. It doesn't seem like you're trying to be a martyr or trying to be special in some way. I mean...

CLIENT: It actually it almost makes me feel... I don't know. Like if something goes wrong, I really find myself thinking it. Like, oh, I hate myself. [00:24:56] Like and it's so... I've caught myself and I'm like wow. Even if Ivan (sp?) says something, if I mess up something, if it's like I'm having trouble getting all my stuff together, like it can be such a range of things. If it goes wrong, even if it's someone else's fault or mine, it's like oh, I just...

THERAPIST: I wonder what you're... when you think about those feelings I hate myself or I'm terrible at this. I hate myself. I hate myself. I hate myself. It's a really kind of beating yourself up as I've read in the past. Do you think about any... does something come to mind about being a kid in your family? Like is that... was that a common mantra even then?

CLIENT: I had it at home definitely especially when I was really depressed. I would write it over and over and over and over.

THERAPIST: You were even writing it specifically. Huh.

CLIENT: I would hide it but I did.

THERAPIST: Yea.

CLIENT: And it... I don't... I think... I really don't know. But I'm assuming it's back to the same coping that if it's my fault or if it's something about... if they aren't showing me... if someone doesn't show me that they love me in the ways that I perceive love, it's not their fault. [00:26:10] It's my fault for not being lovable. It's a comfort. Again, I guess it's about the control. That I have control over the issues and...

THERAPIST: You weren't being shown what you needed and would make you feel lovable in so many ways.

CLIENT: Yea. And I... so Ivan (sp?) is really trying and he's made some real progress. Then there are other times where it's just... it really feels so much like he doesn't love me. And it feels... and then I replace it with he really just married me so I would take care of him which is a horrible thing to believe about... but I really think it is... he really... he's expressing to me that it really is him forgetting.

So Dr. Farrow (sp?) gave us an assignment to sit down and talk about graduation. [00:27:01] We went to do the assignment. He's like, "I can't remember what we're supposed to talk about." And I'm like, the whole point of this was to address the way you... yea. So it's really hard to tease that out and say, "OK, he's struggling with this. It has nothing to do with me." He's like, "I forget the... I forget other things, Ramona (sp?). It's not about you." But it's really hard to do that. So...

THERAPIST: Yea, because as a child you would tell yourself it was your fault when your father... I mean, I could throw a couple at you. Your father was never around as one example or when your mother wouldn't clean the house despite begging and pleading. I guess I start to wonder, did you start telling yourself, "It must be because I'm not that great. If only I were a better person or more this, more that."? I mean, I don't know where your mind went as a kid. What the fantasies were about? [00:28:03]

CLIENT: It was definitely like if I could ask her in a different way, if I could have her in a better mood, if I could motivate her, if somehow it was worthwhile that it would be worth... but more than that it was then the fact that the house was a mess, it really did feel like it was my responsibility. And it was my fault that it was a mess. Because I was at a certain age old enough to clean on some level. And at least help my sister. But it really... I don't know. I guess I do wonder do my parents (inaudible at 00:28:43). My mom at least would tell me that she and my dad stayed together because of us. I wonder I didn't feel a little responsible for the arguments and for the... I don't know. I did wonder if my dad would be home more if I wasn't so critical. [00:29:00] I did wonder if...

THERAPIST: If you weren't so critical? You wondered specifically that then?

CLIENT: Yea. I did wonder if we would have a better relationship if I wasn't so... I broke another promise. You weren't home. You... there was a lot of times... there were a lot of times where I would really tell... like I was just so angry and I would really... and then I got to a point where I didn't want him to be home. I would still sometimes complain that he wasn't home but I didn't... I really got to the point where I was happier or able to clean the house in peace if he wasn't home because I was just so upset. It was just so unfair.

THERAPIST: Yea. When you say because you broke another promise, what would actually happen as you would start to... do you remember sort of the unfolding as you started to get angrier and angrier and let him know. Like what... how did that go?

CLIENT: So it would be something like there were certain tasks outside or at the house that I couldn't do or couldn't do very well. [00:30:05] So weed trimming we have like two and a half acres of property so...

THERAPIST: That's huge.

CLIENT: Not for where we live but...

THERAPIST: But it's a lot to take care of.

CLIENT: It is a lot to take care of especially if you have a pool and a grapevine and a fenced in dog yard and a backyard with... our play set is still there. Just like a lot... and then all the flower beds and all the...

THERAPIST: It's a lot of work.

CLIENT: It is a lot of work if you want it to look nice. And so sometimes there would be things that would be like really just that he could do. And I would like do the bargaining, the pounding, the... there were a couple times where I made him sign a piece of paper saying he would do them by a certain date. So childish but so...

THERAPIST: Like what kind of things? Do you remember what you...

CLIENT: Yea. So it's like, "I will trim outside. I will move the trailer that I left sitting forever out there. I will cover the pool. I will clean out the pool." Things like that that we just... it was really pretty much entirely outside. [00:31:05]

THERAPIST: With your dad.

CLIENT: Yea, because cleaning was never the man's job in his family or in his perspective. And my mom never... doing the outside, she felt, was his job. So I mean, at least they seemed close to agree on that. Not that I think it's right but... yea. So it would be stuff that... because it was embarrassing. I could never have friends over.

THERAPIST: Because like the pool would be filled with leaves or things like that.

CLIENT: No I mean, because the house was filthy inside and outside he would leave all kinds of stuff sitting. My parents... both of them would. Like they'd take stuff out and just like leave it there. They wouldn't trim, wouldn't weed, wouldn't... Emma (sp?) and I always...

THERAPIST: Because it's all overgrown.

CLIENT: Yea, Emma (sp?) and I always did the mowing but there is a limit to much we could do outside.

THERAPIST: Of course.

CLIENT: And we mostly cleaned inside. And he... I mean, he would... he still right now he has like a trailer sitting at the corner of the lane because we have a lane because it's back in the country. And his old truck is sitting on the property as well because it broke down and we've begged him. [00:32:10] Like, "Dad, just donate it and take it some kind of tax credit. Just let it go." "No, no. It'll be worth something." So now there's like an animal living in there, I feel. (chuckling) And it's just like so...

THERAPIST: Yea, yea.

CLIENT: It... we... it's just these battles.

THERAPIST: And would your sister be involved in this kind of battling, too?

CLIENT: So when she was in high school, they went through a phase where they had fights, arguing, yelling. Like where she would beg and do the same exact things. And then when I...

THERAPIST: And all begging and pleading to take care of the household kind of stuff?

CLIENT: Right. Yea, come home, take care of his bills. I mean, Emma (sp?) and I tried so many... she actually did a lot of... she did some billing for him at one point she would consistently work for him. And I did a summer where I did surgery packs and unloaded drugs and like stocked the shelves and stuff. [00:33:00] So we've both done some but we would beg him like, "Please just send out your bills once a month." Or, "Please give them to... give them out as you do the service."

THERAPIST: How would you even know that... in other words, his practice wasn't at the house, right? It was.

CLIENT: Mm-hmm.

THERAPIST: Oh.

CLIENT: Right. So he has a huge office with this gorgeous huge desk that you can't see, leather desk with a glass on top. I mean, it's a beautiful... and his... anyway...

THERAPIST: So you could see the inside of this office...

CLIENT: Yea.

THERAPIST: ...and it was very disorganized.

CLIENT: Yes. That would be the (inaudible at 00:33:37).

THERAPIST: And did you know that you were... like were you low on money? Like how did you know he wasn't sending bills out?

CLIENT: That's the thing. So we always knew he wasn't sending bills out because there would always be stacks of bills. Like you could go through a client and have bills from the 90s. Have bills from... right.

THERAPIST: Oh my goodness.

CLIENT: And people that we knew from hearing the fights with my mom and dad who hadn't paid tens of thousands of dollars of bills because that care is very expensive actually.

THERAPIST: Of course. Yea. [00:34:06]

CLIENT: And that he would still continue to go and work for them. And he would still take on new clients. And he would still... like it just... it really... and it's still going on. I mean...

THERAPIST: Yea.

CLIENT: It's a mess. But I guess my mom... that might have been part of the way that we really knew how bad things were sometimes. But it wasn't that... so the kicker was it was never that we didn't have money because my dad was working. He was earning... he had all these bills to send out. People owed him tons of... they still owe him tons of money. So it was never that we couldn't afford things. But it was that he would also in his poor business management and a desk that's piled high with random like bills would not get paid. He was very disorganized. So we would get calls on the phone. So and so is due. A notice on the door your electric is going to be cut off. [00:35:01] And it wasn't that we didn't have the money. So it was just...

THERAPIST: Just unbelievable stories.

CLIENT: It is kind of... yea, right. Well, but in all fairness... maybe it's not fair. But he went to vet school and he went to college and he's never taken a business course in his life.

THERAPIST: But he also didn't... if he... so to be aware, OK, this isn't my strength. I'm really disorganized. You'd hired somebody then.

CLIENT: It's a control thing.

THERAPIST: Yea.

CLIENT: So he now has like a secretary of some kind who does some work. But it's also hard to keep someone when you're that behind and that much of a mess and that like difficult... with a crazy schedule. It's hard to... and he has to... he won't just give her things and let her do them. He has to have a lot of control. So it's like he's his own worst enemy in a lot of ways.

It's really sad because especially Emma (sp?) went to a college where there were a considerable number of wealthy people. It was not an inexpensive college. [00:36:00] It was... anyway. People thought that she was wealthy because when you say my dad has his own practice people don't think that you're poor. And my mom doesn't work. It really does sound... and that's hard. And I've heard that sometimes and that's hard because it's like... it's not so much the...

THERAPIST: It's like there's a stream of income that should have been there but it wasn't always necessarily there at all.

CLIENT: Right. But when he really needed to or when we really needed... like of course he always found a way to make somebody pay or...

THERAPIST: Yea.

CLIENT: Yea.

THERAPIST: So you end up as a little girl in this system starting to feel like maybe the way to feel better about this level of chaos you're living in is to take it on yourself for you to become the secretary in a way, for you to become the manager of your household. And if only you could get good enough at that, you could help your parents out of this or somehow help them see the light.

CLIENT: Yea. [00:37:07]

THERAPIST: It's quite a construction. I mean, even... you can hear it... I think you caught yourself a few minutes ago when you said, "Because I was old enough to... at that point to clean." Even if you're 16, you're a teenager who should not be in charge of keeping an entire household running.

CLIENT: I know.

THERAPIST: But there's a way you have set up inside you that somehow at the very least it could have been all your responsibility and you should have taken care of everything.

CLIENT: Yea. And I still... sometimes I still have an urge to like go home and deal with...

THERAPIST: Yea.

CLIENT: And I still catch my... the other day I called my mom and she's like, "Oh, I just vacuumed the living room. I thought I'd take a break before I vacuum the kitchen or whatever." And I just like... I thought... I caught myself getting like, "So, does that mean the house is OK? Does that mean the rooms that are like the disaster rooms are just the only ones left? Does that mean it'll be like that when I come home?" And then training myself like Emma (sp?) tells me "Don't get your hopes up. Just let it go. It is what it is." [00:38:07] So that's... I'm also pretty stressed actually about... like I really want to see my parents. But I literally had a nightmare last night about their arguing, their fighting. And I just feel so...

THERAPIST: What was it? Again, I'm going to ask you details.

CLIENT: That I don't remember. That I don't... I just when I woke up, that was like at the forefront of my mind. I was just dreaming about that.

THERAPIST: Them screaming at each other?

CLIENT: No, just I guess fighting. But it's... I will say I... Emma (sp?) always tells me. She's like, "But you don't have to be like them in the ways that you don't... the things that you see that..." And I do. I feel really horrible because my mom is so critical of my dad. Like unbelievably. Like she will put him down, belittle him, embarrass him in from of Emma (sp?) and I as like on the phone, in person. Like constantly. It's like impossible to have a conversation where she doesn't make some kind of put down towards him. [00:39:03]

And I understand why she's... like I'm not saying my mom doesn't have the right to be angry. But it doesn't like... it's really bad and it's... I so don't want to hear it. And I think to myself, that is me sometimes with Ivan (sp?) and I don't want to be that person. And it doesn't... it's not even like it's a means to an end. It's not even helpful. It's not going to make a difference.

THERAPIST: You can hear when she's yelling at him. Sometimes it's just... it's different than to be... have a constructive delivery of being, "I'm frustrated with this. Let's talk about it." But there's something you're saying that just sounds mean. She can just be cutting.

CLIENT: It's... and it's like any conversation can be a platform for it.

THERAPIST: Yea, yea.

CLIENT: I'm calling her and telling her that I need to get some fillings done. And she's like, "How is Ivan (sp?)?" And I'm like, "Oh, he's good. He didn't need to get anything done at the dentist." She's like, "Well, that's how your dad is. You know he never goes to the dentist and he still doesn't." And I was like, "I know he doesn't go to the dentist. I know he doesn't go to the eye doctor. I know that..."

THERAPIST: So like any subject could get turned into a way of bashing him. Yea.

CLIENT: It's so... it's not like the most malicious... saying that he doesn't take care of his teeth isn't the most malicious thing in the world. [00:40:04]

THERAPIST: No, no. But it's like this subtle constant dig, dig, dig, dig, dig at him.

CLIENT: It's really hard to be around.

THERAPIST: Yea.

CLIENT: And it's just... so that combined with my in-laws combined with... I just I feel so...

THERAPIST: It's going to be a lot. (chuckling) I mean, even without your in-laws. Just your parents being here, it's such a rare thing.

CLIENT: It is very rare.

THERAPIST: It's... there's a lot riding on it and so much feeling. Ramona (sp?), one thing I hear to think about is just as a concept maybe for this week. Your parents because they themselves are very narcissistically self-preoccupied, they're in their... your dad is in his own world doing his own thing not thinking about his accountability to other people or to the rest of the world. Your mother is in her own world just lobbying subtle or loud accusations, criticisms at your father. Telling you, "We stayed together only for you." [00:41:05] She's not thinking about what that's like to hear as a child.

CLIENT: No.

THERAPIST: She's only operating for what works for her inside her own private psyche. Not thinking about other people. So what happens in that way then in development is you don't get taught by either one of them how to begin to recognize that your mind is separate from theirs. Because they never recognize your mind is separate. The solution that you came up with to manage this chaos is one in which it's as though there's no boundary between your mind and theirs. If they're not cleaning it must be my fault. If they're not getting it, then there must be something I could do differently to get them to do it. Do you hear how it's like our minds... my mind is part of theirs. So if I could only... if I could do something different, it'll change their mind. [00:41:59]

It's as though you're not a separate person from them. Same thing with Ivan (sp?). It's like some people just use the expression a narcissistic extension of the self. It's as though your dad not cleaning is a reflection on you. So you better change something so that this happens differently. It's like what happens in my hand over here is part of me, right? And my brain is controlling. It's as though you would tell yourself it's so connected to you that as long as you did something up here, you could make it do something different out here. Rather than knowing they're separate.

Again, what would have helped you so much, let's say you still lived in filth and the bills being unpaid. But if your parents could have even paused from time to time and said, "Ramona (sp?), I just want you to know this is not your fault. This is not your responsibility. I'm really sorry that I'm falling short in this way. It's my depression. It's your father and I have a rough time in the relationship. That has nothing to do with you. Don't take responsibility of that." You would have been in such a different place if just that sense of, "Oh OK, not my fault, nothing to do with me," could have been given to you. [00:43:07] Even if you still lived in the same stuff. That's where the worst trauma happened of all is that no one recognized your separateness and the impact on you that you were slowly taking this all as your problem, your badness. I actually think there are ways that got fed in a way that...

CLIENT: There... oh, I'm sorry.

THERAPIST: No, go ahead.

CLIENT: I was just going to say there have been some times when they've been really apologetic and like, "This is so horrible that I let this go and this is all my fault." And like, "You shouldn't have to deal with this." And my mom will sometimes even say like, "I don't want you to come home and clean. I don't want..." And my dad will really try. Like, "I really want to have a closer relationship with you. I really want..." And so there are periods of that and they seem few and far between. And they seem brief.

Then there are other times where it's like, "It's your fault for wanting the house to be clean. It's your fault for wanting me to work less. It's your..." [00:44:03] And literally my mom saying like, "Well, your sister..." Like my mom... my sister would come home from college or whatever. And the house wouldn't be clean and I would ask my mom if we could... she could help. And she's like, "Well, she's not the queen of England. We don't need to..." And that kind of like, "It's your mentality that's the problem, not the..."

THERAPIST: Yes.

CLIENT: But it's... I agree that it's very hard for me to separate out like this is their problem, this is their thing. It doesn't reflect on me. They would've done it no matter. If they had had (inaudible at 00:44:31) maybe. It's hard for me to do that with Ivan (sp?).

THERAPIST: Yea.

CLIENT: And it feels... even if I'm able to step out for a minute and at least try to say that, it feels really hurtful still.

THERAPIST: Yea. I think it is the truth with Ivan (sp?) that it did... I don't... there's nothing I've heard from Dr. Farrow (sp?) or Dr. Bourd (sp?) or even my sense of him here as brief as it was that he's doing this on purpose because he doesn't love you.

CLIENT: No, no. [00:45:02]

THERAPIST: Do you know what I mean? In some ways, that's a more satisfying explanation because you can... then it's your fault again. I think he has deficits that have nothing to do with you. That doesn't mean you have to then, "Oh, well, now I'm going to love his deficits." And I'm thinking no, that's not it either. You then are faced with, "Well, it's disappointing that he has these deficits and it... I don't know if this is going to be OK with for the rest of my life." But it's different than saying, "Oh, it must be me. It must be that I'm just not worth more than this."

That's what you and I have to work on together. That feeling because it's just not true. And I actually think if you felt like you were worth more and you really just knew that, I think some of the stuff that would happen with him would start to unstick some too because you... it comes... the anger and the criticism sometimes that comes out. Underneath that even if you don't say it in the moment is tremendous self-loathing that drives the criticism. [00:46:07]

In other words, it's like when you're yelling at your dad as a teenager, you're feeling in your own self, "I'm a piece of shit because you do this." So you're yelling at him, it's like yelling at your hand, "Stop doing that," right? So that... because you feel like it's your fault. There's so much self-hatred inside that I think who knows what would happen, I guess, if we could help you, over time, start to unpack that and look at the ways in which you've hated yourself for things that had nothing to do with you and weren't your fault. That it might shift some of the ways the criticism plays out for... of him. And allow you to hold him more accountable in different kinds of ways. Not less accountable because, oh now he's just sick and I have to accept his deficits. [00:47:00]

No, a different kind of accountability might be possible. So just go about, I think, a task of just thinking about this separateness of your minds. It doesn't mean... separate doesn't mean I have to love them this. It could still mean I really don't like that. Now that I... sometimes you might even dislike it even more once you recognize that it has nothing to do with you. But just trying to draw the boundaries and recognize (inaudible at 00:47:31). And you're going to do the things (inaudible at 00:47:34).

(inaudible at 00:47:39) the next few days to let some things go, OK? Just keep working and keep trying to say, "OK, I'll go for a walk instead of cleaning the apartment or instead of reading this chapter a few times. (inaudible at 00:47:52) allowing yourself some practice with it. (inaudible at 00:47:57) not be so (inaudible at 0:48:00) perfect all the time. (inaudible at 00:48:02). OK? (inaudible at 0:48:05).

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