TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Ramona, just to let you know, the Monday of Memorial Day I’m going to be out.

CLIENT: What date is that?

THERAPIST: It’s the 27th, so two more weeks after this. It will be three weeks from now I’ll take a week off.

CLIENT: Okay.

THERAPIST: You’re graduating soon. Is it around then that you’re graduating?

CLIENT: Actually it’s on the 18th, the Saturday, so I was actually wondering maybe for those two weeks if we could find another time, since you’ll be away the next week. That Monday my in-laws are leaving in the morning, which I don’t know if that means I should be around or not.

THERAPIST: So we should take off the 20th?

CLIENT: Yes, the 20th and then, I guess, the 27th, if there are other times those weeks. (pause) [00:01:06]

THERAPIST: If you want to take a look next week as it gets closer.

CLIENT: That’s fine.

THERAPIST: The reason it’s tricky for me is that that week I’m out Friday, so at the moment I’m pretty booked solid for the week.

CLIENT: I could probably be okay. I should probably talk to them and make sure.

THERAPIST: Going two-and-a-half weeks – it could be okay for the time?

CLIENT: Yes, I can try. I should probably just clarify with them what they’re doing anyway.

THERAPIST: If it makes any difference, I might have a time open a little bit later in the day. I don’t know if that helps at all.

CLIENT: No, it probably would because they said they were going to leave in the morning.

THERAPIST: I’m almost definitely going to have a 1:20 time. Would that be better?

CLIENT: That would probably. Yeah.

THERAPIST: Okay. So I’m going to put you down with a question mark for then. Do you want to check on it and let me know?

CLIENT: Yeah, absolutely. [00:02:02] (pause)

THERAPIST: Where are you?

CLIENT: I guess a little better. I’m done pretty much; I just have to finish up some research hours.

THERAPIST: Congratulations.

CLIENT: Thanks. And do my loan exit counseling, so that’s not too huge of a deal. The final that I was worked up about, I already got my grade and I got a 97, so that was good.

THERAPIST: Wow!

CLIENT: That was my main class, so that was good. I had a job interview at the [ ] (inaudible at 00:02:36) on Friday, so that’s good.

THERAPIST: Oh, my goodness.

CLIENT: And then I had sort of another pseudo-interview during the week. I say “pseudo” because she just has to wait for her new job to be secure before her position officially opens, but they already asked for my resume and gave it to her boss, so that’s hopeful.

THERAPIST: Where is that? [00:03:00]

CLIENT: That’s at Walter Reed at the clinic. That one I’m more interested in. So, yeah, it’s going.

THERAPIST: And these are for research assistant-ship kinds of positions?

CLIENT: Sort of. The one at the [ ] (inaudible at 00:03:12) was a data coordinator, which it turns out is kind of a glorified data entry person and you don’t need a Masters or anything for it. The other one is actually a patient navigator, which I don’t know if you know, is kind of a new thing.

THERAPIST: I don’t.

CLIENT: For the HIV. Everyone at the Walter Reed gets screened for HIV and then they would get screened additionally if they’re positive for the study and they pretty much have to have almost full-blown AIDS or actually have full-blown AIDS and be IV drug users – so pretty serious cases. Then it’s an NIH trial that’s being done in ten major cities and there are three arms of the RCT, and one of them is patient navigations. [00:04:01] You basically go with them to their doctor’s appointments. You learn about their medications and their side effects. You go tour their methadone clinic with them. You’re in contact a lot with them and it’s to really be a support system and encourage them to adhere. That’s one of the arms of the trial, so it sounds interesting. She also evaluates the program. So it’s less epi and more infectious disease. It was interesting and good. I just have to wait and hear what happens from her.

THERAPIST: It’s nice to feel that there are irons in the fire and possibilities of things.

CLIENT: Yeah, it was encouraging to have interviews before I’m even done, so that was helpful. I haven’t even applied to that many yet, so it feels a little hopeful. So that’s good.

THERAPIST: How have things been with your sense of yourself? You finished this exam. This is a big deal, this transition, but I wonder kind of where . . ? [00:05:03]

CLIENT: Yeah, it’s funny. My mom called the other day and asked, “I just wanted to know how your interview and your exam went.” And I told her and she’s like, “And how are you feeling about yourself?” (laughs) “Are you feeling any better about yourself?” I guess the answer is not really, which is weird because you would think. But not too much.

THERAPIST: It’s not that weird. That’s why I ask because these other things can kind of cover up and, for the time being, make it feel like the external is going a little bit better; but the long-term, deeper work is still about your feelings about your own person, regardless. The reason is why it’s not surprising, Ramona, is that you’ve gotten plenty of A’s in the past, for example, and it doesn’t touch this feeling. It’s not like “Oh, now I’m a worthwhile person” and that gets inside now.

[ ] (crosstalk at 00:05:51)

CLIENT: It feels like an expectation. In fact, I felt a little . . . It’s silly because I’m old enough. But I told my mom that I was good and I got a 97 and she was like, “Of course you did. Of course they let you interview. Of course it went well.” [00:06:07] I know how she meant it. She meant it like “I had no doubt. I have confidence in you,” but it felt a little bit like – it’s baseline. (chuckles) So it’s okay. I had a really long week, just really, really long days. I was exhausted, but then somehow Saturday morning by 9:00 I’m redoing one of the kitchen cabinets and I thought, “Okay, at least I held off.” I let it go during the week, but the kitchen counter was gross and I couldn’t let it go anymore; so I did that. I did one cabinet and the rest of the apartment still needed to be cleaned. I let it go.

THERAPIST: Meaning you stopped at one cabinet; you got one cabinet cleaned?

CLIENT: It was already clean, I just decided I wanted to rearrange it a little bit, dishes and stuff like that.

BREAK IN TAPE FROM [00:07:05 to 00:08:38]

THERAPIST: It could also be that you’re a human being who gets tired and needs a break and some time to sleep more and some time to not do as many activities. If it stays like that, that’s a different story; but I also never hear that you get to say to yourself “I get a break today.”

CLIENT: Saturday and Sunday I didn’t apply to any jobs. I kept up with [ ] (inaudible at 00:09:01), but it was okay. I’m not going to apply to any jobs. It’s okay. I didn’t do my loan exit counseling either, which I can do online, which I just want to make myself do today. So it’s good; but I also recognized the part we were talking about, like it’s never enough. I guess I’m still waiting to really feel good and now it’s okay. I can get the apartment floor room cleaned, especially because everybody is coming to visit and if I get a solid job offer that I want, that I accept and that I have a start date and I finish up these last couple of things that I have for school, then it’s good. It’s like that’s the new . . . I’m like once that happens, there’s going to be something else. So on the one hand, it’s probably normal to feel relief once you get a job lined up; but on the other hand, it’s like there’s no moment where I’m stopping and feeling just good about “it’s done; it’s over.” [00:10:10] It’s probably also because I’m terrified that school is over and it does not feel good at all to have it be over because it’s all I’ve ever done. It’s been the one thing throughout everything in my life that has been steady and a place where, even if it’s baseline or it meets everybody’s expectations only, it still feels good and other people recognize it. Just being in school with all the worked-in deadlines and activities, it’s such a productive atmosphere. I guess I always based my worth or self-esteem off of doing all of that and if I’m left to my own devices, what’s going to happen? And if I don’t have those grades, whatever they are, or if I can’t obsess over those things to make me feel good or alleviate my anxiety, what am I going to do? [00:11:07] I’ve already gone down the thought process of “what if I get fired from whatever job I get?” which is so bizarre; but it’s so typical for me to have a worst-case scenario survival plan in place. I know that’s really unhealthy. I’m not proud of it. So that’s scary for me. On top of which I’m pretty scared that once it’s over and I start working, I’m really worried that a lot of resentment is either going to be solidified or it’s going to really come out – especially with Ivan because it’s going to be the end of the two-year agreement and he’s still going to be not quite holding up his end – still really struggling to say supportive things about what I’ve done – and it’s going to be over. There’s going to be no room to correct it, fix it, deal with it, and I worry about that. [00:12:09]

THERAPIST: When you say “the end of the two-year agreement” what’s the two-year agreement?

CLIENT: We just agreed that I was going to go to school for two years and we agreed that Ivan was going to work full time for two years. That was pretty much it.

THERAPIST: And after that?

CLIENT: There wasn’t really, although it was kind of implied. Before the whole grad school thing happened it was implied that Ivan was going to be working for those two years and he was hopefully going to be getting started on his PhD or getting into better jobs – and I would probably just work for a while. I really worry about that and it sounds like I can’t get over it. I mean I can’t, evidently, and I don’t want to be like that. I don’t want to carry around this grudge, but I’m worried that that’s what’s going to happen and I’m also worried that in whatever happens with him, I’m not going to have this school thing that’s kept me afloat to hang onto. And what if I’m not good at my job? And what if it doesn’t pan out? And what if my coworkers don’t like me? And what if there is no baseline measure of success? I don’t know.

THERAPIST: What if you struggle the way Ivan has?

CLIENT: I feel all of this pressure to either get the perfect job that pays a lot of money or what if I don’t have anything for a while and then I could be applying or not applying like he has been and just in this limbo. It feels right now like no matter what I do, I’m really scared that it’s going to bring that issue with us. [00:14:03]

THERAPIST: It feels like those things and how you feel about yourself in this stage of your life and how you feel about him in this instance are so intertwined. It’s like you are simultaneously imagining “this is going to make me feel this much more critical of myself as well as of him.” I was thinking the same thing about your quitting school. Even though you talk about your childhood a lot of times, it sounds like school – and I may be projecting a little bit because you haven’t said it in this level of detail – but I imagine you going to school, getting homework assignments, coming home, doing your homework. This has been kind of structuring and the scaffolding, in a way, that’s given you a sense of yourself. It feels like something that you can hang your hat on that makes you feel good enough about yourself is getting good grades, meeting deadlines, getting on top of things. [00:15:03] To be at this turning point where you’re imagining letting go of that as the scaffolding of your positive sense of yourself is terrifying. Who are you going to think of yourself? How are you going to think of yourself as an employee, at a job, where it’s not . . . There aren’t grades. Certainly, there will be evaluations of some kind. At every job there are, but it’s really, really, really quite different. You felt good about yourself or about checking off the boxes of school. In some ways, to me, this is an opportunity to get to know more about what those feelings are underlying because they’ll come out a little bit more without this scaffolding.

CLIENT: Yeah, I’m really worried. It also feels like the one place I’ve always been where I get recognized for doing well in varying levels, but also all of the adults are responsible and they’re there and they’re reliable. [00:16:07] It’s an environment where I can count on other people where it’s a very strict expectation. If this professor didn’t get back to you, that just isn’t allowed to happen. They have their people to answer to. There are all these other people who are doing the same thing. I guess it feels supportive, it feels safe, it feels secure. How can going to school be a bad thing? You’re doing something really good and productive that’s contributing.

THERAPIST: It’s a really interesting association, too, because in a way you’re saying that school is an environment where you have mostly gotten to count on the authority figures doing what they’re supposed to do.

CLIENT: Yeah.

THERAPIST: They might be better or worse at their job a little bit, but they’re still going to show up. They have to teach the class. They have to grade your papers. They have to get their grades in or else they get in trouble, right? There’s another authority holding them accountable and that’s been so reassuring to have adults in your life who do their job. [00:17:08]

CLIENT: I feel like it’s a place where people who have potential have to use it. At some level, they all have to. I guess I feel like my parents and Ivan – there is so much potential and they don’t have to fulfill it. I’m also a little scared that it’s going to be hard because it’s the one area in which my dad can talk. He can talk about school, he can talk about work, and that’s like it. And he’s already . . . He wants me to go to vet school, pretty much. I was pre-vet undergrad. That was my focus.

THERAPIST: He says that?

CLIENT: He would never say that, but he’s still like, “What about those jobs with . . . I know a couple of the people at school who are vets. What about contacting them?” It’s not something that I’m opposed to, but I just feel that he still really wants that for me. [00:18:04] I guess it’s a little scary to let go of that, too, because it’s the one area in which he always looks favorably upon me.

THERAPIST: It’s a way you feel like you have contact and connectedness with him.

CLIENT: Right. And I’ll have that if I get a good job. I will have that. But I already feel pressure because he’s like, “Now, don’t take the first offer you get, Ramona. If someone does give you an offer, you don’t have to rush.” I feel all this pressure. I know he probably doesn’t mean to put it that way. Between that and my mother-in-law continually harping on the CDC, I’m just like I really just want to get something; and whatever I get I want people to not make a fuss, but I want them to have something positive to say instead of “Oh, it’s okay, but you could have done . . .” especially in light of what’s been going on with Ivan. [00:19:01] If you don’t think it’s fair for his parents to say he’s managing a coffee shop and that’s just the way it is; but “why aren’t you working for one of the biggest [ ] (inaudible at 00:19:12) organizations?” It feels like all or nothing. It feels

BREAK IN TAPE FROM [00:19:16 to 00:20:44]

CLIENT: But I’m not going to let that work me up. It’s my job and I’m going to do what I want or what I’m capable of doing. That would be the healthy way to go about it. (laughing)

THERAPIST: So who – this is your father, maybe, inside you? What could this possibly feel like with her? Did he have expectations? How did that play out as a kid – expectations around job and school? Was there pressure from your parents?

CLIENT: Yeah. That’s the thing, my parents would never in my entire life ask me or, to my knowledge, call me to work on homework or study for an exam. To have done that would have been an insult. In fact, sometimes my dad, even just in grad school, would be like, “Well I know you’ve got to study.” That type of thing, which is kind of insulting because coming from them, they would just never have asked us to do our assignments or anything like that because (laughs) we were never not going to do them. It’s just the way things were.

THERAPIST: Both you and your sister?

CLIENT: Yeah.

THERAPIST: You automatically did your work?

CLIENT: Right.

THERAPIST: They could just take that as a given?

CLIENT: Yes. I don’t feel like there was ever a situation – no. And they never said like “we need you to get all A’s” or “we would love you more if you got all A’s,” but it was also never a big deal. [00:22:06] Sometimes we’d go to dinner at the end of a school year or something or once we did get our report cards, but it’s not like a “let’s go celebrate.” They never did that, but my dad did have a tough time the first time I got a D in chemistry. (laughs) He did have a tough time.

THERAPIST: What happened?

CLIENT: It was just a marking period grade. It wasn’t my total grade, but I had done very poorly on the exam and it wasn’t because I hadn’t studied. I’m still bad at chemistry, kind of, but he was just speechless. He just didn’t say anything and then there was a parent/teacher conference that came up and he went in and spoke to my chemistry teacher alone and wanted to know what I should be doing. (sighs) And then he spent some time with me preparing for the next exam and telling me “okay, these are the sample book questions that your professor thinks the exam is really based on the book, so you need to be doing these instead.” [00:23:10] I know he meant well, but it felt a little difficult because I wasn’t slacking off. That would have been one thing, I guess.

THERAPIST: There is no emphasis on applauding your effort and you’re working really hard at something as a kind of paramount thing and the grade is really secondary.

CLIENT: Yeah, but I think my dad would never think of it that way because he works insanely hard. His dad worked insanely hard. No one would ever – it would be like an insult if someone asked him to go to work or asked him to apply to a job because it’s just understood, expected, baseline. [00:24:04]

THERAPIST: That’s kind of how you feel when Ivan’s parents are saying things like that to you, like “do they know who I am? Don’t they know I’m going to get a job and I’m going to do well?”

CLIENT: Yeah.

THERAPIST: But I guess that’s the thing you’re describing. It’s so assumed. I don’t know how to describe this. It’s almost like you don’t get to get applause if you do well at something. It’s just taken as a given expectation – your mom saying, “Well, of course.”

CLIENT: Yeah, I guess. I had a situation in which I got really upset about it, which is really weird for me.

THERAPIST: When you were younger you’re saying?

CLIENT: No. Within the last couple of years. My friend, Judy, from college, a really great friend, I really love her. She’s wonderful, but we’re different in a lot of ways. She did this internship down at Disney. She likes to cook and she did this cooking program for one year during college. [00:25:03] She came back from the internship and she moved in with her parents and she didn’t have a job until May and she came back around Thanksgiving; and they were totally fine with this because she was like, “If I take a bad job, I know myself and I won’t apply to more.” So they just let her not do any – and my parents would never let me. This is unthinkable.

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