TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: How are you?

CLIENT: Okay.

THERAPIST: How are things going?

CLIENT: I guess somewhat similar to last week.

THERAPIST: Mm.

CLIENT: One thing I want to make sure, I guess, I do in my session today is to come up with something to, I guess, ask of Ivan to do once a day.

THERAPIST: Mm hm.

CLIENT: As per (laughs) the deal we made with Dr. Farrow (sp)

THERAPIST: Yes, yes.

CLIENT: So I definitely want to do that.

THERAPIST: You didn't meet with Ivan, I mean with Dr. Farrow (sp) last week, right? She's away?

CLIENT: Or this week. She's on vacation.

THERAPIST: Okay. Okay.

CLIENT: Yeah.

THERAPIST: So you've had some time give it thought. (laughs) (pause) Are there other things on you mind?

CLIENT: Mm hm.

THERAPIST: I know you often say (laughs) within five minutes before [you have to go] (ph).

CLIENT: Mm hm. Right.

THERAPIST: "One thing I want to talk about." What else is on your mind, just so we make sure we get to everything.

CLIENT: Um. (sigh) Yeah. So I guess a lot. I feel like I'm being, lately I'm realizing at least, feeling very triggered by certain things.

THERAPIST: Mm.

CLIENT: And by triggered I just mean feeling that it's very much a repetition, feeling very, very worked up about it. [00:01:03]

THERAPIST: Mm. Mm hm.

CLIENT: I'm just feeling kind of stuck in that I've made some progress here, but there are some things that are still, I don't know, they've been happening for a really long time and it's part of, I guess, what we've been trying to work on.

THERAPIST: Yeah.

CLIENT: But it's hard to be patient sometimes with that.

THERAPIST: Mm.

CLIENT: So I'm feeling some of that.

THERAPIST: Triggers, the triggers specifically in things Ivan is doing or not doing. Is that what you're referring to?

CLIENT: (sigh) I think, yeah, by and large.

THERAPIST: Or stuff you're doing yourself?

CLIENT: Yeah, I think by and large with Ivan. But then I'm also noticing with myself feeling even more responsible for other people's things lately. Or feeling more, I don't know, more anxious or more, like even if things are going well, like the job search well whatever that means that feeling just like, "I'm never going to get a job. This is the end of the world. Like this is horrible. I feel so horrible about myself." And just feeling Which is not new. But just a persistence of that, I guess. [00:02:10]

THERAPIST: Hm.

CLIENT: And, I don't know, I guess that's a lot of it. I also, I mean, talked with our parents recently, or my parents, and I need to go home at some point in July because I need to get my car inspected.

THERAPIST: Mm.

CLIENT: So I was talking with my sister about that. And then she got kind of worked up because my Mom is having some health problems. I mean she's okay, but she's having some health problems and just like the typical, "What do we do when we go home?"

THERAPIST: Mm.

CLIENT: Because we usually spend the whole time taking care of the house, helping with certain projects, mediating (laughs), and just it's really difficult.

THERAPIST: Mm hm. Mm hm.

CLIENT: So I guess it's natural to feel a little triggered thinking about all of that -

THERAPIST: Sure.

CLIENT: and anticipating it, and planning. So I guess that's the summary.

THERAPIST: Mm. Hm. (pause) That's a lot. I also am aware, and this relates to the unfolding of how things will go for you in the next few weeks. Dr. Farrow's (sp) back next week? [00:03:20]

CLIENT: Mm hm.

THERAPIST: Yes. This might be a place just to make sure we cover this as well, just to start, is my being away next week -

CLIENT: Mm hm.

THERAPIST: and how that's going to feel to you. I know she's back. I was really happy when I found out. We checked in on our vacation times a month ago that they wouldn't overlap too much. But it's occurred to me that the person who is covering my practice is actually [Britney Keller] (ph), (laughs) so we should talk about whether or not we should come up with another name for you or I assume that would feel a little strange to see her if something came up.

CLIENT: Mm hm.

THERAPIST: Or if seeing or talking to Dr. Farrow (sp) would feel sufficient. Would it just help to have another name? I want to check in with you about that.

CLIENT: Um. I don't know. I guess I feel a little, in theory it might be good. But I guess I feel a little reluctant because I've spent so long -

THERAPIST: Yeah.

CLIENT: and I guess you've spent so long, getting to know me and -

THERAPIST: Yes.

CLIENT: understanding what's going on.

THERAPIST: Yeah.

CLIENT: And I don't know how effective a forty five minute session with -

THERAPIST: Yup.

CLIENT: For all intents and purposes, a complete stranger -

THERAPIST: Yes.

CLIENT: would be. Not that they aren't, you know, good at their job. But I just wonder how much of that time I would just spend explaining my situation. [00:04:35]

THERAPIST: Which I totally agree.

CLIENT: (laughs)

THERAPIST: So just so you know, for the record, I was not suggesting that you set up an appointment with this person, but only that you have someone in case there were an emergency.

CLIENT: Oh, oh, oh, oh. I understand.

THERAPIST: Do you know what I mean?

CLIENT: Yeah. And if there was an emergency I think I would feel okay.

THERAPIST: You could talk to Dr. Farrow (sp)?

CLIENT: Yeah. So I think that's fine. So thank you.

THERAPIST: I just wanted to make sure because that would be weird if you called to get my covering person and then we hadn't talked about the fact that it was somebody you knew in a different context.

CLIENT: No, that's fine. Thank you.

THERAPIST: Dr. Farrow (sp) does know I'm away too.

CLIENT: Okay.

THERAPIST: The system, even Dr. Bourd (sp) knows, is aware kind of when people are in and out. So your issues around your going home, issues around Ivan -

CLIENT: Mm hm.

THERAPIST: issues around your own self responsibility and trigger which relates to going home and Ivan.

CLIENT: Yep. (laughs)

THERAPIST: So I wonder, I guess I wonder if we start even with you, what's been happening? What have you been trying? I was looking over your list of cognitive distortions. I reviewed it and it occurred to me I should probably get that back to you to write down challenges for each one. Because so many of them are so active for you right now. [00:05:51]

CLIENT: Yeah.

THERAPIST: You were coming up with really good and current examples, that it sounds like figuring out what's an alternative way of thinking about this could help you during this very vulnerable time. You're in your first job hunt, so one of the first things I think cognitively is a strategy to keep in mind is that it's not always going to feel this way.

You're going to find a job at some point. Even if it takes you two years. (laughs) I know that's horrible to say to you. But your professional development is going to unfold and it won't always feel this bad. But right now is the worst it's going to get.

CLIENT: I think something I'm aware of So, for example, I have three short interviews tomorrow, all for the same job.

THERAPIST: Mm hm.

CLIENT: So this past week I got an interview scheduled, I met with somebody at the U (ph) who had a bunch of names of people they worked with -

THERAPIST: Ah.

CLIENT: who do AIDS research, etc. So I got a bunch of names to e-mail, I did my job seekers workshop that I meet with every week.

THERAPIST: Mm hm.

CLIENT: I found a couple of more jobs and applied to them which was amazing because I was going for a while and just not finding anything that looked good to apply to -

THERAPIST: Mm.

CLIENT: that felt appropriate. So those would all sound like positive steps. [00:07:10]

THERAPIST: Mm hm.

CLIENT: But emotionally or, I don't know how to describe it, it feels the same.

THERAPIST: Mm.

CLIENT: It feels just as kind of hopeless, depressing, anxious -

THERAPIST: Ah.

CLIENT: as the week when I had no interviews, I found no new jobs to apply to.

THERAPIST: Interesting.

CLIENT: I mean I still did the workshop. But you know what I mean?

THERAPIST: Yeah.

CLIENT: So it's like that would look like progress but it's not acceptable, it's not good enough. And I thought even if I would get this job tomorrow -

THERAPIST: [The same.] (ph)

CLIENT: and that sounds like what I want to do. And in all fairness, I applied to it two months ago. (laughs) So -

THERAPIST: Mm.

CLIENT: And they're just now getting around to -

THERAPIST: Oh really?

CLIENT: Yeah. Evidently, because they just now called me for an interview.

THERAPIST: [So interesting.] (ph)

CLIENT: So unless they have been interviewing for two months, yup. (laughs) So that's just like really, that's hard to take.

THERAPIST: Mm.

CLIENT: And I just started, like I did orientation for another volunteer position which was great to add to my resume.

THERAPIST: Mm hm.

CLIENT: Good skills to develop to apply to jobs. So like those would all sound like really good things.

THERAPIST: Yeah.

CLIENT: But to me it feels the same.

THERAPIST: Hm. Which is? How would you describe the thoughts and feelings? [00:08:15]

CLIENT: It feels hopeless. It feels like, I guess maybe the best way to describe it is, there's no belief that these steps will lead to a really, you know, a good job, a good paycheck, a good experience. a good There's no really firm underlying belief. There's a vague like, "At some point I'll get a job."

THERAPIST: Mm.

CLIENT: But it's more flooded with "what if?" It's not What if I have to take a (inaudible 00:08:41) job for now?

THERAPIST: Mm hm.

CLIENT: What if I have to (sigh) do a temp job? What if I And so I know that's me.

THERAPIST: Mm hm.

CLIENT: And that the tendency to focus on the negative as opposed to the positive, I know that's me.

THERAPIST: Yeah. Well it also sounds like, it reminds me of you and academics in your classes and in studying. The way you describe your study process was, it's as though you didn't have any history of having studied well and done well before.

CLIENT: Yeah.

THERAPIST: Each exam would be like the first exam you ever have taken. And the anxiety would be so high. And the feeling that you would have to cover everything and then some, and over and over and over and over again, and use every spare second until the exam comes.

CLIENT: Mm hm.

THERAPIST: Rather than What's missing is trust, sort of a built foundation of trust in yourself. That sounds like that's the kind of place you're in with this. You don't trust that any of this is going to go anywhere.

CLIENT: Yes. And I think a common thread is if, using the test example, if I could have read ahead into the future, if I could have done some fortune telling -

THERAPIST: Mm.

CLIENT: and known I would get an A on the exam -

THERAPIST: Yeah.

CLIENT: with the studying I had done, you know, a few days before -

THERAPIST: Uh huh.

CLIENT: instead of obsessing until the last minute, I still would have felt the need to obsess until the last minute because it would have felt shameful -

THERAPIST: Mm.

CLIENT: or arrogant, or it would have -

THERAPIST: Wow.

CLIENT: Right? And I think that's where I'm at with the job thing too. [00:10:10]

THERAPIST: Ah.

CLIENT: There's no, even if I have a belief that I will Even if I could, which right now I don't feel that way. (laughs)

THERAPIST: Yeah.

CLIENT: Even if I could have the belief that I will get a decent job, it will not be forever, I would still feel the need to be down on myself and be upset that I'm not earning money. Because otherwise what am I doing? Would that be lazy?

THERAPIST: Hm.

CLIENT: Would it be, you know, a similar scenario. So, like I said, it's times like that when I realize externally things are going better.

THERAPIST: Hm.

CLIENT: I mean getting an interview, and getting more names to contact.

THERAPIST: Yeah.

CLIENT: Those are all positive things, but if I don't feel, if my emotions don't match up with that, I recognize that's just me.

THERAPIST: Yeah. Yeah. It's like you bring a you who has a whip out whipping yourself wherever you go. Whether it's going very well or not very well, it's the same whipping that's happening. [00:11:15]

CLIENT: Well and I think it just keeps If I got this job offer tomorrow, instead of saying, "I got a job offer and I've been working and things have been going a little better recently."

THERAPIST: Yeah.

CLIENT: "And now at least I have an option."

THERAPIST: Yeah.

CLIENT: I wouldn't say that. I'd say, "But this isn't the job I really want."

THERAPIST: Yeah.

CLIENT: Or, "This isn't the salary." So there's a part of that that feels a little fair. Like maybe it really isn't a job that would be my first choice.

THERAPIST: Sure.

CLIENT: But there is a part of that is also, "Is it ever going to be enough?"

THERAPIST: Yeah. I think, Ramona, even if you got the perfect job right now -

CLIENT: Yeah.

THERAPIST: Not that any job is perfect, but a job that is like the best job that you can think of that is available right now and you got it. I think there would still be a way that voice would be with you. Quickly it would find something else to make you feel like you're not enough. It might even simply be, "Okay, what am I going to do after this, because this is fine for a year but this isn't going to get me anywhere further." And, "Why didn't I go to get my doctoral degree."

CLIENT: Yeah. [00:12:15]

THERAPIST: You know? It's the running, it's like a tape of self-criticism that just shifts what to criticize depending on what's happening. That's really, really powerful. And the more you kind of start to recognize that it doesn't matter what you do, that voice is going to still be there. Because I think right now the voice convinces you that it's still like, "No, there's still something factual that we're being critical of. And if this factual things changed then we would lighten up on you." I think it sometimes feels that way.

CLIENT: It's really hard to separate out because -

THERAPIST: Yeah.

CLIENT: the tape, as you call it. I feel like there's a component to it that is legitimate. Like you might not have, like, "I really don't have any job offers now."

THERAPIST: Yeah.

CLIENT: Or, "I really have not been applying to as many. It's been hard to find " So there's a portion of it that feels legitimate. And there is a portion of it that I agree would be there no matter what. [00:13:16]

THERAPIST: Yeah. Even the legitimate portions though, here's where I think the self-criticism would have legitimacy. Let's say you've been sitting burying your head in the bed for a month and haven't gotten any applications out because you were so depressed you couldn't do anything. Okay? Or it had been two years of applying and you still hadn't gotten anywhere. Or somehow every day you went to go look for jobs and you just couldn't and you watched TV instead.

That would be, okay, you're not doing enough. Right? And we have to help you do more so that you're doing enough to keep up with things. But that's not what you're describing, Ramona.

CLIENT: Yeah, but I do feel like there are some days, especially I'm thinking of, I guess, not this past week but the week before where I really didn't, I don't know if I applied to any jobs that week.

THERAPIST: And why not that week?

CLIENT: (sigh) Because I just got so gosh darn frustrated.

THERAPIST: Mm hm.

CLIENT: And I found myself not finding ones to apply to. And I did find myself on my laptop ending up doing other things because I just got so sick of looking through job board after job board and not finding. And I feel like that's an excuse because, you know, it is what it is. I can't just not keep looking because I went through a few job boards and there was nothing. [00:14:33]

THERAPIST: Yeah.

CLIENT: But I'm not (sigh) having the, for whatever reason, I just don't want to sit in front of a laptop any more.

THERAPIST: Mm hm.

CLIENT: Even to do non-job search things.

THERAPIST: Mm hm.

CLIENT: And sometimes it's just so overwhelming and so -

THERAPIST: So I think if only this critic weren't so bad. Because actually, Ramona, what you're describing sounds very reasonable to me. You've searched and searched and searched, and applied and searched and applied and searched as much as you can. And then you took a week off from doing that.

CLIENT: But it wasn't even But then -

THERAPIST: You couldn't conceptualize it as a week off.

CLIENT: (laughs)

THERAPIST: But not only did you take a week maybe to get Who doesn't get tired sitting at their laptop all day long? Most people need to have some time where they say, "Okay, I don't care what else is out there, I have to go get away from this," for one. Two, my guess is your brain actually was making some calculations about the fact that in the past several days hardly anything had come up.

So the idea that taking a break, maybe there was room to take a break because you've exhausted, for a little bit, looking at things. And you might want to wait some time, let some things get posted again, and then start applying again. Do you know what I'm saying? [00:15:42]

CLIENT: I do. I even find myself in the days or the time when I take a break -

THERAPIST: Mm hm.

CLIENT: Like yesterday I helped my sister get ready because she's going to be moving in a few weeks.

THERAPIST: Mm.

CLIENT: So I didn't do any jobs yesterday.

THERAPIST: You helped her?

CLIENT: Right. (laughs) That was great. But then sometimes there are days when, and Saturday I did. So Saturday and Sunday I did not do any job stuff, even though I'm actually excited because I now have, like there's another job I've worked on the application and I'm getting ready to submit it. And I find myself being critical. Like, "I took this day to relax, but did I really spend the day really relaxing or did I waste it just watching random TV."

THERAPIST: Mm.

CLIENT: Or did I, like, "Was the apartment clean before I relaxed." Like did I really, actually thoroughly relax.

THERAPIST: Oh my goodness! Oh my goodness! Yes!

CLIENT: So it goes the other way. Like, "Did I work hard enough? Did I really relax?"

THERAPIST: Did you relax well enough? (laughs)

CLIENT: Did I maximize the time. And, I don't know, I guess I'm feeling stuck because the ways in which I would usually feel good about myself for doing things are completely absent now.

THERAPIST: Mm.

CLIENT: No job, no school.

THERAPIST: Yeah.

CLIENT: The most I can do is clean the apartment. [00:16:46]

THERAPIST: Yeah.

CLIENT: I don't even feel good when I was doing job applications so much because I haven't gotten a single offer. I've done all these applications, no offer. It's like I could have never done them.

THERAPIST: Mm.

CLIENT: Not like I could have never done them, but it hasn't yielded anything.

THERAPIST: Mm hm. Yeah. That's the pigeon analogy.

CLIENT: (sigh)

THERAPIST: That it won't unless you keep doing it, but it's very infrequent reinforcement. You're left with your core sense of yourself right now. That's, in your mind, really, really not good. The ways you've compensated for that are by doing well in school, succeeding, achieving, A's, studying. So without that and without the immediate reward right now, "Okay, I put in job applications, I got the interviews, I got the job," to make you feel good about yourself and sort of check for having efficacy in your life.

CLIENT: Yeah.

THERAPIST: You don't know what to do and how to feel about yourself. I mean the fact that you can even get critical about how you're relaxing. (laughs) [00:17:51]

CLIENT: I don't. And the worst, I don't want to say the worst part, but something that does not feel very good is Ivan does not ask like, "So how many applications?" Or, "Did you find any good jobs?"

THERAPIST: Mm.

CLIENT: Sometimes he will ask a really generic question or I'll just tell him. That's more frequently the case.

THERAPIST: Mm hm.

CLIENT: He's never once said like, "Well, maybe you should try this."

THERAPIST: Yeah.

CLIENT: Or there's never even been a hint of criticism or a hint of -

THERAPIST: Mm.

CLIENT: "It would be nice if you got something soon."

THERAPIST: Hm.

CLIENT: I remember distinctly, like there was a day when I just didn't, I don't know. I don't even remember the exact circumstances, but I told him, "I didn't apply to anything." Or, "I didn't really get a whole lot done in that day."

THERAPIST: Mm.

CLIENT: And he just said, "Oh, it's okay." And it just was like, "No. I don't want to hear that from you. I don't want you to let me be you."

THERAPIST: Ah.

CLIENT: "I don't want that to be okay." And the other night I, internally, just kind of lost it because he's like, "Yeah, I know what that's like to apply to jobs and not hear back." And I'm like, "No."

THERAPIST: Mm.

CLIENT: Like, "This is not the same. I am not doing what you did. I am not you." And it might be unfair, it might be snobby even, but a lot of his jobs he was just like submitting resumes on Craigslist, to Craigslist listings. [00:19:00]

THERAPIST: Yeah, yeah, yeah.

CLIENT: And that's a lot different from going through a hospital website and -

THERAPIST: Ramona, you're not Ivan. You will never be Ivan.

CLIENT: (sigh) But it's scary to me -

THERAPIST: You're not that.

CLIENT: that that would be acceptable to him, potentially.

THERAPIST: Mm.

CLIENT: And I even felt bad because I thought, "What if he's thinking to himself that his process is the same as mine." And what if he's thinking, "Well, finally it's my turn and I'm not going to be critical of her the way she was of me." What if he -

THERAPIST: Mm.

CLIENT: And I don't know, I hate that comparison because it doesn't feel like the same process, first of all. I am actually looking for pretty specific jobs with specific intent as opposed to lots of random jobs just throwing out my resume in large amounts.

THERAPIST: Mm.

CLIENT: I don't know. It was (laughs) not good for me.

THERAPIST: Yeah. The problem is though then that then there is no room in your relationship with each other to hold each other compassionately. To even say to each other, "It's okay. It's going to be okay." [00:20:01]

CLIENT: I think it's hard to have that balance because for Ivan I don't know if I could reach the point where he would have even a loving criticism.

THERAPIST: Mm hm.

CLIENT: Or, you know, even a problem solving approach to it.

THERAPIST: Mm hm.

CLIENT: As opposed to the always, "It's fine." I wonder if there would come a point. And that bothers me.

THERAPIST: Hm. So if he were to say, "Okay, Ramona, why don't you try this?" That would feel empathic right now?

CLIENT: It might.

THERAPIST: Hm. Like it would feel like taking care of you.

CLIENT: Or it would feel like a small amount of accountability. I don't feel like it would be appropriate for him to say like, "You haven't been trying. You haven't been interviewing," because I have.

THERAPIST: Yeah. That's what I [would be wary of] (ph).

CLIENT: But there's a -

THERAPIST: How could be possibly descend with criticism right now when you've been doing everything you can? Do you know what I mean?

CLIENT: I wouldn't say I've been doing everything.

THERAPIST: I would expect you to respond by saying, "Are you kidding me?" You know, "Do you know what I do? I do everything? Look at you. Why don't you criticize yourself for a second?" Do you know what I mean?

CLIENT: I don't know.

THERAPIST: Maybe taking loving interest, maybe that's the word. Rather than just, I could imagine, "It's fine," could read like, "I don't care." [00:21:12]

CLIENT: It's just I don't want him to feed into my anxiety.

THERAPIST: Yeah.

CLIENT: But I guess I want him to have some level of concern. Like it feels good to know that if I don't have something in the next couple of weeks he's not going to say like, "What the heck? You're not contributing?"

THERAPIST: Yeah. Yeah.

CLIENT: It's good to know that that's not the case. But right now it feels like the opposite. It feels like if in a year from now I was just still kind of doing this and not, that he would maybe be a little annoyed. And that doesn't feel good either.

THERAPIST: Mm.

CLIENT: It feels like whatever.

THERAPIST: So does it feel like that when I say to you, "You've got to be able to have days off?" Does it feel like I'm not concerned enough?

CLIENT: Maybe.

THERAPIST: A little bit?

CLIENT: I think for me it mostly, like when you say I've been doing everything I can. I'm like, "No."

THERAPIST: Yeah.

CLIENT: "There's no way I've been doing everything I can."

THERAPIST: Okay.

CLIENT: I am not sitting in front of my laptop eight hours a day. I am not even putting in thirty five hours a week, I'm sure, which is what they are recommending. You know, if you don't have a job to be, thirty five hours a week job search.

THERAPIST: Mm hm.

CLIENT: Including interviews and networking stuff and -

THERAPIST: Mm hm.

CLIENT: meeting. (sigh) But I don't think I'm hitting that. [00:22:18]

THERAPIST: Mm hm. Who is recommending that?

CLIENT: Career Services. (sigh)

THERAPIST: Thirty five hours a week?

CLIENT: If you don't have a job. (sigh)

THERAPIST: Okay. How many hours do you think you're doing a week?

CLIENT: I have no idea.

THERAPIST: It sounds like it's varied from week to week, somewhat.

CLIENT: It has been. It also varies day to day. And there are days when I'm spending the majority of five hours a day, you know, volunteering plus a couple of hours transportation.

THERAPIST: Yeah.

CLIENT: So that day is, like that's a lot of that day.

THERAPIST: Yeah. Although that's important for your applications too, that work. That's not -

CLIENT: I know. I also felt, this is, I don't know, I guess it's off topic, but I felt kind of bad because at our last job seekers workshop there were only four of us. And the one girl didn't show up because she got an offer.

THERAPIST: Mm hm.

CLIENT: Another girl did show up but she had, it sounded like, a pretty good offer. And that had only taken her a couple of weeks to get it.

THERAPIST: Mm hm.

CLIENT: Which she admitted from her job search was very atypical that it would go that quickly. [00:23:21]

THERAPIST: Mm hm. Mm hm.

CLIENT: But a consulting job, huge paycheck.

THERAPIST: Mm.

CLIENT: Like really amazing.

THERAPIST: Hm.

CLIENT: And she still came and still worked on it because she's like, "Well, it's not, you know, a done deal yet." But I just felt like (sigh)

THERAPIST: Consulting and this is in public health also?

CLIENT: Yeah. It's a research, it's a consulting agency and it pays really, really well.

THERAPIST: Mm hm. Is that something you would want to do? Like is that even something you would apply to?

CLIENT: I don't know that I would have enough experience.

THERAPIST: Oh.

CLIENT: She definitely had more. She did more DOR (ph) in school -

THERAPIST: Yeah.

CLIENT: than I did.

THERAPIST: Okay.

CLIENT: But I just felt like, (sigh) I don't know.

THERAPIST: Yeah.

CLIENT: Like even if I got a job I would be thinking to myself, "She's making almost double what I might be making."

THERAPIST: Mm hm.

CLIENT: "What's wrong with me? Why aren't I making (laughs) that?" I don't know. So, like I said, there's a part of it that feels rational and there's a part of it that feels like if I got a great job, even if it was in my interest -

THERAPIST: Mm hm.

CLIENT: I'd be thinking, "Why aren't I making as much as she's going to be." [00:24:20]

THERAPIST: Yeah. So if you were to try to find the voice right now that feels like a reasonable way of looking at what's happening with your job search, how would you describe? If your finding I'm not even talking about just rational, like, oh, not just the challenge that says, "Don't worry. You'll find a job eventually." You know? In other words, what is realistic about what's happening?

Other people, someone's gotten a job offer. Why? Why haven't you? What's the reality based challenge to some of the fear thoughts?

CLIENT: Um. I guess, so there's a really real element that there has been some funding cut to infectious research, to government research.

THERAPIST: Mm hm.

CLIENT: And some of those have been jobs that I've applied to. I guess, I don't know, I probably did a good thing by going from undergrad to grad. [00:25:22]

THERAPIST: Mm hm.

CLIENT: But a bunch of people I went to school with didn't.

THERAPIST: Mm hm.

CLIENT: And they had some great experiences in between.

THERAPIST: Mm hm.

CLIENT: And some of them also worked during, like more substantially, and competing with them.

THERAPIST: This is some of your co-wart (ph) you mean? Like they took a few years off before going to school?

CLIENT: Mm hm.

THERAPIST: Okay. That makes a difference.

CLIENT: Yeah. (laughs)

THERAPIST: In reality, that can totally make a difference getting a job, people with experience can make it harder for you. But not because you're an idiot. (laughs)

CLIENT: No. But it doesn't, it just doesn't feel good. I don't know how to describe it. I'm not used to -

THERAPIST: You're used to being at the top.

CLIENT: Not necessarily even at the top, but -

THERAPIST: Getting what you want, in other words.

CLIENT: Going after something and having a reasonable chance of getting it, I guess. And right now it feels a little more like -

THERAPIST: Mm.

CLIENT: I was definitely a small fish in a big pond in grad school.

THERAPIST: Mm hm.

CLIENT: But it didn't always feel that way.

THERAPIST: Hm.

CLIENT: Some pretty small classes. But then now it feels like I'm -

THERAPIST: Hm. Like you mean an even smaller fish in an even bigger pond? [00:26:30]

CLIENT: Yup. (laughs)

THERAPIST: Yeah. Some of it is the reality of how the world is an enormous pond and you're not alone in feeling like a small fish. That every person is a small fish. I think there is a way you take that reality and then make it be something bad about you.

CLIENT: Oh yeah. Absolutely.

THERAPIST: Do you know what I mean?

CLIENT: I mean I'm already thinking, I started on this research study in February, and I'm thinking, "Why wasn't I doing that last February?"

THERAPIST: Mm.

CLIENT: Why wasn't " I just, like I went to this orientation for this volunteer thing at BMC. And there are juniors in college who are volunteering. Not for the same thing.

THERAPIST: Mm hm.

CLIENT: But I don't know if they'd be able to do the same thing, or be allowed rather. But I'm thinking, "Why wasn't I volunteering at some major hospital when I was junior in college?" (laughs)

THERAPIST: Mm hm.

CLIENT: Like what?

THERAPIST: What's the answer to that? If you follow that, what's the reality about why not?

CLIENT: Well I did internships at vet clinics which, if you want to do research in a hospital they don't care as much. [00:27:38]

THERAPIST: Mm hm. And at the time, do you know why you did that?

CLIENT: Because I was pre-vet. (laughs)

THERAPIST: Yes. There you go.

CLIENT: Yep. I mean I still looked at jobs at the, like over at Angel at Tufts Veterinary.

THERAPIST: Yeah.

CLIENT: But a lot of them aren't, they're not where I'm at exactly.

THERAPIST: Hm.

CLIENT: So I would be really far above or really like cleaning exam rooms.

THERAPIST: Yeah. But, so in other words, here's a really classic of example of where you can get into that your current life, seeing someone else got specific experience in your field in your college. "Why didn't I do that?" The why you didn't do that, there's a very good reason, Ramona. You didn't even know you were going to be doing this. (sigh)

CLIENT: But that's the other unacceptable element. I don't know what ultimately what my dream job is.

THERAPIST: Mm.

CLIENT: I don't know ultimately what, you know, do I have my last degree now? When am I going to do another one in the future? What is it? [00:28:40]

THERAPIST: Mm.

CLIENT: Like that's not acceptable to me to not have, especially given, like I said I got really triggered a lot this week.

THERAPIST: Mm.

CLIENT: The other night I was doing job stuff and Ivan got on his laptop and sat on the couch. And he just looked up jobs by a salary number.

THERAPIST: Mm hm.

CLIENT: And that, in and of itself, isn't maybe a huge deal. Like he was just curious what a certain salary range, what those jobs might look like.

THERAPIST: Mm hm.

CLIENT: But for me, I just lost it. I just, like inside of me there was something that just, it was like the end of the world.

THERAPIST: It felt so unfocussed?

CLIENT: So unbelievably unfocussed. Not even like, "No, just a number." And I just, I couldn't do it. I'm like, "Wow. He is twenty six. He has no clue what he wants to do." He's not even trying to search by job category, let alone title. (laughs)

THERAPIST: Hm.

CLIENT: It's just like, I don't know. I could not handle it. And maybe that's not fair, but I just could not handle it. [00:29:44]

THERAPIST: Well I think that one of the things that comes up when you feel that strongly towards some part of him is that maybe there's a piece of the feeling you're having for him that is also for yourself.

CLIENT: That's the -

THERAPIST: That's what you're describing feeling towards you.

CLIENT: That's the problem. If I had, I could have a little more room for him to have no clue what he wants to do, a little more room -

THERAPIST: Mm.

CLIENT: if I had a very exact, very detailed plan for myself with real outcomes. If I was enrolled in a PhD program and had a full time job and, you know -

THERAPIST: Mm.

CLIENT: knew that I was going to be coming out with x, y and z in five years.

THERAPIST: Yeah.

CLIENT: That would feel much more acceptable. That at this point I'm the one who doesn't have a job right now.

THERAPIST: Mm hm.

CLIENT: I don't have anything definite and he's over there like, "Whatever." You know, just searching by Like totally not applying to any of those jobs. Just looking at what they might be. (sigh) I know that sounds, it is, it's very unforgiving, it's very harsh. But to me it felt representative of a much bigger problem. [00:30:46]

THERAPIST: The person I think you're harshest on of anyone in the world is yourself, Ramona. You and Ivan are quite different, you are not in the same category about where you are with job searches. You're not struggling the way he struggles to find focus and to find direction and to be on top of things. You just aren't. You might some weeks a little bit. That is within the range of normal.

Every person looking for a job struggles some weeks some. No one perfectly does thirty five hours a week. Not a single soul on the face of the earth does that. Right? That's called trying to strive for some perfection that doesn't exist. I think when you fall off of being absolutely perfect, you feel like you're somehow doing what he's doing. Which is not the case.

You are not searching by salary. You would hope you might if you were curious and that would be okay. And maybe if he were doing a great job search otherwise and then just one day wanted to search by salary because he was curious, that would be a different story. That's not what you're saying is happening with him, right? There's something, it's a symptom of his being unfocussed.

You are not unfocussed. You are hyper focused and hyper critical. [00:32:05]

CLIENT: But it's just, I guess it's feeling hard to meet somewhere in the middle. And it feels like Ivan is slowly coming up in some of those skills.

THERAPIST: Yeah.

CLIENT: But to me, and I recognize that this is critical and unfair and in reality he is making progress at a significant rate, I guess.

THERAPIST: Mm hm.

CLIENT: But it feels like way too slow. It feels unacceptable.

THERAPIST: Yeah.

CLIENT: It feels like the same stuff over and over.

THERAPIST: And yet that might also might be a symptom of your being really, really critical still.

CLIENT: It might be.

THERAPIST: Do you know what I mean?

CLIENT: It might -

THERAPIST: Because forget towards him. You are that way towards yourself when we know it's not really rational.

CLIENT: But I don't think I apply my standards to myself to Ivan.

THERAPIST: Mm.

CLIENT: I don't know that that really happens. I find myself settling more and more.

THERAPIST: Mm.

CLIENT: But I'm genuinely freaked out by things like him searching by a salary.

THERAPIST: Mm hm.

CLIENT: Or that there have been a couple times now where if he wakes up he doesn't know what day it is. He doesn't know what's going on. He's totally disoriented and -

THERAPIST: Yeah.

CLIENT: And that -

THERAPIST: Your worst nightmare. [That's what you were saying.] (ph)

CLIENT: (laughs) I can't, I don't know what to do. (pause) [00:33:18]

THERAPIST: With him. Let's focus on that for a second because we're going to run out of time and I want to make sure you leave with that and a couple of other things. What do you think you would like to ask him to do? What would be helpful to you and your self-criticism and anxiety and depression that you have?

CLIENT: I don't actually know.

THERAPIST: What can he do for you?

CLIENT: I don't feel like I even want there to be something because I can't I know it's unfair. I really do.

THERAPIST: Mm.

CLIENT: But I can't handle there being one more reasonable, understandable thing that I ask him to do that does not happen.

THERAPIST: Mm hm.

CLIENT: Because I've just felt an unreal amount (laughs) of being triggered the other day when the exact same thing happened.

THERAPIST: Mm.

CLIENT: I just can't do it anymore. I'd rather I'm really coming back to the place I am with my parents where, in reality, the way to get along or the way to have peace is to lower the expectation.

THERAPIST: Mm hm.

CLIENT: Don't ask. Like stop asking them to clean the house. Stop asking him to take out the trash. Like just stop because it's not going to lead to anything other than a fight and disappointment and just feeling really crummy. [00:34:22]

THERAPIST: So how do you put that together, though, with that he is making changes that you can feel palpably? Or he's doing some things better than ever before?

CLIENT: I think that's what I'm saying. I'm not doing a good job of putting those things together.

THERAPIST: Okay.

CLIENT: Especially, again, I think it's unfair of me, but right now it feels like he's putting in the effort in places not for marriage.

THERAPIST: Mm.

CLIENT: It feels like he'll try to take his medication to go to work.

THERAPIST: Mm hm.

CLIENT: He will not take it at home. I have no clue if that affects him positively or not.

THERAPIST: Yeah.

CLIENT: Or in, like seeing it first, it just feels like I'm not worth the trouble.

THERAPIST: Mm.

CLIENT: So I know that's not fair. I know that it's really hard for him to take the medication. I know he feels self-conscious. And I know I do not dare to say, "It would be really great to see if, you know, you could be more organized or focused at home." You know? Like, "That would be nice for us."

THERAPIST: Mm hm.

CLIENT: I can't say that. But (pause) [00:35:21]

THERAPIST: Mm hm. So you don't want to think of anything that he could do? Is that what your answer is? (laughs)

CLIENT: No, there's a part of me that does, but I'm just so incredibly done with -

THERAPIST: Mm.

CLIENT: I find myself (sigh) What happened this week was I said, which I've said so many times, "You know, maybe we could each do part of cleaning the apartment "

THERAPIST: Mm hm.

CLIENT: " instead of me cleaning the entire apartment." (laughs)

THERAPIST: Mm hm.

CLIENT: And it goes from there to, "Do you want to help for just a little bit," to "You could do this." "Okay, why don't you just mop the kitchen and the bathroom floor. They're tiny. It will take like twenty minutes max."

THERAPIST: Mm hm.

CLIENT: And, guess what, it still hasn't happened. (laughs) Days later he still hasn't. And I just, it was such an acute, that's exactly what I've always been doing with my parents.

THERAPIST: Yeah. So I understand you're afraid to ask him to do something more. Do you want to not do the homework assignment then? Do you think it's just you're too emotionally stressed right now to try it?

CLIENT: I can try it. I just feel like it's It would be reasonable to expect that that would not be a consistent happening considering the baseline is not consistently happening.

THERAPIST: Mm hm.

CLIENT: I don't know why I would think that more would be the answer. [00:36:28]

THERAPIST: Well, if it's an assignment. So, in other words, if it's put in front of him, "This is what you're going to be asked to do every day." And you agree to this in front of Dr. Farrow (sp). And then you go home and he doesn't do it. She gets to take it up more with him in the couples therapy then.

CLIENT: There will be no consequences. There will be no Like we've done this before. Nothing, like that's not going to impact it.

THERAPIST: Mm. You're really mad.

CLIENT: I'm really mad. (laughs)

THERAPIST: I have the feeling today it's like there is nothing I can say or do to help. Anything I say you reject.

CLIENT: Maybe. But I'm not sure that's completely fair because it's like he doesn't do it, he doesn't do it and it doesn't matter.

THERAPIST: Mm hm.

CLIENT: It's really exactly what happened with my parents. No matter now reasonable, no matter small, it's still not going to happen.

THERAPIST: Yeah, yeah. That's actually been your experience.

CLIENT: Yes. And so saying, "But, Ramona, just give it one more chance. Just add one more thing to the 'To Do' list." It's like then the criticism is on me, not him. [00:37:32]

THERAPIST: Yeah. Oh, no, no, no. For the record, I've said this before over and over, you're very patient with something very real that is his deficit. That's really happening. I'm only bringing this up because you said you wanted to make sure we found time to figure something out. (laughs)

CLIENT: (laughs) No, I'm sure I need to do that. I just hate it.

THERAPIST: But you might not. Maybe what you're saying, maybe what you needed to do is talk it out and realize maybe what you're feeling is so frustrated that, why on earth would you do this homework assignment when you've done this before and he doesn't do it? Maybe that's what you need to go back and say to Dr. Farrow (sp) again. That he does not follow through so you're feeling hopeless.

I think I You're the one who knows what is happening better than I do and better than Dr. Farrow (sp) does. So I'm listening to you saying sometimes it feels like there have been real changes and sometimes it feels like nothing has changed, that it's the same old person. [00:38:31]

To the degree that there have been real changes, that's the side of me that would hope maybe this would help him. And I'm not talking about something like cleaning. I was thinking more along the lines of him saying, "So how is the job search going," once a day. Just asking you something about it. Or, "How are you? How was your day?"

CLIENT: Which I think is a great idea, in theory, but the homework she has been giving us -

THERAPIST: Mm hm.

CLIENT: like even the "money meeting" once a week, it happens when I say, "Ivan, we're going to sit down and do this."

THERAPIST: Mm hm.

CLIENT: And quite frankly, I'm seriously angry about saying those words.

THERAPIST: Yeah.

CLIENT: I am seriously up to here with being his Mom. And I know that's not fair when you -

THERAPIST: No, it is fair.

CLIENT: this might be a way for me to make progress.

THERAPIST: It is fair.

CLIENT: But I'm the one being stubborn saying like, "Don't push me anymore." But it really feels like I'm not going to ask him to do this every day because I see that happening.

THERAPIST: Was Ivan assigned that he has to bring up the money problem?

CLIENT: Nope. It was supposed to be mutual.

THERAPIST: Okay. So that's to me the only thing that's different. Is this would be his assignment and you cannot remind him to do it. And then you take a tally over seven days. "Did he do it seven days out of seven or did he not do it?" In other words, if he doesn't do it you're not going to go, "Remember, Ivan. You have to ask my how my day went." You're not supposed to that in this kind of thing. [00:39:43]

CLIENT: We've done that before. We've done with basic split household chores. He doesn't -

THERAPIST: He doesn't do it.

CLIENT: Right. And then at the end of the week I say -

THERAPIST: So why is she assigning this then?

CLIENT: I'm not sure.

THERAPIST: Mm.

CLIENT: I guess I don't understand as well.

THERAPIST: Hm.

CLIENT: But I guess that I'm not supposed to remind him, I'm not supposed to hound, because that's supposed to be mutually freeing. But then eventually it just doesn't happen and we're back to square one and what am I It feels, I don't know, it feels critical of me because I'm not supposed to ask for it.

THERAPIST: (cross talking at 00:40:11)

CLIENT: I'm not supposed to do it myself. I'm not supposed to criticize.

THERAPIST: And he's actually not doing it. Ramona, he's actually not doing it.

CLIENT: I'm just supposed to let it go.

THERAPIST: I feel your frustration. You're just caught between a rock and hard place right now that is a repetition of your childhood. It's not just your transference to it. It's actually happening and I think that's what is so hard and sad, and hard to face in a way. What if you have found yourself with someone who is repeating the same patterns? And you didn't know you were getting into this but this is what you're in. What do you do then? (pause)

You know, I think in your childhood you turned to criticizing yourself, probably from a very, very young age, in order to kind of make up for the ways in which all the people around you who were supposed to loving you and taking care of you were not. And that criticizing yourself became a very familiar and comfortable way of keeping order in your life. Whipping yourself into shape, right? [00:41:36]

You then don't have to If you're in the constant pain of self-flagellation, you don't really have to think about other people not doing their jobs as much. It doesn't really have to hurt as much that other people can't do the bare minimum to demonstrate loving, affection and taking care of you. And I think you're finding the same things happening with Ivan right now. And in some ways it's pushing you further into the corner of self-flagellation.

CLIENT: Because what else would you have me do? Like the one message I consistently hear is that I'm not to criticize to Ivan. I'm not supposed to ask him to do his stuff no matter what. I'm not, like we're not supposed to even talk about the elephants in the room most of the time.

THERAPIST: Mm.

CLIENT: Or we just don't because I'm not supposed to initiate it. And heaven knows he's not. And so where else does that go? (sigh)

THERAPIST: Yeah, yeah. Some of that is maybe coming from couples therapy. I don't agree with all I think you should have expectations of him. I think you should be sharing disappointment. I think you should be giving him assignments and when he then doesn't do it, and it was a hundred percent on him and you keep your mouth shut, you get to come in and say, "This is not changing fast enough." [00:42:51]

CLIENT: But I don't think that changes But saying that, what does that do?

THERAPIST: What if it does nothing?

CLIENT: Yeah. That's where I'm at.

THERAPIST: That's what it sounds like you're coming up against. What if his change rate is way, way too slow?

CLIENT: I think I need to find some room to be more patient. I just don't know how to do that, especially without me hating myself more.

THERAPIST: Mm. You just said something so important because I think that's the only way you've developed patience over your life. The only way to not feel angry at these people is to go back and turn it all in against yourself. So that's so, I think that's incredibly insightful, what you just said. How can there be some space where you get to find patience for yourself and for another person at the same time? I think that's a really, really, really big question. [00:43:49]

That could even come up in here too. Like you could be feeling today critical of me. Like I know this kind of session. We've had this kind of session before where you will leave often and feel fed up and frustrated and this is a waste of time. And that the criticism comes out at me or it's going to go back at you. And, you know, I'm not doing enough. I somehow didn't make enough of this.

Hopefully, we've changed a little bit. We changed gears I think about ten minutes ago. We started to talk about this in a different way. How on earth do you have time and patience that is held compassionately, lovingly for both you and Ivan? Where you're in something together that's important to both of you right now, that you don't want to leave. And some changes are happening.

But there are some things that are happening that are still so frustrating and feels unbearable sometimes. It's likes trying to grow a little bit of safe space that you knew nothing about as a child, Ramona, nothing. [00:44:51]

CLIENT: I still don't always I know this is flawed thinking, but I still don't always see the point in separating like, "This is their responsibility." Or, you know, this is someone else's responsibility. If they aren't doing it, it has nothing to do with me.

THERAPIST: Yeah.

CLIENT: It's really hard. It actually sometimes even doesn't feel like there's any point to reaching that level of consistent intellectual understanding.

THERAPIST: Mm. Mm hm.

CLIENT: Because, at the end of the day, the floors still need to get mopped. (laughs) At the end of the day, bills still need to get paid. At the end of the day, like what's the point?

THERAPIST: Yeah. Mm hm.

CLIENT: And is there any point in reframing it as the rate at which Ivan is making progress doesn't feel very good.

THERAPIST: Mm.

CLIENT: Or it doesn't always feel fast enough versus it's my fault for not being patient.

THERAPIST: Hm.

CLIENT: Is there any point in Pick one. Does it make any difference really?

THERAPIST: See I don't think either of those is the total truth though. Do you know what I mean? I think he's working on his deficit and you're working on yours. (pause) And the reason I reframe it like that is that I think one of the (sigh) How to put this? [00:46:11]

The deficit that is in you that you bring to the table with the relationship with him, and with any relationship, is how hard you are on yourself. I think that is the central, core problem inside you. It's not how critical you are of him.

CLIENT: But would being less critical of myself actually improve my relationships at all?

THERAPIST: I think it would. But how you get there is another question. Because this is where to me cognitive therapy falls a little short for you. Because it's not a matter of just saying, "Okay, go home, Ramona, and be less critical of yourself." If you could do that you would do it already. Right? It's not just a switch you get to turn off in your brain.

You've identified being critical of yourself is safe. It is your protection in the world. You don't even know what your world would feel like if you could hold yourself and give yourself a hug in this process, and love yourself with compassion during this job search. That's so foreign to you to actually be held lovingly and affectionately. [00:47:18]

CLIENT: Yeah.

THERAPIST: You survived in your family by being critical of yourself. I often think, if there is a cognitive therapy intervention around this that might do something, the number of times you've said, "I hate myself. I hate myself. I hate myself. I hate myself." They have literally done studies where you can look in the mirror and if you say, "I hate myself," a hundred times, your mood drops.

So we have someone without depression, right? And that you can actually show an effect of change, a negative effect, if you get them to say something that they don't even believe. Right? This is someone who comes in with a good self-concept. Get them to say that a hundred times, their mood will drop.

If we were to start trying to find some statement you could say to yourself that would become more of a mantra about yourself. Forget Ivan. But something that you could find that is a more compassionate self-statement that we want to actually start pulling out, "I hate myself." Because I think it can become a kind of obsessional ritual in your head. [00:48:21]

CLIENT: Yeah. I agree.

THERAPIST: And if we could actually, to the degree that you can, turn that off and find a competing statement. I don't know what statement that would be because it's got to be something you can be interested in, at least. I know you won't believe it at first, but something that sounds like, "Okay, I could at least repeat that a number of times to myself." So maybe could you try to come up with something like that?

CLIENT: I can.

THERAPIST: "I love myself." "I love this about myself." "I'm doing the best I can." "I'm a good person." These are examples. Something along those lines.

CLIENT: I can try to do that. I think part of the negative, the reason the self-hate is so adaptive for me is because then if I feel really crummy about the way things are or aren't happening outside of what I have control over, I have control over that really awful feeling. As opposed to letting it go and saying, "That's on them. They control it. I can't "

THERAPIST: Yeah.

CLIENT: (laughs) So I'm not sure I know that's part of the problem. [00:49:26]

THERAPIST: That's why I think even giving you a substitute thought, you can control that thought if you want to. Like it might be, "I'm doing the best I can." Something like that that doesn't say, "I'm doing great," because maybe you don't believe that. But, "I'm doing the best I can."

CLIENT: Okay.

THERAPIST: And try to see if you can write that. Maybe even you could type it out, print it, put it on your computer. That might not even be a good one. When you think of what feels like it's something you're willing to try.

CLIENT: Okay.

THERAPIST: Drop me a line.

CLIENT: Okay.

THERAPIST: And try that for a couple of weeks. So we're not meeting next week.

CLIENT: Okay.

THERAPIST: Okay.

CLIENT: Okay.

THERAPIST: See you then.

CLIENT: Do you want to give back my? Or no?

THERAPIST: Yes. Let me Will you in the meantime fill these in, competing thoughts.

CLIENT: Sure.

THERAPIST: Even if you need to move on to the back.

CLIENT: Okay.

THERAPIST: Okay. And let me know what thought you come up with.

CLIENT: Okay.

END TRANSCRIPT