TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: So how are you?

CLIENT: I guess pretty anxious so a little more depression lately. Some just changes and stuff going on, I guess. (pause)

THERAPIST: How so?

CLIENT: I don't know where to start. My mom went in for a routine... not routine. She went in for a biopsy. She had three nodules on her thyroid and the doctor had said 15% was the chance that anything negative would be the outcome. And my mom, of course, said, "Oh, that's such a high number." And I said, "Actually, that sounds pretty good." I really called her just to call her to see how... like what the results were. And she has cancer so...

THERAPIST: Oh my goodness.

CLIENT: ...it's just like very... it was very bizarre. It's like I don't understand. How do you have cancer? So the good news is her... it's on her thyroid. So her entire thyroid can be removed and she's cancer free, done hopefully. [00:01:06] It's just I don't know. It's been a little to take in.

THERAPIST: It's a big deal.

CLIENT: Yea. And she's... my mom is 66 so it's a little... it's weird for me because my mom was so old when she had me. It doesn't feel like my mom is that old but she is. So I think Emma (sp?) and I were talking about... the surgery is not scheduled yet, just the pre-op for August 5th but trying to see if we can change when we were going to go home when the surgery is. So I mean it's OK in the sense that the surgery should be fine. Her thyroid will be removed. She'll just have to take medicine for the rest of her life. And it's not like other types of cancer where we have to keep worrying.

THERAPIST: So they know it hasn't metastasized to other areas of her body? [00:02:00]

CLIENT: That's what seems to be the case.

THERAPIST: That's what they're saying.

CLIENT: They're saying they're going to remove her thyroid and it'll be done.

THERAPIST: That's a relief. That's great.

CLIENT: That's what it seems to be. So it is... yea, it's a big relief. So it's like a heavy weight but at the same time it's maybe not.

THERAPIST: It could be worse.

CLIENT: Yea, it's OK. It's not the end of the world. So that's just been kind of interesting to digest.

THERAPIST: Yea, what... you say that in a kind of intellectual way. I'm not sure what are your feelings about it when you first heard?

CLIENT: I was mostly just... I guess disbelief. Like it just seemed... a little denial I guess. (pause) A little upset but mostly just in denial and mostly it's not a big deal. She's going to have surgery. It will be fine. Just have to get her through the surgery and I told Ivan (sp?) and he just... he has trouble communicating. He has trouble verbalizing I should say. And I just said, "Do you want to say something?" And then he said, "Oh, I'm really sorry to hear that." Like it's just... and I try not to take it personally, but it was a little... like he really has trouble speaking sometimes. [00:03:09] But...

THERAPIST: Like he wasn't quite available emotional that...

CLIENT: He just didn't say anything.

THERAPIST: ...(inaudible at 00:03:15) how scary and overwhelming this kind of news is. He didn't say anything.

CLIENT: He was pretty quiet. He didn't really say anything and then I... like there was a pause. And it's probably in reality maybe 30 seconds, 60 seconds. But he just wasn't going to so I just said, "Do you want to say something?"

THERAPIST: So not just like, "Oh, I'm so sorry. That's so scary."

CLIENT: It was hard for him, I think, to... this is a... I mean, it's an ongoing thing. But I guess I'm not just sure quite how to react. I can't get worked up about it. I can't.

THERAPIST: That might be an interesting example to bring to couples therapy, though. Because in some ways it's a benign example in that you're not only criticizing him for being withdrawn. But there's a way... in that example, what is it that's inhibiting him from being more with you? [00:04:15] You're not saying something, in other words, critical of him. You're saying... you're talking about something that has nothing to do with him, right?

CLIENT: No.

THERAPIST: It's of you and your mother and even still he's inhibited.

CLIENT: Yea, but we've had that discussion before.

THERAPIST: So what will he say about...

CLIENT: He still just has trouble getting it out. He still...

THERAPIST: Just finding words in general then.

CLIENT: Right. No, we've talked about that in couples actually. On an unrelated note, we talked about like the example of us in the kitchen which is... it's not teensy tiny but it's not huge. And if I'm unloading the dishes and he's trying to get past, he would rather stumble over me or like...

THERAPIST: Than say...

CLIENT: ...than say, "Excuse me." The other night he actually accidentally dropped a whole box of pasta. It was a mistake. He just... he had an accident. (chuckling) He was getting out the spaghetti and he... there's spaghetti all over the floor. And he just would not say a word. [00:05:07] He wouldn't say anything. And I said, "Ivan (sp?), what is going... you need to speak. It's not a big deal."

THERAPIST: Oh sure.

CLIENT: "We can pick it up. It was a cheap box of spaghetti. Like just anything and he just was so overcome with like... I said, "Why would you feel that ashamed? It's a box of pasta. I don't understand. So...

THERAPIST: There at least you can say that, OK, maybe he's ashamed. Granted, it's totally disproportionate. People do that all the time. But even when it's your... you're talking about your mother's cancer. There's nothing for him to feel ashamed about.

CLIENT: No.

THERAPIST: It has nothing to do with him.

CLIENT: Right, but there's still...

THERAPIST: But he still can't find the words.

CLIENT: Nothing for him to feel ashamed about if he's like trying to put a big knife in the dishwasher and I'm also like cooking or something.

THERAPIST: Right. To say excuse me.

CLIENT: To say excuse me or like, "Hey, can I get in here?" There's nothing to feel shame about there. There are lots of instances in which he still has trouble verbalizing when it's not an emotional or a heavy topic. [00:06:06]

THERAPIST: Like he's just stuck inside himself? What will say about why that is?

CLIENT: He won't.

THERAPIST: He just can't find words.

CLIENT: He won't. And if I say like, "Why aren't you speaking? Ivan (sp?), can you please speak. It's hard to know what's going on without you saying something." He just won't. He will clam up further and further and further. And he can do that for a very long time. And it...

THERAPIST: It just sounds exhausting for you.

CLIENT: It's... (pause) I don't know. The other day he told me that Dr. Bourd described his... like that his problem just on a much larger scale is called is existential despair. That's the phrase he used to describe it. And I can see some of that in Ivan (sp?) when he describes almost like an existential crisis with like haven't taken out the trash. It's so shameful.

It's so like... but quite frankly I'm not proud of this. [00:07:05] But it's really hard to... it's really hard for me to validate that as like a... I validate to some extent. Everybody has those moments where it's like, what am I doing with my life? But it shouldn't take over every aspect of... I guess it seems like too much to me. And it's hard for me to validate that that's like a real thing that can prevent you from doing everything little too big. It's just hard to be sympathetic and I don't like that in myself. But it's hard.

THERAPIST: My guess is Dr. Bourd would see that as a part of the problem. And you see that as a part of the problem. I can't... that doesn't explain everything. Do you know what I mean? There's something else happening about how stuck he is inside his own mind. It's like there's a neurological syndrome. [00:08:01]

I don't think this is it at all that it reminds me. They call it locked in syndrome where you're... there's not a capacity to express the self at all and literally at a neurologically inhibited speech affect. There's something is blocking him from just taking up space in the world with his words to actually be a person. Even to say, "Excuse me." Maybe that feels like kind of asking for his needs to get met or announcing his space. And none of this I say, by the way, to say you need to just be patient and have empathy with it. Just I'm still understanding how profound a deficit it is because you're saying it's coming up not just in areas where there's obvious shame but everywhere.

CLIENT: No, I mean, we've had this discussion before. He was devastated at one point because his manager told him he needed to use his words, which is a phrase that I used with him. And it's not a very nice way to ask but it's like when you get that frustrated and they just... it feels like a choice. [00:09:03] And I realize for Ivan (sp?) it's probably not that cut and dry. But again, I guess I feel a little bad about the way I'm dealing with it. But it's hard to look at him and say like, well, he's not talking to me. Just deal with it.

THERAPIST: You're capable of producing speech.

CLIENT: It's just like it's really hard to always...

THERAPIST: You're married to him. You're not just his boss. You have to deal with it all the time. (pause) It's exhausting, Ramona (sp?).

CLIENT: It is and it's a little... I'm not proud to say it. It's exasperating. It really like... it's not that it's 24/7. There have been some times when Ivan (sp?) has made some progress. But a lot of the time it really... after he dropped the spaghetti and I said like, "We really need to talk," the other night he just sat staring at his dinner pulling his glass for two hours. He would not say a word. He would not move. He would not make no effect to resolve. No effort to like... at any point, like, OK, now we can talk about this. [00:10:01] Or, "I'm sorry I was clamming..." Just no...

And eventually I just said, "Ivan (sp?), eat your dinner and get ready for bed," like his mom which is horrible. But he really might have stayed there all night. I don't know. That's a long time to sit there in silence. And it's just I know that I guess I'm learning more and more that shame can be exceptionally powerful for Ivan (sp?). But it's just... again, it's hard to validate that to such extremes because...

THERAPIST: Yea, that's very extreme behavior. It sounds infuriating.

CLIENT: I really have experienced even personally that sometimes it can be hard to move forward with something if you feel bad about not having done it or you haven't done it as well as you could in getting a little stuck. But it just feels like such an extreme... I don't know. It's hard for me to take that as seriously as it sounds like it is for him. (pause)

THERAPIST: Yea. I mean, it's almost starting to sound like there's some... it's a major, major deficit in that's a real deficit. What if... what do you do with the reality (inaudible at 0:11:13) if you're married to somebody who has significant communication deficits? I don't know, for example, what happened in his family that would lead to such deficits. That makes me curious. Does it happen with them, too?

CLIENT: Yea.

THERAPIST: That he'll go quiet?

CLIENT: Yea, I think it does.

THERAPIST: How about when you guys are talking about something totally lighthearted where you're on the same page? So you're watching a movie and you're talking about the movie and laughing or joking about something. Can he find words then or is he still very not communicative relative to other people?

CLIENT: I think it depends. But it really... I don't know. There are some topics where he can. But I do realize I think even with the like trying to talk about our days at the end of the day, I'm doing most of the talking. And I don't know if that's my fault. If I need to like be more quiet so that there's more space and time for him to talk. [00:12:03] Or if that's how it goes because that's part of our dynamic right now unfortunately.

THERAPIST: Like if you said, "Ivan (sp?), how's your day? Tell me about how work is going."

CLIENT: It's not a lot.

THERAPIST: What would he say?

CLIENT: It's not a lot of information. It's pretty short. And I don't know if that's because there isn't anything that different in one shift from another or if that's just... but it's usually pretty short. (pause) I think lately I feel like I'm convicting myself a little bit more of being more critical and wondering if that isn't pushing him to withdraw more because I think that has sort of been our... like I'm the one who's very vocal, pushy, pursuing, pursuing. He is avoiding and not speaking and withdrawing. And I wonder if we aren't getting back more into that because...

So I think I did... I felt like I made a little progress in saying things like it's not my fault. [00:13:07] I don't hate myself for X, Y and Z not ever getting done. That's really his fault. I can feel some anger at him. I can... but then I learn in couples therapy that there is like nowhere to go with that anger and I was actually sort of being... he was being sympathized with. I was being not sympathized with for being angry about that. And I understand why that would be the tendency especially because Ivan (sp?) is pretty fragile about some of these things and is very emotive.

THERAPIST: Are you saying you learned meaning from our conversation last week? My wondering that?

CLIENT: Somewhat but I also learned it definitely in couples therapy where... and so it felt a little... I don't mean this to be critical of either process. But it felt a little counterproductive for me to reach that point where I was starting to feel a little OK about myself. And a little like, well, it really is his fault if he didn't do his chore and I'm not going to take the blame for it. [00:14:05] And I'm not going to get worked up at it and say that it's my fault and think of ways to make him do it. I'm not going to... and then so that puts the blame on him. That puts the responsibility on him but there's nowhere to go with that. There's nowhere to like... it's totally counterproductive.

THERAPIST: You mean so counterproductive to reach that conclusion?

CLIENT: Mm-hmm, which is something I felt like I actually did a significant amount of work to reach while not criticizing or complaining. But then it's like more... it's actually a little more frustrating because now it's out of my hands and I'm not supposed to criticize. I'm not supposed to complain about it. I'm really not supposed to ask him to do it. So (inaudible at 00:14:54) I don't know where to go there. It's very stuck.

THERAPIST: It feels like then you're only left with then just having to sort of tolerate the disappointment of what he's not doing. There's nothing that gets it done then. Like you're recognizing it's not in your control. It's not in your power. It's not your fault. OK, so it's his fault but then he's not doing anything about it either. So nothing gets done about it. So what's the good of that?

CLIENT: Yea. And I guess it feels from my perspective anyway like in couples we talk a lot... we talked a lot about me not criticizing or asking him to do things and a little bit about him stepping up to do it. But there's never any...

THERAPIST: But not a lot.

CLIENT: ...follow through where Ivan (sp?) ever comes in and says, "Ramona (sp?) has not been criticizing me but I really haven't gotten around to it yet." And I'm certainly not allowed to come in and say, "I haven't been criticizing Ivan (sp?) but he's really not doing his part," because that's critical. And I'm not allowed to say anything critical. And I understand the goal of that.

It just feels like pushing me into a corner a little bit because the other day I said... I didn't openly criticize him. [00:16:01] But it was sort of a backhanded or like a passive aggressive... it's like, "Ivan (sp?), I really need to wear something professional to go into the hospital today and I don't have anything. Maybe like is everything really in the laundry?" And he's like, "Well, I think your long pants... I think..." I have one pair of dress pants. He's like, "I think that they are on my nightstand in between my clothes."

And I said, "First of all, why would I look in the pile of your stuff on your nightstand for it? And second of all, it's 90 some degrees outside. I'd really like to wear a skirt instead of long pants." And maybe like why isn't his response, "You know what? You're right. I totally haven't done any laundry. I'm sorry about that. Let me do some because that's my responsibility." As opposed to, "Why aren't you wearing pants?" Like it's just... it doesn't feel like it's working.

THERAPIST: You feel like you're being held accountable for your... the behavioral goals that have been set up for you and that he's not being held accountable in the couples work. [00:17:04] So for example you don't revisit, "OK, this is what we tried last week. How did it go, Ramona (sp?)? Oh, great. You get a check. You did your part. You didn't nag him. You didn't ask him. You didn't, right? Ivan (sp?), how did it go? Did you do your part?" And that's not coming up?

CLIENT: We did it one week. And...

THERAPIST: Recently?

CLIENT: No.

THERAPIST: Just a while ago?

CLIENT: Yea. And the thing is if we try that as a specific homework assignment for one week, it can work out. But after that week, it's done.

THERAPIST: Falls off.

CLIENT: And I'm not like... I get that there are bigger fish to fry. I get that it's not the end all, be all. It just... I've tried to explain it to Ivan (sp?) a little bit more in terms of what I need and want as opposed to like this really sucks for me. And I've said, "I really need clean clothes. You really have clean dishes every day because I do the dishes at least once a day, usually twice a day. And that doesn't feel respectful. I don't feel appreciated."

THERAPIST: You've said all this. [00:18:00]

CLIENT: I've said it.

THERAPIST: Like this?

CLIENT: Yes.

THERAPIST: Oh, it's a lovely way of putting it.

CLIENT: And I thought the word respect really captured it because... I don't know. So...

THERAPIST: And you're also not saying it in a way that sounds like this. You're talking about what you need in order to feel safe and loved in a relationship.

CLIENT: I feel like at this point I've tried both. I've definitely gone like... and I don't like being the critical like complaining, nagging, mommy him. I hate it. I hate it so much. But it feels like if I say nothing and things still aren't happening... I'm not supposed to do it myself. I'm not supposed to ask him to do it. It's like it's not going to work out that way. (pause)

THERAPIST: What happens if you shared this dilemma with Dr. Farrow? For example, you can say, "I feel caught right now because I am not supposed to do this, this, this and this. And I'm working really hard not to because that's what my assignment and my goal was. But when he then doesn't do it, it doesn't get done. So what do I do when Sunday comes and I need a dress for tomorrow and there's nothing clean because he hasn't done his job? [00:19:10] What would you, as our couples therapist, like me to do about that situation? Should I say something then? Should I then go do it? Like I can't show up to work with stains all over my dress and wrinkled from before, right?"

I wonder what she would say to that about how to handle that if he doesn't keep up his part. If you kept up your part and he has not kept up his end of the bargain, then what? In other words, putting it back in Dr. Farrow's hands like, "What do you think, Dr. Farrow? What should I do?" Do you know what I mean? Because then she... I think maybe she's not understanding the dilemma enough. I wonder also if it'd be helpful for me to touch base with her and share a little bit of your sense. I know I'm getting your sense. I don't get Ivan's (sp?) sense but maybe that would kind of help things a little bit. [00:20:01] I don't know.

CLIENT: No, I think maybe...

THERAPIST: Would that help?

CLIENT: I just... I feel stuck. And I don't want to go back to criticizing him. But I really do want us to keep making progress.

THERAPIST: Does it feel like progress is... it was feeling like there was something happening and like it's plateaued or something?

CLIENT: It feels a little like a plateau. It sounds like from what he's telling me that things are really still going really well at work for him. And that his... like he told me yesterday his employees told him like, "Ivan (sp?), you've really stepped up as a manager. You're doing a much better job." And I'm hearing... like this isn't the first time he's come home and said that. And that's huge.

THERAPIST: That's... given his interpersonal deficits, that's enormous.

CLIENT: No, it's really huge. He's telling me he's taking his medicine before his shifts. That it's helping but that he's also developing skills. He's reluctant to give too much credit to the medicine and I understand that especially given his feelings about it. But what I was going on... like things are going well at work.

THERAPIST: Well, that's something.

CLIENT: And he's staying late when someone else isn't ready. He's been more reliable actually than the other shift managers. [00:21:05]

THERAPIST: And getting there on time more?

CLIENT: Yea. Well, I don't know about the mornings. He's usually leaving...

THERAPIST: Because you're out.

CLIENT: ...(inaudible at 00:21:10) when I see it but... so that's going well. I just feel a little like it's not always the case at home.

THERAPIST: So what would... what... I guess if you were to say... also say, "What do you want?" What would be the concrete things that he needs to work on more if you were to tell me about them because you're allowed to complain in here? There's no supposed to in here. (pause) Doing the laundry, that's one that comes up all the time (inaudible at 00:21:42).

CLIENT: It's just like we could change. We could switch up the chores but we each have our own jobs. And for me, usually I do the dishes. I'm supposed to bring in the mail like every other day or whatever. I take care of Eloise. I do all her stuff. And I usually clean the apartment.

THERAPIST: Who's Eloise?

CLIENT: Oh, I'm sorry. She's our cat. [00:22:03]

THERAPIST: Oh, OK. I don't think I've ever heard her name before.

CLIENT: So I take care of her. But... so Ivan (sp?) was supposed to do laundry and trash and he doesn't really have an assigned part of clean the apartment and he usually doesn't. So it's usually whatever I do and that... I don't know how to explain it but it's not that I just have like a personal obsession with laundry and trash being like is (inaudible at 00:22:31) them. It's really more just like I constantly feel like... I guess I feel a little bit like I did at home where I'm doing my part and people aren't doing theirs. And...

THERAPIST: You'd like them to be done once a week. Would that be... if he reliably, like every Sunday, did laundry and took the trash out...

CLIENT: That would definitely...

THERAPIST: ...or whatever your trash day is, took the trash out that morning.

CLIENT: It would definitely be a start.

THERAPIST: Would that feel like that would be a big chunk of the daily grind stuff that's coming up?

CLIENT: I would definitely be a start. [00:23:02] Like I just... I don't know. It feels a lot like... I journaled a little bit about it and I came up with something that sounded a little... I don't know. But it occurred to me that both at home and now with Ivan (sp?) that it feels like there's a small amount of accountability for his, for their responsibilities that they are very much like pushing towards me taking on their responsibilities. That there is like that the way to progress or getting along or peace in the family is if I don't... and respect. Like my parents always push that it was a respect thing. No criticizing, no complaining, no asking them to do it. Even if it's their job, even it would be totally in line... like it was never in line. It was never OK. Not allowed to criticize. But then there would be a weird thing in which they could criticize how I did what was their responsibility. [00:24:04]

So if I clean the house and like there's all this displaced furniture in the middle of the room and I would move it somehow to try to organize, try to clean up, they would sometimes say like, "Well, they're my things and I want to arrange them differently," or like, "You shouldn't..." Or my dad like, "I have a different mowing pattern. I want you to mow it this way." Just like there's no space for...

THERAPIST: Wow.

CLIENT: But then there's space for them to criticize. So it actually like...

THERAPIST: You really got criticized then (inaudible at 00:24:35).

CLIENT: Right. For doing something that wasn't my job. And I guess sometimes with Ivan (sp?) it feels not so much that he is criticizing the way I'm doing things, but it's more like it doesn't occur to him always to say thank you or to notice like the apartment got clean again this week. I wonder how that happens. Like it just doesn't... and that was very much with my parents. They would not say thank you when the house was clean. I think because it was shameful that... and I'm sure that's the case with Ivan (sp?), too. [00:25:01] But it feels a little bit like a repetition and I'm kind of done with it.

THERAPIST: I can also see, Ramona (sp?), that it could feel like even there is a little criticism of you if you finally just go and do the job that's Ivan's (sp?). You feel like you're not supposed to do that. Like that's been assigned to you in couples therapy almost like...

CLIENT: No, yea. No, no.

THERAPIST: So you do get criticized for doing it anyway.

CLIENT: Well...

THERAPIST: Do you know what I mean? That's sort of implicitly there that you're not supposed to be doing it.

CLIENT: And if I feel resentful for doing jobs that aren't mine because they really legitimately aren't done, that's on... that's my fault.

THERAPIST: Then you're not supposed to say that.

CLIENT: That's my fault.

THERAPIST: That's your angle.

CLIENT: I chose to do it.

THERAPIST: See... so I disagree. If that's actually what's getting said, I just fundamentally disagree. I just want... just of the record. I do agree that as part of working on a pattern and breaking through a pattern, helping you to inhibit some of the criticism for the a while to see if that helps Ivan (sp?) become more accountable makes sense, right? [00:26:03]

But it doesn't make sense if you've been doing that for seven months and he hasn't been being more accountable. Do you see what I'm saying like that? So what are you supposed to be doing with those feelings in the meantime? So I might put it back. Are you meeting with Jody this week?

CLIENT: Yea, every week.

THERAPIST: See if you can make... I don't know if there's a way and if you could... I don't know how you guys typically start it up but say, "I actually have some questions that have been coming up in my individual work that I'd like to pose to you. I feel like I've been working really hard. I know I'm not always perfect but I feel like I have been working hard to not be critical. Not express resentment. Not step and do his job to kind of be the parent all the time. And I don't feel like Ivan (sp?) has met me there in doing the jobs. What, Dr. Farrow, do you suggest that I do then when we reach Sunday and I am feeling these and I need my dress?" And kind of see where that heads. [00:27:01]

I'm also happy to drop a line to support this side of things. Because I've heard this enough from you that you're really feeling like he's not getting held accountable enough maybe in the couples work.

CLIENT: It's just I don't want to be petty because I hear that he's making a lot of progress at work and I'm very happy about that and I...

THERAPIST: So say that. That's... like even for you to say, "I am thrilled with how much progress you've been making at work, Ivan (sp?). I feel like the next steps at home are this area and I don't know what to do next. Like how do we... I feel stuck around this." Do you know what I mean? So you're coming at it even from a, "Let's brainstorm about this because I need help figuring out what would you like me to do to move this system that we have going forward?"

You're asking for help, in other words, instead of just only criticizing. And I think that will help. Maybe she'll even get it in a different than she gets it now. That you're feeling like you've been doing it and he hasn't for a while and what's on him. [00:28:03] Like even to answer the question concretely. What should you do? That's a good question. At that point you need the dress. Is it OK if you go do it yourself and feel a little resentful?

CLIENT: I mean... yea.

THERAPIST: Of course.

CLIENT: I mean I can... I've done it. It's just not going to work as a long term solution. I'm not saying Ivan (sp?) has to be perfect and I get it. It doesn't always have to be 50/50 or even like... it's just we're not. So...

THERAPIST: He's never going to be.

CLIENT: And that's fine.

THERAPIST: And you're never going to be.

CLIENT: Yea... I guess that's fine to an extent. It just feels like maybe sometimes we're both at extremes.

THERAPIST: Yes. So you're saying, "I feel like I've been trying to come over here and letting some things go and not being so reactive and just keeping my mouth shut a little bit." And you don't feel he's come as far towards you in trying to do a little more, trying to keep with deadlines and you're having some feelings about that. You don't know what to do. [00:28:59]

I would use the laundry example specifically as a concrete example. Because that's a really good one of saying like, "What should I do if I reach the end of the week and there are no clean clothes and I have to go to work the next day?" That's the dilemma, right? You have to have clean clothes. So you have to sort of do this thing then that you think you're being told or have been told you're not supposed to do. Do you know what I mean?

CLIENT: Yea. I just... recently I decided there are some things that I... there are a lot of things. I look at them and I think if I don't do this it's not going to get done. Can I deal with it not getting done? And at home, the answer is always no. I couldn't deal with it not getting done. And in our apartment, I recently... I was like... I usually clean out the fridge. The fridge is due to be cleaned out. And I thought I really want to do it. It really needs to be done. I'm not going to do it for a while. And maybe I'm even going to say, "Ivan (sp?), I usually clean out the fridge. Would you mind doing it this week?" And I don't know... like that comes back to me asking. [00:30:00] But I just thought like I can't always be the solution because I'm going to be resentful.

THERAPIST: Totally.

CLIENT: And he's going to be like... so anyway.

THERAPIST: I totally agree with you. It does not work. It wouldn't work for you. I don't think it would work for any couple, married couple, to have one person be constantly doing these kinds of responsibilities. Sometimes people last that way for ten years, right? I have seen people who are ten years into their marriage and finally coming in and saying, "God damn it, I've been doing all this work for a year and you've done nothing." And it finally erupts. It does erupt. You're totally right.

CLIENT: I think he... I think a lot of it though is he and I just deal with feeling anxious or depressed or stressed just very different way. Very, very...

THERAPIST: That's also part of what you're trying to understand about each other. It's a huge point you're saying. Some of it is the practicality of shared stuff. Some of it is when anxious, he withdraws and when anxious, you clean more. You get (inaudible at 00:31:00). And he's never going to be that way the way you are. You're never going to be the way he is. You're never going to be just, "Oh well, just avoid and not do anything in order to manage my anxiety."

So the more to the greater degree you can start knowing in yourselves that, "Wow, this is what I do when I'm anxious. I have to get hyper organized and clean and that's kind of what helps me feel better. And in fact when I'm anxious I can get irritated at him for not hyper organizing and cleaning because that would help me feel better about my anxiety." That's different than actually sort of morally better. Do you know what I mean?

CLIENT: Mm-hmm.

THERAPIST: Neither one of those ways is morally better. And it's different than an actual practicality of there are daily responsibilities that you share as a couple and you have to do some and he has to do some, right? That's another sort of dimension of the experience. I think the more you can articulate this and say you're owning how much of this comes from anxiety, how much a piece of it comes from anxiety. [00:32:03]

But the practical part of it actually has to get done still. And what does she suggest as you're trying to move out of this plateau to a new place? How should you guys negotiate that together? Do you know what I mean? (pause)

CLIENT: Sometimes I worry if I feel really overwhelmed. Sometimes I get so overwhelmed that I almost want to take Ivan's (sp?) approach and like I can't. Right now I can't get worked up about my mom's upcoming surgery. I can't... I'm helping my sister move Tuesday and Wednesday.

THERAPIST: You said that.

CLIENT: Yea. So I did that all yesterday instead of spending the day preparing for my interview that's today.

THERAPIST: You have an interview today.

CLIENT: I do.

THERAPIST: Wow.

CLIENT: I'm just like... and I can't get worked up about that. I can't get worked up about taking two whole days that I need to do other things. I really want to help her but I can't even get stressed for her. [00:33:00]

It's just too much. I can't even... this week is so busy I can't even think like, when am I going to apply to more jobs? When am I going to... it's just feeling really overwhelming and it gets to a point where I just don't know what to do. Ivan's (sp?) parents want us to come visit and he's like not really dealing with it. And I don't know what to do about that. I can't deal with that. It just feels like too much at times and then... (pause)

THERAPIST: What I think is so cool and exciting about one aspect of what you're saying. I know it sounds like a strange response to have. (chuckling) There's a little bit of you saying... you started off saying this. Sometimes you can feel how like the urge and the impulse or how good it might feel just to avoid and withdraw. Not that I necessarily think that's a kind of, in totality, a healthy thing to embrace. But if you can find a little bit of that, there might actually be some healthy influence on you to have a little bit of Ivan's (sp?) avoidance. [00:34:05]

In other words, any defense is a defense that's used to protect us from our anxiety and some defense and we want people to have defenses. Otherwise, you're in a state of constant horrible anxiety and shame or guilt or whatever is feeling. Having a little bit of being able to say, "You know what? I'm going to avoid this thing and putting more in CBT coping language it's kind of like putting it on the box... in the box on a shelf, setting it aside in your mind saying, "I cannot worry about that."

You can't, for example today, worry about anything else but getting through your interview today. Today the interview is the priority and you have to almost avoid the other things. Same as he could benefit from having some of your defenses get incorporated in him. It would be cool if for him one day he said, "You know what? I'm so anxious and so ashamed about how dirty the house is, I'm going to go clean it instead of avoiding it, right?" That would be helpful for him to have some and that that's part of bringing you both closer together. [00:35:00]

The skill for you then is CBT. It's setting aside in your mind focusing in on one thing at a time instead of allowing yourself to get overwhelmed with so many things at the same time. It is a kind of avoidance in a way of the other things that are out there.

CLIENT: It almost felt good to spend the day yesterday. No one likes packing but organizing all of Emma's (sp?) stuff and just packing up last minute stuff. Helping her like... it felt better to spend the whole day doing that as much as it wasn't fun than it was to sit at home obsessing about... like rereading about this organization and forcing myself to apply to jobs. The other day I tried. I thought like I have some time. I can apply to at least one job this evening. I was just so like... I don't know why. I sat down at my laptop and I pulled up... like I went through and I looked and I found a couple of (inaudible at 00:35:57) that I might I apply to but I was just like so I don't know so overwhelmed. I just like couldn't do it which isn't good and probably makes me more overwhelmed. But I just like... it feels overload right now.

THERAPIST: It doesn't sound bad to me. I have say there's... I think that's really great that you could go help your sister pack instead of stay home and obsess about where to apply. It's kind of giving yourself a little break. Some space to go just be in the moment doing something. And it's still organization, right? In some ways, still capitalizing on the thing that's soothing for your anxiety. But it's also not engaging so much in the overwhelming perseverative obsessionality about every single aspect trying to get control over it because it's a fantasy. It doesn't work.

It's not necessarily going to get you a job. You know yourself. You get prepared and then you prepare and you prepare and you prepare and you over-prepare some more. The preparation helps. The over-preparation doesn't for job interviews and classes and things like that. So I think that's really great that you can find another way of just getting some space, getting a little break inside that Ivan (sp?) knows how to do too well, right? [00:37:03] But he doesn't know how to do it. So just it's sort of taking a page from his book and doing it a little bit. He needs to take a page from your book and do that a little bit, too.

CLIENT: Do you have any I don't know suggestions or insights on how to... so right now of course because this is the way I am, I'm already thinking about this job interview and the like, what if I got offered this job? Turnaround was actually super-fast with this one. I just applied to it like less than two weeks ago and they already asked me to come in. But it I get... what if I get an offer for this job? There's another job that looks like actually more in my interest that... but it's not going to be open until August. So I can't really like get back in touch with that person until Thursday.

And what if I do if I have to play the waiting game and how much longer can I go without a job? And oh my gosh, Ivan (sp?) is talking about getting a raise from Subway in October. What if he stays in Subway forever? I need to pick up the slack. [00:38:01] It's not productive. I understand that. It's not healthy to some extent. I mean, it's probably good to thinking about getting a job but it's just really...

THERAPIST: It's good to think about it some. Not to the extreme that you do. And Ivan (sp?) needs to think about it more, right? It's like you're having to try to (inaudible at 00:38:24) both coming towards the middle. So I hear you. You can get very sort of snowballing into the unfolding details of what... how this could affect him, you, your future, another job offer, money.

The skill I would come back to is trying to say to yourself, "I'm going to cross one bridge at a time," because you could worry about all of that right now for nothing. Let's say you'll get the job offer. Then all of this emotional space has been taken up for no reason.

I also don't think that this... sometimes it makes sense for people to worry about something that could happen even though you don't whether it'll happen. [00:39:07] If you're going to be so crunched for time that it's extremely important that you have the answer about what you're going to do right then and there, I don't... this doesn't sound like the case. It sounds like you can wait till you get the job offer. And once you get the job offer, cross that bridge then.

CLIENT: So that's the only... I don't know if this is realistic or if this is my all or nothing thinking but I don't know how long they... like I would imagine a few days after the interview if they're only doing one round.

THERAPIST: They told you they're only doing one round.

CLIENT: They didn't say. They didn't say this is round one, this is... they didn't say anything about that. But it was a pretty quick turnaround so I don't know. But...

THERAPIST: From when you submitted the application to getting the phone call.

CLIENT: Very quick. So the only thing I do know is once you get an offer, you're supposed to take 48 hours max to give an answer.

THERAPIST: Because they said that or...

CLIENT: Because career services says that's all you can do. They said it's... you can give yourself two days and hope that it's over the weekend. [00:40:03] Then you have a little extra time. But you really can't like keep them on the hook for a week or so. It's just not OK to do that.

THERAPIST: Or PC appropriate conduct.

CLIENT: So I can't wait until this 48 hours but I might not get anything so it's just like...

THERAPIST: So one of the things you're wondering is, even between now and when I see you next, what if you get a job offer, should you take it? Is that kind of what the question is?

CLIENT: Maybe essentially. Or how to deal with that like pent up... this is a good job but it's not going to pay a ton probably. And the job that would be open in August if it would be open would be much more would I want to do, I believe, and just feeling anxious because there's uncertainty. And right now I'm not enjoying all the uncertainty with Ivan (sp?), with my mom's surgery, with getting a job, with moving my sister. It's just like that's not my forte to begin with clearly.

THERAPIST: It's such a common bind, too. You're not alone when people... it's like a bird in the hand sort of that's the expression. Do you know the expression? [00:41:08] You have something certain and then there's this thing you want more but it's not certain. And you can't know whether it's going to be certain until you have to make a decision about the certain one. So what do you do?

You do sound, Ramona (sp?), like you have... there's a lot of uncertainty everywhere right now. And there's a part of you that would just be relieved to just have a job that you take. The only place where people hedge their bets a little bit about that for example is have you interviewed at the one that's opening in August yet or no there?

CLIENT: So I did an informational and he told me it was upcoming and actually someone who... like my advisor at school is part of that group. So he's like I can put in a word for you. I know the doctors who will be on the clinical trial. So he's like, "Let's stay in touch and... but it won't be open until August. See if you can get into even part-time into Walter Reed so that you're done with HR by the time the job would come up. I can't make any promises." That's what he said. [00:42:02] "We'd have to consider other applicants, of course." But he saw my resume so I'm hoping he wouldn't have bothered to mention it if I was completely unqualified or anything.

THERAPIST: So it sounds like there are some promise. Maybe more than the average job you could apply to. And yet it's also still a little ambiguous and vague.

CLIENT: It is and the worst thing is the job I'm interviewing for today is at Walter Reed so if I got that...

THERAPIST: It is at Walter Reed?

CLIENT: Yea, so if I got that and then in half a month's time he said, "We would like to... we could make you an offer for this." That's where I couldn't leave. But again, like I understand that's ten steps ahead. It's just...

THERAPIST: No, it's about the decision of whether are you going to say yes to the offer if it comes in between now and Monday.

CLIENT: It's not... I don't know if it would even happen.

THERAPIST: But if it did, what... where is... what is your gut tell you about what (inaudible at 00:42:56)?

CLIENT: Part of me is like I've got to get a job. Everybody must be looking at me saying, "She still doesn't have a job? What is wrong with her?" On the other hand, I know myself and I don't like to settle. And if I knew that I was within weeks, even four weeks, of getting a job that was much more in line with my interests, I would hate myself for taking something that wasn't as interesting just to get some experience. Especially if it's going to be comparable pay, I might as well do something that I'm really interested in.

THERAPIST: Sometimes when people get an offer, even if they haven't gone through the process yet at somewhere else, they call and say, "I have an offer that I need to accept or decline in 48 hours. I so would rather have this position. Is there any chance of getting in for interviews or any way of knowing?" Getting a little more detail sometimes you can push people a little bit on that to figure out.

Then they might say, "Oh yea. No, we're actually putting off for the next 30 days." So then that can kind of tip the scales or they could say, "You're a total shoe in. Please don't take that offer. I can't guarantee you anything but we really kind of want you. I've seen your resume." Do you know what I mean? [00:44:02] And then that tips it back the other way. I think you could feel free to make that kind of call if you get an offer to help get some information.

CLIENT: No, it's fine that I'm still doing this career... this job seekers workshop. So (inaudible at 00:44:13) has been... she would help me in that situation. But I don't know.

THERAPIST: It's a dilemma, Ramona (sp?), because you're weighing your own sense of certainty and anxiety management by having something secure against what you actually want sort of in the long run pleasurable interests, professional interests. That sounds like where the bind would be. (pause) It's your bind. Do you know what I mean? I think it's sort of difficult when you have to choose between two things where one set of needs gets met and the other one doesn't. This one might but you're going to be waiting on a period of time then, right?

CLIENT: And I might not get anything from today. [00:45:01] So I shouldn't even... but that's just my nature and I think you know that.

THERAPIST: You've articulated what the dilemma is going to be if you get the offer. I don't think you can know everything enough to obsess on it right now to come up with an answer.

CLIENT: No, and I shouldn't be. That's the problem. I shouldn't be but I am so...

THERAPIST: I think try to let it go. Put it... put the decision in a box on a shelf and say, "I'm going to try to just tackle this interview today to the best of my capacity." It's experience. Who knows? Maybe they'll pay you more that no matter what it is, it would be worth..." Do you know what I mean? Probably not.

CLIENT: No.

THERAPIST: I'm just telling you. You never know how these things sort themselves out. And until you know, you don't know. So if you need to come in here because you are faced with a huge decision that you're racked with conflict about, call me up. We'll figure out something. We can even talk on the phone to talk it through if that would be helpful. (pause) We got to stop. It sounded like you wanted to something, though.

CLIENT: No.

THERAPIST: Good luck today.

CLIENT: Thanks.

THERAPIST: And good luck putting it on the shelf. [00:46:10] One thing at a time.

CLIENT: Thanks.

THERAPIST: That's another good motto.

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