TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: I don't know if you understood my message about, as far as -

CLIENT: I think so. (sounds out of breath/anxious)

THERAPIST: we agree, from here on out, I'm happy to do the Tuesday phone session time, if you'd like to do that weekly. If that feels like you don't being on the phone is not that useful or helpful, we will do that on occasion. Then, I understand it might make sense until January. You have this dilemma of you have to pay the deductible now and then again in January, is that right?

CLIENT: Yes, but I actually worked out the math. It's cheaper to do the HMO, if I'm only going to see you twice in November and December.

THERAPIST: Yes.

CLIENT: Which, the max I would see you would probably be three times anyway. And since we're still working out a time, I assume that two times each of those months will probably be realistic. So if that's true on your end, then I'd probably just (short of breath) go with the HMO and save a couple or so hundred dollars. [00:01:00]

THERAPIST: And then you'd be able to pay $120 per session here.

CLIENT: That would be cheaper, that's how I figured it out. I've actually brought $240.

THERAPIST: Oh, last week and this way, okay, $240.

CLIENT: One-twenty and 120.

THERAPIST: Right, because this won't be (inaudible).

CLIENT: Correct. And if I went with the PPO, it would be less, but either way you're paid for these two sessions.

THERAPIST: Got it. That's a lot of numbers.

CLIENT: It is. I spent hours over the weekend, my poor dad, I was on the phone with him for two hours. But, anyway, I wanted to let you know that I also got another e-mail from the insurance guy, for the September plan. I was on the phone with him yesterday but then he e-mailed me also, and I did fax him the claim, the (inaudible). Anyway, he said that he knew about the he knew about the preexisting condition clause but that it should have worked out. He said the reason that they're asking for my medical records is they need to make sure that it's medically necessary within, I guess that 12 months after having a previous condition. So, (sighs) I think I'm back to square one, with them asking for my records, and that's just, it is what it is.

THERAPIST: But you're supposed to have coverage even if you don't have a medically necessary diagnosis. Do you know what I mean? You're supposed to get ten sessions. [00:02:26]

CLIENT: But that's not that doesn't seem to be what he thinks. He seems to think that those actually justify it as well.

THERAPIST: Even if it's an adjustment disorder. In other words, medical necessity is when you have a very severe diagnosis. You have to justify that you actually have the diagnosis.

CLIENT: Right.

THERAPIST: But if you don't have the diagnosis, your plan says that you still, for a non-bio based disorder. So if you came in just saying, I'm having some stress with school, and that's all that was the problem, so there's no biological condition, it's not medically necessary, but your plan says you're still supposed to have ten sessions.

CLIENT: So that's the discrepancy. So he said at minimum, he could show the statement to someone that he works with that has more knowledge, and see what they say.

THERAPIST: It's so silly because it's eight or nine sessions and we're talking about ongoing care.

CLIENT: So, I think I saw you six times since September.

THERAPIST: That might even be, yeah. I don't know the exact number.

CLIENT: I believe, because there were two weeks when I saw you twice, so that would be four and two, and then October will be covered, thank goodness. [00:03:29]

THERAPIST: Does he know that's what we're talking about, your six sessions?

CLIENT: Yes. I think he does and I told him I want to retroactively cancel October 1st, because even though six days would use less coverage. So anyway, I apologize for all of the hopefully I will never again have to handle three insurance plans at once, but hopefully it will be resolved soon.

THERAPIST: Of course, you've been doing everything you can. You should have been told that too.

CLIENT: Yeah. (laughs nervously)

THERAPIST: I understand that you can't have a previous condition clause. In Connecticut, it's illegal to have that.

CLIENT: Yes, and it will be with the ACA.

THERAPIST: Yeah. So he, you know, if they're operating at a Louisiana lot, he's just used to that big standard, whereas here... I told you I resubmitted with a different diagnosis, so we'll see. I don't know if he didn't have that in the record, we'll see what that does. How do you feel otherwise, about my submitted the medical record? That's also very unusual. Usually people will act for a doc to doc phone call.

CLIENT: Right.

THERAPIST: But to actually be submitting... [00:04:29]

CLIENT: I don't feel very comfortable with an insurance company that I'm not even familiar with, just getting my medical records. All I know is that that feels invasive. I don't know. I mean, I'm sure it would remain confidential but I guess I have some mixed feelings about that, especially when we're talking about literally, $480 that I would have to that's what I would have to pay versus they should have paid that, and after which, they may not pay anyway. So I guess I want to see what he has to say first.

THERAPIST: Yeah. He said maybe he could even do something for you.

CLIENT: He said if it worked out that they wouldn't and I don't know if that means if they wouldn't after they saw the record, or if they wouldn't before seeing the record, but he would work it out with me on a personal level, and I'm not sure what that means. My dad seemed to think maybe try to work something out to compensate for the fact that I paid a premium that did nothing.

THERAPIST: I can also the other option is I can type up a paragraph summary. That's often what I do when people ask when they say the insurance company is insisting on the medical record, so that it's not invasive session by session or month by month. [00:05:35]

CLIENT: That would be very different.

THERAPIST: That would be very different. We still want to be I don't know whether we'd put it in terms of trying to justify depression and anxiety. You know what I mean? Which has been there, but actually, technically, I think that part has gotten better, so it's sort of the adjustment side of things or working on the relationship. I put a V-code for the second round, which is partner, relational problem. So, we'll just cross that bridge when we come to it.

CLIENT: Okay, thank you.

THERAPIST: Keep me posted. It's a hassle for you. So what's on your mind, where are you?

CLIENT: We're going to see Dr. [Farrow?] again this week, tomorrow. Ivan has made a lot of effort, so that's been great. So overall, like that's been pretty consistent. Something that was I don't want to like wash over that or make that really brief, because that's true and that's been really great and pretty consistent, but something that wasn't okay. Well, it didn't feel okay. I found out after the fact, that Ivan booked a trip to see his parents in the beginning of November, booked flights. I mean, they're paying for the flights but that's not the point. [00:06:58]

THERAPIST: Flights for both of you?

CLIENT: No, no, just for him, and didn't tell me about it. So I found out about it after it was done and that felt first of all, it triggered the kind of severe feelings of finding out about things and hiding things. So even though, like a trip to see his parents is certainly not the same as the other really big betrayals. It's just still, it's like there's no room for that, even in a smaller way than this.

THERAPIST: Had he booked it recently?

CLIENT: Yes, it was very, very recent. But we had talked a few weeks ago. His parents had been really, really, he said very persistent, asking him, they really wanted him to come home. They really wanted to talk about what was going on with him face-to-face, which they've been talking very regularly with him on the phone, so I'm not sure what more he would do in New Orleans. And he had said that he wasn't going to go. He said that he didn't want to, "run home to mommy and daddy," is how he put it, and I kind of thought that that was a good thing, that he wasn't going to go, simply because in the past, when he's gone home around difficult things like this, that have been going on with him, it's been more avoidance. That's kind of been a family coping mechanism, and so going home and going out to the movies and going out to dinner and seeing his grandparents and stuff, and not talking to me while he's there, actually has made things worse. [00:08:31]

THERAPIST: Yeah, that makes sense.

CLIENT: So, (sighs).

THERAPIST: And when you found this out did you talk to him about it? Did you ask why he didn't say what did he say?

CLIENT: I mean that was the fight. It did not go well, he shut down, he withdrew. Eventually he said that the reason he wanted to go was because and the reason he wasn't telling me was or he was going to tell me the next day supposedly, the day after it happened, and the reason he wasn't was because he hoped that he would spend Thanksgiving with me, but he didn't feel like he could bring that up because it was too soon and he didn't want to push or be too far ahead, so that he wanted to see his family in early November. And I honestly don't know if that's true or if it's kind of like a best case scenario explanation. I'm kind of starting to feel that way with a lot of his explanations, because they all kind of paint him in the best light possible.

THERAPIST: Yeah. [00:09:32]

CLIENT: So I don't know, it didn't go well. I was really upset because he hid it. I was really upset because historically, the visits are the total opposite of what he says they're going to be. Also, because his parents will not speak to me.

THERAPIST: Really?

CLIENT: They will not.

THERAPIST: Still?

CLIENT: Still. Ever since the assault, they will not speak to me, and it's very bizarre and it seems very backwards. I could understand if my parents didn't want to speak to him, that would seem more than fair, although my mom has talked to him a little bit or at least she's e-mailed or texted him. But they will not speak to me and Ivan because point blank, I guess asked them several times, like why aren't you what's going on, you need to, and they will not.

THERAPIST: They don't talk to you why?

CLIENT: Ivan says to some extent, they say that they think I don't like them, or that they feel like I would just reject them or they might say the wrong thing and basically just I feel like they're avoiding. I don't know, but I would imagine they would feel pretty embarrassed, humiliated, ashamed. [00:10:53]

THERAPIST: It's so similar to your and Ivan's dynamic, where you're identifying that they're avoiding, and they're also in a place of feeling like they're worried they're going to get attacked themselves, whether true or not, that's kind of what leads Ivan, in many ways, to keep avoiding or he avoids. I could imagine, for example the trip home, it's sort of it's not even that big a deal of a thing. Like even though, what could you imagine the worst, worst case scenario is not that, it's not that bad. Do you know what I mean? In other words, versus the best worst case scenario justification, but it still sounds like there's something about it that he was afraid to bring up to you and in his fear he then just avoids it and it gets so much worse.

CLIENT: Mm-hmm.

THERAPIST: He'd be so right now, just the more these things could get above ground. You can say, like I really want to do this, you could say I really don't want you doing it. You can say I really want to do it, you can have a conversation, make a decision then. [00:11:58]

CLIENT: We've talked about this and Ivan seems to be aware to some extent, that his fear of confrontation, whether it be confronting himself by admitting something or confronting me by saying I really do disagree.

THERAPIST: Yes.

CLIENT: It's just, it's disabling, or at least it really presents him from being transparent, which is evidently something he and Dr. [Bourd?] are really working on. I mean that's kind of a problem. I also feel uncomfortable because they've been very, very, very supportive of him since what he did, and it feels like supportive to the extent of and not talking to me, it feels like. He says, and I guess I don't really believe, but it feels like they support what he does. In other words, I guess it would feel different if I knew that they were making sure he was okay, but maybe showing even a little bit, any frame of concern towards me, since I wasn't the one who did the like, I was on the receiving end. On top of which his mom, she sent him job descriptions for New Orleans. His dad has yeah.

THERAPIST: Really? [00:13:05]

CLIENT: Which I would think would be over the line. His dad, when I graduated, you know, telling my mom, Ramona can look for jobs in New Orleans. So many of his family members have pushed for him to move back. His whole family lives within 30 minutes of each other, in New Orleans. So there's that.

THERAPIST: So you're aware, they might be trying to get him to come back, to move home.

CLIENT: Yeah, I am, and I almost wonder if they aren't saying you did these things because you're depressed, it's Ramona's fault that you're depressed, because she was critical about you being depressed and having ADHD, and not working and things like that. It feels like they've blamed for the depression, because they themselves have kind of turned away. I mean, Ivan has been struggling with these things since middle school, like his teachers noticed, and they never... So, maybe that's not completely appropriate to feel so strongly about, but I feel very angry at them too. [00:14:15]

THERAPIST: They're in some ways, worse versions of what he's doing, and he's the victim of what they're doing too in this case, right? They're doing it with him, colluding with the avoidance.

CLIENT: It's frustrating because if I say to him, I really wish you would have gotten help sooner, I wish you would have gotten help when you were writing those things in middle school, like I really wish. He never says, I'm really angry with my parents or I'm hurt, or any type of he won't confront them. And I guess they just feel angry because now they say they want this visit to be an expression of them supporting him having depression, or like getting help for depression, and I'm really angry because I actually did that these past two years and they have never said to me, we said that you were judgmental when you pointed out his depression, but in reality, we're really grateful that you... I guess I'm really angry and I feel really and him going to visit almost feels like siding with that or prioritizing them.

THERAPIST: Yeah. [00:15:27]

CLIENT: So I guess it's not that I don't want him to see his parents at all. It's that in this context, it feels and in the way it was done, it feels very different.

THERAPIST: Even if he were still to visit, when it felt so different and he could say look, I don't really want to go home right now either, but it feels like, to keep the peace, there should be this trip. How do you feel about that, let's talk about it, you know, kind of needed a discussion and a decision between the two of you, you might have come around to saying okay fine, make the trip. Or I don't want you to make the trip but you're going to do what you're going to do, but at least then it's been above ground. I think that's a big difference in the trust that you're trying to build.

CLIENT: It even would have felt different for me if we talked about it and I voiced all those concerns that I did after the fact anyway, and we at least I don't know. [00:16:29]

THERAPIST: It got aired.

CLIENT: It got aired.

THERAPIST: Who knows what you would have decided together or separately.

CLIENT: Or even for Ivan to say I'm going to go home but this time, instead of, you know, going out to the movies with my dad, I actually am going to have that discussion. I think that's fair.

THERAPIST: Yeah.

CLIENT: So that's been a tough point, especially since, I mean they were here the beginning of September. It's not been long since he's seen them. If he lived close-by, they would see him multiple times a week, so this feels like way too long. They've been very unsupportive of us living here, I mean they've, multiple times, when are you moving home? I think they viewed it as they're living there because she has to go to school, he has to live there because of her, but as soon as she's done, and it doesn't feel fair. It was such a focal point of when they came up for graduation, that they couldn't handle that he was living on his own, that he was like, it was just such, it's like you never want to see us, we haven't been here before. [00:17:44]

THERAPIST: Saying to him directly?

CLIENT: We have to see the apartment the night we get here, like why don't you want to see us, and a lot of guilt-tripping. And I wish, for his sake and even for theirs, that they could say... I don't know, that they could encourage him to be independent or they could encourage, like you're married, you should live in your own apartment wherever you want, because I feel like there's a difference between saying we want to see you, we love you, we miss you, and why don't you live within the 30-minute radius that everybody else does. When we moved here, Ivan's dad called every single day. Dinnertime, nighttime, any single time of the day, and it's just like...

THERAPIST: It feels unhealthy.

CLIENT: Yes.

THERAPIST: I mean certain I don't know, what's his background, cultural background, in nationality? What are the parents? Have they been in the United States for a long time?

CLIENT: Yes. Yes, this ain't a cultural thing. [00:18:47]

THERAPIST: I know they're not directly from Europe, but there are certain subgroups, even if it's been multiple generations, of Italian family, where it is considered disloyal if you move away from where the family lives. And that doesn't have to necessarily be unhealthy, but I think what you're describing is that it's really quite an extreme that's about making him dependent in a way that inhibits his growth. That doesn't sound like it's culturally based either.

CLIENT: No, I don't think so. His aunt lives next door to his grandparents. It's not like it's very and his grandfather has a joke that everyone needs to live within 30 minutes, but all but one of them do, and that couple gets a lot of, a lot of -

THERAPIST: Grief?

CLIENT: Yes, for living in Texas. So I don't know, it's upsetting, and especially since Ivan's dad has always taken on the friend role, as opposed of the dad role. They're so, so close, and Ivan will not say no to his dad. And it feels like an unhealthy expression on my end, but I often feel almost jealous, because it almost feels like they have such a close emotional intimacy, even though I wouldn't want a relationship with Ivan where he wouldn't say no to me, but it's like... [00:20:06]

THERAPIST: The way he's inserted in between you two in a way.

CLIENT: But that's like even more upsetting, because he said around the visit, that his parents have expressed that they think Ivan chooses me to the exclusion of them.

THERAPIST: You're his wife.

CLIENT: I'm like, why shouldn't I be your priority? Like, wouldn't that be I mean, you don't abandon your parents when you get married, but shouldn't living with your wife be more important than living with your parents at that point. I guess it feels like they force him to choose, and Ivan feels like he has to choose them because he could not say no. I mean, his dad really guilt-trips, and I don't know what to do.

THERAPIST: He's in the middle of his own kind of intense, the heat from them and fear of losing them, you know the kinds of feelings that you could recognize, that make it hard even to identify, how your parents have hurt you in so many ways.

CLIENT: Mm-hmm. [00:21:13]

THERAPIST: Right? You're a lot further along in that. He's so early on in the recognition of their role in his difficulty that it sounds like he was just sort of remaining dependent. Slow steps but it's a long haul in front of him to feel he could separate from them more. A lot of the way you're describing him, Ramona, is I wish that they were this, I wish that they were that, these are such understandable wishes about your identification of what would be healthier in them, in him, in you, in the whole system functioning together. It makes me wonder though, given that for the time being they're just wishes, what do you do with this inside you? If knowing that they are who they are, this is the unless they get into their own intensive therapy, this is kind of the way it's going to be for a little while. Where does that sit with you? [00:22:20]

CLIENT: It feels kind of horrible. I've gone to a lot, a lot, a lot, of very large family functions for Ivan's family, a lot. I've done so much with his family and I guess I feel betrayed, because they what Ivan did was horrible. Ivan's not a horrible, horrible person, but what he did was very horrible, and the fact that they can't face their own avoidance or they can't face their own it feels... I think this is maybe critical of me but it feels like inexcusable. It feels like if I have to deal with this face on, you are twice my age and this is your son, you should definitely have the capacity and the maturity to a minimum... like it might be difficult but at minimum, just are you okay? We're here if you need something. We're making sure that all Ivan's needs are met after what he did but... (sighs) Or even, how is your mom doing? Like, anything, absolutely anything. What I dread is that Ivan says that they I don't know, he brought up, in some context, about the holidays and they said something like they would want to see me and Ivan said he didn't think I'd want to go, and they're not talking to me, which is absolutely true. And maybe that's not fair, for me to impose that, but what I would [00:23:55]

THERAPIST: No, it's fair. It's a question of whether would they start talking to you again, if they're wanting you to come for the holidays. I can't imagine them wanting you to come and then they ignore you?

CLIENT: They would act like nothing is going on, because this has happened before.

THERAPIST: Okay, that's different than ignoring you though.

CLIENT: No, I'm sure if I was there and his 20 other family members were there, they would act like nothing was going on.

THERAPIST: What would you like them to do if you went for the holiday?

CLIENT: Before that, they would need to actually talk to me. I would not feel comfortable with them ignoring me and not talking to me for months after something that I didn't do, and then say well of course, come over for Christmas and we'll just have a great time, and there's never any acknowledgement. Because even around the grad school thing, the loan thing, like other big things that were less I mean those were very personal things but less intensely personal than the assault of the websites. There was never they acted like I didn't know. They would talk to him evidently, briefly, when we visited, but they would do it in secret, in private, and they wouldn't even say, we want to go talk to Ivan about this. It was like I didn't know, like I'm not the one living with him.

THERAPIST: Mm-hmm. [00:25:10]

CLIENT: And I don't feel comfortable with that arrangement, and I would feel like a doormat if I allowed them to not speak to me for months after something that their son did, and then allow them to act like nothing was going on.

THERAPIST: It's complicated, because I think it wouldn't be out of the range of normal if a husband and wife are separating, for the husband's family to stay loyal to him, in a way. In other words, the phone calls going in that direction and not necessarily wanting to bring everything up with you because in health, respecting that that's in some ways your own business, between the two of you. But I hear you're saying even just something like an e-mail to just say, just to let you know, we're thinking about you, sorry this has been so hard. Something that acknowledges, instead of completely ignores.

CLIENT: That's exactly it, especially because they were doing this before we separated.

THERAPIST: Yes. [00:26:11]

CLIENT: So it wasn't even that. I guess the other thing is I don't feel comfortable with them saying we don't want to get in the middle when they're sending him job listings for New Orleans. Like, either you don't want to get in the middle or you do, when it works for you.

THERAPIST: Yes. That doesn't really make sense.

CLIENT: I hear how critical that is.

THERAPIST: No, it's a very mixed message.

CLIENT: It feels like they're avoiding and I understand that Ivan acknowledges that they avoid and that he has learned that with them. He won't say that to them.

THERAPIST: It's hard enough for him to break through it, so now imagine trying to get his parents not to do that, just impossible.

CLIENT: Which I think to some extent, I hope to a great extent actually, I can acknowledge unhealthy patterns with my parents, and I know that some of them are in me, but I hope that I acknowledge and work on them. But I don't think that should have to affect Ivan and me, nor do I think his parents, you know, like their inability to deal with their children's problems, should have to affect us, I think, if Ivan is working on it.

THERAPIST: Yeah. [00:27:23]

CLIENT: The fact that they avoid it should be a much smaller thing, because I also think we should visit them a few times a year and he should talk to them regularly, but it's okay if they're not able to talk about the tough stuff. It's not okay, but I mean it shouldn't have to affect us to this extent.

THERAPIST: That's also what I think, is even if they were doing nothing different and doing exactly what they're doing and it's infuriating, if you felt Ivan was in a place of saying Ramona, I get it, I'm working on it in me. I can't change my parents but I can change myself and that's what I'm here to do. In a very clear and concrete way, you were a team, I think you can then sort of look at his parents and say, well you know, these are their limitations. You can't change your mother, you're not going to change who she is as a person. You can't be her therapist, right? She is who she is at this point and even if you wanted to, you couldn't as Ivan said, I can't stand the way your mother talks to you and treats you. You can't do anything about changing who she is. What you can do though is your own response to her, your own engagement with it, your own enabling it. That's the part that's your responsibility and I think to the degree that Ivan could feel like you're getting it, you're working on it, you are a team then. But I think your feeling with Ivan, sometimes you're a team and sometimes he's really, really drifting back to being sucked into the way his family operates, and that's when you feel like we're not even on the same page. You don't have the safety of the two of you as a unit going home to New Orleans right now, where he gets it, you get it, and you're together, and you're seeing the same thing.

CLIENT: And that would be okay, and to accept the visit for what it is.

THERAPIST: Yes. [00:29:10]

CLIENT: Which is what I try to do with my parents. It's great to see them.

THERAPIST: Exactly, exactly.

CLIENT: But I would not go home and depend or rely on my parents to really support me, or I guess I wouldn't expect them to meet needs that I know that they haven't been able to meet, but I would go home to visit them and take it for what it is.

THERAPIST: If he were stronger and could stand up to them and not as enmeshed, you would take the visits more sort of in some ways, that's what visits with in-laws and family are for people eventually. Your family is who they are and there's the good, the bad and the ugly, and you go home and have a visit. But it sounds like he's not in a place where he's able to stand up to it all the time.

CLIENT: No. I at least feel like that's a tiny bit good, because I don't have the expectations of this visit that I've had before, and then he's gone home and they don't talk about any like, I mean, and he can't answer the phone because they're always out doing, you know? So I guess I hope that that's not the case this time, but I don't have the expectations of that really happening. They also have another person living with them. They took in an exchange student, so Ivan doesn't even have the guest room any more. It's a very weird situation. I said, like how many serious conversations are you going to have, like it's not even just your family in that house. It's just... (sighs) If he doesn't spend Thanksgiving with me, which right now, I don't know that that could happen. My sister has not I don't think it would happen. [00:30:56]

THERAPIST: Your sister has not...?

CLIENT: Spoken to him. They haven't seen each other since the assault, back that far, and she's still very angry, hurt, upset. I think it would take a lot for me to think that he's going on a different path. I think it would maybe even, in some ways, take more for her. She's protective. I guess the point I made to him was, are you going to go home the beginning of November, at the end of November, at the end of December/beginning of January? Is that necessary, you just saw them in the beginning of September.

THERAPIST: What do you want right now, in how you're spending time and holidays coming?

CLIENT: It's weird, because I've said in here before, I would not want us to get back together, because for me the holidays are really important, or events around that would so I guess, I (sighs). I don't know, I guess I want to back up and say when he like the past few weeks, he has consistently been meeting me, picking me up from the subway when he's not working that evening, and he made dinner, doing things, taking care of me, being supportive of my job, asking about my day, spending time talking with me. He's been definitely proactive about the couple's sessions. These are all great things, I mean these are impressive things, so I feel really good about that and it almost has gotten to the point where if he's there each evening and there have been, I want to say three nights in total, where it's been close to ten, and he works at four-thirty, and I have just said, "Why don't you sleep on the couch." You're going to be gone before I wake up, I don't care. That's felt a little weird but it's also felt a little comforting, because it was such an adjustment to get back to nobody being in the apartment. So it's almost gotten to the point where I'm like when is he going to move back in, because he's here each evening. This is like more effort actually.

THERAPIST: Yeah, yeah. [00:33:12]

CLIENT: It would maybe be easier for some of these things to happen. And I've said to Ivan, would he be interested in talking with Dr. Farrow about what that would look like, to do that in an appropriate way or a healthy way. He says he doesn't feel like he can bring it up because he doesn't want to push moving back in. He wants to really respect whatever I need.

THERAPIST: Which is really actually quite mature of him.

CLIENT: It's good.

THERAPIST: To wait until it comes from you.

CLIENT: It's good, but I guess I do want to talk about it.

THERAPIST: So you can say that, I would like to talk about it, when you're ready to talk about it.

CLIENT: Yeah, yes, and I brought that up with Dr. Farrow and I felt good because she said I told her I wanted to take in the whole thing, like the really bad things plus these consistent daily efforts, and she said that would look like the effort is continuing, but also setting aside times every single week to talk about it. It's like a special reserve, like appointment almost, to talk for an hour or whatever, at a time. [00:34:20]

THERAPIST: How does that sound to you?

CLIENT: That sounds good. That sounds like what I need.

THERAPIST: Yeah.

CLIENT: I think so and we have talked about it to some extent. I guess I also just, I don't know if it's the critical part of me, but I think in terms of efforts, it could be relatively easy to pick someone up and make a nice dinner and talk about their day. And it's huge for Ivan, but in the scale, in relativity or in relation, I think sitting and talking about the assault or talking about the websites, like talking about all of those things and some serious long-term changes, that might be less attractive or less easy. And I think I've started to feel like when things are good, things are good, if that makes sense? So in other words if I come home and we just talk about our days and we just eat dinner and watch some TV, and then he leaves and I go to sleep. There's not going to be a conflict or a confrontation. But if we sit and talk about some of these big things, he's going to hear some things he doesn't like, I'm going to hear some things that make me really upset and renew those feelings. So in that situation, when it's not going smoothly, how would that go, because that's the part that I guess would need to happen in order for it to be okay for him to move back in. [00:36:01]

THERAPIST: Yeah, I mean I guess the part that I feel like, as you're talking, is the most dangerous for you, is that you might be going into this expecting that he won't betray you again. In other words, he's doing all these things that are very different in the day-to-day, that's really happening, in some ways is the easier of all the things to be done. So, you want to make sure what happens when we bring up the stuff from the past. The other piece, I would say you want to keep in mind for you, is that I think it's extremely likely, and I'm putting it that way to be really clear about it, that there are going to be future things that feel like betrayals. And here's why I say that. No one can completely change their character in even six months, right?

CLIENT: Mm-hmm. [00:37:04]

THERAPIST: It takes years of long-term work. So, what just happened, something like a booking and a flight, it goes right under again. I think things like that are going to continue to happen from time to time, because that's just the pace of which change happens.

CLIENT: Yeah.

THERAPIST: So that's more, I would not want you to move back in on the like, he had an unconscious assumption that that's not going to happen. So, if it's a very big thing that happens again then that's not what I'm expecting. If there's something that has to do with pornography again, that's a real or assault, right? These are the loud things that I think it's going to be very serious if that happens again. But I do want you to know and expect that okay, I'm moving back in with someone who's really working on this, but he's not going to get it right all the time. I'm going to feel disappointed in this part of him. And the question would be not so much does it happen or not, but how you both navigate it when it does. Or, on his part, if he's feeling like he's getting cornered with attacking questions, like I need to know, I need to know, I need to know, or something like that, that's for him, the repetition of the thing that doesn't feel good to him from you. How does he handle that? Like, coming up with different ways to say okay, this thing that I have feelings about is happening. How can we shift this conversation and talk about it in a kind of more even keeled way, so that you get to know each other's minds more. That's, I think what's realistic if you're moving back in now. It would be different if you said okay, let's wait two years, and he does all this work, right? But going in with the expectation there are going to be bumps in the road of the same kind, and hopefully you have more tools now and more awareness, both of you, to begin to talk about it when it happens, in a way that actually is really effective and productive. Does that make sense? [00:39:01]

CLIENT: It does, and I think I'm glad that you expressed that, because part of me would like to think that never again. Part of me also thinks that if they were relatively small, maybe even smaller than booking tickets for a few days, the more he builds up, almost like a credit, (chuckles) by doing all these positive things and having those conversations and going to Dr. Bourd and starting an antidepressant and going to couples. There's a little room and it's not unbearable, especially if I know that he knows that it's not okay and that he's working on it.

THERAPIST: There's room and yet room you also don't want it to be that he then gets away with it, because I think this is something you want to talk about when it happens and say yeah, I do have feelings about it. Even though you've built up a history and the track record right now is I trust you, when this happens it breaks my trust a little bit.

CLIENT: Mm-hmm. [00:40:08]

THERAPIST: I wonder about a possibility of working on a system together where one of the things he's afraid of and the things he's avoiding is your reaction, I think.

CLIENT: Yes.

THERAPIST: So he's afraid you're going to say no, or you're going to get really angry at the request, or judge him or something. And I'm not even saying that's true or not. I'm just describing what his fears are.

CLIENT: Oh, yes.

THERAPIST: So he puts it under wrap. What if you were to say to him, Ivan, it's so important to me that we talk about things. I wonder what would happen if he says okay, Ramona, there's something I'm thinking about that I'm really afraid to bring up with you, could you I just want to name that first, and could you try your hardest to keep your reaction in check, like even just listen for five minutes while he talks about it. That, sometimes, like even working with children, where children are lying a lot. If you say okay listen, if there's something you're scared to tell me, say mommy is here to tell you this, and then I will do my best as a parent to have a very calm reaction, and to applaud you, first and foremost, before I have any other reaction, for being honest with me. It doesn't mean not to have your feelings at all. I don't mean don't react, I don't mean don't disagree, I don't mean even don't judge. You might have judgments of what he's asking, but you will say, for the first few minutes of our talking, I'm going to listen and I'm going to say to you, thank you for saying this above ground. We will acknowledge that first and then we'll have our discussion about what my feelings are and what your feelings are, so that he feels like he'll know that rather than if he names something then.... like this, happens, that you'll say okay, you have two minutes of my just listening and I'm going to first acknowledge that you said it to me and I really appreciate that, no matter what it is that you say, so that even if he says okay, I need to let you know, I was on the website again, you could say first and foremost, thank you for telling me, that's really important that you told me. I do have a lot of reactions to that, that we've got to talk about, we have to sort through. I'm very angry, I'm very upset but the first thing I want to say to you is thank you for telling me, that's very important you told me. Does that make sense? [00:42:27]

CLIENT: Reinforcing the honesty?

THERAPIST: Yes.

CLIENT: Positive reinforcement.

THERAPIST: Reinforcing the honesty but also saying to him like, you could even have sometimes couples can have a catch word, like you come up with some symbol or phrase or something that means all right, there's something I've got to say and I'm afraid for your reaction, so that he could just say that, so that he knows now, you're going to be okay, taking your deep breath and that there's going to be a little space for him to say it without being attacked right away. I think that might help him be braver to start pressing through, and then you'd get to have more of a discussion about it. Does that make any sense?

CLIENT: It does. Can I ask you, what about, so for example his phone?

THERAPIST: Mm-hmm?

CLIENT: I guess it's like I don't know, that's where he is on the websites, his Internet, on his phone. So, the times when I have looked at his phone, I think it's been twice, he's very, very uncomfortable. He says he feels violated if I am reading anything, if I am seeing anything, and my point is, if you have nothing to hide what's the problem? [00:43:42]

THERAPIST: Yeah.

CLIENT: Because if I knew that you were going through my stuff, I really wouldn't care, I have nothing to hide. You can read my e-mails, I really wouldn't care, and the fact that he has that reaction of what are you reading, oh my gosh, is not okay with me. So if he understands the severity of what's happened and the need to be transparent, what's the problem?

THERAPIST: Yeah, yeah. I think you have a very good point. People have to have a coded password from their spouse, why?

CLIENT: Exactly.

THERAPIST: What is happening that you don't want me to know about? It could be something like oh, I had this intimate conversation with my buddy and he told me these things and he doesn't want me to tell anyone, but then he should be able to say that to you, that's all that's there. So this is, I think something to bring up in couples. [00:44:35]

CLIENT: We have, because there was something around that, that happened, but it was mostly so he's, you know, texting his cousin and saying around the separation, he was pretty cavalier about it, like I don't think there will be a reunion, I think I'm looking for a roommate in a few months, would you be up for that, type of thing. And of course when I read that I was like are you kidding me? This was back in August, but he was really like, he's like well I talked to him after that, I promise I did, I told him what was really going on, he said I needed to work on stuff. He wasn't supporting me. He's like I'm worried because you're going to read things and read into them and interpret. And I said, then why don't you sit down and tell me what was going on, you know like you have a chance to I guess the point is, I really do need to know, and I also need to know that I'm not checking and he's just getting better at hiding things, deleting the e-mails.

THERAPIST: Here's where I have a little bit of a counter balance view of that exchange. In the middle of a couple separating or having huge problem, they are going to vent, sometimes to a friend, to a parent, to a sibling, a conversation that is actually not meant for your ears and your conversation not meant for his ears necessarily, right? Things that you sort of say no, you didn't need to hear that, that was me just venting. So to the degree that something was happening around that time, I'd have a little forgiveness for him, like right okay, he's talking to his friend, things were on the rocks. But moving forward is a different story. Now, if you're setting a clean slate here about communication and honesty, you don't really want there to be something at this point he's venting to someone else, that he wouldn't feel comfortable saying. Even if he's really angry, you want to know that. [00:46:21]

CLIENT: Yes.

THERAPIST: Right? You want that to get communicated, not just vented in some counterproductive, disdainful or mean way to you. You want to know that that's happening and that's not appropriate.

CLIENT: I also, maybe it's not fair, but I do feel like he didn't have any right to vent. And he wasn't so much as saying, you know I'll be moving out or I'll be, you know, it won't end well or.

THERAPIST: Yeah.

CLIENT: I guess I don't feel like he I could understand that if it was a mutual problem, but I guess in the context, I feel like what does he have to vent about? What did I do? I mean, I know in the marriage globally, there are plenty of things that he could vent about and justified, but in that situation... So.

THERAPIST: Yeah, and so you'll have to keep holding onto these red flags about what is he not understanding about what needs to be confronted still. How do you hold onto you were talking about the whole, that he's doing that, and he's also making these other changes. That's what you're trying to how you're trying to evaluate what to do about moving in together, about once you move in together, how do have the rhythm work, about the holidays, the whole picture. Again, bracing yourself and knowing, if you're trying to be in reality, that it's not going to be all roses. Right?

CLIENT: Mm-hmm. [00:47:48]

THERAPIST: And I think you're then much better prepared when it happens, rather than it feeling like oh my goodness, how could this happen again? It's not that you're not upset by it, but you get prepared, actually okay, this was going to happen at some point. How do we talk about this now, in a way that actually is productive. And the same thing for him towards you. He's having feelings about your coming at him in some way, or wishes you would talk to him in a different tone of voice or have the dialogue go in a different way, that he has to be able to find the words to talk to you about that and not simply just avoid. Okay, we'll keep playing it by ear.

CLIENT: Okay.

THERAPIST: Okay?

CLIENT: If you could let me know if you have cancellations.

THERAPIST: I definitely will.

CLIENT: I'd appreciate it, the mornings definitely work well. Thank you.

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