TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: How are you?

CLIENT: Okay.

THERAPIST: You were feeling pretty anxious last week.

CLIENT: Yeah.

THERAPIST: And today?

CLIENT: To some extent but I've been working a lot so I've been able to focus the anxiety on that. It's been helpful as a distraction, even if it's unhealthy.

THERAPIST: How is work going, by the way?

CLIENT: It's going okay. I actually worked Saturday, too, because there was a commission meeting and my boss is a co-chair of that commission, so that was a great opportunity to go and listen. It's okay. There is a really tight deadline for one of his publications, so I'm working on that. [00:00:58]

THERAPIST: Are you enjoying the work? You were uncertain about exactly what the possibilities would be, but it was looking like it was pretty good.

CLIENT: No, they should be pretty good, but right now all I'm doing is administrative stuff, which is not good. It's supposed to be a one-time it's a textbook, actually, on surgery, that he had put together a couple of years ago, but it needs to be wrapped up. He got a new publisher within the past couple of months and I'm e-mailing like 150 people. (chuckles) So I guess it's satisfying that there is a lot of progress.

THERAPIST: And there is a lot of responsibility.

CLIENT: Yeah, there is a lot of responsibility, so I guess that's nice.

THERAPIST: It's not just data entry.

CLIENT: Right, it's not just data entry, but it's not, obviously, what I want or need to be doing. But it is interesting to hear some of their stories. So that should hopefully be done by February 1st and I can get on with research and stuff. [00:02:03]

THERAPIST: It feels like it's working out as a position for you?

CLIENT: It's a really great opportunity.

THERAPIST: Where are you otherwise?

CLIENT: I guess I'm not sure. I kind of go back and forth with still being really unsure. It's bizarre to go unsure about how you want to react to something for so long, but that's still where I'm kind of at. Yesterday Ivan and I both had off and I was just exhausted. I realized I just wanted time by myself. I didn't really want to spend time with him. I think that might be an avoidance of kinds, but it just feels so unfair because I would want to spend time with him because that was what our pattern was becoming. [00:03:03]But now it's kind of taken that from me so now it feels lonely.

THERAPIST: Did you have a couple's therapy session at all?

CLIENT: Yes.

THERAPIST: Was it helpful?

CLIENT: I guess. We talked some more about the assault. Ivan brought in what Dr. Bourd had told him or what they had discussed a little bit. It sounds very bizarre to me. I don't really understand it at all. When Dr. Farrow tried to explain it, it was more unsettling so I'm really unsure what it is about, but I guess Dr. Bourd told Ivan that he was delusional in what he did, that he had a delusion of what he was doing or what he was getting or what the situation was. [00:04:03] I guess kind of detached from the reality. He wanted to be close, obviously, doing something that's very distant.

THERAPIST: Which is what we said.

CLIENT: So the word "delusion" obviously reframed it very much from what you and I discussed, even if it's the same thing. That's scary to me, especially because then Dr. Farrow described it as a pseudo-psychotic state. That's a word way over my head. I don't know what that means. It sounds very scary. It sounds very serious. It sounds much different from Ivan wanted something but didn't know how to express himself; and I don't know if this is just a clinical term and a layman's term for the same thing or if there is more to it. It's just very scary, obviously. [00:04:57]

THERAPIST: Can you say more of something about those words makes it feel more serious?

CLIENT: It does. Right. In my mind if I could picture one spouse being told, "Your spouse really wants this and they just aren't sure how to express it with you. They're really feeling stuck and they're ashamed." That feels very different from, "Your spouse is having a pseudo-psychotic state when they are assaulting you in your sleep." These are very different and maybe the goal is you're trying to interpret it in a way that it's the same thing, but I reacted to those very differently because one sounds not okay, but very, very different from the other. When it sounds like that, she makes it sound like a condition almost, which maybe it is. My question is "can he even control it?" Is this a mental illness or a condition of some kind that he can't even control? [00:06:03] What does that mean?

THERAPIST: They both sound more serious and also it sounds like it's something that's been more permanent inside him for some time rather than just a blip on the radar screen that won't happen again.

CLIENT: My reaction, again, is different if I know that Ivan can control it or if I know that Ivan has no control over it. Those are different.

THERAPIST: How did Ivan react to this language as it was talked about?

CLIENT: Not so great. I asked her what a delusion meant, what the pseudo-psychotic meant, and she said several times, "I'm talking in general about what it means. I'm not saying this is what Ivan was experiencing." But she just described it the way it would be defined literally, and I could tell Ivan was upset by that because it was unsettling to hear that sometimes medication can help it, to hear that sometimes people can't control it; sometimes it's a learned response that people have learned; sometimes it's a coping mechanism. [00:07:11] She went through a pretty wide definition and some of it was pretty disturbing. I did feel bad for Ivan because he's like, "Is there something I can take so that this doesn't happen?" I don't think that was her intent, to say like . . . Honestly, to hear pseudo-psychotic is disturbing. I'm sure Ivan felt more guilt and shame. I'm absolutely sure of that. He told me that Dr. Bourd just asked him to let it sink in, what they had talked about with the fact that he went through kind of a delusional state and that he should just think about it and let it sink in. [00:08:01] I guess that's also scary for me because I feel like I'm consistently being asked to be more and more patient; and I'm not wanting to be more and more patient any more. I feel like it's just way too much. Everything that happened before the separation, to still be trying to figure out exactly what happened and why and now more? It's like "but you need to wait for answers" and "you need to be patient" and "Ivan might need to journal and he might need to let it sink in for a week at a time. And we have no clue. It's overwhelming and scary.

THERAPIST: I think while I hear you experiencing that it's just asking you to be more patient, I actually know for a fact that Dr. Bourd would completely understand and be empathic with your being done or not wanting to be patient. I think his intervention with Ivan, to tell him to try to let it sink in probably comes more from trying to say to Ivan that he needs to not push this aside in your mind because it's too scary. [00:09:11] You really need to let yourself have this, what we talked about, and try to just learn from it. Let it slowly seep into your understanding of yourself rather than tucking it away. Do you know what I mean?

CLIENT: Right and I completely understand it. For Ivan's process that's all very necessary, but for me it feels like too much to ask. It's very necessary for Ivan, but it just doesn't feel great for me because it has gotten to a point multiple times where it feels like not only do I need to let it happen, but I don't have to get a reason why. In addition, I have to wait and wait and wait and wait and we may or may not have scheduled conversations. On top of which new, big things like this can happen that totally derail the progress of talking about the other things because suddenly it's the most important thing. [00:10:07] It's really frustrating and I do find myself feeling like there is not room for a lot more patience or maybe there is not a lot of point to it because (chuckles) I can't resolve anything because something else is continually coming up and it's all a mystery why it happens. And that doesn't seem right because it's not right that it's happening in the first place and then on top of that to expect me to settle for no answers or settle for . . . (sighs) It's too much.

THERAPIST: Are you saying that you're feeling so done with this and not patient any more around it that you're wanting to make a change with him from where you are, like you don't want to keep working on it?

CLIENT: No, I'm not saying that, but I am saying maybe something has to change. [00:11:03] I'm not saying I am done because, again, it's very bizarre. It's really like two different mindsets because on the one, Ivan really made a ton of progress and those couple of months were really, really, really helpful.

THERAPIST: [Closer and closer to him] (ph?)

CLIENT: They were great and I would say they were great even if we had not had problems before. Even if that weren't the comparison, I would say they were great. And then this happens and so I don't fully discredit all that great stuff. It's not like an on and off switch. I still felt like we were going to watch a TV show that night and have dinner Thursday night and Tuesday morning was when this happened. We're not doing that anymore and I miss that. But at the same time, I can't say that I miss it, really, because what kind of doormat would I be if Ivan does that and I . . ? [00:11:59] It's hard to separate because it does seem kind of like two different people, the person who is making all this effort and then the person who is right back. It's very bizarre. So no, I don't want to let go of all of that.

THERAPIST: What do you imagine would help you with that right now? What do you feel like would be the something different? What do you need for your state of mind where you are that would be helpful?

CLIENT: I guess I need a way to kind of make it stop.

THERAPIST: To make sure that he never does it anymore?

CLIENT: Of course. Of course.

THERAPIST: Is that what it is or is there something else?

CLIENT: There is more, I guess. In our couple's work we started with grad school and the loans and then the websites and the assaults and I have just never been able to really believe, feel like, we got our feet underneath us to really keep moving forward. [00:13:01] In fact, when Ivan started making all those efforts it was like drinking something after being really dehydrated after a long time. You just want to keep drinking and drinking and drinking so that you don't feel that way anymore; and I felt like if we could have kept going like that for months and months even with tiny, like the really dumb white board lie even with that, if we could have kept going like that for a long time.

THERAPIST: You were headed on the path.

CLIENT: And I felt like we could really get our feet under us to be able to deal with that, but then if it wasn't happening anymore we could even get to a point where we had more positive experiences than negative ones and that would be maybe what I need. But it's hard to get there if I feel like we're backsliding or something like this is you've used the word loud a lot louder. I just need to stop that in order to make any progress because I think it's already a lot to ask for me to be willing to sit around and talk about why he lied about all these things and why they all happened. [00:14:11]

THERAPIST: Of course, it's a given to me that you need the loud examples to stop happening so you can keep making progress. I wonder what we can help you with or what you're empowered to do around that to help with that. This is what I meant: I can't stop Ivan from doing it again. You can't even stop him from doing it again. That's on him. What do you need to feel held and safe enough right now that you will continue to stay and work on it? Because it does sound like you're not ready to call it quits now.

CLIENT: No, but the second time when Dr. Farrow said, "Most women, a lot of women, would not still be sitting here," I'm starting to feel like the fool (sniggers) for about the millionth time. [00:15:05] Like I said, I don't want to keep hitting my head against a brick wall and then really complain and look for sympathy about how much it hurts. I really don't want to, but I also want to be patient enough and persistent enough that if Ivan is able to keep making these changes what I experienced those couple of months was really wonderful if it's worthwhile.

THERAPIST: So question then: If he were to do this assault again a third time, do you think that would be it?

CLIENT: I don't know because I'm starting to discover or I'm starting to think what if there is something about me and I don't know what it would be or what it would mean but no matter what he does, I won't leave. What if that's the case? [00:16:02] I started to think about that. What if this does happen another time? What if a website happens another time? What has to be the final straw?

THERAPIST: And personally and I know this is just one opinion but I actually consider a website a less egregious offense than assaulting you in bed while you're asleep.

CLIENT: It is. It's a very different type of betrayal, but it's also . . . I don't know how to . . .

THERAPIST: But I get it. You're saying that as you're rattling off the things he's done, what if these things continue? Would you ever leave?

CLIENT: Right.

THERAPIST: What would it take for you, do you think?

CLIENT: I feel pretty strongly that if Ivan was ever physically violent with me that I would have no choice, but that would be very difficult.

THERAPIST: He was physically violent with you, though. [00:16:56]

CLIENT: You're talking about the . . ? I understand that you've described that as an aggressive thing, which is still I don't know. I'm not even clear on what to think or make of it, but I mean if Ivan physically harmed me, which I don't think he would ever do but I have to say I didn't think Ivan would ever do a lot of these things.

THERAPIST: It doesn't sound like the way his personality works, loudly in-your-face being aggressive is never going to happen. It's more like he's taking a quiet path where he doesn't have to be noticed, without knowing that it's still aggressive or disowning the fact that it's still aggressive. I do think it is an act of violence to touch someone's body sexually while they're asleep without their awareness, especially in the context now of knowing how much you don't want this to happen. It's been 100% clear. It's taking advantage of your powerlessness to take something without permission from your body. You're saying if it were to become above ground and he would hurt you, hit you, maybe rape you so you're consciously awake when that's happening, that would feel like that's where you'd draw the line. You're still questioning what if these subtler versions happen although some of them are not so subtle [ ] (inaudible at 00:18:47) actual formal overt physical abuse, would you ever leave? What comes to mind about it? [00:18:57]

CLIENT: First of all, I don't believe that Ivan would ever do what you just described, the conscious violence. I don't believe that would ever happen. I don't think that's who he is at all. As bizarre as it sounds, I don't think that what Ivan has done was meant in an abusive way, although I completely understand that it's wrong and aggressive and inappropriate. I understand that, but I don't know that what Ivan did makes him like the person that would do it consciously.

THERAPIST: Yes. It's very different. I agree with you.

CLIENT: And I don't know if that's a good or bad distinction, but I don't think he's like that and I'm left with my own thoughts to guess why. That's part of my biggest frustration now, which means there is no clear way to react, but I don't think it's to gain power or control over me, which is what I would think would be a motive of someone who wants to abuse their partner. [00:20:07] I don't feel like Ivan is struggling for that. It is really hard to figure it out when in one instance you're very clear that it's abusive, it's aggressive, it's violence. In other conversations we've talked about it and it's been clear not clear but Ivan has said "I just want to be close to you" and you said he probably doesn't know how to voice that. Dr. Bourd has said it is a delusion in which he is thinking that this would be okay, but it's not. Those are very different descriptions.

THERAPIST: So let me actually clarify the language that I'm using. I do not mean that he is intending to be abusive. If we're talking about what is in his mind, the intentionality I think is exactly what Dr. Bourd and I guess Dr. Farrow agrees could very much be wanting to be close to you. [00:21:09] This is what we talked about, that he wants something but is afraid to do it above ground, so he just is trying to get it in a way that doesn't embarrass him and maybe, in his head, could be not hurting you then. "No one gets hurt if she doesn't know about it. I just want to be close and this is the only way I know how." When I'm talking about it being abusive and aggressive and an act of violence, the effect of his behavior is a violent one. He's unaware of it being violent. I don't think he's trying to be violent. I don't even think he's trying to get power over you. In fact, it's quite the opposite. He's trying to sort of not have enough power over you as a conscious waking self to say "This is what I want to do. Where are you?" Sort of negotiate it with a full person who has power next to someone else who has power. [00:22:00] So it is not the same as overtly, consciously being abused by somebody. I only want to continue to be clear that the effects, what it actually is even though he doesn't know it and that's not what's motivating his abuses. Do you know what I mean? Delusion and I think pseudo-psychotic states are helpful terms because they describe not somebody who is pervasively psychotic at all. What being psychotic means is not being in touch with reality, not having adequate reality testing. The loudest, formal diagnosis is someone who is seeing someone and hearing things that aren't really there, right? That's not Ivan. He's not anything like that. He's not a psychotic. He does not have a psychotic disorder. All people in healthy, [ ] (inaudible at 00:22:55) states can find themselves in a place that is like pseudo-psychotic places. [00:23:00] Giving a brief example, someone who you love tremendously dies and you literally can feel convinced for an hour that that didn't happen, right? That massive amount of denial of reality where you are convinced that person is still alive, that's the kind of minor, almost ordinary example of pseudo-psychotic states that can happen in ordinary people. When we're talking about that kind of state, where Ivan can find himself in a bubble where he's convincing himself and is convinced of something that is not reality. He can be in touch with reality testing in all the rest of his life, but in this area he convinced himself that this was a way that he can be closer to you. And I believe that he actually, in the moment, believed that. I don't think he's thinking, "I'm hurting her." I don't think he's thinking, "This is violent." He's only feeling, "I want to be close to her and this is a way of being closer." [00:24:02] What's psychotic and that means not in touch with reality about it is that it's not. He's wrong. It's not a way of being closer to you at all. In fact, it's a violent thing to do towards you because you're not awake. But he thinks it is in the moment. I think the reason why, again Dr. Bourd is saying I'm going to use this word that is going to scare you and probably Dr. Farrow, is that it's trying to sort of shake that bubble, like Ivan, you're not getting it. You're deluding yourself. People delude themselves, right? Again, delusional. He's not saying he has a formal delusional disorder, right? Not by any stretch of the imagination does he have that. People delude themselves about things all the time. You're applying to college and you think your grades are better than they really are so you're assuming you're going to get into a top school and you're shocked with the reality when you don't and you realize "Oh, I've been deluding myself this whole time." Convincing yourself of something that actually, in reality, is not true is what he's talking about, but I think they're trying to use a language to say to Ivan that you really are not in touch with reality in this place when you crawl into bed. [00:25:09] We've got to help you wake up to reality, even in bed, because you're losing it a little bit in that kind of context. I think that language can be helpful, then, because it makes it really real and serious and helps to say let's pull reality into the bedroom, even into the bed at 2:00 in the morning. Keep in mind this is not going to bring you closer to her. It is, in fact, going to push her away. I think the more they're trying to sort of poke holes in that delusional bubble, the more it will sort of deflate and he'll have reality there, too. So I think that's probably why, technically, the reasons for some of the language, not just to scare you into thinking this is worse than it actually is, but just trying to describe that this is what it is and this is how we help you come back to reality around it. Does that make sense? [00:25:57]

CLIENT: It does help. It's just, I will say, been a lot to take in since we got married to learn that Ivan not turning off the stove and not locking the door, that he has ADHD, and that's okay. But to learn that he really does have depression and it's not just that he's down sometimes, that he's really kind of drowning in shame and guilt a lot of the time. Or now to learn that him doing these things, the assaults are the result of him fooling himself, tricking himself, into thinking that this is a way to be close. It's bizarre and it's a lot to take in.

THERAPIST: It's not how you saw him when you got married, in a way. It's really getting to know the complexities of him and it's been a lot.

CLIENT: It has. And learning that it's been with him for a long time is also a lot and I admit it makes me unbelievably furious with his parents and so resentful because it wouldn't have had to be like this for us. [00:27:06] He could have gotten help a long time ago and we wouldn't have had to have these issues, not that those things go away, but he could have done a lot of this hard work and benefited from it a lot sooner. It is a little hard from my perspective purely, it is hard to sit and think about the websites, for example, and think this is what it looks like. It looks like he was advertising to have an affair and it looks like he was looking for other women and then to hear his explanation of "I just wanted to imagine those things with you. I wanted to facilitate the fantasy of you. I wanted those things only with you. I never wanted anyone else." It's all kind of bizarre and hard to take in. [00:27:59] And if I sat down with one of my girlfriends and said, "Yeah, things have been rough. Ivan is on these websites, but it's okay. He was only thinking about me." It sounds crazy. Or if I said, "Yeah, I've been really upset this week. Ivan is touching me in my sleep inappropriately, but it's okay. He's just having this little state." It sounds very bizarre and very far-fetched and I think it's a lot for me to take in.

THERAPIST: I just want to say, as you're talking and imagining these conversations, you keep tacking on "but it's okay" in a kind of sarcastic way. You don't think it's okay. Just because we're describing this delusional bubble and I'm saying that I don't think it's as bad as maybe it sounds, like he doesn't have a formal psychotic disorder at all, it doesn't mean that it's okay. [00:28:58] You need your husband to be in touch with reality all the time, not some of the time, and you need him not to slip into kind of bubble states where he just is sort of passively trying to do something in a quiet, deluded way. It's not okay. But it also then isn't maybe the worst case scenario either. Do you know what I mean? And that's the thing. Again, there is this really weird middle ground of trying to get to know very complicated parts of his psyche that you didn't necessarily know what they were in the beginning. What do you do with this? It would almost be easier if it were just perfectly okay or perfectly not okay.

CLIENT: It feels like it's very clear that what he's done is not at all okay in any way, but then his explanation makes it different from what it looks like on the surface and it's just hard to take all that in and trust it and believe it because I see a pattern of Ivan lying and avoiding to get out of trouble. [00:30:04] How do I know that that's not what a lot of this is? I'm trusting Dr. Bourd, obviously, that he would see through something like that, but it's just a lot, I think, to ask of someone to not only accept that it happened and be willing to move forward, but then on top of it I'm supposed to try to roll up my sleeves and listen to these explanations and really get to the root of it and be supportive of that process and patient.

THERAPIST: It is a lot, Ramona. And Dr. Farrow said so much so that some people would not want to stay. Sometimes it sounds like you make your own [interests and conflicts] (ph?) about do I tolerate this and be patient around it and keep working on it, given what's happened, or is that just too much to ask of me? And make it more like an interpersonal debate, as though someone is telling you that you need to just be patient and then you say to that person that it's a lot to ask of someone after all I've been through. I don't think any of the three of us, unless I'm wrong about them, are telling you that you need to sit and wait and be patient. Nor do I think any of us are telling you that you need to get out the door right now. We don't know what you feel and what's right for you. We can tell you averages and statistics, but that doesn't mean that's the right answer either. We can tell you what we think is going on with him. You're the one left then with what do you do inside yourself with it? "This is what's going on with him? He gets into this bubble where he denies reality and can hurt me, even though his intention is to get close to me." If that's what's actually happening, what do you do with that? [00:32:04] Is that something you want to keep working on or not? Is what you get from him as a partner worth fighting for still or not? And I think you are in conflict about that. Do you know what I mean? It's like one side of you is saying, "I want to keep working on" and another side of you is saying "But this is too much to ask of me. How can I possibly keep working on it?" And another side of you is saying you're not going to leave no matter what.

CLIENT: Which is a really scary, sad thing to think. And no one is telling me that I need to put up with this, but I do take my vows to Ivan very seriously. I don't know what it sounds like to a lot of people, but I'm not necessarily here because I made a promise to Ivan and I can't break a promise to a person, even if they break their promises to me. I'm here because I made a promise to God and I view marriage as more than a legal union and we get tax breaks and we live together. [00:33:05] There's a personal decision that I decided, this very serious thing, and not a light commitment. Ultimately, it's not just promising to spend your old days with someone, so it's hard because I want to take that very seriously. But I also don't want it to come at any cost because that might not be very ethical or very honoring to the original intent of the promise.

THERAPIST: It does come at a cost, right? Anytime you commit your life to another person, there will be downsides.

CLIENT: And there should be. That's fine.

THERAPIST: It's a question of how great a cost was intended, even in God's eyes, for example. [00:34:03] Marriage is an institution to be respected as a promise that you're making before God. Is the assumption at all costs? If you had a child he was beating, for example.

CLIENT: I don't believe that at all, but I do believe that it does mean the difference between moving in with your boyfriend and girlfriend and getting married does mean that when things go wrong you don't just walk out the door. You don't just pack up. You don't just break up. And when your spouse is having some serious issues which, I guess, that's an umbrella to put this stuff under, you don't just say, "Good luck with that. I'll see you later." But I don't know that you also are obligated to stick around indefinitely and put up with things with no limits. [00:35:00]

THERAPIST: Maybe one of the things you're saying then is that there has been so much improvement that the side of you that feels like this is worth fighting for maybe has even grown. The parts that have been great in the last three months really are great. They're just as real as what he did in this one time. Those have really happened. It does take time, though, to sort of see if this thing will continue to happen, will you continue to get hurt and violated, just by Ivan learning about this part of his mind more in therapy? Can it change. This is one of the big bumps in the road right now.

CLIENT: In the past three months when things have gone so well, I felt like we had started to really have a relationship again, but I also realized how much I had missed Ivan as a friend because we had a lot of positive time together, obviously, or we wouldn't have gotten married. [00:36:11] It was just great. It was just really wonderful.

THERAPIST: What do you enjoy about him when it's been good?

CLIENT: We share a meal together and that's great and we talk about our days and it's just great to talk with Ivan. He knows me genuinely very well and that's wonderful to have a close friend that you know and that knows you really well, down to the order you like your salad, just the little things. But also someone who makes you laugh that you enjoy. One of my favorite things is when Ivan really laughs really hard, even if it's at me. It's so nice. Or we have things that we both like that we enjoy doing together. We played a game of chess the one night. The friendship things that are part of the relationship are just really nice. Just to lie up on the couch and watch a funny TV show. [00:37:09] It's just really nice. Decorating our Christmas tree together. Ivan makes fun of me because I can't reach the top. I don't know. A lot of things and it's not all just inconsequential. It felt very positive and I remember thinking to myself that maybe I didn't realize how permanent marriage was when I got married. But I'm also glad that when things went so terribly that I didn't immediately leave him because I would have missed out on all this. I maybe didn't realize how permanent that would be as a solution either. I felt good about that, but now I find myself wanting to, obviously, turn the clock back and go back to those three months. [00:38:01] It's really hard and I feel bewildered and unsure of how to really react to this recent thing.

THERAPIST: It's hard for [ ] (inaudible at 00:38:11). There is a little moment [where you may be able to] (ph?) feel compassion for Ivan in this moment and your wish to turn back the clock if you could, if you might, these are the kinds of things about undoing reality, really wishing and wanting to be in a place where you missed him is another version of that kind of psychotic fantasy and trying to get to pretending this isn't here. I think that's what he's grappling with, too, given some of the ways he's hurting you more. That's the kind of thing in your past you're saying "how do I let myself know this happened and not have it ruin all of reality?" because it doesn't. [00:39:01] It's just as real that laughing together, cooking together and he knows how you order your salad. He's been coming home on time and picking you up to give you rides places. Those things are really real. How do you trust, as you continue to talk about this incident, what he says about it, what he's learned from it and what he will try to do. We might even need to have a joint conversation, Ramona, for about what you might need to know he is going to do the next time he has the urge to do that because I would guess he then struggles with urges. It might come up from time to time. It might have come up even before then that he has had an urge to do that. Maybe he stopped himself. Right? What does he do to get clear? It's like if he were an alcoholic or something and you don't necessarily want to leave him just because he's an alcoholic; but you're saying I demand that you're sober if you want to be with me. So what are you going to do the next time you have an urge when you drive by the liquor store? [00:39:59] Trying to get both of you more and more talking about this really happened and how do we deal with it? How do we make sure that it doesn't happen again? Because you're worth it to each other. This is like neither one of you is wanting out from the other person.

CLIENT: No. The saddest thing is that Ivan, as much as he knows, he says "I just want to be close to you. I really just want to be with you and I know that you deserve better than to be treated like this." It's so hard to hear that. I was confused or interested by Dr. Farrow saying that maybe there was a reason . . . I mentioned that that night we had a really nice night and then we had a conversation at the end of the evening and we talked about some of the physical contact and what it would mean to move forward and what I really needed to make sure that things were still moving forward and how that could be possible. [00:41:02] Ivan talked about how he was so hopeful and felt really good and she said, "I'm not blaming anyone, but maybe that was a trigger for it or that maybe it wasn't a coincidence that that was the night that it happens." And I don't understand.

THERAPIST: I'm not sure I followed the "I'm not blaming anyone."

CLIENT: She was saying talking about moving forward with your physical, having that type of conversation, could have been part of the reason why it happened that night, but I'm not blaming anyone for having that conversation.

THERAPIST: I don't know what she would have meant, but I don't know if you remember me saying to you I think it's probably not coincidence that it happened the very night you had that conversation. I don't mean that it sort of makes it less of an offense, that Ivan's excuse was that, really, he was thinking you were heading in that direction. No. I mean actually the opposite, that in some ways it might have been a version of self-sabotage. [00:42:02] The very night things are feeling hopeful about having real sexual intimate contact soon maybe not that night but you're getting there. You're talking about it. You're having a more intimate conversation about it than ever before. That's a real intimate thing to do with each other. Did he get scared? Did he feel ashamed? Did he feel worried that he was pressuring you? And so he reverts back, he regresses back to this little pocket place rather than really doing the work of keeping it above ground between you.

CLIENT: Maybe. But is that because he's afraid to keep trying because it might fail? Does he sometimes do the self-fulfilling prophesy where he makes sure that it fails so that he doesn't have to worry worry worry that it will?

THERAPIST: I think these are good guesses. He's done a lot of self-sabotaging things. [00:43:02] He's used to living in a state of self-chastising. That's kind of where he lives. So the idea that he could have sex with you one day and it doesn't have to be something you have to feel guilty over that's foreign to him. It could actually be a good thing that you both enjoyed that was mutual? That's not where his mind lives. His mind lives in a place of shame and guilt, shame and guilt, shame and guilt. And consensual sex between two members of a married couple, to have that be allowed and allowed by you, could feel disorienting to him almost. Do you know what I mean? So he goes back to this familiar thing. It could be that it titillated the urge very strongly and he slipped in his capacity to keep being patient with keeping it above ground. Do you know what I mean?

CLIENT: Yes, and that's something I raised in the session. It has been seven months since we've had sex and I would feel that a man and a woman might react differently to that, not that what Ivan did would ever be appropriate, but was it like a kind of passive refusal? [00:44:08] I don't know. Ivan says no.

THERAPIST: I think the more you can talk to him and ask him about "what was it like for us to have that conversation about being more physically intimate? What stirred in you?" Was he aroused? Was he so excited that he couldn't control himself? Did it make him feel guilty? Did it make him feel ashamed? Did it make him feel like he was going to hurt you soon because you were going to have sex and, really, he thinks that you don't want to? The more you can talk about what he assumed and then to be able to say to him, "Let me tell you what was on my mind. This is what I was feeling." Just to talk about it might help clear the air some. And again, ultimately, it's his responsibility to keep on top of whatever comes up and keep holding onto the reality that it's harmful to you if he does that again. [00:45:05] We'll stop for now. See you next week.

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