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CLIENT: Well, unrelated to other things, I got really great news this weekend. I was so excited. Emma told me this is typical of her, she�s so reserved. But she�s like, well, I just wanted to let you know I�ve been thinking about going back to school. And I applied and I start my Ph.D. Wednesday. I�m so excited.

THERAPIST: You didn�t even know she had applied?

CLIENT: No. Which is very typical of her. She�s so private. She hasn�t even told our parents yet. But that was nice. So I took her out to dinner and we celebrated a little bit.

THERAPIST: Ph.D. in what?

CLIENT: She did her MA in psychology and her MS in behavioral analysis. And she�s a BCBA, so now she�ll I think this is also behavioral science.

THERAPIST: So in psychology or in -

CLIENT: I think behavioral science. Yeah. [1:03]

THERAPIST: Where?

CLIENT: Simmons.

THERAPIST: So staying local.

CLIENT: So that was nice, too. Because selfishly, it would have been sad if she had moved. So that was really nice.

THERAPIST: It�s really exciting.

CLIENT: It is so exciting. So that was really nice.

THERAPIST: I don�t know if it stirs other feelings, too, besides happy for her?

CLIENT: No. I�m so excited for her. I just kept saying She�s acting like she didn�t get in. You know, someone who wouldn�t tell her family. I mean, she even found out earlier in the week. She�s like, well, I wanted to tell you in person. But she didn�t tell her roommate. She didn�t� tell anyone. She didn�t really want to celebrate. So that�s like -

THERAPIST: So self-protective and private.

CLIENT: Right. I think she�s almost afraid to tell our parents, because she could already hear my mom maybe saying, like, how are you going to handle it all. Or, isn�t that expensive, or how are you going to get that, you know. And she�d rather not. That would be my guess. [2:11]

THERAPIST: Is that familiar for her? In your life that she�s kind of kept to herself as a way of coping?

CLIENT: Oh, yes. The same reason why, you know, if she was dating anyone, she wouldn�t tell my parents. The same type of thing. So it�s just kind of sad, because this is something huge. Like, she should be celebrating. That�s a really big deal. She�s like, it�s not a big deal. I don�t want to make a big deal out of it. I was like, it is a big deal. And if it If the roles were switched, she would say it was a big deal. So I felt kind of sad. And I�m a tiny bit worried, �cause she mentors grad students at Simmons. Plus, she has her full-time job. Now they�re saying that she could teach classes at the college as well. She could also be a research assistant to her advisor. Like, work on some of his projects. [3:05] So it�s just a little worried about her, because she already sometimes tilts towards taking on a lot. Working really, really hard.

THERAPIST: You can see in her the trauma of your family. It�s so unusual and atypical and a sign of how much damage has happened.

CLIENT: It�s really sad, because I, you know, even with everything, it�s really sad that she still she probably still hasn�t told them. And it�s just a shame.

THERAPIST: And you have this to some degree, too. You know, when something really good happens that is an achievement or an accomplishment of yours, it�s really hard for you to stay in a place of feeling just joyful and proud and celebratory and excited and sharing news. It�s more like, that just the relief of having checked something off a list and you immediately switch over into what�s next that I need to drive myself forward on. It�s so hard to pause and like, give yourself a pat on the back. That�s not internalized for either one of you that that�s really important and there�s a moment of someone inside you, a parent inside you being so excited for you. [4:37] You�re able to do that for each other, some. You�re excited for her looks so genuine and pure.

CLIENT: Oh my gosh, I was screaming and hugging her. And she�s like, it�s not a big deal. We were like, going to go out for pizza anyway, because she�s So she�s presenting at this association for behaviorists international conference in Milwaukee this weekend. It�s like Emma, it�s a big deal. Let�s go out to dinner or something. So we planned to get pizza or whatever. And I was like, let�s go somewhere nicer. Like, let�s do something and celebrate. She�s like, it�s not a big deal. I don�t even want to like But if it were me, she would -

THERAPIST: She�d do it.

CLIENT: Yeah, she�d be very different. [5:19]

THERAPIST: What happens if you say to her, you know if it were me, you would -?

CLIENT: I did.

THERAPIST: Can she get it?

CLIENT: She knows.

THERAPIST: It�s so great you have each other.

CLIENT: Yeah. No, I�m really grateful.

THERAPIST: She�s lucky to have you, too. I know you often talk about how much she takes care of you, but you take of her, too. At least this time, it�s so clear. It�s really great. I�m happy for you that she�s going to be around, too.

CLIENT: Yeah. No, I�m excited, �cause she has been thinking about this for a couple of years. And at one point, she talked about a program in West Virginia or whatever. Like, she talked about a couple of different So I was wondering if she was going to move eventually. So this is really nice. But yeah. [6:13] This is so good for her.

THERAPIST: What about you? Where�s your mind on this?

CLIENT: I think sometimes I�m so excited for her, but sometimes I do worry a little bit that she that inadvertently we become like our parents a little bit. And I wonder that she sometimes could be a little like my dad and work really long hours and do so much extra, and not take care of herself. Really stretch herself thin and that she doesn�t. Like, we both were so adamant, so clear what my dad did was so hard on him and sad for him. But also, so hard on everyone and really took away He doesn�t have hobbies. You know, he doesn�t have friends really anymore. He doesn�t Like, nothing. [7:18] He doesn�t, I guess also, you know problems in his relationship with my mom. And sometimes I worry, although I would never tell my sister.

I�d like to see her date someone. She doesn�t have to get married. She doesn�t have whatever is right for her is right for her. But sometimes I wish she would be interested in that. But she�s at work all the time. And then, on the weekend she�ll hang out with me sometimes. And sometimes I wish I don�t know. That would be nice for her meetingSometimes I�m really scared that she�ll see my parents and she�ll see what Ivan and I have gone through and she�ll think that, why even bother. I feel a tiny bit responsible there, even though I know that�s maybe not completely fair. [8:06] It would be nice to see if she could you know, someone who would take care of her or help her find time to relax. Or tell her, you know, how proud they are. That it is a big deal, you know, that would be nice.

THERAPIST: So it�s not just TV night. She has her own life partner, not yours.

CLIENT: It would be nice, but it would I�d like to Not that you have to have a significant other to have a to be happy or anything like that. I don�t believe that at all. But sometimes I wonder if that wouldn�t if she wouldn�t enjoy that.

THERAPIST: Well, you�re cognizant of the ways she defensively throws herself so extremely into work the way your father did. She has a tendency and will that, over time, kind of erode her capacity for relating even to you, Ramona. And I know you guys have a pretty decent relationship, but there�s a way if work is that much of what drives her, it�s it is a part of your relatedness as a sister if you, for example, to wish that she had a significant other, so that you were kind of on the same page about that in your development in life. [9:19] Or that you both had kids one day. Or that you both would do things together as a foursome or something. You know, that�s -

CLIENT: No, that would be nice. And sometimes a lot of times like, Ivan works Saturday evenings, not that you should know that. So she�ll come over and hang out and we�ll end up We�ll find a Pinterest recipe and we�ll make it and like, watch a movie. Like, have a girls night in or whatever. And that�s nice, but sometimes I think like, why isn�t she out on date? You know, like, why isn�t she doing something. You know, not like it�s great that we�re like, best friends. We�re not just, you know, we don�t do it out of obligation. We like to hang out together. It�s wonderful. We plan things together. But sometimes, I wish I don�t know. I wish she would do more like that. But anyway.

THERAPIST: What are you thinking?

CLIENT: I don�t know. I don�t know that I have a lot more. I just worry about her so much. That�s all. [10:33]

THERAPIST: (inaudible at 10:38)

CLIENT: I just I worry, �cause she�s so private. So, so, so private. She could honestly be dating someone occasionally, and I would never know. She had a boyfriend in college and she never told anyone. She went, after college she and her friend, and I think maybe her boyfriend at the time, too. They went to the beach for a few days. She didn�t tell anyone, because she knew my parents would probably not approve and provably have lots of adjustments and questions. But she should have been able to do She�s just so private, and I worry that she�s so private to the extent that it�s okay for me to get in a little bit, but it would be so hard for her, for example to I guess, date someone and let them know that eventually they�d find that my dad is a workaholic and my mom You know, to really get to Because if you�re with someone for a long time, you eventually -

THERAPIST: It�s another family. [11:36]

CLIENT: Yeah. And that that would be a lot to take in.

THERAPIST: What�s your understanding, Ramona, of privacy? Because you certainly have that some. Maybe not to the extreme that she has, but with your parents, you�ve learned over time to keep a lot of things to yourself. It doesn�t go that well when you share. What�s your sense of your sister�s privacy? What would happen growing up around?

CLIENT: I think she always kept it private, because she was so busy taking care of me. And so she, for example, would not come to me and say that she had a problem, because she was essentially mothering me a lot. [12:17] Which think is It would have been appropriate had she been my real mother. You know, when if like, if your mom�s going through something difficult, it might not be completely appropriate for her to lay it all on the child, and expect them to be equal or even like, even almost like a parent figure to her. You know what I mean? Like, to problem solve and listen and give input and not reciprocate, you know? So I think that�s really tough, because she�s always felt pressured to do that. And sometimes, even if she tells me like, she had a long day at work and I�ll say something like, oh, well, get off the phone. Go put your feet up. Please, get some dinner or something. Or, I�ll worry about her and I�ll make a comment about it later. Like, I know you had a long week, and she�ll She�s like, I don�t want you to worry about me. I don�t even want to tell you if I had a terrible day or if something went wrong, because then, you�ll worry. And she doesn�t want that. [13:15]

THERAPIST: What would it look like as kids when you say she would always mother you?

CLIENT: I mean, she would help me clean up my room. I mean, she would make sure that I covered my books before school started. I mean, she would make sure that we did something for dinner. She would be the one, you know, to listen and talk about things. She would play like, the intermediary when things were so difficult with my parents. She would know things. Because she was older, she would know more about what was going on there and she wouldn�t tell me. You know, she would keep me as distant and protected as possible. The only this is so silly to even bring up, but the only birthday party I ever had at my parents� house was for my 16th. And it was because my sister cleaned up the house, not my parents. And like, I still remember my mom saying, your sister�s hands are red from scrubbing, and reminding me that I should really be so grateful to her. But I just felt so horrible because -

THERAPIST: Oh, my goodness. She said that?

CLIENT: Yeah. And she meant it in a, look how much she cares about you and that she did this. But it felt horrible, because it shouldn�t have to be like that just to have friends over.

THERAPIST: It was meant also to guilt you, in a way.

CLIENT: I mean, maybe. But she would be the one to make sure that those things happened. [14:44]

THERAPIST: So she�s really a parentified child. It�s the role she stepped into.

CLIENT: Yeah. No, all the time. She would help my dad with his business.

THERAPIST: Oh, my goodness.

CLIENT: Oh, yeah. I mean, I did at some point, too. But never as much as she did. She�s the one who would like, kind of take charge and organize things. If we were going to clean up part of the house, she�d be like, okay now you do this and I�ll do this.

THERAPIST: And where�s your mom when that�s happening? She�s in her room or would she come and join sometimes?

CLIENT: No, not really. I remember she helped me we made it into a game. Like, taking care of the birds. We made it into a waitressing game. Like, how many just water and food. But, you know. So I don�t know. But I think because she took on that role so much, it was really hard for her to step into just being able to be my sister and I don�t need to be taken care of. And then, I feel horribly guilty, because with everything that�s happened with Ivan, she I think has felt even more like she needed to step into that role. [15:51] And it�s also, with the academic piece, it�s really hard. Because I feel like she can never quite get over it. So at her college graduation, my mom begrudgingly went, pretty much. She made a scene at the graduation which I don�t think Emma knows about.

THERAPIST: What? Begrudgingly why?

CLIENT: Because she just has huge issues going to graduations.

THERAPIST: Why?

CLIENT: She even brought it up at my graduation last year. Because she dropped out of college. And so she always like, makes it into oh, I felt so horrible. I felt so self-conscious. I�m the least educated person here. And it really I�m sure she maybe she does feel that, which is so sad. Because none of us would ever say like, mom, I wish you would have finished college. I�ve never said or thought that. But it�s just so sad. Because in doing it, she completely robs whichever one of us is graduating. So she made a huge scene at her college graduation. It was shortly after my dad�s affair. She Emma and her friends and their parents, they were all going to out to dinner that night to celebrate. And Emma wanted to go. [17:06] And she ended up going alone, because My dad�s like oh, you know, maybe we can go. Because they had kept saying, no. But then, at graduation, at the day he went to take my mom�s hand and she like, jerked away. And she�s like, no. And Emma was humiliated. And she had to go alone while her friends had their parents there. And it�s not like It is a big deal, actually.

THERAPIST: Your mom wouldn�t go to her graduation dinner.

CLIENT: No. I mean, it wasn�t like, a school thing. It was like, she and her close friends and their parents were all going to go out to dinner. And my mom was like, no, I won�t go. Because she was angry at my dad, which was horrible to punish Emma for. On top of which, she was begrudging when we got there, wouldn�t get out of the car. Locked the car. Finally got to graduation, wouldn�t stand near my dad. She took a nap during it. It was horrible. And Emma didn�t know all of that. But it was like, what she did see and what she did know. It was really, really horrible. And Emma�s never It wasn�t until my college graduation that my mom apologized to Emma for that. [18:09] And that was five years later. So she just had a horrible And during it, my mom often would not even go like, Emma went to school an hour and a half away, but she wouldn�t go to her -

THERAPIST: Where did she go?

CLIENT: Franklin and Marshall. It was a really good school. And Emma did very well. And she wouldn�t go to her voice recitals. Emma studied opera. She was really great. She wouldn�t like, go to concerts. Emma was in the symphony. She just wouldn�t.

THERAPIST: Why?

CLIENT: I think in part, because she didn�t want to go with my dad and in part because she doesn�t like to leave the house. And it would mean being in a crowd and it would mean -

THERAPIST: So part the agoraphobia.

CLIENT: Probably.

THERAPIST: Part, she�s so wrapped up in anger at hour father that that gets in the way of doing anything with him for her daughters.

CLIENT: It�s just really bad. And then, when Emma graduated with her first masters from Northwestern, my mom didn�t come. [19:05] My dad did. And then, when she got her second masters from Simmons, Emma didn�t go to the graduation, so nobody went. And I wonder if that isn�t already on her mind. I am not going to this graduation, I don�t want to deal with it. Like, the fact that I�m even going to this program is a secret.

THERAPIST: Why would she tell your parents, in a way. I mean, it fleshes out more of the adaptive part of the self-protection. What do they have Does your mother especially have to have that information at that point if she�s not even going to show up to recognize it.

CLIENT: Yeah. It�s really hard. Emma has even mentioned my mom forgets where she works sometimes. Emma has worked there for like, six years, and now she�s at the head of the My mom won�t remember it. She came to visit twice, and she still hasn�t seen where Emma works. And Emma would never complain about it or say like, I feel really hurt that you don�t support what I�m doing. [20:07] That you went shopping instead of just coming to see where I work all these years, with the kids. So that�s really sad. I know at least my dad, if she tells my dad about it, he will be so proud and so enthusiastic. Because when it comes to school and work, he�s all about that. He�s so supportive of learning. He�s so supportive of work. �Cause I think it�s what he can relate to.

THERAPIST: It�s really serious neglect of both of you that happened. You make what�s the face?

CLIENT: It�s my It is what We can�t change it. It�s really hard, �cause I just feel sad for her. This is such a This is so wonderful.

THERAPIST: What about you though, too. You know, you make that face, and I know that statement from you, it is what it is. I think there are ways that you get what happened, but I don�t know if you ever really have sort of had the space to have the feelings that are there about what happened.

CLIENT: I don�t I think I�ve had them somewhat. But it doesn�t do any good. And my mom like, making her comments about how and I just pray that she doesn�t say anything when Emma eventually tells her. I just In fact, Emma�s like, I have to get them both on the boat at the same time, or else there would be a fight over who was told first. [21:50] It shouldn�t be how it is, you know? �Cause there was a fight when she got into Northwestern. There was a, you told your dad first and why didn�t I hear it at the same time. It�s just like, it�s not about you. But I mean, the comment about how like, she dropped out of school and this is terrible. And she�s the least educated. And that�s so unfair. It�s so unfair, because why would -

THERAPIST: It�s so self-centered. It�s so narcissistic.

CLIENT: It�s really hard, because telling her that would never end well. It wouldn�t help. It wouldn�t change it. For my wedding she told me so many times, if I had my choice, I wouldn�t go. So many times.

THERAPIST: Oh, my goodness, Ramona.

CLIENT: Your dad has ruined it. I don�t want to walk with you. It�s not the same family. It�s just like, this has always been Picking out my dress, she�s like, well, they are expensive. You say you�re only going to get married once. She just can�t Sometimes I think it�s maybe over her stuff with dad. [23:00]

THERAPIST: It has nothing to do with you

CLIENT: But it just really does.

THERAPIST: Every part of your life, she relates to from her own feelings and experience.

CLIENT: Which I think is probably natural for parents.

THERAPIST: No, it�s not. Not to this extreme.

CLIENT: I mean, �cause if it was in a positive tone, if it was oh, I�m so excited that you get to go back to school. I loved it when I got to. You know, if it was that type of a -

THERAPIST: I have to tell you, though, if that�s all it was, that too would feel shallow. That the only reason I can love it for you is because it was great when I did it? That�s not actually seeing you.

CLIENT: No, but it would be so much better than -

THERAPIST: It would be better. But it�s sort of like a smidge next to what you actually should have had, which is separate recognition of your separateness as a person. And being happy for you is something that makes you happy. Not because it made her happy. There�s no separateness there. It�s all about me, still. [24:01]

CLIENT: But it�s What do you do? What do you do?

THERAPIST: Is it weird to you to hear my say that I think it does do something to have the feelings?

CLIENT: It�s not weird, because I think that�s what you expect to hear from a psychologist. Right.

[Laughter]

CLIENT: You should be you should explore your feelings. And it makes a lot of sense, but I think for me, exploring my feelings meant saying like, it is unbelievably hurtful that you want to Or, poor Emma, I don�t think she ever said anything to my mom about her graduation. Or, you know, it doesn�t help. And it happens again and again and again and again. And if I sobbed to her. If I told her how angry or hurt I was, she would perceive it as criticism. She would be very unkind, I think. �Cause we�ve tried this type of thing before. I think the fighting for whatever we needed growing up, if it looked like not talking to them, coaxing, begging, bargaining, yelling, you know, whatever it looks like to try to get what we really needed. It never got it. And at the end of the day, you have to kind of come to accept if they don�t want to do it, they�re not going to do it. [25:14]

THERAPIST: So what I mean by it, having feelings is not necessarily telling your parents about your feelings. You might want to do that or try that again one day. I don�t know. But separate from a communication to them, I�m talking about just having them in here as extremely valuable. And maybe even that doesn�t quite make sense. Like, why would you get all upset about something if they are not going to change who they are.

CLIENT: Right. And I think to some even if I�m not actively feeling them, I�m aware that it�s hurtful, it�s cruel, it�s competitive. It really robs me or my sister of something really good that we It�s so sad. [26:15]

THERAPIST: You�re so intellectualized though, saying that. Do you hear yourself? It�s like, you could be telling me a children�s short story or something about the story of your life. It�s really devoid of affect. And I get, Ramona, that that�s been adaptive for you to do it. You learned it did no good. Your tears even did nothing. Your feelings about it. Your having all the loss feelings. Your having all the anger feelings went nowhere in that relationship. Where I�m unsure about and say that I tilt towards it being valuable is that I think, when you get triggered into being in places of tremendous self-loathing. Like, in your relationship with Ivan around the list, around your own career trajectory and unfolding.

These kinds of things where you get this into this place periodically where you hate yourself. [27:12] Horrible. I mean the words of the, you know, I said that the start of your last the journal entries you sent me last week, and I just read the first few lines of the first one which (inaudible at 27:21) I think this place inside you is related to your feelings about the way you were treated. And that the more in here we can start connecting those things up, even if you never breathe a word of it to your parents. You know it does no good there. They�re not going to change who they are. I think it starts to settle and shift your own self-esteem by having had the feelings in connection to where they really started. So that at a job, so that in the relationship with Ivan. So that in a relationship with someone else if you don�t stay with Ivan. Wherever it is that there�s a calmer, more confident sense of yourself inside. [28:05] I don�t Does that make any sense?

CLIENT: Maybe. I just don�t know what that would look like. And it�s hard to trust. I mean, I guess I would trust you. But it�s hard to believe that that would really do that. �Cause again, I think I�ve had a lot of opportunities that I have taken to cry or be really hurt. Or, even if it was in private.

THERAPIST: That was another person, though.

CLIENT: No, maybe not always. Emma, I think has a good understanding. But she would never come to me and say, I don�t want to tell them, because I still I worked my butt off in college, and that�s how my parents responded, you know.

THERAPIST: You have more self-awareness at this point than she does, then in a way.

CLIENT: No, I think she knows. I think she just -

THERAPIST: You do?

CLIENT: Oh, yeah. I think she knows what they did was completely wrong, and she knows that she worked hard and I think she has a good I hope she has a good feeling of that. But she would never tell them, because she knows it wouldn�t change anything. [29:23]

THERAPIST: She has a hard time telling you that, too.

CLIENT: Well, yeah. �Cause she has to protect me. And that if I were to say something like that, she has to be there to listen, not to reciprocate, because she�s still taking on the -

THERAPIST: She�s a good example, then, for looking at her for a second instead of you. Even though she may have a lot of awareness that what they did is being really, really wrong and hurtful, she�s structured now around pain of that. So that she�s very, very counter-dependent. So independent that she doesn�t rely on anyone, right? That�s going to carry with her for the rest of her life until she looks at this.

CLIENT: It�s just I don�t know. It�s so hard, because even if I could try to get her to talk about it, or, even if What do you do? We go home and my mom So my sister is a blue-eyed blonde. She�s colored like my dad and I look like my mom in terms of She�s so pretty.

THERAPIST: I can picture that.

CLIENT: Right? People always say we look like twins, because of our bone structure, or they say like, you�re really from the same parents. But she So anyway, she�s so beautiful. But my mom will make comments sometimes. She�ll be like, hah, you�re so blonde, or something like that. And it always drives me insane.

THERAPIST: As though it�s a criticism.

CLIENT: Yes. It always drives me insane, because it�s like a People say like, oh, blonde moments. Or, you know, people will say that. But it�s so cruel. Or sometimes, she�ll look at Emma. And because Emma was a lot healthier than I was in college and she went out with friends sometimes, and she didn�t obsess and obsess and obsess over her grades. And she was so much happier. And she�s tried to teach me that. And I wish I had been more like her. I probably would have enjoyed school a lot more. My mom looks as that and she thinks She�s not impressed. [31:26]

THERAPIST: By her. Or enjoying school.

CLIENT: Emma�s not as nerdy, because she or not as grades weren�t as high all the time. It�s just like, even if Emma could It�s just so hard. Going home, I know it sounds ridiculous, but going home is just so freaking hard. Even being on the phone with her is so hard.

THERAPIST: I believe it, Ramona.

CLIENT: And it shouldn�t be.

THERAPIST: Why should it not be? I feel like the healthier you get, the harder actually, you�re going to be it is to be around here. That�s your health that you recognize how hard it is to be around someone who doesn�t see anyone else but herself. It�s painful.

CLIENT: But what do you do, because I�ve said to my mom, and she It doesn�t really end well since mostly she gets angry. You know, would you consider seeing someone again for to, you know, to talk or to She still a lot of the time�s actively grieving about losing her mom a few years ago. [32:38] How would you feel about that? And mostly she uses it as a way to bring up my dad. Like, he won�t pay for her to see this one person that she was seeing that wasn�t licensed, and therefore, insurance wouldn�t cover her. And I said, there are plenty of licensed people around. It�s so hard.

THERAPIST: And you�ve tried your whole life. You were a fighter as a kid. Trying to get through to her.

CLIENT: The thing is, and I realized this with Ivan, too. The really hard thing for me about depression which probably shouldn�t be, since I struggle with depression. Still, is that it doesn�t, at least growing up, it doesn�t feel like mental illness. It feels like a choice. I know it�s not a choice, because I�ve had it and I�ve been there. But growing up, watching your mom not get out of bed, not get dressed, not help with the house. Not go to things. Telling me how she couldn�t make it out the side yard to our wash line when we were little. That she was that agoraphobic. [33:43] It felt like Or, like, every Saturday night she would consistently be sick, so that she couldn�t go to church the next morning. Couldn�t see people. Couldn�t get out of the house. Couldn�t do something with my dad and the rest of us. It felt like a choice. It felt like Or, you know, if she was harsh. Or, asking for her to help with something and it resulted in a lot of anger or really, really not nice things. It felt like someone not being nice to you. It felt like someone not taking care of you. It felt like I have a lot of anger about that. And sometimes even with Ivan when he�s like, oh, it�s so hard to do this. I don�t have confidence. Or, it�s so It�s like it�s really hard to accept that. And I don�t think it�s entirely the depression. I think part of it is how you handle it or respond to it. [34:45]

THERAPIST: I don� think, Ramona, you give yourself enough credit internally for understanding that you actually are speaking about something else besides the depression. In both of them.

CLIENT: I don�t know what that is, though.

THERAPIST: Right. You keep sort of, almost like, chastising yourself a little bit. I know I should understand, it�s not a choice. It�s just depression. People can�t help it.

CLIENT: What kind of person looks at their mother or their own spouse and sees that they can�t get out of bed or they won�t see anyone. They won�t get dressed in the morning?

THERAPIST: What kind of daughter wouldn�t look at that with rage?

CLIENT: But I mean, I�m old enough to be mature and to say like, wow, that�s so difficult, and can you imagine living like that.

THERAPIST: See, I don�t know that that�s maturity.

CLIENT: I don�t But I feel like that�s what it should be, you know? Just like, if she had any If she was in a wheelchair, I wouldn�t be like, boy, you can�t, you know, help with this thing, and I�m really angry that I always have to do it. I wouldn�t respond that way. [35:51]

THERAPIST: So here�s the difference. I think when you are cognizant of feeling angry and hurt and betrayed and pissed off on Sunday morning, because she�s sick again. You are picking up on something that is different and separable from being depressed. And I think that calling depression and calling it anxiety collapses these things that are really important to be kept separate all into something that kind of lets her off the hook, just as it does with Ivan. You have had depression. What have you done with it? You went and got treatment.

CLIENT: Right. But that doesn�t mean there weren�t times when I coped unhealthily. Or times when I I mean, I channeled it different ways. That doesn�t make it I may have been more adaptive. But like [36:45]

THERAPIST: But Ramona, you�ve also sought help more than once because you had awareness of this being a struggle. Because you didn�t want it to be a struggle, because you wanted to work on it. It�s hard work to seek help. It�s hard work to do this work. It costs money. It costs time. You�re doing it. And that is so much more than you can say for your mother. This is the part where I�m saying, you can be up. There are lots of people who have depression in the world, right? It�s a very, very common diagnosis. About fifty percent of the United States population has it at some point. A depressive episode in their life.

CLIENT: But can I ask, is there a difference I�m sure everyone experiences depression. Like, you know, you feel down sometimes versus I am depressed and this is a long-term thing that I�m getting help with. And, you know, like extremes like my mom.

THERAPIST: Yeah. There are gradations where people can have a mild, moderate, severe, long-standing, pervasive depression. You may consider her having long-standing, severe, pervasive depression. [37:49] There are still people who have that who approach it in a very different way than the way it sounds like your mother did. It is in part, what do you do with it, then. This is what you were handed. You can say the same thing for cancer. Someone gets a cancer diagnosis. What are you going to do with it? And you can see the person�s personality then play out a variety of different ways that they actually choose to handle that diagnosis. Some of which even lead to longer life. It�s been proven now, if you get into a support group for cancer, you live longer through cancer. We�re not even talking mental health. We�re talking about a physical disorder. Because you�ve handled it differently. [38:32] So I think you�re picking up on an overlay or maybe you would say rather the underlay, the foundation on which the depression is happening is character logical. So personality based. The tendency to give up.

The tendency to avoid. The tendency to blame other people. The tendency to make excuses. The tendency to think only about oneself rather than thinking about other people. Right? There are people with severe depression who would, as a parent, have acted differently than she did as a parent, including saying to you, if she�s so depressed she can�t get out of bed, this is what I�m struggling with. I�m so sorry this is affecting your life. Here�s what we�re going to try to do to help you guys, so that this doesn�t impact your life as much as I think it will. We�re going to get a babysitter. We�re going to help. This kind of thing. [39:33] Come in, I�ll read you a book once a day. You know, the kinds of things that have attentiveness to you as a separate person were not there. And that that is possible, even in the middle of a serious depression. And you didn�t get it. I think you�re picking up in a way in your mother and in Ivan the depression gets used in a kind of passive-aggressive way. Your mother is highly, highly hostile towards your father.

CLIENT: Yeah, I know that.

THERAPIST: She�s hostile, whether she knows it or not, consciously, towards you and your sister, too. All the time. So many things you�ve described to me have to do with nitpicking at you and cutting you down or belittling and demeaning some success of yours.

CLIENT: I don�t think she thinks of it that way, though.

THERAPIST: I�m sure she�s not thinking of that consciously. That would make her a sociopath or a kind of monster. That�s not her. But I think she�s not aware of the aggression that comes out towards you and Emma by her being so, so, so passively withdrawn. So unwilling to set herself aside to do something for the benefit of one of you. It might be very understandable, for example, to go to a graduation if you haven�t graduated yourself, and have a lot of feelings inside. That would be so reasonable and understandable. What you do when you�re a parent is you say okay, I�m not going to talk about that out loud. I�m going to go anyway and have my own private experience with this that I�ll bring to a therapist or talk to my husband around or talk to a friend about. But not vent at my daughter�s graduation and refuse to go. It�s really aggressive. [41:35] What are you feeling?

CLIENT: I feel like she would never she never means it to be. She did graduate from nursing school. She went Like, I didn�t see her for a year during one of my years in elementary school. Because she went she wanted to be a nurse, so she went. She got her LPN. I don�t think either of my parents meant or even though that they were being aggressive or negligent or cruel. But somehow, they both end up essentially putting themselves first. Or with my dad, it�s really his business. And that�s hard. �Cause it�s hart when they say how important you are to them and how they would do anything for us. It�s, when the chips are when you�re really in that situation, absolutely they would. It was just a shame, not the rest of the time. [42:51]

THERAPIST: If you�re clarifying, it does not feel like even unconsciously there�s an aggressive, destructive element of avoidance to you. It feels more like it�s just being totally self-preoccupied and unaware that the impact on you is so hurtful.

CLIENT: Maybe unaware, but also, I don�t know what the what a real way would be to describe it with my mom. It�s like sour grapes. When I saw a counselor at that time, it was before we got married. But I kept saying how hard it was to hear her over and over if she had it her way, she wouldn�t go. She bought seven dresses. She just would not It was about her. And it was so hard to keep hearing that. And she�s like, oh, it�s bringing up feelings of her marriage. It�s bringing up She had a broken engagement. She got divorced in her first marriage, and now in this marriage there�s been an affair, and still hasn�t gotten over that. [43:58] So I could understand. You know, it�s really hard to take in someone else�s success if you feel pretty not good about yourself. It might be hard to just be completely openly happy for them. I still wish there were something in her that let her keep that to herself or -

THERAPIST: That�s the part that feels hostile. It�s one thing even to recognize I can�t feel happy because I feel so much envy that I want to run the other way. But the venting out loud.

CLIENT: I don�t think she has a sense of a filter, though because she�s so isolated. It�s so much She�s now even moved into a separate room in the house. I don�t think she even really sees my dad much. It�s the Pats and phone calls mostly. So I think it you�re not socially engaged, you probably do lose track of what is okay to say and what�s not. [44:55]

THERAPIST: So in which case, you�re describing it more like she�s unaware of this is back to being unaware of your separateness. So she�s not even thinking about the impact on you, Emma, your sister hearing this or you or in your marriage, your wedding. She�s only like, in her narcissistic bubble just venting and spewing from that place and not thinking about the fact that this other people will have a reaction not what she�s saying. [45:26] Which is different than being overly hostile. I think that�s what, in a way, what you�re saying. It feels like she�s just like in her own warped bubble of place, and just not thinking about other minds in the room.

CLIENT: No, it�s true. It occurs to her. And I think confronting her about that, or saying wow, that�s so hurtful or so she would even still sometimes justify it. But this really is true, or your dad really did ruin this. Or no, really, I think everyone�s looking at me and saying -

THERAPIST: (inaudible at 45:59) For your own self-awareness, your own development about what impact that had on you exactly. You know, for example, the more I get to know that, it starts to help flesh out a little bit more about how it�s been hard to see Ivan as separate sometimes from you.

CLIENT: Yeah.

THERAPIST: And so if his shortcoming becomes your shortcoming, and it actually isn�t. It�s his shortcoming.

CLIENT: It�s been hard to see the separation between his depression and coping mechanism as well. I know. I wish we had more time.

THERAPIST: I know.

CLIENT: So next week I got your e-mail, thank you. And I meant to respond, but I know you�re away. So if you have any other times, I would -

THERAPIST: Yes. And I also don�t know, Ramona. It seems like the kind of work you�re doing these days. It�s a lot to get over here. But if you ever wanted to go back to finding a second time.

CLIENT: That would be wonderful.

THERAPIST: If it�s crossed your mind.

CLIENT: No, it has. It would be wonderful. I just don�t know schedule wise how feasible. I think it would probably have to be early in the morning and then, maybe one day a week. It could be like, you know, I could take out work hours if it doesn�t conflict. But I probably couldn�t get away from work twice a week.

THERAPIST: Right. What if it were 8:00 in the morning, or something like that? Is that late enough? I mean, is that early enough or is that -

CLIENT: I could do earlier, �cause I�m supposed to be at work at 8:30.

THERAPIST: And you�re saying, you could do earlier?

CLIENT: I could do earlier. Yeah. I could come here and then Usually it takes around a half hour to get there.

THERAPIST: But I mean, if you could could you come in a little late two mornings a week? A little bit late?

CLIENT: Yeah. No, I think that�s very potential, because I usually I have the hours. I have the extra hours and I can always put in extra hours. It�s just if something conflicts that I can�t possibly miss. That�s the tricky But yeah. [48:11]

THERAPIST: So I�m going to have an 8:00 actually an 8:00 on Tuesday and an 8:20 on Thursday opening soon. So I don�t know if -

CLIENT: So I could never probably do Thursday, because I have a 7:00 a.m. meeting at work. That�s one of my extra. So I couldn�t miss that. But Tuesday I think, very likely. A very good possibility.

THERAPIST: Okay.

CLIENT: And that would probably work maybe better either way.

THERAPIST: Either way than this time.

CLIENT: Probably. �Cause it seems like I can�t predict the schedule.

THERAPIST: So once I don�t know for sure when that�s going to be free, but I think I think it�s going to be early June. One of the first couple weeks in June. So once I know that for sure, I�ll let you know.

CLIENT: That would be great, thank you.

THERAPIST: Would you want to try to keep this as a second time?

CLIENT: We can. I just think it�s going to be like a -

THERAPIST: Variable.

CLIENT: Yes. Very much so. But then, next week if you have any other times. I know you�re out on Monday.

THERAPIST: Yes. I�m just looking quickly. I do. I have somebody out. So I could do 8:00 on Tuesday.

CLIENT: Next week?

THERAPIST: On the 27th. That will work?

CLIENT: Let me just check. Can you pencil me in and I�ll e-mail you and confirm. That would be lovely. �Cause I don�t want to miss.

THERAPIST: And if that doesn�t work, I have a midday Friday. 8:20 Thursday you couldn�t do.

CLIENT: No, unfortunately. But 8:00 on Tuesday.

THERAPIST: 8:00 Tuesday.

CLIENT: Okay, thank you.

THERAPIST: Great.

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