TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: Oh no. It's going around.

THERAPIST: Yea. I had the flu which was OK actually.

CLIENT: Oh no.

THERAPIST: Because I had had the flu shots, I think it wasn't so bad. Then I got a sinus infection and that really sucked.

CLIENT: Oh my God.

THERAPIST: And now my kids have the throwing up thing (inaudible at 0:00:16).

CLIENT: Oh my gosh.

THERAPIST: I'm hoping to be done with it all and not get that one.

CLIENT: That one is the scariest, I think. Oh man. Well, good luck.

THERAPIST: Thank you. I'm purelling consistently. So… (chuckling)

CLIENT: Yea. (chuckling)

THERAPIST: So where are you and where have you been?

CLIENT: Well, I've been at home because I got fired. (chuckling)

THERAPIST: Oh my goodness.

CLIENT: Yea. So that was new.

THERAPIST: When did that happen? I know you... when I last talked to you, you had had a conversation with one of our bosses or mentors.

CLIENT: So it was like a week and half or two weeks after that.

THERAPIST: OK.

CLIENT: So I... it was the stupidest thing ever. But I was actually... I thought I was doing really well and improving and stuff. But then I accidentally replied to an e-mail Reply All that was meant for one person. [0:01:04] And then I was fired the next day. (chuckling)

THERAPIST: E-mail can be a dangerous thing.

CLIENT: Yea. And so that didn't go very well. (chuckling) But it was actually really nice to... well, it was actually really hard because I felt like... I was... I knew that I was…

THERAPIST: From really nice to really hard.

CLIENT: Well, it was nice that... to see how much the doctors really cared about me and stuff. They were e-mailing the company. I was like, "You don't have to do that." But they wanted to and I was like, oh well, that's really sweet that they would want to do that. And one of them actually e-mailed me and they're like, "Well, we could try to create a position for you." And I was like, whoa, like... so that meant like even if that…

THERAPIST: That means a lot.

CLIENT: Right. Even if that wasn't necessarily feasible because of my timeline, it really meant a lot to me. Because when I got fired, I just... I kind of took it really… well, as everything. I took it really personally. And I was like, oh my God, does this mean that I can never be a doctor? [0:02:01]

THERAPIST: (sneezes) Excuse me.

CLIENT: Bless you.

THERAPIST: Thank you.

CLIENT: Or that like what if I'm not I don't know I can't deal with this kind of stuff. And what if I can never be a doctor? And I'm like of course I took it super to the extreme. But that they clearly respected me and wanted to work with me and thought I was nice and stuff, that was... that made me feel a little bit better. I was like, well, maybe it's not me. Because I mean, I really… my problem with the company started when they hired my new manager. So I could sort of trace it to the start of him. And I was like, well, maybe it was just like one of those things where you don't get along with someone. Because from the moment we met, it was like…

THERAPIST: Do you feel like the e-mail mistake was what they used to base a decision that they had already come to…

CLIENT: Yea.

THERAPIST: …sort of based on other things?

CLIENT: Yea. Yea, it was kind of like the final straw kind of thing. So it wasn't like all of sudden. It... so I mean, it kind of was all of a sudden because I mean, "Your contract is terminated effective immediately." [0:03:03] But thankfully one of the p.a.'s accidentally told me the morning of. And like that... it would have been so much worse to just randomly get an e-mail. But since I kind of had a little bit of a heads up that morning, that made me feel a lot better.

THERAPIST: How did that scribe know?

CLIENT: Because they called a secret conference call with all the p.a.'s and excluded me. And then one of the p.a.'s was new. I was just training her and she was asking me like, "Hey, what is this conference call? Why... what should I... where should I be? Should I be quiet?" Or whatever. And I was like, "What are you talking about?" And so she forwarded me the e-mail and I was like, OK. It was like a clear... it was like, "We are meeting effective... like immediately. This is a mandatory meeting regarding leadership changes," or something like that. So I was like, OK, I get it. I'm getting fired. But if I hadn't had that heads up, that would have been really terrible. (crying)

THERAPIST: Yea. That's really hard to hear that somebody is unhappy with you. And being fired is a pretty clear indication.

CLIENT: Right.

THERAPIST: They're unhappy with your performance. [0:04:06]

CLIENT: Right. I mean, and I was pretty unhappy with them, too. I just thought that their treatment of their employees was super unethical. And I mean, I was just... I think it was... overall, it was kind of for the best to part ways. But I didn't want to part ways so soon. I just wanted to stay on until March. And so now I have all this time and I'm trying to find babysitting jobs or whatever to fill the time.

But then I actually was offered a different position with a different company. And I felt bad because... so usually when things are my fault, I get pretty anxious if I have to explain them or trying to intricately weave some sort of way that I can talk about something to make it sound less bad. Or I don't... I can't think of any specific examples. But since I really didn't think that was... I mean, it was my fault that I sent out the e-mail. That's true. [0:05:02] That was inappropriate or whatever. But also, I mean, to be fair given the e-mails that are…

THERAPIST: People make e-mail mistakes a lot.

CLIENT: Right.

THERAPIST: Was it something very specific in that e-mail that made it such a grievous error to them?

CLIENT: Well, it was…

THERAPIST: Because certainly people have replied all…

CLIENT: Right.

THERAPIST: …by accident before.

CLIENT: Well, right. It was an e-mail that I was sending to Liza one of the p.a.'s there and we sort of kind of bitch about the company to each other all the time. And so I was saying like, "Oh, I'm so... I'm done fighting with them. I don't care. I'm just going to do whatever they want to do," or something like that.

THERAPIST: Yea, so the fact that it was specifically saying… kind of bad mouthing the company.

CLIENT: Right, yea. So…

THERAPIST: (inaudible at 0:05:38).

CLIENT: I... yea. I know it was…

THERAPIST: It's unfortunate.

CLIENT: It was my fault. But at the same time like…

THERAPIST: It was an error. I mean, you made an error.

CLIENT: Right, right. And I had just woken up so that was probably part of it, too. But... well, so I had an interview with a different company. And I got really super anxious. I mean, she was really like… maybe 70 percent of the interview we spent talking about why I got fired. [0:06:04] And she like tried… she was like, "What specifically made you get fired?" And I was like, whoa, I don't want to talk about that that specifically. I think I ended up fibbing a little bit but whatever. I mean, I... but…

THERAPIST: What do you feel like the true answer would have been?

CLIENT: Well, the e-mail thing, right? And I think poor communication with my boss and just I think poor communication to the extreme. I sent him an e-mail. We... during our phone conversation I think I told you about this. I sent him this e-mail that he pulled up as one of the most unprofessional e-mails that he received. And I was like… oh, because it said like, "Hey…" Well, this is how I meant it. But this is not how he heard it. I meant it like, "Hey, you're totally right. I'm sorry. I totally have a fever and I messed up. But here's the... here's what you're asking for." [0:07:01] And I think I said, "My bad," too or something like that.

And he totally took it as to be sarcastic like, "You should know that I'm sick," kind of thing. That's totally not how I meant it. And so I guess that's one of the things is like it's difficult to communicate via e-mail if that's your only way of communicating. Because, with my housemates, I know them and…

THERAPIST: Right.

CLIENT: …a terse e-mail does not make an angry roommate. You know what I mean? So…

THERAPIST: But there's a big difference between e-mailing your roommates and e-mailing your boss.

CLIENT: Well, right. Well, what I'm saying is the level of familiarity because I know them in real life so…

THERAPIST: Right.

CLIENT: …it's easy to decipher e-mails.

THERAPIST: Right. But when you don't know someone in real life, you have to be really careful about what you write.

CLIENT: Right.

THERAPIST: Because they don't have that experience…

CLIENT: Exactly.

THERAPIST: …in which to interpret.

CLIENT: Right. I thought I was being careful. But I guess not. Maybe it's something I can work on. But I don't know.

THERAPIST: I mean another thing that's tricky is e-mail tends to get used so often for casual communications. [0:08:07] And when you're using it in a professional setting, remembering that it's still a professional setting. And so trying to keep it one more level of formality by more completely communicating your thoughts and writing out actually salutations and things like that that get dropped off casual e-mails. And even I think… we even e-mail back and forth.

CLIENT: Sure.

THERAPIST: And I think one thing I noticed is when I send out a first e-mail, I start with like, "Dear Leanne." And write out what I want to say. I'm always typing on my phone so they tend to be really short.

CLIENT: (chuckling)

THERAPIST: And I usually sign them. And then by the third back and forth, I've dropped of the Dear Leanne.

CLIENT: Sure.

THERAPIST: And I'm just, right, just answering a question. And I might even give you the one liner. And that's something I kind of think about. And think, well, it's not really a very respectful way for me to actually write a letter. [0:09:01] To not use somebody's name and not personalize it. And I think people do tend to get comfortable with that when maybe we're taking liberties that we shouldn't.

CLIENT: Sure.

THERAPIST: And I guess I err sometimes on the side of being a little bit too casual when there's been a back and forth. And also because I feel like I do have some history where we get to talk and you maybe have a sense of how I feel about you and that I do respect you. But that's something I think that's sometimes we can take for granted.

CLIENT: Sure.

THERAPIST: And especially when you're communicating with a boss, erring on the side of being a little bit more formal a little bit more thorough than maybe you need to be. Because sometimes you don't know how it's going to be taken.

CLIENT: Right. And I mean, like I said, I thought I was.

THERAPIST: Yea.

CLIENT: So may... I don't know. I really just think... because I've never had this problem before with anyone.

THERAPIST: Yea.

CLIENT: And I e-mail the doctors all the time in group.

THERAPIST: And they…

CLIENT: And it's... I don't know. [0:10:01] So I…

THERAPIST: Yea. You can't be responsible for all of it.

CLIENT: Right, yea.

THERAPIST: There's a dynamic between you and your bosses. But you only have control over yourself.

CLIENT: Right.

THERAPIST: For the next... for taking away something from this situation, can you apply it to... hopefully you won't have to apply it to the next situation.

CLIENT: Right.

THERAPIST: But what... if in case, what can you take with you?

CLIENT: Yea, that makes sense. But I think it was even more than the e-mails. It was like even… because he visited the site once. So I did meet him in person once. And just from the moment… you know those people you just like…

THERAPIST: Didn't jive.

CLIENT: Just no. I don't know what it was. But we just did not get along. And that's a really shitty relationship to try to work through to begin with and then to do that via e-mail…

THERAPIST: Yea, that's really hard to do that.

CLIENT: …which is already kind of obscure. And so anyway... and then people were like, "Oh, it's probably for the best." And I was like it's probably not for the best. I just wanted to see it out until March. (chuckling) [0:11:01] But I understood people try to make me feel better. But actually it was really nice. It gave me an opportunity to... we had a little commiseration party for... we just hang... we hung around the house and ate chocolate and cheese and wine. And it was nice and…

THERAPIST: So your roommates were able to…

CLIENT: Yea. So that was really sweet. But yea, I guess. So that's been kind of on my mind. And I've been kind of trying not to take it personally. But it's still kind of been taking it personally. And after that, I did kind of so poorly on the interview. Actually I got the job but I turned it down.

THERAPIST: So you couldn't have done that poorly in your interview.

CLIENT: But it was... I mean, it didn't really go very well. I think the only reason that I got the job was because she asked for recommendations. Well, understandably. If I've been fired from this job, she wanted recommendation from the doctors. Just a quick e-mail like, "Hey, she's not crazy." And so they e-mailed her within 30... half a day that I asked them to. [0:12:03] And so she was like, "Whoa, you've got some really glowing recommendations," or whatever. And so I think that's mostly why she hired me.

But the timing would be off and so... and there's this other thing. And I know it's (inaudible at 0:12:18) and super weird. But I just like… I feel like I'm never going to have time to do it otherwise. And so I want to take a road trip. I'm going to take a road trip with my cat. And it's something that I... once I got fired, I was like, well, there's this thing that I've been wanting to do anyway. And then we I got this position, I would have been working until the day right before class starts in like… at the end of May or something.

And so I feel like the timing was just off. And in my e-mail to her, I was like, "I really appreciate your time and the position," blah, blah, blah. But I think… because we had even talked about like working the year after. [0:13:02] And I was like that would be really perfect for me because I think my timing is getting even more constrained and stuff. Not because I super wanted to… even just excluding the road trip, it was still just a really tight timeframe. And I would have to move to a different city and get housing. And…

THERAPIST: Am I missing an update on school?

CLIENT: Oh wait. No, well no, no. Not really. I mean…

THERAPIST: OK. (chuckling)

CLIENT: …just assuming that I get in, right? Because now I'm applying to three programs. I called my advisor and she was like, "So you're only applying to two programs?" And I was like, "Yea, well, there was a third. But I didn't really know. And it's kind of late now." And she's like, "OK, cool. So we're applying to three." And I was like, "OK." (chuckling)

So now I'm applying to three three Postbac programs. And they all start in the summer which... and by summer I mean end of May. So it would be like two semesters of chemistry in the summer and then fall and spring would be orgo, biology and physics and then MCAT in the summer. And then take… either I could take a year off which is kind of what I want to do. Take a year off and then go to med school. Or this is all obviously assuming I get into (inaudible at 0:14:10).

THERAPIST: OK.

CLIENT: Or there's… they offer linkage programs which are… like a school gives you special consideration. And they accept a later MCAT because you were part of this program. They're friends or whatever. But they have some really nice school linkages that I would actually consider. So I don't know. But anyway, that's also really nerve-wracking, right, because interviews are coming up. I never interview for anything. I didn't interview for grad school. I didn't interview for undergrad. So... and then having the... this is where I was going with this. This really crappy interview makes me very nervous.

THERAPIST: Makes you nervous about the interview process.

CLIENT: Right.

THERAPIST: Very different interview, I would imagine.

CLIENT: I'm sure, yea. I'm sure. But still. So that's kind of... as soon as I got fired, I was like, well, applications. [0:15:01]

THERAPIST: Yea, move on. I mean, it allows you to... I mean, there was a greater plan anyway.

CLIENT: Right, right. And so that's kind of why I don't feel too bad about going on this road trip because, well, I have a plan. It's not like I'm just being unemployed to be unemployed.

THERAPIST: Right.

CLIENT: And I think it would be really fun. So I'm going to see some sites throughout the United States. (chuckling)

THERAPIST: Cool.

CLIENT: Yea. But anyway, that's…

THERAPIST: Well, it sounds like a fun plan and a great opportunity to do something that you want to do.

CLIENT: Right, yea. And I think I've always like gotten a lot out of road trips thinking and stuff.

THERAPIST: It's a really nice time for reflection having all that quiet space.

CLIENT: Yea. So I don't know.

THERAPIST: How long are you road tripping?

CLIENT: I don't know. (chuckling) [0:16:02] It could be like a couple days or two weeks or it depends. I'm going... I'm buying a tent and I'm going to sleep at camping grounds, I think, and with a cat. (chuckling) It'll be weird.

THERAPIST: So you're waiting until it's a little bit warmer? Or not camping until it stops.

CLIENT: Yea, that would be good, too. And I'm going to try and stay with friends, too. So in places where it's a little cooler, I'll stay with a friend. And plus I want to see her, anyway. But anyway, so that's super exciting. I'm really excited about it. But I'm also really nervous about... oh, so the other thing I was nervous about was going back to school. So I'm auditing a class. But it's just one class. And I'm nervous about like concentration and stuff like being able to do work because I wasn't very good at it here.

THERAPIST: What are you finding? [0:17:00]

CLIENT: I'm sorry?

THERAPIST: What are you... well, I guess you just started probably if you're auditing. Is that this week starting?

CLIENT: Oh, right. No, well, yea. No, I mean, it's... I'm not taking the registry for anything. I'm really excited which is that's why I added it to the road trip.

THERAPIST: I'm seeing the connection.

CLIENT: But I mean, I'm thinking back to withdrawing from physics and chemistry and I had to write essays explaining why I withdrew for the applications and stuff. And it was actually a really nice opportunity to think about what I've learned since I withdrew and stuff. But it still makes me really nervous because I don't think I've ever had like a really successful semester since I graduated college. Where I was like I did really well that semester or like… because I remember feeling that. I was like I did my best and this is good work and I like it. And if I fail, then so be it.

THERAPIST: If someone was to look at your master's work for your master's degree, what would they think? [0:18:04]

CLIENT: I feel like there was a lot of cramming and typing things out quickly without being super careful and not a lot of advance planning some insight but not much. I wasn't really proud of the work that I did for my master's like I was for my undergrad. And now... but I do look back at the work that I did for undergrad and think, wow, I didn't know anything so I have learned stuff. I just… I guess I'm not that good at reflecting. That's always… that's been like a lifelong thing.

I was always best at Biology. But I always got like 88, 89 and stuff like that. And I'm worried because grades really matter for med school, right? And so I don't really... yea, that's... but I also don't want to be scared like I was here because then that's totally like a petrifying… like I couldn't move like not moving kind of petrifying. [0:19:10] Because what if I mess up or something? I don't know. That's been on my mind a lot, too.

THERAPIST: What got in the way of focusing?

CLIENT: Well…

THERAPIST: What did you find happening?

CLIENT: Well, I think... well, it was two things, right? So the work thing like obviously I was overloaded and I... there wasn't enough time to do everything. So that was like OK legit.

THERAPIST: Definitely for your most recent experience.

CLIENT: Right.

THERAPIST: The extension school I think you had completely overscheduling and sleep deprivation.

CLIENT: Right, right. But I think the other thing was that there's this weird way... I can't really explain it. And it's like everything I have to do... or everything I do has to be perfect. If I make a mistake and I'm writing with a pen, I have to start all over on a new sheet or something. I mean, like that level of precision. And here I didn't really have the time for that, right, obviously. But that makes it hard because you're doing all this other work that isn't really productive. [0:20:06] I don't know. Does that make sense?

THERAPIST: Yea. You're spending a lot of time almost doing busy work...

CLIENT: Right, exactly. Instead of actually…

THERAPIST: …which doesn't leave time for the deeper introspective work of writing or memorizing complex concepts.

CLIENT: Right, or learning how to balance equations or whatever. (chuckling) So... and… but that's... I think that's been like a long term thing in that. I'm worried about my study habits a lot. I think that's what I'm worried about. And I'm kind of trying to maybe use this class as like a warm up or something.

THERAPIST: Well, let's think about what are the parallels between the way you think about your work in terms of academic work and the way you think about your interpersonal relationships? [0:21:01]

CLIENT: What are the similarities? I don't know. I honestly… I have no idea. I feel like those are separate worlds for me. (chuckling)

THERAPIST: I think we need to connect them. The thing that I'm thinking and tell me if I'm... I may be putting a lens on something that doesn't actually exist but what kind of jumped out to me is when I think about your interpersonal relationships and the thing that sometimes gets in the way, is how quickly you can go from thinking that things are OK to being really intensely angry at someone and thinking you've got to exit the relationship. The whole thing has to be scrapped.

CLIENT: We can never be friends again, yea.

THERAPIST: We can... yea. We can never be friends again. When you were talking about, "I make a little... I'm writing in pen and I make a mistake and I've got to scrap the whole thing and start over." For some reason, those two things jumped out to me like, oh, that's sounds kind of similar to me that there's this sort of absolutism…

CLIENT: Yea.

THERAPIST: …that's either all crap or it's perfect. [0:22:02] And so I wonder if… the same thing that you've been working on in here, we haven't focused much on academic work.

CLIENT: Yea.

THERAPIST: But the idea of trying to find where's the medium? Where can you be angry at a friend that the relationship doesn't have to be over? How upsetting is a particular event in a relationship in the perspective of the whole thing? I feel like you've done a pretty good job working to find some grey area and working to find something between 0 and 60 in relationships. And I wonder if some of what you learned there can be transferred to, OK, well maybe that's not perfect. But maybe you don't have to scrap the whole thing. Maybe there's a way to work from what you have so that you don't have to lose all the time and effort that you already put into developing a concept or working through a 25 step equation and whatever the task is.

CLIENT: Yea.

THERAPIST: That you don't have to lose everything just because it isn't going exactly the way you would hope ideally. [0:23:02] Am I stretching or does that make some sense?

CLIENT: No, that makes sense. It's just... it sounds scary. (chuckling)

THERAPIST: OK. Tell me about scary.

CLIENT: No, I mean, I just... it sounds like… I don't know. Because it's so important for me to get… I really want straight A's. I really, really want straight A's. Like so much that I'm like doing it full-time and I'm not anything else. And this was my... going to be my life. I'm taking loans out. And there's all this stuff going through my head that's like kind of above the material, right? And so I think…

THERAPIST: And you want straight A's because…

CLIENT: Because? Well, because... I mean, I always want straight A's but I don't necessarily always get them. But I think that in this case I don't just want them. I need straight A's, right, to be considered for good medical schools and kind of end up where I want to be. And I guess I wouldn't want to... maybe that's the other extreme is to think that would be... like to be complacent. [0:24:09] I wouldn't want to be complacent with like, oh well, I got five problems wrong. But I don't care. Here's the homework. So I know that that's kind of the other extreme of that, I guess. But I don't know. Does that make sense?

THERAPIST: OK. So there are a couple assumptions going on. One is that you need to get straight A's to go to a medical school that you would consider good enough.

CLIENT: Well, I want to try my best because... I mean, if I infer…

THERAPIST: There's a difference between trying your best and getting all A's.

CLIENT: Well, be... well, I guess I assume that I'm capable of getting straight A's. Maybe that's not an assumption I should make. I don't know.

THERAPIST: Well, so the grade isn't totally in your control. What… your work the work that you do and the effort you put in that's in your control. So what if we made the goal about the kind of work you would do and leave the grading up to the professor? [0:25:04] See the difference between the... it's the difference between the process. You have control over the process. But you don't have control over the product. The grade is the outcome.

CLIENT: That's like the... yea.

THERAPIST: We'd like to think they're linked.

CLIENT: Sure.

THERAPIST: And they are probably somewhat linked. But they're not the same exact thing.

CLIENT: I think... that's funny is because that's the way that I think about classes here. I never really cared oh, A minus, B plus, A. OK, whatever. I've never really been about grades. And in undergrad my... the professor that I took three classes first semester with, he's... in first day of class first semester of freshman year he's like, "I do not discuss grades with students. I give grades and you receive them." And so I've never ever discussed grades with a professor. That's never do been the thing.

But I've also always been in the Humanities. And I think it's different because it seems more like their objective measuring things that I have to meet that are almost under the control of the professor, too. [0:26:03] It's just like you either do it or you don't kind of thing. Maybe it's like I'm nervous about the sciences as opposed to the humanities. Because they do... because that's literally how I think about classes. I'm like I don't... I'm not consciously thinking about grades.

THERAPIST: Right. And so it does feel a little bit different. Like when you're taking your physics class and they give you a problem, there's…

CLIENT: It's right or it's wrong.

THERAPIST: There's a right answer and you get the right answer, you get something. Get the wrong answer, you get something else. But it's still somewhat out of your control because who knows... is there room in the grade for class participation? Is there room in the grade for maybe you did... maybe you had the right process written down for the math but you actually forgot to carry a one somewhere. So you're going to get partial credit. Maybe there's some credit given for actually turning in all your problem sets even though you don't necessarily get all the right answers on the problems.

So I think... these are the... what you have control over is, do you show up to class? Are you awake and engaged during class? [0:27:02] Are you turning in all the problem sets whether they're right or wrong? Are you putting in your best effort? Are you going to office hours if you're confused about something? Those are all the things you have control over. Exactly how they grade the PSATs how do they grade... how much weight is given to this exam versus that thing versus that thing that's the grade and that's what you don't have control over.

CLIENT: Right, OK.

THERAPIST: Yea. I mean, can you go and lobby your grade if you want to? Maybe…

CLIENT: Yea.

THERAPIST: …but that doesn't matter.

CLIENT: But that's horrifying. (chuckling)

THERAPIST: (chuckling) I think making your goals more based on the things that you truly have control over gives you a lot more… I think it just gives more control and gives you more power. Because you don't... ultimately you don't have power over what letter they write down, right?

CLIENT: Right. [0:28:00]

THERAPIST: I don't know how that necessarily translates to this idea of sort of all or nothing. That absolutely perfect or scrap it.

CLIENT: Well, no. I think it does because… I don't know. All that sounds like a grey zone to me.

THERAPIST: All the effort stuff sounds like grey zone.

CLIENT: Yea, I mean, well, that's... it's not the effort. I've always kind of... I've never been too scared of pulling an all-nighter or kind of doing all that kind of stuff. But that's kind of all for me. But I don't know. It just… it sounds… it makes me nervous, right, because I really want to do well because grades have never mattered to me before. I've just... I've done well because I've enjoyed what I'm doing. And I'm scared because I don't think that I'm going to enjoy what I'm doing. I see this program or these programs as a stepping stone something that I have to overcome to like…

THERAPIST: To get the thing you want. [0:29:02]

CLIENT: Right. And I mean, and I realize… like I've never spoken to a single doctor that's like, "Oh yea. All the pre-med stuff is so useful to me. It's so applicable to my day-to-day job." Maybe I'm wrong I don't know because obviously I'm not there. But…

THERAPIST: Have you talked to the doctors about that stuff?

CLIENT: I have.

THERAPIST: I mean you have access to a lot of doctors.

CLIENT: Yea, yea. I have and they're like, "Yea, I know it's not really that useful." It gets useful to understand cellular processes that you learn in biology. But other than that, it's not really... unless you're doing like I don't know if you're working for like Pfizer or something. You're not really using a lot of the other stuff.

THERAPIST: Right.

CLIENT: So I don't know. I mean, so this is... it's definitely…

THERAPIST: Right, it's stuff you got to get through.

CLIENT: Right, exactly. It's not like, this class that I've been waiting for a year that I'm super excited about and I can't stop reading ahead. And I'm really excited about. But it's something that... I mean, I hopefully I will enjoy. I'm not totally going in with a negative attitude either. [0:30:04] I don't think that's productive. But it's scary. It's really scary because I failed at it before. And I don't know. Having that I don't know having that precedent makes me really nervous especially when I need to do well which is a new pressure I've never had. I mean, at (inaudible at 0:30:26) school I was... you have to keep above a B. OK. But I've never had that before. You know what I mean? I don't know.

THERAPIST: But it is going to be a different scenario because you're not balancing against working overnight shifts and driving out of state.

CLIENT: That's true.

THERAPIST: And so... and that's another thing because thinking about what's in your control and what's not in your control. So one thing that's really in your control is how do you create a schedule that makes it possible to focus and not feel overwhelmed in the way that did before? And I think… I mean, you were taking those kinds of classes last spring?

CLIENT: No, fall, yea.

THERAPIST: In the fall. (inaudible at 0:31:13). You were totally overwhelmed. Not just by the class material, but by the time pressure. You felt like you had very limited time with which to grasp the material. If you didn't get it in that one hour window, then you didn't get it because you were off to a work shift. And that's very different.

CLIENT: Yea. Maybe there's just a lot of new and I'm just scared because there's a lot of new.

THERAPIST: There's a lot of new.

CLIENT: I mean I've never done the whole science thing before. So maybe…

THERAPIST: Yea, it's very different. Yea, it could... maybe it won't actually feel so different. I mean, it's very different content. But maybe it won't feel so different from being an undergrad where you did lots of different things.

CLIENT: Yea.

THERAPIST: But you don't know. It's uncertain because it's... you haven't done this yet.

CLIENT: Right. [0:32:00] And I did take undergrad astronomy class. I'm like that was my only C in college. I was like, oh. But anyway... oh, and I think maybe part of the reason I'm super OCD about little things like the little mistakes and stuff is because a lot of what happened in that class. The reason I got a C wasn't because I didn't understand the material. Actually I thought it was really cool. But it was always mistakes with like, oh, I missed a decimal point. Or I didn't do the multiplication. What is it? Like significant figures or whatever. I messed up on one number and like, whoa, thinking...

THERAPIST: So figuring out what to pay attention to, where do you need to be really precise and where can you let some things go.

CLIENT: Yea.

THERAPIST: And that's a lot of what attention and focus is because I know you struggled with... I'm in (inaudible at 0:32:54) school you struggled with what to attend to. [0:33:00] And figuring out how to filter out what's the extraneous stuff that's not important that you can let go of so that you know what are the limited things that you actually really do need to really attend to. That's going to be a practice of figuring out this is important, this is not. Decimal points, small, important whether you went over the line, not important and figuring that stuff out in both a classwork way and also a life way.

CLIENT: Yea. OK. (pause) (chuckling) I can try. That sounds (inaudible at 0:33:43). OK.

THERAPIST: So the piece of life that I haven't heard about is what happened to the boy. You were dating a boy.

CLIENT: Oh, he moved away. Yea, he moved away. And then he actually came up and visited and it... I don't know. This is weird because we knew that we were just friends. [0:34:00] And... but he was acting differently and I was just confused. And I was like, I don't know. I don't know. And I didn't even feel too badly or whatever. Did I tell you we had that… the conversation about like, "I'm not going to have kids with you," kind of thing? (chuckling)

THERAPIST: No, I missed that one. (chuckling)

CLIENT: So at one point we were... because... so on the fourth date he was so... oh God, what did he ask me? He was like, "Oh, so do you want to have kids," and all this stuff. And I was like, whoa, whoa, that's moving really fast. This is a fourth date. And so it kind of made me really nervous and I started noticing that I didn't really want to spend as much time with him as I had before.

And then at one point, we were having some conversation. And I was like, "Well, I don't really know that I really know where I'm going," or "I really don't want to do anything. I'm kind of just around for the time being," or whatever. "I don't really want to have kids or at least not now," that kind of thing. [0:35:08] And he's like, "Oh my God. I can't believe you thought that I wanted to have kids with you. Oh my God. I'm so sorry. That's not what I meant. I was just trying to be friendly or talk about... make conversation or something." And I was like, "Oh."

THERAPIST: That's a serious conversation to just make conversation about.

CLIENT: Well, yea. But I mean I don't exactly remember how it came up but it wasn't totally out of the blue.

THERAPIST: Yea.

CLIENT: But it was good because I was actually really happy that I brought it up because usually I just kind of don't do that.

THERAPIST: Yea, you kind of run with your assumption.

CLIENT: Right. And so he was like, "No, no, no. I really want to have kids in a family but is that going to be with you? Probably not. That's OK." (chuckling) And I was like, "Oh, OK. Good." And then I had a great time. I spent a lot of time with him and… I don't know. It made it really fun. [0:36:01] And I wanted to see him. And so that was really nice after that. I don't know. And he apologized and I apologized and then we made up. And so yea, that was nice. (chuckling)

THERAPIST: Yea, so it was a positive experience. I mean, I know it was really nerve-wracking to sort of go on those first few dates and…

CLIENT: Yea.

THERAPIST: But you've got some experience.

CLIENT: Yea. And I think maybe now if I... well, I mean, I don't know where I'll be in the next couple of months, right, but if I like going on dates or something…

THERAPIST: But you can talk and flirt with boys.

CLIENT: Right. (chuckling) So I don't know that I'm that horrified to do it anymore. It kind of was a little fun. (chuckling)

THERAPIST: Well, good for you. Yea. Good for you because that can be a big piece of a road trip. I mean, you're going to meet people. You're going to be talking... hopefully you'll be talking to people.

CLIENT: (chuckling) Yea.

THERAPIST: And is the goal necessarily to meet the love of life as you're passing through a particular state?

CLIENT: Not necessarily. (chuckling)

THERAPIST: No. Not necessarily. [0:37:00] But I think feeling more comfortable, being able to just casually talk with people, getting a sense of comfort in yourself and in your body, that's…

CLIENT: That might be hard.

THERAPIST: …a nice thing to just experiment with.

CLIENT: Yea. Oh yea, that was a really positive experience. But then the other day… I don't know if we still have time or not.

THERAPIST: Yea, we have five minutes.

CLIENT: OK. So I was waiting for the bus because it was running late for something. And I think it was coming in five minutes or something. This was by my house and I think it was going to the Square. Anyway, this guy parked right in the bus stop. And it was like... OK. Admitted, I should not have said anything. (chuckling) It's totally my bad. But I don't think the reaction was called for. Anyway, so I was like, "Oh, this is the bus parking spot. You can't park here. It's illegal." And I honestly, totally honestly, the reason I said it was because I miss shit like that all the time and I park in really inappropriate places. (chuckling) [0:38:06] So I would appreciate if someone said it to me. So I tried to say that to him.

And he walked away and was kind of like... or he was like, "What, what? I don't understand," as he was passing… as he was walking away. And I was like, "Your car." I thought he didn't understand English because he had kind of an accent or something. And I was like, "Oh, this is an illegal parking spot. You're not allowed to park here. You'll get a ticket." And he was like, "Mind your own business." And I was like, "Oh my God. He speaks English. He knew what I was saying. That's so rude." And I like festered for this whole time. I was like I can't believe he just made me say that a couple of time. And that's so rude. He just... he totally knows what I'm saying but he still parked here anyway. (chuckling) And I was really angry.

And then by the time he came back, I didn't say anything. But I was looking at him like death stare status. And he was like, "You should mind your own business," or something when he came back. And I was like, "Well, you shouldn't park in illegal spots. It's illegal." [0:39:01] And started getting pretty heated. And then he turned to me and said, "Well, you should walk to wherever you're going because that's why you're fat because you ride the bus." And I was like, "Oh no you didn't." I was so mad.

THERAPIST: Yea.

CLIENT: So I snapped a picture of his car and sent it to the cops. But... so that made me feel better.

THERAPIST: Good girl. There's absolutely no reason for him to comment on your body.

CLIENT: Right. But then... but it was also like... it also made me feel like, OK, so if some... if random people see me on the street, then that's the first thing they think of me is what they're seeing and they think that I'm fat. And it was like, Oh my God. This is like sixth grade all over again.

THERAPIST: You're jumping from him to all random people.

CLIENT: Right.

THERAPIST: OK. And that's your only mistake. Pointing out that he was parking in illegal spot, you started off being a very helpful civilian. And then you got really angry because he didn't respond. [0:40:01] He didn't say, "Ooh, I didn't notice," or "Hey, thanks for letting me know but I'm going to chance it anyway."

CLIENT: Even that would have been... I would have been like, "Oh. That's fine. I do that sometimes too."

THERAPIST: So you got really angry. And you held onto it. But there's absolutely no reason... it's completely inappropriate for someone to comment on someone else's body. And did he notice that… for him your body wasn't what he considered perfect. But that's his thought. And that's doesn't have to be everybody's thought. And I think, for you, your worth is not based on what your... what the size of your body is. It doesn't need to be. That's not really what your value is.

And so there are a couple of things to disconnect. How important is whatever your specific size is? Right now it's determining a lot of how you feel about yourself and you're assuming that it's determining a lot about what other people think of you. [0:41:01] This guy is not everybody. And this guy's values are not everybody's values. And I think what's really going to determine how you feel about yourself is figuring out what actually is really important and what's not. And so there's still some work to do at separating that. The size of your jeans does not determine the importance of your being.

CLIENT: Yea. I think that that's probably why I've kind of always focused on my mind rather than my body. But it's still… I don't know. It was like he didn't even think about... he didn't have to think about it until like... and what would he have said if I was super skinny? You know what I mean? It just... I don't know.

THERAPIST: Yea. He may not have made a comment or may have made some other hurtful comment. We don't know it.

CLIENT: Yea. [0:42:00]

THERAPIST: And yea, I'm not going to debate with you, is there a value on being skinny in this culture? Absolutely there is. Does that mean that you have to adopt it? No. Because it's not necessarily an appropriate value. But yea, absolutely, people make incorrect assumptions about what body size means how much control somebody has over it.

CLIENT: Right, right. Yea, he assumed I was lazy where I hardly ever take the bus. (inaudible at 0:42:31).

THERAPIST: Yea. And that is a... if you look at some social psych literature, people do make those assumptions. They assume that heavier people are not as smart and not as motivated. Is that true? No. Not at all. But yea, some people do make those assumptions. And I think it's important for you not to make those assumptions about yourself.

CLIENT: Yea. [0:43:01]

THERAPIST: They're hard connections to undo once you've made them in your mind. So it's going to take…

CLIENT: Oh, wow.

THERAPIST: We're going to have to focus on challenging those assumptions over and over and over again until the new ones stick. So we should probably wrap up here for today. So…

CLIENT: Yea. I called Blue Cross. And they said it was a mistake on…

THERAPIST: OK.

CLIENT: And so they said... OK. They said that the authorization should have been automatic. OK, so the first 12 sessions are covered. And so apparently that generates a... I don't really know if this makes sense. It generates an automatic authorization. And then after that, then you would have to request the authorization.

THERAPIST: OK. But we didn't go beyond 12 on your... on that insurance.

CLIENT: Right. So…

THERAPIST: So let me make sure that I have the right number because I resubmitted it and got denied again.

CLIENT: Really, because I asked. I was like, "Oh yea, she said that she had submitted it and that she got declined." And she was like, "Well, we don't show declined. We just show that there's no authorization that should have automatically been generated," which I mean, like I said, I don't really know what that means. [0:44:06] But they said that they were going to fix it and that you didn't have to resubmit it or whatever.

THERAPIST: OK.

CLIENT: But I still feel kind of uncomfortable having such a large balance pending.

THERAPIST: Well, but if it... so I have... do you have your card…

CLIENT: Yes.

THERAPIST: …still just to make sure that I'm using the right numbers. Although it sounds like if they have record of it, it should be right.

CLIENT: If they... yea, they have.

THERAPIST: (inaudible)?

CLIENT: Yea.

THERAPIST: OK. So why don't you pay for today because today won't be covered by insurance anyway.

CLIENT: Right.

THERAPIST: And then you can feel like you paid something.

CLIENT: OK. That'll be good.

THERAPIST: And…

CLIENT: And I mean, I… like I said…

THERAPIST: We'll keep working on this.

CLIENT: Yes. But they said it might take a few weeks.

THERAPIST: That's OK. That always happens.

CLIENT: So I would be... I… like I said, I don't really feel comfortable having such a large balance just pending. So I'd be happy to…

THERAPIST: I'm sorry that you're uncomfortable with it. [0:45:01] But you're going to have to sit with that.

CLIENT: (chuckling) OK.

THERAPIST: (chuckling) Because that's how billing works. It always takes a couple of weeks for things to get processed. That's... it's part of my deal being in private practice. That's mine to deal with.

CLIENT: OK.

THERAPIST: Because there's no way you should be paying for something out of your pocket that should be covered by insurance. And if you did, that means I have to figure out how do I deal with the fact that you paid me money that I actually owe you? And then I got to write a check back to you. You don't want to do that.

CLIENT: OK. Well, as long as you're OK with it. I just…

THERAPIST: Yea, I mean, I think it's frustrating. But it's my frustration with Blue Cross not with you.

CLIENT: OK. And I mean, like I said, they said that they would be working on this.

THERAPIST: Yea, so…

CLIENT: Whatever authorization was supposed to be automatically generated. I don't think... that's not the one I want.

THERAPIST: Would you like a clipboard?

CLIENT: Oh, I'm OK. Thanks. Was it…

THERAPIST: So it's 145 was your old rate and we're sticking with that.

CLIENT: Yea.

END TRANSCRIPT