TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
THERAPIST: (inaudible at 00:05)
CLIENT: Yeah, I had to send it before I got here. I was spending a lot of my cab ride thinking of better ways to improve it. Do you have time?
THERAPIST: Sure. I mean, I could it's up to you. I should leave about 20 after because I actually have a class that I have to go to. But we can punt (ph) on the discussion of the (inaudible at 00:40) or we can talk about, you know, we can wait to talk till Monday about that or talk about it now, whatever you want to do.
CLIENT: Yeah, we could talk about it for a few minutes. (pause) Do you think her response should be taken in the context of (pause), like, the article that you sent me? In that she's reading the data wrong or she has a different opinion of...
THERAPIST: Well (ph)...
CLIENT: ...[is out there] (ph) or do you think that was a political response and that that's not the real reason??
THERAPIST: Yeah, that's why I put no (ph) response. Most clinicians are not real I mean, including me, are not reading (ph) up on the outcomes of literature (ph) and don't read it.
CLIENT: They run one at the randomized control trials. It was very dense. It doesn't seem like it would be that fun to be up on it.
THERAPIST: It's probably that and it's probably I'm trying to think of how to sort of [do this] (ph) really quickly. Like, in a lot of fields of medicine there's a close relation between the outcome literature and, like, techniques and practice. And for psychotherapy/psychoanalysis that's really not very true, particularly when it comes to more psychodynamic work. It's a little bit like if you leave your keys you look, you know, at night, you look for them where it's light (ph) it's easier to see them there. You know, it's easier to study things like manualized (ph) treatments. They tell you exactly what to say. They're very structured interventions. So certainly there's been more study of those kind of things. [00:02:45]
But the understanding is that like, I think for some things they're actually very useful and probably more useful and much more efficient, but [there are] (ph) lots of things that are not. And there's certainly more [they're going to be] (ph) cheaper. So it's a great thing to be able to get behind if you are, like Donna, trying to balance sort of the resources and [need of the] (ph) community with individual needs, [I don't know] (ph).
CLIENT: It's just not clear what the purpose of a student mental health clinic is.
THERAPIST: You got that right.
CLIENT: Like, are you there really for student safety and taking care of them in crisis? Or are you much more interested in I mean, of course that's a given but is there scope to influence (pause) well-being on a much, like, longer trajectory? You know, like, the article talked about three, four, five, six years of follow-up on treatment and lasting effects. And doesn't that seem like it should belong in the discussion of services to students? [00:04:15]
THERAPIST: So I was a [post doc] (ph) at the health services I think about ten years ago. And I haven't worked there since but I've sort of been in touch with people over there because (inaudible at 04:29). And over the years there sort of (inaudible at 04:33) change, but particularly in the last five or six years it's really about sort of (pause), like, safety and keeping a closer eye on students who are really unsafe or might need to be hospitalized, who kind of need that level of care, who might get seen [next week] (ph) or during (ph) a crisis. And other than that, it's about sort of short term or intermittent work and not really about sort of longer term or intensive work or working people with issues.
I mean, [they have] (ph) different models. Like, sometimes they used to do, like, a semester (inaudible at 05:26) you could get seen weekly for, like, 12 or 15 weeks and that was it. Otherwise, they've done, like, you can see somebody every two or three weeks but not more often than that. They've kind of switched around in that but if you want more than that you kind of get sent (ph) out.
CLIENT: I think that's fine. I couldn't imagine a way for them to provide anything with regularity for all the students who want it. But it seems like the message should be much clearer than it is and...
THERAPIST: Yeah, I think the mission is generally muddled. And it used to be different, you know, especially going back eight or ten years or more. There are college counseling centers around who would see people, you know, intensively for longer periods of time. I saw people when I was there once or twice a week all year.
CLIENT: Wow.
THERAPIST: And there are other counseling centers that were doing that too that mostly probably aren't anymore. So generally, [there's a] (ph) trajectory in the field towards seeing people shorter term and less frequently. But I don't think anybody's really making the case just because [you now] (ph) treat people more efficiently or that work better. It's just about cost. And, you know, that's reasonable. I wish they were a little more upfront about that. But...
CLIENT: I'll (ph) see [what they have to say] (ph).
THERAPIST: And I guess (laughter) if you wouldn't mind not mentioning names.
CLIENT: I won't.
THERAPIST: OK, thanks. Because they refer to me and...
CLIENT: (inaudible at 07:12)
THERAPIST: If I disagree with some things that they're doing and at some point maybe I want to do something about it but I...
CLIENT: This is not your domain. I'm using your as a resource because I just value your opinion and I also want to make sure that I'm not causing a scene for something that I'm just completely misinformed about. It doesn't sound like that's the case.
THERAPIST: Correct. Actually, there's another thing that you learn about, which is that so (inaudible at 07:56) so universities don't have to [abide by that] (ph), you know that.
CLIENT: Right, yeah.
THERAPIST: Which, I mean, that's not their doing or their fault but it's outrageous.
CLIENT: Why not sort of suggest that if employers have to provide a certain standard of care and universities aren't required to, that's not necessarily because universities are doing something that's better. OK. I look forward to fighting that battle.
THERAPIST: Fighting the good fight. I hope it goes well.
CLIENT: Yeah, I think it's going to be a long term thing and maybe an aspect of it will just be, like, (pause) being a personable person who can hear all of the sides.
THERAPIST: (inaudible at 09:08) know of her. I mean, I've shared patients with Donna and I actually like her. We've always gotten along well. I think for a clinician she's actually not [everybody other there is] (ph) but I think she's quite good.
CLIENT: People who are in management or leadership or administrative roles are often really good at why they got there, but not necessarily at the things that they have to do. Like, Kelly is a really good scientist but a bad manager.
THERAPIST: [And] (ph) hasn't been managing that (inaudible at 09:45) I think it's been two or three years.
CLIENT: That's good to know.
THERAPIST: Although she worked there as a clinician a long time before.
CLIENT: So she probably has a sense of whether she thinks she [gets changed] (ph) or not?
THERAPIST: Yeah.
CLIENT: Why do you think that I knew that you have had a family member who's a retina specialist?
THERAPIST: I think there are probably three factors. One is I was just so surprised because that's (ph) a particular thing.
CLIENT: And I sort of, like, made it seem like I was familiar (inaudible at 10:46)?
THERAPIST: No, no. That part of it was mostly just me going, you know, like, (laughter) being surprised. And then something about the way that you smiled when I said it. And then the other thing was you had mentioned, like, kind of Google stalking me a little bit a while ago. So it seems like something that easily could have come up. So...
CLIENT: Well, I did look him up after [our session yesterday] (ph) but, no, it didn't come up in my Google stalking. I think so my dad's sister is an eye doctor and my grandfather has (ph) retina. One of his eyes became detached. So I guess I am more familiar with the ways of the retina than the average person.
THERAPIST: I mean, I did not think that you knew about that (inaudible at 11:47) think about it that way. (inaudible at 11:49)
CLIENT: Yeah (inaudible at 11:51)
THERAPIST: I was more...
CLIENT: Well, that would have been sneaky.
THERAPIST: I don't think you've done that.
CLIENT: I haven't been manipulative here.
THERAPIST: No, I really don't find you that way and that's not at all what I meant. It was as much just because I was sort of like (inaudible at 12:13).
CLIENT: I feel badly about my Google stalking of you. I feel very bad.
THERAPIST: [How so] (ph)?
CLIENT: Because I'm really good at it and I feel like I violated something here and I wish I could take it back. (pause) And I also feel like I violated (ph) the privacy of you (inaudible at 13:08).
(silence)
THERAPIST: I don't have the impression that your sort of (inaudible at 13:36) reaction so much (inaudible at 13:37) wishing you hadn't done it.
CLIENT: Well, I guess I'm wondering if you're curious.
THERAPIST: About what you found?
CLIENT: Yes. Actually, I'm wondering if you're going to ask me.
THERAPIST: I guess I was thinking of asking whether (inaudible at 14:22) that you want to talk about.
CLIENT: I mean, I really don't so maybe (inaudible at 14:41). I guess I didn't really bring it up but it reminded me of it yesterday (inaudible at 14:51).
(silence)
CLIENT: So the last session before the (inaudible at 16:04). No, the last session. (inaudible at 16:20) I'm sorry I let myself go a little bit, in terms of my respect for (pause) the neutral basis of this relationship or the neutralness (ph) that you bring to it and thought that it would bring me some relief if I could, like, just, like, attribute some things to you that would make me understand you as just a person, which I think I have (pause) I'm able to attribute those person things to you just through our interaction in the last month. So it's not like I'm really looking for that in such a desperate way, though I am always looking for it. So I...
(silence)
CLIENT: Sorry.
THERAPIST: [To me] (ph)? You all right?
CLIENT: Yes. (pause) I don't know what to do.
(silence)
THERAPIST: Anything (ph) you're concerned about?
CLIENT: I'm concerned about (pause) I think it's a lot of things. I think it's very complex. (pause) So if you go to anywho.com (ph) you can find out where people live. And the town publishes their voter registrations and you're an active voter. And they also publish the address of where people live and your life as an active voter. And she lives in the same house as you, I think.
THERAPIST: I'm (ph) pretty sure.
CLIENT: So I got her name and I Googled stalked her. And I stopped. And I think you have at least one daughter. I feel very badly. I feel badly at the amount of curiosity and desperation it took to persist in that pursuit and I feel (pause) scared about what you'll think of me. And I feel badly for your wife (ph) that your patients can, like, find out who she is. But I guess technology, while it does make things easier, it doesn't change it hasn't changed human nature. It's just made it that, like, I could stop here and feel satisfied and not, like, have to follow you home or something. I don't think I would go that far but I was trying to think of, like, what the equivalent seventy or eighty years ago. [00:22:20]
THERAPIST: It's funny. Twenty or 30 years ago, like, a lot of therapists, you know, wouldn't publish their home phone number, you know, and now it seems so...
CLIENT: So not publish your home phone number? Like, what's the point of worrying about your home phone number when there's so much else out there? [So I'm sorry] (ph).
THERAPIST: It's OK.
CLIENT: It's pretty bad.
THERAPIST: How so?
CLIENT: It's dishonest. It feels dishonest that I've [come to this] (ph) (inaudible at 23:19) but it's a long discussion. And it also feels like I'm a (ph) rebellion.
(silence)
THERAPIST: What were you concerned I would think about you?
CLIENT: I think (pause) I would no longer be special to you? (inaudible at 24:35)
THERAPIST: Because I'd be mad? Because I'd be disappointed you? Because I'd see you as a different kind of person?
CLIENT: Yeah, all those things. Or, like, maybe there are other patients who have done this and maybe you don't like them or maybe they're not (pause) maybe they have negative qualities or your relationship with them has negative qualities that would, like, seep into ours. Because it's kind of like, "Oh, only, like, really crazy people would do that." [00:25:39]
But I think it's a matter of perspective. I think I mean, Jeremy's dad Googled me extensively when he found out that Jeremy was dating me. He was so psyched. And then he e-mailed me about it, about his findings, and asked me questions.
THERAPIST: Wait, before you met him?
CLIENT: Yeah. It was totally sweet. Like, he's a very sweet and just cool man. There's nothing about him that has ever made me uncomfortable. In fact, I really love him deeply but he is an informationaholic and, like, will not have a conversation with you without nothing that he needs to look something up or looking it up, like, in front you. So he used his resources to understand or get to know something he wanted to get to know better. And I think I was kind of flattered. So I don't think this is always a bad thing. [00:27:12]
(silence)
CLIENT: But it's nice to feel like I'm not hiding anything now.
THERAPIST: Good.
(silence)
CLIENT: I think of you as a father (ph) often.
(silence)
THERAPIST: Do you know what was going through your mind or what you were sort of hoping or wanting to find when you were looking up stuff?
CLIENT: Yeah, I think I wanted to, like, find out who you were married to and whether you were a father (ph).
(silence)
CLIENT: And also just, like, sort of stuff to fill in (pause) to fill in the shell.
(silence)
CLIENT: I guess earlier I, like, found the title of your PhD thesis and found that you went to (inaudible at 30:09)
(silence)
CLIENT: That sort of stuff is nice. But it doesn't stop. It's very (pause) addictive (pause) right now I think it will not be addictive forever. So I was pretty scared or upset over my sort of ferocity (ph) and (inaudible at 31:03) with respect to you.
(silence)
THERAPIST: Yeah, it seems to me that it has something to do with wanting to feel close and connected to me in ways that I gather you don't. And that is very difficult, not to be able to feel that you are.
CLIENT: Yes. It's also very difficult to fight back. (pause) Very difficult to not fight and it's very difficult to fight it.
THERAPIST: I think (inaudible at 32:17)
CLIENT: The feeling of not being close or not being close enough or as close as possible. I think I do feel close to you and I think I do feel close enough to you. I think there's so much more (pause) potential. So it's really hard to ignore that but it's also really hard to try to pursue it, like, on my own using Google. It's less hard to pursue it here because I can (pause), like, talk about it (inaudible at 33:05) and pursuing it and you can be like that question that (inaudible at 33:11) and that's totally fine. So I guess I've...
THERAPIST: I'm guessing it's not completely fine. I mean, I appreciate that you accept it but I am, like, that you understand it and all that stuff. But I don't think (inaudible at 33:32).
CLIENT: Yeah, it's not fine.
THERAPIST: And I think (inaudible at 33:47) I think that right there, whatever just happened with that was probably what happened in the fall that made it hard to see or be in touch with some of what happening.
CLIENT: [What, right there] (ph)?
THERAPIST: Your (pause) inclination to think it was I mean, that (inaudible at 34:22) like fine for me to answer the way I did. I know at one level it's fine and you understand why I would answer that way. Go ahead.
CLIENT: Well, the level at which it's fine is, like, (pause) I'm not going to break down. I'm not angry in way that I, like, really am aware of or want to act on. I'm not (pause) I don't have a clear feeling of sadness, though probably there is some sadness and I'm not really going to, like, stop or, like, it's not going to change so much of how I outwardly interact with you. I guess it's not fine in all the ways that are hard to describe that I don't really know about.
THERAPIST: We [only have a] (ph) few minutes.
CLIENT: I interrupted you. What were you going to say?
THERAPIST: I think you sort of spoke to it. It was something about sort of the different levels and kind of [laid them out] (ph). There's the (ph) ways in which it's fine and the sort of nebulous and sort of clear but somewhat nebulous ways in which it's not.
CLIENT: And the fact that maybe I didn't stop to consider the nebulous not fine parts in the fall led to...
THERAPIST: Or just now.
CLIENT: Or now, led to or lead to?
THERAPIST: Well, not knowing some important things that you think and feel. (pause) (inaudible at 36:23) very present (ph), very intense.
CLIENT: A lot of me just responds, like, well that's the way it is or that's the way it has to be for this to work. And if I really, like, got through to you and broke some boundaries and you fell in love with me, like, we wouldn't really be able to see each other anymore. (pause) But I trusted (pause) but I trusted you would know that and you would know if it was interfering with your work.
THERAPIST: And at another level, that might be what you want anyway. And it might be, you know, just that you want it but really upset that it hasn't already happened that way.
CLIENT: Yeah, I would be able to declare a lot of success (inaudible at 37:45). But...
THERAPIST: I think there's some stuff about that that's harder to, like, talk about and look at.
CLIENT: Yeah.
THERAPIST: I don't think you want that to be as strong or to matter as much as it does.
CLIENT: Right.
THERAPIST: I'm not entirely sure why you don't but (ph) that seems important.
CLIENT: OK. How much time do you have left for your psychoanalytic (ph) training?
THERAPIST: I've finished just about everything. I'll probably be done actually next fall [after this] (ph).
CLIENT: Like fall of 2014?
THERAPIST: Fall of 2013.
CLIENT: Do you have to take an (ph) exam?
THERAPIST: No, you have to [basically do an analysis] (ph) and you have to take a lot of classes (inaudible at 39:11)
CLIENT: OK.
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