TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: How are you?

THERAPIST: I'm okay. Thank you again for the lemon squares. They were very good.

CLIENT: You're welcome.

THERAPIST: And I have a piece of bad news from Blue Cross which is that...

CLIENT: Me too. (inaudible at 00:00:22).

THERAPIST: I'm sorry and surprised. I feel bad about it. I've not seen them do that before. The situation last year where I was out of network for a months it's a long story but I had to write similar things and they didn't nag them. And I had talked to other people who had left Blue Cross around that time to find out if it would be a problem to get people covered who I haven't seen and they said no as long you agree to the in-network rate. What's the downside for them. So anyway, but I feel like I was I was, I think, quite optimistic with you about getting good news from them so I feel bad that I was entirely wrong about what's going to happen. [00:01:28]

CLIENT: It's okay.

THERAPIST: And I don't know if it's a new policy for this year or what the story is.

CLIENT: Yeah. I could appeal it. I don't know if I'm going to. (Pause) It seems like a strange thing to convey to an insurance company. (Pause) You almost have to be (inaudible at 00:02:21) or something. (Pause) Yeah, I don't know what to say about it. [00:02:34]

THERAPIST: You look kind of torn.

CLIENT: (Pause) Do you have a patient (inaudible at 00:02:51)?

THERAPIST: (Pause) What?

CLIENT: I've had a lot of things around my mind lately. Yeah. [00:03:06]

THERAPIST: Well (pause) tell me and if we need to find more time to meet later today or (inaudible at 00:03:28).

CLIENT: Okay. (Pause) I don't know what to say. (Pause) I wish you could upload my brain. [00:04:08]

(Pause) I wish I could upload your brain. I think I feel like things aren't okay a lot (pause) and it's really scary. (Pause) I feel (pause) like it's not okay to be like being doesn't feel okay and I wonder what it's like to feel what it feels like to not be. (Pause) And what doesn't feel okay about me isn't the presence of something. It feels like it's the absence of things. [00:06:01]

(Pause) The last couple of days have been bad a lot like that. I think it's because of where I am in my menstrual cycle. I'm sort of close to the end and I think that this is a pattern every month, but I haven't really been keeping track of it. Like I'm more of an average concentrated couple of days. It's sort of... (pause) depressive feelings? [00:07:26]

THERAPIST: When did you get the letter?

CLIENT: I got the letter yesterday night. It felt like it came at a time where there's already so much (pause) up and down. So in the context of that it didn't feel like a really moving experience to get the letter but it did feel a little shitty. [00:08:17]

And the uncertainty is a lot worse than knowing so there was some sense of mobilizing like making a plan about what two days a week would be like. And it involved really committing to my sitting practice and having feelings time every day because it doesn't and that feels like a great plan. Not blinking. [00:09:05]

THERAPIST: No. I think you're terribly upset.

CLIENT: I think I would've felt upset before the letter came. I don't know what kind of effect the letter is.

THERAPIST: Okay. I think you're really upset on both accounts. (Pause)

CLIENT: I cried during my sitting time Monday. It was a long and arduous sitting (pause) full of existential doubts. The same question keeps coming up with you. If you let your thoughts and feelings go what would it mean and is it worth being presented? [00:10:35]

Gosh. Your expression is (pause) not light.

THERAPIST: No. No it's not. Go ahead.

CLIENT: I've been trying to pay attention to times when I might be experiencing joy in the face of this suffering. Not like happiness or even joy but even just like stillness like does it ever feel okay. [00:11:36]

THERAPIST: (Pause) Okay. So I have some thoughts about where you may be getting stuck. It seems to me that whatever was going on that was making you cry on Monday in addition to the news from the letter... [00:12:27]

CLIENT: And the news that we didn't get a $700.00 refund from United Airlines for canceling last year's August trip which we got this morning. And that we canceled our other trip because of the snow this past week but the same thing happened. We got the refund on both cases but we have to use the money with the airlines. We have $700.00 to use with United, $350.00 to use with Jet Blue, and... [00:13:05]

THERAPIST: Right. But none of it can pay your rent.

CLIENT: And two sessions a week with you and it's all entangled with logistics, and planning, and money which just feels so overwhelming and not even at getting at anything that's deeply overwhelming. So just to complete here your sense of annoying things like that.

THERAPIST: Yeah. It sucks because (pause) I'm not sure this is right. To me it seems like you (pause) move in pretty quickly to reframe it so it's okay, or so you can make the best of it, or so you can contain it that you actually preempt how shitty it feels and how overwhelmed you are because those things can be kind of intolerable. [00:15:04]

CLIENT: Uh huh. I don't think I can tell how it feels because it still feels shitty.

THERAPIST: Uh huh.

CLIENT: Maybe I don't fully feel how shitty it is, but I feel it partially enough.

THERAPIST: Yeah. And be kind of stuck with it, I think, partly because you've not (inaudible at 00:15:47) feels if that makes sense. Like... (Pause) It's kind of hard to allow yourself the moment where you just feel overwhelmed and it feels awful, and you don't know what you're going to do or how you're going deal with it. [00:16:23]

CLIENT: And I think it's going to be a lot more in the moment.

THERAPIST: I think so too.

CLIENT: I don't know why I would do that. (Pause) Why would I allow it?

THERAPIST: Why would you allow yourself to feel that way?

CLIENT: (Pause) Other than...

THERAPIST: Because that's how you feel.

CLIENT: Because it would help it go away. That seems like the only good reason. Or if I have plenty of time I think I'd feel kind of squeezed a little bit. [00:17:21]

THERAPIST: My hunch is when you were saying the other day the fact that I (inaudible at 00:17:31) that did create the space for it.

CLIENT: I think sitting always does. (Pause) But I have to go to lab, and I have to mentor, and I have to do jazz, and I go to a Thursday night jam session, and I'm getting fat and I need to go to boxing. And boxing is really good for a lot of aspects of my health. And I want to cook dinner, and knit, and read, and go to sleep by 10:30. (Pause) I don't know how I could do those things while feeling so bad. [00:18:55]

THERAPIST: Uh huh. Those are wonderful things. (Pause) I don't know if it also really matters that you are really upset and having a really hard time. [00:19:28]

CLIENT: I don't think I'm ignoring it. I think I'm (pause) aware of how much resistance there is to it. And I'm aware that it's there; that I feel that way sometimes. Maybe all the time.

THERAPIST: You think you may feel like this all the time?

CLIENT: Well I don't know what is distraction from it and what is like a true feeling something else. (Pause) I don't think I deal with this all the time, but I don't know how much I feel it. [00:20:29]

THERAPIST: That makes sense. I don't think you do either. I think you may feel like you're not supposed to feel this bad like you're supposed to be somehow able to do things in such a way that this doesn't happen. It's not supposed to be like this.

CLIENT: (Pause) Yeah. But suffering exists. I think I know that in part of my brain but it doesn't really penetrate. (Pause) I do think I'm a little caught up with (pause) suffering exits and there is an end to suffering and maybe I can catch a little piece of that today for five minutes. Sometimes there's a lot of forced awareness, or forced (inaudible at 00:22:02), or meditation, or forced (pause) anything. [00:22:12]

THERAPIST: I think it feels like there's really something the matter with just feeling bad.

CLIENT: I don't know that I...

THERAPIST: I don't think that forcing it helps all that much but all the more evidence there's some reason you're forcing it then.

CLIENT: Uh huh. (Pause) I guess I'm afraid of what will happen. (Pause) Like I might cause the world to end or something, (pause) or I might really hurt people or scare them, (pause), or more practically I won't be able to do the things that I do. [00:23:36]

(Pause) It also feels like it would be a lot of hard work to let myself feel so badly or it's not familiar to me. It wouldn't... My instincts are not that. So it would be like teaching myself a new way of experiencing feelings which is a hard thing to do. [00:25:08]

THERAPIST: I would put it slightly differently. I don't know. To me I couldn't say it before but it would be like... (inaudible at 00:25:23) allowing yourself to feel so bad as in being in touch with how bad you actually feel. I mean we're talking about making up new feelings. I'm talking about what's actually going on in make sense of which you're kind of in touch with that or (inaudible at 00:25:39) from it.

CLIENT: I don't know what it would feel like to be more in touch with it. (Pause) Monday night I (pause) felt a little bit in touch with it. I don't know what I felt, but I (pause) described to Jeremy how I was feeling and didn't really want anything but just to say the words. And we were lying in bed, and he (pause) held me, and I felt really bad and okay. [00:26:54]

(Pause) I had a pretty bad insomnia spell last night. It happens sometimes with this (inaudible at 00:27:46) which I'm not really taking that much. I'm taking it enough for it not to wear off. Anyway I took it yesterday after four or five days, and I had what feels like REM sleep while being awake which I've described here a lot before. Like you feel really sleepy but your brain is very active and almost feels like you're playing out things that are too much to bear in your real waking life. [00:28:31]

But it's not I'm not really with it enough, or I don't have enough energy to really pay attention to what it is. It's just like scenes, and images, and feelings, and thoughts (pause) Like insomnia it's just like an alternating battle of just lying there, and experiencing it, and trying lots of different things, and lying there, and experiencing it, and trying lots of different things. And it took two hours last night. [00:29:30]

And when it passed it was so wonderful (pause) like what the transformation was. It felt like You know myelin sheaths? The myelin sheaths have a structural roles for our neurons, but it felt like there were a whole bunch of emotional myelin sheaths that were missing during the REM sleep while awake period. I was getting banged into things left and right and there was no buffer, or awareness, or distance (pause) or distance, I guess. [00:30:43]

And then when it passed, when I was finally able to just sort of lie there and feel okay, it was like these emotional myelin sheaths had come back and there was like this kind of positive glow to everything (pause) that didn't feel wonderful because I haven't experienced it before. It felt wonderful because I think that's how I experience the world almost always (pause) except when I don't. [00:31:27]

(Pause) I don't know why I don't reach out to Jeremy during those times. He's said many times before that I can wake him up but it wouldn't feel right. (Pause) Like I have to do it on my own or something. [00:32:19]

(Pause) I don't think I really cry when I'm feeling deeply sad. I think I cry a lot when I'm frustrated. And I was thinking about why it seems like I'm not like I can't feel something sad here or I feel less that. And I was wondering if you think that I don't cry as much here. I don't think you think that but (pause) maybe it just suggests some things are really easy to get in touch with and some things aren't. And when I'm feeling frustrated it's like the easiest thing in the world to cry. [00:33:49]

But when I'm feeling sad or empty I can't really I don't cry in the same way. [00:34:20]

THERAPIST: (Pause) I imagine you're feeling quite distant from me.

CLIENT: I felt really bad to read the words depression and anxiety in the letter. It made me feel distant from you. [00:35:31]

(Pause) Yeah. I think that I have a lot to share with you now but I really have to share it. There's some things... I don't know. It's like (pause) describing my feelings when it's bad. (Pause) When I feel bad. (Pause) Describing how I feel when I feel bad. (Pause) Can I e-mail you? You don't have to reply. [00:37:08]

THERAPIST: Okay.

CLIENT: Maybe I'll e-mail me once between sessions. (Pause) Is that bad?

THERAPIST: Why would it be bad?

CLIENT: Well if all your patients e-mailed you once between sessions you wouldn't have time to see them in person. Also is it bad because I'm not because I'm aware of being together in the same physical space is important. [00:38:11]

THERAPIST: I think for you now it could help to kind of bring in some things that tend to get let off a little bit when you are here from when you're not.

CLIENT: I think so too. Also...

THERAPIST: I think it would be more facilitative if you're talking about them than avoiding them.

CLIENT: Yeah. I think it would help to... I think fear is such a big component of feeling bad for me. And I think fear drives me to do a lot of things that aren't necessarily going to lead to being in touch with the feelings. I think being in touch with you a little bit more but... I wouldn't make the fear go away at all but it would I don't know. We'll see what happens. [00:39:44]

THERAPIST: We still have a few minutes. (Pause) Would you prefer that to trying to find some more time between now and tomorrow or would you prefer to find some time?

CLIENT: (inaudible at 00:40:07).

THERAPIST: Okay.

CLIENT: Or not. I have to make the day. It's great if I don't then it's assigned too. [00:40:20]

(Pause) I'm happy to be here like however much I love it when I'm not feeling in crisis. Maybe I need to be feeling in crisis to connect with the feelings.

THERAPIST: Uh huh. I think that in the emotional level you are in crisis I don't think you're in the sort of crisis that requires hospitalization for your safety or difficulty functioning. [00:41:15]

CLIENT: Right.

THERAPIST: But...

CLIENT: Yeah you're right.

THERAPIST: (inaudible at 00:41:23) I think you sometimes use the evidence from the former to explain to yourself why you're not.

CLIENT: Uh huh. (Pause) Yeah. I guess that the spectrum can be as (pause) fine the gradations can be as fine as they are. It doesn't have to be (pause) if you're sick you stay home from school. If you're not sick you go to school. Like you can be sick at school. [00:42:19]

THERAPIST: Yeah. (inaudible at 00:42:24). I think what we're trying to look at now relates to the things that weren't as clear to hear about at various points in the fog. (Pause)

CLIENT: So I guess I'll see you tomorrow. But next week we should talk about it. Bye.

THERAPIST: Bye. [00:43:27]

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