TRANSCRIPT OF AUDIO FILE:

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THERAPIST: Too sunny over there?

CLIENT: What?

THERAPIST: Is it too sunny over there?

CLIENT: It’s been a really difficult week for me. I got my period on Monday, which was great. So great, all seems to be back to normal there. And I have been taking the 20 milligrams for the five days prior. And then I went back to ten after the five days but then I took two this morning because the last few days on the ten, back on the ten, I really went downhill in terms of how I was feeling, so I just decided to self-prescribe. [1:07] I’m seeing him on Tuesday and should just talk to him about the whole thing or whatever. But it’s just felt like a really difficult week in terms of feeling like worthless and hating my life and hating everything about my job and my roommate. And I told you she lost her job, right, again? So apparently she had an interview yesterday, and I asked how it was and then she said… she said something about oh, I feel like I’m sleeping a lot, or tired. But she had changed some medication because she has some medication that she takes only sometimes when it happens because she has something… she gets something called… what is it called… dipthemia [ph?] or something.

THERAPIST: Dysthymia? [2:13]

CLIENT: Yes. So she takes this special medication for that during the times that she’s having a bout of it because generally she’s just bipolar or something.

THERAPIST: That doesn’t make any sense to me but whatever.

CLIENT: Why does it not make sense to you?

THERAPIST: Because dysthymia is a kind of long term, low grade kind of ongoing depression, so it’s… the symptoms are usually a little less than some major depression disorder which is what people think of with depression.

CLIENT: Oh, well then maybe it’s not that.

THERAPIST: [inaudible] longer period. Yeah.

CLIENT: Maybe something else.

THERAPIST: There’s something called diphtheria, but that’s a medical…

CLIENT: No. (laughter). Yeah, whatever, who cares. She’s fucking mental.

THERAPIST: Okay.

CLIENT: Is like whatever. And then she tells me yesterday, oh, the interview went well despite my having 101 temperature. [3:15] Apparently I’m really sick; I just went to the doctor. I was like what the fuck. Oh great. And then she says she has a salvatory [ph?] gland infection, something in her neck. I’m like ewww. No, not oh my gosh, Josh.

THERAPIST: Okay, tell me how it is. So…

CLIENT: If it’s not one thing it’s another with her. And now… and then I went home and Lysoled my whole house. I don’t even know if it’s catching. So now I’m like oh my God, I’m going to get sick now, too, on top of everything. And on top of I hate her. Or I don’t know, yes, oh gosh, oh gosh, if she lived alone and wasn’t my roommate, or I liked her.

THERAPIST: I take your point, okay. That’s all I meant. Okay.

CLIENT: I mean it’s fine for you to say that, obviously, and feel like (overlapping talk) that sucks because…

THERAPIST: …because I’m not entirely on your team if I’m feeling bad for her.

CLIENT: Exactly. [4:17]

THERAPIST: …busy infecting you and you don’t like her anyway.

CLIENT: Right. She was at her parents last night. But I just have felt like shit all week, just total shit. So and I’m not really sure, in fact it’s all proponent of that; it’s just the medication, and I need to get the medication right, whatever. Then yesterday I was on Facebook, and of all people, Sergio’s brother posted. Okay, and I know that he’s not… he’s had some issues or something because I remember at one of the birthday parties he wasn’t drinking, he said, at the moment. And then he just always seemed a little like quiet and maybe not here or whatever. And then he posted this status that I’m going to read to you because of course I’ve been feeling so depressed all fucking week. And it kind of made me mad although I didn’t know the story or whatever. And he wrote anybody who’s suffering from depression, pray first, which of course was like get your ass up, get sunlight, say fuck the depression, start living happy, live in the moment, forget the past and plan for the future. Blessings, be healthy. And I was like okay, there’s like the… I’m conflicted by how I feel about this message because part of it I’m like yeah, but then the other side I’m like it’s not that fucking easy. [5:59] You get some fucking sunlight and… but then apparently… so I messaged him and was like it’s not that easy buddy, right. And then I wrote your status. And he was like trust me, I know. I went through it . And then so we got to talking and he was like oh, I want to talk to you because he was on,… basically that he wanted to tell me what he did because he was like no, I went through it. Or I said something about pills and he was like yes, I know. I was on pills. So then he told me that he did some program called… hold on. Mind Body Institute.

THERAPIST: Mind Body Institute?

CLIENT: Have you heard about that? It’s at the hospital…

THERAPIST: Probably. I don’t mean that…

CLIENT: Yeah, that’s fine.

THERAPIST: But the last… it’s by this guy who’s like relaxation. Could be that.

CLIENT: Okay. [7:08] No, Mind Body Institute.

THERAPIST: Yeah, no, I’m… there might be somebody else.

CLIENT: Oh, you’re saying you know the name Mind Body Institute.

THERAPIST: Exactly.

CLIENT: Okay, got it.

THERAPIST: I’m not saying that the name is wrong; you have the name wrong.

CLIENT: Okay, well I hadn’t looked it up until this moment, so that’s what I just did. But anyway, apparently he did that because he didn’t want to be doing meds and that, yes, he did get into religion, but that’s not the point. The point is that he learned all these other coping mechanisms that he’s… and he forwarded me all the titles of these books that he read, like Undoing Depression, Undoing Depression by Robert O’Connor. I mean who knows, whatever. And The Mindful Way Through Depression. This is all body mind stuff probably. And he’s like and I started working out and blah, blah, blah, and I feel so much better and I’m not taking medication. And it was nice of him to share that information with me, but I don’t even feel like I am in a place where I could, I don’t know, I can’t even think about it. [8:31] I don’t even feel like anything’s going to work or, I don’t know. I don’t even felt the desire to start anything like that or something.

THERAPIST: You’re not… you’re too unmotivated and hopeless, I think, is what you’re saying.

CLIENT: Yes. Yeah. (pause) And that’s why I think Stephanie’s saying no, get the right medication, so you can feel like doing stuff or something. Which I get it (pause) and I try to but it’s just [inaudible] I’m… because it’s like… that it’s even… I’m in this situation even.

THERAPIST: Sorry, it’s what, that you’re in this [inaudible]

CLIENT: It’s… that that’s like…

THERAPIST: Depressing and demoralizing that…

CLIENT: Yeah

THERAPIST: ...the only thing you’re actually sort of feeling up to doing is upping your meds.

CLIENT: You’re right. [10:18] (pause)

THERAPIST: I guess my impression is that you are feeling like in a way what you feel like doing is being upset and frustrated about how awful things are, going to bed, and hating the fact that those are the only two things you really feel like doing.

CLIENT: Yeah. Yeah, basically. (pause)

THERAPIST: And not every day, but many or most days bring sort of some new smack in the face.

CLIENT: That’s what it feels like at least.

THERAPIST: That’s what I mean. [12:05] (pause) And then that way it feels like I guess there’s some things you’d rather do than others, like at times talk to that guy with your mother or just not be at work. But more like those are a respite than they’re actually going to help.

CLIENT: It doesn’t really feel like anything helps. (pause) And even the living situation. [13:57] Even if I decided to try to just [inaudible] myself or something. That’s still not until September, which feels like forever. And the living situation is really awful. (pause)

THERAPIST: Yeah, my impression is that she’s both sort of depressing to have as a roommate when she’s sort of a sloppy, messy couch potato.

CLIENT: Oh, and she said she wasn’t going to drink. Remember I told you that? But she drank.

THERAPIST: And also frustrating because she doesn’t pull her weight

CLIENT: Yeah, because she sucks as a roommate too. [15:04] I’m depressed but at least I can keep my house nice. (pause)

THERAPIST: As far as therapy, I guess my sense is that you don’t see this making things worse, and that there are times when maybe talking to Stephanie or spending time with your mom, it can be good to put stuff out there but it certainly doesn’t feel like it’s making anything any better, nor is it feeling like if we do have some insight into something, it really gives you much traction on how you’re feeling these days.

CLIENT: It doesn’t because, well, I just still feel like shit so (pause) I don’t know, I don’t… I know what to do; I just don’t want to do any of it. [16:39] I don’t want to do anything or something. I don’t know. I know I should work out and all that stuff, and I just don’t want to. I don’t know what to say. Because it’s just a distraction, and I feel like what’s the point. (pause) And this weather is killing me already. [17:56] (pause) Or I want to move or, I don’t know. Stephanie said [inaudible] said I’ll just be unhappy somewhere else alone. (pause) And I have to see my father and my whole family twice this weekend because today we’re all going out to dinner for Ethan’s Geography Bee. He does this stupid Geography Bee every year and then we go out to dinner after. And then on… tomorrow is my brother’s birthday; it’s Michael’s birthday. Maybe I should skip dinner with them tonight. [19:10] I’ll be unpleasant. I don’t (pause) but then everybody will probably be mad at me. I don’t know what I’m going to do, nothing, instead, probably. (pause) But that’s the thing, I don’t even care. I’m not even expecting anything. I’m expecting it to help in therapy or talking or whatever in the sense that I can get stuff off my chest, but I’m not really expecting you to help me feel better or something. [20:46]

THERAPIST: And I think there is a change there in that it’s tricky. I’m not trying to defend the therapy, I don’t think, but just to point out that I don’t think generally you see therapy as something that makes you feel a whole lot better. But I do think there have been… frequently been times when you’ve said that… lots of insight into things in a way that helps you feel a little more in control, or you get a little more traction or a little clearer about what to do or what’s going on. And I don’t have a sense that you expect that either now. I mean my point is that it seems like your perspective has changed on that as well. And it seems related to the sort of resignation and kind of giving up that you seem to feel in general.

CLIENT: Right. I think that’s right. [22:11] (pause)

THERAPIST: I (pause) it’s my impression that what happened with Sergio on Sunday… I could be wrong, but my hunch is that that’s part of what’s made you feel worse this week. [23:46]

CLIENT: Yeah, I think that’s part of it. I mean I think being hormonal has something to do with it too. (pause)

THERAPIST: And maybe that what happened with him is kind of more than you can bear now.

CLIENT: I mean…

THERAPIST: And more upsetting than you can deal with at the moment.

CLIENT: Yeah. [24:47] (pause) I just have this feeling of (pause) being valueless, or that, yeah, not being valuable in any way, or there’s still worthlessness, whatever. I don’t feel like I do anything worth mentioning or worthwhile or philanthropic or charitable or caring or anything. I don’t know. It’s like (pause) I’m just on a hamster wheel in my own world, doing nothing. [26:36]

THERAPIST: I hadn’t really thought about it this way before but I guess what you’re saying in part is that you feel like the people around you have reason to be just as disappointed in you as you are, and all of us. That seems to be part of what you’re describing.

CLIENT: It just… these feelings are so overwhelming that I don’t even know how to think about where to start. (pause)

THERAPIST: The feeling of being sort of valueless or worthless and not doing anything constructive really. [28:04]

CLIENT: Huh?

THERAPIST: Do you mean the feeling of being valueless and worthless and of not doing any constructive [inaudible]

CLIENT: Yeah, and just where do you… yeah, just too much to improve, too much to have to do better and have to work on and have to fix and have to do in order to not feel that way.

THERAPIST: Yeah, especially when you feel that way. It sounds like sort of the gap widens. The worse you feel the more you have to make up for or you have to do to fix it.

CLIENT: Right. And also the more things I think of to add to the list. [29:17] (pause) And I don’t even want to think about exercising until it’s actually warm enough to walk outside. [30:46] I don’t know; everything’s an excuse, also, right now. Also, I’ve been sleeping… I’ve been having night sweats this week. I had to… almost every night I had to change my pajamas in the middle of the night because I was soaking wet. So that’s been really uncomfortable. So I haven’t been sleeping that well, either, I don’t think. And maybe it’s because the 20 milligram down to 10 milligram. I don’t know.

THERAPIST: Yeah, I thought about that too. I don’t know either.

CLIENT: I just don’t feel like doing anything, particularly with anybody that I can’t… that I have to put on a happy face for, particularly because I do that at work. [32:14] (pause)

THERAPIST: Are you also pretty frightened? I could imagine you feel like you’re kind of in a freefall, everything sort of… it feels like they’re getting worse.

CLIENT: Yeah.

THERAPIST: And at first the medicine seemed to be helping enough, and now it doesn’t seem to be helping it now. Things don’t seem to be getting better in your external life and…

CLIENT: Yeah, it just feels like everything’s just getting worse all the time, or staying the same, which is still worse. Or something, somehow. [33:24] (pause)

THERAPIST: Your feelings are further and further behind in terms of what you imagine you need to do to make things better.

CLIENT: Yeah, and also I can’t even... I’m getting further and further away from even being able to imagine that things will feel better.

THERAPIST: I see.

CLIENT: How will anything ever feel better if my job is going to stay the same, if I still have to live with this girl, if I still have all this debt and I can’t afford anything anyway? (pause)

THERAPIST: We should stop for now.

CLIENT: Okay. Can I pay my bill that you sent me?

THERAPIST: Sure.

CLIENT: Or if you want, we can do it on Monday.

THERAPIST: Want to do it quickly? Do you know how much it was?

CLIENT: $199. Yeah, $199.71. Okay.

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