TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi, come on in.

CLIENT: How are you?

THERAPIST: Good, I’m just going to grab some water.

CLIENT: Sure.

(pause)

CLIENT: A lot of rearranging, huh?

THERAPIST: Yeah, I don’t know if you’ve been here since…

CLIENT: No.

THERAPIST: …I got some new furniture.

CLIENT: Yeah, it looks nice.

THERAPIST: Great, thank you.

CLIENT: I have a check for you that is late, so I’ll give it to you now.

THERAPIST: Oh, yeah, no worries.

CLIENT: Sorry about that.

THERAPIST: (crosstalk at 00:00:40)

CLIENT: Completely my fault.

THERAPIST: No worries, (crosstalk at 00:00:42).

CLIENT: I put both November on December on that one.

THERAPIST: All right, great. Thank you very much.

CLIENT: Yeah, sorry. Totally slipped my mind.

THERAPIST: Welcome back. [00:01:00]

CLIENT: Thank you. I don’t know when the last time we sat here, it was…

THERAPIST: Before you went away.

CLIENT: Yeah.

THERAPIST: Probably a week or so before Christmas.

CLIENT: Yeah. I don’t know. I don’t know what to…

THERAPIST: Where to start?

CLIENT: What to tell you about, yeah. Everything’s good. Yeah. I don’t have anything heavily weighing on my mind at the moment.

(pause)

CLIENT: Yeah, I don’t know. [00:02:00]

(pause)

CLIENT: I don’t know.

(pause)

THERAPIST: Do you think the long break has something to do with it, not knowing where to start?

CLIENT: Yeah, maybe. I feel like in the last couple months, when something would happen, it would make me anxious or something like that. I file that away, talked to Dr. Feldman about that. [00:03:00] I don’t feel like I had many of those moments. I’m not not anxious, but there haven’t been any large events. I don’t feel like I’ve had any freak-outs. Yeah, I don’t know.

THERAPIST: Were you with your family over the holidays (crosstalk at 00:03:22)?

CLIENT: When we had the snowstorm, we were briefly with my family, just for a day or two, when we got back from Oregon. We were with Amelia’s family in Oregon for our vacation.

It was nice, it was the perfect vacation. We had perfect Oregon weather and we did lots of hiking and we were outdoors a lot. Amelia and I spent a lot of time together, it was really nice.

It was a little stressful. Our families are very, very different. They’re like East/West Coast versions of each other. [00:04:02] My family is the very typical—they’re both very stereotypical in their own ways. My family is very stereotypical Jewish Chicagoans. They know everything that’s going on all the time, they call me all the time, I call them all the time. When we went home for Thanksgiving to my parents’ house, my mom made an entirely second menu so that I could be able to eat stuff. They just dote on Amelia and I. We never leave there without bags and bags and food, whether or not I have an ulcer. Everything is always taken care of.

Amelia’s family is the very stereotypical Oregon beach family: super laid-back, a little bit aloof, almost. As much as my parents are in your business to a fault, Amelia’s parents are completely out of it, almost to a fault.

Amelia and I talked—I was a little bit stressed before we went out there. [00:05:02] My family, in general, they eat very healthy. My mom’s obsessed with her weight and sees a nutritionist. For me, finding something to eat at my parents’ house is really not a problem, because they basically eat only what Amelia and I eat, anyway.

It was always like a vacation when we go to Amelia’s family’s house, because there’s alcohol all the time. They eat well, but not like well in a healthy way. It’s a lot of red meat, a lot of booze, processed foods, fast food. I didn’t really notice it as much before, because we would just eat whatever they ate, because we didn’t have any reason not to before I got sick.

I knew, going into this, I was a little bit worried about it. I knew it’s always a lot of drinking and a lot of eating things that I can’t eat. I talked to Amelia about it before we went out. I was like, “Look, this is what I’m concerned about. [00:06:00] It’s kind of making me real stressed, and I don’t like traveling anyway. I’m worried because it’s not—”

I don’t have any qualms about getting my mom a shopping list, and for me, it all has to be—it’s expensive. Gluten-free, organic, all this stuff is not like the cheap stuff at the grocery store, the stuff that I’ve been eating. Our families are in really different financial situations, as well. I didn’t feel comfortable giving Amelia’s mom a grocery list of the most expensive items in the supermarket. Even though she asked for it, she was like, “Well, what can Kelsey eat? Can you give me…?” Amelia was like, “Look, if we give her a list, she can have some things in the house.” We were getting in late at night, so I was—I told Amelia, “Look, I’m trying to be polite, here. I don’t really feel comfortable giving your mom all the expensive things in the supermarket to buy.”

We agreed that we would just tell her just the basics for when I wake up in the morning: bananas, rice cakes, and peanut butter. [00:07:02] At least I have something to eat before—and then Amelia and I will go to the store ourselves. That seemed like a good plan to me.

What ended up happening was that her brother as home, as well. He’s just like my brother, a typical 23-year-old dude; he’ll eat whatever’s in the house, not really paying attention to who got it or what it is. It ended up being that we went to the grocery store every single day. We must have spent a couple extra hundred dollars on groceries, because we were unintentionally feeding her family, too. I don’t mind, if they want to eat the stuff that we got that is the only thing I could eat in the house, that’s fine, but maybe give us 20 bucks to go to the store.

We were grocery shopping almost every day. Doing a lot of cooking. I didn’t feel like people were—we cooked dinner a couple nights, and they’re like, “Oh, this is great! Thanks!” No one really did say, “Thank you.” [00:08:01] No one offered to give us some money for the groceries that we were buying that everybody else was eating. There was a couple nights that there ended up being no food for me to eat, because either her dad or her brother had eaten it all during the day. Amelia was getting upset about it, also. I think she was embarrassed. We ended up finally talking about it. I wasn’t going to say anything, but I was really not super-happy and ready to come back home.

We went down to San Diego for Christmas, where her grandparents live. That was another whole big, stressful event, because what am I going to eat Christmas dinner? We find out that, okay, I can actually eat baked ham as long as I take the skin off, and that’s fine. I’d never eaten ham before; I grew up in a kosher household. It’s kind of funny that that’s the only thing that I was able to eat at Christmas dinner.

We decided we would make a couple dishes, as well, to add to it that I could eat. [00:09:02] We spent another $75 getting ingredients for this massive—because I knew, because we had an incident at Amelia’s house where we had to bring—we had ordered sushi and we had to bring one of the rolls back to the restaurant, because they put some sauce on it that I couldn’t have. While we were gone, her mom ate the only other thing that I could eat.

It’s funny, kind of, how completely aloof they were to what was going on. They didn’t do it in a malicious way.

THERAPIST: They had to have known that you were bringing these particular foods for particular reasons.

CLIENT: I have no idea! I must have had—I think it actually concerned Amelia, a little bit, at how out of it her parents seemed to be and how not understanding of my diet they were. I even had a ten-minute conversation with her mom on the porch one morning about what I could and couldn’t eat and why.

I know it’s a lot—there are a lot of restrictions right now, so it’s hard to take in. [0:10:01] I think it’s just—this is just their way of life, that they just don’t really think about these things. The things they were eating, they probably thought their mom had bought from the store, because she usually goes to the store every day or something. I just don’t think they thought to ask.

THERAPIST: She didn’t—

CLIENT: Right.

THERAPIST: Her mom didn’t—

CLIENT: Exactly. No, I know, I was really—I was aggravated. Amelia was aggravated, as well.

Then we get to Christmas and we make this massive, two-pound squash casserole. I’m thinking, “Look, if we only make enough for me to eat, I’m not going to end up getting any because someone else is going to eat it all. Let’s just go for it and we’ll double all the recipes.” We made this massive thing of squash casserole, I guess whatever you want to call it. Then huge trays of roasted vegetables, like asparagus and Brussels sprouts. People devoured it. There almost wouldn’t have been enough food had we not cooked what we cooked. Nobody even said, “Thank you!”

The next day, her mom and her grandma were going back and forth, “Oh, thank you for cooking.” [00:11:00] “No, thank you for cooking!” Amelia was like, “Hey, is anyone going to say, ‘Thanks,’ to Kelsey, because she made half the meal yesterday?”

That was aggravating. Amelia was very…I felt guilty, because she was supportive. She’s been so great throughout this whole thing and just in solidarity the whole week with me. Ate what I was eating and didn’t—her parents brought in—they wanted to take us out to dinner. Of course, they were like, “Let’s go to this steakhouse.” There’s (inaudible at 00:11:34) places, they were like, “Let’s take you girls out to dinner.”

It was laughable how wrong the menus were for me. There was nothing we could do. They ended up ordering in barbecue or something. I’m sure Amelia would have loved to have some ribs, because she loves red meat, but she had beans with me. I told her she didn’t have to do that, but she was really insistent of sticking with me. [00:12:00]

THERAPIST: Is red meat supposed to exacerbate an ulcer?

CLIENT: Yeah. I’m not supposed to have red meat. If I could have red meat, it would not—I couldn’t get it from a fast food restaurant with all the sauces and stuff on it. According to my nutritionist, no red meat.

I felt bad, because she was—I didn’t want her to think poorly of her family. I don’t know, I just felt like a big burden the whole time. She kept assuring me that I wasn’t, and it is what it is, and I’m sick right now, and it’s not a problem, but I felt bad.

We had this conversation when we got down to San Diego. I finally was like, “Look. I’m feeling completely drained because I don’t feel like I’ve been—I feel like I’m just,” aside from her, being with me, “completely on my own, here. The two of us are shelling out money for groceries, people are not really acknowledging it. I was trying to be polite by not giving your mom a grocery list but that apparently was the worst thing that I could have done, because no one else is giving us the same politeness,” or however you describe it, “that I was awarding to them, no one’s affording us the same manners.” [00:13:22]

It was really aggravating. However, on the same token, I think it was—it was the first time that the two of us had the conversation about something that had happened with one or the other’s families that was bothersome to us. I think it made us—it made me feel like at least that we really had created our own separate life here. Both of us talked about how, in the last couple months, the ulcer’s been like—it’s been really shitty, but at the same time, we’ve picked up some really healthy habits from this new diet that I’ve been following that I think will stick with us, because they make us feel good. [00:14:02]

We’re not drinking as—well, I’m not drinking at all, but she’s not drinking as much as we used to. We eat really, really well and we like it. She realized, while we were out there, that her parents really—her family’s not healthy at all. I think that it was—both of us were ready to come back home, here, to this, our home and to our lifestyle and stuff. It was kind of nice.

THERAPIST: Is the idea that you continue on this strict diet?

CLIENT: No. I have an appointment in two weeks, now. The idea is that – hopefully – in two weeks, when I go in, because I haven’t really had symptoms for a while, that they’ll tell me I can start going off the medicine. You can’t just go off it, I have to taper it.

Once I am completely off the medicine, see how it goes, still on the diet. [00:15:02] Then I can start—if everything’s good, then I can start adding foods again. That’s the idea.

THERAPIST: It seems so particular—you can eat ham, but not the skin of the ham.

CLIENT: Yeah. I don’t know.

THERAPIST: You’re not going to eat the entire skin of an entire ham.

CLIENT: Right.

THERAPIST: That little piece of skin seems—

CLIENT: Who knows? I’m sure I ate a little bit of skin while I was eating. In that regard, eating things has been going kind of well for me, lately. I’ve been adding some things and eating more things that I definitely wouldn’t have even touched.

Oregon is actually the best place to have dietary restrictions, because everywhere, you can get gluten-free everything. It was great. We really got to—it was actually the night before we left or a couple of days before we left, we had this fundraiser and my boss wanted to out for drinks afterwards. We ended up going to—I tried to back out at the last minute and invite her to our apartment, so we could cook dinner so I could have something to eat, but Amelia was like, “No, we’re going to the pub across the street, because they have turkey burgers and you’re just going to get it plain. [00:16:11] You’re going to eat it because it’s just grilled and it’s going to be fine.”

She made me, which was good, because then I ended up eating—I did. I got what I would have normally gotten, which is the turkey burger, and I just got it without the bun and without the, whatever, the cranberry ketchup. They just gave me some roasted potatoes—they had butter on them and stuff, but on the side instead of French fries. I ate the whole thing and I felt great afterwards.

Then it was great, because when we got to Oregon, it was like I had my restaurant confidence back. We went out to eat a bunch of times and I ordered things that I don’t think I would have ordered a month prior to that. I even had pizza. [On that] (ph), I can’t have tomato sauce, but I had gluten-free pizza without sauce, which was pretty greasy. [00:17:03] It’s gluten-free crust but it wasn’t minus oil or anything and devoured it. I felt good. I’ve been adding things that—gained two pounds.

THERAPIST: That’s great.

CLIENT: Yeah. Now I feel like I’m finally in—I’ve been weighing myself at the gym, I’m in this range, give or take five pounds. I feel like it’s stable. I’m exercising and feeling good about it. I feel like I’m eating well.

THERAPIST: This ulcer exacerbated your preoccupation with food.

CLIENT: Yeah.

THERAPIST: Which I don’t think was good for you, in the end.

CLIENT: No. No, I mean, it’s like—

THERAPIST: A phobic response, almost.

CLIENT: Yeah, yeah. Well, the same thing happened to me when I was younger. Whatever I was having, it was different than this. Maybe it was gastritis, I don’t know if it was pre-ulcer or ulcerous or something, but I was vomiting every morning. [00:18:00]

It was also when I would eat things that—this was when I was kind of transitioning from my binge eating to almost extreme healthy eating, when I was in college. I would vomit the mornings after – not make myself vomit, but feel like I had the stomach flu or something – only after I would have really big binges the night before.

When they put me on a very restricted diet, back then, and because of the vomiting all the time and the feeling sick, it did create this phobia of certain foods, just because, I don’t know, I likened it to—I kind of remember this one time, I got too drunk in college and I vomited right after I ate a whole stick of Rolo’s or something. To this day, I can’t even look at Rolo’s, because you just associate getting sick with certain foods. When you’re sick all the time, you associate it with all of these foods. It’s hard to bring them back in, because you’d rather just not eat than feel sick. [00:19:01]

I’ve been adding things. I ate new things yesterday—I’ve been eating new things almost every day. We’ve added cookies, added carrots. I feel like proud of myself. I now feel like I have enough of a variety that I don’t even feel like it’s limited. I miss having alcohol. I’d really like to be able to have a glass of wine or some whiskey or something. I even had a couple sips of Amelia’s drinks over the vacation, which was nice.

We’re getting there. I spoke to my doctor before I went to Oregon, because I put a lot of pressure on myself to be healed by the time we went to Oregon. I was really disappointed when I wasn’t. They told me it was going to be another three to four months before I could off this diet. In the grand scheme of things, six months is about the average time it takes for someone to completely heal from an ulcer, and it’s only been three months for me. [00:20:03] I was really upset about it and did talk to my doctor before we went. She was like, “Now, more than ever, the diet is important, because it’s just this last little bit that you need to let yourself heal.” We’ll see what she says on the 16th.

THERAPIST: It’s a fine line, because it’s good to follow a doctor’s orders, but it can become obsessive.

CLIENT: Oh, I totally became—and that’s exactly what happened.

THERAPIST: It reminds me of when you were losing weight and people were saying, “Oh, you look great,” it’s sort of like the nutritionist saying, “Oh, you’re doing grand, you’re following it to the T.” That’s actually not always that good.

CLIENT: Yeah. I chatted with her a little bit, as well, before we went on vacation, because I was, at that point—because I think it was easy for me to be, “I’m going to do this even more than they’re saying I’m going to do this, because then I’m going to heal faster.” [00:21:07] When that didn’t happen, I kind of was like, “I can’t. This is not sustainable. I can’t only eat these five things.”

I did a chat with her, briefly, as well, before I went to Oregon. I was like, “Look. I really need some variety now. I can’t…I’m really feeling like I’m eating the same thing every day,” which I was.

Then she gave me a list of things, too. I eat trail mix now. I don’t know if I told you that I was drinking the almond milk, finally, but all the things that I kind of—that she had already said was okay but I wasn’t doing. I added all of those, as well.

She’s like that. She’s got my mom on almost a liquid diet. Not a liquid diet, she eats real food, two meals a day. She has a shake every morning, and then sometimes she has what she calls two-shake days, which are if she’s feeling like she needs to make up for going out to dinner the night before or something. [00:22:08] This woman is a no-nonsense woman, this nutritionist.

It’s funny, because I probably—I know that the medication I was taking is what gave me the ulcer, but had I not—if you were to subtract my anxiety and what my anxiety does to my stomach, maybe it wouldn’t have gotten to that point. Maybe I would have had some inflammation but not an ulcer, or something like that. It’s not funny but—I don’t think “ironic” is the right word, either. I ended up getting this ulcer because I’m so anxious and stressed about everything, but then the ulcer makes me more stressed about everything. Then, of all things to happen to me, the last thing I need is something completely focusing on food. [00:23:00] It’s just the perfect storm for me to just become completely obsessed.

(pause)

CLIENT: It fuels my phobia about taking medicine, also, because now I really can’t take a lot of medicine because of my stomach. I was having sinus headaches over the weekend. We had to do 45 minutes of research to find a Sudafed that had acetaminophen in it instead of ibuprofen or instead of naproxen. By that point, I don’t want to take anything, because who knows what’s in it? I didn’t take anything. [00:24:00] I took a nap and I felt better. I don’t know.

I get annoyed with myself, because when I was in Egypt, I’d get really sick all the time and I would pop pills—whatever the nurse practitioner told me I had to take. I would go to a Egyptian pharmacy, where things weren’t even written in English and take whatever they gave me. Then I’d feel better, because that’s what medicine does to you when you’re sick.

Now, I can’t even take a Sudafed when I have a headache or sinus congestion or whatever.

THERAPIST: You don’t actually know that.

CLIENT: Well, no, Sudafed I can take. That’s apparently what I can take, because it’s acetaminophen.

THERAPIST: Right, but you could take something else with ibuprofen and take one dosage and you could be just fine.

CLIENT: Yeah. I don’t know, they told me not to take anything with ibuprofen.

THERAPIST: After certain procedures, they tell you not to take – is it Tylenol that thins your blood? It’s something that thins your blood – for I don’t know how long.

CLIENT: Ibuprofen. [00:25:00]

THERAPIST: That’s crazy. If you speak to other doctors, they say it’s absolutely crazy. These things are not going to kill you. One dose of things is not going to kill you.

CLIENT: Yeah. I’m convinced it will. [laughs]

THERAPIST: I know you are. (crosstalk at 00:25:20)

CLIENT: It’s like, what’s worse: the panic attack of taking the pill or just taking a nap for a couple hours while I wait for the headache to go away?

THERAPIST: Right, but the panic attack is not necessarily inevitable. I know it feels inevitable, but it’s inevitable because it’s triggered by a series of thoughts.

CLIENT: Yeah.

(pause)

CLIENT: Where my anxiety kind of fluctuates between Amelia’s safety, my safety, my health, that’s kind of—I share the love with all sorts of things in my life. [00:26:09] My brother’s is just focused on health things. You think I’m bad? He doesn’t have the same issue with mediation—

THERAPIST: Did I say you were bad (inaudible at 00:26:18)?

CLIENT: Not bad, but I’m like, “I won’t take Tylenol,” or, “I won’t take one Advil because my stomach will bleed out.”

He is a very severe hypochondriac. He has shingles, apparently. He’s only 23, and so that happen frequently to people that young. I kind of feel badly for my mom, right now, because she has me on one end, freaking out about my stomach and all those things, and then he’s really having a tough time, right now. He found one article in “The Chicago Times” that mentions a study about people getting shingles when they’re under 40 and linking it to cardiovascular disease or something. [00:27:01]

He’s just beside himself, at this point, about what to do with his shingles. Of course, over the weekend, my mom’s telling me, “Well, we think your brother has shingles. We’re trying not to tell him too much about it, because he gets so worked-up over these things.” I didn’t really know much about shingles, and this was at the same time I was this headache that I wouldn’t take medication for.

I Googled it and was just reading about what shingles was. Of course, it says, “Early signs are headache and flu symptoms without a fever.” I’m like, “Mom, I think I need to stop. Don’t tell me anymore, because now I’m convinced I have shingles because I have a headache.” Just my family, its all of us.

THERAPIST: There’s a certain feeling un-safety (ph) in your body.

CLIENT: Yeah.

THERAPIST: Seems very unsettling.

CLIENT: Yeah. It makes me really frustrated, because I didn’t—I wasn’t always like this. [00:28:00]

I read I guess the—I don’t familiar if you’re familiar, but it’s like an online—I guess it’s an online magazine, I don’t know, “The Atlantic”? They’re doing a series on anxiety right now.

THERAPIST: It’s not “The Atlantic Monthly,” it’s a separate—?

CLIENT: I’m not sure. I don’t read it.

THERAPIST: “The Atlantic Monthly” is more of a literary magazine.

CLIENT: Ah, yeah. I don’t think it’s literary—I don’t think, anyway. I’m not sure, because I just stumbled—I stumbled upon random articles from them through other people, most of the time. I have never actually looked through their website too much.

They did a miniseries on anxiety. Their editor, I guess, suffers intensely from anxiety, since he was a kid. He wrote this really long piece. I really liked it. It was funny and just about all of his anxieties and his phobias and the stomach issues they give him. He told some crazy stories about pooping his pants in the Kennedy house (inaudible at 00:28:50) doing an investigative report story—I don’t know, just things that—he’s like, “Oh, hey, that doesn’t always happen to me.” [00:29:00]

Wait a minute, what was I…? There was a point to me telling you this…

Oh! I had shared it with Amelia. We were chatting about it. After the piece that he wrote, they kind of opened it up and invited readers to share their own experiences with anxiety. Of course, I was reading everybody’s, which probably—I was fine while I was reading his thing, but then when I was reading everybody else’s, I started to be like, “Well, maybe I should be checking my pulse every 30 seconds.” I stopped reading those.

Amelia and I were chatting about it, and I was telling her that it seems that it’s pretty—he was writing about how it can be—I don’t know if it’s officially really common that this happens or just he knows of a lot of people who seem very put together and calm and laid back on the outside and give off that impression, but the other people don’t—you would not necessarily know how much someone’s suffering from anxiety or a phobia or something all the time. [00:30:07]

I was telling Amelia, I was like, “You know, it was interesting to see that that is a common thing.” I feel like people tell me, when I do get close enough to someone and let them know about my issues with anxiety, I’m always met with surprise. When I went back to school for a presentation in the fall and I ran into a professor who I’m close with and we were chatting about my stomach. She was like, “Man, I can’t believe you got an ulcer. You were like the least stressed person I’ve ever met.”

Of course, I know that that’s completely far from the truth. Amelia was like, “Really? I can’t believe people would think that you’re calm or laid back.” That made me kind of upset, because when we first dating and when she got to know me and when she fell in love with me, I wasn’t like this. Now, it’s upsetting that this has become such a part of my personality that she doesn’t even remember. [00:31:00]

I was like, “Well, don’t you remember before we—when we were in Egypt, this wasn’t such a thing?” She was like, “Really? I don’t remember.” The fact that she can’t even remember me before…this became such a serious issue is upsetting.

THERAPIST: You’re feeling something was lost in that?

CLIENT: I don’t know that something in our relationship is lost, necessarily. That just reminded me of the fact that this is a big issue that I need to deal with. That she can’t even remember what I was like before, knowing about all my anxiety.

THERAPIST: I do think medicine would help you.

CLIENT: I don’t know.

(pause)

[00:32:00]

CLIENT: I just feel like that can’t be the only option. There has to be something I can do to control it myself.

THERAPIST: Medicine isn’t the only thing, but it’s certainly something that would help a lot. One can’t control anxiety. That doesn’t happen. That doesn’t work that way. People can develop techniques to calm themselves down in the moment, but the ongoing, underlying anxiety, it’s such a sort of wired state. You can’t really control that. It’s like trying to control your mind. That doesn’t happen.

I won’t say “definitely,” because people react differently, but there’s certainly medication with anxiety that also helps with sort of obsessive thinking. [00:33:01]

I just think you could feel better. It makes me a little sad to know that you [won’t give] (ph) yourself that opportunity.

CLIENT: I’m just worried about the side effects. I don’t want it—I hear all these stories that people who go on this medication and it changes their personality a little bit. No?

THERAPIST: No. Not really. Not in my experience. I work with a lot of people who go on medication. I’m not a pill pusher. I don’t even prescribe.

CLIENT: Right.

THERAPIST: It’s not something that I—

CLIENT: Right, yeah, no, I know.

THERAPIST: I do think—

CLIENT: It’s just making my stomach turn thinking about it.

THERAPIST: On a practical level, taking medication is never as big a deal as it might feel. First of all, because if it doesn’t help you—if it works, great. [00:34:01] If it doesn’t work, you just stop taking it.

CLIENT: Yeah.

THERAPIST: Your losses, in a very practical sense, are nil.

CLIENT: How soon do you know whether it’s working or not?

THERAPIST: Depends on what you’re prescribed. There are certain medications that help alleviate anxiety in the moment, those are pretty obvious pretty quick. There are the medications that take a couple weeks to build up into your bloodstream.

I’ve seen some people—they don’t get much of a reaction. Some people, it really makes a huge difference, a dramatic difference, in how they feel. They’re in sort of a steady state.

CLIENT: What do you mean?

THERAPIST: When I think about—one aspect of anxiety is just sort of an ongoing experience, and also how your mind works. Have you ever said, “Stop obsessing and don’t think about food anymore”? [00:35:00] How does that work? It’s the way your mind is processing—

CLIENT: I feel like when I’m doing well, I can channel it. Do you know what I mean? In a healthy way.

THERAPIST: Maybe, but you’re not always going to do well. Not everybody always does well.

CLIENT: Right.

THERAPIST: (inaudible at 00:35:13) stressed you out. Not because of who you are, just because of life.

CLIENT: Yeah.

THERAPIST: I brought it up because I think, at the very least, it’s important to sort of think about.

CLIENT: Yeah. I’ve never even given it thought. I feel like I channel my mother. When I was younger – I think it was in high school, maybe middle school – and they took me to—I don’t know if she was a psychiatrist. I think she might have been a psychiatrist, child psychiatrist or something, because I wasn’t doing well in school – as well as my mother thought that I could do. [00:36:04] Which I later proved her right, when I had suddenly started making the dean’s list in college, it was like, “I told you so.”

I did those ADD tests and whatever. Yeah, I’m a little bit like—I’m a high-energy person. I wasn’t being stimulated in the ways that I needed to be stimulated when I was in middle school and high school. I wasn’t enjoying what I was doing in school, so I wasn’t motivated to do any more than the bare minimum. When you sit me in front of a computer screen, I have to follow with that. I’m 14 years old, I’m probably going to not follow it the entire time, whatever the test was.

This woman said, “Yeah, this kid needs to be in the resource room. You might want to give her Adderall,” or whatever was the medication at the time. You know what that was not what my mom wanted to hear. My mom wanted to take me to this psychiatrist so that they would tell me that I’m totally fine, I’m just not fulfilling my full potential. [00:37:00]

It was like, “You don’t need medication. We’re going to deal with this ourselves.” I never went back to see that woman.

That’s kind of how I feel about this, where I’m like, “No. I don’t need—” it’s almost like admitting that the situation is out of my control and I need medication to fix it.

THERAPIST: Well, it’s interesting. The story that you told, your mom didn’t really want to consult with a professional. She wanted the professional to fulfill her idea of what was wrong. She wanted to stay in control. She wasn’t actually looking for expert advice.

CLIENT: Yeah.

(pause)

[00:38:00]

CLIENT: I guess, in a way, that’s like—with my other therapist [I saw in Chicago] (ph), it’s like I come in the first day and I’m like, “Listen, I’m here because I want to deal with this issue, but I’m not taking medication.” I don’t know if it’s—if I should relinquish—I don’t know. I want to be able to hold onto that and figure out how to make my situation work without going there, but I don’t know.

THERAPIST: Jehovah’s Witnesses don’t take medication because it’s a religious principle.

CLIENT: I’m afraid of what it’ll do to me, aside from potentially make me feel better.

THERAPIST: It’s more a, in a sense, practical. It’s not like a moral issue, per se.

CLIENT: No, it’s not a moral issue for me at all. [00:39:01] I’ve done drugs and I drink. I’m not opposed to—I have this issue with putting things in my body that would alter my state of mind, at this point.

THERAPIST: It’s interesting, because, in a sense, that that’s what the medication would help with. It has (crosstalk at 00:39:20).

CLIENT: My old therapist laughed, because she made the suggestion when I came back from Red Cross. I went to see her before moving up here and process—well, because I was starting to have these anxiety issues, suddenly. When I got back from Egypt was when it really started.

I went to see her while I was living in Chicago. We talked about the experiences I had in Egypt and how they were potentially pretty traumatizing and this is how I’m reacting to it, because I didn’t process them while I was there or whatever. It was pretty fucked up, a lot of the stuff that happened to me while I was over there, so it’s natural—I would understand that that would be the trigger for this to become such an issue, here. [00:40:05]

She said, “Look, I really think if you just—not stay on medication permanently, but if you just—there are certain medications you take for a certain amount of time – six months, per se – and then you can go off them. You’ll feel better.” I was like, “No, that makes me anxious to think about taking medication,” and she laughed. It was like a joke, but it’s true. I start to feel like my chest is burning when I think about taking…anxiety mediation.

THERAPIST: Well, it sounds like part of it is feeling like you’ll lose control, like your personality will be altered, there’ll (ph) be that lack of control that makes you very anxious.

CLIENT: Yep.

THERAPIST: Which is a fear that really has no practical consequence, because if that actually happened – which it probably wouldn’t – you just stop taking it. [00:41:07] There’s nothing to be lost, in that sense, but that’s not the point.

My goal is not to push it on you, but to look at why this is that you’ve closed off an option that could potentially be helpful to you.

I’ve certainly seen therapy be more effective when people are getting treated properly, psychopharmacologically.

CLIENT: Do you think I’m just doomed if I don’t try it?

THERAPIST: I don’t even know where to start with that! [laughs]

CLIENT: Not “doomed,” but is that—I just always wanted to think of my anxiety as something I deal with but something that I…I don’t know. [00:42:01] I also feel like—on the one hand, yeah, I’m just terrified of taking medication, terrified. I feel like I want to cry. On the other hand, I also don’t want to—I feel like that’s like admitting that my anxiety has complete control over me. I feel like there is a social stigma to it, as well.

THERAPIST: Okay.

CLIENT: Which is not—you know—

THERAPIST: (crosstalk at 00:42:24)

CLIENT: It’s not—now I might just be making up excuses. It’s mostly the fear of actually taking medication.

THERAPIST: Again, the issue of—the anxiety of relinquishing control is part of the problem.

CLIENT: Right. I know. It’s been (crosstalk at 00:42:39).

THERAPIST: It’s definitely a catch-22.

CLIENT: Yeah.

THERAPIST: We don’t have control over our affective states. We can think about them and there are things that we can do that can help them, but you can’t will away anxiety. I certainly don’t think you’re doomed. I think it will help. You certainly have a wiring for it. [00:43:01] It’s in your family. That doesn’t mean you’re doomed and it doesn’t mean other things won’t help. From my perspective, I’m a pragmatist at heart. Why not do everything you can to make it better?

CLIENT: Yeah.

THERAPIST: Or at least try.

CLIENT: Yeah. It’s a conversation that I’m willing to have, but I can’t assure you that I’m not just saying that to make you happy right now. [laughs] I’ll talk about it, but I’m pretty stubborn. I don’t know that I’ll be convinced, ever. I think I should talk to my brother, because I think that he’s on medication. I know he’s on medication, I’m pretty sure it’s for anxiety. I think I should talk to him.

THERAPIST: Well, far be it for me to take your anxiety to take your anxiety away from you. I don’t want to…

CLIENT: [laughs] How dare you? [laughs]

THERAPIST: I don’t want to break up…

CLIENT: Yeah.

THERAPIST: …the attachment. [00:44:02]

CLIENT: I guess I just don’t know anyone that’s like, “Oh, I’ve had such a great time with my anti-anxiety pills.” Maybe Jaime will tell me, like, “Yeah, Kelsey. They help a lot. You need to see a psychiatrist.”

THERAPIST: For some people, they really do. I’ve seen really a very—I don’t think they’re like the cure-all for some people, they just don’t feel like they do much. Certain anxiety medication, the biggest complaint I’ve heard is that it’s – and this is not all anxiety medication – but kind of flattens you a bit, and people don’t like that and they’ll go off because of that.

CLIENT: Yeah.

THERAPIST: That’s not everybody’s experience. That’s only one kind of medication. To me, that’s the biggest complaint I’ve heard. Not anything else – no one complains, “God, my personality is completely transformed. I don’t even recognize myself anymore.” I don’t hear that very much.

CLIENT: I guess what I mean, “My personality would change,” that flat feeling, that’s what I’ve heard.

THERAPIST: That’s not really personality. [00:45:00]

CLIENT: I feel like it’s dulled (ph). Because I [am that] (ph), I think that my anxiety contributes to my high-energy personality, which I like about myself.

THERAPIST: Again, that’s only one type of medication, one classification.

CLIENT: Right.

THERAPIST: It’s certainly not the only option.

CLIENT: I will talk to my brother…

THERAPIST: Good (ph).

CLIENT: …and to Amelia.

THERAPIST: I think, practically, that’s good. Also, just the meaning of it and this issue around control and how your anxiety—your wish to control your anxiety feeds your anxiety. That’s sort of the catch-22. I think that’s an important piece.

Kelsey, we need to stop for today.

CLIENT: Yeah.

THERAPIST: Okay, so I will see you next week!

CLIENT: Yeah. I start classes on Monday, so my schedule changes a little bit. I get out of class at 1:00 on Thursdays…

THERAPIST: Okay.

CLIENT: …so let’s try it next week, and then if it seems like it’s going to be too—I don’t know of anything else about my academic schedule [without looking at it] (ph)…

THERAPIST: Okay. [00:46:01]

CLIENT: …so I don’t know what else I would necessarily have going on. Next week should be fine…

THERAPIST: Okay.

CLIENT: …but we might need to have a conversation next week about (inaudible at 00:46:08).

THERAPIST: Okay. The very first week of February, I’m away the week.

CLIENT: Okay, no problem.

THERAPIST: Okay? Okay.

CLIENT: All right.

THERAPIST: See you next week, take care.

CLIENT: Thanks so much.

THERAPIST: Okay, bye-bye.

END TRANSCRIPT