TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
THERAPIST: Hey.
CLIENT: Hey.
THERAPIST: (inaudible) upsetting yesterday. And also that I didn't really (inaudible) about not (inaudible). [00:00:18]
CLIENT: Yeah, I appreciate that you wanted to (unclear).
(Pause): [00:00:56 00:01:03]
CLIENT: Do you get why it made me upset?
(Pause): [00:01:06 00:01:17]
CLIENT: You're not getting (unclear) accepted. Did you have to be that way?
THERAPIST: You mean I made you upset?
CLIENT: Yeah.
THERAPIST: What I imagine was that I couldn't refer you to our usual time, our usual allotted time.
(Pause): [00:01:32 00:01:43]
THERAPIST: When it had sounded as though I could have (inaudible).
CLIENT: No, I think you were clear.
(Pause): [00:01:52 00:01:59]
THERAPIST: In that case I guess I don't understand.
CLIENT: (inaudible) but things change a lot for me when I have a choice; I have options.
THERAPIST: Okay.
(Pause): [00:02:22] 00:02:26]
CLIENT: Like if you hadn't gotten in touch at all, and this was just what we planned, which is to me (inaudible) I wouldn't have – everything would be different.
(Pause): [00:02:43 00:02:49]
CLIENT: And I wouldn't have been as upset and it wouldn't have quite the ripple that it did.
(Pause): [00:02:53 00:03:04]
CLIENT: I know that you were trying to be helpful by giving me options. Thank you. It had the effect of I guess forcing to the surface that I wanted both options and that either you're telling yourself like that is fine or like anything I wanted at all. Like I do not want to come here for one session.
(Pause): [00:03:45 00:03:57]
CLIENT: I was upset because I was disappointed that I couldn't have both and I think it also brought out disappointment that I can't text Warren this week which I didn't really – like I felt a little bit but I didn't – I feel completely different now. And it also brought out kind of like when I was upset because it's stressful to – I think today is a stressful day. You know, it's a happy day. (Pause) So like the logistics of just being here are a little bit stressful and feels like I didn't want to do it for one session.
(Pause): [00:05:10 00:05:29]
CLIENT: I want to tell you why today is stressful. It's a good thing. (Unclear) I'm building the lab and the concert we're playing tomorrow would be drummers from (inaudible), the University of (inaudible). But –
(Pause): [00:05:51 00:05:59]
CLIENT: – the way you chose to respond to my not wanting to meet today felt really bad.
(Pause): [00:06:07 00:06:20]
CLIENT: One – it felt like you didn't understand why I was upset. And two – you made me feel like a patient.
(Pause): [00:06:31 00:06:40]
CLIENT: For you to say, "I recommend."
THERAPIST: Um hmm.
(Pause): [00:06:42 00:07:19]
THERAPIST: Yeah, I'm sorry I put it that way. I can understand how that felt like that.
CLIENT: Like you could have said it to sound differently.
THERAPIST: Yeah.
CLIENT: But you chose that one.
(Pause): [00:07:37 00:07:46]
CLIENT: Maybe you didn't mean it, maybe. But it was a conscious choice on your part. (inaudible).
(Pause): [00:07:53 00:08:01]
THERAPIST: Meaning what? What's the (unclear). I know you mean concretely to put it that way or not?
CLIENT: Yeah.
THERAPIST: But did you mean like –
CLIENT: Oh, like to put on your doctor hat.
THERAPIST: Oh. No. I think I know probably why I did or I think I know what was doctor-y in my thinking but it's not the way I would have wanted to come across exactly. And I was making an assumption that – may have been partly right and partly wrong – about your not wanting to come in today, that was a doctor-y kind of assumption. I mean what I imaged was that you were hurting, that you were hurt and angry with me and what I imagined was that part of why you didn't want to come in was you wanted to like (unclear) or not, even though you were feeling that way towards me, which I thought like if that was what was going on would be a good thing to talk about.
CLIENT: Yeah, of course. That would have been better to say.
THERAPIST: Um hmm. More explicitly.
CLIENT: From my point of view it was like you're going to take away a double session and I'm going to take it away again and I'm going to take it away a third time and I'm going to tell you what I recommend. And the people who – the types of people who recommend things are advisory panels and doctors. And maybe you're like both, but you're also a whole lot of other stuff.
(Pause): [00:10:36 00:10:52]
CLIENT: Anyway, I was caught kind of in a whirlpool. I don't know, so, that's not entirely fair.
(Pause): [00:10:58 00:11:35]
THERAPIST: Yeah, I guess I could have said something like, "I think you should come in." I imagine that part of why your not wanting to is your being very angry with me and not wanting to come in feeling that way.
CLIENT: Um hmm [yes]. (Pause) More like what (inaudible). This is important to you. (Pause) So, therefore, I think it's important to talk about it.
THERAPIST: Yeah.
CLIENT: So (unclear) this long tone – like tone of your e-mail and my e-mail analysis by the end like 12:15 –
THERAPIST: Like previous e-mails?
CLIENT: No, just this (unclear) one.
(Pause): [00:12:46 00:12:54]
CLIENT: It helped a lot to just have (unclear) there and have (inaudible).
(Pause): [00:12:58 00:13:05]
THERAPIST: Did you draw a clear conclusion (inaudible)?
CLIENT: No.
(Pause): [00:13:08 00:13:12]
CLIENT: I mean other than what I told you (unclear).
THERAPIST: Right.
CLIENT: You were doctor-y and I don't get that (inaudible).
THERAPIST: Right.
CLIENT: It sort of felt like a very special part was going away. Combined with the double session going away.
(Pause): [00:13:50 [00:14:30]
CLIENT: And I have all these mixed feelings about your migraine. And identifies about like you or me coming down with a terminal illness that forces things to come up and I don't know, kind of like what happened yesterday (Pause) and I didn't like it at all. There were parts that I didn't really like. (Pause) But it felt like I (Pause) (unclear) had arrived for a brief moment and that you were like doubling back.
THERAPIST: I see. Yeah. Right.
(Pause): [00:15:25 00:15:37]
THERAPIST: When you came in I was like me with a migraine more so than me as a therapist. And that was good in a way, I mean – not that I had a migraine, but –
CLIENT: You made me feel pretty shitty that you weren't feeling well. I felt (inaudible). So it wasn't good in that way.
THERAPIST: Yeah.
CLIENT: But it was really good.
THERAPIST: (inaudible) and thank you for the (inaudible).
CLIENT: (inaudible). I have a strong (unclear) history. [00:16:28]
THERAPIST: And I think I get the (unclear). Like I get what you mean about the (inaudible) thing.
(Pause): [00:16:53 [00:17:00]
THERAPIST: The way I (inaudible).
CLIENT: Um hmm [yes].
(Pause): [00:17:03 00:17:11]
CLIENT: It's very hard (unclear). (inaudible) is better. But neither, in fact, good.
(Pause): [00:17:19 00:18:09]
CLIENT: I woke up with (unclear) anxiety of three kinds (unclear) and it took like two hours for it to go away. One was about my concert. I always get performance anxiety both about performing but more so about feeling, anticipating feeling badly about how I play.
(Pause): [00:18:41 00:18:49]
CLIENT: The second is about building a new version of my chemostat. (Pause).
THERAPIST: That's the thing you're building in the labs?
CLIENT: Um hmm [yes].
THERAPIST: What's a chemostat?
(Cross talk)
CLIENT: A chemostat is really cool. It is essentially a culture vessel, a bottle where you grow bacteria or other microbes. Normally when you have a population of growing bacteria and a (unclear) amount of food, the bacteria will eat the food until it's gone and it'll stop growing. So you've got a period of an exponential growth and then no growth. Some bacteria tend to like hang out and some die. If you want to study processes that take a long time like many generations to happen, or if you want to study processes where you need to have the bacteria be in essentially like the same growth phase (Pause) and you still have like exclusive control over that you use something like a chemostat which is like a perpetual growth vessel. Basically you drip media, liquid food or (unclear) and you allow the culture to outflow at the same rate and that allows the bacteria to essentially see the same concentration of nutrients forever. So they never deplete nutrients because they're getting diluted out at the same rate that nutrients are coming in.
So I'm studying – I'm trying to understand what drives drug-resistance in TB. And drug-resistance occurs by chromosomal mutations. So mutations occur in the DNA spontaneously in all of our DNA and they occur at quite a low rate so I (unclear) to observe populations of bacteria for a very long time for me to understand –
THERAPIST: Because the mutations occur at a very small rate and the ones that confer drug-resistance occur (unclear).
CLIENT: (inaudible). So chemostats (unclear) what –?
THERAPIST: They need to observe a lot of microbes over a long time.
CLIENT: A lot of microbes over a long time. And you can get away with observing like a lot of microbes over a little time but actually the question I'm specifically asking right now is, challenging the paradigm that mutations occur as a function of replicating the DNA. So normally we think of that process as being somewhat error-prone and the machinery that is in charge of replicating DNA make errors at some small rate and so the more replications there are, the more mutations you see.
In TB most of it, the bacteria's like time, is spent like not really about replicating that much. It is a late – it has a very successful latent phase. About two billion people in the world are latently infected with TB and that's like they inhaled TB. It went into their lung alveoli and like doesn't – really isn't replicating. And things like HIV infection or other immunosuppressive events will reactive – or actually we have no idea what reactivates TB. But it seems like those latent bacteria are still acquiring drug-resistance at a similar rate to the active bacteria and that's where (unclear) in monkeys are (unclear).
THERAPIST: So this is where you come in.
CLIENT: Yeah. So I'm trying to ask the question, "are there other drivers of mutation that could account for mutations accumulating in –
THERAPIST: I assume they have to be with the latent bacteria to be developing at a similar rate to the (inaudible).
CLIENT: The DNA damage is the strongest candidate for what's causing mutations but we have no idea. So my chemostat experiment is like very slow-growing bacteria, fast growing bacteria – do they accumulate mutations at the same rate per time?
THERAPIST: Right.
CLIENT: So if you had like –
THERAPIST: Sort of taking the reproduction, rate of that.
CLIENT: Yeah. I built a chemostat once. It held a lot of bacteria, a big volume. But there were all sorts of problems with that and so now I'm ditching that and building a very small chemostat, which holds like a fifth of the volume and today I started my first like test of that. I often dream about the chemostat when I, like the night before something is going to happen. There are these like really repetitive loop (unclear) phase where I'm like putting together the chemostat, like over and over and over again.
So last night the third performance anxiety thing was coming here. And last night I was awoken by dreams like this perfect hybrid of you and the chemostat and I don't remember it accept that I was like pushing needles through rubber stoppers and like you were there. I'm not sure if I would interpret the pushing needles through rubber stoppers thing much but you can if you want to.
THERAPIST: (Laughs)
CLIENT: (Laughs)
(Pause): [00:26:09 00:26:24]
CLIENT: I mean like I did that all day yesterday so there is a clear physical/muscle memory of it. Maybe you also did that all day yesterday to me.
(Pause): [00:26:34 00:28:20]
THERAPIST: (Unclear) my (unclear) is a little different to (unclear) your coming in here feeling hurt and mad, it hurts. Really hurt. And being really worried about that.
CLIENT: But I think I was right about everything changing. (inaudible).
(Pause): [00:28:57 00:29:12]
CLIENT: Not like that I was going to do anything different that would change things for you or for us for that matter. I was really mad at you for treating me like a patient had already changed.
(Pause): [00:29:34 00:29:39]
CLIENT: And like for not really conveying if you got it.
(Pause): [00:29:44 00:29:53]
THERAPIST: Do you mean like –
CLIENT: For not really conveying that you understood why I was upset at you, specifically that all my double sessions were (inaudible).
(Pause): [00:30:04 00:30:15]
CLIENT: Because I only give blood to anyone who can (inaudible).
(Pause): [00:30:15 00:30:46]
THERAPIST: I wouldn't be able to be this same way with you as usual, like I'm sort of out of it if you were upset and my not understanding about it would be an indication that I wouldn't understand (inaudible) someone else.
CLIENT: You'd have to find an out in response to what?
THERAPIST: Like, if you're mad at me on being clinical on you or I'm going to not get it or something, or not be here and hopefully be who I usually am, like listen to and understand what I think.
CLIENT: I think I was more afraid about my feelings changing.
THERAPIST: Okay.
CLIENT: Like mourning a potential loss of (inaudible) but not like you (inaudible).
THERAPIST: (Unclear) that you're going to change me as that you'd sort of be disappointed and feel like it just felt different?
CLIENT: Yeah. I was (Pause) (inaudible). I'm very attached to that feeling and (inaudible).
(Pause): [00:32:50 00:33:58]
THERAPIST: How does that feel?
CLIENT: It feels a little (inaudible) like the quality is different.
(Pause): [00:34:14 00:34:53]
CLIENT: I've been wanting to bring up your earlier migraine day. Like every other session but I guess I rather (inaudible).
THERAPIST: Oh.
(Pause): [00:35:07 00:36:00]
CLIENT: (Unclear) two other things I wanted to say to you. One was that you look very tired. And two was what's going on in Jay (unclear)? But the thing I said was you've been distracted like this before and it was yesterday.
THERAPIST: Yeah.
(Pause): [00:36:11 00:36:32]
THERAPIST: Yeah, I sometimes get migraine and usually sort of (inaudible) like (inaudible).
CLIENT: (inaudible)
THERAPIST: Yeah. And (inaudible).
(Pause): [00:37:01 00:37:12]
THERAPIST: And I think that I do things like (inaudible). And that's a lot easier than the fact of (inaudible).
(Pause): [00:37:36 00:37:39]
CLIENT: (Unclear) going to happen?
(Pause): [00:37:41 00:37:46]
THERAPIST: (inaudible)
(Pause): [00:37:46 00:38:01]
CLIENT: I think it's various things like combinations of like amount of sleep and stress.
Pause): [00:38:13 00:38:27]
CLIENT: But I think it's unlikely – (inaudible).
(Pause): [00:38:44 00:39:00]
THERAPIST: Right. Like how it happened we meet twice on the day of (unclear).
CLIENT: That was the time I realized there were many hours (inaudible).
THERAPIST: Right. And I think I usually get them in the afternoon. But I'm not aware of any pattern in general of getting them. (inaudible).
CLIENT: You can't make a pattern because it's only happened two times, but – I'm glad I know what's happening that day. (inaudible).
THERAPIST: What was it like that day?
CLIENT: It was very distracting to me. And it also made me, I think it gave me a like body/mind experience when I left.
(Pause): [00:40:19 00:40:23]
CLIENT: I don't know. I think I was (unclear) expected what my reaction was to (unclear). I – did you get one the Thursday before Easter?
(Pause: [00:40:48 00:40:57]
THERAPIST: I don't think so. I don't remember. I certainly didn't leave. I haven't had to leave work from one in a while. Like more than six months. (Pause) No I don't think I did. Why? Did I seem a little out of it or tired or something?
CLIENT: Yeah. I don't know. I had this dream about (inaudible). And that day in December was the Thursday before Christmas. So anyway it's not so consistent. The (inaudible).
(Pause): [00:41:47 00:41:52]
CLIENT: Yeah, it felt like you were going through something and I didn't know what it was but I really wanted to know and that was like, I guess I'm not going to see you again. So it was like the empathy bells were ringing very, very strong for me and yeah, it wasn't a pleasant setting.
(Pause): [00:42:28 00:42:32]
CLIENT: Like stopping on that day wasn't (unclear).
THERAPIST: Yeah. I remember really feeling like I didn't feel well. I also felt out of kilter but it was not the kind of session that (inaudible).
(Pause): [00:42:53 00:42:57]
CLIENT: And you were willing to let it be that way?
(Pause): [00:42:57 00:43:30]
THERAPIST: Well, yes I was. I think generally when they occur it is like I kind of plan on them ending like that, you know, it seems (unclear) to day, let's meet again and (unclear).
CLIENT: (inaudible).
THERAPIST: Yeah.
(Pause): [00:44:01 00:44:28]
THERAPIST: You know, I know (unclear) right, but I don't think there was something I could do, like I (inaudible).
(Pause): [00:44:34 00:44:47]
CLIENT: You know that (Pause) this relationship is a once in a lifetime (unclear)?
THERAPIST: Of course.
CLIENT: Good. Yeah, and thanks for saying that. I know you – I feel that way.
(Pause): [00:45:12 00:45:17]
CLIENT: I also tend to feel that way about a lot of things. Like more things than other people do and I like things meaning people and life experiences and things like that. And I wonder how much of that is driven by like it has to be that way for me to – because like if it's not – well it is that way. Like I genuinely feel that way about us. And other stuff but if it's not that way like the sense of longing and loneliness becomes unbearable. I just wonder how those two things are connected.
(Pause): [00:46:29 [00:47:05]
THERAPIST: (inaudible).
(Pause): [00:47:05 00:47:17]
CLIENT: I don't think you like saying that.
(Pause): [00:47:17 00:47:24]
THERAPIST: No, not particularly.
(Pause): [00:47:24 00:47:32]
CLIENT: (inaudible)
(Pause): [00:47:32 00:47:42]
CLIENT: Okay.
(Pause): [00:47:42 00:48:00]
CLIENT: See you.
THERAPIST: (Unintelligible).
END TRANSCRIPT
