TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
CLIENT: Hey Doc (ph).
THERAPIST: Hi Allison (ph). Good afternoon. [00:01:05]
CLIENT: How are you doing?
THERAPIST: I’m doing all right.
CLIENT: Remember when I stopped with you in December? I was very, very upset. I think I was feeling very rejected by your insurance decision. I don’t think I was actively, I don’t think I knew about feeling upset apart from that but I remember feeling really utterly rejected by your decision and it because it made me feel vulnerable and insufficient. . [00:02:46]
It also made me feel badly about what I thought might be motivating you in your decision. And I brought it up once I remembered. I remember being aware that I didn’t like it. And you said, after we talked about it I don’t think we really talked about it. I think I said that I was upset by your decision or I didn’t like it because it wasn’t [inaudible at 00:04:02] people. I’m going to try to do that. [00:04:07]
So I didn’t have the extent of what I said to you about it and you said you had, I guess we had a conflict of opinion or a conflict of interest. Maybe not directly to that but at the end of that question and then I remember feeling like stomping my little feet. And then that was it. I don’t remember, I don’t think there was much processing or coming to the surface of anything else. But I remembered that day today and that there was probably a lot more in there. [00:05:09]
[Pause]
THERAPIST: I can imagine what you thought was difficult is feeling like I had made a decision that seemed to be for reasons different from I imagine your sort of thing and mine. This reflected a difference between us; you would not have decided against the people. [00:06:08]
CLIENT: I wouldn’t. I would want to see poor people. I got really bored seeing only people who prepay out of pocket. But that’s not the case with you. I know that you see plenty of people who don’t have insurance. But it actually turns out I had no fucking clue. I’m not in your shoes. And if I ever have a practice maybe I’ll feel completely differently. But yes, as an instinctual thing it feels bad in my gut so something would have to evolve which might be my own family, being about my people instead of wanting to be all the people. But yes. [00:07:17]
THERAPIST: But I think even now as you’re talking you’re sort of maybe reducing or sort of dismissing the possible differences. I’m not saying you’re wrong in what you’re saying I mean I understand that maybe you’re right. But I guess I wonder if there’s some of it motivated by it’s important to feel like actually if we were looking, if we were in the same situation we would be doing it the same way. [00:08:15]
CLIENT: Yes I think that feels pretty important. [Pause] Maybe it feels important because I don’t know much about it. If I actually knew some concrete things about your decisions and not actually you did explain it to me. It’s not like I feel in the dark about it. But stuff that you’re not going to explain to me. [00:09:42]
THERAPIST: Do you remember roughly what I explained?
CLIENT: You said, well I don’t know because I think some of it was influenced by your feeling guilty. But you said that the paperwork was really bad for the other, for the insurance that you were not going to take anymore. But now it occurs to me that you stopped taking all insurance. Is that true? [00:09:42]
THERAPIST: Essentially yes. Although at that point that just meant going off the insurance and [inaudible at 00:10:33] anything else.
CLIENT: I see. Have you been taking other insurance?
THERAPIST: Not in a bunch of years.
CLIENT: So, yes, so the paperwork was annoying; it took a lot of time. There is something. There’s something. You’re nervous or amused or kind of a combination of something. Paperwork, other people that you’re training who are at your level aren’t taking insurance anymore and they’re charging $200 more. [00:11:28]
I guess those are the reasons I remember. And I guess you get more money this way. I think I feel really uncomfortable assuming what I would do too. I think the difference is hard, if we were in the exact same place the difference is very hard for me. But it also feels really icky too. Clearly I’ve made that leap but I’m not pretending that I haven’t. [00:12:12]
THERAPIST: But at the same time you feel very uncomfortable about it, yes.
CLIENT: Yes. I see myself doing it and say whoa it’s dangerous.
THERAPIST: Yes I sort of imagine to you it would feel like questioning a parenting decision I might make or something, or somebody else might make.
CLIENT: No, there’s a compassion in my view. My grandmother is called the Mother Theresa of Kentucky, by that community, and her mother was that figure in all the ways that at least in the way that her mom and my mom talk about it. There’s a shrine with a real life-sized statue of her at the little temple that she built and her devotees still visit it twice a day. I mean she was their guru. And I think it’s about 50 people now who come but when she was alive it seemed like she had this incredible spiritual gift that she gave to people. [00:13:50]
My mom said that her strongest memory of her is she’s sitting cross-legged in the middle of a room meditating. It’s this multi-family house; I’ve been to it. It’s crazy. It’s all these levels and there’s, at that time there were my grandmother, her children, her five brothers, their children, the parents and then various people’s people who needed help. So five families, there were five families. So she, the memory was she was sitting on the ground and there’s eleven kids running around my mom’s memory. She’s just sort of quietly meditating through it all and smiling; very, very peaceful. [00:14:47]
So to judge you for your decision feels like it’s leaving some important part out that I want to cultivate or that is important to my mom or is important to me. I want to have compassion for you and your family and what you need. But when I’m being directly negatively affected by it that’s sort of faraway over there and the judging feels much closer. [00:15:45]
[Pause]
Then well my grandmother and my great grandmother would still be taking everybody’s damn insurance.
THERAPIST: [inaudible at 00:16:36] another context. Clearly what I wanted to [part of] (ph) the upper middle way. [00:16:38]
[Laughter]
CLIENT: That’s funny. Yes, there’s very little middle way-ness in Waltham but as a practitioner from what I see there’s a lot of upper middle way. [Pause] Some other stuff I wonder like maybe everybody else’s problems are the same. It doesn’t matter who you see, it’s still just as authoritative. I mean maybe it doesn’t matter what class you see or maybe if you took everybody’s insurance it would not change anything about the location or the composition because the ones you want to stay can get the screen and then they’d stay. And the ones you want to go are gone. Can you help me out? [00:18:46]
THERAPIST: [Pause] I guess in a way you want sort of my help making myself back into a good guy somehow. [00:19:54]
CLIENT: If that’s what you’re going to say about it. But I guess I want to know if those three things, those three reasons that I basically remember are right.
THERAPIST: Yes that sounds right. I don’t mean to be fuzzy about something that I already said but I happened to not be able to remember. But you remembered, yes, that sounds probably like what I would’ve said. [00:20:31]
CLIENT: Well I guess I want to know, I’m more curious than anything and I also do want to turn you back into a good guy, that’s true. I’m curious about whether it has changed your patient composition or if, and it doesn’t need to be answered in the case you are in, but if you think what classifications you see makes a difference to half fulfilling your record. [00:21:21]
[Pause]
THERAPIST: I guess as I try to think about it more closely this is a little bit desealed (ph) to me as bus driving. And if you’re a little bit trying to have me answer to you about my decision about the insurance because which I think it’s probably almost like sort of pulling yourself together or maybe turning the tables a bit from your not having had an iota of say or even all that much of an explanation really about something I did to you among other people. [00:24:43]
CLIENT: Yes it feels very bus drivy. It didn’t at the beginning; it did five minutes ago. It’s sort of hard to control or hard to stop myself. Not that you’re asking me to stop but I guess the feeling -
THERAPIST: Right, it kind of happens pretty simply. [00:25:37]
CLIENT: Yes. It feels like, it does feel like something that I wish something about that I could know it when it’s happening and then I could stop it and then I could not do it. [00:26:12]
THERAPIST: It’s hard. I think it’s partly a response to really feeling quite vulnerable and powerless.
CLIENT: I think I -
THERAPIST: It kind of sticks to me.
CLIENT: I think I also picked up some vulnerability in you and for some reason that made me want to go on the offensive. [00:27:01]
THERAPIST: I’m smiling because one thought is either it made you uncomfortable or maybe it would work.
CLIENT: I think both. I think it makes me uncomfortable that you’re not sometimes I picture a stoic sort of gray old man in your place who doesn’t give me any pique (ph). For the record I wouldn’t be here if that were the case.
THERAPIST: Right, good. [] (ph) where I’m concerned, yes.
CLIENT: Yes. Yes. So it doesn’t matter that you’re not that person because it wouldn’t work I think. But sometimes I feel like that would be more instead of are you leading me adrift, are you next to me, are you angering me, like that. Those questions that would be really clear like you’re leading me or you are not affected by me at all. And I don’t get those cues that you are not affected. Like just a few minutes ago. [00:29:25]
THERAPIST: When I was something?
CLIENT: When you were something. I don’t know why I don’t actually sort of rest or not because it’s exactly what I want but my reaction I think was just pounce.
[Pause]
I kind of don’t like to sit on the couch in the morning for the same reason I don’t like to do vigorous exercise in the morning. I’m not warmed up. I feel totally warmed up right now [inaudible at 00:33:58] a bit. It’s also a very different session. Maybe [inaudible at 00:34:20] like not stretching before or something or not having eaten and after not having moved and having been awake for a long time. You asked about Friday morning, if you ask about Friday morning, it never cools down. [00:34:45]
THERAPIST: From Thursday?
CLIENT: From Thursday. Or the week has gone on and on. I haven’t cooled down from the week either but Mondays are generally coming from a pretty concertive and different place. Do you have any thoughts about why I pounced? [00:35:51]
[Pause]
THERAPIST: I sort of remember something about that at the moment but I am wondering whether what you just said is a certain kind of acknowledgement of vulnerability that is sort of maybe partly taking back something that you had seen in me? [00:36:49]
CLIENT: About the insurance?
THERAPIST: Well, yes or about whatever I was reacting to, yes. And then, you know Mondays I come in and I feel half baked. I feel like it reflects a little not really presenting the same way. [inaudible at 00:37:57] the couch. [00:38:08]
CLIENT: I don’t get the part about taking something back.
THERAPIST: Well before you were saying you partly pounced after having the impression that I was a bit vulnerable or responding to something and in a way that I was kind of off or not quite with it or -
CLIENT: No, you were totally on. You were totally with it. It’s what I want or it doesn’t matter what I want but -
THERAPIST: I see. You’re saying that my motive earlier seem more associated when I’m being engaged. Yes, now that makes sense.
CLIENT: But I didn’t react to it that way. This is what’s confusing or upsetting to me.
THERAPIST: I see is that you like feeling I’m that way. Naturally, I mean of course you do. And yet [laughs] [00:39:16]
CLIENT: And yet I can’t handle it somehow or I handle that sort of weird. Often shivers is a smothering reaction to it, like I want to take advantage of you or drive you around.
THERAPIST: But, and then I guess in a way that feels like it’s a little aggressive. I’m not saying that because you seem exactly aggressive to me but it sounds like it might be a little that way. [00:40:14]
CLIENT: My persona?
THERAPIST: When you use words like pounce I guess.
CLIENT: Yes well there’s a lot more where that came from. It does come out because you started talking about bus driving and it went away.
THERAPIST: We’ve just got a few minutes.
CLIENT: The association about the couch, do you still have that?
THERAPIST: That’s something possible to me, yes. I do take your point. I think you’re right that you’re talking maybe you’re not being disengaged but a little unprepared, whereas I seem like very engaged with it in that moment. Maybe not prepared in a way for what you’re going to do. [00:41:11]
CLIENT: And I feel that way now, today, in this session on Monday in the afternoon.
THERAPIST: Like not quite comfortable on the couch or warmed up?
CLIENT: Warmed up.
THERAPIST: Okay, yes. That’s what I thought you were saying, yes. So it seems to fit although I’m not sure what more to do with it. Yes.
CLIENT: I had some really me experiences in Maine. The lake has frozen over which I never, doesn’t happen very often. We walked and cross-country skied and snow shoed all around these little crevices and bays and I was a bit onto the open ice. It was so mysterious on the icebergs. There’s snow on top of ice but there’s some areas with black ice. And it’s this huge body of water underneath and it’s alive and you can hear it when you’re on top of it. [00:42:45]
And we skied over some island and there’s all these feature of the island you could never see in a kayak or something you might never see, too high. It was very cool; it was like being on a desert. There were all these patterns in the snow that you see in deserts with sand. It was a very open place there was so much space there for everything. [00:43:34]
My parents live in the country. They live on this big apple orchard and it’s surrounded by farms. And then there’s a big annex (ph) to the east and the lake to the west and the other annex to the west. And it’s all within five miles. You can just go anywhere on skis or by foot or by horse. And yet everybody’s talking about yoga and trolleying in the river. It’s an interesting blend of rural oak and cosmopolitan people who have a sense of what’s happening in the world. It was very, very hard to come back to my lion’s mouth. [00:44:51]
THERAPIST: We should stop for now.
CLIENT: They’re savvy.
THERAPIST: Oh, thanks.
CLIENT: Are they new?
THERAPIST: No, it’s not quite snowy enough for boots. It’s five blocks so we’re in good enough shape but it would take a little more than [inaudible at 00:45:42]on my shoes so.
CLIENT: [inaudible at 00:45:48].
END TRANSCRIPT
