TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: So good morning. How are you?

THERAPIST: I'm all right.

CLIENT: Good. (Pause) So I was thinking about this morning... We've been talking about (pause) the state of something, the state of X, that's associated with a sense of homelessness I guess versus location. Exactly which way the arrow points is a little bit unclear. [00:01:47]

I've had a sense, I think, or a consensus about that that I'm manufacturing it sometimes, or that I'll be in a situation and there's some kind of homeostasis to this relationship. That even when I need to feel dislocated or where there's an opportunity to feel something other than dislocated it's preserved in certain ways that I'm relating to the people around me. And it's to the extent that there are unusual emotional responses. I'm not quite sure how to describe what the states of feeling that I'm having in the course of these interactions. They all seem to be associated with the state of dislocation in one way or another. I think we're kind of in agreement about that. [00:02:55]

So I guess what's hard right now since... In one way or another my professional development at the evolution of my sense of work is all associated very directly with relationships that I made right around the time that my father died. What I was kind of meditating on this morning, I guess, was the extent to which it's really a very (pause) constitutive aspect of my personality and to what extent it's kind of contingently related to a very specific trauma. In other words, this network that I've been trying unsuccessfully, I think on both ends, to navigate certainly since I got back to the city is one that I came to literally the same week that I was called back to San Diego to be at my father's bedside during the last crisis. [00:04:30]

I came to graduate school two years before that and three weeks later I got a call saying that there was a cancerous tumor in my dad and would I come out. Certainly for the first couple of years of interactions of both horses that I've been alternately trying to ride for the last 15 years or more so it's really very closely... [00:05:16]

THERAPIST: What are the two different horses?

CLIENT: You know this sort of academic (inaudible at 00:05:20) stuff and this public health stuff each of them somewhat separately. One was associated... You know one was kind of entangled in my father's illness and one was entangled in my father's death; very pragmatic as well as more ineffable ways. There are practicalities to this too in the sense that my father left mom bankrupt and so I had to think about making decisions based on what would provide cash flow. Because normally if you're in grad school, in the humanities particularly, you rely on your extended network and I really couldn't which is nothing. My mother's roof was falling in literally. [00:06:24]

And this group of people was aware of that. In other words, Kevin would say to me pretty often really, "How's your mom doing?" And I think that some of the thought in his mind was trying to kind of help me keep it together as well as I could do.

THERAPIST: Sorry. Where was Kevin at the time?

CLIENT: At the time he was the executive director of the non-profit.

THERAPIST: Okay.

CLIENT: Is that clear?

THERAPIST: (inaudible at 00:07:08).

CLIENT: Oh the organization was a non-profit that I had come to in kind of an activist capacity. You know they hired me basically to work on an advocacy project. [00:07:25]

THERAPIST: Oh okay.

CLIENT: So I guess what I was musing about this morning and it's not the first time I've done so is the extent to which I've been so frozen and unable to leave these things that on the face of it I haven't fit in at even if I could have. Like I haven't taken the step. I didn't take the steps to fit in at an organization whose very clear direction an organization who would've loved to have had me whose very clear direction is the Provision of Clinical Care. I mean they're an implementation organization. They don't even do really especially since Kevin left Kevin was the guy who was interested in policy stuff. They don't really do that anymore truth be known. [00:08:21]

There was kind of a partnership between two very successful people one of whom really thought of himself and thinks of himself as a clinician and one of whom who thought of himself (inaudible at 00:08:35).

THERAPIST: And that's Luke and Kevin?

CLIENT: Uh huh. So I'm thinking to myself I'm wondering why I didn't leave or why I didn't stay. In a way these decisions are really curious and there's certainly some aspect of all of this. However, whatever kind of historical associations one might make, whatever kind of etiology model I proposed there's some aspect that clearly involves something frozen; something that's not moving. I'm not moving just like literally I'm not making a place for myself now. [00:09:27]

THERAPIST: It's like you're referring to decisions you made at that time talking about...

CLIENT: At that time now I mean... It's just been so clear to me for so long that unless I do X, Y, and Z there's really no place for me in this organization. And yet I've been so reluctant to leave. I kind of persisted with this attempt to find a path in this really stubborn way in a way that I had foreseen in advance all kinds of fiscal downsides for me, all sorts of professional downsides for me. I mean it wasn't a mystery to me that there's no place institutionally within this academic framework, kind of incentive structure, that I could potentially fit into. I had a kind of fantasy that people were probably... I don't know whether they indulged me in it or whether they just were to reticent to say you know that really doesn't work, but I just kept pushing it. [00:10:54]

This morning I was kind of trying to meditate on why. So there was an event last night that kind of set me on that (pause) track. The back story on my end is that throughout this semester even though I've been tutoring for one section of this social medicine class and the way it works is it's one day a week. There are faculty meetings including tutors and the faculty of the course every day, and then there's lecture typically, and then there's the tutorial so it's like a three hour block. [00:11:47]

I don't know whether the tutor's routinely come but at a certain point when it became clear that there was really no place for me within this system for the first couple of weeks after that I was going to tutor meetings. And then it was so difficult to go there. I just felt really, really bad. I felt very alienated and angry maybe is part of it. It was really, really hard. So I stopped going to the meetings. I went sporadically to the lectures and generally speaking just went straight to the tutorial (pause) except for last week. [00:12:43]

So I mean the course directors are Tim whose a historian that I know and Luke who kind of shows up and cracks jokes. I mean I think he's involved in the kind of very high level conceptualization of the course but he doesn't do any of the work. But he shows up and it's important to him. This course is kind of his brain child in making social medicine the kind of mandatory part of the curriculum for all entering medical students. It's certainly something that's important, and I think the course leads quite a few people to the projects that he directs so it's important to him. And whenever we interact in that setting he's kind of nice. [00:13:39]

But the other part of it, I guess, is that whenever I've asked him for anything over the last couple of years with the exception of one time when I had this very kind of anguished response to Justine, as it seemed to me, kind of putting me off when he wrote immediately a very nice message. He just hasn't responded. He's been completely unavailable. So when I hope for his help and support in navigating all of this he's really been hands off. And it may well be that it was partly out of analysis rather similar to the one I just presented that his sense was that I was hanging onto something. I don't know. Like I don't know. I don't know what's going on there. It could be just that it's too much to deal with or whatever. [00:14:50]

So my sense of where we are is that he's been benevolent and kind and not... He's been nice. He's been nice, and he's related to me in a very kind way, but he's not been available at all in the way that I had, I think, hoped when I came back or tried to come back. So last night there was a party for somebody who has been in this group for 13, 14 years. And what I heard from others including Kevin was that she and Luke had an affair and so her I don't know there are complex interpersonal things in this system. But some people came to her going away party which was advertised. She got an endowed chair at a university so she was leaving after this long association and all these complex undercurrents. [00:16:16]

And we've been very friendly she and I. So there was no question of not going and yet it was really hard for me to go because I'm in the process, I guess, of saying goodbye. And as you know I'm not great at saying goodbye. And if there's any kind of truth, or reality, or substance to model that I'm meditating over right now then it would be even clearer why it's hard for me to say goodbye. I don't think I was really conscious of that aspect of this exactly as I was feeling agonized over it. Agonized isn't quite right but (pause) feeling conflicted, I guess, over going but I came back after not going to the tutor meeting, and lecture, and hung out with Jennie for an hour and a half or so and then got in the car and drove back to the medical area. [00:17:38]

And I got there at about half past when it was starting. It was starting on the hour and I got there about a half an hour later. There were a couple of people that I really know and have liked including Lou (sp?) who this summer had kind of interceded and tried to find this alternate appointment for me that would allow me to apply for grants and stuff. I talked to Luke and had received a very enthusiastic response from Luke which...

THERAPIST: (inaudible at 00:18:17).

CLIENT: Well I never heard anything from any of them. And when I wrote to Lou (sp?) over the summer who was trying to finish a book I didn't hear back from Lou (sp?). I never heard from anybody else and so I just left. And Lou (sp?) was like what? But Luke gave this incredibly enthusiastic response. I don't quite understand what happened. And I don't him that it really didn't matter in some sense since it wasn't an appointment that would for me. [00:18:45]

THERAPIST: So you just found out last night about Luke's enthusiasm?

CLIENT: No. He told me before but I was like okay. This summer I said that's great that Luke's enthusiastic, but I've never heard back from Luke. And I never heard back from Luke on this occasion and it's like I have to make plans. So we have this conversation. But I interact with people pretty well, and it was nice, and then Luke shows up. [00:19:21]

And I just have... I don't know. He shows up and I'm standing there with Robin (sp?) whose another person. (inaudible at 00:19:39) and doesn't acknowledge me. And likely it was nothing. It was just you have to say hi to people one at a time otherwise it doesn't work I guess. I just had this very strong response. And I turned to Robin (sp?) and I said, "You know I've got to go a little bit early." And I went past Lou (sp?) and I said, "Yeah, I've got to take off unfortunately" and I went home. [00:20:13]

So I mean, I guess, this was the content that was kind of trying to meditate on last night and over the morning. I had been for a run last night and I don't know I was just chewing on this all evening. I slept, and woke up, and this is what I came up with. It's just that I'm trying to say bye. I mean it fits a lot of things. I don't know. I like single factor analysis. It's kind of my favorite. I don't know. [00:21:07]

THERAPIST: What...

CLIENT: That's why I've been so stuck.

THERAPIST: What was your feeling last night when he sort of snubbed you or at least that's how it felt?

CLIENT: What was my feeling? I felt snubbed. Huh? It's easier to fly at 10,000 feet. I felt like he was mad at me for blowing off all of these tutor meetings. That was the thought that was in my head especially after Lou (sp?) reiterated in exactly the same terms that he had this summer that Luke was very enthusiastic and he didn't understand what had happened. [00:22:12]

THERAPIST: Okay.

CLIENT: That I had done something wrong, I guess, was the kind of construction that was in my mind. I shouldn't have that I should've remained engaged during these last two or three months rather than withdrawing. And then I kind of tried to process that initial feeling or condition I guess. And I'm like well they made no space for me. Like how should I have handled it? At some point if there's genuinely no space I have to start saying goodbye and I guess this was one way of saying goodbye in a situation where there was unusually high emotional valance for me. I didn't want to just go to all of these meetings and just sit there and feel awful and alienated. I mean there's a limit to how...

I don't know. [00:23:27]

This is a rationalization clearly, but there's some truth to it. It made it really difficult for me to go to the tutorial afterwards. I was actually not teaching. In fact, on several occasions when I think I described walking home and feeling almost suicidal if not actually suicidal it was from there. It was from those meetings. So I don't know how much reality there was to this snub or if there was reality to it and whether Luke was... The only possible explanation for it would've been Luke's feeling miffed about this, but there was a real reason for it. [00:24:16]

THERAPIST: It matters a lot more than your reality of it is I think acknowledging...

CLIENT: It's important to me. It's important to me. Preserving all of these relationships felt important to me and it was like a sense of disconnection. It was a sense of leaving. At the end of the day that was what it meant was that I was kind of leaving and that I was leaving without much ceremony I guess.

THERAPIST: You were leaving without any acknowledgement.

CLIENT: Yeah.

THERAPIST: And last night, I think to the rest of this, you sort of did your part in showing up. [00:25:14]

CLIENT: I did. I did do my part and I felt good about that.

THERAPIST: The only reason you didn't show up for the tutorial meeting was because (pause) in a way you were so (pause) sort of hurt by (pause) how you were treated when you sort of showed up in other ways for that institution.

CLIENT: Okay. No. I agree. I mean it wasn't purely a reflexive response. I was aware of why I was handling things the way that I did. And I think in retrospect it was fine. I think that it was fine. And yet clearly I don't know about the substance of it. There is definitely a sense of being left behind rather than leaving. [00:26:34]

THERAPIST: Yeah.

CLIENT: There's a sense of being abandoned rather than abandoning. And there's also a confusion about precisely who moved the first move. You know who abandoned first. Who said the first goodbye and that's important. If I have the sense that somebody else is saying the first goodbye, that's very painful for me. If I then come to the opinion that they're only saying that goodbye because I said goodbye first, then I feel guilty. There's a kind of double bind that I'm putting myself in there I guess. [00:27:35]

THERAPIST: I think who knows where Luke's head was really at, but I imagine you immediately went to (pause) the scenario that he was snubbing you because you snubbed him.

CLIENT: Yes. That is the scenario that I had in mind.

THERAPIST: Yeah. And I think that's because that's the thing that you're particularly sensitive to and have experienced often there. In other words, I'm not saying in reality is wrong. Obviously I have no idea. [00:28:19]

CLIENT: I have no idea.

THERAPIST: But I think it's no accident that that was your immediate thought was that he was responding to your having snubbed him.

CLIENT: Yes.

THERAPIST: Because that's what's on your mind.

CLIENT: Yes.

THERAPIST: And I imagine if you want to go goofy about it then...

CLIENT: Goofiness is...

THERAPIST: Well the chicken and the egg I think in some important way are coming from you.

CLIENT: Yes. Oh I mean 99 percent I don't if 99 percent but something greater than 50 percent of all of this is in my head.

THERAPIST: Yeah. And on both sides. I mean both in terms of the clear hurt that you feel having been kind of abandoned and the (pause) sense of hurt you imagine...

CLIENT: Yes. [00:29:22]

THERAPIST: In those who you...

CLIENT: Feel hurt by.

THERAPIST: Yeah.

CLIENT: Yes. Yes. No, that's not goofy at all. (Pause) I don't know. So I guess what I'm engaged in is what I want to be engaged in seeing a therapist which is trying to make some more productive meeting out of this confusing episode but I don't know. I find myself going large as I often do.

THERAPIST: Well the thing that...

CLIENT: And kind of reflecting on what's really weighing on me you know what we were talking about, I guess, on Wednesday which is why it's so hard for me to just make workplace for myself. Why I can't apply for real jobs? Why I'm so stuck to this group of people that as it happens played a kind of important part in the (inaudible at 00:30:38) process of my family. [00:30:43]

THERAPIST: Well it seems to me that the thing that you sort of struggle with at each step in the problems you describe is sort of (pause) I would say bearing how hurt you feel. And what I'm referring to is I think it was pretty reflective last night after feeling snubbed that you felt you had to get out of there.

CLIENT: That was reflexive for sure. For sure. [00:31:24]

THERAPIST: And I think the other thing that's reflective in it is the sort of projection onto the other party that they're hurt, or snubbed, or retaliating in some way. And I think both of those things point toward the difficulty. They point to how much it really hurts when this happens to you and how you tend to reflectively react to it because its too much (inaudible at 00:32:06).

CLIENT: You think small. (Laughter) It's good. [00:32:15]

THERAPIST: All right. (Laughter)

CLIENT: Okay. I agree. (Pause)

THERAPIST: It's probably also part of how you felt when your father died. (Pause) Also I think pretty clearly how you felt at times when he was alive.

CLIENT: (Laughter) (inaudible at 00:33:14) It sounds a little too glib on the face of it, but certainly after he died. I don't know. Like being abandoned and just kind of reflexively turning away from something. I'm not sure what the something is. It's an analogy. I don't know. It's a little different. [00:33:45]

THERAPIST: I see.

CLIENT: I was kind of intensely involved in the grieving process and probably morbidly to some degree. I was very aware of it or my engagement. If that's the analogy then it's not quite right. But I guess what I'm meditating about or monitoring over is whether (pause) I didn't run away what usually comes after you leave home, or a parent dies, or something which is just kind of moving on and making a life for myself. And there I'm, I'm a talented person. I'm 41 and I'm still just sort of struggling to find a place. So I turned away from something or stayed fixated on something that I haven't been able to let go of. And if that's the kind of large version of this small kind of interaction that you're correctly, I think, pointing to then I think that makes sense. [00:35:23]

THERAPIST: I think you go biggest in your head.

CLIENT: Okay. So without going big just in my head trying to follow your association with my father's death, what would it mean? What are you talking about? What do you have in mind I should say?

THERAPIST: (Pause) Maybe there's something you felt last night that was a little like you felt when he died. I know you felt a lot of things when he died but maybe that was one of them.

CLIENT: Maybe. (Pause) Maybe it's totally irrelevant. Maybe we're just looking at a species of interaction that's common, and repeated, and ingrained and has nothing to do with any of this. [00:36:33]

I have an intuition you know. My intuitions are often not bad. They're not always useful but it is an intuition and it does relate to a very practical problem that we're trying to solve. So it's not to be totally dismissed.

THERAPIST: I think the reason it's hard to tell and that you're sort of (pause) waxing a bit conceptually is because it's very painful to feel. In other words, you're saying I don't really know. It's not obvious to me that what I felt last night was one of the things I felt when my father died. And I think some of the reason it's hard to tell is because it's hard to feel. [00:37:41]

CLIENT: Now you're going large I think. You know my pretty clear sense is that... Well we know that there's some relationship between the two because of this episode after I got back from (inaudible at 00:38:03) that one time in April when I felt like I was being snubbed in really a damaging way. I mean I'd never had it when my dad was dying; just this wail of grief. You know it was overpowering. I must've been pretty scary for Jennie. I just sat there for three minutes and bellowed. And it was unmistakable. It was unmistakable as anything but grief. [00:38:37]

So at some level there is a relationship between the way that I process or did not process, and point of fact, the death of my father. I was hyper aware of it. I cried. It wasn't like I was kind of frozen. I cried but never anything like that. And the one thing that provoked that particular response was the sense of being cast out or rejected by this group of people. So we know there's an association there. [00:39:22]

But having said that, and I guess by the same token, I never had that response when my father died. So in some sense the analogy doesn't work. It works in reverse of the way that you would expect it to. The expected response would be to feel very sad when somebody cast you out and feel this intense grief when your father dies and, in fact, for me it was reversed for reasons unknown.

THERAPIST: (Pause) What does the grief bring to mind?

CLIENT: What is it?

THERAPIST: The grief bring to mind. [00:40:12]

CLIENT: (Pause) The truth is what comes into my mind is just a few interactions all of which were extremely nurturing and kind. You know meeting Justine a couple weeks later. An exchange with Luke. My interaction with Jennie; you know that moment. Those three I guess. [00:41:09]

THERAPIST: (Pause) Being treated kindly?

CLIENT: That's what comes to mind. I mean I don't know. I still don't know what to make of all this. (Pause) I genuinely don't... As you said, in some ways I certainly haven't been catered to. It's been pretty rough to the extent to which I have not been able to find or get a place or foothold. But I feel completely un-angry I guess as I think about it. I don't know. I mean I don't feel angry, and I don't feel guilty as I think. I'm just sort of trying to relay my... Like I said I'm having more emotions than sort of... What's coming to mind is more feelings than interactions, or episodes, or thoughts. But I don't feel angry as I think about this not in a fucked up way where I'm just sort of avoiding something that's painful. I genuinely feel a sense of bewilderment about all this. It feels very complicated and unfathomable still. I feel like I want to understand better and I want to respond to it. There is a practical problem here. [00:42:58]

THERAPIST: Yeah.

CLIENT: But I don't feel like... I feel benevolence. I feel like our 45 minutes is probably up.

THERAPIST: Yeah.

CLIENT: Okay. So Wednesday. I didn't bring anything.

THERAPIST: I'll be here.

CLIENT: Okay. [00:43:34]

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