TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Analysis: There are a few things. One is there are some people for whom it's not really like the... where the intensity can be more... Certainly the only difference between analysis and what we're doing is it's usually four or five times a week and then the couch is used. For some people that degree of intensity is kind of counter-productive, like it stirs up more stuff. As with any kind of therapy it can be upsetting and certainly difficult, but the hope is that that's in the service of growth. But sometimes it just causes trouble, like the person doesn't pull it back together. There are people like that or people who just wouldn't [make any use of it] (ph at 00:01:12) . And then for a lot of people, including you, it's a decision sort of like if you want more emersion, that will do it. (both laugh)

CLIENT: Any more emersion I'm not sure huh. All right. I was just curious.

THERAPIST: Yeah, sure. The couch is a particular... it tends to get one in one's head a little bit more, sort of growing a little more reverie. There are certainly plusses and minuses of not having the social contact and social feedback. It can be easier to say certain things and feel less self-conscious in some ways. You also don't get the reassuring sort of visual back and forth that we do.

CLIENT: Right.

THERAPIST: Sort of leaves more to the imagination I guess that way.

CLIENT: Right. [00:02:30] (pause) So where does today begin? I felt like I was a thread that was sort of dangling on Wednesday. (pause) [...] (inaudible at 00:03:13) The process at the bank is interesting. On Monday I think I mentioned or Tuesday, it was before our meeting so I probably talked about it, although I don't remember. We had had a long-awaited conversation with this team that we're interacting with that I'm a little skeptical about on the convention they reported that the process that we've been talking about for the last month or so I had been engaged to work with them on was going to be submitted to a kind of panel of senior management. I think I talked about this. From my point of view that was pretty much a pain in the ass in theory, at least, because just on a practical level I'm billing when I'm doing work and this has the potential at least to significantly delay the progress of this work, as well as making the ultimate deliverables kind of murky. [00:05:09]

I also have my usual kind of uncertainties/anxiety about working with other people, I guess, is the easiest way to say it. Having expectations of me from other people, especially when there's this kind of distance. They've solicited things from me and I've delivered them to them and they've not been responsive, I think because they kind of don't know what to do next more than anything else. Also probably because it's pretty hard, for me at least. Maybe other people are better at assembling and it's just a basic aspect of socialization that I don't have. [00:06:12] If I really don't feel much affinity with people when I sort of produce things and interact with them; they'll write something and I'll completely rewrite it rather than, I don't know, sort of half rewriting it. It's like I produced something, I sent it to them, they kind of rewrote it in a way that I thought was stupid and so they asked me to revise it again and I revised it pretty thoroughly. My sense is, or has been, that rightly or wrongly, frankly, I'm concerned about this. I have some anxiety about this in addition to which there's an exchange with Kevin where he mandated that I be a team player, so this is something that I'm unusually conscious about, if not self-conscious about. My sense has been that that might have been from the standpoint of working with this team, a misstep. The ultimate value of working with this team is not clear to me frankly, except insofar as there may be some possibility of a more permanent position past June. The truth is I wouldn't want to work with this team past June. (laughs) [00:07:36] They're just not very interesting frankly. At any rate, I have a sense that there is some coolness there. They've been very engaged and engaging and I feel some coolness there. Most of the likely read is just that there's all this bureaucratic uncertainty and my role given the fact that all of the interactions with the bureaucracy and the senior management, this weird collaborative process is going to have to take place on that end. It's not really I don't have the capacity to interact with that in any very significant way, although I did set up some meetings jointly with them in the city in a couple of weeks. [00:08:37]

THERAPIST: Meetings jointly with...?

CLIENT: With people that I know here who work on things that are tangentially relevant. The guy who directs this team asked me to he said he wanted to meet such-and-such, who are old colleagues of mine, so I said okay. Beyond that, what role I can play and what writing process there would be to engage in in the next three to four weeks likely is unclear. From my standpoint the tactical problem insofar as I have a two contracts now, one through February, one through June. If I'm not working then the days that were allocated in the space of those contracts are expiring, given the way the accounting works, so it's actually a financial hit to me. [00:09:30] In addition to which I want to be doing work and I want to be doing productive work and, quite frankly, my strong sense is that it's really not a very good thing for Kevin and for the administration for this initiative at all to be diverted into this bureaucratic morass. It's actually kind of a bad sign in my view that this should ever really be subject to such a committee of people who have a lot of ulterior motives and potentially could divert it in uninteresting and unproductive ways. At the practical, fiscal level, at the intellectual level, at the strategic level at all of these levels this is a development that is kind of frustrating. [00:10:40]

After our conversation on Wednesday, Wednesday and much of yesterday Wednesday in particular I was feeling pretty stressed out. It was like, "What am I supposed to be doing now?" Thursday I got up and I kind of took matters into my own hands a little bit. I had had a scheduled conversation with Jack on Wednesday and he just wasn't answering. I got very, very nervous in my usual way. The absence of communication made (laughs) vocations for my visits for psychoanalysis. The absence of communication was extremely disturbing to me, being stuck on the couch so to speak really was a bit traumatic. I began imagining that I had really somehow genuinely fucked things up in not being deferential enough to this team and there wouldn't be any place for me. I had submitted a bill and the bills that I had submitted are for outrageous amounts by my reckoning. So I'm like, "Oh, did they see it," and I'm thinking to myself, "Oh, they're not being responsive. Was submitting a bill the wrong thing to do given the uncertainty?" Whatever. [00:12:12]

THERAPIST: You really got rolling.

CLIENT: I really got rolling. There are all kinds of reference being created to the basic feeling or sensation which was sort of uncertainty. At the end of the day, that's what it was. We'd reached a kind of point where we had to figure out how to respond to unexpected events Jack and I.

THERAPIST: Can I make a very brief comment about your comment? This is sort of taking off from your comment about the couch, not that analysis is the point here, but that actually speaks to your fitness or something like that; and yet the thing that you have trouble with is not that when you don't get that kind of feedback the person actually isn't there, the problem is that it feels so strongly like the person isn't there, even though they actually are. [00:13:15]

CLIENT: Yeah. No. I totally agree. Maybe occasionally they're not, but my sense is that generally speaking, it's like the response is far more traumatic and in some cases damaging than the actual condition. So I agree. I totally endorse that. At any rate, there was this real uncertainty and all of a sudden we had a plan, we had been proceeding within this framework and we were improvising, naturally, but we kind of had an idea of how it might go and what I might need to produce, what the deliverables would be and then all of a sudden the deliverables are thrown into data. So Wednesday was really tough. It turns out that Jack's aunt had died, and so he wasn't communicating specifically because of that. Whatever. We have great rapport and a great working relationship and interactive style and he's been extremely responsive and I should be grateful for it, so there's no reason to assume that even if there was something of the sort that I most feared that he would respond in that way. It just wouldn't happen. This is not a kind of rational assessment of evidence and process or hypothesis, it's a reaction kind of reflective response. [00:14:53]

I woke up the next day and was still feeling pretty stressed out and affected and still not able to run, for example. I talked about it on Wednesday, I think. At a certain point in the day I kind of sat down. Actually, more or less first thing in the morning I sat down and the first thing I did was I wrote a note about deliverables. I said, "You know, I've been thinking about this and I think it's important to have a deliverable for the consultancy, which ends on the 28th of February. What would you think if I drafted an article?" et cetera. I described it a little bit. Then I began setting up interviews. I wasn't hearing back from people and Jack at a certain point in the afternoon wrote back this is yesterday and said, "Let's talk." At any rate, I began suggesting things and I began setting up interviews and I began sort of going through and synopsizing some of the materials that I found the archival research that I'd done, et cetera, et cetera, et cetera. Jack began to respond and he said, "Sorry, my aunt's death and family... sorry I didn't get back to you yesterday. Can you talk at ‘x' time?" It turned out I had an interview. Whatever. Between one thing and another it was the end of the day before we were able to speak. Throughout that period at some level I was still feeling really stressed out. In fact, Wednesday night Jennie (sp?) and I went to a salsa dancing lesson and I was really so stressed out that she was concerned. This continued all the way up to the time that I talked with Jack. [00:16:55] I really felt a strong sensation with no rational thought process that I could somehow interpose that I was just going to be dropped. I guess that's probably the most succinct way of putting it. I felt like I was about to be dropped. He had written back a message saying something like, "Yeah, we've got lots to talk about," in response to these propositions that I'd made.

THERAPIST: And you decided [...] (crosstalk at 00:17:29)

CLIENT: Yeah. In retrospect, it was a very typical and very familiar but very baroque way of parsing information. So anyway, I've perseverated at length about this when it's not especially unique or novel, it's just kind of one more brick in the wall, but I don't know. It was just very striking and very familiar and curious in a way because there's no reason for it. There was really no reason for it. There was some uncertainty. It had to be managed and we had to deal with it but basically, Jack said, "Yes, that sounds like a good idea. We need two tracks. There is this bureaucratic track and we have to kind of let that play itself out. That's kind of what's going on right now, but I agree with you that we need to produce something and that production, that articulation of the ideas can't be captive to all of these cooks." Mixed metaphor. (both chuckle) I can't be captive to all of these savages. "That sounds like a good idea. Why don't you just start working full time on it?" which is exactly, obviously, what I wanted to hear. I don't know. It's just curious. It's not novel. It's not unprecedented. It's not even unusual, but it's curious. [00:19:14]

THERAPIST: I think part of your effort in describing what happened is towards one of us being able to make some contact with the part of you that actually feels that way. Do you know what I mean?

CLIENT: Yeah. Totally. I mean, you know. (sighs) I guess I feel like I have contact in the sense that I remember very intimately what I was feeling. I remember kind of what I was computing as evidence for this conclusion, but why I should think that I feel a little puzzled by or how I should think that. In other words it's weird it's like there's this loop or this pathway or whatever metaphor you want to use for it that gets deployed in situations where there is this kind of uncertainty. There's this kind of uncertainty in relationship to somebody, there's uncertainty in the future, there's uncertainty in all kinds of things, and it just gets deployed. That is a puzzle to me. That I don't have contact with. [00:20:49] I would love to be able to divert that either at the point of departure in the extreme, and this analytical maybe analytical isn't the right word... [00:21:19]

THERAPIST: There's some kind of solidity in the contact that you feel even with Jack that's missing for you and clearly it's not because of how you actually transact or anything that's happened between you, but still it's missing. I wonder if possibly the right metaphor for it is what you were describing with this other group that you've been working with and how any work product that you actually do that matters or at least the one that you're working on that matters gets submitted to this kind of senior managers who are all going to have their own opinions and who are one step removed from you and who are going to make some... [00:22:28]

CLIENT: But it's even worse than that because it has to be their creation, so I can't write something down and show it to them. That was a strategy that they explicitly rejected. In other words...

THERAPIST: You wrote something and then the guy from this other team shows it to them and then...

CLIENT: No, no. The way that it would work in theory would be that they would sit around with these senior managers and have a conversation. On the basis of that conversation they would come up with some key bullet points. On the basis of those bullet points they would draft something. In theory, potentially, depending on how our interaction was going, they would then send it to me. I would do something with it. They would reprocess it and take it from there. It would just go through a million different iterations, most of which I wouldn't have any control over. I mean they wouldn't be using me very well through this process. [00:23:31]

THERAPIST: Right.

CLIENT: It's not like what I created would be subject to...

THERAPIST: I thought that's what you were hitting on.

CLIENT: I am, but these are not things that have been sent to senior management. These are just things that have been submitted to them and some of them are not native English speakers. Apart from the intellectual component, they just cannot evaluate what's good prose.

THERAPIST: It's like more fucked up than I thought.

CLIENT: Yeah. If I really had to be bound to them, why they're participating in this is frankly a management failure to my mind; but apart from that, yeah. If I was bound to them it really would just be a fuck-up. It's a total waste of the money that they're paying me, frankly, because they keep on reprocessing it in this sort of stupid way. (pause) [00:24:56]

THERAPIST: Is that part of the fantasy, even when something happens with Jack, that all of a sudden you're in a situation where he's being swayed by these sort of interests outside of the interactions the two of you have had?

CLIENT: Jack is not being swayed by any interest. He is finishing up the same time my contract finishes up in June. He's going off to medical school at the age of 50. I told you this story. It's kind of an inspiring story, I think.

THERAPIST: I don't recollect...?

CLIENT: I didn't tell you it? Oh. Jack is an amazing guy. He was a professor at a college or something like that, and just decided he didn't like it.

THERAPIST: What did he study? [00:25:48]

CLIENT: What was his specialty? I don't remember. I don't remember what exactly his specialty was. He got his PhD at Yale in the philosophy department and taught for a few years. I think he was genuinely well liked but he just didn't enjoy it. He was doing public health work for a number of years. We had collaborated on a book even before [he finished.] (ph) At the World Health Organization he was one of the principle authors there was a commission on social deterrents of health and he was one of the principle authors of their report. He works for Center for Health and Human Rights for several years. He and his wife moved to DC because she got a job. She kind of followed him for awhile and then he went back and followed her and he decided that he was tired of being a kind of pet for hire. He wanted to go and get a nursing degree so he went and did all of the post-back stuff and just discovered that he really loved doing it so much that he didn't want to just get a nursing degree, he wanted to get a medical degree. I think it took him about three years a really brilliant guy. I think it took him two years to finish all the prerequisites after having not taking that since high school. [00:27:34] Concurrently with being an advisor to the president, a full time politically difficult job, he's been finishing up the last credit requirements and applying to med school. Just about everybody he applied to said yeah. So he's heading off and he really doesn't give a shit. We're very [suguonago] (ph?) on this score. I can't imagine I would have any genuine fears of him being in sympathy with these bureaucrats. [00:28:12]

THERAPIST: Well, you've got fears of him of some sort. I don't necessarily mean that when you're worried he's actually going to tell you that you're fired, you think it's because he's been talking to the other people. It doesn't sound like that at all, but you've got some idea.

CLIENT: Somewhere.

THERAPIST: Yeah. About some other interest he's beholden to or some other judgment he's having that's entirely apart from what you've seen in your interactions with him that gets a terribly strong grip on you and makes you very anxious. [00:29:04]

CLIENT: I guess that's one sort of illustration of the causal chain that there's some construction that I have that is leading me to this conclusion.

THERAPIST: Sure.

CLIENT: Some sort of hypothetical on analysis of interests and relationships that leads me to this conclusion. The other is I don't think they're necessarily mutually incompatible but another way of thinking about it, at least, is that I have an anxiety and I populate it even with things that aren't really motivated. In other words, it kind of comes together out of nowhere even when it doesn't make much sense. [00:30:02] For example, I used to have this kind of anxiety I remember it with my sister or my mother. I don't know what possible hypothesis would associate them with I'm just saying that the most intimate, reliable, unproblematic I don't know if you can call a relationship in the family, close family member an unproblematic relationship but you don't think you're going to get cut out except that I do. So I guess one of the things that I wonder and this seems like an important decision about how to understand things, regardless of whether you make a definitive assessment at any given point in time is whether this process starts with a kind of hypothetical understanding of relationships or whether it starts with a feeling and just gets populated, even with things that kind of don't make sense. You have very strong feelings about this? [00:31:21]

THERAPIST: Yes. I'm starting to get this "door #1".

CLIENT: Why?

THERAPIST: For a few reasons, one of which is that it's a very specific anxiety. It tends to come up precisely with the people that you're closest with and can rely on and have been able to rely on, if you think about it. Also it just tends to work that way. (chuckles) It's triggered by very specific events. I guess there's another reason. You don't hear back from Jack. It's not like you were generally feeling anxious and then you didn't hear back from him and then all the anxiety went there. [00:32:26]

CLIENT: Well, I don't know. I would like to I don't know how useful these ruminations are, but I have a model for better or worse. My model is kind of a childhood-development model and it has to do with whatever the way in which these things are sort of created, there is some sort of attachment issue. There's something about being abandoned, feeling like people are leaving, so when you say there is a very specific I can't remember what you called it anxiety or fear or something, to me it's specific in the sense of relating to people leaving and people being present rather than to just sort of a free-floating anxiety. But it's not specific in its attachment to any given individual person. [00:33:38]

THERAPIST: I wonder why you get so worried that people are going to leave you and when there is a hitch and a hitch that later looks fairly minor or clearly explicable in other ways, you get terrified that it's because the person has dropped you in a kind of personal way.

CLIENT: You wonder why?

THERAPIST: Yeah.

CLIENT: (pause) I don't know. I guess that's a good question. I mean I guess what I imagine to be the case, and I don't know how well I've interrogated this, is that there are some permanent hopefully not permanent but long-lasting changes in one's orientation to people as a social being that results from certain ways of being brought up. [00:35:20]

THERAPIST: The question you're answering is, "How could a person in general develop this sort of response?"

CLIENT: I think that I did. I think that I did.

THERAPIST: Right, but I'm asking about you.

CLIENT: Okay. You're asking about this specific precipitating event?

THERAPIST: Yeah, in order to have you regulate it well when too much stress is put on.

(crosstalk)

CLIENT: I have vague ideas about the kinds of things, as you just said, that might precipitate this, some of which are vaguely, broadly consistent with my vague understanding or partial recollection of the way that I was as a child, but specifically? Can one even demand this level of granularity of...? [00:36:22]

THERAPIST: Yes, and here's why. Not that you have to do some archaeology and find out what happened when you were three, but because this just happened Wednesday and yesterday. And you had some fantasy which remains unconscious which is fine, although it's causing [...] (inaudible at 00:36:54) about why Jack would drop you like that. It really felt, I gather for quite a while until you talked to him, quite disturbing. You were preoccupied when you were dancing, you couldn't go running, which is very dramatic to be so anxious that you couldn't go running. Some part of you was very sure that this was it and it was terrible. It wasn't even when Jack said, "Hey, I'm sorry. I had a death in the family," that wasn't even what ameliorated it. It wasn't until you talked. [00:37:45]

CLIENT: It helps.

THERAPIST: Right, but it didn't fix it until you guys actually talked and you heard that he was on the same page. Clearly there is some kind of idea you begin to have when there is a bump like that about what you mean to the other person or how quickly their opinion could change or maybe it's just this is where I was going before but maybe it's not right maybe there's something you actually never knew about where they were coming from.

CLIENT: Often. Almost inevitably. [00:38:38]

THERAPIST: Yeah like, "Oh, my God, he's been thinking this the whole time and I never knew. Finally the shit's hitting the fan and now I see how it really is," or something like that. There must be some ideas like that that play an important part in how you're feeling. Okay, I'm willing to sort of put aside the kind of meta-issue of does the anxiety come first? Does the idea come first? Is the idea just an explanation for the anxiety? Is the idea just driving the anxiety? Whatever. Let's say that they do co-occur anyway. Yeah. I wonder what's going on. [00:39:31]

CLIENT: (both chuckle) Let me ask you a strategic question. I think we're probably close to winding up. To intervene, in your view given your approach, do you need to figure this out? Is that a prerequisite? Is that the sequence of events?

THERAPIST: (pause) What matters isn't so much the intellectual understanding of it. What matters is coming to terms with the feelings associated with it. So, let's say, we figure out tomorrow that, oh my gosh, you have this idea that when somebody is gone for a minute it points back to a childhood memory and it points back to ideas in front of it. It's like they're in another room having a grown-up discussion that you're not part of, but is going to change the course of your life and there's nothing you can do about it. You're totally out of control. It would be something about getting ahold of that terror that you feel and sort of getting some perspective on where that was coming from that would make a difference. [00:41:34]

CLIENT: What I couldn't do on Wednesday was get a handle on that. What I could do yesterday was get a handle on it. It wasn't like I wasn't having that sensation, but somehow I managed it a little bit better. Anyway, we can take up this thread next week.

THERAPIST: Good luck in the storm.

CLIENT: Thank you. (laughs) You, too. You don't have far to drive?

THERAPIST: No.

CLIENT: All right. See you then.

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