TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: So...so we were in the middle of observing an episode on Wednesday?

CLIENT: I don't think I described in much detail kind of what it feels like, just sort of generically. One of the things that happens is I sweat a lot. Another thing that happens is I gag a lot; my gag reflex is very frequently activated, a lot. It's how I know when I'm feeling stressed out cause I'll just start gagging as if I were nauseous. [00:01:11] I talked a little bit about the tunnel vision, it's as if there's no horizon, it's sort of compressed to a point, no focus. Relationships become very cement, sort of there's simplification of the meaning of interaction, the kind of context of interactions. Jennie (ph?) has kind of a running joke because when I'm feeling this, there's like something that I guess for a long time I wasn't even aware of, like a term of art, I would say "Yeah I had a really complicated series of interactions, I should know that I'm actively feeling...this anxiety about these relationships." Relational anxiety. [00:02:24] When I say that I think what I'm stealing is just a sense that, you know, my place is in the process of being in a place where I imagine sitting or would like to sit and feel that it's my right somehow to have room to sit, that place is being removed so I won't have any place and maybe I guess figuratively you can imagine that these physiological responses, this compression, there's a sense of compression in my throat, in my vision, perception of my body, it just feels compressed as if there's no space. Space is just being progressively niched until there's nothing left. So when I'm actively feeling that, it's one thing and on the other end of it there's this sort of surge in energy. [00:04:05] (sighs) Which is also part of...because I was exploring (inaudible). (pause) [00:05:30]

THERAPIST: Um (pause) Well I'm not really sure what to say about it. [00:06:46] (pause) What is it...it's sort of a bit of a leap or reassuring or like a pleasantly calm thing to be able to like come here and talk with me about it.

CLIENT: I don't feel reassured at the moment. I feel very concerned, in fact as soon as I had said that you were reflecting, I was completely elsewhere in this complicated series of interactions.

THERAPIST: Wait, sorry, you were what?

CLIENT: (inaudible)

THERAPIST: You were elsewhere in this complicated...

CLIENT: In this complicated series of interactions. (over talking) I said deliberately and I was being facetious.

THERAPIST: Right.

CLIENT: No I mean I was just off kind of feeling. Feeling this, feeling it, it's kind of there. I was feeling displaced, I was feeling...thinking about you know, about these politics and the prospect of not having a place and the difficulty of interacting in this very instrumental and in many ways...I mean the kind of self-promotion that's necessary, that people engage in, the insincerity, etc. [00:09:04] I was just kind of feeling the weight of it and it happens to trigger this very deep, abiding anxiety that I have about being displaced. These kinds of interactions specifically trigger that anxiety and so I'm aware of how it functions but my ability to respond to it in the way that I would like is really impeded. It's impeded by that anxiety so on the one hand I think this could be probably generalized, I was talking a little bit on Wednesday about this strange kind of paradoxical set of impulses I have that on the one hand to gravitate toward these very high powered, self-promoting systems and on the other hand this sense that A. they are corrupt, I object to them and B. that I have a difficult time functioning within them because of this...I suppose at some level it's hard to separate, maybe impossible to separate, what's kind of constitutional like I'm made anxious by this kind of interaction and what's normal events like, I think's kind of a direction that's bullshit, people should interact in a different way. Do you know what I'm saying? In other words the fact and the value are kind of unclear, whether it's because I'm anxious that I feel judgment or because I feel judgment that I'm anxious on some level, it kind of doesn't matter. [00:11:12] But I have difficulty navigating these places that I've insisted somewhat unreflectively at times in navigating. I keep coming back.

THERAPIST: Right.

CLIENT: And I'm very good at analyzing it, like I have an acute sense in the moment of what's going on. I'm not stupid but for this kind of symmetrical reason the judgment and the reality of my anxiety, I can't act very well on it, on that analysis on that observation of what's... how these political interactions are taking place and I feel the burden of that so that makes me dependent, like if I want to remain in the system the only way to function with that when I'm handicapped this way is through relationships and even right now, for example, I'm dependent on how I can protect my space, the space that we've been spending the last few weeks kind of imagining and I don't know if he's able to A. or up to it B., but I'm going to kind of find out in an hour or so but I really fear that he's not either able to A. or B. just sort of constitutionally dispose to serve that role. [00:12:56] You know...which leaves me feeling very anxious. (pause) [00:14:05]

THERAPIST: What was it that he did, it was Sunday I think, that sort of settled you down following the last intervention I did? It was (sighs)...it was just the interaction. Really?

CLIENT: But also some things hadn't yet gone into motion so now there's a parallel process that's not at all controlled from the president's office that you know has just kind of gone into motion, this kid has sort of (inaudible) to it.

THERAPIST: Mm hm.

CLIENT: So...

THERAPIST: (inaudible)

CLIENT: Yeah. And you know, I mean it's fine. (pause) [00:15:35] So anyway, I mean I feel the concern that I talked about on Wednesday. I think in a slightly less manic way, maybe it's because I'm now back on the downside of it although I think in our interaction, other than the tendency to become just sort of lose the track of the conversation, which is another feature of this (inaudible), I guess I'm kind of back in the downside.

THERAPIST: Yeah.

CLIENT: I don't have the sense of articulateness, I don't have the sense of (pause) energy. Our relationship is on a sound enough footing that I don't feel acute anxiety about this interaction in particular but I don't feel fluid. [00:17:32] There's a sense of fluency that comes from this other side.

THERAPIST: Do you feel like... I guess somewhere in between that and the kind of really constrictive state we were talking about at the beginning?

CLIENT: Yeah, yeah. But I just sort of, intellectually I feel the concern.

THERAPIST: Right. (pause) [00:18:44] Yeah I mean you feel a little shut down.

CLIENT: I feel a little shut down?

THERAPIST: Like, um...

CLIENT: I guess, yeah.

THERAPIST: Yeah like you can't quite think your way around what's going on and hope it's going to be okay and (pause)...

CLIENT: Well I mean you know I feel this urgency, I feel this urgency and I feel like this process we're engaged in addresses some of it but there's this kind of acute response that it's not addressing. [00:20:06] And I'm not sure what to do about that. I mean, I'm not sure how to understand it in the...I'm not sure how to understand it. I'm not sure if it means I need to try something else or that I need to stick with this and ask your advice about what else might be helpful...just stick with this and kind of wait for it to play out? I feel really concerned by the kind of acute nature of response and I feel just exhausted by it. I'm so exhausted. (pause) [00:21:34]

THERAPIST: I (pause)...there's um (pause)...it's tricky. It's sort of like now, you're in part having a reaction to what's going here and how helpful this is or can be and the way that's not sort of touching this experience of terrible distress that you have when these things happen with work. So there's kind of a...there's something going on there but I don't, it doesn't seem like it's quite the same thing that happened in the first place and that's kind of what I'm trying to puzzle out, if that makes sense.

CLIENT: It doesn't seem like it's quite the same as what happened in the first place.

THERAPIST: In other words, what happens at work is something threatens your place.

CLIENT: Yeah.

THERAPIST: And you sort of constrict or shut down and get really anxious.

CLIENT: And your sense had been that there was a symmetrical process at work here and you don't see the symmetry...?

THERAPIST: Well it's not, it's related but it's not the thing, it's not as simple as the same thing happens here.

CLIENT: I don't know. I don't know why it's necessary to imagine that what I'm telling you is like some anxiety response, it's actually a practical concern. [00:24:03] It's not...why would one even look for symmetry? It's not, I'm not...it's a genuine question, it's a genuine concern, it's like a therapeutic issue going on.

THERAPIST: Because it's a genuine concern that always comes up in this way when you're feeling like it's because of work and in the past anyway has often involved, probably more dramatically than now, kind of forgetting about...

CLIENT: No I don't forget anything. I see what you're saying but I don't forget anything, I think I was pretty explicit about this on Wednesday, you know, I think the process has been extremely rich and helpful and I hope it will continue to be so, I'm not...I don't have difficulty accessing that at the moment. I feel a genuine concern about the issues I'm scratching.

THERAPIST: Right.

CLIENT: And you know just kind of the acuteness of the distress that it's not addressing. That feels like a really practical issue.

THERAPIST: It is.

CLIENT: Now I sense that it's not in some sense designed to deal with that, this kind of therapeutic interaction is not designed to deal with these acute episodes. Maybe I'm misunderstanding what our objectives here are and the parameters of the exercise are but I guess I kind of I'm back to the question...

THERAPIST: Do you have something in mind that could?

CLIENT: I don't know. I don't, if I did I probably would have gravitated toward it a while ago. My sense is whatever it is, is not very easily addressed by the usual kind of instrumentalities.

THERAPIST: It's not an instrumental problem.

CLIENT: It seems not to be an instrumental problem and yet what we're doing, it's still there. This week I really, really feel it.

THERAPIST: Yeah.

CLIENT: At this moment I really feel it. [00:26:24] I feel exhausted by it, I feel troubled by it, I feel concerned by it. I'm going to have a baby in the fall if it's on schedule and I'm still struggling with this and among the things that are very difficult because I'm struggling with it is job applications. I just can't imagine myself functioning in this way in a completely new environment. It's terrifying to me. So I feel the stress or strain or pressure of being able to provide for a new little one. So I just...there's the acuteness of...symptomatic acuteness, there's the knock on effects of that kind of acute strain and distress, just fatigue and exhaustion, what have you. There's the interference of that with various kinds of processes that are important for sustenance of the household and I feel urgency at all of these three levels and probably five more to deal with it and I feel concern that these very rich interactions that we're having are not dealing with it, they're not taking away the basic feature, which is the distress and my response to it. [00:28:12] That's practical. I don't think it has to be artifactual.

THERAPIST: Well, I think it's both...

CLIENT: Sure.

THERAPIST: In that (pause) it feels to me like there is a sort of an "I don't know the way out of this but I'm just going to frame it how I see it and go from there I guess." It feels to me like there's a bit of a collapse of the process in that when you get to this point of distress you talk about how this isn't working and how we're not addressing what your struggling with and that conversation seems to take us away from the...it points to or alludes to the intensity of your distress and pain which is horrible and hasn't been fixed. I'm not disagreeing with anything you said but there's a way that you kind of turn to and evaluate...turn to how this isn't working at these moments of distress that also kind of feels like that your saying "Ouch, I need some help" but at the same time there's something about talking about how it didn't help, you're not getting help, that seems to turn away from like an exploration of what's going on perhaps.

CLIENT: We've been exploring what's going on, I mean I guess I'm focused on something that we've wanted to me to focus on which is just sort of the immediate feelings associated with this which I'm sometimes divorced from so that's part of the process and...

THERAPIST: Right. I think there's probably something going on there between us where you focus on and absolutely it is something you often have not been able to access and it is important and it probably are fantasies that relate to the physical feeling that you're having which you started to touch on in saying "It feels like I'm holding myself in" or "getting constricted" and that the physical feeling fit right in with the metaphor of being squeezed out of my place. [00:31:32]

CLIENT: Yes.

THERAPIST: And that made sense to me and I found it quite important and I imagine there's more there, though I'm not sure what it is or what you have to say about it but I wonder if it felt to you that I dropped the ball a little bit in not responding and you had just said it was this important thing that we both recognized, something new you're kind of accessing now and you haven't before and I didn't really respond to it?

CLIENT: Yeah I guess thinking back on my side of the conversation there was a little bit of that although I was coming because of my description of it, I had suddenly been vaulted, I suddenly vaulted into the thing itself, I was coming back from a distance (over talking).

THERAPIST: You were not back in it in the way that you seem to be since we started talking I don't think.

CLIENT: I was not back in.

THERAPIST: Maybe I'm wrong but my impression as you walked in, as you said what you did about the physical feeling, was that you were not quite in it, yet you were remembering it.

CLIENT: And then I was in it.

THERAPIST: And then you were in it. [00:33:15]

CLIENT: As you were reflecting the reflection that ultimately produced the kind of...what I think you're describing...

THERAPIST: Not much.

CLIENT: As you know, not much.

THERAPIST: Yeah.

CLIENT: I was in it.

THERAPIST: You were in it.

CLIENT: It was happening while you were engaging in that reflection.

THERAPIST: Yeah maybe (over talking)...

CLIENT: It didn't produce much of a comment. Where I was at that time was there.

THERAPIST: Yeah.

CLIENT: Exactly.

THERAPIST: And so that actually reminds me of interactions we've had and talked about before though not recently where you have missed a very clear feeling of doing your part, both here and at work and then not getting it back in a good way. In other words...

CLIENT: Yeah.

THERAPIST: I guess my impression is that's probably what you felt, like "hey, I'm here doing the work. I've come up with this important thing and I've put it out there and where are you?"

CLIENT: Yeah.

THERAPIST: I imagine it was that that contributed to putting you back into it. [00:34:41] A part of it anyway I think. The way it's sort of occurring to me like you are not well met in a way which you weren't. I'm not...

CLIENT: Maybe I mean the truth is that as you were talking just now I was back in it again and you were being perfectly engaged and engaging, I'm not sure you can take responsibility for that. I do remember remarking on the fact that your reflection of that particular moment didn't produce anything. I don't think...

THERAPIST: And that it was coincident with your getting back into it, having not been in it.

CLIENT: It was coincident with my not getting back into it, having not been in it?

THERAPIST: Yeah.

CLIENT: I don't know. Coincident?

THERAPIST: Yeah. Occurring at the same time.

CLIENT: Just happened to converge?

THERAPIST: Yeah. So...and that is not an experience...so what you're saying is "Look Marshall, you're not having met me well and that moment may have something to do with...maybe it doesn't cause even now as your talking I'm getting back into it and you do seem to be right there and addressing stuff and yet I'm getting back into it." [00:36:31]

CLIENT: Yeah. If we're looking for symmetries, here's the symmetry potentially that I see.

THERAPIST: Yeah.

CLIENT: I think the point of intersection is this metaphor of being squeezed or constricted.

THERAPIST: Yeah.

CLIENT: Can this help me? Is this a process that can help me? Is this a process that can accommodate me? Is this process in which the space that I need to inhabit in order to deal with this acute distress is going to be served? That's the symmetry there frankly. When I feel as if it's not, when I have concern that it's not, regardless of whether that concern is the product of a reality based function or not, it may well be, I think it's a genuine, practical concern. Any therapeutic approach or interaction whether it's working or whether it's useful or whether its...it might be useful for some things but not for the thing you really worry about but that sort of structural or symbolic attribute, character, fits very well with this sense of constriction. [00:38:15] I think that's where it is. I think that's the symbolic intersection of the two phenomenon.

THERAPIST: Well I have two thoughts. One is (pause) ...

CLIENT: Serious (inaudible) voice.

THERAPIST: Let me go to this one first. I think that (pause) I guess I don't think it's as simple as that being a practical consideration...the symmetry or the parallel goes further in that I think you have that reaction in a sort of intense way in a sense grows when circumstances provoke it. For example, you come in with something new and important, I don't say much, you then start to have doubts about whether this can help you and can address this problem and you go big and you start to feel shut down. In other words...

CLIENT: I guess I'm not seeing the intervention here. [00:39:50]

THERAPIST: It's very clear in the way this unfolds in a work setting that in some sense your reaction can be out of proportion to what's going on. Like "Steve's an ambitious, young, douche bag" and you feel threatened in a way that you also recognize you really don't need to by him. Right? So and we can both look at it and say that is was triggered and this is what happened and duh, duh, duh but as much as there is an important reality, we can also say you're feeling threatened in a way you don't need to be by this particular interaction with this particular guy. Am I clear so far? Except only in here like...I know it's a running concern of yours and it's not sort of new in the moment but you bring in something important, you say something about it, I don't have much to say about it and all of the sudden your worrying about whether this can actually really help you with this problem at all. [00:41:00] And...and your feeling kind of shut down and you can't quite think as clearly as you could a minute before like similarly to the work situation. It seems to me like you've gone very big with those worries in the wake of a sort of, kind of a micro interaction. I'm not saying that the issue your worried about isn't important and isn't a thing...

CLIENT: The interaction was micro but the response was not micro.

THERAPIST: That's what I'm saying, yeah.

CLIENT: Well...

THERAPIST: It's kind of like...

CLIENT: The way that I understand what you're saying is that I'm going big here in our interaction and my presentation of what's going on. The bigness is not the trigger for the sensation or state of being or what have you, the bigness is the state of being and the state of being is...the stress is extreme so it's not that I'm going big and just kind of I don't know, being histrionic, it's terrible. I wake up...

THERAPIST: That's not what I...Okay let me put it in another context. [00:42:29]

CLIENT: I'm clearly not getting something.

THERAPIST: It sort of...let me try one more time. Maybe I'm just not explaining it that well, that's something else it could be so let's say and I'm making this up that your writing your dissertation and you have a bad day, its unproductive or whatever and you're like "Shit do I even want to be doing this?" and you feel anxious and terrified and the whole enterprise is useless and it's not really going to get you where you want to go anyway and like "What the hell is the point?" Now those are bad questions to ask about almost any dissertation (laughs) I mean I'm in character but you know what I mean?

CLIENT: Yeah.

THERAPIST: Clearly it was occasioned on that day by this particular thing, having a bad time and then kind of a worry that goes big about the whole process and it's frustrating to have a bad day. It's difficult and these are important question about whether the dissertation is worth actually writing or not but there's some way that that's getting a little mixed up on that day where the trigger of having a bad day working sort of gives an urgency...this bigger question that kind of doesn't quite fit. [00:43:44]

CLIENT: I guess what I'm trying to say is that...

THERAPIST: And I'm not saying that either the over concern about the dissertation and whatever sort of physical thing that goes along with it is not warranted, I mean those are big questions, its important stuff, if there's a freak out then there's a freak out and I'm not saying it's not a big deal not to have a bad day working on something or it's not going to go so well but there's some way that they get...

CLIENT: But Marshall I'm not...I don't know. We're talking past each other a little bit I sense but I'm not talking about having a bad day. I'm talking about the cumulative effect of all of these extreme responses to having a bad day and feeling as if, you know, this is what I came to address and it still is acute as it ever was so maybe...

THERAPIST: It isn't as acute as it ever was. It is in the sense that you still have these reactions and they're as extreme as they ever were but it's not in that you actually in this job so far have not shut down in any way that had any consequences for you in spite of repeated little shut downs you've recovered from each of them and you're much clearer about what's going on and you know where as in previous work...you've gotten into a hole and in a way it's the same hole but you've kind of got out of it each time without any actual professional repercussions. In fact...

CLIENT: There have been professional repercussions. [00:45:21] Its possible I feel...I feel the possibility of their being professional repercussions so far as I haven't produced a big thing yet and now this process is starting and it may be that I'm aced out because I haven't put my marker down. I haven't produced a paper. I've produced a draft of something and I know where it can go but I'm having trouble sitting down and working on it and as a result it may be that I feel the prospect of this week being displaced.

THERAPIST: Okay.

CLIENT: I haven't been enormously productive. I've been productive in thinking about a situation in which I could be productive.

THERAPIST: You told me a number of times through the course of this job about things you've produced that have been good, well received, you've been happy with and maybe it was two or three days late but I don't have a way of knowing other than what you've told me, but what you've told me a number of times is " yes, I had a freak out over the weekend, I got it in on Tuesday instead of on Friday when I said I would but they really liked it and it blah, blah, blah," and you were quite positive about it. You said that happened at the time...

CLIENT: Okay so there have been these little freak-outs...

THERAPIST: And you're in it.

CLIENT: So I'm in it. Okay.

THERAPIST: You're in it and I think this feeling of "Marshall you don't understand this is the week it's really all on the line." (laughs)

CLIENT: (laughs) It's a little overblown. Okay I see your point.

THERAPIST: I'm sorry but we also have to wrap this up.

(over talking) [00:47:08]

CLIENT: Okay well there is a practical question that I have, a real question and maybe I should've raised it five minutes ago before we had to stop but maybe we can take three minutes and...

THERAPIST: We actually just took five.

CLIENT: We just took five. Alright.

THERAPIST: I'm sorry.

CLIENT: Okay, I guess the question is just whether I need a referral so maybe I'll give you a ring?

THERAPIST: Okay. For?

CLIENT: I don't know.

THERAPIST: A referral for something?

CLIENT: Well I need to be working with a psychiatrist...I feel concern about all this distress and I'm not sure, I have to go on Wednesday, I'm not going to be here and on Friday I'm not going to be here.

THERAPIST: Oh next week you're gone?

CLIENT: Next week I'm totally gone.

THERAPIST: Oh. Okay. Let's stop for now. Why don't you send me an e-mail about your schedule and what you think you might be looking for and we'll find some way to address it Wednesday.

CLIENT: (inaudible)

THERAPIST: Okay.

CLIENT: Thanks.

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