TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Good morning.

CLIENT: (inaudible at 0:00:22). (pause)

THERAPIST: So I mentioned I think that I'm away next Friday.

CLIENT: Friday, OK. (pause) [0:01:00] So... (pause) I felt at some conscious level I felt better since our last conversation. I felt some sense of release, relief, symmetry. Something that suggests to me that's kind of stumbling in the right direction and yet my sleep is very troubled. [0:02:02] And yet I had a great deal of difficulty doing anything yesterday even though I had a very clear idea of what I wanted to do in exactly the same way that I have when feeling consciously very upset. So, all of it just suggests to me that something complicated is going on.

And Jennie (ph) and I had a fight this morning. Like not really a fight, more of a bicker which normally we're able to resolve before walking out the door at some level. She was being kind of a little pissy. But one of the reasons she was pissy was that she was under slept and I was very restless. [0:03:00]

And so the restlessness is what's on my mind. In other words, on whatever it is that we put our... we were putting our finger on Wednesday and whatever its relationship to these kinds of disruptions in my kind of normal, everyday functioning. Those disruptions themselves have kind of independent significance and urgency of resolution. And it's not... and I think one of the questions or dilemmas have been very urgent to me in the last few weeks has been this issue of figuring out how to address them while giving time to resolve this other track. [0:04:15]

In other words, on the one hand there's some relationship. I'm clear on that. On the other hand, even when it feels like we're making progress on figuring out what this sort of thematic... figuring out via this thematic approach or whatever. I mean this relational investigation. What some of the things that might be behind it. The fact that there are these very concrete implications... I don't want to say implications. You see why I'm kind of fumbling around here. [0:05:02]

In other words, I sense that they're related. I sense that there's some relationship. I also sense that they have independent kind of ontology. And to some extent, it may just be kind of the way that I'm wired. To some extent, it may be a direct outcome or through some complicated interrelationship of what we're talking about. But the urgent thing to me is partly these things.

THERAPIST: Sure.

CLIENT: And so on the one hand, I feel a sense of accomplishment at some level. And I feel relief from that process. But on the other hand, there's... this is still happening. It's like we haven't... the fact that we've... I think I sense had some kind of insight that's kind of becoming clarified doesn't seem to help with it. [0:06:00] And that feels urgent or frustrating to me.

THERAPIST: Sure. (pause) [0:07:00]

CLIENT: And I guess the last thing that I would is that I do worry about the reality of and kind of the meaningfulness of this exploration of some of the source of inner conflict. It was compelling and clearly at some level I feel I'm better for it. But it was just so narrative. And I guess I'm very suspicious of narrative at this point.

It's like OK, fine. So there's some... I don't know. I feel whether because I'm still having difficult doing the things that I want to do or because I'm suspicious of these kinds of explanations. Because I've come to them in the past and they haven't been helpful. [0:08:00] Because it's not clear to me what it would resolve to kind of arrive at the right narrative. I don't know. But I feel very... I feel at some level on the one hand relief. And on the other hand very, very cautious, if not suspicious of anything in this vein that we might arrive at no matter how nice it sounds. (pause) [0:08:57]

THERAPIST: Well, maybe some of the suspiciousness is itself very much tied in with what we were talking about.

CLIENT: I'm aware of this theory of yours that...

THERAPIST: What version do you have in mind?

CLIENT: That when I am skeptical of the kind of narrative interpersonal therapeutic process it's because I'm distancing myself from it. [0:10:03] And in some sense modeling the alienation that I feel from other people in this venue so that...

THERAPIST: Well, I happen...

CLIENT: ...suspicion is kind of a replication of the overall dynamic.

THERAPIST: Yea. I have something even more specific in mind today based on what we had been talking about. In particular that. (inaudible at 0:10:47). I mean, it seems to me that the heart of what we're talking about is thus your being suspicious of narrative that... of the collectiveness narrative. [0:11:07] That you kind of believe in it in one way and feel loyal to it and want to abide by it. And at the same time get really disappointed, frightened, angered when people who you thought were kind of with that program do something that feels contrary to it. There's a huge sense of betrayal. (pause)

CLIENT: True. Well, OK. Well, make the relationship and then I'll comment.

THERAPIST: So imagine you feel that same kind of worry here. That like it's all well and good for me to propose a narrative that upholds my psychotherapeutic world view. [0:12:01] In other words, clearly I have the belief that this sort of relational and psychological narratives that we're describing and especially the kind of feelings they provide context for have therapeutic value. I mean, I imagine you're kind of wary of my like sort of commitment to that and promulgation of it with you.

And it leads you to think, "Well, OK Marshall. I hear that that's the way you're saying you see the world and you're kind of talking about my experience. [0:13:05] And kind of maybe encouraging me to see the world that way. But I'm wary. I don't know how much I buy into that or think that this is physiology. Or think that maybe in theory that would work. But in practice we don't seem to be touching on some of what's troubling to me or it keeps happening. And so maybe the problem is that whole... your whole kind of world view and approach." (pause) That there's a parallel kind of as to suspiciousness and wariness of the world view that I imagine it feels like I'm espousing in what we're doing. [0:14:05]

CLIENT: Well, I don't know. I mean, I feel... look, I guess another way to put what my concern or sense of unease is that I mean, I feel like it's kind of a word game in which whatever is going on is just kind of put into a narrative. The thing about a narrative is it can explain all sorts of different things. And I feel like the concern that I'm expressing here is only very loosely... I mean, it's like an obvious concern in any psychotherapy that anybody would have. Whether they grew up in a collective and were born in a squat. [0:15:00] Or whether they... or a Wall Street banker. I mean, it's like you want to know where the rubber meets the road. And I feel like I'm expressing very ordinary a kind of basic question about the process. And I'm a little skeptical when you fit it into this... skeptical about fitting it into this narrative about a conflict between a collectivist and an individualist world view.

I mean, it seems to me that there's a real danger that is not only kind of intellectual. But in my case, really urgent and concrete in the sense that if we fuck around with this for months and months and months and it turns out that we're just, again, playing another word game in which yet another kind of narrative describing what's going on is replacing another 15 ones that have come before. [0:16:07] I'll just be putting a lot of energy and time and hope into something that's not... that doesn't show any route to change.

I mean, that's really the issue, I guess, that concerns me is that throughout this entire process I've had like probably ten very well elaborated ideas related to each other obviously since they're in some sense biographical. But none the less, very well elaborated and distinct ideas about what kind of I don't know phenomena might be causing this thing since it doesn't seem to me a simple serotonin reuptake problem. [0:17:09] And none of them seem to be any better than the others. And they all seem to leave me in exactly the same place. Except that, when they're done, I'm one year down the road.

And I mean I just feel... I feel troubled by my inability to say, "Well, that's obviously meaningful and that will help. That will promote a change in this state that even now years and years and years down the road in this process seems to be just as troubling as it was five, six, seven years ago." (pause) And that's... and in some sense, it's a very funny thing to say when we've come to some part in the process that seems to be a relief at the very least. [0:18:03] And all to the good. And another... so like I'm aware of that. I'm aware of the oddness of this concern that seems so urgent to me. But on the other hand, I feel, I guess, troubled by the number of times that this has come to pass before in the course of this kind of therapeutic interaction. Does that make sense? I mean, I'm not sure that I'm being coherent. But that's the way that it feels.

THERAPIST: I think so. I mean, what I gather is that you're mindful that on Wednesday we talked about things that you clearly had strong feelings about and felt quite meaningful. And that contributed to a sense of relief and sort of release emotionally. [0:19:03] And yet sort of while that you kind of are holding that in mind, it's also the case that things like that have happened before here and in other therapy office.

CLIENT: And it didn't like make a material difference. That's the other thing. Like yesterday was just as bad as all of the other yesterdays. But weirdly because while I felt really impeded and kind of upset, like at some level I wasn't quite in even in touch with it. (pause) [0:19:58]

THERAPIST: Wait, that part... I don't understand. There... yesterday was just as bad as all the other yesterdays except for some reason...

CLIENT: But it didn't feel like... it's like the process was the same. The sense of just like struggling to do something was the same in the sense just like being... moving through oatmeal was the same in the sense of being disrupted and disturbed was the same except that at some conscious level I didn't feel freaked out about it. As if that was separate from all of these other things that are going on. And quite frankly, the not feeling freaked out about it kind of freaks me out.

THERAPIST: (chuckling) Right, right. It seems like... yea.

CLIENT: So something got resolved. And yet the thing that got resolved seems not to be the thing that's really fucking me up. Seems. I mean, I'm not like making a strong assertion. I'm just saying...

THERAPIST: That's how it feels.

CLIENT: That's how it feels. And I don't get it. (pause) [0:21:01] There was a release. When you said something about grieving for X or Y, there was something there that I responded to. And everyone else it may or may not have been.

THERAPIST: Right.

CLIENT: It had meaning for me. Meaning it was emotionally true.

THERAPIST: Yea.

CLIENT: But the real thing that we're sitting here at infinitum or ad nauseam whichever comes first is still there strongly. Like very concretely.

THERAPIST: Right.

CLIENT: Anyway, (inaudible at 0:21:40). I already have, so...

THERAPIST: Well... (pause) [0:22:00]

CLIENT: (sigh) (pause) Well, I'm sorry. I keep interrupting. One more piece.

THERAPIST: Yea, sure.

CLIENT: Even when I was feeling worst, I have had no trouble running over here. And this morning, I ran and then I would stop and walk. And I ran and I would stop and walk. And this is something that happens when I'm very kind of troubled about something. But...

THERAPIST: I think you may be troubled that we got to something on Wednesday. I know at one level that feels like a relief and you're clearly saying so. [0:23:02] I think it may also trouble you. I think it... I'm going to say it kind of the way I think it feels. Not sort of the way that I see it actually being. But I think it's scary and sometimes I feel like I might be right. (pause) Or that we together really are more onto some things about how this all has always looked for you. (pause) [0:24:00]

CLIENT: Yea, I don't know. I'm not aware of that. I mean, it seems like something that one would... that's kind of a theory or hypothesis that one might come up with in this context.

THERAPIST: Sure.

CLIENT: And it seems consistent with some of the things that we've been talking about. I'm not aware of that. But I wouldn't be. (pause) [0:25:00]

THERAPIST: And I guess I also should make it clear that I presume that what you're saying as to (inaudible at 0:25:47) there certainly continue to be things that I miss or misunderstand or have the wrong view of. I guess some of what this is putting me in mind of are the instances when you were a kid if I'm remembering this correctly like you're having trouble of getting ready and getting out the door. Was that a big thing? Where like there would be a lot of fussing and fighting and you kind of felt down around like getting yourself ready and getting out the door to go to some school or someplace and kind of the validity on both sides.

I mean, it's easy to look at that and say, "Well, you were being difficult and all they wanted to do was get you out the door. And wouldn't go and you're being very resistant." (pause) The struggle around autonomy and all that and some of that's probably true. [0:27:01] But clearly they were also missing a whole lot about what was going on with you. Why you would have needed to struggle that way. How out of control in 12 different ways you were probably feeling in your life. And how much of your experience you felt was sort of drastically missed or misunderstood. And my view that kind of (inaudible at 0:27:41) fall apart. (pause) [0:28:05]

CLIENT: So in this analogy we're kind of at the door. It's time to go. I'm going to head to the ferry and get to school. And I just can't go. I can't walk through the threshold. I can't finish the last bit of dressing and preparing in what would be necessarily in order to embark on this journey. This necessity is kind of obvious and dictated by sort of the things that people do. [0:29:00] (pause) So I'm throwing a bit of a fit saying, "No, I can't get out." And you're casting yourself in or rather being reflective about what it would mean to accompany me out the door in a way that's more constructive than...

THERAPIST: Yea. And I imagine it feels to you like I'm trying to yank you out the door or just saying, "C'mon. We just got... we've got to go. And what kind of... what the heck is going on with you?" And like at some level there's the kind of push and pull around that and... yea. (pause) [0:30:00]

CLIENT: OK. I mean, it seems like an interesting and useful analogy. I can see how it would work that way. (pause) What do we do with it? (pause) [0:31:00] (pause for one minute)

THERAPIST: Well, I guess at the moment I find myself interested in the part where it... where I speculate that it feels to you as though I'm trying to pull you out the door. That I'm...

CLIENT: Say that again. I didn't follow.

THERAPIST: Yea. There's a lot of... I wonder about the part where as I'm imagining it it feels to you like you're on the threshold and I'm grabbing your arm and yanking.

CLIENT: Why it feels that way to me? I mean, it feels that way to me because you've just given us analogy. [0:33:02] (pause) Most concretely.

THERAPIST: And I guess that feels like it has a pretty directive tugging intent.

CLIENT: So yes, I do feel like you're... I'm expressing some uncertainty about what to do with this conversation we had on Wednesday. And you're tugging me in the direction of considering it to be meaningful and significant and something that we need to come back to. So yes, you're tugging me in that direction. And if we think about that train of thought as the door, then yes, you're kind of tugging me out the door. [0:34:00] I guess I mean, I'm being very conscious here. (chuckling) And I don't... and I'm not quite running with your metaphor, I guess, because I'm keeping some sort of Archimedean point from which to survey rather than sort of living inside it. But I think that's where I... I mean, I think that's what you're talking about. You're tugging me...

THERAPIST: That's certainly what I'm talking about.

CLIENT: ...to a kind of analogical space. You're tugging me toward a train of thought between us. And I'm kind of staying on the other side of the door where I can still see the analgesic aspect of it rather than...

THERAPIST: Just inhabiting it.

CLIENT: ...inhabiting it as I am often prone and happy to do. (pause) [0:35:00] But I don't feel like I'm resisting in a kind of I don't know unreflective and... like I'm... it doesn't feel... I guess to push back a little bit as if that isn't what I've been doing all along.

THERAPIST: (chuckling)

CLIENT: I don't feel just kind of like it's a tantrum. Maybe it's a tantrum. I mean, this is just a 41 year old equivalent of a tantrum. But I just feel wary, Marshall (ph). I feel wary. (pause) And I feel kind of scared. Let's see if I can articulate that a little bit. I feel scared. I feel scared about putting stock in things that haven't, until now, helped me. [0:36:03] And I'm also aware of the fact that maybe one of the reasons is that I haven't really exerted... run with them or have been willing to walk through something. Maybe I just haven't believed enough. Maybe I've been...

THERAPIST: Well...

CLIENT: Maybe the skepticism is exactly what hasn't changed. I don't know. Maybe it's just the same... a reflection of the same dynamic that has... that's what kept me in this space.

THERAPIST: Or maybe... it's tough for me to know what the reality and this is. But my impression is things have helped to some extent and are better in some important way. I do not doubt your experience with the frustration and fraughtness of writing and being organized and stuff with Jennie (ph) sometimes. [0:37:03] And there's still a bunch of it around and that's very important. I'm not trying to say otherwise.

But what it seems to me like you're nearly as hamstrung as you've often been or as paralyzed. I mean, as I understand you actually... I mean, you haven't been at this job that long. But you have not hit a snag that actually caused you trouble. You've certainly hit a snag that has caused you stress, frustration, angst, delay. But I don't know. I mean, you came in. You talked about a job you had a year before so where you had to resign because you for like weeks or months hadn't been able to do anything. [0:38:05]

It does sound to me like you're a long way from that. And of course it's hard to tease apart the extent to which there are circumstantial factors of the sort that we talk about contributing. In other words, like there was more uncertainty about your place there or people are leaving me. I don't know enough of the details to really argue. But... and this is this sort of distinction that, to me, seems increasingly like it's important. And I'm sure it feels to you and maybe either there are degrees to which is true. Like that kind of arguing for the benefits of what we've done. But really I hope what I'm more interested in is establishing what's true. [0:38:59]

In other words, one possibility is that I'm trying to convince that therapy is working. Another possibility is that you're actively trying to sort of minimize, push aside, weigh the therapy has helped for reasons that relate to what we're talking about.

CLIENT: While it's still going on. No, I get it.

THERAPIST: Yea.

CLIENT: I do get this. I just don't know at this point what it would mean to not do that. In other words, I could just sort of paper over it. I could say, "All right. Well, let's go with it." So I mean, I'll say it right now. OK, let's go with it. It's fine. I'm just trying to be...

THERAPIST: Well, my point is like is one thing true.

CLIENT: Describe to you what's going on.

THERAPIST: Like I care what's actually happened. Like...

CLIENT: I think what you're saying is true. I think what you're saying is accurate. I'm not... I don't dispute the facts of the case.

THERAPIST: OK. All right. Yea, I know. And from my vantage point, I've only had them very partially enhanced. So I...

CLIENT: Yea. No, I mean, I don't dispute the facts of the case. [0:40:00] I genuinely don't know. I genuinely sense some unease or uncertainty or concern about the fact that on the one hand... I mean, the only thing that I would... that I wonder about is something you spoke of a moment ago which is that it's not clear to me whether it's genuinely that I'm doing better. That I don't know what... I don't how to evaluate the improvement. I don't feel significantly improved. I don't feel like this episode two weeks ago was really... that there were... it showed improvement. It seemed pretty much like all the other ones had been. It feels like this is a much more forgiving environment and one that has meant the financial stress that I have often felt a part... no small part and as a result of all of this stuff that we're talking about has been less. [0:41:05] And then...

THERAPIST: Well, let's look at that.

CLIENT: ...the people on the other end have been much more forgiving. And I've kind of set it up... I've done my best to set it up that way in a way that's term limited.

THERAPIST: Do you mean they are forgiving of things you sort of (inaudible at 0:41:16)?

CLIENT: Oh, they're just not demanding. They... like the demands from that end for my performance are less.

THERAPIST: You mean fewer pieces of work and fewer contributions in meetings?

CLIENT: I guess so. I mean, it's like I'm working remotely and I understand that in New York there are people who really exploit this as a career.

THERAPIST: Yea.

CLIENT: This situation in which you're kind of a remote consultant and you participate in things. And you get paid very well. And the outcomes measures are not totally obvious. But shit man. I don't know. [0:41:58]

THERAPIST: You mean you've talked to me about pieces of writing.

CLIENT: I know. No, no, no, no. I'm not saying that I've not done them. I'm just saying that it's not clear to me that like the... whether this is symptomatic or descriptive, I can't tell you. But my sense is that it might not be different. It's not clear to me that the parameters of this interaction or exchange are so different... are not so different from the ones that really by both of our mutual agreement were very acute symptoms. It's not clear that the conditions aren't so different that we can't really evaluate it. So, on the one hand I haven't been stuck in this really...

THERAPIST: Right.

CLIENT: ...state of suffering for months and months and months. But on the other hand, it might be not that I've improved or changed.

THERAPIST: Or the situation in the context.

CLIENT: But rather the situation in the context for a variety of reasons is more forgiving.

THERAPIST: OK. [0:43:04]

CLIENT: I'm just saying I have uncertainty about it.

THERAPIST: Yea, yea, yea. I... yea.

CLIENT: And I'm freely willing to admit that this uncertainty that I'm having...

THERAPIST: But it's unclear where...

CLIENT: ...might be symptomatic. Might be exactly what you're talking about...

THERAPIST: Yea, yea. I hear you.

CLIENT: ...being reluctant to walk through the door.

THERAPIST: Right.

CLIENT: But I just have this uncertainty. And this uncertainty bothers me enough that it's hard for me to kind of run with your metaphor...

THERAPIST: Right.

CLIENT: ...and say, OK, well this is just like it was when I was 10 or 13 and couldn't get out the door. And let's run with that and figure out what that might mean. And get very exciting about the fact that there seems to be this consonance. (pause) [0:44:00]

THERAPIST: Yea. So curiously this kind of blurriness around how much productivity just in fear in the same way that the...

CLIENT: OK, so another analogy, yea.

THERAPIST: Another analogy, yea. We should stop.

CLIENT: (chuckling) OK, all right.

THERAPIST: I'll see you on Wednesday.

CLIENT: Yea. I want to stop wrestling. I don't want to be wrestling. I really want to deal with the fact that it's so difficult for me to look for some redundant thing. All right, I'll see you then.

THERAPIST: Yea.

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