TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Good morning.

CLIENT: Good morning. (sigh) (pause) (clears throat) (pause) (sigh) (pause) So. (pause) [00:01:18]

So (pause) So our conversation on Friday was interesting. I found it (pause) (sigh) I felt like it expressed some things clearly. And afterwards I felt, you know, a sense that, you know, some useful, you know, tensions had been articulated. But (pause) I also felt, I think, the usual frustration in the sense that I don't really know how to operationalize it. I mean, I guess, which is part of what we're talking about. (pause) [00:02:48]

And maybe part of the problem now in articulating that is just that I'm still sleeping very badly. And this, you know, this morning I woke up even earlier than I I feel like I'm progressively waking up earlier and getting less sleep. (sigh) So that's a burden not only in general, but also on this process today and I think on my ability to get anything useful out of what we're talking about.

Which is, I think, originally why I gravitated away from conceptual discussions and toward concreteness. And it feels like there's a kind of basic prerequisite for being able to engage in the kinds of questions that you were raising as counterpoint to my, you know, desire for concreteness. And that's just, you know, kind of being able to function in certain kinds of ways that feel troublesome. [00:04:12]

So, (sigh) just in practical terms right now it's not totally clear to me how to get over the fact that I got three hours sleep or so. In more general terms, I don't know how to get over the fact that, you know, some key processes that make it possible to, you know, take a discussion here and implement it in various ways outside of this context are, you know, really impeded by whatever the structural phenomenon is other than narrative. (sigh) [00:05:11]

And I think, you know, as expected, I'm a little skeptical. Just in, not that it's relevant, but just that I mean it seems like kind of a generic comment to be making about somebody who is having trouble writing or working.

THERAPIST: Is?

CLIENT: Is that there's some defect in their narrative faculty. And also, by definition, if you have writer's block you have a problem with narrative. How deep seeded it is and how comprehensively you can tie it to personal history is another question. In my case I certainly can see, I can see your point.

But it just seems like something, in one way or another, this particular faculty or tendency or conceptual process is obviously impeded whenever work is, the writing kind, is difficult. [All of my work is that.] [00:06:30]

(clears throat) So I mean I liked your formulation, I guess. So my starting point is that, you know, I felt like thinking about a tension between, you know, the possibilities of a gift that I have and the skepticism about it or sense of uncertainty or unreliability about it. I don't know if that's the most articulate way of describing what you were talking about but, you know, I think that it's certainly an evocative framework and I think like the other formulations that we've had. Of course, in the time that we've been talking together I think, you know, it's fairly descriptive of certain important things. [00:07:40]

But in this moment I feel challenged to, you know, to do anything with that. I think, in general terms, I feel challenged to do anything with it. And I'm not sure beyond my immediate capacity for uptake, I'm not sure, you know, how much specific information gives us about what's going on.

It would be like It might be like saying I worry, I wonder whether it might not be like saying that, you know, somebody who is, I don't know, depressed is, you know, has some problem with arousal. Right. It's almost a topology (ph).

THERAPIST: Hm. [00:08:40]

(long pause) (clears throat a few times) [00:10:33]

THERAPIST: It seems to me there's a pattern, especially recently, to our sessions in which I think they often start, especially on Wednesdays but in general, with something like this: You know, "Hey, those were some interesting ideas from last time." But they really don't give me anything kind of concrete or substantial to work with.

You know, there's this sense of, which is not the sense at the time we talked about them in the previous session. To me it feels like sort of My impression from the way you talk about it is as thought something has kind of drained out of them. Like a substance or a like a heft or maybe I wouldn't go so far as to say a utility. [00:11:46]

But something you could hold on to a bit and that was there when we sort of were in the thick of talking about them in the previous session or whatever, has kind of been, has kind of drained out. You know, even as you've tried to kind of hold on to it or take it with you or maintain a connection to it.

CLIENT: And your observation is that it's very patterned, this tendency.

THERAPIST: Yeah.

CLIENT: It happens less between Wednesday and Friday then between Friday and Wednesday.

THERAPIST: I think so, but I, just in terms of my memory I'm less sure but I sort of have that impression. But I'm less confident in saying that than in saying I think this pattern does exist session to session.

CLIENT: (sigh)

THERAPIST: And, you know -

CLIENT: Well, I mean, there are a couple of ways of explaining that, I guess, but you have one in particular. [00:13:02]

THERAPIST: Yeah. I think (pause) I think it's a sense of a connection between us that gets lost and kind of displaced onto the ideas as though -

CLIENT: Hm. (pause) Okay.

THERAPIST: as though. Yeah, I think you're sort of trying to like keep a hold of and implement and feel a sense of concreteness to what we talk about. I think it's really a way of like trying to stay in contact with me and with our sort of connection and relationship. And that that's what drains away from one session to another. (pause) [00:14:47]

CLIENT: (sigh) (pause)

THERAPIST: And that we then sort of get back over the course of a session in which it sort of comes to feel like often by the end like you have something before it's time to stop. And then it's kind of gone by the next time you come in. And you talk about something, "Well, it was useful but I couldn't really take it with me.

"And, you know, actually now that I think more about it, the beginning of the subsequent session, really it was kind of generic, abstract, didn't have a lot of sort of specific content or utility." Which is quite different from your feeling, at least as you describe it, you know, two thirds of the way through the previous session where it feels like there's something to what we're talking about that's not that abstract or empty. (pause) [00:15:59]

CLIENT: I mean, a couple of -

THERAPIST: Sure.

CLIENT: A couple of thoughts. I'm fully prepared to, you know, join with the opinion which we've, you know, expressed and chewed over many times in the past. That there's, you know, a relationship between this interruption or lack of narrative or lack of confidence in it. Or interruption of work flow and a sense of the tenuous nature or difficulty remembering or imprinting upon relationships with the person that I'm engaging or [having a] (ph) conversation with or a narrative with. That makes sense to me. (pause) [00:17:00]

There's a relationship between them. What the association is, I'm not sure. They're correlated somehow. I don't really I don't know that a causal, you know, sort of linear causal analysis is particularly useful, but they interact in some very intimate way. These two things that have the project of -

THERAPIST: I actually think it's pretty clear the causal connection.

CLIENT: (loud exhale)

THERAPIST: There's a lot of evidence about that. The more connected you feel to the person, the more you feel engaged with the work.

CLIENT: Fair. Fair. You know, so -

THERAPIST: When you get a phone call from somebody who you felt distant and disconnected from and all of a sudden it's easy to write. (pause) And in my hypothesis what I'm proposing, and you were talking about, this is sort of what you said, you explain it like or you come in here after five days and feel more disconnected and what we talked about seems empty. That being the flipside of like getting the call from somebody and then you're connected and it's easy to write. [00:18:23]

CLIENT: You say, "empty." You're putting words in my mouth now.

THERAPIST: Yes, I am.

CLIENT: I said that I'm not 'A', I'm not quite sure what to do with it in practice or, you know, how to transition between the conversation and, you know, the limitation of it in my life. And 'B,' there are certain very concrete kinds of things like being able to sleep, you know, regularly and deeply, that interfere with the ability to (cross talking at 00:19:00)

THERAPIST: Sure.

CLIENT: that I'm hard pressed to just sort of will away.

THERAPIST: Of course.

CLIENT: I mean they exist.

THERAPIST: Yeah.

CLIENT: In some sense they're kind of prior (ph) just in the practical sense that part of these connections just sort of, you know, cognitively depend on enough rest that, you know, you can kind of function adequately on a day to day basis. In other words, there's no question in my mind that some component, some quantum of my difficulty sustaining these connections is just about being so desperately under slept. I mean so, you know, I'm not saying that they're empty.

THERAPIST: But you did say that what we talked about last week at, you know, as you were thinking more about it just a few minutes ago seemed sort of true, but so general as to be tautological. [00:20:07]

CLIENT: (sigh) The bit about narrative did potentially feel Unless, you know, we can make that observation more specific, you know, I think it's hard for me to know how to implement it. But that wasn't a general comment about the conversation.

THERAPIST: I see.

CLIENT: That was a specific comment.

THERAPIST: Okay.

CLIENT: [This showed] (ph) narrative. I mean I'm not disagreeing with you here.

THERAPIST: Yeah.

CLIENT: I'm disagreeing that I'm disagreeing. (laughs)

THERAPIST: (laughs) Okay. (laughs) Okay.

CLIENT: (laughs) I'm not.

THERAPIST: Okay.

CLIENT: I'm actually not disagreeing with you.

THERAPIST: Sure.

CLIENT: I think that' it's a formulation that, you know, that I can sign on to and that is the product of -

THERAPIST: Yeah.

CLIENT: many endless hours of conversation between us or therapeutic hours of conversation.

THERAPIST: Sure.

CLIENT: But -

THERAPIST: And I take your point that (pause) you're really fried from not sleeping. [00:21:22]

CLIENT: I'm fried. I'm fried. Not just from not sleeping.

THERAPIST: Uh huh.

CLIENT: But you know, just this weird state of arousal that encompasses all of these different specific processes including, you know, not being able to sleep well and, you know, getting very revved up and, you know interactions that -

THERAPIST: I know you slept about three hours last night and I think you said about the same on Friday maybe. But is that consistently how little you've been sleeping.

CLIENT: Um. Five, three to five or six. Sometimes I'll, you know, let myself just stay in bed and I'll go back to sleep.

THERAPIST: Right.

CLIENT: Sometimes I'll just lie awake and just say, "Fuck it. This is stupid. I'll send some e-mails." You know? Yeah, it's not certainly an [uncommon precedent.] (ph)

THERAPIST: I'm going to get myself in trouble here -

CLIENT: Okay.

THERAPIST: suggesting something concrete.

CLIENT: (laughs)

THERAPIST: (laughs)

CLIENT: (inaudible at 00:22:27) (laughs)

THERAPIST: (laughs) Have you ever tried sleeping meds?

CLIENT: Yeah. Oh, fuck, man.

THERAPIST: (cross talking at 00:22:37)

CLIENT: Okay, Ambien totally doesn't work.

THERAPIST: Okay.

CLIENT: You know the new somnolents don't work.

THERAPIST: Okay.

CLIENT: I achieve tolerance very quickly to benzodiazepines.

THERAPIST: Alright. You've really been around that block.

CLIENT: I take Benadryl and it puts me to sleep great but it doesn't keep me asleep.

THERAPIST: Okay.

CLIENT: Benadryl, I mean Benadryl's great because it's over the counter and cheap and all that stuff.

THERAPIST: Yeah.

CLIENT: I don't know. I mean maybe there is something I could try that would just put me under.

THERAPIST: Alright. It seems like you've certainly talked to people about it and (pause) I guess, as I said, (pause) I think sleeping three to five hours a night is a really big deal and it clearly would be scrambling you in lots of different ways and making many things more difficult. And also probably just making you feel like shit a lot of the time. [00:23:49]

It probably won't interfere with our work as much as you think, in that like a lot of this relies more on kind of the emotional exchange and what happens at that level. I mean we talk conceptually, and I know you've got to be like [cognizant in terms of what we're saying] (ph). But you have this fantasy that like you're supposed to kind of clearly remember the ideas and go away and do something with them.

CLIENT: That's not quite it.

THERAPIST: Okay.

CLIENT: That's not quite what I'm saying. What I'm saying is that my sense is -

THERAPIST: Yeah.

CLIENT: that the sense of attenuation of relationships -

THERAPIST: Is related to the lack of sleep.

CLIENT: is related to the lack of sleep.

THERAPIST: Right.

CLIENT: In other words, you know, there's a kind of unreality that is consequent to -

THERAPIST: Yeah.

CLIENT: not sleeping well. Just, you know, in some sense I'm like, you know, (laughs) in a constant dream state. [00:24:50]

THERAPIST: Yeah.

CLIENT: If I'm lacking adequate REM sleep and my intuition is that one of the factors underlying -

THERAPIST: Yeah.

CLIENT: my sense of the unreliability of these connections is, you know, a direct outcome of just being so tired.

THERAPIST: Yeah.

CLIENT: Now, yeah, I do have that tendency. I know, from time to time.

THERAPIST: Right, but that's not what you're referring to now.

CLIENT: Um. I accept and I think I've said on several occasions in the recent past that it's kind of a proxy and that that seems sensible to me. I mean, I fully endorse what you're saying. You know, I get it. I want to emphasize that, you know, I say this maybe symptomatically but also in the spirit of -

THERAPIST: Yeah.

CLIENT: you know, really wanting to wrestle with where to go with that. [00:25:54]

THERAPIST: Yeah. Sure. (pause)

CLIENT: One thing I take from what you're saying now, you know, an elaboration of a thought that we only had a moment with before it was time to go on Friday is that when you're saying "narrative," you're talking about a shared narrative. You're talking about the narrative of two people interacting. Or my relationship to another person and my interaction with another person. That's the relationship you're talking about principally, I think. It's a narrative of the relationship. [00:26:59]

THERAPIST: Hm. I hadn't (pause) Sorry. Is your sense I was referring to that and saying what specifically?

CLIENT: The thought that -

THERAPIST: Yeah.

CLIENT: we ended with, which was evocative enough that I remembered it -

THERAPIST: Right. Right.

CLIENT: and sort of chewed over it -

THERAPIST: Yeah.

CLIENT: over the next few days, was that you're kind of, I don't know, summary formulation that a lot of what's troubling me and is sort of impeding my, I don't know, whatever is being impeded, you know, has to do with a sense that these seals (ph) that I have or, you know, description and narrating things which are very well developed are useless. [00:28:30]

That I've been disappointed by the narrative process in the past and, therefore, I kind of can't, I can't deploy these skills. I don't have the confidence in, you know, this process that would allow me to take them and kind of make a life out of them.

THERAPIST: Mm hm.

CLIENT: That was how I understood your formulation.

THERAPIST: Mm hm. Yeah.

CLIENT: And I guess what, you know, the implication of that observation or formulation of narrative for this conversation here, you know, is that the specific kind of a narrative, there's a genre of narrative that we're talking about specifically here. Or a relationship between, you know, the narrative process and the, you know, kind of a socialization process. [00:29:45]

There's a specific relationship between them which is that, you know, a key aspect of any relationship is developing the shared and collaborative narrative. So if I've lost If there's something that's impeding my, you know, ability to remember and call to mind and have confidence in relationships, then in some sense that's a narrative problem.

And conversely, you know, if I'm having a problem with narrative it will be very difficult to sustain -

THERAPIST: Yeah.

CLIENT: and feel confident in, you know, these kinds of social relationships.

THERAPIST: Yeah.

CLIENT: I was just sort of integrating -

THERAPIST: Mm hm.

CLIENT: to service (ph) the conversation.

THERAPIST: Mm hm.

CLIENT: (inaudible at 00:30:45) (sigh) I mean I think that's right. I feel You know, once again I feel a sense of shared accomplishment in describing these things.

THERAPIST: Yeah.

CLIENT: Yet, once again I feel challenged partly, again, just by fatigue. By the prospect of bringing this to bear in life. And (clears throat) I do take your general point that it doesn't matter (laughs) whether, you know, that if it's working right, if the attachment is, you know, proceeding well -

THERAPIST: Yeah.

CLIENT: and we're doing our job interacting then, in theory, you know, it should just kind of happen automatically. [00:31:45]

THERAPIST: Um.

CLIENT: But I feel -

THERAPIST: I think I was actually I had been speaking in a kind of concrete sort of way in saying that, but I think it's actually a very central point because I think you're so worried that if you're not thinking, processing, implementing you know, at some level. I know you may know it at another level, you know, you doing this but that you're so busy trying to kind of hold on to, make use of, you know, process, for example, things we talk about, I mean as well as other relationships.

I think that may be part of what's making it hard for you to sleep is that you worry that if you're not attentive, thinking, conceptualizing, implementing then the contact is going to be lost. [00:33:00]

CLIENT: Contact? What? I'm not sleeping because I'm not certain whether concrete (cross talking at 00:33:06) sessions are useful.

THERAPIST: What I mean is that I found -

CLIENT: That doesn't [make sense.] (ph)

THERAPIST: No, no, no, not like that. So what I had said a few minutes ago is like, "Hey," as you just paraphrased I think very nicely, "Eh, if we're doing our jobs, you don't need to be thinking hard about this. And you don't have to be able to conceptualize well. It will just work." Right? I mean that's what you just [paraphrased, characterized] (ph) what I said. I think that's true.

I think it's central because I think you often feel very much otherwise. And I think the anxiety about that in this case with me, although in other relationships as well is probably part of what makes it hard for you to sleep.

CLIENT: Anxiety about sustaining relationships with people.

THERAPIST: Yeah. Like, okay, your fantasy was, contrary to what I said, "If I can't think clearly. You know, if I can't think about what we've talked about. If I can't think about how I'm going to put it into practice because I'm so tired. If I can't think in those ways, then " [00:34:18]

CLIENT: That's not what I was saying. Maybe I didn't articulate myself. Likely I didn't articulate myself well.

THERAPIST: Okay.

CLIENT: What I was trying to say, or what the thought I mean, you know, maybe it was a Freudian slip, but (laughs)

THERAPIST: Go ahead.

CLIENT: The thought that was in my mind was -

THERAPIST: Yeah.

CLIENT: more that, you know, being tired You know, maybe this isn't true, I don't know.

THERAPIST: Sure. (cross talking at 00:34:36)

CLIENT: But the idea was that being tired interferes with attachment. You know, there's something about the very four dimensional or longitudinal process of, you know, of being related to somebody that requires, especially when they're not physically there, you know, a kind of memory or, you know, or requires the kinds of, the very same kinds of, you know, narrative and other intellectual cognitive functions that being grossly under slept might interfere with.

That was my thought. That was what was in my mind. It wasn't so much about -

THERAPIST: Just wondering if it goes the other way around that -

CLIENT: Yeah. Right. I see. I see that you're wondering.

THERAPIST: Okay.

CLIENT: I see that you're wondering that. I'm just -

THERAPIST: Yeah, I don't want to be wondering at misquoting you. (laughs) [I guess I've been corrected.] (ph) [00:35:38]

CLIENT: Yeah. I'm just not, I don't feel like I'm actively trying to hold these I don't know. Maybe you're right. I don't mean to dismiss it out of hand, but it doesn't Something about it doesn't -

THERAPIST: Connect? (ph)

CLIENT: It just doesn't At any rate Now I lost the thread.

THERAPIST: How long have you been sleeping only three to five hours a night.

CLIENT: Since my twenties. Sometimes I get a little more. But I've been early waking since My construction of it, and maybe this is -

THERAPIST: Whatever.

CLIENT: I always hesitate to bring something like this up because, for obvious reasons. It will be obvious in a moment. My recollection or reconstruction of it is it has been since my Dad died. Before my father died I slept very well and deeply and afterwards it didn't. Which also coincided with my mid-twenties so, you know, (inaudible at 00:36:49).

THERAPIST: Okay.

CLIENT: Even assuming that this is empirically true, I think it's gotten worse in the last six or seven years though. (pause) Three to five hours. Three is not usual. It's usually more like five. Three indicates some kind of a -

THERAPIST: Yeah.

CLIENT: disturbance in the force.

THERAPIST: Do you ever get seven or eight?

CLIENT: Do I ever get?

THERAPIST: Seven or eight?

CLIENT: Straight through?

THERAPIST: More or less.

CLIENT: Very rarely. Almost never. Certainly not continuously. [00:37:48]

THERAPIST: Right.

CLIENT: Like sometimes, you know, I'll go to bed at ten -

THERAPIST: Yeah.

CLIENT: and, you know, sleep until two, wake up, usually take two Benadryl, fifty milligrams of Benadryl, and go back to sleep until seven or eight. (pause) So another, you know, piece, scattered piece. [00:38:51]

THERAPIST: Yeah. I'm having another thought as well, but go ahead.

CLIENT: You're having another thought? Finish your thought now. (pause)

THERAPIST: I think this would be easier for you if this was analysis.

CLIENT: This would be easier for me if this was analysis.

THERAPIST: Yeah.

CLIENT: Meaning every day.

THERAPIST: Meaning four days.

CLIENT: So that it's not It's not interrupted.

THERAPIST: (inaudible at 00:39:26) is, I mean it's still interrupted but not as long. And it would just give us more time to I mean, I guess it's more evident to me in talking the way we are today about your sleep, how very wound up you are in a kind of chronic way. And -

CLIENT: Can I ask you just a completely direct and frank question?

THERAPIST: Yeah.

CLIENT: Are you convinced And, maybe, anyway. Are you convinced that there's not some sort of important basic organic reason for this wound-up-ness? [00:40:28]

THERAPIST: I'm not convinced, no. But there are a number of signs that (pause)

CLIENT: Just lay it out for me, the signs.

THERAPIST: Okay. There's a few things. I mean, I'll do this sort of in two steps.

CLIENT: Sure.

THERAPIST: The first step, of course there's an organic contribution. I mean, there's something about your temperament or whatever that predisposes you to this degree of what I take to be anxiety.

CLIENT: Sure.

THERAPIST: And (pause) [I actually think] (ph). Yeah. Well it makes me wonder whether Have you I'm not asking or recommending that you do this now, but just diagnostically interesting, whether you've tried other things to help you sleep. Anxiolytics? [00:41:48]

CLIENT: I've tried benzodiazepine for years.

THERAPIST: Uh huh.

CLIENT: And different kinds of benzodiazepines. Lorezepam.

THERAPIST: Yeah.

CLIENT: Two different benzodiazepines.

THERAPIST: Okay.

CLIENT: I can't remember.

THERAPIST: Alright. Anyway, so the things, there's a lot sort of from our conversations and from your life, I mean, that make it clear that psychosocial events have a very strong effect on your level of anxiety. Tenuousness at work, things in your relationship, sometimes stuff here. You know, when things happen you react. There's not a kind of -

Some of this, I guess like the sleep, are, well there's kind of a baseline of difficulty sleeping. But as you're saying, there's also fluctuation around that in response to psychosocial events. But, you know, one thing that makes me think about the kind of psychological as opposed to biological contribution to the problems that you're having. [00:42:58]

The other thing is, (pause) like the symptoms just seem so much about being anxious and wound up, wound tight. You know? Whether you're worried about people leaving. A sense, like a kind of feeling of disconnection. Difficulty letting go and sleeping. This sort of agitation seems to go along with difficulty.

CLIENT: Not to interrupt the flow here. But it's not difficulty letting go and sleeping in the sense that I never, almost never, it's extremely rare for me to have trouble going to sleep. It's difficulty sustaining sleep.

THERAPIST: Hm. Oh, I didn't know that. (pause) So you can get into bed at whatever hour and conk out.

CLIENT: No problem at all. I can go to sleep at the, what I expect at this stage of the game, the drop of a hat and often do. [00:44:13]

THERAPIST: Yeah.

CLIENT: Just like in an instant (snaps fingers) and wherever I am.

THERAPIST: Yeah.

CLIENT: That hasn't changed. That has always been true also.

THERAPIST: Right.

CLIENT: And it has not changed.

THERAPIST: Right.

CLIENT: But I don't stay there.

THERAPIST: Right. You wake up at three or five or whatever.

CLIENT: And just can't. At that point I can't go.

THERAPIST: Right. (pause) I guess those are the sorts of things that make me think about a kind of psychological contribution to the problems that you're having.

CLIENT: Yeah.

THERAPIST: And (pause) I'm not saying, you know, I think analysis can fix all of this. I don't know. But I do think it will make it Yeah, I'm perfectly happy to be working as we have been. I think it's been helpful, and (inaudible at 00:45:23) we can talk about it.

But I think it would be easier to get a hold of, work on, make progress with and sort of stay in working on things if you're coming more often. And I, yeah, you know, I wouldn't suggest if I didn't think, which I do, that this could help and that that could make it easier to get a hold of things.

CLIENT: That's true. (ph)

THERAPIST: And, yeah, there are signs, as I've said, that point to me towards this having a kind of substantial psychological contribution. And, you know, that line actually may not be as important. Because I might think in that, for example, like an analogy. I think of like physical therapy. Right? [00:46:36]

I mean if you have a biological predisposition towards weak tendons, or whatever. If you strengthen muscles in physical therapy, you can kind of ameliorate the problem. In other words, like you don't necessarily have to intervene at the level at which the problem occurs to (inaudible at 00:46:54) I mean, it's complicated.

CLIENT: Mm.

THERAPIST: I guess this is just sort of my sense. We're going to have to stop.

CLIENT: (sigh)

THERAPIST: We'll talk more on Friday.

CLIENT: Okay. (pause) Okay, see you then.

THERAPIST: Yeah.

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