TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: So. (sigh) Um. With regard to analysis.

THERAPIST: Yeah.

CLIENT: I thought about it and there are a few considerations.

THERAPIST: Sure.

CLIENT: Just the most concrete of them is that it will cost a lot more, I think.

THERAPIST:[Why is that?] (ph)

CLIENT: Uh, well -

THERAPIST: I mean, I'm -

CLIENT: I'm assuming under the PPO, I don't know what I have.

THERAPIST: Oh.

CLIENT: You know, what the reimbursement possibilities are.

THERAPIST: I assume it's the same.

CLIENT: It's unlimited.

THERAPIST: Yeah. At least I would never presume to predict what an insurance company is going to do.

CLIENT: Yeah.

THERAPIST: However, with people I see on PPOs, I have not run into any -

CLIENT: You haven't had any problems. You've not run into any problems. [00:01:20]

THERAPIST: Yeah, exactly. And I've seen people three or four or five times a week.

CLIENT: Okay, well that helps.

THERAPIST: Yeah.

CLIENT: Our physical situation is very uncertain.

THERAPIST: Sure.

CLIENT: Right now I'm assuming that New York will not happen beyond June just because it's been gummed up in a million different things.

THERAPIST: I see.

CLIENT: I don't really know at this point.

THERAPIST: Yeah.

CLIENT: This month has basically been lost. In other words, you know, I had this very, you know, concrete and encouraging conversation on May first, and we basically haven't heard anything since.

THERAPIST: I see.

CLIENT: So, I mean in think in terms of the content for our discussions that might be relevant.

THERAPIST: Important.

CLIENT: But in terms of the practicalities of it -

THERAPIST: Yeah.

CLIENT: I'm starting to get a bit worried about that.

THERAPIST: Sure.

CLIENT: And I think first and foremost, my primary concern right now is making sure that I don't make any, you know, [financial claims that help extend this.] (ph) [00:02:32]

THERAPIST: Sure.

CLIENT: So if we decide to go ahead with it then, you know, I'm depending on you for a good read or at least some help in the strategy of figuring out how to make sure that I'm covered. I mean whether it's a good strategy to be proactive and to, you know, call them up and make sure that they do. Whether that would give them an opportunity to say "no."

THERAPIST: Yeah, I would -

CLIENT: You wouldn't.

THERAPIST: I wouldn't.

CLIENT: You would just do it and then fight it if they using precedent [or whatever else is at your disposal?] (ph)

THERAPIST: I would do it and then -

CLIENT: There's another piece to this too.

THERAPIST: Yeah.

CLIENT: Which is that basically they have been only reimbursing They've been reimbursing at less than the expected rate. [00:03:37]

THERAPIST: Oh.

CLIENT: So it's been about seventy percent. (pause) (sigh)

THERAPIST: You mean like because it had been I remember when I did there was (inaudible at 00:03:52) it was a hundred and twenty bucks or something. It's been less than that?

CLIENT: I'm trying to remember now. They've been reimbursing a hundred bucks.

THERAPIST: Okay.

CLIENT: So with our arrangement I guess that leaves twenty five bucks a session.

THERAPIST: Ah. Then it leaves nothing, doesn't it. I bill you at a hundred because of the recording.

CLIENT: You bill me at a hundred.

THERAPIST: Yeah.

CLIENT: Okay, okay, okay. Okay, I mean, so I'm feeling very worried about finances, I guess.

THERAPIST: Sure.

CLIENT: And I'm concerned about taking on an encumbrance.

THERAPIST: Sure. I (pause)

CLIENT: Your sense is that it wouldn't be an encumbrance.

THERAPIST: Well -

CLIENT: It wouldn't be any more of an encumbrance than it is right now, substantially. [00:05:00]

THERAPIST: Uh. Well, let's see. I mean the (pause) I mean, this isn't costing you anything right now and I guess the only way that would change, one is -

CLIENT: If the reimbursement changed or the insurance changed.

THERAPIST: Yeah, the reimbursement from the insurance changed.

CLIENT: Okay.

THERAPIST: And the other is, I guess if your health insurance changed.

CLIENT: Yeah. Right now I'm just paying five hundred bucks a month for (inaudible at 00:05:51).

THERAPIST: Yeah. Right. So I guess as far as the first question, I mean what's the turnaround on their paying you out?

CLIENT: About a month.

THERAPIST: About a month. Okay.

CLIENT: So it just requires that, you know, I keep a health insurance account in which I have enough to cover twenty sessions up front a month.

THERAPIST: Right. So if they just kind of stop If they stop paying cold turkey, kind of the most you could be liable for would be a couple of thousand bucks I guess. And I'm happy to think about that. I mean, and like I'm happy to at least think about, you know, [paying you] (ph) to take some of that risk.

And say like, you know, if that happens and they just sort of stop dead with payments and, you know, as long as, you know, I'll split that with you or something. Let me think about it, but I might be willing to do something like that. [00:07:04]

CLIENT: Alright. So the second -

THERAPIST: Yeah.

CLIENT: issue that occurs to me is threatened (ph) I don't know.

THERAPIST: Yeah.

CLIENT: I mean, again, this is also a reasonable jumping off point -

THERAPIST: Sure.

CLIENT: for an actual conversation between us. Sleep. The morning is great. It means that, you know, I can do it on a workday.

THERAPIST: Yeah.

CLIENT: And I think if we were doing it five days a week, that would be important obviously.

THERAPIST: Mm hm.

CLIENT: But, you know, it means I'm getting up at six thirty every day. I'm not falling asleep. I don't know. Sleep is really a concern.

THERAPIST: Do you tend to -

CLIENT: Even in my diction and presentation here I can see the effects of sleep loss.

THERAPIST: Do you wake up later on mornings you don't come here?

CLIENT: I can just try again.

THERAPIST: I see.

CLIENT: I can just try again. (sigh) I don't know. I'm not This is a larger issue (inaudible at 00:08:27) last couple of meetings. I don't know what to do about it. Last night I went to bed at eleven and woke up at three.

THERAPIST: Um.

CLIENT: [I tried to go back to sleep] (ph) for a bit.

THERAPIST: I don't know.

CLIENT: I don't know. I'm not sure. I'm not sure how to think about this. The other concern.

THERAPIST: Yeah, it seems to me they, both these issues, they cut both ways. On the one hand, I think that really the money one doesn't. I mean, you know, if you were risking a thousand bucks or something. That's not nothing, absolutely. But it's not -

CLIENT: It's not destitution.

THERAPIST: (cross talking at 00:09:14) kind of thing. And the sleep thing, yeah, it sort of cuts both ways in that like obviously part of the point would be to be helping that. And yet at the same time I understand what you mean that, if you were coming here four or five mornings a week, yeah, you can't kind of try again to get some more sleep if you wake up at three or four. Yeah.

CLIENT: Anyway, so until I have a better sense of what my sort of location is going to be -

THERAPIST: Mm hm.

CLIENT: I don't want to start. I don't want to start and stop. That doesn't seem to make any sense to me.

THERAPIST: Mm hm.

CLIENT: And hopefully I'll know more quite soon.

THERAPIST: Mm hm.

CLIENT: Also, I'll be gone the entire month of July.

THERAPIST: Oh.

CLIENT: So I'll be leaving on the fifth and I think returning on the thirtieth or something. So -

THERAPIST: Where are you going? [00:10:23]

CLIENT: Going to Well I have a conference in Egypt and I'm going to meet Jennie's father, meet Jennie's father and stepmother in Jordan.

THERAPIST: Mm hm. Is she like being (inaudible) or something?

CLIENT: No. I mean it's complicated. And -

THERAPIST: Okay. So gone in July.

CLIENT: So, you know, I don't know. I mean off our topic for discussion, but it occurs to me that starting something like this before then might not make a lot of sense. It might make sense, it might be fine, but you have a better sense of the rhythm of these things. [00:11:27]

THERAPIST: Um. (pause) The (pause) Let me think about it. (pause) Let me think about it. I mean I guess my inclination would be like (pause) Yeah, let me give it some thought actually before making a bit of another recommendation. [00:12:46]

CLIENT: Alright. (sigh) (pause) I feel (clears throat) (pause) I feel really worried. I feel really concretely worried.

THERAPIST: Uh huh.

CLIENT: I've put a lot of eggs in this basket and I don't really have a good back up, which Jennie repeatedly expressed her concern about.

THERAPIST: Yeah.

CLIENT: And a possibility that she may have been right, you know, raises a couple of issues. One issue is that, you know, this is a real major booming issue for our relationship. I feel very worried about that. Two, I can't (pause) I can't envision a path for myself. There's like the substantive issue of not being able to do things in my own behalf. [00:14:13]

I mean the reason why I haven't been able to pursue a backup is, you know, the same reason why I'm in the situation to begin with.

THERAPIST: Mm hm.

CLIENT: It's like (clears throat) and aphasia (ph) or something. That's what it feels like. I can't promote myself. I don't know. I don't quite know how to do it. You know? And at times when I've attempted to do so I've kind of been rebuffed, I guess.

But mostly it's that I can't do it. I have a hard time describing my own program. I have a hard time presenting myself for inspection. (pause) A hard time remembering to pick up the theme from Wednesday. You know, what it is that I've done sufficient to pursue a new thing or pursue collaboration of that. [00:15:33]

It's like the speech, the talk or lecture -

THERAPIST: Mm hm.

CLIENT: in August. Or there are any number of examples of this. And I don't know how I can earn a living and support a household and support a family if I can't do this. I just don't know how I can do it. I don't know how I can sustain a relationship if I can't do this. It's like this yawning gap.

And even when I feel very settled about it, when I feel very confident in it in a sense of mastering accomplishment and continuity, there's no continuity to that sense. In other words, you know, there are moments when I feel continuity, when I can connect the dots and see them, but they're fleeting. I can't preserve it. [00:16:28]

THERAPIST: Mm hm.

CLIENT: And I think that that, you know, failure of continuity is like an instability of personality, I guess. Some conceptual framework is one reason why you thought that analysis would be a good idea. On the other hand, I don't know. I mean, I don't know.

THERAPIST: Yeah.

CLIENT: I'm kind of panicked by the failure, apparent failure, of this New York gambit. I'm kind of panicked by it. It's a huge fuck up. But it's not like a fuck up that It's not a fuck up by an intention or by lack of knowledge that there needed to be back up. I literally, I feel like I cannot do this. [00:17:28]

THERAPIST: I know you have hardly been able to bring it up here even, as you are actually doing very clearly now. And also couldn't really bring it up around the time you were applying to the New York gig. You know, you sort of said, "Well geez, I should have other alternatives. I should be applying more broadly or looking more broadly, and I know I'm not."

Like it's always been hard, I think, for you to really raise it as an issue. And not because you didn't think it was one, but I think because it has really been so terrifying.

CLIENT: But it's terrifying not because I mean, I suppose in some sense it's terrifying because of whatever. It's terrifying to apply for things. But ultimately, you know, what's so frightening is that I don't feel like I have that capacity. I don't feel like I actually don't feel like I have that continuity of something. I'm not sure that I'm articulating. [00:18:52]

THERAPIST: What I get from what you're saying is -

CLIENT: It feels like there's something -

THERAPIST: you just don't feel like you can do it.

CLIENT: I just don't feel like I can do it. (pause) (sigh) I don't know. I don't know. I'm at a loss. And I feel, you know, so secondarily I feel a sense of defeat about our interactions since, after all, this is principally what I came to you for help with.

THERAPIST: Mm hm. (pause)

CLIENT: I mean, I do think that that's secondary or -

THERAPIST: Yeah. [00:19:55]

CLIENT: You know, it's a Narcan (ph) effect, this incapacity or I mean I think incapacity is question begging. It embeds a premise that's unproven. But whether it's a question of capacity or will or some combination of the two or some interaction of those two phenomena, I try, I want to. I mean all these things, I want to do them.

THERAPIST: Yeah.

CLIENT: All of my interests are inclined in that direction.

THERAPIST: Yeah.

CLIENT: I mean I feel undone about it. I feel completely undone about it. There's no mystery, there's no delusion on my part. I know how serious it is not to be able to do these things. (sounds like he might be crying) I mean it makes it impossible to make a life in any sense. I feel terror about the implications of it, but I don't know what to do. And, you know, some of what's talking now, I'm sure, is sleep deprivation. [00:21:14]

THERAPIST: Matt (ph), this is a very big deal.

CLIENT: But it's real.

THERAPIST: Absolutely.

CLIENT: It's real.

THERAPIST: Sure.

CLIENT: And we haven't, you know, I don't lay this on you. You know, and maybe analysis offers some, you know, more efficient means to this end. But we haven't been able to do it.

THERAPIST: Mm hm. (pause)

CLIENT: We haven't been able to do it. It's not that it's been obscured in our conversations. I don't think. I'm not sure I completely agree with you that I've had difficulty bringing it up here. I think I've brought it up on numerous occasions. But I don't know what to do about it. I mean the conversation doesn't go anywhere beyond saying, "Well, there's this." (pause) (sigh) So I feel fairly terrified. [00:22:28]

(long pause)

CLIENT: And I feel terrified, among other things, by, you know, a sense that whatever progress we've made, which I know, I don't dismiss -

THERAPIST: Mm hm.

CLIENT: has not really made a dent in this, the most important venue of whatever these struggles may be. [00:23:27]

(long pause)

THERAPIST: Well (pause) it does seem pretty clear to me that this is the same issue as -

CLIENT: Sure. Fine. No, I agree.

THERAPIST: (cross talking at 00:24:29) different venue in that there's sort of work of a particular kind to be done. In this case networking and applying. It's thinking networking and applying. And kind of by definition it's a venue where the senses of connection and attachment and also self-promotion are -

CLIENT: Self-definition (ph), I would say. (pause)

THERAPIST: Well self-definition (ph) but also self-promotion. We've talked about how you're really uncomfortable and sometimes stymied when things like competitiveness or people being out for themselves come up. I'm not, you know And (pause) I guess part of what I'm saying is like let's keep straight what's cause and what's effect. [00:26:02]

CLIENT: No, I'm not disputing any I mean I'm not diverging, I think, from our consensus at this point.

THERAPIST: Uh huh.

CLIENT: Oh, Okay. Sorry. (pause)

THERAPIST: And like I said, it seems to me that you're really not sure when you're as worried as you are now about whether this is a kind of incapacity, as in a lack of the requisite skills, at least as I understood you to mean. Or an inhibition, which is what we have kind of consistently identified it to be. Everywhere we've run into it.

CLIENT: Okay, so I mean, you know, at what point does an inhibition become an incapacity. Right? I mean if you're inhibited from, I don't know -

THERAPIST: No, but (inaudible at 00:27:12) they're very different in that, you know, if I really thought this was an incapacity and (inaudible), we'd like send you to somebody to help you learn how to network, and write a resume, and write cover letters and whatever. But this isn't about a lack of those, or your not possessing those skills. This is about tremendous anxiety that comes up around looking for a job. (pause) I imagine that -

CLIENT: Yeah. Looking for a job where I don't know anybody.

THERAPIST: Okay.

CLIENT: I think.

THERAPIST: I'm not sure, yeah.

CLIENT: I'm trying to make jobs.

THERAPIST: Yes. [00:28:14]

CLIENT: You know, I've pursued things that are difficult and uncertain and -

THERAPIST: Yeah.

CLIENT: have all these uncertainties. And I've pursued them, you know, at length and over long periods of time.

THERAPIST: Yes, but that in itself has been very hard.

CLIENT: That's true.

THERAPIST: And I remember you telling me when you were sort of at networking with the New York people, saying, I'm pretty sure something like, "I know I should be looking elsewhere too. [But you know there are periods of uncertainty.] (ph) But I just can't even imagine doing it."

In a way that I took, at the time, to mean like it was so hard to be pursuing New York with all of the uncertainty there that to be taking on another kind of alternative was just overwhelmingly anxious. [00:29:21]

And (pause) so I guess that's part of what's making me think that, sure well I imagine it helps to kind of make the job and already have a bunch of the connections and know at least somebody. Even so, it's very daunting. Yeah, it's very difficult and kind of horrendous, actually.

It's not just that it's difficult, this anxiousness, it's a horrendous process for you. And I guess I have to imagine that that's a lot to do with, you know, with kind of by definition or inherently a part of the process which is, you know, uncertainty about the connection, attachment. [00:30:55]

CLIENT: Yes, that's it. (pause)

THERAPIST: I guess another way I can put it is, clearly it's so hard to be investing a lot, as you inevitably would, in a, you know, possibility or like an opportunity knowing that it might or might not work out. And your control over that is quite limited. Your knowledge of how it's unfolding is going to be very limited.

You know, that you're probably not going to get a lot of information from the people you're talking to about how they're making a decision. I mean, in a way like these are all your buttons. [It winds up in this horrible way.] (ph) [00:32:12]

CLIENT: So -

THERAPIST: Yeah.

CLIENT: You know, all that being said -

THERAPIST: Yeah.

CLIENT: I feel some anguish, fear, concern -

THERAPIST: Sure.

CLIENT: that whatever progress we've made -

THERAPIST: Mm hm.

CLIENT: hasn't yet made a dent in that kind of core basic condition.

THERAPIST: Mm hm.

CLIENT: To the point where I still don't have the capacity to overcome it or steel myself to endure it, or what have you. I just You know, Jennie gets very frustrated -

THERAPIST: Yeah.

CLIENT: naturally. And she's managed it very lovingly and well. [00:33:12]

THERAPIST: Mm hm.

CLIENT: But, you know, I think when I make the call that New York is definitely not going to happen it's going to burst out.

THERAPIST: Mm hm.

CLIENT: And I fear that, you know, turn in our relationship. She doesn't You know, to her it feels like not wanting to do something.

THERAPIST: Sure.

CLIENT: You know, to her it seems like -

THERAPIST: Well, it is not wanting to do something.

CLIENT: (sigh)

THERAPIST: You also terribly want to do it. I mean, let's be fair, but it's what an inhibition means. And, you know, I imagine she doesn't understand that you know, this isn't a knock on her, it's just (inaudible at 00:33:55) you know, that she attributes it to a somewhat more conscious desire not to do it. Which is not at all the level at which the desire to do it operates. You know?

CLIENT: (clears throat) Yeah. I mean I've been trying for two weeks to write up a one page description -

THERAPIST: Mm hm.

CLIENT: of the program that I'm developing.

THERAPIST: Mm hm.

CLIENT: This hub that I'm developing as part of our Brown project.

THERAPIST: Yeah. Oh.

CLIENT: And I sit down to do it and I can't do it. It's not just that I can't open it and start, I like cognitively I can't put it together.

THERAPIST: Yeah. Well it's like a step into hell. It's a (cross talking at 00:34:40)

CLIENT: I can't put it together, Marshall. You know, I sit down to prepare a CV. I can't put it together. I just don't (clears throat) It's like being at a maze (ph). A perfect analogy, it's like being at a speech and not being able to read it or, you know, not having your glasses on.

THERAPIST: Mm hm.

CLIENT: Or not being able to speak.

THERAPIST: Yeah.

CLIENT: It's like not being able to speak. And I know this happens to people. And I guess it's also an inhibition in your, you know, conceptual framework.

THERAPIST: This is has been happening to you all over the place -

CLIENT: People who can't, you know -

THERAPIST: for your whole adult life. I mean this -

CLIENT: (loud exhale)

THERAPIST: You know, it's the same thing. You say exactly the same thing when there's something that you're trying to write and can't write at work. Or when you're -

CLIENT: (sigh) (sounds like crying) So, I don't know what to do. I mean it's like, here's my life. (pause) So we have to stop in three minutes or whatever, and here's my life. There it is. And, you know, I'm perfectly open to and even inclined to entertain the possibility of doing it more frequently, these interactions. But to be honest, I don't feel hopeful. [00:36:10]

THERAPIST: I know.

CLIENT: I mean, I say that not in the spirit of rejection but just honesty and exclusiveness. I don't feel hopeful. I don't see change. I see (sigh) I see something. I'm able to manage my anxiety better, I guess. The anxiety surrounding the incapacity or however.

THERAPIST: Well, yeah and actually the fact is that you've been in an easy job overall. You have been able to work better. You have not had any sort of long frozen periods. You've not handed in anything that's been late enough to actually get you in any kind of trouble there.

CLIENT: (sigh)

THERAPIST: If they don't renew your contract, at least as far as I've heard, it won't have anything to do with your reliability or the quality of your work. Which is not how it's gone even where you were just before. [00:37:27]

I mean I think you're right that we have not made a significant dent. Clearly, you're right. And you're ready to like pursue other jobs. But, you know, with some of the smaller but still quite important kind of instantiations of the same dynamic, things are better. (pause)

And I'm aware that every time, every time you're at this particular path where there is a task in front of you that you are not currently able to do, you're convinced we've done nothing or we haven't -

CLIENT: I didn't say that. I don't think that that was the way I introduced this. [00:38:39]

THERAPIST: You're right. No you're right. That's me going too far. (pause) But there is a sense of hopelessness about being able to tackle the bigger things. And (pause) Yeah. (pause)

CLIENT: Okay.

THERAPIST: Clearly tackling the, I don't want to say smaller things, because it's not smaller it's just like sort of less difficult situations in which the dynamic is there, but it's not as intense. I guess I can put it like that. [00:39:46]

CLIENT: (sigh)

THERAPIST: It feels like dealing with that stuff in the way that we have and you have really, has no bearing.

CLIENT: No. I know that it has. Look, this, you know, the sort of commonality or commonalities in the dynamic are obvious. We've done a very good job, I think of, you know, kind of teasing them out and whittling them down and trying to isolate exactly what's going on and what might be the aspects that are common. [00:40:35]

But at the end of the day This is what's discouraging. At the end of the day, I came I'm not talking about to you in general but I came to, you know -

THERAPIST: Yeah.

CLIENT: an understanding that, you know, psychotherapy was something that I just had to throw everything that I had at because, you know, my life had just been completely disrupted by this phenomenon. You know, I was not building a life the way that I needed to or wanted to or that would be fulfilling to me.

And it's, you know, just on a practical level it's still fucking me up in this very profound way. And particularly in this very concrete, you know, kind of interaction that feels troublesome.

THERAPIST: Yes, it absolutely is.

CLIENT: I feel like I'm making progress. You know, I don't deny that. [00:41:39]

THERAPIST: Mm hm.

CLIENT: I don't deny that I'm managing certain things better.

THERAPIST: Mm hm.

CLIENT: But that the core dynamic, I don't know how to I don't know. The core dynamic is still, you know, as painful and difficult as it ever was.

THERAPIST: Mm hm.

CLIENT: And the practical implication of not being able to pursue work directedly is as troublesome as it ever was.

THERAPIST: Mm hm.

CLIENT: I mean literally, the last job that I applied for in the usual way -

THERAPIST: Mm hm.

CLIENT: was this job the month that my father died.

THERAPIST: Mm hm.

CLIENT: Now that says something right there, I'm sure. And I don't think it's the first time I've raised it.

THERAPIST: Mm hm.

CLIENT: But it's probably not something to bring up, you know, in the last minute of our conversation. (laughs) But there it is and I don't know what to do about it. And all of this time, you know, these last seven years of doing this, you know, I'm in a room, hasn't really made a dent in that. (pause) [00:43:05]

I don't know how much, how long I can just keep getting back on the horse. So, Wednesday.

THERAPIST: Yeah.

CLIENT: (sigh)

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