TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Good morning to you. (Pause) I have an administrative thing for you.

CLIENT: Oh yeah. I had one on Wednesday, and I'd forgotten it. Or are you inferring that I have an administrative...?

THERAPIST: No, I have an administrative thing.

CLIENT: Oh, you have an administrative thing. Yes.

THERAPIST: You do not have an administrative thing.

CLIENT: I have a question. I just sent the check for the bill that you sent for April, I guess, to the bill pay. So they should be sending you the check imminently.

THERAPIST: Oh, okay. [0:00:55]

CLIENT: You had said that... since, I guess... I'm realizing in retrospect as I talk this out to you what you had intended to mean with respect to the March 1st date, which was that since you'd already got reimbursement for it you didn't put it officially on the bill but that it should be included in my check to you. Is that right? Right, I did not do that, so that's still outstanding.

THERAPIST: Okay.

CLIENT: But we can stick it onto the next bill.

THERAPIST: All right. Yeah, that was the administrative thing I had to bring up, just billing, because it had been a while, [and I'm getting ready to bill again] (ph).

CLIENT: Right. So that's supposed to be paid, I think, probably beginning of next week. They should send it out to you.

THERAPIST: All right.

CLIENT: Yeah.

THERAPIST: Okay, and I will just send you a bill for May.

CLIENT: For May itself, right? Let's see. [0:01:56] (Pause) (Exhaling) The insurance (sp?), which has proven to be a big hassle, sent me a notice saying that they intended to impose a reasonable fee standard for all billing, starting (ph) January 1st. I don't know what that's going to mean until I submit my request (inaudible at 0:02:43) for reimbursement. They haven't done that. They did that to us with tomorrow (sp?). And it was substantial. According to the policy, there were supposed to pay 70%, and they ended up paying 50%, simply by virtue of imposing this standard. [0:03:03]

THERAPIST: Right. They...

CLIENT: They haven't done it with other billing for this year yet. But they just sent me this notice, so it's unclear whether they're planning to institute this policy or whether they've gotten complaints about billing that they've already done. If the latter, then we're fine. If the former, then we may discover that they're 30% less than they had before. So... I mean, that's my problem in some sense, but it's our problem in the sense that it would affect things like whether we decide to do this every day. So...

THERAPIST: Right. Do they...?

CLIENT: I don't know whether the insurance regulator has anything to say about these kinds of things. It seems odd that they can just arbitrarily say, well, we're just going to pay you less...

THERAPIST: Yes. Exactly, yeah. [0:03:58]

CLIENT: Even though we have agreed contractually to pay more. But I'm guessing it's a loophole.

THERAPIST: Huh. Yeah, I've... (Pause)

CLIENT: This insurance seems awful.

THERAPIST: Really?

CLIENT: I would... as soon as it's open enrollment I'm gone.

THERAPIST: Yeah. That's one I've not heard of, and I've heard of insurance... I mean, sometimes insurance will say up front, we pay X for the first Y sessions and Z for the... you know what I mean?

CLIENT: No (ph), they just arbitrarily say...

THERAPIST: Yeah, no, I got it.

CLIENT: Based on our research, blah blah blah.

THERAPIST: Wow.

CLIENT: Yeah. So... (Pause) (Exhaling) I mean, essentially what they're trying to do is make you go through their network. [0:05:00] I mean, that's what this is. This is a way of getting people to pay more for PPOs but creating disincentives to actually use them.

THERAPIST: Right.

CLIENT: It's really a PPO issue, it's not an insurance market-side issue. (Pause) So where were we? (inaudible at 0:5:36) question. (Pause) I was tired and under-slept. [0:05:55] I was finding it curious that I... many of my responses were... to uncertainty in some of these professional settings were the usual ones. And yet they weren't necessarily accompanied by the same feeling that they often have been, right? I wasn't sure whether I just created new mechanisms to dissociate from that (chuckling) or what and, I guess, finding it interesting that my kind of implicit folk causal theory about what produced the avoidant behavior and other things that have been troublesome wasn't... didn't seem to be the product of the feeling itself. [0:06:59] The feeling turned out to be a little bit... kind of epiphenomenal.

You made... I remember that you'd made an observation that seemed very trenchant and pertinent, but I don't remember what it was, about the way that I was setting things up. (Pause) You said among other things that while I sort of underscored the importance of and my desire to focus on this question of work and seeking it. [0:08:01] I hadn't really talked about it or made any substantive offering in that (inaudible at 0:08:11) that thing, and that it's curious that I hadn't brought up any... couldn't mention or point to anything that I actually explored. [There are no details] (ph). It's all very vague, the process of looking, creating redundancy. (Pause) I mean, there have been some developments on the New York end. And interestingly... I mean, good... potentially good developments. [0:09:02] (Pause) Interestingly what that seems to have provoked is the feelings that I thought were kind of difficult, painful, that sense of stress. (Pause) Glimmerings of them, not quite the same thing in the sense that it's not... it hasn't been cursive (ph), static, circular, [looking for] (ph) the right metaphor. I haven't been trapped in it exactly, although I did wake up... go to bed very late and wake up very early today. [0:09:57]

I'm probably operating on two hours sleep, although I napped quite a bit in the evening. So that changes it a bit, but, I mean, my sleep pattern's completely disrupted by all of this. And that's a real problem. Cognitively, I feel fine this morning, which seems odd given sleep deprivation, [we'll see when] (ph) I crash. My mother's coming into town for the weekend. Jennie's (sp?) mother was here last weekend, so it's been a very motherly weekend, motherly week. Yeah, so that's curious, I guess. (Pause) Yeah, I wish I could recapture the direction of our conversation from Wednesday, because all these elements were there. [0:11:00] But I'm not... I'm finding it difficult to reconstruct the train of thought, which, I guess again, is kind of classic. And that may be factored (ph) in what you were talking about, I don't remember. So... (Pause) [0:12:00] [0:13:00] [0:14:00] [0:15:01]

THERAPIST: Well (pause), this is a bit unusual these days I think, for you to sort of feel or at least refer to this degree of your disconnection with what we were talking about just recently and to sort of not have something else that you're kind of coming in with, as you often do. And (exhaling) I speculate that it may be in part because of our talking about money at first and sort of looking at... I don't know what exactly, like, the more transactional or business aspect of this. [0:16:17] And that... maybe leaving you to feel a little sort of warier or less connected or something and so sort of struggling around reconstructing how things were on Wednesday.

CLIENT: Honestly?

THERAPIST: Sure.

CLIENT: I think probably it has to do with sleep deprivation, keeping emotional continuity and train of that and what have you from day to day when you have a nap and two hours' sleep, it's challenging, especially when it's difficult to begin with. [0:17:12] As I sit here, I feel... and this is quite unusual I think, I feel my clarity of mind dissipating a little bit as I try and focus on the topic at hand. I mean, I kind of dance around my fate (ph). There are details that I remember, but I'm not quite sure how to put them into a shape. And I think that's characteristic of a particular state of mind. [0:17:57] I'm not... I don't necessarily have the sense that (pause) it's unusual of late, although I trust you, [I expect] (ph).

Yeah, I'm having... as I sort of formulate a response, I find that I'm having difficulty with it. I think plausible idea... I mean, I... we went out for ice cream... or not for... excuse me, we went out for ice cream afterwards. We went out for dinner with a friend, and I fell asleep in the restaurant and then got into the car. And we went for ice cream, and I fell asleep in the car in the back and Jennie... I woke up half an hour later when they returned... when Jennie and our friend returned with their ice cream cones and went to get an ice cream of my own. [0:18:59] But then I came home and I fell asleep again. I mean, so the degree of sleep deprivation is getting to the point where, at a certain hour of the day at least, I really can't function. And as I recall one of the things we were talking about on Wednesday was how to calibrate an approach that both addresses some of the structural factors or, I don't know, concrete issues and the... those concrete issues. Concrete issues like being sleep deprived and what the sequilla (sp?) of sleep deprivation are and also simultaneously, in an integrated way, thinks about the emotional component of psychological component. [0:19:59] You had a pithy comment about that that I can't call to mind.

THERAPIST: It was undoubtedly very pithy.

CLIENT: So pithy you can't reconstitute it. Anyway, I mean, really I feel the kind of structure of my thought here crumbling a little bit. And whether it's because this is a difficult topic or because there's some tension in our relationship or because there's tension in my life outside right now or stress outside or because of sleep deprivation and almost certainly some combination of all of these things...

THERAPIST: Right. Sure.

CLIENT: I feel... I... literally as we talk I feel the kind of clarity of the delineation of my thoughts wavering. Right now in comparison with ten seconds ago it feels a little more sure. [0:21:05] I feel more alert. But I can feel it fluctuating...

THERAPIST: Hmm.

CLIENT: Which would suggest that there's actually some actual kind of concrete neurological o... whatever.

THERAPIST: So...

CLIENT: Blood sugar regulation is here. (Pause) [0:22:00]

THERAPIST: Hmm. (Pause) [0:23:00] [0:24:00] [0:25:00] What was (inaudible at 0:25:32)?

CLIENT: So there was... before I came on, this group had been delegated to kind of spearhead this initiative. And I really hadn't thought very much of them, and I'd said so to Jack often. I've talked of this I think. [0:26:06] But they'd been empowered, and the institutional process had begun. And... (Pause) Anyway, so I said to Kevin on a couple of occasions that I didn't think they were really making much of this, and we had been working with another person in the public sector, who's brilliant, and just... we're very simpatico. And we have... we really developed a nice rapport. And I... many of the times that I'd gone down there in the last few trips it was to work with Dave. [0:27:08] We cooked up things, we made proposals, we did talking points. But he's being retired at 62-which is the retirement age bizarrely-in October. And I think he's looking for a deep beyond there. And as I recall executive fiat can overturn these kinds of things in extraordinary circumstances. So he was hoping that we would promote him within the president's office. And we were very excited to do so. But meanwhile this other team had responsibility for pushing this forward. So the news was that there's going to be a shakeup, and this guy's going to be put in charge of it. [0:27:56]

THERAPIST: Dave's going... in charge of the team?

CLIENT: Dave's going to be put in charge of the team. Well, in some... yeah, as yet unspecified form, but apparently... so I got an e-mail from Kevin, just this one-line e-mail saying, I'm not... I don't' like the way that it's going, which I knew already. I'm going to shake it up. And then three minutes later he wrote an e-mail to Jack-which Jack promptly forwarded to me-saying, we want Dave to go to this big meeting in overseas. And it was clear that this was the shakeup. So... plus the incoming chief of staff, whose relationship to me is a little unclear, is really eager to promote him as well. And so we had a telephone call, Jack and Dave and I, shortly after a series of messages. And we're just kind of talking it out. But, if they give it to him, I have a pretty good relationship with him. So the prospects for doing... exactly how it gets orchestrated so that... I don't know. [0:29:08]

I mean, it's complex because I think bringing somebody on as a short-term consultant is one thing. Bringing somebody on as a more long-term hire is another thing. And we've exhausted my short-term consultant time at the end of... in other words, they can't give me another short-term consultancy after June. So there would have to be a different mechanism, and that different mechanism would require some specific... I don't know. I'm not sure what they would appeal to. [0:29:56] At any rate, it can't... it's delicate because I had a preexisting relationship with the president, so it could not be done through the president directly. And I think significant care has to be taken to avoid overt impropriety in that respect. This is all my inference, but it makes the mechanism by which I would continue to work on this as a job a little bit murky. (Pause) [0:31:00] [0:32:00] [0:33:00]

THERAPIST: So the not sleeping seems to me a bit like the not being able to work thing...

CLIENT: (Exhaling) Yeah?

THERAPIST: In a few different regards. First, you... subjectively you experience it, I think, in a similar way as though it is being done to you entirely outside of your control, which is sort of in a way true but sort of not true at the same time. [0:33:57] That's something you're subject to. That's one thing.

CLIENT: Okay.

THERAPIST: Another thing is (pause) it creates a similar disconnection with the people around you. Either, like you were saying a few minutes ago, here you feel more kind of... actually people are less palpable because your mind is blitzed from not having... from your not having slept. Or I guess yesterday, when you literally fell asleep in the middle of social stuff. [0:34:57]

CLIENT: I... it wasn't quite like that. We ate dinner, and I was interacting normally. And then suddenly I felt this wave of fatigue come over me, and I said to Jennie and Miranda (sp?)... I said, I'm going to fall asleep now, or something to that effect. I'm feeling, and they know me. And they've seen it happen before, and they're like, oh, okay, fine. So I just fell asleep sitting up...

THERAPIST: I see.

CLIENT: My back leaning against the back of the seat. It wasn't... it was socialized.

THERAPIST: Actually, it wasn't. I mean, in a way it was checking out. But in another way it was for you and they... and them, part of the social discourse.

CLIENT: In a weird way, yeah.

THERAPIST: Yeah.

CLIENT: It's just part of who I am at the moment. And I can anticipate it in the short term and account for it. [0:35:59] So there's that. I mean, I'm struck by your formulation... sort of parallel formulation of the working and the sleeping. Clearly they interact with each other at some important levels. But beyond that... one thought that I've had frequently is that my sleep deprivation is not conscious exactly but controlled. In other words it's not... I'm doing it to myself for some obscure reason. I seem to have... I don't know if it's unusual, but I seem to have quite a bit of control over when I wake up. I never use an alarm clock for example.

THERAPIST: Hmm.

CLIENT: I wake myself up. And I... this thought occurred to me shortly after I started talking to a shrink, that for some unfathomable reason I'm trying to deprive myself of sleep. [0:37:07] Or I'm trying not to sleep, which is probably the more prudent or measured construction. I don't... maybe because I'm having bad dreams. It's not necessarily the case that sleep deprivation is the objective. That may be, but I'm not sure.

THERAPIST: Right.

CLIENT: But for whatever reason I'm trying not to sleep or just trying to sleep less or trying to... I'm interrupting it.

THERAPIST: Yeah.

CLIENT: So, that may be parallel as well. I think I'm resistant to... and historically I've been very resistant to this formulation, that, when I wasn't working, it was because I didn't want to do it. [0:38:00] And people had continually kind of bludgeoned me with this assumption that it was completely under my control, and, as soon as I decided I wanted to do it, I could.

THERAPIST: Right. Yeah, I don't see it quite like that.

CLIENT: Yeah, I don't... I'm not accusing you of seeing it like that. I'm just explaining why I am sometimes resistant to this formulation. But obviously there's some truth to it. And it would be interesting if the sleep aspect were also implicated in that process. The follow up questions, though, I have no clue about. (Pause)

THERAPIST: Well, the other thing... or another thing about the way the sleep and the writing seem similar is that they're both sort of dangerously high stakes. [0:39:01] I mean, you've made it pretty clear how not sleeping to the extent that you are can really mess things up. I mean, that it... at least as you described it recently, can feel quite dire or that will have quite dire consequences, which is also how you frame the problems with writing. And I'm not saying you're incorrect. I'm just saying you describe the consequences of both in similarly sort of scary and dire terms. I'm just saying, they seem similar that way, too. [0:39:56]

CLIENT: I guess one more point of similarity is, they're kind of altered states.

THERAPIST: Mm-hmm. Yeah.

CLIENT: They're both states that are not... for me at least, right? The process of writing or working involves some kind of altered state. It's not... there's a degree of focus and kind of clarity in the process of proceeding from one thought to another and building them together and making the words fit. And that's different from the way that I am in the everyday world. And sleeping similarly. And so there's... because there's something unfathomable about it, like how I get into it, why I get out of it, why I can't get into it, I think. [0:41:07] Yeah, I'm not sure what to make of that parallel. But they do... they also feel anomalous to me on that level.

Anyway, I don't know what to do with all these parallels or analogies. They do seem connected. I endorse that proposition. I'm not sure what to do. I mean, look, put it this way. If we were... assume that they're not only analogous but homologous. If we were to solve that homologous structure or those homologous... sort of resolve whatever conflict is impeding them, I would say, we're done. Or I would say that, at the very least, I kind of come... gotten what I initially came here for and felt like I've gotten my money's worth. [0:42:00] So insofar as this parallelism helps us identify really what the object of... the research object is or whatever, the problem to be solved is, then that's good. I'm not sure what to make of the parallelism. What...? It probably tells us something useful and important, but I'm not sure what that is yet. (Pause) There's an inhibition. It's not really about writing, per se, insofar as it also applies to things like job search, right? Things that are, in my mind, articulations of my attachment to something. [0:42:59] I'm free associating a little bit. (Pause) It's not just about writing. There's some altered state that allows me to do things. There's some altered state that I have to shift into...

THERAPIST: Like a kind of a writing mode...

CLIENT: Well, yeah. I mean, it's all about writing insofar as that's kind of how the people in the knowledge economy. It's about production. It's about the process of producing the things that are to be produced. And as I think about it the same altered state really applies to doing... picking up laundry or... it's like there are tasks. There's a task to be done. And... yeah. [0:43:53]I mean, I think at one point I just tried to articulate or was asserting in a parallelism between the process of writing and the process of trying to clean my room at the age of whatever, at a very young age, just having a similar feeling about the difficulty and recalling a similar feeling when that difficulty was resolved, usually through a very baroque process in which I kind of mounded everything up in the middle and, again, distributing it to... again, free associating. I think maybe that's useful at this juncture.

But my sister... I had had my books in my sister's basement, all of my books just about, with few... relatively few exceptions since I finished my dissertation. And she's... I think they're remodeling or doing spring cleaning or something. [0:44:57] And I had said independently of this fact that I'd like her to send them back now that we have a stable household with room enough for the books. And so she sent them to me. And I put them in the office at work. And suddenly felt, as I sort of placed them on the shelves in order... suddenly I felt intellectually situated in a way that I hadn't before. It was like I could remember kind of what I was thinking about or what the various thoughts that I've had. It was a very weird... I mean, a nice feeling, but a very weird feeling. It was like, in the last five years, however long it's been, four and a half years, I just have been completely out of place because I didn't have that tangible sense. And I... there's a direct connection there not only to the room cleaning, the kind of juvenile process of not being able to find the space, the kind of altered state in which I could clean my room, and the sense of not really knowing how to be productive. [0:46:06]

THERAPIST: Yeah. (inaudible at 0:46:10)

CLIENT: Oh, fuck. Okay. All right. So I will see you on Wednesday, unless I have to New York, which is not completely out of the realm of possibility, in which case I will let you know by Sunday.

THERAPIST: Okay.

CLIENT: Does that work, to...? All right. See you then.

THERAPIST: Okay.

CLIENT: Bye bye.

THERAPIST: Bye bye.

END TRANSCRIPT