TRANSCRIPT OF AUDIO FILE:

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CLIENT: So (pause) I can barely stand up. I'm still not sleeping. Again, it's clearly the priority, it's not working. So, at a minimum, I'm not sure how much I can get out of our discussions frankly because... I don't know, it's just not happening for me (inaudible at 0:00:59). [0:01:05] [To interact will] (ph)... I feel frustrated and kind of disappointed, mainly disappointed. On a practical level I think it's just not useful to try and engage at the level that you have to engage at, if I can't sleep. Now on the question of whether it's useful (inaudible at 0:01:45). I feel very deep disappointment with this. [0:02:02] (inaudible at 0:02:02) (Pause) Last night I went to bed at 10:30. I got about three hours sleep aggregate. (Pause) And this is classic. This is... there's no mystery to me about it. [0:02:58] So Jennie (sp?) woke up with me, woke up at a certain point and just started crying. (Pause) She asked me if somebody could prescribe me medication, but (ph) medication's useless. So... (Pause) I just feel disappointed in all of the... I feel like I've given so much of my time and resources to just about every possible configuration of mental health professions, and I've gotten nothing back. I mean, it's just the same as it ever was. (Pause) [0:03:56] I feel very scared (ph). (Pause) [0:05:00] [0:06:00] [0:07:00] [0:08:00]

THERAPIST: Well, you seem very (inaudible at 0:08:38) feeling very strongly and very invested in the idea that I am very much responsible for your... the trouble that you're having and that... [0:08:56]

CLIENT: What? In what sense did I say that you were responsible for the troubles that I'm having?

THERAPIST: I've blown it.

CLIENT: I didn't say you were responsible for the troubles that I'm having. I never said.

THERAPIST: Galen, you just said you invested so much...

CLIENT: I feel disappointed...

THERAPIST: In everybody sort of... many sort of alternatives in the mental health system. (inaudible at 0:9:23) time and money [or just] (ph)... but you've invested so much and gotten nothing back. I mean...

CLIENT: I did not say that I've gotten nothing back...

THERAPIST: You did.

CLIENT: I said that I'm still there. I said that I'm still there.

THERAPIST: No, you said you got nothing back.

CLIENT: Okay, [it'll be on the tape] (ph). I certainly did not say that you were responsible for... I never used that word, and I never used that implication.

THERAPIST: No, you didn't. What you're saying in front of me is, I've invested so much, and I've gotten nothing back. [0:09:59] I'm not... this may not be what you consciously think, but [it seems like a] (ph) quite clear at least partial implication.

CLIENT: I don't know. I'm not sure the use of this discussion is. What I thought and intended to say was that, when I began doing this eight years ago, it was because I couldn't sleep and because I couldn't work and because I felt this deep failure of attachment that was in some way implicated in that process. And that's exactly the way that I feel now after all of this investment of time and resources of whatever kind. [0:11:02] And it's not... it wasn't about my...

THERAPIST: Well, I didn't think you were terribly disappointed, (crosstalk).

CLIENT: I said I feel disappointed.

THERAPIST: You feel very disappointed, but it (crosstalk).

CLIENT: To say that is not to say that I hold you responsible for...

THERAPIST: Okay, let me put it another way. Why wouldn't you, the way you're talking? I mean, you say you've invested all this time, (crosstalk)...

CLIENT: I hold you responsible for my disappointment. I don't feel... hold you responsible for my state of mental health. That's a completely different statement. I hold you... I hold the mental health professions and you as their proxy responsible for my disappointed... you've disappointed me.

THERAPIST: Okay.

CLIENT: I feel disappointed by the... my inability to transcend, correct, repair, whatever this is.

THERAPIST: Okay, and how is that...? I'm... this is actually [my point] (ph) of how is that totally different from holding me responsible...? [0:12:00]

CLIENT: To holding you responsible for the condition itself?

THERAPIST: Yeah.

CLIENT: I mean, that would be irrational. Holding you responsible for my disappointment seems completely rational and reasonable.

THERAPIST: I guess here's the part I don't understand, being (ph), in a way you say, I hold you as a mental health professional completely responsible for not fixing it but not... I guess I... but not for the condition as it currently is. I guess I don't see how those are different, if you...

CLIENT: Really?

THERAPIST: Yeah, if you say, don't (crosstalk)...

CLIENT: Suppose I take a car to a garage and my car has a, I don't know... why do I have to...? Why does it...? I didn't engage in a confrontation. Why are you pushing back at me like this? If I take a car to a garage, and my car has a broken transmission, and they try to fix it, and in the end they can't for whatever reason, am I holding them responsible for the transmission? That's the way that you just expressed it. [0:12:55] I can hold them responsible for being unable for whatever reason to fix the transmission. Maybe the transmission is shot. Maybe there's no... it's an obsolete car, and there's no replacement for the transmission.

THERAPIST: Well, then why would you feel... if that were true, why would you feel so disappointed in them?

CLIENT: Because I had placed hopes in them. I mean, I hoped that I was reparable. I hoped that it could be repaired. I'd invested a lot of money in it being repaired. If I hold them responsible for anything, it's not telling me that I couldn't be repaired to begin with, in that sense. But, I mean, it's obvious what I'm saying. Either you're simply being provocative or you're missing something.

THERAPIST: I'm really not intending to be provocative. I think...

CLIENT: I don't want to be angry. I mean, I'm angry because you're putting words into my mouth that are clearly not the case in a moment where, I mean, it's important to be very precise. But I'm not... I'm disappointed. [0:13:55] I feel sorrow and grief after all this time nothing has changed.

THERAPIST: I think that...

CLIENT: I'm still the same as I ever was, and that state is a really difficult one. It's a really painful one. And it's one that makes it... I mean, it limits my life. I came hoping that there would be some intervention, and I haven't gotten that. I'm disappointed in that. And, to the extent that you were not able... you weren't able to, [it feels] (ph), do anything about it. I feel... I hold you responsible, I guess, in that sense. But I don't have... I don't think that there are any guarantees. I don't think that I have illusions about the great, omnipotent powers in this discipline. But I feel disappointed. [0:14:58] I hoped that it would be possible to do something. (Pause) And I don't think I said anything else, and I'm not quite sure why you're expanding the scope of my statement. So, I mean... unless you feel (inaudible at 0:15:26) or just reasonable. I don't begrudge you that, but that's not what I said.

THERAPIST: Well, another alternative is that I heard what you said as a... as relating to your feeling at the moment. [0:16:01] And this is not the entirety [you're feeling] (ph) but one aspect of it, I want to be clear, about the attachment between you and me, which seems central to what you come in about in the first place.

CLIENT: (inaudible at 0:16:16) (Exhaling) You heard me saying something about the attachment between you and me. Well, sure, naturally if I'm disappointed in you, it relates to the attachment between you and me insofar as that attachment is about your... the cope (sp?) of your ability to help me with what I've come to you for help for. And when I say that I'm disappointed it reflects on the attachment. [0:16:55] But I don't think that means that I hold you responsible for causing my pain, causing whatever this dysfunction is causing.

THERAPIST: No, I think you...

CLIENT: That's different. And that is the way that you expressed it. And I think...

THERAPIST: I meant... I don't think you feel like I caused it to begin with, of course, more so that (pause) I-this is how it feels right now-haven't been able to help at all with ameliorating it...

CLIENT: Yes, that's true.

THERAPIST: And that... I mean, I suppose... and here's maybe where the finer distinction is, and I'm not sure actually how important this is. But what I heard was you saying you were disappointed in me. [0:17:57] And I'm not sure if you're saying, well, I'm just disappointed that it hasn't happened. In other words, as with the example of the transmission, in a way you're not really holding the garage responsible if they can't fix something that's unfixable. But in another way you kind of...

CLIENT: I hoped, when I brought it to the garage... I hoped when I invested X...

THERAPIST: Right.

CLIENT: And that's a much more transactional relationship, but, when I invested X, I hoped, naturally.

THERAPIST: Right. So (exhaling)... and (pause) this is...

CLIENT: (Exhaling)

THERAPIST: So familiar.

CLIENT: Well, I mean, Marshall, of course it's familiar. It's...

THERAPIST: Not just with me. Everywhere. [0:18:57] With every work environment that's supposed to provide you with a stable, consistent place of employment and so on and so forth. This always happens. It always feels like that.

CLIENT: (inaudible at 0:19:09) [what do you want me to say] (ph)? I'm not sleeping.

THERAPIST: I understand it's horrible. I'm not doubting that in the slightest. (Pause)

CLIENT: There's no difference from 2001, none. I mean, really, in that dynamic, there's none.

THERAPIST: Yeah, no, the sleeping... it sounds different to me. (inaudible at 0:19:42) it's different in terms of writing and work. But the sleeping doesn't sound (crosstalk)...

CLIENT: It's not different in terms of work, Marshall. It's not. I'm sorry.

THERAPIST: And we've agreed on that, like, 15 times (crosstalk).

CLIENT: Marshall, I can't... when I am in this state, I can'twork. [0:19:57] I... things are piling up.

THERAPIST: I understand. But...

CLIENT: I mean, it's good that you want to claim these accomplishments, and maybe there's been some incremental progress. But this pattern has reasserted itself...

THERAPIST: Clearly.

CLIENT: And it's the same. And, I mean, I guess with the bite or anger that... or frustration, I think probably, most precisely, that you hear in my voice as I respond to you right now, is that I feel as if you're looking for some irrationality in my assessment. And while, given the sleep deprivation, that wouldn't be completely out of the realm of possibility, it's not.

THERAPIST: And I'm not looking for irrationality because of sleep deprivation. Let me make a distinction, okay?

CLIENT: It's not. It's... the assessment... there's nothing wrong with this assessment, and I feel like you're creating work for yourself. (Pause) [0:21:00]

THERAPIST: [Let me make] (ph) a distinction, to try to be clear. I don't... I'm not doubting at all that the sleeping hasn't improved across the board and that, when you're in the state that you're in now, nothing's different from how it ever was in this state. When you're this fully into it, as you are now, it's no different than 2001, 2006, 2000-whatever.

CLIENT: (Exhaling) Okay.

THERAPIST: I don't disagree with any of that. But... (Pause) [0:21:59] The whole dynamic is in some sense irrational. Of course it is. And (pause) that's reasserting itself in the way that we're interacting about it now, and that's what I'm trying to get at.

CLIENT: I don't know. I mean, whatever. I hear you say the words. (Pause) You know...

THERAPIST: Yeah. (Pause)

CLIENT: It's not as if I've not been able to do any work before I came to you ever. [0:22:56] I wrote a doctoral dissertation...

THERAPIST: Yeah (ph), you finished a PhD...

CLIENT: I...

THERAPIST: And much more but Brown (ph) is an obvious example, yeah.

CLIENT: I mean, at times... so I'm not sure exactly how to assess the productivity of the interactions with (crosstalk).

THERAPIST: Don't take my word for it, you've told me it many times.

CLIENT: I was hopeful! I hoped that there was something that was moving, in the same way that I hope that one work environment or another would be one that would be stable. I hoped. I placed hopes in this interaction, and in that context I was willing to imagine that maybe something somewhere had changed. Maybe something somewhere had been repaired. I hoped! (Pause) [0:24:01] I don't want to argue, but, I mean (pause), I'm disappointed. (Pause) I mean, what do you suggest that I evaluate? (Pause) What would you have me do? (Pause) [0:25:00]

THERAPIST: I mean, I guess I feel a little like you're setting me up in some way, in that (pause), by saying anything... (Pause) Saying that you've gotten anything out of this... (Pause) [0:25:56] I'm clearly sounding to you like either I'm personally being defensive, which you were sympathetic about, or I'm trying to make work for myself, or I'm being combative. And yet you're also telling me that (pause) what you want, in a way I think more than anything, is some real help with this, that provides you some benefit. And the way I feel kind of trapped at the moment is that... (Pause) [0:26:58] I don't... (Pause)

CLIENT: (Exhaling)

THERAPIST: I would agree that there are... there are a lot of ways that this hasn't helped, and there are things it hasn't touched. But I'm not trying to tell you I think there are ways this has helped-and important ones-because I'm trying to make myself feel better or trying to get you to stay here in my own interest. I'm telling you because... (Exhaling) (Pause) [0:28:00] I think... I'm sort of trying to move forward...

CLIENT: You think that I'm... that the pattern is being articulated in the interaction between us...

THERAPIST: Right.

CLIENT: (Exhaling) Which would be a success of a kind.

THERAPIST: It would be a success of a kind, I mean, especially to the extent to which we can kind of identify that and get a handle on it in a way that is helpful, you know what I mean? Often in therapy it is an indication of some success when the dynamics do start to repeat, but that's not... I mean, that can also just be because that's who a person is and that's where... how they're going to be in lots of places. [0:29:00] But really, if we can see that in action in a way that helps make you feel a little more settled, a little less confused, a little more in touch, that's something, in my mind. And it's tricky because I, at the same time... I'm quite... I don't want to argue against how you're feeling. I don't' want to tell you you're not disappointed. I think you're terribly disappointed. I think that's terribly important. I don't want to sort of not make room for that here or not take responsibility for ways in which I haven't been helpful or this hasn't been helpful. (inaudible at 0:29:52) I have no interest in avoiding that topic. [0:29:57] But it's complicated, because-at least as I hear it, and maybe I'm wrong-that always threatens the entire treatment.

CLIENT: Say it again, the last...

THERAPIST: The feeling I get, and maybe this is wrong, is always like, look, Marshall, maybe I'm just kind of done with this because I'm just so... feeling so unhelped and so disappointed in what I've gotten out of what I've put in here, that I'm just done. And that I am definitely putting in your mouth. You have not said that. But...

CLIENT: [Yeah, well, I haven't] (ph). I haven't said that.

THERAPIST: But I guess it's... and maybe this is an error on my part, that's part of the impetus for my saying (pause), hey (chuckling). [0:31:03] This is something playing out as opposed to just letting it play out, you know what I mean? (Pause) This is complicated. Yeah.

CLIENT: Quite complicated. (Pause) (Exhaling) I don't know. (Exhaling) (Pause) [0:32:00] It's played out a million times, what...? (Pause)

THERAPIST: Yeah, no, I can imagine from your point of view it's like, look, Marshall, this has played out a million times. Great, we're identifying it. But, if it's going to play out again in exactly the same way, ad infinitum, that's not so helpful. Where does that get us?

CLIENT: Yeah.

THERAPIST: If you identify global warming and don't do anything about it, where has that gotten you? I mean, maybe you know to move away from the beach, but, other than that, really it doesn't change anything.

CLIENT: Okay, so...

THERAPIST: So... (Pause) [0:33:01]

CLIENT: (Exhaling)

THERAPIST: I guess there's one reason I think that the issue of incremental progress is important, not because it means you feel any better at a time like this than you ever have, but because otherwise when you're feeling like this you kind of throw everything out. And...

CLIENT: Okay. Fair. And here I am, I'm articulating it to you very concisely, in a way that's comprehensible without just leaving.

THERAPIST: Right. Yeah, and this is sort of in the nature of how I see the... how I see it. Maybe I am wrong, and maybe you have sort of skewed positive for wanting to be hopeful at work, but...

CLIENT: I have.

THERAPIST: Okay. But my impression... I'll say it anyway, and you... (Chuckling) but I'm not going to... is that you felt similarly anxious, you felt similarly delayed, but kind of, when push has come to shove at this job-at least so far, though it sounds like it's probably different now-you've kind of been able to sort of squeak it out. [0:34:07] And you haven't given up, and you haven't just sort of retreated and said, I can't do this. And you haven't said this really just isn't working at this job (pause) so far, in spite of the fact that you know now [it was leaving] (ph), you've known the contracts were short term, I mean, things that clearly are going to push your buttons... (Pause) Whereas at your job-I mean, to take the... well, the other example from [you firsthand] (ph) or immediately secondhand or something-when you heard Phil (sp?) might leave and there wasn't going to be a place for you there long term, you really checked out. And I'm not...

CLIENT: I didn't check out.

THERAPIST: You told me you would sit there and (crosstalk)... [0:34:56]

CLIENT: Oh, yeah, I mean, I was checked out in the way that I'm checked out now.

THERAPIST: Right, but have not, at least so far, been checked out in any ongoing way at your current job, in spite of...

CLIENT: I haven't?

THERAPIST: No.

CLIENT: That's (crosstalk).

THERAPIST: Not in an ongoing way, that you... I mean, you've told me you haven't got anything in substantially late.

CLIENT: Well...

THERAPIST: Or at least late enough to where it made a difference.

CLIENT: No. Well, it's more complicated than that.

THERAPIST: Okay, all right.

CLIENT: (Crosstalk) whatever. I mean... (Exhaling) (Pause)

THERAPIST: All right. So what you're saying is, look, I can currently concisely identify this in a way that I haven't and see this is operating. But it actually really has not made any difference in my performance, certainly not in my sleep. [0:35:58] And...

CLIENT: Last... on Wednesday, you were...

THERAPIST: Uh-huh?

CLIENT: Drawing an explicit parallel between the production of sleep and the production of (inaudible at 0:36:11). I think that's reasonable, but (pause) I don't know. (Exhaling) I mean, the other piece of this is that (pause) I'm in a committed relationship. So taking credit for my ability to kind of hold it together in a very rudimentary way is probably a little capricious (ph). [0:36:58] Jennie is [in this crisis, and there are other difficulties she's trying not to spawn] (ph).

THERAPIST: Absolutely, oh yeah. No.

CLIENT: So if I were to point to one significant variable that seems possibly related to any improvement in therapy it would be her (inaudible at 0:37:27). (Exhaling) I don't know what to say. I hear... I do hear you about the replication of the dynamic in our interactions, and that would not be surprising because producing that transference is kind of job one. So on the one hand there's potentially some insight there. [0:37:58] On the other hand, it's not as if this suggests to me that we've been especially productive. I don't know. I feel disappointed. I feel disappointed, and I also feel, I guess, as if, while it's true that the dynamic that repeats itself again and again could be replicated if I act on that disappointment by just saying, this isn't working, thank you, goodbye, it's also the case that the dynamic that is pathological is only an exaggeration or a distortion of things that happen all the time. [0:39:03] I mean, in normal, non-pathological life, one frequently comes to the conclusion, well, this isn't working, so I'll (ph) move to plan B or C, D or C or alpha prime. So I don't know. I mean, that's really... frankly, in all of this, that's always the call. Is this the usual just sort of process of coming to the conclusion that...

THERAPIST: Right.

CLIENT: This isn't working, that it's not productive, that it's not healing, that it's not giving you what you need. Or are you... am I replicating this dynamic? And I don't have an Archimedean point right now. [0:39:57]

THERAPIST: Right. We do need to stop, okay?

CLIENT: (Exhaling) Okay. Well... (Pause) So I don't know the answer yet.

THERAPIST: Sure.

CLIENT: So I'll think about it.

THERAPIST: Okay. (inaudible at 0:40:22)

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