TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: Okay, so where were we? (Pause) [0:00:57] I am honestly not sure which way to go. (Pause) I mean, on the one hand, Wednesday was very difficult, and yesterday was productive and better. So I think both in terms of my sort of response to distress, I guess, and in terms of... oh, I don't know. I'm not... I mean, I'm finding myself at a bit of a loss for words, I guess, unusually. [0:02:01] (Pause) I don't know what to make of this process. I don't really know how to evaluate where I am in it. And I think the way... my fear right now is that the issues involved are very simple and that, even meeting as often as we do, we're actually making it more complex. I guess that's my fear.

THERAPIST: Uh-huh.

CLIENT: And it's hard for me to get a handle on what aspects of the process it's been helpful with. Just, you know, being perfectly frank about it...

THERAPIST: Right, yeah.

CLIENT: I'm trying to evaluate at this moment. [0:02:59] The... to the extent that the things that are problematic are very straightforward... in other words the deficits that are kind of the proximal cause for my coming to engage in this process are difficult and very disruptive but concrete. I just... I can't... I'm finding it hard to evaluate how much the narrative... our narrative is helping. And I can see some ways in which it's actually making it more complex to resolve.

THERAPIST: Hmm. (Pause)

CLIENT: I think it stimulates my impulse to come up with a story, an overlapping story or a million stories, each of which I hold onto for a while and we talk about, this meta-narrative. [0:04:07] So I don't know. I mean, the other alternative scenario is that it's just part of the process, that it's just very hard. And I definitely accept the possibility that... [the chief] (ph) transference. And this is yet one more recrudescence of this pattern, in which case sticking with it rather than aborting would be desirable. So that's kind of where I am with it.

THERAPIST: Right on. [0:04:56]

CLIENT: I don't... I feel myself at this moment of all moments very challenged by my inability to really find some way of adjudicating between...

THERAPIST: I see.

CLIENT: These two binary scenarios. I don't know how to do it. And, I mean (pause), I guess I don't feel as hopeless. I mean, I think that the hopelessness of our... that I felt during our conversation on Wednesday has dissipated somewhat. But at this point, I don't know, I feel...

THERAPIST: Yeah, [because it plays] (ph) with uncertainty.

CLIENT: I feel very challenged by my... (Pause) [0:06:00] I feel very challenged by this spot that I find myself in. I shouldn't... I feel a little bit angry and resentful, I guess, at least a pre-floating (ph) anger and resentment. It feels like I shouldn't have to be struggling the way that I am. Maybe this is juvenile and entitled and what have you. But I feel like I... given the skills that I have, I shouldn't have to be fighting through some of this shit. And (pause) I'm meandering a little. (Pause) [0:06:59] It's not clear to me why I'm having to struggle so much. It's not mysterious why I'm struggling or the ways in which I'm struggling. But I don't understand why... I don't deserve it, the kind of... it's not fair (chuckling). And I think that that sense of injustice is probably preventing my... (Pause) The sense of injustice is an obstacle right now. I think it's an obstacle in our interaction. It's an obstacle to things like finding a real satisfying and rewarding job situation. [0:08:07] It's keeping me in interactions that aren't nurturing or useful or aren't validating. And I don't think... I think that the sense of injustice is palpable and damaging. And I'm not sure how... I'm not sure exactly what to do about it. I didn't intend [to say any of that] (ph). So it probably means it's useful.

THERAPIST: Mm-hmm. (Pause) [0:09:00]

CLIENT: But I guess the way to integrate that into the conversation I thought we'd started this morning is that on... I can't tell whether I'm kind of... being done an injustice is probably some (ph) distorted. But I can't tell whether I'm getting back what I put into this, how to evaluate that, and whether this kind of ambient sense of injustice is structuring the way that it feels in moments of distress. In other words, this kind of template of feeling wronged, what role might it be playing in my sort of intuitive sense of how to evaluate the costs and benefits of our interactions. [0:10:07]

THERAPIST: I see. Like (pause) in a way it's sort of harder to tell whether you're getting kind of a good deal in some sense here or not because of the sense of feeling wronged or injustly... unjustly treated, which might cloud your judgment of that?

CLIENT: Yeah, I mean, I think that's the thought. It's... I mean, it's not... getting a good deal I guess is one part of it, but then the other more practical maybe, sort of rational part of it is just opportunity cost. [0:11:02] What...?

THERAPIST: Are there other alternatives?

CLIENT: Should I just be doing... should I just be dealing with my sleep issues? What exactly is going on here, and what's the downside of engaging in the narrative at this level? I mean, I don't know. So it's not just, am I getting a good deal. It's also...

THERAPIST: Right, it's in a context of what else would you be doing.

CLIENT: Am I doing the right thing, and am I losing opportunity to do another thing that might be more immediately productive by doing it? Yeah. (Pause) I mean, I guess you can think of injustice in two different ways. One of them is kind of moral and ethical, and one of them is the sense of injudicious, just kind of more pragmatic. Is this a judicious...?

THERAPIST: (inaudible at 0:12:02)

CLIENT: Injudicious versus unjust. (Pause) It's an interesting interaction, I think, in terms of my life process, between the two of those phenomena, in the sense of injustice leading to injudiciousness and vice versa. (Pause) [0:13:00]

THERAPIST: Well, I think (inaudible at 0:13:02) there's something that kind of came up on Wednesday as well, which is... (Pause) I mean, and clearly exists as a kind of a trend, transference interpretation of it. You tend to... your first impulse tends to be one that's sort of more critical or more frustrated or seems to have more... a little more anger in it? And then I think as you revise that gets sort of squeegeed (sp?) out, and it gets a little more abstract. [0:13:45] You go from the kind of feeling unjustly treated here, which is where you started, to in that feeling clouding your decision about what to do to, well, really it's about, is this judicious, which is a much more (pause)... which has little to do with feelings at all, actually, and everything to do with rational assessment. And I think that happened on... at some other times as well, when you start with something that kind of involves more hurt and frustration, and you kind of get a little more abstract and a little less... a little further away from those feelings in particular, I think. [0:14:58]

CLIENT: I don't know about the other times, but today I didn't. Today we started with kind of rational considerations, and this feeling intruded, a kind of unexpected train of thought, one that I guess I've been musing about a little bit. But it was generalized. It was like I had been thinking about it as I ran over kind of resentfully, in the context of particular relationships. And it somehow squeezed its way into a very kind of practical discussion about our process and the sort of evaluation of it. And then I stepped back. So, I mean, I don't know how other people do it, but that seems to me kind of the normal process. It's like... especially in this setting it's like you're talking about X, you bring something to the table, and then all of a sudden unexpectedly something else jumps in, and then you kind of try and understand what's going on with that. [0:16:00] I mean, I take your point that your method generally is to... for the feelings a little bit rather than the practical considerations, the justice rather than the judiciousness. But that wasn't kind of how I'd frame this discussion, so, while that would be an interesting... it would be interesting to follow up the rawer, less abstract analytical threads, I don't think it was that much of a diversion to come back to what I had started with. (Pause) And I'm not sure the trajectory that you outlined just now really fits this particular conversation, in the sense that I began with the abstract or at least the practical and less kind of emotional... [0:17:08]

THERAPIST: So... sure.

CLIENT: I'm so...?

THERAPIST: Sure.

CLIENT: Sure about what?

THERAPIST: What you're saying.

CLIENT: Yeah. I remember our conversation. (Pause)

THERAPIST: Yeah, I remember our conversation, too. It... you're absolutely right that it didn't start with the felt part. That sort of slipped in. So it slipped in, and then it kind of waned as you went. I think that's why...

CLIENT: The waning as I go, the sort of winnowing of the emotional content, as if that were chaff. Is that what you mean, that I have a tendency to start with emotion and to finish... to proceed in the direction inevitably of...? [0:18:08] I just... I mean, I guess what I'm trying to say, though, is that the terms of reference of this conversation were not emotional. And, I don't know, I mean, I feel as if we're at kind of a junction, a crossroads. And I'm kind of interested in exploring that a little bit. And the feelings are there, our conversations are defined as substantially about feelings...

THERAPIST: Yeah, in my mind you probably... I mean, but you've told me that the problem that you're having is, you feel quite uncertain...

CLIENT: True.

THERAPIST: And it is my experience generally doing this kind of work that (inaudible at 0:18:52) that often, when someone's having trouble (pause) assessing how they really feel things to be or at the kind of crossroads that you're describing, that feelings or reactions to feelings that they're only partially aware of have important bearing. [0:19:24] In other words (pause), [it ain't physics] (ph). It's... thinking through the kind of thing you're describing generally isn't done effectively... I mean, this sort of problem, unlike other problems in life, is generally thought through effectively as the dynamics around it are observed.

CLIENT: Totally reasonable observation. I guess I'm... [0:19:56]

THERAPIST: So that's where I'm (crosstalk)...

CLIENT: I mean, I guess I'm resistant or maybe a little annoyed by...

THERAPIST: Yes, annoyed (chuckling).

CLIENT: This attempt to create a global evaluative mechanism for understanding the things that I do or the way that I do them as if there wasn't a perfectly justifiable reason for going toward the concrete rather than...

THERAPIST: Well, there's (crosstalk).

CLIENT: Sure, but, I mean, I guess I would have been fine with your saying, well, in terms of the uncertainty the feelings are important here. Let's take a look at that rather than saying, well, you have a tendency to blah blah blah blah blah. And maybe I do have a tendency, I'm not denying that. But I think in the context of this conversation it wasn't the tendency per se that led me to kind of try and bring this... to return from this unexpected diversion back toward the practicalities of figuring out what we're doing and how it's going, so... [0:21:05]

THERAPIST: It seems like the feeling then is that I'm trying to derail or even undermine or slightly subvert the way you're trying to go about...

CLIENT: No, I don't think you're trying to subvert it. I just don't...

THERAPIST: That actually would be true in a way. I mean, not... I think we'd probably agree not with mal-intention...

CLIENT: No, I (crosstalk).

THERAPIST: But that is true, and that...

CLIENT: I feel like it's under... I mean, I feel like these kinds of global assessments in which the thrust is that you're engaging in something that's kind of a behavioral or cognitive pattern that you're not quite of aware of are undermining. It's like it's saying, well, you don't really know what you're doing. Or, oh, well, you have this tendency. There's this thing that you do that's kind of unexamined. [0:22:02] And so, instead of taking the conversation in the direction that's interesting to you, I'd like to go back to this feeling of injustice and how it is articulated within you. That seems kind of like a... (Pause) It's an appeal to some kind of authority rather than kind of meeting me halfway and saying, well, that's good, but let's... I suggest that we go back to blah blah blah, and just kind of engaging the collaborative exercise.

THERAPIST: But it... (Pause) It would be one thing if...

CLIENT: I feel resentful about it (crosstalk).

THERAPIST: Yes, clearly. It would be one thing if, I guess... (Pause) It's interesting. [0:22:55] I mean, to my mind, if you said, look, Marshall, that may be so, but I'm really more interested in thinking about this this way, I... let's flag it or table it or do whatever with it. But the aspect of the conversation I'm really more interested in right now, the thing I'd really like to be talking about is (pause) the way I was sort of constantly intending to go as opposed to this other thing that you're pointing out.

CLIENT: It was the way that you... I don't want to belabor this, because it's frankly not that important. I think we got a little bit sidetracked. But given... I mean, there's something about finding some kind of apparently at least idiosyncratic tendency rather than just saying, well, in the context of this conversation, there are a couple ways we could go about it, and I suggest we focus on this one. [0:24:02] It's different. It's like... it implies some kind of special expertise rather than meeting the other person in conversation halfway. It's as if you were to say in the middle of a negotiation between the Egyptian Ministry and some development partner, well, the reason why you want to preserve local autonomy for this project is that you have some bureaucratic concern versus sort of... either some weird bureaucratic process at work and... versus saying, well, there are two ways you can go about it. You can have local control, or you can have more oversight by the development agency. And let's think about what the costs and benefits of each of them are. [0:24:56] (Pause)

So that's... I mean, and I don't think... I think it's not unreasonable to ask that we just have a straightforward conversation rather than dragging in some supposed pattern, which may be true. It may be true that there are... there's bureaucratic infighting and pressure from the hierarchy to structure the relationship with the development agency a certain way. But that's not really germane to this conversation necessarily. That might be something that you would talk about in confidence but not as part of the actual discussion. (Pause) I think my resentment is probably a more interesting topic of conversation and the specific excuse for it...

THERAPIST: Okay.

CLIENT: I would guess. [0:25:58] (Pause)

THERAPIST: I am happy to go either way. My model of things is that (pause) oftentimes the kind of interesting material or need of a general feeling or general issue is found in the detail... in the same way that in novel writing... but that's fine. I can go either way that you want. I mean, that's fine. (Pause)

CLIENT: (Exhaling)

THERAPIST: And I guess...

CLIENT: I feel derailed. (Pause) [0:27:00]

THERAPIST: This is exact... (Pause) This is exactly what happens. (Pause) There's a tension, a struggle, a sense of disconnect, and you get derailed, and you feel somewhat at loose ends. (Pause)

CLIENT: Okay.

THERAPIST: And I think where we're getting stuck is, you in a way quite reasonably are saying, Marshall, don't fucking do the things that derail me. Let's have this conversation that I'm trying to have and lay this out clearly in a way that we can make sense of it. [0:28:03] You keep saying these things which, in a variety of ways, kind of throw me from that. Either it's the sort of stance you have or bringing in some cause that seems to me more peripheral rather than centrally what I'm trying to get at. Or we've had kind of this push and pull about it, and that sort of throws me off. I mean, I'm not getting this exactly right, but more or less. And, look, Marshall, just can't we have this fucking conversation, etc, in kind of the way that I want so that I can lay my thoughts out clearly and we can understand what's going on.

And I'm coming at it from the point of view, like... (Pause) [0:28:59] Let's look at what's throwing you in the micro-interactions and sort that out, because that's what always happens and in a way it seems to me is the problem that... the big problem that you came in to try to address in the first place... is the way these things happen in relationships, and it short-circuits your ability... or it throws you in a way that you then can't think, and you're derailed. And in a way you're sort of quite reasonably saying, well then, just don't fucking do it so I can think this through (laughing). And I'm saying, yeah, but it's all about looking at how that happens. And it's happening, you're saying, ahhhhh (sp?) that's throwing me off (inaudible at 0:29:50). Stop it! I'm saying, well, but wait a minute. So in that sense it seems like we're both perceiving quite reasonably... [0:30:00]

CLIENT: (Laughing)

THERAPIST: But getting into a big mess.

CLIENT: (Exhaling) (Pause) Whatever. I mean...

THERAPIST: Okay.

CLIENT: (Chuckling) (Pause)

THERAPIST: The other thing I would say, and then I will shut up, is that this kind of stuff, these little throws and little derailments and the kind of interpersonal... scale of interpersonal context... palpable interpersonal context that that evokes for you, I think the way that all happens, it's ongoing. [0:31:02] And it obscures or clouds the data that you need to actually make the decisions you're trying to make or do the things you're trying to do...

CLIENT: Yes.

THERAPIST: And that... I guess this is another reason that I, from my point of view, although I'm aware it feels quite different to you... isn't going to work so well to just sort of try to do this without any interruptions and really just think it through carefully and lay all your thoughts out in a way that makes sense and then arrive at the... through that process arrive at a satisfying conclusion. But, as I say, with that I will be quiet.

CLIENT: Hang on. So that's a useful observation.

THERAPIST: Okay.

CLIENT: I mean, I think... I mean, I have analytical skills and approach...

THERAPIST: Absolutely. [0:31:56]

CLIENT: Which would be extremely useful were it not for this weird attachment difficulty which intervenes. So if, through whatever process, I'm able to resolve it then the powers of... and strategies of analysis that I have will be extremely useful. But what you're saying is that I'm trying to jump the gun. I'm trying to engage in a process that's actually impeded by precisely the difficulty that I've come to you for help in resolving.

THERAPIST: That's my impression, yes.

CLIENT: And so in each of these exchanges, this trajectory that you've proposed represents my effort to engage in a process that I have the capacity to do, that is... I'm good at doing, that I engage in in a useful way. [0:33:05] And yet, because it's undermined by this disconnection, this sort of recurring sense of dislocation, it doesn't work. It ought to work. It looks like it would work. I feel the capacity for it to work, and yet it doesn't work because of disconnection.

THERAPIST: I think so, yeah.

CLIENT: Okay. That's persuasive. So what does that mean? And what would that mean...? (Pause) (Exhaling)

THERAPIST: One thing...

CLIENT: Well, going to a sleep specialist will probably help with some of the sense of disconnection in the sense that I probably have accumulated a sleep debt of about 15 years at this point. [0:34:00] And that's got to have some impact on my sense of dislocation. I know that it does.

THERAPIST: Right.

CLIENT: I guess the question is how you and I could in some complementary way...

THERAPIST: Part of what this also means is that... and this is pretty much always true, that therapy is kind of going to suck and be really hard and unpleasant work a lot of the time.

CLIENT: I know, no problem with that. It's not being hard and unpleasant that I have a problem with? It's this sense of whether or not it's useful and whether or not it diverts from... I mean, I'm... believe me, it wouldn't have been my preference for eight years running to sit and talk about very difficult and embarrassing things end on end and put myself in a frame of mind... I mean, we need... [0:35:04]

THERAPIST: I'm not meaning to say by that that you (crosstalk)...

CLIENT: No, I'm not accusing you of anything. I'm just saying it... if there's some sense of some way that it could be productive, that's great. If it's just about doing the analysis itself for its own sake, I don't know. I mean, it just seems like there's both an opportunity cost and there's potentially, in a way that I don't totally understand, a cost in the way that it orients me in the world and kind of makes me focus on things that are potentially just diverting and a distraction. So yeah. I don't have a problem with pain. I have a... as high a pain threshold as I have. Anyway... (Pause) [0:35:59] I mean, I guess at this juncture... and maybe this is an unreasonable request. I just feel like I want some kind of a map. And you're giving me a bit of that. I'm pushing you, and you're giving me a bit of that I guess in pointing to this specific mechanism and pointing to the relationship between modes of thought and that mechanism. What I'm struggling to see... and again I'm not defending this necessarily as a reasonable thing to ask or something that's possible to deliver on, but I just want some kind of a map. I want to have a sense of some way in which all of this talking can possibly be therapeutic. I agree that there's something about attachment that is very dislocating. [0:36:57] And I feel some satisfaction about our capacity to kind of zero in on it.

THERAPIST: And the map, to my mind, that you want is sort of... (Pause) You want the map because it's something to hold onto, for God's sake, in the midst of this confusing, sort of upsetting, uncertain process. And I think that's again the attachment piece there.

CLIENT: I don't know. That's one way of telling the story, I guess. The other way of telling the story is, you go to somebody who's providing a service. You have... you ask them for a statement of the problem after their evaluation, and then you ask them what their plan is.

THERAPIST: You have all that at the level of generality at which that's usually provided. [0:37:56] And...

CLIENT: (Chuckling) I mean, we're two competing models here, I guess, once again. And...

THERAPIST: And it's also... I want to be clear because it seems like it may not seem this way to you. (Pause) I'm really not holding out on you. In other words, it's not as though I have a map, and I'm not going to give it to you because I think you have to figure it out yourself or some other thing like that, or...

CLIENT: True.

THERAPIST: Or even... a minute ago, like, hey, and I pushed you. And you told me this thing. It is true that you're pushing me in a way (chuckling). But I also... I would say something like that in any case if I thought of it, you know what I mean? I'm actually sort of... from my perspective I'm trying to give you the best maps I can as soon as I get them. [0:39:00] That's actually what I'm trying to do, although I know there's some way that's feeling sketchy.

CLIENT: Fair. Touch�.

THERAPIST: But again I think that's... sort of part of how I'm thinking about the attachment problem itself is that there's always a sense of wanting something from the other person that you can really hold onto and it gives you a sense of solidity and security there...

CLIENT: Yeah.

THERAPIST: And I absolutely appreciate that you're not getting that and that it leaves you feeling sort of uncertain about how to evaluate this and what you want to do. But really unfortunately I think that's sort of related to the nature of the problem that you're coming in about, although again this is the sort of potential double vantage point that you're struggling with. [0:40:00] It's... that's one side of it, and the other side is, or maybe this isn't giving me what I need. We do have to stop.

CLIENT: Okay. (Pause) Okay.

THERAPIST: So I'll see you Wednesday.

CLIENT: All right. Oh, no, probably not.

THERAPIST: Oh, okay.

CLIENT: I'll likely be (inaudible at 0:40:24). We're finalizing the itinerary at noon today, so I should be able to give you a precise read on how long I'll be gone. It will likely be for both Wednesday and Friday...

THERAPIST: Okay. Yeah, if you could let me know that by midday, that would be (crosstalk). Okay.

CLIENT: But I'll let you know the itinerary by, hopefully, 2:00 or so.

THERAPIST: Okay. All right. Thanks.

CLIENT: Okay. See you. Bye.

THERAPIST: In that case you'd be back the following week?

CLIENT: Yeah.

THERAPIST: Okay.

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