TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi.

CLIENT: Hey. (Pause) So after our conversation Friday I was kind of meditating on... trying to understand what you meant when you said basically that... [0:01:00] (Pause) I want to get it right. Basically, you said, okay, so what's going on here, what we've been talking about for the last year and a half is essentially that you're being neurotic...

THERAPIST: (Chuckling)

CLIENT: And the implication of that, I guess, is that really the only thing to do for it is to stop being neurotic. (Pause) At the end of the day, that would be the distinguishing feature of a neurosis as opposed to some organic defect, which is that A, it's not organic, it's not congenital, it's not genetic, it's some (ph) injury. And the only possible response is just to stop it. [0:02:01]

THERAPIST: Well, (crosstalk).

CLIENT: Maybe the... presumably the whole point of psychotherapy is to assist you in that process. But ultimately, at the end of the day, if you're... I mean, I think the analysis that you proposed was that I'm engaging in two contradictory and equally self-harming activities with regard to work and my attempts to create a stable work for myself. [0:02:52] Ultimately the only solution for it is to stop engaging in that contradiction and stop harming myself. I guess. I mean, I... (Pause) (Exhaling) That was how I took it anyway. Basically the solution is just to stop it.

THERAPIST: Huh. That was not how I meant it. (Pause)

CLIENT: That was what it sounded like. (Pause)

THERAPIST: No...

CLIENT: There's this thing that I do... (Pause) I can't... I'm having difficulty calling to mind the exact phrasing or formulation (crosstalk)...

THERAPIST: You're right about the... I mean... about the part about my saying (chuckling), you're being neurotic. That's true. But... (Pause) [0:04:00] One can't generally just decide to stop doing something neurotic. Otherwise (pause) nobody would be doing anything neurotic, and...

CLIENT: I know that pause. And...?

THERAPIST: I'm not... it's not entirely an act of will. I mean, neurosis is unconsciously mediated, and so one generally doesn't have conscious control, however hard one might try, over the thinking and ways of seeing things and... that are in integral part of the neurosis. [0:04:57] I guess that's one thing. The other thing is, I also did (pause), I think, recommend pretty clearly I thought it'd be a good idea to go to your PCP to check in again about getting something to help you sleep, because while I agree with what you said about neurosis sort of being psychological-to put it that way rather than generally more favorably looked at as kind of a biological problem-there sometimes does come a point where it's important to intervene with meds because, while it doesn't fix the neurosis, it helps people... it helps you live your life. [0:05:58] I mean... and it probably makes it easier to work on your neurosis oftentimes. So... (Pause)

CLIENT: I mean, I think of these mouse experiments where they intervene in some way in early childhood and create mice that consistently bang their head against the bars of the cage. They really never bother to wonder what would induce the mice to stop banging their heads against the walls of the cage. The experiment kind of stops there once they've produced the favored result. And presumably the assumption is that... [or at least, this would be a very interesting finding] (ph) if they were able to prevent this from happening or stop this from happening, that it's impossible to stop it once you've created such a mess. [0:07:06] (Pause)

THERAPIST: I see, so...

CLIENT: So I guess the premise of psychotherapy is that... this is... walking back a neurosis is a higher order function that is feasible in people where it might be in mice, limitations of a mouse model. But...

THERAPIST: Little mouse couches. Yes, that's right. But (chuckling)...

CLIENT: [As a psychotherapist] (ph) presumably you need to have some kind of transference that [might be difficult with a] (ph) person. I mean, I don't know.

THERAPIST: Look, some of it is just simpler and closer at hand I think than you're describing. [0:07:56] For example I'm sure you and I and most people can recall instances where they were really steamed up about something, really confused about something, really upset about something, had a conversation with somebody, and in the course of just laying it out got a clear handle on what was going on, felt more settled down, and knew what to do. Sure, the time scale is longer than that, dealing with a neurosis. But it's not that different from that. I guess... or in a way that mysterious. In other words by talking about stuff you become clearer about what you're talking about and kind of have more access to things that you were only half aware of or not so aware of before. And that generally helps on settle down and be clear about what to do. [0:09:00] (Pause)

CLIENT: Okay. (Pause)

THERAPIST: I guess when I step back and think about it you're sort of saying (pause), this is not working, or... this is what I am imputing from what you were saying. It's not what you were saying, this is my inference about sort of... not exactly what you're saying but how you may be feeling. You're banging your head against a wall. [0:09:55] And (pause) sort of... (Pause) I guess a couple other things. The sort of... (Pause) There's not a model that makes a whole lot of sense to you for how to stop doing that. And, I think maybe crucially, like I'm telling you, hey, this is just all on you, you're being neurotic, you just need to stop (pause), which I guess makes me think of the situation you have... that we talked about a lot maybe seven or eight months ago, where you feel like (pause) you're being told you are in control of your behavior and just need to... and... (Pause) [0:11:14] Now I'm going quite beyond what you've just said. I'm sort of extrapolating, maybe correctly maybe not. You're kind of being told you're being oppositional, that you're digging your heels in, you're just deciding you don't want to do this. Yeah, by this I mean sort of get better. And it's your fault, and it's just up to you to decide that that's what you want to do. And you've described those to me as extremely frustrating and kind of alienating interactions with people. [0:12:01] And it sounds like you're kind of, maybe at moments, feeling that way.

CLIENT: Yeah.

THERAPIST: Again, I'm totally putting words in your mouth, so I may [be wrong at times, but that's what it sounds like] (ph).

CLIENT: No, I think you're right. (Pause) You're certainly right in the association. That is indeed what it felt like.

THERAPIST: Yeah.

CLIENT: Hmm. (Pause) I think that, as I reflect on those instances in the past, what is most frustrating about them or just kind of enraging, I guess, at some level...

THERAPIST: Hmm. [0:12:54]

CLIENT: Is not so much that it was unfair. I think at the moment maybe that was, at some unconscious level, I responded, but just that it was ineffective. Here was an opportunity to do something, and this model in which it was pure oppositional behavior to be rectified only by the cessation of the oppositional behavior... I mean, it did as much damage as any other interaction in my childhood and adolescence.

THERAPIST: Yeah.

CLIENT: I mean, it was just such an egregious mistake. So that's the upset. I mean, ultimately, at the end of the day... just to kind of work backward from what you're saying, that's what's most upsetting. Here it is, the thing itself, this thing that has just been a millstone around my neck for my entire life... [0:14:03]

THERAPIST: Absolutely.

CLIENT: And here... there it was, right out in the open. And the response was, well, get over it.

THERAPIST: I see. Let me explain where I was coming from. Maybe that will help to clarify.

CLIENT: Okay, I mean... yeah, go ahead. (Pause)

THERAPIST: You had been describing your work problems in a way that sounded to me like you were kind of saying it's the state of the world, by which I mean, I can't... there are no... (Pause) I have no prospects out there in reality for a secure and stable job. [0:15:01] I am... maybe I even lack the skills to apply for something like that, but one way or another there's nothing like that out there for me. It doesn't exist. There was more, but that's, I guess, the part I remember most clearly. And my point was to say, hey now, I don't think this is mostly about the state of the world. I mean, the state of the world is important, and (pause) it may be harder, it may be easier to find sort of opportunities out there. [0:15:44]

But first, I think mostly that's something that has to do with the neurosis basically and that the idea that you aren't good at applying for things or finding opportunities also just seems to me more a kind of neurotic appraisal of it just given ways that you've succeeded in finding things, although things that unfortunately don't lead to much stability for long. And so... but... and I can see how that could seem to have an implication. So hey, it's on you. Just do different, or, now that I've told you that there probably are opportunities out there and you have the capacity to go get them, obviously what you should do is just go start applying for jobs and get one. [0:16:53] That... I can see how what I said could come across as though there were that kind of implication. That's not what I had in mind. My... what I had in mind was more to say, hey, this is about the emotional stuff. And it is playing out again in this way, and it's important that we figure out (pause) how that's happening or what's making that happen in the hopes of easing it.

CLIENT: I mean, isn't that what theoretically we've been doing all along, since August of 2012?

THERAPIST: Yes.

CLIENT: 2011, excuse me.

THERAPIST: Yes, that is (crosstalk).

CLIENT: August of 2011. That is in theory what we've been doing. [0:17:59] I mean, I guess that gets to the other... so, if one sort of underlying point of frustration was the apparent resonance of this formulation of yours from Friday with this kind of longstanding grievance of mine, the other was exactly this kind of phenomenological analysis, or... what's the right way of putting this? The... it's kind of platonic. There's the world, and then there's the form. (Chuckling) There's the world, and then there's the... is the neurotic appraisal, and then there's the world. [0:18:56] And the neurosis at some level consists in taking the world for this internal construction. Or maybe that's the way the neurosis actually impedes life, liberty, and the pursuit of happiness, right? In other words, I'm saying to you, well, there's this structural reality, I've got a problem. And you're saying, no. That's not a structural reality, that's not the world. It's only the shadow of the world flickering on the side of the cave, right?

THERAPIST: Yeah.

CLIENT: And I guess what was... I remember thinking this literally at the time in these terms more or less. What was frustrating was that... I mean, that's like any... that's the human condition (chuckling). It's... you have some perception, and the perception leads to a cognition, and the... or cognition leads to a feeling, or vice versa, or however the sort of mental process is... asserts itself. [0:20:00] And you have to figure out what's what and kind of come up with some response. And the whole problem is that I'm obviously aware of the fact that it's unclear how good these appraisals are. And I'm aware of the fact that they're not... but I... I mean, I guess what I have been hoping for in these conversations of ours is that there would be... just be useful mechanism for distinguishing or differentiating or categorizing or taxonomizing (sp?) the one from the other, the one component from the other. And I don't feel... or at that moment at least... in that moment...

THERAPIST: Sure.

CLIENT: The momentary grievance, I don't feel much further along in making that distinction.

THERAPIST: (Crosstalk) of your intensive psychotherapy and have your therapist say, oh, well, you're being neurotic. [0:20:58] I mean, true presumably, or you wouldn't have come in.

CLIENT: It's known.

THERAPIST: (Chuckling) But it... [when does it end] (ph) exactly, right? I mean, I have more to say, but (crosstalk).

CLIENT: So yeah. I mean, no, so I guess at the end of the day, I'm aware that the truth lies somewhere in between the impossibility of finding a job and the... (Pause)

THERAPIST: (Crosstalk)

CLIENT: Sense that that... and the sense that that is a kind of distortion mediated by whatever the hell it is that we're here to talk about. But I knew that on day one, at some level.

THERAPIST: Right, so... (Pause) [0:21:59] Let's see. So unraveling neurosis is a lot about process, which sounds very vague, but let me make it more specific. I hear you, that you knew that on day one. And I know that's true. But it raises the question, why, on day 500 or 520 or something, were you coming in and saying, no, Marshall, this is the state of the world? This is just how it is even though I've been through this 500 times?

CLIENT: Touch�.

THERAPIST: And (pause) when I sort of pose that question, as I kind of did the other day, again my point isn't, well, and you should know the answer right now, any more than it is, and you should just be able to do differently. But it is to say, in the sort of process of your neurosis operating, the tracking of which is very helpful in unraveling these sort of things, there's some reason that you come in on Friday and say something which you're telling me, and I agree at another level you kind of completely know better about. [0:23:15] So what the heck is going on there? I'm not... I don't mean to pose that aggressively to you. It just sort of seems like a very salient question to me.

CLIENT: It's a very salient question, indeed (chuckling). (Pause)

THERAPIST: And...

CLIENT: It is a very salient question to me. And? (Pause) [0:24:00]

THERAPIST: And (pause) I think... (Pause)

CLIENT: (Exhaling) [0:25:00]

THERAPIST: Okay. I think that, at a conscious level on one side of a conflict that's implicated and is going on with you, you think well of me and put a lot of faith in me, are working very hard here, and want nothing other than to get better and for your life to be easier and more stable. [0:25:54] On the other... on another level, which is generally less conscious but which sort of leaves a lot of footprints or motivates a lot of your activity here? You're very skeptical and wrestle with me a lot about the process and whether... and how or even whether this can help at all or questions to do with what the model is and whether it's plausible. In a way that's what... you're telling me today about how you were upset on Friday. [0:26:56] But you're also framing that in terms of... (Pause) In a way... there's a subtle way, I think, that you're (pause) kind of... well, let me... what I had in mind is... and maybe this will help me to sort of abstract better.

Yeah, on one had you say, hey, in a way, the model collapsed here. If I'm just telling you to suck it up and get better (chuckling) that's kind of a collapse of the psychotherapeutic model. I understand that it also has particular resonance for you in these very painful, frustrating, and maybe primarily useless things that people have said to you for years. [0:27:58] Just get better. Just do the writing. Just get a job. Just do whatever. (Pause) Well, I guess I think you wrestle and fight with me a lot. People generally don't do that as much as you do that (chuckling). And I'm not... I think... I'm not... that's okay. I'm not upset about it, I'm just saying that's got to be an integral part of what you're struggling with, is the kind of very frequent questioning of, what is this doing? What are you doing? Has this helped? How could it help? What's the model by which it helps? [0:28:57] Is that model viable?

CLIENT: I mean, you said yourself, all this is, is process. Process is it. Isn't that what you said a moment ago?

THERAPIST: I said process is very important, but yeah.

CLIENT: No, I don't think you said very important. You... maybe I'm not reproducing your words verbatim...

THERAPIST: Okay. Process isn't everything, but process is a lot.

CLIENT: But it's pretty close. It's pretty close. Something like, this is about process. Maybe that wasn't an all-inclusive.

THERAPIST: Okay.

CLIENT: But... and maybe about allows for other inputs. But that's the way that it sounded to me at any rate. And so... and I think that for better or worse, rightly or wrongly, that is indeed the way that I understand it. There's... as a therapeutic approach it's kind of a curious idea that you can just... two people can sit down in the same room regularly over the course of some, I don't know... some regular interval. [0:30:04] And through some interaction between them things like neuroses are obviated. I mean, I don't... I want to be as general as I can. I'm (ph) just fighting it.

THERAPIST: Okay, that's pretty general. Yeah, sure.

CLIENT: But I... so insofar as process is very important and, or central, and, or even the main thing, I'm going to engage with it the way that I engage with processes generically. And the way that I engage with processes generically is kind of dialectical. It's like... that's the way that I engage with the world. It's a little bit skeptical. It's... you test things. How else are you going to kind of probe the interaction as it exists or the interactive process and see where it is, understand it, interact with it? [0:31:06] I mean, that's as reasonable way of going about it as any. How else would you propose that I do so? (Pause) And certainly answering a question with a question is an old tradition.

THERAPIST: (Laughing) Well... (Pause)

CLIENT: What do other people do? [0:31:56]

THERAPIST: I think you are... the way that you do that (pause) here and elsewhere... (Pause) Look, what happens I think for you here and then often at work is, you are a bit paranoid about how you do that. And it (pause) contributes to (pause) this kind of... [0:32:59] (Pause) And you're quite vigilant about it. And it becomes so much a part of how you engage in the process that it (pause) can get in the way of your getting what you want out of it.

CLIENT: So you're saying that I'm interacting with this process intended to intervene my neurosis in a way that's neurotic.

THERAPIST: Yes, and... but I think I'm being, I think, quite a bit more particular than that. [0:33:54] I mean, that one could say about anybody's psychotherapy [with someone] (ph) if it's getting traction. But the interesting part is the way in which everybody does that, in my opinion. For somebody else, it might be to just passively withdraw. Somebody else might be to be very compliant. There are people who go along. It takes you a year and a half or two years to realize that, jeez, it seems like everything is going swimmingly, but how can everything be going so swimmingly but there are... there aren't really changes? And then the person's like, aha! It's because they're just unconsciously agreeing with everything, you know what I mean? There are all sorts of ways we do it.

But your particular brand of it-and I think it's visible both here and pretty clearly at work generally-is to be... (Pause) Yeah, in a neurotic way, not in a psychotic way, a bit sort of paranoid, quite vigilant about what... about the system as a whole, keeping an eye on the system as a whole, and about its utility, and to sort of constantly have questions in mind about that. [0:35:01] And to be sort of... kind of use that as a kind of resistance. Like, I say, it sounds to me this way. Well, no it doesn't. That's not how I meant it. And, like from the other day where... or from today, where I say... (Pause) You constantly frame your questions or concerns, you go big and relate them to kind of this model as a whole or rats in the lab or...

CLIENT: Mice, thank you.

THERAPIST: Mice. (Chuckling) Fair enough. Or you generalize to the point where all the particulars of what's going on with you are lost. [0:35:54] And then we're kind of in a debate about how psychotherapy works, which... it's an interesting debate but in a way isn't a whole lot about you. In a way it is a whole lot about you, because that's what you do, but in a way abstracts us away from the particulars.

CLIENT: Yeah, I mean, I don't know. I... if you were referring to our conversation today, I just wanted to know what you were saying. I mean, you used particular technical jargon, and so, insofar as I'm trying to kind of make meaning out of that, it involves an interpretation of technical jargon, which involves sort of understanding...

THERAPIST: Well, what are you (crosstalk)?

CLIENT: Neurosis. I mean, like, what the hell are you talking about? You can say, bang your head... you used a particular word, and I was trying to understand what you were saying. So my tendency to go large is not disputed by me by any means (chuckling). I understand what you're saying about the danger of that kind of cognitive style in this setting, in abstracting away from the... whatever it is that we're dealing with... [0:37:05]

THERAPIST: I mean, this is the nature of your attachment problem, is... to frame it in a way that you put it before...

CLIENT: Okay.

THERAPIST: Is that you have a very deep worry about what the other person is there doing with you or to you and are vigilantly attentive to that and very often question it and sometimes in a way that leaves you feeling quite disconnected and left out of the process or left out of the relationship. (Pause)

CLIENT: So the neurosis here would be imputing something, just a regular pattern of imputing something to someone and fearing... and alienating myself out of fear that I'm alienated from them. [0:37:57]

THERAPIST: Yeah, you... I mean, I would say once every... at least once every two weeks and sometimes once a week, you question sort of the process of psychotherapy overall...

CLIENT: This is an outrage (laughing).

THERAPIST: Well, what if it looks like... no, it's okay. But it's quite... that's not typical. I mean, I... it just isn't. And it usually serves to...

CLIENT: Or just be an interesting feature of my personality...

THERAPIST: I think it's very interesting.

CLIENT: That's part of my uniqueness and charm. Why does it have to be a neurosis (laughing)?

THERAPIST: It is... well, because of how it occurs and what it does in the process. And it is a very interesting and unique feature of yours as well. I mean, that's often the case with neuroses, too, is that the things that somebody's neurotic about in a way that are harmful to them also relate to what their personal strengths are. I mean, your ability to do the kind of work you do, I imagine... I mean, your work... as I understand it, you've been employed currently to figure out how this organization can implement some kinds of organization-wide change so as to be more effective. [0:39:11] I mean, I think to me this is very much related to your talent for thinking about sort of institutions...

CLIENT: Yes.

THERAPIST: In a kind of... a way that's abstracted from immediate experience, what it feels like to go to work every day and sit at your desk. You use... you're very good at sort of thinking big about the institution and how it's functioning and how the parts move and getting abstract about it, I think.

CLIENT: I mean, last week was really kind of awful, but there was one... just completely draining and difficult and ultimately unsatisfying. But there was one really wonderful moment where I felt just totally exhilarated. [0:39:56] And that was the moment where I took this thing that we'd been working on for two years, this institution, and I created a memorandum of understanding that embodied it. And what was exciting was there here was not only this kind of vision for how it might work that was embedded in our proposal but a practical agreement between two entities that called it into being. It incorporated it. That was a great moment. And I think it was a great moment because it was a device for taking something that was abstract and making it concrete.

THERAPIST: Uh-huh.

CLIENT: So, I mean, what's satisfying to me is not the abstraction or the capacity for abstraction. It's putting it into practice. And I think that what you call wrestling and neurotic blah blah blah (chuckling)... I don't want to put words in your mouth. [0:41:03] But, I mean, that's my attempt... maybe self-defeating in its approach, but that is my attempt to say, okay, well, here's the abstraction. I've successfully come up with a model. How is it realized? How does it function? How can...?

THERAPIST: I think the wrestling is part of how you know I'm here with you....

CLIENT: Yeah. Well, okay. That's another...

THERAPIST: Which I think is related to...

CLIENT: It's an evocative way of putting it. I think that's true. And I've had, not in exactly those terms, but I've had that thought, too. It's like, how...? It's so upsetting to me, for example, when someone doesn't write back, because it means that the process by which I engage in this sort of... the engagement with the other is aborted and impossible. [0:41:59] And it just... it means that I can't function in the way that I function. (Pause) So, I mean, maybe I... look, I mean, the very fact that I'm here once again means that I agree with you at some level...

THERAPIST: Yeah.

CLIENT: That the kind of basic processes that I've developed for interacting with people in this particular sphere are dysfunctional and self-defeating. So I'm not... at some level of course I would endorse the way that you've presented things (chuckling). And yet...

THERAPIST: You're doing both, because you usually do both, right? I mean, you... I mean, I think we're on the same page. You're here, and on balance in some way you must figure this is helpful and agree with me and have hopes, or you wouldn't keep coming. [0:42:53] At the same time you [started doing this] (ph), but, well, Jesus, I don't want to hear my shrink after 18 months say, oh, well, you're neurotic.

CLIENT: (Laughing)

THERAPIST: (Chuckling) That's the problem. So there's... it seems to me that there is something very important in this wrestling process. And I guess it's probably both what we're both talking about, the way that you make contact, in this case with me and also a way that you move from abstractions about, say, neurosis, to, emotionally, what really matters to you and what you're upset about or what you're struggling with. I mean, that it seems to be is the gap to be bridged there, is between the kind of abstract view of this sort of illness and how you feel.

CLIENT: I mean, I sense that we're probably winding down...

THERAPIST: Yeah. [0:43:55]

CLIENT: So I have a thought that was in my head as I came in, for better or worse. And the thought was that... Jennie suggested this to me, and it's occurred to me before. But she put it in a way that was evocative. I mean, I really went through this with... a very similar process with my ability to be with a partner, a very similar process. I mean, here was a feature of my life and my engagement with other people that was really damaging me...

THERAPIST: I hear you.

CLIENT: Causing me great pain and suffering. And for, I don't know, a year and change, I saw this female psychotherapist who was in her 30s, and she was attractive. And we had very good rapport, and it was very nice. [0:44:56] And at a certain point we kind of had a fight, and I said, okay, well, I'm done. And exactly at that moment, I met Jennie. And Jennie has often remarked on the fact that, in our courtship or however you want to call it, I did everything right. I was just always... I was always on. Every move that I made, even in kind of identical sorts of interactions that could have gone in either direction... I made the right call. And, in previous... one of the things that I talked about with Penelope was that there have been all of these instances in which I just made the wrong decision or a decision that led in the other direction. And this time I made the right one. And I have often thought... or... not I've often thought... I was thinking to myself as I walked in about this fact, this curious coincidence of pushing Penelope away...

THERAPIST: Yeah, you split (crosstalk).

CLIENT: And opening myself to Jennie. And I'm not... I don't know where that goes. It wasn't like I was thinking, well, the thing to do in order to resolve this difficulty is to stop meeting with Marshall at which point a similar process has exerted itself...

THERAPIST: (Crosstalk)

CLIENT: But there's something... I mean, the last thought that I would leave with given that we're out of time is just that there's something about this struggle that can potentially be productive. Or at least in some incarnations of this struggle it's less about just being oppositional and probing and testing. And there's some element of, I don't know, spinning and spinning and spinning with the dimly understood or dimly appreciated ambition of finally putting the rubber to the road once you feel confident enough to do so and moving on. [0:47:01] I don't know where that goes, but maybe we can talk about it on Friday.

THERAPIST: Okay. All right.

CLIENT: See you then. Bye.

THERAPIST: Take care, Galen (sp?). I'll see you. Bye.

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