TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: I'm just trying to over-praise her because she (inaudible at 0:00:03) again, so... before it got bad, so, if this is actually... I don't know if this is just coincidence or not. But I figure if I just reinforce that and if it really is true that she can tell, who knows?

THERAPIST: What happened? How did she tell you?

CLIENT: She just refused to... like, I was trying to get here, trying to get here, trying to get here, and she sat down, and she refused to move. She'd not lay down like she was tired. She sat, and she completely refused to move. And she's done that a couple of times.

THERAPIST: And it's just preceded an asthma attack?

CLIENT: Within two or three minutes, yeah.

THERAPIST: Wow, that's amazing.

CLIENT: So...

THERAPIST: That's pretty awesome.

CLIENT: I don't know if it's just because my exasperation's causing me to breathe more, or... I'm trying to be really open-minded as to what is cause versus correlation. But thank you. You're a good girl, yeah. She probably just notices something in my body and... language or something I'm doing different. I don't think she's psychic or anything. [0:01:01]

THERAPIST: Yeah, no, it makes sense that, particularly when you're in a state that's probably a bit agitated, she could be picking up on something more easily than you.

CLIENT: Yeah, so... something where... because I'm not getting enough oxygen I'm not even processing the information enough to notice it. So...

THERAPIST: Sorry about the attack.

CLIENT: Oh, that's okay, I've been having them all the time right now, so... I... luckily, when I was at my parents' house, they gave me quite a bit of money to do some things with. And one of them was to be a very expensive filter that I could not normally justify in any way, shape, or form. I would have gone with one less expensive...

THERAPIST: Right, not as good.

CLIENT: But Mom and Dad, they basically explained to me that... you know, we talked about it. And they said, because of the fact that most of the less expensive ones, cleaning a filter releases all... you know, you have to get it out, it's not self-contained. But it's meant to be reusable. [0:02:02] It's... those ones, they look like they're better, but it's... you're just going to get it all over you getting it out. Therefore (exhaling), not helpful. And I thought, oh, I'll just get Mike to do it, or something like that. But they're right. I should just get one that is self-contained, that... it's not a reusable filter, you buy the filter for every year. So... but... so that's actually been helping a little bit.

THERAPIST: Good.

CLIENT: But I think it's also ozone, which is...

THERAPIST: I see.

CLIENT: I don't know. My doctor thinks it's because I'm obese. That's pretty much... I don't know even know why I bother taking his... he has a 4 PM emergency appointment every day for people that need to be seen. And I took it yesterday. And he said to me, your tonsils are swollen. You should probably get them taken out. [0:02:57] And you should lose 15% of your body weight. And I'm really frustrated because I went through a lot. I mean, I had to cancel with you. I still had to [do it through the heat] (ph) at 4PM yesterday to get there, to just... I mean, I could have asked them to call in a new... I mean, not new, but extra inhalers because I'm going through them faster. I could have called and gotten that. I honestly was expecting something. I don't know what I was expecting. But (pause) I am pissed, really pissed that, no matter what happens with me... it's not just my GP. I mean, just about everybody but my rheumatologist, who... she's a little less so because she knows that it's all so interconnected. [0:03:55] She just simply tells me that it's more of a snowball effect. If I can lose the weight, then I'll be able to move more, which will help with this, and... she thinks it's a snowball effect. But she's nicer about it at least. But no matter what it is, it is, lose weight. You know?

THERAPIST: Mm-hmm.

CLIENT: It's not like I'm not trying. I... I did the last thing I can right now on my own without actually seeing someone in bariatrics. I am now using an app with a specific... that has you scan the barcode of what you eat. You write in... you type in the amount that's weighed, and you take a picture of it, to blog every single thing that you eat.

THERAPIST: My God.

CLIENT: Yeah.

THERAPIST: That's a lot of work.

CLIENT: Well, at least once you've eaten the same food again you don't have to scan the barcode.

THERAPIST: I see.

CLIENT: But still...

THERAPIST: Right.

CLIENT: At first I'm like, well, isn't food with barcodes worse for you? [0:04:58]

THERAPIST: Right (chuckling). Yeah, right.

CLIENT: (Laughing) Then I found out there are barcodes on all fruit, too. They're just very small.

THERAPIST: I see, yeah, I'm thinking about labels on apples.

CLIENT: They're fickle (ph), yeah. But it just... (Pause) I'm not lazy. I don't... it's not that I don't have self-control. I've got way more self-control...

THERAPIST: Yeah. You told me a lot of it was the steroids that you've been on.

CLIENT: My spouse is worried because he said that, basically, the kind of behavior that I've been going through the past month, month and a half life this, with getting so much harder to lose weight from medical things, he's like, if this was not being justified by your doctors, I would worry about you being anorexic.

THERAPIST: Uh-huh. You're eating very little?

CLIENT: I'm eating very little but also obsessing about the food and thinking of the food as poison... not poison, but... [0:05:59]

THERAPIST: Yes.

CLIENT: Being as it's the enemy and all this other stuff.

THERAPIST: Right.

CLIENT: The sheer amount... and it's not like I really like food that much. I really... I'm not a person who...

THERAPIST: (inaudible at 0:06:09) before this all happened it was not so much an issue really.

CLIENT: No, I mean, I liked food, but it wasn't like I really...

THERAPIST: Yeah.

CLIENT: It was just... it was there. Sometimes I forgot to eat.

THERAPIST: Right.

CLIENT: I've never been a huge person to medicate myself with food. In fact, 99% of the arguments I've had with my mother is... has to do with... really, true, no hyperbole, 80% of the fights I've had with my mother has been about food, because she wants to, oh, well, you did this. What's...? It's good, bad, everything is food. And it's like I'm a little kid, I've been... my willful thing with her about this has... you had a bad day, let's do this. You had a great day, let's do this. I just don't have that kind of drive. I don't hate it, but now I do. [0:07:00]

THERAPIST: Right.

CLIENT: And then [you're told by the doctor] (ph) that sugar is poison. Well, I don't really... I don't even own refined sugar in my house. But I really don't eat that much sugar or anything like that.

THERAPIST: How many calories do you eat a day?

CLIENT: Right now, 1100.

THERAPIST: Oh my God.

CLIENT: Yeah.

THERAPIST: You must be hungry a lot. I mean...

CLIENT: Not really, more light-headed. But yeah, sometimes hungry.

THERAPIST: [What are you supposed to do] (ph) at work? I mean, I get that it's in response to what your doctors are saying. I just...

CLIENT: And I've lost all of two pounds. I should be losing two pounds a week.

THERAPIST: Sure. Yeah, you're avoiding (ph) about half of what your body needs to...

CLIENT: Mmm, they have a different description of it.

THERAPIST: Sure, I don't know much about it, yeah.

CLIENT: Yeah, steroids change the way that your... insulin responses. [0:07:59] So you gain weight, and get tired instead of being able to have the energy to go do something.

THERAPIST: Yeah, it's kind of a double whammy in that you both... it changes the way you absorb the calories or something, and it makes you too tired to go run around.

CLIENT: Yeah. So it is... and then that's the reason why I don't want to use this anymore, because this is more steroids. (Pause) It made me sunburn so badly without being out in the sun that much, and, I mean, it just... steroids are bad. They're really bad for you. However, I need them to live, and I don't want to. I want to get off of them.

THERAPIST: Uh-huh.

CLIENT: I do everything they say. I am staying away from foods that tend to make an inflammatory response. I'm doing... I almost (ph) honestly believe this whole thing's bullshit anyways. [0:08:59] I really... half the stuff they call an alkaline diet... by the way, if you read the actual ph levels, are not in the base category. They're acids. And no way is lemon an alkaline.

THERAPIST: (Chuckling)

CLIENT: So I'm also the person who gets all upset when people call the word organic... use the word organic when they're... technically anything that's carbon's organic, too, so I'm kind of a pain in the ass about this.

THERAPIST: Wait, I missed something.

CLIENT: The word organic. I mean, I took a lot of organic chemistry. That just means there's carbon in it.

THERAPIST: Oh, okay, I get what you mean, yes. As in organic versus inorganic chemistry.

CLIENT: Yeah, they need to make a word for it.

THERAPIST: A different word.

CLIENT: I get very pissed about that. I want a different word.

THERAPIST: Right. Nobody's eating inorganic food.

CLIENT: Yeah. Well, actually I just... I've been sort of talking to one of the models that I work with. And she's been telling me some of the things that they... that she used to do back when she was in Paris to stay skinny, and it scares the bejeesus out of me. Usually, it involves swallowing non-digestible objects.

THERAPIST: Oh, really?

CLIENT: Like pennies. [0:10:01] Yeah.

THERAPIST: Why?

CLIENT: So that if you feel a penny, a penny's heavy...

THERAPIST: I see, you feel full.

CLIENT: You feel it in your stomach, and then you pass it. And there's no calories in copper, but I told her it's actually not mostly copper any more.

THERAPIST: Right. CLIENT: But yeah.

THERAPIST: That's horrible.

CLIENT: Yeah. So... (Pause) But I'm doing the best I can.

THERAPIST: Yeah.

CLIENT: I'm trying to be really open-minded (pause) about it, but it's hard. It's really hard. (Pause) It makes me really pissed, because, as a person who has a lot of very specific... I am a subject expert on a couple of things. [0:11:03] Like, I'm extremely knowledgeable on many, but on a couple of things. And therefore I understand subject experts on things. Therefore I am willing to give them the respect due, because that's what they've studied for. I obviously don't' know better than they do.

THERAPIST: (inaudible at 0:11:17)

CLIENT: But then, when they fail me and they really don't have the knowledge that they want, they try to tell me about something that's not true or irrelevant (pause), it becomes harder and harder to put my faith in them. (Pause) (Exhaling) And that's pretty much... yeah. [0:11:57] (Pause)

THERAPIST: [There's some things] (ph) that remind me of the way your in-laws have treated you, in that you're being treated as though...

CLIENT: They know me better than I do?

THERAPIST: Yeah, I guess I was going to put it a little bit differently, (inaudible at 0:12:21), but (pause) that... (Pause) I was just distracted thinking that I had your container [and wondering if she wanted to use it as a water dish] (ph).

CLIENT: (Chuckling) Actually, she's not thirsty anymore, so...

THERAPIST: (Chuckling) Okay. [0:12:49] So (pause) my impression is that it at least feels like there's... and there probably often is an implication when a doctor is telling you that you need to lose weight, that you're being irresponsible (pause) and maybe even a little noncompliant?

CLIENT: And unknowledgeable.

THERAPIST: And ignorant. And (pause) you're not being any of those things. I mean, you're actually kind of over the top. You're counting your calories to the fifth decimal place and restricting them considerably, and-I'm not sure but I'd imagine-trying to sort of do as much physical activity as your system can physically bear, which may not be a lot. But that's not because you're not trying. It's because of your illnesses, your illness. [0:13:55] And yet you're being treated as though you're being noncompliant and, as you say, ignorant.

CLIENT: And possibly lying to them.

THERAPIST: Yeah. Obstinate. Non-responsive.

CLIENT: On top of it, I am trying to, in speaking to them, use precise terms, not terms I looked up on WebMD but actual precise terms for things. The only person who's going to be able to take charge of this is myself, and they use hyperbole, like using the word morbidly obese to me. And I said, actually, I am not morbidly obese. I am one BMI category into the obese. That is it. I am... morbidly obese is over 35. I am 30.

THERAPIST: Yeah.

CLIENT: That is not... do not use that phrase. And he says, well, what I'm trying to bring to mind is how this is going to kill you.

THERAPIST: Right. So clearly the implication... the idea is that you're not taking this seriously. [0:14:59] And they need to be threatening and dramatic, because you're failing to acknowledge and take responsibility for what's going on with you, which is really treating you as someone, as you say, who's very different...

CLIENT: Than how I am.

THERAPIST: Yeah. (Pause) I guess you put it a little differently, as though they know you better than you do.

CLIENT: Yeah. And I do get... I get the idea that, because you're on the inside, you don't... sometimes there's a whole different part of you that you don't see. It's what others see, blah blah blah. But I don't know that that...

THERAPIST: That's not what's going on. I mean, nobody's more into that than people like me. (Laughing) And, at least to me, that doesn't (inaudible at 0:15:15). [0:15:58]

CLIENT: No, and the thing is that I know people like that...

THERAPIST: If there was somebody who was going to get excited about that, it would probably be me, and often I do. But that's I don't think what we're talking about.

CLIENT: No.

THERAPIST: No.

CLIENT: And I... the thing is, I've been here so long, I trust you to, if for some reason something is not what... what's really happening is different than what I see it as, that you're going to tell me.

THERAPIST: Yeah, I would tell you.

CLIENT: I mean, the most extravagant thing I bought recently is a new bed and an air cleaner (chuckling), so...

THERAPIST: (Chuckling) Yeah. You do the same thing with your finances that you do with the calories...

CLIENT: I'm trying to do the best I can.

THERAPIST: Be able to manage really scant resources.

CLIENT: Yeah. (Pause) And it's funny, because it's not even like... well, luckily I've been able to simplify it because of my health things I've been eating oatmeal for breakfast for the past five years. [0:17:00] So it's not like I have to really know that I'm eating more or less, it's the same packets.

THERAPIST: Yeah, it doesn't sound like the money is a huge issue.

CLIENT: I mean, the money is. I couldn't afford to eat extravagantly, let's be honest here.

THERAPIST: No, the money's an issue in its own right, but it doesn't sound like that's interacting much with the food stuff. (Crosstalk)

CLIENT: No, but I'm just saying, in terms of same thing with my... it's very... I've got it down to a science, such that this is all I can do.

THERAPIST: Right.

CLIENT: Therefore there aren't that many choices to get confused and bogged down with, which is actually kind of good.

THERAPIST: Sure, because there's a lot of organization involved in all of this.

CLIENT: IF I had to worry about... honestly with certain things, if I had a bigger budget for food, I could go crazy with this whole diet thing and find all kinds of special foods and this and that. And I could spend a lot of... not only just money but emotional time planning it?

THERAPIST: Sure.

CLIENT: This is really just like taking a vitamin or getting a shower in my life. It's really... [0:17:57]

THERAPIST: Yeah, no. It isn't... I've seen a lot of people who have pretty complicated relationships with food for emotional reasons. And that's okay. People who eat when they're anxious, or people who don't eat when they're anxious, or people for whom food takes on all sorts of meanings. I don't really think that's you.

CLIENT: I brought back a dozen and a half macaroons from Cincinnati. I still have a dozen of them left, and I split the six that I ate with my husband. So I've had three (chuckling).

THERAPIST: Yeah, it's not that you don't like food, [there's nothing wrong with liking food] (ph). (Crosstalk)

CLIENT: No, I understand in terms of that. But I'm just saying, that would be irresistible if I had a problem with emotional eating.

THERAPIST: Yeah, no, I know. It's just not your thing. I mean, it's the same with you don't have a problem with impulsive spending.

CLIENT: I do fall into habits, but the thing is, it's not about impulsive spending to make myself feel good about it. It's often like I begin to have... like, when I was traveling, because everything was constantly doing an expense report, I just forget. [0:18:56] But it wasn't...

THERAPIST: No, I'm sure it wasn't.

CLIENT: But it wasn't that bad. It was never that bad.

THERAPIST: It's not the worst thing in the world to be, but you're not neurotic in those ways.

CLIENT: No. I've got other ways to be neurotic (laughing).

THERAPIST: (Laughing)

CLIENT: I... it's funny because I can totally see myself right now as this progresses becoming extremely... not germ-phobic, but contaminate-phobic kind of thing, not really, but... how to explain this? Trying to make sure that there are... there is no dust or anything else in the house in terms of bothering my lungs.

THERAPIST: I see, yeah.

CLIENT: I... doing the vacuuming and cleaning and changing the seats, I could see myself easily (crosstalk)...

THERAPIST: [As getting obsessional about it] (ph). Not like OCD-obsessional, but another direction. Yeah.

CLIENT: No, just... you know. [0:19:58] But... pardon me for a second. I just need to make sure everything's okay there.

THERAPIST: Sure.

CLIENT: I hope everything's okay.

THERAPIST: (inaudible at 0:20:08)

CLIENT: I don't know who it is.

THERAPIST: Oh, okay.

CLIENT: Oh, his bus broke down.

THERAPIST: Oh no.

CLIENT: Well, he made friends, that's good. (Pause) He just wanted to let me know that he was stuck (ph) at the stop waiting and had made some friends because the shuttle broke down. But yeah, I mean, it's not really OCD... like, yeah, it is, I mean, the behavior's the same. But the driving force behind it isn't? I don't actually think, though... I mean, more than... I think... right now I'm having to tell this to myself. [0:20:57] I really don't feel like vacuuming more than every other day-we only have one room with carpet-on the room with carpet, is (ph) really going to do significant amounts of changes. So I'm just trying to make sure that it's like, okay, which days am I going to do it, because I need to make sure I do it every other day. That kind of stuff. Or just that kind of thing, to make sure that I'm just exposed to less stuff.

THERAPIST: Yeah.

CLIENT: But, for being a person who takes immune-suppressants, I'm actually remarkably un-germophobic.

THERAPIST: Uh-huh.

CLIENT: I have friends who are perfectly healthy, that won't use certain public bathrooms. And I'm just like, well, I guess I'm just going to have to wash my hands extra hard, and everything (ph) will be fine. Just surviving.

THERAPIST: Well, I think the main thing you're dealing with is incredible amounts of stress... [0:21:58]

CLIENT: Yeah.

THERAPIST: And not a lot of resources to deal with them. In other words, when Mike is feeling relatively well, he's really there for you. And your parents and some friends are really there for you, I think, to the extent that they can be.

CLIENT: Yeah.

THERAPIST: And your parents can help out a bit financially, and you guys have enough income to live, although it's close.

CLIENT: Yeah, it's a growing experience.

THERAPIST: But you don't have a lot of money. You don't have a lot of family really close by. Mike can really be there, but sometimes he's really... he really can't be because of his own stuff...

CLIENT: And sometimes I need to force him to go to work.

THERAPIST: Yeah.

CLIENT: He would sometimes blow... it's almost like he's acting out by trying to take care of... well, he doesn't actually take care of me. But he'll think he needs to be very vigilant. [0:22:56]

THERAPIST: Yeah.

CLIENT: It's just another way for him to escape.

THERAPIST: Yeah. Right. You have so much stress, with your health, with money...

CLIENT: The fact that I realize that I am literally trying to kill myself. Let's be honest here. My body is trying to kill me.

THERAPIST: Uh-huh. Yeah.

CLIENT: I do tend to sometimes be a little bit over-exaggerating. But my body was dismantled at one point in my life. My nervous system, right now my ability to breathe, I've had infections. I've had to have parts of my body taken out and replaced with metal.

THERAPIST: Yeah. Absolutely.

CLIENT: My body's trying to kill me. It doesn't know it. There's no consciousness involved.

THERAPIST: Yeah. It's not mal-intended.

CLIENT: And the worst part about that is the fact that it's really hard not to get wrapped up in that. [0:23:54] I mean, there is... I've had a couple people in my life tell me that I need to stop being so hard on myself and my body will stop, which is extremely well-intentioned but not true. Being self-critical is not making my immune system tear my body apart.

THERAPIST: Geez, how many goddamn ways is everybody going to make this your fault?

CLIENT: Yeah. Well, it's never mal-intentioned.

THERAPIST: I don't care. I mean, I guess I feel [bad and] (ph) protective of you. I understand they're well-intentioned. That's better than if they weren't. (Chuckling) But it still lays the blame on you.

CLIENT: Yeah. But I don't need that, because they don't understand, very few people understand that I am the type of person who stresses out because I am too stressed out. I cannot force myself to relax. When I do get massages...

THERAPIST: [You know what it is that] (ph) you're doing?

CLIENT: I actually stress out that I'm not relaxing enough. Luckily these things... the kind of stuff I get done is not something where you need to really be relaxed...

THERAPIST: Right.

CLIENT: But, back when I used to get ones that were for pampering things, I can't let go. [0:24:58]

THERAPIST: Yeah. You need people telling you that you're working incredibly hard, that you're doing everything you can and then some, that you are absolutely as on top of all of this as anybody could reasonably be, and that it is just really awful in so many ways that are not at all your fault.

CLIENT: Yeah. Could I just record that and play it back every so often?

THERAPIST: Sure, I'll (crosstalk).

CLIENT: (Laughing) I'm mostly joking maybe, but it's so hard because... and the thing is that... the reason why... the thing is the maliciousness I can usually shrug off.

THERAPIST: Right.

CLIENT: I have actually had customers tell me that my weight is killing me, too. They're like, it's like putting a gun at your head and pulling a trigger. And they're just being mean. They're just being fat hating or something like that or just people being nasty. [0:25:57] I can usually shrug that kind of stuff off. But when people try and be like, oh, well, as soon as you come to accept yourself and stop being so hard on yourself, that your body's going to stop... maybe. Maybe my blood pressure might go down. But that's really... I mean, we're talking, in the big picture of things...

THERAPIST: Right.

CLIENT: These are not...

THERAPIST: That's like number 79 and 83 on the list.

CLIENT: Yeah. And maybe they're influenced... like I said, again, not...

THERAPIST: Not the issue.

CLIENT: I became this way after I got sick. Being this way did not make me sick.

THERAPIST: No.

CLIENT: I lived in denial for years over being sick. (Pause) I think that it's the mindfulness, that this whole, I need to be more mindful about everything I do and be aware of my body... I think it's the mindfulness that's killing me.

THERAPIST: Uh-huh.

CLIENT: It's the ignoring. I need to shut out what my body is telling me all the time so that I can be happy. [0:26:58]

THERAPIST: I see. Like, if you pay attention to the pain or the tension or the, I guess, hunger at times, you'd be totally overwhelmed all the time.

CLIENT: Hunger isn't really the big thing, but the rest of it is.

THERAPIST: Uh-huh.

CLIENT: But yeah. It... (Pause)

THERAPIST: Yeah, I guess it's funny I wasn't thinking about it because you don't bring it up a lot, although you have told me and it's clear. But have chronic pain. You're in pain all the time. [0:27:54] I mean, there have been a few times where I guess it's been a little less, and there are sometimes where it's more...

CLIENT: Yeah.

THERAPIST: But, I mean, you've made it very clear that it's always there.

CLIENT: (Teary) It's always there. And by saying I need to not pay attention to it I am not saying I need to take pills for it or I need to do drugs for this or something like that. I'm not looking for an escape.

THERAPIST: Yeah, or to lie to yourself about whether you have chronic pain.

CLIENT: Sometimes I do, but that's only a temporary thing.

THERAPIST: Yeah, my impression is that it's like (pause) somebody who has ringing in their ears just trying to block it out because otherwise it drives you nuts.

CLIENT: Yeah. Just sometimes you have to just sort of... it's the equivalent of, okay, only five more reps, you can do this.

THERAPIST: Right.

CLIENT: You tend to lie to yourself just long enough to get what needs to be... not like five reps, but, for me, there's only a few more dishes in the dishwasher. Everything's okay. You're doing great. [0:28:56]

THERAPIST: Yeah.

CLIENT: That kind of lie to yourself... I mean, I'm not even talking long term, really.

THERAPIST: Yeah.

CLIENT: But...

THERAPIST: Sure.

CLIENT: I just struggle so much with this, because (pause) being aware of the limitations all the time is too much.

THERAPIST: Uh-huh.

CLIENT: And I'm kind of sick of it. So I do spend a lot of time trying to distract myself.

THERAPIST: Yeah. And as you say you get totally opposite (inaudible at 0:29:31).

CLIENT: Yeah. Well, my GP's like, well, how about this mindfulness-based meditation and this and that?

THERAPIST: Right.

CLIENT: I am all about this whole bio-feedback thing. But you know what? I tried to explain this to him in terms of signals on... electricity signals. I understand this idea, but there's so much in the system that you can't actually tell what's happening.

THERAPIST: Yeah. [0:29:55]

CLIENT: And he just... it just... (Pause) And the worst part is that my... when things are really bad, like right now with my breathing and other things like that, or just in general whatever's happening... because I almost always have some sort of random extremely annoying thing du jour that I just try and ignore because it's just so bizarre that nobody would ever have it. The... (Pause) Whenever I tried to... I just... that's exactly the problem I'm having, is that I'm losing my attention and my focus. I have now sat down and watched an awful lot of things with my spouse. I have no idea what I watched. I couldn't... I mean, I could tell you the name of the thing, but I couldn't tell you anything about the story. Sometimes when people talk to me and they tell me whole sentences I retain exactly zero of it. [0:30:56] My focus and my attention are being completely bled away...

THERAPIST: Yeah.

CLIENT: By the fact that there's all this noise in the system constantly telling me...

THERAPIST: Ow.

CLIENT: Ow. (Pause) (Sneezing)

THERAPIST: Bless you.

CLIENT: I have tried... my old doctor did believe very much in the idea of certain things related to break through a pain, of, when things get to a certain level, you have to stop it before it gets too bad, because then it gets very hard to control it.

THERAPIST: Huh. I see.

CLIENT: Basically understanding at what level you should take Vicodin or this or that...

THERAPIST: I see. Yeah.

CLIENT: Specifically because, if you don't do it at this point, when you take it when it gets worse, you're not going to be able to take enough to get rid of the pain. So...

THERAPIST: I see. Huh. Like, you've got to take it when it's a six, because if you wait until it's an eight...

CLIENT: Yeah. [0:31:57]

THERAPIST: Then it's too late.

CLIENT: It's too late. And you may have to take a whole lot more.

THERAPIST: I see.

CLIENT: And I really do believe in that as much as I... but the problem is that it really isn't... I mean, it's sort of effective. It's better than nothing else. But I don't really like the way I feel when I'm on those things either.

THERAPIST: Yeah. I mean, if part of the reason you want to be getting rid of the pain is so you can pay attention to things, be focused... I mean, not the only thing, but I guess that's part of it, and remember stuff...

CLIENT: Yeah.

THERAPIST: I would think Vicodin is really not ideal. Yeah.

CLIENT: Or even just be awake (chuckling). Yeah, so I only really use that... and we talked about it for a long time, and we did figure out... because you have to figure out what works for you. [0:32:55] This is why I so miss him. I hope he doesn't go to jail for life at this point. It's breaking my heart. Realizing that we had needed to use that awareness for sleep, it was maybe not for during the day, but, hey, if you wait, if you're in pain and you're sleeping, if it gets to the seven or, whatever, six, whatever, take something now because once you get to an eight there's no way in the world you're going to take enough to be able to get back to sleep.

THERAPIST: Yeah.

CLIENT: And (pause) so for me that's really how I have adjusted to that. But I don't really even do that that much anymore just because I'm sort of afraid of the stigma?

THERAPIST: (inaudible at 0:33:45) taking more painkillers?

CLIENT: Yeah.

THERAPIST: Huh.

CLIENT: On top of it, I don't really... I mean, I do have some left over from other things. But I do not have a doctor right now who is actively prescribing me opiates...

THERAPIST: I see. [0:34:01]

CLIENT: Therefore, in the event that something were to happen, like I got a job interview or something like that, I'd have to do a drug screening, I wouldn't be able to have a note. I probably could call my rheumatologist and told her this (ph), that I had something. But the point is that it's not already recommended less, so I usually wait until it gets extremely bad anyways. But (crosstalk)...

THERAPIST: If it weren't for different things like job screenings and what other people thought of you, would you take them more? Like, if it were just about...

CLIENT: Maybe.

THERAPIST: A balance between your level of pain and your level of awakeness?

CLIENT: Probably. That just... (Pause)

THERAPIST: Shitty decision to have to make.

CLIENT: Yeah. Those are the... basically the drawbacks of it aren't especially great. Opiates don't do great things to your body. [0:34:54] And I'm not talking about not getting enough medicine not great things to your body. I'm talking immediate, more obvious things. So I really don't like them.

THERAPIST: Yes.

CLIENT: And like I said I'm not as bad as Mike. My spouse really... he gets carsick when he gets them, so I know that it actually could be a lot worse. I just don't feel well. It's like having a little off day feeling...

THERAPIST: I see.

CLIENT: When I'm having it. He literally will be in a hospital bed when they've given him stuff for his kidney stones. He's standing still, and he feels carsick.

THERAPIST: Wow.

CLIENT: Yeah. Which is completely amusing, thinking about the fact that his younger brother is addicted to those things...

THERAPIST: Right.

CLIENT: And from recreational... not because of, he had an injury and started doing that. He started doing it recreationally.

THERAPIST: Yeah.

CLIENT: Here's Mike, who's afraid of needles, and this makes him sick.

THERAPIST: Right. [0:35:57]

CLIENT: And then here's the IV user. How different can that be? (Pause) But it's just... (Pause) It's just so damn hard these days. And I know it will pass. But (exhaling) (pause) I just don't want to spend another day of my... the problem is I'm just so afraid that I'm [going to get] (ph)... in the end I'm just going to be bitter. I mean, I'm already a little bit bitter now. But the supposed best days of my life kind of things (pause) have been pretty much wasted with crap.

THERAPIST: Yeah.

CLIENT: I found pictures of me... I scanned a couple of them in, of me back when I was young. [0:37:05] And it's funny because I used to say I was [amazingly knocked out] (ph), you would stop traffic, literally. And I looked at this thing again, and I'm like, no, this is true. Even looking back, I've had other people just quickly just take a glance at this, and (pause) I used to have it all. I used to really, legitimately have it all. (Pause) And I feel guilty for being mad about what I have now, because quite frankly there are people that have worse.

THERAPIST: (Crosstalk) a whole lot to lose.

CLIENT: Yeah. [0:37:56]

THERAPIST: And [this is for better or worse] (ph), but actually not because of really anything you have or haven't done.

CLIENT: No. Not really. I mean, there's a few things, but these are maybes. Like, maybe if I had started paying attention to the pain a little earlier or been a little bit more this, a little bit more that. But I think I mentioned to you that I had mentioned about the Socratic (sp?) pain when I was in my teenage years. And the doctor felt as if it was just teenage nonsense, angst things. And my dad believed him because that was the... my dad believed because of the doctor's say.

THERAPIST: Yeah.

CLIENT: This is the premier person for diagnosing things. I still want to send that man a very nasty letter. Do you think if I did that that I would get in trouble, there'd be people calling me or...?

THERAPIST: If you sent a mean letter? No. [0:39:00] I mean, you might get a response. Probably, my guess is you wouldn't.

CLIENT: I'm just afraid that maybe something like they would thing that I'm threatening him or something, because I'm not. But...

THERAPIST: No, I mean, you'd be just talking about how angry and disappointed you are with how he treated you or what he missed.

CLIENT: Yeah. (Pause) I mean, it's very easy to vilify just one person. And there's just a lot of things on the way, but that was one of the first people who could have identified it.

THERAPIST: Mm-hmm. And your life would be pretty different.

CLIENT: Yeah. I don't blame... when I was six I was taken to hospital for some repetitive stress problems back before they even knew what repetitive stress injuries were. [0:39:55] They didn't diagnose it because that was just simply that they didn't know. So I don't blame that, but this person's supposed to be the person who... (Pause) That's their job, not like the people at the ER. And that was when I was 16, or 15 or 14 or... I remember seeing him a couple of times. (Pause)

THERAPIST: Well, we should stop.

CLIENT: Thank you so much for accommodating me this week. I appreciate it very much.

THERAPIST: Sure, you're welcome. I've got this time (inaudible at 0:40:44).

CLIENT: So... I will see you next week.

THERAPIST: Sure. Good luck with the asthma (inaudible at 0:40:57).

CLIENT: Thanks. Yeah. [0:41:01]

END TRANSCRIPT