TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: I haven't heard back from Reese (sp?) yet.

THERAPIST: Oh, okay.

CLIENT: So I don't know...

THERAPIST: Sure, no problem. I'm not in a rush.

CLIENT: Okay.

THERAPIST: Let's see. I mean, like I said, I expect to actually have most of those in July.

CLIENT: Okay. Yeah, I asked her if it would be okay for me to do that this weekend, several weeks in July (crosstalk).

THERAPIST: Right. I see, yeah. And if 7:30 makes a difference that's fine.

CLIENT: Okay. So James's parents are here. And I love them...

THERAPIST: (Chuckling)

CLIENT: But it means there are four people in the apartment all the time, and...

THERAPIST: They're staying with you?

CLIENT: Yeah.

THERAPIST: Uh-huh.

CLIENT: And so I'm kind of going insane (laughing). Yeah, I might have to, after this, have emergency tea and reading session... [0:00:58]

THERAPIST: Uh-huh.

CLIENT: In a coffee shop somewhere. Just be like, I just didn't come back from therapy until much after you expected me to. No, I told them I might. (Pause) It's very hard to be around people all the time (chuckling).

THERAPIST: Yeah. (Pause)

CLIENT: Yeah. And particularly going back to work tomorrow I don't feel like I've had the chance to rest, and so I don't know.

THERAPIST: Yeah. (Pause) [0:02:00]

CLIENT: Yeah, I'm not doing so well. (inaudible at 0:02:09) sort of hard to tell.

THERAPIST: Mm-hmm.

CLIENT: I ended up going to church last night by myself, which was good. And I was serving as a lay Eucharistic minister, and there... it was... (Pause) They've been having contemplative services every other week in the evening and offering prays for healing or healing prayers at the... as well? And one of the guys who's doing (inaudible at 0:02:53) didn't show up. [0:02:58] So, at the very last minute literally in the middle of the service...

THERAPIST: Oh, wow.

CLIENT: The priest was like, hey, can you do this? And so I did that. And I already was... I told him that I didn't want to sign up for that anymore because it made me too anxious. So he was like, you can say no, it's okay.

THERAPIST: Right.

CLIENT: But I did, and it was fine.

THERAPIST: You did do it?

CLIENT: Yeah.

THERAPIST: Uh-huh. (Pause)

CLIENT: It was nice, but anxiety [creeps in] (ph).

THERAPIST: How come?

CLIENT: Well, it's extemporaneous prayer...

THERAPIST: Oh.

CLIENT: Which I'm really not good at...

THERAPIST: I see. Uh-huh.

CLIENT: Or uncomfortable with. And people come up and they ask for prayers for the things that are... that they're going through that are really hard for them, and... [0:04:00]

THERAPIST: I see. You may have explained this to me once.

CLIENT: I don't know.

THERAPIST: Okay.

CLIENT: I think that... I think they started it during the ECT, because I know there was a training session that I went to. (Laughing) But I have no memory of what it was.

THERAPIST: Yeah.

CLIENT: I only know that I went to it because it was in my schedule.

THERAPIST: Right. (Pause)

CLIENT: So it's important. (Pause) (inaudible at 0:04:43) I have been thinking a lot about what we've sort of been talking about on and off. [0:04:59] (Pause) I don't know if I can talk about this. It's just too (inaudible at 0:05:30). (Pause) [0:06:00] I got this idea that these horrible and sad parts of me are there. [0:06:55] And I both want to experience them and then really frightened of it, scared, too...

THERAPIST: Mm-hmm. (Pause)

CLIENT: And that that's... in some way if (ph) I don't experience that I feel like I lose touch with myself or I'm not myself. So I cry after sex a lot, a lot of the time (chuckling), which James is okay with. So that's good. [0:07:57] He's not freaked out by it (chuckling). He's sort of like, well, that's how I know it was good for you (laughing).

THERAPIST: (Chuckling) Uh-huh. (Pause) It puts you in touch with yourself.

CLIENT: Yeah. (Pause) It's frightening to think that (pause), what if that's all there is when I'm in touch with myself? [0:09:01] It's just being sad. (Teary) What if that sadness is who I am? (Pause) Today, I'm just so sad, and I can't be sad with James's family (pause), and not because of them but just because they are people. [0:09:57] They are other people who are not me (chuckling). (Pause) [0:11:00] It is troubling and scary to me that sometimes I really welcome it. Sometimes it's a huge relief to be so sad.

THERAPIST: Mm-hmm.

CLIENT: I don't know what to do with that. (Pause) And then that brings up the question of, what am I doing in here? [0:11:55] And what am I doing with my life? And how am I...? What would it even mean to be taking care of myself?

THERAPIST: What do you mean about what you're doing here? Do you mean, if you're so sad and [sort of] (ph) getting in touch with it, then clearly you're not doing the right therapy or that sort of thing?

CLIENT: (Chuckling) Yeah, something like that.

THERAPIST: Uh-huh.

CLIENT: I mean, just that (pause) I'll come home from therapy some days and clearly have been crying and be just real sad for a lot of the rest of the day. And James will say, rough session? I'll say, no, it was good (laughing).

THERAPIST: Mm-hmm.

CLIENT: Maybe... I don't know how much of this is James and how much of this is me putting this into James's eyes. [0:13:02] But I... (Pause) If... but... I don't know how to say it. I feel like it's concerning? (Pause) [0:14:00] And, if the point of therapy and taking care of myself and all this stuff I'm doing is to keep me out of the hospital and to get me well, I don't know what that looks like. (Teary) I don't think well means never really quite feeling like I am connected to myself. [0:15:01]

THERAPIST: Mm-hmm. (Pause)

CLIENT: Yeah, I don't want that. But it's hard not to feel like other people want that for me because they... it distresses them to see me in distress.

THERAPIST: Mm-hmm. (Pause) [0:16:00]

CLIENT: But then it's also not something I can control or put away when the time comes with... or reliably, so I... it scares me. (Pause) [0:17:00] (Teary) Right now I feel like it's about to get really bad, and I don't know whether I want that or don't want that.

THERAPIST: Are you referring to right now as in the next few minutes?

CLIENT: Yeah. (Pause) [0:18:00] And I think, well, that's something that's just really wrong with me (pause) [in some way] (ph). [0:19:00] (Pause)

THERAPIST: I'm hearing you describing the wrong [inaudible at 0:19:12) you different places, like, in the expectations of people, people that you feel better, and my sort of... I don't know, being part of how you connect with things that [feel the worse] (ph), or (pause) sort of in your having all these awful feelings in the first place. [0:20:00] (Pause) [0:21:00]

CLIENT: I don't know what to say.

THERAPIST: Uh-huh. And (pause) I guess I'm feeling (pause) sort of (chuckling) a bit trapped in a way that I think is related to how you're feeling quite trapped, I think, which is, on one side I'm inclined to say things about (pause) how actually most of the time... (Pause) [0:22:07] There are limits, or there is some containment on how often you're feeling... [you feel awful] (ph) the rest of the day...

CLIENT: Yeah.

THERAPIST: [Feeling that bad] (ph). Or maybe James sort of can't hear everything but can hear some things. Or in a way what you're saying today is, part of the story now is that [we care about our time] (ph) and your 28 square foot apartment. [0:23:09] I got the idea it was small (chuckling).

CLIENT: (Laughing) Yeah.

THERAPIST: It's in Andover, so...

CLIENT: [The whole under] (ph) 500.

THERAPIST: Small in Andover is pretty small, so yeah. And these are four days you're not working, right? So even partly to just kind of be depressed and be upset in what I suspect is sort of an uneven, partly successful mixed sort of way, but a way that helps when James's parents aren't there.

CLIENT: Yeah.

THERAPIST: So on one hand I'm inclined to sort of (pause) say, well, I think there are these sort of parameters, although you're saying, no, I feel like when I fall I'm just never going to hit the bottom, or... [0:24:23]

CLIENT: Yeah.

THERAPIST: If I'm walking on water, I'm just going to be drowned forever.

CLIENT: It's like, I know there are these parameters. But in the past sometimes they've really... sometimes things kind of peter out over time. And sometimes it just picks up on itself.

THERAPIST: Sometimes it does. Let me just also say...

CLIENT: Yeah, the other side (chuckling).

THERAPIST: (Crosstalk) the other hand was (chuckling). But then we should come back for you to (inaudible at 0:24:57) of course. [0:24:59] (Pause) What I was going to say... my concern, though, is then that you'll hear what I'm saying as a kind of reassurance that's sort of missing the point or telling you you're not supposed to feel as overwhelmed and as sort of lost as you do... [0:26:11]

CLIENT: Hmm.

THERAPIST: In other words, however sort of carefully couched, that I'm basically saying, well, you don't need to be feeling that bad or that hopeless.

CLIENT: (Chuckling)

THERAPIST: But what's interesting to me is that, before I said that, you responded by saying, well, hey (chuckling). Sometimes there are no parameters. It can't be contained... (Pause)

CLIENT: Yeah.

THERAPIST: Which... (Pause) [0:27:02] Which in a way sort of, I think, kind of anticipates or preempts what I was going to say in a way? But I guess the point is... (Pause) [0:27:58] (inaudible at 0:28:09) I'm inclined to say (pause), it's more... well, this is imagery (ph).

CLIENT: (Chuckling)

THERAPIST: It's more complicated.

CLIENT: That's a good, safe... that's a safe thing to say (laughing).

THERAPIST: Right. I mean...

CLIENT: Yeah. (Pause) [0:28:59]

THERAPIST: But the point isn't to keep you out of the hospital. The point is to roll with what's going on with you in a way that's as helpful as possible.

CLIENT: Hmm. Okay.

THERAPIST: And... (Pause) Uh-huh?

CLIENT: (Teary) That was me starting to cry, not me starting to have something to say (chuckling).

THERAPIST: (Chuckling) (Pause)

CLIENT: I feel like a lot of what I do to protect myself is just to say, well, if I don't really look at this too hard, maybe it will go away. [0:29:55] I feel like a lot of what you do is say, no, it's clearly there. Maybe you should look at it.

THERAPIST: Hmm.

CLIENT: (Chuckling) (Pause) (Teary) It's like, I don't listen to music very much because it just gets too hard for me. It's just too overwhelming emotionally, but I love music. I love it. (Pause) [0:31:00] (Crying) I don't know, I'm just not okay with thinking of myself as someone who... (Pause) I feel like (pause), if I'm not very careful in how I manage myself or whatever, I'll fall into that. And most of the time it passes, but sometimes it doesn't. And then it gets horrible, and I can't understand or control it. And I don't know when that's going to happen. (Pause) [0:31:59] But I don't feel like a real person if I don't feel that bad sometimes.

THERAPIST: Mm-hmm.

CLIENT: (Crying) And that's a little... I don't like that. That (chuckling)...

THERAPIST: Well (ph), it's really quite disturbing.

CLIENT: Yeah. (Pause) (Crying, blowing nose) [0:33:00]

THERAPIST: Well (pause), it has usually... (Pause) There's been a pretty clear sort of proximal trigger pursuant to your going to the hospital most of the time in the last nine months or so. [0:34:12]

CLIENT: Okay. I don't remember (crosstalk).

THERAPIST: Sure. So (pause), when you... [so you're either in the hospital] (ph) or just getting a lot worse right then. But the first one in the fall was showing the apartment, I think?

CLIENT: Okay.

THERAPIST: Do you remember, or do you...? This was after James moved here. And this was kind of on you, and you were determined this was something you were going to do. [0:34:55] And then [you discovered] (ph) you couldn't. Or there was another one, I think, after you came back from being with your family after Christmas...

CLIENT: Mm-hmm.

THERAPIST: And were hit by being away from them in a way you didn't expect or at least certainly didn't see coming. Or another one was when you were determined to get to work on job stuff. There was another one that happened pretty soon after Amanda left.

CLIENT: Okay.

THERAPIST: And then there were...

CLIENT: (inaudible at 0:35:42)

THERAPIST: Yeah.

CLIENT: I just don't remember.

THERAPIST: Sure. Yeah, those were all a few months prior to the ECT. [0:35:55] And then there were some around the time of the ECT, but they're probably harder to... harder to think out what caused them.

CLIENT: Okay.

THERAPIST: Or I don't remember. (Pause)

CLIENT: [But still] (ph) it doesn't come out of nowhere.

THERAPIST: It has not (inaudible at 0:36:19). I think the one subsequent to those was... in a way seemed more to come out of nowhere. You could say that you were so on the edge from that period that...

CLIENT: Yeah.

THERAPIST: One of them, I didn't send you in, but you went in and saw somebody at Frederick who probably, I think, was probably a little more conservative than me and was like, no, you've got to be in. So stuff like that. [0:36:57]

CLIENT: Mm-hmm. (Pause)

THERAPIST: Yeah, but that was... otherwise there were... and obviously that's the trigger. That's not sort of the whole situation [of kind of impression] (ph) of how you were feeling, but there were things like that.

CLIENT: Yeah. Yeah. (Pause) Which is helpful in some ways, but then in other ways... but I can't keep those triggers from happening (chuckling).

THERAPIST: No, you can't. (Pause) But... (Pause) [0:38:00] But those are different situations. What you're worrying about now is feeling what you feel and getting so overwhelmed by it that you can't get out of it. And you need to go back to the hospital.

CLIENT: Hmm.

THERAPIST: And things get really awful again. And I'm not saying that couldn't happen. I'm just saying that's not what's happened.

CLIENT: Right.

THERAPIST: I mean, to pick a more recent example, I think the most recent thing that was really scary in the way this early stuff is scary was when you called me recently when you were deciding whether to go to your friend's for the weekend or not. Not the time you did go, but the time you didn't. [0:38:58]

CLIENT: Yeah. Family (ph), but yeah.

THERAPIST: Sorry. Yeah. Right, it was Jason's graduation, so (inaudible at 0:39:04). So... sorry. So...

CLIENT: No, that helps.

THERAPIST: Yeah. That was more the feel of what it was like...

CLIENT: Uh-huh.

THERAPIST: Rather than you just kind of feeling awful getting in touch with it and then getting totally lost.

CLIENT: Yeah. (Pause) Is that just how it's going to be? It's just... (Pause) If I look back closely at myself, somewhere I'll just feel awful? [0:40:02] Yeah, I can't answer that question. (Teary) But I... yeah, I worry that it's not like I am feeling this awful somewhere today and tomorrow, but that that's just a state of being for me. It's just how I am. (Pause) My... (Pause) My impulse is to say to myself, there there. Of course not. No, no, no. [0:40:57] But that's not actually helpful at all (chuckling).

THERAPIST: [What occurred to me] (ph) is there's not quite an answer to your question, although I will answer (ph) your question. But I think you've also been on a bit of a sort of bend away from how you've been feeling over the last four to six weeks or so, I guess? (Pause) I think with working three days a week and switching from five to three days in here-which really for three or four weeks there was two days-I think was a big change.

CLIENT: Mm-hmm.

THERAPIST: And it seems to me you're kind of coming around from that maybe a little bit now?

CLIENT: Yeah. I really have been really invested in making that change work and being okay with it. [0:42:00]

THERAPIST: Uh-huh.

CLIENT: It's just really important to me to be okay with it. (Pause)

THERAPIST: I can't sort of shake the feeling of something here that I also can't explain very well (chuckling), which is...

CLIENT: (Laughing) Pay back. Sorry. I know that feeling very well.

THERAPIST: (Laughing) Uh-huh. [0:42:55] Which is... (Pause) I've said this a few times, but you probably don't remember when things were really awful a few months ago. But [in a sense] (ph) also part of one happens... I mean, you feel [it constantly] (ph), those things just getting awful after one of these triggers or (inaudible at 0:43:24) events. And then you're sort of getting really suicidal and needing to go to the hospital, kind of like that. But I think I also probably said something at the time about how it seemed to me as well there was a... some feeling of both defeating James and I, and really wanting to put yourself in somebody's hands to be taken care of at the hospital?

CLIENT: Mm-hmm. [0:43:58] I remember the second part, but not the first part.

THERAPIST: Yeah. (Pause) The sense of...

CLIENT: Noticing (ph) I was this bad?

THERAPIST: Yeah, I can't handle this, and you know what? You can't handle it. And (pause) I really need to be helped in a different way.

CLIENT: Hmm. (Pause) I don't know. [0:44:58] So does it feel like that to you now?

THERAPIST: I guess I may hear some very faint echoes of that in our conversation, where I'm like... yeah. Well, there's kind of a shape to some of the... where there's this awful stuff, I'm afraid of going there. And it's all... I worry it's always going to be like that. And [the thought of mine] (ph), when I said, well, actually there's this kind of shape to it and blah blah blah. And then you're like, well, but then sometimes there isn't.

CLIENT: (Chuckling)

THERAPIST: And I'm like, well, but kind of there is. And you're like, well, is it always...? (Crosstalk) a little bit of kind of...

CLIENT: Yeah.

THERAPIST: And it's a very faint echo. [0:45:59]

CLIENT: I guess it more feels to me like...

THERAPIST: Uh-huh? (Pause)

CLIENT: Like you're saying, well, there's kind of a shape to it, and it passes, and all these things. It's true, and it's in some sense reassuring to me to hear? But in another sense it doesn't quite get to the things that I'm really worried about?

THERAPIST: Yeah, [I can tell] (ph).

CLIENT: But I can't really tell... I'm having a hard time formulating what I'm actually really worried about?

THERAPIST: Yeah.

CLIENT: And so... yeah. (Pause)

THERAPIST: I think that's right. I think what I'm saying doesn't quite get at what you're really worried about.

CLIENT: Yeah, but I don't... I don't know how to say it.

THERAPIST: Right. We should stop. Will you get some time on your own today? It sounds like it could help.

CLIENT: Yeah, I think I just need to right now go... [0:46:59]

THERAPIST: Yeah.

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