TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: I have one administrative thing first. I looked over the billing stuff this weekend and boy it’s unpredictable. So it’s hard for me to make up a bill because I don’t know who the insurance is going to pay.

CLIENT: Right.

THERAPIST: Because sometimes they pay me and that’s okay with me. And the amount even changed.

CLIENT: Yep.

THERAPIST: It looked like it went up which is good for both of us, which is good I guess. Except for you. It went up from 80-something to $103, so for the sessions I’m just crediting you three bucks essentially.

CLIENT: Okay.

THERAPIST: In other words I’ll like charge you (unclear). But I have no idea what they’re going to do next.

CLIENT: Neither do I. Would it be helpful to call and ask them what they’re going to do next?

THERAPIST: (Laughs)

CLIENT: I don’t imagine I’ll get any answers, but I can try.

THERAPIST: Right. Wouldn’t it be trusting (cross talk)?

CLIENT: I don’t know.

THERAPIST: I probably have like another – I’m not sure what to do. The other thing is that they seem quite – actually, I don’t even know if they’re spotty in paying or if the dates they haven’t paid me they paid you for but I just haven’t heard.

CLIENT: Right. Like how would you hear?

THERAPIST: They usually send me a paper record, but I ignore them because when they pay me they send me an electronic indication of that with all the information, so it’s very easy for me to like (unclear) and everything’s cool. But otherwise –

CLIENT: They send a thousand individual –

THERAPIST: They send me a whole bunches of pieces of paper and I just –

CLIENT: Yes.

THERAPIST: So I’m not sure what to do. I guess part of the reason I say that is because (Pause) so I think there are dates from April that I don’t have records of them having paid yet.

CLIENT: Okay. So would it be helpful for me to go home and figure out what they’ve paid me for the last several months and what is still outstanding or what they still have not paid me?

THERAPIST: Yeah, I guess if you have those dates.

CLIENT: Yeah, I think I’m – I know that we have all those pieces of paper somewhere.

THERAPIST: Right.

CLIENT: I know James’ been keeping track of them.

THERAPIST: Okay. Is that a, like a reasonable thing for you to do?

CLIENT: Yeah.

THERAPIST: Okay.

(Pause): [00:02:59 00:03:06]

THERAPIST: The other thing that I thought of which would make this simpler, but also would add some work for you, although I think not a lot – would be to just have you send them claims. Like I would give you a statement.

CLIENT: I think we can do that.

THERAPIST: Of like the dates that we met and charges and I’d probably give a diagnosis or something and then you could submit that to them somehow, my thought being –

CLIENT: Well, we submit the claims for Dr. Hoffsteder.

THERAPIST: Okay. Well, we can do that. (inaudible?)

CLIENT: I don’t think so.

THERAPIST: Okay. It’s easy for me to make up that kind of bill and I guess you never know, but my thought is if that just sort of takes me out of the loop, then it’s kind of like they’re either paying you or not paying you, but it’s not like the left hand does not know what the right hand is doing.

CLIENT: (Laughs). Okay. That would be fine. I think they started, I think I’ve reached my out of pocket maximum.

THERAPIST: Oh okay. That might explain the problem

CLIENT: So that might be why they’re switching to paying you, but I don’t –

THERAPIST: That wouldn’t explain why they’re paying me. That would explain why the reimbursement went up.

CLIENT: Yeah, I guess it does.

THERAPIST: Because they don’t – I don’t know why the rate would be $103. That doesn’t make any sense.

CLIENT: (Laughs)

THERAPIST: Maybe she went out of network. No, she didn’t go out of network, so who knows? (Unclear).

CLIENT: Yeah. I’m not (unclear).

THERAPIST: Right.

(Pause): [00:04:42 00:04:56]

THERAPIST: Okay. I’m sort of happy to do anything you want to do on this because my thought would be, to me the simplest step would be step one – figure the date they paid you. If you give me those, or if it’s easier I can give you the dates that I have of our meeting.

CLIENT: Okay.

THERAPIST: And if it turns out that they’re actually keeping up with the payments and just randomly paying one or the other of us, in that case (unclear). The thing is that like sometimes they’re paying you and sometimes they’re paying me and sometimes they’re not paying for a while. That’s where (cross talk).

CLIENT: And how are you going to make up a bill for the last month when –

THERAPIST: Exactly.

CLIENT: They have 60 days to decide what to do.

THERAPIST: Right.

CLIENT: Okay. So I’ll just send you like our records of what they say they’re paying you, what they say they’re paying me. How far back should I go?

THERAPIST: I think April?

CLIENT: Okay. And I will talk to James, like part of this is we’re trying to make it so that I do more of the work here, but we sort of haven’t done that yet. So I’ll talk to James about like what it would mean for us to submit the claims and because I feel like, oh, that would be easy, but actually (unclear) James could think of that, so –

THERAPIST: Yeah. All right. And I’m happy to do it more or less whatever you guys want. I mean, do you want me to keep submitting them and just keep giving you the like bill the best that I can and then and then we’ll adjust to pay. Whatever you want to do, I’ll (unclear).

CLIENT: It sort of sounds like we might have to do that anyway. Like do the best estimate?

THERAPIST: Yeah.

CLIENT: Okay.

THERAPIST: Right. (Unclear) the questionnaire if you’re going to do that or start submitting claims in hopes that if you did that they would stop paying me. But you never know.

CLIENT: Yeah. I do not know.

THERAPIST: Yeah.

CLIENT: Okay.

THERAPIST: And, I’m so sorry. I still don’t know about Friday afternoon this week.

CLIENT: That’s fine.

THERAPIST: I should know later today or tomorrow morning at the very latest. And I will probably reschedule for another time on Friday.

CLIENT: Okay.

THERAPIST: (inaudible).

CLIENT: Thanks. That would be good if we could reschedule although I tutor and usually don’t get back from that until about 2, so late afternoon may not work.

THERAPIST: Okay. When do you go to tutoring?

CLIENT: Actually, like a quarter to nine.

THERAPIST: Okay.

CLIENT: Yeah, and it’s a long trip. But I could probably drive, in which case I would want to leave at like quarter after nine.

THERAPIST: Okay. All right so I’ll (unclear) in mind. (inaudible).

CLIENT: Okay. Thank you. So as it turns out I – we didn’t go on the beach. We went to the island but it rained the whole day, so. So of course it was intermittent on and off raining so we rented bikes and rode bikes in the rain the whole day. It was pretty good, actually. Everybody got sunburned somehow. And it felt deeply unjust to me because we couldn’t put on sunscreen because we were so wet and it couldn’t stay on.

THERAPIST: And yet –

CLIENT: And yet – James was bright red by the end of the day. But that was cool. Yeah, it was a really good day, actually. Of course, his parents were hilarious. I’m glad they’re not my parents but I enjoy them a lot. His father works in a naval auxiliary company and is very much the role all the time, like we were supposed to meet him down at the docks at 9:45 –

THERAPIST: I’ve never really been sure what a naval auxiliary company does.

CLIENT: I’m not sure either. I think it’s’ just like –

THERAPIST: I (unclear) part of the (cross talk).

CLIENT: Yeah. He is not, I think, affiliated with the military but like sometimes their ships get co-opted by the military.

THERAPIST: I see.

CLIENT: Do things like spy on North Korea. (Laughs)

THERAPIST: Okay.

CLIENT: He missed their – because his younger brother’s college graduation because he planned on being able to come home and they’re like, ‘oh no – you’ve got to go spy on North Korea now, so that was funny. So we were eight minutes late to meet him and as we got there he was like at the telephone in a booth trying to call us because we were late. And on the way back he was like, ‘got to be there at five.’ And it’s just – he was very nice. He’s like me. He was like eerily like my father in some ways. Not the punctuality, obviously. (Laughs). He sort of had the attitude of, ‘nice to meet you, Roger’s friends.’ Now I’m going to mess with you and see what you do. Which James and I were pretty comfortable with because that’s what my dad does.

THERAPIST: I see.

CLIENT: So, in subtle ways. So when we got back we’d ended up tracking some mud onto the boat because we’d been biking in the rain all day. And it was a new boat and he’s really proud of it. And so he says, ‘so, have you guys been walking through the mud?’ Kind of like trying to make us feel guilty about that. And James said, ‘yeah, you know, we were in some puddles. What are you going to do? I know for a fact that this boat will be washed down. I have washed these boats. It’s going to be okay.’ (Laughs)

THERAPIST: I see. (inaudible).

CLIENT: Yeah. (Laughs)

(Pause): [00:12:13 00:12:24]

CLIENT: And his mom just talks all the time, all the time. Very like, self-consciously playful. Very sweet. I like her a lot but also after about 20 minutes okay, I was like I’m going to go sit with Roger and James who were staring silently into space. James and Roger are kind of two of a kind in being – like I think Roger really likes James because James is about as much of a misanthrope as Roger is. (Laughs)

CLIENT:

THERAPIST: Makes a very (unclear).

CLIENT: It really does. (Laughs)

THERAPIST: (inaudible).

CLIENT: Yeah. Yes. Yeah.

(Pause): [00:13:14 00:13:18]

CLIENT: Roger is telling us about his boyfriend who doesn’t seem like – it doesn’t seem like the relationship is destined to last forever to me in large part because when Roger says, ‘I kind of need to be alone tonight, I don’t think I can take other people,’ his boyfriend says, ‘well, I’m not other people,’ and comes over anyway. (Laughs) And Roger is like, ‘that’s not going to work, Dylan.’ No. (Laughs) (Pause): [00:13:48 00:14:21]

CLIENT: We ended up spending a lot more money than we had intended but also kind of get that it might end up that way. You know, it just happens when you go out with friends. And both of us got a little nervous but – ‘we’ll be fine, we’ll be fine.’ I was interested in how much it felt like how much our spending more money than we had planned to do was all my fault even though, I mean literally, none of it was on me. None of it was my suggestion. And it feels like I need to apologize to James for it.

(Pause): [00:15:07 00:15:24]

CLIENT: So tonight I’m supposed to go to have drinks with some acquaintances I haven’t seen since college and really I don’t know how it’s going to turn out. We’ll see.

(Pause): [00:15:38 00:15:48]

CLIENT: I’m not even looking forward to it. I’m sure once I get there it will be fun.

(Pause): [00:15:53 00:16:18]

CLIENT: It was really nice to be out on the boat.

THERAPIST: (inaudible).

CLIENT: Yeah. They – Roger’s family lives on an island which is right next to Newport and a 45 minute boat ride over to the island, which I love the water, I just love it.

(Pause): [00:16:37 00:16:51]

CLIENT: Roger’s dad kept saying, ‘well, if it gets too rough for you up on the bow, it’s a lot smoother down astern, like down by the driver. And no, no, I want to be on the front like the waves are the best part. Yeah, it was really great.

(Pause): [00:17:13 00:17:26]

CLIENT: The biking was difficult though. A lot of hills. It’s a really hilly island. They’re mostly small but I’m just desperately out of shape and even if I wasn’t it’s like me and James and Roger, both of whom are pretty big guys and pretty fit. And I’m just really not at all. Parts of that were rough though (unclear). But I think it was more like rough from feeling like I’d been in this situation countless times before of being the person who is holding everybody else back by my physical weakness or like not being the person who is cap – is being the person who is just not being able to keep up.

(Pause): [00:18:25 00:18:39]

CLIENT: We brought rain jackets but didn’t break them out on the bikes. We did on the boat, which in retrospect was a really bad idea. (Laughs)

(Pause): [00:18:51 00:19:08]

THERAPIST: I guess I was getting (unclear) your misanthropy.

CLIENT: Yeah. It’s less obvious with me than with James and Roger, but there’s a reason I’m married to James. (Laughs)

(Pause): [00:19:29 00:19:55]

CLIENT: Having two special social situations in a weekend is actually really too much for me. James planned this trip to the island and I had plans to spend with these friends from college and so it just sort of happened that way.

THERAPIST: I see.

(Pause): [00:20:10 00:20:31]

THERAPIST: Yeah, I guess it’s a little embarrassing when you don’t really like to be around other people and it makes you feel bad. You need to feel bad. It’s not saying you don’t also really like people.

CLIENT: Yeah.

THERAPIST: (Unclear). But

CLIENT: I’m a little more okay with not liking to be around people than I used to be. I feel like I’m much more direct with myself and with other people about saying, ‘no, I need to come home and be by myself for a couple of days now.’ But I’m not good at like getting out of social situations that way. I’m better at not getting into them in the first place. I get anxious and –

THERAPIST: Yeah. Like I’m thinking about what you’re saying and (unclear) like I think you like me and you want to be coming here but like (unclear).

CLIENT: (Laughs) I don’t know.

THERAPIST: I don’t really take that personally.

CLIENT: (Laughing) Well that’s good. The thing is, I find you easier to deal with than almost anybody, so it’s like if I don’t want to be dealing with you, it’s like very difficult for me to tell.

(Pause): [00:22:23 [00:22:47]

CLIENT: I don’t know that that’s true or not. What you said.

(Pause): [00:22:49 00:23:04]

CLIENT: Like in one sense, you are not other people. In another sense, everybody is other people. (Laughs)

THERAPIST: No I – what I was thinking of was the one Dylan made to Roger.

(Pause): [00:23:19 00:23:32]

CLIENT: I think I find it like I find myself feeling like just not up to therapy more often now that I like have a job and am doing more social things and have less time to just sit and stare into space.

THERAPIST: Yeah.

CLIENT: It’s interesting coming here on Tuesday mornings because then I have to go to work. That is a really, really long day. Yeah, I think it would be much easier to go into therapy and then to work I think it’s probably easier than work into therapy. But I’m still like finding it difficult in different ways.

(Pause): [00:24:32 00:24:45]

CLIENT: It takes a lot out of me.

THERAPIST: Yeah.

CLIENT: For a while I’d just go home and take a nap the whole winter.

(Pause): [00:24:52 00:25:08]

CLIENT: But it’s like a different kind of depletion than like going to have drinks with a friend. Like it’s (unclear).

(Pause): [00:25:18 00:25:38]

CLIENT: And then you know, the same thing happens, I mean, on the other hand the same things happened to me tonight. Like I expect happens like I show up. It’s sort of hard to commit myself to it because I’m so exhausted. Once we start having a conversation, then it’s okay.

THERAPIST: I see. (Pause): [00:26:05 00:26:28]

THERAPIST: I’m not doubting what you said in response to my thought is true – like I’m not doubting what you say. I think in addition to whether or not it’s true, the alternative makes you anxious. In other words, like I guess I thought as you were talking, maybe there is also a kind of smoothing over quality to the way you put it which in addition to the larger truth of what you’re saying, seems like an important part of what you’re saying or the way you’re doing it is the same thing.

CLIENT: Yeah. (inaudible).

(Pause): [00:27:27 00:27:38]

CLIENT: I feel like I do that a lot.

THERAPIST: Uh huh. And I think it makes you less anxious to do that. But I’m not sure you like doing it. In other words, it may be helpful in making you less anxious, or feel lessening – (inaudible), but –

(Pause): [00:28:06 00:28:23]

THERAPIST: I don’t know, my thought is that you don’t like to have to do that.

(Pause): [00:28:28 00:28:44]

CLIENT: I feel like it would help to say essentially that some friends don’t like people including me and there are different ways to frame that. And I try to frame that in a way that’s true but also that I’m comfortable with. I think it’s just that that framing doesn’t stick necessarily for a long period of time.

THERAPIST: Your?

CLIENT: In the way I frame it in like the comfortable way. And so I get just uneasy about it. I’m like, I believe this is all that’s going on while I’m saying it. And probably for some time afterward, but it’s probably not going to stick. And so then I have to like defend this framing of it and so it’s not complicated and distressful. But also it’s not, that’s not saying what I really have to do. So I don’t know that it’s – I don’t know if it’s quite right to say that I don’t have to do it because like that’s not what I feel like I’m doing when I’m doing it. I feel like I’m just trying to explain what’s going on.

THERAPIST: I see. Yeah.

CLIENT: I know you say like, ‘that doesn’t seem like that’s all that’s happening.’ And I’m like, ‘yeah, you’re probably right.’ And then I have to deal with that. I don’t think I’m explaining myself very well.

THERAPIST: One aspect it seems to me of what you’re saying is that it’s – you say something that sounds right and solid as you say it, but then later it seems zero insubstantial and sometimes you try to keep defending it.

CLIENT: I feel like I’m doing better at being able to say like, ‘no, what I said before I think isn’t actually true.’ Or that is not the only thing that’s true. I’m getting better at being able to revise it. But I still feel like if I have to revise it that means I failed at (unclear) or I’m being dishonest about something.

THERAPIST: Funny, my thought was kind of like the opposite of what you’re saying where I imagined that you backed away from what you first said or it seemed fuzzier as a kind of way of not intentionally, but kind of unconsciously like backing away from your side of an argument a little bit, like you know that you sort of lost faith in what you said almost or like lost confidence in what you said, or it didn’t feel okay to have what you said out there working against what I said, or something like that. Which is a very different way from what you were describing. But I don’t know (unclear).

CLIENT: That’s interesting.

(Pause): [00:32:57 00:33:13]

CLIENT: Because I sort of like recognize that also.

(Pause): [00:33:15 00:33:53]

THERAPIST: Maybe – I don’t know if this is right or not, but maybe it’s just that I – maybe I tend to like back away from what I’ve said or when I’m talking to somebody else I feel like I have to defend the way I originally framed it like in my own mind.

CLIENT: Yeah, that makes a lot of sense.

(Pause): [00:34:19 00:34:28]

THERAPIST: Like there’s one part, a more unconscious part losing faith in what you said and then another part, conscious part, trying to hold onto it and defend it.

CLIENT: Yeah, yeah.

THERAPIST: And (inaudible).

(Pause): [00:34:41 00:35:01]

CLIENT: Have you read any P.D. James, the mystery novelist. She writes very beautifully. She writes a lot of complex books so her hero is a detective who is severely an introvert so she talks a lot about like on a case she will take any excuse possible to go be by herself and she describes that like feeling of relief of when one is alone, just beautifully. It is very reassuring to me.

(Pause): [00:35:44 00:36:12]

THERAPIST: Sometimes I feel like – so Roger and James roomed together in college for a year – or Roger in his senior year and James still had a semester. And I think they got along – they were really, really good roommates, in part because I think they aren’t “other people” to each other but then they are also really good at staying out of each other’s way (inaudible).

(Pause): [00:36:49 00:36:57]

CLIENT: And I am pretty much the most bubbly and outgoing of pretty much any of James’ and my friends but I think I handled it pretty well. Because I think like the bubbliness is also genuine. That is a real part of me.

THERAPIST: Yeah.

CLIENT: You know, I’m less that way than I was in college, but it’s genuine.

THERAPIST: Yeah.

(Pause): [00:37:32 00:37:47]

CLIENT: I did feel bad though in that I did spend a lot of time talking to Roger’s mom when I just didn’t want to be talking to anybody. (Laughs)

THERAPIST: Uh huh.

CLIENT: So.

(Pause): [00:38:06 00:38:12]

CLIENT: You know I think being the other woman had something to do with that. There was a very funny moment where we were about to start home and Roger’s dad said, ‘I have a Murphy Stout – does anybody want it?’ Like looking at Roger and then looking at James.

THERAPIST: A what?

CLIENT: A stout – like a beer. I said, ‘I want it.’ And he just like really was not expecting that at all. ‘Really?’ Really, really. This is not a groundbreaking example of femininity – or feminism here. But I got a beer, so that’s good.

THERAPIST: Right. Yeah.

CLIENT: Although it’s sort of hard to drink a beer with James (inaudible).

(Pause): [00:39:04 00:39:26]

CLIENT: It’s getting increasingly hard to live with James in a studio. It’s just – mostly when I’m sad I just (inaudible). Like I can feel like I’m alone at opposite ends of the apartment when we’re just like reading or working or something, but when I need to cry I can’t feel comfortable doing that with James there.

THERAPIST: Doesn’t he work at home?

CLIENT: Yeah.

THERAPIST: That must be stultifying.

CLIENT: Yeah. He’s been going to the library a lot recently, which I encourage him to, (inaudible) but he’s basically always there.

THERAPIST: Yeah.

CLIENT: He’s going to Ohio for two weeks on Wednesday.

THERAPIST: Yeah?

CLIENT: Which he’s sort of been planning for a while.

THERAPIST: Yeah, you kind of mentioned it was in the offing.

CLIENT: Yeah. (inaudible).

(Pause): [00:40:35 00:41:12]

CLIENT: For a while I used to go and take baths when I wanted to be sad, but I feel like that will just make him too uncomfortable now.

(Pause): [00:41:25 00:41:28]

THERAPIST: Is that because you’ve been hurting yourself?

CLIENT: Yes.

(Pause): [00:41:30 00:41:41]

THERAPIST: Is that often that you would hurt yourself?

CLIENT: Yeah. There was one time where I like brought a plastic bag into the bathroom and envisioned killing myself. So, yeah.

(Pause): [00:41:57 00:42:14]

THERAPIST: What happened?

CLIENT: I called you.

THERAPIST: Yeah, that’s what I thought I remembered it. (inaudible).

CLIENT: I thought better of it. Called you. Went to the hospital. I don’t actually remember it.

THERAPIST: I do, but I – at least I think I (unclear) for that in mind. (inaudible).

CLIENT: Yeah.

THERAPIST: Yeah.

CLIENT: (inaudible).

THERAPIST: Yeah. (inaudible).

CLIENT: Yes, please.

THERAPIST: Okay. I’m not happy about it. Let’s see. So I think this was one time, I think it was around 10:30 on a Friday night or something like that and I asked (unclear), “are you cutting your throat?”

CLIENT: Okay.

THERAPIST: Or something. Or maybe. But – and this would have been before the ECT. If I’m remembering the right one – it was – you told me later that week when we talked on the phone that if either you hadn’t called me or I hadn’t sent you to the hospital you were pretty sure you would have killed yourself. If I’ve got the right incident. You definitely told me that and I think it was that incident.

CLIENT: Okay.

THERAPIST: And I think it was one of the few times where, one or two, where I was talking to you over the phone about where you would go as opposed to like -

CLIENT: Just needing to be talking?

THERAPIST: Yeah, or like let’s talk now (cross talk) and not tomorrow.

CLIENT: I mean, not like just (unclear).

THERAPIST: Yeah.

CLIENT: (Laughs).

THERAPIST: Or it was kind of uncertain but you were probably going to meet me the next day and we would be talking about it. So, yeah you called me (unclear) edge, how you sounded. You were angry about calling me. You had decided that you weren’t going to do it but you also wanted to (unclear) but you had that sort of mixed feeling about calling and (cross talk).

CLIENT: I remember that.

THERAPIST: So you –

CLIENT: I remember that feeling. I don’t remember it tied to anything specific, but I can remember feeling that way.

THERAPIST: And then when you called me on the phone and James (unclear) and it seemed pretty clear (unclear). So I told you and you said okay and then I also wanted to tell James and so you put him on the phone and I told him and he said okay and here we are.

CLIENT: Okay, thanks.

THERAPIST: Yeah. It was not one of those situations like (inaudible). Like before the ECT, you told me you were pretty sure if you had (unclear) that night you would have done it.

CLIENT: Okay.

THERAPIST: Yeah. That’s what I remember.

CLIENT: Thanks.

THERAPIST: We should stop.

CLIENT: Yes.

END TRANSCRIPT