TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: I saw a friend of mine who’s in a Ph.D. program at Dartmouth, posted an article written by…from like a local paper. It’s written by an undergrad who had been hospitalized for suicidality and then like forced to withdraw.

And basically it was like, “Hey, it’s really shitty when we make students withdraw after being suicidal.” And in her case, it seemed like a situation where she was feeling suicidal and she like self-injured. But it wasn’t a suicide attempt and it wasn’t even really close, and like it was kind of…was a shitty situation.

And…I don’t know. I sort of started reading it and like her experience with hospitalization was like really bad and she had very bad things to say about it and it also seems like…yeah. It seemed like it kind of sucked and she wasn’t really treated very well. Basically I just felt really bad after reading it. Like it made me very like anxious and afraid and upset, and ahmm…yeah. [inaudible 0:01:52] like have anything to say about that, but now I really can’t get that out of my head.

THERAPIST: So that was today?

CLIENT: Yeah. It was just like a couple of hours ago. Yeah. I guess one of the things that sort of struck me was that like this triggering situation that she was describing was like it’s still sort of a weekly thing for me. (Laughs) I’m like, “Oh. Okay.” (Laughs) I don’t know what to say about that. (Laughs) Other than like I’m glad that my treatment’s better than hers. (Laughs)

THERAPIST: Yeah. I imagine it makes you feel in danger. I don’t mean like from yourself. I mean…I don’t even mean sort of like realistically somebody’s going to come in and do something. I don’t think you think that, but ahmm…I [inaudible 0:03:03] like you have such a strong sort of inclination toward thinking like it’s going to be really bad if this gets out. You know? Or if you’re really having trouble and especially if people really know.

CLIENT: Yeah.

THERAPIST: And that’s exactly what…I mean in a way what she’s saying happened to her.

CLIENT: Yeah. Ahmm…yeah. I mean it seems like from the way that she described it, it seems like she was committed like involuntarily. And that she was not expecting to be committed. Like that was not a consequence that she was expecting of seeking help, which is why what she did.

Like she talked to her counselor and they took her to urgent care, and then things sort of spiraled from there. Yeah and like…yeah. I guess it makes me feel very vulnerable. Yeah and there are things about being hospitalized that like even if I can see their reasoning, it’s still pretty traumatic. Yeah. Like being strip searched. That sucks. Like it’s awful. Yeah. I don’t know.

THERAPIST: [inaudible 0:05:17] pretty well for the sense of exposure and vulnerability.

CLIENT: Yeah. Yeah. [Pause] Yeah. Like I’m…I guess I…yeah. I could have not read the article, but once I started reading it, I could not finish it. Or like it wasn’t you read one paragraph and then that was [inaudible 0:06:19]. It wasn’t. And like…I don’t know. I guess I feel like it just sort of snuck up on me. [Pause]

Something that like I can tell people about [inaudible 0:06:57] or I cannot tell people about it, but like neither one of those really is perfect, because if I don’t tell people about it, then it’s still there. And if I tell people about it, like I can’t control their reactions. Like I can’t…I don’t know. [Pause]

At the same time, I feel like if I had read that article before I was ever hospitalized, it would have made me very, very resistant to being hospitalized and it’s like that would be a bad thing. Like “Being in the hospital sucks.” But like being dead is probably worse. I don’t know. But at the same time, like if we don’t talk about the failures in mental healthcare, then we can’t fix them and so… [Pause]

THERAPIST: Are you worried that you belong in a hospital or should be in a hospital or somebody [inaudible 0:09:15] thinks so?

CLIENT: I’m worried that people will think so. I don’t know. [Pause] I don’t know. I feel like it’s sort of…I don’t feel like I could say no. Like it doesn’t seem right, but I don’t…that question doesn’t help me sort of track down what I’m worried about.

THERAPIST: I see.

CLIENT: But it feels like there’s something to track down.

THERAPIST: Yeah. I kind of got that sense too. [inaudible 0:10:19] quite feel like what we got what shook you up.

CLIENT: Yeah.

THERAPIST: Or at least some important part of that.

CLIENT: I think one thing that I found sort of worrying or disturbing, is that like after reading the article, like I was left with a very strong desire to cut myself. I didn’t, but I really wanted to and I thought about it. I don’t know. Things still just feel so precarious.

THERAPIST: Yeah.

CLIENT: But I don’t know how to make them realize the precarious or more stable. Like I don’t…this is pretty stable for me. (Laughs) I don’t know. Maybe a part of it is that like in some way like I feel so lucky in so many ways. Like I feel lucky in like being able to see you. I feel lucky in having insurance that covers this. I’m lucky in living in Cambridge.

Like, you know, I sort of like…yeah. If I’m going to be suicidal, this is the place and time to do it. (Laughs). Right. (Laughs) Ahmm. And [Pause] yeah. I don’t think it’s that I’m getting worse necessary. It’s that it feels very precarious. [Pause]

James told me a story that was like a news article that he was reading earlier today. I don’t remember why he told me it. It’s a terrible read, I think. Didn’t really have much…I don’t know what it was. But it was like a young man in the 60s was diagnosed as paranoid schizophrenic after I think he killed his whole family. And spent six years in a mental institution and was eventually released.

While he was in there, he started taking college classes. He was really…he got a degree. Got a masters in psychology. Moved to Central Illinois and started teaching at like a liberal arts college and is still there teaching. Like has his Ph.D. He changed his name and recently somebody like tracked him down and published like “This is where this guy is.” And the university has been like, “Yeah. No. We’re not firing this guy. He’s a valued part of our faculty.”

And like there wasn’t actually any point to the story. Like I don’t think there was a punch line to it for James to tell me this. I don’t know why he told me, but like, “That sort of shook me up” or like…I don’t know. I’m really having a hard time pulling this together. [Pause]

THERAPIST: Yeah. It seems to be something like he sort of seemed to be [inaudible 0:15:30] with something in you that’s really…I think that feels very disturbed or very much not well and not even close. And that I think is probably not something you talk about very much or talk easily about or something. But it got like jangled a little.

CLIENT: Yeah.

THERAPIST: By these stories.

CLIENT: Maybe.

THERAPIST: That’s not very particular, but I feel like it’s something in that direction. [Pause] I [inaudible 0:16:40] something like the part of you that feels like [inaudible 0:16:42] feels like him, he’s getting the message that, you know, either you’re going to be kicked out for it, locked up against your will and then kicked out for it, or kind of tracked down and exposed, even if you’ve totally rebuilt your life, and had been living it in a perfectly reasonable way.

CLIENT: Yeah. Yeah. I don’t know. And it sort of feels like by just talking about it a lot and trying to be open about it, like I’m trying to forestall that in some ways. But I don’t think it actually works like that. I…yeah. And also…I don’t know. I feel sort of disingenuous or dishonest to you to be talking so much about having not been well, while trying really, really hard to hide the fact that I’m not well. Does that make sense? I don’t know.

[Pause] Yeah. And sort of not at my best with the kids in the last couple of weeks. Like I can’t say to Kim like, “I’m sorry. I haven’t done a great job. Like I’ve just been really depressed.” (Laughs) I…yeah. I can’t say that. I’m really angry at myself that it feels like I haven’t really like wanted to be at work or haven’t really been at my best. Like I’m angry that I’ve sort of let myself be affected by all the stuff that’s going on. Yeah. [Pause]

THERAPIST: Because when you think like maybe you’re not often kinder, any kinder or more tolerant of like the way which you feel so depressed, then like just folks in the articles were kinder to than those people.

CLIENT: Yeah.

THERAPIST: [inaudible 0:21:05]. [Pause] I wonder if like both of those things feed into like you’re having cut afterward.

CLIENT: Well I didn’t actually.

THERAPIST: I’m sorry. [inaudible 0:21:36] impulse to. Right. [inaudible 0:21:39].

CLIENT: (Laughs) I feel like whatever gold star I get for it, I want to make sure that you know. (Laughs) Ahmm, I don’t know.

THERAPIST: Like the gold star…

CLIENT: I honestly think it was just sort of like I wasn’t having a great day and it…like the idea was put into my mind by something else. And so I said, “Oh, that’s like a good idea.” Like that is so easy for me now. Like that connection is so easy and that sort of spooks me.

THERAPIST: So it was more like the cutting just being mentioned?

CLIENT: Yeah.

THERAPIST: And having a bad day.

CLIENT: Yeah. Not like a bad day for any reason. Just I’m having bad days.

THERAPIST: But the gold star, is that me that gives you the gold star? It sounded maybe that way.

CLIENT: I don’t know. Ahmm.

THERAPIST: I think that was [inaudible 0:22:52].

CLIENT: I don’t think anybody gives me the gold star. I think I just wanted to make sure that you know that I get one. (Laughs) [Pause] Ahmm, [Pause]. I don’t know whether I worry that I should be in the hospital. One thing that sort of spooks me is that like when I think about suicide, it’s sort of split in my mind at this point between like asking for help to almost feel like suicidal on one hand.

And on the other hand, like if I decide that I do want to commit suicide, like I’m not going to ask for help. Like…and so…and that’s scary. [Pause] It’s just…it doesn’t feel close, but it doesn’t feel that far away. But I don’t…

THERAPIST: I guess the scary part is like imagining yourself deciding to do it and just doing it.

CLIENT: Yeah. [Pause] Yeah. [Pause] One of the things that I’ve been saying to James increasingly about laying hand wavingly, [inaudible 0:27:29] is that like he has to trust me to run my own life. Like he has to trust me with it and our relationship is not going to work if he doesn’t. But I also sort of feel like well maybe he’s right not to trust me, but like I don’t…yeah. [Pause] I don’t know. I say that and like it’s something about that rings sort of false for me, but I don’t know what it is. [Pause]

THERAPIST: I don’t know. What occurs to me is that there is this part of you that really does want to kill yourself a lot.

CLIENT: Um hum.

THERAPIST: And that you worry about that part taking over or wearing…I think maybe wearing the other parts of you down, or getting the upper hand in some particular moment.

CLIENT: Um hum.

THERAPIST: And acting and I imagine it comes from that worry, the thought that “Maybe you shouldn’t trust me to run my own life.” But even if you’re worried about being able, you may have other things in mind about whether you might decide suicidality. But even if you’re worried about not being able to manage it, I don’t think the alternative that you want for somebody else to just do it.

CLIENT: Yeah.

THERAPIST: And I wonder if that’s maybe what rings false. Like that what you might want would be something a little more collaborative. I don’t…

CLIENT: [inaudible 0:31:11]. [Pause]

THERAPIST: Yeah. I don’t know. [inaudible 0:32:09].

CLIENT: Yeah. I’m not sure. [Pause] It feels like, it’s sort of like I’m unsettled about something or unhappy about something and I’m sort of like going down one conversational path that we sort of had already and like well maybe this is it. But I don’t know that’s actually it. Then it doesn’t help me. (Laughs) [Pause]

THERAPIST: I [inaudible 0:33:02] the first part of what I was saying before, about like there being a part of you that sort of often and intensely wants to kill yourself. Like that sort of ain’t quite right.

CLIENT: Yeah. No. That’s definitely true. (Laughs)

THERAPIST: And maybe it’s also that there’s something about like letting you know that I know that. [inaudible 0:33:41] that deemed relevant.

CLIENT: That makes me feel better. Ahmm…yeah. It’s very helpful to me that you don’t, for example, make me go to urgent care every time I come here. Ahmm…yeah. [Pause] But maybe I still sort of want to question your judgment on that. (Laughs) [pause]

THERAPIST: [inaudible 0:34:31]. [Pause] How so?

CLIENT: Just because I don’t…it sort of feels like you’re saying like, “No. You can do this.” I’m like, “I don’t know if I can. I don’t know.” Yeah. Today I sort of think that I won’t be able to. [Pause] It’s not that I’m there yet, but I can sort of see it coming or see it…picture coming. But I don’t think that there’s anything to be done about it. [Pause]

THERAPIST: Yeah. I guess it feels to you like I maybe don’t get the precariousness and also sort of feeling like overestimate your like strength.

CLIENT: Certainly the latter. [Pause]

THERAPIST: Because if I didn’t, I would probably do something.

CLIENT: That’s the thing. I don’t know that you would. Like I don’t think so. [inaudible 0:37:24].

THERAPIST: Sometimes what’s clearer is my sort of in a way like a confidence in you.

CLIENT: I guess it’s sort of imagining you saying like, “Well you might be able to live into this confidence and you might not. But confidence is sort of the best bet.” Does that make sense? I don’t…like [Pause]. I guess it sort of…it seems clear to me, but like it’s not…it wouldn’t be helpful for you to panic when I tell you that I’m feeling suicidal or be, you know, have…take more actively intervening steps, like [inaudible 0:38:33] and sort of being in the hospital, like sort of know what you’re going to do and that’s pretty limited, like sort of done it. As if doing it again wouldn’t be helpful. But I don’t know.

THERAPIST: Maybe part of what [inaudible 0:38:50] is that you panic a bit.

CLIENT: Yeah.

THERAPIST: And so if I’m not, it’s almost like in a way I don’t think you get it the way that you do, how dangerous things are. Although I do understand that you also know and know that I know what actually happens in a hospital.

CLIENT: I don’t think that’s quite it.

THERAPIST: I see.

CLIENT: I don’t know. [Pause] I don’t know. Maybe you’re right.

THERAPIST: Well I don’t know. I mean what you seem clear about was that you do panic a bit yourself.

CLIENT: I do. Ahmm. [Pause]

THERAPIST: [inaudible 0:39:55] a little. [inaudible 0:39:59] about that. Yeah.

CLIENT: I’m trying really hard not to worry about precise language here. So… (Laughs)

THERAPIST: Yeah. You panic.

CLIENT: (Laughs) Ahmm. [Pause] I mean the way that I sort of think about it I feel like I don’t…it feels like I don’t have any choice about whether to panic or not. Like I don’t intend to panic. I just do. Ahmm, it’s sort of your job not to panic. (Laughs) Ahmm and so like…I don’t know. I guess I worry that like you act like you think I’ll be okay because that’s the most likely to have a good outcome, but I don’t know how likely that likely is. Yeah. I think that’s about right.

THERAPIST: It could be terribly risky.

CLIENT: Yeah. [Pause]

THERAPIST: Well, [inaudible 0:43:20] explain that…

CLIENT: (Laughs) You sound so surprised. (Laughs)

THERAPIST: Yeah. [inaudible 0:43:28] but like I have two things in mind, which are somewhat at odds. One is, you know, your safety and the other is your having a chance to talk about this with me. If it’s plausible to me, that’s crucial to addressing this, whatever the outcome of that…you know, whatever the therapeutic outcome that will be. If it’s so incendiary or like it means I have to react and send you some place, that’s a problem.

CLIENT: Um hum.

THERAPIST: And in most settings like sort of by their nature, that’s not really part of the agenda.

CLIENT: How do you mean? What do you mean by “most settings?” I’m sorry.

THERAPIST: Like an urgent care setting or a short-term treatment setting.

CLIENT: Okay. I see.

THERAPIST: The point isn’t like to address [inaudible 0:45:00].

CLIENT: Yeah. (Laughs) No. No. (Laughs) No. Yeah. I understand what you mean.

THERAPIST: And…so yeah. It seems to me quite important to like be enough room to talk about it, you know. While at the same time obviously your safety is important too.

CLIENT: True.

THERAPIST: We should stop.

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