TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi.

CLIENT: Hi. (pause) Good week.

THERAPIST: Good. (pause) You know, it’s good to see you back.

CLIENT: Yeah. (pause) Yeah, here I am. (pause) I don’t know how in the loop you’ve been kept. Okay. (chuckle) That was sort of my thought, (chuckle) while you were on vacation.

THERAPIST: I mean it wasn’t – to be fair, like if it wasn’t for (inaudible at 00:00:33) I probably got three calls from; I forget her name, but (overlapping voices) all three times. I tried her back twice; I may try her back again today.

CLIENT: Okay.

THERAPIST: So it wasn’t, you know – it was just trying to (get) (ph) to each other, it wasn’t that they didn’t call or whatever.

CLIENT: Yeah. (pause) I don’t know what the rest of the day’s schedules are like, but they usually – that team’s usually on the short-term unit like early in the morning, at like 8:15 to 10 maybe. (pause)

Yeah, well I feel a lot better.

THERAPIST: Good.

CLIENT: Yeah. (pause) You know I’m pretty anxious about being out in some ways; I’m pretty anxious about like what happens next; how this is affecting James. And he’s worried about me, and that makes me worried; we’re just worrying over there. (chuckle) (pause) Yeah. (pause) [I don’t have the answer to like start talking] (ph). But I’m glad to be here.

THERAPIST: Thank you. [00:02:00] (pause)

CLIENT: I feel like I need to sort of change the – my approach to managing my moods. Like maybe I just need to stop managing them so much. (pause) I came in, you know, I just sort of met with the psychiatrist there; Dr. (Bell) (sp?); 20 minutes at a time; she was coming into the scene last year, and she’s – I think she’s very good. She doesn’t really pull punches. So like in a longer term situation that would have been a problem. And I’m like, so it would go to me whether, and I’d be like, “Well, I feel like she’s going to yell at me about something, and I don’t feel like I have control over what that is.” [00:03:17]

THERAPIST: I see. (pause)

CLIENT: But basically, (pause) I was like, “You know, I feel better; I think I feel pretty safe.” And she was like, “You’re not really practicing anything.” And she just sort of poked me until I started crying a lot, and then she was, yeah. (laughter)

I mean it helped; it was like she was trying to do what you do, but she only had 20 minutes. So she didn’t really have time to f*** around. (laughter)

THERAPIST: Which day was that?

CLIENT: That was on Friday I think.

THERAPIST: Okay. (pause)

CLIENT: So I spent a lot of the weekend just sort of trying to sit with exact, which I think helped. (pause) But that’s hard.

THERAPIST: Yeah. [00:04:16] (pause)

CLIENT: I don’t want things to just go back to the way they were. (pause) Or to the way they have been recently. (pause) [00:05:10] (pause) It seems like [two hours] (ph) a day (pause) I was like so tired all the time. I would (sigh) (pause) I don’t it was so much like avoiding feeling the things; it’s like I would deal with things for about half an hour, and then that would be so tiring, that I would just like be done (chuckle) for the next several hours. (chuckle) (pause)

I then I was (tired) (ph) all week; I’d have trouble falling asleep, or I’d wake up and not be able to get back to sleep. You know, I had a roommate who snored, so that (overlapping voices). But, yeah. [00:06:05] (pause)

THERAPIST: It was really not obvious to me that before you went in, the issue was you’re not sort of dealing with things, or just wanting to kind to shove them aside.

CLIENT: Okay. (pause) Well definitely the -

THERAPIST: The consensus?

CLIENT: The consensus (chuckle) (pause) I don’t know. I don’t know what the issue was. [00:07:00] (pause) I’m really anxious about what’s going to happen with James. I don’t know, you know, if sort of Tristan or James could stop handling it. But like now is the point where he stops having to do a good job handling it. So it’s sort of seeing where he is. (pause) [00:08:09]

It’s hard because it’s such a different atmosphere. Like it’s – (pause) in some ways, I feel like this thing that I – the things that were difficult for me are sort of very different in that hospital setting. And that they’re – I sort of resolved those, and then like leave, and now there’s this new set of problems. And in some ways, the problems don’t carry over that well. (pause)

So I spent a lot of the time there sort of, I mean talking to people about like the self-injury, because it was surprisingly hard for me to be in a situation where I couldn’t self-injure. Like I was sort of taken back by how big of deal that was.

THERAPIST: I see. [00:09:10]

CLIENT: And like that’s something that they had the resources to deal with, and they like to talk about – yeah. So I feel like that was helpful.

THERAPIST: Good. (pause)

CLIENT: I also feel like I’ve talked about that, is why I’m not talking about the suicide. But I don’t know. [Sounds good] (ph). (pause) But I wondered like (pause) you know, I always feel like they’re very separate things, but I think that they feed into each other really. (pause) [00:10:00] (pause)

So, (pause) I’m trying to start to figure out the rest of the week. Like do I go back to work tomorrow? But I don’t know; I feel like I should go back to work tomorrow, but it’s also sort of daunting to daunting to like, you’re like, “Okay yeah, that’s great. Now start the work week.” (pause)

THERAPIST: If it would be my choice, I’d say yeah, but I’m certainly happy that you have the thoughts I have about it. I mean like in other words, usually I don’t (inaudible at 00:10:51); and even when I have, I think you pretty much have (laughter) (overlapping voices) anyway. I’m not (inaudible at 00:10:59) like that. But if I had thoughts about (overlapping voices) – yeah. I don’t – haven’t yet, but -

CLIENT: Yeah, I guess I really don’t take your advice; no.

THERAPIST: I don’t really give into you that many times, but I remember the times you have – I have sort of – I remember it being clear that you didn’t – I mean in other words, like you made it clear.

CLIENT: (chuckle) Yeah. (pause)

THERAPIST: I often remember what it was about, sort of.

CLIENT: Yeah, I mean I remember it was like you gave me advice about tutoring at some point. And I was just like, that’s a good idea. And then didn’t really do it. (pause) Yeah, because I really like want you to give me advice all the time, but apparently I don’t want to take it. (laughter) (pause) [00:12:00] (pause)

I feel like I have a lot of questions that I wanted to ask you about. (pause) I can’t remember what they are. (pause) It’s about the future. (pause) But I can’t remember what they are, and I (inaudible at 00:12:54), and I don’t whether they’re questions that I would tell you. (pause)

I have a question.

THERAPIST: Yeah.

CLIENT: What would a good outcome look like for me? (pause) [00:13:49]-[00:14:49]

THERAPIST: Okay, so let me be clear up front that I’m going to interpret the question instead of answering that.

CLIENT: Oh yeah, not that was clear all right. (laughter)

THERAPIST: (overlapping laughter) I just don’t want to (object) (ph) that that’s what I’m doing, you know, if you’ve got the question. But (pause) this is – a bunch of this is making me think about your use of the hospital as a [rest pit] (ph). I mean there’s been the least of it in which like you’re getting sort of what I imagine is a, like in a way, I have more concrete kind of help around the self-injury stuff. In which, I assume that – but maybe I’m wrong, but I imagine that that’s where you meant you had thought of questions -

CLIENT: Mm-mm.

THERAPIST: you wanted to ask me about. Which I know that’s something you do all the time, and I just don’t hear about it. But I – at least you don’t tend to bring it up. So I was wondering if like (pause) there was some sense of me while you were there, as somebody like you could ask questions like that to. [00:16:05]

You know, I mean I guess where I’m going with all of this is to say that I think (pause) I mean some of last year was sometimes you coming up, I can identify in a different way that like you allow yourself in a different way to want help or ask for help. Or get certain kinds of help, (pause) in going to the hospital; I think in being in the hospital maybe. Like maybe it’s a little easier; like some kind of a guard or a sense of independence – I mean it I think usually weighs pretty heavily that you like relax when you’re there.

CLIENT: Yeah; yeah. (pause) It would be nice if I could find a less extreme inexpensive way of asking for this kind of help.

THERAPIST: Ah-huh. [00:17:07] (pause)

CLIENT: So – (pause)

THERAPIST: [Completely more of that questions I kind of never thought you’d ask] (ph).

CLIENT: Okay. Well the thing that it makes me think of is, or of what you just said made me think of this, that both Mark and Camilla, two of the priests from Calvary visited. You know, and they were very surprised that I was doing that like that. They both sort of asked me like, “You know, what can we do?” And I just said like, “Just know that I’m really not okay. (pause) I need to tell you up front that I’m really not okay, because I can’t act like I’m not okay. I don’t know how to do it.” But a lot of times it’s [just what I do] (ph). (pause)

You know, and it remains to be seen whether that is something that they will be able to hear, and like take away.

THERAPIST: Right. Yeah my thought when you said you know, I wish I could find a less extreme, less expensive way, (pause) it made me think, “Well, you know there’re ways in which (inaudible at 00:18:30) is pretty extremely expensive for you too, which just makes me think that you don’t know (pause) what they’ll come with, or how much they’ll be there, or how well they’ll kind of keep you in mind that way. [Were you sad about that] (ph)?

CLIENT: Yeah. (pause) [00:19:00] (pause)

THERAPIST: I also don’t know if this is true, but I wonder if it’s a part of why (pause) my view of the hospital of whether you’re avoiding things could be different in that -

CLIENT: What do you mean?

THERAPIST: You went there for a breather in part I think, assuming like you didn’t have to feel responsible for your safety. (pause) And the other too in which that you had, and you know, I see what it looks like when it’s hanging over you in times where you go, and some of the things that are (pause) relatedly causing you trouble and difficulty. You know whereas, maybe when you get there like you’re asking for help; you’re not wanting to talk about it, or maybe deal with some of that stuff. [00:20:21]

I mean maybe that’s not true, but that’s what I gather you mean when you say they seem to think you’re avoiding stuff.

CLIENT: Yeah. I don’t know. (pause) It’s not that clear to me in part, because like I’m pretty sure Dr. (Bell) was just sort of trying to like push my buttons, and so she was being – asking a lot of provocative things, and I felt like she would like demand an explanation, and then I would try to give her an explanation. Then she would be like, “You’re over intellectualizing.” I’d be like, “I have no idea how to deal with it. Like I don’t – this is how I work; like this is what I do.” (chuckle) And so yeah, that was frustrating.

I do feel like (pause) like I cried more in the last week than I had like in the last several months. It’s gotten really difficult for me to cry, and that also seems to be really important somehow. But like, (pause) you know, even in here like where I sort of – basically I feel like a lot of days I come and I’m like, “I’m really bad, but I can’t figure out where or why, and I need you to help me like pull that out.” Even when I don’t, (pause) I don’t cry; it’s like I don’t (pause) I sort of feel like I’ve been just sort of keeping it at arm’s length. [00:21:57] (pause)

THERAPIST: I mean, I’m glad you’re frank with me about it, but you cry in here.

CLIENT: A little bit. (laughter)

THERAPIST: I mean man, I don’t like how (inaudible at 00:22:17) you had in mind, but there are times where you’ll like sob pretty hard, or -

CLIENT: Yeah, I guess I just feel like (overlapping voices) I want to cry a lot more than I do.

THERAPIST: Yeah that you see it like – yeah. (pause)

CLIENT: I don’t know.

THERAPIST: No, I think I clarified that somewhat that sort of – maybe you want like – so that that doesn’t happen, but it doesn’t happen nearly as much as you, in a way like -

CLIENT: Yeah.

THERAPIST: want it to or – (pause)

CLIENT: Yeah, it’s also like – (pause) like I’m really glad that we can meet on Tuesdays unless it’s before work, but it’s sort of hard to like be like, “Okay, now I have to be back together.” And then go on.

THERAPIST: Yeah. (pause) [00:23:57]

CLIENT: It seems funny like (pause) (sigh) it was a strange – it’s strange to sort of be like – hang out with the other patients, and sort of be comparing my health both to them and to like my memories of where I was like a year ago of what I was dealing with. It’d be like, “Yeah, I feel like I’ve come a long way (pause) in some good ways, and I feel good about that.”

THERAPIST: Good. (pause)

CLIENT: But also like but I’m still (chuckle) in the hospital. (pause) I brought T.S. Eliot’s Four Quartets, [and I’m] (ph) a dick, so I think I was the most pompous patient initially. [00:24:58] (laughter)

THERAPIST: That’s the claim, [you get an award] (ph). (laughter)

CLIENT: It’s true, but I think I won. (laughter)

THERAPIST: Congratulations. (pause)

CLIENT: The Four Quartets are pretty good (pause) in terms of like, (pause) I don’t know, talking about pain. (pause) So like (pause) there’s one expressive therapist in particular who really goes in for like cheesy aphorisms and uplifting things. I’m sure you’re shocked to hear that. (chuckle)

So she had like a little book, and like little different like hopeful things that we have. And all I could think of was a line from the Four Quartets which is, “People change and smile, but the agony abides.” (laughter) I’m like, “Well that conquers me.” [00:26:20] (laughter) (pause)

I was very worried that they were going to sort of push medication or ECT, and they did not, so that was good. So I sort of made it clear to them at the beginning that I didn’t want them to push that and that I was worried that they would. So they just backed off, which was good.

THERAPIST: Wow.

CLIENT: Yeah. (pause) You look surprised.

THERAPIST: I’m surprised they didn’t push medication.

CLIENT: Yeah, we just didn’t talk about it. Yeah. (pause)

THERAPIST: That’s good. I’m not anti-medication, but -

CLIENT: No, me neither. (laughter)

THERAPIST: (inaudible at 00:27:30).

CLIENT: Yeah. (pause) But it’s interesting, like (sigh) it was very unsettling to sort of be so close up against pieces that are missing (pause) like from my memory. So like to be on the same (yehh) (ph) and like – we like to take walks around the grounds, and I’d be like, “I don’t remember any of this.” And then I’d sort of see one sort of view that looked familiar, but (sigh) (pause) like I did a partial program there, right? Like I spent a lot of time there. (pause)

I think I did the like mood and anxiety partial program. (pause) Actually, I’m sure I did, because I remember like you walk by, and I saw the inside of it, and I was like, “Yeah, I’ve been in that room; it gets really crowded.” It’s like, you know, the buildings aren’t really designed for what they’re doing now. [00:28:40]

THERAPIST: I see.

CLIENT: But (pause) so it’s just – yeah, weird.

THERAPIST: Right. Right because in your regular life, like I would imagine you don’t sort of run into holes like that. I mean they’ve been filled in, not necessarily that you remember, but you know, you can ask James or whatever.

CLIENT: Yeah, or I can say like, “This is a piece; I know this happened, but I don’t remember it.”

THERAPIST: Yeah.

CLIENT: Yeah; it’s not quite as close.

THERAPIST: Right. (pause)

CLIENT: People remembered me, which I was not expecting; like the staff. And I remembered faces, but like not names or any reactions. But it was also weird, because I would like have a very strong like emotional feeling though. I would be like, “Oh, this is the relationship that I think we have, but I have no idea what that’s based on.” (chuckle) So that works like both ways, you know, some people are like “Oh I really like you.” And then a couple of people was like “I really don’t like you.” But I don’t know why. (laughter) I usually became a player.

THERAPIST: Yeah. [00:29:59] (pause)

CLIENT: But I was surprised that people remembered me, which was good. (pause) There are a lot of people [who are good] (ph).

THERAPIST: Yeah. (pause) It sounded like it was a pretty different – (pause) like it was different I think or different than they were. I mean I didn’t know that, but (pause)

CLIENT: You mean they’re different now than they were a week ago? Or different now than they were a year ago?

THERAPIST: Well I had in mind more the latter, that like the nature of your time there was quite different.

CLIENT: Yeah, it was a much better experience in (both) (ph) ways. (pause) Yeah.

THERAPIST: Yeah, good. (pause) [00:31:20]Yeah, it sounds like, I mean so far, it was – even though it was different, I know I was talking about that a few minutes ago; like black different; a black sort of discontinuance with (pause) what came before, than I think last year. (pause)

CLIENT: I don’t quite follow what you’re saying; I’m sorry.

THERAPIST: Yeah, that’s okay; I’m trying to right here. Like (pause) what I have in mind is I mean like that (pause) you were kind of (pause) more ready last year to like just be taken care of, and just have a break, and a little bit more sort of (inaudible at 00:32:29), quite frankly like regressed in that way.

You know like (pause) or this time it seems like you (pause) were different in some ways where (pause) I don’t know, a little more yourself like you had been before you went in. I mean it – you felt better, and easier to rely on people, but it doesn’t sound like you – it doesn’t sound like you felt like (pause) a different person. I mean this is probably stretching it for last year, but I think it was little more like that.

CLIENT: Okay. I don’t remember what I was like last year.

THERAPIST: Yeah. (pause)

CLIENT: I believe that I didn’t feel like a different person. I mean I, you know, it was hard to sort of be taken care of there; like it was hard to sort of relax into that. (sigh) You know I talked to people, and like I’m good at talking to people, then they sort of want me to like take care of them and comfort them. Then I get like super overwhelmed, because I’m like “I’m also a patient.” (chuckle)

THERAPIST: Right. [00:33:43]

CLIENT: I’d like – I was mistaken for staff like many times, or multiple times, which is not actually helpful for me. And like that is not a compliment right now. (chuckle) So I was getting very sort of anxious about that, and it’s like, I’d be like, “Okay, I’m done with people.” And go spend time in my room.

THERAPIST: Yeah. (pause)

CLIENT: That sounded like me. (pause) Yeah, I’m really anxious about (pause) about what comes next. Like about I don’t know what to expect. (pause) [00:35:00] (pause) James really likes to have a plan; he likes to stick to the plan, and (pause) I sort of don’t feel up to dealing with that right now. (chuckle) (pause)

You know, it’s like (pause) I feel like he – so the sort of narrative that he and I have been talking about, is that of working, you know, that I need to sort of spend more time just sitting with my emotions, so that I don’t get so overwhelmed, and that that will sort of help the suicidality.

And like (pause) I don’t feel like I can now say to him, “Well like that’s not actually what it is.” Or in three days say to him, “Well, you know, the way that I’m dealing with this has changed over time.” Like I don’t feel he’ll be able to hear that. But I also feel like he needs to – for like he wants to (pause) he wants to be in the loop. But I don’t know how much it’s the loop – I don’t know. (pause) Am I making any sense? (pause) Not really. (chuckle)

THERAPIST: Well – [00:36:42] (pause)

CLIENT: Maybe not the sense I need to make. (laughter)

THERAPIST: So when you (laughter) I didn’t say that. (laughter) When you refer to the narrative, what is that from? Like is that -

CLIENT: From like the last couple of days.

THERAPIST: Okay.

CLIENT: We’ve – as I’ve been talking with him about (overlapping voices)

THERAPIST: That was when you (went) (ph) from the hospital -

CLIENT: Yeah.

THERAPIST: So it was kind of like your feelings were – or your feelings, your special bad ones I mentioned, then that will release your suicidality.

CLIENT: Yeah; yeah. Wow you just really did put that in one sentence; well done. (laughter)

THERAPIST: And (pause) Maybe there’s more of a rotten thing – probably the only thing, but (pause) is that the part of the loop he’s supposed to be in – is like what’s the approach you’re supposed to be? [00:38:12]

CLIENT: It’s definitely the part he wants to be in.

THERAPIST: Only so that he can kind of help you with it? I mean (pause) I mean it sort of gets into stuff that I don’t know as much about this, but I see James, I started talking somewhat (inaudible at 00:38:32) is like (pause) and he wants to be in it so that he can help? Or thinks that he knows what’s going on?

CLIENT: I think both. More of the former. (pause)

THERAPIST: I guess I (pause) it seems to me a reasonable topic for discussion, whether that is like he should be helping. I guess it seems to me that’s the sort of thing that has caused trouble at times in the past, (pause) where like, you know, in an absolutely understandable way. Like you know, very involved and very in the loop, and how being supportive or whatever he can be.

But that also (pause) then again with that sort of worn out and scared and feel like (pause) maybe it’s very confusing in the world on his own sort of needs or (pause) whatever, like where all that stuff should be in a relationship. I mean I don’t know a lot about this, but this is my (inaudible at 00:40:08).

CLIENT: Yeah, (inaudible at 00:40:10). And just (pause) yeah, we need to talk about it.

THERAPIST: I mean what [I am] (ph) what you said before, was that you’re questioning a little bit, or you were thinking a bit of the (mob) (ph) and the hospital about you need to be doing. And then that leaves you with, well how do you explain to James what you’re supposed to be doing, or what’s going to help?

CLIENT: It’s more like (pause) I feel like there’s a lot of sort of flexibility and experimentation in like the way that I’m talking about it with you, and that that is a good thing, and that’s sort of what I need. But that is something that doesn’t really translate very well into like explaining to James where I am. (pause) That (sigh) he sort of wants me to be in the same place two days running, and that’s not always -

THERAPIST: Right.

CLIENT: I don’t know.

THERAPIST: Yeah, you’re in a transition.

CLIENT: Yeah.

THERAPIST: Along with that in the hospital, which is (pause) something which is not easy. (pause) Would it help if I (inaudible at 00:41:47)? I mean I don’t know a lot of what’s going on there, and so forth. I just –

CLIENT: That’s like an idea. Maybe you can send an e-mail [anyway; that’d be good] (ph).

THERAPIST: Yeah. (pause) We just have a few minutes. I guess I’m also thinking about the word question.

CLIENT: Yeah. (pause) Did you have any thoughts? (pause) I’ve missed them. (chuckle)

THERAPIST: Good for you.

CLIENT: Yeah; one of the – one of the patients had like nine-month-old daughter that she brought in. And so there’s, you know, this huge circle of fans. I’m like, “Oh that cute baby.” But like I really just miss Sharon. (laughter)

THERAPIST: Yeah. (pause)

CLIENT: Tomorrow is also Ash Wednesday, which is like sort of a big deal in the Christian calendar. [00:42:53]

THERAPIST: Wait; tomorrow?

CLIENT: The day after tomorrow; Wednesday.

THERAPIST: Right. (laughter) That’s what I thought, but I – (laughter) (pause)

CLIENT: This is why Christian views are given the day of the week. (pause) Yeah, so I would need to ask to like get off an hour or so early anyway. Or I’m sort of debating whether to ask for that time off, but like to go to an evening service.

THERAPIST: Right.

CLIENT: I don’t know. (pause)

THERAPIST: I haven’t heard anything from you today that makes me think you shouldn’t go to work.

CLIENT: Okay.

THERAPIST: It also kind of seems like you kind of want to.

CLIENT: Yeah; yeah. Part of me also doesn’t, but I think that’s more just being scared, and being scared about anything in particular. [00:43:56]

THERAPIST: Yeah. (pause) Also, I guess if this was (pause) things you’ve said about work before, like (pause) it hasn’t seemed to me that really bad things happen at work. I mean it can be tiring; you can feel kind of squeezed; there’s not a whole lot of room for your emotional life, running around with the kids. You said Kim can be a little intrusive, (pause) so it’s like some stresses and pressure, and I could have imagined, you know, some other version of you being sad at a hospital and feeling like just a little fragile for it.

But that’s not the sense I’m getting as you’re talking; I’m not saying you’re not fragile in some ways, but –

CLIENT: No, that makes sense. I think what I need to do is go to work, but set it up such that on like over the weekend, that I don’t have a lot of responsibility. Because I guess what I’m worried about is that is sort of stress, and like working all the time will put me in the situation where I need a break and can’t take one.

THERAPIST: Yep. (inaudible at 00:45:14).

CLIENT: Yeah, and that I can do easily, I just can’t do it on Friday. (pause)

THERAPIST: Okay. Well let’s stop for now.

CLIENT: Okay.

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