TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Dr. Smith.

CLIENT: Okay.

THERAPIST: Right. I've talked to them about us and me and you yesterday and...

CLIENT: Yeah. Dr. Smith said she that was going to get in touch with you.

THERAPIST: Yeah. I'm going to talk to her later today.

CLIENT: Okay.

THERAPIST: And I think they may have talked as well.

CLIENT: Okay.

THERAPIST: I wasn't in on that one, so I'm not sure.

CLIENT: Okay. Yeah. So, Dr. Smith just thought that our, that having James just kind of stick right close to me all the time was a really terrible idea. Which I'm really glad she did because I thought it was a pretty terrible idea too and as it turns out, so did James. I think both of us were kind of like okay, if this is what we need to do, but it has not been good. [00:01:10]

So, I don't know, I don't know what to do. Today I feel pretty okay. I've been applying for a job. Last night was really, really bad. Yeah. Yeah, I kept thinking about, I kept thinking about cutting my throat. Yeah. I, James has been looking for jobs for me which I think is him dealing with how powerless he feels, but it feels to me, I don't know. I just don't like it. I really know why I don't like it. I'm like angry with him, but mostly I just feel really horrible and feel really badly about myself and feel upset with myself for being angry with him. He e-mailed some of our friends and family about like, to like crowd source job ideas and I really didn't like that. [00:03:00]

THERAPIST: Oh, he did that?

CLIENT: Yeah, and he didn't ask me about it first and it, you know. It was humiliating and also I felt like, you know, taking away my agency and but for him I think it was just he's trying to ask for help when he needs help. I felt like, you know, here is Tanya who is nuts and I can't find a job and has this problem. Help me fix Tanya's problem. Yeah. So, I'm just mad. I got my hair cut though which lasts for only a month or two months, so, you know. That felt good. [00:04:15]

THERAPIST: So, I imagine you're really quite desperate. I mean you don't really have a plan. I'm going to say how it seems to me and then let me know if I'm wrong. The plan for your safety has been to have James around and that's causing real trouble between the two of you. I mean for each of you in particular, I guess. And, so, I mean there's not another plan as far as I know. And you're feeling better. I'm glad you're feeling better today. That's good, but you were feeling really bad last night. So, I would imagine, I mean there's nothing really in place for your safety. [00:05:45]

CLIENT: No. Other than myself.

THERAPIST: Yeah.

CLIENT: Yeah.

THERAPIST: Do you think having now, I heard from. I should say a little more about what I heard from Smith and Vaughn, just so that you know what I heard. I heard a lot. Yeah. Smith said like that like James wasn't leaving you alone for more than a few minutes at a time and that this was putting a lot of strain on both of you. You're both getting angry at each other about it which is pretty similar to what you told me about, you know, sort of the black mailing each other that I think you mentioned yesterday. Although, it feels a little different for me to hear it from her who's hearing it from James first hand. I guess I imagine it's easier for me to sort out what her projections might be on to James than what yours might be. You know, in other words, it's hard for me to tell. I imagine like... [00:07:45]

CLIENT: It's much easier to tell how I feel about James than how James feels?

THERAPIST: Yeah. I mean you have said there are times when you're sure he's furious when he's not and other times when you're sure he isn't and he is.

CLIENT: Yeah.

THERAPIST: It sounds like he's angry now. Yes. You know.

CLIENT: Yeah.

THERAPIST: And, she also said she wondered about partial hospitalization and it was unclear if she had said that to you or not.

CLIENT: She mentioned it. She asked if you and I had been talking about it and I said not really.

THERAPIST: Yeah.

CLIENT: I've been thinking about it.

THERAPIST: Yeah.

CLIENT: But, I don't know. I don't know whether my insurance would cover it. I don't know how to tell whether my insurance would cover it. I don't know whether it would be a good idea.

THERAPIST: Right.

CLIENT: Yeah.

THERAPIST: And Eve was just worried and she wondered like, a little bit, you know, so, I think therapy's very helpful or it didn't help too much. (inaudible at 00:08:55) opposed to with her but I mean there are some things that.

CLIENT: Yeah.

THERAPIST: Yeah.

CLIENT: Yeah. I mean I'm glad you guys are all talking. I don't know. I sort of feel like you, as well as Dr. Vaughn and well as Dr. Smith are kind of expecting, want me to say what I need and I just don't know. [00:09:35]

THERAPIST: Yeah. I imagine you have no idea.

CLIENT: No.

THERAPIST: I'm not sure what conveys the sense from me that I'm waiting for your input.

CLIENT: I guess from you. It's not like you hadn't brought up like partial hospitalization for me or like any other plan other than just like keep an eye on me and Dr. Smith asked me what I needed. So, yeah. I'm good at that. Yeah. [00:10:40]

THERAPIST: Yeah. At least with me it's not your job to figure this out what you need or to make a plan. Maybe your job is to provide some input about how you're doing.

CLIENT: Yeah. I feel like this plan's not working.

THERAPIST: Yeah. Right.

CLIENT: It's not working.

THERAPIST: Right.

CLIENT: Just to be clear.

THERAPIST: And, right now, I guess I'm letting you know that stuff, mostly just to let you know what I've been hearing from them because I feel like it's sort of important for everybody to be on the same page that way. I guess I found out something new from me to hear that. About sort of the way the current plan puts a lot stress on things between you which you had kind of said and maybe I didn't pay enough attention to that is certainly possible which, you know, can emphasize and it sounds like it's very clear to you as well. [00:12:00]

CLIENT: Yeah. She said a couple of times yesterday I don't want you to feel trapped. I don't like want you to feel like a prisoner. Either of you. I'm like well, that's exactly what I feel like. That's exactly it. I don't...

THERAPIST: Well, I don't think there is a way to avoid that. I mean that doesn't mean every theory is the same.

CLIENT: Yeah.

THERAPIST: But there's not going to be an instrumental solution to this, or a strategic, that's a better word, a strategic solution to this. I mean, there are better strategies and worse strategies and hopefully we'll figure out one of the better ones. [00:13:10]

CLIENT: I'm trapped by being alive. That's pretty much how it's going to go.

THERAPIST: Yeah. I think so. I mean, yeah.

CLIENT: Yeah.

THERAPIST: I mean it doesn't sound like she was really seeing just someone, not someone, something that both you and James are having tremendous trouble bearing. Like, to the extent to which you feel in prison by each other among other things with people.

CLIENT: Yes. Yeah. And that I have trouble thinking clearly. I was having trouble yesterday with the thoughts in my head. So, I just felt really bad. [00:14:40]

THERAPIST: Tell me about that.

CLIENT: Like, James is working really hard and making tremendous sacrifices in order to keep us together and to keep me around and to keep us, you know, financially solvent and all of these things. And, I'm not helping. But, it's like I resent James for doing all these things and I don't like that in myself. So, I hate myself for resenting James and...

THERAPIST: I think you probably feel like you're in a bitter, bitter war. Probably all over the place.

CLIENT: Yeah. [00:15:45]

THERAPIST: Certainly with James where, you know, he's trapping you with being alive and you're trapping him with doing all these things for you.

CLIENT: Yeah.

THERAPIST: And I think that's not the only place. You know, I think you probably feel that way like with work to some extent? With Starbucks to some extent? I mean it sounds like as of yesterday you were kind of done there.

CLIENT: Yeah.

THERAPIST: But, let's say up until recently then, you know, feeling like you've known for a while the way you felt trapped there, I think.

CLIENT: And I am going to give two week's notice there.

THERAPIST: Yeah. [00:16:45]

CLIENT: I have to go back tonight.

THERAPIST: Right. And, I think, you know, the other place would be here.

CLIENT: Yeah.

THERAPIST: You know, I think sometimes it probably feels like with me and sometimes it probably feels like with the things we talk about, but I imagine you feel like you're in kind of a bitter war in that you really are motivated to be sort of getting in touch with the way things are hurting. The things that are making you suffer so intensely and just think as directly as possible about that. But, it is incredibly painful and difficult and unfamiliar. Well, familiar, maybe, but I think so. [00:18:00]

CLIENT: It's hard.

THERAPIST: And, I, now that I appear to be monologing here, I...

CLIENT: Easier for me.

THERAPIST: I imagine you're, perhaps consciously I suspect more so, you're not terribly worried about excessively burdening me or like trapping me in some way like you're trapping James where I'm, you know, going to do all things to take care of you or pay attention or be there or listen. I'm not saying you want all these different things.

CLIENT: No.

THERAPIST: You're kind of dirty laundry, but...

CLIENT: I mean I worry about calling you.

THERAPIST: Yeah.

CLIENT: I worry about, you know, the plan is that when things are bad I call you and I, that's really hard.

THERAPIST: Yeah.

CLIENT: You know, I have to kind of calculate how likely I am to be inconveniencing you versus how much I need to talk to you.

THERAPIST: I see. [00:19:25]

CLIENT: And, you know, it feels like every time I really need to talk to you it's when it's really not convenient for you. Of course. And that is really scary for me.

THERAPIST: Do you worry I'm going to get revengeful or sick of you or might decide this just isn't working or I can't do this?

CLIENT: I don't know. All of those things. Yeah. That, you know, I feel like the boy who cried wolf here. Like, you know, I keep saying I feel bad enough to kill myself, but I haven't tried to kill myself and people sort of say that's a good thing, but I don't know. I worry that he will not take me seriously or that he will think that. That it can't be that bad.

THERAPIST: Oh. I see. What will I make of it instead? [00:20:45]

CLIENT: I don't know. That I just want attention. That I'm lazy, you know, I don't want to do the work myself and that I'm not strong.

THERAPIST: I do think you want attention. I do think that you can't do a lot of the work yourself. I don't think that's why you call me. You know? And I, I don't actually have a problem with any of those things, but I hope you get what I mean. [00:22:00]

CLIENT: Yeah. I know. I understand.

THERAPIST: Yeah.

CLIENT: Why do you think I call you?

THERAPIST: I think you generally call me when you're desperate. When you are worried that you're going to try to kill yourself. And to one degree or another, or when you're, like, when you've got a feeling or impulse you don't feel you can handle on your own or you don't have confidence you can handle on your own.

CLIENT: Okay. [00:23:10]

THERAPIST: And, and, you want some help with it. Is that true?

CLIENT: Yes.

THERAPIST: I guess what I meant to say in saying a bit about you wanting attention and at times not being strong enough and not being able to handle things on your own and it's like I think for you those can feel like the crimes of the century.

CLIENT: Fair enough. Yeah. They do. [00:24:25]

THERAPIST: And I completely disagree with you about that.

CLIENT: Okay.

THERAPIST: And sure, it's not so good to manipulate people to get those things and so forth which I think is what you're worried about doing when you're calling me. You seem that way to me.

CLIENT: I try not to, but I do worry about doing it.

THERAPIST: Yeah.

CLIENT: The hardest thing is that being in the situation is like kind of manipulating it or like I'm holding him hostage with my condition.

THERAPIST: There's something going on there. Yeah.

CLIENT: As with most things, I just really don't want to be like my mom. [00:25:25]

THERAPIST: I see. Well, the really one curious thing is... How can I say it? Like, there is clearly something that has really heated up between you two around the dynamic which is sort of putting really in part the by fact that this wasn't happening before he moved here. Like, you didn't need him calling you every five minutes before he moved here.

CLIENT: Sort of. But I sort of did.

THERAPIST: Oh, did he? You guys were talking?

CLIENT: No. I mean he wasn't calling me every five minutes, but it might have been better if somebody were, had been. Maybe. I don't know. I don't know.

THERAPIST: You were, you sort of, I think I can put it like this. I don't think you were less safe then.

CLIENT: No. I guess what I'm trying to say is that I'm not certain that I was significantly more safe. [00:27:00]

THERAPIST: Yeah. Sure.

CLIENT: But I'm not very good at gaging those things.

THERAPIST: Right.

CLIENT: I don't feel very good at it. But, yeah.

THERAPIST: You less often felt like you were imminently suicidal, I think. I mean, I'm sure you didn't tell me about the full extent to which you were during those times. I don't.

CLIENT: I feel like I've been more careful about telling you all the time.

THERAPIST: Yeah.

CLIENT: Yeah.

THERAPIST: Yeah.

CLIENT: But, what does he know? It takes many repetitions for me to realize that's actually what you want.

THERAPIST: Right.

CLIENT: I'm like no; people need to know, Tanya.

THERAPIST: Right.

CLIENT: Not just when you absolutely can't keep yourself safe.

THERAPIST: Right. Well, but see that's another...

CLIENT: (inaudible at 00:28:07)

THERAPIST: Yes. Also, what you just said about it is one thing that, let's see. I imagine that one way to understand why you have to overcome something or it can be difficult for you to let's say be candid with me in an ongoing way about how suicidal you feel and how worried you are is that you are trying to head off just the sort of thing that's happening most clearly now with James where you get in to this situation where you sort of have been like feel kind of handcuffed, you know, to being alive and to, you know, being candid about something being wrong. And you feel like you're also kind of handcuffing the other person to dealing with it. Something that is scary and overwhelming. [00:29:35]

CLIENT: Yeah.

THERAPIST: And sometimes requires like, you know, a pretty immediate response. You know, like I mean something's got to be done about it.

CLIENT: I would rather avoid this situation. I would rather just not tell anybody about it.

THERAPIST: Right.

CLIENT: Continue on. I don't know.

THERAPIST: Right. Well, I guess what I'm saying is like there's a kind of exactly out of the frying pan in to the fire because I think it's just like a, you know, not necessarily that, probably all going in a good direction eventually, but you may completely disagree.

CLIENT: I see how you think that.

THERAPIST: Yeah.

CLIENT: I suspect you're probably right. It just doesn't feel good. [00:30:35]

THERAPIST: How about we agree it's going to change and we completely table whether we think it's going somewhere good or bad. I'm happy to do that. I think it's a change and I think it's clear in some ways what's better and what's worse about doing it this way. It sets up things that are anxious and difficult with other people or it feels so to you.

CLIENT: I feel like I'm constantly having to ask for things and then I'm constantly having people paying attention to me in ways that I don't want also. Yeah. And both of those I don't like.

THERAPIST: Yeah. [00:31:40]

CLIENT: You know, the more I ask for things the more I feel like I'm just a burden on everybody and I just don't want to anymore.

THERAPIST: Actually, that makes sense. I'm not sure it's true because I think you always felt like a burden on everybody. I mean at least since I've known you I remember you saying that very clearly early on and while I can sort of appreciate the logic of when you're asking more people you feel more like a burden, but I'm not sure that's your actual experience.

CLIENT: You think I feel consistently like a burden and it's just kind of hitting the refresh button every time I actually ask for something?

THERAPIST: Maybe.

CLIENT: It's still the same.

THERAPIST: Maybe. I'm not sure. I just I know that you said that. [00:32:40]

CLIENT: No, that's not a new thing. Yeah. Bryant used to threaten to commit suicide when I broke up with him.

THERAPIST: Oh. What, do you know what made you feel so bad last night?

CLIENT: I went to bed really early and James like took the lamp to like the far corner of the dining room. There aren't any chairs. He's just like on the floor in the dining room kept working. And he was working on like finding jobs for me and I was going to bed and I was like James, please, just like sit at the desk. It's okay. Like, I don't, you're not bothering me. Just like be comfortable. He wouldn't do it. I asked him several times and he wouldn't do it. It's like dude, like it would be a kindness to me to do that and he just wouldn't. It's just like why am I not grateful, but I'm not grateful. [00:34:35]

THERAPIST: Well, you don't want him to be looking for jobs for you.

CLIENT: Oh, I know. I don't like it. I can't figure out why. Like it doesn't, it's not clear for me.

THERAPIST: Well, you wouldn't have wanted him to go in and do your job at Starbucks for you either. I think that probably would have made you feel worse because you would have felt really guilty about it and because you would have felt more helpless and infantilized.

CLIENT: Yeah. Like, it makes me feel helpless that he does these things, but I actually am that helpless, so I feel like I don't get to ask for that sort of, like I don't get to ask for that. I don't get dignity or whatever. I hate that. But, I also hate being angry at him. I just had to find a way out. [00:35:50]

THERAPIST: I see. So, what did you do?

CLIENT: I went to sleep. Yeah. Cried and went to sleep.

THERAPIST: What is the plan now between you? Like, has that changed? Is that kind of up in the air?

CLIENT: No, it's sort of up in the air. You know, I've told him that I feel pretty confident in my ability to call you if I need to.

THERAPIST: Yeah.

CLIENT: If I have to. I try to handle it.

THERAPIST: When?

CLIENT: I think like he kind of like actively been not like leaving me alone but, you know, finding some where he goes to. I don't go anywhere. I stay in the apartment.

THERAPIST: Right. You guys are seeing Dr. Smith tomorrow I think she said?

CLIENT: Yeah. [00:37:15]

THERAPIST: You know, I don't, I don't think a partial program is the way to go for now.

CLIENT: No?

THERAPIST: No, I don't think so. I mean I think it would have some advantages. Like, there would be something structured to do during the day. You and James would be apart from each other some during the day, which I think sounds like it might help.

CLIENT: Yeah.

THERAPIST: And, you've not found the sorts of things that are helpful so far as far as I know.

CLIENT: Yeah. I always feel like they're going to be so helpful and then they're not as helpful.

THERAPIST: I had another thought and I'm actually talking to Dr. Vaughn about it. Which was, I'm not sure about this. I'm like quite tentative. At some point, some of those kind of skills. I think one reasons, and I could be wrong, that it hasn't been helpful is because they feel like they feed in to the problem more than fixing it in that, you know, I think so often, as we talked a lot about what has been so difficult for you is like nobody's paying attention to what you're actually suffering with. Like why, what's going on? I want to know what the story is. And when somebody tells you like schedule your day or replace your bad thoughts, you feel like it's, you know, a very, in a way, another example of the very thing that causes such trouble and pain. [00:39:35]

CLIENT: It sort of feels like telling me to keep doing that. I'm already doing it. Just more effectively. You know, mask your thoughts better. Mask your emotions more effectively. I think well, I'm pretty good at it, actually.

THERAPIST: Right. Not the problem.

CLIENT: Yeah.

THERAPIST: That makes me wonder if, you know, I'm not sure about this. But, I have had a thought like so in combination with something like you and I continuing to meet just the way we are. Is there some kind of structuring and coping kind of stuff like that that could be helpful or would it just make you feel like shit in the way that it always has? Do you know what I mean?

CLIENT: Yeah. I think made me feel like shit less in that they pay more attention to you. Like, describe your emotions and honor them and then like then deal with them.

THERAPIST: Right.

CLIENT: Which I thought was good, but, you know. I don't know.

THERAPIST: Yeah. I don't see that as something for tomorrow, but we can have the conversation while you're sitting here.

CLIENT: Yeah. The main thing is I think I need to just get out of the house more or something.

THERAPIST: Alright.

CLIENT: Just not be at work all the time. [00:41:20]

THERAPIST: Like, you guys could do like some work doing your own things. Are you worried about going to work tonight?

CLIENT: Yeah. I think I'll be okay. I just have to do it.

THERAPIST: And what makes you think it will be okay?

CLIENT: The fact that most of the things that I think are impossible I just need to start doing them and end up fine.

THERAPIST: Not that they end up fine, but they do happen.

CLIENT: They happen.

THERAPIST: Yes.

CLIENT: The fact that, you know, up until I guess Monday, every other day I just said well, got to go to work and then I went to work.

THERAPIST: Yeah.

CLIENT: And it happened.

THERAPIST: Do you, I could imagine you feeling a little less trapped by working knowing you're going to be done soon.

CLIENT: Yeah.

THERAPIST: Yeah.

CLIENT: It helps. Not as much as you might think, but it helps. [00:43:00]

THERAPIST: Yeah. I'm certain.

CLIENT: Since I've always tended to think of things as a day at a time. Like, I just have to deal with this junk.

THERAPIST: Right.

CLIENT: Yeah. Things are so awful. I don't know what to say about that. Just that they're awful.

THERAPIST: You don't necessarily have to say a lot.

CLIENT: Yeah, but I always feel like my responsibility is to talk.

THERAPIST: No, I think this has been the worst week since you went to the hospital and in part when you were in the hospital you were one of the worst you've had in a while. I mean things are really kind of coming to head in a way between you and James. [00:44:15]

CLIENT: I do feel like they're coming to a head. It feels like it. It's just going to protract and continue to suck.

THERAPIST: I see.

CLIENT: I didn't say anything to James about, like, I haven't told him I really don't want you to look for jobs for me. I don't know how to talk to him about that. I feel like I don't have a right that I really don't want him doing that. I mean I know I do, but I shouldn't.

THERAPIST: Well, it would prioritize which

CLIENT: Yeah. That's crazy talk.

THERAPIST: That's what I'm saying. It feels horrible.

CLIENT: Yes.

THERAPIST: That's exactly what I mean.

CLIENT: And James's not very good at being able to do things just because one wants something.

THERAPIST: Yeah.

CLIENT: You have to give a reason for it and I just don't feel up to having that discussion. Either try and come up with a reason or telling him that I don't need a fucking reason. Yeah.

THERAPIST: I don't think I'll talk to Dr. Smith too long, but I may mention that if that's okay with you.

CLIENT: Yeah.

THERAPIST: And she may have something to say about it. In other words, like I don't want you to feel like, you know, now you told me and I'll tell her and so she's going to take it up. You know what I mean?

CLIENT: Yeah.

THERAPIST: We should stop for now.

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