TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: I'm sorry. I have a scheduling thing first. So I think we're scheduled to meet on Wednesday at 10:00. I guess I wondered if we could change the time on Thursday to a little earlier.

CLIENT: I have us at Friday at 10:00. But I might be wrong about that. And I can Thursday also.

THERAPIST: OK. I have us at... on Friday at 10:00.

CLIENT: OK.

THERAPIST: Are we not on on Wednesday?

CLIENT: I have us on Wednesday and Friday, not Thursday. [0:01:00]

THERAPIST: Oh, OK.

CLIENT: We can... I mean...

THERAPIST: Do you want to meet on Thursday? Or talk on Thursday?

CLIENT: I guess so. But in the morning, we're going to be driving.

THERAPIST: OK.

CLIENT: So I couldn't meet until the afternoon.

THERAPIST: OK. All right, I have us at 12:45. Is that what you have us on?

CLIENT: No. I didn't write it down on Thursday.

THERAPIST: Oh, I'm sorry. You didn't have it at all. OK, right. Let's see.

CLIENT: I'm not... like I don't know that I could guarantee that I could talk then on Thursday...

THERAPIST: Sure.

CLIENT: ...since the risk of just...

THERAPIST: Being in a car.

CLIENT: ...driving from one place to another and then having lunch and so forth.

THERAPIST: OK. (pause) OK. [0:02:05] Let's see. I think I could do 5:15...

CLIENT: OK.

THERAPIST: ...on Thursday. So that would mean... OK, planning on for Wednesday at 10:00; Thursday, 5:15; Friday, 10:00.

CLIENT: Yea.

THERAPIST: Yea? OK. All right. [0:02:59] And let's see Skype?

CLIENT: Yea. My I.D. is [inaudible](ph).

THERAPIST: OK.

CLIENT: (inaudible at 0:03:10) is my e-mail.

THERAPIST: OK, all right. OK. (pause)

CLIENT: Yea. I'm nervous about this. So I met with Dr. Vaughn (ph) yesterday. And she suggested to me I think what she talked with you about that DBT might be a good thing which has more weight coming from her than from somebody else. [0:04:03] I don't know how to talk to you about it because then I feel like I'm trying to like mediate between you two somehow. (chuckling) I wonder where that comes from. (chuckling)

THERAPIST: Does that mean you think I think it's a bad idea?

CLIENT: Sort of, yea.

THERAPIST: Oh, I don't necessarily think it's a bad idea.

CLIENT: OK.

THERAPIST: I mean, there's a level at which your fantasy and well, it's important but maybe...

CLIENT: (chuckling) But the actual reality in this situation is also important.

THERAPIST: I think so in this case, yea.

CLIENT: OK, yea. She said that she thought it would be a good idea if it was not going to get in the way of what we do here. And I don't know whether it would or not. [0:05:00] Part of me wonders it seems like a lot of the DBT skills are basically it's ways to avoid dealing with... ways to avoid having to tackle your emotions head on when they're too big.

And so I don't know... so I guess my question is, I feel like a lot of what we've been doing is I'm very good at avoiding tackling my emotions. And I feel like a lot of what we've done is to sort of I don't know take away my excuses for doing so. [0:06:00] So I don't know whether there's a way to kind of put emotions aside that does not make them... doesn't magnify them. And I sort of worry that the more I put them aside, the more I am just a coward. I don't want to deal with it at all. And I don't want to. (crying) And I don't know how to handle this.

THERAPIST: Well, I don't think the problem is you being able to put aside or have ways of kind of coping with rather than, let's say, confronting your emotions. [0:07:01] I think one problem is when you do that without realizing that you're doing that. And when there's no good time to deal with them.

But I suspect that doing some DBT... I mean, I have a few thoughts about this sort of the context for it. But I don't think it would necessarily get in the way of what we're doing here. In fact, it's possible it could be helpful in that if you feel more confident about being able to sort of cope more, let's say, rather than facing more. [0:08:11] Cope more with rather than facing more what you're feeling when that seems like the more appropriate thing to do. If that helps you be less scared of the intensity of what you're feeling and how it could affect you, it makes this easier. I mean, not a lot.

CLIENT: (chuckling) Well thanks.

THERAPIST: I mean I wish it would but... sorry.

CLIENT: (chuckling) No, it's OK. I...

THERAPIST: (chuckling) But...

CLIENT: I wouldn't believe you if you said it would it make it a lot easier. So...

THERAPIST: (chuckling) Oh, you wouldn't. [0:09:00] It could take some of the edge off. I mean, I know a lot of what you worry about is what gets stripped away here or what we look underneath. And having to go home and live through the next day or night or whatever. And I'm sure that is part of what makes it hard to get into something when you're here.

CLIENT: Yea.

THERAPIST: Probably somewhat consciously and somewhat not. And I would imagine if you felt a little more confident about being able to manage that stuff while you're at home or wherever, you might be less scared here. [0:10:04] I mean, plus it's obviously in extent to what you're really not scared of is a good thing.

CLIENT: OK. Thanks. (crying)

THERAPIST: One thing, I think, probably is important and I'm sure you that you felt this as well is totally that you work with someone individually on the DBT stuff as opposed to...

CLIENT: A group thing.

THERAPIST: ...a group.

CLIENT: Yea.

THERAPIST: Like someone...

CLIENT: Based on my experiences with groups, I think that's probably true. (chuckling) That I just...

THERAPIST: Yea, I think for the person to like get to know you. And there are people who do that kind of work. [0:11:02]

CLIENT: Yea, I know. Part of the thing that it's I just don't want to work with anybody else. It just sounds really hard. (chuckling)

THERAPIST: Yea. (pause)

CLIENT: So I don't know.

THERAPIST: If I had to guess, I would say it would probably not be nearly hard as this. That's probably... there are probably people for whom that's less true. But I think for you, I think that kind of work...

CLIENT: It comes pretty naturally in some ways.

THERAPIST: Yea. I think the hard part would to be having to be quite explicit about the person you were working with about how you've been doing and what has been going on. And how well the coping strategies work or didn't work. [0:12:02] But...

CLIENT: Yea, I don't think of myself as somebody who finds it difficult to be explicit about that. But I guess I really do. (chuckling) I'm pretty terrible about it, actually.

THERAPIST: I don't think that you're terrible at it. It's just it's hard for you to say you've been feeling really suicidal. It's hard to say you really don't have a lot of hope for anything.

CLIENT: Yea, it gets easier.

THERAPIST: Yea. Well, that's good.

CLIENT: Well, sort of good. It gets easier because the range of possible things to say is drastically narrowed.

THERAPIST: Yea.

CLIENT: Yea. [0:13:02] I just don't have the energy to make shit up.

THERAPIST: Yea.

CLIENT: I guess I want to think about it some more.

THERAPIST: OK, sure. I guess I'm curious as to your mental thoughts of those parts. It's not something you talk much about. I'm just...

CLIENT: I don't know. It's one of those things that everybody seems to think would work really well for me. But it's just very tiring to think about doing in some ways. [0:14:03] (pause)

THERAPIST: In you're already working so incredibly hard sort of way.

CLIENT: Yea.

THERAPIST: Yea.

CLIENT: And honestly, I do find it very stressful to navigate you talking to Dr. Vaughn (ph) and Dr. Smith (ph) and talking to you about that. I get really anxious about it.

THERAPIST: Oh.

CLIENT: And I'm like I don't want to have to introduce somebody else to you. (chuckling)

THERAPIST: Right. (pause) I know you just said you felt really anxious. I had imagined that would partly to do with thinking Dr. Vaughn (ph) and I were sort of on opposite sides of this one. [0:15:04]

CLIENT: Yea, I worry that people will disagree and then I'll have to choose or something. And yea, I just find it hard to handle. (pause) I guess there's not really that much space in mind the idea of you talking with somebody with another person and not disagreeing. Conflict seems to be the norm. (chuckling) (pause) (crying) [0:16:01]

THERAPIST: I mean, I don't know. The hell with reality has been I know that we haven't really disagreed.

CLIENT: I mean, I wouldn't reasonably expect you to.

THERAPIST: I mean, I... in part because I think we each have sort of like respect for the importance in type of work that the others are doing. And Dr. Smith (ph) does this kind of work as well as (inaudible at 0:16:45) and...

CLIENT: She's a little (inaudible at 0:16:47).

THERAPIST: Does she? Oh, that's good.

CLIENT: (laughing).

THERAPIST: (chuckling) I like Dr. Smith (ph).

CLIENT: I imagine you do.

THERAPIST: (inaudible at 0:16:56).

CLIENT: I mean... (chuckling)

THERAPIST: Yea, right. I sent her (inaudible at 0:16:59). Yea, and the...

CLIENT: James really likes her.

THERAPIST: Oh, good.

CLIENT: Yea.

THERAPIST: Good. That's terrific.

CLIENT: Yea, I'm really happy about that.

THERAPIST: James likes a therapist. That's important.

CLIENT: (chuckling) Very important.

THERAPIST: Yea.

CLIENT: He really likes you also, which is good.

THERAPIST: That's cool.

CLIENT: Yea.

THERAPIST: You're also the same person.

CLIENT: What's that?

THERAPIST: You're also the same person in Dr. Vaughn's (ph) office and here.

CLIENT: I wonder. (chuckling) I mean...

THERAPIST: We all see the same person. I mean...

CLIENT: See, you say that.

THERAPIST: Yea.

CLIENT: But like I'm not always... I mean, not so much with like you and Dr. Vaughn (ph) but I'm not always sure that that's true of people in the hospital. I mean, Dr. Smith (ph), I don't really have a good gauge for her yet. [0:18:05] I don't know. I guess... yea, I guess I worry that I don't show up as the same person. Case in point it would be difficult for me to saying things to somebody else successfully for this long. (chuckling)

THERAPIST: Right. Well, and sometimes you do have a long history of that. Not like for any malintent (sic) or anything but in a way. But I guess empirically that hasn't been the case with (inaudible at 0:19:02) and I. And I think there are ways in which I've seen different sides of you like you talk a lot more often, blah, blah, blah. But again and it happen so far that she said something and then I'd say, "Whoa," or vice versa. (pause)

CLIENT: I guess I'm mostly thinking of being at [inaudible]. Or I think I... you know I was living there for that long. And I think my psychiatrist at least was pretty convinced that I was trying hard not to be helpful. [0:20:02] And was angry and uncooperative basically. It's how I feel like I came off based on how they treated me. I don't know. Uncooperative isn't usually some (inaudible at 0:20:27) people would use to describe me. (laughing)

THERAPIST: That's right. Right, absolutely.

CLIENT: For better or for worse. (chuckling) They really don't want me to quit this job. Like they're not giving me a hard time about it but...

THERAPIST: The coffee shop job?

CLIENT: Yea. I do a really good job.

THERAPIST: You're being uncooperative.

CLIENT: Yea, yea. (pause) [0:21:00] I'm really scared.

THERAPIST: Yea. (pause)

CLIENT: I can't I haven't been able to put my game face on for long enough to do much in the way of applying. (crying) I don't even know how to think about it without going off the deep end. I think I should just suck it up and keep bringing it at the coffee shop but I just can't do it. (crying) Every day I'm just the only thing keeping me there has been knowing that I don't have to be there very long anymore.

THERAPIST: Yea, I think you're right. I think you can't do it.

CLIENT: (inaudible at 0:22:02). (crying)

THERAPIST: Right. I know that didn't leave you anywhere good.

CLIENT: Yea, yea. (pause) (crying) [0:23:00] I haven't been sleeping well the last few nights. I'm finally off the Xanax which thank the Lord but now I can't sleep.

THERAPIST: How well of sleep have you been getting?

CLIENT: It's hard to tell. I go to bed really early and just toss and turn. I would kind of drift in and out of sleep. So I don't know. Anywhere from like four to six hours. I'm opening tomorrow and the next day also. So I got up at 3:30 this morning. It's pretty hilarious to get up at 3:30. Let me tell you. [0:24:00] (chuckling)

THERAPIST: And you just couldn't stay asleep?

CLIENT: No. I had to go to work.

THERAPIST: Oh.

CLIENT: Yea.

THERAPIST: How early do you open? Is it like...

CLIENT: 4:30.

THERAPIST: Wow.

CLIENT: I guess 3:45 I kind of get up. (pause) This job is terrible. (chuckling) It's a terrible job.

THERAPIST: Yea, yea.

CLIENT: They have me all openings and closings from like the last three weeks which one I could deal with but both is... (pause) [0:25:00] I sort of don't want to go home. It's just that I don't know how to talk to anybody.

THERAPIST: I think you're also completely terrified that we won't be meeting. I mean, we'll be meeting through Skype for a few days next week. But that's a lot less.

CLIENT: Yea.

THERAPIST: And in a different way.

CLIENT: Yea. And there is never any privacy at home.

THERAPIST: And if you need to go to the hospital, it'll be harder for me to like... I mean, I'll help any way I can, of course. [0:26:02] But I think my point is that like I imagine there's a little reassurance in being here and like the way things went when you went to the hospital before where like (inaudible at 0:26:14) that you called. We met. (inaudible at 0:26:18).

CLIENT: Yea. (pause) I've been very determinedly not thinking about next week. (chuckling) Really the thought that I might go to the hospital next week had not crossed my mind at all even though all the pieces were there. I just...

THERAPIST: Didn't want to think about it.

CLIENT: I'm very good at not thinking about things. (chuckling)

THERAPIST: Yea.

CLIENT: When it comes to the point... (crying) [0:27:00] (pause)

THERAPIST: I wonder if at another level you would find certain things sort of gratifying or reassuring to wind up in the hospital next week. What I'm thinking is your family would see it right in front of their face which I know in a way would be the last thing you would want. [0:28:08]

CLIENT: Yea.

THERAPIST: But another way I could imagine it might be something you'd want.

CLIENT: I don't know. (pause) I'm not sure if any way I prefer (ph). (pause) I will feel like most of my family both really gets it and really doesn't get it at the same time. And I'm not sure that being closer to it would make them get it anymore.

THERAPIST: I see. [0:29:03] (pause)

CLIENT: I mean, they that I think about that it's reassuring. That that would be reassuring would be just not being my own responsibility for a while.

THERAPIST: Yea.

CLIENT: I don't know. I guess also I so strongly don't want to burden my family with something like this. That it's hard for me to tell whether it would also be gratifying, if that makes sense. [0:30:02] They've been through it all along before, in a sense. (pause) They know the drill. (pause) [0:31:00] Yea. (pause)

Even when I was in the hospital, papa came to visit me. I pretty much had it together when he was there. But they see me when it gets really bad. [0:32:00] (pause) And I also just feel like I have to tough the next week out.

THERAPIST: It's a long time.

CLIENT: Yea, yea it is. But it's not actually any different from what I've been doing. [0:33:00] (pause)

THERAPIST: I guess not although I wonder if you'll have less space and more pressure to be together. And there can be some of that or even a fair amount of it with James around in a small apartment. Yea, but James has got nothing on our relatives for filling up a room. (chuckling)

CLIENT: Yea.

THERAPIST: Yea.

CLIENT: In the past years, I have gotten good at asking for space. And so they've gotten good at sort of giving into me so that's good. I think we're going to have own back room which is nice. [0:34:01] And people are usually OK if I kind of retreat up there. But I can't really spend the whole trip in the bedroom. (chuckling) So does that make senses? Yes. (pause) Which is... I mean, I think the thing I should be worried about is being left alone for extended periods of time. So I don't have to worry too much about that. (pause)

THERAPIST: Do you have a bad feeling about the trip?

CLIENT: I don't know. [0:35:01] I have bad feelings. (chuckling) I don't know.

THERAPIST: Yea, maybe I'm focusing too much on the change in the trip and not enough on the fact of the ongoing awfulness.

CLIENT: I don't know. (pause) So one thing that is scary that I find in my kind of constant mental calculations is sort of almost on I can't do this to James to. [0:36:04] Well, is there any way that it would be so horrible to find me?

THERAPIST: What have you thought of?

CLIENT: Pills which are very ineffective as far as I can tell. But it seems like the least horrible thing or just going somewhere else. (pause) [0:37:01] (crying) It's very strange that this is my life. (pause) (crying) Those thoughts are actually less horrifying than you have keeping... staying alive. (pause) I'm working so much. I'm working really hard. (crying)

THERAPIST: Yes. I knew that. [0:38:07] (pause) It sounds like you're working most of the time these days.

CLIENT: Yea, yea. Well, not all the time but most of the time.

THERAPIST: And that it sounds like it's a real fight.

CLIENT: Yea. I don't know how much farther there is like how much more ground that I could lose because I haven't lost it yet. Does that make sense? Like I don't know how much worse it could get?

THERAPIST: Yep. That's how farther down there is to go in a way? [0:39:01]

CLIENT: Yea. So that's where I am. (pause)

THERAPIST: So it's getting worse. Do you have to fight harder?

CLIENT: Yea.

THERAPIST: And more desperately.

CLIENT: Will that I lose ground without really noticing it? Again, thought about the fact that like the terms of the bargaining that's going on in my head are changing but they are.

THERAPIST: And as far as that you can't do this to James too.

CLIENT: Too?

THERAPIST: Maybe there's a way you can do this so that it won't be too horrible?

CLIENT: Yea.

THERAPIST: The way he finds you or somebody finds you?

CLIENT: Yea. [0:40:03] (pause) Even though I kind of snap back into something more like sense. That's hard. I think that is the hardest. I just feel like there's no way out of this. (pause) (crying)

THERAPIST: So it's kind of like a rationalizing to yourself...

CLIENT: Yes.

THERAPIST: ...that you're doing like as though it wouldn't be so bad to him if it wasn't so bad of how you were found which allows you to sort of consider it more seriously. [0:41:10]

CLIENT: Yea. (pause)

THERAPIST: And this has been especially the last few days?

CLIENT: I don't know. I don't remember honestly. It feels like it's been every day forever. But I know that's not true. So...

THERAPIST: Yea, right. But it's important. Those things are important.

CLIENT: At least... it's been at least a week, I think. [0:42:01]

THERAPIST: Some of it is that I am taking off on you. I mean...

CLIENT: OK.

THERAPIST: ...like some of the proximal thoughts.

CLIENT: That doesn't ring that many bells to be honest. But I don't know.

THERAPIST: [You mean the other?] (ph)

CLIENT: Leaving my job is one that is much more... that I'm much more aware of at least. And not knowing what I'm going to do after that.

THERAPIST: Yea. Is it specifically the leaving? I would have guessed from what you've said that it's the burden of having to look for a job.

CLIENT: Yea, and just not having a job.

THERAPIST: Yea. [0:43:06]

CLIENT: Yea. (pause)

THERAPIST: And so then part of the kind of I don't know like triggers or something for that would be pending work on Sunday?

CLIENT: Yea.

THERAPIST: I mean, then in another sense like not a whole lot is going on a job search wise next week. But you are stopping your job on Sunday. So that's kind of...

CLIENT: Yea. That's jumping off the cliff it seems to me. [0:44:07] (pause)

THERAPIST: Are you pretty terrified of not having a job? [0:45:00]

CLIENT: Yes. I don't know what's going to happen to us. When I'm at work, I pull myself together to do the work and I hate it. And I'm miserable. But I'm miserable in a very different way.

THERAPIST: Yea.

CLIENT: So it makes my life much harder on like either end of the work. But when I'm there, it's like not a big deal with the way I'm feeling.

THERAPIST: Yep. And it also (inaudible at 0:45:38). (pause) Well, we should stop.

CLIENT: Thank you.

THERAPIST: Yea.

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