TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: That was my sister.

THERAPIST: I gathered that. I couldn't see her, she's kind of behind a plant but I figured.

CLIENT: Well, yes, that happened. The good thing is it just seems like the ECT is actually working, so that's nice. I feel like it was about time for a break.

THERAPIST: Maybe a little over time.

CLIENT: Maybe. But yes.

THERAPIST: Good.

CLIENT: The I know they memorize all those problems like you do, which is a little bit disconcerting, but it's okay. So, do you think I'm a Borderline Personality Disorder?

THERAPIST: No, I don't think so. I think you have some features of it or whatever they call it, some related vulnerabilities but I don't think you quite fit that.

CLIENT: Okay. It would be okay, I just wanted to know.

THERAPIST: Do you have one particular question about...

CLIENT: I'm trying to remember why I would want to know. Oh yes, so I ended up talking with some medical students who's [inaudible at 00:02:26] basically one I'm sorry I'm really absent-minded basically I just talked to the medical students and the conversation seemed to center around Borderline Personality Disorder. So they asked me a couple questions and... [00:03:03]

THERAPIST: But they were interviewing you or something?

CLIENT: Yes, basically, and they were asking very transparent questions of like do you have this symptom of Borderline Personality Disorder? And I'd be like no I don't have that symptom. [Laughing] But I, yes, just wondered. I mean it would make sense in something like I'm fairly certain my mom does have it. I would not be surprised that those were the kind of vulnerabilities that could be passed from generation to generation. So, I don't know. But yes, I seem to be able to have stable relationships, which is the important thing. I mean I don't care if I have it as long as I have stable relationships. [Laughs] [00:04:32]

THERAPIST: Yes, I think that the primary feature that you lack of that prognosis. I think there are times when you have stronger reactions to things that happen in your close relationships that you're sort of not aware as such at the time. Like, I'm thinking of examples more from over the current events of recently. where you talk to James, he wouldn't be so helpful, you get really hurt, and then you'd go into a tailspin, and it wouldn't be clear until later that you actually reacted strongly to something he had done or said and really upset or angry or offended about it.

But it doesn't really create instability in the relationship I don't think, like you and James don't have a lot of pain. I mean there's a lot going on and it appears worst when times are easier but I you never said like there were ups and downs in the relationship, like a sense of being much closer or much less close. And it was always presented sort of there was a lot of being much close or being less close, [inaudible at 00:05:40] distance if it's connecting at best. I don't get that feel.

CLIENT: I would expect the times when I was closer to James to be themselves symptoms, does that make sense? I don't know. I mean, I just feel like I'm I just feel like James and I are pretty solid, and [00:06:08]

THERAPIST: Yes, and you kind of have that feeling in a kind of consistent, ongoing way that's atypical of Borderline Personality Disorder . It sort of contradicts the usually...

CLIENT: Okay, thanks. Thanks for [inaudible at 00:06:39].

THERAPIST: Sure. You're welcome. So you were in the hospital?

CLIENT: Yes. I really did.

THERAPIST: I guess I [inaudible at 00:07:09]. I'm sorry you happened to be in the kind of shape where that when you need it.

CLIENT: Yes. Don't worry. Doctor's in town, obviously.

THERAPIST: Just in time for the waiting room.

CLIENT: Yes. That turned out good.

THERAPIST: Good. What did she say?

CLIENT: A couple days ago. I don't remember.

THERAPIST: Earlier this week?

CLIENT: Yes. Yes, she's great. James was pretty great [inaudible at 00:08:25].

THERAPIST: [inaudible at 00:08:26],

CLIENT: Yes. [Laughs] I don't know. And then my [inaudible at 00:09:22] are starting to get to me. Kind of constant low-level uncertainty, just like I wasn't sure where to get off the bus when we were coming back here. I knew there was a really good coffee shop somewhere but I couldn't remember where it was. I couldn't remember what it was, so I just kind of wandered around. Yes. [00:10:10]

THERAPIST: How long does it last usually?

CLIENT: I don't know. They say it's temporary. I imagine probably continual until I'm down to maybe once a week, maybe once every two weeks, which will be another couple two weeks. Actually ECT is not work, distracting at all.

THERAPIST: Good. Glad to hear that.

CLIENT: They're really nice to you. Really nice to you. All the nurses are super nice. So that's the picture (ph). I feel like [inaudible at 00:11:35], honestly.

THERAPIST: Yes? Well what happened?

CLIENT: You go in the room and you just sit down on a bed and they put a blood pressure cuff on you. Then they wheel you into the ECT room and they put a put you out. And so the part that you're conscious for, there is no part that you're conscious for. And then I think while you're out they, while you're out they put gel in your hair I still had gel in my hair and I guess pass a current through your head for, which I think it's only like a couple of minutes. But it went back up and then and that's it. [00:13:18]

THERAPIST: And so you continue to not have headaches?

CLIENT: No I haven't thankfully. I take 800 milligrams of ibuprofen a couple of hours beforehand and that usually takes care of it. I did they did forget to give it to me once last time and then I hadn't had anything afterwards, so I need to not forget that. But yes, it's really not bad.

THERAPIST: Good.

CLIENT: Yes, I don't like being so uncertain and feeling like I'm not speaking very well and it seems like I don't have my act together, but I'll be okay. I can deal with it. I've seen Matt. Very funny.

THERAPIST: Yes.

CLIENT: Yes.

THERAPIST: I guess you were there for two weeks? [00:14:50]

CLIENT: Yes, for two weeks. That's a long time. I was really ready to be gone.

THERAPIST: It sounded that way, yes.

CLIENT: Yes.

THERAPIST: We talked on Tuesday.

CLIENT: Did we? I don't remember that.

THERAPIST: Yes, we talked about seven in the morning [inaudible at 00:15:12], 7:45.

CLIENT: Yes, I was really, really homesick.

THERAPIST: What were you missing?

CLIENT: James. And my stuff. And kind of my routine. Yes. I was convinced I was going to be late to come here.

THERAPIST: Oh really? [00:17:02]

CLIENT: Yes. I wasn't, we were a half-hour early but I was convinced because I missed my appointment with Dr. Vaughn (ph) yesterday well I didn't miss it but Dr. Vaughn (ph) was sick and we got to her office and the door was locked and she wasn't there. And it was and she'd sent an e-mail but I hadn't gotten it before. So that was not very much fun.

THERAPIST: Where's her office? Is it far?

CLIENT: [00:17:55].

THERAPIST: You were worried that, that's somehow related to you're worried about being late here?

CLIENT: Yes, because you have to stay, they have a little lounge area where you have to stay in [inaudible] for...

THERAPIST: Or you come back to [inaudible at 00:18:14] on Friday, right? So today you were coming back?

CLIENT: Yes, so I was coming straight from the hospital to here. And we were kind of booking it to get back in time. But we made it. I'm really ready to get better.

THERAPIST: You've had enough? [00:19:11]

CLIENT: Yes. I know it doesn't actually work like that but I'm about ready. I'm just really tired of being down all the time. I've got to go look for a job. I want to get to work on that. It's about time. [Laughs] I was going to kill myself.

THERAPIST: Why?

CLIENT: I'm glad I didn't but I was not glad that I called you. [Laughs] I'm just really tired.

THERAPIST: How is it to come back here after a couple of weeks? [00:22:18]

CLIENT: Good. Yes. Yes. I feel like I have freedom. Yes, I don't quite know what to say.

THERAPIST: [inaudible at 00:23:31] better?

CLIENT: Definitely that.

THERAPIST: [inaudible at 00:23:31] is helping, finally?

CLIENT: Yes. Yes. Okay, I don't know so I don't [inaudible].

THERAPIST: Well that's great. You have been working so hard under pretty excruciating conditions. [00:25:12]

CLIENT: Yes, I kind of don't know how I have made it this far. It is surprising to me as [inaudible].

THERAPIST: I'm very glad it's been going well for a long time.

CLIENT: Yes. Their people up there [inaudible at 00:26:59] clinic have been pretty careful to ask about suicide [inaudible at 00:27:09], which I mean I don't know why that would be a surprise but they really don't want me to slip through, which is good. [00:27:43]

THERAPIST: Yes I think Tuesday you said that you said nothing [inaudible at 00:27:52].

CLIENT: Yes. Yes. Could have gotten bad again but not that bad. I don't think. There was a woman in the hospital who was [inaudible at 00:29:53] back by her [inaudible at 00:29:58] ECT. Seems like it's not working.

THERAPIST: About [inaudible at 00:30:09]?

CLIENT: Yes. She's really tough.

THERAPIST: [inaudible at 00:30:16].

CLIENT: Yes. Really, really tough but I'm glad I'm not her. My God I hate [inaudible at 00:31:12]. It's so hard. Yes, I'm having a hard time over the idea it might be over.

THERAPIST: Well it hasn't been that long.

CLIENT: No it really hasn't. Like a week.

THERAPIST: On the phone with [inaudible], it doesn't seem like that much fun. [00:32:14]

CLIENT: Yes.

THERAPIST: I'd imagine you're trying to prevent yourself from having too much hope.

CLIENT: Yes. Yes. I can't go back there. If I do, I'm not sure what I would do to prevent my thought from coming back down there but...

THERAPIST: Well you can say you can't go back down that road now and [inaudible at 00:33:06] have no way of stopping it.

CLIENT: Yes. That sounds scary.

THERAPIST: And you may not go back down there.

CLIENT: Yes. [inaudible at 00:33:37].

THERAPIST: At best we don't know yet. And yet, that's a good sign.

CLIENT: I am ready for things to get [inaudible at 00:34:51]. Any time now.

THERAPIST: And then you can settle for easier.

CLIENT: [Laughs] That is true, I would, I would settle. I'd settle for not excruciating. James really wants me to take it easy. When we were talking about my discharge, he was very anxious to insist that I not go back to looking really hard for a job right away. He really wants me to take it easy. [00:36:11]

THERAPIST: Yes, you and I talked about it as well on Tuesday.

CLIENT: Did we?

THERAPIST: Yes. No, no, no, I understand. Yes I think I heard something in regards to that. It would be a good idea whether we go to [inaudible at 00:36:34] or [inaudible] running. That I like. Had this really awesome article [inaudible] but...I...

CLIENT: You can just say it. I'll believe you. [Laughing]

THERAPIST: I think I'd say if you wind up literally (ph) back to the hospital your job search isn't going to matter all that much. So...

CLIENT: You make a compelling case. [Laughing]

THERAPIST: So and I when you had explained that the window for finding things was basically now to May so that we're still in the powers (ph) of continuing it on one hand, that you'd be missing sort of prime time, taking off wouldn't cut you now but not most of it.

CLIENT: Yes, yes. It would not be catastrophic to take some time off now.

THERAPIST: And it also seems like we'll know more in a week or two. All we know now is what it's like to be back home, what it's like to have ECT no longer, stuff like that. [00:38:17]

CLIENT: Yes, fine.

THERAPIST: I know you're eager to get moving.

CLIENT: Yes. Yes. It won't hurt to relax a little bit. Yes.

THERAPIST: And it would seem that he already knows and that it actually makes an awfully big difference just to feel better even for a little while. Like, it sounds like you can see really how far down you were, how it's not inevitable that you'll always feel that way. I guess what I'm saying is I imagine there are things about taking it easy and the way that could help feel good that could be beneficial, though I'm also unclear that some of the toughest times for you have been when you have not worked and you wanted to or expected to [inaudible at 00:39:57].

CLIENT: Yes, yes, it's hard for me not to be working.

THERAPIST: Yes. [00:40:10]

CLIENT: I just really don't want May to come up without me having a job. I just really don't want to miss out on that. I guess I have to suck it up.

THERAPIST: I think that's probably a good idea for now.

CLIENT: Okay.

THERAPIST: Not for too long. I mean, not...

CLIENT: It's going to require some real effort to pull it off. I think I can probably do that.

THERAPIST: Okay. [00:42:12]

CLIENT: If it's not, I'm ready to come back. It's really not too for real I'm not going -

THERAPIST: No. I think it's possible that you could start doing job search next week and it will be fine. But it seems to me it would probably increase the risk a lot to wait a little longer. It may make you feel better. I agree in a way it's sort of a long way to come back but that doesn't necessarily mean it's going to be a long time before you're more functional than you've been. I think it'd probably be more like it may take a while to come to terms with the stuff happening and why and whatever. I understand you're somewhat divided but a good outcome would be you could do that while you're busy living your life more or less the way you want to be. [00:44:26]

CLIENT: Yes.

THERAPIST: We'll stop for now. [inaudible at 00:44:39] real soon. Are you up as far as the regular schedule [inaudible at 00:44:46]?

CLIENT: Tuesdays I'm [inaudible at 00:44:47] 7:45 or 8:30, Thursday 11:15.

THERAPIST: No, that's our old time. Thursday -

CLIENT: Oh, 11:55.

THERAPIST: Yes.

CLIENT: Okay.

THERAPIST: Or no, not 12:55.

CLIENT: 12:55. Right, thank you.

THERAPIST: Okay. [00:45:29]

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