Client "Ma", Session February 18, 2013: Client is extremely anxious in this session; she can't even look at the therapist while speaking to him. trial
TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
CLIENT: Hi.
THERAPIST: Hi.
CLIENT: You got a haircut.
THERAPIST: Yes, they cut [inaudible at 00:00:04].
CLIENT: Oh, sorry. Never mind. I forgot the way to your office. I couldn't remember how to get here. It was interesting for a moment.
THERAPIST: Does it mean anything?
CLIENT: Yes. I'm sure it does.
THERAPIST: And that never happened before?
CLIENT: I don't think so. Anyway, yes.
THERAPIST: Are you aware of maybe (ph) being nervous to come in?
CLIENT: No, not really. I am, though. Yes. Oh well.
THERAPIST: I guess the first thing that crossed my mind about it is that you'd be concerned about something being different the night you left the hospital or something like that.
CLIENT: Yes, I mean I am concerned about it. Yes. [00:02:09]
THERAPIST: Do you know what in particular?
CLIENT: No. Not really. [Pause]
THERAPIST: Well what's on your mind?
CLIENT: I don't know. [00:04:26]
THERAPIST: If you have certain thoughts I can bring them about but -
CLIENT: No.
THERAPIST: No? Okay. Okay, I kind of have three alternatives.
CLIENT: Okay.
THERAPIST: One is that you're worried that I'm going to say you can't come in or not as much or this isn't working or I've had enough or something like that.
CLIENT: Okay.
THERAPIST: Another is you're going to say I don't want to come in, I've had enough, this isn't working, something like that. And the third is, remember what we said on Thursday? I don't know how much you remember but I had a thought sort of halfway as we were talking and more fully I think after that I think it can feel very bad to you sometimes if somebody says something maybe moving forward or in a way getting better. [00:06:46]
And more with the way in which I was saying that on Thursday, like there was another way in which I was not saying that or which I was not saying that I don't think things aren't getting better, and some ways in which I thought they might be. And I guess I wondered I just sort of talked about it and I know you knew, sort of you wanted to know what I meant and did mean, that maybe you'd react bad in some way or feel like I really don't understand what this is like or that you would be feeling misunderstood and real mad if I was suggesting that in any way things might be moving forward. Sorry, these are the three alternatives I can think of. And I don't know if any of them relate to your being anxious. Do you notice that? [00:08:38]
CLIENT: Not really. No, it makes sorry.
THERAPIST: You want me to [inaudible at 00:09:17]?
CLIENT: Well, sorry, that I sorry. Sorry. [Pause] [00:10:48]
THERAPIST: The last time, the second one, first one? None of them?
CLIENT: Yes, sorry.
THERAPIST: You're incredibly anxious. [00:12:26]
CLIENT: I think so.
THERAPIST: I think you're having a terrible time collecting your thoughts.
CLIENT: Yes, I'm sorry.
THERAPIST: Is this something that you're feeling physically or otherwise?
CLIENT: No, I just sorry.
THERAPIST: Would it help to go onto something else? [00:13:08]
CLIENT: I'm sorry?
THERAPIST: Would it help to go onto something else?
CLIENT: Maybe, if I were if I sorry. [Pause] That's much better. Sorry.
THERAPIST: You wanted to tackle [inaudible at 00:15:27]?
CLIENT: I the I I can actually, sorry. I can actually see you as opposed to not at all. Sorry. [00:16:28]
THERAPIST: It's all right. And it's easier to talk when you're looking down?
CLIENT: I'm sorry?
THERAPIST: It's easier to talk without looking at me?
CLIENT: Yes. How did you know? Yes.
THERAPIST: I don't think I've seen you this anxious about me here before.
CLIENT: Yes.
THERAPIST: Do you know why that is?
CLIENT: I don't know that I've been this anxious about it. Yes. [00:18:49]
THERAPIST: And it seems like it started so far it seems like it's kind of unconscious anxiety in a sense that if you were coming in here aware of being worried about a particular thing, like this isn't true but you said you couldn't meet tomorrow morning that means you probably never want to meet ever again, so I'm a little anxious about that even though I know that's probably not true. That's a little more conscious in a way. But it seems like it's really unclear what's making you this anxious today. It's something about being here. Is it do I have that right? [00:20:04]
CLIENT: Seems like it must be. I guess so.
THERAPIST: Yes. It's really hard to think anything.
CLIENT: Yes. Yes.
THERAPIST: And even a few weeks ago, I don't know what you remember about the [little scenarios] (ph) but you were very quiet here. But I'm pretty sure you even told me about being very worried because it wasn't feeling super anxious, you just sort of didn't know what to say. Underneath you were really anxious but it wasn't like today.
CLIENT: Okay.
THERAPIST: I know because I asked because we pieced it out when you hadn't had much to say and it made you very nervous and you felt very bad about it. And so then a few weeks ago it was like you don't seem to be really feeling anxious or bad feelings, etc. No.
CLIENT: All right. Okay.
THERAPIST: But -
CLIENT: No, I remember that.
THERAPIST: Today it's different. Were you anxious earlier this morning, or anxious this morning period? [00:22:02]
CLIENT: Not that I can think of. No I just can't really think of having anything to say. I don't know.
THERAPIST: Are you perplexed by that?
CLIENT: Yes. Yes.
THERAPIST: Me too.
CLIENT: Okay. Yes, I don't know.
THERAPIST: Do you know if you got hit by kind of a wave of anxiety at some point, either when you were in the waiting room or when you came in here or at some level since you've been here, or getting lost? [00:24:09]
CLIENT: Feels like I've been hit by anxiety but I don't know. Yes, I don't know. [00:24:45]
THERAPIST: Are you thinking any thoughts?
CLIENT: Not that I am aware of. Yes, I don't know.
THERAPIST: How was the weekend?
CLIENT: It was okay. It was okay.
THERAPIST: Yes? In a [inaudible at 00:25:45] round, what these days passes for okay?
CLIENT: Yes. Yes. Yes, really. It was okay. [00:26:11]
THERAPIST: I wonder how much [inaudible] will be up in the air related to your being anxious. Let's take a look at scheduling for a minute.
CLIENT: Okay.
THERAPIST: So this week anyway, I have [term division] (ph) tomorrow at 3:45. I can't imagine you have this interview at 11:00 and they say okay just stick around for the rest of the afternoon.
CLIENT: I don't even know. [00:26:49]
THERAPIST: Okay. My inclination would be to say I'm happy to schedule a 3:45 and then if they keep you there for more than 3-1/2 hours or something then we'll cancel. I won't charge you then. Unlikely and I don't think I'll feel bad but anyway yes, that looks like that's fine with me.
CLIENT: Okay.
THERAPIST: And Wednesday morning I guess it should happen at 7:45, which would probably be before the partial started anyway, even if you're in that day. Thursday and Friday are a little trickier. I have you do [inaudible at 00:27:47] on Thursday and I have a mid-day on Friday but I guess we can wing it, see what happens tomorrow but you said we were kind of on the counter for tomorrow and Wednesday and then we'll see what happens, I don't know, for one. Starting next week I'm having some time with people starting at the end of the week. I really would stay open tomorrow. And I imagine the hours would be something like 9:00 to 3:00, that's usually what they are. Does that seem right to you? [00:28:36]
CLIENT: I think so.
THERAPIST: Yes, okay. I'm pretty sure I can work out something on Friday that would work. Thursday could be tougher for me to find something in the beginning or end of the day.
CLIENT: Okay.
THERAPIST: I'm pretty confident I can work out something that was around a partial schedule if you were there on Friday.
CLIENT: Okay, thanks.
THERAPIST: Sure.
CLIENT: Yes, I think that would work really well.
THERAPIST: And the next week I got, sorry, Tuesday and Friday times would probably be fine before or after. And let's see what I can do for Monday, Wednesday, Thursday. Yes. I'm sure I can do Monday. Wednesday? I can probably do one or two of them [inaudible at 00:30:20].
CLIENT: Okay. [Pause]
THERAPIST: Do you recall ever having felt this anxious before?
CLIENT: Not really. Not really, no.
THERAPIST: Is there anything else that you're feeling? I wonder if you're afraid I'm going to be angry with you? [00:32:32]
CLIENT: I don't know. [Pause]
THERAPIST: Yes, I guess I would comment I feel like more [inaudible at 00:37:00] more than other times when you've been quiet and sort of bored (ph) into me or all boarded up. Say something, I think, probably because I suspect you don't feel anywhere close to having a thought. [00:37:18]
CLIENT: Yes. That's about right.
THERAPIST: You're right. We could sit here for six hours and nothing would come.
CLIENT: Yes. [Pause]
THERAPIST: [inaudible at 00:39:10]?
CLIENT: No, just I remember it being [pause]
THERAPIST: I think we'll stop now. [00:44:50]
CLIENT: Okay. Thank you.
THERAPIST: So tomorrow, tomorrow at 3:45?
CLIENT: Okay.
THERAPIST: Tomorrow at 3:45?
CLIENT: Tomorrow at 3:45? Okay. [00:45:16]
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