TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
CLIENT: That makes sense.
THERAPIST: Well thank you.
CLIENT: (inaudible at 00:00:09). So the ECT is making my memory go. It's just distracting.
THERAPIST: I got a call from what's her face at the health center.
CLIENT: Yeah.
THERAPIST: That you talked to.
CLIENT: Yeah. She said that they were not going to take me.
THERAPIST: What she said to me was that it seemed like probably because of the ECT or something else that you were having trouble... I'm not sure how she put it. It was something like thinking clearly, bringing words to mind. [00:01:12]
CLIENT: Certainly bringing words to mind. Yeah.
THERAPIST: Yeah. And that when that abates they'd be happy to...
CLIENT: Yeah.
THERAPIST: Talk to you again after (inaudible at 00:01:32).
CLIENT: I don't know when that will be.
THERAPIST: Is that because of the ECT?
CLIENT: I think so. I mean yeah I'm pretty sure but I don't know. (Pause)
THERAPIST: Did you talk to the ECT people about it today? [00:02:11]
CLIENT: Yeah.
THERAPIST: Okay. What did they say?
CLIENT: Not much. They didn't say very much. (Pause) I don't know. I just don't know what to do. [00:03:12]
THERAPIST: (Pause) Do you mean for the ECT or in general?
CLIENT: Probably the ECT. Yeah. I don't really know what to do. (Pause)
THERAPIST: What are your thoughts? [00:04:00]
CLIENT: I don't know that I have any thoughts. Yeah, I don't really. (Pause)
THERAPIST: Are you aware of having feelings about it?
CLIENT: (Pause) (inaudible at 00:05:36).
THERAPIST: Do you remember what you told them today when you went to talk to the ECT people? [00:05:48]
CLIENT: No. (Pause)
THERAPIST: Do you know if you have this much trouble word finding at home? [00:06:30]
CLIENT: Yeah.
THERAPIST: You do?
CLIENT: Yeah. I've been having so much trouble finding words it's ridiculous. It's frustrating.
THERAPIST: All right. I assume James is pretty clear about this?
CLIENT: Yeah. James is not happy about it.
THERAPIST: Good. (Pause) I'm trying to think of the right way to coordinate this like maybe James can talk to the ECT people. My concern is that when you talk to the ECT people it's hard for you to convey how much trouble you're having because you're having so much trouble. [00:07:40]
CLIENT: That makes sense.
THERAPIST: And while almost all the time you advocate fine in a situation like that, I'm concerned that you have a hard time conveying to them the severity really of what's going on whereas I imagine James would be able to make it quite clear. [00:08:30]
CLIENT: Yeah.
THERAPIST: And so, I guess, I'm thinking is he the best person to tell them. My other thought would be either I would probably be the other person. I'd be inclined, I think, to have James tell them rather than me. Yeah. So did you stop by there today after going to the in-take? [00:09:11]
CLIENT: No.
THERAPIST: Okay. You had a pretty good conversation with them.
CLIENT: Yeah.
THERAPIST: Do you remember anything that they said?
CLIENT: I'm sorry who?
THERAPIST: The ECT people said.
CLIENT: No, I don't remember anything they said. I'm sorry.
THERAPIST: That's actually the problem with talking about it to them.
CLIENT: Yeah. But I'm not very happy about it.
THERAPIST: Sure. (Pause) Okay. When do you go in for you're next thing?
CLIENT: In a couple of days. (Pause) On Friday. [00:10:13]
THERAPIST: Today is Tuesday. Yeah, I would have James call them tomorrow and explain that he would potentially like that you're having such trouble with your memory and such trouble finding words and seem to be so unclear about what you think and feel that he really needs to speak for you about it and that they can certainly call me as well if they want to. They've known you there long enough to know that... They can also talk to me. I mean they've known you long enough they have to know that he's not trying to intrusively speak for you. Now you may not remember this so do you want me to e-mail you? [00:11:43]
CLIENT: Yes please. Actually I would like you to do that.
THERAPIST: All right. The other thing I could imagine would be... I'm trying to think would there be any benefit to bringing James with you here tomorrow so we can talk for a few minutes about it.
CLIENT: Okay.
THERAPIST: But I'm trying to think is this a five sentence e-mail or is it a ten minute conversation.
CLIENT: I don't know. [00:12:23]
THERAPIST: Yeah. No, I'll figure it out. So I'll figure that out. I'll e-mail you one way or the other. I'll just say hey if you can come bring James in tomorrow or let's not waste his time. Here's what he may want to say.
CLIENT: Okay.
THERAPIST: When you meet with the ECT people how long do you talk... My impression is that they do some kind of a check-in like a verbal check-in.
CLIENT: Yeah. It's very brief. Yeah.
THERAPIST: All right so they don't talk to you long enough or necessarily know you well enough to be able to see the difference?
CLIENT: That's what it feels like anyway. [00:13:25]
THERAPIST: Okay.
THERAPIST: All right. Yeah, I think we should get on this. The difference is pretty striking.
CLIENT: Yeah. Okay.
THERAPIST: And (pause) I recall they're saying, or at least you told me, that your short term memory could be effected or your memory could be effected and just memory.
CLIENT: No, just functioning. [00:14:21]
THERAPIST: Yeah. It's finding words. It's being clear about how do you feel. (Pause) It's being able to think.
CLIENT: Yeah. I really hate that.
THERAPIST: Now it's remotely possible that it's something psychological and not just ECT. But if it's happening everywhere it's probably the ECT. (inaudible at 00:15:11). If this is happening at home as much as it's happening let's say here it's probably the ECT. Okay. [00:15:17]
Yeah, and I would like to talk to James about it. Okay. I will send you an e-mail as a reminder for you to bring him in because partly I just want to check in with him about what he sees because there may be things you're forgetting and partly I want to talk to him because (pause) as a mental health clinician there may be ways of putting things to them that will make more sense to them. I'm sure James can describe everything very well but... [00:16:15]
CLIENT: Okay.
THERAPIST: He and I can compare notes and get the story straight and make it easier to talk to them about it.
CLIENT: Okay. Thanks.
THERAPIST: Sure. (Pause) And (pause) there could be some ways that they're doing things that I don't understand or things about the situation I'm not clear about, but (pause) I think they're being a little negligent here and not picking this up. Because they say oh well we just let the clinicians pick up like me trying to give you something. That's fine. But then they should be calling me or her. [00:17:38]
CLIENT: Okay.
THERAPIST: But this is a fairly profound reaction and the people at the ECT and they're not talking to you long enough to figure out. This is not some subtle episode. So they should be on that and if they're going to leave it to other people to talk to more, like me, that's fine, but then they should be reaching out to me. [00:18:06]
CLIENT: But you do think I'm (inaudible at 00:18:13)?
THERAPIST: Yeah. I mean I think in terms of symptoms and functioning this is quite profound. That doesn't mean it's (inaudible at 00:18:36) pathology meaning this... I have no idea. It could be the kind of thing they stop or change the way they're doing the ECT and this goes away. I don't... I have no idea how big a deal it is to ask them. But yeah, you're (pause) cognitive functioning is profoundly impaired by this. [00:19:05]
CLIENT: Yeah.
THERAPIST: And I would imagine... Well I don't know how much this is effecting your daily living functioning. But cognitively it seems... They don't want to take you at a partial hospitalization program because they don't think you're lucid enough and you were at graduate school last year. You know something's very out of whack here.
CLIENT: Yeah. Yeah.
THERAPIST: Again, it doesn't mean it's difficult to fix. I don't know about that. But this is a big deal. Although with a short term memory loss I cannot remember what you had for dinner yesterday is okay, but sitting here yesterday and not being able to find words for 20 minutes at a time that's different.
CLIENT: Okay. Thanks. [00:20:01]
THERAPIST: Yeah. (Pause) Have you been feeling much that you remember or do you feel pretty flat emotionally?
CLIENT: I feel pretty flat. I mean I haven't been the best.
THERAPIST: Well that part is I guess.
CLIENT: I don't know.
THERAPIST: Do you have suicidal thoughts?
CLIENT: No. It's good.
THERAPIST: Do you feel relieved?
CLIENT: Not really. No, not really. (Pause)
THERAPIST: Yeah. Do you feel worried? [00:21:20]
CLIENT: Not really. Not that I am cognizant of.
THERAPIST: And yesterday here you were, I thought, quite anxious. Do you remember? You had trouble finding your way here.
CLIENT: I'm sorry. Yeah.
THERAPIST: And you said you felt really anxious and neither of us could come up with anything that seemed to stick. In other words, (pause) that seemed to resonate with you about why you might be anxious. I couldn't smile because naturally I assumed it was a some psychological thing that you would come here, or talking, or something, but it might have just been you weren't feeling very with it. You got lost on your way here and that made you anxious. It's not something I would've thought of (inaudible at 00:22:45). But that's what it was. Do you know what I mean? [00:22:49]
CLIENT: Maybe. I don't know.
THERAPIST: I guess what I'm saying I'm not sure how clear I'm being with it maybe just getting lost and feeling like you weren't able to remember the directions here and being a little confused that was part of what made you anxious. And you don't know what it could be?
CLIENT: No. I don't know. [00:23:28]
THERAPIST: (Pause) Are you been able to have a conversation with James?
CLIENT: It's tricky. Sort of but it's tricky. [00:24:24]
THERAPIST: Is it easier when there's more context? In other words, if you guys are clearing your dishes from lunch or something like that and you're sort of talking about what you're doing so that there's a lot of context.
CLIENT: It helps. Yeah.
THERAPIST: (Pause) My feeling is you like the folks over at the ECT it sounds like; who worked with you at the ECT? [00:26:25]
CLIENT: Yeah.
THERAPIST: They seem decent to work with?
CLIENT: Yeah.
THERAPIST: Good. (Pause) Has there been any changes with the ECT in the last two or three weeks?
CLIENT: Not that I can think of.
THERAPIST: No.
CLIENT: No, it seems to be pretty (inaudible at 00:26:55).
THERAPIST: All right. Well (pause) I imagine that will be helpful to have James and both I talk to them. [00:27:22]
CLIENT: Okay.
THERAPIST: Are there other things going on that you want to talk about?
CLIENT: No. I don't know of any. (Pause)
THERAPIST: What have you been doing during the day like yesterday? [00:28:05]
CLIENT: (Pause) I don't know.
THERAPIST: Can you remember?
CLIENT: Yeah. I've been reading a lot.
THERAPIST: Things you've read before?
CLIENT: Yeah. Most likely but that's generally the case for me. I almost always will read the book that I read before.
THERAPIST: There's not that many new books.
CLIENT: Oh yeah. Pretty much. Yeah.
THERAPIST: And do you remember having read them before like do you remember what's going to happen next? [00:29:02]
CLIENT: Sort of. I mean I don't expect new things. I don't expect anything like I it's like I remember that I don't remember it.
THERAPIST: Is it a surprise when it happens?
CLIENT: Yeah. I'm not surprised. Yeah.
THERAPIST: If somebody stopped you and said okay what are the two things that are going to happen next, you couldn't...
CLIENT: I wouldn't remember. Yeah.
THERAPIST: And that's different, I imagine, from what it was like two or three months ago where if somebody said what are the next two things that are going to happen you could give them the next 12.
CLIENT: Yeah. (Pause)
THERAPIST: Well I'm glad you can read. [00:30:27]
CLIENT: Yeah me too. I don't know how to deal with all this, but now I can always read.
THERAPIST: Good. What are you reading?
CLIENT: Right now I'm reading a book called "Subtle Knife". The fantasy...
THERAPIST: Yeah. I think I've heard of that. It's part of a trilogy.
CLIENT: Yeah. It's part of a trilogy.
THERAPIST: The Dark Materials trilogy.
CLIENT: Yeah. It's very, very good.
THERAPIST: Is it?
CLIENT: Yeah. I would highly recommend it. Yeah. [00:31:04]
(Pause) (inaudible at 00:31:26)
THERAPIST: Yeah?
CLIENT: Yeah.
THERAPIST: Why?
CLIENT: It's very richly written. Yeah. I don't know. It's very complicated.
THERAPIST: Is it the plot or the characters? [00:32:01]
CLIENT: The characters are beautifully written. The guy just really, really understands character so they're just beautifully written. I don't know.
THERAPIST: What's it about?
CLIENT: It's about (pause)... I don't know. (Pause)
THERAPIST: What are the main characters like? [00:33:10]
CLIENT: They're children. (Pause)
THERAPIST: I'm really sorry this is happening to you.
CLIENT: I'm also really sorry it's happening to me too. I don't know what's wrong with me. I mean I'm not usually that good at describing books, but I'm not usually this bad either. [00:34:06]
THERAPIST: Yeah. I (pause) I'm actually not going to take you at your word that you're bad at describing books. When you're better I'll judge for myself.
CLIENT: Okay.
THERAPIST: But I'll consider it anyway because you said it.
CLIENT: Yeah. I don't think I'm very good at describing books. I'm good at... I'm very good at reading, obviously, and I'm very good at... I don't know. [00:35:02]
THERAPIST: I imagine you're very good at the way books work just talking about the way books work.
CLIENT: Yes.
THERAPIST: How the characters and the plot function hypothetically like that. And maybe it's true you're not good at describing books and if that's true I would gather that you probably usually so many thoughts about them that it's hard to like...
CLIENT: Yeah. No, I'm good at books.
THERAPIST: Yeah. And usually you have a lot to say about that.
CLIENT: Yes.
THERAPIST: Maybe that's what it's about. I imagine the whole thing is sort of narrowing down all the things you could say.
CLIENT: Yeah.
THERAPIST: (inaudible at 00:36:05) it's like that.
CLIENT: Yeah. [00:36:10]
THERAPIST: You can say it actually gives you more questions about it. What is it about?
CLIENT: (Pause) That's really far.
THERAPIST: Yeah. (Pause) Is it clear to you how much different this is than usual?
CLIENT: Yeah. (Pause) I don't know what it is.
THERAPIST: What do you mean? [00:37:07]
CLIENT: I mean it's just (pause)
THERAPIST: I mean I would describe it as almost certainly related to ECT, and I would say that the ECT is profoundly impairing your cognitive functioning and emotional functioning in that it's causing you (inaudible at 00:38:06) memories that you've made, and word finding, and that effects your (inaudible at 00:38:20) a lot. Well externally it's sort of that but I'm thinking more of your description that you don't feel much. I mean it's good that you're not feeling depressed. It's good that you're not thinking about suicide. That's great. But it's also a problem if you're not feeling much of anything. [00:38:45]
CLIENT: Yeah.
THERAPIST: And I would imagine that's (inaudible at 00:38:59) emotional life and the ECT. That's sort of happening alongside the cognitive effect. (Pause) At least as far as I know they didn't warn you this could happen. They said there could be memory loss. [00:39:34]
CLIENT: Yeah. They said there could be memory loss. Is that who said it?
THERAPIST: Yeah. (inaudible at 00:39:41).
CLIENT: Yeah. (Pause)
THERAPIST: I guess I'll just send this out. I'll e-mail you and I'll cc James. [00:40:59]
CLIENT: Okay.
THERAPIST: With a reminder to bring him so we can all talk about the side effects you're having from the ECT. (Pause) So does 7:45 work for you tomorrow?
CLIENT: I think so. [00:41:29]
THERAPIST: And would that work for him?
CLIENT: I think so.
THERAPIST: Okay. He's enough of a morning person too. (Pause)
CLIENT: Sorry. [00:42:15]
THERAPIST: It's okay. (inaudible at 00:42:21).
CLIENT: Yeah? You are more of a morning person than I am anyway.
THERAPIST: Okay.
CLIENT: So...
THERAPIST: Okay. Well let me know if anything else comes up otherwise we'll talk more in the morning.
CLIENT: Next time?
THERAPIST: Yeah. Yeah.
CLIENT: Okay. Thank you.
THERAPIST: Thank you. [00:42:54]
END TRANSCRIPT
