TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
THERAPIST: Let's talk about scheduling stuff?
CLIENT: Yeah.
THERAPIST: So maybe I had miscommunicated. I didn't have this 7:30 on Friday as an ongoing thing.
CLIENT: Oh, okay.
THERAPIST: I had it for a few weeks or something and was away and I – if we're going to do twice a week, probably Wednesday and Thursday works for you and if I can move the appointment to a better time, I will.
CLIENT: Thank you.
THERAPIST: How's that?
CLIENT: Yeah, that's fine.
THERAPIST: Okay.
CLIENT: I was looking for Friday kind of, but –
THERAPIST: Okay, if I can make a swap and do it, I will.
CLIENT: Okay.
THERAPIST: (Whispering) (inaudible).
CLIENT: (Chuckle)
(Pause): [00:00:58 00:01:12]
CLIENT: I've been sleeping really poorly for months and I don't know what to do about it.
(Pause): [00:01:17 00:01:22]
CLIENT: I mean it obviously means to actually get on the phone and make an appointment with a doctor who can prescribe me sleeping meds that's going to help, but I have fear and anxiety around the medical system and making doctors' appointments.
(Pause): [00:01:41 [00:01:48
CLIENT: I still don't have a primary care physician because I don't know how to go about getting one. And it's really demoralizing because when I try, everyone says they're not taking new patients.
(Pause): [00:01:59 00:02:09]
CLIENT: I don't understand how there can be so many hospitals and so many doctors in this area and yet no one is taking new patients. It doesn't add up in terms of the sizeable population and number of doctors here, except that the doctors here in each specialties and not enough primary care physicians. But still, it's frustrating and demoralizing.
(Pause): [00:02:40 00:02:56]
THERAPIST: (inaudible) I remember going to a walk-in clinic in (unclear) once, and at the end of the visit there they handed me a list of doctors and said, ‘oh, here's our list of primary care doctors who are accepting new patients.' So it makes me wonder if you like call –
CLIENT: Well, so I actually did go to their walk-in clinic a couple of weeks ago because I had a sore throat and that needed to be dealt with and I asked for a list of primary care. I asked for a list of primary care physicians and they said, ‘well, here's a list of everyone who has privileges at our hospital. We have no idea who's accepting new patients.
THERAPIST: Oh yeah?
CLIENT: Yeah. And I asked the nurse who gave me the list, you know, ‘can you tell me like are any of these doctors known to be LGBT friendly?' Like this is a thing I'm concerned about a and she was like, ‘well, I can't tell you that. You know, that would be giving a personal opinion and I'm not allowed to do that.' And I was like, ‘but, but, yeah.' So, yeah, that was upsetting.
(Pause): [00:03:58 [00:04:12]
CLIENT: And I did manage to drag myself to go see the gynecologist once a year but they're not willing to prescribe me Ambien.
THERAPIST: Yeah.
(Pause): [00:04:24 00:05:01]
THERAPIST: Who are you seeing for psych meds?
CLIENT: No one. I'm just not taking anything.
(Pause): [00:05:07 00:05:18]
THERAPIST: Do you want to be taking something?
CLIENT: I don't know.
(Pause): [00:05:19 00:05:48]
THERAPIST: (inaudible).
(Pause): [00:05:54 [00:06:03]
THERAPIST: It helps if you've got a primary care doctor and I was laughing because it's often easier to find a prescriber at the hospital where you have a primary care doctor insists that you see a psychiatrist in the hospital, that the primary care doctor is at the same hospital, but it's sort of a (inaudible).
(Pause): [00:06:29 00:06:35]
CLIENT: I should call the guy whose phone number you gave me.
THERAPIST: That's right. I'm forgetting we talked about that a month or so ago. I'm sorry.
CLIENT: That's okay.
THERAPIST: Yeah.
CLIENT: I have it sitting in my in-box with a star next to it, but –
THERAPIST: Yeah.
CLIENT: – I don't know. Making cold calls from the phone scares me.
(Pause): [00:06:55 00:07:01]
THERAPIST: Maybe an e-mail would be easier – I'm not trying to push you to call him, but I think – I remember his e-mail which makes me think he gets e-mails from patients on an e-mail.
CLIENT: Yeah, e-mail is definitely easier.
THERAPIST: Yeah.
CLIENT: There's just a whole backlog of phone calls I need to sit down and make.
THERAPIST: Yeah.
CLIENT: For example, I called the optometrist a month ago and got contacts but I can't actually see out of them.
THERAPIST: (Laughs)
CLIENT: They were fine in the office, they were fine for driving and distance, but if I'm sitting at the computer, I can't read the words. They're all blurry which given my profession, is a problem. So I'm wearing these glasses, which are – the prescription is a year out of date now. And I need to call and say the contacts you gave me aren't working. I need you to re-examine me because this isn't – it's not okay to not be able to read my computer screen. But every time I pick up the phone, I end up imagining all of the ways in which they might block me or refuse or charge me money or just be mean to me and I can't bring myself to actually make the call. It's very upsetting. It's just a simple thing and if they're mean to me, so what? Like, or, you know, if they charge me money – it's not the best thing, but I probably won't break my budget and I need to be able to see, like that's not negotiable here. I just can't do it.
(Pause): [00:09:04 00:09:21]
CLIENT: My dentist has been telling me for years that I need to see an orthodontist because of misalignment causing me jaw pain and also my top tooth is slowing chipping because my bottom tooth keeps hitting it, because my teeth are misaligned and it's been two and a half years since he gave me the name of an orthodontist to call and I still haven't done it because the whole process is just intimidating to me.
(Pause): [00:09:54 00:10:17]
THERAPIST: It makes me think of, though I think it's getting less so, how difficult it's been to talk here about the stuff – some of the stuff that happened in May. Like the certain metaphor I have in mind is like it's hard to get in touch with a doctor about that stuff.
(Pause): [00:10:58 00:11:11]
THERAPIST: And maybe for similar reasons or worries that I wouldn't be available or like I somehow take it in and not listen to it or it would be your fault in some way. I don't think that you consciously or in some way irrationally think that I would be necessarily, but we're talking worries. That's what I'm hearing.
CLIENT: Right. Well maybe.
(Pause): [00:11:56 00:15:06]
THERAPIST: I wonder if it feels like when I make a comment like the one I just did, it feels like there's something dangerous in it, which shuts you down or makes it harder to talk.
CLIENT: I just don't know what to say in response to it.
THERAPIST: I see.
(Pause): [00:15:31 00:15:42]
THERAPIST: Are there, like do you have sort of dissociation to it, as opposed to responses? In other words, like it's one thing to kind of make an evaluation of whether you think it's true or what you think about it, and it's another thing to just sort of have whatever your reaction happens to be.
CLIENT: Right.
THERAPIST: And I guess I'm wondering about like, these are – I wonder if part of your reaction is to feel like you have to feel sort of impelled to have a clear and reasonable evaluation like, ‘well, that seems right because of blah, blah, blah,' or, ‘no, that doesn't really seem right because of blah, blah, blah.' Or, ‘well, that could be because of the (unclear) side of the conflict.' Something like that.
(Pause): [00:17:06 00:17:15]
CLIENT: Yes, I often feel like I'm expected to either make a clear statement of agreement or a clear statement of disagreement with bullet point reasons for the why or why not.
(Pause): [00:17:25 00:17:37]
CLIENT: It's a little awkward, too, because I feel like yeah, on one hand I can say, ‘I totally agree with you. I don't trust you,' which, you know, is an awkward thing to say to a person. But on the other hand there is, ‘no actually I do trust you, even though you seem to think I don't,' which then gets into, "maybe she doth protest too much" kind of territory and I don't know, it seems like there is no right answer and it feels like a trick question sometimes.
THERAPIST: Like I'm setting you up?
CLIENT: Um hmm [yes].
(Pause): [00:18:12 00:18:22]
THERAPIST: I think that if you tell me you don't trust me, well, that's just not a very nice thing to say.
CLIENT: Right. It might hurt your feelings.
THERAPIST: I see.
CLIENT: Or your ego.
THERAPIST: I see.
(Pause): [00:18:23 00:18:37]
THERAPIST: Whereas, if you say, ‘I don't know if I do –'
CLIENT: Right.
THERAPIST: Then, ‘well, I don't know,' sounds like you're too, ‘thou doth protest too much,' like you sound a little too sure about that, like it has to be (inaudible).
(Pause): [00:18:56 00:19:18]
CLIENT: There are things I feel inhibited about talking about here.
THERAPIST: Yeah.
CLIENT: Largely because I'm judging myself and kind of coming to the conclusion that everything on my mind is too ridiculous even for me, like stop being ridiculous, that's the answer. I don't need a shrink to tell me that.
(Pause): [00:19:39 00:20:00]
CLIENT: (Unclear) of the things I feel embarrassed or ashamed about.
THERAPIST: Sure.
(Pause): [00:20:02 00:21:05]
THERAPIST: This is probably already quite clear to you, but in case not – (Pause) we kind of talked implicitly about transference and what that is, but do you know what I mean by that?
CLIENT: No, I don't.
THERAPIST: Okay.
CLIENT: I'm sorry if we've talked about it, I've forgotten.
THERAPIST: No, that's all right, maybe we haven't. So the idea, is probably kind of implicit in things that we've talked about, like I assume that your sort of reaction to your fantasies about me – I don't necessarily mean like by fantasies – explicit scenarios involving me, but things like the kind of quick thought that like, ‘if I think I'm ridiculous, you, absolutely are going to think I'm ridiculous.'
CLIENT: Right.
THERAPIST: (inaudible). It may, in different measures, be in part to sort of, in some sense, how I've actually been with you or what you've actually seen of me and predictions that don't so much have to do with me, personally, but that this is set up in part to evoke. If that makes sense.
CLIENT: Right.
THERAPIST: And you know, that latter part is sort of generally referred to by those of my ilk, as transference. You know, the collection of predictions that one has and usually talked about in reference to a therapist or analyst, although it occurs all the time in daily life. And finally it generates into a history like in some fashion makes like people to respond the way that people important in a life have responded (inaudible).
(Pause): [00:23:16 00:23:53]
THERAPIST: It's the kind of identification and elaboration of those fantasies is sort of part of how this therapy works. And I mean I think that some of this is familiar, like, ‘oh, yeah, I guess I did expect you would like come throw me out the window when I said that, but now thinking about it I guess you wouldn't do that, and actually when we talked about it, you didn't do that.'
CLIENT: Right.
THERAPIST: You know.
(Pause): [00:24:29 00:25:22]
THERAPIST: It's like you said something like, ‘maybe he'll be insulted if I say I don't trust you.' You know, I can take that all sorts of ways, like – maybe I have been defensive when you said stuff like that about me, or maybe I haven't, but you're, there's something coming from you about my being untrustworthy or maybe there's something coming from you or from me about being able to put a sort of something critical like that on the table. Maybe either I have reacted about that or other people have and you know, you react to that, you know, and that's why you're (unclear) here.
(Pause): [00:26:30 00:26:51]
THERAPIST: Do you have any questions about any of that?
CLIENT: (inaudible).
(Pause): [00:27:00 00:27:03]
THERAPIST: Is that stuff that was sort of like kind of implicitly fairly clear?
CLIENT: Yeah.
THERAPIST: Okay, I thought so.
(Pause): [00:27:06 00:29:26]
THERAPIST: I guess there is something that can feel a bit adversarial – I mean going back to what you said, in part, about the question or my thought about your thought about not trusting me in certain ways or (inaudible).
CLIENT: Right.
THERAPIST: Like I'm kind of setting things up so that I'm (unclear) you, whichever way you go.
(Pause): [00:30:07 00:30:33]
THERAPIST: Which hasn't been particularly encouraging.
CLIENT: No.
(Pause): [00:30:35 00:33:31]
CLIENT: I'm also really sleepy right now.
(Pause): [00:33:36 00:33:43]
THERAPIST: What's your sleep been like? I know bad, but –
CLIENT: Like, I'll generally be in bed between I don't know, 10 and midnight and it will generally take two to three hours for me to actually fall asleep and I'll wake up two or three times in the middle of the night for anywhere from 20 minutes to a couple of hours.
THERAPIST: When do you wake up?
CLIENT: Between 7 and 8.
THERAPIST: I go to bed at 11, actually conk out around 1:30 and then wake up at 4 and 5, and get up at 7:30.
(Pause): [00:34:24 00:34:59]
CLIENT: The really frustrating thing, though, I'll be watching TV or reading a book or working on a project or knitting, or whatever, and I start to feel really, really tired and so you know, I'll get up and brush my teeth and put on my pajamas and go to bed and feel really tired and exhausted throughout that whole process and the moment I'm lying down I'm wide awake and can't sleep.
(Pause): [00:35:21 00:35:31]
CLIENT: And then I get anxious about my inability to sleep and if I don't get enough sleep will it be safe to drive tomorrow, will I be able to get any work done if I don't get enough sleep – which just makes it harder to go to sleep and then, you know, am I waking up Dave, am I tossing and turning too much. Am I making it difficult for him to sleep? Is it fair to him? And then, you know, the self-flagellation cycle begins and it's just awful.
(Pause): [00:35:55 00:36:53]
CLIENT: It's generally better on nights that I spend at Ashley's.
(Pause): [00:36:56 00:37:05]
CLIENT: Because Ashley enjoys really ridiculously athletic sex so I'm really just physically tired and in addition to mentally exhausted by the time I actually start to sleep. But I was actually kind of counting on that last night. For whatever reason, I still couldn't sleep.
(Pause): [00:37:24 00:39:41]
CLIENT: I also end up blaming myself for my inability to be like –
(Pause): [00:39:45 00:39:51]
CLIENT: It usually takes the form of, you know, the logical argument of, ‘well, if I just went to the gym and exercised, I'd have all this exercise endorphins and sleep would be easier and to a point it's true that when I was exercising on a daily basis, like going to the gym and doing intense workouts almost every day, I did sleep better and had less knee pain and less ankle pain, joint pain in general and everything was better. But I'm brow beating myself to where it isn't actually going to get me to go to the gym.
(Pause): [00:40:25 00:40:38]
CLIENT: Something will be a bootstrapping problem there, too, because –
THERAPIST: It's hard to go to the gym when you are exhausted.
CLIENT: It's hard to go to the gym when I'm in pain which I am, almost every day. And in the long term, exercising frequently reduces like average pain over time, but it does hurt a lot to actually be in the gym.
THERAPIST: I see.
CLIENT: So it's hard to move to do something that I know will hurt when I'm already in pain.
THERAPIST: We should stop for now.
CLIENT: Um hmm [yes].
END TRANSCRIPT
