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THERAPIST: I can send you our schedule for that
CLIENT: That would be good, thank you.
THERAPIST: I will do that. Also, I didn't respond to James's e-mail. But I will do that later on today.
CLIENT: Okay, I will (inaudible)
THERAPIST: Okay. I want to glance at it quickly again too. Because of that, (pause) there we go, alright. Maybe I'll just read it quickly. Hi Chad. I'm writing in reply to your questions about (inaudible phrase at [00:01:00]) and what Dr. Hellman had to say this morning. I am copying Dr. Vaughn because she is interested and concerned also. Tanya and I went through yesterday afternoon, and you're not going to see Dr. Hellman, is it Hellman, I thought it was Hellman?
CLIENT: I don't know.
THERAPIST: But for the treatment sessions by waiting an hour, I think, (inaudible phrase at [00:01:17]) made up to memory testing, and timed after the ECT, and I did talk with him. I described to him some of the memory clinician problems I had observed. He did not seem concerned. Dr. Hellman explained that they have pre-parameters that they can vary the type, which James thought meant unilateral vs. bilateral. Power and frequency, by which James thought he meant the pulse frequency, not sort of how often you go in. They lowered the power on Tuesday and again on Friday, and they will probably alter frequency as well. Treatment schedule will be once this week, probably once next week, and then wait a couple of weeks for the next one, and then wait a month. [00:02:01]
He compared the treatment to treating cancer. I want to make sure to get the whole cancer before stopping. Apparently with what that is, to carrying too much weight.
(inaudible phrase at [00:02:14]) Today, I just realized she was upset about taking ECT. (inaudible) I don't want to do it anymore. Then he said you seem kind of more cool to him each day since the weekend, last week. Which was, I was glad to hear him put it that way, it seemed to confirm what I saw. (inaudible) that you seemed to be more with it by the end of the week. And clearly so was the memory spell. But more so with it at the end of the week than the beginning of the week. Let's, but also, as the sadness and anxiety comes back as the clarity comes back. And then he sort of goes on a little bit about (pause) you know, how it does make sense that the sadness and anxiety would be expectable. And then he goes on to say he thinks that (inaudible from [00:03:23] to [00:03:32]).
CLIENT: Yeah. I'm not really super happy. I still don't know what to do.
THERAPIST: I think, back to the e-mail for a second, I see there is nothing in there as surprising or striking.
CLIENT: No.
THERAPIST: Okay, I just wanted to make sure before we left it.
CLIENT: Yeah, yeah.
(pause from [00:04:02] to [00:04:14])
Yeah I don't really know what to say.
(pause from [00:04:15] to [00:04:34])
THERAPIST: Do you just feel like your mind is going blank or nothing comes to mind or?
CLIENT: Yeah a little bit.
THERAPIST: Are you piecing things together or what?
CLIENT: Not really, I just kind of don't want to be doing that.
THERAPIST: It's easier.
CLIENT: Yeah. That's about it. (pause from [00:05:02] to [00:05:13])
THERAPIST: How come?
CLIENT: (pause from [00:05:14] to [00:05:31]) I don't know.
(pause from [00:05:32] to [00:05:48] Yeah, I don't really know.
(pause from [00:05:49] to [00:06:30]) (inaudible)
(pause from [00:06:31] to [00:08:09] yeah, I don't know.
THERAPIST: I think you're tired of coming in here and not having much to say, or access. In a way I think it more as not having access to much to say. I also, have the impression that, you seem more frustrated on your own behalf, that you don't have more to say. Not because I'm going to get bored or sick of you, or think you're doing this wrong or something like that. But I know you still often have other impressions, like that you are more anxious, and you have other (inaudible).
(pause from [00:09:14] to [00:09:35])
THERAPIST: Then I get a little, and I could be off page that you could be like, there are no more things to talk about. That you don't have to (inaudible) and you kind of think of it, but that's just speculative.
(pause from [00:09:56] to [00:17:31])
THERAPIST: Are you upset you have what (inaudible)
CLIENT: I don't know. I'm, yeah, a little bit. I,
(pause from [00:17:44] to [00:18:17]) I feel like, (pause) I feel kind of stuck.
(pause from [00:18:33] to [00:19:36]
THERAPIST: What can you (inaudible)
CLIENT: I, (pause) I, (pause) I don't know. I (pause [00:20:22] to [00:21:54])
THERAPIST: Do you think you might have meant that you don't think we can do much until your mind kind of comes back. Or the part that's gone comes back? (pause from [00:22:12] to [00:22:43] You have a look on your face, and your posture is as though you are feeling and thinking things. Though I gather that's not what it looks like.
CLIENT: Oh yeah, I mean, (pause) I feel like I'm stuck here. (pause from [00:23:10] to [00:24:20])
THERAPIST: Stuck where?
CLIENT: Stuck in this, (pause) stuck in this institute. I don't know. (pause from [00:24:50] to [00:25:15])
THERAPIST: Like you are trapped?
CLIENT: Yeah I guess. (pause from [00:25:17] to [00:26:14])
THERAPIST: Is it because, the nature of the ECT, makes it hard to sort of speak up about not wanting to do it?
CLIENT: That's what it feels like, very much. (pause)
THERAPIST: Are you clear that you are almost done with it?
CLIENT: I'd like to be almost done with it. (chuckles)
THERAPIST: Did you get the schedule that he proposed?
CLIENT: Yeah, yeah, I did. But, I don't know, I have a hard time believing in that. I just
THERAPIST: Oh, you mean you think they will recommend more?
CLIENT: I just, I would not be surprised if they did.
THERAPIST: How come?
CLIENT: (pause) I don't know. Just, I feel that will happen. (pause from [00:27:52] to [00:28:26]).
THERAPIST: One thing I've wondered about with the ECT is, I remember when you were in the hospital, we had a conversation, and I was saying, it does seem to me, that there have been some things about you that have changed. But could originate here, though not coming out in ways that were, suicidal or down or distraught. I guess a metaphor that I could come up with was like, a transition, the transmission in the car. Like the transmission in the car is running smooth but is still in the tree. Do you remember?
CLIENT: A little bit.
THERAPIST: And one of the, it's going to be a longish point, I'm still clearing, finding my way there. So, one of the things that I thought of was that, you seemed sort of more familiar with, and maybe less alienating towards some of the most distraught, or in a way like most ill, but kind of most pained part of yourself. Like last summer or last spring, you go through periods of what appears like feeling fine, and kind of not even believe those other parts existed, and wham, they came back. [00:30:57] And it was like a different world. Then it seemed to me more recently, mostly, well most of the time. But also like, you seem clearer, (inaudible phrase at [00:31:22]) both. You can take (inaudible) and felt better while (inaudible) was here, worse after she left. Maybe you were still surprised a bit, but it was like, this person talked to be talking. More to each other rather than on a complaintive. Does that make sense? And here's the point I'm leaning towards, (pause) I could imagine you have the fantasy that the ECT was geared towards basically, silencing, or maybe like attacking or obliterating. And you are, or feel more like suffering parts of yourself, and that (pause) like shutting them up isn't going to do the trick. (pause from [00:32:45] to [00:33:04]) And like you are tired of those parts being walled up or shut up, and it touches back in real life I think. I'm saying exactly that it's like, so objective since that's what the ECT is, but I imagine one of the ways you may be experiencing it is, kind of making sense of it at one level is, you feel like it's geared towards shutting those places down. And you aren't happy with that.
CLIENT: Yeah. Yeah. (pause from [00:33:44] to [00:34:51]) Yeah. (pause from [00:34:56] to [00:38:17]) Yeah. (pause from [00:38:18] to [00:40:58])
THERAPIST: Do you feel, in part, that you would rather be living with how bad you felt? That would be (inaudible) to you?
CLIENT: Maybe. (pause from [00:41:17] to [00:41:31]) Yeah. I think so.
THERAPIST: (pause from [00:41:34] to [00:42:00] We should stop for now.
CLIENT: Okay.
THERAPIST: (inaudible phrase) your schedule.
CLIENT: Okay.
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