TRANSCRIPT OF AUDIO FILE:
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CLIENT: I've been having a tough time, yeah.
THERAPIST: I'm sorry to hear that.
CLIENT: I don't' really know what to do other than just, yeah, things have been hard. (pause from [00:00:32] to [00:01:03])
I've been applying for jobs, so that's been fun. (pause) I guess I've just been really sad. (pause from [00:01:29] to [00:02:53])
Yeah, anyway. (pause from [00:02:53] to [00:03:25])Yeah, I'm just sad most of the time with this. Don't know how to get over it.
(pause [00:03:33] to [00:05:36]) Yeah, I think I would not be so sad all the time if I were more together.
(pause from [00:05:52] to [00:11:27])
THERAPIST: Are you having thoughts?
CLIENT: Not really. Yeah, just drawing a blank.
THERAPIST: Is that true elsewhere too?
CLIENT: Somewhat. (pause)
THERAPIST: You said the bad feelings had come back, or some of them, to some extent.
CLIENT: Yeah.
THERAPIST: Because you didn't, you weren't feeling bad, when you were here last week. That you were aware of.
CLIENT: I don't think so. But I am now.
THERAPIST: Right. So you remember last week, of being as you not feeling as bad.
CLIENT: I don't anymore, but I believe you. (chuckles)
THERAPIST: Okay, I just wanted to...
CLIENT: Yeah, I mean, I'm surprised I don't want to hurt myself again.
THERAPIST: You had said yesterday that it's actually pretty hard not to hurt yourself.
CLIENT: Yeah, yeah.
THERAPIST: Do you remember wanting to yesterday as well?
CLIENT: Yeah.
THERAPIST: Okay, I'm just trying to, I want to assess your memory a little bit to know what you are (inaudible).
CLIENT: Yeah. [00:14:19]
THERAPIST: Because prognosis is saying there used to be.
CLIENT: I don't know, I don't remember.
THERAPIST: What is it that you want to do?
CLIENT: I just want to cut myself, or, yeah, damage myself.
THERAPIST: How?
CLIENT: (pause) I want to like, scrap up my arms or legs a lot. To cut myself. (pause from [00:15:46] to [00:16:43]). Yeah, so a lot of it is, you know, preventing myself from actually doing it. Holding off there.
THERAPIST: That can take a lot of effort to hold yourself back.
CLIENT: Yeah, I don't always hold myself back.
THERAPIST: You have cut yourself?
CLIENT: Yeah.
THERAPIST: Had you before yesterday?
CLIENT: Yeah. (pause from [00:17:35] to [00:19:03]).
THERAPIST: I can imagine it feels really bad to talk about it.
CLIENT: Yeah it's not one of my favorite things to talk about. I'm not really comfortable with it.
THERAPIST: It makes you feel self-conscious and ashamed?
CLIENT: Yeah. (pause from [00:19:26] to [00:20:45]) It's something that I just really want to go away, but it doesn't.
THERAPIST: I guess before it stopped feeling like that.
CLIENT: Yeah, (pause) but it doesn't. (pause [00:20:59] to [00:23:32])
THERAPIST: Has the sense of (inaudible) come back?
CLIENT: Not as much. That's good.
THERAPIST: That is good.
CLIENT: Yeah. (pause from [00:23:57] to [00:24:08])
THERAPIST: It seems your brain is working a little better than it was.
CLIENT: Yeah. (pause from [00:24:12] to [00:25:12]).
THERAPIST: You feel hope yet?
CLIENT: Not quite. Yeah, I don't know. Yeah, I don't, it just seems like, self-injury is just there.
THERAPIST: (pause) Were you always concerned with that. That it seems that it's just there?
CLIENT: (pause) I don't know. You know, I (pause) just have the impulse to cut myself. I don't know why. (pause)
THERAPIST: Like it's kind of compulsive?
CLIENT: Yeah, I guess. (pause) I don't know. (pause from [00:28:12] to [00:31:10] (inaudible)
THERAPIST: I imagine that I think you have suffered, and thinking about cutting yourself sometimes beats how you are feeling.
CLIENT: Yeah it could. (pause from [00:31:27] to [00:31:44]).
THERAPIST: I think it is probably a way of expressing sometimes about how awful you are feeling that you can't tell in words, to describe them.
CLIENT: I guess so.
THERAPIST: Which is a very tight spot to be in. To feel so horrible, so entirely badly, and not be able to (inaudible) anything about it.
CLIENT: (whispers) Yeah.
THERAPIST: Are you including (inaudible) the process to James?
CLIENT: Yeah.
THERAPIST: You may injure yourself and you're not sure, probably?
CLIENT: (pause from [00:33:16] to [00:36:00]
THERAPIST: I wonder if that some of what's going on, with the compulsive thoughts about hurting yourself, I know you have had them before, I gather it's sort of similar. I mean sometimes you've had them before as kind of a stepping stone, you could focus on that rather than on cutting yourself. And at other times, that's just what you were focused on. I wonder if, some of it now actually relates to ECT (ph) in that, I think you have a hard time talking about stuff. Like, your memory is better, but your access to words still isn't at all what usually is. And that you are feeling bad, like really bad. And so, like, [00:37:30] (pause) let me describe, oh I have it in my head. (chuckles) Maybe it's the past, you know sometimes when you are feeling awful and you couldn't talk about it, for a variety of reasons, you would feel like cutting yourself. And now, maybe for some of the reasons you can't talk about it. Some of them are probably the same and then there's this new one, which is also to say you can't find your goddamn words. (chuckles) The way you usually can, but it produces some of the same outcome.
CLIENT: It makes sense. Yeah.
THERAPIST: So it, you have experience (of getting silence stolen from you.) (ph) And this is your response. [00:38:31] Obviously, I'm not saying that things are all different than how they used to be. You know, you might be feeling this way anyway, you might be feeling it to some extent. My sense, my impressions of some of the push is from not being able to talk. So, you know, some of it may be the same reasons you have been thinking of hurting yourself more all the time.
CLIENT: That makes sense. I don't know.
THERAPIST: Yeah, sure. Well we'll see what happens, as you become more able to talk.
CLIENT: Yeah.
THERAPIST: That will be over the next weeks.
CLIENT: Yeah. Hopefully, actually when I'm more able to talk.
THERAPIST: Are you worried you won't?
CLIENT: Yeah. I mean, yeah. [00:40:02]
THERAPIST: Does it feel like your mind will come back?
CLIENT: Yeah, and then, you know, I don't have any guarantee. And it feels like things are just gone. (pause)
THERAPIST: Do you still feel like they are going to change the ECT regimen and sort of give you more of that than they had planned?
CLIENT: I don't know. I don't know. I mean, I feel like I need to do less ECT regardless. But I don't really know.
THERAPIST: Do you not know what the plan is?
CLIENT: I don't really, I mean.
THERAPIST: James e-mailed it to me on Friday. And I can tell you what he e-mailed me.
CLIENT: Yeah, I think he told me, but I don't remember anyway.
THERAPIST: That's tough.
CLIENT: They were going to go do less and less right?
THERAPIST: The plan was I think, once this week, once next week, and then once two weeks after that. And then once a month after that.
CLIENT: Okay.
THERAPIST: So that would be like three more times. Over the next several weeks.
CLIENT: That makes sense. (pause from [00:41:56] to [00:42:25])
THERAPIST: I think, you're feeling like they are going to, sort of, well yesterday you were saying, not yesterday, that they would change their minds and do more.
CLIENT: Yeah, that's what I'm afraid of.
THERAPIST: Yeah, you can say no I think.
CLIENT: Yeah, I know, I just
THERAPIST: You are afraid you are going to get that pressure.
CLIENT: Yeah. (pause) But I will be okay.
THERAPIST: And you are also afraid, even if they stop that things won't come back.
CLIENT: Yeah.
THERAPIST: That you will probably continue to have trouble getting words after that.
CLIENT: Yeah.
THERAPIST: At one, like, I wonder if that comes partly from just always feeling kept down. Or kept quiet.
CLIENT: I don't know. (pause from [00:43:58] to [00:44:37])
THERAPIST: Do you feel like you will be like this for the rest of your life? Without memory or?
CLIENT: God I hope not. I don't think so.
THERAPIST: I'm just asking kind of the nature of the (inaudible) you say like, you don't think these things will come back, like how far out you are looking.
CLIENT: I'm not really sure.
THERAPIST: Yeah, just have the feeling.
CLIENT: I'm not sure how far out I'm looking.
THERAPIST: Yeah. (pause from [00:45:18] to [00:47:22] Do you know why you are shaking your head?
CLIENT: Nope. (chuckle) (pause [00:47:24] to [00:49:14]
THERAPIST: Is it frustrating being here when you aren't sure what to say or can't talk to say?
CLIENT: A little bit. (pause) Yeah, I don't quite know what to say. (pause)
THERAPIST: Well we'll stop for now. We'll talk more tomorrow.
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