TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
CLIENT: Talk to you about a claims agent actually. I called him yesterday and I had to do that.
THERAPIST: The claims agent?
CLIENT: Yea. She... they were... I call after 4:30 which is when they all leave for the day.
THERAPIST: Right.
CLIENT: So she was like, "Yea, these are a little late." And I was like, yes, they're very late. (chuckling) So...
THERAPIST: I also... it's like I wouldn't hesitate if you have any doubts at all and maybe if you don't to ask the claims agent or whomever to talk to somebody (inaudible at 00:00:31).
CLIENT: OK.
THERAPIST: I have spent much more time in my life than I want to on the phone with Blue Cross. And that seems to be something that sometimes helps is sometimes someone like that can sort of... especially if you have a story like, "I've called three times. Every time they say they're going to be put through as urgent. And it's going to be a week and nothing happens."
CLIENT: Yea, OK.
THERAPIST: It's well over 45 days or just how long it's supposed to take (inaudible at 00:01:02).
CLIENT: Yea. I mean, I still have claims outstanding from October.
THERAPIST: Oh, wow.
CLIENT: Yea, maybe not October but definitely November. Yea, and those... yea, got sent through wrong. And so... because they just decided that I hadn't paid my deductible and so they were like, "Oh, well this comes out of the deductible." And I'm like, "No, no. It really doesn't. It really doesn't." So yea. (pause) So not being... so I mean... so you decided not to be like an in network person. Does that mean that you have to talk to them less? Or...
THERAPIST: Yes.
CLIENT: Good. (chuckling)
THERAPIST: I have one more batch of claims from the fall that I'm still trying to wrangle with them. [00:02:07] But actually I don't have to talk to them so much.
CLIENT: OK.
THERAPIST: But thank you. (pause)
CLIENT: So I think with talking to you yesterday. I think that helped a lot. And so going to board game night with Franco (sp?) helped a lot also. Well, I've lost horribly. They're just both so good at board games. It's really sad. (chuckling) I mean, I'm pretty good at them. But they're just like really, really good so yea, the story of my life with Franco (sp?) and James. (pause) And... but it was a really, really good day. [00:03:03] So yea, I've been doing a little better. Or a lot better actually.
THERAPIST: Good.
CLIENT: Yea. It's easier to get up today. So now I'm just focused. Now I just know I'm going to go home and say, "Well, you're feeling better so clearly that means that you should be doing well with these things. And you should have them already done. And..." So I'm trying to cut myself a little slack. But I have kind of a short memory for moods. So it's like, well, I'm feeling better now so the fact that I was where I was yesterday. It's just gone. [00:04:04] (pause)
I told James (sp?) also that things were pretty bad which he sort of known and sort of not known. And I didn't really... I was kind of two minds whether to tell him or whether to talk to him about it. (pause) I feel like he should know. I don't want to surprise him again but at the same time I want him to be able to work. And I want him not to have to worry about me. [00:05:05] (pause)
So he kind of said, "Well, it's good for me to know," but he was... he said he was pretty sure that if I had kind of kept him more updated in the last few days he would not have finished the paper that he just finished. Well, no, you don't need to know anything different. You really don't. And so... (pause) You look skeptical about James (sp?) finishing the paper. [00:06:01]
THERAPIST: You thought that I was?
CLIENT: No, I said that James (sp?) did not think he would have finished the paper and you kind of went hmm. (chuckling)
THERAPIST: As though I would... I was actually (inaudible at 00:06:16) explain but...
CLIENT: Oh, it doesn't matter.
THERAPIST: But I want to understand. To you it seems like I was skeptical of his claim?
CLIENT: Yes.
THERAPIST: And that as though I thought that if he had known how you were doing, he would have finished the paper anyway?
CLIENT: Yes.
THERAPIST: I see. No, what I was actually reacting to was concern that that was more... was stressful for you to hear because... which it didn't seem to be which was good. [00:07:04]
CLIENT: Yea.
THERAPIST: As though like as you were saying a minute ago you can feel in a pickle about whether to tell him or not.
CLIENT: Yea.
THERAPIST: And he's saying, "Well, if you had told me, I wouldn't have finished," (inaudible at 00:07:21) for you. But that was what I was thinking. And good if that's not what you were thinking.
CLIENT: Yea. (chuckling)
THERAPIST: Do you know what I mean?
CLIENT: Yea. (pause) I feel like the more off the cuff things I say to you, like I'll say something without thinking about it first and then maybe you would be completely terrified. I don't know if that comes across. (chuckling)
THERAPIST: I see.
CLIENT: I don't know why. Like was that wrong? [00:08:01]
THERAPIST: I guess those are moments where you feel kind of more unguarded or less guarded.
CLIENT: Yea. And the thing is it's probably not really very clear what I'm saying thinking about it first and what I'm not thinking about first is how I think I come across.
THERAPIST: Like when you're more spontaneous, you mean...
CLIENT: Yea.
THERAPIST: ...and when you're more careful?
CLIENT: Yea. I feel like the way that I talk with most people is very carefully so as to create the impression of spontaneity. (chuckling)
THERAPIST: I see.
CLIENT: That's the goal anyway. (chuckling) [00:09:02] (pause) Yea, I'm not sure why I find talking to be more frightening. [00:10:02] Or like I get scared more. Or at least it seems to me that I need a little help.
THERAPIST: Right.
CLIENT: I don't remember anything (inaudible at 00:10:12). So... (pause) maybe I'm telling you about it more. (pause) [00:11:01] I don't know what we're going to do when Franco (sp?) moves away.
THERAPIST: Is he going end up moving?
CLIENT: Not (inaudible at 00:11:18). He's going on the market in the fall, I think.
THERAPIST: (sneezes)
CLIENT: Bless you.
THERAPIST: Thanks. (sneezes)
CLIENT: Bless you.
THERAPIST: Thanks.
CLIENT: I think he's really anxious about his job prospects. I think he feels like...
THERAPIST: (sneezes)
CLIENT: Bless you. I think he feels like...
THERAPIST: (sneezes) (chuckling)
CLIENT:(chuckling) I'm sorry.
THERAPIST: (chuckling) I think that's the last one.
CLIENT: That's OK. [00:12:01]
THERAPIST: So he's really anxious about his job prospects?
CLIENT: Yea, I think he feels like he's been working on projects that his advisors have really wanted him to work on and have been interesting but have not been necessarily the ones that...
THERAPIST: Like as marketable?
CLIENT: Yea. And I think he feels like he has a lot of... I think he feels like many of his colleagues have been working for less time and not as hard as he does and have lots of shiny things.
THERAPIST: I see.
CLIENT: Kind of shallow. But I mean, I suspect Franco (sp?) will be just fine. Or at least if there is any justice in the world, Franco (sp?) will be just fine. But I don't know. I don't know. (pause) [00:13:00] Yea, that's a pretty big if if there's any justice in the world.
THERAPIST: Yea. Jury is still out.
CLIENT: Yea. (pause)
THERAPIST: Yea, I wonder if that's a little bit how you can feel like you're in places when you kind of put yourself out there. You're just sort of at the mercy of whatever is going to happen, if that makes sense. [00:14:06]
CLIENT: Yea.
THERAPIST: Stakes still pretty high.
CLIENT: Yea. (pause) Yea, I mean, I think one of the reasons that I'm doing so much worse now than I was, say, two weeks ago is that like there's not... there aren't the same kind of concrete things that I can do. There aren't that many new jobs being posted.
THERAPIST: I see.
CLIENT: Yea, I've kind of applied for the set of positions that there are and I'm just waiting. (pause) And yea, so now there's nothing between me and this kind of looming failure. [00:15:11] (pause) I keep sort of going back through and kind of thinking about my major choices over the years. Why did I leave? Why did I come to this school instead of going somewhere else? Why did I do these things? It just doesn't really do me any good. [00:16:02] (pause)
Yea, some of those choices still seem like good ideas and some of them seem like less good ideas. (pause) Yea, I mean, I left so I could be with James (sp?). Didn't work out that well. We... this is... I feel like we kind of got screwed here. We really wanted to be in these programs. We wanted to be at the same school. So he applied to... we each applied to seven schools. Six of which were the same school and one of which was mine. He applied... he got into four schools. I got into three and the only that I got in was that one was the only one. [00:17:13] It was tough.
THERAPIST: You guys are a couple of hours apart.
CLIENT: Three and a half, maybe. It was... they're 200 miles apart.
THERAPIST: OK.
CLIENT: Almost exactly.
THERAPIST: Yea. (pause)
CLIENT: Yea, but I really, really wanted to be at this school. And now I can't remember why. [00:18:01] (pause) Are you OK?
THERAPIST: Yea. Coughing and sneezing it up over here. Yea, no, I'm fine. (pause)
CLIENT: Yea, now I'm just brooding (inaudible at 00:18:35). Just thinking, what am I going to do? What's going to happen and I think, what am I going to do? And I don't actually come up with any answers but I kind of get more and more worried and feel worse and worse about myself until I am basically incapacitated. [00:19:07]
THERAPIST: So I think the first thing that comes to me which is I think you seem to have to be very careful with what you allow yourself to think about. I started thinking about these transitions and why I made the changes that I did. And then you said it didn't get me (inaudible at 00:19:37) anywhere. Or just like what you were just saying about (inaudible at 00:19:43) and that's how you do it. And then my impression is that you have to be careful like that because you can get yourself into emotional deep water very quickly. [00:20:03]
CLIENT: Yea.
THERAPIST: ...with (inaudible at 00:20:07) and disastrous consequences for your mood. So you can be in a fine part of town driving along and then if you're not careful wind up in a really bad part of town that's very dangerous very quickly.
CLIENT: Yea.
THERAPIST: And I think it's probably similar with me. There's a way in which there's sort of something about your anxiety in relation to sort of me and my responses to you that it's sort of been unclear. I mean, in a way, sure, there's your sort of unpredictable and sometimes explosive (inaudible at 00:20:50). I'm sure that's part of it.
But maybe this other thing is part of it too where that I think probably fairly regularly if not quite often I have said things that are on the face they're not so bad or really appear to be helpful. Whatever that can be sort of hurtful or similarly kind of put you in a bad neighborhood very quickly. I'm not like I sound horrible for doing that. I'm just saying in the same way that if you're not careful and you kind of know because it's in your own head a little bit more that sometimes if I'm not being careful because I may not even see the arrangement so well, it can have similarly dangerous consequences. [00:22:12] And so that contributes to feeling scary. (pause)
CLIENT: I feel like I have a hole (ph).
THERAPIST: Yea.
CLIENT: I feel like I have so much invested in you not doing things like that that I'm not sure that would even... that I'm not sure I would admit that to myself. So I'm not sure I can tell. (chuckling) (pause) [00:22:59] Yea, I mean... (pause) So I can't think of any examples right now. But it seems to me that when you've said something that's kind of sent me off in a bad direction, I've sort of immediately and very firmly thought, well, no it wasn't what Chad said that sent me there. [00:24:12] That was just me going there. So I'm not sure how to evaluate that. It sounds like...
THERAPIST: A sense of determining who's responsible for it?
CLIENT: Like I'm not... in the sense of like knowing whether you're right or not.
THERAPIST: I see.
CLIENT: I'm not sure whether I would... it sounds like that makes sense. But... (pause) [00:25:00] Yea, I mean, in the same way that I have a lot invested in not being angry with you. I have a lot invested in you not saying things that hurt me or...
THERAPIST: I see.
CLIENT: ...send me downhill. (pause) [00:26:00] I keep thinking about Bryan (sp?), my high school boyfriend. (pause) [00:27:00] It's sort of after we broke up then like have kind of remember things that he had said or done and be like, wow, that was really bad. Why was I not angrier at him then? (chuckling) Why did I not see this? That was really bad. (pause) When you were like it's one thing to be... it's much easier to be angry with my dad for things that he did when I was a little kid than it is to be upset with him now. (pause)
THERAPIST: The distance seems to make it much safer.
CLIENT: Yea. [00:28:02] (pause) Hey, you're probably right. (pause) It's one of the things that make really good sense. But I don't have...
THERAPIST: Why is it? You're pretty clear what you're saying. [00:29:02] Like it's so frightening the possibility that it's too scary to really think all that hard about whether it's true.
CLIENT: Yea, yea. It's less frightening when you say it. (pause) But I feel like I don't have any data that I can trust at this point, if that makes sense. (chuckling)
THERAPIST: It's less frightening when I say it?
CLIENT: Yea. (pause) I can elaborate. [00:29:59]
THERAPIST: Sure.
CLIENT: (chuckling) I mean like it's... so you said yesterday that you were probably going to disappoint me. And that's something that I sort of know but would not be able to admit to myself. But it's a huge relief for you to say that.
THERAPIST: Right, OK.
CLIENT: And basically say, OK. Yea, that's about right.
THERAPIST: I see. Yea, so let me think. Similarly when I say or do things that are hurtful to you, that's certainly not what I'm wanting them to be. [00:31:14]
CLIENT: Yea, I know.
THERAPIST: Yea. And... (pause)
CLIENT: In some ways that makes it harder for me to kind of recognize it. So like because I know that you don't intend to hurt me, then it is... it's like I have to take you at what you're trying to do rather than what actually happens if that makes sense. [00:32:03] Like I... like it's... I'm... if you say something that sets me off in some way that I then kind of spiral downhill, I can't say to myself, well, Chad said this thing that set me off. But I have to say, Chad said this thing that he meant in this way and that is the important thing.
THERAPIST: I see.
CLIENT: So that being set off is really all on me.
THERAPIST: Yea. (pause) There's the prospect of leaving some of it on me. [00:33:03] I guess it sounds like part of what you're saying can be helpful if I put it on me.
CLIENT: Yes.
THERAPIST: That's helpful.
CLIENT: It is actually.
THERAPIST: OK. Well, in that case I'll bring up an example...
CLIENT: OK.
THERAPIST: ...which I think is on me. From a couple days ago when you talked about burning yourself and I asked you for more details about it and about the frequency, I think it was a crazy thing for me to ask you about. But I think it was hurtful and I think I made a mistake in asking as much as I did. [00:34:11]
CLIENT: Actually I don't agree with you there. (chuckling)
THERAPIST: OK.
CLIENT: In that self-injury is something that it's really hard for me to talk to you about or talk to anybody about.
THERAPIST: Sure.
CLIENT: But I sort of want people to know. But I'm not sure I would have said... I don't think I would have said anything else if you hadn't asked.
THERAPIST: So you were glad or relieved that I knew?
CLIENT: Yea.
THERAPIST: I see. And that feels more important than how painful and (inaudible at 00:35:01) it was to talk about it?
CLIENT: Yea. It's really difficult to start talking about or to bring up. And it's something I'm really ashamed of. But it's also like I think there's a reason that I do things that leave marks. (pause) Yea.
THERAPIST: Yea, I guess I had the impression that I had been... I felt I had been a little too pushy about it knowing and being able to also see you in the moment how painful and shaming it was for you to talk about. [00:36:08] So I felt like... my thought afterwards was that... that was that I wish I hadn't done that.
CLIENT: Well, thanks.
THERAPIST: Sure. And it wasn't because I didn't want to know.
CLIENT: Yea. No, I know.
THERAPIST: It was because I thought I was hurtful to you.
CLIENT: Yea, but I'm glad that you did actually.
THERAPIST: Yea, OK.
CLIENT: So terrible example. (chuckling) I'm sorry.
THERAPIST: (chuckling) Sure.
CLIENT: See that would be something that I didn't think about before I said it and then as soon I said it, I was like ah. [00:37:03]
THERAPIST: Well, I know you meant to be reassuring in telling me it was a terrible example.
CLIENT: OK, thanks. (pause)
THERAPIST: And I'm not put off by having come up with a terrible example.
CLIENT: Well, that's good. (chuckling) (pause) Yea, I mean, in general I think you tend to work by not asking very many questions and sort of letting me direct things. [00:38:11] But I actually find it very reassuring when you ask questions. So yea, but then I don't have to make so many mistakes (ph). (pause) [00:39:00] And yea, and with the self-injury something that I want you to know about but it's just very, very hard to tell you about. I think that it's just really hard to talk about. (pause) I'm so ashamed of it.
THERAPIST: Yea. (pause) [00:40:01]
CLIENT: You know that mark on my arm that I think James (sp?) saw last night. I have not told him about it. Sorry, James (sp?). (pause) Why do you turn the clock so you can see it and I can't?
THERAPIST: I just turn it so I can see it. It's not for you to not to see it.
CLIENT: (chuckling) OK.
THERAPIST: I used to have two clocks the other one that I put either there or there.
CLIENT: OK.
THERAPIST: And one... the other one ran out of batteries and I just never bothered to get them replaced. But there's no set reason.
CLIENT: OK. [00:41:00] I don't know. I feel like you're very careful about the way you compose the room in other ways. So I don't know what is (inaudible at 00:41:09) and is not. (chuckling) (pause)
THERAPIST: Did you have a fantasy about it? In other words...
CLIENT: Why do I think you do? That it would be... it seemed to me that it would... I mean, I feel like I would focus too much on what time it was.
THERAPIST: I see.
CLIENT: And kind of measure what I said by the time which I was thinking about because I was like, well, it's probably getting close to time. So I don't know if I want to start something new.
THERAPIST: I see. I see. In fact, it is. [00:42:01]
CLIENT: Yea, is it time?
THERAPIST: Yea.
CLIENT: Thank you.
THERAPIST: Take care. You too.
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