TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
CLIENT: I've had a hard time working recently. Like, yesterday, I got home after a session and just couldn't do anything for a while, for most of the rest of the day. I was just too sad. It's very frustrating. You know, I don't have much patience with myself when I'm like that, but at the same time, I just can't be alive or can't, can't stand the way I am. James has been very kind to me. Very insistent that I cut myself some slack and take care of myself. (pause) I think about suicide a lot. [00:02:10]
THERAPIST: Come back.
CLIENT: Yeah. Yeah. Come back to the extent that I am, it's not clear to me how much it really went away. You know, it feels like it never really went away, but I'm not sure that's actually true. But, anyway, it's come back for at least like the last week pretty consistently.
THERAPIST: You reported that it went away.
CLIENT: Okay. Well, then I would believe that. [00:03:05]
THERAPIST: Yeah. For most of the time you were doing the ECT you said you didn't think about it.
CLIENT: Okay.
THERAPIST: And, sort of even initially as you were off you said you didn't think about it.
CLIENT: Okay. Well, it has come back pretty heavily.
THERAPIST: Yeah.
CLIENT: It's a good thing I'm married. That's what makes the difference. (pause) It also feels like a bad thing that I'm married. In a lot of ways I really wish I weren't married.
THERAPIST: Because that's what makes the difference? [00:04:25]
CLIENT: Yeah. Yeah. (pause) If I weren't married, I wouldn't feel so guilty about it. (pause) It feels like something I just shouldn't bother you with. I guess that's probably not true, but... (laughter) [00:05:40]
THERAPIST: That's correct.
CLIENT: Yeah. I don't know. I find myself increasingly reluctant to talk about it.
THERAPIST: You mean the suicidality?
CLIENT: Yeah.
THERAPIST: Oh, okay. I wasn't, I didn't know if you were introducing something.
CLIENT: No.
THERAPIST: You were just mentioning that.
CLIENT: No. Which is unfortunate. (pause) I expect that I am reluctant to talk to you about it in direct proportion to my likelihood of falling from it. So, that's not good. Oh well. I just don't know what to do about it. You know, it's just I just don't think there's anything to do about it. (pause) [00:07:30]
THERAPIST: Well, I think at least part of what's very tricky about it is that it's, it's a defense by which I mean that it's in part something you think about in order to not think about other things that are more painful.
CLIENT: That makes sense. [00:09:00]
THERAPIST: I'm pretty confident of that because it's essentially what you told me a couple days ago.
CLIENT: Okay. (laughter)
THERAPIST: I'd like to take credit. No, I'm joking. But, were talking, we were talking about betrayal and feeling angry and you said something along the lines of how that gets to be too much very fast, the betrayal and the anger and you sort of described them right to a suicidalily. So, my point is that. [00:10:00]
CLIENT: Yeah. That, those times are not the times I really worry too much about. That's not, I mean that's bad, but I guess the times that I worry that I am going to follow through on this are when I kind of sit up and look around at my life and say okay, well, things are just this bad and this is just worse than I can take and I'm not going to be able. I'm not going to be able to take this anymore. And it just it feels very calm and it feels as though, it feels as though I am taking control of my life in some way. Yeah. (pause) [00:12:00]
THERAPIST: Is there an aspect of reasserting control over things?
CLIENT: Yeah. Like, saying well, things are this bad and here is something I can do about that because there is nothing else I can do about that. (crying) (pause) [00:13:20]
THERAPIST: It's like you're being tortured and you're helpless in a way?
CLIENT: Yeah. Yeah. But, you know, it's not just me that's helpless. It's not like people aren't trying to help me. It's, there's just nothing to be done. You know, all the things that people suggest really just make things have had bad side effects. (crying) (pause) You know, therapy helps some, but it doesn't touch it in some ways. (pause) But it helps some and I don't know. I don't know. (pause) [00:15:45]
THERAPIST: I think something important that happened a bit or so ago. I don't know if it felt this way to you, but to me, it seemed like when you asserted that the most sort of dangerous times for you occur when you said you look around at your life and you just feel like it's too much. [00:17:20]
You feel calm, but you feel like you just can't take anymore. You know, I don't know how clearly you remember, but I had said some things before that about what I thought the generally had to do with that you had said and one thought I had as you were saying what you did it was like you were kind of like taking the ball back from me. Like, I had it, you know, and I was like dribbling it around and shooting and doing my thing or whatever and then you took it in a very deliberate way. [00:18:30]
CLIENT: Well, I felt like what I said earlier in the week was, you know, one thing that happened but not really the most important thing that is going on right now. Yeah. So, yeah. (pause) [00:19:20]
THERAPIST: That makes sense to me and I know that that's true, but I have another point here on it as well which is, and maybe I'm wrong, but I had the feeling that like by trying to say something or make an explanation about you being suicidality or being suicidal that I was a little bit going to explain it away or maybe try to take it away or reduce it something and that it was very important to you to not let that happen. [00:20:45]
CLIENT: I don't know. I guess what I'm most clear about is that it's really important to me that this come across right to you. You know, that you understand what I am talking about.
THERAPIST: I am 100% convinced that there have been many times I guess in the last few days and, you know, before the ECT as well, many times when you have looked around at your life and really wanted to die. [00:22:00]
CLIENT: Yes.
THERAPIST: And, that like you've been in a kind of, you know, the sort of physical equivalent would be like intense chronic pain, because this is like emotional chronic pain.
CLIENT: Yeah.
THERAPIST: That has been unbearable and you can't think about tolerating it for more than a few seconds or a few minutes at a time when it's really bad.
CLIENT: Yeah. Yeah. That's about right. Yeah. [00:23:00]
THERAPIST: Yeah. And, I think (pause) I think though this probably is not true at one level, but at another level is probably true that you feel as though the best way to make it clear how painful it is say to me or probably the only way to give any indication of what it's really like is to make it very clear you'd rather die. I don't, I'm not saying you wouldn't. You know. I'm not saying like that...
CLIENT: But that...
THERAPIST: There are no other words.
CLIENT: Yeah. Yeah.
THERAPIST: Any other words or any explanation or context or narrative could not contain how excruciating it is. [00:24:35]
CLIENT: Yeah. Yeah. I mean it doesn't mean I don't try to explain it. It doesn't really lend itself to wild inclinations. I mean even saying I would rather be dead is, it just doesn't mean that much.
THERAPIST: I think you fear narratives and explanations about it because they inevitably minimize.
CLIENT: Yes.
THERAPIST: Or kind of invalidate.
CLIENT: Yes.
THERAPIST: What you're going through. (pause)
CLIENT: Thank you. [00:26:00]
THERAPIST: Sure. (pause)
CLIENT: The problem with wanting to kill myself I have problems with this also is that I feel like I have to structure the narrative very carefully in order to make people not freak out too much about it. You know. But, I also have people tell me I have a responsibility to talk about these things and I believe them. [00:27:15]
THERAPIST: I think it's also possible that there is a disconnect in you that relates to all of this which is that you do not believe how badly certain things that happen can make you feel that there could not possibly be proximal or distal causes. [00:28:15]
CLIENT: Right.
THERAPIST: For how like incredibly awful you feel. Especially when you are in it, but I think other times too. Like, you don't usually, sometimes you do, but you don't often make a connection between this happened and then I felt like that.
CLIENT: Yeah. I know. Most of the time it just feels like it springs up on me out of nowhere.
THERAPIST: I think part of the reason it is that way is because you, there's a disconnect. You don't believe that something that happened could have made you feel that incredibly bad and, and that to try to describe it that way, again, is terribly minimizing or misguided and invalidating because, you know, it feels like somebody saying yes, you stubbed your toe and that's why your whole body was wracked with horrible anguish for days. [00:30:00]
CLIENT: Yeah. (pause) Okay. (pause)
THERAPIST: So, either the other person couldn't possibly bear to know how bad it is or doesn't want to think about it or like (inaudible), but like yeah. I think that's true. I think that's what kinds of feels insulting. [00:31:35]
CLIENT: What? To have people give me reasons for why I feel bad?
THERAPIST: I don't think it's like you really want to be dead, but like you've had to fight with everything you've had and give up your entire fucking life. Not your entire life, but a lot of your life, to deal with this and, like, I don't think it's about that really. (pause) [00:32:35]
I know. I guess I'm more actually literary this week, because I'm thinking of another example from yesterday. There's a play I saw like decades ago. It was like Lilly Tomlin; I think and in one part of it...
CLIENT: Was it the Search for Signs of Intelligent Life in the Universe?
THERAPIST: Maybe. Yeah. There's one part of it...
CLIENT: I did that play actually.
THERAPIST: Oh, really?
CLIENT: Yeah. I performed in it.
THERAPIST: Yeah.
CLIENT: It's cool.
THERAPIST: Is it that, you know it better than me then, isn't there a part where like they talk about, you know, reasons. Like, what reasons, like, reasons could have caused us to drop an atomic bomb or something? [00:33:10]
CLIENT: I think so.
THERAPIST: I mean the point was like how could reasons really be worth all that much if they led us to do something like that?
CLIENT: Yeah.
THERAPIST: You know, like, how could, how could...
CLIENT: It's a good play. (laughter)
THERAPIST: Yeah. Yeah. I guess I imagine you kind of feel like that.
CLIENT: Yeah, I guess so. (pause) I don't know. I'm not; I'm not quite jumping on this.
THERAPIST: Sure.
CLIENT: But I don't think you're wrong. So, I don't know. (pause) [00:35:00]
Mostly I just think what the fuck is wrong with me that, you know, all of these things that are really not that bad I experience as being so fucking bad. Yeah. And, I know that hating myself is what I do when I can't handle being upset with somebody else, but it's not really clear to me how that's working. Mostly I just, I'm upset with myself. [00:36:15]
THERAPIST: I'm not clear when you say I don't know how that's working.
CLIENT: Like, you know, if I had to guess, I would say that I'm upset at somebody else and I'm translating that in to hating myself.
THERAPIST: I see.
CLIENT: But, I can't see that going. It can't, it doesn't feel that way.
THERAPIST: Oh, I see. I thought you meant you can't really see how that could be helping you.
CLIENT: Oh, no.
THERAPIST: Or, a better option. But, you mean like actually maybe that's not even, you know, that's not true, it doesn't. It sort of makes an intellectual kind of sense.
CLIENT: Yeah.
THERAPIST: Yeah. (pause) [00:39:00]
CLIENT: Yeah. (inaudible) (pause) [00:40:00]
I don't cry that much anymore. I used to cry all the time. It's just not how I function anymore.
THERAPIST: Yeah. I remember you would just sort of cry for hours at home, right?
CLIENT: Yes. I just don't seem to anymore. (pause) [00:41:00]
It feels like I have better control over myself, but I have no way of knowing whether that's actually true or not. (pause) [00:42:10]
It feels like, I don't know. I just feel like crying is basically feeling sorry for myself and I just don't have much room for that or something or much patience for it. It's just not what I want.
THERAPIST: We should finish up now.
CLIENT: Okay.
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