TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: Hi. (Pause) So it's been a tough day. Yesterday was a pretty tough day. And I'm reluctant to talk to you about it. Because, I know that at some point you have to send me to the hospital and I really don't want to go to the hospital. And I don't know where that point is. I haven't hurt myself. But, (Pause) you know, it's been a day I want-it's been, I have really wanted to kill myself. And I feel like that it just came out of nowhere. Or not exactly nowhere, it doesn't come out of nowhere. But, I feel like it came on very suddenly. (Chuckle) You know, and that's died down somewhat, but I'm still having a tough time.

(Pause from [0:01:29.5] to [0:01:36.9]) I haven't really told James about it. You know, but last night I-after about six or seven, I just said, you know things are getting on towards crisis. I really need to deal with that. And what that means is that I really need to just be watching TV and distracting myself. Because it's like, I can't think about anything. It just gets overwhelming.

(Pause from [0:02:21.2] to [0:02:35.0]) At one point, I went into the kitchen and got a knife and kind of put it up against my wrist and then I said, okay, that's enough of that and put it back. Went on with my evening. (Pause) It's not necessarily that I want to die so much as I want to have some control over my life. (Crying) Or feel like I do. And don't want to be in the situation that I'm in. (Pause)

THERAPIST: Or more normally.

CLIENT: Yeah. Yeah.

THERAPIST: In a lot of ways that you really don't have control over it. Which is very difficult.

CLIENT: Yeah. Yeah, I still can't quite, I can't shake the feeling that I ought to have control over feeling this way. You know, I ought to be able to just shut it down. [0:04:00.8]

THERAPIST: I see.

CLIENT: (Pause) You know, but it doesn't really shut down. I haven't gotten much work done today. I got a fair amount of work done yesterday. But most of that was in the morning.

(Pause from [0:04:18.4] to [0:04:38.9]) Anyway, it seemed like something that you probably needed to know.

THERAPIST: Is there more that you don't want to say?

CLIENT: No that's about it. (Pause)

THERAPIST: Do you know what brought it on?

CLIENT: I think it was the job stuff. (Pause) Yeah.

THERAPIST: What was going on?

CLIENT: I don't know. You know, mostly what I talked to you about yesterday. (Pause) Realizing that you know, James's and my financial situation is getting pretty tight. (Crying) And feeling like I've let him down and like I'm a burden to him. (Pause) You know, on the one hand and feeling like I've sort of done everything right and it's not worked out for me. And the other hand feeling like I can't possibly have done everything right because it hasn't worked out for me. [0:06:01.4]

THERAPIST: Sure. I can imagine it could be both. I mean I could feel both ways.

CLIENT: Yeah. Just, just feeling hopeless. Then I you know went to my first tutoring session with these two high schooler's. And it didn't go terribly but it didn't go as well as I would like it to in an ideal world. Which, when does it. And also, but also I sort of feel like I'm not really qualified to be teaching them some of these skills. I'm not really sure how to proceed, etc., etc. You know, they are really nice girls. Their dad is very nice. I think I would really enjoy working with them. But, I'm not sure how helpful I will be. (Pause) It was-you know the frustrating thing about tutoring is-teaching was like this for the first couple of months and then I sort of go over it. But, you know, I worry and worry and worry, I'm just incredibly anxious and then I go to the session and have a really good time. I feel like I'm doing good and I feel like I'm actually helping. And then I leave, feel good about it for about an hour and then I start to second guess myself and worrying about the next time. [0:07:50.9]

THERAPIST: I see.

CLIENT: So it's both something I really want, and (Pause) just I have very high expectations of myself. (Pause) [0:08:10.6]

THERAPIST: A new way that makes something pretty fraught.

CLIENT: Yeah, yeah. (Pause from [0:08:15.8] to [0:08:41.6]) Yeah, normal (inaudible)

(Pause from [0:08:43.7] to [0:09:15.3]) I'm dealing with it partly by, (pause) reminding myself that I am in all these relationships with people and I have a responsibility to the people around me. And partly by reminding myself that this comes and also goes. (Pause from [0:09:38.7] to [0:09:58.0])

THERAPIST: It's hard work.

CLIENT: Yes. Yeah, I work hard. (Pause from [0:10:06.4] to [0:10:26.4]) Yeah, I've got a pretty tight hold of myself. (Voice breaks) (Pause from [0:10:29.2] to [0:11:08.1])

THERAPIST: Were there things that were different about yesterday with the job stuff or was it just for some reason a day where it felt very bad. Or I'm probably not accurate, worse than usual?

CLIENT: The only thing that would be different is that James and I talked. Briefly, night before last, and then I said okay, we're going to talk about this again, but I haven't really been up for it. About this being kind of untenable situation. (Pause [0:11:55.3] to [0:12:04.1])

THERAPIST: Financially with you not working?

CLIENT: Um hm. (Pause from [0:12:05.9] to [0:12:32.0]) So you know, we kind of talked briefly, and said, yes, this is an untenable situation. And then we talked at some point about what would we do about it.

(Pause from [0:12:47.7] to [0:13:03.0]) None of the, (Pause) none of the pieces seems big enough to account for it. You know, I had like a good week where I didn't really think about suicide at all. Which is a long time for me. (Chuckle)

THERAPIST: Yeah.

CLIENT: Just to be clear. (Chuckle) (Pause from [0:13:31.8] to [0:13:58.6])

THERAPIST: Did having to cut back disturb you?

CLIENT: Yes and no. (Pause) You know on the one hand this is pretty familiar ground.

(Pause from [0:14:22.2] to [0:14:37.2]) It sort of feels like, well fuck, now I've got this to deal with. It just feels like bad timing. (Chuckle)

(Pause from [0:14:46.7] to [0:15:17.7]) I feel like (Pause) I feel like in some ways, both closer and farther away from actually doing something than I have been.

(Pause from [0:15:40.1] to [0:16:01.4]) Closer in that (Pause) you and I have talked about this a lot, farther away and the more I think about it the more I recognize it's not actually something I want.

(Pause from [0:16:22.3] to [0:16:53.5]) I just want not to hear everybody's fear. (Crying) (Chuckle)

(Pause from [0:17:05.8] to [0:17:54.2]) I really don't want to go to the hospital. (Pause) I don't think it will help. It's just (inaudible whisper) (Pause)

THERAPIST: There have been times when I really thought that's what you needed. But this doesn't seem like one of them.

CLIENT: Okay. Good. Thank you.

THERAPIST: Yeah. (Pause from [0:18:31.0] to [0:18:53.3])

CLIENT: I will keep working. (Pause from [0:18:54.3] to [0:19:29.8])

THERAPIST: I guess I am a bit concerned about the conversation with James. About you working and finances and untenability. Because, (Pause from [0:19:48.0] to [0:20:22.1]) Well, I guess I'm concerned that the conclusion is going to be, well you need to get a job. And you're already looking for jobs, at least teaching jobs, and you'll feel like you're sort of in an impossible situation. Or, you're supposed to be making something work that you can't make work or something like that. And that will be bad. That will be intolerable. Like-

CLIENT: I mean that's about how I feel. [0:20:58.4] (Chuckle)

THERAPIST: Uh huh.

CLIENT: But, (Pause from [0:21:03.1] to [0:21:37.5])

THERAPIST: Like, you're supposed to bringing in "X" hundred more dollars every week than you are to keep things a float and you're not and you can't find a way to do the work.

CLIENT: Yeah, something like that. (Pause from [0:21:51.5] to [0:23:23.5])

THERAPIST: And you don't see a way out of that.

CLIENT: (Pause) No. (Pause) You know one possibility is, I mean a possibility that I should probably pursue is going through the temp agency. Or something like that. But, (Pause) You know, then, that means cancelling or rescheduling most of my sessions with you. And at least half of my tutoring sessions. Which, you know, I'm not looking forward to.

(Pause from [0:24:39.2] to [0:25:02.0])

THERAPIST: Do you know how much tutoring you'd have to do to make it work?

CLIENT: I haven't worked it out. That's something to talk about. (Pause from [0:25:12.7] to [0:25:27.2]) That'd be good though. (Pause) You know the last couple of days, all of this has been hampered by, like as soon as I start trying to look at the problem practically, I get so overwhelmed by feeling terrible about myself that I just can't even, can't face it. (Pause) Which is frustrating. [0:26:07.1]

THERAPIST: Sure. (Pause from [0:26:07.8] to [0:26:53.7])

CLIENT: I think talking to James about it more is going to be better. And that he, he tends to have the mindset of, okay, what do we do about this?

THERAPIST: Which kind of beats the shit out of, I'm just horrible. (Chuckle) I think that's-

CLIENT: Yeah. (Laughter)

THERAPIST: Yeah. (Pause from [0:27:24.1] to [0:28:00.2]) I, (Pause) I wonder if this is largely a kind of psychological resistance to getting better. (Pause from [0:28:34.2] to [0:28:56.9]) You haven't been feeling as suicidal. (Pause) So this has been making like a little more sense. And I think has made come a little more, comprehensible and grounded. (Pause) And, I guess I find myself wondering whether (Pause) I guess this is partly like circumspect.

CLIENT: So can I ask you, and you don't have to answer this; is this like a wondering of you actually wondering or a wondering of you're pretty sure you're right but you are just phrasing it that way? [0:30:00.0]

THERAPIST: Fair question.

CLIENT: I just want to know.

THERAPIST: Yeah, yeah. (Pause) I am genuinely uncertain about it. It sounds plausible to me. But I think I would need to think about it and also hear more about it from you to have more confidence in that's what going on. It's like an idea that seems to fit pretty neatly but that doesn't mean it's right. I guess that's kind of where I'm at.

CLIENT: Okay, because it, it sounds pretty plausible to me also. But I don't, I don't have any way, I don't have an, I don't know how you would confirm or deny that. And I don't' know what you'd do about it if that is true. Of course that's what it is, it's focused on. (Pause) But yeah, I mean, (Pause from [0:31:07.7] to [0:31:18.5]) I feel like I have been feeling better. And in some way, that feeling like this makes more sense to me. It's more comprehensible. (Pause) [0:31:38.1]

THERAPIST: You mean like this, as in bad again?

CLIENT: Yes. (Pause from [0:31:42.7] to [0:31:59.0]) You know, but-and-I'm sort of like coming up with reasons why this is the case now at this point, so I don't-

THERAPIST: Sure, yeah. Why, like my hypothesis may cracked or why definitely isn't cracked?

CLIENT: Why I may be cracked. [0:32:23.7]

THERAPIST: I see. Okay, well here are my thoughts about it.

CLIENT: Yeah.

THERAPIST: At (Pause) a kind of, this is allaying the worry about having to go back to the hospital, also may be connected to a wish to go back. Like the part of you that wants to go back. Both because like, you're taken care of in certain ways there. Although, fully not in other ways. Because that shows that this isn't fixable and nobody can reach it. (Pause) It can't be controlled.

(Pause from [0:33:12.4] to [0:33:29.4]) And, (Pause) And then I guess kind of on the other side of it, (Pause) it seems pretty hard, like you have this fantasy that you're going to have to do something that you just can't do. Like if this situation is just untenable. You don't have enough money. You're the one who's gotta find a way to make more money. Whatever you're going to have to do is something either you can't do or can't, kind of work you can't find. Like, compared to, is you feel like it's going to be impossible. And like some sense that it isn't just going to be workable. You know, that you'll wind up at a temp job 40 hours a week. You'll have to find one and that will be humiliating and awful, which is was before. And then you'll have to do it, and that will be humiliating and awful. (Chuckle) [0:34:51.4]

And like, the scenarios you envision seem to me somewhere, like variations on the impossible kind of. I'm extrapolating I guess from what you said I guess obviously. But I guess this is what I have in mind.

CLIENT: No, I think you're right. [0:35:07.0]

THERAPIST: And that it seems to me probably in advance of the fact, I mean (Pause) like, (Pause) you know, maybe it's five or six more hours of tutoring a week. (Pause) You know, you'd make similar money like that plus what you're doing already, to the temp job from hell. Or, you know like, you sort of don't know the facts. Like how much you're short. And like, when whatever money you are using now is gonna run out. (Pause) And how things changed. I mean James's job is changing in a few months. What that means. Whether there is uncertainty, because he doesn't know what he will do next. Or he'll make more money, that seems up in the air. So I guess I, (Pause) jumping to these conclusions without sort of knowing the data. And then kind of be unable to think about or look at the data. Buy just imagining that it's all going to be horrible. That sort of sounds a little fishy in a way, if that makes sense. [0:36:48.8]

CLIENT: Yeah, it makes sense. (Pause from [0:36:51.4] to [0:37:02.7])

THERAPIST: Let me be absolutely clear, it sounds really stressful, you know. Like (Pause) you guys are really short on money, that you're gonna have to make a change somehow, some point soon. And that could involve, likely would involve you doing more work. And you know, it's hard to find the kind of work that you'd want to do, and it's uncertain-you know like, it's all very stressful. I'm not saying that it isn't. But (Pause) imagine that it feels to you pretty like, totalized. (Pause) That to me sort of has like a, a feel or like a whiff of (Pause from [0:38:05.8] to [0:38:28.5])

Some of the like, darker, angrier, more depressive, more omnipotent parts of you trying to take over. (Pause from [0:38:47.7] to [0:39:39.6])

CLIENT: So the biggest reason that I can think of, biggest thing that would kind of support this being kind of a reaction to getting better, or resistance to that. Would be that (Pause) I feel like if I'm this sick, a situation is less my fault. (Pause [0:40:19.1] to [0:40:42.7]) You know, I hear what you're saying.

I don't know what to say about it, but I hear you.

THERAPIST: Yeah. (Pause) But your thought is that you would be (Pause) sort of trying to avoid the judgment and punishment you would heap on yourself. Or how responsible you feel, and that if you're sicker you can (Pause) end that off. (Pause) (inaudible whisper)

(Pause from [0:41:51.0] to [0:42:26.4]) Whereas, if you are a little better, (Pause) then the onus really is on you.

CLIENT: Yeah. (Pause) Yeah I guess. (Pause from [0:42:52.3] to [0:43:28.9])

THERAPIST: And you're (inaudible)?

CLIENT: Yeah.

THERAPIST: Do you feel bad?

CLIENT: Well yes, but I mean that's (inaudible) generally. (Chuckle)

THERAPIST: But you had a sort of look of, of pain.

CLIENT: I am. I am. I'm trying to work it out. (Pause from [0:43:52.6] to [0:44:23.9]) You know, I don't know if, (Pause) It's like (Pause) part of me is convinced that it's all going to be horrible forever and this is never going to work.

THERAPIST: Yep.

CLIENT: And part of me is saying no, it's a problem, you can solve it. You need to look at it and sit down and break it down and figure out what you need to do. But (Pause) when I try to look at it and break it down and figure out what I need to do. Before I can see it, there's just this kind of overwhelming sense of it's all horrible and it's all my fault. And you know, this is not in just the last couple of days, it's all the time. (Pause) So I, I don't know how to get to it. (Pause from [0:46:06.4] to [0:46:51.8])

THERAPIST: I have some thoughts about how some of this can play out between you and me. Or this thing can happen like today where you come in sort of very much in the grip of the sort of way of feeling a part of yourself. Is something where it feels like it's all going to be horrible. Worried about the hospital and everything. Worried about your safety and sort of tell me about what happened and how bad you've been feeling. And sort of present it to me, or even confront me with it as something that is really untenable or impossible. And then I say it like, uh-huh (Chuckle) you know like, (Laughter)

CLIENT: Okay. (Laughter)

THERAPIST: And say like, ah, maybe this isn't so monolithical. Or you know, maybe if we look at this another way, it actually makes sense in light of this current circumstances or situation and comprehensible. Like, there are some particular feelings in play here and reasons why this is going on as opposed to being a kind of inherent monolithically awful state of the world forever. [0:48:42.1]

And, so far, I don't know if it fits, but it makes me feel like I or both of us start to then play like chicken with that part of yourself a little bit.

CLIENT: (Laughter)

THERAPIST: You know, like where (Pause) you know because it does very scary stuff, and it doesn't like to be called on what it's doing or what it might be doing. And I guess I sort of feel like that's what we're both trying to grapple with. (Pause) We should stop, but if you have another thought.

CLIENT: No, no.

THERAPIST: Okay.

END TRANSCRIPT