Transcript of Audio File:

BEGIN TRANSCRIPT:

CLIENT: So the insurance decided that my deductible started in January rather than in August so they misprocessed all of my claims for this. I was like they're going back to August that they missed processing. The claim was submitted in August. They got around to it in March so now I don't know what's going to happen.

THERAPIST: Well that's weird. So (pause) if they misprocessed it in August...

CLIENT: No, it's like they processed some of the claims in August when they were actually submitted. And I filled out my I paid my deductible by September. [00:01:08]

THERAPIST: Oh okay. I get it.

CLIENT: But there were other claims that were submitted in August that weren't processed until now with the new computer. They're like oh well I guess she has to start over again so we're not going to cover any of this. I don't know. It was rough. The woman I was talking to was very nice and she was like clearly this is wrong. We'll fix this. But she would not stop talking. I think she was maybe just anxious about she didn't want me to be really angry at her because it was reasonable for me to be very angry about this situation. So she wouldn't let me get a word in edge wise and then James was trying to talk to me at the same time and I couldn't hear. James got really upset and I was like why are you angry at me? He's like I'm not angry at you. I was like okay that might be true but I'm the only one in the room and you're angry. So that's still happening. I'm working on it but it's still happening. [00:02:17]

I don't know. I was having a really good day up until then. (Pause) I guess it's hard for me to tell whether being as depressed as I am is normal or not. I don't know how I stack up in some ways and now that I don't remember any of the last six months I especially don't know it. (Laughter) [00:03:08]

THERAPIST: (inaudible at 00:03:12) people around yourself historically.

CLIENT: I think both. The historical part is more difficult because I just never told anybody about it for so long so I don't know. So James and I were talking about this woman, who used to be our couples counselor and now she just sees James, and I forgot how that happened because I don't remember anything from the last six months. And so James reminded me how that happened because I made a joke to him about stealing our couples counselor. And he was like no, you were in the hospital and she and I met individually during our regular time. And at some point she told me that you were doing so badly that traditional couples counseling wasn't an option. I'm like oh, okay. Well that makes more sense now. (Laughter) [00:04:17]

THERAPIST: I'd never heard it that way either.

CLIENT: Oh okay. Well I feel a little better about that then. (Laughter) Yeah, so I don't know whether that's like more thinking about well maybe I was really sick or more just still feeling like my life before about a month ago is just gone. I don't have a clear memory of that. I remember her name. (Laughter) Yeah, I don't know. [00:05:08]

THERAPIST: You don't remember meeting with her?

CLIENT: I very, very vaguely do as in I remember that we met with her. And I remember liking her a lot. I think she was pretty good, but I couldn't tell you what that was based on. I don't know. James really likes her I think. I don't really...

THERAPIST: He's continued to see her?

CLIENT: Yeah. Which I'm really glad about. I think it's really important. (Pause) Yeah, I know. [00:06:10]

A friend of mine we were best friends in high school but I've been out of touch with her a while now wrote on her blog recently saying that she's just been really, really depressed this winter. She has a lot of the same pressures as I do, and she's doing everything right like she's taking her medicine. She's visiting her therapist. She's doing what she's supposed to do, and taking time for herself, and all these things and nothing budges it. (Pause)

But I guess like (pause) I feel like I know longer know what she's talking about when she says she's been really depressed this winter. Like when we were in high school in part we were really close because both of us knew what it was like to be really depressed and both of us had difficult relationships with our parents and other things. [00:07:42]

(Pause) I don't know where I'm going with... Like she kept teaching. She's still with her husband. She still has her kids. I'm like her life is going on. (Pause) So I don't know whether to say well she clearly doesn't have it as bad as I do or whether to say I just don't have the same fortitude as she does. And I'm not sure that this is a useful comparison at all. [00:08:52]

THERAPIST: There's something here I think. I'm not sure what it is. But to be clear you had a depression which over the last at least year and a half or so has been severe at times.

CLIENT: Yeah.

THERAPIST: Go ahead.

CLIENT: Yeah. I mean I'm not sure what that means though.

THERAPIST: Okay.

CLIENT: I mean it's okay. You don't need to... I don't know. I don't know. [00:09:27]

THERAPIST: I think what I'm going to explain but I probably won't answer the questions you have that are most important, but this still seems like stuff that you should know or that would be good to know like depression can be clinical depression. It can mild or severe through the year. You know often those (inaudible at 00:09:59) aren't worth that much but somebody with a milder or moderate depression can often keep working and can kind of hold it together enough to keep doing a lot of the things in their life that they have been doing before; working some. You know taking care of relationships; things like that. And when you have a little bit more moderate depression it gets more mixed. You know sometimes it's just too much for whatever reason or a person can work part time. They can work but not really do really what they really could do or whatever. What you have is a little more severe than that I think. [00:10:53]

(Pause) I mean a lot of time you think about suicide. It is very hard for you to work for pretty much of it. It's not for lack of trying, or desire to work, or for lack of sort of (pause) will. And you have the act of crying for a long time or had a sort of very strong conviction that it was not ever going to change. Again, depression often involves blaming somebody. It doesn't have to mess things up for other people but you know... [00:11:53]

CLIENT: Well it's got to be somebody's fault right?

THERAPIST: You know the degree of self hatred with you it pretty intense and debilitating. You know sometimes people who are really severely depressed really just kind of sit around all day and can't do anything and usually it wasn't you. I mean when things were bad it was a little bit easier to watch TV or read; not much else. But more often you tended to see people a little more or do some stuff. But (pause) depression has been severe in the last year and a half. [00:12:58]

CLIENT: Okay. How long have I been meeting with you? I don't remember.

THERAPIST: I think it's been a little bit more than a year.

CLIENT: Okay. Thanks. Okay. (Pause) Yeah.

THERAPIST: I don't generally get ECT I don't think for mild or for even moderate depression usually. [00:13:34]

CLIENT: Yeah. I think I'm... I think this is coming up for me mostly because I've just been feeling so much better in the last week or two. And, of course, that's freaking me out. (Laughter)

THERAPIST: Absolutely.

CLIENT: What do I do?

THERAPIST: One other thing I would just add to that information wise is you've not had any psychotic thinking like some other people do who get very, very depressed. But happily that's not been part of this. [00:14:14]

CLIENT: I was reading back through my journal. I had a very grumpy book I read. It's like I remember that happened. There was one doctor at one of the hospitals who was like convinced that I was manic and kept trying to ask me questions to illicit my response like that would prove that I was manic. I was like I know where you're going with him. I'm like you're just wrong. No. (Laughter) I've seen that. That's not me.

THERAPIST: That's not you.

CLIENT: (Laughter) So that would've been really funny except this is somebody who has power over me. (Laughter) [00:15:01]

THERAPIST: Right.

CLIENT: Now it's funny. (Pause) Yeah so I guess as I start to feel better and start to kind of look around and say oh okay so here are these pieces of the my life that maybe I should kind of put back together now that I'm capable of doing so. Then, of course, I'm like yeah but why did I let them drop in the first place? I'm like oh. (Pause) I'm working on it.

We had lunch with Franco today. And he and James were talking and they both are like this close to getting their PhD's...

THERAPIST: Oh okay.

CLIENT: But he's like two-thirds statistics. So he's in one department but he does a lot with statistics. And one of his colleagues... He's kind of grumpy because it's a colleague who's a year younger than he is or a year behind him in the program who most of her work has been done collaboratively with him, and I mean knowing Franco he's done more than half of the work. But she's been getting cold calls from schools saying we want you to come interview with us and she actually got a job offer. So he's, I think, trying to decide whether to be grumpy about this or happy for her. (Laughter)

THERAPIST: (inaudible at 00:16:51) market this year too.

CLIENT: Well she's not on the market. She's still got a year and a half left at least.

THERAPIST: Wow.

CLIENT: Yeah. She hasn't done anything out and he doesn't go on the market until late summer. So this coming year he'll be on the market. But (inaudible at 00:17:11) gotten into it. I'm happy for her and thinking she should take the job because it will mean that they're not on the market presenting the same material at the same time. But (laughter) he's a fairly generous person. It's a situation where it's hard to be generous I think, but he's doing a pretty good job. [00:17:38]

So part of me is just sad that I quit this program or feeling like a failure. I really don't want to go on the academic job market ever. (Laughter) The further away I get from it the more I'm like that's a horrible place to be particularly in (inaudible at 00:18:11) where there just are no jobs. There is no market. (Pause) But I still (pause) have to kind of say that it's okay you quit. It's okay. This kind of illness plus realizing that you actually want to be doing something else with your time that's a good reason to leave and I don't believe it. [00:18:45]

THERAPIST: Well (pause) I wonder if you're also kind of resentful. I'm not exactly sure about what could be worse than stopping the program. I have some thoughts. But you talk about not remembering stuff, and your friend whose saying she's depressed but is continuing with everything in her life, and Franco who has probably led the way and done more work than his colleague who not even being on the market got a job offer. [00:19:42]

CLIENT: Yeah, I do sound really grumpy about it. (Laughter)

THERAPIST: So I mean those are all about, I think, not being treated fairly or having things feeling badly done by actually. (Pause) Yeah.

CLIENT: That's really interesting (pause) because mostly what I've been aware of today and yesterday is it's just so good to not feel horrible all the time. (Laughter) [00:20:29]

THERAPIST: Yeah.

CLIENT: Wow. (Laughter) This is really nice. (Pause) And then you also have... I spend portion of my time recently feeling horrible all the time and I don't (pause) have a way to explain that.

THERAPIST: Explain why your thoughts are horrible?

CLIENT: Yeah. I sort of want that to be my fault because then it would make sense in a way that just now it doesn't. [00:21:23]

THERAPIST: I think you probably want it to make sense so that you'll be less angry about it.

CLIENT: Uh huh.

THERAPIST: I mean there's lots of reasons it's nice when things make sense. I think in this case one of the reasons is because if it doesn't or it isn't your fault it gets that. I suspect you're angry about it.

CLIENT: That makes sense. (Pause) Yeah. You know I can't even tell people about it. (Pause) I can't even say the reason I haven't very done very much in the last six months is because I've been this depressed. It makes people awkward and they don't take it seriously. They treat me differently. [00:22:58]

(Pause) I don't know how much of this is the way people actually perceive depression and how much of it is the way I perceive depression and project onto people, but I always feel like they're thinking well she just must not have very much willpower and that's why. Because you know people get sad and they can still go on with their lives. And I got sad and everything just stopped. So there must be something really wrong with me. [00:24:12]

THERAPIST: Well there has been something really wrong with you. It's nothing that's your fault.

CLIENT: Yeah. Yeah.

THERAPIST: It isn't a feeling you could will yourself out of.

CLIENT: Yeah. You know it's sort of like my father telling me well you'll feel better when the spring comes. (Pause) On the one hand I know that it's not something I can will myself out of. On the other hand... I feel like everybody else is thinking that about me that I should just get over it, and I feel like I probably am just thinking bad about myself. (Laughter) Yeah. [00:26:00]

(Pause) Yeah, I guess I'm pretty angry about that. (Pause) I am angry about the ECT because I don't remember anything about the last six months of my life. Who are you? I already lost the last however long six months a year I don't know. [00:27:10]

(Pause) It feels like I've worked really, really hard. I did all the right things for a really long you know for most of my life and now I just have to start over. (Pause) So I'm feeling better. I'm feeling like I can start over, but I don't know how long that's going to last. [00:28:23]

(Pause) Yeah, how do I make plans when it just feels like this could just happen again at any point? An extreme example like how are James and I supposed to have kids. What would I have done if I had a kid during this last year? [00:29:19]

(Pause) Now do I have kids knowing that there's a good chance they'll be depressed. I mean for starters be a little more vigilant than my parents were but...

THERAPIST: I (pause) imagine that it makes you a little worried to continue in this angry vein partly because (pause) there's some worry that won't react well to this. [00:32:00]

CLIENT: I don't know. (Pause) I sort of feel like when you say well I think you're kind of angry about this, but it strikes a real cord, and I think yes I am very angry about this. But I don't really know how to be angry if that makes sense. I say oh okay I'm angry about this and then I just shut it back down.

THERAPIST: Well it sounds like you know right there.

CLIENT: (Laughter) Okay.

THERAPIST: When you say something like I'm kind of (inaudible at 00:32:44) have kids.

CLIENT: Yeah.

THERAPIST: Or I don't know when this is going to come back. I mean those could things could be said with a variety of tones. It's not just in the content. But it felt to me like you had a bit of an edge to saying them which I understand. [00:33:17]

CLIENT: Yeah. I mean I guess it's stuff I should get angry about. (Pause) Yeah.

THERAPIST: I think (pause) also it worries you a lot because there's probably a smidge of that directed at me.

CLIENT: How so?

THERAPIST: (Pause) Partly I say that because of the feeling (inaudible at 00:34:09) and partly because you're pissed about your mental health. And I'm not saying I think you see in a general way as having not been there for you or trying to be helpful and not having been helpful in certain ways. But (pause) I'm like the person or a person whose job it is to help you with this and have this be better. [00:34:46]

This summarizes it well. You're saying look you can't give me any guarantees. You can't tell me that this is going to be okay or this is going to be okay if I have kids. It's not going to fuck everything up. And we both know you're right. I can't give you any guarantees. And in a different part of your mind you know that, of course, I can't. It's not my fault and all that. But then there's another way which, of course, you want a fucking guarantee. You know what I mean? And it's sort of in that way because that probably encapsulates. If that's there I would think it would make you quite nervous. [00:35:22]

CLIENT: I would agree with you.

THERAPIST: Yeah.

CLIENT: I don't know. (Pause) And you know I genuinely don't know. I'm not just saying that because I don't know or I feel it in conversation. Yeah. (Pause) Yeah I don't know. [00:36:20]

I don't feel any kind of (inaudible at 00:36:28).

THERAPIST: Okay.

CLIENT: (Pause) Yeah. I don't want to say no I think you're wrong because it fits so well like it fits really, really well. But I'm just not aware of it. [00:37:38]

THERAPIST: Yep. (Pause)

CLIENT: It's funny that the things I said like how am I going to have kids and etcetera; how do I know this isn't going to come back? When is it going to come back? All of the other things I think about in a pretty rapid cycle but it's all stuff that I worry about. Like I'll sit there and think about being fearful or not angry about. Maybe that's how I experience it. But yeah, (pause) clearly I am angry about it. [00:39:13]

THERAPIST: (inaudible at 00:39:28) it feels very unsafe.

CLIENT: Yes.

THERAPIST: And even there's not a piece or you're sort not in contact with a piece either way it's sort of directed at me I think. You're just rambling around.

CLIENT: Yeah.

THERAPIST: Makes it scarier.

CLIENT: Yeah. (Pause)

THERAPIST: (inaudible at 00:40:14) tell you why you shouldn't feel that way. [00:40:24]

CLIENT: (inaudible at 00:40:27). Yeah. James has been... You know I'm sort of in the habit of just telling James what I think when I think it which is good in some ways and less good in other ways. (Laughter) But he's been doing kind of a lot of telling me why I shouldn't feel the way I feel. Why I shouldn't be upset about something right or something boring. (Pause) And then I think well I just won't tell you and then I can't do that. (Laughter) So... (Pause) I guess I worry most that you won't be interested. [00:41:45]

THERAPIST: (Pause) Okay well that's all for me.

CLIENT: Thanks. [00:43:21]

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