TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: Hi.

THERAPIST: Hi.

CLIENT: (pause) This may sound like I'm giving you a hard time, which I don't really intend to do, but I kind of don't know what to do when you're not running late. (both laugh) [00:01:00] I just got here and I don't know what to say. I'm doing most of the things I do when I'm not doing well, like sleeping too late and spending long periods of time just staring into space and thinking about suicide a lot. I had four goals today and the first one was not to hurt myself. So far I've not hurt myself, so thumbs up. (pause) I finally made an appointment to get all of my thyroid things checked, which I've been supposed to do for about two months now and just have not done. [00:02:24]

THERAPIST: You mean like your thyroid [...] (inaudible at 00:02:26) levels or something?

CLIENT: Yeah, there's a standard thyroid test that they can do and that's what they have done since they found the goiter. Then there's a whole bunch of other thyroid tests that they can do that I should know more about, but don't even though I think I've had that explained to me several times. Dr. Vaughn (sp?) wanted me to do them. I've just been avoiding finding a lab which, when I actually sat down to do it, it took less than ten minutes to make an appointment. As always... (pause) [00:03:43]

I feel really bad about myself right now. (pause) I don't like not having a job. I haven't been applying for jobs the last couple of weeks. I'm applying for tutoring jobs as they come up, but that doesn't really count. (pause) [00:05:20]

It feels like things aren't at their worst, but they're going to get there soon and I just don't care or know how to stop it or have the energy to do what I usually try to do to kind of head these things off. (pause) [00:06:28]

THERAPIST: Yeah, I think partly you don't care and part of you is really terrified.

CLIENT: Yeah. (crying) (pause)

THERAPIST: It kind of feels like you're telling me this and I should be doing something about it.

CLIENT: I don't know. (pause) I don't know what there is to do about it. I sort of feel like I'm telling you this because it's what I'm supposed to do. [00:07:58]

THERAPIST: I see. (pause) I think you do suspect that at another level it feels like I should do something or should be able to do something that's going to be able to help and make it better even if, in a rational way, it's unclear what that would be. [00:08:50]

CLIENT: Yeah. (pause) Yeah, I want you to be able to help. (pause)

THERAPIST: Maybe I'm feeling kind of neglectful if I'm not [doctoring.] (ph?) (pause)

CLIENT: This is really hard for me. [00:09:48]

THERAPIST: Uh-huh. Yes. I would imagine that.

CLIENT: I guess I feel like sometimes you say things that really help and sometimes you don't, and I don't know what the difference is. (crying) (pause) But I show up and think, "Maybe this will be the day when Chad really helps me." [00:11:13]

THERAPIST: That must be very hard for you to say, in a way.

CLIENT: Yes. (crying) (pause)

THERAPIST: I think you feel sort of worried, too probably I would guess sort of guilty and sort of worried about how I might react.

CLIENT: Yeah. Yeah. I have this strong urge to apologize. [...] (inaudible at 00:12:11) (pause) Saying something that I think is going to be hurtful to you and then just keep sitting here that's really hard. (laughs)

THERAPIST: I feel like part of what's going on now, why you're having a harder time, not the only reasons I think, but I think [the work is starting to point to many other things] (ph?), but I think even telling me that you're in a very tight spot here knowing me and trusting me enough to talk about some things like you just did makes you very, very anxious. [00:13:38]

CLIENT: Yeah, it feels like the work thing sort of felt like I've been really unhappy with myself and anxious and so I kind of put that on the work, like it's like I'm looking for a reason that I'm so unhappy with myself. Also that I haven't been doing as much to try to get out of the place that I'm in. I think, in part, because I'm anxious and unhappy with myself. It's hard to... [00:14:44]

THERAPIST: You have been here, actually. When you say that you haven't been doing a lot to try to get yourself out of it, I know that you're referring to ways of coping and things like that.

CLIENT: You mean applying for jobs and things?

THERAPIST: Yes. But here you have been working very hard.

CLIENT: Thanks. I'll try to keep that in mind. Thanks. And, yes, yes I have. (laughs)

THERAPIST: And probably in a direction of some of what's caused your depression in the first place. I can elaborate if it's not clear what the hell I'm talking about. [00:16:05]

CLIENT: Yes, please dissert.

THERAPIST: It seems to me that this business about having very important things that you want to tell me to do with our relationship, then you are terrified to tell me for fear of your own guilty reaction, or for fear of my response to them, has been a central problem, essentially, in your life for a long time and probably has a lot to do with or has a lot to do with why you're depressed in the first place. There's a lot of specificity I don't know. For instance, I don't know about [...] (inaudible at 00:17:15), but I'm pretty sure that's true. It's not just about your kind of external relationships with people, in other words what you can tell people around you; but it's also about how you have to hold and configure yourself internally to manage what you can and can't say. [00:18:03]

CLIENT: That makes sense.

THERAPIST: For example, it seems to be making you very anxious through your life, like outside of here I mean, for being in this very anxious and difficult spot with things you want to tell me, but are terrified to. That's not confined to how we interact here.

CLIENT: I don't just leave it here, you mean? Yeah. Yeah. Okay. (pause) I'm sort of waiting for the other shoe to drop here and I don't think there are any other things I've wanted to tell you that I now have not told you, so it's like what are you going to do? Yeah, I guess the fantasy that I have about that is that you are going to wait until I'm not expecting it and then bring these things up and use them to hurt me. (pause) [00:20:01]

THERAPIST: I see.

CLIENT: (crying) Just so you know.

THERAPIST: It's also pretty scary to say.

CLIENT: Yeah. Yeah. And it's too late now; I can't take them back. (pause) (crying) [00:20:56]

THERAPIST: And again, it sort of involves me being either someone who doesn't really know you or doesn't care, or someone who is very cool.

CLIENT: Yes, although I do a lot of mental gymnastics so as not to think of that as cool. (pause) [00:22:22]

THERAPIST: Which I think in a way can put you in a dangerous position when you're working to conceal or talk yourself out of how someone is and sort of might be cool or unfair or something like that.

CLIENT: How do you mean? I don't know if you can get any more explicit.

THERAPIST: One association I have is to Bryan.

CLIENT: Yeah, I've been thinking a lot more about him in the last couple of days than I almost ever do. [00:23:28]

THERAPIST: I don't know, obviously, if this is fair, but I think you probably did similar gymnastics.

CLIENT: Oh, yeah. I was a pro. (laughs) (sniffles) Yeah. It's sort of hard for me to reconstruct the ways that I thought about him when we were together, just because my thinking about him and about that relationship changed so much after we broke up. I was like, "Oh, wow. That was really bad." That was really bad pretty much the whole time. I used to be so angry and so upset and so hurt at him at a specific thing he would do, but it never bled into saying, "This is part of a pattern. It's not just this time." With Bryan I did a lot of saying, "He can't help it." Yeah. [00:25:06]

THERAPIST: With me, I imagine if you were kind of hiding him behind "he can't help it" or hiding things that he did, hiding his cruelty behind "he can't help it," I think you hide mine sometimes behind "this is ultimately therapeutic and helpful. "

CLIENT: "I'm sure this must be good for me somehow. " (laughs)

THERAPIST: "This must be the way this works." I'm not saying you're wrong or correct with it.

CLIENT: Yeah, that's the thing. I'm pretty darned right about that or I feel like I would be right about that. (laughs)

THERAPIST: I believe you are, but you're kind of also using them to conceal what it feels like sometimes, which is very different. [00:26:17]

CLIENT: So if I say that this is ultimately good in some way, then it doesn't matter how it's making me feel. Is that sort of what you mean?

THERAPIST: Yeah. Like I'm cutting my arm off or doing surgery. (pause)

CLIENT: Okay. (pause)

THERAPIST: And as a [...] (inaudible at 00:27:05) you really need me. It's not for no reason that you're doing the gymnastics, you really need me and that's hard to reconcile, I think, with how cruel it can feel like I'm being and also how little tolerance you sort of imagine that I'd have for seeing it that way. (pause) [00:28:03]

CLIENT: Yeah, I keep thinking about what you said about tutoring. "Get them to like you." (laughs) Something about this kind of therapy that is (sighs) I don't know what it s but like none of this conflict would be in place if I didn't really need it. [00:29:06] Well, I sort of want to say, "I can't say I didn't sign on for it," because you know I did some research. That's me. I feel like if I understand the situation I can control it. That's not actually how it works at all, so here I am. (long pause) [00:30:46]

So you clearly have seen this coming for a while. You've been kind of pushing me a little bit in this direction for a little while. Is it hard to wait for patients to get there on their own not on their own, but to get... you're probably not going to answer this question. I find one of the most difficult things in teaching is when a connection is very, very clear to me, but it doesn't do any good for me to make the connection for the student. I have to set up the pieces and make the connection. That's the only way that's going to be useful for them, but I get impatient. This is in the course of a five-minute conversation, so something like this that I can talk to you about these things this week or it could have been another couple of months... Is that hard? [00:32:15] (pause)

THERAPIST: Well, you're right about me not answering that directly.

CLIENT: (laughs) Okay. (pause) [00:33:41]

THERAPIST: I'm just thinking about the questions.

CLIENT: You don't have to answer that. (laughs)

THERAPIST: The thing about how to answer the question is how to respond to the question or what it means, that's usually what I do. (pause)

CLIENT: Well, I get uncomfortable so I try to make you talk.

THERAPIST: Okay. (pause) [00:34:34] There is something that feels a little student and teachery about the question. It's also sort of a comfortable mood, I think. (pause)

CLIENT: I'm also asking you about your perspective, which is really not comfortable for me.

THERAPIST: Huh.

CLIENT: Which I guess I sort of didn't anticipate until I'd already asked the question. (laughs) Now it's like out there. (laughs)

THERAPIST: Like which part about asking for my perspective is uncomfortable? Is it because I'm not likely to answer or because I might answer or...? [00:35:43]

CLIENT: It sort of feels unfair to you.

THERAPIST: I'm not nodding because I necessarily doubt it, but there are things you said just now or at other times where it seems like feel you've done something that's unfair.

CLIENT: Or like that's not what I'm supposed to be doing here. (long pause) [00:37:34]

THERAPIST: And, again, the burden is kind of on you to know about and manage what's there to ask me because...

CLIENT: Yeah, I guess so. That had not occurred to me at all. (chuckles) (pause) [00:38:30]

THERAPIST: It's as though I'm going to be reactive to being asked.

CLIENT: Yeah. You said that. "I guess the worst I could do is not answer the question," but it's like no, that's not the worst you could do. Not by any means. (laughs)

THERAPIST: Yet you don't seem... I would imagine it doesn't feel good, but it doesn't seem like it's not that horrible if I don't answer questions like that.

CLIENT: No. Not at all.

THERAPIST: sometimes it feels a bit rejecting, even if you know I'm not going to answer it probably. [00:39:26]

CLIENT: I don't know. I mean maybe, but that's not what I worry about. I guess if I ask you a question that you don't want to answer, the problem is with me trying to ask the question, not with you for not answering it; so I don't want to ask you questions that you're not going to want to answer because I don't want to be the one asking like I don't want to be asking them. [00:40:18]

THERAPIST: I see, so because I didn't answer it makes you feel like you shouldn't have asked?

CLIENT: Yeah.

THERAPIST: Oh.

CLIENT: Less so because we literally had a conversation about this exact topic a while back. (laughs)

THERAPIST: [So this is a conversation we might have had?] (ph?) (both laugh) [00:40:43]

CLIENT: Where you asked me what the things were that I wanted to know about you that I wasn't asking you. That's on the list. That kind of made it to here.

THERAPIST: Well, that's good.

CLIENT: Yeah, I guess. (long pause) [00:42:29] What?

THERAPIST: I guess you seemed you were reacting to something or having some thoughts that looked like you were just about to convey but you don't have to. (client laughs) All I'm saying is

[...] (crosstalk at 00:42:50)

CLIENT: I was thinking about The West Wing. (laughs) The first was you said you liked The West Wing, and I thought, "Of course you do." (laughs) The second one was I think the thing for me that's difficult about it is that I like the show when I think of it as a fantasy. I don't like the show when I think of it as trying to actually be realistic in any way. I guess I feel pretty betrayed by politics like I didn't vote in the last election because there wasn't anybody that I felt good about voting for. It's sort of heart breaking to see these people that it's like, "Yes, these are the people I would like to be running my country." But they're not the people I have and there's nothing I can do about that. That's a struggle for me.

THERAPIST: We should finish up.

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