TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: Hey, real quick, I'm trying to hammer out some details for next year. Because I mean I have to submit my budget for like the entire year. And I should have done it, you know, a couple weeks ago probably. But I'm trying to get this information from the health insurance. And I've been able to figure out some stuff about what the plan is going to be.

THERAPIST: Who is this?

CLIENT: This is the health care for Suffolk University.

THERAPIST: Oh okay.

CLIENT: The student health care plan that I'm going to be going on -

THERAPIST: Yeah.

CLIENT: in February, if not earlier. And I'll be on it for quite some time. And, I mean, I've been trying to do this after hours, like after five. So it's impossible to get folks on the phone. But it's a student plan, but I think it says it's a PPO. [00:01:09]

THERAPIST: Oh yeah.

CLIENT: I don't know what that means. What does that mean?

THERAPIST: That means you can see people that don't take your insurance. It will cover visits.

CLIENT: That's good.

THERAPIST: Yeah.

CLIENT: That's better than the other? What is the opposite (ph)?

THERAPIST: It's actually really Well first of all Well here's some things. One is that it kind of will work like your plan does now. Actually, I take this insurance now but I'm not going to be taking it starting January first. You know, I'm not going to be taking insurances. But if you have a PPO plan, they'll cover the visits. And not only that but the plan will cover twice a week. It will cover multiple times a week. It will cover three or four.

CLIENT: When you say the "Plan" can you even say that with certainty without knowing like the details of it. [00:02:08]

THERAPIST: As long as it's PPO. And the only other thing, yeah, I can say that if it's Well, no I can't say that with certainty. You never can with insurance companies. (laughs)

CLIENT: Yeah. (laughs)

THERAPIST: But with people that I see with PPO, they don't manage, there's no management of a mental health benefit. Which means that it's up to the discretion of you and me how often we meet. They don't -

CLIENT: Really?

THERAPIST: Yeah. At least at current. Now the only thing that, with a PPO plan not the HMO plan.

CLIENT: I'm on an HMO now?

THERAPIST: No.

CLIENT: I'm on a PPO?

THERAPIST: You're on a PPO. The basic different between any HMO and a PPO plan, as far as I know, all HMOs you have to be an in network. You have to see somebody that's an in network provider, that is, has agreed to, and is on the panel of health care. [00:03:17]

CLIENT: So they are considered less desirable then.

THERAPIST: I think sometimes they can be.

CLIENT: [Well, regardless anyway.] (ph)

THERAPIST: Yeah. Well the HMO, the plan itself, yeah, is much less desirable but it's cheaper. Sure.

CLIENT: Cool. Okay, I understand.

THERAPIST: And the PPO plans for other means you can see anybody you want. Now there's been a lot of, like your benefit for instance, they will manage your out of network benefit.

CLIENT: Mm hm.

THERAPIST: Actually, it's a big legal question whether they actually can because it's considered, lawyers consider that discrimination against mental health care versus like, you know, they don't manage other benefits. [00:04:16]

CLIENT: Mm hm.

THERAPIST: Anyway, that's besides the point. But just getting back to the plan, the PPO plans that people have that I see they don't manage them, with the exception of people that have certain student plans, including Yale and Amherst. They will have like a limit to how many visits you can have, like twenty four or something like that. And it's basically the way it's contracted with them. Now Emory, no problem. It's like every other PPO plan. They don't manage it.

CLIENT: Hm.

THERAPIST: But with Yale and Amherst, for instance, they have specially arranged contracts with the insurance.

CLIENT: Mm. So then I should Yeah, man, I just need to get someone on the phone that I can talk to. I just want to figure out what that's going to be, you know, for you. [00:05:24]

THERAPIST: Yeah.

CLIENT: Like I've looked at some of the paperwork and stuff but it's really unclear. I mean I think there's something along the lines of they I mean it's going to be 60/40 out of network for mental health. But I can't get any hard information on like the annual deductibles or anything.

THERAPIST: Okay.

CLIENT: I've kind of made my budget and I'm ready to send it in if I can't get more information, assuming that there's a thousand dollar deductible, and assuming that we would be able to keep seeing each other at least once a week. And at the price that we're at now?

THERAPIST: Yeah.

CLIENT: I don't know if that's even reasonable. But, yeah, maybe what I would do is if I could I'll just at least take this like basic, like I go on the website and there's like 2012, 2013 health care plan which is already in effect that people are on. And there's all sorts of information (inaudible at 00:06:21) let me figure out anything else about it. But then for the 13-14 there's like this two page PDF that like is just really, really like superficial. It doesn't really have any details.

THERAPIST: It doesn't have deductible? It doesn't have mental health?

CLIENT: I mean it says like it's a fifty dollar deductible. But I know that that's not what it's referring to for I don't know. Maybe.

THERAPIST: Okay..

CLIENT: I would be shocked if It says a fifty dollar deductible, which is a combination of like in network and out of network coverage. Maybe this is just like an incredible plan -

THERAPIST: Could be.

CLIENT: compared to the one I'm on now.

THERAPIST: Well for students they have less risk. There's less kind of utilization. If they can keep the cost down because they're students.

CLIENT: Yeah, but these are student health care plans. They have a monopoly on this market. Students have to take it. You know what I mean? Like they literally have like a gun to students head. You know what I mean?

THERAPIST: Yeah.

CLIENT: If you didn't have to you could worry about being a desirable product. You know what I mean? I have to take this health insurance. You know what I mean?

THERAPIST: Yeah. Yeah.

CLIENT: I don't know. I just know that the co-insurance at US Providence is atrocious (ph), horrible.

THERAPIST: Is that right?

CLIENT: Yeah. But maybe what I'll do is even, not to the limit that you can do so, I might just send you the PDF. [00:07:28]

THERAPIST: Yeah.

CLIENT: And maybe if you can take a glance at it, if you can understand it really clearly.

THERAPIST: Yeah.

CLIENT: But I just don't know when I'm going to be able to get on the phone with these folks.

THERAPIST: Yeah, somebody should be able to tell. I mean, somebody should know that stuff. I mean that's If they're not, I mean, there should be somebody that can answer those questions. Those are basic questions.

CLIENT: Yeah.

THERAPIST: You should be able to.

CLIENT: Yeah. I should be able to. But I might just send it to you anyway just to see what you -

THERAPIST: Oh yeah, sure. Yeah, yeah. I'll tell you whatever I can. Send it to me though, yeah.

CLIENT: Yeah. That's that. (pause) I don't want to talk about that anymore. I want to talk about some other stuff. It's funny. I was thinking about it a little bit today, like what am I going to talk about today. And I was thinking about that. Because this stuff with my Dad has kind of just fallen off my mind. [00:08:36]

THERAPIST: Hm.

CLIENT: You know? It's not depressing. Even after I kind of like got to the other end of it and I got that job and I had kind of, you know, removed myself from that situation, I was happy. And for a little while I was like still really focused on how kind of glad I was that it worked out the way that it did. Almost with the same intensity as I was focusing on it when it was bothering me. You know? But I just don't even think, I haven't even been thinking about my Dad lately.

THERAPIST: Mm.

CLIENT: I mean, In a good way. I haven't really been talking to him much on the phone or anything. And I've been feeling, I've been feeling good lately in a weird way. And, yeah, I was trying to think about it earlier today. Like one of the things I thought I wanted to talk about today was like me smoking. Me wanting to (pause) Me wanting to stop smoking. [00:09:48]

THERAPIST: Hm.

CLIENT: You know? I think we've talked about me smoking before, but I feel like we've talked about like to kind of understand it and stuff. But I almost want to talk about it more with a focus on like trying to stop doing it.

THERAPIST: You've been wanting to stop?

CLIENT: Yeah. For a little while now I've felt like I've really wanted to stop in a very, I don't know, looking at myself from a thousand feet above type thing. You know?

THERAPIST: Mm.

CLIENT: You know, even as I have wanted to be having cigarettes. Do you know what I mean? It's not as if I've like not wanted cigarettes as much, but I've wanted to like imagine myself and move towards not doing that.

THERAPIST: I see.

CLIENT: In a weird way. You know? And at one point today I was in the bathroom, I was washing my hands, and I was like, "Oh!" I remember I heard one time that Matt Damon did like hypnotherapy or something, in an interview, and he said that it worked like incredibly well. And I was like, "Yeah, I should try that or something." [00:10:55]

And then I was like, "Well, maybe I should just talk about it hear." Do you know what I mean? But I guess I never really saw this as something like I think I acknowledge that there's obviously like a connection between what we do here and things that I do. But I guess never envisioned it as like that.

THERAPIST: Hm.

CLIENT: Like A, B type thing. Do you know what I mean? But like that could be like a focus of something that we could work on here.

THERAPIST: Oh. Uh huh. Uh huh.

CLIENT: Yeah. And I just had the thought, I wanted to like ask you. Is that something that you've liked worked on with people?

THERAPIST: Smoking cessation?

CLIENT: Uh, because that's like an area of therapy, right? That's like a type of thing people do or something, right?

THERAPIST: Yup. Well, yeah, no, it is. Yeah, it's an area where people kind of focus on, I mean there's a lot of, they tend to become like behavioral focus. I'm sure there's a lot. [00:12:10]

CLIENT: Like worksheets (ph) and stuff like.

THERAPIST: Uh. Maybe. Maybe not, though.

CLIENT: Just the idea of it seemed very different than like what we do here.

THERAPIST: Yeah. Well, what did you envision. Tell me about it.

CLIENT: When?

THERAPIST: About like what you had in mind about me helping you.

CLIENT: I don't know. I just feel like it just seemed odd to me because I thought to myself immediately, if I wanted to try to stop smoking I would take like Nicorette gum or something, or go see like a hypnotherapist or something. But not -

THERAPIST: But do you bring it here to me?

CLIENT: I feel like I would bring it here to you. But like when we talked about it last time I really enjoyed our conversation about it. But I didn't feel like we were working on me quitting smoking.

THERAPIST: Yeah.

CLIENT: You know what I mean? Like it just feels very different. You know what I mean? [00:13:09]

THERAPIST: Yeah. Yeah, yeah, yeah, yeah. Well, in terms of me helping, yeah. No, I mean I certainly think it can be helpful. And, yeah, yeah, no, I'd be happy to try to help you out in any way.

CLIENT: It's not even It's a weird questions because I kind of know the answer to it. That like, yeah, in a way that's what I've been doing here. I've been trying to affect changes with other things. But I guess what I saw was just sort of like a distinction between this very, (pause) I don't know, just a different type of way of approaching it, I guess. It was just a small thought. [00:14:14]

THERAPIST: Yeah. Did you have anything in mind though? Like the way that I could come, that you'd want me to approach it, or that you felt, "Hey, can we could approach it a different way than we're normally talking?"

CLIENT: No, I mean I guess I just I guess what I'm just trying to express is like I have this thought like, "I want to stop smoking." And for like a brief second in my head I was like, "Ah maybe there's like a pill I could take or something. Maybe there's like a medicine or maybe there's a thing I can do to try to stop that.

And I guess what I just sort of thought to myself was like, it just struck me as odd that this didn't even really like seem to fit into that very, kind of these list of things like a nicotine patch or taking -

THERAPIST: It didn't. Yeah.

CLIENT: you know, taking Wellbutrin or something.

THERAPIST: Mm.

CLIENT: You know what I mean?

THERAPIST: Mm hm.

CLIENT: But then I kind of thought to myself, like, yeah, I think this is a way. I think this definitely is a place that I would probably feel more confident about the prospects of being able to handle it. [00:15:17]

THERAPIST: Mm. Yeah.

CLIENT: Do you know what I mean?

THERAPIST: Yeah.

CLIENT: Yeah. (pause) But, you know, getting off of that. I mean it strikes me, it just feels different, even just like the way that my mind has been falling on it. And it seems to be like an indicator, falling on it, like the way that my mind just sort of starts randomly to think like, "Ah man, I should try to stop doing this." You know? Like that's not something that happens to me a lot.

THERAPIST: Oh. Huh.

CLIENT: You know? It's a very different There's ways that, you know, I've always kind of thought to myself in the past, "I need to stop smoking." But it was always accompanied by, you know, "But not now." You know? "I can't right now." [00:16:22]

THERAPIST: Yeah, yeah.

CLIENT: You know, that that's not a priority. "There are other more important things that require your attention." And, you know, it's almost like an act of comforting (ph) or something. Do you know what I mean? You know it's not right, but it's just like a coping thing to get through stuff.

THERAPIST: Yeah.

CLIENT: And for whatever reason it's just interesting because for some reason I can just sort of think about that now.

THERAPIST: Mm.

CLIENT: I can actually think about that as like a thing. Do you know what I mean? I can think about tomorrow. I can think about, "Wow, maybe that can be something I can work on tomorrow."

THERAPIST: Hm.

CLIENT: Whereas, prior to that, or typically in the past, I would think to myself, "Oh man. I really need to stop smoking but I can't tomorrow because of x, y and z." You know what I mean? But for some reason that just seems not to [00:17:24]

THERAPIST: It more seems possible that you can consider stopping tomorrow. Is that what you're saying?

CLIENT: Yeah. For example, like a week or two ago I would have said to myself, "Yeah, it's important that I stop smoking at some point." But I would have said, "I'm going to have to deal with this shit with my Dad. I'm going to have to find a job. I'm going to have to " You know, the list goes on. You know what I mean?

And that was always the way that I kind of thought about it. And it just feels very different to be able to think about it like there's not those other things that just seem to immediately take precedence over it.

THERAPIST: Mm hm. Yeah.

CLIENT: Do you know what I mean? And sort of the reaction to that, I noticed it. And I'm like, "God, did I actually " That makes me feel kind of good. [00:18:27]

THERAPIST: Mm.

CLIENT: That I could think about it tomorrow and I can actually like I can actually, you know, think about ways that it could be as opposed to just even thinking about tomorrow as already hostage to concerns and anxieties. Do you know what I mean?

THERAPIST: Mm hm. Yeah.

CLIENT: Do you see what I'm saying? And that's just the way that I've always thought about it. Smoking is something I do so much that I think about that like twenty times a day. You know what I mean? Because every time I smoke a cigarette I'm, you know, thinking about that. You know?

THERAPIST: Yeah.

CLIENT: And I want a cigarette right now. But I also want to It's like the gym. You know, [I saw people at] (ph) the gym a little while ago.

THERAPIST: Mm.

CLIENT: I'd like to start going to the gym, but (pause) You know, even like the way that I would talk about it with my Dad. Like how it boggles my mind sometimes that he'd go running because there's so much stuff going on. [00:19:46]

THERAPIST: Uh huh.

CLIENT: Do you know what I mean?

THERAPIST: Yeah. No, that's an element. Like there's a feeling of there's so much stuff going on. I don't want to -

CLIENT: How can you think that there's nothing worth your attention more than going for a jog for your health.

THERAPIST: Oh yeah. Yeah, yeah, yeah.

CLIENT: Do you know what I mean?

THERAPIST: Oh yeah. I remember you saying that. Yeah.

CLIENT: I always felt like it was being on the complete other side of that point -

THERAPIST: Okay.

CLIENT: that led me to smoke. Do you know what I mean? And that that was what That's why it made sense to me, or something. You know?

THERAPIST: Because it's like what? It's like you're taking out time for yourself to work on yourself. And how do you have time to focus your attention on that matter? [00:20:42]

CLIENT: It seemed, yeah, I mean running and going to the gym, eating vegetables. I mean that seems like, you know, everything is, you're just polishing up the edges of something that is just fine. You know, it's -

THERAPIST: Hm.

CLIENT: I don't know. I can't explain this. This is just what I think.

THERAPIST: Mm hm.

CLIENT: I don't know. I just want you to like I feel weird that I can't put it into words because it's just something that I just think so much.

THERAPIST: Yeah. No, no, no. Keep trying. It sounds like superfluous. Is it superfluous? I mean kind of like -

CLIENT: It would seem like someone on death row like choosing their last meal, like it being salad because it's better for you than McDonalds. Do you know what I mean? [00:22:00]

THERAPIST: Oh.

CLIENT: Like you wouldn't do that.

THERAPIST: Oh.

CLIENT: You know what I mean? Why would you do that? Do you know what I mean?

THERAPIST: Ah. Huh.

CLIENT: Tomorrow's about getting through tomorrow.

THERAPIST: I see.

CLIENT: You know, who even knows if there's going to be a day after tomorrow. Do you know what I mean?

THERAPIST: I see. I see.

CLIENT: Like, literally, that's the -

THERAPIST: I see, yeah. Yeah. I see, yeah, yeah, yeah. Right. I get it.

CLIENT: And like that's the (pause) That's the thought process that I've been in for a long, long, long time. For a very long time. There's never (pause) You know it was hard to think about like, "Oh, how can I make things better now. How can I start to like polish off the edges of my life." As opposed to like, "How do I just put my head down and just get through this." [00:23:25]

THERAPIST: Just get through. Yeah.

CLIENT: Do you know what I'm saying?

THERAPIST: Yeah. Yeah.

CLIENT: And the fact that I'm even thinking to myself, "God, you know, maybe between now and law school like that's a thing I could do."

THERAPIST: Mm.

CLIENT: I mean when I think that it feels weird and it feels, it almost invokes on some level like what I've spoken to you about in the past where I start to get nervous almost. Like, "What am I not paying attention to?" or something. You know, "What am I overlooking?" or something. Do you know what I mean?

THERAPIST: Mm hm. (pause)

CLIENT: But I continue to keep smoking at the same time. (pause)

THERAPIST: Yeah. What do you -

CLIENT: I don't know. That's just what I do.

THERAPIST: Yeah. When you kind of How do you get from like Do you think about it and then do you go to like, "I'm smoking," and continue to do it? [00:24:49]

CLIENT: I guess I'm, it's just the way I'm putting it I suppose and think, "Oh, well then you wouldn't need to smoke then, you know, if you don't feel so much weight on you," or whatever. You know. But I still do. Have you ever smoked? Have you ever been a smoker?

THERAPIST: No.

CLIENT: No?

THERAPIST: Yeah. Why do you ask?

CLIENT: I'm just curious because I had a conversation once with someone a long time ago. I remember this girl I used to work with at camp, she was from Scotland. And I was talking to her and I had been smoking at the time and she was a lot older than me. And I was like, "God, when are you going to stop smoking?"

Because in my mind it was never something I was going to do forever. You know? It was always a phase or something. You know, this thing that I did but it wasn't like, I was never a smoker. I was like, "When are you going to stop?" And she was like, "I don't know. I don't think I'm ever going to stop. I love it." You know? [00:25:58]

And it seemed really foreign to me. It seemed like a very weird way to think about it. But in a big way I don't want to stop.

THERAPIST: Oh yeah. There's another side of even still. You don't want to stop.

CLIENT: Yeah, I don't. I feel that now.

THERAPIST: Yeah.

CLIENT: I love smoking.

THERAPIST: Uh huh.

CLIENT: I love everything about it.

THERAPIST: What about it?

CLIENT: I (pause)

THERAPIST: How much do you smoke a day, by the way? How many cigarettes?

CLIENT: It comes and goes, but I mean if I'm working I smoke less. But if I'm not, I mean a pack a day would be like the upper end of it.

THERAPIST: A pack a day.

CLIENT: You know?

THERAPIST: And what kind?

CLIENT: Camel lights.

THERAPIST: Camel lights.

CLIENT: Mm hm. Camel Blues now. You can't call them Camel Lights anymore. It's deceptive.

THERAPIST: Oh they made them take away the "Lights?" (laughs)

CLIENT: Mm hm. They have to call them "Blues" now.

THERAPIST: (laughs) It's a nice color.

CLIENT: Sorry?

THERAPIST: It's a nice color though.

CLIENT: It is. Yeah, it's a great color. I mean the packages look the same as they did when they were Camel Lights, there's just a little blue piece on it so they can call them "Camel Blues." [00:27:08]

THERAPIST: [It's amazing how the deal with it.] (ph)

CLIENT: Yeah. They look exactly the same. But no, I love it. I mean I guess the way I think about it, they're a great This might sound sort of like corny or something. They're like a great companion of mine, a great friend of mine. You know? They're (pause) They're always there. I don't know.

THERAPIST: There always there. Yeah. Huh.

CLIENT: I'm relying on them. I look forward to them. They are a reason to get out of bed in the morning a lot of the times.

THERAPIST: Hm.

CLIENT: Literally. Like, God. If I get in the shower I can get that cigarette. You know?

THERAPIST: When do you have your cigarette? What do you do?

CLIENT: In the mornings typically it will be. I get ready pretty fast in the morning, so I'll usually hop in the shower, have some coffee and then get out the door and have a cigarette. [00:28:17]

THERAPIST: When you leave your place?

CLIENT: Mm hm. Yeah, walking to I mean if it's the weekend I just make a cup of coffee and then I just go out on the porch and have a cigarette.

THERAPIST: Ah, ok.

CLIENT: But they are (pause) They are my alone time. You know? They are what I look forward to on like a long-ass day with my family.

THERAPIST: Mm.

CLIENT: When I go home I get to have my cigarette. (pause) I don't know.

THERAPIST: A companion. Yeah.

CLIENT: Yeah. Absolutely. That's what I think about.

THERAPIST: Reliable.

CLIENT: Yeah. Absolutely. Absolutely. You know, when I'm upset I like them. You know? That's what you do, you know, when you're stressed. You smoke. You know?

THERAPIST: Yeah.

CLIENT: And, you know, who knows. Maybe it makes me more stressed all things considered. But at the moment in serves my purposes. [00:29:21]

THERAPIST: Well, yeah, but there's also something, I guess, about it that -

CLIENT: I mean, when I'm doing it I feel better.

THERAPIST: Yeah.

CLIENT: Sometimes that's, you know -

THERAPIST: Well, yeah, there's the biological what the actual kind of nicotine does to your system. But there's also the There's the real psychological relationship piece that you're talking about almost, that's [always there] (ph). That there's something about having a companion in there. You know? It's with you. It has like a quality of an entity that's with you, it's living with you.

CLIENT: Mm hm.

THERAPIST: In a way, or at least the way you're describing it.

CLIENT: No, Absolutely. I mean when I think about stopping smoking I think about, like I just look back, you know, at how much I've smoked. And like (pause) Yeah, I don't know. Almost like, If we're going to keep that metaphor going. I feel really silly using this metaphor, but it just keeps coming to mind that, "All the times we've had together," or something almost. Do you know what I mean? [00:30:38]

THERAPIST: The times you had together. It would feel like a break up.

CLIENT: It would be. You know? It's a very personal thing. It might be one of the few things that's very personal to me that I really like.

THERAPIST: Hm.

CLIENT: You know, where I feel like a lot of the things that are very relegated to the personal are objects of shame an stuff. You know?

THERAPIST: Hm.

CLIENT: Things that I don't want to You know, in a way I can see my smoking as like an object of shame. I hide it from people. You know? I don't like to let people see me smoke. I mean I prefer not to do it in public. You know?

Like at school when I take my breaks, when I'm working of something, I'll always go like somewhere where there aren't people walking around to smoke. You know, almost like I still smoke the way that I smoked when I was sixteen and it was like a secret or something. [00:31:39]

THERAPIST: Mm hm. Mm hm.

CLIENT: You know? But it's something that, yeah, something I look forward to.

THERAPIST: And it's kind of like what? If it's seen people will see that you have this thing that you need that you depend upon. That kind of thing?

CLIENT: I don't really know why. I just feel shame. I guess I developed a relationship with it as something that was a secret. Like when I was living at home.

THERAPIST: Huh. Okay.

CLIENT: And it just seems like I have to make a decision to have it not be a secret as opposed to the other way around. Do you know what I mean?

THERAPIST: Yeah. Right.

CLIENT: And even when I'm doing it in public sometimes it feels a little bizarre or something. But I still just associate doing it with like kind of just private places and stuff.

THERAPIST: When you started it, what were your associations about ? Why were you keeping it a secret?

CLIENT: Because I was living at home with my parents.

THERAPIST: And what would they do?

CLIENT: They'd freak out.

THERAPIST: Because.

CLIENT: I'd be smoking.

THERAPIST: Bad for your health?

CLIENT: Yeah. I'd be -

THERAPIST: What, what, what?

CLIENT: Yeah, I don't know. I mean, I guess I feel like that just justifies itself. Like, why? Smoking's not good. You know? But I suppose there's probably more to it. You know? I don't know. [00:33:09]

THERAPIST: Oh yeah.

CLIENT: I suppose -

THERAPIST: What it means to be "not good," for starters. What is that like? (laughs) That's a good place.

CLIENT: Yeah, like I know that when I was living at home with my Mom it would have been a concern to her. She would have been very worried.

THERAPIST: Mm.

CLIENT: She would have been very She probably would have felt guilty. She smoked when I was very young. I barely remember it but I know that she smoked. And she relapsed, you know, occasionally when she was splitting up with my Dad.

THERAPIST: Mm.

CLIENT: Yeah, she probably would have felt like it was her fault or something.

THERAPIST: If you play that out, what is it? What would she feel guilty about? That? [00:34:10]

CLIENT: It's just, I play it out, she would have felt guilty about the fact that I was smoking and if it was either of my parents faults it couldn't have been my Dad's fault. Maybe it wasn't my Mom's fault because simply on the grounds that she smoked in the past and maybe I saw it, or something. But it could not have been my Dad's fault because my Dad goes for runs after work. You know, he doesn't smoke. Do you know what I mean?

THERAPIST: Yeah.

CLIENT: So if it was going to fall anywhere it would have had to fallen -

THERAPIST: She would.

CLIENT: in that type of dynamic. Yeah. I think she would have felt that. And I think, yeah, I don't know, it probably would've, you know, "Why do young kids start smoking?" Do you know what I mean?

THERAPIST: Why?

CLIENT: Because they're upset.

THERAPIST: Yeah. Yes. Yes.

CLIENT: You know. There's something going on or something.

THERAPIST: Yes.

CLIENT: And that definitely would have been a thing.

THERAPIST: Mm. Yeah.

CLIENT: And for my Mom that would have been a thing.

THERAPIST: Yeah. Yeah.

CLIENT: And that would have (pause) contributed to those kinds of guilt and shame. [00:35:33]

THERAPIST: Yeah, you felt like it would've been a sign to her that something was wrong and you were needing something. You were needing to smoke because you were upset (ph).

CLIENT: Mm hm. Probably.

THERAPIST: Something was troubling you. I was thinking about your, I think it was when you were at a club, and you saw the woman smoking.

CLIENT: Mm hm.

THERAPIST: And it just, what? It seemed to be connected to a kind of an acknowledgement or an exhibition of the fact that she was troubled by something. She was ashamed -

CLIENT: Mm hm.

THERAPIST: And wanting to hide that she was troubled by something. She needed to go somewhere, but smoking being an extension of this feeling troubled.

CLIENT: Yeah.

THERAPIST: That she didn't want to show people.

CLIENT: Mm hm. Like if my parents found out that I smoked, I imagine them just saying, "Why."

THERAPIST: Yeah.

CLIENT: Not, "Oh my God," but "Why?"

THERAPIST: Why? Yeah.

CLIENT: You know? Like, "What caused this?" [00:36:50]

THERAPIST: Uh huh.

CLIENT: "What went wrong?" You know? (pause) I never really played it out much farther than that because that's just something to avoid as opposed to something that I actually want to think about, like engaging with. But (pause) yeah it was something that, hiding it from my parents is something that I took very seriously.

THERAPIST: Huh.

CLIENT: It was not like I stole some cookies from the cookie jar and I didn't want my parents to find out, but if they do it's going to suck because I'm going to get grounded for a week. Like that would be out in some epic proportion, some Armageddon type thing, you know, that it just cannot happen. [00:38:16]

THERAPIST: Mm.

CLIENT: You know?

THERAPIST: Oh yeah. Yeah. There's something about it.

CLIENT: (laughs) I don't know. Almost as if like you would do anything to cover your tracks.

THERAPIST: Mm.

CLIENT: You know, nothing would not be worth keeping that a secret. You know?

THERAPIST: Did they ever catch on?

CLIENT: My Mom (pause) My Mom noticed at times that I had smoked, I think. She definitely, I think partially Eric started smoking at the same time as me. And he was a lot more nonchalant about it. He didn't care so much if his Mom knew. And by association like sometimes I think I might have smelled like smoke a tiny bit. I think she was probably very perceptive to it as well having been a smoker. So she knew that I had dabbled. But I don't think she had any idea, and she certainly doesn't to this day, that it has been the type of thing that it has been. You know what I mean? [00:39:30]

THERAPIST: Like, yeah sometimes up to a pack a day, kind of?

CLIENT: Yeah. Or even I think she might of thought maybe, you know, when I'm with my friends I have a social cigarette when I'm drinking of something. I don't think she has any more reason to believe anything more.

THERAPIST: Mm.

CLIENT: She certainly doesn't think that I do now. And my Dad just has absolutely no idea at all. (pause) So in a way, yeah, it's always sort of been like it's never been something that I've been able to, like the identity of a smoker. It wasn't something that I sort of accepted and assumed at the time. It was always somehow I was very careful about it. I was kind of stepping into these shoes that I was going to get out of eventually.

THERAPIST: Ah.

CLIENT: You know what I mean?

THERAPIST: Mm. (pause)

CLIENT: But it made sense. I mean it was like it was, you know, the logic of during a war time suspending habeas corpus or something. It's a crisis time decision. [00:40:52]

THERAPIST: To get through it. Yeah.

CLIENT: You know? And (pause) And I'd be inclined to say that I, even looking back on it, I think I was probably right. I mean, I don't look back on it and say, "Oh man, I was just justifying this to myself. I was lying to myself saying that I had to do this." You know? I really think I probably I don't know how I wouldn't have because sometimes that was, literally, like the You know, I didn't do other drugs. I didn't like other drugs.

THERAPIST: Mm.

CLIENT: You know? I never cared much for stuff like that. I never drank. I never liked marijuana at all. Which is worse. It was the worst thing ever. I used to get so anxious. Do you know what I mean?

THERAPIST: Huh. (pause)

CLIENT: Yeah, it was really helpful as a thing, as a practice, as a You know, in ways so much more than just like putting nicotine into my blood. [00:42:22]

THERAPIST: Yeah.

CLIENT: Like it was just, it was far You know, and I genuinely would have a hard time thinking about like what could have filled that void absent that. You know?

THERAPIST: Yeah. Yeah. I was thinking in one way it's almost that it's been a signifier, I think, for like of something. Of some inner distress that was hard to kind of, was not something you felt you could kind of show your family.

And it almost made it difficult to yourself. I was thinking like in a way it was some way of kind of, what I was imagining at least, is that it was some way to kind of, yeah, put a kind of a, well signify, that something wasn't cool. Something was troubling you.

CLIENT: It didn't seem so. I certainly didn't -

THERAPIST: Why? What happened?

CLIENT: I mean, I guess I don't mean to give the impression that like when I was in high school and stuff like I certainly wasn't thinking to myself, "I'm stressed out. I need a cigarette." [00:43:45]

THERAPIST: Oh, it wasn't.

CLIENT: No, it wasn't. It was I don't know if it was. I mean, it's not what I remember.

THERAPIST: Yeah. What did I mean, [what did you think] (ph)?

CLIENT: I didn't think I was. I never thought to myself, "I feel really stressed right now." Like I never -

THERAPIST: Okay.

CLIENT: I didn't I don't know. I guess at that time I was still, I guess I didn't have the view of myself that I do now looking back -

THERAPIST: Okay.

CLIENT: that I was particularly stressed. If you had asked me I probably would have said that I wasn't all that stressed. You know what I mean? But I think I was. I think I was extremely stressed out.

THERAPIST: Mm hm.

CLIENT: And I think I did things that followed that line of logic in ways that I didn't really acknowledge so much. [00:44:54]

THERAPIST: Mm hm.

CLIENT: When I look back on it it's just extremely obvious to me.

THERAPIST: Hm.

CLIENT: Like even when I would be checking things, I always thought I was doing it because I was weird or something. You know what I mean?

THERAPIST: Yeah.

CLIENT: It wasn't something I saw as the effect of me being stressed or something.

THERAPIST: Right.

CLIENT: You know? Which is why it's bizarre sometimes when you look back and see how much it seems like so obvious that I was. But I didn't really see that at the time. You know?

THERAPIST: Yeah. (pause)

CLIENT: Which is weird. I do this a lot, right? Like I'll provide this, I'll tell a story about something and I'll explain it to you in a way like when I'm young. And I'll be explaining it to you in a way where I like attribute this intentionality to things that I'm doing. Like I smoked because I needed a way to deal with stuff. Like it was a way for me to like cope and get through the day. [00:46:04]

I agree with that. But then when I actually think about it, and I actually remember the things I did and the ways that I felt, there's a discrepancy between those two things frequently.

THERAPIST: Mm hm. Mm hm. Yeah, that wasn't your experience of it at the time.

CLIENT: No, no, it wasn't at all.

THERAPIST: Right. It was something that just you liked to do?

CLIENT: I guess what I was saying earlier, like I guess that's what I think was going on.

THERAPIST: Yeah. Okay. Uh huh.

CLIENT: I suppose. I don't know.

THERAPIST: Yeah. Huh.

CLIENT: I guess to me that's what is still going on or something. I don't know.

THERAPIST: It's still going on?

CLIENT: I guess maybe that's what I'm really thinking about. It's like that's kind of what I'm still doing right now.

THERAPIST: (inaudible at 00:47:07)

CLIENT: It's sort of like imposing that back upon, you know, myself. I don't know.

THERAPIST: I see.

CLIENT: I don't know.

THERAPIST: Yeah. No, I see. I think I get what you're saying. Yeah.

CLIENT: A lot of things I've tried to make sense of like in different ways. You know, like smoking I've tried to make sense of. Like, "Why do I do this? This is stupid." You know?

THERAPIST: Mm.

CLIENT: I want to keep talking about this.

THERAPIST: Yeah. By all means.

CLIENT: I want to keep going on about smoking.

THERAPIST: Okay. Yeah. Well, you mean just in terms of what you're talking about, I think there's a lot to it, a lot there to unpack in terms of meaning to it. Because, yeah, there's a lot to the smoking itself that has its own kind of importance. And it also, it's like it's had this kind of critical role in your life. That seems important to kind of unpack in some way. [00:48:07]

CLIENT: Um.

THERAPIST: I mean, you know, I'll say it just say it. Because I don't think that's all there is to talking about it or stopping smoking. (laughs) But if you're looking just to, if you're like, "All I want to do is stop this damn thing." You know, there's -

CLIENT: Hypnotherapists.

THERAPIST: And there's the mad rush in the (inaudible at 00:48:33). It's a pretty good success rate. So you can do that.

CLIENT: Mm hm.

THERAPIST: You know. I'm being totally I would never stand in your way. I think it would be fine. You know, it would be good if you wanted to do it that way. And it doesn't need to be one or the other.

CLIENT: Mm hm.

THERAPIST: But I think there's something to what you're saying. Is there's something about this, yeah, the behavior, the meaning, everything about it that is important to understand.

CLIENT: I feel like when I, like I go off the topic, I move it a little big, I start to see like tons of stuff starts coming to my mind.

THERAPIST: Mm.

CLIENT: Like things are coming into my head that I have to hold back on right now until next time, but it's (inaudible at 00:49:20) associations (inaudible).

THERAPIST: Yeah. (laughs)

CLIENT: I know the way out.

THERAPIST: Okay. Good, good, yeah.

CLIENT: Yeah. I will shoot you an e-mail.

THERAPIST: Yeah, send me that stuff. I'll let you know.

CLIENT: That was a helpful conversation that we had.

THERAPIST: Good.

CLIENT: Hopefully this all works out.

THERAPIST: Yes.

CLIENT: Alright, thank you.

THERAPIST: Yeah. Sure.

CLIENT: Take care.

THERAPIST: Yeah.

CLIENT: I'll drop this in the sink (ph) for you.

THERAPIST: Okay. Thanks.

END TRANSCRIPT