TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
THERAPIST: Okay, yeah.
CLIENT: Sorry about that.
THERAPIST: Yeah.
CLIENT: The train was running a little slow, but I should have just left a little earlier. How was your week?
THERAPIST: It was good, yeah, it was good.
CLIENT: It was good?
THERAPIST: Yeah, it was relaxing.
CLIENT: Relaxing?
THERAPIST: Relaxing, that's how I'd put it.
CLIENT: I bet. It was relaxing for me too. Was it relaxing because you were for some reason other than not being at work?
THERAPIST: Well, yeah, partly that, and just, you know, I went somewhere warm and sunny, where I didn't have to be bundled up and dealing with snow. That was probably more relaxing than anything else. [0:01:00.3]
CLIENT: The reason I ask, is I found it kind of I actually found it sort of relaxing to not, you know, be here for a week almost. It was like yeah, I don't know, I mean obviously, I would have liked to come, but not being there, it was sort of...
THERAPIST: Yeah, what did you... Relaxed, I guess is one way to put it.
CLIENT: I don't know, maybe even just like scheduling wise, it was sort of easy. Obviously, I would have liked to have come last Monday or last Thursday, but it was easy for me to find things to do.
THERAPIST: Yeah.
CLIENT: I didn't spend the whole week, you know, like it wasn't like if I couldn't have coffee for a week or something, you know what I mean? It just kind of surprised me. I think it was a nice period to sort of step away and be able to just kind of like process and stuff too, you know what I mean? [0:02:09.5]
THERAPIST: Mm.
CLIENT: Because I feel like I'm here a lot, you know, I never really go more than a couple days. It was sort of like a little hiatus that kind of let me just kind of like debrief almost.
THERAPIST: Mm-hmm.
CLIENT: Yeah, so it wasn't horrible. I think there was a productive element to it almost, I mean particularly because the big thing on my mind about this right now is, you know, how I'm going to navigate this deductible. I think it was almost nice to kind of step away, now that I think about it, on my own a little bit, and gather my thoughts about that, you know? And it's something I'd like to speak with you about a little bit, just because, I mean, I've just been thinking about it, how I would pay that, and then also, you know, what kind of like a responsible way to deal with that. No matter how I kind of try to spin it or cut it, it's going to be difficult for me to find some source of revenue or potential funds, to be able to contribute towards that above and beyond what I kind of have at hand, you know? [0:03:50.0]
THERAPIST: Yeah.
CLIENT: I feel like in a way it's not really new, dealing with this. I feel like for a long time, we've been kind of trying to figure out, well this kind of money needs to come about, how are we going to make it work, and I'm really amazed at how, how many things you're able to utilize to kind of make it work, you know what we've been doing.
THERAPIST: Yeah.
CLIENT: You know, you just being very flexible and understanding with, you know, letting things kind of sit for a week or two, you know, so I can kind of come up with the money, which has been incredibly helpful, to you suggesting this, you know, this program here, without which, we wouldn't have been able to keep doing what we've been doing. I feel like the mindset that I have kind of gotten into is like, how do you figure out how to make this work, do you know what I mean? I feel like I'm almost in a mind-frame now, where I feel like there's going to be something, you know what I mean? [0:05:00.7]
THERAPIST: Yeah.
CLIENT: Like there's, you know, what else, do you know what I mean? Because I mean, some of the obstacles that we've been able to get over really kind of surprised me. I didn't really think we'd be able to, you know?
THERAPIST: Yeah.
CLIENT: But when I think about this, one of the things that I've come to is I've just kind of said to myself, really kind of soberly, in a way that hasn't really made me feel really horribly upset or worried or anything, is that I think you know, I think I might need to take a break until I can catch up financially, until I can get myself in a place where this is something I can financially and responsibly commit to. You know?
THERAPIST: Yeah. You don't feel like you're doing that now, is that what you're kind of left with, feeling like you're not able to do that? [0:06:06.2]
CLIENT: I feel like a lot of things have come up, whether it be like the sort of insurance company saying we're not going to cover as much, then the cost changed. We're not going to cover as many appointments and then the cost changed. We've been able to get over those things, you know?
THERAPIST: Yeah.
CLIENT: And we've been able to do it in a way that is a stretch at times, but I'm able to do it, and I feel like I'm able to do it responsibly, even though I feel like I might be at the threshold of what I can responsibly commit to, but I feel pretty comfortable. This feels like, I don't know how I could kind of bring it into that domain, and the only conclusion that I've been able to kind of come to, just thinking about it with myself, is like I don't know that I would feel really comfortable, like even if I tried to say, I'm going to break this up over a couple of payments, which I could get it to you over a couple months, I don't even know if that would work for you. I would just feel uncomfortable continuing to do this and continuing to, you know, building up bills that I know I don't have the money for. [0:07:14.9]
THERAPIST: Yeah, yeah.
CLIENT: And I've come to this conclusion. One of the things, or I guess the only thing I've really been able to kind of comfortable settle upon is like, you know, I take... I take a little time off and then when this is something that I'm financially able to do, you know, I come back.
THERAPIST: Yeah. By the way, how did you pay the deductible the last time?
CLIENT: The last time, I think I called you right away when I got my referral from you.
THERAPIST: Yeah.
CLIENT: And we kind of talked about it and you kind of said, I think this is how it works, so I called my insurance company, and when they told me that I was just like, I'm not going to be able to do this.
THERAPIST: Yeah, right.
CLIENT: And then it was a long time until I called you back and it was almost four or five months, and that was at a time when yeah, I mean I guess I felt like it was really important for me to start doing something. My mom was kind of aware of it and she offered to and I kind of told my mom, like oh, I got this referral for someone, you know, it's a really kind of exciting prospect, and then when she sort of when I brought her into some of the stuff that was going on with me, she was like why don't I give you the thousand dollars to cover that deductible, and then you can start paying for it yourself. That would have been the only way I could have gotten over that.
THERAPIST: Right. [0:08:49.2]
CLIENT: So that's how I was able to cover that and yeah.
THERAPIST: Yeah.
CLIENT: But that's kind of what I've sort of come to in my head, you know? And I'll add, like it surprises me how kind of comfortable... I mean, I guess I feel, when I have spoken about it to people, like when I shared that idea with my mom, she was kind of like oh, no, like how would that be for you, would that be really disastrous for you? And I was like I don't know that it really would, you know? The way that I put it to her is I feel pretty confident that I would be able to come back to this.
THERAPIST: Mm-hmm. [0:09:52.6]
CLIENT: You know? I actually feel comfortable with this kind of dynamic, and I guess I'm curious to hear, like if that's something that occurs with people here. I have to imagine, with the type of therapy that people do for so long, and there's ups and downs in people's lives.
THERAPIST: Mm-hmm.
CLIENT: I feel you know, does it happen at times, that some people say, I need to step back for a bit and then once I can be in a better place for this, like?
THERAPIST: I think if like I think that can happen if it feels like all other kind of... I mean first of all, it depends on the person, what they feel comfortable with, you know, what they want to do. A lot of times, I think something can be worked out in such a way that hey, yeah, things like deductibles happen. Somebody might lose a job and have to run a balance for a while, something like that. Usually though, I try to find a way to work something out, so if they have to carry a balance for a while for an extended period. If I feel okay with it, then yeah I'll do that.
CLIENT: Yeah? [0:11:23.1]
THERAPIST: Yeah, yeah. You know, in these situations, if it was something like if your insurance was changing to the point they weren't reimbursing anything. I don't know what else would happen, but that might be something that I would sort of say hey, this might put you in too much of a bind for you to feel comfortable with, or something like that. I mean, my impression is like a thousand dollar deductible I mean this is my own bias is something that I think we could work our way to figuring something out, I hope, but I mean if all other avenues are exhausted and you feel like that, I still don't feel comfortable with it then, you know, I'm not going to stand in the way of what you're supposed to what you feel is best for you. But, you know, I think... I feel like if you ever run a balance and wanted to spread it out over a year, that's fine with me.
CLIENT: Really? [0:12:43.6]
THERAPIST: Yeah. For me that's I'm comfortable with that. Whether it is for you, that's but yeah, I do that with people.
CLIENT: I guess what I would feel comfortable with on some level would be would stem from what you feel comfortable with on some level, you know?
THERAPIST: Sure, sure. Sure, yeah.
CLIENT: So I imagine you would feel that therapeutically, there would be much to be gained from maintaining the continuity.
THERAPIST: Oh, yeah, sure.
CLIENT: Yeah? [0:13:43.0]
THERAPIST: Yeah. I mean, not that like, you know. I think you're right, it's not going to be I don't imagine it being catastrophic if you were to stop, by any stretch but, you know, if we could keep working, let's keep working, that's why I mean it's more that, that's where my idea is coming from, as opposed to, you know. And even if you took a break, it would just mean that we'd well, I don't know how that would shake out honestly, but it certainly wouldn't I could certainly see us doing productive work if you took time off and had to come back. My line of thinking is well, if we can figure a way to kind of keep going, let's keep going.
CLIENT: Yeah, and I suppose that's a big if, which for me, to sort of fill that in with some concrete stuff, would require me hearing that from you, do you know what I mean?
THERAPIST: Yeah, yeah. [0:14:48.1]
CLIENT: I mean, I guess I'm a little even surprised, you know?
THERAPIST: Oh, yeah?
CLIENT: Yeah, I don't know, I mean that's a lot of money to me, you know? If someone was sitting on that kind of money and they owed me that, I don't know, it would need to take a certain level of priority, and I guess I just assumed that it could for you, you know? It wouldn't surprise me. It wouldn't seem I wouldn't be insulted.
THERAPIST: Oh, yeah, you mean me wanting it?
CLIENT: No, I thought -
THERAPIST: Okay, yeah.
CLIENT: So, what kind of like perspective way for that to play out look like, like splitting it over some payments for the next couple of months?
THERAPIST: Do like a hundred extra bucks a month or something like that.
CLIENT: Ten months, huh? [0:15:52.9]
THERAPIST: Yeah, but if you think you can do that, if you're okay with that.
CLIENT: I guess it would yeah, it would, it would have a lot to do with if you felt okay with it, which that's what I hearing from you now. So I guess I didn't really consider that too much.
THERAPIST: Yeah, if anything, I'm kind of surprised. I mean, not that it's it's not unusual, but I'm a little bit surprised that you wouldn't have thought of other possibilities. Almost as if I was thinking you would assume that I would say or that would be too presumptuous, to ask for anything beyond hey, you've got to pay this off in a couple months kind of thing. [0:16:56.4]
CLIENT: I think you've been very accommodating, beyond what I would have expected.
THERAPIST: Oh, is that right, okay.
CLIENT: Yeah. I think, I don't know, that's asking a lot. I think it would have been a lot for me to expect, you know?
THERAPIST: That's what I was wondering. Yeah, I was wondering if it felt like a lot to expect for other possibilities or something like that. Not that you should or shouldn't expect that.
CLIENT: Yeah, but it surprises you.
THERAPIST: Yeah, yeah, a little bit.
CLIENT: Why?
THERAPIST: Well, because didn't we I thought we oh, you paid that pretty fast though.
CLIENT: What?
THERAPIST: You had the we had to do something back in the fall.
CLIENT: There was a period of time when the insurance company said they were going to when they did their little magic number and they said they were still going to cover 60 percent.
THERAPIST: Oh, yeah, yeah. [0:18:04.8]
CLIENT: But 60 percent of a lesser number, which is like really funny to me, because that's basically saying they're not going to cover 60 percent. So the price went up, we kind of said and this is when I was still looking for another job, like I said, until I can get another job, I'll keep paying what I was paying prior. And then a pretty small fraction was getting built onto a credit, and I got a job the next month, so it was -
THERAPIST: That's right, that was pretty right, right.
CLIENT: I think that was like under a hundred dollars.
THERAPIST: Oh, is that right, okay.
CLIENT: And this seems like a lot.
THERAPIST: Oh, okay. I thought it was more but okay.
CLIENT: Either way, it was -
THERAPIST: Anyway, that's what I had in my head, I was like well, we did something like this.
CLIENT: A thousand dollars seems like in a completely different kind of bracket. I think initially too, I was shocked that it was it seemed like already, like a couple months delinquent, you know? And I was like oh man, like this is this is already super late, you know what I mean?
THERAPIST: Oh, it was the [0:19:11.8]
CLIENT: And it's so much money. Yeah, I don't know.
THERAPIST: I can see that.
CLIENT: I don't know, I respect the fact that there was dynamics and obligations, you know what I mean? And they're important.
THERAPIST: Yeah.
CLIENT: And things don't things can't survive forever if there's not some recourse to those at times, you know?
THERAPIST: No, I hear you, you're trying to be mindful of what my needs are. Yeah, what I would say is that it's almost like, not that this is not, you know, like a I guess this could come across as a criticism or something, but I was thinking there's almost like a way of you being so mindful of my needs and what it means to me, that it's almost like well what about you? You know, like what about what you, you know. Not that there is one or the other kind of thing. More like I'm just I was thinking more that you might be concerned about what it was doing to me so much that it was hard to think about, well what about you, what do you need, what do you want? [0:20:43.0]
CLIENT: That's a familiar set of terms for me to be playing around with, I feel like.
THERAPIST: Yeah.
CLIENT: I mean, the way I see it, just sort of clearly, it doesn't mean it this decisions have been made on a number of occasions, completely based upon what I need. I don't think that my needs have been void at all here. I think they have been the determining factor every single time there's been a shift in money up until this point.
THERAPIST: Ah-huh.
CLIENT: And quite frankly, I am very aware of my needs. My needs, I think my biggest concern, if I was to think of it, would be to maintain this, to keep this going, and if your needs are taken into account, then.
THERAPIST: That's what I mean.
CLIENT: For me, that's the big issue.
THERAPIST: You're hitting it better than the way I'm hitting it.
CLIENT: Yeah, yeah. Like that that's the biggest way for me, am I going to act in the interest of my needs. If I built up a credit here, you know, if something else happened next month and then it was six thousand dollars, this would fizzle out and probably not be sustainable. [0:21:47.2]
THERAPIST: Right, so it's more about being aware of it. Yeah, yeah, so you've been aware.
CLIENT: You know? I mean your needs, I see them as very much kind of my needs are like deeply sort of entangled with yours in a way.
THERAPIST: No, that's yeah, that's the thing, that's the critical part of it.
CLIENT: I don't know, that's familiar to me.
THERAPIST: Yeah. Tell me what do you...?
CLIENT: My need is to keep this alive, you know? To keep this to keep this going, you know? And if, if your needs aren't met, then it's not going to, you know? And in that sense, you could be very much in my interests the way I see it, to step back for a little while if it meant that this if it preserved sort of a greater longevity level. That's completely my needs.
THERAPIST: Yeah, yeah. [0:22:57.0]
CLIENT: You know?
THERAPIST: Yeah. And something along my lines, like something about that I'm not getting, you know, complete payment or something like that, brings up the whole matter of well I'm not there's this sort of sense of inequity.
CLIENT: Yeah, I mean you're, you know, not to be too crude, but you have bills to pay. You've got to I imagine that there's a threshold within which you can be pretty flexible. I imagine there's a threshold, a certain category that you can't you have to say within, you know?
THERAPIST: Yeah.
CLIENT: I mean, I'm sure you have, just as I have, heating bills and stuff. I don't know if every single other one of your patients is doing the same thing. It's totally possible, you know what I mean?
THERAPIST: Yeah, right, right. [0:24:00.9]
CLIENT: I don't know. But I don't take that as a criticism, I suppose. I thought you were going to say something a lot more damning. Because that seems like a good thing for someone to do.
THERAPIST: Yeah, I guess criticism wasn't exactly the right word I was thinking of but yeah. Yeah, no, and I'm thinking too, about what it will mean for you to run a balance. What will that mean for you and me, what you'll feel about having that be part of our arrangement, if it was if it feels agreeable. Because I think it brings up that issue, right to the head, you know?
CLIENT: Yeah. [0:25:09.0]
THERAPIST: I just think in a way, I think there's a way you're just pretty careful about not putting yourself upon being somebody that puts upon somebody else much, you know, put yourself in those situations where...
CLIENT: No, I -
THERAPIST: You know? And I think that it's -
CLIENT: Yeah, yeah, that there's something, there's some common denominator between what it would feel like for me to ask that of you, or even to accept that of you, and your offer. That takes a lot of different forms and different sort of relationships. Not wanting to take up space in people's lives, be a source of I don't know, of ah yeah, I don't even know what. It seems to increase probabilities for things to go awry, and I try to -
THERAPIST: If things can go awry. [0:26:35.5]
CLIENT: minimize that if I can.
THERAPIST: Ah-huh.
CLIENT: You know? It's, yeah, I don't know.
THERAPIST: Yeah.
CLIENT: It doesn't seem like it is amenable to sustain things or whatever. I don't know.
THERAPIST: Yeah, right, right. In some areas, it kind of makes things, like it just adds another unknown quantity into the mix.
CLIENT: Yeah. I mean, I have no idea, maybe something would happen tomorrow or today or right now, that would mean that you didn't want to keep doing this anymore. There's a whole category of things that are completely out of my control, that I have absolutely no control over. I have no ability, you know, that I'm completely just subject to the whim of -
THERAPIST: Yeah. [0:27:40.4]
CLIENT: Moving and (inaudible) you, wanting to stop being a psychotherapist, this program these are things I just have no control over whatsoever and sort of aware of that. But then there are a select few things that I feel like I kind of do have some ability to exert some control over. You know, not going over 50 minutes, you know? Not being a source of financial duress to you, not canceling appointments all the time. Do you know what I mean? These are I see it as things I cannot do, you know? Yeah, I don't know, I try not to do those things. So, I don't know, yeah. But I've done some of that stuff with you, more than I have with a lot of other folks, you know?
THERAPIST: Right. [0:28:58.3]
CLIENT: And it's been instructive in ways, to kind of it's a kind of, you know, reality testing or whatever, between things that I sort of associate, consequences I associate with that kind of stuff, and the fact that it plays out okay, you know?
THERAPIST: Yeah, yeah, no, and I think it makes me think about the fact that, I guess one of my reactions initially was when you were talking about taking a break, and you were sort of saying well, you know, it's not going to be catastrophic. While I agree with that, I was also very aware of the fact that you were telling me the week before we left, how important this whole arrangement was with your gig at Providence College, and leaving, and how much that was going to be such a critical thing, kind of emotionally, psychologically for you, to confront. And yeah, I'm sure you'd find your way through it and go on to law school and all that stuff, without it ultimately obstructing you, but it's going to be a I was thinking about yeah well, I guess you'd be okay, but it's also a critical time for you. You made it pretty clear, you want us to work together on this. [0:30:45.0]
CLIENT: Mm-hmm. Yeah, no, definitely. I mean in a way, I don't mean to I feel like this could almost be taken as me sort of trivializing this process or something, but if I reflect on myself. There's always going to be a pretty burning and immediate or at least there always kind of has been. It doesn't this is, this is you know, this issue is unique in many ways, but the fact that there's this thing that is like searing a hole in my conscience isn't unique.
THERAPIST: That's going to be another thing.
CLIENT: In that respect. You know?
THERAPIST: Yeah.
CLIENT: I suspect that for much of my life, there will be some pretty serious things, and I'm sort of saying what I said before, but it's like well do I I just think about as how do I act responsibly in here, and aware of your needs and not only my needs, so this can be something that doesn't become sacrificed. I mean, what I, what I anticipate is me being selfish, and then asking too much and taking too much, and then under that weight, you know, it falls apart, you know? And then it would be far worse, because then there was an infinite number of pressing things for the rest of my life that I opened up, you know? I mean, that's just the way that I would sort of react to that, because I did think that in my head, you know? Like wow, I mean this is because I remember talking about that with you. [0:33:06.9]
THERAPIST: Yeah.
CLIENT: That just seems like what people do when they're in relationships, you know? In any kind of an interpersonal thing.
THERAPIST: Yeah, well what?
CLIENT: You... You sacrifice, you know? You don't do things, you know, you don't get what you want all the time. Sometimes it sometimes they come to it before and yeah, that happens. It just seems important to be aware of that. I feel like people don't like people that don't think about their needs. I don't know, but it's all I ever thought about when I went to my dad's house, you know to bring that in was the things I was thinking and feeling. [0:34:19.8]
THERAPIST: That's interesting, right.
CLIENT: He ended it pretty fast, you know?
THERAPIST: Yeah, yeah. That will be the end of it.
CLIENT: That just seems kind of simple, you know?
THERAPIST: Yeah, yeah. Well, I think in a way, that was like that was and that is one of the central questions, is like what do two people have together when there are two different like competing needs? Does one have to give sacrifices for the other and how much, and is there room for a mutual is there room for a coexistence of those things?
CLIENT: Mm-hmm.
THERAPIST: It's always it seems like it's kind of always... And it certainly seems like it's something relevant to the job. Listen, you're not making out of thin air, the fact that it's putting, you know, work in a bind, in a certain sense. They're going to have to find somebody, training somebody. It's not like you're just making you know? But I think what you grapple with then, is like how do my needs and their needs kind of coexist in this sorts of situations. [0:35:48.5]
CLIENT: Yeah, yeah. How do they yeah, I mean do they coexist, can they even, you know? Does one necessitate the sacrifice of (crosstalk).
THERAPIST: It seemed like such a critical part of what was going on between you and your dad, and certain like critical moments in your relationship, a feeling of your dad really your sort of take on the situation with him was very different than his, but how did both of your needs, your needs to say and see and be connected with what you're seeing in your father and his need to be seen as a good father coexist.
CLIENT: Yeah, yeah. [0:36:49.3]
THERAPIST: Maybe that's too heady and cerebral.
CLIENT: No, I mean I think I mean that's, that's kind of the dynamic, you know, that yeah, what kind of yeah, is there room for both, without everything kind of falling apart.
THERAPIST: Yeah, yeah.
CLIENT: It doesn't seem like it to me, you know?
THERAPIST: Yeah, yeah.
CLIENT: At least that's what I anticipate.
THERAPIST: That's right, and I think that's what happened maybe, with the deductible issue in some way, is this sort of sense of I don't know how to maybe you feel like you didn't know how to really negotiate it without you kind of going listen, my needs, I know I've got them, but I've got to shelve them in order for this to kind of continue.
CLIENT: No, completely. The only way I would rephrase that is saying like that, doing that seemed like negotiating my needs and your needs. [0:37:56.1]
THERAPIST: Yeah.
CLIENT: I didn't think I was not negotiating and that just seemed like how I did.
THERAPIST: Yeah, how you did, right, right.
CLIENT: You know?
THERAPIST: Yes.
CLIENT: And that felt like the right that seemed like the right thing, consistent, comfortable.
THERAPIST: Yes, yeah. That's, I think an important part. It kind of eases the unsettled quality of what would be there if it wasn't, you know?
CLIENT: If what wasn't?
THERAPIST: Well, if you didn't negotiate it in that way, you know?
CLIENT: Yeah. Yeah.
THERAPIST: Like what you're feeling and anticipating, you're negotiation with your job, as you're going to leave.
CLIENT: Mm-hmm. Yeah, sort of the maximum amount that I could like if you think about a situation, something has come up, like and there's two spheres. There's your sphere and then there's my sphere, and it's like this unfortunate thing. Where does that pie fall, you know? Like on who's plate, you know? [0:39:12.6]
THERAPIST: Yeah.
CLIENT: If I can imagine a scenario where the majority of it would fall on my plate, seems like the thing to do or the safest or the least unsettling.
THERAPIST: Falling on the grenade or something.
CLIENT: Yeah, no, completely, yeah, yeah. I mean that's those are heroic folks, right? Thank you.
THERAPIST: Yeah.
CLIENT: So Thursday?
THERAPIST: Thursday, yeah.
CLIENT: And I realize that this is still a little up in the air.
THERAPIST: Obviously, that's what I'll I'm pretty comfortable with that arrangement, and I say pretty comfortable, because I was just thinking about your comment of, you know, you said well, if things changed or something like that, what would happen. The only thing I can say is I don't anticipate my situation changing, where I would necessitate me saying hey, I need that money quicker or something like that, but if it does, I'll certainly tell you. But I go into the arrangement thinking that I'm doing it because I know I can, you know? As opposed to, I don't know, if my house burns down and I'm like suddenly needing that. You know? [0:40:29.1]
CLIENT: Yeah.
THERAPIST: But short of that, I'm going in with -
CLIENT: With all available information.
THERAPIST: Yeah.
CLIENT: Yeah, let me um yeah, then on Thursday, let's, you know, we can try to leave with a plan in place then.
THERAPIST: Good. Thank you.
CLIENT: Yeah, thanks. I'll see you Thursday.
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