TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: So how are you today?

THERAPIST: I am OK.

CLIENT: Good.

THERAPIST: How are you today?

CLIENT: I am good. I did the what do you call it multicultural fair yesterday. And...

THERAPIST: What was that? Excuse me.

CLIENT: Well, what it was is like a lot of different clubs here trying to raise money for the club. And they offered $100. So the club that does the best presentation or whatever and I don't know who won yet.

THERAPIST: (chuckling)

CLIENT: So my God, I never did so much talking in my life so fast. Hello, how are you? Ooh.

THERAPIST: So wait. And how do they measure winning?

CLIENT: Well, what they did was they're multicultural. They created these little mock passports. And it was so cute. And what everybody had to do was they had to go around because each table represented different countries. And like I said, if you walked up and you were interested to know what was going on, we would tell you, "You have to go into the center and go to that table and pick up a passport. Pick the passport up. Now you have to go and visit three countries." [00:01:08] And then each country that you visit, you'll get a sticker from that country onto your passport. And there's only enough space for three countries. So whichever three you like the most, then you go to them and get your sticker. Now each table, they had like food and you know, from that country.

THERAPIST: Nice.

CLIENT: So I mean, it was really nice.

THERAPIST: So...

CLIENT: And it was the different clubs and everything. And I mean we had a good turnout. We kept running out of stickers.

THERAPIST: And what was your club again?

CLIENT: Speech club.

THERAPIST: Oh, that's right.

CLIENT: Yea, that's one of them.

THERAPIST: The one that you are the secretary?

CLIENT: Vice President. (chuckling)

THERAPIST: Vice President.

CLIENT: And I recruited like I don't know fifteen people yesterday.

THERAPIST: And have they joined?

CLIENT: No. I told them that they will get some information via e-mail. And if they want to come join or well, actually come visit and check us out, see if you like it. And if so, you can join at any time. And a lot of them said, "I heard a lot. Yes, I want to." [00:02:04] And I'm like, I got some literature for you. And I was working it. Yes. (chuckling)

THERAPIST: So it's been awhile since we met. How are you doing?

CLIENT: I'm good. But I keep wondering something. I said... and this was just this morning because I think what made me think this yesterday or two days ago... I don't know. Something like this. Today is Tuesday. It was maybe from last week. And I keep saying... it's like I was just ironing my uniform and then I said all of the stuff that I know I've been doing, why can't I remember any of it? And I know we had this conversation. But I don't know. I think it kind of bothered me a little bit because I feel like if I was to... if I were asked a question, I don't think I could answer it.

THERAPIST: A question about what, Yvette (sp?)?

CLIENT: I mean, about anything I've done. I mean, I question myself and I'll say, I know...

THERAPIST: Anything you've done? [00:03:04] I'm confused.

CLIENT: Maybe I'm not saying it right. Let me see. I'm thinking about the workshops I've just done, right? And I'm interested in fundraising. I've just taken a fundraising workshop. I don't remember.

THERAPIST: You don't remember what?

CLIENT: (chuckling) What I remembered. I mean, it's like I can remember some.

THERAPIST: Stop for a second. Close your eyes. (pause) Tell me a bit about what you learned in the fundraising workshop, just the general ideas.

CLIENT: General ideas?

THERAPIST: Yea.

CLIENT: Well... (pause) Well, first I have to know why we're having a fundraiser. And then I guess we have to know what people we need on a team. (pause) We have to know how much money we need to raise and what we're going to do to raise it. [00:04:05]

THERAPIST: All right. So you have to set fundraising goals?

CLIENT: Yes.

THERAPIST: All right.

CLIENT: And then... (pause) I'm trying to remember. (pause) Oh, so... and then after we do that, then we have to find sponsors.

THERAPIST: How do you go about finding sponsors?

CLIENT: Well, we can solicit people. Phone calls... oh, I do remember. Oh God, this is embarrassing. (pause) Phone calls, flyers. (pause) [00:05:03]

THERAPIST: Stop for a second. You're trying to remember the exact words, are you? I don't need you to remember the exact words. I need you to remember just some of the ideas that were talked about in the workshop. The main points of what you learned.

CLIENT: (pause) I think it was three types or ways of... I can't remember the last one. Phone calls...

THERAPIST: Stop. Open your eyes. As you go through this process, tell me what is it you're trying to remember?

CLIENT: Everything.

THERAPIST: That's the problem. Give me a book. Give me a textbook.

CLIENT: A textbook?

THERAPIST: Yes, anything from one of your classes.

CLIENT: This is the book that we have...

THERAPIST: That has... that does not have numbers in it, please.

CLIENT: Oh. (chuckling)

THERAPIST: (chuckling)

CLIENT: Well, this is a book that we have to read right now.

THERAPIST: So this book is called "After the Bridge Was Crossed: A Journey of Thought" by Darryl Cooke. [00:06:08]

CLIENT: Yes.

THERAPIST: So I'm going to look at a page. This page is called... is Chapter 2. It is called "My Interpretation of Love." So let me read this page. Give me a second. (pause) So here's the chapter. I just kind of skimmed it. And from just kind of skimming it, it looks like he's trying to explore the idea of, what is love?

CLIENT: Right.

THERAPIST: What is love to him? What is love to other people?

CLIENT: Exactly.

THERAPIST: He's trying to kind of understand what the concept is and why it has so many different meanings.

CLIENT: Right. And what love used to mean to him.

THERAPIST: I didn't get that far. That's all I got. All right, what did I just do there?

CLIENT: You summarized what you've just read. [00:07:06]

THERAPIST: What is the difference in what I just did... and I didn't summarize...

CLIENT: And not word for word.

THERAPIST: You keep putting it on yourself to remember exactly the words being used. And that's inefficient, all right? That's not the mark of intelligence and that's not the mark of anything, right? But if I say... if we're having a conversation... let's say we're over at the cafeteria and I say, "Yvette (sp?), I heard you took that fundraising workshop." And you say, "Yea. Well, what did you think about it? It was pretty cool. What are some of the things you got out of it? What..." and we had a conversation about it. What kinds of things would say to me?

CLIENT: I would say... (pause) This is a problem that I have. (chuckling)

THERAPIST: You're just kind of giving me some basic ideas about it.

CLIENT: I would say that I've learned, well, the basic principles of fundraising. [00:08:06] It entails the reason for the fundraiser. Who all is needed. How do we get the help that we need for solicitation? The general ways of raising the money.

THERAPIST: Stuff. That's perfect. That's perfect. What's wrong with that?

CLIENT: Because it don't seem like enough information.

THERAPIST: Listen. If I asked my students... I think we talked about this. If I asked my students after a 16 week course what they learned in the entire 16 weeks, how long do you think it will take them to summarize it? This is wrapped up in your idea that sometimes you think you're not as smart as you should be.

CLIENT: I know. I'm trying to...

THERAPIST: And nobody's memory... very few people have photographic memories where they memorize things word for word. [00:09:06] That's not efficient and if... I would not listen to you... how long was the workshop? How many hours?

CLIENT: It was three days.

THERAPIST: Why would I need you to tell me three days' worth of information ever unless I took the workshop myself? Instead, a summary well, it was cool because we learned, what's the purpose of fundraising and how you go about starting it and how to set fundraising goals. That's far more interesting than a word for word analysis.

CLIENT: So now... so maybe that's what my son means then. He'd say, "Mom, you're doing too much." I'm trying to understand what does he mean? When I asked him to explain it to me, he doesn't have the time to explain it to me. So I'm trying to see what it is that he's saying that it's too much.

THERAPIST: Why do you think you're stuck there because this seems to be a point we get stuck a lot?

CLIENT: Yea, I don't know. It's like when I used to do the Facebook with my family or whatever, my son would say, "Mom, nobody is going to read that because it's too long." [00:10:08] And...

THERAPIST: Tell me what's too long.

CLIENT: Usually when I get on Facebook, it's around the time for voting or something like that. So I'm trying to let people know, look this is the time to get for real because, to me, Facebook is like a bunch of garbage. So when I think it's something that they need to know, then I get on there and I'll type some stuff (inaudible at 00:10:31).

THERAPIST: What is it you're typing?

CLIENT: Oh, I'll tell them, "OK Facebook, now is the time to get out and do something constructive. It's time to vote. It doesn't matter who you vote for. Just vote. This is the time to teach the children blah, blah, blah." I mean, and I don't know. And I just think I keep going.

THERAPIST: So do you find it hard to find the main point? Or you think everything is equally important? [00:11:02]

CLIENT: I think everything is equally important.

THERAPIST: It's not.

CLIENT: And it's not. Yea, see I have to... OK. And it makes sense to me but why can't I do that?

THERAPIST: Do you have a lot of anxiety...

CLIENT: Yes.

THERAPIST: ...that happens when you think you miss something?

CLIENT: Yes.

THERAPIST: All right.

CLIENT: I do.

THERAPIST: And tell me about that process, that feeling anxious.

CLIENT: Well, it's like when I was a kid, I used to feel like when you wake up in the morning... and I did because I used to think about this a lot. When you wake up in the morning, you get ready, you get dressed for school and then you go off to school. And then while I'm at school, I'd be wondering about what's going on at home because I'm not there. So what am I missing? And then when I'm at home and I have homework to do or whatever, then I start doing homework. But then I'm wondering. Like, I'm going by this house. What am I missing because I'm not there? [00:11:58]

It's almost like with your children that with your kids, you take them to school. But then you feel like if you're not there, you don't know if they're OK, if they're... I mean, do you know what I mean?

THERAPIST: Mm-hmm.

CLIENT: And I think that's...

THERAPIST: Why do you feel you are always missing something?

CLIENT: I don't know. It's weird. And I've been telling myself, no, you're not missing nothing. And then it's like, when it's time to go to bed, I will say, well, dang. I haven't had a chance to even watch TV. You know what I'm saying? What did I miss?

THERAPIST: How long... can you tell... take me back to the earliest point in your life where you remember this happening this feeling of missing something or having anxiety about missing something.

CLIENT: (pause) Ooh, God. (pause) It'd have to be my high school years.

THERAPIST: Tell me first experience there.

CLIENT: Ooh, I don't know if it would be the very first but maybe from what I can remember. [00:13:09] (pause) Maybe the first time I moved out, I think, and maybe not even then. Maybe living with my mom and going to school, I would be wondering, "OK dawg (ph), did she lock the door? Is the door open?" I mean, do you know what I mean? I'm not there to make sure that...

THERAPIST: And what bad things have happened when you haven't been there to make sure things are OK?

CLIENT: Well, she got into a fight with a guy that lived across the street and stabbed him with a knife.

THERAPIST: That's pretty traumatic.

CLIENT: And I've thought maybe (inaudible at 00:13:56) if he called the police she's going to jail.

THERAPIST: And what else?

CLIENT: (pause) Maybe... I'm trying to see if that's it, though. But maybe if I hadn't have moved out...

THERAPIST: What?

CLIENT: ...then my sister wouldn't have ran away. (pause)

THERAPIST: You still blame yourself for that.

CLIENT: Well, I'm thinking if I had been there, the situation could've been different. I could've said something or maybe done something or... do you know what I mean? So I don't know. So it's like I know I'm good. I'm good, I think. But every now and then, I get that thought.

THERAPIST: What thought?

CLIENT: Like (inaudible at 00:14:52).

THERAPIST: You look sad.

CLIENT: (chuckling) Yea, I could feel it but...

THERAPIST: Tell me what's happening for you right now.

CLIENT: Well, I don't know. [00:15:02] I think... OK, yesterday I had to do the board for the...

THERAPIST: What are feeling right now?

CLIENT: (pause) I think appreciation. And I don't know it's the tears but I think they're happy tears.

THERAPIST: Are they?

CLIENT: I think. I don't know.

THERAPIST: You looked sad a minute ago.

CLIENT: (crying) (pause) Let me see. How do I say it? I think I'm happy because my sisters, I needed them yesterday, right? And they was right there.

THERAPIST: What happened yesterday?

CLIENT: I needed help with that board. (chuckling) And I had nothing done. I'm way behind in a lot of stuff and trying to juggle everything. I think this week was whew, God. I didn't know what day of the week it was, what... I was just all over the place.

THERAPIST: Overwhelmed?

CLIENT: Yes. [00:16:01] I felt like I was almost at a breaking point.

THERAPIST: That's pretty significant, Yvette (sp?). Why?

CLIENT: Well, I had to get dad's medicine done. My stepdaughter came in with the baby. I haven't seen her so I wanted to spend some time with her. But I knew I didn't really have the time to give. I have so much just... and then had to do dad's medicine. So I had to get over there. And then I knew that the project was here so I had to have that done. But I don't want to give 40% when I know I can give 100%. Do you know what I mean? And I don't know. I don't... (pause) I don't know what it is but when I call my sisters and I told them, I said, "Look, I need some help."

THERAPIST: Good for you.

CLIENT: And I just did it. [00:17:01] And she was like, "Well, OK. Just come on." (crying) And I said, "OK." And I think I'm a little happy, too, because she stopped... well, both of them. No, let me see. How can I say it? Maybe one half... one sister, she actually stopped smoking. Well, they both stopped smoking cigarettes. One, she said she stopped smoking cigarettes and weed. So I'm so happy for that. But the other one still with the weed, she thinks it's not a problem. So I'm happy because they're making some progress and...

THERAPIST: You're almost surprised that they came over to help you with the project.

CLIENT: (pause) Well, I'm glad because it's the way that it turned out.

THERAPIST: You're surprised.

CLIENT: Well, yea.

THERAPIST: You're surprised. Why are you surprised that they would help you?

CLIENT: Well, because usually it'll be like early in the morning. Friends are over early in the morning and they are smoking and I mean, and this is the morning. So it'll be like, OK sister, come on, but trying to juggle the two. [00:18:07] And I think I'm surprise because one of her friends did come over and she was ready to smoke. She was just sitting, just quiet the whole time. Never said a word. So I'm talking to this friend and I'm wondering, who comes to someone's house and just sit there and says nothing?

THERAPIST: Why are you surprised that your sisters helped you?

CLIENT: Well, it's the way that they did because usually it'll be juggling the two of us, me and the friend. You know what I mean? But this time it was all about me. And the friend was just sitting there to the point where she just got up and said, "Well, I'll see you all later."

THERAPIST: But I think that's what touched you.

CLIENT: Yea.

THERAPIST: That they pitched in to help you and it was all about you.

CLIENT: Right.

THERAPIST: And well, the theme that we're back to, right?

CLIENT: What?

THERAPIST: The trauma piece.

CLIENT: Oh. Well, yea. [00:19:02]

THERAPIST: Do you see how?

CLIENT: (pause) No.

THERAPIST: So this anxiety that you have, that you have to be... if you're not some place helping someone, something bad will happen.

CLIENT: Right.

THERAPIST: You're not a home. It can't be anyone else to give your dad his medication. It has to be you. And there may be some definite truth to that. But stemming back from the time you were a kid. When you left your house, your mom got into trouble.

CLIENT: Right.

THERAPIST: When you left the house, her drug use got worse. When you left the house, your sister ran away.

CLIENT: Right.

THERAPIST: Right? And so that translates or at least it's sounding like you have to learn every word. You have to write every letter.

CLIENT: Yes. You know how when you're just taking notes, a lot of people would abbreviate to make it a lot simpler and take up less time? I tried that. And do you know I still to this day cannot abbreviate even though I'm just note taking? [00:20:05]

THERAPIST: Because what happens if you should abbreviate? What do you feel?

CLIENT: I feel like I'm going to misinterpret what that abbreviation was. What it's...

THERAPIST: So this is this anxiety that you have to get it right.

CLIENT: Yes. And I am so sick of it.

THERAPIST: I would imagine it's exhausting. Let me ask you if you have... this is going to seem a little off topic. I'll tell you where I'm going in a second. Do you have kind of things that you have to absolutely do every day in a particular order? Any kind of rituals that you have to do?

CLIENT: (pause) Well, if you mean like... if I was in my kitchen my bathroom I hate it... it may sound crazy but I hate it when the sink is wet. How like when the faucet is running and you leave water. If it's supposed to be shiny, I want it shiny.

THERAPIST: So what do you do? [00:21:05]

CLIENT: I go in and I dry the water off of there.

THERAPIST: Do you have to do that every day?

CLIENT: No. Not like... it's just on my mind. Like, I wonder if they did that. But if I go in there and I see it, then yea, I have to dry it off.

THERAPIST: And are there other things that you have to do in particular order each day to make yourself not as anxious?

CLIENT: In a particular order?

THERAPIST: Uh-huh.

CLIENT: (pause) No. It's just that whatever it is that I'm doing, I just want to do it right.

THERAPIST: All right. And when you don't feel like you're doing it right, that's when you feel anxious.

CLIENT: Yea. And then that's when I start to like keep going over it. It would just take me forever. Do you know what I mean? And then I try to break myself from it.

THERAPIST: And what happens when you walk away from it?

CLIENT: Then I feel like I had to hurry up and get back to it. [00:22:00]

THERAPIST: All right. And then tell me what happens inside your head as you're doing that.

CLIENT: (pause) I really don't want to do it. (chuckling) But I know I have to do it.

THERAPIST: So if you're reading something and feel like you're missing words, tell... and you put it down, what are... tell me what your thoughts might be? Let say you... that... in that book, you put it down. What are some of your thoughts?

CLIENT: Just that I have to hurry up and get back to it.

THERAPIST: Because?

CLIENT: Because then... especially like I know that today... and I think that's another thing. Today we have to discuss this book. And when I go back and I look and say, dang, I'm only on page 12 or whatever. When it's only like a 100 page book. I could've read this and been done with it. But...

THERAPIST: So you beat yourself up.

CLIENT: Yea.

THERAPIST: Yea, it's pretty interesting. Do you see where we're going with this? They're linked.

CLIENT: Is it? [00:23:03]

THERAPIST: That's what it sounds like to me, this anxiety that you have. You're so hard on yourself. You sat through a three day workshop and you can tell me what the workshop is about perfectly well. But you're trying to remember the exact words. And until you remember the exact words and tell me the exact word theme and structure setting, you don't feel like you've learned anything. It's almost like something bad will happen if you don't know the exact words.

CLIENT: Yea, it's like...

THERAPIST: What bad will happen?

CLIENT: As far as the fundraiser goes?

THERAPIST: No, as far as if you can't tell me the exact words the instructor said during the workshop, what bad thing will happen?

CLIENT: Oh, then I feel like, oh my God. I'm not going to be able to pass the test. I'm not going to be able to... do you know what I mean? When it all boils down to counting at this very moment, am I going to remember?

THERAPIST: And if you don't remember, then what? [00:24:00]

CLIENT: Oh man, when it's time to take that test, I'm a mess.

THERAPIST: And...

CLIENT: It's like I draw a blank.

THERAPIST: And you draw a blank and then what?

CLIENT: (pause) If it's not time, then I'll just sit there for a minute and I'll regroup. And I'll actually really take my time. I'll try to like... because I think maybe my breathing, I just get... I don't know. And I would have to have that piece of gum just to not chew, but just to know there's like a security.

THERAPIST: So what's happening inside your body, Yvette (sp?)?

CLIENT: (pause) I think for the most part, I just... I always tell myself... it's like a conditioning thing maybe. And I'll tell myself, just calm down. Take it easy and you can do it. But then it always seems like when... if I give myself positive feedback, then the opposite happens. But if I tell myself, "You're not going to do good," then I'll get it. [00:25:07]

THERAPIST: You think that's true?

CLIENT: Sometimes I do. And I don't know why that is. I always ask myself, I said, that doesn't make sense. Why do you do that?

THERAPIST: So your anxiety is based in this fear that something bad will happen if you don't get all the words down. If you're not at home, if you're not with the people you love, something bad will happen.

CLIENT: Yes. I feel... yea.

THERAPIST: That's exhausting.

CLIENT: Yes.

THERAPIST: Yea, how do you deal with that every day?

CLIENT: I don't know. It's like my stepdaughter; they were on their way home. And I tell you, I cannot sleep until I get that phone call and they say, "We made it. We are home." Or it's like if my son tell me, "Mom, I'm going to store." Then that means that if you're going to the store that means you're coming right back. [00:26:07]

And if he doesn't come right back, then I said, well, he's been gone for over an hour. I know he's 18 years old and I don't treat him like he's 3. But if you said you're going to the store, then that makes me think you're coming right back. Now I'm thinking, well, let me just call make sure you're OK. And then I'll call and then you'll answer the phone. So now I'm thinking maybe something happened. Then I'm calling again and then you don't answer. Then later on because then I just tell myself. I said maybe he doesn't want me bugging him. He's 18 years old. Just back off a little bit.

THERAPIST: And all the while your anxiety is doing what?

CLIENT: It's going crazy, yea. And then when he finally calls me, now I'm upset because I'm thinking, you don't have any consideration. If you know... I mean, it'd be different if you didn't live with me. Then what you're doing is your business. But you live with me so if you're telling me you're going and coming right back, that's what I'm expecting. [00:27:00] And I'll explain that to him and he said, "OK mom." But then does it again. And I keep telling myself, oh, just... this is what he does. But still somewhere inside of me I cannot relax. I have to know that you are OK. Yea, and oh God. (chuckling)

THERAPIST: Do you think it's because, as we've talked about before, you had all these traumatic, scary, unpredictable things that happened to you as a kid.

CLIENT: I think so.

THERAPIST: And you couldn't control them.

CLIENT: No.

THERAPIST: So they came out of nowhere.

CLIENT: Right.

THERAPIST: Yea. So again, some of your anxiety, a lot of it comes from those experiences and now they've translated into schoolwork.

CLIENT: Yea. I guess so.

THERAPIST: Yea.

CLIENT: How do you get rid of that?

THERAPIST: Well, I'm glad you're here.

CLIENT: I mean, oh God. Yea.

THERAPIST: I was... let me tell you what I was kind of doing earlier and we'll talk about how you get rid of it. Because in some ways, I think this can help shape the nature of our work together. So in... I was... you're familiar with certain disorders, right? [00:28:07] Certain anxiety disorders we've talked about like posttraumatic stress disorder. Are you familiar with one called obsessive-compulsive disorder?

CLIENT: Yes.

THERAPIST: You're smiling. (chuckling)

CLIENT: (chuckling) Yea.

THERAPIST: (chuckling) Tell me what you're thinking.

CLIENT: (chuckling) Because I'm like, oh. I had somebody tell me that before.

THERAPIST: Tell you?

CLIENT: It was my son's girlfriend and she said that we should go in the kitchen. My son... well, my son was talking about it. He said, "Mom, why does all of the cans have to be facing..." The face is toward where you can see exactly what it is when you go. And I said, "I don't do that. But now that you say that and I'm thinking..." (phone ringing) Ooh, I'm sorry.

THERAPIST: That's OK.

CLIENT: I thought I had it off. I'll cut it off.

THERAPIST: That's OK.

CLIENT: (pause) I cut it off. [00:29:02] And I told him, I said, "I don't do that." So one day I go in the kitchen and I just started laughing because it seemed like the majority of the cans and stuff was facing me. And I said, "Do I really do this?" Then I have all of my canned tomatoes over here or the soups over here or...

THERAPIST: Why do you think you do that?

CLIENT: Easier to find stuff when you want something and you got to get it real quick, you know where it is.

THERAPIST: And what... any other reason?

CLIENT: I don't think so.

THERAPIST: Does it make you feel comfortable when things are predictable?

CLIENT: No. Actually I like it when it's unpredictable.

THERAPIST: Do you?

CLIENT: I think so. Well, maybe certain things, I guess, maybe not all things.

THERAPIST: Like?

CLIENT: Like... well, I know I like the towels... this may sound crazy and maybe it's starting to make sense to me now. I go in the bathroom and you know how everybody has their towels hanging. [00:30:04] And if a towel is just thrown up there, oh, it drives me nuts.

THERAPIST: Sure.

CLIENT: Because I'm like that is so just not neat. That is just...

THERAPIST: Well, you like things neat and orderly.

CLIENT: Yea. I mean...

THERAPIST: Yea, that's not obsessive-compulsive. We all have...

CLIENT: You were scaring me.

THERAPIST: No, no. I was asking you some questions to kind of evaluate for that. But that's not... it doesn't sound like that to me at all, right?

CLIENT: Because I just like it clean and...

THERAPIST: Sure.

CLIENT: ...everything is where it's supposed to be.

THERAPIST: But it does sound like you had a chaotic upbringing.

CLIENT: Well, I... yea. I can admit that. Yes.

THERAPIST: Yea, and there were some very scary things that happened to your family. I mean, your parents are together and then they broke up. And then there was drug addiction on both sides and people were coming and going. And your grandparents helped raise you and they got sick. And then you left the house. You had all these kinds of comings and goings. And I can understand. You want your life to make sense.

CLIENT: Yes. [00:31:04]

THERAPIST: To be predictable, orderly in some ways.

CLIENT: Yes.

THERAPIST: There's safety in that routine. Yea, there's nothing wrong with that. I mean, does that fit for you?

CLIENT: Yes.

THERAPIST: So I think that's important. But when this anxiety, I don't think it's due to memory problems. I think your expectation, though, your fear is if you don't know every word on the page, you're going to fail a test or there's going to be an extreme negative consequence for that.

CLIENT: Oh yea, that's so scary to me. Yea.

THERAPIST: But the thing that's happening is you have a 3.7 GPA, right? The business plan you showed me, how long was it? Was it like eight pages?

CLIENT: Yea.

THERAPIST: So it...

CLIENT: Somewhere around there.

THERAPIST: Yea, but it wasn't 500.

CLIENT: No.

THERAPIST: So that means you do have the ability to screen out information and put it together in a way that it makes sense, right? As opposed to writing 500 pages of a business plan...

CLIENT: Right. [00:32:09]

THERAPIST: ...you wrote an eight page, very concise, well written business plan, right? So you do have the ability to screen out some information that's not important and put it together in ways that are important. You understand?

CLIENT: Yea.

THERAPIST: And you have a 3.7 GPA which means you are having to do that all the time. And we know this because when you take a multiple choice test, you do finish the test. You may... it doesn't sound like you're agonizing over every answer to the point where you don't finish.

CLIENT: No, no.

THERAPIST: All right. But you still have the fear that if you don't read every word or if you're not every place, something bad will happen.

CLIENT: Yea, and that's self-doubt. Oh, I will go back and I would question. And that's when I have to like just tell the teacher. Just please take it.

THERAPIST: Sure.

CLIENT: Because I'll start changing stuff even though I know that this is the answer. But then somewhere deep in my brain something will say, "No, that is not it. Go back and..." [00:33:11] And now I'm starting to mix stuff up. And oh my God, when I start to do that, I be on... I don't even know how to explain it. I just... I could remember the last test I took in my Business Ethics course. It was my final. And I noticed all the scratch outs I started to put on there. And I looked at him and I had to tell him, I said, "Oh God, just take it." And I had to do that.

THERAPIST: But you still did it.

CLIENT: Yea.

THERAPIST: So you're very uncomfortable with this anxiety.

CLIENT: Yes.

THERAPIST: But it doesn't actually prevent you from doing well. It costs you emotionally but it's not costing you academically.

CLIENT: No.

THERAPIST: When you give a speech, right, you are able to cut to the chase. You... from what your process, you put it on notecards but then you don't use the notecards. [00:34:05]

CLIENT: Right.

THERAPIST: You get up and you just give the speech.

CLIENT: Yes.

THERAPIST: So you're actually doing well when it comes to deciding what the main point is. You're just torturing yourself behind it, though.

CLIENT: Yea, what do I need? A drink? (chuckling)

THERAPIST: (chuckling) Now when you say a drink...

CLIENT: (chuckling) (inaudible at 0:34:25).

THERAPIST: ...what kind of drink are you talking about? (chuckling)

CLIENT: I'm trying to figure it out. Oh my God, so what is it?

THERAPIST: But there... I guess what we should explore is, why are you able to do that in some situations...

CLIENT: Right and not all. Yea.

THERAPIST: ...pretty easily and not other situations? To the point where I mean, this is... in some ways, it's a trauma related response and it costs you emotional. But it doesn't cripple you to the point where you can't be successful. (pause)

CLIENT: I can see that.

THERAPIST: I just wonder what's getting triggered for you. So when you're reading, what's triggered for you? [00:35:06] I know like for example remember when in our first session you told me about the guy. He has some racism issues...

CLIENT: Yes.

THERAPIST: ...when you took the standardized test. Well, that was so painful for you. You kind of went down for the count.

CLIENT: Oh yes, yes.

THERAPIST: So I think some of that gets triggered for you. But it doesn't get triggered all the time.

CLIENT: No.

THERAPIST: Why does reading trigger?

CLIENT: Because I can remember since being a kid, that when I would read something, it's like... and I do that right now to this day. I try to still figure out, am I auditory, visual or both? Now I try to figure it out and I still don't know. But I can remember sometimes if the teacher is lecturing and I'm listening and I can get it. But sometimes I can't get it listening. But if I read it, I can get it sometimes and then sometimes I can't get it. [00:36:01] It's almost like I guess if I really just think about it, maybe it's all dependent upon how I'm feeling that day.

THERAPIST: Maybe or the topic.

CLIENT: Maybe. Maybe. I guess if it's interesting, then I could read it and I'll get it. Or if you're telling it to me, I can get it. But if it's... and I guess that's normal, I guess, with anybody. If it's something that's not interesting, then you'll lose them maybe. I don't know.

THERAPIST: Yea. I mean, I think there's that coupled with this idea of trying to control your environment so bad things don't happen like they happened to you in the past.

CLIENT: Maybe, yea. I could see that.

THERAPIST: You're not just agreeing with me, are you? (chuckling)

CLIENT: No. No, honestly I could see that.

THERAPIST: But I think that's what... it sounds like that's what may... this may be about. A way of coping with the fact that life has been unpredictably difficult. [00:37:11]

CLIENT: Yes.

THERAPIST: So if you have order, if you can repeat things word for word, if you can get it all, then that's a way of controlling the environment. But that's not actually true.

CLIENT: Well, it's like I can see that.

THERAPIST: I know you know that.

CLIENT: (chuckling) I mean, but you know... (pause) Oh man.

THERAPIST: You're smiling.

CLIENT: Yea, because I feel like I'm getting somewhere now because I really want to get rid of this. You know what I mean?

THERAPIST: How do you think you should get rid of it?

CLIENT: I don't know. Which... what... which... what... (chuckling) Because I wanted to try anything.

THERAPIST: Well, but in some ways you have if not gotten rid of it functioned through it. [00:38:06] There... it doesn't affect you equally all the time.

CLIENT: No.

THERAPIST: And it doesn't affect you academically. It really doesn't.

CLIENT: But it's like academically if I'm doing it right now and I can get it right now. But like math, if I'm doing the math and I'm coming to class every day and it's repetitious. I got it. Let six months go past. I'll use that as an example. And if you put it in my face right now, six months later, I can't.

THERAPIST: But that's just about everybody.

CLIENT: Six months though?

THERAPIST: Yes. Unless it's your area of expertise, that's everybody.

CLIENT: Because I was thinking six months. I'm like...

THERAPIST: Yea, but again, I think it not only goes back to it now... I'm glad we're talking about this today because it helps me see as well. [00:39:07] It's not only an unreasonable expectation for what you think your brain can do. Your brain is an efficient machine. It dumps what you don't need, right? It goes into long term memory and it gets tucked in the corner and unless you...

CLIENT: Like the recycle bin, huh?

THERAPIST: Yea, and unless you access the networks that you need that information, right, you're not going to get it. Well, when you learn it again six months later, it might not take you as long. But you're not going to remember it word for word.

CLIENT: And that is so true.

THERAPIST: Right.

CLIENT: Do you know I took a remedial math class once. And the teacher... because I thought I needed it and they told me, they said, "Well, go and see a math advisor," when I took the entrance exam. And I said, "Why do I do that?" They said, "Well, because you scored higher than normal for math." But I felt like they made a mistake, right? [00:40:01]

THERAPIST: Because they made a mistake with you.

CLIENT: Yea, so I went and oh God. I took this remedial math class and I had some students tell me... well, actually I overheard them talking. And they were saying, "I don't know why she took this class if she knew she was going to get all A's trying to show everybody up, right?" So the teacher would make everybody go to the board. And when it was my turn to go to the board, I did the problem.

THERAPIST: Right.

CLIENT: And every time I would go, the teacher then she made a comment and said, "Why are you in this class?" But I felt like I needed to be in that class because...

THERAPIST: Because?

CLIENT: ...I did a problem before and I was told that it would've been correct had I not missed this step.

THERAPIST: So you just thought you needed remedial math class.

CLIENT: So I felt like if... what if I continue to miss this step and I get everything wrong?

THERAPIST: But I think that's... I'm beginning to see why you don't trust your brain. I mean, your brain is doing what it's supposed to do, right? It dumps the information that you don't need. And if you need it, you have to go back and get it in your brain, right? [00:41:03]

CLIENT: Yea.

THERAPIST: Or you relearn it and the learning is quicker a second time.

CLIENT: Yes, quicker.

THERAPIST: I mean, I'm no expert in cognition but that's kind of my general understanding.

CLIENT: Yea, but you're right though. It's...

THERAPIST: You keep expecting to encode the information...

CLIENT: And keep it.

THERAPIST: ...in a word for word format. It doesn't happen that way. So if you asked me right now to talk to you about a topic in abnormal psychology at the undergraduate level, I could do that. Do you know why I can do that?

CLIENT: Because you're doing it every day?

THERAPIST: Because I do it every day. Because I teach that class. I think I've taught that class 20 times. If you ask me a basic concept in statistics, I probably could not do that or explain it to you. Do you know why?

CLIENT: You don't do it every day.

THERAPIST: I haven't done it in 12 years. Not on any serious level, right? So I would have to go back and someway relearn it, right, because it's tucked way in the corners of my brain. Unless my brain has dumped it because I don't do that all the time, right? [00:42:00] So the things that are practiced that you do every day... your nursing background is right here at the forefront of your mind.

CLIENT: And I feel like it's so far back here.

THERAPIST: But the parts that you use but because you... because of this anxious response that you have given some of the past trauma issues, feeling the need to be prepared. But for you, prepared means learning something word for word and that's not true.

So when we go back to this idea about trusting your brain, you have a 3.7 GPA. You do really well in school. If you could actually trust and rely upon your brain without excessively questioning yourself and some of that's kind of recognizing what you know and how you learn and realize that learning is not a word for word process I think you'd enjoy it more. I mean, what do you think?

CLIENT: I think so, too. Because I even like... I even said I don't feel like reading so I'm going to skim. And oh God, I just can't do it. Then in my brain, it'll say, "Just take the book. What you do is don't let anything interrupt you and just read. Just read." [00:43:10] And I've tried to do that. And again, like I told you before I get to that word I don't know, I grab the dictionary. Now that stops my process.

THERAPIST: So what if I gave you a homework assignment where you read a whole chapter of something and you don't look up any words.

CLIENT: (pause) I can't promise you I can do that.

THERAPIST: Just with one chapter.

CLIENT: (pause) Ooh, God. I'm telling you that'll be so hard. If I run across something that I...

THERAPIST: And it would be hard because?

CLIENT: Because if I feel like then I don't understand.

THERAPIST: But you won't know if you can understand. There's nothing wrong with the dictionary. The problem is you're stopping your thought process by going to get the dictionary, looking it up. Then you get lost.

CLIENT: Yes, and I have to start all over again.

THERAPIST: And you are not allowing yourself to understand the meaning of the word with the context clues.

CLIENT: Exactly. [00:44:04]

THERAPIST: Right. So you're actually doing yourself a disservice. You're not helping yourself.

CLIENT: And I figured that.

THERAPIST: Yea, my mom was a reading specialist. She'll tell you... and she's the one who used to harass me as a child, "Go get the dictionary," right? Because I'd be like, "What's this word mean?"

CLIENT: (chuckling) Yea.

THERAPIST: She's my dictionary. But you're actually stopping yourself. And for you, stopping yourself involves this whole anxious process where you question yourself and you question how smart you are. That's not helping you. So your homework and I want you to work at it is to read a chapter of something and don't look up any words.

CLIENT: Don't look up any words.

THERAPIST: No, just read it. When you're tested on something, you're tested on some details and mostly the main idea. So just read a chapter of something and don't look up any words. How will that be to do?

CLIENT: That's going to be hard. I kid you not. That's going to be very hard. [00:45:01] Because I have two dictionaries on the table. And if one is over here I don't worry about it because I can grab this one. I mean...

THERAPIST: What's the last word you looked up, by the way?

CLIENT: The last word I looked up was didactic.

THERAPIST: Didactic. And do you remember what you were reading about?

CLIENT: Well, I had a thesaurus. It was for speech actually. It was our word for the day. And I can remember that it has something to do with the way we study, the way we teach somebody. It's something that means educative, informative, something of that nature.

THERAPIST: So then you looked up the specific definition and did it help you?

CLIENT: Yes.

THERAPIST: In what way?

CLIENT: It helped me... well, I mean, I was able to get it and I could make sentences with it. And I like to play around with words. [00:46:04]

THERAPIST: But you were about to get it... you were going to get the main idea of whether... because you kind of knew what it meant.

CLIENT: Well, from the definition?

THERAPIST: Oh, is that what you just gave me?

CLIENT: Yea.

THERAPIST: Try to not look up any words. This'll get you to hopefully as we work more trust your mind, right?

CLIENT: And that's... I mean, because I want to be able to just...

THERAPIST: Yea. And it's not that I don't... I'm saying never use a dictionary. I'm saying...

CLIENT: I know what you're saying so that I don't get lost and have to... and it's so time consuming. And like you said, learn from the context clues and...

THERAPIST: I got an idea. This might help you get through it. Don't look the word up but you write down any word that you don't know and then go back to reading. So you have a piece of paper next to you. So I want you to read the chapter but to kind of quell your anxiety, why don't you write down the word and the page it's on. And then after your reading, go back and look up the word if you must, only if you must.

CLIENT: Only if I must.

THERAPIST: Only if you must. All right. But I hope you don't. [00:47:08] So this way you can feel like you still get to use your dictionary. But I want you to try to practice reading without looking up words. Just write it down then go right back to reading. It's still a problem because you're still interrupting yourself. But it's still quicker than stopping to look up the word. So let me know how that goes this week. OK?

CLIENT: I can do that.

THERAPIST: All right. Let's see how that goes.

END TRANSCRIPT