Annie Session 3 Tuesday October 14, 1982
The therapist encourages the patient to reflect further on how she relates to him in the room, and he clarifies her anxieties and inhibitions in this unfolding relationship. Because this is early in the analysis, the therapist remains near to the patient’s experience, while also providing salient, emotionally evocative responses to the patient’s uncomfortable feelings.
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1 P: I brought you the article from the Times if you’d care to read it later.
2 T: Oh, thank you. mm-hm. [warm]
3 P: (pause) I’m tired.
5 P: Yeah. I slept better last night than I did the other night. you know, running around, I guess, and just; tired (laughs) and I don’t feel like talking would you believe. (laughs)
6 T: you don’t feel like talking. [pt.feelings]
7 P: No. I think I talked yesterday about so much that I just, uh (laughs) talked myself out.
8 T: mm-hm.
9 P: Oh – told myself today; you’re going to lay on the couch, right?
11 P: I could try.
12 T: okay. [warm]
13 P: What do people do with their shoes?
15 P: This?
16 T: yeah.
17 P: Okay. I was wondering about that.
19 P: Yeah. (laughs) you know, you do walk outside and you do sit on there, you know.
20 T: mm-hm.
21 P: Mm – I fall asleep if I lie down (laughs) (pause) (sighs) is this what you’re supposed to feel like in a psychiatrist’s office?
22 T: Supposed to what? [elab]
23 P: feel like this; you look at the ceiling (laughs)
25 P: (pause) Would you believe I’m not comfortable?
26 T: You’re not comfortable? [elab]
27 P: No.
29 P: I know. I practice at home. It’s easy to lay on my couch, you know that’s your home and that’s your you know, you lay there and watch t.v. but (sighs) this is different. (sighs) You know, the world isn’t normally like this, you know. It’s usually right side up, not sideways. (sighs) (pause) mm; (pause) (sighs) (one word inaudible) (pause) uh, gosh (sighs); I feel like I talked myself out yesterday. it was really; I talked a lot. (sighs) (short pause) I feel like the room is going to all of a sudden, spin or move. (pause) gosh , I wish you’d say something because I feel like you disappeared.
31 P: yeah. like all of a sudden; (laughs)
32 T: No. I’m here. and I’m listening. [support]
33 P: Just – I don’t know.
35 P: It’s a possibility. it’s, uh; I don’t like being alone. that is one, uh, I know that for a fact. when *Nick used to be in the reserves (?) which was all night duty, I had every light on in the house, you know, even when he goes out after work and, you know, drinking with the employees where he used to work, uh, I ‘ d look at the clock every ten, fifteen minutes; be up all night waiting ’til he got home. just really don’t like; I like being alone during the daytime; get my work done but not really that much at night (pause) why is it every time I come here in the beginning, I want to cry? God;
36 T: I don’t know. Have you any idea what you want to cry about? [elab]
37 P: No. I don’t know. The first day I walked in here and sat down I wanted to cry; or tears filled up and the same; yesterday the same and sort of right now but after a while it; it goes away.
38 T: What I noticed was that your eyes filled with tears; on two occasions I especially noticed it; and that was when you were talking about the, uh; how much you wanted to go to your daughter’s things at school; that was when you got tearful. [COMMENT] [clarify]
39 P: Mm. I have tears now.
40 T: Just at my mentioning it? [elab]
41 P: No. I had them but it’s; they’re getting more (laughs) mm; you know, uh;
43 P: That; yeah. I do.
45 P: I would (laughs) also I haven’t gone to; about a year now; maybe not quite; uh, I said we had a block club party (laughs) I’ve never gone to one of the meetings yet (laughs)
46 T: You’ve never gone to what? [elab]
47 P: One of those meetings either.
48 T: which kind? [elab]
49 P: The block club where all the neighbors meet and discuss once a month, you know, what’s been going on
50 T: oh, yes.
51 P: and *Nick is vice president so, uh; but I will be at the next one because it’s at our house.
53 P: Nick said that’s one way of getting our basement cleaned, you know, but, uh, yesterday, uh, I came home about six thirty and, uh, there was a neighbor already there who had left his car because Nick he’s like a mechanic; he’s good. he’s very handy. and, uh, so the neighbor was there and, uh, I found out during the conversation, uh there’s a Christmas party, supposedly, coming up and, uh, it kind of scared me when the neighbor had mentioned it, uh, and I said, ” how come you didn’t tell me? ” He says , ” well, I was saving that for a surprise. ” You know, *Nick just didn’t tell me, you know. He just, I guess, doesn’t like to get me shook up but, uh; they mentioned like where we going to have it and try to find a hall for it and that was the first I’d ever heard of it and right away I had cramps and I was getting scared and I said, ” They’re only talking about it. Slow down. ” You know. mm; I thought everything was kind of all over , you know. Doesn’t end that way.
55 P: Well;
56 T: You feel that yesterday should have done it. [clarify]
57 P: No no no no.
58 T: I thought that’s what you meant when you said everything would be all over. [straightforward]
59 P: I, well, I meant, not really all over but there wouldn’t be anything coming up that I have to think about or worry about. I don’t really have to think about or worry about it. anything;
61 P: Yeah. and with the Christmas party; it’ll be something that I know *Nick, you know;
62 T: But the block party; or the block club meeting is soon, when is that? [elab]
63 P: November first, first or second Sunday; Tuesday of the month. but see, that’s a little different, uh; that’s kind of weird. When I have something at my house or like like, uh; the block club meeting’s going to be coming or like I had an Easter dinner at our house or the children’s birthday — they had their birthday a day apart in November, we had a party for them. I can handle it. I don’t get that that scared or nervous or upset. I can handle it. I’m so busy doing details and cleaning that I guess, uh, maybe my mind’s distracted or, but it doesn’t get me that upset. It’s, uh, maybe I feel secure being in my own house, you know, I can always– the bathroom’s real close or something; I don’t know, but like for this meeting, it’s not going to ; I don’t think it’s not going to bother me that much because I’ll be busy cleaning and baking and, you know, getting ready for it. It doesn’t scare me as much as like going somewhere; going out somewhere. That ‘ s the problem.
65 P: I know it. Right. you know, like I know my own house, you know, like when, uh like, uh, even my mother’s house, uh, I don’t; well, my mother had a graduation party for my brother last summer; end of summer; did he graduate this year or last year? Anyway, I was pretty.. I couldn’t go to his graduation. I felt bad about that too, you know. I really wanted to go and sit there. It was at Jordan Temple and, uh, it would have been nice, really; I did go to the house and started the coffee and got a few things going and then during like the early part of the afternoon, my aunt wanted to come over and see how we had remodeled and tiled our bathroom and, uh, we knew an outlet store that was really reasonable and, uh, sort of show her what we’d done and give her the address, so I took her over there but I went in her car and then on the way back, she was going to stop by her sister’s house which was like two blocks to my mother’s house; well, I never got back to my mother’s, I just said I had the flu and I didn’t feel good and, uh, I stayed home the rest of the day. I just… it was more not going back to my mother’s, I just didn’t want to go someplace strange like, you know . it, uh; that’s just it going somewhere, I guess, I’m just not sure of myself. I don’t know. like I said, I guess, yesterday, I could; could that be lack of confidence, that I’m scared of people or what. I – couldn’t be that strong of a feeling; that’s what I keep denying. (pause) My dad was over yesterday too but he didn’t say two words; too much, uh, he came over to have a clamp put on the tail pipe; one had broke loose and the pipe was hitting the bottom of the car; but, uh , he didn’t say very much because he was chewing his tobacco and when he’s chewing his tobacco, you don’t get two words out of him so it was kind of a nice visit, you know. (laughs) my mom asked me when I dropped off; uh uh, *Sparky; *Nicky, jr. today, you know; what did Daddy have to say. I said, ” he really didn’t say too much. he was chewing his tobacco. ” and she said, ” maybe it’s better off that way. ” you know , so I said, ” yeah. I know what you mean. ” but, uh, gee;
66 T: What was that, that? [elab]
67 P: Geee; ?
68 T: The gee, yeah.
69 P: Uh, I said that without getting, uh; you know, going in a different direction. seems like when I talked yesterday, I was all over and anywhere not, uh, talking about one thing or keeping one subject going, it was just;
71 P: I don’t know. I would think you’re not supposed to go off in tangents as much. you know, just; I don’ t know. I don’t think it’s good at all. You start talking about one thing and you never finish it and then you go to another thing and, uh;
73 P: is it really?
75 P: That’s a nice ceiling. I wish we had it in our basement. (laughs) how’s that?
76 T: You wish you had what in your basement? [elab]
77 P: Your ceiling.
78 T: Oh, the ceiling.
79 P: I like it. we’re trying to remodel our house and after looking at this everyday maybe that’s what’ll end up on there. It’s really nice looking; mm. (sighs) I know you brought up going back to, uh; not going to my daughter’s things, I’m I’m waiting for one to come. it’s got to they’ve got to have one in October maybe, uh, each teacher works on the class and they do a little skit, you know. It’s not a very big school. it’s an elementary school that only goes up to sixth grade and the assemblies are held in the gym. They don’t have an auditorium and, uh, kind of decided and made up my mind that I’m going to go to her; because; well, like in the fall or January, uh; can I; gee, I’m going to ask you to do something (?) do it, uh; *Sparky is the nickname for our youngest boy and, uh, we just call him *Sparky all the time; just keep calling him *Sparky and he ‘ s going to be in some too and if I end up going to one of his and hers together, you know, she might feel bad that I never went to one of hers just singly so I made up my mind when the next one comes, this kid is going; no matter what, you know.
81 P: I was going to ask you if I could call *Nicky, jr. , *Sparky; how do you like that? that’s what I call him all day long. I…there’s no necessity to ask you that , right? I mean,
83 P: I don’t know, uh; (sighs) how to put it in words .
84 T: Well, let me try to do it for you. it reminds me of you saying a moment ago that you you ought to stick to one subject and not wander, it’s almost as though you think of me as some sort of a school teacher or something; and you’re supposed to behave and do the right thing here [transference, interpret]
85 P: Yeah.
86 T: And I’m supposed to say something if you call your son *Sparky. [transference]
87 P: Right.
89 P: Well, uh, you could say it’s kind of like I know you’re a doctor and I respect you, you know, and I’m kind of keeping you up on a pedestal kind of like I don’ t know (laughs) is it wrong to do it; like I was going to ask you yesterday, do you like tomatoes, I’m getting so much from the yard now that I’m having an over supply and I was going to bring you a couple and I was going to say it looks like an apple for the teacher which isn’t what I really want to do. I just want to bring you some tomatoes like, you know, let you enjoy something, you know. They’re not hot house, they’re fresh grown, you know just, uh (sighs) I don’t know (laughs) do you like tomatoes?
90 T: I do sort of like tomatoes and I appreciate your wanting to bring me some but I think you’ll find that it’ s better if we sort of confine our relationship to what goes on here. [confront // support, pt.self-esteem // therapy sugg]
91 P: mm-hm.
92 T: When you have such a thought, I’d like to hear about it so we can analyze what it means but it’s better, in general, to understand things than to carry them out in action. [COMMENT] [elab // support // therapy sugg]
93 P: Could it be something like, uh; sort of like bribing or buying one’s one’s respect or like like I think we got on it yesterday, uh uh, sort of worry about what people think of me or;
94 T: I think that’s right. I think you’re worried about what I think of you and so you know, an apple to the teacher is not entirely (laughs) the wrong way to put it. (laughs) [transference, interpret]
95 P: No. (laughs)
97 P: Well, you know, I give the children; they’ve taken cut flowers from the yard and they’ve taken,them to the teacher; they asked me to take some cookies that I had made to the teacher . We did that. I, we didn’t take any vegetables at all. They wanted to take tomatoes because some other children had brought but, uh, at that time, I didn’t have that many coming in but, uh, I guess I kind of feel like the kids, I’m going to my session or my school; they’re going in their direction, you know. It’s not so much that; I don’t know; it’s I have this fifty fifty. it’s kind of like I want you to like me and it’s kind of like I want to give you something that I’ve got a supply of and I don’t want to end up throwing away either. Uh;
99 P: Do people want to have everybody like them and, uh;
101 P: In a way, I think I am. I want everybody to think I’m a nice person. You know, I don’t want to hurt anybody’s feelings or go against what they think and, uh , it’s like, uh; this is getting a little, uh – uh ; how to say this? I’d say it to a girl very easily or my husband, you know, but lying on the couch is presenting a block a little bit.
103 P: It seems like a wall, I, uh; I don’t know.
104 T: A wall between us. [transference]
105 P: I have to get used to it. yeah. uh, I just; hey, Annie. I really hate wearing a bra, right? and I usually don’t wear one at home at all but like when someone comes over, I’ll run in the bedroom and put it on, you know. It all depends who though, you know, like my sister or, uh, somebody I feel comfortable with , I won’t because it’s not that noticeable but like like *Nick’s father or my parents, you know, I feel like I have to because I don’t want to; you know, they , uh; they deserve some kind of respect, in a way, you know. this is something they wouldn’t like; they’ d object to and I don’t want to get them not to like me I don’t know if I can get back to; it’s like they would think less of me and I don’t want them to. it’s like keeping an image up.
106 T: And you feel, for instance, that I would think less of you if you came here without a bra? [transference]
107 P: Uh, well, that I won’t; no; well, I’m going out in public; usually when I’m going out in public I put one on too but I really don’t like what; that personally, one of the real things I don’t like, uh, my mother used to fight with me to wear one. in fact , in eighth grade we had a big battle in the kitchen where she slapped my face and put it on and said, ” now go to church ” you know. I just never did like one. I don’t know. maybe they just never fit right or something. uh, that’s just one personal thing to me, you know, that I, you know, have certain, uh; I really feel, you know, strong or comfortable without one, I don’t know . I mean, not strong or comfortable; strong about, uh.. oh, what? I can’t get it out (sighs) (pause) anyway (laughs) whatever that meant.
109 P: Yeah. I did. I did. I really did. I really didn’t wanna.
110 T: Did you have it in mind? [elab]
111 P: Well, I didn’t went you to take the word strong and comfortable together, it was a different connotation. I didn’t want to have you think something I wasn’t thinking, see, it’s, uh; I didn’t express myself right and, uh,;
113 P: Well, strong didn’t belong there. comfortable belonged but strong was for a different, uh; strong is how I feel about wearing one. it’s, uh, uncomfortable to me and comfortable is without one, you know, that that’s mainly what I wanted to get across.
115 P: Right right.
117 P: and and; right; it’s not that way. It’s, uh , just I feel strongly about not wearing one, you know, as far as comfortable, you know, clothes or you know, like if you go to a party and you’re not wearing the right suit or you’re not wearing the right dress, you don’t feel as easy as if you were wearing;
119 P: Right. (laughs)
120 T: Even such a thing as you mustn’t say *Sparky, is that what you call him? [clarify]
121 P: Sparky, right.
122 T: *Sparky, right.
123 P: I don’t know if he’ll get an inferiority complex but he likes the Nickname. his Mommy and Daddy call him that and it’s not anything bad and it’s just spunky, you know. and Ericka, she’s kind of a tomboy, uh. we were kidding her and calling her Tom but she doesn’t like thatthat much but, uh; the, uh; the, uh; few of the friends and *Sparky were calling her, uh – uh, Snookie; or no. (pause) Snoopy Snoopy and she didn’ t like that. she was crying and just stamping her feet, you know, saying, ” I don’t want *Sparky calling me Snoopy anymore. I don’t like it. ” and I talked with her and asked her why not and she said because you’re supposed to get a nickname from your parents and not your friends. I said, ” well, that’s not true. ” you know. I tried to explain to her and I said, ” well, would you like me to call you Tom or what if Mommy and Daddy gave you the name, Snoopy, you know, then would it be better? ” you know, but, uh;
124 T: And her real name is; [elab]
125 P: Ericka.
126 T: But you call her? [elab]
127 P: Well, we really don’t call her, uh every once and a while, we’ll call her Tom;
128 T: Tom? [elab]
129 P: Yeah. because she’s such a tomboy, you know.
130 T: Oh, I see.
131 P: She plays with the boys, climbs trees. recently, she’s seen a t.v. show with Evil Knievel on and she built herself a ramp and been going over it with the bike and, uh, it isn’t too high, you know, she she could get hurt but it’s not that high and she seems to be in control of her bike. Of course, I hope it doesn’t lead into anything more dangerous like a higher ramp or anything like that. uh, she likes playing with guns, you know, just not very girlish. She has one baby doll. it’s like a baby but she doesn’t play with that too often but she likes her, you know. She’s not like; I would like her to be more ladylike, you know, and she hates wearing a dress sometimes. She just completely hates it and I understand it because I hated wearing a bra when my mother forced me to do it but, uh, we try to talk things out. I think Ericka and I are a lot closer than my mother and I were. uh, I want it to be that way. uh, I sometimes think my ma and I; you know, I want to be closer to her but, uh, I don’t know. she just, uh – now why does a person think of all; just the way she even said, “you always; you kids always think of the bad things and none of the good things,” you know. If our parents did something we didn’t like, we’d hold it against them, you know, and I’d never let them forget , you know, but yet, they’re the same way, if we do something they don’t like, they always bring it up or they gave you this or did this for you and you’re not giving anything in return and, uh; I don’t know.
132 T: I’m sorry. I didn’t follow that last. You’re talking about parents and children; [elab]
133 P: Yeah. and, uh, saying that I’d like to be closer to my mother and, uh, they’ve just got a habit of, uh – I don’t know, they seem to think that buying us things or giving us money during our life or trying to do what’s best for us or we’re supposed to respond and I don’t know; do something fantastic for them and; I just broke my watch; uh, I don’t know, reward them for their well doing or something. I don’t know. I think parents are expected to do that for their kids. I don’t want to throw that up in my kids face and say, ” we’re buying you your clothes and feeding you food and you’ve got to behave. ” I think that’s; I don’t know. that just isn’t right. uh;
134 T: You know, I have the idea you may have some feeling towards me; something like that. you said earlier you sort of put me up on a pedestal. I wonder if you have the feeling that because I’ve taken you in treatment and all the rest of it that I’m going to have the feeling now that you owe me something. [transference, interpret // pt.feelings]
135 P: Possibly;
137 P: Well, like you said something or we both sort of talked about; if it didn’t work, I’d make you feel bad. I’d feel responsible that, you know, like he’ s not getting anywhere with me and I’d start, you know; [COMMENT]
139 P: Yeah. you know. could it; do you believe in astrology? uh, I was thinking of this coming here. I’m a libra and everything’s got to balance out, you know. uh, sometimes I wonder if that’s not true. I just took my sign too seriously, you know. uh;
140 T: I wasn’t quite clear. what is it that you’re trying to balance? [elab]
141 P: Well, a Libra is balancing a scale.
142 T: Yes. that I understand. [straightforward]
143 P: and; oh, like anything; like in my decorating or , uh, people, uh; oh;
145 P: Well, like, uh,; like you said if I; like keeping you on a pedestal and having respect for you that, uh uh, it’s kind of balancing me out. uh, and then if things don’t work out, I’m going to feel bad that, uh; you know, like you’re not getting through to me or something like that, that then I’m lower on one side than on the other side and I want to kind of keep it equal, you know, uh, I don’t want to stay here you know and just, uh uh, I don’t know, talk and say words and, uh, mm, nothing be happening but; or coming out of it; yeah, I guess maybe, in a way, if I got cured or this one certain part of my life getting so upset and nervous or scared and don’t know what I’d do with myself, you know. I’d; to me, I’d be perfect, you know, to myself, you know, I have faults and; but if that one part was; I think I’d be a very happy person. I was wondering if I could; after being so miserable for so long , could I be happy. like that article; that one part says half of me wants to get well and the other half of me wants to stay sick because you’re used to it, you know. uh;
147 P: (laughs) I’d give that up, you know; that part of it when it happens, I’d give that up, I really would but, uh, gee, what would I do with myself, you know. (laughs) I mean, what are you supposed to do with yourself. God, you know, just the thought of it’ s not occurring and just being calm and relaxed and, you know , just talking and being happy, wow, you know, that’ s (laughs); oh;
149 P: Yeah. it is. it really is. you know, getting back to one point, you know, about being afraid of people, it really keeps coming up in my mind. can I be; I don’t know; be that scared of people. I mean, there’s good people in the world and nothing bad is going to happen. (sigh);
151 P: Right.
152 T: Why is that hard to admit? [elab]
153 P: I don’t know. Maybe because I don’t have enough confidence in myself that, uh; well, you know, sometimes I think I’m a very naive person. I, uh; I don’t know I go along with people and agree with what they say and try to win, I guess, their liking for me instead of maybe sometimes if I think in a different direction, I don’t voice it. I, uh, just agree with the person whoever is talking about certain subjects and other times I’ll, uh, express a viewpoint of something I know and, uh – that’s confusing. most of the time I can’t and sometimes I will just let myself tell a person something I know or something I feel about a certain subject when you’ re talking, you know, but most of the time I just; I guess, I’m trying to win their liking me. (laughs) that’s bad. that’s bad. I know that’s bad.
155 P: Yeah. I guess I want everybody to like me. kind of ; doing that, you know, I guess I don’t like myself sometimes, you know. (sighs) like *Nick and I never really, really fight or argue. I hold a lot of things in and then I get mad and I leave, you know (laughs) go for;
156 T: You leave, you say? [elab]
157 P: Yeah. I get in the car and take off for two hours. I go walking in a store thinking, calming myself down saying, you know; why didn’t you tell him what you’ re mad about or you don’t like, you know, uh, well, he doesn’t fight either. He doesn’t argue about things or tell me what he doesn’t like either like about each other maybe or something around the house. it’s hard to explain really. you know, it’s like one day you want everybody, you know; not one day but, uh, most of the time you’re trying, uh, I guess to have everybody like you; I guess maybe you try mostly your parents or something but, uh, and then the next day, you just don’t, you know, give a darn, you know; if they don’t like you, they don’t like you but then I take it to heart too much. I take everything to heart too much. I think I do. super sensitive or something like that. (pause) but, uh; (pause) this is the first day I didn’t get a parking meter. I went in the lot. I’m spoiled after a quarter a day, I got to go pay three dollars.
159 P: It just, uh; I felt lucky the first two times, I guess, I uh; I drove around a couple; the first time, last Wednesday, I got it right in front of the; right in front of the door, I couldn’t believe it and then, uh, yesterday, it was a little way down the block but it was a parking meter and it seemed like today, I went around three or four times and, uh, just couldn’t find one but at least, I’m lucky to have the parking lot right across the street. if that wasn’t across the street, I don’t know what a person would do. Park in a no parking zone and take your chances of getting a ticket, maybe. Does that, uh; is that privately owned, I mean,? The university doesn’t own it?
160 T: What, that lot? [elab]
161 P: Yeah.
162 T: No. that’s University owned. [straightforward]
163 P: Oh, so the University is getting the money for it?
164 T: mm-hm.
165 P: Well, that’s; well, so long as it’s going to a good cause. I thought maybe a private individual is making money on hard working students and doctors or something. balancing it out, you know, I want the money to go to a right cause.
167 P: That’s an example of balancing.
168 T: I see.
169 P: Right, you know.
171 P: Well, I’m not supposed to think of that, you know , uh;
172 T: You’re not supposed to what? [elab]
173 P: ; supposed to think of that, right? (laughs)
174 T: You’re not supposed to think of that. [elab]
175 P: Right. that’s;
176 T: What do you mean? [elab]
177 P: Well, we only have so much coming in financially that , uh, you know, I, you know; It’s like having that respect for you, you know I think you’re worth more , you know, and what *Janey and *John said that, uh, you don’t want to cheat anybody out of anything. that’ s another thing of balancing, you know. you want to give people what they deserve. you know if a person is nice you want to let them know that they’re nice.
179 P: Right. I haven’t even given it yet, you know. (laughs)
181 P: I keep thinking, you know, I got to remember it Friday, you know.
183 P: Well, not cheapens you; well, I hope not but, uh, then I have to remember that we’re using the university facilities and it’s like you explained, uh uh , the university is probably paying your salary and, uh;
185 P: They’re the ones who are benefitting by whatever I pay, not you. you’re still getting paid for your job, uh,; privately, it would be a different story, I guess, but as the university is doing it, it changes the picture. uh;
186 T: Yeah. I would like to tell you what the facts are about that. uh; of course; of course, I get a salary and, of course, the only way I could do this is because of that because this is research. it is also true, however, that the money that you will pay goes into a fund which is earmarked for my research so it does make some difference. [straightforward // therapy sugg]
187 P: mm – yeah. it does, doesn’t it. that’s great. You know, *Nick asked me, I think, some psychiatrists, I know are from $200 to $300 on the average. I know some probably charge more but, uh, he was wondering if like; if an individual is going to a private psychiatrist and they usually; they charge $100 or $200 and like, in my case, what; I’m coming four times a week; does the psychiatrist pay; get paid that much every session or do they work out an over long fee? going for four times a week, uh;
188 T: You can’t believe anybody’d pay that much money, huh? [pt.feelings]
189 P: (laughs) right.
190 T: (laughs) Yes. Some people do. of course, nowadays , uh, a lot of people get some help from insurance, but there are people who pay that. [life sugg]
191 P: I’ve got a feeling this new job he started yesterday is not going to last. he’s going to go back to the other one. he went to work at seven and he didn’t get home until six thirty. that’s putting in eleven and a half hour and, uh, he doesn’t; he’s spoiled. he doesn’t like that. he had a job that he he was his own boss, in a way. He called his own shots. if he went in at nine or went in at ten, it was his whatever he had planned as far as customers went and, uh, there’d be many times he’d come home early in the afternoon and do something around the house. uh, that’s getting up early in the morning and neither one of us; when I rolled out of bed this morning, I said, ” you want my honest opinion, I wish you’d go back to work at the other place ” because neither one of us used to get up until eight o’clock in the morning and now, you know, six o’clock; it’s like getting up in the middle of the night (laughs) just, uh; we were spoiled, you know. so I don’t know; I ‘ m not telling him what to do, you know, but I’ve got a feeling he’s not going to last. he doesn’t want to work that that many hours; that many days a week; five days a week or so and his salary and, uh, with this company where he’s at now, today, is like starting him out as much as what now he just left; they’re both even as far as now as the raise is concerned, he wish he would have pulled a stunt and pretended he had another job lined up just to get the raise without changing but, uh, you know, it really gets to be a dilemma after a while which way you turn; how do you tell people, I’m going back here or I’m staying here or I’m leaving or; a lot of decisions.
192 T: You know, I kind of wonder if you think I may feel that I’ve taken on a job with you, so to say; that is going to, uh, be more trouble than it’s worth and I may not last at it. [transference, interpret // pt.feelings]
193 P: Well (laughs) I’ve thought that. I’ve;
195 P: that, uh; oh, I’m going to get tears in my eyes ; that I could be a hopeless case, you know, just, uh , maybe never really, you know, let loose enough or let out enough what, uh, could be the underlying cause, you know.
197 P: Well, no. not as much as the money as the time; like you could be giving it to someone who really does have a; there goes the tears;
199 P: I don’t know. I guess, uh;
200 T: You’re obviously feeling then that; [elab]
201 P: don’t want to take advantage
202 T: that what? [elab]
203 P: ; You know, of; don’t want to take advantage of or get you not to like me again or something like that, I guess. it goes back to a person liking;
204 T: Don’t want to take advantage, what do you mean? [elab]
205 P: of your time if someone else is got more of a serious problem, you know. you know, in comparing myself to someone who might really have a problem.
207 P: I do and; when it happens but, you know; (laughs)
208 T: (laughs) it’s not happening this minute. [elab]
209 P: (laughs) no. it’s not, you know, so I feel guilty about it not happening or; I don’t know.
210 T: Then you think I’m sitting here trying to [elab]
211 P: I don’t want to waste your time.
213 P: Yeah. I think that maybe the next day you might say;
215 P: How do you; how do you; I mean, uh; I; thoughts; thoughts have crossed my head like maybe in a week he’ll say (laughs) I don’t want to see you any more , you know; that’s just, you know;
216 T: Mm-hm. that’s what I meant then. you know, your husband taking this new job and he’s going to give it up quickly and maybe pretty soon I’m going to say; oh, boy, I didn’t realize what I was getting into. I don’ t want to have anything to do with this. [transference, interpret // pt.feelings]
217 P: Yeah. I feel like I’m starting a new job, you know, on myself though, uh, exactly, you know;
219 P: I might; I may; I might be a failure to myself and I don’t want that to be, I mean, no way; I mean, I wouldn’t want; I don’t want you giving up on me, you know, that’s what it comes down to, you know. I thought about; well, gee, maybe you’ll get fed up at seeing me. I talked a lot yesterday. geez, I talked a lot. (laughs)
221 P: (laughs) oh, you know;
222 T: that helps explain at the beginning you thought I [transference]
223 P: I just seemed to rattle off, you know.
224 T: was fed up with all that stuff you threw at me. [clarify]
225 P: That’s right. gee, did that girl make any sense.
227 P: In a way, yeah. like did she make any sense, you know, she just kept going on and on on different tangents and maybe half of it didn’t make any sense, you know. I guess, one or fifty minutes isn’t, uh; I don’t know, I guess; what did I expect, you know; tell this man you expect, in three months, to be cured, you know. you know, he might not expect that. he’s got different thoughts, uh; he has different ways of helping you, you know.
228 T: I didn’t quite follow that. [elab]
229 P: I think yesterday, I mentioned that I wasn’t going to be here for a year; three months at the most, you know , if I wasn’t cured by then, you know; gee, well I guess I’d consider myself hopeless. I I;
231 P: Well, I thought maybe I shouldn’t have said that, you know, uh;
233 P: yeah.
234 T: and boy, I might say; well now, if that’s the way you feel; if she thinks that three months is the limit and she’s setting down all these rules; heck, I’m going to quit right now. [transference, interpret]
235 P: Right. exactly. I’m glad you’ve got a way with words because that’s how I feel but I couldn’t say it, you know. I felt kind of bad after saying it, you know; take your time, don’t rush it; that’s what I started thinking, I mean, uh; you’re not going to get cured instantly just take your time and sooner or later ;
236 T: Oh, I see. that’s another way of putting then what you feel happened yesterday [elab]
237 P: Yeah.
239 P: right. (laughs)
241 P: Yeah. exactly. exactly. You don’t feel that way , do you? (laughs) (dr. laughs) don’t give up on me. mm, it’s like, uh; almost like I’ve got no one else to turn to, you know; you talk to your parents, you talk to friends, you talk to your husband, I mean, where do you turn to now, you know (crying) and like you’ re my last source, you know. other than that I could, I guess;
242 T: It would be really awful then if I; if I didn’t find you; [clarify]
243 P: I guess that’s why *John didn’t want to get somebody who would abandon me.
244 T: because you’d feel then [interpret]
245 P: I guess he hit it on the head.
246 T: that’s it, this is my last hope and that’s gone and;
247 P: I do. I really do. you know, like I really won’ t, uh; you know, I guess I can; I don’t know; go on. I’m not supposed to think that. I’m supposed to think I’m supposed to get cured, right.
249 P: Well, it could be tomorrow; no, today’s going to be my last pill for; so I’m probably am going to be getting depressed and tired because, uh, I usually get tired the week before it comes though. that’s uh;
251 P: My period comes so, uh, I’ll probably be depressed and I’ll probably be crying all this week and next week I won’t be, you know.
252 T: You cry before your period and then you; [elab]
253 P: I get; I get;
255 P: Yeah. I could be worrying about that too, mentally , huh / / you know.
256 T: Which? I’m not clear. [elab]
257 P: I always worry about, you know, becoming pregnant, you know, and;
259 P: Oh, yeah.
261 P: Oh, that pill. yeah.
262 T: I thought you meant those pills that that, uh; [elab]
263 P: The tranquilizers?
264 T: tranquilizers; oh, no. you mean the birth control pills.
265 P: Yeah. today is going to be the last day so like the next two days that’s going to be on my mind until it does come, you know. that’s, you know, when you asked before; the other day about what did the pastor think, , you know, that and so forth; no, I never really confessed that (laughs) I never really thought about it. I just felt very strongly that I didn’t want anymore children and, uh, there was enough people in the world and I wanted one of each; a boy and girl; and I was lucky to get it that way , uh uh, I have strong feelings about too many children; the beginning ones you’re very strict with and towards the end, uh, you get lenient and it’s; see, there I am balancing out again, you know, (laughs) that it wouldn’t be fair to the first two if you had two after that. uh;
267 P: It does! it does. it means;
269 P: Yeah. She was there all last year, you know, so uh; you know, I; that’s; I; think of astrology and a libra is balancing those scales, you know, you just wonder about your life; is that what I’m doing most of my life, you know, just;
270 T: Time is up for today.
271 P: Okay. (laughs) (pause) wow – uh;
272 T: What was that?
273 P: I’m real hot and dizzy.
274 T: Yeah. mm-hm.
275 P: Well;
276 T: Goodbye.
#18: The therapist provides supportive guidance in how to proceed with the process, which puts the patient more at ease. A precise attention to her feelings in the room keeps in focus her ongoing expectation of criticism. LR+SW
#28: The therapist is highly engaged with the patient, as she attempts something that feels frighteningly unfamiliar. He does not hesitate to share his particular awareness of her discomfort. LR+SW
#29, 32, 34: This illustrates a desirable sequence from acknowledging a feeling of discomfort, clarifying this as related to feeling alone, and interpreting this as related to her fear of lying down. LR+SW
#36, 38: The therapist encourages the patient to think more about her tearfulness, in part by providing his own associations, stitching together the present moment with other instances in which he noticed her tears. LR+SW
#54, 56, 58, 60: By acknowledging that his understanding can easily be mistaken, he is building the therapeutic relationship through encouraging collaboration. LR+SW
#66, 68, 70: In his engaged listening, the therapist is quick to draw her attention to the relentless way she expects to be criticized and criticizes herself, implicitly reassuring her and encouraging her to elaborate on her feelings in the room. LR+SW
#72, 74: The therapist does not hesitate to encourage her to explore the thoughts and feelings that come up in the session. LR+SW
#80: The therapist is actively engaged with the patient, picking up not just words but events between the two of them. Exploring the texture of what happens between them—including shifts—leads to a deepening of her awareness of her feelings, including those she unconsciously steers away from out of discomfort. LR+SW
#84, 86, 88: Seeing the patient struggle in linking several painful thoughts and feelings with words, the therapist is active and supportive in helping her clarify how these feelings fit together, by making use of evocative metaphors about the role of a school teacher or ‘holding [her] nose to the grindstone.’ He encourages her awareness of her feelings in the room with him. This brings what initially seemed impossibly uncomfortable to say into greater focus in their conversation. LR+SW
#90, 92: The therapist tactfully guides her and acknowledges her feelings about him. Decades ago, there was an emphasis on avoiding action, even such an action as accepting gifts from a patient, on the grounds that the goal of treatment was for emotions to come out in words. Nowadays, we have a more integrated view of the therapeutic experience being a blend of thought and action from both parties. Generally, we might not steer the patient as much as was done here, but we are more accepting of the patient’s initiatives, provided they are reasonably appropriate. LR+SW
#94, 96, 98: Building on what has just been said, the therapist makes an additional interpretation of her feelings in general, extending the experience in the room to ongoing concerns in the rest of her life. LR+SW
#100: The therapist chooses to make a somewhat confrontational remark to the patient, whereas he could have let her elaborate on her feelings in the moment without steering her so abruptly. She is not thrown off by this, but taking a somewhat different tack, she continues to explore her relationship with the therapist in the here-and-now. The therapist might instead have commented upon how difficult it must be for the patient not to be able to track his feelings about her, and whether he might be displeased with her. LR+SW
#102: The therapist’s calm, steadfast reflection of her feelings subtly draws her to her discomfort about being in the room with him. Once he draws her to ‘between us’, her mind leads quickly to the dangers of being sexually attractive and her need to keep this in check. LR+SW
#108-112: Sensitive to her nuanced way of speaking, the therapist encourages the patient to elaborate in a way that gives increasing clarity to the sexual aspect that she is defending against. Her internal conflict about her own sexual attractiveness is becoming clearer here, as early as the third session, and may well prove to be crucial in understanding her agoraphobia. In the previous session (paragraph #168), it is when her husband ignores her that she suddenly develops the symptoms that took her away from the party, where she could have retaliated for her husband ignoring her by being strong and comfortable with other men. LR+SW
#114-116: Rather than making a deep interpretation about her anxieties about sexuality, the therapist stays attuned to the patient’s expressed feelings towards him, describing how uncomfortable it must make her feel to think that he would misunderstand her. LR+SW
#118: By bringing into focus the patient’s fears that strength in the sexual realm is something that she should inhibit in this very conversation, lest the therapist consider her improper, the therapist links the present moment in the conversation to an earlier instance in which she was also uncomfortable with his view of her. This extends the pattern of her uneasy feeling to something safer to discuss than something expressly sexual. LR+SW
#134-136: The therapist interprets the feelings she is experiencing towards him (a transference interpretation), which she is implying but not directly articulating. When she contributes a further elaboration in #136, he draws forth even more specifically the nature of the feelings she is experiencing with him. LR+SW
#137: The patient seizes upon the therapist’s transference interpretation, and contributes something about her own character in general, thus broadening the topic in a useful way. LR+SW
#180: His precise and concise description of what her feeling is allows for further elaboration of her discomfort. Very frequently, patients’ different feelings about the fee are important to explore tactfully. LR+SW
#184-186, 190: The therapist’s straightforwardness and respectfulness in sharing with her his point of view puts her at ease in this discussion of the fee, once again building the therapeutic alliance. LR+SW
#192: The therapist refines his earlier interpretations using increasingly evocative language that is nevertheless close to the patient’s own language. She responds with tearful acknowledgment of a pervasive idea of herself as a ‘hopeless case,’ selfishly taking advantage of others’ time and money, and the sadness and anxiety about others becoming so burdened by this as to resent her. LR+SW
#206-214: As the patient struggles to manage a range of difficult feelings, the therapist tactfully interprets the paradox in the patient’s oscillation between two contradictory views of herself in relation to the therapist—either as so serious that she will burden him, or as not serious and thereby burdening him. The gentleness and tact in pointing this out acknowledges the patient’s struggles, remains hopeful, and furthers her curiosity about this issue. LR+SW
#222-246: His articulating her fear of displeasing him and the risk of his abandoning her strengthens the therapeutic alliance. The therapist focusing attention on earlier moments in their relationship fosters therapeutic engagement with one another. LR+SW
#250-254: The patient’s abrupt switch to feelings about getting her period and the risk of pregnancy can only be understood by the confession at the end of the next session. When it is not clear why she introduces this topic, the therapist returns to simply encouraging elaboration and further reflection. LR+SW