Annie Session 2 Monday October 13, 1982
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The patient continues to explore her feelings about beginning treatment. The therapist remains supportive, but also increasingly explores her feelings evoked in this new relationship.
1 P: You don’t have to lay down, do you?
3 P: Mmmm….
4 T: Is that hard for you? [elab]
5 P: Ah, yes. (laughs) Difficult, really. I don’t know if I’d be comfortable I’d feel uneasy. Uh, you know, we talked about checking with the insurance for this-
6 T: Mmm hmm.
7 P: …uh, today, my husband started a new job and at the end of the week, he’ll know whether he wants to stay with this new job or not –
8 T: Mmm hmm.
9 P: …so then he could go back to the previous employer…
11 P: Yeah. It’s–he’s got like an ace in the hole.
12 T: Mmm hmm.
13 P: And, uh, he might come home with some paperwork today, I guess, from this chemical company so then I could look at that paperwork too. I looked in our filing cabinet and I can’t find the previous company. There was a whole sheet of what it covered and I can’t find it-
14 T: Yes.
15 P: … so if, uh–if it’s–is a week too long?
17 P: Is that okay?
19 P: Otherwise, you know, we talked it over and he said–well, if you’ve gotta come four times a week, you know, we’d see if we could cover like–say, twenty dollars a week, would that be good?
20 T: Twenty dollars a week. [straightforward]
21 P: Yeah. From us.
23 P: Yeah. That sounds terrible, doesn’t it (laughs) but, uh, I thought–I only thought like we, were gonna come once a week or once a month. I don’t know what I thought but, uh-
24 T: Yeah.
25 P: …I–when it was four times a week, that’s a lot. And, uh, which days before I forget.
26 T: Monday, Tuesday, Wednesday and Friday. [straightforward]
27 P: Friday. Thursday is the one. I wasn’t sure. [subjective]
28 T: Yeah.
29 P: Okay.
30 T: Friday would be instead of 11:00, ten minutes after 11:00–there’s ten minutes difference. [straightforward]
31 P: Okay. See, I’ll go–l have my son by my mother’s, my daughter’s eating lunch at school and we worked this all out and then I’m gonna pick him up and take him to school when we get done so, uh…
32 T: Your daughter will stay at school. [pt.feelings]
33 P: Yeah.
34 T: And your son is with your mother and then, [pt.feelings]
35 P: I’ll pick him up right from here and then I should get him there by quarter to one
36 T: I see.
37 P: It should work out real easy like that.
38 T: Mmm hmm.
39 P: The extra ten minutes after eleven, I think it should work out, the time element.
40 T: Yeah.
41 P: Uh, I’ll–it’s–traffic wasn’t bad today. In fact, I got here about quarter to and I left about ten-thirty.
42 T: That’s short. [pt.feelings]
43 P: And I went around the block twice too so it, uh–you know, it worked out okay. Huh (laughs, sighs) I’m not getting any sleep at night, you know, (laughs) wondering what’s gonna happen, what are we gonna talk about and how are we gonna do it. Uh. . .
45 P: No. It’s–just I think about it more than I ever did, you know.
46 T: What seems so hard about lying down? [elab]
47 P: Uh – you know, that’s what my husband said ’cause we were talking last night and we were both lying down and he said, “You’re doing it now.” (dr. laughs) and I said,”I-I know but you’re there all the time and going to sleep at night, you lie dawn, you know.” “Then you just talk, you know.” I don’t know. Uh, did people let out their feelings more lying down or do they feel more comfortable or. . . .
49 P: (laughs) I think if I lay down I’ll never get up again.
51 P: I don’t know. It’s just…I don’t know, I just…
52 T: It’s also true that if you’re sitting up, you’ll probably watch my face regularly for this, that or the other as to a clue as to how I may be feeling you will imagine about what you’re saying and if you lie down, it relieves you of that and it relieves me of having to keep . . . . [support]
53 P: Okay. That makes a lot of sense. It does. ummmm….let’s see. This is like an ordeal. it’s not–! mean, doesn’t–(sighs) I don’t want to. I really don’t. I–what if I look over there.
54 T: If you look over there, you think that…
55 P: Yeah. Instead of at you. Yeah. (laughs)
56 T: Well – it’s warm in here. I don’t want to force you to do anything you don’t want to do, obviously, and you don’t have to lie down until you feel able to. [pt.feelings, support, warm // therapy sugg]
57 P: Yeah. Okay. I’d appreciate that (laughs)
58 T: I think probably we need to talk more then about what seems so upsetting about it. [elab]
59 P: I don’t know. I don’t know.(pause) It just scares me. I don’t know.
60 T: Well, I noticed you, um-when was it you talked to your husband about it, last night, you said the two of you were lying down. [clarify]
61 P: Yeah.
62 T: You were in bed ready to go to sleep.
63 P: Neither one of us was sleeping last night. We tossed and turned ’cause he’s starting his new job today and that’s on his mind and this is on my mind so the both of us are a little (?) you know.
64 T: Yeah. Well, it just occurred to me to wonder whether, eh, since you mentioned that whether lying down almost feels to you like-like, uh, like lying down in bed in the presence of a strange man or something. [transference, interpret]
65 P: Possibly. I don’t know. Uh…
66 T: Do you have any such thoughts? [elab]
67 P: No. That I–that-that didn’t come to me. don’t know–I just–maybe I’m- a–you know, I’ve got this sort of thing that,-like when I talk to *Nick– we knew each other for like-two years–sort of friends–he knew the family and sort of knew–and I guess, I just poured out to him because I thought he knew me, you know, and he’s a nice man, you know and you’re really a stranger, you know, but I do want to get to know you–but have you as my friend, you know and just let it go, you know, and then you tell me what’s wrong.
68 T: Well, that occurred to me as another possibility. you said if you lied down, our feelings pour out more easily; maybe you’re afraid that if you lie down, everything will come rushing out and that scares you, [interpret, conflict, defenses // pt.feelings]
69 P: Well, I know I’m overtired and, you know–and I’ll probably say a lot of things that–you know when you’re overtired you probably say things you mean but you don’t mean, you know. you usually don’t say them. you can, uh,
71 P: Really?
72 T: Yes. That’s the whole idea. [straightforward]
73 P: If I say one word you won’t take it in one direction and that’s the way she must really feel,
74 T: No. I won’t. I understand that this is a situation in which you’re gonna speak freely and you can’t say everything at once. you may express certain feelings about something and you may have exactly opposite feelings about the same thing that you express on another occasion. [conflict // support // therapy sugg]
75 P: Cause the words sometimes can’t express what you’re really feeling.
77 P: Okay. That-that was going through my mind.
78 T: That goes for me too. I may make this, that or the other suggestion just because it seems to me to be a possibility–not because I’m laying down the law. [COMMENT] [support, subjective // therapy sugg]
79 P: Oh I’m open for suggestions, that’s for sure. Uh – *John made one and I’ve tried. He said, Go out. Do it. Go out.” you know. “Do it” you know, and, uh, like um-when was it yesterday, Saturday evening–I had my sister-in-law over, she’s in seventh grade and in the evening, we were supposed to take her back…
80 T: She’s in seventh grade, you say? [elab]
81 P: Yeah. She was playing with *Ericka and-and *Nick…
82 T: Both of these are much younger. [elab]
83 P: Yeah. But we were supposed to take her back home but my husband had to stop at a friend’s house to get a tool part for his dad to work on his car ’cause his dad had trouble with his car and it was an ordeal for me, you know–you know, I could have got out of it, right. I could have stayed home and just let him take her but I really didn’t want to go. I was scared to go but, uh, I said, “Okay. This is one of the times you push yourself and you go.” And I was in the bathroom for about five minutes (laughs) before we went and all we did was go, I sat in the car and he drove to his friends and I stayed in the car and then we went to his mother’s house and took *Nora home and, ah. just that–there was nothing I mean, nothing. And here, I was all scared and nervous to go just to take her home.
85 P: I’m almost ready–I-I’m trying it but I’m ready to say–ready to scream and say-I don’t want to do it if I don’t have to do it, you know.
86 T: That’s what I mean and I think maybe you’re expressing that same thing about lying down. You’re afraid that I’m going to force you and make you start doing these difficult things so maybe you’re sort of testing me to see if I’m going to force you to lie down too, you know. [COMMENT] [transference, interpret, patterns]
87 P: That-that’s a possibility. That is, that really is.
88 T: I might tell you in a more general way, by the way, that with regard to what you do outside of here–whether you make yourself do something or don’t make yourself do something, that’s entirely your business. I will not tell you to do things. I will not tell you not to do things. My-my business here is to help you understand yourself. What you do with that understanding is your business. [support // therapy sugg]
89 P: Mmmm. I’m, uh–you know, it’s like you think and think at night, uh–what are you gonna say, how is he gonna help me, you know and all this thinking is a waste of times just go there and talk and tell him what you feel and then maybe after so many sessions, he’ll–he’ll really help you, you know. I have an optimistic viewpoint because there’s no place else to turn (laughs) That’s just how I feel.
90 T: Yes. I understand that you’d rather not do this and the reason you’re doing it is because you feel desperately in need of help and you hope it’ll work. I don’t expect you to come here joyfully and very happy to have to come to the doctors No. I know you don’t want to. [conflict // pt.feelings // therapy sugg]
91 P: Okay.
93 P: There was an article in the *Times about women and their psychiatrists, I don’t know if you read it.
94 T: No. I didn’t see it. What did it say? [elab]
95 P: I’ll bring it in tomorrow. it says one of the things if you start copping out is if you start missing sessions and being late, you yourself are–because half of you wants to stay well and the other half of you wants to stay sick, you know. And *Nick read it too because there was also a part where the husband can feel that–well, this guy is helping her and he’s not and he’s her husband and if he starts sounding off and intimidating her that all the psychiatrist’s work can go down he drain for awhile, you know, like, uh–you can start but you just be quiet you know, (laughs)
96 T: Let me understand that better. How might the husband feel, uh….? [elab]
97 P: Resentful that you’re helping and that he’s not.
99 P: Possibly. Uh, and he could start–but he’s so busy changing jobs that he’s got that on his mind that, uh, you know, we’re in two different worlds right now in a way (laughs) in a way, it’s good ’cause he’s been depressed about his job and I keep telling him he’s doing–it’s gonna be better–it’s gotta be better and we wanted to stay,-every other day, he was staying or he was leaving, you know. It was just up and down and I was getting very upset about it too, didn’t know what to tell him–just not saying anything and I’m just going to now what happens when he comes home today at five o’clock. you know, how did it go, did he like it,(laughs) because my ordeal will be over until tomorrow.
100 T: Of course, he may be dying to ask you what happened with that doctor too. [life sugg]
101 P: Oh..I
103 P: Well, I just said, “Don’t start, uh, intimidating me.” I says–I said, you know,… Well, once before about a year ago, he said, you need help. Go see somebody” you know, but then he can say one thing and another thing–you know, once he gets settled in his own mind, who knows what he’s gonna think, you know.
104 T: Say, I’ve another idea about that now. Maybe… [subjective]
105 P: Read too much (laughs)
106 T: What? [elab]
107 P: I shouldn’t have read that article, I know.
108 T: Oh, you can read anything you like. I don’t make rules like that. No. It occurs to me that maybe you’re a little bit afraid that your husband might-might be jealous and if it’s true that lying down has a kind of intimate feel about it maybe- [transference, interpret // support, subjective]
109 P: We’re very…
111 P: Well, that could be the Catholic upbringing too.
113 P: (laughs) That’s–I guess, there’s a lot of everything, isn’t it. could be a little bit of everything, you know.
114 T: By Catholic upbringing, you mean…. [elab]
115 P: Oh – you get mentally brainwashed about a lot of things, you know, and you get out in the world and you find things are a lot looser than they’ve been telling you and there’s been a big change during our period of growing up and we resented it, uh, as far as the Catholic church went and now, uh….
116 T: Do you think the Catholic church is opposed to psychoanalysis? [elab]
117 P: No. I mean, just basic changes in mass and different attitudes about things-mostly the mass, we got use to doing the Latin–and singing certain ways and then they changed it all to English and we thought the other was much beautifuller, you know–much more pretty. Uh. that-that kinda made an excuse for us for awhile to slump with our religion but now that our children are growing up, we’re getting involved with it a lot more so, uh–I don’t even know how we got on this (laughs)
119 P: Oh ,yeah.
121 P: Yeah-yeah. Because, uh–I don’t know, you see a lot of people cheating on each other and all this other stuff–changing wives and all that. It’s me and *Nick–and nobody else, you know. And that’s it, you know. Sometimes the world scares you with all that going on or you meet somebody who is a little pushy or something like that.
123 P: No-no. I watched Sigmund Freud–that movie–he was very good. I know–and it takes two people. There’s–you know one could say yes, the other one could say yes but if one says no, you know, it’s nothing like that. it’s just, uh…
124 T: Then you’re not afraid of me in that way.
125 P: No-no. Not that way. I just–I guess, you don’t know me and I don’t know you I could say things and you don’t know my upbringing or my family life and, uh, I know there’s like taking time and talking with each other, you’ll learn everything, you know, so, uh–well, I’m just–that one thought went through my head that he’s not gonna pass judgment so that-that’s–that relieves me already just that part, you know. but, uh…
126 T: Pass judgment. [elab]
127 P: Yeah. you know…
128 T: You think there are things that… [elab]
129 P: Well, my parents are great at that. I think a lot of this has got to do with them. They’re very severe, uh-uh-uh–oh, gee, you know. I had this all written down like where my ma was from one to six years of age. There were a lot of things that went on and that I remember and I was wondering if all this stems back from something in my childhood or the way my mom and dad brought me up or a combination of both or–’cause I can’t understand why it went away and-and it’s coming back so bad that’s (sighs) doesn’t make any sense. My father for awhile, when I was in high school uh – daily it was said that if you don’t have an education you’re a nobody, you know, and I did go to college for a year and it didn’t work out and I just, uh…
130 T: Where did you go? [elab]
131 P: *Denver Community.
132 T: Uh huh.
133 P: And, uh, that was like the year before–well, I was there the day they put the shovel in for this, you know–when they had the mockup and everything but so then I kinda felt like a failure to him. His attitude is changed now and education isn’t everything, you know, so long as you’re a nice human being but, uh, and like they weren’t very constructive, uh…
135 P: No-no. (laughs) Still want me to lie down – would it be better? (laughs) I’m going back on that. Uh-uh-gee, no. (laughs) That didn’t cross my mind–not at all. I feel comfortable sitting up. I, uh–maybe tomorrow (laughs)
137 P: I’ll practice at home (laughs) Oh, gosh, uh…It kinda made me feel guilty talking about my parents (laughs) ’cause, uh…
139 P: Yeah.
141 P: Well, I love them because they’re my parents but I don’t like them as people, (laughs) if you can understand that.
143 P: They’re, uh–my mom takes things to heart–like if you don’t do something you’re out to hurt her and my dad. It’s really weird. Uh, like if you’re doing something your own way–I don’t know if I can give you an example–my brother just left home. They had a fight and he left home. Couldn’t take it anymore and he left home to hurt them. That’s their attitude. He doesn’t…
145 P: Four.
146 T: And this…
147 P: He’s the youngest.
148 T: He’s the youngest.
149 P: And, uh…
150 T: And you are? [elab]
151 P: The oldest.
152 T: Mmm hmm. So your brother…
153 P: Yeah. He just got fed up with the whole thing. They talk like…
154 T: How old is he? [elab]
155 P: He’s, uh, eighteen and a half. He turned eighteen in May.
156 T: Yes.
157 P: And, uh, he got mad and left so my mother takes it like he left because he doesn’t love her and he hurts her–he’s doing it on purpose to hurt her–and he’s not really–he just–he’s been talking about this for a year–he just wants to make it on his own and I guess, to–it’s like that with my mom and dad, uh, my dad could be in the house not even five minutes and he’s sounding off–none of these kids are any good. They’re all stupid idiots. Like that. It’s–he’s really–you know, even *Nick’ll tell you. He’s just–he just doesn’t have any faith in the kids. I think he gave me a compliment once and I almost–you know, I couldn’t believe he did it, you know. He’s very, uh–even if it were a man, he doesn’t give out compliments. He doesn’t have–you know, like I remember being twelve or thirteen and I asked him how the gas bill is paid, you know, inquisitive. And, uh, he says, “None of your business.” you know. I just–or when you’re trying to do some arithmetic or something, he doesn’t have the patience with you to work it out and wait until you get done, he’ll just “Gimme the paper, stupid.” you know, and just do it, you know. He doesn’t have patience like that and then he’s always trying…
158 T: I think you’re gonna think I’m harping on it but, uh–I’m not trying to make you do anything but, I think, that’s another thing you wanted to find out maybe whether I would be impatient and would say, “Now this is the way it’s supposed to be done and you lie down and let’s do it. [transference, interpret, development // support]
159 P: Yeah. That’s–you–I’ll agree with you that-that–I have, uh–I never thought of it but–yeah, I would like to know that–yeah. It’s uh–you can say they’ve been very critical–growing up–I think part of it is, uh–I can say like I don’t have confidence in myself because of the way they talk or have an idea of life but, uh–but I’m still doing things. I’m still, you know, doing things I like and things come out of them, you know. Like I’ve got a garden in the backyard and I’m digging vegetables and flowers and everything like that, you know. It’s, uh…
160 T: Is that something they’re opposed to- [elab]
161 P: No. It’s just…
162 T: …or is that just an example you’re giving of how you… [elab]
163 P: Uh, my father can come over–well, he could come over and say, “Well, how come this isn’t done and how come that isn’t done.” you know. And we’re working–*Nick and I are both…We bought a house last year. It was completely dilapidated. It was a mess. It was filthy but we got a good price on it and that’s why we bought it and all it needed was cleaning and painting and, you know, he just, uh–it’s unreal, you know. He used to say people are no good and all this stuff and you get out in the world and it’s different and sometimes, you now–you want to believe your parents, right–and-and when you go out and you find their way of thinking is different than everybody elses, you start wondering about them and then when you go back and you try to converse or argue or talk with them about something–gee, you know, you can’t. You can’t. They get all mad and huffy and puffy and you try to stay on the good side of both of them but sometimes I think that growing up kind of–I don’t know what I think of people, you know. I think I’m scared of them in a way. That could be part of the reason I don’t want to go places because I’m scared of them–or scared of people– scared of how I’m supposed to project myself across but then–but then, you know, I’m holding my own. I’ve got my husband and my two children and I’m doing things myself, that should give me enough confidence to, uh, go out without being scared–nervous. (sighs) I don’t know.
165 P: I have–I have-
167 P: …tried to take myself apart to find out, you know, what gets me that–so scared and so upset and even after realizing stuff like that or admitting stuff to myself like that, it’s still happening. I still had instant diarrhea to go take *Nora home Saturday night. Friday night, *Nick and I were out all night (inaudible) before. It was his last day at work and everybody met after work at this one lounge and we had like a party–like a going away–goodbye ceremony type thing and, uh–you know what I do sometimes to get out is I get very overtired. I work around the house and the kids and everything and I’m overtired that when I don’t have any feelings. I’m just tired and I get there. Well, during that evening, he left me for like an hour and a half almost and I was talking to this one girl and then her boyfriend came back and then another fellow employee that my husband worked with and he came in and the three of them sort of talked together but I was next to them but I was getting backed and I was hearing half of every other two words but I was laughing going along, you know, pretending to be there, you know. And finally, I got kinda tired not hearing anything, you know, so I went back by the washroom where the pool table is where *Nick was playing pool. I stood there but he didn’t even notice me and, uh, when the girl came out, I went in and, uh, I just–I’m going home, I can’t take it anymore, you know. So I went up to him very quietly and I-I told him, I said, uh, “I’m not making a scene. I’m leaving. I’m going home.” And I left. And I went to the car and all I did was start crying and–’cause I said, “Gee, this is his night,” you know and I’m not supposed to mess it up again, you know, pulling any stunts or getting sick or anything like that and he came out and I was crying and then he suggested, “Let’s go back in.” and it hit me–there I was, the whole–all evening, you know, no problem with the fear or any upset feeling and I just didn’t want to go in but after ten minutes of talking, I went in but I headed straight for the bathroom and, uh, that-when you’re nervous–this has happened on occasions to me too–where when I vomit, all I get is bubbles–just bubbles. Is that, uh…
169 P: No. We had a whole pizza that night. Usually nothing is empty, uh-uh–I didn’t eat all day and all I had was two pieces of pizza but I thought that was gonna come up for sure but it was just bubbles, you know. I haven’t eaten–I haven’t eaten at all today. I have had half a bagel to get her and when I get home, I’m gonna stuff myself.
171 P: Right. Or to get there so why waste all that food, right? you know. I–it just–I don’t know (sighs) I really give myself the third degree and think of everything that’s happened in my life and what’s causing it and I…
173 P: Well, sometimes I wish you would when it’s happening so you could find out and get it over with, you know. Uh, I’m telling myself that this is not gonna take a year, you know-this is three months at the most to get this out with, you know.
175 P: I know. I know. I just–I’m hoping that, you know, I’m gonna be….
177 P: No-no. No. If that were the cause I just wouldn’t come (laughs) I-I just–I have confidence because of *John and because of *Janey, you know. They–and ’cause who else am I supposed to go to, you know.
179 P: And *John said he was going to find someone who wouldn’t abandon me–whatever that means. I guess I feel like I’m being abandoned or something. He has different theories he-he voiced out but, uh, you know, *Nick asked me last night, he said, “Do you think you’re gonna go there and talk to him and let everything out and he’s gonna come up with something and you’re gonna be instantly cured?” (dr. laughs) I said, “Yeah. I am. I’m expecting that.” I mean, I don’t expect it to happen overnight or anything but I said after a certain amount of time, I hope, you know, he can help me. That’s what–I’m hoping something like that happens, you know, ’cause I don’t know what else to expect. I guess it’s from reading things or seeing that Sigmund Freud movie that…
181 P: Well, that-that-that I under–that would be better.
183 P: Do you believe in things happening in childhood that could upset a person later in life, uh…?
185 P: I wish I would have brought that piece of paper. I had my mother–I remember certain things–a lot of things in my childhood….
187 P: Oh, she had dated which would give you a time age, uh-uh….
188 T: Oh, she wrote out the… [elab]
189 P: I asked her–like she got married in December of ’55 and I was born in October of fifty–no, she got married in December of ’54 and I was married–born in October of ’55. Well, she came back to *Denver, my father was in the service in the Navy–and she came back in Augustof ’55 and a few months later she had me and my father never came in-in until December of ’55 so he didn’t see me for about like two months and then we went back to *Florida. Now mymother said I was fine until I was nine months old and there’s no way I could believe a baby of nine months old can get upset. I mean, so that mentally, in later life, it could–I used to be playing in the backyard and I’d just end up throwing up and I just–they took me to doctors to see if I had any heart problems or anything. They thought it was my tonsils and I had those removed in about 3rd grade. Uh, you know (laughs) didn’t help. But, uh, there was a lot of moving around and she said people–we lived with a couple of different strangers and she left me with them to babysit and she says, who knows, something could have happened then, you know.
191 P: Yeah. Until about, uh, ’57. And it was like four months after we had–my mother said they had gone back in December ’55 that they had been transferred again and shipped somewhere but, uh, then I found out that, uh–that they came back to *Denver in about ’57 and stayed with my grandparents–you know, it was an eastern European family and everybody lived with everybody and I found out that also that my dad and her slept upstairs in the attic–my dad had made a room addition on the end and I stayed with my grandmother and I thought–well, maybe isolation from my mother or something ’cause I read a lot of these things, you know.
192 T: Maybe what? Did you say isolation from mother? [elab]
193 P: Yeah. Possibly, you know.
194 T: At that time you were how old? [elab]
195 P: Two to say, uh, five, you know.
196 T: Oh, they lived there that long. [elab]
197 P: Well, no but my mother, uh–they bought a house after a year or so, she said–gee, I had this written down exact dated and she was working and she’d take the bus and take me to my grandmother’s and then go to work so I was still at my grandmother’s during the day. Uh, and I loved my grandmother. You would have loved her too. She was a she–died about three, four years ago but even then we could argue and talk things out–she was a fantastic person, you know. Really like her a lot. Should say loved because she was my pal.
199 P: I had it last week but I had dated of like how old I would have been and stuff.
200 T: Yeah. Were you gonna bring it today is that what you…. [elab]
201 P: Yeah. I–well, I didn’t think I’d need it. I didn’t know what we were gonna do but I’ll…
203 P: Okay. But I thought maybe time element–age, uh–I could tell you that–things I remember–there was my grandmother’s mother would be my great grandmother
204 T: You mentioned her last time, didn’t you? [elab]
205 P: Yeah. I don’t know if I did. I wanted to.
206 T: The one who died the day that the collie….
207 P: I did mention all that. Good. Yeah. And I thought she looked like a witch and all–I did mention that.
209 P: (laughs) I guess so. I know those things I wanted to get out because I remember them. Uh-uh, the fact that I saw the collie–I did all that–good.
210 T: I don’t know if you did all that whatever all that means but you did tell me about the dog, yes. [straightforward]
211 P: Uh, that I saw it get killed and that-that was the same day–in the evening, my great grandmother had passed away and everything. I don’t know if there’s any thought–that’s when I should lay on the couch and just go back or something maybe something traumatic happened there. I don’t think I told you this–how old would I be–about four and a half–I was staying by my grandmother’s again and my mother went to have my sister and, uh, I was very excited–very excited.
212 T: That’s the first baby after you.
213 P: Yeah. That would be four and a half. Well, she had a miscarriage before that too so she might have been away, who knows, in the hospital.
214 T: That you’ve been told. You don’t remember.
215 P: Yeah. I don’t remember. I just remember staying by my grandmother’s a lot, I remember. Uh, I have a cousin, *Franky, who’s like about six months old than I am and he lived right next door–my uncle and aunt lived right next door to my grandmother’s–well, we played a lot and I had played with him all that week and I was so excited, my baby sister came home, you know, and I was told not to leave the house and–but I went to go get him to come see her and, uh…
216 T: Oh, you went to get your little friend to come see you r new sister.
217 P: My cousin. Yes. Definitely. I was delighted with this beautiful little thing and I’d played with him all week and why shouldn’t he see something I like, right? I went there and I was sitting on the bannister and, uh, these are the type of buildings they have like, uh–like English type basement apartments and-and then two floors above that and I was sitting on the bannister and I fell over–fell down and, uh, I remember falling and fainting or passing out whatever–blackout–and, uh, apparently, I–well, they have the bricks laid in the bottom there and I hit that and got a nice scar up there and I remember my uncle picking me up and taking me back to my grandmother’s house and the kitchen sink and just all this–getting water poured on my head, you know, rinsing off the blood and I remember my father–my mother was in the rocking chair with the baby and my father was kinda next to her and he was shaking that finger and telling me, you know, “I told you not to go. You were told to stay in this house,”you know. What a foolish thing–she’s stupid–all that type thing again. Uh, I remember that. I remember that. It was…
219 P: Yeah. It was that day. It was the same day, uh, because I went to get *Franky to bring him back home. That I remember very vividly. It just seems like every time I was suppose to have a good time or I was happy about something, they kind of like, uh – frowned upon it or made it terrible–made something terrible out of nothing, you know, and sometimes I think that if I think I’m going to go out and have a good tine, I’m either gonna get punished for it or something terrible’s gonna happen and this-this-this I have thought of because of certain incidence growing up and, uh–like if I went out on a date, uh, I wouldn’t be asked if I had a good time. I’d get the third degree, you know.
221 P: Yeah. And there were times I was called certain thin’s and nothing had ever even happened, you know, and-and that kind of,uh, you know, you just–you start maybe mentally, I don’t have that confidence in myself but I’ve thought all this and still that-that fear is coming out, you know–instant takeover.
222 T: I want to say a word about that because you said that several times now. You’ve said, “I know this and I know that and I’ve thought this and I’ve thought that, and it still doesn’t help.”
223 P: Yeah
224 T: It’s as if you’re afraid that you’re gonna find out all sorts of things here but nothing will change–that you’ll still have the problem. [COMMENT] [transference, interpret, patterns // pt.feelings]
225 P: Well, not really. Uh….
226 T: Or that maybe I expect–maybe that idea you had was really, in a way, an idea about me that I think suddenly I’m gonna see something and I’m gonna tell it to you and then you’re supposed to be cured and go about your business and stop bothering people…. [transference, interpret // pt.feelings]
227 P: I don t expect that fantastic of a–you know, of a miracle happening.
228 T: No. But maybe you think I think that and maybe you’re afraid I’m gonna say something and expect these wonderful things to happen and if they won’t and then I’ll be disappointed. [interpret // pt.feelings, pt.self-esteem]
229 P: Yeah. I thought of that. I thought of that.
230 T: You did think of that. [elab]
231 P: Yeah. That occurred to–I thought of that the other day.
232 T: What did you think? [elab]
233 P: Just similar to what you’re saying that maybe he’ll keep trying to help me and I ain’t responding ,uh, you know…
234 T: Mmm hmm. And then he will… [elab]
235 P: He’ll not like me, right?
236 T: Right (laughs) [support]
237 P: It’s as basic as that. Uh, could I have that much lack of confidence in myself that-that-that’s causing it? I….
239 P: I don’t know, I don’t want to admit that to myself because it would hurt, I guess, my pride or something , uh, it just….
240 T: I think that’s why when you tell me those things sometimes, you emphasize all the things that you’ve done–that you’re- married, that you have a house, you’ve fixed it up and you have these two kids- [interpret // pt.self-esteem]
241 P: Yeah.
242 T: …it’s as if you’re trying to say to me–now, look, it may be true that I-that I have a lack of self-confidence and I can’t do this and I can’t do that but just don’t write me off as a nothing. I have done a lot of things. [interpret // pt.feelings, pt.self-esteem]
243 P: Yeah. Right.
245 P: Right. I mean, it’s not every day-to-day living–twenty-four hours a day that this thing is occurring but it’s occurring enough that, uh, it–it’s a nuisance, you know. I wish you could be there when it happened (laughs) Not really but, uh…Well, like you said I have…
247 P: Uh – noooo.
248 T: Oh, you mean, this is mild compared to that.
249 P: Noooo. This is mild compared to that.
250 T: I see.
251 P: That is a complete takeover of my whole inner self or whatever. I cannot–it takes a long time–a good five, ten minutes–to me is a long time–of trying to get myself back calmed down and not so nervous. Uh – it just–oh–where do you go from here (laughs) you know. Oh….
252 T: You have a feeling you have to keep talking a mile a minute–fill up every minute.
253 P: Sort of. Yeah. I figured the way I-
254 T: That I expect it from you. [interpret]
255 P: …. that everything I feel or everything I experienced come out, the sooner will get to the conclusion.
257 P: I don’t expect it today though (laughs)
259 P: Yeah. Maybe you know. Oh, dear–that,uh-I don’t know.
261 P: Yeah. ‘Cause I don’t want this to happen anymore. This, uh (sighs) you know coming here, I saw people walking and put people in two different categories They were educated, you know, or trying to get educated or they had some terrible thing with them that they were coming for medical aid or you know, I’d see mothers with their children and I start thinking — gee, you know, like–you’ve got your health, you know, what are you complaining about, you know. why are you going to see someone for something that is really minor compared to what maybe a lot of people have, you know–physical-mental, uh, physical-medical….
263 P: Yeah. It’s–then I say, well, wait a minute girl, then it hits you–when you get that upset and then your husband says, “Come on, let’s go.” and you can’t get out of there, and it’s really kinda wrecked you-it really, uh, takes a lot out of you. To me, it’s major you know.
265 P: Yeah. And-the fact that there are things–the children are growing up and I want to go to–I want to be there–I don’t want to be sitting there with my fears and my hangups–I want to sit there proud and happy with whatever they’ve done, you know. Like the last two or three days, I haven’t been able to give myself as much to my husband as far as feelings for him leaving his job. This is a traumatic thing to him changing a job and I haven’t been, uh–like before I was comforting him and, uh, saying, “It’ll work out either way, you know. At least, you’re trying. You know, you’re not stagnant. You’re not just staying there.” The last three days, I’ve been in my own, you know, upset feelings…
267 P: Right. Right. So it’s–but I told him, you know, I said,”This is for both of us” you know. I said, “When you ask me to go somewhere–to the movies, I’m not gonna run–I’m gonna be happy and we’re gonna go and we’re gonna have a better time, you know. we’re not gonna–at the end say, ‘Gee, I want to go home.'” you know, if he wants to go out -have a ice cream sundae or something, I can go, you know. That’s–that’s what I want. That’s what I really want. I feel like, you know–not that I know you any better but I feel, I don’t know-more confidence in you – today. you know, I just–l have the fact we got that over, you know, that you’re not gonna pass judgment and, uh, I don’t have to take anything literally–maybe I took *John’s suggestion seriously because at that time I was very desperate and any good suggestion would have–I’d try, you knows but, uh-I’m thinking about it (laughs), and I don’t want to if I don’t have to but I’m trying you know.
268 T: Now which suggestion exactly do you have in mind here. [elab]
269 P: To go out. When you have to do something go out and do it.
270 T: Just force yourself to do it.
271 P: Yeah. Force myself to do it. that’s what I was doing and, uh, even after it was all over, I said, “I did it. See, you did it. that were you so upset about?” and I can’t come up with an answer.
272 T: How long ago did he make this suggestion? [elab]
273 P: August.
274 T: And you’ve been trying ever since.
275 P: Well, I had those tranquilizers go fail back on. I took one to get here last week but Didn’t take anything today ’cause I felt like–well, I’ll save them for when I really need them, you know.
276 T: A real emergency, huh?
277 P: Right (laughs) And right. Uh, he gave me two boxes–I guess,there’s sixteen in each box–I finished one box since August and that was for to be godmother and to go to that wedding–that family wedding. I took four to get there and it didn’t seem like it would, the–I didn’t have that upset feeling but, uh, I wasn’t as calm as I wanted to be. I didn’t want to–I didn’t, uh-when you go somewhere you want to be happy and enjoy it, you know, and just want to get involved in it, you know, and I’m always, you know, I guess, holding backs uh, for some odd reason, I guess, just, uh, very critical of myself maybe, you know. My mother says I’m a perfectionist. Everything I try to do, I try to make perfect. I use to be that-way but now, there’s not enough time to be that way(laughs) you know. When I put it on the table, that’s what you get, you know. Uh, I just, uh–I would like to do something like I use to-just, uh-when I use to clean a bedroom, I use to get every corner nook until I was satisfied and completely, you know, happy that everything was done and now I realize there’s just not enough time in the day with the two children and, uh, your time has go towards them for homework or something like that, It doesn’t help. This lady across the street is meticulous and it does not help. It’s unreal. she works all day long and comes home and washes all the windows in the house underneath the awnings–it’s just, you know (laughs) and she has children and she works all day long and her house is like walking into a District Furniture warehouse, you know–immaculate. And when you see that and you say–gee it can be done, you know.
279 P: Yeah.I would say so, really. I try to be in ten places at one time. You know, when you’re cooking something and you’re to get it on, uh–always end up burning something or,un, overboiling something because my mind is someplace else, you know, really. It’s-it’s just scattered at times. It, uh, doesn’t stick to one item which is very aggravating. Like I’ll soak the dishes and I’ll run downstairs and put a load of clothes in and I’ll come back up and make up the beds while they’re still you know–then I’ll forget about closing the lid on the washing machine in the basement after it’s agitated a little bit and I’ll get water all over and, you know, ii’s just–why don’t you just stay there in the basement with your clothes, *Annie and-and don’t worry about anything else but I guess, I try to get things going all at one time, you know. I think it’s good people should be critical of themselves, in a way, makes a better person out of them, doesn’t it (laughs) Trying to justify myself.
280 T: Within limits. Within limits. Yes. I-I wasn’t being critical of you for being critical of yourself (laughs)I was just remarking that you seemed to be very critical of yourself. [support, pt.self-esteem, warm]
281 P: I–it s gotta be my father and my mother–it’s gotta be.
282 T: ‘Cause they were so critical, huh?
283 P: Yeah. They, uh…
285 P: Well, and the fact that father will still come over and say, “how come this isn’t done?” or “how come that isn’t done?” (laughs)
287 P: That-that–you know, I really want–if anybody should see a psychiatrist–oh, that man should. He’s just so miserable. I feel sorry for him, you know, like I just uh-like I play piano and I was taking lessons and, uh, we had recitals every year and instead of him wanting to go, he said, “I don’t want to go. I’ve heard it all week long.” you know, and he was only joking, you know, but it hurts. It just–he’d still go to it–he’d sit at it and he’d-but, you know, he just, uh…
288 T: But he’d leave you with a bad taste in your mouth, huh?
289 P: Yeah. you could say that. Uh…
290 T: It’s interesting in the light of your saying that one of the things that bothered you the most about your symptoms is that you can’t go to your daughter’s things at school. [COMMENT] [development // pt.feelings]
291 P: Oh, yeah. That is–I could go but…
292 T: Your father came to your things but he didn’t do it very graciously, did he? [development]
293 P: And my mother she even went on an airplane this year,which shocked the heck out of me, you know. Ah, you know, her….
294 T: What was special about that? [elab]
295 P: She’s never been one on in her life. And, oh-uh, I don’t know, she’s a funny person. One day she’s very liberal, and outgoing and the next day she’s, oldfashioned as all heck.
297 P: Yeah. My father would never go. He still won’t go on–he’s deathly afraid of planes–and boats–I was surprised at boats–I just found out recently. Boats maybe somewhere in my childhood–I’m deathly afraid of heights though because when I get up high, I get dizzy and I’m afraid I–and I think it’s partly because I fell off into that–from that first floor into that–the day my sister came home. [COMMENT]
298 T: When you hurt your head, yeah. [support]
299 P: Yeah. ‘Cause I remember falling–that’s a terrible feeling. My husband he loves planes.
300 T: How far a fall was that? [elab]
301 P: Uh it’s–it’s gotta be–you know how an old english type basement is–the windows are right at-
302 T: At the street level. [elab]
303 P: …right, and then you’ve got stairs going to the first floor.
304 T: And you fell from the first floor bannister down to the… [elab]
305 P: Yeah. I was sitting on the bannister.
306 T: I’m afraid our time is up for today.
307 P: That’s okay. (laughs) Oh – I gave you a lot to think about.
308 T: You’re giving me a lot to think about, you say?
309 P: Yeah. I’ve got nothing else to say. Oh, my–gee…
310 T: Two doors…
311 P: Well…
312 T: Mmm hmm, Bye.
313 P: Goodbye.
#44: The therapist picks up on her feelings about him, acknowledging her immediate anxieties in an accepting way. LR+SW
#70, #74, #78: The therapist is doing three things at once here. He is reassuring the patient in acknowledging her contribution, responding to her feelings, and also taking the opportunity to structure the treatment in the patient’s mind by suggesting she need not be correct or consistent in what she says. As will be seen in the next sessions, he is undoubtedly aware that her anxiety reflects a considerable fear of being judged and controlled, and his comments are intended to make her less fearful of expressing her point of view. LR+SW
#64, #68, #84, #86: This constitutes a first transference interpretation. It is precisely aimed at exploring the potential meaning of her discomfort in entering treatment. While remaining tentative and respectful, the therapist’s calm and flexible approach actively invites her to reflect about her feelings more deeply. LR+SW
#90, 92: The therapist acknowledges the possibility of the patient being of two minds about coming for treatment, framing the complexity of the patient’s distress in terms of an internal conflict. This leads to a broader exploration of how internal conflict can generate misunderstandings in close relationships, including the patient’s intimate relationship with the therapist. LR+SW
#100-102: The therapist intuits that issues of sexual jealousy may be contributing to the patient’s uneasiness about turning to another man, the therapist, for help, since the patient is uneasy about lying down in the presence of a stranger but comments that it is OK to lie down at home with her husband. By inviting consideration of whether her husband’s feelings may have a component of jealousy, he is priming the patient’s ability to consider and describe such feelings in herself as well. It will be seen later in the session (#168) that she describes her symptom of having to run to the bathroom as arising when her husband ignored her at a party. See Helm 2018 for a description of the role of priming. LR+SW
#104-122: The therapist makes his first explicit interpretation about her feeling she shouldn’t do something ‘improper.’ The ambiguity and generality of this word allows the patient to steer her response toward whichever meaning of ‘horsing around in an improper way’ might resonate with her. Meanwhile, it is only by the end of session 4 that she is able to reveal a fuller history behind this anxiety. LR+SW
#134-140: The therapist further refines his interpretation of the patient’s worries about how he might be critical of her. The straightforward nature of his comments thus far, and the calm, supportive, curious stance he maintains allows the patient to consider an associated, antecedent anxiety and anticipatory guilt about being critical of her parents. LR+SW
#158-166: By staying attuned to the patient’s anxiety level in the room, the therapist’s interpretation contextualizes her relationship with him as similar to the experience of her parents’ criticism. LR+SW
#172: The patient introduces language about ‘the third degree’ that is a useful short-hand for her expectations of criticism from others, and her related tendencies toward self-criticism, which the therapist is quick to acknowledge. LR+SW
#208: The therapist responds in a sensitive, accepting way to her indirectly expressed discomfort in coming to the sessions, interpreting the patient’s difficulty remembering something from a recent session as reflecting her distress. In this way, he encourages further exploration of her feelings in the room. LR+SW
#210-218: The therapist encourages elaboration and clarifies (especially in 218) how this significant early memory fits with the conversation at han. This allows the patient to experience the emotional connections to these memories more deeply. The therapist is no doubt aware that there are rich connections from this material, including the idea that, if one is not careful and inhibits oneself enough, bad things happen (i.e. her getting hurt and reprimanded, the dog dying). This incident, in which the patient is impulsive in responding with excitement, sharing with her cousin about the new baby, but gets reprimanded by her father, anticipates a parallel, serious transgression as an adult, which she is only able to confess to at the end of session 4. LR+SW
#220: There is something wrong or ‘naughty’ in ‘going out and having a good time,’ particularly as it may worry or anger one’s parents. The therapist remains curious as to what might make such a thing ‘naughty,’ inviting the patient to elaborate. LR+SW
#222-244: By highlighting the patient’s worry that she may be a ‘hopeless case’ that will frustrate or burden him intolerably, the therapist addresses this sensitive subject in vivo, defusing the patient’s anxiety and fostering her curiosity. LR+SW
#246: The therapist brings the patient’s anxieties more vividly into the room. The situation they are in is sufficiently contained and mild so she can survive her distress, but also allows it to be a more present experience that can lead to change. LR+SW
#260: The patient experiences in her relationship with the therapist in the room what she has been describing with him and others, in terms of her tendency to push and criticize herself. In response, the therapist clarifies both the pain of the patient’s self-criticism and her fears that he too will be just as awful and demanding with her as she is with herself. By both acknowledging her fears in beginning to speak with him in this way, and by implicitly suggesting that she may not have to feel this way, the therapist encourages her to explore her feelings further. LR+SW
#262-266: The therapist understands the patient’s feelings and sensitively articulates what she is going through, and in response, she opens up even more in the next turns of speech. LR+SW
#278-286: The therapist interprets how the patient’s experiences with significant others throughout her development have contributed to her harsh criticism of herself now, and her expectation that the therapist will also criticize her. He provides a setting in which reflecting on these experiences does not necessarily mean relentlessly attacking herself. LR+SW
#290: The therapist is sharing with the patient his active and engaged understanding of her, and promoting the stitching-together of material from disparate aspects of her emotional life, which can be a favorable way to expand their therapeutic exploration. LR+SW
#297: The patient foreshadows an important dream about falling in session 4. LR+SW
Helm, F.L. (2018). Free Association Continues. Psychoanal. Inq., 38(6):446-456.}