db psyc 620
MasterQ37
TranscriptDialecticalBehaviorTherapyWithaFemaleMilitaryVeteran.docxDialectical Behavior Therapy With a Female Military Veteran
1: Opening the Session
Okay, Sara. So it's good to see you. SARAH: Nice to see you. ALEXANDER L. CHAPMAN: And so I
5 seconds ALEXANDER L. CHAPMAN
[00:05] ALEXANDER L. CHAPMANnoticed that you brought in your diary card. SARAH: Yes, sir. ALEXANDER L. CHAPMAN: Great. So, let's spend a little bit of time talking about that. And it looks like you fill it out every day which is great, which is, you know, for every single day which is not easy to do. SARAH: Right. ALEXANDER L. CHAPMAN: I know, when I've tried to fill up one of these things. I inevitably forget a day and have to come back later on and so. Alright, so... SARAH: It's helpful when you set a time to do it.
30 seconds ALEXANDER L. CHAPMAN
[00:30] ALEXANDER L. CHAPMANYeah. That makes a big difference if you actually like put it in your schedule or something like that, or say at the end of every day I'm going to do this. SARAH: Yes. ALEXANDER L. CHAPMAN: Yes. So alright, so it looks like, what we will do is we will spend a little bit of time talking about this and just kind of how your last week has gone. And then we will figure out like where we are going to put the most priority on; where we are going to spend our time talking about. And I'd like to hear also where you would like to spend your time talking about as well. What will be the best thing to focus on. And then we're kind of do that and then maybe when there is about ten minutes left we will start to wrap up and talk about what we have talk about and maybe our plan for the future and what you are planning to do? So, when it comes to the diary card it looks like you've had several days where you have had like two's and three's for thoughts about suicide, is that right? SARAH: Yes. ALEXANDER L. CHAPMAN: Okay. And so it looks like the highest it got was Tuesday. But what -- is this typical for you, like do you find that two's and three's are pretty normal? SARAH: Around anniversaries
1 minute 40 seconds SARAH
[01:40] SARAHof traumatic events, I usually get high into suicidal thoughts. Usually it's around like a one, like it's always there nagging on me.
1 minute 55 seconds ALEXANDER L. CHAPMAN
[01:55] ALEXANDER L. CHAPMANOkay. So it's like even with when there is no anniversary coming up of a traumatic event, like you might find that it's about a one. SARAH: Just like
2 minutes 5 seconds SARAH
[02:05] SARAHa nagging. ALEXANDER L. CHAPMAN: Okay. But when it gets
2 minutes 10 seconds ALEXANDER L. CHAPMAN
[02:10] ALEXANDER L. CHAPMANto -- when it gets to two or three what are we talking about, so it's no longer just kind of nagging at you, or what? SARAH: It's starting to get a little more intense, it's not
2 minutes 20 seconds SARAH
[02:20] SARAHto the point that I've thought out a plan and I'm going to carry out a plan, but it's to the point where it's coming up to the forefront of my mind.
2 minutes 30 seconds ALEXANDER L. CHAPMAN
[02:30] ALEXANDER L. CHAPMANOkay. Right, and it's coming up and it is not, you are not planning, but you have like what types of thought are coming up, like let's say on Tuesday for the three. SARAH: Like
2 minutes 40 seconds SARAH
[02:40] SARAHwhat's the point, you know, all I do is, you know, get money from the government and sit at home and go to school. I don't really -- I'm not really providing for anything. ALEXANDER L. CHAPMAN: Okay.
3 minutes 0 seconds ALEXANDER L. CHAPMAN
[03:00] ALEXANDER L. CHAPMANSo there is a lot of thoughts about what's the point and what else pops up? SARAH:
3 minutes 10 seconds SARAH
[03:10] SARAHJust looking for a reason, a reason to live
2: Identifying Focus for the Session
3 minutes 15 seconds SARAH
[03:15] SARAHkind of -- ALEXANDER L. CHAPMAN: Okay. Alright, so at that point
3 minutes 20 seconds ALEXANDER L. CHAPMAN
[03:20] ALEXANDER L. CHAPMANyou start to get, you have the thoughts that like life is -- your life is pointless right now.
3 minutes 25 seconds SARAH
[03:25] SARAHYes. ALEXANDER L. CHAPMAN: The way it's going on. SARAH: Yes. ALEXANDER L. CHAPMAN: Okay. So, it sounds like maybe that might be really important for us to talk about. What do you think? SARAH: (inaudible ). ALEXANDER L. CHAPMAN: Yeah. Because even though you
3 minutes 35 seconds ALEXANDER L. CHAPMAN
[03:35] ALEXANDER L. CHAPMANare saying you are not coming up with plans like, do you think that as the day gets closer it's like April 26th, right? SARAH: Yes. ALEXANDER L. CHAPMAN: Do you think things are going to get, you know, these like thoughts are going to get more intense or more frequent. SARAH: Yes, I think so. ALEXANDER L. CHAPMAN: Okay. So it will be very good for us to kind of talk about that now. SARAH: Yes. ALEXANDER L. CHAPMAN: Okay. So that's -- what do you say. SARAH: Before it gets more severe,
3 minutes 55 seconds SARAH
[03:55] SARAHwhere I can’t handle it. ALEXANDER L. CHAPMAN: Yeah. Definitely, I agree with that.
4 minutes 0 seconds ALEXANDER L. CHAPMAN
[04:00] ALEXANDER L. CHAPMANAnd so that's one thing. And I also noticed on here, so no, really no urgest to hurt yourself it looks like. SARAH: No. ALEXANDER L. CHAPMAN: No, okay. And I also noticed alcohol you are not drinking at all currently. SARAH: No. ALEXANDER L. CHAPMAN: No, okay. No drugs; you are taking medication and it looks like you have been taking it every day. SARAH: Yes. ALEXANDER L. CHAPMAN: And what are you taking right now?
4 minutes 25 seconds SARAH
[04:25] SARAHI take selegiline, olanzapine, clonazepam, lorazepam and ritalin.
4 minutes 40 seconds ALEXANDER L. CHAPMAN
[04:40] ALEXANDER L. CHAPMANOkay. Alright, so not only you have to organize yourself to do the diary card, but you have to remember all those medications taken every day. SARAH: I have a nice set up,
4 minutes 50 seconds SARAH
[04:50] SARAHwhere at night I set up my morning pills and then I take my nightly medications. ALEXANDER L. CHAPMAN: Right. Okay, very good. So,
5 minutes 0 seconds ALEXANDER L. CHAPMAN
[05:00] ALEXANDER L. CHAPMANalright and then, it looks like, so there is other part where it talks about the skills. You've just been in group for how long again?
5 minutes 10 seconds SARAH
[05:10] SARAHAbout seven weeks now. ALEXANDER L. CHAPMAN: About seven weeks. Okay. So if you were to do
5 minutes 15 seconds ALEXANDER L. CHAPMAN
[05:15] ALEXANDER L. CHAPMANthis, next time you were to do one of these, maybe think about which skills you practiced and maybe how much you practice them. It's kind of a nice way of keeping track of that, just so that you can actually look at and say, Oh! Okay on Monday, I practice mindfulness, and Tuesday I practiced interpersonal effectiveness or something like that. SARAH: Okay. ALEXANDER L. CHAPMAN: So it might be worth doing that. Sometimes people find they actually practice more if they keep track of it. SARAH: Okay.
5 minutes 40 seconds ALEXANDER L. CHAPMAN
[05:40] ALEXANDER L. CHAPMANOkay. So, let's talk a little bit about what else you might want to talk about today. [sil.]
5 minutes 50 seconds SARAH
[05:50] SARAHThe anniversary is coming up. And I wish that I am a veteran, and so I don't know. I just feel like I was treated wrong in the military and -- ALEXANDER L. CHAPMAN: Yeah.
6 minutes 15 seconds SARAH
[06:15] SARAHAnd then I get out and I'm actually getting some help now. But while I was in the service, no one was trying to help me out. I was left the fend for myself kind of.. ALEXANDER L. CHAPMAN: Right. Okay. And so when you
6 minutes 40 seconds ALEXANDER L. CHAPMAN
[06:40] ALEXANDER L. CHAPMANsay the anniversary is coming up, and this is the 26th, it's a specific event that happen to you or -- SARAH: Yes. ALEXANDER L. CHAPMAN: Okay, okay. And so, and thinking about, talking about that, are you kind of hoping to figure out maybe like how to cope with it for instance over the next little while. SARAH: Yeah. ALEXANDER L. CHAPMAN: Yeah. As it comes up. SARAH: Yeah. ALEXANDER L. CHAPMAN: How many years since has it been again since you've been in the military? SARAH: I got out
7 minutes 5 seconds SARAH
[07:05] SARAHDecember 7, 2007. ALEXANDER L. CHAPMAN: 2007.
7 minutes 10 seconds ALEXANDER L. CHAPMAN
[07:10] ALEXANDER L. CHAPMANOkay. So you have had a few April 26th's since then, okay. SARAH: Yes. ALEXANDER L. CHAPMAN: So this is all, so it sounds like most of all we are going to talk about is kind of wrapped up in the lead up to that. SARAH: Right. ALEXANDER L. CHAPMAN: And so this is very important for us to talk about clearly. SARAH: Yes. ALEXANDER L. CHAPMAN: And is there anything else that we will be missing, is there anything else that you really want to make sure we talk about today? SARAH: No. I think that's
7 minutes 35 seconds SARAH
[07:35] SARAHthe big topic. ALEXANDER L. CHAPMAN: Okay.
3: Middle Phase: Talking About Thoughts of Suicide
7 minutes 40 seconds ALEXANDER L. CHAPMAN
[07:40] ALEXANDER L. CHAPMANSo let's start a little bit with the thoughts about suicide and then we will move a little bit more into kind of getting a better understanding of what's happening as you kind of get closer to the date. And so when you -- maybe let's pick Tuesday for instance, when you are having a three of thoughts of suicide. What was happening on that day and what types of emotions were you feeling when you are thinking about it? SARAH: I had
8 minutes 10 seconds SARAH
[08:10] SARAHgroup therapy and that was kind of a difficult group we talked. ALEXANDER L. CHAPMAN: Yeah. SARAH: It was an emotional filled group. ALEXANDER L. CHAPMAN: Okay. SARAH: So, kind of got my emotions running a little higher, and then, just being in a crowd; one of my classes I take, there is about 30 students in the class and that kind of amps up my stress too. ALEXANDER L. CHAPMAN: Okay. Right, so is it always the case for you
8 minutes 55 seconds ALEXANDER L. CHAPMAN
[08:55] ALEXANDER L. CHAPMANin crowds or like in a class room or is that more these days that you are finding. SARAH: More in these days. ALEXANDER L. CHAPMAN: Yeah. Okay. And are you -- so with the group was it different than how it normally goes, like more emotional it sounds like.
9 minutes 10 seconds SARAH
[09:10] SARAHYeah. It was more emotional than other group. ALEXANDER L. CHAPMAN: Okay. How so
9 minutes 15 seconds ALEXANDER L. CHAPMAN
[09:15] ALEXANDER L. CHAPMANwhat was happening? SARAH: We were
9 minutes 20 seconds SARAH
[09:20] SARAHdiscussing fast. ALEXANDER L. CHAPMAN: Okay, yeah. The fast skills
9 minutes 25 seconds ALEXANDER L. CHAPMAN
[09:25] ALEXANDER L. CHAPMANfor the interpersonal effectiveness, yes. SARAH: Fast skills, yes. And
9 minutes 30 seconds SARAH
[09:30] SARAHthey say like at the no apologies part, a lot of people -- like I even said, well what if you apologize for even existing. ALEXANDER L. CHAPMAN: Right. SARAH: You know, when other people were feeling the same way, so like it was kind of emotionally triggering.
10 minutes 0 seconds ALEXANDER L. CHAPMAN
[10:00] ALEXANDER L. CHAPMANOkay. And so you were saying, what if you apologize for even existing which by the way is not a DBT skill. SARAH: Yes, I know, it says no apology. ALEXANDER L. CHAPMAN: Yeah, exactly. So you -- was that that you find yourself doing that and -- SARAH: Yes. I have called my mom before,
10 minutes 20 seconds SARAH
[10:20] SARAHand just apologize first like even being.
10 minutes 25 seconds ALEXANDER L. CHAPMAN
[10:25] ALEXANDER L. CHAPMANRight. So when that was brought like you found, what types of emotions came up for you as you are having that discussion group. SARAH: Depression,
10 minutes 35 seconds SARAH
[10:35] SARAHjust thoughts said, I don't know, am I wasting my time just doing this or am I ever going to get better. ALEXANDER L. CHAPMAN: Oh, okay. So it was kind of
10 minutes 50 seconds ALEXANDER L. CHAPMAN
[10:50] ALEXANDER L. CHAPMANhopelessness starting to see. SARAH: Yeah. A kind of hopeless, yes,
10 minutes 55 seconds SARAH
[10:55] SARAHto put a word on it. ALEXANDER L. CHAPMAN: Yeah. And so when you say depression, what were
11 minutes 0 seconds ALEXANDER L. CHAPMAN
[11:00] ALEXANDER L. CHAPMANthe -- was it like sadness or what felling? SARAH: Yes, sadness and kind of
11 minutes 5 seconds SARAH
[11:05] SARAHempty. ALEXANDER L. CHAPMAN: I'm wondering, I'm guessing, just guessing
11 minutes 10 seconds ALEXANDER L. CHAPMAN
[11:10] ALEXANDER L. CHAPMANlike that whole discussion and how your mind went, how you apologize for even existing. Is it really that just brought up like how big your problems are, like how big that what you are facing is.
11 minutes 25 seconds SARAH
[11:25] SARAHIt made me think how big I think my problems are. I don't know if they are that big compared to, you know, they are not as big as someone else’s, but they can be bigger than some. So I don't really know how to gauge, how bad my situation is kind of. ALEXANDER L. CHAPMAN: Right. And the good news is like
11 minutes 55 seconds ALEXANDER L. CHAPMAN
[11:55] ALEXANDER L. CHAPMANthe way you just said, it brings up thoughts about how big my problems are. Is that your kind of seeing the difference between like your thoughts and maybe your experiences a little bit, like sometimes you may have the thought that something and someway and you are recognizing a little bit like that it is a thought. SARAH: Right. ALEXANDER L. CHAPMAN: Yeah. And maybe did you do that a little bit of mindfulness that we talk about differences between thought and facts.
12 minutes 20 seconds SARAH
[12:20] SARAHLittle bit. ALEXANDER L. CHAPMAN: Yeah. Okay. SARAH: And the wise mind, the rational mind, emotional mind. ALEXANDER L. CHAPMAN: Right.
12 minutes 30 seconds ALEXANDER L. CHAPMAN
[12:30] ALEXANDER L. CHAPMANAnd so you -- so this discussion came up in group and how did you go from there to maybe having these thoughts of suicide pop up.
12 minutes 40 seconds SARAH
[12:40] SARAHJust the context of, you know, what we are talking about -- what we were talking about, just brought it up. ALEXANDER L. CHAPMAN: Okay. While you are still in group or when you -- after you left. SARAH: After I left, they kind of processed that a little more and then I started feeling bad.
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[13:00] ALEXANDER L. CHAPMANOkay. And then, when you -- say you processed a little more, what was going through your mind and what were your feeling when you are doing that?
13 minutes 10 seconds SARAH
[13:10] SARAHI was feeling very unhappy with myself. And I just was thinking that, you know, I've been in therapy since I got out probably about January of '08 they have been doing therapy and all the different types of
4: Middle Phase: Recognizing Client Skills, Checking Resources
13 minutes 35 seconds SARAH
[13:35] SARAHtherapy. And I'm not trying the DBT therapy and hoping that this will the therapy that will work and -- ALEXANDER L. CHAPMAN: Right. SARAH: But sometimes it just feels hopeless that like, yeah, it's another therapy and it is not going to work. ALEXANDER L. CHAPMAN: Yeah. So it sounds like maybe
14 minutes 0 seconds ALEXANDER L. CHAPMAN
[14:00] ALEXANDER L. CHAPMANwhy the hopeless thoughts came in even more and you are thinking about -- so you are thinking about how you've tried all these things and things are as different as you really want them to be. SARAH: Right. ALEXANDER L. CHAPMAN: And, yeah, you keep going so, you know, it sounds like what you weren't thinking was, I keep persisting to try and help myself like I keep going.
14 minutes 20 seconds SARAH
[14:20] SARAHRight. ALEXANDER L. CHAPMAN: I'm not giving up, I haven't given up. SARAH: Right. ALEXANDER L. CHAPMAN: That and then your mind at that time.
14 minutes 25 seconds SARAH
[14:25] SARAHNo. I feel obligated, like if I, say I'm going to do something I feel like I'm obligated, committed to doing it.
14 minutes 35 seconds ALEXANDER L. CHAPMAN
[14:35] ALEXANDER L. CHAPMANYeah. SARAH: Once I said I'm going to do something I feel obligated that I have to
14 minutes 40 seconds SARAH
[14:40] SARAHfollow through and follow the commitment all the way through.
14 minutes 45 seconds ALEXANDER L. CHAPMAN
[14:45] ALEXANDER L. CHAPMANRight, okay. Okay, so you have got like sort of your word is important to you. SARAH: Yes. ALEXANDER L. CHAPMAN: And commitments are really important to you. SARAH: Yes. ALEXANDER L. CHAPMAN: Which is good news too. Okay. So we have the bad news which is that the hopeless thoughts sometimes really knock you down. SARAH: Yes. ALEXANDER L. CHAPMAN: And the good news is that you really persist like you keep working even though you had obstacles, even though things don't necessarily change as fast as you want them to, like you keep working to help yourself if sounds like. SARAH: Right.
15 minutes 15 seconds ALEXANDER L. CHAPMAN
[15:15] ALEXANDER L. CHAPMANAnd you make commitments that you stick to, so that's really good news. Can you see that?
15 minutes 20 seconds SARAH
[15:20] SARAHYeah. Especially in the times when I'm feeling more suicidal and my care team will make sure I make commitments to appointments closer and closer together. ALEXANDER L. CHAPMAN: Yeah. Right.
15 minutes 40 seconds ALEXANDER L. CHAPMAN
[15:40] ALEXANDER L. CHAPMANVery good. So when it comes to like the sadness, the emptiness, and the hopelessness. If you were to, for instance, have this start to hit you like something reminds you, again it's like a remainder in group of the problems that you've faced in that. And how hard it is to work on them and fix them sometimes?
16 minutes 0 seconds SARAH
[16:00] SARAHYes. ALEXANDER L. CHAPMAN: If you have more of those reminders pop up, like they probably will maybe over the next couple of weeks or so.
16 minutes 5 seconds ALEXANDER L. CHAPMAN
[16:05] ALEXANDER L. CHAPMANI'm wondering, what do you think could be helpful to kind of steer you toward, you know, steer you away from getting stuck in hopelessness or getting stuck in pointlessness.
16 minutes 20 seconds SARAH
[16:20] SARAHUsually call or try and call someone to talk about what's on my mind. And I also have my dog that I can -- that I talk to, he doesn’t talk back. ALEXANDER L. CHAPMAN: Right. Which is probably a good thing, sometimes right. SARAH: If I just want to talk and not hear anything back, I will talk to my dog and he will just climb on my lap and -- ALEXANDER L. CHAPMAN: Do you have some people you talk to, anybody in particular who is really
16 minutes 55 seconds ALEXANDER L. CHAPMAN
[16:55] ALEXANDER L. CHAPMANhelpful to talk to. [sil.]
17 minutes 5 seconds SARAH
[17:05] SARAHTalking to my mom is helpful, but on some topic she is not that helpful, like on the topic of suicide she is not that helpful, she is just like, well just think about something happy. And it's like it is not that easy. ALEXANDER L. CHAPMAN: It is not that simple. No. SARAH: If I could think something happy, I would -- and that would all go away. ALEXANDER L. CHAPMAN: It would be gone by now, right.
17 minutes 35 seconds SARAH
[17:35] SARAHRight, right. I wouldn’t be feeling this way. So I'll talk to Dr. Collins my psychiatrist usually. She is probably the one that listens to me the most. ALEXANDER L. CHAPMAN: Okay.
17 minutes 55 seconds ALEXANDER L. CHAPMAN
[17:55] ALEXANDER L. CHAPMANSo you can talk to her, sometimes your mom can be helpful. SARAH: Yes.
18 minutes 0 seconds ALEXANDER L. CHAPMAN
[18:00] ALEXANDER L. CHAPMANAnd sometimes there is like, the invalidation where it just sounds too simple for a way you are facing. SARAH: Right. ALEXANDER L. CHAPMAN: And because it is. And so what about skills, like if there been anything that's come up in group that you have thought, okay, I could use that, that would help me, when I'm starting to sink into the emptiness, the sadness, the hopelessness.
18 minutes 20 seconds SARAH
[18:20] SARAHIt's mainly emotional mind, so I try and move into wise mind with putting some rationality into what I'm thinking. ALEXANDER L. CHAPMAN: Okay.
18 minutes 35 seconds ALEXANDER L. CHAPMAN
[18:35] ALEXANDER L. CHAPMANExcellent. So, you notice that you are in emotion minds. SARAH: Right.
18 minutes 40 seconds ALEXANDER L. CHAPMAN
[18:40] ALEXANDER L. CHAPMANYeah. Which is sometimes not easy to do. Sometimes you can be so deep in emotion mind that you have no idea that you are actually in there. SARAH: Right. ALEXANDER L. CHAPMAN: Does that ever happen to you? SARAH: Yes, it has.
18 minutes 50 seconds ALEXANDER L. CHAPMAN
[18:50] ALEXANDER L. CHAPMANYeah. So how do you move from -- what helps you to move from emotion mind to wise mind then?
18 minutes 55 seconds SARAH
[18:55] SARAHI'll start writing out feelings, sometimes poetry or something, and then from writing out the feeling, I'll be able to look at it and then like kind of comprehend what, I'm not sure how to say it. Try to comprehend what I'm thinking ALEXANDER L. CHAPMAN: Okay.
19 minutes 25 seconds SARAH
[19:25] SARAHEmotionally and then try and bring some rational thoughts to it. ALEXANDER L. CHAPMAN: Right. So you will be -- you will
19 minutes 35 seconds ALEXANDER L. CHAPMAN
[19:35] ALEXANDER L. CHAPMANwrite out how you are feeling and maybe a little bit of poetry which is sort of like expressing how you are feeling.
19 minutes 40 seconds SARAH
[19:40] SARAHYes. ALEXANDER L. CHAPMAN: Okay. Which can be a really helpful way to regulate your emotions, if you
19 minutes 45 seconds ALEXANDER L. CHAPMAN
[19:45] ALEXANDER L. CHAPMANare just start of stuck with them and they are turning around inside you, sometimes expressing them in some way it can actually help. Make them more bearable little bit. SARAH: Right. ALEXANDER L. CHAPMAN: But it sounds like also you look at it and then you get a perspective on it. SARAH: Right. ALEXANDER L. CHAPMAN: Yeah. Okay. So that's definitely
5: Middle Phase: Practicing Coping Ahead
20 minutes 0 seconds ALEXANDER L. CHAPMAN
[20:00] ALEXANDER L. CHAPMANone thing you can -- that you can do for sure. Where I guess we are sort of talking about cope, what's another skill that you probably will get down the road, but it's like called coping ahead of time which is a little bit of what we are doing right now. And it's like, if you know that there is something coming up that might be really hard to face, then the idea would be to have to plan.
20 minutes 20 seconds ALEXANDER L. CHAPMAN
[20:20] ALEXANDER L. CHAPMANAnd to even practice and rehearse the plan a little bit. So we are kind of talking about it, but I wonder if one thing we should do also might be to do a little bit of practice and rehearsing of what you might do. SARAH: Okay. ALEXANDER L. CHAPMAN: I know one thing is the writing down stuff and another one is getting supported which is great to do.
20 minutes 40 seconds SARAH
[20:40] SARAHRight. ALEXANDER L. CHAPMAN: Sometimes it works, sometimes it doesn’t. SARAH: Right. ALEXANDER L. CHAPMAN: And so, let's
20 minutes 45 seconds ALEXANDER L. CHAPMAN
[20:45] ALEXANDER L. CHAPMANimagine -- okay, let's imagine that it’s like a week or two from now and things are getting harder for you because you know the date is coming up. And you've gone to group as a example, and it's -- you are vulnerable already because you know the date is coming up and things are hard for you. And then you get a reminder in group of, maybe just how big the problems you are facing or you get a reminder of the actual traumatic event that happen to you. Let's have you maybe just imagine, you know, you come home and imagine in your mind what you would be doing if you are really coping well, if you were doing what you like to see yourself doing.
21 minutes 30 seconds SARAH
[21:30] SARAHI'd be -- I'd focus on school work, if I had any school stuff papers to write or books to read or something like that. ALEXANDER L. CHAPMAN: Right.
21 minutes 45 seconds SARAH
[21:45] SARAHSpend time with my dog, workout, I have a treadclimber at my house, so I can work out inside. ALEXANDER L. CHAPMAN: Yeah.
22 minutes 0 seconds SARAH
[22:00] SARAHI eat more meals. Usually when I'm really depressed, I'd only eat like once a day. Usually eat more than once a day.
22 minutes 15 seconds ALEXANDER L. CHAPMAN
[22:15] ALEXANDER L. CHAPMANRight. Like maybe snack regularly or something. SARAH: Right. ALEXANDER L. CHAPMAN: Keep your fuel up. SARAH: Yes. ALEXANDER L. CHAPMAN: That's very wise, because these days, you know, they find that managing your own emotions and your behavior, it takes lot of energy. And it's like your brain uses up glucose or blood sugar whenever you are trying to do that. And so that's especially the time when you really need to keep the gas tank at least above like a quarter full or half full or whatever.
22 minutes 40 seconds SARAH
[22:40] SARAHRight. ALEXANDER L. CHAPMAN: Yeah. That's great. So those are things. So maybe in that and
22 minutes 45 seconds ALEXANDER L. CHAPMAN
[22:45] ALEXANDER L. CHAPMANbefore we -- so before have you imagine that, let's just think of one more thing which would be -- what would be the thing that will be hardest for you, like what's the thing you are most afraid of or that will be most difficult between now and April 26. [sil.]
6: Recognizing Emotion in the Moment
23 minutes 5 seconds SARAH
[23:05] SARAHThe worst outcome would be that I get so overwhelmed that I just take my own life, so that would probably be the worst case scenario. ALEXANDER L. CHAPMAN: Right. Okay. Is that what you are like most
23 minutes 20 seconds ALEXANDER L. CHAPMAN
[23:20] ALEXANDER L. CHAPMANafraid of between now and then or is there something else? SARAH: No,
23 minutes 25 seconds SARAH
[23:25] SARAHthat's about the worst thing I can think of.
23 minutes 35 seconds ALEXANDER L. CHAPMAN
[23:35] ALEXANDER L. CHAPMANI noticed just when you are saying that that your breathing changed a little bit. And I can't tell exactly, but it looks like you might be feeling a little sad or overwhelmed.
23 minutes 45 seconds SARAH
[23:45] SARAHLittle sad. ALEXANDER L. CHAPMAN: Yeah. Right at this moment. SARAH: Yeah. ALEXANDER L. CHAPMAN: Okay.
23 minutes 50 seconds ALEXANDER L. CHAPMAN
[23:50] ALEXANDER L. CHAPMANHow do you and where do you notice that, like in terms of how you feel physically.
23 minutes 55 seconds SARAH
[23:55] SARAHMy stomach gets filled or it gets kind of jumbled up. [sil.]
24 minutes 10 seconds ALEXANDER L. CHAPMAN
[24:10] ALEXANDER L. CHAPMANSo your stomach feels jumbled up and -- SARAH: I can tell my breathing is different.
24 minutes 15 seconds ALEXANDER L. CHAPMAN
[24:15] ALEXANDER L. CHAPMANDifferent like more shallow or -- SARAH: Yeah, more sallow.
24 minutes 20 seconds ALEXANDER L. CHAPMAN
[24:20] ALEXANDER L. CHAPMANIs it sadness or is there other stuff going on too that you are noticing, other emotions. SARAH: Sadness and just kind of helpless,
24 minutes 30 seconds SARAH
[24:30] SARAHfeel helpless to like, that might, you know, that's a real thing that may -- ALEXANDER L. CHAPMAN: So
24 minutes 45 seconds ALEXANDER L. CHAPMAN
[24:45] ALEXANDER L. CHAPMANlike, that might actually really happen like you might. SARAH: Right. ALEXANDER L. CHAPMAN: It's almost like sort of being behind the car, the wheel of a car that is out of control like you are not entirely sure you can get it back in control?
24 minutes 55 seconds SARAH
[24:55] SARAHRight. ALEXANDER L. CHAPMAN: Yeah. Between now and then? SARAH: Yeah. That worries me.
25 minutes 0 seconds ALEXANDER L. CHAPMAN
[25:00] ALEXANDER L. CHAPMANYeah. Okay. Well, it's very good that we are talking about this. And even that you are able to step back and notice how you are feeling, like right now you notice the physical feelings which you are probably in group you are going to get to this later on, but this is like what we call mindfulness of your emotions. So where you step back and you notice them in a sense sort of like ride them as a wave for a little while. SARAH: Right. ALEXANDER L. CHAPMAN: And is that different from what you normally do when you feel that what you just felt like the helplessness and the sadness. [sil.]
25 minutes 35 seconds SARAH
[25:35] SARAHWhen I feel that way it depends on where I am, what I do. Like if I'm in the car and I feel that way, I'll drive faster.
25 minutes 45 seconds ALEXANDER L. CHAPMAN
[25:45] ALEXANDER L. CHAPMANRight. SARAH: Or if I'm playing the guitar and I feel that way,
25 minutes 50 seconds SARAH
[25:50] SARAHI'll start strumming harder. Or if I'm just somewhere I might get short tempered with my dog for doing something that just annoyed me because of the way I'm feeling. ALEXANDER L. CHAPMAN: So it sounds like you got maybe a tiny bit on the reckless side when you feel those
26 minutes 15 seconds ALEXANDER L. CHAPMAN
[26:15] ALEXANDER L. CHAPMANemotions like maybe sort of you kind of like act, you kind of jump.
26 minutes 20 seconds SARAH
[26:20] SARAHYeah. I have this urge to act, to do something. ALEXANDER L. CHAPMAN: Yeah.
26 minutes 25 seconds SARAH
[26:25] SARAHLike I need to do something to get rid of these emotions that are troubling me. ALEXANDER L. CHAPMAN: Right. Yeah. And which make a lot of sense
26 minutes 35 seconds ALEXANDER L. CHAPMAN
[26:35] ALEXANDER L. CHAPMANbecause it sounds like they are really, really painful to just -- to experience, like to sit with, does it feel like -- SARAH: It is very painful to just sit with
26 minutes 45 seconds SARAH
[26:45] SARAHthe emotion, it take a lot out of me. ALEXANDER L. CHAPMAN: Right. Okay.
26 minutes 50 seconds ALEXANDER L. CHAPMAN
[26:50] ALEXANDER L. CHAPMANSo maybe that down the roads, it might be something we did just a very little bit of here, but down the road it might be something to work on would be -- maybe in small doses like when you have that wave of the sadness or the helplessness or kind of like the powerlessness is maybe notice how you feel and step back and observe it and just like the sensations like, feel for a little while. Because I think over time if you get practice at doing that you might find that you feel a little bit more free of having to like, do anything when you feel those emotions. SARAH: Right. ALEXANDER L. CHAPMAN: Then you can experience them, they might come and go, one thing we know about emotions is, they don't last forever.
27 minutes 30 seconds ALEXANDER L. CHAPMAN
[27:30] ALEXANDER L. CHAPMANSo they might feel like they are lasting forever, but they don't. So it might be that you learn that from practicing this a little bit. So maybe one thing, can we agree that you might maybe over the next week of about three times if you can, if you notice those emotions coming up, just get a little practice at sitting with them for a little while. SARAH: Okay.
27 minutes 50 seconds ALEXANDER L. CHAPMAN
[27:50] ALEXANDER L. CHAPMANAnd see how that goes. SARAH: Okay, I can do that. ALEXANDER L. CHAPMAN: Great. Now why on earth would you want to do that given how uncomfortable they are.
28 minutes 0 seconds SARAH
[28:00] SARAHIf it's going to be helpful to me, that's cost benefit analysis basically. The cost is to sit with these uncomfortable emotions, the benefit maybe that I can handle them better later on. ALEXANDER L. CHAPMAN: Right. I can see you
28 minutes 25 seconds ALEXANDER L. CHAPMAN
[28:25] ALEXANDER L. CHAPMANare going to be really good pros and cons when you come to that skill. That's great. So the cost, you are right, it's uncomfortable to sit with it and the benefit is long term, right. SARAH: Right. ALEXANDER L. CHAPMAN: Is that you might feel better if you do -- if you kind of drive recklessly or do things. Right then you probably going to feel better quicker. But over the long haul, you might actually learn how to tolerate the emotions when they come up and they may not as be as nearly as overwhelming or scary. SARAH: Okay.
7: Imagining Coping Well
28 minutes 50 seconds ALEXANDER L. CHAPMAN
[28:50] ALEXANDER L. CHAPMANOkay. write on, so that's one thing. And then the next thing is maybe, let's go back and do the -- just a brief sort of imagination thing where you imagine yourself coping well with some trigger that kind of gives you those feelings. And so it could be group and then you get home. Are you somebody, who feels comfortable closing your to imagine things or is it better opening them. SARAH: I keep my eyes open.
29 minutes 15 seconds ALEXANDER L. CHAPMAN
[29:15] ALEXANDER L. CHAPMANOkay. So keep them open and can you get an image of yourself in your mind, like when you imagine things. SARAH: Yes. ALEXANDER L. CHAPMAN: Okay. So imagine you've had group and you are coming home and there is maybe a discussion just like this one or something and it's even closer to the date that you are worried about. And you have the same types of emotions popping up, maybe the sadness, the hopeless thoughts, those types of things. Now imagine yourself doing the really effective things that you just mentioned about five minutes ago. SARAH: Okay. ALEXANDER L. CHAPMAN: And maybe describe it as if it's happening right now to me. So I'm coming -- as an example, I'm coming home, I'm coming through the door, this is how I'm feeling that kind of thing.
30 minutes 0 seconds SARAH
[30:00] SARAHComing home, feeling hopeless, helpless, [sil.]
30 minutes 10 seconds SARAH
[30:10] SARAHKind of intense sadness. I guess walk and greet my dog, maybe workout to try and, so then it will be like a positive urge to do something. ALEXANDER L. CHAPMAN: Okay. So you are walking in and you are greeting your dog
30 minutes 30 seconds ALEXANDER L. CHAPMAN
[30:30] ALEXANDER L. CHAPMANand then you are maybe planning to workout. SARAH: Yeah. ALEXANDER L. CHAPMAN: Yeah. And how high is the sadness and how high are the emotions you are feeling? Let's say zero to ten for instance. SARAH: Probably seven.
30 minutes 45 seconds ALEXANDER L. CHAPMAN
[30:45] ALEXANDER L. CHAPMANOkay. So you are greeting you dog, you are thinking I'm going to work out, what else is going on.
30 minutes 55 seconds SARAH
[30:55] SARAHI could focus on school after that, focus on any type of school work, because I value my education. ALEXANDER L. CHAPMAN: Right.
31 minutes 10 seconds ALEXANDER L. CHAPMAN
[31:10] ALEXANDER L. CHAPMANOkay. So one thing you are doing right is you are imaging this is your planning which can be really effective, like if you are hitting an overwhelming situation, overwhelming emotions, you are walking into your apartment and immediately you are planning this is what I'm going to do. These are the steps I'm going to carry out. And it might be working-out, it might be then, like focusing on school for a while. SARAH: Go on the internet to see
31 minutes 40 seconds SARAH
[31:40] SARAHwhat's happening in social media.
31 minutes 45 seconds ALEXANDER L. CHAPMAN
[31:45] ALEXANDER L. CHAPMANOkay. Yeah, going on the internet. Does working on school give you hope.
31 minutes 50 seconds SARAH
[31:50] SARAHYeah. That one day I can get a job and help with either work with juveniles or veterans and juvenile justice or veteran justice kind of way.
32 minutes 10 seconds ALEXANDER L. CHAPMAN
[32:10] ALEXANDER L. CHAPMANRight. Okay. Because one of the best things to do and that sounds like a really important goal is, one of the best things to do when you feel hopeless, when you are hopeless. Hopelessness is kind of like a thinking pattern, it's thoughts like
8: "Doing What Hopelessness Tells You to Do"
32 minutes 25 seconds ALEXANDER L. CHAPMAN
[32:25] ALEXANDER L. CHAPMANthings are going to change or what's the point those types of things. SARAH: Right. ALEXANDER L. CHAPMAN: One of the best things to do is to do the very opposite of what hopelessness would tell you to do. Like if hopelessness was sitting on your shoulder, let's say, imagining you are in your apartment and you have got hopelessness on your shoulder telling you. What will hopelessness be telling you to do? SARAH: I just
32 minutes 45 seconds SARAH
[32:45] SARAHsit there and do nothing. ALEXANDER L. CHAPMAN: Yeah.
32 minutes 50 seconds ALEXANDER L. CHAPMAN
[32:50] ALEXANDER L. CHAPMANAnd how does that workout. SARAH: Doesn’t help at all. ALEXANDER L. CHAPMAN: No. Yeah, so if you do exactly how you feel when you feel -- when you have hopeless thoughts, then you probably going to get more of the same as you might have, have you noticed this in the past if this happened sometimes. SARAH: Yeah. I kind
33 minutes 5 seconds SARAH
[33:05] SARAHof like go into vegetative state, like depression and hopelessness and just kind of withdraw.
33 minutes 15 seconds ALEXANDER L. CHAPMAN
[33:15] ALEXANDER L. CHAPMANRight. Yeah. So things actually in a sense become more hopeless. SARAH: Right. ALEXANDER L. CHAPMAN: If you do what the hopelessness tells you to do. So, and like hopelessness is a thinking pattern, but it also often comes with sort of like a emotions that comes with a feeling like you want to do something. And in this case it's like stop everything and don't do anything into this vegetative state. So instead if you work on something that's meaningful to you like working on your school work and then maybe it's going to be more meaningful if you keep that goal in mind of helping other people.
33 minutes 50 seconds SARAH
[33:50] SARAHRight. ALEXANDER L. CHAPMAN: So might be that you need to remind yourself this is why I'm doing this,
33 minutes 55 seconds ALEXANDER L. CHAPMAN
[33:55] ALEXANDER L. CHAPMANyou know, sometimes graduate school is drudgery, right. It's not like it's fine every single minute.
34 minutes 0 seconds SARAH
[34:00] SARAHRight. ALEXANDER L. CHAPMAN: But if you always think like this is why I'm doing this,
34 minutes 5 seconds ALEXANDER L. CHAPMAN
[34:05] ALEXANDER L. CHAPMANmaybe even have that written down somewhere that might keep your eye on the -- like the goal which is a hopeful goal. SARAH: Right. ALEXANDER L. CHAPMAN: Yeah. Okay. So
9: Checking In Before Session Winds Down
34 minutes 15 seconds ALEXANDER L. CHAPMAN
[34:15] ALEXANDER L. CHAPMANwe got maybe about like ten minutes left or so. SARAH: Okay. ALEXANDER L. CHAPMAN: So I'm wondering before we start to wind down, is there anything that we are missing in our planning? You know, in one session we are not going to be able to conquer everything, but I'm hoping we have planned, we have done some planning that is really going to help you. But what if, is there anything that we've missed? Any little detail that will be important.
34 minutes 40 seconds SARAH
[34:40] SARAHNo. I think we hit everything. ALEXANDER L. CHAPMAN: Okay. So
34 minutes 45 seconds ALEXANDER L. CHAPMAN
[34:45] ALEXANDER L. CHAPMANbecause I know it is really important to you to talk about how you are going to deal with the date that's coming up.
34 minutes 50 seconds SARAH
[34:50] SARAHRight. ALEXANDER L. CHAPMAN: And like is there anything about that. We've dealt with like
34 minutes 55 seconds ALEXANDER L. CHAPMAN
[34:55] ALEXANDER L. CHAPMANthe sad, some of the sadness and hopelessness and focused on that and thinking about suicide. And what about the fact that you said the thoughts were going to go possibly more intense. SARAH: Then I'm just going to have
35 minutes 10 seconds SARAH
[35:10] SARAHto use my support system a little more. ALEXANDER L. CHAPMAN: Okay.
35 minutes 15 seconds ALEXANDER L. CHAPMAN
[35:15] ALEXANDER L. CHAPMANAnd you are willing to do that. SARAH: Yes. ALEXANDER L. CHAPMAN: Okay. And are you willing to do whatever it takes to keep yourself alive between now and then and afterwards as well. SARAH: Yes. ALEXANDER L. CHAPMAN: Yeah. What do you think it's going to take?
35 minutes 30 seconds SARAH
[35:30] SARAHLot of extra focus. [sil.]
35 minutes 40 seconds SARAH
[35:40] SARAHTime, just working with my therapy team, making sure they know at what level my suicidal thoughts are at. ALEXANDER L. CHAPMAN: Right. SARAH: So if they, if I'm in trouble and they are getting overwhelmed, I can tell them and they know what appropriate measures to take, how to bring them down or how to help me to lower, get the thoughts lower less intense.
36 minutes 25 seconds ALEXANDER L. CHAPMAN
[36:25] ALEXANDER L. CHAPMANRight, so being really clear with them about where you are with the thoughts. SARAH: Yes. Be very honest and clear. ALEXANDER L. CHAPMAN: Okay. So that's definitely one thing and then the other thing is that I'm thinking that if you were to really practice some of the things we were talking about that you came up with in terms of coping like working on your school work doing something hopeful, working out, spending time doing maybe writing and writing down things to kind of get yourself into wise mind, like the way you were going to write down, how you are feeling and the poetry and that type of thing. I think if you were to do that and as good that we are doing this now because we've got a few weeks. If you were do that really, really regularly, I'm hoping and guessing that it may actually seem more manageable than it did earlier if you thought about it like if you really did this almost every day. SARAH: Alright. ALEXANDER L. CHAPMAN: Practice to your coping plan regularly.
37 minutes 20 seconds ALEXANDER L. CHAPMAN
[37:20] ALEXANDER L. CHAPMANNow would there be anything that would stop you from being open with your treatment, providers seeking support doing the things to lower your risk.
37 minutes 35 seconds SARAH
[37:35] SARAHReally the only thing that would stop is if they wanted to admit me to the psych clinic, the psych ward. ALEXANDER L. CHAPMAN: Okay. Right.
37 minutes 50 seconds SARAH
[37:50] SARAHThat would be only hesitation. ALEXANDER L. CHAPMAN: Okay. So you would be afraid if
37 minutes 55 seconds ALEXANDER L. CHAPMAN
[37:55] ALEXANDER L. CHAPMANyou -- would you be afraid if you are open with them that they would want to do that.
38 minutes 0 seconds SARAH
[38:00] SARAHIf they got too overwhelming I would be afraid they would. ALEXANDER L. CHAPMAN: Okay. What if there is some way around
38 minutes 10 seconds ALEXANDER L. CHAPMAN
[38:10] ALEXANDER L. CHAPMANthat, and some way. I mean there maybe or do you time that could be a time when it would be needed or do you feel like it would be really better for you to just try and get through without having to go the hospital. SARAH: Well,
38 minutes 25 seconds SARAH
[38:25] SARAHsometimes its necessary that they can do more in less time because they are constantly, they are somewhat constantly watching you for medication side effects if they change your medicine or, and your safe on the ward there is nothing dangerous or anything. ALEXANDER L. CHAPMAN: Right.
38 minutes 55 seconds ALEXANDER L. CHAPMAN
[38:55] ALEXANDER L. CHAPMANSo sometimes it can be helpful and it sounds like though there's in some ways you want to avoid it. SARAH: Yes. ALEXANDER L. CHAPMAN: Why is that? SARAH: Just not home,
39 minutes 5 seconds SARAH
[39:05] SARAHyou know, you've got this, got paper, clothes, sleeping on a mattress.
39 minutes 20 seconds ALEXANDER L. CHAPMAN
[39:20] ALEXANDER L. CHAPMANOkay. That's exactly. SARAH: It's just not ideal
39 minutes 25 seconds SARAH
[39:25] SARAHliving, the foods not any good.
39 minutes 30 seconds ALEXANDER L. CHAPMAN
[39:30] ALEXANDER L. CHAPMANYeah. It's not like you’re going to take us to some kind of five star resort or something.
39 minutes 35 seconds SARAH
[39:35] SARAHRight. And then you've got someone every 15 minutes coming and see how you are doing? ALEXANDER L. CHAPMAN: Yeah. SARAH: That's get bothersome.
39 minutes 45 seconds ALEXANDER L. CHAPMAN
[39:45] ALEXANDER L. CHAPMANYeah. That would be, being monitored like that over time. SARAH: Yes. Just like, just leave me
39 minutes 50 seconds SARAH
[39:50] SARAHalone, I kind of want to do my own thing. ALEXANDER L. CHAPMAN: Right. Which you can do
39 minutes 55 seconds ALEXANDER L. CHAPMAN
[39:55] ALEXANDER L. CHAPMANin your home. So it sounds like in your mind it's like maybe this as a last, as a worst case stop gap if you really needed to could be there and maybe a few really did think that you, you wouldn't be able to get through without your fear coming true like the big fear being that that you are going to be like behind the wheel of that car and it's going to be careening out of control. So if you got to that point maybe it would be worth at least recognizing that and talking to them about it. SARAH: Yes. ALEXANDER L. CHAPMAN: But even before that point, one thing that -- one thought that came to my mind is that if you were talking to them about having suicidal thoughts and you are really open with them about it.
40 minutes 35 seconds ALEXANDER L. CHAPMAN
[40:35] ALEXANDER L. CHAPMANAnd you also mentioned and these are the skills and this is my crisis plan like these are things I'm going to do. SARAH: Right. ALEXANDER L. CHAPMAN: And I've got all these steps I'm going to do that I would do, well before I would ever even consider hurting myself. SARAH: Right. ALEXANDER L. CHAPMAN: Then I think getting that across to them might be really effective. What do you think?
40 minutes 55 seconds SARAH
[40:55] SARAHWe have developed a crisis plan. ALEXANDER L. CHAPMAN: Okay, good.
41 minutes 0 seconds SARAH
[41:00] SARAHSo during this time, as it gets closer, they would double check see if, everything on the crisis plan, it is still valid. And then give me a copy and I'll be able to follow that.
41 minutes 20 seconds ALEXANDER L. CHAPMAN
[41:20] ALEXANDER L. CHAPMANOkay. So you've got that in place already. SARAH: Yes. ALEXANDER L. CHAPMAN: Okay. So let's go back and look a little bit about -- so we talked a little bit about and it was really important to get that information about what happened after group because that gave me a really clear, sort of a clear sense of what happens with when you get a remainder of, just maybe how overwhelming things are,
10: Ending the Session
41 minutes 45 seconds ALEXANDER L. CHAPMAN
[41:45] ALEXANDER L. CHAPMANor how hard things are. SARAH: Right. ALEXANDER L. CHAPMAN: And so we talked about that and we talked about what you might do which is the expressing yourself to writing downs, to going home and working out, seeking support from somebody else. And also really importantly a sense, in a sense sort of like doing the opposite of hopelessness, sort of like opposite action to hopelessness a little bit about opposite action before. SARAH: I've heard of it. But
42 minutes 10 seconds SARAH
[42:10] SARAHI haven't practiced it because I'm not sure of all the skills involved in that. ALEXANDER L. CHAPMAN: Okay.
42 minutes 20 seconds ALEXANDER L. CHAPMAN
[42:20] ALEXANDER L. CHAPMANSo, yeah, later on you will definitely get to that in your group and but even for now you could think okay it's just doing the opposite of what the emotion is telling me to do, kind of thing or what the thoughts telling me to do. And then we've also -- what else that we've got, what else do we talk about that you would do? [sil.]
42 minutes 45 seconds SARAH
[42:45] SARAHPlay with my dog, play the guitar.
42 minutes 50 seconds ALEXANDER L. CHAPMAN
[42:50] ALEXANDER L. CHAPMANYeah. SARAH: Go on social media, homework.
42 minutes 55 seconds ALEXANDER L. CHAPMAN
[42:55] ALEXANDER L. CHAPMANRight. So those are all really, probably really effective distraction strategies. And you know what you might even do is look ahead to the distress tolerance skills, where they've got a whole list of distraction types of activities that you could do. Okay, so our deal is that you are going to practice those things. SARAH: Right. ALEXANDER L. CHAPMAN: And the three times over the next week you will practice mindfulness of your sadness, sitting with it for a little while, doesn't have to be free like half an hour or you know that's how you do for a long-time, but it may just be a few minutes or something like that.
43 minutes 30 seconds SARAH
[43:30] SARAHOkay. ALEXANDER L. CHAPMAN: Where you just notice how you feel like in your stomach, could even go from your toes to your head.
43 minutes 35 seconds ALEXANDER L. CHAPMAN
[43:35] ALEXANDER L. CHAPMANSee how you feel? And just use your mind as a -- almost like a magnifying glass just as hone in on just exactly what you are feeling? And then we've got you putting in place your plan and practicing that regularly and I would probably recommend at least a few times a week that even if you don't have any triggers popping up. SARAH: Okay. ALEXANDER L. CHAPMAN: That you practice it, so that you are ready for when you do.
44 minutes 0 seconds SARAH
[44:00] SARAHOkay. ALEXANDER L. CHAPMAN: Okay. So anything that may get in the way of, you are doing all these things?
44 minutes 5 seconds SARAH
[44:05] SARAHMental, mental fatigueness. ALEXANDER L. CHAPMAN: Okay.
44 minutes 10 seconds SARAH
[44:10] SARAHJust mentally can't bring myself to do it. ALEXANDER L. CHAPMAN: Okay. Do you think that's likely to pop-up.
44 minutes 20 seconds SARAH
[44:20] SARAHIt may. ALEXANDER L. CHAPMAN: What would you do to get around that?
44 minutes 25 seconds ALEXANDER L. CHAPMAN
[44:25] ALEXANDER L. CHAPMAN[sil.]
44 minutes 30 seconds SARAH
[44:30] SARAHI'd probably try and pick up the phone and call someone. Yes, I would be like the least amount of energy. ALEXANDER L. CHAPMAN: Oh, yeah, great. So when it's -- when
44 minutes 45 seconds ALEXANDER L. CHAPMAN
[44:45] ALEXANDER L. CHAPMANfatigue is basically saying do nothing than do something that doesn't require tremendous amount of energy. Do you every get a bit of boost when you talk to somebody.
44 minutes 55 seconds SARAH
[44:55] SARAHIt depends on who I'm talking to. ALEXANDER L. CHAPMAN: So talk to somebody who gives you a boost and if you are in that
45 minutes 0 seconds ALEXANDER L. CHAPMAN
[45:00] ALEXANDER L. CHAPMANsituation, so that maybe you get a little a bit of fuel to kind of do these other things. SARAH: Right. ALEXANDER L. CHAPMAN: It might be worth remaining yourself to like even if I feel fatigued, like in some ways you kind of have to deal from the outside-in, you sort of like act, don't wait until you don't fatigued is the point. SARAH: Right. ALEXANDER L. CHAPMAN: If you wait until you don't feel sad, or don't feel fatigued, or don't feel whatever it is that you are feeling then you could be waiting long-time. And so might be just remain yourself to even do this, even though I don't feel like doing it. And just kind of see what happens. SARAH: Okay. ALEXANDER L. CHAPMAN: So it's again a little bit of opposite action like doing the opposite of way you might feel like doing. SARAH: Right. ALEXANDER L. CHAPMAN: And seeing as a bit of an experiment.
45 minutes 40 seconds ALEXANDER L. CHAPMAN
[45:40] ALEXANDER L. CHAPMANAlright, I am going to try this, it might be miserable, but I'm going to try it anyway. That sound doable? SARAH: Yes. ALEXANDER L. CHAPMAN: Okay, good. Okay, Sara well, and it was good talking with you. SARAH: Nice meeting with you. ALEXANDER L. CHAPMAN: And I'm glad we've got a plan and I hope it's works really well for you. SARAH: Thank you.
