Dialogue with a Therapist

Hello. My name is Dr. S… please take a seat. How are you doing today?

Good. I mean, could be better. Obviously if I was good I probably wouldn’t be here. I guess I could be good and still be here. Ahem.

No need to apologize. What brings you here today?

I’m not sure how to describe it. Ahem. I just don’t really feel like doing anything. Something feels out of joint.

How long have you been feeling this way?

As long as I can remember. Ahem…

Have there been any changes in your sleep patterns? Trouble falling asleep, or oversleeping?

Not really. I’ve always been a light sleeper.

How about appetite?

Same as always.

Have you experienced any physical symptoms?

Headaches, but I don’t think that’s related. Cough.

Are there any particular areas such as work, relationships, or hobbies that have been impacted by your symptoms?

Not that I can think of. Ahem. Sorry, my throat is dry. Cough. I’ve said more words now than I usually say in a day. Cough.

Do you often find it difficult to concentrate or stay focused?

Yes, my mind tends to wander. I always find myself reaching for my phone or computer. It’s not one of my favorite habits. I wish I could get rid of the phone, but I need it for work.

Have you sought treatment or been diagnosed with depression in the past?

Yes, back in college.

How did that feel?

I wouldn’t say it was the best. It was probably my fault. I wasn’t the easiest patient and I didn’t really give it a chance or have an open mind for it.

Have you ever had thoughts of self-harm or suicide?

...Ahem…Cough…

Would you like a drink of water?

No, thank you. Cough. I should be feeling fine soon. Ahem. I just need to warm up my voice. Cough. I’ve spoken more words today than I usually do… Cough… and my vocal chords aren’t used to it. Cough, cough. On second thought, a drink of water isn’t a bad idea. Sorry about that.

Here’s a bottle of water.

Gulp. Thank you, and the answer to your question is no.

Have you noticed any patterns in duration or intensity in your feeling depressed?

Not really.

So, would you say it’s a consistently low mood you feel?

Pretty much.

I noticed that your answers are very brief. I understand that it can be difficult to open up and share and that is perfectly understandable. I want you to know that I am here to listen and support you and I am interested in learning about your experiences on a deeper level. Sometimes, providing more detail can help me gain a better understanding of what you are going through so we can work on it more effectively. If you feel comfortable, I will encourage you to explore what is holding you back from sharing. We can move at whatever pace you feel comfortable with.

My last therapist said the same thing. I told myself before coming here that I would try to be more open. It’s just a little strange to pay someone to talk to them. I mean, talking to other people is something so basic, and having to pay to talk to someone just seems a little off. Feels like paying for a prostitute. Not that I would know anything about that. I mean, I should be able to reach out to someone and talk about these things, but here I am paying you, or technically my insurance is. Well, I guess there are some added perks I get from paying you. You have those degrees on that wall which your average person on the street doesn’t have. Then there is also the fact that you can’t go telling everyone what I said here today, or at the very least you can’t put my name to anything I say. If I say something ridiculous you can share it with your friends or wife and entertain them but at least you can’t give them a name. Sorry, I’m babbling now.

No need to apologize. It’s okay to babble. Every thought and feeling you share is valuable. It’s perfectly natural for a conversation to wander. I appreciate you sharing your concerns and uneasiness with therapy. I understand the discomfort and artificiality of the situation. Please rest assured that I will do whatever I can to ease your concerns. Your privacy is of the utmost importance to me and it is a crucial part of being able to provide the best help I can. Please take your time and we can continue exploring your concerns and experiences at a pace you feel comfortable with.

That’s all I really have to say about that.

Is it alright if I continue with some more questions?

Sure.

Is it difficult for you to experience pleasure or interest in activities that you used to enjoy?

Not really.

What do you enjoy doing?

Reading and writing.

What do you like to read?

I’ll read just about anything, fiction and nonfiction. I mostly read nonfiction until I realized there was often a lot more truth in fiction than there was in nonfiction. And now I read nonfiction as fiction and it has become a lot more interesting. Not sure if this makes any sense. As far as authors or books, you can’t go wrong with Shakespeare. I’m a big fan of Hamlet. Dostoevsky is another good one. I identify a lot with his Underground Man. I’m big into the classics. For the longest time I didn’t think it was worth reading anything written after 1950. I also used to think that most American authors were bad unless they were from the Lost Generation, but that is starting to change. You can’t go wrong with Don DeLillo. I enjoy a lot of poetry too. ‘Who, if I cried out, would hear me among the angelic orders?’ That’s Rilke, one of my favorites. I get a lot of crap for reading poetry because most people think poetry is girly or feminine even though if you look at it most known poets are men which you would think means poetry is manly. I’m so sorry, I am babbling again. You got me going on a topic I enjoy.

No need to apologize. I appreciate your enthusiasm for reading. I am happy that you are able to find solace in books. I completely agree with you about poetry. I am glad that despite the criticism you hear you are still willing to pursue it. Your insight and excitement about these topics are valuable. Feel free to express more about your interest in reading. Remember, this space is for you to express yourself in.

That’s all I have to say about reading for right now.

How about writing? Are you willing to share with me what you write about or what you enjoy about writing?

I am not really good at it. I really never had any artistic talent. I can’t paint or draw or sing or play an instrument, so writing was really my only option as a creative outlet. I like to think I paint pictures with words, although what I do is probably more like drawing stick figures with words. What do I write? Mostly trash. Sorry. You need more. I just write about little everyday things I see. Strangers I see, little everyday events. You know what they say, write about what you know and I really don’t know space travel or war or romance so I write about what I do know, which is the boring old everyday stuff. I usually end up feeling like a disappointment after I reread what I write. If I type it on my computer I usually end up deleting the file, and if I write it on paper I burn the paper, although I worry it’s not enough. You ever hear the line ‘Manuscripts don’t burn’? Sorry, I’m babbling again.

Please, don’t apologize. Would you be willing to share some of your writings with me?

Sure, but I’d have to kill you after you were done reading them. Just kidding. I didn’t mean it.

What scares you the most about someone else reading your writing?

I’m not sure.

That’s alright. It’s understandable to feel unsure about what scares you. Exploring our fears is an important part of the process. More generally, beyond having your writing read, do you mind sharing some things that you might be scared of?

Good question. There is not much that comes off the top of my head. That’s not to say that I am brave, there just isn’t much that I would say that scares me. I’m scared of spiders but I’m guessing that’s not what you meant. I mean, there are a lot of things I dislike but I wouldn’t say I am afraid of them. Even something like death isn’t something I fear; as a matter of fact I’d probably be more scared of living forever. Can I think about it a little bit?

Of course. Take your time. There is no rush.

...I’ve got nothing, but I like that question. I’ll have to get back to you on that.

Can you tell me a little bit about your family and what life was like growing up?

It was a pretty normal upbringing.

Can you expand on that?

My parents worked hard and were always able to provide food, education, and shelter. They did what they had to and I can’t complain. Most of my memories from my childhood are good. Worst thing was probably that my father was a bit of a drinker, but who isn’t these days?

Do you drink?

No. I tried the stuff and hated it.

How do you feel about your father’s drinking?

I feel nothing. It was a part of life.

It’s interesting to note that our lack of feelings can sometimes be a way of protecting ourselves. While you may feel you have no emotions regarding your father’s drinking, there may be underlying emotions or effects that you haven’t fully explored…

The last therapist tried to follow this thread and found nothing. Can we move on?

Certainly. Are there any other aspects of your family you would like to touch on?

I told you. It was a typical family upbringing, which makes it more difficult to understand why everything feels out of joint. It would be easier if I did have some trauma or abuse to point to, but things were good. I never wanted for anything. I got a great education, which led to a decent paying job, and yet here I am.

I understand your frustration. Depression can affect people from different backgrounds and has complex causes which we will continue to explore. Is there anything in particular you want to address that may help better clear up the issue?

I think I have an answer to your question.

Go on.

I fear being a slave. I fear not being free.

Can you expand on what you mean by being a slave and what it means to be free?

Do you know how people always say they need to do something? They need to go to work, they need to get married, they need to do this and that. Well, there is nothing in this life that you have to do. You don’t even need to eat or breathe. If you wake up one morning and you decide you are better off not eating, then so be it. That is a choice you make. Saying you need to do something is just an excuse to not take responsibility for your actions and who you are. When people give you two choices in something and they use the phrase ‘If you have a gun to your head, would you pick A or B,’ I am always surprised by how many people don’t see the gun as a viable option. It’s not that I am advocating for self murder, but it is an option that maybe needs to be taken more seriously. Sorry, babbling again.

Thank you for sharing your thoughts on the matter. It seems you have strong beliefs regarding personal freedom. Regarding your mention of the phrase ‘if you have a gun to your head,’ it’s worth noting that this is used figuratively to present extreme situations and highlight the importance of a decision. However, I want to emphasize that your wellbeing and safety are of utmost concern. If you ever find yourself considering self-harm…’

I still can’t get over the idea of paying a person to talk to them. It just feels so dirty. Tell me, how do you sleep at night? You speak to all these people who are suffering from so much psychic pain and here you are profiting from it. Not to mention how many people out there could use your supposed services but probably can’t afford it. I mean, if I was you I could not live with myself.

I understand your concerns…

What is with you and all this I understand bull? What does that even mean? Do you mean you understand the words coming out of my mouth, cause I sure as hell hope you do. Are you saying that you understand how I feel and have experienced it yourself? Were you at one point some unmotivated, alienated, depressed schlump who didn’t care much for the world so you know what I know? Or do you understand that taking people’s hard-earned money in exchange for an hour of conversation and connection is a little shady? My bet is that it’s just an empty word that you use because it happens to work on 95% of patients. Personally, I wouldn’t mind it if you could actually admit that it’s for the money instead of trying to feel high and mighty by saying you are helping people… Cough… Sorry, I told myself I was going to be a good patient and here I am babbling away again. Sorry about that. Cough cough cough.

I apologize if the use of the phrase I understand comes off as insincere. It was not my intention to diminish or invalidate your feelings. It is intended to convey empathy. As for my personal motivations, I became a therapist because I genuinely believed I could help people. It was never about feeling high and mighty. I appreciate you sharing your concerns. It seems our time today is coming to an end. Is there anything else you would like me to know before we finish today?

Not really.

It was a pleasure meeting you and I look forward to working with you. If you go to the front desk they can schedule you for a follow-up next week.