Transcript of 12th Session between Charles Balis, M.D. and Ms. Cassandra Evans, Tuesday, July 15, 1997 at 5:00 pm.

Ms. Evans: Hello, Doctor. Thank you for squeezing me into your schedule. I had such a bad night yesterday. I didn't know what to do, or where to go, or who to turn to. I spent most of the morning crying.
Dr. Balis: Hello, Cassie. Why don't you tell me what's bothering you?
Ms. Evans: Gosh, I'm not sure I know where to start. Let's see, David came by yesterday like always. Everything seemed pretty much status quo--same shit, different day. He brought over take-out for dinner. We were going to watch a video and maybe play a game of cards or something. But he seemed quite fidgety and began to snap at me over the stupidest things. Why didn't I bring more than two napkins over to the table? Why do I always leave the window open a crack? Everything I did seemed to annoy him. Then we got into an argument over finances. He has been very gracious to me--lending me money if I need it for something, paying whenever we do anything together. I mentioned that I might take a friend out for lunch sometime this week. She just got a promotion, and I wanted to do something special for her. Not extravagant, mind you. It's not like I was going to take her to the Four Seasons for the weekend or anything like that. Just a quiet lunch somewhere--a little more upscale than a drive-thru. Well, he freaked! I have no business doing something like this--how am I going to get the money? Do I think he's made of money? Just totally unleashing on me. It was so odd, so unlike him. I was doing my best to hold back the tears. I didn't want him to see me cry, but I felt so humiliated! I wasn't going to ask him for the money to take her out, and she has treated me...and him many times!
Dr. Balis: Hmm. Why do you think David overreacted like that?
Ms. Evans: I'm sure he feels the need to ensure that I'm well taken care of, especially the necessities. But he's not my father, and I never asked him for help. It's bad enough I'm in the position that I need it--that I can't help myself or pay for my fair share of things. But dominate! It makes me feel so worthless and insignificant. Since I stopped working, the only thing I can afford to give people is me--my time and so on. But I'm ill, and my time is not worth so much these days--it just doesn't go very far anymore. I know my friends must think they are nurses or babysitters of some sort when we go out together. They have to pay for me, pick me up, drive me wherever, take care of me when I'm not well. It sucks! And this one woman has been a doll since the first day I met her. I have some rainy day mad money. This is how I decided to use it. Why shouldn't I be able to make that decision without a consultation with David first? It makes me feel like I need to go behind his back when I want to spend money.
Dr. Balis: Did you explain your feelings to him?
Ms. Evans: I started to, but then I stopped.
Dr. Balis: Why? Was he not listening?
Ms. Evans: Well, he had an attitude for starters. Whatever I said wasn't going to be good enough to explain my actions. And I guess I was afraid.
Dr. Balis: Afraid of what?
Ms. Evans: I don't know.
Dr. Balis: Did you think he was going to hurt you? Hit you?
Ms. Evans: No! He'd never do that.
Dr. Balis: Then what?
Ms. Evans: I guess I was afraid of sounding stupid, of him getting even more upset with me, of feeling more pathetic.
Dr. Balis: Okay, let's address each issue separately. Feeling stupid. Did you think David was going to think you were stupid?
Ms. Evans: Maybe. He can twist my words around. And before I know it, I've agreed to one of his points and my whole argument has been deflated. That makes me feel stupid.
Dr. Balis: Hmm. Next time, try not to make it an argument. Consider it an "explanation" session. Explain your feelings and allow him to describe how he feels. Don't allow interruptions. Allow each other to say your peace. And then, allow some quiet time to sort things out.
Ms. Evans: But I don't want him to think I'll give in. Or that I'm giving up simply because we're taking a time-out.
Dr. Balis: Then tell David that. I think this approach might alleviate some of the pressure you feel in talking with David. Okay, as far as David getting more upset with you, can you explain what you mean?
Ms. Evans: Well, when we get into these conversations and they lead to arguments, I feel a chill in the air and the heat of words. It's like the blood pressure of the room begins to rise. Do you know what I mean? It makes me feel awful. Like I'm being punished or something. Or like I'm not a good person.
Dr. Balis: When people argue, they get upset and feel bad. David's probably feeling much the same way you do. And it even might be that David's not upset with you personally. He might be feeling frustrated with the issues at hand and his own inability to get them fixed. What do you think?
Ms. Evans: I never thought of it that way. I guess it just makes me feel like a little child getting into trouble again.
Dr. Balis: But you haven't done anything wrong, Cassie. You aren't in trouble. Do you feel this way in all your confrontations?
Ms. Evans: Well, I don't like them, if that's what you mean. I guess I get intimidated easily. It's like my opinions and beliefs have no value. I suppose this is a self-esteem issue I need to work on, huh?
Dr. Balis: That would help. You know, Cassie, many patients with chronic illnesses have similar feelings. They feel a lack of self-worth. They believe themselves to be a burden on their families and friends. Their self-esteem has taken a battering. And arguments can cause additional stress. I think you need to talk about these concerns with David. Not during an argument, but during a nice quiet time. Remember not to place blame. Now, let's talk about why you feel pathetic. Tell me what you mean.
Ms. Evans: I think I may cry--I just feel so helpless, so pathetic. I can't do a damned thing without someone intervening on my behalf. I'm a prisoner of war, and the fight...the struggle is within my body. I have been invaded, and it has screwed up my life! One of the reasons I don't come here often is because I have to ask someone to take me and bring me home. People have to rearrange their schedules for me. I feel like a pest. Actually, I might as well be an animal. Someone's sick pet. Feed me, bathe me, take me to the doctor....And I just sit around, wondering when I get my life back. Wondering when I get a chance to be "normal". I just don't understand why this happened to me. How did I get this awful disease? I always tried to be a good person, to do the right thing...can I please have a tissue? I'm sorry for breaking down like this.
Dr. Balis: Cassie, take a deep breath. You have nothing to apologize for. Things are difficult for you right now. I know you are frustrated and upset by it all. And...
Ms. Evans: I think I know what you're going to say, Doctor--life has a weird way of working things out. Enjoy what you can and take the help you need. There are people who care very much about you. You are a special person, and you are worthy of assistance. That's about it, isn't it? Yeah, I'm special all right.
Dr. Balis: Hmm. But wouldn't you help someone else out if they needed it?
Ms. Evans: Yes, I probably would.
Dr. Balis: So why is it so difficult to accept someone else's help?
Ms. Evans: It's a lot different to take help rather than give help. You see?
Dr. Balis: I understand. It is difficult to take somebody's help. Some patients find it almost painful to be someone else's debt. Tell me, what's your average day like?
Ms. Evans: Not very eventful, really. It depends on the day and how I'm feeling. I watch television, listen to music, thumb through brochures. I've been trying to keep track of the social security crap, gather information as needed. I try to straighten my room as it gets messy. Occasionally, I'll do a load of laundry. Nothing exciting, obviously.
Dr. Balis: Then I'm going to give you some homework. I want you to get a hobby--find something meaningful, something that you derive pleasure doing. Then, as you feel up to it, work a little on it. Work on it even if it's just jotting down some notes or doing some drawings. Think about how you can accomplish some goals or reach a certain competency in your hobby field. Do you think you can do that?
Ms. Evans: I suppose. But why?
Dr. Balis: Unfortunately, there is very little information on the prognosis for CFIDS, so we don't know when you will have you old life back. And the one thing I don't want you to do is sit around and wait for the moment when you'll get all better and will be able to do all the things that you were used to doing before this happened.
Ms. Evans: That does sound bad.
Dr. Balis: I don't want you to spend your life waiting. I want you to engage in life to whatever degree that you're capable of at the moment. Taking on a new hobby will give you a chance to start fresh and new--to plan a life for yourself. That's what I want you to do--design and implement a new life. Okay?
Ms. Evans: I'll give it a try.
Dr. Balis: Good.
Ms. Evans: I'd like to bring David in for a session, if that's okay with you.
Dr. Balis: Certainly. I have no problem with that.
Ms. Evans: Okay. I hope to see you again soon. Goodbye, Doctor Balis.
Dr. Balis: Goodbye, Cassie.
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Button to Dr. Balis' Notes Doctor Balis' Notes on this Session

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Button to Cassandra Evan's Patient File Cassandra Evans' Patient File

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