Transcript of 1st Session between Charles Balis, M.D. and Ms. Christina Herald, Thursday, February 27, 1997 at 12 pm.

Ms. Herald: Hi, do I have the right office? I'm looking for a therapist named Dr. Balis, and I got so hopelessly lost...
Dr. Balis: I'm Dr. Balis. How can I help you?
Ms. Herald: Oh good, I found it! I'm Christina Herald and I have an appointment with you today. Right now, by the looks of things.
Dr. Balis: Oh, I see. It's nice to meet you Ms. Herald.
Ms. Herald: Oh, call me Chris please. Whenever I hear Ms. Herald I keep expecting to see my mother.
Dr. Balis: All right then--Chris. Please have a seat.
Ms. Herald: Thanks. I'm sorry for jumping down your throat with the name thing. I'm just not one for standing on antiquated formality. I didn't make you uncomfortable, did I? I don't want to get off to a bad start.
Dr. Balis: You didn't make me uncomfortable.
Ms. Herald: Oh good. Because a lot of the time I wind up making people uncomfortable without meaning to. I can be very direct to the point of having no tact whatsoever and I don't even stop to think about anyone else. My father says that I'm a very assertive person. My mother just says I'm bossy. I think they're probably both right to some extent. I just worry about hurting people's feelings, because I did it to my ex-boyfriend all the time without meaning to. I didn't come here today to talk about all this and I'm rambling. You'll hear all about my family, my ex, and my big mouth soon enough, I'm sure. So maybe I'd better tell you why I actually came here today, right?
Dr. Balis: All right. Why are you here Chris?
Ms. Herald: Ah, the real reason that I'm in here for therapy. Okay. Well, since I was about fifteen years old, I've been having panic attacks. It's kind of a hereditary thing, I guess, because my mom, her sisters, and my grandmother all have them. They started when I was still in high school. The first time I ever had one, I thought I was having a coronary or something. I literally thought my heart would burst, it was pounding so hard.
Dr. Balis: I see. And you've been having them regularly ever since?
Ms. herald: Yes, for about eight years now. Oh, it really wasn't a regular thing, at least not at first. Just every once in awhile. Until my first year of college that is. I had decided to go to school up in Washington state, so I moved up there, thinking it would do me good to get away from my parents for awhile. But the panic attacks got a lot more frequent after I moved. I missed classes and spent a lot of time asleep, because I'd feel so drained after an episode that all I'd want to do is go to bed. I managed to keep my grades high enough to transfer to Berkeley, and I left Washington after my freshman year.
Dr. Balis: And this is the first time in eight years you've ever sought help?
Ms. Herald: Well no. Not exactly. The first time was about four years ago when I was still up in Washington. I went to the Health Center and they had one of their staff psychologists talk to me. The guy was a total ass. He basically asked me if I was pregnant or if I was taking any drugs, then grilled me about how I was doing in school and whether or not I cared about my grades. I never went back after the one meeting. Not care about my grades? That was the whole bloody reason I went there, for god's sake.
Dr. Balis: I see. What happened after you transferred back to Berkeley?
Ms. Herald: Things got better for awhile. I liked the school a lot more and my friend Janey and I moved into our own apartment. I got a part time job at the cutest little old bookstore near campus--Shakespeare Books, do you know it? I was fairly happy, and the panic attacks were only happening once in a great while. But about six months ago, they started getting worse again. I have my own studio apartment now, because Janey left to go to grad school in New York. I'm going to graduate at the end of this semester, and I already have a job lined up at a high school not too far from here. I don't know why these damned things have been so bad lately, but my schoolwork and personal life are both starting to suffer.
Dr. Balis: How are the attacks affecting your school and personal life?
Ms. Herald: I'm just starting to get behind on my assignments. I'm so tired all the time and I have a hard time caring about anything. My father calls it senioritis and makes jokes, but then threatens me with all sorts of dire consequences if I fail out. Like I could flunk now if I tried. But if things keep going well, I could graduate cum laude, and that would be really nice.
Dr. Balis: And your personal life?
Ms. Herald: Oh yeah, that was a two part question wasn't it? I'm just starting to snap at people and take out my irritation on my friends when they're not at fault. I rather unceremoniously dumped the guy I've been seeing last weekend after blowing things way out of proportion in an argument we were having. I knew the relationship was over anyway, but had I been myself I might have been a little kinder about it all. Oh well, it's too late to take it all back now.
Dr. Balis: I see. And could you tell me what happens during one of these panic attacks?
Ms. Herald: Ugh. My heart starts pounding--not really faster but harder and somehow louder. I can almost hear it. I start having trouble breathing, my hands get sweaty and shaky, and I start to feel claustrophobic. Sometimes I just want to curl up in a corner with all the lights out and hide. And then sometimes I absolutely can't stand to be inside because I feel like I'm choking. I spent something like four hours one day last week on my little patio, chain-smoking and trying to force my heart to slow down. Another thing is that I get this really strange, sick feeling in the pit of my stomach, like I'm standing on the edge of a high cliff. That's the worst part.
Dr. Balis: I understand. Are there any particular triggers that you've noticed, something that brings on the attacks?
Ms. Herald: Yes and no. Sometimes if I have a lot of caffeine, I'll have a really bad panic attack. One of the worst ones I've ever had was when I was a freshman in college, and I washed down four Vivarin with a raspberry mocha. Stupid huh? Other times I'll just be sitting at home, reading or watching TV--not doing anything in particular--and kerboom! One big whopping panic attack coming right up. So I'll have to get out for awhile. I'll sit on the patio or go for a walk until I calm down. It can take most of the night for that to happen though, which is why I'm not getting any sleep lately. Stress can bring it on too. Finals, work, fights with the family or whoever the man is this month. I can take so much and then it's just like the roof blows off, you know?
Dr. Balis: I think I do. Have you tried any sort of relaxation techniques or meditation to try to calm yourself down?
Ms. Herald: What, you mean like envisioning white light or whatever that was? Yeah, I tried it. It never really helped though. And how do you explain to the professor standing over you that you were ignoring his lecture because you were envisioning your mind filled with white light? We're talking instant F here.
Dr. Balis: All the same, I think it would be beneficial if we started you on a program involving some relaxing techniques. They can be as simple as putting on some relaxing music. Also, you might want to try cutting back on the caffeine.
Ms. Herald: But caffeine is a necessary nutrient for survival. It makes the world go around, or at least a student's world.
Dr. Balis: I remember. We used to say it was one of the four basic food groups when I was at college. I didn't say you had to cut it out, just cut it back. I'd like to try some relaxation training with you. I have a sheet here which describes the technique. Basically, I want you to lower the lights and either sit in a comfortable chair or lie down in bed. And start at your toes, start to tense the muscles and then completely relax them. Do that twice and then move up your body, tensing and relaxing each of your muscle groups. I've found this technique effective in helping patients with sleeping difficulties. It seems to help discharge energy and tension.
Ms. Herald: Discharge energy? What do you mean by that?
Dr. Balis: Just think of it as a way to abandon the cares of the day and to gain some voluntary control over feelings of tension and relaxation. Just give it a try, if you will, and let me know how it goes in our next session.
Ms. Herald: Oh, so you're kicking me out now?
Dr. Balis: Um, I...
Ms. Herald: I'm just kidding, Doctor. I think I've bent your ear enough for today and I have to be at work in an hour. I'll leave you be now.
Dr. Balis: Can we schedule next week's appointment?
Ms. Herald: Hmm. Next week? Same bat time, same bat channel?
Dr. Balis: That sounds fine. It was very nice talking to you, Chris. I'll look forward to seeing you next week.
Ms. Herald: Yes, you'll see me. I keep coming back like a fungal infection. So I'm not totally nuts then?
Dr. Balis: No, I don't think so.
Ms. Herald: Okay, glad to hear it. My father will definitely be relieved. See you later, Doctor.
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