Transcript of 9th Session between Charles Balis, M.D. and Mr. George Landau, Monday, April 21, 1997 at 2:00 pm.

Mr. Landau: Hello, Doctor. How are you today?
Dr. Balis: Hello, George. I'm fine, thanks. You seem relaxed. Has a week away from me done you some good?
Mr. Landau: Relaxed...I don't know if that's the right word. But I do feel different. Resigned, perhaps. Or focused maybe.
Dr. Balis: Is that due to your experience two Mondays past?
Mr. Landau: Was throwing up on the sidewalk a pivotal experience for me, do you mean?
Dr. Balis: I was thinking more of...
Mr. Landau: I know. Acknowledging my fears but then confronting them without preparation. I've had some time to consider it, Doctor. Don't worry. I might be a stupid old man, but I'm not stupid.
Dr. Balis: I thought we had agreed before that you weren't a stupid old man.
Mr. Landau: It's strange, actually. If I had been sick in the street four months ago, I would have been hideously embarrassed. I would have been worried about being taken for a drunk. But now...I leaned against a garbage can and felt something as I watched people pass by. It was almost pride. Not quite, but almost. I suppose I felt virtuous because nobody stopped to see if I was all right, and if the situation were reversed, I would have stopped. Do you see what I mean?
Dr. Balis: I think so. You felt that you had more compassion?
Mr. Landau: Hmm. How else can I put it? I was thinking: This is me. I'm not some disgusting drunk. I have a problem which I am trying to deal with, and it has caused me to be sick in the street. I don't deserve your contempt. Not one of you cares enough about your fellow man to stop and see if I need help. I actually felt good about the situation after the shakes had worn off.
Dr. Balis: I think that's positive, George. I'm pleased you feel that way. Some kind of phobia affects seven out of every hundred Americans. It's really nothing to feel ashamed of.
Mr. Landau: I'm not quite ready to proclaim it to my staff yet.
Dr. Balis: That's different. There is another issue there because you manage these people and you have to retain their respect. But we will get to that. Our immediate priority is to prepare you for your next training session.
Mr. Landau: There isn't going to be another. Not for some time at least.
Dr. Balis: Have the company stopped offering the course?
Mr. Landau: No, I've taken myself off the list until you and I are both sure I can deal with it.
Dr. Balis: I think that's a very sensible move. Then I suppose our short-term concern is how to deal with Mr. Taylor. He won't be pleased to hear that you have signed off the course.
Mr. Landau: He didn't mind after I explained the whole thing.
Dr. Balis: You told him?
Mr. Landau: Yes. I waited until he wasn't busy and then talked to him in his office. He was pretty reasonable once I had laid the whole thing out and told him that you and I were going to work to get me over it.
Dr. Balis: This is Simon Taylor, your boss, we are talking about here?
Mr. Landau: Yes.
Dr. Balis: George, I am floored. You've approached this in the most positive way I could imagine. If your boss is behind you and we don't have an imminent deadline, we can really take the treatment at the pace which you find comfortable.
Mr. Landau: Okay.
Dr. Balis: There is one thing which has been puzzling me.
Mr. Landau: What's that?
Dr. Balis: Your carpal tunnel syndrome. You haven't been wearing your wrist brace for a while.
Mr. Landau: No...
Dr. Balis: And you told me that when it was diagnosed, the doctor said it was probably brought on by using a computer keyboard and mouse. But you haven't been using a computer keyboard or mouse much...
Mr. Landau: This bit I do feel ashamed about.
Dr. Balis: Tell me.
Mr. Landau: I didn't have wrist problems diagnosed. That period is a little unclear in my memory. At the time I did feel pain in my wrist. At least, I think I did. I had read about repetitive strain injury and how firms had to look after their workers. I suppose it had stuck in my head.
Dr. Balis: Are you saying you don't have CTS? I was surprised it's not mentioned in your personnel file.
Mr. Landau: I believed in some way that I did. It was all very vague. I didn't set out to deceive anybody. I just told myself that I didn't need to go to the doctor. I had a pain in my wrist and I knew what it was. I knew how to deal with it. I have a friend who works in a hospital. He was able to get me the brace...I told myself I was saving the doctor's time. Looking back, I suppose, I was trying to convince myself.
Dr. Balis: So you started wearing the wrist brace to work?
Mr. Landau: I thought I needed to. Maybe on one level I knew I was deceiving myself. I mean, I knew I had hardly touched the keyboard or the mouse thing, but still I believed my wrist had been damaged by them. I was convinced enough to bring it off at work anyway.
Dr. Balis: To bring off the charade?
Mr. Landau: Yes. I suppose it was a charade. I didn't think of it as such though. I still don't, really. I was deluding myself, but I was also the one being deluded. So I'm innocent as well as guilty. Does that make sense?
Dr. Balis: Well, I think it is important that you acknowledge that you were deluding yourself.
Mr. Landau: I was. I think I was.
Dr. Balis: What effect did the wrist brace have at work?
Mr. Landau: People showed a lot of concern. It was very noticeable, particularly when I had my jacket off. Tom Windsor was very good about it for a while.
Dr. Balis: He was your superior before Mr. Taylor arrived?
Mr. Landau: That's right. You have a good memory, Doctor.
Dr. Balis: Plus extensive notes. But you said he was good about it for a while. Did that change?
Mr. Landau: I think by the end he was becoming suspicious. He would look at the brace strangely when we talked. He was too nice a man to be a manager really. It would have upset him to confront me about it. As it happened, he left before matters came to a head.
Dr. Balis: What other effects did the brace have on your work?
Mr. Landau: It was very handy when people came to see me in my office and we had to look something up on the computer. It would have been more natural for me to drive the thing. But I could squeeze my arm as if it hurt and naturally my visitor would offer to drive the computer for me. I think my arm often did hurt in those situations.
Dr. Balis: You mentioned several times today that you felt pain although you didn't suffer from CTS.
Mr. Landau: Yes. That's quite frightening, now that I think about it. I think I perhaps wandered out on occasion.
Dr. Balis: Wandered out?
Mr. Landau: I wasn't quite myself. I was seeing things in strange ways. Part of the delusion maybe.
Dr. Balis: Can you tell me more about this?
Mr. Landau: It was just a frame of mind. My brain tried to tell itself to believe something which another part knew wasn't true, so it had to move out a little to resolve the picture. To change the perspective. I don't want to make a big deal out of it. It just happened. I think I've exaggerated it today. This self-analysis is heady stuff.
Dr. Balis: Well, let me bring you back to Earth and tell you about the treatment I want to try.
Mr. Landau: Please do.
Dr. Balis: There is a technique called "flooding." It involves you experiencing imaginary situations which confront your fear. However all the time you will be in the safe environment of my office.
Mr. Landau: You make it sound easy. But I imagine it is distinctly unpleasant.
Dr. Balis: I'm afraid it is. But it's a very effective treatment.
Mr. Landau: The idea is that after I have experienced the worst in my imagination, the real thing won't be half as bad?
Dr. Balis: It is a little more subtle than that. But you have grasped the broad principle.
Mr. Landau: Hmm. I don't suppose there is an equally effective treatment which is relaxing and pleasant?
Dr. Balis: I'm afraid not.
Mr. Landau: No. Well, I suppose I can be brave for a while longer.
Dr. Balis: I think you are a brave man, George. Particularly in light of what you told me earlier.
Mr. Landau: If I was truly brave, I would have dealt with it years ago. No, let's do it. But let's have one session every two weeks. I found the extra time to think very valuable.
Dr. Balis: It certainly worked this session. All right then, George, then I'll see you next on Monday, May the 5th, at 4 pm.
Mr. Landau: I'll be there. I'll try to be ready.
Dr. Balis: I'm very pleased with your progress, George.
Mr. Landau: Thanks, Doctor. Tell me that again after we've done this flood stuff.
Dr. Balis: Flooding. Okay, George, it's a deal.
Mr. Landau: Goodbye, Doctor.
Dr. Balis: Goodbye, George.
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