Transcript of 4th Session between Charles Balis, M.D. and Ms. Madeline Trent, Tuesday, September 15, 1998 at 12:00 pm.

Dr. Balis: Good afternoon, Maddie, please come in. How have you been?
Ms. Trent: I've been plugging along like normal, Doctor Balis. It's good to see you. As soon as I opened the door to your building, I felt the tension in my shoulders melting away.
Dr. Balis: How have you been doing with your stress management?
Ms. Trent: There are so-so days, and there are horrible days.
Dr. Balis: Hmm. Maddie, today I'd like to do something a little different, if you don't mind. I'd like to spend our session first evaluating the stressors in your life and then figuring out how we can reduce them. I'd like you to really understand how stress works.
Ms. Trent: I think I understand stress.
Dr. Balis: I know you understand the symptom. I'd like you to understand the disease. Is that all right with you?
Ms. Trent: Sure, what do I do first?
Dr. Balis: Well, I'd like you to take a look at this list. This is a list of the various stressors that can affect a person's psychological well being. I've marked everything that I thought applied to you. I would like you to go over this list and make sure that everything that should be checked has been. Please mark all events that have occurred during the past twelve months. There's no magic associated with this list; it is simply a way for us to gauge how stressed you are.
Ms. Trent: Hmm. Okay.
Dr. Balis: Please feel free to mark off anything that I've circled incorrectly. Take your time, I'll work on these notes.
Ms. Trent: Okay, here you go. I've added several items.
Stress Test as Marked
Dr. Balis: All right, Madeline, I'll take a look at your list later. Okay, are you ready for my little lecture--"The Effects of Stress and How to Minimize Them." Understanding stress and how to combat it is paramount. There are many ways to decrease your stress level. One way is to regulate your body clock--the little group of cells known as the pineal gland. Your pineal gland acts as a type of repository of serotonin. On a daily basis, serotonin is chemically converted to melatonin; and then the melatonin is converted right back to serotonin. The whole cycle from serotonin to melatonin and back is called your body clock.
Ms. Trent: What are serotonin and melatonin?
Dr. Balis: Serotonin and melatonin are hormones and neurotransmitters. Simply put, melatonin is the chemical in your brain that allows you to sleep. It's responsible for making sure that your body is physiologically ready for sleep. If your brain is not producing the right amount of serotonin, you'll have difficulty falling asleep and resting peacefully. Serotonin is a chemical that helps regulate the sleep-wake cycle.
Ms. Trent: Okay...
Dr. Balis: For the next two or three weeks, I'd like you to try to regulate your sleep.
Ms. Trent: Hmm...
Dr. Balis: This means working out a schedule that will allow you to sleep for at least eight hours a night. Since it will take two to three weeks for your body clock to synch up with a new schedule, it's imperative that you stick to the schedule. Next week, I want to know how much success you've had doing this on your own. If you have problems sleeping, I'll look into some medication...
Ms. Trent: What if I can't fall asleep?
Dr. Balis: If you've tried to fall asleep but are still awake after forty-five minutes, try reading a book. Sooner or later, you'll start to feel sleepy. Try to go to bed at the same time each night. Eventually, your body clock will kick in. Since you are still nursing Natalie at night, it will be hard for you to get a full night's sleep. I know how strongly you feel about nursing Natalie, but if you can, delegate the midnight feedings to Jesse.
Ms. Trent: I don't know, Doctor Balis. I'd feel like I was shirking my responsibility. Besides, I really do enjoy nursing her.
Dr. Balis: It's something to consider. And you don't need to make this decision right away. Last week, we've discussed creating a schedule for you. Have you tried it?
Ms. Trent: Yes. And I feel less tense than before. I feel like my brain is better organized. And my memory has improved--I used to forget little things all the time.
Dr. Balis: Good! Keeping a regular schedule is another way to help get your body clock back on track. If you can, try to keep regular hours at work as well. I know you are working hard right now, but try to keep the overtime to a minimum. Also, try to eat lunch outside or get outside at some point during the day. Getting enough daylight is yet another way to help regulate your body clock.
Ms. Trent: These seem like such small steps: some sunlight, a schedule, no overtime, regular sleep.
Dr. Balis: Yet together, they can have a very large overall effect.
Ms. Trent: I'm finding all of this very interesting! I might spend some time on the Internet, researching stress management.
Dr. Balis: You'll learn all my secrets!
Ms. Trent: Ah ha! I've found you out!
Dr. Balis: The Internet is a wealth of information; I highly recommend that you do a bit of stress-free surfing as long as you get some time outside in the fresh air.
Ms. Trent: I'll do my best, Doctor.
Dr. Balis: Good. Getting your body clock on track will help reduce your stress, but it's not the whole answer. You need to give your body time to heal and regenerate. You have mentioned anxiety, great fatigue, and an overall lack of enjoyment with your life. You need to allow your body time to regenerate its happy messengers.
Ms. Trent: Happy messengers? Doctor Balis, have you gone off the deep end?
Dr. Balis: No, no. Your brain creates trillions of messages a day; some are happy, some are sad. The happy ones are known as endorphins. Stress disrupts the delivery of happy messages. If the stress continues or increases, the happy messages may fail completely. This means that the nerve centers will only receive sad messages, causing the brain to become distressed and pain thresholds to lower. This chemical imbalance is often caused by overstress.
Ms. Trent: Am I overstressed?
Dr. Balis: Yes, I think you are overstressed. But we can work on that by getting your body clock back to normal, keeping your blood sugar steady, and dealing with the problems that contribute to your daily stress. I can teach you some relaxation techniques, but the most progress can be made by simply changing your frame of reference, learning how to deal with stressful situations, and dealing with the causes of your stress.
Ms. Trent: What are some of the relaxation techniques?
Dr. Balis: There are different techniques to deal with long-term and short-term stress. Because you are feeling so much immediate stress, I'll show you the short-term stress techniques. These will help you deal with the adrenaline rushes and the tenseness in your muscles.
Ms. Trent: All right.
Dr. Balis: One of best relaxation techniques is exercise. Exercise gets your blood flowing, which circulates more oxygen to your brain. Exercise also produces endorphins, which give you a feeling of happiness and well being.
Ms. Trent: Next, you're going to tell me to count to ten before I do things, right?
Dr. Balis: In a way, yes. Taking ten deep breaths and feeling each breath fill you up and exit is very relaxing. When combined with relaxing imagery, this concentrated breathing exercise can be very effective. Would you like to try it right now?
Ms. Trent: Okay. Am I supposed to think of my grandmother baking bread?
Dr. Balis: If that will help you relax. Or you can think of being someplace pleasant and relaxing like laying on a beach with a warm sun above you and the surf beating on the shore, maybe some seagulls flying overhead...
Ms. Trent: Okay. I'm there.
Dr. Balis: Close your eyes. Picture yourself on this beach. The warm sun is shining and toasting your skin. A gentle breeze flutters through your hair. Now slowly breathe in as I count to five, then exhale as I count from five to ten. One, two, three, four, five. Exhale. Six, seven, eight, nine, ten. Good, let's do it again. Inhale. One, two, three, four, five. Exhale. Six, seven, eight, nine, ten.
Ms. Trent: This is nice. I can get used to this.
Dr. Balis: You should try to spend at least twenty minutes a day doing this. Okay? What do you think?
Ms. Trent: I feel a little overwhelmed. I've learned a lot.
Dr. Balis: Good. You need to understand what is happening to you when you feel stressed so you can fight it better.
Ms. Trent: I'll probably do some research on stress and stress management over the weekend. Once I do a little research, I'm sure all of this will come together for me. I feel better armed already. I'm prepared to fight off stress and enjoy life.
Dr. Balis: Good.
Ms. Trent: I do appreciate your help. Doctor Balis?
Dr. Balis: Yes?
Ms. Trent: I'll work on regulating my schedule. Look, our hour's up. See, I'm getting on schedule already. It seems that getting my body clock back on track will help alleviate some of the tension I've been feeling. Aside from that, it just makes me feel good to be organized. I wonder what Jesse is going to think of all of this. We were discussing "quiet time" for children as a discipline, but it looks like I'll be the one getting "quiet time."
Dr. Balis: Everyone can benefit from a little quiet time.
Ms. Trent: Thanks again, Doctor Balis. I'll see you next week.
Dr. Balis: Have a good week, Madeline.
Arrow, Straight, Left, Earlier Arrow, Straight, Right, Later

Button to Dr. Balis' Notes Doctor Balis' Notes on this Session

Button to Madeline Trent's Transcripts Transcripts of Madeline Trent's Communications
Button to Jesse Trent's Patient File Jesse Trent's Patient File
Button to Madeline Trent's Patient File Madeline Trent's Patient File

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