Transcript of 1st Session between Charles Balis, M.D. and Ms. Claire Steven, Monday, December 8, 1997 at 10:00 am.

Ms. Steven: Doctor Balis? Thank you for seeing me on such short notice.
Dr. Balis: Ms. Steven, I presume? Please come on in, sit down.
Ms. Steven: Actually, I don't really know what took me so long to come and see you, considering.
Dr. Balis: Considering what?
Ms. Steven: Oh, please call me Claire. Ms. Steven is my mother-in-law, and God doesn't take you long to jump into things.
Dr. Balis: Our time is all too short. Now, what were you going to say, Claire?
Ms. Steven: Well, I meant considering how long I've had this problem.
Dr. Balis: Claire? Here are some tissues. Can you tell me why you're crying? What are you feeling?
Ms. Steven: I don't know. I've just been like this lately. My family is passing it off as PMS, but that's not it. They just don't understand.
Dr. Balis: Have you noticed an association between crying and menstruation?
Ms. Steven: No. I'm just kind of bitchy, I guess. I've been bitchy a lot lately. I don't really know what is my problem. I know I just can't live like this anymore. If I don't pull myself out of this soon, my husband is going to leave me and that would kill me.
Dr. Balis: Hmm. We're covering a lot of ground, and I'd like to slow it down a bit and find out about yourself and your life first. Does that sound okay? I can tell that you are very nervous and frustrated. Try to relax a bit. You're safe here. Breathe slowly. Good. Now, you're not a San Francisco native, right?
Ms. Steven: That's right. I'm...uh, from Indiana. I grew up there, not far from Chicago. The area I'm from has many nick names--like "The Region"--but I like to call it the "Armpit of the Nation."
Dr. Balis: Why is that?
Ms. Steven: Because it is. I mean...there is nothing there. It's bland, boring. Where I'm from, everything comes out of Chicago: the television stations, radio, news, everything. It never gets noticed. Except for Gary that is. It has been the murder capital of the nation so many times that I've never even seen the downtown and we lived fifteen minutes from it. It's just like the armpit--it never gets any attention paid to it except for the smell and the dirt. That's the area I spent most of my life in. It's really not much to talk about, but it's still home. Don't get me wrong, Doctor, I'm glad I'm gone. But it was the only place I knew. I felt comfortable there.
Dr. Balis: So what brought you out to California?
Ms. Steven: My husband. God! I love him so much. He is the only thing holding me together right now. He's the best thing that ever happened to me in my whole shit-filled life. Oh God, here I go again. I just can't seem to stop crying, Doctor.
Dr. Balis: It's all right, Claire. This is a good place to cry.
Ms. Steven: Christ, if I hear that one more time, I think I'll slit my wrists.
Dr. Balis: Claire, try to relax. Have you been thinking of suicide recently?
Ms. Steven: No. It's just an expression, Doctor. I couldn't do that to Aaron; it would kill him. Aaron is my husband. We've been married for almost two years. I met him in college. He was a senior, and I had just started my sophomore year. He was great--very handsome and very confident. The first words he said to me were: "So, should we get married this weekend, or do you want to wait until next weekend?" I thought he was trying to pick me up--which he was--but there was something about him. I can't explain it. He warmed me up somehow. I knew at that moment that I would eventually marry him. But at the time, I was in a relationship and just brushed him off. Somehow, he found out what my class schedule was and arranged to be in the same class with me sometimes. I went to Indiana University, so the classes were huge--two to three hundred people in huge lecture halls. At least, that's the way it was in the weed-out classes.
Dr. Balis: Weed-out classes?
Ms. Steven: I'm sure you're familiar with the format--large class, no access to the professor, and extremely difficult to pass. Only about a third to a half of the original class remains at the end. They were set up to weed-out those people who weren't really interested in that field. Higher level classes were smaller and more individual. And the profs seemed to care more about their students because they remained in that major. Anyway, Aaron was a senior and these large classes didn't mean anything to him. So I knew that he was there just for me. After a while, I decided to go out to dinner with him. He was a pure gentleman. And the next day, I broke off my other relationship--which didn't seem to bother him too much. And, like they say, the rest was history. Aaron and I got married during the Christmas break of my junior year. Mom and dad were not too happy, but they got over it. Aaron had already graduated and was working for the university while I finished school. I graduated this past May, and in June we moved here. Aaron has a degree in finance and wants to start an accounting firm here, so we moved. Things were not going quite as we planned, so I had to get a job here at SII. I work in Human Resources. I basically set up interviews with prospective employees and conduct the first ones. If they are qualified and seem like sensible people, I set up a second interview with whatever department they are trying to get in. I have a lot of contact with the heads of all the departments at SII. I really don't know how I got the job, but I like it. It's just that I don't like who I am as a person. I don't like the way I look. Although Aaron tells me every chance he gets just how beautiful I am, but he is supposed to tell me that--he's my husband, for Christ's sake.
Dr. Balis: Does your husband know how you feel?
Ms. Steven: Yes. He doesn't know I am here, though. He knows that I've been very down lately, but I'm not sure he realizes just how bad it is. I know he is frustrated with me in one respect, though.
Dr. Balis: And what would that be?
Ms. Steven: Well, I haven't been interested in having sex. It's not that I don't want to have sex with him, it's that I just don't want to have sex. So I need to learn to like it before he decides to leave me.
Dr. Balis: Hmm. Let me ask you, did you come here today expecting to learn some trick that would help you appreciate sex?
Ms. Steven: Yes, I guess I did come in here expecting you to give me an answer today. But I'm willing to work with you for as long as it takes--I'm getting desperate.
Dr. Balis: I'm glad you're willing to commit to working with me, because therapy is work. I believe that with time we could improve your situation and raise your libido. Now let me ask you another question. Was there ever a time in your life when sex was fun for you?
Ms. Steven: No, never. I thought that after I got married, everything would fall into place. But after our wedding night, I knew there was a problem.
Dr. Balis: What happened?
Ms. Steven: Aaron was very gentle and loving towards me. He was soft and caring. I was very nervous. I didn't want to do it, but I didn't tell him. Right in the middle of it, I burst into tears. Aaron thought he was hurting me, so he instantly stopped and just held me telling me that he loved me and everything would be all right. I felt horrible. I knew from that moment that sex was something that was going to be a problem in our relationship. We've been married for almost two years, and I still...
Dr. Balis: Take a deep breath, Claire. Good. Do you have sexual relations with your husband at all?
Ms. Steven: Yes, we have sex. But I'm sure it's not enough to please him. There are times when I'm in the mood, but those are few and far between. During those times, I enjoy sex. But then afterwards, for some reason, I feel guilty...or dirty. Aaron is very good in bed. But since I turn him down so much, I feel that he believes that I don't find him attractive. And that can't be further from the truth.
Dr. Balis: How often do you have sex?
Ms. Steven: Maybe once or twice a month, sometimes less.
Dr. Balis: I see. Do you believe that your husband has been unfaithful to you at any time during your relationship?
Ms. Steven: No, not at all. We've had our little spats about it, but he has never threatened me with an affair. He is very supportive, and he believes that there is something in my past that causes me to feel this way. He has been wanting me to see someone for a long time now.
Dr. Balis: What finally made you come in?
Ms. Steven: My mother. I talked about this with her, and she said that I needed to work this out before Aaron decides to leave me. I never thought Aaron would leave me until my mother said he might. I need to do something. I can't lose my husband.
Dr. Balis: It sounds like your husband believes that there's a problem as well. After just one hour together, Claire, I don't have enough information to tell you whether your problems are purely emotional in nature, or if there's a physical component to your aversion to sex. Hopefully, we can figure this out over the course of therapy. And I might want you to consult with a gynecologist as well. But perhaps I can suggest something.
Ms. Steven: Oh, Doctor, please. I'm a desperate woman.
Dr. Balis: There's a difference between being intimate and having intercourse. It's obvious that intercourse is making you so uncomfortable that you lose your ability to be intimate with your husband.
Ms. Steven: I never thought of it that way, but I guess that's true.
Dr. Balis: Why don't you try setting up situations that are romantic and lead to intimacy. You can negotiate with your husband beforehand to avoid the possibility of having sex during such an encounter. This way, you won't get stressed over that issue and might fully enjoy the company of your husband and allow him to get close to you. This is not a solution, but it might help. I would also suggest that you tell your husband that you're seeking professional help. That would help him see just how serious you are about trying to restore sexual relations between the two of you.
Ms. Steven: That sounds like something I can do. Thank you, Doctor.
Dr. Balis: Our time is running out , Claire, but I'd like you to keep a journal if at all possible about your feelings. You can write down anything; it doesn't have to be about sex. You can show me the journal or not, as you choose. I'd like you to get into the habit of recording some of your thoughts--it'll be helpful to you later as we spend more time together.
Ms. Steven: I'll try.
Dr. Balis: Well, our time is up. Does Monday at ten work for you in general?
Ms. Steven: Monday's fine, but I don't think I'll be able to make it every week. Can we meet every other week?
Dr. Balis: That's fine.
Ms. Steven: Thank you, Doctor. I'll see you next time.
Dr. Balis: Well, we're getting into the holidays. I know it's weird to start therapy and then have to put it on hold for so long, but two weeks from now is the 22nd of December. I'm going to be here during that week, but I'm just seeing patients who are in crisis that week and the next. So let's make our next session two weeks after that. That'll be Monday, January 5th at ten. Does that work for you Claire?
Ms. Steven: I guess so. I'm pretty busy over the holidays anyway. I'll think about what you said about intimacy, Doctor.
Dr. Balis: Good. Goodbye, Claire. I'll see you in January.
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