Transcript of 7th Session between Charles Balis, M.D. and Ms. Rachel Tanner, Tuesday, January 6, 1998 at 3:00 pm.

Dr. Balis: Happy New Year, Rachel.
Ms. Tanner: Same to you.
Dr. Balis: How was your week away from home?
Ms. Tanner: It was a good visit. I wish I could have stayed longer. I was starting to get used to the lifestyles of the poor and degenerate.
Dr. Balis: That would be your brother and his roommate?
Ms. Tanner: Exactly. Michael wasn't around that much because he had to work. I was a little concerned about having to spend a lot of time by myself, but it didn't turn out that way. Evan was there most of the time, except when they'd take off mountain biking.
Dr. Balis: Did you feel comfortable in Michael's home?
Ms. Tanner: Yes, except for one incident. They both seemed comfortable having me there. I used the laundry and bike room as my own. They set up a cot, and there was a laundry tub with hot and cold water. In one sunny corner was a big chair where I sat to do my journaling with bicycles hanging over my head and Sssh in my lap.
Dr. Balis: Sssh?
Ms. Tanner: Those stupid boys named their cat Shit Head, but now they call her Sssh as in her abbreviations, S.H. They didn't really know how to train her when they first got her, so she was on their bad side a lot. Now she's pretty close to what I'd call a perfect cat.
Dr. Balis: Hmm. You mentioned there was one unpleasant incident. Do you want to share it with me?
Ms. Tanner: I guess. Evan is a DiCaprio/Chandler cross. Adorable. I think I experienced my most embarrassing moment to date.
Dr. Balis: Hmm.
Ms. Tanner: I thought I was alone, because Michael was at work and Evan had left for a ride. I couldn't wait to get into the bathtub. There I was laying on the bottom of the tub, warm water flowing, legs spread so I know? And Evan walked in! I guess he thought I was just getting the tub ready. He thought he could dart in to get his cycling gloves that were hanging on the towel rack to dry. Oh my God! I was so freaked!
Dr. Balis: How did he react?
Ms. Tanner: He said, "Whoops!" But he got a good look. I didn't say a word. He was gone for about three hours on his ride. I dreaded seeing him again. Here I had this major crush on him. I had one more day until Gram picked me up. And he caught me getting myself off. I'm afraid it brought back some of my old habits.
Dr. Balis: Which ones?
Ms. Tanner: I showered until the water got cold. I brushed my hair until my scalp hurt. I didn't do any damage, but still. I guess the only good thing was that I stopped my rituals. It was not because I felt like I had completed the tasks, but rather because I felt silly--like it wasn't going to do me any good.
Dr. Balis: So you didn't repeat any of your rituals later?
Ms. Tanner: No. When Evan got home, he acted like nothing had happened. I'm sure I blushed like a young bride, but I'm hoping he didn't notice. Once my brother got home, things felt like normal again. Actually, better than normal--that was a concert night, and we were in the mood to party.
Dr. Balis: Does your brother knows about your OCD? Does Evan?
Ms. Tanner: Yes. We talked about it the first day I got there. Michael must have told him, because he asked me over and over if the laundry room was going to be an okay place for me to hang out. Then he said he knew about it. He was really cool to talk to. He made it sound like it was normal to have nervous little habits, and he described some of his own. We laughed a lot.
Dr. Balis: So how was the concert?
Ms. Tanner: Great. It was at the Concord Pavilion. We got to sit outside under the stars. They were spinning.
Dr. Balis: What do you mean?
Ms. Tanner: Well, it's confession time. I smoked some pot and had a couple of beers. Michael didn't pressure me; it wasn't like that. And it wasn't a first or anything. It's like an everyday thing for my brother. And I just wanted to party with the boys. I'm glad I did. Why do you look so serious?
Dr. Balis: I can't condone recreational drug use, Rachel. It goes with my profession. Did you consider that it might interfere with the medication you are taking?
Ms. Tanner: You didn't warn me about it, so I assumed it wouldn't hurt. It didn't hurt, as a matter of fact. I had a great time. Please, don't pull a Dad thing on me, Doctor Balis.
Dr. Balis: It's a Doctor thing, Rachel. Please continue.
Ms. Tanner: Anyway. A day later, Gram took us all out for dinner and then drove me home. How depressing.
Dr. Balis: To be home again?
Ms. Tanner: How do you keep them down on the farm, once they've seen Sausalito?
Dr. Balis: Are you really depressed?
Ms. Tanner: You're so clinical today, Doctor. No, it's just an overused expression. Actually, I think I'm ready to try school again.
Dr. Balis: Did our discussion last time help you decide?
Ms. Tanner: Yes. That and having a good time at my brother's. Surviving all those new experiences helped me realize that I'm not that far from normal. When I think of how I was back in August, when I first started seeing you, I'm amazed. I want to know how much of this is the fluoxetine. And what happens when you take me off it?
Dr. Balis: Fluoxetine is used to help relieve the urge to perform rituals in the OCD patients. Serotonin uptake inhibitors help cut out the background noise that patients, including you, have described. Do you find that your self-talk is not only reduced now, but focused more on what you're doing right, rather than on what you're doing wrong?
Ms. Tanner: Yes.
Dr. Balis: And so with more positive feedback, your confidence has increased, allowing you more freedom--freedom to travel, freedom to try new things...
Ms. Tanner: Freedom to explore my sexuality.
Dr. Balis: That too. And freedom to go back to your old life or the better parts of it. I'm pleased to hear that you want to try school again. When does it start?
Ms. Tanner: In a few weeks. I won't get a very good selection of classes, since I'm registering late. But...oh well.
Dr. Balis: It's a start. I didn't answer all of your questions about the medication. For now, I would like to continue with the same dosage and continue with sessions every two weeks. Let's give school a chance. Rachel, some people stay with this medication for years, particularly in cases of chronic depression. I'm hopeful that as your OCD symptoms decrease, your need for medication will diminish. When we do decide to discontinue, it will take a few weeks for it to actually leave your system. But let's not rush into anything just yet. Let's continue with the medication.
Ms. Tanner: So, I'll see you in two weeks?
Dr. Balis: Actually, I'm going on vacation. I'll be gone the next two weeks. So how about Tuesday, January 27th?
Ms. Tanner: That's fine. I'll be busy with school anyway.
Dr. Balis: Good. And good luck with the registration.
Ms. Tanner: Thanks, Doc. Have a good time.
Dr. Balis: Thank you. Goodbye, Rachel.
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