Transcript of 9th Session between Charles Balis, M.D. and Ms. Rachel Tanner, Friday, March 27, 1998 at 3:00 pm.

Dr. Balis: Rachel. Come in. How are you?
Ms. Tanner: Better.
Dr. Balis: You look very good.
Ms. Tanner: Thank you, Doctor Balis.
Dr. Balis: Have a seat. So, how have you been?
Ms. Tanner: You already asked me that.
Dr. Balis: I would like a bit more detail, if you don't mind.
Ms. Tanner: School is going well. I'm actually enjoying its challenges. I can't say it's boring. By the way, thanks for changing my sessions to Friday. I don't have any classes on Friday this semester, and it should work out much better. And I'm sorry about missing another session.
Dr. Balis: No problem. As I recall, you had two papers and two tests coming up last time. How did they go?
Ms. Tanner: I don't know what I was so nervous about. I guess it was because they were the first ones and I didn't know how I'd do. I aced the Anthropology test and got 88% on the other. The papers were pretty good, too, but I still have trouble writing and editing.
Dr. Balis: Did you try taking a break from your writing every twenty or thirty minutes like I suggested?
Ms. Tanner: Those two papers I really sweated over. But I did so well on them, that since then, I haven't worried as much about writing. I guess my hardest class to prepare for is speech class. I'm not exactly in control over the outcome, you know what I mean?
Dr. Balis: Yes. A paper can be reworked, but a speech can only be edited in the planning stage. You just have one shot at the performance.
Ms. Tanner: You said it. The teacher videotaped us last time. It was weird.
Dr. Balis: Visual feedback can be revealing. What was weird about it?
Ms. Tanner: I fidget a lot. I kept doing something with my left hand on the podium. I found a place where the fake veneer was peeling away from the wood base. During my speech, I kept putting my fingernail into the crack and then pushing it back to mend it. It kept me from making eye contact--my teacher's pet peeve. I worked hard most of my life not to be noticed, but I have nowhere to hide when I'm up there at the podium.
Dr. Balis: I don't want to embarrass you, Rachel, but you are dressed like you want to be noticed.
Ms. Tanner: I didn't wear this to school, Doctor.
Dr. Balis: You seemed to have put a a lot of effort into looking very sharp today.
Ms. Tanner: I was should I put it? Experimenting, I guess.
Dr. Balis: Hmm.
Ms. Tanner: Maybe I wanted you to notice.
Dr. Balis: Why?
Ms. Tanner: You're the only person besides Gram that I talk to in a friendly way. And you're a man. And you help me and care about me. And I wanted to...oh, I don't know!
Dr. Balis: Rachel, it's true--I like you and I want to help you. And I always pay attention to you. But it's not the same kind of attention you were seeking, I think.
Ms. Tanner: No.
Dr. Balis: I'm concerned that you would go to this much trouble for me. This seems out of character for you. What was your experiment? What were you hoping to discover?
Ms. Tanner: I guess I wanted to find out if I was attractive to someone. To you. I wanted to see if anyone would notice me. I wanted to know if I could compete. It's all those things. Every day at school, I see people exude their sexuality. I don't feel right about doing that. I don't tend to act or dress in provocative manner. But I thought it would be safe to dress for you and see what you thought. Is it weird?
Dr. Balis: No, it's not weird. I think you look very attractive and sexy.
Ms. Tanner: Thank you.
Dr. Balis: But it would be inappropriate for me or for you to sabotage the doctor/patient relationship...
Ms. Tanner: I know, I know. I get it. I guess if I passed the test with you, I might try doing this in school. I dress pretty dumpy most of the time.
Dr. Balis: I am encouraged that you are showing confidence in the way you look. Now that you're in school, you have contact with a variety of people. And I'm glad you have more self confidence. But are you ready for the responses you are going to get?
Ms. Tanner: I don't know. I'll find out. I'm not going to do anything stupid like last time.
Dr. Balis: You mean the incident two years ago?
Ms. Tanner: Yes. The stupid study buddy...
Dr. Balis: The rape.
Ms. Tanner: Whatever.
Dr. Balis: You were raped. It was not your fault.
Ms. Tanner: I'd rather not talk about this, Doctor.
Dr. Balis: All right. But it sounds like we should work on this. I think you might be having trouble accepting...
Ms. Tanner: Yeah, yeah. I accept it. I just don't want to talk about it again right now.
Dr. Balis: Okay. Rachel, does your grandmother help you shop for clothes? Is she actively involved in your decisions?
Ms. Tanner: She still thinks I'm just a kid, not a woman. We don't share that much together. We watch TV, movies...we watched the Academy Awards together the other night. As far as clothes go, I've never seen her in a dress, or dressed up even. She doesn't really have a clue. Why do you ask?
Dr. Balis: Sometimes it's useful to have a woman's perspective and feedback. Magazines can give you ideas about what to wear, although I believe their content tends to be somewhat extreme. Are there any women in your classes that you might befriend?
Ms. Tanner: There are a couple of nice people in my poetry class who asked me to join a writers' group. Maybe I'll try it and start making connections with real people.
Dr. Balis: I think it would be very healthy for you to spend time with new acquaintances. It's a good idea to join that writing group and see if there are people there with whom you can be comfortable. By going to school, you are putting yourself in situations where you can meet people. I think you can start making choices that get you involved. How does that sound?
Ms. Tanner: Not so bad. It sounds normal.
Dr. Balis: It is normal. Sharing your life with friends is normal. Will you try it?
Ms. Tanner: Sure. Hey, my brother got that letter you made me send during our last session. He couldn't figure out why I wrote to say basically nothing, especially since I e-mail him all the time. I explained it to him.
Dr. Balis: Do you share very much of our sessions with your brother?
Ms. Tanner: Sometimes. I tell him what I'm working on. I ask him questions like what he remembers about certain events. Also, I feel this need to keep my mother's memory alive, so we talk about what we remember about her. He said the same thing you just did--about getting a new life. I'm not ready for too many changes, but I think I'm ready to relate to people other than a sixty year old woman.
Dr. Balis: Do you ever hear from your brother's roommate? What was his name?
Ms. Tanner: Evan? Michael talks about him a little because I ask. I still have a major crush on him. They are both supposed to be visiting on their way to Baja during Spring Break. They're going to stay at the house for a day or two. Gram's nervous.
Dr. Balis: Why?
Ms. Tanner: Well, Michael's always smoked pot, but he started doing a lot of coke right after my mom died. Living with Gram didn't work out for him. He kind of dropped out. He was cutting classes, getting stoned, getting an attitude. I felt like I didn't even know him for a while. I was afraid I'd lost him, too. Maybe that's why I had so much trouble for those two years. I was a lot worse back then. When I think back on it, I'm surprised I could even go to school. Anyway, that's all in the past.
Dr. Balis: Your past is part of who you are today. Remember that it was not that long ago that you thought breaking one of your rituals would cause harm to your brother. How is the counting?
Ms. Tanner: I stopped that. After our last session, I started taking breaks from writing. Instead, I got up to pace. And I felt like an idiot. I actually laughed at myself as I starting to walk around my big bed. I stopped mid stride like I was daring myself. Instead, I tapped my foot four times: north, south, east, west, and that stopped it.
Dr. Balis: You replaced one ritual with another?
Ms. Tanner: I don't think of it that way. The "north south east west" thing is what I do to stop a ritual. It works. I only have to do it once when I get the urge to count off my steps. Isn't that better than pacing? Now I just do it with my finger. I tap it out, and it's done. I make myself stop. It could be just as bad if I tapped and tapped and that became something I had to do twenty times or something. But I stop it.
Dr. Balis: Did you find the relaxation tape I gave you a few months ago? I asked you to use it again. Have you?
Ms. Tanner: Well, I started a yoga class. Now I do stretching and relaxing, plus what I guess you'd call meditation. Besides swimming, it's actually the best thing that I've ever found for this thing I'm plagued with. I'm serious!
Dr. Balis: How do you think it helps?
Ms. Tanner: You find out what your body can and can't do. You challenge yourself to get to the edge, then go past your edges. It's a body awareness thing for me. You free your mind. One of the teachers talks about the ego. He tells us to leave it at the door before we come in.
Dr. Balis: I would be out of business if I told my patients to do that.
Ms. Tanner: So the better I get at yoga, the less I'm going to need you?
Dr. Balis: I guess I should worry about that. Seriously, Rachel, I do not foresee keeping you as a patient for years. I've been honest with you all along during your treatment. I anticipate continued improvement with the possibility of moving you off of the medication at some point in the future. When that happens will depend on your progress. It depends on your goals. What would you like to be able to do in the future that you think would be difficult to do now?
Ms. Tanner: Well, I would...I'm not...
Dr. Balis: It's okay, Rachel.
Ms. Tanner: I want to be normal. I want to feel normal. I'm not sure what normal is, though. I feel desirable. I feel smart. But I'm lonely. I don't want to live with my grandmother, but I'm not ready to leave. I'm not as independent as I would like to be. I want a career. I want friends. I want someone to notice me, but I'm afraid.
Dr. Balis: I understand. I want to help you have all those things, when you are ready--step by step. It sounds like you're meeting your current challenges well. I think it is important to continue to relax, whether through yoga or the tape. You need to try to make new friends and keep up with the medication. Keep your fitness level up. Are you eating right?
Ms. Tanner: Yes.
Dr. Balis: That's important. I noticed you lost some weight. Doctors recommend not more than one or two pounds per week of weight loss, though.
Ms. Tanner: I've only lost twelve pounds since November. I'm not dieting, but I like the way I look, so I just don't get carried away anymore. I can say one thing for Gram--she's a great cook.
Dr. Balis: Good. We're out of time. Let's end this session with the hopes of not canceling another, okay? Our next one will be April 10th. Is that during your break?
Ms. Tanner: Yes, but it won't be a problem. I'll be here.
Dr. Balis: I will see you then. Goodbye, Rachel.
Ms. Tanner: Goodbye, Doctor Balis.
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