Transcript of 11th Session between Charles Balis, M.D. and Ms. Rachel Tanner, Friday, April 24, 1998 at 3:00 pm.

Dr. Balis: Come in, Rachel.
Ms. Tanner: You moved things around.
Dr. Balis: Yes, I did a little spring cleaning. What do you think?
Ms. Tanner: Um. I can't sit in my regular spot now.
Dr. Balis: Does that make you uncomfortable?
Ms. Tanner: I'll get over it. Your desk is in the same place, but everything else has been moved around. What have your other patients said about it?
Dr. Balis: You are the first one to say anything. I did it late yesterday afternoon.
Ms. Tanner: I guess change can be good.
Dr. Balis: Speaking of change, how is school going? Your writing group?
Ms. Tanner: I had a lot of fun with that writing task--the gender bender I told you about. Want to read it?
Dr. Balis: Of course. But if you don't mind, I would rather read it later--I don't want to take time away from the session. Do you mind leaving it with me? I'll return it, of course.
Ms. Tanner: No, it's okay. I have copies that I made for the group.
Dr. Balis: Great, thanks.
Ms. Tanner: Anyway, I came out during the last meeting.
Dr. Balis: Came out?
Ms. Tanner: Yeah, about my OCD.
Dr. Balis: That is a big step. What were the circumstances?
Ms. Tanner: Well, it was in my writing. The rituals came through even though I was writing as a guy.
Dr. Balis: So you wrote as if you were an OCD male?
Ms. Tanner: Yes.
Dr. Balis: Are you still performing rituals?
Ms. Tanner: Doesn't everyone?
Dr. Balis: Yes, but...
Ms. Tanner: I just fictionalized a few that I thought a guy would go through--like shaking it after you pee. My brother says if you shake it more than four times, you're playing with it!
Dr. Balis: An interesting demarcation, but I want to backtrack a moment. You mentioned rituals, but I was under the impression that you had eliminated the repetition in most things, like grooming--that was one of your original OCD behaviors when I started seeing you. What is the status of your rituals now?
Ms. Tanner: I brush my hair about fifty strokes every morning and every night, but there isn't that feeling that it has to be done perfectly or I have to repeat it if I lose track of the number. Let's see, what else? I think I will always count the number of stairs as I climb. But now, I can just add whatever number of steps to it that will make fifteen in my head. Most steps are thirteen, like in people's houses. Have you ever noticed that?
Dr. Balis: No, but it's not surprising. The height of a second story is usually determined by building codes, and the height of each stair is usually consistent. So, you do still count, but you no longer feel the need to correct or redo.
Ms. Tanner: No. Besides, I can undo it with the north south east west thing.
Dr. Balis: Show me that one again?
Ms. Tanner: Like this. It's sort of like crossing yourself, I guess, but I'm not a Catholic. Am I bad?
Dr. Balis: No, Rachel. But like I said before, I'm concerned that you might be replacing one ritual with another, although the fact that you don't need to redo or spend an inordinate amount of time on a ritual is a good sign. Let's get back to your writing club. How was your OCD received?
Ms. Tanner: They were a lot like Evan, my brother's roommate. They just asked me a few questions. Everyone had seen "As Good As It Gets," so they wondered about a bit about the soap and the checking of the locks on the door. Roger--the older guy in the group--was the one who figured out that the guy in my story had OCD. I was pleased that he caught on. I was kind of testing the group by putting OCD behaviors into my character. Roger looked straight at me and asked if I had OCD, too. He was right on.
Dr. Balis: Hmm. I'm looking forward to reading the piece you wrote. By the way, did you think Jack Nicholson's character was a realistic portrayal?
Ms. Tanner: There is only so much a two hour movie can accomplish. But no, I didn't think he seemed like a true OCDer. We didn't really get to see him struggle with his illness before he was being asked to start changing. I can't imagine having a contamination thing and then letting a dog into my home, no matter what kind of favor I owed. Besides, did the director think that just putting a few bars of soap in the medicine chest is enough to convince us that he had OCD? Give me a break!
Dr. Balis: Hmm. Now, I didn't mean to get off the subject of you, but I was interested in your opinion. So, how does it feel now that you have let your group know about your OCD?
Ms. Tanner: Good, really. After the others had left, Mattie said that she had no idea--she couldn't really tell anything by my actions. We talked for another half hour about it. Mattie confessed she gets really weird about unplugging her toaster, her coffee pot, the iron. I pointed out what you just said about OCD--it's about how much time the rituals take and if they interfere with your life. I also mentioned medication. I think it's helping.
Dr. Balis: You don't sound so sure.
Ms. Tanner: I guess I thought that it would eliminate my symptoms all together, that they wouldn't return. But right after school started, I started resorting to my old habits, and it got really ugly again. Then I was able to push them away. Will it always be like this--coming on strong and then retreating?
Dr. Balis: I'm afraid so. But it's a reflection of the swings of life, the highs and the lows. Stress comes and goes. The key to your treatment, as I have said before, is the addition of therapy to the equation. Medication plus therapy equals recovery. Let me show you something. I have a book I want you to see. Look at this appendix page about the lifestyle changes the author recommends. See anything familiar?
Ms. Tanner: We have done all of them! Except maybe this one, number three.
Dr. Balis: Oh, I think you have been willing to express your feelings. Certainly with me you have. I'm still puzzled about your relationship with your grandmother, you don't speak of her much. I forgot--how did your brother's visit and that dinner go?
Ms. Tanner: Michael was his charming self. Everyone was having a good time. Evan and Michael have been roommates for three years now, and they are so funny together. At dinner, us kids kind of monopolized the conversation. The neighbors were cool about it, though. After the tour of the house, Michael and Evan went out to visit some friends. I was bummed because they didn't invite me. I was back to just sister status. It was weird because Evan looked shocked when Michael said I needed my beauty rest. I think he might have been disappointed. I heard them come back around midnight.
Dr. Balis: So they stayed the night at your house?
Ms. Tanner: Yes. It was a good thing too, because they were pretty blasted. One of them banged the bathroom door against the tub really loud. That was what woke me up. Then I decided to make my move.
Dr. Balis: What move?
Ms. Tanner: I was wearing this T-shirt with a slit up both sides. I went to the bathroom and kind of posed there hoping to get caught. And fortunately it was Evan, my target.
Dr. Balis: Hmm.
Ms. Tanner: He got another eyeful. It was pretty exciting.
Dr. Balis: How did he react?
Ms. Tanner: He exhaled and at the same time said, "Whoa." I'll never forget how he said it. Then he leaned against the wall in the hallway like he was falling. It took all I could muster to pass him on the way to my room. I surprised myself by looking back once I got to my door--he was still gaping at me. I said good night; so did he. That was it.
Dr. Balis: You were teasing him?
Ms. Tanner: Someone could look at it that way. I prefer to think of it as a lucky coincidence.
Dr. Balis: I must say, Rachel, that you are coming out in more ways than one. I cautioned you a couple of sessions ago about dressing to kill.
Ms. Tanner: Yeah.
Dr. Balis: Men are easily stimulated visually and, while I commend you on your self expression, you have to be prepared for a reaction. You deliberately tried to sexually excite this young man. Are you prepared for the possible consequences?
Ms. Tanner: Doctor, you sound like the father I never had. I appreciate it. You are the one who has helped me gain confidence. Please don't tell me to back off when I'm just getting started.
Dr. Balis: Well, you experimented at home, and that's fairly safe. One wrong move and you'd have had your grandmother and brother to the rescue. They won't always be around, however. Enough said.
Ms. Tanner: I enjoyed imagining what it would be like to be a guy in that paper I gave you.
Dr. Balis: Hmm. May I give you a writing assignment, too?
Ms. Tanner: Like what?
Dr. Balis: I'd like you to write one page about what life will be like once you have recovered from OCD. You wrote about how it would feel to be a man for a day. Now write about your near future, maybe one year from now. Write about what you will be doing. I think it will give me an idea of your goals, and help you visualize them for yourself.
Ms. Tanner: I'll try to squeeze it in. I might just write it in my journal. I've been writing more often, especially since I started in this writing group. A renewed hobby.
Dr. Balis: Sounds good. Rachel, I want you to know that in the six or so months I've known you, you have made incredible gains. Continue to be strong, but just be careful.
Ms. Tanner: Thanks, Doctor Balis. Goodbye.
Dr. Balis: Goodbye, Rachel.
Essay Delivered During a Session by Rachel Tanner, 04/24/98 Essay Delivered During a Session by Rachel Tanner, 04/24/98

Transcript of Essay Delivered During a Session by Rachel Tanner, 04/24/98

Oh man, I was just dreaming that I was Cheryl Crow's bodyguard, except that she shoved this guy out of the way and pretty much saved my ass instead. Then there was this obligatory kiss, and it might have gone farther, but I woke up to the KGO traffic report. Bummer. Time to take a leak, except that...wait a minute!! What's up with the new equipment? Whoa! I'm a dude!

Hey, this is cool. I can stand up for a change. God, I don't know how these guys do it-there's so much in the way, but what a relief! Now it's time to shake it. How much is enough? Woops. I guess I'm like most of the others, dribbling here and there but especially on the rug that was just washed and placed here. And, I have to be sure to leave the seat up!

Wash my hands. That's the same as ever. Soap in right hand. Run the hot water until it's really hot, mix in the cold. Dip the soap in, then turn it in my palm five times, put the soap back in the dish, rub palms back and forth ten times, five times right hand over left, five times left over the back of my right hand, right, left, right, left, right. Rinse left, right, left, right, left. Always turn the hot off first. Screw up and start over. Damn!

Ten minutes later, on to shaving. Or maybe I should grow a beard, now that I can. Is this going to last a day or forever? How about leaving stubble and enjoying the rough, outdoorsy look? The bushy eyebrows have to go. No, wait. Can't pluck any more. Maybe just a couple strays. Who would ever know? Got to find five, though. Ooh, check out the nose hairs! Which reminds me...check out the ears, too. Guess I'm going to be busy for awhile. I'll be sure to leave a few hairs in the sink for the world to see how virile I am.

Do I mousse? Do I trim the 'burns? Where should the part be? Getting kind of thin on top. Just wet it down and comb it through. One, two, three, four, five over the right side with the fine side of the comb. Five on the left. Turn the comb around. Five more on the left, five more on the right. Back top, straight down, then fluff with the left hand. Try it once more. Good enough. I don't have time for this! I'm hungry!

I have a craving for some serious carne. Pork is best. Maybe a Denver with plenty of ham chunks. Douse it with hot sauce to make me feel like a man. I don't care if I burp thru my laps at the park later, or ruin my breath. They can kiss my...

I think I'm going to like this guy stuff. I feel mean all of a sudden, like taking something that isn't mine, driving fast, kicking some leather, yelling at traffic, spitting, flipping someone off. It's the testosterone talking.
Arrow, Straight, Left, Earlier Arrow, Straight, Right, Later

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

Button to Rachel Tanner's Transcripts Transcripts of Rachel Tanner's Communications
Button to Rachel Tanner's Patient File Rachel Tanner's Patient File

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