Transcript of 13th Session between Charles Balis, M.D. and Ms. Rachel Tanner, Friday, June 19, 1998 at 3:00 pm.

Dr. Balis: Good to see you, Rachel.
Ms. Tanner: You too, Doctor Balis.
Dr. Balis: Is school over yet?
Ms. Tanner: Yes, thank God. I just finished a paper for my anthropology class. Better late than never!
Dr. Balis: Yes, I thought the semester would have ended by now.
Ms. Tanner: It did. She let me sneak it in late. I had shown her the first half of it and she gave me a reprieve and an A. Cool, huh?
Dr. Balis: How fortunate for you. You must have had a rapport with the instructor.
Ms. Tanner: Carla is really nice. And her class has been fascinating, especially the way she teaches it. We read "The Naked Ape" by Desmond Morris. Have you ever heard of it?
Dr. Balis: Yes. But I think it was over twenty years ago.
Ms. Tanner: For two weeks, instead of meeting in a stale building, we sat in the quad outside and discussed it, section by section. She has a way of pursuing opinions that really makes you hang your butt out on the line. The conversation got pretty heated up every once in a while. It's sexy stuff, don't you think?
Dr. Balis: To be truthful, I don't recall. So you befriended the instructor?
Ms. Tanner: I guess you could say that. I'll probably have her again this summer for Human Sexuality. It's a required class. I'm taking it easy this semester with only nine units. Journalism, Art and the sex class. Also, I'm going to try swimming at the school pool.
Dr. Balis: What prompted that idea?
Ms. Tanner: I want to see how I do with the contamination thing.
Dr. Balis: You haven't had any incidents with that for awhile, have you?
Ms. Tanner: Not about swimming. Something new came up that I haven't told you about.
Dr. Balis: Go ahead.
Ms. Tanner: Well, I went into the bathroom at school and someone hadn't flushed. It was only urine, but just the look of the pale yellow water in the toilet bowl and the smell of someone else's pee made me dizzy. I thought, if I can smell it, then some of the molecules must have entered me. It's in me! I think I actually moaned out loud, because this woman looked at me really funny when I blasted out of there. I washed my hands and face and used tons of paper to dry off. Then I went into the hallway, found a drinking fountain and rinsed my mouth out. When I thought it was rinsed enough I drank about a quart of water. I still hadn't peed at this point.
Dr. Balis: Would you describe this episode as a panic attack?
Ms. Tanner: Oh, I was panicked all right.
Dr. Balis: Then what happened?
Ms. Tanner: I remembered where a staff bathroom was and eased my way past some of the faculty offices without being detected. What a relief! I know the issue will come up again. How do I get past it?
Dr. Balis: What is your fear based on?
Ms. Tanner: I don't think of it as fear, exactly. I don't ever sit on a public toilet when I pee. My mom taught me to squat above the seat. You have to have strong quads to do it, and it took practice to get it right. I don't like smelling it--even my own. I certainly don't want to see someone else's, unflushed, in a public bathroom. I don't want any chance of it splashing on me.
Dr. Balis: By using public restrooms, you'll always run the risk of seeing or smelling someone else's urine. Let's work on this right now. Let's brainstorm some ways to keep the panic at bay. I'm thinking that you might find restrooms that are less used, not necessarily staff bathrooms, but perhaps one in a less popular building.
Ms. Tanner: That's an idea. I'm not going to the extremes of wearing diapers or not drinking liquids.
Dr. Balis: Should we discuss the biology of urine? It's basically sterile, you know. There are no diseases transmitted through urine from toilet seats. It sounds like you modify your use of public facilities so that there is no contact. I'm concerned that you felt you could absorb contaminated airborne particles. We're talking parts per million in which there could be no impact on your system other than a detectable odor. Having said all that, what other concerns do you still have?
Ms. Tanner: I just never know when or where this OCD is going to take me. I don't like surprises. I mean, obviously I've had this thing about toilets thanks to my mother, but to have such a reaction was kind of out of the ordinary. I go along feeling good about myself and then it slaps me in the face and says, "Take that!"
Dr. Balis: I see it as twenty steps forward, one step back, in your case. Every day, every week, we all have conflicts that arise and then get resolved, over and over. I suppose it makes life more interesting to have highs and lows. I am not minimizing your struggle, Rachel. I think, at times, you will have to work at slapping your OCD into submission. Self talk is your best ally.
Ms. Tanner: What do I tell myself? That it's not urine, it's jasmine I smell?
Dr. Balis: I don't mean denial. If logic is ineffective, turn to the recognition that it's your OCD talking. It's an unreasonable little brat, Rachel. Talk it down, scold it, send it to its room if that analogy works for you.
Ms. Tanner: I've had practice at being a mom. That should work. I could get into spanking!
Dr. Balis: It's important to use these episodes as a learning tool, although I hesitate to call them episodes. They really don't come up that often, unless you aren't telling me everything.
Ms. Tanner: I don't share every little detail, every little moment of self doubt. But this one was a biggie. I'll know how to handle the next one when it happens.
Dr. Balis: You mentioned that you want to start swimming at the school. I'm sure the same issue will come up again. You'll get more practice at letting it know who is boss--or mom.
Ms. Tanner: Right.
Dr. Balis: Any plans for the summer?
Ms. Tanner: Just school. I want to go up and visit my brother again. Evan has been quite communicative via e-mail. Carla has a "Thank God It's Over" party coming up that I might go to.
Dr. Balis: Carla, your instructor?
Ms. Tanner: Yes. Oh! Gram is going to Germany for two weeks in late July. I haven't ever had the place to myself so that should be interesting.
Dr. Balis: Rachel, is there anything else you'd like to discuss? We still have some time.
Ms. Tanner: Not really. I could give you a manicure.
Dr. Balis: Are you still doing that?
Ms. Tanner: Of course! Don't you notice my nails?
Dr. Balis: Well, I mean, I knew you did your own. I...
Ms. Tanner: Come on, Doctor. I have files, clippers. I just need a towel, these tissues, and some warm soapy water. Try it!
Dr. Balis: Well...why not? I'll be right back.
Ms. Tanner: Cool!
Dr. Balis: Did I forget anything?
Ms. Tanner: This is fine. Maybe you should scoot over to this edge of the desk. Just rest one hand in the bowl for a minute to soften up the cuticles. Any problem areas?
Dr. Balis: I pulled at this hangnail yesterday and I keep worrying it. You might want to go easy on it.
Ms. Tanner: Do you prefer a certain nail length?
Dr. Balis: No. I'll trust you to decide.
Ms. Tanner: Actually, I'll skip the trimming, since we don't have much time. I'll just file a little once I push these cuticles back.
Dr. Balis: I didn't realize how relaxing this would be.
Ms. Tanner: Dr. Balis, are you a virgin?
Dr. Balis: Excuse me? Oh! Yes, this is my first manicure.
Ms. Tanner: It's like getting a massage or a haircut. Any time you let someone work on you, as long as you trust them, it can be quite soothing. Morris brings up the grooming ritual thing in that book I was telling you about. It's a primitive need. You can start soaking that other hand now. Do you have any lotion?
Dr. Balis: I think there's some right here. Yes.
Ms. Tanner: I can tell you have a desk job. Your hands are so soft. You have another session coming up?
Dr. Balis: No, not immediately, but I think that we should probably wrap this up pretty soon.
Ms. Tanner: I have to do your other hand. I'll be quick. It's amazing how it all comes back to me, even though it's been awhile since I worked officially. Hey, I could give you a manicure while we do our sessions!
Dr. Balis: I don't think that's a good idea.
Ms. Tanner: Mind if I ask why not?
Dr. Balis: It's a bit distracting. I would rather focus my complete attention on you and our discussion, wouldn't you?
Ms. Tanner: I see your point. I don't really care. If we ever have extra time again, I'd be happy to work on you.
Dr. Balis: I appreciate the thought.
Ms. Tanner: Just let me lotion you up and we'll be done. You don't look so relaxed any more.
Dr. Balis: It doesn't feel professional.
Ms. Tanner: I'm a pro, don't you doubt it, Doctor.
Dr. Balis: Not you, me. I'm not sure it is appropriate.
Ms. Tanner: It's a different kind of hand job. I wouldn't worry about it.
Dr. Balis: I...I'll see you in two weeks, then?
Ms. Tanner: Same time, same place. Take care, Doctor Balis.
Dr. Balis: Thank you, Rachel.
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