Transcript of 14th Session between Charles Balis, M.D. and Ms. Rachel Tanner, Friday, July 10, 1998 at 3:00 pm.

Ms. Tanner: What's up, Doc?
Dr. Balis: Hello, Rachel.
Ms. Tanner: Aren't I supposed to have a carrot in my mouth when I ask that?
Dr. Balis: Funny. I'm glad you're in such a good mood. How's school?
Ms. Tanner: It's a lot more relaxing because it's summer session. Guess what?
Dr. Balis: I'm not very good at guessing.
Ms. Tanner: It's just an expression. Anyway, I went swimming in the college pool.
Dr. Balis: Great! How did that go for you?
Ms. Tanner: It took a lot out of me just to get to the edge of the pool. Hell, just being in the locker room was a big step. I went to the noon swim--a time when mostly staff goes. I practically had the whole pool to myself. I did see Carla there.
Dr. Balis: I think you mentioned her last session...
Ms. Tanner: She was my former anthropology teacher. Now she's teaching my Human Sexuality class.
Dr. Balis: Hmm.
Ms. Tanner: When I saw her swimming, it got me motivated to get in. I mean what was I going to do--have a panic attack, turn around and retreat? I did my half mile, no problem. Once I got into the rhythm, it felt a lot like it does at home. Lap after lap. Pretty monotonous, but it gets me centered. That and yoga.
Dr. Balis: So it went well.
Ms. Tanner: Yes...
Dr. Balis: Yes, what?
Ms. Tanner: The showers were kind of gross. Someone's bathing suit was on the floor, and there were empty shampoo bottles and trash here and there. I kept my flip flops on while I showered. Once I got the water temperature nice and hot, I didn't worry as much. Plus, I brought my own soap. The other weird thing was that there were people in there.
Dr. Balis: Of course.
Ms. Tanner: How many people do you shower with, Doctor Balis?
Dr. Balis: Weren't there a few private showers?
Ms. Tanner: I didn't see them until I was already wet. Maybe next time. I'm just not sure I want people checking me out.
Dr. Balis: Rachel, women will usually not be too interested in staring at you. They don't like being stared at either. Well, at least that's how it tends to go in men's locker rooms.
Ms. Tanner: I never thought about that.
Dr. Balis: Did you see anyone looking at you?
Ms. Tanner: As a matter of fact, I did.
Dr. Balis: How did it make you feel?
Ms. Tanner: Self conscious. She was dressed and I wasn't. I thought she was doing her hair or something at the big mirror. But when I glanced in her direction, she was watching me.
Dr. Balis: Staring? Glancing? Watching? Which was it?
Ms. Tanner: I think she's got an eyeful. She smiled at me in a way that gave me chills.
Dr. Balis: Was it a come on?
Ms. Tanner: What's that? Do you mean was it like she wanted me or something?
Dr. Balis: What was your impression?
Ms. Tanner: Maybe. It was Carla.
Dr. Balis: The woman looking at you was Carla?
Ms. Tanner: Yes. I guess she studies sexuality in and out of class.
Dr. Balis: Hmm.
Ms. Tanner: Maybe she was doing research. I can tell she really enjoys discussing sex...I mean sexuality. I think she likes making people squirm as she talks about certain things. In the shower, she had the same kind of twinkle as she often has in the classroom.
Dr. Balis: Would you say she's playful?
Ms. Tanner: I guess that's the best word for it. Maybe mischievous.
Dr. Balis: Have you been to her class since the shower incident?
Ms. Tanner: No, the class meets Mondays and Wednesdays and...
Dr. Balis: Are you going to do anything about it?
Ms. Tanner: Nothing. I'll pretend like it never happened. I'll give her the benefit of the doubt. Maybe she was looking at the clock; maybe she was staring at my tits. I'll try not to think about it.
Dr. Balis: Hmm. Do you have any more public restroom stories to tell?
Ms. Tanner: No. I found a sanctuary--I use the staff bathroom between my two classes, and I watch what and when I drink.
Dr. Balis: So you're controlling your bladder. Sounds like you've figured out a way of avoiding the problem.
Ms. Tanner: Isn't that what we discussed?
Dr. Balis: Not exactly. Your OCD is still controlling you. What happens next time you find yourself in a public restroom that smells like urine?
Ms. Tanner: I can hold it, or I can find another one.
Dr. Balis: Yes, but you're avoiding the issue by running away from it. What do you think a person in control of the situation would do?
Ms. Tanner: Tell it who's boss.
Dr. Balis: For example?
Ms. Tanner: They'd use the restroom anyway. I guess I can breathe through my mouth so I don't have to smell it. I can flush the toilet before I using it. And I'll never sit on the seat.
Dr. Balis: You know just the right things to say. Do you think you can do these things next time?
Ms. Tanner: Normal people avoid things that are unpleasant. Why can't I?
Dr. Balis: You can. However, this bathroom thing represents a much larger issue for you. If you can take some of the energy away from it by plowing through it, you'll be able to apply that energy to more important things. Do it for practice--to get yourself ready for the bigger battles.
Ms. Tanner: I don't see any big battles coming my way.
Dr. Balis: I do.
Ms. Tanner: Like what?
Dr. Balis: Well, a few things come to mind. Let's see, didn't you say that your grandmother is going to leave for two weeks this Summer? You will be completely on your own while she's gone. Also, some day, you may want to get intimate with someone. Contamination issues will probably arise in relation to sex.
Ms. Tanner: Yes, but...
Dr. Balis: Then have you ever thought of learning to drive a car? That would give you a considerable amount of freedom...
Ms. Tanner: And keep me away from a host of unpleasant situations involving gross public transit riders.
Dr. Balis: Yes, well. And what about work? Won't you be looking for a job eventually?
Ms. Tanner: I guess...
Dr. Balis: These are only a few of the things you'll need to confront in the not too distant future. And there are others...
Ms. Tanner: Why are you doing this to me, Doctor?
Dr. Balis: A few sessions ago, you painted a charming picture of your future that included finishing school, working, and being with a man. I'll be reminding you of those goals over and over. Rachel, try not to avoid things that make you uncomfortable. Divide and conquer is a key to overcoming some of the handicaps of OCD.
Ms. Tanner: Okay, okay. Point taken.
Dr. Balis: Here you are. I really didn't mean to make you cry.
Ms. Tanner: You make me feel like a little kid, so sometimes I cry like a little kid.
Dr. Balis: I'm sorry, Rachel. Why don't we try an exercise? There is a bathroom just a few doors down the hall. It's really only my patients and I that have access to it. Why don't you...
Ms. Tanner: It must be so amusing to you to play Doctor...
Dr. Balis: Rachel, I think...
Ms. Tanner: You're wrong.
Dr. Balis: Do you remember when you were proofreading and editing until the middle of the night and you still couldn't let go? So we tried a little spontaneous exercise--you wrote a note to your brother and we walked together to the mailbox and sent it off without any corrections. Remember?
Ms. Tanner: Yes, I remember. It made me very uncomfortable.
Dr. Balis: This is the same technique. It's called exposure. It's a legitimate exercise. I sincerely apologize if I'm making you feel uncomfortable.
Ms. Tanner: Uncomfortable?
Dr. Balis: I'm sorry you're so upset, Rachel. Some of what I do as a therapist does smack of manipulation. It's like teachers who use rewards or negative consequences to change student's behavior. It's psychology. Sometimes it works.
Ms. Tanner: Some of what you've done--these little exercises--have helped. But I don't see these...these exercises as anything more than just games. I've got to go, Doctor.
Dr. Balis: I don't want to end the session like this.
Ms. Tanner: Well, I don't feel like giving you another manicure, if that's what you're thinking.
Dr. Balis: I was thinking of showing you a web site I found a few weeks ago. I think you might find it interesting.
Ms. Tanner: This had better not be...
Dr. Balis: I had this bookmarked because I've been meaning to show it to you. It's an OCD message board. It's not a chat room, but there are quite a few regulars. Here. Take my chair. The list of posts is in chronological order. Just read through a few of these messages to see how others are dealing with OCD.
Ms. Tanner: It's interesting, I guess. How come you never prescribed Anafranil or Zoloft for me? There seems to be quite a few posts about these drugs.
Dr. Balis: Well, although they have differences, Zoloft, Anafranil, and Prozac are all serotonin reuptake inhibitors, so they're actually quite similar drugs. In my evaluation, I concluded that Prozac was a better choice for you than the others, although either may have also been an effective choice. Although Anafranil is an excellent drug for treating OCD, I think of it as a second line option because of its small, but significant chance of causing grand mal seizures. Anafranil is an interesting drug because it was being used in Europe in the sixties and seventies but wasn't approved in the U.S. until 1990 or so because of its potential to cause seizures in about 1% of the people who take it. If you hadn't responded to the Prozac, though, I certainly would have considered moving to Anafranil. There're are other serotonin reuptake inhibitors, too, that work well for compulsive disorders--Luvox, for example. But each drug has its problems. Prozac seems to have worked quite well for you with no side effects that I'm aware of. What you're currently experiencing with public restrooms and the like is the difficulty of making behavioral changes. Your OCD doesn't have the grip on you which it had before. It makes you much more independent and in control than you were before. But I'm droning on and on. Let me write down the address of this site for you in case you want to find it again.
Ms. Tanner: Thanks. Doctor?
Dr. Balis: Yes?
Ms. Tanner: I'm sorry I blew up like that. I don't really know why my reaction was so strong.
Dr. Balis: It's all right. You're allowed, once in a while.
Ms. Tanner: Thank you.
Dr. Balis: Well, our time is up. Take care, Rachel. I'll see you at the end of the month? Let's see, that'll be July 24th at 3 pm.
Ms. Tanner: Yes, that's fine. I'll let you know how living solo is going.
Dr. Balis: Good. Goodbye, Rachel.
Ms. Tanner: Goodbye, Doctor Balis.
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

TCT Bottom Bar Links to Top of Page Pipsqueak Productions © 1998. All Rights Reserved.