Transcript of 18th Session between Charles Balis, M.D. and Ms. Rachel Tanner, Friday, October 16, 1998 at 3:00 pm.

Ms. Tanner: Hello, Doctor Balis.
Dr. Balis: Rachel! How are you feeling?
Ms. Tanner: Better, I guess. I look awful, I know.
Dr. Balis: You don't look well. Have you seen a doctor?
Ms. Tanner: Yes. I've got all kinds of lotions and potions to fix me up.
Dr. Balis: What have you been prescribed?
Ms. Tanner: Let's see. I got Kenalog for my cold sores, some kind of steroid cream for my psoriasis, Prozac, of course, and antibiotics for the sinus infection. It seems like when the weather changed, my body freaked. It's still protesting. I might have to make this session short, Doctor Balis.
Dr. Balis: Let's just catch up a little, then we'll let you get back home to bed. How does that sound?
Ms. Tanner: Good.
Dr. Balis: So, you had a cold, and now it turned into a sinus infection?
Ms. Tanner: Yes. Allergies are a late development in my life, lucky me. At first, I thought the sore throat was just drainage, but then it turned into a full blown cold. I missed a couple days of school. Then I got the cold sores, then the sinus thing. I'm tired, but I've been hanging in with the school stuff. I'm only taking six units this time around, thank god!
Dr. Balis: Tell me about the psoriasis.
Ms. Tanner: Oh, that. Well, off and on for years, I've had bouts with it. When I was about twelve, I had to wear these gloves at night while my hands were lathered up with cream. My nails almost fell out. This isn't so bad. Just in time for Halloween, huh?
Dr. Balis: Sometimes, psoriasis crops up due to stress. Do you feel like you have more demands on you than usual?
Ms. Tanner: I think I told you that my grandma and I hadn't been getting along that well lately. She's been really sweet since I got sick, but before that, we got into a few yelling matches. She thinks I'm spoiled and ungrateful. She's right. I know she wants to move back to Germany, and I'm keeping her from it. She's restless, and I'm needy. She's kind of stuck until I get my act together.
Dr. Balis: And, of course, there's your school.
Ms. Tanner: Yeah.
Dr. Balis: How is your semester going?
Ms. Tanner: So so. I feel kind of out of it. I'm taking a poetry class, that's the best. It starts first thing in the morning. The teacher is young, and energetic, and romantic. He makes it fun. Then I have a biology class. It's one of those huge lecture classes. And then there's lab two days a week. That's about all I can handle right now.
Dr. Balis: Are you keeping up with the homework?
Ms. Tanner: Of course. Did I tell you that I have a 3.6 grade point average?
Dr. Balis: No. That's great, Rachel.
Ms. Tanner: Actually, I got all A's. I wasn't as successful a couple years ago, so my old C's brought the average down.
Dr. Balis: I'm glad you stayed with school. I think you're a person who likes to learn, and you do better when you're involved.
Ms. Tanner: I do; I am. I have felt out of it for so long. School gives me a way to enter the real world again.
Dr. Balis: Some people go to school to escape the real world.
Ms. Tanner: Well, it's more real than the rest of my life has ever been.
Dr. Balis: Yes, it's good for you. Keep up the good work, Rachel. Now, according to my notes, you were going to try to reduce the hair pulling.
Ms. Tanner: I armed myself with toys, like you suggested. I had no idea there were so many feelies on the market.
Dr. Balis: "Feelies?"
Ms. Tanner: That's what I call them. It seems their only purpose is to provide people like me with something to do with our hands. It was fun shopping. I can't say I manipulate them that much. My hands are suffering again, as you've probably noticed. They are a mess.
Dr. Balis: I can remember your hands were so well manicured at one point. Can you turn this fidgeting into something more positive? Instead of picking at the nails and skin, can you nurture your hands?
Ms. Tanner: I wish I could just leave them alone altogether. I even dream about my hands. I can see them, just in front of me, typing on the keyboard, writing, wringing something out, dialing, pointing. I bet they twitch all night long. It's like they never get to rest!
Dr. Balis: And the hair pulling?
Ms. Tanner: I'm still doing it. For about two days after our last session, I caught myself each time I did it. I even wrote down what I had been thinking just prior to the act, but it didn't last. God! I'm always picking at myself! I wish I could just stop!
Dr. Balis: Rachel, you've been struggling for a while now, and I see additional manifestations of your OCD that concern me. I think I would like to increase your dosage of Prozac. What do you think?
Ms. Tanner: Really?
Dr. Balis: In fact, I would like to try doubling your dosage to forty milligrams a day. It will be a year in November since you've started taking Prozac. And it's not uncommon to adjust the dosage periodically. I think it might take a certain edge off, perhaps even reduce some of your anxiety. I would also like, with your permission, to speak with your regular physician. I'd like to coordinate our efforts so that we could both work on helping you. My concern is mainly with the psoriasis. I want to make sure that our treatments are compatible. Would you object?
Ms. Tanner: Not at all. His name is Doctor Malcolm. Gram can get you his phone number. Should I expect to feel different because of the increased amount of Prozac?
Dr. Balis: In general, Prozac can cause sleeplessness, sometimes headaches and weight loss. But you've responded so well to it, that I don't anticipate any adverse effects.
Ms. Tanner: I'll try it. Will it help me feel less agitated?
Dr. Balis: Is that how you feel now?
Ms. Tanner: Yes. It's like I'm itching from the inside out. And it's not just physical, it's a mental itch, too. I want to act on my ideas, but I keep holding myself back. I'm ready, but not quite ready. I'm very restless, Doctor.
Dr. Balis: I see. Yes, this should help. Technically, it should suppress intrusive urges. But you'll have to be more diligent about therapy, Rachel. Medication alone won't give you relief.
Ms. Tanner: To tell you the truth, I'm already relieved a little. I'm not so good at hiding my OCD these days. You've helped give me the courage to push onward, but sometimes, I look at myself in the mirror, and I can't believe I'm going out in public--scarf on my hair, cream on my hands, rabbit's foot dangling from my backpack, my grandmother driving me to school. What a nerd!
Dr. Balis: Rachel, I know you have moments when you feel powerful, and brave, and on top of things. Remember that Rachel Tanner when you feel weak. Try, okay?
Ms. Tanner: Yes. Is this a good time to end the session, Doctor?
Dr. Balis: Yes. We can end here.
Ms. Tanner: Good. I'm tired, and Gram is probably sick of waiting for me.
Dr. Balis: Well, our next session will be two weeks from now, on October 30th, okay?
Ms. Tanner: Sounds good. Thanks, Doctor Balis.
Dr. Balis: You're welcome. Goodbye, Rachel, take care yourself.
Ms. Tanner: Goodbye.
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