Transcript of 3rd Session between Charles Balis, M.D. and Ms. Rachel Tanner, Tuesday, October 21, 1997 at 1:00 pm.

Dr. Balis: Hello, Rachel. How are you?
Ms. Tanner: Not that great, Doctor. I lost my job.
Dr. Balis: I'm sorry. What happened?
Ms. Tanner: In September, my hours were cut back. That was when Doria, my boss, told me she might have to let me go, period. I think I shocked her, because I started crying right there in the shop. So she backed off a little and told me to just come in six hours a week for awhile. Well, I've been coming in on Mondays and Wednesdays in the afternoon, but my clientele has been dropping off. To make things worse, when things get slow at the shop, I have to help clean the place up. But Doria doesn't make me sweep dead hair or anything, thank God. I just clean up the retail stuff, move products off the shelves, wipe the counters off--you know, jerk work. But you know what's weird? I checked the calendar and guess what? Monica's doing most of my people now--they're right there in the books. I'm down to four people when I used to have at least two dozen regulars. Doria has been scheduling my customers with Monica instead of me! I've been a nervous wreck ever since September, because I thought I was going to get canned. All that sweat for nothing--she fired me anyway!
Dr. Balis: Why do you think Doria fired you? Any idea?
Ms. Tanner: I don't really fit in. All the other beauticians do hair and waxing and permanent make-up. I just do nails. And my hair doesn't look that great most of the time, so maybe she doesn't like my image. She's offered many times to give me a discount or a trade to do my hair, but as it is, I can hardly stand to be in the shop with all the chemicals and stuff floating around. Anyway, I didn't want her to see know, bald spots.
Dr. Balis: I see. Sounds like you weren't particularly happy working there.
Ms. Tanner: I wasn't that happy there. I felt like a stranger more and more. Since I stopped driving, it also became an inconvenience. I guess I can think of a lot of reasons why it wasn't that great a job.
Dr. Balis: Your grandmother mentioned that you had once enrolled at the junior college, but later quit. Have you considered going back to school?
Ms. Tanner: I don't know, Doctor Balis.
Dr. Balis: It's certainly an option. And you might discover something that you really enjoy doing...a new profession.
Ms. Tanner: Maybe so.
Dr. Balis: Your grandmother said that you were a very dedicated student. Your family was proud of your grades.
Ms. Tanner: Compared to my brother's grades, yes.
Dr. Balis: You have to give yourself some credit, Rachel. And you've been open to my other suggestions in the past. It surprises me to hear you shut these doors so quickly now.
Ms. Tanner: I'm kind of joking, but kind of not. I'm bummed about losing my job, but I'm not sure I'm ready to hit the books just yet, that's all. Can I change the subject?
Dr. Balis: Go ahead.
Ms. Tanner: I've been writing in my journal every day. It gives me something to do instead of nervous things.
Dr. Balis: Excellent. I've noticed your nose has healed.
Ms. Tanner: Yeah. And I tried the relaxation tape twice. I like side two with the longer exercises. They go for about twenty minutes.
Dr. Balis: Are you able to relax? The goal was to try to keep your hands still for a prescribed amount of time.
Ms. Tanner: Sometimes, I get lost in the meditation--I don't really know what I've been doing until it's over. I lie on the floor and I feel great. I don't think about anything except what Sylvia tells me.
Dr. Balis: Sylvia?
Ms. Tanner: The woman who speaks on the tape. Her name is Sylvia.
Dr. Balis: Oh, right. Are you sleeping any better?
Ms. Tanner: Not really. I think about the stupid job a lot. I think about Gram and my mom. I think about my brother and what might happen to him. I think about you.
Dr. Balis: You've mentioned your brother before. Can you tell me a bit more about him?
Ms. Tanner: Michael is two years younger than me. He now lives in Sausalito with his friends because Gram kicked him out. He managed to pass the G.E.D. last month. He's one of those kids who is really smart but unmotivated. He waits tables and rides his mountain bike. He's cool.
Dr. Balis: Why do you worry about him?
Ms. Tanner: Because he's kind of a druggie. Sometimes, I think he's too smart to let anything stupid happen to him. But then, I know how drugs can mess you up. It scares me. I do what I can to help him.
Dr. Balis: What do you mean?
Ms. Tanner: Here we go again. This is hard for me.
Dr. Balis: I can see that. Tell me what you can. I'm here to help you.
Ms. Tanner: Well, remember I said that I count things? Whenever I climb the stairs, I count. There are thirteen steps in my house, and that's an unlucky number. So I have to take two giant steps from the top of the stairs to reach my bedroom--that makes fifteen. If I have to go to the bathroom, that's two steps in the other direction--that's still cool. But when I have to take something to Gram's bedroom, or walk down to the hall closet, or to Michael's old room I get screwed up. If my steps don't end with a multiple of five, I feel like it will end up in bad news. I mean, bad news for Michael.
Dr. Balis: Have you ever noticed a connection between a wrong number of steps and something bad happening to Michael?
Ms. Tanner: Hmm, I'm trying to think. Um, I don't know. Bad stuff is always happening to him. His bike got ripped off, he cut his hand at work on one of the glass table-tops, his hard drive crashed. But I don't think it had anything to do with what I did. I just don't want something really bad to happen to him.
Dr. Balis: So you feel like you can guard against bad things by carefully counting your steps and making sure that you always stop on a multiple of five.
Ms. Tanner: I guess so.
Dr. Balis: You don't sound so sure.
Ms. Tanner: It sounds kind of lame. Hmm?
Dr. Balis: I'm glad you think so.
Ms. Tanner: Yeah.
Dr. Balis: Why don't we do a little exercise? I have a tape player right here. I want you, in your own voice, to say: "If I carefully count my steps and make sure I stop on a multiple of five, then Michael will be safe." We will record it and play it.
Ms. Tanner: You want me to hear just how ridiculous I sound, right?
Dr. Balis: I think that might be a good idea.
Ms. Tanner: Okay. I'll try it.
Dr. Balis: I'm going to start the tape to give it a lead, and I'll give you the thumb's up to begin speaking. Say the sentence about five time. Ready? Go.
Ms. Tanner: If I carefully count my steps and make sure I stop on a multiple of five, then Michael will be safe. If I carefully count my steps and make sure I stop on a multiple of five, then Michael will be safe. If I carefully count my steps and make sure I stop on a multiple of five, then Michael will be safe. If I carefully count my steps and make sure I stop on a multiple of five, then Michael will be safe. If I carefully count my steps and make sure I stop on a multiple of five, then Michael will be safe.
Dr. Balis: Very good. Here's your tape. Try listening to it a couple of times a day. Listen to the whole message each time. You can even make a tally marks on the tape box itself for each time you listen if you want to keep track.
Ms. Tanner: Okay. I'll try it.
Dr. Balis: Hopefully after listening to yourself a number of times, you'd internalize just how illogical this obsession is and you'll be able to disassociate Michael's well-being from the ritual. The number of steps you take have nothing to do with Michael, and you know it. Now, you have to reprogram your brain to believe it. Your OCD is like a rocking chair--it moves, but it doesn't get you anywhere. Counting your steps is like that. But I'm not asking you to abandon the counting ritual right now. I just want you to feel freed from the responsibility and burden that this obsession places on you.
Ms. Tanner: That would be nice.
Dr. Balis: Okay then. For the next two weeks, I want you to continue the relaxation exercises, concentrating on keeping your hands still. I would also like you to listen to the tape we made today. I'm glad you're writing your journal, and I hope you will continue. I would also like you to start keeping track of your sleep--note in the journal if you had a good night's sleep or not, how long it took to get to sleep, and if you remember any dreams jot those down, too. Any questions?
Ms. Tanner: You're cool, Doctor Balis.
Dr. Balis: Thank you. See you in fourteen days. Or should we make it fifteen?
Ms. Tanner: Funny.
Dr. Balis: Goodbye, Rachel. Wait. Actually, I have a conflict at this time. Can we make it 3 o'clock instead?
Ms. Tanner: Sure, now that I'm unemployed...actually 3 is better because that's really 15 o'clock. Have a good week, Doctor.
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