Transcript of 5th Session between Charles Balis, M.D. and Ms. Rachel Tanner, Tuesday, November 18, 1997 at 3:00 pm.

Dr. Balis: Hello, Rachel. Have a seat.
Ms. Tanner: Thanks, Doctor Balis.
Dr. Balis: Did you start taking the medication?
Ms. Tanner: Yes, I started on Wednesday, a week and a half ago.
Dr. Balis: How do you feel?
Ms. Tanner: I definitely feel the drug. It reminds me of those twelve hour cold medicines--you don't really feel bad, just kind of nervous. And you have to swallow a lot. I don't know. My senses are heightened, like I see and hear more clearly or something.
Dr. Balis: Are these feelings unpleasant to you?
Ms. Tanner: Not really. I feel like I have a lot of energy, and swimming has been fantastic even in the rain. I've still been restless at night, but that's nothing new. Oh, and my journal! Look at all I've been writing!
Dr. Balis: Good, Rachel. Do you want me to read this?
Ms. Tanner: Well, that's not why I brought it. I take it with me all the time now, wherever I go. I've been writing a lot. I'm going to need a new one pretty soon.
Dr. Balis: What do you write about?
Ms. Tanner: How I feel. Things that happen regarding my OCD. Like the other day when Michael, my brother, e-mailed me, he told me that he got a staff infection. And I was going, "Whoa, is it because of something I did or didn't do?" So I wrote a bunch of maybes. Here, I'll find them. Okay. "Maybe I should never have stopped counting the stairs. Maybe I should just forget the way I arrange my stuff on the dresser. Maybe it doesn't make any difference what I do sixty miles away from my brother." It goes on like that.
Dr. Balis: I like the part where you question the logic of your rituals. Could you read a couple more?
Ms. Tanner: Sure. "Maybe my brother and I were twins, and Mom never told us. Maybe that's why I feel like my actions influence his. Maybe he has OCD, too." That's all.
Dr. Balis: Rachel, OCD is sometimes called the "doubting disease." Your brain reroutes the same message, and you obsess over it. What you need to do is to break the chain of thoughts and redirect it. A good analogy is a car with a standard transmission--you decide when to shift, not your car. You have to focus your attention on something more constructive. Do something else when you get the urge to count your steps, or brush your hair, or clean your nails. Fight the impulse to call your brother or get reassurance from him. Replace the undesired behavior with another, more useful activity.
Ms. Tanner: Like writing in my journal?
Dr. Balis: That's exactly right. But do not replace one ritual with another. Don't pluck your eyebrows instead of brushing your hair, for instance. Some people try waiting for fifteen minutes when they first get the urge to perform a ritual. Set a timer if you have to, but wait. In fifteen minutes, you may find that you've forgotten that you were waiting.
Ms. Tanner: I could try it. Maybe I should find other things to do besides write, though. Just in case. Like maybe take a walk or play the piano.
Dr. Balis: Do you play?
Ms. Tanner: Mom forced me to take lessons. I hated it at the time, but now I can pick up any hymn book and play, as long as there aren't too many sharps or flats.
Dr. Balis: That's good. It's also important to process your feelings after you've waited the fifteen minutes. Maybe you could do that in your journal. At least make mental notes of how your symptoms feel and perhaps even wait fifteen more minutes. Try this with keeping your hands still or away from your face. Break the old habits, especially with this medication. You'll probably find that the noise you were talking about during our last session will dissipate. Have you given any more thought to enrolling in school?
Ms. Tanner: I've thought about it.
Dr. Balis: And?
Ms. Tanner: I don't think I'm ready yet.
Dr. Balis: I know school would be a big change for you. What exactly do you feel uneasy about?
Ms. Tanner: Well, getting there and back, for one thing. I don't want to be a burden on my grandmother for transportation, and I don't feel like I'm ready to take the city bus. And shouldn't I wait until after the fall quarter ends?
Dr. Balis: Rachel, these considerations seem minor to me. I'm sure your grandmother would be happy to drive you. And there are classes that last only a few weeks and could be taken at any time. What else concerns you about going to school again?
Ms. Tanner: I just don't feel right about it. I...
Dr. Balis: Talk to me.
Ms. Tanner: Well, it's been a long time since I was a student--two years. What classes would you suggest I take? And don't tell me dental hygiene!
Dr. Balis: You seem to have a lot of resistance to the idea of going back to school. Are you sure there isn't something else?
Ms. Tanner: Maybe. I don't want to talk about it.
Dr. Balis: Is there something you're afraid of?
Ms. Tanner: Doctor, I said I don't want to talk about it!
Dr. Balis: Hmm.
Ms. Tanner: Can I go early today? I don't really have anything more to say.
Dr. Balis: We could drop the school issue for now and move to something else. But... Rachel? Rachel!
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Button to Dr. Balis' Notes Doctor Balis' Notes on this Session

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