1 >> Counselor: Welcome Marsha. Please make yourself comfortable on the couch. >> Marsha: Okay, thank you. >> Counselor: Today I'd like to get some information from you so I can best come up with a plan to help you. Would that be okay? >> Marsha: Yeah. Definitely. >> Counselor: Can you tell me a little bit about what's going on and what are some of the issues you'd like help with? >> Marsha: I basically came in here because I've just been, I just feel kind of like down, you know? Like, I feel anxious and I try to take care of myself but it doesn't seem like it's working so I thought I'd come in here and see if I can get some help from you. Are you feeling depressed at all? >> Marsha: Yeah, I think I am actually. >> Marsha: I just feel like I'm down and I don't want to be like that all the time. >> Counselor: Can you tell me a little bit more about that? >> Marsha: Yeah, I just, so I don't want to sound funny like weird but when I'm out in public I get really anxious cause I feel like people are looking at me. I know that sounds strange, like they're not all looking at me but I feel like they are and I feel like they're probably thinking like, oh that girl probably used to be really pretty. You know? Like- >> Marsha: back when she, you know, if she would just lose a few pounds she probably would look really cute. Counselor: Can you tell me a little bit about what's going on and what are some of the issues you'd like help with? >> Marsha: I basically came in here because I've just been -- I just feel kind of like down, you know? Like I feel anxious and I try to take care of myself. But it doesn't seem like it's working, so I thought I'd come in here and see if I can get some help from you. Are you feeling depressed at all? >> Marsha: Yeah. I think I am actually.
2 >> Marsha: I just feel like I'm down, and I don't want to be like that all the time. >> Counselor: Can you tell me a little bit more about that? >> Marsha: Yeah. I just -- so I don't want to sound funny, like weird, but when I'm out in public I get really anxious because I feel like people are looking at me. I know that sounds strange. Like they're not all looking at me, but I feel like they are. And I feel like they're probably thinking, like, oh that girl probably used to be really pretty. You know? Like -- >> Marsha: -- back when she -- you know, if she would just lose a few pounds, she pry would look really cute. >> Counselor: So does it make you uncomfortable when you think people are looking at you? >> Marsha: Yeah it does. I mean, I guess that's what I think of myself, you know? I always think like, I would be way cuter if I lost some weight. >> Marsha: And so I just kind of think they are probably thinking that too. That's all. >> Counselor: Marsha have you always felt this way? >> Marsha: Yeah. I mean most of my life I would say so. Like back when I was a kid, I used to be in sports. And I was like pretty toned, and I was pretty slim. >> Counselor: Mm-hm. >> Marsha: And I looked good. I mean, I felt really good back then. >> Counselor: Mm-hm. >> Marsha: Like people used to be like, oh my gosh you're so pretty. Or they'd be talking to my parents, and they'd be like, oh your daughter, she's really, you know, she's really pretty. >> Counselor: Mm-hm. >> Marsha: And I just don't feel like I ever get that kind of attention any more. You know, I kind of miss that. And I know I can do something about that. Like I should. People out there know how to diet, and [inaudible]. They can be really skinny. And so if they can do it; I can do it. >> Counselor: So let's go into the dieting. What kind of things do you do to diet?
3 >> Marsha: Well I've pretty much tried everything. You know? Like, I've done , I don't know if you've heard of that? >> Counselor: No, uh-uh. >> Marsha: It's complex. >> Marsha: I've done the South Beach Diet, I've done the Atkins, I went to Weight Watchers, but they like, they require that you eat a certain amount per day and I think it's just a little bit too much what they ask of you. I mean, I don't see how you're going to lose weight that way. >> Counselor: Okay, you thought the calories were too much? >> Marsha: Um, yeah. So. >> Marsha: So I've done pills, I still do pills. I just do whatever I can to just not eat, you know? Like I used to just go to lunch and have a half of a bell pepper, and I'd just eat that and I would think like that's a lot of fiber, I should be pretty full. So, and sometimes that works. Sometimes I can go the whole day and I'm fine. >> Counselor: Okay, so tell me a little more about the pills. Are they prescription pills, or are they over-the-counter, what kind of dieting pills are you taking? >> Marsha: Um, well like, gosh, I've tried everything. I mean if you just go to the grocery store and you walk down the aisle where it says dieting pills, anything that curbs your appetite, I've pretty much tried it all. >> Marsha: It just helps, you know, when I try to like not eat very much, it kind of helps me to not have those cravings. >> Counselor: Is there other things that you do in terms of the dieting, have you ever binged or purged? Or used laxatives? >> Marsha: Um, yeah, I mean, I do that. I don't--that's probably kind of gross. But um... >> Counselor: It's not gross. >> Marsha: Well, I do. I do it like, sometimes what happens is I will go the whole day without eating, and then I get home and I'm like, that was good, you did a really good job, just maintain until you go to sleep, you just have to get through the next few hours. >> Counselor: Mm-hmm.
4 >> Marsha: And when I can do that, I'm like "Yes!" You know? I got through the whole day and it feels kind of good. >> Counselor: Uh-huh. >> Marsha: But there are some days where I get home and I'm like, "Oh, I just want something," you know, I just want to eat something, and so I'll take out like, um, like some celery and some peanut butter, and I'll be like one teaspoon of peanut butter should be enough, and I'll eat it, and I'll be like, oh, then I eat some more, and I eat some more and pretty soon like a whole jar is like, like half the jar is empty and I'm like "Crap," you know, that was so many calories, I mean. So then of course I go and I throw up. Yeah. How often? Do you purge? >> Marsha: These days I probably purge more often than I used to. I used to be a lot better at not eating the whole day, but now I probably purge like five days a week. >> Marsha: Sometimes six days a week. >> Counselor: Once a day? Twice a day? >> Marsha: Um, it's...kind of embarrassing when it happens at work, but it happens at work too sometimes, where I have to go to the bathroom and I'm just like I hope people don't hear me, because that's like, I don't really want them to know. >> Counselor: Yeah. >> Marsha: You know what I mean, right? Kind of gross, like. >> Counselor: Yeah, well I want you to feel comfortable talking about it, and I don't want you to feel embarrassed, so >> Marsha: Okay. >> Counselor: It's not grossing me out. >> Marsha: Okay. >> Counselor: Okay? Um, and how about laxatives. Have you ever taken any laxatives? >> Marsha: Um, yeah. I have. >> Marsha: I prefer to just throw up to be honest with you. But I have taken laxatives before, to be completely up, honest with you.
5 >> Counselor: And have you had any physical symptoms because of the dieting and the purging? >> Marsha: I do feel like I'm just not as energetic as they used to be. >> Marsha: I used to have a lot more energy and I used to be able to do a lot more. And now I just feel like I'm just not as energetic as I used to be. And that's maybe just the depression and stuff going on. >> Counselor: Okay, so you're feeling more tired? >> Marsha: Yeah. I do feel pretty tired. Like sometimes I get home and I'm like, ahh, I just go to bed at like 8:00. >> Counselor: Mm-hm. And you know, some women when they diet a lot they can skip their menstrual cycle. >> Marsha: Mm-hm. >> Counselor: Has that ever happened to you? >> Marsha: That used to be how it was a long time ago, back when I -- I used to be really skinny. >> Marsha: And back then I used to miss my periods. >> Counselor: Mm-hm. >> Marsha: But like, that doesn't happen anymore, you know? >> Counselor: Okay so -- >> Marsha: I can't seem to get my weight down low enough where that happens. So you're not missing periods right now? >> Marsha: Nn-nn. >> Counselor: Now thank you for sharing all of that information. I'd like to ask you a little bit about your childhood. Could you tell me about your childhood? >> Marsha: Um yeah, sure, I mean, yeah I mean I had a pretty good childhood. You know, it was fine. I can't complain, it was pretty good. We had enough money, not a ton, but we had enough. My parents got divorced when I was pretty young, and my dad, he used to, you know, he didn't have a ton of time to hang out, but
6 he would come to like all of my games, so whenever I was doing sports and I had games at school, he would always come and he'd always watch me, and that was kind of like a point of pride for me that my dad used to come and watch me, you know? >> Counselor: Uh-huh, I can understand that. >> Marsha: Yeah, he was really proud of having a girl who was athletic and he really wanted me to get a scholarship so I could go to college, and so it was really important that I get straight As. And what kind of relationship did you have with your mom? >> Marsha: My mom, she's pretty cool. She's really Christian, and back when I was like little, I used to be into that too, like we'd all go to church as a family and I liked that, but as I got older, I kind of took some distance from that. I'm not really that into church anymore. My mom's really into it, like I mean she goes to church every Sunday and she's like, she always looks perfect, she's like really prim and proper and her life is like very organized, and everything looks good. You know? But I don't, that's not really, that's not really how I am. >> Counselor: Well I think what I'm hearing is in your childhood, was there a lot of expectation to be perfect? >> Marsha: Definitely, yeah, I mean, I had to be a straight A student, I had to be really responsible, and quite honestly, I think my parents were kind of proud of me for being athletic, and my dad especially was really happy to introduce me as his daughter because, you know, I was, I was pretty cute, and he was like "This is my daughter," you know, I was like his pretty little girl. >> Counselor: Yeah. >> Marsha: Nowadays, I kind of feel like my dad, you know, he doesn't say anything, but I can tell that he's like, um...you know, he kind of wishes that I wouldn't eat certain things or that he, he kind of wishes I could just like do something about, just lose a couple pounds. I could tell. >> Counselor: Do you feel like he's judging you? >> Marsha: Yeah. >> Marsha: Definitely. >> Counselor: That must be difficult to think that. >> Marsha: Yeah. >> Counselor: Did you tell me, have you had anything traumatic happen in your life?
7 >> Marsha: Um...traumatic? Like, what do you mean traumatic? >> Counselor: Well, anything really frightening, any type of abuse? >> Marsha: Um? I mean, I don't know if this is really that important to get into, but like I had one thing happen to me like a long, long time ago. Long time ago, I mean, I don't even think about that anymore. >> Counselor: Can you share that with me? >> Marsha: Um, yeah, it's like, not that big of a deal. It's just um...well, I guess it's kind of a big deal. I don't know. Like, when I was 13, I was at this party with some friends, and there was this guy there who I really liked, and I thought he was really cute. And anyway at the party he like, he took me upstairs, and I thought like, "Oh, okay, we're probably going to kiss," like okay. And um...well um. Sorry, I don't know why, this is just hard for me to talk about. I don't know. I don't mean to like get all emotional on you. >> Counselor: No, it's totally okay. Take your time. >> Marsha: It's just that he ended up like, kind of, he forced me to have sex with him, and uh, I just haven't really thought about that for a long time. >> Counselor: That sounds like a very painful memory for you. >> Marsha: Yeah. I'm sorry I just, um...i don't know. I mean, I thought I was really, I mean its so long ago I don't even know why I'm feeling like this right now. Anyway. I kind of feel like, you know, whenever I think about it, I just feel like mad at myself, because I shouldn't have been there, and I should've known better, and if my parents ever knew that that happened, I mean, if they ever knew. My God, they'd be so disappointed. You know? Like, they taught me better than that. >> Counselor: Well, you know, I hope as we continue to meet, that I can change your mind about feeling it was your fault, because it was definitely not your fault. I'm very sorry you had to go through that. >> Marsha: Yeah, thank you. >> I know that was a painful thing to talk about. Could you, could we move on and you could tell me a little bit about where you work? >> Yeah. Yeah. Definitely. Yeah, I work at a, it's a local law firm actually. >> OK. >> I am in law school. I mean, actually like my life is fine. Like everything is going really well. Like I'm in school. My career is going to be moving forward. I got this great internship at this law firm, and so everything should be fine. I should be really happy. I mean, that's why I'm kind of confused because everything I ever wanted in life I pretty much have it, you know? I don't know why I can't seem to get myself to like be happy about that.
8 >> Well, can you tell me have you ever had any type of treatments for feeling anxious or depressed [coughing]? >> I talked to my PCP about this, and he gave me some Zoloft. >> OK. >> Which I took for a while. But I think the Zoloft is really not helping me very much because it makes, I think it, I think I am gaining weight because of it honestly. >> OK. >> So I am not taking that anymore. That's, no. So anyway, I talked to my PCP about that, and he was like, he's the one who recommend that I come and talk to you. >> OK. >> Counselor: Well, great. I'm glad you came. >> Marsha: Yeah. >> Counselor: Can you tell me do you think that your dieting is an issue? >> Marsha: Uhm, I know it sounds extreme but it's really not that big of a deal in my opinion. It's just who I am and it's how I've dealt with weight issues my whole life. So, I really don't think that's the issue. >> Counselor: What issues would you like to work on? >> Marsha: I guess I just want to get my energy back. I want to feel excited again. I want to feel like in the morning I don't want it to be hard to get out of bed. >> Counselor: Yeah. >> Marsha: I don't want to feel my heart pounding in my chest when I'm about to open the door to go to my office, you know, like that part really scares me because I'm afraid what if I don't make it through law school if I keep feeling that way, you know? >> Counselor: Yeah. So what I'm hearing is you want to focus more on the depression and the anxiety? >> Marsha: Yeah. Definitely. I want to thank you for sharing all that you've shared with me today and we're going to end the session for now but we're going to talk more at a later date. Is there anything else you'd like to share? >> Marsha: No. I think that's about it.
9 >> Counselor: That's about it, okay. We'll set up a time when we can continue our discussion. Thank you for coming in, Marsha. >> Marsha: Okay. Thank you.