diff --git a/AnnoMi-therapist/dev.tsv b/AnnoMi-therapist/dev.tsv new file mode 100644 index 0000000000000000000000000000000000000000..b51d5f6c176fff711ef8f7b119943df936db6a07 --- /dev/null +++ b/AnnoMi-therapist/dev.tsv @@ -0,0 +1,474 @@ +id text label dimension +100_137 Oh, you do? question communication behavior +100_139 Good for you doing that. reflection communication behavior +100_141 Yeah. Smart. reflection communication behavior +100_143 Discouraged. reflection communication behavior +100_145 Discouraged, yeah. reflection communication behavior +100_147 Mm-hmm. other communication behavior +100_149 Mm-hmm. other communication behavior +100_151 Uh, yeah, it does. Uh, I am yet to- it-it seems to me just in this time we've been talking together that you, um, um, do have a sense that a lot of it has to do-do with, uh, timing, luck, who you know, and being, are you able to have that conversation where you know that you can sell yourself and your skills and, um, and your competencies and the fact that you've overcome so many things like, um, substance abuse problem and, uh, have been, you know, uh, a good upstanding citizen all this time. Um, to me, if I were an employer, you know, I would- I would be impressed with that. reflection communication behavior +100_153 Uh-- You're welcome. And- so what about, um, I know I had a client that told me a couple of things. He was doing some work on this, uh, if you- if you'd be interested I could tell you what he shared with me. therapist_input communication behavior +100_155 Okay. Um, he found the most valid information on blogs done by felons. therapist_input communication behavior +100_157 They are your experts. therapist_input communication behavior +100_159 And, uh, they-they are actually, uh, uh, much what you have said, they said, but they also, uh, uh, talked about which places and companies they did find were open. For instance, family-owned businesses just tend to-- They can, if they can-- therapist_input communication behavior +100_161 Right, right. other communication behavior +100_163 Or start your own business. That was another thing that I thought was really-- therapist_input communication behavior +100_165 Uh-huh. other communication behavior +100_167 So being an entre- being an entrepreneur fits for you. reflection communication behavior +100_169 Mm-hmm. other communication behavior +100_171 Mm-hmm. other communication behavior +100_173 Well, that, you know, now that's a-a really different way of looking at it than how you were looking at what you can do versus what's getting in your way that you know you can't do. reflection communication behavior +100_175 So, um, what kinda- what-what are you starting? What's this business? If you-you don't have to tell me if you don't want, I know it's on the up and up, but you don't have to tell me if you don't want. question communication behavior +100_177 You'd be so good at that. reflection communication behavior +100_179 Uh-huh. other communication behavior +100_181 You-you would be the corporate company. reflection communication behavior +100_183 CEO. reflection communication behavior +100_185 [laughter] other communication behavior +100_187 So. Yeah, I- I've heard that-that in recession, uh, those are often the best opportunities for people to start doing business is to, um, see an area where you see a need go in and fill it. therapist_input communication behavior +100_189 One. other communication behavior +100_191 You're comfortable with that? question communication behavior +100_193 I know. That's fantastic. It is. reflection communication behavior +100_195 Acting out would be what? question communication behavior +100_197 Okay. Gottcha. other communication behavior +100_199 Like you are now. reflection communication behavior +100_201 So the-the-the law of, um, felony convictions is-is something that you don't have any control over. I mean, nobody does. So, um, you know, and I'm thinking about how you were talking about getting all the way through the interview and then getting rejected, you know, versus being upfront about it and-and even on the telephone to see whether it's a deal breaker or not, because it must- it sounds like it's so much harder to have that good interview and walk out of there ad know you've done well, and then get turned down. reflection communication behavior +100_203 Mm-hmm. other communication behavior +100_205 And your brother didn't know that when he gave you the lead on the job, that there was a background check involved? question communication behavior +100_207 Okay. other communication behavior +100_209 Mm-hmm. other communication behavior +100_211 You're not a criminal. reflection communication behavior +100_213 That's right. You're rehabilitated. reflection communication behavior +100_215 A plus shining new guy. reflection communication behavior +100_217 Oh, I think so, too. other communication behavior +100_219 I guess I would just have a tendency to say it. I'm a recovering person, and back in my former life, I have a felony conviction. And before we go any further, I don't wanna waste your time. Uh, would that be a problem in even getting the interview, what would you think about saying something like that? therapist_input communication behavior +100_221 Mm-hmm, mm-hmm. other communication behavior +100_223 Okay. I mean, I'd be happy if you wanna work on a few, you know, things, uh, to write down that sound comfy and fit, you know, how you talk and you use words and stuff. 'Cause I-I also think, you know, interviewing is a good schoo- a good skill, and the more you do it, the better you get at it. And you've been getting a lot of practice at it. So that's-that's been useful too. therapist_input communication behavior +100_225 I mean, even-even though you get turned down, that feels terrible. The actual and, I bet you with every single one, you get better at it. therapist_input communication behavior +100_227 Uh-huh, uh-huh. other communication behavior +100_229 Yeah. I bet you're even better now. therapist_input communication behavior +100_231 You got lots of practice. reflection communication behavior +100_233 Yeah. Well then lastly, just getting back, um, to this, another source that that same client was an advocacy group called the John Howard Society. therapist_input communication behavior +100_235 I don't know if you've ever- other communication behavior +100_237 Yeah. other communication behavior +100_239 Uh, he, yeah, uh, he- they have a lot of, uh, they have a lot of really good stuff on there about this because they're trying to change the laws about that because- therapist_input communication behavior +100_241 -they are so, um, they are so prejudicial. They really are. And I would check with the ACLU too. I mean, just as I-I don't know much, and now I'm very curious and I wanna find out about it myself, but yeah. therapist_input communication behavior +100_243 Mm-hmm. other communication behavior +100_245 Oh, absolutely. other communication behavior +100_247 Absolutely. other communication behavior +100_249 You're not allowed to vote. therapist_input communication behavior +100_251 And you're not allowed to vote. therapist_input communication behavior +100_253 That shocked me when I found that out. therapist_input communication behavior +100_255 I couldn't believe that. therapist_input communication behavior +100_257 Do you know how many millions of people and when you think about that racially, um, hmm. therapist_input communication behavior +100_259 Yeah, mm-hmm. other communication behavior +100_261 Mm-hmm. other communication behavior +100_263 That's a great word for it there. Yeah. So, um- reflection communication behavior +100_265 Yeah. So-so maybe you- if you- if you wanted to, and this is really up to you, you could check out the blogs, you know. Um, I can see if I can track him down and stuff and the John Howard Society. And, um, I'd be really interested if-if you wanna get together to see what you have found out. therapist_input communication behavior +100_267 Mm-hmm, mm-hmm. other communication behavior +100_269 But this has affected it. reflection communication behavior +100_271 Rejection-rejection, yeah. reflection communication behavior +100_273 Yeah. other communication behavior +100_275 Yeah. other communication behavior +100_277 I'll do some checking around for you. I will. Yeah. reflection communication behavior +100_279 Oh, you are welcome. Thanks for being so open with me. I appreciate it. reflection communication behavior +100_281 Yeah. Okay. other communication behavior +101_0 So, Jill, um, I know you're here to talk about your blood pressure today. reflection communication behavior +101_2 Um, before we get into that, I see you filled out our annual screening forms here. So if-if you're okay, can we take a minute to talk about that? question communication behavior +101_4 Okay, great. It looks like, um, the way you filled out the alcohol form puts you into our, uh, third zone of drinking. Can you- can you tell me a little bit about your drinking habits, where you drink, what do you like to drink? question communication behavior +101_6 Okay. other communication behavior +101_8 Mm-hmm. other communication behavior +101_10 Okay. Kind of socializing? reflection communication behavior +101_12 All right. How often do you do that? question communication behavior +101_14 Okay. And on a regular night, how much do you-- how many glasses of wine would you guess you drink? question communication behavior +101_16 Mm-hmm. other communication behavior +101_18 Okay. Okay. other communication behavior +101_20 Mm-hmm. Okay. So let me just show you on this, um, card here, um, from a medical perspective, we know that there's good evidence that shows that women you're age who drink more than, um, three drinks on any one occasion at any- at any sitting or more than seven in a week, are likely to run into health problems from their drinking, either problems they're having right now or maybe in the future. therapist_input communication behavior +101_22 Yeah. Surprised, ain't you? reflection communication behavior +101_24 It sounds like you're drinking a bit more than that right now. reflection communication behavior +101_26 Mm-hmm. From this, uh, drinker's pyramid over on this side of the card, you can see that the-the score on your screening sheet shows that you're up in the harmful category of drinkers. So that it's likely you're drinking, you know, in quantities probably more than about 90% of the folks who come in to see me here at the clinic. therapist_input communication behavior +101_28 It doesn't feel like a problem to you right now, yeah. reflection communication behavior +101_30 Yeah, okay. And then the other thing I should mention, Jill, um, drinking more than these quantities, it's-it's possible it could be pushing your blood pressure up a bit, and I'm wondering if that might be affecting the difficulty we're having getting your blood pressure down right now. therapist_input communication behavior +101_32 Mm-hmm. Yeah, it can sometimes. therapist_input communication behavior +101_34 My perspective as a doctor, it would be good if you could think about cutting back a little bit or doing something different about your drinking. What-what do you think about that? therapist_input communication behavior +101_36 Okay. So on a scale of 0 to 10, 0 being not ready at all to do that and 10 being very ready, where would you lie on that scale? question communication behavior +101_38 Okay. Okay, so that sounds-- I think that's great. So why would you be up at a six and not down at a two level? What kinds of thing would push you to be there? question communication behavior +101_40 Yeah. other communication behavior +101_42 Okay. other communication behavior +101_44 Yeah. Yeah. So you've got some good reasons to try to cut back a little bit. reflection communication behavior +101_46 Yeah. And it sounds like you're willing to maybe try not going to the bar quite as much and maybe drinking a little bit less when you go to the bar. reflection communication behavior +101_48 Okay. So to what levels do you think you could do that? Where-where would you wanna go with your drinking? question communication behavior +101_50 Okay. Okay. other communication behavior +101_52 Mm-hmm. So you'd drink maybe just a couple of times a week and maybe a little bit less on each occasion? Is that what you're saying? reflection communication behavior +101_54 Okay. Okay. other communication behavior +101_56 And you think you're-you're able to cut down to those levels of no more than seven a week? question communication behavior +101_58 Okay. I think that sounds like a great step for you as your doctor. Why don't we revisit this the next time you come in to talk about your blood pressure in about six weeks or so and, um, then we can see how you're doing with it. therapist_input communication behavior +101_60 All right? other communication behavior +101_62 Well, let's get back to your blood pressure then and see what we need to do about that. other communication behavior +103_0 Thanks for coming back, [unintelligible 00:06:00]. I know last time we talked about, uh, maybe going out and joining some activities in the community- other communication behavior +103_2 -to work on meeting some people, so- other communication behavior +103_4 -maybe you could tell me about how that's going? question communication behavior +103_6 Yeah, I know you've mentioned that in the past. When we were talking about the pros and cons of going out to one of these activities- other communication behavior +103_8 -you really mentioned that anxiety- reflection communication behavior +103_10 -is a big con. other communication behavior +103_12 I remember that. other communication behavior +103_14 Okay. To make a change- reflection communication behavior +103_16 -that you've wanted for some time. reflection communication behavior +104_0 Before you go, do you mind if I take a look at the questionnaire you filled out before the visit? question communication behavior +104_2 Thanks. I want you to know that whenever patients and I talk about alcohol and drugs, my role is to share information and learn from what they want to do, if anything. Does that make sense? therapist_input communication behavior +104_4 Great. So, you wrote here that you've used alcohol in the last year on at least eight days? question communication behavior +104_6 Okay. How would you describe your drinking? question communication behavior +104_8 Okay. What kind of alcohol do you drink at parties? question communication behavior +104_10 How much do you think you usually drink at a party? question communication behavior +104_12 Yes. other communication behavior +104_14 Speaker 1: Okay. You checked the box here that drinking helps you feel relaxed, feel better about yourself or fit in? question communication behavior +104_16 And you also checked that sometimes you forget things when you drink. question communication behavior +104_18 What kind of things do you forget? question communication behavior +104_20 Sometimes you forget where you're at. reflection communication behavior +104_22 Here's the part where I share information. The safest level of drinking for teenagers is zero drinks. That's because we know a number of negative things are more likely to happen when adolescents drink. We know alcohol can harm how the brain develops as an adolescent and teens who drink are more likely to hurt themselves by accident. Sexual assault is another thing more likely to happen and so are sexually transmitted diseases. I'm curious, do you think your drinking has anything to do what the possibility of having an STD? therapist_input communication behavior +104_24 Do you remember giving consent when you had sex? question communication behavior +104_26 How do you think drinking alcohol affected using a condom this time? question communication behavior +104_28 Sounds like drinking changes how you think in those moments? reflection communication behavior +104_30 There's something else I wanna share. When people forget where they are or how many drinks they've had, that's a sign of heavy drinking. And when people keep drinking despite experiencing negative consequences, that can be a sign of what we call alcohol use disorder. therapist_input communication behavior +104_32 I'm curious. What do you like about drinking alcohol? question communication behavior +104_34 Okay. And what about your drinking do you not like? question communication behavior +104_36 Anything else? question communication behavior +104_38 Right. So, on one hand, you like the feeling of being relaxed and having fun when you're drinking and on the other hand, you don't like forgetting where you are or forgetting how many drinks you've had and you don't like putting yourself at risk for STDs? reflection communication behavior +104_40 So, when you think about what you like and not like about your drinking, where do you wanna go from here? What would you like to change about your drinking? question communication behavior +104_42 How ready are you to not drink too much? If I asked you to pick a number on a scale of 0 to 10, and 10 being totally ready, what number would you pick? question communication behavior +104_44 Very ready to stop drinking too much. Why do you think you picked such a high number like nine rather than a lower number like a six or a seven? question communication behavior +104_46 Okay. What plan could you come up with to make sure you achieve that goal? question communication behavior +104_48 Great. Who could help you reach this goal? question communication behavior +104_50 Okay. And how about unprotected sex? It sounds like you don't want to experience that again. reflection communication behavior +104_52 All right. So, you're very motivated to change your drinking and you have a plan to keep from drinking more than two drinks at parties and keep from having unprotected sex. I would like to share how it's working for you. What do you think about coming back in six weeks or so? reflection communication behavior +104_54 Great. Thanks for talking with me and I look forward to seeing you again soon. other communication behavior +105_0 . So, um, tell me about the exercise. question communication behavior +105_2 You have? question communication behavior +105_4 That's fantastic. other communication behavior +105_6 So, what else have you noticed other than your-your pants are fitting better? question communication behavior +105_8 Mm-hmm. other communication behavior +105_10 Your-- my what? question communication behavior +105_12 Wow. other communication behavior +105_14 Mm-hmm. So and what would you-- What would- What would help you get to building up to it? Spending more time there. question communication behavior +105_16 Mm-hmm. other communication behavior +105_18 Mm-hmm. other communication behavior +105_20 Mm-hmm. other communication behavior +105_22 Mm-hmm. But you made it-- You made it one day- reflection communication behavior +105_24 -instead of zero days. reflection communication behavior +105_26 That's fantastic. other communication behavior +105_28 Even with this, you know, pretty horrendous schedule going on. reflection communication behavior +105_30 So you-you'd like to get buffed? question communication behavior +105_32 So, but for right now, it sounds like the-- just having the pants fit better- reflection communication behavior +105_34 -sounds really, you know, like it's making you feel good about yourself and— reflection communication behavior +105_36 What other positive things have you noticed about the exercise? question communication behavior +105_38 In what way have you gotten a little bit better? question communication behavior +105_40 So you're at the second thought part. And what do you think would-- might take you, uh, over to actually doing it if you wanted to? question communication behavior +105_42 Mm-hmm. other communication behavior +105_44 Oh, okay. The payoff just wouldn't be worth that two hours of treadmill versus that double fudgy browny thingy. reflection communication behavior +105_46 'Cause it is decadent, it's lovely. therapist_input communication behavior +105_48 Yeah, yummy, so- therapist_input communication behavior +107_0 Well, let's talk about then how you ended up cutting yourself. other communication behavior +107_2 So, what happened. So first of all, tell me what you did, exactly. other communication behavior +107_4 Well, I mean, where did you cut yourself? I know you said you cut yourself when you- question communication behavior +107_6 Like your arm? other communication behavior +107_8 What did you cut yourself with? question communication behavior +107_10 How deep? question communication behavior +107_12 Yeah. Let me see. You know those look to me like they-they-- did you go to the-- It doesn't look like you went and got any stitches, but that looks to me like you could have used them. What do you think? question communication behavior +107_14 Okay, but part of the problem is those look deep and like you're going to have significant scars. So my suggestion is in the future, if you do it, is that you put some sort of bandaid on it to keep it closed. But let's talk about how, um, how this happened. First of all, tell me, you were telling me on that phone that you wanted to die. But, um, did you-- Was this a suicide attempt or do you think it was just-just a cutting? Were thinking of killing yourself or wanting to kill yourself or wanting to die when you did it? therapist_input communication behavior +107_16 Okay. So let's-- Okay, so it sounds like me not being avai-- Was me not being available with you, rela-related to you cutting yourself? question communication behavior +108_0 Well, I want to thank you for coming in today to see me. Um, I do understand from talking with your counselor that you've got quite a bit on your plate, you've got a lot going on. Can you tell me a little bit about that? therapist_input communication behavior +108_2 Yeah, I could see that. Um, may I ask, are you also a single mom? question communication behavior +108_4 So you've got a lot of stressors right now. You're a single mom raising a two-year-old, you're working full time, and you're going back to school. What do you think would be the most helpful for us to focus on today? reflection communication behavior +108_6 Okay. Can you tell me a little bit about that? question communication behavior +108_8 Okay. So I'm hearing you say that the situation with your mom's not ideal. You actually miss class sometime and had to lose some work shifts as well, and that's problematic. reflection communication behavior +108_10 Okay. Um, outside your mom, is there anyone else that can help with childcare? question communication behavior +108_12 Okay. other communication behavior +108_14 Hmm. So what I hear you saying is this neighbor was supportive when you really needed her to be. reflection communication behavior +108_16 Stepped in last minute. Um, when you picked up your son, you didn't have any concerns and he seemed happy? reflection communication behavior +108_18 Okay. Let's pursue that neighbor a little bit. Um, people like that, I like to think of as natural resources, but I know for a lot of people, the major problem with, uh, childcare is affordability. therapist_input communication behavior +108_20 Have you given any thought to, if you'll be able to afford to pay someone on a regular basis to watch your son? question communication behavior +108_22 Yeah, I can understand that. Um, what are some of your natural skills? question communication behavior +108_24 Oh, I bet you're a really good cook then. Um, what would you think about a plan where you worked out an arrangement with this neighbor, where in exchange for her watching your son, you would prepare dinner for her and her, um, daughter? therapist_input communication behavior +108_26 Um, you know, you could maybe swap a meal for child care. What do you think of a idea like that? therapist_input communication behavior +108_28 Okay. Okay, I'm glad you think so. Um, so, other than this neighbor, or is there anyone else that could help you? question communication behavior +108_30 Okay, I can respect that. You-you really have to go with kind of your gut and follow your own intuition on that. Um, what about the baby's father, is he of any help? question communication behavior +108_32 Okay, fine. You know what? We've got one really good lead with the neighbor. I think if you would follow up in pursuing that, you might find some relief and resolve some of your childcare issues. Um, how many days a week are you in school? therapist_input communication behavior +108_34 Okay. Um, so what would it look like if you had a plan where both your neighbor and your mom were helping you out? question communication behavior +108_36 Okay. So what I'm hearing you say is that, if you could just reduce the amount of time that you're needing your mom, she might be more supportive, more onboard? reflection communication behavior +108_38 All right. Um, so what do you think would be your next steps in working out a plan between your neighbor and your mom? question communication behavior +108_40 Okay. Sounds like you got a good plan to follow up on there. All right. Um, now you mentioned that your son is two. When will he turn three? reflection communication behavior +108_42 Okay. Well, in that I-- in that case, I've got another idea for you. Um, what about, um, maybe when he turns three, you could enroll him in Head Start? Are you familiar with that program? therapist_input communication behavior +108_44 Okay. Head Start is a very affordable, very high-quality preschool program. Um, it was really created for parents and families, just like yours, folks who have a lower income and fewer resources, but Head Start really prepares your child both socially and intellectually for going to school. Um, and you know, by the time he turns three, you may find that that routine is something that's better for him to get used to before he starts kindergarten. Uh, would you like some more information on local Head Start sites? therapist_input communication behavior +108_46 Okay. Well, good. Um, all right. It sounds like you've got a good plan there going forward. Um, now I did see from the nurse practitioner's notes, you're also working on reducing your smoking and your drinking. How's that going? question communication behavior +108_48 Okay. So what I hear you say is that it was a bigger challenge than you expected, yeah, but you're working on it. You're-you're still committed to it. So yeah, that's really to be commended. I just want to ask you one thing though. Have you thought about secondhand smoke and the dangers of that and how that might be impacting your son? reflection communication behavior +108_50 Oh, okay, good. You know, I can tell you really have your son's best interest at heart here. You know, just from our conversation today, I can tell you're a really good mom. Um, let's reflect back on what we've discussed here so far. Now, we've got a couple of good options between the neighbor and Head Start programs for childcare. What do you see as your next steps in getting that going? reflection communication behavior +108_52 Okay, okay. Good. Um, I think you've got a good plan there. Um, what would you say to us getting back together, say, in two weeks, just for us to kind of revisit and see what kind of progress you've made, you know, if you've got something worked out, great, but if you've hit a bump in the road, I tell you what, we'll put our heads together. We'll come up with another plan. question communication behavior +108_54 All right. Good. Well, I want to thank you again for coming in today, Sarah. It was really nice to have met you. other communication behavior +108_56 You're very welcome. other communication behavior +109_0 Okay, hard part's over. So the good news is no cavities. therapist_input communication behavior +109_2 Yes, always happy to hear that. I do have some concerns though because I'm seeing some irritation in your mouth in the palate that's called nicotinic stomatitis and- therapist_input communication behavior +109_4 Yeah, it is. It's some damage to the roof of your mouth that happens from tobacco smoking and so I'm wondering if you can tell me a little bit how-- about how tobacco fits in your life right now. question communication behavior +109_6 So you've made a decision in your life not to smoke cigarettes, that's something you didn't want to do. It sounds like you're kinda concerned about the health effects of cigarettes. But you have been smoking the little cigarillos at least one or two every time you go out. reflection communication behavior +109_8 Yeah, so you're not-- You're not like those chain smokers, you're not smoking packs and packs a day. reflection communication behavior +109_10 The amount you smoke is so miniscule you can't even imagine that it would cause any harm and yet here it is damaging the roof of your mouth. reflection communication behavior +109_12 Uh-huh. So smoking has kind of become a big part of your social life now. When you go out, you're smoking, and even during breaks at work, you're smoking. reflection communication behavior +109_14 So aside from that social aspect, what are the things you like about it? question communication behavior +109_16 Okay. other communication behavior +109_18 Okay. How about the other side? Have you noticed any not-so-good things about the smoking? question communication behavior +109_20 Yeah. So we're noticing some pretty negative effects in terms of your oral health with the smoking. Are there any other things that you're concerned about? question communication behavior +109_22 Mm-hmm. So there's your oral health, there's the financial aspect, and then e-earlier you brought up some concerns about smoking cigarettes and how that can be harmful for you. reflection communication behavior +109_24 Were you aware of the fact that smoking these little cigarillos, the Swisher Sweets, can have some of the same negative health effects? question communication behavior +109_26 Mm-hmm. So it's kind of surprising to you that something you've been doing and you've been doing more and more of it is actually pretty bad for you. reflection communication behavior +109_28 Mm-hmm. What do you kind of make of that now that you realize that you're actually a tobacco user and that you might actually be causing some pretty se-serious health effects. question communication behavior +109_30 Mm-hmm. other communication behavior +109_32 Well, the good news is in terms of the nicotinic stomatitis, at the point in which you stop smoking, you can actually reverse all the negative effects that occurred and you might also know that you can stop the progression of any other diseases that had started, just by quitting smoking. therapist_input communication behavior +109_34 Yeah. Is that something you'd be interested in? question communication behavior +109_36 Mm-hmm. Well, if you think about it on a scale of 1 to 10 where 1 is really don't think you could do it at all and 10 is really confident that you could quit if you tried, where do you think you fall? question communication behavior +109_38 Okay, what made you choose seven or eight as opposed to a-a five? question communication behavior +109_40 Mm-hmm. So, it sounds like just to kind of summarize, you've noticed some negative effects of the smoking, you have some concerns about health effects that could occur, there's the financial aspect, and yet you feel pretty confident that you could quit if you tried. So, where do you think we should go from here? reflection communication behavior +109_42 Okay, well, I'd be happy to talk to you more about that and give you some tips and advice and give you some suggestions about where you can get some support with quitting. therapist_input communication behavior +109_44 I really appreciate you talking to me about this today. other communication behavior +110_0 --today. other communication behavior +110_2 Okay. So, you want your son to grow up in a great environment and to have more than you had? reflection communication behavior +110_4 Is that right? so that's on your mind right now? question communication behavior +110_6 Mm-hmm. other communication behavior +110_8 Mm-hmm. Is there anything in particular that's happening right now where this is more of a concern for you than usual? other communication behavior +110_10 What you want to do in life? Can you explain? question communication behavior +110_12 So you feel that your differences in career choices is-is having an impact on your relationship with your son? reflection communication behavior +110_14 Mm-hmm. other communication behavior +110_16 Mm-hmm. other communication behavior +110_18 Mm. Okay, so your boyfriend? question communication behavior +110_20 Is he your fiance or your boyfriend? question communication behavior +110_22 Okay. other communication behavior +110_24 Okay. And he's a truck driver? question communication behavior +110_26 Does he drive long distances- question communication behavior +110_28 -or just local? question communication behavior +110_30 And so sometimes he's gone away from home for, what like, days, weeks? question communication behavior +110_32 Okay. And so he's a truck driver and you are an aspiring social worker, and you have a son who you want to give a really great life to, and you feel that you and your boyfriend are in different, going in different directions- reflection communication behavior +110_34 -maybe? Is-- Can you elaborate on the part that you're maybe the most concerned about or that's the most on your mind right now? question communication behavior +110_36 Mm-hmm. other communication behavior +110_38 Okay, okay. And so that-that realization that you're having right now is, it sounds like, it seems like maybe, just from your nonverbal, that maybe you feel like you need to make some sort of a choice. Is that right? reflection communication behavior +110_40 Yeah? Okay. reflection communication behavior +110_42 Mm-hmm. other communication behavior +110_44 Well, you know that he's not physically available- reflection communication behavior +110_46 -to do these things that you want to do- reflection communication behavior +110_48 -like go on picnics. reflection communication behavior +110_50 "He's saying to you, ""why is it a problem?""" reflection communication behavior +110_52 Mm-hmm. other communication behavior +110_56 Yeah. other communication behavior +110_58 So, your heart says you want this great relationship where there's like a true family unit and you can go on picnics and be together but your mind says, what? reflection communication behavior +110_62 Mm-hmm. other communication behavior +110_64 Mm-hmm. other communication behavior +110_66 Mm-hmm. other communication behavior +110_68 Mm-hmm. other communication behavior +110_70 Mm-hmm. other communication behavior +110_72 Mm-hmm. other communication behavior +110_74 Okay, so you know what you want, you're not so sure that your boyfriend wants the same thing. His actions indicate that he doesn't. reflection communication behavior +110_76 His words indicate that he does or he doesn't? You're not sure? I'm not sure about that part either? question communication behavior +110_80 Yeah. other communication behavior +110_82 Mm-hmm. So now you have this information and it's on your mind, is there-- have you given any thought about what you might want to do about it? question communication behavior +110_84 Mm-hmm. other communication behavior +110_86 Mm-hmm. [chuckles] other communication behavior +110_88 Mm-hmm. other communication behavior +110_90 Mm-hmm. other communication behavior +110_92 Mm-hmm. other communication behavior +110_94 Mm-hmm. other communication behavior +110_96 Oh. other communication behavior +110_98 So that's another realization. reflection communication behavior +110_100 "It's like, ""Wow,"" it's really, really prevalent for you right now, you realize that you are the caretaker, you are the person who listens to other people but you don't necessarily have someone like that for you and so—" reflection communication behavior +111_0 Hi, are you Katie? question communication behavior +111_2 Hi, my name is Beth. I'm the nurse that works with the nurse practitioner Mrs. Smith that you just saw. Do you have a moment to talk? therapist_input communication behavior +111_4 I know you were here to get a prescription for birth control but while you were waiting to see Mrs. Smith, you filled out a healthy habits questionnaire- therapist_input communication behavior +111_6 -and you answered some questions about your marijuana use. Would it be okay if I asked you some questions about how marijuana plays a role in your life? question communication behavior +111_8 I notice you use marijuana regularly, and I wanted to ask you more about that. therapist_input communication behavior +111_10 No. No, no, no. Not at all. Um, I just wanted to ask you how it helps you and how you use it. Can you tell me a little more about how you use it? question communication behavior +111_12 Marijuana is really useful in your life in helping you relax? reflection communication behavior +111_14 Mm. You're a very successful student and you have a lot of responsibilities, and it's really adding to your stress. reflection communication behavior +111_16 Mm. You've been very successful academically and the transition to college has been hard for you. reflection communication behavior +111_18 I promise you, you're not in trouble, I wanna help. therapist_input communication behavior +111_19 Uh, tell me besides helping you relax, what are some positives about pot? question communication behavior +111_21 Hmm. Uh, when you use pot in a group you feel more at home with your peers and more accepted? reflection communication behavior +111_23 So how is it working to help you fit in? question communication behavior +111_25 Mm. So smoking pot with your peers to try to fit in more but it doesn't seem to be making you feel more comfortable with your friends. reflection communication behavior +111_27 What are some downsides to smoking pot? question communication behavior +111_29 So smoking pot doesn't help you feel more socially comfortable with your peers and it increases your stress because you're worried about your family and legal consequences? reflection communication behavior +111_31 Can you think of any other downsides to smoking pot? question communication behavior +111_33 So smoking pot also reminds you of your financial situation and you don't have extra cash to spend on things? reflection communication behavior +111_35 Katie, it sounds like smoking pot is helping you somewhat in helping you relax and it's also causing you a lot of stress because you're trying to use it to fit in and that's not helping, you're worried about getting caught, you're worried about family disapproval. Having said all that, what do you think you wanna do about your pot use? reflection communication behavior +111_37 Would it be okay if I made a suggestion? question communication behavior +111_39 You mentioned at the beginning of our conversation that you have a history of dealing with anxiety, have you ever talked to a counselor about that? question communication behavior +111_41 Can you tell me more? question communication behavior +111_43 Mm. So the idea of counseling in your family is for crazy people only and it's looked down upon and the cost would cause a problem too? reflection communication behavior +111_45 Katie, we know that many kids come to college and have a lot of stress and deal with a lot of anxiety, and we've also found that when they talk to our counselors and learn specific skills about dealing with anxiety, they do much better. Um, and it's been really successful for a lot of kids. Um, I'm wondering if you think it might be helpful for you? therapist_input communication behavior +111_47 Can you describe why you're hesitant? question communication behavior +111_49 Well, the cost is free and the counseling services we provide, we are legally obligated to protect your privacy. We can't tell your parents. There are some exceptions to that privacy rule, including, uh, mostly if we're concerned about- that your safety. therapist_input communication behavior +111_51 Exactly. other communication behavior +111_53 Well, uh, we can go into some more specifics if you decide to see the counselor about what-what privacy rules there are, but for the most part, you wouldn't need to worry about us sharing anything with your parents. therapist_input communication behavior +111_55 So, uh, if-if you're walking out now, I can walk out with you and just take you around our counseling center. I can even introduce you to one of the counselors. therapist_input communication behavior +111_57 No. No, no. I just wanted to show you where it is and let- make sure you know about our resources here at the college. therapist_input communication behavior +112_0 So, Chris, I wanted to talk to you. Um, you know, you're one of our star athletes. I really value you as a team player. As Athletic Director, one of my jobs is to, kind of, keep tabs on the players and make sure everybody is performing at their best. And something came up this weekend. I've been hearing some chatter about a big party that went down and understand you were there. And so I wanted to talk to you a little bit about how partying and alcohol fits in your life right now. therapist_input communication behavior +112_2 Mm-hmm. other communication behavior +112_4 Mm-hmm. other communication behavior +112_6 So, here you are. You're an honors student. You're a star athlete. You've, kind of, been doing everything you've been told for all these years, and maybe last month sometime, you started getting more involved in the party scene. reflection communication behavior +112_8 And it was fun at first. But now you're already noticing some consequences. reflection communication behavior +112_10 Mm-hmm. other communication behavior +112_12 It's really changed your focus. What do you like about drinking? question communication behavior +112_14 So, it helps you, kind of, loosen up, feel more relaxed. reflection communication behavior +112_16 Sounds like you're noticing quite a few not so good things about alcohol though your mom got mad at you, you're having decreased focus, you're, kind of, not doing so well in school, maybe- reflection communication behavior +112_18 -or any other things? question communication behavior +112_20 Mm-hmm. other communication behavior +112_22 So, your-your friends that you were hanging out with, there's a little tension there now. reflection communication behavior +112_24 Mm-hmm. other communication behavior +112_26 Okay. other communication behavior +112_28 Well, given that you've sort of noticed all these changes where it's affecting your friendships, it's affecting your studying, it's affecting your relationship with your mom. Where do you think you should kind of go from here? question communication behavior +112_30 Mm-hmm. other communication behavior +112_32 Mm-hmm. other communication behavior +112_34 Yeah. other communication behavior +112_36 Your mom is really important to you. reflection communication behavior +112_38 And how she feels about you is important to you. reflection communication behavior +112_40 How important is it to you to make, uh, an adjustment in your drinking or even to quit? question communication behavior +112_42 Okay. other communication behavior +112_44 Okay. other communication behavior +112_46 How confident are you that you could actually change your drinking or-or even cut down or quit? question communication behavior +112_48 O-on a scale of 1 to 10 where one is not at all 10 is completely what number would you give. question communication behavior +112_50 Okay. other communication behavior +112_52 Why did you say eight or nine rather than six or seven? question communication behavior +112_54 Mm-hmm. other communication behavior +112_56 All right, what do you think's a realistic goal for you then? question communication behavior +112_58 Mm-hmm. other communication behavior +112_60 So your goal is kind of to do not drink at all or if you are at a party, uh, a maximum of one at the very most. reflection communication behavior +112_62 Yeah. Chris, I really appreciate you talking with me about this. I know it seems like something that's been on your mind as it is and, you know, like I said I really care about you as a student and an athlete and want what's best for you. So I'm glad we were able to talk about this. It really seems like you have a good plan going forward, you know, really striving for not drinking alcohol at all and if you find yourself in a situation where there's alcohol, making sure to have that limit of one drink maximum. It sounds like something that will work for you. reflection communication behavior +112_64 It's my-- yeah it's my pleasure. It's part of my job and it's probably like this so. I'm going to hurry up and get changed for practice. therapist_input communication behavior +113_0 Hi, Sandra. other communication behavior +113_2 Thanks for coming in and talking with me for a couple of minutes. I understand you don't have very much time, but I really appreciate you stopping by. reflection communication behavior +113_4 So I get the impression that there are some things that you're concerned about, but that overall, coming in here wasn't necessarily the first thing that was on your mind when you came to the hospital with your daughter. Um, so can you tell me, what was it that made it possible for you to even come in? What-what were some of the things you were thinking about? reflection communication behavior +113_6 So the last thing you'd want is for your daughter to start smoking. reflection communication behavior +113_8 Hmm. And it sounds like your smoking, setting an example, those are some things that-that you're also, uh, a bit concerned about, um, but as you said earlier, not-not really ready to put down your cigarettes immediately. reflection communication behavior +113_10 So Sandra, what's good about smoking? What do you like about it? question communication behavior +113_12 What else? Tell me what else is good about it. question communication behavior +113_14 Okay. So is there anything else that you like about it? question communication behavior +113_16 So let me make sure that I understand all of the good things about smoking, the things that you like about it, and let me know if I've missed anything or left anything out. reflection communication behavior +113_18 So it sounds like it's a way to relax. It's a way to socialize with your friends from work, and it's hard to imagine what it would be like for you at work if you couldn't go outside and smoke. reflection communication behavior +113_20 You also mentioned that smoking is a way to manage your weight, and concern that if you were-were going to quit smoking, what that would do in terms of, um, gaining weight, and that smoking after meals is pleasurable, that it's something that would be really hard to give up. reflection communication behavior +113_22 I also heard that it's very much a part of your life. It's something that you've done for a really long time and almost impossible to think about yourself as a non-smoker. Does that capture, for you, some of the good things or things that are keeping you smoking? reflection communication behavior +113_24 So I'm hearing there are some things you really like about smoking. What about the other side? Can you tell me about some of the not-so-good things? reflection communication behavior +113_26 Sandra, can you give me an example of a time that you did something that you think left an impression on your daughter or set a bad example for her? question communication behavior +113_28 So this morning, that experience, it really brought home how she does watch you, and she does really look up to you and notice what you do. How did that feel when you looked up and saw her watching you? reflection communication behavior +113_30 And again, thanks for your honesty in talking about this. I appreciate that this is a- this is a tough topic. This is a-a hard behavior to think about giving up. Um, I guess one thing that- one thing that doesn't make sense to me is that, you know, on the one hand, you talk about how being a good parent is your highest priority, it's really important to you to set a good example for your daughter- reflection communication behavior +113_32 -um, and on the other hand, I'm hearing you say that smoking is important in terms of stress relief, socializing, and it's something you can't imagine ever changing. How do those two things fit together? question communication behavior +113_34 So what would it take for quitting or changing your smoking to be something that was more important, that raised it up in the list of priorities for you? question communication behavior +113_36 Okay. other communication behavior +113_38 "So, it's-it's not so much that you don't wanna quit in a way, it's almost, ""How could I do it that would work for me?""" reflection communication behavior +113_40 Okay. I appreciate. We've- we've probably used up the time that we have. I would love to see you next week if you'd be willing to schedule another appointment and talk with you more about this. Is that something that would be helpful? therapist_input communication behavior +113_42 Okay. So I hear-- [crosstalk] other communication behavior +113_44 [chuckles] Not necessarily the-the most exciting thing for you to do, but I appreciate you are willing to do that. Can I also ask you to do a little bit of homework between now and next week? I promise it's not too time-consuming. Um, we have a booklet that we like to give folks who are just thinking about changing, who aren't sure that this is something that they're ready to do, and one of the exercises is to write down your top three reasons for change, why you would even consider quitting smoking. And then to reflect on some of the good things as we talked about, as well as some of the less good things about quitting and about continuing to smoke. Is that something you'd be willing to do over the next few days? therapist_input communication behavior +113_46 Okay, here you go. other communication behavior +113_48 So thanks for coming in, Sandra. We'll see you next week. reflection communication behavior +114_0 In summary, the Minnesota State Mankato security report states that you were stopped on stadium road last Friday, cited for driving under the influence and you're transported to detox. Plus the report lists your age as 20. Dylan, what is the accuracy of the report? And can you share with me some details leading up to the incident? question communication behavior +114_2 You decided to drink more than you intended because you were disappointed at how the Vikings were playing. And when your roommate couldn't give you a ride home, you decided to drive yourself home. Did I get that right? therapist_input communication behavior +114_4 Yeah, I understand that your intention was to have a good time while watching the game with your friends. You didn't think about what could go wrong when you drank alcohol underage because you were at your friend's house and not a big party and you made an effort to be safe by finding a ride home. reflection communication behavior +114_6 Dylan, you told me what brought you here today, what do you think the problem really is? question communication behavior +114_8 Sounds like you attribute your current situation to bad luck. If that's what you believe and you don't attempt to make any change in your behavior, what consequences might result? question communication behavior +114_10 How important is it that you avoid future problems with the police or school, Dylan? question communication behavior +114_12 Yeah. What would you be willing to do to prevent going to detox again and getting suspended? question communication behavior +114_14 On a scale of 1 to 10, how confident are you that you'll be able to follow through with that plan with 10 being very confident? question communication behavior +114_16 What steps could you take to move that six to a seven or eight? question communication behavior +114_18 "In what ways might your life be better if you succeed in +making the changes you mentioned?" question communication behavior +114_20 College is all about making choices. Can you tell me about your beliefs and values that influenced your decision-making and how do those beliefs and values align with the decisions you plan to make about drinking? question communication behavior +114_22 Thanks for coming in for participating today. Your sanction will involve being placed on university disciplinary probation and attending an alcohol education seminar that will cost $150. therapist_input communication behavior +116_0 Molly, thank you so much for coming over and yakking with me today. other communication behavior +116_2 Yeah, I appreciate it. So, um, uh, your mom had given me a call and said that, um, um, there were some problems with kids kinda given you problems at school and being mean and things like that, and, uh, that's a hurtful thing. therapist_input communication behavior +116_4 That's a- that's a lot of school to, yeah, and, you know-- therapist_input communication behavior +116_6 People like to make up stories. reflection communication behavior +116_8 For, like why do you think, wh-what kinds of- question communication behavior +116_10 So it's, uh, so when you were talking about like nagging on, tell me a little bit more about, can you give me an example of what you mean? question communication behavior +116_12 And-and what happens when you don't leave it be, what usually happens? question communication behavior +116_14 Okay. other communication behavior +116_16 Okay. other communication behavior +116_18 Okay, so and then what-what's it like for you after that, once you get spanked in the principal's office? question communication behavior +116_20 Mm-hmm. other communication behavior +116_22 Mm-hmm. other communication behavior +116_24 That's pretty cool that you did that. reflection communication behavior +116_26 You should be proud of yourself, and how did you do that? question communication behavior +116_28 Uh, that says a lot about you and your mom's relationship though that you can kind of put yourself in her head and think about how she would feel about it. reflection communication behavior +116_30 You know what I mean? It's pretty cool, not everybody can do that, so. So you could kind of put yourself ahead, uh, it's almost like watching a movie ahead- reflection communication behavior +116_32 -and knowing how it's gonna turn out. reflection communication behavior +116_34 That's the worst, the silent treatment. reflection communication behavior +116_36 Yeah, so, um, so but that worked for you, where you just let it go, you thought about your mom, you like what we would call like, you channeled to your mom, you know, and, uh, channeling mom, and then, um, you were able to walk away, and you were proud of yourself and nothing bad happened. reflection communication behavior +116_38 Is that right? question communication behavior +116_40 Does it-- question communication behavior +116_42 Yeah, so- and so when you- when somebody else told you that they or people said you that you're an easy target, um. question communication behavior +116_44 Okay. other communication behavior +116_46 Okay, so they-they kinda know how to hook you. reflection communication behavior +116_48 -and reel you in- reflection communication behavior +116_50 -right, and get you upset. And then bad things happen and then you get in trouble. reflection communication behavior +116_52 Yeah. So, yeah. And it's, uh-- So, um-- so you-you know that when you're kind of channeling your mom, that helps. It sounds like you taught yourself almost. Like there's- reflection communication behavior +116_54 -a conversation inside. What other ideas do you have about what you could do? question communication behavior +116_56 Mm-hmm. other communication behavior +116_58 I don't know what pickleball is. other communication behavior +116_60 It looks like a pickleball? question communication behavior +116_62 There's no pickle? question communication behavior +116_64 Okay. other communication behavior +116_66 I wanted to pickle and stuff. other communication behavior +116_68 That's a really good decision. other communication behavior +116_70 Yeah. No, but how smart on your part to know that if you would- if you would had to play with her, something bad would've happened. reflection communication behavior +116_72 You knew that. question communication behavior +116_74 Right? You knew that. So- question communication behavior +116_76 So you know actually which kids- question communication behavior +116_78 -know how to push your buttons that real you in. reflection communication behavior +116_80 That's okay. That's-- Yeah, 'cause it's not important. The important thing is for you to be happy. And, uh-- other communication behavior +116_82 Uh-huh. other communication behavior +116_84 Uh-huh. other communication behavior +116_86 Yeah. other communication behavior +116_88 Yeah. That's-- that-- it's-it's really big unknown territory. Pressure High School class is probably 1,000 kids. reflection communication behavior +116_90 1,003 kids. other communication behavior +116_92 2,000- therapist_input communication behavior +116_94 -potential enemies, friends, who knows which ones. reflection communication behavior +116_96 That must have been hard for you. reflection communication behavior +116_98 Yeah. other communication behavior +116_100 Mm-hmm. So but finally after three months, time went by- reflection communication behavior +116_102 -and you got-- question communication behavior +116_104 Okay. And so how else do you identify who your friends are that you can really trust who have your back? question communication behavior +116_106 You trust her back then? question communication behavior +116_108 Okay. Well, that makes a lot of sense that people-- it goes both ways. reflection communication behavior +116_110 You know. And, um-- So and for you, friends that, um, kind of, um, give you the attention that you'd like to have. Texting you- reflection communication behavior +116_112 -calling and you hanging out with you, and stuff like that, rather than pretending to be a friend- reflection communication behavior +116_114 -when you know maybe they're gonna-- reflection communication behavior +116_116 Mm-hmm. other communication behavior +116_118 Mm-hmm. other communication behavior +116_120 Mm-hmm. other communication behavior +116_122 Mm-hmm. Wh-what don't you like about her? question communication behavior +116_124 Okay. So she sounds like she's, um-- reflection communication behavior +116_126 Or-or not worth your time. reflection communication behavior +116_128 She's not worth your time. So what would it be like for you to really just spend time with the friends that you know are really-- question communication behavior +116_130 Good. That's really good. Yeah. And if-if you need like some extra support from them-- question communication behavior +116_132 Right, and what kind of things do you ask from them? question communication behavior +116_134 'Cause they can do that. They can- they can kinda give you some, uh, information like, uh, um-- they can give some accurate information, um, and back up your story versus the other person's story. question communication behavior +116_136 So, okay. So we're-- You know what? Um, it sounds like you actually have some pretty good ideas about, um, how to handle this, and yet kids are-- I know kids-- actually, adults can be really mean too. But, um, I know in high school, i-it's really bad. reflection communication behavior +116_138 So I'm wondering if, um, uh, if-if you wanted to, we could get together again and continue to talk 'cause you-you've got some good ideas already. And I'm very open that if you wanted to bring any of your good friends in, that that would also be totally cool too. therapist_input communication behavior +116_140 So would that be something-- question communication behavior +116_142 Yeah. other communication behavior +116_144 Okay. other communication behavior +116_146 Yeah. other communication behavior +116_148 Well, I would want this session though to be for you though, Molly. therapist_input communication behavior +116_150 I mean I'm willing to see her too, you know. therapist_input communication behavior +116_152 It sounds like she really needs-- she'd like someone to listen to her. reflection communication behavior +116_154 Yeah. So, um, we could maybe talk about some other ways of, um, helping, uh, deal with this because, um, it does sound like, um, people are, you know, just being plain old mean to you for no good darn reason. reflection communication behavior +116_156 Yeah. And, um, so you'd be willing to come back and talk about it then? Okay. All right. And I just wanna let you know that I think that you're, um, really doing a good job of-of, uh, dealing with how hard it is to be in high school, 'cause it is hard. reflection communication behavior +116_158 It is. other communication behavior +116_160 Yeah. And it is hard, and-and I-I think it gets better. My experience was it got a little better. The freshman and sophomore year, you know. reflection communication behavior +116_162 But, um, anyway, I think you are hanging in there beautifully, and I love hearing that you're involved in swimming and some other things 'cause they must help connect you up with some pretty-- I would hope- other communication behavior +116_164 -[unintelligible 00:13:12] people. So okay, anything else? No? Okay. All right. question communication behavior +116_166 Thank you. other communication behavior +117_0 Hello, nice to meet you again. And, uh, and what seems to be the-the problem or what-what prompted you to come along? question communication behavior +117_2 Okay, so you feel as if drinking is a problem for you at the moment? reflection communication behavior +117_4 Okay. Wh-What makes you say that it's gotten worse? question communication behavior +117_6 Okay. other communication behavior +117_8 Yes. other communication behavior +117_10 Sure. other communication behavior +117_12 Okay, okay, so you've noticed over, I guess, uh, the last six months in particular since you decided, you know what? I'm going to take a risk and-a-and go out to try to meet a-a-a pot-potential partner again that it's with an increase in drinking. reflection communication behavior +117_14 Okay. other communication behavior +117_16 Sure, sure. So you're noticing that the drinking at the moment is a way of perhaps calming the nerves? reflection communication behavior +117_18 To-to-to speak to-to potential partners? reflection communication behavior +117_20 Who-who-who, boys? question communication behavior +117_22 Okay. other communication behavior diff --git a/AnnoMi-therapist/test.tsv b/AnnoMi-therapist/test.tsv new file mode 100644 index 0000000000000000000000000000000000000000..2297c8c5d0743b019839f1153a1ab3c81d4cae04 --- /dev/null +++ b/AnnoMi-therapist/test.tsv @@ -0,0 +1,1141 @@ +id text label dimension +117_24 Okay. other communication behavior +117_26 Sure. other communication behavior +117_28 That's interesting isn't it? You-- 'cause you kind of mentioned it there, like, you know, on one side of the coin, um, it helps calm the nerves to get yourself get out there and- reflection communication behavior +117_30 -talk to guys at the same time, on the other side it's not working you're finding. And i-i-it results in hangovers or? reflection communication behavior +117_32 Okay, and so I guess, you know, what would you like to do given the circumstances? question communication behavior +117_34 Yeah. other communication behavior +117_36 Okay. other communication behavior +117_38 Okay. other communication behavior +117_40 Okay, okay, so, uh, sounds like you really want to stop drinking, particularly during the weekdays? reflection communication behavior +117_42 Right, because you're noticing it's having a negative impact on what you're eating. reflection communication behavior +117_44 No, I get it. Yeah. I mean, you know, it sounds like it's, it is helpful to a degree for you when you go out because it makes you feel a little bit more calm to talk to-to guys is that right? reflection communication behavior +117_46 Yeah. other communication behavior +117_48 Yeah. other communication behavior +117_50 Sure. other communication behavior +117_52 "Yeah, yeah. So, you've got, you know, some benefits there then, you know. The social element, hanging with friends and-and going out together is something which is-is quite enjoyable. So, it's not a case of removing it completely but it’s a case of, ""Okay, I’m noticing this is impacting on me more than what I’d like to."" Yeah. Yeah, okay." reflection communication behavior +117_54 Has there been times in the past where you’ve tried to cut back on drinking? question communication behavior +117_56 Oh, this is the first time anything like this has come up? question communication behavior +117_58 Yes, yes. other communication behavior +117_60 Okay, yeah. Well, it’s great that you’re able to identify, you know, what’s going on at the moment and you've-- not only know that, you almost picked up on a bit of a pattern too you're in- other communication behavior +117_62 -as to why you’re-you're drinking. In terms of looking at cutting back on-on drinking, you know, on a scale of 0 to 100 and 100, uh, meaning it’s tremendously important for you and 0 not important at all. How important is it for you to cut back on the drinking? question communication behavior +117_64 Okay, yeah yeah sure, you're already taking a huge step forward in many ways by coming along to-to start talking about it. other communication behavior +117_66 Um, I guess 80 is quite high, what makes you say an 80 over say 50? question communication behavior +117_68 Okay. other communication behavior +117_70 "Okay, yes, so you’ve got this real sense of, ""I've gotta do something.""" reflection communication behavior +117_72 That’s what it seems like. reflection communication behavior +117_74 So, at the moment, it's been a case of the last six months, this is a pattern that you’ve been noticing more and more, um, a sign that it has had negative impacts on your lifestyle which you’re not happy with and you are in you're in a position where, you know what? I wanna do something about it. reflection communication behavior +117_76 Okay, I mean what do you think that next step is? therapist_input communication behavior +117_78 Yeah. other communication behavior +117_80 Okay. other communication behavior +117_82 Okay. other communication behavior +117_83 -so it just doesn’t go crazy. other communication behavior +117_84 Okay, okay, so you’re thinking about perhaps looking at trying to keep weekdays free of alcohol? Was that what you were saying? therapist_input communication behavior +117_86 Okay, how does that sound like a first step goal for you? therapist_input communication behavior +117_88 Okay. other communication behavior +117_90 Okay, you sound really mad about it to-to turn it around. reflection communication behavior +117_92 Okay, oh, that-that's excellent, okay. other communication behavior +119_0 Thanks for coming in. Tell me what's been happening since we last spoke. question communication behavior +119_2 Wow, that's so great. other communication behavior +119_4 You sound disappointed. reflection communication behavior +119_6 It's gonna keep happening that you have to turn down opportunities. reflection communication behavior +119_8 Mm-hmm, okay. Well, tell me, um, on a scale from one to 10, how important is it for you to get a job? question communication behavior +119_10 Yeah. You're-you're-you're it. reflection communication behavior +119_12 You have to provide for your children. reflection communication behavior +119_14 Um, and tell me on a scale from one to 10, how confident are you that you could get a job? question communication behavior +119_16 So, it sounds like, you know, the childcare issue has been getting in the way, and so finding something that would work for you would be really helpful. reflection communication behavior +119_18 And then also it sounds like you're kinda feeling not so great about your resume and your experience. reflection communication behavior +119_20 Okay. What is it that you- what is it that you want? question communication behavior +119_22 Yeah. Yeah. So, if you had- if you had consistent work, it would change your life in a lot of ways. reflection communication behavior +119_24 Mm-hmm. It would provide the income that you need and you wouldn't worry so much. reflection communication behavior +119_26 Right. So every day you know where you're going. reflection communication behavior +119_28 Okay. And you know, what's- what's happening for the- for the day, for the week. reflection communication behavior +119_30 Yeah. other communication behavior +119_32 Right. Yeah. Because you're- you're the kind of parent that wants to make sure your kids are doing well. reflection communication behavior +119_34 Yeah. Um, so tell me, what would it take to get you to like a five in confidence, to feel a little bit more confident about getting work? question communication behavior +119_36 Okay, Yeah. other communication behavior +119_38 Mm-hmm. other communication behavior +119_40 Yeah. Because you definitely need to go to an interview in order to get the job. reflection communication behavior +119_42 So having taken care of that part, having some reliable childcare would definitely help. reflection communication behavior +119_44 What else would get you to a five? question communication behavior +119_46 Okay. other communication behavior +119_48 Mm-hmm, mm-hmm. other communication behavior +119_50 Okay. other communication behavior +119_52 Yeah, so if you had something on your resume that was around education training, maybe a certificate of some kind of a field that you're interested in, that you would feel proud of yourself. reflection communication behavior +119_54 Mm-hmm. Okay. What-- do you have any ideas as to what fields you might be interested in getting some more education, more training? question communication behavior +119_56 Like what's going to be fastest. reflection communication behavior +119_58 Okay, and so if- if you were, it sounds like if you were going to do something you'd wanna to do something really quickly like a short- a short certificate. reflection communication behavior +119_60 Yeah, sort of like a short-term or transition into something else. reflection communication behavior +119_62 But that would be steady and pays well? reflection communication behavior +119_64 Okay, and allow you to afford everything you need to afford. reflection communication behavior +119_66 Okay, so specifically getting some computer skills will help? reflection communication behavior +119_68 The technology. reflection communication behavior +119_70 Mm-hmm. Okay. So whatever and so far it sounds like getting a job is really important right now and you really need the money and you really need to take care of your children and it sounds like you have some ideas as to how you could get to these interviews for one, and then once you're there at the interview, feeling more confident about your skills, um, getting some child-- reliable child care certainly sounds very important. reflection communication behavior +119_72 Um, as well as maybe doing some sort of certificate or getting some classes and training in computers? question communication behavior +119_74 Okay. other communication behavior +119_76 So what would you like to do next, you think? question communication behavior +119_78 Okay, okay. other communication behavior +119_80 That's a priority. reflection communication behavior +119_82 Yeah. other communication behavior +119_84 Yeah. other communication behavior +120_0 Well, I'm glad we figured that out and I think you'll feel better over the next few days. other communication behavior +120_2 Well, since I have you here and we still have a few minutes left, I'd like to bring up another topic. I noticed that your blood pressure and your weight have been climbing a bit over the past few years. We haven't really had time to talk about this much before and I may be able to offer some useful strategies. Would it be okay if we discussed weight and health for a few minutes? question communication behavior +120_4 I know how you feel. Managing weight can be frustrating. Maybe we can just start trying to figure it out together and I'll be here to help you through the challenges. reflection communication behavior +120_6 Yeah, that's certainly understandable. We both know that there's a lot that plays into weight management, but there's no need to figure it all out today, especially since things are so busy for you right now. Maybe we could put our heads together and think about something small that fits reasonably into your life and then we can take further steps when you're ready. therapist_input communication behavior +120_8 Well, let's see. One of the things that's involved in managing weight and health is being active. Physical activity benefits the whole body. It's healthy for our joints, our stress levels, and especially for weight management. Perhaps we could talk about some ways of adding activity that fit into your life. therapist_input communication behavior +120_10 Well, I understand that. I don't have an hour to go to the gym every day either, but one of the great things about physical activity is that any amount in any type of activity can be very helpful. For example, let's think about some activities that you enjoy doing. therapist_input communication behavior +120_12 Me too. Walking is great exercise. therapist_input communication behavior +120_14 Actually, even just a few minutes of walking is really healthy and worthwhile, and then when you have time to do even more, that's great. Walking is also great because you can do it anywhere, it doesn't need to be at the gym. therapist_input communication behavior +120_16 That sounds great. other communication behavior +120_18 Well, dancing is a great exercise, especially because it's fun. therapist_input communication behavior +120_20 Oh, that's great to hear that your family is so supportive. And I bet there's a dance class somewhere around where you live or maybe even a dance fitness class at the gym. reflection communication behavior +120_22 Would you like to do some research on this and give it a shot? therapist_input communication behavior +120_24 Well, small steps can go a long way. So, even things like taking the stairs instead of the elevator every once in a while or parking just a bit further from the door when you go to a store can be ways to increase movement in your day. therapist_input communication behavior +120_26 How about we start there and let's plan to follow up in a few weeks so we can see how it's going and then maybe talk about some other strategies that might help. therapist_input communication behavior +120_28 Not necessarily. What we eat is certainly important for weight and health, but just like we did today, we can talk about some small steps that can fit into your life, and especially ones that you feel good about. therapist_input communication behavior +120_30 That's great. I'll see you soon other communication behavior +121_0 Uh, welcome. And, uh— other communication behavior +121_2 I'd say my name is Mark and I work here at Green Prescriptions. And- therapist_input communication behavior +121_4 I know a little bit about you from the referral letter from the doctor. reflection communication behavior +121_6 From your GP, yeah. reflection communication behavior +121_8 But before we get to anything, I'll probably want to just ask you a little bit about what's led you to come here today and get a bit of an idea about what's been going on for you. other communication behavior +121_10 Mm. other communication behavior +121_12 And what did he have to say? question communication behavior +121_14 mm. other communication behavior +121_16 Right. other communication behavior +121_18 Mm. other communication behavior +121_20 Right, so he kinda gave you a directive? reflection communication behavior +121_22 Mm. other communication behavior +121_24 So it kind of came a bit of a surprise, you feeling okay. reflection communication behavior +121_26 "You go for this checkup with the doctor. And he says, ""You've got Type II diabetes.""" reflection communication behavior +121_28 Mm. Came out of the blue for you? reflection communication behavior +121_30 Mm. other communication behavior +121_32 And you said you kind of don't fit that kinda Type II diabetes look. That you kinda have had this idea- reflection communication behavior +121_34 -you've been-been overweight with it. reflection communication behavior +121_36 Mm. other communication behavior +121_38 Mm. other communication behavior +121_40 Mm. other communication behavior +121_42 Mm. other communication behavior +121_44 Hmm. So it doesn't quite fit in your head, Type II diabetes and- reflection communication behavior +121_46 -your lifestyle? question communication behavior +121_48 Comes as a big surprise. And what was your reaction when he told you that at the time? question communication behavior +121_50 Mm. other communication behavior +121_52 Mm, mm. other communication behavior +121_54 Yeah, yeah. other communication behavior +121_56 He's got a lot to do. reflection communication behavior +121_58 Mm. other communication behavior +121_60 Right. other communication behavior +121_62 Mm. other communication behavior +121_64 So how are you feel in your head- question communication behavior +121_66 -and what the tests say kind of like don't join up. reflection communication behavior +121_68 Mm. other communication behavior +121_70 Hmm. other communication behavior +121_72 Hmm-hmm. other communication behavior +121_74 Hmm. other communication behavior +121_76 Yeah. What's the problem? Mm. reflection communication behavior +121_78 And how did this happen is probably kind of what you're also thinking. Well, how did this--? reflection communication behavior +121_80 Mm. other communication behavior +121_82 Okay. other communication behavior +121_84 Yeah. other communication behavior +121_86 Mm. other communication behavior +121_88 So he mentioned, it might be a family thing. And so you- reflection communication behavior +121_90 -maybe got from your parents or something of the sort. reflection communication behavior +121_92 Mm. other communication behavior +121_94 Mm. other communication behavior +121_96 Right. other communication behavior +121_98 Mm-hmm. other communication behavior +121_100 Yeah. other communication behavior +121_102 Mm. other communication behavior +121_104 Right. other communication behavior +121_106 So he fits the picture- reflection communication behavior +121_108 -when you think about what he-he-- Yeah, he's stereotypical. reflection communication behavior +121_110 A little bit bigger, perhaps doesn't look after himself that well, and he fits that foot reflection communication behavior +121_112 Yeah. other communication behavior +121_114 Mm. So you got this knowledge as a witness there's some family history of diabetes in the past? reflection communication behavior +121_116 Doctor mentioned that as being a factor. reflection communication behavior +121_118 That's certainly true. Yes. We know that people who've had parents or have been in the past, there is a hereditary factor or genetic factor in-involved. therapist_input communication behavior +121_120 Mm. other communication behavior +121_122 Correct. Yeah. therapist_input communication behavior +121_124 But it's not inevitable. therapist_input communication behavior +121_126 Because its genes or the-the-the-the hereditary factor is not the only factor that causes it or is involved in it happening to you. So there's other factors that come into play. therapist_input communication behavior +121_128 Well, you've-you've mentioned some of the things you know, and one of those is hereditary factors. You mentioned that the doctor mentioned that. And what else do you know or have you heard? You say you haven't had a lot of time to do the research. What else? Other things you've. question communication behavior +121_130 Yeah. other communication behavior +121_132 That makes a bit of sense. other communication behavior +121_134 Yeah. other communication behavior +121_136 Yeah. other communication behavior +121_138 They managed with it. reflection communication behavior +121_140 Okay. I don't know if it'd be helpful for you if you'd like to know a little bit more about some of the factors involved in time Type II diabetes. other communication behavior +121_142 If that would help. other communication behavior +121_144 Well, I'll perhaps share with you what I know from working with other people and some of the things I've experienced in working with people. other communication behavior +121_146 And see what you make of it. See if it fits a little bit more with where you're at. We know that there is a strong family factor or hereditary factor, so that's one aspect. So also it tends to happen a little bit later in life, rather than something you might get when you're a teenager, this type of diabetes. So-so it's a later onset. It takes a bit of time for it to develop maybe. And the main reason I think, um, the main aspect of it is that it, have you heard about insulin. therapist_input communication behavior +121_148 So that's a hormone or a chemical, it allows you to utilize sugar in your body. therapist_input communication behavior +121_150 All right. And Type II diabetes typically people have a resistance or a resistance to insulin in their cells, in their fat cells or their muscle cells or liver cells. They can't use insulin. And so sugar builds up in your system. therapist_input communication behavior +121_152 You need insulin in your cells, individual cells in muscle or in fat or wherever to, um, use up excess sugar or to utilize sugar. therapist_input communication behavior +121_154 That's right. other communication behavior +121_156 Kind of, as your. other communication behavior +121_158 Yap. other communication behavior +121_160 Yeah. other communication behavior +121_162 That's a good way to think. other communication behavior +121_164 Exactly. And what's happening in Type II diabetes is your-your fat cells and liver cells and muscle cells are resistant to insulin. It's almost like they're saying we can't use that. therapist_input communication behavior +121_166 And if-- Well, there's a number of-- We're not entirely sure, there's a lot of research still going on as to how this happens and how that could be modified. But what we do know is that, um, one of the key things in managing it is to try and modify or modulate, control the amount of sugar that are in your system. therapist_input communication behavior +121_168 Yeah. So there's a couple of things that we know that people with Type II diabetes have to look after and have to think about if they want to control the amount of sugar that's in their system, which is the main issue that's causing some of the health problems that people have with Type II diabetes. Too much sugar, and if it's not able to be utilized in the blood cell, in the fat cells, or liver cells, and the muscle cells stays in your bloodstream. And that can cause problems with your circulation. So too high blood sugar and too low a blood sugar can be a problem. So sugar is the main concern in Type II- Type II diabetes.And you mentioned earlier on, a couple of things that the doctor-- You've mentioned some signs that he was kind of a little bit concerned about. Well, what things did you notice over the-over the last month or so? therapist_input communication behavior +121_170 Yeah. other communication behavior +121_172 Yeah. other communication behavior +121_174 Yeah. other communication behavior +121_176 Yeah. other communication behavior +121_178 A slightly more sedate lifestyle. reflection communication behavior +121_180 Yeah. other communication behavior +121_182 Yeah. other communication behavior +121_184 Yeah. It should feel like there's something really wrong with you. other communication behavior +121_186 What's-how have you been feeling over the last month? So, you say you're very busy you're doing a lot of work. question communication behavior +121_188 Yeah. other communication behavior +121_190 Mh-hmm. other communication behavior +121_192 Okay. other communication behavior +121_194 So a little bit sort of energy is not quite there sometimes? The vitality. reflection communication behavior +121_196 Yeah, Mh-hmm. other communication behavior +121_198 Yeah. other communication behavior +121_200 Mh-hmm. other communication behavior +121_202 You haven't noticed it. So it's a progressive, you know, you've just seen this, as-as you got older, things have slowed down. You know those activities you used to do, but that's kind of like what happens. reflection communication behavior +121_204 Mh-hmm. other communication behavior +121_206 Yeah. other communication behavior +121_208 Okay. other communication behavior +121_210 Hmm, a bit of a mystery there. reflection communication behavior +121_212 Really? So what I'm hearing is there's actually a lot of aspects in your life which are really good. reflection communication behavior +121_214 From your perspective, things are going well? reflection communication behavior +121_216 Yeah. It doesn't fit. reflection communication behavior +121_218 Mh-hmm. other communication behavior +121_220 Right. other communication behavior +121_222 Yeah. When you get uh, a headache. reflection communication behavior +121_224 Yeah. other communication behavior +121_226 So the idea of having to test-test your blood sugar and take medications is kinda like off-- reflection communication behavior +121_228 And you know that's a bit too- other communication behavior +121_230 Too much. reflection communication behavior +121_232 Yeah. Okay. other communication behavior +121_234 And you're here today and that's probably something in you you've thought well I'll follow this through, you know I'll-I'll come along and see what-see what they've got to say. And I'm just wondering for this session, for the time we have today, there's a number of things we could talk about. You mentioned a couple of things about your lifestyle and, um, medication is one thing you've been told by the doctor you might need to do that. And a number of things that we could talk about today. Which-which area would you think would be useful for you to focus on? question communication behavior +121_236 Hmm. other communication behavior +121_238 Okay. other communication behavior +121_240 Mh-hmm. other communication behavior +121_242 So then, since you've been on your own since you've separated, divorced and you've noticed that the things you eat and how you eat has changed. reflection communication behavior +121_244 Hmm. other communication behavior +121_246 Yeah, yeah. other communication behavior +121_250 Hmm. Yeah, yeah. other communication behavior +121_252 Yeah. And your-- part of your wife used to do a lot of that for you? reflection communication behavior +121_254 Yeah. other communication behavior +121_256 And so she would kinda look after what you ate and healthy things that you had, spread in front of you and off you go. reflection communication behavior +121_258 Mm-hmm. And now you have to think about what you might eat and sometimes you don't eat the best. reflection communication behavior +121_260 Okay. other communication behavior +121_262 Hmm. other communication behavior +121_264 Yeah. other communication behavior +121_266 Yeah. reflection communication behavior +121_268 Very appealing, isn't it? reflection communication behavior +121_270 Mm-hmm, Mm-hmm. other communication behavior +121_272 Yeah they look pretty good on the plate, don't they? reflection communication behavior +121_274 Yeah. other communication behavior +121_276 They're food choices in what you eat and what's in your diet it's not what-something you actually you've actually been aware of or had to think about in the past. reflection communication behavior +121_278 So one thing that you noticed is diet and the eating patterns and- reflection communication behavior +121_280 -when you eat. That's one aspect. What other aspects do you think you've-- you would be--? question communication behavior +121_282 Right. other communication behavior +121_284 You kinda juggle those two things and kinda-- reflection communication behavior +121_286 You still run and have a cigarette? reflection communication behavior +121_288 Hmm. Hmm. Yeah, part of the culture. reflection communication behavior +121_290 Yeah. other communication behavior +121_292 Yeah. other communication behavior +121_294 Hmm. other communication behavior +121_296 But over the years, you've actually reduced your smoking or you've stopped altogether or at times? reflection communication behavior +121_298 Hmm. other communication behavior +121_300 Okay, so you meant to reduce. reflection communication behavior +121_302 You were noticing that it's having an impact on your breathing and health wasn't so good. reflection communication behavior +121_304 When you related that to your smoking, so you managed to reduce your smoking. reflection communication behavior +121_306 So you've made our decision to do that? reflection communication behavior +121_308 Hmm. other communication behavior +121_310 Yeah, and it's hard to get to stop something you enjoy, isn't it? reflection communication behavior +121_312 Hmm. other communication behavior +121_314 Yeah. other communication behavior +121_316 Hmm. other communication behavior +121_318 But they go together so well. And sugar in the coffee? question communication behavior +121_322 Hmm. other communication behavior +121_324 "You're drinking more coffee. So what I've heard you say so far is, if I can just start right back from the beginning and you used to come in and sais, ""I went to the doctor."" You went for-- it sounds like you went for just a checkup." reflection communication behavior +121_326 MIT. reflection communication behavior +121_328 Got to check out, why not? reflection communication behavior +121_330 Hmm. other communication behavior +121_332 Yeah. other communication behavior +121_334 So everything else looked pretty good? reflection communication behavior +121_336 Cholesterol good, your weight is good. reflection communication behavior +121_338 Um, you are smoking, but you've managed to reduce that. reflection communication behavior +121_340 And anything else, you know, you go ticking down the list. The tire is good, oil good. reflection communication behavior +121_342 So we're looking good. reflection communication behavior +121_344 And ah, hang on. reflection communication behavior +121_346 Yeah, there's something wrong with the, uh, with this bit. reflection communication behavior +121_348 And it doesn't quite fit with how you see your own lifestyle. reflection communication behavior +121_350 Because you've-- it sounds like what you've been doing, you've made some conscious effort to be aware of some of those things you might think are important. reflection communication behavior +121_352 Mm. other communication behavior +121_354 Yeah. other communication behavior +121_356 So like a domino effect, and they'll all be just sitting- reflection communication behavior +121_358 Mm-hm. other communication behavior +121_360 A bit broad kind of like you've gotta change everything. reflection communication behavior +121_362 Yeah. And your thought was, yeah, right, I hear that, but actually, I don't want to make all these big changes in my life. reflection communication behavior +121_364 Feel like you need to. Yeah. reflection communication behavior +121_366 Mm. other communication behavior +121_368 The test, is the test, and experience, yeah. therapist_input communication behavior +121_370 I don't know. I think it's up to you where we start, and that's the question I've got in my mind. You've mentioned a couple of things that you've already made some effort, or been conscious of. You've mentioned the diet, you've mentioned your smoking, those are two quite important aspects that we often talk about here in how people work. reflection communication behavior +121_372 It can have an impact, yes. So smoking, um, affects your blood system, so it hardens the arteries, um, and over time, it can have a significant impact on the healing of wounds. So people with Type II diabetes, often, if they get a cut, or a bruise, or something, it takes a long time to heal. Smoking reduces the amount of oxygen in your system, so that can further, you know, limit the time it takes your body to heal. therapist_input communication behavior +121_374 So we know that smoking and Type II diabetes together- therapist_input communication behavior +121_376 -isn't a good combination. therapist_input communication behavior +121_378 Well, the question is, I suppose, that I have for you is, where would you think, for you, would be a good place to start? If you were gonna make any changes, even small changes at the beginning, rather than just thinking, oh, I got to change everything, which it sounds like you're not prepared to, you know, do a whole lifestyle change, and I don't think that's what we're talking about here. Where would you feel most comfortable to start if you were gonna make any changes at all? question communication behavior +121_380 Yeah. Hmm, that might be a start. therapist_input communication behavior +121_382 Hm. What we also find is that people make these little changes, small changes, and that starts to kind of well, it makes them- therapist_input communication behavior +121_384 -rollover, the domino effect starts to happen, and they start looking at other aspects. reflection communication behavior +121_386 "So rather than thinking, ""oh, my God, I have to change all these things. I've gotta stop smoking, I've gotta exercise more, I've gotta, you know, start eating more fruit and vegetables,"" you might start with these small changes, and then-" reflection communication behavior +121_388 Um, I-I'm reluctant to give a prescription for that because I think it's really up to you. And I think it depends on how things go, as to how much you need to do. therapist_input communication behavior +121_390 You mentioned earlier on, the doctors talking about you monitoring your blood sugar. reflection communication behavior +121_392 So on how-- It depends on how-how that goes. Let's say, if you started doing that and you do some more exercise, you start to have longer blacks, rather than short blacks with lots of sugar. And you get down the sugar and you find your blood sugar starts to come down, then we're heading in the right direction. reflection communication behavior +121_394 So it's really, I suppose, up to how things go for you, and you get that feedback. And if that's going in the right direction, you carry on doing and do some more of that. reflection communication behavior +121_396 I think where we start is where you feel comfortable starting. other communication behavior +121_398 Apples for breakfast. therapist_input communication behavior +121_400 So what I'm hearing you're kind of saying is, that there's-- You're now starting to think of some very useful little starting points. reflection communication behavior +121_402 Not huge changes, but some little things you could do. reflection communication behavior +121_404 And it's kind of dawning on you there may be some possibilities here for making some changes. Let me ask you this. Um, let's say you put some of these things in place and you start to make some of these small changes. reflection communication behavior +121_406 Um, where do you see that taking you in the next set of three, four, five years? You know, where do you want to be in three to four years' time? What would be your ideal picture? question communication behavior +121_408 No. other communication behavior +121_410 Yeah? You like the social aspect? reflection communication behavior +121_412 No, no, I get that. I get that. other communication behavior +121_414 So part of that whole keeping fit and exercise stuff is actually the social side of it, isn't it? reflection communication behavior +121_416 Yeah. other communication behavior +121_418 Haven't quite that- other communication behavior +121_420 And the coffee helps a little bit because it perks you up? reflection communication behavior +121_422 And the sugar in it helps too. reflection communication behavior +121_424 So what I'm hearing is that your life, your work, your routines are-- Sometimes you're driving or you've got to keep awake, get up in the morning sometimes and you haven't quite got that buzz or the energy. You need a shot, and then throughout the day you might need just more shots to keep that energy up. reflection communication behavior +121_426 Yeah. other communication behavior +121_428 And an activity which has got a starting to finish and it's something you do for a slot. therapist_input communication behavior +121_430 And then there's maybe some social aspects to it as well. reflection communication behavior +121_432 You can see some benefits and some enjoyment that. reflection communication behavior +121_434 That sounds like a great plan. reflection communication behavior +121_436 Yeah, sounds like a good idea. other communication behavior +121_438 I think anything you do, it has to be something you've decided. You know, just start where you want to start. You've mentioned some really good ideas about possibly getting a little bit more exercise into your life, doing something like squash or something of that nature. You've mentioned some really good ideas about reducing the amount of sugar you-you-you're-you're intaking during the day, and coffee is a good place to start. Having an apple for breakfast, I think you mentioned that, a bit of fruit. reflection communication behavior +121_440 Those are some really good ideas and good starting points. So thinking about it like that, what-- Where are you now? What's your-- What-what-- Where-where is your thinking now? question communication behavior +121_442 What's to lose? What's to gain? question communication behavior +121_444 It does make sense, yeah. other communication behavior +121_446 So when you look at it, there's probably more to gain from making these changes than there is to lose. reflection communication behavior +121_448 Right. other communication behavior +121_450 Yeah. other communication behavior +121_452 So you've got to work these things on your mind. You know, the-- And workout where's the place to start. reflection communication behavior +121_454 Yeah. other communication behavior +121_456 You've been stuck? reflection communication behavior +121_458 Yeah? other communication behavior +121_460 Indeed, yeah. other communication behavior +121_462 So rather than-- other communication behavior +121_464 Carrying on. reflection communication behavior +121_466 So it's been a bit of a-a bit of a shock, but now you kinda reflect on it. reflection communication behavior +121_468 Maybe this is the- other communication behavior +121_470 "-bit of a shake that I needed, you know, just sort of remind me. I might feel okay. I might-- From my perspective, your perspective, you're thinking, ""Well, what's the problem? Everything's fine.""" reflection communication behavior +121_472 "But now you seem to be thinking looking and thinking, ""Maybe things weren't, or aren't, as good as I thought they were.""" reflection communication behavior +121_474 Things could be better? reflection communication behavior +121_476 Yeah, I sense that. I sense that in you that you're-- reflection communication behavior +121_478 Quite invigorated with the idea of-- reflection communication behavior +121_480 Making some of these changes. Yeah. reflection communication behavior +121_482 You're up for the challenge? reflection communication behavior +121_484 So think about when you were-- This-this is an interesting question to see what you think. You were- you were a coach. You-- Maybe you'll be a coach again. reflection communication behavior +121_486 "What would you say if you were talking to yourself, if you like, you know, if you were the coach saying, ""Right--""" question communication behavior +121_488 Yeah, what-what would you be saying? question communication behavior +121_490 Yeah. other communication behavior +121_492 Yeah. other communication behavior +121_494 And, I suppose, our own personalized a little bit like that, there's lots of different aspects that need to be tweaked. therapist_input communication behavior +121_496 Modified and looked at, to get the best out of ourselves, to get the best out of the opportunities we have. therapist_input communication behavior +121_498 Yeah, yeah. other communication behavior +121_500 "Some good things I'm- some things I'm good at and there are some other aspects we think, ""Well--""" reflection communication behavior +121_502 It's not about giving up your personality or- reflection communication behavior +121_504 -changing who you are fundamentally. reflection communication behavior +121_506 It's just tweaking things. Just fine-tuning a few areas and being a bit more aw-aware of one aspect of your life a bit more, like the food choices or whatever. Well, Mike, I-I've really enjoyed listening to your perspective, and your story a little bit, and it's helped me a lot to get an idea about where you're coming from, and a little bit about who you are, and what's happened in your past. And-and we've also talked a bit about what's going to happen next. And you've come up with some great ideas. What I hear you saying is that, you know, before all this, before you met the GP, things are going fine.Well, as you would of-- As, you know, as you'd seen it, you were just doing your thing, and getting on working, and being busy, and being successful, and then suddenly this diagnosis, this doctor tells you that you've got a problem. reflection communication behavior +121_508 It comes along to me and talk today a bit about how you felt about that. Initially, it can be quite a bit of a-bit of a shock. It didn't quite fit with how you saw things. reflection communication behavior +121_510 And as we've been talking, I'm hearing you're saying that maybe if you look back to where you were before you went to the doctor, things weren't quite that right, maybe. Things weren't as good as you thought they were. reflection communication behavior +121_512 Yeah. other communication behavior +121_514 And what I also hear you saying, it's possibly the-- It's now possibly more possible, in your mind, that you could make some of these changes, rather than bring broad-brush, you know, huge changes to your lifestyles. It's not about changing who you are, it's not changing huge facets of your life, but maybe small steps that need to be taken. reflection communication behavior +121_516 What you're kind of thinking about what those might. reflection communication behavior +121_518 Mm. other communication behavior +121_520 Yeah. other communication behavior +121_522 Nobody there too. reflection communication behavior +121_524 Yeah. other communication behavior +121_526 Mhm. other communication behavior +121_528 So now it's time- reflection communication behavior +121_530 -to think about looking after yourself a bit more. reflection communication behavior +121_532 Why not? reflection communication behavior +121_534 Yeah. So, we've run out of time but I also want to ask you a final question, where to from here, what's next? question communication behavior +121_536 You'll start with that? reflection communication behavior +121_538 Yeah. other communication behavior +121_540 The gym. reflection communication behavior +121_542 Yeah. other communication behavior +121_544 Yeah. other communication behavior +121_546 Yeah. other communication behavior +121_548 Yeah. other communication behavior +121_550 Yeah. other communication behavior +121_552 And you also mentioned you'll perhaps go and- back and see the doctor and just give him a bit of an update as to- reflection communication behavior +121_554 Yeah. other communication behavior +121_556 Mhm. other communication behavior +121_558 Yep. other communication behavior +121_560 It's fine. other communication behavior +121_562 Sure. other communication behavior +121_564 Mhm. other communication behavior +121_566 You are gonna make a start? reflection communication behavior +121_568 It is. Well, just to help you, because there's probably a lot of other questions you might have, other questions that might come up after this session. other communication behavior +121_570 -before we go, I'd like to just-just give you a lot of- some information that might help-help you. therapist_input communication behavior +121_572 Not too much, just some stuff that might just give you a little bit of background information on- therapist_input communication behavior +121_574 -some of the things that have- other communication behavior +121_576 -around type- around Type II diabetes and some,- other communication behavior +121_578 [unintelligible 00:36:53] some of that. other communication behavior +121_580 Um, and I'd like to us- for us to meet again, so to catch up with you and make an appointment before you leave. Just to see how things are going and- therapist_input communication behavior +121_582 -see what sort of little changes you've managed to make. I'd be really [unintelligible 00:37:07]- reflection communication behavior +121_584 It's really up to you. Probably a little bit sooner would be good. therapist_input communication behavior +121_586 That'd be great. other communication behavior +121_588 How does that sound? question communication behavior +121_590 Because you don't know the timeline? question communication behavior +121_592 Mhm. other communication behavior +121_594 Yeah. other communication behavior +121_596 Excellent, excellent. Thanks, Mike. [croostalk] other communication behavior +122_1 Mm-hmm. other communication behavior +122_3 Got it. other communication behavior +122_5 Uh-huh. other communication behavior +122_7 Mm-hmm. other communication behavior +122_9 Mm-hmm. other communication behavior +122_11 Yeah. So-so you've got this new group of friends and-and, um, you-you actually kind of like where you're at with things right now. And your mom was going through your stuff and found your stash, and it's just turned into a, you know, all of this. reflection communication behavior +122_13 Yeah. reflection communication behavior +122_15 Yeah. reflection communication behavior +122_17 And, uh, sounds like you're-you're pretty upset with your mom for-for doing that? reflection communication behavior +122_19 Yeah. reflection communication behavior +122_21 Right. It's like your private place and, you know, it's-- that's-- it's your stuff. reflection communication behavior +122_23 Yeah. So why should she go through yours? reflection communication behavior +122_25 Yeah. Yeah other communication behavior +124_0 Okay. So what ideas do you have, Natalie for, um, getting started in adding more physical activity? question communication behavior +124_3 Great. It sounds like there are a lot of activities that you do like- reflection communication behavior +124_5 -and I'm hearing a theme of climate control, [chuckles] being important to you and you've already been researching gyms. reflection communication behavior +124_7 Tell me more about that. question communication behavior +124_9 Right. Okay. So you're looking for some-something that's reasonably priced- reflection communication behavior +124_11 -and that you don't have to sign a contract and you're right. It's hard to tell what the cost is just from looking on the website. reflection communication behavior +124_13 And I completely agree [laughs]about wanting to avoid the sales pitch- reflection communication behavior +124_15 -um, element of it. What seems like a logical next step based on-- You've kind of already gotten the ball rolling. What feels like a logical next step? question communication behavior +124_17 Okay. So maybe visiting a gym and then also choosing a non-gym activity to sort of get started when the weather's permitting. reflection communication behavior +124_19 I have one, um, idea that is jumping into my mind as you're talking. Is it okay if I share that? question communication behavior +124_21 I'm wondering about the price of the YMCA compared to other gyms. Uh, is that one that you have an interest in or have looked at already? therapist_input communication behavior +124_23 Yes. And honestly, I don't either. [chuckles] I just suspect that it might be slightly cheaper than some of the more private gyms. other communication behavior +124_25 So something to look into if you're interested. reflection communication behavior +124_27 And they-- I would suspect they'd be less sales pitch-oriented than a private gym. So it might be a safe place to explore first- therapist_input communication behavior +124_29 -and to build some confidence in that conversation. reflection communication behavior +124_31 Okay. Great. So, um, in addition to exploring the gym possibility, what sounds like a logical next step for a non-gym activity to get started, some small goal that feels doable, um, and you have control over because it doesn't require the perfect weather- question communication behavior +124_33 -or the perfect gym? reflection communication behavior +124_35 Okay. So exploring some yoga classes. Is-is doing yoga in your living room appealing to you at all? question communication behavior +124_37 That's great. It's important to know this about yourself, what works, and what doesn't work, and what you feel motivated to do. So, it sounds like we sort of have two small goals right now. One is to maybe visit the YMCA and-and find out how much that costs- reflection communication behavior +124_39 -and the other goal being maybe just a walk, um, one time between now and the next time I see you. Um, and I say one time, you can, of course, go more than that, but just with snow in the forecast, it might be reasonable to start with a small goal like that and go for one nice day between now and a few weeks from now when I get to see you again. How do those two goals sound? reflection communication behavior +124_41 Okay. So you'd like to kind of get motivated with- with the use of an app and that might help you get started. reflection communication behavior +124_43 Okay, fantastic. So, on a scale from 0 to 10, 10 being really confident, I can research a gym and go for one walk, and zero being not at all confident, how are you feeling about these two small goals? question communication behavior +124_45 Okay. other communication behavior +124_47 Wonderful. Are there any other barriers that would be helpful to sort of talk through? question communication behavior +124_49 Okay. So being creative with your indoor space is a-is a solution you've come up with yourself for - f there just aren't any good days, nice days outside. reflection communication behavior +124_51 Great. Well, you came in today feeling pretty discouraged about your energy levels and your mood and, um, feeling lousy about your body in general. And, uh, today we've talked about a small-small step to get started and you're hoping to experience some mood boost and some energy as you get rolling here. Um, how are you feeling about today's session? reflection communication behavior +124_53 Great. Well, I look forward to checking in with you, and thanks so much for coming in. other communication behavior +125_1 So, what you're saying is you've had a rough night? reflection communication behavior +125_3 So, she needed to eat every three hours last night and that was really frustrating for you? reflection communication behavior +125_5 Hmm. So, based on what your mom told you, you were expecting Lilly at this point to be sleeping through the night? reflection communication behavior +127_0 So, where you said you'd like to start, Sal, is talking about your asthma and specifically about your dog and how one is affecting the other. reflection communication behavior +127_2 Hmm. So, what- can you let me know or-or what do you know about your asthma and the things that affected or might make it worse? question communication behavior +127_4 Mm-hmm. other communication behavior +127_6 Hmm. other communication behavior +127_8 Right. other communication behavior +127_10 Okay. And that your pet has never been mentioned as a concern? question communication behavior +127_12 Hmm. Yeah. And I-I can see that you've already worked hard to make some changes. You've almost quit smoking. reflection communication behavior +127_14 You're just down to your last couple of cigarettes- reflection communication behavior +127_16 -and you're not even smoking those in the house. reflection communication behavior +127_18 So, your house is totally smoke-free. reflection communication behavior +127_20 Yeah, okay. And you have also thought about cutting back on alcohol. reflection communication behavior +127_22 -and-and I think you mentioned done-done a little bit towards that. reflection communication behavior +127_24 Okay, okay. other communication behavior +127_26 So now almost like that's not good enough, like now you have to, now it's the dog and now- reflection communication behavior +127_28 -what's next. Right. Okay. So, I mean, there is certainly a lot of evidence that pets in the home and the dander from their fur can make asthma worse. therapist_input communication behavior +127_30 -but I wonder what are your experiences with Oscar, you know, when he's in the house or-or maybe sleeping near you or you're around him, what happens with your asthma symptoms? question communication behavior +127_32 Okay. other communication behavior +127_34 Hmm. So, it doesn't make total sense to you that-that it's all Oscar's fault and that- reflection communication behavior +127_36 That's that the only solution. other communication behavior +127_38 I guess I also wonder whether, regardless of-of if your asthma symptoms are connected to Oscar, that may be part of you feels like it's worth it because he's been- reflection communication behavior +127_40 -such a big part of your life for so long. reflection communication behavior +127_42 Hmm. Yeah. And-and in the end, you know, whatever you- whatever you do, about Oscar, about your asthma, about all the other things that we talked about on that agenda-setting worksheet, I mean, you are in the driver's seat solid. It really is your choice. other communication behavior +127_44 Mm-hmm. other communication behavior +127_46 There's a lot of decisions and a lot of change with your wife, with the new baby. reflection communication behavior +127_48 And now thinking about, looking after your health and wanting to be healthy for your wife and your baby. reflection communication behavior +127_50 Mm-hmm, so what-what would need to happen or how would you know, when you- when or if you ever did have to make a decision about whether to keep Oscar with you or not? question communication behavior +127_52 Mm-hmm. other communication behavior +127_54 Yeah and I get the feeling that it's something that you wanna think about that this is a really big decision- reflection communication behavior +127_56 -and it's not one that you're gonna make in a hurry. reflection communication behavior +127_58 Mm-hmm. other communication behavior +128_1 Yeah. He wasn't too happy with the exam, was he Hailey? question communication behavior +128_3 Um, well the good news is that the exam's over and I don't think Jake has pneumonia. What I actually think he has is a cold. So there are some things you could do to manage his symptoms. Would you be interested in knowing? question communication behavior +128_5 What I would recommend is that you avoid over-the-counter cold remedies, keep him away from any friends or family who may have the flu, keep him well hydrated, um, avoid excessive dust, and avoid smoking. And at least that last one's easy because you are an ex-smoker now. therapist_input communication behavior +128_7 Oh, fun. other communication behavior +128_9 All right, Well, first I'd just like to commend you for your honesty and that's really helpful information that you shared with me. Thank you for letting me know that you're smoking again and-and, um, I also appreciate the fact you're taking so many measures to protect your son from secondhand smoke. Can I give you some advice on how you could protect him, even the- even further? question communication behavior +128_11 So, my sense is that you're smoking and you're minimizing hi-his exposure by not smoking in the same room and smoking near windows. Is that- therapist_input communication behavior +128_13 -correct? question communication behavior +128_15 So what I would recommend then, is to move your smoking outside completely. As a smoker, the ideal situation for a smoker in the house is if their home can be made smoke-free and the smoking is moved entirely outside, especially while he's experiencing this cold. therapist_input communication behavior +128_17 Okay, so, what I'm hearing you say is that, it sounds like a feasible short-term plan, not ideal and not comfortable because what you really enjoy is that cigarette with a glass of wine, kicking back up on the sofa and chilling out perhaps while you're watching TV. And to maintain that long-term outside smoking outside in Canadian winters where it's cold and snowy, not realistic. reflection communication behavior +128_19 So, on the one hand I'm hearing smoking and drinking at night as a way to chill out but at the same time the next day, you're not feeling so great. reflection communication behavior +128_21 Would it be helpful to give you some information on low risk drinking guidelines? question communication behavior +128_23 Okay. Well, Hailey, what they suggest is that women don't have more than one to two standard drinks a day or a total of nine standard drinks in a week. How does that fit for you? therapist_input communication behavior +128_25 So, it sounds like you'd be open to reducing as a way to still enjoy the wine but perhaps alleviate the way you feel in the morning, some of the hangover effects that sounds like you're experiencing. reflection communication behavior +128_27 Okay. So, you're gonna try to reduce the drinking, not sure about the smoking, what the plan is but I think we did agree upon earlier that you would move it outside, at least while he's sick? question communication behavior +128_29 That's okay. All right and, um, I guess we'll see you next week for Jake's six-month checkup. Is there anything else we could talk about that might be helpful? question communication behavior +128_31 Sure, of course, Hailey a-and again I really appreciate your openness and honesty about letting me know what's going on with, you know, the stress levels and coping and drinking. I just had a thought that there's also a good mom's group, we run out of our center. So if you'd like a referral to that or some information, I'd be happy to give you and while you think about it, if you want to, um, talk about this further with one of my colleagues, I'd be happy to make you an appointment. therapist_input communication behavior +128_33 Thanks, Hailey. We'll see you next week. other communication behavior +129_1 Huh, you feel like you dodged the bullet. reflection communication behavior +129_3 It feels like it was like two days was a year? question communication behavior +129_5 Ah. other communication behavior +129_7 Okay. other communication behavior +129_9 Okay. other communication behavior +129_11 So what would have happened if you found out that you were pregnant? question communication behavior +129_13 Okay. That's a big step and that's not the direction you want to go in right now. reflection communication behavior +129_15 Would you be open to kind of exploring the idea of birth control and family planning? question communication behavior +129_17 Now, it's a discussion you don't really wanna have. reflection communication behavior +129_19 At the same time, you have some concerns about the possibility of getting pregnant. reflection communication behavior +129_21 "So you found some ways to prevent pregnancy up until-- well, maybe, um, you've been pretty fortunate, and then there is also some times where you feel like, ""Oh, no. What if I didn't dodge the bullet?""" reflection communication behavior +129_23 Mm-hmm. other communication behavior +129_25 Okay. So, you've been able to kind of avoid any kind of consequences, and right now, you're not feeling that talking about birth control is something on your-your list. reflection communication behavior +129_27 Sure. I totally appreciate that, and it's your decision, Olivia. You know yourself best and what fits for you. If you ever feel like you like to open up the idea of conversation about family planning or birth control, I'd love to talk to you about that another time. therapist_input communication behavior +129_29 Okay. other communication behavior +129_31 Okay. I respect that. Thanks though for coming in to see me today. other communication behavior +129_33 And I'm glad that this appointment was a positive one for you. other communication behavior +129_35 You're welcome. other communication behavior +132_0 Hello, again, Mr. Green. It's really nice to see you again. If you remember last week, we looked at your results here and you've got impaired glucose tolerance and you were a bit worried about type two diabetes, your blood pressure and your cholesterol are up a bit too. So today, we're meeting up to talk through some of the things that you could do for yourself that might improve the situation. And as you know, there's all sorts of things can affect your health. So can we just have a bit of a general chat, but how are you getting on? reflection communication behavior +132_2 Actually, I'm not going to do that because you're the boss. It's up to you what you want to do with you about your own health. therapist_input communication behavior +132_4 You don't seem too happy about that. reflection communication behavior +132_6 Well, there's a lot of things you can do yourself that will improve the situation as well. So what we can do today is wee up some of those things, smoking, diet, exercise, weight, loss, all those kinds of things. So we're just gonna start and see how you feel as we go. therapist_input communication behavior +132_8 Well, it's very much up to you, you're the boss of your own life. Where would you like to start? question communication behavior +132_10 Well, I could give you my opinion. Um, and I can give you lots of information, but I think you know the score pretty well. And I think you'd know what I would say. therapist_input communication behavior +132_12 Absolutely. Spot on. So stopping smoking would have a huge impact, that would have a big impact very early on. Losing weight would also have a big impact because that would help with your blood pressure, your cholesterol, and also lower your diabetes risk. So what-what'd you think about those things? Uh, question communication behavior +132_14 It’s really tough. It's hard to know where to start, isn't it? reflection communication behavior +132_16 How important is it for you then to lose weight? question communication behavior +132_18 So can it be in there for your-your family's important to you? question communication behavior +132_20 Yeah. So w-where do you think you can start with that? question communication behavior +132_22 What's kind of the first thing you might think about doing? question communication behavior +132_24 Yeah. That would be a really good place to start, mm-hmm. reflection communication behavior +132_26 So I think it should be really supportive of that then. reflection communication behavior +132_28 So what would you do to make sure you didn't get hungry at work? question communication behavior +132_30 Yeah. Well, a big bowl of vegetable soup. You could probably count that as one or maybe even two of your five a day. So it'd be a really good place to start. Anything else you could think about doing? reflection communication behavior +132_32 Well, that's good. That's probably benefited you already. And the other thing you might not be aware of is that salt intake is linked to loss of calcium from our bones, which makes the bones more fragile. So reducing your salt intake will really help with that too. therapist_input communication behavior +132_34 So well, maybe you can help her as well and that would be good. Well, I think you've got off to a really great start, Mr. Green. You're very well aware of what you-you need to do, and you've obviously thought about it and got some good plans in place. So you're going to reduce your-your alcohol intake, you've already started by reducing your salt intake. Um, perhaps when we meet up next time we could talk a little bit about smoking and exercise as well, when you're ready for that. So how do you feel now? reflection communication behavior +132_36 That's great. So should we meet up at the same time next week then? question communication behavior +132_38 That’s great. All the very best then. other communication behavior +133_0 Thanks for coming in today. I guess you've, uh, sat in that seat with lots of people like me in the past. question communication behavior +133_2 Yeah. And you have some ideas about that and some experiences about that. So today I wanna- be good for us to talk about that and, um, I'm really interested to know what you've been thinking about in terms of what you may wanna change in your life 'cause we're gonna be working together for a while here. question communication behavior +133_4 What you've been thinking about, um, over the last little while about getting your life back on track. 'Cause I noticed you've— question communication behavior +133_6 Yeah. other communication behavior +133_8 Sure. So what I'm picking up is-is that-that-that's a life that you know a lot about. reflection communication behavior +133_10 And you can make lots of money and set yourself up well. What's the other side, because I guess when I talk to guys like yourself who have done time, often they're thinking about actually, mm, maybe life can be with different. So I'm wondering where-where you're at with the kind of thinking about— question communication behavior +133_12 Okay. other communication behavior +133_14 Sure. So life on the outside is pretty different than the kind of- reflection communication behavior +133_16 -the expectation of life on the inside something? question communication behavior +133_18 Yeah? question communication behavior +133_20 So tell me how you've been managing. 'Cause I don't know if you'd been back dealing? How have you been managing to-to-to— question communication behavior +133_22 Okay. other communication behavior +133_24 Yeah? other communication behavior +133_26 Uh, tell me- question communication behavior +133_28 It's there and-and-and you've a lot of contacts? question communication behavior +133_30 You've been in the system, so lots of context. So this isn't a new challenge for you. reflection communication behavior +133_32 So what stopped you over the last-- How long have you been out now? question communication behavior +133_34 Yeah. other communication behavior +133_36 Three weeks, isn't it? question communication behavior +133_38 So what's been there? What's it about that you haven't done in three weeks one day? question communication behavior +133_40 22 days you've actually made a decision not to-to pick up your old life and continue on. reflection communication behavior +133_42 Okay. other communication behavior +133_44 Right. So the one hand you've-you-you could sit yourself up and-and take the risk, but on the other hand, you know, that actually it might not last? reflection communication behavior +133_46 Never lasts. Mm. You seem like a bit of a crossroads to me. reflection communication behavior +133_48 Mm. But there've been times when those crossroads would be more sort of focused than other times. reflection communication behavior +133_50 Yeah. And it sounds like maybe like- reflection communication behavior +133_52 Yeah. other communication behavior +133_54 Yeah. other communication behavior +133_56 Okay. Okay. So— other communication behavior +133_58 No. Well, I've-I've got lots of ideas, but I'm really interested to hearing your ideas kind of first though because you know, and there might be some things that we can work on. other communication behavior +133_60 But I guess what I'm really interested in is-is you've made a commitment 22 days, drug-free. Haven't gone back into that lifestyle. What-what's keeping you, 'cause you're at the crossroads, you kind of just pause there at the moment. I'm not sure about this other bit over here. What keeping you in that place? question communication behavior +133_62 Yeah? question communication behavior +133_64 Tell me about Fiona? question communication behavior +133_66 Okay. other communication behavior +133_68 Okay. So you've been with Fiona for how long? question communication behavior +133_70 12 years. Okay. So she's stood by you then for the time, [crosstalk] but this time she said, it happens again I'm out of here? reflection communication behavior +133_72 Okay. And it sounds like you're listening to that black and white line. reflection communication behavior +133_74 Yeah, yeah. other communication behavior +133_76 Yeah. other communication behavior +133_78 Okay. So something's changed in your relationship between you, yeah? question communication behavior +133_80 Okay. So what's Fiona want you from you? question communication behavior +133_82 She wants him. So which him does she want, Daryl? question communication behavior +133_84 Does she want the- did she want the-the him that she fell in love with and saw great things in? question communication behavior +133_86 Or does she want the-the-the-the him that's- that keeps on getting into trouble? question communication behavior +133_88 Okay. other communication behavior +133_90 So what's it gonna take to reclaim this Daryl that she fell in love with? question communication behavior +133_92 Sure, yeah. other communication behavior +133_94 "All right. Well, let's-let's just play with this idea a little bit, Daryl. So what did Fiona fall in love with? What were the qualities of Daryl that she said, ""This is him""?" question communication behavior +133_96 I know. other communication behavior +133_98 Sure. Everyone will age, but that will happen on time. reflection communication behavior +133_100 Um, but that's okay. So-so it's she fell in love with this, the sense of fun, the sense of Daryl, and things have changed, but she's still with you? reflection communication behavior +133_102 Yeah? other communication behavior +133_104 Yeah. And you're still with her? question communication behavior +133_106 Yeah. So catch me up with the conversations you've had with Fiona about this crossroads you're at. You know, these 22 days, you haven't gone back, you've coming out and you're not back? You could pick up this dealing quite easily and probably some workout here tomorrow and get back into it. question communication behavior +133_108 Okay. All right. So-so back together, things are starting to get tense at home, and your relationship a little bit? reflection communication behavior +133_110 Yeah. Don't put words in your mouth. I'm sure if that is— reflection communication behavior +133_112 Oh, yeah? Yeah? other communication behavior +133_114 Second, I'd like to talk, Daryl, about this all- whole idea, that's this crossroads idea, yep? So on the one hand here, you've got this 12 year history of being in the other system and done some time and being away from Fiona, but you're now back, sitting back together, and you've got some choice about where to go. So, in that 'where to go', what ideas have you been thinking about in terms of where this-this Daryl, non-dealing [crosstalk] guy— question communication behavior +133_116 Okay. Yep. So a part of you knows you need to go something different, but the direction doesn't seem to be that clear at the moment? other communication behavior +133_118 It [unintelligible 00:09:33] picking up? question communication behavior +133_120 No idea. Okay. So I'm wondering, you've been in the system a while. You're now 34, is it right from the pick-up? question communication behavior +133_122 "Yeah. So, you know, often at 34, guys start to think about being with a girl in their life and what's important. And-and you would have also been part- not as a guy, so they've actually made some shifts and changes and thought, ""Time to move on""." reflection communication behavior +133_124 And now you've got— other communication behavior +133_126 Not many? question communication behavior +133_128 But some. question communication behavior +133_130 One? question communication behavior +133_132 Yeah. other communication behavior +133_134 Yeah? question communication behavior +133_136 Tell me something about that. question communication behavior +133_138 Okay. other communication behavior +133_140 He did it? reflection communication behavior +133_142 Yeah. other communication behavior +133_144 Cool. So how interested would you be to find out more information about how he did it? 'Cause I'm thinking about this is someone who you know, you've done time with, got a relationship. question communication behavior +133_146 No, I'm not suggesting you-- No, not about being a drug counselor, but about he made that transition from-from being involved in crime- therapist_input communication behavior +133_148 -to a transition about being in a different place. other communication behavior +133_150 Okay, no 12-step higher power idea? question communication behavior +133_152 So that might work for him, but what might work for you? question communication behavior +133_154 Sure. other communication behavior +133_156 Okay, so part of being here with me, and the work we might do, will be to find- try and find- search for that- therapist_input communication behavior +133_158 -thing. Whatever it is. other communication behavior +133_160 Well, it's a search, isn't it? reflection communication behavior +133_162 No. other communication behavior +133_164 Yep, it is a big ask. So what qualities would you need to have to-to go there? question communication behavior +133_166 Guts? Yeah? other communication behavior +133_168 I think it is. other communication behavior +133_170 Yeah? So you're the sort of guy, Daryl, with guts? reflection communication behavior +133_172 Yeah. other communication behavior +133_174 Not yet? question communication behavior +133_176 Yeah? other communication behavior +133_178 Yet you're sitting here with me today- reflection communication behavior +133_180 -and-and-and you're talking about stuff. reflection communication behavior +133_182 Well, you're sitting here, and you're talking with me- reflection communication behavior +133_184 -about stuff that's-that's quite deep- reflection communication behavior +133_186 -in a way. Um, that takes guts. That takes courage. reflection communication behavior +133_188 In my view, it does. other communication behavior +133_190 'Cause you could've come in here and said- other communication behavior +133_192 "-""Look, Ken, you know, I'll come in, report in, I'm outta here.""" other communication behavior +133_194 You could've done that, but you're not. So I'm wondering what's different? 'Cause you may have done that in the past, I don't know, Daryl, with other people like me, but-but sounds like something's different this time. reflection communication behavior +133_196 Yeah? other communication behavior +133_198 Yeah. other communication behavior +133_200 Sure. other communication behavior +133_202 I kind of see a sense of sadness there when you have to kind of think about this. reflection communication behavior +133_204 Yeah. other communication behavior +133_206 Okay. So I'm interested in this idea, let's, uh-- Opportunities come and go all the time. reflection communication behavior +133_208 They do. other communication behavior +133_210 Well you said before you had an opportunity to pick up and start dealing again. reflection communication behavior +133_212 And-and so-so-so there's opportunities- there's opportunities in one world, and I'm wondering about what might make it hard to see opportunities in a different world? question communication behavior +133_214 Sure, sure. You're in the system- reflection communication behavior +133_216 -you're not in the system. Pick up that, where is it gonna take you? question communication behavior +133_218 Yeah, what-what's gonna happen if you start dealing again? question communication behavior +133_220 Yeah. other communication behavior +133_222 Okay, okay. other communication behavior +133_224 So-So again, I'm-I'm wondering about this other world, and you're saying it doesn't look to attractive at the moment. reflection communication behavior +133_226 You can't se it? question communication behavior +133_228 Yeah? other communication behavior +133_230 Yeah? You just described to me how it looked like a minute ago. reflection communication behavior +133_232 Minimum wage- reflection communication behavior +133_234 -night shift, petrol station. reflection communication behavior +133_236 Yeah? other communication behavior +133_238 Yeah? It is really hard. therapist_input communication behavior +133_240 Sure. other communication behavior +133_242 Sure. We talked about courage before and you've got the guts to be talking with me about this stuff today, and I'm wondering if you actually do have some courage to think about these ideas. I'm not saying that pumping gas at minimum wage is where you wanna go, but-but the guts to actually start steeping into this other world. I wonder if you do have, I'm-I'm-I'm just not sure. reflection communication behavior +133_244 Maybe. You're not convinced at the moment, I understand that and, um— other communication behavior +133_246 Sure. Well, it's hard to me to convince you- therapist_input communication behavior +133_248 -'cause this is your life and this is your story, and you-you've got to walk your life and I can't walk your life for you. I only walk my. And so, but I can walk with you on this life to try and think about-- 'Cause I-I-- You know, I-I've no interest in actually you falling over and going back into-into a lifestyle a crime 'cause I know where it'll take you. And I'm hearing that with your relationship, where it's going to take your relationship too, [unintelligible 00:16:39] got the bottom line drawn pretty clearly. reflection communication behavior +133_250 So it seems like what's gonna push in this direction, just tip that balance a little bit to give this other world of go? Because it is new, it's different. It means doing stuff, a lot of stuff actually that-that's kind of mundane. question communication behavior +133_252 It's kind of cool? question communication behavior +133_254 Not part of on the wire? reflection communication behavior +133_256 No? question communication behavior +133_258 You don't. And who's sitting on the porch with you? question communication behavior +133_260 Mm-hmm. other communication behavior +133_262 Cool. So I'm picking up this world actually has the freedom to you to be your own man? reflection communication behavior +133_264 Maybe? question communication behavior +133_266 Yeah? other communication behavior +133_268 Yeah. other communication behavior +133_270 Yeah it is. It is. other communication behavior +133_272 Absolutely massive. And, uh-- So, is there a challenge you're up to, to start creating some-some-some of that sort of world for Fiona? 'Cause I'm hearing that— question communication behavior +133_274 Sure. So what I'm hearing is, you're not convinced at the moment. reflection communication behavior +133_276 "No. So what would convince you to-to make that shift? 'Cause I hear a lot of kind of-- And in this hard, like, y-you've done time and then once you've got a record, the employers- you know, we know, I know that. That's-that's not easy. You can't just wonder into a job, a high-paying job and go, ""Pick me, pick me, pick me."" I know that." question communication behavior +133_278 You know that. other communication behavior +133_280 So, um-- And-and maybe it's about small steps and first steps. therapist_input communication behavior +133_282 Well, you trying to get a job, maybe and get into some routine. other communication behavior +133_284 Okay. other communication behavior +133_286 "Yeah. I'm confused though at the moment because you're saying, ""Yeah, I could make in a night what you make in a week,"" but you've haven't. 22-22 days-" reflection communication behavior +133_288 -and you haven't done that. So-so tell me what that's about. question communication behavior +133_290 So you told yourself you wouldn't, so you're once you- you're the sort of guy that once you make a decision you're gonna go, you're staunch with that decision? question communication behavior +133_292 Oh, it's a decision whether it's right or wrong-- It's not gonna be- reflection communication behavior +133_294 Yeah, you're that kinda guy okay, so once you make a decision. So you made a decision that you're not gonna- you're not gonna go back to dealing? reflection communication behavior +133_296 Yet. question communication behavior +133_298 You're keeping the door open- reflection communication behavior +133_300 -at the moment, is what I'm picking up. reflection communication behavior +133_302 Yeah, okay, so that will be a call you-you've got to make. other communication behavior +133_304 I'm-I'm not gonna- I'm not gonna make that call. You'll make that call, but there's a consequence of making that call, and there's big consequences more time probably and Fiona not being around. On the other hand, what I'm picking up is a call to-to do some- do some stuff that may not be racy and exciting and in the big dollars, but me being with Fiona and engaging in this transition into a-a different life. reflection communication behavior +133_306 Yeah. other communication behavior +133_308 No. other communication behavior +133_310 But we're talking about it. other communication behavior +133_312 So how much time have you been talking about this- question communication behavior +133_314 -position? question communication behavior +133_316 Okay-okay, so the fact we're even having a conversation about it, it's kind of interesting? reflection communication behavior +133_318 Yeah, so I wanna summarize, Daryl, what-what I picked up so far and then just so I make sure I'm really listening to you well 'cause it's important, isn't it? 'Cause, you know, it's important you're listened to- question communication behavior +133_320 -by people me. So what I'm picking up is-is-is that if you've-you've got this long 12-year history, you can make some big money or you can dealing, doing crime, that stuff, I'm-I'm picking up that Fiona's set the bottom line, is if you go back in that lifestyle, she's out of here, yet she stayed here for 13, 12, 13 years? reflection communication behavior +133_322 Nearly 13 years, so and-and so-so she stuck with you, and I'm pick up that's important to you, um, and-and-and yet you talk about it, it just seems easy, this bit over here, this whole lifestyle. reflection communication behavior +133_324 This other lifestyle over here though when we talk about, actually thinking about, you know, doing stuff, doing the stuff that-that everybody else generally does, [unintelligible 00:22:30] will gets on doing, it doesn't have that same kinda seem to excitement, and it doesn't seem to be a-a starting point for you over here. reflection communication behavior +133_326 Oh, it does? reflection communication behavior +133_328 Right, okay. other communication behavior +133_330 Okay, you're over that one, okay. So, let's start to think about what might be the first step. therapist_input communication behavior +133_332 Yeah, with while going in, I think you got a high steep. reflection communication behavior +133_334 Yeah, a steep, you see before you had a mate who turned his back on offending. reflection communication behavior +133_336 And for him this 12-- You wondered that the 12-step stuff working for him. reflection communication behavior +133_338 Yeah, maybe that, I'm wondering the conve- the conversation with him that might be around actually how did he do it, and how did he stay without slipping back across the line, 'cause like-like get this crossroads you've got the path and go the other path and go here, so I'm wondering about conversation with him, what would it take to have that conversation? question communication behavior +133_340 Ringing him? question communication behavior +133_342 Yeah. You seem a little surprised, I'm-I'm [crosstalk] wondering about, surprising face. reflection communication behavior +133_344 So possibility to call? other communication behavior +133_346 Yeah there's possible. other communication behavior +133_348 Yeah, okay, and Fiona's been pretty staunch. reflection communication behavior +133_350 Is someone who actually who has some pretty clear ideas about where she wants you as a couple to go- reflection communication behavior +133_352 -I get a sense. other communication behavior +133_354 Yeah. other communication behavior +133_356 Yeah, but I'm picking up though behind that doing what you're told, she's got some hopes. reflection communication behavior +133_358 So what will it take for you to start thinking about some of her hopes and sharing some of her hopes? question communication behavior +133_360 Yeah? other communication behavior +133_362 You said before you're sort of guy that once you make a decision you're pretty staunch with that decision. reflection communication behavior +133_364 So if you made a decision to go there, it might be a scary as shit but again it seems that, uh, it could work if see it look, this is important, this relationship's important, let me go for— reflection communication behavior +133_366 Sure. other communication behavior +133_368 Yeah. That's-that's what I'm thinking- I'm thinking actually. Here's someone that actually has made a different decision then, uh, it sounds like that's the pathway that starts over here and I'm wondering. I wonder whether you might have wisdom about what it's like to t-to tread that path. reflection communication behavior +133_370 So you know there's a part of you going, I was thinking in this place that's hard work. reflection communication behavior +133_372 And this is a pretty lonely road to-to walk by yourself. I'm wondering who else might be around you that might actually walk with you? question communication behavior +133_374 Yeah. other communication behavior +133_376 You know maybe they'll walk that road with you too. other communication behavior +133_378 There's a couple of people. other communication behavior +133_380 If you want to do that. It gotta be your call. therapist_input communication behavior +9_0 So now that we've discussed a little bit of your medical history and- and taking your vitals, I'd like to ask you a few more questions. The- therapist_input communication behavior +9_2 -the rise in your blood pressure is concerning to me, so I'd like to gather a bit more information about your lifestyle. therapist_input communication behavior +9_4 Okay. Have you had any major stressful events recently or any change in your work situation? question communication behavior +9_6 Yeah, that's certainly true. I'd also like to ask about some health habits that can contribute to high blood pressure. other communication behavior +9_8 Okay, do you smoke at all? question communication behavior +9_10 Okay, great. Um, do you drink alcohol, including beer or wine? question communication behavior +9_12 Okay. Well, I'm concerned about the amount that you're drinking currently. It sounds like you're having about 15 to 20 drinks per week, and that's definitely more than what we would recommend and could certainly be contributing to your high blood pressure. therapist_input communication behavior +9_14 Well, according to your chart, your blood pressure has gone up since July, and you said that you've been drinking more recently, so do you see the connection there? therapist_input communication behavior +9_16 Alcohol can have some dangerous effects on your body. So along with contributing to high blood pressure, it can have a big impact on your liver, which you need to keep in mind. So your liver has several different roles in your body. First, it helps process excess fatty acids before they get distributed to the rest of your body. It also helps process alcohol and other drugs. So when you have an excess of alcohol, your liver can't work as efficiently and the fatty acids build up, and over time, your liver won't be able to work as well. therapist_input communication behavior +9_18 Okay. And how about the use of other drugs like cocaine, heroin, marijuana? question communication behavior +9_20 Okay. Have you ever used any prescription medications that weren't prescribed for you or in a way that wasn't prescribed? question communication behavior +9_22 Okay, excellent. Well, it sounds to me like the increase in your drinking could certainly be contributing to your high blood pressure. I think decreasing the number of drinks that you have when you go out and maybe decreasing the number of times that you go to the bar each week could be the best thing that you can do for your health. therapist_input communication behavior +9_24 Okay. And then we'll set up an appointment for about a month from now. We'll recheck your blood pressure and see how you're doing with all this, sound okay? therapist_input communication behavior +9_26 Okay. other communication behavior +10_0 Hi. You are [unintelligible 00:00:02]? question communication behavior +10_2 Okay. Um, what brings you in? question communication behavior +10_4 Mm-hmm. I see- I see that your A1C or your blood glucose is very high. therapist_input communication behavior +10_6 Mm-hmm. Well, you do need to take your medicine. We, uh, will need to start dieting, uh, you know, lose some weight, change-change your eating habits, exercise, uh, to get your diabetes under control, because your doctor is right, it is very serious. therapist_input communication behavior +10_8 So, it sure can. therapist_input communication behavior +10_10 So, uh, you know, we-we need to start looking at doing all those different things to get your diabetes under control 'cause your-your number is very high. therapist_input communication behavior +15_0 Can I help you? question communication behavior +15_2 So you want nicotine replacement, but you don't wanna quit smoking? reflection communication behavior +15_4 We don't really recommend that. The idea is you would use the nicotine replacement to actually quit, so then you wouldn't be smoking at work, but you also wouldn't be smoking the rest of the time either. therapist_input communication behavior +15_6 Okay. Well, smoking really is really bad for you, you know. It causes things like lung cancer, emphysema, heart disease- therapist_input communication behavior +15_8 -oral diseases. therapist_input communication behavior +15_10 Well, to be honest with you, you mentioned the patch. I can't recommend a patch to you if you're gonna continue smoking. That can actually be pretty dangerous for you. In order to advise you about this at all, I need you to tell me a little bit more about your smoking history and how much you're smoking now. therapist_input communication behavior +15_12 Okay. Well, we actually consider 20 cigarettes a day to be a significant amount, and in fact, I would then recommend to you that you would start on the highest dose of nicotine replacement. therapist_input communication behavior +15_14 Well, there are some products that you could use to take away some of your cravings, and probably the gum would be the best option for you. It's not something you would continue to use continuously throughout the day, however, but gum is something you use just when you have a craving. therapist_input communication behavior +15_16 Well, we have that here, but again, the-the idea would be for you to actually quit smoking. therapist_input communication behavior +15_18 Well, aside from the gum, you could try the nicotine lozenge, that would be another option for you. Again, that's not something you'd wanna use continuously throughout the day. The nicotine patch is the best for continuous nicotine replacement, but again, that's not something you can use while you're continuing to smoke. therapist_input communication behavior +15_20 Okay. other communication behavior +17_0 Okay, so I'm just gonna ask you a couple of more background questions. therapist_input communication behavior +17_2 Do you use any tobacco products, or smoke cigarettes? question communication behavior +17_4 Okay. How about in the last year? question communication behavior +17_6 Okay. And how often do you have a drink containing alcohol? question communication behavior +17_8 Okay. So it sounds like you're drinking about four times a week, anywhere between three and eight drinks on a given day. So, maybe around 20 drinks a week? question communication behavior +17_10 Okay. Do you use any street drugs like any marijuana, cocaine, heroin? question communication behavior +17_12 Do you, um, do you ever use any prescription medicines that were not prescribed for you, or ever use your own prescriptions in a way on which they were not prescribed? question communication behavior +17_14 Okay. So, you know, as we said before, you're drinking-- it sounds like you're drinking about 20 drinks a week, over the course of a few days. And I did want to point out to you that the recommended limit for women is actually no more than seven drinks a week, and no more than three on a given day. therapist_input communication behavior +17_16 So you're doing more than that right now. And when you drink more than this amount, it puts you at risk for a number of things, okay? Things like greater risk of injury, damage to different parts of your body, um, just a bunch of different problems. And, uh-- so I'm going to recommend that you cut down- cut down that amount to the recommended limit. Again, that's no more than seven drinks a week and no more than three on a given day. Do you think you could do that? Would that be a good goal for you? therapist_input communication behavior +17_18 Yeah, I know that making changes isn't always easy. But when you drink more than what's recommended, it creates problems. You know, you said you hurt your ankle when you came out of the bar this time. reflection communication behavior +17_20 Yeah. Well, it's possible you strained your ankle as a result of the alcohol. You know, it can actually affect your balance and stability. So, really, you know, for where you are right now, you're drinking a good amount more than what's recommended. And, you know, I want you to be healthy. And I don't want to see you coming back in here for something else. So I'm really gonna recommend that you try to cut down to that amount. So, do you think you could do that, cut down to no more than three drinks on a given day? therapist_input communication behavior +17_22 So, it sounds like, you know, the amount you drink is pretty normal- reflection communication behavior +17_24 -amongst the people you typically drink with. But these limits are-- they're actually recommended for all adults. And studies have shown that when you drink more than this, it creates a bunch of problems like we talked about. So, you know, why do you think you drink the amount you drink? therapist_input communication behavior +17_26 Well, I think you can still have fun within these amounts. So that's what I'm gonna recommend. Um, I think this is a really good goal, and hopefully, we won't see any more injuries. Okay? So why don't you try that? therapist_input communication behavior +17_28 All right. Thank you so much. other communication behavior +27_0 I understand that your asthma symptoms have been just really out of control. So, we need to look at some of the ways that you can get healthy and not be back here again. therapist_input communication behavior +27_2 Yeah. other communication behavior +27_4 Well, you sound a bit surprised by that. But I'm sure that you've seen some of the material that-that the clinic gave you about asthma symptoms and managing your asthma, and pets are a really big source of problems in that respect. therapist_input communication behavior +27_6 Mm-hmm. other communication behavior +27_8 Well, uh, wait a second, Sal, what do you mean you-you- ha- If you-- As in-- You know to be informed about-- I'm just really taken aback by that because I understand from your chart that you have a young baby- other communication behavior +27_10 -a new baby. other communication behavior +27_12 -and you are very concerned about your health, you wanna be there for your baby and that you've already taken some steps, you've-you've almost quit smoking- reflection communication behavior +27_14 -which is fantastic. So, the next step is to really deal with the dog, deal with the pet. I know it's- so- It's gonna be hard to do that. But there are always people who will adopt animals. I'm sure that you have friends or family members. therapist_input communication behavior +27_16 It's you that I'm worried about, Sal. It's you that I'm worried about, okay? The-the symptoms are worse. You've had two or three major asthma attacks. And-and do you appreciate how-- This is, uh, a risk to your life that there are some-some adults with severe asthma who actually can die as a result of their symptoms? It-it truly is something to take very, very seriously. I can't emphasize that enough. therapist_input communication behavior +27_18 Sal, what, uh, do you understand that what happened 6 years ago or 10 years ago, your asthma is progressively getting worse. You know very well that the puffers, the strength of the medication is getting higher and higher, and there's only so much that can be done with medication alone. You know this. therapist_input communication behavior +27_20 Sal, you're almost on the strongest one. And if Oscar is that important to you, then do you put Oscar higher than your baby, than your wife? Like, uh, that makes no sense to me. Do you understand how important this is? therapist_input communication behavior +27_22 Uh, okay, well other communication behavior +32_0 In summary, the Minnesota State, Mankato security report states that you were stopped on Stadium Road last Friday, cited for driving under the influence, and then you were transported to detox. Plus, you're only 21 years old. Is the report accurate? therapist_input communication behavior +32_2 Okay. Behavior like this could get you suspended, doesn't that concern you? therapist_input communication behavior +32_4 What were you thinking when you got into your car after having six beers, you could have caused an accident and killed somebody. question communication behavior +32_6 You need to take responsibility for your actions. If you keep partying like this, your problems will only get worse. You're likely to face costly legal citations, poor grades, health problems. Getting kicked out of school and disappointing your parents. You don't want that to happen, do you? therapist_input communication behavior +32_8 Your behavior is not what Minnesota State University expects of its students. If you wanna be a student here, you'll need to show that you're able to follow our rules. Do you think you can do that, otherwise, you'll be suspended? therapist_input communication behavior +32_10 Okay. Well, your sanction is you'll be placed on university disciplinary probation and you'll have to attend an alcohol education seminar that'll cost you $150. Also, disciplinary action is progressive and cumulative, meaning that any further violations will result in suspension for one semester or longer. therapist_input communication behavior +44_0 Hey, hi, Andrea. Thanks for coming in today. So I don't know how much you've been told about why you're here, but basically, it's my job just to meet with all the students. I usually meet with you once or twice a semester. And I'm going to be talking to you kind of about your life and your goals and some behaviors that you might engage in and just the sorts of things like that. reflection communication behavior +44_2 So why don't you start by telling me a little bit about yourself? question communication behavior +44_4 Oh. other communication behavior +44_6 Okay. other communication behavior +44_8 Okay. How long ago did you start playing saxophone? question communication behavior +44_10 Wow. That's a long time. What other instruments? question communication behavior +44_12 No kidding. other communication behavior +44_14 That's awesome. And you play tenor sax? question communication behavior +44_16 Wow. And how long have you been in marching band? question communication behavior +44_18 Okay. Couple of years. Great. And how do you like Marching Band? question communication behavior +44_20 What are your favorite parts about it? question communication behavior +44_22 Oh, okay. other communication behavior +44_24 Uh-huh. other communication behavior +44_26 Okay. other communication behavior +44_28 Cool. And do you have a lot of friends who are in band with you or- question communication behavior +44_30 -friends outside of band or? question communication behavior +44_32 Okay. other communication behavior +44_34 Great. And then, um, tell me a little bit about your family? question communication behavior +44_36 Oh, wow. other communication behavior +44_38 Okay. What kind of dog do you have? question communication behavior +44_40 Oh, nice. other communication behavior +44_42 Charlie. other communication behavior +44_44 Oh, cute. Have you had him a long time? question communication behavior +44_46 Oh gosh. Yeah. Okay. Very cool. And what are your plans for after high school? question communication behavior +44_48 Wow. other communication behavior +44_50 You've got big dreams. other communication behavior +44_52 Cool. All right. Have you started thinking about schools or majors? I guess you're thinking about psychology as a major. question communication behavior +44_54 Right. other communication behavior +44_56 All right. And how about your grades? question communication behavior +44_58 Okay. Good. Very good. All right. Well, what are the kinds of things do you do for fun on weekends? question communication behavior +44_60 Mm-hmm. other communication behavior +44_62 Mm-hmm. When you're hanging out, is there ever alcohol? question communication behavior +44_64 Uh-huh So how often do you think you drink alcohol? question communication behavior +44_66 Oh, so you're drinking a lot? question communication behavior +44_68 Okay. And how much are you drinking on the days that you're-- on the days that you drink? question communication behavior +44_70 Mm-hmm. other communication behavior +44_72 Mm-hmm. other communication behavior +44_74 Got it. So you've-you've had some pretty heavy drinking. What-what do you think is the most you've ever had? question communication behavior +44_76 Yeah. other communication behavior +44_78 Okay, so you don't even know. question communication behavior +44_80 Okay. So, and then your friends drink too? question communication behavior +44_82 Okay. And how much do they typically drink? question communication behavior +44_84 Okay, so it's one cup, but it's not-not one drink. other communication behavior +44_86 It has a lot of alcohol in it. other communication behavior +44_88 Okay. Um, so gosh, you're-you're actually really drinking quite a lot. Um, you know, your level of drinking puts you in what we call a high-risk group. therapist_input communication behavior +44_90 So, is that surprising to you? question communication behavior +44_92 Yeah. Um, so we call it high-risk because it means that there's actually quite a bit of chances that you're gonna have some bad consequences from drinking like that. So, you know, things like, um, having car accidents, or other accidents, or getting in fights, or, you know, sexual assault, or health problems, or developing alcoholism. Have you thought about those things? question communication behavior +44_94 Uh-huh. other communication behavior +44_96 Uh-huh. other communication behavior +44_98 Okay. So it's, um, so it's good, because you're not drinking and driving, but you're still really drinking a lot. Um, and yeah. Okay. So, let's-let's talk a little bit about that, how you might be able to make some changes. Because I think you really need to- need to stop drinking like this. other communication behavior +44_100 So, um, do you think you could quit drinking or? question communication behavior +44_102 Uh-huh. other communication behavior +44_104 Uh-huh. other communication behavior +44_106 Okay. So, does that mean you're gonna stop drinking? reflection communication behavior +44_108 Uh-huh. other communication behavior +44_110 Okay. Um, you don't sound very much like you think that's gonna work. reflection communication behavior +44_112 Mm-hmm. other communication behavior +44_114 Okay. So, how are you gonna quit drinking without your friends thinking you look stupid? question communication behavior +44_116 Okay. Um, so I mean, do you think they're really good friends of yours if they're gonna give you such a hard time? question communication behavior +44_118 Uh-huh. other communication behavior +44_120 It sounds like you might be better off without them though. They’re- reflection communication behavior +44_122 - maybe not very good friends. reflection communication behavior +44_124 Mm-hmm. So, um, so I think we should set a goal that you're gonna stop drinking. therapist_input communication behavior +44_126 And, um, I think you should probably stop as soon as possible, like this weekend. therapist_input communication behavior +44_128 Um, so the way this normally works is, you know, we set you a goal, and then I'll have you come back and we'll talk about it again in a couple of weeks and make sure that you actually stopped. Um, and so what do you think about that? therapist_input communication behavior +44_130 Okay. So- other communication behavior +44_132 Okay, great. So, the plan is gonna be that you're gonna quit and, um, the friends that you have that you don't think are supportive, you're just gonna, I guess, not hang out with anymore. other communication behavior +44_134 Okay. And then, um, you know, like, are your friends in band drinking? question communication behavior +44_136 Uh-huh. other communication behavior +44_138 Okay. So, that might be good, is really just to focus more on band. Um, because you know, the other big concern I have for you is if you wanna go to medical school, you're not ever gonna get into medical school if you're drinking like this. other communication behavior +44_140 You know, like college is gonna be really hard. And especially with all those pre-med classes, you're not gonna be able to handle it drinking this much. You know, have you thought about that? question communication behavior +44_142 Yeah. Okay. So, setting this goal then of quitting drinking is gonna be really helpful for you. And um, it sounds like i-it shouldn't be that tough really, um, especially because you can just stop hanging out with- therapist_input communication behavior +44_144 -the people who drink a lot, um, since you have some other friends. Um, yeah. So, do you have any questions for me or? question communication behavior +44_146 Mm-hmm. other communication behavior +44_148 "Well, you know, one good option would be to just review with them review with them all the bad things about alcohol. You can say, you know, ""I thought about it, and I realized it's gonna mess up my schoolwork. And you know, it's really a lot of risk for my health."" ""I don't want to become an alcoholic."" Um, you know, ""I don't want to get liver disease."", ""I don't want to end up driving drunk or getting into accidents-" therapist_input communication behavior +44_150 "-or getting in fights."" You know, one thing you could bring up is, ""I've heard a lot of stories about kids who you know, are at parties and they're drunk and acting stupid, and then people post stuff on Instagram.""" therapist_input communication behavior +44_152 And you know, that's it for their social life. It's like over. other communication behavior +44_154 So— other communication behavior +44_156 Mm-hmm. other communication behavior +44_158 Yeah. So I think just tell your friends you know, you realized there's always bad things about it and you don't want to do it anymore, so you're just not going to. therapist_input communication behavior +44_160 And then- other communication behavior +44_162 -you can tell them to stop too. You know, then that'd be really good. You'd being a good friend. other communication behavior +44_164 Yeah. Yeah. Exactly. All right. Any other questions or anything else I can help with? question communication behavior +44_166 Okay. So, like I said, I'll plan to meet with you again in a couple weeks. other communication behavior +44_168 And make sure that you actually quit drinking. other communication behavior +44_170 All right. other communication behavior +44_172 Great. other communication behavior +53_0 Hi, Laura. So, thanks for coming in. I'm not sure how much you know about why you're here or what we're supposed to talk about. So, basically, I'm going to be meeting with all the students in the school usually once or twice per semester. And we're going to talk about, you know, whatever's kind of going on in your life. I'll ask you some questions about, you know, your goals and what you like to do for fun and those sorts of things. And then we'll talk a little bit about, you know, different behaviors and-and stuff like that. And so, it's-it's pretty casual, pretty informal, just sort of a chance for me to get to know you if that's all right. question communication behavior +53_2 Okay. Why don't we start by just having you tell me a little bit about yourself? question communication behavior +53_4 Okay. And what do you like to do for fun? question communication behavior +53_6 Mm-hmm, and when you and your friends are hanging out, and what- what do you do? Do you go to football games, go to parties? question communication behavior +53_8 Okay. And what kind of hobbies do you have? question communication behavior +53_10 Oh, cool. What are your plans for after high school? question communication behavior +53_12 That's great. What do you think you'll study? question communication behavior +53_14 Oh, neat. other communication behavior +53_16 Yeah, that's great. That's a really good goal. other communication behavior +53_18 It's, uh, hard work to get into law school. Are you doing well in school? What kind of grades do you get? question communication behavior +53_20 Okay. What classes are you not getting A's and B's in? question communication behavior +53_22 Okay. And do you know where you're going to apply to college? question communication behavior +53_24 Okay. Cool. And, you know, what made you decide maybe law school or-or journalism? question communication behavior +53_26 Okay. Great. Sounds like you have, like I said, really good goals and you're working hard in school. Um, you said that when you're going out with your friends, you like to hang out and shop and stuff like that and also go to parties, so do you drink alcohol? question communication behavior +53_28 Okay. And how often do you think you drink? question communication behavior +53_30 Mm-hmm, so like once or twice a month you're having alcohol? reflection communication behavior +53_32 Okay, and so that's maybe like 20 times a year. question communication behavior +53_34 So that's actually kind of a lot of drinking then? reflection communication behavior +53_36 Okay. What do you think is the most you've ever had? question communication behavior +53_38 But you've been drunk before? question communication behavior +53_40 Okay. Um, so the most you've ever, ever had is two drinks in a day. reflection communication behavior +53_42 Okay. Interesting. So, do you know all the bad stuff about alcohol? question communication behavior +53_44 Okay. Um, so one of the things that, you know, is really important to talk to teenagers about is drinking and driving. So, um, you know, that's actually a really big problem. And even around here, we have kids die every year from getting in a drunk driving accident. So that's something that you really need to make sure you're not doing, all right? Have you ever done that? Have you ever gotten in the car- question communication behavior +53_46 Okay. Uh, how much do your friends drink? question communication behavior +53_48 Okay. What about at these parties you're going to, are there other kids there who are drinking a lot? question communication behavior +53_50 And do you hang out with them? question communication behavior +53_52 Mm-hmm, so, you know, even just hanging out around kids who are drinking a lot actually puts you at a lot more risk. Did you know that? question communication behavior +53_54 Yeah, so, there, I mean, a lot of the other dangers of drinking, like, um, not just car accidents, but you can have other accidents, you know, people, um, you know, will fall or, um, you know, break things or a lot of people actually end up breaking their bones and ending up in the emergency room because they've been drunk and falling down or, you know, as a girl, it's really important too that you're careful because you could be sexually assaulted. therapist_input communication behavior +53_56 You know, especially if you've been drinking, then, you know, you're at a lot more risk because a guy can take advantage of you. Did- have you thought about that? question communication behavior +53_58 Mm-hmm. other communication behavior +53_60 And then, um, you know, people get in fights more often when they've been drinking too. Um, also, you know, there have been a lot of kids, even at this school, who've gotten in trouble because they were drinking and someone took pictures with their cell phone and put it up on Facebook- therapist_input communication behavior +53_62 And then their parents find out or the school finds out and, you know, we have a no-tolerance policy here about drugs and alcohol, and really can get you into trouble, and it could put your whole college career in jeopardy. Have you thought about that? therapist_input communication behavior +53_64 But you're still drinking. other communication behavior +53_66 Uh-huh. So, I mean, do you think it's the thing to do if you wanna be an attorney? question communication behavior +53_68 Mm-hmm. other communication behavior +53_70 Mm-hmm. Okay. Hmm. So, I mean, I guess what we need to do then is kinda talk about some goals for how to be- other communication behavior +53_72 -safer. other communication behavior +53_74 Um, obviously, you shouldn't be drinking at all. Um, what do you think about that? question communication behavior +53_76 Mm-hmm. So, do you think you can quit? therapist_input communication behavior +53_78 Okay. So, I'm going to write down then that you've decided to quit. therapist_input communication behavior +53_80 And, um, that's gonna be your goal, and that's great, you know, that's really why we're here, is to talk about that and-and make sure that you come to that decision. Um, so, I guess, can you quit this weekend then? therapist_input communication behavior +53_82 Okay, and then what about your friends who are still drinking? question communication behavior +53_84 Okay, and-and what if they won't? question communication behavior +53_86 Yeah. Probably if your friends won't quit drinking, you should just find new friends. other communication behavior +53_88 'Cause, you know, the problem is if they're drinking, they're gonna pressure you into drinking and then you're gonna feel awkward and, you know, you're gonna be stuck and-and not know what to do and really you'd just be better off probably without them. If they're- if they're the kind of people who are gonna keep drinking- reflection communication behavior +53_90 -they're probably not a good influence. reflection communication behavior +53_92 Um, and then, then you'll be better set for college too because, you know, the issue is you're getting good grades now, but when you get to college, it's a lot harder and, you know, if you're needing really good grades to get into law school, which you will need, then you really can't be distracted by alcohol. other communication behavior +53_94 Okay, so, um, that's great 'cause it pretty much covers all the stuff that I think I needed to go over with you. Um, let's see. I guess we didn't talk about what would happen if your parents found out you were drinking. other communication behavior +53_96 Mm-hmm. other communication behavior +53_98 Okay, so, yeah, just another reason why you probably need to just quit then. Um, okay, yeah. I-- Okay, so, like I said, I'm gonna right down here that you've decided to quit and, um, uh, you know, I'm gonna be meeting with you again probably in the next semester sometime, so we can kinda check-in and-and make sure that, you know, that's still going well- therapist_input communication behavior +53_100 -and you're still not drinking and not hanging out with any people who are drinking. Um, is there anything else you'd like to talk about while you're here? therapist_input communication behavior +53_102 Okay. Um, any questions or anything- question communication behavior +53_104 -like that? question communication behavior +53_106 Okay. You're sure? Okay. All right. Um, well, that's probably it then. You can, uh, head back to class and-and thanks for coming in. other communication behavior +57_0 Mr. Johnson? question communication behavior +57_2 Uh, I'm here to talk to you about, uh, your cholesterol and the, um, medicine your doctor prescribed. other communication behavior +57_4 But well, it's my job too, uh, to-to help you understand how to use your medicine and, uh, give you information about getting the most benefits from it. other communication behavior +57_6 So your-your-your doctor told you that if your cholesterol remains elevated, you're at risk of stroke or heart attack? therapist_input communication behavior +57_8 Okay. Well, the-the side effect is something that's very, very rare, it's not really something you need to worry about, and the risk of stroke or heart attack is much worse. therapist_input communication behavior +57_10 Well, I-I-I understand that. Um, but like I said, it's very rare. If you feel some muscle weakness, you'll let your doctor know. It's not permanent, okay? Yeah, it won't get to the blood- it won't get to the point where it affects your job— therapist_input communication behavior +57_12 You- you really need to take it, and-and like I said, the-the muscle weakness is rare. If you feel muscle weakness, just let your doctor know. He can take you off or switch. It's not permanent. therapist_input communication behavior +57_14 It's-it's not permanent. other communication behavior +57_16 Okay? So a stroke or heart attack is much worse, so make sure you go ahead and pick up your medicine as you're on your way out and, uh, one-one every day to get your cholesterol down. therapist_input communication behavior +57_18 Okay. other communication behavior +59_0 So, what you told me earlier was that you've got into a car with someone you knew had smoked marijuana earlier. What were you thinking? therapist_input communication behavior +59_2 Science fair project or not, don't you know what happens when someone drives under the influence of marijuana or alcohol? It's bad. They can wreck the car, you can lose your life. I thought you were smart, you're taking AP classes, you wanna get into a Ivy League school. This is not the way you do that. therapist_input communication behavior +59_4 It's a big deal. You can't drink either. You're 16. The drinking age is 21. I think you know that. You could get into an auto crash. Uh, I just wanted you to hear this. I don't' tolerate it as a doctor drinking or driving with somebody who's under the influence, and if you do it again, I'm gonna tell your parents. therapist_input communication behavior +69_0 Hi, Dr. Martin. I heard you had a question for me. What did you want to talk about? question communication behavior +69_2 Yeah, I'm the pharmacist on duty. Citalopram, okay. It's an antidepressant and it comes in 10, 20, and 40-milligram strengths. It's excreted in the urine and it has a half-life of about 35 hours. For side effects, there are sexual side effects, heart side effects, and stomach side effects. therapist_input communication behavior +69_4 Oh, um, yeah, I think that should be fine. therapist_input communication behavior +69_6 All right, thanks. Call me anytime. other communication behavior +72_0 All right, Chris, so I need to talk to you because as you know, we have a zero-tolerance policy for drugs and alcohol at this school. And as-as athletic director, it's my job to check in with our student-athletes and make sure everyone's adhering to that rule. And I've been hearing some chatter from some of the other kids about a party this weekend, and from what I hear, where you were there and, you know, I can't confirm or deny anything. So I'm not at the point where I can give you consequences, but I did want to talk to you about whether or not you're drinking and how, you know, you really can't be doing this as a member of one of our teams. therapist_input communication behavior +72_2 Mm-hmm. other communication behavior +72_4 Yeah, you know, I get it. Like, we've all been there. Okay. You know, I was in high school ones too, you know, I drank too. I get it. There's not a ton to do in this town a-and kids drink, but, you know, promise we have these rules- therapist_input communication behavior +72_6 -and you're on a team, you have to stick by the rules. therapist_input communication behavior +72_8 Yeah. Chris, come on. You're getting peer pressure? therapist_input communication behavior +72_10 Yeah, but you're one of the leaders. therapist_input communication behavior +72_12 Yeah. Well, maybe you can start leading as a non-drinker then. therapist_input communication behavior +72_14 You're a star player, who's going to pick on you? question communication behavior +72_16 All right. Well, yeah. So the issue again is I can't be hearing reports about you drinking. I can't be hearing that you're at parties and you can't be seeing pictures on Facebook. You know, there-there are rules at this school and in my job, I have to enforce them. So, you know, like I said, I get it, you know- therapist_input communication behavior +72_18 -I'm not saying I know what it's like. I-I get that you want to have fun in your teenage years. I get that. But, you know, you are a star player, we want to keep you on the team. You know, we got to figure out a way to get through this. therapist_input communication behavior +72_20 What do you mean? question communication behavior +72_22 All right. Yeah. I mean, we got to have a deal here if you're going to be on the team. Okay? therapist_input communication behavior +72_24 All right. You promise? other communication behavior +72_26 All right. Shake. question communication behavior +72_28 All right. I'll see you later. other communication behavior +72_30 All right. other communication behavior +74_0 Hi, Emily. How are you? question communication behavior +74_2 I'm good. Um, wow, what's changed? What do we have here? question communication behavior +74_4 Emily, why? Why did you get your lip pierced? question communication behavior +74_6 You're- other communication behavior +74_8 -gorgeous. Your teeth are lovely. You do not need a piercing. therapist_input communication behavior +74_10 Do you know what- question communication behavior +74_12 -those oral piercings can do to your teeth? question communication behavior +74_14 Well, yes, except that, you know what's gonna happen. See how-- Do you feel how when you're moving your lips-- Smile for me. Okay. So, do you see how when your muscles are moving, that piercing is rubbing against your gums- therapist_input communication behavior +74_16 -as well as your teeth. So, we can see some recession that's gonna start to happen- therapist_input communication behavior +90_0 So, Tommy, I wanted to talk to because I was on Facebook the other day and saw some pictures that are kind of concerning to me of you and some of your friends at a party, and, you know, you're such a good kid. Like, I don't know what you're doing drinking. It's going to ruin your life. therapist_input communication behavior +90_2 But, Tommy, there's so many consequences with drinking. You know, you're not even 21 yet, you could get arrested, you could, you know, have a drunk driving accident. You could, you know, mess up your schoolwork. You have such a bright future ahead of you. It just really, really concerns me. therapist_input communication behavior +90_4 There's really no such thing as not drinking too much. I mean, anything that's drinking when you're underage is drinking too much, you know. Like, think about it, think about all the things that can happen to you. therapist_input communication behavior +90_6 How much are you drinking? question communication behavior +90_8 Is it like every weekend? question communication behavior +90_10 Tommy, I'm just so concerned, you know, can't you think of anything better to do? question communication behavior +90_12 Yeah. Is-- are your friends the problem, like maybe you should just start hanging out with more kids in the youth group and not hang out with those kids that you were partying with? therapist_input communication behavior +90_14 Well, there's a lot of things that seem fun in the moment that we know aren't a good choice, right? That's some of the things we talk about all the time is making good choices for our life and-and really doing what's best for you. And I just, you know, I really think you should think about making a big change here. therapist_input communication behavior +90_16 I think you really need to quit. therapist_input communication behavior +90_18 I think you're wrong. You know, it really worries me. Anyway, um, I wish you would quit. If all you're going to do is cut down, that's better than nothing. You know, I appreciate you talking to me about this, but I'm gonna keep talking to you about it. It's really important. therapist_input communication behavior +90_20 Do you wanna wait for that happen? Do you wanna wait for a dramatic experience? question communication behavior +92_0 Hi, are you Julie Thompson? other communication behavior +92_2 Hi, I'm Bruce Berger, I work in the clinic. I know you're here to pick up a prescription today. reflection communication behavior +92_4 Um, I noticed, uh, we noticed some of your records that, uh, you've been coming in and getting Sarah's resc-rescue inhaler for her asthma quite frequently, and you haven't got a chronic inhaler for quite some time now. I also know she has been in the emergency room several times this year. Is-- can you tell me what's going on there? therapist_input communication behavior +92_6 Well, I-I need to tell you that the-the medicine that she's taking, the chronic inhaler, which is really essential to controlling her asthma does-- is not a steroid like you're thinking. It's-it's much safer, it's very safe, she-- and she needs to take it to get her asthma under control, and I also want to tell you that, uh, your smoking does affect her asthma, even if- even if it's outside, it gets on her clothes, and to be honest, I'd like to see you quit smoking for you anyway. But, uh, if you want to keep her out of the emergency room, she needs to use that chronic inhaler every day, and you need to watch your smoking. therapist_input communication behavior +92_8 Okay, I, you know, I-I don't want to argue with you about this. I-I know that if you-you know, and if you want to keep Sarah out of the emergency room, uh, I-I just wish you'd heed what I'm saying. She needs to use that chronic inhaler every day to get her- to get her asthma under control, and the smoke on your clothes and the smoking flares her asthma up. So she really needs to use that chronic inhaler, and you really need to think about quitting smoking. therapist_input communication behavior +92_10 Okay, well, I-I hope you really listen to what I'm telling you about her using that chronic inhaler, and I hope you consider quitting smoking. therapist_input communication behavior +92_12 Okay. other communication behavior +102_0 Hi, Liz. Well, thanks for meeting with me today. other communication behavior +102_2 So what's something that you'd like to change or, um, work towards? question communication behavior +102_4 And you've been talking about that a lot lately. So I really- reflection communication behavior +102_6 -feel like this is something that you need to do soon because, um, a lot of times, you're just a lot of talk. And then, there's no action. And if you really wanna see results, I think it's something that needs to be done. And, you know, stop being lazy about it and just do it. therapist_input communication behavior +102_8 Yeah. other communication behavior +102_10 And that sounds like a lot of excuses to me. So I feel like you had shared with me before that you do have a gym membership. So I think that's something that you just need to fit in your schedule. So for you to really see results that you want, my guess is you need to go about three to four times a week and really fit in that hour workout, um, on a daily basis. therapist_input communication behavior +102_12 Mm-hmm. other communication behavior +102_14 And it seems like if you really want to see the results you have to put the time in. And if it's gonna take you two hours, then it's gonna take you two hours. And, again, if you want the results that you want, you need to start, and you need to start now. therapist_input communication behavior +102_16 All right. Well, um, I look forward to talking to you tomorrow. And I'm hoping that you're gonna be able to tell me that you went to the gym. therapist_input communication behavior +102_18 Thanks. other communication behavior +106_0 Okay, so I wrote a prescription for an antibiotic for Aiden and that should help with the ear infection, but in looking through the chart, I mean, it seems like he's had six or seven of these just in the past year or so. other communication behavior +106_2 That's really a big problem. other communication behavior +106_4 Well, one of the primary risk factors for multiple ear infections in kids is actually smoke exposure. Are you smoking? question communication behavior +106_6 Well, the fact that he's having these ear infections is indicating to me that he is being exposed to smoke, and so, what can you tell me about that? other communication behavior +106_8 I really need you to quit smoking. Both for your health and for Aiden. Did you know s-smoking around your child is associated not only with ear infections, it could get to the point where you have to put tubes in his ears pretty shortly here. Also, things like vitamin C deficiency, cavities, like dental cavities, behavior problems, um, asthma, other upper respiratory infections. It's really putting him at a lot of risk. In addition to that, kids of smokers end up smoking themselves. Do you want him to grow up to be a smoker? therapist_input communication behavior +106_10 Well, now's the time to quit. It's really gotten to the point where you can't keep smoking. Not only for him, like I said, but also for you. You're putting yourself at risk for lung cancer, for emphysema, for oral cancers, for heart disease, for all kinds of things- other communication behavior +106_12 Well, there's all kinds of things you can use now. It's not as hard as it used to be. You can use nicotine replacement. There's patches, there's lozenges, there's gum, there's the inhaler, there's nasal spray. We can talk about medications. You can try Chantix, you can try Zyban, there's quit smoking groups you can go to, there's hotlines you can call. therapist_input communication behavior +106_14 There's no reason why you shouldn't be able to quit, this is really important. other communication behavior +106_16 Well, what can be more important to you than the health of your child? other communication behavior +106_18 I really need you to tell me that you're gonna quit smoking. This is really important. other communication behavior +106_20 Okay. Well, I think you really need to think about this seriously. Like I said, it's really putting yourself and your child in danger. other communication behavior +106_22 Okay. other communication behavior +115_0 Okay, so why don't you have a rinse, David. How are you feeling? question communication behavior +115_2 Good. Here, take a look, see what you think. And that feeling- other communication behavior +115_4 -and the color's okay? You know, there is quite a lot of staining so, um, I'm just wondering about, um, some concerns about smoking. question communication behavior +115_6 Possibly- other communication behavior +115_8 -coffee, tea. Yeah, you've heard this before, I'm sure. other communication behavior +115_10 Mm-hmm. So, you know, the smoking is going to be related not just to some of the other negative consequences. You know, physically, it affects dental caries, dental cavities- therapist_input communication behavior +115_12 -um, healing- other communication behavior +115_14 -in your mouth. other communication behavior +115_16 So-- other communication behavior +115_18 Yes, and I really want to be helpful. I really want to-- you know, my commitment is to your oral health, so um, there are lots of medications out there, David, that actually take away a lot of the cravings. They're-- they make quitting so much easier. therapist_input communication behavior +115_20 Mm-hmm. Yeah. other communication behavior +115_22 .No, it-- but David, it's not a waste. Research shows that people take on average about seven tries before they quit smoking, so think of it as you're one step closer to quitting, so-- therapist_input communication behavior +115_24 Well, I don't think I'm giving you a lecture, that's certainly not what I meant. I-- other communication behavior +115_26 Well, there's-there's a reason that [crosstalk] people are concerned. other communication behavior +115_28 No. But as I said, these medications-- so you've tried the medication, you've been willing once. therapist_input communication behavior +115_30 Then, can I write you a prescription for the medication? Can we talk about how you could use it? Because this is something that-that's very important. Not just for your overall physical health, for your oral health-- therapist_input communication behavior +115_32 Oh no, the smoking's going to cause you more problems than the-- than anything else. I can promise you that, David. therapist_input communication behavior +115_34 The side effects from the medications are nothing compared to what can happen from the smoking. therapist_input communication behavior +115_36 Like, that's the, I think, thing to really consider. other communication behavior +115_38 I'm-- okay, but you know-- other communication behavior +115_40 Okay. Well thanks for listening, and honestly, I- I am really worried about the smoking, so-- therapist_input communication behavior +115_42 I um-- other communication behavior +115_44 I'm here to help, okay? other communication behavior +115_46 So-- other communication behavior +118_0 Hi, come in. [door closes] Sit- sit yourself down. Uh, what can I do for you today? question communication behavior +118_2 Okay. other communication behavior +118_4 All right. Um, okay. Um, well let's, uh, let's just have a look shall we? See what's going on. You just wanna open your mouth for me. Say ah. therapist_input communication behavior +118_6 Okay. Right. Uh, to be honest, you know, looking there, it just looks like one of those viruses that are going around at the moment that are causing these sore throats. So, uh, I think that we should just perhaps go for a bit of paracetamol and, uh, some fluids and let nature sort it out. therapist_input communication behavior +118_8 Well, I mean, I'm sorry we're a bit late, but you know that's the general practice, isn't it? You know, sometimes these things happen. Um, but it doesn't alter the fact that you do just have a virus, uh, and they are very common. And the nice thing is that it will get better with paracetamol and fluids, and the paracetamol will help the pain. Um, with giving it to the kids, I'm afraid there's nothing we can do about that. It's unlikely they'll get it, but I can't guarantee it. therapist_input communication behavior +118_10 Uh, well- well, not really. Uh, you need to self-certify in your first seven days off sick so if you're going to take some time off, just take some paracetamol, lots of fluids, get a self-certified note, uh, in to your employer, and put sore throat there. therapist_input communication behavior +118_12 Uh, well, obviously that's a non-NHS thing so we have to charge you for that and our going rate for that is, uh, £12. therapist_input communication behavior +118_14 Oh, I'm sorry. But, you know, if you have just got a sore throat, then there's not much I can do about that. It's just, you know, something that we all get from time to time. Perhaps, what you really need to do is, uh, you know, just take some paracetamol and get some fluids. therapist_input communication behavior +118_16 Okay, that's pretty unlikely with sore throat. I think that's so, you know, a little bit of grand staging there. therapist_input communication behavior +118_18 Okay. other communication behavior +118_20 Bye. other communication behavior +123_0 Okay, I finished the exam. I have some good news and I have some not-so-good news. Looks like you don't have any cavities, so that's the good news. therapist_input communication behavior +123_2 However, I'm pretty concerned about something I'm noticing in your mouth. Actually, if you look up here, the roof of your mouth, I'm noticing a lot of irritation that's really consistent with tobacco use. And you had said on your form that you're not a tobacco user, so I'm just wondering what's going on. therapist_input communication behavior +123_4 Okay. Well, as I said, there's a lot of irritation, in particular, like I was mentioning, up here in the roof of your mouth, it's turned really definitely white-colored and there's little red spots. And you probably didn't notice because we don't spend a lot of time looking at the roof of our mouth, but you're really damaging this tissue in your mouth, which can really cause some severe problems in terms of your oral health. It's called nicotinic stomatitis. And this is something we don't see in any patients who don't use tobacco. So, maybe you're not smoking cigarettes, are you smoking a pipe or cigars? Or is there something else that could be contributing to this? Because I don't know what else might be causing it. question communication behavior +123_6 Mm-hmm. other communication behavior +123_8 Okay, so I think that's a pretty common misconception, because they're fruit-flavored, people think they're okay. Those are really bad for you. Did you know that? question communication behavior +123_10 Right. They're still cigars and they're still tobacco and so they still cause lung cancer, oral cancer, emphysema, all those same kinds of things that you would see with cigarette, so it's really important. therapist_input communication behavior +123_12 Uh-huh. Well, that's, I mean, at least you're not doing that, so that's good, but it's still causing a lot of problems. And as I said, I can see that the evidence in the roof of your mouth, you're causing some serious damage, and this needs to stop. Have you thought about quitting? question communication behavior +123_14 What do you mean? question communication behavior +123_16 So you're gonna quit then? question communication behavior +123_18 What do you mean, maybe? I just told you how bad it is for you. It's messing up your mouth, you're putting yourself at risk for all these other diseases. This is really important. You need to quit. therapist_input communication behavior +123_20 What's there to think about? [chuckles] You said it's not that something you do all that often, and there's all these negative side effects, there's all these risks that you're putting yourself in. therapist_input communication behavior +123_22 Okay, well, that's a good start, but cutting back isn't going to do it. If you actually quit the smoking, you can reverse all the damage you've done in your mouth, and you can stop yourself from- from being at risk for these other diseases. But as long as you're continuing to use these cigars you're really putting yourself in a lot of danger. therapist_input communication behavior +123_24 You're choosing to really damage your mouth and actually, it can cause problems with your teeth too. I don't know if you notice your teeth might be getting yellower than they were before. That's another side effect. There are a lot of really negative things that go along with any tobacco use, whether it's cigarettes, cigars, dip, chew, snuffs, snus, hookah, any of it. This is a really important decision that you're making and you said it's your choice, but you're really choosing to make yourself sick and potentially die. therapist_input communication behavior +123_26 Well, I appreciate you thinking about it. I hope you'll think about it really hard. You know, this is something that I'm gonna continue to ask you about because it's something that really needs to change. therapist_input communication behavior +126_0 Hello, Kaylie. It looks like you're here to pick up a prescription today. reflection communication behavior +126_2 Okay. It looks like cholesterol statin. Do you know how you're supposed to take the medication? question communication behavior +126_4 Well, you just take it once a day. Did he tell you what side effects to expect? question communication behavior +126_6 Well, some of the common ones are nausea, vomiting, headache. There are some severe ones like dermatomyositis, liver failure, lupus, rhabdomyolysis, hemorrhagic cerebral infarction. If you have any of those, just call your doctor. therapist_input communication behavior +126_8 It's for your dyslipidemia. Oh yeah, just one tablet a day. Do you have any questions for me? therapist_input communication behavior +126_10 All right. Great. Have a good day. other communication behavior +126_11 Hello, Kaylie. I see you're here to pick up a prescription today. other communication behavior +126_13 Oh, it looks like he called in cholesterol statin. Do you know how you're supposed to take this medication? question communication behavior +126_15 Okay. Well, you take this one once a day. Did he tell you what side effects to expect? question communication behavior +126_17 All right. Well, some of the common side effects are nausea, vomiting, headache. There are some severe side effects like dermatomyositis, liver failure, lupus, rhabdomyolysis, hemorrhagic, cerebral infarction. If you have any of those, you should call your doctor. other communication behavior +126_19 It's for your dyslipidemia. Oh, and you should take one every day. Do you have any questions for me? therapist_input communication behavior +126_21 All right. Great. Well, have a good afternoon. other communication behavior +126_22 Hello, Kaylie, I'm Lori, the pharmacist here at Bulldog Pharmacy. I see that you have a new prescription for cholesterol statin 20 called in by Dr. Ferris today. I wondered if you had a minute to talk to me. I just want to make sure that you know how best to take it, and if you have any questions. question communication behavior +126_24 Okay. What did the doctor tell you cholesterol statin is for? question communication behavior +126_26 He's right. This medicine is designed to help lower your cholesterol, and that means that it will help lower your risk of having a heart attack or a stroke. How did your doctor tell you to take this medicine? reflection communication behavior +126_28 Okay. Well, you're going to take one tablet of cholesterol statin 20 one time a day by mouth, and you can take that with or without food. When do you normally take your medications? therapist_input communication behavior +126_30 Okay. That's perfect because cholesterol statin works best if it's taken at night, though you can take it any time of the day. And you should take it every single day. It's important to keep that up. Where do you store your medications? therapist_input communication behavior +126_32 All right. Do you have any children in your home? question communication behavior +126_34 Okay. Well, then that sounds like a perfect location for you. Medicines keep best if they're stored away from light and heat and moisture. What did the doctor tell you to expect in terms of side effects? question communication behavior +126_36 All right. Well, this medication is pretty well tolerated, which means it doesn't have very many side effects. But you might experience some mild muscle aches and pains. If they seem really severe to you, then you should call Dr. Ferris and talk to him about that. Also this medicine can interact with a lot of other medications, and even over the counter things. So check with the doctor or myself before you start anything new. And lastly, grapefruit juice can interact with cholesterol statin 20. So if you use grapefruit juice every day, I probably would switch to a different juice while you're on this medication. therapist_input communication behavior +126_37 Just so I know we're on the same page, can you repeat back to me how you'll take this medicine? question communication behavior +126_39 Great, Kaylie. I know we went over a lot today. What other questions do you have for me? question communication behavior +126_41 Fantastic. All right. Well, here's your prescription. I even put it on auto fill for you so that it will be filled for you every- at the same time every month. And if you have any other questions later, our phone number is right here on the bottle, and you can call me at any time. Thanks so much. Have a great day. therapist_input communication behavior +126_42 Hello, Kaylie. I'm Lori, the pharmacist here at Bulldog Pharmacy. I see that you have a new medication to pick up today. Called in by Dr. Ferris for cholesterol statin 20. Do you have a minute to talk about it? I want to make sure that you know how best to take this medicine and to answer any questions that you might have. question communication behavior +126_44 All right. What did the doctor tell you cholesterol statin is for? question communication behavior +126_46 All right, and he's right. This medication will help lower your cholesterol, and it will help lower your risk of having a heart attack or a stroke. How did the doctor tell you to take this medicine? therapist_input communication behavior +126_48 All right. Well, you're going to take one tablet of cholesterol statin 20 one time a day by mouth, and you can take that with or without food. When do you usually take your medications? therapist_input communication behavior +126_50 That's perfect. This medication can be taken any time of the day, but it does work best if taken in the evening, and it's important to take it every day. therapist_input communication behavior +126_51 Where do you store your medications? question communication behavior +126_53 Do you have children in your house? question communication behavior +126_55 All right. So that sounds like a perfect place for you to store those. Medications are best when they're stored away from light, heat and moisture. reflection communication behavior +126_56 What did your doctor tell you to expect in terms of side effects? question communication behavior +126_58 All right. Well, this medication is usually well tolerated, which means that it doesn't have very many side effects, but you might experience some muscle aches or pains. If they seem really severe to you, then you should call Dr. Ferris and talk to him about that. Also, this medication can interact with over-the-counter medicines or even other medications. So before you start something new, you should check with either Dr. Ferris or myself. And lastly, this medication can interact with grapefruit juice. So while you're taking this medicine, I would avoid grapefruit juice. therapist_input communication behavior +126_59 Just so we know we're on the same page, can you repeat back to me how you are going to take this medicine? question communication behavior +126_61 That's great, Kaylie. I know we went over a lot today. What questions do you still have for me? question communication behavior +126_63 All right, good. Well, here's your prescription. I even put it on autofill for you so it'll be ready at the same time every month for you. And if you have any questions later, our phone number is right here on the bottle, and you can call me at any time. Thanks so much. Have a great day. therapist_input communication behavior +130_1 Yeah. Well, the good news is he doesn't have pneumonia. It's just an upper re-respiratory tract infection and a cold. So there's some things you can do to make- to help him get better. You can avoid excessive dust. You can keep him hydrated, avoid over-the-counter cold remedies. Keep him away from people who have flu or cold-like symptoms and avoid smoke. And the last one should be easy because you quit smoking during your pregnancy. therapist_input communication behavior +130_3 No, wait a minute. That has everything to do with what we're talking about. I can't believe at the end of this appointment, you're just slipping in the fact that you've resumed smoking again. That's very, very important information for me to know. And I'd like to spend some time talking about it now. therapist_input communication behavior +130_5 Come on, Hailey. You're here because you thought he had pneumonia. You're telling me that Jake can't breathe, you're concerned about his breathing. And then you just slip in the fact that you're smoking cigarettes and you think there's no relationship? Do I really need to review all the risks of smoking in front of your-your child or exposing him to secondhand smoke not to mention the risks that you're posing to yourself and your own health? question communication behavior +130_7 So it sounds like if you have alcohol, then smoking is very difficult to avoid and you know what you need to do. You need to go home and as your-your son's doctor, I need to tell you you need to go home and throw out those cigarettes. You need to quit. therapist_input communication behavior +130_9 And let's talk some more about wine. You keep throwing wine into the conversation. It sounds like it's become a significant part of your daily routine. How much are you drinking? question communication behavior +130_11 Well, no one said motherhood was going to be easy, Hailey. So let's talk about these drinks. Are we talking about the-the low-risk drinking guidelines, one to two standard drinks a night or are we talking about a mug of Margarita's? question communication behavior +130_13 What are you drinking? What's the quantity that you're drinking. question communication behavior +130_15 There's other ways to relax. There's yoga. There's deep breathing. You need to stop raising the roof and raise your kid. This is not okay. You're not just worrying about Hailey anymore. It's Hailey and Jake. You're a mom now. therapist_input communication behavior +130_17 I'm trying not to be hard on you, Hailey, but I've got to tell you as a position, it's a very big deal. Your drinking and your tobacco use are red flags for me and they need to stop immediately. So we've already talked about your plan for smoking. You're going home. You're throwing out your cigarettes. You're putting on the patches. What's the plan for the alcohol? therapist_input communication behavior +130_19 Sounds good. And if you need to relax, go for a walk, join a moms group, read a book. How about you come back in a week when we have Jake's six months checkup and you can let me know how that quit plan is going. therapist_input communication behavior +130_21 Thanks. other communication behavior +131_0 Good morning. It's really nice that you've come along to see me to talk about stopping smoking. other communication behavior +131_2 What have you got in mind, what do you want from us? question communication behavior +131_4 Absolutely, we're in the right place for that. other communication behavior +131_6 Okay. Well, just remind me again why it is you want to stop. question communication behavior +131_8 Oh, good, and so feeling under pressure here. reflection communication behavior +131_10 And so that-that can't feel a little uncomfortable being by yourself. So that sounds like one of the reasons you have to quit is it's a little getting smelly and it's getting embarrassing. reflection communication behavior +131_12 Any other reasons? question communication behavior +131_14 How much does it actually cost you a week? question communication behavior +131_16 £7 a week or a day? question communication behavior +131_18 So your pack a day— other communication behavior +131_20 £50 a week. reflection communication behavior +131_22 Even more mess, you see. other communication behavior +131_24 Okay. So we're talking about spending £50 a week- reflection communication behavior +131_26 -being one of the few left smoking in your crowd, and not liking the smell. That sounds like three reasons. reflection communication behavior +131_28 Do you think that's enough to make you say goodbye to cigarettes? question communication behavior +131_30 Great, okay. So have you got a date in mind when you'd like to stop smoking? question communication behavior +131_32 Generally, it works well if you find a time when you're not under a huge amount of other stresses and strains. therapist_input communication behavior +131_34 What are the main reasons why you actually smoke? What do you enjoy most about it? question communication behavior +131_36 Mm-hmm. other communication behavior +131_38 Okay. What do you think you'll miss most about it? question communication behavior +131_40 Mm-hmm, what sort of stresses? question communication behavior +131_42 Mm-hmm. question communication behavior +131_44 Yeah. And what is your favorite cigarette of the day? question communication behavior +131_46 Okay, so the end of the day- reflection communication behavior +131_48 -the thing that helps you just unwind, put an end to the work section and move into your own time. reflection communication behavior +131_50 Okay. So after you've had the quit date, what do you think you might do when it it's the first day at work and it's time to go home if you're not gonna have a cigarette? question communication behavior +131_52 Okay. other communication behavior +131_54 Have you managed to stop smoking in the past? question communication behavior +131_56 Okay. And what got you back? question communication behavior +131_58 So something just happened- reflection communication behavior +131_60 -so it took you back into it. All right. Let me just make sure I've understood what's going on here. You really want to stop smoking because you're kind of the last guy in your group still smoking, it costs a lot of money, and you don't really like the smell. reflection communication behavior +131_62 The main reason that you smoke is because, at the end of the day, it gives you a kind of relaxation, and if there's quite a little stress that's going on which you're using cigarettes to help you cope with. reflection communication behavior +131_64 What you'd like to do is stop and you'd like to sort of like choose a time to quit when it's going to be there's not as much stress around as possible. When do you think would be a good time for you to choose to be your quit date? reflection communication behavior +131_66 Okay. other communication behavior +131_68 So Monday morning after the party will be a good day, and that's next week. Okay. Now, one of the things that we do in the pharmacy is recommend that you use medication to help you. You know this increases your chance of success and it makes it more likely that can manage any cravings that come along. A lot of people like using nicotine replacement therapy which comes in a variety of formats like patches, gum, you've probably seen people using any of these products. And other options are tablets which you can get from the GP. therapist_input communication behavior +131_70 So, yeah, again-- Um, so have you something in mind that you might like to use to help you through managing the cravings? question communication behavior +131_72 Okay. So a patch is something you've already seen, and- reflection communication behavior +131_74 -and, again, I'll get some out and I'll show you what they look like. This course of medication lasts for 10 to 12 weeks. And we strongly recommend that people stay on the whole course of medication and that that gives you the best chance of success. Stopping smoking is not easy but it's possible and with the type of support that we offer here in the pharmacy, you absolutely make your chance of success four times greater than trying on your own, so, that's why it's really good that you've come to see me. Now, what you said is you really want to do it and that next week sounds like a good day for you to start because the party is over and done with. therapist_input communication behavior +131_76 You've got the time at the end of the day when you finish work, which might be the first time you've gone without a cigarette. So, what I'd like to recommend is that you use two products perhaps and I'm thinking of you're having a patch and then suggesting that you might use something that you can top up with. Often, a person who smokes knows exactly what it feels like when they're craving for a cigarette. What does it feel like to you, when you can't have a cigarette and you want one? therapist_input communication behavior +131_78 Okay. other communication behavior +131_80 And that's exactly one of the symptoms of nicotine withdrawal that I'm looking to stop happening to you. therapist_input communication behavior +131_82 So, I would strongly recommend that you have the patch. I'll talk to you about how to use that and that we have another product that I leave you to use as when any of those feelings of irritation are coming up, particularly in that first week. therapist_input communication behavior +131_84 So, you're happy with the date for [unintelligible 00:06:16]? question communication behavior +131_86 Okay and would you like to come back and see me again? question communication behavior +131_88 And what would you like me to do if you don't come back? question communication behavior +131_90 I'd be very happy to do that. therapist_input communication behavior diff --git a/AnnoMi-therapist/train.tsv b/AnnoMi-therapist/train.tsv new file mode 100644 index 0000000000000000000000000000000000000000..3462c9c3a6577191fc94ef50911140d5f3c57494 --- /dev/null +++ b/AnnoMi-therapist/train.tsv @@ -0,0 +1,3162 @@ +id text label dimension +0_0 Thanks for filling it out. We give this form to everyone once a year regardless of why they come in. It helps us provide better care. Is it okay if I take a look at what you put down? question communication behavior +0_2 So, let's see. It looks that you put-- You drink alcohol at least four times a week on average- therapist_input communication behavior +0_4 -and you usually have three to four drinks when you do drink. therapist_input communication behavior +0_6 Okay. That's at least 12 drinks a week. therapist_input communication behavior +0_8 Okay. Just so you know, my role, um, when we talk about alcohol use, is just to share information about risk and to help patients who want help. This is different than telling them what I think they should do. I don't do that. therapist_input communication behavior +0_10 Uh, what else can you tell me about your drinking. question communication behavior +0_12 Okay. So, can I share with you some information on alcohol use? question communication behavior +0_14 Okay. So, there has been a lot of research on alcohol use and the guidelines we use in this country says that having seven or more drinks per week can raise the risk of health problems for women. therapist_input communication behavior +0_16 Seven. therapist_input communication behavior +0_18 Yeah, you're surprised to hear that? question communication behavior +0_20 Well things like heart disease, cancer, liver problems, uh, stomach pains, insomnia. Unfortunately, uh, people who drink at a risky level are more likely to be diagnosed with depression and alcohol can make depression worse or harder to treat. therapist_input communication behavior +0_22 Well, how do you think your drinking relates to the depression you've experienced? question communication behavior +0_24 Okay. And how do you feel after you drink? question communication behavior +0_26 So, there are some answers on this form here. Uh, less than monthly you drank more than you intended to. therapist_input communication behavior +0_28 And sometimes you feel guilty after you drink. therapist_input communication behavior +0_30 So you're not proud of finishing a bottle? question communication behavior +0_32 Right. By the way, binge drinking is defined for women as having more than, uh, three drinks and there are about five drinks in a bottle. So, you enjoy drinking wine because it helps make things, uh, a little bit more interesting when you're feeling down but at the same time you don't like drinking when you have more than you want it to and then the depression returns after you drink. reflection communication behavior +0_34 Where do you wanna go from here? What do you wanna change about your drinking habits? question communication behavior +0_36 If I gave you a scale from 0 to 10, 0 being not ready at all to cut back on drinking and 10 being very ready, what number would you be at? question communication behavior +0_38 Okay. Why do you think it's not something less like a six? question communication behavior +0_40 What would help you cut back to two drinks? question communication behavior +0_42 Having less wine in the house will help? reflection communication behavior +0_44 What else besides drinking helps you relax and unwind in the evenings? question communication behavior +0_46 So, it's not just wine that helps you relax. Um, there's reading a book, watching a movie, and taking a hot bath too. reflection communication behavior +0_48 Okay. So, it sounds like you have some reasons to cut back on drinking and you have ways to relax besides drinking and it sounds like you're pretty ready to cut back. therapist_input communication behavior +0_50 Great. I'd be interested to see how well you do on your goal in the next few weeks. Would you be willing to come back and talk to me about it? question communication behavior +0_52 Great. So, let's see how well you're doing with these new meds. other communication behavior +1_0 And before you leave, uh, is it okay if we go over this screening form that you filled out today on your alcohol use? question communication behavior +1_2 Okay. Uh, thanks for filling this out. Uh, looks like you use alcohol two to three days a week? reflection communication behavior +1_4 Okay. And then when you do drink alcohol, you typically have five or six drinks. reflection communication behavior +1_6 Okay. Well, the reason why I like to talk to patients when they fill out this form is because sometimes, uh, alcohol use can impact our health. Um, and my role is to be helpful. I can share some information with you about alcohol use, um, but I don't tell anyone what to do. It's always up to the patient to decide what they wanna do about their drinking. Um, so is it okay if we talk a little bit more about your alcohol use? question communication behavior +1_8 How would you define drinking too much? question communication behavior +1_10 Mm-hmm. Well, in this country, the guidelines are men can drink up to 14 drinks a week or up to four on one occasion and still be low risk. therapist_input communication behavior +1_12 So a limit of four a night doesn't feel right to you? reflection communication behavior +1_14 You're not alone in feeling that way. Uh, binge drinking can feel normal to some people. reflection communication behavior +1_16 Why is that? question communication behavior +1_18 Mm-hmm. Well, technically, we define binge drinking as having more than four drinks on one occasion. therapist_input communication behavior +1_20 Well, uh, we know if someone binge drinks over time, there's kind of two categories of risk. There's the short-term risk where someone who binge drinks is more likely to fall down, hurt themselves through an accident, uh, they're more likely to drive while under the influence. Uh, but over the long term, binge drinking can also, uh, cause things like heart disease, uh, different kinds of cancer, liver problems obviously, and then even mental health issues like depression and anxiety are more likely to happen. therapist_input communication behavior +1_22 Can I ask you, uh, what do you like about drinking alcohol? question communication behavior +1_24 And so what about your drinking do you not like or is there anything that worries you about your drinking? question communication behavior +1_26 So, on one hand, you like how beer tastes, uh, it's part of your social life to some extent, um, but on the other hand, you don't like the idea of it posing risks to your health over the long term? reflection communication behavior +1_28 So weighing those things, you know, what you like about your drinking, what you don't like about your drinking, uh, where do you wanna go from here? Uh, what would you like to change about your drinking? question communication behavior +1_30 Well, how about hypothetically if I were to ask you, how would your drinking have to impact your life in order for you to be ready to change your drinking? question communication behavior +1_32 So if you experienced a negative consequence from your drinking, uh, that would feel meaningful to you? reflection communication behavior +1_34 Okay. Well, I like to give this handout to patients. Uh, it defines risky drinking, it talks about what the consequences are, uh, and it also lists signs of what an alcohol use disorder is. So thanks again for taking the time to fill this out and being honest with me, uh, to talk about it. I provide better care, uh, when I know about my patient's substance use. When we come back for a three-month follow-up appointment for your ADHD, I'd also like to talk to you and check in about your alcohol use too, if that's okay with you. therapist_input communication behavior +1_36 Okay, great. See you next time. therapist_input communication behavior +2_0 Hi, John. Nice to see you again. So, tell me, how are things going? question communication behavior +2_2 Well, I appreciate you bringing your weight to the forefront. Do you mind if we explore this issue further? question communication behavior +2_4 All right. Uh, well, it sounds like you've been struggling with your weight recently. And I understand how difficult it is to lose the weight and then have it come back again. So, tell me what you did to lose that initial 5 pounds. reflection communication behavior +2_6 But you did have some success. Tell me how you felt when you lost the weight. reflection communication behavior +2_8 Okay. Well, it sounds like you realized that when you lost the weight you feel better and that it's gonna affect your overall health. So, tell me what you think changed that caused you to gain the weight back. reflection communication behavior +2_10 And how many servings of fruits and vegetables on average per day would you have? question communication behavior +2_12 John, it's very important that you recognize that some fruits, but especially fruit juice can contain a huge amount of calories. Did you know that a glass of orange juice has almost as many calories as a can of cola? therapist_input communication behavior +2_14 You're absolutely right, but keep in mind that the food pyramid is to be used as a guideline only. When it comes to nutrition, we have to have a more personalized approach. So I have a hunch, and that is the excess fruit that you were consuming probably caused your weight rebound. What's your impression? therapist_input communication behavior +2_16 Indeed. Let me ask you something, knowing what you know now, how important is it to you to lose the weight by decreasing the amount of juice that you're currently taking in? question communication behavior +2_18 Oh, I understand. Let me ask you this, on a scale from 0 to 10, 0 meaning that there's no way you can do it, and 10 meaning that you're 100% confident that you can do it, how confident are you that you'll be able to reduce the amount of juice you're currently taking in. therapist_input communication behavior +2_20 All right. So, you're not a zero. So, that tells me that you've got some confidence that this is doable, this is something you certainly can do it. Why are you not a zero? question communication behavior +2_22 So, you realize, again, that if you decrease the amount of juice you're taking in, you're gonna decrease your weight, you're gonna feel better, and you're gonna impact your po- health positively? reflection communication behavior +2_24 But you're also not a 10, and that tells me that there may be some obstacles to your success. What would it take for you to be a 10 or even an 8 or 9? question communication behavior +2_26 Okay. Now, if the juice was still there, can you think of anything else you could do? question communication behavior +2_28 Excellent. John, I get the impression that you want to stay in course with weight reduction. And the best way to do this will be to decrease the amount of juice that you're currently taking in. So if I saw you in two weeks and I asked you how much juice you're t- drinking and how you did it, what would you tell me? reflection communication behavior +2_30 Excellent. Well, it sounds like you have a plan. Same scale, 0 to 10, how confident are you that you can, uh, make this happen? question communication behavior +2_32 I agree. All right. Well, you-you know what? I'm not gonna start any medications today. Your levels were a little bit off, but I think we can handle this from a purely lifestyle standpoint. What do you think? therapist_input communication behavior +2_34 Excellent. I'll see you in two weeks. therapist_input communication behavior +3_1 Okay, and so what I'm hearing is that you don't feel like your health is concerning you right now, or anything like that? reflection communication behavior +3_3 Okay. other communication behavior +3_5 Okay. Have you noticed putting on any weight, or anything like--? question communication behavior +3_7 Okay. Okay. And how about going to see the doctor? Have you gone to-- for a visit or anything recently? question communication behavior +3_9 Okay. But you feel that you feel good? question communication behavior +3_11 Okay. Um, and so what I hear is that you're-- you feel like your wife might be, uh, overreacting to this? reflection communication behavior +3_13 Sure. Sure. Okay. Um, and so one thing I'd just like to do is maybe give you some information on, um, maybe obesity or diabetes if you're interested or open to that. If you're, you know--? question communication behavior +4_0 Hi, Emily. other communication behavior +4_2 It's been a while. other communication behavior +4_4 This is something new. reflection communication behavior +4_6 You got your lip pierced. How long ago did you get that done? question communication behavior +4_8 Hmm. other communication behavior +4_10 What made you decide to get-get a lip piercing? question communication behavior +4_12 Hmm. other communication behavior +4_14 Yeah, and it looks nice. other communication behavior +4_16 Um, I guess, you know, as your dentist, I have- I have a couple of concerns about lip piercings, oral piercings. I wonder what have you heard about how having an oral piercing can affect your-your teeth or your gums? question communication behavior +4_18 Mm-hmm. other communication behavior +4_20 You do. you have beautiful teeth as I always tell you- other communication behavior +4_22 -every time you come in. other communication behavior +4_24 Um, I mean I have had some patients with oral piercings and they can erode some of the gum right, um, just right there at the front. therapist_input communication behavior +4_26 Um, so that's one-one thing, and the other is, um, I do see fair amount of chipped teeth- therapist_input communication behavior +4_28 -just from contact with it. I wonder what are your thoughts about that? question communication behavior +4_30 Yes, flossing. reflection communication behavior +4_32 There's nothing yet. reflection communication behavior +4_34 Yeah. There's certainly been-- There's no problems and you, as you said, only have had it for a short time. reflection communication behavior +4_36 "Um, what would- what would make you decide, ""This is something that's not right for me?""" question communication behavior +4_38 Mm-hmm. other communication behavior +4_40 Mm-hmm. other communication behavior +4_42 I guess that it does. other communication behavior +4_44 Yeah, it looks nice. So, you want to monitor it and-and- therapist_input communication behavior +4_46 -really watch- therapist_input communication behavior +4_48 -the effect? Okay. therapist_input communication behavior +4_50 Mm-hmm. other communication behavior +4_52 Emily, you said it so well it- other communication behavior +4_54 -the-the piercing might not last forever, but your teeth really are- reflection communication behavior +4_56 -hopefully forever. So, okay, well thanks for-for talking about it- other communication behavior +4_58 -with me, and also before I do the exam, you know, I'm always on your case about flossing, so maybe we can take [inaudible 00:02:46]- other communication behavior +5_0 Hi, Billy. other communication behavior +5_2 Hi, another session and another session where you are actually on time. other communication behavior +5_4 You've done-- You've got a really good track record of, uh, being on time. Yeah? Do you realize that? other communication behavior +5_6 Yeah. Yeah. You know, I've been thinking about, um, thinking about you, and thinking about, um, that first meeting we had, and where you are now. So, wh-what do you think some of the changes are that-that you've made in this- in this, sort of, five-five to six weeks that we've been meeting? question communication behavior +5_8 Yeah? other communication behavior +5_10 Yeah? other communication behavior +5_12 It's helped heaps? question communication behavior +5_14 Yeah? So, what sort of things has it helped with? question communication behavior +5_16 Mm-hmm. So, what changes have you made, Billy? question communication behavior +5_18 Mm. other communication behavior +5_20 Mm-hmm. other communication behavior +5_22 Yeah. And, get-getting to the polytech and getting the forms, that's a pretty big deal. reflection communication behavior +5_24 Yeah? I was thinking about the Billy, say, the Billy of six months ago. I'm wondering if the Billy of six months ago would've done that? question communication behavior +5_26 Mm-hmm. So, what shifted that made it that you were actually able to go to the polytech and get the forms? What's shifted in you? question communication behavior +5_28 Mm. other communication behavior +5_30 Yeah. Where have you got to with the forms? I mean, we talked about that quite a lot last time. question communication behavior +5_32 Mm-hmm. other communication behavior +5_34 Okay. So, what did you say to Donna? question communication behavior +5_36 Mm-hmm. other communication behavior +5_38 Mm-hmm. other communication behavior +5_40 Okay. So, where did you get to in terms of telling her that, uh, reading and writing is not that [unintelligible 00:27:23] for you? question communication behavior +5_42 Mm-hmm. other communication behavior +5_44 So, I was thinking about how that stuff about not feeling confident around reading and writing has, um, really got in the way for you. reflection communication behavior +5_46 And I mentioned that's somewhere where you don't feel so confident, and I'm wondering what it would be like to feel confident with reading and writing. What difference would that make to your life? question communication behavior +5_48 Mm. other communication behavior +5_50 Yeah. Yeah, I can really see that you're making an effort. In fact, I can see that you're really making an effort in lots of areas, not just in terms of reading and writing. other communication behavior +5_52 Mm. other communication behavior +5_54 So, where are the forms now? question communication behavior +5_56 Mm-hmm. other communication behavior +5_58 So, what needs to happen next? question communication behavior +5_60 So, you actually have to deliver them to the polytech, do you? question communication behavior +5_62 Mm-hmm. So, when do you think you're gonna do that? question communication behavior +5_64 Mm-hmm. So, by the end of this week, so by next time, when you come here, as in, those forms will be at the polytech? question communication behavior +5_66 And what-what happens next in terms of what happens once the forms are there? question communication behavior +5_68 Mm-hmm. So what's the- what's the-- Say, if you get on the course- other communication behavior +5_70 -and, um, you're, like, real good with, uh, hands-on stuff, but the stuff around the manuals, and the assignments, and those sorts of things, um, don't feel so good. What-what do you think we need to do around helping you with that? question communication behavior +5_72 Mm. Yeah? other communication behavior +5_74 So, all these changes that you've- that you've made, um, Billy, where-where is the offending fitting into all of that now? question communication behavior +5_76 So, offending gets in the way of the life that you're starting to lead? reflection communication behavior +5_78 Yeah? So, what temptations have you had to, kind of, go back to offending? question communication behavior +5_80 Mm. So the drinking is something that we talked about can make it easier for you to offend. reflection communication behavior +5_82 So you've noticed that when you've been drinking that those feelings are coming back again, or? question communication behavior +5_84 It's harder to think straight when you've been drinking? question communication behavior +5_86 Yeah. Yeah. And so you've got Donna around at the moment? question communication behavior +5_88 And that's helping keep you in check, as you said? reflection communication behavior +5_90 Yeah. What would happen if she wasn't around say or at a party or? question communication behavior +5_92 Okay. So Donna at the moment who kind of being there is like a strength? reflection communication behavior +5_94 Mm. What do you think? question communication behavior +5_96 Mm. Yeah. 'Cause I was thinking about that dream that you've got about the job and a life with Donna and- other communication behavior +5_98 -kids and stuff like that and how you were saying that the offending doesn't fit in with that dream or that idea. reflection communication behavior +5_100 So there's that on the one hand, but on the other hand, there's the kind of immediate, um, feeling when you've had a few to drink and you're with your mates and it feels like it would be a bit of a laugh? reflection communication behavior +5_102 So you've got-got those two things going on at the same time. Yeah? question communication behavior +5_104 And it sounds like sometimes when you're in there with your mates and had a few drinks, it's hard to hold on to that vision of the future. reflection communication behavior +5_106 Okay. So what-wh-- in the moment, what are you thinking? question communication behavior +5_108 Not really thinking or simply not thinking beyond the next- question communication behavior +5_110 -kind of minute or so- question communication behavior +5_112 So it's not your idea. And you also go along with it? question communication behavior +5_114 Mm-hmm. What would happen if you say no? question communication behavior +5_116 Mm-hmm. So it's hard to actually say no to your friends- reflection communication behavior +5_118 -'cause of what they- what they thought of you. reflection communication behavior +5_120 Yeah. So I'm wondering what the-the thinking, 'cause, um, one of the things that's really changed for you is being with Donna. other communication behavior +5_122 So I'm wondering, you know, most of them butt-butts head on your friendships with those- with those guys. other communication behavior +5_124 Mm-hmm. other communication behavior +5_126 Then so when you're-- so you're spending less time with them and more time with Donna? question communication behavior +5_128 Yeah. And you're saying you're kind of hanging out with her and going to movies and stuff? Yeah. And that means you're spending less time with your-- with those people that have actually led you in trouble in the past? question communication behavior +5_130 Okay. So tell me- tell me what it is that they do so I get a better understanding of it. question communication behavior +5_132 Yeah. other communication behavior +5_134 Okay. So that's just what you've always done. reflection communication behavior +5_136 But we're also talking about this idea that it doesn't fit with what your goals are or what your hopes are? reflection communication behavior +5_138 Yeah. Mm. How would you like it to be? question communication behavior +5_140 Mm, well the stuff about when you're in the moment. Yeah. other communication behavior +5_142 When you've had a few drinks and you kind of go and get into trouble. How would you like that to be different? question communication behavior +5_144 Mm-hmm. other communication behavior +5_146 Okay. So-so Donna's helped calm you down and you'd like, um, them to calm down too? question communication behavior +5_148 Mm. other communication behavior +5_150 So am I hearing that it's tricky in some ways to hang out with them sometimes- reflection communication behavior +5_152 -now that you're with Donna? question communication behavior +5_154 Hmm. other communication behavior +5_156 Okay. So-so what's the definition, for you, of a good mate? question communication behavior +5_158 Mm-hmm. other communication behavior +5_160 So, someone who's loyal, someone who's got your back, yeah? What else? What else is really your definition of a really good mate? question communication behavior +5_162 Hmm. other communication behavior +5_164 Oh, so, someone who'll stand up for you? reflection communication behavior +5_166 Yeah? Yeah. Sounds like a really strong definition of a good mate- other communication behavior +5_168 -for you? So, I'm wondering about, um, whether good mates lead you into trouble, if it's something you wanna do. If you got something different that you wanna do, what would a good mate do in that situation? question communication behavior +5_170 Yeah. How-how would you wanna be supported, Billy? question communication behavior +5_172 Mm. Okay, so that's-that's the kind of support that a really good mate would give you? It sounds- other communication behavior +5_174 -like these guys have been around for you- reflection communication behavior +5_176 -for quite some time, and they're really important to you. reflection communication behavior +5_178 "Yeah. Okay. So, I'm wondering how we can get to that point where, yeah, you can say, ""No, I don't wanna do that,"" and they're supportive of you?" question communication behavior +5_180 What do you think it would take? question communication behavior +5_182 Okay. So, how would they know you're serious? question communication behavior +5_184 Okay. other communication behavior +5_186 Okay. That's the second time you've used that word 'guilty'. other communication behavior +5_188 Yeah? So, it sounds like it's a really-- something's really important to you about that. reflection communication behavior +5_190 Mm. other communication behavior +5_192 Okay. So, it's almost as if you feel a bit torn because you wanna be with Donna, but you also wanna be with your- reflection communication behavior +5_194 -with your mates? reflection communication behavior +5_196 Mm. other communication behavior +5_198 Yeah, so they're still important to you? reflection communication behavior +5_200 Hmm. I also am hearing that you don't wanna get into trouble anymore. reflection communication behavior +5_202 Mm. Yeah. other communication behavior +6_0 Hi, Sal. Thanks for coming in today. other communication behavior +6_2 I saw that your doctor made the referral and, um, and I really appreciate you taking the time to come and make that appointment. therapist_input communication behavior +6_4 So you made it in here- reflection communication behavior +6_6 - and do you have a sense of-of what some of the doctor's concerns were that led her to refer you? question communication behavior +6_8 So your asthma has been acting up and there's a lot of stuff, not just the asthma going on? reflection communication behavior +6_10 Mm-hmm. Almost— reflection communication behavior +6_12 Almost overwhelming it sounds like. reflection communication behavior +6_14 Well, we have about, I guess, 15 or 20 minutes together and I wonder, would it be okay, if we took a couple of minutes and just kind of looked at all of the different things that are going on for you and maybe you can let me know, what would be the most helpful to spend-spend some time on? question communication behavior +6_16 Okay. Well, one of the things that-that we use are these-- it's kind of like a worksheet and it's an agenda-setting worksheet basically. therapist_input communication behavior +6_18 So if you were to-to list all of the different things that people around you are saying that you need to work on or you need to change, what would some of those things be? And, Sal, just because we write them down here, it doesn't mean that you have to change them. question communication behavior +6_20 It really-- You're in the driver's seat, so it's just to kind of put all the cards on the table, so to speak. other communication behavior +6_22 Yep. other communication behavior +6_24 Okay, so asthma is one. reflection communication behavior +6_26 What else? question communication behavior +6_28 So your dog, and-and the doctor's saying the dog's— reflection communication behavior +6_30 Okay. other communication behavior +6_32 That's pretty shocking to be told that you have to get rid of your dog. reflection communication behavior +6_34 Hmm. So that's a huge stress right now? reflection communication behavior +6_36 Okay, so smoking and-and I'm working towards quitting completely sounds like that's a goal for you? therapist_input communication behavior +6_38 Okay, so money. reflection communication behavior +6_40 Right. Right, right. So the appointments and time. reflection communication behavior +6_42 Um, and some of these things are kind of related to each other I think we're already seeing. reflection communication behavior +6_44 Okay, wow. So there's a lot happening right now, Sal. Anything else that that's concerning you? question communication behavior +6_46 Right. Well, so where would you-- I mean, if you-you had to pick somewhere, one or two kind of high priorities or-or things to talk about in our time this morning, where would you wanna start? question communication behavior +6_48 Okay. other communication behavior +6_50 Okay, and those are ones that are pretty related to each other- reflection communication behavior +6_52 - sounds like. Okay. other communication behavior +7_0 So I know we've determined that you sprained your ankle yesterday and I'm wondering if you can tell me a little bit about how that happened? question communication behavior +7_2 Sounds like a wild night. reflection communication behavior +7_4 Yeah. other communication behavior +7_6 No, I guess that that would be the end of your, uh, shaking and moving. I know-- I wonder if you'd be open to exploring your alcohol use and what that looks like during the week. question communication behavior +7_8 You're still feeling the effects of- reflection communication behavior +7_10 -last night, are you? question communication behavior +7_12 Oh wow, it was- other communication behavior +7_14 -really a rough night. reflection communication behavior +7_16 So what is a typical week for you as far as your alcohol use? question communication behavior +7_18 So a few drinks is nothing new to you? question communication behavior +7_20 And what does a few drinks look like? Is that per night? Is it two drinks? question communication behavior +7_22 All right. Do you have any concerns at all about your alcohol use? question communication behavior +7_24 Okay, so at this point, you're not too concerned and you think that, you know, this is what the other students are doing? reflection communication behavior +7_26 Would you be open to kind of looking at the low-risk drinking alcohol guidelines? question communication behavior +7_28 I don't know how you're feeling right now but I'm just wondering if we can take a-just a quick glance at this- question communication behavior +7_30 -and what the safe limits are for women is 10 drinks for women a week with about two drinks, uh, per day. therapist_input communication behavior +7_32 Yeah. other communication behavior +7_34 Where do you- where do you feel you fall into that? question communication behavior +7_36 Okay, okay. other communication behavior +7_38 Okay, so it's kind of a way to cope through stress? reflection communication behavior +7_40 Right, and is that something that has been, you know, a way of coping for a while? question communication behavior +7_42 Okay. Does that concern you at all? question communication behavior +7_44 Mm-hmm. other communication behavior +7_46 Okay. other communication behavior +7_48 Do you feel like you have any reasons to kind of bring your alcohol use down within the limits? question communication behavior +7_50 Tell me more about that. question communication behavior +7_52 So you can see some advantages to reducing the amount of drinking- reflection communication behavior +7_54 -um, that you consume during the week? question communication behavior +7_56 Is this something you would be willing to explore with me a little further at another time maybe when you're feeling a little bit better? Is this something you'd be willing to come back and talk to me about? question communication behavior +7_58 I'd love to, uh, set up an appointment for you if you can come in later this week or early next week to- therapist_input communication behavior +7_60 -kind of explore this a little bit further and maybe some of those advantages of reducing to the safe limits. Is that something that we could do? question communication behavior +7_62 That's okay with me. other communication behavior +7_64 Thank you. other communication behavior +8_0 So, what brings you here, Bob? What's, what can I do to help? question communication behavior +8_2 So, you're not too happy to be here. This is the last thing that you want to be doing this afternoon. reflection communication behavior +8_4 You've taken time off you, it's costing you time and money being here. reflection communication behavior +8_6 So, let me ask you this, Bob, what are some of your wife's concerns about your smoking? question communication behavior +8_8 Wow, that she's been showing you and making you read. reflection communication behavior +8_10 So, you're pretty angry about it. It's pretty outraging that you're forced to change your whole life because of a decision she made six months ago. reflection communication behavior +8_12 So, from your perspective, do you see any consequences to your smoking? question communication behavior +8_14 So, let me make sure I understand kind of the whole scenario 'cause there's a lot of pieces to it. Your wife is on your case and your kids are ganging up too. So, you're sort of isolated, you're put in a corner and you're being told this is something you have to do, you have no choice in the matter. reflection communication behavior +8_16 You have a few concerns about your health, but that's not really the driving force. It sounds like it's most of all that it would be nice if things just went back to the way they were before she quit smoking and that all of this stuff wasn't something that you had to deal with anymore. Does that pretty much sum up--? reflection communication behavior +8_18 I get the feeling that your relationship is really important to you. That you would do anything. reflection communication behavior +8_20 So, it strikes me that the way that we're talking about it, it's like it's all or nothing. Either you keep smoking the way you are, things continue to go downhill and get worse, your wife gets more and more on your case, or you put your cigarettes down starting the moment you walk in the door tonight and never pick them up again. It's almost like one or the other. It strikes me that as well there might be some middle ground here that it took you a long time to learn how to be a smoker and maybe it's going to take some time to learn how to stop smoking. reflection communication behavior +8_22 There are some medications and some different approaches that we can use that aren't so abrupt. Recognizing that it-it's going to take some time and practice to get to where you might want to be. therapist_input communication behavior +8_24 If you wanted to bring your wife along, I'd be more than happy to talk with both of you. other communication behavior +8_26 Okay. That sounds good. other communication behavior +8_28 Thanks for coming in. other communication behavior +11_0 What else has brought you here? other communication behavior +11_2 Mm-hmm. other communication behavior +11_4 Mm-hmm. other communication behavior +11_6 Just enough for your own use? question communication behavior +11_8 Yeah. Yeah. Yeah. other communication behavior +11_10 Yeah, we-- You know, we have about 15 to 20 minutes to talk today, total. Um-um, which certainly it's just the first of-of some sessions that we'll have together over the next six months. It'd be a natural question you'd wanna know how much time this will take, of course. Um, what else would you like me to know about you and your perspective that you think will help me work with you over this time? therapist_input communication behavior +11_12 Okay. You're more focused on what you need to do to get this behind you? reflection communication behavior +11_14 .Okay, mm-hmm. Well, I'm wondering then if it's okay with you and-and I have a form that we can use if you'd like, um, just to put out some different ideas on an agenda that we could share as we're working together so that I-I can support you to be successful in getting this behind you. Would-would this feel like a natural time to-to move towards figuring out where we might go together? question communication behavior +12_0 Sarah, I'm so glad you came in for your well-woman exam today. I think we addressed a lot of your concerns. However, I would like to ask you more about your smoking. Would that be okay? question communication behavior +12_2 Okay. So about how much are you smoking over the course of a day? You had said it had increased over once or twice a day. question communication behavior +12_4 Okay. So about eight cigarettes. So over the course of a day, just under half a pack? reflection communication behavior +12_6 Okay. And that's changed over what period of time? question communication behavior +12_8 Okay. So over the past year, the smoking has increased. And that's been mainly in the evening? question communication behavior +12_10 Mm-hmm. Well, that's the time when you can relax and unwind. reflection communication behavior +12_11 Yeah, exactly. You know, I told you, my-my schedule is kinda crazy right now. I, um, I work full-time and I just started back at night classes. So, you know, all that combined, you know, I enjoy that time to myself in the evening. other communication behavior +12_12 Sure. Sure. Well, it's a time to relax and you've got a lot going on. reflection communication behavior +12_14 So are there other things you do in the evening to relax? question communication behavior +12_16 Okay. A drink or two. So about how many drinks would you say you have over the course of a day? question communication behavior +12_18 Two max. How many drinks would you say you'd have over the course of a week? question communication behavior +12_20 No, I understand- I understand. And I'm certainly not here to tell you what to-to do, Sarah. I'm interested in hearing your thoughts and sharing some information with you, and what you do with that information is totally up to you. You've got a lot going on. You're a mother, you're working, you're going to school, and our healthcare team wants to make sure that you have all the resources available to you to meet your goals, including good health. And my job as your healthcare provider is to listen to you and to share information with you, including healthcare concerns associated with smoking and alcohol. Would that be okay with you? question communication behavior +12_22 Okay. Well, we do know that an increase in smoking and alcohol is associated with certain kinds of cancer; colon cancer, cervical cancer, breast cancer, lung cancer, and, um, also pancreatic cancer. It's also associated with liver and lung disease as well as heart disease, diabetes, and hypertension. So that's a lot of information, but I'm- therapist_input communication behavior +12_24 -interested in what your thoughts are, Sarah. question communication behavior +12_26 So you're consciously trying to cut back. reflection communication behavior +12_28 I have a readiness ruler in my pocket here, 0 means not ready to stop smoking at all and 10 means absolutely ready to stop smoking. Where do you see yourself on that scale? question communication behavior +12_30 About a five. So you're halfway there. So why did you choose a five rather than a four? question communication behavior +12_32 Right. Well, that's a lot of information to think about. So given, the fact that these healthcare concerns are a possibility, and that you're worried about your family and you certainly have goals you want to succeed at, where are you in your consideration to making a change? In other words, what steps would you consider taking for this number to move closer to a 10? question communication behavior +12_34 Okay, great. Let's quantify that a little bit. So how many cigarettes would that be? therapist_input communication behavior +12_36 Okay. So you-- that's cutting back quite a bit. That's a big step. So since we're kind of running out of time here today, I'm wondering if we could-- would be willing to come back in about four weeks to review this plan? question communication behavior +12_38 Okay, good. So we can go over your laboratory results at that time, as well as review your plan. Now, would you like some information on smoking cessation? question communication behavior +12_40 Okay. Well, I've got a brochure here and this has-- it's a really good brochure. It has some distraction techniques in it in case you get those nicotine cravings. So it's- therapist_input communication behavior +12_42 -been helpful, um, in-- with patients before. I'd also like to ask you, would you be willing to see one of our counselors? question communication behavior +12_44 Well, Dr. Kirtley is one of our counselors and he is an expert in-- at discussing the association between alcohol and stress. I want to share something with you. The National Guidelines recommend that women have no more than seven drinks of alcohol per week to-to stay at that low risk level, to avoid the healthcare concerns that we spoke of earlier. therapist_input communication behavior +12_46 You've indicated that your alcohol consumption is a bit higher than that, putting you at risk. So that's why I asked if you'd be willing to talk to Dr. Kirtley. therapist_input communication behavior +12_48 Certainly, certainly. I'm glad you're willing to talk to him. So before you leave here today, we'll, uh, stop by the scheduler's desk and make an appointment for you to see me back in four weeks, as well as the appointment with Dr. Kirtley. And that way, before you leave, you're all set. So do you have any other questions for me, Sarah? question communication behavior +12_50 Okay. Well, it's very nice to meet you. I'll see you in a month. other communication behavior +13_0 Hi, Mrs. Smith. I wanted to let you know that at this appointment, we're gonna be giving Lilly some vaccines. therapist_input communication behavior +13_2 Hmm. Can you tell me more about your concerns about vaccines? question communication behavior +13_4 Okay, so you were thinking that maybe exposing Lily naturally to these diseases would be a better choice than using vaccines to help her get stronger? reflection communication behavior +13_6 That's right. Having chickenpox as a child means that you are less likely to have chickenpox as an adult because you've developed a-a natural immunity. Uh, but is it okay if I offer you a little bit more information about the other vaccines that we're- we were going to give her Lily today? question communication behavior +13_8 Okay. So, uh, before vaccines were developed, often when children had a natural exposure to some of these diseases, they ended up with, uh, sometimes death, disability, measles caused brain damage and, uh, deafness and blindness. Polio caused, uh, paralysis in children. And so, allowing children to have natural exposure to these diseases, sometimes was a little bit of a gamble, it could be dangerous. therapist_input communication behavior +13_10 Hmm. Some of these things I've mentioned to you, you're-you're not familiar with. Uh, and I think that's because we've done such a good job of eliminating some of these diseases that a lot of people your age, and even my age, are unfamiliar with those things. Um, so having shared this information with you, what do you think about the idea of vaccines for-for Lilly? question communication behavior +13_12 It's really important for you to make sure that she's protected and that you make good decisions and do your research before you make any medical decisions for her. reflection communication behavior +14_0 So, again, I hear your overall goal is really, to not give up these things you'd like but to cut back on how much you have- reflection communication behavior +14_2 -on that. All right. So, I'd like to ask you, uh, kind of a scaling question about this 'cause I'm hearing that this feels really important to you that you'd be way up there on the high- on the high end of importance. reflection communication behavior +14_4 "So, I'm gonna ask the question this way, on a scale of 0 to 10, where 0 is not at all confident, and 10 is like, ""I'm very, very confident,"" where would you put yourself on a scale right now of confidence in starting this new plan?" question communication behavior +14_6 Mm-hmm. other communication behavior +14_8 A six. reflection communication behavior +14_10 Okay. All right. So, let's talk about that, um, so we should just assume we're gonna be at a four. reflection communication behavior +14_12 Okay? question communication behavior +14_14 So, why are you at a four and not even a lower number? Why are you not like a zero or a one? question communication behavior +14_16 Okay. other communication behavior +14_18 Okay. other communication behavior +14_20 Uh-huh. other communication behavior +14_22 Okay. other communication behavior +14_24 Okay. other communication behavior +14_26 Okay. other communication behavior +14_28 Okay, all right. other communication behavior +14_30 Okay. So, what would help increase that confidence? What-- Because that sounds like where we really need to focus on. What's gonna help you feel more confident about this? question communication behavior +14_32 Mm-hmm. other communication behavior +14_34 Mm-hmm. other communication behavior +14_36 Uh-huh. other communication behavior +14_38 Uh-huh. other communication behavior +14_40 Okay. other communication behavior +14_42 All right. other communication behavior +14_44 All right. other communication behavior +14_46 Okay. other communication behavior +14_48 All right. Well, if it's okay, just for a moment, let's put the- let's put the changing the eating pattern off to the side, and let's take a look at some other time in your life that there was something you really wanted to accomplish and you did. And what is it about you- what was it about you? What kind of strengths did you bring to the table that allowed you to tackle something that felt like a challenge and-and allowed you to be successful? question communication behavior +16_0 So, Rick, just in regards to your flatmate situation at the moment with Tristan. Uh, you know, we talked about how walking through this program and with the support of your parents and having some positive influence to help you through this. I just want to rethink a bit if you stay living with Tristan. What are the sort of pros and cons of that? What are the good things about living there, what are the not-so-good things about living there? question communication behavior +16_2 Yeah. So, in terms of being supportive and a sort of support you're gonna need to make these changes. therapist_input communication behavior +16_4 What's your thinking around that? question communication behavior +16_6 Mm-hmm. other communication behavior +16_8 Yeah. other communication behavior +16_10 Right. other communication behavior +16_12 Okay. You're good to explore, but I just want to ask you about, how much does Chris-Christian-Christian know-- Tristan know about you changing your life? What does he really know about the changes you wanna make? question communication behavior +16_14 Mm-hmm. other communication behavior +16_16 Right. other communication behavior +16_18 Okay. What are some of the pros and cons about moving in with whāna, moving in with your auntie and uncle? question communication behavior +16_20 In terms of that freedom and in charge of yourself, and the changes that we're talking about, and building your own family, and to enable you to do that, where do some of that freedom stuff sit with re-engaging back with your whānau and your children, your partner? Is it something you're gonna wanna hang on to, or how you're going to manage that? question communication behavior +16_22 Mm-hmm. other communication behavior +18_0 So I get a sense it's a little anxious being here today and, uh, meeting someone like me, and, um, what we're gonna be doing today is-is inducting, but also I wanna talk about, um, yeah, the issues that-that have got you here and we need to do some sorting out around, um, yeah how serious you are to sort of sort those issues. So? reflection communication behavior +18_2 Sorry? other communication behavior +18_4 All right. other communication behavior +18_6 Yeah. other communication behavior +18_8 So first, it might be trying to sort out what are the important issues to sort out. therapist_input communication behavior +18_10 Yeah, that makes sense? Yeah? So how confident are you that-that, you know, you can sort out the issues related to, um, you know, uh, taking the money from your employer? And another thing, in your precinct's report, there were some issues around gambling, and some issues around alcohol use. So those seem to be important issues that are kind of getting out. So how confident are you that you can get those sorted in the nine months we've got? question communication behavior +18_12 Yeah. other communication behavior +18_14 Yeah, yeah. other communication behavior +18_16 Yeah. See one of the things I'll be really interested in-in talking with you about is, um, yeah, what's-what's the, um, what's the worst thing that has happened in terms of pokies, in terms of you know behavior around the pokies, what's the worst thing that's happened? question communication behavior +18_18 Yeah, yeah. other communication behavior +18_20 Yeah. So how often do you end up with no money in your pocket? Can be the times when you end up with money in your pocket question communication behavior +18_22 Yeah, yeah. So if we were to think back, say the last month, the last four weeks, how many times would you have gone down to the- to the pokies, the pub? question communication behavior +18_24 Yeah. Yeah. other communication behavior +18_26 That-that you're up for the money and-and then-then they slot you. reflection communication behavior +18_28 Okay. So-so thinking about this, say a couple times a week, you know, two or three? question communication behavior +18_30 Yeah, yeah, yeah? So that's 12 times. So how many times would you have walked away with money in your pocket after, any out of the 12, what's your- what's your sense? question communication behavior +18_32 Okay. Okay. So you're saying about 50-50? question communication behavior +18_34 'Cause you have to understand the odds are about-- sort of-of tend to be about 25% on the 100, that-that's [crosstalk] therapist_input communication behavior +18_36 Yeah, you might be lucky then. So-so what do you reckon like in terms of like you're saying you're not sort of sure if that's an issue, and that's probably something that we can be working with, uh, figure it is an issue. question communication behavior +18_38 And, yeah, it might be an issue, I don't know if it's an issue at this point. It'll be interesting to sort of talk about that. But I'm wondering what happens, yeah, when-when you get on the pokies out there, they're certainly at the pub, pokies around? So what happens in your body when, um— question communication behavior +18_40 A bit of a rush. Yeah. 'Cause other people I have worked with say that, yeah, sometimes they get a bit of a rush, that somehow the rush takes over and they don't know when to stop. Not sure if that's what- if that's what it's like for you, but other people have told me that, so. therapist_input communication behavior +18_42 Yeah, yeah. Yeah, yeah. So that could be an issue we could spend some time talking about here, 'cause obviously you know, you don't- you don't - you don't wanna be here, and then my interest now is just getting you o-out of the system, not getting you into the systems. So-so here, um-- how-how much do you think this is an issue for you, you reckon? The pokies and the gambling. question communication behavior +18_44 Yeah, yeah. Thinking about your friends, you know, how would you soft of think about your friends 'cause, you know, I guess you go out with your girlfriends and stuff. question communication behavior +18_46 Yeah, yeah. So, in terms of their behavior, like how did your behavior sort of match with their behavior? Are they much the same as you, are they different than you? question communication behavior +18_48 Yeah, yeah, yeah. Then, in terms of the pokies and stuff they much as they like doing the pokies so much as your doing the-- You know, compared to you doing the pokies? question communication behavior +18_50 Oh, okay, okay. Who's-who's-- What's your girlfriend's name, your best- your best friend, best girl friend? question communication behavior +18_52 Sarah, So what do you think Sarah would say? question communication behavior +18_54 What would she say about— question communication behavior +18_56 Yeah, what would she say about-- 'cause she knows you pretty well. She'll-she'll-- she goes to the pubs with you probably and see you putting the money on pokies, what would she reckon? question communication behavior +18_58 Absolutely, and that's what you want from friends, isn't it? question communication behavior +18_60 You want that acceptance, absolutely, yeah, yeah. But won't you say, you know, friends also-- good friends also can, you know, call you on stuff too, can't they? Yeah? question communication behavior +18_62 At times. Yeah, so-so what you-- wha-what she might say to us about about- a-a-about your gambling? question communication behavior +18_64 Okay. other communication behavior +18_66 Okay. But you owe her some money and you get the sense that-- Or I'm picking up, you get a sense that she's not terribly happy. reflection communication behavior +18_68 Yeah, yeah, okay, okay. So Sarah might see it as an issue. And-and I guess there's a part of you also sees it as an issue, part of you, you know. Part of you may not, but a part of you does. reflection communication behavior +18_70 So the part of you that does see this is-- as an issue, yeah, that the gambling sometimes can be out of control, you know, tell me that part of you that-that maybe knows that, uh, it's getting you into trouble and it's gone way-- just moved you off from that point, there have been some— question communication behavior +18_72 Yeah. other communication behavior +18_74 Mm. other communication behavior +18_76 Yeah, and-and in some ways getting caught might be a good thing. I know it might sound a re-really sort of strange thing to say, but I wonder if like getting caught might have been a good thing. Because you would have read the papers about other people's of-- you know. They're the hands that would turn on stuff and end up with gambling problems and big money. So I want- I want to hear much that it might have been a good thing that you got caught at this stage, and you got a chance to do some talking about it and working around some strategies to get it under control so it doesn't control you. What's your hunch about that? therapist_input communication behavior +18_78 Yeah. Yeah, so you're not a bad person. Certainly, I don't make judgments about people being bad people. So that seems sort of actually thinking about this, you sensed that you could've stopped. question communication behavior +18_80 Have you put on a kind of real hat, you know, you get a real hat here, you know? What-what's your hunch about that? Is it a kind of-- that kind of realization it's a bit of a smoke screen, what's your hunch? question communication behavior +18_82 How about then your-your kind of hunch about that? question communication behavior +18_84 Mm. other communication behavior +18_86 Yeah- other communication behavior +18_88 -so, what did it add up to, at the end of the day? What are we talking here? question communication behavior +18_90 Yeah, yeah. It's a little bit here, a little bit there, so it then adds up, yeah? Yeah. reflection communication behavior +18_92 Mm. other communication behavior +18_94 Yeah. Okay. So-so, there's some-some questions you've got around some-some ways you, kind of, explained them. And then, as we work together, you know, we-- there might be some other ways we look at it and see it too, you know, that-that's part of working together. So, I'm wondering, how open are you to, you know, seeing this situation from lots of different angles? therapist_input communication behavior +18_96 Yeah? Yeah. other communication behavior +18_98 Yeah, yeah. other communication behavior +18_100 Okay. So, what other things have you've been open to at other times in your life when you've been open to-to new ideas and being able to talk about stuff, that may be tough to talk about? question communication behavior +18_102 Yeah. other communication behavior +18_104 Yeah, and-and, coming in, talking to a stranger, you know, and someone who can be honest to what you did, talking to a stranger, coming in this time, what do you sense about how you're doing so far? reflection communication behavior +18_106 Mm. other communication behavior +18_108 Yeah. You know, like-- I-- And, some people wouldn't even, sort of, get in the door or wouldn't be as open as you've been today, okay, to an extent, so, you know, like I said, good on you, yeah. You know, being able to-- It's hard to come to a place like this and start to really open up, so, you know, you've just shown that you can do that. Yeah. reflection communication behavior +18_110 Well, you have a choice about what you open up to me about. Absolutely, you have a choice about that, yeah. That coming, being on sentence, no, you don't have a choice about that, um, well, you have a choice, 'cause, I mean, you can choose not to come, and you'll be breached and get to head back to court. therapist_input communication behavior +18_112 Um, but you do have a choice about how you are here when we meet, and what-what we talk about here. So, um, you know, so you do have lots of choices within that. And, my sense is you're, sort of, you know, a young woman who will make some good choices about that 'cause you're not a bad person, and you know that. reflection communication behavior +18_114 Yeah. other communication behavior +19_0 So you're sick of this? reflection communication behavior +19_2 Mm-hmm. other communication behavior +19_4 Okay. other communication behavior +19_6 So, it sounds like you're ready. You're ready to give this up. reflection communication behavior +19_8 But, maybe the path to doing that isn't so clear. reflection communication behavior +19_10 Mm-hmm. other communication behavior +19_12 And it's fun. reflection communication behavior +19_14 Mm-hmm. other communication behavior +19_16 Uh-huh. other communication behavior +20_0 So I wrote a prescription for antibiotics for Aiden. therapist_input communication behavior +20_2 Um, I did wanna talk to you though. I'm a little bit concerned looking through his chart of how many ear infections he's had recently. And I-I noticed that you had checked the box that someone's smoking in the home. So I was wondering if you can tell me a little more about that. therapist_input communication behavior +20_4 You have a lot of things going on and smoking's kind of a way to relax and destress. reflection communication behavior +20_6 Sure. And it sounds like you're trying not to smoke around him. Why did you make that decision? reflection communication behavior +20_8 So on the one hand, you're worried about how your smoking might be affecting him and on the other hand, you're not so sure if it's really the smoking that's causing these problems? reflection communication behavior +20_10 What made you decide to quit smoking when you were pregnant? question communication behavior +20_12 Right now, though, it feels almost too difficult to even manage or even to try? reflection communication behavior +20_14 How were you successful when you quit before? question communication behavior +20_16 Mm-hmm. other communication behavior +20_18 Mm-hmm. The risks were so scary then that you were able to stop? reflection communication behavior +20_20 But they don't feel as scary to you now? reflection communication behavior +20_22 You're doing the best you can do. reflection communication behavior +20_24 Okay. But it sounds to me too like part of you really does want to quit? reflection communication behavior +20_26 It's on your to-do list. It's just not making it to the top? reflection communication behavior +20_28 If you did decide to quit on a scale of 1 to 10, where 1 is not at all confident, and you don't think you could do it and 10 is you feel pretty certain that you could, where do you think you fall right now? question communication behavior +20_30 Well, what made you say five rather than two or three? question communication behavior +20_32 Okay. So it sounds like you have a lot of reasons why you'd like to quit. You have been successful quitting in the past, and right now you're just feeling a little bit hesitant about your ability to do it? reflection communication behavior +20_34 Where do you think we should go from here? question communication behavior +20_36 Sure. Well, if you'd be interested, that's something I can definitely talk to you about. There are a lot of new options that can actually help people be way more successful in their attempt at quitting. There's different medications you can try. therapist_input communication behavior +20_38 Okay. There's also a lot of support groups and classes that you can take where you have other people to go through it with you. And sometimes just having that support can be a big part of it, especially for people like you where smoking is such a stress reliever. therapist_input communication behavior +20_40 Sure. It feels like something that would take up a lot of time and maybe not fit into your life. I wonder if we could talk about some options that might fit into your life. question communication behavior +20_42 Okay. Well, if you're willing, then we could set up another appointment where you could come in and we could talk more about that. therapist_input communication behavior +20_44 Great. other communication behavior +20_46 Sure. other communication behavior +21_0 Hi, Laura. other communication behavior +21_2 Thanks for coming in. Um, so, I'm not sure how much you know already about sort of what you're doing here. If it's okay, I'll give you a little rundown. question communication behavior +21_4 So, basically, we're here, I'm just gonna talk to you for a little bit about sort of what your goals are for your life, um, get to know you a little bit better and talk about some different behaviors that you might be engaging in. It's not my job at all to judge you or to try and change you, you know. Basically, I'm gonna talk to you about how things are going, any changes you might want to make in your life, how I could help you with that, and just what I can do that's going to be most beneficial for you. therapist_input communication behavior +21_6 Does that sound okay? other communication behavior +21_8 All right, so, I guess just to get started, can you tell me a little bit about yourself? question communication behavior +21_10 Okay. And, what kinds of things do you plan for your life? other communication behavior +21_12 Hm. other communication behavior +21_14 That's great. other communication behavior +21_16 Do you have a plan as to where you might want to go or? question communication behavior +21_18 Oh. other communication behavior +21_20 Cool. other communication behavior +21_22 So, kind of keeping your options open. reflection communication behavior +21_24 Great. And, do you have an idea about what you might want to study or? question communication behavior +21_26 Oh, wow. Okay, that's exciting. reflection communication behavior +21_28 All right, cool. Uh, what do you like to do for fun? question communication behavior +21_30 Mm-hmm. other communication behavior +21_32 You like to have a good time? reflection communication behavior +21_34 And, you have a lot of friends or a few close people, or? question communication behavior +21_36 Mm-hmm. other communication behavior +21_38 All right. other communication behavior +21_40 That's a good way to be, right? reflection communication behavior +21_42 All right, so, um, it sounds like, in general, your-- Things are going pretty well for you. How are your grades right now? question communication behavior +21_44 Okay. other communication behavior +21_46 Great. Well, one thing I want to ask about is, you know, different people have sort of different values or things that are important to them. They might, you know, be really close with family or really have, you know, their friends as being something particularly important. So, I'm gonna show you just a few things on this sheet, and if you can look at them all. So, there's things like belonging, community, cultural identity, family, friendship, modesty, religion, respect, self-determination and spirituality. Which of those do you think is sort of important to you? question communication behavior +21_48 Okay. other communication behavior +21_50 What's important to you about your family? question communication behavior +21_52 Hm. other communication behavior +21_54 Okay. Do you have brothers or sisters? question communication behavior +21_56 Okay, great. And, how about friendship? question communication behavior +21_58 Great. So, being a good friend and- reflection communication behavior +21_60 -having people who are good friends, too, is important. And then, what about belonging? You mentioned that one too. question communication behavior +21_62 Hm. other communication behavior +21_64 Yeah. Wanting to be part of a group- reflection communication behavior +21_66 -and kinda. Okay, great. All right, well, one of the things I wanna talk about is, you know, um, you mentioned that you'd like to go out with friends and-and party, and that sort of a thing. And, I'm curious, when you're out in the parties, do you ever have any alcohol? question communication behavior +21_68 Okay. Can you tell me a little bit about how alcohol fits into your overall social scene? question communication behavior +21_70 Hm. other communication behavior +21_72 Okay, you're kinda getting pressure from other people who are drinking, and it feels easier for you to- reflection communication behavior +21_76 Okay. other communication behavior +21_78 And, do you think that, um, this is most weekends or occasionally? How- question communication behavior +21_80 -often do you think that you are around alcohol. question communication behavior +21_82 Okay. other communication behavior +21_84 So, one or two weekends a month you're in a situation where there is alcohol? reflection communication behavior +21_86 Okay. And what sort of situations are you in? question communication behavior +21_88 Uh-huh. other communication behavior +21_90 Hm. other communication behavior +21_92 So, mainly, just kinda hanging out with friends. reflection communication behavior +21_94 Are you ever, um, places where there are parents around or- question communication behavior +21_96 -or mostly just-just with the kids? question communication behavior +21_98 Mm-hmm. And, what about driving? question communication behavior +21_100 Yeah. Do you ever go anywhere in a car after you've had any alcohol? question communication behavior +21_102 Okay. So, that's something that you've sort of made a decision about. It sound like you— reflection communication behavior +21_104 Okay. What do you know about how that's dangerous? question communication behavior +21_106 So, you're really are trying to be safe and-and make sure that- reflection communication behavior +21_108 -you're not putting yourself- question communication behavior +21_110 -in those situations? That's great. You know, it's-it's tough to do sometimes, and I really commend you for being able to-to stick with that. reflection communication behavior +21_112 So, you mentioned, you pretty much will like hold a drink or maybe have a drink or two. What do you thinks is the most alcohol you've ever had in-in one day? question communication behavior +21_114 Okay. So, the-the absolute most- reflection communication behavior +21_116 -was two? Okay. And, what kinds of things do you like about alcohol? question communication behavior +21_118 Uh-huh. other communication behavior +21_120 Mm-hmm. other communication behavior +21_122 So, it just kind of makes you feel relaxed or? reflection communication behavior +21_124 Okay. Uh, anything else? question communication behavior +21_126 Mm-hmm. other communication behavior +21_128 Okay. And, any not-so-good things about alcohol? question communication behavior +21_130 Mm-hmm. So, you've seen a lot of other kids who- reflection communication behavior +21_132 -had some consequences- reflection communication behavior +21_134 -and decided that's not for you? reflection communication behavior +21_136 Got it. I-I can understand that. [chuckles] Uh, any other things that you can think of? question communication behavior +21_138 Mm-hmm. other communication behavior +21_140 Okay. Well, so, you know, as someone who's not 21 yet, it is-- Underage drinking is something that's not legal- therapist_input communication behavior +21_142 -and it is something that is considered pretty risky. So, I wonder what you think about that, just in terms of how it fits into your life. question communication behavior +21_144 Uh-huh. So, it's kind of something that you're— other communication behavior +21_146 It's just there? Okay. And, I'm curious, you mentioned, you know, your friends are important to you, and your family's important to you, and, sort of fitting in is important to you. How does alcohol play a role with that? question communication behavior +21_148 Okay. other communication behavior +21_150 Okay. So, from your family perspective, the drinking is not something that fits very well? reflection communication behavior +21_152 And with friends, you feel like it's easier to-to hang out with alcohol, or maybe you wouldn't have as much fun, or your friends wouldn't like you as much or? reflection communication behavior +21_154 Okay. other communication behavior +21_156 Got it. other communication behavior +21_158 Okay. Well, when you think about your drinking and, sort of, looking forward in 5 years or 10 years, how do you think that drinking might fit in with your life? question communication behavior +21_160 Mm-hmm. other communication behavior +21_162 Okay. Can you expand on that a little bit more? What do you mean? question communication behavior +21_164 Okay, so, the-the alcohol is something that might make it harder to reach your goals? reflection communication behavior +21_166 Um, so, when you're sort of looking ahead, how often do you think you might be drinking, say, when you get to college? question communication behavior +21_168 Mm-hmm. other communication behavior +21_170 Okay. So, you sort of have a plan to cut back on- reflection communication behavior +21_172 -your drinking eventually? reflection communication behavior +21_174 How might that go? question communication behavior +21_176 Yeah, so, you don't feel the need to make any major changes, but you feel like you could make some adjustments that would make it easier or— reflection communication behavior +21_178 Okay. How important is it to you to make some adjustments to your drinking, on a scale of 1 to 10? Where 1 is not at all important, not something you're thinking about, and 10 is most important thing. question communication behavior +21_180 And why did you say five or six rather than like two or three? question communication behavior +21_182 Okay. So, it is something you have thought about or something. reflection communication behavior +21_184 Okay. And, how confident are you that you could make a change if you decide you wanted to on that same scale? question communication behavior +21_186 Mm-hmm. other communication behavior +21_188 So, what number do you think you'd say? question communication behavior +21_190 Mm-hmm. other communication behavior +21_192 Yeah. other communication behavior +21_194 Okay, and why'd you say 8 or 9 rather than even like 5 or 6? question communication behavior +21_196 Okay. All right. Well, kind of keeping that in mind, it sounds like, um, you do have sort of a-a vague plan to make some adjustments in your drinking at some point- reflection communication behavior +21_198 -and, it's moderately important to you. It's something you would like to do because you have these big goals for yourself, and you actually feel very confident that you could be successful with it. What sort of goal do you think might be good to set for today? question communication behavior +21_200 Okay. Um, do you feel pretty confident that you could just stop completely? question communication behavior +21_202 Uh-huh. other communication behavior +21_204 Okay. other communication behavior +21_206 What-what might be some benefits of following through with that goal? question communication behavior +21_208 Uh-huh. Anything else? question communication behavior +21_210 Mm-hmm. other communication behavior +21_212 Okay. So, it's-- It sounds like you're actually pretty comfortable with setting a goal of not drinking anymore a-at least at the next part? and seeing how it goes. reflection communication behavior +21_214 Okay. Do you think it would be all right if we met again to kinda check in on how it goes and-and see if it's working out for you? question communication behavior +21_216 All right, great. And then, i-it sounds like some of the benefits you're expecting are, um, health benefits- reflection communication behavior +21_218 -having an easier time with achieving your academic and career goals, and just sort of not having to deal with some of the consequences that your peers do. reflection communication behavior +21_220 Okay. Well, very good. Um, is there anything else that you think would be important for me to know? question communication behavior +21_222 Oh, that's a great question. So, a lot of times, kids who are trying to cut back, it's harder if their friends are still drinking, and one of the easiest things is trying to have more activities that don't involve alcohol, but- therapist_input communication behavior +21_224 -of course, that's harder if you're not the one planning. So, some of the things that can be useful if you're at a party say, um, and there's already alcohol there, and there are other kids that maybe aren't your closest friends, um, some of the things that I would recommend since you're interested are, you know, carrying around a different drink that looks like it has alcohol in it. So, you know, even carrying an empty beer bottle or beer can or, you know, if people are having a mixed drink, just having the coke, say- therapist_input communication behavior +21_226 -without any alcohol mixed into it. Um, often, having anything in your hand is a good barrier for people who are trying to offer you alcohol, because you already have something in your hand- therapist_input communication behavior +21_228 -and it-it kinda, um, prevents them from trying to stuff something else in there. Do you think any of those things might work for you? question communication behavior +21_230 Okay. What about in terms of talking to your friends about it, have you thought about how you might approach with them or is that something else you'd like some tips about, about telling them about your plan to- question communication behavior +21_232 -to stop drinking. other communication behavior +21_234 Uh-huh. other communication behavior +21_236 Your friends would be pretty comfortable with that? question communication behavior +21_238 Okay, great. Any other concerns or questions? Anything else I can help with? question communication behavior +21_240 Okay. So then, like I said, um, I'll try and see if we can meet up maybe in a few weeks and see how it's going- reflection communication behavior +21_242 -and then, um, if things are going great, then fantastic, and if you run into any stumbling blocks, then we can maybe problem-solve together. other communication behavior +21_244 That sound okay? question communication behavior +21_246 All right. Thanks so much. other communication behavior +22_0 You did your values clarification handout, and that was part of what I wanted to go over with you today. I wanted to hear about your values and just talk to you a little bit more about that. Do-do you wanna tell me what some of your top five values are? question communication behavior +22_2 That's number one? question communication behavior +22_4 Mm-hmm. other communication behavior +22_6 Oh. So, right now family value is the most important thing to you? question communication behavior +22_8 Family happiness? question communication behavior +22_10 Okay. Would you like to talk more about that? question communication behavior +22_12 Mm. Because even though it's important to you, maybe they don't know it's important to you. reflection communication behavior +22_14 Is that what you're saying? Yes? question communication behavior +22_16 And you want them to know? question communication behavior +22_18 Uh-huh. other communication behavior +22_20 Okay. other communication behavior +22_22 Okay. other communication behavior +22_24 Uh-huh. other communication behavior +22_26 Right. So, right now, it really is important to you to put the family values first? And religion is still very important to you, but you feel like maybe you're losing faith a little bit? reflection communication behavior +22_28 Uh-huh. other communication behavior +22_30 Because you know that other people experience it too. reflection communication behavior +22_32 So, you know it's normal. reflection communication behavior +22_34 But sometimes it's not something that people talk about. reflection communication behavior +22_36 Especially in the church. reflection communication behavior +22_38 Mm-hmm. other communication behavior +22_40 Yeah. other communication behavior +22_42 And it sounds like right now you're at a place of acceptance about that also. reflection communication behavior +22_44 Uh, that it's okay with you, and you-you know that it's gonna change because that's been your, uh, experience. reflection communication behavior +22_46 You've done numerous values clarification handouts and every time they're different- reflection communication behavior +22_48 -so you know that it's going to change. reflection communication behavior +22_50 And you accept that? question communication behavior +22_52 Mm-hmm. other communication behavior +22_54 Mm-hmm. other communication behavior +22_56 Yeah. other communication behavior +22_58 Yes. other communication behavior +22_60 I really applaud you for being open-minded enough to realize that where you are now is not necessarily where you are, that you don't have to always have it be the same. other communication behavior +23_0 Hi, Hannah. Nice to meet you. other communication behavior +23_2 So I understand that you were referred to me by your GP because you've been experiencing some anxiety difficulties. other communication behavior +23_4 Okay. other communication behavior +23_6 Okay. Is this the first time that you've left home? question communication behavior +23_8 Okay. So it has been quite a big step and a big change and it sounds like that that was what led you to go to your GP. reflection communication behavior +23_10 So how has that, uh, changed things for you? question communication behavior +23_12 Okay. So how do you feel about being here today? question communication behavior +23_14 Okay. So you'd, you're feeling a little bit anxious about today. reflection communication behavior +23_16 Okay. So I guess just going back to why you went to the GP and how you've ended up kind of coming here today. So it sounds like you've been experiencing anxiety for quite a few years. Um, but just recently you moved out of home for the first time and, um, and that was what kind of led you to go to the GP. So how did that change things? How were things after you moved out? reflection communication behavior +23_18 Okay. So what other kinds of difficulties that you have been experiencing? question communication behavior +23_20 Okay. So you said that, um, your difficulties are getting in the way of you doing certain things. So they're, they're stopping you from taking up kind of certain types of work and as a freelance photographer, I guess that- that can be kind of a problem. And they're also stopping you or you feel like it's stunting you, uh, socially. You're not kind of able to make new friends and get to meet new people. reflection communication behavior +23_22 So you're kind of worried about how, where this is going to lead to. reflection communication behavior +23_24 So you said that you first noticed the anxiety kicking in about five or six years ago. reflection communication behavior +23_26 So you would have been about 19. reflection communication behavior +23_28 And what was happening around that time? question communication behavior +23_30 What kind of work is the most difficult for you in your job? question communication behavior +23_32 So I guess, tell me a bit more about what happens then. So let's focus on maybe an invitation to do a job with, uh, you know, it's going to involve, uh, photography with- with a group of people and you're going to have to have social interaction. What kind of thoughts go through your head? question communication behavior +23_34 "Okay. So it sounds like you have quite a lot of thoughts rushing through your head then at the point where you get that invitation and you think, ""People will look, people will stare, people will think I'm a weirdo."" So there's quite a lot about what you- what you think other the people will think. And how does that make you feel?" reflection communication behavior +23_36 Okay. Can you give me an example of a-a recent situation? Maybe we can focus on that. question communication behavior +23_38 Yeah, time when you were maybe doing a job with some people and you felt the social anxiety, you know, that you're describing, you felt that kick in. other communication behavior +23_40 It's quite interesting. Was that a fashion shoot or something? question communication behavior +23_42 Okay. other communication behavior +23_44 So it wasn't what you expected? reflection communication behavior +23_46 So how long ago was that? question communication behavior +23_48 Okay. So it was quite recent. reflection communication behavior +23_50 So on that particular day, what were the thoughts that you had in your head when you were in that situation? question communication behavior +23_52 I can tell you're getting kind of anxious, even just thinking about that day. reflection communication behavior +23_54 Okay. So you're describing quite a lot there to me. So you're saying that you, you kind of got hot and sweaty, you said that you- you held the camera. reflection communication behavior +23_56 W-what was, do you mean you kind of try to hide behind it or? question communication behavior +23_58 So you're holding the camera very tightly. reflection communication behavior +23_60 W-why was that? Why was that helpful? question communication behavior +23_62 Okay. So, okay. So it sounds like you had a lot of thoughts going through your head. Um, you said that you're worried that everyone's looking at you. What other thoughts were there that were in your mind? reflection communication behavior +23_64 They could tell what— question communication behavior +23_66 Oh, it was all-all that they could see that-that was- reflection communication behavior +23_68 Okay. other communication behavior +23_70 So, I mean, you've already described it to me a little bit, but if you think about how you looked that day, how'd-how'd you say, how'd you think you looked? question communication behavior +23_72 Okay and what-what did you do about-- How did you try and conceal that or hide that? question communication behavior +23_74 So you avoided looking at people. It sounds like you wore black as well in kind of preparation anyway. reflection communication behavior +23_76 Okay and how did it end? question communication behavior +23_78 Okay. other communication behavior +24_0 Hey, can I help you? question communication behavior +24_2 So your workplaces went smoke-free and you're not too pleased, huh? reflection communication behavior +24_4 Okay. Tell me a little bit about how smoking fits in your day. It'll help with the— question communication behavior +24_6 Okay. So you feel like, right now, smoking's a pretty important part of your life. It's not something you're ready to change, but if the time came when you did decide to quit, you feel pretty confident that you could go ahead and do that. reflection communication behavior +24_8 Okay. What makes you so confident? question communication behavior +24_10 Mm-hmm. And so in terms of, uh, uh, readiness to actually go ahead and make a quit attempt, where do you think you fall on the scale of 1 to 10, where one is, I'm not considering it at all, and 10 is, I'm definitely ready, I wanna quit. question communication behavior +24_12 Okay. What made you say two instead of one? question communication behavior +24_14 Well, there are a lot of products available now that can actually help you curb that urge to smoke. We have products that can help to replace nicotine, which can help to decrease withdrawal symptoms that you might experience when quitting or cutting down and also some medications that your doctor could prescribe for you that might take away even some of the desire to smoke. therapist_input communication behavior +24_16 Sure. And back to that scale, you mentioned, you said you were a two. What do you think it would take to move you up to a four or five? question communication behavior +24_18 Sure. I wonder if now that your workplace is going smoke-free, if there will be some people at work who planning to quit. question communication behavior +24_20 Okay. Well, it sounds like you're really here just for information today. I'm happy to help you pick out some of these products if and when you decide that the time is right for you. therapist_input communication behavior +25_0 So, Liz, what's something that you'd like to change or maybe that you're feeling two ways about right now? question communication behavior +25_2 Okay, and-and why would you want to make this change? question communication behavior +25_4 Mm-hmm. other communication behavior +25_6 Mm-hmm. other communication behavior +25_8 Yeah. So, you're not feeling comfortable with the way that, you said, your clothes fit. reflection communication behavior +25_10 What are some of the reasons why, um, it would be good for you to kinda make this change? question communication behavior +25_12 Mm-hmm. other communication behavior +25_14 So, to heal-- feel healthy for yourself as well be a good role model for your kids? reflection communication behavior +25_16 So, if you did decide to get exercising more into your daily routine, how would you go about doing it? question communication behavior +25_18 Mm-hmm. other communication behavior +25_20 So, it's that balance of doing something for yourself, but it sounds like you don't want that schedule to affect too much into your family routine. reflection communication behavior +25_22 So, on a scale from 1 to 10, 1 being not important and 10 being very important, where would you rate yourself on how important it is to start exercising more? question communication behavior +25_24 Okay, and how come not at like a five or a six? question communication behavior +25_26 Mm-hmm. other communication behavior +25_28 So, to summarize, it's important for you to do this. You're starting to feel sluggish, you're not feeling healthy, and you know that you've got other people in your family watching you, and you want to be a good role model for them to know that this is gonna be just a part of your life, is your exercise. Yet for you, you're struggling just a little with the logistics of when to schedule time for you so it doesn't interfere too much with your family. reflection communication behavior +25_30 So, knowing this, what do you think you'll do next? question communication behavior +25_32 That's great. It sounds like you've got some options and leads on how- on how to get that done. reflection communication behavior +26_0 So what's been going on? question communication behavior +26_2 All right. yeah, I was told that you're phone calls was taken away reflection communication behavior +26_4 What-what happened? question communication behavior +26_6 Okay. yeah, it was weird when I, uh, got that report because for the most part since you've been here, uh, you'd been like, uh, model-model resident, uh, always making their bed, uh, been pretty, uh, respectful of the staff, of all the other residents. So, uh, is it something to do with you getting out in three weeks? It must be pretty hard. reflection communication behavior +26_8 Mm-hmm. Yeah, you used to have contact with your mom, you know, almost every other night and now for just about a week, you haven't even gotten to talk to her. I can imagine that being pretty difficult. I remember you saying something about like your dad's birthday coming up? reflection communication behavior +26_10 Okay. other communication behavior +26_12 Like I said, it's been, um, a long time and this is basically the first time that we've seen this behavior from you, so I know for a lot of other guys right before they get out, uh, a lot of anxiety, a lot of frustration comes around because they haven't been out in a while and then like the pressures of being on the outside are starting to settle in. So is that something might be going on with you? reflection communication behavior +28_0 Hi Carrie, thanks for coming in today. other communication behavior +28_2 What brings you in? question communication behavior +28_4 So, you'd like to give up those cigarettes? reflection communication behavior +28_6 Yeah, so then it's, um, right now, uh, tell me a little bit about, um, right now at this point in your life why it's so important to quit. question communication behavior +28_8 Like being a leper in a leper colony right now to be a smoker. reflection communication behavior +28_10 'Cause you can't find a leper colony anymore. So, um, so it-it's really important for you to be a good mum- reflection communication behavior +28_12 -and model for your- for your daughter who's at this age where 15 would be a really common age at which she might decide to smoke. reflection communication behavior +28_14 Okay. So, you-you wanna look good, you know, and she's proud of you I'm sure anyway and then this just would be an added benefit. Yeah. reflection communication behavior +28_16 So, and then you mentioned quite a few things about medical problems. So, um, you mentioned, um, asthma, um, acute bronchitis did you say— reflection communication behavior +28_18 Oh my goodness. Okay. And so, and that-- yeah, that's very-- that's really scary beginnings of emphysema, I'm sorry to hear that. reflection communication behavior +28_20 Well, I mean that's-that's, you know, tell me about when you were diagnosed with that. question communication behavior +28_22 Mm-hmm. other communication behavior +28_24 Mm-hmm. other communication behavior +28_26 Smart girl. reflection communication behavior +28_28 Mm-hmm. other communication behavior +28_30 Tell me a little bit about what happened with the-the Chantix. question communication behavior +28_32 Mm-hmm. Mm-hmm. Wh-What sort of if-if you are willing to talk about what kind of side effect— question communication behavior +28_34 Mm-hmm. other communication behavior +28_36 Mm-hmm. other communication behavior +28_38 Oh really. You know, and I've heard that too, Carrie, that people especially you know those are, um, some people seem to have a lot of success but when people do have the adverse side effects they are really pronounced like the ones you just described. therapist_input communication behavior +28_40 Want the good [crosstalk] no good right? And how long ago was that that you— question communication behavior +28_42 Okay, all right. other communication behavior +28_46 Mm-hmm. other communication behavior +28_48 Mm-hmm. other communication behavior +28_50 Okay. other communication behavior +28_52 Mm-hmm. other communication behavior +28_54 It just didn't fit for you to do the online. reflection communication behavior +28_56 Okay. So, um, but you gave it a good try and it was just not a good fit for you like you-you really listened to what your body told you like nightmares, nausea, I mean those are really bad things. reflection communication behavior +28_58 Oh yeah. other communication behavior +28_60 So, it's already piled I'm thinking up for you, you don't need anything else so you're looking for some relief and not something to make you feel worse. reflection communication behavior +28_62 Um, have there been some times in the past where you were able to quit smoking completely? question communication behavior +28_64 Okay. other communication behavior +28_66 Okay. So, what's the longest you've ever gone without a cigarette including being in the hospital? question communication behavior +28_68 Oh, three days. You know, that's a long time and I felt, you know, that's a pretty long time to go without smoking and I would imagine, I think that's pretty good. reflection communication behavior +28_70 You were forced to- reflection communication behavior +28_72 -not smoke? reflection communication behavior +28_74 What did you notice during those three days when you weren't smoking? question communication behavior +28_80 You were [unintelligible 00:06:04] other communication behavior +28_82 Okay. other communication behavior +28_84 Right. other communication behavior +28_86 Mm-hmm. other communication behavior +28_88 Mm-hmm. other communication behavior +28_90 Mm-hmm. other communication behavior +28_92 Mm. other communication behavior +28_94 It does, uh, it does a lot of positive things for you. reflection communication behavior +28_96 "And it sounds like it's paired, like a coffee and a cigarette. I mean, you know, probably hard to think about, ""How will I have a cup of coffee without a cigarette?""" reflection communication behavior +28_98 You know, and, um, that's actually, yeah, that's a-- I think it does become very paired with lots of different things. And, um, you might already know this, and so let me know if you do, um, because of the way cigarettes you're describing it and accurately is-- it is really what we call an almost perfect drug in a lot of ways. And- therapist_input communication behavior +28_100 -it will do whatever you need it to do at any given time. The downside is-is it-it kinda get, it gets in the end with the health. therapist_input communication behavior +28_102 It'll-it'll take a good usually 10 years off your life minimum. therapist_input communication behavior +28_104 Okay. What do you think when she says that to you? question communication behavior +28_106 Glamourous. reflection communication behavior +28_110 So, and I would- I would-- it really is because it wasn't like that 20 years ago. reflection communication behavior +28_112 It wasn't like that for sure 30 years ago. reflection communication behavior +28_114 So, it's become harder to be a smoker. You light up a cigarette-cigarette and people make assumptions about you. reflection communication behavior +28_116 Mm-hmm. other communication behavior +28_118 Mm-hmm. other communication behavior +28_120 Mm. other communication behavior +28_122 Okay-okay. So— other communication behavior +29_0 So you shared that you're, um, here today because you're having some dissatisfaction with your body and your confidence and your mood and your energy. And you're looking for, um, some different patterns to kind of turn things around for yourself. And what I like to do as I get to know clients is-is let them know a little bit about my philosophies, about health and wellbeing. Um, but first, I'd love to hear what are your philosophies about health and wellbeing? question communication behavior +29_2 Yeah. Well, I'm so glad that you reached out for help, um, and just know that you're not alone. And-and so, yeah, is that okay if I share a little bit about, um, how I tend to work with clients on that topic? question communication behavior +29_4 Yeah. Well, um, first of all, I really am passionate about looking at the whole picture, um, physical health and emotional wellbeing and what I found in working with clients in the past is when, um, we make a focus of weight loss, sometimes, uh, physical health improves, but at the cost of emotional wellbeing. therapist_input communication behavior +29_6 Um, many people find that when then- when they are restricting their intake or starting some, uh, ac-activity patterns that are really rigorous, that, um, a piece of their mental health suffers because they start to obsess, um, more than they'd like to be about those things. So, my approach with clients is just a more holistic approach. Looking at certainly some behavior changes that you could make to be more physically active, improve your energy levels. therapist_input communication behavior +29_7 Um, and also look at activities that enhance your mood. We can also take a look at some dietary patterns and see if-if there are ways you could tweak how you're fueling your body throughout the day, but at the same time, sort of letting go of what happens on the scale. Letting go of, um, the final, you know, weight outcome of that, and really focusing instead on healing your relationship with food and also adopting sustainable physical activity patterns. What do you make of all that? therapist_input communication behavior +29_9 Yeah, I-I found in the past when working with clients that creating a prescriptive meal plan, um, tends to work for a few days, but then clients usually get really tired of the foods on there. Um, and so instead, I'm really more interested in equipping you to learn how to space your meals and snacks out in a way that makes your body feel energized. Um, and then I can also support you, you know, in looking at the grocery shopping patterns and the meal planning patterns that come alongside all of that. Um, so really teaching you how to do more of your own meal planning, um, to fuel your body in a way that gives you energy, but also in a way where you're really still enjoying food. therapist_input communication behavior +29_11 Food is meant to be enjoyed, and it's a source of pleasure. So I'd want to help you certainly look for ways to add more fruits and vegetables and-and things that nourish your body, but also look for ways to add pleasure- other communication behavior +29_13 -to your meals and snacks. other communication behavior +29_15 Think about all of that. question communication behavior +29_17 Yeah. other communication behavior +29_19 Mm-hmm. other communication behavior +29_21 Yeah, I'm all about trying to help you figure out what types of physical activity bring you the most joy because those are the things that you'll make time for. other communication behavior +29_23 So if-if the gym is what brings you the most joy, then we can work with that, but if you, um, start to think about it and discover there other activities that you're more excited to attend and you're more, um, you're looking at rear-rearranging your schedule too because you really want to be there- therapist_input communication behavior +29_25 -um, then we can pursue those things. So it's really just about what brings you joy in terms of how you move your body and I'm just here to help you figure that out. therapist_input communication behavior +29_27 Yeah. other communication behavior +29_29 Exactly. Yeah. So helping you find changes that feel sustainable because they bring you both nourishment health, but also pleasure. reflection communication behavior +29_31 Mm-hmm. other communication behavior +29_33 Sure. other communication behavior +29_35 Absolutely, I appreciate you sharing that piece with me and you absolutely get to have that desire. And, um, we certainly are bombarded all day long with messages about how a body is supposed to look and so we all, um, certainly have moments of feeling dissatisfied with how our bodies look. And so you're absolutely, um, welcome to hold that and we can have space for that and you can certainly talk about that in these sessions. And I'll check in with you as we're going through the process of behavior change, um, to see how your body confidence is, um, as we talk more. therapist_input communication behavior +29_37 Fantastic. Thanks, Natalie. other communication behavior +30_0 Hey, Mary. I wanted to bring up to you, um, that your battery died last night. So, can you tell me what happened? question communication behavior +30_2 So, it's something you just aren't willing to do? question communication behavior +30_4 So, it's not really a priority for you right now, to be charging it? reflection communication behavior +30_6 Okay. Um, and do you understand then the con-consequences of-of what that would be? question communication behavior +30_8 Okay. Um, would it be okay if I do share you what will happen if you don't charge your battery. question communication behavior +30_10 Um, you will be getting violations for that, and then if you get so many violations, I mean, we'd have to write a warrant for your arrest, which is looking more of, um, detention time. therapist_input communication behavior +30_12 And that's still doesn't seem to bother you. question communication behavior +30_14 Okay. other communication behavior +30_16 Um, so I know that you, you know, you know the consequences of it, and yet you're sharing with me it's just not a priority for you at this time. question communication behavior +30_18 Okay. You know, that is your choice. I mean, I-I-I can't make those choices for you, it is something that you decide to do. Um, so with that being said then, these will be the consequences. I'll have to read the-the violation for you. therapist_input communication behavior +30_20 Okay. Um, any questions about that? Any questions about kind of the next steps from here? question communication behavior +30_22 So, your confidence that you'll be able to deal with possibly going back to detention? question communication behavior +30_24 Okay, and it sounds like you know that it's probably coming then? question communication behavior +30_26 Okay. Well, you know I will be back later. If any questions would arise, we can always talk about that then. Um, otherwise, again, I will have to write a violation, and, um, if you have any questions or need anything from me, please let me know. Um, otherwise, again, I'll be back later today. therapist_input communication behavior +30_28 All right. other communication behavior +31_0 Hi Mr. Johnson? question communication behavior +31_2 Hi, I'm Tonny Brownie, I'm a pharmacist here, uh, and I- and I was wanting to spend just a little time with you talking to you about your cholesterol. I found out you're newly diagnosed and your medicine for your cholesterol. therapist_input communication behavior +31_4 Okay, certainly glad to hear that your doctor did spend some time with you, um, I-I see myself as somebody who works with your doctor, uh, to help you get the most benefit from your medicine, uh, because you are gonna spend money on it we wanna make sure that you get the most benefit from it. Uh, also sometimes it may be difficult to reach your doctor we're also here, uh, and so we try to work together, wo-would that be okay? therapist_input communication behavior +31_6 So-so on the one hand, the doctor talked to you about high cholesterol, down the line possibly causing a stroke or heart attack- reflection communication behavior +31_8 -and that would be pretty serious. On the other hand, uh, when you found out that this drug might cause muscle weakness, that really alarmed you. reflection communication behavior +31_10 Especially with your job and- reflection communication behavior +31_12 -preventing you from doing your livelihood. reflection communication behavior +31_14 Okay, um, would you mind if I talk to you, if-if I- if I gave you a little bit of information about the muscle weakness, and you tell me what you think? question communication behavior +31_16 Okay. The muscle weakness with this drug is very rare, uh, usually doesn't even happen, okay? Uh, if it happens it usually happens within the first month of taking the medicine, you'll notice it in terms of weakness in the arms, uh, or some muscle pain, it's not usual. If this should happen, uh, if you let the doctor or me know right away, we can get you off the medicine, it's completely reversible. It's, the muscle weakness will go away within a couple of days, right. therapist_input communication behavior +31_18 Now, you don't wanna let that go on for months at a time, that's when it can become serious. therapist_input communication behavior +31_20 But otherwise, again it's rare, and it's completely reversible if you let us know. other communication behavior +31_22 Okay, and, uh, so talk to me a little bit more about what the doctors told you about-about your risks of stroke or heart attack while you're ta- while you have high cholesterol. question communication behavior +31_24 Okay, well how important would it be for you to-to, uh, do whatever you can to reduce your risks of stroke or heart attack down the line? question communication behavior +31_26 Yeah, and-and one of the- certainly one of the risks of stroke is paralysis, and if you wanna be active that could be- therapist_input communication behavior +31_28 -really a problem. therapist_input communication behavior +31_30 Okay, well this medicine can really help lower your risk of having a stroke or heart attack so that five years so now when you do retire you can enjoy it without any disability, uh, what are your thoughts about that? therapist_input communication behavior +31_32 Sure. other communication behavior +31_34 Mm-hmm, yeah it would, I-I-I think that would, uh, go a long way toward reducing those risks. therapist_input communication behavior +31_36 Okay, um, so if so where we are right now if I understand is you're feeling more comfortable about the concern about muscle weakness? reflection communication behavior +31_38 Uh, you seem fairly committed to taking the medicine to reduce your risk so that you can enjoy your retirement. reflection communication behavior +31_40 Uh, and so at this point, you're gonna get the medication and- therapist_input communication behavior +31_42 Definitely, can lower your cholesterol to 50%. other communication behavior +31_44 So it's pretty effective. therapist_input communication behavior +31_46 Okay, um, and at some other point we can talk about some other things that you may be able to do including diet, changes in your eating habits, it can lower your cholesterol even more. therapist_input communication behavior +31_48 Okay? other communication behavior +31_50 All right, uh, well they have your medication ready, and, uh, if you have any questions let us know. therapist_input communication behavior +31_52 All right, good to meet you. other communication behavior +31_54 Okay. other communication behavior +33_0 Okay, David. So, why don't you take a rinse, and how are you feeling? therapist_input communication behavior +33_2 Would you like to- question communication behavior +33_4 -check this out? What do you think? question communication behavior +33_6 Yeah. other communication behavior +33_8 Yeah. other communication behavior +33_10 Yeah. No. other communication behavior +33_12 It went well. Good. Excellent. I did notice quite a lot of staining, actually. I'm wondering what are your thoughts about what might be related to that. therapist_input communication behavior +33_14 Yeah. other communication behavior +33_16 Any thoughts on considering quitting smoking at this time? question communication behavior +33_18 "Okay. And it's like here I am one more person, the next- the next doctor who's saying, ""You need to quit smoking, David.""" therapist_input communication behavior +33_20 Mm, and I'm sorry, that's not how I mean to come across at all. therapist_input communication behavior +33_22 Mm-hmm, and if it was as easy as the doctor is saying or your partner- reflection communication behavior +33_24 -saying- reflection communication behavior +33_26 -you have to quit. reflection communication behavior +33_28 Yeah. other communication behavior +33_30 Yeah. other communication behavior +33_32 Yeah. And what's been your past experience with smoking? Tell me-- Can you tell me a little bit about kind of how the role it plays in your life, how long you've smoked? question communication behavior +33_34 Mm-hmm. other communication behavior +33_36 Mm-hmm. other communication behavior +33_38 It sounds like almost you've tried a lot of things that are out there and it's not something that you're— reflection communication behavior +33_40 Yeah, yeah. other communication behavior +33_42 Yeah. other communication behavior +33_44 Mm-hmm. other communication behavior +33_46 Mm-hmm. other communication behavior +33_48 Yeah. And it really is your choice. You're absolutely right- therapist_input communication behavior +33_50 "-that nobody has the right to tell you what to do. Um, can I ask? If you were to-- Uh, if there was to be a situation where you decided, ""I must quit,"" what-what would that situation be?" question communication behavior +33_52 Mm-hmm. other communication behavior +33_54 Right. other communication behavior +33_56 Mm-hmm. other communication behavior +33_58 So, this is something that you-you- reflection communication behavior +33_60 -pretty much see yourself doing for- reflection communication behavior +33_62 Yeah. Okay. Well, I really appreciate you being willing to even talk about it. And I get that right now, this is not something that you wanna pursue. Would it be okay if I brought it up in our next visit? 'Cause I-I know that you've said you don't want a lecture, but on the other hand, I am- I am concerned. therapist_input communication behavior +33_64 As long as I don't talk too much? reflection communication behavior +33_66 Okay. [chuckles] other communication behavior +33_68 Hmm. other communication behavior +33_70 [chuckles] You're glad to keep him as a doctor? reflection communication behavior +33_72 Yeah. Well, and, David, honestly, wherever you're at, we'll work with it. therapist_input communication behavior +33_74 Um, and so thanks for- thanks for taking a couple of minutes and talking about smoking. therapist_input communication behavior +33_76 Okay. other communication behavior +34_0 Thank you for coming in to see me today, Nina. I'm looking forward to getting to know you a little bit and hearing a little bit about you and what brought you in here today. other communication behavior +34_2 Okay. He's thinking you were a little irresponsible. reflection communication behavior +34_4 And you're feeling kind of concerned about that. reflection communication behavior +34_6 Okay. So, you're concerned about the consequences, and you really care about your baby, and you want to give your baby the best start you can. reflection communication behavior +34_8 And you're wondering a little bit about this time that we're going to spend together. reflection communication behavior +34_10 So here you are today and, um, you're sharing that you have been drinking alcohol throughout your pregnancy. reflection communication behavior +34_12 Okay. other communication behavior +34_14 Mm-hmm. So, there's this external pressure coming from the people you care about to sort of stay in the scene. reflection communication behavior +34_16 Kind of feels like You're between two worlds. In one world, you're preparing to be a mother and bring a baby into this world, and this other world is the world that you've been in for a while where you're kind of having a good time and- reflection communication behavior +34_18 -drinking and your friends are- other communication behavior +34_20 Okay. So, this party-time world's- are you feeling like this is something you want to move out of and move into that mom world? Or does it feel like I want to hang out there still too? question communication behavior +34_22 "So, for you, you're feeling like once the baby comes and actually in your arms, then things are going to change, but right now, while you're pregnant, you're thinking, ""I can kind of hang out in both worlds a little bit,"" but part of you may be thinking maybe that's not the case. It's time to go to the mom world maybe." reflection communication behavior +34_24 Okay. So, you've got a lot of concerns about what's happened to- up until this point, as far as your drinking. What do you know about, um, drinking alcohol throughout pregnancy? question communication behavior +34_26 So, you were thinking because your-your friends weren't pressuring you to stop drinking, that-that it must be okay. reflection communication behavior +34_28 And then there's this other part of you that's- was thinking maybe it's not okay. reflection communication behavior +34_30 So, your gut is telling you what? Tell me about that. question communication behavior +34_32 And you really wanna do what's best for your babe. And kind of wondering, um, how to move forward from here, is that where you wanna, you know, kind of focus in on, or what are your thoughts about giving up drinking altogether? question communication behavior +34_34 So, you kind of have this identity, dual identity going on. I wanna be that person, yet, that person- reflection communication behavior +34_36 Mm. So, embraces this life of the picket fence and the, you know, the little house and having the baby in this- reflection communication behavior +34_38 So, you don't wanna be that- that- that woman that's just sort of living in this house with the baby carriage, and at the same time, that world's kind of saying it's behind you. reflection communication behavior +34_40 You care about them. reflection communication behavior +34_42 It's just the scene that they're-they're still in because their life maybe hasn't taken that change that your life has made. And so now, you're here and you're not sure. You want the baby, but you're not sure about the suburbs and the picket fence thing. You're not sure— reflection communication behavior +34_44 You don't want that. reflection communication behavior +34_46 You want this baby. reflection communication behavior +34_48 And you wanna be, um, take care of your baby as the baby's growing. reflection communication behavior +34_50 You don't wanna let your baby down. reflection communication behavior +34_52 "And at the same time, it's hard to let go of the past, but on the other hand, you're thinking, ""I don't have a choice. I've got to look this way."" Is that kind of what it feels like?" reflection communication behavior +34_54 Nina, I'm wondering, what's your hope for the future? When you think about where you are today, um, what do you hope for when you look ahead? question communication behavior +34_56 "You put your heart there that the baby is really- it was almost kind of like a sign for you that was saying, ""This baby is giving you a kind of a new chance at life, or giving you a plan B,"" and you guys both get to decide what plan B is gonna look like." reflection communication behavior +34_58 "While this baby's growing in you and you think of all the opportunities that could come out of this, there's a part of you that says, ""I'm still that same girl that was drinking and partying,"" and-and maybe not living the life you wanted to live." reflection communication behavior +34_60 "While this baby feels like this is your second chance, you're wondering, ""Do I deserve that second chance?"" And then this other part of you that says, ""Why not? It's here and I wanna go for it.""" reflection communication behavior +34_62 Mm-hmm. You got a lot of people around you that are kind of pulling it down, and it's kind of taking you back to the old life. And the baby is a constant reminder that there’s this new life ahead. reflection communication behavior +34_64 When you think about, you know, embracing this new life, and taking that different path, turning away from path A and moving into path B, how confident are you that you can take path B and be successful in raising this baby, and letting go with the drinking and the life that you were in-in path A? question communication behavior +34_66 "Mm-hmm. Tell me more about that, what makes you say, ""I have to take that path""? What makes you feel like you need that?" question communication behavior +34_68 "This part of you that says, ""I don't have an option to-to-to make this life better,"" it's wondering, ""Do I have the confidence to be able to make that life a reality?"" What do you think you need to increase your confidence that you can do this?" question communication behavior +34_70 So you're thinking that, um, once your friends see you with the baby in your arms that they too will see that there's a different path for them too? question communication behavior +34_72 Mm, kind of feel like you're pulled between two worlds there. reflection communication behavior +34_74 "It's not easy to be in that world and also having that constant reminder that the baby is coming and this baby is saying, ""I want this better life,"" and you want to give the baby a better life too. Who can support you, do you think when-when you look around who's in your circle right now, who do you think can support you in moving towards path B?" question communication behavior +34_76 And your parents are a support for you and support you from giving up the drinking, the alcohol use, that's something that they would support- reflection communication behavior +34_78 Okay. other communication behavior +34_80 That would be a concern for them as well as for you now. reflection communication behavior +34_82 Yeah. Is that something that, um, maybe you and I could meet again about-and talk about having those conversations with-with the family, maybe having conversations about, you know, the folks, your-your friends that are currently in the lifestyle that you were involved with, um, and then sort of what it would look like to go down path B, is that something that you would be open to meeting with me about again? question communication behavior +34_84 Mm-hmm. other communication behavior +34_86 Kind of feels like you're climbing Mt. Everest. reflection communication behavior +34_88 And you don't have equipment. reflection communication behavior +34_90 You're concerned that they're gonna kind of treat you like a child. reflection communication behavior +34_92 Oh, oh, you're talking about your friends. other communication behavior +34_94 You're wondering if they're gonna kind of be like children and you're gonna be like the parent saying- reflection communication behavior +34_96 You just wanna be like peers talking. reflection communication behavior +34_98 And you want them to support you. reflection communication behavior +34_100 You don't wanna lose your support group, yeah. You just wanna them to support you in being healthy, while helping them, raising the babe, and so we're just taking path B. You don't wanna lose them, just maybe the lifestyle it sounds like. other communication behavior +34_102 Mm. You kind of wanna have the best of both worlds. reflection communication behavior +34_104 I want the friends and the relationship that I get from my friends, and at the same time, I don't want the party scene that goes with that. reflection communication behavior +34_106 Well, Nina, you know yourself best, and you know, you know, you know what your world looks like and what those, you know, like, you know the support that your friends give you and the support that you get from your family, you know that. And I-I really just wanna support you in being able to make those choices and have those conversations, and I wanna do whatever I can to support you with that. Um, and I'm just wondering if maybe we can kind of pick this up, um, in a next visit, but before we go there, I'm just wondering, is there some steps that you would be willing to kind of take or consider, uh, with-with regards to your drinking? question communication behavior +34_108 You're concerned about the health of your baby. I just would love to share with you, Nina, that every day without alcohol is a good day for your baby, and you know, starting today to have zero alcohol is a great start, and I'm wondering if that's the sort of something you'd be open to as no more alcohol at this point. therapist_input communication behavior +34_110 Okay, sounds like this is really important to you. You want to make this happen. reflection communication behavior +34_112 Is there anything that I can support you with before we wrap up as far as giving up alcohol today? question communication behavior +34_114 You kind of got a reality check today. reflection communication behavior +34_116 You did really well talking with me today, and I thank you so much for just sharing your heart. other communication behavior +35_0 Hi, Natalie. I'm Dawn. therapist_input communication behavior +35_2 Nice to meet you, too. Thanks for coming in today. other communication behavior +35_4 Yeah. Tell me a little bit about yourself. question communication behavior +35_6 Yeah, you're feeling a little bit dissatisfied with your health patterns? reflection communication behavior +35_8 Okay, so you're feeling some low energy and you know, in the past, when you've been more active and eating differently, you've had more energy? reflection communication behavior +35_10 Yeah. Tell me more about that, those previous times that you've been active. question communication behavior +35_12 You had energy, and you were like the Energizer Bunny, just keep going and going and going. reflection communication behavior +35_14 So your days are just as full now that you're working and a career person, um, and your energy level isn't what it used to be. What-- Do you have any ideas about why that might have shifted? question communication behavior +35_16 Right. So in the past, it wasn't up to you whether you had the choice to go be physically active. Now it is up to you, and-and you're looking back at the last few years and saying, I wanna do things differently. reflection communication behavior +35_18 I want to be more physically active than I've been. reflection communication behavior +35_20 Great. And you've noticed a mood enhancement effect of exercise. reflection communication behavior +35_22 Tell me more about that. What do you notice specifically about your mood on the days you're physically active? question communication behavior +35_24 Yeah, you feel more accomplished and-and you feel less irritated by the small stuff. reflection communication behavior +35_26 Great. Well, let me see if I've got this all. You came to Arizona six months ago, you're trying to figure out new rhythms and patterns for yourself. You're looking back at the past few years, and in college, you were real active because you were an athlete, and now it's more up to you about making that choice of physical activity, and you're discovering that, um, not being active has affected your energy level and your mood, and that's something you're looking for more of, both of those things, energy and-and a mood booster. reflection communication behavior +35_28 Yeah. Tell me more about your weight concerns. When did you start feeling dissatisfied with your body? question communication behavior +35_30 Mm-hmm. Okay, so it sounds like a sort of a vicious cycle and-and maybe the lacking physical activity has made you feel less confident in yourself. I wonder if that's also a piece of this puzzle since you mentioned that's been a big difference from what was happening in the past. reflection communication behavior +35_32 Okay. So you had a pretty strong self-confidence, pretty strong body image all the way up until a few months ago and, um, you're hoping to kind of get back to that place where you feel good about yourself. reflection communication behavior +35_34 Great. other communication behavior +36_0 Barbara Roberts? question communication behavior +36_2 Hello, there. other communication behavior +36_4 My name's Dr. Betty. I'm one of the new GPs in the practice. First of all, what would you like me to call you? question communication behavior +36_6 Okay, that's fine. Okay. So, Barbara, I'm seeing you today, um, but I think it's usually Dr. Brown that sees you, is that right? question communication behavior +36_8 Okay. What is it that's brought you to see me today? question communication behavior +36_10 All right. Okay. Can you tell me a bit more about your tummy problems? question communication behavior +36_12 All right. So, quite a few symptoms there- reflection communication behavior +36_14 - and some of them sound- other communication behavior +36_16 - quite troublesome to you. reflection communication behavior +36_18 Okay. And how long has this been going on? question communication behavior +36_20 Mm-hmm. Okay. Okay. So you think it began about four years ago after this holiday? reflection communication behavior +36_22 Okay. And what's- what sorts of treatments have you tried for-for this before? question communication behavior +36_24 Mm-hmm. other communication behavior +36_26 Right. other communication behavior +36_28 Right. other communication behavior +36_30 Right. So, these different tablets that you've got from the- other communication behavior +36_32 - the herbal shop- other communication behavior +36_34 - how are you taking them? question communication behavior +36_36 Right. other communication behavior +36_38 Right. other communication behavior +36_40 So, am I- am I right in thinking you perhaps decide on a day-to-day basis- reflection communication behavior +36_42 - what you're gonna take- other communication behavior +36_44 - depending on what your stomach's doing? question communication behavior +36_46 Okay. Okay. And what about tests? Have you had any tests for these problems? question communication behavior +36_48 A gastroscopy. other communication behavior +36_50 You got the tube down-down from the top? question communication behavior +36_52 Okay. other communication behavior +36_54 Right. other communication behavior +36_56 Okay. other communication behavior +36_58 Right. other communication behavior +36_60 Right. other communication behavior +36_62 Right. It sounds as though you're-you're not happy with that. reflection communication behavior +36_64 Right. other communication behavior +36_66 Right. other communication behavior +36_68 Mm-hmm. other communication behavior +36_70 Right. other communication behavior +36_72 Right. other communication behavior +36_74 Right. So you feel as though actually, enough hasn't been done in the way of-of tests? reflection communication behavior +36_76 Right. Okay. It sounds like you-you've had these problems now for about four years. reflection communication behavior +36_78 You've-you've got a lot of various symptoms in your stomach. reflection communication behavior +36_80 Um, you've tried a lot of tablets. Some prescribed, some herbal remedies- reflection communication behavior +36_82 - and you've had some investigations, but you're not entirely happy that-that you haven't been investigated thoroughly enough. reflection communication behavior +36_84 Is that- is that about- reflection communication behavior +36_86 - if I got the story right. reflection communication behavior +36_88 Okay. And can I ask you, Barbara, how-how is all of this affecting you day-to-day? How's-how's it affecting your life? question communication behavior +36_90 Mm-hmm. other communication behavior +36_92 Right. other communication behavior +36_94 Right. Right. other communication behavior +36_96 Right. other communication behavior +36_98 Right. other communication behavior +36_100 Sounds as though that's something you quite enjoyed. reflection communication behavior +36_102 Right. Okay. other communication behavior +36_104 Mm-hmm. other communication behavior +36_106 Right. other communication behavior +36_108 Mm-hmm. other communication behavior +36_110 Right. other communication behavior +36_112 Yeah, it does- it does sound as though over the last few years your life has really changed- reflection communication behavior +36_114 - quite a lot because of these symptoms. reflection communication behavior +36_116 It sounds- it sounds like you're doing the review of the things that you used to do. reflection communication behavior +36_118 Right. other communication behavior +36_120 So, what is it you'd spend your average day doing now? question communication behavior +36_122 Mm-hmm. other communication behavior +36_124 Mm-hmm. other communication behavior +36_126 They certainly do. other communication behavior +36_128 Mm-hmm. other communication behavior +36_130 Right. other communication behavior +36_132 Okay. Okay. And have there been any times over the last four years that you've noticed any significant changes in your symptoms? For example, have there been any times when things have been better for you? question communication behavior +36_134 Right. other communication behavior +36_136 Mm-hmm. other communication behavior +36_138 Mm-hmm. other communication behavior +36_140 Mm-hmm. other communication behavior +36_142 Right. other communication behavior +36_144 Right. And how were you tummy symptoms then? question communication behavior +36_146 Right. Okay. other communication behavior +36_148 Right. Right. other communication behavior +36_150 Right. That's interesting. other communication behavior +36_152 And are there any times when your-your tummy symptoms bother you more? Seem particularly bad? question communication behavior +36_154 Right. other communication behavior +36_156 Right. other communication behavior +36_158 Right. other communication behavior +36_160 Uh-huh. other communication behavior +36_162 Right. So you notice it's a bit worse when your husband's not around? Okay. reflection communication behavior +36_164 Right. I know you've been seeing Dr. Brown about this for the last few years. other communication behavior +36_166 What is it that he's said that he thinks might be wrong with you? question communication behavior +36_168 Right. other communication behavior +36_170 Right. Okay. other communication behavior +36_172 And what do you think? question communication behavior +36_174 Right. other communication behavior +36_176 Mm-hmm. other communication behavior +36_178 And have you had any thoughts yourself about what you think might be causing it? question communication behavior +36_180 Mm-hmm. other communication behavior +36_182 Right. other communication behavior +36_184 Right. other communication behavior +36_186 Right. other communication behavior +36_188 Mm-hmm. other communication behavior +36_190 Right. other communication behavior +36_192 Oh, dear. other communication behavior +36_194 Right. Right. other communication behavior +36_196 Right. other communication behavior +36_198 So you're- you-you're kind of prodding, having a feel at night? reflection communication behavior +36_200 To see if you can feel anything? question communication behavior +36_202 Right. other communication behavior +36_204 Right. Okay. other communication behavior +36_206 Okay. So just to-to make sure that I've got the-the story straight, you've-you've seen Dr. Brown for a couple of years. reflection communication behavior +36_208 You've-you've tried a variety of medications- reflection communication behavior +36_210 - some prescribed, some- reflection communication behavior +36_212 - from the-the herbal shop. None of them really made a great deal of difference. You've had some investigations- reflection communication behavior +36_214 - but you perhaps feel you've not had enough investigations. And at times, you worry that this could be something quite serious like a- reflection communication behavior +36_216 - a cancer. Is that-- Have I got the- reflection communication behavior +36_218 - story right? reflection communication behavior +36_220 Okay. other communication behavior +36_222 Okay. Barbara, what was it that you were hoping that I'd do for you today? question communication behavior +36_224 Mm-hmm. other communication behavior +36_226 Right. other communication behavior +36_228 Right. other communication behavior +36_230 Right. Right. So you were hoping that I'd send you for more tests? question communication behavior +36_232 Okay. other communication behavior +36_234 Right. other communication behavior +36_236 Right. Okay. Well, I think, Barbara, having-having heard your story, and heard about the symptoms, I'm not sure that actually sending you for more tests at this point would be the most useful thing that we could do for you. And the reason for that is because you've-you've had some of the main investigations in the last couple of years, and-and they've not shown anything. And your symptoms haven't really changed that much. So it's very unlikely that if we were to send you for more tests now that-that they'd show anything different than what we already know. So a bit-- I think it would be a waste of time for you to go for more tests. other communication behavior +36_238 Uh, no. I think that you clearly have pain, and clearly you have lots of physical symptoms, and they're clearly getting in the way of- other communication behavior +36_240 -your life and causing you a lot- other communication behavior +36_242 -of disability. other communication behavior +36_244 I guess- I guess the way I think about these things is that they're not necessarily either all in the mind or all in the body. other communication behavior +36_246 Sometimes these things can go together. Uh, I guess I'm thinking about how you told me that last year, when your son got married, uh, and you were very busy- therapist_input communication behavior +36_248 - and quite happy, that somehow your symptoms seemed less. other communication behavior +36_250 And, uh, when your husband's away, which is something you don't like very much, sometimes, somehow, your symptoms then will seem greater. So, I guess what I'm wondering, Barbara, is if there might be some kind of a link with you between how you're feeling in your mind, and what's going on in your life, and-and how much your symptoms trouble you. Do you think that's a possibility? reflection communication behavior +36_252 Mm. I'm not saying that the pain's in your mind. Um, I guess what I'm saying is that sometimes the way that we feel, and the way that our lives are going, can impact how we notice our symptoms. Given that we've tried medication for you, and we've tried investigations, and we've drawn a blank really, with those, none of those have really helped you- reflection communication behavior +36_254 - I guess I'm wondering whether now it would be a good idea to try a different approach to your problems. other communication behavior +36_256 Well, I guess, thinking a little bit about those other areas of your life, um, uh, I'm thinking about the fact that over the last four years, your life's really changed. It seems to have really shrunk down. other communication behavior +36_258 And it sounds as though you're not doing lots of the things that you used to do. That you- reflection communication behavior +36_260 - used to get pleasure out of. Is that right? reflection communication behavior +36_262 Yeah. other communication behavior +36_264 Yeah. And I guess I wonder-- Uh, it sounds as though you've-you've dropped doing those things because you felt you couldn't do them, but I wonder if, in a funny way, what's happened is the fact that you're not doing those pleasurable things now, has kind of fed into you feeling- reflection communication behavior +36_266 - unhappy with the way that-that your life is at the moment. And-and I guess I wonder whether that can then make your symptoms worse for you. reflection communication behavior +36_268 Mm. other communication behavior +36_270 Well, I guess what I'd be wondering is whether one of the approaches we need to be using now is thinking about what you do with your life, and what you do with your day, and maybe trying to bring back some of those pleasurable things, you know, even if it's just meeting up- therapist_input communication behavior +36_272 - with your-your female friends once a week, and whether actually doing those sorts of things might generally- therapist_input communication behavior +36_274 - improve your quality of life. I'm also thinking about the tablets that you're taking. therapist_input communication behavior +36_276 And the fact that you-you seem to be taking quite a lot of them, and I'm wondering whether it's worth, though, sitting and looking at them and-and maybe trying to rationalize them a little bit, and really decide which are helping you, which are doing nothing, and which may actually be making some of your symptoms worse, I guess. reflection communication behavior +36_278 What would you think about trying that slightly different approach for say-say two or three months, just to see whether or not it makes any difference? therapist_input communication behavior +36_280 Right. other communication behavior +36_282 Mm-hmm. other communication behavior +36_284 Well, I guess if we- if we did decide to-to work together like this- therapist_input communication behavior +36_286 - in this new approach, I'd be seeing you regularly. We can keep an eye on your symptoms, and if they change, then we can investigate as appropriate. But if they stay the same, then, you know, we can be- therapist_input communication behavior +36_288 - pretty clear that there's nothing new happening that-that we're missing. therapist_input communication behavior +36_290 How would that sound? therapist_input communication behavior +36_292 I think that would be a good idea. I think we've only just begun to talk about it- therapist_input communication behavior +36_294 - and I think perhaps you need to have a bit of time to think about it and then perhaps come back. Perhaps if you're booked in for a double slot next week, and that would give us a good chunk of time to think about this new approach. therapist_input communication behavior +36_296 And perhaps if you could also bring your-your tablets in or-or make a list of them, we can look at what you're taking and perhaps go from there. How would that sound, Barbara? therapist_input communication behavior +36_298 Yeah. other communication behavior +36_300 Yes. other communication behavior +36_302 Yes. I think so. other communication behavior +36_304 I think that would be a good- a good start. other communication behavior +36_306 Yeah. other communication behavior +36_308 Okay. All right. other communication behavior +36_310 So, shall I see you again next week? question communication behavior +36_312 Okay. All right. Thank you, Barbara. other communication behavior +36_314 Bye-bye. other communication behavior +37_0 Kia ora, Ricky, welcome back. other communication behavior +37_2 Good. Are you okay today? question communication behavior +37_4 All right. So where we left last time, you were going away to think about a few things and to, um, develop some sort of plan of action. How'd it go? What were you up to? question communication behavior +37_6 Right. other communication behavior +37_8 Good to know, excellent. other communication behavior +37_10 Things are looking pretty good. reflection communication behavior +37_12 So you've rung your mom, had a chat to her. other communication behavior +37_14 Any other whānau members? You talked about your brothers and sisters last time. question communication behavior +37_16 Here in Christchurch? question communication behavior +37_18 Okay. other communication behavior +37_20 No? question communication behavior +37_22 What are you not sure about? question communication behavior +37_24 Okay. Just sort of interested, when you rang your mom and, um, told her what's happening, how difficult was it to talk about the issue of violence and being violent towards your partner? question communication behavior +37_26 We-we talked about, uh, last time that this is hard stuff and that, um, we are prepared to kind of do the hard yard. So you've gone away, you've talked to your folks, put it out there about your issue of violence? Um, I'm thinking about, uh, with-with Tristan and the whole alcohol issue there. So it sounds like to me if you've- you've started to put quite a bit of stuff in place. reflection communication behavior +37_28 Yeah. What does it tell me about you as a man, as a father, as someone who wants to get moving? question communication behavior +37_30 Grand. You talked a little bit about, uh, you'd really like to get back with Kristie? question communication behavior +37_32 And-and-and your kids and developing that whānau. Have you had an opportunity to get in touch with her and— question communication behavior +37_34 Right. other communication behavior +37_36 Okay. So what do you think you're gonna need to do to show her and others, uh, to convince them that you are serious? question communication behavior +37_38 Mm-hmm. other communication behavior +37_40 Yeah. other communication behavior +38_0 Hi, Sarah, it's great to meet you. My name is Delwyn, and I'm a counselor here at the clinic. And I heard from your nurse practitioner that you recently had an annual exam in which the topics of smoking and alcohol use came up. Would you mind filling me in a little bit about that? question communication behavior +38_2 So, you've decided you wanna cut back on your smoking a little bit, but, you're not really concerned about your drinking. reflection communication behavior +38_4 It's a nice sort of form of stress relief. reflection communication behavior +38_6 Sort of escape from your hectic schedule. reflection communication behavior +38_8 So, you're working, and then, on top of that, juggling being a single mom and going to school? reflection communication behavior +38_10 It's pretty exhausting work. reflection communication behavior +38_12 So, you're not only doing really tiring work and going to school, but you're also worrying about your finances. reflection communication behavior +38_14 Yeah, it does. It sounds like a lot that you're trying to deal with, and it makes sense that you feel like you need some kind of break or reward. reflection communication behavior +38_16 So, tell me a little bit more about your drinking. Tell me a little bit about how much you're drinking, and, um, the pattern, and what raised concern. question communication behavior +38_18 So, you're drinking, perhaps, two drinks a day. Um, and I'm wondering, what have you heard about the recommendations for drinking levels? question communication behavior +38_20 Okay, will you be interested in hearing about those recommendations? question communication behavior +38_22 Okay. Well, so, the recommendation for women is to have no more than three drinks a day, and no more than seven drinks over the course of a week. Yeah, um, and, really, the reason for those recommendations is to just reduce the risk that people have trouble with accidents, or chronic diseases. Like certain types of cancers, or high blood pressure, and then also psychological problems. I don't know what you think about all that? question communication behavior +38_24 It just doesn't seem that abnormal to you, especially when you compare it with your family. reflection communication behavior +38_26 Yeah, you really feel like you need that reward. reflection communication behavior +38_28 And then it also sounds like, um, your drinking has perhaps increased a little bit over time? question communication behavior +38_30 Yeah, and so it sounds like you've noticed that the more stressed you're feeling, the more you're drinking. reflection communication behavior +38_32 So, let me summarize a little bit what you've told me. It sounds like you have a pretty hectic, stressful life, and you really feel like you need some kind of- reflection communication behavior +38_34 -reward or stress relief. Um, and then, on the other hand, you've noticed, um, that your drinking has increased a little bit over time. And also that the more stressed you're fe- you feel, the more you're inclined to drink. reflection communication behavior +38_36 So, I'm wondering, have you noticed any problems from your drinking? question communication behavior +38_38 So, you've noticed that it's starting to call to you a little bit in the evenings. reflection communication behavior +38_40 And it's perhaps taking you away from things that are more important to you? reflection communication behavior +38_42 And it doesn't feel good? reflection communication behavior +38_44 Yeah. And so, it sounds like there's a bit of a dilemma there, because-- And I guess we should be clear, it's not the occasional drink that's an issue. Um, it's-it's really the quantity of drinking, and-and whether your drinking is escalating and interfering with things that are, perhaps, more important. reflection communication behavior +38_46 And you've perhaps never seen it in that light before. reflection communication behavior +38_48 I-it seems like it-it would be quite a hard pattern to change. reflection communication behavior +38_50 So, it seems like it would be really difficult to change because it's something that's really important to you right now. reflection communication behavior +38_52 But on the other hand, it does sound like there are things that you- that you value that you don't want the drinking to interfere with. reflection communication behavior +38_54 So, I guess I'm wondering if you've given any thought to other ways in which you could cope with stress without relying on the drinking so much. question communication behavior +38_56 So, if you could somehow tackle some of these stressful issues, um, that could make a difference, and, what-what would that be, for example? question communication behavior +38_58 So, having more reliable childcare could make a big difference. reflection communication behavior +38_60 And it sounds like your mom has been an option in the past, but perhaps not so much anymore. reflection communication behavior +38_62 So, one thing that could make a big difference is if you could figure out some sort of more reliable, affordable childcare, and that would help you not want to drink as much. reflection communication behavior +38_64 Anything else? question communication behavior +38_66 Yeah. It-it sounds like, um, you know, money could make a big difference, and you are working full time and trying to go to school to address that in the long run. Um, but on the other hand, you know, it sounds like you have some other ideas of cope- of how you might cope with stress better. Um, so, I guess I'm-I'm wondering, given our conversation so far, kind of where you are with everything. question communication behavior +38_67 Um, we started off talking about how your drinking has sort of drifted into a risky area, and it would be advisable to cut back. Um, but it sounds like you feel like that's fairly important to you and not something you necessarily want to do. But on the other hand, we've talked about ways in which that perhaps could be made a bit easier, but I'm not sure if you're ready to tackle that or pursue that right now. I'm just kind of wondering where you are. question communication behavior +38_69 So, um, it would perhaps be helpful if you could narrow it down to just one thing, and what would that be? question communication behavior +38_71 Okay. Yeah. It sounds like from everything you're saying, that keeps coming up as one of the main issues. Um, so there may be some resources I can point you towards, but I'm- guess I'm wondering, have you looked into alternatives, more affordable, reliable childcare? question communication behavior +38_73 Okay. Well, one thing you could consider is talking to one of our social workers, they sort of specialize in helping people who have a lot on their plate identifying resources that they may need, uh, things you haven't thought of or aren't aware of. So, I don't know, would you be interested in doing something like that? question communication behavior +38_75 Okay. Great. Well, I can definitely set you up with that, and you can- other communication behavior +38_77 -um, try to tackle, um, your childcare issue, um, with some assistance. Is there anything else you'd like to do, um, for example, would you be interested in talking with me again, um, just as things progress? question communication behavior +38_79 Yeah. So, these are not problems that are going to go away in a week. It's going to take some time to resolve. Okay, great. So, um, it sounds like we have a couple of things, uh, to pursue. other communication behavior +38_81 Anything-anything else? question communication behavior +38_83 Would you be interested in perhaps thinking about setting a goal with respect to your drinking? question communication behavior +38_85 Okay. Try to cut back a bit and see how that goes. reflection communication behavior +38_87 Okay. So, you can give it a go and, I think doing managing, you might just learn a little bit about how easy or difficult it's going to be, and-and also what it's like to cope with stress in other ways. reflection communication behavior +38_89 Okay. So, it sounds like we have two avenues to pursue, anything else? question communication behavior +38_91 Okay. Well, that sounds good. So, why don't we meet again in a couple of weeks and you kind of update me on how cutting back on your drinking has gone, and also, what it was like when you met with a social worker? Sound good? question communication behavior +38_93 Okay, great. I look forward to talking next time. other communication behavior +39_0 Um, so you've talked a bit about like the emphysema. Um, what did the doctors say to you when you were diagnosed? I mean the obvious, right? question communication behavior +39_2 Mm-hmm. Finger comes out. reflection communication behavior +39_4 Mm-hmm. And there was a war going on? reflection communication behavior +39_6 Yeah. Well, and your daughter. reflection communication behavior +39_8 And the social stigma, because you don't want your daughter to think of you like that, whatever that- that as a smoker, you know. You know there're people who make the assumption and it- it sounds like those are more important to you than the medical things, and who cares why it's important? reflection communication behavior +39_10 It doesn't matter. So what- what ideas do you have about what might be most helpful for you in quitting smoking? question communication behavior +39_12 So that was helpful for you that it's a, um, I can't remember. I know what you're trying to get a little ball. reflection communication behavior +39_14 It shows you your lung capacity. therapist_input communication behavior +39_16 But it might be helpful if you- if you quit or it's, you know, it did if you were gonna decrease or whatever, to see how much better you're doing with the ball going up and your lung capacity increasing, is it? therapist_input communication behavior +39_18 Okay. other communication behavior +39_20 So, I don't even know where you can get those. I think— other communication behavior +39_22 Oh, you have one? question communication behavior +39_24 Oh, okay- okay. other communication behavior +39_26 Oh, did you? question communication behavior +39_28 Okay. All right. other communication behavior +39_30 It's so interesting because there's immediate feedback. I mean, that's immediate feedback. Um, so we're- we're talking about quitting or here quitting completely. What thoughts do you have? You tried the Chan- the Chantix, meditation, you like that so, um, I can run some ideas that some other clients have used [crosstalk]- question communication behavior +39_32 So, um, since you like meditation so much, it's highly likely that you'd be a great candidate for hypnotherapy. therapist_input communication behavior +39_34 Yeah, okay. other communication behavior +39_36 Yes, it is true. Yeah. It is. I mean, people don't come walking through the door who are not interested in it, you know? So, um, yeah, so that's-- So you'd be interested in something like that and, um, what- what other ideas have you thought about that would work for you? question communication behavior +39_38 Okay. Okay. other communication behavior +39_40 Might become a better friend when you quit. reflection communication behavior +39_42 Um, because I know you mentioned you tried the Chantix. Um, what have you tried? Uh, Zyban or Wellbutrin? question communication behavior +39_44 Okay. other communication behavior +39_46 Yes, it is. other communication behavior +39_48 It's the same thing. It's Wellbutrin, and when they found out by accident through what we call serendipity that you know what, Viagra. [laughs] That when- when people were on Wellbutrin that they tended to decrease and stop smoking, and, um, there were a couple of different reasons for that. Number one, people tend to get depressed when they quit smoking, because it puts you in such a state of deprivation and, um also-- well, so Wellbutrin really is a good antidepressant for them. therapist_input communication behavior +39_49 The other thing is its a slight stimulatory effect and when people go off nicotine which is a stimulant the-they tend to get pretty tired overheard-- you know it's the opposite of however the nicotine makes them feel. And the Wellbutrin kind of with stimul-- you know stimulatory enough. [crosstalk] [unintelligible 00:05:56] And I-- the last I've read, and I've not kept real current about it, but I'm wondering about the-- what your thoughts are if any about the-- any of the nicotine replacements like the gum patch, the inhaler. therapist_input communication behavior +39_51 Chewing gum. other communication behavior +39_53 That strong spirit of you got instilled with her. reflection communication behavior +39_55 Could be? question communication behavior +39_57 It is becoming a pain in the butt reflection communication behavior +39_59 Mm-hmm other communication behavior +39_61 Like it's a little treat. reflection communication behavior +39_63 I've never heard of Union break. I love it how you said. I love it. other communication behavior +39_65 I love it. Union break. other communication behavior +39_67 It's great other communication behavior +39_69 Union break. Yeah. le-leverage, and you know so it's something else you might know about nicotine is, um is that actually depending on how you smoke it, it can- it can be stimulant when you want it to be a stimulant if you smoke it in short, shallow puffs and then it can be a depressant like after a meal and you take longer inhalations, and it really tends to act on your central nervous system as a depressant. So it kind of does whatever you want at any given moment and yet there is this price that you pay therapist_input communication behavior +39_71 Financially. Right, getting back to the finances and you know, you know, you know I'm thinking your daughter what a pain but it's become the finances the emphysema. I'm really-- because I would think that in 10 years, how much are you smoking now? question communication behavior +40_1 Nice. other communication behavior +40_3 Since the-- since you used, uh-- since the last time you used meth, right? question communication behavior +40_7 Good. other communication behavior +40_9 Nice. other communication behavior +40_11 So-so, uh, have-- last time we talked, you know, you were kind of cutting the-the ex-boyfriend out. This is because he was your dealer, so-- reflection communication behavior +40_13 And how is that going for you? question communication behavior +40_15 Okay. other communication behavior +40_17 So it sounds like you've made some good changes. The change in your environment, and some of your behaviors, and, uh, and these new friends. reflection communication behavior +40_19 So it sounds like-- other communication behavior +41_0 So, thank you for coming in today. other communication behavior +41_2 How are you feeling today? question communication behavior +41_4 Yeah? Good. other communication behavior +41_6 Good. other communication behavior +41_8 And so you did your clarifications, value clarifications- question communication behavior +41_10 -and what are your top five? question communication behavior +41_12 Really? question communication behavior +41_14 Do you have any idea why that is? question communication behavior +41_16 True. other communication behavior +41_18 Mm-hmm. By not putting yourself on the back burner so much? reflection communication behavior +41_20 Yeah. other communication behavior +41_22 Mm-hmm. other communication behavior +41_24 For someone else? question communication behavior +41_26 For your family? question communication behavior +41_28 You think it is so much of a fact that you put yourself on the back burner that you were neglecting yourself, or that you were putting others so much before you that you just didn't even think about yourself? reflection communication behavior +41_30 Wow. other communication behavior +41_32 There's so much of your-- Part of your paradigm? reflection communication behavior +41_34 So, do you think sometimes you weren't even aware question communication behavior +41_36 Yeah. other communication behavior +41_39 The very first time that you can remember? question communication behavior +41_41 That's not a selfish thing. reflection communication behavior +41_43 Right. other communication behavior +41_45 Cool, that's great. other communication behavior +41_47 Yeah. And so you felt you came about this change, and-and-and how does it make you feel? question communication behavior +41_49 Because you're- felt so obligated. reflection communication behavior +41_51 Yeah, is that on your top five also question communication behavior +41_53 You get peace with yourself? reflection communication behavior +41_55 That's very good. other communication behavior +41_57 Sure. other communication behavior +41_59 You feel resentful. reflection communication behavior +41_61 Right. other communication behavior +41_63 Right. other communication behavior +41_65 You don't feel fulfilled. reflection communication behavior +41_67 Like you've done anything helpful. reflection communication behavior +41_69 It's because you showed up and you gave out reflection communication behavior +41_71 Meaningful. reflection communication behavior +41_73 Sometimes it's the small things that really count, too. reflection communication behavior +41_75 So all of these things put together feel like right now at this point in life, that it is really healthy change for you, like where you are right now. reflection communication behavior +41_77 That's great and is there anything else on the list you felt like it was coming close to some of the other top five that you had or something similar? question communication behavior +41_79 Uh-uh. other communication behavior +41_81 All the chattering. reflection communication behavior +41_83 Thank you so much for sharing. other communication behavior +42_1 Right, so you've hit a plateau in your weight and despite all the things that you're trying to do to increase your activity, it doesn't seem to be working on the scale? reflection communication behavior +42_3 Right. So you feel like you're spinning your wheels, you're doing more exercising and it's not showing results on the scale? reflection communication behavior +42_5 And you're not feeling so good about that? reflection communication behavior +42_7 Uh, so you feel like you're doing this all alone? reflection communication behavior +42_9 At home or you think that they'll be supportive but they're not giving- they're not giving you what you need? reflection communication behavior +42_11 Oh, okay. other communication behavior +42_13 Tell me about that. question communication behavior +43_0 Well, thank you, Tanya, for meeting with me today and talking about this. So, there is something I'd like to ask you that we can kind of discuss in our conversation is what's one thing about yourself or something in your life that you'd like to change that maybe you've been feeling kind of ambivalent about? therapist_input communication behavior +43_2 Yeah. This anxiety is this obstacle for you and it sounds like it, then you're just not feeling confident that you could do it and do it successfully to this exam. reflection communication behavior +43_4 And so, it's easier for you to just not do it. reflection communication behavior +43_6 Yeah. So, on a scale from 1 to 10, 1 being not confident at all, 10 being very confident. How confident are you that you feel you can manage your anxiety in regards to taking this exam? question communication behavior +43_8 Okay. So, four or five. How combat, like, not like a two or three. question communication behavior +43_10 Yeah. Yeah, and you also mentioned that you've actually made the appointment that you have to take this exam. reflection communication behavior +43_12 And before you've been putting it off. reflection communication behavior +43_14 Okay. So, you've made this appointment before in the past and the anxiety has kind of taken over where you've rescheduled it. reflection communication behavior +43_16 And this time, it seems like it's a little bit different this time. How come this time you feel like you might not reschedule this time around? question communication behavior +43_18 So that's really encouraging you thinking about how good you'll feel afterwards once it's done and taken. other communication behavior +43_20 Yeah. You kind of want to avoid that. Yeah. Have those other feelings that could come up and if you don't have. reflection communication behavior +43_22 I'd love to hear from you. When was the time in the past that you were feeling anxious about something and you actually did it and it turned out well? question communication behavior +43_25 Yeah. other communication behavior +43_27 So, in that experience, it really built up your self-confidence and it almost not only changed the way you saw yourself, but maybe how other people saw you and you really, you liked that feeling. reflection communication behavior +43_29 Yeah. And that must've been really brave for you to do something that seems really daunting at first, yet you were really successful at it. other communication behavior +43_31 Um, how do you think you could relate that to what you're dealing with now? question communication behavior +43_33 Mm-hmm other communication behavior +43_35 So for you to create opportunities to create those moments that you can have that feeling again reflection communication behavior +43_37 And you just mentioned too, you feel really proud of yourself. other communication behavior +43_39 So to end our conversation, how do you think you couldn't move? You originally said, you were at four or five, what would have to happen to get you to like a seven, to feel more confident? question communication behavior +43_41 Mm-hmm other communication behavior +43_43 So that positive self-talk could really go a long way for you? question communication behavior +43_45 So to summarize, it sounds like you are still feeling kind of anxious about this test coming up, you've rescheduled it, um, over the past couple years. Yet, this time around, you seem more confident to just get it done. And you've even mentioned times in the past where you were feeling anxious and you were successful about it and that you felt proud about yourself. And you liked the way it means, you see yourself and how others saw you, and it seems like y-you're ready to finish this exam and-and remind yourself that you can be successful? reflection communication behavior +43_47 Okay. Well, thank you, Tanya. other communication behavior +43_49 Mm-hmm. other communication behavior +45_0 Hi, Mary, how was your day? question communication behavior +45_2 Well, you can sign right there. Seems like you're not in the mood to talk today. reflection communication behavior +45_4 Okay. You know it seems like you had uh, a day at school. I noticed that uh, you missed your first hour of class today as well. therapist_input communication behavior +45_6 It seems like that doesn't-isn't really a concern for you at this time? question communication behavior +45_8 So you're kind of wondering what the point of these visits are, me coming to your house. reflection communication behavior +45_10 Okay. Would it be okay with you if I kind of explained again kind of what this program is about? question communication behavior +45_12 You know that I will be stopping by every day just to make sure that you're here and following and-and responding to your GPS and making sure that that's charged up every day and that, um, if you're leaving the house without permission, that we will be aware of that as well. Um, and kinda just to get to know you as well when I come for these visits 'cause, um, you know that's kind of my role as your caseworker is just to-to monitor your day-to-day stuff. therapist_input communication behavior +45_14 It does kinda come off as nosy at times I'm sure. reflection communication behavior +45_16 I know uh, some clients have struggled with understanding that I really do care about you. And you know that when we first met that you had expressed a goal of, um, getting off this program as quickly as possible. other communication behavior +45_18 So I know just kinda being here when you need to be here is one way of doing that. therapist_input communication behavior +45_20 Yet you still can seem kind of annoyed that this is something that we still have to do. reflection communication behavior +45_22 So you're still kinda concerned that you're not quite sure if you will be able to do this successfully? question communication behavior +45_24 Um, and-and I'm sure that does seem kind of confusing too 'cause I'm sure you've got a lot of other people involved in your life right now with the courts I'm sure, I know that your mom is concerned about you as well and there's this one other person kinda checking in on you as well. reflection communication behavior +45_26 I'm sure it's pretty overwhelming. reflection communication behavior +45_28 Mm-hmm. other communication behavior +45_30 Yeah. And there is and I'm sure that it is really struggling at times too. reflection communication behavior +45_32 Um, and I know some clients have expressed just really valuing their freedom. They didn't realize how much they really valued that until it was gone. other communication behavior +45_34 Your freedom? question communication behavior +45_36 What would be some ways you could go about being able to get your freedom back? question communication behavior +45_38 Mm-hmm, yup that's one step, just sign the papers when I come by. Even though it seems like it's kinda annoying at times, it is something that we're contracted to do. therapist_input communication behavior +45_40 What are some other ways you feel like you can get your freedom back? question communication behavior +45_42 So that's something that will motivate you to not do what you did, not commit that crime, and, um, 'cause you do not like when we stop by? question communication behavior +45_44 That's okay. Well, I know that you are making an effort. I do appreciate then and when-when I do stop by that you still sign the paperwork even though you feel like it's annoying at times. So, thank you for, uh, at least doing that. other communication behavior +45_46 Okay. Um, before I leave today is there anything else you'd like to add or-or need to share with me? other communication behavior +45_48 Okay, well just so you know, again, I do have to come back so I'll see you later today then. therapist_input communication behavior +45_50 All right. other communication behavior +46_0 So, Jacob, everything looks very normal on your physical exam. Do you have any questions for me? question communication behavior +46_2 Okay. I see that you filled out our, um, alcohol and drug questionnaire. Is it okay if we go through this together? other communication behavior +46_4 Okay. What we talk about is confidential. I only tell your parents about what we say if you give your permission or if I become worried about a danger to-to you or to someone else. Does that make sense? therapist_input communication behavior +46_6 Okay. So, let's take a look. So I see that you have marked that you sometimes use alcohol, and that you have used alcohol to relax, feel better about yourself or fit in. Do you mind telling me a little bit more about your alcohol use? therapist_input communication behavior +46_8 Okay, so how many do you usually have at a time? question communication behavior +46_10 Okay. And how often? question communication behavior +46_12 Okay. So, you drink with friends, sort of three or four beers or mixed drinks, one or two times a month. How long have you been doing that? question communication behavior +46_14 So, for about six months. I'm curious. What do you like about drinking alcohol? question communication behavior +46_16 Yeah. other communication behavior +46_18 Okay. So, it sounds like you feel relaxed and have fun when you're drinking with friends and you like the taste. reflection communication behavior +46_20 Okay. I'm also curious, are there any parts about your alcohol use that you don't like? question communication behavior +46_22 Mm-hmm. other communication behavior +46_24 Have you ever experienced a-a blackout, like when you've been drinking and you wake up and you don't remember what happened? question communication behavior +46_26 Okay. And have you had any problems related to-to your drinking alcohol, like at home or school or somewhere else? question communication behavior +46_28 Mm-hmm. other communication behavior +46_30 Mm-hmm. Have you told your mother that you drink with your friends? question communication behavior +46_32 So more negative things about your drinking, like getting into trouble with your mom and missing a class at school when you had a hangover? question communication behavior +46_34 Okay. I see on the questionnaire that you have not ridden in a car with someone who's been drinking and you haven't driven a car, um, after you've been drinking. Is that correct? therapist_input communication behavior +46_36 That's great. And I hope you continue to avoid those things. As your doctor, I want you to know that I'm concerned about your drinking. When teens drink, things can go wrong, like injuring yourself. Even when you don't drink too excess, though, your brain is still developing and is very sensitive to the effects of alcohol. therapist_input communication behavior +46_38 That's why I recommend that all my adolescent patients not drink at all. So if you were thinking today about how ready you feel to stop drinking alcohol on a scale of zero to ten, with zero not being ready at all and ten feeling very ready, what number would you pick? question communication behavior +46_40 A five? So, I'm curious. Why didn't you pick a lower number like a two or three that would mean you're only a little bit ready to stop drinking? question communication behavior +46_42 Okay. What could you do to avoid getting into trouble? question communication behavior +46_44 [chuckles] Have you ever tried not drinking or stopping drinking? question communication behavior +46_46 Okay. What some people your age do is try stopping drinking for a period of time just to see what that feels like. therapist_input communication behavior +46_48 So, how long do you think you could go without drinking? question communication behavior +46_50 Do you think you could go two months without drinking? question communication behavior +46_52 Okay. What things would make it easier for you to not drink? question communication behavior +46_54 Anything else to make things easier for you? question communication behavior +46_56 Okay. Is there anybody in your life that you can talk to about this, who give you some support for not drinking? question communication behavior +46_58 Great. So you've come up with some reasons to stop drinking, like having hangovers and throwing up and getting into trouble. And you've developed some strategies to-to try to not drink, like spending more time with friends who don't drink or having non-alcoholic drinks when people around you are drinking alcohol. I think that's a great plan. I'm really proud of you for giving this a try. How about if I have you make an appointment for two months from now and then I'll see you back and we can see how things are going? reflection communication behavior +47_0 Hey, Mary, how are you? question communication behavior +47_2 Um, I noticed some yelling going on in the house, what's going on? therapist_input communication behavior +47_4 So nothing you want to talk about right now? reflection communication behavior +47_6 My guess is you're probably involved in that. reflection communication behavior +47_8 Okay, I understand that sometimes if you're feeling angry or upset about something, the last thing you want to do is share with your caseworker at that time, but, um, you know I am here for you, and if there's anything you ever want to talk about or share with me, that is something that I would love to-to here, and I'll just see sit here and listen if that's something that you would find helpful. therapist_input communication behavior +47_10 Okay. You know what? I-it seems like things have been really a struggle for you lately, and I have noticed that you haven't been in the best mood, so I'm really- I am concerned about you, but again, it's your choice if that's something that you feel like you want to share with me. reflection communication behavior +47_12 All right, well, you know I will be by later today. If, um, you have any questions or if you want to talk, um, otherwise, again, I'll stop by and call you later. therapist_input communication behavior +47_14 All right, take care, bye. other communication behavior +48_1 Mm-hmm. other communication behavior +48_3 Mm-hmm. other communication behavior +48_5 Okay. other communication behavior +48_7 Uh-huh. other communication behavior +48_9 Uh-huh. other communication behavior +48_11 Sure. other communication behavior +48_13 Mm-hmm. other communication behavior +48_15 Uh-huh. Uh-huh. other communication behavior +48_17 Uh-huh. other communication behavior +48_19 You probably think that I'm going to get on your case about that or something. reflection communication behavior +48_21 Yeah. other communication behavior +48_23 Hmm. other communication behavior +48_25 Yeah and I-- Yeah, you really-- You're already like, you're taking a look at this and sure don't need me like-- Obviously, you don't want to be doing that in the first place, but— reflection communication behavior +48_27 Yeah, clearly, you made a decision because you didn't want to stand out in some way I'm guessing. So, let's-let's talk more about that. Tell me where would you like to take this? reflection communication behavior +49_0 All right, Catherine, welcome back. I'll be interested to, sort of, after we met last time, what-what were you-- what have you been thinking about over the week 'cause, you know, I-I remembered last time I asked you what you were thinking about coming, but- question communication behavior +49_2 -what was different this time and your thoughts about coming? question communication behavior +49_4 Yeah. other communication behavior +49_6 Okay, okay. So, there's a shift from last time? question communication behavior +49_8 "Yeah. Yeah. My sense is we'll be able to work pretty well together. That's my, sort of, sense of, uh-- After last time, I thought, you know, ""Here's a young woman who's, you know, got some energy to get things together-" therapist_input communication behavior +49_10 "-and, uh--"" So, really, what we'd like to talk about today is-is get a sense of, um-- Let's talk about the things that would be good to work with, um, over the next, you know, nine months together, really." therapist_input communication behavior +49_12 So, one of the things that we started to touch on, last time, was this issue of gambling, and, um, you were talking, last time, about how the gambling had, sort of, got you into trouble with your family. reflection communication behavior +49_14 Yeah. So, thinking about, like, you know, last time, you-you started to say that, well, you thought it was-- you deserved it and there was some thinking around that, so I'm, sort of, wondering how open you are to-to exploring that from some different angles? question communication behavior +49_16 Yeah. Yeah. other communication behavior +49_18 Yeah. Yeah. other communication behavior +49_20 "Yeah, so how-how-- You know, like-- 'Cause, sometimes, when we start to open things up, and then you think, ""Oh, it feels a bit uncomfortable."" So, how do you manage things when you get uncomfortable? How have you managed those in the past?" question communication behavior +49_22 Yeah. Yeah. So, how would I know if we were talking and you were blocking off? What would I notice, uh, in our session together? question communication behavior +49_24 Yeah? other communication behavior +49_26 Yeah, that's okay. other communication behavior +49_28 So-so, what would be really helpful maybe because I might miss it, you know, so, like, could you tell me? It would be really helpful if— question communication behavior +49_30 "Yeah, yeah. If you could just say, ""Ken, hi, I am starting to, you know, tune it out here, starting to get uncomfortable,"" that would be really helpful." therapist_input communication behavior +49_32 Yeah? question communication behavior +49_34 Yeah, thanks for that, okay. So, let's think about the-- It has to do with how you just sorted out the thing around the gambling 'cause last time you were here, you told me that you get a buzz, you know, it seemed like you were gambling a bit more than your girlfriends were aware of, and-and you said you owe one of your friends some money. reflection communication behavior +49_36 So, um, how serious do you think this issue is to sort? question communication behavior +49_38 Yeah, okay. other communication behavior +49_40 Yeah. other communication behavior +49_42 Okay. So, again, on a scale of 1 to 100, how serious-- how important is it to sort it out? Yeah. question communication behavior +49_44 About 80? Right up there, yeah, yeah? And another question that's, sort of, related to that, how confident are you that you can, you know, you can actually get it sorted and get on with life? question communication behavior +49_46 Yeah? But, what would- question communication behavior +49_48 -your level be on a scale of 1 to 100? Where does your confidence sit? question communication behavior +49_50 Well, to get it sorted. Not necessarily to stop. But we don't- we don't know whether-whether stopping's the right answer here, I don't know, but-but, your confidence to sort it out. therapist_input communication behavior +49_52 Mm. other communication behavior +49_54 Hmm. other communication behavior +49_56 Yeah. Yeah, so-so, you fluttered last night with them? question communication behavior +49_58 Yep. Okay, okay. And-and when they stopped fluttering, were you still fluttering or did you stop with them? Where-where were you with— question communication behavior +49_60 Okay. Okay. Okay. Yeah, yeah. So, you were saying before that, you know, there was, you know, money you couldn't really afford- reflection communication behavior +49_62 -'cause you owed your mom and dad some money, and they weren't bailing you out anymore, and you had to go out and find some money, I think? question communication behavior +49_64 Yeah? Yeah. Yep. So, it seems like almost, like, you're still in the behavior, you know, still creating some problems? question communication behavior +49_66 Yeah? Yeah. other communication behavior +49_68 There's some feelings when you, kind of, think about that? question communication behavior +49_70 Yeah. other communication behavior +49_72 Mm. other communication behavior +49_74 Yeah. other communication behavior +49_76 Okay. So, again, that, sort of, sounds really important. So, what's-what's your dreams? What are your dreams? Where do you wanna be in five years' time? Where does Catherine wanna be? What do you wanna be doing? What are your dreams? question communication behavior +49_78 Yeah, yeah. other communication behavior +49_80 Okay. other communication behavior +49_82 Okay, okay. So, it seems like you're-you're, kind of, in a state in your life of considering your next steps. reflection communication behavior +49_84 "Yeah? Yeah. ""Do I continue with the, you know, my little current lifestyle,"" and you are so much the party girl you used to be-- I was speaking to last time-" reflection communication behavior +49_86 "-wasn't that-- Is that right? Yeah? So, ""Do I live a party lifestyle-- party-girl kind of lifestyle, or am I got some other dreams to follow?"" So, they're hard calls to make. And-and it all-- And there are no three ways. We will have to make those calls at some point." reflection communication behavior +49_88 And, my sense, is that some of the challenge for you, at the moment? Yeah? question communication behavior +49_90 When you think five years ahead, which-which position do you wanna be in? Which-which feels best? Party girl still, you know, with those four credit cards maxed out major, or would you wanna be actually, you know, thinking about having traveled and, you know, maybe, starting a family, those other things? Which-which direction feels best for you at this point? question communication behavior +49_92 I don't know. other communication behavior +49_94 What's your hunch? Yeah. question communication behavior +49_96 Yeah, yeah. Where in particular? You've got any ideas about what— question communication behavior +49_98 Egypt? question communication behavior +49_100 Uh, what's that about Egypt, that, uh? question communication behavior +49_102 Yeah? question communication behavior +49_104 Oh. other communication behavior +49_106 Yeah. other communication behavior +49_108 No, that's true. other communication behavior +49_110 But for obvious times. other communication behavior +49_112 It could be very different. other communication behavior +49_114 Yeah. Okay, so you've been-- How long have you had this-this idea for that that's what you'd like and that's where you'd like to go? question communication behavior +49_116 Oh, yeah? question communication behavior +49_118 Mm. So how much does the kind of, uh, current lifestyle rob you of that, you know, take away from that dream? question communication behavior +49_122 There you go. So there's some decisions to make around, uh, which dream, which path you wanna follow. other communication behavior +49_124 Hmm. What do you reckon to be the-the hardest bit of taking that pathway to-to traveling and realizing the-the dream? What would be the tough things that you'd have to confront? question communication behavior +49_126 Yeah. other communication behavior +49_128 Mm-hmm, mm-hmm. So I see this is- this is something you've been thinking about for a while. So how far away do you think you are from that change? You know, 'cause obviously it can-can be on the never, never, but how far away are you from it, making some decisions about that? question communication behavior +49_130 No, no. That'll be easy. So what is the first step for you? question communication behavior +49_132 Okay. other communication behavior +49_134 Yeah, it's hard, isn't it? It's hard being in the pub thing, in that environment. question communication behavior +49_136 We'd-we'd-we'd have an illustration for them, I suppose. We call those high-risk situations. You know, it's that-- so you might learn some language about some sort of the way that we describe- therapist_input communication behavior +49_138 -it and stuff, but, you know, being at the pub, you know, you want to sort of get the buzz of, you know, gambling, you know, horror situation, really easy to just go against what you decide that you wanted to do. Yeah? therapist_input communication behavior +49_140 Yeah? So how today have you sort of found some ways to manage that? question communication behavior +49_142 Mm. other communication behavior +49_144 Yeah. I think somewhat being tough with yourself, what-- yeah, people often say that, but, you know, it's not-- I think there are some things that you can do, and you've already-already identified a really good strategy. therapist_input communication behavior +49_146 Well, it's a couple of ideas. O-one, thinking about who your friends are and will your friends support you to realize your dream of traveling to Egypt. therapist_input communication behavior +49_148 Um, and the other idea you talked about before was, actually, cutting up your credit cards. So kind of amazing what that thing makes there on different cards isn't it? question communication behavior +49_150 It's very helpful and healthy. So, yeah, a couple of really good ideas already you've got, guess so? question communication behavior +49_152 Yeah. So that's-that's some work that we can continue to work with. Yeah? Yeah? other communication behavior +49_154 So 'cause-'cause I asked the question before, is what might be the hardest thing, and you'd identified that your friends, you know, could be one of the habits. question communication behavior +49_156 Yep, yep. Could that mean that some of your friends are probably moving around some similar sort of stuff like you, wondering about where they're going and- question communication behavior +49_158 -what they want to further their dreams, yeah? question communication behavior +49_160 Okay, so we talked about sort of where things you-w-- Where you might be in five years and which path you wanna take, yep, yep? And you seemed very clear about it. other communication behavior +49_162 Yeah, yeah. Something we can- we can do over the next while is-is really get some very concrete things in place to support you to do that. therapist_input communication behavior +49_164 Yeah. So what's one thing you can do between now and the next time we meet? question communication behavior +49_166 Yeah, find the scissors. reflection communication behavior +49_168 Yeah, yeah, yeah. other communication behavior +49_170 Yeah. other communication behavior +49_172 Truly. reflection communication behavior +49_174 Yeah. Okay, so sounds like so-some budget to buy stuff will be helpful. therapist_input communication behavior +49_176 Yeah, and of the things that-that we often put people in touch with here is some budget advice service, it's a great service here, um, and something that you can get to. therapist_input communication behavior +49_178 So let's talk about how we can organize a-a meeting with them. therapist_input communication behavior +49_180 Okay. other communication behavior +50_1 Okay. Um, but we were talking a little bit earlier-- earlier in our conversation, you had said that you did feel like it was maybe causing some of your agitation. So it's a little bit of, I'm not sure of what-- Um, so where are we? Did-did you-- do you feel like you do have some agitation out of coffee, or is it just no problem at all? reflection communication behavior +50_3 Yeah. other communication behavior +50_5 Yeah. So let me see if I had this. So y- so you got some positives, the-the awareness, and then you feel kinda on your game? reflection communication behavior +50_7 Um, and then there's some negatives with, um, you know, your-your co-workers, um, that they don't, you know-- then your boss may not want you, you know, checking out- reflection communication behavior +50_9 -on the hospital floor, you know, for frequently. reflection communication behavior +50_11 Yeah, yeah, and then the blood pressure thing. Does that sound about right? question communication behavior +50_13 Yeah. How about frequency? Do you feel like you're good on how much coffee you're drinking? question communication behavior +50_15 Okay. Okay. And that feels about right to you? reflection communication behavior +50_17 Mm-hmm. other communication behavior +50_19 Yeah. other communication behavior +50_21 Yeah, yeah. What would happen if you-- if you looked at, maybe reducing that with that habit? Would that get rid of maybe some of the things that are problematic? therapist_input communication behavior +50_23 The number. Just the number. therapist_input communication behavior +50_25 I don't-- you tell me. I mean, um, you're-you're drinking four a day. therapist_input communication behavior +50_27 Um-- other communication behavior +50_29 Yeah. other communication behavior +50_31 Yeah. other communication behavior +50_37 Yeah. other communication behavior +50_39 Yeah. other communication behavior +50_41 I think that's great. therapist_input communication behavior +50_43 I think so. So you've identified one of the four that might-- you might be willing to-to try- reflection communication behavior +50_45 -for a while to-to let go of. What do you- what do you think of that? question communication behavior +50_47 Okay. other communication behavior +50_49 Good. other communication behavior +51_0 Tell me what you know about the flu shot? question communication behavior +51_2 Mm, um, so you're thinking it's really just for people who are-are vulnerable to illness? reflection communication behavior +51_4 Would it be okay if I shared a little more information with you about the flu vaccine and the importance of it? question communication behavior +51_6 So you're right that you're young and healthy and you don't have a lot of complicating illnesses that mean that you would probably do okay if you got the flu. But we do know that the elderly are more at risk, pregnant people, babies are at risk of having serious complications from the flu, and by you getting the vaccine, that helps prevent you from passing it on to other people. therapist_input communication behavior +51_8 So having shared that information with you, how do you feel about the idea of the flu vaccine? question communication behavior +51_10 Mm. other communication behavior +51_12 Mm-hmm. other communication behavior +51_14 Okay, so you've got some people in your life who are vulnerable to possible illness, and making this decision to get the flu shot will help protect them. reflection communication behavior +52_0 Hi, Nick. Thank you for completing the CRAFFT questionnaire. I also appreciate you sharing some information about yourself. reflection communication behavior +52_2 sI see from the questionnaire, did you have got in trouble while using alcohol? Can you tell me more about that? question communication behavior +52_4 That must be really scary. reflection communication behavior +52_6 I understand. So tell me, how often do you drink? question communication behavior +52_8 I'm gonna make sure I understand. You have tried drinking a couple of times, and you almost got in trouble once. Did I get that right? reflection communication behavior +52_10 As your provider, I'm a little concerned about your health. Drinking alcohol could harm you, and I would like to share some information with you. Is that okay? question communication behavior +52_12 I understand. You're just experimenting with alcohol. Then, how about if you share with me what the effects of alcohol are? question communication behavior +52_14 Are you surprised what that might be true? question communication behavior +52_16 Well, you might not be drinking that much, and other kids are also trying alcohol. I'd like to share with you the risk of using. Alcohol and drugs could really harm you because your brain is still changing. It also-- you're very high risk for becoming addicted. Alcohol and drugs could also interfere with your role in life and your goals, especially in sports, and it could cause unintended sex. How do you feel about this information? therapist_input communication behavior +52_18 Based on your reason for your visit today, I feel like you really wanted to play soccer, and you have great goals about that. reflection communication behavior +52_20 That's a great goal to have for yourself. reflection communication behavior +52_22 Scholarship will really help you achieving your goals. reflection communication behavior +52_24 I would like to share with you these materials to show the risk of drinking at younger age. I also wanted to encourage you to think about these risks. What do you think about that? question communication behavior +52_26 It sounds like you're in the right track, looks like you care about your health, and you care about your goals in life. I'm here to answer any questions. reflection communication behavior +52_28 You're welcome. other communication behavior +54_0 Oh, hello Scott. other communication behavior +54_2 Um, we were talking a little bit earlier, and you said you wanted to talk about exercising. reflection communication behavior +54_4 What's going on with that? question communication behavior +54_6 Well, I mean, I think you just need to maybe sit down and write down a list of reasons why you need to get back to the gym, and then on the other side of the list, put down, you know, um, ideas about what's going to help you get there. therapist_input communication behavior +54_8 What gym do you belong to? question communication behavior +54_10 Okay. And-and how far away is it from your house? question communication behavior +54_12 Just a couple of miles. Mm. So you-- you know, you could, like, ride your bike or walk there, and it would be [unintelligible 00:01:12] too. therapist_input communication behavior +54_14 Well, I don't know about that. Um. That-- you know, it's really important that you get your, um, not just your cardiovascular-- that's a good idea for the cardiovascular, but also, you know, your, um, weightlifting, the [inaudible 00:01:32] [crosstalk] therapist_input communication behavior +54_16 Yeah, yeah. other communication behavior +54_18 Yeah. So why-why do you want to-- what do you wanna do with that? You want to look different, or--? question communication behavior +54_20 Okay. other communication behavior +54_22 Okay. Yeah, because your-your health really, to me, it's more important than your-your looks. I mean, don't get me wrong, I understand what you're saying, but, you know, it'd be great to get back in those jeans, but— therapist_input communication behavior +54_24 Mm-hmm. Well, I think you know what to do. You've done it before. reflection communication behavior +54_26 Yeah. Just a matter-- You just gotta do it. therapist_input communication behavior +54_28 Yeah. other communication behavior +54_30 Yeah. And so that might mean, you know, like giving up an hour's sleep, getting up an hour earlier in the day, and going there and getting it done then. That's what I do. therapist_input communication behavior +54_32 Yeah. other communication behavior +54_34 So when I see you next time, you know, that's what I'd like you to do is to, uh, experiment with getting up an hour earlier and, um-- You know, 'cause, uh, getting healthier is more important than sleep, you know. I mean, I know sleep is important, but-- And then bring that list back that we talked about. therapist_input communication behavior +54_36 Okay? other communication behavior +54_38 All right, so I'll see you next week. other communication behavior +54_40 All right. All right. Bye. other communication behavior +55_0 Miguel, before we end the call, I did want to go over the answers you gave me on the questionnaire about drug use. Is it okay if we go over that right now? question communication behavior +55_2 Thanks. When I looked at your form, it looks like you use heroin weekly and you injected. What part of your body do you normally inject in? question communication behavior +55_4 Do you mind if I take a look at your arm, please? question communication behavior +55_6 Okay. Well, I don't see any redness. Um, can you go ahead and touch that Miguel, and tell me if it feels warm to you or if it hurts? question communication behavior +55_8 Thanks. Just so you know, when I talk to patients about drug use, my job is to be helpful. I'm not going to tell you what to do or what you should do. What I can do is share some information and be a resource. Does that make sense? therapist_input communication behavior +55_10 Right. What else can you tell me about your heroin use? question communication behavior +55_12 A couple of times a week. And where do you get your syringes? question communication behavior +55_14 Uh, what one do you remember? question communication behavior +55_16 Okay. How often do you use new deals when you inject? question communication behavior +55_18 Yeah, it sounds like your health is important to you. reflection communication behavior +55_20 And you showed up today to take care of your migraines. reflection communication behavior +55_22 So, uh, you wrote on here that you've experienced withdrawal symptoms when you've stopped using in the past, is that right? question communication behavior +55_24 What does that feel like? question communication behavior +55_26 That sounds awful. What do you do when that happens? question communication behavior +55_28 Okay. How else does injecting heroin impact your life? question communication behavior +55_30 Yeah. You want to stay healthy. I'm curious, what do you like about using heroin? question communication behavior +55_32 And what about your use do you not like? question communication behavior +55_34 Mm-hmm. So on one hand, using heroin feels like an escape from things you don't want to think about. On the other hand, it puts you at risk for an overdose in infections. reflection communication behavior +55_36 So weighing what you like and don't like about your use, where do you want to go from here? What do you want to do differently? question communication behavior +55_38 Well, some patients who inject heroin are interested in a medication called Suboxone. It reduces cravings, withdrawal symptoms without making you high. Some patients want information on how to inject drugs more safely or where to get new syringes. Other patients want to carry Naloxone which is a drug that can prevent one from overdosing. therapist_input communication behavior +55_40 Yes. other communication behavior +55_42 Where do you keep it? question communication behavior +55_44 In case you see someone overdosing? question communication behavior +55_46 Your housemate may be willing to give you Narcan if they see you overdosing. reflection communication behavior +55_48 Anything else you want to do about your use? question communication behavior +55_50 Okay. I can email you some information on how to inject in a way that reduces the chance of infection and we also have behavioral health specialists in our clinic who can go over how to reduce harm with you. I bet the syringe exchange has similar resources too. therapist_input communication behavior +55_52 So it sounds like you have two goals right now. You want to tell your housemate about where you keep the Narcan in case you overdose and you want some information on how to inject safely? reflection communication behavior +55_54 How confident are you to do these two things? On a scale of 1 to 10, 1 meaning not ready at all and 10 meaning very ready, what number would you pick? question communication behavior +55_56 Okay. You're very ready. Why do you think you picked a 10 instead of a lower number like 8? question communication behavior +55_58 What kind of plan could you put in place to make sure you meet these goals? question communication behavior +55_60 That's great. And how do you want to get the information on injecting? question communication behavior +55_62 Okay. I'd like to hear how your plan worked out for you if you're willing to come back for another appointment. I look forward to hearing about what worked for you and what was challenging say in four weeks. other communication behavior +55_64 Great. I'll see you then. other communication behavior +56_0 Hi, Mrs. Smith. I'm Denise. I'm the social worker here at the clinic work that's working with Dr. Fields and the rest of the team. And, um, I know you were here to see Dr. Fields today, and I-I just wanted to let you know, I usually work with people who are similar to- have situations similar to you, and that have gone back home from rehab. And, uh, so I'd like to find out a little bit if you would, if that's okay, about how it's been going since you got home. question communication behavior +56_2 Yeah? other communication behavior +56_4 Yeah. What are you really glad about? question communication behavior +56_6 Yeah. other communication behavior +56_8 I know, I-I understand that it was really-- That was your goal. That was a really important thing for you to be able to get home and it sounds like you've been able to really en- enjoy parts of it, and I know you've been going to the- both the physical therapy and the Tai Chi and how's-how's that going? reflection communication behavior +56_10 So, I'm wondering if something happened that that led you not to go. You look a little, um, down. reflection communication behavior +56_12 Mm. So you've been working really hard- reflection communication behavior +56_14 -through this whole thing, you worked really hard to get home. reflection communication behavior +56_16 And you- you've continued to work really hard with both the physical therapy and the Tai Chi and taking care of your house and doing all those things. reflection communication behavior +56_18 And you had this fall or semi-fall, and you're feeling like maybe- maybe you were pushing too hard? reflection communication behavior +56_20 Yeah. other communication behavior +56_22 Yeah, yeah. It's a lot of work. reflection communication behavior +56_24 What are you concerned about? question communication behavior +56_26 Mm-hmm. other communication behavior +56_28 Yeah, yeah, yeah. And- so you don't want to hurt yourself. reflection communication behavior +56_30 And what are- what are your concerns about-- It doesn't sound like you-you feel like you hurt yourself in this fall. question communication behavior +56_32 Mm-hmm. other communication behavior +56_34 Yeah. And, what are you concerned will happen if-if you get hurt or if something- question communication behavior +56_36 And it feels like the only way that you can really stay safe and not fall is to not do anything to kind of just hunker down. reflection communication behavior +56_38 Yeah, yeah. other communication behavior +56_40 Mm-hmm. Mm-hmm. other communication behavior +56_42 Yeah. So the physical therapy is can- you can kind of still see that it's helping you to build your strength, which- reflection communication behavior +56_44 -might have probably helped you break your fall this time. reflection communication behavior +56_46 Um, I'm wondering what you remember about what-what Dr. Fields said about the Tai Chi in relationship to falls. Did she talk with you about that? question communication behavior +56_48 Yeah. other communication behavior +56_50 "Yeah. So you're feeling a little betrayed like it didn't-- ""Look, and I did this, I was doing my Tai Chi, and all of a sudden, I- here, look at this, I fall.""" reflection communication behavior +56_52 Right. other communication behavior +56_54 So you're just starting to question a little bit about whether or not it might be what is useful and, you know, it-it does really come down to what works for you and what-wh-what you decide will help you stay safe. And I'd like to work with you as I know Dr. Fields would, to-to help build a plan that will help you feel as safe as you can in your home- reflection communication behavior +56_56 -and to keep you there and to keep you feeling safe. reflection communication behavior +56_58 Wh-what do you think about that? question communication behavior +56_60 Yeah. other communication behavior +56_62 Yeah, right. other communication behavior +56_64 Yeah, yeah. other communication behavior +56_66 So it really kinda strikes you that you're- that you're there alone and this could happen and-- reflection communication behavior +56_68 What thoughts do you have about that? What have you heard that others have done, or what are- what are- what thoughts do you have? question communication behavior +56_70 Yeah, yeah. other communication behavior +56_72 Yeah, yeah. I know what's worked for a lot of the-the folks that I've worked with is there's like- it's called a lifeline and they can wear it around their neck and it's hooked up and- so that if you need help, you can push the button. therapist_input communication behavior +56_74 Mm-hmm. other communication behavior +56_76 It does really work. therapist_input communication behavior +56_78 Right. Right. other communication behavior +56_80 No, it is something that there's a couple of different of, uh, you know, a couple of different products out there, but it-it does- it can really help, uh, and-and it kind of gives- might give you this sense of security that you have at your fingertips. therapist_input communication behavior +56_82 Mm-hmm. other communication behavior +56_84 Yeah. other communication behavior +56_86 Mm-hmm. other communication behavior +56_88 We- we're gonna work with you to help you stay home as long as you possibly can and be safe. therapist_input communication behavior +56_90 So what do you think that will take, um, because you're the one that really knows how you're feeling about in the house and how you're feeling about your safety. What do you think? The lifeline is a possibility, that's something you can consider. question communication behavior +56_92 Mm. other communication behavior +56_94 Mm-hmm. What else do you think it would take for you to feel safe? question communication behavior +56_96 Yeah, yeah. other communication behavior +56_98 Mm-hmm. other communication behavior +56_100 Yeah. other communication behavior +56_102 Yeah. other communication behavior +56_104 So you'd like to have a little bit more support- reflection communication behavior +56_106 -and a little bit more connection maybe that- reflection communication behavior +56_108 -that-that, um, that has to happen. Would you like some suggestions about that? question communication behavior +56_110 Um, so one of the things that- that we also have here, we-we have- we can get some case- what they call case management services and that might be someone who comes in and checks with you at home and helps you figure out some of the things that might need to be done like you were talking about, give you a little refresher on safety at home- therapist_input communication behavior +56_112 -and, uh, and-and also might help you organize and connect up with other services that might be out there or do things, um, like that. I don't know. What it- how does that sound to you? question communication behavior +56_114 Yes. I was going to say the other thing that I would say- that I would consider because the senior center, and I know you were really active in the senior center before- therapist_input communication behavior +56_116 -and I'm wondering if you feel like there's support there. They have a lot of activities going on at the senior center that- and I- and I don't know what was in the Tai Chi included that might be- not only serve the purpose of the exercise but really help with some of that support. therapist_input communication behavior +56_118 Yeah. It sounds so crazy, doesn't it? Like the- it- when it feels like inside, what you're- what I'm hearing from you is that it feels like inside like moving is unsafe. reflection communication behavior +56_120 And-and yet, we know we can't make perfect safety, but we know that the more you move and the more active that you stay, the less likely it is that you're going to fall and the more safe you're going to be. therapist_input communication behavior +56_122 Yes. other communication behavior +56_124 Can't prevent all of it- therapist_input communication behavior +56_126 -but we can make it less likely. therapist_input communication behavior +56_128 Mm-hmm. other communication behavior +56_130 Yeah. Takes a lot. Takes a lot. And you're the only one that'll- that can know what it is you're willing to work through that fear for. reflection communication behavior +56_132 Mm-hmm. And that's a strong enough motivator for you and gives you enough purpose that you're willing to like kind of push through that fear that even though it's there and that, that sense of- reflection communication behavior +56_134 -concern about being safe. reflection communication behavior +56_136 Yeah. other communication behavior +56_138 Yeah. Yeah. Well, we can definitely talk about it when you come in again like- therapist_input communication behavior +56_140 -again, and-and- other communication behavior +56_142 Not at all. other communication behavior +56_144 Not being a baby. This is a pretty normal- this is- other communication behavior +56_146 -very normal. Absolutely. It's an absolutely normal thing to feel that, and especially when you've suffered something that you have and suffered to it, the stroke and the trying to get rehabbed and trying to find a way to get back home and going through the wobblies, this is perfectly normal. therapist_input communication behavior +56_148 Yes. And actually, you-you have really demonstrated to me anyway, a lot of strength and courage because you have continued to persevere and work through this and not everybody does. And you have found a way to get home and you seem really committed to staying home. So you-you've got a lot of strength there that you're working with. reflection communication behavior +56_150 And we can work together to make sure that-- And-and Dr. Fields too, I know, is very interested in that. We can work together to do what we can to keep you there. therapist_input communication behavior +56_152 Not yet. therapist_input communication behavior +56_154 Mm-hmm. other communication behavior +56_158 I'm really glad you did too. I really appreciate it because that's the only way that we can work together- other communication behavior +56_160 - to help you feel safer. And I hope you're going away home today feeling safer. other communication behavior +56_162 Mm-hmm. other communication behavior +56_164 We'll get you hooked up. therapist_input communication behavior +56_166 Mm-hmm. other communication behavior +56_168 Mm-hmm. other communication behavior +56_170 Mm. other communication behavior +56_172 Good. Well, you've got some good plans and we'll go check it out and make sure they happen. other communication behavior +56_174 All right. Thanks. other communication behavior +58_0 Hi, Scott. other communication behavior +58_2 Hi. You were saying over the phone, uh, you want to talk about exercise? question communication behavior +58_4 Okay, alright. Where would you like to start with that? question communication behavior +58_6 That's really a lot. Very good. reflection communication behavior +58_8 Wow. other communication behavior +58_10 Mm-hmm. other communication behavior +58_12 Mm-hmm. other communication behavior +58_14 But that goal of the half-marathon, you know, it's really important that you were willing to put all the time into getting ready for it, which, from what I've heard from other people, is almost like a job in and of itself. reflection communication behavior +58_16 What'd you like about it? question communication behavior +58_18 Uh-huh. other communication behavior +58_20 I-it a-almost, um, feels like you identified as being a runner, like an athlete? reflection communication behavior +58_22 Do you really? question communication behavior +58_24 [unintelligible 00:01:40] other communication behavior +58_26 Okay. other communication behavior +58_28 Got into the culture? reflection communication behavior +58_30 Okay, alright. Cause it’s tough, it's really, it is. I mean I’ve, um, I’m sure you’ve been told before by whomever, uh, diagnosed your foot injury, but if not, let me know if it gets so tough on your body [unintelligible 00:02:10] let me know. So-- other communication behavior +58_32 Okay. other communication behavior +58_34 Oh, and yet and at the same time you know your body well enough, and you-you’re willing to pay attention to your doctor’s advice about the running, right now, for you, not the best thing. Um, so, riding a stationary bike. Um, what else do you like to do that's cardiovascular? question communication behavior +58_36 If you were to pick one of those, which one do you enjoy the most, um, would be most likely to do? question communication behavior +58_38 The elliptical. Okay. Yeah. [unintelligible 00:03:07] like kind of almost like running. other communication behavior +58_40 [chuckles]. other communication behavior +58_42 Okay. And-and what do you- do you-- Some folks, you know, [unintelligible 00:03:18] put on music, kind of- kind of. other communication behavior +58_44 Yeah. other communication behavior +58_46 Okay. Get your rocking out, running on the elliptical playlist. reflection communication behavior +58_48 And, um, so you were-- You said that you’ve been going several times a week, which is really an extraordinary number, I-I think it’s four, five times a week? question communication behavior +58_50 Nothing. Okay. reflection communication behavior +58_52 So what ideas do you have about initially just getting started, and what-what would you do [unintelligible 00:04:13] ? question communication behavior +58_54 What would help you do that? question communication behavior +58_56 Mm-hmm. other communication behavior +58_58 [unintelligible 00:04:45]? other communication behavior +58_60 Mm-hmm. other communication behavior +58_62 Mm-hmm- mm-hmm. So that-that-that half marathon was, uh, a very specific concrete thing and you could envision yourself, and you're ready for it and the day of and all that kinda stuff. reflection communication behavior +58_64 Um. other communication behavior +58_66 Mm-hmm. other communication behavior +58_68 So sometimes-- almost sounds like, um, your feedback would be, uh, useful to you. Like some immediate feedback in terms of like, um, like [inaudible 00:05:53] reflection communication behavior +58_70 [inaudible 00:05:55] other communication behavior +58_72 [inaudible 00:06:01] other communication behavior +58_73 -somebody there and, you know, hooking up with somebody. therapist_input communication behavior +58_75 Okay. other communication behavior +58_77 Okay. other communication behavior +58_79 There might be something [unintelligible 00:06:43] because you're such a social guy. And so to be able to be exercising and be talking and enjoying yourself- you like the music too, right? reflection communication behavior +58_81 And if you arrange to meet somebody there, you're very good at, uh, you know, uh, keeping the agreement. therapist_input communication behavior +58_83 And in for right now it just be, you'll be happy with getting there one time. reflection communication behavior +58_85 Mm-hmm. other communication behavior +58_87 Mm-hmm. other communication behavior +58_89 And days that you know of on your less rigorous schedule that you're more likely to succeed [unintelligible 00:07:40] I really like how you're picking like three days a week instead of some days a week. reflection communication behavior +58_91 Very clear you understand the whole idea of giving yourself a day off in between. reflection communication behavior +58_93 Okay, yeah, I know that, yeah, yeah. Okay, so. So, um, so are you sure you wanna try to start out with the- that initial [unintelligible 00:08:07] reflection communication behavior +58_95 When you find someone to go with, great, if not, you get your own [unintelligible 00:08:12] your own music and uh, I'll be- I'll be trying just to-to see um, what is like for you, having actually done that [unintelligible 00:08:20] reflection communication behavior +58_97 Yeah, okay. other communication behavior +58_99 Thanks. other communication behavior +60_1 Yeah. other communication behavior +60_3 Mm-hmm. other communication behavior +60_5 You bond other smokers. reflection communication behavior +60_7 That's very common. I mean, you go where you know, um, no one's gonna look down on you. reflection communication behavior +60_9 And you're instant friends. reflection communication behavior +60_11 And now a total stranger will give you a cigarette- reflection communication behavior +60_13 "-whereas like, you can't go up to him and say, ""Hey, can I have some of your McDonald's French fries,"" and take them out—" reflection communication behavior +60_15 Right, yeah, but with cigarettes, there is a sharing. You don't see that with any other drugs? reflection communication behavior +60_17 You can't, no, not one of mine. So, um when are you thinking you might want to do this? question communication behavior +60_19 Okay. Do your homework. reflection communication behavior +60_21 Okay. other communication behavior +60_23 Okay. other communication behavior +60_25 Sure. reflection communication behavior +60_27 Okay. Yeah, no, all those things are good. I mean, I think you know, the will- picking a quit date has been found to be really effective. And, um, uh, I know you had talked earlier and then we'll end in just a couple minutes, but about, you know, like, the willingness or the readiness and most-- a lot of people, a lot of my clients have shared with me that when they woke up that morning, they truly had no idea that was going to be their last cigarette. therapist_input communication behavior +60_29 No. Or- or some of them didn't have an exact date, but m-more importantly, was they-they just didn't know that was the day. therapist_input communication behavior +60_31 Right, right. It's just like you-you-you-- Some people pick a quit date, like January 1st is still the most popular quit date— therapist_input communication behavior +60_33 There's a smoke update coming up. therapist_input communication behavior +60_35 It's for the cancer society. therapist_input communication behavior +60_37 Yeah. other communication behavior +60_39 Yeah. other communication behavior +60_41 Yeah. other communication behavior +60_43 Actually, you would be amazed how many people do it. therapist_input communication behavior +60_45 Yeah, yeah, they really do, and smokers. Yeah, and drinkers, they do, yes. Yeah. therapist_input communication behavior +60_47 Like a new beginning. reflection communication behavior +60_49 So, for you, it's your, you know, it sounds like you really want to be prepared. reflection communication behavior +60_51 And yet, on some level, you know, that it's gonna be a lot of hard work for you because of, you know, you've already known how anxious you get about a stash- reflection communication behavior +60_53 So if you have a stash Nicorette gum if you decide to use it, I mean, you'd have to have other stashes, you know. therapist_input communication behavior +60_55 That worries you? reflection communication behavior +60_57 Yeah. So, so if-if your doctor says it's okay with the Wellbutrin, one-- uh, we see very little if any weight gain- therapist_input communication behavior +60_59 -with the Wellbutrin, yes. reflection communication behavior +60_61 Yeah. And, um, the same with the Nicorette gum, because it- nicotine is an appetite suppressant. therapist_input communication behavior +60_63 Yeah. other communication behavior +60_65 If you will. And that's if you decide you want to try a replacement therapy and that's what we call it and it-it kind of sounds from what you've described with your fear about you know, what it would be like of the withdrawal and everything like that. W-why you don't have to do it that way, you don't have to go cold-cold turkey. therapist_input communication behavior +60_67 Yeah. other communication behavior +60_69 Yeah. other communication behavior +60_71 Yes. Yeah, yeah. So I think that- I think, I'm just a really big advocate of w-whatever is gonna enhance the quality and the length of your life. And if somebody becomes addicted to nicotine go- gum, God bless them. They're still gonna live longer, you know what I mean? therapist_input communication behavior +60_73 So— other communication behavior +60_75 So, we'll do that so we'll-we'll talk about the hypnosis a little bit more, you know, you'll talk to your doc. Um, you'll do your research, you know, about programs and stuff, I'll give you any information I have and we'll take it from there. But it's sounding like the quit date might be coming up fairly-- like within the next two, three months. therapist_input communication behavior +60_77 I, uh, mean that's up to you. reflection communication behavior +60_79 You get to decide. reflection communication behavior +60_81 Yeah. Is it appealing the thought of quitting with a group at the same time? therapist_input communication behavior +60_83 Uh-huh. other communication behavior +60_85 Okay, yeah. other communication behavior +60_87 Okay. So, that really sounds like something we can do. reflection communication behavior +60_89 So, that would be can- the Cancer Society. So, we can look into that. therapist_input communication behavior +60_91 All right. Well, I appreciate you coming in. We'll set up another appointment and, um, get our resources together. We'll take it from there and— reflection communication behavior +60_93 Oh, you're welcome. My pleasure, thank you. other communication behavior +61_0 Hi Mrs. Smith, my name is Terri, I'm one of the nurses who works with Dr. Fields. other communication behavior +61_2 Yes, I think when you were in last time. other communication behavior +61_4 And I know that, uh, Dr. Fields talked with you last time about maybe trying a tai chi class to see how that would go, and I wanted to-to check in with you and see how tai chi went. question communication behavior +61_6 Uh-huh. other communication behavior +61_8 Uh-huh. other communication behavior +61_10 Mm-hmm. other communication behavior +61_12 Uh-huh. So, you thought it was beautiful and you liked the instructor, but you were a little self-conscious because you were in a chair? reflection communication behavior +61_14 A lot self-conscious, uh-huh. reflection communication behavior +61_16 What were you hoping to achieve with the, um, by going to tai chi? question communication behavior +61_18 Uh-huh. So, you're hoping that it would help with balance, but you didn't see the- maybe the results you were looking for? reflection communication behavior +61_20 Not yet. reflection communication behavior +61_22 Uh-huh. What is your overall goal? What are you working towards? question communication behavior +61_24 Uh-huh. other communication behavior +61_26 Mm-hmm, and what is it that's important to you about getting home? question communication behavior +61_28 Mm-hmm. other communication behavior +61_30 Yeah. other communication behavior +61_32 Uh-huh. So, you're wanting to get home to your dog, your garden, back to your life, your independence? reflection communication behavior +61_34 Mm-hmm. other communication behavior +61_36 What do you think you need to do in order to be able to achieve that goal of getting home? question communication behavior +61_38 Uh-huh. other communication behavior +61_40 And do you agree that that's what you need to do in order to be able to get home? question communication behavior +61_42 Uh-huh. other communication behavior +61_44 Uh-huh. other communication behavior +61_46 Uh-huh, and tell me how your physical therapy is going? question communication behavior +61_48 Mm-hmm. other communication behavior +61_50 Mm-hmm. other communication behavior +61_52 So, it sounds like, um, you can see that you're making some progress in physical therapy- reflection communication behavior +61_54 -and that you were hoping that the tai chi would help you with the wobblies. Uh-huh? reflection communication behavior +61_56 And so, are you wanting to go back to tai chi? question communication behavior +61_58 Uh-huh. I think it's important, um, that you know that you're the one who has to make the decision about whether or not tai chi works for you. other communication behavior +61_60 Uh-huh. other communication behavior +61_62 So, you haven't seen the results that you want yet- reflection communication behavior +61_64 -but because Dr. Fields has recommended it and your friend has- reflection communication behavior +61_66 -and it sounds like you like the instructor- reflection communication behavior +61_68 -it sounds like you'd like to try and give it another chance? reflection communication behavior +61_70 So, what has to happen in order for you to get to tai chi again? question communication behavior +61_72 Uh-huh. Yeah. other communication behavior +61_74 Uh-huh. So, how confident are you on a scale of 1 to 10 with one being not at all confident and 10 being very confident that you can make the arrangements in order to get to tai chi. question communication behavior +61_76 Mm-hmm. other communication behavior +61_78 Five. reflection communication behavior +61_80 Uh-huh, so- other communication behavior +61_82 Uh-huh. What is it that makes it a five instead of a one, no confidence? question communication behavior +61_84 Mm-hmm. other communication behavior +61_86 Uh-huh. other communication behavior +61_88 Uh-huh. other communication behavior +61_90 So, in order for you to feel more confident, you would like some help in making those arrangements? reflection communication behavior +61_92 Uh-huh. other communication behavior +61_94 And is that something that your daughter can do for you? reflection communication behavior +61_96 Okay. Um, so is that something that you'd like us to help you with? question communication behavior +61_98 Uh-huh. other communication behavior +61_100 Sure we can make those arrangements with the rehab center. They have a van- therapist_input communication behavior +61_102 -and-and they've done this for other patients so we can certainly make those arrangements if you'd like. therapist_input communication behavior +61_104 Okay. So, are there any other barriers or obstacles in the way to you getting to tai chi? question communication behavior +61_106 Okay. other communication behavior +61_108 All right. other communication behavior +61_110 Well, it sounds like you can see that you're making some progress in your physical therapy. reflection communication behavior +61_112 And that you're wanting to give tai chi another chance, and that if we can help make arrangements for you to get there with the van to the rehab center, that you'll give it another chance. reflection communication behavior +61_114 Okay. other communication behavior +61_116 Well, um, before you leave today, we'll go ahead and, um, I'll call the rehab center and make those arrangements. other communication behavior +61_118 Sure. I'm-I'm happy to do that. other communication behavior +61_120 And then when you come back in, I know you've got another follow up appointment with Dr. Fields, I'd like to check back with you then and see how class went the second time. other communication behavior +61_122 All right. other communication behavior +61_124 Well, thank you very much for coming in today Mrs. Smith and I look forward to hearing about the progress that you're making. other communication behavior +62_0 -- doing today? question communication behavior +62_2 Good. Why don't you fill me in on what's been going on since I saw you last? question communication behavior +62_4 Okay. other communication behavior +62_6 So she talked to you a little bit about it, but it sounds like you're kind of unsure exactly the details. reflection communication behavior +62_8 Okay. So why don't you tell me what you remember from having your conversation with your case manager? What do you know so far about community service? question communication behavior +62_10 Okay, gotcha. So, you know, that it needs to get done- reflection communication behavior +62_11 Yes.-you know, you have till the end of your probation- reflection communication behavior +62_13 -but you're a little fuzzy on the details. reflection communication behavior +62_15 Okay. Um, so maybe if it's okay with you, I can share with you some of, um, the requirements, maybe go over the details a little bit more. other communication behavior +62_17 Is that all right? other communication behavior +62_19 Okay, great. Um, so with your community service I know you've got 25 hours left to do, um, so that does need to get done by the end of your probation, and your case manager is a really great resource to help you find a place where you can do it. So I know in the past some clients have done their community service at food pantries or shelters, or anywhere in the community that's not, you know, a family member or a friend. Um, the urban ecology center is a really great place. You can kind of work outside, work with younger kids. Do any of those options seem like a fit that you might be interested in? therapist_input communication behavior +62_21 So that's something that you can work with your case manager on. therapist_input communication behavior +62_23 So, um, that's something you can absolutely ask her or quest- or me some questions about, but they'll be able to come and bring you some options- therapist_input communication behavior +62_25 -of places that you can work with, some phone numbers to call. therapist_input communication behavior +62_27 And that is something that we'd kinda like to see you do on your own, but if you're really feeling like you're struggling, those are phone calls that either you and I can make together or you and your case manager can make together. therapist_input communication behavior +62_29 Well, I mean, 24 hours in a weekend sounds to me like it might be a lot of time. therapist_input communication behavior +62_31 I can- I can hear that you are really eager to just get it finished- reflection communication behavior +62_33 -and get it out of the way. Maybe I know in the past it's been helpful for some other clients to sit down and take a calendar and just mark out, okay, I'm gonna do five hours this day, I'm gonna do three hours this day, two hours of this day. Does that sound like something that might be helpful for you? therapist_input communication behavior +62_35 Okay. other communication behavior +62_37 And then, you know, it might be, I definitely think that if you're committed and it's summer break, it's something you could easily get done in a week. therapist_input communication behavior +62_39 What other questions do you have for me about community service? other communication behavior +62_41 Yup, absolutely. other communication behavior +62_43 But you know that if you have any more questions, you can always come to me or your case manager and we're here for- to be a support for you. therapist_input communication behavior +62_45 You're welcome. other communication behavior +63_0 So Tom, this infection is been pretty painful for you but we have antibiotics. If you take it faithfully for 10 days, I'm sure that your infection will be gone. Can you do that? therapist_input communication behavior +63_2 And do you mind if we talk about a screening form that you filled out earlier today on drug use? question communication behavior +63_4 Let's take a look. It says that on occasion you use, uh, drugs other than medical reasons. Which drugs do you use? question communication behavior +63_6 Snort it, smoke it? question communication behavior +63_8 Don't inject it? reflection communication behavior +63_10 Use any other drugs? question communication behavior +63_12 And, uh, um, you do this how often? question communication behavior +63_14 Mm-hmm. other communication behavior +63_16 So you're an occasional meth user. You don't use very often? reflection communication behavior +63_18 Only snort it? question communication behavior +63_20 Well, as I think you know, Methamphetamine use is associated with some health risks. And the amount that you're using it-it puts you in a category that we consider a risky user. And that contrasts with someone who it says addicted, um, someone who's a heavy user but it's not in a healthy category because people who use Methamphetamine tend to run to a number of consequences. And actually one of them is, um, sexually transmitted diseases. Do you suppose that your STD might be associated with your Methamphetamine use? therapist_input communication behavior +63_22 So you're normally very careful and you use protection when you have sex? reflection communication behavior +63_24 And it seems to you that methamphetamine may have clouded your judgment? reflection communication behavior +63_26 Anything else happening with Methamphetamine in your life? Is it affecting you in any way? question communication behavior +63_28 Yeah, you know, I'm concerned bout it too and I'd actually recommend that you stop using Methamphetamine altogether. And, um, there-there are a lot of reasons for this but that's-that's would be my recommendation. therapist_input communication behavior +63_30 So you recognize Methamphetamine has some problems associated with it and you also on the balance see that a lot of your social life and your sex life involves Methamphetamine, it would be difficult to quit using? reflection communication behavior +63_32 Well, if you were to, um, consider how ready you are to stop using Methamphetamine completely- question communication behavior +63_34 -with zero being not ready at all- question communication behavior +63_36 -and 10 being ready, where would you put yourself? question communication behavior +63_38 Why not a one or a two? question communication behavior +63_40 Are there any other concerns that you have about Methamphetamine? question communication behavior +63_42 Mm, so when I was first talking to you, I thought that you'd have a very, um, really not much interest in not stoping using Methamphetamine but it sounds like you have a number of reasons why you really would like to stop using Methamphetamine. And that is, um, that it might be cut with something else, um, you could get another ST- STD including HIV. reflection communication behavior +63_44 Um, what do you think would make it easier for you to cut down or quit using Methamphetamine? question communication behavior +63_46 How could you get a different social life? question communication behavior +63_48 Is there anyone in your life who doesn't use methamphetamine? question communication behavior +63_50 Does she-- Have you talked to her about your meth use? question communication behavior +63_52 So on the one hand, it would be difficult to quit using Methamphetamine because there are so many positives that you get from using it. But on the other, there are reasons why you want to quit using methamphetamine. reflection communication behavior +63_54 And there's some things that you might be able to do that would make it easier to not use methamphetamine including talking to your sister and getting some support. reflection communication behavior +63_56 Well, great. I recommend that you not use Methamphetamine at all but what you do is up to you. therapist_input communication behavior +63_58 I could see you again in a month. Would that work out for you? question communication behavior +64_0 Well, welcome, Ricky. other communication behavior +64_2 Nice to meet you. other communication behavior +64_4 And you found us okay? question communication behavior +64_6 Alright. other communication behavior +64_8 Yeah other communication behavior +64_10 Have you been here before? question communication behavior +64_12 Mm. Okay. Alright. Well, um, I know a little about why you're here today- other communication behavior +64_14 -um, but it's great to see you, and so maybe a good point to start with is, tell me why you're here. question communication behavior +64_16 Right. other communication behavior +64_18 And that's led you to being here today? question communication behavior +64_20 Alright. other communication behavior +64_22 Right. So it sounds like you thought there was something that, uh, that you needed to look at, something that was concerning you? question communication behavior +64_24 They were concerned for you? question communication behavior +64_26 Alright. other communication behavior +64_28 You were surprised? question communication behavior +64_30 Yep. other communication behavior +64_32 Mm-hmm. other communication behavior +64_34 You're not sure that applies to you? question communication behavior +64_36 Okay. other communication behavior +64_38 Alright. other communication behavior +64_40 I'm trying to understand you so far, something's concerning you and something's concerning your friends- reflection communication behavior +64_42 -but you're not sure whether it's- whether-- just how bad it is or- and you're just wanting to check that out? question communication behavior +64_44 Mm-hmm. other communication behavior +64_46 Yeah. other communication behavior +64_48 Because they care about you and-and you respect what they say, and you're wondering whether something about what they're saying may be right, but let's check that out a bit? question communication behavior +64_50 Alright. other communication behavior +64_52 Well, let's do some checking out. therapist_input communication behavior +64_54 So tell me a little bit about what you're doing, what is- what is the concern that they are raising. therapist_input communication behavior +64_56 Mm-hmm. other communication behavior +64_58 Alright. other communication behavior +64_60 Okay. other communication behavior +64_62 Tell me a little bit about what now and again means, and-and-and how often. question communication behavior +64_64 Is this- is this with, uh, with the drug? question communication behavior +64_66 This is meth you're talking about? A couple of times a week? question communication behavior +64_68 Well, maybe, we c-- we can check that out to see whether-whether it's a lot or-- But maybe also importantly to-to discuss with you what the effects are and-and-and what your concerns are about it. But help me to understand a little bit more of what it's like for you. Tell me- tell me what are the things about your, uh, use of meth that you- that you've liked that you found good for you? question communication behavior +64_70 Mm-hmm. other communication behavior +64_72 I know Family Bar, yes. other communication behavior +64_75 So Auckland, coming to Auckland from Palmerston for you was-was like taking charge of something that you were going to look to make something different in your life? question communication behavior +64_77 Right. other communication behavior +64_79 Which you weren't aware of in Palmerston? question communication behavior +64_81 Okay. other communication behavior +64_83 Mm-hmm. other communication behavior +64_85 Palmerston. Mm-hmm. reflection communication behavior +64_87 Yeah. other communication behavior +64_89 It sounds like you're ready to move up to something that was different. reflection communication behavior +64_91 And-and you came- reflection communication behavior +64_93 -here to Auckland. reflection communication behavior +64_95 Alright. other communication behavior +64_97 And how does that feel for you now? question communication behavior +64_99 Mm-hmm. other communication behavior +64_101 So coming out, feeling-- being gay- reflection communication behavior +64_103 -being part of a gay culture here in Auckland, is feeling good- reflection communication behavior +64_105 -for you? question communication behavior +64_107 And at the same time, it's-it's linked closely with the- with the drug scene with the meth scene for you? question communication behavior +64_109 And you're not experiencing where these two things are separate? They just seem to be together more often than not? question communication behavior +64_111 So— other communication behavior +64_113 It just sounds like something's worrying you about that there's-there's a part link there but there's not a link and that-that maybe that the drugs is-is becoming a more important part in your life. reflection communication behavior +64_115 Okay. other communication behavior +64_117 So something's changed recently? question communication behavior +64_119 Yeah. other communication behavior +64_121 Tell me about those things you're noticing that you hadn't noticed before. question communication behavior +64_123 That surprised you? question communication behavior +64_125 Mm. other communication behavior +64_127 Alright. other communication behavior +64_129 Okay. other communication behavior +64_131 So you're worried a little bit about it and you're going to find out more about it, but you're-you're not gonna take on this notion of being a headache or anything as yet— reflection communication behavior +64_133 Okay. other communication behavior +64_135 So tell me then, um, Ricky, what- what's the other side of the good things that-that using meth or doing some smoking does for you? Is there a downside to it? Are there problems that you're experiencing? question communication behavior +64_137 Mm-hmm. other communication behavior +64_139 Quite a lot's changed over the last year from— reflection communication behavior +64_141 It doesn't sound like it was part of the plan. reflection communication behavior +64_143 Sure. [chuckling] It's not a secure profession- reflection communication behavior +64_145 -and it's-it's hard- reflection communication behavior +64_147 -it's hard. But is-is there, I just wonder, is there a connection at all between the-the-the-the acting and the meth use in terms of the effect of the meth use on your- on your ability to get work? question communication behavior +64_149 The drug may have had an effect on that? question communication behavior +64_151 Hmm. Hmm. other communication behavior +64_153 Alright. other communication behavior +64_155 Alright. other communication behavior +64_157 Right. And they got questions too- reflection communication behavior +64_159 -to ask are they— other communication behavior +64_161 You're beginning to-to think about those things and-and-and what effect they may have on you. reflection communication behavior +64_163 And the choices that you might have about it. reflection communication behavior +64_165 What else? Are the-the-the-the problem of around the use of money, you know, the choices that you make around money, and the meth use has taken up quite a lot of the money- question communication behavior +64_167 -over the last year and maybe also the effect on-on um, your job and being able-- maybe you're not auditioning as well as you might. reflection communication behavior +64_169 And maybe the effects um, also on-on your physical appearance. An interesting question around the effect of meth use on physical appearance. reflection communication behavior +64_171 Um, what-- are there any other problems? Any other things that-that are a bit of a downside to this? question communication behavior +64_173 Yeah. other communication behavior +64_175 And that's a problem? question communication behavior +64_177 Why? question communication behavior +64_179 They're important. reflection communication behavior +64_182 YHmm. other communication behavior +64_184 Hmm. But Ricky, let me just check, 'cause I may got this wrong, just check with you that um, there are some friends that you've got who do use who are still concerned about you. Did I get that right from what you said earlier that-that those who are concerned about you and were part of this intervention some of them use. question communication behavior +64_186 And you-- So they have their concerns and-and you are beginning to-to ask questions of this use as well and- reflection communication behavior +64_190 And we're g- we're gonna leave labels all that kind of stuff aside 'cause, you know, I'm picking up from you that that's not what that's about. therapist_input communication behavior +64_192 I'm happy with that. What do you think will happen, what might happen if you can turn your-your uses- you're on now? What-what concerns do you have about not making any kind of change? question communication behavior +64_194 Alright. other communication behavior +64_196 This is gonna be your career. This is the career- reflection communication behavior +64_198 -you want to make. reflection communication behavior +64_200 Mm-hmm. It's harder when you're trying to create your career, get that going. You gotta- you gotta be at your- at your top, top pitch. therapist_input communication behavior +64_202 Yeah. other communication behavior +64_204 Yeah, and-and maybe the meth use is-is compromising that. reflection communication behavior +64_206 Hmm. other communication behavior +64_208 Alright, so it's back to the money thing again which is- reflection communication behavior +64_210 Yeah. yeah. other communication behavior +64_212 That creates problems? question communication behavior +64_214 Yeah. other communication behavior +64_216 Let's just come back to another thing, uh, that we were talking about a little bit earlier, and it's around your meth use as well and-and-and with your gay friends, with gay lifestyle. And-and that sounds like you're saying that-that-that when you party, when you go into the clubs, when you're being with friends that the meth use is always there? question communication behavior +64_218 The-the availability of it is there. reflection communication behavior +64_220 And everyone, most people are using. other communication behavior +64_222 And it might be hard to be part of that scene and not to be using drugs? question communication behavior +64_224 Right. other communication behavior +64_226 So there is a possibility that there are other parts of the scene that don't rely on drug use- reflection communication behavior +64_228 -or particularly on-on meth use? question communication behavior +64_230 So that might be something that we can look at but later if you're interested in is maybe what are some of those other parts of the gay scene, whose still party and party medley, but when meth is not a- is not a dominant- therapist_input communication behavior +64_232 -factor in that partying, and we- where-where there are, uh, uh, uh, gay groups that support people who-who are not wanting to be-- they have a lifestyle that is heavily weighted to drug use. So there are some options there to look at some other ideas if you're interested and we might look at that, for you to think about- therapist_input communication behavior +64_234 -to consider, so it's not about giving up anything, it's not about huge major changes, it's about how can I improve the situation. reflection communication behavior +64_236 It's what I'm hearing you saying bring-- be a little bit more in control of what's-what's going on for me. reflection communication behavior +64_238 So that I can pursue that plan. reflection communication behavior +64_240 What could be a- what could be a first step towards that? question communication behavior +64_242 So that needs some thinking about, doesn't it? question communication behavior +64_244 As to what- question communication behavior +64_246 -what would work for you- question communication behavior +64_248 -as an alternative. question communication behavior +64_250 Yeah. other communication behavior +64_252 Yeah. Yeah. And there are things that have gotta work for you, so that- reflection communication behavior +64_254 -that's your ideas on there which are really important. But again there are some options, that if you wanted to look at, you know, just to at least be able to know what they are. question communication behavior +64_256 Because there are clubs and there are groups and there are all kinds of things that meet through the week. therapist_input communication behavior +64_258 And so, though they're not going to be necessarily like the party scene, they are other activities. Now I'm talking about gay groups and gay activities which are an option that- therapist_input communication behavior +64_260 "-you know, good to know about and-and-and maybe in-- within those options or something you might say, ""Oh yeah, I'd give that a go. Have a look.""" therapist_input communication behavior +65_1 Mm. other communication behavior +65_3 Mm-hmm. other communication behavior +65_5 Mm-hmm. other communication behavior +65_7 Mm-hmm. other communication behavior +65_9 Okay. So right now you're seeing that it's a part of your life. It's been a part of your life off and on for 18 years. reflection communication behavior +65_11 It's become a more important part of your life because you found yourself smoking at times that you thought I'll never smoke then. reflection communication behavior +65_13 Yeah. And your worry is that if you stop, you will end up gaining weight. So I'm hearing this kind of list of things that don't feel so positive about stopping. reflection communication behavior +65_15 I'm wondering what else might be on that list. question communication behavior +65_17 Mm. other communication behavior +65_19 Mm-hmm. other communication behavior +65_21 Mm-hmm. Okay. Yeah. So added to the other list is the having to go through the withdrawal- reflection communication behavior +65_23 -the unpleasantness of that. Okay. What else might be on the, not so good side about smoking- about stopping? question communication behavior +65_25 Mm-hmm. other communication behavior +65_27 Mm-hmm. other communication behavior +65_29 Mm-hmm. other communication behavior +65_31 Mm-hmm. other communication behavior +65_33 Mm. other communication behavior +66_0 Hi, Mr. Stowe. other communication behavior +66_2 How are you doing today? I'm Bruce Berger. question communication behavior +66_4 I, uh, I'm a case manager with your health plan. I understand that you came in today to talk about your diabetes. reflection communication behavior +66_6 So you just- you just saw the doctor and, uh, you know, you sound like you just got blindsided, uh, with, uh, not only how, how frightening this seems that you have diabetes and that, uh, she-- you say she told you a whole lot of things that can happen with your eyes and circulation and all those kinds of things. reflection communication behavior +66_8 And so you're really kind of reeling right now from, uh, all of that. And you sound a little bit pretty, pretty scared actually. reflection communication behavior +66_10 So it sounds like- other communication behavior +66_12 So it sounds a lot like, uh, on top of the fact that you've got something you're really scared about having consequences in terms of everything that can happen, what worries you also is all the different things that she told you you're going to need to do to get it under control. Can't imagine doing all those things, so you almost feel like all that bad stuff's gonna happen. reflection communication behavior +66_14 Okay. And I-- And what I want to do is help you kind of break this up into some-some doable chunks so that we can get your blood sugar down. I, you know, on the one hand, your doctor is right, you know. Your blood sugar is very high and we do wanna get it down so that we don't have those consequences happen. Uh, and-and there are a number of things that you need to do in order to-to get your blood sugar down. Um, you know, on the other hand, we can take this a step at a time, so it's not so overwhelming. therapist_input communication behavior +66_15 And I'd like you to be able to tell me what kinds of things that you can do right now. You know, for example, there- there's basically three things that need to be worked out with diabetes. Taking your medicine as prescribed. And honestly, if I was gonna work on one thing right away, given that everything seems so overwhelming would probably that-that first, because that'll have the biggest impact. How-how does that sound so far? therapist_input communication behavior +66_17 So that's easy to do. reflection communication behavior +66_19 Yeah. 'Cause it looks like you need to just take your medicine, uh, uh, once a day from-from the prescription. So that sounds doable right now. therapist_input communication behavior +66_21 Okay. The other things that need to be worked on over time certainly would be changing your eating habits, you know, to eat- eat healthier, uh, not necessarily less, but healthier. And the other thing would be getting, um, some more physical activity. And by the way, that doesn't mean going to a gym. That means things like more walking, maybe using stairs instead of an elevator or an escalator, stuff like that. Uh. therapist_input communication behavior +66_23 Yeah. And that really is to give you feedback about how those other things are doing so that it keeps you on task. therapist_input communication behavior +66_25 So it helps you know that when you're taking your medicine, when you're changing your eating habits, that it's really having an impact on your blood sugar 'cause getting your blood sugar down is going to keep you from having all of those other problems. How does all this-- where does this leave you now right now in terms of how you're feeling? therapist_input communication behavior +66_27 Okay. other communication behavior +66_29 It sounds like you're very committed to that. reflection communication behavior +67_0 Is it okay if we go over the form you had filled out? We give this out to everybody who comes in. question communication behavior +67_2 All right. So here, it looks like you wrote that you drank alcohol on a few occasions in the last year, and you have used marijuana more often, 30 days in last year. therapist_input communication behavior +67_4 Okay. When students and I talk about their substance use, the first thing I always say, I don't like to tell anyone what to do. That's not my job. Instead, I like to see if there's anything they would like to do, if anything, about their use. So what can you tell me about your marijuana use? question communication behavior +67_6 Okay. How often? question communication behavior +67_8 Do you vape anything else besides marijuana? question communication behavior +67_10 Okay. Is it okay if I share some information with you? question communication behavior +67_12 We know marijuana has effects on the developing brain. For example, it can make it harder for you to concentrate, it can make it harder for you to remember things, and vaping can seriously hurt your lungs. About one in six people who begin using marijuana as a teenager, later on, become addicted. So what do you think about all this information that I've shared? therapist_input communication behavior +67_14 How do you think it affects you? question communication behavior +67_16 Is there anything about marijuana that worries you, many things that you don't like? question communication behavior +67_18 How could you get in trouble at school? question communication behavior +67_20 So staying in school and playing on the basketball team is important to you? question communication behavior +67_22 So when you think about these things, are there any things you would like to change about your marijuana use? question communication behavior +67_24 What would be the benefits of that? question communication behavior +67_26 Marijuana affects how well you play. What would be the other benefits for you? question communication behavior +67_28 Okay. Well, it sounds like you have a goal of not using marijuana once basketball starts. How long do you think you could not use? therapist_input communication behavior +67_30 Okay. If I asked you to pick a number, 0 through 10, 0 meaning you're not very confident at all in meeting your goal, or 10 meaning you're very confident, what number would you pick? therapist_input communication behavior +67_32 A seven. Why do you think you picked that instead of a lower number like five? therapist_input communication behavior +67_34 So, what steps could you take to help you stop using for a month? therapist_input communication behavior +67_36 How about this question? What might happen within a month that might make you want to vape? question communication behavior +67_38 What else could you do instead of vaping when you feel that way? question communication behavior +67_40 Anything else? question communication behavior +67_42 Playing basketball and playing video games are a way to feel better. reflection communication behavior +67_44 Well, I'm glad to hear that you have a goal of quitting for a month and you are confident of reaching that goal. If you're willing to come back in a month or so, I would be curious to hear how your plan works out. therapist_input communication behavior +67_46 Well, Good luck with basketball practice. If you want anything or need to talk about something before our next appointment, I'm here Monday through Thursday, and it's always good to see you. other communication behavior +68_0 Hi, Andrea, thanks for coming in. other communication behavior +68_2 So I don't know how much you know already about sort of my role here and why you're even here. So I thought I'd start by telling you a little bit about myself. other communication behavior +68_4 Basically, my job is to meet with all of the students. I meet with everybody about once or twice a semester and just talk with you a little bit about how things are going, different behaviors that you might be engaging in, and thinking about any changes you might wanna make for your life if you decide that you do. It's not my job to change you. I couldn't even if I wanted to. That's not my role at all. It's really to help you think about, you know, how things are going for you and how you might like making changes or moving forward. therapist_input communication behavior +68_6 Does that sound okay? question communication behavior +68_8 All right. So why don't we start by you telling me a little bit about yourself? question communication behavior +68_10 Oh, neat. other communication behavior +68_12 Wow. You really are involved in music. reflection communication behavior +68_14 When did you start? question communication behavior +68_16 Wow. other communication behavior +68_18 Very cool. I've always wanted to be good at music. [laughter] All right. So it sounds like you're in band and a-a few other musical ensembles, any other hobbies you have or things you like to do for fun? question communication behavior +68_20 Mm-hmm. other communication behavior +68_22 Just kind of everyday sort of stuff? question communication behavior +68_24 Okay. Tell me a little bit about your family. question communication behavior +68_26 Cute. What kind of dog? question communication behavior +68_28 Oh, nice. Okay. other communication behavior +68_30 [laughs] Very fun. All right. And how are things going in school for you? question communication behavior +68_32 Okay, great, so you're doing well. What sorts of goals do you have for after college- oh, after high school? question communication behavior +68_34 Oh, all right. other communication behavior +68_36 Okay, you have some pretty big dreams. reflection communication behavior +68_38 That's great. That's really exciting to think about that- other communication behavior +68_40 -and sort of be looking forward to the future and those things. All right. Well, one thing I'm going to ask you about is, um, you know, different people have sort of different things that they really value in their life. Whether it's, you know, their cultural identity or their family or their friends or job or hobbies, things like that. So here's the little sheet that goes through just some basic values that, um, might be more or less important to certain people. therapist_input communication behavior +68_42 Like belonging or sense of community. Again, cultural identity or family, friendship, modesty, religion, respect, self-determination and spirituality. So, when you think about yourself, which of these are kind of most important to you in terms of your life? therapist_input communication behavior +68_44 Okay. other communication behavior +68_46 Respect, okay. Can you tell me a little bit about why you picked those three? question communication behavior +68_48 Mm-hmm. other communication behavior +68_50 Mm-hmm. other communication behavior +68_52 Okay. other communication behavior +68_54 Okay, great. So sort of being a part of a group and being a part of a team gives you a sense of, um, uh, belonging, like you said. reflection communication behavior +68_56 And sort of a-a sense of purpose in a way. reflection communication behavior +68_58 And then the respect is really sort of all-encompassing. reflection communication behavior +68_60 Not just authority, but respecting yourself, respecting your teammates or your bandmates and other people around you. Okay, that's great. reflection communication behavior +68_62 All right. Well, um, one of the things I wanted to talk to you about sort of relates to belonging and your friends. So what kinds of things do you like to do when you get together with your friends? question communication behavior +68_64 Mm-hmm, and when you're hanging out with friends, is there ever alcohol involved? question communication behavior +68_66 Okay. Can you tell me a little bit about how alcohol fits into sort of your social scene? question communication behavior +68_68 Mm-hmm, mm-hmm. And so when you go to parties, most of the time there's alcohol there? question communication behavior +68_70 Okay. And how often do you think you would say you're drinking? question communication behavior +68_72 Mm-hmm. So about half the time you're drinking and half the time you're not. Can you tell me what's different about the days when you choose to drink versus not to drink? question communication behavior +68_74 So it really depends on what the activity is, whether or not alcohol is gonna be there? question communication behavior +68_76 Okay. And do you notice a big difference or can you tell me about the difference in your enjoyment level at say a party versus a night you're playing board games? question communication behavior +68_78 Mm-hmm. other communication behavior +68_80 Uh-huh. other communication behavior +68_82 Mm-hmm. other communication behavior +68_84 Okay. So there's sort of pros and cons on both sides? question communication behavior +68_86 Okay. What are the things that you like about drinking or like about alcohol? question communication behavior +68_88 Mm-hmm. other communication behavior +68_90 Okay. So sort of in the-the too much drinking or-or at times, can you tell me some of the less good things or not so good things about alcohol? question communication behavior +68_92 Mm-hmm. other communication behavior +68_94 Mm-hmm. other communication behavior +68_96 Mm-hmm. So you're trying to, like you said, not engage in really dangerous activities? question communication behavior +68_98 You're trying to stay put, you're not driving. You're trying to stay with people that you trust. Um, but yet it sounds like there's still some-some things happening from time to time. reflection communication behavior +68_100 Can you tell me a little bit about that? question communication behavior +68_102 Yeah. Throwing up is never fun. reflection communication behavior +68_104 And how often do you think that happens? question communication behavior +68_106 Mm-hmm. other communication behavior +68_108 Mm-hmm. other communication behavior +68_110 Okay. other communication behavior +68_112 Uh-huh. Okay. So, on the one side, some of the fun things associated with alcohol are people are just more relaxed, sorta, um, carefree can kind of let loose a little bit more, on-on the other hand, there's a little bit more, I guess, planning involved- reflection communication behavior +68_114 -because you have to make sure that you're doing it safely or as safe as you can. And then, um, there can be some other consequences like throwing up or even if it's not you, that sometimes you're stuck your-your fun is sort of ruined when you're stuck dealing with a friend who drunk too much. Okay. And the other not so good things about the alcohol? reflection communication behavior +68_116 Mm-hmm. other communication behavior +68_118 So you're kind of stuck being exposed to things you don't need to see. reflection communication behavior +68_120 Got it. Okay. Um, all right. Well, you mentioned a couple of times that you've made a few decisions to try and limit the dangerous aspect of the drinking. Why did you make those decisions? question communication behavior +68_122 Mm-hmm. other communication behavior +68_124 Mm-hmm. other communication behavior +68_126 Okay. Yeah, it sounds kinda similar to your, um, your value of respect to yourself. reflection communication behavior +68_128 On the one hand, you- the drinking maybe helps with the belonging community to start. reflection communication behavior +68_130 If there's too much, then it sort of— reflection communication behavior +68_132 Right. And then with the respect, one of the things you mentioned, is really wanting to respect yourself and not sort of cross boundaries, not sort of cross lines. reflection communication behavior +68_134 Um, how do you think that the drinking fits in with that? question communication behavior +68_136 Mm-hmm. other communication behavior +68_138 Okay. other communication behavior +68_140 Mm-hmm. other communication behavior +68_142 Mm-hmm. other communication behavior +68_144 Mm-hmm. other communication behavior +68_146 Okay. So you're sort of looking for that balance- reflection communication behavior +68_148 -of how much you can drink to have some of the positive benefits but not cross over. reflection communication behavior +68_149 Okay. And what have you come up with at this point? Do you have sort of a-a limit that you stick to or are you--? question communication behavior +68_151 Mm-hmm. Okay. And do you feel that that's working pretty well for you or do you sometimes exceed that limit or-or what do you think? question communication behavior +68_153 Okay. other communication behavior +68_155 So, uh, uh, a portion of the time it's working well for you and another portion of the time maybe you would like- reflection communication behavior +68_157 -would like to make some adjustments- reflection communication behavior +68_159 -to-to make it a little smoother. Okay. So, kind of thinking along those lines, how important is it to you make some changes or make some adjustments to your drinking to sort of fit with your values and your goals for yourself? question communication behavior +68_161 Okay. other communication behavior +68_163 Right. other communication behavior +68_165 Mm-hmm. other communication behavior +68_167 Uh-huh. So kind of combining you alls- reflection communication behavior +68_169 -goals. Okay. So, you-you have a goal it sounds like, of actually cutting back on your drinking. How important is it to you to work on that goal and on a scale of one to ten, where one is not at all important and ten is it's the most important thing right now? question communication behavior +68_171 Oh, okay. other communication behavior +68_173 Uh-huh. Why do you say six or seven rather than like a four? question communication behavior +68_175 Uh-huh. other communication behavior +68_177 Yeah, looking ahead, you can't keep drinking this way and reach the goals that you have for yourself. reflection communication behavior +68_179 Okay. Well, how confident are you that you could cut down if you wanted to- question communication behavior +68_181 -on that same scale from one to ten? question communication behavior +68_183 Oh, wow. Okay. Why do you say 10? question communication behavior +68_185 Okay. And so you mentioned the- you know, quite a few reasons why you would like to cut down. Um, have you thought at all about how you might go about doing that? question communication behavior +68_187 So sort of, um, trying to plan more activities that don't involve alcohol- reflection communication behavior +68_189 -and then also trying to participate in activities without drinking yourself or maybe even drinking less than you're drinking. reflection communication behavior +68_191 Okay. Does that sound like a goal you want to work on now or? question communication behavior +68_193 Okay. Um, so I guess we'll talk about, um, less alcohol activities. I'm just making some notes to myself and then maybe, um, reducing the amount of drinking that you're doing if alcohol is involved. Okay. Um, so that-that goal sounds feasible, you said? Would it be okay if we met in a couple of weeks to sort of see how it's going? therapist_input communication behavior +68_195 Does that sound like something you'd like to do? question communication behavior +68_197 Okay. Well, I really appreciate you spending the time talking to me, you know, it sounds like you have a lot of really good goals for yourself, really ambitious goals of going to medical school and, you know, becoming a psychiatrist or, um, some-some other form of physician. Um, you're really looking forward to doing well in school so you can get there. reflection communication behavior +68_198 And it sounds like you have a pretty active social life and a-a lot of friends who you feel probably would be, uh, supportive, even if you cut down on alcohol and that, you know, there's a lot of benefits you see both to your body and your health, um, your school performance, and even some of the social stuff in terms of feeling a sense of belonging without having to deal with some of the gross consequences of-of, um, drinking too much. reflection communication behavior +68_199 Um, so yeah, you know, it really sounds to me like you have a good plan in place and as long as you're willing and-and interested in meeting again, I'd be very excited to be able to talk with you about how it's going. reflection communication behavior +68_201 All right. Great. So I'll-I'll plan to see you then in a few more weeks. other communication behavior +68_203 Great. other communication behavior +70_0 Hi, Dr. Martin. I'm Lori. I'm the pharmacist on duty here today. I understand that you have some questions about the medication citalopram. Do you have a minute to talk about that? question communication behavior +70_2 All right. Well, do you have any specific questions? question communication behavior +70_4 Okay. Well, citalopram is an SSRI medication. Its indication is for depression and it's typically dosed as a 20-milligram tablet but it is available as 10, 20, and 40 milligrams. Any patients started on this medication should be monitored for improvement in symptoms in four to eight weeks. therapist_input communication behavior +70_6 If there are some side effects to this, it can include GI effects, sedation, or sexual dysfunction. But if you have a patient that suffers from any of those things, you can try either decreasing the dose or changing them to a different agent. Do you have any other questions? therapist_input communication behavior +70_8 Oh, that I'm not sure of. Um, can I get back to you later on this afternoon with that answer? question communication behavior +70_10 Fantastic. Thank you. other communication behavior +71_0 So, you've got this dream by the sounds of it, which is, you know, to have a partner, and a house, and a nice car- reflection communication behavior +71_2 -so don't forget the nice car, and some kids, and be a- be a good dad- reflection communication behavior +71_4 -to your kids. So, is this dream starting to-- I am getting a picture of? question communication behavior +71_6 Yeah. Okay. So, what I'm really interested in is how offending fits in with that picture, that dream. question communication behavior +71_8 Yeah, how doesn't it fit, Billy? question communication behavior +71_10 Yeah? question communication behavior +71_12 Yeah. It kinda messes up that dream, that picture? question communication behavior +71_14 Mm. Makes it harder? Yeah. Well, it can make it harder to keep a job, aye? question communication behavior +71_16 And harder to— reflection communication behavior +71_18 Yeah. other communication behavior +71_20 And we've talked about that idea of you getting a job and something to do with cars 'cause that's where your passion is. reflection communication behavior +71_22 Yeah? So, what have you been thinking, um, since we last met, about what you might do about getting that kind of job? question communication behavior +71_24 Mm-hmm. other communication behavior +71_26 Okay, so you know some people? question communication behavior +71_28 You've gone down that road of kind of going back to school in some ways and getting a tryout or- reflection communication behavior +71_30 -getting a qualification? question communication behavior +71_32 Yeah? So, what-what would interest you about going down that same, sort of, path? question communication behavior +71_34 Mm-hmm. Yeah, so what in particular? Like, if you could have whatever you wanted, in terms of that sort of work, what would you do? question communication behavior +71_36 Mm-hmm. So, as long as it has to do with cars, you'd be sweet with that? reflection communication behavior +71_38 Yeah? question communication behavior +71_40 Okay. So-so what sort of things do you think you need to do to go down that path to get that qualification? question communication behavior +71_42 Mm-hmm. other communication behavior +71_44 Okay. So, what sort of training did you-- did these people, that you've been talking about, what did they do? question communication behavior +71_46 Mm-hmm. other communication behavior +71_48 Mm-hmm. other communication behavior +71_50 Yeah. So, how confident are you that you could do something similar to these-these friends that you've got? question communication behavior +71_52 Okay. So, it would be pretty easy. So, if it's pretty easy, what do you need to do next, Billy? question communication behavior +71_54 Okay. So, you actually went to the polytech— reflection communication behavior +71_56 -and picked up some forms? question communication behavior +71_58 Wow. other communication behavior +71_60 That's fantastic, Billy. other communication behavior +71_64 Tell me- tell me what happened when you say they-- like it didn't help you? What-what-what happened? question communication behavior +71_66 Yeah. other communication behavior +71_68 Okay. So, they gave you a horde of forms for a particular course? other communication behavior +71_70 Mm. other communication behavior +71_72 Yeah. other communication behavior +71_74 Okay. So, you got the forms, took them- took them home? question communication behavior +71_76 Mm-hmm. You said the forms were confusing? question communication behavior +71_78 Yeah? What-what's the confusing bit? question communication behavior +71_80 Yeah. So, when you've had to write things or fill out forms before, how-how's that been for you? question communication behavior +71_82 You don't like writing? question communication behavior +71_84 Yeah. So, wondering what that's about, about not actually liking writing. question communication behavior +71_86 People can't read-- People can't read your handwriting? question communication behavior +71_88 Oh, you must be a doctor. other communication behavior +71_90 Yeah? [chuckles] Yeah? other communication behavior +71_92 Okay. So, you need some help to fill out the forms? question communication behavior +71_94 Mm. other communication behavior +71_96 Okay. All right, so what-what do you need to do, Billy, to actually get to that point where you can fill out a form and post it off? question communication behavior +71_98 Okay, so you feel like it would be embarrassing to ask Donna to give you some help- reflection communication behavior +71_100 -because you feel that she might find out something about you that you're not quite sure you want her to find out? question communication behavior +71_102 Okay. other communication behavior +71_104 Hmm. So, who else could you ask to help you? question communication behavior +71_106 Well, have you got the forms with you? question communication behavior +71_108 Okay. I'm wondering about-- because it sounds like this whole idea about filling out the forms, is getting in the way of this bigger dream that you've got which is around getting a qualification around something to do with cars- reflection communication behavior +71_110 -and getting on this road where you're staying out of trouble because you've got this, um, interest- reflection communication behavior +71_112 -which you can do. So, it seems a real shame that the forms are gonna get in the way, so we need to find a way around the forms. other communication behavior +71_114 Yeah? So, what do you think, between now and next week, you can do around the forms? question communication behavior +71_116 She'd probably help you, but you don't really want to. It sounds like you're a bit embarrassed. reflection communication behavior +71_118 Mm. other communication behavior +71_120 So, the whole thing about going back to poly-- going back to school- reflection communication behavior +71_122 -going back to polytech is-- would-would require a really big change in the way which you're currently living, and you're not quite sure if you can do that. reflection communication behavior +71_124 Yeah. So, there's something here about your level of-- about how confident you are around writing or how unconfident you are, that sounds like it's getting in the way. reflection communication behavior +71_126 Mm. Okay. other communication behavior +71_128 All right. So, it sounds like we might need to have some more conversation around that. therapist_input communication behavior +71_130 So, what's really getting in the way? question communication behavior +71_132 Well, this writing business. What's really getting in the way? question communication behavior +71_134 Well, I'm wondering, like-- it sounds like it's a thing that you're putting up as saying you can't do- reflection communication behavior +71_136 -so I'm wondering where you are around your writing and you're reading? question communication behavior +71_138 Mm. other communication behavior +71_140 Yeah. Well, I have to say, I think it's really obvious that you're not retarded. other communication behavior +71_142 [chuckles] other communication behavior +71_144 Yeah, we are having a really good conversation here. other communication behavior +71_146 So, reading and writing is not a strong point for you. reflection communication behavior +71_148 Mm. other communication behavior +71_150 So, how much reading and writing is involved in the course that you're gonna go on? question communication behavior +71_152 So, what'd it be like if you were more confident in your reading and writing? What'd that be like? other communication behavior +71_154 Mm. other communication behavior +71_156 Mm-hmm. other communication behavior +71_158 Yeah. other communication behavior +71_160 And, I guess that there will be manuals and stuff like that on- other communication behavior +71_162 -your course that, you know, to-- the hands-on stuff, it sounds like you're really confident around doing, but it's the more reading, writing, book, kind of, stuff that you are not so-- reflection communication behavior +71_164 Mm. other communication behavior +71_166 Mm. Okay. So- so like before you get to here where you got this dream and there's some things that need to happen before that. reflection communication behavior +71_168 Yeah. So, mm, we need to think about what's the very first step. therapist_input communication behavior +73_1 So with his encouragement, you-you tried some drugs. reflection communication behavior +73_3 You tried oxy? Okay. reflection communication behavior +73_5 Okay. And he encouraged you to do that. reflection communication behavior +73_7 He said that it would help you with some of the pain that you've been having. reflection communication behavior +73_9 Yeah. other communication behavior +73_11 Okay. So you trusted him on that, and you tried it out and you found that it helped you in certain ways. What are some of the things that you said it's-- takes some of the pain away, it's not just-- you know. reflection communication behavior +73_13 Okay, so that's helped you. reflection communication behavior +73_15 Mm-hmm. So it help— reflection communication behavior +73_17 Okay. So it's not something you wanna rely on, you don't see yourself continuing to use this. It's something that you'v found at least for the moment very helpful? reflection communication behavior +73_19 But it's not something that you wanna make a habit of becoming reliant on, or dependent? reflection communication behavior +73_21 Yeah, okay. Um, and-and so that's a lot going on right now for you? Yeah. reflection communication behavior +73_23 You've been managing in the best way you can. You also have some doubts about it too, it sounds like? reflection communication behavior +73_25 Okay, so for now you know that it makes you feel good. reflection communication behavior +76_1 Hi, Deborah. How are you doing today? question communication behavior +76_3 Yes, um, so you did do your Values Clarification Sheet. Is there anything that you'd like to talk about that you discovered? question communication behavior +76_5 Oh, so it's your first? question communication behavior +76_7 Mm-hmm. other communication behavior +76_9 So, health being your number one, um, which is kind of pushing you into this new direction, as far as you being a prior officer worker? You're doing something that you're actually living to do. reflection communication behavior +76_11 Now, have you done this sheet more than once? question communication behavior +76_13 And then, has health always been number one for you? question communication behavior +76_15 Inner harmony is number two? question communication behavior +76_17 Mm-hmm. other communication behavior +76_19 So, would you like to express more on the inner harmony part of how that affects your life? question communication behavior +76_21 Mm-hmm. other communication behavior +76_23 So, yoga, is that based on the number two, like inner harmony? That's where that comes from? question communication behavior +76_25 Mm-hmm. other communication behavior +76_27 Yes, yes, yes. So, basically, reflecting on how you felt before about you were coming second, third, and fourth. Um, it was- it was really a problem, you know, like, how could you be so, you know, selfish, and think about yourself when- reflection communication behavior +76_29 -the reality is inner peace and inner harmony is based around, you know, self-self worth, and you know, self-- and-and dealing with- reflection communication behavior +77_0 Hi, Mrs. Smith. It's really nice to see you again. I see you're back to follow up on the stroke you had. How are things going for you at the rehab facility? question communication behavior +77_2 Kind of slow? question communication behavior +77_4 What kind of things have you been in your rehab? question communication behavior +77_6 It hurts? Oh, I'm sorry to hear that. Where are you having pain? question communication behavior +77_8 Well, you know, I-I understand that pain is hard to work through but a lot of time when you're having rehab after a stroke, that pain is telling you that your muscles and joints are starting to work again. So you can kind of think of it as a positive way to, you know, know that your-your body's getting back to normal. therapist_input communication behavior +77_10 But what are your goals for the long term? question communication behavior +77_12 Oh, of course, of course. And what are the things that you'd like to be able to do once you get home? question communication behavior +77_14 Yeah, yeah. And so that's a very important goal to be able to get back home, to be able to get back to your independence. Have you thought about what it might take to get there? question communication behavior +77_16 Mm-hmm. Yeah, you're absolutely right. And it's also going to be very important that once you're home, you're able to continue on a regular activity program. Have you thought about what that might look like? question communication behavior +77_18 Not really, okay. Well, have you ever heard of something called Tai Chi? Is that a familiar term to you? question communication behavior +77_20 You've heard of it? question communication behavior +77_22 Okay. other communication behavior +77_24 Well, you know, Tai Chi is one of the best ways to get your balance back after you've had something like a stroke. And it's also really good for preventing falls. And if you wanna be home and you wanna be doing the things you wanna do and going for walks with your dog, it's very important to make sure that you don't fall 'cause that would cause more problems down the road. therapist_input communication behavior +77_26 So what do you think about Tai Chi? Is that something you think you might be able to try sometime? question communication behavior +77_28 Mm-hmm. other communication behavior +77_30 Yeah, yeah, yeah. Well, it's not that easy to get started. You do certainly have to have some motivation to want to do it. Um, and when you first start, oftentimes you do feel a little wobbly or a little insecure. therapist_input communication behavior +77_32 Yeah, yeah, I understand. So there are lots of places around that have it. Your local senior center would have it. And what I recommend is that you start by doing it in a chair. Just sitting in the chair. therapist_input communication behavior +77_34 You could. You can talk to the instructor and that way you won't fall, you'll feel confident and you'll start to learn some of the moves. And then gradually over time, as you get a little bit better at doing the moves in a chair, you can start to stand up, use the chair to lean on, and then eventually, you'll be able to get to the point where you can do it on your own. therapist_input communication behavior +77_36 You know, it cuts your risk of falls in half. It also helps to reduce pain although that's not a short-term benefit, you do have to stick with it for at least three to six months to start have it help reduce your pain. But it does have a number of things that I think would get you to your goals of being home and able to play with your dog and doing your own cooking and things like that. therapist_input communication behavior +77_38 I do Tai Chi. I do it three days a week and it's really helped my balance as well. therapist_input communication behavior +77_40 All right. Well, I'm delighted. It's a pleasure to see you again. I hope your rehab continues to go well and we can talk some more about this at our next visit. other communication behavior +77_42 All right. Thank you for coming in. other communication behavior +78_0 Hi. Are you Julie Thompson? question communication behavior +78_2 Hi, I'm Bruce Berger. I work in the clinic and, uh, I noticed that you're in to pick up a prescription for Sarah's, uh, rescue inhaler- therapist_input communication behavior +78_4 -for her asthma. I noticed that she's been in the emergency room five times in the last year for her asthma. What's that- what's that been like for you? question communication behavior +78_6 Yeah, it sounds like you'd be willing to do whatever you can to try to prevent that from happening. reflection communication behavior +78_8 Okay. I-I also noticed that, uh, it's been about three months or so since you picked up the prescription for her chronic inhaler. therapist_input communication behavior +78_10 Are you having some difficulties with that? other communication behavior +78_12 Okay. other communication behavior +78_14 Well, it sounds like you care about Sarah a great deal. You-you don't want her, uh, using steroids. You're worried about what kind of effects those would have on her and you're- you're working hard to keep your smoking away from her so it doesn't affect her asthma. reflection communication behavior +78_16 Okay. Uh, would you mind if we talked a little bit about the chronic inhaler and the medicine that you're concerned about with, you know, the steroids because, you know, I certainly don't want her using a medicine that has steroids in it, like the ones that you're worried about for athletes. Uh, can we talk about that just a little bit? question communication behavior +78_18 Okay. Even though, uh, even though this medicine isn't the-the medicine that's in this is in the same broad family as the steroids you're worried about, and those are called anabolic steroids. therapist_input communication behavior +78_20 Which build people up and have masculinizing effects. therapist_input communication behavior +78_22 If-if I can draw an analogy-- Again, even though this medicine is in the same family as those big broad-broad family. If I could draw an analogy, a grape and a watermelon are in the same family of fruits, you know, and obviously, grape is much smaller than a watermelon. And if you eat one grape, you'd be fine. If you ate an entire watermelon, it can make you very sick. If we look at the grape as the medicine your daughter's taking, again, it's in the same broad family, the amount of drug that your daughter is getting is very small. Uh, and not only that it's not an anabolic steroid, even though it's in the same big family. And what this drug does is actually reduces the inflammation in your daughter's lungs. And-and it doesn't even get absorbed into the body. It only goes to her lungs. And as I said, I wouldn't want your daughter taking a medication that could have the impact of those anabolic steroids. This is really safe for your daughter to use. So what-what are your thoughts about considering having her using this? therapist_input communication behavior +78_24 Mm-hmm. other communication behavior +78_26 "Yeah, def-definitely would not. I mean, probably you saw the name corticosteroid and thought, ""uh-oh.""" therapist_input communication behavior +78_28 You know. And so-- yeah, and that- and that does concern people. But I do want to reassure you that this is medication that only goes to her lungs, and won't get in her body and they're not the same kind of drugs as the ones you're worried about. therapist_input communication behavior +78_30 Do you mind if I talk to you a little bit about what your daughter's lungs are like when she's having these inflammations and needing to go to the emergency room? question communication behavior +78_32 Okay. When-when somebody has asthma, their lungs are like hypersensitive. If I could use an analogy, again, if-if you had the skin burnt off your arm, if somebody brushed up against you before he had the skin burned off your arm, it wouldn't bother you at all. But when the skin's burned off your arm, you literally react to it. Her lungs are exquisitely sensitive. Uh, and like the skin on your arm would be if the skin got burned off. And what this drug can do? This chronic inhaler is reduce the inflammation in her lungs so that her lungs don't remain exquisitely sensitive. Because otherwise, everything in the air like dust, pollen, uh, reacts with her, uh, in ways that it would not normally affect us. therapist_input communication behavior +78_34 And so this chronic inhaler can really prevent that from happening. Okay? Which is why it's so important to use it. therapist_input communication behavior +78_36 The other thing I was going to tell you is that, unfortunately, uh, even though you are smoking outside and keeping the smoke away from her, the smoke on your clothes, because her lungs are so sensitive, can also affect her lungs and cause her to have a reaction. Now, something I'd like you to think about is that, if you use the chronic inhaler every day, she may not be sensitive to the smoke on your clothes, but she still maybe because her lungs are just very different than ours. Um, honestly, I'd love to see you quit smoking for you too because, you know, as you know, it's not real good for you. therapist_input communication behavior +78_38 Uh, and it would certainly help her. Um, but what I'd like you to do is to, kind of, keep an eye on what happens when she uses the chronic inhaler. And if she's still flaring up when you're around her, if there are any, if there is smoke on your clothes because it-it can flare her up. therapist_input communication behavior +78_40 Yeah. Yeah. therapist_input communication behavior +78_42 It-it-it-- Yeah. It may not- it may not when she uses the chronic inhaler, uh, but you'll need to keep an eye on that. Obviously, it would be- what would be best if it didn't get on your clothes, or you quit smoking. therapist_input communication behavior +78_44 Mm-hmm. other communication behavior +78_46 Very hard. It's very relaxing, and- reflection communication behavior +78_48 And-and it's hard to replace it with something. therapist_input communication behavior +78_50 So, uh, any thoughts on what you may be able to do to-to help at this point, if you don't choose to quit right away? question communication behavior +78_52 Oh, that-that sounds like it would be great if you were able to do that. Obviously, don't smoke in the house, you know- you know. therapist_input communication behavior +78_54 Um, so yeah. If you're willing to do that, that certainly would help. therapist_input communication behavior +78_56 Uh, again, if you get to the point sometime down the road where you're willing to quit for both you and her, uh, we'd be glad to help you do that. Because you're right it is- it's not an easy thing to do. therapist_input communication behavior +78_58 Okay. other communication behavior +78_60 So it sounds like right now where we are, is you're willing to-to have her use the chronic inhaler- reflection communication behavior +78_62 -to try to get the inflammation down, so she doesn't need to go to the emergency room and do whatever you can at this point to keep the smoke off your clothes. And I think you're gonna see big changes in terms of, uh, her not needing to go to the emergency room, and you probably won't need to use the rescue inhaler hardly at all. therapist_input communication behavior +78_64 Yeah, because you'll get that inflammation down. therapist_input communication behavior +78_66 Okay. other communication behavior +78_68 Yeah. So we'll go ahead and get both of those prescriptions ready. therapist_input communication behavior +78_70 Use the chronic inhaler every day, keep the rescue inhaler around if she needs it. Uh, and let's see how that works. therapist_input communication behavior +78_72 Okay? question communication behavior +78_74 All right. Good. other communication behavior +79_1 How did you know you messed up? question communication behavior +79_3 Was it that something happened, um, where you put something that was really important to you at risk? Is that what that was about, um, when you say you felt guilty, uh, you felt bad talking to Erin on the phone? reflection communication behavior +79_5 So you saw yourself putting something that was important to you at risk. reflection communication behavior +79_7 Here you are actually, three months on, three long months as you say, um, and things have been going really well, Uh, you even get a bit of— reflection communication behavior +79_9 Yeah. Well, and then you get the kind of, I don't know if it felt like a green light or a yellow, it went from red to cautionary, you could see your kids, and that was something that was really what you were working for. reflection communication behavior +80_0 Jean, it's good to see you again. other communication behavior +80_2 So, what's been different since the last time we talked a week ago? question communication behavior +80_4 Okay. other communication behavior +80_6 Mm. other communication behavior +80_8 Sure. other communication behavior +80_10 Sure. other communication behavior +80_12 So, you've been able to cut down by two or three cigarettes? That's amazing. I mean, given how much you were smoking. reflection communication behavior +80_14 So, you were able to keep the, uh, the journal? question communication behavior +80_16 You-- Sounds like you did that, and that allowed you to really focus on the time [unintelligible 00:00:57] delaying your cigarettes. So-so that's gone well. So, what are the things that are not going as well as you'd liked? therapist_input communication behavior +80_18 Right. other communication behavior +80_20 Yeah. other communication behavior +80_22 Okay. So, these automatic cigarettes, when you're socializing and you're-- you have time on your hands, really, are the problems that you're facing- reflection communication behavior +80_24 -uh, and that you've noticed are more difficult than the others? question communication behavior +80_26 In marking it down, okay. reflection communication behavior +80_28 Okay. So, and you've thought about already, what you might do, such as getting a hobby. Any other thoughts of what you might do to help you overcome this? question communication behavior +80_30 Okay. other communication behavior +80_32 Right. other communication behavior +80_34 Right. other communication behavior +80_36 Sure. other communication behavior +80_38 Okay. So, from now to the next time you come back and see me, what is it that you'd like to-to work on? therapist_input communication behavior +80_40 Okay, so you can continue with that. therapist_input communication behavior +80_42 Sure. other communication behavior +80_44 Okay. other communication behavior +80_46 You said five cigarettes this time. therapist_input communication behavior +80_48 And any thoughts about what concretely you could do to make that happen? question communication behavior +80_50 Right. other communication behavior +80_52 Right. [unintelligible 00:02:58] other communication behavior +80_54 Sure. other communication behavior +80_56 Sure. other communication behavior +80_58 So, given what you're-you're attempting to do, when would it be good for you to come back and talk about this? question communication behavior +80_60 Absolutely. Okay. other communication behavior +80_62 Good. So, we'll see you in a week. other communication behavior +81_0 Did you like how your parents raised you? question communication behavior +81_1 Tell me about how your parents raised you? question communication behavior +81_2 Tell me about how you've been feeling? question communication behavior +81_4 Mm, what's that like for you? question communication behavior +81_6 So you're feeling uncomfortable with changes in your body? reflection communication behavior +81_8 Mm. other communication behavior +81_10 Why do you think it makes you so hesitant to call? question communication behavior +81_12 What about it seems overwhelming? question communication behavior +81_14 Mm. So some of your feelings, uh, of being overwhelmed or about the logistics of the appointment, and some of it is you just don't like medical appointments and medical people? reflection communication behavior +81_16 How can I help you with these things? question communication behavior +81_18 Sure, we can do that together. other communication behavior +81_20 I can try. I can't guarantee because it depends on my schedule, but we can brainstorm about ideas on who can go with you to support you so you feel better about attending. therapist_input communication behavior +82_0 Would you like to answer some questions and kind of do a self-evaluation about how you're feeling around alcohol and the contraception? question communication behavior +82_2 Okay. So we're working on a 10 point of scale 1 to 10, 1 being not important, 10 being very important. One being not confident, one being very confident. So on a scale of 1 to 10, which number best reflects how important it is to you to drink the-- what risk limits? question communication behavior +82_4 You'd say an eight. Okay. And on a scale of 1 to 10, how confident are you at the present time that you can drink below risk levels? question communication behavior +82_6 Amount of four. reflection communication behavior +82_8 Okay. And so let's look at those two. You're-you're thinking it's pretty important, but your confidence is down here, uh, a four, but it's not a one. What makes you confident that you can drink below risk levels and you remember what those are? question communication behavior +82_10 Okay. So that gives you a good reason not to drink. Okay. Anything else? question communication behavior +82_12 So you have a support group that gives you the ability to have fun and still drink below risk levels? reflection communication behavior +82_14 Okay. Anything else? question communication behavior +82_16 Now let's look at your self-evaluation of your birth control. So now we're doing the risk of pregnancy and the use of birth control. So on a scale of 1 to 10, how important is it to you to use effective birth control every time you have sex to keep from getting pregnant? question communication behavior +82_18 An eight. Okay. And on a scale of 1 to 10, how confident are you at the present time that you- that you can use effective birth control? question communication behavior +82_20 Every time. therapist_input communication behavior +82_22 Correctly as it's prescribed. therapist_input communication behavior +82_24 Probably a six. Okay. So you're pretty confident that you can do it. And why are you a six and not a two or three? question communication behavior +82_26 Okay. So it's kind of linked to your drinking, the fact that, um, that you can-- if you can take care of that drinking, you can take care of the- reflection communication behavior +82_28 -birth control issue and this importance comes down as your reason why you're not down here. reflection communication behavior +82_30 Very good. So it looks like, um, you're using a good method of birth control, you're just not able to use it effectively. And you've linked it back here to the drinking. So would you like to develop a plan around your alcohol use at this-- today? question communication behavior +82_32 Yes. other communication behavior +82_34 Okay. And if you need more information, we can get that for you. therapist_input communication behavior +82_36 Okay. other communication behavior +83_0 Hello, Rick. Welcome. other communication behavior +83_2 Good to see you here. I see on your file that you're, uh, [unintelligible 00:01:18]. other communication behavior +83_4 What part of the [unintelligible 00:01:22] are you from? question communication behavior +83_6 Oh, okay. other communication behavior +83_8 Right down the bottom? Down Bluff? question communication behavior +83_10 Oh, are they? So you were born down there and- question communication behavior +83_12 -raised down there? question communication behavior +83_14 Country boy. Been up in Christchurch how long? question communication behavior +83_16 Oh, so you've been here a while? question communication behavior +83_18 Oh good. You got family out here? question communication behavior +83_20 Just your own whānau here. [unintelligible 00:01:51]. Well, Rick, I'm sort of, uh, interested in that, you know, you and I are gonna been doing some work together for a while. I'm sort of wondering what sort of thoughts you'd be having on your way here today. therapist_input communication behavior +83_22 Right. other communication behavior +83_24 Okay. I see you've had a bit of experience with, uh, coming to prevention services. therapist_input communication behavior +83_26 What's that been like for you in the past? question communication behavior +83_28 Right. other communication behavior +83_30 Okay. Similar sort of offending in the past that's brought you back again this time? question communication behavior +83_32 One of the, um, things that I've learned over the years, Rick, is that a lot of guys get to the doors out there and don't come inside and, um, you've come inside. What does that tell me about you? therapist_input communication behavior +83_34 Yeah. other communication behavior +83_36 So is that different from when you've come in here before? question communication behavior +83_38 Yeah. other communication behavior +83_40 Yeah. So they're really important to you? reflection communication behavior +83_42 Yeah. And do you have your kids with you full-time or- question communication behavior +83_44 Okay. And what's it like for you? question communication behavior +83_46 Mm-hmm. other communication behavior +83_48 What would you really like to happen in terms of, uh, you and your children? question communication behavior +83_50 Yeah. other communication behavior +83_52 Right. other communication behavior +83_54 So coming along to see me and you and I are doing some work together, then you're going on to do a program, how important is that gonna be for you and your children? question communication behavior +83_56 Mm-hmm. If I was to put it on a scale of say 1 to 100, 1 being not really important, 100 being really, really important, whereabouts on that scale would you you be? question communication behavior +83_58 Right. other communication behavior +83_60 Right. other communication behavior +83_62 Yeah. What do you think it'd be like for your kids if they were sitting here now and they heard you say that this was really, really important to you and to them? That you gave this program 100%. Well, then what might that be like for them to hear that? question communication behavior +83_64 Okay. other communication behavior +83_66 Good. Anybody else in your family that would be really proud of-- that you're taking these steps? question communication behavior +83_68 Yeah. Your is mum still down south? question communication behavior +83_70 Yeah. Does she know that you're here today? question communication behavior +83_72 So how might it be for her if she knew that you're talking like this today? That-- 'Cause it sounds to me like you're really serious this time making some changes. reflection communication behavior +83_74 Yeah. other communication behavior +83_76 So do you think doing this program and completing this program this time would be a good place to start? question communication behavior +83_78 Yeah. So you and I are going to be doing a little bit of work together then. And, um, and sometimes it-it can get quite tough. And I'm just wondering before we go any further, when the going gets tough, a lot of guys bail out. I'm just wondering are you one of those guys? question communication behavior +83_80 Right. other communication behavior +83_82 Good. One of the other things we're really conscious of with is, um, sometimes we do this work in isolation from others. And one of the things we want to ask people is about who they're going to be accountable to. I'm thinking like with your children, uh, your mom and other people that maybe you're interacting with. Who-who else in your life do you think would be supportive of you, and who would you need to let them know that you're actually going through this sort of program? therapist_input communication behavior +83_84 What was-- what was your partner's name? question communication behavior +83_86 Kristy. reflection communication behavior +83_88 Right. In terms of your employer, would they be supportive? question communication behavior +83_90 Okay. What do you think it might be like for you to explore that with them? question communication behavior +83_92 Any other family members that, uh, live close that, uh, you think would be supportive? question communication behavior +83_94 Okay. The reason why I'm asking this, Rick, is just, um, you know, part of, um, uh, being responsible is turning up and doing the program. therapist_input communication behavior +83_96 The other aspect of that is kind of like who we're going to be accountable to while we're doing the program. So one of the- one of the challenges, one of the riddle I'm going to put in front of you is like who else can we get involved to support you while you're going through this? therapist_input communication behavior +83_98 Okay. other communication behavior +83_100 Okay. So as we're gonna do this work together and go through this, uh, this program, one of the things we-we don't want to do is fall into the same trough we did last time. So I-I just want to leave that with you to think about next time we come together. There may be two or three other people that you think of that can be really supportive, that we-we need to let know that you're [unintelligible 00:10:50] each gonna make these changes and this time, you're serious about it. So let your mother and, uh, and, um, your partner, how might that happen? How does that sound to you? therapist_input communication behavior +83_102 Rick, I get a sense that you're kind of padding this walk a little bit on your own at the moment. Would that be true? reflection communication behavior +83_104 Your family is down south. I mean,who-who-who else do you think would be really interested in sup-supporting you, rowing with you if you like on this journey? question communication behavior +83_106 Okay. other communication behavior +83_108 Yeah. other communication behavior +83_110 Yeah. How would it be for your mum, do you think, if you were to tell her that this is something that you're-- is really important for you and that you know that this time you really need to do this for her and for the family? What-what might that be like for her to hear? question communication behavior +83_112 Yeah. All right. other communication behavior +83_114 Brothers and sisters, that, uh, would also be very supportive if you were to make this journey? question communication behavior +83_116 Good. So how would you go about getting them to support you, to come on board, and be accountable to doing this work together? question communication behavior +83_118 And, um, I’m just trying to imagine what do you think your mom would want to say to you if she was sitting here with us now and she heard you talking about this? question communication behavior +83_120 Mm. What do you think she might want for you, like upon her for your children? question communication behavior +83_122 I’m getting a strong sense that's what you want as well. reflection communication behavior +83_124 So, in terms of having the confidence to do this with the support of your whānau and ours, where do you think your confidence level might be now? question communication behavior +83_126 That's a huge move up the scale, isn't it? So getting your family on board, getting your whānau on board is going to be really important for us. reflection communication behavior +84_0 Hi Billy. How are you doing? question communication behavior +84_2 Yeah. Hey, it's good to see you here and good to see you here on time. Yeah, it's really good to see a good start to the-- to your probation time with us here is to see you being here on time. So how did you get here today? therapist_input communication behavior +84_4 Yeah, caught the bus to-to that-- to the stop outside the office? reflection communication behavior +84_6 Yeah, okay. So I'm noticing that this isn't the first time that you've been to see someone at probation and it's not your first, um, community sentence. So I was wondering when you're sitting on the bus thinking about coming here, what was- what was going through your head about being here? question communication behavior +84_8 "Just was feeling like, ""Ugh, it's gonna be a waste of my time coming here.""" reflection communication behavior +84_10 Mmh. So how come you thought it was going to be a waste of your time? What was it based on? question communication behavior +84_12 Yeah, didn't- didn't work out very well. reflection communication behavior +84_14 Okay. So you're hoping that it was gonna help you and it didn't. That was-- ended up feeling like a waste of your time. reflection communication behavior +84_16 Mm. So it sounds you're worried that it's gonna be a waste of your time this time too. reflection communication behavior +84_18 Mm, okay. So what sort of things do you think made it a waste of time last time? question communication behavior +84_20 Okay, the probation officer we're talking about here? reflection communication behavior +84_22 Mm. So it felt like she bossed you around, didn't really listen to you. reflection communication behavior +84_24 Okay, so actually having someone listen to you and hear about what you're saying is important to you? reflection communication behavior +84_26 Mm. So what's it gonna be like do you think working with me 'cause I'm also a female probation officer? Um, I'm wondering what-what's it gonna be like do you think? question communication behavior +84_28 Okay. other communication behavior +84_30 Yeah. other communication behavior +84_32 Okay, and all of those things are true. therapist_input communication behavior +84_34 You're right. I don't know what it's like to be you and what I'm getting a sense of is that it's actually important that the person sitting opposite you in this role needs to understand what it's like to be you. Is that right? therapist_input communication behavior +84_36 Yeah, okay. So I guess the invitation for both of us really over the next few months of, um, on the sentence is for us to get an understanding about what it's like to be you. reflection communication behavior +84_38 "Yeah, okay. So in terms of the things that have brought you here, in terms of the things that have got you into trouble and got you into offending, I'm wondering how interested you are in, um, really getting an understanding of it. So one or zero is like, ""Ugh, not interested at all.""" question communication behavior +84_40 "100 is like, ""I'm totally interested and-and getting it nailed and sorted and, you know, getting on the straight and narrow."" Where would you be on that scale?" question communication behavior +84_42 Okay. other communication behavior +84_44 All right. So it's kind of silly stuff that's getting you into trouble. reflection communication behavior +84_46 Is that what I'm hearing? Yeah. So in terms of dealing with it, where-where would you be, do you reckon? How interested would you be in dealing with that stuff? question communication behavior +84_48 Okay, so you don't wanna be back here. You don't wanna be sitting here and- reflection communication behavior +84_50 -to talk to a probation officer again. reflection communication behavior +84_52 Okay. So where would you be do you think? question communication behavior +84_54 "Zero being, ""Argh, not interested at all,"" 100 being totally into it." therapist_input communication behavior +84_56 25, okay. reflection communication behavior +84_58 So I know that you're kind of 25% interested- reflection communication behavior +84_60 -and really thinking about what's got you into trouble and hence something about what gets you into trouble. reflection communication behavior +84_62 You wanna stop getting into trouble. reflection communication behavior +84_64 Mm, okay. other communication behavior +84_66 Okay, so getting into trouble and, uh, getting caught and-and we see [unintelligible 00:05:36] does about luck and this time being unlucky. reflection communication behavior +84_68 Yes, tell me a bit more about that, Billy? Kind of give me the [unintelligible 00:05:46] the cops have got it on for you? question communication behavior +84_70 Mm, so it feels like you always seemed singled out and, um, end up being unlucky. reflection communication behavior +84_72 Okay, so you get singled out and that's what, um, means that you end up getting-- having to go to court and get sentenced and end on probation. reflection communication behavior +84_74 "Yeah. So I'm wondering, um, if there are things that you think, ""Well, I can see that that's got me into trouble,"" and, you know, kind of cops aside, things that might have got you into-into trouble." other communication behavior +84_76 "Mm-hmm, okay. So some stuff that you can think, ""Oh yeah, I had, you know, I did some stuff that yeah, got me into trouble.""" reflection communication behavior +84_78 "It wasn't perhaps about the police singling you out. So those little things, well, you think, ""Mm, yeah, maybe-maybe if I'd done something differently, I wouldn't have ended up in trouble."" How interested are you in thinking about those things and-" therapist_input communication behavior +84_80 -trying to get a handle on that. question communication behavior +84_82 Yeah. other communication behavior +84_84 Okay, so you don't wanna end up kind of being in prison again 'cause you've done some time inside. Yeah, and you don't wanna end up going back to prison, yeah. So-so that's one thing about wanting to make a difference and the way things are at the moment, yeah. reflection communication behavior +84_86 Cool. What else would, um, would help to kind of keep you out of trouble do you think? question communication behavior +84_88 Mm-hmm. other communication behavior +84_90 Yeah. other communication behavior +84_92 "So the things about that have got you into trouble in the past, um, how confident are you that, um, that you can do something to not keep going down the same path? Zero is like, ""I'm not confident at all that I can make any changes,"" and 100 is like, ""I'm so supremely confident."" Where would you be?" question communication behavior +84_94 Okay. other communication behavior +84_96 All right, so if you were in a good job- reflection communication behavior +84_98 -one with cars, one that- reflection communication behavior +84_100 -you really liked, you feel that you would be pretty confident to deal with the stuff that gets you into trouble? reflection communication behavior +84_102 Okay, so you don't have any cash and that's the stuff that causes you to do the small stuff- reflection communication behavior +84_104 -and get you into trouble. reflection communication behavior +84_106 Okay, so if you had a job, you feel pretty confident, but if you don't have a job, your confidence is much-is much lower, is that- reflection communication behavior +84_108 -what I'm hearing? Yeah. question communication behavior +84_110 Okay. other communication behavior +84_112 Okay, so if you don't have a job you reckon, um, you'll probably gonna keep on offending. reflection communication behavior +84_114 Okay, so part of this, what's going on is you also getting bored? reflection communication behavior +84_116 Mmh. Yeah, say something more about that. It sounds really interesting about you knowing that you get bored really easily. therapist_input communication behavior +84_118 Yeah, what-what makes you say that? question communication behavior +84_120 Okay, so you wanna kind of get some action, don't wanna sit around- reflection communication behavior +84_122 -all the time. But one of the things I'm noticing, we've been going here for a wee while now talking and, uh, I haven't noticed any lack of attention. therapist_input communication behavior +84_124 Okay, so we [unintelligible 00:09:47] something that interests you. reflection communication behavior +84_126 Mmh, and when we might be talking about something that doesn't interest you, what would I notice? question communication behavior +84_128 Okay. All right, so-so one of the challenges is for us to be talking about things that interest you. Yeah. therapist_input communication behavior +84_130 Um, and also maybe get to the point where things are different in your life Where you're not getting into trouble and things feel a bit more sorted in your life. therapist_input communication behavior +84_132 Hi, Billy, how are you doing? It's good to see you again. question communication behavior +84_134 Yeah, how's things been? question communication behavior +84_136 Okay. So you're keeping out of trouble. reflection communication behavior +84_138 Yeah, so how'd you get here this time? Like 'cause other times you got the bus? What-what did you do this time? question communication behavior +84_140 Oh yeah. Who's- who's Donna? You haven't mentioned Donna before. question communication behavior +84_142 Oh okay. Tell us something about Donna. question communication behavior +84_144 Hmm, you get along with her really well. reflection communication behavior +84_146 So what's special about Donna? question communication behavior +84_148 Oh okay. So someone who's both a friend and a girlfriend? reflection communication behavior +84_150 Hmm, yeah. It's really special when you find someone who can be both a friend and girlfriend, eh. therapist_input communication behavior +84_152 Yeah. You were made to say you're lucky. reflection communication behavior +84_154 Hmm. Okay, so she dropped you off here today. reflection communication behavior +84_158 She doesn't want to get you in trouble and I heard you say earlier on that you've been keeping out of trouble. reflection communication behavior +84_160 So what sort of things have you been doing together? question communication behavior +84_162 Okay. Gives you something to do. So we talked like back on that first time we met about how you reckon you've got a short attention span and like things to like to be doing things. reflection communication behavior +84_164 So you're watching movies with her, you're hanging out? reflection communication behavior +84_166 Yeah, and keeping-keeping out of trouble. reflection communication behavior +84_168 Okay, what's the mostly? question communication behavior +84_170 Mm-hmm. So when you say mostly, it kind of leaves a little bit of room for there to be some trouble. reflection communication behavior +84_172 Am I picking that up? question communication behavior +84_174 Okay, so she's- she's got a job. reflection communication behavior +84_176 Yeah, what does she do? question communication behavior +84_178 Mm-hmm. So kind of 9:00 to 5:00 sort of job. reflection communication behavior +84_180 All right. other communication behavior +84_182 Mm-hmm. So you two get to spend Friday together and the weekend. reflection communication behavior +84_184 Mm-hmm. Okay, so when she's at work, what happens then? question communication behavior +84_186 Mm-hmm. So what sort of mischief are we talking about here, Billy? question communication behavior +84_188 Mm-hmm. Okay, so you're kind of skating on the edges of getting in trouble again. reflection communication behavior +84_190 Mm-hmm. Okay. So I'm wondering how much of what you do on Fridays you tell Donna. question communication behavior +84_192 Well, if we're talking about this idea about kind of scaling around the edges of trouble again,- therapist_input communication behavior +84_194 - I'm wondering if she knows that. therapist_input communication behavior +84_196 So what do you reckon would happen if she knew? question communication behavior +84_198 She'd tell you off. reflection communication behavior +84_202 Well, what-what are her hopes for you, Billy? question communication behavior +84_204 Mm-hmm. Yeah. So she wants you to be happy. reflection communication behavior +84_206 So what would- what would like a really happy life for Billy look like? question communication behavior +84_208 Mm-hmm. A nice car, a nice house. Mm-hmm, what else? What must be a happy life for Billy? question communication behavior +84_210 Mm-hmm, okay. So in five years' time, it's fast forward to the future. Five years time, how would you like it to be? question communication behavior +84_212 Okay. So, you'd be with Donna, and you'd have a house, and you settle down, maybe have some kids? reflection communication behavior +84_214 Yes? So, it sounds like having children is something you've thought about? Um. reflection communication behavior +84_216 Mm-hmm. She'd be a good mum? reflection communication behavior +84_218 Yeah? What sort of dad do you reckon you'd be? question communication behavior +84_220 Mm-hmm. Yeah? other communication behavior +84_222 What would be special about you as a dad? question communication behavior +84_224 You wouldn't boss them around? reflection communication behavior +84_226 Mm-hmm. That's something- that's something that's come up before with-with-- when we've been talking about that idea about not liking being bossed around. reflection communication behavior +84_228 What's that about, Billy? question communication behavior +84_230 Okay, I see. You wanna be a different sort of dad- reflection communication behavior +84_232 -to-to the dad that you had? reflection communication behavior +84_234 Yeah. Okay. other communication behavior +85_0 So, we were, um- we were just talking a little bit about sustained talk, which most people call denial. therapist_input communication behavior +85_2 You're a lucky man. reflection communication behavior +85_4 "So, um, it also, um-- Anyway, it's-it's when people are just saying, ""Um, you know, this is why I don't wanna change. You know, I'm happy the way that I am. You know, it's, you know, um, God made it that marijuana stuff,"" you know, things like that. So-" therapist_input communication behavior +85_6 -so, you're gonna, um, play with me a little bit and, um- therapist_input communication behavior +85_8 -and you're gonna— therapist_input communication behavior +85_10 Right. So, you're-you're a, um-um, a patient who's been diagnosed with some s- maybe schizophrenia, bipolar. therapist_input communication behavior +85_12 Okay, mild schizophrenia is fine. Good. Okay, so- reflection communication behavior +85_14 -just a touch. reflection communication behavior +85_16 Okay. [laughs] And-and-and, uh, if you wanted to maybe even, you know, a little drinking and weed in there 'cause it's also very kind. [crosstalk] other communication behavior +85_18 Okay. other communication behavior +85_20 Yeah. other communication behavior +85_22 Yeah. other communication behavior +85_24 Okay. other communication behavior +85_26 Yeah. other communication behavior +85_28 Yeah. other communication behavior +85_30 Mm-hmm. other communication behavior +85_32 Well, that is a bummer. I mean— reflection communication behavior +85_34 So you said the-the first one you said, you don't like the way it makes you feel? question communication behavior +85_36 So, tell me a little bit about what you don't like about- what you've noticed about it? question communication behavior +85_38 Very dull. reflection communication behavior +85_40 Very dull. reflection communication behavior +85_42 Yeah. other communication behavior +85_44 Mm. So, and then you said, you don't like how it makes you act, um, if you can tell me a little bit about that. question communication behavior +85_46 It's really, your timing is [unintelligible 00:03:13] reflection communication behavior +85_48 So you feel slow. reflection communication behavior +85_50 So, it's, you know, thinking as quickly and responding as quickly and-and things like that-- [crosstalk] reflection communication behavior +85_52 Yeah. other communication behavior +85_54 Yeah. other communication behavior +85_56 Yeah. other communication behavior +85_58 To tell you, it sounds terrible, actually. Yeah. So, that that-that really-- And then- and then, to top it all off, literally, I mean, no sex drive. reflection communication behavior +85_60 And-and your wife, what does she have to say about that? question communication behavior +85_62 Yeah. Where's Scott? Where did- where did Scott go? That feisty, spirited guy, where- where'd he go? reflection communication behavior +85_64 With the libido out the door. reflection communication behavior +85_66 Oh, okay. other communication behavior +85_68 I didn't even know they had a spice channel. [chuckles] other communication behavior +85_70 "So they-- So, um, before you started taking the medication, though, when she was, you know, um-- Even though now she's like, ""Where is my old Scott,"" and stuff, well, were there any times when she wanted you to go on the medication? And, if so, what-what prompted those?" question communication behavior +85_72 You were right. reflection communication behavior +85_74 Okay. other communication behavior +85_76 Might get you into trouble [unintelligible 00:05:06] reflection communication behavior +85_78 Okay. What else? question communication behavior +85_80 What do you think about the hospital? question communication behavior +85_82 No. other communication behavior +85_84 So, you'd really like to stay out of that hospital? question communication behavior +85_86 I agree with you, I really do. So-- And I- and I think that a lot of times, um, the medications, they do have a lot of side effects, and I completely understand why people don't wanna take them- other communication behavior +85_88 Yet, at the same time, I know running around and getting in trouble for being naked or having to go to the hospital, not such a good thing either. Um, I'm wondering if, um- if I could run some ideas by you that some other patients of mine have tried? question communication behavior +85_90 Okay, thanks. Um, we could if you're-- 'Cause, as you can tell, this is really more of an art than a science, um, try some other medications and see how you do on them, and perhaps, you won't have these side effects. And, um, it-it really is just a matter of kind of experimenting around to get, uh, to see if we can get to a point that at least you're not having these really bad things happen of getting into the hospital and getting arrested and stuff versus feeling more like that-that spirited Scott that, you know, watches Spice channel, you know, I mean-- Because I can tell the spirit of Scott is, uh, a hoot. therapist_input communication behavior +85_92 Well, you know, uh, Scott, well, tell me a little bit since you brought that up. Yeah, obviously, drink and tell me a little bit about your [unintelligible 00:07:35] question communication behavior +85_94 Mm-hmm. other communication behavior +85_96 Mm-hmm. other communication behavior +85_98 How-how often do you do that? question communication behavior +85_100 Maybe every other day? question communication behavior +85_102 Okay. other communication behavior +85_104 Mm-hmm. other communication behavior +85_106 Okay. other communication behavior +85_108 How would you know if it was a problem? question communication behavior +85_110 So, if you got a DUI, you would really know. reflection communication behavior +85_112 Okay. other communication behavior +85_114 Well, you know, what, I-- There are a lot of people that wouldn't disagree with you on that exactly. You know, so, um, uh, but I know that they-they were never quite sure how they were all interacting all together. Like the, um- the weed kind of tends to make people a little paranoid anyway. therapist_input communication behavior +85_116 Yeah. Why, what happens if you take a little too much of it? question communication behavior +85_118 Yeah. other communication behavior +85_120 Yeah. And you don't like that? question communication behavior +85_122 Running around naked. reflection communication behavior +85_124 Okay. other communication behavior +85_126 You must like that statue. reflection communication behavior +85_128 So, if-if-if we could maybe find a medication that didn't give you as bad side effects, perhaps you might not have to drink as much or at all or smoke a little weed to take the edge off. I mean, who knows? [unintelligible 00:09:55] reflection communication behavior +86_1 You're hopeless about what's going on. reflection communication behavior +86_3 You seem at a loss of where to go from here. reflection communication behavior +86_5 You feel like people aren't willing to help. reflection communication behavior +86_7 You feel alone. reflection communication behavior +86_9 You realize it's something you shouldn't have done. reflection communication behavior +86_11 You're feeling regretful. reflection communication behavior +86_13 Uh, it's something that just happened. reflection communication behavior +86_15 You're nervous that you've lost control of your behaviors. reflection communication behavior +86_17 You've really had a good week. reflection communication behavior +86_19 You seem excited about that. reflection communication behavior +86_21 You definitely know how to make good decisions. reflection communication behavior +86_23 You know that, um, positive peer influences have been helpful for you. reflection communication behavior +86_25 You feel like you're letting your family down. reflection communication behavior +86_27 You feel like you've been a disappointment for them. reflection communication behavior +86_29 This is not what you've envisioned. reflection communication behavior +86_31 You're willing to take steps to improve on that. reflection communication behavior +86_33 You don't want to be here. reflection communication behavior +86_35 You seem motivated to follow the rules. reflection communication behavior +86_37 It's something that's always on your mind. reflection communication behavior +86_39 It takes a lot of, um, strength to still not smoke, even though you're still craving. reflection communication behavior +87_0 So let me tell you what I normally do in this, um, this interview, and we-we'll talk for up to maybe 20 minutes or so. Normally what I do is just give some feedback from all of those questionnaires that you answered last week- therapist_input communication behavior +87_2 -and then we just talk together about that. So, um, but I always like to just start with wherever you would like to start as well. therapist_input communication behavior +87_4 Mm-hmm. other communication behavior +87_6 Mm-hmm. other communication behavior +87_8 Hm. other communication behavior +87_10 You were pretty shocked at what you learned about your patterns. reflection communication behavior +87_12 Hm. other communication behavior +87_14 Mm-hmm. other communication behavior +87_16 Yeah, this information has opened your eyes in some ways and as you talked to your roommate about it, she was even shocked to know that you were drinking as much as you- as you realized when you did the questionnaire. reflection communication behavior +87_18 Mm-hmm. other communication behavior +87_20 Yeah, the fact that your drinking stands out from others is clearly not something you had ever really taken into consideration before? reflection communication behavior +87_22 Mm-hmm. other communication behavior +87_24 Okay. other communication behavior +88_1 So, um, everyone that comes on the South Whisky program, we'd like them to pick at least three goals that they'd like to work on in the next 30 days. Because what we will do is we will monitor you and we'll check in 30 days to see how you're going with your goals. So with that being said, we want you to pick something that is relevant for you, something that you're willing to work on. So with that being said, is there anything that you would like to change your work on either at home or school, um, [unintelligible 00:00:30]? question communication behavior +88_3 Okay, so for you getting on time for first hour is something you'd like to work on the next 30 days? question communication behavior +88_5 Okay. What a great goal. So why do you want to make this goal for yourself? question communication behavior +88_7 And who are these people? question communication behavior +88_9 So that's something you definitely wanna avoid? reflection communication behavior +88_11 Okay. So getting to school for your first hour is something that you're going to work on as your goal. reflection communication behavior +88_13 So what are some specific steps you would need to take to get to school on time for first hour? question communication behavior +88_15 Okay, so it's not just one major thing? reflection communication behavior +88_17 So knowing that a couple of things can really get in your way, what do you think would work best for you to get to school on time? What do you know you need to do? question communication behavior +88_19 What time would you need to get up then? question communication behavior +88_21 So you're still kind of unsure if this is something that you could do yet you're saying you really wanna do it because you don't wanna go back for sanctions. reflection communication behavior +88_23 Okay. other communication behavior +88_25 Okay, so you're willing to at least attempt it? reflection communication behavior +88_27 So what time would you have to go to bed at night to make sure you're up by 6:15? question communication behavior +88_29 Okay. Okay, so you're willing to go to bed at 11:00 and then you're going to set your alarm for 6:15 the next morning? reflection communication behavior +88_31 When would be a great day for you to start this? question communication behavior +88_33 Okay, so if I would write down here, um, what do you think- what would you want me to write? Tomorrow or the next day? question communication behavior +88_35 Tomorrow. Okay, great. So who would be able to help you get to bed on time and make sure you're up on time by 6:15? question communication behavior +88_37 Your mom. reflection communication behavior +88_39 Okay. Anything that your mom could do to help you with that? question communication behavior +88_41 "So it's almost like you want your mom to make it say that this is for you. It's not because your mom's making you get up like you want your mom to remind you, ""Hey, remember, this is something that you want for yourself is to be in time for first-hour class""." reflection communication behavior +88_43 Great. What could maybe get in the way of you not getting up by 6:15? question communication behavior +88_45 Not going to bed on time. reflection communication behavior +88_47 Okay. So if you are feeling tempted to stay up later- reflection communication behavior +88_49 - how could you respond instead? question communication behavior +88_51 Okay, so a phone is a distraction for you. So keeping your phone away- reflection communication behavior +88_53 - and even actually turning the lights off and making sure that it's dark? question communication behavior +88_55 Kind of a reminder it's time to go to bed. reflection communication behavior +88_57 And-and also the support of your mom too. reflection communication behavior +88_59 Great. So how will you know that you-your plan is working? question communication behavior +88_61 So for you being in your class, when that bell rings, then you know, this is the goal. reflection communication behavior +88_63 So what I've been hearing so far- what again, what a great goal. You've already had some insight of how to do this. So for you, it's really important that you're getting to your first hour because you don't want to go back to sanction days. You don't having- like having all these extra people checking up on you and all those things.You've already have a plan of going to bed by 11:00, turning off the lights, putting your cell phone away. Even the support of your mom is really gonna be helpful for you, um, getting up at 6:15 in the morning with that alarm. I know that seems really early in the morning, but you seem willing to do it. And if you're not able to do it, your mom's gonna help you out as well. reflection communication behavior +88_65 What a great plan and you said you're going to start tomorrow. reflection communication behavior +88_67 Great. Well, thank you. other communication behavior +91_0 Hi, Jean. I'm Dr. Selby. Nice to meet you. other communication behavior +91_2 How can I help you today? question communication behavior +91_4 Yes. other communication behavior +91_6 Right. other communication behavior +91_8 It's time to do something, okay. So you've been diagnosed by- question communication behavior +91_10 A respirologist diagnosed that, and-and how are you feeling right now? question communication behavior +91_12 Mm-hmm. other communication behavior +91_14 All right. So it sounds like you've been smoking for such a long time and then this diagnosis was given to you, uh, and now that's really causing you to be afraid and frightened. reflection communication behavior +91_16 Okay, okay. Now, have you thought about when you wanted to quit by? question communication behavior +91_18 Okay. So what I'm hearing you say is that, although you want to quit smoking in the next six months, you're feeling a bit, um, under-confident that you'll actually be able to do this and you're-you're worried about failing. reflection communication behavior +91_20 Mm-hmm. other communication behavior +91_22 Right. So you've been able to quit smoking, but only when you were in the hospital. reflection communication behavior +91_24 Okay. Let me just step back a little bit and ask you a question so that I can better understand where the difficulty that you're having with is. Uh, could you tell me what is good about smoking for you? question communication behavior +91_26 Mm-hmm. other communication behavior +91_28 Right. other communication behavior +91_30 Sure. So, Jean, I want to make sure that I've understood what you've told me of what you find good about smoking. So it helps you calm down. It gives you something to do. It's been part of your image. You know, you feel sophisticated. You feel like a movie style. In fact, the way you talk about it, it seems like that's what it makes you feel like. Is that right? reflection communication behavior +91_32 Okay. Is there anything I missed? question communication behavior +91_34 Mm-hmm. other communication behavior +91_36 Right. other communication behavior +91_38 Sure. other communication behavior +91_40 So it's hard for you to quit smoking when everybody else around you is smoking. And it's so easy to go out and take a break and have a cigarette. reflection communication behavior +91_42 You've told me what is good about smoking for you. Uh, can you tell me what is not so good about smoking for you? question communication behavior +91_44 Mm-hmm. other communication behavior +91_46 Is there anything else that's not good about smoking for you? question communication behavior +91_48 Okay. So let me make sure I've understood this piece as well. So the not good things or the not so good things about smoking for you are the effects on your health, effects on your physical appearance and how you'll look and-and-and the amount of investment that you're making in makeup and getting your nails done, et cetera. And then the cost of smoking. reflection communication behavior +91_50 So-so let me ask you this, given everything going on in your life right now on a scale of 1 to 10, where 10 is the most important thing to do, and 1 would be the least important thing to do, how important is it for you to quit smoking? question communication behavior +91_52 Definitely most important. reflection communication behavior +91_54 Let me ask another question and follow up to that. Again, given everything going on, where 10 is the most confident you've ever felt about anything and 1 is the least confident, how confident are you that you will be able to quit? question communication behavior +91_56 35-40%. Okay. reflection communication behavior +91_58 Okay. Now, help me understand why you said 40 and not something like 10 or zero because you mentioned that you don't even want to quit. reflection communication behavior +91_60 Mm-hmm. other communication behavior +91_62 Okay. So you said 30 to 40%. What would it take to build that confidence to about 45%? question communication behavior +91_64 So if you got help, that would help you say that you went from 40% to 45%. reflection communication behavior +91_66 Okay. other communication behavior +91_68 Okay. So Jean, I really want to congratulate you on taking this very important first step towards addressing this problem that you've had for such a long time, but as the first small step, I wonder whether you'd be open to actually just monitoring your smoking for the next week. And the reason why I say that- because as you were mentioning to me, smoking is so automatic for you that sometimes writing it down helps make every cigarette a conscious act. And I noticed that you were saying to me, you feel a loss of control over these cigarettes. And sometimes just being mindful and writing something down will help you get some control over what you're doing. And that's often the first small step. What are your thoughts about that? therapist_input communication behavior +91_70 That's correct. And writing it down helps that process. therapist_input communication behavior +91_72 Mm-hmm. other communication behavior +91_74 Okay. And I can give you a little card that can help you keep track of it. And if you can bring that back to the next appointment, it could be something we could discuss. Okay. Anything else? therapist_input communication behavior +91_76 Excellent. Well, thank you so much for coming in today. reflection communication behavior +91_78 You're welcome. other communication behavior +93_0 So there are a lot of different directions that we could take. Um, you've mentioned wanting to make changes in your physical activity. You've mentioned wanting to make changes in your eating habits and also just wanting more body confidence. Um, what- what's on your mind is as far as a- as a change topic for the rest of our session today? reflection communication behavior +93_2 Yeah. Okay. So physical activity is feeling like the easiest change to look at first. reflection communication behavior +93_4 Great. So tell me a little bit more about your motivators for getting started in being more physically active. I know you shared energy levels and I know you've shared, um, that you'd like to see a boost in your mood and feeling less irritable and stressed. Any other benefits that really make you wanna make this change right now? reflection communication behavior +93_6 Yeah. So you're wanting to feel stronger so that you can open jars and other things and- and also just have a better sense of confidence. reflection communication behavior +93_8 Great. So on a scale from zero to 10, zero being not at all ready to make a change in the area of physical activity, and 10 being let's- let's do this. I'm excited. I'm ready. Um, where- where do you fall on that scale? question communication behavior +93_10 Okay. So you're- you're feeling fairly motivated. reflection communication behavior +93_12 Uh, why didn't you pick a six? question communication behavior +93_14 Okay. You're noticing there- there are too many great benefits to being physically active and, um, today you've mentioned energy, mood, strength and body confidence. reflection communication behavior +93_16 Am I missing anything else? question communication behavior +93_18 Okay. Those are the big ones for you. reflection communication behavior +93_20 Fantastic. Well, um, now we can start looking at if you're interested in how that might look- therapist_input communication behavior +93_22 - and- and what activities you might end up, um, choosing. other communication behavior +93_24 Okay. other communication behavior +94_0 Good, so, um, we're here today to talk just, uh, about whatever it is you'd like to talk about it. other communication behavior +94_2 Okay, so, um, there would be, so what you're, what you're attempting to do is, um, well-- Tell me, I guess, uh, tell me a little bit more about it so I understand it a little bit more. reflection communication behavior +94_4 Mm-hmm. other communication behavior +94_6 So that's a really kind thing of you to do to take someone into your home like that when they need help like that. And, um, but right now, you're thinking that, uh, time is up you'd like to get this person, you know, you're-you're-you're ready to have him or her move out and have your place back to yourself. reflection communication behavior +94_8 Mm-hmm. And what would, uh, what would help you get to the point of actually, um, booting them out? question communication behavior +94_10 Mm-hmm. So you kind of feel two ways about it. You-you'd like to, um, you feel like at some level that the time is up for that person to go, and on the other hand, there's a certain amount of security in having him in the house and in knowing he's around. reflection communication behavior +94_12 But you're not quite ready if you wanna sing that song. reflection communication behavior +94_14 I thought you did a pretty nice job singing there right there, it's scary to be quite honest with you and I appreciate, I also appreciate your sense of humor in-in doing that. reflection communication behavior +94_16 That really helps you get through things is to be able to laugh about it. reflection communication behavior +94_18 Your new career. reflection communication behavior +94_20 So, um, what are the uh, uh, what would be the benefits to you right now to having him out of the house? question communication behavior +94_22 Tell me a bit more about that. question communication behavior +94_26 Uh-huh. other communication behavior +94_28 Cause you wanna do the right thing because you're- because you're a good person and that's a- that's a really important value to you is that you- is that you help people out. reflection communication behavior +94_30 But you've done your duty. Duty is done. reflection communication behavior +94_32 And so, what have you done in order to start getting them to Hit The Road, Jack? question communication behavior +94_34 Okay. other communication behavior +94_36 So, uh, you were telling me earlier though that you've talked to some other people and he has some options about some other places to go to. other communication behavior +94_38 Mm-hmm. other communication behavior +94_40 So, you might have to literally like pack his bags and help them get to those places, um. reflection communication behavior +94_42 Okay. Are you-- This is something you've done before. reflection communication behavior +94_44 So whe-when-when are you gonna do it? question communication behavior +94_46 Mm-hmm, Mm-hmm. other communication behavior +94_48 And it's kind of scary. reflection communication behavior +94_50 And he's that extra trunk. reflection communication behavior +94_52 Okay. other communication behavior +94_54 Okay. All right. So, it sounds like you-you've actually worked this out until be out within a couple of days. reflection communication behavior +94_56 Okay. other communication behavior +94_58 Okay. Well, I have a funny feeling your plans will prevail. [laughter] other communication behavior +94_60 Well, thanks for-for talking and playing with our little things here. other communication behavior +95_0 Right. Hi, Ruth, thank you for coming today. How are you? question communication behavior +95_2 Well, Ruth, it sounds like you're very frustrated first of all. And you're saying that you're just tired. You've lost all your willpower. reflection communication behavior +95_4 You don't want to continue. reflection communication behavior +95_6 So you feel really, really like you've had it up to here. reflection communication behavior +95_8 Yeah. You're-you're tired. You're stressed. You feel so sad to the point that you're hurting yourself physically so that you can feel something other than what you're feeling right now. reflection communication behavior +95_10 So you were in a lot of pain? question communication behavior +95_12 I'm sorry about that. It must be very, very frustrating to feel all that pain and not be able to do anything about it. And it seems like the only thing that you can do right now is to cry. reflection communication behavior +95_14 It's okay, Ruth. I understand. Pain inside. reflection communication behavior +95_16 So your mom doesn't understand you and you don't have a dad, that's around? reflection communication behavior +95_18 So you feel like your hands are tied, you feel like you're a burden to mom. She's a single parent. She works a lot. You have all of these problems in your life. And it sounds to me like you feel like you're just adding more problems to her. reflection communication behavior +95_20 And if you're not alive, that's gonna solve the issue for her. She'll do better. reflection communication behavior +95_22 How is she gonna be better off without you? question communication behavior +95_24 And how are you a burden now? question communication behavior +95_26 And how do you help her now? question communication behavior +95_28 Okay. So then even by you coming here today, Ruth, and talking to me and opening up and telling me that you don't feel like you want to continue moving in and telling me and-and confiding in me that, you know, you hurt yourself and all this pain that you feel, that is you trying to help yourself out in one way or another. And that shows that you care. And even more, it shows that you care about your mom and that, in the end, it doesn't sound like you wanna leave her alone because you're still worried about ot-you're still worried about all the burdens on her that you're even thinking of removing yourselves to make her life easier. That shows me that you care about her so, so much, but right now the immediate solution that you have in your mind, it seems like it's-it's- reflection communication behavior +95_30 -How could it be the right one? Ending your life hurting yourself when it's just you and your mom. And you just said, she's a single parent. She doesn't have a husband, you don't have a dad. It's just the two of you. So how could it be the right choice? But I understand your pain and I know where you're coming from. And I know that the release that you feel physically is something that helps you in the moment. Are there other things that we can help you find to start replacing, um, that behavior? question communication behavior +95_32 You're not sure. So you have a lot of on your mind right now. You just opened up to me. You told me that you've been cutting, that you've also been thinking about hurting yourself, killing yourself, not being here. Short-term, the cutting is helping you. You feel like a burden to mom, that stresses you out. That makes you sad. You see how much she struggles, but also on the same hand, we see how much you've been trying and how much you've been trying to help out by trying to go to school. We know your attendance is good. You go most of the time, you know, you're trying to keep up your grades.You have a C average, even having A in math, which we know was the lowest grade you had all semester. So all of those things shows how much effort you've put in and we see that effort. So you've been doing what you can and it's normal to feel like sometimes it's not enough. But that's-that's what we're here for so that you can tell us those things and we can help you. reflection communication behavior +95_34 Oh, thank you, Ruth. Thank you for coming today. other communication behavior +96_0 Thank you for coming in today, Katie. I'm looking forward to getting to know you, and maybe just wanna start off with just sharing a little bit about you and what brought you in today? question communication behavior +96_2 So you're following through on meeting with me today and you mentioned he has some concerns. Can you tell me a little bit about that? question communication behavior +96_4 Okay. And I'm wondering if you have any concerns about that. reflection communication behavior +96_6 No. Okay. So that's- that's not been an issue for you. Uh, it is an issue for him and not for you at this point. reflection communication behavior +96_8 Okay. So what about maybe sharing a little bit about your alcohol intake and maybe a little bit about what your- what your life's like a little bit for me today? question communication behavior +96_10 Okay. other communication behavior +96_12 So it was kind of been a part of your culture a little bit, and you know, just find alcohol, maybe takes the edge off a little bit and- reflection communication behavior +96_14 Okay. So you don't feel very comfortable with somebody telling you what you should be consuming, what kind of alcohol, and how much alcohol you should be consuming. And, um, it sounds like you've been getting some mixed messages, your doctor's saying there's no safe amount of alcohol you can drink, and asked you to come and see me. And then also, you've been checking- sounds like you've been checking things out a little bit. reflection communication behavior +96_16 Okay. other communication behavior +96_18 So you know yourself best and you wanna be sort of the boss of your body and you don't want somebody else telling you what- what's okay and what's not okay. And it seems like you're not maybe too concerned right now about your substance use. reflection communication behavior +96_20 "Okay. And I'm wondering if that concern is coming from, ""It's been okay. I've got these messages from friends.""" reflection communication behavior +96_22 """Um, media has said it's okay to drink during alcohol. And so that concern, um, just sort of, I don't have it and, and maybe the doctor might be wrong.""" reflection communication behavior +96_24 You're not sure if he's sort of playing things up a little bit there? reflection communication behavior +96_26 It might be a bit extreme to- reflection communication behavior +96_28 -to quit drinking. Um, I'm just wondering, have you, um, would you be open maybe to just kind of taking a look at what Canada's guidelines say about drinking? Um, is that something you'd be open to? therapist_input communication behavior +96_30 Yeah. other communication behavior +96_32 What if- uh, can I show you a brochure about that? question communication behavior +96_34 Yeah? question communication behavior +96_36 Well, if we take a look at the low-risk-alcohol drinking guidelines, what it says is for women, um, the safe limits are 10 drinks a week for women and 2 drinks a day. And that's if a woman isn't pregnant. And when it says in the guidelines, as far as drinking, uh, throughout pregnancy, there is no safe amount to drink during pregnancy. So really zero alcohol is, um, the woman should not be drinking any at all. And I'm just wondering what-what are your thoughts on that? therapist_input communication behavior +96_38 So when you see it here in kind of black and white, you're not sure if this is, uh, you know, enough- reflection communication behavior +96_40 -to con- sort of convince you that-that it might be dangerous to be drinking through alcohol? question communication behavior +96_42 So you feel like, um, what the doctor's saying and this brochure just kind of feels like, yeah, it's just kind of blowing things up out of proportion a little bit. reflection communication behavior +96_44 And it sounds like you-you've got some solid information already that alcohol, you know, has been safe to-to have during pregnancy. Tell me about that information that you've-you've explored. reflection communication behavior +96_46 Mm-hmm. You mentioned you looked up some articles and it sounds like evidence is really important to you. So, um, those articles, is that something recent? Um, you can tell me about that. reflection communication behavior +96_48 Mm-hmm. other communication behavior +96_50 So you felt like, um, the information that you found supports the values that you have of being able to be independent and autonomous, to be able to make your own choice and the information that your doctor shared or spoke to you about, and then this brochure kind of feels like that's challenging sort of your values. reflection communication behavior +96_52 Mm-hmm. other communication behavior +96_54 Mm-hmm. other communication behavior +96_56 Wha-what's the big deal if you're drinking and— reflection communication behavior +96_58 Maybe we can kind of put that on the shelf for a moment, and we'll come back to it and sort of look at, you know, what is- what does the guidelines have to say about why. And, um, and-and I'm wondering if we can kind of just have a look for a moment at, um, your pregnancy, and is this something that you were- you were hoping to have a baby? question communication behavior +96_60 That was something that you'd been planning? question communication behavior +96_62 Okay. And I'm wondering as far as, um, bringing the baby into the world and, you know, your future as a parent, ho-how important is it to have a healthy baby to you? question communication behavior +96_64 Mm. What does being a good parent look like? Tell me more about that. question communication behavior +96_66 Hmm. Kind of like protecting your baby and- reflection communication behavior +96_68 -guiding your baby and- reflection communication behavior +96_70 -you know, nurturing that baby is really important to you- reflection communication behavior +96_72 -and raising your baby well? question communication behavior +96_74 That's something that- that really matters to you and, um, I'm-I'm hearing you say that, you know, protecting your baby is important to you and at the same time, um, kind of clashes with some of the information that's in the brochure. reflection communication behavior +96_76 What do you make about that- what do you think about that? question communication behavior +96_78 You wanna see it in black and white. reflection communication behavior +96_80 You wanna know that it's the latest and the greatest kind of thing. Um, this is information that, uh, that I have been sharing with you earlier, this is the latest information evidence-based, um, on the latest research since 2011 and, um, a lot of research has gone into what is-what is okay for a mom to consume, like, alcohol. There's the-the evidence that we have, um, but in the end, you choose what's best for you and what's best for your baby. What are your- what are your thoughts on that? therapist_input communication behavior +96_82 Mm-hmm, kind of feels like, you know, you were making some really good decisions about your baby. You've done research and you wanna be able to bring your baby up well and take care of your baby. And I-I can see that that's really important to you. I hear you saying that and it kind of feels like this information isn't kind of what you were expecting to hear. reflection communication behavior +96_84 What would you feel like would be helpful as far as next steps, like when you think about maybe moving away from drinking alcohol throughout the rest of your pregnancy? question communication behavior +96_86 Mm-hmm, that's some really significant steps you're talking about. You're talking about putting the alcohol away, that's huge. That's-that's really big steps. reflection communication behavior +96_88 I really want to thank you for, you know, exploring this with me today, and I'm wondering if we can kind of continue this conversation again, and talk about those steps, and how it goes with talking to your partner about giving up drinking and, um, the- giving you a chance to do some more research and, you know, maybe looking through these brochures and kind of just coming back and sharing a little bit more about, you know, what you thought about the information and what feels right for you. Is that something you'd be open to? therapist_input communication behavior +96_90 We definitely can cover that again on our next meeting. Thank you for coming to see me. reflection communication behavior +97_0 Well, Mr. Smith, that's your medication sorted out. therapist_input communication behavior +97_2 Blood pressure's a little on the high side. therapist_input communication behavior +97_4 Okay. I wonder if I could raise the subject of your weight. question communication behavior +97_6 I wondered if we could spend just a couple of minutes talking about your weight. question communication behavior +97_8 Yeah. other communication behavior +97_10 Yeah. other communication behavior +97_12 Yeah. other communication behavior +97_14 Yeah. other communication behavior +97_16 Yeah. other communication behavior +97_18 Yeah. other communication behavior +97_20 Right, and you-- so you're busy enough, and— reflection communication behavior +97_22 Yeah. other communication behavior +97_24 Yeah, yeah. other communication behavior +97_26 And it wasn't essentially easy for you to make the time to come down, and you had to wait in the waiting room, and now I raised the subject of weight just when you're thinking of going. reflection communication behavior +97_28 Yeah, yeah, yeah. other communication behavior +97_30 Right. other communication behavior +97_32 Right. other communication behavior +97_34 Right. And so it-it-it's been a bit of a rush for you coming in. reflection communication behavior +97_36 And, I- I'm sorry about the wait in the waiting room. other communication behavior +97_38 Yeah, yeah, that's, um, and that- that's not easy for you, because you- you'd like to go really soon, and here I am asking you to spend just a couple of minutes with me. other communication behavior +97_40 Yeah. other communication behavior +97_44 Yeah. other communication behavior +97_46 Yeah. other communication behavior +97_48 Yeah. other communication behavior +97_50 Yeah. other communication behavior +97_52 Yeah. It counts. reflection communication behavior +97_54 Yeah, exactly. Exactly. It's up to you, just a couple of minutes. other communication behavior +97_56 I promise. other communication behavior +97_58 I want- I wanted to simply ask you how you feel about it? question communication behavior +97_60 Yep. other communication behavior +97_62 Right. other communication behavior +97_64 Right. So you can see the links between your weight and your health, and you'd like things to be a bit better. reflection communication behavior +97_66 You'd like to, if you could? reflection communication behavior +97_68 Yeah. other communication behavior +97_70 Yeah. other communication behavior +97_72 Ready meals, and that sort of thing. reflection communication behavior +97_74 Okay, yeah. other communication behavior +97_76 Let me see if I can summarize what you've said, um, and then we'll see what next. Um, you lead a busy life. reflection communication behavior +97_78 Um, you run a business, and you've got a lot to do. reflection communication behavior +97_80 Yeah. Um, you're- you're- you're aware of the- of the links between your health and your weight, and you are concerned, to some extent, about that, and ideally it sounds like you'd like to do something about it, it's just that your life is busy and rushed, and you tend to use convenience foods in order to get the work done. reflection communication behavior +97_82 Yeah, yeah. other communication behavior +97_84 I get it. I get it. And so, if you could fit it in, you would like things to be different, but that's not so easy. other communication behavior +97_86 Okay. Can I suggest that you come back and see me in a couple of weeks time just to chat about this? question communication behavior +97_88 Right. other communication behavior +97_90 Right, right. other communication behavior +97_92 Exactly. other communication behavior +97_94 Exactly. I'll tell you what might be a nice solution, is if you come down first appointment, and I give you an appointment at 8:30- other communication behavior +97_96 - and then there'll be absolutely no waiting. And, the purpose of that- of that visit will be to have a look at how you really feel about how you could move forward, and somehow fit in a more healthier lifestyle into the busy work life that you've got. other communication behavior +97_98 Yeah. other communication behavior +97_100 Yeah. other communication behavior +97_102 Good. other communication behavior +97_104 Good. And see if you can fix it up, and also give some thought to what we've talked about. reflection communication behavior +97_106 Good stuff. Okay. other communication behavior +98_0 Hi, Mike. I'm Kathy. Appreciate you coming in today. other communication behavior +98_2 I'm sure there's so many other places you'd rather be than here today talking with me, but, um, you're here, and, um, thank you. other communication behavior +98_4 Um, I wanted to ask you first how you're doing physically. Um, I wanna make sure you're okay, if you feel okay. And, um, 'cause your-your safety is of, uh, most importance. So, if I could just ask you a couple of questions- other communication behavior +98_6 -surrounding that, will that be okay? question communication behavior +98_8 -um, we-we're-- You're here probably because of your speeding ticket. That's what I gathered. therapist_input communication behavior +98_10 Oh. Oh, okay. So, Um, around that, um, do you ever feel-- You feel bad or-or sick when you're-- Right now, is there something-- question communication behavior +98_12 Do you feel okay. Okay, good. I just wanted to make sure, um, uh, and, um, if the last time you-you drank was-- question communication behavior +98_14 Uh-huh, yeah. other communication behavior +98_16 Sure. other communication behavior +98_18 Oh, okay. Well, I appreciate that. other communication behavior +98_20 Um, and also, if there's any-any-any information that you need from me, please, um, feel free to ask. Um, that the reason that he asked you to come in was because of the blood alcohol level was 2.8. therapist_input communication behavior +98_22 So, um, that was legally beyond the limit that you should be driving. therapist_input communication behavior +98_24 Well, it's-it's high, uh, you know, they-- therapist_input communication behavior +98_26 For driving. therapist_input communication behavior +98_28 And so, um, the officer at the- at the scene, um, when you blew the 2.8, he-he did-- he-- There was a- there was a problem. therapist_input communication behavior +98_30 Was he freaking out? Yeah-yeah. reflection communication behavior +98_32 Right-right. So, um, I'll just ask you a couple of questions, um, if you don't mind about-about your drinking. And-and your-- So, um, you said the couple was two weeks ago was the last time you drank? question communication behavior +98_34 Yeah. Okay. And, um, that night, what was it that you-you drank and, how much? question communication behavior +98_36 Right. Yeah. Um, I was-- Maybe, you could tell me about how much you drank. question communication behavior +98_38 Mm-hmm. Five, six drinks, like? question communication behavior +98_40 Oh, okay. So, I guests maybe five or six. reflection communication behavior +98_42 Um, yeah. And-and, w-what were the drinks, were? question communication behavior +98_44 Hmm. other communication behavior +98_46 Oh, okay. So, um, you said that it was pretty much just five or six. Do you-- How often do you use that? And you said it's not a- question communication behavior +98_48 -not a normal occasion for you to drink that much? question communication behavior +98_50 Right. Yeah. Um, so, you usually don't drink that much. Um, on an average, maybe a week, how much would you say you drink? Just-- question communication behavior +98_52 Uh-huh other communication behavior +98_54 Right. other communication behavior +98_56 Right. So, it doesn't get in the way of your- reflection communication behavior +98_58 -every day. reflection communication behavior +98_60 Right. Oh, that's good. other communication behavior +98_62 So, um, looking back, Mike, uh, when was it that you started thinking that when you did use alcohol, um, most in your life? question communication behavior +98_64 So, that is- that is a complete, uh-- A question that is even applicable? question communication behavior +98_66 Okay. other communication behavior +98_68 That's fine. other communication behavior +98_70 That's fine. Okay. Um, so, what about the, uh- the first DUI, could you tell me a little bit about that? This was your second one? question communication behavior +98_72 And so, that's sort of why I was asking about it earlier in your life if that was a-- therapist_input communication behavior +98_74 It was those two times. Yeah. reflection communication behavior +98_76 It sounds like bad luck. reflection communication behavior +98_78 Yeah. other communication behavior +98_80 Oh, okay. other communication behavior +98_82 But just that bad luck? question communication behavior +98_84 Yeah. Is there alcohol with the- with-- Goes hand in hand with the bad luck or just-- question communication behavior +98_86 Yeah. Oh, okay. So-so, what about that? The-- Is there other incidences that you could think of that seems, uh, um, alcohol was there, and then your luck just sorta took a-a turn, or it was just those two times? question communication behavior +98_88 Mm-hmm. other communication behavior +98_90 Oh, good. Oh, good. And-and so, where do you usually, um, have your drinks? Is it at home or, uh, out-out for, uh- after work, social drinking? question communication behavior +98_92 Mm-hmm. other communication behavior +98_94 Mm-hmm. other communication behavior +98_96 Would that help? question communication behavior +98_98 So, it sounds like you've already been thinking about, uh, ways to-to get around safely. reflection communication behavior +98_100 You have been giving this a lot of thought. other communication behavior +98_102 Yeah, good. other communication behavior +98_104 Trouble's not fun. reflection communication behavior +98_106 No. other communication behavior +98_108 Yeah. So, tell-tell me a little bit more about, um, when you fi-- If you'd find yourself, and then that-that thought comes about maybe doing something other than getting in the- in the car, does that come and go, or-or is it something that you think you-- Next time you might do? question communication behavior +98_110 This, it-- What-what-what was different? question communication behavior +98_112 Hmm. other communication behavior +98_114 Wow. You-you need your license- reflection communication behavior +98_116 -to get around. You need your license for work. reflection communication behavior +98_118 Oh. other communication behavior +98_120 Mm-hmm. other communication behavior +98_122 No. therapist_input communication behavior +98_124 No, no. That's-- therapist_input communication behavior +98_126 That would be entirely up to you, um, to-to have that. therapist_input communication behavior +98_128 Oh, no. other communication behavior +98_130 Well, you're here. And-and-and I have you give, uh-uh, credit for that. It took a lot to come in today and, um, when, um- when somebody is actually talking safety for themselves, which I-I hear you saying, um, calling a taxi or-or staying home. other communication behavior +98_132 So, what does staying home look like for you? Is that something that-- You know, you-you talked about drinking at an event. Would staying home be-- question communication behavior +98_134 Mm-hmm. other communication behavior +98_136 That would work for you? question communication behavior +98_138 Yeah, yeah. other communication behavior +98_140 Uh, so, uh, would people come and drink at your house, and then they would be fine with that? question communication behavior +98_142 Yeah. other communication behavior +98_144 Yeah. other communication behavior +98_146 So, an event at your house. reflection communication behavior +98_148 Yeah, good. That sounds good. Mike, has there even been, if any, um, a time in your life when you've thought about, um, not drinking at all? question communication behavior +98_150 Right. Six months. That's a long time. reflection communication behavior +98_152 What were those six months like for you? question communication behavior +98_154 Friends? question communication behavior +98_156 Whi-which? If you don't mind me asking, which friends were those? I don't mean to get too personal, but, the friends that normally drank with you or just your- question communication behavior +98_158 -social circles. Okay. reflection communication behavior +98_160 Wha-wha-what do you think made-made them n-not hang out with you? question communication behavior +98_162 Did you ask them? question communication behavior +98_164 And your girlfriend's important to you- reflection communication behavior +98_166 -and that relationship was important to you. reflection communication behavior +98_168 At the time it was important, yeah. reflection communication behavior +98_170 Is it-- Why'd she leave? question communication behavior +98_172 Oh, after the six months. reflection communication behavior +98_174 Oh, okay. So-so, um, you started drinking again, and then she left? question communication behavior +98_176 You felt isolated? question communication behavior +98_178 And, so you're-you're an independent guy- reflection communication behavior +98_180 -and, no one's going to tell you what to do. reflection communication behavior +98_182 Yeah. So, have, uh-- So then, you started drinking again, and that was-- If you could just kind of give me a little timeframe of how long ago that was, that-that six months of complete-- question communication behavior +98_184 Absolutely. Yeah. other communication behavior +98_186 So, in-in what ways has, uh, drinking, um, sort of, uh-- What is kind of the good things about drinking since those couple of- those couple of years, and then-then maybe not so good things? question communication behavior +98_188 Mm-hmm. And those friends that were not hanging around with you, did they come back? question communication behavior +98_190 Did they not get along with your girlfriend? question communication behavior +98_192 Yeah. other communication behavior +98_194 She was separate then from your other friends and- reflection communication behavior +98_196 -those relationships just didn't come together? question communication behavior +98_198 And what do you think? question communication behavior +98_200 So, you-you-- other communication behavior +98_202 You would have been fine if they didn't- if they didn't give you those-those shots. Yeah. reflection communication behavior +98_204 Oh, so, the-the-the mailbox, where did that come in? That was the- question communication behavior +98_206 -first DUI that got you. reflection communication behavior +98_208 That must have been scary. other communication behavior +98_210 Oh, that was blackout type? question communication behavior +98_212 Right. Yeah. other communication behavior +98_214 Oh, okay. other communication behavior +98_216 I'm-I'm sorry. I didn't mean to assume that- other communication behavior +98_218 -it was blackout that-- Forgive me for that. other communication behavior +98_220 Um, so, that it was sort of after that that the girlfriend-- Your girlfriend, I don't know, well, her name. Um, your girlfriend decided-- The mailbox and she's-- reflection communication behavior +98_222 Mm-hmm. other communication behavior +98_224 Yeah. other communication behavior +98_226 Oh. other communication behavior +98_228 Yeah. You felt like she was the only person that, um, you had in your life, you needed your friends and-- reflection communication behavior +98_230 No one likes to be controlled, uh, yeah. Yeah. Uh, and, in what ways, well, did you feel that, um, uh, at any time, did you feel controlled by your friends. You said they-they made you drink those shots. That-that sounded like maybe you felt a little controlled? But-- [crosstalk] question communication behavior +98_232 Yeah. other communication behavior +98_234 Right, they weren't looking out for your best interest at that point. reflection communication behavior +98_236 And then sent you out in your car. reflection communication behavior +98_238 It's a hindsight again. reflection communication behavior +98_240 Yeah. other communication behavior +98_242 Hindsight? Oh, yeah, they'll-- it'll take the- it'll take the blame. Um, so, you still-- Do you still, uh, you know, you started drinking again, and then, um, the second DUI, what-- Is it the same circle of social-social circle, same friends? question communication behavior +98_244 Same type of situation. [crosstalk] reflection communication behavior +98_246 So, they're important to you? question communication behavior +98_248 Mm-hmm. Yeah. And-and sometimes, um, people have friends who are friends, but then there's friends who would stay on in our lives and are constant. So, these would be your constant core-- reflection communication behavior +98_250 Yeah, okay. other communication behavior +98_252 Have you ever had, um, uh, interest outside, um, the social drinking, the friends, um, like, what do you do when you're not with them? question communication behavior +98_254 Yeah. And any other relationship, if you don't mind me asking-- [crosstalk] question communication behavior +98_256 How's that going? question communication behavior +98_258 Oh what-- So, what does serious look like? Um-- question communication behavior +98_260 Yeah. That's all right, yeah. That's good. It sounds like you know yourself pretty well. reflection communication behavior +98_262 Okay. Right. So, um, now that we-we are looking at, um, your second DUI and, um-- Well, so now, Mike, if you don't mind me asking, what would you do differently, um-um, from here on now? question communication behavior +98_264 Since the co- the court sent you and we have to sort of explore what would happen if you went out and did this again. therapist_input communication behavior +98_266 Yeah. Is there somebody that you could call? question communication behavior +98_268 Right. other communication behavior +98_270 They'll come. reflection communication behavior +98_272 Yeah. They'll come. As long as you got the money, they'll come and get you. Yeah. other communication behavior +98_274 Yeah. other communication behavior +98_276 Oh, so, when you use your-your bar money, it would be somewhere else? question communication behavior +98_278 Your bar money would be somewhere else, not in your wallet? question communication behavior +98_280 There you go. Okay, yeah. So, that, y-yeah. other communication behavior +98_282 That makes- that makes a lot of sense. So then you'd have your money tucked away someplace different. reflection communication behavior +98_284 Mm-hmm. other communication behavior +98_286 Sounds like a good plan. reflection communication behavior +98_288 Yeah. So, uh, how often do you think you'll be needing that plan in the-- question communication behavior +98_290 Right. other communication behavior +98_292 Mm-hmm. other communication behavior +98_294 And then-- Yeah, and then also you said if you're going to have people, uh, you're gonna be drinking for the Super Bowl. Was is it Super Bowl? question communication behavior +98_296 I'm sorry, I'm not a football fan but it's Super Bowl coming up, right? question communication behavior +98_298 So, you'd have them in and, um, I'm just curious about the folks who are leaving your house, would they-- Would-would you be concerned about them, there'll be a taxi. Sometimes designated drivers I-- question communication behavior +98_300 So, it would be up to them? question communication behavior +98_302 Mm-hmm. other communication behavior +98_304 It sounds like you have-- You've thought about this, and you're-you're willing to put some things in place, the-the wallet, um, money in the wallet and-and for the taxi- reflection communication behavior +98_306 Have folks in to-to socialize for an event, and that you still have your-your social-- Your friends and your core group and-and, uh, just be careful. What was the six months of not drinking like for you? If you were to choose to not drink. question communication behavior +98_308 Six months is a- is a long time. There was, um-- Try to think back, were there- were there other people? Was it- was it just you? question communication behavior +98_310 All right. other communication behavior +98_312 So-so, if you were not to-- If you were to go with the plan of maybe not drinking, which you mentioned- reflection communication behavior +98_314 -um, uh, your girlfriend Mary is-is not a part of your life- reflection communication behavior +98_316 -right now. reflection communication behavior +98_318 Would there be something else that would, um, sort of, uh, fill in that-- The-the friends area, do you think? question communication behavior +98_320 But, yeah, I-I see what-what you're saying, for sure. Um, there-there's those friends that they drink but they don't drink that much, I heard you saying. reflection communication behavior +98_322 Mm. Sure. other communication behavior +98_324 Right. other communication behavior +98_326 Yeah. So-- other communication behavior +98_328 Mm-hmm. other communication behavior +98_330 Um, it's one drink per hour. therapist_input communication behavior +98_332 Mm-hmm. other communication behavior +98_334 Or one shot or- therapist_input communication behavior +98_336 -one glass of wine or one beer. therapist_input communication behavior +98_338 Um- other communication behavior +98_340 Mm-hmm. other communication behavior +98_342 Yeah. Uh, the, uh- the idea of, um, having the friends and not drinking, is that something that i-- Would be even, uh, a reality? question communication behavior +98_344 Then, who are- who-who-who are they? question communication behavior +98_346 Would it-- other communication behavior +98_348 Yeah, so wha-what would-- What do you think it would do to the relationship of you not drinking but still being with the-these folks-- These friends? question communication behavior +98_350 Would-would it work out and-- question communication behavior +98_352 It's uncomfortable. reflection communication behavior +98_354 What makes it uncomfortable? question communication behavior +98_356 How-- So, messing with you would be like what? question communication behavior +98_358 Oh, and-and-- Oh, I see, yeah. other communication behavior +98_360 Yeah, like sort of- other communication behavior +98_362 Oh, yeah, yeah. other communication behavior +98_364 Right, so you make-- other communication behavior +98_366 Mm-hmm, and- other communication behavior +98_368 -it's [unintelligible 00:24:05]. I-I-I know that you, um- you value friendship and-and friendship is very important, uh, and, I'm just wondering how important, um, it would be for, uh, you to remain friends with them and still have your-your sobriety. question communication behavior +98_370 And see what happens. reflection communication behavior +98_372 Yeah-yeah, how important would it- would it be? Zero being not so important and 10 being pretty important that you-- question communication behavior +98_374 Mm-hmm. Okay. [unintelligible 00:24:52] something you'd be willing to try. Okay. therapist_input communication behavior +98_376 It sounds-- That sounds good. other communication behavior +98_378 Well, maybe that's something that we could talk about next time if you- if you want to. therapist_input communication behavior +98_380 Yeah. other communication behavior +98_382 Well, I sure-sure would, um, tell the-the people who-who need to know- therapist_input communication behavior +98_385 -and then, um- and then it would be up to you mostly. The choice is-is completely yours. And, um, it sounds like to me that there's no reason why you wouldn't be able to do this. You've given it a lot of thought, and you have some plans in place, and anything else that you might come up with, uh, to help you stay out of the driver's seat when you've been drinking. other communication behavior +98_387 Then you wouldn't have to worry. reflection communication behavior +98_389 Yeah, because worry's no fun. other communication behavior +98_391 All right. Well, thank you Mike. I appreciate this. other communication behavior +98_393 Thank you. other communication behavior +99_0 Steve, before we're done with our visit today, I was wondering if you'd be willing to take a few minutes to talk about your drinking. question communication behavior +99_2 Well, you filled out this survey for us today, which was great. Thank you very much. I just wanted to review a couple of things on here. I noticed that you said that you drink two to three times a week, drink three or four drinks at a time when you do drink, and weekly, um, have more drinks than that. So six or more drinks, it says on here. reflection communication behavior +99_4 Does that sound realistic? question communication behavior +99_6 Okay, okay. I just wanted to let you know, I'm a little bit concerned about your level of drinking. We know that excessive drinking can make problems worse or can actually cause health problems at times, and I was just wondering if you thought about the connection between your drinking and things like the anxiety and the insomnia that you came in with today? therapist_input communication behavior +99_8 Mm-hmm. other communication behavior +99_10 Mm-hmm. other communication behavior +99_12 Well, you're not alone, a lot of people think that drinking helps them sleep better, and in reality, drinking might make you fall asleep faster, but it has what's called this rebound effect, and this rebound effect means that you wake up, may, might wake up in the middle of the night or early in the morning and have a hard time falling back asleep. therapist_input communication behavior +99_14 Mm-hmm. Well, I just wanted to just show you this little chart here. For your age as a male, you're drinking more than those at a low-risk level. Um, the low-risk level for men under 65 is no more than 14 drinks a week and no more than four a day. And, in this case, a drink is considered 12 ounces of beer, 5 ounces of wine, or an ounce and a half of distilled spirits. And you're right, you're not drinking as much as some people out there. The way you answered our questions here, you're actually falling in the high-risk category, the risky or hazardous category, category two. therapist_input communication behavior +99_16 That's why it's helpful to look at this and give some perspective. On a scale of 1-10, what is your readiness to change, 1 being I don't want to change at all, and 10 is I really want to change? question communication behavior +99_18 Well, that's great. That's halfway there. What kept you from just giving it a one or two, something lower? question communication behavior +99_20 Mm-hmm. Okay. Well, that's a good place to start. So, I heard you say your health is important, and you're getting ready to run a marathon, so you wanna be able to do what you can to make that successful. And you also were a little bit surprised that you fell into this risky or hazardous category. reflection communication behavior +99_22 Okay. So, based on all that information, what are you willing to think about doing to change right now? question communication behavior +99_24 Mm-hmm. So, what would that look like for you? question communication behavior +99_26 Okay, okay. Well, sometimes when people aren't ready to make changes like this, it helps if they write down their goals, it gives them a chance to see them in black and white. If you were to look at this little form here and figure out where you want to go with your drinking, what would you put down as your goal? therapist_input communication behavior +99_28 Okay. So that's an improvement. So you're headed in the right direction. I do wanna let you know that with 18 drinks a week, you're still falling above this low-level risk category, and that it would be my recommendation that at some point you would fall below into this 14 or less a week. But it's an improvement, and it's a great place to start, and I really commend you for your willingness to take a look at this and try to make some improvements. therapist_input communication behavior +99_30 So I'm hoping that in your appointment next month, we can touch base on this and see how it's going. reflection communication behavior +99_32 Okay. Good. other communication behavior +100_0 There, um, what brings you in today? question communication behavior +100_2 It's really getting in the way of you becoming who you wanna be. reflection communication behavior +100_4 Yeah. So what-what-what about your criminal record is blocking you from getting where you wanna be? question communication behavior +100_6 There's a, uh, your record has a conviction? question communication behavior +100_8 Okay. Ah, there's- reflection communication behavior +100_10 -the big trouble. Yeah. reflection communication behavior +100_12 Mm-hmm. other communication behavior +100_14 Mm-hmm. So when you, um, when you put in applications or anything like that, the felony con-conviction, whether you know it or not, seems to knock you out of the ballpark. You're not even considered as an applicant? reflection communication behavior +100_16 Mm-hmm, mm-hmm. other communication behavior +100_18 Mm-hmm. other communication behavior +100_20 So do you- do you, um, put out there about the felony conviction before you even go for the interview? therapist_input communication behavior +100_22 Seems like it's a done deal. reflection communication behavior +100_24 Mm-hmm. other communication behavior +100_26 Mm-hmm. other communication behavior +100_28 So you didn't hurt anybody. reflection communication behavior +100_30 You didn't hurt anything, right? reflection communication behavior +100_32 Yeah. other communication behavior +100_34 Yeah, 'cause you're-you're, especially with going back to school and having done all that footwork and stuff. I mean, you really have something to offer somebody. reflection communication behavior +100_36 Yeah. And, um, and at the time the big crisis was actually maybe prison and all the crisis around the arrest and-and, uh, you know, it's like you're a leper and the leper colony. reflection communication behavior +100_38 Um, have there been any times when you've started the interview with that conversation so that you don't even have to go through the whole thing and then get rejected? therapist_input communication behavior +100_40 Mm-hmm. other communication behavior +100_42 What do you think would happen if you did that? therapist_input communication behavior +100_44 Mm-hmm. other communication behavior +100_46 Would that be, um, what would they be like versus getting through this great interview, knowing you're-you're good for the job and all that kind of stuff, and then they boot you out? therapist_input communication behavior +100_48 Mm-hmm. It's, uh, I mean the lesser of two evils is that what we're getting at- therapist_input communication behavior +100_51 Right. If that's a deal-breaker and you both know it from the very beginning, I'm wondering if then really the interview is really something else. I mean, whether they get the job would truly be based on the interview and not-not your criminal record. therapist_input communication behavior +100_53 Mm-hmm. other communication behavior +100_55 Not like you're working for the government or for a bank or, you know, the FBI where- those are not things you're applying for. They're jobs where you would wonder why a-a non-violent felony would even-- reflection communication behavior +100_57 Right. other communication behavior +100_59 Mm-hmm. other communication behavior +100_61 Mm-hmm. other communication behavior +100_63 Mm-hmm, you didn't go to college for that. reflection communication behavior +100_65 Mm. other communication behavior +100_67 Mm-hmm. other communication behavior +100_69 Mm-hmm. other communication behavior +100_71 Mm-hmm. So, what have you looked into about, um, you know, advocacy in that area or expungement or anything like that? therapist_input communication behavior +100_73 What did you find out? question communication behavior +100_75 Uh-huh. other communication behavior +100_77 I-I didn't know that. So I, you know, I know a little bit about it, um, and not, yeah. So that's-that's very interesting. Oh, what about advocacy groups? therapist_input communication behavior +100_79 Mm-hmm. other communication behavior +100_81 Mm-hmm. other communication behavior +100_83 Mm-hmm. other communication behavior +100_85 Mm-hmm. other communication behavior +100_87 Mm-hmm. other communication behavior +100_89 Mm-hmm. So you're-you're Middle Eastern. So you wonder-- I-I bet you've had experiences where you really have experienced some absolute racism and prejudice because of that. reflection communication behavior +100_91 And then, um, you walk into these places and they might just be almost storefront- reflection communication behavior +100_93 -type places. And the job market is terrible. therapist_input communication behavior +100_95 Mm-hmm. other communication behavior +100_97 Mm-hmm. Mm-hmm. other communication behavior +100_99 What do you have going for you? question communication behavior +100_101 Mm-hmm. other communication behavior +100_103 Mm-hmm. other communication behavior +100_105 Mm-hmm. other communication behavior +100_107 It's a long time. reflection communication behavior +100_109 Mm-hmm. other communication behavior +100_111 And you can- you can prove that and document that. reflection communication behavior +100_113 Yeah. A lot of folks can't. therapist_input communication behavior +100_115 Yeah. And you've been going to school. I mean, all-all your movement is in this really positive, highly motivated way. And, um- and I think your-your thoughts and ideas about the fact that one day a conversation will- you'll strike up with somebody and it will happen to be with somebody who works for a company that perhaps does not have a policy against hiring people with felony convictions. therapist_input communication behavior +100_117 It's individual. Yeah. reflection communication behavior +100_119 It-it is individual. reflection communication behavior +100_121 It-- I believe it is. therapist_input communication behavior +100_123 There's no-- I don't think, any State or federal law that says. therapist_input communication behavior +100_125 Okay. other communication behavior +100_127 Right person, right company- reflection communication behavior +100_129 -we're looking for here. Yeah. reflection communication behavior +100_131 Mm-hmm. other communication behavior +100_133 Mm-hmm. other communication behavior +100_135 I wonder what it'd be like if you ran your own background check and got the report to see what's in there. therapist_input communication behavior