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100_78
I've looked into, um, a fe- um, I've looked into a few groups that are supposedly helping convicted felons get-
neutral
communication behavior
100_80
-work.
neutral
communication behavior
100_82
Um, again, the-the only-- I mean, I think what I saw was a whole bunch of, you know, dead end jobs.
neutral
communication behavior
100_84
And the other thing that I saw was that it was very politically charged. You know, I didn't think that, um, I was, uh, you know, allowed to kind of get an interview right away with one of those counselors that they offer. Um, I-- it just didn't seem like a type of place that was willing to help, you know. And-and, uh, I saw that there was a lot of, um, I wouldn't say racism but I would say a little bit of racial favor, I suppose. And, uh, I found it really hard to get in and to get an interview with a counselor to match me up with a job. Um, I think that those-those types of groups are cool if they work. I just haven't had any luck with, um- at working with- through that group.
neutral
communication behavior
100_86
You know?
neutral
communication behavior
100_88
Um, you know, I don't know. I don't know if there's anything else out there.
neutral
communication behavior
100_90
Mm-hmm.
neutral
communication behavior
100_92
Mm-hmm.
neutral
communication behavior
100_94
Right. It's-it's, uh-- There is a lot stacked up against me.
neutral
communication behavior
100_96
Let's just put it like that.
neutral
communication behavior
100_98
You know, uh, but that isn't—
neutral
communication behavior
100_100
Well, that's what-- yeah. That's-- I mean, uh, I'm able to, um-- I'm able to carry a conversation.
neutral
communication behavior
100_102
So at some point, I would imagine that maybe I strike up conversation with the right person-
neutral
communication behavior
100_104
-that would probably want to hire me regardless of that sort of thing. Um, I think that at the this point in time, that it doesn't really matter what degree you have. I don't believe that it matters where you went to school. I think it's all about who you know. You know, we live in a very politically charged city. And I think that even if we didn't live in a politically charged city, at this point, jobs are so scarce that people who know people who know people are the ones that are ending up, um, at work-
neutral
communication behavior
100_106
-and getting jobs. And I think that, um, if I continue to, you know, go to school and, uh, you know, uh, get time from that felony, you know. So it's been seven years now and—
change
communication behavior
100_108
Yeah. And at some point, I probably don't even have to report it, you know, and I have that going for me. It's been seven years. I have the fact that I'm, you know, uh, good at, um, interaction with people, that's good.
neutral
communication behavior
100_110
You know, um, I've been clean from that sort of lifestyle for that long so that's-that's-that's up for me, you know, that's-that's good. Um—
change
communication behavior
100_112
Yeah.
neutral
communication behavior
100_114
They don't.
neutral
communication behavior
100_116
Yeah. Well, that's my hope.
neutral
communication behavior
100_118
Yeah. That's my hope.
neutral
communication behavior
100_120
It is. It should be. You know, I-I—
neutral
communication behavior
100_122
Yeah.
neutral
communication behavior
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