HighLowQualityCounseling/transcripts/high_082

T:	hi gene I'm dr. sabe nice to meet how can I help you today 
C:	well doctor I made an appointment with you finally because I was diagnosed over three months ago with the pulmonary disease COPD yes and although I didn't call right away I really need some help in quitting smoking right so I thought well this is my first step so it's time to do something 
T:	something okay so you've been diagnosed by this progress brother just diagnosed that and and how are you feeling right now 
C:	I'm I'm really scared because I don't feel well I haven't felt well for a while I'm getting coughing fits even when I'm on the telephone with customers
T:	it sounds like you've been smoking for such a long time and then this diagnosis was given to you and now that's really causing you to be afraid and frightened 
C:	mm-hmm I I don't know what I'm going to do about it okay
T:	no have you thought about when you want to quit
C:	fine I'm giving myself six months six months and and that seems like a long time away but I have a feeling I'm going to fail at this point in time I don't even have % faith in myself 
T:	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 under confident that you'll actually be able to do this and your word about failing 
C:	I don't know what to do I've tried to quit smoking I've had I've taken pills I've taken the patch I've gone through therapy nothing's helped I finally I went to the doctor I was actually in the hospital they took me to the hospital for a week that's the longest I quit 
T:	so you've been able to quit smoking but only when you were in the hospital 
C:	I had no choice I have no choice and then next day I was back to smoking again what I smoked okay
T:	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 this could you tell me what is good about smoking for you
C:	it's part of my life it's I started smoking when I was   at home my parents smoked all their friends smoked it was on television everybody looks so grand smoking and all dressed up and and fancy clothes and had me be having a drink in their hands and having a nice meal I didn't really think about it's just an extension of me I guess it's good for my nerves right I mean I feel like it is I know when I've got a package in my pocket or I know if I'm going through some stress I say oh I'll have a cigarette and think this out sure
T:	so gene I want to make sure that I understood what you've told me of what do 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 feel sophisticated you feel like a movie star in fact the way you talk about it seems like that's what it makes you feel like is that right that's right okay is there anything I missed
C:	um I enjoyed it just it relaxes me it's great after a meal yes um free mm-hmm we all just do it it's a little group of people my family right the people I work with we go out in the courtyard have a cigarette and talk that's how you make friends a lot of people would like a little group now we're all a little bunch of us 
T:	so it's hard for you to quit smoking when everybody else around you're smoking and it's so easy to go and take a break and have a cigarette
C:	I I never thought of it that way but probably you're right now 
T:	you've told me what is good about smoking for you ah can you tell me what it's not so good about smoking for you 
C:	well it's bad for my health and it's scaring because I don't feel well I haven't felt well for a while I'm getting coughing fits even when I'm on the telephone with customers
T:	is there anything else that's not good abouts looking for you 
C:	um it's expensive really god expensive and I smoked  sometimes  cigarettes a day and I'm starting to buy a different makeup because I'm starting to really age starting to get lines in my face and wrinkles and my skin is getting really clogged up and I'm spending a fortune on cosmetics 
T:	okay so let me make sure I've understood this piece as well so they're not good things on the not so good things about smoking for you are the effects on your health the effects on your physical appearance on how you look and the amount of investment that you do making in makeup and in getting your nails done etc and then the cost of smoking yes so so let me ask you this given everything going on in your life right now on a scale of  to  where  is the most important thing to do and one would be the least important thing to do how important is it for you to quit smoking 
C:	it's for me for my health and for the money and everything I said I would say it's  or out of  that I should quit smoking 
T:	definitely most important 
C:	yes a hundred percent one of the most important things 
T:	let me ask another question and follow-up to that again given everything going on where  is the most confident you ever felt about anything and one is the least confident how confident are you that you will be able to quit 
C:	um I'd say  or  percent confident sorrowful yeah I'd like to say more but um 
T:	okay now help me understand why you said  and not something like  or  because you mentioned that you don't even want to quit 
C:	well I'm I guess I'm still a fighter and III it's starting - I'm starting to realize it and I do feel pretty good that I came to see you it was a step and a couple of people who care about me actually gave me a pat on the back that I came to see you so this was big step so I guess yes it wouldn't have been as high maybe last week okay
T:	so you've said  to  percent what would it take to build that confidence to about % 
C:	maybe if I could come to see you again or maybe some ideas were suggested maybe if there was a group or something I I don't know but I need some help
T:	so if you got help that would help you say that you went from % to % 
C:	I think so because I feel a little better that I just came to see you today okay discussing things helps me I always feel better when I get things out okay
T:	so Jean I really want to congratulate you on taking this very important for a 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 is 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 notice 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
C:	in other words think about it more don't don't just do it automatically 
T:	that's correct and writing it down helps that process
C:	yeah I think so because and when I get the urge I could maybe fight it and maybe wait till the next urge and maybe mark that down that I didn't go right away when something went wrong and yes I can try that 
T:	okay and I can give you a little card that can help you keep track of it and then if you can bring that back to the next appointment it could be something we could discuss okay anything else 
C:	no that gives me something to work towards until I see you next week
T:	excellent well thank you so much for coming in today and thank you for seeing me doctor you're welcome