Upload 103 files

Counseling dataset

HighLowQualityCounseling/README.txt

@@ -0,0 +1,58 @@
+High and Low Quality Counseling Dataset
+===================================================================
+Verónica Pérez-Rosas, Xinyi Wu, Kenneth Resnicow, Rada Mihalcea
+University of Michigan
+
+vrncapr@umich.edu
+wuxinyi@umich.edu
+kresnic@umich.edu
+mihalcea@umich.edu
+
+Version 1.0
+July 2019
+-----------------------------------------------------------------
+1. Introduction
+This document describes the dataset used in the paper: What Makes a Good Counselor? Learning to Distinguish between High-quality and Low-quality Counseling Conversations (Perez-Rosas et. al, 2019).
+
+-----------------------------------------------------------------
+2. Content
+
+The archive contains three folders and one README file. The README (this file) contains information about the data collected and their sources as well as citation and acknowledgements information.
+The folders are as follows:
+- Transcriptions: The folder includes the transcripts of counseling conversations in the dataset. 
+- labels.csv: a csv file containing the id of the transcript and its corresponding label.
+- urls.csv: a csv file pairing the transcript id and the video url in YouTube  (whenever available). Urls retrieved  as of July 15th, 2019.
+-----------------------------------------------------------------
+3. Dataset Information
+The dataset consists of counseling videos that are publicly available on YouTube channels and other public websites.  The set of videos consist of Motivational Interviewing (MI) counseling demonstrations by professional counselors and MI role-play counseling by psychology students. Each video portrays different speakers and the conversations cover various health topics including smoking cessation, alcohol consumption, substance abuse, weight management, and medication adherence. More details on the data collection process are available in the paper that introduced the dataset (Perez-Rosas et al, 2019; full reference below).
+
+The dataset consists of 259 counseling conversations, with 155 video clips labeled as high-quality counseling and 104 labeled as low-quality counseling. The length of the conversations in the dataset ranges from 5-20 minutes.
+
+-----------------------------------------------------------------
+5. Transcripts 
+
+Transcriptions of the videoclips were collected using YouTube automatic captioning and Mechanical Turk whenever automatic transcription was not available. Speakers in the conversations are labeled manually and also following a heuristic to label the speaking sequence. 
+
+-----------------------------------------------------------------
+6. Feedback
+For further questions or inquiries about this dataset, you can contact: Veronica Perez-Rosas or Rada Mihalcea
+vrncapr@umich.edu
+mihalcea@umich.edu
+
+-----------------------------------------------------------------
+7. Citation Information
+Bibtex:
+@article{Rosas19What,
+author = {P\'{e}rez-Rosas, Ver\’{o}nica, Xinyi Wu, Kenneth Resnicow, and Rada Mihalcea},
+title = {What Makes a Good Counselor? Learning to Distinguish between High-quality and Low-quality Counseling Conversations},
+journal = {Proceedings of the 57th Annual Meeting of the Association for Computational Linguistics},
+year = {2019}
+}
+
+
+Text:
+Verónica Pérez-Rosas, Xinyi Wu, Kenneth Resnicow, Rada Mihalcea. 2019. What Makes a Good Counselor? Learning to Distinguish between High-quality and Low-quality Counseling Conversations. In Proceedings of the 57th Annual Meeting of the Association for Computational Linguistics (ACL). Florence, Italy. 
+
+-----------------------------------------------------------------
+8. Acknowledgements
+This material is based in part upon work supported by the Michigan Institute for Data Science, by the National Science Foundation (grant #1815291), and by the John Templeton Foundation (grant #61156). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the Michigan Institute for Data Science, the National Science Foundation, or John Templeton Foundation. 

HighLowQualityCounseling/labels.csv

@@ -0,0 +1,260 @@
+id,label
+high_001,high
+high_002,high
+high_003,high
+high_004,high
+high_005,high
+high_006,high
+high_007,high
+high_008,high
+high_009,high
+high_010,high
+high_011,high
+high_012,high
+high_013,high
+high_014,high
+high_015,high
+high_016,high
+high_017,high
+high_018,high
+high_019,high
+high_020,high
+high_021,high
+high_022,high
+high_023,high
+high_024,high
+high_025,high
+high_026,high
+high_027,high
+high_028,high
+high_029,high
+high_030,high
+high_031,high
+high_032,high
+high_033,high
+high_034,high
+high_035,high
+high_036,high
+high_037,high
+high_038,high
+high_039,high
+high_040,high
+high_041,high
+high_042,high
+high_043,high
+high_044,high
+high_045,high
+high_046,high
+high_047,high
+high_048,high
+high_049,high
+high_050,high
+high_051,high
+high_052,high
+high_053,high
+high_054,high
+high_055,high
+high_056,high
+high_057,high
+high_058,high
+high_059,high
+high_060,high
+high_061,high
+high_062,high
+high_063,high
+high_064,high
+high_065,high
+high_066,high
+high_067,high
+high_068,high
+high_069,high
+high_070,high
+high_071,high
+high_072,high
+high_073,high
+high_074,high
+high_075,high
+high_076,high
+high_077,high
+high_078,high
+high_079,high
+high_080,high
+high_081,high
+high_082,high
+high_083,high
+high_084,high
+high_085,high
+high_086,high
+high_087,high
+high_088,high
+high_089,high
+high_090,high
+high_091,high
+high_092,high
+high_093,high
+high_094,high
+high_095,high
+high_096,high
+high_097,high
+high_098,high
+high_099,high
+high_100,high
+high_101,high
+high_102,high
+high_103,high
+high_104,high
+high_105,high
+high_106,high
+high_107,high
+high_108,high
+high_109,high
+high_110,high
+high_111,high
+high_112,high
+high_113,high
+high_114,high
+high_115,high
+high_116,high
+high_117,high
+high_118,high
+high_119,high
+high_120,high
+high_121,high
+high_122,high
+high_123,high
+high_124,high
+high_125,high
+high_126,high
+high_127,high
+high_128,high
+high_129,high
+high_130,high
+high_131,high
+high_132,high
+high_133,high
+high_134,high
+high_135,high
+high_136,high
+high_137,high
+high_138,high
+high_139,high
+high_140,high
+high_141,high
+high_142,high
+high_143,high
+high_144,high
+high_145,high
+high_146,high
+high_147,high
+high_148,high
+high_149,high
+high_150,high
+high_151,high
+high_152,high
+high_153,high
+high_154,high
+high_155,high
+low_001,low
+low_002,low
+low_003,low
+low_004,low
+low_005,low
+low_006,low
+low_007,low
+low_008,low
+low_009,low
+low_010,low
+low_011,low
+low_012,low
+low_013,low
+low_014,low
+low_015,low
+low_016,low
+low_017,low
+low_018,low
+low_019,low
+low_020,low
+low_021,low
+low_022,low
+low_023,low
+low_024,low
+low_025,low
+low_026,low
+low_027,low
+low_028,low
+low_029,low
+low_030,low
+low_031,low
+low_032,low
+low_033,low
+low_034,low
+low_035,low
+low_036,low
+low_037,low
+low_038,low
+low_039,low
+low_040,low
+low_041,low
+low_042,low
+low_043,low
+low_044,low
+low_045,low
+low_046,low
+low_047,low
+low_048,low
+low_049,low
+low_050,low
+low_051,low
+low_052,low
+low_053,low
+low_054,low
+low_055,low
+low_056,low
+low_057,low
+low_058,low
+low_059,low
+low_060,low
+low_061,low
+low_062,low
+low_063,low
+low_064,low
+low_065,low
+low_066,low
+low_067,low
+low_068,low
+low_069,low
+low_070,low
+low_071,low
+low_072,low
+low_073,low
+low_074,low
+low_075,low
+low_076,low
+low_077,low
+low_078,low
+low_079,low
+low_080,low
+low_081,low
+low_082,low
+low_083,low
+low_084,low
+low_085,low
+low_086,low
+low_087,low
+low_088,low
+low_089,low
+low_090,low
+low_091,low
+low_092,low
+low_093,low
+low_094,low
+low_095,low
+low_096,low
+low_097,low
+low_098,low
+low_099,low
+low_100,low
+low_101,low
+low_102,low
+low_103,low
+low_104,low

HighLowQualityCounseling/transcripts/high_001

@@ -0,0 +1,19 @@
+T:	hey Monica how are you doing today
+C:	I'm okay right now but I'm a little anxious because thinking about how Black Friday is soon and my friends want to go to the mall for Black Friday but I really can't go and I want to go but I really to interesting
+T:	so it sounds like you really want to go to Black Friday with your friends you're feeling a little anxious about it
+C:	yeah Monaco but interesting but I was thinking about it and maybe if I could make an image or something that I could use while I'm there maybe I'd be able to go so I was wondering if I could give you that very well
+T:	that sounds like a great idea can absolutely do that
+C:	okay
+T:	so we have some materials on the table but if you'd like to use anything else that we've used previously just let me know and I'll get them to you for you
+C:	um do you have a Sharpie
+T:	it do did you have a color that you wanted
+C:	black maybe
+T:	all right here
+C:	this
+T:	welcome
+C:	ok I think I'm done
+T:	all right is there anything you'd like to tell me about it
+C:	well I'm sure um I drew mountains and lake because when I think about things like Unicom I think of nature so I drew a scene that I think would keep me calm
+T:	so it sounds like nature and mountains are coming to you do you think that this will be helpful I'm black Franny
+C:	yes as long as I can remember to think about this image when I'm there but maybe I'll bring it with me when I go so I can refer to it when I'm anxious
+T:	that sounds like a great idea

HighLowQualityCounseling/transcripts/high_006

@@ -0,0 +1,110 @@
+T:	hi Andrea thanks for coming in
+C:	thank you
+T:	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 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 want to 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 that sound okay all right so why don't we start by you telling me a little bit about yourself
+C:	sure um as you know I'm Andrea I uh I'm a junior I'm in the marching band I played at center sacks I mean yeah I'm also in the little bit of a band geek I play you know the Wind Ensemble and the Jazz Band things like that
+T:	wow you really are involved in music
+C:	yeah
+T:	when did you start
+C:	I started playing about 10 years ago actually
+T:	Wow
+C:	yeah I start on the violin first and then I went on explored a little with the piano clarinet finally found the tenor sax hmm yeah
+T:	very cool I've always wanted to be good at music all right so it sounds like you're in band and a few other musical ensembles any other hobbies you have or things you like to do for fun
+C:	um you know just hanging out with my friends or go to the beach things like that
+T:	it's kind of everyday sort of thing okay tell me a little bit about your family
+C:	uh well I have one older brother he's about eight and a half old years older than me my parents and I have dog
+T:	cute what kind of dogs
+C:	the golden retriever
+T:	oh nice
+C:	I'm a big boy
+T:	very fun all right and how are things going in school for you
+C:	pretty good grades have been pretty all right still like 3.7 ish
+T:	okay great so you're doing well what sorts of goals do you have for after college or after high school
+C:	I'd like to you know I'd like to of course graduate high school hopefully go to a nice Ivy League school or I mean that might not happen and then I'd like to go on become a doctor study psychology you need to come a psychiatrist or something
+T:	okay you have some pretty big dreams
+C:	yeah
+T:	it's great that's really exciting to think about that and he's going to 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 a little sheet that goes through just some basic values that might be more or less important to certain people 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
+C:	um I think a sense of community and belonging
+T:	okay
+C:	I think those two and um respect respect
+T:	okay can you tell me a little bit about why you picked those three
+C:	yeah well I think the community belonging I kind of related them um you know how I said I was in the marching band I really you know I really enjoyed being in like that team setting of you know being with other people and all working to work together towards that one goal
+T:	mm-hmm
+C:	and then in terms of respect I I kind of view that as one of like my major like rules like I I really do think respect is important to respect myself or respect those around me so
+T:	okay
+C:	I place great importance in that
+T:	okay great so sort of being a part of a group and being a part of a team gives you a sense of belonging like you said a sense of purpose anyway and then the respect is really sort of all-encompassing it's not just Authority but respecting yourself respecting your teammates or your bandmates and other people around you okay that's great all right well one of the things I want 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
+C:	um sometimes if you just you know go to the movies go to the beach like I had said or sometimes we just get together someone's house play some board games and hang out
+T:	mm-hmm and when you're hanging out with friends is there ever alcohol involved
+C:	yeah sometimes
+T:	okay can you tell me a little bit about how alcohol fits into sort of your social scene
+C:	uh well it's mostly just for for parties or party settings it's kind of to get things going and got everything loosened up as they say
+T:	mm-hmm and so when you go to parties most of the time there's alcohol there okay and how often do you think you would say you're drinking
+C:	I'd say um on a not busy month for instance I'd say about like two weekends out of the month two three
+T:	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
+C:	the days that we drink are mostly like I said they're parties so it's more of that whole partying and dancing and you know having everyone have fun and then when we don't it's a lot more relaxed it's a lot more hanging out playing board games watching a movie it's not yeah
+T:	so it really depends on what the activity is whether or not alcohols get
+C:	definitely
+T:	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 and that you're playing board games
+C:	I think of them as as different I think you know like in playing board games and things it's meant to be relaxing so it's nice to have like that kind of breather versus with a party it's a lot more energetic it's a after at all it's very draining
+T:	mm-hmm
+C:	but in the moment it's quite fun to dance and have
+T:	okay so there's sort of pros and cons
+C:	oh yeah
+T:	okay what are the things that you like about drinking or like about alcohol
+C:	um it's you know when we drink we we tend to have more fun because I guess we're not you know everyone's drinking together we're a lot more loosened up and relaxed and not really thinking about stresses or things like that but it can be when it's too much drinking it can be can be obviously bad
+T:	okay so sort of in the the too much drinking or our times can you tell me some of the less good things or not so good things about alcohol
+C:	um a lot of times it will make make people stupid yeah you know people make dumb decisions and things like that we we usually try to be as safe about it as possible so like sleepover friends house and so you know we're not driving and it's mostly within our friend group so we're not worried about strangers putting weird things in our drinks but um definitely some of the ideas people can have when they're stupid when they're drunk can can be really stupid
+T:	hmm so you're trying to like you said not engage in really dangerous activities you're trying to stay put you're not driving you're trying to stay with people that you trust but yet it sounds like there's still some some things happening
+C:	sometimes yeah
+T:	can you tell me a little bit about that
+C:	well I especially don't like it whenever me or one of my friends like we drink too much and we hadn't up like throwing up and things like that that I don't that's not fun
+T:	yeah throwing up is never fun it's not and how often do you think that happened
+C:	for me that's happened to me once it was the first time I ever drank and it was it was a lot and you know what I was doing I was mixing all kinds of weird things I'm just kind of taking anything ever anyone gave me and that didn't end well but after that I have it but I do have friends that that still do sometimes so I'll end up like having to take care of them or something and
+T:	okay
+C:	it kind of put it down around my my fun
+T:	huh okay so on the one side some of the fun things associated with alcohol are people are just more relaxed sort of carefree and kind of let loose a little bit more on the other hand there's a little bit more I guess planning involved because you have to make sure that you're doing it safely or as safe as you can and then 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 you drink too much okay any other not-so-good things about the alcohol
+C:	yeah people can get a little like sloppy I guess like they're all loose like with people and corners doing things that should be done in private and that kind of stuff
+T:	so you're kind of stuck being exposed to things you don't mean busy
+C:	yeah
+T:	got it okay all right well you mentioned a couple times that you've made a few decisions to try and limit the a dangerous aspect of the drinking why did you make those decisions
+C:	I just I you know have an aunt who is an alcoholic so I I see like the issues that are involved and I've seen movies and things I know that drunk driving is an issue so I you know I want to be as safe as possible in those terms and be in a setting where like we can let loose but still be safe like I someone's house or someone's parents home or something but so I like I know that there are dangers involved and I guess I want to limit that and still be able to have fun
+T:	okay yeah it sounds kind of similar to your your value of respect too so on the one hand you the drinking maybe helps with the belonging community to start if there's too much then
+C:	it sort of defeats the purpose
+T:	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 how do you think that the drinking fits in with that
+C:	in terms of what in terms of respect I think well in a way I do think that drinking is probably a form of disrespect to my own body because I'm not putting things I'm putting things in it that shouldn't be there and then but in terms of hot ways I am respecting myself I am I'm respecting myself by like trying to stay in someone's house and like trying to limit my drinking so I don't get to that blacked out like throwing up and everything and try to you know let loose but still be in control of my behavior so I'm not going to go with some random person I met in - I don't know where to do I don't know what and things like that
+T:	okay so you're sort of looking for that balance yeah how much you can drink to have some of the positive benefit but about crossover okay and what have you come up with it at this point do you have sort of a limit that you stick to or
+C:	usually well I start off by make sure that I make my own drink so I know what's in it how much is in it so that way I control how much I drink so I'll usually just you know get one of those cups and then make one drink and then I'll try to make it last as long as possible and I'll be like all right this is my one drink and I'm good in that way I still have something in my cup some people aren't going to be like oh here have some more like no I'm good I have mine and I'll still be you know having some to like let loose a little
+T:	mm-hmm and do you feel like that's working pretty well for you or you sometimes exceed that limit or or what do you think
+C:	for the most part it works pretty well because like I said people you know people come asking me trying to pressure me I'll be like no I'm good I have you know I still have so I'm like I'll get some later and then never end up getting anything but sometimes they'll be like hey let's take a shot and everyone's got it around like the kitchen or something ready to take a shot and then at that point I'll be like oh well maybe I can take one more and that's when I start you know falling into
+T:	okay
+C:	too much
+T:	so a portion of the time it's working well for you and another portion of the time maybe you like
+C:	I'd
+T:	like to make some adjustments to to make it a little smoother okay so kind of thinking along those lines how important is it to you to make some changes or make some adjustments to your drinking to sort of fit with your values and your goals for yourself
+C:	um I'd like to make sure that I you know in terms of respecting myself of my body I'd like to you know try to drink less
+T:	okay
+T:	like I you know it is nice to let loose and have fun but I'd also like it to be so you know I'm not damaging my body and I like my liver doesn't work by the time I'm like 22
+T:	mm-hmm
+C:	and um you know have my friends on board with a similar mentality so we can kind of work at it together as a group as a community
+T:	uh-huh so kind of combined he has goals okay so you're 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 on on the scale of one to ten where one is not at all important antennas it's the most important thing right now
+C:	I'd say about like like a six or a seven oh I like to work on it but you know if I get around to it I get around to if I don't I don't
+T:	uh-huh well why did you say six or seven rather than like a four
+C:	um because I still think it's it's important
+T:	uh-huh
+C:	I still you know like I said I don't want my body tried specially going to my school like I know how things affect your body and also affect your your social and your schoolwork and things like that I know that once I get to college it's not it's not gonna gonna work out being you know drinking every weekend and I'm like trying to wake up early and go to school take an exam I know that's not that's not feasible it's not a good idea
+T:	yeah looking ahead you can't keep drinking this way and reach the goals that you have for years now okay well how confident are you that you could cut down if you wanted to
+C:	I think
+T:	on that same scale from one to ten
+C:	I think if I made the decision I was going to for sure then I think definitely like a ten I know I
+T:	oh wow okay why did you say ten
+C:	it's just because I know that once I make the decision I know I can making the decision in the first place okay weather
+T:	okay and so you mentioned you know quite a few reasons why you would like to cut down have you thought at all about how you might go about doing that
+C:	um I'm thinking of maybe like trying to convince my friends without sounding you know dorky or something be like hey you know let's just stay in today like let's not go out or something or just be like hey I'm not like I'm not going to drink today and even if my friends do like being okay with them drinking around me not doing it and then then being okay with me drinking me not drinking and them doing whatever they want
+T:	so sort of trying to plan more activities that don't involve alcohol and then also trying to participate in activities without drinking yourself or maybe even drinking less than you're drinking okay does that sound like a goal you want to work on now or
+C:	I think so I think it's it's very feasible I think it's possible
+T:	okay um so I guess we'll talk about less alcohol activities and just making some notes to myself and then maybe I'm reducing the amount of drinking that you're doing if alcohol is involved okay so that's that goal sounds feasible you said would it be okay if we met in a couple weeks to sort of see how it's going
+C:	I think so that's good
+T:	does that sound like something you'd like to do okay well I really appreciate you spending the time talking to me and you know it sounds like you have a lot of really good goals for yourself really ambitious goals and going to medical school and you know becoming a psychiatrist or some some other form of physician you're really looking forward to doing well in school so you can get there and it sounds like you have a pretty active social life and a lot of friends who you feel probably would be 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 you 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 drinking too much 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 interested in meeting again and be very excited to be able to talk with you about how it's going
+C:	I'd like to
+T:	alright great so I'll plan to see you then in a few more weeks
+C:	Thanks

HighLowQualityCounseling/transcripts/high_007

@@ -0,0 +1,27 @@
+T:	hi Lucy nice to see you today how you been going
+C:	yeah well thanks
+T:	great I'm just fully get started has anything changed with your medical history since I last saw you like any new medications or serious operations
+C:	No
+T:	great and is anything maybe worrying you about your teeth or your gums today
+C:	I think I might have a hole in my tooth
+T:	oh no what makes you say that
+C:	I can feel it with my tongue and it's a bit sensitive
+T:	mmm well let's lie you back I'll pop some gloves on and we'll have a little look Lucy it definitely looks like you need a filling um I'd love to help you figure out why you've got this new hole in your tooth do you mind if I ask you a few questions so we can try and figure it out
+C:	Yeah of course
+T:	great well here's a risk assessment form it's just a few questions that might help us figure out what the problem might be
+T:	great yeah it says here that you're drinking soft drinks in between meals what do you know about the effect of soft drinks on your teeth
+C:	I know it's not good for them
+T:	that's right um the bacteria in your mouth can use the soft drink to create acid that eats into the tooth surface and causes the holes the more that your teeth are coated in the sugar the more likely it is that you'll develop a hole did you know the one can of soft drink can have 10 teaspoons of sugar in it
+C:	I didn't know that so I shouldn't have soft drinks at all I'm not sure I could do that
+T:	yeah I understand it does sound like you're worried about getting holes in your teeth though there are a few options that you can do to help improve how you consume sugar would you like to hear about those
+C:	well I don't like getting feelings so that would be great
+T:	yeah probably drinking soft drink you could try drinking it all in one go instead of sipping on it or you could try drinking just at mealtimes instead of in between meals so does either of those sound like they might work for you
+C:	yeah I mainly sort of drink soft drinks in between meals though maybe I could just have them with lunch and dinner
+T:	great I'm in Romania to get a break from the sugar I sort of on a scale of 1 to 10 with 10 being the most how motivated do you feel you are to make this change
+C:	I don't like getting feelings so an 8 or a 9
+T:	great and you maybe have any ideas that you could implement to help you avoid having soft drinks in between meals
+C:	I could carry a water bottle around with me
+T:	great that's a really good strategy and waters great for you too umm you can also try chewing sugar-free gum I mean is that something you're interested in
+C:	I might give the water bottle a try first
+T:	okay cool well look I'll put a little note in your file and the next time I see you if it's okay I'll check how you're going with avoiding soft drinks between meals
+C:	yeah that'd be fun and hopefully I won't have any holes next time

HighLowQualityCounseling/transcripts/high_008

@@ -0,0 +1,11 @@
+T:	so Jane it sounds like you're angry with your supervisor would what would I be right in saying that
+C:	well I think I'm pretty angry
+T:	all right look maybe to help me understand you know more about that anger I'm wondering if you could you know choose two or three pictures here that look like how you were angry at the time which which of the cards here that would show how angry you were okay don't I might just take a look at those okay it does look like anger doesn't it it's a pretty big anger so after you'd had that you know a big thing with your mum you you went to your room right
+C:	well she got really angry at me because on the way to my room my idiot sister got in the way so I pushed her out of the way she's just annoying so then I went into my room the only place that I really feel safe slammed the door and then mums favorite picture fell on the floor
+T:	thank you for sharing that with me because it really and being for being so honest about your anger because what it does is help I don't know if it's helping you but it's certainly helping me to understand that this is really big for you and it's a big expression but surprisingly you know anger anger's a good thing in a way because it's it's letting you know that something wasn't right and wasn't fair that he he just did change the thing without your permission without you knowing so in some ways you had a right to be angry but what happens what I heard you saying in as you were telling me what happened next what happened next was that your anger took charge and he it did more than what it's meant to do your your anger is just just to let you know that you're angry okay but what it did what I feel it did it just pushed you out of the road and said I'm I'm taking control here so Jane when you were angry did you feel it anywhere in your body
+C:	well my neck is really sore and its really paining and and my shoulders I just it's really like it's it just feels like I've been I've been hit by something
+T:	the end of the day that that pushing your sister over and yelling at your mum did
+C:	it's made it worse yeah
+T:	yes which is hard to see at the time I I do understand that but what I'm thinking is that if sometimes if we tell our anger look thank you you've done a good job it doesn't have to get so angry then because you you know you you're telling it that it's thank you you've done a good job you've let me know I'm angry now I'm going to deal with it from here
+C:	you have to help me with that a bit i think
+T:	we will

HighLowQualityCounseling/transcripts/high_009

@@ -0,0 +1,21 @@
+T:	hi I'm Amy the pharmacist so I understand you have some questions
+C:	hi I'm Mario and my doctor suggested I talked to a pharmacist about quitting smoking do you have the time for this
+T:	sure why don't you tell me a little bit about what you're thinking how soon you'd like to quit and why you want to quit
+C:	my cholesterol and my blood pressure are high my father and my uncle both had heart attacks when they were pretty young so my doctor's been telling me that if I quit I'll cut down on my chances of having a heart attack
+T:	that's correct quitting would be important for you and it will reduce your chances of having heart problems
+C:	so that's the situation I've tried to quit a couple of times before but it didn't work so what I was hoping is that you could go over the different options and help me pick the best one
+T:	hmm I'd be happy to do that first tell me exactly which products you used and more importantly how you use them
+C:	first I tried the gum I like to chew gum so I thought this would be good so I chewed about three to four pieces of gum a day but I was miserable and I started smoking after four days then I tried the patch a couple of months later I felt pretty good for about a week so I quit using it didn't think I needed it anymore started smoking two days later
+T:	based on what you've told me it sounds like you didn't get the full benefit of the product a few pieces of gum won't get enough nicotine into your body to make you comfortable you need at least nine pieces a day for it to be effective and it has to be used in a very specific way not chewed like regular chewing gum
+C:	I admit I didn't read the directions last time
+T:	as for the patch sounds like it worked for you you just didn't stay on it long enough we recommend 10 to 12 weeks and this gets enough nicotine into your body to help reduce most of the withdrawal symptoms while you work on learning to live your life without cigarettes you were able to quit for a week with it so it seems like it might be a good choice now but there are others as well
+C:	yeah my doctor said something about a pill I didn't like the taste of the gum much
+T:	well that's understandable but you should know there are new flavors that my patients say tastes better to be honest all the medications are effective it's just a matter of what you prefer you've already tried the patch there's also a nicotine lozenge a nasal spray an oral inhaler in tablet form we have bupropion which you've probably heard called zyban and there's a newer medication varenicline or chantix
+C:	yeah I've heard of those but I think I'd rather stick with the patch and this time I'm gonna make sure I keep it on long enough it
+T:	sounds like a good choice for you and given that you have some experience with it and you know that it works for you um how many cigarettes do you smoke a day
+C:	about a pack a day
+T:	okay so you'll want to start with the 21 milligram patch for six weeks and then the 14 milligram patch for two weeks and then the seven milligram patch for the last two weeks it's pretty easy to use in the morning of your quit day I want you to put one patch on a hairless part of your upper body and leave it on for 24 hours and the next morning you take that off you put another patch on in a different location you want to switch site so you don't get any skin irritation if you have trouble sleeping you can take it off before you go to bed you read the directions on the box and if you have any questions let me know
+C:	okay I'm gonna try it again and read the directions and stick with it this time
+T:	one more thing there are two parts to smoking so there are two parts to quitting it's an addiction to nicotine and a habit the patch will take care of the physical addiction and help with the withdrawal symptoms but you'll have to make changes in your behavior if you want to stay quit for good
+C:	yeah dr. Ward mentioned that to me and he gave me the card for this quitting line
+T:	that's perfect our stay quit line is excellent and convenient so let's talk about picking a quit date and we'll get you set up with a box of patches

HighLowQualityCounseling/transcripts/high_013

@@ -0,0 +1,29 @@
+T:	there's great seeing you thank you for coming to diabetes clinic today my name is Mark Smith I'm a pharmacist I work with dr. Pham and I we run the diabetes clinic and we basically serve to educate our patients so that I can better manage their their diabetes and looking at your chart I see that you are pre-diabetic so what we're going to do now is kind of focus on nutrition mostly diet and exercise okay
+C:	dr. Pham already made me get a nutritionist I know what you're going to tell me so Kyle Eve
+T:	okay okay that's fine I'm glad you had the opportunity to talk with the nutritionist I'm she's a very nice lady and she has some very valuable information do you mind telling me some of the things that she discuss with you
+C:	it's the same stuff you're gonna tell me
+T:	okay well I will show you what I normally go through with my patients and then you can let me know if there's any information that you covered with the nutritionist or any of the material it's new to you then that would be great as well basically we feel that going over the nutrition aspect of diabetes and pre-diabetes is so important there's so much that we can do without taking medications and we've seen many patients that have benefited from making just minor changes to their diet that are greatly impacted their health in a very positive way so to start off I'm just going to ask you a few questions about what you eat to get a better picture of your diet so first what did you have for breakfast
+C:	couple eggs bacon biscuits great
+T:	okay all right and then what about lunch
+C:	turkey sandwiches and chips
+T:	okay chips and then for dinner
+C:	spaghetti salad bread
+T:	okay spaghetti salad and bread okay so tell me then what about any snacking that you do throughout the day like any snacks or anything like that
+C:	I don't really snack but sometimes ice cream after dinner may be free in between meals benign occasion not very often
+T:	okay and also what kind of beverages and things that you drink what are some of the things that you drink throughout throughout your day
+C:	or constant constantly feeling hydrated some thirsty so I drink sweet tea all day long
+T:	okay okay well thanks for sharing a bit of information within this patient this kind of gives us a better idea of what you throughout the day so now I'm going to give you some information or show you some information about nutrition okay
+C:	all right know what you're going to say I need to eat less I've heard it all before it doesn't work for me so good
+T:	okay all right so that's that's that's my ministrations but just just kind of bear with me so when I gather from your best far as that you know already you're fully aware of the things that you need to do in order to live a healthy lifestyle and take care of yourself however you seem to find it difficult and you don't think that it works for you is that that's kind of the fish that I'm getting so explain to me what are some of the barriers that you feel exists that prevents you from eating healthier and losing weight
+C:	it's mostly the money it's expensive to buy foods that are healthy and I just can't afford it consistently also like foods it tastes good I hope these stuff doesn't taste good and I just don't want it and also my kids want the good taste in food so they wouldn't even eat it if I made healthy food
+T:	okay okay then I understand completely that finances can be a potential issue and an issue especially when it comes to eating healthy more importantly picking out the right healthy foods for your kids to end and also to have good taste is also a priority to you so tell me about you know we're going to switch and transition from diet and talk about exercise tell me about your normal exercise routine
+C:	honestly I only have one I haven't exercised in years just don't feel like it put all the money to join again
+T:	okay okay and then what are some of the barriers you believe that prevent you from exercising on a regular basis
+C:	well kids they take a lot of time group and money like I said gym memberships or there's several close to my home but they're too expensive for me to get and I just don't have enough time the kids take a ball a day of the day and then work
+T:	all right and then what what ultimate benefits let's talk about benefits what benefits that you feel that you can ultimately gain by by seeking out more nutritious foods and incorporating exercise into a daily regimen regimen and an overall losing weight what do you think would be the benefits of doing all that
+C:	I guess it's good for you dr. Pham always gets mad at me and says I'm not healthy and always talks about my weight
+T:	okay
+C:	maybe
+T:	okay maybe yes yes ma'am well and and then those things are exactly correct on what I would like to do miss Fisher I know that you're pressed for time I'm not going to take too much of your time but I would like to schedule min and I and basically sit down with you and kind of go over some some helpful alternatives and basically look at some cost effective type thing since cost is an issue with you and then also look at some resources that we can channel into when it comes to exercise you'll soon find out that some of the exercises that you can do they don't even require a gym membership so you know if that's something deal at because you mentioned to me that time and money are contouring for you so we basically want to work with you together to see if we can get something that that better suits you you know and get you on the right track when it comes to your pre-diabetes and overall losing weight so would you like to come in and scheduling Pullman with us about a week from now
+C:	yeah I mean you can help me with the finances and Ty
+T:	yes ma'am yes ma'am I believe that so what what we do is we'll schedule a week from now and but it was it was a pleasure talking with you and I very much look forward to working with you okay all right yeah we good rest of the day okay all right

HighLowQualityCounseling/transcripts/high_014

@@ -0,0 +1,25 @@
+T:	hi I'm Andrea
+C:	until nice to meet you
+T:	nice to meet you so what brings you here today
+C:	well I just been feeling really stressed out lately because it's coming to the holidays and my teachers have decided to lower the class with everything these next couple weeks so it is overwhelmed with it all I had I have like feel like I have so much stuff to do and what are those personalities like for crafting a variant I can't with what I have to do and I wanted to well but I trust I'll be doing that and have the holidays I'm trying to prepare to my home Thanksgiving lots of stuff going on then and then boy is coming to visit me for Christmas
+T:	that's nice so hearing me say is that you're stressed with all this going on at school and preparing for the holidays that's that big it's really a lot on your plate
+C:	it's like if it was just the work if you find that I'm stressed about that too and I'm worried about me even think oh it sounds kind of silly but you know your boyfriend coming home for Christmas is kind of a big deal
+T:	for sure
+C:	and it's like I wanted to like my family but I I'm not excited you didn't put him to be bored you know I mean that's I shouldn't even be in my mind you know I should be totally focused on school right now it's just
+T:	so do you feel like you but obviously we're this far on this semester how well do you think you've done well thus far
+C:	yeah actually I've been doing a lot better in this semester and I think that because of it I wanted to want to keep to move on I want to get I like I'm over a cheer instance I like skip good grades but that makes the procrastination like I'm really good at working under pressure but I can't work under pressure with this up because if I don't start doing in advance I won't get it done and I'm trying to figure out how to just balance to you
+T:	do you think if you do what are some options that you see you may have preparing yourself to get the assignments done
+C:	oh I guess just I've considered you know being very turning off all of my electronics of when my computer I'll need it to do the whole market and doing like a to-do list and just really disciplining myself that you know I have to do it but as soon as I get my computer and like Facebook and gave you the things that distract me I keep finding myself putting it up and putting it off
+T:	have you tried anything that might have works in past -
+C:	well we recently had fire home and we did the whole fascinating and I fasted like my computer completely I was a lot more with internet at all and to really do anything with electronics and I think that just having that goal in my mind and because it was forgotten I was able to really just not do it and I did so much homework during that week that I've ever done so maybe just really sitting at one with God could help me to better I should I should do it it's just so much easier said than done you know because we're college students who want to go have fun and we wanted to be with our friends but I mean I've had to cancel all my plans and this is why purple holidays at lunch sometime a benefit just frustrating me the teachers you know I mean I know that they did all something followed but there's just so much to do
+T:	it's overwhelming that getting all your stuff inside working out strategies
+C:	I think that you know girls are always overachievers and we can't just chill and like even my fans always like why don't you just relax they're plump up your deal but I'm trying to think that but I don't like it's a big deal school some things ago because I'm not really talented with my music okay dance or any of those things but so many people are into it so school is like my gift I do good and I understand it so to not feel secure and that is kind of
+T:	so you put a lot of pressure on yourself when I hear saying it's cool because you like that -
+C:	hey I guess it is a lot of pressure I mean I remember in high school my brother was like the good pop and he's older than me he would come back with bad grades and I would come off straight A's I'm so excited you know tell me about your day Ethan Anthony was just like give him all these pitches he did so bad the whole time I always wanted to shine [Music] maybe I do need to just relax and know that the day-to-day thing
+T:	do you feel like you've done involve thus far the semester your classes
+C:	I think I've got some of my closest I'm not sharing because we don't really get product reports in them but both classes I do you know yeah I'm doing well and but you know there's so much riding on these next few weeks I don't do well on these assignments like it could totally mess up all that work so
+T:	so your primary concern really is for the speak you have to get done this week I remember me just said earlier about creating possibly the creating the to-do list or do you think do you think those things that you mentioned earlier would be good
+C:	probably just do it talk about it but I guess it's just nice to know that
+T:	completion with that and going the holiday do you feel like when you do how do you feel stressful week
+C:	toy was always really really relaxing so I think that'll be good it's kind of like a reward for getting through it but then I have I mean these goodies won't need a week and I feel like we'll be doing a lot in preparation for my boyfriend coming for Christmas so it won't be everlasting back for three more weeks of school and then like columns here and no it's like breach I mean it should be
+T:	so it seems like you have a lot going on this week but you seem motivated and now to complete it and you have the break to look forward to but you said it so that sounds like you you're almost there you're going to make it so it's good hearing from you [Music]

HighLowQualityCounseling/transcripts/high_025

@@ -0,0 +1,21 @@
+T:	hi Josh great to see you how's everything going with you
+C:	yeah fine thanks
+T:	great okay so before we get started are there any changes to your medical history such as any new medications you might be taking or any serious operation since the last time I saw you
+C:	no not that I can think of
+T:	anything worrying you about your teeth or gums
+C:	no not really
+T:	okay so what would you like me to do for you today would you like me to simply do a check-up let you know what I find and perhaps help you have a healthy mouth
+C:	yeah checkup sounds good
+T:	sure okay let's lie you back very some became one of your lower molars unfortunately Josh it does look like you're going to need a feeling I would like to try to help you so we can determine just how you got this new hole may I ask you a few questions so we can avoid it from happening in the future
+C:	can't you just put a filling in it and just fix it
+T:	it sounds like you're keen to get healthy I like your practical attitude the new filling will fix this hole but it won't stop new holes from occurring as I said I really would like to try to help you so we can avoid you having to get any fillings in the future on that note would be really great to try to get to know what you've been eating and drinking
+C:	look I know I've got a real sweet tooth I don't need you to talk to me about that
+T:	you obviously know yourself pretty well thanks for these helpful information
+C:	I know it's bad for my teeth can we just get this feeling done
+T:	you're right that it's bad for your teeth should I possibly give you any more information
+C:	yes sure
+T:	the bacteria actually use the sugar that's in your mouth to create acids and it's these acids that eat through the tooth surfaces to cause holes so you could say the more the teeth are coated in sugar the more likely it is that you're going to get holes if we're able to chat a little bit more about your diet I might be able to help you so that we can reduce the risk of you needing fillings in the future
+C:	or anyone I chat about my diet right now can we just get this feeling done
+T:	okay it sounds like you're not ready to chat about this today is that okay with you if we have this conversation at some point in the future
+C:	yes sure
+T:	okay great I'll make sure I make a note in your file and then if it's okay with you next time you come in we won't be able to pick up where we left off today you've got a lot in your mind and I don't really want to overwhelm you some people actually like to jot down the sorts of things they've been eating and drinking and bring it into the next visit or have actually seen some really great apps on smart phones where you can record this sort of information really easily it's up to you of course I'll leave it to you to think about you

HighLowQualityCounseling/transcripts/high_030

@@ -0,0 +1,56 @@
+T:	great hello my name is Sara I'm the student pharmacist at what's a name and how can I help you
+C:	you can comment miss trans I'm just having like a migraine today so I'm coming in hopefully you can make any recommendation for me I choke fatigue cold and tired
+T:	all right when a scale one to ten how bad is your headache
+C:	it's about seven
+T:	oh I see you and a lot of pain right now
+C:	yeah
+T:	when did it start
+C:	um it start a couple of hours ago and it's it's getting worse
+T:	did you take any medications yet
+C:	um no not not at all not at all
+T:	so what makes it better and what makes it worse
+C:	so if I'm exposed to allow noise and then light I tend to tend to get worse but then if I you know I'm going to a room and dark room and no light no without noise and I'm it's getting better but still I'm still having like a you know really bad migraine
+T:	dude they do again those migraines select orphan
+C:	um only once once in a while is very rare I'm not really often at all
+T:	okay so before I recommend that medications to be and before I will I want you to ask you about your past medical history
+C:	okay
+T:	do you take any medications or do you have any medical conditions
+C:	I I have diabetes so I'm currently taking metformin twice daily other than that I don't think I take any other medications at all alright
+T:	alright do you smoke
+C:	um I don't
+T:	do you drink alcohol
+C:	occasionally
+T:	occasionally how much
+C:	drink one drink like maybe what
+T:	it's all right
+C:	yeah
+T:	no that's all right there's any allergies
+C:	not that I know no
+T:	okay so I will recommend medication this one it's called excedrin extra strength it has if the one tablet contains three different medications inside first one is acetaminophen it's a pain reliever and the second one is aspirin it's a pain reliever and it's also anti-inflammatory drug hours and also it contains caffeine
+C:	okay
+T:	and caffeine scanners constrict your blood vessels in your brain and also can relieve pain from from the migraine
+C:	okay
+T:	all right so this medication because of your your headache is very bad I would recommend you to take two terabytes
+C:	okay
+T:	by mouth every six hours but not more than eight tablets a day I say and you should not be taking this medication for more than 72 hours not more than three days and if you still feel the symptoms they're handing now after three days you should consult your doctor
+C:	okay
+T:	all right
+C:	okay
+T:	and the best way to take this medication is with water
+C:	okay
+T:	with a full glass of water and if you feel upset stomach you should take it with meals
+C:	okay
+T:	food okay
+C:	okay
+T:	usually this medication does not cause any major side effects however it make was obsessed Omikron or vomiting and you may feel a little bit nervous of shaking
+C:	okay
+T:	because of caffeine all right and then I would advise you not to drink any alcohol tourist medication because it may increase your risk for a stomach bleeding or a liver disease all right and you should not be taking any other medications over-the-counter like Tylenol or ibuprofen advil that personally don't take any of this because it already contains no aspirin okay because it contains a renter those products so you should not be taking too much of it and I would also advise you not to have too much coffee or caffeine in general
+C:	okay
+T:	all right because this product contains caffeine inside
+C:	okay
+T:	all right and also this medication does not have any drug interactions with your metformin so don't worry affect that's what I am concerned okay and you know so how so do we have any questions for me
+C:	um so so I just take two tablets every six hours for the cost of water
+T:	all right
+C:	perfect thanks so much
+T:	oh yeah oh you're welcome so you need any more help any questions you can always find me here
+C:	okay perfect thank you

HighLowQualityCounseling/transcripts/high_031

@@ -0,0 +1,19 @@
+C:	many people have told me if I quit smoking I'm gonna gain weight well food really doesn't taste good but they say it tastes much better if you quit smoking
+T:	mm-hmm
+C:	now the downside to that is I'm gonna gain weight
+T:	mm-hmm
+C:	that means a new wardrobe which I'd like to have but I can't afford
+T:	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 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
+C:	yeah
+T:	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 I'm wondering what else might be on that list
+C:	withdrawal hmm they say it's awful being cranky
+T:	mm-hmm
+C:	and if I do go through this I just hope my friends understand and will support me and what I'm trying to do
+T:	mm-hmm okay yeah so added to the other other list is they're having to go through the withdrawal the unpleasantness of that
+C:	okay
+T:	what else might be on the not-so-good side about smoking and that's talking
+C:	um I think everything's on the bad sad about smoking but I'm just smoked so long I just can't imagine not going through life without smoking I know I've got to stop I'm having no health problems from cigarettes
+T:	mm-hmm
+C:	at present but when the doctor told me this morning what could be waiting for me in the future
+T:	mm-hmm
+C:	that made me rethink everything

HighLowQualityCounseling/transcripts/high_036

@@ -0,0 +1,30 @@
+T:	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
+C:	yeah my as was just been out of control lately and my doctor says it might be connected to Oscar
+T:	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
+C:	I've got allergy testing it's just the dust makes it bad I thought the smoking was the main thing that's cut down and then they said the drinking might contribute to it too so I got a lot of different things I'm working on so that's what I know the drinking the smoking and the dust that I got the scratch test for
+T:	right
+C:	and and that's what I know and that I take the medicine for it
+T:	okay and that your pet has never been mentioned as a concern
+C:	no I've had it for 12 years and now it's a concern I don't understand
+T:	hmm yeah and I I can see that you've already worked hard to make some changes you've almost quit smoking you're just down to your last couple of cigarettes and you're not even smoking those in the house and your house is totally smoke-free
+C:	does that work what the boy said yeah
+T:	okay and you have also thought about cutting back on alcohol and and I think you mentioned done done a little bit towards that
+C:	mm-hmm I'm a little I'm a couple down I used to drink for a night now I'm down to three at least
+T:	okay so now almost like that's not good enough like now you have to douse the dog and I mean and now what what's next
+C:	yeah yeah okay
+T:	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 but I wonder what are your experiences with Oscar you know when he's in the house or maybe sleeping near you or you're around him what happens with your asthma symptoms
+C:	well we keep him clean like he's clean so all the dander doesn't really make sense but I have been noticing sometimes when he comes on the bed or just beside I wheeze a little bit but I think it has to do with um the hair the in my lungs cleaning itself up from the smoking so I don't know if it's that that's where I'm confused I don't know how this could be happening
+T:	hmm so it doesn't make total sense to you that that it's all Oscars fault and then that's the only solution
+C:	but the wheezing is something that I've definitely noticed a little bit
+T:	I guess I also wonder whether regardless 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 such a big part of your life for so long
+C:	mm-hmm mmm I just want some medicine and I want to keep Oscar and I want to feel better about myself because I'm making all these changes in my life in it honestly feels like my my nose is just above the water
+T:	mmm 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 salad it really is your choice
+C:	hmm ya know that feels good that I you know ELISA it is my choice I just feel like just about I'm not feeling happy about just all these different things that are coming up and I'm kind of sad about things and I don't know I don't know what to do
+T:	there's a lot of decisions and a lot of change with your wife with the new baby and and now thinking about looking after your health and wanting to be healthy for your wife and your baby
+C:	you know I want I want Giancarlo to grow up with Oscar so he has his friend when he's young too and I just it's a lot of stress and a lot of things you got to think about and I'm not feeling good about it
+T:	mm-hmm so what what would need to happen or how would you know when you win or if you ever did have to make a decision about whether to keep Oscar with you or not
+C:	yeah how would I know I don't know I think if my asthma got really bad and the medicine if she gave me the strongest medicine and I wasn't working
+T:	mm-hmm
+C:	that would be the way right now cuz I can't see I don't know how I'm gonna give this dog
+T:	oh yeah and it got the feeling that it's something that you want to think about that this is a really big decision and it's not one that you're gonna make in a hurry
+C:	no no it's something I got to just sit there and kind of put the pros and the cons on the table about but something's going on

HighLowQualityCounseling/transcripts/high_037

@@ -0,0 +1,29 @@
+T:	hi my name is Arielle and I'll be your dietician today
+C:	hi my name is Emily
+T:	nice to meet you Emily what can I do for you today
+C:	well my doctor sent me to you because I have diabetes type 1 and I've been struggling with that blood sugar diet
+T:	have you been keeping up with your insulin injections
+C:	I have actually but I've skipped some a few times because I heard not taking them actually helps you this week
+T:	and you have lost weight recently correct
+C:	yes
+T:	I see well looking at your anyone C value of 12 tells me that your blood sugar for the past few months has been very high we want to try and get that value down to seven when you skip your injections do you notice anything different or do you feel differently
+C:	um get headaches sometimes and
+T:	okay those are actually symptoms of hyperglycemia or high blood sugar let's caused by a deficiency of insulin in the body do you know what ketoacidosis is okay when there is no insulin in the body the cells cannot get the energy they need to function to compensate that your body begins breaking down fat body this is what is referred to as ketoacidosis and this can be very life-threatening by leading to coma Oren's of your cases even death so those experiencing I'd usually have stomach pain nausea sometimes I have breath that's most fruity or like they say it smells like acetone or they have very labored reading what they call Kussmaul respirations and this is why taking your insulin injections it's very important so without it your body can't function
+C:	Oh I dunno about that I knew I was supposed to take them but I thought skipping with you here and there wouldn't be such a big deal
+T:	well your body is completely dependent on those injections as without them that glucose gets built up in your blood if continued hyperglycemia will develop which is very detrimental to your body and then it's not corrected quickly it will need to ketoacidosis
+C:	if there's so much sugar in my blood then why or whenever I should get my injections then wait
+T:	that's a good question my guess is that all the sugar it needs somewhere to go so your body gets rid of it through urine which is why you're always using the bathroom because you're gonna run up someone to fluid
+C:	we're going to lose weight
+T:	you're basically depleting your wash stores and becoming dehydrated
+C:	oh that makes sense now that explains why I'm so thirsty after I just get injections
+T:	exactly what we want to focus on is keeping your diet and insulin dosage in check also physical activity can help lower your blood sugar and help you lose weight and healthy weight what is your normal diet look like
+C:	well to be honest I pretty much eat whatever I want the whole carb counting is just really okay
+T:	well hopefully I can explain carb counting a little more in-depth for you with carb counting our goal is to spread out the consumption of carbohydrates throughout the day in order to normalize your blood glucose so in general 15 grams of carbs equals one serving of carbohydrates so this will make it easier for you and trying to determine how many units of insulin you need to take and after eat a meal so one unit of insulin for 15 grams of carbohydrates at d1 service or however your doctor tells me so how many nails and snacks do you eat today
+C:	I need three meals and snack appropriately throughout the day so it's a couple of times
+T:	okay so a starting point I would say aim for about 60 grams of carbohydrate or four servings at each meal and then between zero and 20 grams for each snack which would be about one serving of carb and also with each time you're getting your carbohydrate so at each meal make sure that you're dancing that out with some protein and fat as well so for example if you're eating like a piece of toast maybe put some peanut butter on it so that way you're getting your protein and your fat in there as well so do you know what counts as a carbohydrate
+C:	bring
+T:	yes but there are cards instance of other places you find think up like fruits starchy vegetables milk yogurt and sweets and generally the next Rishon table can tell you how many carbs are in something so I haven't had that for you and on this front and up it shows you the nutrition label and it tells you the total carbohydrates and it kind of helps you break down the steps and like how to do the math so in the total carbohydrates you wants to have sugar alcohols and fiber and because you don't completely absorb those those don't quite count in your total carbohydrate so this helps you do the math on that and it makes it a lot simpler and this basically just breaks it down for you completely on the other side I hat side I have listed the some examples of foods that may not have nutrition labels on them so like fruits like apples and bananas they don't usually come with nutrition labels but on here I have like what a serving would be and we come to cards I would be for that surgery it's like one small half would be 15 grams of cards so does this make any easier
+C:	sure does
+T:	alright well just be sure to keep track at the top calories and fats are consuming as they can add up really fast and lead to weight gain I also recommend staying active as I can how can you lose weight and lower your blood sugar just be sure to check with your doctor on what you can do and then you should take your is one before changing up your routine
+C:	I will check on that thank you for seeing me and explaining everything in such great detail I will give you my carb counting and another counting another chart
+T:	my pleasure I look forward to seeing you and our follow up where we'll check on your progress

HighLowQualityCounseling/transcripts/high_038

@@ -0,0 +1,57 @@
+T:	what's going on what are you feeling right now
+C:	um I'm feeling disgust to Scully about what hope I can't do this like you can't do this
+T:	so so tell me what that feeling of disgust is what are you disgusted about
+C:	uh just my body like just I don't know I feel like eating that just makes my body feel you know gross
+T:	mm-hmm
+C:	uncomfortable I don't know
+T:	yeah well it sounds like there's some judgments in there right so it sounds like probably you're having some judgments like I'm feeling really bad yeah
+C:	yeah
+T:	that sort of thing
+C:	yes
+T:	but but you did say it more descriptively which is great which is you're feeling uncomfortable right now
+C:	right just eating that makes me feel icky I don't know just
+T:	yeah and I can totally understand how you get to there if you're thinking I'm feeling fat I'm going to get fat you know it's an easy place to get to okay
+C:	okay
+T:	but I feel like we're missing something too because I don't think it's just discussed I think there's another primary emotion in there what do you think that might be
+C:	well I feel like just looking at that I that cake I feel like I just want to run out the door I just I don't want to be here
+T:	sure so what what emotion do you think that is
+C:	being afraid being fearful
+T:	yeah
+C:	of what will happen if I eat that
+T:	I think that's exactly right that's what I'm seeing you know I see you kind of curled up over there you know you have a very worried face you know and you're having a hard approaching it I think I think that's absolutely right that you're feeling fear and I want you to know that makes a lot of sense to me you know when's the last time you've eaten cheesecake
+C:	I honestly I can't remember I don't know
+T:	I know it's been it's been a really long time he certainly didn't need it all through you know when you were really stuck in your eating disorder you know I used to
+C:	I used to like it I remember that but it was such a long time ago and uh
+T:	and so you've been avoiding food like this for so long that it totally makes sense that you're feeling fear
+C:	right
+T:	and you had said this is one of the hardest foods for you so that makes sense to me
+C:	right so just see it like as a big blob of fat
+T:	right
+C:	that was that it looks like to me
+T:	that's what what what is that it's a big Wobbuffet
+C:	no judgment
+T:	yeah exactly you know I'm not gonna let you get away with saying stuff like that all right
+C:	okay
+T:	so because that's just not going to be helpful right now so what I'm wondering is since we know that it's fear that we're dealing with maybe if we can do some opposite action to that emotion do you remember what I mean by opposite action
+C:	mm-hmm
+T:	what do I need
+C:	instead of wanting to turn and run away from the fear of eating this and just you know check out basically right you want me to go towards it and you know just experience what I'm feeling and not go away from it
+T:	right exactly so you know fears associated with that urge like you said to run out the door so instead of running out the door we want you to approach the thing that's scary which is this cheesecake right now right
+C:	right
+T:	okay so I see how hard it is for you and I honestly it's hard for me to watch and I wish I could just take that away but as you know the reason opposite action is so important is if you if I just take that fear away by saying no more cheesecake it's just going to make you more fearful the next time you come in front of some kind of food that's tough for you make it work yeah so by doing this hopefully over time your fear all go down okay
+C:	okay
+T:	so can we have the fear right now and still take a few more bites all right
+C:	okay
+T:	let's do it so how was that
+C:	it's difficult
+T:	yeah I can see how difficult it is
+C:	what I'm doing it but it's not football
+T:	exactly
+C:	doesn't feel comfortable
+T:	no I wouldn't imagine it would but you did perfect opposite action right there which is you are feeling really uncomfortable and I can tell that but you still did it
+C:	right
+T:	do you feel a little bit proud of yourself
+C:	yeah
+T:	yeah
+C:	a little bit
+T:	okay so this shows me that you can do it so let's try again let's take a breath and then we'll go back and do more opposite action

HighLowQualityCounseling/transcripts/high_039

@@ -0,0 +1,38 @@
+T:	hi George my name is Kaylee I'll be your nurse today I just want to let you know that everything we talk about here is confidential however I do have to let someone know if you're at risk of harming yourself someone else or this child abuse going on is that okay with you
+C:	yeah that's there
+T:	okay so George doing a little bit about why you came into the clinic today
+C:	well I have type 2 diabetes and I can't seem to find the time to exercise
+T:	okay would you mind if we explore this issue a little further
+C:	no that's okay we can do that
+T:	okay so why don't we start by having you tell me a bit about your day and what seems to be getting in the way of you exercising right now
+C:	well I live a very busy lifestyle and had work I've children I have John you know and then being a diabetic there's so many soft activities that come along and it seemed to have gotten control of everything else but it's just exercise I can't seem to find the time for it and it's very overwhelming and I feel this encouraged
+T:	okay so it feels like you're having trouble fitting exercise into your schedule and you're starting to feel pretty discouraged and frustrated
+C:	yeah I just found out what to do anymore
+T:	okay so how important would you say this change is for you to make in your life we'll try on a scale from zero which is not important at all to time which is very important to me
+C:	they've always talked about exercise being important to diabetics and I can see how that is important both to me and maybe it's a seven
+T:	okay pretty important yes and how confident would you say you are right in this moment that you'd be able to make this change and we'll do the same zero to ten scale
+C:	oh goodness um there's just so much I don't think I can make this change maybe a two -
+T:	okay so hopefully we can get that confidence up a bit and from what I hear you saying it sounds like you have been successful in the past making these changes related to lifestyle and incorporating exercise into your schedule is another really big change that might be really difficult for you to make
+C:	yeah it might just even be too difficult maybe I should have even come here today
+T:	well you know what I'm glad you did come in today it shows you're in a serious about your health and you really want to manage your diabetes better I'm sure was really hard to come in especially since you're not sure you if you really want to make this change right now
+C:	well I know how important it is for to keep my diabetes under control and how exercise can have an impact on my lifestyle and my diabetes but I've tried everything and I just can't seem to find a time
+T:	okay so it sounds like you know what can happen if you don't incorporate exercise so you know the risks and at the same time life is life is getting in the way
+C:	yeah like I said that it's I just don't know what to do I know it's important for my health
+T:	mm-hmm okay so from what I hear you saying you're having difficulty incorporating exercise into your schedule and at the same time you know the importance of exercise and the risks associated with not exercising and being a diabetic is that correct
+C:	yes
+T:	okay but you mind if I provided you with a little bit more information about the benefits of exercise
+C:	sure I think that would be beneficial
+T:	okay good so for a diabetic an exercise can help lower your blood glucose which is very important you can also help lower your blood pressure and the great thing is that regular exercise can also help improve your energy improve your sleep and strengthen your bones and muscles which one of these benefits do you think you would appreciate the most
+C:	well I would definitely love to have more energy it's very very overwhelming you're having to do all these things they're not advantage I feel so tired and even though I feel tired I don't get any sleep at night I find that I can't sleep so it would be wonderful to have the energy do the things to my day and be able to sleep at night
+T:	okay so it sounds like you're willing to make a change and you're getting kind of excited about possibly having more energy
+C:	oh yeah
+T:	okay so can you think of any ways you might be able to incorporate exercise interest go to area
+C:	well I Drive my kids to school every morning kiss them to go to school because I don't start work till like nine o'clock so maybe I could walk them
+T:	okay that sounds like an excellent plan how many times do you think you could walk them to school this week I assume they go to school every day
+C:	oh yeah they do um I Drive them to school so maybe I can try walking them to school five days a week
+T:	okay George that would be great that sounds like a really good plan do you think there might be anything that could get in the way of this plan this week
+C:	no it should be a problem I'm talking so late and the wife sleeps here in the house so I'll be fine
+T:	okay so great so the plan is to walk your kids to school every day this week and maybe you can keep track of this on a piece of paper just maybe take off every day of the week that you've done your exercise for the day this way you can keep track of things visually and you know you can watch your progress okay so if you have any problems during the week please feel free to call the clinic and ask for myself or another nurse although this is your decision ultimately we are going to support you along the way I don't want you to ever feel like you're lowering this and we will we'll play to meet in one week to see how things are going and hopefully we can follow up after that and get that confidence level up
+C:	okay wonderful I'm glad to have you as it's important that you
+T:	thanks so much for coming in today I really commend you for taking that first step towards change thank you George
+C:	thank you can we for your help

HighLowQualityCounseling/transcripts/high_040

@@ -0,0 +1,81 @@
+T:	well cast our walls I'm really glad that you were able to find some time to actually get get together
+C:	well it's good to see you're finally where you been
+T:	yeah that's right I know I was thrilled to see that you've made an appointment on my calendar and you know you have this benefit as a health coach and we've just never been able to find time to get together I know you're always running around helping someone someone or whoever I hear about that raving about pastor wall it's great help
+C:	well I've got people that try to fit into the schedule to meet him for breakfast or lunch and around the work schedule and that keeps me occupied and trying to fit the schedule is
+T:	sounds like you're really running 24 7
+C:	or 7 24
+T:	that's happily so blonde glad that you took the time out to you know think a little bit about yourself and spend a little time that we could talk about how things are going for you you know you give a lot of your time to everyone else but it's also good for you too you have some balance and think about things for yourself also
+C:	is it really sounds like it so that's great that you decided to come in well thank you for letting me come you okay
+T:	so tell me about how things are going over overall I know you had mentioned in your email that you lost some weight recently
+C:	yeah dead wife quit feeding me know
+T:	your wife's foot feeding you huh well I'm sure if you quit feeding you you would find some other great way to eat
+C:	but that's all good little exercise helps on that and splitting meals sure meals instead of eating that big portion that the restroom gives you you know we split it that works
+T:	so you thought you've really found that when you want to eat you both order wasn't one portion and share it
+C:	most of the time
+T:	okay so that and then adding more exercise
+C:	more exercise yep
+T:	that's what seems to have worked for you
+C:	yeah exercise helps
+T:	well what kind of exercise do you like to do I mean you probably get enough exercise just running around between folks
+C:	well I do that but you know I roll out of bed then I run around the block three ties then it kicked the block under the bed and go back to bed
+T:	you do do you have to go for that early morning block block and monitor the neighborhood
+C:	bicycle League works
+T:	basically
+C:	yeah that works um
+T:	how did you get into that
+C:	had a bike there and that's a good place to ride so that's easy to do
+T:	ok
+C:	easy to do and
+T:	sounds like something you enjoy
+C:	yeah yep good check out the neighbors see what they're doing is why they're really awesome right
+T:	then everyone's waving down pastor Walt with their
+C:	30
+T:	latest thing that they're not talk to you about oh good well if there was anything about your health you're still thinking about now in terms of you know what's your next goal or what your next step or something you're thinking about
+C:	mm not really that I know about
+T:	so overall things seem to be going pretty special you are you
+C:	things are good
+T:	yeah so that's that's that's awesome it sounds like good a great place and sounds like the things you have implemented
+C:	their works
+T:	and working really well
+C:	it works
+T:	well on this scale of one to ten you know like we use that pain scale with people as nurses how confident are you that you'll continue on with what you've been doing as far as the portions and though bike riding
+C:	Oh probably seven
+T:	is that a seven or an eight
+C:	sure
+T:	so pretty confident that things will continue on it you can maintain what you've been doing and that's great you're not a zero
+C:	well yeah like Cyril
+T:	well what makes you a seven and not a four in terms of confidence
+C:	I guess that's just the way I am is just tough and it can be done in maybe do it
+T:	well because you've been doing it and you've been consistent and successful with it
+C:	correct
+T:	and what would it take to make you be a nine in terms of being more confident that it'll happen all the time
+C:	oh just another couple days on the bike a couple days out good
+T:	so what I'm hearing you say is that's kind of what you're wanting to get to is being able to global add a little more to what your schedule is and how do you see yourself doing that
+C:	well that's the child because if you go to meet people for breakfast at seven thirty eight o'clock
+T:	Wow 730 a clumsy
+C:	and try to ride a bike before and shower and stuff ahead
+T:	that means you're getting up pretty early
+C:	so you do it in the afternoon what a ton of degrees no that doesn't work either so evenings maybe
+T:	okay so of course the Florida whether you've got those hundred degree humid temperatures where you feel like you're hot then you get on the bike
+C:	right
+T:	island by the evening is it is it cool down some and we committed to taking off a little need me
+C:	on the rare occasion all day
+T:	huh so that it's kind of picking those days of window I feel like going out there do I feel like sweating right now on the bike
+C:	that's it
+T:	uh-huh so that seems kind of like your next focus on just trying to implement that
+C:	yeah a little more be good but
+T:	well it sounds like you know you're doing a lot to really think about your house and to have a balance between what you're offering to other people but also taking time for you do you do anything just do do anything just for you time just to you know be able to just have your own time to enjoy and mind
+C:	like grab a good book
+T:	mmhmm
+C:	yeah
+T:	grab a good book that's always a great way to
+C:	personal leadership
+T:	uh-huh
+C:	looks
+T:	and you find that that gives you
+C:	what yeah not one of those fluffy novel things
+T:	none of the fluffy Harlequins or whatever that the women like to watch read huh
+C:	yeah note those
+T:	leadership something that gives you some more tools to work with folks that have some depth to them well that sounds great if we could just perhaps maybe talking you know a couple maybe four to six weeks and kind of see how that bicycling is going for you and just know I'm here for you and
+C:	that's good so you're going to be here
+T:	yeah I'd love to continue to be your support

HighLowQualityCounseling/transcripts/high_047

@@ -0,0 +1,41 @@
+T:	we'll there's some things that have come up in in what I've seen so far I I just want to talk to you about your blood pressure it looks higher than I'd like and and obviously that concerns because there are some things that can happen with high blood pressure and I got to point out that the smoking in combination with the blood pressure concerns me and there may very well be cause and effect I'm sure the last thing you need is is somebody to to nag you but could we talk a bit about your smoking
+C:	yeah sure I'm comfortable
+T:	okay okay so you smoked how long
+C:	well 35 my first time I smoked was a I was 12 years old it progressed as I got through high school and I've been a regular smoker since about the age of 17
+T:	okay so about half your life you've been a regular smoker
+C:	yep
+T:	okay about how much you did
+C:	well oh it's kind of buried over that span of time but I'd say right now I'm about about half a pack a day
+T:	okay okay the most important thing I mean I've got slides will and statistics and all kinds of scary things I can say but the most important thing from my perspective is what your thoughts are about your smoking where you at with being a cigarette smoker
+C:	well I am aware that it's it does have adverse health effects and down the road I perceive me at making a change in my behavior and and knowing that the health consequences associated with with smoking but that day is not today I don't feel like I really use you know when it started off as I mentioned as a teen it was more of a social thing
+T:	sure
+C:	and acceptance my friends were doing it I got to college I was open and open to more people who were were smokers as well and it seemed to be more accepted and I've just been you know continued that uses of as an adult
+T:	yeah
+C:	you know it's it's for me it's now become much more of a habit and just a routine as much it is is the I feel like the the nicotine in the effects of the the cigarette itself it's very much part of my daily routine this is part of your life this is what you do
+T:	yeah and you know I know it's it's you know the cost and have gotten increase in over the last few years with with the cigarettes but uh but like I said at this point in time in my life I have a trouble seeing myself quit I'm a little bit concerned about you know I've had friends who tried to quit as well some successful some haven't been as successful ones that you know have quit they've noticed they've gained a lot of weight and and that's kind of concerns me in my age ranges what kind okay so you're doing a lot of good thinking well what what I heard you say and clearly you're a guy who sought through some things about your health what I heard you say smoking has some negative consequences and I don't want those things to happen but today's not the day I'm not gonna sign up and say today all all quit cold-turkey right you know appreciate that I would like to know will more about what you know about potential negative consequences when you think about what happens to smokers even half a pack a day what consequences are we concerned about
+C:	well my grandfather had had emphysema
+T:	chirp
+C:	which is you know a direct cause of his smoking non-filter cigarettes for 35 plus years
+T:	yeah
+C:	that concerns me
+T:	yeah
+C:	you know shortness of breath I noticed you know I still try to do some limited and exercise and and sometimes it's very labor intensive for me when I'm exercising that's a concern you know the health of my family my wife you know being exposed to secondhand smoke is mostly concern you know we're looking at starting a family soon and and I know that behavior will need to change when when that when that time comes but I guess you know in terms of other health concerns you know you know the more unpleasant ones the the complaints from the family members about the smell of me
+T:	yeah yeah it's our that the the social pressure is a rough
+C:	you know and now you know I with with different places and businesses outlawing you know smoking in side restaurants and bars around our area it's become much more of a challenge maybe publicly
+T:	so these real big health problems some of which your grandpa has emphysema certainly lung cancer another risk that people take and then you look at what's going on in your own health already a little short of breath sometimes not having the lung capacity that you'd like to have social pressure exposing your wife you know I I wish I could say that's not a word but I think you're doing some good thinking I do think part of why all this hassle about smoking publicly has happened is because if your wife's exposed certainly it's the two of you had children if your children were exposed there are some real health consequences to people who are around you when you're smoking and already some some sense of some symptoms you've had with so it's you're breathing all right are there any other you mentioned breathing and people's negative reactions your fear for your wife's health are there any other things that I should understand that you don't like about being a smoker other concerns
+C:	you know uh I mean I guess it's in terms of my health you know the my teeth the yellowness of that the whitening of teeth and the appearance that I have you know the I guess there's one thing on the surface that's of concern you know really I think that the respiratory issues that we talked about you know
+T:	sure
+C:	the lung cancer those were pretty much my primary big ones you're not concerned with but you know the the routine that I have with the smoking is it's so ingrained in my lifestyle that it's just really hard for me to fathom being of stopping
+T:	yeah
+C:	you know I've not really made a strong effort in the past to to quit you know if I've sampled some of the nicotine gum from friends who've tried it
+T:	right
+C:	and didn't care for that it was found it you know not an equal replacement for the real thing
+T:	yeah yeah
+C:	and I think that's kind of worrying
+T:	okay so so when you weigh things you just say man I'm concerned about weight gain this trick I know the gum didn't seem so great what else do you know we'll about sort of small steps people could take who don't want to get emphysema or lung cancer or have this thing progressed are there any small step you're telling me you're not really quit cold-turkey
+C:	well I think I mentioned in the beginning when we were talking at you know the the volume of cigarettes that smoke is kind of varied over the years there was a time in my early 20s where I was pushing close to a pack a day including trying to reduce the amount great is is one I guess more tangible a realistic option and in terms to losing it
+T:	absolutely
+C:	rather than cold turkey although I've kind of heard mixed messages that maybe cold turkey is the best way to go or not so I'm not really clear on what would be the best strategy to apply
+T:	well you've taken an important step will one of the first things I say to people who say I can't stop cold turkey is could you consider cutting back that's a huge step that is significant it's not perfect but I'm not in the business of perfect patience will I'm in the business of people taking small steps and this is this is a big one and I want to congratulate you I do know some things about other steps will and and even it sounds like quit cold-turkey isn't a step today but I do know some other options some other options to lay out potentially would it be ok if you and I talked about those other options that you could just file away for when you're ready
+C:	sure I'm always open to some suggestions and advice when it comes to this absolutely
+T:	great

HighLowQualityCounseling/transcripts/high_048

@@ -0,0 +1,42 @@
+C:	I'm feeling very stressed out lately a lot of tension couldn't tell me more about that I just feel like nothing I do is good enough I work really hard I try really hard but I'm still having a really hard time
+T:	so what I hear you saying is that you're feeling really stressed and kind of stretched out too thin
+C:	I am stretched too thin I'm trying so hard but I can't live up to my dad's expectations I really love him but it doesn't feel right or what it should be like my friend's parents support them
+T:	and what do you wish things would be like
+C:	I like to have more free time I have lots of friends and they get to relax and hang out after school and I don't get to do any of those things I like to do that or spend time with my boyfriend my dad has always pushed sports if it's not volleyball it's another sport and I just want to make him happy
+T:	that sounds exhausting so it sounds like you're feeling this contradiction of pleasing your dad and meeting his expectations but you also want to enjoy yourself and be young is that right
+C:	yeah
+T:	so that must be really frightening to be so confused about your dad's expectations and I also imagine you feel pretty frustrated with them yeah I am frustrated with them
+C:	if I don't please him it makes me feel like I'm not good enough
+T:	what do you think your dad wants you to be like
+C:	well he wants me to be in really good shape make the best of grades graduate with honors so I can get into a really great school and I know he just wants the best for me and I want to make him happy
+T:	I can really hear you really love your that don't you
+C:	yeah which is why not living up to his standards is so hard and
+T:	so it's this feeling that only a part of you is acceptable and that doesn't leave much room for you to be human does it
+C:	no it's like he wants me to be perfect perfect like those women in the magazines
+T:	yeah and if his love for you is based on picture what's the good at that
+C:	you're right it is no good I can't ever be good enough for him I can't ever live up to his expectations and we have this college visit coming up I feel like college is too far away is too far to the future I feel like it's too much pressure and I'm not even sure if that's where I want to go to school I could visit at any point but it's this weekend my boyfriend was going to take me to a concert that all my friends are going to I want to enjoy my life not worry about the future my dad said we had to go now even though he knows about the concert this weekend what should I do it's not where I want to go anyway but I can't tell my dad I could never tell him that's not where I want to go I want to be a kid I want to enjoy my life I just don't think it's fair why do I always have to live up to what he wants me to do what should I do should I tell my dad I don't want to go
+T:	so this is the conflict it's really hard for me because I want to give you an answer and I really wish that I could give you the answer you want I really mean that
+C:	but that's why I'm going to therapy I thought you were supposed to tell me what to do
+T:	well I don't mean to be evasive about this but I just I want to know what do you think you should do in this situation
+C:	I don't know why can't I just be like a normal person and tell him I don't want to go why do I tell him things I really don't mean
+T:	and so I catch that the real deep puzzle is you feel this what should I do sometimes it's sad for me to notice how hard you are on yourself about yourself and I really appreciate you sharing this with me well
+C:	yeah I'm hard on myself because I need to be but I hate how I always have to live up to such high standards
+T:	and so the thing that comes to mind is me asking what do you wish I would say to you
+C:	I wish you would tell me what to do I feel like there's a part of me that really wants to please my dad but in order to please him I don't feel like I can be myself there's just a part of me that feels lost and unsure of myself
+T:	yeah I really hear that and to me at the same time you don't sound too uncertain
+C:	oh really
+T:	yeah judging by the tone your voice it sounds like the thought of doing what your dad wants you to do is more uncomfortable than it is for you to actually tell him how you feel
+C:	I just wish you would listen that he wanted to know how I feel he just wants me to be the perfect daughter but he doesn't even know the real me
+T:	and so you sort of feel this I want my dad to like me for who I am
+C:	yeah I'm not the straight a size zero perfect girl and I can never be good enough I can never be smart enough or skinny enough and
+T:	when I think I'm hearing you say is that you'd like to feel accepted for your dad
+C:	yeah that's what I want how can I do that do you think I should say something to him
+T:	well I feel like this is a really private thing that I couldn't answer for you but I'll definitely try to help you come to your own answer
+C:	it doesn't matter how much I want him to accept me you wouldn't like the real me I could never live up to his expectations the thought of even saying anything is terrifying because I know he would be so disappointed would it even be worth it to say something to him
+T:	I'm really not sure it's an awfully risky thing to live and you'd be taking a chance with your relationship with him and you'd also be taking a chance with yourself
+C:	yeah it really is risky I'm never in control of anything sometimes I feel like the only thing I have control over is
+T:	that sounds really upsetting I think what I'm hearing you say is that by controlling food is the only way that you feel it you can make a choice for yourself
+C:	even just talking about it right now is making me really tense because it's making me think of everything I ate today counting the calories is one of the only things that makes me feel better because it's something I can control
+T:	so you're feeling anxious at the moment and like your only relief is in controlling what you eat
+C:	I guess that's the only thing my dad can't control that it's just mine I don't think that's right I wish I didn't have to be so hard on myself and I could eat like everybody else does
+T:	so it's quite clear that the problem isn't just with your dad or your relationship with him but it's also at you as well and in this question of how can I accept myself

HighLowQualityCounseling/transcripts/high_049

@@ -0,0 +1,58 @@
+T:	hi Alex my name is Tony I'll be your nurse for today how are you doing
+C:	I'm okay I guess just waiting for the stitches to come out it would be nice
+T:	okay tell me a little bit more about this firefight
+C:	okay story time you rate this so proud my girls having a fantastic time looking off on fleek and ish and then this girl like she has the nerve to stare at me from across the room it gives me this kind of it come on like this and then she comes up to me she bumps into me she spills my drink and she comes up and then she's like there man so I'm like excuse me so obviously I pushed her she pushed me kind of thing and yeah one thing led to another all right so it's a blur from that point on but all I know is that cops showed up I'm here and I have this to deal with fantastic great
+T:	okay from what I'm getting here is you were intoxicated at that point in time and then you had a confrontation with this girl which led to the bar fight and
+C:	I was more than toxic it Oh smash oh you should have seen it but like this type of thing doesn't happen often so I don't want you to be sitting here and referring me to some AAA because yo I'm not an alcoholic
+T:	okay so it seems that you can't offend that they feel offended you refer to me
+C:	yeah I'm not an alcoholic no I'm
+T:	okay because it labels you guys mom
+C:	yeah exactly
+T:	over yeah all right of all we do have some time right now if it's okay with you I wonder if we could talk a little bit about your drinking habits
+C:	yeah sure no
+T:	I do you what is drinking you for you would have
+C:	yeah well you know being 25 that's what we do like we get together we'd hang out we get a couple of drinks it's me and my girls we do this all the time and I love this it breaks the ice when we go socializing so meet new people kind of thing you know girlfriends circle it's it's fantastic and it definitely relaxes me after a stressful week and my weeks are so stressful is I need this you know so I mean yeah but just so you know I do drink responsibly and I never drink and drive and I don't intend on doing that
+T:	okay so to me this is our drinking is your way of relaxing with your friends is your way to socialize and it breaks that I guess right it helps you socialize and you know I'm I also wanted to say that experience I was responsible of you to be drinking and not driving
+C:	thank you
+T:	how does it affected your life
+C:	who has it well I mean now that this happens I do have it because of that bar fight and he's gonna be disappointed so I guess you could say that my relationship with Henry it's been great fantastic but he says that when I drink it's like I'm not myself it's like somebody has never met before and obviously you can imagine the arguments the fights and oh my god all that stress it's just I love him so much but you know but it does stress and that's like I don't forget to make it it it's just
+T:	so for my understanding drinking it helps you socialize his friends it relaxes you it's you know here we have just you know it breaks that ice for you on the other hand it's causing that a lot of arguments of do you and your significant other Henry
+C:	yeah
+T:	and it's causing a lot that that all those arguments are completed you a lot of stress in your relationship this manager
+C:	yeah I mean we're engaged you look pretty this is well I don't like you put it that way I mean I'm worried because what's he gonna think of me later on the link once again I tell our children all your mom is an alcoholic she drank this and they go into fight I don't want I don't want anyone to ever think of me that way but at the same time I mean I don't want to quit cold-turkey I mean you must understand how hard this is for me to even be here and talk about it but I love him so much I mean I would do anything for him and he's gonna be so he didn't even say I don't know how can I face him
+T:	this seems like a little Brady lucky died to have someone who loved him that much
+C:	mmm boy seriously he's not gonna find anybody that loves him as much as I do trust me on that it's not gonna happen
+T:	so what I'm getting here right now is that if you just want to quit
+C:	yeah
+T:	yeah and it's just partly because um but this alcohol is the leading to the arguments with Henry and it's necessary relationship
+C:	yeah
+T:	I noticed over a year there and I know you don't really like like the idea of it but what do you know about it eh like what's one shift of light on that
+C:	it's a place or alcoholics go to discuss their problems and like I said I'm not an alcoholic
+T:	mm-hmm well you're right there for multiple walks of life and they share their drinking stories and everyone just kind of helps each other through this journey if you can so prayer together
+C:	okay
+T:	I don't even want to join eight at this point in time
+C:	okay
+T:	mom's but hypothetically speaking would you ever consider joining it
+C:	if this is what I have to do to get my guy back and I'll do it
+T:	mm-hmm okay well on a scale of 1 to 10 I'm 10 mean like for sure and 1 being not really sure about it at all what would you say where you are on the scale with 20 an 80-acre know that you
+C:	put it that way and everything I told you I would say 6 yeah
+T:	why would you say sticks instead of say that's really I mean you're really adamant about not doing anything
+C:	well it's all about it's all about Henry at the end of the day it's it matters to me if I want to keep disengagement and I will do anything for that man so of course this is what I have to do this to do this is him live including his relationship with me and it's so much more important to me than drunk in a bar I'll tell him that
+T:	yeah so right now we're sitting at a six what needs to happen stated maybe we can jump that to an eight or nine
+C:	um you know like flexible hours maybe if that isn't even an option um also maybe there's maybe if there's a place nearby somewhere like nearby my house I'll be great so off to waste gas its expense I already go to work and it's far anyway and um like I guess I guess it has to do with attitude as well I don't want to sit there in a circle like this and somebody judging me because the way I look and my drinking habits and all of that so I guess I'm just looking for a good vibe you know I don't want to be judged not labeled
+T:	yeah all of these are like really understand aborning it's just of course you want something I mean you need to be close to use you don't have to commute so far and
+C:	yeah
+T:	we all have very busy schedules
+C:	yeah
+T:	the fish is very busy sniffle and Emily makes sense and of course the environment I mean if you're not happy they're just an even and learning and if you're not comfortable in it and it's very hard for you to
+C:	yeah
+T:	you know to be in that environment
+C:	yeah
+T:	well actually today I was wondering if it's a great view I can give you this for sure it's just for any medium you're really close to your location where you live
+C:	okay
+T:	and my number is also on then you can always give me a call if you have any concerns and also I just want to thank you today for sharing your stage of drinking and I know it's not you know easy to just tell me no this is a very sensitive subject down so I want to
+C:	thank you thank you for listening to me no one has actually sat down and talked to me about anything and I feel like you shed some light on an issue so thank you you're very really good he's alive
+T:	they're very welcome and if it's okay with you perhaps maybe we can schedule another follow-up meeting I'll tell you about like two weeks or so
+C:	yeah sounds fine
+T:	yeah that's okay two weeks work there
+C:	two weeks okay something

HighLowQualityCounseling/transcripts/high_052

@@ -0,0 +1,52 @@
+T:	look Carl how are you doing today
+C:	oh good good area I'm doing well thanks for asking last week you were talking in therapy
+T:	yeah I mean and I thought a lot more about it this week after I mentioned it last week but a joke I was telling you about Jill my coworker and you know she was kind of bothering me in the past couple weeks but really this this past week was like the worst right so she's not doing her paperwork and the thing is is that she has to do these reports in order for me to do my reports so if she doesn't have hers I can't do mine and then I can't get mine out in time for the next person to do their it's a mess the whole thing's a mess and it's just it's annoying me
+C:	so her work slowdown would not be efficient work is affecting your work productivity
+T:	yeah yeah it definitely is and it it's one of those things that like you know has it gives me a bad a bad evaluation you know like it if I'm not eating my stuff in in time then it reflects negatively on me you know and it's it's all kind of she's she's the first level you know and then all the other levels are kind of dependent on her turning things in on time so she doesn't then I don't then the next person and so forth
+C:	and it makes it seem like you're not doing your job
+T:	right yeah and my boss doesn't like it my boss's boss doesn't like it so forth you know and I try to explain to them you know she's the problem but it doesn't always I don't always have the time to go up and tell them like here's what's happening or it just somehow it doesn't come out
+C:	you don't always get the opportunity to tell people that are important at your work about the situation
+T:	yeah and that's pretty annoying too because you know it's one thing if people get mad at me but then I'm able to tell them why I'm not doing my job like I'm supposed to but it's another thing for them to get me into me not realizing my fault you know
+C:	you have an explanation for why the works that get done
+T:	yeah I did I do that's the thing but I can't always get it out you know I can't always tell the person that's has the complain about and yeah I mean I tried talking to my my boss and I tried talking other people too you know but really hasn't gotten anywhere
+C:	so you're feeling stuck with this whole thing
+T:	yeah yeah I mean I talked to Jill a little bit about it too you know and I tried to ask I tried kind of gently reminding her you know like such-and-such needs to be turned in by Tuesday at 12 o'clock yeah I didn't want to be real abrasive you know but I I tried to remind
+C:	it was a polite approach
+T:	yeah yeah and it didn't didn't really seem to work because it's still happening
+C:	your attempt to fix the problem hasn't really worked the way you wanted
+T:	no it really hasn't and and that's just I feel like I've tried everything that I could try you know and even like I came home and I was talking to a friend about it and I was trying to think of other solutions right you know I was trying to think like what else I could do what else I could say who else I could talk to things like that you know and I mean my friend you know he was listening in staffing had some good suggestions but it he didn't know what to do either like cuz he doesn't know the way the company so like I got nothing
+C:	you're not getting help you need for this
+T:	yeah not at all feeling pretty lost with it and then I wish it was just like a clearer way to do things like this is what you should do now and I don't see anything
+C:	some sort of clear plan
+T:	yeah yeah but I yeah I don't I don't see a way to go about it I mean I so I right so this is the way I lay down my mind I tried talking to the people above me mm-hmm didn't work out the way I thought it would I tried talking to the people below me so to speak just lower on the before me in the process that's what I mean and that didn't work out which it's just Jill and I talked to her and that didn't work so like there's nowhere else I could turn
+C:	the options are exhausted
+T:	yeah that's what it seems like to me
+C:	and this is frustrating for you yeah it is and I've been trying to Rack my brain you know like what else could I do you know like maybe if I could maybe if there was like a committee or something that I could go to you know and be like well this person's not doing what they're supposed to be different but there's not a committee like that or even if there was like a person you know like a resolution person or whatever but there's there's nobody like that
+T:	there's no other Avenue
+C:	that's what it seems like to me yeah and you knows I'm even trying to think like I don't know should I write a letter to somebody maybe but I don't even know who or what
+T:	you've thought about a letter but who would you send it to
+C:	yeah or like just something else that I could I can do instead of going to this person though that person that didn't work could I could I call us somebody is there anybody else in the company that you know might handle stuff like that but I mean there's there's HR people but that's I I can't really see where they could come in I don't know how Human Resources could deal with something like that
+T:	you don't view them as a potential solution
+C:	wonder me if there's like a but there's I mean I'm thinking now that there's got to be something or somebody or somewhere that I could put in like almost like a complaint or something like something's out of my hands and I don't know what to do about it look there's got to be something and now that I'm saying this I'm thinking that there's got to be
+T:	some other resource you haven't tried yet
+C:	yeah yeah and I mean now I'm trying to think back to my training you know initially you know what I think now that I'm now that I'm thinking a little bit harder about it a little bit differently about it I'm thinking that there's like man I forget what they call it now but maybe like a complaint but it's not the right word but maybe a complaint box or like suggestions or something and I think if I remember correctly those suggestions and those complaints get brought up at every staff meeting which we have like every other week
+T:	they're discussed at this regular meeting
+C:	yeah and I'm I'm thinking now I mean nobody really uses it but I'm thinking like maybe that's an avenue that I can use you know and like maybe that'll get brought up and maybe that's something that then might actually work
+T:	this could be another option for you
+C:	yeah it could be and then if it does work it'll get thrown and rather if they do read it it'll get brought up at the staff meeting where everybody's at my boss my boss's boss Jill everybody's there and maybe that's a way for it to come to everybody's attention that deadlines being missed affect other people in ways that you don't really know about
+T:	so everyone will hear your complaint and maybe react in a way to help you
+C:	maybe yeah I think that's I mean that's gotta be the way to do it and maybe that's the best way ever I really think yeah I mean after saying all that after going through that I really think that that's probably the best way to do it and if it if it doesn't and I guess I could find another way but I really think that's the best way to do it
+T:	you feel as though you found an option here
+C:	yeah yeah and even if that doesn't work then it'll be brought up and maybe it'll allow me to talk to my boss further about it and maybe he'll understand really where I'm coming from but this will at least be a start to something you know how to make me a lot less stressed with deadlines and stuff
+T:	you are frustrated with all this
+C:	yeah but maybe maybe after I do that you know put in the complaint or suggestion
+T:	mm-hmm
+C:	maybe I won't be as frustrated I'm gonna feel a little bit less frustrated now even thinking if there is another opportunity
+T:	it feels better now as you're contemplating and another potential Avenue here
+C:	yeah yeah
+T:	well this might be a good place to wrap this session up that feels like the right move for you
+C:	yeah
+T:	and well schedule so I see you next week and we can pick up from there
+C:	sounds good
+T:	all right cool thanks Carl
+C:	thank you

HighLowQualityCounseling/transcripts/high_053

@@ -0,0 +1,60 @@
+T:	yes there it goes okay hi I'm Sheila I'll be your pharmacist today um first can you describe by your name and birth date
+C:	um my name is carb and my I am 57 years old
+T:	okay that's good enough I just wanna make sure I have the right person and so I have three things for you today is that when you're expressing
+C:	yes
+T:	okay I just wanted to take a minute and go through these with you all right okay great I was like - these are results for you we have the Lance's insulin which is your long-acting insulin and then we have the metformin catalyst cannot look like what you've been picking
+C:	yes that's women taking
+T:	okay great and so I'm how do you be using these
+C:	uh my metformin I take twice a day and then the insulin I just take in the evening
+T:	okay great and then on this it says 48 units are you still taking that much or
+C:	yes for me
+T:	okay and have you noticed any side effects or any problems with these but I can help you in
+C:	no the doctor says my diabetes isn't under control
+T:	okay all right well it looks like they decided to add another influence and so what this is is novalog which is also called a smart insulin looks like um this one is one that you're gonna actually I should rephrase that and what did your how did your doctor tell you to take this
+C:	I guess I have to take that on before I eat carbohydrates
+T:	right okay great and um why did your doctor amasses
+C:	um because my diabetes is on control teas done
+T:	alright okay great so um you're right you're going to use this with meals and you're going to actually try to get before you eat so that may be a little bit difficult because you're going to estimate how much carbohydrate you're going to eat before you actually eat it so it might be a little dicey at first um try to help you with that um what did your doctor tell you to expect with the medication
+C:	um that the same thing that you said I'll have to do a certain amount of units for each amount a card
+T:	okay now with insulin there's some things that we'd like to that sometimes can be a problem too like hypoglycemia have you experience animal
+C:	yeah I have a little bit
+T:	okay how have you been managed genius
+C:	uh I eat like soda or drink soda sorry or like glucose tablets
+T:	oh okay great and usually keep something on you then okay it's going to be even more important now that you're going to be doing it so basically you're going to start with the one unit for 15 grams of carbohydrate and that might be a little bit abstract for you so I don't know if you've ever done carb counting before so I got you some information um this is just a general like nutrition facts thing that you would see on a food label
+C:	okay
+T:	so they make it really easy for you guys it just says right here a total carbohydrate so this is per serving though so I wanted to draw your attention to the top where it says it's serving size is you might have to do a little bit math here like on this one a serving size is one ounce but there's four servings in there bad
+C:	oh
+T:	if you ate the whole bag you would have to multiply this by 4
+C:	so that'll be four carbs rather than one
+T:	umm right for a unit right because this is almost 15 or
+C:	4 units
+T:	right so you would use for a units of insulin to cover a full bag of it so that's how you do the math
+C:	okay
+T:	now unfortunately this is more of a general average and since you're just starting on it it's probably not going to be realistic so what you're going to want to do is monitor this monitor your blood sugar and any type of like thing you can sense that you have when you first start this is um mainly a really like a range and some people leave one unit for like 9 grams and cards and some people need one unit for like 30 grams of carbs so it's really going to be dependent on how sensitive you are to insulin
+C:	so I might have to go up
+T:	yeah you might have to go up or down just depending on how you react so what I would suggest is keeping like a log with you I don't know if you're logging your blood sugar reading and like a paper log or if you're just keeping it in your letter
+C:	in my meter yeah
+T:	yeah it might be good idea to have like a moment of madness you just when you get started so you can kind of figure out exactly how many units you need per amount of carbs just as far as what you respond to yeah
+C:	okay
+T:	you know this is just another little thing about when you first start getting used to counting carbohydrates just grant information for you so um I know you've been on the Lantis and it's an injectable how have you been doing the injection
+C:	um just in my belly that's that area punching the pan now are you using like the same area on your abdomen or do you kind of use different sauce I rotate it between each side
+T:	okay now that we're adding another influence you're going to be adding three more injections a day perhaps so I gave you a little chart here there are other places on your body that you can inject other than your abdomen so it might be a good idea because you really do want to rotate by Senora tation okay um so you're pretty familiar with how to use a syringe then
+C:	yes
+T:	okay you have a sharps container at home to secure the needles great okay so just to refresh they're only going to be using a couple of units at a time with this so I'm each each mark on here is a one unit and it goes up to 50 so pretty easy at least it's not done by twos or anything
+C:	right
+T:	okay um so we've gone over a lot of information and just to make sure I didn't leave anything out we've come through a lot of stuff here um can you just tell me how you're going to use these
+C:	okay yeah um well my old medications I'm going to continue taking so I'm going to take the metformin twice a day and the nighttime insulin at night and then with the new one I'm going to take one unit for 15 grams of carbohydrates but rotate site so that I don't get any atrophy and then I'm going I think it's a good idea to keep that logbook and monitor my route post levels in case the doctor will need to adjust the dose of that
+T:	I think it's actually great and yeah I just wanted to maybe ask another question about um you know what kind of exercise habits we have or how is your blood pressure been I noticed that as far as what information I have it was a little high which is something it concerns us with diet medication so I would have even
+C:	um well I have the back pain so I can't exercise that much and lately I just haven't been going to the nutritionist as often as I should
+T:	okay what kind of barriers are standing in the way of that
+C:	my job I'm a principal I'm pretty busy this time of year
+T:	okay um as far as your back pain and what is the root cause of your family you know if it's like something that maybe a chiropractor or massage might help there's the low impact exercise maybe a hope it for you I don't know maybe you can bring it up your doctor or two or Long's we're gonna be getting on something like just walking or like a stationary bike or even swimming if any of those are things that you can implement it'd be a really good improvement come and anyone needs much insulin -
+C:	oh okay
+T:	one other quick little thing is that um so insulin and your amount of exercising and activity kind of go hand-in-hand so if you start to exercise more all of a sudden you may need less insulin so once you get started on this and you know how much you're going to use per how many carbs it may change with you come around which is a good thing yeah but just keep in mind because you may have more hypoglycemic events if you don't alter
+C:	it watch it but maybe I won't have to use as much
+T:	yeah exactly so what other questions you have for me
+C:	um I just had one question I don't know if you'd answer this or the doctor but my eyesight oh if I get this if I use the insulin and get better control well my eyesight get better or shot getting is worse
+T:	um it should hopefully stay blind not get any worse I'm not sure if it will repair at all I don't think it will but it's best to stop it now you know I stopped their progression so the better control you have the better it should be as far as not getting worse but I've definitely something it's gonna be important - especially your occupation so so yeah getting under control - great a great thing
+C:	okay thank you
+T:	all right well thank you very much and give me a call if anything comes up I have some more information for you here which is very much just what we've gone over but that we can write all right
+C:	thanks

HighLowQualityCounseling/transcripts/high_054

@@ -0,0 +1,55 @@
+T:	all right before our are you today
+C:	I'm good how are you
+T:	I'm pretty good sons outshining makes me happy
+C:	definitely very warm
+T:	thinking that wait so why are you here today it'll be a any specific reason sir
+C:	Oh my doctor said I had type 2 diabetes so I don't really want to go on medication so
+T:	oh that's actually very common today with medications doing it by a natural healthy lifestyle so she said you have text red beans did she tell you anything about that or I will level are we right now with the understanding of what type 2 diabetes is
+C:	well I know I had something to do with the insulin but she didn't really understand
+T:	well I'm here for you so what type 2 diabetes is is in your body that working called your pancreas secretes this insulin excrete hormone called insulin and what the insulin does is takes up the glucose that's in your blood it brings it into yourselves that they use for energy and in your case your body is still producing insulin but it's just not either producing enough or it's having trouble getting it into the cells for various reasons or you're producing it it's just not working your body loses insulin resistant right now so do you know why your cells need the glucose
+C:	err
+T:	yes exactly it's due form of energy and your brain needs a minimum level of glucose to function along with all your other organs so by not getting that insulin or by not getting the glucose into yourselves there's some sense there's starving going to ketoacidosis a lot of complications can happen with that so it's very important to maintain blood glucose and control your Sugar's with a type 2 diabetes
+C:	so that's why I've been so tired recently
+T:	yes that's a very good cause of it so yeah that's perfect so well let's talk about your daily routine in your diet and see how that plays into it right now so what do you do on a normal day or what times would she be okay
+C:	well usually I just start breakfast eggs bacon
+T:	okay
+C:	that for lunch they'll usually say like some deli meat bread
+T:	hybrid wait girl in purple and
+C:	then for dinner on like pasta or some kind of poultry
+T:	okay so have you ever considered maybe trying to buy like different made whole grain bread or whole grain pasta
+C:	yeah I mean we don't usually do it
+T:	okay okay so you know that you need to not control your blood glucose levels right to maintain the healthy lifestyle so what are your goal is to try and do that or why why would you want to do that
+C:	well I don't really do much exercising my husband you know sometimes their dog so
+T:	yeah
+C:	okay
+T:	so and then the exercise that's going to help by reducing the adipose tissue around your cells which will make it easier for the insulin to pick up the glucose and bring it into your cells so losing weight is always a key part in maintaining diet or helping to control diabetes and even if you're not necessarily using weight doing the exercise one really help you gain more muscle mass which what is the bad news and both is just another word for fat is it late with that around yourselves adipose tissue is that too soon yeah so okay so we've gone over some brainstorming ideas so let's pick some two or three things that we can really focus on so for next time maybe we can hopefully see a little luck because um before I said the doctor happened to give you a glucose meter do you know what that is or
+C:	know that when you pick your finger
+T:	that is what are you prick you maker yes and that will tell you what your blood glucose is so remind me at the end of thing and we can give you one of those if that sounds like a good option and then we can start having blood glucose readings and that will also manage your blood sugar that's a way to
+C:	how about help
+T:	well that will let you know where your blood glucose is so say in the mornings generally your blood who was this putting much lower because you've gone all night not having anything to eat you're gonna start the day fresh but at night it's kind of obvious that you've got all day you're eating you're tired your body's gone through a rough day your blood Sugar's public we're generally much more higher so if we have glucose readings say next time when you come in we can say see where you're at see if they're generally starting to decrease of what we're doing is helping or not and then you can go from there always and hopefully that will help so you won't have to run the medicine
+C:	okay what would be a good range question
+T:	usually we want to try and keep your blood Sugar's under 100 and especially in the morning waking up not having anything in your system I know 100 be a good number at night of course it's going to be a little bit higher so 120 80 would say we're trying to keep anything under there and you know what if you mess up and they're higher that's okay because things happen you may have wanted to go to a party that day eat a cake you know anything so things are going to fluctuate but if we come back and you generally have lower glucose that's as much that's very good sign much better for your body so so okay so I'll call these pretty serving things what do you think we can what are like two or three main things that you choose that you will focus on
+C:	okay well I think testing is pretty important then I could definitely try to exercise more because I haven't really been doing much of that
+T:	right right
+C:	and then I maybe the whole grains too
+T:	yeah and you always don't have to switch by it over either we can say go to the grocery store this time by white bread the next time I buy whole wheat bread or make your pasta half white half wheat things like that under sandwiches maybe one slice of white bread once it's we brighten everything up whatever work for you and also does your husband eat well or
+C:	I mean we pretty much the same nothing right cooking
+T:	okay so that's perfect do you think it's a good support
+C:	I can try to get
+T:	yeah exactly and you know what maintaining your health and maintaining his health is just going to better the both of you anyway so it's always nice to have someone to help support you and what you're doing and going on the walks
+C:	okay
+T:	and if instead of staying or going on a walk everyday maybe you can go every other day with him but it's a learning process so you don't have to jump into everything right away as long as you're taking the initiative now and trying that's always what's gonna help so if it goes wrong it is okay so let's go back and summarize what we've decided you know some be the three goals that
+C:	we've shared more pool greens more exercise
+T:	okay perfect and do you what times do you think will work good for testing for you or do you have an idea of how you'll like keep a journal maybe or
+C:	so I can keep the journal I'm more of a morning person
+T:	okay
+C:	Chuck Tesla
+T:	in the morning and then you'll know what you are for the day you go from there they said that sounds good to me so you seem very motivated and excited like you want to get better and that's always a good sign
+C:	I definitely want to stick around a long time for
+T:	I agree that's yeah it's a mingle a lot of people healthy lifestyle so okay do you plan on coming back and see an appointment for next time or
+C:	yeah that's a really good checkup
+T:	okay does three months okay and that way we can give you a long time because well look at your anyone see again your anyone see is a measure of how sticky your blood is basically and so it's a three month measure so you would take it two or three months it'll tell you how much sugar and stuff on to the red blood cells of your body basically so we can see if it's higher or lower it'll tell how you're doing and so
+C:	okay
+T:	that would be a good indicator where you're at next time I see you
+C:	okay
+T:	so thank you for coming in today Jamie

HighLowQualityCounseling/transcripts/high_055

@@ -0,0 +1,36 @@
+T:	you 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 are transported to detox plus you're only 21 years old is the report accurate
+C:	I guess so I don't really remember much like those a week ago so I was kind of drawn to
+T:	ok behavior like this could get you suspended doesn't that concern you
+C:	mm-hmm I mean not really I'm gonna be 21 in a couple months I'm potentially alone the cops came to me a minor I mean I'm not a heavy drinker like like my friends or anything I don't get wasted at all and I just hey be careful I just won't get caught I'm just trying to find like a normal college student
+T:	what were you thinking when you got into your car after having six beers you could have caused an accident and killed somebody
+C:	whatever I didn't know I called my roommates for a ride you sleepy so idea home somehow and this is name of my fault I can ride all the time but I didn't do anything
+T:	you need to take responsibility for your actions do you keep partying like this your problems will only get worse you're likely to face costly legal citations for grades health problems getting kicked out of school and disappointing your parents you don't want that to happen do you
+C:	no no like I said this is my fault like are we done here have class in 15 minutes
+T:	your behavior is now a Minnesota State University expects of its students if you want to 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
+C:	look I really like corn I miss you and I gilja sand you you're making some really good points and i'll think about them okay
+T:	okay well your sanction is you'll be placed on university disciplinary probation and you'll have to attend an alcohol education seminar that will cost you one hundred and fifty dollars also disciplinary action is progressive and cumulative meaning that any further violations will result in suspension for one semester or longer
+C:	$150 are you serious I can't pay that all right I'm done with those I'm good
+T:	in summary the minnesota state mankato security report states that you are stopped on Stadium Road last Friday excited for driving under the influence and you're transported to detox plus the report lists your ages twenty Dillon what is the accuracy of the report and can you share with me some details leading up to the incident
+C:	I guess that sounds that sounds right I mean I was kind of drunk and it happened like a week ago I just I drove over to my friends house just to go watch the game and you know we're having a couple beers and X and O the Vikings accountabilities in pretty big so we drank a little bit more than usual and I mean at the end I had to get home and I couldn't find a ride so I just rolled
+T:	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
+C:	yeah that's exactly how it happened I mean I'm a normal college kid I had to drink in a house and buddies I mean it wasn't a big house party or anything that got busted
+T:	yeah I understand that your intention would have a good time while watching the game with your friends you didn't think about what could go wrong when you drink alcohol underage because you were at your friend's house not a big party and you made an effort to be safe by finding a ride home
+C:	and I tried to be safe I mean I tried to call her roommate but I am getting in trouble anyways
+T:	dawn you told me what brought you here today what do you think the problem really is
+C:	um let's say I have a drinking problem I think I probably have more of a like getting caught problem I mean my friends they drink like fishes and I they don't ever get cotton and you got me over here and I get caught and left
+T:	sounds like you attribute your current situation a bad luck if that's what you believe and you don't attempt to make any change in your behavior what consequences might result
+C:	I guess I got some more problems with police in school and I really don't have like the time or the money for any of that
+T:	how important is it that you avoid future problems with the police or school villain
+C:	it's just super important because just just going to detox alone was was awful the experience I don't want to do that again and my dad said if I get suspended from school I'll have to have to go work on my uncle's farm in Iowa and that would just kill my social I don't see any of my friends and I mean it's already bad enough like my parents took my car away when I got the DUI
+T:	yeah what would you be willing to do to prevent going to detox again and getting suspended
+C:	well yes I I guess the easy one is I want to drink so much and I try to avoid situations where I'm more likely to get in trouble so probably I don't want to drink so much
+T:	on a scale of one to ten how confident are you that you'll be able to follow through with that plan with ten being very confident
+C:	I guess I would say like I don't like over halfway is so maybe like a sex
+T:	what steps could you take to move that six or seven or eight
+C:	I could probably I guess well it's the big thing would be like kind of where I drink so like drinking like if I'm only like in my apartment so then I'm not risking myself to drive very like if I go out to a party waiting to like I'm 21 to drink maybe find stuff to do that doesn't revolve around drinking like I'm guessing like a town this size there's got to be more to do the just drink
+T:	in what ways might your life be better if you succeed in making the changes you mentioned
+C:	um I mean I guess the big one would be like I went I won't be hungover all the time like I would make it to my 8 a.m. then well even even when I make it to my ATM's now like I just I sleep like I wake up I'm like oh my god what's going on and then I get to my 8 a.m. and I'll just sleep through and then I'm this just about everything that's on the test so I think if I if I reprioritize what is important to me it probably helped me succeed I mean in high school I had a 3.5 GPA is I know I could do it here
+T:	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
+C:	um I mean education is really important to me and and also my family talking about it and I really I really want to be an international journalist to be on the news like I mean I have the face for it so I guess if I reprioritize mind if I read prioritize what I need to do like and I won't drink so much I probably want to be disappointing my parents and I'd be able to get a really good education
+T:	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 RS
+C:	Oh what is the seminar

HighLowQualityCounseling/transcripts/high_062

@@ -0,0 +1,74 @@
+T:	understand your boobs a little down lately
+C:	yeah I'm not feeling so hot
+T:	can't tell me how long you've been feeling down
+C:	yeah you know it's been a while extended like probably six months
+T:	six Ross okay tell me how many times you've felt this way in your life we've got periods of feeling down like how many of those
+C:	you know it's really the maybe second
+T:	the second time
+C:	yeah okay
+T:	how long did the first time
+C:	last year
+T:	so I'm gonna ask you some different questions about what's going on or it could be going on do you feel like your mood is depressed most of the day nearly every day
+C:	yeah
+T:	you do here are feelings of hopelessness emptiness I'd like that a little bit okay two other people see you as being sad yeah do you feel like your interest in pleasurable activities has decreased mustard a nearly every day you still have some how about significant weight loss or weight gain
+C:	yeah I don't fit in my clothes I've got about 15 pounds
+T:	is that unusual for you have you had any difficulty sleeping too much too little
+C:	the lime soup a lot
+T:	you feel like you're restless how about feeling of being slowed down any symptoms of feeling tired or losing energy coming fatigued
+C:	yeah
+T:	you feel that way how about inappropriate guilts or feelings of worthlessness
+C:	sometimes
+T:	sometimes
+C:	yeah
+T:	nearly every day or
+C:	yeah
+T:	have you noticed it's been more difficult for you to concentrate or being more indecisive that's right now have you had recurrent thoughts of dying or committing suicide any suicide attempts
+C:	I'm just really sad low energy not great
+T:	no how long has this been going on
+C:	for about six months
+T:	about six months
+C:	yeah
+T:	so I'm gonna ask you a few questions which ones resonate with you which of these items resonate with you that you're experiencing and which ones maybe don't apply okay do you feel like that your moods been depressed most of the day nearly every day like feelings of sadness hopelessness things like that
+C:	not every day I mean a lot
+T:	how about have you noticed a significant change in your interest in pleasurable activities most of the day nearly every day has your weight change significantly either losing weight or gaining weight
+C:	yeah
+T:	yeah
+C:	I barely have any clothes I can wear it about 15 pounds
+T:	is that what kind of weight gain unusual for you how about having trouble sleeping too much or too little
+C:	if they're like I'm up in the middle of the night or I'm sleeping you know like 10:30 yeah I'm sleeping a lot
+T:	I mean hours do you notice yourself either being more agitated or more slowed down in terms of your movements
+C:	slowed down so that's actually my husband said something about it
+T:	how about symptoms of fatigue or losing energy
+C:	I just feel like I I feel like a waste of space like I'm not living up to my potential like I've let my parents down I've let my husband Alan look guilt
+T:	you're having thoughts of ending your life
+C:	it's good to see you I was like last night I was thinking about when I was going to come in and I was thinking about like things that I wanted to talk to you about and I've really been concerned about a lot of things but you know what I mean it's you don't know what I mean cuz I would even set it yet am i saying but I'm really you know I'm getting a lot done I'm getting a ton done around the house I'm not sleeping very much you know I've been up you know all through the night but I had this where did I put that list where I could it but I have whole list of things I wanted to talk to you about tonight but you know my husband wanted me convinced I'm here and what is it that he wanted to talk to me about
+T:	well I wanted to talk to you about something we talked about earlier session which was a time it sound like a few months ago
+C:	yeah yeah I totally was it's so different from now I mean it's amazing now I love this feeling
+T:	you don't feel anything at all now
+C:	right now no I'm not I'm not I mean life is beautiful are you kidding me oh well I guess you could say that in the end I you know get it but I'm totally getting off topic what were you saying
+T:	well my sister questions about that that period of time in your town
+C:	is that significant I mean do you really mean
+T:	I'd like to find out what's going on there
+C:	okay
+T:	yeah that's okay
+C:	no that's fine that's fine
+T:	I know these things can be hard to talk about
+C:	it's okay so what was it that you wanted to
+T:	well remember we talked before you said it was a time it sounded like a started about a year ago
+C:	oh yeah
+T:	we were kind of down like now you're you see my good little off
+C:	oh oh you mean like my summer yeah right it was less no it wasn't it was last year about this time but then it lasted to the summer it lasted but women you know it was at six months and that was miserable I do not want to feel like that again and I mean I felt like that before I've been a couple times I think but you know like can I just tell you I am so productive right now that right back then I was not I definitely was not I thought it was such a different type of feeling I was like lying around on the sofa all day I was you know oh my god it was sleeping all of it I hate everyone meets right now it's fantastic I mean I categorized all of my photographs from when I was a baby through graduate school and I've got them and all these look good anyway what was I saying - I was talking about
+T:	is normal enjoy playing with your kids
+C:	oh yeah yeah
+T:	you just not through that time
+C:	that was horrible no
+T:	and you mentioned that you weren't sleeping too well do you have any weight changes during that time
+C:	definitely you know closer to 150 back Bettany about right now 15 and that's great but ya know I gained a lot of weight I do not want to go back to that again yeah I'm like 115 right now I went to Bloomingdale's last night do not tell my husband but they were having the most amazing sale I think I spent too much I mean I probably
+T:	spent a lot
+C:	but it was on sale and the stuff is gorgeous I mean if he saw it he really could not complain because I was meant to have it again seriously these sweaters are beautiful
+T:	so this symmetry which how you're feeling now sounds really opposite way you felt six months ago
+C:	oh yeah yeah yeah completely but I mean this is good so during that time so I'm going back down back to that time for a second did you have feelings of worthlessness
+C:	yeah but I mean I could probably guilt ya
+T:	can tell me about how the symptoms the presence of the symptoms like the frequency duration for example during that time period was that most of the day nearly every day that you felt this way did you have any trouble concentrating or making decisions
+C:	yeah
+T:	having a thoughts of suicide this is back this information is very helpful thanks Ian

HighLowQualityCounseling/transcripts/high_063

@@ -0,0 +1,134 @@
+T:	at least how you doing today
+C:	I'm doing well thank you
+T:	doing well what's going on
+C:	I have family coming into town and I have to go to the airport to pick them up
+T:	so you have family flying in
+C:	yes I get very anxious about having to cross the bridge I have to cross the Ben Franklin Bridge and then get over the bridge that goes to the airport by the stadium I think that's a Gerrard Point Bridge don't wanna yeah that's two levels there I have to do that both ways and then call you in coming
+T:	both ways you have to do it across four times
+C:	yes
+T:	so what kind of feeling is just bringing up for you
+C:	I get very anxious even or thinking about it right now
+T:	so you're anxious right here with me
+C:	yes yeah
+T:	so I want to try to scale this we talked about this before with cognitive therapy so let's say that 10 is really the most anxious you're felt about crossing bridges right and one is no anxiety where would you be right now right now
+C:	probably an 8 it's worse when I'm at that point of that day but right now I think just knowing that I have to do that yes
+T:	and what's it on that day
+C:	yes
+T:	all right so but even now how far away is the until they
+C:	oh it's a week there's we coming yet
+T:	so even now a week out loses it's Nate this is really hurt
+C:	No
+T:	so for your job and local travel you don't really have to cross any
+C:	ten minutes to work everyday and bang so 20 minutes I went shopping centers and everything that's just within the vicinity I don't have to cross any bridges
+T:	right so no snow bridges yeah thanks probably planned it that way it's good I don't know
+C:	it worked out well okay all right coming up pick up the family you will be crossing so let's look at this in each stage okay so I mean you're clearly anxious now as you mentioned let's go to trying to move forward a week to the day that they'll be fine at what time they find it
+T:	it's gonna be a four o'clock flight
+C:	so about what time would you have to leave -
+T:	I would have to leave probably at 3 o'clock because it's only about 20 minutes to the airport really
+C:	really
+T:	but I would like to leave earlier they're probably taking up time by the time they land and to go through you know they're getting their luggages they probably won't even come out till maybe 4:30 but I'd like to make sure I'm there at around 3:30 4 o'clock
+C:	all right so let's go to the best day it's good that day and said that afternoon
+T:	okay
+C:	so you're still at home and let's say we're about 15 minutes before you have to get in the car what are you thinking then
+T:	I have to do this to to get up and go they need me to be there this this week it's my parents coming in and they're elderly so I don't want them to be stuck at the airport there's no one else that actually can go pick them up so I have to get up and go and pick them up so
+C:	that's going here
+T:	that is what's going through my mind that you know there's nobody else that can do this I mean it's cheaper than there's nothing I can't probably can't even afford to get a taxi for them because you'd have to cross that's from Philly to into New Jersey so that's gonna be very expensive I can't afford that when all I'd have to do is pay $5.00 for the tow and maybe gas up my car for $10 or something but hey I'll be thinking about it I have to do this and I'm not really doing it you know it's something that I can save money that way and I don't want to leave them stranded definitely someone else can I mean baby lost they're not familiar with there but in Philly the airport is crazy to me
+C:	it's a big place a lot going on so so you're sitting at home in 15 minutes before you eat in the car and you're thinking I have to do this but your reasons are positive like you to save money and protect your parents from having to be there alone so ones things I do come in
+T:	um just the thought of the bridge there it's just I could drive off the bridge you know they can fall off usually what I do is try to stay in the middle lane I can't do more miles an hour and I just I'm shaking I have the radio on and windows down because I can't swim so for any reason I'm to fall off I mean that's it for me I even have a little metal one of those so I think it's an instrument that you used in the house for I don't know pliers or something is something real hard that I can hit the glass with it sits right there on my door so I'm all ready I planned and I have that I planned ahead of time I know what I'm gonna do as soon as I approach the patient but I still feel anxious
+C:	you're anxious before you leave and you're and you're starting to think about the bridge at that point we already think about it
+T:	yes
+C:	how about when you get your car you start driving toward the bridge say a prayer I'm still anxious I turn on the radio the closer I get to especially the toll points and I know it's at me and you see those lights flashing last exit before you know
+T:	you know you're going over one
+C:	yeah I have no there's no turning back there's no turning back
+T:	so before that when you can still exit what's your anxiety level
+C:	before when I can still Excel yeah it's probably still high it's about the other than the high nor so it's still high but
+T:	it's not maxed out yet but every lap
+C:	it's gonna be
+T:	yeah I think it's pretty bad at that point
+C:	and how about when you cross through the that's an inside the tendon okay
+T:	yes yes
+C:	so your specific fear as you start to cross this is the bed Frank want to be the first bridge right you can do across is that your car will go off the bridge
+T:	yes
+C:	and when does that so that's a 10th anxiety when does that anxiety start to go away
+T:	as soon as that getting close to getting off the bridge and now leaving that little sigh of relief there's a little release there and I know that I've been able to manage those two three minutes of cross that into how many minutes it takes actually of crossing crossing the bridge and I start feeling a little bit of relief but then again I know I have to do my back exit and there's another one coming by that so starts all over again all
+C:	right Sonia crossed the second bridge the drug point fridge you go to the airport as your anxiety dropping those points
+T:	Oh as soon as this I'm descending from the Gerrard Point Bridge there's less you know it's almost reduced I'm not coming you know really low it's almost going yes it's not Muskaan
+C:	yes
+T:	and when you start thinking about that you're gonna have to cross them again
+C:	as soon as I'm exit I'm getting back on 95 going north and I know here we go again and cars that zooming by and you know
+T:	as you're not going to really
+C:	know I'm that person into the middle lane doing 40 miles an hour yes
+T:	all right so you're you're doing everything you can to keep your car on the bridge but you're still feeling anxiety like you're gonna go off the bridge
+C:	yes the whole the whole time until you start really descending
+T:	exactly
+C:	and then you feel like you've made it
+T:	yes especially when there are those big trucks tractor trailers coming
+C:	does the air
+T:	yes yes if it's also in bad weather or at night it's worse because on the bridge especially the top one you kind of see the sky and there's nothing else you see so it's like you're gonna fall off yes
+C:	so in the lower level it's not as bad
+T:	all the lower level coming back it's not as bad because you're kind of like protected here and there so it's not as bad but going is definitely worse yes
+C:	are you aware of any time a car will gone off the bridge
+T:	I hear all the news once in a while you'll hear something happen or sometimes in movies you see things happen I think it's possible
+C:	it's possible do you think it's a high risk
+T:	no maybe none of that um Girard bridge because I I noticed I was checking it the other day I had to go to the airport and I was trying to measure the distance between the metal poles just to see if a car could fit there really and I think a car could fit there but you know it just depends on the angle you were hit or something or if you flipped so yeah done some thinking she's
+C:	done some calculations geometry right and you've concluded that it's not really likely but it could all right so but either way your anxiety is maxed out on each bridge now when you get home I mean get your parents back to you take them back to your house
+T:	yes
+C:	and you feel them
+T:	I don't even recall all the anxiety know why it was such a big deal anyway I don't think about it at all
+C:	all right so you when you arrived home you're down to one
+T:	yes yes
+C:	all right so going back to the the first stage like when you're getting ready you're thinking that you have to go
+T:	yes
+C:	and it would save your parents money
+T:	it would save me money how it can be the one calling the can but if people want to pick them up and save them from being stranded at the airport than being in a land that they they're not familiar with an area they're not familiar with so make sure that they're safe
+C:	how important is their safety to you know very important yes
+T:	so it clearly it sounds like you picked them up before
+C:	yes
+T:	so picking them up is it's worth all the anxiety
+C:	it's worth but yes it's
+T:	tough
+C:	it's still something that bothers me that I have to do yeah it's worth the inside
+T:	that's worth it but you wish that you could do it without anxiety
+C:	yes I wish there was another route that I could take any bridges at all that's not known yet defined yeah
+T:	and how long have you had that anxiety we try to approach it
+C:	as long as I can remember that I know maybe even that when I was younger but perhaps as a mother and you know someone as I got that life was important I mean prior to maybe marriage and kids
+T:	all right developed along the way somewhere it's been with you ever since
+C:	yes
+T:	so I'd like to do what kind of therapy we call a refrain and actually you've kind of already done it but I want to make it a little clearer so you suffer things I D and you suffer it to protect mostly protector your parents
+C:	yes
+T:	so as you're going over the bridge you're thinking about the automatic thought we talked about these before right the thought that kind of pops in your mind is I'm gonna fly off the bridge
+C:	yes
+T:	so that seems pretty unlikely all right that's not something that maybe as you talk about geometrically maybe there's some way your car could find the bridge with physics now maybe could happen but it seems like it would be do you fairly like
+C:	yeah
+T:	so you could challenge that and this isn't the refrain part but you could challenge that on that thought which with a statement and adapt a response like it's pretty unlikely I think it's going to happen alright that might help a bit to keep applying then the chances are vastly in your favor I could sing how many cars you cross that bridge I'm a fly off the bridge alright heard of plan out for those bridges but the other you know the refrain part is that you're you're doing this you're willing to take on the bridges and have this anxiety for the betterment of your parents for their safety
+C:	yes
+T:	so in this whole equation of crossing bridges and anxiety and you're really really the good guy in this you're you're willing to you're willing to suffer and overcome a fear to make sure your parents are saying yeah I mean and you've thought about before like before you leave you think I only have to pick a month but you've never really connected it to want to be in the good guy here
+C:	well yeah
+T:	okay does that make sense
+C:	yes it does it does yes like here go my guess my family size my brothers and sisters appreciate that yes
+T:	yeah you've overcome it before to pick them up and when you pick up again you'll you'll overcome it again and you'll suffer but I the difference here is that that reframe I want you to apply that reframe when you're feeling that anxiety issue get ready to leave and as you're trapped with the bridge that you're really you know you're doing what you feel is right for the good of your family
+C:	yes
+T:	all right so the automatic thought that's gonna come in in is you're gonna fly off the bridge okay that's what that's what the exoti is about Miss Spears and the reframe in this case the reframe adapter response is I'm doing I'm doing this for my family and the probabilities preloaded like the bridge that's a separate thing but the reframe is I'm no I'm the hero of this I think that's a great way to look at here to hear of this situation
+C:	so think of that terms at the beginning of that day or they went up to hold
+T:	the whole day yeah yeah just kind of go over that should rather than like something you must do because really you don't have to do it strictly speaking right I know you feel you have to do it but you're willing to do it you're willing to sacrifice and suffer to do it
+C:	okay
+T:	and I'd rather that be the theme that you're getting is a positive thing that you're that you're willing to do it has to be done it's uncomfortable you'll survive it it's uncomfortable I focus on that kind of reframe then focusing on the very low probability that you're the risk that you're going to fly off the bridge so it's very low low risk
+C:	okay look uh make
+T:	sense and
+C:	make sense and make sense
+T:	so it's not so much being forced to do it me forced into an extra situation you're voluntarily in brave and I know it's hard it's hard for you didn't use your say it's a 10 on the anxiety to get that's that's the highest score right so it's hard for you but the way to look at it maybe would be you're doing has to be done you to flee go your family they need you have you ever had any close calls on a bridge or anything
+C:	um when it there was that day when there was a lot of thunderstorm and there was wind so I could literally feel the car shaking on the bridge and there was a day I think I was coming into Delaware I had to stop and call those they say if you need help crossing the bridge and I stopped and call them but they talked me before they talk to me for about half an hour or so and then they told me that it would take another hour for someone to literally be able to come and get me and this was like that I was leaving here it was self probably around 10:00 10:30 class was over I was on the bridge and it was late at night raining and I just I couldn't do it but after a while I think I calmed down with their conversation and I was able to just take it easy in that middle lane she always managed to overcome
+T:	yeah and that might be another a good automatic thought or adaptive response to that on that thought is that I've always managed overcome this and it hurts but managed overcome it
+C:	yes
+T:	I kind of taken charge like that and being assertive that might help reduce that automatically
+C:	ok
+T:	you think if you try that this time is you
+C:	that's thinking in that positive way I've done this before and then that can do it again
+T:	yeah
+C:	all right all right
+T:	so I'll see you again in two weeks which will give an opportunity
+C:	to pick them up from me you're quite a bit
+T:	and then we'll see how things start with that and we'll move from there
+C:	okay
+T:	all right thanks sweetie
+C:	thank you very much

HighLowQualityCounseling/transcripts/high_064

@@ -0,0 +1,75 @@
+T:	so I'm hearing the good part about drinking is that it keeps you calm and I'm also hearing the downside about it is that you started wanting spenders and your family get a bit concerned it must be tough so what is that like for you
+C:	a little bit down and or Danika really pick-me-up is a good drink
+T:	yeah so you kind of use it as a way to shift your mood a little bit yeah okay and so what what do you what would you like to do what would you like to change
+C:	I don't like the way that makes everybody feel when I get overly intoxicated so I feel like I need to just find another way I need to stop
+T:	okay so you noticing that it's kind of a little too long and so you want to find an alternative means of coping or trying to relax
+C:	yes
+T:	okay and what are some alternatives
+C:	well my buddy from work told me about some places that might be able to help me with some some strategies around giving up drinking
+T:	yeah
+C:	thought about going back to church
+T:	so on a scale of zero to 100 how important do you think it is for you to make this change
+C:	I know it's it's it's clearly above 50% I feel like if I don't stop just now end up in a grave somewhere so I need to take this
+T:	okay so around 50 and on a scale from zero to 100 100 how confident are you in making this change
+C:	I've tried before maybe a day or two and then something really bad happened or things got tough and I just went right back to drinking
+T:	the good side of it is that you understand that you need help and I think that's awesome really really good for you to have that insight so I'm hearing that you're not that confident okay so from from 0 to 100 where are you
+C:	I'm gonna be in less than 50% because I have been way too long without drinking uh sometimes when I work I think about getting off just to have that one
+T:	so in terms of importance you're around 50 in terms of confidence it's less than 50 so I'm hearing that it's important you know that it's important for you to make that change but in terms of confidence you're not that confident okay so what do you think it would take to help build that confidence
+C:	well I live alone really have anybody that comes and shakes on me so
+T:	yeah
+C:	maybe if I had somebody you know take your time to check on me
+T:	right right
+C:	find out how I'm doing every now and again that might keep me encouraged
+T:	so I'm hearing that you you would like someone to help keep you accountable and also to help encourage you and motivate you towards making this change and and this is the reason why you mentioned your belief system before and if I if it's okay if I may ask your permission what the people at your church be some of the people that you can turn to for some of the the accountability and you know help motivate you to change
+C:	I guess that's what church is for I've been in church since I was a little boy I don't know that that's where you go to get right so all of you are the right people
+T:	right so I hear you say I want to get right and I kind of hear that willingness to want to change can you tell me 103 best reasons for you to make this change
+C:	she's always telling me I don't need to drink she doesn't want me to hurt myself I see how makes me feel when I drink I'm usually in the rut I feel good terrible again I just want to do I want to go out and achieve some things in life change this
+T:	okay so some of the things I'm hearing is that you might want to do it for your mother and I'm hearing that you would want to achieve this you're maturing on in life and so for you and what's another one
+C:	just thinking oh maybe I'll grow healthier tonight some that drink as much quartz I drank it all
+T:	yeah
+C:	people you know they don't drink and they seem to be really healthy
+T:	uh-huh
+C:	so maybe I maybe I can be that one day
+T:	walk me through a day of drinking for you
+C:	well not working
+T:	okay
+C:	I wake up in the morning and I usually try to fix myself some some breakfast but I end up drinking a little bit because I keep a little something
+T:	okay
+C:	but by the middle of the day I find that I'm really loose after having a few drinks and I say a lot of terrible things I don't recall it in in particular but I've been recorded and friends have told me you know things that I've said under the influence and it really rowdy anything I'm taking out nobody when I'm when I'm drinking then I get kicked out of places
+T:	yeah yeah
+C:	I can drive and
+T:	yeah
+C:	it's just not it's not the way I want to live it's I feel too dependent upon having the right drink
+T:	yeah
+C:	it can't be empty and
+T:	some hearing when you wake up you've had a drink in the morning right before breakfast
+C:	yes
+T:	and by that time you're calm and you're loose and anything you just get a little belligerent okay it's causing you to get kicked out a lot of places you know and I'm hearing them you're saying that that's no way to live and so you no longer want that yeah and the good the good thing about what I'm hearing is that you have friends
+C:	yes
+T:	well care enough to notice what's going on and bring it to your attention by recording you
+C:	yes
+T:	and so when you see yourself
+C:	I feel I feel bad sometimes we make fun of me because my buddies dream today drink yeah but not unlike me I'm the worst on everyone and they can take it in to have one beer be done and me I'll just keep going everybody goes home and you know it's just me
+T:	and something your buddies have in common right
+C:	yeah but they I think they're just seeing me in a different way when it went out I've hurt so many people
+T:	yeah
+C:	and I just don't want to do it anymore they told me I mean oh and I believe our new home
+T:	yeah
+C:	everybody's saying that he helps or I must I must in Galax
+T:	yeah and so help is available I have a few substance abuse places that I'd like to refer you to and maybe some hey have you heard of alcohol Anonymous meetings as we mentioned before support group and your church as you mentioned so these are the avenues that you said you would like to go into
+C:	I mean sounds alright I don't want to feel like I don't have control
+T:	right
+C:	I don't want to feel I don't want to drink I want help I just don't want to feel like I'm trapped in one particular program I mean they do make community do these guys helped me to find strategies
+T:	absolutely absolutely it definitely helped me with strategies and you know a lot of affirmation and helping you to get there control that you said that you wanted these are definitely some and great place is to go into to help you get your life back sound like what I'm hearing you say
+C:	yes good
+T:	okay so we've talked about where you are in terms of wanting change we talked about where you act as far as feeling confident in change we also discussed a little bit about the reasons why you want to change the three reasons you mentioned your mom you mentioned for yourself you mentioned your health in the session we also discussed some avenues that you may take in terms of getting that support that you want we talked about your belief system a little bit we talked about church we talked about referrals in places that you may be interested in so you talked about a lot and I want to hear from you how is this going for you how how was the session been going for you in the past the last session that we had before
+C:	I mean our key I came back because the first time I spoke to you you didn't judge me
+T:	yeah
+C:	you didn't tell me I was some scumbag whose side of the road you told me I needed a clean up because I'm a junkie so I came back and you've made it very easy for me to speak to you and that's the only reason because everybody else talks to me but they they talk down to me and I don't like that and not feel ashamed of myself but speaking to you telling me I understand I can get man up and I can do something different nothing regain my self-confidence
+T:	yeah well thank you I'm glad that you have had a wonderful experience in terms of speaking with me today and I'm glad that you've also decided on what you want to do in terms of making those changes for your life and I'm glad that I can I can be a partner in helping you to achieve those things I really really appreciate it so if there are any goals that you would like to achieve for our next session or in the future
+C:	I just want to be I want to I want to not drink
+T:	yeah
+C:	at all yes between now and our next session I would think that would make me very happy
+T:	Wow
+C:	I warned them I want to have something to talk about
+T:	yeah yeah wonderful session okay we'll go ahead and schedule those referrals

HighLowQualityCounseling/transcripts/high_065

@@ -0,0 +1,85 @@
+T:	hi nice cute
+C:	you two
+T:	so why don't you tell a little bit about yourself
+C:	so when it was Kelsey Harris I am a student here I'm a senior double majoring tiger balm on campus I play a sport I do collectivities home very busy around campus from with your lineup I was born and raised here so I like beyond my family a lot
+T:	just sounds like you're really busy all the time yeah
+C:	yeah you can say that you got home a lot
+T:	um actually no not really I only live a couple hours away but my parents come here not frequently but enough that i get to see them so you say they play basketball
+C:	yes
+T:	yes
+C:	yes so walgreens whopping two-year like what you decide
+T:	well I've been struggling with some anxiety issues lately and I can't seem to figure out why I just I've been having some like anxiety attacks and panic attacks just wasn't like the last couple months and I thought him just go away on their own and like they think has come on at night sometimes or at first I thought they were centered around like papers and normal collops things but then like I had one were fall break whenever I didn't have anything to do looking to be here
+C:	have you so you see that it has nothing to do with schoolwork because you said you have a really cool place and you don't think I hadn't anything to do it back
+T:	I don't think into this and I mean it's a big school of constant thing so it's my senior year or two and I had to pop up until now so I I don't know I can't really figure out what could be causing it
+C:	how are things at home with your family
+T:	I'm dinner going well my little sister actually she's a freshman in college this year so my parents are at home with the emptiness and trying to figure out what i'm going to do with their free time and call me a lot i went off a lot but I mean everything's fine I see my grandparents pretty often my sister is going well
+C:	that's good so so you and your family are going well
+T:	we're we ever pretty close
+C:	how I was like the social life like how are things at school you know with your friends and ball how are things going
+T:	socially everything is going well too just trying to keep everything balanced it's a but I mean I feel like I'm doing a pretty good job of it
+C:	you get very clean school and stuff
+T:	yeah and i will say that senior year brings you know the senioritis around sometime so it's hard to get some motivation in there but um I mean schools would well like I I'm happy with my grades are socially I'd say that I mean my friends are still there like I love my friends I'm i feel like i do the same things that is nothing different going on
+C:	okay
+T:	socially I
+C:	just just get anxiety attacks just randomly
+T:	yeah
+C:	do you notice any pattern maybe when things id attack occurs
+T:	so I had probably five or six within the past month a couple of them happen at night only who actually most only the only one happy birthday but I wasn't like around anybody see any patterns with that at a loss
+C:	but he had any strange or reoccurring dreams
+T:	um actually I have they're just been like weird dreams that it's like I don't know it kind of plays on the future a lot but then like whenever i wake up i can't remember like specific details from it like you have you had a dream where you it feels so really you wake up and you Cameron really what just happened
+C:	yeah that's usually how you know it works a lot of people put a note pad next to their their bed and the second they wake up they write down what they dreamt about so they don't forget and like it's just something that people do but maybe that's something that you can try oh my good yeah so you say your sister her brother
+T:	sister
+C:	just left home why she going to school
+T:	she is in school at Spelman in Atlanta so she is having fun hopefully studying oh no she's not playing sports she just ran their students
+C:	she's a regular student
+T:	yeah
+C:	you know how many thousand things on your plate like you did
+T:	yeah I was I don't know cuz every time I talk to her she's like like they have a lot of going on down there Nixon is it Lana like it's my Burlington North Carolina so I talked to her I'm like when you ever study I don't really you know every time I talk to your do it comes you too jealous but we should
+C:	yeah okay so when you have anxiety like wouldn't have these attacks like what are you feeling
+T:	I feel like scared I feel almost like a pressure like I can't breathe you type of thing but more like a scared feeling
+C:	do you feel helpless
+T:	yeah
+C:	yeah what do you thought
+T:	well the first time it happened like I never had before so I didn't know what's going on and I was like in my room just about a little bit not doing anything in particular so the first time it really scared me and then you know it took me a few seconds just like started reading my guardian graduate and then a house wine so I think the more they happened I hope they will just call myself down and just keep going few minutes later and not think about it but I don't want them to keep all right well
+C:	that's good that you're about to keep my calm yourself down and that's good have you talked to any of your friends about it
+T:	no
+C:	it's the first time you're talking about it
+T:	yeah I've seen any doctor like I don't have a weird thing with like taking medicine everything I want to be supplied with always like home
+C:	just type in it
+T:	yeah I feel dependent on medicine
+C:	yeah I feel the same way uh okay so how would you toss the team looking this year how's the basketball team looking
+T:	really good um I want to seniors on the team so everybody's looking up to me so it's a little bit of pressure but i like i like it it's different you know our team's different
+C:	yeah
+T:	it's it's hard to compare this team to like other years and I mean it's kind of like unknown going into it just like you have a heavy patient because there's young you know two layers yeah we were going you taking my captain girl you'd say that oh just stepping into whatever goal the coaches want me in want me to 70 keep me like I'm trying to be a leader like vocally and it's different for me because I'm not used to being so vocal about it
+C:	so you feel a pressure a little bit this year
+T:	I can just always pressure there but I guess it's like a little more pressure just because he had a lot of the
+C:	yeah
+T:	one of the few seniors
+C:	ok so
+T:	the pressure is good though no yeah
+C:	yeah actually I agree um and then so with school are you feeling any pressure there
+T:	um I guess not I think about it I mean I am a little bit um so like my GPA is it's pretty good I have a like 33 I'm pretty close till you at 36 Soleil I'm trying to keep it up like a 35 the rest of the year and we depart of zoo but doesn't aiming for yeah so yeah yeah but it's all like a pressure go myself like nobody's really like telling me I have to do it just for or else but it's just something that kind of doing
+C:	so are you are you a leader in your sorority any kind like you have actually there
+T:	well I'm the treasure in my sorority but we we had a lab new members come in last year some kind of like showing them the ropes kind of likes taking steps back you know like them starting to read some things so it's not really that much pressure in that
+C:	but it sounds like you a lot to do
+T:	yeah
+C:	Billy today
+T:	yeah I think I'd rather do that then have so much free time
+C:	yeah
+T:	I'll have to do is probably sleep it like egg sleep or watch TV you know or Netflix
+C:	oh okay so I want to hear more about you know your family like tell me a little bit more the relationship you have like with your sister and be with your grandparents look if you have
+T:	so my parents are from Greensboro my grandparents on both sides actually still live in greensboro so they're 20 mins away if that they all come to my games pretty much every home game if season tickets but I don't create my advice he said tickets but my family so uh I mean we're like I really close I don't know like I don't go see them like very often maybe like once a month but I try to go see them at least once a month or once every other month version like that but I see them so much because they come to my games I was like
+C:	yeah
+T:	yeah
+C:	yeah yeah
+T:	yeah well yeah this is why don't I go home that often either obsess my parents quite a bit to my sister like I thought it like she's a freshman in college so she's having fun um I'm seven actually just had laser their homecoming this past week so I know she's been busy so yeah oh my mom's birthday last week president again yeah we're pretty close
+C:	yeah and I guess
+T:	no I think about it I love it gradually
+C:	yeah we have to face the real world pretty soon I think it's just been like all facing the reality of the fact that you're gonna be graduated
+T:	yeah I mean I kind of have a plan of what i want to do blood change changing you know it's just like funny hearing some people you know like have their first job offer sounds like
+C:	is that stressing y'all
+T:	not yet but I feel like it might I probably will in the spring right now I'm still like I still feel like really invested in elon so I still feel like I'm here yet so probably in the spring out I have to like start
+C:	configuring out
+T:	yeah
+C:	well I hope everything goes
+T:	thank you

HighLowQualityCounseling/transcripts/high_070

@@ -0,0 +1,128 @@
+T:	hi Michael it's good to see ya well glad you came in today when I douse up
+C:	well I came back here because I had to I had to make an appointment so I could get my prescription for my blood pressure medicine refilled and they wouldn't do it it wouldn't refill it it's a drugstore unless I came back here so
+T:	you're you're angry what
+C:	well I'm not angry at you but I'm angry at the situation and I gotta come back in here take time off from work just to get that prescription filled but but you know you do what you got to do and
+T:	well I appreciate your bringing that up that is does sound frustrating but by coming in it gives us a chance to to sit down and and and talk and see how things are going with the medication which is what I'm most concerned about I know we started at about three months ago or so and I am real interested to hear how you're how you're doing on
+C:	well uh yeah whenever I get my blood pressure checked at the drugstore it looks like I'm that it's working and that respect but it does seem to take away all my energy you know
+T:	kind of fatigued
+C:	yeah yeah my I got no get up and go if you know what I mean
+T:	so kind of has taken the wind out of your sails
+C:	absolutely yeah
+T:	how long have you noticed that
+C:	oh I don't know I at least since I've been on this medication at least that long
+T:	yeah doesn't sound like it's working well too working too well for you have you tell me about how you're taking the medication have you taking it very regular
+C:	oh yeah I take it I take it just like it says take it on the bottle you know I take it every morning when I get up
+T:	okay so you've been pretty consistent and taken
+C:	the all yes
+T:	anything else going on in terms of symptoms no just this overall lack of energy which I know my wife doesn't particularly care for
+T:	your wife coming a little bit more about how it affects the relationship between the two of you
+C:	well as I say I get up and go got up and went and there's not much going on between the two of us like there used to be
+T:	so sexual performance is not as good as it as it might be
+C:	nope but I think it's because of that damn medicine
+T:	so does this sound like something that you want to continue or should we talk about possibly other other options for you it sounds like it's kind of affecting your life negatively well
+C:	yeah yeah but you know I I'm worried about my blood pressure because my my mother had a stroke not long ago and I know it was so they told us it was because of her high blood pressure so I don't want that to happen to me
+T:	so you're concerned about having a stroke
+C:	well yeah I mean would you be you know it sort of runs in families I think
+T:	yeah so taking care of your blood pressure is is very important to you
+C:	yeah yeah absolutely
+T:	again it doesn't sound like this particular medicines working out too well for you if it's okay I could talk to you about possibly changing the medication so on the one hand we'd be keeping your blood pressure under control but on the other hand we wouldn't be causing these types of side effects hopefully would that be okay
+C:	well are you talking about on more medications or just a different medication
+T:	yeah so uh I think probably it sounds to me like probably changing medications at this point as a start we can always add another medication later if that becomes necessary
+C:	yeah well I'm not real interested in adding any more but if changing it it would keep my blood pressure down but not take away all my energy than I might that give better idea
+T:	so you'd at least be willing to try a change and and see how that goes
+C:	yeah yeah I know well
+T:	if it's okay I can tell you about a group of medications that I I like but if but first if it's okay that they give you a kind of my rationale for using that medication to start with so you know one of the things you'd mentioned to me was some of the financial concerns and the medication that you're on is pretty dirt-cheap and for most people at this dose particularly a low dose because you have mild hypertension most of the time it doesn't have many side effects obviously for you that was different does that make sense
+C:	yeah
+T:	yeah so the medication I'm thinking about is something called an ACE inhibitor ACE inhibitors are very very well tolerated and occasionally people will get a dry hacky cough with them but it's fairly rare but there's very low risk of side effects in terms of sexual side effects in particular and most people as a matter of fact it's one of the the drugs that actually helps your heart beat a little bit stronger and better and many people don't have any kind of a decrease in their energy so how does that sound
+C:	yeah it sounds though it sounds like a good idea if it still controls my blood pressure but doesn't take away my energy it sounds like a good idea
+T:	okay so what other things can you tell me about that might affect your blood pressure
+C:	uh-oh uh-oh my work is sometimes stressful and some of the people I work with kind of drive me a little batty occasionally and I I don't know if it I don't really know if that it causes my blood pressure to go up or not but it certainly could I guess
+T:	so there's some stressors at work
+C:	yeah
+T:	and if it's okay I'm going to write down some of these things that as we talk through them so what else can affect blood pressure that you know of
+C:	um well you know just mostly from watching TV shows I guess I am aware that alcohol and I drink some a moment that alcohol has some effect on blood pressure I think it might even say so on the label though I'm not sure
+T:	it can't it can't anything else you can think of
+C:	no
+T:	well sometimes sometimes weight can be an issue and explain this little tool to you this is for what it's worth called a agenda mapping so it sounds like there's a number of things that you know of and then we can talk about that affect your blood pressure you mentioned stress and an alcohol and we talked about weight certainly you know blood pressure medication can affect you there and I would say another big one might be exercise does all that makes sense
+C:	well yeah
+T:	so we could we can talk about a lot of these things with which one might you want to talk about and if we need to we can set up for appointment and talk about this more if we run out of time but
+C:	well um exercise I'm I actually like to exercise
+T:	and tell me about the exercise that you're doing
+C:	well I play golf and walk the golf course
+T:	so you carry your bag or do I drag it along on a pull cart
+C:	my wife says that that doesn't count as exercise but I say try it yourself it is exercise
+T:	it is exercise it is exercise Michael look at your your weight when we came in
+C:	yeah
+T:	and you were about 160 or so yeah which is actually according to your BMI body mass index in the in the overweight range how do you feel about that
+C:	well I don't think I'm overweight
+T:	yeah you don't look terribly overweight but according to the the charts there it's in the overweight category so you're actually getting you into the normal category would be about a loss of about 15 to 20 pounds
+C:	15 or 20 pounds
+T:	yes 15 or 20 pounds
+C:	I haven't weighed that since I was in high school
+T:	I understand I understand but you know I'm not saying that we need to lose 20 pounds sometimes just a loss of 10 pounds can make a tremendous impact on your on your blood pressure
+C:	okay
+T:	so 10 pounds sounds like something that might be negotiable
+C:	5
+T:	5 is the number
+C:	okay
+T:	let's go you do with thigh
+C:	okay I think I can do 5
+T:	all right so if you were to want to lose 5 pounds how would you go about it
+C:	I'd probably go back to the gym
+T:	as that worked in the past
+C:	yeah I mean I used to go to the gym and work out a lot and uh I've done it for a while but I guess if if I'm I'm sure I could lose 5 pounds if I wanted to
+T:	and that would actually kind of take care of two of these things right your weight and your exercise both of those would have a really positive effect I think on your on your blood pressure
+C:	okay well
+T:	so we've talked about changing your medication stopping the medication you're on changing you to this ACE inhibitor and then perhaps looking at the weight and going getting back to the gym and starting an exercise program is that about right
+C:	well what would it take for me to not have to take the medication at all
+T:	at all
+C:	yeah I mean if I did enough exercise and lost enough weight would you not what I not need to take the medicine
+T:	I I really wonder if you would I think that's an excellent question and if you're motivated to lose that kind of weight I'm with you I can't leave I this good I can lose five pounds well it may it may take more than five pounds to get the desired effect on your blood pressure that's really getting back down into that normal weight range if you will in that one 35 to 40 range probably
+C:	I I just want to make sure I understand if I if if I lose uh five pounds and I do it through exercise that I could you would recommend that I try going without the medicine for a while too and see what happens
+T:	I don't think I'm ready to go there yet Michael but it sounds to me like you want to get off of your medication
+C:	yeah if I can yeah
+T:	well it there it's a blood pressure rate that you are right now blood pressure number that you are right now I probably wouldn't recommend that that that's going to take a plan for us to work out over probably a period of months so that you could one lose a little bit more weight to exercise really regularly we might want to talk about the alcohol um can I ask you how much your you're drinking now our regular basis
+C:	two or three beers a day
+T:	two or three
+C:	yeah
+T:	it is okay I'd like to share with you a little bit of information about alcohol and its effect on blood pressure Merryn research has shown that for men more than two drinks a day and for what more than one drink a day really can significantly impact your blood pressure negatively it raises blood pressure how does that how does that sit with you
+C:	you're saying two or three
+T:	more than two more than three
+C:	okay so two is still considered aa safe and regard to blood pressure
+T:	that's what most of the research shows
+C:	okay I'll do two
+T:	you'll do two okay and you said that you did two three every day
+C:	most every day yeah sometimes a little more on the weekend I guess
+T:	can you think of any ways to maybe cut back on that to where you wouldn't be getting as much alcohol in your system on a regular basis
+C:	oh yeah I guess I could you know I mean uh I you know I don't I I don't have a drinking problem so I could take a day or two and not drink at all if but if if two a day doesn't hurt my blood pressure um I think I could go with that
+T:	so two a day um keep in mind too there are significant amounts of calories involved and alcohol particularly beer
+C:	I suppose I could drink Light beer
+T:	light beer doesn't appeal to you
+C:	might as well not drink beer at all you drink Light beer but I suppose if I suppose I could do that
+T:	scale of zero to ten zero being not willing at all to do that ten being very willing to do that where do you think you
+C:	probably about it I
+T:	why did you say a five and not a three or four
+C:	just because uh you know doc habits are hard to break you know and it usually don't drink Light beer and so it would be a change it would be something different but uh well you know I'm willing to give it a try
+T:	tell me the good things about cutting back on alcohol and maybe switching to light beer talking about the good things
+C:	well I did you know obviously a good thing is I'd probably lose weight which is what we're trying to do here
+T:	so you'd lose weight
+C:	uh and there there may be other things about alcohol that has something to do with blood pressure that I did not understand but but I suppose it would help keep my blood pressure down and my weight low or if I didn't drink as much beer or if I drank light beer and so that's the good side the bad side is I don't like it as much
+T:	on a scale of zero to ten zero being not very important and ten being very important how important is it for you to to get better control of your blood pressure
+C:	very important I put that up really pretty high I'll give that a nine
+T:	so in terms of making a change what are some of the things that you'd be willing to do in order to make that happen
+C:	well you know I'm willing to do the things but most of what we've just talked about
+T:	which are
+C:	um drinking Light beer drinking no more than two beers a day going to the gym again and sticking with a different medicine for a while
+T:	okay so to recap changing your medication you're willing to go to the gym and exercise switch to light beer and keep the beer to a maximum of two a day okay now only you can make that decision Michael I can't do it for you is that somewhere that you're willing to go
+C:	yeah I think I'm willing to do what it takes to keep my blood pressure at a level that doesn't concern me and if this is what it takes I'm going to give this a try
+T:	so one more scale in terms of your readiness to make to do this zero being not ready at all and ten being ready where would you fall on that
+C:	six and a half
+T:	six and a half and watch six and a happen and not two or three
+C:	because I know when I walk out of here that if I keep doing what I'm doing I I'm either going to have to live with the blood pressure medicine that takes all my energy away and I don't like that or I'm going to have to let my blood pleasure get real high and I know that can cause all sorts of bad things to happen
+T:	so you're really worried again about the health consequences of not keeping your blood pressure under control
+C:	people keep telling me that high blood pressure causes all sorts of bad things to happen so yes I am concerned about that
+T:	so if it's okay I'm going to put this in your record that we talked about well we're certainly going to switch your medication but you're going to be working on losing some weight going back to the gym cutting down on your beer usage and switching to light beer is there anything I missed
+C:	five pounds
+T:	five pounds that's the number now I'd like to see you back and about let's call it a month let's see back in a month
+C:	I'm the five pounds going by then
+T:	my pounds will be gone and we'll see how things are going and probably talk about this some more and see how successful you've been with this plan and then we'll go from there

HighLowQualityCounseling/transcripts/high_071

@@ -0,0 +1,140 @@
+T:	hello Becky
+C:	hello
+T:	my name is Jenny ponds
+C:	nice to meet you I
+T:	good to meet you and I hear that you met with dr. Johnson and you were looking at your concerns about wage is that right
+C:	yes
+T:	okay and how has that been for you
+C:	very frustrating
+T:	uh-huh
+C:	I've been trying to get my weight under control over 15 years boy but
+T:	it sounds like you've been working at it but this the years go by it gets pretty pretty frustrating
+C:	yeah
+T:	and and how um is your weight affecting life for you what's life like sort of where you are
+C:	um well it crepe lot of pain I'm having problems with my knees recently had knee surgery me so it's really I know the physical pain has shown up that's that's the newest thing you know before it was about what I felt you know what I might look like now it's about how I'm feeling I'm older much older and the pain in my body the sluggishness
+T:	so as the years have gone by it's it's it's becoming more and more of a problem
+C:	yes
+T:	yeah yeah okay and any other sense of how it's affecting the pain course is a very noticeable you know subject but anything else that you experience
+C:	um like things you're able to do we able to do the same sorts of things well some of that I attribute to age but
+T:	oh yeah right the cardiovascular as well yep
+C:	yep yep so the biggest one that motivates me is the pain right now because get you away from it
+T:	and you're in you know that if you lost some weight that then you'd have less pressure on those knees in you can be you
+C:	can get around towns would make it too hot you know it doesn't take much just to to feel that difference unfortunately I'm going in the wrong direction
+T:	yeah well it sounds as though you feel pretty strongly about this that you've been your back in here really wanting us to help you get something going
+C:	yes
+T:	so first off I have to hear a ruler rubens and if if you might indicate if you wish from a scale of 0 to 10 just how strong your conviction is about this being a problem you know just as you're describing it the pain and the concerns about your cardiovascular you know all of the ways that it's affecting your life okay from zero that it's really not that much of a problem to 10 this is a serious problem that needs to be addressed
+C:	okay
+T:	so where would you put it
+C:	well I would say that hmm intellectually I'm probably at a nine and physically I'm in the tab
+T:	hey all right
+C:	yep so physically my body telling me every day
+T:	why you say
+C:	my mind just this needs to be
+T:	and on what what do you think your mind is you know what the concerns are that your mind has are the are any doubts or anything
+C:	well I'd say that that it's less because I because of a frustration because it feels like I ok I'm not committing to doing what needs to be done to get rid of the pain and take care of the body so it just doesn't feel like my intellect not knowledge but intellect
+T:	or emotional baggage with your body
+C:	yeah or otherwise wouldn't I be doing it
+T:	yeah it's very close though
+C:	it's much closer than the business much closer than it's ever been I mean intellectually have been that's what I've been stalling with cuz I've known what to do or thought I knew what to do and I would tinker with it but I didn't make the commitment and now my body says you gotta get it or you're going to be down to the count
+T:	yeah absolutely um and nine so that's really quite high too
+C:	okay
+T:	attends the top of the scale with your body but nine with you not just your thoughts and feelings about it so what makes it a night and not a seven or an eight
+C:	um the fact that something on my mind every day
+T:	hmm
+C:	and I know that making the choices is coming up for me I just haven't made the break through like I'll I'll realize that I've done something that was a good back right after the sack yeah I need to realize it before the back and then like could make the change uptake
+T:	yeah that sounds like that's a source of frustration
+C:	oh yeah
+T:	yeah yeahs
+C:	out of an internal fight
+T:	yeah yeah if I could share a perspective that i have about giving what goes on with our mind and our body you'd be interested
+C:	yo head okay
+T:	well and this is just my theory but I really has a sense that you know we've got an appetite center in their brain right I'm part of our brain that regulates it might be getting messages about how much energy we have available probably a lot of other things too but basically that's monitoring our body to make sure that we're getting enough nutrition I think one of the challenges as we gradually gained weight and that's what happens with a lot of us know is that over time we gradually gain weight and then we look and we say well this is you know 10 15 20 pounds more than I want to be now but up here okay this this Center in the brain is doing its job of maintaining all those new cells okay you know it's going you know our job two days make sure that everybody gets fed and so we're working against something that's quite automatic in there you know the appetite that we have you know the appetite that we have when we have carb cravings you know I my sense of it is is that that's just something very very automatic Amanda but I also know that it's possible for us to especially someone with a strong conviction that you're demonstrating you know to to really start making some changes so maybe we'll explore for a moment if you like some of the things that you've tried and maybe your sense of what some of the things you you know might might like us to look into it now
+C:	so i tried the you know looking at diets and of course any of that stuff always leads to putting on more way
+T:	yep
+C:	I've turned changing diets I've had major life changes where I'm not working anymore thinking that I would now have all this time to exercise
+T:	and it's actually a more sedentary
+C:	yeah especially because they have here i am the less i can move around cuz it's so painful
+T:	so kind of a vicious cycle
+C:	oh yeah and I was having got diagnosed with severe apnea sleep apnea and learning about all that impacts and now I've been on using machine for about five weeks and I feel the difference both emotionally and physically and they say it takes three to six months to even really i could feel even better than when i'm feeling now so this is definitely the time to make this change they say the lack of sleep to sleep apnea impacts wait
+T:	I think it does
+C:	so it's possible that was contributing to my you know to my weight gain
+T:	yeah absolutely and then even just the factor that the apnea causes you to feel very tired during the day
+C:	oh I told them a larger gym
+T:	yeah you don't have that energy to beginning of the doing things
+C:	oh just just the diet just so diet and I you know I five books I don't always read them with all the things to get all to try to change my mind around I've television shows about and it saved a lot of research wow I've done I've done the lazy persons research but but I you know I've been tuned into it and I've tried writing down what i ate didn't last very long
+T:	can they keep it rising on us
+C:	no no I think once i got realized how much i was eating i stopped writing um but yeah well that's really
+T:	about it right on that i might share
+C:	uh-huh
+T:	if you're interested a book that i read a while back called why french women don't get fat
+C:	oh
+T:	and our goal isn't to be like french women but there are some things in in the in the diet in or lifestyle in that country that are different than the lifestyle in the united states and seem to contribute to better fitness and not quite so much overweight in the book she is a high school student exchange student going to the US and she encountered chocolate chip cookies and brownies and things could put a lot of weight on her and the amount of time look what just happened that must be must be youtube doing that I've all guys folks um and when she got back to the to France she'd gained a lot of weight went to her family doctor and he suggested that that's the first step getting that making a food log
+C:	mm-hmm
+T:	and then the perspective that he used was was to just find what he called the offenders we'd like one or two things that oh hi you know concentrated Swedes or concentrated fat and I see a not happening here then what what comes up driver when it I
+C:	ice cream
+T:	ice cream yep
+C:	ice cream
+T:	yeah ice cream I think pretty much is at the top of the list for all of us you know I swear that ice cream when I have it it just goes right to my hips you know it doesn't pass go doesn't go like two hundred dollars it just goes right there so have you had you looked into that as a possibility if so i might try to cut back
+C:	oh yeah at times i have but i struggled a little bit recently and I um I was gone through ice cream consistently over a couple we carry then guess what my week when I just get so single-minded in focus that's when I go into the grocery store that's all I go for that's all I can think about
+T:	mmm yeah I think it's really got that reward circuit in our brain down yeah yeah yeah yeah well is that something you'd like to cut back on
+C:	Oh a little
+T:	ill so you'd like to be I love I got ice cream okay
+C:	and let the point one I I don't forgot to say no never but I'm at the point where saying just don't need it I mean I could go for two but buying it out of the grocery store it's not working for me it's not allergies
+T:	only you're thinking not getting into the house
+C:	yeah I keep it out of the house
+T:	haha not come thank you a very good idea you are not shutting down will not let this happen I've already been with apple support it looks like YouTube needs a talking okay so ice cream is the goal
+C:	yeah
+T:	okay
+C:	a leather go
+T:	all right and in what would you say your your specific goal would be about ice cream that you really like to not have it in the house is that your main thing or
+C:	not having a now yeah that's that would be huge to having it cuz that's really where I'm breaking down is when I bite it and I gallon put it in two days you know
+T:	yeah and that's so easy to do because it's not filling you know and you know we it turns to liquid in our stomach to everybody
+C:	I mean it for breakfast
+T:	oh sure
+C:	yeah
+T:	oh absolutely yeah that is one of the strategies I used once I just have a little in the morning and burn it off you know and all that's doing is lighting that fire in there I don't know something ya
+C:	got extreme hung up
+T:	okay so the goal is just not have it at home
+C:	okay yeah
+T:	and how confident would you say you feel and again we're going to go back to as if you roll the clock 0 to 10 0 and 0 is you don't feel at all confident and 10 as you feel completely confident that you will be able to make this change if not having ice cream in the house and maybe we'll say Joanna for the time of you know an estimate of help for how long
+C:	um
+T:	week two weeks
+C:	let's say two weeks
+T:	yeah
+C:	so I'm going to have to find a healthy choice to get when i get those urge for that ice cream and then instead of walking in the store going to present food i'll keep the ODI go the other way and pick up fruit
+T:	yeah it's funny when I think it's hannaford here in Calais the ice cream is over that way and the produce is over the head okay no it's like making a right turn instead of a left turn
+C:	it's an interesting it sorry
+T:	yeah it's the right and it's the right way you go yeah young you could have a cup am i right yeah all right thank you let's take the right turn out of the right right whatever nothing yet
+C:	um so uh do we could be the challenge to we could be a good challenge
+T:	so why would you put your confidence 0 to 10 and i'll let you make a mark to feel like
+C:	i'm gonna say a seven right now
+T:	um
+C:	just just because i can think of go right lots of cash registers between there and the foot the frozen food so if i get out before that
+T:	um
+C:	that would be good it would certainly if i die that was thinking about the pain and my loss of mobility can write that I hereby your ruler I can remember that if I go all the way the other way to the frozen food so I go left I'm going to have pain if I go right come on much better chance of feeling better
+T:	okay
+C:	and
+T:	and that brings up an idea I might be able to help you with maybe next time we meet if you like
+C:	okay
+T:	and that is of course we'll check in and see how it was not going fun also there's a process called thought mapping that's a method where you walk yourself through step by step going into the store how you're feeling anything to do with feelings about ice cream and and you can rehearse in your own mind
+C:	uh-huh
+T:	making the right turn instead of the wrong turn
+C:	peddling visualization like athletes do
+T:	yes exactly and part of that yeah the way that they visualize they want to do that I left then I hi pole vault oh and they by picturing themselves doing it they actively Prix the performance improves
+C:	yeah
+T:	same story here
+C:	okay I understood that
+T:	so we might we might plan that or it sounds like you kind of got a sense of how it works
+C:	yeah I'm familiar with visualization I'm good at all which is I think pretty close to mind mapping so so you think about it down the painful way and then you replace that with thinking about it with a healthier
+T:	yeah yeah it's a little bit of a but if if you already it sounds like you've already got a sense of how visualization works on and you might be able to just decide say I mean what it makes sense to you even as you're young either in the car about to get it go into the store that you're visualizing yourself or maybe at home before you go out you know whatever makes sense to you you could even experiment a bit on your own
+C:	oh yeah
+T:	it works yeah yeah and visualizing now so I'm ever visualizing the fruit you know and having kinds that you really like you know and if you like variety you know one make it as enjoyable as possible but you are so wise to come up with that idea of substituting something you know putting having something else in place of because when we just take something away something else in the brain goes 0 or you're taking my you know it didn't
+C:	ya
+T:	I'm going to have this instead this is much better
+C:	yeah
+T:	and I should check the time for measures when we are I get 15 minutes
+C:	I hackathon and over here
+T:	we are on not seeing oh yes we are i think we can stop ok so i will look forward to seeing you in a couple weeks and
+C:	yeah
+T:	wish you well
+C:	thank you very much do we have to attract a great plan going here ok

HighLowQualityCounseling/transcripts/high_076

@@ -0,0 +1,273 @@
+T:	good afternoon miss Joe knobbly my name is
+C:	afternoon
+T:	my name is Jessamine all knobbly and I will be leading you through our nutrition and education and counselling meeting today
+C:	okay
+T:	just a little bit about myself I am a Nutrition and Dietetics student at Loma Linda University and we'll be sitting for my Rd exam next June
+C:	fantastic
+T:	so I just want tell you know I got into this field because I just really wanted to enhance and improve people's health through making advantageous dietary choices so
+C:	that's great
+T:	before we get started would you like a bottle of water
+C:	I'd love to have a bunch of water
+T:	okay
+C:	thank you very much sure yeah can I start drinking now
+T:	yes go for it so in today's session I would just like to hear about some of your personal goals why you came to the session today obstacles you may be facing in regards to nutrition and just figure out some ways to overcome challenges that you may be facing
+C:	okay well number one I'm really really happy to have this opportunity to sit down with you and discuss my really horrible eating habits especially by you know recently I have been actually struggling with wanting to lose the weight I would say for about a good six seven months now and all that I have seen so far is that I've been basically actually basically fluctuating between 199 and 206 sometimes even 208 the struggle today has been the frustration level of when I get on this okay I'm going to get on this quote-unquote diet and I'm going to lose the weight something amazing happens I actually end up painting I'm tired in the morning I'm stressed because we started this whole new business that we have here and I'm totally out of control I feel that I'm totally out of control when it comes to eating I think a lot of it has to do with not eating quote/unquote properly or systematically
+T:	okay so for you I just threw a lot at me so I'd like to go back and recap some of the things that you were saying to make sure that I'm understanding everything clearly
+C:	okay
+T:	so in January 2010 you started a meal plan that was very strict and you were able to maintain it for a few years
+C:	no few months
+T:	few months yes you think a few months and then you started to travel and you know kind of things kind of went a little bit astray from there
+C:	yes
+T:	you went from this strict dieting all-or-nothing kind of plan do not really knowing how to make food for yourself or compose a meal for yourself because you were
+C:	let me was you know it's interesting you say that because that meal plan that I was on that diet plan yeah what's called a no decision
+T:	yes it's a
+C:	no decision diet which means you don't have to make any decisions about anything this is the prescription and you live with that prescription you'd be alright anyone else I kind of denied it
+T:	so you almost kind of missed out on the education portion of how to eat when you're on your own
+C:	yes
+T:	which is what in the long term we want to achieve is for you to be able to make healthy food choices when someone isn't there to tell you what to do you're able to critically think for yourself and regardless the nutrition
+C:	yeah
+T:	so some other things that you mentioned was that you're just feeling frustrated and kind of out of control in regards to your weight-loss initiatives which I can which is very it seems very frustrating if you want to be losing weight and you're not not seeing it and then you said that you were tend to be eating more so those are all very frustrating things and not and then you also said that during your day you're not really eating consistently
+C:	at all
+T:	you're kind of all over the place and kind of looking for more of you know consistent meal plan day in which you're not you know starving and then overeating later
+C:	I do the kind of like keeping it's like I wish I had one person walking behind me this fear you whatever that says okay mealtime here it is it was like preparing it here it is you know so that because I just eat such a stressful and such a work living environment
+T:	let's talk about where you get most of your meals from
+C:	I would literally stop at the supermarket or I would stop at a 7-eleven or I would stop at a couple of times I didn't know a lot of times i stopped at Dunkin Donuts right that pick up the donuts or at the other daughter shop I would pick up because it's fast a lot of times I'm eating out and it's not you know the best thing in the world
+T:	okay um so I'm hearing that you get most of your meals from outside of the home
+C:	yes
+T:	and not typically cooking meals and kind of go for those more convenience convenience meals that's easy yes so how would you feel about going over some tips for when you're dining out that if that's if you're very busy and like that's the option that you're doing right now I'm just making some little tweaks because cooking at home may not be an option for you at this moment
+C:	that's very true probably I would say yes
+T:	so making little changes
+C:	yes in regards to the restaurant is the way everything changes
+T:	yes are some some tips that you can implement when you're at the restaurant
+C:	okay
+T:	so some of the things that I would like to talk about so when you're ordering food from a restaurant you want to stay away from words such as like fried or just like also deep fried and kind of go for those words like royal bake and steam
+C:	okay
+T:	so recently you told me that you went to a restaurant and I have the menu printed out here and I would give you a copy of that
+C:	yes
+T:	and and you told me that you ordered the New York strip steak
+C:	yes
+T:	and you had bread and butter for your meal
+C:	yes I do
+T:	so just looking at the options here we do have a fresh fish option at the top
+C:	yes
+T:	and it says it's simply grilled with olive oil or you could get it pan-seared baked or blackened with lemon shallot butter
+C:	mm-hm
+T:	so I would probably say maybe to stay away from the lemon shallot butter noise and maybe steer towards that simply grilled with olive oil or the maybe the baked or
+C:	a boy in this use
+T:	you could do the pan serve but the other ones are better option
+C:	okay
+T:	so that's um -
+C:	I would have enjoyed the tilapia for exam
+T:	okay so
+C:	that's what I like to eat that they were Chilean sea bass I would have enjoyed that too
+T:	so that's an opportunity that you would be
+C:	yeah
+T:	you enjoy billing to go change
+C:	yeah
+T:	so going for those terms and maybe doing like maybe a fish option every once in a while as opposed to doing a steak
+C:	yes
+T:	okay some other tips so when you're ordering if you want to order a salad instead of ordering the salad and getting kind of like a Caesar dressing or something like that they typically kind of put a lot of dressing on salads so maybe ordering it on the side is a better option because then you can be in control of how much you would like to add on to the salad
+C:	okay
+T:	and typically going for maybe like a balsamic dressing is good or you could do a balsamic and olive oil dressing
+C:	mm-hmm
+T:	typically most restaurants will have that option
+C:	yes and I like both stomach vinaigrette
+T:	so also in regards to restaurants portion sizes are typically very large and you had mentioned earlier that you know sometimes you just don't know when to stop eating or you tip you think you're hungrier than you are you just eat a lot at once
+C:	yes
+T:	when you give that example with the bread
+C:	yes
+T:	so a good tip is to kind of ask for a to-go box in the beginning when you get to the restaurant
+C:	mm-hmm
+T:	after your meal comes and just put half of the food in the box and you don't open the box can't get home it's kind of bang for your buck too right because then you can either other real later
+C:	yes
+T:	and you could if you do choose a healthy option you can take it to work the next day and you'll have a lunch option for you here at the office
+C:	yes
+T:	um also when it comes to salads you really don't so here they have the chopped spinach salad for example there's bacon egg radishes mushrooms and warm bacon dressing just because a menu item has all these things included does not mean that you have to get it with all those things in it
+C:	okay
+T:	so you can easily tell them oh can I have the chopped chicken it's chopped spinner salad without the bacon
+C:	right I don't like bacon
+T:	so that is something that you could ask for for that side because I mean spinach is great mushrooms are great radishes are great egg is great you can always take out egg whites I mean the egg yolk if you don't want the egg yolk or anything like that so a lot of restaurants I think analogies are accommodating because they want to have your certainty they want to have your business
+C:	yes
+T:	so they're gonna try their best to make the customer happy
+C:	yes
+T:	so for me personally I often ask for changes in my in my orders unless they specifically specified please do not make changes on to the order or we can't make a change for this order I typically change majority of my orders
+C:	hmm
+T:	because the foods that you eat or the foods that are commercially made are not necessarily the healthiest
+C:	yes
+T:	they're made to appease the palate
+C:	right
+T:	so they usually have lots of fat and you know sugar and sodium and those kinds of things added to it to appeal to a wider variety of individuals
+C:	mm-hmm
+T:	I have a little handout here so we can talk about some like portion sizes
+C:	okay
+T:	so a fist would be considered like a cup of rice or pasta or fruits or vegetables it's about the size of your fist is one serving
+C:	now that's cooked rice oh
+T:	yes good right the palm of your hand is about three ounces so that would be for fish meat or poultry that's about the size some people say like a deck of cards it's about 4 ounces
+C:	hmm
+T:	it's around there and then if you're gonna have nuts of reasons a handful is about 1 ounce there's like a little handful so one thumb would be one ounce of hard cheese or peanut butter and you said
+C:	Wow I love cheese you know
+T:	and then for your thumb is a a teaspoon of our thumb tip is a tea spoon of cooking oil or margarine or butter and sugar
+C:	teaspoon
+T:	as a teaspoon why don't you try and start setting some goals for you in regards to some food we do
+C:	okay
+T:	of what would work
+C:	that seem so you go one
+T:	so what is what is one goal
+C:	that you want you would like to accomplish for what's the eating out that I want to accomplish for eating out
+T:	yeah so would you um what a goal be that you want to choose grilled options
+C:	well I see
+T:	what you mean okay are you willing to do that choose grilled options
+C:	you know it's sometimes that would be a goal
+T:	so how do you feel about journaling
+C:	hate was difficult to do but it was very exciting
+T:	mm-hmm
+C:	because it is making me it helps me actually meet that objective
+T:	okay so that seems like something that we could
+C:	yeah I usually get up with you already six o'clock in the morning
+T:	would you have time to journal that
+C:	yeah I can make the time for that
+T:	okay so um how many of these a week would you say you could draw
+C:	I can technically journal every day
+T:	okay so why don't you give a range of times so why don't we say four to seven times a week in the mornings for we can say until our next session so we can go you can go back and recap how the journaling is going for you
+C:	what am i generally I'm gonna do it in the morning
+T:	generally how you're feeling physically maybe the food reflect on the food choices that you had made the day before maybe set some you said you like setting little objectives maybe little mini goals for yourself for the day things like that
+C:	that is easy for me to choose actually
+T:	okay that's great so why don't we just make sure we're doing that let's say seventy-five percent of the time you're eating out
+C:	okay that is really very doable for me
+T:	okay
+C:	because I do it every lunchtime when I go that's exactly
+T:	what I do we try and good ideas living by kind of like an 8020 percent rule so eighty percent of the time you're making healthy choices twenty percent of the time you can kind of you know feel like you're not as restricted because it seemed like in the past being on a very strict diet doesn't work in the long run because that's not how life works
+C:	yeah
+T:	and things are thrown at you and you have to be a little bit valuable to your different situation
+C:	yes
+T:	so those are some good goals now I would like to talk a little bit maybe up some physical activity
+C:	yes so I would love to be accused might cost me too much money
+T:	yes so I'm understand that you do want to become more physically active and you've had experience in the past being physically active what do you feel has prevented you from from being physically active is it time is it being tired
+C:	it's actually both time being tired
+T:	okay you know what kinds of physical activity do you enjoy doing if you were to do physical activity what do you like doing
+C:	I would I'm looking
+T:	biking swimming activities
+C:	I love swimming
+T:	okay
+C:	I would I don't mind actually gonna get a treadmill on the place I don't I do enjoy those things because they do we find me when I do it I don't just like I'm tired
+T:	you start that's difficult he's very different getting there
+C:	yes yes
+T:	okay so um okay so starting is difficult but just remember that any little changes you're making are are good even if it's going to the gym for just a little bit in 20 or 15 20 minutes or just walking outside of your house and you know after work or in the morning around the lunch break just going outside getting some fresh air how do you feel about maybe parking further
+C:	I do that
+T:	okay
+C:	you know it's interesting but I don't do it all the time
+T:	so maybe we'd like to set a goal for that so what about well what what seems good for you how often do you want to do it every time
+C:	what
+T:	would you like to park far
+C:	actually get all the time for a while I did and then I stopped I'm gonna park like the closest I can
+T:	so even that alone will give you a little bit more
+C:	that's physical activity
+T:	exercise so maybe parking I don't know an exact distance but parking further away if you're going to the grocery store if you're going in and out of places just walking more in general
+C:	yes but I get the idea though
+T:	typically once you start something you kind of like and start seeing results
+C:	yes
+T:	so that's where your motivation
+C:	yes yes
+T:	so your motivation lies and seeing results
+C:	yes yes
+T:	okay so then something to remember is that results don't come overnight and that's hard
+C:	yes
+T:	to have to stick to something and constantly remembering that and maybe that's something you could write about in your journaling too I'm saying that results literally writing results don't happen overnight
+C:	mm-hmm
+T:	because if you do stick to a plan over time you will see results yes we exciting for you
+C:	yes
+T:	I'm the greatest so maybe getting up in the morning and going on the treadmill how often would you be willing to do that sure we
+C:	you know
+T:	it's realistic a week realistically
+C:	I mean I would love to do is float accent
+T:	four times a week so for how long do you think you can even go on
+C:	I always wanted to be on the treadmill for about 60 minutes
+T:	60
+C:	yeah it feels good when I'm on threatening for 60 minutes
+T:	do you think that would be realistic for your schedule and now that we're saying that we're gonna be journal
+C:	you start out you mean you know
+T:	okay so why don't we start trying with 20 minutes
+C:	okay
+T:	so for 15 or 10 minutes or 50 Matt what works best for your schedule
+C:	well
+T:	what is realistic
+C:	I have to tell you that I have tried the 10 and 15 minutes and it doesn't do much at all it doesn't feel like I have done much you know I mean
+T:	over time
+C:	I guess it depends on how I'm using the treadmill
+T:	mm-hmm and over time it will help but you also have to couple it with your with I don't is
+C:	I put down 20 minutes
+T:	20 minutes
+C:	doctor for 20 minutes or day for four days a week
+T:	mm-hmm
+C:	excuse me on the treadmill and I can start without doing the incline or anything just to get myself back into doing it
+T:	okay
+C:	getting used to it
+T:	yeah it's going through the motions so yeah well it becomes kind of second nature
+C:	right right
+T:	they say it takes about like 27 or 30 somewhere around their days to develop a habit
+C:	I really that's interesting point
+T:	I'll have to get you the exact number later but yeah so for it to start feeling second nature so it seems like you are really you want to make you're you're preparing to make the changes right so
+C:	yes
+T:	you know you know that you want to make the changes and you feel ready to make you feel ready to make these changes
+C:	I actually do yes I mean I'm was really really happy when you approached me to have this this meeting I really was and that's why I was sharing with you the details
+T:	mhm
+C:	it's almost like going to confession and because because I don't feel good about where I am I really don't
+T:	maybe one last thing I can mention right now
+C:	um
+T:	his water
+C:	is why it's I like water and I it's easy for me to drink water is because my throat got used to actually taking in that much water it's not a five-piece to be a fight than to begin
+T:	yeah
+C:	you know
+T:	that's like me to drinking water for me is a struggle and I have to make myself do it but I know that I'll feel rejuvenated and I'll my body will function better and let my metabolic processes happen like they should and get my food and digestive system going so they're very I mean we're made up of mostly water so your thought you brought he needs that
+C:	yes
+T:	and just keeps you more alert when you're dehydrated do typically more sluggish and you're less more likely to make poor nutrition decisions
+C:	yes yeah
+T:	so just drinking water so why don't we you said you've done it in the past right how do you feel about drinking five bottles
+C:	I honestly would not mind at all especially if I started exercising I think
+T:	so you know it's really cool as they have apps now
+C:	though
+T:	that you can track how much water you're drinking I'll have to drop
+C:	and you give them out to anyone that for you
+T:	mmm-hmm yeah and you can track how much water you're drinking out of there and there's other web sites or apps like MyFitnessPal that you can track what you're eating and it will track all the calories and things like that for your day so why don't we go over um why don't we recap some of the goals so I just wanted me to say your understanding you know what we went through and some things that we talked about
+C:	okay let me tell you what they are
+T:	yes please
+C:	okay so the first thing he said is how about if I did some journaling and he said to do it between four and seven times per week in the morning and then I should actually indicate also in my journaling how I feel also he said to reflect on the food choices that I made for the day the day before and that should be part of my journaling
+T:	yes you should be noting some goals for the rest of the day so I want to drink five remember to drink five bottles of water
+C:	and I last part of my journal
+T:	things like that just was kind of like reminders for yourself
+C:	okay the second thing there were five things all together the second thing was we talked about restaurants because I eat a lot
+T:	mm-hmm
+C:	and he said that I really should choose always put in my mind that I should be choosing Royal Baker steamed 70% of the time but if I go with the 8020 rule it would be good I can do 82% of the time I should be doing good choice since 20% of time it can't be bad choices that's okay because many minutes so that's basically what I remember you say
+T:	well I also want to reiterate that it's you know there's no good food and bad food right there's no such thing as good food bad food that's when we we come to pick like portion sizes right
+C:	Oh
+T:	so food is food
+C:	yes
+T:	but we want to have more you know plant-based foods and we meats and low-fat dairy and whole grains and things like that
+C:	um
+T:	and fruits and things because of all the health benefits that they have
+C:	yeah
+T:	and then we want to you know for sweets and other other treats and desserts we want to keep them as treats and desserts and by doing by keeping a portion the size small we can also you know continue our goal of weight loss
+C:	okay
+T:	because we don't want to you know deprive you and then all of a sudden oh I want to binge eat all this food
+C:	right
+T:	so and you know there's you know events and parties and things like that that you kind of need to be you know okay with you know living a little bit
+C:	yes
+T:	so that's it
+C:	okay that's very good points and I noted those things the third thing is the physical activity he said that I should really begin if I do like and enjoy using the treadmill for example I ought to consider maybe 20 minutes to start every 29 to 30 days chances are you will develop a habit
+T:	I don't remember the exact timeframe but it's somewhere around there
+C:	okay
+T:	maybe keep it as a goal just to get there just to get to that
+C:	oh yes yes
+T:	mm-hmm
+C:	even if you go into the office
+T:	yeah
+C:	so that's very logic number five the fifth thing you talked about is which was more of an educational piece and you said it was all about calories and you said that what I should be considering is taking in about what would be 500 less calories per day and if I did that it would equate a loss of one pound per week
+T:	yes
+C:	and and don't forget to increase your water intake by basically take the five bottles that I basic I was saying that I used to do so start drinking more water and drink water is because carbohydrates attached themselves to water and it is a good idea to reduce carbohydrates are important for the body but at the same time a lower intake of the carbohydrates would probably be helpful in weight loss
+T:	well it will have to be helpful with water I mean it will result in water weight loss but that's not really fat loss so that removes water weight will come back when you drink a bunch of water again so that's not really the weight loss were looking for we want fat loss
+C:	okay
+T:	you want a decrease in fat and increase in lean mass
+C:	so I mean how are you gonna lose the fat the yeah the fat loss
+T:	through your diet and just exercising well and
+C:	better choices you write coochie which is basically I always think Roy big steam right
+T:	yes because three 3

HighLowQualityCounseling/transcripts/high_077

@@ -0,0 +1,76 @@
+T:	hi-oh Vina how are you doing today it's good to see you 
+C:	I'm just tired 
+T:	just tired yeah you know we did some pre-visit planning with you and your phq- which is a short depression screen was actually positive so we asked the nurse to give you a little longer screening tool which is a phq- and that actually did come up with a score of  which is in the mild depression range so how does that how does that feel 
+C:	well I knew I felt different I didn't know I was depressed 
+T:	but you knew something was something was wrong 
+C:	I didn't feel like myself or have it and feeling like myself no 
+T:	tell me a little bit more about not feeling like yourself 
+C:	when I just go to work and I come home and I sleep I wake up in the morning and I'm still tired I just have no energy 
+T:	so you sleep a lot but even though you're sleeping you don't wake up rested no not at all doesn't sound like good quality sleep 
+C:	no I just have no energy I don't want to do anything but just sleep 
+T:	how long has
+C:	that been going on hmm I guess a couple months  or  months yeah 
+T:	what else is going on 
+C:	w-well you know I been drinking more I'm a drink socially but I find myself that when I come home you know I have a glass of wine and then I just go to sleep 
+T:	and that's worrisome to you 
+C:	it is cuz I don't usually drink that often during the week so it's increased yeah yeah 
+T:	I can see where that would be bothersome to you what else what else is going on with 
+C:	you well you know my mom died a year ago so Mother's Day is coming up so you never think about mom a lot I miss her a lot 
+T:	that anniversary is is close 
+C:	yeah
+T:	that's particularly hard when those anniversaries come around for the passings of our parents that's a that's a very difficult time I 
+C:	yeah and I took care of mom so that's hard because for a long time well she was sick and she died from cancer so I took care of her so for a long time that's all I did was take care of mom and work that was so now that she's gone it just kind of brings up everything all over again 
+T:	it's kind of a hole in your life
+C:	yeah we were really close 
+T:	I'm really sorry for your loss and thank you for sharing that with me I know that's I know that's very difficult so it sounds like your sleep has really been affected you're not getting good quality sleep you're really fatigued yeah I'm just kind of going through the motions it sounds like during the day and then how's your appetite been 
+C:	I'm not really eating that much you know so I have energy you know before I would come home cook dinner or you know meet some friends after work but I don't want to do that I just come home and have a glass of wine just go to bed 
+T:	so you used to be more socially involved than you are now 
+C:	yeah don't do anything now a little  T;	more isolated 
+C:	yeah just working come home and sleep 
+T:	so if there was something that you could do about this what do you think you might like to do
+C:	well I don't want to stay like this this isn't Who I am you know just sleeping all the time this is I don't want to stay this way 
+T:	kind of feels like you're stuck yes point 
+C:	yeah I just don't want to do anything or go out my friends anymore and just work and come home and sleep I don't want to do that 
+T:	it's kind of the same old routine um I wonder if it would be okay if we could talk about some of the options that are out there for folks that have some mild depression
+C:	okay 
+T:	like you would that be alright most of the time we typically think about medication as a as a possible answer so no medication at this point ation 
+C:	no
+T:	all right then I think as important certainly perhaps more important than medication is counseling and getting you to talk with someone about your feelings on a regular basis and getting some feedback on that 
+C:	I'm okay with that you know when Mom was sick you know she was in hospice care so she had cancer and the nurses and the doctors you know had our family talked to someone you know about what we were feeling you know 
+T:	so that was the face pretty good experience
+C:	yeah yeah to talk to someone that understood what we were going through sure 
+T:	something else might be exercised another possibility would be a natural product there are some things over the counter that I think for mild depression may be appropriate and those that's another thing that we could talk about if you wanted to learn a little bit more about those 
+C:	may be something natural exercise I don't have energy I don't want to I just don't feel like doing anything so I know I'm not going to exercise right now but if it's something that's natural you know I can maybe try that 
+T:	okay if it's okay let's go back to talking about the counseling for a minute and then we can hit some of those other things too okay so um is there a counselor that you know or that you have a relationship with this lady that worked with you during your mom's death is she you don't want us out in the community 
+C:	she was really nice for me yeah I liked her 
+T:	so it sounds like you're pretty ready to do that could you say on a scale of zero to ten ten being really ready zero being not ready at all how ready would you be to do some counselling 
+C:	maybe like a six or seven
+T:	so a six or seven  why a six or seven and not a four or a five 
+C:	well because I don't want to stay like this and you know I've already talked to her before she was really nice so I wouldn't mind going back to her and she told me you know when I saw her last time if ever needed I could come back 
+T:	so it sounds like you've got a connection there already that's really good yeah um does that sound like something you're ready to do then and maybe make a plan about that yeah I can definitely check with her and see if she can see me again okay yeah 
+T:	well that's okay then it would be all right if we talked a little bit about the exercise I know you said that didn't really sound like an option for you at this time and that's perfectly fine only you can make those decisions Alvina but if it's okay I wanted to give you a little bit of information about exercise and its effect on the brain okay exercises is again a number of studies has been shown to be as effective as prescription antidepressants okay I didn't know that yeah it actually raises serotonin have you heard about serotonin yeah I asked kind of the happy hormone yes so um it actually raises serotonin and also something called BDNF which is well it doesn't really matter what it is but it helps actually your your brain actually grow and help repair itself so exercise can help in lots of ways by improving serotonin and decreasing stress certainly and in actually improving the quality of sleep how does that sound at this point 
+C:	well if I try to exercise and if I call her to talk to her again does that mean I have to run the medication
+T:	right now we can try that absolutely again those are yours to sit your decisions and I'm I'm here to really support you in those so if those sound like things that you might be willing to do I'm I'm all for it well I'll try then let's go on the medication 
+C:	okay I have some friends they exercise and workout that I could probably call and exercise with them 
+T:	so you have some friends that are already involved in an exercise program yeah is that something you talk with them about and that you possibly could get into that group 
+C:	yeah I have friends that run and friends that go to gym I have some friends that walk after work 
+T:	so it sounds like a wide variety of things that you could do yeah which of those tend to interest you most
+C:	well then also you know my church on the weekends they have exercise classes too so yeah but I think I guess I don't have energy really to exercise but I'll try it but I'll definitely call the person I had talked to a mom passed away and I'll do that right away
+T:	very good well I think it sounds like this is important for you to to feel better and it sounds like you're really ready to kind of make a plan how do you see this fitting into your life at this point again kind of getting back to the counseling and and the exercise 
+C:	well when I saw her I could see her after work so I can call her and see if I can still see her after work for therapy and exercise I mean I can do that you know after work or on the weekends my friends they exercise various time so
+T:	yeah let's talk a little bit more about that you're say on a scale of if we can do use another one of those scales zero being confident that you could start an exercise program zero being not very confident at all in  being very confident tell me where you are in this exercise thing 
+C:	honestly maybe a five okay and I'll try it it say if I have to do that so I have to go on medication then I'll try it okay that
+T:	sounds like a pretty strong commitment yes I'll try it
+T:	okay and tell me a little bit more about your plan for exercise at this point
+C:	then well you know my friends have been calling but you know I'm just sleeping all the time so when they call them sleep so I haven't really called them back but I know I can just return their calls and just let them know I'll want to meet up with them and you know at least maybe just start walking 
+T:	I think that's a great decision you have a couple of friends in mind that you could call 
+C:	yeah real close close friends that live not too far from me yeah so tell me how to 
+T:	tell me about a plan that you would think could perhaps get you going with with the exercise 
+C:	well I probably shouldn't come home I probably would need to call one of my friends and make a plan to maybe walk after work and take a change of clothes and maybe drive to one of my friends house after work and change with her 
+T:	it would be difficult to do it in the morning you don't see that happening
+C:	no because it's so hard when I get up in the room so tired that I can't I can't say doing in the morning 
+T:	you think it would be easier to do it after work 
+C:	cuz I'm already out yeah as long as I don't come home so I come on Monica's sleep come home it's over yeah yeah all right
+T:	well good it sounds like we have a plan for the counselor and when you check out today I will put this in your record and that will want to get in touch with the counselor that you work with when your mom was going through okay her passing in the grief situation and then I'll want to depend upon you to call your friends and then get involved in the exercise program 
+C:	okay I'll try that 
+T:	all right and if it's okay I'd like to call you in a week to one see how you're feeling and to the exercise is helping you may really find that after you give the exercise a good trial you may actually look forward to it because my hope is that will actually help you feel better and improve your mood and then I would also like to see you back in two weeks just to check on things now we've talked about exercise apartment we've talked about medication not being on the table at this point but I want you to know you know you can call anytime and I will work to get you in and that might be something that we need to do if our plan is not working okay  

HighLowQualityCounseling/transcripts/high_078

@@ -0,0 +1,111 @@
+T:	hi Michael it's good to see ya well glad you came in today when I douse up 
+C:	well I came back here because I had to I had to make an appointment so I could get my prescription for my blood pressure medicine refilled and they wouldn't do it it wouldn't refill it it's a drugstore unless I came back here so 
+T:	you're you're angry what 
+C:	well I'm not angry at you but I'm angry at the situation and I gotta come back in here take time off from work just to get that prescription filled but but you know you do what you got to do and 
+T:	well I appreciate your bringing that up that is does sound frustrating but by coming in it gives us a chance to to sit down and and and talk and see how things are going with the medication which is what I'm most concerned about I know we started at about three months ago or so and I am real interested to hear how you're how you're doing on 
+C:	well uh yeah whenever I get my blood pressure checked at the drugstore it looks like I'm that it's working and that respect but it does seem to take away all my energy you know 
+T:	kind of fatigued 
+C:	yeah yeah my I got no get up and go if you know what I mean
+T:	so kind of has taken the wind out of your sails 
+C:	absolutely yeah
+T:	how long have you noticed that oh I don't know I 
+C:	at least since I've been on this medication at least that long yeah
+T:	doesn't sound like it's working well too working too well for you have you tell me about how you're taking the medication have you taking it very regular 
+C:	oh yeah I take it I take it just like it says take it on the bottle you know I take it every morning when I get up 
+T:	okay so you've been pretty consistent and taken the 
+C:	all yes 
+T:	anything else going on in terms of symptoms no just this overall lack of energy which I know my wife doesn't particularly care for
+T:	your wife  tell me a little bit more about how it affects the relationship between the two of you 
+T:	well as I say I get up and go got up and went and there's not much going on between the two of us like there used to be 
+T:	so sexual performance is not as good as it as it might be 
+C:	nope but I think it's because of that damn medicine 
+T:	so does this sound like something that you want to continue or should we talk about possibly other other options for you it sounds like it's kind of affecting your life negatively
+C:	well yeah yeah but you know I I'm worried about my blood pressure because my my mother had a stroke not long ago and I know it was so they told us it was because of her high blood pressure so I don't want that to happen to me 
+T:	soyou're concerned about having a stroke
+C:	well yeah I mean would you be you know it sort of runs in families I think 
+T:	yeah so taking care of your blood pressure is is very important to you 
+C:	yeah yeah absolutely 
+T:	again it doesn't sound like this particular medicines working out too well for you if it's okay I could talk to you about possibly changing the medication so on the one hand we'd be keeping your blood pressure under control but on the other hand we wouldn't be causing these types of side effects hopefully would that be okay
+C:	well are you talking about on more medications or just a different medication 
+T:	yeah so uh I think probably it sounds to me like probably changing medications at this point as a start we can always add another medication later if that becomes necessary 
+C:	yeah well I'm not real interested in adding any more but if changing it it would keep my blood pressure down but not take away all my energy than I might that give better idea 
+T:	so you'd at least be willing to try a change and and see how that goes 
+C:	yeah yeah I know 
+T:	well if it's okay I can tell you about a group of medications that I I like but if but first if it's okay that they give you a kind of my rationale for using that medication to start with so you know one of the things you'd mentioned to me was some of the financial concerns and the medication that you're on is pretty dirt-cheap and for most people at this dose particularly a low dose because you have mild hypertension most of the time it doesn't have many side effects obviously for you that was different does that make sense
+C:	yeah yeah 
+T:	so the medication I'm thinking about is something called an ACE inhibitor ACE inhibitors are very very well tolerated and occasionally people will get a dry hacky cough with them but it's fairly rare but there's very low risk of side effects in terms of sexual side effects in particular and most people as a matter of fact it's one of the the drugs that actually helps your heart beat a little bit stronger and better and many people don't have any kind of a decrease in their energy so how does that sound
+C:	yeah it sounds though it sounds like a good idea if it still controls my blood pressure but doesn't take away my energy it sounds like a good idea 
+T:	okay so what other things can you tell me about that might affect your blood pressure 
+C:	uh-ohuh-oh my work is sometimes stressful and some of the people I work with kind of drive me a little batty occasionally and I I don't know if it I don't really know if that it causes my blood pressure to go up or not but it certainly could I guess so there's some stressors at work
+T:	yeah and if it's okay I'm going to write down some of these things that as we talk through them so what else can affect blood pressure that you know of
+C:	um well you know just mostly from watching TV shows I guess I am aware that alcohol and I drink some a moment that alcohol has some effect on blood pressure I think it might even say so on the label though I'm not sure it can't
+T:	it can't anything else you can think of
+C:	no 
+T:	well sometimes sometimes weight can be an issue and explain this little tool to you this is for what it's worth called a agenda mapping so it sounds like there's a number of things that you know of and then we can talk about that affect your blood pressure you mentioned stress and an alcohol and we talked about weight certainly you know blood pressure medication can affect you there and I would say another big one might be exercise does all that makes sense 
+C:	well yeah 
+T:	so we could we can talk about a lot of these things with which one might you want to talk about and if we need to we can set up for appointment and talk about this more if we run out of time but 
+C:	well um exercise I'm I actually like to exercise and 
+T:	tellme about the exercise that you're doing well I play golf and walk the golf course so you carry your bag or do 
+C:	Idrag it along on a pull cart my wife says that that doesn't count as exercise but I say try it yourself it is exercise
+T:	it is exercise it is exercise Michael look at your your weight when we came in yeah and you were about  or so yeah which is actually according to your BMI body mass index in the in the overweight range how do you feel about that 
+C:	well I don't think I'm overweight 
+T:	yeah you don't look terribly overweight but according to the the charts there it's in the overweight category so you're actually getting you into the normal category would be about a loss of about  to  pounds 
+C:	or  pounds 
+T:	yes  or  pounds 
+C:	I haven't weighed that since I was in high school 
+T:	I understand I understand but you know I'm not saying that we need to lose  pounds sometimes just a loss of  pounds can make a tremendous impact on your on your blood pressure okay so  pounds sounds like something that might be negotiable 
+C:	
+T:	is the number okay let's go you do with thigh okay I think I can do  all right so if you were to want to lose  pounds how would you go about it 
+C:	I'd probably go back to the gym
+T:	has that worked in the past 
+C:	yeah I mean I used to go to the gym and work out a lot and uh I've done it for a while but I guess if if I'm I'm sure I could lose  pounds if I wanted to 
+T:	and that would actually kind of take care of two of these things right your weight and your exercise both of those would have a really positive effect I think on your on your blood pressure 
+C:	okay well 
+T:	sowe've talked about changing your medication stopping the medication you're on changing you to this ACE inhibitor and then perhaps looking at the weight and going getting back to the gym and starting an exercise program is that about right 
+C:	well what would it take for me to not have to take the medication at all 
+T:	at all 
+C:	yeah I mean if I did enough exercise and lost enough weight would you not what I not need to take the medicine 
+T:	I I really wonder if you would I think that's an excellent question and if you're motivated to lose that kind of weight I'm with you I can't leave I this good 
+C:	I can lose five pounds well 
+T:	it may it may take more than five pounds to get the desired effect on your blood pressure that's really getting back down into that normal weight range if you will in that one  to  range probably
+C:	I I just want to make sure I understand if I if if I lose uh five pounds and I do it through exercise that I could you would recommend that I try going without the medicine for a while too and see what happens 
+T:	I don't think I'm ready to go there yet Michael but it sounds to me like you want to get off of your medication 
+C:	yeah if I can yeah 
+T:	well itthere it's a blood pressure rate that you are right now blood pressure number that you are right now I probably wouldn't recommend that that that's going to take a plan for us to work out over probably a period of months so that you could one lose a little bit more weight to exercise really regularly we might want to talk about the alcohol um can I ask you how much your you're drinking now our regular basis 
+C:	two or three beers a day 
+T:	two or three yeah it is okay I'd like to share with you a little bit of information about alcohol and its effect on blood pressure Merryn research has shown that for men more than two drinks a day and for what more than one drink a day really can significantly impact your blood pressure negatively it raises blood pressure how does that how does that sit with you
+C:	you're saying two or three more than two more than three okay so two is still considered aa safe and regard to blood pressure 
+T:	that's what most of the research shows 
+C:	okay I'll do two
+T:	you'll do two okay and you said that you did two three every day most every day yeah sometimes a little more on the weekend I guess 
+T:	can youthink of any ways to maybe cut back on that to where you wouldn't be getting as much alcohol in your system on a regular basis 
+C:	oh yeah I guess I could you know I mean uh I you know I don't I I don't have a drinking problem so I could take a day or two and not drink at all if but if if two a day doesn't hurt my blood pressure um I think I could go with that
+T:	so two a day um keep in mind too there are significant amounts of calories involved and alcohol particularly beer 
+C:	Isuppose I could drink Light beer 
+T:	light beer doesn't appeal to you 
+C:	might as well not drink beer at all you drink Light beer but I suppose if I suppose I could do that 
+T:	scale of zero to ten zero being not willing at all to do that ten being very willing to do that where do you think you 
+C:	probably about it I 
+T:	why did you say a five and not a three or four
+C:	just because uh you know doc habits are hard to break you know and it usually don't drink Light beer and so it would be a change it would be something different but uh well you know I'm willing to give it a try
+T:	tell me the good things about cutting back on alcohol and maybe switching to light beer talking about the good things well I did you know 
+C:	obviously a good thing is I'd probably lose weight which is what we're trying to do here 
+T:	so you'd lose weight 
+C:	uh and there there may be other things about alcohol that has something to do with blood pressure that I did not understand but but I suppose it would help keep my blood pressure down and my weight low or if I didn't drink as much beer or if I drank light beer and so that's the good side the bad side is I don't like it as much 
+T:	on ascale of zero to ten zero being not very important and ten being very important how important is it for you to to get better control of your blood pressure
+C:	very important I put that up really pretty high I'll give that a nine 
+T:	so interms of making a change what are some of the things that you'd be willing to do in order to make that happen
+C:	well you know I'm willing to do the things but most of what we've just talked about which are um drinking Light beer drinking no more than two beers a day going to the gym again and sticking with a different medicine for a while
+T:	okay so to recap changing your medication you're willing to go to the gym and exercise switch to light beer and keep the beer to a maximum of two a day okay now only you can make that decision Michael I can't do it for you is that somewhere that you're willing to go
+C:	yeah I think I'm willing to do what it takes to keep my blood pressure at a level that doesn't concern me and if this is what it takes I'm going to give this a try 
+T:	so one more scale in terms of your readiness to make to do this zero being not ready at all and ten being ready where would you fall on that 
+C:	six and a half 
+T:	six and a half and watch six and a happen and not two or three
+C:	because I know when I walk out of here that if I keep doing what I'm doing I I'm either going to have to live with the blood pressure medicine that takes all my energy away and I don't like that or I'm going to have to let my blood pleasure get real high and I know that can cause all sorts of bad things to happen 
+T:	so you're really worried again about the health consequences of not keeping your blood pressure under control
+C:	people keep telling me that high blood pressure causes all sorts of bad things to happen so yes I am concerned about
+T:	that so if it's okay I'm going to put this in your record that we talked about well we're certainly going to switch your medication but you're going to be working on losing some weight going back to the gym cutting down on your beer usage and switching to light beer is there anything I missed 
+C:	five pounds 
+T:	fivepounds that's the number now I'd like to see you back and about let's call it a month let's see back in a month
+C:	I'm the five pounds going by then my
+T:	pounds will be gone and we'll see how things are going and probably talk about this some more and see how successful you've been with this plan and then we'll go from there  

HighLowQualityCounseling/transcripts/high_079

@@ -0,0 +1,65 @@
+T:	morning page 
+C:	hello how are you 
+T:	it's good to see you up and about how are you feeling after your last little hospitalization 
+C:	well it was pretty scary I'm I'm definitely improving but I don't feel as well as I think I should um the COFF is a lot better but my breathing is still not what I think it should be right now 
+T:	so you're you're still struggling to breathe some 
+C:	I guess you could call it struggling I just when I walked to the mailbox or up the stairs I get out of breath easily
+T:	exercise tends to make the breathing worse 
+C:	it does seem so yes 
+T:	so you're better but not quite where you want to be and 
+C:	I'm definitely not where I think I should be I feel like I should be better by now usually after a cough or bronchitis I'm able to breathe easily and it's not like that this time
+T:	so you usually bounce back pretty quickly but this time is taking longer and that's a that's a real concern to you 
+C:	it was when I was with you in the hospital you gave me a little oxygen in the beginning and I just never thought I would be a person that would have to have oxygen that was scary too
+T:	so that the oxygen piece is something that scary it almost feels like ear were really really sick when you needed oxygen  C	it does I never picture myself needing a I guess I'm scared of needing an oxygen tank and carrying it around with me and having the tubes in my nose um that I just don't see myself needing that I always think of myself as being healthy 
+T:	and now it seems like you may have some real or some permanent damage
+C:	that's what it seems like 
+T:	Paige would it be okay if we talked a little bit about your disease process 
+C:	sure
+T:	you know with a flare-up of bronchitis like this you very well may have done some damage to your lungs the good news is as you continue to heal I mean we have a spirometry today which is that breathing test that you did we compared that  about six months ago it is quite a bit worse now a lot of that will get better with time but also a lot of that kind of depends upon whether you continue to smoke or not 
+C:	oh this one we're going to talk about my smoking huh 
+T:	well Paige we don't have to talk about anything you don't want to talk about um those are going to be decisions that only you can make I can't make you quit and so that's just going to have to be your decision I I want you to know though that I'm here to support you and even though we've talked about smoking cessation and some things that you could do in the past you've been kind of resistant about that I wonder if having this bout in the hospital has done anything to change your mind
+C:	well I think I need to seriously think about it again I just evidently my health is on the line because it it was just a really bad experience for me 
+T:	so bad experience mm-hmm so if we look down the road maybe five ten years and you decided not to quit smoking what do you think that would look like for you
+C:	probably not good I would see me not being able to breathe at all and again just my biggest fear would be needing oxygen every day all day that 
+T:	oxygen is a pretty strong motivator for you isn't it yeah well so it sounds like if it sounds to me like if if you didn't quit smoking that you feel like your overall health might really be at risk
+C:	yes 
+T:	where does that where does that leave you  C	I need to start considering it more seriously than I have in the past if I want a different outcome if it's
+T:	okay at this point Paige it's great and but let's talk about it's okay what's something called a decision balance so and involves four things to think about it's almost like writing it on a page but we're going to do it in the air or whatever so what are the good things about smoking that you like if you didn't side to quit what are some of the negatives about smoking if you didn't decide to quit and then if you did quit what would be some of the good things and then what would be some of the negative things if you did quit so tell me if you would what are some of the good things about that you like about smoking if you continue to smoke the way you are 
+C:	okay um I like the taste I like how it feels in my throat I love the social aspect of it I have smoking friends I have non-smoking friends and just when I'm with my friends that smoke it is just a lot of fun it's just something we do as loud as that sounds um and I love it with my coffee first thing whirring a lot 
+T:	so some of the good things are the taste we regularly with coffee and how it makes you feel and then it sounds like there's a big social component to smoking for you there is tell me about then what would be some of the negatives if you continued to smoke and didn't quit 
+C:	my health that would be the number one things that are negative about smoking the snow and my clothes my hair and that it's a lot of people that are surround myself with it's not socially acceptable anymore and that does make me uncomfortable
+T:	so some of the negative things would be it's a impact on your health right the the smell clothes and so forth and then there's a lot of kind of social pushback
+C:	yes there is 
+T:	with cigarette smoking I see what else 
+C:	well you know my husband Dan recently stopped smoking and was it yeah he's done quite well but now it's seems like he's righteous and I'm an addict and he says things like you could just do it if you'll just do it you know what those cigarettes are gonna do to you why don't you just stop I tell them I've stopped a hundred times and I'll stop when I'm ready but it you know that's put a strain on things 
+T:	it does sound like he's concerned about you and and concerned about your health and that he loves you 
+C:	I know it just doesn't feel that way sometimes but I know that he would be supportive because he wants what's best for me 
+T:	but it's on the other hand it's it's hard to put up with some of that stuff and I think I think it shows a lot of inner strength in you to put up with some of that even though it's kind of a pain 
+C:	well thank you I'd like to think so
+T:	so what would be some of the positives some of the good things about quitting based on what you told me here today
+C:	even if I have some permanent damage you encouraged me to believe that if I stopped that I could get better and definitely avoid the oxygen tank that would be the biggest positive the second positive was that Dan and I would have a little more peace in our home and get along better and he would see that I you know want to be on the planet my clothes would smell better my hair would smell better a car would smell better I wouldn't have to worry about you know sneaking somewhere when I wanted to smoke and it wasn't socially acceptable in the situation I'm in so there are a lot of positives okay
+T:	so again on one hand there are a lot of good things that you enjoy about smoking and on the other hand there you've given me quite a list of things that if you did quit there would be a lot of ways that your life would be better so where does that leave you now 
+C:	but I just really need to do this and to concentrate on the good things and just be ready to stop I just need to stop 
+T:	sounds like you're pretty committed so honest let's talk about a scale then on in terms of being ready to quit zero being not ready at all and ten being like yeah I'm really ready to quit where are you on that do you think 
+C:	I'm gonna say an eight 
+T:	an eight why an eight not a five or six 
+C:	it all just goes back to this recent event and the fears that I have or where it would be I'll go back to your five to ten years from now and that's just not
+T:	not a pretty picture no no it's not tell me some of the things that you are aware of that can help you in this quest
+C:	well I'm very familiar with nicotine gum and nicotine patches I do wear the patch and they work very well for me um especially at work because I'm not allowed to smoke at work nor but I want to be smoking at work again with the people that I'm with um and that's really about all I've ever tried or called Turkey and that just never will I never want to offer you mm-hmm
+T:	do you know about the NC quit line 
+C:	I've heard the commercials on the radio but I've never looked into it 
+T:	would it be okay if we talked about that for a minute sir this is a fantastic program page they have a lot of information but the great thing is you can actually have your own personal smoking counselor and you can call them or you can leave a message with them to call you but there's a tremendous amount of support there and that's been a very helpful thing and the great thing for me is they will actually call me and give me kind of follow-up information on how you're doing mmm how does that how does it sound 
+C:	sounds very intriguing sounds like it could be helpful yeah not just depend on Dan with my journey yeah 
+T:	so he's just uh sounds like more support right you wouldn't feel you wouldn't feel alone in this battle right yeah so I heard the nicotine patches and gum and then possibly the Quitline anything else that you've heard about or that you might be interested in there
+C:	well I do know Dan um had a quit date is that something I have to do 
+T:	again decisions that only you can make H and but if it's okay I can tell you a little bit about the research about the quit date okay um most of the research shows that if indeed you can kind of look at your calendar and see a time that would be better to quit them than not it's really helpful to have a quit date and to tell as many people as you can about that this is the day I'm quitting again it tends to garner that social support and increases the commitment level how does that sound
+C:	well that makes sense why it would be better than just today will be the day
+T:	is there any time that would be better for you to get a quit date than another day 
+C:	we do have some plans coming up so I think a week from Monday socially would be better that's the day a week from it yes 
+T:	would it be okay if our office called you on that day to just begin to give you a little bit more support let you know that we're with you sure that would begin so let's go back to another one of those scales scale of  to  in terms of your confidence about doing this zero being no confidence  being they have a lot of confidence about my ability to quit where would you be on that scale 
+C:	I think with everything we discussed today I would like to leave on a  and that's how I feel that's tremendous it is tremendous good good feels good feels I could still be a little weary
+T:	but it feels good 
+C:	yeah but it feels like you have a play on this time good as what I feel better 
+T:	well congratulations I think that's probably the biggest health decision that you could possibly make in your life particularly in light of what you've just been through so right I think this is a really good time and I have I applaud your courage doing it takes a lot to to make this decision so good for you 
+C:	well thank you 
+T:	so I will call you and we'll give you some information about the Quitline when you leave you can take care of the patches and and gums instead of over-the-counter and if it's okay let's schedule an appointment and two to three weeks out and get you back and see how things are going  

HighLowQualityCounseling/transcripts/high_082

@@ -0,0 +1,41 @@
+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  

HighLowQualityCounseling/transcripts/high_083

@@ -0,0 +1,34 @@
+T:	able to come in it's just great you know we haven't seen you in like six months how have you been girl
+C:	they've been doing a little better yes
+T:	we'll talk about that you know it looks like on here that your ac is down a little bit I think it's down to about ten now yeah so you've really been making some progress tell me about how it's been going 
+C:	well I do exercise a lot more I exercise a lot more yes I have my little portion controls they don't have too much of a certain food I make sure that you know I have my insulin at the right time the right amount 
+T:	so it sounds like you've really been doing a couple different things that have been working for you it's exercising more which I want to hear about and you've been really looking more at your portion sizes yes you know those measuring pieces we had talked to talk some time about yes and then the third one is Oh taking your insulin at the right times okay I'm really the schedule on where it is yes does that seem to be making you feel better as far as the insulin or what do you noticing 
+C:	um I'venoticed that well I'm very sure we discussed this before when I used to go out I used to just kind of check my blood sugar and make sure that it was low enough to have whatever I kind of wanted to okay I see right yes well now I mean I still go friends of course but as you should as I said um but one like once I go out now I kind of I tried looking for something like if my friends are gonna have a candy bar or something I try looking for maybe a granola bar or something that's a that's like sort of like a candy bar but it's a little healthier and I know that it won't rise my blood sugar that much 
+T:	so you've been looking for other alternatives so you still feel like you're doing one but they're doing I'm looking at the carbs a little or seeing where it would be with your sugars 
+C:	yeah like I mean of course I'm teenager I still love candy or whatever but 
+T:	nobody can stop you from having candy completely exactly 
+C:	but you know I still try go to go out and have fun I mean even though my friends do eat whatever they kind of want I just I take better better care of myself I eat something healthier it's something that'll make me feel more energetic instead of like a little sugar rush and then just crash later on 
+T:	so you know how you feel when you get that sugar rush and cry yes that feeling hasn't been something you've enjoyed in the past yeah so you've you've been feeling a little more even keel it sounds like how that's going so talking about the exercise piece you say you've been exercising more what have you been enjoying 
+C:	well now that I'm in school I mean I tried out for the basketball team yeah hey yes
+T:	oh I know you said you're really looking forward to that
+C:	yes and it's a lot of fun I enjoy it the workouts are pretty harsh but I like it I have fun I enjoy it and you haven't been feeling as though your sugar that you want to crash during checkouts
+T:	you've been able to manage while you're out with your energy level 
+C:	yeah I mean I always keep some fast-acting sugar on me just in case super I'm glad crash 
+T:	and that had added something you've had to use or haven't had to use during exercise also know how good deal good so you've been able to kind of go into it with the right sugar level yes so that you haven't bottom doubt 
+T:	well with all these things that you've been working on so well what what's your main goal right now what's something that you're you know really trying to be focused on for you 
+C:	well my main goal is well I've lowered my ac a little bit but I'm trying to get it to where it's really actually supposed to be so that sure myself healthy you know
+T:	so so keep moving in that direction we've got it from a from a  down to a  which is a huge success in the time period that we've been looking at and maybe let's try to move it down even a little further to you know nine to start and move down to an age exactly okay so that's that's that's great so the bigger goal is getting the ac down a little and then these smaller pieces are your what you're doing to make that happen yes so how important is it for you to have an ac let's say eight in the next six months on a scale of one to ten kinda like that pain scale we use where would you put yourself on a scale of one to ten just how important it is 
+C:	I would actually have to say about an eighth
+T:	it's an eighth Wow so it's not a two or three it's an eighth
+C:	my goal I want I really want to reach my goal I want to be able to feel good and you know I want to make sure that I know that I'm healthy and that I know I was the one who did this for myself 
+T:	but you said it wasn't about your mom it wasn't about dr. Smith but it was about what Elizabeth wanted yes so what would it take to move you just a little bit higher up to a nine as far as importance what would have to happen 
+C:	I'm not really sure actually I mean it's really important to me but I do have you know has to have school and sports exactly you know I have to worry about other things too 
+T:	we all have a lot of things we're juggling and to be honest I don't think anyone can ever really be a ten in terms of importance because we have all these things that we have to manage and sometimes they're higher up and sometimes they're lower up depending on the day or even the minute so I'm that same kind of scale of  to  where would you put yourself in terms of how confident you are that you can bring down your ac - what did we say at  within the next six months how confident are you that you can make that happen 
+C:	about a  actually 
+T:	Wow yeah wow that is awesome so tell me about that 
+C:	well I'm really comfident because I mean if I was able to get my blood my ac from  to  and only a couple of months yes I've believed that I can do the same thing again thank you what I'm doing up 
+T:	soreally just continuing to do what you're doing you've already shown here in the last few months that you've dropped it substantially and I'm sure you were really excited to get to see that score you know to see what the number was really gonna be 
+C:	yeah it made me feel really good I know that I'm doing better and that I'm healthier so 
+T:	did you have a sense when you came in did you have an idea of what you thought your number might be 
+C:	I did actually because I know that before I wasn't doing as well as I I could and by pushing myself I knew that you know what I know it's lower I know that I did good and I've been taking care of myself I know it's most definitely lower okay
+T:	so you could feel confident coming in at hey when I see that number I already know the work I've been doing so it darn well better be lower because yes we're not put into this so that makes sense it sounds like for you just continue to do what you're doing continue on with getting onto the basketball team and you know continuing on with those things you're playing out with your with your insulin you haven't been in the hospital now for over  months so I mean that's you know that's a huge progress in success as far as keeping yourself stable and feeling good and enjoying high school yeah so how bout we check back again you know an hour another  days and just kind of see where that the ac is then yeah and kind of go from there and you know if you have any questions or you're not sure about something by all means you can stop and that's what we're here for okay thanks Liz it's great talking to you today it's great down you too you  

HighLowQualityCounseling/transcripts/high_084

@@ -0,0 +1,30 @@
+T:	little bit of information as to why you're here but but maybe you can go ahead and just tell me 
+C:	yeah well my wife basically just said if I don't get um final stop drinking then she's leaving 
+T:	Wow okay so she's doing pretty tough stance on it 
+C:	yeah yeah she said you know she's told me for a long time that she doesn't like it and our kids have said they don't like it she's never she's kind of threatened it but I think she needs it this time I don't
+T:	okay all right so pretty important to you I mean she's taking the stance on it your kids have said similar things and now you're here I mean it's gotten point that you've you agreed to go ahead and go into treatment she's saying not just get treatment she's saying quit I mean Jesus she's being pretty yeah she just wants me to stop pretty out of about it okay so what do you think 
+C:	well I'm thinking that I've worked hard my whole life and I should be able to to drink if I want but you know I don't you know I never been arrested you know I've got I've done really good with the money that we have you know we live a pretty good life she gets to do what you wanted I get to do what I want and this is just something that I want to do so you know I and it's been that that you know I've been drinking since I think we met yeah we can vary it a long time oh so I don't know what I I'm kind of like I know what the big deal is really and all right I don't want to quit
+T:	what's always you feel you know I mean it's like you know you work you you're responsible you do what you think is expected of you and so it kind of feels a little unfair to you know you're a man you're a head of the household you know you're doing your duty and it feels a little unfair to have people trying to dictate your behavior and telling if you've got to give this up 
+C:	yeah I don't like it people tell me what to do yeah no no usually I just usually if someone tells me what to do like tell him to back off wouldn't what to do and so but she's serious it's time so I don't know what to do
+T:	so all right all right well so I guess that's kind of the that's the dilemma I guess you know on the one hand she's uh she's very out of it she's very concerned and is making her expectation very clear on the other hands you know you're being asked to give up something that you don't particularly want to give up um what do you think what do you think she's what you put why do you think she's so concerned 
+C:	well she says she's worried about my health you know cuz I have high blood pressure you know worried about because my dad died of a heart attack at a really early age so she's afraid I'm just gonna I'm just gonna drop dead you know I outlive my dad by so many years and I you know and again it's my life yeah so yeah 
+T:	yeah certainly it's you know people can tell you what they want right you know and but all ultimately it's up to your choice what you're gonna do so you know she she can threaten you and she can she can tell you that you know if you don't do this she can you know she's gonna leave and she can leave you know it sounds like you really don't really don't want that
+C:	but but you know everybody's got their choices to make in this situation
+T:	okay so she's concerned about your health and has pointed out that you have a you know your father so he drank and
+C:	that's but I was really little okay when when he died so I don't know 
+T:	so you're not sure if that we died of heart attack okay you know so you're not sure if that played a role in his heart attack or not I probably did probably crank song but so you're not sure about how well you know he died did it earlier and she points that out as evidence that like you've got media genetic predisposition to having health related problems associated with drinking 
+C:	yeah the dollar I've said I should quit drinking the dog or they know okay you're not convinced but with the dog don't exactly that  years ago I need to quit drinking and
+T:	okay so it almost seems like evidence to the opposite they told you to quit drinking  years ago and here you are it's still alive then 
+C:	I pretty much do whatever I want when I yeah you know surely no life because the way it's been I've given everybody wrong yeah of everybody okay Wow
+T:	okay so you feel like you know you beaten the odds so else you can say the live 
+C:	yeah you can say that okay max I'll work my way up I'm working my way up and once really high up my confident for a retiree okay huh you've always thought I would do it
+T:	so it's kind of you know the state you know you have this determination you're the kind of person that you know you you do what you trust your gut and you do what you think you should do and you know you work real really hard and you and you've had a lot of success in your life is right it seems like in your in your job and and and with your family the fact that you're a married man with kids and you know you've raised them up and you know I think there's no denying that you had a lot of success in real life in it and and you know and you know better than anyone how hard you had to work could she be back so 
+C:	um  and she doesn't get she doesn't she wasn't I don't think she recognized how hard I worked for it to have what we have okay you know and I wish she just let me live the life I've always wanted to live you know and then part of its drinking I like drinking so okay 
+T:	okay all right so she's got all these concerns about it how do you and you mentioned your kids have some concerns - they talk about it I mean what is your sense of and it sounds like so far you feel like well I've beaten the odds and I'm this kind of guy like I'm always a kind of guide it sort of pushes the envelope and you know has proven a lot of people wrong over the years and so you're very skeptical when anyone tells you that drinking is going to kill you like yeah is it it's almost like if somebody tells you that you're gonna say you know you're not gonna believe that I mean you just don't believe that's the truth 
+C:	well I would yeah because it might kill other people but I'm not going to let kill me
+T:	okay okay all right so what so what if anything in what they're telling you do you believe it turns out like a possible negative effects that I may have obviously it has not killed you you're standing here right now yeah okay so as it killed you but do you think but have you seen any do you think there's anything to anything any validity to what your wife is saying your kids and the doctors with regards to having a negative effect on your health or otherwise I mean just just very honestly if you sit there and you look back and kind of go well and is there anything that you think that is going on that that it's valid right now
+C:	if I if I tell you what I'm really thinking are you tell my wife but 
+T:	no no I mean confidentiality is such that no I want you to know I'd never feel comfortable talking I do not assess us but you know
+C:	I think you you I think you kind of get me kind understanding so I really you know my um my son's in AAA okay and and you know when he went into his treat treatment and he really was hard on me like he said that he blamed me for him you know get you know going down that path and and and I really felt like maybe I could have done more he and i were really close now we're not as close because he I can tell you this doesn't like to be around me as I drink and my daughter is she sent me a letter a while ago saying that she loved me and that she didn't want me to die and wanted my kids to be around her but her kids to be around me but she um she didn't want him around as much because cuz she didn't like it when I'm drinking so well so yeah I've had I've had those couple things that that maybe go maybe maybe that maybe I need to rethink this yeah and then I'm always one way and that's really like I still want to lose her I just don't
+T:	well you know gosh I really appreciate the Jew did you feel comfortable sharing with me to know who those things with me and and I can see that you know this has been very painful and I just I can't commend you enough for being willing to put yourself out there and come in and trust this process it's not easy to do so I really appreciate the fact that you've done that  thank thanks for talking again together I'll be hopping your straight shooter or I really appreciate that
+T:	alright okay thank you very much thanks easy  

HighLowQualityCounseling/transcripts/high_085

@@ -0,0 +1,38 @@
+T:	why miss Clark my name is Alan Lyme I'm a social worker at the Family Health Center 
+C:	dr. Sheila asked me if I would spend some time with you today
+T:	I'm really glad that you here I'm just curious as to why he would send you to me 
+C:	well I came to see dr. Steele last week because of increasing stress and anxiety that's kind of getting the best of me and in the course of my appointment with him he was asking how I was dealing with that stress and I mentioned that my one or two glasses of wine a few nights a week is turning into more frequent in maybe three or four on some nights and he had some concerns about that and and felt like maybe you could help me with stress or something
+T:	yeah so he he actually see me because he went to him for increased stress and he's concerned that your alcohol consumption may be a part of that increase and prior to prescribing you anything you want to make sure that you had someone to talk to about that
+C:	I suppose okay I saw you filled in one of the pink sheets might take a little bit he told me to fill that out and bring it with me 
+T:	okay thank you so you say here that you have four or more drinks in one week you mentioned that you may be increasing that a little bit as well um and that you have one or two drinks in one setting typically yeah and maybe monthly you have more than that what what's what kind of drinks do you have what do you drink we need to drive 
+C:	winewith my meals um you know again one or two typically and more frequently three or four  so my stress is increased 
+T:	so starting to increase this times drink a little more okay well based on what you put here you give it gives you six points on this scale scale ranges from zero to forty so six points will put you in what we consider an at-risk zone so if it's okay with you lots to talk a bit about that okay okay so that was sunset run zero to forty it's not it's not a super high risk but it certainly could be a risk for maybe increasing stress maybe some physical Emmas related to alcohol well could start to show up if you were to increase your drinking from there or you can stay there this is a typical standard drink size over here I'm not sure whether that fits your description of a glass of wine a lot 
+C:	I fill the glass up so maybe a little more than
+T:	yeah maybe the little space that it's upside to drink drink and a half each one so that also increased a little bit more so perhaps maybe drinking more than you indicated on here and for women you healthy woman your age no more than three drinks in one setting is considered to be lower or no-risk and / in one week so in total how much total in the week and what you say here is that even on this sheet you're perhaps already drinking more than that mmm
+T:	so what do you make of all that 
+C:	well that news to me you know I thought red wine with your meals is supposed to be healthy and you know no more than seven in a week that seems kind of prohibitive
+T:	yeah it seems it seems a little less than perhaps you've been drinking with what you consider to be healthy drinking and certainly there's this conflicting information out there about what's healthy what's not healthy imagine the increased stresses what because we're concerned or to seal as your stresses increases and if you were to prescribe you anything maybe some interaction between the two but also build and serve them I would think so if you would what is it that you like about alcohol 
+C:	well you know it does at least in the moment temporarily reduce my stress and I you know like a good glass of wine I don't don't drink the cheap stuff I like the expensive what 
+T:	so you like the taste of it mm-hmm and it does help to lower the stress signal which is for that time you're drinking one of those not so good things about alcohol for you 
+C:	um well you know the nights that maybe I have a couple more glasses than I should I wake up feeling kind of yuck and of course part of my stress is finances and I mentioned I like the good stuff and so if I'm drinking more than I'm increasing my financial burden yeah 
+T:	so your financial stress may be increased by the fact that you're drinking 
+C:	yeah kind of defeating the purpose there  the drinking to do stress and increasing stresses
+T:	so the one hand it lowers it on the other hand it's increasing kind of a seesaw teeter-totter effect then what do you make of that give them that on one hand it lowers and the other had it increases and now it's increasing even more 
+C:	maybe I need to find some other way to deal with my stress 
+T:	yeah imagine you've had some thoughts of that what have you thought of trying well I've exercised in the past and that helps right now my schedule is kind of out of whack and I just really don't know what to do that's why I came to see dr. Steele
+C:	I thought maybe he can prescribe me something that would help me you know when I'm feeling overwhelmed and he may be able to I'm not saying that he cannot
+T:	I'm just imagine that he's concerned that if you continue to drink on the level that you are drinking that whatever he prescribes you there may be an interaction with the to imagine that she's concerned I'm not completely sure so you've had some success in the past with changing behaviors and if you were to decide to make any changes here it sounds like you could drop all that to make those changes how important would it be for you on a scale of  through  i below the visual here with that if zero is not important ten is very important to do something about your drinking 
+C:	way mm-hmm well I mean if if it means that it's increasing my stress and or he's not going to prescribe me anything because of my drinking then it's fairly important maybe about a 
+T:	mm-hmm let's put it up there why do you choose a  or a  or  
+C:	well again I've got to get things under control you know my kids are depending on me and I've got to go to work to help ease this financial stress and 
+T:	so you know all those responsibilities there's a lot riding on your decision in what to do this what if anything will bring up too late online on that scale
+C:	um well the you know the risk that you mentioned about the drug interaction I certainly can't afford to you know have any more stress
+T:	yeah so so you choose to lower your stress rather than increase it and if lo and your drinking would have that effect that something be willing to do right now how confident are you that you could do something about your drinking 
+C:	I'm pretty confident and you know probably about a seven or eight 
+T:	okay so it's pretty hot up there again and what if what if anything would you choose to do would be to cut down with a bit to quit
+C:	just in case but you know I like I said like a good glass of wine I don't want to quit altogether I'd be willing to try cutting that but you know if it's going to if doctor seal would agree to prescribe me something for the anxiety and it meant that I had to not drink at all I'd be willing to do that at least for a period of time 
+T:	so you'd be willing to stop altogether that's what was indicated by the physician okay so so based on that how ready are you to do anything right now whether it's to cut back whether it is to quit 
+C:	well again you know if I can get something to help me manage if maybe I can find some other way to deal with the stress then then you know I be pretty ready I again maybe about in on that scale maybe an eighth okay so that's that's pretty hot there as well
+T:	it sounds is that you'll be pretty motivated to do something about this right now given your responsibilities given your children relying at this point and just on on lowering anxiety in general it sounds and that's one of your goals as well well I'm pretty confident that once you decide to do whatever it is you decide to do you'll be able to follow through that based on your experience in the past of of making behavior changes imagine some things that you can draw upon what's one thing that you could do imagine you thought of some things might help to lower your stress 
+C:	well I you know the the exercise but again that's that's kind of difficult to fit in right now hoping that dr. seal will prescribe something for me to take when I'm feeling particularly overwhelmed and maybe just having somebody to talk to to bounce some things off of 
+T:	one of the things we can't offer here is for you to come in and talk to one of our behavioral health specialists may be able to help you talk talk through this there's a terrible stress and sound like responsibility there and we can make a point for you if you like before you leave today dad talk to someone that'd be nice right it also has some information here if you're interested some a pamphlet on alcohol and and how what healthy limits are and how it may be affected by medications that you took as well and I wish you lots of luck it sounds as though you really committed to making this shift in this change and imagined doctors still wanna fight with you and see how you do with your with your change within a few weeks again I look forward to speaking to in the future all right thank you very much you're welcome  

HighLowQualityCounseling/transcripts/high_090

@@ -0,0 +1,48 @@
+T:	um I'm gonna do it
+C:	okay i guess i guess something happened over this past week i I've been looking for a new job since i left my last one and I found I found this really good job on the internet but the problem is that the job is working with kids and they they have to do a drug test in order for me to get the job and it kind of like it made me think is made me think a little bit more about something that I've been considered for a while which is kind of just giving up giving up we'd forget like I've been thinking about it for a while but a guy also kind of think about the way the way we'd really helps me in like if I'm ever feeling like really really anxious about something um I mean we'd kind of as he chill out hub sort of relax and I just don't know if I'm ready to give that up yet 
+T:	so the marijuana has real value for you but you don't want to see going 
+C:	yeah yeah it does it's a it's like a way to self-medicate in the way and 
+T:	at the same time you would like this job 
+C:	yeah so I could see how this would be a you know pincher 
+C:	right yet I'm just kind of like it's put me in a difficult spot like I definitely I definitely want to get that job but you know if I cut it if I cut out smoking like I don't know what else I would do like if I if I started to have a panic attack or if if I was really like anxious about like anything that I'm worrying about I got all I don't when I did Cubs 
+T:	have you been treated for anxiety before 
+C:	um I I did therapy for a little bit but it was like I don't know back then it was kind of like when anxiety was just starting so it wasn't too big of a problem so I like I click there because it was really doing that much yeah 
+T:	you take the marijuana for any other reason other than to help with the anxiety 
+C:	I mean like if i'm bored or maybe if i'm like hanging out with buddies like I don't really have a reason not to do it like until now but it wasn't like like I really use it whenever I like feeling really anxious about something 
+T:	so and you may not be able to answer this question but if you didn't have any anxiety would that change your motivation to use marijuana
+C:	if I didn't have like any kind of anxiety um like it would simply kind of tough to give up because like if I'm hanging out my buddies they offer it to me like that's that's all that's pretty chill but um I don't like I really I'm really looking forward to this job and like the benefits of having that job without weighing the benefits of just like smoking smoking my money's so 
+T:	so you're excited with the job 
+C:	I am yeah it's it's almost kind of a dream job
+T:	tell me about it 
+C:	well it's working with its working with kids with autism and the school so look I would be kind of like a almost like a personal ta in a way so like it's a part of an inclusion program so when the kids are going into the class like I would either sit with them or like maybe back behind the class and kind of like help them out in case something comes up and it's like since my brother as autism that's like it's that's something that I've always really kind of wanted to work with 
+T:	so sounds like a real passion for this type of work and and really the big obstacle here is this marijuana 
+C:	it is it's like a catch- too because it's like I know the job would be great but it's like it's a it's a big step for me to take that job and it's it's going to be super it's gonna make you super anxious you know it's going to be like it's going to be a lot of anxiety taking a new job so it's like if I have to give up the marijuana and then like not have another way to cope with anxiety like to get the job it's that's a good like a catch- 
+T:	yeah it's a predicament yeah you're kind of weighing both sides of this right now I'm wondering do you have you think you have like a physical craving for the marijuana 
+C:	yeah I mean no not really 
+T:	so you're really using it recreationally and as an anti-anxiety agents 
+C:	yeah pretty much 
+T:	so if you were I know you didn't have great success before in therapy we want to combat anxiety but if you were being treated for anxiety and working that job which seems like you would really like do you think you would be able to stay away from marijuana
+C:	I think if the therapy really worked I would be able to UM like it's just so easy now just to kind of light up like that's an easy fix and like I don't think therapy is gonna be that instead so like you know it it would be tough I think if I had real confidence that the therapy would work I could do it but I mean it would have to it would definitely have to work like I just as well as as smoking  you would need to see results  yeah yeah definitely 
+T:	would having the job that you're passionate about reduce your anxiety 
+C:	after a while like after I got use of the job but like just starting the new job would make me kind of anxious and then like it would be tough not to not to smoke while doing that like I don't I I don't even get why they drug test anymore because like it's it's been decriminalized being legalized in so many places and there's so much research saying it's not that bad it's kind of like it's really upsetting that the place that I really want to work as that policy I think it's really silly
+T:	you're frustrated marijuana is illegal yeah it's yeah at the same time it's the reality you're living it right yeah it's I think it will be legalized and like in the state in a couple years but until the end like I mean I can't wait that long to start start working so 
+T:	until then you still need to address this dilemma 
+C:	right yeah these soil problem 
+T:	so you have choices here right you can continue to use marijuana and take the job right and that seems like something that has some advantages for you but some some disadvantages right because you would really like that job
+C:	yeah and i was it's it sound sympathetic to be like no I don't want to take my dream job because I need weed like such it was stupid 
+T:	so what do you think you are in terms of making this change you feel motivated to take some steps toward it 
+C:	I don't like I'm I'm so kind of on the fence because like if I if I have to give it up for the job I could do that but I would definitely need like some other way to get rid of all this anxiety like whether it's therapy or whether it's like something else I yeah i would i would definitely need like a substitute if I got rid of it for good
+T:	so you definitely say you definitely need it so you can't give up the marijuana unless you have some other available alternative that would help with that anxiety right that's that's key to you to make this change yeah but at the same time that would be ideal because then you could take the job
+C:	right yeah I mean I mean if I really thought that I could like it's some kind of treatment that was as good as weed yeah I mean I could i get them maybe quit and especially the house to get this job especially 
+T:	so with anxiety reduction your chances of stopping marijuana increase and then you could take the child that you want yeah yeah I've been notably the best best outcome is that the outcome you would most want
+C:	yeah i think so i think i could give up wrecker like doing it my buddies recreationally I could yeah I'm just light up a cigarette 
+T:	so here's what I'm thinking and let me know what you think about this when you come back next week right what if we start looking at this anxiety if we start you know I start treating this anxiety you know I see if we can get it reduced and kind of work from there because maybe when you start to feel if that works and that anxiety starts to abate it sounds like it'll just be easier for you to stop the marijuana usage yeah what kind of time frame are you on terms of taking this job 
+C:	I mean the job it has a high turnover rate so like even if I like I need to apply this week but if I don't get in more likely another position like it will open up like within a month or two 
+T:	and when would they drug test you 
+C:	um it would be like a right after I apply so if I applied and then did the interview that's when they will give him the paperwork and I have to give you a drug test when was the last time you spend more on 
+C:	just a couple days ago to 
+T:	see what I'm getting at 
+C:	yeah yeah it's a yeah so I like I wouldn't be able to do I wouldn't be able to make it this application but I would like to be off it by the next one
+T:	so you're fortunate in the sense that the turnover is high right because it gives you opportunity to apply later on so do you feel like you could invest in that plan let's work on the anxiety see what happens with marijuana see if we can reduce your usage of it or have you stopped that all together and then kind of move toward this job 
+C:	yeah yeah I could deal with that 
+T:	alright so the next time you come in we'll start talking about the anxiety and let's see what we can do about that move from there all right yeah it sounds good that's good thanks Scott thank you  

HighLowQualityCounseling/transcripts/high_091

@@ -0,0 +1,32 @@
+T:	so brings you here today 
+C:	well my doctor made me come said of my diet is bad and my cholesterol level is up so high that I've got to change the way I eat and honestly I don't really feel like doing that so he said I had to come talk to you and hopes that that's going to help
+T:	ok so what's nothing to me is that your doctor saying you have an issue a health issue at your cholesterol and nearly an allison issue of this present time cycle
+C:	right right it was actually I feel pretty good they do a test on me and says mom not healthy because what I eat them I don't know it doesn't bother me
+T:	ok so you sound a little we're very resistant to change
+C:	I like french fries I like fast food I don't want of time to cook you know this is the food I eat his burgers it's what's my lifestyle and he says I got to stop eating french fries sometimes pizza I like sausage and a breakfast I eat almost the whole pound of bacon log bacon bacon on my eggs bacon on the sandwiches I like bacon on the cheeseburgers the doctors like mr. Hendricks you have to stop eating bacon wait a minute I don't know about that french fries 
+T:	so this is the first time you went to the doctor he makes an account with your high cholesterol okay so how long 
+C:	it's been going on for a while I mean every time he was like yeah I think you how to change the way ye na ma alright and then I keep eating it the this time he's dropped the heavy on me and he said you're gonna have to do this and he showed me pictures of cholesterol problems and told me facts and stories about people that's didn't stop eating the bad foods and cholesterol levels where they ended up not so I don't want to die 
+T:	okay so what do you thing to do to help resolve the issue 
+C:	I'm kind of hoping some other options i'm changing my food 
+T:	have you considered exercise
+C:	we didn't talk so much about that he was so focused on the food but I'd be willing to exercise if I can still eat my fries 
+T:	okay will sound like you have it this semester issue the food thing you are not great to give up but exercising to be a possible Avenue just to lower your cholesterol levels ok so how motivated are you today start like a rigorous exercise routine 
+C:	the lord I kept glycerol was six maybe a seven even okay
+T:	so what could you do this week to start now once you've in this office today to have lower your cholesterol 
+C:	follow the hunger but how odd probably willing to talk to somebody about an exercise program 
+T:	okay have you know participant in an exercise program before 
+C:	no
+T:	okay knows me a lot of work and I respect your decision that you are not ready to give the food but you have a decision to make good choices it is your choice to do with you
+T:	is it D but this is too much for you like you're incapable of this this is beyond you you can now show your dad 
+C:	I can do it but I don't know if I'd be happy 
+T:	so how would you know if you're not happy until you try it 
+C:	I got a feeling I wouldn't be happy but I'm wrong 
+T:	okay so you say motivated like a  or a  mm is that the highest like today that you've been or wish your motivation
+C:	I'm lowering operators after my last doctor appointment 
+T:	okay it is promised been going on for how many watts or 
+C:	yeah probably three to four years three or four years okay he's noticed it's been a while since my cholesterol hasn't started to come down 
+T:	okay so this is like neglect for the three or four years pretty much but you are little motivated now 
+C:	yeah he scared me all about with the health reports he was giving me 
+T:	okay when's next time you go to the doctor
+C:	he wants me back in a month 
+T:	okay so cuz you're a little motivated he said I'm six or seven we can maybe establish a pan for you so we listen good a doctor your clothes will be lower than what it was just this present month that'd be good sorry the plan sorry your plan  

HighLowQualityCounseling/transcripts/high_096

@@ -0,0 +1,24 @@
+T:	good afternoon miss fish I would like to personally thank you for taking time out of your busy schedule to talk to us regarding smoking cessation we're basically going to go through a few questions that will help both of us get a better understanding about your current smoking status and I'm going to just take some notes here as we continue to talk okay first of all how long has you have you been smoking and at what age did you begin to 
+C:	think I was   that's about  years  years okay okay
+T:	and in those  years had you ever trying to quit 
+C:	yeah I tried once when I was pregnant but it just didn't work okay I know I hear it's not worth even the time to be honest 
+T:	okay well that's fine I mean what you definitely deserve some applause for you know your willingness to quit in it as you know smoking is a very difficult habit to quit especially for a time I paid like  years so what were your reasons behind wanting to quit in those previous tips 
+C:	really is one one main time and is right for it right when I got pregnant the doctor kept nagging me my mom kept nagging me they just kept saying how bad it was for my baby and finally I just got tired of fighting the battle and I quit
+T:	okay okay then and then what did your physician tell you about more of the specific dangers in continuing to smoke
+C:	he really didn't say anything just that it was bad 
+T:	he just said it was bad  okay so if I understand you correctly miss Fisher on you saying that you have been smoking for  years with several attempts to quit in the past but ultimately no long-term success okay both your mother and other family members along with your physician have told you several times on that you need to quit but neither of those individuals everyone into the overall specifics about the actual dangers of wanting to quit smoking is that does that sound about right yeah pretty much okay
+T:	okay so let's kind of take it one step forward um and those are tips to quit in the past what was it that you know made you start back smoking again 
+C:	well I needed it to get through the day it calms my nerves I crave it I want a few of kids but they're stressful stressful and I just can't make it without one 
+T:	okay okay then well that's that's quite all right in this fish I mean we have we have a multitude of patients that mentioned those particular reasons specifically right there also you know as you know I mean but I would say that we've had also great successes working with those patients and ultimately getting them to quit smoking so there's there isn't any lost hope with that so let's let's move into talking about your reasons for wanting to quit should you should you desire to do so what will be those reasons for wanting to quit if you decide to do so 
+C:	I still think it's a lost cause but I'm not sure I guess something on TV it says it's back to health my doctor said is bad for my health my mom says it's bad for my health so I guess it's bad for my health I've smoked for so long I don't notice anything to me it's what gets me through my day 
+T:	okay then get you through the day okay well well tell me this what was the longest period of time that you were able to quit in the past you know since you mentioned the previous quit attempts
+C:	guess the pregnancy so about nine months or so I started back pretty much day one after my baby's born
+T:	okay why are you able to quit for nine months that's it that's it that's a pretty big accomplishment miss Fisher if you think about it that's pretty much close to in close to an entire year you know do you does that make sense that that's a pretty long period of time you know one whole year why don't you 
+C:	definitely think about it
+T:	okay I mean and I can and I believe it's safe to say that was a pretty tough decision considering the fact that you've been smoking for  years right one okay and so basically the fact that you are willing to take it upon yourself in the meantime to quit while you're pregnant that speaks volumes of you you know so that would that would basically lead into my next question you on what would have been the worst thing that could have happened to you if you had quit me smoke if you have started to quit smoking for good after your pregnancy 
+C:	yes there's nothing bad
+T:	nothing bad okay okay what Mina in my opinion I believe you're you're exactly right no as you well know I mean the the the journey to quitting smoking is very difficult but if you think about it you yourself you were able to quit for almost a year now you were able to quit for nine months so just as you were able to quit during your pregnancy for the sake of the kids you know you can use that same sort of energy to want to have the desire to quit for the sake of your own health in order to see your kids grow up to be you know healthy individuals also okay and that's and that's really something to think about so I guess my next question for you miss Fisher would be more like a scenario question so if you can kind of roll with me on that on the scale of one to ten how important is it for you to consider thinking about quitting smoking sooner rather than later with one being not important at all or ten being the utmost and most important 
+C:	five okay well well
+T:	why a five and not a three or four 
+C:	I guess you pointed out I did it for nine months cold turkey so maybe I could do it again for longer in this time for my health they're not for my babies okay
+T:	alright that's it and that's a great point that you bring out to me miss Fisher on I believe this gives us some some great foundation you know should we decide to move forward with this to with the smoking cessation if it's okay with you I would really like to schedule another interview with you or another point we can actually sit down and go into further detail about about these other barriers that people face on there when they're smoking and also share with you some of the great benefits that that can come of quitting smoking on would that be something that you would be interested in yeah okay well that would be great I mean I would like to thank you again for coming by and we can schedule you an appointment for advocate I was saying about one week does that work for you yeah time free okay and in the meantime I like to come and hand you this tobacco log right here this isn't it this isn't an attempt to help you quit rather it would help us identify some specific triggers and identify triggers that you may face along the road to quitting smoking okay well thank you very much and you have a good rest of the day okay nice meeting  

HighLowQualityCounseling/transcripts/high_097

@@ -0,0 +1,7 @@
+T:	so now I want to talk to you a little bit about some of those answers I said we would get back to okay so firstly I just want to just summarize kind of way you said that you've tried smoking cigarettes one time didn't like it you've had a few drinks a few different times over the last year at some parties and you also got a ride from someone who you knew was smoking marijuana did I get all those ready right yeah okay all right so I want to say that you know it's a good thing that you seem to not like smoking seem to have decided that you don't want to smoke I hope you would continue to you know to decide that you don't want to smoke it's also really good that you don't use anyone else's prescription medicines I know it's really tempting in high school with your busy schedule and you know just trying to use things to help you study to help keep up with your busy schedule so it's really a good thing that you that you've also avoided doing that but it really it is concerning about your drinking so i just wanted to hear a little bit more about that from you so could you just tell me a little bit about your drinking
+C:	well it's not really that big of a deal it's just on the weekends i have a couple of beers and i think the main thing was the homecoming when I just got a little scared because I didn't remember parts of that night so and like my friend they threw up so it was kind of scary
+T:	okay so just to clarify so it sounds like when the one hand you know you kind of drink to fit in at your friends I'll do it that you felt kind of would help feel a little bit more comfortable in this date but on the other hand just being afraid of some of the consequences and seeing friends get sick or kind of a negative for that well well I am concerned about your drinking you know just so you know we used to think that people's brains were done developing by the time you were  but now we know that they develop well into your s and alcohol really can have an effect on developing brain cells probably that time where you didn't remember everything you did that night we call that a blackout and that's usually an indication that there's some subtle effects of the alcohol in your brain cells so so again that that's concerning not to mention that often people do things that they later regret when they're drinking so so just to think about all that and really I would recommend that you not drink at all until you turn  okay so I mean just to think about that but if I had to have you put on a scale of  to   being not at all interested  being very interested where do you think you'd be as far as your interest in stopping drinking right now 
+C:	that sounds like a good idea probably like nine or  
+T:	okay good so now I just want to talk also about driving with the friend who was smoking marijuana yeah I mean just to make sure you understand it a lot of times people may seem fine but really they're not especially with the the skills you need to drive safely so so that's something that you one to avoid here 
+C:	I'll just call my parents next time I need a run 
+T:	okay yeah i think you know I've known your parents for a long time and I think they'd be understanding and willing to do what they need to do to come get you so good okay what do you have any questions no I think that's good okay so what I want to do is have you come back in a couple months and just check in to see how you're doing with with not drinking so let's see how that goes and you'll come back in a couple months and we'll we'll see how that way okay so good  

HighLowQualityCounseling/transcripts/high_098

@@ -0,0 +1,59 @@
+T:	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 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 want to 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 that sound okay all right so why don't we start by you telling me a little bit about yourself 
+C:	sure um as you know i'm andrea i am a junior i'm in the marching band i plated center sacks honey yeah i'm also in the little bit of a band geek i play you know the wind ensemble and the Jazz Band things like that 
+T:	wow you really are involved in music yeah when did you start 
+C:	I started playing about  years ago actually Wow yeah I start on the violin first and then I went on explored a little with the piano clarinet finally found the tenor sax hmm yeah
+T:	very cool I've always wanted to be good at music it all right so it sounds like you're in band and a few other musical ensembles any other hobbies you have or things you like to do for fun 
+C:	um you know just hanging out with my friends or go to the beach things like that it's kind of everyday sort of day okay 
+T:	tell me a little bit about your family  uh well I have one older brother he's about eight and a half old years older than me my parents and I have dog 
+T:	cute what kind of dogs the golden retriever oh nice okay big boy very fun 
+T:	alright and how are things going in school for you 
+C:	I'm pretty good grades have been pretty alright I still like three point seven ish okay
+T:	great so you're doing well what sorts of goals do you have for after college or after high school 
+C:	I'd like to you know I'd like to of course graduate high school hopefully go to a nice Ivy League school or I mean that might not happen and then I'd like to go on become a doctor study psychology you need to come at psychiatrist or something okay you
+T:	have some pretty big dreams yeah it's great that's really exciting to think about that and you're going to 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 a little sheet that goes through just some basic values that might be more or less important to certain people 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
+C:	um I think a sense of community and belonging okay I think those two and um respect 
+T:	respect okay can you tell me a little bit about why you picked those three 
+C:	yeah well I think community and belonging I kind of related them um you know how I said I was in the marching men I really you know I really enjoyed being in like that team setting of you know being with other people and all working to work together towards that one goal mm-hmm and then in terms of respect I I kind of view that as one of like my major like rules like I I really do think respect is important to respect myself or respect those around me so okay I place great importance in that
+T:	okay great so sort of being a part of a group and being a part of a team gives you a sense of belonging like you said a sense of purpose in the way and then the respect is really sort of all-encompassing and not just authority but respecting yourself respecting your teammates or your bandmates and other people around you okay that's great all right well one of the things I want 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 
+C:	um sometimes you just you know go to the movies go to the beach like I had said sometimes we just get together someone's house play some board games and hang out mm-hmm and
+T:	when you're hanging out with friends is there ever alcohol involved 
+C:	yeah sometimes 
+T:	okay can you tell me a little bit about how alcohol fits into sort of your social scene uh well it's mostly just for for parties or party settings it's kind of to get things going and getting loosened up as they say mm-hmm and
+T:	so when you go to parties most of the time there's alcohol there okay and how often do you think you would say you're drinking 
+C:	I'd say um on a not busy month for instance i'd say about like two weekends out of the month to three
+T:	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 
+C:	the days that we drink or mostly like I said their parties so it's more of that whole partying and dancing and you know having everyone have fun and then when we don't it's a lot more relaxed it's a lot more hanging out playing board games watching the movie it's not yeah so it really depends on what the activity is whether or not alcohols get down there 
+T:	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 and that you're playing board games 
+C:	I think of them as as different i think you know night in playing board games and things it's meant to be relaxing so it's nice to have like that kind of breather versus with a party it's a lot more energetic it's a after at all it's very draining mm-hmm but in the moment it's quite fun to dance and have
+T:	okay so there's sort of pros and cons em yes okay what are the things that you like about drinking or like about alcohol 
+C:	um it's you know when we drink we we tend to have more fun because I guess we're not you know everyone's drinking together we're a lot more loosened up and relaxed and not really thinking about stresses or things like that but it can be when it's too much drinking it can be can be obviously bad
+T:	okay so sort of in the the too much drinking or times can you tell me some of the less good things are not so good things about alcohol 
+C:	um a lot of times it will make make people stupid yeah you know people make dumb decisions and things like that way we usually try to be as safe about it as possible so like sleep over a friends house and so you know we're not driving and it's mostly within our friend group so we're not worried about strangers putting weird things in our drinks but um definitely some of the ideas people can have when they're stupid when they're drunk can can be really stupid 
+T:	hmm so you're trying to like you said not engage in really dangerous activities you're trying to stay put you're not driving you're trying to stay with people that you trust but yet it sounds like there's still some something's happening yeah can you tell me a little bit about that
+C:	well I especially don't like it whenever me or one of my friends like we drink too much and we ended up like throwing up and things like that that I don't that's not fun 
+T:	yeah throwing up is never fun it's not and how often do you think that happened 
+C:	for me that's happened to me once it was the first time I ever drank and it was it was a lot and you know what I was doing I was mixing all kinds of weird things I'm just kind of taking anything ever anyone gave me that didn't end well but after that I have it but I do have friends that that still do some time so I'll end up like having to take care of them banging okay it kind of put it down around my my fun 
+T:	uh-huh okay so on the one side some of the fun things associated with alcohol our people are just more relaxed sort of carefree and kind of let loose a little bit more on the other hand there's a little bit more I guess planning involved because you have to make sure that you're doing it safely or as safe as you can and then there can be some other consequences like throwing up or even if it's not you that sometimes you're stuck your fun is sort of ruined when you're stuck dealing with a friend you drink too much ok any other not so good things about the alcohol 
+C:	yeah people can get a little like sloppy I guess like they're all loose like with people and corners doing things that should be done in private and that kind of stuff 
+T:	so you're kind of stuck being exposed to things you don't mean this video yeah got it ok all right well you mentioned a couple times that you've made a few decisions to try and limit the a dangerous aspect of the drinking why did you make those decisions 
+C:	I just I you know have an aunt who is an alcoholic so I I see like the issues that are involved and I've seen movies and things I know that drunk driving is an issue so I you know I want to be as safe as possible in those terms and be in a setting where like we can let loose but still be safe like I someone's house or something a parent at home or something but so I like I know that there are dangers involved and I guess I want to limit that and still be with a half one 
+T:	ok yeah it sounds kind of similar to your your value of respect to so on the one hand you the drinking maybe helps with the belonging community to start if there's too much then it sort of defeats the purpose 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 glass lines how do you think that the drinking fits in with that 
+C:	in terms of what in terms of respect I think well in a way I do think that drinking is probably a form of disrespect to my own body because i'm not putting things i'm putting things in it that shouldn't be there and then but in terms of how ways i am respecting myself i am I'm respecting myself by like trying to stay in someone's house and like trying to limit my drinking so I don't get to that blacked out like throwing up and everything and try to you know let loose but still be in control of my behavior so I'm not going to go with some random person I met mm-hmm into I don't know where to do I don't know what and things like that
+T:	okay so you're sort of looking for that balance yeah how much you can drink to have some of the positive benefit but without crossover okay and what have you come up with at this point you have sort of a limit that you stick to or I
+C:	usually well I start off by make sure that I make my own drink so I know what's in a and how much is in it so that way I control how much I drink so I'll usually just you don't get one of those cups and then make one drink and then I'll try to make it last as long as possible and i'll be like all right this is my one drink and I'm good in that way I still have something in my cousin so people aren't gonna be like oh here have some more like no I'm good I have mine and i'll so be you know having some to like let loose a little mm-hmm okay and
+T:	do you feel that's working pretty well for you or you sometimes exceed that limit or or what do you think 
+C:	for the most part it works pretty well because like i said people you know people come asking me trying to pressure me I'll be like no I'm good I have you know I still have some like I'll get some later and then never end up getting anything but sometimes they'll be like hey let's take a shot and everyone's got it around like the kitchen or something ready to take a shot and then at that point I'll be like oh well maybe I can take one more and that's when I start you know falling into okay too much 
+T:	so a portion of the time it's working well for you and another portion of the time maybe you like I'd like to make some adjustments to to make it a little smoother okay so kind of thinking along those lines how important is it to you to make some changes or make some adjustments to your drinking to sort of fit with your values and your goals for yourself 
+C:	um I'd like to make sure that I you know in terms of respecting myself of my body I'd like to you know try to drink less okay like I you know it is nice to let loose and have fun but I'd also like it to be so you know I'm not damaging my body and I like my liver doesn't work by the time I'm like  mm-hmm and you know have my friends on board with a similar mentality so we can kind of work at it together as a group as a community
+T:	uh-huh so kind of combined he has goals okay so you're 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 on on the scale of one to ten where one is not at all important and ten is it's the most important thing
+C:	right now I'd say about like like a six or a seven oh I like to work on it but you know if I get around to it I get around to if I don't I don't uh-huh well
+T:	why did you say six or seven rather than like a four um because I still think it's it's important 
+C:	uh-huh I still you know like I said I don't want my body try especially going to med school like I know how things affect your body and also affect your your social on your schoolwork and things like that i know that once i get to college it's not it's not gonna gonna work out being you know drinking every weekend and I'm like trying to wake up early and go to school take an exam like I know that's not that's not feasible it's not a good idea
+T:	yeah looking ahead you can't keep drinking this way and reach the goals that you have for yourself okay well how confident are you that you could cut down if you wanted to I think on that same scale from one to ten 
+C:	I think if I made the decision I was going to for sure then I think definitely like a tent I know I 
+T:	oh wow okay why did you say  it's just because i know that once i make the decision I know I can do it making the decision in the first place okay weather 
+T:	okay and so you mentioned you know quite a few reasons why you would like to cut down have you thought at all about how you might go about doing that 
+C:	um I'm thinking of maybe like trying to convince my friends without sounding you know dorky or something be like hey you know let's just stay in today like let's not go out or something or just be like hey I'm not like I'm not going to drink today and even if my friends do like being okay with them drinking around me not doing it and then then being okay with me drinking I mean not drinking and then doing whatever they want 
+T:	so sort of trying to plan more activities that don't involve alcohol and then also trying to participate in activities without drinking yourself or maybe even drinking less than your drinking okay does that sound like a goal you want to work on now or 
+C:	I think so i think it's it's very feasible i think it's possible okay 
+T:	so I guess we'll talk about less alcohol activities and just making some notes to myself and then maybe I'm reducing the amount of drinking that you're doing if alcohol is involved okay so that's that goal sounds feasible you said would it be okay if we met in a couple weeks to sort of see how it's going I think so that's good does that sound like something you'd like to do okay well I really appreciate you spending the time talking to me and you know it sounds like you have a lot of really good goals for yourself really ambitious goals and going to medical school and you know becoming a psychiatrist or some some other form of physician you're really looking forward to doing well in school so you can get there and it sounds like you have a pretty active social life and a lot of friends who you feel probably would be supportive even if you cut down an alcohol and that you know there's a lot of benefits you see both to your body in your health 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 drinking too much 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 interested in meeting again and be very excited to be able to talk with you about how it's going like all right great so I'll plan to see you then in a few more weeks hurted thanks   

HighLowQualityCounseling/transcripts/high_099

@@ -0,0 +1,80 @@
+T:	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 so basically we're here I'm just going to talk to you for a little bit about sort of what your goals are for your life 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 going to 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 that's not okay all right so I guess just to get started can you tell me a little bit about yourself
+C:	well my name is Laura I'm  years old and I'm a senior in high school 
+T:	okay and what kinds of things do a plan for your life 
+C:	well hopefully go to college get you know get enough grades to go to college that's great do you have a plan as to where you might want to go or um I'm not sure yet might be a few schools in the area I'm looking maybe to apply out of state oh alright being away for college cool 
+T:	yeah so kind of keeping your options open yeah definitely great and you have an idea about what you might want to study or yeah maybe I'm pre-law oh wow okay that's exciting 
+T:	yeah all right cool um what do you like to do for fun 
+C:	well um on the weekends I like to hang out with my friends maybe go like a party or go to the mall to shop or if there's like a school related event we'll go to like a football game or something like that yeah I like to have a good time 
+T:	yeah and you have a lot of friends or a few close people or 
+C:	um I would say like a moderate amount I'm not really really popular or like I have no friends um I'm like normal alright that's a good way to be right yeah alright 
+T:	so um it sounds like in general your things are going pretty well for you how are your grades right now um they're pretty good a zombie's so 
+C:	I'm doing okay okay
+T:	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 I'm going to show you just a few things on this sheet and if you can look more 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 
+C:	um family definitely a friendship and belonging 
+T:	okay what's important to you about your family 
+C:	well I I love them so I want them to think well of me and I want them to be accepting and love me okay and you have brothers or sisters yeah I have one sister okay great and how about friendship 
+C:	friendship I've grown close to many people that I care about so I would like them to be accepting of me as well great so being a good friend and having people who are good friends too is important and then what about belonging you mentioned that one - 
+C:	yeah just a sense of like fitting in and like being accepted you know yeah not 
+T:	wanting to be part of a group yeah kind of okay great all right well one of the things I want to talk about is you know you mentioned that you like to go out with friends and party and that sort of a thing and I'm curious when you're at the parties do you ever have any alcohol 
+C:	um not much maybe like one or two drinks at the most 
+T:	okay can you tell me a little bit about how alcohol fits into your overall social scene 
+C:	um I pretty much just have a drink just just have it like so it looks like I'm drinking even though I'm not so maybe people bug me about drinking or something 
+T:	okay you're kind of getting pressure from other people who are drinking and it feels easier for you to hold a drink 
+C:	have one they're pretending you have it okay and do you think that this is most weekends or occasionally
+T:	how often do you think that you are one or two weekends of the most very much so
+T:	one or two weekends a month you're in a situation where there is alcohol yeah okay and what sort of situations are you in 
+C:	well just I guess at a party or something someone's house uh-huh or even if it's not a party like a small social gathering maybe there'll be like a few beers around mm-hmm so mainly just kind of hanging out with friends pretty much
+T:	yeah are you ever places where there are parents around or are mostly just just with the kids 
+C:	mostly just with us but sometimes I'll go to like a close friend's house and like I'm close to her family as well so well I'll just hang out 
+T:	and what about driving 
+C:	um like drunk driving 
+T:	yeah do you ever go anywhere in a car after you've had any alcohol definitely no I've never drunk driven and I've never been in a car with a drunk driver 
+T:	so that's something that you've sort of made a decision about that sounds I know that's extremely dangerous okay what do you know about how that's dangerous
+C:	um well alcohol definitely impairs your judgment so I mean driving under the influence of alcohol can lead to like crashes and accidents and things like that so I'd rather not be in that situation so
+T:	you're really trying to be safe and and make sure that you're not putting yourself 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 yeah so you mentioned you pretty much will like hold a drink or maybe have a drink or two what do you thinks the most alcohol you've ever had in in one day 
+C:	no more than two drinks okay so the the absolute most yeah those two okay and 
+T:	what kinds of things do you like about alcohol um
+C:	I've never really been drunk so I can't really say that I like that being or not but it's just I I mean you're just in a good mood 
+T:	mm-hmm so it just kind of makes you feel relaxed yeah okay relax okay anything else 
+C:	um no not really like I said I don't drink that much so I I wouldn't be able to tell you okay and
+T:	any not-so-good things about alcohol 
+C:	um definitely yeah I mean what about parties is stuff and it's getting a little late some people that drink like drank too much they start throwing up or they get hurt or they're really loud and obnoxious and that's not fun for anybody
+T:	so you've seen a lot of other kids you had some consequences and decided that's not for you yeah 
+T:	got it I can understand that any other things that you can think of 
+C:	um no I mean I've never you know been friends with anybody that's got into like a serious accident and stuff it's just very like obnoxious thing 
+T:	okay well so you know as someone who's not  yet it is underage drinking is something that's not legal and it is something that is considered pretty risky so I'm wondering what you think about that just in terms of how it fits into your life 
+C:	um I know it's definitely risky but I mean I guess we still do it uh-huh
+T:	so it's kind of something that here it's just there 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 sort of fitting in as important to you and how does alcohol play a role with that 
+C:	um well definitely not in my family life because my parents don't really condone okay alcohol use but friendships I mean when I'm hanging out with my friends that were at a party or something there's usually alcohol involved okay 
+T:	so from your family perspective the drinking is not something that fits very well yeah and with friends you feel like it's easier to hang out with alcohol or maybe you wouldn't have as much fun or your friends wouldn't like you as much 
+C:	I guess I mean this is just there okay so it ties in with the whole blogging okay
+T:	well when you think about your drinking and sort of looking forward and five years or ten years how do you think that drinking might fit in with your life 
+C:	um it probably will have a very small role if any mm-hmm in my life considering I have big plans for my future okay
+T:	can you expand on that a little bit more what do you mean 
+C:	I mean I don't think I would be you know drinking as much your going to parties as much if I'm studying for school or in college or trying to get it off things like that okay 
+T:	so the alcohol is something that might make it harder to reach your goals yeah definitely so when you're sort of looking ahead how often do you think you might be drinking say when you get to college 
+C:	um maybe less than I am now I mean I don't drink much anyway so maybe like one drink every once in a blue moon okay 
+T:	so you sort of have a plan to cut back on your drinking eventually how might that go 
+C:	well I mean I guess right now I would try to stop in highschool and once I get older maybe just like socially once in a while but not anything bigger 
+T:	yeah you don't feel the need to make any major changes but you feel like you could make some adjustments that doesn't get ya that's a good word okay how important is it to you to make some adjustments to your drinking on a scale of one to ten where one is not at all important not something you're thinking about and ten is the most important thing 
+C:	maybe of five or six and 
+T:	why did you say five or six rather than like two or three 
+C:	because um it's not something I do not care about at all but it's not something that's just constantly on my mind that I want to change about myself okay so it is something you have thought about yeah 
+T:	yeah okay and how confident are you that you could make a change if you decide you wanted to on that same scale 
+C:	um I'm pretty confident but I can considering that I'm not really an alcohol user say I'm not really into that whole scene so it's not going to be difficult for me 
+T:	so what number do you think you'd say um on the scale 
+C:	one through ten favorite quit or not yeah maybe like an eight or nine okay and
+T:	why'd you say eight or nine rather than even like five or six 
+C:	because like I said it's not a big part of my life so it's not really types of people okay all right well kind of keeping that in mind
+T:	it sounds like you do have sort of a vague plan to make some adjustments in your drinking at some point yes 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 
+C:	um probably to stop maybe next party I go to not have a drink at all okay 
+T:	do you feel pretty confident that you could just stop completely 
+C:	yeah I mean I can just tell my friends my parent my friends aren't really that pressuring it's just like outside people that I don't really know that well oh so I could just tell them hey I don't feel like having a drink today 
+T:	what might be some benefits of falling through with that goal 
+C:	um definitely I'll have like all my senses there and I'll be aware of everything that's going on uh-huh anything else um health concerns I guess I know alcohol is bad for your health and so that would be one okay so
+T:	it's it sounds like you're actually pretty comfortable with setting a goal of not drinking any more at least at the next party and seeing how it goes yeah okay do you think it would be alright if we met again to kind of check in on how it goes and see if it's working out for you yeah that would be okay alright great and then 
+T:	it sounds like some of the benefits you're expecting are health benefits 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 right okay well very good is there anything else that you think would be important for me to know
+C:	um how would you advise me till I get maybe my friends to stop drinking oh
+T:	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 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 and there's already alcohol there and there are other kids that maybe aren't your closest friends 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 without any all mixed into it 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 it kind of prevents them from trying to stuff something else in there do you think any of those things might work for you 
+C:	yeah for sure
+T:	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 too I need to stop drinking I was just planning on playing them that I don't really want to drink anymore that wasn't me uh-huh no your friends would be pretty comfortable with that yeah I mean now it's my closest friends for sure okay great any other concerns or questions anything else I go but no I think I'm okay okay so then like I said I'll try and see if we can meet up maybe in a few weeks and see how it's going and then if things are going great then fantastic and if you run into any stumbling blocks and we can maybe problem solve together okay great that's sound okay yeah all  

HighLowQualityCounseling/transcripts/high_110

@@ -0,0 +1,49 @@
+T:	I can great to see you today nice to see you too so I understand your smoker and I wonder if you would talk with me about your smoking?
+C:	sure I'll be 
+T:	all right and so can you describe for me your pattern of tobacco use?
+C:	uh it's sort of sporadic I mean it mostly revolves around either  i'm drinking with friends or or when I have you know emotions that I don't know how to deal with whether it's anger frustration or sadness or loneliness or pretty much any emotion that couldn't feel good yeah and 
+T:	so how many cigarettes would you say that you have you smoked each day?
+C:	uh like I said I'm sporadic I don't smoke the same every day but on average maybe a half a pack a day I mean it could be none one day and then the full pack another day and so but maybe on average a half a pack 
+T:	okay and how soon after you wake up in the mornings do you have your first cigarette?
+C:	uh you know it's not right away from me normally I in most days it will probably when I'm in in the car and the way to work you know and just it's one of those places where I'm in a car and start the car and light a cigarette and you know follows right afterwards 
+T:	well it seems like you have a lot of awareness of your triggers for smoking 
+C:	uh yeah you know I don't I don't I think crave it in a way that I think maybe most people do all the time I just have situations for sure that that I by smoking you know 
+T:	okay and how long have you been smoking?
+C:	I had my first cigarette when I was  years old
+T:	and has your pattern been the same since then?
+C:	uh you know what varies a little bit but but it's mostly been like that you know I never smoked a lot more than I do right now or really even a lot less it's mostly been mostly about same on average 
+T:	and so are you interested in stopping smoking?
+C:	uh yeah I mean I I I quit all the time frankly I I've thrown away you know half full packs and and and swear I'm done and then I think I'm done but it only lasts for for a few days and then you know either I'm out with friends drinking all right I I get upset and then and then without even thinking about it I go and buy a pack on I'm a smoker again yeah 
+T:	and so those times when you decide to quit what are your reasons for quitting?
+C:	uh well i think i'm stupid for smoking you know i mean i think everybody knows that it's horrible for you and do awful things to you and your lung cancer and kill you you know and then i have asthma too and so put it on top of that and I you know more recently I've seen family members die lung cancer and it's awful a horrible way to go you know and so it seems more real and I I don't want to do that to myself I wouldn't want anybody I care about to smoke and yet somehow I keep doing it to myself you know I I sort of can't believe that I choose to do it and yet i choose to do it without thinking all the time 
+T:	but it seems like it really fits in with your lifestyle with the friends that you spend time with and
+C:	yeah we we all work nights we all go out afterwards we all drink and smoke and you know I I don't think i could really imagine being out of them and watching them smoking me not doing it to you know I just it would do all it takes is being around it you know and I'm smoke with them 
+T:	yeah well it sounds like it's really it helps you to connect with them and part of socializing 
+C:	well yeah I mean yeah I don't they don't pressure me to do or anything it's just being having it all around me you know and having a drink in one hand you know like it's it's like it couldn't be any other way you know just being being around it and and and and people spoken and I'm I'm gonna smoke with them too 
+T:	it also sounds like when you're really feeling bad or feeling negative emotions that it's the one thing that you know you can go to and for a little while anyways it helps you to feel better 
+C:	uh yeah I with any kind of emotion that I don't know how to deal with it just feels like a ton of pressure inside of me and and and smoking two cigarettes like pushing the pressure release valve you know like I just but I feel relief and I don't feel nearly as angry or sad or frustrated or whatever  and and so it does what I mean it to do I guess 
+T:	let's stop here so we can discuss what you have seen so far consider the following questions how do you think this conversation is going so far? how effective is the assessment? are there other questions you want to ask? what have we learned so far about Kens smoking pattern and history? what are your initial thoughts about potential tobacco cessation medications and counseling strategies? let's see what happens next and so right now in this moment can you talk with me about you know how ready are you to quit? so on a scale from one to ten one being not ready to quit it all and ten being you know you would set a quit date right now where are you? c	 at huh you know I would say maybe six or seven i would say I'd be I'd be happy to be done you know I'd be happy if I didn't ever smoke again I just I just don't really believe it's going to happen I guess you know I like I said I quit all the time and now it's even sort of a joke that that me Quinton's like not quitting at all it just means I'm out  t	um okay well did you know though that um people who quit without any sort of assistance using any tobacco cessation medications or counseling have a four percent chance of success of quitting in the long term 
+C:	you know I that sort of discouraging I guess that no one can get away from it you know but I guess I'm not the only one 
+T:	um but there are some cessation medications and aids that can really help you to successfully quit 
+C:	what a kind of things you're talking about 
+T:	well there are things like um the patch or the gum so nicotine replacement therapy there's also other medications as well as counseling where it could really help you learn and practice some strategies to help you stop smoking especially at those times when you're really triggered or you have some real cravings they'd have to be really good techniques
+C:	i think you know I but like i said i don't i'm so convinced that i'm done each time that I quit and then and then I start again and I don't even think about it you know there's whatever technique would have to uh has a lot to overcome I think in my case 
+T:	so so then that leaves me to asking you about your confidence level so if you could rate yourself your confidence level about your ability to quit on a scale from one to ten one being not having any confidence at all and ten being yeah I know I can do it this time where are you at with that 
+C:	uh you know i would say maybe you two maybe a three out you know I I don't know you know I can go like I said a day or two without smoking but I've never gone for good you know I all I need is you back in that situation again either upset or out with friends and I'm right back and so I just I have a hard time believing I have a hard time even imagining a world in which I really wouldn't wouldn't go to smoke when uh when times get tough I guess 
+T:	yeah well and so can you talk with me a bit more about the reasons why you would really want to be quit?
+C:	so there's health reasons 
+T:	yeah um is there anything else that really you know is one of the reasons why you would want to quit?
+C:	uh you know i just i don't i don't want to live this way where I do things that to myself and I wouldn't do to anybody i love you know I wouldn't want any any loved one to smoke you know and but somehow I I do it to myself you know and and and and I'm trying to start exercising you know doing some running in some hike in and and and then I get short of breath and I cough and I'm worn out if I smoked a lot the day before and and I'm not sure you can choose both smoke and ends being in good shape you know I just I just I don't I don't believe in me making that choice I guess to be healthy and 
+T:	so it really does sound like for you quitting smoking would be an expression a self love 
+C:	i would i would have to love me more i guess to get there like I said I would I would I would want anybody I loved and not smoke and so if I I chose to not smoke if I was actually be able to do it I think it would have to be because because I cared enough about me to do it
+T:	yeah and so your confidence you said is that a two or three why not a one 
+C:	you know because I do go days a time sometimes without smoking I mean as long as I'm not in a situation that sort of forces me to do it you know as long as i'm not out with friends drinking or as long as I don't have some situation gets me upset than I don't I don't feel it has control over me you know just in those situations where there's nothing else I can do you know but smooth 
+T:	well it sounds like quitting smoking is really important to you but that you know you don't really feel confident and you're not sure about what strategies are out there to help you and I'm wondering if you'd be willing to meet and talk with one of our tobacco treatment specialist who can we tell you what your options are get you connected to resources to help you quit would you be willing to do that? 
+C:	you know like I said they gotta have something pretty special I mean I outside of them coming to the bar with me and not going to figure it out of my hands I'm not sure what they can do but but I I don't want to keep Quentin I want to quit one more time and it'd be it'd be it you know so we'll give them a try 
+T:	yeah well in like you said you know you've quit many times before and for multiple days and that is a real success and I know that because you ended up going back to smoking that it doesn't feel like a real success but certainly being able to stop for hours or days at a time is really an accomplishment and I hope you can feel that 
+C:	well it feels like something maybe I mean I'm better off having a few days often then smoking a pack every day but but i don't i don't think you'd really quit until you really quit you know like i don't i don't think my quit and I know you really want to quit I don't I don't know that there's anything better I could do for myself if I could actually do it 
+T:	okay so if I connect you with them with the tts you'll um follow up with them and talk with them about it?
+C:	I'll give them a try 
+T:	in our next meeting we can check in and see how things went for you 
+C:	all right 
+T:	okay well wonderful great talking with you it's good talking you  

HighLowQualityCounseling/transcripts/high_111

@@ -0,0 +1,18 @@
+
+T:	Jeffrey tell me what you'd like to talk about today? um press all you can call me Jeff the time 
+C:	um I don't know there's just so much going on right now hey I lost my job two months ago and I don't know I was like taking care of myself so much better and it's just I stopped going to church as much and it's been really tough because my wife and my two kids aren't living with you right now so I'm just trying to get my just kind of get trying to get myself together right now and so I mean you're the first person I've seen it for days I just don't know I just don't know what to do
+T:	okay so right now what you have so much going on that you're just feeling totally overwhelmed you don't even know where to start yeah thinking about trying to control your diabetes just seems like one more 
+C:	yeah I did likely from like a bun on a job like how can I think about you know check my sugar and I regular basis I'm trying to just get out of bed you know and not sleep till pm like I've been doing you're even feeling a little bit depressed right now yeah yeah it's not helpful 
+T:	so it sounds like you mentioned that you had been going to church and then you also said that your wife and kids you're not with them right now so sounds like the people that you had in your life that men were a source of supporter there aren't there for you 
+C:	yeah hmm maybe that are there hurry i don't i don't know i mean that's part of what I'm scared about is you know what if they aren't there like one thing that was really cool his on Wednesdays me and a few my friends would walk the Bible study instead of driving and it was fun and one of the friends was named Cheryl and whenever I didn't go she'd call up would be like so you know she'd always get me to go and just I didn't want to let them down i also really enjoyed it so we just talked about work I have a job now but I mean we just I don't know we just talked about life you know it's really good 
+T:	so that group is really helpful to you not only just to kind of chill out and have a good time but also you actually had some exercise 
+C:	yeah exactly get into n out of them had diabetes as well so sometimes we were just Chad you know see if people were you know just taking care of themselves get into the clinic doing whatever they needed to do so I missed that you know 
+T:	okay so that was a really helpful thing for you in managing your diabetes and you're feeling a little bit lost not having that 
+C:	yeah yeah I just I just I don't know I just it's just it's just tough because you not only do i miss my friends but i also miss being a good husband and being a dad and and being able to provide and just I mean I had to get fluted the church food pantry you know two weeks ago and you know it shouldn't be like that i should be able to support them and to you know work hard go to or come on you know cook dinner help with the homework i mean i'm not doing any I have no structure in my life right now you know I I mean I could add sleep in till pm because who cares you know
+T:	it sounds a little bit like you're feeling a change that you can't fulfill this role that you it's not so much ashamed
+C:	it's just embarrassed you know it's like I I I mean even just saying this I'm kind of like hope you know that you don't judge me or whatever because I did I can't even it's hard to even just say this I don't want things to be like this you know it's hard enough sometimes having diabetes and being embarrassed around that but throw all this other stuff on and it's too much I just don't even want to acknowledge it 
+T:	really you know you're really frustrated because they fell anything's going on in your life that you feel like you don't even have control
+C:	exactly exactly yeah i mean at least i had control as far as going to work going to charge um taking care of my family i mean those are three things that helped having those in balance i could focus on my diabetes because it was as part of my routine and i got ready for work you know like those just part of my routine 
+T:	so in the past we were able to have the structure and also the support of people around you it's sort of added more daily basis it was easier for you there's a lot easier
+C:	yeah it wasn't easy but it along or I just felt like I could deal with it 
+T:	okay so even though you're really overwhelmed right now and everything just sort out of control and you're feeling really really hope it sounds like you may have identified a few things to think about in trying to figure out where to move forward all right did work in the past right now  

HighLowQualityCounseling/transcripts/high_116

@@ -0,0 +1,37 @@
+T:	so Rose thank you for coming in today can you just start off I tell me a little bit about yourself
+C:	oh yeah i'm a student right now at U of L will not right now i'm taking a little break from school um i live at home with my parents and I I work out I mean right now I'm not doing too much but on college 
+T:	it's your typical college student 
+C:	yeah 
+T:	well it sounds like you're really really happy about your life I can tell with your facial expressions and things like that you seem pretty content to be taking a little bit of time off from school right now and you know that you live with your parents sounds like you really enjoy spending time based off what you're what you're telling me 
+C:	oh not really I do like my family a lot but i kinda want to be back at school I mean I guess I'm kind of friendly person um but yeah I don't know I like starting out of my family for sure I always like to call you home for Christmas and summer break all that kind of stuff but I'm kind of aggravated because here I am my junior year i'm really excited as it gets missing year and graduate and now i have to take another semester because i had to take out this one and I'm really grateful that my parents are like you know letting a little bit them but they are making me look at the same time um so yeah I I got sick a little bit and they asked me to come home and I thought that you know I can get better and i I just I don't want to take any more time off really I want to stick to my age and a graduate on time like everyone else my age so it's aggravating I that I am grateful that I have a family like them I guess 
+T:	so it seems like you're kind of conflicted about what's going on you know I'm hear you say that you got sick and it wasn't really big deal but it seems like your parents may have been your opinion overreacted 
+C:	yeah
+T:	kind of pulling out of school was causing you fall behind what you would like to be 
+C:	yeah i mean everyone gets sick i mean i don't think it's important for me to stay home for that reason you know they may to always be concerned about my health I feel like I think they're a little overly concerned 
+T:	can you tell me a little bit more about what you mean by sick what kind of symptoms and you have what did that lead to 
+C:	well I just kind of always been more easily able to like colds and stuff and it always kind of got worse for some reason for me i'm not sure why but I you know I just it just kind of happened and so I expected it when I got to college of living has lots of random people in dorms and I knew they'd be like freaking out on it and they of course were finally by sophomore year and it wasn't getting too too sick you know I guess some days at work a couple days of school you know every other month or something but junior year I don't know I guess they thought I was getting more stressed dollars I don't know I'm kind of guessing here but um yeah so my symptoms i guess like you asked we're kind of getting the common cold i guess but i would just get really exhausted and sometimes like everyone so i won't be able to get out of bed but 
+T:	so it sounds like you're really confused about why your symptoms even began 
+C:	yeah i mean just I feel like I'm a pretty normal 
+T:	I know that you really discuss that working out was it really important part of your life it's safe it can you tell me a little bit more about that?
+C:	well I want to be a personal trainer that's kind of where I am right now like that's why I wanted to stay on my agenda because after school I have to do like a few more years of school getting my masters I'm really excited about that like I mean I've been reading like magazines for training like since I could remember and it's all about you know being fit and being excited about being fit and having like I energy that kind of stuff which is hard when I'm sick time high energy but I always going to work on my own fitness lifting weights and running and doing extra classes just to kind of build my core that kind of stuff so you know I I think that's kind of why or got so much it's really important to me and one day I'm gonna have to encourage you with the workout so I need me they'll love it myself so 
+T:	well def don't want to be hearing that is this this is probably one of the biggest parts of your life and you know what you're saying and I don't even frustrated but you've been unable to do this inject home 
+C:	yeah
+T:	because of the illness and your parents concerns you know you express that you really like to work out every single day how many hours a day on average would you say that you work out?
+C:	I mean they encourage like what I read is like four arms but like I really want to be a great trainers I'm you like five or six so I know it seems like it I'm like
+T:	you're like time consuming it is 
+C:	yeah I mean I like a friend come running with me around smile but a sort of certain point they don't want to keep running with me or like workout me good so you're not a little socializing but I mean it's what we want to do with my life so I have to get used to it one day i'll be doing it for like  hours a day
+T:	so well it seems to give a lot going on with your life I mean taking that amount of time during a day to run I know it would be very exhausting so I can completely understand that getting the cold may seem pretty doable to you I know that you were referred here by your primary care physician dr. hafer and I know that your parents were just really concerned with not only the amount of exercise that you were doing that maybe also some of your other eating habits yo Mike us try to talk about tonight you can't be a little bit why you think that they're concerned about that at all?
+C:	I mean compared to like my siblings on Michael little thinner so I guess that's probably what they're thinking but I need a workout I want to be fit but I I really watch what I eat you know I mean that's what they disease I'm een and you know I'm not just magazines for more than that it's Boca soon yeah videos and come on part of many blogs and that kind of stuff you know what I hotel my own but you know they just really encourage watching 
+T:	how much fruit you have how much about how many vegetables you have how many you know how much mean you have?
+C:	and so my parents had concern when I have very little meat and when I'm you know when I'm just consuming fruits and vegetables so that's really where they're concerned I guess they want that's must be what it is I mean they think I don't consume enough of anything so they tell me but I mean if you look at like these agendas that I have been following other people survive you know by that most the time so I mean so when I guess
+T:	I'm hear you say is that you're really you're following with the magazines and what the internet what all the other fitness experts are saying right it seems like your parent ships aren't fully understanding that that's just the regimen in the lifestyle that that industry village drives for and they don't follow themselves so 
+C:	I mean they're not going to understand that they've never been really concerned about it I've always kind of encourage them to kind of comment down the heat but you know it's something that yeah I've read these things I and I want to be competitive one day as a trainer and getting other people to be competitive too so I they think us here original question was what was it again I'm sorry I kept rambling I'm nothing 
+T:	you're doing fine you can continue on as you were we can sort of his head in the direction of I know you really discussed a lot about fitness and working out as one of your really important aspects of your life will you have some of the other important aspects of your life?
+C:	um well like i kind of said my family and i really do care about them and so they're very important to me and my schoolwork is very important to me i really try to do well Matt just try to focus my time on that and I also do a couple hours of work everyone everyone's valid during the week at the library so I try to put those hours there just because I need to make the extra money to pay for you know I'll do all the things that I following magazines and my groceries because the campus foods one of the most i joined by our groceries absolutely 
+T:	well it sounds like you are incredibly busy as a college student John sleeping 
+C:	yeah 
+T:	it's something that I think would be very beneficial for the next week before we meet again it's I would like for you to try to do your best to journal kind of document maybe how your day goes you know in the morning what are you doing in the in the afternoon what are you doing it at night time where you're doing just just breathe little notations you know seven o'clock i'm doing this eight o'clock i'm doing this not every single hour but as often as you can remember I'm and I'm likely to bring that in next week for us to discuss that way we can kind of see how your schedule is going around real quick 
+C:	yeah 
+T:	that sounds like we're going to do for training sometimes 
+C:	good 
+T:	all right well I'll see you next weekend are good next thing  

HighLowQualityCounseling/transcripts/high_117

@@ -0,0 +1,44 @@
+T:	hi William I'm Heather I'm so glad to meet you 
+T:	hi Heather thanks for coming in sure how was your trip over 
+C:	it was okay i had trouble finding the place at first
+T:	but you know first time coming here you made it I made it right fantastic and it looks like you brought some paperwork with you  C 	and I didn't I filled out the form 
+T:	thank you for all of that how was all that for you it's a lot of papers a lot to fill out 
+C:	I I wasn't sure on some of it what to put down so I'm hoping you'll help me with that 
+T:	fantastic well thanks so much for going through all of that e note was a lot to ask and I'm so glad that you're here and that you made it and we can most certainly go through any of that that would be useful for you today okay and I'm wondering if maybe at first before we get started I'd like to check in with you and just see if there's any questions things that you've been thinking about or wondering about since you first heard about our program that might have brought you here might be on your mind 
+C:	um-hmm that's a good question well I not really I know a little bit about the program actually because I was a client about seven or eight years ago and didn't really things didn't turn out well so I'm interested to know how things might be different and I'm I'm just not sure I'm just not sure with my situation if you can help me out or not 
+T:	sure so you're back with us again and thinking about gosh this time might be different for you and may be wondering what that might look like 
+C:	I hope so yeah yeah 
+T:	anything else that might be on your mind or even thinking about or wandering about?
+C:	well I have I don't know if I'm getting ahead of myself or not but I have a little bit of a record for some misdemeanors when I used to drink and so I'm I just really feel like I'm not good for much I don't know who would want me for it to work 
+T:	so they're really wondering right now if if if work is possible for you
+C:	yeah 
+T:	do you think it is well I hope that through our work together you'll be able to decide that for yourself hmm and my hope in our process is that that we could be partners and thinking about that together and what what work might look like for you in your life and how it might fit in for you how does that sound 
+C:	okay I thought you might just tell me what to do and I had to do it I'm so this okay I'm I'm ready like I can do that 
+T:	so thinking about for yourself what you know could be possible is almost a new thought for you right now 
+C:	it is usually when I'm at home I'm pretty depressed and thinking this is the rest of my life and it's not something I'm it just doesn't make me happy when I think of it like that so to think there might be alternatives or choices interesting i'm not sure what to do with that
+T:	honestly and something brought you here today it did 
+C:	yeah 
+T:	what was it that made you decide even with all of that sort of thinking about at home?
+C:	i'm not sure if this is possible or this this may not work out for me 
+T:	and yet there was something that brought you here 
+C:	well I consider my chair all day and watch TV shows I get to watch the old days and its really nostalgic and I'm in my mid  so I'm thinking I could be doing this for another  or  years is that really okay for me my son is he's an adult he still lives with me but he's he's capable taking care of himself and I just can't imagine myself sitting in this chair for the next  years and just deteriorating and I don't think I would last  years i think i would ask maybe eight and I'm not ready to go 
+T:	so there was a moment in time when you were sitting in your chair watching your oldies that you thought is this what the rest of my life will be like em hmm will there be something you know that be something more and also you know it's part of the time it's like yeah this is it you know you made your bed be happy with it and this is this is all there is in that's it then this other part is not too sure if that's okay 
+C:	you know I'm not really sure I want to be there yeah not as comfortable but then the end then there's a third voice that says he can't do anything and so it's just like I just feel really confused and kind of tied up in knots and I thought well I'll give you our try again it can't hurt I might get mad but why not 
+T:	well I'm really glad you're here William and I look forward to finding out much more about what it is that's most important to you and what you want your life to be like in it in the future and you do know what's best for yourself you have those voices that you said that tell you what you do like and what works for you and and the voice that sort of says I'm not sure that this is what's best for me you have a lot of things kind of rolling around in your 
+C:	I do it's an just spins around in there it's really really hard sometimes yeah how exhausting that must feel mmhmm yeah and confusing and aggravating and depressing and anxiety-provoking and just all of that honestly it was kind of hard to come in here because I just like I'm feeling kind of hopeless about the whole situation so um but I like I said I just thought I can't hurt and even just talking about it in this moment
+T:	I noticed that you got a little tense and sort of it's almost like those wheels are turning again just considering it as the coaches are tracking 
+C:	it is I just think I'm i don't know i feel kind of dumb it's just like what am i what do i think i'm doing but i'll try not to be negative i'll try to think more positive it's just kind of a habit 
+T:	I guess and you have some hope for your future that things can be different for you I hope so I'm sure what that looks like yet don't know what it looks like 
+C:	yeah 
+T:	so what do you think if the two of us together um could potentially start exploring that journey a little bit some of the things you mentioned just in our brief interaction right now have been that you that you have a son that lives with you that is really doing okay and so you're able to start thinking about yourself in your life and that maybe you're a little concerned about what the future might bring and what some of the things in your life that you're dealing with your criminal history for instance might potentially get in your way and how could you how could you get around that what life could you have for yourself at home it's more than sitting in that easy chair watching your oldies mhm so if we may be delved into a bit more of that sort of what you're thinking about working how does 
+C:	that sound sounds really good I I haven't worked for  years and or maybe eight but it's been a long time and things have changed so much I just know it won't be easy but I'm ready for that you seem like a pretty nice person to talk to so I'll give it a try 
+T:	you're ready to at least explore it huh so um would this be a good time for me to share a little bit maybe about how our program might have changed from the last time 
+C:	sure I'd yes please 
+T:	so how I see things is that I sort of feel like maybe a guide or a partner with you in your journey towards work in thinking about work from where you are now maybe feeling a little bit confused or not sure about what the future may bring and then to bringing you forward to however that looks for you in your life and hopefully to that place where you really want to be where you're doing something that that fits for you and feels good and that we it as a program have some resources that we could potentially utilize together our first step would be of course today to take your application for services and then after that I would be able to look at whether or not you're eligible to work together on this journey and if so we would be able to figure that out together what that path looks like so how does that sound to you?
+C:	it sounds pretty good I'm how long does this take 
+T:	that's a great question so you really you really want to know what the path forward might look like yeah what to expect what to expect 
+C:	yeah I really like to know what to expect that's important to me and everyone's journey is different working 
+T:	oh you and I together can potentially plan that mm-hmm we can talk about there are certainly certain time frames in our program around eligibility our first step is the application and then we have some time frames and together our hope is that we can even improve on those time frame um so I guess it's kind of a wait and see well know when it happens how long it takes absolutely but the first step is just to get started and how about if we along the way maybe kind of check in with each other around expectations and time frames would that be useful?
+C:	hmm mm-hmm thanks 
+T:	yeah yeah totally so if you'd like to get started would you mind if I take a look at your application paperwork and just make sure that there isn't anything that I may have a question about 
+C:	okay thank you very much for bringing fun like I said I  

HighLowQualityCounseling/transcripts/high_118

@@ -0,0 +1,47 @@
+T:	William it's really nice to see you back again 
+C:	hi yeah I'm glad you're here and as I know as I had mentioned on the phone when I set up the time that you have we have found that you're eligible to or the services here and so that means that we can get started and really map out a plan okay and our guidelines are that we need to we need to have we have  days to develop that plan and there's a lot of different ways that we can go about it and think about it and will kind of start that process today how does that say? 
+C:	okay yeah sounds good
+T:	um in before we get started on the specifics of this I'm wondering if there's anything that you're concerned about today or things that you've been thinking about in relationship to that?
+C:	Oh since our last meeting you know it was really interesting because part of the time I was really enthused and part of the time I was really scared and I started just kind of throwing around ideas and but at the same time one thing we didn't really talk about too much last time was some of the this I've got some pain of my ankle my car doesn't always work my son has a mental illness and I hate to say this but I I for the pain i use medical marijuana and so i just wanted to be upfront and honest with that 
+T:	yeah so there's a few other things 
+C:	but you know just that things are still spinning in my head 
+T:	yeah so that you've been thinking about it a lot and about some of the issues that may come up and actually I what I what I put together here is in looking at your paperwork I kind of pulled out some of the things that are possible for us to talk about and I you had indicated on there that you had medical marijuana so I've got that I walk the whole issue with the pain okay on there it does sound like the that thinking about dealing with your son might be an important one for us to consider in this too 
+C:	mm-hmm it is he has his ups and down for sure mm-hmm create a lot of stress so yeah right and makes it up makes it hard to think about being able to take care of that and and go out and do other things too 
+T:	yeah you know you mentioned in your in the paperwork that what you you wanted some help sort of thinking through a work goal or the possibility of work at all 
+C:	yeah like that's it's just like making that decision and really working on it the when I went through also I pulled out a few things and here's what i came up with from that
+T:	and you mentioned last time about the criminal history that you had a little bit of concern about the misdemeanors were there that were there you also have talked about in your that you were on the SSDI and that you had you know for your for the injury based on your injury and the disability and sort of thinking about maybe some benefits thinking about that in relationship to work and has another thing we could discuss so another thing that was on there was the education and you mentioned about the not having a GED or finishing up high school and that's certainly something we can talk about and how that might affect work you mentioned the that there had been some issues with alcohol addiction and certainly that is a topic that we could talk about and how that might you know might play in with the work and then the pain management and the sort of follow-up to the injury and what what that is what that is or what concerns you have about that and as you just mentioned you the issue with your son and how what your role in taking care of him or how much that puts on the family stress mhm and all of those are areas that we could start with and I'm also wondering if there's something that you feel is more important to start with in terms of initiating this journey towards figuring out what your goal is 
+C:	well one thing that's really big on my mind and maybe it's wrapped up in here is that all the work I've done was physical labor work and I can't do that anymore so there's been a whole shift and so I'm feeling really sort of lost about what what's of it what are the odds available i don't even know with physical work there's a ton of things that a person can do 
+T:	yeah 
+C:	and i just can't do that 
+T:	so that's certainly possibly the exploration of what kinds of work that aren't that aren't physical in nature recognizing that you wouldn't be able to do the kind of work that you did previously bright and really thinking about that and certainly there's some resources that we have for helping in that exploration and looking at there are a lot there are other options out there are ya okay for someone my age you think?
+C:	yes okay yeah I do 
+T:	it's just learning more about that
+C:	yeah okay looking through them so okay you know and what I want to say is we can end up touching on we may possibly end up touching on all of these things during the course of our our planning process and it's really about figuring out what is the most important thing to you to start with and what you have the most concerns about or what you think would help you most in that decision-making process what do you think well all of this 
+C:	yeah you're right it all plays a part but I gotta say this pain that I have in my ankle is constant it's always there and it's just sometimes it's worse than other times but it affects my sleep it affects my outlook and then I use some marijuana to help kind of ease that the severity of that pain but the pain is still there so it you know I can get up and think my day is planned this way or this way and I may not be able to get past that that lounger the recliner man to be because of that pain and I'm so I've that really scares me is that going to keep me from working and i don't know if i told you but I've got like nails and and plates are not nails with screws and plates in my ankle and have to use a cane and people are going to notice right off the bat when they see me that there's something wrong with this guy 
+T:	and so it's already it's pretty obvious and it also sounds like that pain is really taken up a pretty big role in your in your life and it feels like a pretty big barrier right there
+C:	sometimes it's all I can think about
+T:	yeah
+C:	is that playing yeah 
+T:	well how about we spend some time really talking about what what that pain management might look like what what you've been doing and and sort of how you see that playing out in your work that be that's not okay?
+C:	definitely 
+T:	tell me you mentioned the marijuana and you mentioned that you um that you know that you have a cane and have some adaptations and tell me what else you're sort of doing to manage the pain right now 
+C:	well like the other day I tripped and I did something to my ankle I don't know exactly what but I have a like a boot you know and somebody hurts your ankle they can put a big boot on it so I've got a boot that helps keep it stable I've also got a brace that helps keep it stable it's hard sometimes one of the wound might open up and become infected so then there's doctors appointments and that kind of pain and it's not very pretty what else have I been doing just not I try not to overdo it but sometimes that's kind of hard because I tend to push myself sometimes i take i don't take any of the heavy duty meds i've had addiction in the past i know and they don't make me feel good anyway so that's a good thing I'm not hooked on some of those really heavy-duty prescription medication so I will take over-the-counter ibuprofen and tylenol things like that I think that's about all I can't think of anything else yeah you know I just do 
+T:	I want to affirm how much you know about yourself that you made decisions about how manage this based on not wanting to get yourself in trouble with addiction again?
+C:	I I really that's a you know I really takes a lot of courage to do that and to sort of live with the pain and figure out alternatives well I always tell people I one drink away from jail so you know that's a pretty good deterrent 
+T:	yeah yeah so that stays at the kind of the forefront to the top of your head to like oh boy and if the stress gets too much that could be a problem 
+C:	yeah yeah
+T:	it's true yeah you know one thing it sounds like the pain management is probably the place where might be useful to start because that might be the most the right up front the thing place to start so we can do that and we can talk about there are alternatives out there and and different programs and different situations that have been useful for others in your situation in terms of managing pain so maybe we will send me to a shrink maybe they'll shrink that ankle 
+C:	yeah i just know he'll say it's all in my head sometimes 
+T:	and so it sounds like you've had some experience that 
+C:	oh I'm being told that it's it's just in your head and it's really that really makes me mad 
+T:	yeah because you really know you know what it is and you've been living with it and working with it and trying to find a way to manage it for a long time 
+C:	exactly yeah
+T:	right don't want somebody telling you
+C:	yeah 
+T:	that you're making it up 
+C:	yeah 
+T:	well I can assure well that that we that we can find alternatives to that
+C:	okay I'll be curious about that 
+T:	yeah okay well how about we go ahead and set that up and we'll start there and we'll keep these others and what I want to let you know is that if other things come up that we need to cover we can put them on this list to to make sure we'll check in about these okay it's time we meet and figure out what if you know where what we want to work on that day okay start with the pain 
+C:	okay sounds great thank you 
+T:	mm-hmm  

HighLowQualityCounseling/transcripts/high_119

@@ -0,0 +1,64 @@
+T:	wondering if you would be willing to share with me what you picked 
+C:	ok I'd be glad to and I just have to say it was really hard to choose the top three and I actually stuck in a fourth 
+T:	it's important to you there is a lot 
+C:	that's important to me and I am 
+T:	let's see do they seem to be in order when I tell you about them? or just however you'd like to start 
+C:	okay 
+T:	um wanting to start with family and it says to have a happy loving family 
+C:	I'm going to kind of family is very important to me having a happy loving family that is kind of a it would be a nice goal but a family that's that gets along well a family that is there for each other and support each other maybe not always happy and loving but you know still there for each other that's really important to me 
+T:	it's a really a family that is kind of your rock and he family is very different than maybe the words that are on this card and yet family really called out to you family did you know that's basically the only people 
+C:	i talked with two is why one friend that comes over once in a while but really all during the week and its family so I don't know you know where I would be without them and and it's just so it kind of blends in with us next on the responsibility I Myers my ability to be responsible has increased so much when it comes to family and I really want to keep that going I I feel like I have a I have to prove something to my family that because I wasn't responsible for a long time and in fact I still have plenty of times I'm not responsible but it's other you know I try I'm trying my best to show that I can be responsible does that make sense?
+T:	so family and responsibilities are tied together for you and responsibility is something that you haven't always been as you would like and yet you've grown in your ability to be responsible possibly partly because of your family 
+C:	well especially with my son he started working so I'm there to take him to work and pick him up so that kind of gets me going during the day whenever we have a family gathering I'm always the first one there and I used to be the last one and so I try to be really punctual and be there for my family when I can i really think i'm kind of the black sheep of the family though i'm not i'm not really worth it a lot so maybe I this is why this is kind of hard because it's almost as if I'm going over and above just to make a point that I'm responsible and then sometimes I just feel like I'm not responsible to anyway I'm just talking in circles 
+T:	so sometimes how they interact with you you don't always feel what you're trying to show them 
+C:	or I don't always know that what I'm yeah I don't know what they're thinking about me so I tend to make things up 
+T:	yeah and because of what you're thinking you sometimes then really try to act responsible and hope that they will be able to see what you're trying to show 
+C:	ya want them to accept me more because I just felt I haven't been all that accepted 
+T:	and you keep trying 
+C:	I do I do yep 
+T:	yeah so this is do these really fit together for you so tell me about the others that you pay
+C:	so i picked cleanliness it's real important to me because like i said before i am i pretty much in my chair watching TV a lot of the time or on the internet or something however it's i don't want to sit in my house all day and have it be a stinking mess with garbage all over the place so I'm a little bit sort of OCD about that you might say I have to have make sure every surface is clean all the time and I vacuumed once a day even though it really hurts on my ankle I get up on a vacuum I have a cat so I make sure the cat box is scooped and if anyone comes over my place is always it's immaculate and I take a lot of pride in that 
+T:	yeah so it gives you pride to be able to show something you are able to do even it's even if it's sometimes difficult '
+C:	mm-hmm sometimes I wonder if I go overboard but you know that's okay it's my house right I can do what I want and you feel good about it 
+T:	you said I do you feel pride mm-hmm I do you know you dirty a dish you clean it and put it away that's that's what you do and if it's difficult and others notice 
+C:	mmhmm yeah I've had family come over every so often and they're like wow this place is amazing it's spotless so yeah I feel good about that 
+T:	so you mentioned that somehow that also connects with family it's not only for yourself it's also sometimes for others possibly being able to show them that you're responsible in your own dwelling in what you're able 
+C:	i am and even though i only get twelve hundred dollars a month or  or something in social security my rent is about  you know I barely can make ends meet I have to sell things all the time I have a clean house I'm proud of and I do what I say if I tell family I'll do it and I want the best for my son who has had lots of rough times so may I never thought about like that before 
+T:	your boy true changes us when you start talking about the right that you have and what you're able to do with what you feel like might not be a lot 
+C:	yeah I was kind of defiant you know some people wouldn't be able to get by as well as I've been able to I think so and then I had that humor because I think I'm really funny and creative and it's important that's really important to me to keep that perspective and to keep that kind of at the forefront or else i could just sink into a deep dark hole that side of you oh 
+T:	so in thinking about family responsibilities and cleanliness there's that sense of pride of something bigger than yourself and you're really working hard here and yet you've got this this hammer that sort of fits in there with all of that no tell me more about how you see humor fitting in in your life with all of these things that seem to be so almost serious mmm really focused well and understand 
+C:	i'm thinking about work along all this time too so because of my creativity and my family tells me i created more that i say i'm creative but my family tells me i'm creative and i we play games okay so i don't know if
+T:	you've seen this game but it's some draw it's like words of friends but you draw pictures and you have the other person 
+C:	i guess what it is it's not easy to draw a picture on an iPad because of the the stylus makes such big lines but boy I can draw some really cool pictures on there and my family takes screenshots and they keep them because they're so cool and then later they'll they'll show them to me and I'll be like wow I really did that so the humor is that they're kind of funny some of them like one of Elvis it was really funny and I just felt like the family you know gave me special record gives me special recognition sometimes they really noticed they notice that have this special ability
+T:	mm-hmm and it touches them in a way that you want to touch them 
+C:	hmm I'm not sure what I could do with that but you know and same with humor just ice I kind of see things from my ionic perspective the and I can't even give you an example right now but I just I just think of really funny things when they pop out of my mouth and and I give I get positive recognition from my family that way 
+T:	so you really have a connection with your family through the actions that you take in your life to show them that you're a responsible person and these relationships with her family are really central to your life right now they are the people that you interact most with and you have pride in yourself so that respect of yourself and being able to show your family what you're really able to do in your life how you're able to keep things clean and presentable and have that sense of pride and yet it seems that your humor and creativity is something that really is almost a more powerful thing in being able to show who you are and getting special recognition for in your life who you are as a person and maybe a part of you that you have yet to fully discover or to show the world who you can be what do you think of all that feels pretty good
+C:	I'm a little embarrassed 
+T:	yeah hmm so haven't really thought of yourself in that way
+C:	I'm usually more negative about myself huh I've got more going for me than I thought this is the best of
+T:	William mm-hmm han couldn't couldn't keep it here this this is important to you this humor the humor yeah keeps me going that creativity yeah keeps me going it's almost like that that light ahead that hope that you were talking about 
+C:	oh yeah yeah 
+T:	I don't think some people realize how important humor and their life is and it's very very important to me clearly as you see the path ahead and thinking about work and I know you mentioned that when you were considering your values you were thinking about work at that time 
+C:	mm-hmm
+T:	how if at all do you see possibly utilizing these core values family responsibilities cleanliness and humor in thinking about what your life could be like with work it work?
+C:	huh well right off the bat I thought of crime analyst because most work environments you know they want you to keep your workspace clean I have to tell you I had a job a long time ago and I was driving around and I would spit sunflower seeds out and just made a mess on my truck and my boss didn't like that I was young I didn't know what the big deal was but now that I'm older it's like 
+T:	okay that's a really important a site to bring through the workplaces having a clean workspace or being like remembering that cleanliness is important in the workplace being a good work partner 
+C:	yeah right because other people don't want to be tripping on on my clutter and 
+T:	of course responsibility because if your employee there's always that expectation that you'll do what is asked of you or that you'll do what you say you'll do and you know you can do that right 
+C:	yeah I think I can and I'm not exactly sure about family but humor when I think of humor and working I think of getting along with coworkers and you know that's that's an important aspect to work to is being able to get along with others and I can do that most of time sometimes I'm not so great at it my humor can be a little bit biting so I might need to watch that sometimes 
+T:	yeah so you really think about others and how they interact with you 
+C:	mm-hmm 
+T:	and who you are as a person that's those are all important things for you 
+C:	it's important for me to know or to have them think highly of me
+T:	well thank you very much William for taking the time and really thinking about your core values and you mentioned this it was difficult to pick um and you shared a lot about about who you are and and sometimes it may be a little uncomfortable and thinking about those those things that are really most precious to us and I just really wanted to thank you for that opportunity to really get to know you about her and I hope that I hope it was useful for you and that we can use it together in our work figuring out what the path ahead might look like he'll work in your life how can I remember these what do you think when you when there are things that you want to remember in your life how does it work for you how do you typically remember things I think I need to write it down so i'll write it on a piece of paper 
+C:	sure 
+T:	keep it with me 
+C:	yeah
+T:	yeah something that you can maybe take no doubt 
+C:	mm-hmm 
+T:	how do you think you might use it?
+C:	well that's a good question Oh ideally when I'm in a situation where I think I'm not getting along well or if I think things aren't going so great just in general or I'm really thinking negative about self is when I could pull it out and look at it and get a reminder so that's something I'll have to keep in mind i'm not sure how much i'll do it but i'll at least it's there and it's a start 
+T:	it's interesting to consider who it might be something as a reminder to yourself about what a really responsible person and that humor is also important to you
+C:	yeah 
+T:	those things that are most important the guiding principles in your life 
+C:	yeah yeah