Case Study Patient: Tina Presenting Complaint Forty-two-year old Tina was waiting for her first appointment with a psychotherapist. She could not believe she was here. If her friends, her daughters, or, heaven forbid, her mother, knew she was here she would never live it down. But Tina was desperate. After weeks of suffering from shortness of breath, dizziness, and “the shakes,” as she called the trembling in her hands, she had gone to see her family physician. She was sure she had heart problems or high blood pressure. A thorough examination and lab workup revealed that she was fine, physically. She was overweight, though, and the doctor told her she needed to quit smoking. Tina smoked two packs a day, as she had since she was in her 20s. She had also taken to drinking to “calm her nerves,” but she did not tell the doctor about that. She really did not like the taste of liquor, but it was the only thing that calmed her down enough to sleep. She felt as if her body was tied up in knots all the time—especially at night. A friend suggested a massage to help relieve her muscle tension, but massages were expensive. And a nightcap was cheap and helped her to sleep. And Tina needed sleep. Since Harry, her husband of 24 years died, the days had been miserable. She had a sense that something else bad was about to happen. Maybe her 14-year-old twin daughters would be abducted on the way to the bus stop. Maybe the bus would be in a horrible crash and they would be killed. Added to her constant worry was irritability born of dealing with teenagers. She used to be able to put up with the twins playing music too loud, talking on the phone too long, and squabbling among themselves. Now the least thing set her off. With taking care of them, worrying about what was going to happen, and getting no sleep at night, it was no wonder that Tina complained of being tired all the time. Tina’s friends told her that she needed something to do. They urged her to take any kind of job to get her out of the house while the girls were in school. “Get out of the house?” she would say. She did not tell them that she had gotten to where she hated to drive. Why, one day just last week she pulled over when she found herself gasping for air. When she stopped, she felt her heart pounding. Her palms were so sweaty she was losing her grip on the steering wheel. She thought she was dying of a heart attack. That frightening episode sent Tina to the doctor. She was so nervous driving to the therapist’s office that she thought she would have to turn around and go home. Traffic was tied up at the bridge. She dreaded crossing bridges to start with (and there were a lot of bridges in the coastal Florida community where Tina lived). Lately she wondered how safe those bridges were, and if they might not collapse just as she reached the top. A part of her was able to see that her fear was ridiculous. After all, she had lived here all of her life and a bridge had never collapsed. But maybe that’s why it will collapse with her on it, she worried. Maybe it’s about time for them all to crumble and fall into the river. The bad part was that there was nothing that Tina could do to avoid bridges. Not in this town. You had to cross a bridge of some sort to get most anyplace. The normal tension that Tina felt got worse every time she crossed one of the larger bridges. She felt a sense of panic as she approached these dreaded structures. When she asked her family physician for something to help her sleep, he said he would consider it, but not until she went to a psychologist. If a therapist thought medication was advisable, Tina could get a referral back to him or on to a psychiatrist. The doctor believed Tina might be suffering from an anxiety disorder and, if so, several medications could be considered.
