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All following cases have been disguised to protect patients' confidentiality.
Dr. C. was a 73-year-old divorced woman of German-Jewish upbringing, with a long history of depression and anxiety, who was referred for psychodynamic psychotherapy by her medication psychiatrist to understand her newly heightened anxiety related to feeling “detached from the world.”
Dr. C. initially sought psychiatric medication management when she started experiencing this kind of unsettling anxiety after she moved back to New York City where she had grown up. She stated that although she had struggled with depressive and anxious symptoms her “whole life,” she had never experienced the kind of anxiety where she felt “detached.” Her medication psychiatrist managed her antidepressant medication (escitalopram) and had contact with her medical doctors, but this psychiatrist felt that her feelings could not be addressed by medication alone, so he referred her to Dr. B. for psychodynamic psychotherapy. Dr. B. agreed with this referral in that she thought that Dr. C. would benefit from talking about her narrative in a more concentrated way rather than just be in medication therapy where the meetings would be less frequent. Also, as Dr. C. appeared to