Ruth arrived at my office early for her appointment. Her appearance was impeccable. She looked like she belonged on the cover of Vogue Magazine with her high fashion appearance. As I started my intake questions it became very clear that Ruth had an organized and clear mind and could recall most of her childhood. Nothing seemed out of place. Further questions revealed the incidents of panic within the past month. All of the incidents did not seem to have anything in common at first but as we probed longer a pattern emerged. The first attack happened while at church with her fiancé, Jack. Shortly thereafter another attack happened while standing in line in her local bank. The other attacks were similar in nature. Shortness of breathe, feelings of unreality, numbness, and dizziness followed by feelings of fatigue.

Ruth was angry and puzzled at the same time because she found herself at the most exciting time of her life and the anxiety was starting to make her avoid school, studies and Jack. She was finishing her undergraduate work and was to marry Jack in June of the next year. Everything seemed to be perfect in her life-all her goals were being attained and she was looking forward to the future with Jack. The one feeling that kept emerging for Ruth was a feeling of death and loss after each attack.

Over the next few months I gave Ruth projective techniques to help us undercover the "why" behind the attacks. One technique included a genogram of family members going back several generations. When asking about her siblings, Ruth did not remember she had a sister who died. Gently probing I was able to discover that Ruth's mother had a stillbirth when Ruth was 10 years old. This information took several weeks to surface.

Ruth cried uncontrollably when she remembered and spoke of the incident. Her affect told me there was something significant in her pain. The same feeling of death and loss that accompanied the attacks was present in the office. There was our key.

When Ruth was 10 years old she was at church with her family. Her mother fainted and was taken to the hospital immediately. Ruth and her siblings were taken home to wait for the news of her mother's well being. Ruth remembered her father coming home and saying, "It's between saving the baby or Charlotte's life". Ruth went into her bedroom and prayed that God would take the baby's life because she needed her mommy and who needs a crummy ol' baby anyway".

What actually took place was different from Ruth's historical memory but the baby was stillborn and Ruth decided she was responsible for killing the baby with her prayer.

Ruth suppressed this piece of knowledge because of the overwhelming consequences it had. She was never to reveal that piece of information to anyone. Because of this hidden piece of fantasy history, Ruth made adult decisions based on her childhood trauma.

Ruth married a man who could not have children. She had dated men who were married or clearly did not match up to her ideal as a mate. Not until after her divorce and pending engagement to Jack did the information begin to surface that Ruth was a baby killer.

The morning in church of her first attack with Jack, Ruth listened to the minister mention all the pregnant women in the congregation. This was the first attack. It dislodged the memory of Ruth's mother fainting at church. Ruth was standing behind an infant on her mother's hip in the line at the bank when the second attack happened. The infant brought up more memory about the stillbirth. Each attack had a baby present and each attack was followed by the tremendous feelings of death and loss.

Ruth unlocked her memory that plagued her for the past twenty-two years. For the first time in her life she was faced with having her own baby with Jack and if she was a baby killer, as she determined at ten years old with her prayer to get rid of her mother's baby, she was panicky about what she would do with her own child.

We did more work to connect the past feelings with cognitive realities of the present. Ruth mourned the loss of her baby sister and forgave herself. The work was painful but rewarding. Ruth and Jack have three healthy children today and I am happy to say Ruth's symptoms never came back because she was able to uncover the why and connect the why with the anxiety.

Anxiety served Ruth well when she thought of herself as a baby killer because it kept her from having a baby, but to have the fulfilled life she deserved uncovering the why was the key to actualize her dreams with Jack.

There is a why behind every anxiety I have treated in my office and with each probe the symptoms fade away. The behavior modification techniques of Lucinda's tapes are extremely valuable when under covering the why. It keeps one feeling safe and in control just like Ruth.

Marsha Marcoe, MFT has a private practice is in Santa Barbara, California. She works individually with patients with anxiety and panic disorder. 805-692-5078.