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behavior became clear in subsequent processing. She recognized that because her father
was the accompanying person, this put her in the role of managing him and his time (espe-
cially since he retired). This sense of control reinforced her pathology. Besides this, her per-
ception of having her parents available to do her driving made her feel somewhat special
because in those circumstances, they were dedicated to her. This aspect was addressed with
her and at the end she realized that she was special to her parents unconditionally and that
she did not need to have anxiety or panic attacks to feel it.
The next EMDR target was the last significant panic attack (October, 2003). The image
related to this panic attack was Adriana once again sitting in her idle car, screaming for her
fiancé. She felt agitated (SUD = 8/9), characterized by heaving breathing and tremors in
her legs. Her negative cognition was “I am in danger” and she wanted to believe “I am safe”
(VOC = 2). After processing this memory, the level of disturbance the client reported when
recalling it was zero and the words “I am safe” were felt to be completely true (VOC = 7).
The following week, Adriana reported driving alone to her fiancé’s for the first time. She
accomplished this twice (Tuesday and Thursday) and was able to manage feelings of anx-
iety. She reported that the anxiety she was still experiencing could be associated to the car
accident her father had when she was a child and to the fact that he subsequently stopped
driving for a long time and delegated that task to her mother. Adriana realized that she had
learned and followed the same model. This target was then processed.
Reprocessing the memory of her father in the passenger seat while her mother drove also
led to some important realizations. Adriana eventually understood that she and her father
bonded to each other because of the panic attacks; it gave him a role and improved their
relationship. Although her father had historically been rigid and irritable, he became a
source of support to Adriana once she began suffering from this anxiety disorder. During
the course of the session, it was revealed that during his bursts of anger, her father used to
threaten to throw her out of the house, causing Adriana to feel terrified of being rejected
and excluded. She became convinced that she had postponed her wedding (officially this
was because of the panic disorder) to avoid leaving her parents’ house where she was able
to receive constant reassurance that she was accepted. By accompanying Adriana, her
father was conveying the message that “he is there” and that “he cares for her.”
The panic disorder and the anxiety had allowed her to remain at home and to establish a
privileged relationship with her father (this alliance and closeness did not exist before
because he was physically distant). It is clear that this was a secondary gain of her anxiety
disorder. The session ended with Adriana acknowledging the positive cognition “now I am
free.” Given the positive role modeling of her father (in that he was able to overcome the
accident and his fear of driving), she concluded that she could be close to her father in other
ways and that she did not need to be ill to have a good relationship with him. Her realiza-
tion and analysis of the secondary gains and the impact on the father-daughter relationship
occurred spontaneously during the EMDR session.
The following week, Adriana reported driving her fiancé’s car (bigger than hers and
unfamiliar) to take him home from his office without anxiety. EMDR was then used to rein-
force the memory of the drive and some neutral and positive feelings associated with the
event. As she reviewed the drive, Adriana noted that she was comfortable and that she had
not suffered from anticipatory anxiety during the few weeks preceding the event. After using
eye movements to process this journey, Adriana reported feeling relaxed and convinced that
56 Clinical Case Studies