Dr. Jenny’s Presentation at SPA Convention 2024, San Diego CA on “Repairing Abuse: Reclaiming the Lost Self”

The AAP is a powerful tool for uncovering traumatic memories and attachment dysregulation.  Very often, Traumatic material is revealed in the attachment narratives of patients who are telling stories in the context of an activated attachment system.  However, this traumatic content is often excluded from awareness by powerful deactivating defenses.  We often see the trauma markers in patient stories, but more often than not, this material is inaccessible to the patient, whose defensive operations have effectively concealed this material in the service of continued functioning.  When looking at a coded story containing the telltale bold red trauma markers, patients will often tell me “I don’t know where that is coming from, my life was pretty good.”

And this makes perfect sense since the defenses are in place to prevent flooding and dysregulation.  As Bowlby put it, regarding defensive exclusion in 1980, “what is pathological is not so much the defensive processes themselves as their scope, intensity, and tendency to persist” (p.35).  And as George & West (2012) state “the process of defensive exclusion is the persistent exclusion of some particular data that should be attended to as signal, but instead is treated as noise” (P.79).  Material then, that is overwhelming or flooding, is managed through defensive exclusion so that the individual is not flooded by traumatic emotion and prevented from functioning effectively.  Painful experience is split-off and contained in the background noise where it does not intrude on day-to-day functioning and allows for the preservation of a functional, though false, internal working model.

In my experience, the therapist can begin to see glimmers of these deactivated states in the confused and diffuse presenting problems of these patients.  “I just don’t feel complete.”  “I feel like something is missing.”  Or, as in the present case “I have these emotions that come out of nowhere.”

This material will first, be of central importance to the patient’s difficulties in living and, second, probably represent level three material that is situated well outside the patient’s conscious representation of him or herself.  The dilemma for the assessor then, is how to make this material accessible, to bring it into the room, in a way that is not re-traumatizing.

In this paper, I will illustrate how I used the Early Memories Procedure (EMP) to help a 61-year-old, male patient experience his attachment traumas more directly and begin to reorganize his models of self and relationships.  While reporting that his early life was “not really that bad,” using his AAP stories and elaboration of a memory on the EMP brought the therapy to a deeper understanding of a significant traumatic abandonment and allowed us to begin processing affect around this event that had been split off.

In my work with trauma, I use the AAP extensively.  Most of the protocols I score fall into the unresolved classification and generally have a lot of trauma markers.  This makes sense given that trauma has often been split off and deactivated as a coping strategy, yet still exerts its influence.

Although the protocols are unresolved, it is useful to consider the defenses that are present and to examine what secondary classification might emerge.  Foe example, one patient might be unresolved but have very little evidence of deactivation.  One might consider whether, given a bit more deactivation, they might have remained organized and land in the dismissing classification.  Alternatively, they may be unresolved but exhibit a broad use of deactivation.  These patients may need help bringing their anger and hurt out of a deactivated state and begin the process of mourning.

The patient I will discuss today, who we will call Brad, is a 61-year-old, White, married, professional male.  He works in computer coding in the finance sector.  He has been diagnosed with adult ADHD and takes a stimulant medication which he has found helpful.  Brad reported that his home life growing up was “mostly nasty and confrontational.”  He reports that his biological father was a drinker, but he remembers him fondly and although they had a significant rupture discussed later, he still has a positive relationship with him. He describes his mother as “self-righteous” and states that “nobody likes my mother.”  His biological father and mother divorced when he was young and his mother remarried, this time to a police officer who Brad describes as “crazy.”   He reported that his stepfather “screamed” at everything including Brad.  He describes the household at that time as being “like World War III.”  Brad moved out by age 18, earned a college degree and has been successful as a computer programmer for a large bank.  He has no siblings.

On his intake form in answer to the question “why are you seeking help now?” Brad stated, “When stressed (I) tend to “bite”. (This) affects relationships. Happens noticeably every few years. Most happen on a level where I don’t notice but others do and don’t mention.”  When asked to elaborate he added: “(I) Reach this point every few years – days around stress a point. I usually see the buildup but can’t remove myself from situation in time. When stressed I do not think clearly – I tend to take things personally. (I) learned (this) from (my) upbringing. (I) was brought up in (a) very confrontational home where controlling and manipulative behavior was common. (My) stepfather (was) enraged on (a) near daily basis. He jumped/jumps to worst conclusion consistently.”  He also added that he, Brad, is “rational 99.999% of the time.”

Brad’s writing belies the fragmentation of his memories around these events.  I had to edit heavily for clarity and placed missing pronouns in parenthesis to make the description more coherent.  He seems aware of the conflicts but struggles to articulate them.

On the AAP we write “attachment plots” that distill the attachment information into a headline to better understand the attachment themes in the stories we code.  We could almost write an attachment plot for this presenting problem.  Something like:  “I am confused by my strong emotions and have nowhere to attach them, when I am overwhelmed, I lash out and then feel shame about it.  My attachment figures were frightening growing up and I learned to “stay rational” and avoid scary emotion.”

Brad completed the MMPI-2-RF and produced an invalid, “naysaying” protocol (TRIN 80F).  One way of thinking about nay-saying protocols is that they represent an attempt to deny the presence of symptoms or distress.  They are the opposite to the high F “crying out for help” profile and might be described as the “nothing to see here” protocols.

This is the heart of the deactivating strategy.  Traumatic material, in this case the yearning for an attachment relationship that could help regulate the self, is excluded from awareness to avoid being flooded.

Bowlby asserted that healing attachment trauma involved mourning which reorganizes internal working models to represent reality more accurately.  To heal, patients need to reclaim the split-off emotions in order to mourn and reorganize their internal working models of self and others.

The AAP shows us where the trauma is and how defensive exclusion is deployed in the service of integration.  The dilemma for the therapist is how to bring this material into the room in an experience-near way without dysregulating the patient.

I have a confession to make here.  In presenting feedback to patients on the AAP, I often find myself slipping into what I call  “professor mode.”  I get wrapped up in my excitement about what the AAP can do and lost in the weeds of the data.  I realize that I have utterly lost the patient and have to re-group.  We collude in an “intellectual” understanding of the data and stay comfortably out of the emotional and experiential realm.  This is not specific to the AAP by the way.  These tools are so powerful, and the data is so compelling it is easy to get caught up in it.  But in doing so, we feed into a kind of deactivation countertransference, if you will.  We are colluding in avoiding the important stuff by staying in an intellectual space.

So how do we/I get out of this trap?  I have found that the Early Memories Procedure (EMP) can provide a bridge between the deactivated material in the AAP and memories of direct experiences and their attendant emotions.

For those of you unfamiliar with the EMP, it was developed by Arnold Bruhn as a “projective assessment of autobiographical Memory” Braun (1992).  The EMP is divided into two parts. Part I asks for five spontaneous early childhood memories and asks the respondent to rate the clarity, emotional tone, and approximate age the memory took place as well as any aspects the respondent would like to change and the clearest aspect of the memory.  The memories from part I are then rank ordered from most to least significant.  Part II is more directive, asking for memories related to school, discipline, family, sibling, mother, father, an admired figure, happiest memory, traumatic memory, parental fight, drugs and alcohol, shame, abuse, and sexuality.

Where the AAP asks respondents to create a narrative describing hypothetical storylines in response to attachment evocative images, the EMP asks the respondent to reach into his or her own lived experience.  Together, these methods can be extremely powerful.

Brad’s AAP was Unresolved with numerous trauma markers. The Bench story contained traumatic shame (“hiding from the world”) as well as themes of helplessness and being overwhelmed.  Characters in stories depicting single characters were always alone, and where there was more than one character, the relationships were functional rather than mutually supportive.  Characters in the stories had limited capacity to take meaningful action (agency) to resolve their distress.

Also noteworthy is the number of deactivation (blue)markers in this protocol.  Brad uses deactivation to “put a lid” on his distress and exclude it from conscious awareness.  There is a lot of planning and problem solving that speaks to Brad’s skills as a computer programmer.  He can reason his way through problems and apply social scripts as maps for navigating difficult emotions.

When Brad and I looked at his AAP and I commented on the trauma markers, he was surprised.  He said something like “it wasn’t that bad growing up” while at the same time acknowledging that his stepfather had been hot headed, and Brad made a point of being out of the house as much as possible to stay away from him.  Holding conflicting internal working models like this is common in trauma.  Some authors refer to this a “trauma logic” (Courtoise, personal communication) that allows seemingly contradictory ideas to coexist without conflict.

To bring the lived experience of Brad’s childhood into the room, I had him complete the EMP.  Like many clients, Brad struggled a bit with the EMP.  He never fully completed the task, but we got enough information to better understand what growing up in a chaotic household with an aggressive, dysregulated, and frightening stepfather had been like.

Brad’s first early memory gives a sense of his isolation: “I had a GI Joe named Mr. Man and also a guy in a parachute who always got tangled in his parachute cords.”  He reported that the strongest feeling associated with this memory was “just doing my own thing” and if he could change anything about the memory “there would be other kids.”  We explored this further, and I asked Brad what that child with GI Joe might have been feeling.  He began with a deactivation statement, asserting that he was able to do whatever he wanted and enjoyed the lack of supervision.  Digging a little deeper revealed a memory of playing in a construction site (unsupervised) and falling into an unfinished basement foundation and hurting his hand.  He recalled figuring out how to get out (problem solving) for which he was justifiably proud in a way.  When I asked him to think a bit more about the feelings of the little boy, he concluded that it must have been scary not to have anyone there to help him.

This led to a discussion of Brad’s additional memory, not one of the six in part I.  He reported a memory from age 7 in which he “ended the relationship with my father – though I didn’t know it.”  As written, the memory is a little hard to follow but the essentials are these.  Brad’s stepfather’s best friend murdered his wife.  This event led to significant distress in Brad’s family and between Brad’s father and stepfather.  “My father, mother, and stepfather were always screaming at each other.  (I) couldn’t take it and started crying about it and confided in (my) father who decided it was best for me to have just one father. Bad decision on his part.”

Brad rated this as his “most significant memory” and wrote “I lost my father for the next 20 years.  My stepfather was an asshole before the murder but was much worse after.  One of my best sanctuaries and father figure was my father and his family (my grandmother) and that was removed.  That memory was a milestone in how not to raise a child.”

Obviously, this event does not square with the deactivated “growing up was not really that bad” internal working model.  In therapy we return to this memory, and we have begun to understand why Brad had “meltdowns” in which he would “bite” those around him emotionally.  These episodes have decreased in frequency and intensity as Brad has been able to sit with his uncomfortable feelings rather than split them off.  He has begun to give himself permission to be angry about his past and begin mourning what he missed.

In conclusion, the AAP is a powerful tool in uncovering split off traumatic material and revealing defensive strategies aimed at maintaining integration.  When these defenses include excessive deactivation, access to emotional material can be limited by a shell of over-functioning and compulsive self-reliance.  In these situations, the EMP can serve as a tool for connecting clients to the lived experiences of their younger selves and thereby open the door to greater retrieval of lost experience.

Asking clients about what the younger versions of themselves represented in the memories might have been feeling can reconnect them with their split off affects.  Recalling actual autobiographical memories is a powerful tool for bringing split off affect states into the room.  AAP narratives point to the traumatic material, and the EMP can then connect with lived experience.  Deactivators can keep trauma at arm’s length when it is happening to a hypothetical character, but this is not so easy when the character is the self in an autobiographical memory.

 

Learn More