Stephen Seger’s Presentation at SPA Convention 2024, San Diego CA

Hello, my name is Stephen Seger, I’m a graduate student at Immaculata University in Pennsylvania. I would like to thank Dr. Edward Jenny and Dr. Carol George for the opportunity to participate in this presentation.
This presentation explores how the Adult Attachment Projective Picture System was utilized in a therapeutic assessment with a couple.

Male 1 and Female 1 are a Caucasian married couple who decided to move forward with a therapeutic assessment after feeling like progress had slowed in couples therapy. Female 1 and I have been working together in therapy since July of 2021 at which time she contacted the practice due to concerns she had related to anxiety, perfectionism, and questions about how to best support her young son who was displaying symptoms of ADHD. Female 1 works for a pharmaceutical company and has been married to Male 1 for 9 years. Therapy with Female 1 initially focused on her background growing up in poverty in a family with significant mental health and addiction issues in a rural midwestern town and how her early experiences of loss, chronic caregiver unavailability, and trauma resulted in a combination of compulsive self-reliance and a chronic sense that all that she had worked for in her life to gain stability and independence was going to be undone. In other words, she never felt like she was on solid ground and often felt alone.

When I inquired as to Female 1’s relationship with her husband she initially explained that her relationship wasn’t an issue. Of course, that choice of words struck me as strange, but the more she and I explored her relationship and contextualized it in her past, it became clear that to her a relationship that just didn’t create more problems was equal to marital bliss. However, as therapy progressed, Female 1 became more aware of her own needs, her excessively self-reliant tendencies, and her feelings of resentment towards her husband.
As these feelings began to be expressed, conflict in her marriage increased. Female 1 eventually approached Male 1 about participating in couples therapy. They did not participate in this process for long, it was only about two months in that they began to avoid scheduling couples sessions. When Female 1 and I discussed this, she explained that she and Male 1 felt as though the couple’s therapist was helpful in promoting the importance of things like intimacy and quality time, but that the underlying patterns that led to conflict were going unaddressed. Female 1 and I discussed options. I could support her in finding another clinician to work with her and Male 1, or we could pursue assessment work between her, Male 1, Dr. Jenny and I. After discussing the benefits and disadvantages of couples TA she talked to Male 1. Soon after, the process began to move forward.

When Dr. Jenny and I first met the couple, Male 1 seem to be exactly as Female 1 had described. He was soft spoken and polite but when asked for his thoughts, he was willing to share some skepticism about the process. After validating Male 1’s concerns and answering his questions about TA, we collaborated with the couple to develop questions. Female 1’s questions focused on why it seemed like she needed to get mad for Male 1 to change his behavior and why she tended to anticipate Male 1’s thoughts before he shared them. Male 1’s questions focused on his difficulty in identifying his feelings and learning to express them. Both Male 1 and Female 1 wanted to learn about how trust could be rebuilt in their relationship.
The first important clue towards Male 1’s attachment status was his difficulty in completing the early memories procedure due to his lack of early memories. As we moved into the assessment, a full compliment of personality measures were given to the couple, with each playing an important role in helping the couple understand the struggles in their relationship. In such an assessment context, the adult attachment projective played a critical role in the ultimate goal of the assessment: helping Male 1 and Female 1 build empathy for one another and move their relationship forward.

The AAP is such a powerful tool for therapeutic work because while other assessments can tell us what is going with our clients, the AAP is uniquely equipped to tell about the why. As Female 1’s therapist, I was coming into this with my own preconceived notions of how her testing would look. While Female 1 would always come into therapy with something she wanted to talk about, there was still a general façade of composure and strength she presented with. She would rarely appear distressed and tended to focus more on her son than herself. Even when something was clearly upsetting to her, like her father attempting to get in contact with her, she would talk about it in a laid back and easy going way. When I would reflect on this, she told me she was aware of it, but there was a lot more going on under the surface than she showed. Still, I was surprised when there were several elevations of note on her self-reports that showed me just how much distress she was really experiencing. This was mirrored on her AAP, where her stories were logical and coherent but showed signs of trauma and anxiety. It was beginning to look like I was incorrect about my initial assumptions of Female 1.
Where I had expected that Female 1 would fall back on dismissive tendencies, there was a complete lack of defensive deactivation. Five of Female 1’s seven stories had no deactivation present and although she maintained her composure throughout the assessment, her inability to deactivate resulted in difficulty developing decisive narratives. For example, the girl in window is unsure of what to do and unsure of if an unnamed person will arrive. It appears there is a connection between the arrival of someone and what will happen next. Although there are no trauma markers in the story, the aloneness and confusion of the child can be felt.

Similar themes of uncertainty around availability are present in Female 1’s departure story where a couple stands at a train station, tense but unable to connect in their finals moments together before one of them leaves. Again, Female 1 keeps her composure as there is no indication of trauma, but the sense of the unavailability of the other in her life is clear in her attachment templates.

More preoccupied defenses are observed in bed before trauma is observed in her two unresolved stories, Cemetery and Corner. Again, neither of these stories are the gruesome pictures of isolation and abuse that are often produced by unresolved clients. Female 1 maintains her composure throughout each narrative and almost gives an impression of security and stability. What is fascinating to me is the parallel between our therapy together and her AAP. Everything seems fine, and while Female 1 has come a long way given her history, there is much pain and confusion there than meets the eye.
Female 1 gives the impression that she is holding it together in such a seamless fashion that it was difficult for me to believe she would be anything besides dismissing, if not secure altogether. This ability to hide distress was developed from an early age as Female 1 was the youngest of two children in a poor family from the rural Midwest. Female 1 generally paints a picture of childhood deprivation but somehow does so in a casual way. She made it clear that there were problems with mental illness, addiction, and poverty in her home as a child, but it took her months to tell me that her father would disappear for weeks at a time when she was a child, that there would be holes in the floor and ceiling of her childhood home that were never repaired, or that the family living room doubled as her and her older brother’s bedroom with their respective areas separated by a tarp hung across the ceiling. She was eighteen when he mother died and nineteen when she began living on her own. She moved from the Midwest to the northeast in her early twenties and met her husband in their early 20s.
To say that Female 1 hid her hardship in the assessment or therapy wouldn’t be fair to her. There isn’t a sense that there is more to be said, that something isn’t being acknowledged, or that Female 1 wants to hide from her past. Instead, it feels more like there is a combination of certainty that others can’t be relied on and that her taking care of problems on her own without being able to rely on others is a simple fact of life. This is how the AAP was able to help Male 1 build empathy for Female 1. The pain and uncertainty in the AAP stories is clear, but Female 1 does such a good job of not being overwhelmed by it and lacks a template for comfort to such an extent that those around her don’t even realize how much pain she is in throughout the day. Reconnection through the AAP relied on Female 1 becoming more open to her need for support and connection. Prior to this TA, it would take Female 1 becoming totally overwhelmed before she gave any indication that she was distressed. Through exploration of Female 1’s AAP, both Male 1 and Female 1 were able to reflect on how well she seemed to be able to hold it together despite her distress. Unfortunately, being unresolved, Female 1 tended to become dysregulated at times when she could no longer contain her anxiety. This would interact with Male 1’s tendency to withdraw. Change through the AAP for Male 1 relied on learning to understand the connection between trauma, shame, and deactivation.

As Female 1’s therapist, I learned more about Male 1 and his background through Female 1 than I did in the assessment role with Male 1. Not only did Female 1’s relationship with Male 1 lead to more detailed discussions of his history but Male 1’s lack of memories about his own childhood, including his inability to complete the early memories procedure made it difficult to collect a detailed history. While Female 1’s background was more outwardly unstable and traumatic, it can be argued that Male 1’s attachment figures actively harmed him more than Female 1’s did. Male 1’s stories are more disorganized than Female 1’s and include some bizarre details where character’s problems are miraculously resolved. Male 1’s window story starts with an indication of dissociation and trauma wrapped up in a humorous remark “Margaret is a 23 year old caught in the body of a six year old.” This speaks not only to Male 1’s trauma and attempt to avoid painful emotions, but in his rigidity. Male 1’s decision to keep with the narrative of the girl in window being an adult even after acknowledging this statement as an initial attempt at humor speaks to his discomfort and confusion around attachment situations. Male 1 uses a distant and detached approach to the AAP initially, describing the pair in Departure as having “made the decision to become romantically involved.” As Male 1’s AAP progresses deactivation using social roles and achievement seems to work. Many of his stories rely on these scripted patterns of behavior from start to finish but even in stories that lack indications of trauma, there is no connection between characters and no capacity for action. In fact, there is actually no agency throughout his entire AAP, and although Male 1 describes a grandparent as providing comfort in ambulance he also acknowledges that the child feels guilty and provides no indication of actual attunement despite his use of secure language.

Ultimately, Male 1’s AAP resulted in unresolved status with deactivating defenses. The lack of capacity to act shown in Male 1’s alone stories surprised Male 1 during our assessment intervention sessions which focused on the dynamic of Female 1 needing to become angry for Male 1 to react to her feelings. Male 1 viewed himself as an action oriented and solution focused person but the lack of CTA in Male 1’s AAP stories spoke to his difficulty with taking action to respond to attachment distress in himself and in those in his family. This resonated with Male 1’s lived experience as a child where he recalled feeling like changes in his life would happen whether he wanted them to or not and needing to accept the emotional unavailability of his caregivers. The solution to this problem, as indicated by Male 1’s AAP and other testing was to withdraw, and a similar pattern could be observed in Male 1’s approach to his relationship with Female 1. Whenever there was some attachment demand or feeling that needed to be expressed, Male 1 tended to withdraw emotionally and physically. This was clear in his bench story, where the the girl on the bench is in a state of “despair”, feeling that “her life is over” when she is informed by her parents that she is moving. Although Male 1 glosses over the distress by stating that she will “snap back from it” how the character copes with the problem and what happens next is unclear. While this is the story the led to Male 1’s unresolved status, it helped Female 1 build empathy for Male 1, as both she and Male 1 were able to connect the dynamic in the story to Male 1’s family history as well as Female 1’s experiences in dealing with her mother in law. When something bad happened in Male 1’s life growing up, he just had to move on. Dr. Jenny and I explained that unfortunately, all people and especially children are not equipped to simply move on when something bad happens. In Male 1’s childhood, attempts at making his feelings known would result in judgement and rejection from his mother which would in-turn cause his father to withdraw, resulting in shame and guilt. Over time, Male 1 developed a façade of deactivation but never learned how to take action in the face of unavoidable attachment distress. This resulted in a tendency for Male 1 to avoid distress at all costs, even if that meant withdrawing from his partner.

Sitting together and discussing Male 1’s AAP results was a huge the step in the process of rebuilding connection. While reflecting on other test results and the TA process helped the couple to understand one another, the AAP was uniquely able to provide context to the couple’s relational dynamics and leave each of them feeling seen and understood. For Male 1, this meant understanding how detachment and withdrawal was a solution to the problem of having no outlet to be heard or understood. In the face of unavailable caregivers, he did his best to turn off his attachment needs. Unfortunately, the intensity of shame and rejection in Male 1’s childhood led more to total withdraw than to deactivation and action. Of course, given his unresolved status, this strategy tended to be fragile and leave him vulnerable to overwhelming distress. An assessment intervention focused on using the bench story to help Male 1 begin to recognize both a lack of caregiver attunement and sensitivity. By focusing on the girl’s attempt to just get over what is happening to her without being grounded in defensive deactivation or capacity to act, connections were made between Male 1’s tendency to withdraw in the face of attachment distress instead of seeking connection or taking action. This intervention enabled Male 1 and Female 1 to being to develop a common language from which to understand and call out Male 1’s patterns of withdraw in a non-shaming manner. Prior to this process, Male 1 understood his tendency to withdraw as being connected with “emotional overwhelm” while Female 1 experienced it as rejection and abandonment. Through developing a common language around this withdraw as being about Male 1’s unresolved attachment status and noting how it only seemed to appear during relational conflict, Male 1 and Female 1 felt more empowered to view this state with openness and curiosity instead of judgment and contempt. This also enabled Female 1 to understand her emotional responses as demonstrated in her AAP and in her relationship with Male 1 as, in fact, connected to her early attachment trauma.

Not only did Male 1’s AAP provide insight into his pattern of withdraw as being connected to his early attachment isolation, it helped Female 1 understand her reactions to that withdraw. Although Female 1’s AAP responses came across as coherent and organized, signs of attachment trauma snuck in. Through my experience in individual therapy with Female 1, we were able to make connections to the disappearance and loss of attachment figures to Male 1’s withdraw and her reaction to it. In the TA process, Male 1’s AAP became a medium for the couple to talk about not only Male 1’s tendency to withdraw but also Female 1’s feelings of isolation and pain when Male 1 did so. The AAP’s use as an empathy magnifier for all involved created a context for this conversation that enabled Male 1 to sit with the discomfort created when Female 1 would finally express her feelings while sitting with and observing his desire to withdraw instead of simply doing it.

This led to a discussion of Female 1’s primary concern going into the assessment, the sense that she had that she needed to get mad for something to change. Through each of their AAPs, the couple was able to identify how lack of consistent caregiver availability for Female 1 and active rejection for Male 1 led to a pattern where Female 1 would express a feeling and Male 1 would withdraw due to shame and anxiety, resulting in anger and frustration from Female 1. Predictably, this resulted in more withdraw and isolation, which would only further erode the couple’s communication and connection.

Male 1 and Female 1 had briefly tried couples therapy but found that is did not get to the root of their problems. The therapeutic assessment process appealed to them because it was short-term, deliberate, and enabled them to ask questions about both themselves as individuals and as a couple. Most importantly, it brought their problems in living into the room in an experiential and collaborative manner. While the Wartegg and MCMI were both useful in understanding Male 1 and Female 1’s personality dynamics, the AAP was uniquely situated to bring the couple’s relational processes into the room. The AAP was a primary focus of the letter written to the couple following the assessment and it is often referenced in ongoing individual therapy between Female 1 and I. Since completing this assessment, Female 1 reports that the couple’s communication and connection has improved and that Male 1 withdraws from discussion much less often, resulting in her feeling more heard and understood. She notes that she is more open to asking for and expecting support from her partner. She also tells me that Male 1 has become more supportive and patient with her when it comes to communication with both her and their son. She also says that Male 1 is expecting patience from her while he works to identify and communicate his feelings. Perhaps most meaningfully, she has noticed changes in how both she and Male 1 connect with, comfort, and love their son. The AAP used within the context of this couples TA was a powerful tool in helping a couple reconnect by building empathy for themselves and one another.

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