Session Abstract: This case discussion will present a collaborative, multi-method assessment of John, a 19-year-old male who presented with significant disturbances in attention and executive functioning. Prior to this assessment, John had been diagnosed through clinical interview with Attention Deficit/Hyperactivity Disorder. His response to stimulant medications was marginal, and both his academic performance in college and his interpersonal functioning with family members deteriorated. John and his parents elected to participate in a collaborative assessment, with hopes of answering their questions about his diagnosis and current struggles.
The first presentation, by John’s treating psychologist, will follow John and his parents through the beginning of the assessment process, including their specific Assessment Questions. The presenter will outline his early conceptualization of the case, and how he selected tests to better understand John. Data from the Rorschach Performance Assessment System (R-PAS), Minnesota Multiphasic Personality Inventory – 2 (MMPI-2), and the Difficulties in Emotional Regulation Scale (DERS) will be briefly reviewed. The next three presenters will analyze and interpret John’s testing data from three key tests in this assessment: Crisi Wartegg System (CWS) for the Wartegg Drawing Completion Test, The Thurston Cradock Test of Shame (TCTS), and the Adult Attachment Projective (AAP). As the data from this assessment are presented, a more nuanced picture of John’s difficulty with emotional regulation, and its impact on his executive functioning will emerge. Testing data will highlight John’s tendency to devote significant ideational and cognitive effort toward understanding and containing the very emotions that confused him and were difficult for him to express. John’s efforts to use cognitive means to manage emotions resulted in him “running down rabbit holes,” a process that led to loose, disorganized thinking. This led to an increase in frustration for John, and his family was confused and unsure how to help. The final presentation will highlight how the treating psychologist used Extended Inquiry and Assessment Intervention techniques to help John and his family understand the emotion regulation dynamics within him, and begin to process the emotions that he found so frightening. An update on John’s progress since the evaluation will also be provided.
Chair Information: Julie Cradock O'Leary, PhD |Private Practice- Anchorage
Presentation 1 Title: The slippery slopes of affect regulation and containment
Presentation 1 Abstract: The treating psychologist will present a Collaborative Assessment case of John, a 19 year old college student experiencing significant attentional and executive functional difficulties, academic problems, and family conflict. The first phase of the assessment process will be detailed, including information gathered about John’s history as well as the concerns presented by John and his parents. The Assessment Questions, which fuel the case conceptualization and guide the process of selecting tests, will be presented for John, his mother and father. His mother’s questions focused on how he could be more engaged and successful, and she questioned his ADHD diagnosis. His father wondered specifically about the presence of an executive functioning problem and if time management could help his son. John’s questions ran deeper, as he wondered about the source and timing of his difficulties, if his difficulties were temporary or indicative of something bigger, how his social and parental relationships might be connected, and how he could better understand and work on his relationships with his mother and father. Collectively, the family was asking important questions. The presenter will address how and why he selected the tests he gave to John. The findings of the Rorschach Performance Assessment System (R-PAS), Minnesota Multiphasic Personality Inventory – 2 (MMPI-2), and the Difficulties in Emotional Regulation Scale (DERS) will be reviewed.
Edward B. Jenny, PsyD | Private practice
Presentation 2 Title: “A pyramid with energy or power coming out of the top:” Using the Crisi Wartegg System to identify intellectual defenses
Presentation 2 Abstract: The Crisi Wartegg System (CWS) for the Wartegg Drawing Completion Test is performance-based personality measure that provides information about client’s cognitive, emotional, and interpersonal functioning, including attachment functioning and coping resources. One of the advantages of the CWS is its ability to identify cognitive and intellectualized defenses, through formal scoring, process-based responses to the test on the part of the client, and metaphorical content. These factors create opportunity for new understanding of client’s stories. This presentation will focus on John’s Wartegg protocol, highlighting certain drawings, and explore how the CWS shed light on his intellectual defenses, affect-management and coping style.
Jacob A. Palm, PhD | Southern California Center for Collaborative Assessment, Long Beach, CA and North American Representative, Istituto Italiano Wartegg- Italy
Presentation 3 Title: “I think it slowly builds on your skin and you can’t get out of your head that you failed at something”: Scrambling to engage defenses against shame
Presentation 3 Abstract: John’s Thurston Cradock Test of Shame (TCTS) protocol will be reviewed in detail, focusing specifically on how his stories contained frequent indirect expressions of shame, and extensive efforts to engage in scorable shame defenses (deflation, aggression, inflation/contempt) and attempts at intellectualization to protect himself from emotion. John’s high number of maladaptive resolutions, the lack of competent and helpful figures in his stories, and repeated expressions of being doomed to fail represent John’s sense of hopelessness about managing his emotion, particularly a deeply painful emotion like shame. His slips into bizarre or violent content, and his tendency to frequently repeat phrases will be explored as they appeared to provide a closer look into his efforts to engage in distancing from affect.
Julie Cradock O'Leary, PhD |Private Practice- Anchorage
Presentation 4 Title: “Rolling in the deep”: The attachment trauma abyss
Presentation 4 Abstract: This presentation will show how the Adult Attachment Projective (AAP) offers us a window into John’s relational world and the profound effects that attachment trauma – the failure of his attachment figures to protect him and help him regulate his emotions – has had on his life. By looking at the specific language John uses to tell his stories, we will be able to “see” the depth of his despair characterized by fear, shame, isolation, and helplessness – the hallmarks of attachment trauma. The link between John’s difficulties with attention and executive functioning and his level of emotional distress will be clarified. An ADHD diagnosis did not fully capture John’s struggles.
Melissa Lehmann, PhD | Center for Therapeutic Assessment
Presentation 5 Title: Bringing affect into the room while staying out of “rabbit holes”
Presentation 5 Abstract: The treating psychologist will review how this collaborative, multimodal approach to testing – as illustrated in the presentations to date - informed his understanding of John’s struggles and dilemma of change. The concepts of Extended Inquiry and Assessment Intervention Session will be briefly reviewed, and the psychologist’s use of the testing materials to help John and his family will be highlighted. Specifically, card VIII of the Rorschach was used to help John inhibit the desire to excessively elaborate, a Rosenzweig Picture Frustration task was created to help bring John’s anger into the room, box 3 of the Wartegg was used to explore the intensity of his ideational rabbit holes, the AAP bed story was used to help John understand his experience of being misunderstood by his attachment figures, and TCTS card 8 was used to help John better understand how he manages and avoids painful emotion. Finally, an update on John’s progress since the assessment will be provided.
Edward B. Jenny, PsyD | Private practice