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Blocking Offers During Enactments to Accelerate Insight (2021)

By Traci Howland, LMFT

Sheila came to therapy with hopes to improve her responses and understanding of her wife Ella’s bipolar disorder. She and Ella have a 4-year-old son, Jason, whom Sheila birthed for the couple and is extremely close with. Sheila is highly educated and tends to over-function in her relationship with Ella, reporting hypervigilance in recognizing and responding to both her family members, anticipating their needs, real or imagined, and trying hard to avoid confrontation or conflict. While Sheila displays some anxious and depressive tendencies, she presents with overall confusion regarding, “Is it me? Or is it her bi-polar?”-

Sheila has started to notice her own resentment at how both she and Jason respond to Ella when she comes home and is in “one of her moods.” Sheila does her best to keep their child quiet and minimize conversation if she senses that Ella’s irritability may be directed towards her, or worse, toward their child. However, Sheila is still quick to defend Ella’s moods (irritability, intolerance for noise or conversation) and attributes them to her diagnosis of bipolar disorder. She notes that Ella will usually “come around” in a few days, acknowledging that she had been distant or expressing awareness of how her moods and behavior affect the family.

As a marriage and family therapist, I helped Sheila explore her family system from her childhood and better understand her current family system with her wife and son. We explored how she was replicating her position in her family of origin, with an alcoholic mother and a brother who had a history of mental illness and drug abuse. She readily identified her role in that family as the “peace maker” and “mediator,” always careful not to anger her brother whose addiction to drugs made his reactions even more volatile and unpredictable. Furthermore, she made several connections to feeling responsible for her family’s emotional outbursts and prided herself in knowing just how to navigate these difficult family of origin relationships. After educating Sheila on co-dependent patterns of thought processes and behaviors, she recognized them in herself and was noticing them more clearly by the way Jason was responding when his other mom, Ella, was present.

Sheila wanted to be able to share with Ella how both herself and Jason respond to her without offending or minimizing Ella’s mental illness. She has noticed that lately she and Jason waited for cues from Ella on whether they should attempt to proceed or not, based on verbal or nonverbal behaviors of Ella that included: expressions of annoyance often leading to arguments; Ella leaving the room; generalized complaining; or shutting off
contact by being “glued to her phone.”

In Rehearsals for Growth (RfG) parlance, one partner’s constructive bids for attention and connection are “offers” which generate validation and positive connection when accepted by the other partner. By contrast, when offers are ignored or rejected (called “blocking of offers”), the relationship suffers. RfG games are embodied enactments used to increase clients’ acceptance of offers to enhance positive feelings and promote good relationship functioning. Sheila’s descriptions matched the problems arising from Ella’s blocking of Sheila’s offers.

In searching for an in-session RfG enactment that would help Sheila to discover and rehearse non-confrontational language/expressiveness that she could later use at home to show Ella how it felt to have her offers blocked, I suggested a variation of the RfG game “Presents” for Sheila and me to play together. Sheila was open to engaging in this game of “Presents” with me and responded eagerly to learning the game.

“Presents” is typically used within a therapy session between couples or family members, but in this case Ella was not involved with the treatment process. In the traditional use of this game, the present is offered neutrally by the Giver and the Receiver is not explicitly instructed on how to react to the gift. I chose to modify the traditional neutrality of the Giver’s actions to heighten the influence of the Giver’s offer. First, I had Sheila imagine that I was going to give her a present, telling her that this present was something that she had always wanted, and I was about to give it to her. I then provided a gesture to indicate that I was happily wrapping the imaginary present to further model and indicate how excited I was to give this present to her, stating, “I know this is something that you’ve always wanted, and I can’t wait for you to open it!” Sheila mirrored my enthusiasm and mimed taking and opening the gift, exclaiming, “this is something I’ve always wanted, I love it! thank you!” Roles were reversed so that Sheila played the Giver and I was the recipient of a coveted gift.

During debriefing following these enactments (termed “Post Enactment Processing” in RfG) Sheila expressed equal pleasure in having played both the Giver and Receiver roles. I then explained how this game can be used to show how it feels to accept another’s offer for attention and how it feels by contrast to block or be blocked in both verbal and nonverbal communication. To demonstrate blocking, we next repeated the “Presents” game whereas Giver I demonstrated great excitement wrapping and giving the present. But this time, before Sheila took the present, I told her, “Okay now, you don’t want it.” Sheila pretended to open her gift and made some polite ‘thank you, but I don’t really want the gift’ gestures, saying, “No, no thank you.” Next, it was my turn to refuse the
gift. I put my hand up to completely block the imaginary gift, saying “No — I don’t want it” with flat affect. Before I could ask her what my response as Receiver was like for her, Sheila exclaimed “That’s it! This is how I feel every day when she gets home! I never know if she is going to accept it or not.” We spoke further about how Sheila was able to identify the marital dynamics through this game. Regardless of whether Ella’s frequent mood shifts might have been due to Ella’s mental illness, Sheila noticed that she was becoming increasingly resentful of the blocking and hurt she would experience. Sheila shared that she and would often feel internal conflict over her own pain at being dismissed by Ella, yet also feel guilty that she was not being more understanding.

In our next session, Sheila reported that she had shared directly with Ella what it was like for both her and their Jason when they felt uncertain of Ella’s moods and were receiving hard blocks of their bids for Ella’s attention. Sheila laughed as she described playing the game with Jason and Ella at home and the fun they had as a family giving and receiving imaginary gifts. Though Jason loved the game, neither she nor Ella could bear to deny any of his presents because, she reflected, “he was just too cute.” Sheila reported that she and Ella did not play “Presents” with one another, but the playful engagement with Ella and Jason was fun to watch and brought them together. Sheila and Ella had also, for the first time in a while, talked collaboratively about Jason, both discussing how he sometimes seemed tentative in his play and sharing with Ella her observation that he would often go to Sheila first or look only toward Sheila for behavioral guidance (when a toy made a loud noise, for example).  Sheila stated that although she wanted Ella to recognize how she felt in a more general way, Ella was able to recognize and talk about how she gets irritated when Jason asks her things while she is “trying to relax” and is on
her phone. And while all objectives had not been met to this point in therapy, Sheila stated, “It’s a good start!”