Tug-o-War for Resolving Morning Conflicts (2011)

by Jami Osborne, MA, CAGS, RDT, LMHC, Rehearsals for Growth Certified Therapist

BACKGROUND AND DIAGNOSIS INFORMATION

Robbie is an 11-year-old Caucasian male, living with his single mom, Angie (age 34), and his maternal grandmother Donna (age 54). In the upstairs apartment of their two-family home, Robbie’s cousin and best friend Kyle and his mom, Angie’s sister, live with Kyle’s dad and two little sisters.

Robbie had 3 episodes of infantile fevers over 105 degrees during the first 6 months of his life, all requiring hospitalizations of over a week at a time. Robbie’s dad has a history of substance abuse, and exhibits many symptoms of bi polar disorder, with psychotic features. Dad is not currently in treatment for any of his presenting problems. Grandma Donna suffers from chronic major depression symptoms, and presents much older than her 54 years. Angie is the sole financial support for the family, as well as providing emotional support for the extended family and educational advocacy for her son.

I have been working with Robbie for almost four years. Angie reported that early on Robbie had a list of disconcerting behaviors, including: obsessive thinking (seat belt on his car seat needed to be redone multiple times because he insisted it was”buckled wrong”), tantrums, trying to escape from moving cars, pulling bedroom door off the hinges (at age 5), putting holes in walls, throwing and breaking things, and apparent total of emotion during the episodes with great remorse afterwards. Robbie was struggling with school, especially completing homework, and the transitions from home to school in the mornings (facilitated by Grandma Donna because Angie is at work by 7 am), and the immediate after-school hour until Angie got home from work at 4:30 pm. Robbie would have tantrums in the mornings, refusing to get ready for school, refusing to leave the house, calling Donna names and telling her he hated her. He would visit the school nurse, sometimes multiple times each day, complaining of feeling nauseous and wanting to go home. At one point, Angie was at risk of being fired because of all the interruptions Robbie’s calls were creating.

Initially, Robbie and I met at a local community youth commission. He loved the games, including Sorry, Trouble, Uno and Mancala which I utilized to help him practice frustration tolerance and emotional regulation. Robbie was then and continues to be a “tumbleweed in a hurricane” whenever he is agitated. He will tumble, roll, wiggle, jump, rapidly change the subject or ask to play ball in the house if the topics he opens up during the session begin to feel too intense for him to deal with. Robbie’s executive function learning disability is behind these behaviors, I think, because they occur most often when he appears to be “flooded by the words.” I have been encouraging him to use that phrase “flooded (or “drowning”) in words” to help his family understand when he is at his limits. An interesting physical characteristic of Robbie’s walk: he is nearly always on tip-toe, even when he runs during a baseball game or rides his scooters. He has a preference for being in socks, no shoes, and struggles to walk “heel-to-toe” reporting it is “painful, it hurts to make my feet do that!”

On the other hand, Angie told me (and I witnessed) Robbie could be sweet, polite, considerate, and very helpful. Robbie shows a great affinity for seeing the patterns in life – Chinese checkers is easy for him, and Mancala is a favorite game. Robbie showed excellent strategy skills whenever we played Battleship, winning nearly every time!

My initial diagnosis of Asperger’s Syndrome was confirmed two years into treatment by a full battery of intelligence and neuro-psych tests. Treatment approaches have included, and are not limited to, play therapy, (free-play, sand tray, and games already mentioned), creative arts therapy, (drawing, painting, building with blocks or legos, etc), talking (until Robbie began to tumble around the room), behavior modification (sticker charts, rewards for positive changes, etc), and EMDR. Our focus has been on emotional regulation, appropriate expression of emotions, frustration tolerance, and calming anxiety induced OCD behaviors.

THE TUG-O-WAR DAY

Shortly after we moved our therapy sessions form the youth commission offices to Robbie’s home, I arrived one afternoon to a battle zone. Robbie was angry with Donna, and she was frustrated and angry with him. The reason, they both agreed, was communication difficulties, especially regarding transition times (getting Robbie home from school with a variation in routine and route had resulted in today’s fight) that each described as a “tug-of-war” to get things done.” I took this as my invitation to try one of the Rehearsal’s for Growth action methods I had recently learned with them. Robbie was used to playing with me, so he was curious and willing. Donna, struggling with her own mental health challenges and the aftermath of the afternoon’s conflict, was less open to the idea. To her credit, she played anyway!

Round-one instructions were simple: “you are playing a game of tug-o-war and there is an invisible rope here. I will be the ref. You each pick up your end of the rope and get ready to play, making it look as real as possible. When you are ready, I will say ‘go’ and you play. Only one condition: no “taffy rope,” so if one of you pulls in the other must lean out.” They played fairly, and Robbie won this round because Donna just dropped the rope with little tug on her part first. Robbie reported he liked winning (something I knew from all the play therapy we had done in the past). Donna reported this is the way things usually were between them, she didn’t really put up a fight because then he would have a bigger tantrum to get his way. She said she “hate the way it feels to always be the one to lose.”

Round-two: “Same rules, except this time Donna must win! Robbie can put up a tug, but ultimately Donna has to be the winner.” Robbie protested, but played fairly, pulling hard, but letting Donna win. Donna wanted to drop the rope again, until I reminded her that this time she would be the winner. Then she stuck with the game. “I don’t like letting her win,” Robbie said. Donna was grinning from ear to ear! I had never seen her smile before! She told us it felt great to win, something she couldn’t remember experiencing since she was a little girl.

Round-three: same rules as round one, only this time Donna put up more of a fight and Robbie ultimately said, “this game was a draw.”

Wrap-up: I asked Robbie and Donna to play with the feelings they discovered during the play. Robbie was to remember the sadness he felt when Donna gave up because she was afraid of him. He had said this upset him because he didn’t want her to be so sad all the time. Donna was to use the phrase, “It’s my turn to win, Robbie” whenever he was refusing to listen to her and there was a real need to stay on schedule, i.e. getting to school on time or home from school for an appointment.

Two months after this session, I checked in again on how the tug-o-war was going and Robbie told me he had taught the game to Angie and his Aunt , played it with Kyle and thought it was a fun way to “make choices about who’s idea gets to happen next” during play. He had modified the game into a conflict-resolution tool! Donna said it was helpful, ” when I remember to stand my ground, which doesn’t happen consistently enough.”

Occasionally Robbie will ask for a family session with Angie. We have used a variety of action methods to foster cooperation between Robbie and his family. Over-stimulation continues to be the biggest problem for Robbie. He seems to completely forget all his hard-won regulatory skills when there is too much unstructured time paired with too many external stimuli. For example, Angie reported that “school vacation week together with a carnival and a sleep-over proved to be too much for Robbie and he had a major meltdown/tantrum complete with hitting family members, throwing things and flailing on the floor. When he calmed down and went to his room he had no idea what had happened or why and the rest of the family was shaken. The look on his face was like a monster from a bad movie!” Clearly, there is more work to be done, and more Robbie has to teach us about his mental health condition.