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Jan 27, 2010
This is an expanded version of The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children,
written for therapists. It includes more detail on the theoretical
underpinnings of Greene's framework, ideas for interviewing parents and
children and for teaching them the CPS model, and information about ways
to apply the CPS model in schools and residential settings as well as
with parents.
Greene's view of "explosive" children moves away from
This is an expanded version of The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children,
written for therapists. It includes more detail on the theoretical
underpinnings of Greene's framework, ideas for interviewing parents and
children and for teaching them the CPS model, and information about ways
to apply the CPS model in schools and residential settings as well as
with parents.
Greene's view of "explosive" children moves away
from DSM diagnosis and into a model which views these children as
learning disabled. According to Greene, explosive children suffer
specific cognitive delays which make it difficult for them to function
in certain everyday situations and to tolerate frustration. Greene
criticizes standard reward-and-punishment behavior plans for failing to
address these underlying cognitive limitations, thus making it difficult
or impossible for the child to modify his behavior on a long-term
basis.
Greene provides an extensive list of these skills and
encourages therapists to begin by interviewing parents and children in
an effort to gauge which of these skills might be delayed in the child. A
second goal of the initial interview is to identify “triggers†for the
child’s explosive outbursts, e.g., sensory hypersensitivities, homework,
sharing, getting ready for school or bed, interacting with a particular
classmate or sibling, etc. Greene provides many helpful examples of a
therapist interviewing a parent in order to discern this information,
which I found to be one of this book’s great strengths. The dialogues
manage to be both realistic and instructive, unlike many other sample
therapy dialogues I’ve read which just sound contrived and hokey.
Although
it may be tempting for therapists to want to jump immediately into
Greene’s suggestions for problem-solving, Greene warns us that the
initial interview is indispensable and that a clear understanding of the
child must be formulated before the therapist can intervene in a
helpful way. One of the advantages of focusing on the child’s cognitive
delays is that it helps the parent move away from motivational
explanations (“He’s just doing it to manipulate us!â€) which are usually
not entirely accurate and in any case, don’t encourage constructive
intervention. Additionally, proactive intervention is far more effective
than reactive intervention, and understanding the child’s cognitive
delays and triggers helps the therapist and parents work to plan
interventions in advance rather than simply putting out fires.
Greene
then describes the three ways of responding to problems or unmet
expectations with children, what he calls “Plan A,†“Plan B,†and “Plan
C.†Plan A is for the adult to impose his will on the child; Plan C is
for the adult to remove or reduce the expectation, and Plan B is what he
calls the Collaborative Problem Solving approach, or CPS.
Typically,
adults will either overuse Plan A, overuse Plan C, or try Plan A and
then switch to Plan C when Plan A fails. With regular kids this may
actually be adequate (if the kid is basically compliant and Plan A or C
doesn’t need to be put into effect all that often), but with explosive
kids neither Plan A nor Plan C is a long-term solution. Thus, Greene
works to teach parents the use of Plan B as a positive alternative that
reduces the explosive behavior, helps parents pursue their expectations
without fear of an explosion from the child, and eventually, helps
remediate the cognitive deficits in the child that are underlying the
explosive behavior.
Plan B involves three steps: empathy (plus
reassurance), define the problem, and invitation. Plan B also has two
contexts – proactive and emergency. Proactive Plan B refers to following
these steps under controlled conditions; Emergency Plan B refers to
following these steps when the child is already approaching the boiling
point. Emergency Plan B, naturally, is more difficult to do and less
effective. This further highlights the importance of understanding which
particular situations set the child off and following the plan at a
calm time rather than waiting for the explosion to hit and then
following the plan.
Plan B’s first step, empathy, can be
surprisingly difficult for adults. Greene suggests initiating Proactive
Plan B with the words, “I’ve noticed that…†For example, “I’ve noticed
that homework has been a bit of a struggle lately†at a calm time, as
opposed to waiting for the kid to blow up over homework. Emergency Plan
B, in contrast, involves reflective listening – restating or
paraphrasing what the child has just expressed to you (“You’re not going
to do your homework.â€).
But empathy does not end with observing
and reflecting – it’s also about clarifying and coming to a highly
specific definition of the child’s concern. “I’ve noticed that…†needs
to be followed by a question like “What’s up?†which is an invitation to
the child to offer specific information on what the problem is. Greene
notes that children tend to make their concerns known through
pronouncements like “I’m not going to school†which don’t give us a lot
of information on what the actual problem is. If parents make the effort
not to be provoked by these statements but instead, use them as
opportunities for exploration and for defining the child’s actual
concern, they will get farther. A response to “I’m not going to schoolâ€
would be, “You’re not going to school. What’s up?†to which the child
might say, “Nobody likes me†or “My teacher gets mad at me when I don’t
understand something,†information that gets the parent and child closer
to solving the problem. If the child can’t define the concern, the
parent can try to make educated guesses (e.g., “Well, I’ve noticed
that…Is that it?â€). Another piece of empathy is reassurance – “I’m not
saying that you have to…†This tells the child that you will not be
using Plan A, which reduces their defensiveness and makes them more
receptive.
The second step is defining the problem. If the parent
has followed all the steps involved in empathy as described, the parent
should have a sense of what the child’s concern is. Now, the parent can
share their concern with the child, because the definition of the
problem is that both the child and the parent have valid concerns. It is
important for the parent not to share their concern in a pronouncement
the way the child might (“You’re not having a snack because it will
spoil your dinner!â€) but to specify their concern in a more useful way,
the way they would answer if an adult asked them, “What’s your concern
about that?†(e.g., “My concern is that if you eat a snack now, you
won’t have room to eat your dinner.â€)
The third step involves
inviting the child to collaboratively brainstorm ideas for solving the
problem in a way that is both realistic and acceptable to both parties.
The key word here is “Let’s,†i.e., “Let’s see if we can figure this
out.†The parent and child then come up with a list of solutions that
would address both concerns. Ideally, the child should be given first
crack at generating solutions but solutions should be voiced by both
parties. If the child can’t think of anything, the parent can then say,
“Well, I have a few ideas…would you like to hear them?†The parent can
respond to unrealistic or unacceptable ideas with, “There’s an idea… but
as I think about it, I’m not sure I (or you) can do my (or your) part a
lot of the time…let’s think of a solution that we both can actually
do,†or “Well, that solution would probably work well for you but it
wouldn’t work well for me. Let’s try to think of a solution that would
work well for both of us.â€
When therapists first present Plan B
to parents and invite them to try it at home, failures are likely. The
therapist should then listen to the parents describe the failure and
look for patterns, such as using Plan A when they could have used Plan
B, overreliance on Emergency Plan B as opposed to making more of an
effort to use Proactive Plan B, skipping some of Plan B’s steps (failing
to empathize and acknowledge the child’s concerns, failing to be
specific about the parent’s concerns, or skipping the invitation step
and jumping straight into Plan A), or problem-solving deficits in the
child and/or the parent.
Greene then moves beyond the basics of
Plan B to discuss the therapy on a more meta-cognitive level. He
discusses the need to form an alliance with both the parent and the
child and how to show them empathy. He discusses the need to remain
neutral and to focus on understanding and clarifying each person’s
concerns without falling into the trap of seeming to agree with one
party or another. He discusses the need for the therapist to take
control of the case by assessing whether the parents and child will be
able to implement Plan B at home or whether they need the structure of
the therapist’s office; taking an active role in determining which
problems should be discussed and who should be present for the
discussion; preventing discussions from deteriorating; and coordinating
with other professionals who might be working with the family to make
sure that the interventions are consistent. He then discusses the
therapist’s role of keeping the discussion on track and focused on one
issue at a time, as well as maintaining realistic expectations regarding
the pace at which family interactions can be expected to change.
Another thing the therapist might need to do is point out where parents
and siblings may be struggling with some of the same cognitive deficits
as the explosive child, which is frequently the case. Finally, the
therapist needs to be attuned to issues of family process such as one
family member continually dominating the conversation, one family member
remaining silent and passive, or one family member continually blaming
others. These issues need to be addressed, either indirectly or
directly.
The main selling point of the CPS model, it seems, is
that it goes beyond addressing the particular conflict and can be used
to teach the lagging cognitive skill. CPS can help children develop
language skills, cognitive flexibility, planning and forethought,
emotion regulation, social skills, and other abilities which, if
improved, may decrease explosive behavior across the board. For example,
Greene encourages parents to teach kids that most solutions fall into
one of three categories -- ask for help, meet halfway/give a little, or
do it a different way. Through teaching this concept to kids, kids can
develop the language and/or flexibility to generate solutions rather
than feeling stuck.
The CPS model sounds great in theory, has
some impressive, if preliminary, research support, and is explained
beautifully in this book. Culturally, I did wonder how marketable these
ideas are to a religious or non-Western individual with a belief that
there is a time and place to respect authority blindly. In the last
chapter, which lists some questions and answers about the CPS model,
Greene addresses some of the reluctance with statements like:
"We
wonder if teaching a child that his concerns are secondary to adult
concerns, that adults have no faith in his ability to solve problems,
and that adults are the only people who are truly capable of coming up
with good solutions to problems is really the best way to go about
setting the stage for a healthy adulthood. We think these lessons have
the potential to set the stage for later relationship problems and other
forms of psychopathology...of course [we feel kids should respect
authority:]...but we don't think the respect should be automatic. Before
kids can respect authority adults must behave in ways that engender
respect."
I have to say that, although I'm no expert, I don't
believe that religious cultures like mine have been found in the
research to have significantly higher levels of pathology, despite the
emphasis on obedience to authority. In my culture we are taught from an
early age to respect our parents because God wants us to; this respect
is completely non-contingent on anything the parent says or does, or on
their performance as a parent in general or as a person. I don't believe
that this belief "sets the stage for later relationship problems and
other forms of psychopathology." Not that I believe parents should abuse
this power; not that I believe that parents' overuse of Plan A is good
for their relationship with their children; but I do think that Greene
has a very Western, individualistic way of looking at things. I'm not
against using Plan B in theory, but I'm also not as monolithically
opposed to Plan A, at least in principle, as Greene seems to be.
That
said, though, I think there's a great deal of wisdom in this book and
I'm hoping it will help me both with my clients and with my children.
...more