K's Reviews > Treating Explosive Kids: The Collaborative Problem-Solving Approach

Treating Explosive Kids by Ross W. Greene
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's review
Feb 02, 2010

it was amazing
bookshelves: professionallit
Recommended to K by: Aliza Kossowsky
Recommended for: Therapists working with explosive kids; parents of explosive kids

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!”) 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.”).

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 school” 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?”). 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!”) 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.”)

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.”

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.
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Comments (showing 1-9 of 9) (9 new)

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message 1: by rivka (new)

rivka Glad to hear this one was so good. His earlier book is on my to-read shelf.

message 2: by K (new) - rated it 5 stars

K I read his earlier one as well. I think I liked this one better because it was from a more professional perspective, but I don't remember the first one that well any more. I'm actually drafting my review now, which will hopefully give you more information about the book.

message 3: by rivka (new)

rivka Professional perspective would be better for you, but not for me. ;)

message 4: by K (new) - rated it 5 stars

K Yeah, you would probably like the first one better although you may find some useful information in this one.

message 5: by Rachayl (new)

Rachayl This was a really interesting review for me at the moment as one of mine (the almost-5-year-old) has been going through a very explosive phase for, oh, two years now. I have been doing the plan A-C-A thing and grappling for plan-B-like methods in rare moments of levelheadedness, and having the choices and methods organized into letters and three "steps" is the kind of thing that might keep me levelheaded more often.
Just now we have been getting him evaluated for some mishmash of language and attention issues and reconsidering next year's school options. His teachers and the people evaluating him don't see his explosive side, but it makes sense that it's related to the cognitive issues. What did you mean by DSM diagnosis as opposed to learning disability - are learning disabilities included in DSM? Was there a DSM category for explosiveness that is not specifically related to its causes?
Sort of overwhelming trying to figure it out- for the moment I'll wait for his therapist(s?) to tell me what to do and just try to stay levelheaded! Thanks for the tips! Free therapy for me!

message 6: by K (new) - rated it 5 stars

K It's always wonderful to hear from you, Rochy! I'm sorry to hear that you've been struggling with explosive issues with your kid. My kids all went through some difficult tantrum phases too (I'm using the past tense, but there are still plenty of flare-ups and they're not completely behind us). It's awful.

I think the DSM has a code for learning disabilities on Axis II (if I'm not mistaken; I would have to look it up to make sure because the place I work at now doesn't encourage us to use the DSM and it's been a while for me), but what I think Greene meant was that explosive kids are often assigned Axis I diagnoses like oppositional defiant disorder, bipolar disorder, intermittent explosive disorder, conduct disorder, etc. which focus on behavior and don't address the possible source of the behavior in specific cognitive delays. Greene feels that we do these kids a disservice by labeling them this way and focusing on their behavior with reward/punishment plans and possibly medication as opposed to trying to figure out where they get stuck cognitively and working to help them think better so that they don't explode with frustration.

It sounds great in theory; in practice I suspect it requires a lot of self-discipline for the parent. Unfortunately, I do a lot more Plan A/C than Plan B myself.

In any case, you may be interested in reading this book, or in reading the one he wrote for parents rather than for therapists -- The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children. You can also ask the therapist(s) you're working with whether they've read the book and what they think of the approach.

Good luck!

message 7: by Rachayl (new)

Rachayl Oh, are we all still awake? Anyway, I don't know what Axis I and Axis II are but I understand the distinctions between the approaches. I certainly think that it's interesting and important to learn about underlying causes of bad behavior and that, if it's caused by frustration related to cognitive delay, it's much more satisfying to treat it by addressing the cognitive issue and ultimately making the child a more rational and calm person rather than by reward/punishment. I'm a big fan of medication, though (assuming it's a medication that actually helps). As each of my kids turns out to be spacy in their own way I'm looking into recipes for Ritalin soup for the whole family. Also the parents. I bet it'll help me read more books and write reviews!

message 8: by rivka (new)

rivka "Ritalin soup". Hee! :D

message 9: by K (new) - rated it 5 stars

K Funny! We actually have the opposite problem here; one psychologist I know referred to it as "hyperfocus" -- the kids (and me too, at times, I admit) tend to get fixated on something and it's very difficult to move them away from it. In our house, that can lead to some tantrums. A little spaciness would actually be an improvement sometimes.

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