Changeable: How Collaborative Problem Solving Changes Lives at Home, at School, and at Work - Hardcover

Ablon, J. Stuart

Hardcover

ISBN 10: 0143129015 ISBN 13: 9780143129011

Publisher: Tarcher, 2018

Synopsis

A bold new way to help anyone change    
 
Why is it so hard to change problem behavior—in our kids, our colleagues, and even ourselves? Conventional methods often backfire, creating a downward spiral of resentment and frustration, and a missed opportunity for growth. What if the thinking behind these old methods is wrong? What if people don’t misbehave because they want to, but because they lack the skills to do better? Or as renowned psychologist J. Stuart Ablon asks, what if changing problem behavior is a matter of skill, not will?
 
Based on more than twenty-five years of clinical work with juvenile offenders as well training parents, teachers, counselors and law enforcement, and supported by research in neuroscience, Changeable presents a radical new way of thinking about challenging and unwanted behavior -- Collaborative Problem Solving -- that builds empathy, helps others reach their full potential, and most of all really works.
 
With illuminating scientific evidence, remarkable success stories, and actionable insights, Changeable gives parents, teachers, CEOs and anyone interested in learning about why we behave the way we do a roadmap for helping people grow.
 
  *Includes a Bonus PDF with charts and graphs.

About this title

About the Author

J Stuart Ablon, Ph.D., is the Director of Think:Kids in the Department of Psychiatry at Massachusetts General Hospital and an Associate Clinical Professor of Psychology in the Department of Psychiatry at Harvard Medical School. He is a sought-after speaker at conferences and institutions worldwide addressing tens of thousands of people each year.

Excerpt. © Reprinted by permission. All rights reserved.

Chapter One

People Do Well If They Can

As a clinical psychologist at Massachusetts General Hospital, I've treated a lot of challenging children and adults-pretty much every variety of dysfunction, disorder, and misbehavior. When it comes to children, some of my favorite to treat are what I call inflexible kids. These kids can be extremely bright and high functioning in many ways. They have an almost uncanny ability to learn and memorize new information-it just seems to burn into their brains. But information retention is also the root cause of their difficulty. Because the cognitive associations they form are so strong, they can't be altered very easily. Once these kids experience something, that's it: A template forms, and they have a hard time adapting to even slight deviations. The inflexible kids I see glom on to structure, routine, and predictability. They must go to their restaurant, dress the way they're used to, sit in class where they've always sat. When life doesn't happen as they expect, they can't handle it. I call them "need to know" kids, as opposed to "go with the flow" kids. They perceive the world as black or white, good or bad, their way or no way, and nothing in between.

One inflexible kid I treated, eleven-year-old Susan, was an all-American girl who loved to play hockey and sent me pictures of her team every season. Susan's parents described her as strong willed, capable, and very intelligent, a great kid in most respects. She'd never had serious behavioral problems before. As Susan's mother told me, "About 85 percent of the time, she's a rock star. She's queen of the monkey bars, a strong swimmer and skier, a great gymnast, and a great hockey player." During the other 15 percent, Susan fell into fits of anger. "It's like a switch gets flicked," her father told me. "She'll yell at her sister or hit her. Does the same with her mom. She'll scream, 'I hate you; you're not the boss of me! You can't make me! Don't look at me! Don't touch me!'"

As bad as these tantrums might sound, in the world of challenging behavior, they're pretty minor. Susan wasn't violent. She didn't harm herself or others. She was coping well enough at school. Frankly, she didn't seem that hard of a case.

For the first several weeks of working together, we made progress in helping her parents understand how she was wired and how this wiring led to some of her challenging behavior. Susan seemed to enjoy coming to our sessions, and we forged a strong therapeutic relationship. It helped that her parents loved her and were bent on doing whatever it took to help their daughter.

Then on Susan's first day of middle school, her parents called and said they needed to see me-Susan was in crisis. I was able to fit her in that day, right after lunch. But that wasn't soon enough. I was out grabbing a bite when I received a frantic text from my office: "Your one p.m. appointment is here. They need you!"

I ran back to the office to find Susan in hysterics. Her father was physically restraining her, and her mother was holding her shoes. As her mother told me, she had taken them so that Susan wouldn't launch herself through a plate-glass door and run away. "Susan, what happened?" I asked. She refused to speak to me. This was unlike her. We had developed such a solid relationship.

It took a good twenty minutes, but we managed to calm her using techniques I'll describe later in this book for dealing with people in crisis. Susan still wouldn't speak, but she would write words and phrases down on pieces of paper. Meanwhile, her parents relayed what had happened. Susan didn't want to go to school, and her parents had been trying to force her. Even her beloved grandfather couldn't manage to coax her into going. She had run away, and when she was brought back home, she said she wanted to kill herself. This was entirely out of character. She might have always had minor anger issues, but she never exhibited any explosive or suicidal behavior before. What could possibly be going on here?

It turned out that at overnight camp a few weeks earlier, Susan had suffered severe migraines and wasn't able to reach her parents by phone. The experience traumatized her. Now, as Susan confirmed through the phrases she was writing, she didn't want to go to school because she was deathly afraid she would get another migraine and not know whom to go to or what to do. She feared she would freak out as she had at camp, and the other students would stare at her and think something was wrong with her.

When I uncovered these concerns, they made perfect sense. As her parents and I had discovered, Susan struggled with cognitive skills related to flexibility. She needed more routine, planning, and predictability than other kids, and when these elements were lacking, she ran into trouble. Like other inflexible kids, Susan especially struggled with transitional situations in which existing templates didn't apply and she was forced to adapt to new conditions. Attending middle school for the first time was such a situation, and it made sense that Susan would have trouble with it. Everything in middle school was different from what Susan was used to: the kids, the lockers, the schedule, the teachers, the building itself-everything. If she got a migraine, she wouldn't know what to do. She had no template, no plan to follow. Susan got so upset and anxious that she didn't know how to express her feelings to her parents. All she could do was lash out. And her parents, who would otherwise have jumped to help her, didn't know what to do.

For many years, Susan's parents had interpreted her temper tantrums as a technique she used to get her way. Most parents would probably have come to a similar conclusion. Like Susan's parents, they would have dealt with Susan's behavior by punishing her, setting boundaries, and "teaching her a lesson." But in this instance, Susan clearly wasn't being difficult because she wanted to be. Her anxieties about a brand-new school and the possibility of getting a migraine there tied into her cognitive makeup, and the more her family tried to force her to go to school, the more explosive she became. Her well-intentioned parents were trying to force their inflexible child to do something she wasn't capable of doing. And that inflexible child, lacking the cognitive skills to deal with the situation and come up with a solution, did the only thing she could. She acted out.

Get Out of Line, Do the Time

Our society has an entrenched way of thinking about behavior. We almost always assume it derives from a person's will-that people behave consciously and purposefully. When people misbehave, we likewise assume that they're doing it intentionally. As a result, whenever individuals in almost any social setting act out or misbehave, those in charge usually respond by punishing the bad behavior. When you were a kid, did your parents take away your TV time or allowance when you misbehaved? Most did. When you continued to misbehave, they probably just stepped up the intensity of the consequences and rewards. And they probably also bestowed privileges when you did the right thing.

School discipline is similar. We assume that when kids misbehave in school, they do it on purpose either to get stuff (special attention, for instance) or get out of stuff (like doing their work or coming inside after recess). In the early school years, teachers punish kids with time-outs. They are taught that kids will use the time away from their peers to reflect on what they did wrong, and that they will feel badly enough at missing out and having been punished that they will want to behave better next time. As kids grow older, schools hand out detentions and suspensions that likewise isolate the offenders and are supposed to teach them a lesson. Statistically, these are the most common punishments in U.S. schools, and I should add that they are also levied disproportionately on kids with disabilities and those of color. All along in our educational system, we assume that people misbehave deliberately, and that reforming behavior means simply providing the right motivation.

When kids really act out and become uncontrollable, we remove them from mainstream schools and put them into therapeutic schools or treatment centers, and, eventually, juvenile detention facilities. Later, we lock them away in adult prisons (I'll have more to say about this progression, which has been called the "school-to-prison pipeline"). These institutions also usually operate according to principles of punishment and reward. In some states, the law mandates very specific punishments for offenses by inmates at detention centers. In some facilities where I have worked, for instance, lying to staff, arguing when given instructions, or disrespecting others can result in punishments like loss of privileges, early bedtimes, time-outs, and extra work assignments. Staff can reward good behavior by bestowing extra privileges such as more TV time, more time playing sports, and later bedtimes. Serious offenses, like possessing weapons or threatening staff, can prompt more serious punishments, like placement in a restricted program or even transfer to a different facility.

The treatment patients receive at most psychiatric hospitals is similarly organized. Virtually all psychiatric hospital care in the United States takes place within structured systems of discipline called point and level systems, token economy systems, or contingency management systems. The institution marks progress in treatment by defining different levels that patients can attain. Behave well, and you bump up to higher levels, receiving more privileges (TV time, movies, special meals, home visits, and so on). When you sustain the highest level long enough, the institution will discharge you. But if you behave poorly, you slide down to lower levels, losing privileges. We assume that this carrot-and-stick approach will motivate people with psychiatric illnesses to behave better. Implicit in this assumption is that they've lacked the willpower in the past to behave well. People misbehave, we think, because they want to.

These practices, however, aren't reserved for people with serious emotional and behavioral disorders. Companies, governments, and entire countries deploy this approach to discipline in an attempt to shape behavior. Did you land a big client or make your numbers? Your boss may give you a bonus or promote you. Did you fail to follow protocol or get another unsatisfactory performance review? Your boss may place you on probation, demote you, or even fire you. Governments try to encourage "good" behavior (like going to college or saving for retirement) by offering rewards such as tax incentives. They discourage "bad" behavior (like polluting or violating workplace regulations) by levying higher taxes, slapping on fines, or providing for civil lawsuits. In foreign policy, we place sanctions on countries that flout international law, and we reward countries for good behavior by lifting sanctions, giving them privileged trading arrangements, and offering their leaders photo-op meetings with our president.

We persist in assuming that if we institute proper consequences, teaching offenders the benefits of behaving well and the costs of misbehaving, they will make better choices and mend their ways. We can trace this thinking back to the Bible and the vengeful God in the five books of Moses who levies harsh punishments onto the Children of Israel for their misdeeds. More recently, twentieth-century behavioral science has seemed to confirm the wisdom of punishments and rewards. Experimenting with rats, researchers found that by manipulating rewards and punishments they could encourage or discourage simple behavior. Like rats, human behavior is an age-old matter of conscious choice and free will-nothing more. Or so it might seem.

Learning from a "Bad" Kid

But what if this thinking is wrong? What if people don't misbehave because they want to, but because they lack the skills to behave otherwise? As we'll see in the next chapter, a large body of neuropsychological research has disproved the notion that poor behavior is a choice, and it has affirmed the idea that skill determines good behavior. In fact, research in the neurosciences has identified dozens of specific, underlying skills that if absent or diminished result in challenging or "bad" behavior.

As compelling as this research is, you don't need science to understand that people do well if they can, not if they want to. During my senior year in high school, when I first became interested in psychology, I got a job at a hospital psychiatric unit for kids. This locked facility admitted kids for short-term stints when they threatened to harm themselves or others. I was supposed to hang around and observe at first, but the unit was grossly understaffed. Almost immediately, staff asked me to help take care of patients in ways I never expected and, frankly, was not trained for.

During my first week, staff members and I were supervising patients on the playground when a twelve-year-old boy-I'll call him Jason-had an explosive outburst. I ran over to lend a hand as the other staff members tried to calm him. Jason broke free and did the unthinkable: He kicked me and spit right into my face. One of the staffers, who was serving as my mentor at the facility, saw this happen. "Hold on," he said. "Let me teach you a few things about what to do here."

He grabbed Jason, turned him around, and showed me how to restrain him. He placed his arms around Jason's body, forming them into a kind of straitjacket. Meanwhile, he stood between Jason's legs so that the kid could not kick him backward.

Jason's outburst and the violence of the restraint unnerved me. But I was in for much more. A few hours later, Jason exploded again and was restrained. Jason was really out of control, so staff members forced him into a seclusion room and placed him facedown on a cold floor. One of the staff members sat on his back to hold him down, and they motioned for me to hold his legs. I did so for several minutes, and it wasn't pleasant. Jason was screaming, crying, writhing, spitting, and calling me and my mother all sorts of names.

Soon Jason ran out of energy and fell asleep on the floor. We, too, were drained. And I found myself struggling with competing feelings. I felt uncomfortable and ashamed to be helping-it seemed crude to me, inappropriate, wrong, as if I were inflicting still more suffering. Yet I felt empowered to be able to help with something so critical. I didn't say anything to the other staff about my ambivalence. They were the experts, and I figured that as painful as it was, restraining Jason was probably necessary or helpful. We were just doing what needed to be done.

Edition details

• Publisher: Tarcher
• Publication date: 2018
• ISBN 10: 0143129015
• ISBN 13: 9780143129011
• Binding: Hardcover
• Language: English
• Number of pages: 304