Reframing the Battle of Wills

Key Takeaways

Common methods of behavior change, relying on rewards or punishments, are often ineffective.
Challenging behaviors frequently stem from underdeveloped neurocognitive skills, not a lack of desire or motivation.
Impulse control and executive functioning are critical skills for preventing negative outcomes and maintaining social function.
Collaborative problem-solving offers a three-step alternative to coercive tactics: empathy, sharing concerns, and mutual collaboration.
True empathy involves genuinely understanding another's roadblock, even if their perspective is undesirable, without necessarily agreeing.
This collaborative approach not only improves behavior in the individual but also enhances skills in the intervener.
Accountability should focus on problem-solving to prevent recurrence, rather than solely relying on punitive measures.

Psychologist Stuart Ablon's early experience as a teenager on a child psychiatry unit involved a patient named Jason who physically assaulted him.
Jason later apologized, explaining he "just lose[s] control like that," highlighting the patient's regret and perceived inability to control his actions.
This interaction prompted Ablon's reflection on the complexities of behavior, revealing actions stemmed from a lack of control rather than ill intent.

Psychologist Stuart Ablon, working with Ross Greene at Mass General Hospital, developed an approach based on the idea that challenging behaviors often signify a lack of neurocognitive skills, not motivation.
This perspective contrasts with the common assumption that misbehavior is due to a lack of will, leading to ineffective solutions involving rewards or punishments.
Frustration can make it difficult for individuals to access rational parts of their brain, contributing to the quick assumption that others lack the will to change.

Challenging behaviors, such as a teenage patient's repeated "I don't care," can be linked to underdeveloped language and communication skills.
The patient's response was a preemptive way to avoid the processing time needed to formulate a thought, rather than defiance.
Waiting to allow the patient time to think enabled him to articulate his perspective, illustrating that perceived defiance can be a skill deficit.

Neuropsychological evaluations frequently reveal significant, often invisible, skill deficits in individuals struggling with behavior.
These deficits include emotion regulation (managing emotional responses for clear thinking) and social thinking skills (e.g., initiating conversations, understanding social cues).
The core principle is that 'people do well if they can,' contrasting with 'people do well if they want to,' advocating for an empathic, skill-building approach.

'Plan A' involves imposing one's will using rewards and consequences, which is often ineffective and can escalate conflict or fail to build skills.
'Plan C' is strategically dropping an expectation or solving a problem the other person's way to reduce challenging behavior, but it does not resolve the underlying issue.
'Plan B,' collaborative problem-solving, is introduced as an alternative to the 'A-C split,' aiming for mutually satisfactory solutions through empathy, sharing concerns, and collaboration.

The initial step of Plan B, empathy, requires courage to understand the other person's roadblock, even if their perspective is undesirable, clarifying that understanding does not mean agreeing.
The second step involves sharing one's own concern after demonstrating understanding, advising the use of "and" instead of "but" to avoid invalidating the other person's perspective.
The third step invites the other person to propose solutions first, fostering ownership and providing an opportunity to assess their problem-solving skills, emphasizing practice.

Psychologist Stuart Ablon implemented collaborative problem-solving at Oregon State Hospital, a maximum-security psychiatric facility with a history of high rates of staff and patient assaults.
Staff at the hospital were receptive to the new approach, recognizing the ineffectiveness of traditional reward and punishment systems that created hostility.
The shift in mindset from "people do well if they want to" to "people do well if they can" was crucial for understanding and addressing the patients' behavior in this challenging environment.

A nurse successfully applied Plan B with a male patient with paranoid schizophrenia who refused therapy, believing others could hear his thoughts via brainwaves.
The nurse used reassurance and reflective listening to validate his concern about privacy without agreeing with his delusion.
Through collaboration, the patient proposed wearing tinfoil under a beanie to block brainwaves, enabling him to attend treatment after years of refusal.

Research at a children's center in Ottawa showed children receiving collaborative problem-solving interventions demonstrated greater decreases in challenging behaviors and developed self-regulation skills.
The benefits extend to interveners; parents and managers using this approach enhance their perspective-taking, empathy, and cognitive flexibility, regardless of age.
True accountability is reframed as an individual being responsible for solving a problem to prevent recurrence, rather than solely facing consequences or punishment.