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Treatments Menu. Social Skills Training

A major goal of Social Skills Training (SST)  is teaching persons who may or may not have emotional problems about the verbal as well as non-verbal behaviours involved in social interactions. There are many people who have never been taught such interpersonal skills as making ‘small talk’ in social settings, or the importance of good eye contact during a conversation. In addition, many people have not learned to ‘read’ the many subtle cues contained in social interactions, such as how to tell when someone wants to change the topic of conversation or shift to another activity.


Social Skills Training helps clients to learn to interpret these and other social signals, so that they can determine how to act appropriately in the company of other people in a variety of different situations. SST proceeds on the assumption that, when people improve their social skills or change selected behaviours, they will raise their self-esteem and increase the likelihood that others will respond favourably to them. Clients learn to change their social behaviour patterns by practicing selected behaviours in individual or group therapy sessions. Another goal of Social Skills Training is improving a client's ability to function in everyday social situations. Social Skills Training can help clients to work on specific issues - eg: improving one's telephone manners - that interfere with their jobs or daily lives.


Treatment of specific disorders

A person who lacks certain social skills may have great difficulty building a network of supportive friends and acquaintances as he or she grows older and may become socially isolated. Moreover, one of the consequences of loneliness is an increased risk of developing emotional problems or mental disorders. Social Skills Training has been shown to be effective in treating clients with a broad range of emotional problems and diagnoses – including anger management. Some of the disorders treated by social skills trainers include shyness, adjustment disorders, marital and family conflicts, anxiety disorders, Attention-Deficit/Hyperactivity Disorder, Social Phobia, alcohol dependence, Depression, Bipolar Disorder (Manic-Depressive Psychosis), Schizophrenia, developmental disabilities such as Autism; Avoidant Personality Disorder, Paranoid Personality Disorder, Obsessive-Compulsive Disorder and Schizotypal Personality Disorder.

A specific example of the ways in which Social Skills Training can be helpful includes its application to alcohol dependence. In treating clients with alcohol dependence, a therapist who is using SST focuses on teaching the clients ways to avoid drinking when they go to parties where alcohol is served, or when they find themselves in other situations in which others may pressure them to drink.


Another example is the application of SST to Social Phobia or shyness. People who suffer from Social Phobia or shyness are not ignorant of social cues, but they tend to avoid specific situations in which their limitations might cause them embarrassment. Social Skills Training can help these clients to improve their communication and social skills so that they will be able to mingle with others or go to job interviews with greater ease and self-confidence. Some studies indicate that the Social Skills Training given to patients with shyness and Social Phobia can be applied to those with Avoidant Personality Disorder - but more research is needed to differentiate among the particular types of social skills that benefit specific groups of patients, rather than treating social skills as a single entity. When trainers apply Social Skills Training to the treatment of other personality disorders, they focus on the specific skills required to handle the issues that emerge with each disorder. For example, in the treatment of OCD, social skills trainers focus on helping patients with OCD to deal with heavy responsibilities and stress.


People with disabilities in any age group can benefit from SST. Several studies demonstrate that children with developmental disabilities can acquire positive social skills with training. Extensive research on the effects of Social Skills Training on children with Attention-Hyperactivity Disorder shows that SST programs are effective in reducing these children's experiences of school failure or rejection as well as the aggressiveness and isolation that often develop in them because they have problems relating to others.


SST can be adapted to the treatment of Depression with a focus on assertiveness training. Depressed clients often benefit from learning to set limits to others, to obtain satisfaction for their own needs, and to feel more self-confident in social interactions. Research suggests that clients who are depressed because they tend to withdraw from others can benefit from Social Skills Training by learning to increase positive social interactions with others instead of pulling back.


There has been extensive research on the effective use of Social Skills Training for the treatment of Schizophrenia, in outpatient clinics as well as inpatient units. SST can be used to help clients with schizophrenia make better eye contact with other people, increase assertiveness, and improve their general conversational skills.


Social Skills Training in combination with other therapies

Social Skills Training is often used in combination with other therapies in the treatment of mental disorders. For example, in the treatment of individuals with alcohol dependence, Social Skills Training has been used together with Cognitive Restructuring and Coping Skills Training. Social Skills Training has also been integrated with Exposure Therapy, Cognitive Restructuring and medication in the treatment of Social Phobia. Social Skills Training has been used within Family Therapy itself in the treatment of marital and family conflicts. Moreover, SST works well together with medication for the treatment of Depression. For the treatment of Schizophrenia, Social Skills Training has often been combined with Pharmacotherapy, Family Therapy and assertive case management.


Precautions

Social Skills Training should rest on an objective assessment of the patient's actual problems in relating to other people.


It is important for therapists who are using SST to move slowly so that the client is not overwhelmed by trying to change too many behaviours at one time. In addition, social skill trainers should be careful not to intensify the client's feelings of social incompetence. This caution is particularly important in treating clients with Social Phobia, who are already worried about others' opinions of them.


An additional precaution is related to the transfer of social skills from the therapy setting to real-life situations. This transfer is called generalisation or maintenance. Generalisation takes place more readily when the Social Skills Training has a clear focus and the client is highly motivated to reach a realistic goal. In addition, social skills trainers should be sure that the new skills being taught are suitable for the specific clients involved.


Techniques in Social Skills Training

Therapists who use Social Skills Training begin by breaking down complex social behaviours into smaller portions. Next, they arrange these smaller parts in order of difficulty and gradually introduce them to the clients – inviting the client to imagine using the skill. Eg: a therapist who is helping a client learn to feel more comfortable at parties might make a list of specific behaviours that belong to the complex behaviour called ‘acting appropriately at a party’, such as:-

The patient would then work on one specific behaviour at a time rather than trying to learn them all at once


Such specific techniques as instruction, modelling, role-playing, behaviour shaping, feedback, and reinforcement of positive interactions may be used in SST. Eg: instruction may be used to convey the differences among assertive, passive and aggressive styles of communication. The technique of monitoring may be used to ask patients to increase their eye contact during a conversation. In role-playing exercises, group members have the opportunity to offer feedback to one another about their performances in simulated situations. Eg: 2 members of the group may role-play a situation in which a customer is trying to return a defective purchase to a store. The others can then give feedback about the ‘customer's’ assertiveness or the ‘clerk's responses.


Content of Social Skills Training

SST may be used to teach people specific sets of social competencies. A common focus of SST programs is communication skills. A program designed to improve people's skills in this area might include helping them with non-verbal and assertive communication and with making conversation. It might also include conversational skills that are needed in different specific situations – eg: job interviews, informal parties and dating. The skills might be divided further into such subjects as beginning, holding, and ending conversations, or expressing feelings in appropriate ways.


Another common focus of SST programmes involves improving a client's ability to perceive and act on social cues. Many people have problems communicating with others because they fail to notice or do not understand other people's cues, whether verbal or non-verbal. For example, some children become unpopular with their peers because they force their way into small play groups, when a child who has learned to read social signals would know that the children in the small group do not want someone else to join them - at least not at that moment. Learning to understand another person's spoken or unspoken messages is as important as learning conversational skills. A social skills programme may include skills related to the perceptual processing of the conversation of other individuals.


Scheduling

Social Skills Training may be given as an individual or as a group treatment once or twice a week, or more often, depending upon the severity of a client's disorder and the level of his or her social skills. Generally speaking, children appear to gain more from SST in a peer group setting than in individual therapy. Social skill training groups usually consist of approximately 10 patients, a therapist and a co-therapist.


Culture and gender issues

Social skills training programs may be modified somewhat to allow for cultural and gender differences. For example, eye contact is a frequently targeted behaviour to be taught during Social Skills Training. In some cultures, however, downcast eyes are a sign of respect rather than an indication of social anxiety or shyness. In addition, girls and women in some cultures may be considered immodest if they look at others, particularly adult males, too directly. These modifications can usually be made without changing the basic format of the SST programme.


Generalisation or transfer of skills

Current trends in Social Skills Training are aimed at developing training programmes that meet the demands of specific roles or situations. This need developed from studies that found that social skills acquired in one setting or situation are not easily generalised or transferred to another setting or situation. To assist clients in using their new skills in real-life situations, trainers use role-playing, teaching, modelling and practice.


Preparation

Preparation for Social Skills Training requires tact on the therapist's part, as clients with such disorders as Social Phobia or Paranoid Personality Disorder may be discouraged or upset by being told that they need help with their social skills. One possible approach is through reading. The social skills therapist may recommend some self-help books on social skills in preparation for the treatment. Second, the therapist can ease the patient's self-consciousness or embarrassment by explaining that no one has perfect social skills. An additional consideration before starting treatment is the possibility of interference from medication side effects. The therapist will usually ask the client for a list of all medications that he or she takes regularly.


One of the most critical tasks in preparation for Social Skills Training is the selection of suitable target behaviours. It is often more helpful for the therapist to ask the client to identify behaviours that he or she would like to change, rather than pointing to problem areas that the therapist has identified. The treatment should consider the client's particular needs and interests. Whereas Social Skills Training for some clients may include learning assertiveness on the job, training for others may include learning strategies for dating. Therapists can prepare clients for homework by explaining that the homework is the practice of new skills in other settings and that it is as relevant as the therapy session itself.


Aftercare

Some studies strongly suggest the need for follow-up support after an initial course of Social Skills Training. One study showed that follow-up support doubled the rate of employment for a group of clients with Schizophrenia, compared to a group that had no follow-up.


An example of Social Skills Training in action: children with Autism

Teaching social skills to children with Autism is an area of behavioural treatment that is continuously evolving. However, there are 5 basic steps involved in SST programmes:-


1. Define one or more social behaviours the child needs to learn in measurable terms

The behaviours to teach the child may be defined broadly - eg: participation in co-operative play -  or more specifically - eg: responding to a peer's comments. The chosen behaviour may be verbal - eg: maintaining a topic in conversation - or nonverbal  - eg: responding to a peer's facial expression such a as smiling by approaching. Whichever behaviours are chosen, the first step is to define these observable and measurable behaviours so that the instructor may record: whether or not the behaviours occur, what type of prompts are helpful (or not), prompt fading procedures, what kind of reinforcement is effective, a time-table for fading reinforcement, and finally, the kind of support that is needed to teach generalisation of the new behaviours across persons, situations and time, as well as the fading of this support.


2. Use discrete trial teaching techniques while discussing with and teaching a child new social behaviours

The language skills a child learns in the early and middle stages of therapy provide necessary building blocks for learning complex and new social skills in later stages of the therapy. Structured discussions can be an effective technique for introducing social themes. However, caution is needed to avoid depending upon this method as the sole teaching technique for social themes; this will seldom lead to independent mastery of the skills discussed. However, discussion is often a crucial factor in the total learning process.


Stories that focus on teaching social comprehension themes may be read and then discussed with the child. Eg: abook that contains themes such as:-

While being read to, the child is concurrently taught to answer questions such as:-

Books should be read and discussed several times or until the child can readily answer questions related to specific social themes, showing that they comprehend the situation described.


3. Facilitate generalisation of social skills to peers using role-playing and video modelling

The ability to talk about what one should do is different from actually doing it. Thus, discussions of social behaviours are often followed by or occur concurrently with role-playing the social scenarios discussed. Video modelling has also been shown to be an effective teaching strategy in facilitating generalisation of social skills


4. Transitioning from a structured teaching situation to everyday social situations

Contrived environments allow the instructors to teach new social skills in a controlled and systematic manner. However, eventually the child must practice in less predictable, real life social situations. During the transition from contrived to real situations the child is often supported by an instructor who can help him or her stay successful by prompting the behaviour if necessary or by providing additional reinforcement in order to increase the likelihood that the child will indeed engage in the new social behavior vis-à-vis his peers.


5. Check for social validity

One of the main goals of teaching social skills to children with autism is that they will learn to independently build rewarding social relationships. To this end, the final step when teaching social skills is to check for their social validity. In other words, the instructors need to make sure that the child can, in fact, use the social skills they have been practicing. Eg: did an increase in the particular social behaviours the child was taught significantly improve the child's ability to interact with others? If not, the situation needs to be reevaluated. It would be important to closely observe and then record the child's social behaviours (or lack thereof) to determine whether the skills taught were generalised completely across situations, environments and persons. It may be the case that generalisation strategies need to be practiced for a while longer. Or perhaps the observations show that the child needs to learn additional skills in this particular area in order to be helped along in his or her general social development.


Normal results

Outcome studies indicate that Social Skills Training has moderate short-term effects, but limited long-term effects. SST programmes that include social perspective-taking may have greater long-term effects than traditional SST programmes based on Cognitive-Behavioural models. In general, Social Skills Training tends to generalise or transfer to similar contexts rather than to contexts that are not similar to the training. SST programmes for patients with developmental disabilities should include programming for generalisation, so that the clients can transfer their newly acquired skills more effectively to real-life settings. One approach to improving generalisation is to situate the training exercises within the client's work, living or social environment.


The benefits of social skills training programmes include flexibility. The treatment can take place either as individual or group therapy, and new trainers can learn the techniques of SST fairly quickly. An additional advantage of SST is that it focuses on teaching skills that can be learned rather than emphasising the internal or biological determinants of social adequacy.


Future research should explore:-