Social skills training
Social skills training (SST) is a form of behavior therapy used by teachers, therapists, and trainers to help persons who have difficulties relating to other people.
A major goal of social skills training is teaching persons who may or may not have emotional problems about the verbal as well as nonverbal behaviors 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 patients 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 behaviors, they will raise their self-esteem and increase the likelihood that others will respond favorably to them. Trainees learn to change their social behavior patterns by practicing selected behaviors in individual or group therapy sessions. Another goal of social skills training is improving a patient's ability to function in everyday social situations. Social skills training can help patients to work on specific issues—for example, 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 patients with a broad range of emotional problems and diagnoses. 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 ; schizophrenia ; developmental disabilities; 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 patients with alcohol dependence, a therapist who is using social skills training focuses on teaching the patients 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 social skills training 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 patients 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 obsessive-compulsive personality disorder (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 social skills training. 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-deficit/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 patients 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 patients 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 patients 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 .
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 patient is not overwhelmed by trying to change too many behaviors at one time. In addition, social skill trainers should be careful not to intensify the patient's feelings of social incompetence. This caution is particularly important in treating patients 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 generalization or maintenance. Generalization takes place more readily when the social skills training has a clear focus and the patient 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 patients involved.
Techniques in social skills training
Therapists who use social skills training begin by breaking down complex social behaviors into smaller portions. Next, they arrange these smaller parts in order of difficulty, and gradually introduce them to the patients. For example, a therapist who is helping a patient learn to feel more comfortable at parties might make a list of specific behaviors that belong to the complex behavior called "acting appropriately at a party," such as introducing oneself to others; making conversation with several people at the party rather than just one other guest; keeping one's conversation pleasant and interesting; thanking the host or hostess before leaving; and so on. The patient would then work on one specific behavior at a time rather than trying to learn them all at once.
Such specific techniques as instruction, modeling , role-playing, shaping, feedback, and reinforcement of positive interactions may be used in SST. For example, 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. For example, two 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 nonverbal and assertive communication and with making conversation. It might also include conversational skills that are needed in different specific situations, for example 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 programs involves improving a patient'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 nonverbal. 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 program may include skills related to the perceptual processing of the conversation of other individuals.
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 patient'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 behavior 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 or 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 program.
Generalization or transfer of skills
Current trends in social skills training are aimed at developing training programs 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 generalized or transferred to another setting or situation. To assist patients in using their new skills in real-life situations, trainers use role-playing, teaching, modeling, and practice.
Preparation for social skills training requires tact on the therapist's part, as patients 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 patient 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 behaviors. It is often more helpful for the therapist to ask the patient to identify behaviors that he or she would like to change, rather than pointing to problem areas that the therapist has identified. The treatment should consider the patient's particular needs and interests. Whereas social skills training for some patients may include learning assertiveness on the job, training for others may include learning strategies for dating. Therapists can prepare patients 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.
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 patients with schizophrenia, compared to a group that had no follow-up.
Outcome studies indicate that social skills training has moderate short-term effects, but limited long-term effects. SST programs that include social perspective-taking may have greater long-term effects than traditional SST programs based on cognitive-behavioral models. In general, social skills training tends to generalize or transfer to similar contexts rather than to contexts that are not similar to the training. SST programs for patients with developmental disabilities should include programming for generalization, so that the patients can transfer their newly acquired skills more effectively to real-life settings. One approach to improving generalization is to situate the training exercises within the patient's work, living, or social environment.
The benefits of social skills training programs 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 emphasizing the internal or biological determinants of social adequacy. Future research should explore the integration of social skills training with the needs of families from different cultural backgrounds; the relationship between social skills training and different categories of mental disorders; the transfer of skills from therapeutic contexts to daily life; and improving patients' long-term gains from SST.
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American Psychological Association, 750 First Street, NE, Washington, D.C. 20002-4242. (202) 336-5500. <http://www.apa.org> .
Judy Koenigsberg, Ph.D.