Social skills training for rehabilitation of psychiatric patients.

1. Social Skills training
By Rakshith H.S

2. • Social skills Training- The term social skills denote that the technique for
facilitation of survival in the social world can be learnt. They are based on
predominately learning experiences.
• Training- It utilizes behaviour therapy principles and techniques for teaching
individuals to communicate their emotions and requests so that they are more
likely to achieve their goals and meet their needs for affiliative relationships
and roles required for independent living.

3. • Skills are the raw material of social competence and comprise the full range of
human social performance: verbal nonverbal, and paralinguistic behaviors;
accurate social perception; effective processing of social information.
• reasonable expectations of situations, and rules of society; assertiveness;
conversational skills; skills related to management and stabilization of one's
mental disorder and expressions of empathy, affection, sadness, and other
emotions that are appropriate to the context and expectations of others

4. • Problem identification” is made in collaboration with the patient in terms of
obstacles that are barriers to a patient's personal goals in his/her current life.

5. Where is the problem?
• Eye contact
• Expression on our face
• Tone & volume of our voice
• Body language

6. Goal setting-generates short-term approximations to the patient's personal goals
with specification of the social behaviour that is required for successful attainment
of the short-term, incremental goals. The goal-setting endeavour requires the
therapist or trainer to elicit from the patient detailed descriptions of what
communication are to be learned.

7. • Role play-Through “role plays” or “behavioral rehearsal,” the patient
demonstrates the verbal, nonverbal, and paralinguistic skills required for
successful social interaction in the interpersonal situation set as the goal.
• Clearly indicate the beginning and end of a role play
• The goals are broken down into easier steps to manage objectives, the
learning and understanding of social skills are enhanced when individual
steps are introduced.
• The steps could be given in handouts to practice and also written on a white
board for practice.

8. • Positive and corrective feedback-“Positive” and “corrective feedback” is given
to the patient focused on the quality of the behaviors exhibited in the role play
Elicit positive feedback from the group participants.
Feedback should be helpful and be specific.
Elicit suggestions for improvement in subsequent role plays
• Limit feedback to one or two suggestions
• Communicate in positive, optimistic manner
A beneficial format for providing corrective feedback includes being:
short, non-fault-finding, and behaviour specific.

9. • A useful manner for providing corrective feedback includes:
For this role play that [name] did, what did you like about the way they did it?”
“For the [name of social skill] social skill, which steps of the skill did you see
[participants name] doing?

10. Repeat supervised Practice-
• inquire into the understanding of suggested change
• Focus on important (to client)and changeable behaviours.
• involves incorporating the corrective feedback-
I would like you to try another role play of this same situation. What I would
like you to do a little bit differently this time, however, is to
include….[corrective feedback]

11. • Homework assignment-
The homework items should begin with easier assignments and
progressively increase in difficulty and complexity as the group members skill
and confidence increases. The homework should follow the theme in the
session and should be attainable to present a challenge. The task must be in
line with the theme of the session

12. Basic theories that come from the laboratory-
• operant conditioning
• social learning theory
• social cognition

13. The need-
• Personal Problems or Needs Utility of Skills Training for Learning
• Persistent positive symptoms Coping skills to manage symptoms and
interpersonal communication to challenge psychotic symptoms in cognitive
behaviour therapy.
• Negative symptoms Verbal and nonverbal communication and emotional
expressiveness.
• Erosion of skills from understimulating environments Countering effects of
institutionalism.
• Social anxiety and avoidance-Incremental steps for communicating with others
in varied situations; modeling and role plays in training situation desensitize
anxiety.

14. • Stressful emotional climate in family or group home or at work Verbal and
nonverbal de-escalation skills, assertiveness rather than passivity or
aggressiveness; social problem-solving skills.
• Cognitive deficitsWork or social problem- solving skills through procedural and
active teaching.
• Acceptance and stabilization of illness; partner in treatment; achieving insight.
Disease management skills; reliable use of medication; negotiation skills with
psychiatrist and other service providers; empowerment and hope through self-
management skills in “getting a life”.
• Stigma-Assertiveness in dealing with discrimination; judicious self-disclosure,
advocacy through peer support and self-help organizations.
• Social isolation-Pleasantness of conversation increases likeability.

15. • Employment Job-finding skills, communicating with employers and co-
workers.
• Independent living Skills in obtaining housing; social problem solving with
roommates

16. • The training takes the form of special education and precision teaching.
Repeated practice or overlearning is essential to ensure assimilation and
durability of interpersonal skills.
• Skill training can be done with individuals, families, and groups.
• There are advantages of each of these modalities; eg, the training process and
acquisition of skills by individuals is more rapid
• Conducting skills training with family members present can directly influence
family communication and problem solving that, in turn, results in reductions in
the stress-inducing “emotional temperature” of the family.
• group therapy is the principal modality for doing social skills training.

17. The Setup for the social skills –
• Instruction- Introduce sessions focus on specific social skills
• Rationale-the reason for learning the skill
• Discussion of the components- step by step of the process.
• Model- a planned roleplay for the session.
a) Supervised practice- begin with compliant or better skilled participant
b) Group leader and client to engage in the role play
c) Client should understand the goal of roleplay
d) Other members should observe the role play/
• Review- The effectiveness of the role play
• Positive feedback- Elicit positive feedback from group participants.
a) Feedback should be specific

18. • Corrective feedback- Elicit suggestions for improvement in the next role plays
a) Limiting feedback to one or two suggestions
b) Communicate in positive, optimistic manner.
• Collaboratively assigned homework and review sessions-
The homework items should begin with easier assignments and progressively
increase in difficulty and complexity as the group members skill and confidence
increases. The homework should follow the theme in the session and should be
attainable to present a challenge. The task must be in line with the theme of the
session
The level of difficulty of the items presented to the client should based on the
observation of the client. And also the successful completion and failure of the
clients in completing the assignments

19. • initiating conversations,
• responding to initiations of others,
• taking turns talking during conversation,
• changing topics during a conversation,
• asking questions during a conversation,
• strategies for what to do when you disagree during a conversation,
• inviting a third person into a conversation,
• leaving a conversation, and
• ending a conversation.

20. Prototype-
The first session might be a little anxiety provoking since most of the
participants might not know each other. Include an “Ice breaker” to build
familiarity.
Activity- ‘My Shoe Ice-Breaker'

21. This involves asking everyone to look down at their shoes and think of how they
would describe them (colour, fit, age, etc.), including a brief storywhich directly
relates to them (e.g. where they were purchased, an unfortunate accident
encountered whilst wearing them) . The therapists begin this ice-breaker, first by
stating their names and then commenting on their shoes. Subsequent participants
then participate by following the therapists examples.

22. • The session can also focus on getting the participants feedback on the type
of rules that would govern the session-
• Use language everyone can understand.
• Sessions are tape recorded —optional.
• All members are respectful and helpful to each other.
• Commitment to therapy.
• Breaks within each session.
• Attend each session and arrive on time.
• Buddy system

23. • Self-Disclosure :In order that participants become accustomed to the process of
self-disclosure, it is important to ensure this is occurring in a safe environment.
• Why Change handout-Upon completion, they are asked to pair up with one of
the other members of the group. At times the therapist may make the pair
assignments. Includes reasons for change.
• Pair the Participant with another in the group and ask them to exchange their
notes and make them interact 3-5 minutes talking about their problems and what
they would like to improve.
• Explain the need to practice the skills taught outside the sessions. Home work
assignments will need to be practiced outside the sessions. Could be reading ,
thinking through their head, and doing the behaviour.

24. role play session-
Activity-You Have It & I Would Like It
The desire to make a request implies that someone wants something from another
person. In order to demonstrate how individuals request items from others, the
following group activity can be used to illustrate how this is done.

25. • Have group members form pairs, with one member of the pair pretending they
have something and want to keep it. The other person attempts to persuade
the first person to give ‘it’ to him or her, by speaking to them.
• After the pair has finished their interaction, a different pair of individuals
should be formed.
• You can make the same pairs, shift their tasks.

26. • Instructions-” Usually, the speaker looks directly into the listener’s eyes, and
the listener moves his or gaze around the speaker’s face. If you are listening, it
is important to be mindful not to stare at one single spot on the speaker’s face.
This could result in the other person becoming uncomfortable . When the
speaker pauses, the listener then has an opportunity to speak, and they usually
‘break off’ eye contact. As opposed to ‘butting-into the conversation‘, the
listener wanting to speak tries to ‘catch’ the speaker’s eyes to signal the desire
for a chance to talk. This is sometimes called correct turn-taking.”

27. • Say exactly what you would like the person to do, and why you need/want it.
• Instructions-A clear and direct request is much more likely to be successful
since it states what is wanted from the other person. An example of a direct
request would be, “I understand that you like to have milk in your tea, but if
you would put the milk back in the refrigerator after using it, the milk would
stay fresher longer, and I would appreciate it.” This statement indicates
precisely what is wanted (putting milk back in fridge after using it). A much
different way involves saying things in an indirect way. An example of this
would be to say, “put things away.” Saying it this way does not help and gives
incomplete information.

28. • Tell the person how you would feel, if your request is carried out.
• Phrases-
“I would like you to ____, and I would
feel……….”
“I would really appreciate it if you would do ___,
and this would make me feel………..”
“It’s very important to me that you help me with
____, as this would make me feel……....”
Break-
Feedback