|Publisher:||Future Horizons, Inc.|
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About the Author
Dr. Roya Ostovar is an Assistant Professor at Harvard Medical School in the Department of Psychiatry. She is a Clinical Neuropsychologist and the Director for the Center for Neurodevelopmental Services (CNS), a program serving those with Autism Spectrum Disorders, at McLean Hospital, the largest psychiatric affiliate of Harvard Medical School. Dr. Ostovar has been part of the faculty teaching the Developmental Disabilities (child and adult) courses and rotations in the MGH/McLean psychiatry residency program. An internationally recognized expert in the fields of Autism Spectrum Disorders, Non-Verbal Learning Disorder, Social Pragmatics Disorder, Social Skills Coaching, and Sensory Processing Disorder. Dr. Ostovar is the author ofThe Ultimate Guide to Sensory Processing Disorder, which received a Creative Child Magazine’s Preferred Choice Award, and the Autism Inventory of Development (AID™) a critical tool used as part of a comprehensive assessment of Autism Spectrum Disorders and Social Pragmatic (Communication) Disorder, both published by Future Horizons.
Dr. Krista DiVittore is an Instructor in the department of psychiatry at Harvard Medical School. She is a staff clinical psychologist at the Center of Neurodevelopmental Services, a program serving those with Autism Spectrum Disorder at McLean Hospital, the psychiatric teaching hospital of Harvard Medical School. In this role she works directly with children, adolescents, and young adults who have neurodevelopmental disorders, sensory processing issues, and co-occurring psychiatric disorders. Dr. DiVittore teaches social/pragmatic skills and skills to tolerate and manage difficult emotions. Dr. DiVittore’s previous work has also included working with children and adults who experienced a variety of psychiatric issues, such as anxiety, mood disorders, and psychosis, all of which impact social interactions and daily functioning. She uses various skills-based modalities including Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) to help individuals master skills that allow them to be more effective and fulfilled in their personal and interpersonal lives.
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Social Skills Are More Than Socializing
A frequent misconception about social skills coaching is that it is helpful only to increase the amount of socializing in your life. While this may be a goal for some individuals, the primary focus of social skills coaching is to increase the quality of the social interactions you have in day-today life and to create positive experiences. By having positive experiences within social interactions, you may be more willing to engage in more socializing. Some simple examples of social skills that often result in positive social interactions include smiling, making eye contact, asking and responding to questions, and giving and acknowledging compliments during a social interaction. Some more complicated examples of social skills include those that have to do with the more subtle nuances of communication, such as unspoken expectations, the meaning behind the words, and sensing what you need to do next. Learning social skills will likely lead to a higher level of comfort in socializing more; however, the purpose is to increase the quality of interactions to reap the positive benefits of connecting with others.
Most individuals who seek social skills coaching services are experiencing some level of ineffectiveness in their ability to relate to others. When you feel like you are able to relate to a peer, colleague, or even an acquaintance, positive interactions are more likely to occur. You also must learn how to relate to others differently. For example, you probably relate to a family member very differently from how you relate to the barista at your local coffee shop or your boss at work. If you are not relating to them differently, it is time to learn that different people in your life require different sets of social skills, whether it is level of formality, sharing of personal information, or other social nuances that are not always clear. This level of interpersonal skill requires awareness and flexibility with how you present yourself and react to others. Individuals who have difficulty relating to others often appear to struggle in their ability to adjust to their audience's preferences and demands, such as level of eye contact or use of humor. Additionally, individuals frequently have difficulty sharing affective experiences or understanding the perspective of others, two skills that are vital to social reciprocity and the development of relationships (Gutstein & Whitney, 2002). One common strategy that social skills coaches will use is perspective taking, which is often presented as questions throughout a social skills coaching session that help build awareness of how each person influences the social interaction (Laugeson & Park, 2014). The questions are intended to improve social knowledge and assist individuals in reading social cues while understanding the perspectives of others. We have developed an exercise to more concretely and simply demonstrate perspective taking. It is a very powerful strategy that helps portray the importance of perspective-taking. It is called "Do You See What I See?"
When a foundation of basic communication skills is developed, the social skills coach also assesses the higher-level interpersonal skills, including making inferences, using non-literal language, and practicing social judgment. Individuals without the necessary social skills often misinterpret others' intentions within social interactions and/or make errors in their social judgment, potentially due to lack of practice or inability to interpret information accurately. As you can imagine, this can lead to confusion, miscommunication, and potentially even conflicts because of misunderstandings. These higher-level skills are learned through self-reflection, performing what we have termed Pause and Reverse (P & R) on social interactions, and perspective taking. We will discuss this exercise later in this chapter.
Understanding Nonverbal Communication
A large and important part of communicating effectively with others is recognizing and understanding nonverbal social cues. This includes the social cues individuals should attend to in order to determine if they are accepted into a conversation, if others like the conversation topic, if others are annoyed, if others want to say something, and more. The ability to understand these cues helps us adjust how we react and interact with others. Individuals with social skills weaknesses often lack the ability to developreciprocal social interactions due to their lack of responsiveness to others' initiations and nonverbal communication. Researchers have also found that individuals with social skills deficits have expressed difficulty comprehending others' facial expressions and understanding the rules of social interaction, sensing the feelings of others, and making adjustments to fit different social contexts or the needs of different listeners (Szatmari et al., 1989; Tantam, 1988; Wing, 1981).
A large part of this difficulty is not being aware of, not understanding, and/or not being able to integrate others' nonverbal cues to make a meaningful interpretation and response. Additionally, the expression of nonverbal communication by individuals with social problems is lacking, including impairments in tone of voice, facial expression, gestures, gaze, and posture (Kerbeshian et al., 1990; Tantam, 1988). The social skills coach provides opportunities to recognize nonverbal communication, interpret nonverbal communication, and use nonverbal communication effectively. By allowing the individual the opportunity to verbally process and interpret what they observe others doing (i.e., nonverbal and verbal social cues) during a social skills coaching session, the individual is also increasing her or his own responsiveness and accuracy of social perception (Koning et al., 2013). Two exercises that we use to practice interpreting nonverbal communication are called "Put It on Mute" and "Tell Me a Story."
Of course, cultural differences and people's different backgrounds and upbringing introduce different degrees of non-verbal cues in social interaction. For example people of Mediterranean descent are generally thought of as more expressive with their use of facial expressions and hand gestures. On the other hand, those from countries of Asia are generally regarded as being more subtle and of using more restraint in their use of non-verbal cues. In Western countries, people who have mastery of this area of communication tend to grab and hold others' attention. Think of the use of non-verbal cues, facial expression, body language, and hand gestures in conversation as the equivalent of various tools used in writing, such as bold text, underlining, using all caps, highlighting, or changing the font in order to communicate differently with the reader. Nevertheless, it is important to understand and use what is the general cultural norm where you are.
It is also important to be aware of how your presence and interactions affect others, how you come across to other people, and how they experience your words and behavior. A very simple and elementary example of this could be when someone is standing too close to you. In this kind of situation, a social skills coach might narrate for an individual, "When you stand so close to me, I feel like you are in my personal space. Even though you don't mean to, you are making me a little uncomfortable, and this might make other people uncomfortable, too. Let's practice how far away you should stand from somebody when you walk up and start a conversation with them." Then the social skills coach would practice with the individual. On a basic level, the social skills coach is narrating for the individual what he or she is communicating with his or her nonverbal communication and helping the individual develop a "self-checklist" to go through when he is with others. This self-checklist may include the following questions: Am I standing too close to someone? Am I moving too much? How is my eye contact? Being aware of your own nonverbal communication is just as important as understanding others' nonverbal communication.
Being self-aware includes having self-knowledge of your needs in social situations therefore increasing your level of insight. Do you get anxious when you approach others to join their conversation? What do you do when you are anxious? How can you regulate your emotions in the moment? The social skills coach will help the individual recognize any internal feelings that occur that may be affecting his or her communication abilities, then find ways to overcome or manage those feelings so that the individual can interact with others more positively and effectively. For example, a social skills coach may prompt you to take a calm deep breath before entering into a social interaction. These prompts can be added to the self-checklist.
We have developed two incredibly effective and important exercises in order to increase our clients' self awareness and understanding of how others may experience being around them and spending time with them. We have termed these lessons, "What Do Others See?" and "What Do Others Hear?"
Creating Positive and Meaningful Interactions with Others
Can you think of a time when you walked away from a really good conversation? You might have thought to yourself, "I really enjoyed that conversation," and you probably felt some positive feelings (e.g., happy, acceptance, excited, energetic, optimistic). Awareness and reflection of social interactions and identifying which interactions were positive, neutral, or negative are also social skills incorporated into social skills coaching. When you cannot understand social cues or are struggling with the basic rules of conversation, it is likely that you don't have many feel-good conversations. This is when misperceptions or misunderstandings of interactions will arise, and the social skills coach will help the individual interpret what happened. Additionally, a social skills coach will introduce social cognition skills, which include expressing emotions, understanding the feelings of others, and empathizing. These higher-level skills allow for an individual to further understand and connect with others in a more meaningful and impactful way. Especially with feedback from the social skills coach, the individual will often be able to notice changes in her behavior and increased effort on her part to interact with others socially.
Many individuals who have social difficulties have likely experienced a lack of opportunities for positive peer interactions, which likely affects the level of their motivation to interact with others. In other words, interacting with others has not been naturally rewarding for them and can sometimes even be a negative experience, so they have learned to withdraw or avoid social interactions. Unfortunately, without the appropriate skill set to navigate complex social situations, individuals without the necessary social skills are more likely to have interactions with others that negatively impact them, including being taken advantage of or being bullied (Carter 2009; Little, 2001; van Roekel et al., 2010). Social skills training is warranted to help prevent unfortunate outcomes like these. By building on mastered skills, teaching new skills, fostering self-awareness, and increasing positive social interactions through practice with immediate feedback from the social skills coach, an individual is likely to increase her social motivation (White, Keonig, & Scahill, 2007).
Social Skills Coaching Is a Frequent, "High-Dose" Service
Just like with medications, coaching services have an optimum dosage level. In this context of social skills coaching, the dose refers to the number of hours of coaching provided per week and the frequency and length of meetings.
Frequency and Length
For many types of treatment or training, more hours per week lead to better outcomes (Lovaas, 1987, Sheinkopf & Seigel, 1998, Smith et al., 2000). Consider again how social skills coaching resembles coaching for athletes; the more you practice a specific skill, the better you will be at it. Generally, social skills training groups spread 30 hours of instruction over 10 to 12 weeks, which has been found to be insufficient for success (Greshem et al., 2001). Studies with longer-term implementation, meaning weekly sessions for up to 16 weeks, were associated with a greater likelihood of significant treatment gains (Miller, Vernon, Wu, & Russo, 2014).
Research has shown that, for individuals specifically diagnosed with autism spectrum disorder, generally 20 to 25 hours per week of one-on-one services has been found to be most effective (Lovaas, 1987; Maglione et al., 2012; National Research Council, 2000; Smith et al., 2000; ViruesOrtega, 2010). Services can include a variety of treatment providers, such as behavioral therapy in the home, individual psychotherapy, executive functioning coaching, occupational therapy, and other venues in which pragmatics and social skills would be practiced (i.e., at school, social skills groups). All services focus on helping the individual increase his social skills and generalize these skills across settings as well as targeting behaviors, thoughts, and emotions that get in the way of social effectiveness. Changes in communication and social skills may only come about with a certain level of intensity of targeted intervention or focus (Kasari, Gulsrud, Freeman, Paparella, & Hellemann, 2012).
Ideally, the individual social skills coaching sessions would be provided three times per week for 90 minutes per meeting. We have found this dose to be ideal and a good general guideline in our work. We also adjust it, of course, to fit the specific circumstances of the individual client. This is especially important for those who have never had any social skills training, start when they are older, have a limited time with their coach, and have the attention and motivation to qualify for the immersion model.
The regular frequency of coaching is very important to provide consistent opportunities to learn and practice newly acquired social communication skills. Think of how much an athlete trains to acquire her skill until the task almost becomes an issue of muscle memory. A primary objective for social skills coaching is for the individual to master social skills to a level of "muscle memory," with the ability to generalize newly acquired skills across settings. We want to practice and generalize the skills until the individual no longer has to think consciously about using the skill. In addition to three 90-minute meetings, in some situations, a social skills coach may also be available for coaching by phone to provide in-the-moment support and feedback on an as-needed basis.
Additionally, social coaching in the community can be added to or replace one or more of the office setting meetings. This is an incredibly powerful way of practicing the skills learned in the office out in the real world with immediate and real-time feedback and input from the coach. We will talk more about the importance and benefits of social coaching in the community in Chapter 4.
Structure of Meetings
Once an individual's goals are identified, social skills coaching sessions typically include a structured lesson on a specific skill, modeling the skill, practicing the skill, discussion, and performance feedback. It has been helpful to split a 90-minute session into two halves. The first half of the meeting is devoted to practicing previously learned skills regarding beginning and maintaining spontaneous conversation. The individual comes into the office or other specified location and starts up a conversation with the coach. The coach will help maintain the conversation, often discussing social interactions that occurred since the last meeting. Sometimes the individual comes in having completed a homework assignment from the previous meeting in preparation for the next session. For example, the client may have had to read three news stories each on politics, popular culture, and sports. Perhaps he was asked to come to the next session and carry on a conversation with the coach about these topics in such a way as he would have a conversation with a friend or coworker about current events.
Sometimes clients may think they are "just talking" and not doing work. It is important to know that a good coach is paying attention to everything while engaging in a seemingly casual conversation with the client — this includes skills such as transitioning from one topic to another, tone of voice, body language, facial expressions, hand gestures, ability to gauge the coach's interest in what the client is talking about, the "feel" of the conversation, the ease of keeping the conversation going, whether it feels more like an interview with short questions and answers, and the natural flow of conversation. This is all critical information for the coach to use as part of the ongoing assessment for the client's plan of care.
Excerpted from "5 Things You Need To Know About Social Skills Coaching"
Copyright © 2017 Roya Ostovar, PhD & Krista DiVittore, PsyD.
Excerpted by permission of Future Horizons, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
What Is Social Skills Coaching?
Who Is a Social Skills Coach?
What Is Social Skills Coaching For?
CHAPTER 1: Social Skills are More Than Scheduling
Creating Positive Meaningful Interactions with Others
CHAPTER 2: Social Skills Coaching Is a Frequent, "High Dose" Service
Frequency and Length
Structure of Meetings
CHAPTER 3: Social Skills Coaching Is Individualized for Everybody
Assessing for Social/Pragmatic Needs
Methods Used to Build Social Skills
CHAPTER 4: Social Skills Happens Inside and Outside the Office
Social Skills Coaching in the Community
Social Skills Coaching with Caregivers, Partners, Schools
CHAPTER 5: Social Skills Coaching Improves Quality of Life
Connecting with Others
What People are Saying About This
The wide-spread understanding is that socializing with others generally brings meaning and comfort to our lives. When our social skills are lacking, weak, or underdeveloped, we may not be able to fully engage with and appreciate our relationships with other people. So, how do we teach socializing and interpersonal connection, something intuitive to so many of us? The approaches do not always seem to fit the need.
Most books on social skills training target the very young and school-age children and/or those who struggle significantly in this area and lack any social skills at all. The books are written in a language that is appropriate for these two groups only, often accompanied by simple cartoons, pictures, and drawings and thought or word bubbles, a format that may be experienced as condescending or disrespectful by many. The assignments, examples, and scenarios are also designed to address young children and those with significant social challenges. What I have found incredibly refreshing and different about 5 Things You Need to Know about Social Skills Coaching is that the content crosses all ages, stages, and abilities from a young school-age child who needs to learn basic greeting to an otherwise successful and highly educated adult who just wants to improve certain targeted social skills.
Social skills groups often target young children and, more recently, teenagers, but what about young adults and adults continuing to struggle with day-to-day social interactions? Psychotherapy often targets the co-occurring issues that influence effective socialization and behavioral therapies are often limited to very basic skills learning. What about the individuals who never developed the skills of interpretation, integration, and inferencing, all critical in any social situation? What about making a connection between a nonverbal and verbal piece of information? There is a need for highly focused, individualized social skills coaching for those who are not receiving the support they need to develop very important skills to keep up with the complexities of social interactions.
This easy-to-read guide provides a helpful overview of social skills coaching for a wide range of people who are entering into this conversation. Written by two psychologists who provide social skills coaching to a wide range of populations, Drs. Ostovar and DiVittore have provided a thoughtful and comprehensive perspective on the importance of developing skills at any time in your life, incorporating wisdom and knowledge from their experience providing coaching and therapy. They share what they have seen benefit so many individuals.
In consulting and working with Dr. Ostovar for more than fifteen years, I have also seen this approach work for individuals with highly complex histories and presentations (including individuals diagnosed with nonverbal learning disorder and autism spectrum disorders), as well as individuals who are considered high-functioning and just need support in a specific set of skills. Because needs vary given the person’s developmental level and where the person is in life, the individuality and customization of social skills coaching provides the necessary level of support to identify what areas need attention.
Among the best features of this book are the practical strategies that can be used within social skills coaching. Although many of us may incorporate these strategies into our life without even being aware of doing so, the way the authors explain their different strategies is relatable and approachable for individuals who may have to work harder at socializing.
Most importantly, the authors emphasize an approach that treats the individual from a supportive and strengths-based approach. Instead of emphasizing what the individual is doing wrong or not doing at all, the authors provide the sense that social skills coaching is meant to work toward the individual’s goal by further developing the skills the individual brings to the table. This allows the individual to feel empowered and confident to try socializing in a different way. The authors’ description of coaching as similar to coaching in sports demonstrates the idea that the social skills coach is not there only to teach and for practice, but also to encourage self-awareness and reflect on the individual’s progress.
This well-written short guide is a wonderful resource for everyone, beginners and experts alike, exploring how to incorporate social skills coaching into their lives and practices. As you will learn throughout the easy-to-follow guide, this innovative approach to understanding and learning social skills coaching fills a gap in the current available resources on the topic.
Blaise Aguirre, MD, Medical Director 3East DBT-Continuum at McLean Hospital, Assistant Professor of Psychiatry at Harvard Medical School
Blaise Aguirre, MD, is an expert in child, adolescent, and adult psychotherapy, including dialectical behavior therapy (DBT) and medication evaluation and management. He is the founding medical director of the 3East Girls Intensive and Step-Down programs, unique, residential DBT programs for young women exhibiting self-endangering behaviors and borderline personality disorder (BPD) traits. Dr. Aguirre has been a staff psychiatrist at McLean Hospital since 2000 and is nationally and internationally recognized for his extensive work in the treatment of mood and personality disorders in adolescents. He lectures regularly in Europe, Africa, and the Middle East on BPD and DBT.
Dr. Aguirre is the author of:
Borderline Personality Disorder in Adolescents,
Depression (Biographies of Disease)
Mindfulness for Borderline Personality Disorder (co-author)
Helping Your Troubled Teen