Journal of Adolescence x979, 2, 229-238
A social skills training group for early adolescents JAMES J. PEASE* A programme of x5 weekly group sessions designed to teach social skills is described together with some theoretical justifications for the choice of methods used. The group members were early adolescents, age range xo'5 to I4 years, with a wide spectrum of psycho-social problems, but having in common inadequate social skills to tackle their problems at an interpersonal level. Originally all had been referred to a hospital based Child Guidance Clinic. Two groups using the format described have been run, and clinical assessment suggests the groups have been effectivein teaching social skills. The relative contribution made by the structured learning programme, direct feedback, and small group dynamics is discussed. Methods of objectively assessing outcome are discussed, and a pilot attempt to measure change is described. INTRODUCTION In an earlier issue Trower described recent research and reviewed a selection of programmes of social skills training for adolescents (Trower, z978); this present paper describes one approach to such training. The research literature on social skills training, together with that on assertive training, has also been reviewed by Marzillier (z978) who concludes that most studies show a trend, suggesting that these therapies are effective in adult in-patients and outpatients, although the problems of measuring the results leave this largely unproven. It would seem possible that teaching social skills to early adolescents (or perhaps children) might be even more successfulsince one would be influencing the acquisition of skills at a time when they would naturally be acquired, and would not be faced with such an extensive task of undoing maladaptive skills. In their book Trower, Bryant and Argyle (1978) discuss how the skills of social interaction may be acquired in childhood. They conclude that the basis of learning is likely to be the child having the opportunity to observe the parents and others modelling social skills, followed by having the chance themselves to imitate and practice what they had seen. Reinforcement of such learnt behaviour by parental approval, or achieving a desired response, will further consolidate such learning. There may also, in their view, be an * Department of Child and FamilyPsychiatry,2, Brookside,Cambridge ox4o-x97x179/o3ozz9+ to
$o2t,oo]o
9 I979 T h e ~ o c i a t i o n for the Psychiatric Study of Adolescents
"29
23o
J.J. PEASE
innate potential for social interactions as well as cognitive abilities that develop to facilitate more advanced interaction. If this is the case, it seems children from backgrounds dominated by parental inadequacy, marital strife, failed communications, conflict with authorities, and family break-up might constitute a group at risk of failing to develop adequate social skills. Support for this hypothesis would come from the high association between such backgrounds and subsequent conduct or neurotic disorders in childhood which have as one component an inability to satisfactorily interact with adults or peers. For most children with these backgrounds, the only settings for appropriate models are those of schools and youth clubs, and perhaps the company of their luckier peers. For the minority who are temporarily institutionalised in adolescent units, assessment centres, community schools, children's homes, and the like, we suggest this opportunity to acquire alternative social skills is an important component of the 'milieu' therapy provided. We have chosen intentionally to teach children passing through our centre these skills, in the hope that we might break their life-cycle of social failure before entering adolescence proper. THE GROUP ORGANISATION T h e group met for one and one quarter hours on 15 successive Mondays. T h e setting was an empty, carpeted room of 4 • 7 metres, with adequate lighting for video recording. T h e group was a closed group of six children. We attempted to maintain the same staff membership, a male and a female therapist (a Child Psychiatrist and Clinical Psychologist) and two fully participant staff members (the Ward Sister and Ward Schoolteacher). This high adult/child ratio appeared most valuable; the adults exemplified a constructive approach to the learning situation, they could give children much needed support, and perhaps desensitise them to witnessing adult emotions. Both therapists were trained in the use of video cquipment. SELECTION OF CLIENTS
Each group was composed of six children at approximately the same stage of psycho-social development, and ranging in age from Io'5 to 14 years. At this age we anticipated they would be mature enough to recognise their social shortcomings and wish to alleviate them, but still young enough to accept and use the educational authoritarian approach we used. Referral was from psychiatrists and psychologists working in a district general hospital child psychiatry clinic and in-patient unit. Formal psychiatric diagnosis did not appear a useful selection criteria, although we excluded any hallucinated or
SOCIALSKILLSTRAINING
23x
deluded child. We considered children of either sex with general interpersonal difficulties,such as having a poor awarenessof others, or of their own feelings; having difficultyin expressing their feelings; feeling shy or lacking the means of making friends; or simply those who, lacked friends of either sex. We conceptualisedthe training as being one componentof an integrated treatment plan in which family therapy, remedial teaching, symptom management, etc., would be dealt with outside the group, usually before joining it. Prospective clientswere screencd by one of the two group leaders, and if the referral was appropriate, offereda place in the forthcominggroup. We accepted in-patients as well as out-patients. A mixture of age, sex, class and problems were all acceptable as the resultant melting pot contained a variety of cultural experiences,provided flexibilityfor potential rolc playing, and increased the likelihood that some would have competence and assets where others had not. PREPARATION FOR THE GROUP Following initial assessment we explained to the child, and his parents, how we believed the successful use of social skills resulted in better relationships with peers, parents and other adults. We then looked at the child's particular problems to see if improving his relationships might help alleviate his symptoms. The organisation of the group was described, how it might help discussed, and the need for commitment to attend (despite setbacks) stressed. In practice all agreed to this contract and it appeared to give them a sense of participation which might not have been the case without preparation. Parental consent for making video recordings was obtained. INTRODUCING THE HARDWARE The use of audio and video equipment was vital to various stages of the group so we wished to minimise the potential disturbance when it was introduced. We used a preliminary session to demonstrate the audio cassette player, the video rover camera, recorder and monitor. Various greeting games were used to give the group the opportunity to hear their voices and see themselves on the monitor. To our surprise the children accepted these novel experiences far more readily than the adults. After this the equipment was only set up for the sessions where it was to be used. CONTENT OF SESSIONS The content may be divided into the group process itself and the educational material that we planned to introduce and practice. These will be artificially separated for the sake of clarity. Though the power of any coexisting group
23z
J.J. PEASE
process was undoubtedly an important factor in outcome we chose only to exploit it to a limited extent. Our intention was to run the sessions on behavioural lines and minimise the interpretive use of group dynamics. Behavioural group therapy is more fully discussed by Johnson (i975).
The group material In the Opening Sessions, plans involved confronting individuals with how others saw their behaviour and encouraging experimentation with more successful behaviours. Clearly these plans could create significant personal insecurity which would have to be countered if the individual were not to withdraw. In view of this, the early sessions were designed to develop a cohesive group identity in which individuals shortcomings were accepted. We found this could be achieved by a high degree of structure, firm leadership, group games that created trust, and the therapists supporting the weaker members. Both staff and children removed their shoes for the sessions, all participated in each game or exercise (unless someone was filming), and when discussing the games all sat on the floor. In these ways equality and preparedness to expose oneself were stressed. In this first phase one might anticipate individuals would idealise the therapists, and model themselves on their behaviour; this proved to be the case, and the staff played an important role in modelling being an adequate group member. It seemed important to mix fun with the more serious material, and also to maintain optimism and create hope. In the middle sessions dynamic material did emerge both in the form of selfdisclosure and challenging the leadership. We attempted to monitor the ongoing group process in our after-group staff discussions, using some developments as the basis of the next week's role plays, and in scapegoat situations choosing pairings that would counteract the situation. Where individual or group feelings erupted in a session, the leader steered discussion onto how the feeling might be common to all group members, emphasising the behavioural aspects of the situation that precipitated the feelings. The continuity with earlier safe sessions was maintained by using a starting exercise (often a cool down rather than a warm up) and inevitably the same closing exercise. After holiday breaks most of a session had to be devoted to recreating the group cohesiveness through games, and holiday anecdote swapping. In the dosing sessions we had other tasks. The two groups we conducted developed strong identities so predictably termination became an issue. Attempts to perpetuate the group by regressing, by producing new problems and by exposing the limitations of what they had learned were all contended with. For these children, most of whom came from abnormal families, the dosing of the group meant the loss of very powerful adult]child relationships
SOCIAL SKILLS T R A I N I N G
=33
with the staff; for some at least this degree of adult caring was a new experience, so the loss all the more difficult to handle. Where the loss of a parent bad been a reality, extra effort was made to work through the loss of a therapist. The educational material
A scheme was developed to introduce the concepts we believed to underlie normal social behaviour, and to do so in a structured way. Complex (real life) social interactions can be broken down into strategies, rituals and elements of social skills. This analysis of social interaction was based on the work of Trower et aL (1978). In our sessions this breakdown process was reversed, the elements taught first, strategies and social rituals added, gradually leading up to role play real life situations by the eleventh session (see Figure I). Non-verbal elements (e.g.: posture denoting anger)
T
Verbal elements (e.g.: tone denoling anger)
Single skill situations (e.g., expressing anger)
Social Conventions (e.g.: avoiding ogressive gestures)
Conversation skills (e.g.: opening Conversation)
Complex skill situations (e.g.; making a constructive complaint)
Accessory skills (e.g.: problem solving)
Complete social interactions (e.g.; returning faulty goods to a shop- gets it off his chest, gets his own way, doesn't cause resentment).
Figure z. Flow diagram showing reconstitution of a social interaction.
Early sessions The so-called dements are sub-divided into non-verbal, e.g. posture, gesture, facial expression; and verbal, e.g. volume, tone, pitch and intonation. Learning about non-verbal elements provided an undemanding introduction
234
J.J. PEASE
tO the group, and introduced the idea that complex behaviour can be broken down into its constituent parts and analysed. We found the group registered the emotions associated with the behaviour under scrutiny, but had to be helped to convey verbally what they saw. Not only was their vocabulary poorly developed, but they lacked the ability to empathise with how the subject might be feeling. It proved possible to teach empathy skills by breaking down the observed behaviour into recognisable elements and then summarising the impressions gained. A useful aid to identify the emotional content of the elements was for the individual to copy the posture, gesture, etc., that he saw and thus experience it first hand. The elements, and their emotional associations, were taught by using awareness exercises emphasising the five senses, by sculptures, and by staff modelling. These early sessions contained four to six games or exercises each designed to illustrate a particular point. The game was played, then the group sat in a circle to discuss aspects of it. The leader attempted to help the children formulate their own concepts from the games rather than telling them what they should have experienced. The exercises were programmed so the understanding of one set of concepts led on to exercises incorporating them in more complex forms. This programming gave the leaders rapid feedback of comprehension, and enabled poorly understood areas to be practised, with additional exercises added for further clarification. The first four to five sessions did not concern themselves with the content of the spoken word, only its emotional characteristics. Social rituals were then analysed, and this process became the basis of teaching strategy in situations demanding complex skills. For example, the group watched two members model a greeting in the street, and then broke down what they had seen into stages, viz: recognition, signalling recognition, approach, physical greeting, adopting conversational posture, eye-contact, verbal greeting, ritualistic question and counter question ("How are you?". "O.K.". "And you?"), start a conversation. At this stage individuals recall of what was observed was so unreliable that video feedback became essential. The children easily learned to break down social interactions into stages, but were dubious about the necessity to follow social convention. Video feedback of members, in this instance, greeting each other soon demonstrated that some created more favourable impressions than others, and missing stages or poorly performed stages could be recognised as helping to generate an unfavourable impression. These conventions could be further emphasised by staff modelling how not to do it, and the children directing them as to how to correct their performance. d~Iiddle sessions
Even with their newly developed inter-personal awareness and social conventions our children could not sustain a conversation. The sessions then
SOCIAL SKILLSTRAINING
235
moved to developing conversational rules and techniques. Initially less threatening group exercises with audio feedback were used to develop rules of turn taking, then video feedback to learn handing-over and taking-up signals, gestures and noises to encourage the speaker, and speaker awareness of his listener. Conversational gambits sometimes described as "active listening" were taught to enable the individual as a listener to help his speaker sustain his story. An example is mirroring, when the listener mirrors (repeats) something the speaker has just said and adds a question that will encourage the speaker to disclose more information. Once the children had developed a set of conversational rules and some gambits to keep conversation going, the group split into pairs to practice. This led to the final format used in the remaining sessions. Late sessions
The final sessions retained a closing exercise to help the group unwind, and become united again, but otherwise were devoted to role play in the form of social behaviour rehearsal. At first, conversations were practised out of their natural context, then complete social situations rehearsed. For these children, to have the experience of four or five social encounters in which they had coped adequately seemed important (on the assumption that based on past failure their expectation of coping was minimal, which usually became a self fulfilling prophecy). Half of each session was therefore spent in practising and planning the role play then in the second half their finished product was videoed and played back to them. Needless to say the results were not always acceptable, the children hastening to eriticise each other, and certainly to emphasise mistakes. Positively reinforcing well performed skills seemed the most appropriate teaching strategy, yet the mistakes could not be ignored completely. A solution was found in designating the dominant therapist the positive reinforcer who stressed effusively the good points, while the other neutral therapist unemotionally clarified the mistakes, and in addition steered the feedback provided by other group members in a positive manner. These role plays were designed to use specific complex whole situation social skills as described by Goldstein, Sprafkin and Gershaw (I976), although these authors list 59 such skills we chose only a few useful ones, e.g. asking someone to do something for you. We tailored role plays to individuals interests and problems, in order to create a balance between success, and giving extra practice in weak areas. It became clear that adults must play adults, and children be themselves if the situations were to be realistic. T h e two participating staff members took the adult role where it was desired to improve child/adult social interactions. T h e format used was to hand the predetermined pair a card bearing the outline of a role play (see Fig. 2), and a
J.J. PEASE
236
framework for this to be broken down into stages. The pair then planned and practised privately in a corner, while the therapists circulated amongst the pairs to give extra help. When everyone was satisfied, each pair's role play (of about 4 to 5 min) was video-taped in turn. The group formed a semi-circle around the monitor and watched each role play, once without comment, once without sound, and once freezing the picture at important stages to illustrate and discuss various points. This system not only gave direct feedback, but also enabled us to emphasise the non-verbal as well as the verbal content of the role plays. In passing, video film is tiring to watch, and reviewing three role plays stretched the children's powers of concentration to their limit. SAMPLE OF ROLE PLAY SCRIPT Asking for help. You will be out all day and you have a canary that has to be given medicine with an eye dropper. You go to your neighbour and ask if he/she can do this for you. (1) (2) (3) (4) (5) (6) (7) (8)
Start conversation. Explain problem. Ask for his/her help. Explain exactly what it is you want to them to do. Ask for his/her reaction. Iron out any misunderstandings and summarise what you have agreed to. Thank him/her. End conversation.
Figure 2. Sample of role play script. EVALUATION OF OUTCOME The programme described was not designed with research in mind, so outcome data is largely anecdotal and subjectively appraised. In other studies two main strategies have been utilised: the client may be presented with a self-rating scale of the social situations (degree of difficulty rated) which includes such items as going to parties, going into a room full of people, being with only one person. This scale would be complete before and after the training programme. The second strategy is to involve the client in a structured role play where independent raters rate general impressions and elements of social interactions such as: voice volume, posture position, gesture, conversation meshing, etc. Again this is carried out before and after training sessions (Hersen, Eisler, Miller, Johnson and Pinkston, x973). These two strategies were used by Trower et aL 0978), other authors have used less
SOCIAL S K I L L S T R A I N I N G
:~37
direct strategies such as presenting situations on film and asking for appropriate responses (Goldsmith and McFall, x975). Another author has constructed sociograms in the school classes from which the child has been taken (Oden and Asher, x977). Sociograms are impractical where the children come from varied sources, and it is uncertain how filmed situations related to real life situations, so these techniques were ruled out. Trower's situations questionnaire was unsuitable for children. We doubted whether it would have any reliability when completed by early adolescents or their parents so it was decided to use a structured role play, video-tape it, and have it independently rated. The method and rating procedure was as used by Trower et al. (x978) with the role play being two youth leaders interviewing the child prior to joining a youth club. As already mentioned, these groups were not designed for research, so in trying this evaluation technique we were only assessing its practicability with this age group. Structured role plays proved to be time consuming to set up, the constraints imposed by unsophisticated video equipment irritating, and obtaining interrater reliability on such small numbers almost impossible. Despite these criticisms the technique did seem to measure relevant components of social interaction, and with more sophistication and inter-rater training could prove effective. RESULTS Of the ten children involved, two were in-patients, and a further five were inpatients for part of the time only; with none of these was there any problem of non-attendance. One of these was invited to join the second group, but did so only sporadically so was discouraged from continuing. Three were outpatients throughout the group, and two of these missed three to four sessions each; in both cases reasons appeared more to do with their mothers' psychopathology than group dynamics. A pattern became apparent where about half the children made quite startling improvements, not only in the group, but in their lives outside. These children typically had introverted personalities and failed socially through poor technique and performance anxiety. This anxious group seemed to do particularly well. The remainder improved less dramatically, although noticeably; these had more extraverted personalities, were less obviously anxious, and often had backgrounds containing inappropriate adult modelling of social skills. This second group was harder to help, perhaps in the short term their maladaptive social skills "got them by", so their motivation was less, and the learning process also involved considerable unlearning. In selecting for a future group a mixture of the two types would still seem desirable but with a majority of the anxious type.
~38
J.J. P E A S E CONCLUSION
This article has set out to describe one approach t o t e a c h i n g social skills to early adolescents, the approach was a pastiche of techniques familiar to the leaders supplemented with additional new games and exercises. V~refound the approach enjoyable both for the kids and staff; more importantly the results were encouraging. It is hoped that the discussion of the techniques used will be of help to others planning such a group. No attempt has been made to isolate and test the effectiveness of components of the group, although an instrument for overall assessment of change was utilised. This project was designed and run as a joint venture with Dr Glenys Parkinson to whom I should like to extend my greatest thanks. REFERENCES Goldsmith, J. B. and McFall, R. M. (x975). Development and evaluation of an interpersonal skill training programme for psychiatric in-patients. Journal of Abnormal Psychology 84, 57-8. Goldstcin, A. P., Sprafkln, R. P. and Gershaw, N. J. (1976). Skill Training for Community Living: Applying Structured Learning Therapy. Oxford: Pergamon Press (Structured Learning Associates.) Hersen, M., Eisler, R. M., Miller, P. M., Johnson, M. B. and Pinkston, S. G. (x973). Effects of practice, instructions and modelling on components of assertive behaviour. Behavlour Research and Therapy IX, 443-5. Johnson, W. G. (x975). Group therapy: a behavioural perspective. 13ehaviour Therapy 6, 3 o - 3 8 .
Marzillier, J. (I978). Outcome studies of skills training: a review. In Social Skills and l~Iental Health. Trower, P., Bryant, M. and Argyle, M. (Eds). London: Methuen & Co. Oden, S., Asher, S. R. (I977). Coaching children in social skills for friendship making. Child Development 48, 495-5o6. Trower, P. (x978). Skills training for adolescent social problems: a viable treatment alternative ? Journal of Adolescence x, 3 I9-29. Trower, P., Bryant, B. and Argyle, M. (I978). Social skills and mental health. London: Methuen & Co. Sources of books for games Brandes, D. and Phillips, H. (x978). Gamesters Handbook : x4o Games for Teachers and Group Leaders. London: Hutchinson & Co. Sacher, A. E., VerralI, C. (x975). xoo+ ldeas for Drama. Heinemann Educational Books.
A social skills training group for early adolescents JAMES J. PEASE* A programme of x5 weekly group sessions designed to teach social skills is described together with some theoretical justifications for the choice of methods used. The group members were early adolescents, age range xo'5 to I4 years, with a wide spectrum of psycho-social problems, but having in common inadequate social skills to tackle their problems at an interpersonal level. Originally all had been referred to a hospital based Child Guidance Clinic. Two groups using the format described have been run, and clinical assessment suggests the groups have been effectivein teaching social skills. The relative contribution made by the structured learning programme, direct feedback, and small group dynamics is discussed. Methods of objectively assessing outcome are discussed, and a pilot attempt to measure change is described. INTRODUCTION In an earlier issue Trower described recent research and reviewed a selection of programmes of social skills training for adolescents (Trower, z978); this present paper describes one approach to such training. The research literature on social skills training, together with that on assertive training, has also been reviewed by Marzillier (z978) who concludes that most studies show a trend, suggesting that these therapies are effective in adult in-patients and outpatients, although the problems of measuring the results leave this largely unproven. It would seem possible that teaching social skills to early adolescents (or perhaps children) might be even more successfulsince one would be influencing the acquisition of skills at a time when they would naturally be acquired, and would not be faced with such an extensive task of undoing maladaptive skills. In their book Trower, Bryant and Argyle (1978) discuss how the skills of social interaction may be acquired in childhood. They conclude that the basis of learning is likely to be the child having the opportunity to observe the parents and others modelling social skills, followed by having the chance themselves to imitate and practice what they had seen. Reinforcement of such learnt behaviour by parental approval, or achieving a desired response, will further consolidate such learning. There may also, in their view, be an * Department of Child and FamilyPsychiatry,2, Brookside,Cambridge ox4o-x97x179/o3ozz9+ to
$o2t,oo]o
9 I979 T h e ~ o c i a t i o n for the Psychiatric Study of Adolescents
"29
23o
J.J. PEASE
innate potential for social interactions as well as cognitive abilities that develop to facilitate more advanced interaction. If this is the case, it seems children from backgrounds dominated by parental inadequacy, marital strife, failed communications, conflict with authorities, and family break-up might constitute a group at risk of failing to develop adequate social skills. Support for this hypothesis would come from the high association between such backgrounds and subsequent conduct or neurotic disorders in childhood which have as one component an inability to satisfactorily interact with adults or peers. For most children with these backgrounds, the only settings for appropriate models are those of schools and youth clubs, and perhaps the company of their luckier peers. For the minority who are temporarily institutionalised in adolescent units, assessment centres, community schools, children's homes, and the like, we suggest this opportunity to acquire alternative social skills is an important component of the 'milieu' therapy provided. We have chosen intentionally to teach children passing through our centre these skills, in the hope that we might break their life-cycle of social failure before entering adolescence proper. THE GROUP ORGANISATION T h e group met for one and one quarter hours on 15 successive Mondays. T h e setting was an empty, carpeted room of 4 • 7 metres, with adequate lighting for video recording. T h e group was a closed group of six children. We attempted to maintain the same staff membership, a male and a female therapist (a Child Psychiatrist and Clinical Psychologist) and two fully participant staff members (the Ward Sister and Ward Schoolteacher). This high adult/child ratio appeared most valuable; the adults exemplified a constructive approach to the learning situation, they could give children much needed support, and perhaps desensitise them to witnessing adult emotions. Both therapists were trained in the use of video cquipment. SELECTION OF CLIENTS
Each group was composed of six children at approximately the same stage of psycho-social development, and ranging in age from Io'5 to 14 years. At this age we anticipated they would be mature enough to recognise their social shortcomings and wish to alleviate them, but still young enough to accept and use the educational authoritarian approach we used. Referral was from psychiatrists and psychologists working in a district general hospital child psychiatry clinic and in-patient unit. Formal psychiatric diagnosis did not appear a useful selection criteria, although we excluded any hallucinated or
SOCIALSKILLSTRAINING
23x
deluded child. We considered children of either sex with general interpersonal difficulties,such as having a poor awarenessof others, or of their own feelings; having difficultyin expressing their feelings; feeling shy or lacking the means of making friends; or simply those who, lacked friends of either sex. We conceptualisedthe training as being one componentof an integrated treatment plan in which family therapy, remedial teaching, symptom management, etc., would be dealt with outside the group, usually before joining it. Prospective clientswere screencd by one of the two group leaders, and if the referral was appropriate, offereda place in the forthcominggroup. We accepted in-patients as well as out-patients. A mixture of age, sex, class and problems were all acceptable as the resultant melting pot contained a variety of cultural experiences,provided flexibilityfor potential rolc playing, and increased the likelihood that some would have competence and assets where others had not. PREPARATION FOR THE GROUP Following initial assessment we explained to the child, and his parents, how we believed the successful use of social skills resulted in better relationships with peers, parents and other adults. We then looked at the child's particular problems to see if improving his relationships might help alleviate his symptoms. The organisation of the group was described, how it might help discussed, and the need for commitment to attend (despite setbacks) stressed. In practice all agreed to this contract and it appeared to give them a sense of participation which might not have been the case without preparation. Parental consent for making video recordings was obtained. INTRODUCING THE HARDWARE The use of audio and video equipment was vital to various stages of the group so we wished to minimise the potential disturbance when it was introduced. We used a preliminary session to demonstrate the audio cassette player, the video rover camera, recorder and monitor. Various greeting games were used to give the group the opportunity to hear their voices and see themselves on the monitor. To our surprise the children accepted these novel experiences far more readily than the adults. After this the equipment was only set up for the sessions where it was to be used. CONTENT OF SESSIONS The content may be divided into the group process itself and the educational material that we planned to introduce and practice. These will be artificially separated for the sake of clarity. Though the power of any coexisting group
23z
J.J. PEASE
process was undoubtedly an important factor in outcome we chose only to exploit it to a limited extent. Our intention was to run the sessions on behavioural lines and minimise the interpretive use of group dynamics. Behavioural group therapy is more fully discussed by Johnson (i975).
The group material In the Opening Sessions, plans involved confronting individuals with how others saw their behaviour and encouraging experimentation with more successful behaviours. Clearly these plans could create significant personal insecurity which would have to be countered if the individual were not to withdraw. In view of this, the early sessions were designed to develop a cohesive group identity in which individuals shortcomings were accepted. We found this could be achieved by a high degree of structure, firm leadership, group games that created trust, and the therapists supporting the weaker members. Both staff and children removed their shoes for the sessions, all participated in each game or exercise (unless someone was filming), and when discussing the games all sat on the floor. In these ways equality and preparedness to expose oneself were stressed. In this first phase one might anticipate individuals would idealise the therapists, and model themselves on their behaviour; this proved to be the case, and the staff played an important role in modelling being an adequate group member. It seemed important to mix fun with the more serious material, and also to maintain optimism and create hope. In the middle sessions dynamic material did emerge both in the form of selfdisclosure and challenging the leadership. We attempted to monitor the ongoing group process in our after-group staff discussions, using some developments as the basis of the next week's role plays, and in scapegoat situations choosing pairings that would counteract the situation. Where individual or group feelings erupted in a session, the leader steered discussion onto how the feeling might be common to all group members, emphasising the behavioural aspects of the situation that precipitated the feelings. The continuity with earlier safe sessions was maintained by using a starting exercise (often a cool down rather than a warm up) and inevitably the same closing exercise. After holiday breaks most of a session had to be devoted to recreating the group cohesiveness through games, and holiday anecdote swapping. In the dosing sessions we had other tasks. The two groups we conducted developed strong identities so predictably termination became an issue. Attempts to perpetuate the group by regressing, by producing new problems and by exposing the limitations of what they had learned were all contended with. For these children, most of whom came from abnormal families, the dosing of the group meant the loss of very powerful adult]child relationships
SOCIAL SKILLS T R A I N I N G
=33
with the staff; for some at least this degree of adult caring was a new experience, so the loss all the more difficult to handle. Where the loss of a parent bad been a reality, extra effort was made to work through the loss of a therapist. The educational material
A scheme was developed to introduce the concepts we believed to underlie normal social behaviour, and to do so in a structured way. Complex (real life) social interactions can be broken down into strategies, rituals and elements of social skills. This analysis of social interaction was based on the work of Trower et aL (1978). In our sessions this breakdown process was reversed, the elements taught first, strategies and social rituals added, gradually leading up to role play real life situations by the eleventh session (see Figure I). Non-verbal elements (e.g.: posture denoting anger)
T
Verbal elements (e.g.: tone denoling anger)
Single skill situations (e.g., expressing anger)
Social Conventions (e.g.: avoiding ogressive gestures)
Conversation skills (e.g.: opening Conversation)
Complex skill situations (e.g.; making a constructive complaint)
Accessory skills (e.g.: problem solving)
Complete social interactions (e.g.; returning faulty goods to a shop- gets it off his chest, gets his own way, doesn't cause resentment).
Figure z. Flow diagram showing reconstitution of a social interaction.
Early sessions The so-called dements are sub-divided into non-verbal, e.g. posture, gesture, facial expression; and verbal, e.g. volume, tone, pitch and intonation. Learning about non-verbal elements provided an undemanding introduction
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tO the group, and introduced the idea that complex behaviour can be broken down into its constituent parts and analysed. We found the group registered the emotions associated with the behaviour under scrutiny, but had to be helped to convey verbally what they saw. Not only was their vocabulary poorly developed, but they lacked the ability to empathise with how the subject might be feeling. It proved possible to teach empathy skills by breaking down the observed behaviour into recognisable elements and then summarising the impressions gained. A useful aid to identify the emotional content of the elements was for the individual to copy the posture, gesture, etc., that he saw and thus experience it first hand. The elements, and their emotional associations, were taught by using awareness exercises emphasising the five senses, by sculptures, and by staff modelling. These early sessions contained four to six games or exercises each designed to illustrate a particular point. The game was played, then the group sat in a circle to discuss aspects of it. The leader attempted to help the children formulate their own concepts from the games rather than telling them what they should have experienced. The exercises were programmed so the understanding of one set of concepts led on to exercises incorporating them in more complex forms. This programming gave the leaders rapid feedback of comprehension, and enabled poorly understood areas to be practised, with additional exercises added for further clarification. The first four to five sessions did not concern themselves with the content of the spoken word, only its emotional characteristics. Social rituals were then analysed, and this process became the basis of teaching strategy in situations demanding complex skills. For example, the group watched two members model a greeting in the street, and then broke down what they had seen into stages, viz: recognition, signalling recognition, approach, physical greeting, adopting conversational posture, eye-contact, verbal greeting, ritualistic question and counter question ("How are you?". "O.K.". "And you?"), start a conversation. At this stage individuals recall of what was observed was so unreliable that video feedback became essential. The children easily learned to break down social interactions into stages, but were dubious about the necessity to follow social convention. Video feedback of members, in this instance, greeting each other soon demonstrated that some created more favourable impressions than others, and missing stages or poorly performed stages could be recognised as helping to generate an unfavourable impression. These conventions could be further emphasised by staff modelling how not to do it, and the children directing them as to how to correct their performance. d~Iiddle sessions
Even with their newly developed inter-personal awareness and social conventions our children could not sustain a conversation. The sessions then
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moved to developing conversational rules and techniques. Initially less threatening group exercises with audio feedback were used to develop rules of turn taking, then video feedback to learn handing-over and taking-up signals, gestures and noises to encourage the speaker, and speaker awareness of his listener. Conversational gambits sometimes described as "active listening" were taught to enable the individual as a listener to help his speaker sustain his story. An example is mirroring, when the listener mirrors (repeats) something the speaker has just said and adds a question that will encourage the speaker to disclose more information. Once the children had developed a set of conversational rules and some gambits to keep conversation going, the group split into pairs to practice. This led to the final format used in the remaining sessions. Late sessions
The final sessions retained a closing exercise to help the group unwind, and become united again, but otherwise were devoted to role play in the form of social behaviour rehearsal. At first, conversations were practised out of their natural context, then complete social situations rehearsed. For these children, to have the experience of four or five social encounters in which they had coped adequately seemed important (on the assumption that based on past failure their expectation of coping was minimal, which usually became a self fulfilling prophecy). Half of each session was therefore spent in practising and planning the role play then in the second half their finished product was videoed and played back to them. Needless to say the results were not always acceptable, the children hastening to eriticise each other, and certainly to emphasise mistakes. Positively reinforcing well performed skills seemed the most appropriate teaching strategy, yet the mistakes could not be ignored completely. A solution was found in designating the dominant therapist the positive reinforcer who stressed effusively the good points, while the other neutral therapist unemotionally clarified the mistakes, and in addition steered the feedback provided by other group members in a positive manner. These role plays were designed to use specific complex whole situation social skills as described by Goldstein, Sprafkin and Gershaw (I976), although these authors list 59 such skills we chose only a few useful ones, e.g. asking someone to do something for you. We tailored role plays to individuals interests and problems, in order to create a balance between success, and giving extra practice in weak areas. It became clear that adults must play adults, and children be themselves if the situations were to be realistic. T h e two participating staff members took the adult role where it was desired to improve child/adult social interactions. T h e format used was to hand the predetermined pair a card bearing the outline of a role play (see Fig. 2), and a
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framework for this to be broken down into stages. The pair then planned and practised privately in a corner, while the therapists circulated amongst the pairs to give extra help. When everyone was satisfied, each pair's role play (of about 4 to 5 min) was video-taped in turn. The group formed a semi-circle around the monitor and watched each role play, once without comment, once without sound, and once freezing the picture at important stages to illustrate and discuss various points. This system not only gave direct feedback, but also enabled us to emphasise the non-verbal as well as the verbal content of the role plays. In passing, video film is tiring to watch, and reviewing three role plays stretched the children's powers of concentration to their limit. SAMPLE OF ROLE PLAY SCRIPT Asking for help. You will be out all day and you have a canary that has to be given medicine with an eye dropper. You go to your neighbour and ask if he/she can do this for you. (1) (2) (3) (4) (5) (6) (7) (8)
Start conversation. Explain problem. Ask for his/her help. Explain exactly what it is you want to them to do. Ask for his/her reaction. Iron out any misunderstandings and summarise what you have agreed to. Thank him/her. End conversation.
Figure 2. Sample of role play script. EVALUATION OF OUTCOME The programme described was not designed with research in mind, so outcome data is largely anecdotal and subjectively appraised. In other studies two main strategies have been utilised: the client may be presented with a self-rating scale of the social situations (degree of difficulty rated) which includes such items as going to parties, going into a room full of people, being with only one person. This scale would be complete before and after the training programme. The second strategy is to involve the client in a structured role play where independent raters rate general impressions and elements of social interactions such as: voice volume, posture position, gesture, conversation meshing, etc. Again this is carried out before and after training sessions (Hersen, Eisler, Miller, Johnson and Pinkston, x973). These two strategies were used by Trower et aL 0978), other authors have used less
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direct strategies such as presenting situations on film and asking for appropriate responses (Goldsmith and McFall, x975). Another author has constructed sociograms in the school classes from which the child has been taken (Oden and Asher, x977). Sociograms are impractical where the children come from varied sources, and it is uncertain how filmed situations related to real life situations, so these techniques were ruled out. Trower's situations questionnaire was unsuitable for children. We doubted whether it would have any reliability when completed by early adolescents or their parents so it was decided to use a structured role play, video-tape it, and have it independently rated. The method and rating procedure was as used by Trower et al. (x978) with the role play being two youth leaders interviewing the child prior to joining a youth club. As already mentioned, these groups were not designed for research, so in trying this evaluation technique we were only assessing its practicability with this age group. Structured role plays proved to be time consuming to set up, the constraints imposed by unsophisticated video equipment irritating, and obtaining interrater reliability on such small numbers almost impossible. Despite these criticisms the technique did seem to measure relevant components of social interaction, and with more sophistication and inter-rater training could prove effective. RESULTS Of the ten children involved, two were in-patients, and a further five were inpatients for part of the time only; with none of these was there any problem of non-attendance. One of these was invited to join the second group, but did so only sporadically so was discouraged from continuing. Three were outpatients throughout the group, and two of these missed three to four sessions each; in both cases reasons appeared more to do with their mothers' psychopathology than group dynamics. A pattern became apparent where about half the children made quite startling improvements, not only in the group, but in their lives outside. These children typically had introverted personalities and failed socially through poor technique and performance anxiety. This anxious group seemed to do particularly well. The remainder improved less dramatically, although noticeably; these had more extraverted personalities, were less obviously anxious, and often had backgrounds containing inappropriate adult modelling of social skills. This second group was harder to help, perhaps in the short term their maladaptive social skills "got them by", so their motivation was less, and the learning process also involved considerable unlearning. In selecting for a future group a mixture of the two types would still seem desirable but with a majority of the anxious type.
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J.J. P E A S E CONCLUSION
This article has set out to describe one approach t o t e a c h i n g social skills to early adolescents, the approach was a pastiche of techniques familiar to the leaders supplemented with additional new games and exercises. V~refound the approach enjoyable both for the kids and staff; more importantly the results were encouraging. It is hoped that the discussion of the techniques used will be of help to others planning such a group. No attempt has been made to isolate and test the effectiveness of components of the group, although an instrument for overall assessment of change was utilised. This project was designed and run as a joint venture with Dr Glenys Parkinson to whom I should like to extend my greatest thanks. REFERENCES Goldsmith, J. B. and McFall, R. M. (x975). Development and evaluation of an interpersonal skill training programme for psychiatric in-patients. Journal of Abnormal Psychology 84, 57-8. Goldstcin, A. P., Sprafkln, R. P. and Gershaw, N. J. (1976). Skill Training for Community Living: Applying Structured Learning Therapy. Oxford: Pergamon Press (Structured Learning Associates.) Hersen, M., Eisler, R. M., Miller, P. M., Johnson, M. B. and Pinkston, S. G. (x973). Effects of practice, instructions and modelling on components of assertive behaviour. Behavlour Research and Therapy IX, 443-5. Johnson, W. G. (x975). Group therapy: a behavioural perspective. 13ehaviour Therapy 6, 3 o - 3 8 .
Marzillier, J. (I978). Outcome studies of skills training: a review. In Social Skills and l~Iental Health. Trower, P., Bryant, M. and Argyle, M. (Eds). London: Methuen & Co. Oden, S., Asher, S. R. (I977). Coaching children in social skills for friendship making. Child Development 48, 495-5o6. Trower, P. (x978). Skills training for adolescent social problems: a viable treatment alternative ? Journal of Adolescence x, 3 I9-29. Trower, P., Bryant, B. and Argyle, M. (I978). Social skills and mental health. London: Methuen & Co. Sources of books for games Brandes, D. and Phillips, H. (x978). Gamesters Handbook : x4o Games for Teachers and Group Leaders. London: Hutchinson & Co. Sacher, A. E., VerralI, C. (x975). xoo+ ldeas for Drama. Heinemann Educational Books.
