Social Skills and Mental Health (Psychology Revivals)

Peter Trower, Bridget Bryant, Michael Argyle

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781317937180
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In the 10 years or so prior to original publication in 1978 new theories and discoveries in the social sciences had given a scientific basis and new impetus to the development of social skills training as a form of therapy. This book explores the progress made with this idea and gives practical guidance for therapists based on several years' experience with the technique.

The book provides an account of the latest ideas at the time, about the analysis of social behaviour – non-verbal communication, social skill, rules, analysis of situations, etc. The different techniques for training and modifying social behaviour – some old, some very new – are described and compared, with detailed accounts.

There is a careful critical review of follow-up studies of social skills training and other forms of social therapy on in-patients, out-patients and volunteer subjects.

The second part of the book consists of a manual for assessing deficits and difficulties, and for training in ten main areas of social deficiency such as observation, listening, speaking, asserting and planning. A rating scale, questionnaire and user's booklet of training exercises is included.

The book should be of interest, not only to psychiatric professionals – psychiatrists, clinical psychologists, psychiatric nurses, occupational therapists – but to many others, such as social and community workers, teachers, prison officers, and lay people who may be interested in forming self-help groups, either on their own or with professional guidance.

Part One

1 The social skills training approach

The definition and treatment of mental disorder has undergone considerable change in the last twenty years, due partly to new theories and discoveries in medicine and the social sciences. One trend has been towards training in new patterns of interpersonal behaviour. In this book we explore the progress that has been made so far with one approach in this field.

This is based on the idea that some forms of mental disorder are caused or exacerbated by lack of social competence, and can be cured or alleviated by means of training in social skills. There are two possible sequences of events. (1) Failure of social competence is primary, leading to rejection and social isolation, which in turn produces disturbed mental states. (2) Other kinds of mental disturbance affect all areas of behaviour, including social performance; social inadequacy results in rejection and isolation, thus adding to the original sources of stress and leading to deterioration.

The two main implications of this theory are that (1) certain groups of mental patients will be socially inadequate, and (2) they should improve or recover as the result of training in social skills. As yet there is no direct evidence on the aetiological sequences described above.

In this book we shall be looking at the evidence on these two points, and will try to answer some of the following questions: First, what is meant by social inadequacy? Chapter 2 describes what is known about normal social behaviour and how this can break down. Second, what are the causes of social inadequacy? Chapter 3 reviews the work on the processes of successful and unsuccessful acquisition of social skills in childhood and adolescence. Third, what are the characteristics of socially inadequate people? Chapter 3 also looks at surveys of the way that socially unskilled psychiatric patients actually behave. Fourth, what techniques exist for improving social skills? The fourth chapter examines therapeutic and other techniques, both new and old, which are designed to alter and improve interpersonal skills. Fifth, do these various therapies actually work? Chapter 5 examines the evidence from experimental studies on training. Sixth, how is training actually carried out? The second half of the book offers a practical assessment and training guide to therapists.

To help provide a framework for the book, the issues that each of these questions raise will be briefly discussed in the rest of the introduction.

What is meant by social inadequacy? A person can be regarded as socially inadequate if he is unable to affect the behaviour and feelings of others in the way that he intends and society accepts. Such a person will appear annoying, unforthcoming, uninteresting, cold, destructive, bad-tempered, isolated or inept, and will be generally unrewarding to others. It will be shown in chapter 2 that these impressions (and their opposites) are conveyed to others by the way in which ‘elements’ of behaviour are used – including speech and non-verbal signals, such as looking, smiling, gestures and so on. The socially inadequate person will be bad at using these skills and at understanding other people’s use of them. Many people who are not psychiatric patients may also be rather bad at this, and what distinguishes them from patients may be more the degree of deficit than any qualitative difference – i.e. the extent to which their inadequacy disrupts social life. The particular skills which inadequate patients lack will be discussed in chapter 3.

Whether behaviour appears normal and acceptable to others will depend on the customs and values of society, and some of the implications of this for both assessment and treatment are also discussed in chapter 3.

What are the causes of social inadequacy? Studies of social learning suggest that social skills are acquired from childhood onwards, partly through imitation of others, including parents, siblings and peers; partly through reinforcement – i.e. encouragement or discouragement on the part of parents and others; partly through opportunity to observe and practice behaviour in a range of situations; partly through the development of cognitive abilities, and partly through innate potential. Social inadequacy may come about in a number of different ways. The relative importance of these influences and the exact processes involved are not fully understood, but some of the evidence is discussed in chapter 3.

Which kinds of patients are socially inadequate? Many patients are recognisable first and foremost through abnormalities of social behaviour. This may be failure to communicate with others, and some of the main symptoms are in the field of interaction and interpersonal relationships. Failure in non-verbal communication, for example peculiarities of looking, posture, gesture, facial expression, tone of voice and so on, together with incoherent speech, lack of affect, poor perceptual sensitivity and perhaps also poor empathic ability, have been found in schizophrenia and some kinds of personality disorders. Chronic schizophrenic patients probably show the most extreme forms of social inadequacy. Depressed patients also show poor verbal behaviour of a generally flat, passive and expressionless kind, lack initiative in conversation, adopt a helpless attitude towards the environment, and may lose interest in friends and social life. Anxious patients may show their anxiety in rapid and breathy speech which is interrupted by speech disturbances, and in tense posture and jerky and poorly controlled gestures, and they are often over-sensitive to the reactions of others, fear that they are saying or doing the wrong thing and dread being the centre of attention. Some develop phobias to specific social situations. Many psychiatric patients have distorted perceptions of their environment, paranoid interpretations being an obvious example; many are ‘egocentric’ in the sense that they lack the empathic ability to perceive themselves and the world from another’s viewpoint. Some patients also have disturbed goals in their encounters with other people, for example aggressive and destructive ones.

Some forms of social inadequacy are not easily classified into diagnostic categories. In a survey of psychiatric out-patients we used the concept ‘social inadequacy’ as a category in its own right, and found a sizeable proportion – nearly 28 per cent of non-psychotic patients – could be reliably classified in this way.

How does social skills training compare with other approaches to this problem? Some dynamically oriented therapists believe that social inadequacy in patients is usually ‘motivated’, i.e. attains some goal for the patient, or is a result of inner conflict, and improvement can only come by resolving these underlying problems. We believe that disturbed motives and conflicts often result from frustrations in interpersonal relations, and that the best approach is to improve communication skills. It follows from the psychoanalytic position that social skills training would simply lead to the emergence of new symptoms, and not improve mental health at all. As we shall see in chapter 5, there is reasonable evidence that social skills training does improve mental health.

Social inadequacy is recognised within the behaviour therapy tradition. Here the emphasis has been on two main forms of failing, lack of assertiveness and social phobias. However, surveys of patients, reviewed in chapter 3, and our own experience of those who come forward for social skills training, show that mental patients display a much wider variety of forms of social inadequacy. These will be listed in chapter 2 and related to the different processes involved in the production of social behaviour. For instance, we shall show how failure in skills can occur at the cognitive and perceptual as well as behavioural levels, and how inadequate behaviour can be seen as a breakdown in the signalling system.

Social skills training is based on the idea that skills are learned and therefore can be taught to those that lack them. Effective social skills training has been made possible by recent advances in many fields of research. Considerable strides have been made by social psychologists, linguists and sociologists in the study of non-verbal communication, speech and conversation, the analysis of situations and other aspects of social behaviour. These are reviewed in chapter 2.

Studies by social and behavioural psychologists on the principles of skill acquisition, such as demonstration, practice and feedback, have provided insight into how behaviour may be learned, and are discussed in chapter 4. Applied studies in the field of psychiatry, education and management have attempted to put into practice and sometimes to evaluate the effectiveness of techniques for changing social behaviour, and these are discussed in chapter 4. Studies in developmental, social and abnormal psychology have provided clues about the origins of social development and possible reasons for the failure to acquire social skills, some of which are discussed in chapter 3.

Our own assessment and training procedures are a synthesis of many of these ideas and findings, together with the conclusions drawn from eight years experience with patients. These procedures appear as the second half of this book in a form which, we hope, will be of direct practical use to therapists in treating a limited range of problems in the field of neuroses and personality disorders. Our method can also be adapted for other patients, such as grossly deficient chronic schizophrenics who require a different form of training programme but with much the same content.

The form of social skills training that we recommend is different, in practice, from the procedures developed by some others, but the basic idea is usually the same. This is that patients or others deficient in skills can be taught directly a new and more socially accepted repertoire of skills, which will enable them to influence their environment sufficiently to attain basic personal goals. This training approach stands in contrast to other therapies, aimed at eradicating or inhibiting maladaptive behaviour or symptoms, or changing underlying neurotic defences and conflicts. Training does not preclude these other approaches, and our purpose is partly to explore fruitful combinations.

The concept of didactic training as a form of therapy has gained a good deal of ground in the last five years, and this trend has been reviewed by Authier et al. (1975) who state ‘…the educational model means psychological practitioners seeing their function not in terms of abnormality (or illness) → diagnosis → prescription → therapy → cure; but rather in terms of dissatisfaction (or ambition) → goal getting → skill teaching → satisfaction (or goal achievement)’.

Patterson and Carkhuff (1969) similarly state: ‘Perhaps theory is not necessary! What we may need is direct training or education of everyone in the conditions of good human relations …’.

Finally, fellow social therapists Goldsmith and McFall (1975) write:‘…in contrast to the therapies aimed primarily at the elimination of “maladaptive” behaviours, skills training emphasises the positive, educational aspects of treatment…. Whatever the origins of deficit (e.g. lack of experience, faulty learning, biological dysfunction) it often may be overcome or partially compensated through appropriate training in more skilful response alternatives.’

References

AUTHIER, J., GUSTAFSON, K., GUERNEY, B. AND KASDORF, J. A. (1975) The psychological practitioner as a teacher: A theoretical-historical and practical review. The Counseling Psychologist, 5, 31–49.

GOLDSMITH, J. B. AND MCFALL, R. M. (1975) Development and evaluation of an interpersonal skill-training program for psychiatric inpatients. J. Abnormal Psychology, 84, 51–58.

PATTERSON, C. (1969) Foreword to Helping and Human Relations (R. Carkhuff). New York: Holt, Rinehart & Winston.

2 The analysis of social behaviour

Introduction

Until comparatively recently, little was known about the elements and processes of social behaviour, and even less about how these might fail. Research and diagnosis were conceptualised in global terms, of personality, styles and traits, and abnormal forms of these. In the last two decades, however, there have been extensive new developments. Social psychologists have carried out experiments on gaze, facial expression and other aspects of non-verbal communication, ‘taking the role’ of the other, and the sequence of social events. Sociologists have pointed to the importance of selfpresentation, the rules of social behaviour and the variation of behaviour from one situation to another. Linguists have examined the different functions of utterances as ‘speech acts’, the ways in which utterances form a conversation and the generative rules governing sentence construction. Anthropologists have shown how some aspects of social behaviour vary greatly between different cultures and subcultures, while other aspects are culturally universal. Philosophers have argued that the old, deterministic model of social behaviour was mistaken, and that people are to a large extent producing social acts which are intentional and consciously planned.

Conceptual models are needed to integrate and make sense of these many findings. This book is concerned with one such idea –the social skills model – though other theories are also discussed. In this chapter we shall describe this model and list the kinds of failure which the model implies. We shall then describe the elements of social behaviour and show how they are organised into higher-order...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Frontispiece
• Acknowledgements
• Part One
• Part Two
• Author Index
• Subject Index