Area 3 - Functioning in Social Relationships/Communication Skills

 

Due to anxiety in social situations, poverty of speech, and difficulties with non-verbal communication, Harold does not socialize with anyone other than his brother. Harold's brother takes him to the mall once a month, but aside from this, Harold engages in no form of social activity outside his R&B. This is a problem because Harold would like to have more friends, and believes that staying around the R&B all day contributes to his feelings of hopelessness.

Due to lack of self-confidence and excessive anxiety in social situations, Leah spends nearly all her time at her B&C and tries to minimize contact with others. Lack of practice in social situations has added to her social anxiety, and she reports fearing that she will do or say something that will make her look foolish in front of others. Leah reports feeling lonely most of the time and wishes she could "do things like other people do."

Due to paranoia, lack of motivation, and feelings of shame, Carlos tends to avoid contact with others and associate only with persons he feels are unlikely to judge him negatively. These are frequently persons with severe drug and alcohol addiction problems, some of whom sell drugs. This is a problem because it puts Carlos's sobriety at risk, and deprives him of the benefits of having good role-models and healthy relationships with others.

Due to irritability, impulsivity, and trouble controlling her temper, Isabel quickly escalates into shouting and threatening when she has a disagreement with someone. This is a problem because it prevents Isabel from establishing stable relationships with others, and from solving common, everyday problems without a significant degree of emotional turmoil. It is also a problem because Isabel could be injured in an altercation, or arrested and jailed as a result.

Due to paranoia, delusional thoughts, and poor boundaries, Matthew does not respect the personal space of others and frequently shouts at them when talking. Matthew stands so close during these exchanges that he sometimes spits on the people he is talking to. Matthew tries to convince others that his delusions are real and becomes aggressive and confrontational when they do not agree with him. For this reason persons who know Matthew try to minimize contact with him or avoid him altogether. In September, this type of behavior resulted in the police being called after Matthew began shouting at a bank teller.

Due to grandiose delusions and pressured speech, Larry dominates conversations and interrupts others when they try to speak. Interactions tend to be one-sided, with Larry talking continuously and not listening to others or showing any interest in what they have to say. Because Larry perceives himself as an authority figure he often makes degrading comments about others and tries to boss them around. This is a problem because it results in Larry becoming involved in frequent verbal and physical altercations with others, putting him at risk of being injured or arrested. This behavior also makes it hard for Larry to hold a job.

Due to irritability and angry outbursts, Helen yells at people around her and threatens to hurt them. As a result, she has alienated or scared away most of her former friends, whom her parents describe as “good kids that Helen didn’t get into trouble with.” Helen's only remaining "friend" is a drug dealer who recently beat her up after being released from jail. Aside from putting her safety at risk, Helen's anger is preventing her from establishing an adequate social support network and depriving her of contact with good female role-models.

Joseph has manic episodes about once a month. During these episodes, Joseph becomes extroverted and hypersexual, and forms brief relationships with others which he describes as “shallow and meaningless.” Often Joseph cannot recall the names of people he has just been with, and expresses concern that he may have contracted an STD. Joseph says he has "never had any real friends" and wishes that he knew how to make them. "When I'm really down," says Joseph, "there's never anybody for me to turn to."

Due to her delusional beliefs, aggressive behavior, and responding to internal stimuli, Carmen confuses and frightens away peers who would like to be her friend. As a result, she has no real social support network to turn to in times of need, and no one to do informal reality testing with on an ongoing basis. Carmen says, "I never know what's really going on, and I don't know who to ask." Carmen does have a few acquaintances, but they're all persons with whom she uses drugs, and they encourage her to engage in unhealthy, counterproductive habits that make her symptoms worse.

Due to irritability, low tolerance for frustration, and difficulty regulating emotional responses, Mildred often shouts and screams at people who have trouble understanding what she wants, or is trying to say. This behavior interferes with her ability to resolve problems, maintain friendships, and develop good working relationships with others.

Timothy reports that when he was younger, his symptoms were not as bad as they are now. He had many friends and liked to socialize. But as he got older his symptoms got worse. By 2013, he could not carry on a conversation with others due to the voices in his head, and he had stopped showering and taking care of himself. Due to feelings of shame over his appearance and behavior, Timothy now tries to avoid contact with what he calls "normal people" by staying behind vacant buildings or in bushes by the freeway, "any place where people won't see me."

Teresa has a history of being taken advantage of by others in social relationships. She is frequently asked for loans or gifts of money, sexual favors, and free lodging in her Shelter + Care apartment by acquaintances who are temporarily homeless. Teresa wants to say “no” to most of these requests, but due to impulsivity, poor judgment, and a lack of assertiveness skills, she almost always gives in. This is a problem because Teresa recognizes that she's being taken advantage of and feels angry and resentful afterwards. It also jeopardizes Teresa's housing certificate, puts her at risk of contracting an STD, and makes it hard for her to meet her own needs on her limited income.

Due to grandiose delusions and difficulty controlling his emotional responses, Charles often becomes enraged if he feels he is not being treated with complete respect or if the value of his contributions is not immediately acknowledged. This is a problem because it interferes with his ability to work cooperatively with others and participate in group activities.

Due to paranoia and delusional thinking, Mitchell isolates in his apartment and attempts to minimize contact with others. He relies primarily on his dog for companionship. Mitchell reports believing that the government is spying on him and that gangs are watching what he does. When he does interact with others, he is generally guarded and reveals little about himself. He tries to avoid going to his mental health clinic at times when other clients will be present. This is a problem because Mitchell would benefit by have a larger social support network.

Due to lack of motivation and energy, mild anxiety, and intrusive thoughts, Irene has difficulty forming close relationships with others. She does attend AA meetings and groups at her apartment complex, but has few close friends and spends most of her time alone in her apartment. This is a problem because Irene would like to have more friends, and when she is alone in a quiet environment, her intrusive thoughts become more pronounced and distressing.

Due to paranoia, restricted affect, and poverty of speech, Gayle has a difficult time interacting with others. Conversations can be awkward, and Gayle at times has trouble recognizing social cues. She reports getting confused during verbal exchanges and not being able to express herself clearly. Unfamiliar surroundings and strangers are especially anxiety-provoking for her. This is a problem because it interferes with her ability to make new friends, share her feelings with others, and expand her social support network.

Due to paranoia, irritability, and limited impulse control, Howard often accuses others of stealing his things, spying on him, and trying to take advantage of him. Once Howard has made an accusation, he refuses to consider additional evidence and will not listen to alternative explanations. As a result, Howard has difficulty making new friends and maintaining the few relationships that he does have. This is a problem because Howard would like to have more friends, and a larger social support network would help him in his recovery.

Due to symptoms of PTSD and BPD, Melanie has trouble regulating her emotional responses to a variety of different stressors. Situations that involve perceived abandonment or rejection often result in Melanie feeling intense emotions and/or losing control of her temper. Inability to attenuate her emotional responses to certain situations is very distressing to Melanie and frequently creates social/interpersonal problems for her. Melanie also appears to have poor interpersonal boundaries, leading to intrusive behavior and unrealistic demands for attention. This results in arguments with others.

William is uncomfortable around strangers and people who have mental illnesses. Due to his belief that others can read his mind, he keeps his distance from people. Rather than sitting in the waiting room, for example, William stands across the street and waits for someone to call him. When William has to be in close proximity to others, he is guarded and anxious. This interferes with his ability to express his needs, convey information, work cooperatively with others, and make new friends.

Due to symptoms of BPD, Charlene has trouble regulating her emotional responses. When Charlene feels she is being rejected, treated disrespectfully, or “made to feel insignificant,” she experiences intense emotions and lashes out at the people around her. As a result, Charlene's friends and acquaintances have been trying to limit or avoid contact with her, and her social support network is becoming progressively smaller.

Due to thought blocking and the distraction caused by auditory hallucinations, Edward often breaks off conversations mid-sentence and has a hard time staying focused on the subjects being discussed. This makes it challenging for Edward to express himself clearly and understand what others are saying. This is a problem because Edward would like to have natural, relaxed conversations with others that are not interrupted by voices and visions.

Colleen is diagnosed with PTSD and Social Phobia. Due to hypervigilance, panic attacks, intense anxiety in social situations, and fear of looking foolish, Colleen is unable to go places in the community unless someone accompanies her and stays by her side at all times. This greatly restricts her ability to do things that require leaving the home. Colleen would like to become more involved with others and attend groups related to her recovery, but reports that she is so afraid of having a panic attack she stays home.

Albert's B&C provides housing for a large number of persons with whom Albert could become friends, and also offers many social and group activities. However, due to Albert's suspiciousness and belief that others want to harm him, he does not take advantage of these opportunities and tends to remain off by himself, avoiding contact or meaningful interaction with others. This is a problem because Albert reports feeling lonely and wanting to have more friends, and because he would benefit greatly from having at least a few friends whose judgment he trusted.

Leonor has a history of spending large amounts of time alone in her apartment and avoiding contact with others. This is likely due to a combination of the direct effects of schizophrenia (i.e., suspiciousness of others), and the indirect effects of having her symptoms poorly controlled for many years (resulting in social-skill deficits & lack of self-confidence). This is an issue for Leonor because she feels happier when she is involved in social activities, and because she's expressed a desire to make new friends. When Leonor spends too much time alone she becomes depressed.

Harold reports that he has always had trouble interacting with others.  Due to negative Sx of schizophrenia, such as flat affect and poverty of speech, he often stares into the distance in the presence of others, maintaining a rigid posture and limiting his verbal communication to one- or two-word responses.  He displays minimal emotional reciprocity with others.  This is a problem because Harold has trouble expressing his feelings and communicating effectively with others.

Due to irritability and low tolerance for frustration, Jordan reacts to minor disagreements by shouting, making threats, and insulting others.  Because Jordan is in the Precontemplation stage of change, he is unaware that a problem exists and sees no point in learning anger management skills. Jordan tells his PSC, "It's not my fault if other people are idiots."

 

All PHI has been de-identified per HIPAA Privacy Rule