Once clients have at least some control over their symptoms, they can shift some of their attention to improving their ability to interact with other people. Interventions in this section include teaching clients how to read body language, how to start a conversation, how to express positive and negative feelings, how to express disagreement, how to set limits and boundaries, how to resolve conflicts, etc.
The links on the left in blue are examples of complete interventions, as documented in progress notes, focusing on that specific topic or skill. There are only 3 now but more will be added every week.
I: Brainstormed with Larry about alternative ways of handling issues with his neighbors. We came up with 4 ideas: 1) Establish a good relationship with his neighbors before problems come up. Offer a friendly greeting, smile, introduce himself, and make small talk if the opportunity presents itself. Neighbors who know Larry in this way are more likely to be responsive to his requests than neighbors who don't; 2) Ask neighbors to turn the volume down politely, by going to their door, saying excuse me, and making his request in a non-threatening manner; 3) When volume levels are high, use that time to run errands, visit friends, go jogging (which Larry likes doing), or do another activity that takes him away from the apartments; 4) Talk to his apartment manager about it. That's what the manager is there for.
I: Met with Peter at his B&C and engaged him in a discussion about how to introduce himself to other people. First we went over situations where he might do this (e.g., at his doctor’s office, at his B&C, at TAO, etc.). Explained that introductions were appropriate in settings where it was likely he would have contact with the person again, not places like the bus or the store or on the street. Introduced Peter to the 4 skills most important for successful introductions – making eye contact, stating a greeting followed by his name, adding a brief self-description, and using an optional gesture. Modeled appropriate eye contact, explaining that he should look directly into the other person’s eyes and maintain his gaze, but not fix his attention in such a way that he appeared to be staring. Role-played walking up to each other and making eye contact. Will cover skills 2-4 in future sessions.
I: Met with Peter at his B&C and continued working him on how and when to introduce himself to other people. Began by reviewing and modeling appropriate eye contact from last week. Then went over skill #2, stating his name after a welcoming statement ("I don't think we've met before -- my name is Pete" or "How's it going? My name is Peter"). Explained that the greeting he chose might depend on the time of day or the formality of the situation, and that he should choose a greeting he thought might be well received by the other person. Role-played and provided feedback. Encouraged Peter to speak in a normal volume so he was not speaking too loudly or too softly, and to speak clearly so others would not misunderstand his name.
I: Reviewed making eye contact and using an appropriate greeting, which we worked on in prior sessions. Today we covered skills 3 and 4 -- adding a brief self-description (e.g., "I live up front" for use at his B&C, or "I've been coming here for about a year now" for TAO). Modeled adding a brief description, cautioning Peter to keep it short as the goal is just to explain his connection and give the other person a way of identifying him. Then I demonstrated gestures he could add, such as a handshake, to formalize the introduction, but told him not to do this unless he felt comfortable with it.
I: Engaged Ramona in a conversation about things she does well, or has been told by others she does well, or has been complimented on at some time in the past. At the same time, I modeled desirable social skills by asking questions, maintaining eye contact, shaking my head "yes", smiling at appropriate times, and showing interest with brief responses to things she said. Afterwards I reviewed with Ramona what I had done to demonstrate interest and encourage her to continue sharing.
I: Reviewed the skills we covered in last week’s session by asking Ramona how things had been going for her and modeling the same skills again as she answered me (i.e., maintaining eye contact, asking her questions, nodding in approval, using facial expressions to show curiosity and concern, maintaining an engaged stance rather than sitting back with my arms folded, etc.). Went through each of these behaviors individually, helping Ramona replicate them one by one. Then I directed Ramona to ask me an open-ended question and try using 2 or 3 of them as I was responding to her. I praised Ramona for doing this with me as I knew it was challenging for her.
I: Assured Ramona she had done well in our prior 2 sessions and asked her how she felt about it. As she answered my question I displayed the same social skills as before, maintaining eye contact without staring, nodding my head "yes", using body language to express interest, smiling at appropriate times, asking her to clarify or expand on things she said, and maintaining an open posture. When she had finished talking, I went over with her what I had been doing while she was talking to me, and why I was doing it. We then switched roles and Ramona tried to do some of the same things while I answered one of her questions.
I: Met with Roberto at his R&B and gave him a ride to the event. On the way there, I role-played with Roberto to help him practice interacting with others. Reviewed relaxation techniques Roberto can use at the event, such as deep breathing, progressive relaxation, and positive/reassuring mental imagery. At the awards, I modeled appropriate behavior when interacting with others and encouraged Roberto to initiate conversations with persons around him. Asked him open-ended questions in front of the group at our table to provide easy entry points and encouraged him to elaborate on interesting things he had said. Provided subtle prompts and feedback. Assured Roberto that he was doing well in order to reduce his anxiety. On the drive back to Roberto’s R&B, I praised Roberto for his efforts and reviewed with him what he felt he had learned today.
I: In previous sessions Gloria learned how to introduce herself to others. Today we focused on the skill of introducing people to each other. I explained to Gloria that she would use this skill when she came together with 2 people who both knew her but did not know each other, and when she had identified a reason they might like to meet. Gave her examples of how these introductions might begin (i.e., she is talking with one person and sees the second person, and waves the second person over, or she is talking with one person and sees the second person, and they both walk over to the second person). Modeled moving close to the people she is about to introduce, leaving enough room between them in case they wanted shake hands. Showed her how their bodies would form a triangle. I will continue teaching this skill in our next session.
I: In our last session I began teaching Gloria the skill of introducing people to each other. I reviewed with her what we covered last week -- why this skill is important, when it should be used, and how Gloria should position herself and the people she wants to introduce. I then modeled the next step for Gloria, which is stating the persons' names and connections. I explained that depending on the situation and the people involved, she should consider what information is common knowledge and what information might be confidential. Suggested she think of connections that did not rely on explicit references to treatment, such as "Sarah and I attend a group together every week" instead of "Sarah and I both see the same psychiatrist." After rehearsing this skill with Gloria and giving her feedback, I had her introduce me to another PSC using our first names and stating our connection ("I talk to you guys every week but I don't know if you've met each other").
I: In previous meetings I taught Peter how to introduce himself to others and how to introduce people to each other (i.e., people he knows who do not know each other). Today I began working with Peter on how to greet acquaintances. Explained that greetings were important because they let the other person know he has noticed them, and because they provide an opening for a conversation. I clarified for Peter that the greeting alone was enough to maintain a friendly connection over time, and that it was not necessary or even desirable to have a conversation with each greeting. I explained that he should greet acquaintances when he saw them for the first time that day, not every time they crossed paths. Will model appropriate greetings for Peter in our next session.
I: Continued working with Peter on greeting acquaintances. Modeled walking up to the other person to within a comfortable speaking distance. Showed him how to approach at a normal speed, not rushing up quickly which could startle the person, or approaching so slowly that they might walk away without seeing him. Modeled where he should stand, showing him how this could change based on how well he knows them and how noisy the environment is. Reviewed making eye contact which we practiced in earlier meetings. Demonstrated appropriate greetings, suggesting he select one that best fit the moment (e.g., "Good morning" or "How have you been?). Modeled higher levels of formality, showing him how a person might greet their supervisor, and describing situations where using titles like "Mr." or "Dr." would be appropriate. Reminded Peter to speak clearly and wait for a reply from the other person.
I. In previous sessions Ramona learned how to introduce herself to others, how to introduce two people to each other, and how to greet acquaintances. Today I began working with her on initiating conversations. Explained that initiating a conversation was just a way of letting the other person know she wanted to talk, and that sometimes people would be too shy or too busy to do that, and that this was okay. Introduced her to the first step in starting a conversation -- choosing a topic. Offered ideas on how to choose a topic based on how well she knew the person (e.g., the weather or current events with strangers, and more personal topics like health and relationships for people she knew better). Provided examples of different situations and topics that were a good fit, such as the weather if she was sitting at a bus stop with someone when it was raining, or things she remembered the other person was interested or involved in if she was already acquainted with them.
I: Last week we discussed how to start a conversation by choosing an appropriate topic. Today I introduced Ramona to the second step, which is making an opening remark. Explained that this could be a greeting, a comment, or a question. I modeled and explained how to start this, first observing the situation and paying attention to the person's body language. I told Ramona that if the person appears to be busy or is talking to someone else, it might be better to wait. Explained that if the person makes eye contact it might be a signal they are available to talk, but if they quickly look away it might not be the best time to approach them. I tried using role-play and role-reversal with Ramona because she indicated she was having a hard time understanding things.
I: Last week Gloria and I worked on how to initiate a conversation. She had a difficult time understanding my descriptions of body language and how to determine whether it was a good time to greet someone and try to start a conversation. Today I spent the session modeling different combinations of body language Gloria is likely to encounter and explaining to her what I was thinking or trying to project with each of them. She was able to correctly identify posture cues fairly quickly (open, closed, mirroring) but eye contact cues were more challenging for her. I praised Gloria for her willingness to try to learn a new language, told her she was doing a good job, and acknowledged that differences in eye contact can be extremely subtle.
I: In our last session Gloria began learning how body language can be used to assess other people's readiness to engage in conversation. Gloria struggled with eye-contact cues, so today I spent the session demonstrating different eye-contact messages and explaining what I was thinking or trying to project. As the session progressed, I began asking Gloria to guess what the messages were rather than telling her, and giving her feedback on her answers.
I: Last week I began teaching Peter how to start a conversation. Today we focused on how to make a follow-up comment after he hears a response to his initial greeting. Explained to Peter that he should listen carefully to the other person's response rather than thinking about what he is going to say next, then identify a reply that stays on topic with what the other person has said. This could be a paraphrase, an opinion, or an additional question to further the conversation. I modeled this for Peter and showed him how to close the conversation if he feels the other person doesn't want to continue (e.g. "It looks like you're busy, let's talk another time"). Role-played with Peter to reinforce these skills and directed him to practice using them over the next week.
I: Introduced Danelle to the idea of discussing social topics rather than personal ones to improve the quality of her conversations. Explained that people can feel annoyed when a person talks only about himself or herself, or embarrassed/invaded when a person talks about subjects that are personal to them. Offered suggestions on topics that were safe to discuss in almost any situation, such as the weather, current events, sports, music, TV shows, movies, and travel. Encouraged Danelle choose several subjects she is interested in and spend time learning more about them.
I: Last week Danelle and I worked on choosing appropriate topics for a discussion (i.e., social rather then personal). Today we discussed the skill of listening and reflecting back. I explained to Danelle that good conversations have a give-and-take quality about them because they go back and forth between the two people. If she dominates the conversation the other person may lose interest. Stressed the importance of listening closely to the other person's reply to her opening comment and basing her response on what she hears them say. Explained the skill of reflective listening, modeled it, then practiced it with her. We took turns starting each conversation with a topic we thought might be of mutual interest.