Therapy And Support Groups For Social Skills Issues
I want people know all of their options for working on their social issues. As I mention in another article, one way to get help and support is to see a counselor one-on-one. Similarly, you could also attend a therapy or support group. This article will provide a general overview of them, and how they can be useful. Groups are a fairly common treatment for social anxiety and the interpersonal difficulties that are often a part of Autism Spectrum Disorder. In some ways groups are especially suited for social issues, because taking part in one is a safe, supportive social experience in itself.
My general philosophy toward using any kind of therapy or mental health services is that it can be useful for any severity of problem. It's not something that's only for really messed up people, just like how you don't have to be morbidly obese to go to a personal trainer. If you think seeing someone may help, and you're willing to go, then why not?
(Quick note: In this article I use counselor/counseling and therapist/therapy interchangeably.)
Treatment vs. Support groups
I'll clarify the difference between treatment, or therapy, groups and support groups. In general group therapy involves meeting with some other people, and one or two facilitators. You're all there to work on specific issues, but the form that takes varies depending on what type of group you're attending. Two forms you'll usually see when it comes to social skills issues are:
Treatment groups are more like little courses. They're more structured, focused on teaching, and they have a clear outcome they're trying to reach. They're lead by one or more mental health professionals, who have instructor-like roles. An example would be a 10-week group designed to reduce symptoms of social anxiety by teaching its members principles and techniques based on Mindfulness. Each session covers specific pre-planned material. A second example would be a general social skills training group, with each week covering a topic such as body language, assertive communication, and so on.
Support groups are less structured and more open-ended. They may run every week all year. They're a place where a group of people who share a common struggle can meet to support and help each other. The emphasis is on the members sharing with each other, rather than most of the content coming from a professional. An example would be an ongoing bi-monthly group where adults on the autism spectrum can talk to each other about the challenges of trying to socialize in their personal and work lives. Support groups may be facilitated by a mental health professional, but rather than going through a curriculum their aim is to help the discussion stay productive and on track. A trained counselor doesn't always facilitate. A support group may be organized and run entirely by its members.
Groups may also be a mix of the two. For example, a monthly support group for people with social anxiety may begin with a quick lesson or presentation about a certain aspect of interpersonal skills, after which the members talk to each other, with that topic kicking off the discussion.
What group therapy involves
Each therapy group is a bit different. Aside from discussion among members and instruction from the facilitators, a meeting could also involve in-class and real world exercises. Meetings usually have about 5-15 members. Some treatment groups have more participants if they're very instruction-focused, and the members aren't interacting with each other as much. Groups can be open or closed. In a closed group once the members are set, no one new comes in. This is more typical in a limited duration treatment group. Open groups allow new members, and are fine with everyone coming to meetings, or not, as they need them. You'll more often see this arrangement in ongoing support groups.
A worry some people have about groups is that they're not comfortable speaking to a bunch of strangers, and that they'll be made to talk during any discussion/sharing portions. No one will force you to speak if you don't want to, though you may get some light encouragement. Like a lot of things, many people find that speaking up in a group isn't that bad once they experience it, though they may need a few sessions of hanging back and watching before they warm up to the idea.
Topics that may be covered in various types of social skills treatment groups
As I said, every social skills treatment group will vary depending on how the facilitators decide to organize it. They'll generally cover the following:
Social anxiety treatment groups
Here the emphasis is on dealing with anxiety, though because those feelings come up in social situations, some interpersonal skills get covered as well. They're usually taught from a Cognitive Behavioral perspective, that is, the school of psychology which holds that a person's thoughts, feelings, and behaviors are tied together, and that by influencing one, you can affect the others. These groups usually include:
- An explanation of Cognitive Behavioral principles, e.g., explaining how knee jerk thoughts such as, "Everyone at the party will hate me" can trigger anxiety, and then providing a system for thinking more realistically and constructively.
- Teaching breathing and relaxation techniques for managing anxiety.
- Teaching some socializing techniques the members may not know (e.g., some general rules for making small talk, so when they talk to people a lack of knowledge on how to do it isn't feeding to their nervousness).
- Exercises where members get to experience firsthand that they don't appear as outwardly nervous as they feel (e.g., members may be asked to sing in front of everyone, and rate their anxiety on a scale of 1-100. As they perform they may give themselves a 90, but when asked how nervous they looked, the other members may only rate them a 40).
- Role playing exercises where group members can practice dealing with a variety of anxiety inducing situations such as job interviews, turning down an unreasonable request, or asking someone to hang out.
- In-class exposure exercises, where members confront fear-inducing situations and realize they can handle them (e.g., members practice asking each other for directions, only to have the other person pretend to get mad at them. Everyone realizes that when this happens, rather than feeling horrendously embarrassed, they just think the other person is a jerk).
- Real world exposure exercises (e.g., the facilitator may take everyone to a nearby grocery store, where the members have to ask other shoppers for help. Once they're comfortable talking to people under a pretext, they may try to initiate small talk for its own sake.)
As mentioned, these types of groups, and the kind I'll cover below, may have time devoted to discussion/sharing/support among the members.
Social skills training groups
These groups are about teaching people basic social skills they didn't get a chance to learn naturally. There are general topics they all tend to cover, but the content will vary a bit based on the type of group. For example, a social skills training group aimed at people with Autism Spectrum Disorder may devote more time to helping the members deal with the particular social weaknesses the condition causes (e.g., reading facial expressions, give and take in conversation, deducing what someone may be thinking).
Commonly taught topics are:
- Listening skills
- Non-verbal communication (e.g., eye contact, body language, personal space)
- Explanations of various unwritten social rules
- Conversation skills (e.g., ways to start, maintain, and end one)
- Assertive communication techniques
- Social problem solving (e.g., what would you do if you found out a friend hadn't invited you to a party)
- Specific scenarios (e.g., dealing with someone being rude to you, approaching your boss to ask a question, etc.)
Training groups usually start with some instruction on the principles to be taught that day. Afterward, members may engage in a variety of exercises and structured role plays. There may be homework practice assignments for the members to do between sessions. The instructors will give the participants feedback, in person, or perhaps by recording and re-watching practice interactions. As the weeks go by, the focus may shift away from role playing and more to real life socializing. Later sessions may involve staging a party where the members all try to naturally mingle with each other. Volunteers may enter the group to serve as practice conversation partners, so the members don't just get used to talking to each other.
Benefits of groups
Attending a treatment group has some obvious benefits. As you read in the section above, you'll be taught specific concepts, techniques, and skills that can help you with your social issues. You'll likely get to practice through in-class and real world exercises, and homework assignments. That alone would be a good enough reason to join one for many people.
Another advantage of group treatment is that being in a group is a social experience in and of itself. This applies to any kind of group, whether it's one for people who live with depression, or are caring for a spouse with cancer. By interacting with the other members, in a specially safe, supportive, confidential environment, you're likely to grow and change. If you joined a support group you'd still get these benefits, even though you wouldn't be given as much direct instruction.
It's not unusual for group members to become friends with each other either. Some people balk at this idea and think, "No, no. I'm a regular person and I'll be attending a group, but I'm different. All the other members are probably super messed up. I could never be friends with them." Once they start the group they see that the other participants are just like them. They may not be compatible friends-wise with every last one of them, but they see they're not complete deviants either.
The therapist Irvin D. Yalom identified several general therapeutic factors that can help people in all kinds of therapy groups. Some that are most relevant to improving social skills are:
Imparting of information
This one is straightforward, and I've already mostly covered it. The information could come from the group leader, or from another member sharing a small talk tip that worked for them.
Development of socializing techniques
This one may seem a little confusing, because the term isn't talking about the explicit teaching of techniques in a social skills group. Yalom is referring to something that can arise from the interactions among members in any kind of therapy group. Through the general discussion, the group provides a safe place where members can try out new ways of relating to others. For example, a member who is normally too shy to share his thoughts can learn to speak up and offer his opinion to another member. Or a participant could learn to assert themselves when a more talkative member cuts them off mid-sentence, rather than reverting to their usual response of abandoning what they were going to say.
While interacting with the other members, someone in a group learns more about how they come across in social situations. For example, they might get direct feedback on how they're sometimes too quick to focus on the negative. They may feel irritated by another member, before realizing they do some of the same things themselves, and that's why their out-sized reaction is coming from.
This refers to how someone can learn new ways of interacting by watching the leader and other members. E.g., they notice the mannerisms the leader uses that show she's being a good listener, they pick up on the conversational style of one of the more happy-go-lucky members, etc.
It can be very healing for people to belong to a tight, cohesive group where they feel accepted, especially if they've never had this experience before.
Some of the other factors Yalom identified aren't as immediately relevant to improving social skills but can still be very important benefits:
Installation of hope
This is when the group gives you the sense of, "I can see that people are working past this, or have already dealt with the issues I'm dealing with. I can do it too."
This is when you see firsthand that other people share your issues and struggles, and that you're not some lone freak for having the problems you do. E.g., someone with social anxiety could hear another member talk about their crippling fear of spilling food on themselves while eating in front of others, something they thought only they worried about.
Catharsis is when you gain a feeling of relief by expressing and releasing strong emotions. For example, a group member may feel better after tearfully telling everyone about his hidden insecurity that no one will ever like him because he's overweight.
The group provides the opportunity to help other members, which can raise someone's self-esteem and teach them new styles of interacting with others.
The group experience can also help people explore and deal with bigger, more existential concerns, like figuring out the meaning of their lives, or coming to grips with their mortality.
Corrective Recapitulation of the Primary Family Group
This one is a little more complicated. Basically, the idea is that when people first join a group they can unconsciously transfer their feelings and baggage about their family onto other members. For example, they may see the facilitator as being like their overly critical mother. They may see another talkative member as their popular, attention seeking sister. If all goes well that member can have a safe, positive experience with this substitute family, and work through some of their childhood baggage.
The effectiveness of social skills groups
A lot of research studies have evaluated the effectiveness of various social skills groups. What they find is that they help, but just a little. That sounds bleak, and like I'm undercutting the whole point of this article, but I'll try to put that finding in perspective. If someone has a lot of difficulty socializing, an 8-week treatment group, or a monthly visit to a support group, isn't going to miraculously cure all their problems, but it's still useful. I think it's like if a 12-year-old basketball player went to a special training camp over the summer. His skills are going to be better after he's done, and he may have picked up some foundational principles that will continue to improve his game long down the road, but in the grand scheme of things he's still twelve and a work in progress. All things being equal it was better for his development that he attended the camp, but it isn't going to single-handedly get him into the NBA. Many people say attending a group has been great for them, even if the results are subtle or don't translate to some numbers changing on a formal assessment.
Where to find social skills groups
If the idea of joining a group interests you there are a couple of ways to find them. Unfortunately groups aren't always as available as one-on-one counseling, but here are some things to try:
- If you're in university or college your school's counseling services probably offers a variety of groups. If they don't have one regarding social skills, you could always request that they look into starting one.
- You can always do a search on the internet for terms like "social anxiety support group (your city)"
- Sometimes classified ad sites or social media groups will have relevant listings, for example in the Groups page of a Community section.
- Mental health agencies in your community may offer a group that fits your needs. For example, the local branch of a mood disorders association may offer support groups for anxiety. An organization that provides autism-related services may hold social skills training groups for adults with Autism Spectrum Disorder. Even if a particular agency doesn't have the kind of group you'd like, you could always get in contact and ask if they can point you in the right direction.
- You could ask your doctor what he knows about groups in the area.
- If you're seeing a therapist, you can also ask them.
- If you're in high school you could talk to the school's guidance counselor or social worker. If you have a good relationship with your parents, you could even ask them to help you find one.