CLINICAL HANDBOOK OF SCHIZOPHRENIA

24. Social Skills Training 245tions after training. SST is clearly a teaching technology that is effective and well receivedby both patients and clinicians. These general findings are reflected in the 2003 SchizophreniaPatient Outcomes Research Team (PORT) recommendation for treatment ofschizophrenia (Lehman et al., 2004): Patients with schizophrenia should be offered skillstraining, the key elements of which include behaviorally based instruction, modeling, correctivefeedback, contingent social reinforcement, and homework assignments.TREATMENT GUIDELINESTailor the Training to Your PatientsThere are several considerations in how best to individualize SST for each patient. Notonly is it important that the skills training content be current, relevant, and useful in thepatient’s life, but it is also critical to maximize learning by adapting the training to thefunctional and cognitive impairment levels of participants.Which Skills to TeachIt is important to teach skills that the patients view as relevant to their lives and realisticallyuseful to them. This makes it more likely that patients not only learn the skillsduring SST sessions but also use them in their daily lives. Generalization to “real life”is unlikely if the skills being taught are not directly applicable to patients’ lives. For example,it does not make sense to teach dating skills to a group of long-term inpatientswho have no opportunity to pursue romantic relationships. Similarly, patients who expressno interest in working do not benefit from learning work-related social skills,such as job interview skills or how to ask their work supervisor for feedback about jobperformance.Patient Functional LevelPatient ability to function should be assessed, and sessions can be adjusted based on thelevel of functioning. In this sort of assessment the therapist makes judgments—both clinicaland behavioral—about the individual’s abilities. The therapist looks at the followingareas when making these judgments:• How effectively does the individual perform the skill when it is first modeled?• How quickly does the individual learn to perform a skill after it is first modeled?• Can the individual stay focused on all of the steps of a multistep skill?In general, therapists should gear SST toward relatively low-functioning patients. Forpersons who are quick to learn, who engage more easily, and who have greater ability todeal with abstractions, therapists should use clinical judgment to increase the complexityof the material (e.g., difficulty level of role-play situations). On the other hand, with individualswho are difficult to engage due to symptomatology or other factors, and/or whohave difficulty attending to the material being presented, the focus should remain onlearning the basics of the skill. The therapist does this by simplifying the exercises andworking hard to keep the individual engaged by asking him or her to repeat session materialand relating to his or her individual experiences. It is almost always better to err onthe side of oversimplification than to overreach. High-functioning patients tell therapistswhen they have oversimplified too much. In contrast, low-functioning patients do not telltherapists when the material is over their heads.