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Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Illness Management and Recovery Workbook
Chapter 5
Practitioner Guidelines for Handout #4:
Building Social Support
Introduction
According to the stress-vulnerability model, stress contributes to the symptoms
of mental illness. Having social support helps people cope with stress more
effectively, which helps reduce relapses. Having family members and other supportive
people involved in relapse prevention plans can also help to reduce relapses.
This module helps people evaluate their social supports, identify places where
they might meet people, and develop strategies for increasing closeness in personal
relationships.
Goals
- Provide information about the benefits of social support.
- Convey confidence that people can strengthen their social
support.
- Help people identify and practice strategies for connecting
with more people.
- Help people identify and practice strategies for getting
closer to people.
Number and pacing of sessions
“Building Social Support” can usually be covered in two to four
sessions. Within each session, most people find that covering one or two topics
and completing a questionnaire is a comfortable amount.
Structure of Sessions
- Informal socializing and identification of any major problems
- Review the previous session.
- Discuss the homework from the previous session. Praise
all efforts and problem-solve obstacles to completing the homework.
- Follow-up on goals.
- Set the agenda for the current session.
- Teach new material (or review material from the previous
session if necessary).
- Summarize progress made in the current session.
- Agree on homework to be completed before the next session.
Strategies to be used in each session
Motivational strategies
Motivational strategies in this module focus on helping people identify the
benefits of having stronger social supports and helping them develop the confidence
that they can be effective at increasing the number and/or quality of their
relationships.
The following suggestions may be helpful:
- At the beginning of this module, review the personal goals
that people have identified in previous sessions. Ask people how having strong
social support might help them achieve some of their personal goals.
For example, if someone has the goal of reducing her alcohol use, having non-drinking
friends could help her enjoy herself without alcohol. Or if someone has the
goal of being less distracted by symptoms such as auditory hallucinations,
having friends to talk could help him pay less attention to the voices.
- Focus some discussion on previous positive relationships
that people may have had. Ask what they enjoyed about the relationships and
how they benefited from the relationship.
- Some people may have had negative experiences with social
relationships. Express empathy, but focus on how using the strategies in the
handout can give people skills that will make relationships go better in the
future. For example, a person may have disclosed personal information too
quickly in the past and the relationship ended in a distressing way. In the
handout, people will learn to gradually increase the level of disclosure when
they want to make a relationship closer.
- Help people evaluate the advantages and disadvantages of
keeping their social support system the way it is, and the advantages and
disadvantages of changing it. Some people have been isolated for several years
and it may be anxiety- provoking for them to think about reaching out to others.
Educational strategies
Educational strategies for this module focus on increasing people’s
knowledge about the benefits of social support and helping them become familiar
with ideas for increasing the number and quality of their relationships.
The following educational strategies were discussed in detail in Module 1:
- Review the contents of the handout, by summarizing the
main points or taking turns reading.
- Pause at the end of each topic to check for understanding
and to learn more about the person’s point of view,
- Allow plenty of time for interaction.
- Pause to allow the person to complete the checklists and
questionnaires.
- Break down the content into manageable “pieces.”
- Find a pace that is comfortable for the person.
Cognitive-behavioral strategies
Cognitive-behavioral strategies focus on helping people to actively practice
and use strategies for increasing the number and quality of their relationships.
Providing opportunities in sessions to role-play strategies for connecting with
others or increasing closeness can be effective. In each session, help people
plan how they might use strategies in their everyday life. Modeling, role playing,
and rehearsing elements of their plan in the session can be help people to follow
through outside the session.
The following examples may be helpful:
- When people are interested in changing their social support
system, take a “shaping” approach and help them start with small
steps in order to maximize the chances of success. For example, if someone
is interested in re-establishing a relationship with an estranged relative,
it might be a good idea to start with a small step, such as sending a short,
pleasant note to the relative.
- As people identify a place where they would like to meet
people (using the checklist in the handout), you could help them plan how
they could actually go to the place. For example, if they would like to meet
people at an exercise class, you could help them locate the phone number and
address of a YMCA or other health club where they could take classes.
- If people enroll in an exercise class in order to meet others,
you could set up role-plays to help them practice how they could start a conversation
with someone in the class.
- Using the “Things You Can Say to Increase Closeness”
checklist, you can help people identify and practice strategies for conversations
that will lead to more sharing. For example, if people wanted to practice
the skill of expressing compliments, you could model how to give a compliment
and/or you could set up role-plays for people to practice giving compliments.
- Using the “Things You Can Do to Increase Closeness”
checklist, you can help people identify and practice strategies for showing
they care about others. For example, if people would like to try arranging
an activity with someone to show they care, you could set up a role play for
them to practice asking someone to join them for a movie.
- Using the “Levels of Disclosure in Relationships”
checklist, you can help people identify someone that they might want to become
closer to. After they identify someone, you could set up a role-play for them
to practice what they might say to someone at a higher level of disclosure.
Homework
During the sessions, people will be identifying ways that they would like
to increase the number or quality of their relationships. Homework could include
making and following through on plans to achieve these goals.
Practitioners should follow up on homework assignments in the next session
by asking how they went. They should reinforce completed homework or the effort
people have made to complete homework. If someone is not able to complete the
homework, practitioners can ask about what got in the way and help him or her
develop (and sometimes practice) ways of overcoming obstacles.
The following examples of homework may be helpful:
- If the person does not have time to complete checklists
in the session, he or she can do this as homework.
- If the person identifies places where he or she would like
to meet people, the homework could consist of either finding out more information
about the place (location, hours, etc.) or actually going there.
- If the person is interested in getting experience starting
conversations, he or she could plan to start at least two conversations before
the next session.
- If the person would like to get closer to someone, he or
she could select a specific person and plan to try out one of the suggestions
in the handout about what people can say or do to gradually increase closeness.
- If the person would like to increase the level of disclosure
in a specific relationship, he or she could plan what he or she might tell
the other person to accomplish this. This homework assignment would also benefit
from determining in advance where and when the person might hold such a conversation.
Tips for common problems
- Some people have had unpleasant experiences with past relationships or
with trying to develop new relationships.
Explore what happened in the past and identify some strategies from the module
that could lead to better results. For example, a person might say, “I
keep asking people to do things together, but they never say ‘yes.’
” You could say, “I’m sorry that’s been happening.
But we could work together coming up with some strategies that might help
you get a more positive response from people in the future.”
- Some people may be very shy about approaching others.
Encourage very small steps, such as smiling at people and saying “Hello.”
When people feel more confident, they might try making small talk. Set up
as many role-plays as possible to help people rehearse what they can say to
others. There are materials available for practitioners to help people learn
social skills in a systematic way (see social skills training references at
the end of Part 1 of the Practitioners’ Guide). People may also benefit
from attending a social skills training group to get more practice and feedback
from peers.
- Some people may move too quickly when trying to establish close relationships.
Encourage the person to get to know other people gradually. Explore what happens
when people share deeply personal information or become physically intimate
early in a relationship. Help people develop skills for gauging other people’s
response to them (e.g., what are some ways to determine whether someone is
interested in talking or would like to become closer?).
Review Questions
At the end of this module, it is helpful to assess how well the person understands
the main points. Practitioners can use the following types of questions (open-ended
questions or multiple-choice).
Open-ended questions
- Who are the supportive people in your life?
- What are some places that you could meet new people?
- What’s a good way to start a conversation?
- What can you say to someone that will increase the closeness
of your relationship?
- What is something you can do for someone to show that you
care about him or her?
Multiple choice and true/false questions
- A sign of a supportive relationship is:
Arguments
Criticism
Helpfulness
- Which of the following is NOT a good place to meet new people?
At your workplace
At a toll booth
At a drop-in center
- When starting a conversation, it is a good idea to first think of
some topics that might interest the other person. True or False
- To increase closeness in a relationship, you can:
Offer someone help when they need it
Keep your thoughts and feelings to yourself
Refuse to compromise
- When you are interested in developing a close relationship, it is
a good idea to tell personal information:
Gradually, as you get to know each other better
As much as possible the first time you talk to them
Never
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