5 Strategies For Incorporating CBT into Social Skills Work
In my last blog post, I talked about the Masters Degree I am studying for, in Cognitive Behavioural Therapy for Children and Young people, specialising in Autism Spectrum Condition. In this blog post, I would like to share some CBT strategies and approaches that I am incorporating into my speech therapy work.
1. Collaborating to set timetables for therapy sessions
Work with children on the spectrum is usually very structured to reduce anxiety and help the child know what, and how much, they are going to do. CBT is all about collaboration, working together on a journey of discovery to bring about change. Where appropriate, I am being more collaborative with timetables, for example asking children if there is anything they want to talk about in the session that we can put on the timetable.
I have found that handing over some of the control in this way has had very positive effects and can lead to more engagement. In one of our social skills groups in one of the schools I work for, I let the children take turns to lead the group. I was amazed at the result. They are all participated more collaboratively with the group, and the person leading helped others in activities, as a teacher/therapist would do.
Asking if there is anything the child wants to talk about during a session has led to children sharing information, e.g. volunteering information about friendship difficulties that they might not have discussed if I had determined the timetable.
2. Setting Goals With The Child To Encourage Ownership
CBT relates the goals to sessions more explicitly than speech and language therapy does, and instead of setting goals with carers, teachers, occupational therapists, etc, in CBT you set them with the child. This encourages the child to feel they have more ownership over the sessions, and they feel more involved in the therapy process. This is a powerful motivator and much more inclusive than setting targets with carers and/or other professionals.
Example of a goal set with a ten-year-old boy I work with
Overarching outcome: I will be able to play with other people at short and long break at school
How will we achieve this outcome?
Ben will work towards this goal by achieving a number of small steps, i.e. by breaking the goal down into small steps.
Step One: I will play with Tom, or another child, once a week, on Wednesdays, for short play.
I will play with Tom/another child for short play:
Day I did it
Before short play:
How worried am I/was I about playing with Tom/another child?
After short play:
How hard was it to play with Tom/another child?
3. Motivating Through Reflecting on Goals
I have observed that it can be hard for children and young people to reflect on goals like these. For many of the goals that we set, we target key areas of difficulty, and there is a lot of emotion bound up in this that can be painful and difficult to talk about. However, the pride if goals are achieved is wonderful to see, and it motivates the child/young person to set another goal.
4. Making Therapy a Collaborative Process
When I work on Speech and Language Therapy goals, I don’t often ask the child/young person if they know why we are doing what we are doing. In CBT, you often ask that question and that has been a surprise for me. I realise I had assumed that children/young people knew why we were doing what we were doing. I assumed a shared knowledge base that I had no right to assume. I was amazed by answers when I asked, “Why are we doing this?” Nobody knew. They did what I asked, but had no understanding of why I wanted them to do it. Speech and Language therapy can be something that is done to a child/young person, rather than being a collaborative process that we do together.
5. Applying a CBT approach to the language used in speech therapy
My training is in reducing speech, language and communication pressures on a child/young person. I am trained in making my language completely accessible to the child/young person, working out what level they are at and then matching my use of language to that so that they we can communicate. I use visual support, for example Makaton signs, symbols, pictures etc.
I reduce the number of questions I ask in order to reduce pressure – speech and language therapists have many strategies they use to enable children to communicate. We use very different strategies with a very different focus to CBT. Obviously, my training as a speech and language therapist is helpful and I definitely bring it into CBT sessions, I can’t help but do that, it is second nature now. However, it didn’t help me with the use of language in CBT. For example, language that is used to:
- Summarise what you have been talking about at regular intervals in order to provide opportunities to check that you have understood what the child/young person is saying.
- Reflect back what the child/young person has said to help them reflect on it.
- Elicit concerns and help the child/young person think about and voice these.
- Provide positive affirmation of the child/young person. To recognise and highlight bravery, skills, progress, etc.
- Help recognise your thoughts and feelings and their impact on behaviour (to provide psychoeducation).
I realised that although as speech and language therapists we deal with many aspects of social skills, e.g. recognising and understanding emotions, initiating, maintaining and ending interactions, understanding what are expected and unexpected behaviours, we do not deal with the feelings or the emotional difficulties, or if we do, not in the same way as CBT does. I was scared by this initially, scared by the emotion and the pain that children/young people and their families were feeling, scared I was not skilled enough to help them. That fear is reducing and I feel I have found the direction I want to move in, and that I have found the right area for me. I feel I will be able to provide the help that I dream of giving and the three years of studying for my Masters will be well worth it.