Communication Breakdown? the challenge of meeting the communication needs of people with ASC in a specialist secure service

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Great Mates and Great Dates
A Healthy Relationship Skills Group for High
Functioning ASD Mary Woodward, Highly Specialist
Speech and Language Therapist Sam Cooper-Evans,
Consultant Clinical Psychologist
A charity leading innovation in mental health
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Aims of Presentation

• Why did we bother?
• Who did we do it for?
• What were the main aims?
• What did we do?
• Did it work?
• How did it go?

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Why bother?

• Lack of published programmes for development of
  adult relationships (both platonic and intimate)
• Recognising that many individuals with ASD have a
  normal desire for friendships/relationships but
  struggle to initiate or maintain them
• Lack of supportive relationships or social
  knowledge is contributing factor to offending
• Need to address relationship skills, as part of a
  wider treatment programme
• address ASD specific need
• maximise the likelihood of individuals having
  successful social lives in the future
• minimise future risk.

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Who Did we Do it For? Group Attendees

• 6 males, aged 20 -28
• All detained under Mental Health Act (1983) for
  having committed offences (mainly sexual
  offences, but also aggression and/or arson)
• Social communication and relationship
  difficulties were considered to be a contributing
  factor
• High functioning ASD/AS, though some literacy
  difficulties
• All had experience of group work
• Some had completed some foundation work on
  relationships in 11 sessions

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What Were the Main Aims?

• to provide an overview of positive relationship
  skills, which may be considered as part of
  offence-related treatment
• to consider different types of relationships
  (personal/professional etc), the differences
  between them, and the intrinsic boundaries
• to consider ways in which they may make friends
  (where/how to meet, how to communicate etc)
• to consider how to transition from friendship to
  dating
• to explore legal issues, e.g. consent
• to consider the possible pitfalls in
  relationships and how to deal with them

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What Did we Do? Practicalities

• Sessions planned and facilitated by a
  multi-disciplinary team
• led by SLT and Psychology
• supported by OT, Education Nursing staff
• 10x75mins sessions, with personal practice

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What Did We Do? Session Content

• FRIENDSHIPS
• What is a friend?
• How do you make a friend?
• How do you keep a friend?
• Trust
• The changing boundaries of friendships (close v.
  acquaintances)
• RELATIONSHIPS
• Acting on attraction when is it appropriate? How
  do you go about it?
• Coping with unrequited attraction
• Forming and maintaining a relationship
• Intimacy emotional and physical
• Legal issues consent, power
• Managing differences and conflict
• Coping with the end of a relationship

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What Did We Use? Resources

• Kelly, A (2004) Talkabout Relationships
  Building
• Self-esteem and Relationship Skills. Milton
  Keynes Speechmark
• Ramey, E.M. Ramey, J.J. (2008) The Autistics
• Guide to Dating. London Jessica Kingsley
  Publishers
• Marc Segar (1997) Survival Guide for People with
• Aspergers Syndrome http//www.asperger-marriage
  .info/survguide/contents.html
• Media clips (DVDs, youtube, newspapers etc)
• Devised own activities

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What Did We Do? Format of Sessions

• Recap what was discussed in the last session
• Watch a funny bit of DVD to introduce the topic
• Have a bit of a chat about it
• Some activities to think more about the topic
• Do some activities on your own between sessions

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What Did We Do? Some Example of Activities

• Friendship Circles
• Emotionally close/distant
• Professional/personal
• What can you talk about?
• What activities would you do?
• Physical contact

Inner circle is for intimate relationships Second
circle is for close friends and close family
Third circle is for friends etc Fourth circle is
for some closer professional relationships Outer
circle is for acquaintances, less close
professional relationships etc Outside the
circles is for strangers
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What Did we Do?Social Profile

• They were asked to
• Describe themselves (physically)
• Describe their personality
• Describe their interests
• Describe what theyre looking for in a
  friend/partner
• Think about the impression theyre creating for
  target audience (i.e. want to stand out but not
  put people off). Honesty being yourself.
• Produce own example.

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Example of Social Profile

• Maria
• Hi, Im 56, slim, with short brown hair. Im a
  bubbly, chatty
• person, and like to have a laugh.
• I have quite a stressful job, so like to relax by
  watching TV or
• movies, doing yoga or dance, singing, or spending
  time with
• friends.  I like cooking, especially Thai food,
  and since buying
• a new house recently, Ive become a bit of a
  domestic and
• gardening goddess, though have to admit I prefer
  lying in my
• hammock to weeding!
• Ive just moved to a new town, and so would love
  to meet more
• people to share my spare time with. I get on best
  with reliable
• people who can be serious, but now how to have a
  laugh, who
• enjoy going out for a meal or to the cinema, and
  maybe even
• joining me for a bit of yoga or dancing sometime!

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What did We Do? Meeting People Plan adapted
from The Autistics Guide to Dating (Ramey and
Ramey)

• Consider how their interests can provide
  opportunities to meet people
• How/where to go about meeting people
• What stages to go through
• Also considering security issues, dos and donts
  of communication, internet dating etc
• Develop their own plan

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What Did we Do? Conversation Starters/Chat-up
Lines

• You look really nice.
• Get your coat, youve pulled
• Do you believe in love at first sight, or should
  I walk by again?
• Hi, my name is.
• I just wanted to show this rose how incredibly
  beautiful you are!
• There must be something wrong with my eyes, I
  can't take them off you
• Can I buy you a drink?
• Is your name Gillette? ...because you're the best
  a man can get.
• Is there a rainbow, because you're the treasure
  I've been searching for.
• Ive been wanting to read that book. Is it any
  good?
• Did it hurt when you fell out of heaven?

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What Did We Do? Physical Intimacy

• NB Not a sexual education group
• Consider bases
• Consider power imbalances
• Consider consent, especially after drinking

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What Did We Do? Pitfalls in Relationships

• Communication breakdown
• Conflict resolution
• Keeping a healthy balance
• Coping with the ending

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Grief/Loss Cycle(from Kübler-Ross, 1969)
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Did it Work? Pre/Post measures

• Self-developed semi-structured interview about
  knowledge
• Self-developed Likert scale re.confidence
• Relationship Skills Assessment (Kelly, 2004, p90)

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• Did it Work? Self-developed Semi-structured
  Interview about Knowledge
• Q. How can you know if someone you fancied was
  also attracted to you?
• Pre enjoys hanging around with you.
• Post You dont know for sure.
• 2) Q. How would you know if a relationship was
  over?
• Pre ?
• Post when you cant resolve your differences
• 3) Q. What would be a good thing to say to
  someone that you would like to get to know better
  as a friend?
• Pre Dont know
• Post Do you have any hobbies?
• Q. When is it Ok to have sex with someone?
• Pre girlfriend
• Post when you both feel ready

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Did it Work? Self-developed Likert scale
re.Confidence
Item
starting a conversation with someone 5 1
being a good friend 5 1
making a new friend 6
recognising your feelings of attraction for someone 4 1 1
recognise someone elses feelings of attraction towards you 3 2 1
asking someone out on a date 4 2
making interesting conversation whilst on a date 4 1 1
keeping a relationship going beyond the first date 5 1
dealing with disagreements in a relationship 5 1
coping with a relationship ending 3 2 1
TOTAL 44 12 4
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Did it Work? Relationship Skills Assessment
(Kelly, 2004, p90)
Service User Pre () Post () Change?
1 40 44
2 67 84
3 70 84
4 77 87
5 67 67
6 67 70
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How Did it Go? Reflections

• PROs
• Enabled therapists to assess further needs
• Covered important foundation skills as precursor
  for other work
• Developed confidence and knowledge, also seen in
  other ward situations
• Good attendance and enthusiasm
• MDT collaboration became part of ward ethos

• CONs
• Anxiety re.attending group rather than 11
• Lack of commitment to personal practice
• Too much to cover in 10 sessions
• Difficulty generalising in this setting
• Lack of robust pre/post measures

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Any Questions?

• mwoodward_at_standrew.co.uk
• scooper-evans_at_standrew.co.uk