How to start a conversation
The client in this example was diagnosed with residual schizophrenia. Things that come naturally to you -- like walking up to someone, saying hello, and having a conversation -- were very difficult for him. Your client may not need this much assistance, but people with severe social-skill deficits often do.
Session 1: In previous sessions Peter learned how to introduce himself to others. Today we focused on the skill of introducing people to each other. I explained to Peter that he would use this skill when he came together with 2 people who both knew him but did not know each other, and when he had identified a reason they might like to meet. Gave him examples of how these introductions might begin (e.g., he’s talking with one person and sees the second person, and waves the second person over). Modeled moving close to the people he is about to introduce, leaving enough room between them in case they wanted shake hands. Showed him how their bodies would form a triangle. Will continue teaching this skill in our next session.
Session 2: In our last session I began teaching Peter the skill of introducing people to each other. Reviewed what we covered last week -- why this skill is important, when it should be used, and how Peter should position himself and the people he wants to introduce. I then modeled the next step for Peter, which is stating the persons' names and connections. I explained that depending on the situation and the people involved, he should consider what information is common knowledge and what information might be confidential. Suggested he think of connections that did not rely on explicit references to treatment, such as "Sarah and I attend a group together every week" instead of "Sarah and I both see the same psychiatrist." After rehearsing this skill with Peter and giving him feedback, I had him introduce me to another case manager using our first names and stating our connection ("I talk to you guys every week but I don't know if you've met each other").
Session 3: In previous meetings I taught Peter how to introduce himself to others and how to introduce people to each other (i.e., people he knows who do not know each other). Today I began working with Peter on how to greet acquaintances. Explained that greetings were important because they let the other person know he has noticed them, and because they provide an opening for a conversation. I clarified for Peter that the greeting alone was enough to maintain a friendly connection over time, and that it was not necessary or even desirable to have a conversation with each greeting. I explained that he should greet acquaintances when he saw them for the first time that day, not every time they crossed paths. Will model appropriate greetings for Peter in our next session.
Session 4: Continued working with Peter on greeting acquaintances. Modeled walking up to the other person to within a comfortable speaking distance. Showed him how to approach at a normal speed, not rushing up quickly which could startle the person, or approaching so slowly that they might walk away without seeing him. Modeled where he should stand, showing him how this could change based on how well he knows them and how noisy the environment is. Reviewed making eye contact which we practiced in earlier meetings. Demonstrated appropriate greetings, suggesting he select one that best fit the moment (e.g., "Good morning" or "How have you been?). Modeled higher levels of formality, showing him how a person might greet their supervisor, and describing situations where using titles like "Mr." or "Dr." would be appropriate. Reminded Peter to speak clearly and wait for a reply from the other person.
Session 5: In previous sessions Peter learned how to introduce himself to others, how to introduce two people to each other, and how to greet acquaintances. Today I began working with him on initiating conversations. Explained that initiating a conversation was just a way of letting the other person know he wanted to talk, and that sometimes people would be too shy or too busy to do that, and that this was okay. Introduced him to the first step in starting a conversation -- choosing a topic. Offered ideas on how to choose a topic based on how well he knew the person (e.g., the weather or current events with strangers, and more personal topics like health and relationships for people he knew better). Provided examples of different situations and topics that were a good fit, such as the weather if he was sitting at a bus stop with someone when it was raining, or things he remembered the other person was interested or involved in if he was already acquainted with them.
Session 6: Last week we discussed how to start a conversation by choosing an appropriate topic. Today I introduced Peter to the second step, which is making an opening remark. Explained that this could be a greeting, a comment, or a question. I modeled and explained how to start this, first observing the situation and paying attention to the person's body language. I told Peter that if the person appears to be busy or is talking to someone else, it might be better to wait. Explained that if the person makes eye contact it might be a signal they are available to talk, but if they quickly look away it might not be the best time to approach them. I tried using role-play and role-reversal with Peter because he said he was having a hard time understanding things.
Session 7: Last week Peter and I worked on how to initiate a conversation. He had a difficult time understanding my descriptions of body language and how to determine whether it was a good time to greet someone and try to start a conversation. Today I spent the session modeling different combinations of body language Peter is likely to encounter and explaining to him what I was thinking or trying to project with each of them. He was able to correctly identify posture cues fairly quickly (open, closed, mirroring) but eye contact cues were more challenging for him. I praised Peter for his willingness to try to learn a new language, told him he was doing a good job, and acknowledged that differences in eye contact can be extremely subtle.
Session 8: In our last session Peter began learning how body language can be used to assess other people's readiness to engage in conversation. Peter struggled with eye-contact cues, so today I spent the session demonstrating different eye-contact messages and explaining what I was thinking or trying to project. As the session progressed, I began asking Peter to guess what the messages were rather than telling him, and giving him feedback on his answers.
Session 9: Last week I began teaching Peter how to start a conversation. Today we focused on how to make a follow-up comment after he hears a response to his initial greeting. Explained to Peter that he should listen carefully to the other person's response rather than thinking about what he is going to say next, then identify a reply that stays on topic with what the other person has said. This could be a paraphrase, an opinion, or an additional question to further the conversation. I modeled this for Peter and showed him how to close the conversation if he feels the other person doesn't want to continue (e.g. "It looks like you're busy, let's talk another time"). Role-played with Peter to reinforce these skills and directed him to practice using them over the next week.
Session 10: Introduced Peter to the idea of discussing social topics rather than personal ones to improve the quality of his conversations. Explained that people can feel annoyed when a person talks only about himself, or embarrassed/invaded when a person talks about subjects that are personal to them. Offered suggestions on topics that were safe to discuss in almost any situation, such as the weather, current events, sports, music, TV shows, movies, and travel. Encouraged Peter choose several subjects he is interested in and spend time learning more about them.
Session 11: Last week Peter and I worked on choosing appropriate topics for a discussion (i.e., social rather then personal). Today we discussed the skill of listening and reflecting back. I explained to Peter that good conversations have a give-and-take quality about them because they go back and forth between the two people. If he dominates the conversation the other person may lose interest. Stressed the importance of listening closely to the other person's reply to his opening comment and basing his response on what he hears them say. Explained the skill of reflective listening, modeled it, then practiced it with him. We took turns starting each conversation with a topic we thought might be of mutual interest.