One of the first things a licensed clinical social worker (LCSW), licensed mental health counselor (LMHC), or licensed marriage and family therapist (LMFT) assesses in new clients is their cognitive (thinking) functions. Do the clients distort their thoughts to sabotage their outlook on the world, or is their thinking not distorted and able to adapt to their environment?
This early type of assessment falls to the sidelines however, when face-to-face with a client with autism spectrum disorders (ASD) or other social learning challenges.
These individuals come into the world with an atypical neural structure that results in thinking patterns very different from their neurotypical counterparts. As a result, many LCSWs, LMHCs, and LMFTs lack confidence in their ability to perform a proper cognitive assessment at a level these clients can process. Sadly, this means many of these individuals who could benefit from treatment are unable to find the services they need.
As a psychotherapist I know the pain and internal struggle professionals like myself face in wanting to help individuals with social learning challenges, but feeling ill-equipped to do so. That was my situation until I discovered Michelle Garcia Winner's Social Thinking® model. The Social Thinking framework provides the bridge into the concrete thinking mind these individuals possess. The concepts and vocabulary upon which Social Thinking is built enables a therapist skilled in cognitive behavioral treatment to effectively access the thought patterns of, and effect positive change in, persons on the autism spectrum or those with other social learning challenges.
What is Social Thinking?
Social Thinking is a teaching framework for parents and practitioners, created by Michelle Garcia Winner, CCC-SLP, designed to assist persons of all ages who struggle to understand the ways of the social world. With Social Thinking concepts, vocabulary, and constructs, clients learn to identify what thought patterns and behaviors are sabotaging their social experiences. Then Social Thinking books and curriculum offer practical strategies to address the problematic behavior and thought patterns.
How Does Social Thinking Connect with CBT?
It is increasingly being recognized that behavioral interventions are limited when working with persons of moderate to high intelligences who manifest social learning/social thinking challenges. Social Thinking goes behind the behavior to the level of thinking and asks a fundamental question, "Why do people use social skills?" Within the Social Thinking framework, several answers are offered: "To participate in a social situation." "To impact how people feel about us." "To figure out how we feel about others." "To consider the thoughts, feelings, and actions of those around us." The idea within Social Thinking that thoughts affect feelings and actions, and actions affect thoughts is reflective of the same cycle of thoughts-feelings-actions within cognitive behavioral theory. Mental health therapists understand this cycle and are consistently working with clients to help them feel their emotions genuinely but then stop and think before acting. This is especially true in cases of physical self-injury. However, blurting, interrupting, dominating a conversation and other unaccepted social behaviors are self-injury of the emotional kind, behaviors that can result in self-imposed social isolation, high levels of anxiety and deep depression.
The Social Thinking framework incorporates cognitive psychology constructs repackaged in a way that respects the developmental level and concrete mind of a client on the autism spectrum or those with other social learning challenges. For instance, Superflex® is a Social Thinking superhero who helps individuals learn to defeat the "Unthinkables" that invade their brain and cause them to act inappropriately. Fourteen unique Unthinkables include Rock Brain, who gets people stuck on their ideas, One-Sided Sid who gets people to only talk about themselves, Glassman who makes people have huge upset reactions, or Brain Eater who distracts people so they are unable to focus on a task. Social Thinking concepts and a common vocabulary that explains abstract social concepts at a more concrete level, help clients learn to minimize socially inappropriate behavior while simultaneously improving their ability to think effectively about the world around them. Concepts such as "thinking with your eyes", "body and brain in the group", "expected/ unexpected behavior", and "people files" do just that.
Infusing Social Thinking into Therapy
In an ideal world a child would be diagnosed with Autism or a neurological difference during the toddler years, receive extensive early intervention and enter school with several years of training that would equip the child to think about the world effectively. The reality is often very different. In many situations, the first professionals brought only board to work with a family with a child on the autism spectrum are LCSWs, LMHCs or LMFTs. Often these cases are the result of behavior issues that are causing distress for the parents, the client, or both. Perhaps the client behaves appropriately at school, only displaying problematic behaviors at home. Or the client's emotional state is being excessively taxed by an inconsistent or changing home environment, or situations exist where the parents are uneducated or uninformed on their child's needs. Oftentimes families seek out mental health clinic and/or private practice services because their spectrum child is having trouble, but they do not have insurance benefits for SLP, OT, or ABA treatment. In many parts of the country the ideal model of a team of school based specialists that collaborate with home care providers is simply not possible. Either the school does not have the resources for speech, occupational and/or behavioral services, or clients needing services have not been properly diagnosed, preventing them from receiving the treatment they need.
A well-trained LCSW, LMHC, or LMFT can bridge the gap between the home and school environment. These professionals can collect behavioral inventories and interview school personnel to better understand the school environment, alongside working to understand the home environment during sessions with parents. Using Social Thinking vocabulary and strategies, an LCSW, LMHC, or LMFT can educate both the family and teachers on how the client is/is not learning from their social environment and how to teach the client to think about others in a more effective way.
LCSWs, LMHCs, and LMFTs are Master's level trained with years of clinical internships and experiences under their belt. However, their ability to work with clients with social learning challenges is largely determined by the amount of self-guided study they have independently completed. The idea that not all individuals are born with intact social brains may be genuinely accepted by these professionals. Learning concrete ways to break apart complex social concepts and teach them effectively is relatively new territory to many licensed counselors and therapists. Extra training is usually warranted and can be obtained at various conferences such as Michelle Garcia Winner's Social Thinking trainings and conferences, at her Clinical Training Program where practitioners can learn directly from Michelle and her core team in a small group format, at annual Autism Society conferences, and at Centers for Autism and Related Disabilities programs at local universities, as well as through a multitude of other venues. Parents should never hesitate to ask what therapy models a mental health professional subscribes to or what conferences/trainings the person attends that demonstrate experience or knowledge in the social thinking field.
Families should also feel comfortable asking their mental health clinician directly about what percentage of their work is done with children and adults with ASD or other social learning challenges. It is a good idea to ask what strategies and frameworks the clinician uses, such as Social Thinking or The Incredible 5-Point Scale (Buron and Walsh) that uses a 1-5 scale for emotion recognition. A well-trained LCSW, LMHC, and LMFT will refer any client with a suspected autism spectrum disorder for appropriate evaluation by a clinical psychologist, SLP, OT, or developmental pediatrician. But as the wheels begin to turn for that evaluation to be completed, the mental health therapist could begin treatment to alleviate the client's symptomology, using Social Thinking strategies. The Social Thinking assessment tools, although not yet standardized, identify social cognition in a way that no standardized tests have been able to duplicate. These tools are practical and usable within a private mental health practice, school, or medical setting.
Making a Difference
Social thinking is a 24/7 skill. As Michelle Garcia Winner often remarks in her workshops and presentations, there is never a time we are not using social thinking. We use social thinking when we are around others, when we are alone, to be effective in relationships and to succeed in academics. An LCSW, LMHC and LMFT trained in Social Thinking can help teach their clients with ASD and other social learning challenges to more effectively interact with the world and engage with their peers and the leaders in their lives in a way that keeps them all feeling positive about the relationship. This positivity will occur because Social Thinking starts at the level of thought, and because of this thinking-first approach, the client's behavior will generate positive thoughts in people with whom they interact. The result is an increased sense of control over their lives, leading to increased self-esteem and a reduction in feelings of hopelessness, helplessness, and isolation. With the high comorbidities of anxiety and depression in persons on the autism spectrum, the Social Thinking framework marks a changing point in treatment effectiveness within the mental health professions.
Ashlea Johnson is a licensed clinical social worker with over fifteen years of experience working with people who have challenges with social living. She obtained her Masters of Social Work degree from the University of Maryland in Baltimore City and completed her clinical mental health practicum at Johns Hopkins Adolescent Clinic. Her work history includes not only private practice experience, but training and working at the Kennedy Krieger Institute in Baltimore, Maryland, program management and job coaching for a youth workforce development agency in Montgomery County, Maryland, and serving students with social thinking challenges in elementary, middle and high schools. She owns a private practice in central Florida where she and her team of clinicians strive to provide the latest evidence-based mental health interventions to improve the quality of life for people of all ages who struggle to understand the social world.
Article copyright ©Ashlea Johnson, 2013. Made available to you by Think Social Publishing, Inc.