Monday 13 January 2020

What do you meme, you aren’t using photocopied worksheets in your social skills sessions?

This year I have been working with an increasing number of young people, who due to such high levels of anxiety, are struggling to engage:
                        - To engage in school expectations
                        - To engage in home expectations
                        - And to engage in ‘traditional’ speech                             therapy sessions
So you do what you know is essential, spend time getting to know the individual, rapport build, offering a reward..
But… what if the YP is still finding it difficult to follow the ‘adult-led’ agenda because there is the underlying demand to comply?
What do you do now?
Well most enthusiastic therapists know the importance of using a child’s interests within therapy sessions to engage them…
But.. what if the YP has limited interest in anything beyond sitting in their bedroom playing computer games all day?
Well of course we could use this as a reward to try and entice them into completing the therapy activities first
But… why would the YP ‘buy-in’ to completing your activity just because you want them too, when they are already happily enjoying their interest without needing to ‘earn it’ first?
            I myself, don’t have to adhere to persuasion of doing something I find difficult, like running a marathon, just on the promise of a ‘glass of wine’ reward at the end, just because someone said it would be in my best interest to do the exercise. I would still find it anxiety provoking to conform to their wishes, however much I liked the person and especially if I was already able to go to the fridge and pour myself a glass without. No exercise necessary!

So… faced with the dilemma of how to support my YP to ‘buy in’ to my sessions I had a serious head scratching moment until I thought about the likelihood of me running a marathon at the same time as drinking wine.
Now that is an interesting concept indeed!! Why does one action necessarily need to precede the other?
Well… despite the complicated logistics of this, I have to admit that the probability of me going for a run has significant increased.
‘Lightbulb moment’ – how can I embed my speech and language targets into the actual activity the child enjoys?

Despite my significant lack of gaming talent, one thing I found I did have in common with the YP I was working with, is enjoying the humour of memes.
So… where to start? Well after having fun sharing our favourites and discussing what we found funny about them I soon realised the previously highly anxious YP, who struggled to engage in any reciprocal social conversation, was soon confidently and spontaneously talking me through the steps of how to create my own Tumblr account.

Now, I must admit those sessions that are completely unscripted, when the therapy plan has gone shooting way off the map, is the most enjoyable part of my job and I’m happy to be a passenger to a student who feels motivated enough to take the lead.
But…what actual speech and language targets am I working on when using memes?
Well to be honest, we were actually working on a lot of therapy goals simultaneously!

Social Thinking Goal 1: initiating communication that is not routine
            When she is not anxious, Emily has no difficulties in engaging in conversations about something she is interested in. However, where before she would just talk ‘at me’, now during the sessions she can confidently initiate a narrative of talking me through the Tumblr sign up process and displayed the best turn taking skills so far; even pausing and allowing me the opportunity to ask for clarification.

Social Thinking Goal 2: Listening with your eyes and brain
When Emily was anxious, she would cover her face with her hair and squeeze herself between the sofa cushions. But now she uses ‘whole body listening’ with confident posture, joint attention and initiation of eye contact when she is communicating.

Social Thinking Goal 3: Understanding abstract language
Most of the language we use is peppered with idioms, metaphors, sarcasm and inferences and each generation of teenagers and young adults leave a trail of new slang for consumption - most of which is abstract. Through memes, I am able to teach Emily how to make a ‘smart guess’ to interpret the abstract language based on her previous knowledge, the context of the picture and the non-verbal communication clues.

Social Thinking Goal 4: Understanding perspective:
The ability to interpret others’ perspectives, thoughts and feelings is critical to social learning. Looking at memes with Emily created the opportunity to work on her Theory of Mind skills by discussing the point’s of view of not only the people in the memes but each other and our individual interpretation of the jokes. Whilst Emily was narrating how to set up my Tumblr account, I reminded her that I had no prior knowledge of the website. She was able to effectively use her own analogies to link these new concepts to the social media knowledge that my ‘inferior brain’ as she called it, already knew so that I could understand her.

Social Thinking Goal 5: Getting the Big Picture
If a picture is worth a thousand words then a ‘meme’ must be worth a million and the opportunity to share an imagination with other people is priceless. These therapy activities focused on teaching Emily to infer how to link individual pieces of information into an overall idea – to get the ‘bigger picture’.

Social Thinking Goal 6: Humour and Human Relatedness
Establishing human relatedness is essential before advancing in any therapy sessions; which is why rapport building is essential, especially with our most anxious students. Emily has a fantastic sense of humour and a very dry wit! But she often feels too anxious to use her humour successfully with others. So starting the therapy process with memes has helped to minimise some of her social anxiety.

Last year, Emily was a very anxious young lady, isolated at home and had little to no social interaction outside her immediate family. Now, although her socialising is still largely from the safe space of her house, her anxiety has decreased enough that she is interacting online with other YP with similar interests and is beginning to leave the house to visit local attractions. Everyday Emily is one brave step closer in gaining social confidence to engage in reciprocal conversations with new people.
We’ve since extended our sessions from also decoding magazine adverts and T.V. commercials to creating our own memes. It was surprisingly easy to embed all of my therapy targets into these activities; the only confusing thing was why I hadn’t tried this idea sooner!   

So what I ‘meme’ is that therapists need to stop thinking about what they think speech therapy ‘should’ look like and instead about what is the most functional and meaningful skills for the YP to learn to help them interpret social information and interact effectively with others. And not a photocopied worksheet in sight!