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Introduction

Social skills training aims to teach individuals how to communicate their emotions or requests so that they are more likely to achieve their goals and have their needs met. Within borderline personality disorder, lack of appropriate social skills, empathy, manners, conflict resolution and self-care may all be demonstrated. By using social skills training, occupational therapy practitioners can optimize the social functioning of individuals with borderline personality disorder by enhancing specific skills, such as identifying and mending problems in social relationships, daily life, work and leisure (Lauriello, Bustillo, & Keith, 1999).

All social skills training follows the same basic structural and implementation outline:

• Identifying the problem
• Setting the goals
• Modeling
• Role playing
• Feedback
• Homework

Theory

Using the Model of Human Occupation, the therapist will gain insight into the client’s motivation using a client-centered approach. The therapist will further gain a sense of the client’s values and how they feel when performing those occupations (“Model of Human Occupation: Theory and Application,” 2017). It is a way to collaborate with the client to identify occupations that are affected by motivation and how the client behaves in various environments.

Evidence

Over the years there has been a growing number of evidence-based therapies for individuals with borderline personality disorders (BPD). Specifically, social skills training on behavioral and cognitive elements of anger management among adults with BPD have been shown to be effective (Dahlen & Deffenbacher, 2001).  The application and acquisition of skills, such as mindfulness, distress tolerance, and interpersonal communication are enhanced through the use of role play and homework (Biskin, 2013). According to Dahlen and Deffenbacher (2001), inductive social skills training targets a reduction in anger arousal. This type of training helps clients to identify and explore effective behaviors for coping with anger through assertive communication, negotiation, and feedback.

Case Study

Serena is a 35-year-old single Caucasian female. Serena engaged in self-harm behaviors for the first time at age 14 while suffering with self-image. In addition to recovering from bulimia, she also was drinking alcohol daily at the age of 18. At age 21, Serena was already addicted to drugs and admitted to a mental health ward where she was diagnosed with borderline personality disorder. Since her release from the ward, Serena still battles with emotional instability and self-harm behaviors. When she feels stressed or has an emotional outburst she self-mutilates her skin. Presently, she lives in Tallahassee, Florida where she works an office job that entails duties such as data collection, answering phone calls, and managing files. Serena stated she does not like her job due to poor relationships she has with coworkers. She said she easily becomes angry when people are not accepting of her ideas during meetings. Her coworkers frequently do not understand her unpredictable “snaps” or emotional outbursts because she appears ‘normal’ on the outside.

Intervention Plan

Problem Statement

Serena’s poor anger management skills with her coworkers is negatively impacting her work performance.

Long Term goal

1. Client will engage in a 30-minute conversation with a coworker using 5 positive anger management techniques to engage in work within 4 weeks.
2. Client will collaborate on a project with a coworker using 5 positive anger management techniques to engage in work within 4 weeks.

Short term goal

1. Client will identify 2 negative anger management strategies and 2 positive anger management strategies in 1 week for engagement in work.
2. Client will role play with the therapist and demonstrate 2 anger management strategies using 3 verbal cues in 2 weeks for engagement in work.
3. Client will use at least 1 positive coping technique with 2 verbal cues during role play in group therapy by 3 weeks for engagement in work.

Intervention format

Individual and group

Setting

Client will meet with the occupational therapist and group once a week for one hour at the clinic.

Supplies 

None

Agenda

• Meet Serena & develop rapport (5 min)
• Assess Serena’s insight into her social skills (2 min)
• Engage in role play of her typical work environment. The scene is a work meeting. The therapist will play the role of a coworker and Serena will play the role of herself. Both are collaborating on a project due next week. (18 minutes)
  • Sample dialog
    • • Therapist: “I was thinking of working on our project tomorrow at 3 pm. Does that work for you?”
      • Serena: “No, I want to do it at home by myself. I don’t need your help.”
      • Therapist: “We were assigned to this project together. I would appreciate collaborating with you on this.”
      • Serena: “I don’t care what you think!” …. Storms off angrily.
  • Have Serena identify what went wrong during the dialogue and what went well. As well as what she could do differently using appropriate techniques. (5 min)

Documentation

S: “All of my coworkers attack me because they do not like my ideas during meetings. I know my ideas would work better than theirs, and when they are not accepting of my ideas I become angry. At the last meeting I yelled at my coworker in frustration and was asked to leave by my manager.”

O: Client participated in a 30-minute session focusing on anger management skills using a social skills training approach. Client demonstrated intense emotions of anger and sadness when role playing her emotional outbursts throughout the week. During the session, the client was receptive and aware to her pattern of anger outbursts. During role play, client implemented relaxation techniques, effective communication, and problem solving strategies.

A: Client was not aware of her anger management problem. Client presents with poor anger management skills impacting her work performance in daily life. Client would continue to benefit from skilled OT services for increased awareness of harmful behaviors in the workplace and implementation of healthy coping strategies for participation in work with others.

P: Continue with skills training approach to develop adaptive coping strategies and routines. Evaluate progressive new habits and continue to refine. Serena will have occupational therapy twice a week for 30 minutes. Following the MOHO approach, client’s homework will be focused on habituation through journaling. The client will keep a diary and record roles and routines that become disrupted due to the presence of anger.

References

Biskin, R. S. (2013). Treatment of Borderline Personality Disorder in Youth. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22(3), 230–234.

Dahlen, E. R. & Deffenbacher, J. L. (2001). Anger management. In W. J. Lyddon. & J. V. Jones, Jr. (Eds.), Empirically supported cognitive therapies: Current and future applications (pp.163-181). New York: Springer Publishing Company.

Lauriello, J., Bustillo, J., & Keith, S. J. (1999). A critical review of research on psychosocial treatment of schizophrenia. Biological Psychiatry, 46(10), 1409–1417.

Model of Human Occupation: Theory and Application. (2017, November 25). Retrieved from https://www.moho.uic.edu/default.aspx