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To the Editor: I am writing in reference to the Rehab Rounds column in the January 2001 issue of Psychiatric Services about training in social problem solving among persons with schizophrenia (1). Dr. Liberman and his colleagues successfully demonstrated the generalization effect of social skills training through the provision of training in problem solving to the clients.
As a researcher in social skills training, I would like to share my experience that problem solving is a key element of success in any social skills training module. I have conducted three controlled studies related to social skills training (2,3,4). In each of the studies, the participants who received social skills training outperformed the control participants in terms of both vocational and nonvocational generalization measures. For example, in a study in which social skills were taught to people with schizophrenia to help them obtain and keep jobs (4), 14 of 30 (47 percent) of the participants in the experimental group were able to acquire a job and had maintained it at a three-month follow-up. One of the reasons for the high success rate might have been the incorporation of problem-solving training into the module. In the last session of the module and at the subsequent follow-up sessions, the main emphasis was on social problem solving using principles similar to those used in Liberman's study.
The results showed that participants who received training in social problem solving had significantly better vocational outcomes than those who received only the traditional skills training module without elements of social problem solving. Clinical observation suggested that the participants who became equipped with problem-solving skills were better able to solve problems related to getting a job. Even though they had failed in previous attempts to secure employment, they were more motivated to continue the process. They were also more motivated to solve interpersonal problems in the workplace once they had found a job.
Although social skills training has received a vast amount of support in the literature, it has been criticized for lack of a generalization effect. In addition, it has been challenged by the success of "place-train" philosophy and supported employment for people with severe mental illness (5). To me, incorporating problem solving into traditional social skills training modules is the key to further development of the skills training approach in the current mainstream of evidence-based practices.
The effect of problem solving on the generalization of social skills training should be examined in a more controlled way. Projects are under way in Hong Kong that aim to isolate the effect of problem solving by comparing social skills modules with and without a focus on problem solving.
Dr. Tsang is affiliated with the department of rehabilitation sciences of the Hong Kong Polytechnic University.
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