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Great Mates and Great Dates
A charity leading innovation in mental health
A Healthy Relationship Skills Group for High Functioning ASDMary Woodward, Highly Specialist Speech and Language TherapistSam Cooper-Evans, Consultant Clinical Psychologist
Aims of Presentation
• Why did we bother?• Who did we do it for?• What were the main aims?• What did we do?• Did it work?• How did it go?
Why bother?
• Lack of published programmes for development of adult relationships (both platonic and intimate)
• Recognising that many individuals with ASD have a normal desire for friendships/relationships but struggle to initiate or maintain them
• Lack of supportive relationships or social knowledge is contributing factor to offending
• Need to address relationship skills, as part of a wider treatment programme:– address ASD specific need– maximise the likelihood of individuals having successful
social lives in the future– minimise future risk.
Who Did we Do it For?: Group Attendees
• 6 males, aged 20 -28• All detained under Mental Health Act (1983) for
having committed offences (mainly sexual offences, but also aggression and/or arson)
• Social communication and relationship difficulties were considered to be a contributing factor
• High functioning ASD/AS, though some literacy difficulties
• All had experience of group work• Some had completed some foundation work on
relationships in 1:1 sessions
What Were the Main Aims?• to provide an overview of positive relationship skills, which
may be considered as part of offence-related treatment • to consider different types of relationships
(personal/professional etc), the differences between them, and the intrinsic boundaries
• to consider ways in which they may make friends (where/how to meet, how to communicate etc)
• to consider how to transition from friendship to dating• to explore legal issues, e.g. consent• to consider the possible pitfalls in relationships and how to
deal with them
What Did we Do?: Practicalities• Sessions planned and facilitated by a multi-
disciplinary team:– led by SLT and Psychology– supported by OT, Education & Nursing staff
• 10x75mins sessions, with ‘personal practice’
What Did We Do?: Session Content• FRIENDSHIPS:
– What is a friend?– How do you make a friend?– How do you keep a friend?– Trust– The changing boundaries of friendships (close v.
acquaintances)• RELATIONSHIPS:
– Acting on attraction: when is it appropriate? How do you go about it?
– Coping with unrequited attraction – Forming and maintaining a relationship – Intimacy: emotional and physical– Legal issues: consent, power– Managing differences and conflict– Coping with the end of a relationship
What Did We Use?: Resources• Kelly, A (2004) Talkabout Relationships: Building
Self-esteem and Relationship Skills. Milton Keynes: Speechmark
• Ramey, E.M. & Ramey, J.J. (2008) The Autistic’s Guide to Dating. London: Jessica Kingsley Publishers
• Marc Segar (1997) Survival Guide for People with Asperger’s Syndrome http://www.asperger-marriage.info/survguide/contents.html
• Media clips (DVDs, youtube, newspapers etc)
• Devised own activities
What Did We Do?: Format of Sessions
• Recap what was discussed in the last session• Watch a funny bit of DVD to introduce the
topic• Have a bit of a chat about it• Some activities to think more about the topic• Do some activities on your own between
sessions
What Did We Do? Some Example of Activities
Friendship Circles– Emotionally close/distant– Professional/personal– What can you talk about?– What activities would you do?– Physical contact
Inner circle is for intimate relationshipsSecond circle is for close friends and close family Third circle is for friends etcFourth circle is for some closer professional relationships Outer circle is for acquaintances, less close professional relationships etcOutside the circles is for strangers
What Did we Do?:Social Profile
• They were asked to:• Describe themselves (physically)• Describe their personality• Describe their interests• Describe what they’re looking for in a friend/partner• Think about the impression they’re creating for
target audience (i.e. want to stand out but not put people off). Honesty – being yourself.
• Produce own example.
Example of Social ProfileMariaHi, I’m 5’6, slim, with short brown hair. I’m a bubbly, chattyperson, and like to have a laugh.
I have quite a stressful job, so like to relax by watching TV or
movies, doing yoga or dance, singing, or spending time withfriends. I like cooking, especially Thai food, and since
buyinga new house recently, I’ve become a bit of a domestic andgardening goddess, though have to admit I prefer lying in
my hammock to weeding!
I’ve just moved to a new town, and so would love to meet more
people to share my spare time with. I get on best with reliable
people who can be serious, but now how to have a laugh, who
enjoy going out for a meal or to the cinema, and maybe even
joining me for a bit of yoga or dancing sometime!
What did We Do?: Meeting People Plan adapted from The Autistics’ Guide to Dating (Ramey
and Ramey)• Consider how their interests can provide
opportunities to meet people• How/where to go about meeting people• What stages to go through• Also considering security issues, dos and don’ts of
communication, internet dating etc• Develop their own plan
What Did we Do? Conversation Starters/Chat-up Lines• You look really nice.• Get your coat, you’ve pulled…• Do you believe in love at first sight, or should I walk by again?• Hi, my name is….• I just wanted to show this rose how incredibly beautiful you are!• There must be something wrong with my eyes, I can't take them
off you• Can I buy you a drink?• Is your name Gillette? ...because you're the best a man can get.• Is there a rainbow, because you're the treasure I've been
searching for.• I’ve been wanting to read that book. Is it any good?• Did it hurt when you fell out of heaven?
What Did We Do? Physical Intimacy
• NB Not a sexual education group• Consider ‘bases’• Consider power imbalances• Consider consent, especially after drinking
What Did We Do? Pitfalls in Relationships
• Communication breakdown• Conflict resolution• Keeping a healthy balance• Coping with the ending
Grief/Loss Cycle(from Kübler-Ross, 1969)
Did it Work? Pre/Post measures• Self-developed semi-structured interview about
knowledge• Self-developed Likert scale re.confidence • Relationship Skills Assessment (Kelly, 2004, p90)
Did it Work?: Self-developed Semi-structured Interview about Knowledge
1) Q. How can you know if someone you ‘fancied’ was also attracted to you?
Pre: enjoys hanging around with you. Post: You don’t know for sure.
2) Q. How would you know if a relationship was over?Pre: ?Post: when you can’t resolve your differences
3) Q. What would be a good thing to say to someone that you would like to get to know better as a friend?
Pre: Don’t knowPost: Do you have any hobbies?
4) Q. When is it Ok to have sex with someone?Pre: girlfriendPost: when you both feel ready
Item # # #
starting a conversation with someone 5 1
being a good friend 5 1
making a new friend 6
recognising your feelings of attraction for someone 4 1 1
recognise someone else’s feelings of attraction towards you
3 2 1
asking someone out on a date 4 2
making interesting conversation whilst on a date 4 1 1
keeping a relationship going beyond the first date 5 1
dealing with disagreements in a relationship 5 1
coping with a relationship ending 3 2 1
TOTAL 44 12 4
Did it Work?: Self-developed Likert scale re.Confidence
Did it Work?: Relationship Skills Assessment (Kelly, 2004, p90)
Service User Pre (%) Post (%) Change?
1 40 44
2 67 84
3 70 84
4 77 87
5 67 67
6 67 70
How Did it Go?: ReflectionsPROs
• Enabled therapists to assess further needs
• Covered important foundation skills as precursor for other work
• Developed confidence and knowledge, also seen in other ward situations
• Good attendance and enthusiasm• MDT collaboration – became part
of ward ethos
CONs• Anxiety re.attending group
rather than 1:1• Lack of commitment to
‘personal practice’• Too much to cover in 10
sessions• Difficulty generalising in this
setting• Lack of robust pre/post
measures
