Therapy task ideas for working on impulsivity and other pragmatic deficit areas

Dear fellow SLPs,

To me, this is the hardest area to target.  When a patient is impulsive, they are often both unaware of it, and not receptive to education and training in this area.  

Common patient reactions to pragmatic therapy:

Yes, it's easy to want to shy away from taking the bull by the horns and addressing these things, but...

 I have a few commonly used phrases when talking to patients about these potentially sensitive areas.  I often say something like this:

          "One of the things I watch for closely during my evaluation are subtle social changes in patients' behavior which can be very common after [an injury like yours].  Many times these are things that can go unnoticed, or even ignored.  I would like to be very frank with you when and if I ever notice these things in you- if you are open to my feedback."

          At this point the patient usually says they are very open to any feedback and frankness.

I then say something along these lines:

         "Let's talk about the most common social and behavioral changes that go along with [this type of 'injury"] and some of the things I have noticed during our evaluation/interactions.  And any time in therapy when I notice these things, I will very frankly point them out.  I don't want to make you feel embarrassed- in fact you shouldn't!  This is why we are here.  And I always say, 'No one is going to be honest with you like you speech therapist is," at least with regard to these subtle social things.  Actually, people will often feel uncomfortable bringing them up with you, so I would rather we discuss it all openly while you're here so you are aware and you can start using strategies and techniques to help you when you interact with others, go back to work, etc."

This tends to create more openness and at least provides a way for me to point out behaviors as they occur.  

Can you add anything to this list below?  Does anyone else have any great materials for working on this area?  Leave your comments below- I would love to hear from you!

Here are all the ideas I could think of today, plus a couple from my fellow SLPs.  What else can you add?

Tasks for pragmatic/social skill areas such as:  Self-Awareness, Self-Monitoring, Self-Regulation, Impulse Control, Disinhibition:

·  Video the patient and have him analyze his behavior/performance

·  Have the patient list his deficits/goals

·  Have the patient predict how they WILL perform on a given task, and then assess how they DID perform afterward (scale of 1-10 or percentage).  

·  Have the pt. take data for themselves

·  Practice social role-plays

·  Give scenarios of “wrong” behavior and have them identify it and propose a solution

·  Descriptions of self (“What motivates me?”, “What do I imagine myself doing in a year from now?”, “What are things I like to do?”)

·  Social interaction role-plays including discussion of compensatory strategies and behaviors

·  Role play job interview questions (i.e., “What is your greatest strength?”) (There are good example is this workbook-- Focus on Function p. 299)

·  Develop tactile cue system for patients with tangential conversation to let them know they have been talking too long/off topic

·  Before starting any task, ask the patient how they think they will perform.  Discuss any differences in expected vs. real performance

Apps: 

·  Moron Test (if you're too impulsive, you'll mess up!)

·  Doodle Pro

What else, SLPs?  Add your ideas in the comments below!