When Clients Have Little or No Interest in Social Connection

Several years ago, I worked with a new program for adults seeking to recovery from homelessness.  This program had built a beautiful new building with forty modern apartments designed as permanent housing for chronically homeless people.  Besides the separate apartments, the building included a number of welcoming public spaces for the residents to eat together, to watch TV together, and to do other social and leisure activities together.  Those spaces were specifically designed to encourage social connection in a group who were generally socially isolated.

A year after the building was filled with new residents, we talked with the residents about what their daily lives were like and who they were socializing with.  Again, we hoped to see that they were spending time with other residents, capitalizing on the natural peer support that would occur among people who have the common experience of working through homelessness and the associated isolation.  What we found surprised us.   After one year of living in a community of similar people, with architecture and programming designed to encourage social connection and community involvement, most of the residents did not socialize with any other residents and did not participate in community activities.  The community spaces were generally empty.  Few people watch TV in the common room.  People did not know the other residents on their floor.  There were a few exceptions of gregarious residents who knew the other gregarious residents, but they were less than 30% of the population.

We assume that because we are all “social” creatures that we all want to be with other people most of the time.  Our culture emphasizes gregarious behavior as being normal and desirable.  The reality is that many people do not prefer a highly social lifestyle, and actually prefer limited, and sometimes VERY LIMITED social contact.  This is not a direct result of social anxiety, but is actually a social preference.

Respect for client preferences is a cornerstone of good recovery services.  If a client prefers to have little or no social contact, we need to respect that preference.  The client is virtually always the decider. 

The problem is that there is substantial research that suggests that low social support and low social contact is associated with poor physical and mental health, and a shortened lifespan (Holt-Lunstad, 2021).  This is true for people who have low social support and who report feeling lonely and wanting more support.  It is also true for those who have little or no social support but who are happy with that level of support.

DEFINITION

Currently, there is not a good term to refer to this group of people.  We are talking about clients who have little or no social support but who are not lonely – their low social contact and support matches their preference.  It is not clear how people come to be in this group.  It appears that some probably have a lifelong preference for little or no social contact.  Others may have had past negative experiences with social contact that left them feeling a lack of interest in further contact.  They are not particularly anxious – just not interested.

ASSOCIATED PROBLEMS

As noted earlier, research is fairly clear that social isolation and low social support are associated with negative outcomes whether the person is lonely or entirely content.  Most dramatically this group is at risk for a significantly shortened lifespan, and the risk is greater than the risk associated with tobacco use or being obese.  Low social support is associated with greater risk of chronic medical problems and of mental illness.  It is associated with poorer use of healthcare when an illness requires treatment.  It is also associated with lifestyle factors such a smoking and overeating that are risk factors for poor health.  How social isolation results in a shortened lifespan is not clear, but the current data suggest that there are likely multiple ways that social isolation contributes (Holt-Lunstad, 2021). 

CURRENT INTERVENTIONS

The key challenge to intervening with this group is the fact they prefer low social contact.  An approach that respects the right of these clients to choose isolation when it has serious health risks relies primarily on the use of education and information to help the client make an informed decision about social contact (Ma et al., 2020).  Providing education about the health benefits of social support and the risks of social isolation may lead some clients to increase their level of social contact as a means of improving their health and longevity. 

Motivational Interviewing (Miller, & Rollnick, 2012) is an approach that can be used to encourage positive health behaviors in ambivalent clients.  There is no published protocol for using MI to encourage increased social connection in isolated adults, but it would be easy to adapt current protocols for this group (Hurlocker, Madson, & Schumacher, 2020).

STRATEGIES TO CONSIDER

1.      Provide education to these clients about the health benefits of social support.  We all do things for our health – often things that we would not do otherwise – some of which we don’t like.  Help these clients see the health benefit of social contact based on the compelling research about medical benefits, mental health benefits and longevity associated with social contact.  I remind clients that many people take exercise to improve their health.  Most people don’t enjoy exercise but we do it because it is good for us.  The same can be true of having social contact.

 2.      Create and/or catalogue easy opportunities for social contact.  Clients who have had little interest in social contact for years, often have no idea how to become more connected.  Provide information about opportunities that are convenient and will take relatively little work for them.  Peer support groups is one of the easiest ways to gain social support.  Simply by showing up, people can easily begin to connect with other people and engage in personal conversations.

 3.      If working in a program, look for ways to program social contact.  Schools require that students sit together in class.  Residential programs often require weekly resident meetings or resident dinners to encourage connection.  Look for ways to help your program design activities that encourage, or even require social contact for clients who won’t pursue it otherwise.

 4.      Consider casual contacts.  There are surprising social and psychological benefits for even the smallest social interactions.  Research suggests that positive contacts with cashiers, people delivering packages or the mail, neighbors, waiters etc., result in significant changes in mood and well-being.  Even attending events where there are other people, like going to a sporting event, have positive impacts even if we don’t talk with the other people.  Clients who are not interested in building friendships may be willing to increase their “casual contacts” and their time in the presence of other people across their daily routine.