Transcript Task Centred Practice

Task Centred Practice and
Crisis Intervention
An exploration of theory, method and
practice
Nigel Horner (University of Lincoln)
Session Overview
 What do we mean by Task Centred
Practice?
 The core elements of TCP
 Applications and evaluations
 What do we mean by Crisis Intervention?
 The core elements of CI
 Applications and evaluations
But firstly……..why are these
lumped together?
 Malcolm Payne’s book sees common
ground between TCP and CI
 Both are rooted in a reaction to
psychodynamic casework relationships
 Both focus on short term, brief interventions
 Both are based upon problem solving ideas,
and are connected to learning theory
What do we mean by Task Centred
Practice?
 It emerged from a research movement that was
critical of the protracted, unproven, fuzzy
casework relationship
 It can be seen as atheoretical - a method more
than a theory – although its theoretical roots are
essentially behavioural
 It is central to Evidence- Based Practice – the
What Works? agenda
 It can connect to other approaches, such as
counselling or cognitive - behavioural work
TCP: A Definition
 “…a method of social work in which clients are
helped to carry out problem - alleviating tasks
within agreed periods of time” (Goldberg,
Gibbons and Sinclair, 1985: 5)
 Social Work students identify Task – Centred
practice as one of the most influential theories
(Marsh and Triseliotis, 1996).
 In other words, it makes sense to student
practitioners
Its behavioural roots……….
 According to Howe (1987: 82) task
centred social work is linked with
behavioural social work insofar as:
 “…problems are defined into identifiable
pieces of behaviour. They are dealt with
discretely. Goals are set and mutually
agreed with service users. Involvement
proceeds by way of small, sequential,
manageable steps”.
Task Centred Practice Key Concepts
 The Mandate for
 Partnership
Practice
 Establishing User
Agreement
 “Clarifying what right
a practitioner has to
undertake the work at
all” (Marsh,1997:
197)
 User Involvement
 Building Upon User
Strengths
 Written Agreements /
Contracts
 Change comes through
TASKS
The sequence of intervention
 According to Doel (2002) Task Centred Practice
is based around four stages and processes:
 Phase 1: Developing a focus on the problem
 Phase 2: Reaching Agreement: Goals and
Contracts
 Phase 3: Developing Goals into manageable
tasks
 Phase 4: Ending and reviewing the work
Task Centred Practice: Goals and
Steps
 Defining the
problem,
establishing goals,
and the steps to
achieving each
goal are the essence
of Task Centred
Practice
Stage One – in more detail:
 Problem scanning , or exploration requires the
following questions to be explored:
 What is the problem?
 Who is involved?
 Where does in occur?
 When does it occur?
 Why does it occur?
 How does it occur?
(known as the 5 Ws and 1 H)
Critical Commentary
 Payne (1991) delineates the limitations of task - centred
work by pointing out that it is based upon the assumed
rationality of the service user.
 The service user needs to able to make connections
between actions and consequences, and with the help of
the worker, to move from stating “What is wrong” to
“What is wanted”.
 What is wanted has to be discussed in terms of
Motivation, Feasibility, and Desirability.
 Objectives are ordered in terms of “Who is Doing
What?” based upon specific time - limits and often
formulated around written agreements.
Evaluation and research
 Sainsbury (1989) undertook research to find out what






service users value about interactions with social workers.
They value:
understanding the intentions and purposes of the service
contributing to the work of the service
the worker’s ability to respond to feelings which are not
always expressed
the worker’s concern even if change is not possible
the worker’s ability to exercise care even when exercising
control
THESE ARE ALL CORE ELEMENTS IN TCP
Research continued…………..
 Marsh and Fisher (1992: 10) asserted
that “task centred practice is the most
congruent model for clear, open and
negotiated processes of partnership
practice”, and that “effectiveness studies,
user views, partnership orientation,
practical use and a developmental stance
which suits the changes now under way in
social services come together in the task
centred approach”
In summary…………..
 Task Centred Practice has links to Behavioural
Social Work, in its focus upon the Here -and Now, and the breaking down of problems into
achievable bite sized chunks.
 It assumes that the successful achievement of
tasks will increase self - esteem and confidence.
 It links with the ideas that inform Self Esteem
and Resilience, Assertiveness, and
acknowledges the structural impediments to
previous task completion - poverty,
deprivation, discrimination and oppression.
Gestalt Problem Solving Activity
Task: Join up all of the dots with 4 straight lines,
without going over the same line twice or taking the
pen off the paper
*
*
*
*
*
*
*
*
*
The Solution lies outside the box!
Sometimes we need to undertake different tasks than what
we see at first to get the best results………….
*
*
*
*
*
*
*
*
*
Why Study Crisis Intervention?
 Anybody is vulnerable to crisis and its potential risks
- in all areas of practice
 It is important to be aware of the potential risks and
positive growth opportunities -particular links to
mental health
 As a central idea in mental health interventions, Crisis
Teams now part of the new National Service
Framework for Mental Health
 International exposure to crisis situations
As a practitioner you need to ….
 Know what crisis and crisis intervention
mean and require
 Recognise the indications that a person is
experiencing a ‘crisis’ and is showing
characteristic ‘signs’
 Possess the skills in working with people
and other agencies within this framework
 Develop an awareness of the ‘risks’ and the
potentials for positive growth and change
The Meaning of Crisis
 From the Greek word Krises, meaning
decision (or opportunity or turning point)
 Developmental Crises: Leaving home,
entering into a partnership, having a baby,
going to university …..these are all crises
in that they all upset your steady state, the
homeostasis, and things will never be the
same again
Definitions
 People are in crisis when they face an obstacle to
life goals - an obstacle that is, for a time,
insurmountable by the use of customary methods
(Caplan,1961)
 Crises are crises because the individual knows no
response to deal with a situation (Belkin, 1984)
 So, it’s facing new challenging situations and the
usual coping / response mechanisms are not
working ………….so the crisis situation becomes
an active crisis
A summary Definition…….
“A crisis is a perception or experiencing of an
event or situation as an intolerable difficulty
that exceeds the person’s current resources
and coping mechanisms.
Unless the person obtains relief, the crisis has
the potential to cause severe affective,
behavioral and cognitive malfunctioning”
(James & Gilliland 2001)
Crisis Domains
Each person and each crisis situation is
different, crisis may be in the following
areas of someone’s life:
 Developmental crises
 Situational crises
 Existential crises
 Environmental crises
Developmental Crises
Situational Crises: There are many different things
that might provoke a ‘crisis’ for those involved in
some way... Some of these are dramatic and
unexpected events, such as the Bali bombing……
Or the Paddington rail
crash……
Existential Crises
Or being a flood victim in Hull
(2007)
 Dealing with environmental crises
Characteristics of a
Crisis…………
 Stressful events experienced as threats, loss
and fundamental challenges
 Characteristic responses include indication
of that level of disturbance: anxiety,
depression, guilt, confusion, tension, shame,
anger, hostility
 May also be another set of psychological
‘coping’ mechanisms: denial, avoidance,
withdrawal, delusion or fantasy
The Life cycle of a Crisis……
 Crises are usually time limited (suggested by a
number experts as being 6-8 weeks), at the end of
which time subjective discomfort diminishes
 Key for intervention - what occurs in the
immediate aftermath of the crisis event determines
whether or not the crisis will become a “disease
reservoir”….transformed into a chronic and long
term state…..or whether the person draws strength
and resilience from the Crisis that will help in the
future
Equation of a Crisis State……..
hazardous event
+
vulnerability
+
failure of previous coping mechanisms
+
intolerable tension
+
lack of social support
=
A CRISIS STATE
Intervention Model
There are three main models & theory bases:
 Equilibrium model - goal is recovery of
equilibrium, stabilization, relevant in early stages
(Leitner 74)
 Cognitive model - crises based in “faulty
thinking”, people gain control of their crises by
changing their thinking (Beck 87)
 Psychosocial Transition - focuses on what
systems need to be changed; the post stabilization
situation (Minuchin 74)
The 6 Step Model of Intervention
(Gilliland, 1982)
Listening
Step 1: Defining the problem
Step 2: Ensuring client safety
Step 3: Providing support
Acting
Step 4: Examining alternatives
Step 5: Making plans
Step 6: Obtaining commitment
Steps in Practice
 Establish a supportive anxiety- reducing rapport:
listen & help the person to gain perspective and to
work collaboratively for potential solutions
 Information is gathered to identify the crisis,
events & process - focus on reformulation
 Explore explanations to expand the person’s
understanding of what has happened to them
 The person modifies assumptions and arrives at
their own solution
The Goals of Crisis Intervention
 Reduction in disequilibrium / relief of
symptoms of crisis
 Restoration of pre - crisis levels of
functioning
 Identification of other support systems
 Initiating new modes of thinking,
developing new coping responses beyond
immediate crisis situation
So, Crisis Work can take place in many
situations…
 Hospitals are common settings; suicide attempts,
crime or accident victims, traumatic surgery
 many settings now include crisis counselling, e.g.
Rape Crisis Centre
 Major incidents important response is crisis
counseling e.g 9/11, Paddington, Hillsborough,
Kings Cross, Lockerbie
 Positive effects of such intervention is
acknowledged in the literature
Characteristics of effective crisis
workers & working
 Attentiveness, accurate listening & responding
 Congruence between thinking, feeling and acting
therapeutically
 Reassuring and supporting skills
 Ability to analyze, synthesize & diagnose
 Assessment & referral skills
 Ability to explore alternatives & solve problems
“ the ideal crisis worker is someone who has
experienced life, learnt and grown from their
experiences”
James & Gilliland, 2001, p 19)
Post Traumatic Stress Disorder
(PTSD)
 We are now much more aware of the extent
of this condition with people who have
experienced or witnessed an event
 Signs are considerable deterioration in
functioning, psychological symptoms
‘flash-backs’- traumatic situation is relived,
may last for many years
 Interventions: cognitive therapies,
‘debriefing’
Summary thoughts……….
 Beware the indiscriminate use of the term
crisis……many families appear to have crises,
but they are not….it is our perception / our
values
 Workers refer to themselves as being in
crisis…..they are describing pressure and
stress……which energises some and MAY lead
to crises for others
 Crises are an opportunity for change …they may
provide the chance to change destructive patterns
of thoughts / behaviours