Task Centred Practice and Crisis Intervention

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Task Centred Practice and Crisis Intervention

• An exploration of theory, method and practice
• Nigel Horner (University of Lincoln)

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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

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But firstly..why are these lumped together?

• Malcolm Paynes 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

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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

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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

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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.

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Task Centred Practice - Key Concepts

• The Mandate for Practice
• Establishing User Agreement
• Clarifying what right a practitioner has to
  undertake the work at all (Marsh,1997 197)

• Partnership
• User Involvement
• Building Upon User Strengths
• Written Agreements / Contracts
• Change comes through TASKS

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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

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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

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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)

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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.

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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 workers ability to respond to feelings which
  are not always expressed
• the workers concern even if change is not
  possible
• the workers ability to exercise care even when
  exercising control
• THESE ARE ALL CORE ELEMENTS IN TCP

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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

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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.

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Gestalt Problem Solving ActivityTask Join up
all of the dots with 4 straight lines, without
going over the same line twice or taking the pen
off the paper
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The Solution lies outside the box! Sometimes we
need to undertake different tasks than what we
see at first to get the best results.
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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

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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

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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

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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, its facing new challenging situations and
  the usual coping / response mechanisms are not
  working .so the crisis situation becomes an
  active crisis

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A summary Definition.

• A crisis is a perception or experiencing of an
  event or situation as an intolerable difficulty
  that exceeds the persons 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)

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Crisis Domains

• Each person and each crisis situation is
  different, crisis may be in the following areas
  of someones life
• Developmental crises
• Situational crises
• Existential crises
• Environmental crises

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Developmental Crises
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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

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Or the Paddington rail crash
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Existential Crises
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Or being a flood victim in Hull (2007)

• Dealing with environmental crises

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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

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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

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Equation of a Crisis State..

• hazardous event
• vulnerability
• failure of previous coping mechanisms
• intolerable tension
• lack of social support
• A CRISIS STATE

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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)

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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

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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 persons
  understanding of what has happened to them
• The person modifies assumptions and arrives at
  their own solution

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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

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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

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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)

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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

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Summary thoughts.

• Beware the indiscriminate use of the term
  crisismany 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
  stresswhich 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