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Task Centred Practice and Crisis Intervention


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Title: Task Centred Practice and Crisis Intervention

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 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

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

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 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

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
  • 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
  • the workers ability to exercise care even when
    exercising control

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

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 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
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
  • 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

  • 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
  • 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

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)

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

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

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,
  • 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

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,
  • 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 persons
    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
  • 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
  • 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
  • Attentiveness, accurate listening responding
  • Congruence between thinking, feeling and acting
  • 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
  • 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
    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
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