Evaluation - Task-Centered and Crisis Intervention Theories

Select a social work intervention, evaluate its theoretical roots and influences and compare it to at least one other approach. Describe briefly how you would apply your chosen approach in work with a service user or carer group and evaluate its effectiveness. Use at least one piece of research to inform your evaluation. You will need to demonstrate the ability to detect, understand and evaluate potential for discrimination generally with particular emphasis on two specific areas.

This paper will evaluate the theoretical roots and influences of two psychological social work intervention theories – task-centred and crisis intervention. They will be applied to practice with a children and family setting. The potential for each intervention to discriminate on the grounds of age and race will be demonstrated and evaluated. Both theories will be contrasted and evaluated in terms of their strengths, weaknesses and effectiveness, by use of informed literature and research.

Theories can provide social workers with a safe base to explore situations and understand complex human behaviour (Coulshed and Orme 2006). Used wisely, they can promote effective, anti-oppressive practice (Wilson 2008). Theory underpins the social work degree (Coulshed and Orme) and the growing emphasis on evidence-based practice ensures theory is at the heart of the profession (Corby 2006).

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The most significant theory within social work is Freud’s psychodynamic theory (Daniel 2008). Payne (2007:80) goes say far as to suggest that “psychodynamic work is social work”. It was the original theory social workers drew upon to understand complex human behaviour (Coulshed and Orme 2006). It is also the theory from which many others have been developed or as Payne (2005) suggests, opposed. For these reasons, it can be difficult to understand other theories without knowledge of psychodynamic (QUOTE, QUOTE).

Psychodynamic is a major underpinning base of crisis intervention, more specifically, ego psychology, developmental psychology, and cognitive behavioural approaches and systems theory (McGinnis 2009). These theories provide an understanding of the “particular psychological characteristic of people in such situations” (Beckett 2006, p110).

By contrast, task-centred was established within social work. Stemming specifically, from Reid and Shyne’s (1969) research into the profession (McColgan (Lindsay ed.) 2010). Reid and Shyne claim the roots and influences of task-centred were not derived or borrowed from any other discipline (Parker and Bradley, 2010; Watson and West, 2006). Therefore, Trevithick (2005) suggests task-centred should be referred to as a “work or practice”, rather than an approach. However, many writers contest this, including Doel (2009) and Marsh (2008) who assert association lies with behavioural and problem-solving approaches to social work. On reflection there are stark similarities between problem-solving tool and behavioural.

Crisis intervention was developed by Caplan from Lindeman and Caplan’s work into loss and grief (QUOTE). It “is not a single model in the way that task-centred casework is a single model, but rather a group of models for short-term work with people at points of acute crisis” (Beckett 2006, p110).

A crisis is a “precipitating hazardous event” which is “meaningful or threatening” to oneself (Payne 2005:104). Crises are often caused by “sudden loss or change” (McGinnis 2010:39). However, it is not the event that defines a crisis, but rather the service user’s perception and emotional interpretation (Parker and Bradley 2010). What may present a crisis for one may be considered a challenge for another because people have different life experiences, cultural backgrounds, coping strategies and levels of resilience. Crises can be predicable, as in Erikson’s psychosocial model (which views developmental conflicts as part of the life course), or unpredictable crises which cannot be foreseen for instance, a natural disaster, ill health and poverty or even a burglary (Hamer 2006) (ONLINE).

Crises reduce the psychological coping ability by challenging the homeostasis (normal equilibrium) (Thompson 1991). When one’s usual coping resources are unsuccessful in responding to their problem and they cannot adopt alternative internal strategies or find another way to cope, they are likely to find themselves in crisis (Hamer 2006).

Caplan argued, that “people act as self-regulating systems” (Trevithick 2005:267), in that they strive to retain homeostasis. He believed that “in addition to the occasional crises caused by unpredicted events” people experience developmental crisis throughout the life course. He further argued that “preventative work, offered at the time of such developmental crises, might be effective in reducing symptoms of psychiatric illness” (Wilson et al. 2008: 361). Unsuccessfully resolved crises can lead to psychologically incapacitating experiences such as “regression, mental illness, feelings of hopefulness and inadequacy, or destructive action” (Wilson et al. 2008:362).

Equally, crises can stir up repressed feelings (Coulshed and Orme 2006). For example, a marriage breakdown may reactivate repressed feelings of rejection and loss from being taken into care as a child. This can add “to the sense of feeling overwhelmed and overburdened (a double dose)” (Coulshed and Orme 2006:135). While this may provide the opportunity to address a repressed event, the more unresolved crises one has, the more vulnerable they are to future crises (Hamer 2006). Similarly, if unhelpful coping mechanisms are employed during a crisis, this has the potential to create another crisis (Watson and West 2006).

Crises produce “biological stress responses” whereby the “fight or flight mechanism is activated”. CHINESE MODEL This energy can be fuelled into developing new coping strategies and resilience for now and the future (Thompson 1991, p20).

Thompson (1991:10 citing Caplan 1961) uses to his three stage model to understand the characteristics of a crisis. “The impact stage” is short-lived and “characterised by stress and confusion” where the event can appear unreal. The second is the “recoil stage”. This is “characterised by disorganisation and intensity of emotion”. For example, emotions can be directed externally (anger), internally (guilt) or both concurrently. There may be psychical symptoms as well such as, “fatigue, headaches (and) stomach disorder”. The final stage is “adjustment and adaption”. Crises take on average four to eight weeks to resolve and it is during this final period that a crisis can be resolved as a “breakthrough or breakdown” (Thompson 1991:10). If unhelpful coping mechanisms are used during this stage, they have the potential to create another crisis (Watson and West 2006). As such, skilled crisis intervention during this time can lead to a “breakthrough” (Thompson 1991:10).

For application to practice, Roberts 2000 cited in Wilson et al 2008:366

Uses a seven stage model:

• Assess risk & safety of service user
• Establish rapport and appropriate communication
• Identify and define major problems
• Deal with feelings and provide support
• Explore possible alternative responses
• Formulate action plan
• Provide follow up service

IN APP:

• Try to find trigger – but don’t get lost in it
• What is happening to them?
• How do they normally cope internally/externally?
• Do they use just psychological or social and community resources to good effect?
• Opp to help back to homeo but also to improve
• Min danger enhance risk
• Mobilise support system – advocate
• Calm, reassure, rapport, interest
• Develop new techs of coping thro counselling
• Remember person open for limited period
• Get SU to set goals – give beginning and sense of control
• Short term incremental to build confidence and new learning
• Don’t set up for failure

If using the example given above, the situation does not constitute a crisis, but rather a series of/or large problem, task-centred can be utilised to address these. Task-centred practice involves five structured steps which are essential to its effectiveness (HOWE BOOK):

The first step is for the social worker to understand the problems faced, the methods used to respond to the problem and the preferred situation. These are defined and expressed by the service user (Thompson, 2005). Anna expresses she is feeling low since the recent birth of her son, she is worried she does not have the natural mothering ability and cannot remember the last time she last had an adult conversation. She doesn’t know where to turn for help. The social worker explores cultural and structural XXXXX it becomes clear that Anna cannot tell her family how she is feeling because it is frowned upon by her culture. She would love to feel happy and in control again. Using feminist perspective….. Her culture….. Age…..

During the next stage the social worker encourages Anna to prioritise which parts of the problems she would like to work on first. With support she breaks the problem down in manageable chunks. This process helps Anna to see that her problem is not insurmountable; it gives her hope and a focus. It is essential during this time that the social worker remains empathetic and builds Anna hopes.

The following stage is based upon negotiation in partnership. Together, Anna and social worker agree a maximum of three problems for desired change. Each goal must be “specific, measurable, achievable, realistic and time-bound” (Doel AND WHO YEAR p36) to ensure Anna is not set for failure. The first of task might be for Anna will visit the local Children’s Centre next week to find out what services they offer. The second step could be attending a session as the Children’s Centre. A timeline for the tasks (usually 12 weekly sessions), together with agreement of who will complete which tasks will form a written contract, signed by both parties.

The agreed contract is implemented and monitored until evaluation or termination. This allows for flexibility should this be required (such as extension of time or reorganisation of problems).

Anti-oppressive practice lies at its core of task-centred and the values of social work practice are integrated.

Partnership working promotes social justice and seeks to reduce the power imbalance between worker and service user. Thompson (2007, p50) agrees stating “user involvement and partnership working are part of a political commitment to promoting social justice, social inclusion and equality.” These aspects are further supported by the British Association of Codes of Practice, Codes of Ethics for Social Work (DATE) (24 October 2010).

The promotion of choice for service users by their own identification of the problem and prioritisation of their goals empowers. It also views the service as an expert in their situation. The nature of breaking down problems (often considered insurmountable) builds a sense of hope for service users to overcome them (QUOTE)

The simplicity of the model means it is easy to understand and apply and enables service user to use it for future problem solving (Doel and Marsh 1995). This builds resilience and empowers service users.

The model recognises and builds upon service users strengths because it considers they have the personal resources to solve their problems with limited support. This empowers by enabling service users to take control and ownership (McColgan, (Lindsay ed.) 2010).

A contract provides transparency and clarity. It places the focus on the problem, rather than the individual. It also allows for flexibility for the level or duration of support to be increased or goals to be reorganised.

Because the model is time-limited it decreases the risk of dependency and creates motivation to respond to tasks (Doel AND WHO, DATE, p36).

The successful completion of tasks, lead to personal growth of the service user, in terms of confidence and self-esteem for now and for the future.

For the worker and agency it offers a time and cost effective intervention. It also saves on future resources by building service users to solve their own problems in the future.

A note of caution is that it would be oppressive and ineffective if used with service users with limited cognitive functioning (such as poor mental health, learning disability or dementia). The model is also incompatible where there are complex underlying issues because it cannot address them. Additionally, it may not consider structural oppression such as class, poverty, ill health, gender or racial oppression.

Because of the nature of partnership, service users need to be willing to participate for the model to be effective (Trevithick 2005).

A written, signed contract may encourage a power imbalance between social worker and service user, placing the social worker as the expert.

Marsh (Davies ed. 2008) warns that while task-centred practice may be the most popular theory among social work students, perhaps owing to its simplicity. The quality of its application is often undermined. Many believing they are carrying out task-centred practice work, when actually they are not. PAGE 121

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In applying crisis intervention the social worker must establish a rapport with Anna using skills of empathy and active listening, while also assessing the risk of harm to Anna and her child (Mc Ginnis 2010). Importance should also be given to the non-verbal communication of the service user.

Anna should be supported in exploring the problem (the objective facts) and her emotional response to the problem (the subjective) (Beckett 2006). The social worker can assist by asking sensitive open questions (to ensure it remains Anna’s story) and responding by showing acceptance. McGinnis (2010, p45) claims “showing acceptance is key to effective relationship building”. It can also promote anti-oppressive practice and social justice by not judging the service user. The information collected should focus upon the here and now, although the past should be acknowledged.

The social worker should find out the attempts Anna has made to respond to her problem, while at the same time reassuring Anna. McGinnis (2010:45) suggests achieving reassurance by “gently reframe(ing) the client’s perception of self and events into a more realistic understanding of the situation”. Therefore, the social worker could say ‘I imagine you feel isolated’; ‘It sounds as if you have had a lot to cope with one you own’. Empathy should be shown the entire intervention by the social worker, by use of lexis and non-verbal communication.

If the service user is assessed as being in crisis the social worker can explain the concept of crisis intervention and agree the nature of the work to be carried out.

Arguably crisis intervention is also anti-oppressive. It seeks to effect positive change in behaviour now and for the future, through the building of resilience and coping mechanisms. It can also release service users from their past by addressing repressed issues. All of which results in empowerment of service user. 

Integrates with codes of practice – WHAT CODES – Active listening and empathy

Crisis intervention provides a safe structure of intervention for social worker, service user and use by voluntary agencies in addition to statutory. QUOTE

The time limited nature is anti-oppressive because it reduces the risk of dependency for the service user. Additionally, it provides an economical intervention for the social worker and agency. This is supported by research undertaken by the NCH…. (QUOTE)

Factors such as individual culture, values, gender, race, class and age can be taken into account because the service user is the expert and defines their own experience. (QUOTE)

Crisis intervention can be applied to many situations, namely, predictable crises in line with Erikson’s ego psychology model and unpredictable crises. (QUOTE)

Conversely, there are many criticisms.

The service user must be committed to working with the social worker to effect change (QUOTE)

The very nature of the word ‘crisis’ can lead to the theory being used inappropriately….. sw may assume su in crisis due to event

There is an imbalance in the power dynamic between social worker and service user because of the vulnerable nature of the service due to the crises. Moreover, the social work is considered the expert. This can leave room for unethical behaviour on the social workers part (QUOTE)

As crisis is short-lived, many social work agencies may not be able to respond fast enough to take full advantage of this window (Wilson et al. 2008). KEYWORD the brevity of the intervention may not be long enough to resolve a service users issues fully (QUOTE)

Research suggests that people respond to crises differently and at varying speeds, due to age, culture and cognitive impairments. Thus the model may need to be adapted to suit the service user and the situation, although, adaptation may render it unsafe for practice (Wilson et al 2008).

The theory involves active listening and empathy on behalf of the social worker. As the intervention involves use of active listening and empathy on behalf of the social worker, this may provoke many emotions. The social worker must remain empathetic and professional with an awareness of self.

Crisis intervention is also criticised as being Eurocentric. Ignoring different traditions and cultures and being concerned simply with fixing the problem as quickly as possible (Wilson et al. 2008). This can lead to oppressive practice.

In conclusion

Psychodynamic as discussed, was the theory of the day. It provided according to Howe (2009), complex, inefficient, open-ended intervention. In comparison, task-centred offered an effective, simply structured, easy to understand, time-limited approach, which dealt with the here and now (Howe, 2009). Reid and Shyne’s concluded through their research, that short-term intervention was effective (Trevithick 2005), and that problem-solving was more likely to be successful if a deadline was in place (Marsh Davies ed. 2008).

SUMMARY

While both interventions are suitable for differing situations, there are several similarities. Both are individualistic-reformist in that neither truly addresses social change.

Both have the potential to oppress and discriminate, but this can be overcome if assessments are sensitive to anti-oppressive practice (Wilson et al. 2008:366).

They are both time-limited.

Payne (2005:105) quoting James and Gilliland (2001) purports there are three crisis intervention models: “The equilibrium model – Caplan’s (1965) original approach.” Individuals are seen as experiencing disequilibrium.

The focus is upon return them to equilibrium enabling them to respond effectively to their problems.

Secondly, “The cognitive model – Associated with Roberts (2000)”

Ego psychology developed by Erikson, views the course of life as a series milestones through which conflicts occur. Developmental psychology considers early experiences shape personalities in adulthood.

(Daniel ed-Davies 2008); “cognitive behavioural approaches and systems theory” (McGinnis 2009:37).

3.3 Strengths (pay attention to AOP and values)

Time limited – reduces risk of dependency

In line with codes of practice – WHAT CODES

SU more open to help and change at a time of crisis (for a limited period)