Introduction to social work
Compare, contrast and critically evaluate Crisis Intervention and Task-Centred Practice. Debate what you see as their effectiveness by outlining potential advantages and disadvantages and with reference to research regarding their effectiveness.
The British Association of Social Workers (BASW) Code of Ethics (2002:1) states that;
"The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environment."
In order to promote such social change and provide high quality professional practice, social workers utilise various theoretical frameworks and apply them appropriately in order to help service users in the best way they can. The intention of this essay is to discus the key features of the task-centred practice and crisis intervention approaches, both of which are widely used methods of social work practice. With reference to research, the effectiveness and limitations of these approaches will be analyzed by outlining potential advantages and disadvantages, and by demonstrating that although these approaches have different origins, they do have some common features.
McColgan (2009:60) states that task-centred practice is;
"...a popular method of intervention in social work practice. It does not depend on any complex theory, is down to earth, makes sense and is easy to understand in its application."
Coulshed & Orme (2006:156) believe that the task-centred approach, also known as "brief therapy, short term or contract work" is probably one of the most researched and commonly used approaches to problem solving in social work practice.
Task-centred practice was developed out of research into effective social work practice by Reid and Shyne in 1969, who found that planned, short term intervention, was equally as or more effective than long term treatment. Task-centred practice originates within social work itself, rather than being "borrowed" from disciplines outside of social work, such as psychology and sociology. Indeed, Reid (1992) states that;
"...task-centred casework rejects any specific psychological or sociological base for its methods and seeks to be eclectic and integrative" (cited in Payne, 1997:97).
At the time task-centred practice challenged the long-term psychodynamic theory behind social work which, according to Woods and Hollis (1990, cited in Cree and Myers 2008:90) expected problems to be "...deep rooted and to require intensive and long-term specialist input to address these difficulties", however Reid and Shyne disputed this approach in favour of "...proposed time-limited, structured and focused interventions to solve problems", which was a direct challenge to the models that encouraged those with problems to move at their own pace.
Reid and Epstein (1972) suggest that the task-centred approach is beneficial for a variety of problems, including interpersonal, social relationship, organisational, role performance, decision making, resource based, emotional and psychological. Doel and Marsh (1992) and Reid and Epstein (1972) suggest that in order to apply effective task-centred practice to such problems, a framework should be adopted, which should firstly look at problem exploration. Doel (2002) states that the first phase should consist of problem scanning and identification in order to establish the services users perspective of the seriousness of the issues. The user should then be guided to prioritise the target problems and clarify their significance and define their desired outcomes or goals. Marsh and Doel (2005:72) suggest that the use of "I want" or "we will" is a guarantee of a statement which results in a goal being achieved, rather than using verbs such as "need". Epstein and Brown (2002:155) recommend that a maximum of three problems should be worked with at any one time - as Doel and Marsh (1992:31) point out "...too many selected problems will probably lead to confusion and dissipated effort". The selection of targeted problems should be governed by feasibility of achievement and in accordance with the partnership of the worker (Cree and Myers 2008:93). Doel and Marsh (1992) identify that making an agreement and agreeing a goal should be a written statement of what the user wants, based on how to directly alleviate the problem. The benefits of a written agreement could include that it is in the service users own words and can be referred to at a later date. However, Epstein and Brown (2002) argue that whilst this may be more necessary with mandated service users, a verbal agreement may be sufficient. It is important to remember that the communication skills of users must be taken into account, and that appropriate media must be used in accordance with the users abilities and skills. Additionally, a verbal agreement may be less frightening for the service user, or they may not be literate, so possibly a tape recording could be used. Healy (2005:121) suggests that the agreement should document the practicalities of the intervention, such as the "duration, frequency and location of meetings" in order for both the service user and the worker to be held accountable. Cree and Myers (2008:94) state that once the practicalities of the agreement have been established, identification of how to address the problems can begin via agreeing to a series of tasks that will contribute towards achieving the goals set out, that is, alleviation of the problem. Dole and Marsh (2005:36) outline that goals ideally should follow the SMART principle; specific, measurable, achievable, realistic and timely. Additionally, goals and tasks should be detailed and clarify who will do what, when, where and how and the service user should have a major influence in deciding on and carrying out the goals and tasks (Cree and Myers 2008:94).
"In short, the goal should be the client's goal, agreed after detailed discussion with the worker about why it is desirable, how it can be achieved and how it is evident that it has been reached. The goal should be as clear as possible, within the capacity of the client to achieve and ethically acceptable to the practitioner." (Doel and Marsh, 1992:51)
Task implementation addresses the methods for achieving the task(s), which should be negotiated with the service user, and according to Ford and Postle, (2000:55) should be;
...designed to enhance the problem solving skills of participants...it is important that tasks undertaken by clients involve elements of decision making and self-direction...if the work goes well then they will progressively exercise more control over the implementation of tasks, ultimately enhancing their ability to resolve problems independently".
According to Doel (2002:195) tasks should be "carefully negotiated steps from the present problem to the future goal."
Once tasks are set, it is important to review the problems as the intervention progresses in order to reassess that the tasks are still relevant to achieving the goals. Cree and Myers (2008:95) suggest that as circumstances can change, situations may be superseded by new problems. The workers role should be primarily to support the user in order to achieve their tasks and goals which may include providing information and resources, education and role-playing in order to handle difficult situations (ibid:95).
The exit stage of the intervention should have been anticipated at the initial phase, in that the contract or agreement will have been explicit about the length of the intervention, and both the service user and worker will be aware of the timescale in which to complete their tasks. A time limit is important as it guards against drift, allows time for a review and encourages accountability. It also acts as an indicator of progress (Adams, Dominelli and Payne, 2002).
According to Cree and Myers (2008:96);
"...the last session needs to review what has been achieved; how the tasks have been completed; to what extent the goals have been met; and what the service user has learned from the process that can be usefully taken into their future lives."
Wilson et al (2008) suggest that the final phase should involve the service user and the worker revisiting the initial problems and comparing them to how the situation is now, along with what the underlying achievements were, and what has been learnt in the process. Additionally, the service user is encouraged to explore how to use the skills learnt for the future, and how the intervention will now end, for example, possible new contracts for further work or referral to another agency.
In contrast, the conceptual origins of crisis intervention come from varied sources, primarily from mental health and have a long history of development (Roberts 2005 cited in Parker 2007:116)
Caplan (1961) and Roberts (1990) (cited in Parker 2007:115) state that crisis is;
"...a time limited period of psychological distress resulting from exposure to or interpretation of particular situations or longer term stress that individuals cannot deal with using tried and tested or novel means of coping."
The theoretical basis of crisis intervention has developed in sophistication, namely through the work of Gerald Caplan, an American clinician, following Dr Erich Lindemann's study of grief reactions after a night-club fire in Coconut Grove, Boston, USA in 1943 in which almost 500 people died. Lindemann interviewed some survivors and the relatives of those who died and concluded that when faced with sudden crisis, the human capacity to deal with problems faltered. An individuals usual coping mechanisms are no longer adequate to take on board the experiences involved following a crisis and these experiences consequently challenge ones normal equilibrium, or homeostasis. Furthermore, during the Korean war in the early 1950's, it was discovered that psychiatric first-aid given immediately to front-line soldiers, often quickly restored them back to duty, whereas those who were sent home for protracted institutional treatment responded slower to intensive therapy, which could suggest that institutionalization confirmed there was a serious underlying problem (Fell 2009).
The experience and resolution of crises could be said to be a normal process which is inevitable at some point during a person's life, however, defining exactly which events or situations constitute crises is more troublesome, as they are construed as crises due to individual perception or reaction to an event, not the actual event itself (O'Hagan 1986, cited in Parker 2007:117). The concept of "crisis theory" provides workers with a theoretical framework of the adaptation processes of the individual following such events that are seemingly overtly stressful and unmanageable. Crisis intervention takes the concept of this theory and applies it to the understanding of the individual's experience, and suggests certain steps to take in order to help those who are experiencing crisis (Wilson et al 2008:361).
Coulshed (1991:68) believes that one of the most significant features of crisis intervention is that crisis does not always indicate an emergency or dramatic event. The crisis instead, may be "developmental" and the result of a new experience such as starting school, adolescence, leaving home, going to university, getting married, or the anticipated death of a relative or friend, or indeed oneself. Similarly, an "existential" crisis refers to inner anxieties in relation to ones purpose, responsibility and autonomy, for example, a middle life crisis. In both cases adjustment fails because "...the situation is new to us, or it has not been anticipated, or a series of events has become too overwhelming" (ibid). For many people, these challenges will not constitute a crisis, although they may feel stressful, but it could be recommended that, in practice, the worker remembers the subjective nature of crisis, in order not to dismiss a service users experience, which would suggest that there are standard reactions to events, as Hoff (1990) states; "...what is a crisis for me may not be a crisis for you".
Alternatively, a "situational" crisis could be said to be an event that happens which is out of ones control, or out of the realms of normal, everyday experience, for example natural disasters, sudden illness or death, sexual assault, abortion, domestic violence, redundancy or relationship breakups (Aguilera 1990). Murgatroyd and Woolfe (1985) however, believe that the threshold level of how an individual deals with such events is not the same for everyone, which leads one to assume that it is how someone comes to terms with the event rather than the event itself, in agreement with O'Hagans earlier statement. Likewise, an individual may be a particularly resilient person, or has previous experience of such situations, or they may have a strong support network of family and friends. Indeed, given an example such as a terminal illness, preparation work may be underway before the inevitable occurs and therefore not develop into a crisis situation (Wilson et al 2008).
Caplan (1964) suggests that crises are time-limited, usually lasting no longer than six weeks, and that an individual's capacity to cope with problems and return to a steady state is based upon a persons internal psychological strengths and weaknesses, the nature of the problem and the help being given. Caplan (1964) also describes the stages of crisis whereby an emotionally hazardous situation presents uncomfortable feelings and signals change in homeostasis, in turn motivating actions to return to normal through employing usual coping mechanisms, which in most cases, are successful in a short period of time. Alternatively, in the case of an emotional crisis, the usual coping strategies are ineffective and the discomfort and unpleasant feelings intensify, cognitive disorganisation increases and novel coping methods and problem-solving techniques are employed to reduce the crisis. The individual then seeks help and support from others and employs an adaptive crisis resolution which deals successfully with affective and cognitive issues and new problem-solving and coping behaviours are developed. Conflicts raised by the crisis are identified and work to resolve them is begun, upset is subsequently reduced and there is a return to the pre-crisis level of functionality. However, maladaptive crisis resolution sees the individual implement novel problem-solving and coping and adequate help is not sought. Underlying issues remain unresolved and sources of help are not fully utilised. Although the disquiet is reduced the individual functions at a less adaptive level than before the crisis. In an adaptive post-crisis resolution, the individual becomes less vulnerable in similar situations due to past resolved conflict, inferring that the novel and adaptive coping skills and problem solving behaviours have been learned and applied. Therefore, individual functioning may have improved, personal growth taken place, and the likelihood of future emotionally hazardous situations of a similar nature developing into a crisis is reduced. Finally, Caplan (1969) describes the maladaptive post-crisis resolution whereby the individual is more vulnerable than before because of a failure to deal effectively with underlying conflicts. The individual has learned maladaptive strategies to cope with emotionally hazardous situations, such as drinking or problem avoidance, and in general their functioning may be less adaptive than in the pre-crisis state, potentially resulting in further emotionally hazardous situations developing into a crisis.
In order to implement effective practice for successful crisis intervention Roberts (2000) recommends practitioners should follow a seven stage model beginning with risk assessment, in order to establish if the person needs immediate medical attention, are they considering suicide as a "solution", are they likely to injure themselves, if they are a victim of violence, is the perpetrator still present or likely to return, if there are children involved are they at risk, does the victim need transport to a place of safety, has the individual sought emergency treatment of this sort before and if so what was the outcome? It is essential to establish rapport with service users who are experiencing an episode of acute crisis, to include offering of information regarding help and support, and genuine respectfulness and acceptance of the person in line with the anti-oppressive and anti-discriminatory practice, therefore adhering to the GSCC Code of Practice. The worker then needs to establish the nature of the problems that have led to the crisis reaction and encourage an exploration of feelings. Roberts (2000) believes this is a key element of the model, whereby service users should be encouraged to express their feelings in a safe and understanding environment within the context of an empathic therapeutic relationship with the worker. The worker should consider alternative responses to the crisis through active listening and encourage the service user to think about what alternative options there are available and what they feel they can bring to this new situation that they find themselves in. Roberts (2000) concludes that an action plan should be developed and implemented which involves the identification of a particular course of action in order to move beyond the crisis state successfully. The service user needs to establish a full understanding as to what happened, why and what the result was, to understand the cognitive and emotional significance of the event, and to develop a future plan based on real situations and beliefs rather than irrationality. Finally, a follow-up plan and agreement can be drawn up between both service user and worker if any further help is needed and by whom.
It is evident that there are various advantages and limitations as well as some common features between both of these methods of practice. In fact Reid (1992) believes that crisis intervention has been influential to the development of task-centred practice. A major advantage for task-centred practice is that it offers an optimistic approach that moves focus away from the person as the problem, to practical and positive ways of dealing with problems. Coulshed & Orme (1998) suggest that task-centred practice does not assume that the problem resides only in the service user and therefore attention is paid to external factors such as housing and welfare and the strengths of individuals and their networks. However, Gambrill (1994 cited in Payne 1997) argues that neither model deals with social change and may not take account of structural oppression such as poverty, poor health, unemployment or racial or gender discrimination or where the problem may not be easy to overcome without political or social change;
"...the failure of political will to respond realistically to deep-seated problems of poverty and social inequality and its effectiveness in dealing with presenting problems may result in society avoiding longer-term and more deeply seated responses to social oppressions" (Payne, 1997:113).
In addition, Wilson et al (2008) argue that the crisis intervention model does not take into account cultural differences regarding traditions when coping with acute distress and the loss of a loved one for example. The criticism is that crisis intervention theory is based on a very western philosophy, which "patches up as quickly as possible". It could be suggested therefore, that if workers carry out a thorough and sensitive assessment before intervention, this should be avoided. On the other hand, Coulshed & Orme (1998:55) believes that the task-centred approach is more generic, in that it is considered to be ethnic sensitive and can be applied to many situations with different user groups;
"...the task-centred approach is the one most favoured by those who are trying to devise models for ethnic-centred practice because its method is applicable to people from diverse cultural backgrounds".
Therefore in keeping with anti-discriminatory practice which is integral to social work ethic and the GSCC Code of Practice.
It could be argued that the success of these two approaches within social work comes from the fact they are brief and time efficient and therefore economical interventions, both for service user and from the care-management perspective. In addition, both approaches involve the service user in examining and defining their own problems and finding ways in which they can work on them using their own resources and strengths. This enables them to regain control of their lives and promote empowerment either by success in problem solving in order to build confidence as in the task centred approach, or helping people become emotionally stronger through learned experience, as with crisis intervention, rather than understanding the origins of present problems in past experience. This in turn helps the service users ability to cope in the near and distant future and become more capable of solving subsequent problems without help (Payne 1997). Equally, the fact that short-term interventions should curtail the service users dependency on the worker, further enhances empowerment. As Ford and Postle (2000:53) state;
"The dangers of social work effectiveness becoming dependent on the worker/ client relationship, which may or not work out, are minimised in the short-term."
The tasks and goals established in task-centred practice are chosen because they are achievable, that is the mutual and specific agreement or contract set up between the service user and the worker ensures that the success of the intervention relies upon the acceptability and participation of the tasks (Wilson et al 2008). As a result of the mutuality of the partnership, anti-oppressive and anti-discriminatory practice and empowerment are at the core of the task-centred approach, all which are key to the GSCC Code of Practice. However, Rojek and Collins (1987:211) point out that as that as task-centred practice is based on contractual intervention, this could set up an unequal power relationship between the worker and the service-user;
"As long as social workers have access to the economic and legal powers of the state and clients contact social work agencies as isolated individuals with 'problems', then there is the basis for inequality. Contract work does not get round these points by affecting an open and flexible attitude."
Similarly regarding power base, Trevithick (2005) believes that the crisis intervention approach can be a highly intrusive method which is too direct and can raise a number of ethical issues such as making decisions on behalf of the service user if they are too distressed to do so themselves, which in turn may offer potential for oppressive practice on behalf of the worker. However Kessler (1966) believes that during the disequilibrium of crisis, a person has more susceptibility to influence by others than during periods of stable functioning which provides a unique opportunity to effect constructive change. This point could be argued in that the "susceptibility to influence others" that Kessler describes is in itself oppressive, although Golan (1978); Baldwin (1979); Aguilera and Messick (1990); Olsen (1984) (cited in Parker 2007:116) maintain that this time of disquiet motivates willingness to change, and this is when the practical application of crisis theory is effective. However, it could be suggested that that this is similar to the bargaining stage that Kubler-Ross (1970) describes in the five stages of grief, whereby an individual becomes so desperate to resolve a situation, that they are willing to try anything, even if it means "striking a deal with God". Accordingly, Coulshed and Orme (2006 cited in Parker 2007:117) see its value in working with people at points of loss and bereavement, which they believe has resonance with the use of this intervention. This poses the question as to whether crisis intervention is more of a "situation specific" intervention. However, Poindexter (1997) believes that crisis intervention is suited to individuals who have experienced a hazardous event, have a high level of anxiety or emotional pain, and display evidence of a recent acute breakdown in problem-solving abilities, therefore implying that this approach could be applied to a range of situations or problematic events.
Both interventions can be seen as time-limited approaches that "superficially fit well with care-management" (Ford and Postle, 2000:59) which implies that they are only used because they fit into the routine and schedule driven aspects of care management rather than for their effectiveness. It could therefore be suggested that due to the general pressures of time, the worker may try to fit either intervention around their workload, rather than around the service user's needs, which in turn may restrict the development of empowerment within the service user, and ultimately not address any underlying problems. Although this is a rather bureaucratic outlook, it could be said to be a sign of the times that most things are increasingly driven by targets and financial considerations. Whilst both approaches seem to satisfy agency requirements as well as maintaining professional practice, Reid and Epstein (1972) believe that the task-centred approach is more structured compared to crisis intervention (cited in Payne 1997:97). It could be suggested in which case, that task-centred practice is more beneficial for the less experienced worker as it follows more defined framework. In addition, it could be fair to say that this method of intervention could be useful for reflective practice due to it following such a framework; the worker, as well as the service user, has to be committed to a series of planned work, therefore could be a valuable tool for future guidance in a professional capacity.
Further to the constraints of short term interventions Reid and Epstein (1972) suggest that these approaches may not allow sufficient time to attend to all the problems that the service user may want help with and that clients whose achievement was either minimal or partial thought that further help of some kind may be of use in accomplishing their goals.
Task-centred practice is an approach which depends on a certain level of cognitive functioning. Doel and Marsh (1992) suggest that the service user must be of rational thought and be capable of cognition in order for the intervention to be effective, therefore may not be suitable for those with on-going psychological difficulties or debilitations;
"...where reasoning in seriously impaired, such as some forms of mental illness, people with considerable learning difficulties or a great degree of confusion, task-centre work is often not possible in direct work with that person."
It is evident that both the task-centred and crisis intervention approaches are popular and generally successful models of social work practice and can both be used in a variety of situations. Both approaches are based on the establishment of a relationship between the worker and the client and can address significant social, emotional and practical difficulties (Coulshed & Orme 2006). They are both structured interventions, so action is planned and fits a predetermined pattern. They also use specific contracts between worker and service user and both aim to improve the individuals capacity to deal with their problems in a clear and more focused approach than other long term non directive methods of practice (Payne 1991). Despite their different origins and emphasis, both of these approaches have a place in social work practice through promoting empowerment of the service user and validating their worth. Although there are certain limitations to both of the approaches, they do provide important frameworks which social workers can utilise in order to implement best practice.
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