Task Centred Approach in Mental Health

“Write a case study illustrating a social work intervention with an individual or family drawn from your current practice placement. The case study should illustrate the application of a social work method / approach (such as crisis intervention, systemic approaches, solution focused approach, CBT etc) to a practice situation and should contain a critical analysis of the chosen methodology.”

Within this assignment I will discuss a case that I am managing within my placement by providing details of the case and other professional bodies that are currently involved. In relation to this case I will discuss the relevant theories and methods that I have used with this client and critically analyse my choice of method. I will also mention other methods or approaches that I feel may have been beneficial to my work with the client. In order to provide evidence of this session with my client I will also attach a process recording to illustrate my chosen method.

Michael is a 47 year old male that is a service user of the Mental Health Team in Ballyfermot. Michael has been diagnosed with schizophrenia and a mild intellectual disability. He currently lives alone in the community with the support of the Mental Health Team. I am managing this case with the supervision of my practice teacher. At the moment Michael has the support of the outreach team in which they manage his medication and food shopping, whereas the social work department manage his finances in regards to his bills and give Michael a daily allowance each week. I am currently working one to one with Michael on a weekly basis in regards to the goals he has set for the following weeks. Each week Michael and I meet to discuss relevant issues that may have arisen for him during the week. Michael and I worked in partnership to complete the recovery star and made a plan to tackle some of the areas in his life that he would like to improve on. An example of this would be attending literacy classes, learning how to text and learning how to cook at home and also finding a job. I am working in partnership with Michael to achieve these goals.

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For this session, I planned to discuss and start the recovery star with Michael in order to understand his lifestyle at this present time. In order to complete the recovery star I used a task centred approach. The theory that I used for this session was behaviourism. Behaviourism is based on the theories of Pavlov, Skinner and Watson (Trevthick.P, 2005). According to Trevthick.P (2005) it was seen that through observable and measureable responses that behaviours are learned and in result behaviours can also be unlearned (Trevthick.P, 2005). According to Trevthick.P (2005) it also states that there are four types of techniques which are systematic desensitization, aversion therapy, operant conditioning, and modelling. In regards to working with Michael in this session, I used one of these techniques which were operant conditioning. “Operant conditioning is a technique where ‘the environment has been specifically programmed to support certain behaviours and discourage others’ (Sheldon, 1995) by altering the consequences that follow” (Trevthick.P,2005:P.96). While working with Michael and arranging to have our sessions in the civic centre every week it is evident through our sessions that the environment around him would have an effect on his behaviour. For example if the civic centre was busy Michael would sometimes seem a little anxious, whereas if the centre was quiet, Michael’s mood would be quite calm. Through operant conditioning it also discusses the possibility of reinforcements in regards to behaviours. Through this it is evident that through our weekly sessions, Michael would understand his reinforcement by participating within the session would be his daily allowance. This has become clear on a number of occasions as Michael has become quite engaging in regards to the sessions that would take place on a weekly basis. Whereas before if Michael received his daily allowance before his weekly sessions he would become disengaging and would abandon the session. Through this theory I then decided to use the method of task centred work with Michael.

According to Adams, R et al (2002) “Task centred casework was described as a method to help people with problems of living.” (Adams.R et al, 2002). According to Payne.M (1997) task centred work looks at problems with the client and ensuring that the client accepts and acknowledges the problems that they have. Also understanding that their problems can be resolved by their actions outside the ongoing work they may have with the social worker and that the problems can be defined clearly. While also having certain issues in the clients lives that they feel that they can change and that these problems are realised by the client and not others that are in the client’s life (Payne. M, 1997). It is also discussed that it should be assessed of the “direction and strengths of clients wants” (Payne. M, 1997), this is explained in regards that the clients want can start an action, although the clients belief system can shape the want while also providing an acceptable way of accomplishing those wants. In result according to Payne. M (1997) a belief can steer an action and by completing certain cognitive therapies these beliefs can be changed. According to Payne. M (1997) this was called a point of leverage. A point of leverage is accuracy, scope and consistency. Accuracy is when a social worker would discuss how accurate a client’s belief is then discuss the scope in which they discuss the range of beliefs that client has and explored with the client when they think these beliefs are limited. And lastly consistency in which the social worker would tackle misrepresentations due to a disagreement between one belief and another in which the social worker would be able to remove these and discuss it with the client. Through this emotions can arise for the client when there is a collaboration of their belief and want. This can then follow onto an action which would be shown by a behaviour which would be carried with intent which then follows on to a plan (Payne. M, 1997). A plan is a portray of intentions which is formed from the interaction of the belief, want and emotion (Payne. M, 1997). Through this a plan can be set in regards to exploring alternative options that may not have been tried by doing so this can give feedback to the client and social worker to understand if the method was successful or not. Through this method it also allows the client to resolve any problems they may have while also providing them with the skills for situations that may arise in the future. In result the client would be able to tackle a future issue that may arise without the need of the social worker.

As cited in Payne. M (1997), Reid (1978) discusses the various stages of task centred practice. These are as follows step one “identify potential problems” (Payne.M, 1997) identifying specific problems the client is having and allowing them to express these problems in their own words in order to gain a full understanding of the situation. Step two is “reaching tentative agreements” (Payne.M, 1997), by doing this you can explore the main problems the client may be facing. Step three is “challenge unresolvable or undesirable problems” (Payne.M, 1997) by completing this with the client the social worker can challenge these problems so the client will not be encouraged to obtain an unrealistic goal. Step four is “raising additional problems” (Payne.M, 1997), through this step the social worker can challenge and allow the client to realise other problems they may be having. Step five is “seek others involvement” (Payne.M, 1997) through this it may be beneficial to seek others that can be supportive or can contribute to finding a solution. Step six is “jointly assess the reason for referral” (Payne.M, 1997); in this step it would be useful to discuss the reason why the client was referred to the service especially if the client was forced to do so. Step seven is “get precise details” (Payne.M, 1997), it would be very important for the social worker to get accurate details into when and where the problems are occurring for the client. Step eight is to specify the problem for the client, step nine would be to identify the clear baselines and lastly step ten would be to decide on the changes the client would like to make (Payne.M, 1997).Throughout this process it is vital that the client and social worker have a similar understanding of what needs to be achieved and also provide feedback at the end of each session in order to understand if certain aspects of their work is not proving successful. Adams. R et al (2002) discusses this that task centred work is a systematic model which examines what works well for the client and what doesn’t work so well in regards to achieving the desired goals that are put in place (Adams.R et al,2005).

In regards to this the main reason why I used this approach with Michael was because he has a mild intellectual disability and it can be difficult to engage Michael in activities for a long period of time. So when starting the recovery star I explained to Michael that we would complete three sections and then continue the rest the following week. Throughout this session Michael became agitated and annoyed as he wanted to receive his daily allowance and leave. Although when continuing to proceed with the recovery star and using the task centred approach it became clear to myself and Michael what improvements he would like to make in the different areas of his life. With this new knowledge, Michael and I were able to set a basic map. While working in this session with Michael, I decided to use the basic map of task centred practice that is discussed by Trevthick.P (2005). The reason I used this specific map instead of the other process described by Payne.M (1997) was because the basic map overall described four basic steps that would be beneficial to the sessions I had with Michael. According to Trevthick.P (2005) a basic map of a task centred approach consists of four steps. These steps are as follows, step one would be targeting three main problems the client has. Through the recovery star there were certain areas Michael wanted to improve on, which was his living skills i.e. cooking and cleaning and also his literacy skills. Step two consisted of a contract which was setting up a plan to achieve these goals successfully and set a time frame for when these would be completed. This was competed by researching the resources that were in the community in regards to the literacy classes and possible cooking classes and looking at the time scale of when Michael would like to accomplish these goals. Step three consists of problem solving which would be solving any problems that would arise for me or Michael in regards to the sessions that take place. For example while working towards improving Michaels literacy skills it was evident that Michael would need one to one tutoring and this wouldn’t be possible for several months, although Michael was adamant to start in which he decided to start in a group. In result as the student social worker I know I will have to support, encourage and motivate Michael in this process as he may find it challenging to be part of a group of sixteen. Finally step four is termination in which will commence when I start to finish up in my placement and hope that Michael will continue with his goals with his own social worker. At this present time because of Michael’s background and his diagnosis this method has been successful to date. I have also been able to use a person centred approach along with the task centred approach with Michael throughout this process in order to allow Michael to open up about his feelings and be honest about what is going on for him at that time and in result has allowed Michael to achieve positive outcomes within our daily sessions.

In regards to the task centred approach that I have undertaken with Michael, at present it has been successful as it looks at the three main problems that he would like to improve on within the short space of time that I will be working with him. By using this approach it was evident that Michael felt motivated to complete these goals as he focused on the three main issues he had in his life. According to Trevthick.P (2005) it can be very difficult to engage in the underlining issues that may be present. In my opinion and the evidence from conducting sessions with Michael this is quite accurate as it can be difficult to engage Michael in certain difficult conversations from his past from a task centred approach. Although by using a person centred approach when discussing these difficult conversations can be suitable as this approach allows him to discuss these issues calmly and reflect on the situation that he may find difficult. For example by using this approach, it allowed Michael to open up about his daughters and the relationship he has with them and how he wants it to improve. He was also able to realise that he wanted to do something about his literacy skills and how this issue could be a barrier for him when searching for a job. By conducting a task centred approach and completing the recovery star I discovered this about Michael and was able to use the person centred approach to discuss it in more depth. Although even though it is discussed that a task centred approach is chosen because it allows the goals to be achievable, it can be difficult for those who may suffer from a mental health illness. Some individuals may find it difficult to achieve the goals that have been set, although at that time it is important for the social worker and client to be able to feedback any difficulties that have arisen and be able to change in accordance with the individual. For example while working with Michael it can be difficult for him in regards to his mental health, so throughout our sessions I ensure that near the end of each session Michael is able to understand what was discussed and his understanding and ensure that he is still motivated in regards to the goals that he has set for himself.

In conclusion, it is evident that the ongoing weekly sessions with Michael have been beneficial in regards to a task centred approach. The reason for this is that Michael can concentrate on three specific goals at a time and doesn’t feel overloaded. From working with Michael on a one to one basis, his history and mental health status, this approach is working in a positive way in regards to what Michael wants to achieve. From previous case notes it has been noted of other methods that have been tried and failed to motivate and encourage Michael. This approach does have its limits for example it doesn’t allow the client to discuss their issues in detail, although that is when the social worker can incorporate other approaches into their work with the client. Throughout my work with Michael this approach has been favourable as with this client it has achieved positive results, while I am also aware that this may not be the case with every client that I encounter. Although while managing this case I plan to continue with this method and incorporate various approaches as needed in order to work in partnership with Michael to achieve his goals while anticipating a positive outcome.

References

Adams. R, Dominelli, Payne.M (2002). Social Work: Themes, Issues and Critical Debates. 2nd ed. Hampshire: Palgrave. P191-199

Teater. B (2010). An Introduction to Applying Social Work Theories and Methods. Berkshire: Open University Press, McGraw – Hill Education. P178-193

Nelson – Jones. R (1992). The Theory and Practice of Counselling Psychology. London: Holt, Rinehart and Winston LTD. P107-120

Payne. M (1997). Modern Social Work Theory. 2nd ed. Hampshire: Palgrave. P104-112

Trevithick. P (2005). Social Work Skills: A practice handbook. 2nd ed. Berkshire: Open University Press, McGraw – Hill Education. P95-98, P275-277

Recovery Star