Case Study :
Ramesh is 45 year old Sri Lankan man who works as a telephone call centre agent. He was close to and lived with his mother, who died 18 months ago. Ramesh was recently hospitalised after a suicide attempt. He had been taking anti-depressants for several months before he took an overdose. According to his sister, he had become depressed and was drinking and smoking a lot, and hardly ever eating. He had been taking time off work, and was at risk of losing his job with BT. His sister says that Ramesh went downhill after the death of their mother, but that she was surprised at this as he always complained about all the things he had to do for her when she was alive. The sister has a family of her own, but says that she has tried to involve Ramesh in her family, but he had mostly refused. He had some friends who he used to play cricket with, but he has stopped seeing them. He had been saying that there’s nothing to live for, and he wanted to be left alone. Ramesh is due to be released from hospital in two weeks’ time.
The purpose of this essay is to critically analyse the Task-centred and client-centred approaches to Social Work Intervention. I will initially explain their main principles, advantages and disadvantages and apply them to the assessment, planning and intervention of the above case study. Particular attention will be paid to how these perspectives inform the application of anti-oppressive practice (AOP). The word ‘perspective’ describes a partial ‘view of the world’ (Payne 1997:290) and is often used to attempt to order and make sense of experiences and events from a particular and partial viewpoint. The reason for choosing these two theories is because they can be used simultaneously. One of the major attributes of the Person Centred approach is the emphasis on relationship building between the Social Worker and the service user, which therefore makes it easier to set out the tasks that need to be carried out because lines of communication have been opened up
Task- centred Approach
The task-centred model is a short-term, problem-solving approach to social work practice. It is a major approach in clinical social work perhaps because unlike other several practice models, it was developed for and within Social Work (Stepney and Ford, 2000). My reasoning behind adopting this approach is because it is essentially a clear and practical model that can be adapted for use in a wide range of situations. It is designed to help in the resolution of difficulties that people experience in interacting with their social situations, where internal feelings of discomfort are associated with events in the external world. One of the many benefits of planned short-term work is that both the Social Worker and Client put immediate energy into the work because the time is limited. The dangers of the effectiveness of the intervention being reliant on the Social Worker/Client relationship, which may or may not work out, are minimised in the short-term. The model consists of five phases.
This is the problem exploration phase and is characterised by mutual clarity. Problems are defined as an unmet or unsatisfied wants perceived by the client (Reid, 1978). The client should be as clear as the social worker about the processes that will be followed in order to fully participate fully in the work. Involving the service user right from the initial phase has the advantage that they feel empowered and is a good example of anti-oppressive practice. Less commonly the worker may take the lead in identifying the problems but however must be careful not to detract from the clients’ unique expertise in the understanding of their own individual situation. This phase normally takes from one to two interviews although some cases may require more. It ends with setting up of initial tasks. In Ramesh’s case the Social Worker will be using the following sequential Steps.
Identifying with Ramesh the reasons for the intervention in the first place. Explain to Ramesh how long the process will take (roughly between 4- 6 weeks). The social worker has to assess Ramesh’s ability to understand his problems and their extent especially taking into consideration that he has issues with alcohol and dependent on anti-depressant drugs. Establish whether Ramesh acknowledges he has a problem and is willing to do something about it. The process of problem exploration will entail the answering of a series of questions: How did his problems begin?
What happens typically when Ramesh drinks a lot of alcohol?
How often this happening iand what quantities of alcohol is he going through per day/week? What efforts (if any) he himself has put into resolving his problems?
This is when the selecting and prioritising of the problems occur. This has to be what both the Social Worker and Ramesh acknowledge as the ‘Target problem’ and explicitly agree will become the focus of their work together. Commonly there will be a series of problems identified and will be ranked in order of their importance (Stepney and Ford, 2000). There are basically three routes for problem identification. The most common is through client initiation. Clients express complaints which are then explored. A second route is interactive. Problems emerge through a dialogue between the practitioner and client in which neither is a clear initiator. In the third route to problem identification the practitioner is clearly the initiator. So for example, using the information in case study, the problems could be listed as: Dependence on alcohol
Following the identification and ranking of target problems stage, the first problem to be identified will need to be framed within a ‘problem statement’. The client’s acceptance of the final problem statement leads to a contract that will guide subsequent work. Both practitioner and client agree to work toward solution of the problem(s) as formulated. The way the problems are framed and defined are crucial in motivating both the Social Worker and the service user. The ultimate goal is to avoid the service user from feeling over-whelmed or that the goals set are unachievable. Therefore they have to be set in a realistic manner which also reflect the concerns and wishes of the service user, again this re-enforces anti-oppressive practice issues. They should be clear and unambiguous and which lend themselves, as far as possible, to some sort of measurement so that the Social Worker and service user can tell what progress is being made. So for instance if it is agreed that Ramesh’s dependence on alcohol is the priority, the Social Worker can suggest and also help him join an Alcohol support group. Agree on the number of meetings he’ll attend. Not only will the support group help him tackle the alcohol issues but will also give him the opportunity to be around other people and interact with them. Gradually this should help eliminate the isolation issues which are major facilitator of depression. Evidence shows that the more support and services the person has, the more stable their environment. The more stable their environment, the better the chances of dealing with their substance problems (Azrin 1976, Costello 1980, Dobkin et al 2002, Powell et al 1998). An important secondary purpose of the model is to bring about contextual change as a means of preventing recurrence of problems and of strengthening the functioning of the client system. One of the issues Ramesh is dealing with is depression which according to his sister was triggered by his mother’s death. With his approval, it might be useful for Ramesh to be referred for bereavement counselling in order to come to terms with losing his mother. Other important things that need to be considered during this phase are ways of establishing incentives and motivation for task performance. The task may not itself satisfy Ramesh’s ‘wants’ but at least he must see it as a step in that direction. Phase four
This is the stage where implementation of tasks between sessions occurs. There is not a great deal to say about this self-evident phase, however, that is not to say it is not an important phase. Its success will depend on all the groundwork undertaken in the previous phases of the process. 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. In this case Ramesh will go ahead and continue attending his alcohol cessation support group and the Social Worker can work on arranging bereavement counselling for him and liaise with him about when he feels ready to start. Phase five- Termination Session
Termination in the task-centred model begins in the first session, when client and practitioner set time limits for the intervention. Throughout the treatment process the practitioners regularly reminds the client of the time limits and the number of sessions left additional progress. If an extension is made, practitioner and client contract on a small number of additional sessions, usually no more than four interviews. It should also be noted that such extensions occur in less than one fifth of the cases in most settings. Any accomplishments made by the client are particularly stressed in the termination session. This emphasizing of the client’s accomplishment serves as a reinforcer. In another final termination session activity, the practitioner assists the clients in identifying the problem-solving skills they have acquired during the treatment process, review what has not been done and why not. An effort is made to help clients generalize these problem-solving skills, so they can apply them to future problems they may encounter. Person Centred Approach
The key emerging principles of the person centred approaches are that individuals must rely on themselves and liable for their own actions (Howe D, 2009). The Person-Centred Approach developed from the work of the psychologist Dr Carl Rogers (1902 – 1987). He advanced an approach to psychotherapy and counselling that, at the time (1940s – 1960s), was considered extremely radical if not revolutionary (BAPCA). In order for people to realise their full potential they must learn to define themselves rather than allowing others to do it for them. the An important part of this theory is that in a particular psychological environment, the fulfilment of personal potentials includes sociability, the need to be with other human beings and a desire to know and be known by other people. It also includes being open to experience, being trusting and trustworthy, being curious about the world, being creative and compassionate. This is one of the most popular approaches among practitioners (Marsh and Triseliotis 1996: 52) because of its hopefulness, accessibility and flexibility.
The psychological environment described by Rogers was one where a person felt free from threat, both physically and psychologically. This environment could be achieved when being in a relationship with a person who was deeply understanding (empathic), accepting (having unconditional positive regard) and genuine (Trevthick,P, 2005). The approach does not use techniques but relies on the personal qualities of the therapist/person to build a non-judgemental and empathic relationship. This in itself could be an issue because of the sole reliance on the Social ability to engage with service users. However, there are disadvantages to this approach. For example, treating people with respect, kindness, warmth and dignity can be misconstrued as ‘’adopting a person centred approach’’. This means the counselling part of the relationship has a risk of being completely over-looked.
The goal would be to work on a one-to-one with Ramesh mainly using counselling skills. He has a sister who has a family of her own so therefore family work can be included as a possibility. If he is willing to perhaps go and temporarily live with his sister when he is discharged from hospital in two weeks, it will be a positive step for him to spend more time in a family setting rather than by himself. That way he might not feel so isolated and depressed. This will also help build his self-confidence and self-esteem. The lack of motivation that Ramesh has for going to work needs to be further explored. It could be he is feeling unfulfilled and that at 45 years of age he has not achieved much. He needs social work intervention which is geared towards him attaining ‘’human potential’’ (Maslow’s basic theory). The Social Worker should encourage him to come up with ways in which he can work towards that and also look at areas in his life where he can make his own choices with an aim to recognise elements in his situation that constrain these and seek to remove them. For example, if he is not turning up for work because he is unsatisfied with his job perhaps he could enrol for a vocational course in an industry he enjoys which will improve his job prospects. The fact that he says he has nothing to live for means he has no feeling of self-worth and hasn’t reached the stage of self-actualisation in his life, this is something he is going to need support in figuring it out for himself because it is relative.
It is evident that both the task-centred and person centred 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 service user 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 2002,). Both of these approaches have a place in social work practice through promoting empowerment of the service user and validating their worth. They do provide important frameworks which social workers can utilise in order to implement best practice However, there are certain limitations to both of the approaches, for example 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. The problems Ramesh is facing are deep rooted psychological problems which may require a longer time frame to sort them out. Depression can take really long to deal with and 4-6 weeks may not be sufficient and the fear is that this might actually have an adverse effect on Ramesh if he does not see any progress within the agreed time frame.
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