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The casework treatment of disturbed children : an analysis of social work method in comparison with psychoanalytic… Zimmerman, Sunny Melvin 1962

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THE CASEWORK TREATMENT OF DISTURBED CHILDREN  An a n a l y s i s of s o c i a l work method i n comparison with psychoanalytic techniques; as a p p l i e d to c h i l d r e n at the Children's C l i n i c , Burnaby, B.C.  by SUNNY MELVIN ZIMMERMAN  Thesis submitted i n P a r t i a l Fulfilments of the Requirements: f o r the Degree o f MASTER OF SOCIAL WORK i n the School of S o c i a l Work  Accepted as conforming to the standard required f o r the degree oft Master of S o c i a l Work  School of S o c i a l Work  1962 The U n i T e r s i t y of B r i t i s h Columbia  In p r e s e n t i n g the  this thesis in partial fulfilment  requirements f o r an advanced degree at the  of  University  of B r i t i s h Columbia, I agree t h a t the  L i b r a r y s h a l l make  it  study.  f r e e l y available f o r reference  and  I  further  agree t h a t permission f o r e x t e n s i v e copying o f t h i s t h e s i s f o r s c h o l a r l y purposes may  be granted by the  Department or by h i s r e p r e s e n t a t i v e .  Head o f  my  I t i s understood  that  copying o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l  gain  s h a l l not  be allowed without my  Department The U n i v e r s i t y of B r i t i s h Vancouver Canada.  Columbia,  written  permission.  ill  ABSTRACT How does the s o c i a l worker respond to the disturbed c h i l d i n d i r e c t treatment when working i n a p s y c h i a t r i c c l i n i c ? In other words, i n the one-to-one r e l a t i o n s h i p with a c h i l d , what techniques does the s o c i a l worker apply i n order to enhance the c h i l d ' s emotional well-being? On what body of knowledge does the s o c i a l worker base-his choice of: technique i n a given s i t u a t i o n ? The present study i s undertaken to explore these questions, with reference to the s p e c i a l circumstances of the p s y c h i a t r i c a l l y - o r i e n t e d c l i n i c . In C h i l d Guidance C l i n i c s ( s p e c i f i c a l l y , the Children's Clinic:, Burnaby, B o C o ) , s o c i a l workers are under the s u p e r v i s i o n off p s y c h i a t r i s t s as well, as senior s o c i a l workers. The other c o n s i d e r a t i o n i n t h i s complex p i c t u r e i s c h i l d r e n are not "miniature a d u l t s " - they present p r a c t i c a l and t h e o r e t i c a l d i f f e r e n c e s from the a d u l t c l i e n t . I t i s not, t h e r e f o r e , a. simple matter of applying casework s k i l l s worked out f o r adults to the d i r e c t treatment of c h i l d r e n i n a p s y c h i a t r i c c l i n i c . To determine the s p e c i f i c techniques a p p l i e d by the s o c i a l workers, one w r i t t e n recording was s e l e c t e d from the caseload of each of a group of s o c i a l workers. In a d d i t i o n , one f u l l y tppe-recorded interview was a v a i l a b l e f o r a n a l y s i s . Each recording followed two c r i t e r i a : (a) the recording showed workers' responses as well as the c h i l d ' s a c t i v i t i e s ; (b) the c h i l d r e n are between the ages of s i x and ten. This age span includes c h i l d r e n o l d enough to v e r b a l i z e to the) extent that enables some verbal communication between worker and child;, and because such c h i l d r e n are young enough to be representative: of. the problems unique to d i s t u r b e d c h i l d r e n . This sample of techniques was analyzed according to two frameworks: ( l ) the accepted s o c i a l work body ofi knowledge and (2) the psychoanalytic viewpoint as set out by Melanie K l e i n , t h i s l a t t e r approach being u t i l i z e d because i t represents the view that c h i l d r e n can be psychoanalyzed on the same b a s i c p r i n c i p l e s as' a d u l t s . The general psychoanalytic s t r u c t u r e i s ; chosen because of the type of p s y c h i a t r i c s u p e r v i s i o n received by s o c i a l workers r e f e r r e d to above:. On the whole, the workers' responses are c l e a r l y i d e n t i f i a b l e . . Almost a l l of these responses corresponded to the d e s c r i p t i o n of s o c i a l work techniques; only a few (four) corresponded to psychoanalytic techniques. The s o c i a l work body o f knowledge ( i n c l u d i n g the p r i n c i p l e s , values, knowledge of human behavior, the caseworker-client r e l a t i o n ship) was i n the main u t i l i z e d by the workers i n the recordings s e l e c t e d , i n s p i t e of the d i f f e r e n t considerations presented i n working with c h i l d r e n and i n s p i t e of the p s y c h o a n a l y t i c a l l y - o r i e n t e d s u p e r v i s i o n . I t appears that t h i s s u p e r v i s i o n or c o n s u l t a t i o n i s u t i l i z e d to increase the worker's understanding of the c h i l d , r a t h e r than u t i l i z e d to apply  iv  psychoanalytic techniques d i r e c t l y . There i s s t i l l room f o r f u r t h e r study, however, on the nature of p s y c h i a t r i c c o n s u l t a t i o n . From such a small sample, the conclusions reached cannot bee considered a p p l i c a b l e to the c l i n i c as a whole. A l s o , since the techniques analyzed were each a p p l i e d i n one interview out of a s e r i e s of i n t e r v i e w s , the b e n e f i t to the c h i l d of the worker's a c t i v i t i e s i s not part of the assessment of t h i s study. P r e l i m i n a r y a n a l y s i s of t h i s kind however i s e s s e n t i a l before these f u r t h e r s t u d i e s can be properly undertaken.  ACKNOWLEDGEMENTS  I wish t o express; deepest a p p r e c i a t i o n to Miss? M u r i e l C u n l i f f e of the School of S o c i a l Work f o r her h e l p f u l n e s s and guidance i n the w r i t i n g of t h i s t h e s i s , which enhanced ny understanding of s o c i a l work g e n e r a l l y ; to Dr. Leonard Marsh of the School of S o c i a l Work f o r h i s a s s i s t a n c e and s t i m u l a t i n g c r i t i c i s m i n the composition of t h i s t h e s i s ; and to my wife J u l i e , and our two c h i l d r e n , D a r r e l l and P e r r i , whose patience and understanding provided continuous support and encouragement toward the completion of t h i s t h e s i s . Further acknowledgement i s made to the s o c i a l work s t a f f of C h i l d r e n ' s C l i n i c f o r t h e i r co-operation and support i n the w r i t i n g of t h i s t h e s i s .  ii TABLE: GF.; CONTENTS::;  Chapter 1.  Casework and Psychoanalysis i n Treatment f o r the Disturbed C h i l d .  Treatment f o r the d i s t u r b e d c h i l d : current knowledge, and" procedures i n use. Casework and psychoanalysis: d e f i n i t i o n s and i n t e r c o n n e c t i o n s . Casework and i t s a p p l i c a t i o n to c h i l d r e n (a) s o c i a l work values; (b) s o c i a l work p r i n c i p l e s ; (c) knowledge of human growth and behavior; (d) caseworker-client r e l a t i o n s h i p ; (e) casework techniques. S e t t i n g of the study. Proposed study and methodology » » Chapter 2 .  S o c i a l Work Interviews: an Examination  29  of Content.  The workers' responses analyzed. Techniques found i n sample case recordings* E x p l o r a t i o n , r e l a t i n g to a f f e c t ; acceptance; a f f i r m a t i o n ; explanation; reassurance:; p a r t i l i B a t i o n . M o d i f i c a t i o n o f environment; guidance; education; a c c r e d i t a t i o n ; , universalization. Setting r e a l i s t i c limits; c l a r i f i c a t i o n ; i n t e r p r e t a t i o n . I l l u s t r a t i o n s of technique a p p l i c a t i o n s . . . Chapter 4 .  Ii  Psychoanalytic Treatment, the Melanie K l e i n A p p l i c a t i o n s to C h i l d r e n .  Main elements of psychoanalysis. Free a s s o c i a t i o n ; r e s i s t a n c e ; transference; i n t e r p r e t a t i o n of dreams. K l e i n ' s adaptation to c h i l d r e n . E a r l y a n a l y s i s ; a n a l y s i s of c h i l d r e n i n latency; i n t e r p r e t a t i o n of p l a y . . Chapter 3*  p  46  C l a r i f y i n g the S o c i a l Work Interview with C h i l d r e n ,  Casework techniques mainly r e l i e d oh: the evidence of the sample. D i f f e r e n c e s from p s y c h o a n a l y s i s : i n t e r p r e t a t i o n of unconscious m a t e r i a l r a r e l y used. L i m i t a t i o n s recpnsidered. I m p l i c a t i o n s f o r f u r t h e r study{benefits of treatment; use of taperecordings; e f f e c t s pf p s y c h i a t r i c c o n s u l t a t i o n . . . . . . . . . . .  58i  Appendices. A. B. C. D. E. . F, G. H. I. Tables 1,  Excerpts from tape-recorded i n t e r v i e w with A r t Recorded i n t e r v i e w with Bob Recorded i n t e r v i e w with Cal Recorded i n t e r v i e w with Diane Recorded i n t e r v i e w with Ed. Recorded i n t e r v i e w with Fred Recorded i n t e r v i e w with Glen Recorded i n t e r v i e w with Helen*.... Bibliography  65 68 770 72 73 74 .76 78 79  Techniques  47/  i d e n t i f i e d i n the recorded i n t e r v i e w s . . . . . . .  CHAPTER I CASEWORK AND PSYCHOANALYSIS IN TREATMENT FOR THE DISTURBED CHILD Work i n a C h i l d Guidane C l i n i c r a i s e s a number of " t h e o r e t i c a l " i s s u e s v h i c h are very important i n p r a c t i c e s 1. I s s o c i a l work with c h i l d r e n d i f f e r e n t from s o c i a l work with a d u l t s ( o r perhaps are there considerations of importance because both are i n v o l v e d ? ) . 2. Are there d i f f e r e n c e s between the c o n t r i b u t i o n s of p s y c h i a t r y and  s o c i a l work, o r at l e a s t d i f f e r e n c e s of d o c t r i n e o r theory  which may be p a r t i c u l a r l y important f o r the s o c i a l worker? I t i s because of t h i s p o s s i b l e confusion that the present undertaken.  study i s  An attempt w i l l i be made to determine whether there are  i n d i c a t i o n s that the s o c i a l workers a t the Children's C l i n i c i n Burnaby. g e n e r a l l y apply s o c i a l work techniques i n d i r e c t casework (the one-to-one r e l a t i o n s h i p , o f t e n c a l l e d " d i r e c t treatment" *^with c h i l d r e n , o r whether p s y c h o a n a l y t i c a l l y - o r i e n t e d p s y c h i a t r i c techniques are a p p l i e d , o r whether both are used, and i f so, t o what extent.  To get some i n d i c a t i o n o f which:  of these a l t e r n a t i v e s i s prevalent, the s o c i a l workers' a c t i v i t i e s with c h i l d r e n i n treatment w i l l be viewed according  to two t h e o r e t i c a l  frameworks; the g e n e r a l l y understood theory o f s o c i a l work treatment as i t i s a p p l i e d to the c h i l d , and one v e r s i o n of psychoanalytic c h i l d r e n , tfeat s e t out by Melanie K l e i n . as the frames of reference  treatment, o f  The reasons f o r s e l e c t i n g these  are as f o l l o w s :  1. S o c i a l workers receive t r a i n i n g i n the s o c i a l work values, p r i n c i p l e s , and techniques,  and i n t h e i r a p p l i a a t i o n i n a  one-to-one r e l a t i o n s h i p with a d u l t s .  I s t h i s body of.  knowledge a p p l i e d d i r e c t l y to c h i l d r e n a t Children's  Clinic?  Hamilton, Gordon, Psychotherapy i n C h i l d Guidance,Columbia U n i v e r s i t y Press, New York, 1947, p. 123.  - 2 2. Because the s o c i a l worker i n t h i s c l i n i c i s under p s y c h i a t r i c d i r e c t i o n , and r e c e i v e s r e g u l a r p s y c h o a n a l y t i c a l l y - o r i e n t e d c o n s u l t a t i o n , t h i s question a r i s e s : to what extent, i f any, does the worker make a p p l i c a t i o n o f s p e c i f i c techniques from the knowledge gained through t h i s c o n s u l t a t i o n ? K l e i n has ( 11 a p p l i e d psychoanalytic techniques directl/to c h i l d r e n , therefore i t would appear appropriate to use her system as one frame of r e f e r e n c e .  This view represents,as w i l l be seen,  an a p p l i c a t i o n of treatment techniques q u i t e d i s t i n c t from the a p p l i c a t i o n of s o c i a l work techniques. But, one may ask, why should s o c i a l workers apply d i f f e r e n t  techniques  when working w i t h c h i l d r e n , from those used when working with adults? I n the f i r s t place|f c h i l d r e n cannot d i s c u s s t h e i r problems v e r b a l l y i n the way that a d u l t s can.  Dorothy Baruch says, " . . . c h i l d r e n o f t e n use t h e i r  muscles i n place of t h e i r mouths. and arms and bodies*  They a c t out t h e i r problems with hands  They r e l e a s e the poison through what they do as well.  as through what they say.  C h i l d r e n o f t e n FLAY OUT t h e i r f e e l i n g s i n s t e a d  2 ofTALKING OUT how they f e e l . "  The s o c i a l worker's response to the c h i l d ,  a c c o r d i n g l y , i s r e l a t e d to the c h i l d ' s play a c t i v i t y , as w e l l as h i s v e r b a l a c t i v i t y . Therefore, the c h i l d i s provided with p l a y m a t e r i a l s during the casework i n t e r v i e w . Gordon Hamilton has pointed out another important d i f f e r e n c e between casework with a d u l t s and w i t h i c h i l d r e n . She says, i n regard to the parents  K l e i n , Melanie, i n her book, The Psycho-Analysis of C h i l d r e n . The Hogarth Press L t d . London, 1950, says, " I t was by applying h i s (Freud's) f i n d i n g s t h a t I gained access to the minds of small c h i l d r e n and could analyze and cure them", (p.7)* Baruch, Dorothy W» New Ways i n D i s c i p l i n e * McGraw H i l l Book Co* New York, 1949, p. 41.  - 3 of c h i l d r e n r e f e r r e d to a C h i l d Guidance C l i n i c ,  1  "The  c l i e n t (that i s ,  the c h i l d ' s parent)*..may come to f e e l , under treatment,  his self-  involvement as a person, w i t h i n n e r d i f f u s e d d i f f i c u l t i e s . case worker may  c a r r y on a p p r o p r i a t e therapy, or may  deeply d i s t u r b e d a d u l t s t o a psychoanalyst.  I f so, the  r e f e r the more  For the c h i l d , the l i n e i s  l e s s easy to draw, more of the unconscious u s u a l l y being brought i n t o the t h e r a p e u t i c process...  • I n d i r e c t therapy ( t h a t i s , d i r e c t casework  w i t h c h i l d r e n ) are used, i n v a r i o u s combinations, h e l p i n : (a) expressing unconscious d r i v e s ; (b) m i n i m i z i n g the e f f e c t of the r e p r e s s i v e super-ego o r b u i l d i n g a super-ego (depending upon whether the problem i s more one  of  a n x i e t y o r a c t i n g o u t ) ; (c) adapting t o the concepts of r e a l i t y , both as 2 represented  by the person of the t h e r a p i s t and the outer  world."  Hamilton's view t h a t the c h i l d ' s unconscious i s brought i n t o the casework process i s supported by F r a i b e r g , who  i n d i c a t e s that i t i s impossible i n  a c h i l d to separate the r e a l problem from the i n n e r c o n f l i c t because the i n n e r c o n f l i c t has not been repressed to the extengp t h a t i t has i n the 3 a d u l t . F r a i b e r g i m p l i e s t h a t the caseworker focuses on r e a l problems, 41  and f e e l i n g s around them, w i t h the a d u l t , r a t h e r than d i r e c t l y on unconscious c o n f l i c t s ; i n the c h i l d the i n n e r c o n f l i c t i s a " r e a l " 5 • problem t h a t must be d e a l t w i t h . C h i l d Guidance C l i n i c i s the term u s u a l l y used i n North America to r e f e r to treatment of e m o t i o n a l l y d i s t u r b e d c h i l d r e n by a c l i n i c under p s y c h i a t r i c d i r e c t i o n , p s y c h o l o g i c a l d i r e c t i o n , o r a d i r e c t o r from some other d i s c i p l i n e . U s u a l l y , though, the d i r e c t o r i s a p s y c h i a t r i s t . The name C h i l d r e n ' s C l i n i c , as i s used i n B.C. i n d i c a t e s t h a t i t i s a p s y c h i a t r i c o u t p a t i e n t c l i n i c f o r c h i l d r e n . That i s , the d i r e c t o r , who i s a p s y c h i a t r i s t , has u l t i m a t e treatment r e s p o n s i b i l i t y . The name was changed i n B.C. from C h i l d Guidance C l i n i c to C h i l d r e n ' s C l i n i c to i n d i c a t e d e f i n i t e l y t h a t t h i s i s an o u t p a t i e n t c l i n i c f o r c h i l d r e n under p s y c h i a t r i c d i r e c t i o n . ( T h i s i n f o r m a t i o n was obtained by the w r i t e r i n a a v e r b a l communication w i t h Dr. Frank McNair, D i r e c t o r of the MentaJ. H e a l t h Centre of Burnaby, p a r t of which i s C h i l d r e n ' s C l i n i c ) * Unless otherwise i n d i c a t e d , the term C h i l d Guidance C l i n i c r e f e r s to an outp a t i e n t c l i n i c f o r c h i l d r e n under p s y c h i a t r i c d i r e c t i o n . g Hamilton, o p . c i t . p. 125-5* F r a i b e r g , Selma, " P r o f e s s i o n a l R e s p o n s i b i l i t y i n Casework Treatment of C h i l d r e n " , i n D i r e c t Casework w i t h C h i l d r e n . Family S e r v i c e A s s o c i a t i o n of America, New York, 1957, p. 2$-21u ibid.p.16. i b i d . p . 21  4  5  - 4 F a r t h e r , i n regard to the c h i l d i n treatment, Hamilton s t a t e s , "In therapy tha stages of c o n s t r u c t i v e i d e n t i f i c a t i o n have s t i l l to be reached by the c l i e n t and are now transference  achieved  i n the experience i t s e l f *  The;  permits the c h i l d "to r e g r e s s " to the e a r l i e r l e v e l s of  developement (that i s , as soon as he i s accepted he goes back to the where he had  s a t i s f a c t i o n b e f o r e ) , and  so to make a f r e s h s t a r t on  level  the  problem of c o n s t r u c t i v e i d e n t i f i c a t i o n with the t h e r a p i s t . " * The e f f e c t of acceptance by the worker on the a d u l t , i s explained  by Perlman thus*  "so, i n the casework r e l a t i o n s h i p , a constant medium i s provided accepting, n u r t u r i n g , and problem-solving  supporting  that i s  at the same time that the stimulus  of  work i s i n j e c t e d to promote the c l i e n t ' s e f f o r t to f e e l ,  2 to be, or to act i n the ways leading to h i s b e t t e r s o c i a l adjustment." The worker's acceptance of the c h i l d causes the c h i l d to regress at the beginning, while i n the a d u l t i t i s supportive  i n i t i a l l y and  creates  stimulus f o r the adult to work on h i s problems. Anna Freud has pointed  out that because the worker i s seen by  c h i l d so o f t e n , he becomes a parent surrogate  the  f a r more q u i c k l y than he i s  3 l i k e l y to when working with an a d u l t . "Since the c h i l d ' s ego  Hamilton adds to t h i s by  saying,  i s immature and incomplete the t h e r a p i s t i s  c l o s e r to a " r e a l " parent i n the c h i l d ' s mind. . . . c e r t a i n l y there i s £ q u a l i t y of " r e a l " support o f f e r e d by the t h e r a p i s t and a corresponding q u a l i t y of " r e a l attachment and dependency n a t u r a l to such an age, w i t h the transference  phenomena.  along  For the most p a r t , the worker plays  p a r t of the parent of the same sex, because the c h i l d had and knows the adult world c h i e f l y as "mommie" and  concrete  the  ideas  "daddy" f i g u r e s .  c h i l d e a s i l y c a r r i e s over to any a d u l t person h i s p a t t e r n toward h i s  The parents."  Hamilton, op. c i t . p. 129-130. Perlman, Helen H a r r i s , S o c i a l Casework, U n i v e r s i t y of Chicago Press, Chicago, 1957, p. 68. Freud, Anna, The P s y c h o a n a l y t i c a l  Treatment of C h i l d r e n .  Imago P u b l i s h i n g Co. London, England, 1946, Hamilton, op. c i t . p. 181*  p. 4 f f .  - 5 Again, the r o l e of the c h i l d i n treatment i s somewhat d i f f e r e n t from t h a t of the a d u l t i n t h a t the c h i l d has not chosen to r e c e i v e casework t r e a t m e n t — h i s parent o r parents were the ones who f o r treatment.  While the c h i l d may  i t upon h i m s e l f to i n i t i a t e  brought him  want to come, i t i s not he who  takes  treatment*  F u r t h e r , the c h i l d i s not an independent being expected to be capable of governing h i s own " • • • i t may  b e h a v i o r , as i s the a d u l t *  Ackerman says,  seem s e l f - e v e i d e n t t h a t the c h i l d i s almost t o t a l l y dependent  on h i s environment, a t l e a s t t o a g r e a t e r e x t e n t than the a d u l t . " Ackerman continues  » " The a d u l t i s conceived as being r e s p o n s i b l e f o r  h i s b e h a v i o r ; the c h i l d i s n o t .  The a d u l t c o n s t r a i n s h i s impulses;  c h i l d c h a r a c t e r i s t i c a l l y a c t s out.  the  The a d u l t a c q u i r e s some i n s i g h t i n t o  the s o c i a l and p e r s o n a l i m p l i c a t i o n s of h i s emotional  i l l n e s s ; the  o r d i n a r i l y has l i t t l e such i n s i g h t o r perhaps none a t a l l * . . The  child  adult  h o l d s some power t o c o n t r o l h i s environment and w i t h i n l i m i t s to change i t ; he can take h i m s e l f v o l u n t a r i l y out of one s i t u a t i o n and p l a c e h i m s e l f i n 2 another;  the c h i l d cannot."  Ackerman has p o i n t e d out i n t h i s passage  r e a l i s t i c c o n s i d e r a t i o n s which may casework s i t u a t i o n w i t h the  e f f e c t the worker's a c t i v i t i e s i n the  child*  Another problem p r e s e n t s i t s e l f i n working w i t h c h i l d r e n , namely the c h i l d ' s l a c k of c o n s i s t e n c y i n symptom f o r m a t i o n and p a t t e r n of  responses.  Ackerman e x p l a i n s , "Because the p e r s o n a l i t y o r g a n i z a t i o n of the c h i l d i s c o n t i n o u s l y changing, the dominant behavior r e a c t i o n s are prone t o s h i f t w i t h the i n t e g r a t i v e p a t t e r n s of p e r s o n a l i t y and the q u a l i t y of the c h i l d ' s i n t e r a c t i o n w i t h the environment a t a g i v e n  time.  " . . . I t i s o n l y as the p e r s o n a l i t y o r g a n i z a t i o n of the c h i l d congeals and s t a b i l i z e s toward i t s a d u l t form t h a t one gets a c r y s t a l l i z a t i o n of 3 s p e c i f i c p a t t e r n s and a corresponding  c o n s i s t e n c y i n symptom, e x p r e s s i o n . "  Ackerman, Nathan Wy The Psyehodynamics of Family L i f e , B a s i c Books, I n c . New York, 195&, p. 196. i b i d . p. 196-7. i b i d . p. 197-8.  To sum up, the s o c i a l worker must be aware of the f o l l o w i n g d i f f e r e n c e s (from a d u l t s ) , i f he i s i n a s o c i a l casework s i t u a t i o n w i t h a child. 1. The c h i l d expresses h i m s e l f through p l a y as w e l l as through verbal a c t i v i t y . 2. The l i n e between the c h i l d ' s  conscious and unconscious i s  l e s s easy to d r a w — h i s unconscious unavoidably i s brought i n t o the casework p r o c e s s . 3. The c h i l d i s s t i l l going through the process of with significant  identifying  a d u l t s i n h i s environment.  4* The a c c e p t i n g a t t i t u d e of the worker g e n e r a l l y w i l l c r e a t e a s t r o n g e r tendency t o r e g r e s s i o n i n the c h i l d t o an e a r l i e r mode of  satisfaction.  5. The worker becomes a parent surrogate more q u i c k l y w i t h the child. 6. The worker i s c l o s e r t o a " r e a l " parent t o the c h i l d * 7* The c h i l d u s u a l l y hasn't chosen to r e c e i v e t r e a t m e n t — h i s parentB approach the c l i n i c f o r h e l p w i t h the c h i l d * 8* The c h i l d i s more dependent upon h i s environment than i s the adult. 9* The a d u l t i s expected t o assume more r e s p o n s i b i l i t y  for his  b e h a v i o r than i s the c h i l d * 10. The c h i l d does not present a c o n s i s t e n t p a t t e r n of b e h a v i o r or sympton e x p r e s s i o n . The s o c i a l worker's a c t i v i t i e s w i t h the c h i l d must be a p p l i e d w i t h an awareness of these d i f f e r e n c e s . copy of an a d u l t .  The c h i l d i s not j u s t a m i n i a t u r e  I t i s not a simple matter of understanding s o c i a l  casework w i t h a d u l t s and of a p p l y i n g t h i s understanding t o c h i l d r e n *  - 7 T h i s i s not to say t h a t s o c i a l work techniques cannot be used i n working w i t h the c h i l d .  I t i s t o say t h a t the use o f the t e c h n i q u e s  must be m o d i f i e d a c c o r d i n g l y because of the d i f f e r e n c e s t h a t a r i s e when working w i t h c h i l d r e n i n g e n e r a l * I t i s upon these c o n d i t i o n s t h a t the f o l l o w i n g d i s c u s s i o n on s o c i a l casework t e c h n i q u e s i s based*  As mentioned p r e v i o u s l y , a c t i v i t i e s o f the  s o c i a l workers i n d i r e c t s e r v i c e w i t h c h i l d r e n a t the C h i l d r e n ' s C l i n i c w i l l be viewed from two frameworks: the a p p l i c a t i o n of s o c i a l work t e c h n i q u e s , and t h e a p p l i c a t i o n of K l e i n i a n t e c h n i q u e s * The f o l l o w i n g l i s t of s o c i a l work t e c h n i q u e s c o n s t i t u t e s the f i r s t The Techniques o f S o c i a l  framework*  Casework.  Technique has been d e s c r i b e d as an "instrument o r t o o l used as a p a r t 2 of a method".  The Community S e r v i c e S o c i e t y of New York has suggested  t h a t there are two subfilethods c u r r e n t l y used i n s o c i a l casework, which they d e s i g n a t e as The S u p p o r t i v e Treatment Method, and The M o d i f y i n g g Treatment Method* Budd C. Mackenzie, i£ h i s study, The P l a y I n t e r v i e w as a S o c i a l Work Technique i n a C h i l d Guidance S e t t i n g . (Master of S o c i a l Work T h e s i s , U n i v e r s i t y o f B. . 1956), demonstrated t h a t s o c i a l casework w i t h c h i l d r e n i s a v a l i d area of s o c i a l work p r a c t i c e w i t h i n the competency of the p r o f e s s i o n a l l y t r a i n e d s o c i a l worker. The present study a l s o presupposes t h i s * MacKenzie's approach i s s i m i l a r t o the one used i n the p r e s e n t study, w i t h these d i f f e r e n c e s : 1. The t e c h n i q u e s used t o form the b a s i s o f r e f e r e n c e i n t h i s study are d i f f e r e n t from those used i n MacKenzie's study*.: 2. P s y c h o a n a l y t i c techniques form a second frame o f r e f e r e n c e i n the p r e s e n t study, w h i l e MacKenzie focused s o l e l y on s o c i a l work t e c h n i q u e s . MacKensie's use of the term " p l a y i n t e r v i e w " i s synonomous w i t h the term " s o c i a l casework w i t h c h i l d r e n " as used i n the p r e s e n t study. u  2. ^'Working D e f i n i t i o n o f S o c i a l Work P r a c t i c e " , by the Sub-committee on the Working D e f i n i t i o n of S o c i a l Work P r a c t i c e f o r the Commission on S o c i a l Work P r a c t i c e , i n S o c i a l Work, A p r i l , 1958, B.6. 3^ Community S e r v i c e S o c i e t y of New York, Method and P r o c e s s i n S o c i a l Casework* F a m i l y S e r v i c e A s s o c i a t i o n of America, New York,1958,p. 15*  - 8 The s u p p o r t i v e treatment method " r e q u i r e s the use of a c o n s t e l l a t i o n of techniques t h a t h e l p the c l i e n t t o improve h i s f u n c t i o n i n g w i t h i n t h e framework o f h i s e s t a b l i s h e d ego mechanisms of defense.  The outward  form of the c l i e n t ' s b e h a v i o r i s m o d i f i e d , although by i n t e n t h i s i n t e r n a l processes are n o t m o d i f i e d .  Some i n t e r n a l changes may occur as  a contingent g a i n . " * The m o d i f y i n g treatment method " r e q u i r e s t h e use of a c o n s t e l l a t i o n of techniques t h a t h e l p t h e c l i e n t improve h i s f u n c t i o n i n g through m o d i f i c a t i o n of s e l e c t e d ego mechanisms o f defense.  The outward form o f  the c l i e n t ' s behavior and s e l e c t e d i n t e r n a l processes are m o d i f i e d . 2'  By i n t e n t unconscious  c o n f l i c t s are hot r e s o l v e d . "  R e c e n t l y a c l a s s i f i c a t i o n o f s u p p o r t i v e techniques ( d e s c r i b e d by S y l b i a A s t r o e t a l i n a monograph  ' ) were f o r m u l a t e d , p a r t i c u l a r l y  i n regard t o t h e i r a p p l i c a t i o n i n casework w i t h a d u l t s .  This c l a s s -  i f i c a t i o n w i l l be u t i l i z e d here t o h e l p examine m o d i f i c a t i o n s as t o t h e i r a p p l i c a t i o n w i t h c h i l d r e n , as d i s s t i n c t from a d u l t s . 1» E x p l o r a t i o n T h i s technique i s a p u r p o s e f u l q u e s t i o n i n g t h a t o f t e n b r i n g s about changes i n t h e c h i l d ' s f e e l i n g s as a r e s u l t of  the c h i l d ' s  r e a l i z a t i o n t h a t the worker i s i n t e r e s t e d i n him. The c h i l d f e e l s supported when the worker takes the time and makes t h e e f f o r t t o know and understand  him and h i s problem.  E x p l o r a t i o n may occur w i t h the  c h i l d by t h e worker a s k i n g him about h i s p l a y a c t i v i t y , as w e l l as h i s verbal a c t i v i t i e s . 2. R e l a t i n g t o A f f e c t This technique i s the n o t i n g aloud the presence of a f f e c t , the nature and r a m i f i c a t i o n s o f which are not c l e a r . step toward understanding  This i s a necessary  the f e e l i n g , which i n t u r n i s a necessary  step  i b i d . p. 15. i b i d . p. 15. A s t r o , S y l v i a e t a l , (The Committee on Content, The School o f S o c i a l S e r v i c e A d m i n i s t r a t i o n , the U n i v e r s i t y o f Chicago). Guide t o t h e Content of Second-Year F i e l d Teaching i n Casework, The U n i v e r s i t y of Chicago P r e s s , Chicago, 1961, p. 19-22.  - 9 toward understanding  the c l i e n t ' s b e h a v i o r .  Naming a s p e c i f i c f e e l i n g  and a c c e p t i n g t h a t f e e l i n g " i s a p p r o p r i a t e ( l ) i f the worker understands the f e e l i n g and (2) i f i t i s t h e r a p e u t i c a l l y i n d i c a t e d t h a t the c l i e n t become a c c e p t i n g of the f e e l i n g i n h i m s e l f or become i n v o l v e d i n the process of understanding  the e f f e c t s of the f e e l i n g on h i s present  functioning." * , When a c h i l d expresses w i t h him i n the same way  f e e l i n g s v e r b a l l y , t h i s technique  i s used  as w i t h the a d u l t , but the worker must be aware  of any f e e l i n g s expressed  through p l a y .  P l a y may  be the o n l y means  through which the c h i l d i s able t o express c e r t a i n f e e l i n g s , and  the  worker must be aware of t h i s and r e l a t e to i t , i f i t i s t h e r a p e u t i c a l l y c o r r e c t — t h a t i s , i f the worker f e e l s t h a t b r i n g i n g these f e e l i n g s out i n the open w i l l be of b e n e f i t t o the c h i l d . 3. Acceptance This technique  i s an " e x p r e s s i o n of an a t t i t u d e of r e c e p t i v i t y .  Its  purpose i s t o enable the c l i e n t to be s u f f i c i e n t l y comfortable w i t h the worker so t h a t he can begin t o face h i m s e l f , h i s problem and h i s s i t u a t i o n , and the f e e l i n g s and a t t i t u d e s he has about these t h i n g s , more realistically.  Acceptance by the worker i s a means by which the c l i e n t  i s helped t o share i n f o r m a t i o n about h i m s e l f which he f e a r s w i l l  result  i n r e j e c t i o n o r which he so thoroughly r e j e c t s i n h i m s e l f t h a t he t r i e s 2 to  conceal i t from h i m s e l f by a v a r i e t y of d e f e n s i v e measures." The worker expresses  also.  t h i s a t t i t u d e of r e c e p t i v i t y w i t h the c h i l d  This a t t i t u d e toward the d i s t u r b e d c h i l d i s u s u a l l y a d i f f e r e n t  experience from t h a t which he has been accustomed t o from h i s p a r e n t s . Gordon Hamilton s t a t e s , " O r d i n a r i l y parents g i v e t h e i r c h i l d r e n an acceptance f a r g r e a t e r than w i l l be g i v e n them i n the o u t s i d e w o r l d . They love and admire t h e i r c h i l d r e n , who a f f e c t i o n , and s u s t a i n i n g a p p r o v a l — i n g o o d  t h r i v e i n t h i s c u l t u r e of p r a i s e , times and bad.  Problem c h i l d r e n  have almost always been deprived of t h i s experience, p a r t i a l l y o r i b i d . p.  20.  i b i d . p.  20  - 10 completely*  The c h i l d ' s experience v i t h the t h e r a p i s t , t h e r e f o r e , may  be h i s f i r s t exposure to the d o r t of deep acceptance t h a t he has lacked hitherto."  h  4. A f f i r m a t i o n This technique i s the g i v i n g of open c o n f i r m a t i o n to the c h i l d ' s v a l i d a p p r a i s a l of h i s own behavior o r f e e l i n g s , o r to h i s r e a l i s t i c a p p r a i s a l of o b s e r v a t i o n s of the behavior and a t t i t u d e s of o t h e r s . However, because of the c h i l d ' s general l a c k of i n s i g h t i n t o the s o c i a l s i g n i f i c a n c e of h i s problems, he can't be expected t o make t h i s v a l i d appraisal often. 5. E x p l a n a t i o n This technique i s the g i v i n g of i n f o r m a t i o n and e x p l a n a t i o n of what i s going on and why.  The use of t h i s technique  " w i l l tend t o reduce 2  uncomfortable f e e l i n g s r e l a t e d to the s p e c i f i c experience". e x p l a n a t i o n w i t h the c h i l d may parents a c t i n c e r t a i n ways*  The use  of  i n v o l v e , f o r example, e x p l a i n i n g why I n u s i n g t h i s technique w i t h a o h i l d , the  worker w i l l have to be c a r e f u l t h a t he i s speaking i n a language the c h i l d can understand* 6. Reassurance This technique as d e s c r i b e d by S y l v i a A s t r o a t a l has two applications.  different  The f i r s t i s a d i r e c t . s t a t e m e n t which i n d i c a t e s t h a t the 'i  client's  f e e l i n g or behavior i s understandable  or permissable; and  the  o t h e r i s an i n d i c a t i o n of the worker's c o n v i c t i o n t h a t s o l u t i o n of the d i f f i c u l t y i s probable.  The l a t t e r a p p l i c a t i o n should be used c a r e f u l l y  w i t h the c h i l d because of the importance of being honest w i t h him.  This;  i s p a r t i c u l a r l y t r u e w i t h the a c t i n g out c h i l d because, as Hamilton p o i n t s 3' out, "The  c h i l d who  a c t s out has no t r u s t a t a l l . . "  The worker  who  reassures the c h i l d t h a t the s o l u t i o n of h i s d i f f i c u l t y i s probable  ,  without f o u n d a t i o n f o r t h i s statement, i s c o n f i r m i n g the c h i l d ' s l a c k of Hamilton, trust. op* c i t . p.  125.  A t r o , S y l v i a , e t a l . op. c i t . p.20 Hamilton, op. c i t . p.  151.  - 11 7. P a r t i a l i z a t i o n This technique i n v o l v e s the s e p a r a t i n g out and d e a l i n g w i t h one problem a t a time when the c l i e n t presents  a m u l t i p l i c i t y of problems  o r a confused c o n f i g u r a t i o n of t h i n k i n g and f e e l i n g *  With the c h i l d ,  i t may i n v o l v e h e l p i n g him t o f o c u s on c e r t a i n p l a y m a t e r i a l s when h i s p l a y a c t i v i t y i s s c a t t e r e d and apparently meaningless.  Or i t may i n v o l v e  a s k i n g the c h i l d t o r e l a t e s p e c i f i c d i f f i c u l t i e s he has a t s c h o o l , w i t h a parent, o r w i t h a s i b l i n g * 8* M o d i f i c a t i o n of Environment T h i s technique i n v o l v e s b r i n g i n g about environmental change "through p r o v i d i n g concrete  s e r v i c e s . * . } working i n an educative  o r psycho-  t h e r a p e u t i c c a p a c i t y w i t h the c l i e n t t o enable him t o use i n f o r m a t i o n , a d v i c e , o r d i r e c t i o n t o achieve e f f e c t i v e use o f s o c i a l resources; working i n an educative  and/or  environment t o b r i n g about c o n s t r u c t i v e change  i n t h e i r r o l e ( r o l e s ) i n creating or maintaining  the s t r e s s . "  1  Because the focus o f the present study i s on the s p e c i f i c one-to-one r e l a t i o n s h i p w i t h the c h i l d , mainly f o r the purposes o f " p s y c h o l o g i c a l " h e l p , one would n o t expect the use o f t h i s technique t o be prominent* The worker, speaking t o the c h i l d ' s parent f o r a s p e c i f i c purpose r e g a r d i n g the c h i l d , i s attempting  t o modify the c h i l d ' s environment,  but t h i s a c t i v i t y does n o t occur w i t h i n the casework s i t u a t i o n as such. For example, d u r i n g an i n t e r v i e w w i t h a c h i l d , the worker n o t i c e s t h a t the c h i l d i s i l l *  At the end of the i n t e r v i e w , he t a l k s t o the c h i l d ' s  parent, recommending t h a t the c h i l d be taken t o a d o c t o r .  This a c t i v i t y  c o n s t i t u t e s ah a p p l i c a t i o n of the technique of environmental m o d i f i c a t i o n . 9. Guidance This technique i n v o l v e s g i v i n g suggestions,  advice OB a u t h o r i t a t i v e  d i r e c t i o n t o the c l i e n t i n h i s management o f a s p e c i f i c f e e l i n g o r situation.  Because the c h i l d ' s ego i s s t i l l i n the process o f growth  and because he i s n o t expected t o assume r e s p o n s i b i l i t y f o r h i s behavior to the extent o f the a d u l t , t h i s technique,  A s t r o , S y l v i a e t a l . op. c i t . p.21.  i f a p p l i e d p r o p e r l y by the  - 12 worker, w i l l be s u p p o r t i v e t o the c h i l d , 10* E d u c a t i o n T h i s technique " i n v o l v e s the g i v i n g o f new knowledge, w i t h s u f f i c i e n t e l a b o r a t i o n o f u n d e r l y i n g premises and g e n e r a l a p p l i c a b i l i t y so t h a t the c l i e n t can u t i l i z e  t h i s knowledge i n a v a r i e t y of s i t u a t i o n s , as w e l l as  i n r e l a t i o n t o the s p e c i f i c s i t u a t i o n which caused the g i v i n g of knowledge." * n  One might expect the c h i l d t o ask more q u e s t i o n s o f the worker because the c h i l d g e n e r a l l y i s more c u r i o u s than an a d u l t *  Many o f these  q u e s t i o n s w i l l be answered by the worker i n a way t h a t may be educative for  the c h i l d . 11. A c c r e d i t a t i o n The a p p l i c a t i o n o f i h i s technique i s t o note openly w i t h the c l i e n t  and g i v e him c r e d i t f o r s t r e n g t h s which he has o r i s d e v e l o p i n g and f o r evidences o f improved f u n c t i o n i n g and more r e a l i s t i c  thinking.  When  working w i t h the c h i l d , a g a i n i t i s p a r t i c u l a r l y important t h a t the use of t h i s technique i s honest.  G i v i n g the c h i l d c r e d i t f o r s t r e n g t h s he  does n o t have w i l l confuse the c h i l d , and w i l l l e a d t o d i s t r u s t of the worker. 12. U n i v e r e a l i z a t i o n The use o f t h i s technique i s t o p o i n t out t o the c l i e n t t h a t most people would have s i m i l a r r e a c t i o n s under comparable circumstances* I t I t a l l e v i a t e s the c h i l d ' s uncomfortable f e e l i n g s based on a f a l s e b e l i e f t h a t he i s d i f f e r e n t from o t h e r people.  The a p p r o p r i a t e use o f  t h i s technique would be p a r t i c u l a r l y important t o the c h i l d because he i s s t i l l i n the process o f i d e n t i f i c a t i o n w i t h s i g n i f i c a n t f i g u r e s .  The  thought t h a t he i s d i f f e r e n t from o t h e r c h i l d r e n (when he f e e l s he shouldn't be) would confuse t h i s i d e n t i f i c a t i o n p r o c e s s . 13*  Summarization  The a p p l i c a t i o n o f t h i s technique i s t o add up f o r the c l i e n t i n a p u r p o s e f u l and concise way, the f a c t o r s and f e e l i n g s he has presented i n a given s i t u a t i o n .  I t i s used o n l y a f t e r the worker has been p r o v i d e d  w i t h the necessary m a t e r i a l from the c l i e n t t o combine these f a c t o r s  ibid.p.22.  - 13 m e a n i n g f u l l y . Because of the complexity of t h i s technique,, the c h i l d f i n d i t d i f f i c u l t to understand when i t i s a p p l i e d .  may  The worker t h e r e f o r e  must be c a r e f u l t h a t he i s a p p l y i n g t h i s technique a t a l e v e l which the c h i l d can understand. The Community S e r v i c e S o c i e t y of New techniques c o n t r i b u t i n g t o support, to  here.  York has o u t l i n e d a l i s t of  which i s s i m i l a r to the one  referred  However, they have i n c l u d e d o n e — S e t t i n g R e a l i s t i c L i m i t s — t h a t  must be added because i t i s a technique t h a t i s not i m p l i c i t anywhere i n the l i s t presented here so f a r . S e t t i n g r e a l i s t i c l i m i t s i s described! as f o l l o w s : "When the c l i e n t ' s c a p a c i t y to r e s t r a i n and p r o h i b i t behavior t h a t i s dangerous t o h i m s e l f and o t h e r s i s s e r i o u s l y i m p a i r e d , the caseworker a f f o r d s the s t r e n g t h of h i s own ego by s e t t i n g l i m i t s ; to the c l i e n t ' s behavior.  I n essence, t h i s technique strengthens the c l i e n t ' s  i n e f f e c t i v e superego s t r u c t u r e .  I t does so by o f f e r i n g a more acceptable  b e h a v i o r and s i m u l t a n e o u s l y a i d i n g the s u p p r e s s i o n of unacceptable 2 impulses and d e s i r e s . " This technique i s p a r t i c u l a r l y important to the c h i l d because the s t r e n g t h t h a t the caseworker a f f o r d s him w i l l be s u p p o r t i v e t o h i s s t i l l d e v e l o p i n g ego.  The c h i l d who  i s allowed to a c t out w i t h o u t any  limits  w i l l l tend t o become more confused about h i s boundaries, which are i n the process- of being understood.  still  This technique w i l l be e s p e c i a l l y  h e l p f u l t o the c h i l d whose main problem i s too much a c t i n g out, provided i t i s a p p l i e d w i t h an a t t i t u d e of acceptance and warmth, such as, " I know, you'd l i k e t o break t h a t window, John, but I can't allow, you to ii  de i t . As mentioned, the above techniques are used i n the s u p p o r t i v e treatment method of s o c i a l casework.  As f o r the m o d i f y i n g treatment  method, the Community S e r v i c e S o c i e t y of New  York says, " C l a r i f i c a t i o n  i s the predominant technique i n the M o d i f y i n g Treatment Method." *  Community S e r v i c e S o c i e t y of New  2  i b i d . p. 17.  3  i b i d . p. 20  York, o p . c i t . p. 16-118.  - 14 They d e s c r i b e c l a r i f i c a t i o n as t h a t technique wich " i s used t o modify behavior and a t t i t u d e s by c o n s i s t e n t l y i n c r e a s i n g the c l i e n t ' s awareness and understanding of the use, meaning, and e f f e c t of d i s a b l i n g p a t t e r n s of response, e v e n t u a l l y i n c l u d i n g the p a t h o l o g i c a l use of a defense mechanism.  Use of c l a r i f i c a t i o n r e q u i r e s s e v e r a l s t e p s , the  f i r s t of which must precede the o t h e r s .  The second, t h i r d and f o u r t h  steps are u s u a l l y interwoven." The f i r s t step i s , "Helping the c l i e n t being t o g e t h e r i n c i d e n t s i n h i s a t t i t u d i n a l responses and episodes i n h i s behavior iin such a way as t o enable him t o see the s t e r e o t y p e d themes or p a t t e r n s they follow•> When the c l i e n t ' s self-awareness i s i n i t s b e g i n n i n g stages o r a t any g i v e n p o i n t i s not s u f f i c i e n t f o r him t o see these p a t t e r n s h i m s e l f , the caseworker takes major r e s p o n s i b i l i t y  f o r p o i n t i n g them out*" T h i s a c t i v i t y  2 on the p a r t of the caseworker i s o f t e n r e f e r r e d to as c o n f r o n t a t i o n . . . " The next s t e p i n c l a r i f i c a t i o n d e s c r i b e d i n t h i s pamphlet i s , "Enabling the c l i e n t to see and understand the conscious: and preconscious d i s s a t i s f a c t i o n s and g r a t i f i c a t i o n s : i n h i s responses t o s e l e c t e d aspects of h i s l i f e ' s  situation..."  The t h i r d s t e p i s , "Encouraging the c l i e n t t o r e c o g n i z e the connection between i n c i d e n t s i n h i s remembered past and h i s c u r r e n t / a t t i t u d e s and b e h a v i o r , and the i n a p p r o p r i a t e i n f l u e n c e of the past on the p r e s e n t . ..... T h i s a c t i v i t y i s c o n s i s t e n t l y repeated, so t h a t i t g r a d u a l l y enables the c l i e n t t o b r i n g under r e a l i s t i c conscious c o n t r o l the i n f l u e n c e of those s u b j e c t i v e experiences t h a t are c a s u a l t o h i s d i s a b l i n g , patterns, o f response..."  4  And the f o u r t h s t e p : "Helping the c l i e n t u t i l i z e hiss acquired; understanding t o a n t i c i p a t e and c o n t r o l d i s a b l i n g responses to h i s c u r r e n t and p r e d i c t a b l e f u t u r e l i f e i b i d . p. 20 2  i b i d . p. 20-21L.  3  i b i d . p. 21.  4  i b i d , p* 21*  5  i b i d . p. 22*  situation."  A g a i n , because of the complexity of t h i s t e c h n i q u e , i t must be a p p l i e d i n a way t h a t a c h i l d can understand*  Because c h i l d r e n u s u a l l y are more  a b l e t o express themselves through p l a y a t the beginning of treatment, the a p p l i c a t i o n of t h i s technique should not occur u n t i l w e l l along i n treatment, because i t i n v o l v e s a g r e a t d e a l of v e r b a l a c t i v i t y by both c h i l d and worker*  (The c h i l d w i l l have had to t e l l the worker a g r e a t  d e a l about h i m s e l f before the worker can attempt t o apply a l l the steps i n t h i s technique)* These are the s o c i a l work ( s p e c i f i c a l l y , s o c i a l casework) techniques from which the i n t e r v i e w r e c o r d i n g s i n Chapter I I I w i l l be analyzed* T h i s l i s t i s not complete i n terms of the schedule to be applied- because the. p s y c h o a n a l y t i c techniques have not y e t been c o n s i d e r e d .  These techniques  w i l l , be d i s c u s s e d i n Chapter I I * . S o c i a l Work Values These techniques t h a t c o n t r i b u t e to the s u p p o r t i v e and modifyiing; casework methods do not occur i n a vacuum.  G i s e l a Eonopka s t a t e s ,  "Method i n s o c i a l work i s by n e c e s s i t y r e l a t e d t o v a l u e s * Since we d e a l w i t h r e l a t i o n s h i p s among human b e i n g s , e t h i c a l v a l u e s permeate the whole f a b r i c of our work." * Konopka' d e s c r i b e s the s o c i a l work v a l u e s ass "The b e l i e f i n the d i g n i t y and worth of each i n d i v i d u a l . The r i g h t of each i n d i v i d u a l t o f u l l developement of h i s c a p a c i t i e s * The r e s p o n s i b i l i t y of each i n d i v i d u a l not t o harm o r misuse o t h e r s . The r e s p o n s i b i l i t y of each i n d i v i d u a l to c o n t r i b u t e ; t o the common o  w e l f a r e — w i t h i n l i m i t s of h i s c a p a c i t i e s . " The s o c i a l worker b e l i e v e s i n the d i g n i t y and worth of the c h i l d as he does of the c h i l d ' s r i g h t t o f u l l , developement of h i s c a p a c i t i e s . I n t h i s r e g a r d , Martha E l i o t says, " I t i s time now., i t seems to me,  that  the s i g h t s of a l l of us were l i f t e d from the l e v e l of h e l p i n g c h i l d r e n through emergencies, 3; developement."  to h e l p i n g a l l c h i l d r e n achieve t h e i r o p t i o n a l  Eonopka,Gisela, "The Generic and the S p e c i f i c i n Group Work P r a c t i c e i n the P s y c h i a t r i c S e t t i n g " , S o c i a l Work. J a n . 1956, p. 72*. i b i d . p. 74. E l i o t , Martha M. " S t r a t e g y f o r C h i l d r e n " , S o c i a l Work. 1956  (Oct.) p.63*  - 16 But,  as mentioned p r e v i o u s l y * the c h i l d i s n o t expected t o assume  r e s p o n s i b i l i t y f o r h i s b e h a v i o r as i s the a d u l t .  The phrase used by  Konopka, " W i t h i n the l i m i t s o f h i s c a p a c i t i e s " , when a p p l i e d t o the c h i l d , i n d i c a t e s t h a t the worker must be aware of the l i m i t a t i o n s on the  the r e s p o n s i b i l i t y the c h i l d i s capable of assuming.. P r i n c i p l e s of S o c i a l Casework Eonopka p o i n t s out t h a t s o c i a l work p r i n c i p l e s grow out o f the s o c i a l  work v a l u e system.  Maas e x p l a i n s t h a t p r i n c i p l e s "guide the caseworker  i n p r a c t i c e , n o t o n l y when the c l i e n t - i n - h i s - s i t u a t i o n i s a t l e a s t p a r t i a l l y understood, but a l s o i n the i n i t i a l i n q u i r i n g phase o f the 2 casework method*" Maas i n c l u d e s the f o l l o w i n g as the g e n e r a l p r i n c i p l e s of s o c i a l casework p r a c t i c e s acceptance, communication, i n d i v i d u a l i z a t i o n , p a r t i c i p a t i o n , c l i e n t s e l f - d e t e r m i n a t i o n , c o n f i d e n t i a l i t y , and caseworker 3 self-awareness. " A c c e p t a n c e " i s a p r i n c i p l e as w e l l as a technique of s o c i a l  casework..  While the a p p l i c a t i o n of acceptance (as a technique) i s the worker's d i r e c t response t o the c h i l d of an a t t i t u d e of. r e c e p t i v i t y , the p r i n c i p l e of  acceptance pervades a l l o f the worker's a c t i v i t y . . I n regard t o the  p r i n c i p l e o f acceptance, Hamilton s a y s , " I n t e r v i e w i n g s k i l l r e s t s on a fundamental p r o f e s s i o n a l a t t i t u d e c a l l e d 'acceptance'. acceptance o f the o t h e r person as he i s —  T h i s means  i n whatever s i t u a t i o n , no  matter how unpleasant o r uncongenial t o the i n t e r v i e w e r , w i t h whatever b e h a v i o r ^ a g g r e s s i v n e s s , h o s t i l i t y , dependency, o r l a c k of frankness he 4 may m a n i f e s t . "  B i e s t e k says, "Acceptance i s based upon the most  fundamental r i g h t of the c l i e n t — t h e r i g h t t o be t r e a t e d as a human being who has the same i n n a t e d i g n i t y , u l t i m a t e d e s t i n y , b a s i c r i g h t s , and needs as any o t h e r human b e i n g . Acceptance i s the acknowledgement by the caseworker, both on the thought and the f e e l i n g l e v e l , expressed! Eonopka, op. c i t . p.77.. Maas,Henry s. " S o c i a l Casework", i n Walter F r i e d l a n d e r ed.., Concepts and Methods of S o c i a l Work* P r e n t i c e - H a l l , New York, 1958, p. 80. i b i d . p. 80-89. Hamilton, Gordon, Theory and P r a c t i c e o f S o c i a l Casework. Columbia U n i v e r s i t y P r e s s , New York, 1951, p> 52»  - 17 p r i m a r i l y i n the manner of s e r v i c e , t h a t the c l i e n t has a r i g h t to be helped w i t h h i s problem o r need r e g a r d l e s s of r a c e , c o l o r , creed, n a t i o n a l o r i g i n , s o c i a l o r economic s t a t u s , or p e r s o n a l i t y pattern."- * J u s t as w i t h the a d u l t , the p r i n c i p l e of acceptance must occur w i t h the c h i l d .  Moustakas says, "Acceptance.•.implies t h a t the t h e r a p i s t  a c t i v e l y accepts the c h i l d ' s f e e l i n g s and h i s p e r s o n a l meanings, h i s 2 perceptions." L a t e r , Moustakas says, " . . . i t i s important f o r t h e . . . g t h e r a p i s t t o be completely a c c e p t i n g ( o f t h e c h i l d ) a t a l l t i m e s . " worker must accept the c h i l d a t a l l times, but he may accept h i s behavior a t a l l t i m e s .  The  not n e c e s s a r i l y  The technique of s e t t i n g r e a l i s t i c ;  l i m i t s , t h e r e f o r e , i s not imeompatible w i t h t h i s p r i n c i p l e . The p r i n c i p l e of communication i s d e s c r i b e d by Maas i n t h i s way* "In any twosome i n t e r a c t i o n , f o r t r u e communication to occur betweefe the persons i n v o l v e d , the meanings of the terms and o t h e r symbols they use and a c t upon must be shared meanings. They may  agree o r d i s a g r e e about  the i s s u e s they d i s c u s s , but i f they are t r u l y communicating, e a c h must understand what the o t h e r means by what he says and does." I t may  be more d i f f i c u l t to communicate w i t h the c h i l d than w i t h  the a d u l t because the c h i l d cannot express h i m s e l f as w e l l v e r b a l l y * . Joy Bryenton says, "One  of the most important developements i n casework,  w i t h c h i l d r e n i n recent y e a r s has been an i n c r e a s i n g awareness; t h a t c h i l d r e n are not j u s t 'miniature a d u l t s ' . ...the methods of communication 53 w i t h a d u l t s are not s u i t a b l e f o r c h i l d r e n . " a I n o t h e r words the techniques of s o c i a l casework must be m o d i f i e d i n t h e i r a p p l i c a t i o n t o B i e s t e k , F e l i x P.'The Non-judgmental A t t i t u d e , " S o c i a l Casework. V o l . 34, 1953, p. 239. 2 g 4 5  Moustakas, C l a r k E. C h i l d r e n i n P l a y Therapy, McGraw-Hill Book Co. New York, 1953, p. 4. i b i d . p. 5. Maas, op. c i t . p. 83. Bryenton, J o y , Communication w i t h C h i l d r e n , A Thesis A b s t r a c t , " The S o c i a l Worker. A p r i l , 1959, p. 36.  - 18 children.  But there i s no doubt o f the importance of t h i s p r i n c i p l e  i n casework w i t h c h i l d r e n .  Moustakas p o i n t s out, " C h i l d r e n grow  e m o t i o n a l l y i n and through t h e i r r e l a t i o n s h i p s w i t h other people. Study o f these i n t e r p e r s o n a l r e l a t i o n s h i p s through...therapy sessions r e v e a l s t h a t t h e e f f e c t i v e n e s s o f any t h e r a p e u t i c r e l a t i o n s h i p r e q u i r e s communication o f f a i t h , acceptance, and respect from the t h e r a p i s t t o the child...Some of the means t o h e l p c h i l d r e n g a i n emotional i n s i g h t s are l i s t e n i n g , conveying understanding!' and p r o v i d i n g o p p o r t u n i t i e s f o r f r e e emotional e x p r e s s i o n . "  ^  The p r i n c i p l e o f i n d i v i d u a l i z a t i o n " i s based upon the r i g h t o f the person t o be treated', n o t j u s t as a_ human b e i n g , but as t h i s human being; with h i s personal d i f f e r e n c e s .  I t i s the r i g h t of human beings t o be  i n d i v i d u a l s , t o be d i f f e r e n t i n c e r t a i n r e s p e c t s from other persons. I n d i v i d u a l i z a t i o n may be d e f i n e d as t h e caseworker's r e c o g n i t i o n , u n d e r s t a n d i n g , and use o f d i f f e r e n c e s o f a c l i e n t i n a s s i s t i n g him i n a 2 b e t t e r adjustment." The  c h i l d , t o o , has a r i g h t t o be seen as an i n d i v i d u a l i n t h i s way,  but because the c h i l d i s a dependent person i n s o c i e t y , " T h i s . . . n e c e s s i t a t e s , i n a l l r e l a t i o n s h i p s w i t h t h e c h i l d , c o n s i d e r a t i o n not o n l y o f the c h i l d , but o f the people most v i t a l t o h i m — h i s p a r e n t s . "  ' The p r i n c i p l e  of i n d i v i d u a l i z a t i o n a p p l i e s t o c h i l d r e n i n t h a t the worker sees t h i s c h i l d as a person d i s t i n c t from o t h e r c h i l d r e n w i t h h i s own personal differences* I n d e s c r i b i n g the p r i n c i p l e of p a r t i c i p a t i o n , Maas says, " I f a c l i e n t i s t o be helped t o e x t r i c a t e h i m s e l f from a s t r e s s f u l s i t u a t i o n and t o r e g a i n a p e r s o n a l - s o c i a l balance t h a t i s s a t i s f y i n g and enduring, he must be i n v o l v e d as an a c t i v e p a r t i c i p a n t i n the c o r r e c t i v e : a c t i v i t i e s 4 of the casework method i t s e l f . " Moustakas, op. c i t . p. 204* 2 B i e s t e k , op. c i t . p. 239. g  4  Bryenton, op. c i t . p* 36. Maas op. c i t . p. 85*  The c h i l d , t o o , must p a r t i c i p a t e i n the casework s i t u a t i o n i f he i s to r e c e i v e h e l p , but h i s p l a y a c t i v i t y can c o n s t i t u t e p a r t i c i p a t i o n " i n the c o r r e c t i v e a c t i v i t i e s of the casework method i t s e l f * " Ann Oren d e s c r i b e d the ideas i n s e l f - d e t e r m i n a t i o n i n t h i s ways " E v e r y person has a r i g h t to freedom i n which t o express h i s own and pursue them i n h i s own way,  aims  unless; t h i s be i n c o n f l i c t w i t h the  r i g h t s of o t h e r s * . • Human beings normally possess some s t r e n g t h s , r e s o u r c e s , and c a p a c i t i e s f o r the management off h i s own a f f a i r s . . * i n d i v i d u a l , u n l e s s s e r i o u s l y damaged, has an urge t o engage h i s  The  own  e f f o r t s i n improving h i s l i f e and h i s environment*" * Because of the controversy i n s o c i a l work over the p r i n c i p l e of s e l f - d e t e r m i n a t i o n (which i s o f t e n considered a v a l u e as w e l l ) , Saul B e r n s t e i n attempted to c l a r i f y i t s i m p l i c a t i o n s * H i s c o n c l u s i o n s J "While s e l f - d e t e r m i n a t i o n i s not supreme i t i s supremely important. Only through the r i c h u t i l i z a t i o n of t h i s concept can we f u l l y honor. the human-worth v a l u e * • • As we study and diagnose each s i t u a t i o n , our concern should be f o r maximizing the c h o i c e s f o r the people we  serve...  Even w i t h young c h i l d r e n , there are a p p r o p r i a t e matters about which 2 they should be helped to make d e c i s i o n s . "  Again, though, i t must be  remembered t h a t the c h i l d i s dependent on h i s p a r e n t s , a f a c t which w i l l , l i m i t h i s self-determination considerably. The p r i n c i p l e of c o n f i d e n t i a l i t y means t h a t "What the c l i e n t t e l l s the caseworker i s never d i s c u s s e d o u t s i d e the c o n f i n e s of the p r o f e s s i o n a l r e l a t i o n s h i p s , aimed a t h e l p i n g th& c l i e n t .  In practice,  t h i s not o n l y means t h a t the content of case records; iis never d i s c u s s e d i n p u b l i c o r s o c i a l c i r c l e s — o n a bus o r a t r a i n or a t a party*.  I t also;  means, f o r example, t h a t what a w i f e t e l l s a caseworker i s never subsequently  communicated t o her husband without the express  of the c l i e n t . "  permission  3  Quoted by Pumphrey, M u r i e l W. " T r a n s m i t t i n g Values and E t h i c s Thtoughi S o c i a l Work P r a c t i c e " , S o c i a l Work.July. 1961, p. 70, from p r e l i m i n a r y m a t e r i a l f o r a d o c t o r a l d i s s e r t a t i o n a t the U n i v e r s i t y of Minnesota. B e r n s t e i n , S a u l , " S e l f - d e t e r m i n a t i o n s K i n g or C i t i z e n i n the Realm of V a l u e s ? " S o c i a l Work. January 1960, p. 8 ( i t a l i c s mine). MaaB, op.  c i t . p.  87.  -20The c h i l d t o o must f e e l secure t h a t what he r e v e a l s t o the caseworker w i l l n o t i n t u r n be d i s c u s s e d w i t h h i s parents* The p r i n c i p l e of caseworker self-awareness " r e q u i r e s t h a t the caseworker be s u f f i c i e n t l y conscious o f responses t o a c l i e n t t o separate out what goes on i n the p r o f e s s i o n a l l y m o t i v a t e d — t h a t i s , aimed a t h e l p i n g the c l i e n t — and p e r s o n a l l y m o t i v a t e d — t h a t i s , aimed a t f u l f i l l i n g the caseworker's  own p e r s o n a l d r i v e s * "  p r i n c i p l e i s p a r t i c u l a r l y important i n working w i t h c h i l d r e n *  This In this  r e g a r d , Hamilton says, "The s o c i a l worker, l i k e any o t h e r t h e r a p i s t , has t o be aware of the p o s s i b i l i t y o f c o u n t e r - t r a n s f e r e n c e i n h i m s e l f , t h a t i s , i r r a t i o n a l l y l i k i n g o r d i s l i k i n g , the c l i e n t , and must guard h i m s e l f a g a i n s t t h i s and c o n t r o l h i s emotional r e a c t i o n s i n the i n t e r e s t 2 of the p a t i e n t . "  T h i s i r r a t i o n a l i t y can oacur when the worker sees  the c h i l d i n treatment as h i s own c h i l d .  As Hamilton p o i n t s out, i t i s  e s s e n t i a l t h a t f e e d i n g s such as these a r e c o n t r o l l e d * As i n d i c a t e d p r e v i o u s l y , these p r i n c i p l e s grow out o f the v a l u e s of  s o c i a l work.  F o r example, one cannot accept a c h i l d unless- he  b e l i e v e s i n the d i g n i t y and worth o f t h a t c h i l d * A l s o , f o r the worker to a l l o w the c h i l d t o determine the choice he w i l l make i n a s i t u a t i o n ; ( w i n h i n r e a l i s t i c l i m i t s ) , the worker w i l l b e l i e v e i n the r i g h t o f t h i s c h i l d t o f u l l developement o f h i s c a p a c i t i e s * In t u r n , the s o c i a l casework techniques a r e a p p l i e d i n r e l a t i o n to the v a l u e s and p r i n c i p l e s *  For example, when the worker a p p l i e s the  technique o f r e l a t i n g t o a f f e c t , he does so because he b e l i e v e s i n the d i g n i t y and worth of the c h i l d , because he accepts the c h i l d as an individual.  He communicates t o the c h i l d t h a t i t i s permissable t o have  these f e e l i n g s ; t h a t he understands the c h i l d has these f e e l i n g s ; t h a t he i s not going t o d i c t a t e t o the c h i l d how he must handle these f e e l i n g s * However, the techniques of s o c i a l casework a r e a l s o a p p l i e d on the b a s i s o f the worker's knowledge of human growth and b e h a v i o r , and o f h i s , Maas, i b i d . p. 88. Hamilton, Gordon, Psychotherapy  i n C h i l d Guidance.op. c i t . p. 121.  - 21 awareness o f the importance of the c l i e n t - w o r k e r r e l a t i o n s h i p . Knowledge of Human Growth and Behavior I t i s g e n e r a l l y agreed i n s o c i a l work t h a t a knowledge and underof normal and d e v i a n t needs and behavior,  as w e l l as an understanding  of environmental f o r c e s which may enhance o r i n t e r f e r e w i t h one's s o c i a l f u n c t i o n i n g , i s e s s e n t i a l equipment f o r the s o c i a l casework practitioner.  Ruth B u t l e r says, "Because s o c i a l work a c t i v i t i e s are  founded on understanding human needs.•.the human growth and behavior (courses) provide the foundation  on which the remainder of the ( s o c i a l  work) c u r r i c u l u m must be based." ^ C h a r l o t t e Towle t o o b e l i e v e s t h a t "In the education  o f s o c i a l workers, knowledge and understanding of 2  human behavior has c e n t r a l importance." I n h i g h l i g h t i n g t h e importance o f understanding b e h a v i o r of c h i l d r e n i n a r e s i d e n t i a l s e t t i n g , F r a i b e r g says, "We must make use o f behavioral observations  and make i n f e r e n c e s from behavior about the g  i n n e r meaning of the c o n f l i c t . We must be s p e c i a l i s t s i n d i a g n o s i s . " I n s t u d y i n g l e a r n i n g d i s a b i l i t i e s i n c h i l d r e n , Margaret Grunebaum s t a t e s , " I n t u r n i n g now t o the i m p l i c a t i o n s o f our study f o r casework p r a c t i c e , I should l i k e t o s t a t e t h e obvious? The g r e a t e r our understanding of a p a r t i c u l a r problem, t h e c l e a r e r w i l l be the i n d i c a t i o n s 4.  for  therapeutic intervention."  I n other words, t h e b e t t e r he  understands the problem, the c l e a r e r the s o c i a l worker w i l l be i n applying the appropriate  s o c i a l casework  techniques.  B u t l e r , Ruth M. An O r i e n t a t i o n t o Knowledge o f Human growth and Behavior i n S o c i a l Work E d u c a t i o n (Volume V I , S o c i a l Work Curriculum S t u d y ) , Council on S o c i a l Work E d u c a t i o n , New York, 1959, p. 5. Towle, C h a r l o t t e , "A S o c i a l Work Approach t o Courses i n Growth and B e h a v i o r " , S o c i a l S e r v i c e Review, 1960, p. 402• F r a i b e r g , Selma, "Some Aspects o f R e s i d e n t i a l Casework w i t h C h i l d r e n , " S o c i a l Casework, A p r i l , 1956, p.. 159* Grunebaum, Margaret G. "A study of l e a r n i n g Problems o f C h i l d r e n ; Casework I m p l i c a t i o n s " , S o c i a l Casework, Nov. 1961, p. 465*.  - 22 The p o i n t , then, i s t h a t whether working w i t h c h i l d r e n o r a d u l t s * the s o c i a l worker must have a sound knowledge of human b e h a v i o r , and thus of: h i s c l i e n t , i f he i s going t o apply the a p p r o p r i a t e technique a t the r i g h t time. When forming a d i a g n o s i s of the c h i l d , the worker must keep i n mind the c h i l d ' s changing symptom e x p r e s s i o n , and the f l u i d i t y of h i s ego.  Because of these f a c t o r s , i t i s more d i f f i c u l t to  make a d i a g n o s i s of the c h i l d .  As Hamilton e x p l a i n s , " I n the  r e l a t i o n s h i p l i f e of the growing c h i l d i t i s not easy t o draw a sharp l i n e between the p a t h o l o g i c a l and the normal." * However, Hamilton f u r t h e r e x p l a i n s , "fhe s o c i a l worker must be able t o d i s t i n g u i s h between eases i n which there i s d e f i c i e n c y i n p a r e n t a l a f f e c t i o n , causing genuine a f f e c t hunger, and cases which show marked s o c i a l pathology  of  an o b j e c t i v e s o r t , as i n d e f e c t i v e , d i s e a s e d and d e t e r i o r a t e d f a m i l i e s . He must be able to d i s t i n g u i s h r e j e c t i o n , whether c o v e r t o r o v e r t , from gross n e g l e c t ; the e s s e n t i a l l y h e a l t h y but e g o c e n t r i c person, who  may  show minor d i s t u r b a n c e s or h a b i t d i s o r d e r s , from the r e a l d e v i a t i o n s ; ; the e s s e n t i a l l y normal c h i l d w i t h m i l d s i t u a t i o n a l problems from the dwarfed!, warped, o r s i c k c h i l d ; he must d i s t i n g u i s h completely d i s r u p t e d and d i s r u p t i n g homes from those t h a t have p o s s i b i l i t i e s of m o d i f i c a t i o n and r e c o n s t r u c t i o n , and f i n a l l y he must understand f l u i d and s h i f t i n g p i c t u r e of c h i l d devebpjTment.  the  I n t h i s l a s t he must  d i s c e r n what p a r t of behavior i s r e a c t i v e t o a c u r r e n t s i t u a t i o n and 2 what has a l r e a d y become a c h a r a c t e r t r e n d . "  To h e l p d i s t i n g u i s h these  f a c t o r s , the s o c i a l worker c a r r i e d w i t h him i n t o the casework s i t u a t i o n a t h e o r e t i c a l understanding of b e h a v i o r , borrowed from o t h e r d i s c i p l i n e s , g mainly p s y c h o a n a l y s i s and s o c i o l o g y . 1. 2  Hamilton, Gordon, Psychotherapy  i n C h i l d Guidance, op. c i t . p. 1ft.  i b i d . p. 19-20. I t i s beyond the scope of t h i s study to d i s c u s s i n any d e t a i l the c o n t r i b u t i o n s of p s y c h o a n a l y s i s and s o c i o l o g y , e t c . t o s o c i a l work* I t i s e s s e n t i a l t o understand^! f o r the purposes o f t h i s study, t h a t the s o c i a l worker's a c t i v i t i e s are i n f l u e n c e d by an understanding o f b e h a v i o r , which i s enhanced by these d i s c i p l i n e s and o t h e r s . Making a d i a g n o s i s depends l a r g e l y on t h i s understanding.  - 23 The  -  Client-Caseworker  Relationship  I t i s v i r t u a l l y i m p o s s i b l e to read a book or a r t i c l e on the process of s o c i a l casework w i t h o u t the i n c l u s i o n of a d i s c u s s i o n worker r e l a t i o n s h i p .  on the c l i e n t -  T h i s r e l a t i o n s h i p i s d i f f e r e n t from the  one-to-one r e l a t i o n s h i p , as Hamilton e x p l a i n s : r e l a t i o n s h i p d i f f e r s from most of c o n v e n t i a l  "The  ordinary  professional  intercourse  l a r g e l y i n the  degree to which the aim must be the good of o t h e r s . . . , i n the amount of self-awareness to be a t t a i n e d by the worker, and be a s s i m i l a t e d client-worker  and  consciously u t i l i z e d * "  i n the techniques to  The  connection between the  r e l a t i o n s h i p and the a p p l i c a t i o n of techniques i s c l e a r l y  expressed i n t h i s passage* The and use  Community S e r v i c e S o c i e t y  of New  York adds t h a t the developement  of the r e l a t i o n s h i p between the caseworker and 2  client i s essential  to a l l aspects of the casework process* The  c l i e n t - c a s e w o r k e r r e l a t i o n s h i p has been d e f i n e d as "...the  dynamic i n t e r a c t i o n of a t t i t u d e s and  emotions between the caseworker and  the c l i e n t , w i t h the purpose of h e l p i n g  the c l i e n t achieve a 3  adjustment between h i m s e l f and h i s environment."  better  In discussing  the g o a l  of t h i s r e l a t i o n s h i p , S y l v i a A s t r o et a l adds: "••.as the g o a l of (casework) treatment i s the c l i e n t ' s r e a l i s t i c , comfortable, constructive  use  of h i m s e l f i n h i s s o c i a l and I n t e r p e r s o n a l environment,  the goal of the p r o f e s s i o n a l and  and  r e l a t i o n s h i p i s the c o m f o r t a b l e ,  constructive,  r e a l i s t i c i n t e r a c t i o n of the c l i e n t w i t h the worker toward the 4  r e s o l u t i o n of the c l i e n t ' s problem."  To enable the c l i e n t to  experience more rewarding r e l a t i o n s h i p s i n h i s s o c i a l s i t u a t i o n , the worker enables the c l i e n t to f i r s t experience a more rewarding r e l a t i o n s h i p i n the c l i e n t - w o r k e r  s i t u a t i o n , by a p p l y i n g the  appropriate  techniques a t the proper t i m e . Hamilton, Gordon, Theory and P r a c t i c e of S o c i a l Casework,op.cit. p. Community S e r v i c e S o c i e t y of New  York, op*  c i t . p.  B i e s t e k , F e l i x P. The Casework R e l a t i o n s h i p . Chicago, 1957, p. 12. S y l v i a A s t r o e t a l , op. c i t . p.  16*  28*.  6.  Loyola University  Press,  - 24 P e r l a a n says, "The  casework r e l a t i o n s h i p begins as the  client  shares some p a r t of h i s problem and as the caseworker demonstrates t h a t he f e e l s w i t h the c l i e n t a t the same time t h a t he  has  p r o f e s s i o n a l competence to b r i n g to d e a l i n g w i t h the problem*"  " The  worker,then, does no$ s e t out to s p e c i f i c a l l y " e s t a b l i s h a r e l a t i o n ship."  As the casework process begins w i t h the worker and  client  working t o g e t h e r on the c l i e n t ' s problem, the r e l a t i o n s h i p devebps along w i t h t h i s process, as the c a i e n t r e a l i z e s the caseworker i s an a c c e p t i n g , h e l p f u l person. Hamilton d e s c r i b e s w e l l the nature of t h i s r e l a t i o n s h i p between caseworker and c h i l d * "The  t h e r a p i s t i s not a parent o r a s u b s t i t u t e  p a r e n t , y e t he p l a y s a " p a r e n t a l " r o l e /  1  He must be a good f r i e n d , y e t  not a f r i e n d i n the o r d i n a r y s o c i a l sense.  The t h e r a p i s t i s never the  r e a l love o b j e c t , though the p a t i e n t , e s p e c i a l l y the c h i l d , so regards him d u r i n g the p e r i o d of treatment.,.A t h e r a p e u t i c r e l a t i o n s h i p i s d i f f e r e n t from other human r e l a t i o n s h i p s i n t h a t i t s purpose i s 2 healing." I t must be noted and emphasized t h a t the s e p a r a t i o n of v a l u e s , p r i n c i p l e s , understanding behavior, and the c l i e n t - w o r k e r  relation-  s h i p as f a c t o r s i n f l u e n c i n g the caseworker's use of techniques, d i s c u s s i o n purposes o n l y .  i s for  I n r e a l i t y , these f a c t o r s become p a r t of the  caseworker and are combined to form the p r o f e s s i o n a l person who i n a t h e r a p e u t i c way w i t h h i s c l i e n t by a p p l y i n g the techniques,  f o r the purpose o f " t h e c l i e n t ' s r e a l i s t i c ,  and c o n s t r u c t i v e use of h i m s e l f i n h i s s o c i a l and environment".  responds  appropriate comfortable,  interpersonal  These f a c t o r s are brought together by Banes, i n regard  to treatment of the latency-age c h i l d :  "The  r e s o l u t i o n of the  client's  b a s i c c o n f l i c t s i s not the s o l e aim of casework treatment any more than i t i s the s o l e aim of p s y c h i a t r i c treatment. Many d i s t u r b e d age c h i l d r e n  latency-  can be helped to modify t h e i r d e s t r u c t i v e behavior  p a t t e r n s and s u b s t i t u t e f o r them new * Perlman, op. c i t . p.  and b e t t e r p a t t e r n s of  behavior,  71.  2 Hamilton, Gordon, Psychotherapy i n C h i l d Guidance, op. c i t . p. 125-6. r e c o r d i n g s examined i n t h i s study are of i n t e r v i e w s w i t h l a t e n c y age c h i l d r e n .  - 25 w i t h o u t r e s o l v i n g t h e i r b a s i c c o n f l i c t s , s i n c e the ego i n l a t e n c y i s s t i l l , f l u i d , and can be strengthened through the medium of r e l a t i o n ship.  This r e s u l t can be ad&eved through the c h i l d ' s c o r r e c t i v e  i d e n t i f i c a t i o n w i t h a caseworker whose understanding of psychosexual development and unconscious c o n f l i c t s as w e l l as the p r i n c i p l e s of casework treatment enables him t o use the r e l a t i o n s h i p to f o s t e r , and support more c o n s t r u c t i v e and s a t i s f y i n g behavior p a t t e r n s . As a r e s u l t of such an e x p e r i e n c e ^ the c h i l d ' s ego functions."  1  i s strengthened i n many of i t s  This statement shows c l e a r l y the i n t e r r e l a t e d n e s s of  the f a c t o r s i n f l u e n c i n g the worker's a p p l i c a t i o n of t e c h n i q u e s , and  the  g o a l s of t h i s a p p l i c a t i o n . The S t r u c t u r e and F u n c t i o n of the  Clinic  Before d e s c r i b i n g the o b j e c t i v e of t h i s study, some words should be s a i d about the way  i n which a s o c i a l worker i s assigned a c h i l d  f o r casework treatment a t the C h i l d r e n ' s The  Clinic.  C h i l d r e n ' s C l i n i c , t o g e t h e r w i t h the A d u l t C l i n i c , forms  the P r o v i n c i a l Mental H e a l t h Centre, s i t u a t e d i n Burnaby,B.C. The p o l i c y of C h i l d r e n ' s C l i n i c r e q u i r e s t h a t parents must r e f e r t h e i r c h i l d f o r treatment. (who  The  c l i n i c team c o n s i s t s of a p s y c h i a t r i s t  c h a i r s a l l conferences and assumes u l t i m a t e r e s p o n s i b i l i t y f o r  treatment),  a s o c i a l worker, a p s y c h o l o g i s t , a p u b l i c h e a l t h nurse,  and when the c h i l d r e f e r r e d has a speech d i f f i c u l t y , a speech t h e r a p i s t . Intake s e r v i c e u s u a l l y c o n s i s t s of one i n t e r v i e w w i t h one or both parents.  The worker presents the p e r t i n e n t i n f o r m a t i o n from t h i s  i n t e r v i e w to the c l i n i c team a t an Intake Conference*;: I f a t t h i s conference i t i s agreed t h a t t h i s i s a s i t u a t i o n a p p r o p r i a t e for the 2 c l i n i c , i t i s accepted f o r d i a g n o s t i c s e r v i c e s , which i n c l u d e s a  Banes, Leonard, " D i r e c t Casework Treatment of a Latency Age S o c i a l Casework, A p r i l , 1961, p. 184-5 ( i t a l i c s mine). The  Child",  c l i n i c ' s s e r v i c e s are o f f e r e d t o c h i l d r e n whose d i s t u r b a n c e s appear to be of an emotional n a t u r e . G e n e r a l l y , the c l i n i c does not o f f e r s e r v i c e s to the d e f e c t i v e or brain-damaged c h i l d , but t h i s r u l e i s not r i g i d l y adhered t o . (For example, a s l i g h t l y d e f e c t i v e c h i l d whose problems are a m p l i f i e d by r e l a t i o n s h i p d i f f i c u l t i e s w i t h h i s parents, may be considered s u i t a b l e f o r c l i n i c services).  -  26  -  p s y c h o l o g i c a l assessment oft' the c h i l d , a s e r i e s o f i n t e r v i e w s between the p a r e n t s and a s o c i a l worker ( u s u a l l y not the same worker as on i n t a k e ) , and a p s y c h i a t r i c assessment of parents and the c h i l d .  At  the end of t h i s assessment p e r i o d (which i s u s u a l l y about one month) a D i a g n o s t i c Conference i s h e l d by the c l i n i c team.  I t i t i s decided  t h a t the c h i l d can ftenefit from f u l l treatment s e r v i c e s , he i s then assigned  t o "continued  treatment". (Regensburg has s a i d , "The i n d i r e c t  approach toward the c h i l d ' s d i f f i c u l t i e s , which we c a l l treatment  of  parents i n b e h a l f of c h i l d r e n , should always be g i v e n f i r s t c o n s i d e r a t i o n f o l l o w i n g the p e r i o d of e x p l o r a t i o n and e v a l u a t i o n . " i s n o t c o n t r a d i c t o r y t o t h i s statement.  The c l i n i c p o l i c y  I f i t i s thought t h a t a c h i l d  may b e n e f i t by treatment of h i s parents o n l y , t h i s w i l l be undertaken. However, the u s u a l r e s u l t i s t h a t the c h i l d a l s o needs d i r e c t treatment). Most o f the d i r e c t s e r v i c e t o c l i e n t s i s c a r r i e d on by s o c i a l workers.  When i t i s decided  a t the d i a g n o s t i c conference t h a t the c h i l d  should be i n v o l v e d i n treatment he i s u s u a l l y assigned t o a s o c i a l worker.  One o r both parents may be assigned  t o the same worker o r a  d i f f e r e n t one depending on the d i a g n o s i s and on the a v a i l a b i l i t y o f workers. Once the c h i l d i s i n treatment, r e g u l a r progress conferences are held.  This i n v o l v e s the s o c i a l worker b r i n g i n g an up-to-date r e p o r t  on the c h i l d ' s progress t o the c l i n i c team.  The team members, t o g e t h e r  w i t h the s o c i a l worker, t r y t o determine the c h i l d ' s movement i n therapy, h i s present needs i n treatment, where the focus of treatment should be in future, etc.  Each member c o n t r i b u t e s knowledge according t o h i s own  o r i e n t a t i o n , and the s o c i a l worker thus  r e c e i v e s a wider p e r s p e c t i v e .  A l s o the s o c i a l worker r e c e i v e s s u p e r v i s i o n once a week from a s p e c i a l work s u p e r v i s o r t o d i s c u s s progress of cases.  Regensburg, Jeanette$1 "Formulation of C r i t e r i a f o r D i r e c t Work w i t h C h i l d r e n i n a Family Agency" i n D i r e c t Casework w i t h c h i l d r e n . pp. c i t . p. 7.  - 27 Scope and Method o f t h e Study The major o b j e c t i v e o f the present study i s t o determine whether the s o c i a l workers a t the C h i l d r e n ' s C l i n i c o f the P r o v i n c i a l Mental H e a l t h Centre i n Burnaby are a p p l y i n g s o c i a l work t e c h n i q u e s , p s y c h o a n a l y t i c ( s p e c i f i c a l l y , E l e i n i a n ) t e c h n i q u e s , o r a combination o f b o t h , and t o what e x t e n t , i n working w i t h c h i l d r e n . The reasons f o r t h i s study have now been s e t out.  S o c i a l casework  techniques have been d e s c r i b e d t o emphasize the way i n which they must be m o d i f i e d i n working w i t h c h i l d r e n , and how they a r e i n f l u e n c e d by s o c i a l work v a l u e s and p r i n c i p l e s ; an understanding o f the c h i l d ' s needs, dynamics, and present s o c i a l s i t u a t i o n : and an understanding o f the child-worker r e l a t i o n s h i p .  As the a p p l i c a t i o n o f these techniques  c o n s t i t u t e s the s o c i a l worker's responses and a c t i v i t i e s , these f i f t e e n techniques w i l l form the s o c i a l work framework from which the r e c o r d i n g s w i l l be a n a l y z e d . The next s e c t i o n (Chapter I I ) i s devoted t o a review of Freudian p s y c h o a n a l y t i c t e c h n i q u e s , u t i l i z i n g t h e work of Melanie K l e i n to i n d i c a t e how they a r e . a p p l i e d t o c h i l d r e n .  This "framework" p l u s  the s o c i a l work "framework" ( s e t o u t i n Chapter I ) a r e then used to & n  schedule f o r a n a l y z i n g a s e t o f i n t e r v i e w r e c o r d i n g s . The a n a l y s i s o f e i g h t case r e c o r d i n g s (seven n a r r a t i v e r e c o r d i n g s p l u s a tape-recorded i n t e r v i e w ) by the seven s o c i a l workers i n v o l v e d i n d i r e c t treatment o f c h i l d r e n a t the C h i l d r e n ' s C l i n i c , i s thus the core m a t e r i a l o f t h i s study (Chapter I I I ) . One n a r r a t i v e r e c o r d i n g from each worker was s e l e c t e d . An a d d i t i o n a l tape-recorded i n t e r v i e w was s e l e c t e d from one o f these workers.  These r e c o r d i n g s are analyzed a c c o r d i n g t o  both s o c i a l work and p s y c h o a n a l y t i c techniques.  When the worker's  response corresponds w i t h a d e s c r i b e d technique, on the b a s i s o f the w r i t e r ' s c l i n i c a l judgment, t h i s a c t i v i t y i s s a i d t o c o n s t i t u t e t h a t technique. The i m p l i c a t i o n s o f the f i n d i n g s and the way i n which they may c o n t r i b u t e t o f u r t h e r r e s e a r c h i s d i s c u s s e d i n a f i n a l chapter. T h i s study i s p u r e l y d e s c r i p t i v e . e f f e c t i v e n e s s o f workers'  No attempt i s made t o e v a l u a t e the  responses.  C r i t e r i a f o r S e l e c t i n g the Sample The c r i t e r i a f o r choosing r e c o r d i n g s f o r the present study are as  - 28 -  f o l l o w s : the ages of the c h i l d r e n are between s i x and t e n y e a r s ; an i n t e r v i e w was chosen o n l y i f n a r r a t i v e r e c o r d i n g was done; and a l l cases are seen once every week f o r a one-hour i n t e r v i e w . These are the o n l y definite criteria.  Some interview:: take p l a c e near the beginning of  treatment and some are w e l l along the way.  When many i n t e r v i e w s w i t h  one case were recorded' n a r r a t i v e l y , one was chosen a t random f o r a n a l y s i s . There i s no concern w i t h determining d i a g n o s i s — the f t c u s here i s s o l e l y on a p p l i c a t i o n of t e c h n i q u e s .  The reason f o r choosing c h i l d r e n  i n the s i x t o t e n age group i s thay they are o l d enough t o v e r b a l i z e to some e x t e n t , and young enough t h a t the d i f f e r e n c e s between a d u l t s and c h i l d r e n , as d i s c u s s e d , apply t o them. L i m i t a t i o n s oft' the Study Probably the most important l i m i t a t i o n o f the present study i s t h a t i t does not d e a l w i t h the s i g n i f i c a n c e of these techniques on the treatment of the c h i l d , although some reference i s made t o t h e i r a f f e c t on treatment.  A c r o s s - s e c t i o n a l approach i s taken — o n e i n t e r v i e w i s  examined out of context o f many i n t e r v i e w s , and i s not viewed i n r e l a t i o n to the o t h e r i n t e r v i e w s . The number of i n t e r v i e w s examined i n t h i s study ( e i g h t , by seven workers) i s n o t a r e p r e s e n t a t i v e sample of the i n t e r v i e w s t h a t take p l a c e in this c l i n i c .  A d i f f i c u l t y encountered  i n t h i s regard i s t h a t few of  the i n t e r v i e w s were recorded i n s u f f i c i e n t d e t a i l t o be examined f o r workers'  activities.  F i n a l l y , p r e c i s e l y s t a n d a r d i z e d c r i t e r i a were not i n e x i s t e n c e i n a n a l y z i n g the case r e c o r d i n g s .  I t i s suggested t h a t c l i n i c a l judgment,  based on a conscious e f f o r t t o be o b j e c t i v e , y e t f l e x i b l e , i s s u i t a b l e f o r the purposes of t h i s study.  No doubt the s e t t i n g up of p r e c i s e l y  s t a n d a r d i z e d c r i t e r i a should e v e n t u a l l y be c o n s i d e r e d , but i n view o f the d i f f i c u l t i e s i n the nature of the m a t e r i a l , t h i s i s n o t y e t p o s s i b l e : i t i s hoped t h a t the present e x p l o r a t o r y study may p o i n t some d i r e c t i o n s f o r f u t u r e work.  CHAPTER I I PSYCHOANALYTICAL TREATMENTt THE MELANIE KLEIN APPROACH TO CHILDREN The K l e i n i a n view of c h i l d a n a l y s i s i s chosen f o r t h i s study because she sees almost an exact p a r a l l e l between p s y c h o a n a l y s i s of the a d u l t and of the c h i l d *  I t t h e r e f o r e presents (as w i l l be seen)  a view q u i t e d i s t i n c t from s o c i a l work treatment of the c h i l d *  By  a n a l y z i n g case r e c o r d i n g s of treatment of c h i l d r e n by s o c i a l workers from both p o i n t s of view ( s o c i a l work and K l i e n i a n ) the w r i t e r hopes t o show whether s o c i a l workers ( a t l e a s t , the ones s t u d i e d here) are u s i n g orthodox p s y c h o a n a l y t i c techniques i n t h e i r work wi$h c h i l d r e n as w e l l as s o c i a l work techniques*  I t must be remembered t h a t a l l the  workers i n t h i s study are working under p s y c h i a t r i c s u p e r v i s i o n * (*•)  The Nature of P s y c h o - A n a l y s i s  F i r s t , t h e n , some g e n e r a l c o n s i d e r a t i o n s o f > p s y c h o a n a l y t i c technique w i l l be d i s c u s s e d .  Noyes and K o l b say of psychoanalysis?,  " I t i s an e t i o l o g i c a l , uncovering type of therapy i n c o n t r a s t to the s u p p o r t i v e , n o n e x p l o r a t o r y t y p e s * . . Doubtless the most important d i s c o v e r i e s of Freud i n r e l a t i o n t o psychotherapy were those of f r e e a s s o c i a t i o n as a means of e x p l o r a t i o n of the p a t i e n t ' s mind, the study o f  r e s i s t a n c e and the a n a l y s i s of the t r a n s f e r e n c e * . . The g o a l of  p s y c h o a n a l y t i c a l therapy i s the uncovering and m o d i f y i n g of unconscious: p s y c h o l o g i c a l f o r c e s . Through the a n a l y s i s the p a t i e n t should d i s c o v e r the i n f l u e n c e s of these unconscious f o r c e s upon the p a t t e r n of h i s d a i l y l i f e and upon h i s r e l a t i o n s h i p to other persons... The a n a l y s t seeks t o b r i n g about changes i n p e r s o n a l i t y s t r u c t u r e by undoing  the  unfavorable patterns established i n e a r l i e r years." These remarks by Noyes and K o l b s e t out c l e a r l y the purposes of  Noyes, A r t h u r P & K o l b , Lawrence C. Modern C l i n i c a l P s y c h i a t r y . W . B . Saunders Co. P h i l a d e l p h i a , Penn. 1958, p.  627.  - 30 psychoanalysis,  -  and some of Freud's main c o n t r i b u t i o n s to psychotherapy.  However, one of Freud's important c o n t r i b u t i o n s i n r e l a t i o n to psychotherapy not mentioned i n t h i s statement i s a n a l y s i s of dreams of the i n t e r p r e t a t i o n of dfearns.  Each of these concepts mentioned ( f r e e  a s s o c i a t i o n , r e s i s t a n c e , the a n a l y s i s of the t r a n s f e r e n c e , and dream i n t e r p r e t a t i o n ) w i l l be discussed  briefly*  Free A s s o c i a t i o n Free a s s o c i a t i o n i s d e s c r i b e d by Wolberg as " a technique*.• used i n formal p s y c h o a n a l y s i s  to d i s c o v e r c e r t a i n deepiunconscious  a s s o c i a t i v e l i n k s i n the person's thoughts by l e t t i n g h i s mind wander a t random, v e r b a l i z i n g w i t h o u t r e s t r a i n t . " * Noyes and K o l b add to t h i s by saying " I n o r d e r t h a t f r e e a s s o c i a t i o n may  be f a c i l i t a t e d ,  the  p a t i e n t r e c l i n e s d u r i n g the i n t e r v i e w , r e l a t e d an a couch, w h i l e a n a l y s t i s seated a l i t t l e behind and to one  s i d e of him... To  such c o n s c i o u s l y unguided a s s o c i a t i o n s , the t h e r a p i s t asks the  the  obtain patient  t o say what ever comes to h i s mind, and warns him a g a i n s t changing the sequence of h i s u n d i r e c t e d  thoughts and a g a i n s t w i t h o l d i n g  because i t seems i r r e v e l a n t or d i s t r e s s i n g . There should be uncensored, u n i n h i b i t e d v e r b a l i z a t i o n of e v e r y t h i n g comes to mind."  anything an  and anything  that  2  The p r i n c i p a l process which the a d u l t p a t i e n t i s aeked to perform i n a n a l y s i s , then, i s f r e e a s s o c i a t i o n , w i t h i n which the o t h e r concepts under d i s c u s s i o n - r e s i s t a n c e , the a n a l y s i s of the t r a n s f e r e n c e  and  dream i n t e r p r e t a t i o n - occur. Resistance Meninger d e f i n e s r e s i s t a n c e as "the t r e n d of f o r c e s w i t h i n the 3 p a t i e n t which oppose the process of a m e l i o r a t i v e change." e x p l a i n e d t h a t , "The  Freud  p a t i e n t . * . e x h i b i t s a l l the m a n i f e s t a t i o n s  of t h i s  r e s i s t a n c e w i t h o u t r e c o g n i z i n g i t as such, and i t a g r e a t step forward Wolberg, Lewis B. The Technique of psychotherapy. Grune & S t r a t t o n , I n c . New York, 1954, p. 310. Noyes & K o l b , op. c i t . p.  629.  Menninger, K a r l , Theory of P s y c h e a n l y t i c Technique. Science E d i t i o n s , I n c . New York, 1961, p. 104.  - 31 when we have brought him to r e a l i z e t h i s f a c t and to reckon w i t h i t . . . "The  r e s i s t a n c e shown by p a t i e n t s i s h i g h l y v a r i e d and  exeedihgly  s u b t l e , o f t e n hard to recognize and protean i n the  manifold  forms i t t a k e s ; the a n a l y s t needs t o be c o n t i n u a l l y s u s p i c i o u s and his  on  guard a g a i n s t i t . " * During f r e e a s s o c i a t i o n , then, the p a t i e n t f o r a v a r i e t y of reasons  i s a t times unable to t a l k about what i s r e a l l y b o t h e r i n g him, and akso i s unable to recognize t h i s i n a b i l i t y .  The i n t e r p r e t a t i o n to him  t h i s r e s i s t a n c e i s a p o s i t i v e step i n the a n a l y s i s . v i v i d i l l u s t r a t i o n of how "Diagramatic "The  of  Menninger p a i n t s a  r e s i s t a n c e occurs by what he c a l l s a  R e c a p i t u l a t i o n of R e s i s t a n c e , " p a r t of which f o l l o w s .  p a t i e n t wants t o get help from the a n a l y s t but i t i s c o s t l y ,  time consuming, s t r a n g e , somewhat f r i g h t e n i n g , e t c . " The p a t i e n t wants love from the a n a l y s t , whomever he  represents,  but o b t a i n i n g love i s dangerous, u n c e r t a i n and c o s t l y . "The  p a t i e n t f e e l s r e s e n t f u l toward the a n a l y s t f o r h i s s i l e n c e and  p a s s i v i t y and would l i k e to t e l l him so, but the consequences might be unpleasant and even dangerous. "The  p a t i e n t responds t o the encouragement of the a n a l y s t and  a n a l y t i c s i t u a t i o n to l e t h i m s e l f go to some e x t e n t , but t h i s his  self-esteem,  'seems sp- s i l l y , ' unbecoming, i n c r e d u l o u s , 2  probably f u t i l e ' . . . "  the  offends 'and  As Menninger i m p l i e s , these f e e l i n g s of r e s i s t a n c e  occur a t s u c c e s s i v e stages i n the a n a l y s i s .  Menninger says, "They  r e f l e c t the e t e r n a l l y c o n f l i c t u a l nature of the moving, p r o g r e s s i v e g process i n v o l v e d i n p s y c h o a n a l y t i c  treatment."  Transference I n regard to t r a n s f e r e n c e , Noyes and Kolb say, t r a n s f e r e n c e i s u s u a l l y d e f i n e d as a r e p e t i t i o n i n the p a t i e n t ' s preseent l i f e ,  «ad  Freud, Sigmund. A General I n t r o d u c t i o n to P s y c h o a n a l y s i s . Perma Books, New York, 1958, pp. 297-8. Menninger, op. c i t . p. 121 f f . Menninger, op. Cit. p.  122.  - 32 and p a r t i c u l a r l y i n h i s r e l a t i o n s h i p t o the a n a l y s t , of unconscious emotional  a t t i t u d e s developed d u r i n g childhood w i t h i n  group and e s p e c i a l l y toward the p a r e n t s .  the f a m i l y  I t represents a c a r r y i n g  over, and a t t a c h i n g to the t h e r a p i s t , of the f r i e n d l y , h o s t i l e o r ambivalent  a t t i t u d e s and f e e l i n g s which the p a t i e n t f o r m e r l y e n t e r t a i n e d  i n r e l a t i o n t o the parent or other meaningful person of the past played a s i g n i f i c a n t r o l e i n h i s l i f e .  who  The p a t i e n t r e a c t s toward the  t h e r a p i s t as i f the l a t t e r were t h i s person."  T h i s t r a n s f e r r i n g of  f e e l i n g s toward the a n a l y s t as i f he were a parent f i g u r e i s c a l l e d "transference neurosis."  Ackerman e x p l a i n s t h i s phenomenon i n the  f o l l o w i n g quotes "In c l a s s i c a l a n a l y t i c process, the r o l e of present 2 r e a l i t i e s i s t e m p o r a r i l y subordinated. u n f o l d i n g of t r a n s f e r e n c e n e u r o s i s .  This i s the m a t r i x f o r the  For a p e r i o d , the u n r e a l i t y of  t r a n s f e r e n c e achieves mot merely a p o s i t i o n of prominence but one dominance.  U l t i m a t e l y and by s u c c e s s i v e s t a g e s , the i r r a t i o n a l  of content  of t r a n s f e r e n c e i s worked through and^matched a g a i n s t the r e a l i t i e s of the a n a l y t i c r e l a t i o n s h i p .  The q u a l i t i e s of the a n a l y s t ' s person are  "not r e v e a l e d u n t i l the l a t e r s t a g e s .  Thus? the check w i t h r e a l i t y i s  g  delayed." Transference  i s u s u a l l y d e s c r i b e d as being p o s i t i v e o r n e g a t i v e ,  a d e s c r i p t i o n of which i s presented i n a l i v e l y way by Ruth Monroe as f o l l o w s : "Freud observed t h a t h i s p a t i e n t s tended t o a s c r i b e t o him  the  a t t r i b u t e of God Almighty - a phenomenon i n i t i a l l y acceptable enough to h i s own ego.  The p a t i e n t s a l s o showed a tendency, however, t o r e a c t to  him as though he were the d e v i l i n c a r n a t e - t o a p o i n t a t which he g l a d to conclude t h a t he could not p o s s i b l y be a bad as t h e i r op. c i t . p.  was  accusations  627.  " The c l a s s i c a l a n a l y t i c process " i n v o l v e s f r e e a s s o c i a t i o n , as d i s c u s s e d p r e v i o u s l y . I t i s noted by Ackerman i n t h i s passage t h a t "the r o l e of present r e a l i t i e s i s t e m p o r a r i l y subordinated," whereas i n s o c i a l casewprk w i t h a d u l t s , the worker attempts to keep the d i s c u s s i o n r e a l i t y - f o c u s e d a t a l l t i m e s . Ackerman, Nathan W. The Psychodynamics of Family L i f e , B a s i c Books?, I n c . New York, 1958, p. 32.  - 33 implied*  -  He w r y l y remarked t h a t he soon found i t necessary to  the f l a t t e r y as w e l l , r e c o g n i z i n g t h a t the p a t i e n t was not an o b j e c t i v e judgment i n e i t h e r d i r e c t i o n . " F e n i c h e l e x p l a i n s how " The  expressing  1  the a n a l y s t handles t r a n s f e r e n c e .  a n a l y s t ' s r e a c t i o n to t r a n s f e r e n c e  of the p a t i e n t , he i n t e r p r e t s .  discount  He  says  i s the same as any other a t t i t u d e  He sees i n the p a t i e n t ' s a t t i t u d e , a 2  d e r i v a t i v e of unconscious impulses and t r i e s to show t h i s to the p a t i e n t . " L a t e r : "The  transference  i s not immediately used f o r t h e r a p e u t i c aims  but i s r a t h e r analyzed; t h a t i s , i t s t r u e nature i s demonstrated to the 3 patient*" Dream I n t e r p r e t a t i o n 4 E n g l i s h and E n g l i s h d e f i n e dream a n a l y s i s technique of p s y c h o a n a l y s i s . . .  as "the fundamental  wherein the c l i e n t r e l a t e s a dream and  f r e e a s s o c i a t e s about i t s elements*  These a s s o c i a t i o n s , i n t e r p r e t e d  w i t h i n the t h e o r e t i c a l framework (which, f o r purposes of t h i s study i s psychoanalytic)  of the t h e r a p i s t , are guides to the c l i e n t ' s  dynamics or m o t i v a t i o n s *  I n psychoanalysis  underlying  elements of the dream are  i n t e r p r e t e d as symbols of repressed wishes or other unconscious processes."^ 6 Noyes and K o l b e x p l a i n c o n c i s e l y  the technique of dream  i n t e r p r e t a t i o n as f o l l o w s : "Freud d i v i d e d the content of dreams i n t o two c a t e g o r i e s * One  he  c a l l e d the m a n i f e s t content - the content as i t appears to and i s r e c a l l e d by the dreamer.  The r e c o l l e c t e d or obvious content i s not,,  however the s i g n i f i c a n t element which i s contained the l a t e n t content. The  2  4 g  i n what i s known as  l a t e n t content, were i t to appear i n i t s naked!  Munroe, Ruth, Schools of P s y c h o a n a l y t i c New York, 1955, p. 305-306* F e n i c h e l , O t t o . The g s y c h o a n a l y t i e New York 1945, p. 30. i b i d . p. 569.  Thought. The Dryden P r e s s ,  Theory of N e u r o s i s . W.W.  Norton &  Co.  E n g l i s h and E n g l i s h equate the terms "dream a n a l y s i s " and "dream i n t e r p r e t a t i o n " . These two terms are a l s o used interchangeably i n t h i s study as d e f i n e d by E n g l i s h and E n g l i s h . E n g l i s h and E n g l i s h , op. c i t . p. 163* For a d e t a i l e d d i s c u s s i o n of the technique of dream i n t e r p r e t a t i o n , see "The I n t e r p e e t a t i o n of Dreams" i n "The B a s i c W r i t i n g s of Sigmund Freud.ed. by A.A. B r i l l , The Modern L i b r a r y , New York, 1938, pp. 181-549. I t i s f e l t by the w r i t e r t h a t t h i s work by Freud i s b r i l l i a n t l y summarized i n the passage quoted here by Noyes and K o l b .  - 34 form, would be too d i s t u r b i n g and p a i n f u l and i s t h e r e f o r e d i s t o r t e d and d i s g u i s e d so t h a t i t s r e c o l l e c t i o n w i l l not d i s t u r b the dreamer. The d i s g u i s e of mental m a t e r i a l , the r e p r e s s i o n of which s u f f e r s a n o c t u r n a l r e l a x a t i o n , i s brought about by the mechanisms of displacement, condensation,symbolization,  d r a m a t i z a t i o n and e l a b o r a t i o n .  The  joint  a c t i v i t i e s of these mechanisms i s known as dream work, a process; by which the l a t e n t dream content i s transformed i n t o the m a n i f e s t  content."  I n other words, the t r u e meaning of the dream i s too p a i n f u l f o r the dreamer to be aware of i t , so by a complex process of mechanisms, the t r u e meaning i s d i s t o r t e d and d i s g u i s e d i n t o the dream t h a t i s r e c a l l e d by the dreamer.  Dream work i s the t o t a l a c t i v i t y t h a t transform  this  p a i n f u l and t h r e a t e n i n g meaning i n t o a dream t h a t can be accepted by  the  dreamer. Noyes and Kolb continue  as follows.: "In psychoanalysis  the dreamer  i s encouraged to r e p o r t to the p h y s i c i a n any recent or r e c u r r i n g dream. S t a r t i n g from the m a n i f e s t employed.  The  content of the dream, f r e e a s s o c i a t i o n s are;  l a t e n t o r u n d e r l y i n g s i g n i f i c a n c e of the symbolic imagery  i n the m a n i f e s t content i s brought to l i g h t .  There a r i s e s here of  course, the same problem of s y m b o l i z a t i o n and i n t e r p r e t a t i o n as i n f r e e a s s o c i a t i o n , and the a n a l y s t must i n the same way  encourage the p a t i e n t  to d i s c o v e r the meaning concealed i n the m a n i f e s t content of the dream, r a t h e r than impose the a r b i t a r y acceptance of f i x e d symbols.  I t should!  be remembered, however, t h a t the o b j e c t i n dream i n t e r p r e t a t i o n i s not so much the t r a n s l a t i o n of c e r t a i n symbols as the d i s c o v e r y of the and motives t h a t are dynamic i n determining h i s waking l i f e . "  ideas  the p a t i e n t ' s r e a c t i o n s i n  2  To sum up the theory of the method of psychoanalysis  as  discussed  so f a r , we have the f o l l o w i n g : The p a t i e n t i s asked to f r e e a s s o c i a t e , **as d e f i n e d p r e v i o u s l y . i s soon d i s c o v e r e d , however, t h a t he i s not able to c a r r y on w i t h t h i s  Noyes and K o l b , op. c i t . p. 633-4. i b i d . p.  634.  It  - 35 f r e e a s s o c i a t i o n smoothly and w i t h o u t i n t e r r u p t i o n *  For a v a r i e t y o f  reasons, he " b l o c k s " a g a i n s t r e v e a l i n g c e r t a i n items t h a t are important to the treatment - t h i s b l o c k i n g i s c a l l e d r e s i s t a n c e .  Also  transference  o c c u r s , which prevents the p a t i e n t from speaking about what he wants i n a " f r e e " manner.  Instead strong f e e l i n g s are brought out i n t h e p a t i e n t  toqards the t h e r a p i s t , which i n t e r f e r e s w i t h the f r e e a s s o c i a t i o n as such. But f a r from being an i n t e r f e r e n c e i n the a n a l y s i s , r e s i s t a n c e and t r a n s f e r e n c e must occur f o r a s u c c e s s f u l a n a l y s i s t o r e s u l t . transference  and the r e s i s t a n c e are i n t e r p r e t e d .  Both the  These i n t e r p r e t a t i o n s  are e s s e n t i a l steps i n a l l a n a l y s i s . One of the most important d e v i c e s f o r i n t e r p r e t i n g t h e r e s i s t a n c e and the t r a n s f e r e n c e  i s the use o f dreams*  By having the p a t i e n t r e v e a l  h i s dreams, the a n a l y s t i s able t o i n t e r p r e t the u n d e r l y i n g meaning o f the dreams t o the extent o f h e l p i n g the p a t i e n t d i s c o v e r t h e i d e a s and motives causing h i s  behavior.  The purpose o f a l l t h i s i s w e l l s t a t e d by Noyes and K o l b as f o l l o w s : "... p s y c h o a n a l y s i s  shpuld so thproughly  r e v e a l t o the p a t i e n t h i s  u n d e r l y i n g s t r i v i n g s and problems t h a t w i t h the a s s i s t a n c e o f the t h e r a p i s t he can r e o r g a n i z e the f o r c e s o f h i s p e r s o n a l i t y , r e d i r e c t h i s : a f f e c t i v e energy i n t o c o n s t r u c t i v e channels and prevent i t s f u r t h e r d i s s i p a t i o n i n d i s s o c i a t i o n , s u b s t i t u t i o n and other e v a s i v e , n e u r o t i c ways.  I t aims  to g i v e t h e p a t i e n t freedom from d i s a b l i n g f e a r s , d i s t r e s s and i n h i b i t i o n s and t o enable him t o achieve i n s i g h t , s u f f i c i e n t t o handle o r d i n a r y c o n f l i c t s and reasonable r e a l i t y s t r e s s * " The d i s c o v e r i e s of Freud have, of course, helped g r e a t l y i n understanding human behavior, and much o f p s y c h o a n a l y t i c psychodynamics has been borrowed by s o c i a l workers.  theory o f However, t h i s study  i s concernedl w i t h techniques used, and a d i s c u s s i o n of p s y c h o a n a l y t i c 2 theory o f b e h a v i o r i s beyond i t s scope. A l s o c o n s i d e r a t i o n s such as 1 2  Noyes and K o l b , op. c i t . p. 634 P o s s i b l y the most comprehensive d i s c u s s i o n o f p s y c h o a n a l y t i c theory i n one volum^e i s found i n The B a s i c W r i t i n g s of Sigmund Freud, ed.by A.A. B r i l l , Random House I n c . New York, 1938*  -  36  -  who i s l i k e l y t o b e n e f i t from an a n a l y s i s w i l l be avoided. to  Suffice; i t  say t h a t the number i s l i m i t e d who can b e n e f i t from a c l a s s i c a l  a n a l y s i s t o the extent t h a t i s d e s c r i b e d by Noyes and K o l b . quoted i n the previous paragraph. (b.)  Kleinian Analysis applied to 6hildren A  I t i s K l e i n ' s c o n t e n t i o n t h a t i n p r i n c i p l e a d u l t and c h i l d a n a l y s i s are e s s e n t i a l l y the same.  I n t h i s connection, she says,  i n both  c h i l d and a d u l t the main p r i n c i p l e s of a n a l y s i s are the same. C o n s i s t e n t i n t e r p r e t a t i o n , steady r e s o l u t i o n o f r e s i s t a n c e s , constant r e f e r e n c e back o f the t r a n s f e r e n c e , whether p o s i t i v e o r n e g a t i v e , t o e a r l i e r s i t u a t i o n s these e s t a b l i s h and m a i n t a i n a e o r r e c t a n a l y t i c s i t u a t i o n c h i l d no l e s s than w i t h the a d u l t .  A necessary  1  w i t h the  condition f o r this  achievement i s t h a t the a n a l y s t should r e f r a i n , as he does w i t h a d u l t p a t i e n t s , from e x e r t i n g any k i n d o f n o n - a n a l y t i c and e d u c a t i o n a l i n f l u e n c e upon the c h i l d . " The c h i l d ' s p l a y , K l e i n i m p l i e s , i s e q u i v a l e n t t o a d u l t dreams, and must be i n t e r p r e t e d i n t h e same way.  She says "The c h i l d expresses i t s  p h a n t a s i e s , i t s wishes and i t s a c t u a l experiences i n a symbolic way through p l a y and games.  I n doing so i t makes use of the same a r c h a i c  and p h y l o g e n e t i c mode of e x p r e s s i o n , the same language, as i t were, t h a t we are f a m i l i a r w i t h i n dreams; and we can o n l y f u l l y understand t h i s  Robert Waelder, i n h i s book, B a s i c Theory p f P s y c h o a n a l y s i s . p u b l i s h e d by I n t e r n a t i o n a l U n i v e r s i t i e s Press Inc. New York, 1960. p r o v i d e s an e x c e l l e n t d e f i n i t i o n of the term " A n a l y t i c S i t u a t i o n " ass f o l l o w s . An a n a l y t i c s i t u a t i o n i s a s i t u a t i o n of a r t i f i c i a l , p a r t i a l and c o n t r o l l e d r e g r e s s i o n f o r the purpose of a study o f i n n e r c o n f l i c t s . I n an a n a l y t i c s i t u a t i o n , the balance between the i n n e r f o r c e s between the conscious and the unconscious, between p u r p o s i v e , goal d i r e c t e d a c t i v i t i e s and impulses a c t i n g upon us — i s a l t e r e d a r t i f i c i a l l y i n f a v o r o f the unconscious and the i m p u l s i v e . Such a change i s necessary t o make i t p o s s i b l e f o r those aspects o f the p e r s o n a l i t y which a r e o r d i n a r i l y prevented from d i r e c t e x p r e s s i o n t o m a n i f e s t themselves more c l e a r l y , w h i l e a t the same time being able to see the i n h i b i t o r y responses which a r e s t i m u l a t e d i n t o i n c r e a s e d a c t i v i t y by the very emergence of otherwise checked impulses." (p.237). K l e i n , M e l a n i e . The P s y c h o - A n a l y s i s London, Eng. 1950. p. 35-36.  of Children.The  Hogarth Press; L t d .  - 37A  -  language i f we approach i t i n the way Freud has taught us t o approach the language o f dreams... F a l l a n a l y t i c r e s u l t s can o n l y be obtained i f we b r i n g these play-elements i n t o t h e i r true r e l a t i o n w i t h the c h i l d ' s sense o f g u i l t by i n t e r p r e t i n g them down t o the s m a l l e s t d e t a i l . "  This  l a s t sentence, as w i l l be seen, expresses the f o c u s o f K l e i n ' s whole system o f - c h i l d a n a l y s i s .  From the beginning of the a n a l y s i s t o the end,  K l e i n i n t e r p r e t s "down t o the s m a l l e s t d e t a i l . ' kaleidoscopic  She goes on t o say, "The  p i c t u r e , o f t e n t o a l l appearances q u i t e meaningless, which  c h i l d r e n present t o us i n a s i n g l e a n a l y t i c hour... a r e seen t o have method i n them and w i l l y i e l d up t h e i r meaning i f we i n t e r p r e t them as we do dreams." She  2  goes on t o e x p l a i n how a d u l t dreams and c h i l d r e n ^ p l a y are  s i m i l a r , i n the f o l l o w i n g way, "Just as a s s o c i a t i o n s t o dream elements l e a d t o the uncovering o f the l a t e n t content of the dream, so do the elements of c h i l d r e n ' s p l a y , which correspond t o tho/se a s s o c i a t i o n s , a f f o r d a view of i t s l a t e n t meaning^  And p l a y a n a l y s i s , no l e s s than a d u l t  a n a l y s i s , by s y s t e m a t i c a l l y t r e a t i n g the a c t u a l s i t u a t i o n as a t r a n s f e r e n c e s i t u a t i o n and e s t a b l i s h i n g i t s connection w i t h the o r i g i n a l l y experienced! o r imagined one g i v e s them the p o s s i b i l i t y o f completely l i v i n g out and 3 working through t h a t o r i g i n a l s i t u a t i o n i n phantasy." K l e i n e x p l a i n s h e r reasons f o r i n t e r p r e t i n g t h i s m a t e r i a l even a t the v e r y beginning o f the a n a l y s i s i n the f o l l o w i n g passage. "When the a n a l y s i s has been s t a r t e d and a c e r t a i n amount of a n x i e t y has been r e s o l v e d  i n the small p a t i e n t by i n t e r p r e t a t i o n , the sense o f  r e l i e f he experiences as a consequence of i t - o f t e n o n l y A  w i l l h e l p him t o go on w i t h the work.  a few s e s s i o n s —  For, whereas he has h i t h e r t o had no  i n c e n t i v e t o be a n a l y z e d , he has now g o t an i n s i g h t i n t o the use and k  i b i d . p. 29. ( i t a l i c s are w r i t e r ' s ) .  2 i b i d . p. 29-30. g  i b i d . p. 43..  - 38 v a l u e of such a procedure, and a i n s i g h t of a k i n d which w i l l be q u i t e as e f f e c t i v e a motive f o r being analyzed as i s the a d u l t ' s i n s i g h t i n t o his  i l l n e s s , " * B u t , as K l e i n i n d i c a t e s , i n t e r p r e t a t i o n a t the beginning  causes a l t e r a t i o n s of f e e l i n g s r a t h e r than of thoughts. To quote "Seeing t h a t c h i l d r e n take i n and d i g e s t t h e i r new knowledgd, mostlji i n an unconscious way, they w i l l not be c a l l e d upon on the s t r e n g t h o f i t t o change t h e i r whole p o i n t o f viwe i n regard t o t h e i r parents a l l a t once. The a l t e r a t i o n w i l l be a t f i r s t one o f f e e l i n g .  Knowledge d e a l t w i t h i n  t h i s g r a d u a l way has always, as f a r as my experience goes, been a g r e a t r e l i e f t o the c h i l d and has g r e a t l y improved i t s r e l a t i o n s towards i t s p a r e n t s , so t h a t i t has become more s o c i a l l y adaptable and e a s i e r t o 2 b r i n g up." K l e i n says the e f f e c t o f i n t e r p r e t a t i o n a t the beginning shows i t s e l f i n p l a y i n a number o f ways, "...such as the expansion o f t h e i r p l a y , the s t r e n g t h e n i n g of t h e i r t r a n s f e r e n c e and decrease of t h e i r 3 anxiety, e t c . "  K l e i n goes on t o say t h a t t h e i i n t e r p r e t a t i o n s are not  understood c o n s c i o u s l y f.br some t i m e .  The t a s k o f the c h i l d o f d e a l i n g  w i t h and working over the i n t e r p r e t a t i o n s i n consciousness "was accomplished l a t e r on, and was bound up w i t h the development o f t h e i r ego and the growth 4 of t h e i r a d a p t a t i o n t o r e a l i t y , w i t h which i t kept pace,"  "The process  of s e x u a l e n l i g h t m e n t , " she says, " f o l l o w s the: same course.  F o r a long  time a n a l y s i s does no more than b r i n g out m a t e r i a l connected w i t h s e x u a l theories, and b i r t h - p h a n t a s i e s .  I t o n l y b r i n g s knowledge g r a d u a l l y by 5  removing the unconscious r e s i s t a n c e s which were a g a i n s t l t . "  She goes  on t o g i v e one o f the g o a l s of c h i l d a n a l y s i s : W l l s e x u a l enlightenment, t h e r e f o r e , l i k e a f u l l a d a p t a t i o n t o r e a l i t y , i s one of the consequences  li d . p. 33. a n a l y s i s . of iab icompleted 2 3 4 5  6  i b i d . p. 36. i b i d . p. 35. i b i d . p. 35. i b i d . p. 35. i b i d . p. 35.  " 6;  - 39 By v i e w i n g c h i l d r e n ' s p l a y as e q u i v a l e n t t o a d u l t dreams, K l e i n i s able t o show the n a t i o n a l e f o r u s i n g i n t e r p r e t a t i o n s . She expands on t h i s by e x p l a i n i n g t h a t " The more p r i m i t i v e nature o f the c h i l d ' s mind makes i t necessary t o f i n d an a n a l y t i c technique  t h a t s h a l l be more  e s p e c i a l l y adapted t o i t , and t h i s we f i n d i n P l a y A n a l y s i s . of P l a y A n a l y s i s we g a i n access t o the c h i l d ' s mos£ deeply experiences  By means  repressed  and f i x a t i o n s and are thus able t * e x e r t a r a d i c a l i n f l u e n c e  on i t s development... The o n l y d i f f e r e n c e (between A d u l t and C h i l d A n a l y s i s ) i s t h a t i t ( C h i l d A n a l y s i s ) s u i t s i t s mode of procedure t o the mind o f the c h i l d . "  M  I n c l a r i f y i n g n o t o n l y the use of i n t e r p r e t a t i o n , but a l s o the "depth" t o which i t should go, K l e i m says, "Another fundamental p r i n c i p l e of p l a y technique  i s t h a t the i n t e r p r e t a t i o n must be c a r r i e d down t o a 2  s u f f i c i e n t depth:to reach the mental l a y e r which i s being a c t i v a t e d . " She  l a t e r goes on t o s a y , . . . The a n a l y s t should n o t be a f r a i d of making A  a deep i n t e r p r e t a t i o n even a t the s t a r t of the a n a l y s i s , s i n c e the m a t e r i a l belonging t o the deep l a y e r s of the mind w i l l come back again l a t e r and be worked through.  ... The f u n c t i o n o f deep-going i n t e r p r e t a t i o n  i s simply t o open the door t o the unconscious, t o d i m i n i s h the a n x i e t y g t h a t has been s t i r r e d up and thus t o prepare the way f o r a n a l y t i c work." The i d e a t h a t i n t e r p r e t a t i o n " t o the deepest l e v e l s " should  begin  immediately seems t o have o r i g i n a t e d w i t h K l e i n . She j u s t i f i e s t h i s approach by the f o l l o w i n g e x p l a n a t i o n .  "As soon as the small, p a t i e n t  has g i v e n me some s o r t o f i n s i g h t i n t o h i s complexes - whether through h i s games o r h i s drawings o r p h a n t a s i e s , o r merely by h i s general behavior - I c o n s i d e r t h a t i n t e r p r e t a t i o n can and should begin. does not r u n counter t o the w e l l - t r i e d r u l e t h a t the a n a l y s t wait t i l l  This  should  the t r a n s f e r e n c e i s there before he begins i n t e r p r e t i n g ,  i b i d . p. 38-39. i b i d . p. 48. i b i d . p. 50  - 40 because w i t h c h i l d r e n the t r a n s f e r e n c e takes p l a c e immediately, and the a n a l y s t v i l l i o f t e n be g i v e n evidence s t r a i g h t away of i t s p o s i t i v e nature*  But should the c h i l d show shyness, a n x i e t y or even o n l y a  c e r t a i n d i s t r u s t , such b e h a v i o r i s to be read as a s i g n of a  negative  t r a n s f e r e n c e , and t h i s makes i t s t i l l more imperative t h a t i n t e r p r e t a t i i o n should begin.as soon as p o s s i b l e .  For i n t e r p r e t a t i o n reduces the  p a t i e n t ' s negative t r a n s f e r e n c e by t a k i n g the negative a f f e c t s i n v o l v e d back to t h e i r o r i g i n a l o b j e c t s a n d ! s i t u a t i o n . "  1  I n answer to the i d e a t h a t some c h i l d r e n are too i n h i b i t e d o r withdrawn to get i n v o l v e d i n p l a y , K l e i n b e l i e v e s t h a t even the most i n h i b i t e d c h i l d w i l l a t l e a s t glance afc o r p o s s i b l y touch the toys i n the room and w i l l thus r e v e a l aspects of h i s unconscious i n t h i s  way.  Perhaps a d e s c r i p t i o n of K l e i n ' s playroom should be g i v e n a t t h i s time*  I t i s d e s c r i b e d by K l e i n as f o l l o w s : "On a lew. t a b l e i n my  a n a l y t i c room there are l a i d out a number of toys of a p r i m i t i v e k i n d l i t t l e wooden men  and women, c a r t s , c a r r r i a g e s , motor-cars, t r a i n s , 2.  animals, b r i c k s and houses, as w e l l as paper, s c i s s o r s , a n d p e n c i l s * " K l e i n takes as her p o i n t of departurethe technique of E a r l y A n a l y s i s , because i t u n d e r l i e s the a n a l y t i c methods she adopts w i t h c h i l d r e n of a l l ages*  By " E a r l y A n a l y s i s " she means a n a l y s i s of  c h i l d r e n p r i o r to the l a t e n c y p e r i o d .  The d i s c u s s i o n up to t h i s p o i n t  a c t u a l l y has been i n r e l a t i o n to E a r l y A n a l y s i s , but as K l e i n says, "For, i n s o f a r as the mental c h a r a c t e r i s t i c s of the q u i t e s m a l l c h i l d o f t e n s t i l l p e r s i s t q u i t e s t r o n g l y i n o l d e r ones, I have found i t necessary to use the same technique as w e l l *  On the other hand, of  course, the ego of the o l d e r c h i l d i s more f u l l y developed, so, t h a t t h a t technique has to undergo some m o d i f i c a t i o n when i t i s a p p l i e d to c h i l d r e n i n the l a t e n c y p e r i o d and a t puberty."  2  i b i d . p.  46.  i b i d . p.  40  i b i d . p.  37.  3  - 41 The  c h i l d r e n i n v o l v e d i n t h i s study a r e , g e n e r a l l y speaking, i n the  latency period.  Because of t h i s f o c u s , some a t t e n t i o n w i l l be g i v e n  to K l e i n ' s technique of a n a l y s i s d u r i n g F i r s t , t h o u g h , some remarks  latency.  w i l l be made about the d i f f e r e n c e s  K l e i n sees between A d u l t A n a l y s i s and C h i l d A n a l y s i s .  She e x p l a i n s  t h a t the way t o the unconscious i s s i m p l e r t o f i n d i n the c h i l d l than i n the a d u l t .  She goes on t o say "... The c h i l d can a c t u a l l y recover  and present t o us i n a d i r e c t way c e r t a i n experiences and f i x a t i o n s which the a d u l t can o f t e n o n l y produce as r e c o n s t r u c t i o n s .  The reason  why... E a r l y a n a l y s i s o f f e r s one o f the most f r u i t f u l f i e l d s f o r psycho-analytic to represent  therapy, i s p r e c i s e l y because the c h i l d has the a b i l i t y  i t s unconscious i n a d i r e c t way, and thus not o n l y t o  experience a f a r — r e a c h i n g emotional a b r e a c t i o n but a c t u a l l y t o l i v e through the o r i g i n a l s i t u a t i o n i n i t s a n a l y s i s , so t h a t w i t h the help of i n t e r p r e t a t i o n i t s f i x a t i o n can t o a c o n s i d e r a b l e  extent be r e s o l v e d . "  Another p o i n t K l e i n makes i n regard t o d i f f e r e n c e s between a d u l t and C h i l d a n a l y s i s i s the f o l l o w i n g .  We have now seen, I t h i n k , t h a t i n  c h i l d a n a l y s i s our angle of approach has t o be somewhat d i f f e r e n t from what i t i s i n the a n a l y s i s o f a d u l t s .  Taking the s h o r t e s t c u t p o s s i b l e  through the ego, we apply o u r s e l v e s i n the f i r s t i n s t a n c e t o the c h i l d ' s •• unconscious ( a s i h a s been d i s c u s s e d , t h i s i s what K l e i n means by i n t e r p r e t a t i o n ) and from there g r a d u a l l y get i n t o touch w i t h i t s ego as well.  A n a l y s i s does much t o strengthen  the c h i l d ' s as y e t f e e b l e ego  and h e l p i t t o develop, by l e s s e n i n g the excessive weight of the super-ego which presses on i t f a r more s e v e r e l y than i t does on the 2 ego o f f u l l - g r o w n persons."  L a t e r on K l e i n says, "But i f we model  o u r s e l v e s on the p r i n c i p l e s of a d u l t a n a l y s i s and proceed f i r s t o f a l l to g e t i n t o contact w i t h the s u p e r f i c i a l s t r a t a o f the mind - those  1  i b i d . p. 31.  2 i b i d . p. 35.  - 42 which are n e a r e s t t o the ego and t o r e a l i t y - we s h a l l f a i l i n our o b j e c t of e s t a b l i s h i n g the a n a l y t i c a l s i t u a t i o n and reducing  anxiety  i n the c h i l d . " * Another important  p o i n t here i s t h a t " U n l i k e the grown-up p a t i e n t ,  the c h i l d cannot, a f t e r i t s recovery, a l t e r the circumstances life.  of i t s  But a n a l y s i s w i l l have helped i t very g r e a t l y i f i t has enabled  i t t o get on b e t t e r and t o f e e l more c h e e r f u l i n i t s a c t u a l environment. Furthermore, the removal of i t s own n e u r o s i s o f t e n has the e f f e c t of improving  the behavior of i t s m i l i e u . I t has been my experience  that  the mother w i l l r e a c t i n a much l e s s n e r o t i c way as soon as a n a l y s i s 2 has begun t o e f f e c t f a v o u r a b l e changes im h e r c h i l d . " The Technique of A n a l y s i s i n Latency One d i s t i n c t i o n K l e i n makes between small c h i l d r e n and those i m l a t e n c y , i s the way they e x h i b i t negative t r a n s f e r e n c e .  She says  " I n s m a l l c h i l d r e n w i t h a g r e a t d e a l of ... apprehension the negative t r a n s f e r e n c e i s o f t e n a t once expressed as u n d i s g u i s e d f e a r , whereas i n o l d e r ones, e s p e c i a l l y those i n the l a t e n c y p e r i o d , i t more o f t e n 3 takes the form of m i s t r u s t o r reserve o r simply  dislike."  K l e i n c i t e s the f o l l o w i n g as o t h e r d i f f e r e n c e s between the small c h i l d and one i n the l a t e n c y p e r i o d . 1.  C h i l d r e n i n l a t e n c y have a very l i m i t e d i m a g i n a t i v e  life,  u n l i k e the small c h i l d , whose l i v e l y i m a g i n a t i o n and acute a n x i e t y enables an e a s i e r i n s i g h t i n t o h i s unconscious. The c h i l d i n l a t e n c y has a strong tendency t o r e p r e s s i o n . 2. C h i l d r e n i n l a t e n c y n e i t h e r p l a y l i k e small c h i l d r e n nor give verbal associations l i k e adults.  The c h i l d r e n i n  l a t e n c y have d e s e x u a l i z e d t h e i r phantasies and g i v e n them an e n t i r e l y d i f f e r e n t form.  i b i d p. 62. i b i d . p. 35. i b i d . p. 50  - 43 3. Small c h i l d r e n a r e i n c l i n e d t o p l a y w i t h toys a t the beginning  of a n a l y s i s , whereas c h i l d r e n i n l a t e n c y sooni  start acting parts. 4. I n g e n e r a l , the a n a l y s t can make g r e a t e r use o f v e r b a l a c t i v i t y w i t h the c h i l d i n l a t e n c y than w i t h the s m a l l child* * However, i n a l l r e s p e c t s K l e i n ' s b a s i c technique o f a n a l y s i s i s the same w i t h c h i l d r e n i n l a t e n c y as i t i s w i t h the s m a l l c h i l d . I n o t h e r words, h e r b a s i c technique w i t h the c h i l d i n l a t e n c y i s interpretation.  She says i n regard t o c h i l d r e n o f t h i s p e r i o d ,  "... I have found i t p o s s i b l e t o e s t a b l i s h the a n a l y t i c s i t u a t i o n w i t h o u t d e l a y by making contact w i t h t h e i r unconscious, as I do i n the case of small c h i l d r e n , but from an angle o f approach which i s s u i t e d 2 t o t h e i r o l d e r minds." To i l l u s t r a t e the p o i n t t h a t the b a s i c technique o f i n t e r p r e t a t i o n i s used w i t h the l a t e n c y p e r i o d , but from a s l i g h t l y d i f f e r e n t angle of approach, the f o l l o w i n g passage i s quoted: " ( i n l a t e n c y c h i l d r e n ) we see repressed  c u r i o s i t y dominating the p i c t u r e .  I f i n our  l a t e n c y - p e r i o d analyses we choose t h i s p o i n t f o r making our f i r s t i n t e r p r e t a t i o n s - by which, o f course, D do n o t mean e x p l a n a t i o n s i n the i n t e l l e c t u a l sense, but o n l y i n t e r p r e t a t i o n s of the m a t e r i a l as i t emerges i n t h e form of doubts and f e a r s o r unconscious knowledge o r sexual t h e o r i e s and so on - we soon come up a g a i n s t f e e l i n g s o f g u i l t and a n x i e t y i n the c h i l d and have thus e s t a b l i s h e d the a n a l y t i c 3 situation."  So, i n l a t e n c y , the i n i t i a l i n t e r p r e t a t i o n s a r e d i r e c t e d  toward the repressed  c u r i o s i t i e s , which do n o t e x i s t t o the same extent  i n the small c h i l d , whose o e d i p a l s i t u a t i o n i s very much  conscious*.  T h i s i s what K l e i n means by the same b a s i c approach ( c o n t a c t w i t h the These f o u r p o i n t s are the w r i t e r ' s summaries o f K l e i n ' s d i s c u s s i o n on d i f f e r e n c e s between a n a l y s i s of the small c h i l d and a n a l y s i s o f c h i l d r e n i n l a t e n c y . See Ch. 4. p.p.94-121. i b i d . p. 94-95. i b i d . p. 96*  44 -  unconscious by i n t e r p r e t a t i o n ) from a d i f f e r e n t angle (toward the repressed c u r i o s i t i e s i n l a t e n c y ) . K l e i n l a t e r goes on t o say, "... but the f a c t t h a t i n c h i l d a n a l y s i s we g e t i n communication w i t h the unconscious before we have e s t a b l i s h e d any very e x t e n s i v e r e l a t i o n w i t h the ego does not mean t h a t .we have excluded the ego from p a r t i c i p a t i n g i n a n a l y t i c ; work.  Any e x c l u s i o n  of t h i s k i n d would be i m p o s s i b l e , c o n s i d e r i n g t h a t the ego i s so c l o s e l y aonnected w i t h the i d and the super-ego and t h a t we can o n l y f i n d  access  to the unconscious through i t . N e v e r t h e l e s s , a n a l y s i s does no$ apply i t s e l f t o the ego as such (as e d u c a t i o n a l methods do) but o n l y seeks t a open up a path t o the unconscious systems o f mind - those systems whichi are d e c i s i v e f o r the f o r m a t i o n o£ the ego." * E a r l i e r when d i s c u s s i n g c h i l d a n a l y s i s i n g e n e r a l , K l e i n s a i d , "But... i n thus p e n e t r a t i n g d i r e c t l y t o those deep s t r a t a of the mind; we s h a l l not by any means completely r e s o l v e the a n x i e t y contained t h e r e , not i n any way r e s t r i c t the work s t i l l t o be done i n the upper s t r a t a , where the c h i l d ' s ego and r e l a t i o n s t o r e a l i t y have t o be analyzed. This establishment of the c h i l d ' s r e l a t i o n s t o r e a l i t y and t h i s s t r e n g t h e n i n g o f i t s ego take place o n l y very g r a d u a l l y and a r e a r e s u l t , not a p r e - c o n d i t i o n , o f a n a l y t i c work."  2  C h i l d a n a l y s i s , then, whether w i t h the s m a l l c h i l d o r the c h i l d i n l a t e n c y , depends from beginning t o end on the technique o f i n t e r p r e t a t i o n , which means c o n t a c t i n g the unconscious,  as d e s c r i b e d by K l e i n . To quote  her:"For i n c h i l d a n a l y s i s i t i s i n t e r p r e t a t i o n a l o n e , i n my  experience,  g  which s t a r t s the a n a l y t i c process and keeps i t g o i n g . " the occurrence  She d e s c r i b e s  of t h i s on-going i n t e r p r e t a t i o n as f o l l o w s : " . . . so long as  the a n a l y s t has been able t o understand what k i n d o f m a t e r i a l i s being put forward and t o e s t a b l i s h i t s connection w i t h the l a t e n t a n i e t y , he i s i b i d . p. 114. i b i d . p. 5 2 . ( i t a l i c s are w r i t e r ' s ) i b i d . p. 1 1 6 . ( i t a l i c s are w r i t e r ' s )  -  45  -  i n a p o s i t i o n t o g i v e a c o r r e c t i n t e r p r e t a t i o n of the most monotonous and unpromising  r e p r e s e n t a t i o n s of i t , w h i l e s t e p by step as he r e s o l v e s  a n x i e t y and removes r e p r e s s i o n s the c h i l d ' s ego i n t e r e s t s and s u b l i m a t i o n s w i l l begin t o make headway." For the purposes of t h i s study, the d i s c u s s i o n of K l e i n ' s f o r m u l a t i o n o f C h i l d A n a l y s i s up t o t h i s p o i n t i s s u f f i c i e n t because i t has brought out what she does i n her a n a l y t i c s e s s i o n s , namely, the i n t e r p r e t a t i o n of the unconscious m o t i v a t i o n from the beginning o f the a n a l y s i s t o end. Whether the a h i l d appears before h e r f o r the f i r s t t i m e , o r whether he i s i n h i s 200th s e s s i o n , K l e i n " i n t e r p r e t s t o the deepest l e v e l s " a l l h i s a c t i v i t y , be i t o b v i o u s l y s i g n i f i c a n t o r seemingly  insignificant.  The technique of i n t e r p r e t a t i o n ( o f unconscious m a t e r i a l ) completes the l i s t o f techniques s e t out i n Chapter I . s i x t e e n techniques  This completed l i s t o f  (the f i f t e e n i n Ch. I p l u s i n t e r p r e t a t i o n ) c o n s t i t u t e s  the schedule from which the f o u r ease r e c o r d i n g s w i l l be analyzed i n Chapter I I I . C h i l d a n a l y s i s by K l e i n , then, attempts t o i n t e r p r e t  unconscious  m a t e r i a l from the beginning o f treatment t o the end i n order t o r e o r g a n i z e t h e c h i l d ' s p e r s o n a l i t y , and thus "cure" h i s n e u r o s i s . S o c i a l casework treatment, on the o t h e r hand, i s concerned p r i m a r i l y w i t h the r e a l i t y aspects of ego f u n c t i o n i n g . I t d e a l s w i t h the c h i l d ' s unconscious  o g l y when the i n n e r c o n f l i c t i s a r e a l i t y problem t h a t must  be brought i n t o the t h e r a p e u t i c p r o c e s s , but t h e o r e t i c a l l y t h i s m a t e r i a l i s n o t d e a l t w i t h by d i r e c t i n t e r p r e t a t i o n - i t i s handled by s u p p o r t i v e or modifying  techniques.  1 i b i d . p. 116.  CHAPTER I I I SOCIAL WORK INTERVIEWS: AN EXAMINATION OF CONTENT  This chapter d e a l s w i t h the a n a l y s i s o f seven n a r r a t i v e r e c o r d i n g s and a t r a n s c r i p t o f one tape r e c o r d i n g o f casework i n t e r v i e w s w i t h c h i l d r e n a t the C h i l d r e n ' s C l i n i c * One r e c o r d i n g was s e l e c t e d a t random from the caseload o f each o f the seven workers i n v o l v e d i n casework w i t h c h i l d r e n a t the c l i n i c .  The tape- recorded i n t e r v i e w was used f o r  a n a l y s i s because the e n t i r e interview, was recorded step by step e x a c t l y as i t o c c u r r e d *  The two c r i t e r i a f o r the s e l e c t i o n o f cases were t h a t  the c h i l d r e n i n treatment were aged s i x t o c t e n y e a r s i n c l u s i v e , and t h a t each c h i l d was seen a t l e a s t once every week f o r a one-hour s e s s i o n * The c r i t e r i o n f o r s e l e c t i o n o f a p a r t i c u l a r i n t e r v i e w i s t h a t i t was recorded i n s u f f i c i e n t d e t a i l t h a t a t l e a s t some o f each worker's a c t i v i t i e s and responses were i n d i c a t e d . The N a r r a t i v e Recordings Analyzed The f o l l o w i n g schedule shows the use o f techniques a c c o r d i n g to each s o c i a l worker's a c t i v i t i e s and responses i n a s i n g l e i n t e r v i e w with a child.  Each response expressed by each worker i s matched  a g a i n s t the l i s t o f t e c h n i q u e s , as d e s c r i b e d *  When the worker's response  f i t the d e s c r i p t i o n o f a technique i n the w r i t e r ' s c l i n i c a l  judgment,  t h i s response i s s a i d t o c o n s t i t u t e t h a t t e c h n i q u e . Examples o f the way i n which each technique was used w i l l be g i v e n immediately a f t e r the schedule which f o l l o w s *  - 47 TECHNIQUES APPLIED ACCORDING TO EACH SOCIAL WORKER'S ACTIVITIES AND EXPRESSIONS Techniques i n I n d i v i d u a l Interviews;  Frequency of Techniques;  A  B  C  D  E  F  G  32  5  63  1  1  2  1  2  50  2  7  3  -  1  2  2  22  36  2  2  1  5  47  Affirmation.,  -  -  -  • -  1 Explanation.  18  3  Reassurance.  9  Partialization.  Exploration* Relating to Affect. I  53  TOTAL  -  -  -  -  1  I  -  1  '-  2  3  1  28  1  2  —  1  2  —  15  1  -  1  -  -  1  -  -  3  M o d i f i c a t i o n of Environment.  —  —  -  —  -  1  —  -  It  Guidance.  2  1  2  31  1  1  10  Education.  3,  2;  -  —  6  -  1  1  1  1  -  -  Universalization*  -  1  Accreditation.  -  -  1  5  Acceptance•  -  2  -  Summari z a t i o n . Setting Limits.  Realistic. 14  1  -  Clarification.  1  1  -  Interpretation.  -  -  1  -  122  20  21  10  T o t a l Number of A p p l i c a t i o n s of TechniquesIdentified.  2  -  -  3  3  -  -  -  4  8  11  15  8  215  -  -  20 2  - 48 >  The number of times eaoh technique i s used should not be over-  emphasized.  Because Case A vas tape r e c o r d e d , i t was p o s s i b l e to f i n d  many more t e c h n i q u e s , as almost every response by t h i s worker c o n s t i t u t e d a technique as d e f i n e d .  Responses such as "m..m.." were not counted  as a t e c h n i q u e , although t h i s type of response could c o n s t i t u t e : acceptance o r e x p l o r a t i o n , depending on the meaning the worker i s t r y i n g to convey. Illustrations  of Each o f The Techniques  One o r more examples of each technique used i n the i n t e r v i e w s w i l l be g i v e n t o show how they are a p p l i e d . 1. E x p l o r a t i o n There were many good examples of e x p l o r a t i o n i n the r e c o r d i n g s studied. I l l u s t r a t i o n s  of the technique were found i n a l } the r e c o r d i n g s .  An e x c e l l e n t example of the uses of e x p l o r a t i o n occurred w i t h Bob, (see  Appendix B ) .  When the c h i l d i n d i c a t e d t h a t there was some magic i n  h i s mother "hearing h i s f e e l i n g s " ,  the. worker wondered what she says."  T h i s response by the worker i s a"purposeful q u e s t i o n " aimed a t a particular  s u b j e c t t h a t was being d i s c u s s e d .  A more g e n e r a l example o f  e x p l o r a t i o n i s i n the case Cal (see Appendix C) wJbien the worker o p e n e d the  c o n v e r s a t i o n i n the playroom by a s k i n g the c h i l d "what he would  l i k e to do today."  The worker was showing h i s i n t e r e s t  t h i s type of q u e s t i o n i n g . (see  i n the c h i l d ! by  With A r t i n the tape recorded i n t e r v i e w ,  Appendix A ) , there were a l s o some e x c e l l e n t examples of the use of  exploration.  When the c h i l d t o l d the worker he wanted to wash h i s hands  before he l e f t , the worker asked, "Who  says you're not suppoed to g e t  your hands d i r t y , anyway?" By doing t h i s he not o n l y shows the c h i l d he i s i n t e r e s t e d i n him, but he a l s o g i v e s the c h i l d an o p p o r t u n i t y to t a l k about what i s behind h i s w i s h to wash h i s hands. 2* R e l a t i n g t o A f f e c t The technique o f R e l a t i n g to A f f e c t i s shown to be used c l e a r l y i n the  case o f C a l . When the l i t t l e bo$ asked f o r a f l o w e r to g i v e t o h i s  mother the worker's response was t o the e f f e c t  t h a t the c h i l d ! would f e e l  - 4 9 anxious when s e e i n g h i s mother because o f the m a t e r i a l he brought out i n t h i s i n t e r v i e w , and t h a t g i v i n g h e r a f l o w e r would make him f e e l better.  Here the worker noted aloud the presence of a f f e c t , the nature  and r a m i f i c a t i o n s of which were not c l e a r . Another example of the use o f t h i s technique occurred i n the case of Helen (See appendix H). When the l i t t l e g i r l s a i d she was q u i t e a tomboy, and l a t e r " s a i d , t h a t l o t s o f t h i n g s she l i k e d t o do were g i r l s t h i n g s , so maybe i t wasn't so bad a f t e r a l l , "the worker " s a i d she seemed t o be w o r r i e d about b e i n g a tomboy..." A g a i n , t h i s worker showed the  c h i l d t h a t h e r f e e l i n g s were r e c o g n i z e d . This? technique i s almost  i d e n t i c a l t o Rogers' "Recognition! o f e x p r e s s i o n . " ^ 3..  Acceptance  This technique was found many t i m e s , e s p e c i a l l y i n the tape recorded i n t e r v i e w w i t h A r t . An example of acceptance i n t h i s case i s found where the  worker s a y s , "Okay, I don't care what k i n d o f c l o t h e s you've got on,  I know you're a boy," i n answer t o t h e boy's? i m p l i c a t i o n t h a t he i s a boy because he i s wearing boy's c l o t h e s . of  receptivity  1  The worker expresses 'an a t t i t u d e  by showing the boy t h a t he accepts him f o r what he i s ,  not what he wears. Another example o f Acceptance i s found i n the case of C a l . When the  c h i l d wondered what he was g o i n g t o do i n the playroom,the worker  "moved over c l o s e t o him and kept s h o v e l l i n g sand i n a p i l e where he c o u l d reach i t e a s i l y w i t h a machine.'' ""Here t h e worker c l e a r l y attempts; to h e l p the c l i e n t 'to share i n f o r m a t i o n about h i m s e l f which he f e a r s w i l l ! r e s u l t i n r e j e c t i o n , o r which he so thoroughly r e j e c t s i n h i m s e l f t h a t he t r i e s t o conceal i t from h i m s e l f by a v a r i e t y of d e f e n s i v e measures. * 1  His  But the worker i s n o t pushing the c l i e n t t o r e v e a l anything?;.  a c t i o n s move a t the c h i l d ' s pace, y e t he i s making the s i t u a t i o n  e a s i e r f o r t h e c h i l d t o express h i s f e e l i n g s , by showing t h a t he (the worker) i s r e c e p t i v e t o the c h i l d .  Rogers, C a r l R. Councelldng and Psychotherapy. The R i v e r s i d e P r e s s , Cambridge, Massachusetts, 1942. p. 118-126.  - 50 4. Affirmation The c l o s e s t example of g i v i n g open a f f i r m a t i o n t o the c l i e n t ' s v a l i d a p p r a i s a l o f h i s own a t t i t u d e s , behavior, etc*, occurred i n Helen's case.  I n the same sequence d e s c r i b e d i n t h i s case, a f t e r the  worker " s a i d she seemed t o be w o r r i e d about being a tomboy," the worker  1  s a i d , "... I thought most g i r l s h e r age l i k e d doing the t h i n g s she t a l k e d about. "  This remark was r e l a t e d t o the c h i l d ' s remark t h a t  l o t s o f t h i n g s she l i k e d t o do were " g i r l s things," so maybe i t wasn't so bad a f t e r a l l .  While the worker's response was a good example o f  U n i v e r s a l i z a t i o n , i t a l s o i n c l u d e d elements o f A f f i r m a t i o n . was  The worker  i m p l y i n g t h a t the g i r l was c o r r e c t i n saying " l o t s oft" things; she d i d  were g i r l s t h i n g s . " 5). E x p l a n a t i o n This technique i n v o l v e s the g i v i n g o f i n f o r m a t i o n and e x p l a n a t i o n of what i s going on and why. A good i l l u s t r a t i o n o f t h i s occurred i n the case o f Bob. When the worker showed the l i t t l e bojs t h a t the l a d y w i t h b i g ears t h a t he drew was her, she went on t o e x p l a i n t h a t " i t was good t h a t I could hear then I could h e l p and not punish him f o r h i s feelings."  This was an attempt t o a l l a y the c l i e n t ' s f e e l i n g s o f  c o n f u s i o n o r f e a r t h a t the worker f e l t r e s u l t e d from l a c k o f c o r r e c t knowledge.  She was s u c c e s s f u l a t t h i s p o i n t , as can be seen by the c h i l d ' s  r e l e a s i n g the f e e l i n g t h a t he thought there was magic i n i t . Another example o f E x p l a n a t i o n occurred w i t h A r t , when the c h i l d ; asked "What's h e l p mean?"  The worker's response was,  "What's help?  W e l i t h a t means when you have problems we t a l k about them o r we do t h i n g s t o g e t h e r t o t r y t o work on them and get t o understand them b e t t e r . " was  This  a r a t i o n a l g i v i n g o f i n f o r m a t i o n t o e x p l a i n t o the c h i l d why he was  a t the c l i n i c . 6. Reassurance This technique i n v o l v e s on one hand a d i r e c t statement which i n d i c a t e s t h a t the c l i e n t ' s f e e l i n g i s understandable  and/or permissable.  An example o f t h i s technique used i n t h i s way occurred w i t h C a l .  When  - 51 the l i t t l e boy s a i d he was a f r a i d o f f a i l i n g i n school because there was something b o t h e r i n g him a l l the time, the worker r e c o g n i z e d t h a t " i t would be hard t o do school work i f he had other t h i n g s on h i s mind*" The worker t o l d the c h i l d , i n e f f e c t , t h a t i t was understandable  that  he would f e e l t h i s way. The o t h e r use o f t h i s technique i s an i n d i c a t i o n of the worker's c o n v i c t i o n t h a t s o l u t i o n o f the d i f f i c u l t y i s probable.  The use o f  Reassurance i n t h i s way i s shown t o operate c l e a r l y immediately the p r e v i o u s example j u s t i l l u s t r a t e d .  after  When the worker s a i d i t would  be hard t o do school work i f he had other t h i n g s on h i s mind, he went on "and t o l d him we can make the school w6rk e a s i e r by f i n d i n g out what's on h i s mind."  T h i s was a d i r e c t i n d i c a t i o n by the worker t h a t  he t h i n k s something can be done about the problem. 7• P a r t i a l y z a t i o n This technique i n v o l v e s h e l p i n g the c l i e n t separate out and d e a l w i t h one problem a t a time.  Only two examples o f P a r t i a l i z a t i o n were  found i n a l l the r e c o r d i n g s . One o f these occurred w i t h C a l .  When the c h i l d t o l d the worker  t h a t he was hungry a l l the time, and t h a t he was a f r a i d t o t e l l h i s mother, e t c . , the worker asked him t o d e s c r i b e h i s food i n t a k e . The worker by responsing i n t h i s way, a l l o w e d the c h i l d t o concentrate on o h i aspect o f the problem* The o t h e r example o f P a r t i a l i z a t i o n i s n o t so c l e a r c u t , but i t does r e p r e s e n t some elements o f t h i s technique* (see Appendix F ) .  I t occurred w i t h Fred,  A t the beginning o f the i n t e r v i e w , the worker brought  i n m a t e r i a l s t h a t would b r i n g out s p e c i f i c a f f e c t s i n the c h i l d , which he p r e v i o u s l y had been unable t o r e v e a l *  She used the technique o f  P a r t i a l i z a t i o n i n t h a t t h e c h i l d ' s a c t i v i t y would be l e s s d i f f u s e because of the way the worker s e t up the playroom f o r t h i s i n t e r v i e w . 8* M o d i f i c a t i o n o f Environment One use o f t h i s technique as d e f i n e d p r e v i o u s l y , i s "working i n an educative o r p s y c h o t h e r a p e u t i c c a p a c i t y w i t h o t h e r persons i n the c l i e n t ' s environment..." Only one example o f m o d i f i c a t i o n o f environment was  - 52 -  found i n a l l the r e c o r d i n g s *  This occurred i n Fred's case, when the  worker "spoke t o f i r s t h i s f a t h e r , then h i s aunt, and mentioned t h a t perhaps they c o u l d send Danny t o the c l i n i c i n some o l d e r c l o t h e s , f o r example , i n j e a n s , "  This was i n essence an e x p l a n a t i o n by the worker  t h a t Fred would be g e t t i n g messy i n the i n t e r v i e w s and t h a t he c o u l d be more f r e e t o do t h i s i f he were wearing o l d c l o t h e s , 9* Guidance T h i s technique i s the g i v i n g o f s u g g e s t i o n s , advice o r a u t h o r i t a t i v e d i r e c t i o n t o the c l i e n t i n h i s management o f a s p e c i f i c f e e l i n g o r situation*  An e x c e l l e n t i l l u s t r a t i o n o f t h i s : technique i s found i n  Cal's case*  When the c h i l d t o l d the worker he was a f r a i d he was going t o  t a l k t o h i s mother about a problem he d i d n ' t t h i n k he should d i s c u s s ? w i t h ; her, the worker "advised him t o w a i t a l i t t l e w h i l e i f he could u n l e s s he f e l t he had t o go i n t o i t immediately."  The worker n o t o n l y gave the  c h i l d advice as t o how he should handle the s i t u a t i o n , but, a l s o he allowed the c h i l d an a l t e r n a t i v e i f he were unable t o f o l l o w the advice*. Another example of theuse of guidance i s found i n Ed's case* (see Appendix E ) .  When the worker attempted  t o focus on the reasons why the  c h i l d i s coming t o the c l i n i c , and got no response, the worker advised: the c h i l d t o t a l k i t over w i t h h i s mother.  T h i s was d i r e c t advice aimed  a t g i v i n g the c h i l d a b e t t e r understanding o f why he i s r e c e i v i n g treatment. 10. Education This technique i s the g i v i n g o f new knowledge w i t h s u f f i c i e n t e l a b o r a t i o n o f u n d e r l y i n g premises and general a p p l i c a b i l i t y so t h a t the c l i e n t can u t i l i z e t h i s knowledge i n a v a r i e t y o f s i t u a t i o n s , as w e l l as i n r e l a t i o n t o the s p e c i f i c s i t u a t i o n which caused the g i v i n g o f knowledge.  An i l l u s t r a t i o n o f t h i s technique occurred w i t h Bob.  When the  c h i l d t o l d t h e worker t h a t he couldn't marry h i s mother because she was too o l d , and wondered, "Do the other c h i l d r e n decide t h i s and g e t someone t h e i r own age?", the worker e x p l a i n e d t h a t they d i d "when they had grown up and were ready f o r i t . " concerned  The worker was aware t h a t t h e c h i l d was  t h a t he was the o n l y one who f e l t t h i s way, and by g i v i n g him  - S3 the  proper " e d u c a t i o n " i n t h i s r e g a r d , she attempted t o a l l e v i a t e the  child's fear, 11. A c c r e d i t a t i o n T h i s technique i n v o l v e s the worker g i v i n g the c l i e n t c r e d i t f o r s t r e n g t h s which he has Or i s d e v e l o p i n g . was found i n combined r e c o r d i n g s .  Only one i l l u s t r a t i o n o f i t  I t o c c u r r e d w i t h Bob. The l a s t  Bob •', sentence of t h i s r e c o r d i n g says " David took h i s h a l f f i n i s h e d house home and decided t o do two p i c t u r e s as I requested a copy o f h i s house." By a s k i n g the l i t t l e boy t o g i v e h e r something which he c r e a t e d ^ the worker i s showing him t h a t she t h i n k s what he has done i s worth something. She i s g i v i n g him c r e d i t f o r h i s a b i l i t y t o c r e a t e something w o r t h w h i l e . 12. U n i v e r e a l i z a t i o n This technique i n v o l v e s t e l l i n g the c l i e n t t h a t most people would! have s i m i l a r r e a c t i o n s under comparable c i r c u m s t a n c e s . T h i s i s i l l u s t r a t e d w i t h Diane (see Appendix D). When the c h i l d s a i d " a l l work and no p l a y " , the worker r e s p onded by saying " i t may seem t h a t way but p l a y i s good f o r everybody."  She was t e l l i n g the c h i l d t h a t i t i s  a c c e p t a b l e t o want t o p l a y , t h a t everybody does i t , and i t i s good f o r the  child to play. Another use of t h i s technique i s i l l u s t r a t e d i n Bob's i n t e r v i e w .  The worker s a i d t h a t " l i t t l e boys, a t some time on another, g e t crushes on t h e i r workers, t e a c h e r s , mothers.  "Because the boy had i m p l i e d t h a t  he had a c r u s h on h e r , the worker attempted t o a l l e v i a t e the c l i e n t ' s uncomfortable f e e l i n g s which are based on an erroneous b e l i e f t h a t he i s d i f f e r e n t from most o t h e r people. Another i l l u s t r a t i o n o f u n i v e r s a l i z a t i o n was d i s c u s s e d under affirmation. 13. Summarization This technique i n v o l v e s summing up by the worker, f o r the c l i e n t , of  the f a c t o r s and f e e l i n g s i n a g i v e n s i t u a t i o n and the o r g a n i z a t i o n ;  of  these i n an o r d e r l y fashion..  the  T h i s technique was n o t found i n any o f  r e c o r d i n g s a n a l y z e d . One would expect by the nature o f t h i s technique  t h a t i t would occur o n l y a t c e r t a i n times d u r i n g casework treatment, because i t occurs o n l y a f t e r much d i s c u s s i o n beforehand.  The d e f i n i t i o n  g i v e n i n Cbapter I s t a t e d , t h a t summarization i s used o n l y a f t e r there has been adequate e x p l o r a t i o n s t o provide the worker w i t h the necessary m a t e r i a l from the c l i e n t t o combine these f a c t o r s m e a n i n g f u l l y , 14. S e t t i n g R e a l i s t i c L i m i t s Involved i n t h i s technique  i s the o f f e r i n g by the worker o f an image  of more acceptable behavior and s i m u l t a n e o u s l y a i d i n g the suppression of unacceptable  impulses and d e s i r e s ,  A good i l l u s t r a t i o n o f t h i s technique occurred w i t h Glen (see Appendix G). was  When the worker e x p l a i n e d t o t h i s c h i l d t h a t t h e i r time  over, and i t was time t o l e a v e . "He ignored me, running around and  f i n a l l y s p l a s h i n g me, I stopped the s p l a s h i n g and s a i d t h a t I wouldn't allow i t . . . . "  Here the worker a f f o r d s the s t r e n g t h o f h e r own ego t o the  c h i l d by s e t t i n g l i m i t s on the c h i l d ' s  behavior.  Another i l l u s t r a t i o n o f t h i s technique was found i n the A case. When the c h i l d asked h i s worker i f he could take a smock home t h a t belongs t o the c l i n i c , the worker s a i d "no, o t h e r people need i t so they can keep t h e i r c l o t h e s c l e a n . "  I t would have been u n r e a l i s t i c f o r  the worker t o comply w i t h the c h i l d ' s request, and he gave the c h i l d a r a t i o n a l e x p l a n a t i o n o f h i s reason f o r s e t t i n g the l i m i t . Another e x c e l l e n t example o f t h i s technique occurred i n the B.case. When the c h i l d attempted t o l i g h t a f i r e i n the playroom t h a t was beyond t h e bounds o f s a f e t y , the worker s a i d , " . . . i t was i n t e r e s t i n g but i t needed t o be kept i n a safe p l a c e so t h a t n e i t h e r he n o r anyone e l s e would be h u r t by i t . "  The worker r e a l i z e d the danger i n what the  c h i l d was d o i n g , but the c h i l d d i d n ' t .  I t became n o t o n l y r e a l i s t i c ,  but a l s o necessary t o s e t t h i s l i m i t om the c h i l d ' s b e h a v i o r .  It i s  i n t e r e s t i n g t o note i n t h i s i n s t a n c e t h a t the worker's e x p l a n a t i o n showed the c h i l d t h a t i t was p a r t l y f o r h i s own b e n e f i t t h a t the l i m i t was  set. 1 5 #  Clarification  This technique(as a l r e a d y d e f i n e d i n Chapter I,) i n c l u d e s f o u r steps but there were two examples o f the occurrence i s r e f e r r e d t o as C o n f r o n t a t i o n .  o f the f i r s t s t e p , which  This step was d e s c r i b e d i n Chapter I  as "Helping the c l i e n t b r i n g i n g t o g e t h e r i n c i d e n c e s i n h i s a t t i t u d i n a l responses and episodes i n h i s behavior i n such a way as t o enable himto  - 55 see the s t e r e o t y p e d themes o r p a t t e r n s they f o l l o w . " One i l l u s t r a t i o n of the use o f t h i s step i n C l a r i f i c a t i o n i s i n A r t ' s case*  When A r t s a i d "Let's j u s t rub our hands on the sand: and  get r e a | d i r t y . "  The worker's response was "And g e t r e a l d i r t y , you  l i k e g e t t i n g your hands d i r t y today do you?"  The worker by t h i s  remark helped the c h i l d b r i n g t o g e t h e r some of h i s a t t i t u d e s expressed during t h i s interview* The o t h e r i l l u s t r a t i o n of C o n f r o n t a t i o n i n Bob's case, when the c h i l d t o l d the worker " t h a t he does not l i k e the i d e a of s h a r i n g the house w i t h o t h e r c h i l d r e n . "  The worker then "recognized t h a t i t i s  d i f f i c u l t f o r B t o share when he needs people and t h i n g s a l l t o h i m s e l f . " The worker here was h e l p i n g the c h i l d see t h a t s e l f i s h n e s s i s ; a general a t t i t u d e he has shown over a p e r i o d of time*. 16. I n t e r p r e t a t i o n I n t e r p r e t a t i o n i s used here as d e s c r i b e d by K l e i n - c o n t a c t i n g "the deepest l e v e l s " o f the unconscious.  I t i s the one and o n l y technique  t h a t she uses from the beginning of treatment t o the end. This technique was found t o occur a t o t a l of f o u r times i n a l l the; r e c o r d i n g s , three times i n one i n t e r v i e w , and once i n another.  Because  i t i s not a s o c i a l work technique as such, each occurrence of t h i s technique w i l l be shown. The f i r s t i l l u s t r a t i o n o f i n t e r p r e t a t i o n t o be d i s c u s s e d occurred w i t h Beir.  When the c h i l d t o l d the worker he was going t o the t o i l e t ,  the worker responded by s a y i n g t h a t "he was going t o the t o i l e t t o make sure h i s d i n k y i s s t i l l t h e r e because he's a f r a i d of l o s i n g i t . "  Here:  the worker i n t e r p r e t e d d i r e c t l y t o the c h i l d h i s c a s t r a t i o n f e a r . I n Ed's case, there were three examples of the use o f i n t e r p r e t a t i / o n as d e s c r i b e d by K l e i n .  When the c h i l d t a l k e d about d a r t s and a bow  and arrow, and l a t e r s a i d he was a f r a i d of snakes, the worker t o l d the c h i l d t h a t h i s f e a r of snakes, and o f the arrow were f e a r of f a t h e r ' s v X  p e n i s , and e x p l a i n e d t o him what a penis was."  T e l l i n g the c h i l d of  h i s f e a r of f a t h e r ' s penis was c e r t a i n l y an i n t e r p r e t a t i o n , but the worker went on t o use the s o c i a l work technique of E x p l a n a t i o n -  -  "and e x p l a i n e d to him was  56  -  a penis was.  " K l e i n would have approved of  the i n t e r p r e t a t i o n * but not the e x p l a n a t i o n . The next use of i n t e r p r e t a t i o n occurred immediately p r e v i o u s statement.  a f t e r the  When the c h i l d suggested he plug the toy vacuum  c l e a n e r i n t o the w a l l , the worker t o l d the c h i l d t h i s was i n t e r c o u r s e . A g a i n , K l e i n weuld have approved of t h i s response. The f i n a l use of i n t e r p r e t a t i o n occurred l a t e r i n t h i s i n t e r v i e w when the worker t o l d the c h i l d h i s p l a y i n g i n itfhe sand masturbation.  This was  represented  a l s o i n t e r p r e t i n g to the deepest l e v e l s .  worker went f u r t h e r and reassured t h e . c h i l d t h a t masturbation  The  thoughts  are p e r m i s s i b l e . I n both i n t e r v i e w s t h a t i n t e r p r e t a t i o n was p r e s e n t , the had been i n treatment  children  f o r a c o n s i d e r a b l e l e n g t h of time (BeJr f o r one  and A r t f o r nine months).  A l s o , both workers were r e c e i v i n g  year  psychiatric  direction. I n regard t o the use of the s o c i a l work t e c h n i q u e s , an example w i l l be g i v e n t o show how  the techniques are based on the s o c i a l work  p r i n c i p l e s , and are used i n r e l a t i o n t o an understanding  of the dynamics  of the c h i l d ' s b e h a v i o r , and the c l i e n t - w o r k e r r e l a t i o n s h i p . I n the f i r s t example snder Reassurance, the c h i l d was w o r r i e d about h i s t r o u / b l e i n s c h o o l , and the worker "recognized t h a t i t would be hard to do school work i f he had o t h e r t h i n g s on h i s mind." of i n d i v i d u a l i z a t i o n i s c l e a r l y o p e r a t i n g here.  The  principle  The worker does not  move ahead of o r behind the c h i l d , but responds to him i n a way  that  would show the c h i l d t h a t he i s " w i t h " him, t h a t he understands how would f e e l .  A l s o the p r i n c i p l e of "Acceptance" i s e v i d e n t .  he  The worker  accepts the C h i l d ' s f e e l i n g s of worry without t e l l i n g him t h a t he shouldn't have these f e e l i n g s , o r t h a t he doesn't need to worry - h e ' l l do a l l r i g h t .  The worker was  "Communicating" w i t h the c h i l d and  he  d i d n ' t a l l o w h i s own f e e l i n g s t o i n t e r f e r e (worker s e l f - a w a r e n e s s ) , w i t h what he f e l t the c h i l d needed. F u r t h e r , the worker, by t h i s r e s p o n s e , shows an understanding  of the  c l i e n t - w o r k e r r e l a t i o n s h i p by a l l o w i n g the c h i l d to f e e l t h a t he i s safe i n t e l l i n g the worker about h i s f e e l i n g s .  This understanding  too  - 57 r e p r e s e n t s an understanding of the s c i e n t i f i c method.  By a l l o w i n g the  c h i l d t o experience a response t h a t says i n e f f e c t , " i t i s a l l r i g h t t o express what you f e e l " , the worker w i l l convey t o the c h i l d , when t h i s i s done over a p e r i o d of t i m e , t h a t he w i l l always be safe t o express; his feelings within their relationship. I t i s more d i f f i c u l t t o i n d i c a t e how t h i s technique i s r e l a t e d t o an understanding of the dynamics of human b e h a v i o r .  In this particular  case, the worker was aware t h a t the c h i l d has been a f r a i d t o express; h i s f e e l i n g s t o h i s parents because when he has attempted t o do i t he was punished f o r i t . The worker, then, a l l o w s the c h i l d t h i s new experience o f e x p r e s s i n g f e e l i n g s w i t h o u t being punished o r c r i t i c i z e d f o r i t . I f the c h i l d ' s main problem i s t h a t he i s allowed too much freedom i n a c t i n g out, p o s s i b l y the worker's g e n e r a l approach would be different. I t should be noted t h a t the techniques as they occurred i n t h i s study sometimes overlapped.  F o r example the i l l u s t r a t i o n ! of A f f i r m a t i o n g i v e n ,  a l s o i n c l u d e d elements of U n i v e r s a l i z a t i o n .  A l s o , the techniques o f  E d u c a t i o n and E x p l a n a t i o n were o f t e n hard t o d i s t i n g u i s h as were those o f A f f i r m a t i o n and A c c r e d i t a t i o n , because each o f these p a i r s c o n t a i n s many of the same elements i n i t s descriptions:.  However, on the whole, the:  techniques were f a i r l y c l w a r and easy t o i d e n t i f y . A l l techniques were found t o be used a t l e a s t once i n the sample s t u d i e d , w i t h one e x c e p t i o n .  The a p p l i c a t i o n of summarization was not  found i n any o f the r e c o r d i n g s a n a l y z e d . Some techniques were found a g r e a t number o f t i m e s , w h i l e others were found o n l y once o r twice.. The techniques o f e x p l o r a t i o n and acceptance were used by f a r the most f r e q u e n t l y . ! Almost any e x p r e s s i o n of "okay", o r " I see", e t c . could be regarded as"acceptance" by the worker, a c c o r d i n g t o i t s d e s c r i p t i o n .  Any i n d i c a t i o n t h a t the worker i s  a s k i n g the c h i l d t o speak i s " e x p l o r a t i o n " . Techniques  such as a f f i r m a t i o n , a c c r e d i t a t i o n , c l a r i f i c a t i o n were  found l e s s f r e q u e n t l y . M o d i f i c a t i o n o f environment was found o n l y once. As mentioned i n Chapter I , one would expect a very l i m i t e d use o f t h i s technique, because the c h i l d i s seen i n the c l i n i c : , f o r " p s y c h o l o g i c a l " h e l p w i t h i n h i s present  environment.  CHAPTER IV CLARIFYING THE FOR  SOCIAL WORK INTERVIEW CHILDREN  The unique problems presented i n working w i t h c h i l d r e n have been d i s c u s s e d i n a g e n e r a l sense as they r e l a t e to s o c i a l work, and  now  professional  s p e c i f i c a l l y i n r e l a t i o n to the s o c i a l worker under  p s y c h i a t r i c d i r e c t i o n at the C h i l d r e n ' s  C l i n i c i n Burnaby*  The  purpose  of t h i s examination i s to determine on what b a s i s the s o c i a l worker responds to the d i s t u r b e d  c h i l d i n d i r e c t treatment, t h a t i s , what  techniques does the s o c i a l worker apply i n a g i v e n s i t u a t i o n ?  One  would n a t u r a l l y expect t h a t i f a s o c i a l worker works w i t h i n h i s area of competence, he must r e l y s o l e l y on s o c i a l work techniques* he do so i n a c l i n i c under p s y c h i a t r i c d i r e c t i o n , or does he apply p s y c h i a t r i c techniques as a r e s u l t of p s y c h i a t r i c Two  also  consultation?  frames of r e f e r e n c e are used to view the a c t i v i t i e s  responses of the s o c i a l workers a t the C h i l d r e n ' s  But does  and  C l i n i c - the method  of s o c i a l casework and i t s a p p l i c a t i o n to c h i l d r e n and the p s y c h o a n a l y t i c method of treatment, p a r t i c u l a r l y the Melanie K l e i n a p p l i c a t i o n to children.  The  reasons f o r the s e l e c t i o n of these two  a l r e a d y been set  frameworks have  out.  F i f t e e n techniques have been i d e n t i f i e d i n the former approacht ( l ) exploration,  (2) r e l a t i n g to a f f e c t , (3) acceptance, (4)  (5) e x p l a n a t i o n ,  (6) reassurance, (7) p a r t i a l i z a t i o n , (8)  affirmation,  modification  of environment, (9) guidance, (10) e d u c a t i o n , ( l l ) A c c r e d i t a t i o n , (12) u n i v e r s a l i z a t i o n , ( 1 3 )  summarization*setting r e a l i s t i c  limits,  and  (15) c l a r i f i c a t i o n .  one  technique i n a l l s i t u a t i o n s - the i n t e r p r e t a t i o n of unconscious,  material.  In the l a t t e r approach, K l e i n r e l i e s on o n l y  These s i x t e e n techniques have been d e s c r i b e d i n d e t a i l .  Recordings have been s e l e c t e d from the caseloads of the s o c i a l workers a t C h i l d r e n ' s  C l i n i c and  the worker's responses i n these  - 59 recordings  -  have been matched w i t h the d e s c r i p t i o n of thetechniques  r e f e r r e d to above.  This method, has been adapted to help determine  whether these s o c i a l workers apply techniques learned i n p s y c h i a t r i c ; c o n s u l t a t i o n , or whether they use t h i s , c o n s u l t a t i o n to help understand the c h i l d , and apply s o c i a l work techniques p o s s i b l y more c o n f i d e n t l y , as a r e s u l t of t h i s i n c r e a s e d understanding.  More s t u d i e s of t h i s  same k i n d are. needed to e s t a b l i s h the s i t u a t i o n more s e c u r e l y ;  but  o b v i o u s l y the k i n d of "experiment" which has been here conducted w i l l h e l p to d e f i n e " S o c i a l Work" more p r e c i s e l y i n t h i s p a r t i c u l a r context. S o c i a l Work Techniques I t i s evident t h a t i t i s proper to speak of " S o c i a l Work Techniques" per se. And  the a n a l y s i s of the s e l e c t e d case o n a t e r i a l , shows t h a t  casework techniques are d i s t i c t l y predominant.  This a n a l y s i s  reveals  a l s o t h a t of the s o c i a l casework techniques a p p l i e d , almost a l l were supportive  t e c h n i q u e s — t h e r e were o n l y two examples of the modifying  technique of c l a r i f i c a t i o n .  I n a d d i t i o n , there were f o u r examples of  i n t e r p r e t a t i o n o f unconscious m a t e r i a l — t h r e e  a p p l i c a t i o n s by one worker  and one a p p l i c a t i o n by another. The  schedule of technique a p p l i c a t i o n s r e v e a l s t h a t the technique  of e x p l o r a t i o n was used a t l e a s t once by every worker; r e l a t i n g to a f f e c t appeared i n seven i n t e r v i e w s out of e i g h t ; acceptance;, e x p l a n a t i o n , and guidance were found i n s i x i n t e r v i e w s ; reassurance appeared i n f i v e ; u n i v e r s a l i z a t i o n and s e t t i n g r e a l i s t i c l i m i t s occurred i n f o u r i n t e r v i e w s ; p a r t i a l i z a t i o n and education appeared i n t h r e e ;  and  a f f i r m a t i o n , m o d i f i c a t i o n of environment and a c c r e d i t a t i o n each appeared; i n o n l y one  of the i n t e r v i e w s .  These are the techniques d e s c r i b e d  in  Chapter I as techniques c o n t r i b u t i n g to support. From the a n a l y s i s of the s e l e c t e d c a s e . r e c p r d i n g s ,  then, a l l the  s o c i a l workers a p p l i e d the s o c i a l casework technique's i n these i n t e r v i e w s , w i t h the p s y c h o a n a l y t i c  technique of i n t e r p r e t a t i o n of  unconscious m a t e r i a l a p p l i e d extremely r a r e l y * The  i m p l i c a t i o n s ; of these f i n d i n g s must be considered  w i t h the l i m i t a t i o n s of the study as s e t out i n Chapter I .  i n accordance I n the  first  p l a c e , the technique of which was  a p p l i c a t i o n s were analyzed i n i n t e r v i e w s , each  taken out of context of a s e r i e s of i n t e r v i e w s .  i m p o s s i b l e to determine the o v e r a l l b e n e f i t to the c h i l d by approach.  It is this  Y e t , the main c o n s i d e r a t i o n i n s o c i a l work w i t h c h i l d r e n i d  the b e n e f i t the c h i l d gains from t h i s experience.  I t i s precisely i n  t h i s area t h a t the most s e r i o u s gap i n r e s e a r c h seems to l i e *  A more  d e t a i l e d study i s needed to show the c h i l d ' s "movement" d u r i n g  treatment*.  T h i s k i n d of study would i n v o l v e a comparison of a c h i l d ' s f u n c t i o n i n g a t the beginning o f treatment w i t h h i s f u n c t i o n i n g throughout amd  a f t e r treatment has terminated.  treatment,  More w i l l be s a i d l a t e r about the  need f o r a study of t h i s k i n d * Secondly, w h i l e the a p p l i c a t i o n of s o c i a l work techniques over 98$  constituted  (211 out of 215) of the responses i n the s e l e c t e d i n t e r v i e w s ,  i t : cannot be conclud'ed t h a t t h i s t r u e of a l l the casework w i t h c h i l d r e n done a t the C h i l d r e n ' s C l i n i c .  A l a r g e r , more r e p r e s e n t a t i v e sample  would be needed to a r r i v e a t a c o n c l u s i o n a p p l i c a b l e f o r the whole clinic.  But because there was  such a l i m i t e d number of  recordings  s u f f i c i e n t l y e x t e n s i v e f o r a n a l y s i s , i t was decided t h a t by t a k i n g a sample r e c o r d i n g by every worker, a t l e a s t some i n d i c a t i o n s o f worker o r i e n t a t i o n could be l e a r n e d through a n a l y s i n g t h e i r a c t i v i t i e s . The t h i r d l i m i t a t i o n s e t out i s t h a t there are no p r e c i s e l y 1  s t a n d a r d i z e d c r i t e r i a f o r a n a l y z i n g technique  a p p l i c a t i o n s . While the  w r i t e r b e l i e v e s most of the w o r k e r s ! responses were q u i t e c l e a r l y e q u i v a l e n t to the d e s c r i p t i o n s of s p e c i f i c techniques, there i s c e r t a i n l y room f o r argument about some of the responses i n the i n t e r v i e w s selected*. I n a n a l y s i n g the s e l e c t e d r e c o r d i n g s , other l i m i t a t i o n s emerged t h a t were not f o r e s e e n .  For example, i n a l l the r e c o r d i n g s ( i n c l u d i n g ;  the t r a n s c r i p t of the t a p e ) , there are p r a c t i c a l l y no i n d i c a t i o n s of workers' a t t i t u d e s u n d e r l y i n g the use of techniques.  I t has  already  been i n d i c a t e d i n Chapter I , t h a t the s o c i a l casework techniques were based on s o c i a l work v a l u e s , p r i n c i p l e s , e t c . but i t would have been h e l p f u l i f workers' a t t i t u d e s were expressed i n t h e / r e c o r d i n g s because" t h i s would provide a more meaningful p i c t u r e of the workers' purposes i n  - 61 -  applying s p e c i f i c  techniques.  Along w i t h t h i s , i s the q u e s t i o n of the amount of the s o c i a l worker's conscious awareness t h a t he i s a p p l y i n g a s p e c i f i c technique.  For  example, when the technique of r e l a t i n g to a f f e c t i s a p p l i e d , i s the worker c o n s c i o u s l y r e l a t i n g to the c h i l d ' s f e e l i n g s , or i s he responding to the c h i l d on the b a s i s of h i s g e n e r a l understanding of the work body of knowledge*  social  I s i t n e c e s s a r i l y h e l p f u l f o r the worker to  be aware of a s p e c i f i c technique he i s a p p l y i n g , o r i s i t s u f f i c i e n t to have an understanding of the v a l u e s and p r i n c i p l e s and behavior o f the child?  I t would he i n t e r e s t i n g to determine the awareness of technique  a p p l i c a t i o n s by s o c i a l workers, but i t i s b e y o n i i t h e scope of t h i s study to do so.  T h i s too may  be a v a l u a b l e area f o r f u r t h e r r e s e a r c h .  The  use of q u e s t i o n n a i r e s would seem to t h i s w r i t e r to be a u s e f u l method f o r g e t t i n g workers to express to whst extent they are aware, o f t h e i r technique a p p l i c a t i o n s . A f u r t h e r problem t h a t emerged was r e c o r d i n g s was  t h a t the a n a l y s i s of the  based on what the workers Sfiid they had done. " "  11  T h i s study's  i  f i n d i n g s , t h e n , are based en what the workers b e l i e v e d was  sufficiently  s i g n i f i c a n t to r e c o r d , not the workers' t o t a l a c t i v i t i e s i n the i n t e r v i e w s . The  r e c o r d i n g s used f o r t h i s study were chosen from the most expensive  on f i l e , y e t even these d i d not seem to r e v e a l the whole p i c t u r e of. the interview.  For example, f o u r of the i n t e r v i e w s showed the a p p l i c a t i o n  of eleven o r l e s s techniques compared to 122 a p p l i c a t i o n s found i n the tape-recorded i n t e r v i e w . contained  I t i s d i f f i c u l t to b e l i e v e t h a t one  interview  122 technique a p p l i c a t i o n s w h i l e f o u r others a c t u a l l y  contaained  eleven or l e s s .  Why,  t h e n , the tremendous v a r i a t i o n between  technique a p p l i c a t i o n s i n the tape-recorded i n t e r v i e w and the interviews?  other  Each worker's b i a s e s w i l l c e r t a i n l y a f f e c t what he. r e c o r d s ,  and no i n t e r v i e w can be remembered i n i t s e n t i r e t y .  I t would be  i n t e r e s t i n g to determine what i n f l u e n c e s cause a worker to record c e r t a i n a c t i v i t i e s t h a t occur i n an i n t e r v i e w , and to omit others*  - 62 While there i s no attempt i n t h i s study t o determine a l l the i n f l u e n c e s a t work, i n d i c a t i o n s of workers' p r e f e r e n c e s do show up i n the schedule*  For example, the t o t a l a p p l i c a t i o n s ^ ' r e l a t i n g to a f f e c t  are f a r fewer than the a p p l i c a t i o n s of acceptance, e x p l a n a t i o n , and e x p l o r a t i o n . Y e t , e x c l u d i n g the tape-recorded i n t e r v i e w , r e l a t i n g t o a f f e c t occurs more o f t e n than acceptance and e x p l a n a t i o n , and o n l y onae l e s s than e x p l o r a t i o n .  I t c o u l d be t h a t there are d i f f e r e n c e s i n  workers' p r e f e r e n c e s i n what techniques t o use, but i t might a l s o be t h a t techniques such as acceptance, e x p l o r a t i o n and e x p l a n a t i o n are not recorded as o f t e n as such techniques as r e l a t i n g t o a f f e c t * ,  In  the present study, there i s no way t o determine which of these a l t e r n a t i v e s i s c o r r e c t , but f u r t h e r study may question.  shed l i g h t on t h i s  A w i d e r use of tape-recorded i n t e r v i e w s would c e r t a i n l y h e l p  i n determining e x a c t l y how  o f t e n and i n which way,  techniques are  a p p l i e d , and would o f f e r an i n t e r e s t i n g comparison w i t h i n t e r v i e w s recorded l a t e r by the workers. However, w i t h o u t m i n i m i z i n g the important f u n c t i o n the use of tape-recorded i n t e r v i e w s c o u l d p l a y i n s u p e r v i s i o n ^ and e d u c a t i o n , one must be c a r e f u l not to overemphasize the. u s e f u l n e s s of v i e w i n g s o c i a l work a c t i v i t i e s i n one i n t e r v i e w out of c o n t e x t , t h a t i s , as o n l y one i n a s e r i e s of i n t e r v i e w s . The purpose o f s o c i a l work w i t h c h i l d r e n i s to enhance the c h i l d ' s s o c i a l f u n c t i o n i n g , and the; success: orr l a c k o f i t cannot be determined by the approach used i n t h i s study*,  As  mentioned p r e v i o u s l y , the g r e a t need i s ; f o r a study to attempt t o determine the e f f e c t i v e n e s s of treatment of c h i l d r e n a t C h i l d r e n ' s Clinic. I n s p i t e of these l i m i t a t i o n s there is& c e r t a i n l y s t r o n g i n d i c a t i o n t h a t the s o c i a l workers a t C h i l d r e n ' s C l i n i c choose to r e l y h e a v i l y on s o c i a l work t e c h n i q u e s .  Another v a l u e of the present study may  be  i n a i d i n g the beginning caseworker t o understand the wa$ i n which the techniques of s o c i a l casework are a p p l i e d by more experienced s o c i a l  - 63 workers.  I n t h i s area too, however, one must be c a r e f u l not to conclude  t h a t because s o c i a l casework techniques are a p p l i e d by experienced  and  t r a i n e d workers, i t n e c e s s a r i l y means they are ajplied c o r r e c t l y and i n a way  t h a t i s h e l p f u l t o the c h i l d ?  Again the question of e v a l u a t i o n  of the e f f e c t i v e n e s s of workers' a c t i v i t i e s presents  i t s e l f , and agaan  i t must be s t a t e d t h a t t h i s e v a l u a t i o n can be made o n l y by  considering  the improvement of the c h i l d as a r e s u l t of treatment. To attempt a study w i t h the purpose of determining  whether and i n  what ways the c h i l d has b e n e f i t e d from treatment, c e r t a i n l y would present serious d i f f i c u l t i e s .  For example, i t i s treacherous to argue t h a t a  c h i l d ' s improvement i n s o c i a l f u n c t i o n i n g i s due he r e c e i v e d a t the c l i n i c .  s o l e l y to the treatment  P o s s i b l y a c h i l d ' s improvement i s due  to  improved p a r e n t a l a t t i t u d e s , o r spontaneous recovery, o r m a t u r a t i o n ,  etc.  But even w i t h these d i f f i c u l t i e s , a study o f t h i s k i n d must be undertaken. There c e r t a i n l y are some changes i n f u n c t i o n i n g t h a t one can a t t r i b u t e f a i r l y d e f i n i t e l y to the i n f l u e n c e of treatment. example, showed v i v i d l y how  Borothy Baruch, f o r  s p e c i f i c a c t i v i t i e s i n treatment caused  c e r t a i n responses o u t s i d e of treatment i n a boy nine years of age asthma. * Much of the i n t e r a c t i o n i n Therapy was the way  with  d i s c u s s e d , as w e l l as  i n which t h i s i n t e r a c t i o n i n f l u e n c e d the c h i l d g e n e r a l l y .  It is  t h i s k i n d of approach, w i t h many c h i l d r e n , t h a t i s needed to form a study at t h i s  time.  I n summary, then, w h i l e t h i s study has shown t h a t s o c i a l workers r e l i e d almost s o l e l y on s o c i a l casework techniques i n t h e i r work w i t h c h i l d r e n i n the i n t e r v i e w s s e l e c t e d , a much l a r g e r sample i s needed before i t can be assumed t h i s s r e l i a n c e i s u n i v e r s a l throughout  Children's  C l i n i c : more important s t i l l , a broader approach i s heeded to i n d i c a t e t h e e b e n e f i t s to the c h i l d t h a t are gained through t h e a p p l i c a t i o n of these  techniques. Other I m p l i c a t i o n s As a l r e a d y i n d i c a t e d s o c i a l workers a t C h i l d r e n ' s C l i n i c r e c e i v e  regular psychiatric supervision.  Baruch, Dorothy.  In the s m a l l sample used i n t h i s study,  One L i t t l e Boy. J u l i a n P r e s s , New  York,  1953.  - 64 s o c i a l casework t e c l i q u e s were used almost [.exclusively. i s the purpose of t h i s c o n s u l t a t i o n ? provided I t was  What, then,  I t appears; t h a t c o n s u l t a t i o n ; i s  to g i v e theeworker a b e t t e r i n s i g h t i n t o the c h i l d ' s dynamics.  argued i n the f i r s t chppter t h a t the: s o c i a l - w o r k e r s  activities  1  are g r e a t l y i n f l u e n c e d by t h e i r understanding ogf the c h i l d , c o n s u l t a t i o n attempts to i n c r e a s e t h i s understanding. of how  and  The whole problem  c o n s u l t a t i o n does i n f a c t i n f l u e n c e the worker i s a l s o an important  q u e s t i o n t h a t i s r e a i s e d by t h i s study, but not answered. use of q u e s t i o n n a i r e s  Again the  seems a p p r o p r i a t e to a s c e r t a i n workers' f e e l i n g s  and thoughts' regarding: c o n s u l t a t i o n and how  i t i n f l u e n c e s them.  Althoughi there were v e r y few i n t e r p r e t a t i o n s of unconscious m a t e r i a l found i n the s e l e c t e d i n t e r v i e w s , i t would a l s o be i n t e r e s t i n g to determine what i n f l u e n c e d the workers to apply t h i s technique a t a l l . Did they f e e l i t , was they d i d , why?? Was  a necessary step i n the. c h i l d ' s ; treatment?  And i f  the a p p l i c a t i o n of t h i s technique recommended by  p s y c h i a t r i c consultant?  Was  the  the a p p l i c a t i o n , of t h i s t e c h n i q u e considered  to be a worthwhile experiment?  Or were there other reasons?  u l t i m a t e g o a l of casework treatment i s to help the child".  The  Therefore, i t  appears to t h i s w r i t e r t h a t s p e c i a l j u s t i f i c a t i o n would be needed f o r the use of t h i s technique by s o c i a l workers s i n c e they are not  specifically  trained i n i t s application. I t appears, t h e r e f o r e , t h a t the worker should be aware of the importance of adhering to and p r a c t i s i n g the s k i l l s he knows; and  he  should d i s t i n g u i s h c l e a r l y , i n h i s own mind and p r a c t i c e , between the uses of p s y c h i a t r i c c o n s u l t a t i o n and s o c i a l work s u p e r v i s i o n .  65 APPENDIX A Excerpts; from tape-recorded i n t e r v i e w s w i t h Art: Arts Workers  T h i s f i r e e n g i n e s here. Ohl I s i t , eh. 1  Long Pause; Ws  (Cough) Yes;, I brought t h a t i n f o r you, 'cause you asked for i t l a s t time.  Pause  (The f i r e engine i s making q u i t e a b i t o f n o i s e as i t runs along the f l o o r . ) Out of my way. (Garbled y e l l ) - might h i t something1 m..m... Can I see ( g a r b l e ) how many d o l l a r s you got? Can you what? Want t o see one dime. A dime? Yeh. You want t o see my money, eh. Yeh. Okay*. While we p a i n t . Okay - t h e r e ' s a dime* Do you m..m*. what — my T.V's, my T.V's broken. I s i t , eh? R i g h t ( g a r b l e ) i n the s t o r e , m*. There's a dime. Only ^ g a r b l e ) a l l the dimes you've g o t . A l l the dimes I've g o t , w e l l t h e r e ' s t h r e e . Wish I could have t h i s money, o n l y one. I can't g i v e you my money because I need i t A. Ohl What I can g i v e you i s ; my f r i e n d s h i p } and h e l p , not money. What's h e l p mean? What's help? Well t h a t means when you have problems we t a l k about them o r we do t h i n g s t o g e t h e r t o t r y t o work on them and g e t t o understand them b e t t e r .  As As Ws As Ws As Ws As Ws As Ws As Ws As Ws As Ws As Ws As Ws As Ws As Ws  J  (A i n t e r r u p t s w i t h - ) As Ws As Ws As Ws  Got no; head, ( l e a d cowboy) m..m.. Who chopped a l l the heads o f f ? Who chopped a l l the heads o f f ? Yeh.. I don't know , I guess o t h e r k i d s .  66 Workers Arts Ws As Ws As Ws A: Ws As Ws As Ws As Ws As Ws As Ws As Ws A: Ws As Ws  As Ws As Ws As Ws As Ws As Ws As Ws As  What's t h a t ? (Mumbles the sentence again.) W e l l look a t t h a t , look* Do you l i k e t h a t c o l o u r ? Yeh. (Then mumbles something about other c o l o u r s . ) Look at t h a t . m.»m.». Oh, I've got on my new s h i r t . Oh. you've got a new s h i r t - t h a t ' s n i c e . I don't want p a i n t on i t . You don't want t o o , maybe you should put a coat on - do you want a smock? Okay, get me one, i t had b e t t e r be a boy's. Oh, w e l l the boys' are p r e t t y s m a l l , I don't know i f i t would f i t you - do you t h i n k i t would, o r do you want t h i s one? W e l l i t ' s only my sweater, okay, and I got t o wear t h i s one. Okay, I don't care what k i n d of c l o t h e s you've got on, I know you're a boy. I t i s r e a l l y n i c e t h a t you're a boy. You can see I'm a boy, you can see I'm not a g i r l 'cause I don't wear g i r l ' s c l o t h e s ; I wear boy's. Oh, you're a boy r e g a r d l e s s of what you wear, you're s t i l l a boy. I s t h a t a man's? I s t h a t a man's what? A man's coat. That's f o r a man o r a woman. Oh., Anybody who wants to wear i t , i t ' s j u s t to keep your clothes clean. Oh. I'm s t i l l a man even i f I wear i t you know* Oh, and I'm s t i l l a boy i f I wear t h i s ? Sure you a r e . 1  We can't go { g a r b l e ) f o r a day, can we? We can't what? We can't go on t h i s day can we? On t h i s day? YehI On t h i s r a i n y day. Here? Yeh. Oh, I t h i n k t h a t there w i l l be day centre f o r you - iff you come. Okay - l i k e to wash o f f my hands. Yeh. You're going to wash o f f your hands, eh? umm.. I t ' s time to go? Yeh, who says you're not supposed to get your hands d i r t y , anyway? No one.  6JT  Worker: Art:  No one, eh. Um-hm..m..m..• You do t h a t t o o l ( T e l l s worker t o p a i n t on w a l l l i k e A i s doing.) W: Okay. A: But you do i t over t h e r e . W: Over where? As You do i t over t h e r e . Ws Here? A: Yeh. Ws Okay, l i k e t h i s ? ( P a i n t s on w a l l w i t h hands.) As - .- Yeh. A: No, no, I want you t o do i t over here so t h a t i t w i l l go therel, . W: Over here? A: Yeh. I'm running out of p a i n t ( g a r b l e s ) . ; Ws How do you l i k e t h a t c u r l y g i g g . (Worker runs f i n g e r n a i l s through p a i n t on w a l l . ) . A:' . What?' ' W: How do you l i k e t h a t c u r l y g i g g l e I made w i t h my f i n g e r nails? A: What's t h i s ? 1  1  Pause Ws As Ws As Ws As Ws As Ws As Ws As Ws As As Ws As Ws As Ws As. • Ws As As: ' ' Ws .'.  m.. • Going t o w a i t t o p a i n t some more. About time t o go? Not going t o p a i n t , eh. Okay* Time t o go? ' Oh, i n a couple of minutes. How much? Oh, about two. Oh, Oh. m. .m. ... E h l can I p l a y t o your o f f i c e , can I , l e t ' s goto your o f f i c e u n t i l i t ' s time t o go. You want t o go t o my o f f i c e do you? Okay — you can go to my o f f i c e f o r a few minuted. I want t o p a i n t the baby. You're going t o p a i n t the baby. Yeh. (Smears blue p a i n t on face and b l a n k e t s o f d o l l baby i n c r i b . ) Yeh, look a t , look a t him, come and look a t him, look a t him, he's a l l crushed up/ He's a l l crushed, up, e h l Um..hm*. L e t ' s j u s t rub our hands on the sand now and g e t r e a l d i r t y . (Gets p a i n t and sand on hands.) And g e t r e a l d i r t y , you l i k e g e t t i n g your hands d i r t y today, do you?. Yeh. • . m. .m..., • . Use some of t h i s . m..m... (W and A both g e t hands covered w i t h p a i n t and sand.) . Get a whole bunch of t h i n g s on you hand. Come; on and g e t them cleaned o f f now. '.Okay. ••  68  APPENDIX B Recorded I n t e r v i e w w i t h Bob  This.was a very i n t e r e s t i n g i n t e r v i e w w i t h Bob. He was a t f i r s t v e r y angry because the d o l l ' s house was n o t e x a c t l y as he had l e f t i t and he took a l l . the f u r n i t u r e out and tossed i t on t o the floor-. He broke a wood en t a b l e and I requested h i s h e l p for. f i n d ! one of the l e g s , which he gave me a l i t t l e u n w i l l i n g l y . We t a l k e d about why he i s so angry and be was able t o say t h a t he does n o t l i k e the i d e a o f s h a r i n g the house w i t h o t h e r c h i l d r e n . I recognized t h a t i t i s d i f f i c u l t f o r Bob t o share when he needs people; and t h i n g s a l l . to> h i m s e l f . He then drew a p i c t u r e o f a woman on the board ( i t was so p r i m i t i v e t h a t he had t o i d e n t i f y i t as a woman) w i t h huge e a r s . I suggested t h a t t h i s lady must hear an awful l o t which perhaps he doesn't want h e r t o . He agreed w i t h t h i s vehemently. I wondered i f the p i c t u r e might be me and he s a i d i t was. I s a i d t h a t i t was good t h a t I c o u l d hear then I could h e l p and n o t punish him f o r h i s f e e l i n g s . He i n d i c a t e d t h a t there was some magic i n t h i s and I assured him t h a t t h i s i s n o t so t h a t I know o n l y what he t e l l s me by words o r h i s b e h a v i o r . I wondered i f he f e e l s h i s mother hears too much and he then drew l a r g e r ears and s a i d t h a t she can heare v e r y t h i n g whether she i s there o r not and again the: same q u a l i t y o f magic pervaded. I wondered what she hears and he was vague i n h i s response. I n r e p l y t o my q u e s t i o n he s a i d h i s teacher doesn't hear anything and drew a p i c t u r e o f h e r without e a r s . Bob i s s t i l l i n the lowest group a t school and says he l i k e s i t t h e r e * BOb then remembered t h a t he had wanted t o l i g h t a f i r e which, we d i d p l a c i n g the; waste paper basket i n the sink/" He wanted t o place more paper i n the basket than was safe but he was able t o accept l i m i t s when I s a i d t h a t i t was i n t e r e s t i n g but i t needed t o be kept i n a safe place so t h a t n e i t h e r he n o r anyone e l s e would be h u r t by i t . He l i t about three l o t s o f paper and turned h i m s e l f i n t o the f i r e dept. and e x t i n g u i s h e d i t w i t h the baby b o t t l e . A f t e r t h i s Bob requested f i n g e r p a i n t s b u t as were out of. them I suggested he use p a s t e l s o r crayons and he accepted t h i s a l r i g h t . He drew a p i c t u r e o f h i s mother and worker and then drew a house w i t h h e a r t s on the door "ypu have been made Mrs. P r e s i d e n t and I am Mr. P r e s i d e n t , we l i v e i n the same house " I wondered i f we were married and Bob s a i d "yes". I s a i d t h a t l i t t l e boys, a t some time o r another, get crushes on t h e i r w o r k e r s , teacher s, mothers^ Bob promptly r e p l i e d "not my teacher o r you, I'm going t o marry my mother". He volunteered; t h a t he d i d d i d n ' t t h i n k h i s f a t h e r would l i k e i t i f he knew..  69  I wondered what he thought f a t h e r would db and he spoke i n a deep angry v o i c e and he s a i d f a t h e r would t e l l him he c o u l d n ' t marry h i s ; mother but he denied having any f e a r s about t h i s . He then v o l u n t e e r e d thatnhe supposed h i s mother WJ|S r e a l l y too o l d anyway. Do the o t h e r c h i l d r e n decide t h i s and get someone t h e i r own age?" I s a i d they d i d when they had grown up and were ready f o r i t . He again spoke of l i k i n g to dress up i n h i s mothers j e w e l l r y but i s d i s a s t i s f i e d t h a t she has o n l y p e a r l s r a t h e r than g r e a t b i g c o l o u r e d t h i n g s . I wondered i f he ever dresses up i n f a t h e r ' s t h i n g s too and he s a i d he o f t e n wears Daddy's shoes. As I had a meeting, and began t o c l e a r up, I e x p l a i n e d to BOb> why I was doing t h i s . He s a i d t h i s was o.k. "as long as I know", but made i t c l e a r t h a t he would not l i k e me doing t h i s i f he d i d n ' t know; however he s t i l l , seems t o f e e l a l i t t l e r e j e c t e d a t t e r m i n a t i o n because he came back t o the playroom f o r another p i e c e of paper. Bob took: h i s h a l f f i n i s h e d house home and decided! to do two p i c t u r e s gs I requested a copy of h i s house.  70 APPENDIX C  Recorded I n t e r v i e w w i t h Cal As u s u a l , when Cal i s f e e l i n g w e l l he runs down to my o f f i c e b e f o r e me and h i d e s behind the door. He expects me to f i n d him a f t e r a b r i e f hunt. I t o l d him I could see he; was f e e l i n g w e l l today. He± prowled around the o f f i c e f o r a few moments and I wondered i f he was l o o k i n g f o r c o o k i e s which I had f o r g o t t e n to p r o v i d e . He s a i d he was s a t i s f i e d today because he had j u s t f i n i s h e d some c o o k i e s which h i s mother had g i v e n t o him. He wanted to use the playroom but f i r s t he was going t o the t o i l e t . I t o l d him he was g o i n g t o the t o i l e t t o make sure h i s d i n k y i s s t i l l t h e r e because he's a f r a i d of l o s i n g i t . We went t o the; piayroom. I asked him what he would l i k e t o db today. I n the playroom, he asked f o r the l a r g e sandtray and the t o y power-shevel (He knows Mike;, h i s b r o t h e r , uses t h i s on Mondays). He,* got up on the shovel and I gave him a p a i l to f i l l . He proceeded to p u l l the v a r i o u s l e v e r s and make the sounds o f heavy machinery. I was s i t t i n g a l i t t l e d i s t a n c e removed and Cal made v e r y few demands. U s u a l l y when he begins a new a c t i v i t y he makes q u i t e a few demands. I made some sounds along w i t h him and r e f l e c t e d his; statements about a b i g load, working h a r d ; e t c . A f t e r 10 minutes o r so, I said- he must f e e l v e r y s t r o n g o p e r a t i n g such a b i g machine. He kept down the sounds f o r a few moments, then c a s u a l l y announced t h a t he was going to f a i l i n s c h o o l a g a i n . I wondered why he s a i d t h a t . He s a i d there) was something t h a t bothered him a l l the t i m e , and he: can't t h i n k o f school work. I r e c o g n i z e d t h a t i t would be hard to do school work i f he had o t h e r t h i n g s on h i s mind, and t o l d him we can make the school work e a s i e r by f i n d i n g out what's on h i s mind. When he made no r e p l y , I wondered i f i t was the a c c i d e n t s ( s o i l i n g and w e t t i n g ) t h a t he spoke, about d u r i n g the p r e v i o u s i n t e r v i e w . He: s a i d i t was something worse than t h a t . I asked i f he could t e l l me about t h i s . He? s a i d he was hungry a l l the time and h i s stomach makes n o i s e s and t h e r e must be; something i n t h e r e because he experienced b u r n i n g s . He has never s a i d anything to h i e mother because she might take him to the Doctor and she makes the r u l e s about e a t i n g . I asked Cal t o d e s c r i b e h i s food i n t a k e . I t does not sound adequate nor does he d r i n k much m i l k because i t i s n ' t c o l d . C a l thought Mike had the same problem too* because he complained of being hungry a l l the t i m e / Mike was probably coming to the C l i n i c because he was going t o f a i l , but how can you expect to do work when you were always hungry. Mike t h i n k s he i s coming t o C l i n i c t o p l a y , he doesn't r e a l i z e he can get h e l p w i t h t h i n g s that, are on h i s mind. ;  Cal r e l a t e d h i s problem i n h i s s e r i o u s c o n f i d e n t manner. He r e q u i r e d v e r y l i t t l e encouragement and showed no r e s i s t a n c e nor d i s c o m f o r t . He seemed l i k e a d i f f e r e n t c h i l d a l t o g e t h e r and I found myself s t r u g g l i n g to a d j u s t to t h i s new person.  71 Cal then returned c l o s e r to h i s former s e l f and wondered what he was going to do. I moved over c l o s e to him and kept shovellings sand i n a p i l e where he could reach i t e a s i l y w i t h the machine. He s a i d he might t a l k t o h i s mother but she probably wouldn't understand. He asked i f I could t e l l Miss B (mother's s o c i a l worker), who could t e l l h i s mother. I i n t r o d u c e d the i d e a of a l l of us being together. He agreed, as long as we met i n my o f f i c e . A l i t t l e i n d e c i s i o n entered i n when he wondered i f I had enough c h a i r s . I s a i d he wants t h i s meeting but he's a f r a i d of i t , t o o . We counted the c h a i r s m e n t a l l y and he decided he could seat everyone - but we must do i t soon because he seemed t o be g e t t i n g h u n g r i e r a l l the time. As an example of how h i s parents couldn't understand, p a r t i c u l a r l y h i s f a t h e r , he asked me t o come to the board w i t h him, where he wrote some a r i t h m e t i c problems of adding and s u b s t r a c t i n g o I t h i n k he was t r y i n g t o e x p l a i n m u l t i p l i c a t i o n t o me but r e a l i z e d t h a t he was not g e t t i n g i t , a c r o s s . I t o l d him he: was t r y i n g t o t e l l me something but he was f i n d i n g i t d i f f i c u l t . He asked i f I would- go to school t o c l a r i f y the problem so t h a t I could e x p l a i n i t to him. I thought t h i s was another q u e s t i o n t h a t we could take up w i t h h i s p a r e n t s , but i f necessary I would go to the s c h o o l . When we retuned t o my o f f i c e Cal asked f o r a f l o w e r I had on my desk so t h a t he c o u l d g i v e i t to h i s mother. I s a i d perhaps he would f e e l a l i t t l e anxious about meeting her a f t e r the kind! of i n t e r v i e w we had bad and g i v i n g her a g i f t would make him f e e l b e t t e r . He s a i d he was a f r a i d he was going to t a l k to her about h i s problem on the way home and she would not understand, or might g i v e him a l i c k i n g . I advised him t o w a i t a l i t t l e w h i l e i f he could u n l e s s he f e l t he had t o gO i n t o i t immediately. I promised t o speak w i t h Miss B before I saw him on Monday.  72  APPENDIX D  Recorded I n t e r v i e w w i t h Diane Son ( p a t i e n t ' s b r o t h e r ) asked to come i n t o the playroom again w i t h us and I repeated what I had t o l d him b e f o r e . We looked f o r new comic books f o r him to read, and he was h a r d l y s a t i s f i e d when he s e t t l e d down w i t h them. Diane remembered the b i c y c l e and took my hand as we went down t o the day c e n t r e . She found o l d t e r r i t o r i e s around the c l o s e d stockroom there before g e t t i n g on the b i k e and I s a i d "she probably misses t h a t day c e n t r e " . "And How" she s a i d . Ouside,on the grass w i t h the b i k e she wanted to be pushed. Then she: wanted to examine the o u t s i d e storeroom near the f i r e p i t and ran around w i t h shouts of. j o $ . She found a steam shovel which she moved i n t o the sand box and made me work r a k i n g sand f o r her to p i c k up w i t h i t . Then she wanted to p l a y on the swings and commented t h a t she i s only nine and enjoys doing t h i s . I s a i d , i t ' s f u n t o p l a y l i k e t h i s and do anything you want j u s t l i k e a baby. She s a i d , she can't though because she has to look a f t e r her baby b r o t h e r . We t a l k e d about how tiresome i t i s l o o k i n g a f t e r younger b r o t h e r s and s i s t e r s and l a t e r i n the sand box she s a i d , Jimmy doesn't do any work, he j u s t s l e e p s i n h i s p l a y pen. She. can't because she has t o look a f t e r him. I asked, can't she have a nap sometimes? Yes, but she doesn't want t o . I thought a person gets t i r e d of working and needs to p l a y . She d i d n ' t agree, and s a i d e m p h a t i c a l l y " a l l work and no p l a y " . I s a i d , i t may seem t h a t way, but p l a y i s good f o r everybody. ;  She adventured over t o the b o i l e r room and c r e p t i n . K machine suddenly s t a r t e d up and she darted o u t s i d e . I e x p l a i n e d t h a t machines do t h a t and t h a t we could examine i t i f she wanted because there i s nothing t o i t r e a l l y and I was p r e t t y sure she wanted t o know how i t worked. Back i n the day centre she d i d n ' t want to l e a v e , s t a r t e d p l a y i n g the piano, running i n t o the v a r i o u s rooms. I s a i d , there i s no q u e s t i o n about i t , we have t o go now and began t o s w i t c h o f f lights?* She f l e d toward me. As we l e f t the day c e n t r e , she saw Mrs. A ( p u b l i c h e a l t h n u r s e ) w i t h some o t h e r nurses and chatted w i t h her f o r a minute*  73 APPENDIX E Recorded I n t e r v i e w w i t h Ed Ed asked to go t o the playroom, where he played i n the sand. He t o l d me he gets a b u l l s eye w i t h d a r t s and bow and arrow. I found myself f e e l i n g sleepy as he t a l k e d and played w i t h c a r s i n the sand, c e r t a i n l y without much meaning. I s a i d we should t a l k some time about why he was coming, and when he had n o t h i n g to say I suggested t h a t he t a l k i t over w i t h h i s mother. arrow won't seems He was  He t o l d me about models which he p a i n t s and about h i s bow and and I suggested he b r i n g them to show me. He s a i d h i s mother l e t him take the bow and arrow out of h i s y a r d and I s a i d t h a t s i l l y , t h a t he was o l d enough to be c a r e f u l about how he used i t . a f r a i d the p o i n t would h u r t people on the bus.  He t o l d me t h a t h i s f a t h e r i s away a l o t and on a boat and t h a t he l i k e s i t when he i s alone w i t h h i s mother f o r q u i t e a w h i l e , then h i s f a t h e r i s back f o r q u i t e a w h i l e . *He t o l f l me he i s a f r a i d of snakes. I t o l d him h i s f e a r of snakes, and of the arrow were f e a r of f a t h e r ' s p e n i s , and e x p l a i n e d to him what § penis was. He had a t o y vacuum c l e a n e r and suggested p l u g g i n g i t i n the w a l l , and I t o l d him t h i s was i n t e r c o u r s e . For some time then he dug i n the sand u s i n g two shovels i n both hands, and I s a i d t h i s represented masturbation which was permissable. The toy vacuum c l e a n e r i s broken and i f i t i s s t i l l broken next week we w i l l t r y to f i x i t .  74 APPENDIX P Recorded I n t e r v i e w w i t h Fred Today I t r i e d s e t t i n g up the playroom i n a d i f f e r e n t way. I did not b r i n g i n the; games, t i n k e r toys and a few other t h i n g s t h a t o f t e n uses but r a t h e r I j u s t brought i n the f i n g e r p a i n t s and paper, crayons, paper, e t c . , c l a y , the sand t r a y , the b a t t e r y - r u n telephone set, water p i s t o l e and o n l y one box of t i n k e r t o y s . I d i d t h i s , because I f e e l f o r a long time now, Fred has been u s i n g the games and o t h e r a c t i v i t i e s to a v o i d any r e g r e s s i v e a c t i v i t y on h i s p a r t . I f e l t our r e l a t i o n s h i p was such t h a t I could t r y something of t h i s nature a t the present time w i t h o u t t h r e a t e n i n g him too much. Had he been o v e r l y threatened I planned t o b r i n g something e l s e i n t o the room. A l s o I l e f t a few toys i n the cupboard should he be t e r r i b l y anxious. When Fred entered the room he asked me as u s u a l what we would do today. I gave him my u s u a l r e p l y , t e l l i n g him t h a t we would do whatever he wanted t o do. This went on f o r a few minutes, w i t h him r e p e a t e d l y a s k i n g me "What do you want to do" and my t u r n i n g i t back to him, when I f i n a l l y t o l d him t h a t I thought i t would be b e t t e r i f he decided what we would do as i t was more important t h a t he do what he wanted. He seemed t o understand t h i s but seemed unable to decide what t o do. I f i n a l l y enumerated the toys t h a t were i n the room and s a i d t h a t he had a choice of p l a y i n g w i t h any of these. He asked f o r the games and then f o r the medals and I t o l d him t h a t I knoew he l i k e d p l a y i n g w i t h the games and b u i l d i n g the models and t h a t we could do t h i s once i n a w h i l e but t h a t I was t h e r e to help him and I thought I could h e l p him best i f we were t o use the toys t h a t were a l r e a d y i n the room. He kept f i n d i n g excuses why he couldn't p l a y w i t h the t o y s i n the room. For example, he s a i d he d i d not l i k e the smell of the p a i n t s , the c l a y was too mucky and there were no s o l d i e r s t o p l a y w i t h i n the sand t r a y . However, he d i d f i n a l l y suggest t h a t we might b u i l d a bridge i n the sand t r a y , u s i n g the t i n k e r toys.. He d i d t h i s and he seemed eager to i n v o l v e me. As the i n t e r v i e w progressed Fred became more and more messy i n h i s use of the sand t r a y . At f i r s t he was c a r e f u l not to get h i s hands i n the sand and was very c a u t i o u s about u s i n g the water. However, I assured him t h a t i t was a l r i g h t to pour water i n t o the tray,, t h a t there was a d r a i n there f o r t h a t reason and i t was a l r i g h t to p l a y w i t h these t h i n g s i n the playroom. H i s p l a y progressed to the p o i n t where he had the t r a y almost completely f i l l e d w i t h water and was s p l a s h i n g around i n i t and emptying buckets of sand i n t o the water and having i t s p l a s h a l l over. He then took the c l a y which was very wet and mucky and s t a r t e d b u i l d i n g a r a f t out o f i t . He t o l d me to come OIL and help him do t h i s and t o use the c l a y . F o l l o w i n g t h i s , he got a handful of c l a y and s e t up a t a r g e t and s a i d "come on, l e t s shoot a t i t " .  75 He began throwing c l a y a t the t a r g e t and e v e n t u a l l y c l a y was f l y i n g , a l l over the room. He seemed t o thoroughly enjoy t h i s a c t i v i t y and kept saying " " I s n ' t t h i s fun"? I s a i d y e s , i t was f u n and i t was a l r i g h t t o do i t here i n the playroom and t h a t I wouldn't l e t him do anything t h a t he shouldn't. There was not, a smock i n the playroom and Fred s a i d he d i d n ' t want t o wear one. I suggested my going out and g e t t i n g one but he s a i d i t was a l r i g h t , h i s aunt d i d n ' t mind i f he get c l a y on h i s c l o t h e s . However, a t the end of the hour he was q u i t e messy and I f e l t r a t h e r anxious about t h i s . When I returned Mm t o the w a i t i n g room I spoke t o f i r s t h i s f a t h e r , then h i s a unt and mentioned t h a t perhaps they could send Fred to the c l i n i c i n some o l d e r c l o t h e s , r a t h e r f o r example, j e a n s . As I l e f t I heard Fred t e l l i n g h i s f a t h e r t h a t he had had a l o t of f u n today.  76 APPENDIX G Recorded I n t e r v i e w w i t h Glen Today when I picked Glen up from the w a i t i n g room I e x p l a i n e d t h a t although I had most of the i n g r e d i e n t s f o r p l a y dpugh I s t i l l needed t o get the b l a c k Tempera powder. I asked Glen i f he would mind w a i t i n g i n the playroom f o r me, he agreed and s a t down a t the t a b l e to eat h i s c a n d i e s , he always i g n o r e s the cookies which are put out f o r him. Glen t o l d me t h a t h i s mother had made p l a y dough f o r him a t home.. I s a i d wasn't t h a t n i c e . When I returned w i t h the powder I asked i f he would l i k e to come w i t h me t o the s t o c k room to get h i s t o y box, he s a i d he wanted me t o get i t f o r him but I had b a r e l y reached the; s t o c k room when he came along took one handle and w o r d l e s s l y helped me c a r r y i t to the playroom. Then he. began making the p l a y dough i n r a t h e r a h u r r y , he c o u l d n ' t decide how much Tempera powder to use and suddenly dumped the whole t i n i n t o the b a s i n , he c a r r i e d the b a s i n to the s i n k then and put f a r too much water i n i t and i t became q u i t e t h i n and Glen became q u i t e e x c i t e d about i t being b l a c k " p a i n t " . Then he got the i d e a of f i l l i n g the s i n k w i t h water and f l o a t i n g ; boats which were on the counter, suddenly, as the water was r u s h i n g i n t o the b a s i n , he announced t h a t he had to go to the; bathroom, I asked him i f he would l i k e more boats and went,.to get them w h i l e he was i n the bathroom. When he returned he played w i t h the water and then decided he wanted a submarine and asked i f we could go to l o o k for- one, I agreed, so we went back t o the stockroom. Glen examined the boats and saw t h a t there was no submarine, suddenly he saw/ a t r a i n s e t and became q u i t e e x c i t e d about p l a y i n g w i t h i t t h e r e , I e x p l a i n e d t h a t t h i s was a place to s t o r e t h i n g s and t h a t the playroom was where we took t h i n g s to>play w i t h . A f t e r some minutes he gathered t h i n g s up and chose the t r a i n s e t and the f i r e engine t o take and we went back. He played f o r q u i t e some time on the f l o o r w i t h the. t r a i n * t r a c k s and l i g h t , however, i t was r a t h e r d i s a p p o i n t i n g f o r him as p i e c e s were m i s s i n g and broken. Glen t o l d me t h a t he had had a t r a i n s e t which was; a Christmas g i f t , I gathered t h a t h i s t r a i n s e t was r e a l l y n i c e r to him than t h i s one, I s a i d t h a t was n i c e and wasn't he l u c k y . I t o l d him I would f i n d out i f there were more p a r t s and i f i t could be f i x e d . He seemed f i n i s h e d w i t h the t r a i n s e t and walked over t o the s i n k where most of the boats had sunk, he looked a t them and began p u l l i n g them out of the water. The p l a y dough was on the counter and I asked him i f he would l i k e t o f i n i s h making i t , he s a i d he would l i k e the b a s i n i m the s i n k , so I put i t there f o r him. The: p a i n t brush he used as a s t i r r e r f e l l i n t o the mixture and he asked me t o c l e a n i t f o r him, which I d i d . He k e p t s t i r r i n g and adding more water so t h a t i t was the c o n s i s t e n c y of p a i n t , he s a i d he wished he could p a i n t something so I  77 reminded Mm of the e a s e l and s a i d he could p a i n t i t , I broughi the e a s e l and he had meanwhile decided to p a i n t h i s name on h i s box again. He has been concerned about the p a i n t on the s i n k and removed the b a s i n to the c h a i r near h i s toy box^ I t o l d him t h a t I would show him how; the p a i n t could be removed from the s i n k and wiped i t o f f w i t h a sponge, w h i l e I was doing t h i s he asked me r e p e a t e d l y to see how w e l l he was d o i n g , I admired h i s p r i n t i n g and he put a b l a c k border around the top of the box. I cleaned the s i n k and went to stand near him to look a t h i s work, the n he plunged h i s hands i n t o the b a s i n and appeared to take p l e a s u r e i n washing h i s hands i n the p a i n t . Next he dropped i n the p a i n t brush and asked me to f i n d i t , I dipped my f i n g e r s i n i t and he s a i d put your whole hands i n l i k e me, so I d i d and we played a game where we took t u r n s dropping the p a i n t brush and the other search f o r i t , t h i s was Glen's i n v e n t i o n . He t i r e d of t h i s and I got up to go to wash my hands when he threw the p a i n t on the f l o o r w h i l e my back was turned, t h i s was f o l l o w e d by q u i t e u n d i s c i p l i n e d p l a y w i t h hands and f e e t i n the p a i n t , f i n g e r p a i n t i n g and t r a c k i n g and i n general r e v e l l i n g i n i t . T h i s , as i s u s u a l f o r Glen's o u t b u r s t s , occurred i n the l a s t f i v e or ten minutes of the hour. He kept extending the area of p a i n t and p u t t i n g ; hand marks on the paper, on the e a s e l and on t a b l e l e g s , e t c . f i n a l l y , I t o l d : him we were over our time and i t was time to c l e a n up and l e a v e . He ignored me, running around and f i n a l l y s p l a s h i n g me, I stopped the s p l a s h i n g and s a i d t h a t I wouldn't a l l o w i t , then I spoke to him about i t making; him mad when I s a i d i t was time to l e a v e , he s a i d yes i t d i d . I s a i d t h a t someone e l s e had to use the playroom, he asked who and I s a i d I d i d n ' t know, another worker and a c h i l d , t h i s was the way t h i n g s were i n r e a l i t y . I s a i d t h a t i t was necessary f o r me to c l e a n the playroom up so t h a t the other c h i l d could use i t and itneeded to be done w i t h i n a few minutes, I asked him i f he would l i k e to h e l p , he s a i d "no" then "yes" and took a small mop w h i l e I used a l a r g e r sponge mop, I f i l l e d the p a i l w i t h water and t h i s provided more s p l a s h i n g and fun f o r 01en, he extended i t over more of the room, I then reminded him of the time and again spoke of h i s g e t t i n g mad a t me. He wanted a l a s t run through the p a i n t and so I put down paper towels a t the door f o r him to walk on. When we went out i n t o the h a l l I showed him t h a t none of the p a i n t came a l o n g , t h a t i t had a l l . been l e f t i n the playroom. I c l o s e d the door behind us. H i s mother wasn't there when he reached the r e c e p t i o n area, he went o u t the window and along theledge. She came i n w h i l e he was s t i l l making h i s way through the f r o n t door. I t o l d Glen that I would; see him again next week and he d i d n ' t answer. Although he refused the smock today, he kept h i m s e l f s u r p r i s i n g l y c l e a n , h i s knees and s h i r t c u f f s became a l i t t l e d i r t y as d i d of course h i s hands and shoes.  78 AEPENDIX H  Recorded I n t e r v i e w w i t h Helen Helen came down t o the o f f i c e on my s u g g e s t i o n . I s a i d I was g l a d t o see h e r today and e x p l a i n e d t h a t I had t o l d her the time would be changed l a s t week because I thought t h i s was the arrangement w i t h mother's new worker* Anne s a i d t h a t her mother was seeing Mrs»H f o r a few minutes and was then going t o w a i t out i n the c a r w i t h Morna for her. She took o f f h e r coat and walked arpund the o f f i c e , showed me her hands and then t r i e d t o h i d them. She s a i d she had been u s i n g c h a r c o a l and had i t a l l over her hands. She s t a r t e d a long s t o r y about a mural they are doing s t school and t h i s was i n e x p l a n a t i o n of why h e r hands were i n such a mess. I wondered what she wanted t o do today and s a i d we could go down t o playroom i f she wanted t o o r o u t s i d e o r s t a y i n the o f f i c e i f she l i k e d . She chose t o go o u t s i d e because she wanted t o p l a y on the t i r e s which she saw from the window* She wanted t o go out without a coat and i n s i s t e d she hadn't had one on a l l day and had been running o u t s i d e * I f i n a l l y l e t h e r go without as I wasn't wearing one e i t h e r and i t d i d n ' t seem too: t e r r i b l y cold;. She was bragging about the reckless- t h i n g s she; does on h e r bike and was swinging around q u i t e r e c k l e s s l y on the t i r e and b a r s . I allowed h e r to do what she l i k e d and commented t h a t she was f e e l i n g q u i t e r e c k l e s s today. She s a i d she guessed she was q u i t e a tomboy and seemed t o worry t h i s around f o r a w h i l e . L a t e r she s a i d t h a t " l o t ' s of t h i n g s she l i k e d t o do were g i r l s t h i n g s , so maybe i t , wasn't so bad a f t e r a l l . " I s a i d she seemed w o r r i e d about being a tomboy and t h a t I thought most g i r l s h e r age l i k e d doing the t h i n g s she' t a l k e d about. Then she; s a i d , "Yes, but you see not a l l my f r i e n d s are my age?." She s a i d a f t e r we got i n my o f f i c e t h a t she would draw a g i r l t h i s time. She s a t i n my c h a i r , rocked i t a b i t and s a i d she wasn't scared o f i t anymore..She drew a very feminine l o o k i n g g i r l which she. completed a f t e r much e r a s i n g and doing over. When I asked h e r who i t was she s a i d she wasn't going t o t e l l me. She g o t up and walked around, s a i d she knew-what she was going t o do w i t h t h i s p i c t u r e , and f o l d e d the p i c t u r e i n h a l f and asked me i f I had some s c i s s o r s . We found some and she c u t s e v e r a l s l a s h e s through the g i r l she had drawn. Then she opened up the paper and looked a t i t . She admired the s l a s h e s f o r a w h i l e , f o l d e d i t again and went over t o the waste basket, then snipped, snipped, snipped as i f she was g e t t i n g r e a l angry. She c u t i t ; a l l . up and s a i d a n g r i l y , "There, I have the r i g h t . " A f t e r t h i s she g o t i n t e r e s t e d i n the t h i n g s i n my d e s l and f o o l e d around w i t h my c o l o r e d p e n c i l and so on u n t i l the time was up, I d i d n o t comment f u r t h e r about, the g i r l as she had l e t me understand a t one p o i n t t h a t she d i d n ' t want t o t a l k about i t . I s a i d I would be seeing h e r again* on Tuesday and she repeated " I ' l l see you on Tuesday and then went running out t o the; car t o j o i n her mother.  79 BIBLIOGRAPHY Akerman, Nathan W., The Psychodynamics of Family L i f e , B a s i c Books, I n c . , New York, 1958. A s t r o , S y l v i a , e t a l , (The Committee on Content, The School, of S o c i a l S e r v i c e A d m i n i s t r a t i o n , The U n i v e r s i t y of Chicago), Guide t o the Content of Second-Year F i e l d Teaching i n Casework, The U n i v e r s i t y of Chicago P r e s s , Chicago, 1961. Baines, Leonard, " D i r e c t Casework Treatment of a Latency Age C h i l d " , i n S o c i a l Casework, A p r i l , 1961. Baruch, Dorothy, New Ways i n D i s c i p l i n e , McGraw H i l l . Book Co., New Mork, 1949. Baruch, Dorothy, One L i t t l e Boy, J u l i a n P r e s s , New York, 1953. B e r n s t e i n , S a u l , " S e l f - D e t e r m i n a t i o n : King o r C i t i z e n i n the Realm of Values?", S o c i a l Work, January, 1960. B i e s t e k , F e l i x P., The Casework R e l a t i o n s h i p , L o y o l a U n i v e r s i t y P r e s s , Chicago, 1957. B i e s t e k , F e l i x P., "The Non-Judgmental A t t i t u d e " , S o c i a l Casework, V o l . 34, 1953. B r i l l . / A.A., The B a s i c W r i t i n g s of Sigmund Freud, The Modern L i b r a r y , New York, 1938. Bryenton, Joy', "Communication w i t h C h i l d r e n - A Thesis; A b s t r a c t " , The.Social Worker, A p r i l , 1959. B u t l e r , Ruth M., An O r i e n t a t i o n t o Knowledge of Human Growth and Behavior i n S o c i a l Work E d u c a t i o n , (Volume V I , S o c i a l Work Curriculum S t u d y ) , C o u n c i l on S o c i a l Work E d u c a t i o n , New York, 1959. Community S e r v i c e S o c i e t y of New York, Method and Process i n S o c i a l Casework, Family S e r v i c e A s s o c i a t i o n of America, New York, 1958. E l i o t , Martha M., "Strategy f o r C h i l d r e n " , S o c i a l Work, October, 1956. F e n i c h e l , Otto, The P s y c h o a n a l y t i c New York, 1955.  Theory of N e u r o s i s , W.W.Norton & Co.,  F r a i b e r g , Selma, " P r o f e s s i o n a l R e s p o n s i b i l i t y i n Casework Treatment of C h i l d r e n " , D i r e c t Casework w i t h C h i l d r e n , Family S e r v i c e A s s o c i a t i o n of America, New York, 1957.  80 F r a i b e r g , Selma, "Some Aspects of R e s i d e n t i a l S o c i a l Casework, A p r i l , 1956.  Casework w i t h  Children,"  Freud, Anna, The P s y c h o a n a l y t i c a l Treatment o f C h i l d r e n , Imago P u b l i s h i n g Co., London, 1946. Freud, Sigmund, A General I n t r o d u c t i o n New York, 1958.  t o P s y c h o a n a l y s i s , Perma Books,  Grunebaum, Margaret G., "A Study of L e a r n i n g Problems o f C h i l d r e n " , S o c i a l Casework,, A p r i l , 1956. Hamilton, Gordon, Psychotherapy i n C h i l d Guidance, Columbia P r e s s , New York, 1947. Hamilton, Gordon, Theory and P r a c t i c e o f S o c i a l Casework, Columbia U n i v e r s i t y P r e s s , New York, 1951. K l e i n j M e l a n i e , The P s y c h o - A n a l y s i s o f C h i l d r e n , The Hogarth Press;, L t d . , London, 1950. KOnopka, G i s e l a , "The Generic; and the S p e c i f i c : i n Group Work ^ P r a c t i c e i n the Psychiatric:; S e t t i n g " , S o c i a l Work,, January, 1956.. Mackenzie, Budd, The P l a y I n t e r v i e w as a. S o c i a l Work Technique i n a C h i l d Guidance S e t t i n g , Master of S o c i a l Work T h e s i s , U n i v e r s i t y of B r i t i s h Columbia, 1956. Maas, Henry, " S o c i a l Casework", W a l t e r F r i e d l a n d e r ed*, Concepts and Methods i n S o c i a l Work, P r e n t i c e - H a l l , New York, 1958* Menninger, K a r l , Theory oft P s y c h o a n a l y t i c Technique,, Science E d i t i o n s ; I n c . , New York, 1961. Moustakas, C l a r k £., C h i l d r e n i n P l a y Therapy, McGraw-Hill Book Co?., New York, 1958. Munroe, Ruth, Schools of P s y c h o a n a l y t i c Thought, The Dryden Press,. New York, 1955. Noyes, A r t h u r B. and K o l b , Lawrence C , Modern C l i n i c a l W.B.Saunders Co., P h i l a d e l p h i a , 1958.  Psychiatry,  Perlman, Helen H.., S o c i a l Casework, U n i v e r s i t y of Chicago P r e s s , 1957., Pumphrey, M u r i e l W., " T r a n s m i t t i n g Values and E t h i c s Through Work P r a c t i c e " , S o c i a l Work, J u l y , 1961.  Social  81 Regensburg, J e a n e t t e , "Formulation of C r i t e r i a f o r D i r e c t Work w i t h C h i l d r e n i n a Family Agency", D i r e c t Casework w i t h C h i l d r e n , New York, 1957. Rogers, C a r l R., C o u n s e l l i n g and Psychotherapy, The R i v e r s i d e Cambridge, Massachusetts, 1942.  Press,  The Sub-committee on the Working D e f i n i t i o n of S o c i a l Work P r a c t i c e f o r the Commission on S o c i a l Work P r a c t i c e , . "Working D e f i n i t i o n of S o c i a l Work P r a c t i c e " , S o c i a l Work, A p r i l , 1958. Towle, C h a r l o t t e , "A S o c i a l Work Approach t o Courses i n Growth and B e h a v i o r " , S o c i a l S e r v i c e Review, I960.. Waelder, Robert, B a s i c Theory o f Psychoanalysis;, I n t e r n a t i o n a l U n i v e r s i t i e s P r e s s , I n c . , New York, I960. Wolberg, Lewis R., The Technique of Psychotherapy, Grune and S t r a t t o n , I n c . , New York,. 1954.  

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