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Casework with the wives of alcoholics : a study of eighteen cases drawn from the files of a family agency Wright, Gordon Richard 1954

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CASEtfQRK WITH THE WIVES OF ALCOHOLICS A Study of Eighteen Cases Drawn From the Files of a Family Agency. by GORDON RICHARD WRIGHT Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORE In the School of Social Work Accepted as conforming to the standard required for the degree of Master of Social Work School of Social Work 1954 The University of British Columbia i i i ABSTRACT This study deals with problems around casework with the wives of alcoholics. Eighteen cases were drawn from the files of the Family Welfare Bureau of Greater Vancouver. This agency.has had a long and direct experience with problems around alcoholism. It's caseworkers are daily asked to give help with the emotional and social conflicts around alcoholism which find expression in desertion, failure to support, brutality, child disturbance and employment difficulties. The wife of the alcoholic is the focus of this study because i t is she who most frequently comes requesting help. Success or failure ia regard to the total family problem is frequently dependent upon the nature and effectiveness of work with her. The cases selected were active in 1952 and deal with families in which there were children. Casework services given are examined part-icularly in regard to the personality patterns of the wives. Six major types of functioning were discriminated in order to supply points of reference in considering the total range of the wives' personalities. Effectiveness of casework help was measured on the Kogan Bunt Movement Scale and the resulting measures were considered in regard to the elements of casework, the personalities of the wives and the alcoholic patterns of the husbands. It appeared from the examination of the records that wives under the stress of adjustment to l i f e in Canada showed particular emotional disturbance. Wives with marked activity drives directed into concern with home and children were more disturbed by threatened economic difficulty than were those wives of a more feminine orientation. Twelve wives seemed capable,in varying degree,of using a warm, sympathetic relationship to find new ways of resolving their problems. Six wives seemed incapable of using such help. Husbands like wives evidenced disturbance i f they were newly adjusting to l i f e in Canada or had grown up in another culture. Movement on the husband*8 part seemed closely related to the pattern of alcoholism. Reactive alcoholics, though not seen themselves, responded positively when their wives were helped. This was not true of neurotic drinkers. It was felt that these tendencies would also be evident in direct work with the alcoholics. There were indications that in order to involve the alcoholic in casework help, i t would be necessary for the caseworker to approach him aggressively and directly and not through his wife. In twelve cases relationship adequate for work with the wife was not achieved. This was seen as related to failure on the caseworker's part to use himself in a professional manner and establish a working diagnosis. The diagnosis was seen as necessarily related to understanding of the wife's personality. When the caseworker did not so function, he failed to appreciate the wife's emotional investment in the marriage and on occasion seemed to endeavour to set casework directions in terms of his own value judgments. i i CASEWORK WITH THE WIVES OF ALCOHOLICS Table of Contents Chapter 1. Elements in Casework with Wives of Alcoholics Page The problem of alcoholism, area of the present study. General casework experience. Source of material, criteria for case selection. Particular concern with personality and movement, Dr. Deutsen's illuminations of woman's personality, relation to division of material in Chapter 2. Material recorded on Table 1, the husband's pattern of drinking, scheduled interviews, problems seen and presented by the wife, evidence of relationship, measuring movement 1 Chapter 2. Personalities of the Women Under Study Six groups of women, basis for this division. Group 1 Women, Mrs. Vowles, Mrs. Grange. Group 2 Women, Mrs. Oliver, Mrs. Riley. Group 3 Women, Sub-group 3a, Mrs. Allison, Mrs. Jensen. Sub-group 3b, Mrs. Barnes, Mrs. Irving. Group 4 Women, Mrs. Edgely, Mrs. Penn, Mrs. Sanderson, Mrs. Fenner. Group 5 Women, Mrs. Yates, Mrs. Underwood, Mrs. Royce. Group 6 Women, Mrs. Hughes, Mrs. TIngley, Mrs. Mason 17 Chapter 3» Treatment Considerations in the Cases Under Review General picture of casework effectiveness in the 13 cases. Incidental matters considered, cultural patterns, economic dif-ficulties, movement and the husband's pattern of drinking. Casework and Movement, relation to movement of the year in which the case opened, relation to-movement of closures and- the number of case-workers, movement as related to evidences of relationship adequate to work attempted, personality patterns of the wives as they relate to movement • 76 Chapter 4. The Implications of the Study Difficulties resulting from individual technique which rendered casework ineffective, failure to achieve relationship, failure to realize the limitations on the client's movement, becoming emotionally involved in the client's problem* The need for diagnosis. Difficulties hampering casework and related to agency policy and general casework practice, unnecessary change of caseworkers, in-adequacy of the home visit to consistent treatment. Indications for future work, casework success and failure with the alcoholic himself, other problems around alcoholism. Value of the present study. Tables in the Text Table 1. Table outlining casework considerations in the eighteen cases following page 75 iv CASEWORK WITH THE WIVES OF ALCOHOLICS Chapter 1* Elements In Casework with Wives of Alcoholics The problem of alcoholism is increasingly occupying the attentions of lay and professional people. Though this study wil l deal with only one segment of the total problem, that segment can be understood only as i t i s seen in relation to the total problem. It i s , therefore, appropriate that at this time consideration be given to the background of the subject. There is probably no word used more freely and confusedly in public discussion of problems of alcohol consumption than the word "alcoholic". Since this work deals with women described as wives of alcoholics, a definition of the term "alcoholic" would seem necessary at the outset. An alcoholic is defined as an excessive drinker whose dependence upon alcohol has reached such a degree that It results in a noticeable mental disturbance or an Interference with his bodily and mental health, his interpersonal relations, and his smooth social and economic functioning or who shows the early signs of such developments^. This definition defines alcoholism by the degree of seriousness of the symptoms but,Implied, is the view that alcoholism Is but one part of a progression with the social drinker on one extreme and the alcohol addict on the other. Robert J. Gibbins, Research Associate of the Alcoholism Research Foundation of Ontario, makes the following estimates of the extent of 1 Based on the definition of alcoholism adopted by the Alcoholism Sub-committee of the Expert Committee on Mental Health of the World Health Organization. Reported in Gibbins, Robert J., "Alcoholism in Canada", Canada's Health and Welfare, February 1954-* Department of National Health and Welfare, Ottawa, Canada. 2 alcoholism in Canada as contrasted with the other nations of the world^. Canada, he finds, has 1 , 9 5 0 alcoholics per 100,000 of the population 20 years of age and over. The United States has a rate almost twice as high as Canada, namely, 3 ,952 per 100,000. The contrast is rendered even sharper by the additional information that in Canada 70 per cent of the population use alcohol while in the United States only 59 per cent use i t . Italy, where vine is almost a substitute for water, has only 500 alcoholics per 100,000 of 20 years of age and over. This might appear more significant had not France, another wine-drinking country, an alcoholism rate second only to that of the United States, 2 ,850 per 100,000. Gibbins further estimates the rate of alcoholism in the Canadian Provinces. British Columbia leads the l i s t with 2 ,532 per 100,000 of 20 years of age and over. The other provinces follow in order Quebec 1,813, Ontario 1,637, Nova Scotia 1,286, New Brunswick 1,278, Manitoba 1,173, Saskatchewan 1,167, Alberta 930, Prince Edward Island 6 7 5 , Newfoundland 5 0 1 . The implications of the figures are not the subject of this study, but i t should be noted that they do make clear that alcoholism as defined is a problem experienced with varying intensity throughout the world. Not a l l users of alcohol become alcoholics. In Canada, out of 6,090,513 users, 137,559 become alcoholics according to Gibbins^. Why then is there such general public concern about the problems of alcoholism? Inmost provinces in Canada there are public and private research and treatment schemes under way a l l specifically concerned with 1 Gibbins estimates are based upon studies made in Ontario together with the Jellinek estimation formula an outline of which may be found in Expert Committee on Mental Health. Report of the First Session of the  Alcoholism Sub-committee. World Health Organization Technical Report Series No. 42, pp 19 - 2 4 , 1951 Geneva. 2 Gibbins, op cit p. 3. 3 alcoholism. Doctors, Ministers, Social Workers as well as many other lay and professional people attempt to deal with the problem. Alcoholics Anonymous, a mutual help organization of alcoholics themselves, has branches in almost every community. The reason for the great interest in this relatively small group of people lies in the fact that the alcoholic in society is a particularly destructive Individual. His problem does not remain his own. It encompasses those around him. Industry is affected through his frequent irresponsibility and absenteeism. The police, the courts, and the gaols are burdened In dealing with resulting violence and accidents. Most basically, the alcoholic's problem affects his family in particularly destructive fashion. He may support his family inadequately or not at a l l and his wife and children may live In constant economic insecurity. His variation In moods and inconsistent attitudes increase that insecurity. Families are frequently damaged or broken completely and their rehabilitation or care becomes the responsibility of the community. It i s the intent of this study to examine one aspect of the community's work in helping the alcoholic and his family. Specifically this aspect is Social Casework as i t is effected through the family service agency. The profession of Social Work has had a long and direct association with the problems around alcoholism^. Initially the problems of the.family In which the husband was alcoholic came to the attention of social workers for material and financial help. As social work developed increasingly successful methods of helping with the emotional aspects of problems 1 Lewis, Marion F., "Alcoholism and Family Casework", TV»O Tawny Vol. XVIII, No. 2, Family Welfare Association of America, New York, N.Y., 1937. This article supplies a striking picture of problems caseworkers were asked to deal with 17 years ago and with which they are s t i l l dealing today. 4 previously seen as purely environmental, the help requested of the social worker altered in these problems. There are s t i l l many requests for help solely with the economic problems but, increasingly, the social worker is asked directly for help in the conflicted marital relationship. At times this takes the form of a request that the social worker control or punish the husband, or that the social worker help the wife to leave the husband. Sometimes, though rarely, the social worker is asked to help both parties with emotionally-based problems in regard to the drinking. In most cases the request for help comes from the alcoholic's wife and i t i s for this reason that the problems attending casework with her have been chosen for examination in this study. Further, this area of casework is one in which social workers meet difficulties which eause them to question their approaches and methods. It is hoped that while so brief a study as this cannot hope to find solutions to problems which perplex the profession, perhaps same light can be cast upon difficulties met and some indications for future exploration and examination indicated. The Source of Records For the purpose of this study 13 case records were selected from the files of the Family Welfare Bureau of Greater Vancouver. Before discussing matters relevant to the selection of the 13 cases, a word about the agency from which the cases were chosen is in order. The Family Welfare Bureau is a private, Community Chest supported agency with a considerable reputation for the maintenance of high standards in its casework practice. From its beginnings in 1923 until January of 1954 i t had one director. During her tenure the agency grew from one worker, herself, until i t had a casework staff of 17. On the whole the staff may be said to be well-trained, though some members have not fully accredited casework training. However, what 5 these workers lack in casework training is to a considerable extent com-pensated for by lengthy experience made meaningful by an effective program, of staff development. Beyond the regular supervision of their work, caseworkers in this agency have at their disposal the consultative services of a case consultant and a psychiatrist. In terms of these intra-agency resources as well as resources in the community, the caseworkers of the Family Welfare Bureau are able to work with considerable effectiveness in the many areas of family service. This agency in its staff meetings and its committee work continually reappraises its efforts In helping with the great variety of problems clients bring to i t . In terms of this continuing assessment, i t has experimented courageously with new ways of making service more effective. Work with problems around alcoholism has received its share of such appraisal and experimentation but most staff members today agree that this is s t i l l one of the most difficult and distressing areas, of casework. Often the worker feels that for the effort put forward by him the client does not seem helped in sufficient degree. Selection of Records The 18 records chosen for study from the work of this agency were selected in terms of three simple criteria* First, each case was active in 1952. This was established as necessary to any comparison of work done. Cases on which work was done five years ago, illuminating though they may be, do not reflect present practice in a profession where development of method has gone ahead rapidly. As such,work done five years ago is not strictly comparable with work done today. 6 The second criterion was that each record must deal with a family In which there were children. This arose from a desire to examine the wives and their families in situations with as many as possible normal pressures and satisfactions affecting the marriage and the wife's plans. Further, i t was hoped that in the wife's relationship with her children significant aspects of her personality would be revealed. The third criterion was that each record should be sufficiently extensive to enable study of both the casework and of the personality of the wife. Simple though i t may seem, this was the most difficult criterion to meet in the cases. This was mainly due to the fact that many of the contacts were of such brief duration that l i t t l e picture of the wife's personality emerged. The cases were obtained by asking caseworkers in the agency to note cases which met the above criteria. There was no attempt to obtain a statistically valid sample of the work of the agency in this problem. As the caseworkers themselves forwarded the cases i t might be advanced they chose those records which satisfied them most from the point of view of effective casework. This is however, highly doubtful in view of the vide range of effectiveness revealed in the records. Particular Foci of this Study This study is focussed particularly upon two aspects of casework with the wives of alcoholics. One of these is the wife in the family and social setting. The other is the apparent movement in the case. These foci were established in terms of the general experience of casework which has shown change or movement in the client's situation to be related to the nature of the casework service given and to the personality of the client. The nature of the client's personality will determine the casework plan which must be followed. If the casework help is given in an ineffective 7 and unplanned manner the amount of damage which can be done is to a considerable extent dependent upon the client's personality. As i t would be expected that casework with the wives of alcoholic men as well as of resulting movement would be similarly dependent upon the personalities of the wives, particular attention is given to the wife's personality in this study* The Bases for Study of the Wife's Personality The basic formulations for study of the 13 wives came from psychoanalytic thought, particularly Dr. Helene Deutsen's work on the psychology of women^ . In one phase of this work she establishes what she describes as the "feminine core" in woman's personality. This she sees as based upon passivity or activity turned inward to concern with personal experience and feeling. In women possessing this "feminine core", this is evidenced by complete sexual readiness in marriage together with willingness to accept the difficulties and burdenB of wifehood and motherhood i f the need for actively-expressed love is met. Deutsch describes four major configurations of woman's personality in terms of their possession of this "feminine core". For convenience here these will be referred to as types though nothing so rigid as categorizing woman's personality was intended by Deutsch or is intended here. The feminine passive woman, in Deutsch*s view, most completely possesses the attributes of femininity. This woman i s characterized by her capacity for erotic participation in sexual relations. She is protected from easy exploitation in this regard by strong narcissistic conditions which her lover must f u l f i l completely. Deutsch distinguishes two types of women in terms of this narcissistic protection and the type of men they are 1 Deutsch, Helene, Psychology of Women. 2 vols., Grune and Stratton, New York, 1944* 8 attracted to, but, the distinctions between them are too fine for the needs of this study. Generally, i t may be said, that the feminine passive woman is attracted either to the active masculine man or to the-untried man in whose strength she can believe. Her relationship with her husband, as with her children, is one of deep almost intuitive identification. Married to a satisfactorily active man, she has l i t t l e tendency to engage in any competitive activity. Another feminine type distinguished by Deutsch is the feminine active woman, who has more active drives than the feminine passive woman. Her relationship with her husband and children is more consciously con-ducted. More than the feminine passive woman, this woman is concerned with the moral rightness of her actions and the actions of those with whom she associates. She can only participate in erotic sexual relations i f she feels they are morally right. This woman is able to channel her activity into home concerns i f her husband is sufficiently active. She then tends to leave a l l outside activity to him while she directs the education of the children and sets the tone of the home. Her considerable feminine intuition usually saves her from a matriarchal attitude and devaluation of her husband. It is interesting that Deutsch states that in the event of a conflict between motherhood and eroticism, these women usually decide more easily than the others in favour of their children^. The third type of woman she delineates is the matriarchal. This woman, she sees as closest to the feminine active but, differing from her chiefly in that the erotic and passive components are weaker. Because her activity is of a motherly character, she tends, under suitable social conditions, to have many children or to undertake substitute endeavours. 1 Deutsch, op. cit. vol. 1, p. 212. 9 This woman also tends to religious activity though not necessarily of an institutional sort. This woman tends not only to rule in the home, but also to direct the fate of her kin outside the homej,. The fourth type of woman, of whom there are innumerable sub-types, is the woman with the "masculinity- complex". This is characterized by the predominance of active and aggressive tendencies that lead to conflicts with the woman's environment and, above a l l , with the remaining feminine inner world. Deutsch holds that " woman's masculinity . originates in a surplus of aggressive forces that were not subjected to inhibition and that lack the possibility of an outlet such as is open to man. For this reason the masculine woman is also the aggressive woman1^. These four types as drawn from Deutsch's work served largely as points of reference in study of the personalities of the 18 wives. The six groups Into which the 18 -wives are divided in Chapter 2 is the result of the pictures of their ego strength and maturity related to the pictures of their personalities. The six groups presented are related to Deutsch's four depicted types, but none of these women, let alone any group, duplicates perfectly any of the types described. The manner, in which these groups are related to the four types will be brought out in Chapter 2. It may be noted that Dr. Florence Hollis in her study "Women in Marital Conflict" also drew heavily on Dr. Helene Deutsoh's classification. Dr. Hollis' study has been accepted as one of the best of its kind by psychiatrists, psychologists and social workers^. 1 Deutsch, op. c i t . vol. 1, p. 289. 2 Ibid 292 3 Dr. J. McV. Hunt comments made at a workshop on research held at University of Washington, august 1951. 10 The Method Chapter 2 is intended to give both a picture of the various personality types and as well presentation of some of the elements in failure and success in the casework. This material together with the material presented in Table 1 supplies the basis for the opinions and conclusions of Chapter 3. The Material on Casework in Table 1 Table 1 requires special consideration at this point. It contains a breakdown of aspects of casework in the various cases as well as other significant elements In the work in each case. Though Table 1 particularly deals with casework, a section of i t concerns patterns evident in the husband's drinking. This is summarized in table form because i t seems valuable to relate matters discussed here with the general studies In alcoholism. In addition, though i t is not directly a matter to be dealt with in this thesis, i t was considered that some understanding of the husband's pattern of drinking was necessary to an understanding of the wife's handling of associated problems and of the casework plan discussed. Patterns of Alcoholism The definition of alcoholism given at the beginning of this chapter, while useful In establishing general directions in study, is inadequate for a differential diagnosis of the husband's problem. In considering the plentiful research done on the subject of alcoholism, a notable disagreement between researchers i s clear. Some hold that alcoholism has a purely physiological or genetic base. Others support the view that the roots of alcoholism l i e In the personality structure. As happens, whenever two groups develop exclusive interests In what are really two parts of one Idea, the psychosomatic unity of the illness is not 11 considered. The views of these groups are today being painstakingly united In the work of various treatment schemes, but this work is only beginning. As the concern here is with the personality of the alcoholic, thinking must be drawn upon which is rendered somewhat out of balance by the lack of integration in the total field. The tiwo-.o categories of alcoholism indicated in Table 1 were drawn together from the work of Dr. Ernst Simmel^ and Dr. Robert P. Knight^. Knight believes that there are two main clinical varieties of alcohol addiction, (l) That In which alcohol addiction appears to be a reactive symptom in the course of neurotic illness developing in adult l i f e and (2) that in which alcoholism is the most conspicuous of numerous devices used by a developmentally deformed character arising from earliest childhood. Earl Menninger^ considers this distinction is valuable clinically as the former group has a much better prognosis. Slmmel postulates a slightly different grouping, classing them as (l) the social drinker, (2) the reactive drinker, (3) the neurotic drinker, and (4.) the alcohol addict. In each, alcohol is seen as balancing an Impaired mental equilibrium. In the f i r s t two groups alcohol defends the ego against the Impact of external circumstances. In the second two groups i t defends the ego against the threat of inner unconscious conflicts which only secondarily Impair the ego's capacity for dealing with reality. Slmmel sees the social drinker as a person living beyond hiB Instinctual means. He needs liquor to enjoy association with people. 1 Slmmel, Dr. Ernst, "Alcohol and Addiction", The Psychoanalytic  Quarterly. The Psychoanalytic Quarterly Inc., Albany N. Y. 1948. 2 Knight, Dr. Robert P., "The Psychodynamics of Chronic Alcoholism", The Journal of Nervous and Mental Diseases. November 1937. Coolidge Foundation, New York, N.Y. 3 Menninger, Karl, Man Against Himself. Harcourt Brace and Company, New York, 1933. 12 For the purpose of the study, this category when i t became sufficiently serious to meet the terms of the original definition of alcoholism was classified in the reactive group. The reactive drinker, Simmel sees, as a not necessarily neurotic individual whose personal l i f e imposes too much deprivation from suppression of instinctual desires. Drinking allows temporarily unrestricted discharges of pent-up aggressive and erotic instinctual energies* This taken together with Knight's description comprised the criteria for the reactive drinker as indicated on Table 1. The neurotic alcoholic Simmel describes as a person who needs to escape from himself. His is the neurotic character which recreates endlessly the same conflicts with people. This Simmel sees as ultimately rooted in unfulfilled infantile urges which the alcoholic Is s t i l l trying to gratify in his adult l i f e . Menninger echoes this and says "This alcohol addiction can be thought of not as a disease, but as a suicidal flight from disease, a disastrous attempt at the self-cure of an unseen Inner conflict, aggravated but not primarily caused (as many may think) by external conflict"^. Clearly Simmel and Knight present much the same picture of the neurotic drinker and together their views supplied the criteria for the neurotic drinker on Table 1. Simmel describes the alcohol addict as a person who has regressed beyond the oral stage. What he describes as a gastro-intestinal stage is more pathological than the condition of any of the 13 alcoholics considered. Though a few of the husbands seemed to be moving toward this state, none fitted i ts criteria and therefore i t is not included in Table 1. 1 Menninger, op. c i t . p. 163. 13 Other Casework Considerations Noted on Table 1  Scheduled Interviews It was considered that scheduled interviews, essential to any treatment plan had been held with a client i f three or more interviews had been arranged by appointment at any time during the contact. Three was selected as the miniTmim necessary to implementation of any casework plan. It may however be no more than opinion that three interviews preferably consecutive, indicate something about relationship and the client's interest in help. Even i f this basis Is seen as arbitrary, i t would seem nonetheless to have validity in assessing relative involvement of clients in the 13 cases* Problems Seen and Presented by the Wife This refers to the most common problems presented by the wife in discussions with caseworkers throughout the agency's contact with her. These were the main problems with which the client requested help and with which help was attempted. Problems seen by the caseworker, but not brought out by the wife in interview are not included. Clearly evident problems with which the wife did not wish help are also excluded. Evidence of Relationship Adequate to the Level of Casework Attempted Relationship, the essential element In casework, may range from the client finding the caseworker a warm, accepting person who can help her deal intelligently with reality problems to the controlled encouragement of transference elements as basic to long-term, intensive casework. The relationship, however, must be adequate to the level of work attempted. If i t is not the caseworker moves out alone to deal with the problem and the client is left behind. It is in this sense that relationship is referred to on Table 1. Service Given or Attempted The section of Table 1 dealing with the service given or attempted is set up in accord with the divisions of casework service suggested by Gordon Hamilton^. This is modified to the extent that environmental help is here equivalent to Florence Hollis 1 term "environmental support^ and includes a l l steps taken to modify the client's environment. The three headings financial assistance, material goods and community resources refer to the major matters around which environmental help was given. Counselling and therapy are used in precisely the sense that Miss Hamilton uses them. Counselling uses the main technique of clarification of the problem and feelings and attitudes around i t so that the client can find a solution to the problem and a new course of action. Therapy refers to treatment in which clarification is accompanied by some reliving and understanding of past living experiences. This is undertaken within the caseworker-client relationship. It should be stressed that In this study supportive help has been considered Integral to a l l classes of casework service. Movement The part of Table 1 that deals with movement is based upon assess-ments made in terms of the work of J. McV. Hunt and Leonard S. Kogan . 3 Since "Measuring Results in Social Casework" was published, the validity of the presented method of measuring movement or change in clients as a result of casework has been the subject of continued discussion. Review 1 Hamilton, Gordon, Theory and Practice of Social Case Work. Columbia University Press, New York, N. Y., 1952, pp. 237 - 270. 2 Hollis, Florence, Women in Marital Conflict. Family Service Association of America, Albany, N. Y., 1949, p. H. 3 Hunt, J. McV. and Kogan, Leonard S., Measuring Results in Social Casework, Family Service Association of America, New York, N. Y., 1950. *5 and examination has been undertaken not only by the Soeial Work profession but by the authors themselves. As a result of this re-examination the validity of this method of measuring movement is no longer questioned. Present attention is focussed upon refinements in the method. The tool used in actual measurement of movement is a rating scale^. Four types of evidence of change or movement are included in this rating scale. These are (l) adaptive efficiency, (2)disabling habits and conditions, (3) verbalized attitudes and understanding on the part of the client and (A) environmental circumstances. Each client's movement is studied by rating i t for each of these on a scale of equal appearing amounts of movement: 4A is the highest score ( m u s trated by an anchoring case), then • 3, <*2, 4 l , with 0 for no movement, -1 where the client is worse at closing than at opening, and -2 for the client who is distinctly worse. Each client is judged in terms of his own movement and not in terms of any absolute standard of perfection. Ideally the movement of a client should be estimated by several persons and their estimates averaged, i f careful discriminations are to be made. It was Impossible to establish the ratings for this study In such a manner. However, the variations in movement were so gross that fine discriminations were not required. The degree to which casework is deemed responsible for movement on the wife's part is expressed in percentage deciles, 0 to 100 as suggested by Eogan and Hunt. Objective in Chapter 2 In Chapter 2, as mentioned, the 13 wives and the 13 cases will be discussed in terms of the six personality groups into which they appear 1 Hunt and Eogan, op. c i t . p. 31. 16 to f a l l . While a presentation of the wife's personality revealed in attitudes and behaviour is the basis for organization in Chapter 2, an attempt wil l be made as well to present the various problems met in casework with representative women in each of the groups. Chapter 2 Personalities of the Women Under Study Each of the IS wives of alcoholic men whose personality was examined through casework records in this study is, of course, an individual, different from the others. If that cliche "typical alcoholic's wife" s t i l l needs to be refuted today the variation in personality pattern should supply adequate evidence. Here are mature and immature women, essentially active and essentially passive women, women with intuitive capacity for motherhood and women for whom mother-hood is no more than an outlet for their own aggressive energies. Yet, despite the variety in the personalities of these 18 women, there are certain patterns of personality expressed in their functioning as wives and mothers. As will be indicated, these patterns of personality appear relevant to casework, both as i t may be attempted with the wife herself and with her husband and family. There seem to be six major types of personality pattern evident in the 18 women studied. Group 1 Women First there are clearly intelligent and competent women who cling to and idealize their alcoholic husbands. These women seem to have real capacity for identification with the feelings not only of their husbands but of their children. These women have the capacity for effective functioning in the business world but they seem to seek and yearn for a situation in which they may f i l l a more passive wifely and maternal role. The two wives who evidence this pattern appear to have considerable of what Helene Deutsch describes as the "feminine core". Perhaps in this 18 regard they approximate most closely of a l l the 18 wives Deutsch's depiction of the feminine active woman. They evidence a considerable degree of concern with moral'values but yet, in their acceptance of the burdens of wifehood and motherhood and in their capacities for intuitive identification with their husbands and their children, they seem closer to her picture of the feminine passive woman. As the records lack the necessary Information for clear comparison with Deutsch's types, we must be satisfied with the statement that these two women are essentially feminine. Consider one of these wives, Mrs. Vowles. Mrs. Vi was 38 years old when she came to Family Welfare Bureau requesting financial help during her second husband's post army job adjustment. Mr. V. was at this time A3 years old. He had functioned successfully as a sergeant in the army and at this time no tendency toward alcoholism was indicated. Mrs. V's daughter Helen by a previous marriage was 13 years old and Joan, her daughter by the marriage to Mr. V. was 10 years old. During this contact only Mrs. V. was interviewed. Mr. V. was out of the home either working or hospitalized, much of the time. The mother and daughters always lived in low cost accommodation but the home was always clean and attractive. Economic difficulty was always the basis of the request for help and casework service never dealt with problems beyond this concern. Mrs. V. was known to the agency from a request for help during her previous marriage when she was concerned about the first husband's threat to kidnap the daughter Helen at the time separation was pending. We have no basis for assessment of her justification for separation in her statement that her f i r s t husband's sexual demands were too extreme. 19 Mrs* V's early home-life appears to have been rigid and moral-istic* She was one of four daughters of a markedly strict Presbyterian family* She seemed only recently to have come to any reconciliation of her adolescent animosity to both parents* It seems that Mrs. V* made only a partial identification with her mother and to have related only B l i g h t l y to her father* Mrs* V's other three sisters were a l l hospitalized at various times for treatment of mental illness. One had an illegitimate child* Mrs* V. never mentioned any of these matters to any caseworker, but, undoubtedly they were inextricably involved in her feelings about her husband who was twice hospitalized with a diagnosis of acute alcoholic psychosis. It appears that she deeply identified with Mr* V. to whom she had given up the idea of marriage at the insistence of her parents prior to her f i r s t marriage* Always in speaking of his difficulties to the caseworker, she presented her husband in the best possible light. Though she effectively moved into employment as a cook in order to support the family when Mr. V* failed, she was even quicker to give up her employment whenever i t appeared that Mr* V* was going to be able to take f u l l responsibility for support. Mr. V* had completed two years of university study prior to his army experience* Mrs* V. who herself had had ambitions of an academic nature, which family financial difficulties had prevented her f u l f i l l i n g , always stressed her husband's education as proof that he was worthwhile. Education was, as well, an Important matter for Mrs. V. in her plans for her children. Mrs. V's concern with academic matters may perhaps be related to the Scottish belief in the merits of education as a means of bettering oneself. Having been unable to meet the standard herself she identifies with the accomplishments of her husband and her children. 20 Mrs. V. should not, however, be thought of as a driving mother satisfying her own ambitions in the lives of her children. She appears to have been able to give both her children the affection and security they needed. Both children had known considerable upset in their lives but both seemed remarkably stable and to be functioning on particularly high levels. Mr. V. was never seen by the caseworker and the record reveals l i t t l e about his background. However, the fact that he did not marry until he was in his late thirties together with the fact that he always strove to work away from his wife and family may in part be indicative of a person emotionally unprepared for marriage. There is, however, no record of the sexual adjustment in this marriage. The disintegration of his personality during the marriage may in part be related to this emotional immaturity and in part to war injuries. Casework was limited to financial help in this case. Mrs. V. the only member contacted was never helped with any of the personal problems she was meeting in the marriage and in the situation around Mr. V.'s alcoholism. This seems clearly to have been the result of failure on the part of the three caseworkers who saw her to establish any measure of meaningful relationship with her. In the record i t appears that Mrs. V. did tentatively open discussion of her own feelings and her own problems both in relation to her husband and to her parents. This however, was submerged and lost in dealing with the requests for financial help. Mrs. V. seems almost to have become convinced that the work of the agency was solely focussed upon financial concerns. There can be no doubt that Mrs. V. had strong feelings about being dependent upon anyone and always placed her requests for financial help upon intent to return the funds. Caseworkers seem to have been 21 deluded by t h i B attitude together with Mrs. V's capacity to support the family in a case of need. They saw her as "a peasant-like controlling woman". More probably she yearned to be somewhat dependent for a brief while and yet, a l l the rigidity of cultural stress on self-sufficiency strengthened her fear of lowering her defences. It would seem that i f the f i r s t caseworker who set the pattern for Mrs. V's expectations from the agency had been able to offer her emotional support as well as financial support, she might have been able to use help with problems concerning her parents family and her husband's alcoholism. Mrs. Grange Mrs. Grange was 36 in 1952. Mr. Grange was 4I. There were three children aged 6, 5 and 2 years. Mrs. Grange was like Mrs. Vowles in that she was an intelligent and in many regards mature woman. She clung to her husband much as did Mrs. V. though her reason for doing so appears to have been quite different. The moral element was strong in her personality and was expressed in an evangelical desire to save Mr. Grange. This attitude enabled her to endure not only lack of support but also drunken beatings. While she believed, as did Mrs. Vowles, that her husband was worthwhile she saw herself as the only influence preventing him from "ending in the gutter, a bum°. We know l i t t l e of Mrs. G's background, but her attitude seems part of a pattern which had earlier led her to become an Anglican Church Deaconess. Unlike Mrs. Vowles, Mrs. Grange had considerable difficulty in moving into employment when her husband failed to support. She wanted the caseworker to t e l l her whether she had."done the right thing" to return briefly to office employment when Mr. G. procrastinated about taking work. 22 Perhaps even more than Mrs. V., Mrs. G. seems capable of a real Identification with the feelings of her children. Repeatedly nurses and social workers describe her warm affectionate handling of the children* according to Mrs. G. Mr. G. as well is good with the children, but we might expect that this was true in the typical pattern of alcoholic inconsistency^. Mr* G. who was seen on one occasion during the contact appears as an intelligent and charming person. His work as a semi-skilled labourer was perhaps not fully demanding of his abilities, but his frequent job changes very naturally obviated promotion* Four caseworkers saw Mrs. G. during the three year period prior to 1952 when the family was known to Family Welfare Bureau. The majority of work seems to have been predicated upon the conviction that the wisest thing for this Intelligent and competent woman to do would be leave her husband. Mrs. G. made several weak attempts at so doing, but at the close of contact she remained in the home. Of the four caseworkers one alone seemed to establish both relationship and diagnosis which indicated help in re-establishing the marriage. It was this caseworker who saw Mr. G. Mrs. G's decision to do as neighbours suggested and lay a charge against her husband for non-support was the basis for terminating contact as i t appears Mr. G. then worked briefly and joined A. A. The record supplies an uncommonly clear picture of missionary zeal on the part of the alcoholic's wife. "Mrs. G. in telling me of her missionary experiences sees herself as a helping person and does not regard him as an equal sharing in responsibility of home and family, but as someone she must help. She many times considered leaving her husband but felt that i f she could save M m she would really have done something worthwhile. She definitely feels that i f she did not stand up by her husband constantly and i f she relaxed her vigilance for a moment he would end on "Skid Row". 1 Newell, Nancy. Ed. M., "Alcoholism and the Father Image". Quarterly Journal of Studies on Alcohol. March 1950» Tale University, New Haven, Conn. 23 This submission to the burdens of constant insecurity and frequent beatings would seem to indicate a very real need for punishment on the part of Mrs. G. It might be wondered how much a part her own behaviour may have played in precipitating the desired punishment. Her manner of handling the "wrong" actions of her husband by punishing him through legal action or threat of leaving seems part of a general belief that crime must be followed by punishment. It might be wondered what the crime was for which she, herself so guiltily sought punishment. The Group 2 Women The second group of women who seem to emerge as a distinct type from the total 13 wives are those who notably strive to control and reform their husbands. These women are less feminine both in their function as wives and as mothers than were the previous two women. While Mrs. Grange above was inclined to see punishment as helping Mr. G., these women lay even greater stress upon i t . They believe far less in their husband's worthwhileness.and evidence much less of a capacity for identifying support, let these women, like the previous two, are intelligent and capable. Their essential rejection of their husbands who have failed to be satisfactorily masculine and active would seem somewhat in accord with Deutsch*s pattern of the feminine active wife. There is the probability that these two women could give up their own active drives completely and restrict their interests to the home and children i f their husbands were satisfactorily active. These women even more than Mrs. Grange are narrowly concerned with right and wrong and this attitude permeates their attitudes to their children. Theirs is not a warm and intuitive relationship to their children, but rather one of educating the children. 24 The record which best reveals the pattern of the two women, Mrs. Oliver and Mrs. Riley is that of Oliver. This is one of the few cases in which extensive casework help for the wife was undertaken and one of the few cases in which there was marked change in the l i f e patterns of both husband and wife. 4s this case is exceptional i t merits considered exam-ination here. Mrs. Oliver Mrs. Oliver was 35 years old in 1952 when she came to the agency requesting help around the problem of her husband's drinking. He at this time was 37 years old. There were three children, girls, aged 11, 7 and 5 years. Mr. Oliver's 60 year old alcoholic mother lived with the family. There was no economic problem in this family at the time of contact. Mr. 0. worked steadily as a butcher and though he occasionally drank and gambled, this seemed in response to pressures from his wife and mother in the home. Mrs. 0. received ample funds to operate the family budget. This had not always been the case and at various times in the past, Mrs. 0. had taken Mr. 0. to Family Court and had adopted the policy of meeting him on payday to obtain his pay envelope, also she had on several occasions gone to Mr. O's employer to describe her problems. The employer was able to ignore Mr. O's family problems as Mr. 0. was apparently an excellent employee, well-liked by both customers and fellow workers. Mr. and Mrs. 0. had markedly different backgrounds. Mrs. O's father was chronically i l l during much of her childhood. She describes her parents as strict, but concerned about the children and spending much time with them. Her mother took on most of the responsibility of supporting the family by operating a small confectionery and lunch room. Considerable goals were set for each of the children. Mrs. 0. had planned to go to 25 University, but as her mother became i l l during Mrs. O's adolescence she had to renounce her plans in order to help out at home and in the business and to enable the other siblings to pursue their goals. Mrs. 0. expressed no resentment of this and i t appeared that she had channelled her aggressive drives into raising a "good" family. She set high standards for her children and was punitive vhen they did not conform. She was also much concerned with the moral education t h e . of her children. She said that she had come to^agency for help because she felt the children were becoming old enough to understand about the difficulties in the home. Obviously, she must have had l i t t l e sensitivity to the feelings of her children or she would have realized that past upsets had had considerable effect upon their development, and that their present capacities to discriminate between right and wrong behaviour were somewhat less important. Also she stressed to them with regard to their father's conduct that "adults should be respected no matter what they did". Aside from the evident narrow moralizing, this is surely a clear pieceeof-1 depreciation of Mr. 0. It as well, probably, indicated the manner in which her own hostilities to a strict mother were reconciled. The sexual relationship seems the vehicle of considerable anxiety for Mrs. 0. She stated at one point that she had been attracted to Mr. 0. during courtship because he did not touch her. It was also apparent that she used sexual refusal as a weapon to punish her husband for misdemeanours. Mr? 0. grew up in a family with few standards. His mother seems to have been an inconsistent and rejecting person who overindulged or ' severely punished her children by turns. Me have l i t t l e picture of Mr. O's father except as revealed in the fact that Mr. 0. related more positively to men than to women and appeared to adapt happily to a benevolent 26 masculine authority as personified in his employer. He seemed tied to his mother with whom he quarrelled frequently and violently, usually after occasions when the two had gotten drunk together. Mr. 0. was never seen by the woman student worker although in the past he had maintained a sporadic contact with a male worker at Family Court. Mrs. 0. maintained a regular contact with the caseworker over a period of several months. Initially Mrs. 0. appraised her marital situation with the caseworker and concluded that there was sufficient in the relationship to make work toward improved relations worthwhile. She expressed from the fi r s t the wish that her husband be changed to meet her standards. She held to this desire throughout the contact though she was able to see that her own attitudes had an affect upon her husband's behaviour. Casework here seemed to help Mrs. 0. give more to her husband and relax her demands upon him. This enabled him to somewhat meet her standard by decreasing his drinking. Also i t appears to have made i t possible for him to suggest to his mother that she end her destructive presence in the home. It seemed that he could cease trying to satisfy his needs in the relationship with his mother i f the relationship with his wife offered him more satisfactions. The record indicates that there was l i t t l e attempt to deal with matters concerning the sexual relationship or around Mrs. O's handling of the children. Mrs. 0. withdrew from casework following the marked improvement in the situation which succeeded the departure of Mr. O's mother and his elevation in status at work. It is interesting to note that Mrs. 0. was charged fees for the casework service. In relation to her great stress upon money values this 27 seems to have helped her to see casework service as something valuable for which she was paying and from which she had to get her money's worth. Mrs. Riley Mrs, Riley the other wife! in this group was 4 O years old at the time she came to F.W.B. in 1952, Her husband was 4 8 years old* Mrs* R. had married for the f i r s t time in her middle thirties. There was one child, John, age 4 years. Mrs. R* like Mrs. Oliver, came to the agency wanting her husband changed. Unlike Mrs. 0. she spoke frequently of bringing him to his senses by leaving him. Her attitude toward him, however, seems to have been quite as consistently a depreciating one. She laid great stress upon the moral rectitude of her views and position. She told on one occasion how when she heard him lying on the telephone to friends In A* A. she took the phone from him and told the friends the truth. Mr. R's pattern of drinking was considerably more pathological than that of Mr. 0. His drinking had disrupted an earlier marriage and he had three adult sons by his first wife. In contrast to the 0s who had married early in l i f e , the R's had married much later. It is interesting that both Mrs. 0. and Mrs. R. had rather strict and controlling mothers who dominated their growing years. In Mrs. R's case, this was rendered more extreme by her father's death in the first World War. This greater imbalance In the original family constellation may perhaps explain why Mrs. R. did not marry until much later In l i f e than Mrs. 0. and then to an eves less stable man. It is perhaps also significant that there is l i t t l e indication of the husband striking either of these women. Both seem to have married essentially immature and passive men who could not threaten their wives' weak orientation toward femininity. Having married such men perhaps .28 because they seemed non-threatening to their own desires to control they were upset to find that the price they had to pay was acceptance of that immaturity. In her attitude to her son, Mrs. R. evidenced the same lack of capacity to understand the child's feelings as shown by Mrs. 0. Mrs. R. thought nothing of bringing the child into the interview with her while she was spilling out the details of her difficulties. Mrs. R. was also like Mrs. 0. in that she was intelligent and competent. She had worked for some years in the business world prior to marriage. There is the feeling that to some extent these women have substituted intellectual competence for their essential femininity. In extreme degree Deutsch feels this is indicative of the woman with strong active masculine drives. However, here the drives do not seem so strong that they could not happily be directed into control of home and children-i f their husbands had been capable of providing a secure medium for such functioning. Casework with Mrs. R. was limited to three interviews and several telephone conversations. In the Interviews, Mrs. R. was able to discuss the problems other than alcoholism and seemed able to use some measure of clarification in regard to the total marital problem. It is quite probable that she would have been able to use casework help as effectively as did Mrs. Oliver had not the caseworker encouraged her to discuss her feelings about her mother more fully than she was ready to handle, as a result she found excuses and avoided keeping subsequent appointments. The Group 3 Women - Sub-Group 3a The third distinguishable type of personality among the 18 wives, is that which embraces four women whose prime or sole focus of activity 29 tends to be around their children. This group of four seems divisible into two sub-groups. One of the sub-groups which shall be referred to as type 3a comprises two women who appear to want to give their children with whom they identify, the things they have not had themselves. These are women like the foregoing four in that they are capable of considerable activity, but that activity seems most happily focussed upon an almost participating relationship with their children. These women seem to lack both the intelligence and competence of the fi r s t four. There are some indications that these women are able to shift the focus of activity from the home to outside with less difficulty than the preceding four women. Mrs. A l H s n n Mrs. Allison is perhaps revealed more clearly in the records than is Mrs. Jensen. Mrs. A. was first referred for advice about her marital situation in June, 1948. At this time Mrs, A. was 32 years old, and her husband 36 years old. There were three children two girls, 10 and 11 and a boy of 8 years. At this time there was some question of the appropriateness of later referral of this non-practicing Roman Catholic family to a Roman Catholic agency. This was not, however, done. During this contact Mrs. A. said that her husband had always been a drinker and gone out with other women. This she felt she could overlook until he began spending increasing amounts of money on liquor and began boasting of his affairs. He had for two years been steadily employed by a laundry. During the July of 1947, he had beaten her severely and during the past Christmas, knocked her unconscious in the street. At this time she had laid a charge against him but later, at his request, had withdrawn i t . She doubted that the subsequent remission in his drinking would continue but did not wish to separate as he had suggested. However, she -30 was concerned about her situation i f he deserted and the caseworker out-lined the difficulties and safeguards for her. An offer to see and help Mr. A. before the situation became acute found Mrs. unready to involve him in any planning. Whether this was the result of fear of his possible anger directed toward her or' really an expression of her own unreadiness is in question. She stated that she did not want him to know that she had complained about him or thought he would desert and decided to leave things stand as they were. There was no further contact until March, 1952 when Mrs. A. was again referred by the same assistance-giving agency that had referred her i n I 9 4 8 . In the interval, Mr-..and Mrs. A. together had established a window-cleaning business which at its peak brought in $300 each month. At the time of this referral i t was decided that as the children attended a Protestant Church, F.W.B. would be the agency to offer help. Mrs. A.'s fi r s t telephoned request to the agency was not for help with the problems in her marriage but for fuel. In the interval between the referral and the telephone conversation, Mrs. A. had forced Mr. A. to leave the home and make a separation agreement paying $7 each week for each child. She had obtained this concession from Mr. a. by threatening to lay a charge against him for a sexual attack he made upon the 15 year old daughter Alice. The daseworker visited and described Mrs. A. as "a worn but s t i l l young looking woman". It appeared to this caseworker that much of the previous success of the window-cleaning firm had been the result of Mrs. A's energy and drive. When she ceased working beside her husband, he had moved gradually into increased drinking. To this caseworker, Mrs. A. indicated concern about handling the boy Harry who seemed to be following his father's pattern of petty thievery. The caseworker felt that Mrs. A. could, with 31 support, hold her family together and the request for fuel was granted as such support. From the record i t does not appear that any definite basis for future help was established except in that i t was suggested that Mrs. A. let the caseworker know how she progressed in plans to get work or take in boarders. The f i r s t caseworker left the agency and Mrs. A. was seen on request two months later by another caseworker. On this occasion Mrs. A. had had to appear in court in regard to Mr. A's failure to pay the stipulated $21 each week. She told how she was having financial difficulty as her lawyer had advised her not to take in male boarders and her accom-modation was not suitable for women boarders. Mrs. A. again expressed particular concern with regard to Harry as he had been involved in sex play with neighborhood children. She told how she had endeavoured to terrify him with descriptions of pregnancy and of venereal disease. She thought that as he had been unable to sleep following her talk with him, she had put a stop to his activities. Following this interview, work with Mrs. A. was transferred to a man caseworker. Prior to his contacting her as arranged, Mrs. A. again requested help in purchasing fuel. This request was granted and this case-worker continued to work with Mrs. A. from the middle of June to the middle of September, at the outset i t was agreed between F.W.B. and the assistance-giving agency referring the case that the latter agency would deal with Mrs. A's financial needs in extreme situations while F.W.E. would work with the family on a regular casework basis. The reasons for this division of responsibility are not relevant to this study. In the telephone contact i t was brought out that Mrs. A. would welcome planning for camp for Harry. He and several other youths had been involved in breaking windows with slingshots. She said "Harry thinks that 32 If his father does as he pleases so can he". The caseworker saw Mrs. A. at home once each week during the summer. & definite focus upon her problem in regard to planning for future support of the family by herself and her husband was established. Also the caseworker endeavoured to institute the equivalent of the office interview with Mrs. &. and It was notable that her varying attitudes toward the interview were expressed in occasional failure to arrange matters in such a way that a proper interview could be conducted. She gave a picture of the marriage and its background in the first two interviews. She said that while Mr. A. was often brutal to her in drunkeness she never withdrew from sexual relations with him until the attack on Alice. She stated that as a girl she had decided that her husband would never have to go to another woman for intercourse. There was a strong feeling of martyrdom in her picture of the difficulties Bhe had met in carrying out this decision. Also, until 5 years ago, when Mr. A . beat her and she "felt all the love for him drain out of her1? she used frequently to get down on her knees to beg him not to leave or drink. She said that during this past five years she had adopted a different policy and had flirted and drank somewhat herself. Mr. A. she said, had been born in the United States and at the age of three years moved to Canada. She believed that he had been in reform school on several occasions and in jail once for car theft. Of his relations to his parents she said "He was his dad's little boy and his mother could do nothing with himn. She told also of the apparent social pattern in Mr. A's drinking. He had grown up and lived much of his life in a prairie community where regular and excessive drinking during the winter was customary. After marriage, Mr. and Mrs. A. and the family lived in this prairie community for a considerable time moving from rented farm to 33 rented farm. Mrs. A. had considerable feeling about the fact that the present old and worn house was the first one they had ever owned and indeed represented the f i r s t stability the family had known during the marriage. Mrs. a. gave l i t t l e picture of her own background except to mention that her people were Russian-speaking Austrian Immigrants and that she had spent much of her youth in onerous domestic work for others. Mrs. A. evidenced a great deal of feeling about being apart from the Roman Catholic Church. She had had the three children baptized in the church but none had been to Communion. It is interesting that the caseworker seemed to have considered further discussion with Mrs. a. in regard to this matter, but rather seems to have become so involved in day to day difficulties that this plan was forsaken. Shortly after the i n i t i a l interviews the caseworker began to arrange for Harry to go to camp. In regard to this the school nurse indicated that intelligence tests had revealed that 15 year old Alice was of somewhat less than average intelligence while 14 year old Helen was average. Harry, also average, had created no difficulties at school but the nurse had repeatedly endeavoured to have the family do something about his teeth which efforts the family ignored. Harry, as he was revealed around the camp referral, seemed to possess a surface assurance and socialization while in reality he suffered a real unsureness and feeling of worthlessness. While Mrs. A. saw the home and her own activities as focussed upon giving her children the opportunity for a happy youth, there were some indications that this pleasure was particularly intended for the two girls with whom she iden-tified and whom she tended to favour. The girls' clothing was of better quality than Harry's and they were not expected to make any particular efforts to keep the home operating. Harry, on the other hand had l i t t l e 34 other than old clothing and was expected to carry the heavy sawdust pails from the basement to the kitchen. Harry did not appear as a-normal healthy 12 year old. Rather he seemed like a serious l i t t l e old man. He was short, slight and had a decided stoop. His teeth were irregular and crowded and he seemed undernourished. From the record i t would appear that the caseworker had con-templated further work directly with Harry, but like the concern with religious matters this avenue of work was foregone. The only help directly to Harry was the camping experience from which the results were rather startling, after no more than ten days Harry returned happier, healthier appearing, and lacking his former notable stoop. Mrs. A. appears as an industrious woman, scrupulous in housekeeping and an excellent and economical cook. She took in sewing and with a friend strove to establish an upholstering business. She also worked for brief periods in canneries but gave this work up when she observed that during her absence her daughters frequently had their boy friends in the home during the entire day. When these lines of endeavour did not bring sufficient remuneration, Mrs. A. was forced to take legal action against Mr. A. Much of the casework was focussed upon helping Mrs. A. clarify her feelings about taking action against her husband. She seemed able to plan fairly well for the future of herself and her children so long as no direct action against her husband was required. It was at one point where Mrs. A. was contemplating action against her husband, that the caseworker visited Mr. A. This was apparently done in an effort to explain the legal situation in as non-authoritarian a manner as possible. The caseworker indicated a willingness to help Mr. A. with his own plans for the future but was met only with veiled hostility. 35 Toward the close of contact Mrs. A. told the caseworker how a man she had known as a family friend for some time had expressed interest in her. She said that she had decided to divorce Mr. A. so that she could remarry. Work with M T B . A . was terminated when she finally took action against her h u B b a n d . As the caseworker was leaving the agency and as i t seemed that the assistance-giving agency already involved would have a more regular contact, the case was transferred to the latter agency. The caseworker in this case did establish a casework relationship with Mrs. a. but i t might be wondered i f the nature of the work which this relationship made possible was not to some extent conceived in error and expediency. The caseworker seems to have approached work with Mrs. A. from the point of view that her decision to leave her husband had been a sound one and that plans to remain apart from him should be encouraged. This is not certain, Mrs. A s t i l l had considerable concern about her husband and evidenced some desire to return to him. Was there not a judgment made on the part of the caseworker in terms of which help for Mrs. A. was focussed? In attempting to help Mrs. A. to do what he felt she should do, the caseworker neglected to give her the help with real problems of attitude which were made clear to him. The caseworker's efforts might have been more constructively directed i f he had helped Mrs. A. with the problems of religion and with what seemed her hostility to Harry. Perhaps in terms of such help Mrs. A. might have been able to find the security in her own emotional l i f e that would have enabled her to reunite with her husband and to give him the support without which he seems to have been unable to work. This casework situation involves in rather subtle form the rights of the client to self determination. The caseworker did not allow Mrs. A. to make her own way through her ambivalence. Rather he endeavoured to help 36 her take the course of action that seemed most correct to him. This difficulty was very probably the result of the fact that the caseworker was neither completely trained nor greatly experienced and evidently did not get needed help from supervision. The establishment of a real diagnosis and the conception of casework directions stemming from such a diagnosis were perhaps slightly beyond his capacity. Mrs. Jensen The other case which falls within this sub-group is that of Mr. and Mrs. Jensen. Mrs. Jensen was 4O years old when she requested help with the problem of her husband's drinking in 1952. Her husband was 48 years old. There were two children, Joan 15 years and George 18 years. Mr. J. had been a logger and at the time of contact was a machinist with a logging company. Daring much of his married l i f e he had been away from the family for long periods of time. As a result Mrs. J. had, she said, "been both mother and father to the children". Mrs. J., like Mrs. A., appears in the record as very much involved in the lives of her children. Like Mrs. A. she seemed to see the home as primarily a place where the children could enjoy themselves with their friends. More clearly than in the case of Mrs. A. she was seen as participating in these enjoyments, almost as an equal. Like Mrs. A. she seemed not only to desire to give her children the sort of adolescence she had not had herself but also like Mrs. A. she was trying to relive a more satisfactory-adolescence herself. As might be suspected Mrs. J., like Mrs. A., was too limited in her own emotional development to really under-stand the feelings and needs of her children. She was pleased when Mr. J's absence from the home gave the children to her completely. 37 at the time of contact Mrs J. had been in town same time. When he again decided to work outside of town, she broke contact with the agency. She returned to the agency shortly afterward when Mr. J., on a trip to town, became involved in an attempt to cut the over-long hair of his teen-age son. The son's subsequent refusal to return from the friend's home to which he had fled, and the recurrence of a rapid heart-beat formerly suffered by the daughter seemed to stimulate Mrs. J. to action. She was prepared to act but stressed that i t had to be Immediate. After discussion with the intake caseworker she returned home and was able to undertake what was for her a difficult course of action. This consisted of telling her husband of her visit to the agency and the reasons. Mr. J. was in i t i a l l y angry but did not resort to his usual outlet in beating her. Instead they were able to talk, she said, for the f i r s t time In many years. He told her of his fear that he would not live long due to a heart ailment. Mrs. J. felt that as they had talked about many Important things and as Mr. J. had promised to try to be more understanding and to try and control his drinking, that the drinking and beatings and difficulties with the children would no longer upset the family. From the brief record i t is clear that Mrs. J. came into marriage with considerable mixed up feelings about the matter of sex relations with her husband. Many of their early disputes were clearly centred upon this matter. However, as her husband was a sufficiently active and aggressive man and as he was away from home a great deal, she had ample opportunity to function as a mother in what was really a protected setting. It is doubtful i f she could have continued the marriage i f Mr. J. had been continually at home, demanding tnat she be a marriage partner to him. Neither could she have endured a weak and passive man who could stay at home accepting her terms. 38 ; The Jensen case and the Allison case differ particularly in that Mr. Jensen's pattern of drinking was in a cultural social pattern while Mr. Allison's was notably neurotic. Following from this Mr. Jensen was a more active and adequate man than Mr. Allison and therefore there was never any concern on the part of his wife over matters of support. The Sub-Group 3b Women The women in this sub-group of the Group 3 women are not notably different from the sub-group 3a women except that they seem to have sublimated their active drives much more completely into care of their children. These women seem closer to Mrs. Jensen in this regard than to Mrs. Allison. Also, no Impression is gained from the records that these women are reliving their own lives and the participating relationship with their children as were the fi r s t two. These women though they do restrict their activities to the home, appear further apart from their children than Mrs. A. and Mrs. J. They show an equal or greater lack of any intuitive feeling for the needs of their children, and their husbands .=>a re-even more really periferal figures in the family constellation as these women maintain i t . Mrs. Barnes The Barnes Case merits close examination for the casework problems revealed. This family was referred by the Social Welfare Branch in Burnaby in 1947 at the suggestion of the Burnaby Police Department. The police pressed for urgent action. This may have been their response to continued appeals of Mr. B's mother that they intervene to force Mr. B. to go to work. In addition the police had some feeling that the B. children might be receiving inadequate care. 39 Mr. and Mrs. B., ages 31 and 21 respectively, were living with Mr. B's parents who were in their late sixties. With the B's were Grace, a 5 year old illegitimate child of Mrs. B., a son Donny, age 3 years and a daughter Susan, age 2 years* Although the fi r s t caseworker in this case endeavoured to el i c i t a request from Mr. B's mother for agency help, she finally responded to police pressure and went in after the mother had forced Mr. and Mrs. B. to move to a shed in the rear of the property. Her resulting contact was an unfortunate one in which, at the insistence of Mr. B's mother, the entire family participated in an inquisition of Mr. and Mrs. B. in the kitchen of the mother's home. Mr. B's mother appeared a clearly matriarchal woman used to dominating and controlling her entire family. Her husband, a weak man, left the major decisions to his wife. Mr. B. of a l l his parents!; five children had been particularly protected. This had been the result of an eye injury in childhood with resultant slow deterioration of vision. During the war Mr. B. had served in the merchant service. He married his wife age 17 in England. She came to Canada in 1943 and lived with his parents for two years prior to his discharge. Following discharge Mr. B. held a series of unskilled labouring jobs. At the same time his parents gave him considerable financial help and the use of various pieces of property owned by them. It was during this period that he fi r s t began to drink. In the i n i t i a l interview with both families, the mother appears to have completely monopolized the discussion. She was particularly vituperative toward Mrs. B. She called her a "chippie" and stated i t was her keeping Mr. B. at home for reasons of Bexual pleasure that made i t impossible for M m to find and keep work. The chronicle of the mother's AO-criticism of the daughter-in-law is too long to record here. However, there was very l i t t l e about the g i r l that she did not find occasion to condemn. In the period following the interview, the mother's behaviour became increasingly violent and her language increasingly crude. On one occasion she accused Mrs. 6. of having sexual relations with the father-in-law and on another occasion smashed the windows in the shack to which she had banished the B's. Mr. Bo was seen on one occasion during this period. This was perhaps considerable testimony to the ability of the caseworker to present herself as an uncritical and helping person in the previous mass interview. Mr. B. requested help in finding housing and on indicating destitution was given $10. During this interview he spoke of his failing eyesight and his belief that he would soon be blind. The caseworker made no definite second appointment. Mr. B's brother and sister-in-law came to the office on one occasion during the above contact to complain of the difficulties in Mr. B's parents home. It is interesting to note the brother's view of Mr. B. "He has always been given too much....always been tied to his mother's apron strings and knows he can soft soap his parents and get any-thing he wants out of them. He has been made more or less the baby of the family although he is the third oldest and has been given everything he wanted ever since his eye was injured". The attitude of the parents to Mr. B. during childhood seem to have been in marked contrast to attitudes evidenced toward the other children. For the other four brothers, the Scottish virtues of thrift and hard work seem to have been set before them like the tracks of a railroad. In considering this f i r s t contact in regard to casework i t seems that the caseworker, though she was unfortunately pressured into uninvited interference in the family problem was able to maintain a considerable professional calm and objectivity. She did not let herself be used to 41 threaten or to control by either the mother or the brother. This calm and objectivity seems to have been recognized by Mr. B. when he requested help for himself later. This contact might have proven the foundation for future work with both himself and his wife had the family not moved from the area served by the agency. • The family was ont of Vancouver for a period of three years. During this time they made one request for financial help which was referred to a more appropriate agency. The case was reopened in October of 1950 in response to a request by Mrs. B's mother through the British War Bride's Association for an investigation of the information that Mrs. B. was being ill-treated by Mr. B. and was begging for food. A male, student caseworker visited Mrs. B. and this was the f i r s t time she was seen by herself. In the three year interval, the B's had had another child, Ruth, born in 19481 Mrs. B. appears at this time as a plump worried-looking woman. Her hair was attractively done and she was tidi l y dressed in old clothes with the exception of a new pair of blue-denim jeans. Mrs. B. gave a picture of Mr.-B. having increasingly failed to support. He was described as a heavy drinker who had not started drinking until he was 24. Mrs. B. said that her husband "wets" continually whether he is drunk or sober and she must use a rubber sheet in the bed. She spoke with feeling of the fact that he criticizes her earlier unmarried mother-hood when he is intoxicated. On this contact the caseworker visited Mrs. B. at home without Mr. B. being notified. Wien the caseworker visited a second time, he found Mr. B. home which resulted in an unfocussed and unproductive interview with him. At this time i t was the caseworker's opinion that Mr. B. was nan immature person who always expects other people, his family or someone 42 else to help him. although he does not seem to want to give anything of himself for this". The caseworker also felt that Mr. B. was greatly dependent upon his wife who was a stronger and more realistic person than himself. Mr. B. brought out considerable concern about housing on which the caseworker might have picked up with him. However, instead courses of action were suggested to Mr. B. The case was closed for the second time in February of 1951. Two months later the case wad reopened when Mrs. B. requested help in leaving her husband who was continuing to drink heavily. She was seen by an Intake caseworker and described his varying support, his Incon-tinence, and his verbal abuse of her when drunk. Casework contact was again resumed by the same male, student caseworker. This caseworker f i r s t saw Mr. andaMrs. B. at home together. As might be expected the caseworker's role in this interview was limited to refereeing. Mr. B. projected blame for his drinking on his wife's nagging and blame for his unemployment on his unemployers. He also expressed resentment of the "interference of the Welfare". Future contact was left with the B's although Mrs. B. was separately encouraged to telephone. The caseworker concluded after this interview that Mr. B. was probably not amenable to casework help, being too Immature to change in the marital situation. Until May of 1951 when this student caseworker left the agency Mrs. B. was seen once and helped to accept what the caseworker saw as the probability that her husband could not change. In terms of this, separation was explained and she was helped to move toward Family Court. During this month Mrs. B. laid a charge of assault against her husband. He was con-victed but when he penitently promised to reform, Mrs. B. forgave him and they went home together. 43 There was no further contact u n t i l October of 1951 when Mrs. B. requested a home v i s i t . Another caseworker with considerable experience though limited training i n casework visited. This caseworker met Mrs. B. on the matter of her real economic need and rarely visited without taking her either clothing or food. This part of the record i s notably concerned with material things. Mrs. B. clearly became increasingly dependent upon the caseworker. It was noted that i n the interval between contacts, Mr. B. had deserted and Mrs. B. had been on Social Assistance for a month and a half. She f e l t that during this time she and the children had been happier than ever before. She indicated at one point that a l l the children, except one, suffered from enueresis. This she attributed to the coldness of the house. One thing that comes out clearly in this part of the record i s the fact that since coming to Canada, Mrs. B. had greatly increased her com-petence i n housewifely concerns. In 1947 she had seemed completely lost both in regard to food preparation and care of the children. In 1951 she i s more competent in care of the children and has learned such techniques as preserving, baking and sewing so that the family i s very nearly able to manage though Mr. B's support i s limited. This growth does not appear to have been materially aided by any of the caseworkers. It seems that this caseworker never dealt with any of the problems underlying the material concerns and tended to encourage Mrs. B's dependence upon her. In terms of this dependent relationship she helped Mrs. B. once more to move toward Family Court. This caseworker made l i t t l e effort to contact Mr. B. and indeed did not at any time see him. The result seems to have been that the relationship between Mr. and Mrs. B. was further undermined. 44 In December of 1951 with a change in d i s t r i c t s , the case was transferred to another caseworker. The new caseworker was a very different person from the previous one. She was not only the possessor of considerable experience but was also five or six years older and well-trained i n case-work. This caseworker continued to v i s i t but did not focus upon material needs or encourage dependence. On one occasion while v i s i t i n g Mrs. B. the caseworker became involved in a double interview that negated any possibility of her reaching Mr. B. Before the caseworker was able to leave this inter-view, Mrs. B. had largely succeeded in presenting "the welfare" as her a l l y against Mr. B. who did not provide adequately for his family. The caseworker was presented by Mrs. B. as the donor of help that would not be necessary i f Mr. B. did his job. The caseworker attempted to offer help: " .we did want to help both Mr. and Mrs. B. and to help them together i f possible. I said I would be very glad to see him at the office any time he wants to come down". Mr. B. said he had nothing to talk about as, "she does a l l the talking". Mr. B. then went on to state that the trouble between himself and his wife had only been going on during the two years in which the agency had been calling. This caseworker met only the most extreme of Mrs. B's demands during January, 1952. Two small amounts of r e l i e f were given and unfor-tunately, these were on an emergency basis and i t was impossible to consult Mr. B. Once in February Mr. B. l e f t a message repeating his former con-demnation of the agency and t e l l i n g the caseworker not to v i s i t further. The caseworker, however, continued to see Mrs. B. only upon request and helped with the hospitalization of one child. In March of 1952 Mrs. B. came to the office. She was planning to take a job and the caseworker encouraged her i n this. 45 In an interview in April, the caseworker refused to support Mrs. P. in an ambivalently desired move toward separation. The case was closed i n August, 1952 and reopened in October of 1953. At this time Mrs. B. had been working for several months, a move encouraged by Mr. B. However, when she began to work, his own employment became more infrequent. Originally he had said that he would help care for the children but had been doing this with lessening frequency. Mrs. B. said that she wished to discuss separation. The caseworker outlined past d i f f i c u l t i e s in regard to Mr. B's antipathy to the agency and said that future help would have to be con-sidered most carefully with her. Mrs. B., however, did not contact the agency again. Despite the length of this record there i s l i t t l e stated con-sideration of Mrs. B's personality. At the beginning of contact Mrs. B. appeared a considerably Immature woman taking a largely submissive role in relation to her husband and his family. In succeeding years she grew and began to appear in the records as a real person. This growth, however, seems to have been the expression of direction of active drives. F i r s t she seems to have been able to direct her energies satisfactorily into home concerns, and seems happiest in care of home and children. Later, as her husband became less active, with l i t t l e conflict she directed her activity into employment. At the end of contact she i s really f i l l i n g the masculine role while her husband unhappily strives to f i l l the feminine role. Her feeling for her husband seems much involved with her mixed feelings about past experiences with an alcoholic father. She t o t a l l y lacks understanding of her husband and his d i f f i c u l t i e s . She c r i t i c i z e s and depreciates him. She desires to punish him by separation and by taking the children from him. Yet, when he promises to reform she takes him back. 46 I t would seem that before Mrs. B. could ever see her husband as a r e a l person, she must understand something of how her f e e l i n g s about her father's a l c o h o l i c pattern a f f e c t her at t i t u d e toward Mr. B. Though, as noted, Mrs. B. evidences considerable concern f o r home and c h i l d r e n , she lacks capacity to understand the f e e l i n g s of her c h i l d r e n . She i s not a l i v e to t h e i r a n x i e t i e s about d i f f i c u l t i e s i n the home and i s unaware of the e f f e c t of her depreciation of t h e i r father upon them. What have we here from the point of view of diagnosis and casework? The f i r s t caseworker although she appears t o have been a s k i l l e d and pro-f e s s i o n a l person, went i n t o the case on an u n r e a l i s t i c b a s i s . She seems, however, to have been able to sustain an objective a t t i t u d e despite Mr. B's mother's condemnations. Mr. B. seems to have seen her as a helping person f o r he reached out to her f o r help on h i s own. I t was unfortunate that at t h i s p a r t i c u l a r moment, the B's moved from Vancouver. I t seemed c l e a r at that time that Mr. B. had been encouraged to be dependent by h i s parents. His " r i g h t " to dependence seems t o have been related to h i s f a i l i n g eyesight, which as a f a c t o r i n h i s alcoholism was ignored i n a l l subsequent casework. His fears of blindness and the implications of blindness f o r him were no more than perceived and only by the f i r s t caseworker. Mr. B's heavy drinking began during the time he and h i s family were i n h i s parents' home. Here the dominating and c o n t r o l l i n g mother seemed to resent her son's movement into an adult sexual r e l a t i o n s h i p . He, himself, seems i n part to have wanted to remain dependant upon h i s mother. I t was speculated that she was t i e d to her son by deep g u i l t - f e e l i n g s , possibly connected with the o r i g i n a l accident to h i s v i s i o n or with phantasies about i t . She suddenly wished the previously over-protected and dependant son to leave her home with h i s wife and M a c t l i k e a man" i n 47 supporting and making a home. Mr. B. with only a weak and inadequate father to pattern himself after could not make his way alone, ^e wanted to return to his mother but the price of so doing was to give up his hetero-sexual bond with his wife. Against this wife, the mother projects a l l her strong and forbidden sexual desires. We see Mr. B's mother at a time when her defences are crumbling and these desires are revealed rawly^. Mr. B. cannot bear to submit to his mother's wishes or give up his wife and endeavours to s t i l l the resulting conflict in alcohol. Mrs. B. at this time seems l i t t l e more than a child. The problems of care for herself and her children are beyond her capabilities. The male student caseworker who followed, visited Mrs. B. without her husband's knowledge. The meeting with the husband on the second visi t established a particularly unrealistic basis for future help. The case-worker lied about the nature of his visit and i t is doubtful i f he could be of any further use to Mr. or Mrs. B. after this. This caseworker, placed on the defensive in the interview, concluded that Mr. B. "was immature and could not be helped by casework. There may have been in this decision more than a small amount of defensiveness on the caseworker's part in regard to his own immaturity. A judgment critical of Mr. B. seems to have been behind this caseworker's support of Mrs. B. in her move toward Family Court. The third caseworker continued the negative work begun by the second caseworker. She undermined Mr. B's shaky adequacy in supporting by gifts of material goods. She encouraged Mrs. B. in making what was really a dependency transference upon her, in which the degree of dependency served no therapeutic purpose, though i t may have satisfied the needs of 1 This picture of the mother's personality is based upon the recorded comments of the case consultant with whom the case was staffed. 48 the caseworker. There is no inference intended to the effect that these goals were objectives aimed at by the caseworkers. Rather, i t is clear from the record that a l l caseworkers involved were well-intended. Good Intentions are, however, no substitute for professional service. The fourth caseworker, though skilled and sensitive, was unable to find any sound basis for casework help to a family in which previous case-work had been so damaging. Though there was some indication toward the end of contact that Mrs. B. was beginning to see the caseworker as a person who could help her to think things through, the pattern of dependency encouraged by the previous caseworker remains strong. Also the fact that Mr. B. had come to project blame for a l l his troubles upon the agency made i t largely impossible for her to help him. As the case consultant later indicated Mr. B. needs a separate caseworker, preferably a man who will go out to him, accept the justified hostility he has to the agency and offer him help with the real problems he has been handling alone from the f i r s t . Mrs. Irving In the other case in this group, the wife seems to have sublimated a l l her active drives even more completely Into care of her children, at the same time her capacity for intuitively feeling the needs of her children seems even less. Mrs. Irving was 38 years old in 1952. Mr. I. was 57 years old. Mrs. l's background was Slavic while Mr. l's was Scottish. Both were Protestants raised in Canada. The l's had seven living children between 1933 and 1944, four boys and three girls. Mrs. I. was the daughter of mentally i l l parents both of whom died in the Provincial Mental Hospital. The father was diagnosed as schizophrenic, the mother as manic-depressive. Prior to her mother's death and during much of her childhood from the age of four years, Mrs. I. lived in various foster 49 homes. When Mrs. I. was ten years old her mother was discharged from the mental hospital and Mrs. I. was returned to her inconsistent and punitive care, at the age of fifteen, she was committed at her mother's request to the Girl's Industrial School as an incorrigible. Here she was described as having a violent temper which she was unable to control. When released she was said to have interests in music and art and though a good worker, was said to be untruthful and "light fingered". On release at the age of seventeen, she was again placed in a foster home and enrolled in a dress-making course. At the foster home she met Mr. I., became pregnant by him, and married him. In the fi r s t twelve years of the marriage Mrs. I. took a largely submissive role in relation tocher husband. Her activity was bound up almost totally In care for the children. In 1944 her doctor described her as "a fine type of woman, brave and uncomplaining in the face of great difficulties." During the eight years from 1944 to 1952 Mrs. I. seemed to metamorphose. As Mr. I. became increasingly irrational, unable to work and unable to provide support other than his World War I pension of $65 a month, Mrs. I. moved tentatively into employment herself. Aside from the relief her working gave to the economic problem she seemed to gain both satisfaction and assurance. She began going out to dances and motion picture shows with friends. She continued working and finally on one occasion when Mr. I. was drunk and demanding she beat him rather severely and left with the three children who were s t i l l in the home at that time. Despite Mr. I's demands and entreaties she refused to return to him. During these last eight years the home was continually upset. Mr. I . was punitive to a l l the children but notably to the oldest boy. The two oldest boys became involved in juvenile delinquency and were sentenced 50 to Boy's Industrial School. The third oldest boy drowned in False Creek in 1948. During this period as during the earlier part of the marriage Mrs. I. evidenced l i t t l e affect in relation to the problems of her children. This was equally true of both the sons and daughters and i t seemed that her energies were bound up in giving them physical care. However, during the eight year period referred to she seemed to find satisfying areas of activity outside the home and the children. This seems in part to be related to the increasing disturbance on the husband's part and the departure of several of the children from the home. It would seem from the psychological point of view that Mrs. I. entered into and sustained her submissive, child-bearing role as a defence against her aggressive feelings which had in the past brought her pain and punishment. Mrs. I. seems to have grown somewhat during the years of maternal responsibility and to have incorporated the needed controls which Mr. I. had supplied externally. Her final break with her husband seems much the adolescent's break with the harsh, controlling father whose protection Is no longer needed. Subsequently, her active drives found unconflicted satis-factions in escape from the feminine role, a t times during this period she followed her own interests to the extent that the children were really neglected. However, though her feeling for her children might not be one of deep maternal identification, she gave them adequate physical care and kept them with her. Perhaps in part this was the result of an identification of them with herself as the rejected and injured child. When this woman's damaging childhood is considered her success as a mother d u r i n g the early years of her children's lives is remarkable. It is clear, of course, that Mrs. I. was emotionally a more dis-turbed woman than Mrs. Barnes. It can be speculated for Mrs. I. marriage and child-raising seems to have been a defence against inward emotional 5 1 turbulence. Mrs. Barnes' marriage and child raising may have had similar elements of redirection of aggressive activity, but wltji a lesser intensity. Mrs. Barnes1 adjustment in this regard was apparently not made with the desperate completeness of Mrs. living's. This is perhaps indicated most clearly in the personalities of the husbands with whom each lived. Mrs. I. needed far more of a harshly autocratic and punitive man in order to direct her concerns into family matters than did Mrs. B. Casework with Mrs. I. took the form of environmental help and information about her legal situation. The case was opened in 1 9 4 4 following a request for homemaker service. It was kept open for six months. Mrs. I. was seen as a uncommunicative client who shared few of her feelings with the caseworker. The case was reopened in 1 9 4 6 when Mrs. I. came to the office asking advice in leaving her husband. The caseworker explored the situation with Mrs. I. and as well saw Mr. I. Work seems to have been directed toward helping the family function more adequately. The situation improved briefly in 1 9 4 7 when Mr. I's drinking lessened and he received medical treatment. Mrs. I. continued to consider separation and in 1 9 4 9 went to work herself. In 1 9 5 0 she left the home, as noted before, taking three children with her. During the period from 1 9 4 9 to 1 9 5 2 the case has been the responsibility of one caseworker who saw Mrs. I. around problems as requested by her. There is some question in regard to the handling of casework with Mrs. I. whether the caseworker's original assumption that Mrs. I. was phlegmatic and not too intelligent did not inhibit help for her. There would, rather, seem to be a very good possibility that after serious trauma during the adolescent period Mrs* I. was really in a state where a l l evidences of feeling were suppressed. She might have benefited from organized interviews with herself and her problems as the focus rather than somewhat casual visits. 52 The Group L Women The fourth group of women who emerge from the 18 cases embrace those who apparently had real difficulty in being either wife or mother. The four women in this group are Mrs. Penn, Mrs. Edgely, Mrs. Fenner and Mrs. Sanderson. Notable in the cases of these women is the fact their relationships with their mothers were largely unresolved or were largely non-existent, admittedly this was true of some of the women in the previous groups but the women in the previous groups seemed to function somewhat effectively in definite areas of the feminine role. They seemed to have at least a partial grip on l i f e . This is on the whole far less true of the women considered here, though there is s t i l l considerable range within these cases. These women act erratically and confusedly in both areas of wifehood and motherhood. They appear to have considerable unmet dependency needs and notable feelings of inferiority. Their actions in any direction have a somewhat compulsive aspect. They cling to their considerably effeminate husbands as though they could not function alone. If these four women were ordered in terms of maturity, the l i s t would read Mrs. Edgely, Mrs. Penn, Mrs. Sanderson, Mrs. Fenner. M T B . Edgely The Edgely case merits particular attention at this point as Mr. Edgely is one of the few alcoholics who participated in casework. The Edgely family was referred In 1951 following a letter to an assistance-giving agency in which Mrs. E. stated that though Mr. E. was working, his drinking resulted in continual financial difficulties. Mrs. E. was 27 years of age at this time. Mr. E. was 29. The E*s had been married for eight years and had four children; three daughters ranging in age from 7 months to 7 years and a son 2^ years old. 53 Mrs. E. appeared to the intake caseworker as "an attractive young woman, well-dressed and groomed". It was notable that In this interview she focussed almost entirely upon her husband and his back-ground. Mr. E., she said, was the son of a prairie doctor who left his family because of his excessive drinking and finally died in a mental hospital. Mr. E. was with his father until he was institutionalized. Mr. E. had worked at a variety of demanding and well paid jobs. At the time of referral he was in charge of distribution for the products of an Eastern Canadian firm. Mrs. E. sees her husband as intelligent and charming when sober. She doubts his statement that he needs to drink to produce ideas. Mr. E., she said, vias aware she had come to the agency and had offered to cooperate fully. The intake caseworker's opinion was that "Mrs. E. will try to salvage her marriage. She s t i l l loves Mr. E. and can talk of her affection easily. She does, however, doubt his word, but is willing to help him i f he wants help". In her first interview with the District caseworker, Mrs. E. says that "she guessed she should not have had so; many children, but Mr. E. was very fond of them and good with them when he was sober". Here as in the rest of the interview she hides her feelings and attitudes beneath talk of her husband. She, as yet, does not wish to involve herself in the request for help. The caseworker subsequently offered to visit as i t was difficult for Mrs. E. to come to the office. During the fi r s t v i s i t Mrs. E. brought out the matter of her interest in another man. She clearly revealed her mixed feelings about this man and her husband. She said she was attracted 53a to the new man because "She thinks i t would be smart to marry him. He is the kind of man she has always wanted—steady and respectable. She was sure he would give her his paycheck. She would not have to worry about money". Yet, in the same interview she says of her husband, "I have not a friend left, because they a l l say Mr. S. is so bad I should leave him, and when i t comes down to thinking about i t , I sort of feel I should stay". After having ignored a previous offer of an appointment, Mr. E . came to the office shortly after the f i r s t visit to Mrs. E . He is described as a particularly nervous man who moved restlessly in his chair, smoked continuously and made nervous gestures eith his hands. He was, however, quite affable and described his drinking problems as follows: °Mr. B. said he had read many things about people who were alcoholics and he s t i l l cannot understand himself or what causes him to drink. He said that when he does not drink he makes the highest sales records in the firms he has worked for. He seems like a person who is tireless and can work night and day. He then gets going to such an extent and is so successful that a l l of a sudden he gets a craving to get a drink and then he will drink and drink until he is saturated". v Mr. E ?s reading together with a sporadic contact with a neurologist had resulted in a superficial understanding which produced such statements as: "Sometimes when he is drinking he wakes up in the morning and says he can feel his ego.and id battling i t out between them to see what he is going to be able to do that day41. In this interview Mr. E. requested a loan from the agency in order to pay his rent. When the caseworker explained that this was impossible Mr. E. telephoned a friend and arranged to borrow the moneyi-He also showed the caseworker pictures of a very modernistic house of cement and glass he had partially finished while living in another com-mdnity. He told how he worked continually at this time and did not drink. At the close of the interview he offered arcomprehensive plan for solving his problem. Included in this was contact with A. A. and 54 allowing his wife to handle the money and the budgeting. The general impression from this firs t interview is of an attractive and intelligent child with tremendous capacities for concen-trated endeavour but lacking any continuity in his efforts. He tests out the caseworker's attitude to him and makes unrealistic requests for money. Then he shows the caseworker that he has friends who are willing to lend him what he needs. When he shows her the pictures of the house he has built i t does not seem that he is solely seeking approval but rather, as well, he wants the caseworker to see what a competent person he is to have made such a lovely and impractical toy. There is also something of the l i t t l e boy who feels he must head off pending parental displeasure. Thus he offers . well thought out plans for solving the problem his wife has brought to the agency. Without further contact with the agency at this time Mr. E. embarked on the outlined plan. Subsequently, he did not drink for a period of two months. During this time the caseworker continued to visi t Mrs. E. and helped her attend the free Gynaecology Clinic for a belated post natal examination and for information about contraceptive methods. Mrs. E. felt that prevention of further births could be her best contribution to planning for her family. She had considerable negative feeling about the gynaecological examination and said that though she had had four children she felt too embarrassed to ask any doctor about contraception. She later said of her clinic examination that she had never had "such an awful experience". She said she left the clinic, apparently 01 in error", before the doctor could f i t her. She also brought out at one point in these interviews that the oldest g i r l was having difficulty in school, being a nervous and 55 undisciplined child. Also she spoke briefly of herself indicating that a i t seemed funny her having a l l this responsibility, she was always the youngest in the family and was looked after. She never thought she would end up having to look after someone else". It seems from the record that the caseworker picked up on neither of these matters brought out by Mrs. E. Mrs. E. attended A. A. meetings with her husband. She was annoyed by his introducing her as the alcoholic but felt that he was making a real effort this time. Until Mr. E. began drinking again the only material help given this family was some curtains which the caseworker volunteered. When Mr. E. began drinking, Mrs. E. took over complete financial control and was helped to consolidate the debts. Financial help for food purchases was given on several occasions along with toys and hampers at Christmas time. The contact was terminated after Christmas of 1951 when Mr. E. obtained another good job and Mrs. E. felt optomistic about the future. The case remained closed until June of 1952 when i t reopened on a referral from a Public Health Nurse. At this time Mr. E. had voluntarily gone to the Provincial Mental Hospital for three months' observation. However, as no plan had been made for his wife and family he came home in two weeks. He was working, but the family were in financial difficulties. Service was offered, but no help was requested by the E's until September of 1952. At this time Mrs. E. requested a supervised homemaker as she expected shortly to be confined with her fifth child. A new caseworker took over work with the family as they had moved to another district. She attempted to help the E's stabalize the home situation prior to the confine-ment. Mr. E. was referred to the General Hospital Psychiatric Clinic and the caseworker was able to obtain a psychiatric opinion as to his 56 condition. The psychiatrist expressed the view that Mr. E. needed a protected work situation where competition could not contribute to anxiety and to drinking. When Mr. E. became unemployed during this period financial assistance was given to him prior to receipt of unemployment insurance. Only a part-time homemaker was used during Mrs. E's confinement as Mr. E. was home much of the time and cared for the children. Considerable financial and general environmental help was given by this caseworker. Mr. E. was seen frequently and his participation effectively elicited. With this caseworker he was able to give vent to some of his hostility to his wife and also to talk of situations in his parents' home which seemed significant. Casework help in regard to bicker-ings around leadership in the home was offered to both Mr. and Mrs. E. following discussions with him around the matter. However, neither Mr. E. nor Mrs. E. responded. Mrs. E. was, however, able to discuss with the caseworker her concerns about her health. In January of 1953 the case was transferred to another caseworker because of a change in districts. This caseworker, though a sensitive and intelligent person, lacked the experience and training of the previous caseworker. Mr. E. obtained another job in selling and, though he continued to drink, worked hard and there were no major financial difficulties. During this contact Mrs. E. induced an abortion and the caseworker was able to help her with her guilt feelings around this. Mrs. E. again became interested in another man and fantasied escape from her marriage. She however, seemed incapable of any decision in regard to this matter. The caseworker's own comment probably sums up this contact quite fairly: 57 "Mr. E. has refused contact with me on numerous occasions, pleading business involvements. Mrs. E. has tended to phone only when financial or health pressures are too much for her. It is doubtful i f she would have told me about the abortion had she not become infected, .with hospitalization a necessity". The case was transferred to another caseworker at this point. However, no further contact has ensued. This case shows positive and negative movement in various phases, but no part of this movement seems attributable to casework. The situation at the end of contact is almost exactly that which existed at f i r s t . It is highly probable .that i f .there had been no casework contact the E's would have solved their problems in much the same ways. The fi r s t caseworker does not seem to have been particularly alert to the tentative bids made by Mrs. E. for help with her feelings about gynaecological examination, care of the children, or about the responsibility of her present situation. This is really the only attempt Mrs. E. made to bring out such material. This caseworker seems to have been happier in dealing with purely environmental problems and the feeling cannot be escaped that more basic problems were sidestepped. Here, as in the case of Mrs. Barnes, i t seems that indiscriminate giving tended to induce a somewhat neurotic dependency on the part of Mrs. E. The second caseworker found i t difficult to help Mrs. E. in terms of her reality needs. However, this caseworker,better-trained and experienced than the first,-succeeded to a considerable extent in involving Mr.,, and Mrs. E. ,in planning. Basic to this would appear to be the caseworker's acceptance of Mrs. E's real disinclination to leave her husband. It is interesting that only with the second caseworker was Mrs. E. able to share any concern over developmental difficulties experienced by her children. 58 Mrs. Penn Mrs. Penn was 36 in 1952. Mr. Penn was 4l« Though of European parentage both were born in Canada. There were two children, a g i r l aged 12 years, bom of a previous extramarital relationship of Mrs. P. and a boy aged 7 years by Mr. .P. Mr. P. was previously married and, as his first wife refuses him a divorce, the present Mrs. P. and himself live in common law union. Mrs. P. accepts this situation and seems undisturbed by its implications for herself and the children.. Mrs. P. showed varying concern about her responsibilities as a mother and as a wife. She could on occasion direct a l l her energies single-mindedly into f u l f i l l i n g these responsibilities. At these times she would seem to be trying to establish the security of the home in just a few weeks. On one such occasion, while pregnant, she engaged herself in caring for several boarders as well as her family and as a result lost the child. Mrs. P. did use casework help in working out her plans around return to her husband at a time when she had separated at the encourage-ment of her relatives. When she returned to her husband there was brief evidence of desire on both their parts to examine the roots of their difficulties, i t this time i t became clear that Mr. P. was a rather passive man who had l i t t l e objection to his wife's activity drives. Indeed, he encouraged her to resume working. Difficulty between them frequently centred around his interest in music. Mrs. P. endeavoured to restrict his musical efforts around the home. She was able to discuss this with the caseworker though i t is not clear If any change eventuated. Mr. P's response was to drink and quit work. When he was working he usually failed to give his wife sufficient money to run the home. When at 59 his -encouragement she went to work, he expected her to share household expenses. Mrs. P. did not object to this as she felt better working and liked to have a l i t t l e money of her own. The caseworker, despite a considerable degree of relationship with both Mr. and Mrs. P. was unable to establish any definite casework plan with them. Mr. P's drinking did abate briefly, but shortly resumed its previous tempo. Mrs. P. attempted.to concentrate on care of her children and work in the home but soon went back to work. Mr. P. however controlled derogatory remarks about the oldest child, the illegitimate offspring of a previous extra-marital union on the part of Mrs. P. Both parents seemed interested in the children but this interest never caused them any anxiety in following out their own plans. It may be suspected that Mr. and Mrs. P. achieve a considerable stability because, while Mrs. P. has l i t t l e anxiety about moving into a masculine active role, her husband has l i t t l e anxiety about not being able to f i l l the masculine role. Mrs. Sanderson Mrs. Sanderson was 40 in 1952. Her husband was 43• The S's have three children, two boys 10 years and 5 years, and a g i r l one year old. Mr. S. is a non-practicing Roman Catholic and Mrs. S. is a Protestant. Mr. S. was diagnosed by a psychiatrist as a psychopathic personality. He has so great an infantile dependence upon his wife that he travels a considerable distance to return home to use the toilet. During the time of casework contact Mr. S. was attached, to a young g i r l whom he had met while a member of a. ft.. He could not break with this g i r l but made elaborate plans so that she would break with him. Mr. S. was a highly successful car salesman when able to work. He frequently 60 lost his job due to drinking but seemed easily able to regain employment. During his periods of unemployment and drunkenness he usually accumulated considerable debt. Mr. S. suffers from a cyst which his wife says prevents him from being very potent sexually. Mr. S. had been married and divorced previously. The older boy is insolent and c r i t i c a l of his father. The father expects the mother to discipline him for these attitudes. His school principal describes the boy as being upset and doing poorly. There is l i t t l e picture of the other children in the record. Mrs. S. was an illegitimate child adopted by friends of her mother. She expressed considerable hostility to her adopting mother and Idealized her natural mother. She says that i f her natural mother's husband by a later marriage had not forbidden i t , she could have gone to her mother. Indeed, she feels that i f this husband of her mother's did not object now, she could go to her mother with the children. Mrs. S's adopted parents were divorced when she was twenty. Despite the fact that this divorce followed her adopted father's infidelities, Mrs. S. retains warm feelings for him. She told how she had arranged a funeralfir him after he died of cancer. Throughput the contact Mrs. S. appeared as a woman largely concerned with the effect of the situation upon her own appearance and health. Mrs. S. is outspoken in her contention that Mr. S. "isn't much of a man". The children echo i t . Despite this feeling, his non support and his infidelity, she several times clearly states her desire to be with him. She see him as " a small lost child" and one occasion said that he "would just go down i f she didn't take him back". 61 In response to the non-support and Infidelity Mrs. S. made plans to resume secretarial work. She evidently wished to both work and remain with her husband. It was her plan to hire a housekeeper to look after the children. The major reason for her not taking action on this plan seems to be her marked sensitivity to the opinions of others. Her doctor had told her quite definitely that "Mr. S. was a bum" and that she should "be rid of him". & woman under whom she had previously worked felt that she should leave her husband, should not return to work but rather remain with her children. Iks a result of these pressures Mrs. S. did separate from her husband and moved to a nearby rural community to l i f e on Social assistance. It might perhaps be wondered how long she can remain separated from her husband. Mrs. S. had had no satisfying mother-daughter relationship and therefore could neither satisfactorily be wife or mother. She seems to some extent to have identified with her adopted father and perhaps as a result her energies tend toward a masculine activity. She strives by depreciation to force her husband from those aspects of the masculine role in which he attempts adequacy. She,on one hand, seems to want him to be a completely passive child and, on the other hand, she seems to need to remain in the punishing situation. Mrs. Fenner Mrs. Fenner is a Dutch war bride 30 years of age. She is married to an energetic clothing salesman of 38 years. Mr. F. seems to have a real need to prove his adequacy and as a result, his business career goes through periods of intense work with resulting success and subsequent decline. The F's have two children, a g i r l of four and a boy of two years. Mrs. F. gives great care to the physical well-being of her children but seems to have l i t t l e understanding of her children's needs and fears. 62 They rarely appear as major considerations in her decisions and in their presence, she spills out the tale of her trouble with her husband. The home and care of the children seem the entirety of Mrs. F's l i f e . Possession of the home and the daily repetition of household tasks about which she seems rather rigidly compulsive seem to be Mrs. F's major holds on security and worthwhileness. Her father died early in her childhood and her mother and the children lived on charity for many years. Further Mrs. F. has always been small and sickly appearing. For years she suffered strong feelings of inferiority and was unable to go shopping without her mother's company. Any threat by her husband's failure to support is deeply up-setting to Mrs. F. for i t endangers her security and her feeling of worth. Her anxiety takes the form of seeking help and planning to separate. Thus far she has never followed through on this plan, but always returns to her husband as soon as the situation is somewhat more optimistic. It is evident also that her anxiety results in considerable nagging depreciation of her husband which no doubt results in aggravation of either his intense and sober concentration on work or his drunken lapses. Mrs. Fenner came to the agency in a near-hysterical state on several occasions when her husband had begun to drink heavily. Through her, Mr. F. was offered appointments but did not respond. It was clear that she very much wanted to stay with her husband and yet her great need for security forced her to contemplate separation. The caseworkerewho saw her were able to help her with l i t t l e more than the anxiety she felt around each interview. Help was offered around separation planning as she stated she wished this help but at the same time as she discussed this 63 matter with the caseworker, she made strong efforts to persuade k. a., to help her husband. After several months she withdrew from contact, remain-ing with her husband. It is not easy to be certain of Mrs. F's attitude toward case-work but i t seems that she did obtain what was for her a valuable temp-orary ease in talking to the caseworker. When the caseworker mentioned planning she very probably felt that the caseworker, as society's representative, would expect her to decide on separation. : Accordingly she did so and in the interviews pursued this view, though she basically remained as ambivalent as before. The Group 5 Women The fi f t h group of women comprising Mrs. Underwood, Mrs. Yates and Mrs. Royce seem almost completely to lack capacity for the wifely and maternal aspects of the feminine role. They have considerable negative feeling about sexual relations and also have l i t t l e tendency to sublimation of their active drives in care for their children. Rather, these women have strong desires to be on their own away from the responsibilities of marriage. In the marriage they are aggressive and destructive toward both husbands and children. It Is interesting that Mr. Yates functioned well in work and supported adequately. Similarly Mr. Underwood was able to support his family well and his alcoholic, problem was of relatively recent inception. The wives of these two men were not therefore threatened by either a totally inadequate husband or by financial insecurity. They therefore tended to remain in the marriage. Mr. Royce was much less adequate in the male role than the other two and his wife seemed to find i t easier to leave the home, though her need for a mutually punishing situation drew her to return. There however seemed no security to hold her in the marriage. 6A Mrs* Yates Mrs. Yates was 34 in 1952. Mr. Y. was 43. There are three children in the home, Gladys, 12, Mrs. Y's child by a former marriage and Thomas 5 and Lorene 4, children of the present marriage. Mr. Y. a haberdasher, owned one shop in 1948 at the beginning of contact. In 1952 he had opened a second store. He was apparently somewhat unrealistic in what he expectejlhis wife to be able to do with her household money^but, except for times when he expressed his anger by refusing to give her funds, support was usually adequate. Mr. Y. seems to drink as a means to allow release of his hostility toward Mrs. Y. On several occasions he has beaten her and by her account mistreated the children. Mr. Y. complained to the caseworker of his wife's inadequacy as a homemaker and as a marriage partner. The boy, Thomas, was described as a hot-tempered child who feared his father's beatings. The daughter, Lorene, suffered from night-mares. The older daughter, Gladys, was the center of concern during much of the record. She seemed unhappy with the Y's. Her father had remarried and wished to take Gladys but Mrs. Y. clung to the g i r l . Mrs. Y. was shown at several points in the record as capable of striking at others through false stories. Therefore much of the information she gave which was not corroborated by the statements of others could not be considered valid. It is definite, however, that Mrs. Y. had a considerable desire to return to work as a waitress. She wished to hire a housekeeper to care for the children. She gave various justifications for this desire. She said that she wanted to earn enough money for a down-payment on a house. She said she felt her husband would respect her more i f she worked. She said she wanted to keep herself occupied, to get out of the house 65 where she felt "cooped up". However, Mrs. Y. continued in the home for considerable time although her husband beat her. With regard to these beatings, she refused to take legal action because she said the fact of discord in the home might result in her losing Gladys to the girl's father. Mrs. Y. says rather mildly that her husband is quite sexually demanding and that she is "not too fond" of their sexual relations. She says that she has never denied her husband sexual relations except during times of pregnancy. Mr. Y. admits to having relations with other women and says with harsh directness of Mrs. Y. that "a man would get more pleasure from a 14 year old g i r l " . Mrs. Y. was never given casework help in this regard. Mr. and Mrs. Y. separated and came together several times. During one separation Mrs. Y. attempted to operate an unlicensed day care home for seven young children. It was necessary for the Children's Aid Society to ask her to close. When last heard from,Mrs. Y. had returned to work. She was enthusiastic about this and was looking for a housekeeper to "take complete charge". Casework with Mrs. Y. took the form of legal advice and as occasion demanded i t , help to Mr. and Mrs. Y. in working out plans which usually culminated in their return together. Mrs. Y. expressed her antipathy to the wifely, motherly role by slovenly housekeeping and lack of response to her husband. She seemed to have a strong desire to return to more active work as a waitress. (Mr. Y. noted that when she was working she was always scrupulously tidy.) However, she did seem to have a real need to f i l l the socially prescribed role of motherhood. She could not part with any of the children despite the fact that she evidenced neither understanding nor feeling for them. 66 What she wished was to both have the children and direct her activity into employment. Finally, after considerable conflict in which Mr. Y's punishment seemed the necessary concommitant of her guilt, she was able to achieve her desire by returning to work and hiring a housekeeper to be a mother for her children. Mrs. Underwood Mrs. Underwood was 44 years old in 1952. Mr. U. was 47. Mrs. U. is of Latvian birth. She came to Canada as an adult. Both Mr. and Mrs. U. have been previously married. Mrs. U. has an older son of 22 years who lives apart from his mother. Mr. U's son Donald lives with them. There are two young daughters by the present marriage, June 9 years and Doris 6 years. Mrs U. previously operated a successful machine shop. In 1952 there was no question of failure to support. Mr. U. worked irregularly and income was supplemented by the proceeds of the machine shop which had been sold. Mr. U. had begun drinking four years previous to 1952 at about the time his mother became seriously mentally i l l . Mr. U's drunkenness at the time of contact had resulted in increasing loss of time at work. When drunk, Mr. U. occasionally beat his wife and forced sexual relations upon her. There was, however, a history of friction prior to the begin-ning of Mr. U's excessive drinking. Mrs. U. said that when she was pregnant with June, there was a period of three months during which she and her husband did not speak to each other. Mrs. U. had an alcoholic father. She gives no picture of her mother. She left home at age eight and was, she says, self-supporting. This is questionable. However, she appears to have lived and worked on a farm. Prior to marriage she worked in a cooperative store in Latvia. 67 Here her industry and careful work brought her recognition and promotion. She recalls this period happily and refers to i t as justification for her feeling that she is better at business than her husband. Mrs. U. has mixed feelings about a l l the children. She spends a good deal of time with fifteen year old Donald but feels that she would not be able to look after him i f she separated. Mrs. U. seems to have had a strong antipathy to June from the f i r s t . As noted above, there were considerable difficulties between Mr. and Mrs. U. prior to June's birth. As a result Mrs. U. was afraid.that she could not love the baby. She describes her first sight of the child as "a dreadful shock" as June was "such an ugly l i t t l e thing n and looked like Mr. U. Mrs. U. says that she was very much in love with Mr. U. when Doris was born and speaks of Doris as being a sweet natured child who will be spoiled. (By precisely what she will be spoiled is not known.) At one time Mrs. U. took an accounting course in an effort to help her husband with his business. She feels she Is really a better manager than he i s . However, when she attempted to work on his books she became intensely i l l and found i t necessary to cease the effort. Mrs. U. blocked a l l effort on the part of the caseworker to see Mr. U. She first broke contact sure everything would be a l l right because he had made a promise. Finally, when the caseworker stressed the need to bring Mr. U. into the planning, Mrs. U. sent him off to a doctor, made plans for the family to move to a farm in Cloverdale and broke ihe contact again. Casework, on the whole, took the form of listening to Mrs. U. and endeavouring to support her in planning. Mrs. U., however, seemed to wish to use the caseworker for nothing more than a sympathetic listener. While this could have been the beginning of a helping relation-ship such did not appear to develop. When late in the contact some brief 63 clarification of her problem was undertaken, she avoided significant matters. Mrs. U. seems to have a definite desire to take over masculine responsibilities, at the same time she seems to have considerable con-f l i c t around any attempt to do so. Her hostile, aggressive tendencies seem to be turned in and expressed in illness. Her operations may in part be in the nature of punishment to ease her guilt over her masculine drives. Mrs. U. has l i t t l e capacity for a warm, motherly identification with her children. Rather, she Identifies June with Mr. 17. and is prejudiced against her. She seems to have identified Doris with some ideal of herself. Her attitude toward Donald seems to have seductive elements and i t may be her fear that she cannot control these feelings without the presence of Mr. U. that causes her to conclude that she could not take Donald with her on separation. The fact that Mr. U. uses alcohol as a means to free expression of strong aggressive and sexual drives toward Mrs. U. may indicate a degree of depreciation of her husband as a worthwhile man and also inhibitory feelings on her part with regard to sexual relations. Mrs. Royce Mrs. Royce was 32 years old in 1952. Her husband was 4O years old at this time. Mr. R. had been married previously but left his first wife after a few months. Both parents are Canadian born. They have one child aged six. Mr. R. works spasmodically, drinks heavily and of late years has frequently beaten Mrs. R. Though Mr. R. frequently lost jobs he was easily able to get new ones through friends he made while a professional athlete. Mr. R. and his friends often followed the local football team to the United States to watch i t play. This was usually the setting for .69 considerable drinking and resulting automobile accidents. Mr. R. showed extreme sensitivity to "disagreements" with Mrs. R. and after them usually stole money from her purse and became intoxicated. Mrs. R. has frequently demanded complete control of Mr. R's earnings. For a time they compromised on a cooperative arrangement where a l l the money was kept in a box from which they both drew. Mr. R. has, however, on the whole resisted his wife's sustained efforts to control family finances. Mrs. R. says that her husband says she gets upset over nothing. She herself relates her nervousness to having had "St. Vitus Dance™ as a g i r l . Mrs. R's reaction to a male caseworker is perhaps to some extent indicative of her regard for the male role. She said "well, I get a man this time! Maybe we'll get somewhere this time!"v The case-worker felt that in relating her husband's brutality Mrs. R. got consider-able satisfauction out of telling about i t and probably very much desired the i n i t i a l punishment. The R's separated frequently. Mrs. R. went to work once but on the whole seemed to prefer to remain in the home awaiting Mr. R's next return. Throughout the interviews Mrs. R. did not speak of the child Ann as having feelings about the situation. On one occasion Mrs. R. used removal of Ann from her husband as a means of hurting him. At one time during the contact Mrs. R. found i t possible to direct her energies into participation in a nursery school activity. Pressure seemed to be taken off Mr. R. and for a time he was able to function somewhat adequately. At last report Mrs. R. was s t i l l with her husband who was drinking heavily. She wondered whether his name could be placed on the -70 Indian List^ or whether he could be given "shots for drinking". Casework with Mrs. R. achieved l i t t l e . She prevented the caseworker from making any contact with Mr. R. and regularly broke contact when -they resumed living together. She declared each time they returned together that she felt sure everything would be a l l right. Usually she wished the agency to use some sort of authority to punish Mr.. R. Casework was successful only in supporting Mrs. R. in her desire to return to her husband. Very probably she would have returned without help. Mrs. R. seems to have a real desire to take over many of the responsibilities which her husband feels are part of the masculine role. She would like to take on a job herself were i t not that she is tied tightly to her husband by her guilt and her need for punishment. Her major concern is with her own experience. The feelings of her child have no reality to her as she seems incapable of a motherly identification. The Group 6 Women The sixth group of women, Mrs. Hughes, Mrs. Tingley and Mrs. Mason seem close to serious mental illness. They cannot function as wives and barely function as mothers. They cling to care for their children almost desperately as i f i t were their only defence against complete personal disintegration. In some respects these women resemble Mrs. Irving and Mrs. Edgely but without the strength of personality of either of these 1 The Indian List is a l i s t of Reservation Indians to whom i t is illegal to sell alcoholic beverages. Many wives of alcoholics believe, erroneously, that i f their husbands make a deposition before a magistrate their names can be added to this l i s t . Mrs. R's interest in this l i s t as well as in the "shots", of course, reflects her desire to depreciate her husband and her need to control him. 71 women. In a l l five cases however, there is evident a real activity drive directed into the production and care of a large family. Mrs. Hughes Mrs. Hughes was 34 years old in 1952, her husband was 37. There were four children, two sons age 12 and 9 years, and two daughters age 6 and 4 years. Mrs. Hughes' four children were, as with Mrs. Tingley the end-a l l of her l i f e . Mr. H. had on the whole supported fairly well and had a good work record. His alcoholism and evident feelings of sexual inadequacy seemed to have gained emphasis during the marriage. An early homemaker contact had revealed him as functioning adequately and with consideration for Mrs. H. Mrs. H. seems to have a real need for punishment and a:good deal of guilt around sexual matters. She has a history of eleven pregnancies. She says she is unable to use contraceptive equipment supplied. She has also had a long series of hospitalizations and operations. She was very much upset when her husband exposed himself in the presence of herself and her daughters. She says that she was originally forced into intercourse by Mr. H. She feels that she did wrong to submit and in some ways seems to regard the marriage as an ensuing punishment. Mrs. H's sense of self worth seems to have been very much damaged in her early years, after her mother's death her brothers apparently forced her into an onerous servant role. She feels unworthy and this together with guilt around sex relations seems to result in her seeking punishment. During casework interviews Mrs. H. referred to the children without feeling, by their ages. She seemed to have l i t t l e understanding about their feelings about disturbances in the home or^difficulties in the school. 72 After a serious altercation with her husband and with use of the information about legal process obtained from the caseworker. Mrs. H. separated from her husband. Subsequently she attempted to supplement Mr. H's payments by funds earned caring for infants in her home. Mrs. Tingley Mrs. Tingley was 37 years old in 1952, her husband was 53* Mrs. T. was married previously and had by the fi r s t marriage three children, two girls 17 and 15 years old and a boy 12 years old. There are three daughters aged 9 years, 7 years and A months by the marriage to Mr. T. It was with considerable ambivalence that Mr. T. first brought Mrs; T. from Scotland as a war bride shortly after World War II. It was at this time that the agency f i r s t made contact with her. Only for brief periods were Mr. and Mrs. T. able to live together as man and wife. Mr. T. was dependently tied to his mother and sisters. The relationship with Mrs. T. seemed to arouse such anxiety that after being with her for a brief period, he always left abruptly. During the lengthy period of agency contact Mr. T. usually supported his wife and family through his mother and sisters who dealt with the agency for him. Shortly after Mrs. T. arrived in British Columbia Mr. T. deserted. Mrs. T. seemed totally unequipped in training or understanding to care for either her children or a home. She was unable to cook or budget and had l i t t l e comprehension of the physical or emotional needs of her children or husband. Her anxiety became Intense and she flailed around In her search for help. She was convinced that she was being persecuted by anyone who could not meet her extreme demands, agency help took the form of support and authoritative control of finances in budgeting. This control was skillfully relaxed as Mrs. T. grew in 73 capacity to cope with her environment. Through a l l her anxiety, Mrs. T. clung to her children with the desperation of a mother hen in the presence of a - marauding fox. She was indifferent to her husband's presence in, or absence from the home. Her only demands were for a house and sufficient funds to feed herself and the children. Mrs. Mason Mrs. Mason was 42 years old in 1952. Her husband was 43 years old. Mrs. M. had been widowed previously. & 22 year old son by her f i r s t marriage lived apart from his mother, a daughter aged 17 worked and helped support Mrs. M. and her children. The M's had also adopted a daughter aged 13* There was one child by the present marriage, a boy of 9 years. Mrs. M. was perhaps the most seriously i l l of the.four women. Psychologically i t would seem that she and Mr. M. were involved in a masochistic-sadistic union in which they used non support, sexual refusal and the children as weapons against each other. Mrs. M. suffered mental disturbance for which she had received sanitorium treatment without notable effect. The illness took the form of cyclic recurrences of anxiety and depression accompanied by hysterical outbursts. It was usually during one of these upset states that she forced Mr. M. out of the home. Prior to his last departure he lived for a year in a basement room in the house while his wife slept with the 8 year old son. Mr. M., while considerably dependent upon Mrs. M., continued to work fairly consistently. He is a skilled workman and although his drinking results in reduced earnings and at times dismissal, he is able to gain new employment easily. Mr. M. seems to have a greater degree of concern for the feelings of the children than has his wife. He is particularly fond of the 13 year old, adopted g i r l . 74 Mrs. M. seems to need the feeling that the children are totally hers. Mrs. M. withdrew the children from casework treatment when they appeared to be relating to the caseworkers Involved* Casework had been felt necessary as the children were evidencing disturbed behavior in the home situation. The adopted g i r l had enuresis,was disobedient and was making a poor adjustment to school. Mrs* M* seemed very much concerned that the adopted daughter was the father's favorite* Mrs. M. says that she had sexual happiness in her fi r s t marriage but has never had i t in this marriage. She says that Mr. M* has peculiar sex habits which she cannot tolerate* These are not elucidated. The children of the f i r s t marriage seem competent and intelligent* The boy has a history of work change and usually lives apart from hie mother* The older daughter has been called upon to give considerable financial support to her mother* It would appear that Mrs* M. functioned considerably more adequately in her f i r s t marriage than in this present one. Casework with this wife, indeed with the entire family centred around long-term environmental help. Initially help on a counselling basis was offered to both Mr. and Mrs. M. When i t seemed clear that neither could use such help, work was centred upon relieving some of the environmental pressures. Mrs. M. was helped to make rational demands for support from her husband, and, he was helped to see his responsibility for care of the children* This was a particularly laborious undertaking which brought about l i t t l e clearly evident change in either partner. Further, an attempt was made to help Mrs. M. behave in a less damaging fashion toward the children. This met with l i t t l e success and the case-worker attempted to help the children directly with the result that Mrs. M. withdrew them from interviews. 75 The IB women discussed above were divided into the six groups In terms of their personality as evidenced In maturity and orientation to activity or passivity. It cannot be stressed too strongly that the six groups discussed are not in any sense mutually exclusive. They are useful In a study such as this because they represent fairly clear points in a range of woman's personality extending from the strong considerably mature personality capable of an identifying and giving relationship with husband and child, to the near disorganized personality clinging to the mere vestiges of normal functioning. There is a great temptation to name each of the six groups of women In terms of their personality and functioning. It is foregone here because essentially i t is the range of personality which must be seen clearly. The groups are intended to make that range visible not to serve as memorable types*the validity of which might be disputed. These IB wives can be grouped in a variety of ways and the variety would probably grow If the number of cases was Increased. The Important thing in casework is the Individual diagnosis and any attempt to f i t a client Into any established type results only in futile casework. The caseworker in establishing the individual diagnosis is aware of the range of human personality and functioning which is re-flected here. He establishes his directions in terms of i t . The fact that the variety exists is certainly not new, but. the scope and con-figurations of that variety in these cases is important to establish as a requisite to farther consideration of casework in these 13 cases. TABLE 1. SUMMARY OF CASEWORK CONSIDERATIONS IN THE EIGHTEEN CASES GROUP OF CASE. NAME OF CASE Vowles Grange 2 u •H H r H -H o « 3a a 0 a m Q> •H a 31 3b Edgely Penn *-Sanderson Fenner 5 0 to S a> ( P O O « 3 & M t? (£5 6 co ©* O H O "8> sp 8 t? fr* J§ CASEWORK Year f i r s t opened Si S"l\ 99Si\9BfA5i *fl 52 Yd S2 98 Vfel So #<, y« Husband's pattern of drinking* reactive neurotic • • • • • • 1 / 1 / • Closures more than two Workers more than two «" * J | v | • • ] • • | v\ ^ sS Scheduled Interviews visits wife office wife visits husband office husband • • • • • iS s ^, Problems seen and presented by wife* Substitute care of children Disturbed behavior of children. Husband's person-ality Wife's personality Economic Legal • • • • • • • V • V 1/ ./ • • • iS ^ 1/ %S • if ^ V • 1/" as ^ if >T Evidence of relation-ship adequate to casework. • • • • Service given or Environmental help Financial assistance Material goods Community resources Counselling Therapy • • • • • • • • • • • %/ ^ S • * • • »» • • • Movement evident since agency knew family. Man Wife -Z U o o + X O +3 O -» •1 f 1 *•! -a •M r i O *• •! O O O O O O O -10 0 -1 +1 0 Extent casework resp-onsible for wife's movement. © o 70 0 6O6O O #0 O 70 O O O O i o ao 0 Chapter 3 Treatment Considerations In the Cases Under Review The over-all picture.of work with the wives of alcoholics as Illustrated In Chapter 2 and Table 1 is not a happy one.. In many cases a great deal of effort and s k i l l were used with l i t t l e effect. In only one case was there any notable degree of movement ( 4 3 ) I n only seven other cases was there even- minimal movement. In only five of these cases was this movement really attributable to casework. In two cases there was apparent positive movement on the part of the husband. In five cases there was apparent retrograde movement on the part of the husband. While In four cases the retrograde movement seemed unrelated to work with the wife, in one case i t seemed clearly related to work with her. The evident and possible reasons for these variations in movement will be explored In the remainder of this chapter. Cultural Patterns and Economic Difficulties In this study cultural patterns and economic difficulties as they affected the necessary diagnosis and the effectiveness of casework have been only indicated. Before proceeding to discussion of casework as related to movement, i t is desirable to draw these matters together. Within the IB wives there is considerable variation In back-, ground. Four wives were fi r s t generation Canadians, two were of British background, two were of Continental European background. A l l four women were married to Canadians whom they had met overseas during the World War II. These marriages Barnes, Tingley, Fenner and Underwood had stresses of cultural adjustment added to personality problems and post 1 See Table 1 following P. 75* Also see Hunt and Kogan op. d t . 77 var adjustments. The particularly disturbed behaviour of three of these women Mrs. Tingley, Mrs. Fenner and Mrs. underwood may be related to this additional stress upon them. Four other wives Mrs. Vowles. Mrs. Allison, Mrs. Irving and Mrs. Hughes are known to be second-generation Canadians. Mrs. Vowles alone is of British parentage. The effect of her parents' harsh, Scottish Presbyterian attitude upon her has been outlined in Chapter 2. Mrs. Irving and Mrs. Hughes were raised in particularly des-tructive and punitive family settings where l i t t l e possibility for relation-ship existed. Of the husbands l i t t l e i s known except thattro men Mr. Riley and Mr. Jensen were f i r s t generation Canadians, Mr. Riley being Irish and Mr. Jensen Norwegian. The stress which changing from one cultural group to another may have placed upon these men cannot be assessed from the records and must merely be presumed to have existed in same degree. Of the others a l l but Mr. Fenn have at least partially British Canadian backgrounds. None of the families showed within themselves any clear cultural patterning that might be said to be distinctively non-Canadian. Economic problems were stressed by the wives in 16 cases. Of these, five were given financial assistance by the agency in order that emergency needs might be met. Within the 16 eases of economic difficulty there was of course a considerable range in degree of need. Actual need, however, is clearly not related to the meaning of economic difficulty to the wife. Her anxious feeling about such difficulty or even the threat of such difficulty seems to depend upon the importance to her of the home and children as an aotivity outlet. The more feminine woman who has some measure of close feeling relationship with her husband and children is less upset by economic problems than is the woman whose home and family -73 concerns are redirections of strong drives toward masculine activity. These women are perhaps wives and mothers only because i t is the approved course of action, and they have the strength to sustain the defense mechanisms making i t possible. As a result they are more rigid than their feminine counterparts and deeply fear any threat to the marriage situation which in itself is a considerable defense^. This i s seen In women such as Hrs. Oliver, Mrs. Riley and Mrs. Fenner who became particularly upset about their husbands' drinking and employment difficulties. These women were not in the financial straits of Mrs. Grange, Mrs. Vowles or Mrs. Barnes but their reactions were far more anxious. This was frequently shown in strong desires to force the husbands to be more adequate and to punish them for not being so. Movement and the Husband's Pattern of Dr^^fy* Before going on to the main considerations of this chapter an examination of the husband's movement as related to his pattern of drinking is valuable. Perhaps the clearest point to emerge in regard to the husband's pattern of drinking is that If i t seems to be a reactive pattern in which too great a suppression of drives is basic, then he can be helped through help to his wife. There i s , however, no Indication in these IB cases that a man whose drinking pattern is essentially neurotic can in any real way be affected beneficially by work with his wife. He can very probably be helped only by direct treatment., • In the one case, Barnes, where an alcoholic whose pattern appears reactive deteriorated daring work with his wife, the reasons seem 1 This statement is based on numerous psychoanalytic references on defence mechanisms. 2 This statement is based on the works of Knight, Slmmel and Mennlnger previously cited together with detailed observations from the case records. 79 to l i e in the caseworkers having failed to perceive the undermining effect on him of the help to the wife. In the four other cases where the husband moved in a retrograde direction, his neurotic pattern of drinking became increasingly destructive of himself and his family. Six neurotic drinkers continued to function as before without notable change of any sort. Casework - The Year the Case Opened The year in which the case opened seems at f i r s t to have l i t t l e relevance to movement. In the five cases Oliver. Allison. Jensen, Penn and Tingley in which there was positive movement clearly related to casework, one was opened f i r s t in 1952, one in 1949, one in 1951 and one in 1947 and one in 1946. In this l i t t l e seems significant other than that the case in which the wife moved most (43) was opened only once and that in 1952. On the whole the cases in which there was movement significantly related to casework differ l i t t l e from the total group of cases Insofar as the year of i n i t i a l opening i s concerned. However, though the cases which did show movement are not specially significant, the cases which show minimal movement only slightly related to casework appear more Indicative. While this is not a subject to be dealt with at any length in this study, i t is interesting to note that in many of these cases the rd cur ring problems around alco-holism were dealt with repeatedly without any measureable degree of success attributable to casework. Mrs. Irving must be excepted from this statement, because, though casework seems l i t t l e responsible she did move on her own. This is also true of Mrs. Sanderson and Mrs. Mason. The latter was unable to use casework help with the marriage problem but the contact was sustained over a considerable period of time because of the need of the children for direct help. In this case i t is highly possible that casework prevented considerable retrograde movement and enabled do Mrs. M. to continue functioning as before* The remaining ten-women were seen Intermittently over periods of time ranging from a few months to several years without any notable movement resulting* Four of these were seen for considerable numbers of consecutive interviews. The other six were seen only sporadically. They came for help when their anxiety about the situation had become too great for them to handle. They usually requested help in punishing their husbands or in forcing them to change. When the husbands repented they broke contact. It may be wondered,had not visiting been the routine method of seeing the f i r s t four of these ten women, whether their con-tacts would not have been quite as sporadic as those of the last six women. In the matter of office interviews as contrasted with home visits, i t is Interesting to note that in the cases of the women who moved as a result of casework V .t two were conducted completely by office interviews and two largely by home visits. In one of the latter two instances, the caseworker made a definite effort to duplicate the Interview situation in the home. In the other case, work was seen from the f i r s t as largely supportive in terms of clearly defined treatment objectives. The major point to be drawn from these observations would seem to be that over considerable, though varying periods of time, a great deal of casework time and effort was expended in the majority of the cases to l i t t l e avail. Where movement is evident and related to casework, the period of overall contact is apparently unrelated to such movement. The one exception to this i s the supportive work done with Mrs. Tingley. It was directed and effective. The period of contact Indicated is one of continual casework effort and could have been no shorter. 81 Closure and Change of Caseworkers The natter of closure and change of caseworkers deserves close attention in regard to these cases* In seven of the 18 cases there were more than two closures* These closures were symptomatic of the ambivalent desire for help pre-viously mentioned and from the viewpoint of professional practice were completely justified. The Importance of these closures, however, con-sidered with the number of caseworkers responsible for work on each case points a situation which was particularly detrimental to casework. There were in a l l ten cases which had more than two caseworkers and the seven cases which had more than two closures were a l l within this group of cases. Only three of these seven cases showed even minimal movement, m the total ten cases where more than two caseworkers handled the case at different times six showed minimal movement on the part of the wife. In only four of these cases was movement attributable in marked degree to casework. In terms of the general experience of casework i t would be expected that frequent closures and changing caseworkers would inhibit the effectiveness of casework. Problems around establishing relationship cannot be rendered more soluble by change of caseworkers. Neither can the Individual and his problem be handled consistently on reopening i f the caseworkers change frequently. The coming and going of caseworkers is peculiarly a malady of Social Work. When a previously known caseworker has left the agency there is no alternative but to assign the case to someone new. There can be l i t t l e dispute about this, but, some of the transfers of case responsibility from caseworker to caseworker when the client has merely moved from one 82 district to another cannot be so easily justified* It should be noted in regard to transfer on change of district that at about the time of this study, The Family Welfare Bureau began to take action to prevent such damaging transfers. In cases such as these 18, where the wives are deeply fearful of the implications for their own l i f e adjustments of seeking help and where unwillingness to continue results In frequent closures, i t seems clear that i f each reopening means a new caseworker, the possibilities for help to the client diminish each time help is requested. Movement on the Parts of the 18 Wives as Related to Relationship The nature and manifestations of casework relationship comprise a complex area In which the profession is s t i l l searching. In this study concern is with the quality of the relationship. Is i t sufficient to enable environmental help counselling or therapy to be undertaken In regard to the problems the wife is facing In living with an alcoholic husband? The client's use of relationship as Gordon Hamilton points out is conditioned by his emotional needs, the goal of treatment and the function of the ageney itself. Not a l l easework situations call for equally strong case-worker-client relationships^. A l l the 13 wives studied except Mrs. Yowles, requested direct help with the problem of their husband's alcoholism at some time or other. All were looking for same mechanism by which an emotionally charged situation could be rendered more tolerable. let, In few cases was a relationship established sufficient to enable help for the wife with her own feelings and attitudes as factors in the situation. It seems that in only six cases Grange, Oliver, Riley, Allison, Jensen and Perm was adequate relationship achieved. Of these six cases 1 Hamilton, op. ci t . p. 29* 83 there was movement in a l l but the ease of Mrs* Riley. The reason for failure to achieve movement here would seem related to haste on the case-worker's part In dealing with upsetting material. Of the others', as noted in Chapter 2 Mrs. Allison might have been capable of greater movement i f the caseworker had not been caught up In a moral judgment about the rightness of returning to Mr. A. If the caseworker had devoted the time given to helping her maintain the separation Instead to help with her own personal problems involved in return to her husband a good deal more might have been accomplished. Mrs. Jensen having achieved a potentially happier state after brief counselling felt no desire for further help. Her husband was supporting regularly and was out of the home much of the time. Mrs. Perm used the casework relationship effectively during a separation from her husband. At this time she was able to consider the effects of her attitudes upon her husband. After return together Mrs. P. was optom-istic and withdrew from service. When she returned later the caseworker was changed and only one interview ensued. Mrs. Grange's caseworkers also seem to have become involved In value judgments with the same effect as in the Allison case. It would appear that there were three other women capable of relationships sufficiently strong to use help with the problems around alcoholism. These were Mrs. Vowles, Mrs. Barnes and Mrs. Edgely. The responsibility for failure to establish relationship in these three cases is largely the caseworker's. The caseworkers who saw Mrs. Vowles seemed to accept her super-f i c i a l appearance of strength without question. True, she was a person with considerable strength and evidenced i t In her planning around economic difficulties. let, at several points in the contact she touched upon her personal concerns as i f testing to see whether this helpful person was 84 really interested in her problems. Mrs. Vowles does not relate easily and the things she fears in herself and in her husband can only be shared with someone she i s certain she can trust. Mrs. V. did not make a strong request for anything beyond financial help and the caseworkers missed her overtures for help beyond this. Mrs. Barnes and Mrs. Edgely, alike, were dealt with largely on an environmental level by visiting caseworkers. In both cases an uncontrolled though controlling dependency was encouraged and the possibility of an adequate treatment relationship negated. The remaining nine women Mrs. Irving, Mrs. Sanderson, Mrs. Fenner, Mrs. Underwood, Mrs. Yates, Mrs. Royce, Mrs. Hughes, Mrs. Tingley and Mrs. Mason seem to be women whose capacity for relationship was insufficient to make possible either intensive counselling or therapy. A l l appear to have suffered considerable damage in early years of development and are incapable of any degree of insight into their own personalities and actions. Work with Mrs. Irving, Mrs. Tingley and Mrs. Mason took into account their limitations and each was given help accordingly. In attempting to help the other six women, caseworkers frequently tried to give the help requested, without appreciating the personality problems and attendant relationship limitations. This resulted in cont-inual planning which never eventuated in any change. In one case, for example, that of Mrs. Hughes a woman with a deep-seated personality disorder, was given Information and advice with the result that this sick woman moved away from her husband, taking her children with her. This was unfortunate as there seemed evidence from earlier contacts that the husband had considerable strength and that his drinking was in a reactive pattern partly, at least, related to his wife's attitude toward him. * 5 It would seem that the use of relationship in these cases points the need for both assessing the relationship capacities of the client In terms of personality and as well accepting the client's limitations in both the capacity to relate and to deal with various problems* This echoes the repeated demand for more adequate diagnosis* Unless the caseworker proceeds in terms of a continually reappraised diagnosis, he 1B working blindly. Unless the caseworker can perceive the personality and potentialities of his client together with the difficulties the client i s having in using casework help the caseworker cannot give such help effectively. When the caseworker works In any considerable degree of ignorance of these things and anxiously hopes to be sustained by l i t t l e more than his good Intentions, then he Is most likely to miss the chance to help the client. He is liable to pursue a plan for the client totally on his own and as well to become Involved in the client's confusion. Diagnosis, of course, embraces a l l the matters affecting the family situation. In this thesis concern i s largely restricted to the 18 wives. Therefore, at this point examination of the various personality patterns as they relate to movement would seem appropriate. Personality Patterns of the Wives as they Concern Casework ~. ' Movement as an expression of effectiveness of casework treatment would seem necessarily closely related to the client's emotional maturity. Dr. Therese Benedek says "Emotional maturity i s a term of ten used to describe a personality which has fully developed i t s potentiality for reconciling internal instinctual needs with the external requirements of society This Implies that the organization of the personality allows for an easy mobilization of psychic energies whenever a new adaptive task 86 requires i t " ^ . The capacity of the 18 wives to handle new adaptive tasks varies considerably. This can best be seen in regard to the personality groupings brought out in Chapter 2. Each of the groups evidence significantly different personality patterns and different capacities to handle new adaptive tasks. In terms of these variations diagnosis must establish differential casework treatment. In Group 1 no movement took place on the parts of Mrs. Vowles and Mrs. Grange. This is unexpected as both are essentially feminine women with considerable capacities for warm, intuitive identifications with their husbands and children. The reasons for their failure to use casework help were brought out in Chapter 2. Mrs. Vowles related more slowly and fearfully than her surface adequacy would seem to indicate natural. Adequate relationship for giving help to her was never established. In Mrs. Grange's case the one caseworker who established sufficient relation-ship to enable her to bring out her feelings about her martyr-like role in relation to her husband, also f e l l into the trap of encouraging her to leave a "worthless husband". Help in this regard was misdirected, failing to take into account the Implications of Mrs. G's ties to her husband. The Group 2 women lacked the capacities for feeling possessed by the Group 1 women. They found i t difficult to comprehend the feelings of either husband or children. These controlling and reforming wives have, however, a great emotional Investment in the marriage and in the moral upbringing of their children. Their personalities are strong but they have a considerable orientation to activity which in the manner of their mothers they channel into socially approved areas of wifehood and mother-hood. 1 Alexander. Franz and Ross. Helen, Editors, Dynamic Psychiatry, The university of Chicago Press, Chicago, Illinois, U.S.A. 1952, p. 111. 87 Casework with these women can be particularly effective as illustrated in the work with Mrs. Oliver («3 movement). These women have many resistances to understanding of their parts in the marital difficulties and in their husbands' patterns of drinking* However, i f their anxiety about using help can be reduced in i t i a l l y their strong desire to continue the marriage can be a motivating force in effective casework* Had Mrs* Riley's caseworker not gone too quickly i t i s possible that she might have moved the same extent as Mrs. Oliver. The Group 3 women, comprising sub-groups 3a and 3b, are more damaged and less mature than the women in Groups 1 and 2* For these women the children are the foci of their lives* They differ largely in their capacities for activity and the manner in which they involve them-selves with their children* A l l this group would appear to have real capacity for working to bring about change in their l i f e situations. In Chapter 2 i t was clearly revealed that the Group 3a women could UBS case-work help to move to more adequate functioning* The 3b women showed a similar capacity to grow up but did so without any real contribution from casework* Both sub-groups are very probably capable of more than +1 move-ment* Mrs. Allison could probably have moved more had not the caseworker devoted his energies to helping her maintain the separated state. It wi l l be recalled that more productive avenues of work were opened early in the contact but not followed by the caseworker. Mrs. Jensen used briefly given help very effectively. In terms of this success i t would seem that she might later return to continue the work. The fact that her husband's regular absence from the home as well as his regularity in supporting the family made her l i f e situation one with l i t t l e tension for the most part, seemed at the root of her failure to continue the contact. Both these 38 women would seem able to use a casework relationship in which their need for their husbands was accepted* Help given on a supportive counselling basis could probably help them find more satisfying relationships to husbands and children. Most particularly these women do not need help toward separation or toward taking legal action. There is a definite temptation to attempt giving them such help as i t is the real service they most frequently request* Rather, they need help as women In growing up In their relations with their husbands and children. Also, either by work with their husband 8 or by work with themselves, they must be relieved of the anxieties which motivate their drives to activity and destruction of a passive husband. This latter statement applies more to Mrs. Allison than to Mrs. Jensen for certainly the letter's husband was anything but passive. What has been said of the 3s women is equally true of the 3b women. Mrs. Barnes, however, has more potentiality for help than Mrs. Irving.. When fir s t seen i t was clear that Mrs. Irving could uBe l i t t l e more than environmental help. Initially this approach was followed, but subsequent caseworkers failed to observe her growth and continued to help her in the same way at a time when she could have used considerable counselling help in working out her plans In moving toward a realistically conceived separation. Among the Group 4 women only two moved and only to the extent of *1. These women found It even more difficult than the Group 3 women to function as wives and mothers. They lack the capacity to understand the feelings of husbands and children and to a large extent are totally unaware of the problems of both. In only one case was adequate relation-ship established and this woman, Mrs. Perm, was able to gain some limited Insight into her part in the marital problem. Both Mrs. Perm :. 89 and Mrs. Edgely show compulsive tendencies and also tendencies to rely on the feminine readiness of their husbands. Though from a psychological point of view they appear fixated in development in the adolescent stage they are considerably more mature than either Mrs. Sanderson or Mrs. Fenner* The latter two seem fixated at much earlier stages of development. A l l four while they do need practical help in their relations to alcoholic husbands, even more need help with their own personality problems. Such help is basic to improving the marriage situation and with these women the progress of such help must necessarily be slow. Although these women present problems for immediate solution there can be no immediate solutions to the problems presented. The Group 5 women, Mrs. Underwood, Mrs. Yates and Mrs. Royce like the Group 4 women, have deep-seated personality problems which render impossible any immediate direct work with problems concerning their husbands' drinking. Their disturbance, though better defended than that of the previous group is very probably of a more serious nature. The degree of this disturbance is probably indicated in the evident difficulty in establishing adequate relationship and in the fact that none of them moved to any measureable extent. A l l three have strong drives toward masculine activity which they are somewhat ambivalent about expressing directly. These women even more than Groups 3 and 4 have serious emotional problems with which they must receive help i f the matters of alcoholism and the accompanying marital problems are to be dealt with. These women need to be helped to be women before they can be helped to be wives. There is a real question, however, whether help with their own problems would either be desired by these women or be within the com-petence of a caseworker. Probably, the test of whether slow, long-term help should be given must rest on whether any of these women ever related 90 sufficiently to make such work possible. The Group 6 women Mrs. Hughes, Mrs. Tingley and Mrs. Mason are, as was clearly perceived in the cases of Mrs. Tingley and-Mrs. Mason, able to use only long-term supportive help together with very limited counselling help. In the case of Mrs. Tingley this resulted In *1 move-ment. In the case of Mrs. Mason there is the Impression that at least considerable retrograde movement was prevented. In regard to Mrs. Hughes, the caseworker's diagnosis was faulty and she was given counselling help around separation and the considerations Involved. This was useless to her and she moved (-1) to separate from her husband. Her action was hysterical and planless. Cases such as these of Group 6 are expensive in time and effort in terms of casework movement. However, If retrograde movement can be prevented i t is of inestimable benefit to the children Involved. Chapter 4 The Implications of the Study As stated earlier, conclusions drawn from but 18 cases are . only hypotheses, the validity of which must be tested in lengthy practice and study. In tills present study several points in regard to work with the wives of alcoholics appear with clarity Bufficient to merit suggestions as to possible directions in casework. Perhaps the simplest approach is through a summation of the difficulties which rendered casework ineffective in the 18 cases. Same were clearly closely related to the individual caseworker's efforts. These were! 1 failure to achieve relationship adequate to the casework attempted and resulting failure to establish any treatment plan; 2 failure to realize the difficulty with which the client must move, with the result that the client was threatened; 3 caseworkers becoming emotionally involved in the problems of their clients i.e. caseworkers making the clients dependent upon them or making moral judgments about the rightness or wrongness of separation and in reality endeavouring to control the clients. Two difficulties seemed more closely related to agency policy and professional practice: 1 change of caseworkers on a case; 2 inadequacy of the home visit to consistent treatment. Consider f i r s t those related to the technique of the individual caseworker. Failure to establish the relationship necessary for casework concerns the foundations of the Social Work profession. Repeatedly i t 92 has been voiced by caseworkers and teachers alike that the client must see the caseworker as a friendly, helping person before casework service can be used. In almost half the cases discussed In Chapter 2 i t was clear that the client could not repose the necessary degree of trust in the caseworker. In some cases this was due to failures on the caseworkers': parts. In other cases i t was due to the nature of the clients' personalities. In both situations, throughout the contact the client continued to present the old dilemmas and conflicts and casework was of l i t t l e help. Why was there so much difficulty in establishing the necessary relationship? The answer would seem to be in part supplied by recent work of Margaret L. Lewis and her associates in the Family Service association of Cleveland, Ohio. Miss Lewis says that while "....the husband's drinking was the overt reason for the applications for help of the women studied i t was rarely the drinking itself which had upset her. Bather something in the husband's behaviour to his wife had upset her usual equilibrium had aroused unbearable tension and brought the wife to the agency for help. The threat seemed almost to involve a question of personal survival"^» She points out that the threats to the wife seemed to f a l l into four general area&j. (l) economic debacle; (2) the resentment of the adolescent children and their loss of respect for both parents; (3) strain on the woman's physical health; (4) fear of loss of her husband. It is Miss Lewis' opinion that fear of loss of the husband was probably the deepest though certainly not the most conscious threat. 1 Lewis, Margaret L., "The Initial Contact with Wives of Alcoholics", Social Casework. Vol. XXXV, Number 1, Albany, N. T. p. 9. 2 Lewis, op. c i t . pp. 9-10. 93 In regard to intake procedures Miss Levis makes the following comments and suggestions. "It is expected at the point that these women seek help, that their resistance will be strong and their defenses highly mobilized. It is therefore important for the worker to show concern about the reality problems and to convey as quickly as possible , his awareness of the personal suffering of the wife herself, even though she is placing a l l her difficulties upon her husband's drinking. Until she feels that the worker understands her anxiety, and usually her basic fear of losing her husband, she is not able to look at her own part in the difficulty or to consider her own needs in a realistic way"^ . In Miss Lewis' study the majority of wives of alcoholics were found to have marked dependency problems and considerable anxiety around sexual relations. These views are certainly corroborated in this present work. While Miss Lewis is optomistic about possibilities for work with the basically dependent women, she feels that i f anxiety is more specifically related to sexual disturbances of a sado-masochistic nature, possibilities for effective work are less hopeful. The six wives in Groups 5 and 6 of this study evidence the sado-masochistic pattern clearly. In only two cases was the requisite relation-ship established and then only in two cases of long-term supportive work. The twelve wives in Groups 1, 2, 3, 4 would seem to f i t in varying degree Miss Lewis' depiction of the woman who can use "a sympathetic, warm relationship in which the worker expresses interest in understanding the strains she is under and offers to help her find Increased satisfactions in the marriage". Variations in the abilities of the twelve women to use such help have been discussed in Chapters 2 and 3* A l l twelve1* however, would seem to have the capacity to relate and use help. Why was i t then 1 Ibid p. 13 9A that of these twelve women In only seven cases was there evidence of relationship adequate to casework treatment? The reason would in most cases, seem to l i e in failure of the caseworkers to realize that these women have a real emotional investment in their marriages. They do not want to lose the husbands with whom many of them identify strongly. They do not wish to lose the elements of security in the marriages* In reading the cases the impression was inescapable that many caseworkers feel, perhaps unconsciously, that a woman should not remain in a marital situation with an alcoholic husband. Further, as i t is often difficult or Impossible to involve the husband in any casework plan, perhaps the caseworker asks himself, "What can I do to help this woman by herself?" As a result the caseworker seems frequently to proceed as though the client were ambivalent solely about following the sensible course she suggested herself, namely, toward separation. It is most natural for a caseworker to accept this as the task with which the wife wishes help, for what more logical and sensible conclusion would i t seem the wife could draw from assessment of her l i f e situation. Much casework time is as a result expended before the wife withdraws from contact to avoid the real threat of having to give up husband and marriage. Among the twelve women in the f i r s t four groups, as would be expected, difficulty in establishing relationship is in direct proportion to the wife 18 disturbance in the wifely and maternal roles. The more fundamental the psychological disturbance in the woman the more difficulty she w i l l have in using help. Relative slowness in establishing bonds of relationship would probably be seen later in slowness of movement in treatment. However, the vital i n i t i a l relationship can never be established unless the wife's feelings about her husband are clearly assessed and accepted by the caseworker. 95 The second and third obstacles to effective treatment, namely, those attendant upon the caseworker failing to appreciate the client's ability to use help, and upon the caseworker becoming caught up in the client's problem, seem attributable to inexperience upon the caseworker's part together with failure to establish diagnosis. Perhaps the fundamental source of both difficulties lies in the inability of case-workers to function in a professional way in their work. The ways in which professional use of self may be striven for by caseworkers and aided by supervision are not topics within the scope of this thesis. It i s , however, obvious that where caseworkers are having difficulty in their professional functioning, there is a real need for fairly Intensive supervision. Cases involving work with the wives of alcoholic men would seem to be ones where the inexperienced caseworker will meet considerable difficulty. This present study together with the work of Miss Lewis would seem to point some directions in differential diagnosis in these cases. In diagnosis the caseworker must learn to recognize both the specific needs of the client as well as her capacities for change in the situation. As stressed earlier the caseworker must avoid allowing his own biases to influence the casework plan. He must respect the client's right to self determination and meet her where she is in her ability to determine her course of action. Help must not be given solely as the caseworker might wish i t given but as the client i s able to use i t . In order to accomplish this the caseworker must understand himself and his own attitudes to the problems being dealt with. The caseworker must realize that the wife is requesting help with a problem that involves her total personal adjustment to l i f e . She therefore needs help with the personality problems that contribute to the 96 marital problem and to the husband's pattern of drinking. Failure to establish a working diagnosis results in dealing with the husband and wife almost as though they are elements in a chemical equation.. If the acid and alkali are apart, no disturbing chemical reaction can take place* By analogy the caseworker seems to conclude that the wife's stated desire to separate would achieve a similar nullification of the marital disturbance* Happily, human relations are infinitely more complex than the operation of a chemical reaction* Perhaps the analogy of a chemical reaction is not too inappropriate i f i t is realized that separation must take place after the chemical reaction when the bonds of mutual experience have made the two compounds quite really one. Separation for the wife means moving out of a state of which she quite really a part and which is quite really a part of her. Such a move in terms of human relationships is both difficult and painful. It is true of these cases as i t has been proven true throughout the growth of casework, that effective help can only be given upon a groundwork of careful and continuing diagnosis. Clearly, far more is needed than simply that the caseworker decide that the new case given him is "a typical wife of an alcoholic 0. There are no typical wives of alcoholics. It is agreed that as Miss Lewis indicates a l l the wives have in common difficulty in sexual relations and deeply rooted dependency needs. Yet, these things are true in greatly varying degrees. Truly there would seem from these 18 cases to be no definite level of intensity of these common problems which might be said to be characteristic of the wife of the alcoholic. The 18 cases studied here with their great variation in the maturity of the wife and her capacity for change seem essentially no different from the wives in countless other marital problems in which .97 alcohol is not involved* There is no such treatment entity as the °vife of the alcoholic 0. Bather there are many different sorts of wives of men who use alcohol in their adjustment to personality problems and l i f e situations. The fact that two disturbed or inadequate people seek each other out in marriage should not surprise us more in a case involving alcoholism, than i t does in a case involving continual criticism, miser-liness, desertion or any of the multitude of other expressions of personality problems and disturbed relationships. It may with some justice be wondered whether many of the difficulties which caseworkers meet in dealing with individual and family problems involving alcoholism are not directly related to half conscious feelings on the caseworkers part about the immorality of drunkenness. Caseworkers, in this present age of enlightenment and particularly as members of a profession which strives to be non-judgmental, may find i t difficult to accept the notion that such a moral judgment makes this particular phase of casework difficult. let, the forces that expressed themselves in the "axe-wieldings? of Carrie Nation and American Pro-hibition are s t i l l active in society. Mute testimony to the reality of these forces is on the f u l l shelves of our Provincial Government liquor stores. The liquor sold in these stores has suffered continuing dilution with water over the past years until i t bears l i t t l e resemblance to its fiery pre-war self. There may be very real fiscal advantages in this dilution, but i t is not justified publicly on this basis. In factsit i s not even referred to publicly by the government. There is no need to justify a policy which is strongly in line with the feelings of temperance groups throughout the province* No criticism is intended here of the efforts of any group to alter the social pattern of drinking. The concern here is with the effects which repeated value judgments about "drink 0, "the drunkard" and 9.8 "the evils of drink11 have had upon the attitudes of social workers. Is the worker's i n i t i a l great willingness to help the wife tinged with a pitying desire to remove her from an "evil" situation? Does the frequent half-disappointed statement that "the wife would rather remain in the punishing situation than use help to get out" really represent the swing to anger against the person identified with, who will not do as the case-worker thinks she should do? Is the sparseness of contact with the alcoholic husband an expression of the caseworker's antipathy to him? There were cases in the 18 studied where no plan other than separation or continuance of separation seems to have occurred to the caseworker. There were cases where the alcoholic man's shaky adequacy was further undermined by the nature of help given to the wife. There were cases where the ease-worker carried service out to the wife, but none where the caseworker aggressively carried service to the husband. Certainly there is just-ification for asking why these things were so. It would be well for a l l caseworkers dealing with marriage partners around problems of alcoholism to ask themselves a few basic questions about their own motivations. Obstacles to Movement in the General Practice of Social Work The period covered by several of the 18 cases i s one in which there have been many developments In Social Work practice generally. These have been reflected in the work and policies of the Family Welfare Bureau. As mentioned earlier, this agency some time ago took steps to alter the situation which resulted In indiscriminate transfer of cases whenever the client moved or the caseworker's district was changed. This has benefited work with a l l types of cases. It might be wondered. If in addition to controlling transfer with change of district similar control of transfer when closed cases are reopened might not particularly benefit work with the ambivalent wives of alcoholic men. Casework with few other types of problems is accompanied by the repetition of closure and 99 reopening evident in these eases. It would seem that withdrawal and re-application for help should be considered as probable aspects of the treatment plan and that wherever possible the same caseworker should carry the case throughout. If this caseworker reviewed the diagnosis at each time of closure, the meaning behind closures could aid the later establishment of a more effective treatment plan. In this way, despite closures,help could be integrated and cumulative. Home interviews appear in many of the eighteen records to have contributed to the Ineffectiveness of casework. This is of course not necessarily true In every situation where home interviews may be used. Home interviews can be a particularly valuable casework tool when effect-ively used. There are however, real difficulties confronting any case-worker who undertakes even relatively intensive treatment in the home setting. The means for expression of client feelings about the service are different in the home vi s i t situation than in the office interviews. The client must speak to the caseworker differently than through tardiness or missing appointments when feeling about the oontact must find expression. The caseworker who wishes to undertake intensive interviews in the home setting must rely on the client to help reproduce same of the controls upon interference present in the office Interview. However, i f the client uses failure to institute such controls as a substitute for not keeping appointments the caseworker's time is wasted. Regardless, however, of what may be done the focussed and directed atmosphere of the office interview is lacking. In the clients mind the home is associated with family l i f e , attendant domestic duties and feelings about hospitality; the office is associated with a professional service. It would seem therefore that in cases of the type discussed, office Interviews are on the whole more appropriate than home visits. Home visits are of course 100 necessary, indeed v i t a l , at certain points, bat they should not be used except In special circumstances* Other Aspects of the Work In Problems around Alcoholism In any work such as this study which endeavours to follow a closely defined course in studying one aspect of a complex subject, other aspects are to some extent illuminated. These deserve mention not so much for their validity as the result of this study, but because of the Indications they may give for future work. It is for this reason that the nature of possible work with the alcoholic husband himself wil l be discussed. Possibilities for Work with the alcoholic The cases chosen for this study together with the many others rejected for brevity reveal clearly that few alcoholics themselves are ever brought into casework treatment. It was wondered earlier If failure to Involve the alcoholics In treatment is not to some extent the reflection of a moral judgment on drinking. At this point i t should be noted that In many cases, i t is beyond any caseworker's competence to bring the husband into planning and treatment. These are cases where the wife will not let the caseworker through to the husband, whatever the reason, i t seems that only aggressive efforts to reach the husband will reveal his ability to use help or the extent to which his "refusal" to come in reflects the wishes of the wife. In most cases the wife comes to the agency only when some new and unbearable stress has been placed upon her. Rightly or not, she blames her husband for this, both in speaking to him and to the caseworker. She has probably threatened many times before to "go to the Welfare" If he did not reform. In this situation there would seem to be l i t t l e use In the frequently used approach of asking the wife to In turn ask the 101 husband to come in* He Is probably s t i l l angry with her and she wil l doubtless, threaten him as before with the club of the "Welfare". The alcoholic must be reached directly, not through h i B wife. This may entail the caseworker telephoning, writing, or visiting the husband. If i t is possible to help the alcoholic participate in treat-ment, diagnosis as to the nature of his personality and pattern of drink-ing will help substantially in determining casework directions. As indicated earlier there is much greater hope for effective casework with the reactive drinker than with neurotic or chronic drinkers* It is highly possible, however, that the neurotic or chronic drinker could be helped to move towards Alcoholics Anonymous or an available treatment centre. There can be no doubt that even this move toward help with his problem is something with which the alcoholic needs consistent and possibly even long-term assistance* He can best use such help i f his wife is herself receiving help and is functioning as a relatively con-structive partner in the marriage* Caseworkers aware of the benefit of counselling and therapy based on relationship have long felt that their profession has something real to contribute to help in the problem of alcoholism. Casework difficulties in treating the alcoholic wife as seen in this study do perhaps appear to augur i l l for work with the alcoholic himself. There i s , however, an indication in this study of the potential effectiveness of casework with the alcoholic's wife. The same potential exists for work with the alcoholic himself but i t is unuseable until he is reached by the caseworker. It would seem well for Social Work to examine the means i t has used to this end. Considerations of treating the alcoholic himself point to some areas of the total problem of alcoholism which merit detailed study. 102 This present study in touching only one part of the total problem in no sense depicts Casework's overall functioning in this area* A study of cases in which both the husband and the wife were involved in extensive treatment in which the husband's alcoholism was concerned, would be valuable. Also, i t would seem worthwhile to invert the subject matter of this present thesis to study casework*s effectiveness in cases involving alcoholism on the part of the wife. Another matter touched on in this study and worthy of more intensive examination is that concerning problems and patterns evident in treatment of the children in families where the fathers are alcoholics. Ample material would undoubtedly be available in the files of family service and child guidance agencies. Co-operation between Alcoholics Anonymous and the Family Agency has been indicated at various points in this study. It would be most valuable i f a thorough examination could be made of the potentialities and limitations in such co-operation. Conclusion This thesis has attempted to outline an approach to casework with a particular group of wives of alcoholic men. Material and conclusions have been presented, which i t is hoped may have something more than an academic value. At the most, i t might be hoped that the conclusions arrived at would, i f they seem valid, be examined and tested in casework practice. However, an equally satisfactory result would consist in the complete rejection of the study, it's bases and conclusions, i f such rejection meant the formulation of a more effective approach to this sort of ease. Certainly, aside from a l l considerations affecting this brief study, the total problem of alcoholism is one in which a great deal of 103 pioneer work remains to be done. Casework as practiced in the family agencies is particularly able to make an important contribution to this work. However, to do so, the family agency must both carefully examine its experience in these cases in an effort to find new insights applicable to the total problem, and, as well explore new directions in treatment. Throughout this study the Social Work profession's awareness of the psychological sufferings of these families has been stressed. Even more so the profession is aware of the intense social suffering of these families as expressed in such matters as evictions, financial difficulties, vocational problems and social disapproval. The costs of alcoholism in devastated homes and ruined lives are everywhere evident today* The family agency and Social Work generally cannot ignore the need for more and effective help. 104 BIBLIOGRAPHY General References Alexander. Franz, M.D., and Ross, Helen, editors, Pyn^f- Psychiatry. University of Chicago Press, Chicago, HI., 1952. A concise and integrated presentation of present day psychoanalytic thinking. English, 0. Spurgeon, M.D., and Pearson, Gerald H.J., M.D. Emotional  Problems of Living. W.W. Norton and Company, Inc., New York, N.Y., 1945. Colby, Kenneth M., "Human Symbiosis". Psychiatry. Vol. 6, 1943. The William Alanson White Psychiatric Foundation, Washington, D. C. An interesting theorization as to the structure of the emotional bonds in marriage. Galdston, Iago, M.D. "The Psychodynamics of the Triad, Alcoholism Gambling and Superstition". Mental Hygiene. Vol. XXV, 1951. The National Association for Mental Health Inc., New York, N. Y. This is a brief but stimulating consideration of possible bases under-lying a l l three human pursuits. Hollis, Florence, Women in Marital Conflict. Family Service Association of America. New York, N.Y. 1949* Horton,D., "Functions of alcohol in Primitive Societies". Quarterly  Journal of Studies in Alcohol. September 1943. Yale University, New Haven, Conn. Josselyn, Irene M., M.D. "The Family as a Psychological Unit". Social Casework. October 1953* Family Service Association of America, Albany, N.Y. A clear depiction of the emotional inter-relation between family members. Williams, E.Y., M.D. "The Anxiety Syndrome In Alcoholism0. The  Psychiatric Quarterly, pp 782-787, 1950. State Hospitals Press, Utica State Hospital, Utica, N.Y. A brief but significant assessment of the role of anxiety In alco-holism. Specific References Chassell, J., M.D., "Family Constellation on the Etiology of Essential Alcoholism". Psychiatry. November 1938, The William Alanson White Psychiatric Foundation, Washington, D. C. An illuminating study of the development of the alcoholic pattern. Well illustrated with case material. Deutsch, Helene, M.D., Psychology of Women. 2 vols. Grune and Stratton, New York, N.Y. 1944* Richly Illustrated with ease material this work supplies a v i t a l and comprehensive understanding of the various personalities and functionings of women. 105 Gibbins, Robert J., M.A., "Alcoholism in Canada". Canada's Health  and Welfare. Vol. 9, No. 5, 1954, Department of National Health and Welfare Ottawa, Canada. i A brief bat careful statistical presentation of estimates as to alcoholism in Canada as compared with other countries. Hamilton, Gordon, Theory and Practice of Social Casework. Columbia university Press, New York, N.Y., 1951. Hunt, J. McV. and Eogan, Leonard S., Measuring Results in Social  Casework. Family Service Association of America. New York, N.Y., 1950. Knight, Robert P., M.D., "The Psychodyaamics of Chronic Alcoholism". Journal of Nervous and Mental Diseases. November 1937, Coolidge Foundation, New York, N.Y. Kogan, Nathan J., Kogan, Leonard S., Hunt, J. McV., "Expansion and Extension of Use of the Movement Scale". Social Casework. January 1952, Family Service Association of America, Albany, N.Y. A valuable reappraisal of previous work in measuring movement. Lewis, Margaret L., "The Initial Contact with Wives of Alcoholics". Social Casework. 1954* Family Service Association of America, Albany, N.Y. Lewis, Marion F«, "Alcoholism and Family Casework". The Family. April 1937. Family Welfare Association of America, Albany, N.Y. Menninger, Earl A., M.D., Man Against Himself. Harcourt Brace and Company, New York, N.Y., 1933. Newell, Nancy, Ed.M., "Alcoholism and the Father Image". Quarterly  Journal of Studies in Alcohol. March 1950, Yale University, New Haven, Conn. An examination of the influence of the alcoholic father upon the development of his children. Preston, Malcolm G., Mudd, Emily H., Froscher, Hazel B., "Factors Affecting Movement in Casework". Social Casework. March 1953, Family Service Association of America, Albany, N.Y. This article describes careful research into factors relevant to casework movement. The conclusion are Important for casework practice. Sapir, Jean V., "Relationship Factors in the Treatment of the Alcoholic". Social Casework. July 1953, Family Service Association of America, Albany, N.Y. The author relates to relationship factors the difficulties and possibilities for work with the alcoholic. Simmel, Ernst, M.D., "Alcoholism and Addiction 0. The Psychoanalytic  Quarterly. The Psychoanalytic Quarterly Inc., Albany, N.Y,, 1948. 

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