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An evaluation of the client-worker relationship : a study of the relationship in a selected number of… Carscadden, Lillian Mary 1951

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/ £ & fS 7 / SSt s s (Z- £ £• 0 AN EVALUATION OF THE CLIENT-WORKER RELATIONSHIP A Study of Relationship in a Selected Number of Cases in The Family Welfare Bureau of Greater Vanoouver LILLIAN MARY CARSCADDEN Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the School of Social Work 1951 The University of British Columbia ABSTRACT "Relationship" i s the term commonly but loosely used i n s o c i a l casework, to r e f e r to the i n t e r - a c t i o n of p e r s o n a l i t i e s which occurs between the caseworker and the c l i e n t i n need of help. The exact constituents of "r e l a t i o n s h i p " , and the part which i t plays i n t r e a t -ment, and i n an improved adjustment, are as yet f a r from having been p r e c i s e l y determined. The present study examines a c a r e f u l l y chosen set of cases with the object of exploring the way to a more d e f i n i t -ive a n a l y s i s . To take account of the range of the problems encountered, the cases are grouped according to three degrees of d i f f i c u l t y . The assessment of the c l i e n t ' s l e v e l of a b i l i t y i n r e l a t i o n s h i p i s approached through a series of six c r i t e r i a : h i s concept of himself, h i s a b i l i t y t o see h i s own r e a l f e e l i n g s , h i s ways of coping with r e a l i t y , h i s a b i l i t y to endure f r u s t r a t i o n , the q u a l i t y of h i s a f f e c t tone, and the pattern of h i s ways of responding t o people. The essen t i a l background of each case i s summarized. Each group of cases i s then reviewed with special a t t e n t i o n to differences i n the c l i e n t s ' ways of responding to persons and s i t u a t i o n s , the attitudes and performance of the caseworker, the development of the case, and the elements i n the c l i e n t which e i t h e r f a c i l i t a t e or retard growth i n maturity and adaptation. The study reveals the emergence of patterns where the promise of r e l a t i o n s h i p was good or l i m i t e d or poor according to the extent that the basic needs of the i n d i v i d u a l had been met. I t shows that the" understanding and acceptance of the c l i e n t by the caseworker en-ables the c l i e n t to modify r e s t r i c t i n g attitudes, and to develop more constructive responses to s i t u a t i o n s . Where these attitudes do not p r e v a i l the caseworker cannot contribute to the growth process of the c l i e n t . The study shows the need f o r greater p r e c i s i o n i n recording, i n diagnosis, i n the s e l e c t i o n of treatment methods, and the ways i n which the c r i t e r i a can be used to help i n these processes u n t i l measurement techniques become possi b l e . Careful s e l e c t i o n of applicants f o r s o c i a l work, improved t r a i n i n g f o r supervisors, smaller and more s e l e c t i v e case loads, and a greater awareness on the part of agencies of the importance of r e l a t i o n s h i p , are seen as the means of improving the e f f e c t i v e use of r e l a t i o n s h i p i n t r e a t -ment. Acknowledgments This study was made possible through the co-operation of Miss Mary McPhedran, Director of The Family Welfare Bureau of Greater Vancouver, and the members of her staff. They gave generously of their time in helping to select the cases studied, and in granting special interviews which were necessary to supplement the information contained in the records. I would like to express appreciation also for the help and encouragement given by Miss Marjorie Smith, and Dr. Leonard C. Marsh of the School of Social Work, University of British Columbia, and to Dr.Elda Lindenfeld, who acted as psychiatric consultant. TABLE OF CONTENTS Chapter I Relationship - the Key to the Helping Process The purpose of the study. Relationship "defined". Some authors discuss relationship. A client discusses relationship. Casework versus "deep" therapy Page Chapter II Methods used in the Study Criteria established. Testing of criteria. Selection of cases. Schedules for background information. The application of criteria. Assessing the caseworker's contribution. Evaluation of results . Page 14 Chapter III Criteria for Evaluating the Client-Worker Relationship Concept of self. Ability to see real feel-ings. Ways of coping with reality. Ability to endure frustration. Quality of affect tone. Pattern of responses to others . . . . Page 21 Chapter TV The One-Talent Client Loss parents by death. Early deprivations deduoed from present behaviour. Severe re-jection. Over-proteotiveness of parents. The unresolved oedipal situation. The case-worker's contribution and the nature of the professional relationship . . Page 25 Chapter V The Two-Talent Client. Some oontrasts in Attitudes Mrs. Fournier, Mrs. Grove The influence of the attitudes of the case-worker Page 53 Chapter VI The Five-Talent Client Mr. Hoar, Mr. Inkster, Miss James, Mrs.Kroner. The ways in which they were able to use rela-tionship Page 69 Chapter VII Treatment methods used and their effectiveness Treatment methods as channels for relationship. A description of the treatment methods used. An evaluation of their effectiveness Page 90 C h a p t e r V I I I F i n d i n g s and I m p l i c a t i o n s A p p e n d i c e s : A . B . A summary o f t h e l e v e l s o f r e l a t i o n s h i p a b i l i t y shown, and t h e c a s e w o r k e r ' s c o n t r i b u t i o n . Ways o f i m p r o v i n g t h e e f f e c t i v e u s e o f r e l a t i o n s h i p , (1) s e l e c t i o n o f a p p l i c a n t s f o r s o c i a l w o r k , (2 ) adequa te t r a i n i n g o f s u p e r v i s o r s , (3) agency p h i l o s o p h y , (4) s m a l l e r and m o r e s e l e c t i v e c a s e l o a d s . I n c r e a s e d u n d e r s t a n d i n g o f r e l a t i o n s h i p e f f e c t s , ( l ) i n t a k e , (2) s e l e c t i o n o f t r e a t m e n t m e t h o d s , (3) r e c o r d i n g Page 103 R e c o r d s o f s p e c i a l i n t e r v i e w s w i t h c l i e n t s . (1) M r . B e l l . (2 ) M r . I n k s t e r . B i b l i o g r a p h y . CHARTS AND SCHEDULES I N THE TEXT (a) C h a r t s 1 2 3 4 5 6 7 8 9 10 11 C h a r t C h a r t C h a r t C h a r t C h a r t C h a r t Char * ; C h a r t C h a r t C h a r t C h a r t A B C D E F G H I J K M r s . A r n o t t M r . B e l l M r s . C o u l t e r M r s . Dean M r s . E a s t M r s . F o u r n i e r M r s . G r o v e M r . H o a r M r . I n k s t e r M i s s James M r s . K r o n e r Page Page Page Page Page Page Page Page Page Page Page 28 31 33 36 39 61 65 72 77 80 84 0 0 S c h e d u l e s 1 2 3 4 5 6 7 8 9 10 11 S c h e d u l e A S c h e d u l e B S c h e d u l e C S c h e d u l e D S c h e d u l e E S c h e d u l e F S c h e d u l e G S c h e d u l e H S c h e d u l e I S c h e d u l e J S c h e d u l e K M r s . A r n o t t M r . B e l l M r s . C o u l t e r M r s . Dean M r s . E a s t M r s . F o u r n i e r M r s . G r o v e M r . H o a r M r . I n k s t e r M i s s James M r s . K r o n e r Page Page Page Page Page Page Page Page Page Page Page 48 49 50 51 52 67 68 86 87 88 89 CHAPTER ONE RELATIONSHIP - THE KEY TO THE HELPING PROCESS Mrs. X. dreaded her arrival at the offices of the Family Welfare Bureau, even as her steps took her slowly in that direction. She needed help and she needed i t now. Things might become even worse . than they had been. Yesterday when Mrs. Ramsey across the street had suggested that she consult the family agency, i t had seemed like a l i t t l e ray of hope. Now she wondered about the wisdom of coming. Would the people in the agency think that she was weak because she couldn't solve a family problem without outside help? How would she be treated? What would they expect of her? The prospect was frightening. Perhaps it would be better not to go, and to try again by herself. She had tried, though, and i t just hadn't worked. She had to have help, and now. Mrs. X. felt a l i t t l e as she had, when as a child, she had needed to ask for help. Some of the fears and attitudes of child-hood were re-activated. So, wanting to come, yet not wanting to, Mrs. X. paused before the door of the waiting room -and at last entered. With her, she carried a l l of her previous experiences and what they had meant to her. With her went her accustomed ways of reacting to people and to situations. A person in need of help had come seeking one who could give i t . 2 In his office sat the caseworker who was scheduled to try to assist Mrs. X. with her problems. He had gone to University and had taken the required courses in social work. He had a good understanding of the meaning of behaviour. He was also a member of a family, a person who had friends, an employee, a member of a community. From a l l of these he had developed ways of looking at people and a sense of values. He had developed needs and defences and fears. He too was a part of a l l that he had known, of a l l that he had experienced. What happens as the caseworker invites Mrs. X. into the inter-viewing room and tries to help her with her problems? What is the nature of the interchange between these two people? There is general agreement, among those social workers who affirm the dynamic approach to personality, that the establishment of a "relationship" provides the atmosphere in which help can be received from another person. But what contributes to this "relationship"? Can minimum requirements be set forth? Under what conditions can the maximum help be given? What ways of responding limit the effectiveness of its use? What are the ..implications of the use of "relationship" on treatment methods and on administrative procedures? The Purpose of the Study This study seeks to find at least partial answers for some of the questions raised above about the nature of "relationship" and its use in social case work. It does this through an analytical 3 study of eleven cases which were selected from the case load of the Family Welfare Bureau of Greater Vancouver. Such a limited number of cases does not make i t possible to generalize about the principles involved. Instead an attempt is made to see what forces seemed to be operating in each specific situation. The hope is that by approaching case study from this point of view something can be added to the understanding of this concept which is the catalysing element in the helping process. "Relationship1* Defined Relationship is a term used in such a general way that its mean-ing has become somewhat blurred, and i t is difficult to define. Dr. Howard Thurman quotes what Dr. William A. White says about the "plus" quality which is implicit in relationship. "When two individuals, be they cells or organisms, unite for a common purpose — let them be two men, A and B, who come together in a partnership for carrying on some sort of business — the union of A and B in such a partnership is not expressible by adding A and B together and setting down the results accordingly. There is something else that has gone into the formula besides A and B, a third component, and that third component is the relationship between them." Dr. Thurman comments"there are various names by which this third component is called, understanding, 1 awareness, . . . friendship and even love". 1. Thurman, Howard: Meditations For Apostles of Sensitiveness, The Eucalyptus Press, Mills College, California. 1949. page 55. 4 The importance of this third component in different kinds of professional work is recognized. There is the teacher - pupil "re-lationship*1 which can accelerate or retard the learning process. There is the doctor - patient "relationship" which can hasten or delay the recovery of health. There is the pastor's "relationship" with members of his congregation which can increase or decrease be-lief and confidence in spiritual values. In social casework the nature of the "relationship" established between a client and a worker depends on the emotional health of both, and on the significance to them of the problems being considered. Because of the wide range of individual reactions and interactions, three different ways of relating need to be distinguished rather than grouped together under the one inclusive term "relation-ship". Using the terminology of psychiatry these are "conscious reality relationship", "transference", and "counter transference". A "conscious reality" relationship exists when a client's way of reacting to the worker is appropriate to the latter's treatment of-him. He may become annoyed i f kept waiting for a long time,; he may express gratitude for help received; he may like or dislike the worker, but his expressions of feelings will be directed to the worker himself and to the immediate and objective situation. This attitude would be found in clients who had achieved a reasonable balance in personality, and who were seeking help with problems involving l i t t l e emotional t 5 2 s t r e s s . F l o r e n o e H o l l i s d e s c r i b e s t h e ego s t r e n g t h w h i c h s u c h a c l i e n t p o s s e s s e s . Many c l i e n t s coming t o a s o c i a l agency do n o t have much c o n f i d e n c e i n t h e m s e l v e s . T h e i r ego d e v e l o p m e n t may a l w a y s have b e e n l i m i t e d , o r , a l t h o u g h n o r m a l l y s t r o n g , t h e y may be r e a c t i n g t o t h e c r i t i c a l s t r a i n s u n d e r w h i c h t h e y a r e l i v i n g . 2 . H o l l i s , F l o r e n c e s Women i n M a r i t a l C o n f l i c t , F a m i l y S e r v i c e A s s o c i -a t i o n o f A m e r i c a , New Y o r k , 1949 , page 1 2 : . . . . The p r i n c i p l e s o f p e r s o n a l i t y d e v e l o p m e n t and t h e d y n a m i c s o f p e r s o n a l i t y f u n c t i o n i n g w h i c h h a v e b e e n d e v e l o p e d by p s y c h o -a n a l y s i s p r o v i d e t h e f r a m e w o r k u p o n w h i c h r e s t s mos t m o d e r n c a s e -w o r k t r e a t m e n t o f p s y c h o l o g i c a l p r o b l e m s . A c c o r d i n g t o t h i s t h e o r y t h e a d u l t p e r s o n a l i t y c o n s i s t s s t r u c t u r a l l y o f t h r e e s e t s o f f o r c e s - i d , s u p e r e g o , and e g o . The i d i s t h e sum t o t a l o f t h e i n s t i n c t u a l l o v e and a g g r e s s i v e d r i v e s o f t h e p e r s o n a l i t y . The s u p e r e g o , known as c o n s c i e n c e , o f w h i c h t h e ego i d e a l i s a p a r t , r e p r e s e n t s t h e r u l e s o f l i f e and i d e a l s t r a n s m i t t e d t o t h e i n d i v i d -u a l f r o m h i s f a m i l y and g r o u p c u l t u r e . The ego i s t h e name f o r t h a t c o m p o s i t e o f q u a l i t i e s t h r o u g h w h i c h t h e i n d i v i d u a l a d a p t s h i m s e l f t o t h e o u t s i d e w o r l d , s e c u r i n g f r o m i t t h e o p p o r t u n i t y t o e x p r e s s h i s f u n d a m e n t a l d r i v e s and t o meet h i s m a j o r n e e d s . These q u a l i t i e s i n c l u d e t h e a b i l i t y t o p e r c e i v e e x t e r n a l r e a l i t i e s and i n t e r n a l f e e l i n g s , t h e a b i l i t y t o f i n d ways o f m e e t i n g i n t e r n a l needs t h r o u g h t h e e n v i r o n m e n t i n a f a s h i o n t h a t w i l l n o t o n l y be s a t i s f y i n g b u t w i l l b r i n g t h e minimum o f d i s c o m f o r t t o o t h e r s o r t o h i m s e l f , t h e a b i l i t y t o f o r e s e e t h e outcome o f v a r i o u s c o u r s e s o f a c t i o n , t o l e a r n f r o m e x p e r i e n c e , t o w e i g h t h e a d v a n t a g e s and d i s -a d v a n t a g e s o f h i s b e h a v i o u r , t o s u p p r e s s and r e p r e s s d e s i r e s t h a t c a n n o t be s a f e l y e x p r e s s e d , i n g e n e r a l t o c o n t r o l , d i r e c t and h a r -m o n i z e h i s a c t i v i t i e s . I t i s t h r o u g h t h e ego t h a t we become aware o f f e e l i n g s o f p l e a s u r e , a n g e r , f e a r , a n x i e t y and g u i l t . We f e e l p l e a s u r e when needs a r e g r a t i f i e d , a n g e r w h e n t h e y a r e t h w a r t e d , f e a r when we a r e t h r e a t e n e d by a known e x t e r n a l d a n g e r , a n x i e t y when we a r e t h r e a t e n e d by s u b j e c t i v e d a n g e r s f r o m t h e f o r c e s w i t h i n o u r own p e r s o n a l i t i e s , o r more g e n e r a l , l e s s d e f i n e d d a n g e r s f r o m w i t h o u t , and g u i l t w h e n we have v i o l a t e d , o r c o n t e m p l a t e v i o l a t i n g t h e t e n e t s o f o u r own s u p e r e g o . I t i s t h e t a s k o f t h e ego , t h e n , t o f i n d as much p l e a s u r e as p o s s i b l e , t o a v o i d t h e c r e a t i o n o f a n g e r by f r u s t r a t i o n w h e n e v e r p o s s i b l e , t o p r o t e c t us f r o m b o t h o u t e r and i n n e r d a n g e r i n o r d e r t o a v o i d t h e d e v e l o p m e n t o f f e a r and a n -x i e t y , and t o do a l l t h i s i n a manner t h a t w i l l n o t a r o u s e f e e l -i n g s o f g u i l t . 6 The client then unconsciously tends to displace on the worker feelings and attitudes which he held toward people who were important to him in his previous experience. This is known as "transference", and some indications of i t are usually found whenever the client's problem is emotionally charged. Gordon Hamilton comments: "It is be-cause the therapist is in a position to help him that the client tends to transfer his early or childish feelings to such a person, and to re-3 enact emotional experiences with previous significant figures". "Counter transference" occurs when the worker's reactions to the client are irrational because of unconscious associations. If the client expresses the hostility which she feels toward her child, the worker may become angry because of unconscious identification with the child who is being discussed. The worker must be aware of his re-act ions, for such anger is intuitively felt by the client, even i f no obvious expression of i t appears. Relationship, as used in this study, includes conscious reality relationship, transference and counter transference. It is necessary in analyzing each case to try to see whether the relationship^which existed between the client and the worker,was predominantly based on reality factors,or whether i t was greatly influenced by unconscious displacements from early l i f e . Some Authors Discuss Relationship Some of the outstanding writers in the field of social work have described what they consider to be the essential elements in relation-3. Hamilton, Gordon: Psychotherapy in Child Guidance, Columbia University Press, New York, 1947, page 128. 7 ship. A brief summary of their thinking on this matter will help to establish criteria for evaluating the effectiveness of relationship. "The therapist is not a parent or a substitute parent, yet he plays a 'parental' role. He must be a good friend, yet not a friend in the ordinary social sense... A therapeutic relationship is different from other human relationships in that its purpose is healing The therapist uses himself as the chief dynamic in treat-ment.... The therapist gives of his understanding, of his own ego strength, and even of his super-ego The therapeutic attitude permits the client to learn that he has nothing to fear. "The 'love' of the therapist consists of warmth, concern, therapeutic understanding, interest in helping the person to get well .... Giving love is in itself not enough -its assimilation by the client must be feasible Consistency, neutrality, and firmness, as well as warmth, enter into the therapeutic relationship". 4 Annette Garrett says that the worker, in his role of parent, is able to give additional strength and courage to the client. The mature ego strengths of the worker serve to reinforce the weak ego strengths of the client, and as a result he is better able to bear frustration. The worker, by showing tolerance, becomes the idealized parent,and then becomes an increasing source of strength. In this role he may help to modify the over-severe super-ego of the client,if this is necessary. The transference renders the client amenable to suggestions from the worker. He becomes more willing to abandon his resistances to facing the emotional disturbance of his personality,and the results of i t . "The client, through .increased confidence, freed ego strengths, relaxed super-ego, or abandoned neurotic displacement, may come to behave somewhat more rationally toward some of the 5 figures involved in his reality problem". 4. Ibid, pp 125-6 5. Garrett, Annette: "The Worker-Client Relationship", American Journal of Orthopsychiatry, April, 1949, page 224. 8 Another writer says, "The successful therapist consciously or un-consciously identifies with the client, and at the same time is "able to look objectively at the problem, formulate its structure, and see a possible resolution to i t . It is this objective approach combined with an identification with the individual that results in the prompt, valid judgments that are necessary to successful treatment in any therapeutic situation. What is often erroneously called intuition is the capaeity of an individual to evaluate objectively the emotional experiences re-6 suiting from identification with another individual". Dr. JoSselyn stresses that the clients readily "intuit" any art i f i c i a l i t y in the relationship. What Jules V. Coleman, a psychiatrist, writes about the essential qualities for the practice of psychotherapy is applicable to case work. "The successful practice of psychotherapy ... implies an acceptance of the patient as a person — his interests, desires, strivings, and feel-ings, a recognition of his right to find his own solution of problems; a respect for emotionally determined attitudes toward his illness and toward the physician; and a willingness to work with the patient in 7 terms of his own way of looking at the world and at other people." Helen Witner, defining the relationships established between several therapists and their child patients, comments: 6. Josselyn, Irene M.: "The Caseworker as Therapist", Journal of Social Casework, November, 1948, page 351. 7. Coleman, Jules V.: "The Teaching of Basic Psychotherapy", American Journal of Orthopsychiatry, October, 1947, page 622. "Each therapist showed the patient that his feelings were understood.. Another similarity in means used for the establishment and maintenance of the relationship is seen in the consistence with which the therapists took the children's ideas seriously — accepted them non-critically and as worthy of attention and consideration ... A l l these devices were directed toward decreasing ... the 'security operations* of the patient — those various means by which we bolster up our self-regard, assure ourselves that we are lovable and beloved persons, and in so doing cut ourselves off from knowing what our real desires and wishes are. Ideally, the therapeutic relationship is one in which such protective devices are not needed; the patient feels wholly at ease with the therapist and can therefore reveal to him the nature of 8 his difficulties". A Client Discusses Relationship Social workers and psychiatrists theorize about the professional relationship, but clients experience i t . To get something of their point of view one client was asked about what the association with the caseworker had meant to her. She was an intelligent young woman who had encountered serious problems in dealing with her small son. What she said about the relationship is very revealing: "Miss V. always gave me her complete attention. My husband goes on playing the piano when I'm talking to him. It makes me feel stupid, as i f I hadn't anything important enough to talk about." There were only three people to whom she could talk about really 8. Witmer, Helen I.: Psychiatric Interviews with Children, The Commonwealth Fund, New York, 1946, page 436 10 personal things, the social worker, her doctor, and a young woman her own age. "I always knew that it didn't matter what I said or how I said i t ; Miss V. would understand. She knew how I felt, without being involved herself". She explained further: "Away from the office there would be things to think about before our next session — She'd want to know what I thought. It had been a long time since I'd considered important things - anything beyond the household routine. I never thought that I could think of things in a way that counted. I guess I just thought I was dumb. . . . when I'd come home I'd find that I could try to understand Alvin (her son) instead of saying to myself, •My but that boy irritates me'. I knew, too, that with Miss V's help I'd be able to work out an answer. She didn't laugh1 at my problem and say, as some of my friends did, 'Alvin will grow out of i t ' . " Casework versus "Deep" Therapy Some of the differences between social casework and the psycho-therapy practised by psychiatrists need to be clarified. Both are concerned with the process of helping people, but their goals differ, as do the methods used and the material brought into treatment. Casework attempts to help by "decreasing the individual's emotional burdens and increasing his inner capacity to meet life's frustrations 9 and to make use of its opportunities". Psychiatry may go further and attempt fundamental changes in personality. Social casework views the person as he stands in the midst of his particular social situation, surrounded by the things which in-9. Hollis, Florence: "The Techniques of Casework", The Journal of Social Casework, June, 1949, page 235 11 fluence his l i f e and the people among whom he must live. The focus of psychiatry tends to be on the inner conflict of the individual. Social casework seeks to help the person in distress by modifying en-vironmental pressures, by giving supportive help, by adding to his understanding of his situation and his reactions to i t . He may came to see more clearly what his patterns of behaviour have been,as his conscious mind produces seme reasons for these patterns. The explora-tion of fuller explanation for behaviour, however, because i t involves the unconscious, must remain the task of psychiatry. But,it may be said, is there any difference between relationship in casework and in psychiatry? The answer is that relationship is as basic to social casework as it is to psychiatry, but i t is used in different ways in these two fields. In casework it serves to encourage and support the client, to strengthen and stabilize useful ways of dealing with situations, and to set free constructive attitudes and capacities. Where transference elements occur, the caseworker will try to relate them to the situational problems of the client. Psychiatrists use relationship to enable their patients to re-live experiences of the past for diagnostic and therapeutic purposes. Dr. Jules Coleman explains the difference by saying "the caseworker works within the transference, and the therapist with 10 the transference". Diagnostic s k i l l is just as important for the caseworker as for the psychiatrist. On this depends the amount of environmental mani-pulation which is necessary, the kind of support given, the degree 10. Coleman, Jules v . : "Distinguishing Between Psychotherapy and Casework". Journal of Social Casework, June, 1949, page 246 12 of i n s i g h t which i s considered pos s i b l e . Caseworkers need to understand unconsoious motivations, although they do not deal with them d i r e c t l y as the p s y c h i a t r i s t does. The problem of the present study i s therefore, to discover i n s p e c i f i c cases, the nature of the r e l a t i o n s h i p between the c l i e n t and the caseworker, why t h i s oocurred, and what e f f e c t i t had on the a t t i t -udes and actions of the c l i e n t . It explores i n a t e n t a t i v e fashion one of the intangible factors which influences movement i n casework. In t h e i r manual, "Measuring Results i n S o c i a l Casework" J. McV. Hunt and Leonard S. Kogan c l e a r l y indicate that they have excluded these intang-i b l e f a c t o r s from t h e i r study. They set up a standard procedure f o r measuring the change i n c l i e n t s and i n t h e i r s i t u a t i o n s , during the period when casework services are being offered. In doing so they have made a s i g n i f i c a n t c o n t r i b u t i o n to the t e s t i n g of casework e f f e c t i v e -ness. The study i s l i m i t e d , however, to the amount of change which took place. How these changes may have come about i s a matter l e f t f o r f u r -ther research. Included i n the f a c t o r s considered "Not movement" are the follow-ing! ( l ) Degree to which treatment goals were achieved. (2;) Degree to whioh casework i s responsible f o r the movement shown i n the case. (3) Degree of s k i l l with which the case i s managed. The nature of the r e l a t i o n s h i p between the c l i e n t and the case-worker i s not mentioned s p e c i f i c a l l y but i t s importance i s obvious. No measurement of the net e f f e c t of casework treatment i s possible without 13 assessing i t . This study makes a s t a r t i n that d i r e c t i o n . Because i t was a task of exploration, i t was often d i f f i c u l t t o know what methods to use. How could anything as intangible as r e l a t i o n s h i p be assessed? 14 CHAPTER TWO METHODS USED IN THE STUDY C r i t e r i a Established One o f the f i r s t problems, which the study presents, i s how to assess the c l i e n t ' s way of r e l a t i n g to people. Can c r i t e r i a be de-veloped to a s s i s t i n t h i s ? Such c r i t e r i a need to be so c l e a r and ob-j e c t i v e that subjective biases are minimized. Aided by suggestions gleaned from the w r i t i n g s of s o c i a l workers and p s y c h i a t r i s t s , s i x measuring rods were set up, as follows: 1. What i s the c l i e n t ' s concept of himself? 2. Is he aware of h i s own f e e l i n g s , and does he know toward what person or object they are directed? 3. What ways of coping with r e a l i t y has he adopted? 4. What i s h i s a b i l i t y to endure f r u s t r a t i o n ? 5. What i s h i s " a f f e c t i v e tone"? 6 . What has been the pattern of h i s r e l a t i o n s h i p s with others? Under each of these headings, i t i s possible u n t i l more exact measurements are found, to c l a s s i f y reactions as "poor", " l i m i t e d " , or "good". I f t h i s c l a s s i f i c a t i o n i s to add to the understanding of r e -lat i o n s h i p , the boundaries need to be c l e a r l y defined. What words de-scribe accurately the c l i e n t who has a "poor" idea of himself, a " l i m i t e d " a b i l i t y to see his r e a l f e e l i n g s , or a "good" a b i l i t y t o stand f r u s t r a t i o n ? The search f o r these words was a rewarding one and important because of q u a l i t a t i v e nature of the study. 15 Testing of Criteria The question arose as to how the accuracy of the criteria selected could be tested. A l i s t was made of thirty clients concerning whose ways of relating to others the writer could make same judgment, since she had known them well over a period of time. In each case the criteria could be applied with considerable ease to the clients being examined, and the results corresponded closely with the original judgments made. As a more valid test of their adequacy, the criteria were then used to study four sample cases. The results were discussed with other professional persons, and from this a more precise use'of some words was attempted. Selection of Cases The next step involved the selection of cases. Because the method of study needed to be an intensive one, a large number of cases could not be considered and, therefore, to generalize about conclusions reached would not be justified. Once the focus was clearly set on studying a small number of cases, the task became easier. The purpose then was to describe7as accurately as possible in each case,what the relationship between the client and the caseworker had been, why this had been so and how relationship was used in treatment. What was needed were cases showing differences in the client's abilities to re-late - some poor, some limited, some good* The outline of the study was presented to the staff of the Family Welfare Bureau at a staff meeting, and members were asked to li s t cases known to them, which did present a clear picture of relationship. It was arbitrarily decided at fi r s t to select five cases in which the client's way of relating to others was poor, five in which it was 16 limited, and five in which it was good. This was not followed strictly as will be seen. To present as rounded a picture as possible the cases chosen presented a wide range of problems: the work of eleven caseworkers was in-cluded, and, as was to be expected, there were great differences in the kinds of relationship formed. Schedules for Background Information In beginning a study of each record it seemed essential to have a pic-ture of the dynamic development of the client as the record revealed i t . A l i t t l e device suggested by Dr. Orr of the Northwest Clinic of Psychiatry and Neurology, Seattle, was used to give this picture. A l l the pertinent infor-12 mation about a person is listed in parallel columns as shown in the diagram. Schedule Age Events in the Family and the Environment Att itudes and Behaviour When this device is used even the blank spaces left are significant. In the cases studied, for example, there was frequently more information for the column on "Events in the Family and the Environment" than for the one on "Attitudes and Behaviour". Sometimes this situation was reversed, and there were few facts concerning events in the l i f e of a person against which his emotional responses could be measured. The Application of Criteria It seemed logical that the criteria should be used to evaluate the client's behaviour as i t became known during the exploratory period, which was necessary before diagnosis eould be established. In same cases this ex-ploratory period took several interviews, while in others i t was completed within one or two interviews. 12. The schedules are numbered, Schedule 1 for the first case discussed, Schedule 2 for the second, etc., and are included at the end of the chapter in which the cases are presented. 17 The results of the application of the criteria were charted. 13 Whereas the schedules present only a series of facts, the charts in-clude a telescoping of the facts and the diagnostic inferences drawn from the record. A check on the accuracy of the charting was made by discussing the results with the caseworker. Since most recording falls short of conveying a l l the pertinent impressions of the caseworker, these in-terviews served to supplement the written record. Often the additional materialisecured in these interviews, caused modifications to be made in the original charting. Assessing the Caseworker's Contribution A study of relationship necessitates a consideration of the part played by the caseworker, and that proved to be one of the most difficult problems. A l i s t of eight points was drawn up to help the caseworker in a self-evaluation. Some of these had to do with knowledge, e.g., "An understanding of the motivation and dynamics of transference". Others had to do primarily with attitudes, e.g., "An objective interest in people and respect for them". These were presented to a few caseworkers and met with no favour at a l l . They said that the greatest objectivity on their part would not reveal un-conscious motivations, or defences. A more practical compromise was worked out whereby the caseworker's part in the relationship would be determined by a study of the record, and by an interview with each caseworker. The fact that the writer knew a l l of the caseworkers 13. The charts are called A.B.C., etc. to correspond with the names , given to the various clients. The chart for each case is in-cluded with the discussion for convenient reference. 18 made i t possible to see, behind the words of the record, a particular individual at work with people. This made i t easier to catch the probable spirit of an interview, — to s i t , as i t were, in the client's chair. The caseworkers discussed the nature of the relation-ship, questions which they had had concerning i t , and positive or negative reactions which they had experienced. Evaluation of Results Having tried to examine the nature of the relationship, and how i t came about, i t was then necessary to see what effect the rela-tionship had had on the attitudes and actions of the client. Had his method of relating to people changed in any way? Had he been able to resume what was, for him, normal functioning, or had he even taken a few steps on the way to greater maturity? Reactions in the last part of the contact were checked against the criteria, to see where the movement had been i f there was any. As always, i t was difficult to be sure how much, of any change noted was due to the relationship established, and how much was due to other influences. The record showed what the caseworker thought about this, or, as was so frequently true, a small part of what he thought. Again an interview served to obtain more complete information. Wherever possible the opinion of the client was also asked. When the study was first started i t was hoped that an interview could be held with most of the persons whose cases were being examined. For several reasons however, this was not possible, except in a few cases. Seme of the cases had been closed, and it was feared that to 19 ask for an interview for the purpose of the study might not be in the client's best interests. Sometimes the marital situation, or seme other problem had reached a point where an interview with another person might jeopardize the treatment being attempted. A few clients were considered too sick to be approached, others so immature that i t was questioned whether an interview with them would accomplish anything. In each case the worker's decision regarding the advisability of seeing the client was accepted without question. Where the client was seen, it was done only after the caseworker had discussed the matter with the client, had ascertained his interest in co-operating, and had arranged the appointment. A word needs to be said.about the nature of the interviews with the clients. It was necessary to clarify with them what they understood to be the purpose of the interview. Each time an effort was made to ex-plain this in terms which the particular individual would find meaning-ful. The essence of the explanation was that the agency was interested in understanding more of what the relationship with the caseworkers meant to people coming for help; so that this part of the service could be improved. They were told that a l l names would be omitted in the re-port made. No further direction was given to the interview, as it was considered that the client's spontaneous reaction would provide the most valuable material. An hour was allowed for each interview. No interview was longer, and several were considerably shorter. In most cases no notes were taken during the interview, but a record of what had been said was dictated on the same day* The f u l l recording of some of the interviews with clients is included in Chapters four, five and six. 20 In t h i s study i t was important to be c l e a r as to how r e l a t i o n s h i p was being discussed, and j u s t what aspect of i t was being assessed. In the preliminary work the term "capacity f o r r e l a t i o n s h i p " was used. The word "capacity" seemed to denote, however, an inate q u a l i t y , rather than t o suggest a present way of functioning. This study could only describe and assess the way i n which a c l i e n t was r e l a t i n g to others at a p a r t i c u l a r time. This was h i s present l e v e l of a b i l i t y i n r e l a t i o n -ship, and i t was decided to use that term. Some prognosis about h i s future a b i l i t y i n r e l a t i o n s h i p might be made from a study of how he was r e l a t i n g i n the present, and how he had done so i n the past. No attempt has been made however, to define what h i s p o t e n t i a l capacity f o r r e l a t i o n s h i p might be. Instead the study l i m i t s i t s e l f t o a consid-e r a t i o n of l e v e l s of functioning i n r e l a t i o n s h i p . These l e v e l s can change as dynamic elements i n the l i f e of the i n d i v i d u a l promote growth or regression. Where the maximum or minimum l e v e l s of r e l a t i o n s h i p f o r any i n d i v i d u a l might be f i x e d , i s a matter l e f t f o r further research. Central i n importance among the methods used i s the establishing of c r i t e r i a t o a s s i s t i n assessing a b i l i t y i n r e l a t i o n s h i p . In many ways the study i s based on these c r i t e r i a . For t h i s reason a d e t a i l e d d e s c r i p t i o n of them i s e s s e n t i a l . 21 CHAPTER THREE CRITERIA FOR EVALUATING THE CLIENT-WORKER RELATIONSHIP The task of se t t i n g up c r i t e r i a demanded a d e f i n i t i o n of boundaries, and a c r i t i c a l appraisal of some of the at t i t u d e s which a f f e c t the a b i l i t y to r e l a t e to others. There had to be some way of eliminating, from a study of t h i s kind, those people who would be unable to e s t a b l i s h a pro-f e s s i o n a l r e l a t i o n s h i p with a caseworker. What might be considered the minimum e s s e n t i a l s necessary i n order t o ensure the p o s s i b i l i t y that some degree of re l a t i o n s h i p might be formed? 1. The person must have had some g r a t i f i c a t i o n i n his experience with people, i n h i s own home, or elsewhere. 2. He must have s u f f i c i e n t i n t e l l e c t u a l capacity to be able to think about h i s problem, and to be able to t a l k about i t . Expression through play i s not considered here, since the study i s l i m i t e d to adults. 3 . He must not be i n a state of mental health or personality de-velopment which would make i t impossible f o r him to relate t o another per-son. Included here would be psychotic states, some psychopathic person-a l i t i e s and some forms of severe neurosis. Having eliminated those people who would not be able to benefit at a l l from the r e l a t i o n s h i p with the caseworker, the rest w i l l have some a b i l i t y to r e l a t e . The s i x c r i t e r i a are used i n an attempt to assess how much of t h i s a b i l i t y each c l i e n t has. 1. What i s h i s concept of s e l f ? Poor: lack of self-esteem to a marked degree; very insecure i n most s i t u a t i o n s ; self-deprecating or attempting to appear always s e l f - s u f f i c i e n t , always r i g h t ; no sense of goal. 22 Limited: self-confidence in some situations; insecure when facing new or previously difficult situations; some sense of goal. Good': good sense of goal and of achievement; confidence in most situations. 2. Is he aware of his own feelings and does he know toward what person  or object they are directed? Poor: has to repress, distort or replace his real feelings. Limited: awareness of real feelings in some situations, usually those in which awareness does not involve too serious a threat to the personality. Good: can admit most feelings to consciousness even i f they are painful. 3. What ways of coping with reality has he adopted? Poor: has many defence mechanisms which are frequently put to use. Limited: same defence mechanisms but less severe in nature and used less frequently. Good: only a few defence mechanisms which tend to be more con-structive in personality development. 4. What is his ability to endure frustration? Poor: almost no ability; unable to complete tasks; feeis that any frustration indicates dislike or discrimination, or accepts it too readily. Limited: uneven ability, depending on the particular situation and its significance to him. Good: can accept frustration and the necessary postponement of pleasure most of the time; can accept criticisms and does r not conclude that criticisms always indicate unjustified attitudes on the part of others. 23 5 . What is his affective tone? Poor: severe repression, brittleness, rigidity, shallowness. Limited: repression in some areas, marked ambivalence, frequent in-appropriate responses. Good: spontaneity, depth, flexibility, appropriateness of response most of the time. 6. What has been his pattern of relationships with others? Poor: primary narcissism; excessive submission; severe aggression. Limited: dependency, anxiety; aggression in some areas; some object relationship but immature. Good: good object relationship Here it is necessary to look at a l l the known relationships of a person to his parents, to siblings, to marital partner, to his children, his. neighbours and friends, his business associates. A study of how he has reacted with people during the course of his l i f e gives perspective to what is happening in the immediate situation. If relationships with most people had been unsatisfactory, then not too much can be expected of the client. No one anticipates a concert performance from the person who has never learned to play the piano. If, on the other hand, past rela-tionships show an ability to share l i f e with people, then the approach to the present problem is a different one. It involves finding out what pressures, external or internal, have interfered with the satisfactory functioning of the individual, or how greater satisfactions can be achieved. With the help of these criteria it is possible to see a l i t t l e more 24 clearly that great differences exist in the ability of individuals to re-late. For some clients any relationship tends to be on a limited infantile level. Others can relate to people with comparative ease and satisfaction. 25 CHAPTER FOUR THE ONE - TALENT CLIENT "But he that had received one (talent) went and digged in the earth and hid his Lord's money." Matthew 25: 18. Why is i t that some people have l i t t l e ability to respond to any of their fellow men with affection and tolerance? Why, i f they become the clients of a social agency, are they so limited in the vise they can make of the social worker? The answers to these questions probably li e in early childhood experiences. To be able to share affection, a child must have learned what affection is through the attitudes and actions of others. If, as a child, he is loved and his needs are met, he is able to move toward the more mature level of giving love to others. If, however, his environment has seemed to the child to be a hostile one, he is apt to remain at that childish emotional level, seeking always to be loved and given to. In the early experiences of some people there are tragic occurr-ences that look like acts of a baleful fate: death of parents at an early age, frequent changes in foster homes, or severe rejection by one or both of the parental figures. In such a pattern i t seems compara-tively easy to see why normal growth, in being able to relate to people has been thwarted. The pattern becomes more complicated when inner con-fl i c t s are interwoven with outward circumstances. To weigh, with accuracy, the relative importance of one or the othe^demands an intimate knowledge of the person being studied. Often our understanding of how 26 this person felt at such and such a time, and from what motives and needs he acted as he did, is so small that i t behooves us to be humble. The most that we can say is that perhaps this is how l i f e looked to him, and that these may be some of the needs expressed in his behaviour. There are great differences in the degrees of emotional deprivation experienced, and in the nature of the individual's response to i t . There is frequently, however, similarity in the result: the person has l i t t l e ability to relate to others. Loss of Parents by Death The outline of events in the li f e of Mrs. Arnott (see Schedule 1) illustrates deprivations caused by the loss of parents through death. Mrs. A. came to the family agency to ask for clothing and financial assistance. The family had large-debts and these were being paid by arrangement with a benevolent fund attached to one of the branches of the armed forces. A part of Mr. A's wages was given to the secretary of the benevolent fund, who paid the creditors. The amount left for living expenses was less than adequate, and did not allow for clothing needs. Mrs. A's requests for clothing and money were frequent, but i t was noticed that usually she asked for an amount that was scarcely sufficient to meet reality needs. She was given the assistance she requested until arrangements could be made to reduce the amount being paid to the creditors. Mrs. A. had suffered the loss of her mother, father and older sister (really a mother-substitute) before she was eight years old. Her sense of closeness to the foster mother was complicated by her fear of the foster father. This home too was "lost" to her through the divorce of the foster parents. As Mrs. A. entered adolescence, the nature of her stealing and lying indicated that she felt insecure,and longed to be accepted by her school mates. What is known of her married l i f e bears out the opinion that Mrs. Arnott has a great need to be loved and cared for on an infantile level. Fear of a depriving, hostile world, has caused her to repress this need. Consciously she is persuaded that she wants to be independent, although sometimes i t appears that her dependency needs are close to conscious-ness. Once she referred to herself as a "headstrong g i r l " and i t looks 27 as i f she were asking the worker to treat her as a child. On another occasion she claimed that she was "tired of carrying the main load" in the responsibility of the home. Mrs. Arnott's manner of asking for help seems to indicate her desire to be given to, but her rationalization that she can be independent. She kept insisting that she would only "borrow" money from the agency, when there was no chance of repayment. She "hated" to ask for help, although her requests were frequent. The caseworker noted that Mrs. Arnott almost abased herself in her desire to win approval, and to receive from the case-worker. This seems to be used as a technique, without any recognition of underlying feelings of inadequacy. The fact that she asked only for a bare minimum where she herself was concerned, may be additional evidence that her needs are so great that they cannot be expressed. The extent of the economic deprivations in Mrs. Arnott's li f e is not known, but i t is obvious that material things are charged with emotional significance. Mrs. Arnott's hostility too, seems to be caused by the greatness of her need to be dependent. Only occasionally does she come close to realizing her hostility towards Sarah, and she seems to have l i t t l e aware-ness of the reasons for her hostility to her husband. Rivalry with Sarah's mother (Mr. Arnott's first wife), rivalry with Sarah for Mr. Arnott's affection may be involved here. Basic, however, is her need to be loved and cared for. Deprived of this as a child, her need is now an exaggerated one. How can she care for another woman's daughter when she herself wants to be the child? Mr. Arnott leaves the management of the heme to her, and every new responsibility is a point of irritation. Be-cause i t is too frightening to see what she really wants, and how much she wants i t , this knowledge has been largely repressed. Consciously Mrs. 28 CHART /A Ability to Relate Mrs. Arnott 1. Concept of Self 4. Ability to Stand FRUSTRATION Only felt that she "belonged" in one borne. Felt inferior because she worked for her board at High School and lied about this. Thought the C. A. S., considered her a thief, and expected her to end up a "bad" g i r l . Feared that she wasn't a good mother to Sarah. Development of physical symptoms —ulcers of the uterus. Was pleased to go to the doctor. Wanted requests for clothing, dishes granted at once, but the reality needs were great. In-sisted that the children a l l needed skates for Christmas so they wouldn't feel "different", although the family had no money for this. Rating: Poor. Rating: Poor. 2. Seeing Real Feelings 5. Affect Tone Didn't recognize her hostility to Sarah, didn't see the reason for hostility to Mr. A. and to people generally. Could only face her dependency needs by asking for things. A feeling of hopelessness but a front of determination and independ-ence. Hostile and distrustful be-cause her needs had never been met. She expected rebuffs, and adopted devices to get what she wanted. Very limited in ability to give love. Rating: Poor. Rating: Poor. 3. Ways of Coping with Reality 6. Pattern of Relationships With Mother) died when she was and Father) young. Planned unrealistically for the children. Claimed that she wanted to "borrow" money when she couldn't repay, that she "hated" to ask for things. Found it hard to refuse any-thing to the children. Was an "immaculate house-keeper" . With Older sister - expressed affec-tion for her. With Foster mother - said she was "close" to her, confided in her. With Foster father - feared him be-cause of his exposure to her. With Husband — resented that he did not look after the home — and her. With Children — some identification with them. Rating: Poor. Rating: Poor. 29 Arnot wishes to be a good mother to Sarah, and to have no need to lean on anyone. Early Deprivations Deduced from Present Behaviour Detailed information about the early years of a person's l i f e was not always available from the records. Sometimes, however, reactions to present situations, gave a clear indication of lack of ability to form satisfying human relationships, and a conjecture concerning earlier de-privations could be made. This was true in the case of Mr. Bell (see Schedule 2). In 1930 Mrs. B. had come to the agency, complaining about Mr. B's unreasonable behaviour and his lack of support. Shortly after her marriage to him in 1926, Mr. B. had supported so inade-quately that Mrs. B. described herself as "almost starving". As more information concerning Mr. B's behaviour was secured it looked as i f he was not able to assume adult responsibilities. His operation and somatic complaints after the birth of his son may have been a reaction to his fear of responsibility,and to his need to be cared for as a l i t t l e child himself. When living in the home of his wife's parents became too irksome, he moved out, leaving his wife and child, without having made any effort to find other accommodation for them. His comment that he had moved out of the home because he "needed5, more fresh air", re-sembled the unreasoning striving of an infant for the satisfact-ion of needs. Mr. B. could give almost nothing to others. He contributed only fifteen dollars to his wife and son over a period of six months, although he was working steadily. He seemed unable to be concerned over other people, or to give affection to them. While he was away from the home, his complaint was that he was missing the opportunity of watching his son's development, yet he made no effort to see the boy. Mr. B. had l i t t l e capacity to stand frustration. Small things produced large irritations. He quoted a doctor as saying "he should go to the country where he could sit quietly a l l day, preferably by the sea, and retire early"."It seems to be another clear indication of his desire to achieve a state of complete irresponsibility and dependency. The facts available about Mr. Bell's earlier experiences are too meagre to warrant conclusions, but they provide room for speculation. 30 His inability to continue the marital relationship raises a question about his attitude to women. Two women, who. presumably were important to him, died. It is possible that the death of one or both of these women spelled desertion to Mr. Bell. If, as a small child, he missed the satis-factions of being mothered and having his affectional wants supplied, he might continue to seek for the hoped-for "good mother" in his two marriages. The first one failed him, either by her personality or by her death, or by both. His second wife was not only unable to minister to his needs, but she asked the impossible: that Mr. Bell should think first of her, and of providing for her. The details of the story of how Mr. Bell missed love-• security as a child are not known. That he did lack this fundamental part of development seems certain. As an adult he finds i t necessary to be concerned with himself and his own needs to the exclusion of other people. Mrs. B. charged Mr. B. with non-support and a court order was made. She then moved to another province taking Allan with her. Although Mr. B. knew in which city his wife was living, he did not know her exact address, and there was no communication between them. In 1946 Mr. B. came to the agency asking for help in con-tacting his son Allan, who was then eighteen years old. Mr. B. claimed that he had a right to the boy's affection, and to help in his upbringing. This step may have been unconsciously motivated by his desire to have someone to care for him, and it looked as i f he wanted his wife to come back. Over a period of three years he continued to come to the agency and his attitudes modified slightly. An incident which revealed much about Mr. B's character-is t i c way of reacting occurred at Christmas time. He was sent a hamper, after he had signified that he wanted one. In a letter, thanking the worker he said: "I was out of bed and going through i t before I was dressed, just as I used to years ago". Following that incident he sent two dollars to the agency, and was able to express appreciation for the service given. For Mr. B. this was a. big step. 31 CHART B Ability to Relate Mr. Bell 1. Concept of Self 4. Ability to Stand Frustration Has to convince himself that he's right. Needs to stress the things he does well, to focus attention on himself, to see everything subjectively. Acts: impulsively without self-control or regard for others. Bursts into tears at times of stress. Psychosomatic illnesses de-veloped when responsibilities in-creased. He quotes the doctor as saying that he should "go to the country, where he could sit quietly a l l day, preferably by the sea, and retire early" . Rating: Poor Rating: Poor 2. Seeing Real Feelings: 5. Affect Tone He cried over missing his son's early development but made no attempt to see him. He claimed that he suppor-ted his son handsomely when he gave very l i t t l e . Tendency to be hostile and aggressive but responds to a show of interest. Little ability to give affection to others. Rigid. Rating: Poor Rating: Poor 3. Ways of Coping with Reality 6. Pattern of Relationships Projects blame for marital situation on father-in-law. Blames his wife for his loss of a job. Gave as his reason for leav-ing his wife and child that he needed "fresh air" near the Park. Said that i f his wife bothered him he'd put her in a home for mental defect ives. Did not - con-, sider his inability to support Mrs. B. when asking her to return. With Mother - not known. With Father - not known. With Wife - unable to assume responsibilities of marriage. Didn't support and deserted. With Son - didn't contribute or make any attempt to communicate until the boy was over eighteen. With other associates - not known. Rating: Poor Rating: Poor 323 Severe Rejection A feeling of rejection, so deep that i t causes a great sense of worth-lessness, can seriously affeot a person's a b i l i t y to react i n a normal way with others. Mrs. Coulter had experienced such rejection. (See Schedule 3). Mrs. C. was aware that she was an unwanted child and that abortion had been attempted by her mother. With the desertion of her father when she was ten years of age, she became com-pletely dependent on her dominating and rejecting mother. So fearful was she of losing this mother, that her ho s t i l i t y to her was deeply repressed. There was identification with her, and her attitude seemed to be» "My mother can do no wrong. Being my mother, I too, can do no wrong, nor can my brothers and sisters, since they are a part of my mother". Mrs. C. said that she could not remember some of the events surrounding her wedding, and this seemed to be because she could not admit a mistake on the part of her mother. Her husband ex-plained that Mrs. C's mother had made arrangements for the wed-ding, beyond her financial capacity. She had f i n a l l y gone to Mr. C's parents and had asked them to assume the cost. This had been done, but Mr. C's parents had considered i t an imposition, and re-lationships had been strained thereafter. Mrs. C. found i t necessary to send her mother frequent g i f t s . She explained that she did this "because mother has had so much loneliness". Before their marriage Mr. and Mrs. C. had been playing crib. The game was new to Mrs. C. When Mr. C. drew attention to her errors — apparently i n a casual manner — she fainted. Mrs. C's needs were so great that there seemed to be no sat-isfying them. In this respect too her reactions seemed to portray one who, as a child, had faced a hostile world. Reaching out for affection and care she had encountered only frustration, and her needs had become exaggerated ones. On one occasion Mr. C. bought fox furs for her. She complained that he had failed to give her a new suit to wear with the furs. Mr. C. who faced l i f e i n a d i r -ect factual manner, thought that the only way anyone could live with his wife would be by conforming to a l l her wishes, and by agreeing with her on every issue. Mrs. C. showed great concern over her health. She wondered i f her headaches were caused by a brain tumor, although assured, by doctors that this was not so. Another time she was sure that she had a cancer. She complained, "I die a thousand deaths from fears", but was unable to control her anxiety. 33 CHART C Ability to Relate Mrs. Coulter 1. Concept of Self Over-compensation for feelings of worthlessness arising from severe rejection. Can never be wrong nor can any member of her family be wrong. Dwells on unhappy incidents years afterwards. Takes even a difference in opinion as complete condemnation. Rating: Poor 4. Ability to Stand Frustration Corrected by Mr. C. as to how to play crib, Mrs. C. fainted. She re-lives injuries from the past. Once.Mr. B. disagreed when she was criticising a sister-in-law un-fairly. Mrs. C. replied that he could only appreciate "loose" girls. Rating: Poor 2. Seeing Real Feelings Can't see her sense of guilt and fear concerning her mother. Sends her gifts "because mother has had so much loneliness". Can't recognize her deep de-pendency needs. Says that she doesn't want to leave her husband 1 because she doesn't want to leave the furniture. Rating: Poor 5 . Affect Tone -Suspicious, rigid, repressed, negative. Has l i t t l e affection to give. Rating: Poor 3. Ways of Coping with Reality Pictures a miserable li f e with a drunken husband, although she has reason to believe that Mr. C. is amr bitious and will succeed. When she is upset Mrs. C. buys things for herself, regardless of what it does to the budget. Distorts facts in order to get the sympathy of rela-tives. "Forgets" unpleasant hap-penings which might involve criticism of her. Rating: Poor 6. Pattern of Relationships With Mother - covers her'fear and hostility to her mother by un-reasoning loyalty to her and iden-tification with her. With Father - reflects her mother's derogatory attitudes but has shown some interest in him. With Siblings - they can do no wrong. With Husband - wants her every whim obeyed. With Child - wants to prove that she is a "good" mother. Rating': Poor 34 Over-Protectiveness of Parents Over-protectiveness on the part of parents can also thwart normal ^emotional development. Ah unconscious feeling of guilt concerning the child often masks itself in unreasonable protectlveness. Such parents tend to hold the person at a childish level. Things are done for him which he is capable of doing himselLf; he is shielded from hurt and from responsibility. As a result he enters adult l i f e unprepared to make wise decisions, to assume responsibilities, or to make ordinary adjustments. It is not surprising that these crippling effects extend to the person's ability to relate to others. Mrs. Dean came from a home where she had been over-protected. For the outline of events in her li f e which are revealed in the record see Schedule 4. Mrs. D. came to the agency because of marital difficulties. She thought that these were caused by her husband's refusal to help her with the housework,which she could not manage by her-self due to a severe eczema condition. As she talked Mrs. D. revealed a pattern of running home to her mother and of depend-ence on her although this had become a threat to her marriage. Mrs. D. married her husband when she was away from heme on a vacation. Most of the first year of marriage was spent in her parents' home as Mr. D. had been sent overseas. Her first child was born while she was with her parents and her mother took over most of the responsibility for the baby's care. After Mr. D's discharge she joined him in British.Columbia, but visited her parents in another province three times during the year. When a second child was born they insisted on taking the oldest one into their home, to relieve Mrs. D. of work and re-sponsibility. In a few months they moved to British Columbia so that they could be near their daughter and help her more. Nothing is known about the onset of Mrs. D's eczema. She had suffered from i t since she was a child but i t had not be-come acute until she had married and had became pregnant. It became worse with each succeeding pregnancy. The only time that the eczema had cleared was when Mrs. D. was in hospital, being treated for a gynaecological condition. It broke out again two hours after she had returned home from the hospital. At that time there had been a quarrel between Mr. and Mrs. D. about Mrs. D's mother being in the home. Mr. D. had maintained 35 that his mother-in-law..'s help was unnecessary as his wife could do the work. Mrs. D. was convinced that she would be unable to manage and that she needed her mother to care for her. These facts are only fragmentary scenes from the total picture of Mr s. Dean's l i f e . They seem to portray however, a woman who has not been able to grow up because of the over-protectiveness of her parents. Her choice of a husband was a poor one as his desire for dependency was as great as hers, and neither can meet the needs of the otheri Con-fronted with the responsibility of looking after a house, caring for children, and being a wife, Mrs. Dean felt so fearful and helpless that she had to run away. She did this directly in the visits to her parents' heme, and in allowing them to assume responsibility for the oldest child. An indirect expression of the same need to be released from the role of an adult may be found in the attacks of eczema. This flares up when new responsibilities loom. It seems significant that i t only clears up in the protected environment of the hospital, where she lies in bed and is cared for. Because of the eczema she cannot go out socially, and she is unattractive to Mr. Dean. Because of i t she has her mother to look after her and to share or take over her responsibilities. The possibility that the eczema represents hostility directed-"; against herself, as well as dependency needs, cannot be overlooked. It is natural to resent those influences which have hindered the normal de-velopment of the self. Mrs. Dean probably resents the undue solicitation of her parents even as she enjoys i t . Any hostility needs to be re-pressed however.;, She is not able to be an adult; she can only be a child. A child needs to be loved and cared for. How dangerous it would be to have hostile feelings and to run the risk of estranging the parents on whom she is so dependent. I 36 CHART D Ability to Relate Mrs. Dean 1. Concept of Self Emphasizes that as a g i r l she was pretty. Wow eczema makes her unsightly. She can't go out, is unattractive to Mr. D. Needs to have attention and shops around for cures. Rating: Poor 4. Ability to Stand Frustration Wants interviews at once. Her apparent use of sickness i n response to frustration e.g. After her eczema had cleared up i n hospital, i t broke out again two hours after she had re-turned home, following a quarrel with her husband. Rating: Poor 2. Seeing Real Feelings Can't see any h o s t i l i t y to her parents, whom she holds up as ideal. Even regarding her husband she is sorry for her-self, rather than angry at him. Rating: Poor 5. Affect Tone Fearful (desire to escape by go-ing to bed). Negative-whiney. No sign of depth of affection. Rating: Poor 3. Ways of Coping with Reality Severe attacks of eczema seem related to increasing or d i f f i c u l t responsibilities. Blames marital unhappiness en-t i r e l y on Mr. D. Wants to hand her problem to the case-worker for solving. Says that when she holds i n her anger she starts scratching. Rating: Poor 6. Pattern of Relationships Mother - always takes Mrs. D's side. Comes running to .help her. Father - Mrs. D. remembers that she used to go for walks with him. He gave financial help since her mar-riage. Husband - Can't see his side. Projects blame on him. Children - May have l i t t l e a b i l -ity to give them love. Quotes doctor as saying she i s not able to care for them. With Neighbours - Thought they did things for her because they were sorry for her. Rating: Poor 37 Overwhelmed by the greatness of her own needs, Mrs. Dean has l i t t l e ability to see another's point of view. Of her husband she remarked, "He has no right to say that he is unhappy, when I am the one who is in an unbearable situation". The over-protectiveness of her parents is crippling her ability to relate to others in a mature manner. If, as Dr. 14 Kuhkel says, "It is the part of the child to want to be loved, but the part of the adult to love," then Mrs. Dean is s t i l l a child. The Unresolved Oedipal Situation Complications in parental ties affect the nature of a person's re-sponse to others. Sometimes such complications are so serious that the person develops l i t t l e capacity to give and receive affection in a normal way. As will be seen by the events in the f i r s t few years in the life of Mrs. East, her mother died when she was five, and in the midst of the Oedipal conflict, and the effect of this is seen throughout her whole l i f e , (see Schedule 5). It is possible that, while she was the only g i r l , she was a favour-ite with her father, and that her tie to him had always been a close one. This appears to be borne out by the fact that he took her on a cruise after the death of the mother. The exclusive possession of her father would intensify Mrs. East's feelings for him. Guilt about viewing her father as a love object may have increased following the mother's death, since the child may have felt that her wishes to be r i d of the mother had resulted in the letter's death. The picture of Mrs. East's emotional development from the age of five and one-half to fourteen is dim, but there is every probability that, dur-ing these years, her attachment to her father and her desire to be impor-14. Dr. Fritz Kuhkel in lectures on Personality Development given at Camp Koolaree, British Columbia, August, 1936. 38 taut to him grew. Apparently no housekeeper gave her much affection. Nothing is known of her friends or her interests, but subsequent attitudes on her part point to the fact that a great part of her affection was cen-tred on her father. In the midst of the increased id drives of adoles-cence, her father remarried. A strong rival for her father's affection had appeared on the scene. It is noted that the hostility which she must have felt toward her father for this act is never expressed toward him, but is a l l directed against her step-mother. Mrs. East says l i t t l e about her step-sisters, but the fact that talking about them is apparently painful to her, may in-dicate that she was competing with them too — perhaps unsuccessfully. How then do these early experiences of Mrs. East influence her abili-ty to respond to other people on an adult level? Little is known about her attitude to her husband before she married him. She met him through her father. He liked the sea as her father did, and both men drank to ex-cess. It looks as i f , unconsciously at least, Mr. East reminded her of her father. She said that she was eager to get away from the home situa-tion because it wasrso unhappy. Was her marriage a move to regain the sole possession of the father-person? If so, i t is not surprising to find indications of a sense of guilt on Mrs. East's part, and a need to punish herself. She claims that she had not loved Mr. Eastland that she knew a l l about his bad habits before marriage. In her attitude to pregnancy and to her daughter, further evidences are found of her desire to win the father, and an underlying sense of guilt because of this desire. She saya that she is afraid that the child will inherit undesirable tendencies such as Mr. East possesses. Probably Mary represents to her, her, own unconscious sense of the marriage being 39 CHART E Ability to Relate Mrs. East 1. Concept of Self Fear of being disliked. Apparent need to buy affection with gifts. Being thanked dis-turbs her. Can't stand to have anyone cancel an appointment. Difficulty in making decisions. Very insecure. Rating: Poor 4, Ability to Stand Frustration Avoids telling Mr. E. why she sent Mary away. Says that the g i r l ran away. Finds i t impossible to accept a person telling her a li e . Avoids friends rather than explain why she can't come to dinner. Rating: Poor 2. Ability to See Real Feelings Cannot recognize her love •tor her father, or her hostility to her step-sisters. Interpreted fear of pregnan-cy as fear that the child would inherit Mr. E's tendencies. Can see only a part of her rejection of Mary. Rating: Poor 5, Affect Tone Rigid, repressed, easily depressed. Generally negative in outlook. Rating: Poor 3 , Ways of Coping with Reality Complains of the unhappy home situation but seems unable to leave i t . Blames herself for Mary's difficulties but doesn't really see this. Is able to seek help by:-(a) coming to the agency (b) getting an appoint-ment with a psychiatrist, ( c) arranging a foster-home for Mary. 6, Pattern of Relationships . With Mother - not known. She died when Mrs. E. was five. With Father - strong attachment but guilty about i t . With Step-mother - bitterly resent-ful. With Husband - is not happy with him but cannot leave him. With Mary - she represents an ex-tension of Mrs. E's "bad" self, and so is rejected. With some women - "just like sis-ters who would hug and kiss you". Rating: Limited Rating: Poor 40 wrong. She rejects the g i r l , and can even put into words her desire to have her out of the home. The need to continue to strive for her husband's attention persists, however. When Mary shows some desire to be with her father, and to accompany him on trips, a l l the old feelings of childhood are probably re-activated. The significance of some of Mrs. East's attitudes to women needs to be given careful consideration. What does it mean when she speaks of some women who were "just like sisters who would hug and kiss you"? Why did she want to go to a woman psychiatrist? Are these things evidence of homosexual tendencies? The question cannot be answered with finality,but it looks as i f Mrs. East was seeking a parental figure^and that her atti-tudes to some women are a part of this search. She wants her father. If she couldn't have him, i f substitute father-figures f a i l her, she would like a mother. There are many variations of emotional deprivation, but the theme is a constant one. Being so deprived individuals long to be loved. Mrs. East like the others who have been described in this chapter, has not had the kind of love she needed as a child. She goes on seeking this love, through an unhappy marriage, through constant rivalry for the affection of a father, through spasmodic groping for a mother who will meet her needs. The Caseworker's Contribution,  and the Nature of the  Professional Relationship As was mentioned in Chapter One, the knowledge and attitudes of the caseworker determine whether the person who is seeking help receives what he is capable of using, or less than that. Knowledge is essential in 41 o r d e r f o r t h e c a s e w o r k e r t o u n d e r s t a n d t h e f o r c e s o p e r a t i n g w i t h i n t h e i n -d i v i d u a l , b u t o n l y as t h e c l i e n t e n c o u n t e r s an a t m o s p h e r e w h e r e i n he i s t r e a t e d as a r e s p e c t e d i n d i v i d u a l , and where he i s s u r e t h a t t h e c a s e w o r k e r w a n t s t o h e l p h i m , c a n he be f r e e t o r e v e a l h i m s e l f . M r s . A r n o t t The c a s e w o r k e r who was h e l p i n g M r s . A r n o t t was s k i l l e d i n d i a g n o s t i c 1 4 a a b i l i t y and was a b l e t o g i v e M r s . A r n o t t a f a i r d e g r e e o f a c c e p t a n c e . She t r i e d t o u s e r e l a t i o n s h i p t o h e l p M r s . A r n o t t f i n d a f e w more s a t i s f a c t i o n s i n l i v i n g . M r s . A . was e i t h e r e a r l y o r p r o m p t l y o n t i m e f o r h e r a p p o i n t m e n t s . The c a s e w o r k e r r e p r e s e n t e d t o h e r a m o t h e r - p e r s o n and she seemed t o e x p e c t h e r r e q u e s t s t o be r e f u s e d . H e r need f o r d e p e n d e n c y , h o w e v e r , o u t w e i g h e d h e r f e a r o f b e i n g d e n i e d . H e r r e q u e s t s f o r m a t e r i a l a s s i s t a n c e came i n l i t t l e b i t s , and t h e s a t i s f a c t i o n o f one need l e d t o t h e u n c o v e r i n g o f a n o t h e r . 1 . F l o r e n c e H o l l i s d e f i n e s " a c c e p t a n c e " as f o l l o w s : : " ' " ' A c c e p t a n c e ' i s a t e r m w i d e l y u s e d t o d e s c r i b e t h e c a s e w o r k e r ' s a t t i t u d e t o h i s c l i e n t . I t embraces two b a s i c i d e a s — one n e g a t i v e and one p o s i t i v e , ( l ) The c a s e w o r k e r , m u s t n o t condemn o r f e e l h o s t i l e t o w a r d a c l i e n t b e c a u s e o f h i s b e h a v i o u r n o m a t t e r how g r e a t l y i t may d i f f e r f r o m b e h a v i o u r o f w h i c h he p e r s o n a l l y w o u l d a p p r o v e . (2 ) I n o r d e r t o h e l p a c l i e n t t h e c a s e w o r k e r mus t f e e l g e n u i n e w a r m t h , a c e r t a i n " o u t -g o i n g n e s s " t o t h e o t h e r p e r s o n t o f o r m a b r i d g e a c r o s s w h i c h h e l p may be g i v e n . He must r e a l l y want t o add s o m e t h i n g t o t h e c o m f o r t and h a p p i n e s s o f t h e o t h e r p e r s o n , n o t f o r t h e s a t i s f a c t i o n o f a s u c c e s s -f u l c a s e ( a l t h o u g h t h i s f e e l i n g may a l s o be p r e s e n t ) n o r p r i m a r i l y f o r t h e b e n e f i t o f s o c i e t y b u t beoause h e r e a l l y c a r e s w h a t happens t o t h i s p a r t i c u l a r i n d i v i d u a l " , p . 197 . The c a s e w o r k e r ' s a t t e m p t t o u n d e r s t a n d M r s . A . , and so h e l p h e r as a p e r s o n , met w i t h a p e c u l i a r r e s p o n s e . A f t e r an i n t e r v i e w i n w h i c h s h e had a s k e d f o r money o r f o r c l o t h i n g , M r s . A . w o u l d s i t b a c k and t a l k a b o u t some o f h e r c h i l d h o o d e x p e r i e n c e s . T h i s was done w i t h o u t any show o f e m o t i o n , b u t w i t h c h e e r f u l n e s s and a p p a r e n t e a s e . A t t h e n e x t i n t e r v i e w she a s k e d f o r t h i n g s a g a i n . I t d i d n o t seem p o s s i b l e f o r M r s . A r n o t t t o u s e t h e c a s e w o r k e r t o i n -c r e a s e h e r u n d e r s t a n d i n g o f h e r s e l f , b u t o n l y as a means o f s e c u r i n g g i f t s . The p a t t e r n o f t h e i n t e r v i e w s s u g g e s t s t h a t h e r e x p e r i e n c e w i t h s o c i a l 1 4 a . H o l l i s , F l o r e n c e : Women i n " M a r i t a l C o n f l i c t . F a m i l y S e r v i c e A s s o c i a -t i o n o f A m e r i c a , N e w . Y o r k , 1 9 4 9 . p . 1 9 7 . 42 workers has taught her that she pleases them by t a l k i n g about her e a r l i e r ex-periences. She seems to be doing t h i s now as a way of manipulating the worker in t o a p o s i t i o n where she would be sure to give what i s asked. The caseworker was aware of what Mrs. Arnott was doing. The worker hoped that by meeting Mrs. Arnott's r e a l i t y needs i n a s p i r i t of understanding, Mrs. Arnott might gain s u f f i c i e n t confidence i n the caseworker to use her i n f a c -ing some of her other problems. It did not t u r n out t h i s way, however. In discussing t h i s case the caseworker admitted that she had sometimes f e l t im-patient with Mrs. Arnott and disappointed when no progress could be seen. I t i s d i f f i c u l t not to be impatient with c l i e n t s whose behaviour i s l i k e that of Mrs. Arnott, but because of the impaot of previous experiences a more com-plete acceptance i s p a r t i c u l a r l y important. Mr. B e l l The use which Mr. B e l l made of the professional r e l a t i o n s h i p was sim i l a r to the pattern followed by Mrs. Arnott. When Mr. B. f i r s t came to the agency he stated that an hour was not long enough f o r h i s interview, and i n s i s t e d on having appointments immediately. He became angry i f he c a l l e d at the o f f i c e without an appointment and the worker was not i n . Mr. B. had been very angry at a previous worker. He had t e l e -phoned the o f f i c e while t h i s worker was on holidays. Although she wrote to him as soon as she returned, and suggested an interview, Mr. B. i n s i s t e d t h a t he had been completely ignored, and had complained to the Community Chest and Council. The purpose served by coming to the agency, as f a r as Mr. B. was concerned, was to secure assistance i n l o c a t i n g h i s son. He seemed to f i n d enjoyment i n coming however, and to modify h i s demanding a t t i -tudes to some extent. The caseworker assigned to Mr. B e l l was a middle-aged woman, w e l l -trained i n casework techniques and warm i n her approach to people. She was objective i n her own approach t o things^and convinced of the value of seeing a l l aspects of a problem. She was able t o keep her attention on Mr. B. and 43 h i s needs even when he was unreasonable and u n r e a l i s t i c . Because of the greatness of h i s n a r c i s s i s t i c needs, Mr. B e l l wanted things done f o r him, wanted to be given t o . Mention has already been made of h i s r e a c t i o n to r e c e i v i n g a hamper one Christmas, and of not getting one the following year. Wherever i t was possible and h e l p f u l , the caseworker did what Mr. B e l l asked. Necessary l i m i t a t i o n s were explained c a r e f u l l y . I t was t h i s w i l l i n g n e s s of the caseworker t o give to him which made i t possible f o r Mr. B e l l to grow a l i t t l e i n h i s a b i l i t y to face r e a l i t y . When he wanted to give vent t o h i s h o s t i l i t y to h i s wife, by w r i t i n g to A l l a n about h i s views on the m a r i t a l d i f f i c u l t i e s , the caseworker asked him to consider the e f f e c t that t h i s would have on A l l a n , and on the r e l a t i o n -ship which he wanted to e s t a b l i s h with the boy. The caseworker was aware that Mr. B e l l ' s tendency would be t o form a very dependent r e l a t i o n s h i p with her, and that there would be a danger of a neurotio transference. This would be too d i f f i c u l t f o r a caseworker t o deal with. To o f f s e t t h i s danger, interviews were focussed on present problems and treatment was supportive i n nature. Mr. B e l l was the only person i n t h i s group who was interviewed concern-ing the study. The recording of the interview with him i s included i n Appen-dix A. He spoke with some emotion about the caseworker's f r i e n d l i n e s s and "sympathy", but spent probably not more than one minute out of the hour-long interview t a l k i n g of her. The rest of the time he talked about h i s son — s p e c i f i c a l l y what he had done f o r h i s son — and about h i s own a b i l i t y i n re-p a i r i n g radios. He received considerable s a t i s f a c t i o n from using t e c h n i c a l terms which he knew were not understood. This s p e c i a l interview with Mr. B e l l substantiates what was said e a r l i e r about his a b i l i t y t o r e l a t e . He does t h i s on a n a r c i s s i s t i c l e v e l . With a 44 p o s i t i v e response from the caseworker, however, Mr. B e l l l i s able to modify h i s attitudes a l i t t l e and to f i n d more s a t i s f a c t i o n i n l i v i n g . Mrs. Coulter Mrs. Coulter seemed to try to make her r e l a t i o n s h i p with the case-worker s i m i l a r to what her r e l a t i o n s h i p with her mother had been. The case-worker, a f r i e n d l y poised person, was a senior worker with considerable.ex-perience i n working with serious emotional d i f f i c u l t i e s . From the f i r s t there seemed t o be some doubt that Mrs. C. r e a l l y wanted the help of the agency. She forgot appointments on three occasions. She interviews were used c h i e f l y t o t a l k about d i f f i c u l -t i e s which she encountered with her husband, and with h i s mother. She complained b i t t e r l y of the interference of her mother-in-law. Mr. C's family were beneath hers. Central i n the things she d i s l i k e d about Mr. C. were h i s "crudeness" and h i s sexual demands. It was true that Mr. C. accepted sex i n a most matter-of-fact way, and he could not understand undue modesty or reticence i n speak-ing of sexual matters. Deviations from conventional morality would not have disturbed him, but as f a r as was known he had been f a i t h f u l to Mrs. C. Attempts to help Mrs.C. face r e a l i t y evoked resistance and r a t i o n a l i z a t i o n s on her part. When she r e a l i z e d that Mrs. C. could not use casework services the caseworker attempted to make the i n t e r -views l e s s frequent, but Mrs. C. reacted by demanding more of the worker's time than she had had previously. During the early interviews with Mrs. Coulter the caseworker probably over-estimated her a b i l i t y t o react i n an adult manner, and_it was not u n t i l l a t e r that, enough information was a v a i l a b l e f o r an accurate diagnosis. Mrs. Coulter seemed to be asking the caseworker to support a l l that she had done i n the m a r i t a l s i t u a t i o n and t o be c r i t i c a l of her husband. Such support she had always received from her mother, because the l a t t e r ' s bitterness t o -wards men was so great. Mrs. Dean Mrs. D. wanted the caseworker t o "change" her husband. Three desired changes included having him help more around the house, be more sympa-t h e t i c , and not complain about Mrs. D's parents coming in.to share her household r e s p o n s i b i l i t i e s or to take them over. Mrs. D. demanded that she have an interview immediately and i n s i s t e d 45 that interviews had to be held in her home. When she learned that the agency had a supervised homemaker service, she thought that this might help her situation. She showed l i t t l e insight and had no sense of contributing to the unhappy home situation. It looks as i f Mrs. Dean wanted the worker to assist her i n satisfying her dependency needs. Her husband should help her more with the work and en-able her to retire into chronic invalidism. No one should hinder her parents in their efforts to care for her as a l i t t l e child. Homemaker service would provide another mother-person to look after her. At f i r s t the worker was inclined to think that Mrs. Dean did need suoh help as homemaker service. After more careful diagnostic thinking, which was assisted by the case consultant of the agency, she directed her use of rela-tionship toward helping Mrs. Dean to become a l i t t l e more independent. Stress was l a i d on things which Mrs. Dean could do, and recognition given to any attempts she made to help herself. She could only move inches in the direction of insight, but she was helped to see that Mr. Dean was not likely to change, and she would have to accept that fact i f she was to remain i n the home. Mr. Dean's accomplishments were emphasized in an attempt to have her see things in a more objective manner. As the interviews continued Mrs. Dean showed some increase i n her a b i l -ity to see her real feelings. Mrs. East The caseworker whom Mrs. East consulted had special psychiatric train-ing, and a reputation for understanding people, and helping them to feel com-pletely at ease. She considered that the relationship with Mrs. East had been influenced by the fact that she (the caseworker) was pregnant during most of the period of contact. She was not sure how to interpret this, how-ever. 46 Mrs. E. frequently commented that she was afraid of taking up too much of the oaseworker's time. When she came to the office she would bring a present for the worker, a jar of jam or some flowers. Her res-ponse to thanks was to burst into tears. "Ho one ever thanks me any more", she would say. She wanted to be told what to do. When her daughter, Mary, broke her arm, Mrs. E. asked whether she should bring the g i r l home from the hospital, and whether she should send her back to school. Because Mrs. E's demands were so great, i t was necessary for the caseworker to confront her with reality limitations. The number and length of interviews was s t r i c t l y adhered to. The caseworker thought that because of Mrs. E's underlying guilt, some definite restrictions would help her to feel freer, and she was at ease in imposing these limitations. Mrs. E. accepted them without any sign of resentment. As soon as Mrs. E. f e l t secure i n her relationship with the case-worker, the latter began, very gradually, to get her prepared to accept psychiatric help. Mrs. E. was able to accept this suggestion, but wanted to go to a woman psychiatrist. After four months of working with Mrs. E. the caseworker had to leave the agency because she was expecting confinement. By this time Mrs. E. had made an appointment with the psychiatrist, and her trans-fer to another caseworker had been discussed. Mrs. E. telephoned the agency, after the caseworker had l e f t , but she did not come in as she had done previously. A l l that Mrs. East did seems to f i t into the pattern of searching for a mother — this time i n the person of the caseworker. Unsure of how she would be accepted she brought presents. She wants to be like a small child whose mother t e l l s him what to do at every turn. Her response to the set-ting of limitations may have been because those limitations eased her guilt feelings, or, i t may have been another indication that she wanted a mother to t e l l her what she could and also what she could not do. The caseworker's pregnancy was a threat to Mrs. East because she can-not stand to have women involved with men. It brings her own desires and her guilt too close to consciousness. It stirs up her feelings of rivalry. It precipitates a negative transference. So Mrs. East moved away from the caseworker. Instead of being the longed-for "good mother" the caseworker had become another r i v a l . Perhaps in the psychiatrist she would find a mother - - - - . In this Chapter clients have been considered whose ability to relate 47 to others was poor. In eaoh case the cause lay i n the f a c t that, as a c h i l d , there had not been enough a f f e c t i o n received to s a t i s f y basic needs. Instead of developing normally, therefore, devious unsatisfactory ways were adopted f o r dealing with a f f e c t i o n a l needs. Mrs. Arnott hid the greatness of her needs from h e r s e l f . The world was a h o s t i l e place, but i f she bar-gained c a r e f u l l y with s o c i a l workers and others, she might get what she wanted. Mr. B e l l retreated from the world of adult r e s p o n s i b i l i t i e s to a small world where h i s needs were considered to the exclusion of a l l others. Mrs. Coulter could only meet a h o s t i l e world by i d e n t i f y i n g with her strong and much-feared mother. Mrs. Dean used i l l n e s s to remain i n a dependent state, but had t o use i t too to punish h e r s e l f f o r h o s t i l e f e e l i n g s directed toward her over-protective parents. Mrs. Hast made of l i f e a con-stant r i v a l r y . Each sought a good mother who would give him what he needed and allow him to grow. Beoause the needs i n these c l i e n t s were so great, and t h e i r ways of adapting t o l i f e so inadequate but so deeply entrenched, the caseworker could only a s s i s t i n a very l i m i t e d way. 48 Age SCHEDULE 1 Events i n the Environment Mrs. Arnott Attitudes and Behaviour horn 1923 2 years 5-1/2 y years 5| - 6 years 6 years 7 years 12 - 16 16 years 17 - 21 Mrs. A. was the youngest of four. Her mother died. A nervous older s i s t e r oared f o r the younger o h i l d r e n . Her father died of T.B. The health of the older s i s t e r had been f a i l i n g , so the younger o h i l d r e n were made wards of the CA.S. Mrs. A. and two s i b l i n g s were together i n a f o s t e r home. Mrs. A. i n a foster-home by h e r s e l f . The f o s t e r mother was a warm person. Early i n her sojourn i n t h i s home, fo s t e r father exposed him-s e l f to Mrs. A. Mrs. A. remained i n t h i s home u n t i l she was twelve, when the f o s t e r parents were divor -ced. Older s i s t e r died of T. B. Mrs. A. was i n two or three homes where she worked f o r her board. She married a divorced man f i v e years older who had a g i r l , Sarah, aged three. Mr. A. was the spoiled only son i n a.family of g i r l s . He was dependent, lacked s e l f - c o n t r o l and good judgment. Mrs. A. married against the advice of the C.A.S. B i r t h of three c h i l d r e n . Mrs. A. expressed a f f e c t i o n f o r her older s i s t e r . At an older age Mrs. A. disparaged her brother who had been i n j a i l , and did not know or care where her s i s t e r was. Mrs. F e l t as i f she "belonged" with f o s t e r mother, but said that she was frightened of f o s t e r f a t h e r and a f r a i d to be alone with him. She claimed that she never f e l t wanted i n any of these homes. She l i e d to the c h i l d r e n at school about working f o r her board. She stole stockings from one f o s t e r mother to wear to a dance. Said that C.A.S., thought she was a t h i e f . Before marriage she thought her hus-band was a "happy-go-lucky" person, such as she had always wanted to be. Mrs. A. was jealous of Mr. A's f i r s t wife, and wanted to surpass her as a mother. Mrs. A. gave Sarah good physical care but had strong h o s t i l e f e e l i n g s toward her which she could not admit. Mrs. A. i s much concerned about g i v i n g things t o the c h i l d r e n so that they w i l l not f e e l " d i f f e r -ent." 49 SCHEDULE 2 Age Mr. B e l l Events i n Environment Attitudes or Behaviour born 1886 A small o h i l d 39 40 42 i n England. An only c h i l d . Mother died of T.B. His father was a minister. A doctor interpreted attacks of r i g i d i t y as heart trouble and advised Mr. B's parents t o pamper him. Mr. B. was a p u p i l teacher i n England. Came to Canada and worked as a chauffeur. He married and h i s wife died at c h i l d b i r t h . Boarded with Mrs. B's par-ents who were active i n church l i f e , as was Mr. B. Married Mrs. B. Mr. B. was "not successful" a f t e r marriage. He and Mrs. B. didn't have enough t o eat. Because of t h i s they moved back into the home of Mrs. B's parents. A son A l l a n born. Two months l a t e r Mr. B. became sick with hernia. How old Mr. B. was when h i s mother died i s not known. He does not mention her. It was Mr. B's wife who talked about these attacks. She claimed that Mr. B. had them when he could not get h i s own way. The marriage was against the wishes of Mrs. B's parents. Mr. B. dates the beginning of h i s troubles from t h i s time. He began to use f o u l language and to l i e . He was le s s i n c l i n e d to work. He com-plained of heart trouble although no physical cause could be found. He became i r r i t a t e d at l i v i n g with h i s parents-in-law but made no move to f i n d other accommodation. Mr. B. moved out of the home, and took a room near the Park. He claimed that he needed "more fr e s h a i r " . He gave almost no support, but was angry when Mrs. B. took oourt action against him. 50 SCHEDULE 3 Events i n Environment Mrs. Coulter Attitudes and Behaviour Mrs. C. was the youngest i n a family of four. She had two sisters and a brother. Mrs. C. was not wanted by her mother and learned of this from her mother. Met Mr. C. when he came to stay with Mrs. C's family. Mrs. C's mother l e f t her hus-band who was said to be "brutal" to her and to Mrs. C's siblings, (not to Mrs. C.) Worked as a stenographer. Married Mr. C. According to him Mrs. C. was eager for marriage and made some sexu-al advances. Mr. C. had been i n the army seven months before the marriage. Mr. and Mrs. C. came to live with Mr. C's mother, whose husband had died. Birth of a daughter. Mrs. C. recognized that she had f e l t inferior since she was a child but did not know how this feeling had arisen. Mrs. C. said that she was fright-ened and hurt at her father's treatment of her mother. She re-called that he used to entertain "big, loud, dark women" (prostit-utes) Mrs. C. claimed that she had re-sented Mr. C's sexual advances before marriage. She said that the f i r s t year of married l i f e was f a i r l y happy. Mrs. C. complained of drinking parties i n the home and that Mr. C. did not defend her when she quarrelled with his mother. Mrs. C. has had two or three "near nervous breakdowns", when she couldn't sleep and cried easily. She consulted a psychiatrist who concluded that she could not use his help. During one such upset period Mrs. C. l e f t Mr. C. She returned to him because, she said, she didn't want to leave the furn-iture which had been purchased with her money. 51 SCHEDULE 4 Age Events i n Environment Mrs. Dean •Attitudes and Behaviour B. 1922 22 22 23 had one brother a l c o h o l i c . now an Mr. D. describes Mrs. D's father as kindly and gener-ous. He was an extreme food f a d i s t . Mrs. D. had eczema from childhood and T.B. glands. Met,Mr. D. i n Vancouver while on holidays. Knew him several months. Married him secretly when he was c a l l e d into the Navy. She and Mr. B.. 7 li v e d ..together f o r one month. She returned to her parents when Mr. D. was t r a n s f e r r e d . f i r s t c h i l d born while Mrs. D. was l i v i n g w i t h her parents Mr. D. discharged. Mrs. D. joined him i n Vancouver and soon became pregnant again. Mrs. D's parents took the c h i l d home with them when Mrs. D. was i l l during her second pregnancy. Later they moved to B.C., i n order to be near Mrs. D. Mrs. D. was immature. He had grandiose ideas. He resented h i s mother-in-law ooming to help and thought that h i s wife could manage by h e r s e l f . Mrs. D. doesn't describe her mother but runs home to her. Her mother always sides with Mrs. D. Mrs. D. says that her parents were generous, understanding, and got along w e l l together. The eczema became worse a f t e r marriage. The eczema became more acute. She returned home to her parents three times during t h i s year. Mrs. D. wanted her husband to help with the housework (because of her eczema). When he pro-t e s t s about her mother being i n the home, Mrs. D. becomes sic k . 52 SCHEDULE 5 Mrs-. East Age Events i n Environment Attitudes or Behaviour B i r t h Mrs. E. was the eldest of three and the only g i r l . 5 Mother died. Father, a sea captain, took her on a six-month c r u i s e . Mrs. E. was very fond of her father. 5-1/2 to 14 A series of housekeepers. Mrs. E. said that she received no a f f e c t i o n from them. 14 Father re-married. Mrs. E. was very "hurt" by t h i s . She resented her step-mother. She claimed that she and her brothers were forbidden t o bring t h e i r -f r i e n d s t o the house. Because of t h i s one brother ran away to sea and was drowned. 20 Two g i r l s were born to her father and her step-mother. Mrs. E. worked i n an o f f i c e . Mrs. E. claimed that she l i k e d her s t e p - s i s t e r s , but refused to give t h e i r names. She said that they had married out of her c l a s s — meaning above i t . 21 A proposal of marriage. Mrs. E. claimed that she had r e -fused, because she was ashamed to t e l l the young man that she could not take him home. Years l a t e r she was s t i l l t a l k i n g about t h i s " l o s s " . 30 Married a man whom she had met through her f a t h e r . Mrs. E. s a i d that she married to get away from an unhappy s i t u a t i o n . She admitted that she wasn't i n love with her husband. She resented the f a c t that her husband was drunk during the whole of the honeymoon. Mrs. E. became pregnant three months a f t e r marriage. She oontinued to work. The baby, Mary, was not an a t t r a c t i v e c h i l d . From the f i r s t Mrs. E. was a f r a i d of pregnancy. She explained t h i s as fear that the baby would i n h e r i t Mr. E's tendencies. 53 CHAPTER FIVE The Two-Talent C l i e n t Some Contrasts i n Attitudes We say that a t t i t u d e s on the part of the caseworker are important, but how important are they? Can we assess the degree to which the a t t i t -udes of the worker influence the growth which i t i s possible f o r the c l i e n t to make? Obviously t h i s i s extremely d i f f i c u l t to do. I f the c l i e n t i s unable t o move very f a r i n the d i r e c t i o n of more s a t i s f y i n g l i v -ing, how much of t h i s i s due t o h i s own l i m i t a t i o n s of experience or lack of desire f o r change? How much may be accounted f o r by the severity of environmental pressures? How much has i t been influenced by the way i n which the caseworker regarded him? Supervisors f i n d i t hard to answer t h i s question, even a f t e r a c a r e f u l analysis of the reoording, supplement-ed by discussions with the worker. The answer may elude the worker too, unless he has enough personal s e c u r i t y t o want to examine, i n a penetrat-ing way, the nature of h i s contact with those whom he seeks to a i d . How important are the attitudes of the caseworker? In analysing cases f o r t h i s study there were two i n which i t was possible t o see something of the c l i e n t ' s reactions t o contrasts i n a t t i t u d e . In the f i r s t one there were two workers. One was bent on im-proving the home f o r the sake of the chil d r e n , but without regard f o r the personality or f e e l i n g s of the mother. The second worker, s e n s i t i v e to the needs of people, believed that only by understanding the mother could t h i s family become happier — and h e a l t h i e r . A more subtle contrast was present i n the second case. Here there was only one worker. Her attitu d e to people was always an e s s e n t i a l l y 5 4 p o s i t i v e one, but only when atti t u d e s changed from "good" to "better" was the c l i e n t able to cope more s a t i s f a c t o r i l y with her s i t u a t i o n . Mrs. Fournier Mrs. Fournier was overwhelmed by the problems of a large family, an inadequate income and an i r r e s p o n s i b l e husband. She had not asked f o r help, but was referred to the agency by the Public Health Nurse because the nurse considered that the youngest o h i l d , a year old, was s u f f e r i n g from malnutri-t i o n . The information about Mrs. Fournier's background was meagre (see Schedule 6 ) . An only c h i l d , she was raised i n a home with a domineering mother, and a father who was s t r i c t because of the i n s i s t e n c e of h i s wife. One incident which she relates seems t o give a picture of the home environ-ment. I f ever she said, "I don't want that, Mother", she was threatened with a strap by her f a t h e r and she always gave i n . It would look as i f Mrs. Fournier's father, Mr. Brown, always supported h i s wife, and that Mrs. Brown, who "always knew exactly what was r i g h t and wrong" might be an un-comfortable person t o l i v e with. Mrs. Fournier was unable to give any d i r e c t expression to h o s t i l i t y she may have f e l t toward her mother and such f e e l i n g s seemed to be deeply repressed. She said only p o s i t i v e things about her, and sometimes appeared to need to reassure h e r s e l f , by s p e c i a l emphasis, that nothing of h o s t i l i t y existed. "Mrs. F. said that she and her mother were one i n heart. What one wanted, the other one d i d " . Sometimes, by r e s i s t i n g i n a passive way what her mother wanted, a part of the underlying h o s t i l i t y was expressed. She married against her parents wishes. She was unco-operative with her mother's e f f o r t s to organ-ize the household more e f f i c i e n t l y . 55 Mrs. Fournier's strong need f o r recognition and approval, her convic-t i o n that she f e l l below her family's standards, indicate that she had not been given the a f f e c t i o n which f o s t e r s a sense of personal worth. Had she married a stronger man on whom she could have leaned, and had she had fewer d i f f i c u l t i e s to encounter, Mrs. Fournier would have been better able to cope with r e a l i t y . As i t was, she was anxious over the children's behaviour, but i n e f f e c t u a l i n doing anything about i t . She worried over what the neighbours might t h i n k of the c h i l d r e n , over her own i l l health, over the whole discour-aging aspect of l i f e . When things become too d i f f i c u l t , she pulled a • •: protective cloak around h e r s e l f . Her greatest needs were f o r recognition and understanding; what would disturb her most would be c r i t i c i s m and d i s a -pproval of which, apparently, she had had so much. (See Chart F.) The f i r s t worker disregarded Mrs. Fournier's e s s e n t i a l needs. A b r i e f synopsis of the agency's contact i s included t o show the action of the case-worker, and Mrs. Fournier's response. 13.6. The caseworker c a l l e d at the home without having made an appoint-ment, and explained that she had come about the baby. Mrs. F. asked her not to come again u n t i l she telephoned. 16.6. The worker c a l l e d without an appointment. Mrs. F. talked about her h u m i l i a t i o n over the children's behaviour, and how overwhelmed she was by the amount of work she had to do. She mentioned that i n her own home she had had no t r a i n i n g f o r housework. Now she was often sick and coultn't get up i n the mornings. The worker gave her advice con-cerning? ( l ) using more milk, (2) the value of regular meals which i n -volved a regular hour f o r r i s i n g , (3) the need f o r taking a knife away from one of the chi l d r e n , (4) the proper kind of food f o r the baby. Material about menus had been sent t o Mrs. F. by the Home Economist of the agency. When asked whether she had received t h i s , Mrs. F. re p l i e d , "I received a l o t , but I had no room f o r i t " . 17.6. Worker ordered kindling for Mrs. F. and telephoned her about t h i s . Mrs. F. said that the whole family had got up on time that morn-ing. 20.6. Worker v i s i t e d without appointment. She discussed the care of the baby and marked passages i n a book about babies so that Mrs. F. could f i n d them e a s i l y . She suggested a d a i l y schedule. "Mrs. F. looked at the worker i n sheer amazement, asking the worker i f she l i k e d g etting up early every day". 56 30.6. V i s i t e d without appointment. The worker enquired how Mrs. F. f e l t and remarked that she was not looking w e l l . "Mrs. F. was very pleased that some a t t e n t i o n was given t o her". She went on to t a l k about her h e a l t h and her childhood. The worker diverted the conversation t o the children's be-haviour. In'a few minutes Mrs. F. referred again t o her parents and her childhood. • The worker urged Mrs. F. to attend a doctor. Mrs. F's res-ponse was that the pamphlets she had received were not much help, and the Cod L i v e r O i l , which had been suggested, didn't agree with the baby. Mrs. F's parents, Mr. and Mrs. Brown, came t o v i s i t her. When the worker c a l l e d , she was introduced to them. In the presence of Mrs. F. Mrs. Brown was very c r i t i c a l of her daughter's handling of the baby and of her poor household organization. The worker made no response. Mrs. F. said that the worker didn't need to c a l l any more. The worker explained t h a t she was worried about Mrs. F. and the baby — that i t was a s t r a i n having your husband away. She commented on how t i r e d Mrs. F. must be. "Mrs. F. leaned comfortably back i n her chair ~ she grinned contentedly and sai d , 'That i s exactly how I f e e l ' . " The worker discussed possible plans f o r Mrs. F. and the baby, without r e f e r r i n g t o her, but t r y i n g t o get the co-operation of Mr. and Mrs. Brown.. The worker took Mrs. F. a g i f t of Swiss Chard. Mrs. F. talked a l i t t l e more f r e e l y . The baby's health had improved, p a r t i c u l a r l y since the coming of Mr. and Mrs. Brown. The case was closed without any discussion with Mrs. F. as to why t h i s was being done. The worker i n t h i s case had good diagnostic a b i l i t y , but she had a sense of urgency because of the baby's poor health, whioh caused her to overlook Mrs. Fournier's e s s e n t i a l needs. She f a i l e d to see the importance of developing a r e l a t i o n s h i p which would free Mrs. Fournier to do a l i t t l e better i n her management of the c h i l d r e n . The fa c t that Mrs. Fournier was reaching out f o r understanding i s c l e a r i n the recording. She responds immediately when the caseworker does things f o r her, as i n securing the k i n d l i n g , and giving the g i f t of Swiss chard. She responds again when the caseworker asks about her health, and that response i s noted and recorded by the caseworker. Its r e a l s i g n i f i -cance, however, i s missed, as she moves on to t a l k about the c h i l d r e n who were her greatest concern. 57 So great i s Mrs. Fournier's need f o r someone to understand, that she can continue to reach out even a f t e r repeated rebuffs. By allowing Mrs. Brown t o c r i t i c i z e her daughter, the caseworker had become i d e n t i f i e d with the c r i t i c a l mother whose standards can never be attained. Mrs. Fournier can not stand a s i t u a t i o n i n which there are two such women. She said that the caseworker d i d not need to c a l l any more. The reply that was made gives her renewed hope. Perhaps there i s someone who knows how things look t o her. But the worker f a i l s her again. She has her mind on achieving a c e r t a i n goal, rather than on understanding a person. Mrs. Fournier i s treated as one who i s inoapable of making plans f o r h e r s e l f and her c h i l d . I t i s noted, too, that the simple courtesy of telephoning f o r an appointment was overlooked. This would scarcely have happened had the worker considered Mrs. F. to be as important as her own f r i e n d s , and worthy of the same consideration. Four years elapsed and the family agency was asked to work with Mr. and Mrs. Fournier i n order t o f a c i l i t a t e Frank's adjustment a f t e r h i s r e -lease from the Boy's I n d u s t r i a l School. This type of work was being done with a few f a m i l i e s on an experimental!, b a s i s . The s i t u a t i o n i n the family had changed, i n some respects, during the four years. Mr. Fournier was home from the army, but he drank rather heavily, and seemed t o take l i t t l e r e s p o n s i b i l i t y f o r the c h i l d r e n . He didn't care i f the c h i l d r e n were w e l l fed as long as he was. The c h i l -dren were now aged t h i r t e e n , nine, seven, f i v e , and one. Again the r e -f e r r a l came, not from the family, but from an agency which thought that Mr. and Mrs. Fournier needed help. This put the family agency i n a p o s i t -ion of authority, and i t may have created s p e c i a l d i f f i c u l t y i n winning the confidence of Mrs. Fournier. 58 Miss Howard, the worker assigned to t r y to help Mr. and Mrs. Fournier, was a student i n her second year of s o c i a l work t r a i n i n g . She was a quiet, f r i e n d l y person, wdth p a r t i c u l a r a b i l i t y f o r sensing the emotional re-actions of people. Miss Howard made three unsuccessful attempts t o see Mrs. F. It i s possible that Mrs. F. was at home but was refusing to answer the door. When she was admitted Mrs. F's f i r s t comment was, "Couldn't you come back another day? I'm awfully busy right now". Miss Howard agreed that i t was pretty d i f f i c u l t to run a house, look a f t e r c h i l d r e n , and get everything done. Mrs. F. relaxed. Miss Howard moved slowly, showing her i n t e r e s t i n Mrs. F. and her a b i l i t y to see things from the l a t t e r ' s point of view. During the f i r s t interview Miss Howard suggested, a f t e r a few minutes, that she would leave, as Mrs. F. was so busy. Mrs. F. r e p l i e d , "Oh, w e l l , now that I've sat down, i t doesn't matter so much. I'm glad to hear Frank i s doing so w e l l " . There was steady growth i n Mrs. F's confidence i n Miss Howard. When fu r t h e r interviews were suggested, she said that she would be glad to see Miss Howard. At the next interview she came to the door almost before the worker had a chance t o knock. She was able to d i s -cuss her husband's shortcomings and the f a c t that the c h i l d r e n were s t e a l i n g . She had never been able t o t a l k about such things with any-body before, but she f e l t that she could do so with Miss Howard. She showed reluctance t o have the interviews terminated. Mrs. F's parents, Mr. and Mrs. Brown, came to v i s i t her, and Mrs. Brown was present the next time that Miss Howard c a l l e d . Mrs. Brown explained that she and her husband were very fond of Frank. He had been a good boy when he was with them. She had l e t him go back to hi s family because she f e l t that he needed t o be with the other c h i l -dren and h i s f a t h e r . She wished now that she had never done so be-cause she f e l t that Frank would never have got himself into t h i s d i f f i c u l t y i f he had stayed with them. She said, "I thought h i s father would be better when he got back from overseas, but he was worse instead. He was always bad enough, but he used to care f o r the c h i l d r e n ; now he's a l l f o r himself". Miss Howard suggested that wartime experiences did tend to mix people up, and Mrs. Brown quoted her husband as saying that i t made people worse. Mr. Brown was very d i f f e r e n t from Mr. F. He didn't drink or smoke and was hi g h l y respected. They had t r i e d t h e i r best to keep t h e i r daughter from marrying Mr. F. They had even locked him out of the house. I t was no use, however, she had i n s i s t e d on marry-ing him. As a r e s u l t she had to l i v e t h i s awful l i f e . She had been w e l l brought up; had taken piano lessons. There had been no need to throw?-herself away l i k e that. Miss Howard suggested that perhaps Mr. F. had seemed d i f f e r e n t to Mrs. F. then. Mrs. F. who had been get t i n g a very pained expression on her face, looked g r a t e f u l , but she didn't get a chance to say any-thing. Mrs. Brown went r i g h t on. She exclaimed again about how 59 t e r r i b l e i t was that she, Mrs. F. had to l i v e " l i k e t h i s " and spoke of the "awful conditions" that surrounded her. She remarked on the f i n a n c i a l s i t u a t i o n and continued her t i r a d e against Mr. F. Miss Howard pointed out that i t did not a l l seem so bad; Mrs.F. had, a f t e r a l l , some a t t r a c t i v e c h i l d r e n and they must mean a l o t t o her-Mrs. F. again looked r e l i e v e d and pleased. Mrs. Brown relaxed, too, and said that she thought a great deal of the c h i l d r e n , espec-i a l l y Frank, as he had been with them so much. She said that she would " t a l k " to him when he came to her again; she was c e r t a i n he r e a l l y was a good boy. Miss Howard said that as f a r as she knew no one thought he was anything but a good boy. This was j u s t a d i f f i c u l t y we could t r y t o help him over. Mrs. F. s a i d , "Yes, he i s a good boy, and I think h e ' l l stay that way". She mentioned some of the other things that she and Miss Howard had discussed as ways of helping him — sports, membership i n the "Y", e t c . In many ways Mrs. Fournier showed the increasing ease which she f e l t i n Miss Howard's presence. She could t a l k about things which she had not f e l t f r e e t o discuss before. She welcomed the worker, once the i n i t i a l resistance which was encountered at every interview, was overcome. As would be expected, there was no steady growth, but rather Mrs. Fournier "came a l i v e " more frequently, with the encouragement and understanding of Miss Howard. There were times, however, when she withdrew inside her "cloak", and there seemed to be no way of reaching her. • A discussion over cake baking shows that some progress was being made. It took place a f t e r Miss Howard had been working with Mrs. Fournier f o r four months. Mrs. F, went on to r e l a t e how she t r i e d to do things f o r her family e s p e c i a l l y at such times as Easter. On the children's b i r t h -days she always baked a cake, even though the birthdays were close together and were i n the summer when i t was too hot to bake. Frank thought he was getting a b i t too old f o r a cake, but she thought he should have one anyway. Worker agreed - saying that cakes did mean something even to grown-ups. Mrs. F. laughed and said maybe one thing that was wrong was that she didn't bake cakes f o r herhusband. He had complained on h i s l a s t birthday that he didn't get any consideration. She had r e p l i e d that he c e r t a i n l y didn't give her any consideration e i t h e r . She thought now that maybe she should give him a b i t of considera-t i o n . Worker suggested that i f she d i d t h i s he would probably be more thoughtful of her. Mrs. F. therefore, planned happily to'bake a cake f o r her husband next time. 60 Some of the improvement noted was undoubtedly because of the lessening of outside pressures. Mrs. Fournier had been worried about whether Frank would get into further trouble and whether she could keep him at school. I t was arranged that he would stay with h i s grandparents and attend school there f o r the r e s t o f the term. When Mr. Fournier's support to the family was inadequate, Mrs. Fournier allowed Miss Howard to t a l k to him. More money, received more regula r l y d i d much to r e l i e v e her anxiety. As soon as Mrs. Fournier became a l i t t l e more oomfortable about her home s i t u a t i o n , a s l i g h t change i n her husband's behaviour became evident. The cycle of ten-sion was unwinding a l i t t l e . As time went on there was a strengthening of family t i e s and a warmer atmosphere pervaded the home. Frank, who returned home a f t e r the school term, got a job and bought a record player with h i s f i r s t earnings. When Frank t o l d h i s mother that he had bought a record player, she said she had r e p l i e d that maybe they needed a lamp more than a record player. She had added that t h i s was h i s money, however, and he could spend i t as he wished. Sam (aged nine) was t h r i l l e d with the new possession, and the week a f t e r the purchase he bought Frank a present of a record, which he had got at a second-hand shop near-by. This pleased Frank immensely. He was s t i l l more pleased and surprised when his father brought home two or three records from the same shop. Mrs. F. spoke of the money which Frank was giving her f o r board. She wondered i f he would regret doing t h i s a f t e r the novelty wore o f f . A question was raised as to whether Frank knew that she was proud of him f o r giving her h a l f h i s wages. Rather thoughtfully Mrs. F. said that she had spoken of i t at f i r s t . Then, smiling, she added that maybe the novelty had worn o f f f o r her too. She would l e t him know that she was proud of him. A f t e r a l l he was j u s t a boy. As was to be expected changes were small ones. A drawing back into the accustomed p a s s i v i t y frequently follows a' period of apparent growth. Perhaps Mrs. Fournier's desire f o r help would never have been great enough to cause her t o reach out for i t h e r s e l f . She can make the most progress toward a more s a t i s f y i n g way of l i v i n g when confronted with a caseworker who considers her to be a person of importance. Involved i n the worker's 61 CHART F A b i l i t y to Relate Mrs. Fournier 1. Concept of S e l f 4. A b i l i t y to Stand F r u s t r a t i o n Needs much recognition and approval. Feels that she f a l l s below her family's standards. Takes l i t t l e care of her person-a l appearance. Recognizes her i n a b i l i t y to go on alone. Some-times says that she wants to d i e . Rat ing: Limited Has had l i t t l e but f r u s t r a t i o n , yet has kept going. Mrs. F. does not meet f r u s t r a t i o n c o n s t r u c t i v e l y but she en-dures. Rating: Limited 2. Seeing Real Feelings She doesn't see her h o s t i l -i t y t o her mother, although occasionally she comes close to i t . When Frank was going t o v i s r : i t his grandparents, Mrs. F. thought that he might l i k e h i s grandmother more than he did her. She knew that she wouldn't l i k e that. Ratings Limited 5. A f f e c t Tone Anxiety over the children's behavi-our and her own inadequacy. Often d i s -couraged but responds to recognition. Frequently negative, but the c h i l d r e n had some happiness and security whioh i n -dicates that she must have had p o s i t i v e a t t i t u d e s too. Ratings Limited 3. Ways of Coping with R e a l i t y Wraps a protective cloak around her. When things are too d i f f i c u l t — numbs h e r s e l f . Is i l l , but doesn't go to a doctor. Inadequate i n managing the house-hold and the ch i l d r e n . Repressesion concerning her parents. The r e a l i t y s i t u a t i o n was hard, lack of money, c h i l d -i s h husband, sickness, too much work, no t r a i n i n g f o r home-making. 6. Pattern of Relationships Mother - repressed h o s t i l i t y . Father - He always supported the mother, but Mrs. D. shows more a f f e c t i o n f o r him. Husband - unhappy f o r he was im-mature and she wanted to be dependent. Children - had not wanted any more c h i l d r e n a f t e r the second, yet gives them a f f e c t i o n . Neighbours - enjoys f r i e n d l y con-ta c t s yet fears t h e i r c r i t i c i s m . Rating: Limited Rat ing s Limit ed 62 attitude is a sensitive awareness to the emotional responses of others, and f u l l recognition of the fact that a person can accept help only at his own pace and i n his own way. Mrs. Grove There was a rather dramatic change in Mrs. Grove's attitudes after she had been working with the agency for a year. Whereas before she had asked for help, but had resisted any attempts made i n this direction, now she co-operated, and placed great confidence in the agency. What caused this change? Mrs. G. f i r s t came to the agency to discuss d i f f i c u l t i e s which she was having with her husband. She had been married for ten years and claimed that the f i r s t six years had been happy ones. Then her husband had suffered a "nervous breakdown". Mrs. G. did not indicate that this had upset her. What she couldn't understand was how Mr. G. could be involved with a young g i r l and do the things which he was doing. He and "the g i r l " loitered near the house at night. Sometimes they hid behind telephone poles or sat in the park across the street. It was so obvious and so queer that the children were teased about i t at school, until they no longer wanted to go to school. If Mrs. G. went out i n the evening the pair would follow her wherever she went. She could give no reason for this except that "the g i r l " wanted to be "mean". Mrs. G's tendency was to project a l l the blame on "the g i r l " . Mr. G. had never behaved this way before — the g i r l must be "egging him on". Perhaps i t might be "another breakdown coming on". When i t was suggested that Mrs. G. could discuss Mr. G's be-haviour with the psychiatrist who had previously treated him, she brushed this idea aside. If she went to a psychiatrist her hus-band would k i l l her. She refused to let the worker talk to Mr. G. or to his relatives. Mr. G. deserted five times within a short period. Mrs. G. clung to the hope that he would get over his infatuation, and a l -ternately blamed the g i r l or his mental condition for his actions. Once Mrs. G. got him to return tothe home by going away herself, but leaving the ohildren there, although she kept maintaining that her husband was mentally i l l . Mrs. G. seemed unable to take any constructive action, or to think r e a l i s t i c a l l y about her situation. She said that Mr. G. beat her, and that this was terrifying the children, but she did nothing about i t . She talked of leaving the city and taking the children to Manitoba. Questions revealed that she had no money for such a t r i p , would have no means of support in Manitoba, and knew no one there. Although the family did not have enough money for essential expenses Mrs. G. would not take court action against her husband, and without this she was not eligible for public assistance. 63 Throughout t h i s period Mrs. Grove used the interviews with the case-worker to r e - i t e r a t e her complaints about Mr. Grove, but she would take no step to help h e r s e l f . The caseworker concluded that f o r some reason Mrs. Grove was receiving s a t i s f a c t i o n by remaining i n t h i s s i t u a t i o n , where she was being punished, and that she did not seem ready to accept any help. The caseworker was a woman with a warm p o s i t i v e a t t i t u d e to people. She worked with patience and her desire to help was sincere. I t was d i f f -i c u l t , however, to know whether the things of which Mrs. Grove spoke were r e a l i t i e s , or whether she h e r s e l f was bordering on a psychotic state. The f a c t that Mrs. Grove blocked any means the caseworker might have used f o r understanding the s i t u a t i o n better pointed i n the d i r e c t i o n of the l a t t e r view. Small wonder then i f the caseworker was b a f f l e d . Mrs. Grove's present capacity f o r r e l a t i o n s h i p looked poor. (See Chart G). There were p o t e n t i a l l y p o s i t i v e elements i n her r e l a t i o n with her step-mother and her report that she had not always been so depressed. Were,'these elements s u f f i c i e n t to change the general impression? A year l a t e r Mrs. G. telephoned to request a supervised home-maker, but appeared to use t h i s as an excuse f o r t a l k i n g again about her d i f f i c u l t i e s with Mr. G. He and his g i r l f r i e n d were s t i l l hang-ing around the house l a t e a t night, she said . She stated that her husband was a t h i e f . He had been discharged from h i s job f o r a l t e r -ing invoices; he had stored s t o l e n radios and then resold them. Be-cause she was so upset over these things, i t was suggested that she might t a l k to a p s y c h i a t r i s t but she refused. When Mrs. G. oomplained of having pains, the caseworker was able to persuade her to consult a doctor who advised an immediate operation. Mrs. G. would make plans t o go to the h o s p i t a l and then cancel them. Her health was being seriously impaired. She allowed the c h i l d r e n t o stay home from school much of the time and r a i l e d against Mr.G. i n f r o n t of them. • The c h i l d r e n , too, begged her to go to the h o s p i t a l , and they were showing the r e s u l t s of the continual emotional s t r a i n . The s i t u a t i o n was so c r i t i c a l f o r Mrs. Grove and the c h i l d r e n that a more d i r e c t i v e method became imperative. The doctor's help was used to 64 convince Mrs. Grove tha t she had to go to h o s p i t a l . She was t o l d that i t would be necessary f o r Mr. Grove to be seen regarding plans f o r the c h i l -dren during her absence. The caseworker s t i l l questioned whether Mrs. Grove could be helped, but hoped that protection against f u r t h e r damage could be given to the c h i l d r e n . When Mr.G. was seen h i s behaviour was such that his wife's s t o r i e s about him no longer seemed i n c r e d i b l e . Mrs. G. gave her permission f o r some neighbours t o be interviewed and what they re-lated confirmed what Mrs. G. had said about her husband's actions. Talking t o them revealed, too, that Mrs. G. had not always been as she was now. They described her as a happy person, a good neighbour, and one who had seemed to be competent i n managing her household. Mrs. G. faced with an operation from whioh she might not recover, was able to admit that one of her greatest fears was about what would happen to the o h i l d r e n i f she died. She did not want Mr. G. or any of his family to look a f t e r them. The l e g a l aspects of t h i s were c a r e f u l l y explored and explained t o Mrs. G. The steps which she could take to plan f o r the future welfare of the c h i l d r e n were out-l i n e d . She consulted a lawyer, and, s a t i s f i e d about the plan which had been worked out f o r the children's care, said that she would have the operation at once. Many d i f f i c u l t i e s continued to confront Mrs. Grove^but now she had an increased a b i l i t y to deal w i t h them. Her health remained poor f o r some time, but her i n t e r e s t i n l i v i n g had revived. She i n i t i a t e d a oourt case t o secure support from her husband. She was interested i n the children's adjustment i n a f o s t e r home, and concerned about the rather severe speech disturbances of two of them. There were lapses i n t o unreasonable behaviour, but not again did she show the negativism which had been so apparent during the f i r s t part of the agency's contact. What i s the reason for the change which had taken place? This question was asked i n an interview with the caseworker, a f t e r the case had been charted, f o r the answer was not c l e a r from the recording. Why had a change taken place j u s t when i t did? The caseworker re-read the record and said, "That was the f i r s t time that Mrs. Grove was convinced that I believed her". She was thoughtful, searching for a deeper reason, and then said slowly, "That was the f i r s t time I d i d r e a l l y b e l i e v e her". As i s usually true 65 CHART G A b i l i t y to Relate Mrs. Grove 1. Concept of S e l f Mr. G. assaulted her, but she did nothing u n t i l the bruises had healed. She was never interested i n food and wouldn't get medical care f o r h e r s e l f . I t was not c l e a r at f i r s t how much her attitude was affected by her i l l n e s s . Rating: Poor 4. A b i l i t y to Stand F r u s t r a t i o n Mrs. E. was i r r i t a b l e with the childr e n , but she was s i c k at the time. Rating: Limited 2. Seeing Real Feelings Mrs. G. verbalized a f f e c t i o n f o r the o h i l d r e n but remained i n the home. She said that Mr. G. was blocking the plans f o r her to go to ho s p i t a l which was not the case. 5. Affected Tone Depressed - e a s i l y excited -anxious. Mrs. G. said that before these events occurred she was a cheerful person. Rating: Poor Rating: Limited 3. Ways of Coping with R e a l i t y She l e f t the ohildren with Mr. G., although she thought that he was mentally i l l . She placed the blame re Mr. G's desertion on the g i r l involved. She refused to get an opinion from a psychia-t r i s t concerning Mr. G. A plan was made t o run away to Winnipeg where she knew no one and had no means of support. 6. Pattern of Relationship  Mother) Father) - not known Step-mother - was at ease with her. Husband - she claims to have been happy with him f o r many years. Now am-bival e n t . Children - expressed concern f o r them, but constantly upset them, by t a l k i n g about Mr. G. i n front of them. Rating: Poor Rating: Limited 66 there were many faotors involved i n t h i s s i t u a t i o n , and to give j u s t one reason f o r the change would be t o over-simplify the f a c t s . I t i s poss-i b l e , however, that the caseworker had brought out what was most c e n t r a l . I t i s possible that t h i s case i l l u s t r a t e s how d i f f e r e n t the r e s u l t s can be when a c l i e n t i s met with an "almost-accepting" a t t i t u d e , and when he i s met with one which i s wholly accepting. Mrs. Grove e n t h u s i a s t i c a l l y agreed to p a r t i c i p a t e i n t h i s study by ta l k i n g about what the r e l a t i o n s h i p with the caseworker had meant t o her. When she was v i s i t e d she was expecting t o be evicted any day. Her house-hold goods were a l l packed. In the midst of confusion she sat q u i e t l y , earnestly, as i f a p r i v i l e g e had been extended to her. This i s what she said: "I don't think that I could have l i v e d through that time without Mrs. Norton, I don't think that I could have kept my sanity. She gave me some-thing true t o hang on to when everything else seemed untrustworthy. I f she said, 'The c h i l d r e n w i l l be w e l l cared f o r i n t h i s home', I knew that they would be. "Mrs. Norton always had time f o r me. I knew that she was very busy, but I could always c a l l her and she never sounded as i f she were too busy to t a l k to me. She t o l d me that I could even c a l l her at her home. "No matter how t i r e d she might be Mrs. Norton was interested i n us. It wasn't the kind of i n t e r e s t that i s put on because i t i s your job. She r e a l l y was in t e r e s t e d . You always know the d i f f e r e n c e " . The cases which have been presented i n t h i s Chapter indicate c l e a r l y that the attitudes of the caseworker can change the nature of the relation - r ship with the c l i e n t , and so a f f e c t the use which can be made of i t . Where 66-a c r i t i c a l attitudes p r e v a i l , which b e l i t t l e the d i g n i t y of the c l i e n t , they serve only t o reinforce the negative regressive elements i n his personali t y . Where there i s f u l l acceptance of the c l i e n t by the caseworker, t h i s can be the means of overcoming resistances, and of re-leasing p o s i t i v e forces which have l a i n dormant. 63 SCHEDULE 6 age Events i n Environment Mrs. Fournier Attitudes; or Behaviour b. 1908 an only o h i l d Father had a good work h i s t o r y . Mrs. F. said that he was s t r i c t but they had been c l o s e . He didn't drink or smoke, was "highly res-pected". Mother - kindly but dom-ineering "knows exactly what i s r i g h t or wrong". 12 Mrs. F. had whooping cough. She was said to have been "healthy before t h i s " . She had never bothered about housework 12 j before her marriage. Mrs. F. said that she went to many dances as a g i r l , a l -though t h i s did not seem consistent with the r e s t of the picture she drew. 25 She married Mr.F. a f t e r knowing him two months and becoming i l l e g i t i m -ately pregnant. He was weak, uncertain, s e l f -centred. 25 - 31 b i r t h of three c h i l d r e n . 32 Mr. F. e n l i s t e d and was sent overseas. 33 F o u r t h c h i l d born. Mr. F. was away from the home. Mrs. F. had been i l l dur-ing pregnancy and various neighbours had to look a f t e r the c h i l d r e n . The c h i l d r e n lacked t r a i n -ing and sometimes took things from the neighbours. 38 The oldest boy, Frank, was sent to Boys' I n d u s t r i a l School f o r s t e a l i n g . Mrs. F. verbalized how wonderful her parents were, what good pals, etc., but blocked with the a u t h o r i t a t i v e worker. Very l i t t l e resentment was expressed i n words. She said she and and her mother were "one i n heart, what one wanted the other one d i d " . When she said "I don't want that, Mother", she was threatened with a strap by her father and always gave i n . Married against the wishes of her par-ents, who said that they would care f o r her c h i l d so that she need not marry f o r t h i s reason. Mrs. F. was s i c k a great deal and worried about money. She was unable to give much security to the c h i l d r e n . She said she hadn't wanted more c h i l -dren a f t e r the second one. Mrs. F. stayed i n bed T a t e almost every morning. Meals were i r r e g u l a r , and poorly balanced, according to the School f u r s e . Although Mrs. F. looked i l l and complained of l i s t l e s s n e s s , she would not consult a doctor. Mrs. F. was worried about what the neighbours thought but seemed power-less to do more f o r the c h i l d r e n . Mrs. F. worried about Frank,but did not v i s i t him and had no plans f o r helping him a f t e r he returned to the home. '68 SCHEDULE 7 Mrs. Grove Age Events i n Environment Attitudes and Behaviour B. 1910 Mrs. G. was t h i r d i n a family of s i x . Her early development was normal, as f a r as i s known. 8 Her mother d i e d . 8 - 13 Various hoarding homes. 13 Father re-married. Mrs. G. speaks highly of her step-mother who died i n 1945. Apparent-l y she enjoyed v i s i t i n g her. 24 Married. Mr. E. had a "nervous breakdown". Mrs. G. considered that her marriage had been a happy one f o r years. Mrs. G's comments concerning t h i s indicated that she had understood i t ; a n d had not been overly-con-cerned about i t . 69 CHAPTER SIX The Fi v e • — Talent C l i e n t "Then he that had received the f i v e t a l e n t s went and traded with the same and made them other f i v e t a l e n t s " . Matthew 25: 16 Often the f i v e - t a l e n t man has been thought of as possessing outstand-ing s k i l l , o r acute business a b i l i t y , o r great personal charm. As i t i s used i n t h i s study, a " t a l e n t " f o r r e l a t i o n s h i p depends upon an honest a t t i t u d e towards oneself, a corresponding a b i l i t y to look at situa t i o n s and people with some o b j e c t i v i t y , and the capacity t o reach out with a f f e c t i o n and understanding to some people. Five cases i l l u s t r a t e how caseworkers used r e l a t i o n s h i p to help people who possessed those e s s e n t i a l c h a r a c t e r i s t i c s , and what the re s u l t s were. Mr. Hoar Mr. H. was referred to the family agency by h i s employer, be-cause of indebtedness. This was caused, i n part, by the f a c t that Mrs. H. ran up b i l l s , and frequently signed worthless cheques. She always denied having run up the b i l l s , or signed the cheques, u n t i l confronted with i r r e f u t a b l e evidence. The employer described her as "brighter than Mr. H.", who also seemed to have l i t t l e a b i l i t y in.managing money. Af t e r an exploratory period, during which the caseworker interviewed Mr. Hoar three times, i t was her opinion that he could r e l a t e to others i n a way that was s a t i s f y i n g and constructive. He always looks at him-s e l f f a i r l y honestly. He knows that he i s n ' t good at managing money, and that h i s judgment i s often f a u l t y . He recognizes, too,how dependent he i s on h i s wife, and that he loves her regardless of what she does. Mrs. Hoar seems t o represent t o him a mother-person whom he i d e a l i z e s , and whom he wants t o be p e r f e c t . He cannot bear to think that she has l i e d to him. Any trouble with h i s wife upsets him, although he can endure 70 other d i f f i c u l t i e s and f r u s t r a t i o n s f a i r l y calmly. In a d d i t i o n t o h i s love f o r , and dependence on h i s wife, Mr. Hoar i s fond o f his c h i l d r e n , and able to see them as i n d i v i d u a l s . He shows some resentment of the oldest boy who i s pampered by h i s wife, and whom he fears may copy some of h i s wife's behaviour, but t h i s seems to be a very normal reaction. In discussing h i s s i t u a t i o n , Mr. Hoar shows considerable a b i l i t y to be objective. He has no need t o project the blame on outside causes. I t i s p a i n f u l f o r him t o admit what Mrs. Hoar had done, but h i s f a i t h i n her never wavers. He maintained that she would no longer run up b i l l s which couldn't be ;met. At f i r s t i t looked as i f t h i s were j u s t w i s h f u l think-ing, but she d i d change, once a plan was presented which provided f o r the e s s e n t i a l expenses of the household. Chart H presents i n summary form why Mr. Hoar's a b i l i t y f o r r e l a t i o n s h i p i s considered to be good. The caseworker who attempted t o help Mr. Hoar was i n her f i r s t year of employment i n s o c i a l work, and had one year's t r a i n i n g i n a school of s o c i a l work. Her i n t e r e s t i n people was noticed at once by her c l i e n t s ^ and she was quick t o sense how they were f e e l i n g . She was secure enough h e r s e l f that she had l i t t l e need to be c r i t i c a l of the actions of others. She was able t o accept Mrs. Hoar's behaviour without being e i t h e r judg-mental or p e s s i m i s t i c . If she had been c r i t i c a l of Mrs. Hoar, even though that c r i t i c i s m had not been expressed, Mr. Hoar would probably have sensed i t . I t would have constituted too great a threat t o him, and he would not have been free to use the caseworker's help. Supportive help was attempted i n two areas: ( l ) to increase the s t a b i l i z i n g influence of the r e l a t i o n s h i p between Mr. and Mrs. Hoar and 71 (2) to add to Mr. Hoar's self-confidence. From the f i r s t Mr. H. eagerly accepted the help of the case-worker. He agreed to and kept regular appointments. A tendency to lean on the caseworker was noticed. He wanted her to speak to h i s c r e d i t o r s , and expressed great confidence i n the agency. "I f e e l that the weight of the world has been l i f t e d when I come to the o f f i c e " . Care was taken t o include Mrs. H. i n a l l planning, and to gain her co-operation. The budget was discussed with her, and changes made, following her suggestions. Even the d e t a i l s con-cerning the time and place of Mr. H's appointments were consider-ed with her. Assured of h i s wife's understanding, Mr. H. could use h i s energies i n reducing h i s debts. He showed capacity f o r hard work, and f o r following a budget that was r e s t r i c t e d to the bare e s s e n t i a l s . He undertook a day job as w e l l as h i s night one. This was a strenuous, but not an impossible arrangement f o r a l i m i t e d time. Mrs. H. realized that her husband could only carry on two jobs as he was freed of a l l r e s p o n s i b i l i t y and worry at home. She took pride i n managing the household so that he would get as much re s t as possible, and Mr. H. expanded under the a t t e n t i o n he re-ceived. The s t r a i n s i n the home were reduced to a minimum, and a s p i r i t of partnership p r e v a i l e d . Mr. H's confidence i n himself developed. At f i r s t he came to the o f f i c e before the payments t o the c r e d i t o r s were due, and discussed each step that he should take. He was l a t e r able to make the payments and discuss them i n more general terms a f t e r -wards. F i n a l l y he could arrange h i s payments f o r a month or more, without consulting with the caseworker. His pride i n accomplish-ment grew, and i n the f a c t that he could t r u s t h i s judgment more. His self-esteem developed too, as the caseworker emphasized h i s a f f e c t i o n f o r h i s home, and h i s d e s i r e t o do h i s best i n a d i f f i -c u l t s i t u a t i o n . There were other evidences of growth. Mr. H. became able to think of h i s wife i n a more objective manner. He could admit that she made mistakes without f e e l i n g g u i l t y about i t . As he gained more confidence i n h i s own judgment, he became less r i g i d than he had been. Whereas before he had refused to spend any money on recreation, he came to see that some recreation was nec-essary and that i t would add to family unity. The effectiveness of the work done with Mr. Hoar was due to h i s a b i l -i t y to use r e l a t i o n s h i p , and the caseworker's s k i l l i n d i r e o t i n g i t e f f e c -72 CHART H A b i l i t y to Relate Mr. Hoar 1. Conoept of S e l f Mr. H. often f e e l s inadequate. He i s not sure of h i s own opinion and needs assurance that h i s judg-ment i s sound. He has the a b i l i t y to c a rry out a plan of a c t i o n as long as he has the approval of 1 those on whom he i s dependent. He i s honest i n h i s assessment of himself. Rating: Good 4. A b i l i t y to Stand F r u s t r a t i o n Becomes worried and anxious when things a f f e c t h i s home l i f e . Is able to do two jobs without complain-ing and to follow a s t r i c t budget. Rating: Good 2. Seeing Real Feelings Mr. H. r e a l i z e s h i s de-pendence on Mrs. H. and h i s love fo r her, regardless of her be-haviour. He claimed that Mrs. H. was " s p o i l i n g " the eldest boy when he was probably jealous of her attentions t o the c h i l d . There was r e a l i t y about the " s p o i l i n g " . Rating: Good 5. A f f e c t Tone Much a f f e o t i o h - f o r h i s wife and c h i l d r e n . P o s i t i v e , courageous most of the time. E a s i l y discouraged when understanding r e l a t i o n s h i p with h i s wife i s threatened. Rating: Good 3. Ways of Coping wi t h R e a l i t y Mr. H. needs help i n getting Mrs. H. to fo l l o w the budget. He faces d i f f i c u l t i e s by t r y i n g to increase h i s own e f f o r t s . He i s a good workman, w i l l i n g to do the l i t t l e "extra" to help others. He i s able t o use the agency to help him i n planning. 6. Pattern o f Relationships With wife - a f f e c t i o n f o r and dependence on her. With c h i l d r e n - fond of them. Can see them as i n d i v i d u a l s . With f e l l o w workers and employer — i s liked«by them. Rating: Good Rating: Good 73 t i v e l y i n the helping process. She oould allow him to be dependent f o r a time, r e a l i z i n g his need f o r approval and support from a mother-person. She encouraged him i n h i s e f f o r t s to reduoe the pressures i n his s i t u a t i o n , to think c l e a r l y about the problems involved, and t o have increasing con-fidence i n h i s own judgment. In spite of inadequacies which he had shown i n the past, the caseworker treated him as a normal healthy i n d i v i d u a l . Without t h i s inherent b e l i e f i n h i s p o s s i b i l i t i e s , i t i s questionable whether Mr. Hoar could have responded as he d i d . Mr. Inkster Mr. Inkster needed the help of the agency when h i s wife l e f t the home, and a series of housekeepers proved unsatisfactory i n caring f o r the three c h i l d r e n . Mr. Inkster was at home i n a machine shop but had l i t t l e experience i n t a l k i n g about inta n g i b l e things l i k e r e l a t i o n s h i p . He was interviewed concerning the study but could only express a part of what working wi t h the caseworker had meant' to him. From the record and from the undertones of what he said, however, i t i s obvious that he had benefitted considerably from that a s s o c i a t i o n . Mrs. I. had decided t o l i v e away from the home because of frequent quarrels with her husband, and, more b a s i c a l l y , because her self-concern made i t impossible f o r her t o assume responsib-i l i t y f o r others. She continued to v i s i t the chil d r e n , however. For some time Mr. I. t r i e d to manage by h i r i n g housekeepers. Each one used the home p r i m a r i l y f o r her own ends. The c h i l d r e n suffered from the frequent changes and because some of the house-keepers were too permissive while others were too s t r i c t or i n -consistent. An experienced homemaker under agency supervision was placed i n Mr. I's home, and the r e s u l t s of a d d i t i o n a l s e c u r i t y were soon seen. As Mr. I. expressed i t , "As soon as the home-maker came I could go to work knowing that the c h i l d r e n would be a l l r i g h t . She knew how t o run the house and how to t r e a t c h i l -dren. They would know what to expect". He r e a l i z e d that t h i s was p a r t i c u l a r l y needed by his c h i l d r e n who were constantly be-ing upset by Mrs. I's v i s i t s to the home. With the assurance of good care f o r the chil d r e n , Mr. I. showed an increasing capacity to see t h e i r needs and to develop 74 . warm family t i e s . With pride he remarked, "My kids seem to be get-t i n g along even better than most of the kids i n the neighbourhood, where they have both parents i n the home". The caseworker who was working with Mr. Inkster was an experienced p r a c t i t i o n e r . She was we l l versed i n t h e o r e t i c a l concepts^and with ease was able to develop meaningful r e l a t i o n s with people. The record and Mr. Inkster's reactions show how great was her appreciation of him as an i n d i v i d u a l . Mr. Inkster's growing r e l a t i o n s h i p w i t h the caseworker i s shown i n l i t t l e i ncidents. Even without being able to see the f a c i a l expression, or to hear the tone of h i s voice, the words of the record t e l l of grow-ing understanding, and of Mr. Inkster's confidence i n the caseworker and i n the agency. At f i r s t Mr. I. consulted the caseworker only about the immediate problem of securing a housekeeper, and there were l i m i t s i n the r e l a t i o n s h i p . He resisted g i v i n g information about h i s debts.and did not see why such information was necessary to formu-l a t e plans f o r the c h i l d r e n . Since Mrs. I. had threatened him with the agency during times of m a r i t a l c o n f l i c t , he undoubtedly approached the agency f i r s t w i t h many misconceptions. Closely associated with the problem of providing adequate care f o r the children^was Mr. I's ooncern over the e f f e c t on them of Mrs. I.'s v i s i t s . Without the help of the caseworker, i t might have been impossible f o r him to deal with t h i s with any equanimity. Mrs. I. was e r r a t i c , g u i l t y about having l e f t the chi l d r e n , and c r i t i c a l of most of the homemakers. She fussed over the children,and t r i e d t o make opportunities to see them alone, so that she could " t a l k t o them l i k e a mother". Every v i s i t s t i r r e d up c o n f l i c t s i n the c h i l d r e n , and i t would be a few days before they could resume a normal pattern of behaviour. The caseworker encouraged Mr. I. t o t a l k about the d i f f i c u l t i e s as they arose. She made him more aware of what he had to contribute to the c h i l -dren, f o r Mrs. I.'s a t t i t u d e to him had been, fundamentally, one of depreciation. She gave recognition to the steadfast way i n which he t r i e d to understand and meet the children's needs. Mr. I. gained confidence i n himself. He could view the behaviour of his wife and the response of the c h i l d r e n with considerable ob-j e c t i v i t y . He could be p o s i t i v e and free from b i t t e r n e s s . Mr. I. began to use the caseworker to discuss h i s children's general welfare. This marked a step from the time when he used the agency only f o r a consideration of immediate problems. He 75 was aware of t h e i r i n d i v i d u a l d i f f e r e n c e s , and was a l e r t to see and use creative things that each one d i d . He was delighted with Tom's ingenuity i n fashioning a snow shovel, and with the lack of s e l f -consciousness of a l l the c h i l d r e n i n presenting a l i t t l e play. He taught Harry t o play f o o t b a l l , and encouraged an i n t e r e s t i n music. When Tom won the soap box derby, Mr. I. came t o the o f f i c e to t e l l the caseworker about i t , and was as pleased as the boy himself. The presents he gave at Christmas were o a r e f u l l y chosen to fu r t h e r stimulate the children's i n t e r e s t s . One of the s i g n i f i c a n t l i t t l e i n d i c a t i o n s of a developing re-la t i o n s h i p came i n an interview near Christmas. The worker said that she hoped Santa Claus would have a good Christmas, as w e l l as the c h i l d r e n . This pleased Mr. I. greatly,and he wished the work-er the greetings of the season too. Mr. I. found i t possible to t a l k even about d i f f i c u l t matters such as the caseworker's a t t i t u d e as i t had been reported to him by Mrs. I. Mrs. I. had stated that the worker, was supporting her i n plans f o r the c h i l d r e n with which Mr. I. did not agree. A f t e r discussing the matter,Mr. I. said that he could r e a l i z e now how things could get twisted. He wouldn't need to get upset again, l i k e t h i s , without checking up f i r s t . Because of the prospect of e v i c t i o n , plans f o r the c h i l d r e n were again i n an unsettled s t a t e . In spite of these problems Mr. I. seemed completely relaxed during the interview. At one point he s a i d , " I f we were going to look at things j u s t from a f i n a n c i a l point of view, i t would be cheaper to place the c h i l d r e n " . Then smiling, he added, "But we aren't doing t h a t " . One day when the chi l d r e n ' s school progress was being d i s -cussed, the caseworker asked Mr. I.'s permission to t a l k to the teachers about the c h i l d r e n . Mr. I. r e p l i e d , "You don't need to ask me i f you can do things l i k e t h a t " . 1:1 Mr. Inkster i n t a l k i n g about the caseworker mentioned what had hap-pened t o h i s family, (see Appendix A) and the inference was that she had helped those things t o come to pass. A family held together, c h i l d r e n developing normally, a man with h i s mind freed to do h i s work and to support h i s family — important things these. There were other areas of growth, not mentioned by Mr. Inkster be-cause he would not have been able to put them i n t o words. These too, were undoubtedly influenced to a considerable degree by the caseworker's use of r e l a t i o n s h i p . There was, f o r example, a developing sense of closeness to h i s own family. Mrs. Inkster's influence had kept the c h i l d r e n away from Mr. Inkster's r e l a t i v e s . I t i s possible that even be-76 fore h i s marriage Mr. Inkster had not been sure of h i s p o s i t i o n i n h i s parents' home. He commented: "I can j u s t telephone and t e l l them I'm coming", as i f , perhaps, he had not always been free to do so. Be that as i t may, he now spent h i s holidays w i t h h i s parents, and took one of the c h i l d r e n with him each time. There was confidence i n h i s r e l a t i o n s h i p with the ohildren. When complications arose which made i t impossible f o r him to take Tom with him on holidays, although i t was h i s turn, he said "But Tom w i l l under-stand". There was a balanced s e l f - r e g a r d . Mrs. Inkster had arranged to take a l l the c h i l d r e n with her on Sundays. Then she changed her mind and wanted only one. Mr. Inkster objected to t h i s change. I f she wanted Sunday t o be a time f o r v i s i t i n g the c h i l d r e n , she should take them a l l . "I come i n here, somewhere", he s a i d . "I'm with the c h i l d r e n a l l week, and Sundays I l i k e to play a game of g o l f with my f r i e n d Sam". His increased self-confidence enabled Mr. Inkster to deal with d i f f i c u l t s i t u a t i o n s w i t h greater e f f e c t i v e n e s s . At f i r s t he was not able to ask a housekeeper to leave the house even when t h i s seemed c l e a r l y indicated. In a second stage he could t a l k about i t with the caseworker,and go away from the interview more ready t o act. Later he was able to act with decisiveness when such a s i t u a t i o n arose i n the home. In a lengthy record about Mr. and Mrs. Inkster and t h e i r children, there i s l i t t l e information about Mr. Inkster*s early l i f e . (See Sched-ule 9 ) . Because Mr. Inkster was able to function i n a s a t i s f a c t o r y man-ner, there was no need f o r securing such information, and he volunteered l i t t l e . It could be assumed, however, that he must have had consider-77 CHART I A b i l i t y to Relate Mr. Inkster 1. Concept of S e l f 4. A b i l i t y t o Stand F r u s t r a t i o n Acceptance of s e l f . Security i n m o s t s i t u a t i o n s . Sense of goal. Sense of achievement. No need to impress others. When things didn't go we l l with house keepers, he said, "Things l i k e that take a while". He had constant trouble with wife but was able to concentrate on the children's needs. There were many changes i n housekeep-ers. He can accept the upsets a f t e r h i s wife's v i s i t s . Sometimes-, he displayed a vi o l e n t temper. Rating: Good Rating: Good 2. A b i l i t y to See Real Feelings 5. A f f e c t Tone 1. He saw c l e a r l y his f e e l -ings f o r his w i f e . 2. He knew how he f e l t about r e s p o n s i b i l i t y . He saw that he li k e d buying f o r the children, caring f o r them, and would miss i t . P o s i t i v e most of the time. Courageous. Capable of depth of a f f e c t i o n f o r the c h i l d r e n . Rating: Good Rating: Good 3. Ways of Coping with R e a l i t y 6. Pattern of Relationships He can accept added respon-s i b i l i t y such as the care of the chi l d r e n . He can see that Mrs. I. can't return t o the home. He does not need to use defence mechanisms often. With Father) - l i t t l e i s known but With Mother) he v i s i t s them. With Wife - fond of her, i n spite of her inadequacy - no bi t t e r n e s s . With Children - can see them as i n d i v i d -uals, and love them. With Housekeeper - f a i r , objective on the whole. With Friends - not much i s known. Appar-ently good. With Employers - s a t i s f a c t o r y . Rating: Good Rating: Good 78 able love and s a t i s f a c t i o n i n his early l i f e i n order to be as mature as events showed him t o be. Miss James Miss James was an unmarried mother who seemed capable of r e l a t i n g to others i n a f a i r l y mature way. The two biggest problems which Miss J . faced because of her pregnancy, were her fear of her mother's disapproval, and the necessity f o r c l a r i f y i n g her f e e l i n g s about the putative father. Her mother had died a few months previously, but not before Miss J . had become pregnant. She was i n c l i n e d to think that her mother had known about her c o n d i t i o n . If she had, what had been her attitude? Miss J . spoke of her mother i n glowing terms. She was "the most wonderful woman, the f i n e s t C h r i s t i a n " , etc. I t seemed cl e a r that unless she could be helped to f e e l f r e e r about her mother's at t i t u d e , her a b i l i t y to develop i n the future would be hindered. The putative father was a married man, who talked of secur-ing a divorce and marrying Miss J. but did nothing about i t . She had come to know him when she was working i n a neighbouring c i t y . Although she was over t h i r t y , Miss J . had had no friendships with men, and i t was the f i r s t time that she had been strongly a t t r a c -ted to a member of the opposite sex. She had thought that she was much i n love, and only the idea of marriage t o him i n the future gave her courage to meet the d i f f i c u l t i e s of her s i t u a t i o n . Miss James was f r i e n d l y and frank about her s i t u a t i o n from the f i r s t , but i t took time f o r her t o f e e l f r e e enough to t a l k about her r e a l f e e l -ings. She could never admit that she had had h o s t i l e f e e l i n g s towards her mother, but could t a l k about her concern over what her mother would have thought about her pregnancy. Miss James was helped t o think out how she would f e e l i f a daughter of hers had acted as she had. She saw that love does not condemn but understands. Since she was convinced that her mother was so much better than she, she was relieved of much of the burden of f e a r concerning her mother's disapproval. The worker t r i e d t o reinf o r c e Miss James' i n t e l l e c t u a l understand-ing by an emotional experience. She consciously assumed a mother r o l e 79 and emphasized with Miss James her strong points, of which there were many, and stressed that i t was the way i n whioh a person met h i s problems which was of utmost importance. The process of s o r t i n g out her f e e l i n g s f o r the putative f a t h e r was a long and p a i n f u l one f o r Miss James, but she emerged stronger because of the struggle. Slowly she saw that i t wasn't r e a l i s t i c t o think of marriage to him, i f he contemplated taking no step to get a divorce. She showed s e n s i t i v i t y too^about what a divorce would mean to h i s wife and c h i l d r e n . She could t a l k about her v a s c i l l a t i o n between accepting the idea of a future without him, and being overwhelmed with loneliness and longing to hear h i s v o i c e . During t h i s process the caseworker was care-f u l t o l e t Miss James take her own time. She t r i e d t o convey to Miss James the f a c t that she had confidence i n her a b i l i t y to think the matter out i n a mature manner. At the same time she stood ready t o help where-ever help was needed. There were some s i g n i f i c a n t signs of developing maturity. Miss James had shown considerable concern about a neighbour across the street f i n d i n g out about her c o n d i t i o n . The neighbour was "very r e l i g i o u s " and would be most c r i t i c a l , she thought. One day she announced that she had t o l d the neighbour. She had argued that the woman would probably findl out anyway, but that she might appreciate being t o l d by Miss James her-s e l f . She had been amazed at the understanding a t t i t u d e of the neighbour. When the question arose as to whether Miss James should see her.baby or not, some of the things to be considered i n t h i s matter were discussed with her. Without f u r t h e r help she was able to make her own d e c i s i o n to see the baby once, while i n h o s p i t a l , and again before he was placed f o r adoption. Several times afterwards she commented on how s a t i s f i e d she 80 CHART J A b i l i t y to Relate Miss James 1. Concept of Self Miss J . assesses her a b i l i t y accurately and has confidence that she can succeed at a job and get along with people. There i s doubt i n her mind about her value as a person when she goes contrary to her mother's standards. Rating: Good 4 . A b i l i t y to Stand F r u s t r a t i o n When the g i r l s at work asked Miss J . i f she were pregnant, she admitted that she was, without undue embarrass-ment or self-blame. She described her-s e l f as a peaceful person who would give i n to others, rather than assert her r i g h t s . Although she has r e a l f e e l i n g f o r her c h i l d she can place him f o r adoption. f Rating: Good 2 . A b i l i t y to See Real Feelings Miss J . seems able t o recog-nize and to admit her r e a l f e e l -ings. She knows that she f e l t g u i l t y about her mother, She had probably repressed any of her f e e l i n g s of h o s t i l i t y . She can express her l o s t reaction as she re a l i z e s that the putative father does not intend to marry her. Rating: Good 5. Af f e c t Tone P o s i t i v e . Courageous most of the time. Capable of depth of f e e l i n g . Rating: Good 3. Ways of Coping with R e a l i t y Miss J. was straightforward i n t e l l i n g her father of her con-d i t i o n , and others who needed to know. She can acoept some f i n -a n c i a l help from the putative fa t h e r but i s ready to assume much o f the r e s p o n s i b i l i t y her-s e l f . She seems t o have no need to project blame or to r a t i o n a l i z e . There i s repress-ion concerning her mother. 6. Pattern of Relationship With Mother - can only express admira-t i o n f o r her, but doesn't t a l k of a f f e c t i o n . With Father - shows a f f e c t i o n f o r him and can confide i n him. With S i s t e r - a good r e l a t i o n s h i p as adults. With Women - mixes e a s i l y with women her own age and assumes some leadership. With Men - l i m i t e d experience. With her o h i l d - can consider h i s wel-f a r e . In her job - gets along w e l l both • with employer and with the p u b l i c . Rating: Good Rat ing: Good she was with t h i s d e c i s i o n . Miss James began t o pay more attention to her personal appearance, and she made plans t o take s p e c i a l t r a i n i n g which would widen her choice of jobs. She talked about what mature love involved, and of her hope that she would marry and have other c h i l -dren. Miss James' a b i l i t y to take the p r a c t i c a l steps mentioned, and to think about h e r s e l f and the problem confronting her i n a more mature way, were c e r t a i n l y influenced by her r e l a t i o n s h i p with the caseworker. The progress made shows how the ego strength of the worker was used to r e i n f o r c e Miss James' egoywhich had been weakened by the pressures i n -volved i n her s i t u a t i o n . Because the.worker, i n the parental r o l e showed acceptance, Miss James i s able t o modify her over-severe super-ego. She has more confidence i n h e r s e l f . She i s f r e e r to develop her own re-sources and, i n so doing, f i n d more s a t i s f a c t i o n i n l i v i n g . Miss James was l i m i t e d i n her a b i l i t y to express i n words what the r e l a t i o n s h i p with the caseworker had meant to her. What she said seems to bear out the v a l i d i t y of the conclusion j u s t made, however. "I don't know what I would have done i f I hadn't known Miss Pearson. Talking to her seemed to make me forget things, made me think the world wasn't such a h o r r i b l e place a f t e r a l l . There was something about her that I didn't want t o lose. She was someone who had shared a secret with me, someone i n whom I could confide. The way she treated me was the same as though my mother was here, and I'm sure she would have looked a f t e r me as Miss Pearson d i d . She was so understanding. What I did was wrong, and yet she made me f e e l that she had f a i t h i n me". Mrs. Kroner Mrs". Kroner came to the agency f o r advice conceming J"family; p'rbb-82 lems, and her r e l a t i o n s h i p with the caseworker remained, f o r the most part, on a r e a l i t y b a s i s . Mrs. K.^an a t t r a c t i v e i n t e l l i g e n t woman of thirty-five^,con-sulted the agency on two occasions about d i f f i c u l t i e s she was en-countering. The f i r s t time she wanted to discuss whether she should leave her husband. He was a quiet, rather i n e f f e c t u a l man who found i t d i f f i c u l t to earn an adequate income, whereas f o r Mrs. K. i t was easy to be successful i n business ventures. On a business t r i p she had met and become infatuated with a man who seemed to possess the strength and decisiveness which she had always admired i n her father. I f Mrs. K. l e f t her husband she could lake her daughter, aged twelve, with her, but her son, who was f i f t e e n , had declared that he would stay with Mr. K. As her f e e l i n g s about her s i t u a t i o n were explored, i t became evid-ent that Mrs. Kroner loved her c h i l d r e n , and that her marriage to Mr. Kroner met many of her needs. To leave home would almost undoubtedly r e s u l t i n a deep sense of g u i l t . When ps y c h i a t r i c opinion confirmed the caseworker's diagnosis, these conclusions were shared with Mrs. Kroner. She agreed tha t the happier way f o r her would be to remain at home. Con-t a c t with the other man was broken, and with renewed energy she set about giving to Mr. Kroner the support he needed i n order to be more successful. A f t e r a period of more than two years Mrs. Kroner came again to the agency, t h i s time asking f o r help i n dealing with her teen-aged daughter who was doing some l y i n g and s u r r e p t i t i o u s l y reading books l i k e "Nana". She was reassured when she saw that her daughter's behaviour was f a i r l y normal f o r her age, but apparently needed t h i s assurance from someone with special t r a i n i n g and experience. She showed that with a f u l l e r un-derstanding she could modify her attitudes t o a considerable degree. Mrs. Kroner draws d e l i b e r a t e l y on the s p e c i a l understanding of family problems which she believes the agency possesses. Her r e l a t i o n -ship i s to the agency rather than t o a p a r t i c u l a r worker, and the f a c t that she had three d i f f e r e n t caseworkers perturbs her not at a l l . The 83 agency seems to represent t o her a dependable authority which she lacked i n her own family experience. (See Schedule l l ) . More sure of h e r s e l f because she has discussed her problem with people i n whose judgment she t r u s t s , she can proceed to cope with her s i t u a t i o n with a sense of adequacy. The interview held with Mrs. Kroner, to discuss what the r e l a -t i o n s h i p with the caseworker had meant to h e r , i l l u s t r a t e s these points. I met Mrs. K. down town as had been arranged. She was looking very smart and seemed happy t o have a chance to do something f o r the agency. She said that, to her, the agency was a place where you could go when you were i n trouble. You might know some of the answers yourself, but i t helped you to be sure, when you got the opinion of experts. I wondered what she meant by t h i s . Mrs. K. was a l i t t l e i n a r t i c u l a t e here. She knew that, cases were studied. The workers would have had experience with many cases a l i t t l e l i k e hers. She. couldn't remember how she had known about the agency. (F.W.B. had interviewed Mrs. K. some years before about d i f f i c u l t i e s i n her parents' home). Then she said "I don't remember how I f i r s t came, but I wouldn't have returned unless I'd received help, would I?" I mentioned casually, that Mrs. K. had had several d i f f e r e n t work-ers i n the agency. She commented that she didn't r e a l l y remember any of them except Mrs.Edis, and s i g n i f i e d that the early contact had been p a i n f u l . (This was when Mrs. K. was considering leaving her husband). Mrs. Edis had helped her so much about Connie. She hadn't understood about Connie's l y i n g , and Mrs. Edis had explained i t so w e l l . She'd seen that she was p a r t l y to blame, and that, sometimes Connie was l y i n g i n order to please her. Once she'd un-derstood, there hadn't been much trouble. Occasionally Connie would s t i l l l i e , but then she' say, "I guess i t wasn't exactly that way". Mrs. K. had been helped, too, by Mrs. Edis' explanation about g i r l s reading rather sensational s t o r i e s . She'd never thought of her reading the Doctor book, as a teen-ager, being the same as Connie reading " K i t t y " and "Nana" today. She'd talked to Connie about i t , but she hadn't worried any more. She was so glad t h a t the agency had given her the advice they had, f o r now she and Mr. K. were getting along w e l l together. "My husband i s becoming the man I always wanted him to be". She. t o l d of h i s reading the newspapers regularly since he knew that she wanted him to be able t o discuss current a f f a i r s . He'd gained more confidence and was going into business f o r himself up north. She was sure he'd make good. As i f not wishing to dwell on i t , she said that i t would have been awful i f t h e i r home had been broken up. I t wouldn't have been f a i r to the chi l d r e n , and she wouldn't have been happy. 84 CHART K A b i l i t y t o Relate Mrs. Kroner 1. Concept of S e l f 4. A b i l i t y to Stand F r u s t r a t i o n Mrs. K. had no sense of be-longing anywhere p r i o r to marr-iage. Lack of confidence i n her own judgment i s shown i n r e l a t i o n to family problems. In other areas she i s confident. Able to endure low income and un-desirable housing conditions f o r years She was able t o stay with her husband, when she saw that t h i s was wise, a l -though she wanted t o go with the other man. Rating; Limited Rating! Good 2. Seeing Real Feelings 5. A f f e c t Tone She appeared t o be confus-ing the man she said she loved with her father. She wished t h i s man.had been the father of her o h i l d r e n . Mrs. K. saw her f e e l i n g s toward Mr. K. c l e a r l y and could admit that she be-came angry at him because she was l i k e Mr. K. Mrs. K. shows some r i g i d i t y but she can change her a t t i t u d e s . There i s ambivalence but i t doesn't c r i p p l e constructive action. Warmth of f e e l -ing exists but perhaps not great depth. Ratings Good Rating! Good 3. Ways of Coping with R e a l i t y 6. Pattern of Relationships Could admit that her a t t i t -udes influenced the children's behaviour. Could seek help with problems. No need t o project blame. Dominating with her son and her husband. Some i n d i c a t i o n of desire f o r dependency i n her wish to marry the aggressive man who would make de-c i s i o n s for her. The children's symp-toms show that the a f f e c t i o n she gave them was l i m i t e d . Rating! Good Rating: Limited 85 Mrs. Kroner uses the r e l a t i o n s h i p with the caseworker i n a way d i f f -erent from that shown i n some of the preceding cases. The q u a l i t y of that r e l a t i o n s h i p i s , however, as important here as elsewhere. Had Mrs. Edis and the e a r l i e r workers not possessed knowledge about human behavi-our, Mrs. Kroner would not have regarded them as "experts". Had they not been able to create a f e e l i n g of warmth and acceptance, she would not have been free t o reveal her worries, to t a l k with honesty about her own emotions, or t o t r y out some of the suggestions made. The professional r e l a t i o n s h i p continues to provide the atmosphere i n which help can be re-ceived. The cases presented i n t h i s chapter show that when the c l i e n t s have a greater a b i l i t y to r e l a t e t o others i n a s a t i s f y i n g manner the case-worker has an opportunity to help them i n a s i g n i f i c a n t way. They are more able t o cope with d i f f i c u l t s i t u a t i o n s . Self-understanding can be increased. The r e l a t i o n s h i p with the caseworker can be used to re-inforce e x i s t i n g strengths, t o decrease neurotic elements, and to re-lease the constructive c a p a c i t i e s of the i n d i v i d u a l . SCHEDULE 8 86 Mr. Hoar Age b. 1914 9 24 28 Events i n Environment V i s i t e d Mrs. H. i n Canada. She was seven years old. Went into the permanent army. Came t o Canada. Af t e r s i x months married Mrs. H. Joined the Canadian Army. Bi r t h of c h i l d r e n . A f t e r discharge from the army Mr. H. d i d u n s k i l l e d work. Attitudes or behaviour Corresponded with Mrs. H. although he had not seen her since she was a c h i l d . He was fond of h i s .children and seemed able to see them as i n d i v i d -uals. He .was a good worker, was l i k e d by h i s employers and got along w e l l with h i s fellow employees. SCHEDULE 9 87 M r . I n k s t e r E v e n t s i n E n v i r o n m e n t y o u n g e s t o f t e n . He was s m a l l i n s t a t u r e . M r s . I . s t a t e d t h a t h e n e v e r l e a r n e d t o c o n -t r o l h i s temper and was n e v e r s p a n k e d . M o t h e r - i s d e s c r i b e d as d o m i n e e r i n g . M a r r i e d M r s . I . who was p r e g n a n t . H i s f a m i l y c o n s i d e r e d s u p e r i o r t o M r s . I . ' s . On r e l i e f Three and o n e - h a l f y e a r s p a r t - t i m e w o r k . On and o f f r e l i e f . B i r t h o f c h i l d r e n L e g a l s e p a r a t i o n . R e c o n c i l i a t i o n . A t t i t u d e s o r B e h a v i o u r C o n c e r n e d o v e r s m a l l s t a t u r e . Had i n f e r i o r i t y f e e l i n g s . L e a r n e d t o b o x w i t h o u t h i s p a r e n t s ' k n o w l e d g e . . I n l o v e w i t h M r s . I . A n t a g o n i s t i c t o a l l s o c i a l a g e n c i e s . He t r i e d t o k e e p w o r k i n g a l t h o u g h income n o t more t h a n r e l i e f . Went w i t h o u t t w o m e a l s a d a y so c h i l d r e n w o u l d h a v e e n o u g h . S . H . s a i d he had a t e n d e n c y t o l e t o t h e r s assume h i s r e s p o n s i b i l i t y . 88 SCHEDULE 10 Miss James Events i n Environment She had one s i s t e r who was three years o l d e r . Her parents were born i n Europe, but they ad-apted themselves quickly to l i f e i n Canada. Lef t school, having com-pleted Grade Ten. Remained at home to help her mother who was f r e -quently i l l . Worked at a lunch coun-t e r . Was manager of the lunch counter. Worked i n a store. Became pregnant by a mar-r i e d man. B i r t h of the c h i l d . Attitudes and Behaviour Mrs. J. described her l i f e as a c h i l d as a happy one. She couldn't see how her mother could have been a better person. She quarrelled with her s i s t e r as a c h i l d but they now get along w e l l . Miss J's subsequent actions showed a f f e c t i o n f o r her father and confidence i n him. Miss J . said that at t h i s time she was shy and a f r a i d of meeting people. Her s o c i a l a c t i v i t i e s were with groups of g i r l s . Being forced to meet people she over-came her shyness, she said. Enjoyed the work and the r e s p o n s i b i l -i t y of the job. Miss J. thought that she was i n love with the man and looked forward to marriage a f t e r a divorce could be se-cured. Miss J's a t t i t u d e to the c h i l d was always warm but she remained sure of her d e c i s i o n regarding adoption place-ment . SCHEDULE 11 89 Mrs. Kroner Age Events i n Environment b. 1911 B u l l i e d by her father who had a severe temper. He was considered hyst-e r i c a l and possibly psy-c h o t i c . The parents quarrelled c o n t i n u a l l y . 18 Married. 20 Son born. Mrs. K. had d i f f i c u l t y with him as at eight he was des-cribed as mean, d i s o -bedient, rough. 23 Connie born. Mrs. K. was seriously i l l following her confine-ment. Mrs. K's mother began to neglect her housework to go out with unsuit-able companions. She appeared t o be promiscu-ous. I t was necessary f o r the agency, who were working with Mrs. K's parents^to consult her at t h i s time. Mrs. K. did not l i k e her father but admired h i s aggressiveness. She had no sensenof belpnging at home. She said that one of her reasons f o r marrying was to get away from home. Attitudes or Behaviour Mrs. K. did not mention t h i s previous contact. She did however, come to the agency when she wanted advice about her m a r i t a l problem. 9 0 CHAPTER SEVEN Treatment Methods Used and Their Effectiveness Treatment methods are but channels through which relationship is used. To be effective channels they must be carefully chosen to meet the particular need of the client. On the basis of his psycho-social situation, which includes his a b i l i t y to relate to people, a decision must be reached as to how each client can be helped the most. Does he need assistance i n modifying environmental pressures which are thwart-ing him? Is supportive help what he wants right now? Could he res-pond to his situation with better judgment, with more courage or with less h o s t i l i t y i f the worker emphasized his strengths, affirmed his positive attitudes, and gave assurance of interest and understanding? It may be that a clearer understanding of his situation and the people i n i t i s a l l that i s necessary^for one person to be able to deal with his problems more constructively. For another the cause of present d i f f i c u l t i e s may l i e buried and unrecognized within himself. If so^does he really want to understand himself more fully? Has he sufficient maturity to take this step? What, for each one, is the most suitable vehicle to use? How does an assessment of the client's ab i l i t y to relate to others influence this choice? For ease i n discussion the classification of treatment methods 14b outlined by Florence Hollis in "Women in Marital Conflict" is used here. 1. "Environmental modification" is used to refer to the steps taken by the caseworker to change the environment i n the client's fav-14b. Hollis, Florences Women in Marital Conflict, Family Service Association of America, New York, 1949. 91 our by the worker's d i r e c t a c t i o n x x x x In general, such environmental modi f i c a t i o n i s undertaken by the caseworker only when environmental pressures upon the c l i e n t are beyond the l a t t e r ' s c o n t r o l but can be modified by the caseworker, or when exact pressures are much more l i k e l y to y i e l d to change when handled d i r e c t l y by the worker rather than by the c l i e n t himself. 2. "Psychological support" embraces processes used frequently by every caseworker. I t covers such steps as the following: encouraging the c l i e n t to t a l k f r e e l y and express h i s f e e l i n g s about h i s s i t u a t i o n ; expressing sympathetic understanding of the c l i e n t ' s f e e l i n g s and acceptance of h i s behaviour; i n d i c a t i o n of the caseworker's i n t e r e s t i n the c l i e n t , his desire to helpj expression of the worker's confidence that a way can be found t o improve the s i t u a t i o n , confidence i n the c l i e n t ' s a b i l i t y to solve h i s d i f f i c u l t y , t o make h i s own decisions; i n -d i c a t i o n of the worker's respect f o r and approval of steps the c l i e n t has taken or i s planning where these attitudes are r e a l i s t i c a l l y warranted. A l l these are designed to r e l i e v e anxiety and f e e l i n g s of g u i l t and to promote the c l i e n t ' s confidence i n h i s a b i l i t y to handle h i s s i t u a t i o n adequately. Also included i n psychological support i s the d i r e c t encouragement of attitudes that w i l l enable the c l i e n t to f u n c t i o n more r e a l i s t i c a l l y as w e l l as more comfortably. This may take the form of encouraging the c l i e n t to assert h i s own desires i f he has a tendency toward too easy submissiveness, or h i s right to pleasure i f he has an oversevere con-science, or, on the other hand, of supporting more responsible behaviour i f a weak super-ego i s cr e a t i n g d i f f i c u l t y . Under c e r t a i n circumstances 92 psychological support may a l s o include giving advice about contemplated actions or suggestions of appropriate steps f o r the c l i e n t to take. When psychological support i s the predominant treatment method, i t rests upon a warm, good-parent type of r e l a t i o n s h i p between c l i e n t and worker. Because the worker i s primarily permissive and giving, p o s i t i v e f e e l i n g s rather than negative transference components are c h a r a c t e r i s -t i c a l l y placed upon the worker. Discussion material comes from the con-soious l e v e l of the mind ^though i t s unoonscious implications may be c l e a r to the worker. The emphasis i n psychological support i s not on the development of understanding by the c l i e n t but rather on r e i n f o r c i n g h i s ego strengths through guidance and release of tension and through reassurance, x x x x 3. " C l a r i f i c a t i o n " . A process which, i n some degree, usually accompanies psychological support i n a c t u a l p r a c t i c e i s c l a r i f i c a t i o n , sometimes c a l l e d counseling. The dominant note i n c l a r i f i c a t i o n i s un-derstanding — understanding by the c l i e n t of himself, h i s environment and/or people with whom he i s associated. I t i s directed toward increas-ing the ego's a b i l i t y to see external r e a l i t i e s more c l e a r l y and to un-derstand the c l i e n t ' s own emotions, at t i t u d e s , and behaviour. This un-derstanding may range i n q u a l i t y from a simple i n t e l l e c t u a l process of thinking through matters that are uncomplicated by strong emotion, to a deeper comprehension of a t t i t u d e s and f e e l i n g s of considerable emotion-a l content, x x x x 4 . "Insight". Insight development involves carrying understanding to a deeper l e v e l than that described i n c l a r i f i c a t i o n . ..Sometimes con-f l i c t i n g f e e l i n g s and strong emotions lead the i n d i v i d u a l t o d i s t o r t r e a l i t y so s e r i o u s l y or react to i t so inappropriately that understand-ing i s impossible without the deeper perception we are r e f e r r i n g to as i n s i g h t . In such cases the worker must help the c l i e n t to modify h i s strong p r o j e c t i o n of inner needs and subjective responses upon the outer world — h i s magnification of careless s l i g h t s into evidence of hatred or complete los s of love, h i s misunderstanding of chance remarks as sev-ere c r i t i c i s m s , h i s r e a c t i o n of anxiety or h o s t i l i t y without s u f f i c i e n t provocation, x x x x In ins i g h t development the worker i s helping the i n d i v i d u a l to be-come aware of faotors below the l e v e l of h i s consciousness which are ad-versely a f f e c t i n g h i s current behaviour. For the most part, these are f e e l i n g s and c o n f l i c t s that have been suppressed or repressed e i t h e r re-cently or i n the l a t t e r years of ohildhood and adolescence rather than i n early childhood, though an occasional memory may break through, x x x Insight development i s always accompanied by some degree of c l a r i -f i c a t i o n and of psychological support, x x x x Psychological support often provides the base upon which the c l i e n t ventures to move on to the more d i f f i c u l t process o f achieving i n s i g h t . . . . . In the cases studied i n Chapter Six combinations of treatment methods are used, i n which environmental m o d i f i c a t i o n and psycholog-i c a l support predominate. This i s what would be expeoted. The one-t a l e n t c l i e n t creates d i f f i c u l t i e s because he does not know how to get along with others. Pressures i n the environment w i l l frequently be too great f o r him t o manage by himself. He needs psychological support also, to s t a b i l i z e and t o strengthen him so that he may p r e c i p i t a t e fewer d i f f i c u l t s i t u a t i o n s , and deal a l i t t l e more wisely with those which occur. I f , however, h i s c o n v i c t i o n that the world i s h o s t i l e i s 94 too deep, the c l i e n t i s not able to allow the caseworker to assume the good-parent r o l e , or to receive assurance and support from him. Where c l a r i f i c a t i o n i s used w i t h c l i e n t s such as these i t needs to be li m i t e d t o simple s i t u a t i o n s where not too much emotional tone i s involved. Otherwise, t h i s process, which c a l l s f o r some degree of ob-j e c t i v i t y i n r e l a t i o n s h i p to s e l f and to others, w i l l be beyond the a b i l i t y of the c l i e n t . Insight development necessitates a f a i r l y strong ego. To be used as a treatment method there needs to be a desire on the c l i e n t ' s part to understand himself better. Because the one-talent c l i e n t usually does not possess e i t h e r the well-developed ego, or the desire to see himself more r e a l i s t i c a l l y , i n s i g h t development i s seldom a sui t a b l e channel through which help can be given t o him. In discussing the effectiveness of the treatment methods used, i t i s important to keep i n mind that t h i s study i s limited to an examina-t i o n of r e l a t i o n s h i p . Instead of considering casework movement as a whole, or the s p e c i f i c changes which occurred as outlined by Hunt and 15 Kogan, a t t e n t i o n i s directed only to any changes noted i n the c l i e n t ' s a b i l i t y to r e l a t e . The c r i t e r i a used at the beginning of the study of each case are used again at the end. No attempt i s made to grade the degrees of change i n r e l a t i o n s h i p a b i l i t y which are noted. It i s d i f f i c u l t to determine how much of any change i n a b i l i t y to rel a t e i s due to the co n t r i b u t i o n of the caseworker,and how much to other oauses. The caseworker usually sees the c l i e n t f o r not more than one hour per week. Many other influences bear upon him during that 15. Hunt, J . McV. and Kogan, Leonard Ss Measuring Results i n S o c i a l Casework, Family Service Association of America, New York, 1950. week and may a f f e c t changes f o r him or w i t h i n him. The degree to which any change which occurred was the d i r e c t r e s u l t of the c l i e n t ' s r e l a -t i o n s h i p with the caseworker tends to he a subjective judgment. It i s no more subjective, however, than many other judgments made constantly by s o c i a l workers i n the course of t h e i r work. In an attempt to be as objective as possible, statements about the development of the c l i e n t ' s a b i l i t y t o relate i n the oases studied have been checked with the case-worker involved, and i n some instances have been substantiated by the remarks of the c l i e n t s themselves. The One-Talent C l i e n t s With Mrs. Arnott^the worker sought t o modify environmental pres-sures by g i v i n g her the clothing and a r t i c l e s which she could not se-cure on a l i m i t e d budget. Psychological support was attempted but Mrs. Arnott could make l i t t l e response. Her previous experiences seemed to have convinced her that she could not be important to people. The help given t o Mr. B e l l , who wanted to f i n d h i s son, was psycho-l o g i c a l support, combined with a small amount of c l a r i f i c a t i o n . He was able to respond a l i t t l e to the i n t e r e s t shown and the encouragement given. His l e v e l of a b i l i t y i n r e l a t i n g to others rose a l i t t l e . A f t e r a period of intermittent work, Mr. B e l l secured a job which was w i t h i n h i s capacity, and he was able to stay at i t . He could admit that t h i s job as a night watchman "wasn't much". It j u s t meant stoking and sweeping. This a t t i t u d e was i n d i r e c t contrast to h i s previous need to exaggerate the importance of jobs. His i n t e r e s t i n people ex-panded a l i t t l e . He commented that he enjoyed the companionship of policemen who c a l l e d i n while he was at work. 96 An increased a b i l i t y to see r e a l i t y was evidenced i n Mr. B e l l ' s d i s -cussion about A l l a n . He seemed t o r e a l i z e that getting to know A l l a n would be a long slow process, and that i t would sometimes involve disap-pointment and a sense of f r u s t r a t i o n . Sometimes he saw that A l l a n would have mixed feel i n g s over suddenly having a father. This more r e a l i s t i c manner of looking at things could not be a sustained one, but even the " f l a s h e s " of understanding were an i n d i c a t i o n of growth. Without the added se c u r i t y a r i s i n g from the support of the caseworker, he could not have considered the reactions of anyone but himself. The caseworker t r i e d to help Mrs. Coulter, who always had to be r i g h t , through modifying the environment, and by the use of psycholog-i c a l support and c l a r i f i c a t i o n . Because she considered that the greatest d i f f i c u l t y i n her s i t u a t i o n was her husband, regular interviews were held with him. While he was able t o see some of the causes of Mrs. Coulter's behaviour and h i s own, he continued t o think that her reactions were c h i l d i s h ones, and to become impatient with her. F a i l i n g t o get the "perfect" support and a f f e c t i o n from her husband whioh she demanded, Mrs. Coulter continued i n her old pattern of behaviour. The caseworker's use of c l a r i f i c a t i o n brought no r e s u l t s , and probably added to Mrs. Coulter's confusion, since the more objective attitudes involved i n that process were beyond her l e v e l of development. Any use of t h i s method probably meant to her t h a t the caseworker didn't r e a l l y understand her. Mrs. Dean, who was sorry f o r h e r s e l f because of her eczema and the inconsiderateness of her husband, came t o the agency asking that several things i n her environment be made easier f o r her, but she res-ponded to the supportive help given, and was enabled to take more res-p o n s i b i l i t y h e r s e l f . The caseworker would not have been using her r e l a -97 tionship with Mrs. Dean wisely i f she had acceded to her desires without a c a r e f u l diagnosis of her real needs. The methods used i n working with Mrs. East stemmed from the caseworker's co n v i c t i o n that Mrs. East was i n need of ps y c h i a t r i c help. Mrs. East's un-conscious needs prevented her from changing her attitudes to her husband and to Mary, but with encouragement from the worker, she was able to move towards getting help with the central problem — her own i n t e r n a l c o n f l i c t . Like Mr. B e l l , she was able to use the caseworker to a li m i t e d extent to c l a r i f y some of her problems. Most important of these was her need f o r p s y c h i a t r i c help. Where the l e v e l of r e l a t i o n s h i p a b i l i t y has been c o n s i s t e n t l y low, l i t t l e improvement would be expected. I t i s so i n the cases which have just been discussed. The methods chosen i n almost every case were appropriate but l i t t l e happened. Behind the pressures and anxi e t i e s of the moment are the deeply intrenched habits o f t r y i n g to s a t i s f y needs i n ways that can never y i e l d s a t i s f a c t i o n . Even i f a s p e c i f i c pressure could be completely eliminated, a new one would soon be created. I f one need were met, ten others would take i t s place. But even the l i t t l e that i s accomplished adds by that much to s a t i s f y i n g and constructive l i v i n g and so i s worth while. The Two-Talent C l i e n t s The methods used i n working with Mrs. Fournier and Mrs. Grove are not d i f f e r e n t from those already described, but the a b i l i t y of these two women to respond to them was a l i t t l e greater. Mrs. Fournier, overwhelmed as she was by work, and the problems of the c h i l d r e n , and the f r u s t r a t i o n of never being appreciated, could s t i l l understand how her c h i l d r e n and her husband might react t o si t u a t i o n s . Mrs. Grove, deserted by her husband, s i c k and f e a r f u l of the future, could think of the welfare of others once she her-s e l f found acceptance. These women had encountered many d i f f i c u l t i e s , and 98 had been c r i p p l e d by some of them. They retained, however, some a b i l i t y to respond t o others, some capacity t o believe i n people, some f l e x i b i l i t y which would make growth possible. Mrs. Fournier's response t o the two workers i l l u s t r a t e s i n a v i v i d man-ner that any method of helping i s i n e f f e c t i v e except as i t i s an i n t e g r a l part of a r e l a t i o n s h i p where there i s confidence, and a lowering of defences, and j o i n t p a r t i c i p a t i o n i n the helping process. The f i r s t worker t r i e d en-vironmental manipulation, overlooking the f a c t that l i t t l e change could be effected unless Mrs. Fournier wanted t o work at t h i s task too. She f a i l e d to see that the only thing which would enable Mrs. Fournier to make any move would be the in t e r e s t and acceptanoe shown by the worker. Because i t was not seen as esse n t i a l t o treatment, psychological support was not used. In Chapter Five Mrs. Fournier's response t o a d i f f e r e n t a t t i t u d e on the part of another worker, and the use of psychological support as a method has been discussed. In the case of Mrs. Grove the methods used at the end were the same as those used i n the beginning. The change was i n Mrs. Grove*'s a b i l i t y to make use of the help extended. I t was as i f the worker b u i l t a f i r e at which she hoped that Mrs. Grove could warm h e r s e l f . The f i r e remained un-l i t , however, u n t i l suddenly a f u l l e r acceptance, a greater f a i t h kindled i i t . Returning t o the methods used, the caseworker did not undertake to modify any of the pressures i n the environment where Mrs. Grove could do i t for h e r s e l f . She did need assistance, however, i n ascertaining what l e g a l steps she could take to protect the c h i l d r e n from her husband. She also needed help i n making plans f o r the ch i l d r e n . Environmental modification i n t h i s case, as i n so many others, involved counselling as we l l , and there were constant e f f o r t s t o encourage Mrs. Grove, to remind her of her 99 strengths, to support her as she t r i e d to plan c o n s t r u c t i v e l y . The Five-Talent C l i e n t s Treatment methods do not change when the work being done i s with c l i e n t s possessing a good a b i l i t y t o relate t o others. There tends to be les s environmental m o d i f i c a t i o n except virhere the circumstances are such that the i n d i v i d u a l i s incapable of helping himself. Perhaps i t i s here that the greatest difference l i e s . With c l i e n t s with a poor a b i l i t y i n r e l a t i o n s h i p the reasons necessitating environmental change may l i e to a large extent w i t h i n themselves. T r i v i a l matters are exaggerated by them and they lack the a b i l i t y to cope with even minor pressures. Where there i s greater development i n r e l a t i o n s h i p , the pressures i n the environment w i l l be more severe before help i s needed. As long as people are people, psychological support w i l l always be needed. The more secure a person i s , however, the l e s s w i l l be h i s needs i n t h i s d i r e c t i o n . The amount of c l a r i f i c a t i o n which i s attempted depends again on the nature of the prob-lem and upon the person's a b i l i t y to see himself and h i s environment with increased c l a r i t y . With Mr. Hoar psychological support was the c h i e f method used. Only at the very beginning d i d he need the caseworker t o act f o r him — to make the arrangements with the Credit Bureau and to t a l k to h i s c r e d i t o r s . A f t e r that he was able t o take any actiom which was necessary himself. I t seems c l e a r that i t was the constant support of the worker which increased Mr. Hoar's confidence i n himself. Such support comes more from the a t t i -tude of the worker than from s p e c i f i c words of encouragement which may be given. The c l i e n t encounters a person who i s relaxed, who has confidence i n him, respect for him, and who i s interested i n helping him t o f i n d f o r himself a happier more s a t i s f y i n g way of l i v i n g . In such an atmosphere 100 fears d i s s o l v e and confidence grows. So i t was with Mr. Hoar. There was some c l a r i f i c a t i o n . Sometimes t h i s was centred around problems fraught with emotion, l i k e Mr. Hoar's a t t i t u d e to h i s wife. Sometimes i t had to do with the importance of r e c r e a t i o n f o r the family. Without the psychological support, any attempt at c l a r i f i c a t i o n would probably have proved too threat-ening. Mr. Inkster was faced with problems which he could not manage s a t i s -f a c t o r i l y himself, so environmental mo d i f i c a t i o n was necessary. A-home-maker was placed to provide f o r the c h i l d r e n the security which a series of housekeepers could not give. This one b i g environmental change was a l l the help that Mr. Inkster needed i n that d i r e c t i o n . To be able to give h i s f u l l c o n t r i b u t i o n t o h i s family, however, he needed psychological support. Probably the most s i g n i f i c a n t aspect of the record i s the way i n which Mr. Inkster expanded, became aware of how he could help h i s family, and i n h i s own rather slow way, went about doing the things he saw. Gradually Mr. Inkster came to look upon himself as a more important person than he had been before. He could see h i s wife i n a more objective manner. Parts of his s i t u a t i o n had been c l a r i f i e d . Mr. Inkster was only conscious of an increased f e e l i n g of s a t i s f a c t i o n . He did not know how that state had been reached. He did not see that support, enoouragement, the caseworker's respect f o r him as a person had increased h i s confidence and lessened h i s need f o r defences. Fewer defences had made i t possible f o r him to see the people around him and himself more r e a l i s t i c a l l y . What happened to Miss James was s i m i l a r to what had occurred i n Mr. Inkster's a s s o c i a t i o n w i t h the caseworker. She too had to have help with the environment; f o r placing her c h i l d f o r adoption was one of her major problems. Since she was l i v i n g at home, and could meet her own medical ex-101 penses, other kinds of environmental help were not needed. Any pregnant woman needs considerable support, and the unmarried woman has the additi o n a l s t r a i n s caused by her s o c i a l s i t u a t i o n . Miss James, needing encouragement, understanding and a warm acceptance, responded at once when she found these things i n the r e l a t i o n s h i p with the caseworker. Helped, supported by the caseworker's a t t i t u d e , she could f u n c t i o n adequately i n her present s i t u a t i o n . She planned r e a l i s t i c a l l y f o r the baby, and never wavered i n her plan f o r adoption, although she loved c h i l d r e n and saw and loved her own c h i l d . The way i n which she was able t o t e l l her father about her s i t u a t i o n , and handle the c u r i o s i t y of the neighbours and the g i r l s at work, r e f l e c t e d the same realism. Perhaps her previous security might have proved s u f f i c i e n t f o r Miss James t o do these things even without the support which the caseworker gave. For the s a t i s f a c t o r y working out of even deeper emotional problems, the caseworker and her use of psychological support and c l a r i f i c a t i o n seemed e s s e n t i a l . Without i t how could Miss James have courage to face the f a c t that the father o f the c h i l d had not ever intended to marry her, although he had talked often of .this? How could she bear to consider what mature love meant and t o see how immature her love f o r t h i s man had been? These things she was able to do because o f the support given to her. I t i s another i l l u s t r a t i o n of how c l a r i f i c a t i o n u s u a l l y needs the s o l i d foundation of good r e l a t i o n s h i p i f i t i s t o be e f f e c t i v e . The growth which had taken place i n Miss James i s shown i n the way i n which she could plan f o r the f u t u r e . Increased self-confidence led her to consider a d i f f e r e n t type of job and to set about t r a i n i n g h e r s e l f f o r i t . She could look to the future with optimism. She had a new acceptance of her-s e l f as a person. Miss James was l i m i t e d i n her a b i l i t y to give verbal ex-102 pression to the meaning which the r e l a t i o n s h i p with the worker had f o r her. There was evidence however, that the indications of growth noted had been permanent ones. In a casual contact some months a f t e r she had stopped com-ing to the agency she stated that she had continued the night school work, and would soon be ready f o r o f f i c e work. Two promotions had been received i n her present job. S o c i a l contacts were s a t i s f y i n g and v a r i e d . She was happy, convinced that she had done the r i g h t thing i n placing the baby, and sure that she had learned a l o t from the experience of her pregnancy. V/ith Mrs. Kroner c l a r i f i c a t i o n was used more extensively and d i r e c t l y than i n the other cases described. She needed t o see more c l e a r l y what the r e s u l t s of leaving her home would be t o h e r s e l f and to the c h i l d r e n . She needed to see Connie's behaviour i n the perspective of what i s normal f o r the teen-aged g i r l . As i s so often true, i t i s d i f f i c u l t to separate the c l a r i f i c a t i o n which took place from the r e l a t i o n s h i p of confidence which made i t possible. The s e l e c t i o n of treatment methods i s influenced t o a large extent by the assessment made of the l e v e l of a b i l i t y i n r e l a t i o n s h i p . The effectiveness with which those methods are used depends on the accuracy of the diagnosis made, and the equipment of the caseworker f o r using r e l a t i o n -ship i n treatment. 103 CHAPTER EIGHT Findings and Implications That r e l a t i o n s h i p i s e s s e n t i a l i n the helping process of casework has been c l e a r l y indicated i n the cases studied. A way of measuring l e v e l s of r e l a t i o n s h i p was found to be an aid i n understanding the attitudes which determine r e l a t i o n s h i p a b i l i t y , and the possible sources of these. The formulation of c r i t e r i a to assess the l e v e l of r e l a t i o n s h i p func-t i o n i n g brought out the things which were of greatest importance i n t h i s area. F i r s t among these i s a man's a t t i t u d e to himself, h i s ways of think-ing and the manner i n which he reacts t o the pressures and f r u s t r a t i o n s of every day. Closely connected with h i s a t t i t u d e to himself i s the way i n which he regards others, h i s f e e l i n g tone f o r them, and how he has l i v e d with them: both now and i n the past. The c r i t e r i a made i t possible to break down the concept of r e l a t i o n s h i p into segments which could be studied. The a p p l i c a t i o n of the c r i t e r i a showed that some c l i e n t s were r e l a -t i n g to others on an i n f a n t i l e and unsatisfying l e v e l . One made ceaseless demands to be given to, but was convinced that no one would give without being manipulated into a p o s i t i o n where r e f u s a l was impossible. One with-drew from a l l the r e s p o n s i b i l i t i e s of being a husband and a father. Another could only meet l i f e as she i d e n t i f i e d with her r e j e c t i n g mother, and phantasied the s u p e r i o r i t y she did not r e a l l y f e e l . S t i l l another c l i e n t t r i e d to evade adult r e s p o n s i b i l i t i e s by r e t r e a t i n g into i l l n e s s . The l i f e of one woman was dominated by a need to search competitively f o r a father or a mother. Attitudes were negative, f e a r f u l , self-centred, regressive. 104 An examination of the p o s s i b l e causes f o r t h e i r unconstruetive ways of r e l a t i n g revealed that a l l of the c l i e n t s had had experiences i n the past which had thwarted t h e i r development i n learning to give love. They had been denied that e s s e n t i a l f o r growth: the f e e l i n g that they were wanted, that they were loved and cared f o r . The s p e c i f i c obstacles which they had encountered included the loss of parents at an early age, severe r e j e c t i o n by a parent, being over-protected by parents, and the c o n f l i c t centreing around an unresolved oedipal complex. In one case, although the p a r t i c u l a r events were not known, they appeared to mean t o the c l i e n t that he had been deserted by the mother figures from whom he had needed love and care. In a more intensive study many more combinations of ob-stacles to growth would undoubtedly emerge. I t i s probable however, that the fundamental s i g n i f i c a n c e of these experiences would remain the same. Where the a f f e o t i o n a l needs of childhood have never been met, a person usually develops unconstruotive ways of responding t o others. The approach of such c l i e n t s t o the caseworker i s aggressive or de-pendent, or a mixture of the two, as the cases show. The greatness of the needs of each makes him d i s t o r t the importance of the caseworker. In-stead of being a person who can be consulted about s p e c i f i c problems, he becomes a symbolic f i g u r e , often linked i n t h e i r minds with a person from e a r l i e r experiences. They react as i f the caseworker himself could s a t i s -fy needs or withold s a t i s f a c t i o n . I t was seen that the development of a neurotic transference is a constant r i s k of which the caseworker needs to be aware. Where e a r l i e r experiences had contained more p o s i t i v e elements, the c l i e n t s were able to be more responsive. It was not always possible to see from what sources the a d d i t i o n a l s a t i s f a c t i o n s had been derived, as 105 the records were not always w r i t t e n with that p a r t i c u l a r focus, and to know those things about a person requires an intimate knowledge of him. The ef-f e c t of those a d d i t i o n a l s a t i s f a c t i o n s which had been experienced,was seen i n the c l i e n t ' s use of the caseworker. With understanding and support from the caseworker he oould move towards a more balanced s e l f regard^and an increased a b i l i t y to see others o b j e c t i v e l y . He could give t o others more a f f e c t i o n and understanding. I t was c l e a r l y indicated that the caseworker's attitudes are of great importance i n determining the nature of the r e l a t i o n s h i p which i s estab-l i s h e d . Where there was a genuine i n t e r e s t i n the c l i e n t and acceptance of him, the c l i e n t responded to the extent that he was able. Where these attitudes did not p r e v a i l , the r e l a t i o n s h i p w i t h the caseworker could not be the means of a s s i s t i n g the c l i e n t . The necessity f o r the caseworker possessing knowledge about human needs and behaviour was not overlooked. It was recognized that without such kriowledge the p o t e n t i a l i t i e s inherent i n r e l a t i o n s h i p could not be f u l l y u t i l i z e d . With c l i e n t s whose l e v e l of r e l a t i o n s h i p a b i l i t y was higher the res-ponse to the caseworker was more on a r e a l i t y b a s i s . This was true even when c l a r i f i c a t i o n extended to problems of considerable emotional s i g n i f i -cance, and the r e l a t i o n s h i p with the caseworker deepened because of t h i s . When supportive help i s given to a client,transference elements become more apparent. These tend to be p o s i t i v e i n nature since the caseworker's r o l e i s that of the giving good-parent. When t h i s method of treatment i s being used i t i s not necessary f o r the c l i e n t to be aware of the trans-ference. I t i s used t o provide an atmosphere i n which he can u t i l i z e h i s strengths, and l e a r n to deal more cons t r u c t i v e l y with the various aspects of his p a r t i c u l a r l i f e s i t u a t i o n . How the nature of the worker-client re-106 l a t i o n s h i p changes when in s i g h t development i s being attempted i s not con-sidered here, since, i n the cases discussed, t h i s treatment method was not used. The most s i g n i f i c a n t i m p l i c a t i o n of the present study i s the need f o r s o c i a l caseworkers who can use the t o o l of r e l a t i o n s h i p s k i l f u l l y . This requires c e r t a i n personal q u a l i t i e s . The caseworker's acceptance of people must be broad enough to include the constant demands of a Mrs. Arnott, the o h i l d i s h self-centredness of a Mr. B e l l , the i n a b i l i t y of a Mrs. Coulter to face r e a l i t y . He must be able to see behind behaviour — a l l kinds of behaviour — a human being with needs. Only^as his own philosophy of l i f e invests each human being with great importance^is he equipped to make of h i s r e l a t i o n s h i p with each a v i t a l part of the helping process. I f the caseworker has not achieved a f a i r degree of emotional security^the demands made by the insecure people who come seeking h i s help w i l l prove too great. Their h o s t i l i t y w i l l provoke his h o s t i l i t y , t h e i r demands w i l l arouse h i s impatience, or the nature of t h e i r needs may cause him to over-identify with them. He may s t r i v e to gain t h e i r approval, or he may express his own resentment or f r u s t r a t i o n i n punitive a t t i t u d e s . The task demands that he see whatever strengths a c l i e n t possesses,even though the weaknesses may be many and obvious. I t requires a c o n v i c t i o n that growth and change i s possible f o r most people. Since a l l people have some negative a t t i t u d e s , some prejudices and b l i n d spots, the case-worker must want to discover w i t h i n himself attitudes which are hindering the help which he could give. He must want to grow even though the pro-cess may at times be p a i n f u l . Because of the q u a l i t i e s of personality required f o r using r e l a t i o n s h i p e f f e c t i v e l y , i t i s not surprising that some caseworkers use i t i n a very uneven fashion. To make of one's own 107 personality a more adequate t o o l i s , however, one of the s a t i s f a c t i o n s of the profession. A more c a r e f u l screening of applicants who want to take s o c i a l work t r a i n i n g may be necessary i f the profession i s to make a greater contribu-t i o n to the understanding and use of r e l a t i o n s h i p . P e r f e c t i o n i n human nature i s not expected, but i n a l l the people accepted f o r s o c i a l work there should be strong evidences of p o s i t i v e attitudes, of self-awareness, and of capacity to use the s e l f i n helping others. It i s not enough that students entering the profession of s o c i a l work should be c a r e f u l l y selected. The philosophy and administration of s o c i a l agencies must be such that workers have opportunity f o r continued growth i n using r e l a t i o n s h i p i n treatment. This means, i n the f i r s t place, that the s i g n i f i c a n c e of the concept of r e l a t i o n s h i p needs to permeate the whole agency. In any s o c i a l agency some cases could probably be found which would show that the workers considered that by doing things f o r people, or by t r y i n g out techniques on them, those people could be helped. The work wit h Mrs. Fournier and Mrs. Grove shows the falseness of any such assumption. Whenever something important has happened i n the l i f e of an i n d i v i d u a l , which has helped him to take another step i n the d i r e c t i o n of maturity, the impact of r e l a t i o n s h i p has usually supplied the motivating f o r c e . S o c i a l workers have an opportunity to give to c l i e n t s an experi-ence i n r e l a t i o n s h i p which w i l l add t o the meaning and the happiness of l i f e . Seen i n that perspective, a l l the varied work of an agency assumes a new s i g n i f i c a n c e . Such perspective would emphasize the importance of having super-v i s o r s who are equipped t o give help i n t h i s v i t a l part of casework s k i l l . A l l the a v a i l a b l e means of s t a f f development should be used to add to 108 t h e i r equipment. Much can be contributed through refresher courses, i n s t i tutes, conferences, s t a f f meetings and the reading of professional l i t e r a -ture. The supervisor can only a s s i s t the worker t o grow i n h i s use of r e l tionship, as he himself possesses the necessary knowledge, and as he practises the constructive a t t i t u d e s which he teaches. A question can be r a i s e d as to how e f f e c t i v e l y the time-honoured system of supervision i n s o c i a l work adds to the development of s k i l l i n the use of r e l a t i o n s h i p . If the worker i s to receive the help he needs i n supervision, he must be free t o t a l k f r a n k l y about h i s attitudes and f e e l -ings, including the negative ones. Such freedom does not automatically de velop between every supervisor and worker. A few agencies are experimenting with other methods of supervision which they hope w i l l make possible the maximum growth i n the use of r e l a -t i o n s h i p . A f t e r a period of o r i e n t a t i o n i n the agency, a worker who has demonstrated h i s capacity to exercise independent judgment, i s allowed to choose the s t a f f member whom he wishes to consult about any s p e c i f i c problem or cas;e. Such an arrangement provides the opportunity for the worker t o examine more courageously h i s strengths and weaknesses. This should enable him to develop more s e n s i t i v i t y i n h i s use of r e l a t i o n s h i p . Regular ps y c h i a t r i c c o n s u l t a t i o n i s e s s e n t i a l f o r increasing s k i l l i n the use of r e l a t i o n s h i p i n treatment. The s i g n i f i c a n c e of some c l i e n t -a ttitudes may not be c l e a r e i t h e r to the caseworker or to the supervisor. The caseworker may need help too i n seeing how unconscious attitudes of h i s are a f f e c t i n g h i s work. Consultation with a w e l l - t r a i n e d p s y c h i a t r i s t by adding to the worker's understanding of the c l i e n t and of h i s own res-ponses, makes possible an expanding use of r e l a t i o n s h i p . 109 Even when agency philosophy and methods of supervision are focussed on using r e l a t i o n s h i p e f f e c t i v e l y , there are important p r a c t i c a l q u a l i f i -cations to add. Case loads need to be small enough to enable workers to plan and study i n preparation f o r interviews, and to evaluate, a f t e r i n t e r -views, the s i g n i f i c a n c e o f what has been done. In many agencies the large number of cases c a r r i e d by each worker l i m i t s , i n a d r a s t i c manner, the ex-tent of suoh planning, and hence the most e f f e c t i v e use of r e l a t i o n s h i p . Perhaps case loads which are s p e c i a l i z e d to some extent would i n -crease the use made of r e l a t i o n s h i p i n any agency. It takes time and ex-perience to l e a r n how t o be completely comfortable with a small c h i l d , or a teen-aged boy, or an e l d e r l y woman. Where s t a f f members have acquired p a r t i c u l a r ease with one group of people, they might be given more of such cases. Increased understanding about how to assess l e v e l s of a b i l i t y i n re-l a t i o n s h i p should have a d i r e c t e f f e c t on casework p r a c t i c e . F i r s t i t should r e s u l t i n a more accurate diagnosis i n the intake interview. In the i n i t i a l interview the c l i e n t often reveals enough about himself that the c r i t e r i a could be applied, and some assessment concerning h i s a b i l i t y to r e l a t e t o others could be made. Such an assessment i s c e n t r a l i n un-derstanding the r e a l nature of h i s problem. If h i s a b i l i t y to respond to others i s poor, then the problems which he confronts are exaggerated and d i s t o r t e d t o him because h i s own great needs mar h i s v i s i o n . Where a person has acquired some ease i n working and l i v i n g with people, the picture which he presents of h i s s i t u a t i o n i s l i k e l y to be a more r e a l i s -t i c one. The assessment which i s made about a c l i e n t ' s l e v e l of a b i l i t y i n r e l a t i o n s h i p indicates, too, what some of h i s basic needs may be. By reference t o i t the numerous b i t s of information given by the c l i e n t can 1 1 0 be f i t t e d more e a s i l y into the t o t a l p i c t ure of how he functions. The c r i t e r i a which are used i n the present study are only suggestive. More accurate methods of measuring l e v e l s of a b i l i t y i n r e l a t i o n s h i p w i l l be found as f u r t h e r study i s given t o t h i s subject. They may prove even more valuable as an aid to diagnosis. The second improvement i n agency p r a c t i c e would be i n the s e l e c t i o n of appropriate treatment methods. Workers would f i n d i t h e l p f u l to balance possible treatment methods against a c l i e n t ' s accustomed manner of r e l a t i n g to people. I f , during h i s l i f e , h e has found l i t t l e s a t i s f a c t i o n with people, he w i l l probably need some help i n changing h i s environment. He w i l l undoubtedly need much psychological support i f he i s to be able to make any constructive move. C l a r i f i c a t i o n and i n s i g h t may be beyond h i s a b i l i t y as the discussion about Mrs. Coulter showed. Any attempt to use extensively c l a r i f i c a t i o n and i n s i g h t development, with a c l i e n t who has not yet learned to share l i f e happily w i t h people, might well be questioned. The other end of the scale needs checking too. If a " f i v e -t a l e n t " c l i e n t has been consulting the agency over a period of time, and the only treatment methods used have been environmental manipulation and psychological support, are h i s needs being met? May he want a d i f f e r e n t kind of help? Better recording about r e l a t i o n s h i p should be another r e s u l t of a growing understanding of how to use i t . As the caseworker beoomes more aware of the i n t e r a c t i o n between himself and the c l i e n t he w i l l describe i t more accurately. One of the d i f f i c u l t i e s encountered i n the present study was that few records had any statement about what the caseworker thought about the nature of the r e l a t i o n s h i p between himself and the c l i e n t . Just as better recording i n casework led to an improved quality I l l of service f o r the c l i e n t , so better recording about r e l a t i o n s h i p w i l l lead t o a more conscious and s k i l f u l use of t h i s t o o l . F u l l e r recording about relationship w i l l make possible more valuable research on t h i s subject. The p o s s i b i l i t i e s f o r f u r t h e r research about r e l a t i o n s h i p are numer-ous. The present study has merely delineated, a.ffield. A c l o s e r examina-t i o n of that f i e l d needs to be made. It may be possible to discover c r i t e r i a which w i l l describe various l e v e l s of a b i l i t y i n r e l a t i o n s h i p with more exactitude than has been done i n t h i s study. An important con-t r i b u t i o n would be made i f the maximum and minimum l e v e l s of a b i l i t y i n re l a t i o n s h i p could be established f o r each c l i e n t . In t h i s study i t was only possible to say that a c l i e n t ' s present l e v e l of r e l a t i o n s h i p was poor or l i m i t e d or good. I t was recognized that where psychological or environmental pressures were severe, the l e v e l was temporarily lowered. The l e v e l of his present functioning could not be seen i n the perspective of what his maximum or minimum l e v e l s might be. Research i s needed a l s o on how caseworkers have been helped to use themselves more f u l l y i n the treatment process. This i s a part of the item "Degree of S k i l l With Which the Case i s Managed" which Hunt and 16 Kogan placed outside the l i m i t s of t h e i r study. The correspondence between a b i l i t y i n r e l a t i o n s h i p and other impor-tant casework concepts could w e l l be made the subject of furth e r research. 16. Hunt, J. McV., and Kogan, Leonard Ss Measuring Results i n S o c i a l  Casework, Family Service Association of America, New York, 1950. 112 The study of Miss Katherine Daly i n "Evaluating theCClient's Capacity to 17 Make a Better Adjustment" v / i l l be one c o n t r i b u t i o n i n t h i s area. The thesis of Mr. Isser Smith on "Measurement i n Sooial Casework - With Part-17 i o u l a r Reference to the Measurement of Movement" w i l l be another. Only by extended research w i l l there develop a c l e a r e r understanding of what i s involved i n casework concepts such as r e l a t i o n s h i p . Research along these l i n e s needs t o be done by s o c i a l workers who are f a m i l i a r with the f i e l d of s o c i a l casework and t r a i n e d i n methods of research. Adequate research can only be done as money i s made av a i l a b l e to support i t . More money would be forthcoming i f s o c i a l workers were convinced that one of the great contributions of the p r o f e s s i o n ^ l i e s i n understanding the nature of relationship,and how i t can be used t o add to human happiness. 17. Theses being w r i t t e n as p a r t i a l f u l f i l m e n t of the requirements f o r the degree of Master of S o c i a l Work at the University of B r i t i s h Columbia. 113 Appendix A ( l ) Interview with Mr. B e l l Mr. B. i n the o f f i c e f o r , h i s appointment, promptly on time. He said that he wasn't quite sure why I wanted t o see him. I explained that the agency wished to increase the effectiveness of the help i t oould give to people. Part of t h i s was our knowledge of psychology, but an important part was the r e l a t i o n s h i p with the worker. Could he t e l l me what i t had meant to him to come and t a l k with Mrs. Moss. Mr. B. responded at once, "Oh she was so sympathetic (tears came i n t o h i s eyes as he said t h i s . ) She was so pleasant, so h e l p f u l . He wondered what more anyone could say. Thoughtfully he added that she had not only been w i l l i n g , but anxious to do everything she could "to bring A l l a n and I together." Mr. B. talked about the coming of h i s son, describing i n d e t a i l the events of the past two weeks which had led up to t h i s . He commented on the faot that h i s son had asked f o r a loan to pay h i s fare to Vancouver . . . . " j u s t a loan, mind you." He had been pleased when A l l a n had accompanied him t o work one night and had swept and c a r r i e d wood f o r him. A f t e r he had talked about h i s work, Mr. B. discussed radio r e p a i r s . At one point I remarked on how l i t t l e I knew of radios. Immediately Mr. B. rushed on to t a l k more about them i n very technical language. As Mr. B. was leaving, I thanked him f o r coming to the o f f i c e , and f o r helping i n the p r o j e c t . He wondered i f I had received the informa-t i o n I wanted. I r e p l i e d that. I wanted each person to t e l l about his r e l a t i o n s h i p with the caseworker i n h i s own way. He had done t h i s . In an expansive manner Mr. B. said, "I'd j u s t l i k e to say one thing dont' f i r e that woman. I don't see how she could be any better." 114 During h i s rather rambling t a l k i n g Mr. B. had mentioned a former worker. He said t h a t she had not contacted him a f t e r her holidays "or something l i k e t h a t " and dismissed i t as of no importance. He had commented on the d i f f i c u l t y i n reaching Mrs. Moss by telephone, but i n h i s present genial mood was able t o accept t h i s . S t i l l with the gaiety which had characterized h i s manner during most of the interview, he said , "Perhaps i t i s because she i s so sympath-e t i c that she's so busy." 115 Appendix A (2) Interview with Mr. Inkster Mr. I. i n the o f f i c e as arranged. He seemed pleased to be i n t e r -viewed about the study and was quite at ease, "ffhen I asked i f he could t e l l me about what knowing and working with Miss Sones had meant to him, he started to t a l k about how the homemaker service had helped him. He'd secured housekeepers, and f o r a while they had seemed good, and then he'd see that each one was there to help h e r s e l f . He gave some i l l u s -t r a t i o n s . It was d i f f e r e n t when you got a homemaker from the Family Welfare Bureau, you knew that they were recommended. The agency wouldn't send them out unless they could be counted on. Sometimes he'd l e f t f o r work i n the morning, knowing that a homemaker would a r r i v e during the day. He knew that things would be a l l r i g h t f o r the c h i l d r e n . Ordinary house-keepers took two or three weeks to get used to things and to know how they should be done. The homemakers j u s t walked i n and even the f i r s t day things went the way they should. They had a routine that worked well i n other f a m i l i e s , and they knew enough to f i n d out what the c h i l d r e n usually ate and things l i k e that. The c h i l d r e n knew what to expect with the homemakers. If i t hadn't been f o r them, he'd have had to go o f f to work without being sure about things. The c h i l d r e n would return a f t e r school and there'd be no one there, and they'd run around. It wasn't s e t t l i n g . Some of the c h i l d r e n i n the neighbourhood, who had both parents, ran around at night and stayed out l a t e . His c h i l d r e n didn't. He thought that they were getting along even better than most of the c h i l d r e n i n the d i s t r i c t . I f i t hadn't been f o r the homemakers he might have had to place the c h i l d r e n . I commented that placement was always hard f o r c h i l d r e n . "Yes", 116 said Mr. I. " j u s t l i k e i t would be f o r an adult. I would have been wonder-ing a l l the time how they were. I'd go o f f to work thinking about them, and I wouldn't even have been able to work properly". I questioned Mr. I. about what he had thought of the agency when he had f i r s t come. He r e p l i e d that h i s wife had been the f i r s t to come. He wasn't sure about the agency f o r a time, but the workers were "nice to t a l k to" and "Miss Sones and I, we got along f i n e together." When I asked i f he could t e l l me a l i t t l e more about t h i s , he r e p l i e d , slowly, "Well she's a l -ways there, and she doesn't mind when I telephone her. She knows that I'm busy at work and I can telephone her when i t ' s easy f o r me". Mr. I. went on to t a l k e n t h u s i a s t i c a l l y about some of the things which had happened i n the family. He mentioned that Tom had won the soap-box derby, and that Harry was learning t o play f o o t b a l l . He spoke of how he had encouraged the c h i l d r e n to be interested i n music, so that now they had t h e i r own "family orchestra". He thought that i t was good f o r them too, to put on plays as they did at home. That would help them to f e e l easy with other people. While he was t e l l i n g these things Mr. I. made no s p e c i f i c mention of Miss Sones, or of her co n t r i b u t i o n to the family, but i t seemed c l e a r that he did r e l a t e the help which she had given to these developments. The chief impression which I received was of his happiness i n h i s ch i l d r e n , and h i s confidence that he was important to t h e i r welfare. 117 Appendix B B I B L I O G R A P H Y Books Alexander, Franz and French: Psychoanalytic Therapy, The Ronald Press Company, New York, 1946. Day, Florence.R: "Changing Practices i n Case Work Treatment," Readings  i n Sooial Case Work, Ed. Fern Lowry, Columbia University Press, New York, 1939. French, L o i s : P s y c h i a t r i c S o c i a l Work, Commonwealth Fund, New York, 1940. Freud, Anna: The Ego and the Mechanisms of Defence, International U n i v e r s i t i e s Press, Inc., New York, 1946. Hamilton, Gordon: Psychotherapy i n Chi l d Guidance, Columbia University Press, New York, 1947. : P r i n c i p l e s of S o c i a l Case Recording, Columbia University Press, New York, 1946. : Theory and Pr a c t i c e of Sooial Case Work, Columbia University Press, New York, 1940. H o l l i s , Florence: S o c i a l Case Work i n Practice, Six Case Studies, New York: Family Welfare Asso c i a t i o n of America, 1939. : Women i n M a r i t a l C o n f l i c t , Family Service A s s o c i a t i o n of America, New York, 1949. Hunt, J . MoV., and Kogan, Leonard S: Measuring Results i n Sooial Casework, Family Service A s s o c i a t i o n of America, New York, 1950. Jewish Board o f Guardians: The Caseworker i n Psychotherapy, New York, 1946. Josselyn, Irene Mi Psychosocial Development o f Children, Family Service Association of America, New York, 1948. Reik, Theodor: Lis t e n i n g With the Third Ear, Farrar,Straus, New York, 1948. Sterba, Benjamin, Katz: "Transference i n Casework", Family Service  Association of America, 1948. Thurman, Howard: Meditations f o r Apostles of Sensitiveness, The Eucalyptus Press, M i l l s College, C a l i f o r n i a , 1948."" 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