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Case work in a neighbourhood house : the role and performance of a case worker in a group work setting Baycroft, Bernice Winnifred 1952

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CASE WORK IN A .NEIGHBOURHOOD HOUSE The Role and Performance of a Case Worker'in Group Work Setting. (A Study Based on an Experimental Project i n Gordon House, Vancouver,B.C., \9h9-$0,)  by BERNICE WINNIFRED BAYCROFT  Thesis Submitted i n P a r t i a l Fulfilment of the Requirements f o r the Degree of MASTER OF SOCIAL WORK i n the School of S o c i a l Work  Accepted as conforming t o the standard required f o r the Degree of Master of S o c i a l Work  School of S o c i a l Work  1952 The University of B r i t i s h Columbia  CASE WORK IN A NEIGHBOURHOOD HOUSE The Role and Performance of a Case Worker i n a Group Work Setting. (A Study Based on an Experimental Project i n Gordon House, Vancouver,B.C., 19U9-!?0.) ABSTRACT This study describes and evaluates the r o l e and the performance of the case worker i n a group work agency, on the basis of a student p r o j ect which was c a r r i e d out i n "Gordon House", a neighbourhood house i n the C i t y of Vancouver, B r i t i s h Columbia. Two case work students from the School of S o c i a l Work a t the University of B r i t i s h Columbia were assigned to the House as a second-year f i e l d placement, to set up case work servi c e s . The period of the project was from September, 19h$> u n t i l May, 19f?0. The study analyses a sample set of cases, (records which were comp i l e d by the students during the p r o j e c t ) , giving p a r t i c u l a r consideration to ( l ) the kinds of problems c l i e n t s brought t o the case worker, (2) the a c t i v i t i e s of the case worker i n t h i s s e t t i n g , and (3) what the case workers added to the services which the agency already offered. The project as a whole i s analysed, with p a r t i c u l a r reference to (a) problems of s e t t i n g up the service, (b) the experimental i n t e r e s t of the project f o r soc i a l work p r a c t i c e , and (c) the value of the project to the community. Considerable evidence was found to v e r i f y - t h a t there i s a place for a case worker i n the neighbourhood house, and that this place i s one i n which the case work function can f i n d adequate f u l f i l m e n t . A wide v a r i e t y of personal problems are encountered i n the membership of the House, and i t requires a case worker with broad knowledge and s k i l l as a p r a c t i t i o n e r t o deal with them. The case worker's r o l e i n the House i s one which i s complementary to group work,,and which does not overlap e x i s t i n g community case work services. Working together, group workers and case workers can provide a s p e c i a l i z e d service f o r those seeking better personal adjustment. The s p e c i a l significance of the study i s i n i t s c l a r i f i c a t i o n of the problems and advantages of adding a case worker to the s t a f f of a group work agency, and what t h i s can do f o r case work-group work cooperat i o n i n the community. I t i s hoped that the study w i l l stimulate thinking with regard to the combined use of e x i s t i n g s o c i a l work s k i l l s , (group work and case work), on the treatment l e v e l and that something further w i l l develop i n the community to "which t h i s study might contribute, which would provide adequate treatment services f o r disturbed c h i l d r e n .  iii  TABLE OF CONTENTS _ Abstract  Page 'iii  Acknowledgements  . . .  iv  Chapter I . People With Problems The people, the p r o j e c t , the s e t t i n g . The group •work function, the Nursery School, problems i n s e t t i n g up the service. The case material, the study. ^  1.  Chapter I I . The C h i l d From Two t o S i x The Nursery School group, the case work services provided. The problem of the broken home, the problem of i l legitimacy, the significance of the experience with t h i s group  18 .  Chapter I I I . The C h i l d From S i x to Twelve The c h i l d i n latency and pre-puberty, case work with t h i s age group. Some latency children who were disturbed could p a r t i c i p a t e i n group a c t i v i t y ; some could not. Problems i n pre-puberty. Case work v/ith these children was revealing. Achievements. .'  32.  Chapter IV. Puberty and Adolescence Puberty and adolescence as phases of development. Treatment of adolescents. Problems i n puberty, problems i n adolescence. The nature of 'teen age problems. Achievements through case work. . . Chapter V.  The Adult  The adult group, the need i n the community f o r i n d i v i d u a l services f o r adults. Problems encountered i n the House among the adults,.family problems, problems of the unattached adult. The r e s u l t s of case work with adults i n the House Chapter VI.  67.  92.  Case Work i n a Neighbourhood House  The nature of case work i n a neighbourhood house. The need t o c l a r i f y the r o l e o f the case worker. The r e s o l u t i o n of working problems. The case worker's methods. The meaning of the service t o the House and to the community. The value of the p r o j e c t . . . . . . . . . . . . . . . .  112.  Bibliography  126. TABLE BI THE TEXT  Table 1.  Persons referred f o r case work during the project.  16.  Acknowledgements. The w r i t e r wishes to express her sincere appreciation to Miss Helen Wolfe f o r assistance given i n analyzing the case material, and to Dr. Leonard C. Marsh under whose d i r e c t i o n t h i s study was conducted. . . -.  iv  CASE WORK BI A NEIGHBOURHQOD HOUSE The Role and Performance of a Case Worker i n Group-Work Setting. (A Study Based on an Experimental Project i n Gordon House, Vancouver,B.C., l°i|-9-50.)  v  Chapter I.  • •  1  1  1  PEOPLE WITH PROBLEMS. ' A neighbourhood house presents to a s o c i a l worker a m u l t i p l i c i t y of people and puts one i n mind of a large and complex family.  A l l ages  are represented, from the three-year-old to the octogenarian, and i n the f r i e n d l y , helping atmosphere of the House, problems are f r e e l y expressed. As the trained s o c i a l group worker attempts to help people, through the group, to gain s a t i s f a c t i o n from the various forms of leisure-time a c t i v i t i e s , he finds that c e r t a i n i n d i v i d u a l problems a r i s e which tax h i s i n genuity sorely to help.  I t becomes apparent that i n order to serve the  members adequately, there i s a need f o r a large measure of i n d i v i d u a l and personal counselling; a lcLnd of service not i n l i n e with the organizing of the club, the dance or the whist drive; and the kind of a i d which i s the s k i l l e d contribution of the case worker. The project which i s the subject of t h i s thesis s t a r t e d from t h i s recognition, that a case work service i n the House would be a means of enhancing the service already provided.  A secondary p o s s i b i l i t y which i t  was thought might be tested out, was that closer working r e l a t i o n s between group worker and case worker would be productive.  The r e f e r r a l process be-  tween group workers and case workers might be f a c i l i t a t e d ; greater f a m i l i a r i t y with the process by agency workers would encourage r e f e r r a l both i n and out of the agency; better mutual understanding, and closer working r e lationships between case worleers and group workers i n the f i e l d could then be developed and, i n general, the project might provide an experience which would be h e l p f u l i n solving the problems of case work-group work r e f e r r a l i n Vancouver. The service was set up t o serve:  ( l ) children and adults r e f e r r e d  to the House from other agencies; (2) children and adults who came to the  -2-  House seeking group work s e r v i c e s j -(3) .members of the community who  had  p a r t i c u l a r problems, and wished help i n f i n d i n g a community resource which might meet their .need.  Case work service was provided by two second-  year case work students, who were placed i n the House f o r a period of seven months, f o r a second-year experience  i n f i e l d work.  Supervision f o r the students was provided by a (case work) f a c u l t y member from the University, with considerable experience.in i n s t i t u t i o n a l work, and i n setting up new s e r v i c e s . Administrative supervision was vided by a (group work) f a c u l t y member who was f o r the agency, and who  pro-  the U n i v e r s i t y consultant  had a good deal of valuable experience i n the i n t e -  gration of services,, and i n administration.  The Physical Setting. The neighbourhood house i n which t h i s project was  conducted i s  located i n the centre of one of the c i t y ' s oldest r e s i d e n t i a l areas. This i s a " t r a n s i t i o n a l " area i n the terms of the s o c i o l o g i s t , and i t pro1.2. vides a v a r i e t y of types and of q u a l i t y of accommodation.  According to  school and other s t a t i s t i c s , population i s quite mobile, newcomers sett l i n g temporarily u n t i l quarters i n a b e t t e r neighbourhood can be found. I t i s an area which also a t t r a c t s old-age pensioners, working mothers, and single men  and women who  are alone i n the c i t y , because of i t s near-  ness to the beaches, shopping and the downtown business section.  West End Survey, Group Work D i v i s i o n , Vancouver Council of S o c i a l Agencies, Vancouver, B.C., May, l U l . Q  2. Norrie, R.E., Survey, Report of Group Work And Recreation of Greater Vancouver Community Chest And Welfare Council, Vancouver, B.C., iW5,  p. si:  I t i s believed that there i s a high percentage of family breakdown i n t h i s area, although there are no r e l i a b l e s t a t i s t i c s to show t h i s . Estimates made by s o c i a l workers and teachers during the period from 19U9 to 1951,  suggest that from t h i r t y - s i x to s i x t y percent of school 3,11,5". age children are from broken homes. The need f o r a neighbourhood house i n such an area i s quite apparent.  The House was established i n accordance with the best t r a -  ditions of the neighbourhood house movement, to serve the t o t a l commun i t y as w e l l as House members; to contribute to the s o c i a l development of the community and of the i n d i v i d u a l ; to provide a place where people can come together f o r the purpose of solving common problems; to serve the i n d i v i d u a l by o f f e r i n g him the advice and help of professional s t a f f i n using other community resources, and to f u r t h e r democracy through the p r a c t i c e of democratic p r i n c i p l e s . Membership i n the House i s open to children from two years of age, when the c h i l d may enter Nursery School, and to adults of a l l ages.  Although membership i s t h e o r e t i c a l l y l i m i t e d to residents of  the area, r e f e r r a l s are accepted from other s o c i a l agencies i f the kind of service the c l i e n t requires cannot be provided i n his.own community. The approximate t o t a l membership during the period of the p r o j e c t was  3. McKenzie, Mrs. Kay, Gordon House Staff Meeting, Vancouver, B.C., January 31, 1950. U. Hutchinson,Ered, "Casework Service In A Neighbourhood House: The Administrative Aspects Of Its Establishment And Operation", M.S.W. Thesis, University of B r i t i s h Columbia, 1952. 5.  1950-51.  Furness, Ann, "Membership Study", Gordon House, Vancouver, B.C., 1  f o r t y nursery school children, two hundred and f i f t y children between six and twelve, two hundred 'teen agers, and s i x hundred a d u l t s . The House provides club rooms f o r friendship groups, a gymnasium f o r larger and more i n c l u s i v e gatherings and sports, kitchen f a c i l i t i e s , an arts and c r a f t s room, a-card room, lounges, a reading room f o r the adults and a music room f o r c h i l d r e n . House' consists of two b u i l d i n g s , and a gymnasium. for  S t r u c t u r a l l y the Most of the program  children goes on i n "Junior House", and the adult program i n "Senior  House", the gymnasium being used f o r both. There i s a trend i n neighbourhood house philosophy to place more emphasis on family membership, and an attempt i s being made to bridge the gap which exists between the two Houses by having a group of seventeen-year-olds meet i n Senior House.  The members of Senior House tend  to regard the juniors with suspicion, and are happy that they have a separate b u i l d i n g because of the noise the youngsters create.  Senior  House having been long forbidden ground to the juniors, entering i t i s quite an exciting experience to them.  Some success i n melding the d i f -  ferent age groups has been found i n money-raising projects such as a "country fair.," Junior House i s open f i v e days a week; from nine A.M. P.M.  f o r the Nursery School; from three P.M.  to f i v e P.M.  to three  f o r s i x to  twelve-year-olds, and two evenings each a week f o r intermediates and seniors, who old  are the twelve to f i f t e e n , and f i f t e e n to eighteen-year-  groups, respectively.  Senior House i s open every day except  Sundays and holidays, and group meetings are scheduled. The House i s administered by an Executive Director assisted by an Assistant Executive D i r e c t o r . She i s responsible to a Board of ,  -5Directors, through a House Committee.  The administrative structure i s  departmental, and the heads of departments are, the Director of Boys' Work, the D i r e c t o r of G i r l s ' Work, and the Nursery School Supervisor. The Young Adult Department, and the Senior Citizens Department come under the Executive Director and her A s s i s t a n t .  The s e c r e t a r i a l s t a f f  of two, and the j a n i t o r i a l s t a f f of two are d i r e c t l y responsible t o the Executive D i r e c t o r . Each House has an Advisory Committee of c i t i z e n s of the community, and there i s also a Nursery School Advisory Committee,. There are various standing committees, which are responsible t o the Board of D i r e c t o r s , and which are concerned .with finance, buildings and grounds, personnel, and p u b l i c r e l a t i o n s .  The membership p a r t i c i p a t e s i n the ad-  ministration of the House through i t s House Council, which i s made up of representatives from the various groups. At the time of t h i s study, the House was staffed with a good percentage of trained workers.  Three women workers had second year t r a i n -  ing i n s o c i a l work, with s p e c i a l i z a t i o n i n group work, and one woman part-time worker had second year t r a i n i n g i n s o c i a l work with s p e c i a l i zation i n case work.  The only male f u l l - t i m e worker was p a r t i a l l y  trained and was attending courses a t the U n i v e r s i t y . One woman part-time worker had no postgraduate t r a i n i n g , but had s p e c i a l i z e d i n psychology f o r her University degree.  ,  There was one woman worker who had no Uni-  v e r s i t y t r a i n i n g , but had years of experience i n the f i e l d .  There were  two q u a l i f i e d nursery school teachers i n the Nursery School. Three secondyear group work students and four f i r s t - y e a r students were placed i n the House f o r f i e l d work.  Volunteers and c r a f t s p e c i a l i s t s i n a r t , pottery, .  woodwork and leather were used extensively,  numbering about t h i r t y .  -6-  Volunteers and c r a f t s teachers were supervised by trained workers or by second year students. A volunteer's manual was i n use, and considerable time was spent i n orienting volunteers.  The s t a f f entertained the volun-  teers annually at a friendly, meeting, a token of appreciation and a t the same time a means of i n t e r p r e t i n g House function and the value of the volunteers' services. The Group Work Function. A l l meetings of groups i n the House are attended by a s t a f f member, which enables the trained s t a f f " t o put group work techniques i n t o practice.  "Interest" groups bring people together who have a common i n -  t e r e s t , such as dancing, c r a f t s , sports, or a desire f o r discussion. "Friendship" groups reqiiire a p r i o r bond of friendship or acquaintance between members.  These groups take advantage  of the proffered club room  f a c i l i t i e s , and plan the a c t i v i t i e s which they as a group wish to follow i n the House.  Because friendship groups are the most cohesive, o f f e r i n g  the i n d i v i d u a l member emotional support, and because there i s a good deal of i n t e r a c t i o n between members, on an emotional l e v e l , they provide the best opportunity f o r the p r a c t i c e of group work.  The i n t e r e s t groups i n  which anyone can p a r t i c i p a t e without friendship connections, provide an entree f o r those who wish to f i n d f r i e n d s , and the aim of the group worker i n these a c t i v i t i e s i s t o help members move on into friendship groups. The House seems to a t t r a c t many children and adults who have emot i o n a l problems which prevent them from getting along comfortably i n o r d i nary community clubs and groups.  For these people the House provides a  protected s e t t i n g , and s t a f f who understand and accept t h e i r behaviour. They are helped to develop an a b i l i t y to p a r t i c i p a t e and to be accepted  -7by other members, and thus to express and s a t i s f y f r u s t r a t e d s o c i a l drives.  The attitude of s t a f f i s a f r i e n d l y accepting one, and there  i s a tendency f o r members to imitate i t . Some members of the House have d i f f i c u l t y i n p a r t i c i p a t i n g i n groups even with the help of the group worker, and despite the f a c t that the demands of some of the groups are very s l i g h t .  Although ap-  parently gaining few s a t i s f a c t i o n s from the House i n terms of f r i e n d ship or "having a good time", these people often continue to be very regular i n attendance, and are the f i r s t to arrive a t meetings and the l a s t to go home.  These are people who apparently have been very de-  prived.in their family l i f e , and have not had the emotional s a t i s f a c tions necessary f o r emotional growth.  Their a f f e c t i o n a l needs are ab-  normal, the accepting group workers provide something i n the nature of what they are seeking, and hence become parental-figures t o them i n t h e i r unconscious minds. are  In a sense i t may be said that such members  a c t u a l l y looking f o r a good parent, and hope to r e a l i z e t h i s kind  of r e l a t i o n s h i p through the group worker.  They compete with f e l l o w  members f o r the group worker's favour, and thus arouse h o s t i l i t y against them i n "the group. Since there i s a permissive atmosphere i n a neighbourhood house t h i s encourages such a person t o express his f e e l i n g s , and c o n f l i c t s and, tensions which have been developed i n "the family i n r e l a t i o n to parents and to s i b l i n g s , are reawakened i n the House.  These are manifested i n  accordance with the pattern which he has developed at home, which may be either one of active expression, or of repression and withdrawal. The., f i r s t method i s p a r t i c u l a r l y the one used by the so-called "delinquent;" He does not recognize that the behaviour i s an inappropriate way of  dealing with the cause, because he i s mainly concerned with e f f e c t s , and i n t h i s way relieves the discomfort of emotional tensions. Because i t i s an unconscious act of protest against previous i n j u s t i c e s lie has endured, he f e e l s j u s t i f i e d . idea that he needs help.  As a r e s u l t he cannot accept the  On the other hand, the person who tends to  withdraw from contact with other people does so because of h i s negative f e e l i n g s toward people. tensions.  He represses these f e e l i n g s , thus b u i l d i n g up  Then, because he has no means of r e l i e v i n g these tensions,  he r e a l i z e s M s discomfort.  He i s often more accessible to help than  the person who "acts out" h i s f e e l i n g s , yet h i s problem i s often overlooked because he i s not a disrupting influence i n the group.  He does  not represent the future lawbreaker, but he may become mentally i l l . One of the problems of the emotionally deprived person i n the group, i s often an i n a b i l i t y to share the leader, whom he f e e l s i s h i s parent, with other members of the group.  He makes excessive demands on  the leader, which'cannot be met because of the very nature of the leader's relationship and r e s p o n s i b i l i t y to a l l the members of the group.  The  leader cannot give him' the kind of i n d i v i d u a l attention that he needs, either i n the group or out of i t , because he must maintain an equitable relationship with the group as a whole. In group work terminology, these people who evidently wish to r e l a t e to others, since they do attempt to p a r t i c i p a t e i n a group, but who are unable to do so successfully, are a p t l y c a l l e d "fringe" people. They are on the "fringe" i n terms of t h e i r p a r t i c i p a t i o n , the degree to which they are accepted by other members, and t h e i r a b i l i t y to grow through the group.  They are people who cannot get along happily i n a group be-  -9-  cause they have never learned to do so with individuals.  The mother i s  the instrument by means of which the child moves from narcissism to object love, and they have missed the satisfying mother relationship which one must have before he can develop a healthy social interest.  Therefore  the primary need of these people i s a satisfying positive relationship with an individual.  They must learn to participate i n a face-to-face  relationship, and to have confidence i n others. They must be helped to realize their individual assets and to gain self-confidence so that they w i l l be able to experience satisfactions i n the group. The case worker often has to play a mother role with a child who has not had this f i r s t satisfying experience, as a person-to-person relationship which paves the way to a person-to-group relationship.  This i s a function of a  case worker, and the point where the group worker refers the client to the case worker i s when he realizes that the needs of the client, as an individual, are greater than the group can meet. The Nursery School. The Nursery ..School i s primarily organized on educational lines. It seeks to teach the child an acceptable plan of living, an appreciation of social l i f e , and the,beginnings "of formal education. Discipline and routine oare provided to prepare the child for the discipline and routine of the public school. The mediums of teaching are regular routines established around the necessary functions of eating, sleeping and toilet, and organized play periods.  The child i s required to accept the habit  routines, but a l l activities are arranged so that he might find them interesting and satisfying.  He i s praised for achievement in order that  he can realize enjoyment in conforming, and find the effort necessary  -10worthwhile.  He i s helped to f e e l independent, and encouraged to take  responsibility.  The play periods provide an opportunity f o r him to  discover the pleasure of s o c i a l companionship i n a c t i v i t i e s 'with others. He i s given freedom to explore i n order that he may learn through experience the consequences of h i s acts, and methods of solving his problems. The teacher assumes a d i r e c t i v e , and a t times a manipulative role.  D i s c i p l i n e i s sometimes taught by arranging the r e s u l t s of a  child's acts so that he w i l l choose desirable patterns of behaviour. The. p e r i l s of f r u s t r a t i o n and f a i l u r e are recognized, and the c h i l d i s helped t o succeed i n h i s endeavours whenever p o s s i b l e . If the c h i l d has minor emotional problems, i t i s the b e l i e f that there i s a therapeutic e f f e c t i n the pleasures and rewards found i n the organized a c t i v i t i e s of the school, and i n the s k i l l e d help given by the trained supervisors when d i f f i c u l t s o c i a l or i n d i v i d u a l problems a r i s e .  Treatment i s considered the function of a s p e c i a l i z e d  c l i n i c , such as the C h i l d Guidance C l i n i c ; not a s o c i a l work s k i l l . The family i s reached through parent study groups and through i n d i v i d u a l discussion of problems with parents. educational b a s i s .  This i s also on an  In cases where serious emotional problems are e v i -  dent, r e f e r r a l i s made to the appropriate agency.  The aim of work with  the family i s t o teach the parents the methods of c h i l d t r a i n i n g which are used i n "the school i n order that these can be continued i n the home. Home v i s i t s are s o c i a l i n nature, at the i n v i t a t i o n of the parent, and only a few homes were w e l l known a t the time of the p r o j e c t . The philosophy, methods and techniques used i n the Nursery School d i f f e r from those of s o c i a l work i n a number of ways.  There i s l i t t l e  -11-  attempt to diagnose problems on the basis of the dynamics of human behaviour.  Personality i s assessed i n terms of the c h i l d ' s a b i l i t y  to play; the use he makes of the p l a y materials; h i s a b i l i t y to conform t o the established norms of habit and conduct; h i s a b i l i t y to learn; h i s a b i l i t y to concentrate, or h i s a b i l i t y to express himself appropriately.  Work with individuals i s c a r r i e d out i n the group  setting, and the group i s not consciously included.  Interrelationships  i n the group are not used to achieve either group or i n d i v i d u a l development . Problems Of Setting Up The Service. Owing to the shortage of time to plan and prepare f o r i t , the project was concerned mainly with setting up the service during the f i r s t few months.  This involved: (a) c l a r i f i c a t i o n of agency p o l i c y to cover  the new services; (b) working out of an intake procedure f o r case work; (c) determination of the r e l a t i o n s h i p of the new services to those which already existed;;(d) determination of the l i n e s of r e s p o n s i b i l i t y ; (e) adaptation of the o f f i c e structure f o r case work purposes, and ( f ) the integration of the new s t a f f into the structure.  A number of administra-  tive problems were encountered, and the job which could be done i n actual case work was retarded as a r e s u l t . Interpretation had to s t a r t from the beginning because many board members thought of the house as a recreation centre rather than as a neighbourhood house.  I t was necessary to c l e a r with the board that-the  house was intended to provide community services, i n order to v a l i d a t e the use of the case workers. C l a r i f i c a t i o n of the l i n e s of r e s p o n s i b i l i t y was necessary i n  -12order to make possible the working out of methods of administration f o r case work.  There were two administrative bodies concerned with the  project, that of the House, and the School of S o c i a l Work, and t h e i r r e spective objectives had to be a l l i e d . A method of intake f o r case work i n the new group work s e t t i n g had to be worked out, since the general r e g i s t r a t i o n of members f o r house a c t i v i t i e s was not s u f f i c i e n t l y s e l e c t i v e . For group work purposes, a l l who sought meiribership i n the House and were accepted, were automatically accepted f o r group work.  Case work could be offered only '  to those who were seeking help, i n the case of adults, or whose parents wished them to have help, i n the case of children, and who had problems of an i n d i v i d u a l nature.  I t was necessary, therefore, to compile a l l  available information, and to give i t some diagnostic study, before accepting the c l i e n t f o r case work s e r v i c e s . It was necessary to determine how the case work service would function i n r e l a t i o n to the other services provided.  There was a prob-  lem of c l a r i f y i n g the respective roles of the case worker and the group worker, and of showing how one service should r e l a t e to the other i n the setting.  These two s k i l l s , although having a common basis i n s o c i a l work,  appeared to have become separated, and there was a need f o r better understanding of the other, on the part of each.  Also there was a t h i r d serv-  ice i n the House, that of the Nursery School, which based i t s p r a c t i c e on a d i f f e r e n t school of psychology than that of the s o c i a l workers. The need t o e s t a b l i s h a practical-method  of r e f e r r a l between  6. group work and case work was a problem.  David Franklin, i n his thesis  6. Franklin,D., "Case Work-Group Work R e f e r r a l " , M.S.W. Thesis, Department of S o c i a l Work, University of B r i t i s h Columbia, 19k9 .  -13points out how few r e f e r r a l s are received from case work agencies by group work agencies.  He believed that this was due to the f a c t that  the c l i e n t , although prepared f o r case work by the group worker, does not follow through by going to the case work agency.  Perhaps Mr. Franklin's  observation is" an indication that the c l i e n t was not being helped suff i c i e n t l y by the group worker to face his problems, t o enable him t o move toward treatment.  Interviewing s k i l l , and an understanding of the  i n d i v i d u a l , must be quite highly developed i f a worker i s to help a c l i e n t i n this way.' A great deal of interpretation was necessary i n order to achieve an adequate working relationship with the s t a f f of the Nursery School..  The Nursery School had an a f f i l i a t i o n with the Psychology Depart-  ment at the 'University, through board and advisory committee members. There, was a desire on the part of the Psychology Department to use the School as a work shop where i t s students could develop treatment s k i l l s . However, the case workers thought that the Nursery School was hesitant as a r e s u l t , to accept case work services.  ,  |  The case work supervisor met with the Advisory Committee of the •School on one occasion t o discuss the problems of disturbed children, and the ways i n which a case worker might help them.  There was a great  deal of opposition to .the case worker's theories of .child  development,  and she was not allowed to continue., When she mentioned that sometimes during treatment a c h i l d might regress, the general opinion of the group was that t h i s "could not be allowed", as the c h i l d might become a problem at the School.  In view of t h i s , and i n view of the Committee's p o l i c y of  refusing applications where emotional problems are apparent i n t h e c h i l d , i t appeared that there was a desire to avoid having children i n the School  who would exhibit disturbed behaviour. The p h y s i c a l structure of the agency was a source of d i f f i c u l t y f o r the case worker, because i t was not suited to the needs of case work. It was d i f f i c u l t t o f i n d a room suitable f o r interviewing. devoted to group work,, o f f i c e space was l i m i t e d .  In an agency  I t was decided that a  play room would be the most u s e f u l type of room f o r interviewing c h i l d r e n , and a room i n Junior House was designated f o r t h i s purpose. -Money vra.s a l l o t t e d by the House committee f o r f u r n i s h i n g s .  I t was soon found that  t h i s room d i d not provide the necessary privacy and quiet however, and so a second room was suggested on the t h i r d f l o o r of Senior House.  This room  had disadvantages i n being some distance from Junior House, and because i t had to be reached through another room i n which sewing classes were u s u a l l y i n progress.  However, i t d i d serve the purpose of the project u n t i l a  b e t t e r room could be made a v a i l a b l e .  I t was furnished with'a d o l l ' s  house,  d o l l s , modelling clay, drawing materials, games, play s o l d i e r s , model cars, airplanes, trucks, o l d magazines, f i n g e r p a i n t i n g materials, p l a y c l o t h i n g , jewelry, and other toys which i t was thought would be u s e f u l to help a c h i l d express himself i n p l a y . Due to l i m i t e d o f f i c e space, i t was necessary f o r the case workers to arrange f o r the use of a club room, or-one of the d i r e c t o r s ' o f f i c e s when they wished to have an o f f i c e interview with an adult.  Interruptions  were quite common during interviews, because no one room had been designated as an interviewing room f o r the case workers, there was not a general appreciation of the importance of privacy and lack of i n t e r r u p t i o n i n a case work interview, and people d i d not hesitate to interrupt an interview i f there was something that they wanted i n the room.  -15-  The case workers did. not think that there was the emphasis on the c o n f i d e n t i a l i t y of records i n the neighbourhood house which one would wish f o r case work purposes.  There was only one s t e e l f i l i n g cabinet  which could be locked, a v a i l a b l e , and the case workers were given the use of t h i s . . The respective requirements of group work and case work i n regard to c o n f i d e n t i a l i t y had to be discussed and c l a r i f i e d , and standards set up. The use of volunteers as r e c e p t i o n i s t s was not desirable f o r case work purposes, as i t was impractical to provide the necessary o r i e n t a t i o n . They changed from day to day, and from week to week, and could not give the dependable service i n taking phone c a l l s and messages that a permanent o f f i c e secretary could.  This was a problem which could not be a l t e r e d .  These are some of the immediate problems which were met, and which were i m p l i c i t i n the use of a plant which had not been intended t o house a case-work s e r v i c e . Also of concern, were the problems involved i n the integration of the services already provided with the case work s e r v i c e . Discussion of these has been reserved f o r the f i n a l chapter, when the reader w i l l have i n mind the case material which i s presented i n the chapters which follow. The Case M a t e r i a l . This thesis i s based on an analysis of twenty-one case records which were compiled by the case workers during the p r o j e c t .  Two of the  cases have been omitted from the text because they contained too much i d e n t i f y i n g information, but they have been considered as part of the t o t a l experience.  This was necessary as one was that of the only young  adult worked with, and the other that of the only older adolescent. '  The case records have been summarized, analyzed and discussed i n such a way as to present the role- and performance of the case worker i n the House, i n terms of a diagnostic description of the problems dealt with, methods and techniques used by the worker, and benefits accruing, to the c l i e n t .  This serves to describe how the project was unique i n  types of problems, and methods used.  I t also points up the advantages  and disadvantages of the p a r t i c u l a r setting f o r purposes of case work treatment. To show the scope of the new service i n the community, thought was given i n analysis and discussion of the case material to the sources of r e f e r r a l .  The table below sets out the numbers of people referred  from the community as compared to those referred from the House membership.  Attention i s also given i n the discussion of cases to the workers'  relationships with other community agencies. Persons Referred For Case Work During The Project. Persons Referred Group Pre School Children.  Children, aged  Referred From: Community  Total  1 2  0 0  1 2  2 3  0 1  2 •u  1 0  2 , 3  6-12.  Adolescents, aged  12-18. 1 3  Adults.  total  '  1 0  2  3  h  h  13  8  21  -17-  For purposes of analysis the cases were c l a s s i f i e d i n accordance with the age groupings used i n the House i n planning group work program. The table above also shows t h i s breakdown, and the numbers worked with i n each sex.  Thus each of the middle chapters deals with.a d i f f e r e n t  age group. Certain advantages accrued from having a case work service i n the House which were not d i r e c t l y b e n e f i c i a l to the people who  received  case work, and which do not a l l come out c l e a r l y i n the case material. These are, however, important i n evaluating the performance of the case worker.  They have been given consideration i n the discussion of the case  material, and i n the evaluation of the project as a whole. Although the sampling of cases i s small, i t i s believed that the v a l i d i t y of the thesis i s strengthened by the f a c t that the writer was of the case work students who took part i n the p r o j e c t .  one  Chapter I I . THE CHILD FROM TWO In working with the two-year-old  TO  SH.  one i s constantly aware that he  has already become a complex being i n whom i n d i v i d u a l needs and characteri s t i c s are w e l l developed. . At t h i s age, the c h i l d whose emotional needs have been adequately met begins to emancipate himself from the mother.  He  i s interested i n exploring the world of adventures and objects around him, and as he advances toward the age of three, discovers the s o c i a l world.  His  interest i n p l a y enlarges to include others; he learns to play games, and seeks companionship i n his play.  he  Past the age of three, the child's aware-  ness of his father, and of the s o c i a l t r i a n g l e of which he. i s a part with his parents, p r e c i p i t a t e s him into a vrorld of s p e c i f i c fears and a t t i t u d e s , and the more general f e e l i n g s which he has previously held about l i f e , f i n d ;  a focus i n the parental f i g u r e s . The parent, no longer merely the ministering mother, has a new q u a l i t y which appears .with the child's discovery of the two sexes.  His interest i s centred on the parent of the opposite  sex.  I f this parent can s a t i s f y his i n t e r e s t , and also e s t a b l i s h f o r the c h i l d the r e a l i t i e s of the r e l a t i o n s h i p between them, Oedipal problems-will be successfully resolved.  The c h i l d w i l l discover a r e l a t i o n s h i p between him-  s e l f and h i s parents which can assure him of emotional health and growth; one i n which he has two supportive parents, each r e l a t e d to him i n a d i f f e r ent way,  each performing a d i f f e r e n t function on his behalf, but working t o -  gether to give him the strengths of maturity., The disturbed c h i l d i n the nursery school group i s i n e v i t a b l y concerned with problems which involve a defective r e l a t i o n s h i p with mother, since she i s the person who plays the dominant r o l e during t h i s e a r l y phase  -19of his l i f e , and hence i s the parent who  i s most meaningful to him.  This usu-  a l l y means that, i n planning treatment, the focus of treatment may be on the mother, and the c h i l d may need a substitute mother, through whom he can experience the emotional s a t i s f a c t i o n s which he has missed with his own mother. If treatment i s successful his own mother w i l l be able to assume her r o l e i n a better way,  and the c h i l d w i l l continue to grow emotionally because his  needs are being  met.  The Nursery School Group. There were f o r t y children between the ages of two and s i x enrolled i n the Nursery School, which provided the agency's services to the pre-school child.  The School was f i l l e d  to capacity, and there was a long waiting l i s t . ,  The majority of the children i n the School came from stable f a m i l i e s ; that i s to say, f a m i l i e s i n which both parents were i n the home, r e l a t i o n ships were good, and there was an adequate income* not have t h i s kind of a background.  Only three c h i l d r e n did  TITO were from broken homes, which had r e -  sulted from a divorce and a separation; the t h i r d c h i l d was had known no f a t h e r f i g u r e .  i l l e g i t i m a t e , and  These three children were being supported by  t h e i r mothers, and l i v e d with them i n the homes of maternal The most frequent reason  given by parents f o r applying f o r Nursery  School placement of t h e i r c h i l d , was where there was no play space.  grandparents.  that they l i v e d i n an apartment b u i l d i n g  Another common reason was that the mother was  not w e l l , and her doctor had recommended that she be f r e e d from the responsib i l i t y of caring f o r the c h i l d during the day.  Eight children had been en-  r o l l e d as a r e s u l t of r e f e r r a l s ; two were r e f e r r e d by p e d i a t r i c i a n s because of feeding and habit t r a i n i n g problems; three by the C i t y S o c i a l Service Department because of problems a r i s i n g from i l l e g i t i m a c y , divorce and separat i o n ; two by the Family Welfare Bureau because of behaviour problems; one by the C h i l d Guidance C l i n i c because he was  s l i g h t l y spastic and showed a  :  -20-  tendency t o block emotionally. Services Provided By The Case Workers. Many families mho applied f o r the placement of a c h i l d i n the Nursery School had serious s o c i a l problems, and needed case work services. The f i r s t use that the Nursery School s t a f f suggested f o r the case work service i n the School was to handle the r e f e r r a l of these f a m i l i e s t o the appropriate agencies i n the community.  The Nursery School s t a f f thought that case workers  helped people only through manipulating t h e i r environment and giving i n f o r mation about resources.  They were not aware of the treatment function i n  case work, nor were they aware that a successful r e f e r r a l sometimes requires f a i r l y intensive case work.  Their conception of case work i s r e f l e c t e d i n  the statement set up by t he agency concerning the f u n c t i o n of case work, namely, "that the case workers would help members of the community who had particular.problems, t o f i n d the community resource which could best meet t h e i r need."  The case, workers d i d not b e l i e v e that they should function on  the environmental l e v e l i n handling problems which could be handled by the group worker, or that they-should extend t h e i r services by offering i n t e n sive help to non-members f o r whom there were other community resources. • Moreover, r e f e r r a l s of t h i s kind from  the School d i d not help i n the de-  velopment of a case work service f o r the pre-school c h i l d . Interpretation of the -role they could f i l l , and the kind of work they wished t o do, brought the case workers three r e f e r r a l s of children who were i n the School.  This occurred toward the end of the p r o j e c t .  The Problem Of The Broken Home. 7. The three children who were r e f e r r e d to the case workers from the 7. Only one of these c h i l d r e n was a c t u a l l y interviewed by the case workers because of the shortage of time, - and other f a c t o r s , such as the breakdown of the r e f e r r a l process, r e f e r r e d t o subsequently.  -21Nursery School group came from homes where there was no father, and where the mother was attempting t o support herself and the c h i l d by working outside the home . One of these children, Laverne W.,  was four-and-a-half years of age,  and had evidently experienced r e j e c t i o n from her brother, and probably from others.  L i f e t o Laverne seemed to mean unhappiness, c o n f l i c t , unrewarded e f -  f o r t , and i n s t a b i l i t y .  Her f e e l i n g s were evident i n her choice of colors, i n  her- crying s p e l l s , i n her unresponsiveness, i n her f e a r of dogs, i n her habit u a l f a l l i n g , i n her thumbsucking, and i n her restlessness vjhile sleeping. Laverne c r i e d f o r her mother and looked f o r the s a t i s f a c t i o n of her need i n other adults.  She showed l i t t l e i n t e r e s t i n other children because the ex-  perience she had had with them i n the person of her brother had been p a i n f u l and unsatisfying.  Laverne was s t i l l performing on an o r a l l e v e l emotionally,  as evidenced i n her thumb sucking.  She was looking inward f o r comfort and  s a t i s f a c t i o n rather than to those around her. cause her troubled unconscious was  Her sleep was disturbed be-  seeking expression.  Laverne had attended the School since she was three years of age. Her older brother had also attended f o r a short period of time, and an antagonistic attitude was noticed between them. Laverne always seemed to have poor balance when l e f t alone. On her f i r s t day at school she f e l l and cut her nose badly, which r e s u l t e d i n having stitches put i n and a night i n ihe h o s p i t a l . When her brother stopped coming she came to school by herself and often arrived crying. Sometimes she s a i d that she had been frightened by a dog, or had f a l l e n . Frequently she could give no reason f o r crying. She would not stop u n t i l she had been held and comforted by an adult. Laverne would s i t by herself f o r half an hour a t a time, sucking her thumb, which was a habit from babyhood. She seemed oblivious of her surroundings then. She was r e s t l e s s during the sleeping period, but would s e t t l e down i f an adult sat near. There were strengths i n Laverne's personality which one could r e l a t e to strengths i n her background, and which might have been used to help her.  She  showed ego strength i n her a b i l i t y to come t o School alone a t the age of  8 . S i n g l e spaced type denotes case m a t e r i a l taken from summaries of actual case records. Double spaced type i s the writer's analysis and evaluation of the case material.  -22J  three; i n her a b i l i t y to p a r t i c i p a t e i n the singing, and to sing alone. She had i n t e l l i g e n c e , and she had a b i l i t y to conform. Laverne always played alone, except during the music period, and then she would j o i n i n the group singing. She l i k e d to sing alone, and she enjoyed the action songs. She enjoyed the sand box and the swings. She l i k e d to draw, always using black crayons. Laverne's routine habits were good, she learned quickly, and was cooperative. She ate w e l l , and muscle coordination was good. The family s i t u a t i o n i l l u s t r a t e d the unfortunate manner of planoften ning which immature people/employ when thejr have f a i l e d i n marriage.  Mrs.  ¥. regressed i n face of f a i l u r e , and sought to become the gay, carefree g i r l of pre-marital days, dependent upon her parents.  Unfortunately,  these parents were now less adequate than ever, and her divorced s i s t e r , now having problems which i n t e n s i f i e d her former negative p e r s o n a l i t y q u a l i t i e s , was also i n the home.  I t became apparent that Laverne  had  known l i t t l e genuine a f f e c t i o n , she had competed unsuccessfully with her brother f o r her mother's love, and her problem with her brother seemed to be a perpetuation of her mother's r i v a l r y with her aunt. * Laverne's parents were separated, and the children l i v e d with, 'the parent of t h e i r own sex, because the mother believed that t h i s was best for them. Mrs.. W. was obviously much fonder of her son than of Laverne. Laverne and her mother l i v e d with the maternal grandparents, and a maternal aunt,-Mrs. V., and her daughter Betty V. Mrs. V. was divorced from her husband and worked i n -an o f f i c e . Betty V. attended the nursery school with Laverne. The grandmother found the children d i f f i c u l t to manage. I f Betty was given something and Laverne was not, Laverne would have a temper tantrum. There was r i v a l r y between Mrs. V. and Mrs. W. The grandfather was away a good deal as he had a t r a v e l i n g job. He seemed i r r e s p o n s i b l e and d i s i n t e r e s t e d i n the problems of his family. Mrs. W. was an a t t r a c t i v e , l i k e a b l e woman, who had many men f r i e n d s , and who l e d quite a gay s o c i a l life. 1  1  s  Mrs. ¥., l i k e Laverne, was seeking a mother as shown i n her tendency to  t a l k about her problem without being w i l l i n g to do anything about i t .  was looking f o r the good mother who would solve her problems f o r her. r e s u l t she was inadequate i n her r o l e as Laverne's mother.  She  As a  -23-  Mrs. W. often discussed her problems i n her family with the nursery school supervisor. She eventually expressed a wish f o r help. It was suggested' that the case workers might help her. She said that she feared that the discord which was mounting i n the home was having, a bad e f f e c t on Laverne. Three appointments were made f o r her with the case workers, but she d i d not keep any of them. Her attitude i n speaking to the case work supervisor on the phone was l i g h t and carefree. Laverne's mother was young and energetic, and able to support Laverne f i n a n c i a l l y .  The case worker might have helped her meet her  r e s p o n s i b i l i t y f o r Laverne's emotional health more adequately.  Play  interviews with Laverne might have helped her mature and give up o r a l s a t i s f a c t i o n s which she clung to because of her need f o r a good mother. This maturity could have been accomplished through b u i l d i n g her ego, helping her to express i n h i b i t e d wishes and impulses, and thus enabling • her to function eventually as a s o c i a l being.  I f Mrs. W. were being  helped to grow at the same time, she would eventually assume her f u l l maternal r o l e , and the case workers'job would be  complete.  This case i l l u s t r a t e s some of the d i f f i c u l t i e s encountered i n making a good r e f e r r a l .  The c l i e n t ' s immediate need when he f i r s t asks"  f o r help should be recognized at that point, i f a relationship i s to be b u i l t which w i l l make r e f e r r a l p o s s i b l e .  There must be some understanding,  on the part of the person r e f e r r i n g , of how the unconscious functions.  In  t h i s s i t u a t i o n the mother expressed the need which i t was s o c i a l l y acceptable f o r her to express, but not her own r e a l need.  U n t i l t h i s got recog-  n i t i o n , she was unable to take the i n i t i a t i v e necessary to carry through with the idea of seeking help f o r her c h i l d .  Help was offered her as a  mature mother who puts the happiness of her c h i l d before her own.  She  was not functioning on t h i s l e v e l and so could not use the help offered.  Laverne's  cousin, Betty V., was another c h i l d whom the nursery  school s t a f f wished to refer to the case workers, and i t had been hoped that she would be reached through a successful contact with Mrs. W.  When  t h i s f a i l e d , there was no time to make other attempts to help Betty, as •the project was nearing completion.  Betty also showed a lack of develop-  ment of s o c i a l interests or a b i l i t i e s .  She tended to withdraw, but  was  more outgoing than Laverne and was able to b e f r i e n d one other c h i l d at school. friends.  However, when she l o s t t h i s f r i e n d Betty d i d not make other She began to turn her i n t e r e s t to things which took her away  from people, as Laverne d i d . but disappointment  She seemed to f e e l that l i f e held l . i t t l e  f o r her.  Betty V. seldom joined i n the play with the other c h i l d r e n . She became f r i e n d l y with one c h i l d , but t h i s c h i l d l e f t the school at Christmas .time, and Betty d i d not make other f r i e n d s . Betty would p l a y with the other children i n the d o l l corner .' occasionally. During the free play period she p r e f e r r e d to look at. a book, or work a puzzle. Sometimes Betty's face would l i g h t up and she would r e l a t e some incident from home which usually concerned her cousin Laverne. One time she came to school beaming. She s a i d that she was to have had her t o n s i l s out, but her grandmother "prayed to God that they would go down, and they r e a l l y d i d . " Betty gave the teacher the impression that something she had hoped f o r had at l a s t come t r u e . Such children as Betty V. and Laverne are e a s i l y drawn into p l a y interviews because they f e e l a need f o r a mother, and so they welcome the attentions of an interested adult who  approaches them with warmth.  Jimmy  B. i s another example of the same kind. The Problem Of I l l e g i t i m a c y. Jimmy B., four years of age, had problems which had i n h i b i t e d h i s emotional and his i n t e l l e c t u a l development.  He seemed to have the i n t e l l i - •  gerce of a c h i l d of two, and d i d not have the s o c i a l i n t e r e s t which i s  -25-  normal f o r h i s age. repression. for  He also showed symptoms of withdrawal and of emotional  He apparently had not found l i f e to be a rewarding experience  his a f f e c t i o n a l needs had been s e r i o u s l y neglected.  He had had l i t t l e  incentive to make the e f f o r t necessary to achieve s o c i a l s a t i s f a c t i o n s , and found s a t i s f a c t i o n i n objects rather than i n people. Jimmy did not seem to f i t i n with his age group, and so he was encouraged t o p l a y with children who were one or two years younger. He d i d not t a l k w e l l and would a t t r a c t the attention of the supervisor by jumping up and down and by making " s i l l y " , noises. He sometimes preferred to sleep while the others were playing. Sometimes he would s i t s i l e n t l y f o r long periods by himself. He showed an abnormal attachment f o r objects. For example, he would become upset to the point of tears i f someone t r i e d to remove an extra sweater that he was wearing. One time he would not go home from school because he could not f i n d his sweater. He would p l a y with a p a r t i c u l a r toy f o r weeks on end, and no other, and would refuse to give i t up. Jimmy's problem was bound up-with i l l e g i t i m a c y , and the desire of an inadequate mother to make a home f o r him.  Miss B., having also suffered  emotional deprivation, was unable to form normal a f f e c t i o n a l t i e s .  Because  she was a passive person, she repressed her need f o r a f f e c t i o n and her feelings of resentment toward the mother who had deprived her.  She found  the opportunity to express these feelings and to s a t i s f y them i n her r e l a tionship with Jimmy's father.  While h i t t i n g out at her mother i n becoming  i l l e g i t i m a t e l y pregnant, she found others who would provide her with a f f e c t i o n , f i r s t Jimmy's father, and then Jimmy. Miss B. was a p l a c i d person, and gave the impression i n the interview that she was used to doing what she was t o l d . She was the youngest of eight children. She s a i d that there had been l i t t l e love i n her f a m i l y . She had never had rapport with her mother, who was very s t r i c t . Miss B. met the father of her c h i l d at a public dance h a l l , and went out with him f o r about six months. During t h i s time she had intercourse with him regularly, and expected to marry him. When she discovered that she was pregnant he t o l d her that he was already married, and had children, and she d i d not see him  \ -26again. Following Jimmy's b i r t h , Miss B...could not give him up. She was unable t o work steadily.because she was often i l l , and had several operations of a gynaecological nature. She applied f o r s o c i a l assistance. Miss B. had two main emotional problems, which unfortunately came into c o n f l i c t with each other.  She had a strong need f o r a f f e c t i o n , and  at the same time a need to be;dependent. -In being i l l she s a t i s f i e d her desire to be dependent. 'However, i l l n e s s threatened her a b i l i t y to keep Jimmy, her source of a f f e c t i o n . r e l a t i n g to men, t i o n a l needs.  Her i l l n e s s also threatened her means of  the only other means she knew of s a t i s f y i n g her a f f e c -  She was anxious as a r e s u l t , and also g u i l t y , because i l l -  ness represented punishment f o r immoral behaviour, which her mother's attitude would have l e d her to expect. Jimmy was more outgoing at home where his mother played with him a great deal. He l i k e d to dance and to sing. While i n the h o s p i t a l , Miss B. worried a great deal about 3ELmmy. She also worried about l o s i n g her sexual desire.. She often had dreams about having intercourse with men. • Miss B. had a poor moral sense and lacked a normal f e e l i n g of self-worth. find i t .  She had a need f o r companionship but did not know how to  She lacked the ego strength necessary to assert herself so-  c i a l l y , or i n . employment.  She was unable to meet her problems i n a r e -  a l i s t i c way as a r e s u l t , and her method of dealing with them was to r e treat into i l l n e s s . Jimmy's mot lie r dressed poorly and unbecomingly, and was awkward i n her movements. She said that she did not go out with men because she was a f r a i d of becoming pregnant again. She went t o shows and dance . h a l l s occasionally, but had no other form of recreation. She expressed a desire to meet "a nice crowd of people." Miss B. had had l i t t l e success i n employment, going from one job to.another, and had no t r a i n i n g except f o r waitress work. Miss B.. had been i n the Army, and had been discharged because of a stomach condition. A f t e r that she only worked sporadically because of her health. She was r e s t l e s s i n her sleep and woke up t i r e d i n the morning. She s a i d that she "just pushed her feelings about her problems dovm inside her."  The f a m i l y s e t t i n g was an abnormal one. had had an unhappy experience with men, they were h o s t i l e toward men. were no men  A l l the women i n the home  and i t i s l o g i c a l to suppose that  This, i n addition to the f a c t that there  i n the home, indicated problems f o r Jimmy l a t e r on.  The maternal grandmother i d e n t i f i e d Jimmy with herself and t h i s made i t d i f f i c u l t f o r her to deny him anything.  Jimmy sensed that her love  f o r him was not healthy, and so he revolted against her.  Then she i d e n t i -  f i e d him.with h i s mother and rejected him. Jimmy l i v e d with h i s mother i n the home of his maternal grandmother. A maternal aunt who was divorced from her husband also l i v e d i n the home. Jimmy's grandmother had also been an i l l e g i t i m a t e c h i l d , and was now separated from her husband. Although she had had many negative feelings about Jimmy p r i o r to his b i r t h , she had come to love him a f t e r ward and could deny him nothing. He was very disobedient with her. She found him most unmanageable when his mother was away, and s a i d that he was "getting w i l d l i k e his mother." During the worker's contact with her, Miss B. found i t d i f f i c u l t to face her problems and to use the services offered.  She was a c t u a l l y shop-  ping around f o r a s a t i s f y i n g emotional experience f o r h e r s e l f . A f t e r her i n i t i a l interview with the worker, Miss B. did not keep appointments. She discussed her problems with a number of workers with whom she came i n contact. She' then became i l l again and had t o be hospitalized.* Miss B. needed help of an intensive nature.  She needed to achieve  emancipation from her mother, and learn to function independently.  She  needed to acquire enough maturity that she would be able to help Jimmy develop, and would not remain dependent on him.  She needed to be able to  face her problems r e a l i s t i c a l l y , and to deal with them i n a r e a l i s t i c T/ay. She also needed to become self-supporting, and to f i n d s a t i s f a c t o r y s o c i a l outlets. For Miss B., the worker was able to enhance the services already offered by means of diagnostic service, and also by use of other s o c i a l  -28-  work resources.  She was.able to demonstrate the kind of cooperation that  could be mobilized i n the community i n order to help the c l i e n t . might have been accomplished  Yflaat  i n the way of d i r e c t help for the c l i e n t  f a i l e d because of lack of time to prepare Miss B. f o r referral'adequately, and because the resources which were available i n the community were i n adequate to cope with her problem. The r o l e of the House case worker f o r Miss B. and Jimmy, was  to  complete a r e f e r r a l to the community resource which seemed most l i k e l y to serve t h e i r continuing need, when i t became c l e a r that t h i s might not be possible i n "the House, because of the c r i t i c a l nature of her problem, and uncertainty as to whether case work services would continue to be a v a i l able i n the House. The C i t y S o c i a l Service Department had r e f e r r e d Jimmy to the Nursery School o r i g i n a l l y i n an attempt to help him with his problems through•changing his environment, as they recognized t h e i r own inadequacy to help him by means of case work treatment. They also recognized that other resources i n the community were l i m i t e d . When Jimmy was referred to the case workers, the C i t y S o c i a l Service Department made t h e i r record available' f o r reading, and agreed to encourage Miss B. to use the case work help which the House could o f f e r . Both Jimmy and h i s mother were to have case work services f o r the purpose of d i agnosis of the problem and r e f e r r a l . Following interviews with Jimmy i n the play room, and o f f i c e interviews with his mother, a conference was held which was attended by representatives of the agencies that had known Miss^ B. They thought that Miss B. was very disturbed and needed'psychotherapy. A f t e r resources had been explored by the House worker, a second conference was held, and i t was decided that the C h i l d Guidance C l i n i c could best serve the need. The House worker made t h i s r e f e r r a l . The C l i n i c d i d not think that Jimmy was s u f f i c i e n t l y disturbed to be e l i g i b l e f o r t h e i r services, and therefore they could not o f f e r services to the mother. Work with Jimmy B's problem, which was a d i r e c t r e s u l t of his mother's problem, i l l u s t r a t e d the value of a family s e t t i n g , which provided not only services but s a t i s f a c t i o n s f o r the mother and her c h i l d . This s i t u a t i o n was most favorable to working with the f a m i l y as a u n i t .  \  -29-  Tliis case i s suggestive of the p o s s i b i l i t i e s there are i n a neighbourhood house setting f o r helping an unmarried mother who  lias  t r i e d unsuccessfully to give her c h i l d a secure home. The trained workers, both group work and case work, can give ego support, help her to develop meaningful relationships with people, s a t i s f y her dependency needs u n t i l she i s able to function independently, and also provide a sense of being loved. who  In the group p a r t i c u l a r l y , she can f i n d friends  give her acceptance, which w i l l contribute to her ego development,  and a sense of belonging which w i l l also provide s a t i s f a c t i o n f o r her dependency and a f f e c t i o n a l needs.  At the same time she w i l l f e e l responsi-  b i l i t y f o r her c h i l d less because i t i s being shared by the case Y/orker, the good mother.  As the mother gains emotional strength, a s i t u a t i o n i s  created which would be most conducive to achieving, with her cooperation, a s a t i s f a c t o r y plan f o r the c h i l d .  j  These Experiences Had S i g n i f i c a n c e . The pre-school children who were referred f o r case work thus ; presented problems which involved r e j e c t i o n , s i b l i n g r i v a l r y , repression, withdrawal symptoms, and behaviour problems.  emotional  These appeared  to stem from parental problems of divorce, separation, and i l l e g i t i m a c y . It was i n t e r e s t i n g that,in a l l three f a m i l i e s represented the problems of the c h i l d could-be traced quite e a s i l y to the problems of the as w e l l as of the parents.  grandparents  This suggested perpetuation of'problems item  generation to generation, and the need f o r objective help from a source outside the family i f the trend i s to be corrected. • The children a l l showed strengths which promised comparatively simple correction of probi lems at t h i s e a r l y stage of development, dependent on successful work with the parent, or placement.  -30-  The f a m i l i e s of Laverne W. and Betty V. showed strengths which indicated that t h e i r problems could have been dealt with by the services provided i n the Ibuse.  Jimmy B.'s problems, including those of his mother,  were more severe, and c a l l e d f o r p s y c h i a t r i c help which could only be offered by a specialized agency.  His needs could not be met i n the House.  However, i t d i d seem that the House could provide a s p e c i a l i z e d service to some unmarried mothers. In work with the pre-school c h i l d i t would appear that his emotiona l functioning i s c l o s e l y a l l i e d to that of the mother, and that a disturbed c h i l d i n e v i t a b l y means a disturbed mother.  For t h i s reason, i t appears that  the emphasis i n a plan of treatment i s more l i k e l y to be on the mother than on the c h i l d , and on helping her to perform more adequately as a mother.  In  conjunction with work with the mother, the worker can serve the c h i l d ' s needs i n the House, by o f f e r i n g him a substitute mother r e l a t i o n s h i p i n the p l a y room, where he can also release his feelings through play; or by i n t e r p r e t ing h i s emotional needs to the nursery school teacher who  can help him i n  the same areas, through her day-to-day oontact with him i n placement i n the school.  I f foster-home placement seems indicated, the worker can a s s i s t •  the c h i l d and the mother to accept t h i s through her relationship with them, and through interpretation to the mother, and she can a s s i s t the placement ^ agency by furnishing a study of the c h i l d . The value of the nursery school as a means of f i n d i n g cases should not be overlooked by a case worker i n the House.  The worker might develop  this resource by o f f e r i n g diagnostic services,' and also by helping the nursery school s t a f f to develop a l i n k and f a m i l i a r i t y with the Family Agency, which should deal with family problems which are detected by the school through contacts with non-members. Because the Nursery School s t a f f  -31lacks the background t o perform the r e f e r r a l function on the case work l e v e l ; however, i t does seem t h a t the case worker i n the House should share with the School the r e s p o n s i b i l i t y of r e f e r r i n g members. In work with the Nursery School, problems of r e l a t i n g the two services l i m i t e d the case worker's a c t i v i t i e s with children i n the School. The case workers found that i t was necessary to work out a common understanding with the Nursery School Committee, and also with the s t a f f , with regard to the treatment needs of disturbed c h i l d r e n .  I t was also necessary to i n t e r -  pret the treatment function of case work. The Nursery School s t a f f did not seem t o have an understanding of the parent of the c h i l d i n the School, nor d i d they pay much attention t o unconscious motivation. This, with t h e i r lack.of knowledge about case work, made i t d i f f i c u l t f o r them t o carry out a r e f e r r a l to the case work servi c e i n the House e f f e c t i v e l y ,  s o that c l i e n t s were found t o be emotionally  unprepared f o r case work, and unaware of the nature of the help that was being offered them, or of how i t could be useful t o them.  This was a prob-  lem which i t was not possible t o work out during the period of the p r o j e c t .  ' Chapter I I I . THE CHILD FROM SIX TO TWELVE..  The c h i l d who i s i n the latency phase of emotional development, which occurs between s i x and ten, i s normally a l e r t , controlled and d i s d a i n f u l of the opposite sex.  He i s looking beyond the home f o r new out-  l e t s and s a t i s f a c t i o n s , and f i n d s these i n the company of his peers; i n " gangs, clubs and secret s o c i e t i e s .  Theories to explain the phenomena of  l i f e are expounded, and energy i s expended i n games, horseplay, and matebelieve adventure.  The'kinds of pursuits which are followed by the  little  g i r l show a preoccupation with becoming a woman, as those of the l i t t l e boy are concerned with becoming a man. The c h i l d who i s i n latency i s t r u s t i n g and f r i e n d l y with an adult of his own sex,;  He welcomes an opportunity to p a r t i c i p a t e i n a  group which i s l e d by such an a d u l t .  Because he i s concerned with the de-  velopment of his ego, an adult leader represents f o r him an ego-ideal and provides him with the sexual i d e n t i f i c a t i o n needed at t h i s time f o r emot i o n a l growth.  The group provides the p r o t e c t i v e strength of the family,  but relationships are less personal, and hence less demanding.  At this  age the c h i l d responds best to r e l i g i o u s t r a i n i n g , sexual drives are r e pressed, and the superego i s i n c o n t r o l .  The influence of adults i s as a  r e s u l t , important at t h i s time i n character formation. In the eleventh and twelfth year, the c h i l d goes i n t o a phase of development which i s known as prepuberty.  This i s p a r t i c u l a r l y true of  the l i t t l e g i r l whose body begins t o change i n preparation f o r motherhood. ality.  The c h i l d i n prepuberty begins to give up repression o f sexuHe i s more interested i n himself as a sexual being, and also i n  the opposite sex.  33-  The c h i l d i n latency and i n pre-puberty who  i s emotionally  disturbed i s struggling with problems which have arisen i n e a r l i e r phases of development, and much of his behaviour i s t y p i c a l of these e a r l i e r phases.  The seriousness of the child's disturbance i s r e l a t e d  to how far'back the o r i g i n a l problem occurred.  The c h i l d who  has had  s u f f i c i e n t a f f e c t i o n that he has been able to develop s o c i a l i n t e r e s t , i s the c h i l d who  i s l i k e l y to be helped i n the group.  The c h i l d  who  has been damaged by lack of a f f e c t i o n during the o r a l and anal phases, and who  as a r e s u l t has developed very l i t t l e s o c i a l i n t e r e s t , w i l l  gain l i t t l e from the group.  Children' at t h i s age express t h e i r d i s t -  urbance quite f r e e l y , and symptoms vary from over-aggressive acting out to  extreme repression and conversion symptoms. Many of the children i n t h i s age group who  attended the House  appeared to have had an unstable family background and resultant deprivation of emotional needs.  Many could n o t " f i n d a place i n the groups,  but spent t h e i r time i n the h a l l s , sometimes, p a r t i c i p a t i n g i n i n t e r e s t groups, and at other times attaching themselves to an adult who to be f r e e .  happened  These children would continue to attend the House despite  lack of. f r i e n d s .  Those who  did p a r t i c i p a t e i n groups often exhibited  abnormal and uncontrolled behaviour.. children a protective s e t t i n g .  The House seemed to o f f e r these  There was less emphasis on achievement  than i n ordinary groups such as Cubs, Brownies, and church groups, and greater consideration was given to the child's emotional v u l n e r a b i l i t y . The group worker's' aim i s to provide an approximation family l i f e to the C h i l d who  of healthy  has not experienced t h i s at home, and t h i s  includes a parental type of a f f e c t i o n from the group worker, which i s expressed i n ways which are, appropriate to the p a r t i c u l a r c h i l d ' s needs.  -3U-  ' '  The group worker recognizes the needs of a c h i l d 'in a p a r t i c u l a r phase of emotional development, such as the need f o r masculine i d e n t i f i c a t i o n i n the boy i n latency, and makes available clubs and a c t i v i t i e s which w i l l help the c h i l d to s a t i s f y these.  The c h i l d i s a s s i s t e d to f i n d and  preserve the friendship a f f i l i a t i o n s which he most desires, and i n latency t h i s generally means those with his own sex. During this p r o j e c t , the group worker i n the House was puzzled about how he could help the "fringe" c h i l d i n latency, because of h i s i n a b i l i t y to give the c h i l d the i n d i v i d u a l attention which he so d e f i n i t e l y asked f o r and needed.  The case'worker i n the House could obviously be  h e l p f u l i n meeting t h i s problem. Case Work With The C h i l d In Latency. In the following case studies of s i x children i n t h i s age group, which were compiled by the case workers during work with them i n the p r o j e c t , are more s p e c i f i c descriptions of the disturbed c h i l d i n latency and i n pre-puberty. I t i s i n t e r e s t i n g that i n working with cliildren i n the group work section of the House, the group worker expressed the idea, and i t 'seemed .apparent to the case worker, that the "normal" c h i l d i n the House would have been considered abnormal i n other community-group  activities.  In  other words, i t was thought that a large percentage of the l e s s normal cliildren of the community congregated'at the House.  As a r e s u l t , many of  the children who were referred to the case workers appeared to be very disturbed indeed. Some Could P a r t i c i p a t e In Group A c t i v i t y . Larry P. was one of the l e a s t disturbed of the latency children referred.  He belonged to a gang, p a r t i c i p a t e d i n sports, and showed'some  a b i l i t y to r e l a t e i n a p o s i t i v e way t o other people.  His negative  attitude toward the House however, r e f l e c t e d a negative attitude t o ward society and toward authority. Larry was a member of a loosely k n i t gang which the group workers were attempting to i n t e r e s t i n House a c t i v i t i e s . Larry was antagonistic toward the House, and was often.on hand when things were broken. He was " not w e l l accepted by his gang, and took an attitude of submission when with them. His embarrassment at being f r i e n d l y with the case worker suggested that Larry had negative f e e l i n g s about father people... Evidently however, he also had a need f o r the attentions of such a person, and had 1  been deprived i n this area.  As a r e s u l t he was i n c o n f l i c t , the gang  representing the opposing means of s a t i s f y i n g t h i s need f o r a c h i l d of his age. There seemed to be some g u i l t on Larry's part about his r e l a t i o n ship with the worker.  In Larry's great need f o r prestige i n his gang,  and i n his excessive r i v a l r y , one could see the e f f e c t of M s p o s i t i o n as the youngest i n a large family. The case worker struck up an acquaintance with Larry i n the House, and asked him to come to the play room to carry a chair up f o r him. Larry responded r e a d i l y . He seemed t o enjoy the play room, and the next week he asked the worker i f he could "play with him again". This time, some of•his" friends asked him where.he was going. He . r e p l i e d with a h o s t i l e , "never mind". In the p l a y room he asked i f he could bring M s f r i e n d s there. The worker explained why he could not. . He played one game of checkers i n an uninterested way and then wanted to return to M s f r i e n d s . The next week he came to the play room with encouragement from the worker. Fie appeared disheartened but d i d not say why. The worker l a t e r learned from the group worker that i t was because he wanted to be elected president of his club but was not. The worker did not see Larry i n the House again f o r about s i x weeks. Larry, M s emotional needs unmet,^ was looking f o r the s a t i s f a c tions he had not found i n M s home, i n the neighbourhood house. also r e l i v i n g i n the House the relationsMps  He was  he had experienced i n M s  -36home, and t r a n s f e r r i n g to the House, attitudes engendered at home about people and society i n general.  Larry had some strengths because h i s  mother had strengths, and she had made him f e e l that she cared about He was  him.  g u i l t y about h i s r e l a t i o n s h i p with the worker because his mother  had not presented his own  father i n a favourable  l i g h t , and Larry was  probably aware of the h o s t i l i t y which i t i s l i k e l y that she held f o r men.  Larry was  insecure i n his gang because d i s t r u s t of people had been  i n s t i l l e d i n him at home. Larry's mother had been separated from his father for-about three years, and i t was suggested that she was intimate with a male boarder who l i v e d with the family. The family vras not well regarded i n the community, although the case worker thought that the mother showed a f f e c t i o n a l strength with her children. The children were having a d i f f i c u l t time at school, where they were i n e v i t a b l y blamed f o r anything that went wrong, i f they happened to be near at hand. The mother's attitude was that c e r t a i n things had happened to herself and her family i n the past which had been misconstrued. She f e l t that society was against them, and that the children needed to learn to f i g h t i f they were to make t h e i r way i n an unjust world. Mrs. P. was antagonistic toward her husband. The family received s o c i a l assistance and the assistance worker had found Mrs. P. to be quite defensive i n her a t t i t u d e . When the case worker f i r s t met  him, Larry had needed support  from h i s gang i n order to accept the case worker.  The group worker  might have provided t h i s i f he had known Larry better, and had been sure of his r e l a t i o n s h i p with him.  Because of his own  dence, the worker at f i r s t thought that i t was  lack of c o n f i -  necessary f o r him to  manufacture reasons f o r Larry to come to the play room. necessary, and d i d not b u i l d Larry's confidence rather aroused his resistance.  This was  not  i n the worker, but  When Larry got the support he needed  from h i s mother, and when the case worker was more r e a l i s t i c i n his approach, Larry vras w i l l i n g to accept help.  Larry used the play room  to express his problems, as i t vras intended to be used, and thus became accessible to help from the worker.  The-worker v i s i t e d the home and asked the mother to encourage Larry to see him. A few days l a t e r , Larry approached the worker i n the House and began to t a l k to him. He agreed to go to the play room to t a l k when the worker suggested i t . Jimmy, a f r i e n d of Larry's followed them to the playroom. The worker allowed Jimmy to stay, explaining that t h i s was Larry's hour, and he would not be able to do so next time. -• From t h i s time on, Larry came to the play room regularly, and showed a very p o s i t i v e attitude toward the worker. He became very aggressive and dominating i n his play. He showed s i b l i n g r i v a l r y i n r e l a t i o n to a f r i e n d who was also seeing the worker. The worker attempted to give Larry friendship on an i n d i v i d u a l b a s i s , which served to give Larry s e l f confidence and enable him to get along more adequately i n the group. Work with the mother was designed to give her support, and to help her to understand Larry so that home pressures would be less f o r him.  Larry showed progress during the few  months contact he had with the worker. The case worker was helping a c h i l d i n t h i s s i t u a t i o n who was able to function i n the group, but was not using the group to advantage.  He  was not s u f f i c i e n t l y disturbed emotionally that he would have been o r d i n a r i l y referred to the C h i l d Guidance C l i n i c .  He was one of-the many  who attend neighbourhood houses because of p e r s o n a l i t y disturbance, but inhabit a "nc—man's-land" where they are reached by neither group worker or case worker,  fie was the kind of c h i l d the case worker i n the House  would work with i n order to help him use group work, with no need f o r other r e f e r r a l . The interdependence of group work and case work i s evident i n the work with Larry.  The case worker cannot reach the c h i l d without the  support of the group worker, or a parent, whom)., the group worker represents. In the neighbourhood house the group worker can assume the function of the  -38-  \  parent i n getting i n d i v i d u a l help f o r the c h i l d . I t was  conceivable i n  working with Larry that the p a r t i c i p a t i o n of his mother was  not necessary,  and case workcservices could have been given on the same basis as group work services, as part of the t o t a l services to be expected by members'  r from the House. During his v i s i t s to the worker, Larry developed a friendship with another boy. His attitude toward the House was reversed, and he became • a w e l l accepted member of his group. He became active i n group p r o j e c t s , and i n a project f o r the House, a country f a i r , he sold irwice as many t i c k e t s as he had been asked to do. He worked e n e r g e t i c a l l y on other phases of the f a i r . He took a more enthusiastic part i n team games of his group. When the time came f o r the worker to leave the House, Larry showed M s maturity by accepting t h i s i n a very manly way, saying that he hoped the worker would have a good holiday. The House worker was able t o get closer to thermother because he was able to v i s i t more often than the assistance worker could, a nd thus obtained her cooperation i n ' the work done with her c h i l d r e n i n the House. Mary K.,  an eight-year-old, was  searching f o r something i n the  HoLise which she lacked at home. Her behaviour i n the group was i n d i c a t i v e of f e e l i n g s of anxiety and tension. She was  f e a r f u l of people i n positions  of power, because they, l i k e adults, had an a b i l i t y to hurt her. She a need to control because t h i s was  insurance  felt  against hurt. She searched f o r  the good mother, yet because of past experiences she feared close r e l a t i o n ships. Her behaviour i n the group suggested that she had experienced unhappiness and r e j e c t i o n at the hands of her  parents.  Mary K. was a regular attendant of the Junior program, and was cooperative and creative i n her group. She was an active c h i l d . She showed deferences to ithose i n positions of power, such as the president of t he group, aa d vented her h o s t i l i t y on the children who had l e a s t status. She was demanding of adult attention, ad seemed t o have learned at an e a r l y age how to manipulate adults. She daydreamed frequently,and was oblivious at times to the presence of others. She had no close f r i e n d s , and appeared to be l o n e l y .  -39-  Mary had been separated from her parents at an age when she could not  understand i t , and when the e f f e c t would have been quite traumatic.  It was i n t e r e s t i n g that i n the interviews she expressed a preoccupation •with herself at that age. In play, Mary expressed he'r f e e l i n g that her parents had rejected her,  and her resentment of babies indicated hurt i n r e l a t i o n to her s i b -  lings.  X Mary r e l a t e d p o s i t i v e l y to the worker a t f i r s t , and there was  evidence of a transference i n the way i n which she attempted to put the worker i n a mother r o l e .  I t was i n e v i t a b l e , i n view of the negative f e e l -  ings which Mary had about her mother, that she would react negatively t o ward the worker as the contact became c l o s e r . Mary often referred t o the days when she had been two years of age. She often asked the worker t o buy things f o r her, take her t o the aquarium, as she s a i d that her mother had done. One time when Patsy, a l i t t l e g i r l Mary's age had come t o the p l a y room with her, the worker asked Mary t o suggest what she would model i n c l a y . Mary said "a good l i t t l e g i r l . " When the worker asked how o l d the l i t t l e g i r l was, Patsy spoke up and s a i d that she was f i v e . The worker asked what was good about her, and Patsy said that she made her bed. The worker questioned whether she was o l d enough to do t h i s , and Mary s a i d that she wasn't, because she was only two. Mrs. K. had complained that one of Mary's problems was that she wouldn't make her bed. Mary expressed d i s l i k e of babies, p a r t i c u l a r l y boy babies. Mary's home l i f e was unsettled because her presence reminded Mr. and  Mrs. K. of t h e i r own inadequacy i n bringing up their son.  I t was as  though their son was punishing them because he f e l t that they had been responsible f o r his ovm unhappy experience i n his marriage with Mary's mother, of which Mary was a symbol.  Because of t h e i r f e e l i n g s of i n -  adequacy, and their f e e l i n g that i t was unjust f o r them to be i n t h i s s i t u a t i o n , Mr. and Mrs. K. sought the help of others i n bearing the r e s p o n s i b i l i t y of Mary.  At the same time t h i s implied r e j e c t i o n of Mary.  Before Mary could have a s a t i s f y i n g home l i f e ,  i t was  necessary  that her grandparents recognize t h e i r tendency to r e j e c t her, as w e l l as the reason f o r t h i s , and that they determine how they a c t u a l l y f e l t about Mary as an i n d i v i d u a l .  They were i n need of support and counsel-  l i n g i n r e l a t i o n to t h e i r methods of handling Mary's problems. Mary's parents had divorced when Mary was two, and Mary had since l i v e d with her paternal grandparents. They were i n t h e i r middle f i f t i e s , and appeared w e l l and vigorous. Mary was r e f e r r e d t o the case worker because her grandparents, Mr. and Mrs. K., had requested help from the House i n understanding her. They thought that because of t h e i r age they could not meet her needs adequately, and hence vrere having trouble i n managing her. Mrs. K. said that Mary's mother had not been heard from f o r several years. Her father had remarried and now had two sons. Although he seemed fond of Mary- and had planned to take her back,his new wife would not agree to i t . Mrs. K. often shared her problems with Mary with tenants of the rooming house she ran. She was not sure that Mary should attend the House because of the "rough and tumble" a t mosphere there. She worried about Mary's health, which the doctor said was excellent. Mary's a c t i v i t y bothered Mrs. K. Mr. K. was fond of Mary, but Mrs. K. was not sure that she wanted to keep her and had talked of sending her to boarding school. She wanted Mary to be a lady. Mary's reaction to the s i t u a t i o n i n her home, was one of overanxiety to please, both at home and i n the House.  In the p l a y room she  often seemed self-punishing, which was a r e f l e c t i o n of her lack of a f e e l i n g of self-worth. Her f e e l i n g s about, her grandparents became clear, and her i n s e c u r i t y seemed to be r e l a t e d mainly to her grandmother.  Mary  was very conscious of the pattern of achievement which she had set f o r „ her, and because of the necessity of repressing her f e e l i n g s , had developed a fear of her own aggression.  In the p l a y room she was  free  enough to v e r b a l i z e her fear that her grandmother would send her away. In the p l a y room Mary l i k e d the games best which she u s u a l l y l o s t , she had no i n t e r e s t i n t h e dart game. She s a i d that she was a f r a i d that her grandmother would send her away somewhere else to l i v e . She expressed fondness f o r her grandfather who was very fond of her, and could deny her nothing. .It seemed that she t r i e d very hard to.please her grandmother. One day when Mary was playing with the puppets with Patsy, Patsy suggested that they would pretend that Mary's puppet would k i l l Patsy's puppet..Mary would not play t h i s way,'.and said-that she would not k i l l her f r i e n d .  During the case worker's contact with this family there was strengthening of relationships i n the home.  a  The grandparents c l a r i -  f i e d t h e i r r e a l f e e l i n g s about Mary, which were a c t u a l l y very p o s i t i v e , and gained a better idea of her.  t h e i r own a b i l i t i e s i n caring f o r  Mary's s o c i a l a b i l i t i e s improved.  As her f a m i l y was b e t t e r able  to serve i t s t r a d i t i o n a l function, Mary had less need f o r the neighbourhood house, and found a f r i e n d with"whom she could enjoy much i n common. Mrs. K. t o l d the worker that she feared that she had r e j e c t e d Mary. • She came to the conclusion that having Mary i n her home a c t u a l l y meant a great deal to her, and she said that she could no longer consider sending Mary away. She said that she and her husband had now become Mary's parents, that they d i d have a great deal to give her, that Mary-was genuinely fond of them both, and that they now thought of her as t h e i r own c h i l d . Mary became-friendly with a l i t t l e g i r l i n the neighbourhood who did not attend the House, and Mrs. K. encouraged t h i s f r i e n d s h i p . She stopped Mary from attending the House. The worker d i d not discourage t h i s . The worker made no attempt to deal with the f e e l i n g s of the grandparents toward Mary's parents. terpretive and supportive.  Her role with them was mainly i n -  She d i d t r y to r e l i e v e the pressure  Mary of her grandparents ambitions f o r her.  on  The main focus of the  worker's a c t i v i t i e s was to gain an understanding  of Mary, i n order to  be able to help Mr. and Mrs. K. to understand her. The worker v i s i t e d Mr. and Mrs. K. and talked to them about the aims of the s t a f f i n the House i n b u i l d i n g personality; the d i f ferent methods used, the s k i l l s employed, both i n the group and on an i n d i v i d u a l b a s i s . At the same time, the worker t r i e d to give them an idea of what i s normal i n a c h i l d of Mary's age, i n t h i s generation. When Mary stopped coming to the play room, the worker supported Mrs. K. i n her plan f o r Mary, and i n her desire to love and keep her, as the worker f e l t that the home had many strengths, and much to give Mary.  The worker d i d not give Mary's need of the mother s u f f i c i e n t recognition to enable-Mary to accept the i n d i v i d u a l relationship which was offered her by the worker, and which was necessary to achieve a p o s i t i v e relationship with her.-.' Exclusion of the other c h i l d , Patsy, at the beginning, would have helped to gain t h i s .  Precedent i n the House had taught  the children that they could expect to share each others a c t i v i t i e s , and the new service had to be interpreted to overcome t h i s .  The worker's  indecision added to Mary's c o n f l i c t between her desire to f i n d the solut i o n of her problem i n the group, and her desire to acquire a mother, which was her primary need. The worker observed Mary in.the group, and became acquainted with her there.. She obtained Mary's permission to v i s i t her grandparents, and Mary seemed delighted with the-idea; Y/hen the worker spoke to Mary about coming to the playroom, Patsy overheard, and i n s i s t e d on coming too. It was.very d i f f i c u l t to refuse her.. Each"day that Mary came to the playroom," Patsy i n s i s t e d on coming. The t h i r d time the worker .attempted to interpret why Patsy could not come with Mary. Patsy reacted a n g r i l y , and Mary became very antagonistic toward Patsy. Mary d i d not come to the play room again, although she was s t i l l f r i e n d l y with the worker when she met her i n the House. In work with Mary the case worker demonstrated some of the techniques which are used i n play interviewing, and also the type of response -..which can be. expected from the c h i l d . with  Some of the d i f f i c u l t i e s of working  a. c h i l d of t h i s age on an i n d i v i d u a l basis show up.  The f a c t that  group a c t i v i t i e s took place i n the House at the same time as the p l a y session drew the c h i l d away from the p l a y room.  The mature c h i l d tends  to p r e f e r the group i n t h i s setting, but the emotionally immature c h i l d needs both the i n d i v i d u a l and the group r e l a t i o n s h i p .  In view of the  advantages which the s e t t i n g also presents f o r case work with the latency c h i l d , i t would seem that the answer i s the development of s k i l l on the part of the worker i n b u i l d i n g a relationship 'with the c h i l d .  Mary i s an example of the kind of c h i l d who  might be r e f e r r e d to  the case worker i n t h i s s e t t i n g as a r e s u l t of a d i r e c t request from the parent.  The problem i s not of a c r i t i c a l nature.  Because of the  nature  of the r e l a t i o n s h i p of members to the neighbourhood house, a f r i e n d l y , neighbourly one, the parent i s able to share family problems with the House workers almost as n a t u r a l l y as i n his own family.  This case also  demonstrates how the c h i l d functioning i n the House i s the c h i l d funct i o n i n g i n the family, and how the group and case work settings p a r a l l e l the s o c i a l and the i n d i v i d u a l performance of the c h i l d i n the home.  It  also shows the use of the s e t t i n g as one where a most comprehensive plan of treatment can be devised. Bobby R.,  aged ten years, presented a picture of a very upset  c h i l d with no apparent a b i l i t y to r e l a t e p o s i t i v e l y to people, and a great deal of h o s t i l i t y f o r them.  having  His 'behaviour suggested that he  was  operating very much on the l e v e l of the c h i l d i n the anal phase of development who  has not y e t achieved s o c i a l i n t e r e s t , or an a b i l i t y to  d i r e c t his energies constructively. Bobby's reaction to the worker, a father f i g u r e , suggested host i l i t y toward his own f a t h e r .  He seemed to want the worker's attentions  as a father very much, but at the same time feared that the worker would not give him the love, and would hurt him. t i o n was  A t t a i n i n g the worker's atten-  an achievement.  Bobby Yiras r e f e r r e d f o r case work services because i t seemed impossible f o r him to get along In the group. He was described as extremel y aggressive, and unpredictable i n h i s actions. In the play room '. 9. Continued observation of this c h i l d i n the play room revealed a pathological sexual adjustment. Punishment.-had been e r o t i c i z e d , and Mary had made a masculine rather than a feminine i d e n t i f i c a t i o n . The psychia t r i s t recommended p s y c h i a t r i c treatment.  he was hyperactive at times, and then extremely quiet. He selected darts and became very excited as he played with them. He threw them haphazardly at the f u r n i t u r e , and then he wanted the worker to stand against the w a l l so he could throw the darts around him. When the worker-said that he could not allow him to do t h i s , he threw one dart very close to the worker. He then became anxious. The worker noted that Bobby found i t d i f f i c u l t t o concentrate. Following the i n t e r view, Bobby bragged to the other boys about his experience i n going to the play room with the worker. Bobby's mother was an emotionally deprived woman who used her children to meet her own needs.  She was absorbed i n her own problems.  She t r i e d t o make Bobby take the place of the husband she had lost'. Her daughter Marie became a projection of the s e l f which she needed to r e j e c t i n order t o r e t a i n her husband's (Bobby's) favour. the  Planning f o r  family centered around herself rather than around the c h i l d r e n be-  cause Mrs. R. had not been able to f i n d expression f o r her own normal . narcissism i n her c h i l d r e n . the  A further source of c o n f l i c t f o r Bobby i n  home was the s i b l i n g relationship i n which he received a l l the f a -  vours from the parent.  Further evidence of the mother's use of the  children f o r her own neurotic needs was the sleeping arrangement which seemed to have deeper meaning than-simple r e j e c t i o n of Marie. Bobby l i v e d with his mother, who was divorced from his father, and h i s s i s t e r Marie. The apartment was small but elaborately f u r nished. The children shared a bedroom. I t was quite evident that Bobby, the eldest, was his mother's favourite, and she made l i t t l e e f f o r t to conceal i t . There were many pictures of him around the room, but none of Marie. At f i r s t Mrs. R. would not t a l k of the children and t h e i r problems, and attempted to keep-the c a l l on a s o c i a l l e v e l . F i n a l l y she said that she was to have an operation i n the summer, and planned to place the children i n a f o s t e r home at that time. She f e l t that Bobby had suffered a great deal from not having a man i n the home. I t appeared that neither c h i l d had received much from the mother to a s s i s t i n emotional growth.  Marie was so rejected and lacked so much  i n a f f e c t i o n from the mother that the f i r s t thing she hoped f o r i n someone new was s a t i s f a c t i o n of t h i s need.  The mother had not met the a f f e c -  t i o n a l needs, of either c h i l d and hence there had been behaviour problems  -16'such as s t e a l i n g .  Because there was. no incentive f o r the c h i l d r e n t o con-  form, the mother found them d i f f i c u l t t o c o n t r o l . There had been episodes of s t e a l i n g on the part"of both c h i l dren. They came i n from school during the worker's v i s i t . Both were very f r i e n d l y toward the'"worker, but Marie who had never seen him bef o r e , was soon holding his hands and putting'her arms around him. The mother was embarrassed a t t h i s and threatened to spank Marie and send her t o her room. The mother showed l i t t l e a b i l i t y t o control the c h i l dren. The pattern which could be seen i n the home, and Bobby's apparent i n a b i l i t y to mature emotionally beyond the p h a l l i c l e v e l , indicated his need f o r further help to support the growth process.  As there was not  time f o r the worker t o give him t h i s , r e f e r r a l to a s p e c i a l i z e d agency was indicated.  A good r e l a t i o n s h i p was developing between Bobby and the work-  er which would have been very h e l p f u l i n r e f e r r a l .  The worker was. also  able to help the mother by giving her support. During the course of interviews Bobby continued t o exhibit the uncontrolled behaviour of the f i r s t interview. He t o l d the worker of d i f f i c u l t i e s lie had with other cliildren and of one instance where he had'been i n the wrong.-'' Bobby began to share his play with the worker • and t o conform to the rules of the game. When the worker was leaving the agency, Bobby became affectionate, pressing close to him. The mother made.arrangements f o r the children t o stay with r e l a t i v e s while she was i n the hospital, and shared t h i s with the c h i l d r e h . The worker f e l t that Bobby would need continued support. As he had started to work with Bobby l a t e i n the project, he was not able to give him the a t tention he needed. 10. The approach of the case worker to Bobby and his problem was successful.  A d i r e c t approach was- used, with an explanation to the c h i l d of  the worker's-purpose, which included use of the permissive technique i n the play room t o encourage ego and super-ego development, and the recogn i t i o n of the c h i l d ' s negative f e e l i n g s accompanied by encouragement to 10. This c h i l d was l a t e r discussed with the p s y c h i a t r i c consultant who suggested placement of both children, as i t was evident that the mother r e jected them. Bobby was being forced to conform t o a feminine pattern of behaviour, and both children seemed a f r a i d of, and h o s t i l e t o the mother.  express them. Bobby had too l i t t l e self-confidence to enter into the r e l a tionship without outside support, and so i t was necessary to seek the help of the mother. The worker became acquainted with Bobby i n the House, and asked him to come to the play room. On the way the worker e x p l a i n ed that he helped fellows when they were having trouble at school, i n the group,- or at home. He s a i d that he thought that Bobby was having trouble, because he seemed to f i n d i t hard to play with the other guys. He said that they v/ere going t o a room where they could play and t a l k . Limitations set up f o r Bobby i n the p l a y room were the rules of the game, and the s t i p u l a t i o n that Bobby and the worker must not hurt each other. Bobby did not keep his next appointment with the worker. The worker then arranged a v i s i t with the mother. Regular play sessions with Bobby were scheduled with the mother, whom the worker was also t o v i s i t r e g u l a r l y . For Bobby, i t s u f f i c e d that the worker had sought his f r i e n d ship and interpreted his own role p r i o r to the v i s i t to the mother. Bobby knew the worker as h i s a l l y , and i t was not necessary f o r the worker to ask i f he might v i s i t .  The latency c h i l d i s more accepting  of the dominant r o l e of the adult, than, as w i l l be seen, i s the adolescent.  The worker was at the same time gaining Bobby's confidence  by recognizing and accepting his need f o r support. Some Had No Group A f f i l i a t i o n . One of the f i r s t of the latency children t o be r e f e r r e d to the case worker was a seven-year-old who problems.  had severe and complicated  Jane J . exhibited symptoms of deep personality disorder.  At times she clung to adults emotionally, and i t seemed that she hoped t o experience through them the mother-love that she had missed. In her shyness she showed her d i s t r u s t , and her h o s t i l i t y f o r people, which she sometimes expressed i n h o s t i l e aggressiveness. Consequently  she was unable to gain the friendship of other c h i l d r e n , and related to adults only i n a negative way.  She expected h o s t i l i t y from people,  and as a r e s u l t was muscularly tense and unable to move f r e e l y .  She  often indulged i n phantasy because i t enabled her to escape the pain of  reality.  Harsh punishment had taught her to repress her emotions.  Mood swings indicated that at times i t required great concentration for  Jane to keep her feelings i n s i d e .  I t was  natural that' Jane was  disturbed because she had experienced very upsetting sexual trauma; had been p h y s i c a l l y hurt and rejected by her f a t h e r .  Her mother had  given her l i t t l e i n the nature of healthy emotional s a t i s f a c t i o n s ; l i f e i n general had presented her with l i t t l e t o be happy about.  Jane J . was shy and r e t i c e n t , awkward i n her movements, and lacked an a b i l i t y to play. She showed l i t t l e confidence i n people, and reacted with undue anger i f anyone teased her. She had no f r i e n d s of her own age. She followed one of the group workers around, but was angry i n her response to her, using her only as a protection from the other children. Jane was dreamy, and often indulged i n phantsies. She had an unhealthy i n t e r e s t i n men, and her mother s a i d that her father had molested.her. Mrs. J . was suspected of p r o s t i t u t i o n , and Jane had had sex experience with boys. Mrs. J . punished Jane severely at times, and Jane seemed to expect punishment whether she deserved i t or not. She was happiest when she. was away from her. mother. She had attended the House r e g u l a r l y f o r two years..  Jane s mother was a very dependant woman who 1  l i v e i n accordance with l i f e ' s r e a l i t i e s . ers  was  men was  seemed unable to  Her need f o r s o c i a l work-  evidence of a continued need f o r a mother; her choice of older evidence of emotional deprivation i n r e l a t i o n  When she seemed t o understand  to her f a t h e r .  the worker's explanation of Jane's needs,  i t i s l i k e l y that she was submitting as the good c h i l d does to the mother.. She was unable to help Jane because she herself had been  -U8emotionally deprived, and was not -equipped to assume a giving mother role.  Her personality exhibited the narcissism which belongs to the  infant, and the tendency to l i v e i n phantasy which i s abnormal beyond childhood, symptoms which suggest psychosis. Mrs. J . had been divorced from her husband f o r three years, and had received s o c i a l assistance continually since the divorce. She was known t o a number of s o c i a l workers to whom she load talked f r e e l y about herself, but had shown no a b i l i t y to use their help. She would accept a s o c i a l worker's explanation of Jane's problems, and would agree t o do her part i n helping Jane, but would not keep her promise. Jane had a number of p h y s i c a l ailments, but Mrs. J . would not keep appointments which were made f o r her a t the hospital c l i n i c . The plans that she suggested f o r herself were u n r e a l i s t i c , and seemed to be her phantasy of what she would l i k e t o be and do. She talked a great deal about her boyfriends whom she said were men i n professional p o s i t i o n s , who had promised t o help her. Mrs. J . showed no capacity f o r insight into her own or Jane's problems. The worker's r o l e was that of a l i a i s o n between the House and'the case work agencies that were concerned about Jane and Mrs. J.,'although t h i s had not been intended a t the time that the r e f e r ral-Was made.  I t i s not the function of a neighbourhood house case  worker to act as a l i n k between the group workers, and case workers, outside the House, .since the, p r o f e s s i o n a l l y trained group workers can .work together with case workers outside t h e i r agency on ordinary referrals.  The unexpected move of the family t o another neighbour-  hood brought about the change i n plan.  x  I t was l o g i c a l f o r the case  worker who had already contacted the other-agencies, and become acquainted with the case material, to continue with ihe r e f e r r a l . I f Jane had continued t o attend the House, the worker could have worked , with her cooperatively with the treatment agency, to help her t o use group work, or helped her give up ihe House f o r more suitable r e sources,,  -k9The kind of cooperation which was achieved between the group work and the case work agencies was excellent, and demonstrates the r o l e of a case worker i n the House i n bringing t h i s about.  The case  worker d i d , at the time of the project, constitute a l i n k between group work and case work. Jane J . had been known at the C h i l d Guidance C l i n i c f o r about a year. The C l i n i c had had considerable d i f f i c u l t y i n working with Jane, and when they heard that there were case workers i n the House," hoped that a j o i n t plan of treatment might be worked out. They had previously planned to close t h e i r case. The House case worker gathered a good deal of information about Jane and her mother, from the Nursery School, the C i t y S o c i a l Service Department, and the C h i l d Guidance C l i n i c . She conferred with the respective workers. Before she was able to contact Jane or her mother however, they moved out of the neighbourhood. They were then referred back to the C l i n i c . Diana M.,  nine years of age had reacted to her unhappy l i f e  experience by developing extreme sysptoms of withdrawal. dependent  Diana was very  on adults, f e a r f u l of her own aggression, and so f e a r f u l of  expressing herself that she seemed to lack muscular control.  The  personality of her sister- i n addition seemed to be the kind which would encourage Diana to withdraw. Diana was very i n h i b i t e d i n her play. While her s i s t e r Donna and a f r i e n d used the paper and crayons i n the p l a y room, Diana sat q u i e t l y between them. With a great deal of encouragement from the case worker, she f i n a l l y attempted half-heartedly to copy Donna's p i c t u r e . The children decided t o skip rope f o r awhile. Diana was unable to coordinate her jumping with the turning of the rope. When she f i n a l l y t r i e d ' t o throw darts with encouragement from the case worker, she threw with her r i g h t hand, clutching the worker's s k i r t with her l e f t . Donna was anxious to enter a group but Diana would not. She s a i d she f e l l down too e a s i l y when she played, and could not run. Donna was t a l k a t i v e and aggressive to the point of boldness. Interviews with Diana's mother suggested that she had rejected Diana, and that Diana had suffered trauma, i d e n t i f i a b l e with r e j e c t i o n , at  an e a r l y age.  The early b i r t h of her s i s t e r again might have rep-  resented r e j e c t i o n to Diana.  L i f e was from the beginning threatening,  -50-  p a i n f u l , and lacking i n r e a l s a t i s f a c t i o n s . Mrs. M. said that Diana had been a premature baby. Donna was born when Diana was just past a year of age/ and i t was necessary a t t h i s time f o r Mrs. M. t o t r a v e l some distance to a h o s p i t a l . She l e f t "Diana with a neighbour whom she had only known a short while, during her confinement. This woman deserted her husband, and Diana was found by neighbours, Tendering cold and starving i n the s t r e e t . For several months afterwards Diana would not t a l k , her body was covered with a rash, and she would not l e t Mrs. M. out of her sight. She always seemed . high strung and nervous a f t e r that. Because Diana d i d not have a close, s a t i s f y i n g r e l a t i o n s h i p with her mother t o reassure her, and help her develop i n spite of her problems, disturbing experiences which she had i n l a t e r years added to her disturbance.  I t seemed that she had negative feelings about herself  which perhaps p r e c i p i t a t e d , and indeed were i n t e n s i f i e d by, the accidents she had.  The error of her teacher probably added to her f e e l i n g of  confusion. When. Diana was four, she f e l l downstairs and gashed the back of her head severely. Her l e g appeared to be paralyzed f o r a time, and she had to learn t o walk a l l over again. When she was s i x , she f e l l and gashed her r i g h t wrist on some glass'. Some of the ligaments were p a r t l y severed, and i t was over a year before she could use her r i g h t hand again. Diana was n a t u r a l l y l e f t handed,, but a teacher i n s i s t e d that she use her r i g h t hand, and Yriien her mother discovered i t , she vrould not go back to using her l e f t ' hand again. Mrs. M.'s r e j e c t i o n of Donna was more obvious.  She was less  aware of Donna's emotional needs because they were l e s s i d e n t i f i a b l e with non-threatening environmental f a c t o r s , and hence more threatening to Mrs. M.'s ego.  Mrs. M. j u s t i f i e d her r e j e c t i o n of Donna by presenting  her as a c h i l d with few problems, who affected Diana adversely.  Actually  she was i d e n t i f y i n g with Diana, the "good" c h i l d , i n whom she saw her own good s e l f , and a means of r e a l i z i n g her own f r u s t r a t e d ambitions.  To  Donna, separation from Diana meant e x i l e from the scope of the mother's approval, or r e j e c t i o n by the mother.  -51Mrs. M. s a i d that Donna had been a healthy, happy baby. She was not breast f e d , but had been given her b o t t l e i n her c r i b . Mrs. M. described her children as opposite i n temperament. Donna was aggressive and, Mrs. M. thought, would be able to make her way anywhere. She recognized that competition with Donna made Diana withdraw, and f e e l insecure-. She t r i e d t o separate the children whenever possible, but t h i s was d i f f i c u l t as Donna always i n s i s t e d on sharing Diana's a c t i v i t i e s . Diana l i k e d to help her mother i n the house, .and Mrs. M. gave her time .for herself, but seldom d i d t h i s f o r Donna. Donna had started school at f i v e years and was always f i r s t i n her c l a s s . Diana .was i n the same class, but w i t h a lower group. Diana had refused t o continue with her music lessons because she could not do as w e l l as * Donna. Mrs. M. believed that both children needed to learn to mix with other children, but.'she r e s t r i c t e d t h e i r play with cliildren i n the neighbourhood of whom she d i d not approve. Mrs. M. found sex d i s t a s t e f u l and as a young g i r l had attempted to deny i t s existence.  She had an i n t e l l e c t u a l understanding of her  children's need f o r sex education, but she rejected them a t the same time f o r having t h i s need. Mrs. M. had been brought up on a farm i n a large family. She said that she had received p r a c t i c a l l y no sex education as a c h i l d and at sixteen knew p r a c t i c a l l y nothing about i t . She seldom saw her brothers or her s i s t e r s naked. She described how shocked and upset she was when she had accidentally seen a naked man, at eighteen. She was shocked at how much children nowadays know about sex, but her own c h i l dren asked f o r information f r e e l y and she had given i t to them as they asked.Mrs. M. showed some g u i l t about her r e j e c t i o n of her children, p a r t i c u l a r l y Diana i n whom she could admit no wrong.  Diana sensed  t h i s and courted her mother's favour by being the "good" g i r l whom Mrs..M. admired.  She attempted t o dominate Donna by playing her  mother against her. not admit i n h e r s e l f .  Donna acted out a l l the badness v/hich Diana could The two g i r l s were inseparable because they r e -  l a t e d to each other as though they were component parts of one personality.  -52-  It was observed i n the Jfiuse that Diana often t a t t l e d on Donna, and she s a i d i n play sessions that she d i d . t h i s at home. Her mother, denied t h i s when she was asked about i t . During.play sessions with Diana, the case worker had d i f f i c u l t y i n keeping Donna out of the p l a y room. A group worker found her to be domineering.in the group,-.and determined to make the worker aware of her- s u p e r i o r i t y to the other c h i l d r e n . She showed a strong need to win, and would cheat to achieve this. Mrs. M. had found few s a t i s f a c t i o n s i n marriage, and would have preferred to remain v i r g i n , and to have l e d the "good" l i f e . tified of the  She iden-  . Diana as a projection of her own good s e l f , even to the point  encouraging her to sleep with her father against her w i l l .  Diana was  v i r g i n a l seductive mother, whom the father dared not harm. Further,  Mrs. M. encouraged Diana to attend a church which was s t r i c t ' a n d narrow, even though she herself belonged to a l i b e r a l church. In play sessions Diana became anxious while playing with the beds i n t h e - d o l l house. .When asked to model a boy, she gave him a very large penis. She said that she slept with her father, and often woke up at night, and could not go back to sleep. Mrs. M. seemed g u i l t y when t h i s was discussed with her. She said.that she had had a nervous breakdown s i x months previously, and stopped sleeping with her husband ^ then. Donna had refused to exchange beds with her mother, and Diana had < done so with some objections. She often asked when she could go-back to her own bed. There was a marital problem, and Mrs. M. said that she and her husband had l i t t l e i n common. Mr. M. d i d not p a r t i c i p a t e i n i n t e r views with the worker. Mrs M. expressed concern that Diana had become attached t o a very s t r i c t church, and vra.s becoming "goody-goody". Mrs. M. herself belonged to a l i b e r a l church. In Diana's use of the play materials, one could again see her fear of-her own aggression, her lack of ego strength, her fear of winning, her c o n f l i c t with her s i s t e r as based on the difference i n t h e i r personalities.  She was able to show her c r e a t i v i t y .  In p l a y she expressed  c o n f l i c t s and fears, which she could not, at f i r s t , v e r b a l i z e .  As she  became l e s s tense through play, she was not only able to v e r b a l i z e , but to show aggression. Although Diana d i d not appear to be anxious about sex, i t seemed from her drawings of people that her adjustment was based on repression of her i n t e r e s t i n sexual functioning, or her desire to  -53-  eventually experience i t i s marriage.  By acceding to her mother's  unconscious wishes f o r her, and looking forward to being the v i r g i n bride, there was no need f o r her to achieve preparedness f o r sexual; r e l a t i o n s i n marriage..  By becoming the ungiving, dominating woman^ <  she had no need to fear masculine aggression.: •By assuring herself of the s u p e r i o r i t y of women, she had no need to doubt her a b i l i t y to dominate. In play sessions, Diana used the clay a great deal, and avoided the darts. She was creative, but became anxious when the worker allowed .her to get ahead i n modelling or i n games. She said that Donna always• won when they played. Diana 'showed no anxiety i n speaking of sexual difference. In playing with the puppets, she gave the boy puppet the r o l e of a "bad" boy, and said that a l l boys are bad. She s a i d that she was never going to marry. When asked to draw a woman and a man she drew a bride f i g u r e with a very stern face, withdrawn, hands, a completely clothed body with no contours showing. The man was smaller than the bride and cut o f f at the waist. He wore a very t a l l hat. • .At f i r s t he had no arms, and when the worker remarked about t h i s , Diana added withdrawn, ones. In working with the mother, the worker found that she  was  unable to face her own problems, which was necessary i f the children were to be e f f e c t i v e l y helped.  She' knew that her marriage was unhappy, but  could not t a l k about the role which she herself had played i n t h i s .  She  could not t a l k about the role which she had played, i n the-development of her children's problems.  She was  i n c o n f l i c t because on the other hand  she was very eager f o r them-to have help.  The most that she could do at  t h i s point was to agree that regular interviews with the children be scheduled. The worker attempted to i n t e r e s t Mrs. M. i n going to the family agency f o r help with her own problems. Mrs. M. d i d not keep the appointments which were made f o r the purpose of planning t h i s . I t was decided that the case work supervisor, who had been working with Diana, would continue to contact her by mail, and would take up the problem again i n the f a l l .  Diana M. exemplifies the dramatic r e s u l t s -which can be  achieved  with a c h i l d through play interviewing, which i n t h i s case was used f o r case work treatment  of a c h i l d .  The worker's success was based on r e - •  lationship, and the use of symbolic materials i n play to help the c h i l d get repressed f e e l i n g out, and to b u i l d her ego. assisted work with the mother, who the c h i l d . a t home.  Work with the c h i l d  saw almost immediate improvement i n  Promising progress occurred with the mother, who  through a longer contact might have been appreciably helped. Diana became more relaxed during interviews, and became f r e e enough to play e a s i l y with the children at the House. She gained b e t t e r use of her arms and legs, and showed an a b i l i t y to "stand up " to Donna. School work improved, and she got several "A"s on her report card. When the worker encouraged her wish to leave her father's bed, she s a i d that she wished to continue to sleep with her father. This was the f i r s t time that she was able to assert herself against the worker. Mrs. M. gained i n awareness of Donna's need f o r a f f e c t i o n , and could accept the f a c t that she was emotionally disturbed a l s o . She was pleased with the progress that Diana made. She sent the c h i l d r e n to a d i f f e r e n t Sunday ' school. She gained understanding of her own r o l e i n the children's problems. The worker proceeded from a supportive r o l e with Mrs. M. to an i n t e r p r e t i v e one, and was able to help her with her feelings of g u i l t . The r o l e of a neighbourhood house i n the f i e l d of s o c i a l work i n f i n d i n g cases, and how a case worker with s k i l l i n observation, diagnosis and p r a c t i c e , can enhance t h i s function i s i l l u s t r a t e d . . not a member of the House, and who.was not a c h i l d who group a c t i v i t i e s , was interviews.  Diana, who  was  could b e n e f i t from  attracted by the opportunity f o r i n d i v i d u a l  I t also shows that individuals desire help i n r a i s i n g t h e i r  children i n t h i s present age, and are ready to support a treatment institution. Diana and Donna f i r s t came to the play room with a f r i e n d who was seeing the case worker. The worker asked Diana i f she would l i k e to return and she said that she would. The worker then discussed her observations with one of the other workers, and i t was decided that the l a t t e r would v i s i t the home to see i f the mother would accept help.  -5"5The worker found that the mother had recognized Diana's need, and had planned to request case work services a t the House f o r her. Mrs. M. was accepting of i n t e r p r e t a t i o n of the play room and of methods used. She gave considerable information about the cliildren, her methods .of dealing with t h e i r problems, and her attitudes about c h i l d care. I t was arranged that, the worker would v i s i t the mother r e g u l a r l y , and Diana would come to the House f o r p l a y sessions with her own worker. Donna would j o i n a group. Mrs. M. was interested i n c h i l d psychology, and previously discussed the children's problems with a s o c i a l worker. She expressed a wish f o r a treatment centre i n Vancouver f o r disturbed c h i l d r e n . The value of the group work s e t t i n g f o r case work, and the value of cooperative work between group workers and case workers, i s also i l l u s trated.  The family needed both case work and group work s e r v i c e s .  Donna  could use the group, although i n a negative way, and the group provided an opportunity to observe her, and t o gain a p i c t u r e of her manner of  r  functioning i n the family, both i n r e l a t i o n to parents and t o Diana. A l though Diana could not use group work at f i r s t , i t was a means of t e s t i n g her progress as she made gains through case work. Problems In Pre-Puberty. Like Donna, i t was evident from her behaviour i n the group that Ann D. had been hurt by parental r e j e c t i o n .  She sought adult attention  because she f e l t deprived of parental attention, and i t could be seen that she d i d not f e e l f r i e n d l y toward adults, but f e l t that she needed t o p l a ~ cate them because they were strong.  Ann t r i e d to dominate the group i n order  to gain the f e e l i n g of power which would give a semblance of s e c u r i t y against their rejection.  She feared the reaction of the group to her own aggrest-: •  siveness, and so t r i e d to r a t i o n a l i z e her behaviour.  She f e l t j u s t i f i e d i n  hurting others because people to her seemed h o s t i l e , and she could not stand further hurt h e r s e l f .  -56Ann showed p o s i t i v e strengths i n her mentality, and i n her creative a b i l i t i e s . Ann D., an eleven year old, was a disruptive influence i n her group, a crafts group. She continually t r i e d to manipulate the group i n terms of what a c t i v i t y they chose on a p a r t i c u l a r day. She , was over-raggressive with adults, and very demanding of their attent i o n . She r e l a t e d to adults i n a h o s t i l e way a t times, becoming def i a n t , and at other times would i d e n t i f y with them against the group. In her relationship with other children, Ann would become v e r y host i l e a t times, and then search f o r a reason to j u s t i f y t h i s . She was over-aggressive i n competing with other children f o r status i n the group. In her a c t i v i t i e s Ann appeared to be i n t e l l i g e n t , and her work showed imagination and creativeness. Mrs. D. r e j e c t e d Ann unconsciously, and hence was anxious i n her interview with the worker, f e a r i n g c r i t i c i s m of her care of Ann.  Because she could not give Ann sincere maternal a f f e c t i o n , she  t r i e d to substitute material things.  Like Mrs. M. i n r e l a t i o n to  Diana, Ann was a p r o j e c t i o n of herself t o Mrs. D., and represented a means of r e a l i z i n g her own frustrated d e s i r e s . Ann submitted to her mother at home, repressed r e s u l t i n g h o s t i l i t y , and t r a n s f e r r e d i t to other adults.  Her feelings could be more f r e e l y expressed i n the per-  missive atmosphere of the group. Mrs. D. was a c t u a l l y r e j e c t i n g the maternal r o l e and seeking a masculine one i n the competitive business world. Having experienced unhappiness and f a i l u r e i n one status she regressed to reassume the adjustment she had chosen e a r l i e r i n l i f e that of the breadwinner. Mrs. D.. showed a great deal of anxiety i n her f i r s t interview with the' worker, and appeared t o anticipate c r i t i c i s m of her care of Ann. She talked about her own struggle t o support Ann, plans she had f o r her, and the things that she would l i k e her t o have. She wanted to be able to provide Ann with the things that she had not had. She wanted Ann t o become a model, and to have dancing lessons, nice clothing, and good t r a i n i n g . Mrs. D. said that Ann was e a s i l y managed at home and was always obedient. Mrs. D. was divorced from her husband, and she l i v e d i n a suite i n the maternal grandmother's home. Mrs. D. worked long hours i n a clothing f a c t o r y as she ras attempting to save enough money to buy a business f o r h e r s e l f .  -57It seemed that Ann i d e n t i f i e d with hurt and sick animals because she f e l t that they, l i k e herself, had been treated unkindly. i n horses -was unusually, strong.  Her interest  I t was thought that she expressed her  repressed desire f o r her father i n t h i s love f o r horses, as symbols of masculine strength. lairs..D. said that Ann was very fond of animals, and would often bring home s i c k or hurt animals to nurse them back to health. Ann was a member of the junior S.P.C.A. She was p a r t i c u l a r l y fond of horses, and spent a great deal of time at a nearby stable where she was allowed to care f o r one of the horses. The walls of Ann's room had dozens of magazine pictures on them, and i n every one was a horse. In the relationship between Ann and her mother, Mrs. D.. denied Ann maternal a f f e c t i o n , and demanded adult companionship which she had l o s t through the loss of her husband.  She would not allow Ann the  dependancy of childhood. Ann submitted to her mother because she feared to lose her as she had her father, and attempted to a t t a i n from her the s a t i s f a c t i o n she missed i n not having her f a t h e r .  She transferred some  of the' h o s t i l i t y aroused by t h i s s i t u a t i o n , i n the d i r e c t i o n indicated by her mother, to her grandmother.. Mrs. D. said that she and Ann were very close, and discussed everything together, and were more l i k e s i s t e r s than mother and daughter. Mrs. D. said that she had never been able to r e a l l y t a l k to her own mother, who had not understood her, and she d i d not wish to have t h i s s i t u a t i o n between herself and Ann. She said that Ann was quite h o s t i l e to the maternal grandmother. Mrs. D.'s  description of her married l i f e gave evidence of her  protest at f u l f i l l i n g the feminine r o l e i n having a c h i l d .  Her husband  had looked f o r a mother f o r himself i n her and could not share her with Ann.  Mrs. D. i n turn had looked f o r strength i n her husband, and his  i n a b i l i t y to accept, r e s p o n s i b i l i t y was a severe disappointment.  Ann  sought to placate her mother by repressing her need f o r her father, and  -58her own dependancy. Mrs. D. married at twenty-one, and bore Ann, her only c h i l d at twenty-eight.. She and her husband had not wanted children, but had become used to the idea. The b i r t h was long and d i f f i c u l t , instruments had been used, and neither mother g o r c h i l d was expected to l i v e . Mr. D. was very proud of Ann at f i r s t , and loved to take her out i n her carriage. When Ann was about two years old, his attitude changed. I f Ann showed preference f o r her mother he became jealous j he would have childish, arguments with Ann, and eventually rejected her completely over some c h i l d i s h thing that she had s a i d . He became abusive, and drank heavily. When Ann,was about seven, Mrs'. D. decided to leave him, as Ann was becoming more and more upset about h i s r e j e c t i o n , and she herself was a f r a i d of him. Ann showed no f e e l i n g at leaving her father, and had not mentioned him since. i  Mrs. D.'s  description of her own early l i f e showed the basis  of her i n a b i l i t y to give wholeheartedly to her c h i l d .  I t also showed  the development of her own compulsive need to repeat the unhappy pattern of her own mother.  One^could also see the development of masculine-  aggressiveness i n her need to take the place of her father with her mother.  Again, with Ann she f e l t that she could f i l l the place of a  father. Mrs. D. was the youngest of a large family. Her mother load entered a forced marriage with Mrs.- D's father at eighteen. She had been happy with him, but he had also been a heavy drinker, and eventually she had to leave him. The maternal grandmother had to earn her cliildren's l i v i n g . She kept Mrs. D. with her f o r some time a f t e r the others had l e f t home, and she was quite dependent on her. Ann i s to be d i f f e r e n t i a t e d from the other children who  have  been discussed^in t h i s chapter, because as an eleven year-old she-was i n pre-puberty rather than i n latency.  In pre-puberty, f e e l i n g the  need to learn how to r e l a t e to boys, she was f e e l i n g the loss of her father more d e f i n i t e l y .  Ann had had l i t t l e opportunity to resolve the  c o n f l i c t s which are related to hetero-sexual r e l a t i o n s h i p s , and  was  threatened by the new i n t e r e s t which her friends were showing i n boys.  -$9-  '  /  She preferred to sublimate her own drives through an i n t e r e s t i n symbols of masculinity, as she could not face the p o s s i b i l i t y that she would be d i s l i k e d .  Ann r e l a t e d r e a d i l y to.the worker because  she was looking around f o r a s a t i s f y i n g r e l a t i o n s h i p with an- adult. It was also.evident, that Ann was confused with regard to her feminine i d e n t i t y , i n view of-her lack of a father, and of having a masculine-aggressive mother.  Her experience i n l i f e indicated that i t  • was b e t t e r to be male, and hence she showed masculine c h a r a c t e r i s t i c s . . She expressed resentment toward her mother who was not helping her with her problems, but f o r c i n g her into a mold which she d i d not want. In play interviews Ann showed a preference f o r clay, from which she attempted to model horses. She talked about her father almost immediately i n the play room, showing a need f o r him, accompanied by a f e e l i n g that he d i d not want her. She t o l d the worker that she had one d o l l that she had saved from the days when she was with her father, which "I keep and love". She said that her father sent her g i f t s at Christmas, but she was not sure that these meant anybhing,. Ann talked about .her time at. the r i d i n g stable a great deal, the couple who. ran i t , and the wonderful horse that she had there. She was eager that the worker would come t o the stable with her. Ann expressed a desire f o r better relationships with other cliildren, but wouldn't accept the h o s t i l i t y which she herself aroused i n them. She objected to the i n t e r e s t which some of the g i r l s were showing i n boys, yet confided to the worker that she had a boy f r i e n d . Ann preferred boys games, and was quite frank about t h i s . She played with the darts often, and apparently got a good deal of s a t i s f a c t i o n from t h i s . She expressed resentment of her*mother, and the pattern which Mrs. D. v i s u a l i z e d f o r her. Ann,  l i k e Diana, grasped the opportunity given her f o r i n d i v i d u a l  attention, and showed a desire t o make use of the help o f f e r e d . The worker was able to give her some understanding of her father's apparent r e j e c t i o n , of human motivation and reactions, and of the l i m i t s of her r e s p o n s i b i l i t y i n relationships.. G u i l t regarding her h o s t i l i t y was relieved.  -60-  Ann came f o r f i v e interviews with the worker.- The worker, during these interviews interpreted human motives i n r e l a t i o n to the actions of her father and her f r i e n d s , i n terms of her lack of r e s p o n s i b i l i t y f o r them. The worker assured her that her father did care about her, or he would not think of her at Christmas. Ambivalence as a common human t r a i t was talked about i n terms that Ann could -understand, and also her r i g h t to f e e l h o s t i l e at times, and to say so. The worker supported her i n the choice of an environment which • would be b e n e f i c i a l to her.  The worker's a c t i v i t i e s with Ann thus helped  her to move out of a s e t t i n g , which was  at that point an unhealthy one f o r  her, and which she had clung to i n her need f o r f r i e n d s , without precluding possible use of i t i n the future. The worker v i s i t e d the stable with Ann, and met the young couple who l i v e d i n the s u i t e above i t and managed i t . They had two children of t h e i r own who were near Ann's age and made up a f r i e n d l y , wholesome family u n i t . They appeared to be interested i n Ann, and w i l l i n g to have her around. The father allowed Ann to take such r e s p o n s i b i l i t i e s as answering the phone f o r him when he was out, as w e l l as caring f o r the horse. The atmosphere appeared to be a healthy one, and the worker encouraged Ann i n her interest.' . Ann decided that she was no longer enjoying the Junior program, and would i n the future spend more time at the stable. She thought that she would soon be too o l d f o r the Juniors. I t was suggested that she might return to the House i n the autumn as an Intermediate. Ann D. i s an example of the very disturbed c h i l d often encountered i n a neighbourhood house, who can be done i n the group.  i s a regular attendant, but f o r whom l i t t l e  Many children who  are l i k e Ann are attracted  by the i n d i v i d u a l attention offered by a case worker. l i k e Mrs. D.,  The parent,  who  resents the r e s p o n s i b i l i t y of her c h i l d , i s also receptive  of help. The method of contacting Ann,  and of arranging interviews with  her showed more maturity than, as an example, that used i n contacting Mary K., where friends of the c h i l d were allowed to i n t e r f e r e .  -61-  )  Anri D. was referred f o r case work as one of the more disturbed children , i n a group composed of " m i s f i t s " . This was an i n t e r e s t group. The case worker became acquainted with'Ann i n her group, and obtained permission to t a l k to her mother. Mrs. D. said that she was pleased to have the worker take an interest i n Ann, because she herself had to work long hours in. the garment factory where she was employed i n order 'to earn a l i v i n g f o r Ann and herself, and could not give Ann as much time as she would l i k e t o . She said that she would encourage Ann to come to the play room f o r interviews. ..When the play room was discussed with Ann, she asked i f she might bring a f r i e n d . .The worker explained that she could not, and Ann agreed to come, quite r e a d i l y . 1  Work With These Children Was Revealing. The case workers, found that emotional disturbances of the latency and pre-puberty children i n the House ranged i n depth from moderate behaviour disorder, as observed i n Larry P., to active psychosis, and. neurosis, as seen i n Jane J . and Diana M.  P r e c i p i t a t i n g causes i n  the environments of the children v a r i e d from lack of opportunity f o r ;.: sexual i d e n t i f i c a t i o n , f a u l t y s o c i a l attitudes, and economic  instability  to, extremely traumatizing experiences such as having been sexually molested by an adult, having experienced severe p h y s i c a l hurt at the hands of a parent, and r e j e c t i o n by parents. F i v e out of s i x of these children came from broken homes, i n which there had thus been a complete breakdown of the marital r e l a t i o n ship.  The s i x t h c h i l d came from a'home i n which there was a m a r i t a l  problem.  Three could not f i t into groups e a s i l y because of aggressive  behaviour which prevented them from gaining the acceptance of the other children i n the group.  One was a c h i l d who tended to withdraw from  r e l a t i o n s h i p s , who p a r t i c i p a t e d i n a group, but was not accepted, and who depended on the support of the leader to maintain her group a f f i l i a t i o n . One c h i l d was a f r a i d to enter a group.  Another had serious emotional  problems which were complicated by dullness, had no group a f f i l i a t i o n , but attached herself to adults.  -62-  The p e r s o n a l i t y c h a r a c t e r i s t i c which was most noticeable i n the s i x to twelve-year-old: i n contrast to the pre-school c h i l d , the ascendancy of the ego.  In a l l i t was  was  evidently seeking expression,  and was a need which could be detected even i n the most disturbed. J . avoided her mother -who worker who  Jane  threatened her ego, and clung to the group  gave her hope of expressing i t . ' Diana M. grasped f o r the  outlet offered by the worker i n the play room.  In a number of children  the needs of the ego were evident i n t h e i r attempts to gain status, t h e i r 'extreme r i v a l r y i n games, and i n t h e i r preference f o r adult company. Work with the latency c h i l d on the basis of a r e l a t i o n s h i p with the c h i l d alone,, and without p r i o r contact with the parent seemed more f e a s i b l e than with other c h i l d r e n .  I t had been hoped that the c h i l d  would come to the case worker a f t e r having been prepared by the group worker, the substitute parent, i n accordance with the accepted r e f e r r a l process.  I f case work treatment was  indicated i n the case worker's  preliminary study of the c h i l d , the next step was f o r the case worker to v i s i t the home, with the child's knowledge and consent, i n order to gain the cooperation of the parents.  Because of the m o b i l i t y of members  and s t a f f i n the House, few of the children mentioned.for a relationship with any of the group workers which was strength to support t h i s preparation.  Those who  r e f e r r a l had  of s u f f i c i e n t  had no close group  connection were p a r t i c u l a r l y inaccessible to the group workers. who  Those  attached themselves to adults i n the h a l l s s h i f t e d t h e i r alle-: . ;  gianc'eSj and. i t was  impossible to t e l l which worker 'might be e f f e c t i v e i n  r e f e r r i n g them. The latency c h i j d did not seriously question the motive of the  -63case worker when i n v i t e d to t a l k t o him i n the p l a y room.  He was used  to accepting adult dominance, and not yet seeking emancipation from i t . The worker' d i d not f u l l y recognize t h i s at f i r s t , and hesitated to ' approach the c h i l d who had not been prepared.  As a r e s u l t there was  also l i t t l e progress made with these children, e a r l y i n the p r o j e c t . Various experimental methods were t r i e d , and then i t was decided that the support of the parent should be sought.  The case worker then found  that these c h i l d r e n d i d not object to the idea of the worker going to the home, and i n some instances i n v i t e d him to come.  Following t h i s  there was greater success. The play room provided a natural medium of expression f o r t h e c h i l d who s t i l l l i k e s to phantasy.  The worker became an adult play  mate vrtio played h i s games and talked h i s language. be used and adapted t o s u i t h i s mood as he chose.  Play materials could I t was a natural tran-  sition from play i n the group to play i n the p l a y room, and there was something s p e c i a l i n the play room i n the s a t i s f a c t i o n s which i t provided, which were unique, and which served to hold the c h i l d ' s i n t e r e s t . The interviewing techniques used i n the play room were adapted to the setting and to the c h i l d .  Although much information f o r diagnosis  and treatment was obtained through observing and i n t e r p r e t i n g the way i n which the c h i l d used the play materials, children i n t h i s age group were able t o verbalize t h e i r problems to some degree, and i t was noted that as f e e l i n g s were expressed through the use of the play materials, they were often much f r e e r to v e r b a l i z e . The t o t a l setting of the group plus the play room made possible observation of the c h i l d both as an i n d i v i d u a l  -6k-  ,  and as ,a s o c i a l being; as an independent u n i t , and as a member of a family.  During r e f e r r a l , and as the c h i l d progressed i n interviews  the group worker kept the case worker informed of progress and of. problems i n the group, so that the case worker could be continually aware df the child's s o c i a l as w e l l as of M s  i n d i v i d u a l needs.  What Was AcMeved? The case workers helped latency and pre-puberty c M l d r e n to achieve easing of personal tensions, improved ego functioning, and necessary super-ego controls.  There was improvement among these c M l d r e n  i n t h e i r a b i l i t y to function i n the group, both i n the House and i n the community.  In the home, the worker attempted to ease detrimental pres-  s u r e s which were there f o r the c M l d .  Family relationships were strength-  ened- '. through case work, and parents were helped to plan more r e a l i s t i cally  f o r the c h i l d . Some of these children could not be appreciably helped by the ,  case worker i n the short period of time.  They were i n need of intensive  treatment, and more time was'required to even accomplish a r e f e r r a l . Others could benefit from the parental kind of r e l a t i o n s h i p which the worker could provide, and from i t gain the security and confidence necessary to enable them to develop relationships i n the group.  Some gained  ego strength which enabledthem to leave the House, and to f i n d greater s a t i s f a c t i o n s elsewhere. Indirect gains resulted from the case workers a c t i v i t i e s with t h i s age group.  The complete r e f e r r a l process was demonstrated, i n c l u d -  ing p a r t i c i p a t i o n by the group worker. i n d i v i d u a l ' s group r e l a t i o n s M p s and M s  The interdependence between the i n d i v i d u a l r e l a t i o n s M p s was  demonstrated; the r o l e of 'the neighbourhood house i n reconstructing the  -65family group, and the need f o r a case worker i n the setting, to round out the  service by providing i n d i v i d u a l r e l a t i o n s h i p needed by the more d i s -  turbed members. It i s of i n t e r e s t to note that only the c h i l d with the most complicated problem, Jane J . , had received help from another community agency. It i s a matter f o r conjecture whether t h i s would have occurred i f the mother- had not been dependent and i n receipt of f i n a n c i a l assistance.  The  value of the neighbourhood house as a case f i n d i n g agency i s c l e a r l y demonstrated i n Diana M.'s this r o l e .  case, which also shows how a case worker sharpens  The case of Diana M. also indicates how receptive people-in  Vancouver might be of a treatment i n s t i t u t i o n . There was a development of cooperation between the House, and case work agencies i n the c i t y .  One agency was encouraged i n t h i s by the f a c t  that there were case workers i n the louse. The examples i n t h i s chapter indicate the r e s u l t s of cooperation between the group worker and the case worker.  More children were worked  with than was possible i n the tfeirsery-School] more was done with regard to helping the c h i l d i n his personal adjustment.  There was greater i n t e r -  change between workers i n conference, i n thinking and i n diagnosis, and i n gaining an appreciation of respective r o l e s .  The case worker's r o l e i n  r e f e r r a l was more l i m i t e d because of the group worker's a b i l i t y to assume this function. The disadvantages of the setting, other than as stated i n Chapter I, seemed to rest mainly on the need f o r the development of s k i l l s , both 1  on the part of the case worker and of the group worker, i n practice of t h e i r respective s k i l l s , and i n using a setting i n which each had access to the services of the other f o r c l i e n t s .  Each needed a better d e f i n i t i o n  as w e l l as a clearer understanding of t h e i r own as w e l l as of the other's r o l e , and they also needed to evaluate more c l e a r l y and conc i s e l y t h e i r own respective a b i l i t i e s and l i m i t a t i o n s .  They needed  to achieve a s k i l l and assurance which would enable them' to proceed s k i l l f u l l y forward i n a plan to help a c h i l d ; to use to advantage any opportunity that presented i t s e l f which would further the p l a n .  Chapter IV.  PUBERTY AMD ADOLESCENCE.  The 'teen age years can be most joyous and s t i l u l a t i n g , most i n h i b i t i n g and depressing, or sometimes both.  B o d i l y changes and new emo-  t i o n a l drives of puberty may mean to the c h i l d e i t h e r a t h r i l l i n g promise of the freedom and power of adulthood, or the frightening threat of demands and r e s p o n s i b i l i t y f o r which he i s as yet unprepared.  The s o - c a l l e d  "average" c h i l d probably enters t h i s phase with mixed f e e l i n g s , and gradu a l l y gains confidence and strength i n himself which enables him to handle the change appropriately.  As he proceeds through adolescence, he learns to  express the "new s e l f " i n progressive, productive ways.  I t i s , however,  f o r the "average" i n d i v i d u a l usually past the middle twenties before the mature adult emerges. The phase of emotional development which i s known as adolescence', begins at about f i f t e e n years, and i s the period of emancipation.  During  adolescence the c h i l d seeks t o a t t a i n the inner strength and s e l f - s u f f i ciency which w i l l permit emancipation from h i s parents, and establishment as an independently functioning being.  To achieve t h i s , he turns to  friends of h i s own age, his "peer" group or gang, with more purpose than does the c h i l d i n latency.  In the gang he finds strength i n numbers; i n -  d i v i d u a l relationships which are stable because they are on a more superf i c i a l l e v e l than those i n his family and have l e s s chance of being a threat to the ego; the sympathy of people who have s i m i l a r problems. He i s free to express himself i n the gang i n the experimental ways which may not be acceptable to parents, but which r e l i e v e tensions due to i n h i b i t i o n of the new impulses.  He i s thus freed and enabled to conform t o the  more stringent demands of h i s parents and of society.  The demands of the  gang are more e a s i l y met by the adolescent than are the demands of h i s parents, because h i s sympathies l i e with the gang, and because he has a need f o r relationships which are on an equality b a s i s .  As he learns to meet  the demands of the gang, i f i t i s a gang which has emotional health, he learns through i t t o meet the demands of society.  He learns to cope with  these demands i n accordance with his i n d i v i d u a l needs; he f i n d s s a t i s f a c t o r y ways of expressing himself as an i n d i v i d u a l , and f i n d s appropriate outlets f o r h i s emotional drives. The adolescent who i s emotionally, disturbed because he has been denied opportunity f o r emotional growth during e a r l i e r stages of development finds adolescence more d i f f i c u l t than the' "average" c h i l d .  Sometimes h i s  i n t e l l e c t u a l capacities have been impaired, and sometimes h i s sense of value may not be i n accord with that of the adults about him.  He may choose  companions who are s i m i l a r to himself, and thus become a member of a group which i s i n c o n f l i c t with society.  The outlets which such a group use, or  the a c t i v i t i e s which i t engages i n , may express the drives of the i n d i v i d uals of which i t i s made up, but i n ways not i n accord with the dictates of society.  Sometimes these groups come i n d i r e c t c o n f l i c t with society, as  f o r example the widely p u b l i c i z e d delinquent gangs i n our larger  cities.  Treatment Of Adolescents. Neighbourhood houses are t r y i n g to achieve therapeutic results with disturbed 'teen-agers through working with delinquent gangs. permissive atmosphere of the House i s i n v i t i n g to the gang.  The  Activities  are provided which are appropriate to t h e i r emotional needs, and which are also acceptable t o society.  The adolescent finds s a t i s f y i n g modes  of expression i n clubs, team games and c r a f t s , and i s furnished with the means of competing successfully through"learning s k i l l s of performance.  As a r e s u l t of the sense of h i s own accomplishment and the  -69-  encouragement of the group worker, his desire to conform can be established. • The adolescent needs an environment where he w i l l be able to find understanding and acceptance; where there i s opportunity to learn to accept and handle his emotions. He needs a means of gaining prestige with his peers, and a sense of his own value. The adolescent who has emotional problems i s often d i f f i c u l t to help on an individual basis.  Because of his emotional conflicts i t i s  very necessary for him to maintain his defences. His tendency to seek solution of his problems in the gang, actually a defence, i s intensified. He does not trust adults, and has a means to avoid them i n the activities of the gang.. To gain his confidence and cooperation i s therefore a d i f f i c u l t problem for a case worker.  Through the practice of professional  group work there i s greater hope of reaching him, hence the problems of the adolescent are of particular interest i n a neighbourhood house. As he finds a place with his gang in the house, and as the gang becomes confident in the group worker, he may become accessible to the case worker through the group worker. This happens with the 'older adolescent, when there are definite problems such as employment and the choice of. a marriage partner, and when group activity has freed him of tensions sufficiently to accept individual attention. Many times the adolescent does progress from the person-to-person relationship with a case worker to satisfying group participation.  He  may have been unable to belong to a group without this individual help. The disturbed adolescent, like any other disturbed individual, lias unresolved conflicts which belong to earlier phases of development; frustrated need for the love of either or both parents; need for adult iden- ' t i f i c a t i o n resulting from loss of a parent during latency; need for a  -70parent substitute because the own-parent had been inadequate; or need f o r parental support because the own parent had been immature and unable to give the s t a b i l i t y which t h e c h i l d needs.  A l l tend to keep the c h i l d  from handling new stages of development i n a mature way.  By meeting these  needs the case worker can form a p o s i t i v e working relationship with an adolescent, and pave the way f o r meaningful relationships i n his peer group.  Gare must be taken n'ot to arouse c o n f l i c t before the c h i l d i s  mature enough to deal with i t .  I t i s usually safer to r e s t r i c t the case  work r e l a t i o n s h i p with a 'teen ager t o ego support plus coping with boyg i r l r e l a t i o n s h i p s ; f i n d i n g a place f o r himself i n the group expressing his growing independence and so on. Insight i n t o his defences should be given sparingly and cautiously. Problems In Puberty. The case studies which f o l l o w are discussed i n progressive order according to age. They present complicated and acute problems.  It i s  i n t e r e s t i n g to note the d i f f e r e n t kinds of c o n f l i c t which occurred i n puberty i n contrast to adolescence, and the d i f f e r e n t techniques which were used successfully with the d i f f e r e n t ages. Jean S., a thirteen-year-old, had a physical problem which had contributed highly to her emotional problems.  (deafness)  T y p i c a l l y , she  tended to use her handicap as a means of escape, and i t aided her withdrawal from s o c i a l r e l a t i o n s h i p s .  I t appeared at f i r s t that Jean's i n -  a b i l i t y to compete successfully with her own age group kept her with a younger group, where she d i d not seem to be happy.  She chose s o l i t a r y  a c t i v i t i e s , and d i d not encourage communicativeness on the part of others. Her h o s t i l e , aggressive nature was also t y p i c a l of many who s u f f e r her handicap.  -71The i n d i v i d u a l -who i s continually aware of what h i s handicap denies him, normally has very strong f e e l i n g s of f r u s t r a t i o n and deprivation, Yfhich he has to l e a r n to handle as other people learn to handle ordinary f r u s t r a t i o n .  Thus the deaf person who  can see the i n t e r a c t i o n  of those around him i s constantly aroused, while the b l i n d person, unaware of h i s , e xcept f o r what he hears, i s more cut off from his environment and as a r e s u l t u s u a l l y i s more withdrawn. Jean S. was t o t a l l y deaf i n one ear, and p a r t i a l l y deaf i n the other. She could read l i p s t o some extent but d i d not take part i n the general conversation, and the other g i r l s seemed to leave her to h e r s e l f . I t appeared that Jean preferred to concentrate on what she was doing as she made l i t t l e e f f o r t to mix with the r e s t of the group. She showed t a l e n t i n drawing and i n f i n g e r painting. Although twelve years of age, Jean was s t i l l attending the Junior program. On one or two occasions i t was noted that she became involved i n quarrels with the other children a f t e r leaving the c l a s s . She would s t r i k e out at them i n an angry way. One day when she had been f i n g e r painting, she refused to go home at f i v e o'clock when the House closed and splashed the paint around a n g r i l y . Mrs. S. showed a great deal of g u i l t i n r e l a t i o n to Jean, and there vra.s a suggestion that she r e j e c t e d Jean i n her reaction to the worker's v i s i t . disappointment  While i t i s natural f o r parents to have feelings of at having produced an imperfect c h i l d , i t seemed that Mr.  and Mrs. S. had such deep feelings about Jean's handicap that they had unconsciously denied i t for many years.  They had rejected her i n r e j e c t -  ing her defect, and as a r e s u l t had damaged her emotionally i n early childhood.  When they r e a l i z e d what, t h e i r attitude was  c h i l d they t r i e d v a i n l y to mate i t up to her. was a symbol to Jean of h e r parents' love.  doing to the  At f i r s t the hearing a i d Then i t became a symbol of  her defect, and she hated i t . lies. S. became very anxious as the worker explained who she was. She thought that Jean must have got into some trouble at the House. When the rrorker explained the purpose of her v i s i t , Mrs. S. began to discuss her problems quite f r e e l y . She said that she and her husband had not r e a l i z e d that Jean vras deaf u n t i l she started to school, and the school nurse discovered i t . They had always thought that Jean was unusually stubborn, and was d e l i b e r a t e l y ignoring them sometimes when she d i d not  -72respond when spoken t o . Jean d i d not learn to t a l k u n t i l she was f i v e , and they feared that she was mentally retarded. Mr. and Mrs. S. had punished Jean severely f o r being stubborn, without a v a i l . When the deafness was discovered they spent a great deal of money on ear spec i a l i s t s who thought that Jean might have been deaf from b i r t h , or from the age of two when she had measles. They bought her the best hearing a i d that they could f i n d . Jean was proud of i t at f i r s t , but now refused to wear i t , except i n the classroom, because children had teased her; In view of the f a c t that the parents were also over-protective of Jean p r i o r t o the discovery of her deafness, the worker suspected that t h e i r lack of awareness of i t had resulted from t h e i r own emotional blocking, that they were r e s e n t f u l and g u i l t y .  They d i d not know how to deal  with t h e i r f e e l i n g s , and because the idea of having an imperfect c h i l d threatened t h e i r own body images, they would not seek help. , As a r e s u l t they denied her an opportunity f o r normal experience and development. In t h e i r r e j e c t i o n of Jean, they underestimated her as a person, and hence feared that i n becoming an adolescent, she would shame them f u r t h e r . They attempted to deal with t h i s problem by holding her back with the younger age group.  As Jean already had a wish to withdraw, her parents thus played  into her weakness, and d i d not give her the support she needed to go ahead i n her development. I t became apparent that the worker's v i s i t was disturbing t o Mrs. S. because i t threatened to break down the adjustment the family had a l ready made to t h e i r problems, about which they seemed to have much unconscious g u i l t . Mr. and Mrs. S. had always been very protective of Jean. U n t i l she was s i x , Mr.-S. would always go out with her and watch her while she played. She had been away from her parents on a holiday only once, and had been very unhappy on t h i s occasion. Mrs. S. encouraged her to stay at home and work on arts and c r a f t s projects, b e l i e v i n g that Jean would thus develop except i o n a l s k i l l to compensate f o r her other shortcomings. Mrs. S. was very conscious of criminal attacks on 'teen age g i r l s which had occurred i n the c i t y , and f o r t h i s reason d i d not allow Jean out at Night. It was f o r t h i s reason that Mrs. S. had not allowed Jean to attend the Intermediate program which took place i n the evening. Jean had begged to be allowed to go. Mrs. S. also feared that the older children would be a bad influence on Jean, as she had heard alarming s t o r i e s about the things they d i d .  -73Jean's behavio\u' at home was consistent with her behaviour at 1  the  House, showing the same tendency to withdraw.  Her b i r d was a sub-  s t i t u t e f o r the companionship and devotion of f r i e n d s , and there was not the  need to compete as with other c h i l d r e n .  Her miserliness seemed to be  an attempt to keep f o r herself the material things she needed to compensate f o r lack of love. Jean d i d not l i k e to have other children i n to play with her, as she said that they took her toys away from her. She had a pet "budgie" b i r d t o which she was very attached, and her mother said that she would spend hours playing with t h e b i r d and t a l k i n g to i t . Mrs. S. also t o l d of how Jean would save odd b i t s of money that she was given, seldom buying anything f o r h e r s e l f . The worker's i n i t i a l interview with Jean revealed a d i s t r u s t of people and a depth of h o s t i l i t y toward l i f e . ing  the subj ect  The worker erred i n broach-  which was most p a i n f u l to Jean before there had been  opportunity to gain her confidence, as the discussion opened up areas of great f e e l i n g and caused a great deal of anxiety.  The worker should have  centered t h i s interview around Jean's desire to become an Intermediate, as a means of developing a p o s i t i v e r e l a t i o n s h i p .  As i t happened, Jean's  reaction was one of negative withdrawal. Jean came to the p l a y room w i t h the worker a f t e r some h e s i t a t i o n . She played with t he darts about f i f t e e n minutes s t e a d i l y , h u r l i n g them f o r c e f u l l y a t the board, and making no e f f o r t to include the worker i n the game. The worker then discussed with her the idea of becoming an intermediate, to which Jean responded e n t h u s i a s t i c a l l y . She t o l d Jean that she would also l i k e to have her come to the p l a y room frequently, to draw, paint or do what she wished, as she knew that Jean had d i f f i c u l t y on account of her deafness, and the worker would l i k e to help her with this.; I t was ' d i f f i c u l t to judge the q u a l i t y of Jean's response to this at the moment. She looked somewhat f e a r f u l , but nodded. Later the mother t o l d the worker that Jean had been very upset following the interview and had said that she d i d not wish to have anything more t o do with the worker. Mrs. S. s a i d that Jean had often begged her not to t e l l anyone that she was deaf. ' . . . . ;  -7k•  --.Mrs. S. was able to face the problem i n t e l l e c t u a l l y , but was unable  t'ofaceit emotionally, hence she was unable to carry through with the ' plans which were made with the worker with regard to Jean's a c t i v i t i e s at the House.  Her neglect of Jean's l i p reading class was another  i n d i c a t i o n of her i n a b i l i t y to face the problem of Jean's deafness. • The worker discussed with Mrs. S. the need f o r Jean to have as normal a l i f e as possible, and the value of allowing her to attend the - Intermediate program at the House as part of t h i s . Mrs. S. agreed, and thought that she or her husband could accompany Jean to the House, and meet her'aftervrard. However, Jean did not appear at the Intermedi a t e program, and Mrs. S. l a t e r s a i d that they d i d not wish her t o go out at nights." With regard to l i p reading classes which were provided at the school, Mrs. S. said that Jean had not been having them the past year, and she thought the teacher must have overlooked Jean. When the worker discussed t h i s with the teacher, she said that Jean had said that she d i d not need them any more, and had stopped coming. She thought Jean should s t i l l have them, but had heard nothing from Mrs. S., whom she had never met. " v  Mrs. S. seemed t o wish to discuss her problems with the worker, . and so the worker decided t o attempt to help Jean through helping her mother. The mother expressed her anxiety quite f r e e l y t o the worker, and seemed t o wish to continue to see her. The worker encouraged her.with regard t o Jean's p o s s i b i l i t i e s , and gave, her support i n her p o s i t i v e e f f o r t s and feelings with regard t o Jean. The father n a t u r a l l y became upset and suspicious when he was not . made a part of the discussion of a problem  which meant a great deal to him.  By allowing h i s antagonism to. develop thus, the worker.lost her contact with Jean through -the mother.  -  ,  The t h i r d time that the worker c a l l e d on the'mother, Mrs. S. said that her husband had "blown up" about the worker's i n t e r e s t i n Jean, and suggested that the worker was looking f o r evidence that they were neglecting her. The mother appeared to wish to discuss her problems with the worker, but d i d not i n v i t e her i n . I t was decided that v i s i t s would be discontinued u n t i l Jean returned to the house. Jean did not return p r i o r to the end of the p r o j e c t .  -75With regard to technique, t h i s case points up the need f o r a carefully  considered approach to a person's problem, p a r t i c u l a r l y  when i t i s evidently a source of considerable pain to w i l l naturally  the c l i e n t .  f i n d i t very d i f f i c u l t to face and r e s i s t help.  He  This  means close cooperation between group worker and case worker f o r purposes of diagnosis, and also time to work with the c l i e n t gradually; time to a l l e v i a t e the pain, b u i l d ego, and gain the c l i e n t ' s confidence.  This  would require that the case worker be employed i n the agency on a f u l l time b a s i s rather than f o r a l i m i t e d period. ness.of r o l e i n the s e t t i n g , and of  Experience, s k i l l , , sure-  function i n the cooperative s i t u a -  t i o n , would be necessary to handle the d i f f i c u l t problems which t h i s case; presented. In her.behaviour at the House, Barbara P., a thirteen-year-old exhibited, h o s t i l i t y toward women, defiance of authority, and i n a b i l i t y to  conform to s o c i a l patterns. She was f e a r f u l of meaningful r e l a t i o n -  ships .with people.  Barbara had the normal adolescent desire t o achieve  status, and to prove her own a b i l i t y to survive, but she had not learned the appropriate means of gaining these ends.  Instead she attempted to  dominate people i n order to avoid r e j e c t i o n , and chose companions who would accept this rather than "those with stronger p e r s o n a l i t i e s .  As a  r e s u l t her friendships were on a s u p e r f i c i a l l e v e l , and were not l a s t i n g . Barbara, a member of Junior House f o r s i x years was r e f e r r e d by the group worker because she was extremely aggressive i n her behaviour, and refused to take part i n any organized program. She was described as a b r i g h t , a t t r a c t i v e g i r l , who sometimes used her attributes i n wrong ways. Barbara's only close contacts with women s t a f f members had" been negative i n nature. She s h i f t e d her a l l i a n c e s from one worker to another. .She showed i n a b i l i t y t o share the group worker with the rest of the group. She worked very hard at the beginning of the current year to r e c r u i t her group, and although she said that she wanted to be president, was not elected. The members were a l l new to the house except one, and none had known Barbara previously. They were described as insecure g i r l s unable to assert themselves,-whom Barbara was able to manipulate.  -76-  Barbara was not close to any of them. The group began to break up at Christmas time, and to r e j e c t Barbara, Yfho became very i r r e g u l a r i n attendance. Barbara was most apprehensive of her own a b i l i t y t o succeed, and hence sought reassurance from those i n authority.  She s t i l l r e -  tained the i n f a n t i l e need to be loved without compromise, and alsosought to r e t a i n the; i n f a n t i l e f e e l i n g of omnipotence.  She had not  learned s o c i a l l y acceptable ways of r e l a t i n g to people of either sex. Barbara was continually seeking approval from leaders-. She' "lapped up" p r a i s e . She said that she wanted people t o love'., her no matter what she d i d . She was continually jumping on the group worker's back, and threw her arms'around people indescriminately. The "P." family had been referred to the male case worker (see Larry P. .p.3U), who became acquainted with Barbara early i n the p r o j e c t . She came up to him i n Junior House, excited and laughing, rushed forward, threw her arms around him, and pressed her body against h i s . When the time ' came f o r the House t o close, she d i d not wish to go home. Barbara was then referred to the female case worker, as i t was believed that she needed someone of her own sex with whom to i d e n t i f y . I t was evident to the case worker that Barbara was very anxious' about her r e l a t i o n s h i p s .  Her pattern seemed to be to "use" people i n  order to establish her own prestige i n the group, and to prove t o hers e l f that she was loved.  She covered up her h o s t i l i t y i n order t o  achieve t h i s end. The case worker noted that i n the group, Barbara worked very hard to hold the centre of attention. She was almost hyper-active. She was i n and out of the room a great deal, and was u s u a l l y chased by boys when she returned. She became quite f r i e n d l y with the case worker i n the group, and was demanding of her attention. Barbara seemed to attempt to f i l l the father's r o l e i n her home, and to displace the male boarder.  This pattern showed up i n the group  where Barbara i d e n t i f i e d with the group worker.  Barbara's emotional  tie-up with her mother, toward whom her attitude was protective, made ' i t d i f f i c u l t f o r workers i n the House to gain her confidence.  The worker  -77seemed to represent to her the l i m i t a t i o n s of society, to which the mother d i d not wish to conform.  Barbara's problem was one of handling  her own strong impulses with l i t t l e super-ego support from her mother. The group worker had v i s i t e d the family, and had found the mother interested i n the House a c t i v i t i e s , but unwilling to face that the children had problems. Barbara had shown concern i n the group about the presence of the male boarder i n her home. There was considerable gossip i n the neighbourhood about her mother and t h i s man. Barbara showed considerable r i v a l r y with her brother, and by getting to the agent f i r s t , secured a paper route that her brother had planned on having. In the group Barbara attempted to take an authoritative r o l e with the other members. She seemed to be mixed up about her sexual i d e n t i f i c a t i o n , and was impulsive and uncontrolled i n her behaviour. I t seemed from Barbara's behaviour i n the play room that. she. needed to get out masculine aggressive impulses a t times, but wanted to play the r o l e of the aloof adolescent. She seemed to have a great deal of repressed sexual c u r i o s i t y . keep her emotions i n s i d e .  She d i d not have the controls necessary to Her need to take her father's place and d i s -  place the unacceptable boarder i n her home, was affirmed i n the p l a y room. Her family's attitude toward authority also reappeared.  Barbara gave a  great deal of herself i n . e a r l y interviews. Barbara was quite controlled when she f i r s t came to the play room. She t r i e d not to defeat the worker i n competitive games, and showed no i n t e r e s t i n aggressive games. She confessed that she preferred boy's games, but seemed to be g u i l t y about .this. Later she became freer.- She began to play with the cowboys and indians. She would show a great deal of aggression at f i r s t , then become very anxious and put them away. She expressed envy of boys, t o l d the worker of her paper route, and said that she gave the money to her mother. She mentioned the boarder i n her house and became anxious. She began to p l a y with the water gun, pressing i t i n front of her l i k e a penis, and shooting water into a p a i l . She showed c u r i o s i t y about sex i n examining the d o l l , but hurriedly put i t away. She said that she d i d not l i k e policemen or teachers. The worker who v i s i t e d Barbara's home said that Mrs. P. was more l i k e a s i s t e r to t h e children than a mother, and made very few demands on them. When unconscious material thus began to reveal i t s e l f , Barbara became f e a r f u l , and sought the protection of her group.  The worker might  have helped her by answering some of her questions about sex; by showing acceptance and understanding of her problems at home.  x  -78-  Barbara missed appointments i n the p l a y room, and came f o r her l a s t interview a t the persuasion of the male caseworker, bringing a f r i e n d with her. The f r i e n d was not allowed t o come t o the plajr room by the worker. She neglected t o discuss Barbara's seeming resistance with her. Barbara stopped coming to the play room although she was f r i e n d l y with the worker when she met her i n the House. The p l a y room and the contact with the case worker appeared to provide a d e f i n i t e outlet and therapeutic e f f e c t f o r Barbara.  The v e r y p a i n -  f u l elements i n her f a m i l y s i t u a t i o n however indicated that time and care were necessary t o r e a l l y help Barbara.  A long period of casual contacts  with her i n the House, used as opportunities to encourage her i n her e f f o r t s , and t o give her a sense of being personally worthwhile j was needed p r i o r to seeking the mother's support.  F a i l i n g t h i s the mother had no  reason to f e e l that the House was helping Barbara, and reacted with s u s p i cion.  Barbara then was thrown into a state of c o n f l i c t , between her desire  to stand by her mother's wishes, and a desire t o grow personally. The group worker s a i d that while Barbara was attending p l a y sessions she was less aggressive, and much more cooperative i n the group. She was also making a constructive e f f o r t to gain friends.. She was v e r y f r i e n d l y f o r some time with the g i r l whom she had wished t o bring t o the play room. A f t e r she stopped coming t o the play room, she went to the other extreme. She eventually stopped coming to the House. Her brothers got i n t o d i f f i c u l t y over the destruction of House property. They were r e jected by the group workers, and Mrs. P. would no longer allow any of h e r . children to attend. The handling of t h i s case showed a development of technique, both i n cooperation between group workers and case workers, and i n case work. F i r s t , i n the vise of the conference and the case committee, and secondly,in the case worker's methods i n i n t e r e s t i n g the c h i l d i n the p l a y room and i n using the play room for interviewing"purposes.  E a r l y i n her contact with  Barbara, the case worker tended to assume the r o l e of the group worker, as a result of her unsureness about her own r o l e , and d i d not achieve r e s u l t s .  -79When her own techniques and r o l e had been established, r e s u l t s were evident. The worker observed Barbara i n her group and became acquainted with her there. Both the group worker and the case worker were concerned about how they might interest Barbara i n seeing the case worker. It was decided that the case worker would f i r s t attempt to become w e l l acquainted with her i n the group. The Christmas concert, and rehearsals f o r i t provided t h i s opportunity. The case worker shared r e s p o n s i b i l i t y f o r the group with the group worker. The case worker's attentions were focussed on Barbara.during these sessions, and Barbara constantly sought them. When Barbara f i r s t stopped coming to the House, the case committee reviewed her case and suggested that a case conference be held i n order to formulate a new p l a n of working with her. I t was decided that Barbara's main need was a p o s i t i v e relationship- with a woman., The male case worker could ask the mother to encourage Barbara to come f o r interviews. Barbara consented to come to the p l a y room. The r o l e of the worker, and the use of the p l a y room were explained t o her. She came f o r three interviews. Work with Barbara demonstrated the value of cooperation between the case worker and the group worker i n diagnosis and planning.  Barbara r e -  sponded p o s i t i v e l y to thoughtful case work, as shown by the change i n her behaviour i n the group.  The plan was not arrived at soon enough however,  to be r e a l l y e f f e c t i v e i n helping Barbara, because of the time l i m i t on the project. Patrick 0., a fourteen-year-old, showed a strong desire to be l i k e d , a fear of adults, and a great need to be accepted.  Ills apparent lack of  ease was t y p i c a l of the boy i n early puberty who i s uncomfortable with h i s new body changes, and emotional impulses.  Pat's reaction t o the female  worker may have indicated either his desire to l e a r n how to succeed with women, or a leaning toward feminine rather than masculine i d e n t i f i c a t i o n . Patrick 0 . was an a t t r a c t i v e , l i k e a b l e boy, whose p h y s i c a l appearance showed t y p i c a l signs of puberty, who was tense i n the presence of adults, p a r t i c u l a r l y women, and always anxious t o please, and t o prove his adequacy. He often expressed concern f o r his mother, and appeared to be very fond of her. He r e l a t e d r e a d i l y to the female worker, whom he chose i n preference to a male worker, and was very f r i e n d l y with her a l l through the contact. He t a l k e d to her i n a manly, worldly, way.  -80-  Pat's p o s i t i o n as the eldest i n his family suggested that he might be required to accept more than his share of"the r e s p o n s i b i l i t y , and t h i s was borne out i n f a c t .  He was making a strong e f f o r t to please at home  also, and to prove his adequacy as a male.  Because of his f e e l i n g of i n -  adequacy at home, he needed t o compensate. Pat was the eldest of three boys. His family l i v e d on a marginal income, and Pat worked i n a bowling a l l e y as a p i n s e t t e r , four nights a week, i n order to earn money f o r clothing, and spending money. He d i d not attend the House, but had membership i n an a t h l e t i c club, xvhich was run by a man who was rather notorious i n the community and of whom Mrs. . 0 . d i s approved. This club sponsored lacrosse and boxing, and Pat was very eager to learn to defend himself. I t appeared that Pat's parents were personally f e a r f u l of t h e i r a b i l i t y to conform to s o c i a l mores, and hence were not t r u s t i n g of t h e i r children.  They were over hasty i n accusing Pat of a recent theft which 1  had occurred i n t h e i r home, as they had been overly anxious to have him punished when he had once been involved i n a delinquency.  They had ap-  parently experienced serious hurt and punishment themselves, and needed t o r e t a l i a t e by taking t h i s out on someone e l s e .  Their choice of Pat as the  object of r e t a l i a t i o n indicated that they were r e j e c t i n g of him. Unconscious c o n f l i c t r e s u l t i n g from t h i s made the mother aware of her i n a b i l i t y to deal with the s i t u a t i o n , and so she asked the help of the worker. Currently, a t home, Pat was i n the bad graces of his family because a wallet containing several dollars•had disappeared, and Pat was suspected by his parents of having taken i t . Mr. and Mrs. 0 . were very upset about the s i t u a t i o n because Pat had been involved with some other boys about a year previously, i n the t h e f t of some tinned f r u i t from a box car. The p o l i c e had caught them and they had to appear i n Juvenile Court. Pat could have been l e t o f f , as i t was his f i r s t offence, but he was placed on a year's probation a t the request of his parents. Pat's mother hoped that the case • worker from the House might suggest some new means of punishing Pat, as she was "at her wits end". She had hoped that by c a l l i n g the worker she might f r i g h t e n Pat into confessing. However, this had f a i l e d .  While the worker was v i s i t i n g the mother, her r e j e c t i o n of Pat became quite apparent. the beginning.  He had caused her suffering and shame from  Her desire to'have, more children following his b i r t h  seemed to be r e l a t e d to her disappointment i n Pat. ' Mrs. 0. had suffered from a womb disorder ever since Pat's b i r t h . In speaking of t h i s , she said that Pat had been a most u n a t t r a c tive-,, jaundiced baby, and she could hardly accept him as her own. His b i r t h had been d i f f i c u l t , requiring instruments, and labour had been about eighteen hours. Mrs. 0. had been badly torn. She had not had an operations, to correct the womb disorder, as she feared that she would-be un- • able-to have more cliildren. Mrs. 0. was a youthful, a t t r a c t i v e woman who exhibited a good deal of narcissim.  4  'In conjunction with a long period of i l l n e s s , Mrs. .0.-.had regressed to become a dependent,, immature woman.  She was unable to face any kind of  r e s p o n s i b i l i t y , and even blamed her family f o r her i l l n e s s .  She was exces-  s i v e l y demanding of her children and showed a desire to be dependent upon them.  That her capacity f o r a f f e c t i o n f o r Jimmy was l i m i t e d was shown i n  her i n a b i l i t y to allow him to enjoy the normal a c t i v i t i e s of boys of-his age.  She strove to r e t a i n his favour because he met some of her 'emotional  needs.  Mrs. 0. competed with Pat f o r her husband.  duce, the worker to f i l l a mother r o l e with her.  She attempted to i n -  Being unable to give of  herself t o her children she helped to create behaviour problems i n them and then attempted to handle these problems through punishment. Mrs. 0. had been undergoing womb operations f o r a year and had spent a great deal of time i n bed. During the worker's contact she had the womb removed. Interviews with the worker were l a r g e l y centered around Mrs. 0's i l l n e s s , and problems of the family as they affected her. Mrs. 0. f e l t very sorry f o r herself, and demanded a great deal from her sons and husband. They d i d t h e i r best to pamper her, and were very concerned about her. She continually sought the vrorker's sympathy. Pat had to turn over a l l of his earnings to her. She appeared to favour Jimmy, but would not allow him out on school days a f t e r four, or allow him to j o i n a boy's club. She wanted his help a t home. Jerry, aged f i v e , was expected to turn over any money he got to her t o buy his clothing. Mrs. 0. resented the friendship 1  -82-  developing between Pat and Mr. Q. She believed i n c o n t r o l l i n g her children through f e a r and punishment. She said that her i l l n e s s had had a good e f f e c t on Pat because he became frightened and conforming when she was i l l . The g u i l t which the mother had induced i n Pat appeared to be • the motivating f a c t o r i n his attempts to meet her demands, as seen i n h i s reaction to her i l l n e s s .  Recognizing  his need at the same time to r e a l i z e  the advantages of the adult r o l e , he resented r e s t r i c t i o n s placed on- him as a fourteen-year-old.  He resented his younger brother because he was  unable to compete s u c c e s s f u l l y with him f o r h i s mother's favour. Although Jimmy and J e r r y reacted unfavourably also to the upset. i n the home, Mrs. 0. was i n c l i n e d to r a t i o n a l i z e t h e i r behaviour and t o center the blame on Pat, again showing her r e j e c t i o n of Pat. ' During the worker's contact with Pat, he t r i e d to assume more than his.share of the r e s p o n s i b i l i t y i n the home, p a r t i c u l a r l y following the mother's h o s p i t a l i z a t i o n . He t r i e d to f i n d a nursery school f o r Jimmy, and-assisted his father i n redecorating the apartment. He found i t d i f f i c u l t to conform to the hours which were set f o r him, and would sometimes s l i p out of the window to go to a show, while h i s parents thought that he was i n bed. He was adamant that he had not'taken the missing wallet, and became very antagonistic toward Jimmy who he said had taken,it. Jimmy became involved i n the stealing of some s k i i s with some other boys, and t h i s was very upsetting to Mrs. 0. She had not been w i l l i n g to accept the idea that Jimmy might s t e a l when Pat suggested i t . She blamed Pat f o r t h i s episode because he had said that the other boys were " a l l r i g h t " when Jimmy asked i f he might go with them, and the mother had been.hesitant to 'alloy/ i t . Mrs. 0. seemed to gain some i n s i g h t into her r e a l f e e l i n g s about her children, but because she was i l l could not face the demands. which, t h i s made on her.  She therefore could not use f u r t h e r help from  the worker. Mrs. 0. scolded Jimmy b i t t e r l y i n the presence of the worker and a neighbour who was v i s i t i n g . A f t e r this she found i t very d i f f i c u l t to discuss her problems with the worker, and v i s i t s were discontinued u n t i l she wished to c a l l the worker again-. The.effect of the support which the worker gave the family was evident.  Mrs. 0. began to accept Pat more favourably, and Pat gained i n  -83a b i l i t y to accept the r o l e which -was - demanded of him i n the home, as the worker gave him the recognition and acceptance which he needed.  His  father's reaction to the s i t u a t i o n assured him of continuing support. Mrs. 0. became more lenient with Pat, and seemed to have a better appreciation of the e f f e c t of the pressure which he was under.  Pat be-  came less b e l l i g e r e n t i n the home. This case i l l u s t r a t e s further the need f o r case work on a long term basis i n order to deal with the d i f f i c u l t problems which are encountered i n a neighbourhood house.  I t also I l l u s t r a t e s the community need  f o r a case work service i n t h i s f r i e n d l y , receptive s e t t i n g and again, the r o l e of f i n d i n g cases before development of severe c r i s i s . Pat came to the notice of the case worker as the r e s u l t of a phone c a l l from his mother asking help from the house with a family problem which had developed as the r e s u l t of the t h e f t of a wallet, which she believed her son Pat had taken. She was referred to the.Family Welfare Bureau; however, she s a i d that she d i d not wish to c a l l that agency, and she hoped that the House might help by i n t e r e s t i n g Pat i n a c t i v i t i e s . Problems In Adolescence.Joan R., a f i f t e e n - y e a r - o l d had been involved i n an act of d e l i n quency, was "acting out" her protest against a world which had mistreated her. .Joan showed strength i n her a b i l i t y to p a r t i c i p a t e i n a c t i v i t y groups, although relationships with people were on a s u p e r f i c i a l l e v e l . She showed a desire to r e l a t e to people i n a more meaningful way.  The  drama group probably appealed to her because i t presented an acceptable opportunity to act out her c o n f l i c t . Joan R., had taken part i n a shop l i f t i n g episode i n the neighbourhood with two other House members. Joan was an a c t i v e g i r l vrho had attended the House f o r about'seven years.- She also sang i n a church choir, and belonged to a figure skating club. In the House few s t a f f members had become acquainted with her. She had had l i t t l e success i n making her way into a friendship group., Of l a t e she had been showing exceptional i n t e r e s t i n a drama group...  -84Because Joan was "acting out" her c o n f l i c t s , she was not subject to the emotional tension and discomfort of people who repress t h e i r f e e l ings.  As a r e s u l t she was l e s s accessible to case work, and was able to  present a brave, defiant f r o n t .  Her manner of dress was part of t h i s f r o n t ,  which she evidently used quite consistently, and she seemed to deny her feminine r o l e .  Joan could not bear to be singled out by the worker because  she depended on the protection of the group.  When she found that the worker  was not threatening, she appreciated how she could gain status i n the group through the interview, and became the group's champion.  As she gained  security i n the s i t u a t i o n , Joan was able to l e t down some of her defences, and express her own problem.  The worker erred i n defending the House as  she thus a l l i e d herself with Joan's mother.. The worker f i r s t saw Joan i n an o f f i c e interview. She asked Joan to have a chair, but Joan said that she preferred to stand. . Joan was an a t t r a c t i v e g i r l who appeared to be f u l l of l i f e and energy. She was wearing blue jeans, her hair was done i n p i n curls covered by a colored scarf and a number of trinkets and chains dangled from her b e l t . When the worker explained her r o l e and offered to t r y to help Joan, Joan was immediately on the defensive, and wanted to know i f the worker knew that there had been others' involved. The worker explained that she d i d not know the names of the others, but suggested that through Joan they might also be helped. Joan said that they d i d need someone whom they could t a l k t o . She a t t r i b u ted •••• the blame to the House because i t was not open every night f o r her group and d i d not have enough equipment to keep them interested. The worker came to the defence of the House at t h i s p o i n t . Joan said that i t had been the same a l l her l i f e , "you can't do t h i s , you can't do that". I t was apparent that Joan had very p o s i t i v e feelings about her group leader.  This was encouraging i n view of the antagonism and doubt  she expressed i n r e l a t i o n to other people i n her world.  In developing a  relationship with Joan the worker should have made a greater e f f o r t to induce her to come to her interviews alone.  The worker could have shown  recognition of Joan's need f o r her friends without assenting to the suggestion that she bring them.  Permitting t h i s , the worker affirmed Joan's  -85-  doubts about her own  .  r  '  strength.  Joan then wanted to know vjho else knew that she was involved i n the s h o p l i f t i n g , and the worker t o l d her that as f a r as she knew, only the Executive Director. Joan said that she f e l t that everyone knew, i n the House, and at the school as w e l l . She said that one of the teachers had snubbed her and she knew that t h i s was the reason. She s a i d that there was only one teacher i n the school that she l i k e d as a l l the others picked on her; the p o l i c e always blamed things on her and s a i d that she was a gang leader; people c a l l e d her a trouble-maker. She j u s t wanted to get something done about the various grievance that "the kids"-had. The worker suggested that Joan might come to the play room i n Senior House one evening to help her f i x i t up, and they could t a l k . Joan then asked i f she might bring two f r i e n d s , and the worker agreed. In her group Joan's personal problems became much more evident; these included her i n s e c u r i t y i n r e l a t i o n s h i p s , her awareness of her strengths and i n a b i l i t y to use them, - her need f o r a dominating p o s i t i o n as a protection against r e j e c t i o n . had adolescent c u r i o s i t y .  In common with her companions-, Joan  While her companions expressed and  sublimated  t h i s adolescent c u r i o s i t y i n a c t i v i t i e s , Joan seemed' to have a tendency to" repress i t .  I t was d i f f i c u l t to determine i n so b'rief a contact  how  these things had affected her emotional growth. .Joan brought three f r i e n d s , two g i r l s and a boy, with her to the play room. Joan seemed to be seeking t h e i r approval desperately. She was not t h e i r natural leader, but they seemed to consider her the i n t e l l i g e n t one. They brought several copies of "Lurid Romance" and "True Romance" i n comic book form with them. Joan, spent most of the evening reading.these. The others were interested i n the rooms which opened o f f the p l a y room, and i t was d i f f i c u l t to keep t h e i r i n t e r e s t i n the playroom. They found some boxes i n one of the rooms which they were very anxious to go through. Joan remained aloof. It was  too l a t e i n the project to work s u c c e s s f u l l y with Joan,  and the worker had missed the opportunities presented f o r gaining a r e l a t i o n s h i p with her by allowing her friends to share her interview.  -86-  The vrorker attempted to arrange an interview with Joan by h e r s e l f . Joan did not keep appointments. Later when the worker met her at Junior House, she. seemed somewhat embarrassed and hastened to say that she had t o l d her friends about the worker's job, but neither they nor Joan had any problems to discuss. Joan's problems arose from a s i t u a t i o n which was common i n the neighbourhood, as has been previously mentioned:  divorce, and the problems  i m p l i c i t i n the mother having to work to support the c h i l d . b i t t e r about her l o t i n l i f e .  Joan suffered as a r e s u l t .  Mrs. R. was  Mrs. R. was  t r y i n g to force the neighbourhood to share a r e s p o n s i b i l i t y which she d i d not f e e l was wholly hers.  B a s i c a l l y Mrs. R . rejected Joan.  •Joan l i v e d with her mother i n a small s u i t e . Mrs. R. was divorced from her husband, and had to work to support Joan and h e r s e l f . I t was known i n the House that there was not a good r e l a t i o n s h i p between Joan and her mother. When the s h o p l i f t i n g took place, Mrs. R. blamed the House because i t was hot open every night f o r Joan's group, and d i d not provide enough equipment to keep the g i r l s interested. The mother requested that the s i t u a t i o n be reported to the House and that the House do something .about i t . She gave her permission that Joan's name be mentioned to the Executive Director, so that her problem might be dealt with i n the House. The mother seemed anxious to have help f o r Joan, and i t appeared that she would have been  r e c e p t i v e of help h e r s e l f .  She recognized that  she had a problem i n her i n a b i l i t y to understand Joan, and seemed to be at the point where she wished t o do something about i t . On one occasion when the worker was attempting to reach Joan by phone, her mother answered and wished to know who was c a l l i n g . The worker t o l d her. She sounded tense and upset, and seemed to wish to t a l k . She said that she found i t very d i f f i c u l t to understand children of today, they seemed to wish to act l i k e adults. The worker talked to her i n a general way about the psychology of adolescence, and showed recognition of her anxiety. Mrs, R. s a i d that i f the worker wished to work with Joan, she had her permission. The worker, suggested that she might also be able to help the mother understand her. Mrs. R. was accepting of t h i s and was more cheerful and relaxed at the end of the conversation.  -87c Information presented by the group worker confirmed the case worker's previous impression of Joan.  She had strengths, i n her a b i l i t y  to perform certain a c t i v i t i e s , and i n her enthusiasm f o r the group. Her weaknesses were represented by her i n a b i l i t y to get close to people, or to give up personal comfort f o r friendship's sake.  Information about the  type of relationship that existed between Joan and her mother added weight to what had already been indicated:  e a r l y r e j e c t i o n of Joan by the mother,  eventual remorse and a desire to make up the lack of a f f e c t i o n i n other ways. The group worker said that Joan was making progress i n the group. She had been successful i n organizing basketball teams, and had maintained the confidence of the group by basing team membership on membership i n the group. Joan came into c o n f l i c t with the group at times, however, as on one occasion when she would not go with them f o r a coke, a f t e r a game, because i t meant going out of her way. The other members had expressed sympathy f o r Joan, as they said that her mother had treated her b r u t a l l y as a c h i l d . The group'worker had noted that Joan was always the best dressed g i r l i n the group and had most spending money. A discussion of the problem a t this point by the group worker and the case worker, and how they might best proceed i n helping Joan, resulted i n conclusions which pointed up the respective roles of the case worker and the group worker i n t h i s s e t t i n g ; t h e i r complementary nature, and how they operate i n order t o help the c l i e n t .  As has been previously shown, a  group worker cannot do case work i n a group work s e t t i n g .  I f he has a  relationship vdth a c l i e n t who i s i n need of case work, he should be able to use that relationship to b u i l d a relationship between the c l i e n t and the case worker.  S i m i l a r l y , i f i t i s thought that the personal needs of  the c l i e n t can be met through the group, and the case worker i s to deal with the home environment, the group worker should use his r e l a t i o n s h i p with the 'teen-ager i n order to gain f o r the case worker access to the home. In working with a sensitive adolescent, confidence can only be maintained by allowing him t o p a r t i c i p a t e i n a l l planning that a f f e c t s him.  -88-  He w i l l n a t u r a l l y i d e n t i f y the case worker with the group worker, since they both are employed i n the House.  I t i s j u s t as important, therefore,  f o r the group worker t o gain h i s assent i n the instance of the case worker going into h i s home, as when 'the group worker himself goes.  Thus we  see the complementary nature of the two services extending into workerclient relationship. In a case conference regarding further planning f o r Joan, i t was thought that the group worker had a relationship with Joan, who was making progress i n the group. I t was' therefore the opinion of the group worker that she should work with Joan, and the case worker should work with Mrs. R., i n an attempt to a l l e v i a t e some of the problems which existed f o r Joan i n her home. The case worker agreed to attempt to do t h i s . In planning an -interview with the mother the case worker r e a l i z e d that t h i s should not be arranged without Joan's knowledge and consent. This was suggested to the group vrorker, who did not think that she could s a f e l y discuss t h i s with Joan without endangering her own r e l a t i o n s h i p with her. .It was therefore decided that i t was best that the case workers r e f e r the problem back to the group workers. Joan was f i r s t referred to the case workers at a time when c o n f i d e n t i a l i t y , as w e l l as the matters of respective r o l e s of group work and case work, and the relationship between them, had not been defined and clarified.  The method of r e f e r r a l used was an experimental one, i n the  absence of adequate precedent to follow, and the experience l e d to constructive consideration of these things.  I t became apparent that c o n f i -  d e n t i a l i t y d i d not mean exclusion of professional people who were not d i r e c t l y concerned so much as withholding d e t a i l e d information which was not u s e f u l to the group worker, working i n a group s e t t i n g .  Knowing generally  that there was a problem might be useful to the group worker i n appreciat i n g the outside pressures that the person was under, but no more.  Hence  the amount of information that a group worker should be expected to be given by the case vrorker should be l i m i t e d to material u s e f u l and necessary to the group vrorker i n the performance of his function.  -89Because c o n f i d e n t i a l i t y had been requested by the detective, Joan -pas referred d i r e c t l y from the Executive Director who talked with him, to the case.worker. The case worker, without explaining to the group worker, requested that she ask Joan to see her i n her o f f i c e a f t e r the group meeting. Later at the request of the group worker, the i n formation was shared with her. As previously explained, the case material regarding one eighteenyear-old has not been included.  I t might be of value t o note b r i e f l y what  the case worker's experience with Tom L. served to add to the p r o j e c t . A d i r e c t approach to Tom L. on "the b a s i s that i t had been observed by the case worker that he was not very happy, was quite successful. was  He'  helped with his problems concerning employment, and education, given  a great deal of ego-support, and helped to c l a r i f y his t h i n k i n g about boyg i r l relationsMps. ing  Thus M s  confidence was gained by discerning and meet-  need, as described e a r l y i n "the chapter. - However, he was unable t o  f i n d acceptance i n the House, was rejected from group p a r t i c i p a t i o n , and the case worker was unable t o go on with him as a r e s u l t . 'Teen-Age Problems Were Complicated. The puberty c M l d r e n who  came to the case workers were reminiscent  of latency and pre-school c M l d r e n i n many ways.  Jean S. was  s t i l l repres-  sing i n t e r e s t i n boys, clinging t o the latency age group, and exhibiting anal c h a r a c t e r i s t i c s .  Barbara P., with her tom-boy personality was  still  searching f o r i d e n t i f i c a t i o n as a g i r l , and the establishment of her superego.  Patrick 0. exMbited  s t i l l much  1  more of the adolescent c h a r a c t e r i s t i c s , but  was  the five-year o l d c h i l d seeking the a f f e c t i o n of the mother.  The impact of puberty was disturbing to these children i n d i f f e r e n t ways; Jean S. .reacted by withdrawing from s o c i a l pleasures wMch she wanted very much; Barbara P. became anxious, and expressed t M s  i n over-  aggressiveness, and i n inappropriate ways of r e l a t i n g to people; Patrick 0. t r i e d desperately to conform, and to meet the unreasonable demands of. M s  -90mother.  In Barbara and.^in Patrick the problem of the -unresolved Oedipus  was much i n evidence, and protective defences were not w e l l established. Jean S. suffered from r e j e c t i o n and emotional deprivation, and found a defence i n a physical problem which served to increase her emotional problem. Joan R., an adolescent, revealed deep hurt, and severe a f f e c t i o n a l deprivation, but presented a strong, defensive f r o n t t o adults i n terested i n helping her.  Tom L. s t i l l involved with the Oedipus, and  equally deprived and hurt, had exhausted the resources of the group t o ' help him with his problem, and had reached the point of being accepting of an adult's help. The problems of the 'teen ager arose from causes s i m i l a r t o those of the younger children, but there was a sense of greater depth, and a desperateness about t h e i r need which had not been previously encountered. Egos were more vulnerable-, and there was greater anxiety about f a u l t y  super-egos.  Coupled with t h i s was .extreme d i s t r u s t and h o s t i l i t y f o r adults; a great need to function independently; a strong desire t o demonstrate a b i l i t y to assume r e s p o n s i b i l i t y , and anxiety over b o y - g i r l r e l a t i o n s . ded up to was a highly unapproachable  What t h i s ad-  age-group.  Case Work With 'Teen Agers Was D i f f i c u l t But Worthwhile. In case work with 'teen agers the case workers found that they did not have an interviewing room which was suitable and the p l a y room was used successfully with one c h i l d i n puberty only.  Neither the parent, nor the  group worker, could be of much help early i n the r e l a t i o n s h i p .  I t was  threatening t o the relationship to contact the parent without the child's f u l l cooperation; the group workers were too anxious about t h e i r r e l a t i o n ships with 'teen age groups to be h e l p f u l i n preparing the c h i l d f o r case  -91work. ,A great deal of supportive help and ego b u i l d i n g were necessary to achieve a working relationship with a 'teen ager, and t h i s f e l l l a r g e l y to the,case worker. The  'teen ager was very sensitive about emotional problems, and  attempts to help him with them were i n e f f e c t i v e because they so often caused him to retreat from the case worker.  'Teen agers had greater d i f -  f i c u l t y than other ages t o r e t a i n the acceptance of the group workers. They found i t more d i f f i c u l t to.control their h o s t i l e impulses, and were sometimes involved i n destruction of equipment and property.  It-was d i f -  f i c u l t f o r the group workers to provide the acceptance demanded because of their r e s p o n s i b i l i t y f o r the House to the community. .When 'teen agers who were seeing the case workers l o s t acceptance i n the House, the case workers could no longer help them. The case workers helped 'teen agers to f i n d greater s a t i s f a c t i o n s i n t h e i r groups; help was given through counselling regarding employment, education, and b o y - g i r l r e l a t i o n s ; pressures were r e l i e v e d i n homes, and parents helped t o gain i n acceptance and understanding of the c h i l d . Help given was quite elementary i n most cases, and was more important as paving the way f o r future work than f o r .the actual b e n e f i t of the client.  At f i r s t the group workers tended to use the case work service as  a means of d i s c i p l i n i n g the 'teen age group, a problem about which they were quite concerned. case work r o l e .  This l e d to considerable e f f o r t to interpret the  Lacking s k i l l s of t h e i r own to approach 'teen agers, the  case workers i d e n t i f i e d with the group workers at f i r s t , and used groiip work techniques i n order t o reach c l i e n t s .  This l e d to c l a r i f i c a t i o n by  the case workers of t h e i r own methods i n working with 'teen agers i n the new s e t t i n g . -  Chapter V.  '  THE ADULT The main subdivisions of the adult membership of the House consisted of the "Young Adults", ranging i n age from eighteen to t h i r t y - f i v e , and "Adults", t h i r t y - f i v e and over.  the  The pension-age members were distinguished  as the "Senior C i t i z e n s " . This group, which had existed as a community organization p r i o r to the establishment  of.the House, was  the nucleus around  which the adult section of the-House had grown. A c t i v i t i e s were v a r i e d , including classes and small i n t e r e s t groups concerned with bridge, square-dancing, arts and c r a f t s , discussion, music, f r i e n d l y get-togethersj and large groups, such as "Open House", or the weekl y dance of the Young Adults.  There was  an atmosphere of good, fellowship,  of cooperation, and p a r t i c u l a r l y among the "oldsters", of reawakened joys which had long been forgotten. The Meed f o r Individual Services. Individual problems of the Young Adult seemed to centre around ployment, dating, achieving group status and approval. here too, as i n the Junior groups, the person who normal family l i f e , who  em-  I t appeared that  had been deprived of  had missed the opportunity f o r s o c i a l and emotional  growth, had been attracted to the House.  In some groups members were unable  to p a r t i c i p a t e i n adult forms of dancing, played c h i l d i s h games, and needed a great deal of help from the group vrorker to function as s o c i a l beings. Considerable  preparation was  required at the time of the p r o j e c t to  the Young Adults to the case work services.  There was  introduce  only one r e f e r r a l from  t h i s grotip. It i s ' u s u a l l y less d i f f i c u l t to r e f e r the young adult to a case worker, than i t i s to r e f e r the adolescent.  He has a better recognition of areas  of performance i n which he needs help; he does not have the emotional block  -93-  to accepting help, which the adolescent i n his search f o r emancipation has. The adults i n middle-age seemed t o have the most acute need f o r case work services.  Middle-age, from about f o r t y t o s i x t y - f i v e years, i s  a period i n which the impact of p h y s i c a l change and -emotional readjustment can p r e c i p i t a t e a psychosis, i f the person has been emotionally unstable. Adults i n middle-age have before them the frightening prospect of loss of vigour and of productive powers.  As -they take stock of the personal r e l a -  tionships, or other s e c u r i t i e s with which the years have l e f t them, there i s sometimes a shock of r e a l i z a t i o n that t h e i r resources are quite meager and t h e i r a b i l i t i e s most l i m i t e d . The problems of old-age, as described i n the case studies which f o l low, are t y p i c a l problems.  The problems of modern old-age are now legend.  They are the r e s u l t of changes which have taken place i n recent years i n family structure and function; i n attitudes about ageing parents; i n our economic pattern, which t h e i r grown f a m i l i e s .  now encourages old people t o plan independently of In a segregated group of "Senior C i t i z e n s " , one finds  unhappiness due t o loneliness and loss of family; inadequate income, and i n adequate housing; emotional upset due to the prospect of p h y s i c a l and mental degeneration.  In the c i t y of Vancouver there are few r e c r e a t i o n a l resources  f o r dependent old people, and many cannot a f f o r d public recreation, i Case work services are also sparse.  Case workers could do much to help t h i s age  group to use and develop the existing f a c i l i t i e s . I t i s s i g n i f i c a n t t o point out that case work services f o r s i n g l e , unattached adults of a l l ages are, f o r the most part, lacking i n Vancouver. The Y.W.C.A, has one f u l l y q u a l i f i e d case worker who provides counselling services f o r the unattached woman. There i s no comparable service f o r men. During t h e i r stay i n the House, the case workers received requests  -9kfrom adults f o r help, both House and community members.  The case workers  were able to provide a p a r t i c u l a r kind of service, and to supplement e x i s t ing community services to some extent. describe the case workers' experience  The s i x case studies which f o l l o w i n working with the adults.  \  There Were Family Problems. Mr. and Mrs. G. and Mr. and Mrs. A. were middle-aged adults  who  came to the case workers as a r e s u l t of r e f e r r a l from the commiuiity. Mr.- and Mrs. G. were i n t h e i r l a t e f o r t i e s .  The crux of t h e i r  problem seemed to be the breakdown of Mr. G's a b i l i t y to carry on i n his t r a d i t i o n a l role^as head of the household. er that Mr. G. was cal-illness.  I t was  evident to the case work-  s e r i o u s l y disturbed, but t h i s was  obscured by his physi-  His wife needed help to accept and to deal with his emotional  i l l n e s s i n a more r e a l i s t i c way. Mr. and Mrs. G. had one c h i l d , a four-year-old boy, David. They had recently come to the c i t y from the p r a i r i e s , where they had f a i l e d i n a farming venture. Mrs. G. had been l e f t the farm by her f a t h e r . Mrs. G. had been described as a competent, controlled woman, but seemed to be quite agitated when she came i n f o r * an interview with the worker. She was-working, but her husband had not worked f o r several months because of a hernia. He had not had an operation because he was not e l i g i b l e f o r h o s p i t a l insurance, and they could not a f f o r d i t . Mr. G. had been caring f o r David, but Mrs. G. s a i d that she d i d not wish'to leave him with Mr. G. any longer because he bothered Mr. G. With prompting from the worker she s a i d that she was a f r a i d to leave David with Mr. G. «She and Mr. G. had quarrelled a good deal l a t e l y . Mrs.. G. s a i d that he had been very despondent of l a t e , having s a i d often that his family would be better o f f without him. Mrs.- G. was pleased when the vrorker offered to t a l k to Mr. G. Mr. G's  deep depression, his u n r e a l i s t i c f e a r s , and his extremely  negative attitude suggested that he was  a c t u a l l y pre-psychotic.  ego strength, undue anxiety about an operation, i n a b i l i t y to face  His lack of surgery,  extreme nervousness, indicated that the roots of his disturbance were deep seated.  It was  apparent that he was  a man who  nant r o l e which i t had become necessary f o r M s  could l i t t l e accept the domiwife to assume.  -95Mr* G. looked very troubled when the worker v i s i t e d , and responded only half-heartedly when introduced. He warned the worker not to speak too loudly, as he d i d not want the neighbours to hear of his predicament. He repeated t h e i r story, h i s hands trembling as he d i d so. He smoked cons t a n t l y , and was much more emotional about t h e i r problem than h i s wife had been. He hesitated to discuss an operation, and when he d i d so, seemed f e a r f u l . He worried'about who would pay f o r i t : whether i t might be performed by an interne; whether the doctor would be competent. He had f a i l e d to keep.an appointment with the s o c i a l worker at the Out Patients Department at the h o s p i t a l . The case worker, not yet secure i n his r o l e , attempted to deal with Mr. G's symptoms, and d i d not make an adequate diagnosis.  As a-result of  the worker's a c t i v i t i e s , Mr. G's anxiety was i n t e n s i f i e d , and h i s disturbance became much more evident.  I f the worker had concentrated on diagnosis,  he would have r e a l i z e d that there was a more r e a l i s t i c .way to help Mr. G.; that Mr. G's f i r s t need was help with his anxiety and emotional tension. Mr. G. was i n need of intensive p s y c h i a t r i c treatment before he would be able to accept surgery. A few days l a t e r , Mr. G. phoned the-House to arrange an appointment with the case worker; He d i d not keep the appointment. The worker^phoned the h o s p i t a l case worker, who s a i d that Mr. G. was scheduled to go to surgery, as planned by the House case worker. Later?Mrs. G. phoned to ask the worker to come to see'her husband a t once. The worker decided to ask the Family Welfare Bureau, which had previously been active with the G's, to continue, and arrangements were made f o r one of t h e i r workers t o v i s i t . The worker l a t e r learned that Mr. G. had been admitted to the p s y c h i a t r i c ward •• at the h o s p i t a l f o r treatment, and surgery had been postponed. This experience with Mr. and Mrs. G. indicates the role that the neighbourhood'house plays i n a s s i s t i n g people of the neighbourhood to use community resources.  I t also suggests how a case worker on the s t a f f of the  House might sharpen t h i s r e f e r r a l service.  The case worker can contribute  a great deal'through an a b i l i t y to diagnose emotional problems, and also through use of h i s interviewing s k i l l s i n preparing people f o r r e f e r r a l . The Nursery School teacher syspected that there were marital d i f f i c u l t i e s in- the G. family, but d i d not uncover Mr. G's pre-psychotic condition, which was b a s i c .  By r e f e r r i n g Mr. G. to the Family Agency f o r advice, the Nursery  -96-  School teacher was a c t u a l l y asking that agency to perform the House funct i o n of r e f e r r a l .  More c l a r i f i c a t i o n of her f a m i l i e s need, based on thought-  f u l diagnosis, was necessary i n order t o give Mrs. G. the incentive to go to another^agency.  Had case work services been w e l l established, and the case  vrorker experienced, the oncoming psychosis of Mr. G. would have been detected by the case vrorker, who would have then referred him to p s y c h i a t r i c services rather than back to the Family Agency.  Psychiatric consultation on such  problems would add much t o both the case worker's and the group worker's performance • Work with Mr. and Mrs. G. demonstrated again how the case worker f i t s into the r e f e r r a l function of a neighbourhood house.  R e f e r r a l of a p a r t i c u -  l a r case may be handled by the group vrorker i f group work s k i l l s seem adequate Whandle i t .  I f not, he refers the c l i e n t t o the House case worker.  If  there i s no case vrorker i n the House, he may c a l l on a case work agency. The r o l e of the House i n case f i n d i n g i s evident i n t h i s case.  Some-  thing about the House- attracted Mrs. G. to i t i n searching f o r a solution f o r t h e i r problem.  This might w e l l have been the f r i e n d l y family atmosphere, of  a f a m i l i a r neighbourhood i n s t i t u t i o n .  The House i s a natural l i n k , f o r the  c l i e n t needing services, with the less known, and more s p e c i a l i z e d s o c i a l agencies• Mrs.G. had come to the Nursery School at the House to ask f o r placement of David. Because the kind of service provided by the Nursery School did not seem to be what she r e a l l y wanted, she was referred to the Family Welfare Bureau f o r advice. I t was thought that there was a m a r i t a l problem underlying her v e r b a l request. Sometime l a t e r , lies. G. phoned the House saying that she was desperate, and i n need of immediate help. She was then referred t o the case vrorker i n the House. Mrs. A., f i f t y - s e v e n years of age, and an e p i l e p t i c , was i n need of help to become r e h a b i l i t a t e d following her i l l n e s s .  Her problem was evident-  l y complicated by emotional maladjustment, but there had been no diagnosis of  psychosis.  Considerable study was necessary to determine how case work plus  group work could best serve her. Mrs. A. had been subject to e p i l e p t i c attacks since the age of f o r t y , and had been confined to the mental h o s p i t a l f o r two years f o r the "regul a t i o n " o f the epilepsy. She received medical and case work services at the Cut Patients Department of the h o s p i t a l f o r s i x months following her release, but became i n e l i g i b l e f o r t h i s when her husband got.a job. Her attacks had been under control f o r three months; medication was heavy. Mrs.-A. was sens i t i v e because of the stigma attached to her i l l n e s s and h o s p i t a l i z a t i o n . She was f e a r f u l about coming i n contact with s o c i a l groups again. Mr. and Mrs. A. seemed to be fond of each other and happy together. However, i t was  also c l e a r that t h e i r r e l a t i o n s h i p was  a neurotic one; that  he s a t i s f i e d her need to be dependent, and she s a t i s f i e d his need to dominate and care f o r someone.  There was  aamarltal problem because i t was  diffi-  c u l t i n t h i s kind of an adjustment to have normal s o c i a l l i f e beyond the home. His depreciation of her was necessary i n order to maintain her dependence, yet i t aroused her h o s t i l i t y , and deepened her f e e l i n g s of i n f e r i o r i t y .  Mrs.  G.  now found an outlet f o r emotions which had previously been expressed i n e p i l e p t i c attacks, i n headaches.  In a s i t u a t i o n which b u i l t up unconscious  anxiety, which she was unable to cope with i n a s a t i s f a c t o r y way and repressed, Mrs. A. became preoccupied, and unable to concentrate.  The neurotic  adjustment which had served to meet her emotional needs i n youth, was  no long-  er adequate i n middle age. Mr. and Mrs. A. l i v e d i n a housekeeping room near the House. Mrs. A. appeared to be a pleasant, motherly, w e l l kept woman, who had experienced some of the good things i n l i f e . She seemed to f e e l that her husband depreciated her, however, and that he thought there vras something wrong with,her mentally. Mrs. A. spoke fondly of Mr. A. who had l o s t his arm about twelve years previously as the r e s u l t of an i n f e c t i o n . He ^had not worked f o r about ten years because" of his wife's illness.. He thought that he .had to stay home to look a f t e r her, d i d not know about community a i d s . He would s c a r c e l y l e t her out of his s i g h t . Even since the attacks stopped, he would not l e t her go out alone, and feared people.would think that he was not caring f o r her. In conversation, Mrs. A's associations were not c l e a r , and she would jump from one t o p i c to another very r a p i d l y . She spoke ^in a preoccupied way about her mother and the mental h o s p i t a l . She s a i d that her old f r i e n d s had f a l l e n o f f during her illness> and she feared to contact them again.She had severe headaches which she.had not had before. She said that she would  -98_  l i k e to j o i n a group at the House i n order to make new f r i e n d s . Mrs. A. seemed t o have good capacity f o r s o c i a l a c t i v i t i e s , and had apparently f e l t very deprived because of lack of s o c i a l l i f e during her i l l ness.  Her reaction i n "the group indicated that the previous worker's assess-  ment of her need f o r s o c i a l l i f e was a correct one. Mrs. G. showed strength i n her e f f o r t s to maintain her attendance at the House.  Her husband's r e -  action  f u r t h e r confirmed that he was using his wife to meet his own neurotic  needs.  I t became clear that the present s i t u a t i o n had been p r e c i p i t a t e d by  his  loss of his-arm as w e l l as by Mrs. A's i l l n e s s .  This evidently had deep  emotional significance f o r Mr. A. I t _was,arranged that Mr.-A. would attend the "Y" club. The group vrorker was to c a l l f o r her and accompany her t o the House. The case worker was to work with Mrs. A. and her husband, i n order t o help Mrs. A. to make a good adjustment i n the group. Mrs. A. seemed to enjoy the meetings of the "Y" club. A t the f i r s t meeting she broke down and c r i e d during the singing. She l e f t the room f o r a few moments, and was happy when she came back, saying that i t had reminded her of the good old times that she and her husband used to have. Mrs. A. came r e g u l a r l y and said that she enjoyed the c l u b . One time when the vrorker was unable to c a l l f o r her, she walked along the street t o the House with some ladies she d i d not know, and d i d not t e l l her husband. She would sometimes phone the'group worker to v e r i f y that a part i c u l a r "thing had happened i n the group, as her husband had not believed her when she t o l d him. Mrs. A's relationship and experience with her parents was important i n determining how to help her with her present adjustment, because she had deep and upsetting f e e l i n g s about them.  I t was evident that there was  a c t u a l l y a marital- problem between Mr-, and Mrs. A.-, also t i e d up with her dead parents.  Mrs.*A. had gained quite a l o t of i n s i g h t into her problems  during her stay a t the mental h o s p i t a l .  She was perhaps beginning t o seek  emancipation from-the parental r e l a t i o n s h i p which she had with her husband. R e f e r r a l to the f a m i l y agency might have-been a l o g i c a l step, doubtful b e cause of t h e i r age.  *  Mrs*'A. had married a t tvrenty-nihe. She and her- husband iiad l i v e d with her parents u n t i l they died. There had been* c o n f l i c t between Mr. A.and her parents, and he said that they demanded too much, of her a t t e n t i o n .  -99She had nursed both parents i n terminal cancer. Mrs. A. had been very upset about the c o n f l i c t , but repressed her feelings as she always d i d i n such s i t u a t i o n s . She began to have nervous attacks, would become v e r y tense and go to bed. Mrs. A. l i k e d to be nice and proper but her family were not. Mrs. A. brought her to Vancouver to get away from them. Mr. A. was more of a '-business man than her father, was quite r i g i d , and a l ways, managed their a f f a i r s by himself. Mrs. A. r e a l i z e d the bearing that a l l these things had on her epilepsy during her stay i n the mental h o s p i t a l . She used to have surges of a f e e l i n g of, r e s p o n s i b i l i t y f o r other patients p r i o r to attacks. She d i d not think that her husband understood t h i s "welling up" of emotions. „ • •• As w e l l as helping Mrs. A. to f i n d s o c i a l s a t i s f a c t i o n s , the case worker helped her f i n d release through interviews, of pent-up emotions' which she had been unable t o express. portive one i n the main.  The worker's role.with Mrs. A. was a sup-  Interviews with Mr. A. revealed an a b i l i t y to  understand h i s wife's problem somewhat, and to use i n t e r p r e t a t i o n from'the worker.  I t was apparent that Mr.. A. also had dependency needs.  A great  deal of help would be required to enable him to resolve these, and to r e lease his wife from the dependency status i n which he seemed to hold her. Mrs. A. said i n mterviews that she f e l t .very angry s t i l l against .her mother because of the r e s p o n s i b i l i t y that she had.expected her to take.The worker encouraged Mrs. A. to think about the present and the future,. •• rather than the past,- as she seemed to have a great deal of disturbing, unconscious f e e l i n g , Mrs. A. was sometimes preoccupied with past unhappy events. When the worker talked to Mr. A. he seemed to appreciate the emot i o n a l aspects of Mrs. A's i l l n e s s ; her c o n f l i c t with her parents and the e f f e c t of too much e a r l y - r e s p o n s i b i l i t y . He related the headaches to the '. same cause as the- epilepsy. He had been very upset when the attacks began, and s t i l l could not allow her. to go out alone, . Group work services and the services of the Family Welfare Bureau were explained to Mr, A. Mrs. A-. was referred back to the group worker. Good r e f e r r a l procedure between a case work agency and a group work agency i s i l l u s t r a t e d i n the case of Mr. and Mrs. A.; the use of conference, the  written summary, and the case committee to b r i n g about good p r a c t i c e .  If i t had not been necessary f o r the h o s p i t a l worker to withdraw because of the  l i m i t a t i o n s of her agenc;/- function, i t would not have been appropriate  for  the case worker i n the House to work with t h i s c l i e n t .  The h o s p i t a l  worker would have been the one to help Mrs. A. use group work.  To add the  -100services of the House'case worker would have caused confusion i n Mrs. A's mind abotit her relationships to her respective workers. In work with Mrs. A.., the workers involved demonstrated the s p e c i a l r o l e of a neighbourhood house i n the r e h a b i l i t a t i o n of a h o s p i t a l patient, and what.a case worker can add t o t h i s function. Mrs. A. was r e f e r r e d to the House f o r group work and case work services by her worker at the Out Patients Department. The worker thought that Mrs. A. would need f u r t h e r help i n returning to normal s o c i a l l i f e . She suggested that Mrs. A. was ready f o r group a c t i v i t i e s , but would need i n d i v i d u a l support. There was a conference between the workers involved and a r e f e r r a l summary was forwarded. The House case worker read the h o s p i t a l record. The case was reviewed-by the case committee, and the r e f e r r a l accepted f o r case work and group work. The h o s p i t a l worker brought Mrs. A. to the House to introduce her to the worker, -and to discuss House a c t i v i t i e s with the group worker. During Mrs. A's attendance at the House there was close cooperation between.the case worker i n the House and the group worker i n Mrs. A's group. Unattached Adults Had Problems Mr. N., f i f t y - n i n e years of age was pre-psychotic when r e f e r r e d to the House for. group work.  He exhibited d e f i n i t e manic depressive symptoms  which had been recognized by the case worker who referred him.  Mr. N. had  p r a c t i c a l l y no a b i l i t y to form meaningful relationships with people, and found emotional s a t i s f a c t i o n i n objects.  Some of his symptoms suggested  episodes of the manic type; he seemed to have delusions, and to indulge a great deal in- phantasy.  He exhibited no capacity f o r i n s i g h t , and was quite  i r r a t i o n a l i n his approach to hiscproblem. Mr. N., a s o c i a l assistance r e c i p i e n t was interested i n c r a f t s , leather and s h e l l work, and bone carving. He had t o l d h i s previous .worker that he was the "black sheep" of h i s family, that he held a degree i n engineering from Queens University, that he had been married, but had had marital d i f f i c u l t y . He was very t a l k a t i v e , drank occasionally and became very depressed. His assistance worker had referred him to a doctor f o r a p s y c h i a t r i c assessment. He was very excitable. He talked of accomplishments of his which were not based on f a c t . He. had no close f r i e n d s . He thought that j o i n i n g a group i n the House would help him because he was s e l f conscious i n crowds. He made u n r e a l i s t i c plans which he could not carry through. <. When the worker v i s i t e d Mr. N. symptoms previously described were  <  -101qaite apparent, and i t was evident to the case worker that Mr. W. was too disturbed to enter a group.  He had r e l a t e d t o his former case worker as a  c h i l d relates to the motherj and there was nothing to suggest that he could r e l a t e t o adults i n any other way.  He seemed t o have i n adulthood the i n -  f a n t i l e f e e l i n g of omnipotence, with l i t t l e conception of himself as an i n dividual in-reality.  With lack o f s o c i a l i n t e r e s t , Mr. N.- had none of the  emotional facets necessary t o carry on ordinary s o c i a l intercourse  •.  Mr. N.'s room was f i l l e d with c u r i o s . Among other things, he had a row of bones drying on a pipe.- He was exceedingly s e l f important, very pleasant and t a l k a t i v e . He spoke of several prominent people i n a very f a m i l i a r way. He s a i d that his former worker'Mrs. C. "got him out of" a > mess". He had been working i n the I n t e r i o r ; earning a.good s a l a r y and i n charge of several men. He,, flew down to--Vancouver f o r a holiday. One of his friends suggested that he should be working i n the flooded area. He volunteered immediately..- They sent him out with a load of soldiers i n a truck. He resented t h i s because he did not think that he should be c l a s s i f i e d with ordinary s o l d i e r s . On a r r i v a l he asked the Colonel f o r a det a i l of s o l d i e r s and twenty-six men. His request was met when i t was r e a l i z e d that-he was a man of some c a p a b i l i t y . He was explaining t o the men a system of t e s t i n g the dykes when a truck struck the vehicle beside which he was standing, and he was thrown f o r t y f e e t into a gravel pit.He woke up i n a h o s p i t a l and a f t e r that h i s fortunes were c o n t i n u a l l y adverse u n t i l he met Mrs. C. He a t t r i b u t e d his need to see a p s y c h i a t r i s t • t o " h i s accident. Discussion between the House case worker, the Assistance worker, and the group worker, p r i o r t o r e f e r r a l , might have eliminated r e f e r r a l to the House' of Mr. N.  The Assistance worker needed i n t e r p r e t a t i o n from the  group worker as t o the function of the House; diagnostic thinking was needed t o determine that Mr. N. could not a c t u a l l y use group work. The House case worker's s p e c i a l i z e d knowledge of individuals would have been h e l p f u l i n the l a t t e r .  Mr. N. was-not a c t u a l l y a candidate f o r case work  services from the House since he was r e c e i v i n g s p e c i a l attention from the assistance worker.  I t was v a l i d , however, f o r the group worker to use the  House case worker i n a consultative capacity i n order t o a r r i v e at a diagnosis, p a r t i c u l a r l y with regard t o Mr. N's a b i l i t y t o use group work.  -102Mrs. C. had referred' Mr. N. t o the House because she thought that he needed s o c i a l recreation. When the group worker talked to Mr, N.,she thought that he was quite disturbed, and questioned whether or not he could use group work. She d i d not think that there was any a c t i v i t y i n the House which would be suitable f o r him. The case worker was asked t o v i s i t Mr. N. i n order that he might help to assess Mr. N's a b i l i t y t o use group work. I t was agreed that the House - could not be h e l p f u l t o Mr. N., he was referred back to the assistance worker, and eventually committed to the mental h o s p i t a l . The r e f e r r a l of Mr. N. to the House took place early i n the project when the method of r e f e r r a l , the kinds of r e f e r r a l s which would be accepted f o r case work, and the case worker's r o l e had not been determined.  The case  of Mr. l\f. i l l u s t r a t e s ' the role of the case worker i n a neighbourhood house i n diagnosis, and i n screening r e f e r r a l s .  Through his contact with group  work, the case worker develops a s p e c i a l understanding of people a s . s o c i a l beings, which other case workers do not generally have. Mrs. D., f i f t y - s e v e n years of age presented a problem of emotional repression, and of new dependency which she was inadequate to meet. Her emotional upset had been p r e c i p i t a t e d by the loss of her husband a t a c r i t i c a l - p e r i o d of l i f e .  I t ?ra.s d i f f i c u l t f o r her to f i n d employment. Her  relationship to her husband had been a neurotic one i n v o l v i n g dependence and repressed h o s t i l i t y ; his death served to i n t e n s i f y her negative f e e l i n g s , and need to be dependent.  With her pattern of emotional repression, unhappi-  ness was i n t e n s i f i e d . Mrs. D. also had a tendency to be self-punishing.  Loss of the pro-  t e c t i v e father figure made her more vulnerable to a world which she considered h o s t i l e , and she could not- express her f e e l i n g s .  Instead she turned a l l these  things i n on s e l f , and migraine headaches were i n t e n s i f i e d as a r e s u l t .  She  presented a pathetic picture of aloneness- and i n a b i l i t y to do anything about it. Mrs. D. was a widow of four months who was subject to severe migraine headaches. Her only income was a s o c i a l assistance allowance from the c i t y ,  -103which was i n s u f f i c i e n t to allow many s o c i a l outings, f o r which Mrs. D. expressed a wish. She had f e l t very l e t down by the death of her husband, and had withdrawn from people since h i s death. Migraine headaches which she had had f o r many years became much worse. She was f e a r f u l of meeting new people. Mr. D. had been f i f t e e n years older than h i s wife, and died from a stroke. They had no children because Mr. D. d i d not want them. Mrs.. D. had l o s t her father, her champion, when she was twelve. She had no close r e l a t i v e s l e f t . She was suffering from a headache when she cane to see the worker. She was a spare l i t t l e woman, with a h e a v i l y l i n e d , unhappy face. There was not an opportunity f o r the worker to assess Mrs. D's needs properly.  I t d i d seem that she would have some d i f f i c u l t y i n using a group  to meet her needs, and would need a great deal of i n d i v i d u a l support.  There  was l i t t l e hope of p e r s o n a l i t y change because of her age. Work with Mrs. D. pointed up the need f o r case work services i n the c i t y , f o r the older, unattached adult.  The C i t y S o c i a l Service worker saw  i n the case work services at the House, an answer to t h i s need. In the " i n i t i a l interview with Mrs. D., i t would have been preferable for  the case worker to concentrate on her as an i n d i v i d u a l with a problem.  Interpretation of group work i n the .House i n t e r f e r e d with t h i s .  Later prac-  t i c e was to have the c l i e n t go t o the group worker f o r t h i s information. Mrs. D. was referred to the House v e r b a l l y , early i n the project, by the C i t y S o c i a l Service worker who thought that she would b e n e f i t from i n tensive case work services and group work. The House case worker phoned Mrs. D.. and arranged to see her i n the o f f i c e . The case worker discussed the d i f f e r e n t groups and a c t i v i t i e s of the House with her and i t was decided that she would attend the "Y" club. Information was also given about the case work service and i t s purpose. Mrs. D. d i d not attend the club because she could not a f f o r d bus f a r e from her neighbourhood, which was some distance. Eventually, near the end of the project, t h i s d i f f i c u l t y was overcome, and Mrs. D.-was pleased. She was referred to the group worker because the case worker was leaving the House. Contact subsequent to the f i r s t i n t e r view had been by telephone only. Mrs. F..., seventy-four years of age, presented t y p i c a l problems of o l d age; emotional problems of long standing now became acute as she f e l t her physical powers s l i p p i n g away, and there were further complications of actual d i s a b i l i t y and disfigurement.  At t h i s time when she f e l t the greatest need  -IC^fbr family t i e s and f r i e n d s , she was  l e a s t capable of finding them,  Mrs.. F. was 'alone i n the world and had expressed a desperate need for s o c i a l L i f e and f r i e n d s . Her only income was an o l d age pension which b a r e l y met«her needs arid, although she was 'active p h y s i c a l l y , she could not work because of p a r t i a l blindness. She had.had a tumour removed from the.side of her face recently, and t h i s had caused paralysis of her face, d i s f i g u r i n g her badly. .She was very s e n s i t i v e about t h i s , and d i d not l i k e to meet people because of i t . . . • In her past l i f e Mrs. F. had shown excellent a b i l i t y to make a l i v i n g and to enjoy s o c i a l l i f e . t i o n a l ties,- and she was  Her great lack had been i n close a f f e c -  now j u s t i f i a b l y disappointed i n l i f e i n view of  the disappointments and f r u s t r a t i o n she had experienced. unable to form normal relationships with men, a neurotic r e l a t i o n s h i p to her own  She had been  and had been unable to use  advantage.  Mrs. F. had had to earn her own l i v i n g most of her adult l i f e , and her occupational background showed considerable strength. She/was, a regi s t e r e d nurse, and had followed t h i s profession f o r about f i f t y years. She had done a good deal of public health nursing. She had attended Univers i t y , was also a trained stenographer. She had done some teaching. She was a member 'of 'the business and p r o f e s s i o n a l womens club. Mrs. F's per-, sonal l i f e had not been happy. During her f o r t i e s she had married-a merchant seaman who was about twenty years younger than h e r s e l f . ,,She had wanted c h i l d r e n , but he d i d not. When she became pregnant he l e f t her. She-spent some time going up and down the coast t r y i n g to locate.him, but never saw or heard of him again. The c h i l d was s t i l l b o r n and this broke Mrs. F's heart, • . As o l d age approached, Mrs. F. had attempted to make an adjustment which would meet her changing needs.  Frustrated i n t h i s , she f e l t the i n -  j u s t i c e of l i f e , -and became more demanding of people. turbance ..became more apparent.  Her  emotional'dis-  I t i s l i k e l y that the loss of'her p h y s i c a l  attractiveness,- and the operation which brought t h i s about, represented punishment from a hos'tile world to Mrs. F. and there was nothing she could do to combat i t except to regress  emotionally.  Mrs. F. had spent most of her l i f e i n the West, but had gone east about ten years previously to.be near r e l a t i v e s . She became a pensioner there because her health broke down, and she said that she returned west on account of her health. Following her' return t o Vancouver she had a great deal of d i f f i c u l t y i n finding accommodation. She demanded a great  1  -105-  deal of attention from case "workers and blamed them personally i f they were unable to help her. Following her operation, she "went down h i l l " noticeably. She had previously been an a t t r a c t i v e woman who took an i n t e r e s t i n her appearance,'followed c u l t u r a l i n t e r e s t s , and exhibited a sense of humour. -She became untidy and unclean, and unable to get along with people. I t was apparent to the House case worker that Mrs. F's disturbance was  deep seated and quite serious.  Paranoid t r a i t s were evident and Mrs.  F. was i n open c o n f l i c t with society.  There'was some strength i n her  a b i l i t y to f e e l o p t i m i s t i c about her eyes and i n her p o s i t i v e f e e l i n g s with regard-to  the c l i n i c .  .In a d d i t i o n to the paranoid b e l i e f that every  one was against her, Mrs. F. showed no capacity f o r insight i n t o possible inner causes f o r her troubles, p r e f e r r i n g t o a t t r i b u t e them to her p h y s i c a l problems and t o the d i s i n t e r e s t and c r u e l t y o f others.  Prognosis was thus,  l i m i t e d a b i l i t y t o gain from case work help.  *  When the House case worker f i r s t met Mrs. F. she was being evicted from' her room. She s a i d that two young men i n the rooming house had looked a f t e r her, but a f t e r they l e f t she had a f e e l i n g that the landlady had wanted to get r i d of her. The landlady had made complaints t o the r e n t a l board about Mrs. F.. Mrs. F. said that she had found people i n Vancouver to. be very unfriendly since her return. She had attempted to make friends' through churches, but had been unsuccessful. She had gone to a neighbourhood house once," but had not l i k e d i t . She was attending the Out Patients Department of the. h o s p i t a l on account of her eyes, and hoped t o have an operation to help her sight and t o restore her f a c e . 1  Supportive help from the, worker brought response from Mrs.. F. and she showed a b i l i t y to r e l a t e i n a group setting, even though i t -was i n a very negative way.  Her lack of insight and f e e l i n g with regard to her phy-  s i c a l , i n c a p a c i t i e s was quite .evident i n the group s e t t i n g and also her tendency to-project on others her own h o s t i l e f e e l i n g s . Mrs. F. decided to j o i n the "Y" group at the House. Personalities i n t h i s group were varied, but most of .the women were warm and receptive. Mrs. F. alienated everyone i n the group against her by getting up i n the meeting and"denouncing them f o r not t a l k i n g about more" worthwhile things, and f o r not doing something for unfortunate people l i k e h e r s e l f . Following the meeting she disparaged the group to the worker because of t h e i r lack of desire t o do service work. She thought that her lack of success i n the group was due t o her f a c i a l disfigurement.' .She continued to attend the group i r r e g u l a r l y .  -106As the worker became better acquainted with Mrs. F., the basis of her past and present d i f f i c u l t i e s revealed i t s e l f .  I t was c l e a r that she  had now l o s t p r a c t i c a l l y a l l of the a b i l i t y that she had formerly to form p o s i t i v e relationships with people.  .Evidently, she had always had deep  negative f e e l i n g s with regard t o men and sex, which had caused her a great deal of inner c o n f l i c t .  Because .of her h o s t i l i t y , g u i l t feelings,.and  sense of uncleanness, she had l i t t l e a b i l i t y to accept h e r s e l f . happiness, plus the e f f e c t of a l l of these feelings seeking  Her un-  expression,  prevented her from achieving the a f f e c t i o n of others. .She was a c t u a l l y shopping around f o r an a f f e c t i o n a l r e l a t i o n s h i p .  In the case of'Mr, Y.  she used the radio and the cane to continue a r e l a t i o n s h i p which she could not maintain i n any other way. . In complaining that Mr. Y. r e a l l y wanted a wife, i t seemed that she-was a c t u a l l y giving expression to her own wishes. During her six-months contact with the worker i n the House, Mrs. F. l i v e d i n . s i x d i f f e r e n t places. Four were rooming houses, one a f i f t h rate h o t e l , and the l a s t a nursing home. One room was i n the home o f an elderl y man, Mr. Y., who wished to make his home a v a i l a b l e t o e l d e r l y people. Mrs. F. took.this room a f t e r a great deal of mental, c o n f l i c t . There was soon open war between her and her l a n d l o r d . He complained that she demanded a great deal f o r her comfort, complained continually, screamed a t him when he got"up i n the night, and had absurd ideas about his intentions toward her, Mrs. F. said that Mr. Y. came into her room without l<nocking, and she was a f r a i d of him. Also she had been sorry-'for him, had i n v i t e d him i n f o r tea, and f e l t that he r e a l l y wanted a wife. She l e f t Mr. Y's home a f t e r two weeks, and he kept her radio because she had put him to.so much extra expense. She Trent to a great deal of trouble t o get t h i s back, even c a l l i n g the p o l i c e , although she d i d not r e a l l y want i t . Then she remembered that she had l e f t her cane and went back f o r i t . Mrs. F. said that young men accosted her and asked her to come to t h e i r rooms. She had a f e a r of contracting veneral disease in.the bathrooms of rooming houses. She d i d contract an i n f e c t i o n , which the doctor said was due to lack of personal c l e a n l i n e s s . In the nursing home she said that the matron discriminated against her. Mrs.'F, made some progress while she was seeing the worker, and made a r e a l " e f f o r t t o achieve acceptance i n the "Y" club, .She was thus able t o use the help offered her b y case work and group work.  Such r e s u l t s j u s t i f i e d  the large amount of time, and e f f o r t devoted t o Mrs. F. .by the workers.Although  -107i t was  not possible to.change her personality pattern, the-worker could  provide the supportive r e l a t i o n s h i p necessary to her to regain past strengths and to enable her.to move on to other s a t i s f y i n g r e l a t i o n s h i p s . Following an eye operation, Mrs. F. began to attend the "Y" club meetings r e g u l a r l y , although members were s t i l l very h o s t i l e to her. She offered to nurse members when they were i l l . . Her appearance had improved' considerably, and she was making a noticeable e f f o r t to dress a t t r a c t i v e l y . It seemed that she was,getting something -out of the group, and event u a l l y would be accepted by i t . The worker helped Mrs. F. by f i n d i n g new places f o r her to stay; through giving her an opportunity i n interviews to f i n d release f o r her f e e l i n g s ; by giving her ego support, and helping her to f e e l worthwhile and accepted.  This helped Mrs. F. to p a r t i c i p a t e i n group projects, to  show a desire to give to the group, and thus to f i n d acceptance and  satis-  faction. The. part played by the case worker i n the r e f e r r a l of Mrs. F. to the House 7ra.s one of conferring with the r e f e r r i n g worker, and of i n t r o ducing .the<client to the agency.  Planning for r e f e r r a l had not included  the case worker, a p r a c t i c e which occurred,in the e a r l y stages of the • project. ing  Better r e f e r r a l procedure with more background m a t e r i a l regard-  the c l i e n t would have.been b e n e f i c i a l . - The case worker-knew too  little  about t h i s woman's emotional c o n f l i c t s i n the beginning, and so used a great deal of time with her i n an i n e f f e c t i v e  way.  Mrs. F. was r e f e r r e d to the House by the counsellor-at the Y.W.C.A., following a conference with the group worker. I t was thought that she would need case work help, to use the group, and she was r e f e r r e d to the case worker. The case worker met Mrs. F. at the. Y.W.C .A. where she was introduced by the Counsellor. There was a short r e f e r r a l summary submitted to the House by the Counsellor. The worker also conferred with the h o s p i t a l s o c i a l service .worker who knew'Mrs. F.,. and the Old Age Pension worker. Mrs. E., s i m i l a r l y , had problems t y p i c a l of ',old devoted her l i f e to a vocation, was tinue i t , and was  age.  She had also  now l o s i n g the p h y s i c a l a b i l i t y to con-  quite disturbed'emotionally as a..result. Mrs. E's  -  -108-  vocation had represented an adjustment t o l i f e , and i t s loss was the greater because of the great emotional investment i t represented.  Personality prob-  lems, which she had been able to sublimate s u c c e s s f u l l y in'her work, now,had no acceptable means of expression., Her.former manner of l i f e had f a i l e d t o provide m a t e r i a l l y f o r old age, and i n i t she had also f a i l e d t o l e a r n the s o c i a l s k i l l s - and i n t e r e s t s which she now needed. Mrs. E., seventy-two years of age, an o l d age pensioner, had once been a s u c c e s s f u l . a r t i s t . ' She was now very unhappy because she was losing her sight, and could no longer paint productively as a r e s u l t . Because of lack of finances, she was forced t o l i v e i n a crowded boarding house where she shared a room with two other e l d e r l y women whom she did not f i n d compatable. • Mrs. E . was otherwise i n good p h y s i c a l health, but had l o s t the sight of one eye, which had been removed, and had only p a r t i a l sight i n the other. She wished to paint f o r a .past-time, and her Doctor thought that t h i s would be good f o r her. She needed a place t o paint and to store materials and help t o obtain these. Mrs. E. expressed f e a r of p a r t i c i pating i n a group. Mrs. E . had gone through l i f e on a very immature emotional  level.  She had only learned to r e l a t e to others i n a very s u p e r f i c i a l way on the basis of a common i n t e r e s t .  She had not faced the r e a l i t y of l i f e by de-  manding f a i r returns f o r her labours.  She seemed to have had a phantasy  idea of herself as an omnipotent being who could not be touched by want. Mrs. E . had been widowed at the age of twenty-two. Her husband had encouraged her t o paint, and following h i s death she turned to an a r t i s t s career. She t r a v e l l e d and studied i n Europe, and had l i t t l e d i f f i c u l t y i n having her work hung i n the salons of Paris.. She enjoyed the a r t i s t s ' l i f e , and the company of a r t i s t s . She was not a business woman and gave l i t t l e thought t o the p r a c t i c a l i t i e s of l i f e , or the f u t u r e . She gave a great deal t o others, and only demanded enough i n return to meet her dayto-day needs,,. .She- contributed war memorial paintings to the Canadian . . . government which she might have s o l d i n the United States f o r a large sum of money. Mrs. E. had been an a r t teacher u n t i l her sight began t o f a i l . She, was now very l o n e l y and unhappy. ..... As the case worker became acquainted with Mrs. E., her s o c i a l i n adequacy became more and more apparent.  Present s a t i s f a c t i o n s were non-  existent, and she was forced to regress to the past.  This was s i m i l a r t o  l i v i n g i n phantasy because i t was l i v i n g i n a time and r e a l i t y which no  -109longer existed, 'Mrs. E.- seemed to have an a b i l i t y to gain insight i n t o her problem and i n t h i s vray was better equipped than Mrs. F.-to deal with i t , Mrs. E. d i d not f i n d anyone i n her boarding house companionable. She l i k e d to t a l k of the past and the others resented t h i s , saying that i t vra,s an' attempt to make herself seem superior, Mrs. E, attended the "Y" club at the House, She d i d not f e e l at home there either, saying that, they had been very nice to her, but t h e i r interests were d i f f e r e n t , and she would prefer to be by herself with her work*, She knew that she was d i f f e r e n t from other people and she also knew that i t was too l a t e f o r her to change. The only r e a l hope f o r her seemed to be an opportunity to regain the o l d s a t i s f a c t i o n s of-self-expression. The role of the worker i n r e l a t i o n to Mrs. E. was to attempt to help her on an environmental l e v e l , through mobilizing resources.  The  worker-also,  played the r o l e of a f r i e n d l y v i s i t o r giving supportive help, i n order to encourage Mrs. E. to attempt to make an adjustment to her new  circumstances.  Mrs. E. needed help to r e a l i z e that perhaps l i f e could s t i l l provide her with worthwhile s a t i s f a c t i o n s . The worker attempted without success to f i n d an a r t i s t i n the neighbourhood who might allow Mrs. E. to use h i s studio. I t was also suggested that Mrs. E. use the a r t centre at the House. However, she did not think t h i s room suitable as i t had a southern exposure and d i d not provide the correct l i g h t i n g f o r work i n o i l s . She load a great deal of eye trouble during the period that the worker knew her. The worker v i s i t e d and t r i e d to give her support. At the end of the project, Mrs. E's eye had improved. The worker arranged with a young widow who had a car that she would take Mrs. E. to the-park during the summer, where she could p a i n t . Permission was also obtained f o r Mrs. E. to use the north end of the lounge as a place to paint i f she wished t o . -) • The r e f e r r a l , although one of the early ones, was w e l l managed 'in that there was j o i n t planning between the group worker and the case worker. An improvement would have been a j o i n t conference between the C.N.I.B. worker who referred Mrs. E., the group worker, and the case worker.  This  could also have included the C i t y S o c i a l Service Worker.. -A written summary should have been obtained, and the CSSD record read by the case worker. • Mrs. E. had been r e f e r r e d to the House by the C.N.I.B. worker, to whom she had been r e f e r r e d by her doctor. Mrs. E's sight was not s u f f i c i e n t l y poor to make her e l i g i b l e f o r C.N.I.B. services. Mrs. E's problem had been discussed with the case worker by the group worker i n planning, and i t was decided that help could be given Mrs. E. on an i n d i v i d u a l  -110basis as i t d i d not seem that Mrs. E. was ready f o r group services. Ref e r r a l m a t e r i a l was given to the"case worker by the C.N.I.B. worker verb a l l y . The C.S.S.D. worker was contacted, plans were discussed with her and she was i n agreement. Case Work, With the Adults Had Results. Among the .-adults who  came to them, the case workers found f a m i l y  problems a r i s i n g from a neurotic m a r i t a l adjustment, and a psychosis i n the marital partner; i n d i v i d u a l problems, r e l a t e d t o h o s t i l e immaturity i n young II. adulthood;  a psychosis p r e c i p i t a t e d by middleage; emotional upset i n old  age due to degeneration and loss of physical health, which meant the breakdown of a neurotic adjustment. Housing problems, i l l n e s s , a need f o r recreation, lack of s o c i a l s k i l l s were common secondary problems i n the adult group, and lav/ income was common to a l l . Through case work with adults, three were helped to make a b e t t e r adjustment i n t h e i r group, one was helped through r e f e r r a l t o the appropriate community agency to deal with his problem, and good relationships were establ i s h e d with two which would be of value i n continued work with them.  The  case worker added to the services offered adults i n the House by means of his  diagnostic s k i l l s , and was used i n consultation i n r e f e r r a l and i n screen-  ing r e f e r r a l s , as w e l l as by means of his work with i n d i v i d u a l s .  '  There was a development of case work method i n working with adults i n this p a r t i c u l a r s e t t i n g .  I t was learned that i t was not the case worker's  r o l e to i n t e r p r e t group work to a c l i e n t , but the case worker d i d acquire a special s k i l l i n diagnosis through gaining a knowledge of group work i n addit i o n to case work. I I . Mr. Y.", thirty-two years of age, had d i f f i c u l t y i n his" group. He was r e ferred to the case worker by the group worker,' and helped considerably as a r e s u l t . Case material i s not included due 'to I t s c o n f i d e n t i a l 'nature.  -111-  Of p a r t i c u l a r i n t e r e s t was the apparent lack of community resources f o r the unattached male.  This i s somewhat surprising- to f i n d i n a .large  .city surrounded by industries which a t t r a c t the unattached male, such as mining, f i s h i n g , logging.  This seems, to be a matter worthy of considerable  thought and community a c t i o n . The role of the House i n case finding .again comes out c l e a r l y i n the work with a d u l t s . Serious emotional problems were dealt with which i n d i cated the need i n t h i s s e t t i n g , as i n other s o c i a l agencies, of consultative psychiatric services. The work with adults,, as with other age groups, contributed a great deal to the development of the case work r o l e and method- i n the neighbourhood house, and the establishment of a place i n the House f o r the s e r v i c e . Factors which.were operative with the other age groups were also operative here.  It i s needless to elaborate those which were not peculiar to the  adult group alone.  Chapter VI. CASE WORK Hi A NEIGHBOURHOOD HOUSE  The case worker i n a. neighbourhood house -works with a wide v a r i e t y of problemsj problems of childhood, problems of youth, problems of adulthood and problems of old-age:  problems which involve physical d i s a b i l i t y ,  economic inadequacy, s o c i a l and emotional maladjustment j emotional problems which range from primary behaviour disorders and neuroses, to psychogenic i l l n e s s and psychosis. The community i n which t h i s project took place provides case work services i n the areas of C h i l d Welfare, Family Service, C h i l d Guidance, Medical and P s y c h i a t r i c S o c i a l Work, and I n d i v i d u a l Counselling.  The House case workers found that they were working  i n a l l of these areas. The case worker's e f f o r t s also extended to types of problems which had as yet received l i t t l e attention i n the community.  The kind  of problem, which, because of i t s nature, evades detection and thus prevents the person from seeking help u n t i l a very serious stage i s reached. These are people whose defences are such that they deny t h e i r need f o r help, and unconsciously develop a pattern of behaviour which hides t h e i r unhappiness from the untrained observer. Diana M.,. and Mr. G. were examples.  Jean S., Bobby R.,  Tom L.,  Sometimes when a c h i l d i s having  d i f f i c u l t y i n the group, his parent i s found to have problems of t h i s kind.  The cooperation of such parents can sometimes be achieved through  the c h i l d , who  i s l e s s r e s i s t a n t t o the worker's attentions.  The case  work service i n the House provided a means of extending s q c i a l service to such people i n the community who were sorely i n need, but had not as yet been reached. Another kind of problem which received the attention of the case workers i n the House, but which was receiving l i t t l e attention i n Community  -113Agencies, was  that of the minor emotional problem i n the young c h i l d , which  might reach serious proportions l a t e r on. amples.  This was  Jimmy B. and Larry I. were ex-  preventive work which was  possible as a r e s u l t of the  nature of the s e t t i n g . I t i s of i n t e r e s t to consider further why Bobby R.,  and Mary K.,  or an adult l i k e Mr. G. had not previously come to  the attentions of a case work agency. to a l l was  children l i k e Jean S.,  financial security.  One c h a r a c t e r i s t i c which was  common  Besides, there had been no p h y s i c a l problem  which might have brought them to the attention of the S o c i a l Service Department of a h o s p i t a l . Mr. G's  current problem was  allow him to seek medical care.  not of the kind which would  Other factors had, perhaps, prevented these  people from receiving s o c i a l work attention:  lack of recognition on the  part of responsible community persons, such as teachers, of the symptoms of t h e i r need; resistance on the part of the person or his parent to seeking help because of c u l t u r a l conditioning; lack of ego strength needed to face problems; lack of awareness of sources of help, or the f a i l u r e of the commun i t y i n providing adequate services and i n making these services known. It i s i n t e r e s t i n g that except f o r the o l d age group, Mrs. R.,  Miss  B. and Mrs. 0., none exhibited c l e a r l y the dependency pattern of the f i n a n c i a l l y inadequate and c h r o n i c a l l y i l l so often found i n case work agencies. It d i d not seem that people were drawn to the House because of a need to be dependent.  Other agencies could better serve t h i s need.  doubt dependency was  Although without  often a f a c t o r i n t h e i r problem, i t seemed that they  were mainly concerned about t h e i r i n a b i l i t y to function as s o c i a l beings; t h e i r i n a b i l i t y to make a place f o r themselves i n the s o c i a l group, and to enjoy the s a t i s f a c t i o n s of s o c i a l l i v i n g .  The breakdown of family r e l a t i o n -  ships had been most traumatic and meaningful, and they sought the answer to  -lllit h i s dilemma i n the family atmosphere of the House. It wouldj therefore, seem that aanother c h a r a c t e r i s t i c of the problems found i n the neighbourhood House was that they were, as a group, somewhat d i f f e r e n t from those found i n agencies which give f i n a n c i a l assistance and medical care, i n that there was not the deep underlying f a c t o r of dependency.  Problems were more concerned with s o c i a l a b i l i t y , or ego func-  t i o n i n g , a r i s i n g from  the breakdown-of relationships i n the f a m i l y rather  than from the family's i n a b i l i t y to meet i t s physical needs. From these observations regarding the kinds of problems encountered by a case worker i n a neighboiirhood house, one might conclude that the services of a s k i l l e d practitioner., adept i n diagnosis and case work practice would be required to f i l l the p o s i t i o n . The Role of the Case Worker Was Hot Clear at F i r s t . The r o l e of the case worker i n the House has so f a r been described i n terms of the following a c t i v i t i e s :  speaking t o groups'; .interpreting  case work to s t a f f ; equipping a play room; adapting o f f i c e equipment and services; organizing and p a r t i c i p a t i n g i n case conferences; gathering case material; and acting as a l i a i s o n between the House and-case work agencies; and performing i n d i v i d u a l and family case work service on the l e v e l s of' counselling, environmental manipulation, and treatment. . L i t t l e has been said about what occurred i n the actual process of achieving case work-group work cooperation, and what the r o l e of the case worker was i n t h i s . There was a great deal of confusion at f i r s t , on the part of both staff.and students as to the difference between group work and case work, and the necessity of defining respective roles was apparent.  It was  cult f o r them to see where group work ended and case work began.  diffi-  There was.  a tendency on the part of the group workers to expect the case workers to do  -123-  group work, and the case worker, unsure of h i s own-role, tended t o l e t hims e l f become involved i n t h i s .  I t seemed that the case worker had a tendency  to i d e n t i f y himself as a group worker, which could be a t t r i b u t e d to the emotional impact of a strange setting or a greatly outnumbered case work staff.  Another f a c t o r which contributed to t h i s confusion was the neces-  s i t y of d i v i d i n g the r e s p o n s i b i l i t y f o r supervision, case work and adminis t r a t i v e , and the f a c t that two separate agencies, the House and the school, had separate i n t e r e s t s i n the p r o j e c t . It was d i f f i c u l t f o r the group worker, at f i r s t , to see why a case worker was needed i n the agency i n view of the f a c t that group workers have case work t r a i n i n g . .They thought that t h i s t r a i n i n g was  s u f f i c i e n t to  enable them to r e f e r c l i e n t s to case work resources which e x i s t e d i n the community, and since these resources d i d e x i s t , why was i t necessary t o have case workers i n the agency?  In the course of the project i t was  even-  t u a l l y agreed that the group worker could make successful'referrals with some c l i e n t s .  However, the group worker does not have a broad knowledge of  case work theory, and has not had an opportunity to develop s k i l l s i n the use of the interview, r e l a t i o n s h i p , and diagnosis, through continuous p r a c t i c e ; he has not developed the s k i l l necessary to know whether a c l i e n t can benefit-from case work; i t i s d i f f i c u l t f o r him to enter the kind of intensive r e l a t i o n s h i p which i s often necessary to complete a r e f e r r a l , without endangering his relationship with his group.  I t d i d seem, therefore, 1  that there i s a place i n a group work agency f o r a case worker i n making r e -  •1 f e r r a l s to other'agencies.  •  The group workers were not c l e a r , at f i r s t , about the r o l e of the * case worker i n providing an i n d i v i d u a l r e l a t i o n s h i p to people who were not s u f f i c i e n t l y disturbed to warrant r e f e r r a l to another agency, but who could  -116be helped through case• work to use the group more e f f e c t i v e l y .  This, was  c l a r i f i e d on the basis that the group worker could not provide these people with the necessary i n d i v i d u a l attention because of his responsib i l i t y to his group, and also because h i s s k i l l s were not s u f f i c i e n t l y developed i n working with i n d i v i d u a l s .  Hence, the r o l e of the case worker  was also t o work d i r e c t l y with problems i n the s e t t i n g of the House. Conscious of the lack of cooperation-which existed i n the f i e l d of s o c i a l work between group work and,case..work,the group workers were anxious to develop cooperation and saw-liaison work between the House and case work agencies as part of the case vrorker's function.  Logically i t  did not seem that t h i s should be the function of the case workers, when the  group workers were p r o f e s s i o n a l l y trained, and had a knowledge of com-  munity resources.  Better to place the emphasis on the needs of the c l i e n t ,  as discussed above, and l e t the group worker function wherever he was trained to meet the c l i e n t ' s needs. It was eventually understood and agreed, that case work and group work are d i f f e r e n t and separate s k i l l s , sharing c e r t a i n generic knowledge which, i d e a l l y , work .side by side. . There i s a place f orb the case vrorker i n the group work agency, and t h i s place i s complementary to group work. Case work does not assume, or attempt to overlap, the group work function. E a r l y i n the project, there was a great deal of concern about how to get the c h i l d who needed case work help to the case vrorker. procedures had not yet been agreed upon.  Referral  The group work students and some  of the s t a f f members were .new to the agency, and d i d not think that they knew the i n d i v i d u a l c h i l d w e l l enough to .suggest that he see a case worker. There was a f e a r of f r i g h t e n i n g the c h i l d away from the House.. As a r e s u l t , children were simply suggested f o r r e f e r r a l , and i t was l e f t .to the case  :-117worker to gather information from the f i l e s , clear •with the s o c i a l service exchange, and contact other agencies that were registered.  The case work-  er- then made the acquaintance of the c h i l d i n the House and attempted to i n t e r e s t him in•coming to the p l a y room f o r regular interviews. This d i d not work out well- as the reader has already been shorn, and i t was recognised that the. r e f e r r a l i n the House should not d i f f e r s u b s t a n t i a l l y from that used between agencies.  Having the case worker i n the House.should  f a c i l i t a t e the process and make greater f l e x i b i l i t y  possible.  Working Problems Resolved.. A s t a f f conference helped to clear up the s i t u a t i o n considerably. Several important conclusions came out of this which helped i n the organization of the s e r v i c e : (a) . The, service was not intended t o duplicate e i t h e r group work services, or other case work services which already existed . i n the community.(b) .Case conferences were important and continuity of leadership should be maintained i n these, (c)  Many c h i l d r e n had been referred because they were disrupting i n the group and r e f e r r a l s should be more c a r e f u l l y considered, as these were not necessarily the- children most i n need of case work help.  (d)  A better method of r e f e r r a l should be developed.,  (e)  A case committee was needed to study r e f e r r a l s .  A r e f e r r a l committee was set up which consisted of the case work supervisor, the executive d i r e c t o r , and her a s s i s t a n t .  The purpose of this  committee was to study a l l r e f e r r a l s that came to the House from ofeher agencies, a l l r e f e r r a l s made to the case workers from groups i n t h e House,  -118-  and t o determine whether or not the person could use case work service i n the House e f f e c t i v e l y .  I f the committee decided to accept the r e f e r r a l j  one of the committee members would be designated by the committee to c a l l a case conference.  The purpose of the conference was to a r r i v e at a ten-  t a t i v e diagnosis, and to decide whether the case should be dealt with i n the House or r e f e r r e d elsewhere.  As vfork with a c l i e n t progressed, there  were to be f u r t h e r conferences i n order to correlate group work and case work f i n d i n g s . . Through.the case committee, c r i t e r i a f o r r e f e r r a l were set up. These were as follows: (a)  The member, a f t e r a considerable length of time i n the House, had f a i l e d t o achieve acceptance by other members which was s u f f i c i e n t to enable him to j o i n a group.  (b)  The member, although a part of a group, was not using the group t o meet his? needs.  (c)  The member, a part of a group, was using the group t o meet neurotic needs and could not be helped by means of group work.  (d)  A community member, not a member of the House, has come to the House seeking help of a nature which case work can provide, which might mean r e f e r r a l to an appropriate case work agency.  (e)  A person referred from another agency f o r group- workybo whom case work help given by the case workers i n the House  -• either on a supplementary  or cooperative b a s i s would be  b e n e f i c i a l i n helping him t o use group work. The case committee also determined what the r e f e r r a l process should  -119consist of.- This was as follows: 1.  The r e f e r r i n g worker should submit a r e f e r r a l summary which, would include the following: (a)  Identifying data.  (b) >A summary of the worker's contacts with the i n d i v i dual which would include whatever was known of his symptoms of behaviour and of his relationships with his f a m i l y and other s o c i a l groups. (c)  A statement of the kind of relationship the worker  .  expected to have with the referred person i n the immediate f u t u r e . 2.  A conference was  3.  There were to be periodic contacts between the group worker  to be arranged between the workers concerned.  and the case worker t o discuss new aspects of the problem and progress. There was a problem of d i s c i p l i n e i n the House because of community pressures, and a t f i r s t the group workers referred some children to the case workers because they needed d i s c i p l i n e .  I t was. established i n the  case committee that t h i s was not part of the case workers' function. I t was the opinion of the committee that cooperative work with the case workers should include professional s t a f f only.  However, i t was  not  c l a r i f i e d during the project whether or not t h i s would preclude work with the Nursery School. The case committee was very h e l p f u l i n c l a r i f y i n g r o l e s .  So also  •was a session which was held at the University between the case work and group work classes on the r o l e of the case worker i n the neighbourhood House.  This determination of r o l e i s very important t o the a c t i v i t y of  -120a c t u a l l y helping the c l i e n t ,- for-' as David F r a n k l i n pointed out i n his thesis,  -  . . . .  12. "The danger of mobilizing anxiety i n the mind of an i n d i v i - . dual i n the group, through confusing the functions of the group leader and the case vrorker who offers case work service within the group .work setting, should never be minimized.-." • • • • Mr. F r a n k l i n further says that part of t h i s i s that the confident i a l nature of the case work r e l a t i o n s h i p must-be preserved.  There was  divergent thought during-the project as t o what c o n f i d e n t i a l i t y i n case work meant, and t h i s was never, w e l l c l a r i f i e d f o r a l l . The Case Workers  1  Methods,  Many of the methods used by t h e case workers i n this s e t t i n g were not new ones, but there was some adaptation of• method to the new setting.,, Children were approached i n a f r i e n d l y manner.  In'working with children  the worker used the c h i l d ' s language-and spoke i n terms of objects and ideas which belonged to. the c h i l d ' s sphere.  However, i n some cases the  worker had t o seek out a c h i l d , who had not been prepared, f o r case work,• • and who had not expressed a need f o r help.  The-progress -of work was-dif-  ferent than i n a case-work setting, b e c a u s e i t went from.the c h i l d to the j  parent as-a-rule,, which .is the .reverse of the u s u a l practice in-case work. From -this developed the method of obtaining the child's-permission before v i s i t i n g a parent, which was very h e l p f u l i n establishing a r e a l - r e l a t i o n ship-with a c h i l d .  With the adolescent group, i t was sometimes very  dangerous .to the relationship to b r i n g the parent i n t o the p i c t u r e at a l l . In the s p e c i a l setting of the House, i t was considered-possible„and e t h i c a l to do a certain- amount of work-with a c h i l d or with an adolescent,without the parent's permission. 12.  Ibid. p. -89.  -121-  The use of the play room i n working with c h i l d r e n was not a  new  method, but i t seemed to lend i t s e l f p a r t i c u l a r l y w e l l i n t h i s s e t t i n g . It was a natural addition to the regular program, because i t was one more place where a c h i l d could play. expression f o r the c h i l d who  just  I t provided n a t u r a l mediums of  was s t i l l l i v i n g a great deal i n phantasy.  I t also provided i n d i v i d u a l attention and response from a g i v i n g parent figure.  The play helped to, drain o f f excess anxiety and to' e s t a b l i s h a  p o s i t i v e r e l a t i o n s h i p between the c h i l d and the worker.  The worker  gained the-information necessary f o r diagnosis and a .plan of through observing and interpreting the way p l a y materials.  treatment  i n which the c h i l d used the  Some children gained i n a b i l i t y to v e r b a l i z e t h e i r  problem as a-result of the f r e e i n g e f f e c t of working with the c l a y and f i n g e r paints.' The case worker could also observe the c l i e n t i n his group which provided the a d d i t i o n a l advantage that the'case worker yras able to see him as he functioned as a s o c i a l being. What Did the Case Work Service Mean to the House and Community? During the course of t h i s project, the case workers helped to sharpen diagnostic thinking; i n cooperation with the group workers a method of cooperation between group work and case work was established; the r o l e of a case worker i n t h i s p a r t i c u l a r neighbourhood House was f i n e d , and an idea was formulated of what might be accomplished  de-  i n the  House i f a case worker were h i r e d on a permanent b a s i s . . I t seems apparent that the addition of a case worker to a neighbourhood house can provide the community with a unique resource which can provide a high q u a l i t y of s e r v i c e .  I t i s a resource which i s b e t t e r s u i t e d  than a case work agency alone to deal with c e r t a i n problems, such as the  -122r e h a b i l i t a t i o n of the unmarried mother or. the person' who has been mentallyi l l , as shown.in the cases of Miss B., and Mrs. A.  I t i s a resource which  attracts people who have p a r t i c u l a r problems which prevent them from going to other agencies and i s , therefore, a valuable center,for case f i n d i n g , a function which the case worker can enhance i n many ways.  It  seems to have an appeal f o r people because of i t s i d e n t i f i c a t i o n with the family, and .the need people have to work out t h e i r problems i n the family. As a r e s u l t of t h i s a t t r a c t i o n , some c l i e n t s can be reached at an e a r l i e r stage i n the development of t h e i r problem than they would have been otherwise and, as a r e s u l t , work of a more constructive nature can be done with them.  I t was easier in' the s e t t i n g of the House f o r the. client'to--seek  case work help because of the f r i e n d l y , f a m i l y - l i k e atmosphere of the setting. Thus i t seems' that a combined social'work service i n the form of case work and group work can deal more adequately with certain emotional problems than a case work service alone; the c l i e n t can be reached at an e a r l i e r stage i n the' development of his problem; through the group setting c l i e n t s can be contacted who might never go to a case work agency, yet who could be expected to become serious s o c i a l problems. An examination of the sources of r e f e r r a l outside the agency i s of value i n evaluating the s e r v i c e .  I t also points up certain lacks which  exist..in the community. Clients came to the case workers who were not.members of the House at the time of f i r s t contact: (a)  As a r e s u l t o f r e f e r r a l from other s o c i a l work agencies, the T.W.C.A., the C i t y S o c i a l Service Department, and the S o c i a l Service Department of the Vancouver General Hospital.  -123(b)  From the community as a r e s u l t ' o f the c l i e n t ' s own request, as i n the' case of Diana-M. ~  . <. .  Referrals' were made to the case workers i n the House by other agencies that were already serving the c l i e n t f o r " a number of 'reasons: "." .(l) The House provided a more' extensive service i n the combinat i o n of case work and group work than the r e f e r r i n g agency could provide. The r e f e r r a l "of Mrs. F.'- from the Y.W.C.A-. •is ah example .•  '  (2)  The House offered a more intensive case work service than  „  the r e f e r r i n g agency could provide, and also group work.  "•• ,  The r e f e r r a l o f Mrs.- C. from the C i t y Social Service• Department i l l u s t r a t e s t h i s . '(3)  The combined resource of case work and group work was a bett e r one f o r Mrs. A-., than any'other-that the c i t y could'-provide •  .  .  (Ii)- There was.no case work'resource available i n t h e - c i t y f o r ' • ." - the single unattached male, as was "required by Mr.' Ii. The group workers i n the House referred c l i e n t s who were already r e 1  ceiving services from other case work agencies f o r the following reasons: (a) • I t was believed that a more intensive service was required by the. c l i e n t than that which the active agency could provide, in.order t o enable him to use group work e f f e c t i v e l y . Examples ".' were- Barbara I., Larry I.,.'/and Jimmy B.,, a l l of whom came from • assistance f a m i l i e s . (b)  The c l i e n t appeared'to need'more help than the active agency or the'group vrorker could provide, t o enable -him to use community resources e f f e c t i v e l y .  Mr. G. was an example.- (His  case was active with the Family Day Care Association.)  -I2tt-  (c)  The c l i e n t could not .use-either the group work or case work which had been offered.-him, and was  i n need of diagnostic  service of a more specialized nature, i n order to get'him to the-proper-community'resource,,  -  From t h i s evidence One .can -deduce that s o c i a l 'assistance agencies i n the community are not set Up to provide the therapeutic and preventive type of case work'service  to the c l i e n t which s o c i a l workers know .can,  bring a community such worthwhile returns.  Moreover, i t i s evident that  the community does not provide adequate case'work service to meet the needs "of the people on s o c i a l assistance who  could use i t , and t h e r e - i s a d e f i n i t e  gap i n case work service^ in-Nthe- lack of- a resource' f o r "the'unattached I t was  male.  natural that the workers, i n ..the public agency should wish to make  use. of t h i s new resource..,  -•  • '• ' •  The a t t r a c t i o n that the.House: had f o r people who i n order t o help them to use group work services, was  needed -case work,  evidence  of the com-  munity need f o r the development of •'case work - group'work cooperation;-This was  a problem- which had previously received considerable, attention, but  small s o l u t i o n . Implicit i n t h i s was  the .need f o r the development of bet-  ter, methods of r e f e r r a l . '  • '  The project revealed the need f o r better diagnostic services i n the community.  S k i l l on the part of'workers i n m o s t s o c i a l agencies i n the  recognition of psychotic and pre-psychotic symptoms i s p a r t i c u l a r l y l a c k i n g . Conclusion.  - -  *  .-  '  I t has been observed that the actual accomplishments of the case workers i n the House i n helping c l i e n t s during the project was This was  limited.,  due to the inexperience- of the workers, 'their resultant i n s e c u r i t y  i n the new s e t t i n g , the problems presented i n the .adaption of case work to  -125-  the  setting, and of the s e t t i n g to case work.  important.  The time f a c t o r was also  Because the type of service was new t o the community, i t  needed time to mature, to demonstrate success, and to achieve community acceptance.  There were also problems with regard to establishing the  place of the service i n the community i n r e l a t i o n to other agencies.. Many of these problems were not completely resolved, and the project a t i t s conclusion therefore presented many facets f o r future development. The project -was not so valuable f o r i t s contribution to .knowledge  c  i n the wider f i e l d of s o c i a l work, as i n the l o c a l community.  Projects.  1  elsewhere have established correct r e f e r r a l procedure between case work and group work, and have determined the correct role of the case -worker i n a neighbourhood house.  The Henry Street Settlement i n New York, f o r  example, has", a full-time, case worker on i t s s t a f f .  The project was of  value i n the l o c a l ' community as a p r a c t i c a l exercise i n case work - group work cooperation. The project does suggest other p o s s i b i l i t i e s f o r the use of case work - group work cooperation which have not been so widely explored: i t s use i n a treatment program; i t s r o l e i n case finding;, i t s r o l e i n preventive work.  Group workers are becoming more and more interested i n group  therapy. . Does t h i s not also have a place i n a treatment setting? t h i s p o s s i b i l i t y been, as yet, s u f f i c i e n t l y explored i n s o c i a l work?  Has'  the f i e l d of  BIBLIOGRAPHY  Books and Pamphlets. 1.  American Association of Group Workers, "Group Work-Case Work Cooperat i o n " , a Symposium-Sponsored by the American Association of Group Workers, New York Associated Press, 19k6.  2.  Coyle, Grace Longwell, "Group Experience and Democratic Values", New York Women * s ' Press, Nevf. York, 19U7.  3.  Gesell, Arnold, and I l g , Frances, "The Infant and the C h i l d i n the Culture of Today", Harper and Brothers, New York, 19U3.  4.  G e s e l l , Arnold, and I l g , Frances, "The C h i l d from Five to Ten", and Brothers, New York, 19li3.  5.  Hamilton, Gordon, "Psychotheraphy i n C h i l d Guidance", Columbia Univ e r s i t y Press, New.York, 1947.  6.  Josselyn, Irene M., M.D., "The Adolescent and His World", Family Service Association of America, Hew York, 1952.  7.  Josselyn, Irene I . , H.D., "The Psycho-Social Development of'the•Child", Family Service Association.of America, Pub., New York, 19h&» -  Harper  8. Wilson, Gertrude, "Group Work and Case Work, Their Relationship and Practice", Family Welfare Association of America, Pub., New York, 19Ul. 9. 10.  Wilson, Gertrude, and Ryland, Gladys, "Social Group Work Practice ", Houghton, M i f l i n and Company, Boston, 19U9. Zackery, Caroline B., "Emotional Conduct i n Adolescence", D. AppletonCentury Company, New York, l°l+0.  Thesis. 1.  Franklin, David S t . George, "Case Work-Group Work R e f e r r a l " , M.S.W. Thesis, Dept. of S o c i a l Work, University of B r i t i s h Columbia, 19U9.  2.  Hutchinson, Fredrick, "Case Work Service i n a Neighbourhood House: The Administrative Aspects of Its Establishment and Operation", M.S.W. Thesis, School of S o c i a l Work, University of B r i t i s h Columbia, Vancouver, B.C., 1952.  Articles. 1.  Bernstein, Saul, "Contributions of Group Work to Individual The Family, V o l . XX, No. I, March, 1939, p. 21.  2.  Josselyn, Irene, "Psychological Problems of the Adolescent", S o c i a l Casework, Family Services Publication, May and June, 1951.,  Adjustment",  -127-  A r t i c l e s (Continued). 3.  Linderman, Wanda, "Patterns of Case Work Services i n Group Work Agenciesy The Group, November, 191+5.  U.  "Group Work and Case Work, Their Relationship and P r a c t i c e " , Family Welfare A s s o c i a t i o n of America Publication, New York, 19U5, p. oii.: ~ :  '5*  Svendsen, Spiker et a l , "An Experimental Project i n the Integra t i o n of Case Work and Group Work Services f o r Children", The Group, March, 19U8.  6.  Weiss, D.,' "Some Aspects of the Case Work-Group Work Process", The S o c i a l Worker, V o l . 17, No. 2, Dec. 19U8, p. 13.  Other. 1. . Minutes of the Meeting of the Board of.Directors of Gordon House, Nov., 19k9, p. 3. 2.  Minutes of the Northwest Neighbourhood House Conference, February, 1950.,  3.  Furness, Ann, Membership Study, • Gordon House,  1950-51.  

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