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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-$0,) by BERNICE WINNIFRED BAYCROFT Thesis Submitted i n Partial Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the School of Social Work Accepted as conforming to the standard required for the Degree of Master of Social Work School of Social Work 1952 The University of British Columbia CASE WORK IN A NEIGHBOURHOOD HOUSE The Role and Performance of a Case Worker i n a Group Work Setting. (A Study Based on an Experimental Project i n Gordon House, Vancouver,B.C., 19U9-!?0.) ABSTRACT This study describes and evaluates the role and the performance of the case worker i n a group work agency, on the basis of a student proj-ect which was carried out i n "Gordon House", a neighbourhood house i n the City of Vancouver, B r i t i s h Columbia. Two case work students from the School of Social Work at the University of B r i t i s h Columbia were assigned to the House as a second-year f i e l d placement, to set up case work serv-ices. The period of the project was from September, 19h$> u n t i l May, 19f?0. The study analyses a sample set of cases, (records which were com-piled by the students during the project), giving particular consideration to (l) the kinds of problems clients brought to the case worker, (2) the activities of the case worker i n this setting, and (3) what the case work-ers added to the services which the agency already offered. The project as a whole i s analysed, with particular reference to (a) problems of set-ting up the service, (b) the experimental interest of the project for so-c i a l work practice, and (c) the value of the project to the community. Considerable evidence was found to verify-that there i s a place for a case worker i n the neighbourhood house, and that this place i s one in which the case work function can f i n d adequate fulfilment. A wide variety 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 practitioner to deal with them. The case worker's role in the House i s one which i s complementary to group work,,and which does not overlap existing community case work services. Working together, group workers and case workers can provide a specialized service for those seeking better personal adjustment. The special 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 staff of a group work agency, and what this can do for case work-group work coopera-tion i n the community. It i s hoped that the study w i l l stimulate thinking with regard to the combined use of existing social work s k i l l s , (group work and case work), on the treatment level and that something further w i l l develop i n the community to "which this study might contribute, which would provide adequate treatment services for disturbed children. i i i TABLE OF CONTENTS _ Page Abstract ' i i i Acknowledgements . . . i v Chapter I. People With Problems The people, the project, the setting. The group •work function, the Nursery School, problems i n setting up the service. The case material, the study. ^ 1. Chapter II. The Child From Two to Six The Nursery School group, the case work services pro-vided. The problem of the broken home, the problem of i l -legitimacy, the significance of the experience with this group 18 . Chapter III. The Child From Six to Twelve The child i n latency and pre-puberty, case work with this age group. Some latency children who were disturbed could participate i n group activity; some could not. Prob-lems 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. Achieve-ments through case work. . . 67. Chapter V. The Adult The adult group, the need i n the community for i n d i -vidual services for adults. Problems encountered in the House among the adults,.family problems, problems of the unattached adult. The results of case work with adults i n the House 92. Chapter VI. Case Work i n a Neighbourhood House The nature of case work i n a neighbourhood house. The need to c l a r i f y the role of the case worker. The resolu-tion of working problems. The case worker's methods. The meaning of the service to the House and to the community. The value of the project. . . . . . . . . . . . . . . . 112. Bibliography 126. TABLE BI THE TEXT Table 1. Persons referred for case work during the project. 16. Acknowledgements. The writer wishes to express her sincere appreciation to Miss Helen Wolfe for assistance given i n analyzing the case material, and to Dr. Leonard C. Marsh under whose direction this study was conducted. . . - . i v 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 social worker a multiplicity 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 friendly, helping atmosphere of the House, problems are freely expressed. As the trained social group worker attempts to help people, through the group, to gain satisfaction from the various forms of leisure-time a c t i v i -t i e s , he finds that certain individual problems arise which tax his i n -genuity sorely to help. It becomes apparent that i n order to serve the members adequately, there i s a need for a large measure of individual and personal counselling; a lcLnd of service not i n line with the organizing of the club, the dance or the whist drive; and the kind of aid which i s the sk i l l e d contribution of the case worker. The project which i s the subject of this thesis started from this recognition, that a case work service i n the House would be a means of en-hancing 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 relations between group worker and case worker would be productive. The referral process be-tween group workers and case workers might be f a c i l i t a t e d ; greater famil-i a r i t y with the process by agency workers would encourage ref e r r a l both i n and out of the agency; better mutual understanding, and closer working re-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 helpful i n solving the problems of case work-group work referral i n Vancouver. The service was set up to serve: (l) children and adults referred to the House from other agencies; (2) children and adults who came to the -2-House seeking group work servicesj -(3) .members of the community who had particular problems, and wished help in finding a community resource which might meet their .need. Case work service was provided by two second-year case work students, who were placed in the House for a period of seven months, for a second-year experience in f i e l d work. Supervision for the students was provided by a (case work) faculty member from the University, with considerable institutional work, and in setting up new services. Administrative supervision was pro-vided by a (group work) faculty member who was the University consultant for the agency, and who had a good deal of valuable experience i n the inte-gration of services,, and in administration. The Physical Setting. The neighbourhood house i n which this project was conducted i s located i n the centre of one of the city's oldest residential areas. This is a "transitional" area in the terms of the sociologist, and i t pro-1.2. vides a variety of types and of quality of accommodation. According to school and other s t a t i s t i c s , population is quite mobile, newcomers set-t l i n g temporarily u n t i l quarters i n a better neighbourhood can be found. It i s an area which also attracts old-age pensioners, working mothers, and single men and women who are alone i n the city, because of i t s near-ness to the beaches, shopping and the downtown business section. West End Survey, Group Work Division, Vancouver Council of Social Agencies, Vancouver, B.C., May, l Q U l . 2. Norrie, R.E., Survey, Report of Group Work And Recreation of Greater Vancouver Community Chest And Welfare Council, Vancouver, B.C., iW5, p . s i : It i s believed that there i s a high percentage of family breakdown i n this area, although there are no reliable s t a t i s t i c s to show thi s . Estimates made by social workers and teachers during the period from 19U9 to 1951, suggest that from thirty-six to sixty percent of school 3,11,5". age children are from broken homes. The need for 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 tot a l commu-nity as well as House members; to contribute to the social development of the community and of the individual; to provide a place where people can come together for the purpose of solving common problems; to serve the individual by offering him the advice and help of professional staff in using other community resources, and to further democracy through the practice of democratic principles. Membership i n the House i s open to children from two years of age, when the child may enter Nursery School, and to adults of a l l ages. Although membership i s theoretically limited to residents of the area, referrals are accepted from other social agencies i f the kind of service the client requires cannot be provided i n his.own community. The approximate total membership during the period of the project 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 Br i t i s h Columbia, 1952. 5. Furness, Ann, "Membership Study",1 Gordon House, Vancouver, B.C., 1950-51. forty nursery school children, two hundred and f i f t y children between six and twelve, two hundred 'teen agers, and six hundred adults. The House provides club rooms for friendship groups, a gymna-sium for larger and more inclusive gatherings and sports, kitchen f a -c i l i t i e s , an arts and crafts room, a-card room, lounges, a reading room for the adults and a music room for children. Structurally the House' consists of two buildings, and a gymnasium. Most of the program for children goes on in "Junior House", and the adult program i n "Senior House", the gymnasium being used for both. There i s a trend i n neighbourhood house philosophy to place more emphasis on family membership, and an attempt is being made to bridge the gap which exists between the two Houses by having a group of seven-teen-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 building 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 is open five days a week; from nine A.M. to three P.M. for the Nursery School; from three P.M. to five P.M. for six to twelve-year-olds, and two evenings each a week for intermediates and seniors, who are the twelve to fifteen, and fifteen to eighteen-year-old groups, respectively. Senior House is open every day except Sundays and holidays, and group meetings are scheduled. The House is administered by an Executive Director assisted by an Assistant Executive Director. She i s responsible to a Board of , -5 -Directors, through a House Committee. The administrative structure i s departmental, and the heads of departments are, the Director of Boys' Work, the Director of Gir l s ' Work, and the Nursery School Supervisor. The Young Adult Department, and the Senior Citizens Department come under the Executive Director and her Assistant. The secretarial staff of two, and the j a n i t o r i a l staff of two are directly responsible to the Executive Director. Each House has an Advisory Committee of citizens of the community, and there i s also a Nursery School Advisory Committee,. There are various standing committees, which are responsible to the Board of Directors, and which are concerned .with finance, buildings and grounds, personnel, and public relations. The membership participates i n the ad-ministration of the House through i t s House Council, which is made up of representatives from the various groups. At the time of this study, the House was staffed with a good per-centage of trained workers. Three women workers had second year t r a i n -ing i n social work, with specialization in group work, and one woman part-time worker had second year training i n social work with speciali-zation i n case work. The only male full-time worker was p a r t i a l l y trained and was attending courses at the University. One woman part-time worker had no postgraduate training, but had specialized i n psychology , for her University degree. There was one woman worker who had no Uni-versity training, but had years of experience in the f i e l d . There were two qualified nursery school teachers i n the Nursery School. Three second-year group work students and four first-year students were placed i n the House for f i e l d work. Volunteers and craft specialists i n art, pottery, . woodwork and leather were used extensively, numbering about th i r t y . -6-Volunteers and crafts 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 staff entertained the volun-teers annually at a friendly, meeting, a token of appreciation and at the same time a means of interpreting 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 staff mem-ber, which enables the trained staff"to put group work techniques into practice. "Interest" groups bring people together who have a common i n -terest, such as dancing, crafts, sports, or a desire for discussion. "Friendship" groups reqiiire a prior 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 act i v i t i e s which they as a group wish to follow in the House. Because friendship groups are the most cohesive, offering the individual member emotional support, and because there is a good deal of interaction between members, on an emotional level, they provide the best opportunity for the practice of group work. The interest groups in which anyone can participate without friendship connections, provide an entree for those who wish to f i n d friends, and the aim of the group work-er i n these activities i s to help members move on into friendship groups. The House seems to attract many children and adults who have emo-tional problems which prevent them from getting along comfortably i n ordi-nary community clubs and groups. For these people the House provides a protected setting, and staff who understand and accept their behaviour. They are helped to develop an a b i l i t y to participate and to be accepted - 7 -by other members, and thus to express and satisfy frustrated social drives. The attitude of staff i s a friendly accepting one, and there is a tendency for members to imitate i t . Some members of the House have d i f f i c u l t y i n participating i n groups even with the help of the group worker, and despite the fact that the demands of some of the groups are very slight. Although ap-parently gaining few satisfactions from the House i n terms of friend-ship or "having a good time", these people often continue to be very regular in attendance, and are the f i r s t to arrive at meetings and the last to go home. These are people who apparently have been very their family l i f e , and have not had the emotional satisfac-tions necessary for emotional growth. Their affectional needs are ab-normal, the accepting group workers provide something i n the nature of what they are seeking, and hence become parental-figures to them i n their unconscious minds. In a sense i t may be said that such members are actually looking for a good parent, and hope to realize this kind of relationship through the group worker. They compete with fellow members for 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 this encourages such a person to express his feelings, and conflicts and, tensions which have been developed in "the family i n relation to parents and to siblings, are reawakened in 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 particularly 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 effects, and i n this way relieves the discomfort of emotional tensions. Because i t i s an unconscious act of protest against previous injustices lie has endured, he feels j u s t i f i e d . As a result he cannot accept the idea that he needs help. On the other hand, the person who tends to withdraw from contact with other people does so because of his negative feelings toward people. He represses these feelings, thus building up tensions. Then, because he has no means of relieving these tensions, he realizes Ms discomfort. He i s often more accessible to help than the person who "acts out" his feelings, yet his problem i s often over-looked because he i s not a disrupting influence in 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 feels i s his 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 responsibility to a l l the members of the group. The leader cannot give him' the kind of individual attention that he needs, either in 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 relate to others, since they do attempt to participate in a group, but who are unable to do so successfully, are aptly called "fringe" people. They are on the "fringe" in terms of their participation, the degree to which they are accepted by other members, and their a b i l i t y to grow through the group. They are people who cannot get along happily in a group be-- 9 -cause they have never learned to do so with individuals. The mother is 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 is a satisfying positive relationship with an individual. They must learn to participate in a face-to-face relationship, and to have confidence in others. They must be helped to realize their individual assets and to gain self-confidence so that they will be able to experience satisfactions in 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 is a function of a case worker, and the point where the group worker refers the client to the case worker is 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 is 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 is required to accept the habit routines, but a l l activities are arranged so that he might find them interesting and satisfying. He is praised for achievement in order that he can realize enjoyment in conforming, and find the effort necessary -10-worthwhile. He i s helped to f e e l independent, and encouraged to take responsibility. The play periods provide an opportunity for him to discover the pleasure of social companionship i n acti v i t i e s 'with others. He i s given freedom to explore i n order that he may learn through ex-perience the consequences of his acts, and methods of solving his prob-lems. The teacher assumes a directive, and at times a manipulative role. Discipline i s sometimes taught by arranging the results 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 frustration and failure are recognized, and the child i s helped to succeed i n his endeavours whenever possible. If the ch i l d has minor emotional problems, i t is the belief that there i s a therapeutic effect i n the pleasures and rewards found in the organized activities of the school, and in the ski l l e d help given by the trained supervisors when d i f f i c u l t social or individual problems arise. Treatment is considered the function of a specialized c l i n i c , such as the Child Guidance C l i n i c ; not a social work s k i l l . The family i s reached through parent study groups and through individual discussion of problems with parents. This is also on an educational basis. In cases where serious emotional problems are evi-dent, referral i s made to the appropriate agency. The aim of work with the family i s to teach the parents the methods of ch i l d training 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 social i n nature, at the invitation of the parent, and only a few homes were well known at the time of the project. The philosophy, methods and techniques used i n the Nursery School di f f e r from those of social 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 in terms of the child's a b i l i t y to play; the use he makes of the play materials; his a b i l i t y to con-form to the established norms of habit and conduct; his a b i l i t y to learn; his a b i l i t y to concentrate, or his a b i l i t y to express himself appropriately. Work with individuals i s carried out i n the group setting, and the group i s not consciously included. Interrelationships in the group are not used to achieve either group or individual develop-ment . Problems Of Setting Up The Service. Owing to the shortage of time to plan and prepare for 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 policy to cover the new services; (b) working out of an intake procedure for case work; (c) determination of the relationship of the new services to those which already existed;;(d) determination of the lines of responsibility; (e) adaptation of the office structure for case work purposes, and (f) the integration of the new staff 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 result. Interpretation had to start from the beginning because many board members thought of the house as a recreation centre rather than as a neighbourhood house. It was necessary to clear with the board that-the house was intended to provide community services, in order to validate the use of the case workers. Clarification of the lines of responsibility was necessary in -12-order to make possible the working out of methods of administration for case work. There were two administrative bodies concerned with the project, that of the House, and the School of Social Work, and their re-spective objectives had to be a l l i e d . A method of intake for case work i n the new group work setting had to be worked out, since the general registration of members for house activities was not sufficiently selective. For group work pur-poses, a l l who sought meiribership i n the House and were accepted, were automatically accepted for group work. Case work could be offered only ' to those who were seeking help, in the case of adults, or whose parents wished them to have help, in the case of children, and who had problems of an individual nature. It was necessary, therefore, to compile a l l available information, and to give i t some diagnostic study, before ac-cepting the client for case work services. It was necessary to determine how the case work service would function i n relation to the other services provided. There was a prob-lem of clarifying the respective roles of the case worker and the group worker, and of showing how one service should relate to the other i n the setting. These two s k i l l s , although having a common basis i n social work, appeared to have become separated, and there was a need for better under-standing of the other, on the part of each. Also there was a third serv-ice i n the House, that of the Nursery School, which based i t s practice on a different school of psychology than that of the social workers. The need to establish a practical-method of referral between 6. group work and case work was a problem. David Franklin, i n his thesis 6. Franklin,D., "Case Work-Group Work Referral", M.S.W. Thesis, Department of Social Work, University of Br i t i s h Columbia, 19k9 . -13-points out how few referrals are received from case work agencies by group work agencies. He believed that this was due to the fact that the client, although prepared for 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 client was not being helped suf-f i c i e n t l y by the group worker to face his problems, to enable him to move toward treatment. Interviewing s k i l l , and an understanding of the individual, must be quite highly developed i f a worker i s to help a client in this way.' A great deal of interpretation was necessary in order to achieve an adequate working relationship with the staff 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 result, to accept case work services. , | The case work supervisor met with the Advisory Committee of the •School on one occasion to discuss the problems of disturbed children, and the ways in 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 child might regress, the general opinion of the group was that this "could not be allowed", as the child might become a problem at the School. In view of this, and in view of the Committee's policy of refusing applications where emotional problems are apparent in the child, i t appeared that there was a desire to avoid having children i n the School who would exhibit disturbed behaviour. The physical structure of the agency was a source of d i f f i c u l t y for 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 to find a room suitable for interviewing. In an agency devoted to group work,, office space was limited. It was decided that a play room would be the most useful type of room for interviewing children, and a room in Junior House was designated for this purpose. -Money vra.s allotted by the House committee for furnishings. It was soon found that this room did not provide the necessary privacy and quiet however, and so a second room was suggested on the third floor 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 usually in progress. However, i t did serve the purpose of the project u n t i l a better room could be made available. It was furnished with'a doll's house, dolls, modelling clay, drawing materials, games, play soldiers, model cars, airplanes, trucks, old magazines, finger painting materials, play clothing, jewelry, and other toys which i t was thought would be useful to help a child express himself i n play. Due to limited office space, i t was necessary for the case workers to arrange for the use of a club room, or-one of the directors' offices when they wished to have an office interview with an adult. Interruptions were quite common during interviews, because no one room had been designated as an interviewing room for the case workers, there was not a general appreciation of the importance of privacy and lack of interruption i n a case work interview, and people did not hesitate to interrupt an interview i f there was something that they wanted i n the room. - 1 5 -The case workers did. not think that there was the emphasis on the confidentiality of records i n the neighbourhood house which one would wish for case work purposes. There was only one steel f i l i n g cabinet which could be locked, available, and the case workers were given the use of this.. The respective requirements of group work and case work i n regard to confidentiality had to be discussed and c l a r i f i e d , and standards set up. The use of volunteers as receptionists was not desirable for case work purposes, as i t was impractical to provide the necessary orientation. They changed from day to day, and from week to week, and could not give the dependable service i n taking phone calls and messages that a permanent office secretary could. This was a problem which could not be altered. These are some of the immediate problems which were met, and which were implicit i n the use of a plant which had not been intended to house a case-work service. Also of concern, were the problems involved i n the integration of the services already provided with the case work service. Discussion of these has been reserved for the f i n a l chapter, when the reader w i l l have in mind the case material which i s presented in the chapters which follow. The Case Material. This thesis i s based on an analysis of twenty-one case records which were compiled by the case workers during the project. Two of the cases have been omitted from the text because they contained too much identifying information, but they have been considered as part of the total 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 in such a way as to present the role- and performance of the case worker in the House, in terms of a diagnostic description of the problems dealt with, methods and techniques used by the worker, and benefits accruing, to the client. This serves to describe how the project was unique in types of problems, and methods used. It also points up the advantages and disadvantages of the particular setting for purposes of case work treatment. To show the scope of the new service in the community, thought was given in 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 member-ship. Attention i s also given in the discussion of cases to the workers' relationships with other community agencies. Persons Referred For Case Work During The Project. Total Persons Referred Referred From: Group Community Pre School Children. 1 0 1 2 0 2 Children, aged 6-12. 2 0 2 3 1 •u Adolescents, aged 12-18. 1 ' 1 2 3 0 , 3 Adults. 1 2 3 0 h h total 13 8 21 -17-For purposes of analysis the cases were cla s s i f i e d i n accordance with the age groupings used in the House in planning group work program. The table above also shows this breakdown, and the numbers worked with in each sex. Thus each of the middle chapters deals with.a different age group. Certain advantages accrued from having a case work service i n the House which were not directly beneficial to the people who received case work, and which do not a l l come out clearly in the case material. These are, however, important in evaluating the performance of the case worker. They have been given consideration in 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 fact that the writer was one of the case work students who took part i n the project. Chapter II. THE CHILD FROM TWO TO S H . In working with the two-year-old one i s constantly aware that he has already become a complex being i n whom individual needs and character-i s t i c s are well developed. . At this age, the child 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 social world. His interest i n play enlarges to include others; he learns to play games, and he seeks companionship in his play. Past the age of three, the child's aware-ness of his father, and of the social triangle of which he. is a part with his parents, precipitates him into a vrorld of specific fears and attitudes, and the ;more general feelings which he has previously held about l i f e , f i n d a focus i n the parental figures. The parent, no longer merely the minister-ing mother, has a new quality which appears .with the child's discovery of the two sexes. His interest i s centred on the parent of the opposite sex. If this parent can satisfy his interest, and also establish for the child the r e a l i t i e s of the relationship between them, Oedipal problems-will be successfully resolved. The child w i l l discover a relationship between him-self and his parents which can assure him of emotional health and growth; one in which he has two supportive parents, each related to him i n a d i f f e r -ent way, each performing a different function on his behalf, but working to-gether to give him the strengths of maturity., The disturbed child in the nursery school group is inevitably con-cerned with problems which involve a defective relationship with mother, since she i s the person who plays the dominant role during this early phase -19-of 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 ex-perience the emotional satisfactions 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 role i n a better way, and the child w i l l continue to grow emotionally because his needs are being met. The Nursery School Group. There were forty children between the ages of two and six 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 in the School came from stable families; that i s to say, families in which both parents were i n the home, relation-ships were good, and there was an adequate income* Only three children did not have this kind of a background. TITO were from broken homes, which had re-sulted from a divorce and a separation; the third child was illegitimate, and had known no father figure. These three children were being supported by their mothers, and lived with them i n the homes of maternal grandparents. The most frequent reason given by parents for applying for Nursery School placement of their child, was that they lived in an apartment building where there was no play space. Another common reason was that the mother was not well, and her doctor had recommended that she be freed from the responsi-b i l i t y of caring for the child during the day. Eight children had been en-rolled as a result of referrals; two were referred by pediatricians because of feeding and habit training problems; three by the City Social Service De-partment because of problems arising from illegitimacy, divorce and separa-tion; two by the Family Welfare Bureau because of behaviour problems; one by the Child Guidance C l i n i c because he was slightly spastic and showed a - 2 0 -tendency to block emotionally. Services Provided By The Case Workers. Many families mho applied for the placement of a child i n the Nursery School had serious social problems, and needed case work services. The f i r s t use that the Nursery School staff suggested for the case work service in the School was to handle the referral of these families to the appropriate agen-cies i n the community. The Nursery School staff thought that case workers helped people only through manipulating their environment and giving infor-mation about resources. They were not aware of the treatment function i n case work, nor were they aware that a successful referral sometimes requires f a i r l y intensive case work. Their conception of case work is reflected i n the statement set up by t he agency concerning the function of case work, namely, "that the case workers would help members of the community who had particular.problems, to f i n d the community resource which could best meet their need." The case, workers did not believe that they should function on the environmental le v e l in handling problems which could be handled by the group worker, or that they-should extend their services by offering inten-sive help to non-members for whom there were other community resources. • Moreover, referrals of this kind from the School did not help in the de-velopment of a case work service for the pre-school child. Interpretation of the -role they could f i l l , and the kind of work they wished to do, brought the case workers three referrals of children who were in the School. This occurred toward the end of the project. The Problem Of The Broken Home. 7. The three children who were referred to the case workers from the 7. Only one of these children was actually interviewed by the case work-ers because of the shortage of time, - and other factors, such as the breakdown of the ref e r r a l process, referred to subsequently. -21-Nursery School group came from homes where there was no father, and where the mother was attempting to support herself and the child by working outside the home . One of these children, Laverne W., was four-and-a-half years of age, and had evidently experienced rejection from her brother, and probably from others. Life to Laverne seemed to mean unhappiness, conflict, unrewarded ef-fort, and i n s t a b i l i t y . Her feelings were evident i n her choice of colors, in her- crying spells, i n her unresponsiveness, in her fear of dogs, in her habi-tual f a l l i n g , i n her thumbsucking, and i n her restlessness vjhile sleeping. Laverne cried for her mother and looked for the satisfaction of her need in other adults. She showed l i t t l e interest i n other children because the ex-perience she had had with them in the person of her brother had been painful and unsatisfying. Laverne was s t i l l performing on an oral level emotionally, as evidenced i n her thumb sucking. She was looking inward for comfort and satisfaction rather than to those around her. Her sleep was disturbed be-cause her troubled unconscious was seeking expression. Laverne had attended the School since she was three years of age. Her older brother had also attended for 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 resulted in having stitches put i n and a night in ihe hospital. When her brother stopped coming she came to school by herself and often arrived crying. Sometimes she said that she had been frightened by a dog, or had f a l l e n . Frequently she could give no reason for 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 for half an hour at a time, sucking her thumb, which was a habit from babyhood. She seemed oblivious of her surroundings then. She was restless during the sleeping period, but would settle down i f an adult sat near. There were strengths i n Laverne's personality which one could relate to strengths i n her background, and which might have been used to help her. She showed ego strength in her a b i l i t y to come to School alone at the age of 8 . S i n g l e spaced type denotes case material taken from summaries of actual case records. Double spaced type i s the writer's analysis and evaluation of the case material. J -22-three; in her a b i l i t y to participate in the singing, and to sing alone. She had intelligence, 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 join i n the group singing. She liked to sing alone, and she enjoyed the action songs. She enjoyed the sand box and the swings. She liked to draw, always using black crayons. Laverne's routine habits were good, she learned quickly, and was cooperative. She ate well, and muscle coordination was good. The family situation illustrated the unfortunate manner of plan-often ning which immature people/employ when thejr have f a i l e d in marriage. Mrs. ¥. regressed in face of failur 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 sister, now having problems which intensified her former negative personality qualities, was also i n the home. It became apparent that Laverne had known l i t t l e genuine affection, she had competed unsuccessfully with her brother for 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 lived with, 'the parent of their own sex, because the mother believed that this was best for them. Mrs.. W. was obviously much fonder of her son than of Laverne. Laverne and her mother lived with the maternal grandparents, and a maternal aunt,-Mrs. V., and her daughter Betty V. Mrs. V. was divorced from her husband and worked in -an office. Betty V. attended the nursery school with Laverne. The grandmother found the children d i f f i c u l t to manage. If 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 traveling job. He seemed irresponsible and disinterested in the problems of his family. Mrs. W. was an attractive, likeable woman, who had many men friends, and who led quite a gay social 1 l i f e . s 1 Mrs. ¥., l i k e Laverne, was seeking a mother as shown in her tendency to talk about her problem without being willing to do anything about i t . She was looking for the good mother who would solve her problems for her. As a result she was inadequate i n her role as Laverne's mother. -23-Mrs. W. often discussed her problems in her family with the nursery school supervisor. She eventually expressed a wish for help. It was suggested' that the case workers might help her. She said that she feared that the discord which was mounting in the home was having, a bad effect on Laverne. Three appointments were made for her with the case workers, but she did not keep any of them. Her attitude i n speak-ing to the case work supervisor on the phone was light and carefree. Laverne's mother was young and energetic, and able to support Laverne financially. The case worker might have helped her meet her responsibility for Laverne's emotional health more adequately. Play interviews with Laverne might have helped her mature and give up oral satisfactions which she clung to because of her need for a good mother. This maturity could have been accomplished through building her ego, helping her to express inhibited wishes and impulses, and thus enabling • her to function eventually as a social being. If Mrs. W. were being helped to grow at the same time, she would eventually assume her f u l l maternal role, and the case workers'job would be complete. This case illustrates some of the d i f f i c u l t i e s encountered in making a good refe r r a l . The client's immediate need when he f i r s t asks" for 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 referral possible. There must be some understanding, on the part of the person referring, of how the unconscious functions. In this situation the mother expressed the need which i t was socially accept-able for her to express, but not her own real need. Until this got recog-nition, 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 for her child. Help was offered her as a mature mother who puts the happiness of her child before her own. She was not functioning on this level and so could not use the help offered. Laverne's cousin, Betty V., was another child whom the nursery school staff 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 this 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 social 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 befriend one other child at school. However, when she lost this friend Betty did not make other friends. She began to turn her interest to things which took her away from people, as Laverne did. She seemed to f e e l that l i f e held l.i t t l e but disappointment for her. Betty V. seldom joined in the play with the other children. She became friendly with one child, but this child l e f t the school at Christmas .time, and Betty did not make other friends. Betty would play with the other children i n the d o l l corner .' occasionally. During the free play period she preferred to look at. a book, or work a puzzle. Sometimes Betty's face would light up and she would relate some incident from home which usually concerned her cousin Laverne. One time she came to school beaming. She said that she was to have had her tonsils out, but her grandmother "prayed to God that they would go down, and they really did." Betty gave the teacher the impression that something she had hoped for had at last come true. Such children as Betty V. and Laverne are easily drawn into play interviews because they f e e l a need for 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 Illegitimacy. Jimmy B., four years of age, had problems which had inhibited his emotional and his intellectual development. He seemed to have the i n t e l l i - • gerce of a child of two, and did not have the social interest which i s -25-normal for his age. He also showed symptoms of withdrawal and of emotional repression. He apparently had not found l i f e to be a rewarding experience for his affectional needs had been seriously neglected. He had had l i t t l e incentive to make the effort necessary to achieve social satisfactions, and found satisfaction in objects rather than in people. Jimmy did not seem to f i t i n with his age group, and so he was encouraged to play with children who were one or two years younger. He did not talk well and would attract 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 for long periods by himself. He showed an abnormal attachment for 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 find his sweater. He would play with a particular toy for weeks on end, and no other, and would refuse to give i t up. Jimmy's problem was bound up-with illegitimacy, and the desire of an inadequate mother to make a home for him. Miss B., having also suffered emotional deprivation, was unable to form normal affectional t i e s . Because she was a passive person, she repressed her need for affection and her feelings of resentment toward the mother who had deprived her. She found the opportunity to express these feelings and to satisfy them in her rel a -tionship with Jimmy's father. While hitting out at her mother in becoming illegitimately pregnant, she found others who would provide her with affection, f i r s t Jimmy's father, and then Jimmy. Miss B. was a placid person, and gave the impression in the interview that she was used to doing what she was told. She was the youngest of eight children. She said that there had been l i t t l e love in her family. She had never had rapport with her mother, who was very s t r i c t . Miss B. met the father of her child at a public dance h a l l , and went out with him for about six months. During this time she had intercourse with him regularly, and expected to marry him. When she discovered that she was pregnant he told her that he was already married, and had children, and she did not see him \ -26-again. Following Jimmy's birth, Miss B...could not give him up. She was unable to work steadily.because she was often i l l , and had several opera-tions of a gynaecological nature. She applied for social assistance. Miss B. had two main emotional problems, which unfortunately came into conflict with each other. She had a strong need for affection, and at the same time a need to be;dependent. -In being i l l she satisfied her desire to be dependent. 'However, illness threatened her a b i l i t y to keep Jimmy, her source of affection. Her ill n e s s also threatened her means of relating to men, the only other means she knew of satisfying her affec-tional needs. She was anxious as a result, and also guilty, because i l l -ness represented punishment for immoral behaviour, which her mother's attitude would have led her to expect. Jimmy was more outgoing at home where his mother played with him a great deal. He liked to dance and to sing. While i n the hospital, Miss B. worried a great deal about 3ELmmy. She also worried about losing her sexual desire.. She often had dreams about having intercourse with men. • Miss B. had a poor moral sense and lacked a normal feeling of self-worth. She had a need for companionship but did not know how to find i t . She lacked the ego strength necessary to assert herself so-c i a l l y , or in . employment. She was unable to meet her problems i n a re-a l i s t i c way as a result, and her method of dealing with them was to re-treat into i l l n e s s . Jimmy's mot lie r dressed poorly and unbecomingly, and was awkward in her movements. She said that she did not go out with men because she was afraid of becoming pregnant again. She went to shows and dance . halls 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 suc-cess i n employment, going from one job to.another, and had no training except for waitress work. Miss B.. had been in the Army, and had been discharged because of a stomach condition. After that she only worked sporadically because of her health. She was restless i n her sleep and woke up t i r e d i n the morning. She said that she "just pushed her feelings about her problems dovm inside her." The family setting was an abnormal one. A l l the women i n the home had had an unhappy experience with men, and i t i s logical to suppose that they were hostile toward men. This, in addition to the fact that there were no men i n the home, indicated problems for Jimmy later on. The maternal grandmother identified Jimmy with herself and this made i t d i f f i c u l t for her to deny him anything. Jimmy sensed that her love for him was not healthy, and so he revolted against her. Then she identi-f i e d him.with his mother and rejected him. Jimmy lived with his mother in the home of his maternal grand-mother. A maternal aunt who was divorced from her husband also lived i n the home. Jimmy's grandmother had also been an illegitimate child, and was now separated from her husband. Although she had had many negative feelings about Jimmy prior to his bi r t h , she had come to love him after-ward and could deny him nothing. He was very disobedient with her. She found him most unmanageable when his mother was away, and said that he was "getting wild like 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 actually shop-ping around for a satisfying emotional experience for herself. After 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 in contact. She' then became i l l again and had to be hospi-talized.* 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 de-velop, 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 in 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 satisfactory social 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 social -28-work resources. She to demonstrate the kind of cooperation that could be mobilized i n the community in order to help the client. Yflaat might have been accomplished in the way of direct help for the client f a i l e d because of lack of time to prepare Miss B. for referral'adequately, and because the resources which were available i n the community were i n -adequate to cope with her problem. The role of the House case worker for Miss B. and Jimmy, was to complete a referral to the community resource which seemed most l i k e l y to serve their continuing need, when i t became clear that this 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 in the House. The City Social Service Department had referred Jimmy to the Nursery School originally i n an attempt to help him with his problems through•changing his environment, as they recognized their own inade-quacy to help him by means of case work treatment. They also recog-nized that other resources in the community were limited. When Jimmy was referred to the case workers, the City Social Service Department made their record available' for reading, and agreed to encourage Miss B. to use the case work help which the House could offer. Both Jimmy and his mother were to have case work services for the purpose of d i -agnosis of the problem and ref e r r a l . Following interviews with Jimmy in the play room, and office 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. After resources had been explored by the House worker, a second conference was held, and i t was decided that the Child Guidance Clin i c could best serve the need. The House worker made this r e f e r r a l . The Clin i c did not think that Jimmy was s u f f i -ciently disturbed to be eligible for their services, and therefore they could not offer services to the mother. Work with Jimmy B's problem, which was a direct result of his mother's problem, illustrated the value of a family setting, which pro-vided not only services but satisfactions for the mother and her child. This situation was most favorable to working with the family as a unit. \ -29-Tliis case i s suggestive of the p o s s i b i l i t i e s there are in a neighbourhood house setting for helping an unmarried mother who lias tried unsuccessfully to give her child a secure home. The trained workers, both group work and case work, can give ego support, help her to develop meaningful relationships with people, satisfy her dependency needs u n t i l she is able to function independently, and also provide a sense of being loved. In the group particularly, she can find friends who 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 satisfaction for her dependency and affectional 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 child less because i t is being shared by the case Y/orker, the good mother. As the mother gains emotional strength, a situation i s created which would be most conducive to achieving, with her cooperation, a satisfactory plan for the ch i l d . j These Experiences Had Significance. The pre-school children who were referred for case work thus ; presented problems which involved rejection, sibling r i v a l r y , emotional repression, withdrawal symptoms, and behaviour problems. These appeared to stem from parental problems of divorce, separation, and illegitimacy. It was interesting that,in a l l three families represented the problems of the child could-be traced quite easily to the problems of the grandparents as well as of the parents. This suggested perpetuation of'problems item generation to generation, and the need for objective help from a source outside the family i f the trend is to be corrected. • The children a l l showed strengths which promised comparatively simple correction of prob-i lems at this early stage of development, dependent on successful work with the parent, or placement. -30-The families of Laverne W. and Betty V. showed strengths which indicated that their problems could have been dealt with by the services provided in the Ibuse. Jimmy B.'s problems, including those of his mother, were more severe, and called for psychiatric help which could only be offered by a specialized agency. His needs could not be met in the House. However, i t did seem that the House could provide a specialized service to some unmarried mothers. In work with the pre-school child i t would appear that his emotion-a l functioning i s closely a l l i e d to that of the mother, and that a disturbed child inevitably means a disturbed mother. For this reason, i t appears that the emphasis in a plan of treatment is more l i k e l y to be on the mother than on the child, and on helping her to perform more adequately as a mother. In conjunction with work with the mother, the worker can serve the child's needs in the House, by offering him a substitute mother relationship in the play room, where he can also release his feelings through play; or by interpret-ing his emotional needs to the nursery school teacher who can help him i n the same areas, through her day-to-day oontact with him in placement in the school. If foster-home placement seems indicated, the worker can assist• the child and the mother to accept this through her relationship with them, and through interpretation to the mother, and she can assist the placement ^ agency by furnishing a study of the child. The value of the nursery school as a means of finding cases should not be overlooked by a case worker in the House. The worker might develop this resource by offering diagnostic services,' and also by helping the nursery school staff to develop a link and familiarity 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 staff -31-lacks the background to perform the referral function on the case work level; however, i t does seem that the case worker i n the House should share with the School the responsibility of referring members. In work with the Nursery School, problems of relating the two serv-ices limited the case worker's act 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 staff, with regard to the treatment needs of disturbed children. It was also necessary to inter-pret the treatment function of case work. The Nursery School staff did not seem to have an understanding of the parent of the child i n the School, nor did they pay much attention to unconscious motivation. This, with their lack.of knowledge about case work, made i t d i f f i c u l t for them to carry out a referral to the case work serv-ice in the House effectively, s o that clients were found to be emotionally unprepared for case work, and unaware of the nature of the help that was being offered them, or of how i t could be useful to them. This was a prob-lem which i t was not possible to work out during the period of the project. ' Chapter III.  THE CHILD FROM SIX TO TWELVE.. The child who i s i n the latency phase of emotional development, which occurs between six and ten, i s normally alert, controlled and dis-dainful of the opposite sex. He i s looking beyond the home for new out-lets and satisfactions, and finds these in the company of his peers; i n " gangs, clubs and secret societies. Theories to explain the phenomena of l i f e are expounded, and energy is expended i n games, horseplay, and mate-believe adventure. The'kinds of pursuits which are followed by the l i t t l e 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 ch i l d who i s i n latency is trusting and friendly with an adult of his own sex,; He welcomes an opportunity to participate i n a group which i s led by such an adult. Because he i s concerned with the de-velopment of his ego, an adult leader represents for him an ego-ideal and provides him with the sexual identification needed at this time for emo-tional growth. The group provides the protective strength of the family, but relationships are less personal, and hence less demanding. At this age the child responds best to religious training, sexual drives are re-pressed, and the superego is i n control. The influence of adults i s as a result, important at this time i n character formation. In the eleventh and twelfth year, the child goes into a phase of development which is known as prepuberty. This is particularly true of the l i t t l e g i r l whose body begins to change in preparation for mother-hood. The child i n prepuberty begins to give up repression of sexu-a l i t y . He i s more interested in himself as a sexual being, and also i n the opposite sex. 3 3 -The child i n latency and i n pre-puberty who is emotionally disturbed i s struggling with problems which have arisen in earlier phases of development, and much of his behaviour i s typical of these earlier phases. The seriousness of the child's disturbance i s related to how far'back the original problem occurred. The child who has had sufficient affection that he has been able to develop social interest, i s the child who is l i k e l y to be helped i n the group. The child who has been damaged by lack of affection during the oral and anal phases, and who as a result has developed very l i t t l e social interest, w i l l gain l i t t l e from the group. Children' at this age express their dist-urbance quite freely, and symptoms vary from over-aggressive acting out to extreme repression and conversion symptoms. Many of the children in this age group who attended the House appeared to have had an unstable family background and resultant depriv-ation of emotional needs. Many could not"find a place i n the groups, but spent their time i n the halls, sometimes, participating in interest groups, and at other times attaching themselves to an adult who happened to be free. These children would continue to attend the House despite lack of. friends. Those who did participate in groups often exhibited abnormal and uncontrolled behaviour.. The House seemed to offer these children a protective setting. There was less emphasis on achievement than in ordinary groups such as Cubs, Brownies, and church groups, and greater consideration was given to the child's emotional vulnerability. The group worker's' aim i s to provide an approximation of healthy family l i f e to the Child who has not experienced this at home, and this includes a parental type of affection from the group worker, which i s expressed i n ways which are, appropriate to the particular child's needs. -3U- ' ' The group worker recognizes the needs of a child 'in a particular phase of emotional development, such as the need for masculine identification i n the boy in latency, and makes available clubs and act i v i t i e s which w i l l help the child to satisfy these. The child i s assisted to find and preserve the friendship a f f i l i a t i o n s which he most desires, and in latency this generally means those with his own sex. During this project, the group worker in the House was puzzled about how he could help the "fringe" child in latency, because of his i n a b i l i t y to give the child the individual attention which he so definite-l y asked for and needed. The case'worker i n the House could obviously be helpful i n meeting this problem. Case Work With The Child In Latency. In the following case studies of six children in this age group, which were compiled by the case workers during work with them in the project, are more specific descriptions of the disturbed child i n latency and i n pre-puberty. It i s interesting that in 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" child i n the House would have been considered abnormal i n other community-group a c t i v i t i e s . In other words, i t was thought that a large percentage of the less normal cliildren of the community congregated'at the House. As a result, many of the children who were referred to the case workers appeared to be very disturbed indeed. Some Could Participate In Group Activity. Larry P. was one of the least disturbed of the latency children referred. He belonged to a gang, participated i n sports, and showed'some a b i l i t y to relate i n a positive way to other people. His negative attitude toward the House however, reflected a negative attitude to-ward society and toward authority. Larry was a member of a loosely knit gang which the group workers were attempting to interest 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 well accepted by his gang, and took an attitude of submission when with them. His embarrassment at being friendly with the case worker suggest-ed that Larry had negative feelings about father people... Evidently how-ever, he also had a need for the attentions of such a person, and had 1 been deprived in this area. As a result he was in conflict, the gang representing the opposing means of satisfying this need for a child of his age. There seemed to be some guilt on Larry's part about his relation-ship with the worker. In Larry's great need for prestige i n his gang, and i n his excessive rivalry, one could see the effect of Ms position 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 for him. Larry responded readily. He seemed to 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 . replied with a hostile, "never mind". In the play room he asked i f he could bring Ms friends there. The worker explained why he could not. . He played one game of checkers in an uninterested way and then wanted to return to Ms friends. The next week he came to the play room with encouragement from the worker. Fie appeared disheartened but did not say why. The worker later 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 in the House again for about six weeks. Larry, Ms emotional needs unmet,^ was looking for the satisfac-tions he had not found i n Ms home, i n the neighbourhood house. He was also reliving i n the House the relationsMps he had experienced i n Ms -36-home, and transferring to the House, attitudes engendered at home about people and society i n general. Larry had some strengths because his mother had strengths, and she had made him f e e l that she cared about him. He was guilty about his relationship with the worker because his mother had not presented his own father in a favourable light, 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 for men. Larry was insecure in his gang because distrust 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 lived with the family. The family vras not well regarded in the community, although the case worker thought that the mother showed affectional strength with her children. The children were having a d i f f i c u l t time at school, where they were inevitably blamed for anything that went wrong, i f they happened to be near at hand. The mother's attitude was that certain 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 fight i f they were to make their way i n an unjust world. Mrs. P. was antagonistic toward her husband. The family received social as-sistance and the assistance worker had found Mrs. P. to be quite de-fensive in her attitude. When the case worker f i r s t met him, Larry had needed support from his gang i n order to accept the case worker. The group worker might have provided this i f he had known Larry better, and had been sure of his relationship with him. Because of his own lack of confi-dence, the worker at f i r s t thought that i t was necessary for him to manufacture reasons for Larry to come to the play room. This was not necessary, and did not build Larry's confidence i n the worker, but rather aroused his resistance. When Larry got the support he needed from his mother, and when the case worker was more r e a l i s t i c in his ap-proach, Larry vras willing 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 later, Larry approached the worker in the House and began to talk to him. He agreed to go to the play room to talk when the worker suggested i t . Jimmy, a friend of Larry's followed them to the playroom. The worker allowed Jimmy to stay, explaining that this was Larry's hour, and he would not be able to do so next time. -• From this time on, Larry came to the play room regularly, and showed a very positive attitude toward the worker. He became very aggressive and dominating in his play. He showed sibling r i v a l r y i n relation to a friend who was also seeing the worker. The worker attempted to give Larry friendship on an individual basis, which served to give Larry self 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 for him. Larry showed progress during the few months contact he had with the worker. The case worker was helping a child in this situation who was able to function i n the group, but was not using the group to advantage. He was not sufficiently disturbed emotionally that he would have been ordinarily referred to the Child Guidance C l i n i c . He was one of-the many who attend neighbourhood houses because of personality disturbance, but inhabit a "nc—man's-land" where they are reached by neither group worker or case worker, fie was the kind of child the case worker i n the House would work with in order to help him use group work, with no need for other r e f e r r a l . The interdependence of group work and case work i s evident in the work with Larry. The case worker cannot reach the child 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 in getting individual help for the child. It was conceivable i n working with Larry that the participation 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 well accepted member of his group. He became active i n group projects, and in a project for the House, a country f a i r , he sold irwice as many tickets as he had been asked to do. He worked energetically 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 for the worker to leave the House, Larry showed Ms maturity by accepting this i n a very manly way, saying that he hoped the worker would have a good holiday. The House worker was able to 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 children i n the House. Mary K., an eight-year-old, was searching for something i n the HoLise which she lacked at home. Her behaviour in the group was indicative of feelings of anxiety and tension. She was fearful 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 f e l t a need to control because this was insurance against hurt. She searched for the good mother, yet because of past experiences she feared close relation-ships. Her behaviour in the group suggested that she had experienced unhappiness and rejection at the hands of her parents. Mary K. was a regular attendant of the Junior program, and was cooperative and creative in her group. She was an active child. 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 least status. She was demanding of adult attention, ad seemed to have learned at an early age how to manipulate adults. She daydreamed frequently,and was oblivious at times to the presence of others. She had no close friends, and appeared to be lonely. - 3 9 -Mary had been separated from her parents at an age when she could not understand i t , and when the effect would have been quite traumatic. It was interesting that i n the interviews she expressed a preoccupation •with herself at that age. In play, Mary expressed he'r feeling that her parents had rejected her, and her resentment of babies indicated hurt i n relation to her sib-lings. X Mary related positively to the worker at f i r s t , and there was evidence of a transference i n the way in which she attempted to put the worker i n a mother role. It was inevitable, i n view of the negative f e e l -ings which Mary had about her mother, that she would react negatively to-ward the worker as the contact became closer. Mary often referred to the days when she had been two years of age. She often asked the worker to buy things for her, take her to the aquarium, as she said 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 to the play room with her, the worker asked Mary to suggest what she would model in clay. Mary said "a good l i t t l e g i r l . " When the worker asked how old the l i t t l e g i r l was, Patsy spoke up and said 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 old enough to do this, and Mary said 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 dislike of babies, particularly boy babies. Mary's home l i f e was unsettled because her presence reminded Mr. and Mrs. K. of their own inadequacy i n bringing up their son. It was as though their son was punishing them because he f e l t that they had been responsible for his ovm unhappy experience in his marriage with Mary's mother, of which Mary was a symbol. Because of their feelings of i n -adequacy, and their feeling that i t was unjust for them to be i n this situation, Mr. and Mrs. K. sought the help of others i n bearing the re-sponsibility of Mary. At the same time this implied rejection of Mary. Before Mary could have a satisfying home l i f e , i t was necessary that her grandparents recognize their tendency to reject her, as well as the reason for this, and that they determine how they actually f e l t about Mary as an individual. They were i n need of support and counsel-ling in relation to their methods of handling Mary's problems. Mary's parents had divorced when Mary was two, and Mary had since lived with her paternal grandparents. They were in their middle f i f t i e s , and appeared well and vigorous. Mary was referred to the case worker because her grandparents, Mr. and Mrs. K., had requested help from the House in understanding her. They thought that because of their age they could not meet her needs adequately, and hence vrere having trouble in managing her. Mrs. K. said that Mary's mother had not been heard from for 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" at-mosphere there. She worried about Mary's health, which the doctor said was excellent. Mary's activity 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 situation i n her home, was one of over-anxiety to please, both at home and i n the House. In the play room she often seemed self-punishing, which was a reflection of her lack of a feeling of self-worth. Her feelings about, her grandparents became clear, and her insecurity seemed to be related mainly to her grandmother. Mary was very conscious of the pattern of achievement which she had set for „ her, and because of the necessity of repressing her feelings, had de-veloped a fear of her own aggression. In the play room she was free enough to verbalize her fear that her grandmother would send her away. In the play room Mary liked the games best which she usually l o s t , she had no interest i n the dart game. She said that she was afraid that her grandmother would send her away somewhere else to l i v e . She expres-sed fondness for 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 this way,'.and said-that she would not k i l l her friend. During the case worker's contact with this family there was a strengthening of relationships in the home. The grandparents c l a r i -f i e d their real feelings about Mary, which were actually very posi-tive, and gained a better idea of t heir own a b i l i t i e s i n caring for her. Mary's social a b i l i t i e s improved. As her family was better able to serve i t s traditional function, Mary had less need for the neigh-bourhood house, and found a friend with"whom she could enjoy much i n common. Mrs. K. told the worker that she feared that she had rejected Mary. • She came to the conclusion that having Mary i n her home actual-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 did have a great deal to give her, that Mary-was genuinely fond of them both, and that they now thought of her as their own child. 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 this friendship. She stopped Mary from attending the House. The worker did not discourage t h i s . The worker made no attempt to deal with the feelings of the grandparents toward Mary's parents. Her role with them was mainly i n -terpretive and supportive. She did try to relieve the pressure on Mary of her grandparents ambitions for her. The main focus of the worker's ac t i v i t i e s was to gain an understanding of Mary, in 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 staff i n the House i n building personality; the d i f -ferent methods used, the s k i l l s employed, both i n the group and on an individual basis. At the same time, the worker t r i e d to give them an idea of what is normal i n a child of Mary's age, in this generation. When Mary stopped coming to the play room, the worker supported Mrs. K. i n her plan for 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 did not give Mary's need of the mother sufficient recognition to enable-Mary to accept the individual relationship which was offered her by the worker, and which was necessary to achieve a positive relationship with her.-.' Exclusion of the other child, Patsy, at the begin-ning, would have helped to gain t h i s . Precedent in 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 this. The worker's indecision added to Mary's conflict between her desire to f i n d the solu-tion of her problem in 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 insisted 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 play-room," Patsy insisted on coming. The third time the worker .attempted to interpret why Patsy could not come with Mary. Patsy reacted angrily, and Mary became very antagonistic toward Patsy. Mary did not come to the play room again, although she was s t i l l friendly with the worker when she met her i n the House. In work with Mary the case worker demonstrated some of the tech-niques which are used i n play interviewing, and also the type of response -..which can be. expected from the child. Some of the d i f f i c u l t i e s of working with a. child of this age on an individual basis show up. The fact that group activities took place i n the House at the same time as the play session drew the child away from the play room. The mature child tends to prefer the group in this setting, but the emotionally immature child needs both the individual and the group relationship. In view of the advantages which the setting also presents for case work with the latency child, i t would seem that the answer is the development of s k i l l on the part of the worker in building a relationship 'with the child. Mary i s an example of the kind of child who might be referred to the case worker in this setting as a result of a direct request from the parent. The problem is not of a c r i t i c a l nature. Because of the nature of the relationship of members to the neighbourhood house, a friendly, neighbourly one, the parent is able to share family problems with the House workers almost as naturally as in his own family. This case also demonstrates how the c h i l d functioning in the House i s the child func-tioning i n the family, and how the group and case work settings parallel the social and the individual performance of the child i n the home. It also shows the use of the setting as one where a most comprehensive plan of treatment can be devised. Bobby R., aged ten years, presented a picture of a very upset child with no apparent a b i l i t y to relate positively to people, and having a great deal of h o s t i l i t y for them. His 'behaviour suggested that he was operating very much on the level of the child i n the anal phase of de-velopment who has not yet achieved social interest, or an a b i l i t y to direct his energies constructively. Bobby's reaction to the worker, a father figure, suggested hos-t i l i t y toward his own father. 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. Attaining the worker's atten-tion was an achievement. Bobby Yiras referred for case work services because i t seemed im-possible for him to get along In the group. He was described as extreme-l y aggressive, and unpredictable i n his actions. In the play room '. 9. Continued observation of this child i n the play room revealed a pathological sexual adjustment. Punishment.-had been eroticized, and Mary had made a masculine rather than a feminine identification. The psychi-a t r i s t recommended psychiatric 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 furniture, and then he wanted the worker to stand against the wall so he could throw the darts around him. When the worker-said that he could not allow him to do this, 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 to concentrate. Following the inter-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 tried to make Bobby take the place of the husband she had lost'. Her daughter Marie became a projection of the self which she needed to re-ject i n order to retain her husband's (Bobby's) favour. Planning f o r the family centered around herself rather than around the children be-cause Mrs. R. had not been able to find expression for her own normal . narcissism in her children. A further source of conflict for Bobby i n the home was the sibling 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 for her own neurotic needs was the sleeping arrangement which seemed to have deeper meaning than-simple rejection of Marie. Bobby lived with his mother, who was divorced from his father, and his sister Marie. The apartment was small but elaborately fur-nished. The children shared a bedroom. It was quite evident that Bobby, the eldest, was his mother's favourite, and she made l i t t l e ef-fo 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 talk of the children and their problems, and attempted to keep-the c a l l on a social level. 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 foster home at that time. She f e l t that Bobby had suffered a great deal from not having a man in the home. It appeared that neither child had received much from the mother to assist in emotional growth. Marie was so rejected and lacked so much in affection from the mother that the f i r s t thing she hoped for i n some-one new was satisfaction of this need. The mother had not met the affec-tional needs, of either child and hence there had been behaviour problems -16-'such as stealing. Because there was. no incentive for the children to con-form, the mother found them d i f f i c u l t to control. There had been episodes of stealing on the part"of both c h i l -dren. They came in from school during the worker's v i s i t . Both were very friendly toward the'"worker, but Marie who had never seen him be-fore, was soon holding his hands and putting'her arms around him. The mother was embarrassed at this and threatened to spank Marie and send her to her room. The mother showed l i t t l e a b i l i t y to 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 phallic level, indicated his need for further help to support the growth process. As there was not time for the worker to give him this , referral to a specialized agency was indicated. A good relationship was developing between Bobby and the work-er which would have been very helpful i n referral. The worker was. also able to help the mother by giving her support. During the course of interviews Bobby continued to exhibit the uncontrolled behaviour of the f i r s t interview. He told the worker of di f f i c u l t i e s lie had with other cliildren and of one instance where he had'been in the wrong.-'' Bobby began to share his play with the worker • and to 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 for the children to stay with relatives while she was i n the hospital, and shared this with the childreh. The work-er f e l t that Bobby would need continued support. As he had started to work with Bobby late in the project, he was not able to give him the at-tention he needed. 10. The approach of the case worker to Bobby and his problem was suc-cessful. A direct approach was- used, with an explanation to the child of the worker's-purpose, which included use of the permissive technique i n the play room to encourage ego and super-ego development, and the recog-nition of the child's negative feelings accompanied by encouragement to 10. This child was later discussed with the psychiatric consultant who suggested placement of both children, as i t was evident that the mother re-jected them. Bobby was being forced to conform to a feminine pattern of be-haviour, and both children seemed afraid of, and hostile to the mother. express them. Bobby had too l i t t l e self-confidence to enter into the re 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 explain-ed that he helped fellows when they were having trouble at school, in the group,- or at home. He said that he thought that Bobby was having trouble, because he seemed to find i t hard to play with the other guys. He said that they v/ere going to a room where they could play and talk. Limitations set up for Bobby in the play room were the rules of the game, and the stipulation that Bobby and the worker must not hurt each other. Bobby did not keep his next ap-pointment 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 to v i s i t regularly. For Bobby, i t sufficed that the worker had sought his friend-ship and interpreted his own role prior to the v i s i t to the mother. Bobby knew the worker as his a l l y , and i t was not necessary for the worker to ask i f he might v i s i t . The latency child i s more accepting of the dominant role of the adult, than, as w i l l be seen, is the ado-lescent. The worker was at the same time gaining Bobby's confidence by recognizing and accepting his need for 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 to be referred to the case worker was a seven-year-old who had severe and complicated problems. Jane J. exhibited symptoms of deep personality disorder. At times she clung to adults emotionally, and i t seemed that she hoped to experience through them the mother-love that she had missed. In her shyness she showed her distrust, and her h o s t i l i t y f o r people, which she sometimes expressed i n hostile aggressiveness. Consequently she was unable to gain the friendship of other children, 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 result was muscularly tense and unable to move freely. She often indulged i n phantasy because i t enabled her to escape the pain of r eality. 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 inside. It was natural that' Jane was disturbed because she had experienced very upsetting sexual trauma; had been physically hurt and rejected by her father. Her mother had given her l i t t l e i n the nature of healthy emotional satisfactions; l i f e in general had presented her with l i t t l e to be happy about. Jane J. was shy and reticent, 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 friends of her own age. She followed one of the group workers around, but was angry in 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 interest i n men, and her mother said that her father had molested.her. Mrs. J. was suspected of prostitution, and Jane had had sex ex-perience 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 regularly for two years.. Jane1 s mother was a very dependant woman who seemed unable to liv e i n accordance with l i f e ' s r e a l i t i e s . Her need for social work-ers was evidence of a continued need for a mother; her choice of older men was evidence of emotional deprivation in relation to her father. When she seemed to understand the worker's explanation of Jane's needs, i t is l i k e l y that she was submitting as the good child does to the mother.. She was unable to help Jane because she herself had been -U8-emotionally 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 for three years, and had received social assistance continually since the divorce. She was known to a number of social workers to whom she load talked freely about herself, but had shown no a b i l i t y to use their help. She would accept a social worker's explanation of Jane's problems, and would agree to do her part i n helping Jane, but would not keep her promise. Jane had a number of physical ailments, but Mrs. J . would not keep appointments which were made for her at the hospital c l i n i c . The plans that she suggested for herself were unrealistic, and seemed to be her phantasy of what she would like to be and do. She talked a great deal about her boyfriends whom she said were men in professional positions, who had promised to help her. Mrs. J. showed no capacity for insight into her own or Jane's problems. The worker's role was that of a liai s o n between the House and'the case work agencies that were concerned about Jane and Mrs. J.,'although this had not been intended at the time that the refer-ral-Was made. It i s not the function of a neighbourhood house case worker to act as a link between the group workers, and case workers, outside the House, .since the, professionally trained group workers can .work together with case workers outside their agency on ordinary referrals. The unexpected move of the family to another neighbour- x hood brought about the change i n plan. It was logical for the case worker who had already contacted the other-agencies, and become ac-quainted with the case material, to continue with ihe referral. If Jane had continued to attend the House, the worker could have worked , with her cooperatively with the treatment agency, to help her to use group work, or helped her give up ihe House for more suitable re-sources,, -k9-The kind of cooperation which was achieved between the group work and the case work agencies was excellent, and demonstrates the role of a case worker in the House in bringing this about. The case worker did, at the time of the project, constitute a link between group work and case work. Jane J. had been known at the Child Guidance C l i n i c for about a year. The Clinic 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 joint plan of treatment might be worked out. They had previously planned to close their case. The House case worker gather-ed a good deal of information about Jane and her mother, from the Nursery School, the City Social Service Department, and the Child 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. Diana was very dependent on adults, fearful of her own aggression, and so fearful 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 inhibited in her play. While her sister Donna and a friend used the paper and crayons in the play room, Diana sat quietly 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 picture. The children decided to skip rope for awhile. Diana was unable to coordinate her jumping with the turning of the rope. When she f i n a l l y tried'to throw darts with encouragement from the case worker, she threw with her right hand, clutching the worker's skirt with her l e f t . Donna was anxious to enter a group but Diana would not. She said she f e l l down too easily when she played, and could not run. Donna was talkative and aggressive to the point of boldness. Interviews with Diana's mother suggested that she had rejected Diana, and that Diana had suffered trauma, identifiable with rejection, at an early age. The early birth of her sister again might have rep-resented rejection to Diana. Life was from the beginning threatening, - 5 0 -painful, and lacking i n real satisfactions. 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 at this time for Mrs. M. to travel some distance to a hospital. 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 street. For several months afterwards Diana would not talk, 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 after that. Because Diana did not have a close, satisfying relationship with her mother to reassure her, and help her develop i n spite of her problems, disturbing experiences which she had in later years added to her disturbance. It seemed that she had negative feelings about herself which perhaps precipitated, and indeed were intensified by, the accidents she had. The error of her teacher probably added to her feeling of confusion. When. Diana was four, she f e l l downstairs and gashed the back of her head severely. Her leg appeared to be paralyzed for a time, and she had to learn to walk a l l over again. When she was six, she f e l l and gashed her right wrist on some glass'. Some of the ligaments were partly severed, and i t was over a year before she could use her right hand -again. Diana was naturally l e f t handed,, but a teacher insisted that she use her right hand, and Yriien her mother discovered i t , she vrould not go back to using her left' hand again. Mrs. M.'s rejection of Donna was more obvious. She was less aware of Donna's emotional needs because they were less identifiable with non-threatening environmental factors, and hence more threatening to Mrs. M.'s ego. Mrs. M. ju s t i f i e d her rejection of Donna by presenting her as a child with few problems, who affected Diana adversely. Actually she was identifying with Diana, the "good" child, in whom she saw her own good self, and a means of realizing her own frustrated ambitions. To Donna, separation from Diana meant exile from the scope of the mother's approval, or rejection by the mother. -51-Mrs. M. said that Donna had been a healthy, happy baby. She was not breast fed, but had been given her bottle in her crib. Mrs. M. described her children as opposite in temperament. Donna was ag-gressive and, Mrs. M. thought, would be able to make her way anywhere. She recognized that competition with Donna made Diana withdraw, and fe e l insecure-. She tried to separate the children whenever possible, but this was d i f f i c u l t as Donna always insisted on sharing Diana's a c t i v i t i e s . Diana liked to help her mother in the house, .and Mrs. M. gave her time .for herself, but seldom did this for Donna. Donna had started school at five years and was always f i r s t i n her class. Diana .was in the same class, but with a lower group. Diana had refused to continue with her music lessons because she could not do as well as * Donna. Mrs. M. believed that both children needed to learn to mix with other children, but.'she restricted their play with cliildren in the neighbourhood of whom she did not approve. Mrs. M. found sex distasteful and as a young g i r l had attempted to deny i t s existence. She had an inte l l e c t u a l understanding of her children's need for sex education, but she rejected them at the same time for having this need. Mrs. M. had been brought up on a farm in a large family. She said that she had received practically no sex education as a child and at sixteen knew practically nothing about i t . She seldom saw her brothers or her sisters 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 for information freely and she had given i t to them as they asked.-Mrs. M. showed some guilt about her rejection of her children, particularly Diana i n whom she could admit no wrong. Diana sensed this and courted her mother's favour by being the "good" g i r l whom Mrs..M. admired. She attempted to dominate Donna by playing her mother against her. Donna acted out a l l the badness v/hich Diana could not admit in herself. The two gir l s were inseparable because they re-lated to each other as though they were component parts of one person-a l i t y . - 5 2 -It was observed i n the Jfiuse that Diana often tattled on Donna, and she said in play sessions that she did.this at home. Her mother, denied this when she was asked about i t . sessions with Diana, the case worker had d i f f i c u l t y in keeping Donna out of the play room. A group worker found her to be the group,-.and determined to make the worker aware of her- superiority to the other children. She showed a strong need to win, and would cheat to achieve thi s . Mrs. M. had found few satisfactions i n marriage, and would have preferred to remain virgin, and to have led the "good" l i f e . She iden-t i f i e d . Diana as a projection of her own good self, even to the point of encouraging her to sleep with her father against her w i l l . Diana was the v i r ginal seductive mother, whom the father dared not harm. Further, Mrs. M. encouraged Diana to attend a church which was strict'and 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 in the-doll 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 guilty when this was discussed with her. She said.that she had had a nervous breakdown six 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. did not participate in inter-views with the worker. Mrs M. expressed concern that Diana had become attached to 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 win-ning, her conflict with her sister as based on the difference in their personalities. She was able to show her creativity. In play she expressed conflicts and fears, which she could not, at f i r s t , verbalize. As she became less tense through play, she was not only able to verbalize, but to show aggression. Although Diana did not appear to be anxious about sex, i t seemed from her drawings of people that her adjustment was based on repression of her interest in sexual functioning, or her desire to - 5 3 -eventually experience i t i s marriage. By acceding to her mother's unconscious wishes for her, and looking forward to being the v i r g i n bride, there was no need for her to achieve preparedness for sexual; relations i n marriage.. By becoming the ungiving, dominating woman^  < she had no need to fear masculine aggression.: •By assuring herself of the superiority 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 in modelling or in games. She said that Donna always• won when they played. Diana 'showed no anxiety in speaking of sexual difference. In playing with the puppets, she gave the boy puppet the role of a "bad" boy, and said that a l l boys are bad. She said that she was never going to marry. When asked to draw a woman and a man she drew a bride figure with a very stern face, withdrawn, hands, a completely clothed body with no contours showing. The man was smaller than the bride and cut off 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 this, 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 effectively helped. She' knew that her marriage was unhappy, but could not talk about the role which she herself had played in this. She could not talk about the role which she had played, in the-development of her children's problems. She was in conflict because on the other hand she was very eager for them-to have help. The most that she could do at this point was to agree that regular interviews with the children be scheduled. The worker attempted to interest Mrs. M. in going to the family agency for help with her own problems. Mrs. M. did not keep the appoint-ments which were made for the purpose of planning this. It 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 results -which can be achieved with a child through play interviewing, which in this case was used for case work treatment of a child. The worker's success was based on re- • lationship, and the use of symbolic materials i n play to help the child get repressed feeling out, and to build her ego. Work with the child assisted work with the mother, who saw almost immediate improvement i n the home. Promising progress occurred with the mother, who through a longer contact might have been appreciably helped. Diana became more relaxed during interviews, and became free enough to play easily with the children at the House. She gained better 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 said 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 in awareness of Donna's need for affection, and could accept the fact that she was emotionally disturbed also. She was pleased with the progress that Diana made. She sent the children to a different Sunday ' school. She gained understanding of her own role i n the children's problems. The worker proceeded from a supportive role with Mrs. M. to an interpretive one, and was able to help her with her feelings of g u i l t . The role of a neighbourhood house in the f i e l d of social work in finding cases, and how a case worker with s k i l l i n observation, diagnosis and practice, can enhance this function i s illustrated.. Diana, who was not a member of the House, and who.was not a child who could benefit from group ac t i v i t i e s , was attracted by the opportunity for individual interviews. It also shows that individuals desire help i n raising their children in this 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 friend 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 latter would v i s i t the home to see i f the mother would accept help. -5"5-The worker found that the mother had recognized Diana's need, and had planned to request case work services at the House for her. Mrs. M. was accepting of interpretation of the play room and of methods used. She gave considerable information about the cliildren, her methods .of dealing with their problems, and her attitudes about child care. It was arranged that, the worker would v i s i t the mother regularly, and Diana would come to the House for play sessions with her own worker. Donna would join a group. Mrs. M. was interested i n child psychology, and previously discussed the children's problems with a social worker. She expressed a wish for a treatment centre in Vancouver for disturbed children. The value of the group work setting for 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 services. Donna could use the group, although i n a negative way, and the group provided an opportunity to observe her, and to gain a picture of her manner of r functioning i n the family, both in relation to parents and to Diana. A l -though Diana could not use group work at f i r s t , i t was a means of testing her progress as she made gains through case work. Problems In Pre-Puberty. Like Donna, i t was evident from her behaviour in the group that Ann D. had been hurt by parental rejection. She sought adult attention because she f e l t deprived of parental attention, and i t could be seen that she did not f e e l friendly toward adults, but f e l t that she needed to pla~-cate them because they were strong. Ann tried to dominate the group in order to gain the feeling of power which would give a semblance of security against their rejection. She feared the reaction of the group to her own aggrest-: • siveness, and so tried to rationalize 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 hostile, and she could not stand further hurt herself. -56-Ann showed positive strengths in 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 in terms of what ac t i v i t y they chose on a particular day. She , was over-raggressive with adults, and very demanding of their atten-tion. She related to adults in a hostile way at times, becoming de-fiant, and at other times would identify with them against the group. In her relationship with other children, Ann would become very hos-t i l e at times, and then search for a reason to jus t i f y t h i s . She was over-aggressive i n competing with other children for status in the group. In her activities Ann appeared to be intelligent, and her work showed imagination and creativeness. Mrs. D. rejected Ann unconsciously, and hence was anxious i n her interview with the worker, fearing criticism of her care of Ann. Because she could not give Ann sincere maternal affection, she tried to substitute material things. Like Mrs. M. i n relation to Diana, Ann was a projection of herself to Mrs. D., and represented a means of realizing her own frustrated desires. Ann submitted to her mother at home, repressed resulting h o s t i l i t y , and transferred i t to other adults. Her feelings could be more freely expressed in the per-missive atmosphere of the group. Mrs. D. was actually rejecting the maternal role and seeking a masculine one in the competitive business world. Having experienced unhappiness and failure in one status she regressed to reassume the adjustment she had chosen earlier 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 to anticipate criticism of her care of Ann. She talked about her own struggle to support Ann, plans she had for her, and the things that she would like her to have. She wanted to be able to provide Ann with the things that she had not had. She wanted Ann to become a model, and to have dancing lessons, nice clothing, and good training. Mrs. D. said that Ann was easily managed at home and was always obedient. Mrs. D. was divorced from her husband, and she lived in a suite i n the maternal grandmother's home. Mrs. D. worked long hours i n a clothing factory as she ras attempting to save enough money to buy a business for herself. -57-It seemed that Ann identified with hurt and sick animals because she f e l t that they, l i k e herself, had been treated unkindly. Her interest i n horses -was unusually, strong. It was thought that she expressed her repressed desire for her father in this love for horses, as symbols of masculine strength. lairs..D. said that Ann was very fond of animals, and would often bring home sick or hurt animals to nurse them back to health. Ann was a member of the junior S.P.C.A. She was particularly fond of horses, and spent a great deal of time at a nearby stable where she was allowed to care for 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 affection, and demanded adult companionship which she had lost 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 attain from her the satisfaction she missed i n not having her father. She transferred some of the' h o s t i l i t y aroused by this situation, in the direction indicated by her mother, to her grandmother.. Mrs. D. said that she and Ann were very close, and discussed everything together, and were more li k e sisters than mother and daughter. Mrs. D. said that she had never been able to really talk to her own mother, who had not understood her, and she did not wish to have this situation between herself and Ann. She said that Ann was quite hostile 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 role i n having a child. Her husband had looked for a mother for himself in her and could not share her with Ann. Mrs. D. i n turn had looked for strength i n her husband, and his i n a b i l i t y to accept, responsibility was a severe disappointment. Ann sought to placate her mother by repressing her need for her father, and -58-her own dependancy. Mrs. D. married at twenty-one, and bore Ann, her only child 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 gorchild 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. If Ann showed preference for her mother he became jealous j he would have childish, arguments with Ann, and eventually rejected her completely over some childish thing that she had said. 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 his rejection, and she herself was afraid of him. Ann showed no feeling 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 child. It 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 in 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 for some time after the others had l e f t home, and she was quite dependent on her. Ann is to be differentiated from the other children who have been discussed^in this chapter, because as an eleven year-old she-was in pre-puberty rather than i n latency. In pre-puberty, feeling the need to learn how to relate to boys, she was feeling the loss of her father more definitely. Ann had had l i t t l e opportunity to resolve the conflicts which are related to hetero-sexual relationships, and was threatened by the new interest which her friends were showing i n boys. -$9- ' / She preferred to sublimate her own drives through an interest i n symbols of masculinity, as she could not face the po s s i b i l i t y that she would be disliked. Ann related readily to.the worker because she was looking around for a satisfying relationship with an- adult. It was also.evident, that Ann was confused with regard to her feminine identity, 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 better to be male, and hence she showed masculine characteristics.. She expressed resentment toward her mother who was not helping her with her problems, but forcing her into a mold which she did not want. In play interviews Ann showed a preference for clay, from which she attempted to model horses. She talked about her father almost immediately in the play room, showing a need for him, accompanied by a feeling that he did not want her. She told the worker that she had one do 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 gifts at Christmas, but she was not sure that these meant anybhing,. Ann talked about .her time at. the riding 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 to the stable with her. Ann expressed a desire for better relationships with other cliildren, but wouldn't accept the h o s t i l i t y which she herself aroused in them. She objected to the interest which some of the g i r l s were show-ing in boys, yet confided to the worker that she had a boy friend. Ann preferred boys games, and was quite frank about this. She played with the darts often, and apparently got a good deal of satisfac-tion from this. She expressed resentment of her*mother, and the pattern which Mrs. D. visualized for her. Ann, lik e Diana, grasped the opportunity given her for individual attention, and showed a desire to make use of the help offered. The worker was able to give her some understanding of her father's apparent rejection, of human motivation and reactions, and of the limits of her responsibility i n relationships.. Guilt regarding her h o s t i l i t y was relieved. -60-Ann came for fiv e interviews with the worker.- The worker, during these interviews interpreted human motives i n relation to the actions of her father and her friends, i n terms of her lack of responsibility for 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 in terms that Ann could -understand, and also her right to feel hostile at times, and to say so. The worker supported her i n the choice of an environment which • would be beneficial to her. The worker's act i v i t i e s with Ann thus helped her to move out of a setting, which was at that point an unhealthy one for her, and which she had clung to in her need for friends, without preclud-ing 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 lived i n the suite above i t and managed i t . They had two children of their own who were near Ann's age and made up a friendly, wholesome family unit. They appeared to be interested i n Ann, and willing to have her around. The father allowed Ann to take such responsibilities as answering the phone for him when he was out, as well as caring for the horse. The atmosphere appeared to be a healthy one, and the worker encouraged Ann in her interest.' . Ann decided that she was no longer enjoying the Junior pro-gram, and would in the future spend more time at the stable. She thought that she would soon be too old for the Juniors. It was suggested that she might return to the House in the autumn as an Intermediate. Ann D. i s an example of the very disturbed child often encountered i n a neighbourhood house, who i s a regular attendant, but for whom l i t t l e can be done in the group. Many children who are l i k e Ann are attracted by the individual attention offered by a case worker. The parent, who like Mrs. D., resents the responsibility of her child, 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 child were allowed to interfere. ) -61-Anri D. was referred for case work as one of the more disturbed children1, in a group composed of "misfits". This was an interest group. The case worker became acquainted with'Ann in her group, and obtained permission to talk to her mother. Mrs. D. said that she was pleased to have the worker take an interest in 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 for Ann and herself, and could not give Ann as much time as she would like to. She said that she would encourage Ann to come to the play room for interviews. ..When the play room was discussed with Ann, she asked i f she might bring a friend. .The worker explained that she could not, and Ann agreed to come, quite readily. 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 in 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. Precipitating causes i n the environments of the children varied from lack of opportunity for ;.: sexual identification, faulty social attitudes, and economic i n s t a b i l i t y to, extremely traumatizing experiences such as having been sexually molested by an adult, having experienced severe physical hurt at the hands of a parent, and rejection by parents. Five out of six of these children came from broken homes, in which there had thus been a complete breakdown of the marital relation-ship. The sixth child came from a'home in which there was a marital problem. Three could not f i t into groups easily because of aggressive behaviour which prevented them from gaining the acceptance of the other children i n the group. One was a child who tended to withdraw from relationships, who participated 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 child was afraid 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. - 6 2 -The personality characteristic which was most noticeable i n the six to twelve-year-old: i n contrast to the pre-school child, was the ascendancy of the ego. In a l l i t was evidently seeking expression, and was a need which could be detected even in the most disturbed. Jane J. avoided her mother -who threatened her ego, and clung to the group worker who gave her hope of expressing i t . ' Diana M. grasped for the outlet offered by the worker in the play room. In a number of children the needs of the ego were evident i n their attempts to gain status, their 'extreme r i v a l r y i n games, and i n their preference for adult company. Work with the latency child on the basis of a relationship with the child alone,, and without prior contact with the parent seemed more feasible than with other children. It had been hoped that the child would come to the case worker after having been prepared by the group worker, the substitute parent, i n accordance with the accepted referral process. If case work treatment was indicated i n the case worker's preliminary study of the child, the next step was for the case worker to v i s i t the home, with the child's knowledge and consent, in order to gain the cooperation of the parents. Because of the mobility of members and staff in the House, few of the children mentioned.for referral had a relationship with any of the group workers which was of sufficient strength to support this preparation. Those who had no close group connection were particularly inaccessible to the group workers. Those who attached themselves to adults i n the halls shifted their alle-:;. gianc'eSj and. i t was impossible to t e l l which worker 'might be effective i n referring them. The latency chijd did not seriously question the motive of the -63-case worker when invited to talk to him in the play room. He was used to accepting adult dominance, and not yet seeking emancipation from i t . The worker' did not f u l l y recognize this at f i r s t , and hesitated to ' approach the child who had not been prepared. As a result there was also l i t t l e progress made with these children, early i n the project. Various experimental methods were tried, and then i t was decided that the support of the parent should be sought. The case worker then found that these children did not object to the idea of the worker going to the home, and i n some instances invited him to come. Following this there was greater success. The play room provided a natural medium of expression for the child who s t i l l likes to phantasy. The worker became an adult play mate vrtio played his games and talked his language. Play materials could be used and adapted to suit his mood as he chose. It was a natural tran-sition from play i n the group to play i n the play room, and there was something special i n the play room in the satisfactions which i t provided, which were unique, and which served to hold the child's interest. The interviewing techniques used i n the play room were adapted to the setting and to the child. Although much information for diagnosis and treatment was obtained through observing and interpreting the way in which the child used the play materials, children i n this age group were able to verbalize their problems to some degree, and i t was noted that as feelings were expressed through the use of the play materials, they were often much freer to verbalize. The total setting of the group plus the play room made possible observation of the child both as an individual -6k- , and as ,a social being; as an independent unit, and as a member of a family. During referral, and as the child progressed i n interviews the group worker kept the case worker informed of progress and of. pro-blems in the group, so that the case worker could be continually aware df the child's social as well as of Ms individual needs. What Was AcMeved? The case workers helped latency and pre-puberty cMldren to achieve easing of personal tensions, improved ego functioning, and necessary super-ego controls. There was improvement among these cMldren in their a b i l i t y to function in the group, both in the House and i n the community. In the home, the worker attempted to ease detrimental pres-sures which were there for the cMld. Family relationships were strength-ened- '. through case work, and parents were helped to plan more r e a l i s t i -c a l l y for the ch i l d . Some of these children could not be appreciably helped by the , case worker in the short period of time. They were in need of intensive treatment, and more time was'required to even accomplish a re f e r r a l . Others could benefit from the parental kind of relationship which the worker could provide, and from i t gain the security and confidence nec-essary to enable them to develop relationships i n the group. Some gained ego strength which enabledthem to leave the House, and to find greater satisfactions elsewhere. Indirect gains resulted from the case workers activities with this age group. The complete referral process was demonstrated, includ-ing participation by the group worker. The interdependence between the individual's group relationsMps and Ms individual relationsMps was demonstrated; the role of 'the neighbourhood house in reconstructing the -65-family group, and the need for a case worker i n the setting, to round out the service by providing individual relationship needed by the more dis-turbed members. It i s of interest to note that only the child with the most compli-cated problem, Jane J., had received help from another community agency. It i s a matter for conjecture whether this would have occurred i f the mother- had not been dependent and in receipt of financial assistance. The value of the neighbourhood house as a case finding agency i s clearly dem-onstrated in Diana M.'s case, which also shows how a case worker sharpens this role. The case of Diana M. also indicates how receptive people-in Vancouver might be of a treatment institution. There was a development of cooperation between the House, and case work agencies i n the ci t y . One agency was encouraged in this by the fact that there were case workers in the louse. The examples i n this chapter indicate the results 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 child in his personal adjustment. There was greater inter-change between workers in conference, i n thinking and i n diagnosis, and in gaining an appreciation of respective roles. The case worker's role i n referral was more limited 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 in Chapter I, seemed to rest mainly on the need for the development of s k i l l s , 1 both on the part of the case worker and of the group worker, in practice of their respective s k i l l s , and in using a setting i n which each had access to the services of the other for clients. Each needed a better definition as well as a clearer understanding of their own as well as of the other's role, and they also needed to evaluate more clearly and con-cisely their own respective a b i l i t i e s and limitations. 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 child; to use to advantage any opportunity that presented i t s e l f which would further the plan. 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 -hibiting and depressing, or sometimes both. Bodily changes and new emo-tional drives of puberty may mean to the child either a t h r i l l i n g promise of the freedom and power of adulthood, or the frightening threat of de-mands and responsibility for which he i s as yet unprepared. The so-called "average" child probably enters this phase with mixed feelings, and grad-ually 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 self" i n progressive, productive ways. It i s , however, for the "average" individual usually past the middle twenties before the mature adult emerges. The phase of emotional development which i s known as adolescence', begins at about fifteen years, and is the period of emancipation. During adolescence the child seeks to attain the inner strength and s e l f - s u f f i -ciency which w i l l permit emancipation from his parents, and establishment as an independently functioning being. To achieve thi s , he turns to friends of his own age, his "peer" group or gang, with more purpose than does the child i n latency. In the gang he finds strength i n numbers; i n -dividual relationships which are stable because they are on a more super-f i c i a l level than those in his family and have less chance of being a threat to the ego; the sympathy of people who have similar problems. He i s free to express himself i n the gang in the experimental ways which may not be acceptable to parents, but which relieve tensions due to i n h i b i -tion of the new impulses. He is thus freed and enabled to conform to the more stringent demands of his parents and of society. The demands of the gang are more easily met by the adolescent than are the demands of his par-ents, because his sympathies l i e with the gang, and because he has a need for relationships which are on an equality basis. 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 to meet the demands of society. He learns to cope with these demands in accordance with his individual needs; he finds satisfactory ways of expressing himself as an individual, and finds appropriate outlets for his emotional drives. The adolescent who i s emotionally, disturbed because he has been de-nied opportunity for emotional growth during earlier stages of development finds adolescence more d i f f i c u l t than the' "average" child. Sometimes his intellectual capacities have been impaired, and sometimes his sense of value may not be i n accord with that of the adults about him. He may choose companions who are similar to himself, and thus become a member of a group which i s i n conflict with society. The outlets which such a group use, or the act i v i t i e s which i t engages in , may express the drives of the individ-uals of which i t is made up, but in ways not i n accord with the dictates of society. Sometimes these groups come i n direct conflict with society, as for example the widely publicized delinquent gangs i n our larger c i t i e s . Treatment Of Adolescents. Neighbourhood houses are trying to achieve therapeutic results with disturbed 'teen-agers through working with delinquent gangs. The permissive atmosphere of the House i s inviting to the gang. Activities are provided which are appropriate to their emotional needs, and which are also acceptable to society. The adolescent finds satisfying modes of expression i n clubs, team games and crafts, and i s furnished with the means of competing successfully through"learning s k i l l s of per-formance. As a result of the sense of his own accomplishment and the -69-encouragement of the group worker, his desire to conform can be estab-lished. • The adolescent needs an environment where he will be able to find understanding and acceptance; where there is 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 is often difficult to help on an individual basis. Because of his emotional conflicts i t is very necessary for him to maintain his defences. His tendency to seek solution of his problems in the gang, actually a defence, is intensified. He does not trust adults, and has a means to avoid them in the activities of the gang.. To gain his confidence and cooperation is therefore a dif-ficult problem for a case worker. Through the practice of professional group work there is greater hope of reaching him, hence the problems of the adolescent are of particular interest in 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 un-resolved conflicts which belong to earlier phases of development; frus-trated need for the love of either or both parents; need for adult iden- ' tification resulting from loss of a parent during latency; need for a -70-parent substitute because the own-parent had been inadequate; or need for parental support because the own parent had been immature and unable to give the s t a b i l i t y which the child needs. A l l tend to keep the child from handling new stages of development i n a mature way. By meeting these needs the case worker can form a positive working relationship with an adolescent, and pave the way for meaningful relationships i n his peer group. Gare must be taken n'ot to arouse conflict before the child i s mature enough to deal with i t . It is usually safer to r e s t r i c t the case work relationship with a 'teen ager to ego support plus coping with boy-g i r l relationships; finding a place for himself i n the group expressing his growing independence and so on. Insight into his defences should be given sparingly and cautiously. Problems In Puberty. The case studies which follow are discussed i n progressive order according to age. They present complicated and acute problems. It i s interesting to note the different kinds of conflict which occurred i n puberty i n contrast to adolescence, and the different techniques which were used successfully with the different ages. Jean S., a thirteen-year-old, had a physical problem (deafness) which had contributed highly to her emotional problems. Typically, she tended to use her handicap as a means of escape, and i t aided her with-drawal from social relationships. It 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 did not seem to be happy. She chose solitary a c t i v i t i e s , and did not encourage communicativeness on the part of others. Her hostile, aggressive nature was also typical of many who suffer her handicap. -71-The individual -who i s continually aware of what his handicap denies him, normally has very strong feelings of frustration and depri-vation, Yfhich he has to learn to handle as other people learn to handle ordinary frustration. Thus the deaf person who can see the interaction of those around him i s constantly aroused, while the blind person, unaware of his, e xcept for what he hears, is more cut off from his environment and as a result usually 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 to some extent but did not take part i n the general conversation, and the other g i r l s seemed to leave her to herself. It appeared that Jean preferred to concentrate on what she was doing as she made l i t t l e effort to mix with the rest of the group. She showed talent i n drawing and i n finger 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 after leaving the class. She would strike out at them i n an angry way. One day when she had been finger painting, she refused to go home at five o'clock when the House closed and splashed the paint around angrily. Mrs. S. showed a great deal of guilt i n relation to Jean, and there vra.s a suggestion that she rejected Jean i n her reaction to the worker's v i s i t . While i t is natural for parents to have feelings of disappointment at having produced an imperfect child, 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 in reject-ing her defect, and as a result had damaged her emotionally i n early childhood. When they realized what, their attitude was doing to the child they t r i e d vainly to mate i t up to her. At f i r s t the hearing aid was a symbol to Jean of her parents' love. 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 freely. She said that she and her husband had not realized 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 deliberately ignoring them sometimes when she did not -72-respond when spoken to. Jean did not learn to talk 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 for being stubborn, without av a i l . When the deafness was discovered they spent a great deal of money on ear spe-c i a l i s t s who thought that Jean might have been deaf from birth, or from the age of two when she had measles. They bought her the best hearing aid that they could find. 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 fact that the parents were also over-protective of Jean prior to the discovery of her deafness, the worker suspected that their lack of awareness of i t had resulted from their own emotional block-ing, that they were resentful and guilty. They did not know how to deal with their feelings, and because the idea of having an imperfect child threatened their own body images, they would not seek help. , As a result they denied her an opportunity for normal experience and development. In their rejection of Jean, they underestimated her as a person, and hence feared that i n becoming an adolescent, she would shame them further. They attempted to deal with this 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 did not give her the support she needed to go ahead in her development. It became apparent that the worker's v i s i t was disturbing to Mrs. S. because i t threatened to break down the adjustment the family had a l -ready made to their problems, about which they seemed to have much uncon-scious g u i l t . Mr. and Mrs. S. had always been very protective of Jean. Until she was six, 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 this occasion. Mrs. S. encouraged her to stay at home and work on arts and crafts projects, believing that Jean would thus develop excep-tional s k i l l to compensate for her other shortcomings. Mrs. S. was very conscious of criminal attacks on 'teen age girls which had occurred i n the city, and for this reason did not allow Jean out at Night. It was for this 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 stories about the things they did. -73-Jean's behavio\u'1 at home was consistent with her behaviour at the House, showing the same tendency to withdraw. Her bird was a sub-stitute for the companionship and devotion of friends, and there was not the need to compete as with other children. Her miserliness seemed to be an attempt to keep for herself the material things she needed to compen-sate for lack of love. Jean did not like to have other children in to play with her, as she said that they took her toys away from her. She had a pet "budgie" bird to which she was very attached, and her mother said that she would spend hours playing with the bird and talking to i t . Mrs. S. also told of how Jean would save odd bits of money that she was given, seldom buying anything for herself. The worker's i n i t i a l interview with Jean revealed a distrust of people and a depth of h o s t i l i t y toward l i f e . The worker erred i n broach-ing the subj ect which was most painful to Jean before there had been opportunity to gain her confidence, as the discussion opened up areas of great feeling and caused a great deal of anxiety. The worker should have centered this interview around Jean's desire to become an Intermediate, as a means of developing a positive relationship. As i t happened, Jean's reaction was one of negative withdrawal. Jean came to the play room with the worker after some hesitation. She played with t he darts about fifteen minutes steadily, hurling them forcefully at the board, and making no effort to include the worker i n the game. The worker then discussed with her the idea of becoming an intermediate, to which Jean responded enthusiastically. She told Jean that she would also li k e to have her come to the play 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 lik e to help her with this.; It was 'difficult to judge the quality of Jean's response to this at the; moment. She looked somewhat fearful, but nodded. Later the mother told the worker that Jean had been very upset following the interview and had said that she did not wish to have anything more to do with the worker. Mrs. S. said 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 intellectually, 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 ac t i v i t i e s at the House. Her neglect of Jean's l i p reading class was another indication 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 for 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 this. 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 Intermed-iate program, and Mrs. S. later said that they did not wish her to 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 this with the teacher, she said that Jean had said that she did 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 to wish to discuss her problems with the worker, . and so the worker decided to attempt to help Jean through helping her mother. The mother expressed her anxiety quite freely to the worker, and seemed to wish to continue to see her. The worker encouraged her.with regard to Jean's p o s s i b i l i t i e s , and gave, her support i n her positive efforts and feelings with regard to Jean. The father naturally 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 his antagonism to. develop thus, the worker.lost her contact with Jean through -the mother. - , The third time that the worker called on the'mother, Mrs. S. said that her husband had "blown up" about the worker's interest i n Jean, and suggested that the worker was looking for evidence that they were neglect-ing her. The mother appeared to wish to discuss her problems with the worker, but did not invite her i n . It 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 prior to the end of the project. -75-With regard to technique, this case points up the need for a carefully considered approach to a person's problem, particularly when i t i s evidently a source of considerable pain to the client. He w i l l naturally f i n d i t very d i f f i c u l t to face and resist help. This means close cooperation between group worker and case worker for purposes of diagnosis, and also time to work with the client gradually; time to alleviate the pain, build ego, and gain the client's confidence. This would require that the case worker be employed i n the agency on a f u l l time basis rather than for a limited period. Experience, s k i l l , , sure-ness.of role in the setting, and of function i n the cooperative situa-tion, would be necessary to handle the d i f f i c u l t problems which this 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 social patterns. She was fearful of meaningful relation-ships .with people. Barbara had the normal adolescent desire to 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 rejection, and chose companions who would accept this rather than "those with stronger personalities. As a result her friendships were on a superficial level, and were not lasting. Barbara, a member of Junior House for six years was referred by the group worker because she was extremely aggressive in her behaviour, and refused to take part i n any organized program. She was described as a bright, attractive g i r l , who sometimes used her attributes i n wrong ways. Barbara's only close contacts with women staff members had" been negative i n nature. She shifted her alliances from one worker to another. .She showed i n a b i l i t y to share the group worker with the rest of the group. She worked very hard at the beginning of the current year to recruit 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. - 7 6 -Barbara was not close to any of them. The group began to break up at Christmas time, and to reject Barbara, Yfho became very irregular in attendance. Barbara was most apprehensive of her own a b i l i t y to succeed, and hence sought reassurance from those in authority. She s t i l l re-tained the infantile need to be loved without compromise, and also-sought to retain the; infantile feeling of omnipotence. She had not learned socially acceptable ways of relating to people of either sex. Barbara was continually seeking approval from leaders-. She' "lapped up" praise. She said that she wanted people to love'., her no matter what she did. 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 project. She came up to him in Junior House, excited and laughing, rushed forward, threw her arms around him, and pressed her body against his. When the time ' came for the House to close, she did 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 identify. It was evident to the case worker that Barbara was very anxious' about her relationships. Her pattern seemed to be to "use" people i n order to establish her own prestige in the group, and to prove to her-self that she was loved. She covered up her h o s t i l i t y i n order to achieve this 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 in and out of the room a great deal, and was usually chased by boys when she returned. She became quite friendly with the case worker in the group, and was demanding of her attention. Barbara seemed to attempt to f i l l the father's role i n her home, and to displace the male boarder. This pattern showed up in the group where Barbara identified 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 for workers i n the House to gain her confidence. The worker -77-seemed to represent to her the limitations of society, to which the mother did 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 visited the family, and had found the mother interested in the House ac 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 in her home. There was considerable gossip i n the neighbourhood about her mother and this man. Barbara showed considerable rival 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 role with the other members. She seemed to be mixed up about her sexual identification, and was impulsive and uncontrolled in her behaviour. It seemed from Barbara's behaviour i n the play room that. she. needed to get out masculine aggressive impulses at times, but wanted to play the role of the aloof adolescent. She seemed to have a great deal of repressed sexual curiosity. She did not have the controls necessary to keep her emotions inside. Her need to take her father's place and dis-place the unacceptable boarder in her home, was affirmed i n the play room. Her family's attitude toward authority also reappeared. Barbara gave a great deal of herself in.early interviews. Barbara was quite controlled when she f i r s t came to the play room. She tried not to defeat the worker in competitive games, and showed no interest i n aggressive games. She confessed that she preferred boy's games, but seemed to be guilty 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, told 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 play 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 curiosity about sex i n examining the d o l l , but hurriedly put i t away. She said that she did not l i k e policemen or teachers. The worker who visited Barbara's home said that Mrs. P. was more li k e a sister to the 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 fearful, 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 play room, and came for her last interview at the persuasion of the male caseworker, bringing a friend with her. The friend was not allowed to come to the plajr room by the worker. She neglected to discuss Barbara's seeming resistance with her. Barbara stopped coming to the play room although she was friendly with the worker when she met her in the House. The play room and the contact with the case worker appeared to pro-vide a definite outlet and therapeutic effect for Barbara. The very pain-f u l elements i n her family situation however indicated that time and care were necessary to 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 ef-forts, and to give her a sense of being personally worthwhile j was needed prior to seeking the mother's support. Failing this the mother had no reason to fee l that the House was helping Barbara, and reacted with suspi-cion. Barbara then was thrown into a state of conflict, between her desire to stand by her mother's wishes, and a desire to grow personally. The group worker said that while Barbara was attending play ses-sions she was less aggressive, and much more cooperative i n the group. She was also making a constructive effort to gain friends.. She was very friendly for some time with the g i r l whom she had wished to bring to the play room. After she stopped coming to the play room, she went to the other extreme. She eventually stopped coming to the House. Her brothers got into d i f f i c u l t y over the destruction of House property. They were re-jected by the group workers, and Mrs. P. would no longer allow any of her. children to attend. The handling of this 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 interesting the child i n the play room and in using the play room for interviewing"purposes. Early i n her contact with Barbara, the case worker tended to assume the role of the group worker, as a result of her unsureness about her own role, and did not achieve results. -79-When her own techniques and role had been established, results 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 well acquainted with her in the group. The Christmas concert, and rehearsals for i t provided this opportunity. The case worker shared responsibility for 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 sug-gested that a case conference be held i n order to formulate a new plan of working with her. It was decided that Barbara's main need was a positive relationship- with a woman., The male case worker could ask the mother to encourage Barbara to come for interviews. Barbara consented to come to the play room. The role of the worker, and the use of the play room were ex-plained to her. She came for three interviews. Work with Barbara demonstrated the value of cooperation between the case worker and the group worker in diagnosis and planning. Barbara re-sponded positively to thoughtful case work, as shown by the change in her behaviour i n the group. The plan was not arrived at soon enough however, to be really effective in 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 liked, a fear of adults, and a great need to be accepted. Ills apparent lack of ease was typical of the boy in early puberty who i s uncomfortable with his new body changes, and emotional impulses. Pat's reaction to the female worker may have indicated either his desire to learn how to succeed with women, or a leaning toward feminine rather than masculine identification. Patrick 0 . was an attractive, likeable boy, whose physical ap-pearance showed typical signs of puberty, who was tense i n the presence of adults, particularly women, and always anxious to please, and to prove his adequacy. He often expressed concern for his mother, and appeared to be very fond of her. He related readily to the female worker, whom he chose in preference to a male worker, and was very friendly with her a l l through the contact. He talked to her in a manly, worldly, way. - 8 0 -Pat's position as the eldest in his family suggested that he might be required to accept more than his share of"the responsibility, and this was borne out i n fact. He was making a strong effort to please at home also, and to prove his adequacy as a male. Because of his feeling of i n -adequacy at home, he needed to 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 alley as a pin setter, four nights a week, in order to earn money for clothing, and spending money. He did not attend the House, but had membership in an athletic club, xvhich was run by a man who was rather notorious in the community and of whom Mrs. . 0 . dis-approved. This club sponsored lacrosse and boxing, and Pat was very eager to learn to defend himself. It appeared that Pat's parents were personally fearful of their a b i l i t y to conform to social mores, and hence were not trusting of their children. They were over hasty in accusing Pat of a1 recent theft which had occurred in their home, as they had been overly anxious to have him punished when he had once been involved in a delinquency. They had ap-parently experienced serious hurt and punishment themselves, and needed to retaliate by taking this out on someone else. Their choice of Pat as the object of retaliation indicated that they were rejecting of him. Uncon-scious conflict resulting from this made the mother aware of her i n a b i l i t y to deal with the situation, and so she asked the help of the worker. Currently, at 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 situation because Pat had been involved with some other boys about a year previously, i n the theft of some tinned f r u i t from a box car. The police had caught them and they had to appear i n Juvenile Court. Pat could have been l e t off, as i t was his f i r s t offence, but he was placed on a year's probation at 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 calling the worker she might frighten 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 rejection of Pat became quite apparent. He had caused her suffering and shame from the beginning. Her desire to'have, more children following his b i r t h seemed to be related to her disappointment in Pat. ' Mrs. 0. had suffered from a womb disorder ever since Pat's b i r t h . In speaking of this, she said that Pat had been a most unattrac-tive-,, jaundiced baby, and she could hardly accept him as her own. His birt h had been d i f f i c u l t , requiring instruments, and labour had been about 4 eighteen hours. Mrs. 0. had been badly torn. She had not had an opera-tions, to correct the womb disorder, as she feared that she would-be un- • able-to have more cliildren. Mrs. 0. was a youthful, attractive woman who exhibited a good deal of narcissim. '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 responsibility, and even blamed her family for her i l l n e s s . She was exces-sively demanding of her children and showed a desire to be dependent upon them. That her capacity for affection for Jimmy was limited was shown i n her i n a b i l i t y to allow him to enjoy the normal activities of boys of-his age. She strove to retain his favour because he met some of her 'emotional needs. Mrs. 0. competed with Pat for her husband. She attempted to i n -duce, the worker to f i l l a mother role with her. Being unable to give of herself to 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 for a year and had spent a great deal of time in bed. During the worker's contact she had the womb removed. Interviews with the worker were largely centered around Mrs. 0's illn e s s , and problems of the family as they affected her. Mrs. 0. f e l t very sorry for herself, and demanded a great deal from her sons and husband. 1 They did their 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 after four, or allow him to join a boy's club. She wanted his help at home. Jerry, aged f i v e , was expected to turn over any money he got to her to buy his clothing. Mrs. 0. resented the friendship -82-developing between Pat and Mr. Q. She believed in controlling her children through fear and punishment. She said that her illness had had a good effect on Pat because he became frightened and conforming when she was i l l . The guilt which the mother had induced in Pat appeared to be • the motivating factor i n his attempts to meet her demands, as seen i n his reaction to her i l l n e s s . Recognizing his need at the same time to realize the advantages of the adult role, he resented restrictions placed on- him as a fourteen-year-old. He resented his younger brother because he was unable to compete successfully with him for his mother's favour. Although Jimmy and Jerry reacted unfavourably also to the upset. in the home, Mrs. 0. was inclined to rationalize their behaviour and to center the blame on Pat, again showing her rejection of Pat. ' During the worker's contact with Pat, he tr i e d to assume more than his.share of the responsibility i n the home, particularly following the mother's hospitalization. He tried to find a nursery school for 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 for him, and would sometimes s l i p out of the window to go to a show, while his 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 skiis with some other boys, and this was very upsetting to Mrs. 0. She had not been willing to accept the idea that Jimmy might steal when Pat suggested i t . She blamed Pat for this episode because he had said that the other boys were " a l l right" 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 insight into her real feelings about her children, but because she was i l l could not face the demands. which, this made on her. She therefore could not use further help from the worker. Mrs. 0. scolded Jimmy b i t t e r l y in the presence of the worker and a neighbour who was v i s i t i n g . After 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 in -83-a b i l i t y to accept the role which -was - demanded of him in the home, as the worker gave him the recognition and acceptance which he needed. His father's reaction to the situation assured him of continuing support. Mrs. 0. became more lenient with Pat, and seemed to have a better appreciation of the effect of the pressure which he was under. Pat be-came less belligerent i n the home. This case illustrates further the need for 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 encoun-tered i n a neighbourhood house. It also Illustrates the community need for a case work service in this friendly, receptive setting and again, the role of finding cases before development of severe c r i s i s . Pat came to the notice of the case worker as the result of a phone c a l l from his mother asking help from the house with a family problem which had developed as the result of the theft of a wallet, which she believed her son Pat had taken. She was referred to the.Family Wel-fare Bureau; however, she said that she did not wish to c a l l that agency, and she hoped that the House might help by interesting Pat i n a c t i v i t i e s . Problems In Adolescence.-Joan R., a fifteen-year-old had been involved in an act of delin-quency, was "acting out" her protest against a world which had mistreated her. .Joan showed strength in her a b i l i t y to participate in activity groups, although relationships with people were on a superficial l e v e l . She showed a desire to relate to people in a more meaningful way. The drama group probably appealed to her because i t presented an acceptable opportunity to act out her conflict. Joan R., had taken part in a shop l i f t i n g episode i n the neigh-bourhood with two other House members. Joan was an active g i r l vrho had attended the House for about'seven years.- She also sang i n a church choir, and belonged to a figure skating club. In the House few staff 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 late she had been showing exceptional interest in a drama group... -84-Because Joan was "acting out" her conflicts, she was not subject to the emotional tension and discomfort of people who repress their f e e l -ings. As a result she was less accessible to case work, and was able to present a brave, defiant front. Her manner of dress was part of this front, which she evidently used quite consistently, and she seemed to deny her feminine role. 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 situation, 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 office interview. She asked Joan to have a chair, but Joan said that she preferred to stand. . Joan was an attractive g i r l who appeared to be f u l l of l i f e and energy. She was wear-ing blue jeans, her hair was done in pin curls covered by a colored scarf and a number of trinkets and chains dangled from her belt. When the worker explained her role and offered to try 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 did not know the names of the others, but suggested that through Joan they might also be helped. Joan said that they did need someone whom they could talk to. She attribu-ted ••  the blame to the House because i t was not open every night for her group and did not have enough equipment to keep them interested. The worker came to the defence of the House at this point. Joan said that i t had been the same a l l her l i f e , "you can't do this, you can't do that". It was apparent that Joan had very positive feelings about her group leader. This was encouraging in view of the antagonism and doubt she expressed i n relation to other people i n her world. In developing a relationship with Joan the worker should have made a greater effort to induce her to come to her interviews alone. The worker could have shown recognition of Joan's need for her friends without assenting to the sug-gestion that she bring them. Permitting this, the worker affirmed Joan's - 8 5 - . r ' doubts about her own strength. Joan then wanted to know vjho else knew that she was involved i n the shoplifting, and the worker told her that as far 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 well. She said that one of the teachers had snubbed her and she knew that this was the reason. She said that there was only one teacher i n the school that she liked as a l l the others picked on her; the police always blamed things on her and said that she was a gang leader; people called her a trouble-maker. She just 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 talk. Joan then asked i f she might bring two friends, and the worker agreed. In her group Joan's personal problems became much more evident; these included her insecurity i n relationships, her awareness of her strengths and i n a b i l i t y to use them, - her need for a dominating position as a protection against rejection. In common with her companions-, Joan had adolescent curiosity. While her companions expressed and sublimated this adolescent curiosity i n a c t i v i t i e s , Joan seemed' to have a tendency to" repress i t . It 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 friends, two g i r l s and a boy, with her to the play room. Joan seemed to be seeking their approval desperately. She was not their natural leader, but they seemed to consider her the i n t e l -ligent one. They brought several copies of "Lurid Romance" and "True Romance" in comic book form with them. Joan, spent most of the evening reading.these. The others were interested i n the rooms which opened off the play room, and i t was d i f f i c u l t to keep their interest i n the play-room. They found some boxes in one of the rooms which they were very anxious to go through. Joan remained aloof. It was too late in the project to work successfully with Joan, and the worker had missed the opportunities presented for gaining a relationship with her by allowing her friends to share her interview. -86-The vrorker attempted to arrange an interview with Joan by herself. 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 told her friends about the worker's job, but neither they nor Joan had any problems to discuss. Joan's problems arose from a situation which was common i n the neighbourhood, as has been previously mentioned: divorce, and the problems implicit i n the mother having to work to support the child. Mrs. R. was b i t t e r about her l o t i n l i f e . Joan suffered as a result. Mrs. R. was trying to force the neighbourhood to share a responsibility which she did not fe e l was wholly hers. Basically Mrs. R . rejected Joan. •Joan lived with her mother i n a small suite. Mrs. R. was divorced from her husband, and had to work to support Joan and herself. It was known in the House that there was not a good relationship between Joan and her mother. When the shoplifting took place, Mrs. R. blamed the House because i t was hot open every night for Joan's group, and did not provide enough equipment to keep the gi r l s interested. The mother requested that the situation 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 for Joan, and i t appeared that she would have been receptive of help herself. She recognized that she had a problem in her i n a b i l i t y to understand Joan, and seemed to be at the point where she wished to 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 calling. The worker told her. She sounded tense and upset, and seemed to wish to talk. 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 like adults. The worker talked to her i n a general way about the psychology of adolescence, and showed recognition of her anxiety. Mrs, R. said 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 this and was more cheerful and relaxed at the end of the conversation. -87-c 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 for 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 for friendship's sake. Information about the type of relationship that existed between Joan and her mother added weight to what had already been indicated: early rejection of Joan by the mother, eventual remorse and a desire to make up the lack of affection in 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 conflict with the group at times, however, as on one occasion when she would not go with them for a coke, after a game, because i t meant going out of her way. The other members had expressed sympathy for Joan, as they said that her mother had treated her brutally as a child. 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 at 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 in this setting; their complementary nature, and how they operate in order to help the client. As has been previously shown, a group worker cannot do case work i n a group work setting. If he has a relationship vdth a client who i s i n need of case work, he should be able to use that relationship to build a relationship between the client and the case worker. Similarly, i f i t i s thought that the personal needs of the client can be met through the group, and the case worker i s to deal with the home environment, the group worker should use his relationship with the 'teen-ager i n order to gain for the case worker access to the home. In working with a sensitive adolescent, confidence can only be maintained by allowing him to participate in a l l planning that affects him. - 8 8 -He w i l l naturally identify the case worker with the group worker, since they both are employed i n the House. It is just as important, therefore, for the group worker to gain his assent i n the instance of the case work-er going into his home, as when 'the group worker himself goes. Thus we see the complementary nature of the two services extending into worker-client relationship. In a case conference regarding further planning for Joan, i t was thought that the group worker had a relationship with Joan, who was making progress i n the group. It was' therefore the opinion of the group worker that she should work with Joan, and the case worker should work with Mrs. R., in an attempt to alleviate some of the problems which existed for Joan in her home. The case worker agreed to attempt to do t h i s . In planning an -interview with the mother the case worker realized that this should not be arranged without Joan's knowledge and consent. This was suggested to the group vrorker, who did not think that she could safely discuss this with Joan without endangering her own relationship with her. .It was there-fore decided that i t was best that the case workers refer the problem back to the group workers. Joan was f i r s t referred to the case workers at a time when confi-dentiality, as well as the matters of respective roles of group work and case work, and the relationship between them, had not been defined and c l a r i f i e d . The method of referral used was an experimental one, i n the absence of adequate precedent to follow, and the experience led to con-structive consideration of these things. It became apparent that confi-dentiality did not mean exclusion of professional people who were not d i -rectly concerned so much as withholding detailed information which was not useful to the group worker, working in a group setting. Knowing generally that there was a problem might be useful to the group worker i n apprecia-ting 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 limited to material useful and neces-sary to the group vrorker in the performance of his function. -89-Because confidentiality had been requested by the detective, Joan -pas referred directly 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 office after 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 eighteen-year-old has not been included. It might be of value to note b r i e f l y what the case worker's experience with Tom L. served to add to the project. A direct approach to Tom L. on "the basis that i t had been observed by the case worker that he was not very happy, was quite successful. He' was 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 thinking about boy-g i r l relationsMps. Thus Ms confidence was gained by discerning and meet-ing need, as described early i n "the chapter. - However, he was unable to find acceptance i n the House, was rejected from group participation, and the case worker was unable to go on with him as a result. 'Teen-Age Problems Were Complicated. The puberty cMldren who came to the case workers were reminiscent of latency and pre-school cMldren i n many ways. Jean S. was s t i l l repres-sing interest i n boys, clinging to the latency age group, and exhibiting anal characteristics. Barbara P., with her tom-boy personality was s t i l l searching for identification as a g i r l , and the establishment of her super-ego. Patrick 0. exMbited 1 more of the adolescent characteristics, but was s t i l l much the five-year old child seeking the affection of the mother. The impact of puberty was disturbing to these children i n different ways; Jean S. .reacted by withdrawing from social pleasures wMch she wanted very much; Barbara P. became anxious, and expressed tMs i n over-aggressiveness, and i n inappropriate ways of relating to people; Patrick 0. tried desperately to conform, and to meet the unreasonable demands of. Ms -90-mother. In Barbara and.^in Patrick the problem of the -unresolved Oedipus was much in evidence, and protective defences were not well established. Jean S. suffered from rejection 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 affec-tional deprivation, but presented a strong, defensive front to 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 to ' 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 similar to those of the younger children, but there was a sense of greater depth, and a des-perateness about their need which had not been previously encountered. Egos were more vulnerable-, and there was greater anxiety about faulty super-egos. Coupled with this was .extreme distrust and ho s t i l i t y for adults; a great need to function independently; a strong desire to demonstrate a b i l i t y to assume responsibility, and anxiety over boy-girl relations. What this ad-ded up to was a highly unapproachable 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 play room was used successfully with one child in puberty only. Neither the parent, nor the group worker, could be of much help early in the relationship. It was threatening to the relationship to contact the parent without the child's f u l l cooperation; the group workers were too anxious about their relation-ships with 'teen age groups to be helpful i n preparing the child for case -91-work. ,A great deal of supportive help and ego building were necessary to achieve a working relationship with a 'teen ager, and this f e l l largely to the,case worker. The 'teen ager was very sensitive about emotional problems, and attempts to help him with them were ineffective 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 to retain the acceptance of the group workers. They found i t more d i f f i c u l t to.control their hostile impulses, and were sometimes involved in destruction of equipment and property. It-was d i f -f i c u l t for the group workers to provide the acceptance demanded because of their responsibility for the House to the community. .When 'teen agers who were seeing the case workers lost acceptance i n the House, the case workers could no longer help them. The case workers helped 'teen agers to find greater satisfactions i n their groups; help was given through counselling regarding employment, education, and boy-girl relations; pressures were relieved i n homes, and parents helped to gain i n acceptance and understanding of the chi l d . Help given was quite elementary in most cases, and was more impor-tant as paving the way for future work than for .the actual benefit of the client. At f i r s t the group workers tended to use the case work service as a means of disciplining the 'teen age group, a problem about which they were quite concerned. This led to considerable effort to interpret the case work role. Lacking s k i l l s of their own to approach 'teen agers, the case workers identified with the group workers at f i r s t , and used groiip work techniques i n order to reach clients. This led to c l a r i f i c a t i o n by the case workers of their own methods i n working with 'teen agers i n the new setting. -' 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 th i r t y - f i v e , and the "Adults", thirty-five and over. The pension-age members were distinguished as the "Senior Citizens". This group, which had existed as a community organization prior to the establishment of.the House, was the nucleus around which the adult section of the-House had grown. Activities were varied, including classes and small interest groups concerned with bridge, square-dancing, arts and crafts, discussion, music, friendly get-togethersj and large groups, such as "Open House", or the week-l y dance of the Young Adults. There was an atmosphere of good, fellowship, of cooperation, and particularly among the "oldsters", of reawakened joys which had long been forgotten. The Meed for Individual Services. Individual problems of the Young Adult seemed to centre around em-ployment, dating, achieving group status and approval. It appeared that here too, as i n the Junior groups, the person who had been deprived of normal family l i f e , who had missed the opportunity for social and emotional growth, had been attracted to the House. In some groups members were unable to participate i n adult forms of dancing, played childish games, and needed a great deal of help from the group vrorker to function as social beings. Considerable preparation was required at the time of the project to introduce the Young Adults to the case work services. There was only one r e f e r r a l from this grotip. It is'usually less d i f f i c u l t to refer the young adult to a case work-er, than i t i s to refer the adolescent. He has a better recognition of areas of performance in which he needs help; he does not have the emotional block -93-to accepting help, which the adolescent i n his search for emancipation has. The adults i n middle-age seemed to have the most acute need for case work services. Middle-age, from about forty to sixty-five years, i s a period i n which the impact of physical change and -emotional readjustment can precipitate 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 rela-tionships, or other securities with which the years have l e f t them, there is sometimes a shock of realization that their resources are quite meager and their a b i l i t i e s most limited. The problems of old-age, as described i n the case studies which f o l -low, are typical problems. The problems of modern old-age are now legend. They are the result 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 now encourages old people to plan independently of their grown families. In a segregated group of "Senior Citizens", one finds unhappiness due to loneliness and loss of family; inadequate income, and i n -adequate housing; emotional upset due to the prospect of physical and mental degeneration. In the c i t y of Vancouver there are few recreational resources for dependent old people, and many cannot afford public recreation, i Case work services are also sparse. Case workers could do much to help this age group to use and develop the existing f a c i l i t i e s . It i s significant to point out that case work services for single, unattached adults of a l l ages are, for the most part, lacking i n Vancouver. The Y.W.C.A, has one f u l l y qualified case worker who provides counselling services for the unattached woman. There i s no comparable service for men. During their stay i n the House, the case workers received requests -9k-from adults for help, both House and community members. The case workers were able to provide a particular kind of service, and to supplement exist-ing community services to some extent. The six case studies which follow describe the case workers' experience 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 result of referral from the commiuiity. Mr.- and Mrs. G. were in their late f o r t i e s . The crux of their problem seemed to be the breakdown of Mr. G's a b i l i t y to carry on i n his traditional role^as head of the household. It was evident to the case work-er that Mr. G. was seriously disturbed, but this was obscured by his physi-c a l - i l l n e s s . His wife needed help to accept and to deal with his emotional illness i n a more r e a l i s t i c way. Mr. and Mrs. G. had one child, a four-year-old boy, David. They had recently come to the c i t y from the prairies, where they had f a i l e d i n a farm-ing venture. Mrs. G. had been l e f t the farm by her father. Mrs. G. had been described as a competent, controlled woman, but seemed to be quite agitated when she came i n for * an interview with the worker. She was-working, but her husband had not worked for several months because of a hernia. He had not had an operation because he was not eligible for hospital insurance, and they could not afford i t . Mr. G. had been caring for David, but Mrs. G. said that she did not wish'to leave him with Mr. G. any longer because he bothered Mr. G. With prompting from the worker she said that she was afraid to leave David with Mr. G. «She and Mr. G. had quarrelled a good deal l a t e l y . Mrs.. G. said that he had been very despondent of late, having said often that his family would be better off without him. Mrs.- G. was pleased when the vrorker offered to talk to Mr. G. Mr. G's deep depression, his unrealistic fears, and his extremely negative attitude suggested that he was actually pre-psychotic. His lack of ego strength, undue anxiety about an operation, i n a b i l i t y to face surgery, extreme nervousness, indicated that the roots of his disturbance were deep seated. It was apparent that he was a man who could l i t t l e accept the domi-nant role which i t had become necessary for Ms wife to assume. -95-Mr* G. looked very troubled when the worker vi s i t e d , and responded only half-heartedly when introduced. He warned the worker not to speak too loudly, as he did not want the neighbours to hear of his predicament. He repeated their story, his hands trembling as he did so. He smoked con-stantly, and was much more emotional about their problem than his wife had been. He hesitated to discuss an operation, and when he did so, seemed fear f u l . He worried'about who would pay for i t : whether i t might be per-formed by an interne; whether the doctor would be competent. He had f a i l e d to appointment with the social worker at the Out Patients Depart-ment at the hospital. The case worker, not yet secure i n his role, attempted to deal with Mr. G's symptoms, and did 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 intensified, and his disturb-ance became much more evident. If the worker had concentrated on diagnosis, he would have realized 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 psychiatric treatment before he would be able to accept surgery. A few days later, Mr. G. phoned the-House to arrange an appointment with the case worker; He did not keep the appointment. The worker^phoned the hospital case worker, who said that Mr. G. was scheduled to go to sur-gery, as planned by the House case worker. Later?Mrs. G. phoned to ask the worker to come to see'her husband at 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 for one of their workers to v i s i t . The worker later learned that Mr. G. had been admitted to the psychiatric ward • at the hospital for treatment, and surgery had been postponed. This experience with Mr. and Mrs. G. indicates the role that the neighbourhood'house plays i n assisting people of the neighbourhood to use community resources. It also suggests how a case worker on the staff of the House might sharpen this referral 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 his interviewing s k i l l s i n preparing people for 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 did not uncover Mr. G's pre-psychotic condition, which was basic. By referring Mr. G. to the Family Agency for advice, the Nursery - 9 6 -School teacher was actually asking that agency to perform the House func-tion 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 families need, based on thought-f u l diagnosis, was necessary i n order to give Mrs. G. the incentive to go to another^agency. Had case work services been well 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 psychiatric services rather than back to the Family Agency. Psychiatric consultation on such problems would add much to both the case worker's and the group worker's per-formance • Work with Mr. and Mrs. G. demonstrated again how the case worker f i t s into the referral function of a neighbourhood house. Referral of a particu-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 . If not, he refers the client to 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 role of the House in case finding i s evident i n this case. Some-thing about the House- attracted Mrs. G. to i t i n searching for a solution for their problem. This might well have been the friendly family atmosphere, of a familiar neighbourhood institution. The House is a natural link, for the client needing services, with the less known, and more specialized social agencies• Mrs.G. had come to the Nursery School at the House to ask for place-ment 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 for advice. It was thought that there was a marital problem underlying her verbal request. Sometime later, lies. G. phoned the House saying that she was desperate, and i n need of immediate help. She was then referred to the case vrorker i n the House. Mrs. A., fifty-seven years of age, and an epileptic, was i n need of help to become rehabilitated 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 epileptic attacks since the age of forty, and had been confined to the mental hospital for two years for the "regu-lation"of the epilepsy. She received medical and case work services at the Cut Patients Department of the hospital for six months following her release, but became ineligible for this when her husband got.a job. Her attacks had been under control for three months; medication was heavy. Mrs.-A. was sen-s i t i v e because of the stigma attached to her illness and hospitalization. She was fearful about coming in contact with social groups again. Mr. and Mrs. A. seemed to be fond of each other and happy together. However, i t was also clear that their relationship was a neurotic one; that he satisfied her need to be dependent, and she satisfied his need to domi-nate and care for someone. There was aamarltal problem because i t was d i f f i -cult in this kind of an adjustment to have normal social 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 feelings of i n f e r i o r i t y . Mrs. G. now found an outlet for emotions which had previously been expressed i n epi-leptic attacks, i n headaches. In a situation which b u i l t up unconscious anxiety, which she was unable to cope with i n a satisfactory way and repres-sed, 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 in middle age. Mr. and Mrs. A. li v e d i n a housekeeping room near the House. Mrs. A. appeared to be a pleasant, motherly, well 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 depre-ciated her, however, and that he thought there vras something wrong with,her mentally. Mrs. A. spoke fondly of Mr. A. who had lost his arm about twelve years previously as the result of an infection. He ^had not worked for about ten years because" of his wife's illness.. He thought that he .had to stay home to look after her, did not know about community aids. He would scarcely l e t her out of his sight. 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 for her. In conversation, Mrs. A's associations were not clear, and she would jump from one topic to another very rapidly. She spoke ^ in a preoccupied way about her mother and the mental hospital. She said that her old friends had f a l l e n off 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 - 9 8 _ l i k e to join a group at the House i n order to make new friends. Mrs. A. seemed to have good capacity for social a c t i v i t i e s , and had apparently f e l t very deprived because of lack of social l i f e during her i l l -ness. Her reaction in "the group indicated that the previous worker's assess-ment of her need for social l i f e was a correct one. Mrs. G. showed strength i n her efforts to maintain her attendance at the House. Her husband's re-action further confirmed that he was using his wife to meet his own neurotic needs. It became clear that the present situation had been precipitated by his loss of his-arm as well as by Mrs. A's i l l n e s s . This evidently had deep emotional significance for Mr. A. It _was,arranged that Mr.-A. would attend the "Y" club. The group vrorker was to c a l l for her and accompany her to the House. The case worker was to work with Mrs. A. and her husband, i n order to help Mrs. A. to make a good adjustment i n the group. Mrs. A. seemed to enjoy the meetings of the "Y" club. At the f i r s t meeting she broke down and cried during the singing. She l e f t the room for a few moments, and was happy when she came back, say-ing that i t had reminded her of the good old times that she and her husband used to have. Mrs. A. came regularly and said that she enjoyed the club. One time when the vrorker was unable to c a l l for her, she walked along the street to the House with some ladies she did not know, and did not t e l l her husband. She would sometimes phone the'group worker to verify that a par-ti c u l a r "thing had happened in the group, as her husband had not believed her when she told 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 feelings about them. It was evident that there was actually a marital- problem between Mr-, and Mrs. A.-, also tied up with her dead parents. Mrs.*A. had gained quite a l o t of insight into her problems during her stay at the mental hospital. She was perhaps beginning to seek emancipation from-the parental relationship which she had with her husband. Referral to the family agency might have-been a logical step, doubtful be-cause of their age. * Mrs*'A. had married at tvrenty-nihe. She and her- husband iiad lived with her parents u n t i l they died. There had been* conflict between Mr. A.-and her parents, and he said that they demanded too much, of her attention. -99-She had nursed both parents in terminal cancer. Mrs. A. had been very up-set about the conflict, but repressed her feelings as she always did i n such situations. She began to have nervous attacks, would become very tense and go to bed. Mrs. A. liked 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 affairs by himself. Mrs. A. realized the bearing that a l l these things had on her epilepsy during her stay i n the mental hospital. She used to have surges of a feeling of, responsibility for other patients prior to attacks. She did not think that her husband understood this "welling up" of emotions. „ • •• As well as helping Mrs. A. to find social satisfactions, the case worker helped her find release through interviews, of pent-up emotions' which she had been unable to express. The worker's role.with Mrs. A. was a sup-portive one i n the main. Interviews with Mr. A. revealed an a b i l i t y to understand his wife's problem somewhat, and to use interpretation from'the worker. It 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 re-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 responsibility 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, un-conscious feeling, Mrs. A. was sometimes preoccupied with past unhappy events. When the worker talked to Mr. A. he seemed to appreciate the emo-tional aspects of Mrs. A's i l l n e s s ; her conflict with her parents and the effect of too much early-responsibility. 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 referral procedure between a case work agency and a group work agency is ill u s t r a t e d in the case of Mr. and Mrs. A.; the use of conference, the written summary, and the case committee to bring about good practice. If i t had not been necessary for the hospital worker to withdraw because of the limitations of her agenc;/- function, i t would not have been appropriate for the case worker i n the House to work with this c l i e n t . The hospital worker would have been the one to help Mrs. A. use group work. To add the -100-services of the House'case worker would have caused confusion in Mrs. A's mind abotit her relationships to her respective workers. In work with Mrs. A.., the workers involved demonstrated the special role of a neighbourhood house in the rehabilitation of a hospital patient, and what.a case worker can add to this function. Mrs. A. was referred to the House for group work and case work serv-ices by her worker at the Out Patients Department. The worker thought that Mrs. A. would need further help i n returning to normal social l i f e . She suggested that Mrs. A. was ready for group a c t i v i t i e s , but would need i n d i -vidual support. There was a conference between the workers involved and a referral summary was forwarded. The House case worker read the hospital record. The case was reviewed-by the case committee, and the referral ac-cepted for case work and group work. The hospital worker brought Mrs. A. to the House to introduce her to the worker, -and to discuss House a c t i v i -ties 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., fifty-nine years of age was pre-psychotic when referred to the House for. group work. He exhibited definite manic depressive symptoms which had been recognized by the case worker who referred him. Mr. N. had practically no a b i l i t y to form meaningful relationships with people, and found emotional satisfaction 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 for insight, and was quite irra t i o n a l i n his approach to hiscproblem. Mr. N., a social assistance recipient was interested i n crafts, leather and shell work, and bone carving. He had told his previous .worker that he was the "black sheep" of his 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 talkative, drank occasionally and became very depressed. His assistance worker had referred him to a doctor for a psychiatric assessment. He was very excitable. He talked of accomplish-ments of his which were not based on fact. He. had no close friends. He thought that joining a group in the House would help him because he was self conscious i n crowds. He made unrealistic plans which he could not carry through. <. When the worker vi s i t e d Mr. N. symptoms previously described were < -101-qaite apparent, and i t was evident to the case worker that Mr. W. was too disturbed to enter a group. He had related to his former case worker as a child relates to the motherj and there was nothing to suggest that he could relate to adults i n any other way. He seemed to have i n adulthood the i n -fantile feeling of omnipotence, with l i t t l e conception of himself as an i n -dividual in-reality. With lack of social interest, Mr. N.- had none of the emotional facets necessary to carry on ordinary social intercourse •. Mr. N.'s room was f i l l e d with curios. Among other things, he had a row of bones drying on a pipe.- He was exceedingly self important, very pleasant and talkative. He spoke of several prominent people in a very familiar way. He said that his former worker'Mrs. C. "got him out of" a > mess". He had been working i n the Interior; earning a.good salary and i n charge of several men. He,, flew down to--Vancouver for 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 this because he did not think that he should be clas-s i f i e d with ordinary soldiers. On arrival he asked the Colonel for a de-t a i l of soldiers and twenty-six men. His request was met when i t was realized that-he was a man of some capability. He was explaining to the men a system of testing the dykes when a truck struck the vehicle beside which he was standing, and he was thrown forty feet into a gravel pit.He woke up i n a hospital and after that his fortunes were continually adverse u n t i l he met Mrs. C. He attributed his need to see a psychiatrist•to"his accident. Discussion between the House case worker, the Assistance worker, and the group worker, prior to refer r a l , might have eliminated referral to the House' of Mr. N. The Assistance worker needed interpretation from the group worker as to the function of the House; diagnostic thinking was needed to determine that Mr. N. could not actually use group work. The House case worker's specialized knowledge of individuals would have been helpful i n the la t t e r . Mr. N. was-not actually a candidate for case work services from the House since he was receiving special attention from the assistance worker. It was val i d , however, for the group worker to use the House case worker i n a consultative capacity i n order to arrive at a diag-nosis, particularly with regard to Mr. N's a b i l i t y to use group work. -102-Mrs. C. had referred' Mr. N. to the House because she thought that he needed social 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 did not think that there was any ac t i v i t y i n the House which would be suitable for him. The case worker was asked to 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 to use group work. It was agreed that the House - could not be helpful to Mr. N., he was referred back to the assistance worker, and eventually committed to the mental hospital. The re f e r r a l of Mr. N. to the House took place early i n the project when the method of referral, the kinds of referrals which would be accepted for case work, and the case worker's role had not been determined. The case of Mr. l\f. i llustrates' the role of the case worker in a neighbourhood house in diagnosis, and in screening referrals. Through his contact with group work, the case worker develops a special understanding of people beings, which other case workers do not generally have. Mrs. D., fifty-seven years of age presented a problem of emotional repression, and of new dependency which she was inadequate to meet. Her emotional upset had been precipitated by the loss of her husband at a critical-period of l i f e . It ?ra.s d i f f i c u l t for her to find employment. Her relationship to her husband had been a neurotic one involving dependence and repressed h o s t i l i t y ; his death served to intensify her negative feelings, and need to be dependent. With her pattern of emotional repression, unhappi-ness was intensified. Mrs. D. also had a tendency to be self-punishing. Loss of the pro-tective father figure made her more vulnerable to a world which she considered hostile, and she could not- express her feelings. Instead she turned a l l these things i n on self, and migraine headaches were intensified as a result. She presented a pathetic picture of aloneness- and i n a b i l i t y to do anything about i t . Mrs. D. was a widow of four months who was subject to severe migraine headaches. Her only income was a social assistance allowance from the city, -103-which was insufficient to allow many social outings, for which Mrs. D. ex-pressed 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 his death. Migraine headaches which she had had for many years became much worse. She was fearful of meeting new people. Mr. D. had been fifteen years older than his wife, and died from a stroke. They had no children because Mr. D. did not want them. Mrs.. D. had lost her father, her champion, when she was twelve. She had no close relatives 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 heavily lined, un-happy face. There was not an opportunity for the worker to assess Mrs. D's needs properly. It did 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 individual support. There was l i t t l e hope of personality change because of her age. Work with Mrs. D. pointed up the need for case work services i n the city, for the older, unattached adult. The City Social Service worker saw in the case work services at the House, an answer to this 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 individual with a problem. Interpretation of group work i n the .House interfered with t h i s . Later prac-tice was to have the client go to the group worker for this information. Mrs. D. was referred to the House verbally, early i n the project, by the City Social Service worker who thought that she would benefit 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 office. The case worker discussed the different groups and ac t i v i t i e s of the House with her and i t was de-cided that she would attend the "Y" club. Information was also given about the case work service and i t s purpose. Mrs. D. did not attend the club be-cause she could not afford bus fare from her neighbourhood, which was some distance. Eventually, near the end of the project, this d i f f i c u l t y was over-come, 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 inter-view had been by telephone only. Mrs. F..., seventy-four years of age, presented typical problems of old age; emotional problems of long standing now became acute as she f e l t her physical powers slipping away, and there were further complications of actual d i s a b i l i t y and disfigurement. At this time when she f e l t the greatest need -IC^-fbr family ties and friends, she was least capable of finding them, Mrs.. F. was 'alone i n the world and had expressed a desperate need for social Life and friends. Her only income was an old age pension which barely met«her needs arid, although she was 'active physically, 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 this had caused paralysis of her face, disfiguring her badly. .She was very sensitive about this, and did 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 social l i f e . Her great lack had been in close affec-tional ties,- and she was 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 frustration she had experienced. She had been unable to form normal relationships with men, and had been unable to use a neurotic relationship to her own 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 reg-istered nurse, and had followed this profession for about f i f t y years. She had done a good deal of public health nursing. She had attended Univer-sity, was also a trained stenographer. She had done some teaching. She was a member 'of 'the business and professional womens club. Mrs. F's per-, sonal l i f e had not been happy. During her forties she had married-a mer-chant seaman who was about twenty years younger than herself. ,,She had wanted children, but he did not. When she became pregnant he l e f t her. She-spent some time going up and down the coast trying to locate.him, but never saw or heard of him again. The child was s t i l l b o r n and this broke Mrs. F's heart, • . As old age approached, Mrs. F. had attempted to make an adjustment which would meet her changing needs. Frustrated in t h i s , she f e l t the i n -justice of l i f e , -and became more demanding of people. Her emotional'dis-turbance ..became more apparent. It is l i k e l y that the loss of'her physical attractiveness,- and the operation which brought this 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 near relatives. 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 to 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 attractive woman who took an interest i n her appearance,'followed cultural interests, and exhibited a sense of humour. -She became untidy and unclean, and unable to get along with people. It 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 in open conflict with society. There'was some strength i n her a b i l i t y to f e e l optimistic about her eyes and i n her positive feelings with regard-to the c l i n i c . .In addition to the paranoid belief that every one was against her, Mrs. F. showed no capacity for insight into possible inner causes for her troubles, preferring to attribute them to her physical problems and to the disinterest and cruelty of others. Prognosis was thus, limited a b i l i t y to 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 said that two young men i n the rooming house had looked after her, but after they l e f t she had a feeling that the 1 landlady had wanted to get r i d of her. The landlady had made complaints to the rental board about Mrs. F.. Mrs. F. said that she had found people in 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 neighbour-hood house once," but had not liked i t . She was attending the Out Patients Department of the. hospital on account of her eyes, and hoped to have an operation to help her sight and to restore her face. Supportive help from the, worker brought response from Mrs.. F. and she showed a b i l i t y to relate i n a group setting, even though i t -was in a very negative way. Her lack of insight and feeling with regard to her phy-sical, incapacities was quite .evident in the group setting and also her tendency to-project on others her own hostile feelings. Mrs. F. decided to join the "Y" group at the House. Personalities i n this 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 for not talking about more" worthwhile things, and for not doing something for unfortunate people lik e herself. Follow-ing the meeting she disparaged the group to the worker because of their lack of desire to do service work. She thought that her lack of success in the group was due to her f a c i a l disfigurement.' .She continued to attend the group irregularly. -106-As 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 . It was clear that she had now lost practically a l l of the a b i l i t y that she had formerly to form positive relationships with people. .Evidently, she had always had deep negative feelings with regard to men and sex, which had caused her a great deal of inner conflict. Because .of her ho s t i l i t y , guilt feelings,.and sense of uncleanness, she had l i t t l e a b i l i t y to accept herself. Her un-happiness, plus the effect of a l l of these feelings seeking expression, prevented her from achieving the affection of others. .She was actually shopping around for an affectional relationship. In the case of'Mr, Y. she used the radio and the cane to continue a relationship which she could not maintain i n any other way. . In complaining that Mr. Y. re a l l y wanted a wife, i t seemed that she-was actually giving expression to her own wishes. During her six-months contact with the worker i n the House, Mrs. F. lived in.six different places. Four were rooming houses, one a f i f t h rate hotel, and the last a nursing home. One room was in the home of an elder-l y man, Mr. Y., who wished to make his home available to elderly people. Mrs. F. took.this room after a great deal of mental, conflict. There was soon open war between her and her landlord. He complained that she de-manded a great deal for her comfort, complained continually, screamed at 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 afraid of him. Also she had been sorry-'for him, had invited him i n for 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 after two weeks, and he kept her radio because she had put him much extra expense. She Trent to a great deal of trouble to get this back, even calling the police, although she did not r e a l l y want i t . Then she re-membered that she had l e f t her cane and went back for i t . Mrs. F. said that young men accosted her and asked her to come to their rooms. She had a fear of contracting veneral disease in.the bathrooms of rooming houses. She did contract an infection, which the doctor said was due to lack of personal cleanliness. 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 real"effort to achieve acceptance i n the "Y" club, .She was thus able to use the help offered her by case work and group work. Such results j u s t i f i e d the large amount of time, and effort devoted to Mrs. F. .by the workers.Although -107-i t was not possible to.change her personality pattern, the-worker could provide the supportive relationship necessary to her to regain past strengths and to enable move on to other satisfying relationships. Following an eye operation, Mrs. F. began to attend the "Y" club meetings regularly, although members were s t i l l very hostile to her. She offered to nurse members when they were i l l . . Her appearance had improved' considerably, and she was making a noticeable effort to dress attractively. It seemed that she was,getting something -out of the group, and even-tually would be accepted by i t . The worker helped Mrs. F. by finding new places for her to stay; through giving her an opportunity i n interviews to find release for her feelings; by giving her ego support, and helping her to f e e l worthwhile and accepted. This helped Mrs. F. to participate 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 in the referral of Mrs. F. to the House 7ra.s one of conferring with the referring worker, and of intro-ducing .the<client to the agency. Planning for referral had not included the case worker, a practice which occurred,in the early stages of the • project. Better referral procedure with more background material regard-ing the client would have.been beneficial.- The case worker-knew too l i t t l e about this woman's emotional conflicts i n the beginning, and so used a great deal of time with her in an ineffective way. Mrs. F. was referred to the House by the counsellor-at the Y.W.C.A., following a conference with the group worker. It was thought that she would need case work help, to use the group, and she was referred to the case work-er. The case worker met Mrs. F. at the. Y.W.C .A. where she was introduced by the Counsellor. There was a short referral summary submitted to the House by the Counsellor. The worker also conferred with the hospital social service .worker who knew'Mrs. F.,. and the Old Age Pension worker. Mrs. E., similarly, had problems typical of ',old age. She had also devoted her l i f e to a vocation, was now losing the physical a b i l i t y to con-tinue i t , and was quite disturbed'emotionally as a..result. Mrs. E's -- 1 0 8 -vocation had represented an adjustment to 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 successfully 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 to provide materially for old age, and in i t she had also f a i l e d to learn the social skills- and interests which she now needed. Mrs. E., seventy-two years of age, an old age pensioner, had once been a successful.artist.' She was now very unhappy because she was losing her sight, and could no longer paint productively as a result. Because of lack of finances, she was forced to l i v e i n a crowded boarding house where she shared a room with two other elderly women whom she did not f i n d com-patable. • Mrs. E. was otherwise i n good physical health, but had lost 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 for a .past-time, and her Doctor thought that this would be good for her. She needed a place to paint and to store materials and help to obtain these. Mrs. E. expressed fear 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 l e v e l . She had only learned to relate to others i n a very superficial way on the basis of a common interest. 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 for 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 to paint, and following his death she turned to an artists career. She travelled and studied in 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 artists' l i f e , and the company of ar t i s t s . She was not a business woman and gave l i t t l e thought to the practicalities of l i f e , or the future. She gave a great deal to others, and only demanded enough in return to meet her day-to-day needs,,. .She- contributed war memorial paintings to the Canadian . . . government which she might have sold i n the United States for a large sum of money. Mrs. E. had been an art teacher u n t i l her sight began to f a i l . She, was now very lonely and unhappy. . . . . . As the case worker became acquainted with Mrs. E., her social i n -adequacy became more and more apparent. Present satisfactions were non-existent, and she was forced to regress to the past. This was similar to liv i n g i n phantasy because i t was l i v i n g in a time and re a l i t y which no -109-longer existed, 'Mrs. E.- seemed to have an a b i l i t y to gain insight into her problem and in this vray was better equipped than Mrs. F.-to deal with i t , Mrs. E. did not find anyone i n her boarding house companionable. She liked to talk of the past and the others resented this, saying that i t vra,s an' attempt to make herself seem superior, Mrs. E, attended the "Y" club at the House, She did not f e e l at home there either, saying that, they had been very nice to her, but their interests were different, and she would prefer to be by herself with her work*, She knew that she was different from other people and she also knew that i t was too late for her to change. The only real hope for her seemed to be an opportunity to regain the old satisfactions of-self-expression. The role of the worker in relation to Mrs. E. was to attempt to help her on an environmental level, through mobilizing resources. The worker-also, played the role of a friendly v i s i t o r giving supportive help, i n order to en-courage Mrs. E. to attempt to make an adjustment to her new circumstances. Mrs. E. needed help to realize that perhaps l i f e could s t i l l provide her with worthwhile satisfactions. The worker attempted without success to find an a r t i s t i n the neigh-bourhood who might allow Mrs. E. to use his studio. It was also suggested that Mrs. E. use the art centre at the House. However, she did not think this room suitable as i t had a southern exposure and did not provide the correct lighting for 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 tried 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 paint. Permission was also obtained for Mrs. E. to use the north end of the lounge as a place to paint i f she wished to. -) • The referral, although one of the early ones, was well managed 'in that there was joint planning between the group worker and the case worker. An improvement would have been a joint 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 City Social Service Worker.. -A written summary should have been obtained, and the CSSD record read by the case worker. • Mrs. E. had been referred to the House by the C.N.I.B. worker, to whom she had been referred by her doctor. Mrs. E's sight was not s u f f i -ciently poor to make her eligible for C.N.I.B. services. Mrs. E's prob-lem had been discussed with the case worker by the group worker in plan-ning, and i t was decided that help could be given Mrs. E. on an individual -110-basis as i t did not seem that Mrs. E. was ready for group services. Re-f e r r a l material was given to the"case worker by the C.N.I.B. worker ver-bally. 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 family problems arising from a neurotic marital adjustment, and a psychosis i n the marital partner; individual problems, related to hostile immaturity i n young II. adulthood; a psychosis precipitated by middleage; emotional upset i n old age due to degeneration and loss of physical health, which meant the break-down of a neurotic adjustment. Housing problems, i l l n e s s , a need for recreation, lack of social 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 better ad-justment i n their group, one was helped through referral to the appropriate community agency to deal with his problem, and good relationships were estab-lished with two which would be of value in continued work with them. The case worker added to the services offered adults in the House by means of his diagnostic s k i l l s , and was used i n consultation in referral and i n screen-ing referrals, as well as by means of his work with individuals. ' There was a development of case work method in working with adults i n this particular setting. It was learned that i t was not the case worker's role to interpret group work to a client, but the case worker did acquire a special s k i l l i n diagnosis through gaining a knowledge of group work i n addi-tion to case work. II. Mr. Y.", thirty-two years of age, had d i f f i c u l t y i n his" group. He was re-ferred to the case worker by the group worker,' and helped considerably as a re-sult. Case material is not included due 'to Its confidential 'nature. -111-Of particular interest was the apparent lack of community resources for the unattached male. This i s somewhat surprising- to find i n a .large .city surrounded by industries which attract the unattached male, such as mining, fishing, logging. This seems, to be a matter worthy of considerable thought and community action. The role of the House i n case finding .again comes out clearly i n the work with adults. Serious emotional problems were dealt with which i n d i -cated the need in this setting, as i n other social 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 role and method- i n the neighbour-hood house, and the establishment of a place i n the House for the service. 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 in a. neighbourhood house -works with a wide variety of problemsj problems of childhood, problems of youth, problems of adult-hood and problems of old-age: problems which involve physical d i s a b i l i t y , economic inadequacy, social and emotional maladjustment j emotional prob-lems which range from primary behaviour disorders and neuroses, to psy-chogenic illness and psychosis. The community i n which this project took place provides case work services i n the areas of Child Welfare, Family Service, Child Guidance, Medical and Psychiatric Social Work, and Indi-vidual Counselling. The House case workers found that they were working in a l l of these areas. The case worker's efforts also extended to types of problems which had as yet received l i t t l e attention in the community. The kind of problem, which, because of i t s nature, evades detection and thus pre-vents the person from seeking help u n t i l a very serious stage is reached. These are people whose defences are such that they deny their need for help, and unconsciously develop a pattern of behaviour which hides their unhappiness from the untrained observer. Jean S., Bobby R., Tom L., Diana M.,. and Mr. G. were examples. Sometimes when a child i s having d i f f i c u l t y i n the group, his parent is found to have problems of this kind. The cooperation of such parents can sometimes be achieved through the child, who is less resistant to the worker's attentions. The case work service in the House provided a means of extending sqcial service to such people i n the community who were sorely in 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 -113-Agencies, was that of the minor emotional problem i n the young child, which might reach serious proportions later on. Jimmy B. and Larry I. were ex-amples. This was preventive work which was possible as a result of the nature of the setting. It i s of interest to consider further why children lik e Jean S., Bobby R., and Mary K., or an adult lik e Mr. G. had not previously come to the attentions of a case work agency. One characteristic which was common to a l l was financial security. Besides, there had been no physical problem which might have brought them to the attention of the Social Service Depart-ment of a hospital. Mr. G's current problem was not of the kind which would allow him to seek medical care. Other factors had, perhaps, prevented these people from receiving social work attention: lack of recognition on the part of responsible community persons, such as teachers, of the symptoms of their need; resistance on the part of the person or his parent to seeking help because of cultural 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 commu-nity i n providing adequate services and i n making these services known. It i s interesting that except for the old age group, Mrs. R., Miss B. and Mrs. 0., none exhibited clearly the dependency pattern of the finan-c i a l l y inadequate and chronically i l l so often found i n case work agencies. It did not seem that people were drawn to the House because of a need to be dependent. Other agencies could better serve this need. Although without doubt dependency was often a factor i n their problem, i t seemed that they were mainly concerned about their i n a b i l i t y to function as social beings; their i n a b i l i t y to make a place for themselves in the social group, and to enjoy the satisfactions of social l i v i n g . The breakdown of family relation-ships had been most traumatic and meaningful, and they sought the answer to - l l l i -this dilemma i n the family atmosphere of the House. It wouldj therefore, seem that aanother characteristic of the prob-lems found i n the neighbourhood House was that they were, as a group, some-what different from those found i n agencies which give financial assistance and medical care, i n that there was not the deep underlying factor of de-pendency. Problems were more concerned with social a b i l i t y , or ego func-tioning, arising from the breakdown-of relationships i n the family 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 serv-ices 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 position. The Role of the Case Worker Was Hot Clear at F i r s t . The role of the case worker in the House has so far been described i n terms of the following a c t i v i t i e s : speaking to groups'; .interpreting case work to staff; equipping a play room; adapting office equipment and services; organizing and participating i n case conferences; gathering case material; and acting as a li a i s o n between the House and-case work agencies; and performing individual and family case work service on the levels 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 role of the case worker was i n this. 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 d i f f i -cult for them to see where group work ended and case work began. 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 his own-role, tended to l e t him-self become involved in this. It seemed that the case worker had a tendency to identify himself as a group worker, which could be attributed to the emotional impact of a strange setting or a greatly outnumbered case work staff. Another factor which contributed to this confusion was the neces-s i t y of dividing the responsibility for supervision, case work and admini-strative, and the fact that two separate agencies, the House and the school, had separate interests in the project. It was d i f f i c u l t for the group worker, at f i r s t , to see why a case worker was needed in the agency i n view of the fact that group workers have case work training. .They thought that this training was sufficient to enable them to refer clients to case work resources which existed i n the community, and since these resources did exist, why was i t necessary to have case workers in the agency? In the course of the project i t was even-tually agreed that the group worker could make successful'referrals with some clients. 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, relationship, and diagnosis, through continuous practice; he has not developed the s k i l l necessary to know whether a client can benefit-from case work; i t i s d i f f i c u l t for him to enter the kind of intensive relationship which i s often necessary to complete a referral, without endangering his relationship with his group. It did seem,1therefore, that there i s a place i n a group work agency for a case worker i n making re-•1 ferrals to other'agencies. • The group workers were not clear, at f i r s t , about the role of the * case worker in providing an individual relationship to people who were not sufficiently disturbed to warrant referral to another agency, but who could -116-be helped through case• work to use the group more effectively. 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 individual attention because of his responsi-b i l i t y to his group, and also because his s k i l l s were not sufficiently developed i n working with individuals. Hence, the role of the case worker was also to work directly with problems i n the setting of the House. Conscious of the lack of cooperation-which existed in the f i e l d of social work between group work and,,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 this should be the function of the case workers, when the group workers were professionally trained, and had a knowledge of com-munity resources. Better to place the emphasis on the needs of the client, as discussed above, and let the group worker function wherever he was trained to meet the client's needs. It was eventually understood and agreed, that case work and group work are different and separate s k i l l s , sharing certain generic knowledge which, ideally, work .side by side. . There i s a place f orb the case vrorker i n the group work agency, and this place i s complementary to group work. Case work does not assume, or attempt to overlap, the group work function. Early i n the project, there was a great deal of concern about how to get the child who needed case work help to the case vrorker. Referral procedures had not yet been agreed upon. The group work students and some of the staff members were .new to the agency, and did not think that they knew the individual child well enough to .suggest that he see a case worker. There was a fear of frightening the child away from the House.. As a result, children were simply suggested for referral, and i t was l e f t .to the case :-117-worker to gather information from the f i l e s , clear •with the social service exchange, and contact other agencies that were registered. The case work-er- then made the acquaintance of the child in the House and attempted to interest him in•coming to the play room for regular interviews. This did not work out well- as the reader has already been shorn, and i t was recog-nised that the. referral i n the House should not diff e r substantially from that used between agencies. Having the case worker in 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 staff conference helped to clear up the situation considerably. Several important conclusions came out of this which helped i n the organi-zation of the service: (a) . The, service was not intended to duplicate either group work services, or other case work services which already existed . in the community.-(b) .Case conferences were important and continuity of leader-ship should be maintained i n these, (c) Many children had been referred because they were disrupting in the group and referrals should be more carefully con-sidered, as these were not necessarily the- children most i n need of case work help. (d) A better method of ref e r r a l should be developed., (e) A case committee was needed to study referrals. A referral committee was set up which consisted of the case work supervisor, the executive director, and her assistant. The purpose of this committee was to study a l l referrals that came to the House from ofeher agencies, a l l referrals made to the case workers from groups i n t h e House, -118-and to determine whether or not the person could use case work service i n the House effectively. If the committee decided to accept the re 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 arrive at a ten-tative diagnosis, and to decide whether the case should be dealt with in the House or referred elsewhere. As vfork with a client progressed, there were to be further conferences i n order to correlate group work and case work findings. . Through.the case committee, c r i t e r i a for referral were set up. These were as follows: (a) The member, after a considerable length of time i n the House, had f a i l e d to achieve acceptance by other members which was sufficient to enable him to join a group. (b) The member, although a part of a group, was not using the group to meet his? needs. (c) The member, a part of a group, was using the group to 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 referral to an appropriate case work agency. (e) A person referred from another agency for group- workybo whom case work help given by the case workers i n the House -• either on a supplementary or cooperative basis would be beneficial i n helping him to use group work. The case committee also determined what the referral process should -119-consist of.- This was as follows: 1. The referring worker should submit a referral 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 family and other social groups. (c) A statement of the kind of relationship the worker . expected to have with the referred person i n the im-mediate future. 2 . A conference was to be arranged between the workers concerned. 3. There were to be periodic contacts between the group worker and the case worker to discuss new aspects of the problem and progress. There was a problem of discipline i n the House because of community pressures, and at f i r s t the group workers referred some children to the case workers because they needed discipline. It was. established i n the case committee that this was not part of the case workers' function. It was the opinion of the committee that cooperative work with the case workers should include professional staff only. However, i t was not c l a r i f i e d during the project whether or not this would preclude work with the Nursery School. The case committee was very helpful i n clarifying roles. So also •was a session which was held at the University between the case work and group work classes on the role of the case worker in the neighbourhood House. This determination of role i s very important to the activity of -120-actually helping the client ,- for-' as David Franklin pointed out i n his thesis, - . . . . 12. "The danger of mobilizing anxiety i n the mind of an in 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. Franklin further says that part of this i s that the confiden-t i a l nature of the case work relationship must-be preserved. There was divergent thought during-the project as to what confidentiality i n case work meant, and this was never, well c l a r i f i e d for a l l . -The Case Workers1 Methods, Many of the methods used by the case workers i n this setting were not new ones, but there was some adaptation of• method to the new setting.,, Children were approached i n a friendly manner. In'working with children the worker used the child's language-and spoke i n terms of objects and ideas which belonged to. the child's sphere. However, i n some cases the worker had to seek out a child, who had not been prepared, for case work,• • and who had not expressed a need for help. The-progress -of work was-dif-ferent than i n a case-work setting, because jit went from.the child to the parent as-a-rule,, which .is the .reverse of the usual 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 helpful in establishing a real-relation-ship-with a c h i l d . With the adolescent group, i t was sometimes very dangerous .to the relationship to bring the parent into the picture at a l l . In the special setting of the House, i t was considered-possible„and ethical to do a certain- amount of work-with a child or with an adolescent,without the parent's permission. 12. Ibid. p. -89. -121-The use of the play room i n working with children was not a new method, but i t seemed to lend i t s e l f particularly well i n this setting. It was a natural addition to the regular program, because i t was just one more place where a child could play. It provided natural mediums of expression for the child who was s t i l l l i v i n g a great deal i n phantasy. It also provided individual attention and response from a giving parent figure. The play helped to, drain off excess anxiety and to' establish a positive relationship between the child and the worker. The worker gained the-information necessary for diagnosis and a .plan of treatment through observing and interpreting the way in which the child used the play materials. Some children gained i n a b i l i t y to verbalize their problem as a-result of the freeing effect of working with the clay and finger paints.' The case worker could also observe the client i n his group which provided the additional advantage that the'case worker yras able to see him as he functioned as a social being. What Did the Case Work Service Mean to the House and Community? During the course of this 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 role of a case worker in this particular neighbourhood House was de-fined, and an idea was formulated of what might be accomplished i n the House i f a case worker were hired on a permanent basis. . It seems apparent that the addition of a case worker to a neigh-bourhood house can provide the community with a unique resource which can provide a high quality of service. It is a resource which i s better suited than a case work agency alone to deal with certain problems, such as the -122-rehabilitation of the unmarried mother or. the person' who has been mentally-i l l , as the cases of Miss B., and Mrs. A. It i s a resource which attracts people who have particular problems which prevent them from going to other agencies and i s , therefore, a valuable center,for case finding, a function which the case worker can enhance i n many ways. It seems to have an appeal for people because of i t s identification with the family, and .the need people have to work out their problems i n the family. As a result of this attraction, some clients can be reached at an earlier stage i n the development of their problem than they would have been other-wise and, as a result, work of a more constructive nature can be done with them. It was easier in' the setting of the House for the. client'to--seek case work help because of the friendly, family-like 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 client can be reached at an earlier stage i n the' development of his problem; through the group setting clients can be contacted who might never go to a case work agency, yet who could be expected to become serious social problems. An examination of the sources of referral outside the agency i s of value i n evaluating the service. It also points up certain lacks which 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 result of referral from other social work agencies, the T.W.C.A., the City Social Service Department, and the Social Service Department of the Vancouver General Hospital. -123-(b) From the community as a result'of the client'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 for"a number of 'reasons: "." .(l) The House provided a more' extensive service in the combina-tion of case work and group work than the referring agency could provide. The refe 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 referring agency could provide, and also group work. "•• , The referral of Mrs.- C. from the City Social Service• Depart-ment illustrates t h i s . '(3) The combined resource of case work and group work was a bet-ter one for Mrs. A-., than any'other-that the city could'-pro-vide • . . (Ii)- There case work'resource available in the-city for' • ." - the single unattached male, as was "required by Mr.' Ii. The group workers i n the House referred clients 1 who were already re-ceiving services from other case work agencies for the following reasons: (a) • It was believed that a more intensive service was required by the. client than that which the active agency could provide, in.order to enable him to use group work effectively. Examples ".' were- Barbara I., Larry I.,.'/and Jimmy B.,, a l l of whom came from • assistance families. (b) The client appeared'to need'more help than the active agency or the'group vrorker could provide, to enable -him to use com-munity resources effectively. Mr. G. was an example.- (His case was active with the Family Day Care Association.) -I2tt-(c) The client could not .use-either the group work or case work which had been offered.-him, and was in need of diagnostic service of a more specialized nature, i n order to get'him to the-proper-community'resource,, -From this evidence One .can -deduce that social 'assistance agencies in the community are not set Up to provide the therapeutic and preventive type of case work'service to the client which social 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 social assistance who could use i t , and there-is a definite gap i n case work service^ in-Nthe- lack of- a resource' for "the'unattached male. It was natural that the workers, in ..the public agency should wish to make use. of this new resource.., - • • ' • ' • The attraction that the.House: had for people who needed -case work, in order to help them to use group work services, was evidence of the com-munity need for the development of •'case work - group'work cooperation;-This was a problem- which had previously received considerable, attention, but small solution. Implicit i n this was the .need for the development of bet-ter, methods of referral.' • ' The project revealed the need for better diagnostic services i n the community. S k i l l on the part of'workers inmost social agencies i n the recognition of psychotic and pre-psychotic symptoms i s particularly lacking. Conclusion. - - * .- ' It has been observed that the actual accomplishments of the case workers in the House in helping clients during the project was limited., This was due to the inexperience- of the workers, 'their resultant insecurity i n the new setting, the problems presented i n the .adaption of case work to - 1 2 5 -the setting, and of the setting to case work. The time factor was also important. Because the type of service was new to 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 relation to other agencies.. Many of these problems were not completely resolved, and the project at i t s conclusion therefore presented many facets for 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 social work, as i n the local community. Projects. 1 elsewhere have established correct referral procedure between case work and group work, and have determined the correct role of the case -worker in a neighbourhood house. The Henry Street Settlement i n New York, for example, has", a full-time, case worker on i t s staff. The project was of value i n the local' community as a practical exercise i n case work - group work cooperation. The project does suggest other poss i b i l i t i e s for 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 role i n case finding;, i t s role i n pre-ventive work. Group workers are becoming more and more interested i n group therapy. . Does this not also have a place i n a treatment setting? Has' this p o s s i b i l i t y been, as yet, sufficiently explored i n the f i e l d of social work? BIBLIOGRAPHY Books and Pamphlets. 1. American Association of Group Workers, "Group Work-Case Work Coopera- tion", 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 Ilg, Frances, "The Infant and the Child i n the  Culture of Today", Harper and Brothers, New York, 19U3. 4. Gesell, Arnold, and Ilg, Frances, "The Child from Five to Ten", Harper and Brothers, New York, 19li3. 5. Hamilton, Gordon, "Psychotheraphy i n Child Guidance", Columbia Uni-versity 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&» -8. Wilson, Gertrude, "Group Work and Case Work, Their Relationship and  Practice", Family Welfare Association of America, Pub., New York, 19Ul. 9. Wilson, Gertrude, and Ryland, Gladys, "Social Group Work Practice", Houghton, M i f l i n and Company, Boston, 19U9. 10. Zackery, Caroline B., "Emotional Conduct in Adolescence", D. Appleton-Century Company, New York, l°l+0. Thesis. 1. Franklin, David St. George, "Case Work-Group Work Referral", M.S.W. Thesis, Dept. of Social Work, University of Bri 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 Social 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 Adjustment", The Family, Vol. XX, No. I, March, 1939, p. 21. 2. Josselyn, Irene, "Psychological Problems of the Adolescent", Social  Casework, Family Services Publication, May and June, 1951., -127-Articles (Continued). 3. Linderman, Wanda, "Patterns of Case Work Services in Group Work Agenciesy The Group, November, 191+5. U . "Group Work and Case Work, Their Relationship and Practice", 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 tion of Case Work and Group Work Services for Children", The  Group, March, 19U8. 6. Weiss, D.,' "Some Aspects of the Case Work-Group Work Process", The Social Worker, Vol. 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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