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The effectiveness of family case work : an evaluation of the case work treatment of family relationships… Calnan, Wilfrid Michael 1948

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£/?.3 .a 7 THE EFFECTIVENESS OF FAMILY CASE WORK An Evaluation of the Case Work Treatment of Family Relationships Problems by The Family Welfare Bureau of Greater Vancouver, B.C. . by-Wilfrid Michael; Calnan Thesis Submitted i n Partial Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the Department of Social Work University of British Columbia 1948 THE EFFECTIVENESS OF FAMILY CASE WORK TABLE OF CONTENTS CHAPTER Page I. SOCIAL CASE WORK AND THE FAMILY... . 1 . The"-study of human behaviour. The social work profession. Social case work. Family case work Family Welfare In Canada, -1928 11. „ , 11 Establishing of the Family Welfare Bureau of Greater Vancouver. Function of the agency, the clientele, case work services and the community. Objects of the Present. Study..... 22 The c r i t i c a l importance of ascertaining the capacity of the agency to f u l f i l purpose. II. ATTEMPTS TO MEASURE THE EFFECTIVENESS OF FAMILY CASE WORK..26 Importance of developing c r i t e r i a for measure»ent. St a t i s t i c a l methods of evaluation, F a c i l i t i e s of Family Service Association of America 27 The Evanston study-use of qualitative analysis....30 "'Testing Case Work Results" by Family Service, St. Paul, Minn.- , ...31 Measurement of effectiveness of social case work through reduction of client problems* New York Community Service Society Project In Measurement... ...34 Mowrer and attempts to use quantitative methods of analysis— "Distress Relief Quotient" Hunt and attempts to measure movement in social case work. Family Welfare Bureau Attempts To Devise Systems of Measurement ...40 III. THE PRESENT STUDY AND THE EVALUATION DEVICE USED• ..46 Seeking a method. Using the dynamic concepts The instrument devised .48 Description of the f a c i l i t y variously called case-o-graph, the case-gram, and the case chart. Use of the devices demonstrated Cases selected for examination in this study. IV. THE EARLY YEARS OF MARRIAGE The legand of the golden years of early marriage. The opposite view.. Backgrounds of the marital partners. Age. Education. Occupation and employment. Health. Mobility Family Background The families from which these men and women come. Cultural and social factors. The marriages. Mobility. Economic, Social and li v i n g conditions The children Family case work with these cases. "The case '. work team." V. ADVANCED MARITAL CONFLICT .89 Analyses of marital problems The Children Personal Background Personal adjustment. Occupations and employment Family Backgrounds Family-histories, Cultural and economic factors. Treatment • Length of agency contact; The worker. The.client. The community. VI. DISSOLUTION OF MARRIAGE.. ..... . 109 The circumstance of separation ' Range of examples The Marriage The circumstances of marriage. Preparation. ' < Compatibility. Ethnic and social, factors Family Backgrounds Personal Backgrounds. Occupation and employment. Mobility. Health Treatment. D i f f i c u l t i e s . Roles of case worker, client, and community. VII. RECONCILIATION. ............. 125 Range of examples Family Background The Marriage Partners Ages. Occupation and Employment. Health. . ' The Families The marriages. Cultural and social factors. Children. Treatment. The client leads the"case work team." VIII. PARENT-CHILD"RELATIONSHIPS AND CHILD DEVELOPMENT PROBLEMS. \ 148 The Children and The Problems Described TheTParen.ts Treatment ~ Family case worker. Resources of the community The client. IX.; EFFECTIVENESS OF FAMILY CASE WORK.. . . 172 C r i t e r i a of success .«• ........172 Effectiveness Summary Charts......... 173 . Estimates of effectiveness of treat-ment in.the five groupings of cases. Evaluation of the case-or-graph 188 Recommendations for improvement. Assessment of Family.Social Work Recommendations for the promotion of happy family l i f e 195 Case.work services. Education.: and community action for family living. Indfex of Tables Pages Relief Given by, Family Welfare Bureau 1928-48... 17 The Case-o-graph 50 - 51 The Case-o-graph applied .59 - 60 Effectiveness of Social Case Work Summary Charts I..... 174 II 178 III 181 IV..... 184 V 186 Revised Case-o-graph ««190- 191 T H E S I S A B S T R A C T THE EFFECTIVENESS OF FAMILY CASE TfORK By Wilfrid Michael Calnan Department of Social Work University of British Columbia September - 1948 The purpose of this thesis is to evaluate family case work parti-cularly as seen in the work performance of the Family Welfare Bureau of Greater Vancouver, British Columbia. The research sample comprises fifty-eight casos featured by problems in the areas of marital relationships and parent-child relationships, known to the agency during the five-year period ending April 1, 1948. Selection is exclusive of extreme examples and includes only "whole" families, that is,units in which both parents were living, although not necessarily together. Childless marriages are considered only when there are no contra-indications to fecundity. Age is a further delimiting factor in selection of these cases. The maximum ages for men being forty years, for women thirty-five years. The total research load is subdivided into five groups, basis of grouping being the particular problem most troubling the family. Groupings are;Early Years of Marriage (Ten cases), Advanced Marital. Conflict (Thir-teen cases), Dissolution of Marriage (Eleven cases), Reconciliation (Ten cases), and Child Development and Parent-Child Relationships Problems (Fourteen cases). None of the several evaluation methods examined proved suitable for the cases in this study. The criteria and method of evaluation used in the project are derived from basic case work principles and the concept of social case work as a dynamic process. For want of a better descriptive term the instrument devised is variously called the case-o-graph, case-gram and case-chart. It is a dissecting facility intended to show the dynamics of the case work process as they operate in a given situation. The activity of client, worker, agency and community are proportionately shown in this case-chart which illustrates what takes place in case work as seen in the case record. Results, of case work are subjectively graded. •The case work services of the Family Welfare Bureau are assessed as generally effective. Visiting homemaker service is particularly of good quality. Difficulty in helping people with serious personality conflicts and advanced marital problems underlines the necessity for improvement of case work personnel, increased psychiatric orientation of staff, and revision of community psychiatric services. The role of the family agency in promoting family life education and in supporting all efforts for further family life in the community is emphasized by findings of the project which indicate the general need of people fbr better preparation for life. CHAPTER I SOCIAL CASE WORK AND THE FAMILY While the strain of living during the last twenty years or so has multiplied immeasurably the incidence of personal malad-justment, i t has also led to new interest in the study of human behaviour. The economist, the sociologist, the physician, the psychiatrist, the psychologist, and the social worker have a l l contributed to Increased understanding of the growth processes of the individual. The importance of the family in the development of the i n -dividual has been increasingly recognized. Before the advent of the'modern era" the family had a manifold function including the bestowal of status on i t s members, religious training, educa-tion, economic security and affection. To a great extent i t has been stripped of i t s multiple function. Affection-giving alone has Increased i n importance. On the successful discharge of this role largely depends the individual's ab i l i t y to face the problems of l i f e and to associate harmoniously with his fellows. Belief in the importance of the family is the meeting-point between the sociologist and the psychiatrist. The discoveries about human behaviour which have been advanced in the last gene-ration, particularly by Freud, Rank, Adler, Jung and others, have emphasized the v i t a l r o l e played by the f a m i l y i n human personal and s o c i a l development. As described by the psychoanalysts, the human p e r s o n a l i t y i s a complex l i v i n g organism that from b i r t h to interment i s i n f l u e n c e d by, and i n f l u e n c e s , h i s environment i n c l u d -in g h i s f a m i l y and those persons w i t h whom he comes i n contact d u r i n g h i s l i f e t i m e . The body, the mind, and the emotions, are seen as elements i n the human organism, i n t e r a c t i n g and c o - o r d i -n a t i n g , one w i t h another, each growing.toward an accepted norm of ma t u r i t y . The i n d i v i d u a l i s expected to grow u n t i l he i s capable of d i s c h a r g i n g the p h y s i c a l demands made on the a d u l t , whether i n work or pl a y . Mental r e q u i s i t e s p a r a l l e l the p h y s i c a l . The psy-c h o l o g i s t has developed f a c i l i t i e s f o r the measurement of i n t e l l i g -ence which, although l i m i t e d i n p o s i t i v e u s a b i l i t y , at l e a s t can be h e l p f u l i n judging the i n t e l l e c t u a l c a p a c i t y of the i n d i v i d u a l , iimotional m a t u r i t y connotes the a b i l i t y to accept the normal o b l i g -a t i o n s of adulthood and to car r y out the d u t i e s of the spouse, the parent and the c i t i z e n . I t embraces the a b i l i t y to accept l i f e w i t h i t s joys and i t s sorrows, to'make d e c i s i o n s and to act on them, and to l i v e i n peace f u l a s s o c i a t i o n w i t h one's neighbors* With t l . o Important d i f f e r e n c e s f o r the two sexes, but profound-l y f o r both boys and g i r l s , the q u a l i t y of the r e l a t i o n s h i p w i t h each of the parents, and the degree of acceptance and a f f e c t i o n that the c h i l d r e c e i v e s from i t s parents, i n f l u e n c e s a l l l a t e r development. The successive age periods of the i n d i v i d u a l i n growth from infancy to adulthood, a l l make t h e i r c o n t r i b u t i o n to the s a t i s f a c t o r y development of the b i o l o g i c a l and other d r i v e s ; i n g e n e r a l , the attainment of the ca p a c i t y to face l i f e , to enjoy 2 i t , and to a s s o c i a t e f r e e l y w i t h others. Not only the observable f a c t o r s i n development are important; the subtle-and hidden Influences are of paramount i n t e r e s t . A person may never' be f u l l y aware of some of the f a c t o r s a f f e c t i n g h i s conduct. W i t h i n the i n d i v i d u a l operate three f o r c e s for.which must be achieved a happy equilebrium. In Freudian terminology, the i d represents the n a t u r a l a p p e t i t e s . .xhe ego connotes the inner personal strengths that w i l l determine the a b i l i t y to c o n t r o l these v a r i o u s impulses. The. super-ego i s the • individual''s standard of behaviour, u s u a l l y s t r o n g l y a f f e c t e d by the moral code ind i g i n o u s to h i s n a t i v e • c u l t u r e , and serves to guide him i n the c o n t r o l of . . the i d by the ego. These components of- the"emotional element i n the p e r s o n a l i t y are aided or impeded i n s t r i v i n g f o r a healthy balance through the i n f l u e n c e s of r e l a t i o n s h i p between the c h i l d and others i n h i s environment, e s p e c i a l l y h i s parents, and upon h i s experiences i n l i v i n g . Thus, f a i l u r e of h i s parents to f u l f i l t h e i r r o l e s , disturbance of the f a m i l y environment by clashes between parents and other members, i l l n e s s , i n j u r y , p a i n , poverty or jindulgence may adversely a f f e c t the growth of the i n d i v i d u a l . . -The natural" endowments of each human being that determine .the nature of h i s response to l i f e s i t u a t i o n s , the p a r t i c u l a r character p f the r e l a t i o n s h i p s i n h i s f a m i l y , and e a r l y development d i f f e r e n t i -ate him from a l l other beings. p s y c h i a t r y has devised methods of diagnosing the emotional i l l s of d i s t u r b e d people and has developed treatment methods featured by the Interview i n which the c o n f l i c t s deeply entrenched i n the unconscious are brought to the surface where the p a t i e n t can view them' i n t h e i r true p e r s p e c t i v e and be helped to undergo.a.re-3 education of h i s emotions. In recent years t h i s a p p l i e d science has given i n c r e a s i n g a t t e n t i o n to the p o s s i b i l i t y of c o n s t r u c t i v e and preventive work w i t h the more "normal" people by boosting t h e i r strong p o i n t s i n order to help them become complete and contented persons. The S o c i a l Work P r o f e s s i o n Social'work s t r i v e s to u t i l i z e the f i n d i n g s of these sciences by i n c o r p o r a t i n g t h i s knowledge i n t o a set of d i s c i p l i n e s that have f o r t h e i r object the f u r t h e r i n g of the i n d i v i d u a l betterment and the promotion of sound s o c i e t y * Gordon Hamilton has s t a t e d very simply the broad i n t e r e s t s of s o c i a l work; ^ •' "Reduced to a simple statement t h i s enormous area can be compassed w i t h i n two major f i e l d s and two major o b j e c t i v e s of s o c i a l work, namely, economic w e l l - b e i n g or a h e a l t h and decency standard of l i v i n g , and s a t i s f y i n g s o c i a l r e l -a t i o n s h i p s . Probably a l l p r o f e s s i o n s would sta t e an i n t e r e s t i n these' o b j e c t i v e s , but there i s l i t t l e doubt that s o c i a l work occupies a p a r t i c u -l a r l y i n c l u s i v e p o s i t i o n i n regard to both, x-or the s o c i a l worker the problems i n v o l v e d i n econ-omic w e l l - b e i n g and s o c i a l behaviour are u s u a l l y interwoven. I t i s t h i s e s s e n t i a l l y d u a l ! s t i c r e l -a t i o n s h i p which c o n s i s t e n t l y has shaped s o c i a l work and g i v e n . i t i t s d i s t i n g u i s h a b l e I f not yet wholly d i s t i n c t i v e p a t t e r n . " • S o c i a l work has maintained " t h i s e s s e n t i a l l y d u a l i s t i c r e l a t i o n s h i p " i n the development of these separate but i n t e r -dependent processes. Best known of these i s s o c i a l case work. The second-development, s o c i a l group work, has evolved since. 1. Gordon Hamilton, Theory and P r a c t i c e of S o c i a l Case , YS'hiit Work, New York, N. Y. P. 4 4 the m i d - t h i r t i e s . I t recognizes the importance to man of h i s c o l l e c t i v e associations', and Is d i r e c t e d toward the h e l p i n g him' to use h i s l e i s u r e - t i m e advantageously i n j o i n t a c t i v i t y w i t h others, so that he can' accommodate hi m s e l f b e t t e r to the group l i f e that i s the hall-mark of modern s o c i e t y . <_ The r e a l i z a t i o n that the success of these processes was l i m i t e d by the r e s t r i c t i o n s of.enviroment and'the presence of major s o c i a l needs l e d to the e v o l u t i o n of a. t h i r d process, the aim of which i s to secure m o d i f i c a t i o n of environmental r e s t r i c t -ions and meeting of s o c i a l needs.''This i s community o r g a n i z a t i o n which i s concerned with the use of s o c i a l resources, i n c l u d i n g l e a d e r s h i p , to meet common human needs. I t recognizes the import-ance of the i n t e r - r e l a t i o n s h i p s between the va r i o u s groups w i t h i n a community and uses these i n t e r - r e l a t i o n s h i p s - to secure u n i f i e d a c t i o n w i t h i n a community f o r the meeting of s o c i a l needs, r'or example, i n a community l a c k i n g proper r e c r e a t i o n . f a c i l i t i e s a number of groups might combine f o r a c t i o n to o b t a i n one of school b u i l d i n g s f o r this- purpose. I t would be expected that r e c r e a t i o n agencies, f a m i l y &nd c h i l d r e n ' s agencies, c o u n c i l of s o c i a l agencies, sex-vice c l u b s , parent teachers a s s o c i a t i o n s , and other i n t e r e-steu groups- might combine t h e i r e f f o r t s i n a campaign to induce the educational a u t h o r i t i e s ; to.-permit use of the school f o r r e c r e a t i o n a l purposes. -.-: The v e h i c l e of community o r g a n i z a t i o n may'be the c o u n c i l of s o c i a l agencies, p r o f e s s i o n a l a s s o c i a t i o n s , s o c i a l work conferences - r - indeed, any s o c i a l w e l f a r e o r g a n i z a t i o n that can co n s c i o u s l y a ct f o r the meeting of welfare needs. Thus, the s o c i a l agency w i t h a primary s o c i a l case work or s o c i a l group 5 work purpose, may a l s o p a r t i c i p a t e I n s o c i a l a c t i o n to meet needs i n i t s own p a r t i c u l a r f i e l d of i n t e r e s t . "Community" i s a term v a r i o u s l y used i n s o c i a l work w i t h many d i f f e r e n t meanings\ a geographical area, members of a r e l i g i o u s . denomination or p o l i t i c a l p a r t y , or, simply a group, of persons having a common i n t e r e s t . S o c i a l Case Work. Mary Richmond i n s o c i a l Diognosis enumerated the b a s i c p r i n c i p l e s of s o c i a l case work as f o l l o w s : 1. The importance of i n d i v i d u a l d i f f e r e n c e s i n peoplej 2. The concept of case work as a democratic process, r e c o g n i z i n g the i n d i v i d u a l r i g h t s of the c l i e n t to p a r t i c i p a t i o n and s e l f -d etermination; 5. The interdependence of I n d i v i d u a l s ; -4. The s p e c i f i c nature of the " r e l a t i o n s h i p " between worker and c l i e n t . These tenets have proved of v i t a l concern,- not only i n the d e f i n i t i o n oi' " s o c i a l diagnosis'' but l a t e r ' i n ' the a r t i c u l a t i o n of treatment. The understanding which p s y c h i a t r y threw on the - case work r e l a t i o n s h i p was of p a r t i c u l a r moment i n the development of treatment methods. A l l these c o n s i d e r a t i o n s were r e l a t e d to the o b j e c t i v e s of s o c i a l c asework, as l a t e r stated-'by Miss Richmond i n a d e f i n i t i o n that has won unchallenged acceptance by p r a c t i t -i oners since her time. " S o c i a l case work c o n s i s t s of. those processes which d e v e l o p . p e r s o n a l i t y through adjustments c o n s c i o u s l y e f f e c t e d — b e t w e e n men and t h e i r s o c i a l environment." 1 - . 1. Mary.Richmond, What Is S o c i a l Case Work. R u s s e l l Sage . -Foundation, i\iew York 1922, t. 98. • 6 The a r t i c u l a t i o n of the treatment methods d i r e c t e d to the achievement of t h i s g o a l r e s u l t e d from two important events,- both o c c u r r i n g w i t h i n the l a s t twenty years. The f i r s t was the launching of p u b l i c a s s i s t a n c e programmes i n the 1950' s j the second a. new r e l a t i o n s h i p between s o c i a l case Work and p s y c h i a t r y i n the same period-. 1 The .adoption of • p u b l i c a s s i s t a n c e measures was r e l a t e d to. the e a r l y concept of s o c i a l case ./ork as " s o c i a l therapy".^ This method was used " i n s i t u a t i o n s where causation l i e s i n the e x t e r n a l environment"' 3 as f o r i n s t a n c e , l o s s of income through i l l n e s s or'unemployment. The tr a n s f e r , of t h i s f u n c t i o n to p u b l i c auspices l e f t to t h e v o l u n t a r y agencies the opportunity to employ the second method, "psychotherapy", which " i s designed to b r i n g about some m o d i f i c a t i o n of behaviour and a t t i t u d e s and r e s t s on a d i a g n o s i s of the r e l a t i o n s h i p between two p e o p l e — t h e ' t h e r a p i s t , and' the client'" who wants to be helped. "4 This method employs the knowledge of human behaviour acqu-i r e d through the d i s c o v e r i e s of p s y c h i a t r y . "The techniques i n v o l v e the development and use of the worker-c l i e n t r e l a t i o n s h i p , the use of ego strengths, understanding and use i n appropriate ways of the unconscious motivations manifested 1. L u c i l l e M. A u s t i n , "Trends In D i f f e r e n t i a l Treatment In S o c i a l Case Work." Jo u r n a l of S o c i a l Case Work, V o l . X X I X No. 6 June 1948, P. 205. 2. I b i d . P.• 205 3. Idem 4. Idem 7 i n the ego, the m o d i f i c a t i o n of d e s t r u c t i v e defenses and' the use of environment." 1 Recently three c l a s s e s of psychotherapy have been des c r i b e d . "Supportive" t h e r a p y 2 i s a method of t r e a t i n g . s i t u a t i o n s i n which the ego strengths are not s u f f i c i e n t l y strong to permit more than v e r b a l i z a t i o n of emotion. The sympathetic non-judgemental a t t i t u d e of the worker enables the c l i e n t to ex-press h i s f e e l i n g s . Work to b r i n g about environmental changes and s o c i a l s e r v i c e may be used. The mechanism of transference i n which the c l i e n t acts towards the worker as to a parent or a person i n a u t h o r i t y i s also used. "Intermediary" o r " e x p e r i e n t i a l " therapy^ i s the second method, the worker c o n s c i o u s l y u s i n g the c l i e n t ' s acceptance of him as an a u t h o r i t y to h e l p the c l i e n t modify h i s a t t i t u d e towards a u t h o r i t y and thus to r e c o n s t i t u t e h i s whole sense of values and h i s place i n the s o c i a l m i l i e u . The t h i r d method " I n s i g h t Therapy" 4 i s d i r e c t e d to the h e l p of the r e l a t i v e l y s trong person and i s most n e a r l y a k i n to p s y c h i a t r y , being d i f f e r -e n t i a t e d from i t by the f a c t that i t t r e a t s disturbances comparative l y c l o s e to the consciousness that can be e a s i l y brought to the surfac e . A second school of thought on the nature of s o c i a l case work f i n d s expression i n the " f u n c t i o n a l approach". I t s adherents, 1. A u s t i n Op c i t P. 205 2. I b i d P. 206 3. I b i d P. 207 4. - I b i d t. 210 8 although they r e l y on the p s y c h i a t r i c base, h o l d that the f i r s t type? °r generic case work, Impinges on p s y c h i a t r i c p r a c t i c e and moves .away from the s o c i a l work . f i e l d proper. They f i n d that . i n diagnosing tne whole p e r s o n a l i t y , generic case workers deny the c l i e n t the r i g h t of s e l f - d e t e r m i n a t i o n . Instead, they b e l i e v e , the f a m i l y case worker- snould accept the c l i e n t as he comes to the agency, and help him d e a l w i t h h i s problems tnrough the m o b i l i z a t i o n of h i s own i n t e r n a l s t r e n g t h s . Divergent as are these two views, of recent date there have been n o t i c e a b l e e f f o r t s to ..reconcile them. 1 Despite the vast d i f f e r e n c e s between the two approaches, there are wide areas of agreement and today there are signs-of a p r o f e s s i o n a l r e s o l u t i o n of t h i s c o n f l i c t that w i l l i n time r e s u l t i n new strengt h and sureness, making f o r i n c r e a s i n g l y e f f e c t i v e -use of the s o c i a l case work process. -Fee Se r v i c e s The i n f l u e n c e of p s y c h i a t r y I n both approaches to s o c i a l case work has c o n t r i b u t e d to a broadening .of the c l i e n t e l e . As modern s o c i a l case work can help those who have needs, p h y s i c a l , economic, or emotional, i t concerns the whole community. The enl a r g i n g of the' area of competence has made i t p o s s i b l e f o r 1. The " f u n c t i o n a l approacn" has been discussed i n such a r t i c l e s as: Kenneth L.- M. Pray, "A Restatement of tne Generic • P r i n c i p l e s of S o c i a l Case Work P r a c t i c e ' 1 , J o u r n a l of  S o c i a l Case ftork V o l . XXVIII, No.8, Oct. 1947, P. 283^-90; Florence S y t z , "The Development of Methods I n S o c i a l Case work" J o u r n a l of S o c i a l Case Work V o l . XXIX, No.3, P.83-88 Grace F. Marcus, "Family Case Work In 1948" Jo u r n a l of S o c i a l Case Work V o l . XXIX No. 7, P. 261-79. 9 many agencies to cnai>ge fees f o r t h e i r s e r v i c e s to those able to pay, thus x-emoving the t r a d i t i o n a l stigma a s s o c i a t e d w i t h seeking and accepting help from s o c i a l workers,; S o c i a l Case Recording. As the present study i s l a r g e l y based on the reading of case records some comment on the technique of s o c i a l case record-i n g i s p e r t i n e n t . S o c i a l case re c o r d i n g i n the beginning was l a r g e l y a t a b u l a t i o n of v i t a l s t a t i s t i c s and f a c t u a l i n f o r m a t i o n and observation about the c l i e n t ' s and f a m i l i e s concerned*. Generally speaking, the re c o r d i n g of i d e n t i f y i n g data, commonly termed "face sheet i n f o r m a t i o n " ^ i s s t i l l important. Yet r e l a t i o n s h i p s have become so v i t a l to s o c i a l d i agnosis and s o c i a l treatment that r e c o r d i n g of the communications between c l i e n t and worker may take precedence over the t a b u l a t i o n of the more qu a n t i t a t i v e , data, sometimes even to the e x c l u s i o n of c e r t a i n f a c t u a l m a t e r i a l . There may be variance between'the re c o r d i n g c r i t e r i a f o r s o c i a l research and the r e c o r d i n g of the s o c i a l case work process. This discrepancy has made f o r c e r t a i n d i f f i c u l t i e s i n the present study. Family Case Work. I t was n a t u r a l that the f a m i l y agency, e s t a b l i s h e d f o r the promotion of success f o r f u n c t i o n i n g of the f a m i l y , should be i n the f o r e - f r o n t of the. advancement of s o c i a l case work methods..-Successor to the " c h a r i t y o r g a n i z a t i o n s o c i e t y " , i t has been i n t i m a t e l y a s sociated w i t h the h i s t o r y of e f f o r t s to improve' 1. See sample face sheets used by a f a m i l y agency i n Appendix A* 10 f a m i l y ' l i f e , both by i n d i v i d u a l treatment and; by f o s t e r i n g com-munity a c t i o n f o r the welfare of the f a m i l y . Today across t h i s c ontinent some 200 f a m i l y agencies having membership i n the Family S e r v i c e A s s o c i a t i o n of America share the r e s u l t s of t h e i r e f f o r t s i n developing treatment, and co-operation i n the promotion of . improved f a m i l y l i v i n g . THE FAMILY- 'WELFARE tSUKEAu , . . . . OF GREATER VANC 0 OVflh, b . C . S e t t i n g . I n Vancouver, B. G., a f a m i l y agency has been providing" case work s e r v i c e s since February 20, 1928. I t serves a community that has grown from a small c i t y of 120,000 p o p u l a t i o n i n 1928 to the t h i r d l a r g e s t c i t y i n the Dominion of Canada, w i t h a population approximating 400,000; a t h r i v i n g seaport, i n d u s t r i a l : and business m e t r o p o l i s . The Bureau serves i n a d d i t i o n to Vancouver, three l a r g e suburban communities, w i t h d i s t r i c t o f f i c e s I n each. Family Welfare I n Canada 1928. At the time t h i s agency was e s t a b l i s h e d as the C e n t r a l Welfare Bureau I n 1928, the f a m i l y w e l f a r e movement i n Canada was repres-ented by ten agencies, the o l d e s t of which had been i n existence since the turn of the century.^- These agencies g e n e r a l l y were preoccupied, w i t h the meeting of economic need. This was p a r t i c u l a r l y true I n Montreal and Toronto, the two l a r g e s t c i t i e s i n Canada* i 1. G. B. Clarke,"Twenty E i g h t h Annual Report',' Family Welfare. A s s o c i a t i o n of Montreal, Welfare Work i n Montreal I n 1928. Montreal i?P. 112-118.-11 The statement of the object of the Family Welfare A s s o c i a t i o n of Montreal r e f l e c t e d t h i s primary concern: MTo r e l i e v e poverty among P r o t e s t a n t s by securing adequate a s s i s t a n c e ; to attempt to ease i t by sympathetic, "Grained, i n t e l l i g e n t s e r v i c e and to prevent i t by a c t i v e , c o n s t r u c t i v e work." 1 One agency i n a smaller c i t y , Hamilton, u nt.,•came c l o s e s t to r e j e c t i n g the r e l i e f g i v i n g r o l e . ' Included i n the statement of i t s purpose was s t i p u l a t e d . "The non-granting or r e l i e f even of a temporary nature from subscribed f u n d s " 2 E s t a b l i s h i n g Of The Vancouver Family Agency. Conditions i n Vancouver i n 1923 were p a r t i c u l a r l y favourable f o r the i n a u g u r a t i o n of a v o l u n t a r y f a m i l y welfare programme. Un-l i k e the f i r s t two c i t i e s of Canada, Vancouver had already e s t a b l i s h e d a r e l i e f department and d i d not expect i t s f a m i l y agency to be a dispenser of f i n a n c i a l a i d . On the c o n t r a r y , tne events that in-, s p i r e d the formation of the agency concerned the immaterial needs of the community. In 192? s e r v i c e clubs and p u b l i c - s p i r i t e d c i t i z e n s saw the need f o r an assessment of the c h i l d welfare s e r v i c e s i n the community. The r e s u l t was the f i n a n c i n g of the B r i t i s h Columbia C h i l d Welfare Survey, conducted by s o c i a l work leaders from other parts of. Canada. \ The survey revealed that c h i l d - c a r i n g workers were being hampered i n the execution of t h e i r work by the f a c t that there was l i t t l e or no e f f o r t being made to help the f a m i l i e s of tne c h i l d r e n they were s e r v i n g i The Survey s t a t e d . t h i s need thus: 1. C l a r k e , Op. P i t . p . ..112. • 2.. "A Twentieth M i l e s t o n e " , Canadian Welfare V o l . XIX No. 2, r . 24 June 1943 12 "While the Survey has been p r i m a r i l y concerned w i t h care and p r o t e c t i o n of c h i l d r e n and hence e s p e c i a l l y w i t h o r g a n i z a t i o n s formed to c a r r y out t h i s purpose, there i s a s e r v i c e which i s so fundamental to the c a r r y i n g on of any s o c i a l work -v/ith s p e c i a l i z e d groups, uhat some a t t e n t i o n must be given to the ' f a c i l i t i e s that e x i s t f o r rendering t h i s s e r v i c e , we have reference to family welfare work, f a m i l y case work to use a t e c h n i c a l term."! This Intimate connection of f a m i l y work w i t h c h i l d welfare continued through tue establishment of the C e n t r a l Welfare Bureau and nas remained a primary concern of the agency* The maintenance of t h i s r e l a t i o n s h i p and the concern w i t h c h i l d r e n ' s problems has been but one side of a broad I n t e r e s t i n treatment of problems other than f i n a n c i a l . Evidence of t h i s i n t e r e s t has been the c o n s i s t e n t r e l i a n c e on the resources of the Family S e r v i c e A s s o c i a t i o n of America, which i t joined i n the i n -augural year, and c e r t a i n other events i n agency h i s t o r y such as adopting the present d e f i n i t i v e t i t l e , Family Welfare bureau i n 1931.^ Adherence to t h i s purpose i s seen-in the work of the Bureau i n "normal" times as w e l l as the periods of major catastrophe. During the depression years as governments assumed respons-i b i l i t y f o r r e l i e f , the Bureau l i k e many other p r i v a t e f a m i l y agencies, became f r e e to d e a l w i t h emotional and personal needs of i n d i v i d u a l s and f a m i l i e s . The D i r e c t o r ' s annual r e p o r t f o r 1933 d e s c r i b e d t h i s tr^nd as seen i n Ithose cases r e q u i r i n g i n t e n s i v e s e r v i c e . A f t e r p o i n t i n g out that the number of p e r s o n a l i t y and 1. Report, B r i t i s h Columbia C h i l d l w e l f a r e Survey Committee, Vancouver, B. C. 1927, F. 41. 2. G . F. Strong, M. D. E a r l y H i s t o r y of the Family Welfare Bureau. Read at the annual meeting of the Family Welfare Bureau of Greater. Vancouver, A p r i l 26, 1938. 1 0 . 13 behaviour problems t r e a t e d i n the preceding year had outnumbered the unemployment d i f f i c u l t i e s , the r e p o r t explained t h i s d i s t r i b u -t i o n : " I t i s n a t u r a l that the p e r s o n a l i t y and behaviour d i f f i c u l t i e s would be most frequent i n a p r i v a t e f a m i l y agency whose purpose i s to care f o r those f a m i l i e s where problems other than l a c k of means of subsistence seem uppermost. r t l This focus of agency purpose and a c t i v i t y continued through the worst years of the depression. The D i r e c t o r ' s Report f o r 1936 defines the agencie;'s p o s i t i o n even more c l e a r l y than that of 1933; "In f r e e i n g from a crushing burden of r e l i e f , t h i s has allowed agencies under p r i v a t e auspices.... to d i r e c t t h e i r e f f o r t s to a more comprehensive approach to f a m i l y problems.. .Nov/ r a t h e r than t r y i n g to develop our s k i l l i n c l e v e r q uestioning, we w i l l t r y to see the deep emotional s i g n i f i c a n c e of what they t e l l u s . , i 2 During the Second World War t h i s Some emphasis was preser-ved i n the agency f u n c t i o n . The D i r e c t o r i n g i v i n g an account of.her stewardship i n 19^5 s t a t e d : "We must mai n t a i n our perspective i n c o n s i d e r i n g the importance of the i n d i v i d u a l i n the changing s o c i a l scene-. The war i s threatening the destruc-t i o n of groups and, consequently, we tend to lose ourselves as i n d i v i d u a l s i n a group e f f o r t to pro-t e c t what i s threatened. We have t r i e d to remember, i n s p i t e of tne demands of war time c o n d i t i o n s , that a f a m i l y agency gives s p e c i a l a t t e n t i o n to the p r e s e r v a t i o n of those" strengths and values i n f a m i l y l i f e which have the.greater s i g n i f i c a n c e f o r f a m i l y u n i t y and f o r i n d i v i d u a l growth. Problems of C l i e n t s From the i n f o r m a t i o n a v a i l a b l e on the reasons people have 1. Family Welfare Bureau, D i r e c t o r ' s Report, Vancouver, B.C. A p r i l 27, 1933 PP. 9-10. . 2. - Family Welfare Bureau of Greater Vancouver, D i r e c t o r ' s Report, A p r i l 29, 1936. Vancouver, B. C. 10. 3.. Family Welfare Bureau of ureater Vancouver, D i r e c t o r ' s Report, Vancouver, B. C. A p r i l 29, 1943. 7 14 come to the agency, i t i s apparent that t h i s gospel of s e r v i c e i n the area of personal d i f f i c u l t i e s has been l i v e d as w e l l as preached.- As e a r l y as 1953 the g r e a t e s t number of i n t e n s i v e s e r v i c e cases were c h a r a c t e r i z e d by problems of a personal .or r e l a t i o n s h i p nature,-*- such as behaviour d i f f i c u l t i e s of c h i l d r e n , m a r i t a l c o n f l i c t and p a r e n t - c h i l d d i f f i c u l t i e s . The incidence of economic problems dropped from approximately 25% i n 1933, to 27% i n 1936, to 6 ft i n 1948. 2 An upsurge i n problems of t h i s order during the War years was abnormal, a t t r i b u t a b l e to the rendering of h e l p , by agreement and c o n t r a c t w i t h the F e d e r a l Government, to dependents of servicemen, r e q u i r i n g dependents and contingent a i d . I t i s i n t e r e s t i n g ! t o l n o t e that the agency was f r e q u e n t l y able to o f f e r h elp i n a r e a s - a d d i t i o n a l to the s p e c i f i c request. :• besides s e r v i c e i n economic and personal problems the oureau has throughout i t s existence o f f e r e d help i n problems as s o c i a t e d w i t h h e a l t h , both p h y s i c a l and mental, and w i t h s o c i a l c o n d i t i o n s such as housing. . The C l i e n t s The number of people b r i n g i n g t h e i r d i f f i c u l t i e s to the f a m i l y agency has g e n e r a l l y i n c r e a s e d , w i t h some v a r i a t i o n s be-cause of the e x t r a v^ork during' the war. years. In the f i r s t year of operation 135 f a m i l i e s were helped, i n the tenth year 1899 and- i n 1947-48 the f i r s t post-war year, 1935. 1. Family Welfare joureau, d i r e c t o r ' s Report, 1933. 9-10. 2. . .family Welfare Bureau of Greater Vancouver, Annual .Ueports 1933, 1936, 1948. ~~ 15 Inasmuch as the Family Welfare Bureau was e s t a b l i s h e d to f i l l such a deeply f e l t need I n the area, and, since the philosophy that has governed i t has been based on the concept of the v i t a l r o l e of a f a m i l y agency i n the l i f e of the community, i t would be i n t e r e s t i n g to know the range of people served. U n f o r t u n a t e l y there are no s t a t i s t i c s a v a i l a b l e to show the coverage. This can only be judged, admittedly without great accuracy, from c e r t a i n f a c t s and observations. 16 CHART I PERSONAL SERVICE AND RELIEF 1929-48 (Inclusive) K •a FAMILY WELFARE BUREAU OF GREATER VANCOUVER, B. C. Personal Service R e l i e f . 23 99 OP — I N . "'3 o to b-&<f fa fa iy* /si M />3r V n 0» i V 1 | 'ffo N. M 1 i N IN N i t A Hi «4. 17 re1 I t i s s i g n i f i c a n t , f o r i n s t a n c e , that throughout the years the number of r e l i e f cases has been much fewer than of the non-r e l i e f cases. (Chart I) That i s not to say, however, that those who have not r e q u i r e d f i n a n c i a l a s s i s t a n c e have been people whose incomes have ranged from small to l a r g e . The evidence of e n v i r -onmental problems would i n d i c a t e t h a t the c l i e n t e l e represents mostly those f a m i l i e s i n the lower-income bracket. C e r t a i n l y the cases examined i n the present study, which are f a i r l y r e p res-e n t a t i v e of the c l i e n t e l e , tend to support t h i s contention. I t has been observed that r e c e n t l y , ' e s p e c i a l l y since the War, people from the more p r i v i l e g e d groups, are beginning to use the s e r v i c e s of the agency, whereas a very few years ago they would not have considered so doing. In t h i s connection, the i n c r e a s i n g number of people wishing-to pay f o r s e r v i c e i s s i g n i f i c a n t . Yet i t should not be assumed that the expression of t h i s d e s i r e i s a l t o g e t h e r the r e s u l t of increased knowledge of mental hygene and c o u n s e l l i n g s e r v i c e s . Rather i t must be borne i n mind that greater employment and l a r g e r incomes make i t p o s s i b l e f o r more people to consider paying f o r s e r v i c e . Case Work Se r v i c e s . From the very beginning the Family Welfare Bureau of Greater Vancouver has maintained a keen i n t e r e s t i n the advancement of s o c i a l case work, C o n s i s t e n t l y the agency has t r i e d to i n c o r p o r -ate the best techniques of p r a c t i c e i n t o i t s s o c i a l case work s e r v i c e s . There has been a growing awareness of the presence of the emotional problems of l i f e and an attempt to use t h i s new knowledge f o r the b e n e f i t of i t s c l i e n t s . Treatment might be d e s c r i b e d as being at the half-way mark between environmental 18 methods and psychotherapy. The keen awareness of the p l a c e of the f a m i l y agency In the community backed by a profound p h i l o s -ophy of purpose has a t times g i v e n the work of the bureau c e r t a i n aspects i d e n t i f i e d with the " f u n c t i o n a l approach". Yet, p r i m a r i l y , the agency has based i t s work on the p r i n c i p l e s enunciated by the proponents o f . " g e n e r i c case work". To s t r e n g t h e n case work s e r v i c e s the agency has developed c e r t a i n s p e c i f i c resources.Among these .is i n c l u d e d " l e g a l a i d " , t h a t i s , the s e c u r i n g of f r e e l e g a l h e l p In a p p r o p r i a t e cases, the c o u n s e l always being r e l a t e d to the . p r i n c i p l e s of s o c i a l case y/ork as they are a p p l i e d i n such s i t u a t i o n s . A second agency f a c i l i t y i s the s u p e r v i s e d home maker s e r v i c e . T h i s s e r v i c e p r o v i d e s u b s t i t u t e mothers, u s u a l l y when the n a t u r a l mother i s away from her f a m i l y because of i l l n e s s ; i t has a l s o been used f o r more con-s t r u c t i v e purposes, such as, h e l p i n g a mother to l e a r n household d u t i e s and thus r e l i e v e s t r e s s which her.seeming i n a b i l i t y i n t h i s sphere may have c r e a t e d . The most r e c e n t l y added s e r v i c e i s the p s y c h i a t r i c c o h s u l a t i o n which c o n s i s t s of p e r i o d i c review of d i f -f i c u l t cases w i t h p s y c h i a t r i s t s from the p r o v i n c i a l government s e r v i c e s . The case work s t a f f has always been s e l e c t e d w i t h due r e g a r d to e d u c a t i o n a l q u a l i f i c a t i o n s and experience. The Board of D i r e c t o r s of the C e n t r a l Welfare B u r e a u . i n s i s t e d that the d i r e c t o r whom they would appoint must be t r a i n e d , w i t h e x p e r i e n c e . They a l s o s t i p u l a t e d that a l l l a t e r appointees to the case work s t a f f would have to be graduates of a s c h o o l of s o c i a l work. In May 1931 the f i r s t s o c i a l s e r v i c e diploma graduates from the U n i v e r s i t y of . B r i t i s h Columbia new s o c i a l work course were 19 engaged. Since that time about f o r t y diploma graduates have been on the r e g u l a r s t a f f . The war f o r c e d a departure from the r u l i n g that no untrained, workers should be employed,. I n 1942 when the agency undertook s p e c i a l i n v e s t i g a t i o n s f o r the Fed e r a l Government, "case work aides were engaged. These and those employed.in 1945, 1944 and 1945 a l l r e c e i v e d some " i n - s e r v i c e t r a i n i n g " . C u r r e n t l y only one worker has not a diploma and no new workers w i l l be employed unless they have at l e a s t one year at a school of s o c i a l work. As yet few grad-uates of two year courses have been engaged. . Since 1940, there has been always, at l e a s t one s t a f f member w i t h s p e c i f i c p s y c h i a t r i c t r a i n i n g and experience.. The agency i t s e l f has been assiduous i n promoting the profes-s i o n a l development of s t a f f . P a r t i c i p a t i o n i r i educational " i n -s t i t u t e s " and s p e c i a l courses has always been encouraged. Super-v i s o r s have been r e q u i r e d to attend c e E t a i n of these i n s t i t u t e s . • The-high r a t e of s t a f f "turnover" which has been common to n e a r l y a l l f i e l d s of s o c i a l work, e s p e c i a l l y w i t h i n recent years has a f f e c t e d t h i s agency as much as most othe r s . The"Bureau has been f o r t u n a t e , however, i n r e t a i n i n g a-few key s t a f f members over a f a i r l y long p e r i o d of yea r s . This-core of r e l a t i v e l y permanent s t a f f members has l e n t s t a b i l i t y to the agency-. The t o t a l number of case workers today v a r i e s from f i f t e e n to nineteen. Community Resources. In a d d i t i o n to the Bureau, there are i n Vancouver a Jewish and a G a t h o l i c f a m i l y agency. Unfortunately n e i t h e r has adequate s t a f f . . C h i l d r e n ' s s e r v i c e s includes a non-sectarian and a C a t h o l i c 20 agency, both doing preventive work w i t h f a m i l i e s as w e l l as c h i l d placement.. Group work agencies i n c l u d e Young Men's C h r i s t i a n A s s o c i a t i o n , Young Women's C h r i s t i a n A s s o c i a t i o n , s e v e r a l community centres, and boys' clubs.. P r i v a t e h e a l t h agencies i n c l u d e the V i c t o r i a n Order of Nurses., a v i s i t i n g nurses o r g a n i z a t i o n which provides both bedside nursing ..and p u b l i c h e a l t h n u r s i n g . The a c t i v i t i e s of the voluntary agencies, since 1930, have been co-ox->dinated through a c o u n c i l of s o c i a l agencies, and j o i n t l y f i n a nced through a community fund. F a i l u r e of Community Chest to reach i t s o b j e c t i v e s i n f i n a n c i a l campaigns, e s p e c i a l l y i n recent years,, has r e s u l t e d i n l i m i t i n g the work of p r i v a t e agencies. There i s a beginning of r e p r e s e n t a t i o n of p u b l i c agencies, c i t y and p r o v i n c i a l , on t h e - c o u n c i l . This should c o n t r i b u t e to improved s o c i a l p lanning. Among the p u b l i c h e a l t h and we l f a r e agencies, the c i t y r e l i e f department of 1928 has become a p u b l i c a s s i s t a n c e department render-i n g c a t e g o r i c a l a s s i s t a n c e to the needy r e s i d e n t s e x c l u s i v e of unemployed employables. . : Although the Dominion Government has acknowledged respon-s i b i l i t y f o r the t r a n s i e n t and-the.unemployed no p r o v i s i o n f o r d i r e c t r e l i e f to these groups has been made. Unemployment insurance w i t h a l i m i t e d but growing.courage, and an employment s e r v i c e to which i s attached s p e c i a l t r a i n i n g f a c i l i t i e s f o r workers, are both d i r e c t e d toward the prevention of f i n a n c i a l need among employ-able workers.. The F e d e r a l government has. taken considerable r e s p o n s i b i l i t y 21 f o r ex-servicemen. The S o c i a l Service S e c t i o n of tne Department of Veterans A f f a i r s i n cludes three d i v i s i o n s . There i s a r e f e r r a l s e r v i c e which d i r e c t s veterans who have s o c i a l and personal problems to. the appropriate e s t a b l i u h e d s o c i a l agencies. Secondly, there i s a d i v i s i o n f o r i n v e s t i g a t i o n i n the matters of veteran's a p p l i c a t i o n s to the Government f o r d i s a b i l i t y compensation and various allowances. T h i r d l y , there i s a medical and p s y c h i a t r i c s o c i a l work d i v i s i o n . C l o s e l y a l l i e d to these Federal s e r v i c e s f o r the veteran has Deen the work of a p r i v a t e c i t i z e n 1 committee f o r veterans which u n t i l r e c e n t l y took the r e s p o n s i b i l i t y of p r o v i d i n g emergency s h e l t e r f o r ex-servicemen and t h e i r f a m i l i e s . Community h e a l t h and medical f a c i l i t i e s i n c l u d e : p r o v i n c i a l p s y c h i a t r i c s e r v i c e , t u b e r c u l o s i s , and venereal disease c o n t r o l d i v i s i o n . These, and the general h o s p i t a l have s o c i a l s e r v i c e departments. A d d i t i o n a l h e a l t h and mental hygiene s e r v i c e s are sup p l i e d through the c i t y schools. The r e l a t i o n s h i p between the work of these agencies and the Family Welfare Bureau can be c l e a r l y seen i n the present study. THE OBJECTS OF THE PRESENT STUDY• The e f f e c t i v e n e s s of case work performance by the Family Welfare Bureau i s the subject f o r enquiry i n the present, study, From every standpoint i t i s important to evaluate the r e s u l t s of f a m i l y case work of the agency. The h i g h purpose of the f a m i l y agency w i l l permit of nothing but the best i n work performance.. I t i s o f ' c r i t i c a l importance to a s c e r t a i n the ca p a c i t y of the agency f o r promotion of s u c c e s s f u l f a m i l y l i v i n g , and to discover' wherein i t f a i l s or may not completely succeed. Only when t h i s 22 i n f o r m a t i o n i s a v a i l a b l e can a c t i o n by taken to secure a maximum of e f f i c i e n c y i n serving the f a m i l i e s of the community. As the agency depends on p u b l i c support i t must demonstrate to the community that i t merits that support. Accomplishment i s the best proof of the r e a l value of agency s e r v i c e s . Another major reason f o r e v a l u a t i o n of agency s e r v i c e s and cap a c i t y i s the p e r t i n e n t question of the place of the agency i n a community marriage and f a m i l y c o u n s e l l i n g and education prog-ramme. This i s a question of moment i n Vancouver e s p e c i a l l y ^ a s the auspices of such a programme has been the subject of considerable debate i n t h i s community.-The attempt to measure the e f f e c t i v e n e s s of f a m i l y case work s e r v i c e s of the r'amily e l f are oureau and the ca p a c i t y of the agency to provide to the community s e r v i c e f o r the advance-ment of fa m i l y l i f e i s based on a study of f i f t y - e i g h t f a m i l y cases t r e a t e d during the f i v e year period ending A p r i l 30, 1948. Chapter I I deals w i t h the review o f va r i o u s methods of assessing case work r e s u l t s which we're considered i n t r y i n g %o f i n d a s u i t a b l e measure f o r examination of the cases used i n t h i s study. Chapter I I I presents the device of measurement a c t u a l l y used. Chapters IV to V I I I i n c l u s i v e , describe the s o c i a l case work p r i n c i p l e s as a p p l i e d i n each of f i v e groups i n t o which the t o t a l number of cases was d i v i d e d . Chapter IX discusses the value of tne measure of e f f e c t i v e n e s s used i n the study, and summarizes the e f f e c t i v e n e s s of f a m i l y case work as seen i n the f i f t y - e i g h t cases. ihe ca p a c i t y of the agency f o r botti case work s e r v i c e s to i n d i v i d u a l s and f a m i l i e s and f o r community s e r v i c e s f o r the general improvement of 23 f a m i l y l i f e i s discussed. D e f i c i e n c i e s i n the agency and i n the other s o c i a l agencies i n the community that m i l i t a t e against s u c c e s s f u l f a m i l y case work are a l s o noted and recommendations f o r improvement of the agency and community programmes are made. .ihe challenge of l i v i n g i n the Twentieth Century has become the f a s c i n a t i n g study of the s o c i a l s c i e n t i s t s i n c l u d i n g : the economists, the s o c i o l o g i s t s , and p s y c h i a t r i s t s . Although the s o c i a l s c i e n t i s t s weight d i f f e r e n t l y the i n f l u e n c e s of environ-ment and p s y c h o l o g i c a l f a c t o r s on human s o c i a l development, a l l agree on the importance of the fa m i l y l i f e i n the growth of the i n d i v i d u a l . Most of the t r a d i t i o n a l f u n c t i o n s of the f a m i l y have been reduced during the "modern era". The a f f e c t i o n - g i v i n g r o l e , however, has been re-emphasized and r e - s t a t e d , e s p e c i a l l y by the p s y c h i a t r i s t s under the leade r s n l p of ij'reud, Jung and others. The psycho-analysts have presented the new concept of the human being as a complex dynamic organism, that i s a f f e c t e d by, and a f f e c t s h i s environment, i n c l u d i n g p a r t i c u l a r l y h i s f a m i l y and those w i t h whom he a s s o c i a t e s . The d i f f e r e n c e s i n the two sexes, e s p e c i a l l y i n the successive periods of growth d u r i n g childhood are seen as of v i t a l importance i n the maturation of the human being so that he can take the f u l l measure of h i s r e s p o n s i b i l i t y as an adult w i t h d u t i e s of c i t i z e n and parent. S o c i a l work has s t r i v e n to incorporate these d i s c o v e r i e s i n t o a p r o f e s s i o n a l p r a c t i c e w i t h two major o b j e c t i v e s , "economic we l l - b e i n g and s a t i s f y i n g s o c i a l r e l a t i o n s h i p s " . Three d i s t i n c t but r e l a t e d processes make up the p r a c t i c e of s o c i a l work. S o c i a l group work i s d i r e c t e d towards the h e l p i n g of the i n d i v i d u a l to 24 p a r t i c i p a t e i n the group l i f e that c h a r a c t e r i z e s modern society.. Community o r g a n i z a t i o n concerns i t s e l f w i t h the use of s o c i a l resources i n c l u d i n g community l e a d e r s h i p to meet common s o c i a l needs. The o l d e s t of these three d i s c i p l i n e s , s o c i a l case work' f i r s t a r t i c u l a t e d by Mary Richmond i n 1917, " c o n s i s t s of those processes which develop p e r s o n a l i t y through adjustments co n s c i o u s l y e f f e c t e d between men and t h e i r environment". The four basic p r i n c i p l e s of s o c i a l case work may be summarized as: i n d i v i d u a l i z a -t i o n of human beings, the r i g h t of the i n d i v i d u a l to p a r t i c i p a t e i n planning f o r h i s own e x i s t e n c e , the inter-dependence of i n d i v i -duals and the s p e c i f i c nature of the " r e l a t i o n s h i p " between worker and c l i e n t . As governments have assumed i n c r e a s i n g l y r e s p o n s i b i l i t y f o r d e a l i n g w i t h major s o c i a l problems and as p s y c h i a t r y has advanced i t s d i s c o v e r i e s about human behaviour, s o c i a l case work has moved from " s o c i a l therapy" to psychotherapy. The f a m i l y agency has been of prime importance i n .this development. The Family Welfare Bureau of greater Vancouver, from the beginning, has t r i e d to keep pace w i t h developments i n s o c i a l case work p r a c t i c e by the employment of q u a l i f i e d personnel a v a i l a b l e . The purpose of the present.study i s to estimate the success that has attended the e f f o r t s of the agency to advance i n d i v i d u a l and f a m i l y s o c i a l l i v i n g , to suggest improvements i n agency p r a c t i c e and community s o c i a l - work f a c i l i t i e s and to gauge the c a p a c i t y of the f a m i l y l i v i n g i n the community of which i t i s a p a r t . 25 CHAPTER I I ATTEMPTS TO MEASURE THE EFFECTIVENESS OF FAMILY CASE WORK The Importance Of Developing C r i t e r i a For Measurement Determining the soundness of p r a c t i c e i s v i t a l to the continued improvement of f a m i l y case work methods; E s t a b l i s h i n g r e l i a b l e c r i t e r i a f o r measuring the e f f e c t i v e n e s s of p r a c t i c e , t h e r e f o r e , i s of c r i t i c a l importance. This i s true now as i t always has been i n the h i s t o r y of f a m i l y case work i n i t s develop-ment from i t s rudimentary beginnings to i t s present advanced stage. The complex problems of i n d i v i d u a l and f a m i l y l i v i n g i n the present day and p e r s i s t e n t demands and f i n a n c i a l l i m i t a t i o n s i n s o c i a l w e l f a r e , r e q u i r e that a l l s k i l l s be employed s e l e c t i v e l y and w i t h the g r e a t e s t p o s s i b l e e f f i c i e n c y . ' Yet the quest f o r adequate means to evaluate r e s u l t s , f a r from being new, i s one of the o l d e s t concerns of f a m i l y case work and has encompassed a continuous e f f o r t to adapt the. s c i e n t i f i c regimen to examination oi' the soundness of the process. The d i f f i c u l t i e s i n v o l v e d i n applying the p r i n c i p l e s of science, to t e s t i n g the treatment of human behaviour and s o c i a l i l l s are obvious. The combinations and permutations of human t r a i t s make i t hard to f i n d anything resembling c o n t r o l l e d s i t u a -t i o n s . Yet, however v a r i o u s these c o m p o s i t i o n s t h e r e can be found c e r t a i n elements common to a l l human beings. The accepted concept's of family l i f e i n our s o c i e t y , of s o c i a l adjustment, and the median r a t e a of p h y s i c a l growtn, mental development and emotional maturation of the i n d i v i d u a l a l l f u r n i s h standards of a k i n d f o r the measurement o i e f f o r t s d e a l i n g w i t h human f a c t o r s . 26 Moreover, i t cannot oe assumed that a l l s u b j e c t i v e observation i s " p r e j u d i c e d ; p a r t i c u l a r l y i i . that judgment i s based on knowledge acquired through c a r e f u l study and v a r i e d experience. various Methods Of .flxaniining Performance The p r o f e s s i o n a l conscience of the f a m i l y case worker has f r e -quently provoked the question, "What good has my work done?" I t has been customary to seek - the answer JLn examination of performance through such devices as " s u p e r v i s i o n , " s u b j e c t i v e observation of changed i n d i v i d u a l and f a m i l y a t t i t u d e s of clients,re©reading of rec o r d i n g and estimates of success at time of terminating cases. Sometimes the worker has known the opportunity to r e v i s e t h i s e v a l u a t i o n when the c l i e n t or. another member of h i s f a m i l y has returned to the f a m i l y agency a f t e r . a p e r i o d to seek new servi c e s . S t a t i s t i c a l Methods of e v a l u a t i o n This i n d i v i d u a l i n t e r e s t , i n e v a l u a t i o n has f o a t e r e d and. stim-u l a t e d e f f o r t s by the p r o f e s s i o n a l body as a whole to develop sound methods of assessing the v a l i d i t y of f a m i l y case work. The h i s t o r y of t h i s development l a r g e l y has been a movement from r e l i a n c e on the e m p i r i c a l method to adoption of s c i e n t i f i c p r i n c i p l e s . Mary Richmond w i t h her S o c i a l . D i a g n o s i s provided a s t a r t i n g p o i n t f o r t h i s e v a l u a t i o n . S u c c e s s f u l treatment would imply e l i m i n a t i o n or m o d i f i c a t i o n of the problems concerned i n d i a g n o s i s . I t f o l l o w e d m a t, the e f f e c t i v e n e s s of treatment would be gauged In terms, then, of the e l i m i n a t i o n or m o d i f i c a t i o n of problems. Two d i f f i c u l t i e s asserted themselves i n the d e r i v a t i o n of these e v a l u a t i o n methods. Human nature being so highly v a r i a b l e , m o d i f i c a t i o n of problems would not n e c e s s a r i l y be permanent, and, the suDtle r e l a t i o n s h i p s between c l i e n t , worker and community, would make i t d i f f i c u l t to assess the r o l e of each i n meeting problems. These f a c t o r s were recognized when, i n 1929, the American A s s o c i a t i o n For Organizing Family S o c i a l Work, i n co-roperationLwith the R u s s e l l Sage Foundation, devised i n d i v i d u a l r a t i n g schedules f o r cases t r e a t e d by f a m i l y agencies. These schedules-*- took the form of cards on which were l i s t e d on one s i d e ; 6 9 problems ranging, from "unemployment- to " n o n - c i t i z e n s h i p , " and; on the other s i d e , 85 s e r v i c e s which might be rendered i n r e l a t i o n to these problems. These cards were used co n c u r r e n t l y w i t h the case records, the problems being checked monthly by the a c t i v e worker. Examination of the problems and the s e r v i c e s rendered would, to some degree, r e v e a l the success w i t h which the case had been t r e a t e d , and • purportedly would show the r a t e of progress through the r e d u c t i o n of problems, month by month. P e r i o d i c a l l y , I n the l i g h t of experience and newly-acquired knowledge of,human dynamics t h i s card was revised. In 1938 a new card was i n t r o d u c e d . 2 This c a r d , more^systemetized than the f i r s t , grouped the problems under various headingss "Economic," "Employ-ment," "Family R e l a t i o n s h i p s , " "Health" and " S o c i a l and Environ-mental." R e c o g n i t i o n of the p a r t i c i p a t i o n of the c l i e n t , the f a m i l y caseworker and the community was given i n the breakdown of the e v a l u a t i o n . The v a r i o u s r o l e s were taken i n t o account In t h i s wise: 1. Problems modified from agency standpoint; 1. Appendix B I 2. Appendix B I I 28 2,, Problems modified from c l i e n t standpoint; 5. Problems unmodified because of l i m i t a t i o n of case work resources w i t h i n the agency; 4.. Problems unmodified because of l i m i t a t i o n s ; i n community resources; 5.. Problems unmodified because of l i m i t a t i o n s of c l i e n t ' s c a p a c i t y . 'ih.ese charts have not o f t e n been used to f u l l advantage. Gen-e r a l f a i l u r e of f a m i l y case workers to r e a l i z e the value of such a r a t i n g system to them i n t h e i r d a i l y p r a c t i c e , and l a c k of leader-ship g i v i n g d i r e c t i o n to p r o f i t a b l e use of t h i s d e v i c e , probably account f o r t h i s n e g l e c t . Consequently the busy worker, unless possessed of unusual s t a t i s t i c a l i n c l i n a t i o n , has been prone to consider these cards as a hindrance r a t h e r than as a help to h i m — a necessary e v i l to be d e a l t w i t h h u r r i e d l y at the end of the month. Thus, the f a m i l y agency would s u f f e r from not being able to secure an adequate p i c t u r e of i t s work because of e v a l u a t i o n done i n haste. I t was unfortunate that the card d i d not f i n d greater favour as a means of t a b u l a t i n g r e s u l t s , e s p e c i a l l y w i t h the keen i n t e r e s t that developed i n the techniques of r e c o r d i n g which had as one important object the p r o v i s i o n of opportunity to examine per-formance. Experimentation has continued i n an e f f o r t to secure a quick metnod of e v a l u a t i o n wnich the f a m i l y case worker could use h a n d i l y . Recently the Family S e r v i c e A s s o c i a t i o n of America has introduced a new r a t i n g c a r d 1 of very simple form, d i v i d e d i n t o three p a r t s : 1~ Appendix " B ' l I I " 29 1. Problems Given I n d i v i d u a l C o n s i d e r a t i o n ; 2. S p e c i f i c Lacks or Inadequacies i n Com-munity Resources Which I n t e r f e r e d With Se r v i c e to Family or I n d i v i d u a l ; 5* E v a l u a t i o n at c l o s i n g * The proolems are simply divided- and checked out once. Evalua-t i o n at c l o s i n g i s checked under one of three heads. 1. Service enabled f a m i l y or i n d i v i d u a l to handle s i t u a t i o n b e t t e r ; 2» Service d i d not enable f a m i l y or i n d i v i d u a l to handle s i t u a t i o n b e t t e r ; 3. Unable to evaluate. The Evanston Study Various f a m i l y agencies have experimented w i t h methods of e v a l u a t i o n , sometimes using the N a t i o n a l A s s o c i a t i o n c r i t e r i a , some-times d e v i s i n g t h e i r own. One e a r l y attempt to measure r e s u l t s was the study made i n 1939 by the f a m i l y agency in-Evanston, I l l i n o i s . 1 S i x t y "underbare" cases a c t i v e f o r a three month period during the previous year were examined. R e a l i s t i c a l l y c o n s i d e r i n g t h e i r l i m i t a t i o n s , the agency i n s t i t u t e d a simple system of assessing r e s u l t s , gauging success on the p r i n c i p l e "everything operating to enable the person or f a m i l y to f u n c t i o n more e f f e c t i v e l y or t o enjoy l i f e more f u l l y might be considered improvement". 2 C a r e f u l l y s c r u t i n i z i n g each r e c o r d , they noted tne degree of improvement at 1. Frances Schiffmann and Elma Olsen, A Study In Family Case Work, An Attempt To Evaluate S e r v i c e . Family 'welfare A s s o c i a t i o n . Evanston, I l l i n o i s , (unpaged) 2* I b i d . 50 closing, quantitatively as "no improvement" or !}some improve-ment. "! In each of these sixty cases the worker who had been active revisited the families to form a second estimate of improve-ment for comparison with the f i r s t . L,ven so simple a method of evaluation as this helped the agency to determine strengths and weaknesses of treatment methods and certain social trends that were affecting the workt*. "Testing Case Work Results", St. Paul Family Service The Evanston study bore some resemblance to the more recently publicized experiment begun in 1946 by Family Service of St.. Paul, Minnesota under the leadership of i t s executive secretary, A. A. Heckman.2 Whereas the Evans c o n study had depended on the method' of examining case records and following up with interviews, the St. .Paul agency D e g a n i t a study, by examination of client problems; and the elimination or reduction of uuch through case work treat-ment. A total of ninty-eight dif f e r e n t 3 problems (later increased to ninty-nine 4) have been defined by the staff since 1936, ten years before tne f i r s t phase of the experiment. Many of these problems resemble those li s t e d on the f i r s t s t a t i s t i c a l card de-vised by the Family Service i -Association of America,.^ •Heckman describes these-problems as being "wi chin the area of case work treatment." He expands on this, "A majority of these individual problems thus listed may be said to be symptomatic of social adjustment and benaviour d i f f i c u l t i e s . Some 1. Schiffmann. Up. c i t . 2; A. A. neckman and Allan Stone, "Forging New Tools." Survey Mid-montnly, Vol. IXO.TII, No. 10, October 194V, PS. 267-270. 3. Ibid. P. 268 .4 ,* A. A. Heckman, "Measurement of the Effectiveness or Family Case Work." Paper presented at National Conference of social Work, Atlantic City, New Jersey, April 19^8. Jr. 3 . • 5. Idem . 3 1 represent a ' f a c t , others a s i t u a t i o n . None of them, represent a diagnosed cause of f a m i l y d i s o r g a n i z a t i o n . . 'The phraseo-logy of t h e i r d e f i n i t i o n s comes out of p r a c t i c a l , everyday case work e x p e r i e n c e . " 1 The n i n t y - n i n e problems are c l a s s i f i e d i n t o seven major problem g r o u p i n g s : 2 1. Economic 2. Employment S. Family R e l a t i o n s h i p s ' 4, , P h y s i c a l H e a l t h ( S o c i a l Aspects) 5* Mental Health 6. s o c i a l and Environmental 7. i i e g a l Problems There have been two important observations about the incidence of these problems. I t i s s i g n i f i c a n t that f a m i l i e s generally.have been found to be t r o u b l e d oy a m u l t i p l i c i t y of problems. I t has been noted, a l s o , that ofvthe problem grouping, Family R e l a t i o n -s -ships has the highest i n c i d e n c e . " I n each case, under care the problems are checked at opening and c l o s i n g and i n March and October i f i t i s then open. The f i r s t group of cases, t o t a l l i n g 672, was examined i n March of 1946. This i n i t i a l e v a l u a t i o n served as a ''pilot study s : a f f o r d i n g a compara-t i v e b a s i s f o r the study of 1032 cases, a l l those open i n the f i r s t ten months of the same y e a r . 4 I n the same way as the iivanston Agency, Heckman used q u a l i t a t i v e 1. A. A. Heckman, Measurement of E f f e c t i v e n e s s 4-5 2. A. A. iEeckman I b i d 3 3. A. -A. Heckman. and. A l l a n Stone, Case Work Problems and Agency  S e r v i c e s , Research Department of Amherst i i . Wilder C h a r i t y and f a m i l y S e r v i c e . St. P a u l , Minnesota, 1947. 4. Idem.. 32 r a t i n g s as c r i t e r i a o f ' • s u c c e s s , . l i s t i n g these ass • 1. No improvement 1 2., P a r t i a l improvement 5. D e f i n i t e , improvement-4. No' treatment attempted^ This r a t i n g i s used f o r the i n d i v i d u a l problems o c c u r r i n g i n the case and f o r the major problem grouping i n which the case f a l l s S e v e r a l c r i t e r i a are used i n d e f i n i n g improvement. Keckman s t a t e s : "The problem may cease to e x i s t i n which case obviously there i s improvement. In a m a j o r i t y of instances ooservation or testimony of the i n d i v i d u a l s most d i r e c t l y concerned support a judgment of growing c a p a c i t y i n the c l i e n t t o cope w i t h pro-blems ...there are evidences of a l e s s e n -ing of the tensions, s t r a i n s , and s t r e s s e s f o r the i n d i v i d u a l or f a m i l y . " 2 "No treatment attempted" r e f e r s to a problem appearing i n the f a m i l y among a c l u s t e r ./hich prognosis i n d i c a t e s i s . n o t t r e a t a b l e . Making no apology f o r the use of t h i s type of e v a l u a t i o n , Heckman has a f f i r m e d , "We are.aware that t h i s i s a s u b j e c t i v e process. Our s t a f f , however, i s made up of p r o f e s s i o n a l l y t r a i n e d people. I t seems to us reasonable to assume that p r o f e s s i o n a l case workers can e x e r c i s e r e s p o n s i b l e judgment." 3 This assumption was put to the t e s t by a re-assignment of 100 cases to d i f f e r e n t workers f o r e v a l u a t i o n . The r e s u l t s were not s i g n i f i c a n t l y d i f f e r e n t from the f i r s t . 4 1. A. A. Heckman, "Measuring the E f f e c t i v e n e s s of Family Case Work' 2. i d e m , . -5. Idem 4. ' Idem The a t . Paul experiment as reported to date i s s c a r c e l y past the i n i t i a l stage. There are plans t o continue the p r o j e c t . Data i s being•secured on the s o c i a l and economic aspects of each case and w i l l be r e l a t e d to the problems dis c e r n e d . I t i s intended that thi s , a n a l y s i s w i l l be c o r r e l a t e d w i t h case record reading which now has been s t a r t e d i n s p e c i f i c groups of cases i n which the p e r i o d i c evaluations have i n d i c a t e d the need f o r more i n t e n s i v e examination to determine the r e s u l t s of case work treatment. 1 Mew York Community s e r v i c e Society P r o j e c t I n Measuring E f f e c t s  Of Case Work Almost simultaneously w i t h the St. P a u l experiment, the Com-munity s e r v i c e Society of'New York has been concerned w i t h develop-in g an instrument f o r case work e v a l u a t i o n . Toward the end of 1942, the Committee on the I n s t i t u t e of Welfare Research of- Com-munity Service S o c i e t y commissioned Dr. John Do H a r d , "to determine and express how case work i s c a r r i e d on, at what c o s t , and w i t h what s u c c e s s . " 2 Dr. D o l l a r d considered "success" as the keynote of h i s a s s i g n -ment. He t r i e d t o devise an Instrument'. that would assess the r e s u l t s of : case work " i n a q u a n t i t a t i v e score w i t h known r e l i -a b i l i t y and known v a l i d i t y . " ^ This s c i e n t i f i c p r e c i s i o n of tex-ms r e q u i r e s some explanation. Dr. J . McVIcker xiunt, who has been a c e n t r a l f i g u r e i n t h i s research 1. Heckman, "Measuring The E f f e c t i v e n e s s of Family Care Work". fife.gi;*,. 2. ' J,. Mcv. xiunt, "Toward A Measure or Movement In Case work5'1, A Progress Report." Eaper read at N a t i o n a l Conference of s o c i a l Work. p. 1. ' , 3. I b i d . P'» 2. project, has recently elucidated on these stated aims. 1 R e l i a b i l i t y , as he describes i t , connotes the approximation of results obtained from use of instruments of measurement i n separate instances. If the instrument i s a test, the correlation between the results of different applications should be high and ideally would be + 1.00 or perfect. The support which known cr i t e r i a renders to measures indicates the velidity of the instrument used. "For a scholastic aptitude test, the ultimate criterion i s school grades. In case work we might ask to what extent our measures corres-pond with ( 1 ) the values the clients put upon the case work received, (2) the amount of improvement in the client and/or his situation as judged by those other people whose lives are most affected by his, and (.3) the degree to which the effects of case work continue to show i n the adaptive efficiency of clients after their cases are closed." 2 The professional a b i l i t y to judge results might also be con-sidered as a possible criterion. The Community Service Society began i t s study by rejecting this assumption in favour of a com-pletely objective measure i f such could be devised. Later the re-search workers returned to professional judgment, moved by the .exp.ensiveness of £h> objective measure and by results of experi-ment which showed that " r e l i a b i l i t y of even uncultivated case ,,x-worker judgments " is high; "this r e l i a b i l i t y improves with in-creased professional training and experience"; and the case workers at the New York agency have a' core, of c r i t e r i a for improvement in clients on which they a l l agree.*-* M 1 . Xd^ cV. H o v x r "Towrtv2V A ^ t i s o r t , © f M o v e m e n t - Case W o r k T> 2. Ji>;a_cT? .2. .[v...u.t 1 • ;-5. Ibid. T.i 4. 35 Measuring Tension I n W r i t t e n Documents. The objective..measure devised by D o l l a r d and h i s a s s o c i a t e , Mowrer, i s known as the D i s t r e s s - R e l i e f Quotient or DRQ".1 The premise of t h e i r experimentation was that s o c i a l case work i s es-s e n t i a l l y a l e a r n i n g process i n which the aspect of "reward" oper-ates as. a.means to. reduce tne te n s i o n i n c l i e n t s . The success of treatment w i l l be r e f l e c t e d I n the easing of s t r e s s . 2 In t h i s method the semantic values i n the case record are of prime import-ance. The.emotional c o l o u r i n g of the words used to des c r i b e the i n t e r a c t i o n between the worker and the c l i e n t i n the case work process w i l l give to these words a p o s i t i v e or a negative q u a l i t y , " r e l i e f 1 ' from d i s t r e s s , or " d i s t r e s s " . Obviously c e r t a i n words w i l l have a . " n e u t r a l " c h a r a c t e r . The t o t a l number of d i s t r e s s words i n a s i n g l e page d i v i d e d oy the t o t a l number of d i s t r e s s words and r e l i e f . w o r d s would give a quotient that might represent the degree of r e l i e f from t e n s i o n i n the c l i e n t . D i v i s i o n of the case, record i n t o tenths and comparison of the successive quotients throughout these u n i t s might provide some i n d i c a t i o n of the success of the case work process. The sentence and the "grammarian's thought u n i t " , the c l a u s e , were also t r i e d by the scorers s e l e c t e d to examine 59 cases. The highest i n t e r - c o r r e l a t i o n between scores .88 occurred i n the thought s c o r i n g method. The DRQ using thought -sc o r i n g seemed, t h e r e f o r e , to be a measuring instrument of known  r e l i a b i l i t y . 1. John D o l l a r d and .0. riobert Mowrer* "A Method Of Measuring Tension I n W r i t t e n .Documents." The j o u r n a l of Abnormal and  S o c i a l Psychology. V o l . 4<s, Bo. 1, January 1947. 2. I b i d . , 3 Measuring-Movement I n S o c i a l Case Tt'ork Dr. nunt undertook to compare these r e s u l t s w i t h those of case worker judgment. Using these same cases he sought to measure movement i n these casoS, t h a t i s , :'the pro g r e s s i v e improvement or d e t e r i o r a t i o n i n a case."-*- For -each of tne cases a summary was made and m o d i f i e r u n t i l the worker who had ueen a c t i v e i n the s i t u a -t i o n considered the summary as good as the whole record. The summaries were examined by workers, s e l e c t e d at random, who were asked to rate the amount of movement i n d i c a t e d i n them. Each summary was r a t e d on a f i v e step v e r b a l s c a l e , "none, s l i g h t , medium, cons i d e r a b l e , and g r e a t . " 2 For the purpose of c o r r e l a t i n g scores of d i f f e r e n t workers these r a t i n g s were then given number-i c a l v alues: -2, -1, 0; +1, +2, +'3, and +4.S The scores of the workers produced a h i g h inter-cojfcr e l a t i o n . When, however, the average r a t i n g s were c o r r e l a t e d w i t h the DRQ changes i n the r e c o r d , the r e s u l t i n g c o e f f i c i e n t was only .-2 , completely u n s a t i s f a c t o r y . ' 4 This f a i l u r e to v a l i d a t e the UKQ l e d to two questions: "the r e l i a b i l i t y of case worker judgments, and the v a l i d i t y of the case records on which DRQ d i f f e r e n c e s W o r e based."5 The f i r s t question was answered through an experiment i n which r e p r e s e n t a t i v e groups were formed from d i s t r i c t s e c r e t a r i e s of the Family S e r v i c e Department, departmental workers, s o c i a l 1. «j. Mc'vicker nunt, "Measuring tne r X f e c t s of s o c i a l Case Work." Transactions. Ne* xoric Academy of Sciences, s e r i e s I I , V o l . 9, Wo. 3, jVages 78-oo, January, 19*7. 2. I b i d . 83 5. I b i d . 86 4. I b i d . 85 5. I b i d . -8 6 work students and psychology students. They were asked to estimate movement i n the 38 cases. The highest i n t e r - c o r r e l a t i o n occurred i n the departmental s e c r e t a r i e s group, the second i n the workers. I t seemed, t h e r e f o r e , that t r a i n i n g and experience are p o s i t i v e f a c t o r s i n impx-oving case work judgment. There seemed to he a n e c e s s i t y to f i n d more agreement among workers as to standards of judgment. A study group, t h e r e f o r e , reviewed c r i t e r i a of evidences of movement as proposed by the f i f t e e n case workers who had p a r t i c i p a t e d i n t h i s experiment. Out of t h i s study came a s c a l e of movement defined as: "The change which appears i n the adaptive e f f i c i e n c y , the d i s a b l i n g h a b i t s and con-d i t i o n s and v e r b a l i z e d understanding of an i n d i v i d u a l c l i e n t and/or' i n h i s environ-mental s i t u a t i o n between opening and c l o s -i n g of h i s c a s e . " 1 • •'. The s c a l e was f u r t h e r strengthened by anchoring every other step, that i s , , a t t a c h i n g a sample case which i s r e p r e s e n t a t i v e of the p a r t i c u l a r grade i n the s c a l e , s p e c i a l t r a i n i n g i n the use ofthe s c a l e i s also being given. The s c a l e i s being used now i n an e f f o r t to f i n d the cost of operation and i t s value i n a n a l y z i n g the e f f e c t i v e n e s s of the work being c a r r i e d on by the Family Service Department o f the Community S e r v i c e . S o c i e t y . With the r e l i a b i l i t y and v a l i d i t y of the Community Service methods s t i l l unproven'they could not have been•suitably used i n t h i s study to measure e f f e c t i v e n e s s of f a m i l y case work. One of the p r i n c i p a l impediments to the e f f e c t i v e a p p l i c a t i o n of t h i s method, i s the v a r i a t i o n i n the r e l i a b i l i t y of r e c o r d i n g . 1. J . McVicker xiunt, "Toward a Measure of Movement In Case Work" P. 16 58 •Although the p r i n c i p l e s of r e c o r d i n g have c o n s i s t e n t l y r e c e i v e d a t t e n t i o n from f a m i l y case workers, there i s s t i l l no guarantee that the r e c o r d w i l l a c c u r a t e l y portray the emotions of the c l i e n t and.the q u a l i t y of the f e e l i n g s i n the r e l a t i o n s h i p between worker and c l i e n t . I n agencies such as that engaged i n t h i s study, where very h i g h l y s k i l l e d workers are employed, t h i s method might be r e l i a b l e , but i n l e s s f o r t u n a t e l y c o n s t i t u t e d • a g e n c i e s , t h i s would not be t r u e . Importance of C r i t e r i a of Measurement As A r t i c u l a t e d The instruments f o r measuring a f f e c t i v e n e s s of f a m i l y case . work developed i n the St. Paul and New xork p r o j e c t s were not p r a c t i c a b l e i n t h i s study. The c r i t e r i a f o r measurement i n both p r o j e c t s , however, were of value i n assessing the m e r i t s of the performance of the Vancouver Family Agency. There i s an area of agreement as to c r i t e r i a in the S t . Paul and New York studies.' Both Heckman and D o l l a r d have emphasized the importance of c l i e n t t e n s i o n i n c o n s i d e r i n g the merit of case work performance". Heckman' d e f i n i t i o n of "improvement" as the "growing c a p a c i t y i n the c l i e n t to d e a l w i t h problems" i s but a s i m p l i f i c a t i o n of the d e s c r i p t i o n of movement which serves as a b a s i s of the s c a l e developed by Hunt and h i s a s s o c i a t e s . "The change which appears i n the adaptive e f f i c i e n c y , the d i s a b l i n g haOits and con-d i t i o n s and v e r b a l i z e d understanding of an i n d i v i d u a l c l i e n t and f o r h i s environ-mental s i t u a t i o n between opening and c l o s -i n g of cases." C r i t e r i a of Measurement Used By Vancouver Family Agency Inasmuch as both standards are founded on the goals of s o c i a l case work there was merit i n c o n s i d e r i n g t h e i r u s a b i l i t y i n t h i s 39 study. The s t a t i s t i c a l methods of the agency i t s e l f were also . reviewed as p o s s i b l e sources of c r i t e r i a . A curious set of circumstances i n f l u e n c e d the Bureau i n i t s development of s t a t i s t i c a l f a c i l i t i e s . The date of founding the agency p r a c t i c a l l y c o i n c i d e d w i t h the development of the f i r s t s t a t i s t i c a l eard by the American A s s o c i a t i o n For Organizing Family £ Work. The f a c t t h a t the d i r e c t o r of the new o r g a n i z a t i o n was on the committee which devised t h i s card, gave the agency a v i t a l i n t e r e s t i n u t i l i z i n g t h i s form and those that, l a t e r r e p l a c e d i t . The r e l a t i v e l y unhurried pace of l i v i n g that preceded World .War I I made the u t i l i z a t i o n df the card not too heavy a chore. The Second World War, however, w i t h i t s extensive demands on a l l s o c i a l work, made i t i n c r e a s i n g l y d i f f i c u l t f o r the s t a f f member to spare time f o r proper use of the s t a t i s t i c a l card. Not u n t i l 194v, however, d i d the agency take the r a d i c a l step of abandoning the use of theicard f o r the period o f the f i s c a l year 1947-1948, Agency Attempts To Develop C r i t e r i a The s t a t i s t i c a l committee of the agency, as an experimental venture daring t h i s year, developed a new system of r a t i n g problems and s e r v i c e s rendered i n r e l a t i o n to problems. 1 I n t h i s system the problems as discovered at intake: were c a t e g o r i z e d as* F i n a n c i a l Marriage Child-Parent R e l a t i o n s h i p s C h i l d Care 1. .Appendix C. 40 I l l e g i t i m a c y . H e a l t h Employment Environmental The Aged Immigration and C i t i z e n s h i p Legal These c l a s s i f i c a t i o n s were a p p r o p r i a t e l y subdivided. Then these problems were simply coded by usi n g numerals? f o r the main heads and-lower case alphabet,^or the sub-categories. "Services Rendered 1 1 were s i m i l a r l y l i s t e d and coded. The " problem at i n t a k e " would be coded at case opening. At c l o s i n g the problems at i n t a k e plus a l l problems revealed i n diag n o s i s and " s e r v i c e s rendered" were tab u l a t e d . I n theory the e f f e c t i v e n e s s of the p r a c t i t i o n e r ' s s k i l l s would be i n d i c a t e d i n t h i s code which would r e l l e c t the problems^ of c l i e n t s and the s e r v i c e s rendered i n r e l a t i o n thereto .„ S i m i l a r l y , a composite r e c o r d code,with designations l i s t e d i n a l l cases terminated during the year of experimentation^should i n d i c a t e the scope of agency work and the general standard of performance. This system could be used i n the f o l l o w i n g manner. A s i t u a -t i o n i s presented i n which the behaviour of a seven-year-old c h i l d i s a problem. This deviant conduct might have i t s o r i g i n i n a r e l a t i o n s h i p between a man and a woman which has been casual and never solemnized through formal marriage. The partners might-each be c o n f l i c t e d about t h e i r m a r i t a l s t a t u s . One reason f o r the unl i c e n s e d c o - h a b i t a t i o n might stem from an unhappy home l i f e of one of the partners which caused the ^ motional growth of the person 41 / to be thwarted. •-The behaviour problem would be coded as I I I (Child-Parent R e l a t i o n s h i p ) (e) (Behaviour), the common law r e l a t i o n s h i p as I I ' (Marriage) (b) ( I r r e g u l a r M a r i t a l Status)^-and the unhappy c h i l d -hood r e s u l t i n g i n a r r e s t e d emotional growth VI (Health) (d) (Emotional I n s t a b i l i t y ) . Problems at intake would therefore be coded as: I I b., I l l c ., VI d. Treatment would i n v o l v e ©ervices rendered i n r e l a t i o n to C h i l d -Parent R e l a t i o n s h i p s , Marriage,- and Health. Services rendered might be l i s t e d as I I I (Child-Parent R e l a t i o n s h i p ) ( f . ) ( D i r e c t Treatment of C h i l d ) (g.) ( D i r e c t Treatment of p a r e n t ) , I I (Marriage) (c.) (Legal Procedures A f f e c t i n g Family or P e r s o n a l i t y C o n f l i c t s ) , VI (Health) ( f . ) . (Helping C l i e n t s or Others i n Family Recognize Need f o r Treatment).. Services rendered, t h e r e f o r e , would, be coded: I I c , I I I ( f . ) ( 8 ) , VI ( f . ) . A f t e r c l o s i n g , summary would appear: . PROBLEMS: I I ( b . ) , I l l ( e . ) , VI (d.) SERVICES: I I ( e . ) , I l l ( f . ; ( 8 ) , VI ( f . ) The comparison of problems and s e r v i c e s would, purportedly, i n d i c a t e the degree of adequacy i n treatment. The summary i n a l l cases would suggest the o v e r - a l l achievement of the agency w i t h i t s primary concern, f a m i l y case work. One inherent weakness of t h i s system was that i t overlooked the important f a c t that d i a g n o s i s may w e l l r e v e a l that problems presented at r e f e r r a l of a case are not n e c e s s a r i l y the r e a l problemsc-and ts"o t h i s system would not u n v e i l the true p i c t u r e of • • '. 42 . • agency work. The c o r r e c t a p p r a i s a l of problems at c l o s i n g might redeem t h i s f a u l t i n i n d i v i d u a l case r e c o r d s . Yet, t h i s redemption would be only p a r t i a l as the date of uncovering the problem and therefore the le n g t h o^treatment pe r i o d would not be recorded. Moreover, i t was Impossible to b r i n g the composite record up to ";: date • Because the research value was not proven, t h i s system has been dis c a r d e d and supplanted w i t h tne hew case s t a t i s t i c a l , card of the Family s e r v i c e A s s o c i a t i o n of America. Lack of e v a l u a t i o n Methods S u i t a b l e For This study The need f o r a y a r d s t i c k with which to measure t n e e f f e c t i v e -ness of f a m i l y case work i s abundantly c l e a r . The f a c t o r s . o f p u b l i c support of family agendas 1, of p r o f e s s i o n a l devotion and the s c i e n t i f i c character of f a m i l y case work a l l demand that the process be t e s t e d so that i t can be p r a c t i c e d w i t h utmost e f f i c i -ency. This need has been recognized since the beginning days of pro-f e s s i o n a l p r a c t i c e of f a m i l y case work. L a r l y concrete recogni-t i o n of t h i s need was seen i n the device of case s t a t i s t i c a l cards l i s t i n g c l i e n t problems and s e r v i c e s r e l a t e d t h e r e t o , as developed by the Family Service A s s o c i a t i o n of America. Successive r e v i s i o n of these cards has r e f l e c t e d e f f o r t s to r e f i n e e v a l u a t i o n techniques• u n f o r t u n a t e l y , i n ge n e r a l , i n t e r e s t i n applying s o c i a l s t a t i s t i c s and research to f a m i l y case work has developed more slo w l y than the techniques of p r a c t i c e . Thus, the s t a t i s t i c a l and research f a c i l i t i e s a v a i l a b l e to the p r o f e s s i o n of s o c i a l case work have i n f r e q u e n t l y been used to advantage. An exception 45 has occurred i n St. Jfaul, Minnesota, wnore Family Service under l e a d e r s h i p of A. A. rieckman, over a decade, w i t h the Family S e r v i c e A s s o c i a t i o n s t a t i s t i c a l card as a D a s i s , developed 99 c l a s s i f i c a -t i o n s of proolems t r o u b l i n g f a m i l i e s coming to tne agency. Improve-ment of a c l i e n t , or f a m i l y i n a b i l i t y oo meet l i f e , conceived of as the l e s s e n i n g of t e n s i o n i n the c l i e n t , has "been measured "by the m o d i f i c a t i o n of these problems over a p e r i o d of treatment. The experiment i n v o l v i n g over 1,000 cases i s s t i l l i n che beginning stages. I t i s intended to continue the study through r e l a t i n g problems to s o c i a l and economic data on the f a m i l i e s and through \ r e c o r d r e a d i n g . The Vancouver Family Agency, although from the beginning i t had a v i t a l i n t e r e s t i n Family A s s o c i a t i o n s t a t i s t i c a l f a c i l i t i e s . , d i d not take f u l l advantage of them and f o r one year abandoned them completely, s u b s t i t u t i n g i t s own system which 61 d not prove s a t i s -f a c t o r y . The Bureau t h e r e f o r e , has no means of e v a l u a t i o n such as that of iieckman. The measurement of c l i e n t t e n s i o n i n case records i s an i n s t r u -ment developed by the Community Service S o c i e t y of New York. The r e l i a b i l i t y of the DRQ has been f a i r l y w e l l e s t a b l i s h e d but i t s v a l i d i t y was unproven when a sc a l e of judging i n case records based on p r o f e s s i o n a l case work experience was developed. This was true even a f t e r the soundness of case work judgment had been assured through t e s t i n g of case worker's r e s p o n s i b i l i t y assessing the r e s u l t s 'of h i s performance and by d e f i n i n g "movement." • The St. P a u l and New York p r o j e c t s are two of the.outstanding e f f o r t s to measure e f f e c t i v e n e s s of f a m i l y case work. The i n s t r u -44 ments of measurement were u n s u i t a b l e f o r use i n study of the work performed by the Family Welfare Bureau of Greater Vancouver. The c r i t e r i a of measurement, however, had some i n f l u e n c e i n developing c r i t e r i a f o r the present study. 45 CHAPTER III THE PRESENT STUDY AND THE EVALUATION DEVICE USED Seeking A Method Although none of the methods of t e s t i n g f a m i l y case work r e -s u l t s which; have been reviewed appeared s u i t a b l e f o r examination of Family IVelfare Bureau performance, p e r u s a l of these various means were h e l p f u l . Studying them served to re-emphasize the v i t a l i t y of f a m i l y case work. I t was f e l t that i f t h i s dynamic q u a l i t y could be analyzed i n a.representative case work r e c o r d , then some estimate could be formed of the c o n s t r u c t i v e values of f a m i l y case work des-c r i b e d i n that r e cord. Generic' s o c i a l case' woric p r i n c i p l e s i n themselves would provide & standard of measurement. The e f f e c t i v e a p p l i c a t i o n of these generic p r i n c i p l e s could be measured i n terms more simple than the St. Paul and New York statements of c r i t e r i a but w i t h a l i k e meaning, by the a b i l i t y of the c l i e n t and the f a m i l y to meet prooloms and to make some adjustment to l i f e a f t e r s o c i a l case work treatment had been given. The degree of e f f e c t i v e n e s s could i n elementary terms be defined as i n e f f e c t i v e , that i s , the s i t u a t i o n d e t e r i o r a t i n g d u r i n g contact; n e u t r a l , the status-quo at opening being maintained; f a i r ; the c l i e n t 1 s problems somewhat abating i n course of treatment; and good, i n d i c a t i n g the obviously-s u p e r i o r adjustment. The question arose as to how the dynamica of the case work could De a p p r o p r i a t e l y i l l u s t r a t e d . An Analogy From Medicine' An analogy'from the f i e l d of medicine.; was h e l p f u l i n d e v i s i n g such a r e p r e s e n t a t i o n . Medicine, l i k e s o c i a l case work, t r e a t s the human being. The p h y s i c a l ailments may be as d i f f i c u l t as the •46 s o c i a l to diagnose and, de s p i t e the s p e c i f i c organic f u n c t i o n s , somatic d i s o r d e r s w i t h which the p h y s i c i a n must d e a l are as many as the s o c i a l proolems t h a t the s o c i a l case worker encounters. Yet, the p h y s i c i a n and aurgeon do have methods of. checking the e f f e c t i v e -ness of t h e i r work. .' To evaluate the success of treatment the medical doctor u t i l i z e s many t o o l s . The s i g n i f i c a n c e of symptomology i s consider-ed i n the ex e r c i s e of d i a g n o s t i c s k i l l acquired through education, t r a i n i n g , and p r a c t i c e . As i n fa m i l y case work, the p r a c t i t i o n e r may.employ the devices of c o n s u l t a t i o n and conference. I n a d d i t i o n , there are the s c i e n t i f i c f a c i l i t i e s of la b o r a t o r y and mechanical t e s t i n g . Such instruments as the spigometer and electocardiogram may be used i n the d i a g n o s i s . The f i n a l t e s t of the success of i n d i v i d u a l medical p r a c t i c e i s the r e t u r n of the p a t i e n t to h e a l t h , or, at l e a s t , the a l l e v i a t i o n of h i s d i s t r e s s . At t h i s supposed stage of recovery or a r r e s t i n g of .'physical d e t e r i o r a t i o n , p r a c t i c a l .analysis, l a b o r a t o r y , and mechanical t e s t i n g may a l l again be used to v e r i f y the success' of treatment. The s i g n i f i c a n c e of lab o r a t o r y t e s t i n g and of use of such Instruments as the electrocardiogram i s that they measure the dynamics of organic f u n c t i o n s , the very process of l i v i n g and growing w i t h i n the i n d i v i d u a l human body. These instruments can o f f e r an immediate evidence of change. I t would seem that the idea of the cardiagram i s one that could be considered by f a m i l y case work. S o c i a l case work needs a device that w i l l measure the very heartbeat of the process. Using The Dynamic Ooncepts Only t h i s . e x p r e s s i o n of the i d e a i s new. C e r t a i n f a m i l y 47 workers have long i n t e r e s t e d themselves i n the p o s s i b i l i t y of measuring d i r e c t l y the dynamics of the f a m i l y case v/ork process. One device along such l i n e s has long been favoured by both f a m i l y case workers and p s y c h i a t r i s t s . Shis i s a simple chart which i l l u s t r a t e s the t o t a l c h r o n o l o g i c a l h i s t o r y of the c l i e n t i n a summary from which i s , at once, easy to read and h e l p f u l i n d i a g n o s i s . I t showed not only h i s c h r o n o l o g i c a l development but h i s l i f e i n r e l a t i o n to other members i n h i s f a m i l y and events a f f e c t i n g h i s f a m i l y . On t h i s chart the successive ages of the c l i e n t are placed on the "Y" a x i s . On the "X" axis are placed such f a c t o r s as He a l t h , Parents' R e l a t i o n s h i p s , C h i l d s A t t i t u d e s to Parents, to S i b l i n g s , Parents A t t i t u d e to C h i l d . The v i r t u e of t h i s graph i s t h a t , at a glance, the worker can see the various f a c t o r s operating at any given age, and i n t e r - r e l a t i o n s h i p s of these f a c t o r s ; and so obta i n some understanding of the uorgan-as-a-whole n i n the processes of l i v i n g . Thus the causa t i v e f a c t o r s of problems b e s e t t i n g a person aged twenty years, can be discerned i n events that took place at various previous stages of h i s developments. Doubtless awareness of t h i s simple medium had some i n f l u e n c e upon the present search f o r c r i t e r i a . The f a c t that the w r i t e r was one of three s o c i a l work students who t r i e d to develop t h i s form f o r use i n studying c h i l d r e n placed i n f o s t e r homes had a bearing on the outcome of that seeking. The Instrument Devised The seeming u n s u i t a b i l i t y of other methods of e v a l u a t i o n f o r t h i s study and the p o t e n t i a l i t y . o f the dynamic a n a l y s i s pointed the way toward the development i n f a m i l y case work of a f a c i l i t y -48 comparable to the electrocardiogram In medicines. k number of ! records of clients having problems which might be suitable for study, therefore, were examined. . It was reasoned that a family agency would be concerned with any problem affecting the satis-factory functioning of families. Then i t was but a short step to analyze the component elements of the family. The question asked, therefore, was: "What are the dynamic factors i n the personalities of the individual members which go into the making of family l i f e ? " Following logically was the ques-tion; "In what way does the case worker use that knowledge gained from the social diagnosis?" The case worker knows that to answer these queries, he must also be able to gauge the parts played by the client, and by the community, both intimately related to the worker's role and, i n prac tice ^inseparable;. These questions being answered, the next proposition was to develop a form on which to record answers. It would have to be simple to use and easy to read. The device featured on pages 50 and 51 , which ;f or want of a better name,.will be variously called case-©-graph, casegram, or case chart, was. the result of these deliberations. This graph is divided into two major parts, each represented on a single page of regular business-size paper. The l e f t side represents the growth of the family and Illustrates the inter- . relatedness of the processes of development i n the different members of the family. The right side denotes the function of the family case work processes i n meeting the problems of the client. Each page is divided into three corresponding parts. Section I 49 A . F a m i l y background So C u l t u r a l and S o c i a l C . M u c a t i o n D . Occupat ion and Snployment 1« M o b i l i t y Fm H e a l t h G# L i v i n g C o n d i t i o n s I I - W M I I I H« Marr iage j • * : : .... . . . . . . . . ... , I . Compata-b i l i t y t : . : J J . H e a l t h • K . Economics > L * S o c i a l S ta tus • ! | .,. .... . . . . . . ^ : M . L i v i n g C o n d i t i o n s ; N . C h i l d r e n 50 SERVICE i CLIENT I COMMUNITY A : Bi Ci D E ; F ! ; > G wr T T I I I H I: J, K: L : M, Ns 51 portrays the i n d i v i d u a l development of"the m a r i t a l p a r t n e r s . . • • S e c t i o n I I i s a summary of the adjustment f a c t o r s , or "person-a l i t i e s , " of each, and i s as the meeting p o i n t of the two. S e c t i o n I I I summarizes the m a r i t a l h i s t o r y . ' In Sections I and I I , man, w i f e , c h i l d r e n and f a m i l y are represented i n p a r a l l e l columns. Some of the terms us.ed r e q u i r e e l u c i d a t i o n . Under "Family . .background" i s i n c l u d e d any p e r t i n e n t i n f o r m a t i o n such as f a m i l y cohesiveness, education, p e r s o n a l i t y and character t r a i t s , and i s i g n i f i c a n t death'dates. under the column ''Children and Family" i n the space f o r "Family background" are noted any s i g n i f i c a n t c h a r a c t e r i s t i c s of e i t h e r m a r i t a l p a r t n e r . Throughout Bart One t h i s column can he s i m i l a r l y used. " C u l t u r a l and S o c i a l " i n c l u d e s r e l i g i o n , n a t i o n a l i t y , ethnic f a c t o r s , economic i n f l u e n c e s , ages and b i r t h p l a c e s . M o b i l i t y can be w i t h i n the bounds of the c i t y , the province, the country or the world. Health embraces p h y s i c a l , emotional and mental,and might e a s i l y be cross-referenced w i t h P a r t Two. " L i v i n g C o n d i t i o n s " s i g n i f y the type of s o c i a l area and the k i n d of housing. In S e c t i o n Two, the comparison between p e r s o n a l i t i e s of man and w i f e and the i n t e r a c t i o n between them;can be quite p l a i n l y -seen. Obviously, t h i s s e c t i o n i s a c r i t i c a l one f o r examination of m a r i t a l r e l a t i o n s h i p s Under S e c t i o n Two, "-Marriage" provides f o r the f a c t u a l d e t a i l of marriage. Previous marriages of the husband or w i f e can be noted, as can d e s e r t i o n s " i n the present'marriage. I t i s u s e f u l under the t h i r d column to tabulate the sexes and ages of the c h i l d r e n thus r e s e r v i n g f o r d e s c r i p t i o n , f a c t o r "N" at the bottom of the page. C o m p a t i b i l i t y , so v i t a l i n the marriage, should be l i n k e d " 52 w i t h f a c t o r "A" and Section Two, i n the matter-of. c l i e n t a b i l i t y to form good r e l a t i o n s h i p s . ."Parent-Child R e l a t i o n s h i p s " can be entered i n the t h i r d column of the space giv<en to " C o m p a t i b i l i t y " . H e a l t h i s that enjoyed by each.member since marriage and by tne c h i l d r e n . Here, pregnancies, as w e l l as i n j u r y and i l l n e s s , can be shown. economic data i n c l u d e income and expenses and the c l a s s of work performed such as /'supervisory", " s k i l l e d 1 1 . , or " u n s k i l l e d " . ' S o c i a l Status" can be used to i n d i c a t e s o c i a l f e e l i n g s and c i t i z e n p a r t i c i p a t i o n . , ' while the parts of the r i g h t ' B i d e of the case^chart correspond w i t h those on the l e f t , the columns are d i f f e r e n t . As t h i s side i s intended to represent what happens i n f a m i l y case work, i t i s necessary to provide f o r observation of the p a r t i c i p a t i o n of the c l i e n t , the f a m i l y case worker, the agency andtthe. community. Se r v i c e s i g n i f i e s the a c t i v i t y of the f a m i l y case worker as the r e p r e s e n t a t i v e of the agency. Community i s convenient f o r observa-t i o n of a v a i l a b i l i t y and u s a b i l i t y of s o c i a l resources outside the agency, itesources are taken to include any f a c i l i t y of the com-; munity t h a t can be of e f f e c t i v e use, be i t the s o c i a l agency, church, s c h o o l , s e r v i c e clubs or j u s t p l a i n "'neighbourliness." This t h r e e - f o l d d i v i s i o n can show the a c t u a l f u n c t i o n i n g of the f a m i l y case work process, w i t h the i n t e r a c t i o n bety/een c l i e n t , and the s o c i a l agency i n i t s r e p r e s e n t a t i v e the s o c i a l case worker, and the community-and i t s resources. The examination-of each r o l e performed i n d i v i d u a l l y and a l l c a r r i e d out together can p o i n t up the p o s i t i v e and negative f a c t o r s i n treatment. 55 Demonstration of the.Use of the Case Chart An i l l u s t r a t i o n of the use of t h i s a n a l y t i c a l device i n one <of the cases s t u d i e d may prove h e l p f u l i n understanding i t . . Mrs. Atherton went to a c h i l d r e n ' s agency to seek help i n cop-i n g w i t h the exceedingly d i f f i c u l t behaviour of her three-year o l d son. Sonny was a c t i n g most d e s t r u c t i v e l y and, as much of h i s mis-conduct was t a k i n g place outside of the home, he was causing h i s parents embarrasment among the neighbours. There was no evident need f o r p h y s i c a l p r o t e c t i o n of the c h i l d . Mr. and,Mrs. Atherton supposedly were h a p p i l y married, iience the r e f e r r a l of Mrs.' Atherton to the f a m i l y agency. As the " i n t a k e " worker t a l k e d w i t h Mrs. Atherton she learned that Sonny was c o n s t a n t l y disobedient and t h a t . h i s behaviour, was i n sharp c o n t r a s t w i t h . t h a t of h i s s i s t e r , aged s i x years. Ap-pa r e n t l y q u i t e i n t e l l i g e n t , Mrs. Atherton r e a l i z e d that t h i s constant disturbance was beginning to cause f r i c t i o n between her-s e l f and her husband.. She d i d not so r e a d i l y perceive t h e i r part i n causing the problem. Miss V/est, the d i s t r i c t v i s i t o r , was able to b u i l d , although slowly^, a strong case work r e l a t i o n s h i p w i t h the mother and step-by-step, helped her recognize the need f o r p s y c h i a t r i c examination of Sonny. Upon^examination of Sonny at the c h i l d r e n 1 s p s y c h i a t r i c ' c l i n i c , the p s y c h i a t r i s t found the c h i l d so d i s t u r b e d and u n c o n t r o l l a b l e , that he recommended placement i n a country home. When the worker took t h i s recommendation back to the parents, they were shocked. Both parents had f a i r l y good backgrounds, apparently good i n t e l l i g e n c e 54 and a keen s o c i a l sense.and deep p r i d e . Mrs. Atherton had acquired a moderate education and Mr. A., whil e h i s formal education had been l i m i t e d , had improved h i m s e l f through t a k i n g a d d i t i o n a l t e c h n i c a l courses. He had acquired a good supervisory p o s i t i o n i n labour. With h i s w i f e he wished to enjoy the home which they had acquired through hard work. His i n t e r e s t i n reading and a b i l i t y to p lay the piano-accordion added to the pleasure of t h i s a n t i c i p a -t i o n . Wow he learned t h a t a W e l l q u a l i f i e d s p e c i a l i s t thought h i s home u n f i t f o r h i s son. P a t i e n t l y , Miss tVest set about h e l p i n g Mr. and Mrs. A. make t h e i r home a f i t one. With measured p e r s i s t e n c e she helped Mr. and Mrs. Atherton v e r b a l i z e t h e i r f e e l i n g s about each other and about the c h i l d r e n . At the opportune time she i n t e r p r e t e d to them the "oedipal complex'1 making a simple s t r a i g h t f o r w a r d explanation* Arranging wQ see Mr:.Atherton alone, she helped him see that h i s excessive demands f o r c l e a n l i n e s s o f t e n r e s u l t e d i n h i s w i f e de-v o t i n g time to the care-oif the house at the s a c r i f i c e of care to Sonny. He was helped to see that the f a t h e r ' s r o l e i s more than the passive one'of s i t t i n g i n a c h a i r during the evening and reading an i n t e r e s t i n g book, or r e l a x i n g before the r a d i o . He was helped, too, to see that h i s w i f e having been the youngest i n a f a m i l y , w i t h a brother s i x t e e n years her s e n i o r , had learned to depend on older .people, a le s s o n wxiich she had c a r r i e d i n t o her ' marriage. When Mr. Atherton began to have more understanding of himself and those c l o s e to him, and when h i s w i f e gained s i m i l a r i n s i g h t , matters began to Improve. H i s wi f e was abie to devote more time to the c h i l d r e n and to v e r b a l i z e her f e e l i n g s about the l i t t l e bejy . I 55 He became more a c t i v e at home and more understanding of h i s wife's dependence on him. As Sonny's behaviour improved neighbourhood a t t i t u d e s were mo d i f i e d , at l e a s t to the extent that one neigh-bour o f f e r e d to arrange f o r Sonny to play w i t h h i s son w i t h i n the confines of the enclosed yard surrounding h i s home. "When the agency terminated s e r v i c e at the end of .. seventeen months Sonny was behaving much as any other c h i l d of h i s age and surround-i n g s . Use of the Case Chart; Before u t i l i z i n g the case-o-graph f o r the a n a l y s i s of t h i s case the c l o s i n g summary ana the f i r s t entry of the case were read i n order to get the sense of the s t o r y . Then the face s h e e t 1 was s c r u t i n i z e d to .obtain p e r t i n e n t i d e n t i f y i n g i n f o r m a t i o n to enter on t h i s form. Fo l l o w i n g t h i s , the record i t s e l f was c a r e f u l l y read and' d e t a i l s from i t entered i n the appropriate places on the casegram. The completed form Is-reproduced on pages S9 and A d e s c r i p t i o n of the s e v e r a l parts w i t h the r e l e v a n t explanations i s g i v e n below. Background of the C l i e n t s The man^ This i s almost so obvious as not to r e q u i r e e l u c i d a t i o n . I t may be well,..however, to p o i n t out a few.of the most s i g n i f i c a n t d ata. I t i s seen that Mr. Atherton came of f a m i l y which, i n common parlance, would be c a l l e d 'good stock", f o r people of l e s s advantaged circumstances do not study medicine i n Germany as had h i a f a t n e r . There i s a c e r t a i n degree of i n -s t a b i l i t y i n d i c a t e d i n t h i s famlxy background. Factors "B" show 1. Appendix A. 56 that 'kr. Atherton belongs to a predominant c u l t u r a l group. Adher-ence to an orthodox r e l i g i o n i n d i c a t e s a conservative s t r a i n . F a c t o r "E n f u r t h e r suggests t h i s t r a i t . That he i s not, however, stuck i n " r e s t l e s s s t a g n a t i o n " i s deduced from h i s attempts to improve h i s education as recorded i n "E", and "F" contains explana-t i o n enough when i t i s linked w i t h l fJ" i n s e c t i o n three. "G" i s obviously r e l a t e d to "A" and h o l d s , i n p a r t , the explanation of Mr. A t h e r t o n 1 s love of home as i n d i c a t e d i n '"M" of s e c t i o n three. The w i f e . These f a c t o r s «.re even more r e v e a l i n g than those recorded for- Mr. Atherton. The e a r l y death of tne f a t h e r noted i n ,!A" and the^presence of the brother s i x t e e n years her s e n i o r , recorded i n p a r a l l e l , are both s i g n i f i c a n t i n r e l a t i o n to Mrs,*' Atherton's p e r s o n a l i t y as described i n S e c t i o n Two and the f a c t o r s of " I " given i n Se c t i o n Three. S i m i l a r i t y of r a c i a l o r i g i n s of Mr. and Mrs. Atherton, d i f f e r e n c e s between ages, both important f a c t o r s i n parsing the m a r i t a l r e l a t i o n s h i p , stand out c l e a r l y . The r e l a t i v e l y h i g h educational attainment noted i n "C" provides a c l u e as to the i n t e l l i g e n c e of Mrs. Atherton. jperso.nalit.iea of the C l i e n t s S e c t i o n Three, i n a sense, p u l l s together the s i g n i f i c a n t f a c t o r s noted elsewhere ana i n d i c a t e s i n what respects- the two partners can mesh t h e i r l i v e s , i n what areas they are l i k e l y t o have c o n f l i c t , and to what extent c o n f l i c t may be h e a l t h f u l f o r them. The ^ d e s c r i p t i o n contained i n t h i s d i v i s i o n w i l l ' h a v e a strong oearing on f a c t o r s of "H" and."I" i n S e c t i o n Three. 57 _ 1 m M t J [ CHILDREN:MP FAMILY Ac Family 5 f ^ £ T — - 5 v ^ t w ^ a . e A . sw t H -f-rs*i?_„iv.* T^^t ul I Background'i^^tc.'au^k ^ ^ t e - o , c j ^  ° L o K t s ' °^ ^ w—^Ay. • . I A C T . m r ^ . O . ^ E T A; S-B o C u l t u r a l : i o V s 3 A«^u , T e r,?.c. / T S . 0 » A . «. x ^ T c - ^ ; 0 ^ C*.C : S o c i a l — ; u — ^ ^ £ ~ < ^ ~ A ! Co Education JfoT-^.i. t r ^ A c ^ M . ^ H * . . . , R " - . ' * ' J o — — — — — S o O c c u p a t i o n * ^ , V v s U ^ . f c £ ^ ^ e . ^ ^ - ^ ' o E f U T t - m t ^ t s i o ^ Employment: j S o M o b i l i t y AvV* ;^ »3.c_ u * t i-n ^ c . F o H e a l t h • I ? o o A t » ^ o T S - ^ t < ^ © o L i v i n g ° t o o 4 ! C ^ . A C o n d i t i o n s •  W I I . W . V J ,T> S sy<_Ui . a-U.c C \ . -^^> -rntnt t JL T i l l d.-i-Vs voWo -orvra.Ac kt.T ^ t c ( i-r»-tt .<!lC^^U^S. _S o - i A. o ^ - ^ f^ . ' > yJl c -«-i OT To ^ { -O-l A-=.-t-K S I I <J WT oou.T\l.oas c o © l>tf O -Vkoe. 'S . £S S."r N i t A . L n t ^ t A v-^s.clWV- ST-T- o-rv.<& op'iw.i.willTa.^KVL l^l i-e=k.-t-K S I i S W.T O O ^ T W O X S C O © p t - c o.Vkoe.'S. C 5 S.-r MS. A l a t - K t A >^s .aW\- S T - T - o-r>_<& o t»i VN. i „ -v*.S-^  T- \.V^ O i o . - d O - ' O . C C O T Aiarv.^tB-A t l c W ^ S • MtW. ^ J j . ' o X s -TTVO^ t T &-V t . ^ ^  <^  v^, o ^TI-^ ,. Q « < Tc\tO.-n'. £j>r C , t <?X (Lcl-V o o III H o Marriage • > - ^ - a .uT 0 ^, w m o ^ t B . ^ . f » M i ; - r i t n - i j . M i c.^.c. I o COmpat= ? S e t - w x t A r„ V J E n . ^ E . O ' v o ^ ^ T t . o s V ^ - ^ . r v cK>U u-> ^ g^ -J2j_T_J_-[;y S S Va V £. A c W . U C O o-r- C ^ v ^ . t « . - r - « - t . l s S < » - £ ^ C c T o4\ - T T £ . It^Ai'^-^. ^U_^  p J i x ^ i n , •'P • _ - r" O / , , s i A.-W. A pTto n n . - » « c s ivusciT - r i t J . ?-rf»-.T»r>«.-r t o Heal th . l - a £ . u . T < v o w . et. \ « ) . c t _ v U » - r t i , V - . -r: c . , N. O » • r I •'- \ 1 i o e> / J l A ^ U - r v T - n t i » t o T l i o ^ . V t i ) •Sf i'AH, b . V . A u . \\£.-n.\t<i 1 S o Economic . A i ^ - ^ t ^ c g s tewVw o-»; t ^ ^ S o c i a l I \ e . ;\-txt^£,UeAT.<\. o - r r . f ^ > u U a o l o ^ t ^ c o . . 3 a S t a t u s 2 • ^ s^t.rfU.A.oJ-.  L i v i n g s\_A<tA W o ^ t v A £ . i & o . A V v 0 ^ c V ; c t p t T . L s 1 ; < i — J . C o n d i t i o n s ! ^ >-^ ^ T , : — » Mo C h i l d r e n £^ WiT-ot^ O _ ^ A ^  C r « ^ v ^-t-t^v^.v^w^v^;^^ -^..^^tT. Ut^ A v ^ i v c ^ f A j i "* / - - • . ' ' AV -«.^4t.cV..o vv-oXt^ W u.-r»vt> Sv«.c.k cT,^oo«i ^ U . S J ' I - « £ S S | s T a v ^ ^ n t T »-VN O o-«-->« a. s «. T \ e ^ * i ^ O-T- Va^ktTS t J - f fT-OM-»\. 58 •^SmEiGE , CLXEMffi QOMMTOin" F ° 1 -"v^c^ Vc c c-t- K E. -r-_ -s s_A ' V L V C ^ > K O V \ C S U VVS ; u . vV ^ V . *& c T (_ 0 ^ A^ t w e t . a ^ VjJ «yc«.V<r -A »',j>o.V co-no. pL.fc.jr » " ^ T - s_. " C o - o p oV rrv fWs « . « x p&.t\T v •-tx.ci o o-r a.^ -r-tc_<i U, VvQ-vC .O.^ CC:^ C^l. V. %CC »A>. S ^ A C T S T ^ A ; : . . ^ X ^ ^ Vv.s L : Oi -s v! >• •& ftviK-kL stcu-TtA <^«.v^wV .s ©<f .-j^ xe-AFj' -t-t^CTi.^ V o p T O W \ s ? s ^ U ; * T - « - \ c . s e r o u s . v ^ K - r . V L V p £ . A U i . <, t ^ U ^ o w c ^ ^ t c V » - 4 s o-W 0^r 59 Marriage and Family- Marriage . S i g n i f i c a n c e of the marriage date i s that i t reveals, that Mrs. Atherton was married very young v/hen s c a r c e l y prepared to be a wi f e and mothex~. The " I " f a c t o r s show the s u b t l e connection between the capacity f o r forming r e l a t i o n s h i p s , as do the "A"-factors and p e r s o n a l i t i e s of the partners.. This I s marked i n the Instance of Mrs. Atherton who knew much love and over pro t e c t i v e n e s s i n her own f a m i l y and wanted the same-from-heir husband. The i n a b i l i t y of Mr. Atherton to respond i n these areas a t time of. i n t a k e can be assessed on examination of h i s p e r s o n a l i t y as des c r i b e d i n s e c t i o n two. " J " p r a c t i c a l l y t # l l s a s t o r y i n i t s e l f . .A man who s u f f e r e d from i n d i f f e r e n t h e a l t h would be more i n c l i n e d to stay indoors than one possessed of n a t u r a l v i g o u r , xhe medical h i s t o r y of Mrs. Atherton i s equally r e v e a l i n g ; D i f f i c u l t y at time of pregnancy would n a t u r a l l y have stimulated f e a r s i n her, and that she wished to be s t e r i l i z e d , as noted i n c o m p a t i b i l i t y , might be expected. Her- attempt to give h e r s e l f to the c h i l d she r e j e c t e d even though she was not able to breast-feed him could w e l l be associated w i t h g u i l t f e e l i n g s ' over r e j e c t i o n of' the l i t t l e boy. The trauma of b i r t h which Sonny experienced would almost i n e v i t a b l y have been i n t e n s i f i e d by a def e c t which many human beings do not su r v i v e and t h i s poor s t a r t i n l i f e could provide one reason f o r the l a t e r behaviour p a t t e r n . "H" f u r t h e r adds to p o s s i b l e reasons f o r these d i f f i c u l t i e s . - . -"L" f a c t o r s are what might be expected from the h i s t o r i e s of Mr. and Mrs. Atherton and the unhappy s o c i a l e f f e c t s of Sonny's deviant behaviour are obvious. 60 Family Case Work In This S i t u a t i o n Jdpw e f f e c t i v e l y the three member-team, c o n s i s t i n g of c l i e n t , f a m i l y case worker, and community operated, i n the i n t e r e s t s of t h i s f a m i l y , can be discerned by examination of the r i g h t hand side of the casegram. The s k i l l of the inta k e v/orker In telephone conversation was a computable f a c t o r i n g a i n i n g the confidence of Mrs. Atherton and the success of treatment might be traced back to t h i s i n i t i a l c ontact. As t h i s contact developed the d i s t r i c t worker made r i c h use of the p e r s o n a l i t y of Mrs. Atherton as i t d i s c l o s e d i t s e l f through the d i a g n o s t i c process. E x c e l l e n t use was made of the h i s t o r y - t a k i n g f o r the p s y c h i a t r i c c l i n i c , t h i s being considered as a d i a g n o s t i c t o o l r a t h e r than a r o u t i n e procedure. Through the c a r e f u l l y - t i m e d h i s t o r y - t a k i n g the worker was able to help Mrs. Atherton express her h o s t i l i t y toward Sonny, s and t h i s emotion having been v e r b a l i z e d , Mrs. Atherton was helped to enquire i n t o the basis of t h i s f e e l i n g to the extent that she could develop i n s i g h t . Thus, g r a d u a l l y the r e a l causation of Sonny's behaviour was bared to Mrs. Atherton. Nor was Miss West i n s e n s i t i v e to the v i t a l r o l e of Mr. Atherton i n the f u n c t i o n of the f a m i l y r e l a t i o n s h i p , jugain the worker employed " t i m i n g " as an aspect of " d i f f e r e n t i a l d i a g n o s i s " ( S e c t i o n Two) i n arranging to see Mr. Atherton and then granted him the deference which he would consider h i s due as head of the f a m i l y . Although Miss west obtained from Mrs. Atherton quite e a r l y the f a c t s p r e v i o u s l y c i t e d as c o n t r i b u t i n g to oonny's aberrant conduct i n t a k i n g the s o c i a l h i s t o r y , she went no f u r t h e r than to h e l p Mrs. A. to Ve r b a l i z e . h e r f e e l i n g s about Sonny. She helped 61 the parents prepare f o r the a c t u a l event of the p s y c h i a t r i c examiha t i o n of Sonny and saved most of her observations u n t i l a f t e r she r e c e i v e d the recommendations of the p s y c h i a t r i s t as noted In sec-t i o n t h r e e . Gommunity. Despite-the comparatively small degree of help she r e c e i v e d from t h i s q uarter, she was able to turn i t to good. account, because of her understanding of the p e r s o n a l i t i e s of . Mr. and Mrs.• Atherton as t r a n s c r i b e d to Section Two on the l e f t side of the case-o-graph. Knowledge of the backgrounds of; the parents, e s p e c i a l l y as noted i n A, D, E,.and G, the s i g n i f i c a n c e of w h i c h has been p r e v i o u s l y discussed i n ; a n a l y s i s of the marriage, a l s o helped the worker i n c a r r y i n g out treatment. A l l these f a c t o r s were mustered i n the s t i m u l a t i o n of the Athertons to f i n d some a l t e r n a t i v e to placement of, Sonny. Then Miss West showed her r e a l m a t t l e . She s e l e c t e d the m a t e r i a l from the backgrounds,, e s p e c i a l l y the i'family l i f e of Mrs. Atherton as noted i n A i n the l e f t s i d e . Through her knowledge of the p e r s o n a l i t i e s of the Atherton&p recorded i n Section Two, and t h e i r f e e l i n g s about each other expressed i n " I " , she gauged the a b i l i t y of the p r i n c i -p a l s to accept i n t e r p r e t a t i o n . Her explanation of the o e d i p a l complex noted under s e r v i c e A,B,C,D,E,I, and H, " S e r v i c e " and " C l i e n t " i s one r e s u l t . S i m i l a r l y , she helped Mr.. Atherton to understand the b a s i s of h i s d e s i r e f o r c l e a n l i n e s s and the e f f e c t of t h i s t r a i t on h i s w i f e . This a l s o , can be discerned i n the p a r t s of the operation side of the case~ c h a r t . The p a r t which the neighbour played i s shown under "Community" The case-o-graph i n d i c a t e s , not only that the treatment was success f u l , but the measure of c o n t r i b u t i o n from each team member. I t has 62 been seen that the f a m i l y ease workers employed a c l u s t e r of f i n e l y developed techniques. These i n c l u d e d : observation, s e n s i t i v e n e s s to c l i e n t f e e l i n g , p r a c t i c e d use of the telephone, use of community •resources, and in g e n u i t y i n converting the r a t h e r negative recom-mendations of the p s y c h i a t r i c c l i n i c to p o s i t i v e value i n her t r e a t - . ment. But that.she could apply these s k i l l s was, In no small mea-sure, due to the p o t e n t i a l f o r growth i n the athertons. Neighbour-l i n e s s as a community resource stands out i n a l l i t s l a y brightness . as opposed to the r e l a t i v e p r o f e s s i o n a l inadequacy of the p s y c h i a t r i c s e r v i c e s . The M e r i t of This Device There i s . no pretence that t h i s a n a l y t i c a l device i s a r e v o l u -t i o n a r y d i s c o v e r y i n the f i e l d of case work e v a l u a t i o n , riather i t s m e r i t can be proven only by c o n t r o l l e d experimental use i n many case records and i t w i l l be subject to m o d i f i c a t i o n i n much the same way as are mental t e s t s i n the f i e l d of psychometrios. Use of This Device I n This study The case chart was h e l p f u l i n analyzing the f a m i l y case work performed i n the cases s e l e c t e d f o r t h i s study. I n the i n i t i a l attempt to t e s t e f f e c t i v e n e s s of f a m i l y case work w i t h the a i d of the case-o-graph, i t seemed advisable to s e l e c t cases that would approximate the "normal" f a m i l y . Gases were chosen which, presented problems of family - r e l a t i o n s h i p s , the most common assignment of the f a m i l y agency. The -families were l i m i t e d by age and i n composition. Only f a m i l i e s were chosen i n which the age of the f a t h e r d i d not exceed 40 y e a r s , and, of the mother, 35 years. C h i l d e s s marriages were s e l e c t e d only when there were no c o n t r a - i n d i c a t i o n s to f e c u n d i t y . 63 Some question might be raised, as to why barren marriages could not' be considered i f there were p o s s i b i l i t i e s that the partners might adopt c h i l d r e n . I t was f e l t , however, that the question of adoption i s ioo l a r g e uo be-included, i n any of i t s aspects, i n a study such as t h i s . -"TVhble" ..families only were s e l e c t e d , t h a t . i s , those i n which'both partners were a l i v e , although some were separated. S i t u a t i o n s i n which'extremes such as "murder" or " s u i c i d e " occurred were r u l e d out i n an e f f o r t to secure a more normal case load. . F i f t y - e i g h t cases were s e l e c t e d f o r study. These were chosen as most s u i t a b l e f o r a n a l y s i s a f t e r reading of over two hundred cases a c t i v e w i t h i n the f i v e f i s c a l years i n c l u d i n g 1947-1948. They were d i v i d e d i n t o two groups: " M a r i t a l R e l a t i o n s h i p Problems"; and "Problems of C h i l d Development" and "Parent-Child Relationships'', there being f o r t y - f o u r i n the f i r s t group and fourteen In the second. This p r o p o r t i o n , i t was thought, would compare favourably w i t h that i n the r e g u l a r case load of a t y p i c a l f a m i l y agency. The l a r g e r of the groups f e l l i n t o a number of s u b - c l a s s i f i c a -t i o n s . These i n c l u d e d : "The E a r l y Years Of Marriage" (ten cases)), "Advanced M a r i t a l C o n f l i c t " (fourteen c a s e s ) , "Separation" (eleven c a s e s ) , " R e c o n c i l i a t i o n " (nine cases). " E a r l y Marriages" i n c l u d e f a m i l i e s i n which the age of the marriage d i d not exceed f i v e years.. "Advanced M a r i t a l C o n f l i c t " i n c l u d e d marriages g e n e r a l l y f e a t u r i n g the r a t h e r tempestuous union that p e r s i s t s i n s p i t e o f , or, perhaps, because of v i o l e n t c o n f l i c t . "Separation" designates marriage i n which there i s separation of any k i n d from the i n f o r m a l break-up to d i v o r c e . For l a c k of a b e t t e r d e s c r i p t i v e term " R e c o n c i l i a t i o n " i s l o o s e l y used. While i n t h i s category there were some genuine 64 cases of r e c o n c i l i a t i o n , i n most the f e a t u r e was a tendency to step.out of the marriage and then, f o r some reason, to r e t u r n at l e a s t to the semblance of marriage. Mere r e c i t a l of these c l a s s i f i c a t i o n s might g i v e the impression that marriages i n t h i s study were r i g i d l y i d e n t i f i e d i n c a t e g o r i e s . Such an impression would be f a l s e , f o r there was no wish to f l a u n t the popular p r e j u d i c e against grouping of cases, or to d i s r e g a r d the b a s i c p r i n c i p l e of the i n d i v i d u a l i t y of the human being. The study accepts without question the heterogeneity of any group of f a m i l i e s . A c t u a l l y the groupings are d e r i v e d from f a c t u a l occur-rences i n the marriages. Marriages are not considered i n types. But s p e c i f i c problems are common to c e r t a i n marriages. On t h i s b a s i s some marriages could be discussed under more than one group heading. Thus i t w i l l be seen that problems connected w i t h c h i l d r a i s i n g w i l l not be discussed i n j u s t the chapter s e t aside f o r t h i s c o n s i d e r a t i o n but w i l l enter i n t o study of other groupings as f o r i n s t a n c e , "Advanced M a r i t a l C o n f l i c t " . A ******** The v a r i o u s methods of t e s t i n g f a m i l y case work r e s u l t s prov-i n g u n s u i t a b l e f o r use i n the present study, there was no a l t e r -n a t i v e but to develop an Instrument that could be used. The need f o r a f a c i l i t y to analyze the case record and show the a c t u a l f u n c t i o n i n g of f a m i l y case work was s t r o n g l y f e l t . The device v a r i o u s l y termed case-o-graph, casegram, and case-chart, was develop-ed i n an attempt to answer t h i s need. This t o o l permitted of a 65 graphic p r e s e n t a t i o n of the f a m i l y case work processes as i t took place i n a c t u a l cases, and showed the i n d i v i d u a l and co-ope r a t i v e e f f o r t s of the three-members of the "case work team" i n c l u d i n g c l i e n t , worker, and community. How t h i s case c h a r t might be used has been demonstrated u s i n g the Atherton case, one i n which a three-year-old boy was d i s p l a y i n g aberrant benaviour. The device was employed I n the f i f t y - e i g h t Family Welfare Bureau cases to be considered i n t h i s p r o j e c t . These cases presented f a m i l y r e l a t i o n s h i p problems. They were d i v i d e d i n t o c a t e g o r i e s f o r convenience, not w i t h the thought of r i g i d l y c l a s s i f y i n g them. 66 :" \ . • CHAPTER IV THE EARLY YEARS OP MARRIAGE The - E a r l y Marriage Fable has i t that the beginning years of marriage are "golden", b e a u t i f u l i n the r i c h n e s s of the experience they o f f e r , to the "well-matched" couple, and f i l l e d w i t h promise f o r the -f u t u r e , although the t r a d i t i o n of the "romantic" marriage d i e s hard, there i s a popular f e e l i n g that e a r l y marriage i s a serious a f f a i r , s t r i p p e d of i t s i d e a l l o v e l i n e s s by the prospect of meet-ing the r e a l i t i e s of a world which at once o f f e r s the b e n e f i t s of Invention and the threat of s c i e n t i f i c a l l y - p r o d u c e d d e v e s t a t i o n . Probably there are elements of t r u t h i n both concepts. For l i f e i s a mysterious admixture' of . the good and the bad, of beauty and u g l i n e s s , of happiness and tragedy; and l i f e o r i g i n a t e s i n the .family. The questions that come to mind ares How do these f o r c e s operate i n the f a m i l y ? Can e a r l y marriage's be strengthened i n such a way as to prevent the development of major d i f f i c u l t i e s l a t e r ? . And can observation of these f o r c e s operating i n e a r l y marriage, c o n t r i b u t e anything to understanding the marriages that have entered advanced stages of c o n f l i c t ? Range of jaxamples The ten cases studied i n t h i s chapter w i l l suggest answers to these questions. They i l l u s t r a t e what can and does happen to people who b r i n g the problems of e a r l y married l i f e to a f a m i l y a g e n c y . . . : Mr,. A. w h i l e s e r v i n g overseas married a young woman whose f i r s t marriage had ended i n . d i v o r c e . This marriage bore a l l the marks of a sound r e l a t i o n s h i p . A i r . A. accepted the son of Mrs. A. by her f i r s t marriage. While the As' were s t i l l i n jingland, a c h i l d was born of the second union. A f t e r r e t u r n i n g to c i v i l i a n l i f e i n Canada he. and h i s war b r i d e set about b u i l d i n g a home. They had been married almost three years when they came to- the. Family Welfare uureau. They needed household help w h i l e Mrs. A. entered h o s p i t a l f o r her t h i r d confinement. The marriage was strong enough to- bear the s t r a i n which f i n a n c i n g a home and the b i r t h of another c h i l d produced. .at the opposite extreme were the Js'1'. • A f t e r discharge from a c t i v e s e r v i c e , "Mr. J . was unable to f i n d s u i t a b l e housing f o r h i s f a m i l y , ivirs., J . t a r i n g of t h i s handicap, l e f t Mr. J . to take up residence w i t h a man who had good accommodation. .between these two extremes were marriages of- v a r i o u s strengths L i k e the As1,-. Mr., and Mrs. b. had a f i r m m a r i t a l r e l a t i o n s h i p when M r . b. s u f f e r e d post'parturn d i f f i c u l t i e s ; Mr. B. tenderly a f f e c t i o n ate and very p r o t e c t i v e of her, jeopardized the f a m i l y economy by absenting h i m s e l f from h i s work at the shipyards to look a f t e r her and the three s m a l l c h i l d r e n . ..Mr. C. a.young army veteran had d i f f i c u l t i e s i n securing housing and employment. His concern oyer the welfare of Mrs. C. and t h e i r i n f a n t son aroused strong n a t i v e f e e l i n g s of h o s t i l i t y i n him. More l e t h a r g i c was M r . D who, w i t h sub-normal I n t e l l i g e n c e was not able adequately to support h i s E n g l i s h Ysfar B r i d e and c h i l d . M r s . E. was b a f f l e d by the conduct of her husband, an ex-serviceman who, apparently s t i l l stunned by the v i o l e n c e of b a t t l e j 68 was unable to accept r e s p o n s i b i l i t y and tended to withdraw from a l l s o c i a l c o n t a c t . The P s ' two young people who had known each o ther w e l l be fore M r . F . went overseas f l e d i n bewilderment from t h e i r s m a l l i n t e r i o r B r i t i s h Columbia town to the b i g c i t y , there to h i d e the d i s g r a c e of t h e i r f o r c e d m a r r i a g e . They soon found t h a t change of environment c o u l d not s a l v e the i r r i t a t i o n from t h e i r own c o n s c i e n c e s . I r r e s p o n s i b l e tendencies of M r . G . seemed to have i n c r e a s e d d u r i n g a c t i v e s e r v i c e . H i s r e c k l e s s spending became an e n e r v a t i n g t h r e a t to h i s young w i f e when she found h e r s e l f pregnant s h o r t l y a f t e r m a r r i a g e . The I s ' f i n d i n g themselves unequal to the r e s p o n s i b i l i t y of c a r i n g f o r two c h i l d r e n , one i n h i s second y e a r , the other a few days o l d , were q u a r r e l l i n g and seeking placement f o r t h e i r c h i l d r e n M r s . H . was another parent seemingly unable to f a c e the prospec t of c a r i n g f o r a second expected c h i l d . Her f e a r s i n t e n s i f i e d by M r . H i s i n c o n s i d e r a t e a t t i t u d e toward h e r . P e r s o n a l Backgrounds of The Marr iage P a r t n e r s I n appearance these ten couples were l i k e any c r o s s - s e c t i o n o f s o c i e t y . They were s h o r t , t a l l , t h i n , s t o u t , d a r k , f a i r , f r a i l , s t r o n g , handsome, and p l a i n - l o o k i n g , borne were neat and w e l l -d r e s s e d ; o thers unkempt and" p o o r l y a t t i r e d , borne had brusque manners ;o thers were shy and d i f f i d e n t . Age One f a c t o r common to these f a m i l i e s was the r e l a t i v e y o u t h f u l -ness of the p a r t n e r s . I n s i x out of the seven cases* i n which ages were r e c o r d e d both* p a r t n e r s were i n t h e i r t w e n t i e s . M r s . G . , the 69 youngest of the .wives, was 21 years; Mrs... A., the oldest thirty-two Mr. G. the youngest man, was twenty-two; Mr. A., the eldest thirty-nine. Two of the women were older than their husbands but, each of them, by only a. year. The seven years difference i n the ages of Mr. and Mrs. A. was the greatest for any couple, Intthose families whose ages were not recorded other physical factors suggested age range comparable to the recorded cases. Most of these people f e l l i n the age group, 20 to 30 years. It might be expected that most were sufficiently youthful to be flexible i n meeting the problems of l i f e and marriage, to make some personal adjustment.in their situations. The relative youth and the closeness i n age of partners should have constituted positive elements i n these marriages. Education The intellectual capacity for meeting problems i n the marriage could not be judged from educational achievement. This factor WAs Infrequently recorded. In only one case was the education of both husband and wife ascertained. In two others this was recorded for the men. Mr. F. with senior matriculation standing, had the high-est known qualification. Occupation And Employment Like education, work has significant meaning i n the lives of people. Choice of occupation and vocational achievement are im-portant in the understanding of the individual i n his reaction to the problems of existence and suggest his capacity to adjust to l i f e . Currently there i s increasing recognition of the vast influences *occupational pressures" exert on the personality. The economic and emotional security represented i n employment,, 70 the work h i s t o r y of the i n d i v i d u a l , the s o c i a l aspects of l a b o u r -i n g w i t h , o r , i s o l a t e d f r o m , o t h e r s , each have a b e a r i n g on the p e r s o n a l i t y of the worker and h i s a b i l i t y to f u n c t i o n as a respons-i b l e member of s o c i e t y . I t would be expec ted , t h e r e f o r e , t h a t i n these ten examples there might be o c c u p a t i o n a l and employment d i f f i c u l t i e s a f f e c t i n g a d v e r s e l y the f a m i l y r e l a t i o n s h i p s , and some p o s i t i v e f a c t o r s c o n t r i b u t i n g to the happiness of the f a m i l y . Examinat ion of the case r e c o r d s of these f a m i l i e s r e v e a l s a f a i r l y comprehensive range o f occupat ions and a v a r i e d assortment o f employment f a c t o r s . Occupat ion was recorded f o r a l l the men and f o u r of the w i v e s . 1 F i v e of the men c la imed " s k i l l e d " occupa-t i o n s and one was l e a r n i n g a " s k i l l e d " t r a d e . Four were ' ' semi-s k i l l e d " and one was an " u n s k i l l e d l a b o u r e r ' * . The c o n s t r u c t i o n t rades were most, w i d e l y r e p r e s e n t e d . There were , a l s o : c l e r i c a l w o r k e r s , a j e w e l e r , and a s h i p y a r d worker , and an a p p r e n t i c e . A t l e a s t three men had worked i n two o c c u p a t i o n s . Seven men were employed i n t h e i r s t a t e d o c c u p a t i o n s . Two o thers were w i t h -out employment. Both of these and M r . I . , a c o n s t r u c t i o n worker employed out of h i s t r a d e , had economic d i f f i c u l t i e s , which ap-p a r e n t l y o r i g i n a t e d i n work prob lems . P e r s o n a l i t y d i f f i c u l t i e s w h i c h M r . I . was e x h i b i t i n g seemed to have been brought put through h i s employment prob lem. M r . D . , assessed as d u l l normal i n r e s p e c t of g e n e r a l i n t e l l i g e n c e , was unable to perform any work o ther than u n s k i l l e d l a b o u r , and the f a c t t h a t he had t r i e d to operate a bus inesses of h i s own l e d t o f i n a n c i a l d i f f i c u l t y which added to a m a r i t a l s t r a i n . The female occupat ions i n c l u d e d h a i r d r e s s e r , f u r r i e r ' s 71 h e l p e r , and box maker. Of the four women f o r whom an occupation was l i s t e d , two a f t e r marrying, confined themselves to the d u t i e s of housewife, one worked o c c a s i o n a l l y and one l a t e r took steady employment. S i g n i f i c a n t l y , i t was Mr. I . who worked o c c a s i o n a l l y * Mrs. D. took employment when economic and m a r i t a l s t r a i n reached t h e i r peaks. L a t e r , when Mrs. D. r e a l i z e d the inadequacy of her husband, she accepted her p l i g h t and t r i e d to m i t i g a t e i t by h e r s e l f working s t e a d i l y . Armed Se r v i c e Considered As Employment As the time spent on a c t i v e s e r v i c e represents a per i o d out of the normal span of work l i f e of tne uniformed c i v i l i a n , i t should be considered i n r e l a t i o n to employment. E i g h t of these men were war veterans, s i x w i t h s e r v i c e overseas or a t sea. I n a d d i t i o n , one, Mr. I . had served i n xhe merchant marine. One war b r i d e had been i n a B r i t i s h womenis a u x i l i a r y s e r v i c e . At l e a s t s i x of the veterans had problems connected w i t h armed s e r v i c e . For example, i t was the h a b i t s of d r i n k i n g and spending f r e e l y which Mr. G. had developed wh i l e i n s e r v i c e , t h a t presented a t h r e a t to n i s marriage and made • i t d i f f i c u l t f o r h i s w i f e to use advantageously tne agency budget-t i n g s e r v i c e . Mr. D. the dull-minded labourer had run i n t o f i n a n c i a l d i f f i c u l t y because he had i n v e s t e d "re-establishment c r e d i t , " h i s reward f o r s e r v i c e , i n a business venture, which he was mentally incapable of h a n d l i n g . Both unemployed men were veterans having d i f f i c u l t y to adjust to c i v i l i a n l i f e a f t e r discharge from s e r v i e e . One of them Mr. £• was d i s p l a y i n g a tendency to withdraw from;-all s o c i a l a c t i v i t y . H i s abnormal r e t i c e n c e made him seem almost "psychotic." F o r t u n a t e l y , the f a m i l y case worker, by p a t i e n t attempts to understand him and to h e l p him v e r b a l i z e , and by g e t t i n g i n f o r m a t i o n about him 72 f rom the w i f e d i s c o v e r e d the f a l l a c y o f t h i s o b s e r v a t i o n . D i s -c l o s u r e s about h i s s e r v i c e suggested t h a t he probably s u f f e r e d from the e f f e c t s o f extreme v i o l e n c e i n b a t t l e . The " b a t t l e f a t i g u e " so a c q u i r e d at l e a s t p r a c t i c a l l y accounted f o r h i s I n e r t i a . So complete was t h i s " w i t h d r a w a l " t h a t he tended even to r e t i r e from the marr iage which p r e v i o u s l y had been happy. H e a l t h H e a l t h f a c t o r s are as important as the other/personal a t t r i b u t e s i n the i n d i v i d u a l ' s adjustment to l i f e . The course of human e x i s t -ence i s a f f e c t e d by any d e v i a t i o n from normal h e a l t h , be i t s imple f a t i g u e or major i l l n e s s . T h i s f a c t o r i s ) p a r t i c u l a r l y s i g n i f i c a n t i n t h i s range of cases as the Inc idence of s e r i o u s h e a l t h problems seems abnormally h i g h i n a gi-oup so y o u t n f u l . I n every f a m i l y there was some p h y s i c a l h e a l t h n e e d . The f a c t t h a t i n two OJ£ these the need was connected w i t h normal pregnancy to a degree r e l i e v e s the darknessobf the p i c t u r e . I n f o u r of the f a m i l i e s b o t h husband and w i f e had a p h y s i c a l h e a l t h prob lem. F i v e husbands had such a c o n c e r n , e i g h t women. The a i l m e n t s o f the men i n c l u d e d ches t c o n d i t i o n , anaemia, duodenal u l c e r , l i s t e s s n e s s a p p a r e n t l y a s s o c i a t e d w i t h b a t t l e e x p e r i e n c e , and a s k i n c o n d i t i o n r e s u l t i n g from a war wound. The anaemia was v e r y s e r i o u s o c c u r r i n g i n M r . D . who was a l r e a d y h a n d i -capped by h i s menta l d i s a b i l i t y . The n e c e s s i t y of h o s p i t a l i z a t i o n on t h i s account f u r t h e r c o m p l i c a t e d h i s s i t u a t i o n , jjiiven w i t h h o s p i t a l a l lowances there was an i n t e r r u p t i o n of income pending r e m i t t a n c e o f t h i s b e n e f i t . M r . I . s u f f e r e d from a ches t c o n d i t i o n w h i c h seemed to have an emotional component, t h a t c o n t r i b u t e d to 73 t h e " I n s t a b i l i t y of h i s marriage. Nor d i d the postpartum d i f f u c u l t i e s of his wife improve th e i r r e l a t i o n s h i p . «r. B. one of the unemployed .veterans complained of duodenal ul c e r s accondition which seemed c l o s e l y r e l a t e d to emotional d i f -f i c u l t i e s which took the form of acute anxiety about h i s employment, and inadequate housing. His expression of h o s t i l i t y to the intake worker was the most v i o l e n t ever witnessed at the agency. On the other hand, air. A , . , the veteran who had developed a severe d e r m i t i t i s through b a t t l e wound, appeared to pay no heed to h i s condition. Five of the wives were expectant during the period of agency contact. One of these pregnancies was abnormal. Another wife had suffered a miscarriage previously but was able to carry a second pregnancy to f u l l term and normal d e l i v e r y . Mrs. A. who might have found pregnancy normal suffered from physical d e b i l i t a t i o n after a number of years l i v i n g i n England on a war-time d i e t . Three of the other women suffered from a f t e r - e f f e c t s of c h i l d -bearing. The p o s i t i v e effects of good health showed themselves p l a i n l y i n the marriage r e l a t i o n s h i p s . Mrs. B. enjoyed robust health which may account, i n part, f o r her a b i l i t y to-take hold of her d i f f i c u l t s i t u a t i o n . With the array of health problems occurring In th i s group i t might well be expected that services rendered would be heavily concentrated In t h i s area. The emotional and mental health problems have been continuously mentioned In dlscussion-of physical health. The relationship between the emotional problems and health l a quite p l a i n l y to be seen. I t 7 4 i s well to remark, though, that some of the physically well, suffered emotional disturbances which intensified their problem situations. Mrs. D., although strong and capable, found unusual d i f f i c u l t y i n adjusting to Canada whence she had come as an English war bride. Indeed, i t was- because of this d i f f i c u l t y that she f i r s t came to know the family agency. Mobility Often mobility Is spoken of as though i t were a primary t r a i t of the Individual with a personality problem and i t receives con-spicuous mention in discussion of marital d i f f i c u l t i e s . I t does not, however, seem to have been a computable factor i n the problems presented by the families. Aside from overseas service of the veterans and transport to Canada of the war brides, i t scarcely enters the picture, TWO couples had originally come from Prairie centres but there seemed to be no major problems consequent on this move. The significance of the removal from interior British Columbia to Vancouver has already been noted. The one other situation i n , which mobility had been important was that of Mr. B. who l e f t Ontario due to the jealousy of his mother which threatened the happiness of the marriage as she expressed i t in active dislike of his wife. family Background A primary consideration i n diagnosing an individual problem Is the discovery of the significant facts of the family from which the person originates. The family case worker i s patently aware of the importance of family background. It should be possible, there-fore, i n reviewing these ten marriages, to see circumstances in family backgrounds that furnish, at least in part, explanation of the manner.-inyhich these marriages functioned. Quite surprising, 75 then, i s the fact that these records contained relatively meagre information of this subject. For two cases, no family background data was recorded, and i n two others nothing was learned about the man's family l i f e , let i n every case where this Information was secured, however incompletely, i t was helpful in diagnosis of the situation. Thus, as i n the case of the labourer and his English war bride, the worker secured data which would help in treatment, or which would show that the situa-tion would be hardly treatable. The worker who saw Mr. D. the labourer knew of the man's unstable l i f e , that as a child, he had become known to a children's agency because of his need of protect-ion. This information and the knowledge that his parents had lived In common-law relationship, that his mother had an uneviable record as a responsible human being, and that he himself was not blessed with adequate i n t e l l i g e n c e — a l l led to one conclusion. He had no super-ego to gumde him. Perspicacity of the worker In realizing, on the other hand, that Mrs. D. had been brought up by a mother, who, although widowed, was capable of discharging her maternal duties, gave a clue to the possible strength i n this new marriage. It followed logically that the worker, i f competent, could be of help to the family by lending support to the wife i n the decision to assume major responsibility for family management. Similarly i n the family backgrounds of the Fs» the young couple who l e f t interior British Columbia to come to the coast for birth of their baby, there were unusual strengths, which helped them i n the resolution of their problem. Both partners had come of "good stock". Mr. F. originated from a family group that was known for i t s civic leadership. One of his relatives had been the 76 principal elected o f f i c i a l i n his home community. He himself was very conscious of his social status, saying i n one interview,, "We're nice people". These circumstances, together with the good i n t e l l i -gence of the couple, were u t i l i z e d by the staff member who worked with them, to help effect a happy conclusion to a very miserable problem. Mr. B. was almost too well aware of his wife's background. He was excessively protective of Mrs. B., knowing that her mother had died when she was a child. The father had predeceased the mother, leaving the child to none too merciful relatives. When Mr. B's fears regarding the well-being of his wife, i l l with post-partum disorders, kept him away from the job, i t threatened the economic basis of the family. The d i s t r i c t visitor took into account a l l these factors as she helped relieve the stress by skilful*.;, instal-lation of a vi s i t i n g home maker, thus freeing the husband for return to his work. In the situation of the Hs' which was featured by marital dis-harmony that expressed Itself i n occasional violence, It wasipossible to trace the conflict to unpleasant circumstances In the family backgrounds of both partners. The mother of Mr. H. had been the dominating figure i n his environment. A cold person, possessed of a religious fanaticism, she created a home atmosphere which l e f t . her son badly conflicted as to his relationships with the opposite sex and as to his role as a father. Mrs. H. came from an equally bad situation. Her father and mother quarrelled Incessantly. Ap-parently shiftless, her father seldom concerned himself about the necessity of adequately supporting his large family. Yet, despite these unhappy omens, the worker was able to distinguish enough 77 p o s i t i v e elements i n the s i t u a t i o n to h e l p these two people e f f e c t an ad justment . M r . I . and h i s w i f e were l e s s f o r t u n a t e than the H s 1 . They seemed never t o have overcome the d i s a b i l i t i e s of t h e i r c h i l d h o o d s . When ten y e a r s of age, M r . H . had been committed to care of a c h i l d r e n ' s agency. C u r i o u s l y , two of the q u i t e e f f e c t i v e uses of case work were w i t h the couples f o r whom no f a m i l y background was r e c o r d e d . N o t h -i n g was known of the f a m i l y h i s t o r y o f the C s 1 , the young people f o r whom budgetary s e r v i c e was p r o v i d e d . T h i s s e r v i c e d i d prove v a l u a b l e i n a l l e v i a t i n g the Immediate prob lem. The deeper problem of the i n c i p i e n t m a r i t a l c o n f l i c t , however, was s c a r c e l y touched. Had the worker been able to h e l p M r s . G . d i s c u s s her f a m i l y back-ground i t might have Deen p o s s i b l e to have used t h i s v e r b a l i z a t i o n I n r e l a t i n g i t to the more s e r i o u s problem of eas ing the m a r i t a l s t r a i n . The other s i t u a t i o n f o r which no f a m i l y d a t a was secured was t h a t of the A s 1 , two r e l a t i v e l y mature p e o p l e , f o r whom p r o v i s i o n o f home maker s e r v i c e i n a time or c r i s i s served to s t rengthen t h e i r s o l i d r e l a t i o n s h i p . T h i s b e i n g s o , f o r purpose of meeting t h e i r need s e c u r i n g t h i s d a t a was not necessary and would have been extraneous to the case work t rea tment . C u l t u r a l And S o c i a l F a c t o r s C u l t u r a l h e r i t a g e has an important I n f l u e n c e on the l i f e of the i n d i v i d u a l . I n t h i s group there was a marked homogeneity i n r e s p e c t to n a t i o n a l i t y and e t h n i c g r o u p s . Wi th the e x c e p t i o n of one U k r a i n i a n man a l l were of B r i t i s h r a c i a l o r i g i n . A l l c l i e n t s but two E n g l i s h War B r i d e s were 78 C a n a d i a n - b o r n . These f a m i l i e s were predominat ly u r b & n - b r e d . Only one couple had grown up i n a r u r a l s e t t i n g . Two men and two women grew up I n s m a l l communit ies . There was i n s u f f i c i e n t s p e c i f i c i n f o r m a t i o n r e c o r d e d , to d e t e r -mine the economic s t a t u s o f t h i s c l i n t e l e . Most couples seemed to have o r i g i n a t e d i n the low and middle Income g r o u p s . The d e a r t h of t h i s type of i n f o r m a t i o n i s r e g r e t t a b l e ^ f o r , whenever a v a i l a b l e , i t i n v a r i a b l y had a b e a r i n g on tne problems presented by the c l i e n t . The s i g n i f i c a n c e of . .Mrs. .A(''sx d e p r i v e d , c h i l d h o o d , has been'. :no.ted.bMrV;I. and h i s w i f e b o t h had l a c k e d economic advantages i n c h i l d h o o d . M r . and M r s . D . had a s i m i l a r h i s t o r y . They had i n common the f a c t t h a t t h e i r parents had r a i s e d f a m i l i e s w i t h tne support of g o v e r n -ment a l l o w a n c e s . M r . D ' s mother had r e c e i v e d M o t h e r ' s A l l o w a n c e ; M r s . D ' s mother had r e c e i v e d a B r i t i s h Navy widow's p e n s i o n . No s p e c i f i c ^ a n d l i t t l e g e n e r a l i n f o r m a t i o n was secured about the a c t u a l l i v i n g c o n d i t i o n s , such as h o u s i n g , to which these people had been accustomed i n c h i l d h o o d . W h i l e the case workers competent ly e x e r c i s e d t h e i r s k i l l , sometimes w i t h notab le e f f e c t i v e -ness i n these s i t u a t i o n s , i t might be w e l l quest ioned i f l e a r n i n g more d e t a i l s here as of a l l background m a t e r i a l would hot have added to the soundness of the w o r k . R e l i g i o n U s u a l l y r e l i g i o n i s an important element I n the c u l t u r a l h e r i t a g e of p e o p l e . Y e t i n t h i s group of f a m i l i e s i t had l i t t l e p l a c e . Few c l i e n t s adhered to a f o r m a l r e l i g i o n . A t moderate extremes were the men who admit ted b e i n g " n o n - p r a c t i c i n g Greek C a t h o l i c " and the couple who d e s c r i b e d themselves as " c y n i c s . " 79 The remainder c l a s s i f i e d themselves as P r o t e s t a n t . Only one couple s p e c i f i e d an a f f i l i a t i o n , the Church of E n g l a n d . M a r r i a g e And The F a m i l y The r e l a t i o n s h i p between the f a c t o r s r e c o r d e d i n S e c t i o n s One, Two, and Three o f the c a s e - c h a r t was brought out i n the i l l u s t r a t i o n drawn i n Chapter I I I . Lack of background i n some of these ten cases make i t more d i f f i c u l t to see p l a i n l y the same r e l a t i o n s h i p . Where there i s some background, the r e l a t i o n s h i p i s u s u a l l y q u i t e apparent . The f a m i l y h i s t o r i e s are r e f l e c t e d i n the marr iages of these twenty people i n such mat ters a s : p r e p a r a t i o n f o r m a r r i a g e , c o m p a t i b i l i t y , economic, s o c i a l and l i v i n g c o n d i t i o n s and the r e a r i n g of c h i l d r e n . Circumstances of The Marr iages Length of the marr iages be fore c l i e n t s come to the agency v a r i e d from the three, months the G s 1 had been wed, to the ten y e a r s the B s 1 had been t o g e t h e r . The marr iages have i n common t h a t most o f them were performed i n Canada, there i s mention i n o n l y two r e c o r d s of the much more impor tant matter of c o u r t s h i p . One of these c o u r t s h i p s t h a t of the D s 1 who got a long so p o o r l y together was of o n l y one week d u r a t i o n . I n c o n t r a s t , i s the r e c o r d of the F a 1 whose marr iage was f o r c e d and who " r a n away" to Vancouver . T h e i r long p r e - m a r i t a l acqua in tance , i t i s c l e a r f rom the r e c o r d , had n u r t u r e d i n them a s i n c e r e mutual a f f e c t i o n w h i c h was a s t r e n g t h they c o u l d use i n overcoming t h e i r c r i s i s . , W h i l e t h i s couple were able to r e s o l v e t h e i r g u i l t over t h e i r a c t i o n , the Hs», the other couple who had entered a " f o r c e d m a r r i a g e " , exper ienced more d i f f i c u l t y i n a d j u s t -i n g to m a r r i a g e . U n l i k e the F f a m i l y , backgrounds of bo th the Js* 80 were known. Thus b e f o r e f a i l u r e to ready themselves s p e c i f i c a l l y f o r m a r r i a g e , had been f a i l u r e to prepare g e n e r a l l y f o r l i f e e x p e r i e n c e . C o m p a t i b i l i t y There were o n l y two marr iages i n which the r e l a t i o n s h i p s d e f i n i t e l y were not good. The p l i g h t o f the I s ' has been d e s c r i b e d . The other s i t u a t i o n f e a t u r e d M r . J . who had become " f e d - u p " , a l -l e g e d l y because of hous ing c o n d i t i o n s , and formed a m i s a l l i a n c e , d e s p i t e the f a c t t h a t the husband s t i l l p r o t e s t e d h i s l o v e f o r h e r . That the r e l a t i o n s h i p between the H s ' was tenuous, has a l r e a d y been seen. One c o u p l e , the E s 1 , were separated at the time they came to the agency, but t h i s proved to be the r e s u l t of economic c i rcumstances and a p e r s o n a l i t y d i f f i c u l t y (wi thdrawal ) r a t h e r than r e a l i n c o m p a t i b i l i t y . Economic, S o c i a l and L i v i n g C o n d i t i o n s Environmenta l c o n d i t i o n s had a n o t i c e a b l e e f f e c t on the q u a l i t y of r e l a t i o n s h i p between man and w i f e . Economic c o n d i t i o n s g e n e r a l l y were not v e r y good. F i n a n c i a l se t -ups ranged from the two f a m i l i e s w i t h o u t income due to unemployment up to M r . A . who was earn ing a f a i r s a l a r y , y e t because he was purchas ing a home, was b a r e l y meet ing expenses. M r . H . , one man who was e a r n i n g a good s a l a r y , about f>200 a month, made mat ters d i f f i c u l t f o r h i m s e l f and h i s w i f e , by d o l i n g out money to her v e r y p a r i s m o n i o u s l y . The h i g h Inc idences of h e a l t h problems d i d not improve the f i n a n c e s of these f a m i l i e s . Housing c o n d i t i o n s g e n e r a l l y were p o o r . Accommodations i n c l u d e d s u i t e s i n tenements and rooming houses , s i n g l e rooms, h o t e l rooms, an o l u s t o r e , and the c i t i z e n s ! veterans! s h o s t e l . I n 81 at l e a s t three i n s t a n c e s hous ing d e f i c i e n c i e s added to the g r a v i t y of the problems . The young man who was so h o s t i l e t o the i n t a k e worker was hous ing h i s f a m i l y i n g a r r e t - l i k e rooms. So c o n f i n i n g were these t h a t they accentuated h i s tenseness , and made f o r d i f -f i c u l t i e s between h i m s e l f and h i s w i f e . The conver ted s t o r e was a constant source o f c o n t e n t i o n between the man and w i f e who had both known such unhappy cfeaildhoods. S i m i l a r l y i n : the j f a m i l y i n w h i c h the w i f e went o f f w i t h another man, bo th p a r t n e r s blamed the f a c t t h a t they c o u l d f i n d no p l a c e i t o l i v e except the v e t e r a n s ' h o s t e l , tlaough a c t u a l l y b o t h s u f f e r e d from deepseated p e r s o n a l i t y d i f f i c u l t i e s . C h i l d r e n . E i g h t of the couples were p a r e n t s , two e x p e c t a n t . C h i l d r e n ' s ages ranged from a few days to n i n e y e a r s . The g r e a t e s t number of c h i l d r e n i n one f a m i l y was t h r e e . Most of the c h i l d r e n seemed happy. That three s e t s of parents asked f o r placement might seem to have boded i l l f o r t h e i r f u t u r e . I n two of these s i t u a t i o n s , however, the case worker was a b l e to h e l p the parents through v a r b a l i a s a t i o n of t h e i r f e e l i n g s of r e j e c t i o n to modify t h e i r a t -t i t u d e s toward t h e i r c h i l d r e n s u f f i c i e n t l y to r e t a i n them at home. There was a h i g h i n c i d e n c e of i n f a n t s i c k n e s s , but on ly one c h i l d had s u f f e r e d s e r i o u s i l l n e s s , from w h i c h a p p a r e n t l y he f u l l y r e -c o v e r e d . Problems And R e s u l t s Of Treatment. The scope of t h e problems encountered i n these f a m i l i e s has been r e v e a l e d i n the preceding d i s c u s s i o n . Problems r e l a t i n g t o h e a l t h occurred most f r e q u e n t l y . Economic d i f f i c u l t i e s ranked h i g h . C l e a r l y , the h o u s i n g shortage had a v i s i b l e e f f e c t on t h i s 8 2 g r o u p . F a c t o r s of i n c o m p a t i b i l i t y d i s p o r t e d themselves f r e e l y i n on ly three cases a l t h o u g h o ther unfavourable I n f l u e n c e s almost c o n -s i s t e n t l y weakened the r e l a t i o n s h i p s . The m u l t i p l e c h a r a c t e r of problems was a prominent f e a t u r e . A t the t ime of r e f e r r a l the k i n d or number of problems was not always e v i d e n t and whereas a f a m i l y might be r e f e r r e d f o r h e l p w i t h a s p e c i f i c problem u s u a l l y there were o thers to be t r e a t e d . I n d e M , t r o u b l e s d i d not come s i n g l y i n any s i t u a t i o n . To i l l u s t r a t e the m u l t i p l i c i t y of problems d i s c o v e r e d a f t e r r e f e r r a l to the agency the case o f M r . E . , the h o s t i e ) v e t e r a n can be c i t e d . He came f o r h e l p w i t h a f i n a n c i a l d i f f i c u l t y . A c t u a l l y h i s problems i n c l u d e d , p e r s o n a l i t y d i f f i c u l t y , need f o r r e c r e a t i o n f o r b o t h h i s w i f e and h i m s e l f , hous ing inadequancy, and unemployment M e n t a l h e a l t h needs such as acquaintance w i t h n i s s i t u a t i o n r e v e a l e d appear t y p i c a l l y , to be h i d d e n at time of r e f e r r a l and uncovered o n l y i n the course o f d i a g n o s i s and t rea tment . I n o n l y one s i t u a t i o n , t h a t of the J s * , was no s a t i s f a c t o r y s o l u t i o n r e a c h e d ; at the o ther extreme case work w i t h the A f a m i l y seemed almost comple te ly e f f e c t i v e . The remainder ranged between these p o l e s though, i n g e n e r a l , the case work done w i t h them c o u l d be counted as q u i t e e f f e c t i v e . Treatment The average p e r i o d the cases were a c t i v e w i t h the agency was 150 d a y s , or about f o u r and o n e - t h i r d months. Some had more than-one c o n t a c t and one haa f o u r separate p e r i o d s of a c t i v i t y . The C l i e n t Examinat ion of these cases shows the importance of c l i e n t -83 p a r t i c i p a t i o n i n t rea tment . I n the s i t u a t i o n which was not s a t i s -f a c t o r i l y r e s o l v e d , the w i f e e x h i o i t e d a b s o l u t e l y no d e s i r e to change her- ways.. M r s . J . r e f u s e d even to d i s c u s s the d i f f e r e n c e s w i t h her husband. Her s t r o n g n e g a t i v e - a t t i t u d e which she "ac ted o u t " i n s o c i a l l y unacceptable behaviour would probably have made i t i m p o s s i b l e l o r her- to enter a case work r e l a t i o n s h i p , even i f the s t a f f member had been able to arrange a r e g u l a r s e r i e s of i n t e r v i e w s . She worker who t r i e d to h e l p the D s 1 , put forward strenuous e f f o r t . Y e t , w i t h o u t the s t r e n g t h s which t h i s worker found i n M r . i ) . and w i t h o u t tue support o f those s t r e n g t h s to enable the woman to take a c t i o n the s i t u a t i o n would have worsened. L i k e w i s e the F s 1 found an extremely happy s o l u t i o n to t h e i r problem because of t h e i r h i g h c a p a b i l i t i e s and the w i l l i n g n e s s of the man's f a m i l y to accept the r e s u l t s of the mis take which the young people had made. I n every case i n which movement took p l a c e the c l i e n t s had the a b i l i t y t o p a r t i c i p a t e i n a c t i o n d i r e c t e d to a s o l u t i o n of t h e i r problems. The Worker A n a l y s i s o f these r e c o r d s a l s o shows the importance of the case w o r k e r ' s s k i l l s . The u n d e r s t a n d i n g of the worker who h e l p e d M r . D . and h i s w i f e and the e x t e n s i v e e f f o r t she put i n t o h e l p i n g them a t t a c k t h e i r problem has a l r e a d y been c i t e d . I n n e a r l y every one of these cases the f a m i l y case worker i n v e s t e d e f f o r t equa l to t h i s , i f not s u r p a s s i n g i t . The Important f e a t u r e of the case worker a c t i v i t y i n n e a r l y every example was the d e f t n e s s w i t h which the p r a c t i t i o n e r e x e r c i s e d h i s p r o f e s s i o n a l t e c h n i q u e s , c o n s i s t e n t l y there was r e g a r d f o r the i n d i v i d u a l as p o s s e s s i n g v o l i t i o n that 84 w o u l d , w i t h i n l i m i t a t i o n s h e l p him to daoose h i s own l i n e of a c t i o n . There was c o n t r o l of the d e s i r e to h e l p w i t h c a r e f u l t i m i n g as to s teps to be taken i n t rea tment . use of the v i s i t i n g home maker s e r v i c e was p a r t i c u l a r l y s k i l -f u l . The bes t example of t h i s was the worker who v i s i t e d M r s . A i n answer to a r e q u e s t f o r a s s i s t a n c e on the o c c a s i o n of her t h i r d conf inement . I t might appear s i m p l y t h a t housekeeping s e r v i c e was recommended s i n c e vthe f a m i l y c o u l d not a f f o r d to h i r e o r d i n a r y h e l p . C a r e f u l s c r u t i n y of the r e c o r d , however, showed how she c a r r i e d through t h i s p i e c e of work v e r y c a r e f u l l y , s t ep^by-s tep and though s e v e r a l v i s i t s the s e r v i c e was p r o v i d e d . M r . A had q u i t e a good j o b . X e t , a s he was burdened w i t h the purchase of h i s home, i t was doubt-f u l t h a t he c o u l d a f f o r d t o h i r e r e g u l a r h e l p . I n t a l k i n g w i t h the A s ' the worker l e a r n e d of the w i f e ' s unhappy m a r r i a g e . A l t h o u g h l i t -t l e c o u l d be l e a r n e d from M r s . A about her e a r l i e r m a r r i a g e , i t was p e r c e i v e d t h a t e v e n t u a l l y i t had broken through f i n a n c i a l d i f f i c u l t i e s t h a t touched o f f the m a r i t a l c o n f l i c t . The worker through s e v e r a l i n t e r v i e w s c a r e f u l l y he lped the A s ' to e s t a b l i s h e l e g i b i l i t y f o r home maker s e r v i c e . The r e c u r r e n c e 4^ f i n a n c i a l d i f f i c u l t y which might have resembled u g l y elemants of the f i r s t marr iage as thus a v o i d e d . An u n u s u a l d i s p l a y o f s k i l l was g i v e n by the s t a f f member who was a s s i g n e d to the H s ' . M r s . H reques ted placement of an expected c h i l d , her t h i r d , as m a r i t a l r e l a t i o n s were so s t r a i n e d between h e r -s e l f and her husband. Y e t , she was u n w i l l i n g t h a t the worker should i n t e r v i e w M r . H . E x c e p t i n g t h i s l i m i t a t i o n , the worker arranged to v i s i t M r s . H . once a week r e g u l a r l y . H e l p i n g M r s . H . to d i s c u s s her l i f e h i s t o r y and her marr iage and to express her f e e l i n g s i n these 85 a r e a s , brought her to the p o i n t of a c c e p t i n g Mr,. H . w i t h h i s f a u l t s and enabled her b e t t e r to unders tand her m a r i t a l r e l a t i o n s h i p . Sometimes workers c o u l d meet on ly the immediate needs. Thus I t was p o s s i b l e to h e l p the G s f w i t h t h e i r budgetary problems. A s s i s t a n c e w i t h t h i s p r a c t i c a l d i f f i c u l t y , d o u b t l e s s , a t l e a s t eased the p r e s s u r e o f the i c i p i e n t m a r i t a l d i f f i c u l t y . The Community. The r e s o u r c e s of the community f o r t h i s set of f a m i l i e s proved f a i r l y adequate . Both s o c i a l agencies and unorganized resources were s u c c e s f u l l y u s e d . I n t e r e s t i n g t o note i s t h a t i n two s i t u a t i o n s neighbours c o n t r i b u t e d h e l p to c l i e n t s to an extent f a r beyond the concept of f r i e n d l i n e s s g e n e r a l l y a s s o c i a t e d w i t h urban l i v i n g . F a i l u r e of community r e s o u r c e s , on the other hand was v e r y ap-parent i n one s i t u a t i o n . M r . C . , the h o s t i l e young man p r e v i o u s l y d e s c r i b e d , reached the h e i g h t of h i a emotion only l a t e i n the a f t e r -noon a f t e r he had been b u f f e t t e d about by two s o c i a l a g e n c i e s . Both of t h e s B agencies f a i l e d m i s e r a b l y to g i v e him any a s s i s t a n c e or encouragement. Had i t not been f o r them, he might n o t have advanced „to the p o i n t where he c o u l d g i v e vent to h i s f e e l i n g s . On the o ther h a n d , an e a s i e r r o u t i n g to the agency might have enabled him to p a r -t i c i p a t e a case work r e l a t i o n s h i p i n which he would l a t e r have been secure enough to express h o s t i l i t y i n a t h e r a p e u t i c i n t e r v i e w . O b -v i o u s l y sense of g u i l t i n e s s over h i s e x p l o s i v e behaviour i n the In take i n t e r v i e w made i t d i f f i c u l t f o r h im t o enter a case work r e -l a t i o n s h i p . I t was f o r t u n a t e t h a t the i n t a k e worker was a' s k i l l -f u l as she proved to be . Otherwise the s i t u a t i o n might have ended t r a g i c a l l y . One p o i n t which becomes very c l e a r on examinat ion of these cases 86 i s t h a t the c l i e n t , the f a m i l y case worker and the community n e a r l y always are a l l i n v o l v e d . The resources o f each i n f a c t c o n s t i t u t e the "team" and the success of the case work w i l l he on ly as g r e a t as the s t r e n g t h of the weakest member of the team w i l l p e r m i t . . Heterogeneous as were the ten cases previewed i n . t h i s c h a p t e r , they had three c h a r a c t e r i s t i c s common to a l l • Ages of the m a r i t a l p a r t n e r s were g e n e r a l l y l o w , f a l l i n g most ly w i t h i n the twenty to t h i r t y years age span . Length of marr iage was g e n e r a l l y s h o r t , on ly one couple h a v i n g been m a r r i e d more than f i v e y e a r s . R a c i a l and e t h n i c o r i g i n were s t r i k i n g l y u n i f o r m w i t h a l l but one p e r s o n , a husband, b e e i n g of Anglo-Saxon or C e l t i c e x t r a c t i o n and most bee ing Canadian b o r n . The group seems r e p r e s e n t a t i v e of the lower and middle income and s o c i a l c l a s s e s . The g e n e r a l low e d u c a t i o n s t a t u s appears to suppor t t h i s c o n t e n t i o n : $ 2 0 0 a month was the e x c e p t i o n a l l y h i g h i n c ome• Problems of each f a m i l y were m u l t i p l e . N e a r l y - a l l f a m i l i e s were encounter ing f i n a c i a l d i f f i c u l t i e s . Employment and h o u s i n g problems p l a c e d heavy pressures i n these mairr iages . The number of h e a l t h problems seemed t o be d i s p r o p o r t i o n a t e l y h i g h I n a graup of such young p e o p l e . These problems were f r e q u e n t -l y found i n a s s o c i a t i o n w i t h poor or a r r e s t e d emot ional development. T h u s , these problems brought pressures to the m a r i t a l r e l a t i o n s h i p s of people most of whom were not e m o t i o n a l l y mature . I n these m a r r i a g e s , as i n those s t u d i e d i n Chapter V , the 87 advancement of problems a f f e c t i n g the s t a b i l i t y of the u n i o n seemed tobbear l i t t l e r e l a t i o n t o the l e n g t h o f time s i n c e the wedding d a t e . W i t h an average p e r i o d of agency c o n t a c t of f o u r and a t h i r d months, the f a m i l y case work u s u a l l y proved e f f e c t i v e . C o - o r d i n a t i o n of c l i e n t s , worker and community r e s o u r c e s , as members of the f a m i l y case work " team" , i s h i g h l y important f o r the success of the p r o c e s s . The o v e r - a l l e f f e c t i v e n e s s of the f a m i l y case w o r k ^ t h i s sample of f a m i l y r e l a t i o n s h i p s cases c l e a r l y suggests tthat £hese techniques can be advantageously used to h e l p young'1 people i n the e a r l y years o f marr iage to remedy f a u l t s and to b u i l d f o r the f u t u r e . The interr -g r a t i o n of the v i s i t i n g home maker s e r v i c e of the F a m i l y W e l f a r e Bureau w i t h i t s case work f u n c t i o n s has been p a r t i c u l a r l y success -f u l . G e n e r a l l y t h i s s e r v i c e has been rendered w i t h an awareness of the emot ional f a c t o r s i n v o l v e d . T h i s has been true of most p r o -blems t r e a t e d . I n t h i s group there was one q u i t e s u c c e s s f u l case of "psychotherapy" i n which the worker d e a l t o n l y w i t h the f e e l i n g s of a w i f e i n r e g a r d to her marr iage -and expected c h i l d . 88 CHAPTER V ADVANCED MARITAL CONFLICT. Th® "Punch and Judy" Legend. A few y e a r s ago a screen p l a y took for- i t s theme the s t o r y of a man und h i s w i f e who were almost c o n s t a n t l y at each o thers t h r o a t s . O c c a s i o n a l l y i n t o t h e i r l i v e s came a mutual p leasantness w h i c h was almost extreme as were t h e i r q u a r r e l s v i o l e n t . D e f t l y the s t o r y showed t h a t t h e i r c o n f l i c t was an i n t e g r a l p a r t of t h e i r m a r r i a g e . Indeed, i t almost seemed t h a t i t was an i n t e g r a t i n g element of t h e i r wedded l i f e . About t h i a s t o r y , and about tne many l i k e i t t h a t have found t h e i r way i n t b : ; the l i t e r a t u r e s of p e o p l e s , there seems to be. a poignant sense of r e a l i t y . The "Punch and Judy" legend p o r t r a y s the l i v e s of two persons who, a l though apparent ly they would be h a p p i e r l i v i n g s e p a r a t e l y , seem f o r e v e r j o i n e d . The t h i r t e e n f a m i l i e s choaen f o r study i n t h i s Chapter are of t h i s o r d e r . They are examined i n an endeavour to show what are the b a s i c p r o p e r t i e s of marr iages f e a t u r i n g advanced m a r i t a l c o n f l i c t . I n Chapter IV the e a r l y marr iages d e s c r i b e d showed l i t t l e r e l a t i o n s h i p between the age of a problem and the degree of s e r i o u s -n e s s . S i m i l a r l y , the term "advanced" i s not used here w i t h the con-n o t a t i o n of t i m e . R a t h e r , i t suggests the degree or i n t e n s i t y of the m a r i t a l c o n f l i c t . Thus , i t i s c o n c e i v a b l e , t h a t w i t h i n t h i s meaning c o u l d f a l l m a r r i a g e s , t h a t took p l a c e s e v e r a l years ago, or r e c e n t l y . The couple w i t h many years of wedded l i f e behind them may have a m a r i t a l problem t h a t has i n c r e a s e d i n c o m p l e x i t y 89 and i n t e n s i t y w i t h each y e a r . The couple w i t h i n the f i r s t f i v e y e a r s of m a r r i e d l i f e may be f a c e d w i t h a c o n f l i c t j u s t as s e r i o u s o as t h a t of t h e i r s e n i o r s . M a r i t a l C o n f l i c t These examples i l l u s t r a t e the f a c t that people who, seek h e l p f rom a s o c i a l agency do not alwaya s t a t e t h e i r r e a l needs a t time of a p p l i c a t i o n . Only s i x of these t h i r t e e n f a m i l i e s i n d i c a t e d aware-ness of a m a r i t a l prob lem. The expressed needs o f the other couples i n c l u d e d placement of c h i l d r e n , housekeeping a s s i s t a n c e d u r i n g i l l -ness or confinement of a w i f e . a n d f i n a n c i a l need. S i g n i f i c a n c e of R e f e r r a l 5 One n a t u r a l l y wonders how o f t e n these a p p l i c a t i o n s were the r e s u l t s of a c c i d e n t , and how f r e q u e n t l y the e x p r e s s i o n o f an u n -consc ious need. A p a r t i a l answer may be found I n the c i rcumstances of r e f e r r a l o f these people to the f a m i l y agency. A s o c i a l s e r v i c e department i n a p u b l i c h o s p i t a l r e f e r r e d the E s 1 f o r h e l p i n c o p i n g w i t h s o c i a l problems occas ioned by h e a l t h d i f f i c u l t i e s . As M r s . K . was b e i n g t r e a t e d f o r a g y n a e c o l o g i c a l d e f e c t she must a t l e a s t have sensed the reason she was b e i n g r e -f e r r e d . Moreover , she had a p r e v i o u s acquaintance w i t h the f a m i l y agency d u r i n g which she had been o f f e r e d a s s i s t a n c e w i t h her m a r i t a l prob lem. The 0 f a m i l y , came to the agency v o l u n t a r i l y on the recommendation of tne t u b e r c u l o s i s a u t h o r i t y . They asked s p e c i f i c a l l y f o r h e l p to r e h a b i l i t a t e the w i f e a f t e r i n s t i t u t i o n a l i z a -t i o n f o r t u b e r c u l o s i s . The m a r i t a l problem d i s p l a y e d I t s e l f on ly a f t e r the contac t had been i n i t a t e d . A l t h o u g h the need f o r f i n a n c i a l a s s i s t a n c e to meet the a n t i c i p a t e d expense o f confinement was the 90 staged reason f o r r e f e r r a l of the L . f a m i l y , i t was s i g n i f i c a n t t h a t on one other o c c a s i o n the husband had come to the f a m i l y agency f o r h e l p w i t h t h i s domestic problem. M r s . L . , now r e f e r r e d by a f e d e r a l agency r e s p o n s i b l e f o r g r a n t i n g f i n a n c i a l a i d to dependents o f serv icemen, was a t f i r s t i n c l i n e d to t r e a t the new c o n t a c t i n terms of r e f e r r a l , r a t h e r than of the dis-harmony w h i c h was wreck ing h e r m a r r i a g e . Her r e l u c t a n c e to seek h e l p i n r e s o l v -i n g the m a r i t a l c o n f l i c t i s p e c u l i a r i n tho l i g h t of the f a c t t h a t p r e v i o u s l y , a t t ime of confinement when she had r e c e i v e d home maker s e r v i c e , the case worker had touched on the m a r i t a l problem and g i v e n her some i d e a of the f u n c t i o n of the agency i n m a r i t a l c o u n s e l l i n g . A most c u r i o u s i n c i d e n t l e d the Ms 1 to r e q u e s t h e l p . They needed housekeeping s e r v i c e because of the w i f e ' s convalescence from pneumonia. W i t h no ideas as to where the r e q u i r e d h e l p might b e . s e c u r e d they had been almost n o n ^ p l u s s e d . Then M r s . M ' s s t e p -mother p i c k e d up the telephone d i r e c t o r y , r a n a f i n g e r a long the pages u n t i l she came to the name of the agency. A p p a r e n t l y n e i t h e r she nor the Ms' had known the agency be fore that t i m e . Her t e l e -phone c a l l r e s u l t e d not on ly i n f i l l i n g of the immediate need but . eventuated I n a r e l a t i v e l y happy r e s o l u t i o n of a s e r i o u s f a m i l y c o n f l i c t * When the Ms' sought placement of t h e i r c h i l d r e n , the c h i l d r e n ' s o c i e t y r e f e r r e d them to the f a m i l y agency. Obvious ly t h i s couple were aware of t h e i r c o n f l i c t , f o r M r . M . soon v o i c e d doubts as to whether she should s tay w i t h her husband who tended to be a l c h o l i c . M r s . P . was a woman whose r e s p o n s i b i l i t y f o r her mother was c a u s i n g her to n e g l e c t her m a r r i a g e . R e f e r r e d by a worker from 91 P r o v i n c i a l S e r v i c e s who r e c o g n i z e d the need f o r h e l p w i t h her m a r r i a g e , she h e r s e l f was slow to see her r e a l t r o u b l e . C l i e n t s who d i d r e c o g n i z e that they had a m a r i t a l d i f f i c u l t y , g e n e r a l l y s p e a k i n g , were not aware of the t r u e nature of t h e i r trouDle. These f a m i l i e s d i d come d i r e c t l y to the f a m i l y agency; y e t , i n each i n s t a n c e , there was a minimum i n s i g h t w i t h a tendency t o blame the o ther p a r t n e r f o r the .dis^harmony. T h i s was a l s o t r u o i n the cas© of the fis', r e f e r r e d by the domestic r e l a t i o n s c o u r t . S i m i l a r l y the two c l i e n t s who approached £ ' the c h i l d r e n ' s agency f o r placement , saw accession to t h e i r request as an a m e l i o r a t i v e a c t i o n r a t h o r than c u r a t i v e . I t would seem, t h e n , t h a t one'of the g r e a t e s t h indrances to the s o l u t i o n of the problems wnich these f a m i l i e s presented was \ the l a c k of unders tanding of the problem and the min imal i n s i g h t possessed by th© c l i e n t s themselves . A n a l y s i s of M a r i t a l Problems. A l t h o u g h these c l i e n t s l a c k e d i n s i g h t , i n every c a s e , the f a m i l y case worker q u i c k l y p e r c e i v e d the m a r i t a l c o n f l i c t . Svery worker r e c o g n i z e d the r e a l proolem e a r l y i n the f i r s t i n t e r v i e w , i f no t i n the a c u t a ! r e f e r r a l . I n e v e r y f a m i l y the problem assumed a d i s t i n c t i v e form as though r e f l e c t i n g the I n d i v i d u a l c h a r a c t e r ofeach m a r r i a g e . Elements common to a l l were not many. I n each , the d i s t u r b a n c e of the m a r i t a l r e l a t i o n s h i p was grave w i t h a d e f i n i t i v e emot ional com-penent . The emot ional q u a l i t i e s v a r i e d from d i f f i c u l t y i n a d j u s t i n g t o tne c o n d i t i o n s of m a r r i a g e , to the h y s t e r i a t h a t s i g n i f i e d psycho-sematic d i s o r d e r . 92 I n no s i t u a t i o n was the problem simple and i n d i v i s i b l e . I n -d e e d , there were a t l e a s t two problems i n each c a s e . I n one f a m i l y there were f i v e problems a l l c e n t r i n g on the balance p i n of r e l a -t i o n s h i p between man and w i f e , and g r i e v o u s l y d i s t u r b i n g the " f a m i l y e q u i l e b r u i m " . A h o u s i n g dilemma i n t e n s i f i e d the Qs 1 s i t u a -t i o n . M r . b e l i e v e d h i s w i f e s o c i a l l y i n c o m p a t i b l e w i t h h i m . He was escaping from h i s s i t u a t i o n by e n t e r i n g i n t o e x t r a - m a r i t a l s e x u a l r e l a t i o n s . The h e a l t h of M r . R . i m p a i r e d through i n f e c t i o u s d i s e a s e a decade be fore the f a m i l y came to the agency, made i t Imposs ib le f o r him to meet the s e x u a l demands of h i s w i f e . Another m a r i t a l c o n f l i c t , stemming from a seeming b a s i c i n c o m p a t i b i l i t y of; man- and w i f e was i n t e n s i f i e d by the f a c t t h a t the husband was s u p p o r t i n g i n a d e q u a t e l y . C e r t a i n d i s a b i l i t i e s appeared i n more than one s i t u a t i o n . The happiness o f two f a m i l i e s was j e o p a r d i z e d by p h y s i c a l s e x u a l i n -adequacy. Other p h y s i c a l h e a l t h problems o c c u r r e d i n three f a m i l i e s . A p s y c h o s i s of a w i f e , which became f u l l - b l o w n a f t e r b i r t h of a second c h i l d , v i t i a t e d one m a r r i a g e . S u r p r i s i n g l y , a l c o h o l i s m , or e x c e s s i v e d r i n k i n g , appeared only f o u r t imes ! The m a r i t a l disagreement i t s e l f proved a q u e s t i o n which g r e a t l y upset two l i v e s . Both were i n c l i n e d to leave t h e i r husbands. The c o n f l i c t which t h i s d e s i r e and the sense of n u p t i a l o b l i g a t i o n set up i n them was as d i s t u r b i n g as the a c t u a l d i s f u n c t i o n of the m a r i t a l r e l a t i o n s h i p . From these o b s e r v a t i o n s , i t i s seen t h a t , throughout the sample, d i f f i c u l t i e s seemingly extraneous to the majoroproblem, had a s t r o n g b e a r i n g on the m a r i t a l s i t u a t i o n . 93 The Marriages. Prom the variety of form :which the marital problems took i t might be expected that the range of marriages would be characterized by hetereogeneity rather than uniformity. Descriptions of the marriages shows wide differences i n them. Certain factors,, how-ever, were common to a l l . Preparation For Marriage. Pull diagnosis of the marital problem presumes an intensive effort of the practitioner to ascertain the etiology of the ailment. Theperiod of betrothal would seem, then, to have an extremely important bearing on the whole course of the marriage. From the research aspect, therefore, It is disappointing that most of the thirteen caser: records contain l i t t l e of this data. In only four cases did the visitors record any facts about the pre-marriage period. In this fact i s seen the selectivity of fact-gathering. In two of these cases, i t would have been impossible to proceed without learning at an early stage the degree of preparation for marriage. That one couple lived together before marriage-., coloured the whole of their family history. Mr. S., an apparently i n t e l -ligent and seemingly ''stable" young man, had he waited a sufficient time before marriage, might have saved himself from great misery. Through cohabiting with a "loose" woman.he was drawn into a marriage that later featured a violent psychosis i n the woman. The Ts f likewise seemingly prejudiced their relationship from the beginning by sexual indulgences, the result of which led to a "secret" marriage that was humiliating to them both. This com-plication followed an acquaintanceship of three years, a fact 94 which may give some credence to the popular notion that prolonged engagement i s as harmful to the welfare of those Involved as none at a l l . This contention receives further support from the example of the unhappy couple who, although engaged for two-and -one-half years prior to marriage were not able to develop a happy marital relationship as man and wife. The Circumstances of Marriage-The length of time married for the six cases in which a wedding date was recorded, ranged from three to fourteen years with a f a i r l y even distribution between these two limits. The Us' were married for fourteen years. The complexity of their problem originated in Mrs. U's feeling of personal worth-lessness and her husband's derision of her as not being equal socially to him, and i n his procllviiity to extra-maritaj. sexual relations. Doubtless, the many years over which.this conflict developed built up the disruption to i t s major proportions. Yet the Qs* who had been married only three years had a d i f f i c u l t y almost as serious as the Us 1. Of the seven marriages for which the nature of the ceremony was recorded two were performed by a c i v i l power, five by ministers of religion. There seems to have been no appreciable effect of the choice of ceremony except when there was some dispute between the partners as to which kind of solemnization there should, be. For instance, in the marriage performed by c i v i l authority at the insistence of the husband, and against the wish of the woman, the resentment which the wife later displayed because of this curcumstance added to the intensity of the marital conflict. Similarly, religious doubts were emphasized 95 :•: • married in the marriages of the Vs» who were f i r s t / i n a Protestant church and, shortly afterward, remarried i n a Catholic Church. Compatibility The discussion thus far has indicated generally the differences which these marital partners faced. In their several o b i l i t i e s to accommodate themselves to these differences in each other can be found a key to the resolution of their problems. Great person-a l i t y conflicts between husband and wife asserted themselves i n no less than five situations. The strain took more subtle form i n the remaining number. Sexual d i f f i c u l t y with a physical basis has already been noted i n two marriages. In three other families less tangible maladjustments i n this area were observed. One of these featured Mr. V., a husband who was usually passive i n the sexual act. The consequences i n a relationship, marred from the outset by Mr. V's inadequacy i n the area of personal conduct and economic support, were considerable. Physical violence and wife-beating were the extremes which the personality conflicts took In two cases. The "in-law trouble" of common parlance entered the picture i n only two of these marriages. In both, relatives were helping with the purchase of the home. How tenuous financial arrangements i n these situations led to r i f t between families and i n laws i s described later under Economic and Social Factors. Economic And Social Factors. More easily observable and definable than the intangibles of compatibility i n these marriages were the concrete details of existence sucn as wages, financial obligations and living conditions. These families* like those discussed i n Chapter IV with respect to 96 the early years of marriage, were generally drawn from the lower Income strata. Mr. Q., the man who earned $268.00 a month, was the exception among the five for whom income was reported. The known bottom level of Income was #40.00 a week. One man had no steady source of income and one was s t i l l l i v i n g on the proceeds of war Service Gratuities which he had invested i n a rooming house* The average income would appear to have been approximately, $140 a month. It was not unusual for there to be more than one source of income. Four families drew their income from two sources. Two wives were engaged i n industry; two rented a portion of their' dwellings. Despite the fact that most families had incomes that should have provided at least minimum standards of comfort, the majority encountered financial d i f f i c u l t i e s , while detail was secured infrequently, such data as was recorded Indicated as causes of financial stringency, general in a b i l i t y to manage money, medical and hospital b i l l s and obligations of home-purchasing. The largest known indebtedness was #700. The client was unable to determine accurately how this indebtedness had accumulated. Poor ab i l i t y to manage money seemed to be the primary cause. As previously noted, the two greatest d i f f i c u l t i e s i n home-purchasing were similar. In both situations, the home had been • . purchased by relatives of the wife with the husband undertaking to repay the creditors. There was only one genuine case of home ownership. With this good physical setting the elements of the marital conflict were d i s t i l l e d i n the personalities of the man and wife rather than dilluted i n grievances over environmental dissatisfactions as 97 happened i n several other cases. Mr. Q., with his exceptional income, could afford to purchas his own home and was so doing. The housing d i f f i c u l t i e s which beset him meantime, namely that he could find accommodation only i n ah isolated place, wrought an e v i l effect on his marriage, his wife being an Individual who was constitutionally gregarious and needed human association probably more than the average person. Housing that conspicuously affected the marital relationships in-cluded quarters In ar.tenement and a shared, housekeeping room. A comfortable apartment suite which was provided to the Vs', i n addition to a small stipend to Mrs. V., i n return for care taker service rendered by her, proved too confining. Removal to a home with gardening prospects for Mr. V., relieved the strain at least temporarily. Of the six families that rented homes, the Vs 1 particularly suffered from effects of poor housing. The dilapida-tion of their quarters which led to t'lagging of Mrs. V's interest i n the home contributed to their nuptial disharmony. Interest-ingly the restoration of their home did serve to alleviate their d i f f i c u l t y . Mr. S. whose wife became psychotic housed his family i n con-verted army huts. Any discomfort there suffered resulted from h i wife's condition. The use made of available housing would seem to be a great factor in the well-being of a family as the effects of Inadequate housing. The Children. The unhappiness which quarrelling parents v i s i t upon their children i s amply brought out in study of•these thirteen families 98 The Ws 1 were the only c h i l d l e s s c o u p l e . Mrs. W. had experienced one m i s c a r r i a g e . The d i f f i c u l t y which she had to c a r r y a pregnancy to term was d i r e c t l y a s s o c i a t e d w i t h a g y n a e c o l o g i c a l abnormalty, .which in.addition.made performance of the marriage a c t very p a i n f u l . R e c t i f i c a t i o n o f t h i s t r o u b l e not on l y brought promise of normal pregnancy but e l i m i n a t e d the d i s c o m f o r t experienced i n sexual r e l a -t i o n s and thus a i d e d i n r e s o l v i n g the m a r i t a l c o n f l i c t . In a l l the other f a m i l i e s t here were a t l e a s t two c h i l d r e n . The Us 1 w i t h f i v e c h i l d r e n and a s i x t h born d u r i n g the p e r i o d o f agency c o n t a c t were the l a r g e s t f a m i l y . There were f o u r c h i l d r e n i n each of two f a m i l i e s , and uhree i n one f a m i l y . Ages of c h i l d r e n ranged from a few days to 11 y e a r s . Of the twenty-nine c h i l d r e n i n these t h i r t e e n f a m i l i e s , twenty-one were g i r l s . Of t h i s t o t a l number of c h i l d r e n o n l y two, both boys,of the same f a m i l y , d i d not appear to be d e v e l o p i n g abnormally. The number of parents who brought t h e i r problems to the c h i l d r e n ' s agency o b v i o u s l y had some r e a l i z a t i o n o f the e f f e c t s of the domestic up-h e a v a l upon t h e i r c h i l d r e n . Y e t , two sets o f parents d i d not r e a l i z e t h at tney were p h y s i c a l l y n e g l e c t i n g t h e i r c h i l d r e n . The c h i l d r e n of these f a m i l i e s were s u f f e r i n g , or had s u f f e r e d , from h e a l t h problems w i t h a n e u r o t i c base. More t r u l y psychogenic were the d i s t u r b a n c e s of c h i l d r e n g i v e n to s u c k i n g , having e a t i n g d i f f i c u l t i e s and p u l l i n g out t h e i r own h a i r . Behaviour d i f f i c u l t i e s and d i s c i p l i n a r y problems o c c u r r i n g i n f o u r f a m i l i e s r a n the gamut of stubborness, meanness,cruelty, obedience, ^ s i b l i n g r i v a l r y and marked a n t i - s o c i a l t e n d e n c i e s . I n the U s i t u a t i o n , the c h i l d - v r e n were drawn r i g n t i n t o the v o r t e x of p a r e n t a l disagreement. Mr. U., who accused h i s w i f e of i n r l a e l i t y d u r i n g h i s time away 99 from home and i n armed services, told the three other children that last-born was not his, and attempted to cajole the eldest, an eleven-year-ola boy, into an alliance with him against Mrs. TJ. In contrast to the cases discussed i n Chapter VIII (specifi-cally parent-child relationships and child, development problems), these children had a poor chance or growing up normally. The con-cern of the parents with the discomrorting results of their own deep conflicts tended to blind them to the need of their children. Family case work i n some measure modified this unhappy outlook. Personal Background Review of these marriages, ana of the disruptions that spoiled them, inevitably gives rise to the question: What were the people who entered into these marriages really like? Personal Adjustment Some of the personal development of the twenty-six marital partners has been brought out i n previous discussion. None of these clients coula be considered as having, developed a normal balanced personality. Recorded ages ranged from twenty-five to thirty-eight years for the men, ana from twenty-one to thirty-five for the women, with the scales weighted at the bottom level. Despite the advanced stages of the marital disorder, therefore, the principals were s t i l l rela-tively young. These deviant patterns ranged from incipient alcholism, through obvious emotional immaturity, to the violent manifestations of profoundly disturbed-persons• Mr. U. was described as sleek and a phi3lander, a medium sized person who ruled his home with a napoleonlc tyranny. Mrs. U., with a low opinion of herself, and 100 h i g h l y a e l f - c r i t i c a l , succumbed to h i s dominance. Mr. Q. w i t h h i s good p o s i t i o n , h i s e x c e p t i o n a l income and d r i v e f o r success was possessed of an ambition based on h i s emotional immaturity. H i s a r r e s t e d development was e v i d e n t a l s o , i n a c l a s s consciousness and an a t t i t u d e of i n t e l l e c t u a l s u p e r i o r i t y to h i s w i f e . Mrs. Q. although a t t r a c t i v e and a p p a r e n t l y i n t e l l i g e n t , was a g i r l of r e t i c e n t h a b i t s . She found i t d i f f i c u l t to meet the s o c i a l r e q u i r e -ments her husband had set f o r her. Only the f a c t s t h a t Mrs. Q. has a good i n t e l l i g e n c e and Mr. Q.^  a i n h e r e n t a b i l i t y to get along w i t h people, might save t h e i r marriage. Even l e s s f o r t u n a t e was the f a m i l y i n which the w i f e found d i f f i c u l t y i n meeting people. Unable to r e l a t e to the f a m i l y case-worker thus making treatment i m p o s s i b l e , she r e t a i n e d her problem which r e v o l v e d about her own r i g i d i t y as shown i n her a t t i t u d e toward her c h i l d r e n , and toward her husband who was beginning to g i v e way to the a t t r a c t i o n s ox a l c o h o l . These were but three of the combinations t h a t v a r i o u s l y f e a t u r e d emotional a b e r r a t i o n s and moral weaknesses. E d u c a t i o n School attainment i s g i v e n f o r only three of the men and f i v e of the women. They i n d i c a t e t h a t the e d u c a t i o n of these people was not advanced. Mr. S. had the h i g h e s t r e c o r d e d e d u c a t i o n . He was a capable . u n i v e r s i t y student. H i s obvious c a p a c i t y f o r achieve-ment was f u l l y employed by the f a m i l y caseworker who i n s i s t e d t h a t he assumes r e s p o n s i b i l i t y f o r h i s f a m i l y when these problems w i t h the mental d e t e r i o r a t i o n of the w i f e becomes most c r i t i c a l . Mr. U. had completed h i s secondary e d u c a t i o n . I t was s i g n i f i c a n t 101 that, having l e f t high school In mid-career, he returned to complete his course, an action In keeping with his drive for success. He need not have been so apprehensive of his wife's social graces for she had not only completed high school but had shown talent i n dramatics and had done well i n several courses. Mor need Mrs. U. .have f e l t so l i t t l e personal worth for she had completed her standard education to matriculation and had begun a nursing career. She fact that this course was Interrupted did contribute to her 3 e n s e of failure. Mr* U., passive i n his marital relationships, had shown i n i t i a t i v e In other areas. Although his formal schooling was not advanced he had successfully studied technical courses. Occupation and^aOnpIoyment Four of -the men might be rated as skilled workmen, the occupa-tions incluuing: sign painter, printer/, garage mechanic and butcher. One man was a professional musician. The unskilled labour included truck-driving, hotel clerk, and general. Mr.. Q. held an executive position to which he had "worked up" from a minor position. A tatooist operated his own shop. The quality of his enterprise provided a clue to his personality. His establishment was the rendezvous for lads who were i n conflict •with the law. Other than housewife, occupations were li s t e d for only two of the women; waitress and stenographer. The waitress Mrs. I. eventually returned to v,ork because of the inadequate support she received from her husband. She and Mrs. V. who acted as caretaker of.the apartment were the only ones who worked i n remunerative employment. Six of the men were employed i n the occupation they gave. One 102 of the a l c o h o l i c s had a v a r r l e d employment h i s t o r y . Mr. V. another dipsomaniac w h i l e he stayed w i t h i n h i s s t a t e d o c c u p a t i o n f r e q u e n t l y changed j o b s , he a p p a r e n t l y managed to earn good money at them. The e f f e c t of army s e r v i c e was n o t i c e a b l e i n the employment h i s t o r i e s . Mr. U., the " p h i l a n d e r e r " who had been m a r r i e d f o u r t e e n y e a r s , a s s i g n e d to the same trade i n s e r v i c e which he f o l l o w e d i n c i v i l l i f e ( b u t c h e r ) , p r e f e r r e d to j o i n tne Permanent Force a f t e r the war. Probably h i s adjustment to the sex-vice operated a g a i n s t the s-ccess of h i s marriage as i t gave him the freedom of movement which turned h i s a t t e n t i o n from f a m i l y o.uty. There were p o s i t i v e b e n e f i t s to Mr. S. the U n i v e r s i t y student from h i s s e r v i c e , r e -h a b i l i t a t i o n allowances as they f u r t h e r e d h i s o c c u p a t i o n a l advance-ment. On the other hand, the young man who i n v e s t e d h i s g r a t u i t i e s i n a rooming house c o u l d not s e t t l e down a f t e r d i s c h a r g e , a f a i l u r e which added to the s t r e s s between h i m s e l f and h i s w i f e . M o b i l i t y Armed s e r v i c e proved the most s i g n i f i c a n t f a c t o r i n m o b i l i t y . Four*.arf the husbands had been overseas, and i t was these v e t e r a n s who experienced the most d i f f i c u l t y i n r e h a b i l i t a t i o n . A s i d e from t h i s the average m o b i l i t y was low, as most c l i e n t s had l i v e d i n Canada, the g r e a t e r p a r t of t h e i r l i v e s . However, P r a i r i e - t o - C o a s t migra-t i o n was r e p r e s e n t e d i n three c a s e s . The most u n s t a b l e of the men, the v i o l e n t - t e m p e r e d a l c o h o l i c , was the most f o o t l o o s e of the t o t a l number. S i m i l a r l y i t was Mrs. S. the.psychotic w i f e who, of the women, was most t r a v e l l e d . M o b i l i t y p l a y e d a s o r t of a s e l e c t i v e r o l e i n these m a r r i a g e s . H e a l t h The importance h e a l t h p l a y e d i n the problems of these t h i r t e e n 103 r ^ f a m i l i e s can be r e a d i l y i n f e r r e d from the proceeding d i s c u s s i o n . I n o n l y f o u r f a m i l i e s was the man i n good p h y s i c a l h e a l t h , i n three the women. I n on ly one marr iage d i d the husband and the w i f e b o t h enjoy good h e a l t h . The degree of u n f i t n e s s v a r / i e d from " indi f fe rent '• ' h e a l t h ,to cases of t u b e r c u l o s i s a r r e s t e d a f t e r long t rea tment . The g e n i t a l d i s o r d e r s p r e v i o u s l y ment ioned, and the t h y r o i d , h i g h b l o o d p r e s s u r e , and anaemia s u f f e r e d by the w i f e i n the o l d e s t marr iage s e r i o u s l y i n h i b i t e d the f u n c t i o n of m a r r i a g e s . The most s e r i o u s d i s o r d e r was s u f f e r e d by M r . T . who r e t u r n e d to c i v i l i a n l i f e as a f u l l c r i p p l e and whose menta l and emot iona l balance were a l s o e f f e c t e d . E m o t i o n a l d i s t u r b a n c e , o c c u r r i n g as f r e q u e n t l y as the p h y s i c a l a i l m e n t s , ranged from immatur i ty to h y p o c h o n d r i a . M r s . S. was the o n l y permanent v i c t i m of menta l d i s o r d e r . M r . T . l a t e r made a remarkable r e c o v e r y . F a m i l y Backgrounds  F a m i l y H i s t o r i e s . I n n e a r l y every case the f a m i l y background was c o n s i d e r a b l y l e s s than the i d e a l . I t i s i n t e r e s t i n g that the two f a m i l i e s i n w h i c h the husbands were heavy d r i n k e r s had c e r t a i n common r o o t s . One of the a l c o h o l i c s and the w i f e of on© of the a l c o h o l i c s were b r o t h e r and s i s t e r . T h e i r f a t h e r had been a heavy d r i n k e r and t h e i r mother i m m o r a l ; the break-up of t h i s marr iage had been an exper ience common to t h e i r c h i l d h o o d . M r . U . who i n f l i c t e d tyranny on h i s own home had been the son of a domineer ing moth©*-. M r s . S'. mother spent much of her l i f e i n menta l h o s p i t a l s and was cons idered i n -c u r a b l e . D e s e r t i o n s , s e p a r a t i o n s , d i v o r c e , «.nd poor c i rcumstances were common to many of the f a m i l y backgrounds. 1 0 4 i/ith one exception the twenty-six people grew up in urban surroundings. The ethnic origins of these people were almost homogenous. Except for two men, one of Italian* the other of Ukrainian descent, a l l were of.Anglo-Saxen or Celtic stock. Hearly a l l were Canadisua-born. Religion i n this group of families,, i n contrast to the f i r s t ten studied, was a greater influence, although a negative one. This was observable i n the five families i n which one or both parents had l e f t the Catholic Church. The discomfort they f e l t over this change, however much they tried to deny i t , became woven into the very fabric^ of their marital situation. Treatment The case work had some effectiveness in at least seven of the thirteen cases. Certain qualities of the treatment stood out im-pressively in the casea in which the process was most effective. As opposed to the current trend towards a reduced period of agency contact, usually running from three to six months, the length of treatment i n these particular cases was f a i r l y prolonged. The average length of total treatment in these cases was 340 days or 11 and one-third months. The longest total agency contact, covering three periods, was 1546 days or 2.4 years. The shortest period was thirty days. The two cases open for the longest periods, therUs': and1 c the Ts» featured the best family case work. In both the work was intensive as well as extensive. The workers in each case, but especially that of the disabled veteran, were young but experienced with unusual physical vigour. Their drive seemed, i n large measure, 105 responsible for their success. The Us' throughout their long period of activity with the agency had several workers who a l l displayed this same drive. Thus, there was an insistence that Mrs. U. try>: to establish her work i n her own eyes and prdVe i t to her husband. During one period, following a request of Mr. u. for homemaker service i n order to help the wife clean up their dirty and dis-organized home. The worker Insisted that Mrs. U. prove her capacity for homemaking by participating i n the activity. This was one of the best uses of the homemaker service. Whereas this f a c i l i t y has been generally employed i n the settings characterized by medical problems, this was a real "homemaking1' service with the homemaker being carefully tutored in the active part she was to play in the social treatment. The. same steadfastness of purpose entered the third period of therapy, when Mrs. U.. became pregnant for her sixth time. She was afraid to reveal her condition to her husband, as on every such previous occasion he had unreasonably and heartlessly critized his wife for this normal occurance. The worker now sup-ported the wife continuously U n t i l she was able to face the reality that she must disclose her condition to the man. Even at f i n a l closing when Mr. U. had returned after an affa i r with another woman the worker was firm In trying to help Mrs. U. face the reality that the rapproachment offered no promise of lasting duration. The worker!s capacity for persistence exceeded the woman's-potentiality for growth. The same qualities were evident in the worker's approach to Mr. 0. The f i l e on Mr. T . the disabled veteran reveals not finly the persistence of the worker but also the teamwork of client, worker and the community resources. The formation of this team i s clear. 106 Unquestionably the family case; worker had to lead the team. Ms.and Mrs. I. both had very unstable backgrounds. Their need for expres-sion of h o s t i l i t y was met i n the person of the other. So were the needs of love and security. The ensuing conflict was Immeasurably heightened by the war injury to Mr. T. Their case record i s more unbelieviable than f i c t i o n as i t unfolds the story of two people whose conflicts were so great that they had to plan holidays apart at times and then prepare for the re-union which their emotional selve demanded. Through a l l this the d i s t r i c t worker moved, called out at hours of crises occurring at the oddest times. She was always aware of their needs, and or the effects on the chiluren suffering through separation from parents and from one another. Frequent conferring with the Veterans'psychiatrist and social service, and with the tuberculosis authority over the condition and emotional implications of phthisis i n the wife, kept the worker alert to every aspect of the situation. Although the worker was time-tested, the strain of presenting the f i r s t consistent strength i n the l i f e of either partner at times demanded special intra-agency consultation and supervision. The recovery of Mr. T. to employable status and the quieting of the marital disturbance after years of hectic struggle must in no small measure be attributed to the case worker and her leadership of the "case work team". Comparable positive leadership asserted i t s e l f in the situation in which the family worker insisted that the student veteran take responsibility for the psychotic wife and that of the sexually-handicapped wife who was helped to see her need for treatment and at the same time accept the family of her. ukrainian-de.scended husband. The a b i l i t y of the case workers to act in a medical situation 107 has been observed. It was probably helpful that the case on which most co-operation was secured from the doctor, that the worker had nurse's training. The co-operation of the doctors in this group was remarkably high. Apparently some members of the medical profession have gained consid-erable Insight into marital problems through their practices and realize that these complexities f a l l outside tneir area of competence. The marital problem i n i t s advanced stage, then, i s seen to be complex, Its roots deep-seated and i t s unsalutary effects far-reach-ing i f no amelioration Is possible. The history or some of these thirteen families indicates a congenital transmission of emotional inst a b i l i t y to the third generation. Lack of understanding the human aspects of. marriage by those.assuming connubial responsibilities indicates a general need for broader education i n this area. The Involved motives of clients and the high rate of psychogenic factors give point to the developing iaea uhat group psychiatry must find i t s place among public health and educational services. The family case worker can provide valuable service i n reducing the misery which l i e s behind the Flinch and Judy Show. More attention might be given to recording of factual data concerning personal development and marital nistory. Treatment, i t must be recognized, may have to be long and intensive. There i s need for frequent con-sultation and careful supervision of a nigh order. The problem be-ing so solidly entrenched the family case worker must lead the case work team in assailing the problems besetting this type of marriages i f there i s to be any hope for success. 108 CHAPTER VI DISSOLUTION OP MARRIAGE It i s evident that, in some marriages, husband and wife stay together, no matter how violent the conflict. Yet, i n others, seemingly no more strained,they part company. TOiy, and, when they do, what happens to the man and wife after they go their separate ways? What becomes of their children? The-object of family case work i s to help strengthen the family and to assist each of i t s members attain to his maximum capacity so that he may be a responsible member of society. How can this object-ive be met when the family i s breaking or broken? These are some of the questions which the third group of cases i n this study i l l u s t r a t e . The range of families i s shown by eleven examples, each at some stage of disintegration. They vary from the family obviously moving toward inevitable disruption to the marriage i n which divorce proceedings were under way* The Circumstances of Separation The marriage of Mr. and Mrs. AA had been frought with separa-tion due to tho exigencies of war that took the man away i n service. Although he had l i v c d with another woman for five years and had interspersed his separation with several more affairs of shorter duration, the wife later took him back. S t i l l in love with him, she looked away from the reality of her situation. Ambivalent in her feelings toward'her husband, indecision became the theme of her existence, riot only frustrating her i n every thought and action, but redounding on the children, two of t n c three manifesting extreme behaviour deviations. 109 At the other extreme was Mr. B.B», the young man who "caught" his wife i n the very act of immorality. The evidence of adultery was so irrefutable that i t lead to douole divorce proceedings as the other man involved was also married. The C.Cs1 were a young couple who entered a marriage arranged by their mothers, bent on hiding the "disgrace" of an illegitimate pregnancy,. Incapable of discharging the duties of husband and father, the young man had l i t e r a l l y walked away from his marriage. English war brides i n this group fared badly. Mrs. D.D. found herself l e f t with her parents-in-law, her husband seemingly in-capable of accepting the responsibilities of marriage. Another war bride Mrs. E.E., already forced to place a child for adoption before departing from England because her husband had alleged that i t was not his, arrived i n Canada, only to find that Mr. E . E . had disappeared, leaving no trace of his whereabouts. A third, Mrs. F.F. found her husband there to meet her at the station but suffered violent rejection by him. Not only did he refuse to live with her but he also assaulted her. When Mr. &.G-. quit his wife after she became pregnant for the fourth time,heurepeated a pattern common to every period of expectancy, sacrificing his family to his ambition for success in his own business. The decision to separate already had been com-mitted to the respective lawyers of man and wife. The family agency was l e f t with the task of looking out for the welfare of the child-ren. Not unlike him was Mr. H.H, ambitious young veteran who, with a total disregard of connubial duties, pursued studies i n preparation for a professional career. 110 Two wives refused to stay with their husbands. Mrs. I.I. decMed-the1 immaturity of her husband, alleging that, although he was i n a fine position and earning good money, he was incapable of discharging the responsibility for support, or other obligations of wedded l i f e . . The other wife Mrs.. K.K. declined to live with her husband i n his home.city as she asserted that he was "tied to his mother's apron strings." Her marriage, she f e l t , would have ho chances for success unless they were to live elsewhere. The family of Mrs. L.L. forcefully ejected her husband from the home which they had financed. Mr. L.L's inabi l i t y to meet his obligation to them, reflected an immaturity that made i t impossible for Mrs. L.L. to continue living with them. The family workers had the task of helping the couple adjust to separation and of protecting the children from the havoc caused by severing the nuptial bond. THE MARRIAGES Circumstances of These Marriages These disruptions came after periods of marriages varying from one to seventeen years. Most breaks took place within five years of the wedding. Only four marriages lasted more than five years and only two more than tonj in both the latter, the partners had been wed seventeen years before coming to the agency. In each there was a history of separation that reduced the real wedded l i f e to a period approximating ten years. Mr. A.A. who was separated for the long period and who had a series of affairs during his absence from home, was one of the husbands. The other marriages featured Mr. G.G. who consistently deserted during his wife's pregnancies. There are indications, then, that tne actual length of wedded l i f e i n this group did not exceed ten or twelve years and that a considerable 111 number survived for a much lesser period. Preparation of Marriage. Length of courtship in the six cases in which i t was recorded varied from a few months to two-and-a half years. It i s perhaps not without significance that*.Mrsand Mrs. B.B. the principals i n the divorce case, although they had seriously contemplated marriage, had not been wed u n t i l after the woman became pregnant. Nothing more i s known about the preparation for these marriages. Despite the dearth of information, the inference i n the recording i s that most of these marriages were undertaken with the minimum of serious consideration of the important issues involved in establish-ing a family. Compatibility It might be thought that differences between the man and wife who seperate would be very obvious. Yet, i n almost a l l of the situations, the casegram reveals l i t t l e of the disparity that con-tributed to the dissolution of the marriage. Generally the expression of difference took the form of accusation of one partner by the other, and frequently these allegations lacked conviction. Mr. C.C. stated that he and his wife came of different backgrounds, his be-ing better than hers, but this received no support from any other facts learned about the family. Another man Mr. E.E. stated that ; his wife, i n her associations with other men, had been unfair to him. Mrs. B.B. was one wife who definitely had extra-marital relations. Mr. and Mrs. I.I. both, each with the other's knowledge, had entered into extra-marital relations. The separation of the L.Ls.' was the culmination of differences^ that grew out of their backgrounds-. The man i n his home had known 118 warm, friendly relationships and an easy manner of liv i n g . The wife had been brought up to r i g i d standards i n a family exhibiting as individuals, strong introvert tendencies. Economic and Social Factors. Frequently marital problems were anchored to financial d i f f i c u l -ties. In at least six marriages income was inadequate properly to maintain the family. Mrs. C.C. had to go to work In order to supple-ment the $80.00 a month income her husband was receiving. Such a necessity can only have emphasized Mr. C.C.'s incapacity as a husband and father. In marriages like these, i t followed almost inevitably that the wife could complain of inadequate support. Even i n a family whose bread-winner was earning a respectable salary, d i f f i c u l t i e s over money and budgets occurred. Mr. I.I. tended to Ignore his wife i n financial matters. He preferred to pay a l l the b i l l s himself, to keep her i n the dark as to the true state of finances, and to give her less than was commensurate with the income which he was receiving. Mrs. K.K.. refusing to live in the home-city of her husband, received from him nothing for herself, and only spasmodic support of the children. Despite the small income Mr.. B.'B. received as a student veteran, he had been supporting his wife to the best of his a b i l i t y . Living conditions among these families varied. Two owned homes. One of these was a good home In a very respectable residential section of the city. As i n the two cases cited in the chapter on Advanced Marital Conflict, the L.Ls' living in the home purchased by Mrs.' L.L.'s relatives, suffered from the insecurity of such an arrangement. Failure to pay in-laws for the purchase brought on the bodily ejection of Mr. L.L. from the home, and signified the beginning of the end to the marriage. 113 A small cottage type of house was heavily mortgaged. The woman1s taking i n of borders to defray the costs of the house added to the source of conflict between man and woman. Suites, both basement and at the rear of the house, housekeeping rooms, hotel rooms and veterarefe'5 hostels were other types of liv i n g accomodations used. Living arrangements definitely tended to be of the transient order. Although in at least one family housekeeping standards were poor, most families did not live too badly. Prom the records one senses that the abodes were seldom inviting, frequently lacking the warmth and order of a happy home. Except for the'cases specially noted, housing conditions seemed to be the end^-result of the conflict rather than a contributing cause. PERSONAL-BACKGROUNDS  Ages of Partners. These marriages were predominantly of younger people. Ages i n A the ten cases in which they were recorded, ranged from nineteen to. thirty-seven years for the men; from nineteen to thirty-five years for the women. Only three men and one woman had passed their thirtieth year. Personal Adjustment. In nine of these cases the family case workers were able to know both partners at f i r s t hand. In the other two marriages i t was impossible to see the husbands. Practically nothing was learned about Mr. E.E. after he disappeared. The only information available about Mr. K.K. was tainted with the prejudices of his wife who described him as being "tied to the apron-strings" of his mother. The term "immature" was commonly used to describe the personality of Usually one, and frequently both partners. Mr. E.E. was said to be 1 1 4 immature and further depicted as "dependent", "moody", and unkempt i n his personal appearance". His attachment to his mother was abnormal. Mrs. L.L. was described as immature, inarticulate and unwilling to discuss anything but surface problems. She was notice-ably jealous of the. man's sister and his mother. Mrs. A.A. found i t d i f f i c u l t to make up her mind whether she should part from a man apparently capable of understanding what neglect would mean to those outside his own family, but lacking the personal insight to see the effects of his conduct on the relation-ships in his own family. Character sketches of the L.Ls 1 when placed side-by-side, are very meaningful. Mr. L.L. was a poor provider. His employment record was erratic with six months as the longest time he had ever held a job. In the two years since discharge from service he had been in ten jobs. Even in sports and amusements, except in drinking i n which he engaged too freely, he preferred to be the spectator. Yet he was friendly and outgoing. A l l his l i f e he had been indulged by his mother and his five sisters. Mrs. L.L.,on the other hand;had wide interests in group activities and boasted a good employment history. Yet she lacked assurance. A lonely person, she was too self-conscious to be alone with anyone. At times she had violent bursts of temper. Her strong introvert tendencies apparently were associated with her very strong attach-ment to her mother, a dominant matriorchal figure whom she keenly resented, with a feeling that was always expressed in the lasting dissappolntment that she had never been given a birthday party as were other children. As in this example, throughout this range of cases, the negative attributes of personality seemed to operate more 115 strongly than the positive qualities. Education The scholastic achievement of both man and wife was recorded in only two cases. Educational qualification was obtained for only four other men and two of the women. Undergraduate university standing was the highest known education among the men; grade X among the women. Aside from these, the recorded education was grade VIII, or less. Generally, this data, i f recorded, was significant, as i n the case of the L.Ls'. The husband had completed grade VIII at the age of 16 years. The Otis group intelligence test gave him an intelligence quotent of only 76. Mrs. L.L, on the other hand, had completed grade XII at the age of 18 years. The disparity between the mental endow-ments of the L.Ls furnishes much of the explanation of why the marriage f a i l e d . Occupation and Employment. In none of the groups of families studied, were the factors of occupation and employment more significant than i n this selection. Erratic work histories predominated. Armed service highlighted the occupational activities of the group. Of the eleven men, seven had been On active service and one had been a seaman travelling through war zones. For each of these,war service does not seem to have been so much time taken off from c i v i l i a n l i v i n g , but rather one of a succession of occupational ac t i v i t i e s . For, six of these eight men had changed their occupation after service. In effect, these seem to have been "soldiers of fortune". With five of them bringing English war brides back with them, i t would seem that marriage might have been a part of this series of adventures. Service, for some being 116 as long as seven years, may have been an abnormal extension of one stage of the occupational history. Certainly the quickened succes-sion of jobs, such as those of Mr. L.L. who held ten between time of discharge and the date he came to the agency, and the man who during the period of agency contact had three jobs widely different, would tend to support this contention.. For two veterans, service advancement may have uncovered talents that made for d i f f i c u l t y in re-adjustment to c i v i l i a n l i f e . The total attitude to l i f e of one seemed changed to bitterness when he had to return to subordinate labour after achieving considerable recognition. Mr. H.H., the ex-servicemen who forsook his family for a professional career, had proved hitherto unknown leadership qualities by attaining to good officer rank. The work history of the three non-veterans was almost as signi-ficant as those of the ex-servicemen. Mr.CC. who had sacrificed his marriage for his business had l e f t the teaching profession. That stability in employment is not always synohomous with healthful l i v i n g i s evident from examination of the occupational status of the remaining two men. Mr. K.K. who would not leave his home city or his mother, also clung to the business of his father although the trade he had acquired in this enterprise should have served him anywhere. Mr. I.I. had devoted much time to his work and thus neglected his family duties. His desire to achieve had been kindled by envy of a successful relative in an a l l i e d f i e l d . In a different way the occupational activity of the wives in this group was as significant as that of the men. Seven of them gave pre-marital occupations. Three In addition to one who gave no previous occupation had to seek work because of non-support. Three 117 of them took employment similar to that which they had previously performed. Instability in work was seen here,too, with one woman employed in four successive jobs, one in two. Mobility Glosely a l l i e d to factors of employment,mobility could be expected to be high i n these marriages. The records indicate that this was true. Eight families, in addition to overseas service had travelled widely. Taken together their movements covered most of the western English-speaking world. One woman, as a small g i r l , with her family had fled the Russian Revolution. High mobility of the wife and in-mobility of the husband were salient features in the,marriage of the K.Ks' . Health In only five marriages were health disorder unknown. Disability ranged from the minor ailment to serious lung trouble in one man and congenital specific disease in another. It was sometime after social treatment had been instituted that referral to medical authority revealed that Mr. H.H. the professional-bent ex-ofilcer could not enjoy normal marital relations because of a physical sexual d i s a b i l i t y . Interestingly, he did not avail himself of the opportunity for the surgery that would have r e c t i f i e d this condition. Emotional health already has been seen as generally poor. Mental disease was not disclosed. Mr. L.L. however, was mentally retarded. Mr. A.A. the man who had a mistress for five years was thought to be psychopathic. THE CHILDREN Eighteen children, twelve boys and six g i r l s , ranging in age from two weeks through the sixteenth year, had to withstand the 118 rigours of family dissolution. Seventeen were pre-adolescent, thir-teen of pre-school age. The majority of them, therefore, were in danger of suffering severe trauma because of separation from a parent. It i s hardly surprising,, then, that i n eight of these families un-fortunate results of marital disharmony were already manifest in the children. Deviant patterns were almost as many as the children themselves and included such abnormalities as "withdrawal," hysterical ^ Illness, h o s t i l i t y , undirected behaviour, excessive dirtiness and temper tantrums. FAMILY BACKGROUND  Family Histories That these ailments often are being passed from generation to generation i s amply supported from the family histories of this group. In only three marriages was there no discernible antecedent in the marital history of the parents of the man or woman. Marital conflicts or deprivations had been present i n the families of man or wife in five cases. In. each situation one parent had died while the man or wife was yet a child of tender years. Two people whose parents had remarried had grown up in an atmosphere which they had found very unhappy. Cultural, Social and Economic Factors. Four of the five families for which religion was noted were Protestant. In the f i f t h family, the man alternated between Catholic-ism and Lutheranisra as his faith. Religious fanaticism-lined the family background of Mrs. A.A. In a l l but two of these cases, man and wife were Canadian of Anglo-Saxon lineage. The r a c i a l extraction of one couple was not established. Russian descent of Mrs. A.A. has already been mentioned. 119 Although l i t t l e specific information was recorded a l l indications were that these people generally.come from the low-income of wage-earners, from- families with no significant social status. Treatment It would seem logical that the effectiveness of family case work i n marriages that are facing dissolution would be measured by the degree of adjustment the client i s able to make to his new situation. This involves the surrender of familial unity, restora-tion of the personal l i f e so that the parting members can live with dignity among their fellows, and acceptance of the responsibility of caring for the children or some guaranteed transfer of that authority. By these standards in at least five of these cases the clients were helped with partial effectiveness while in two others i t was too early to know the real effectiveness of the work. When the etiology of the problems presented i n these situations i s recalled this rate of effectiveness may be considered favourable. Discussion of these marriages in the light of the personal and family backgrounds brings out clearly that the client was the weak member of the family case work team. At least eight of the clients "a. were under the disability of being unable to face their dilemma r e a l i s t i c a l l y . The practitioner, then, had the d i f f i c u l t y of trying to help the client, who had never learned how to live properly, renew his existence., so that livi n g would have meaning for him. The awareness on the part of the family case workers of the dangers facing the children of these marriages inspired a leadership of the case work team that found a response In most parents and i n the third memteir of the team, the community, as i t made available resources for the well-being of the children. School o f f i c i a l s , 120 school nurses, Victorian Order of Nurses, psychiatric service and children's services including protection, boarding home and foster home care, were a l l positive elements i n the family case work treat-ment. The staff members helped clients not only when the separation was f i n a l , or appeared to be inevitable, but also before the decision to separate had been made. Thus, advice on matters such as marital rights, separation and divorce was s k i l f u l l y given. Yet i t is well to point out that there was extreme care taken not to invade the domain of the legal profession. The worker who was assigned to the divorce case, without imping-ing on the area of the legal profession, exerted an energetic and encouraging influence that helped Mr. B.B. carry through with a disagreeable task which he f e l t was his duty. While the staff members carefully avoided stepping out of their roles, i t was observable that other professional workers were just as careful not to move out of their areas of competence. This was true of the doctor who would take no part i n a marital situation as i t was not his f i e l d and of a lawyer who acted similarly. Lack of understanding of personal and social implications on the part of the lawyer who served as legal counsel to Mr. B.B. Increased client anxiety to an extent requiring the family case worker to discuss the matter with the barrister. The development of the case work relationship between the worker and Mrs. D.D. one of the deserted war brides suggested the value of a fee service-. * Mthough this client had l i t t l e money she insisted, after a luncheOnaappointment with the worker, on paying for the meals of both herself and worker. It is doubtful whether the worker 121 realized the significance of the client's need to pay for service for she later joked rather flippantly with the woman about i t . That success can attend the efforts to help people accept the inevitability of separation and adjust to i t , is exemplified in the situation x>£ the LLs' . After Mr. L.L. was cast out of his home, he and his wife both came to the agency. The worker then explored the feelings of both. Convinced of the woman's determination to separate, she and fellow visitors who succeeded her, over a period of months, worked steadily to help the man face up to his situation. When this was accomplished consideration was given to care of the children, interference by private citizens resulted in amateur arrangements for adoption placement. There seemed reasonable chance at termina-tion of service that these people could go their separate ways happily and might later end their marriage completely through divorce. Periods of case work treatment with these families have been long, varying from five to 323 days with an average of 6.1 months. With these courses of treatment totalling 409 days the B.B. family had the longest total period of treatment. Disruptions of families coming to the Family Welfare Bureau are thought-provoking. These breakdowns are occurring i n families of young people whose marriages generally do not cover a span of more than ten years. Most couples have been married a much shorter time. The children of these marriages, being mostly of pre-school age are i n grave danger. One question that may well be asked i s , are these children li k e l y to suffer any more than the children who lose their parents through death? Probably the answer l i e s in the type of family l i f e that precedes this change. Whereas the child who has lost a parent 122 through death may have enjoyed a relatively happy l i f e before the tragedy,. tHee child of the "broken home" has lived through a damaging stormy period preceding the separation of his parents. A second question that may be asked Is, would not these child-ren of broken marriages be better placed i n adoptive or foster homes? This question can be answered only oh an Individual basis, the reply related to the particular kind of parent the child has„ "femotional neglect", the term used by many social workers to indicate that a child is being deprived of a happy relationship with parents, that w i l l help him grow to emotional imaturity, is s t i l l d i f f i c u l t to prove in court of law. One thing is certain. Unless these children receive special help i n acquiring proper social attitudes and in developing the capacity for'• personal relationships, they may be destined to carry into adult l i f e the misery that shattered the marriages not nnly of their parents but also of their grandparents. Unprepared for l i f e , these marital partners have been least pre?-pared for marriage. Temperamentally, educationally and vocationally they are ill-equipped to live as celibates, l e t alone as husbands and wives. The family agency has something to offer these people. The staff members to be successful must be forceful professionally; they must discard every notion with regard to the conventional view of marriage dissolution. They can help their cleaving partners to separate successfully. They can help the children of these marriages. But family case work.is not enough. It must form part of a 123 service that w i l l attack universally the problems that lead to marriage disruption seen in this group and those studied under Advanced Marital Conflict. Logically tthe- premise of operation of that service must be the desirability o.f,:prevehtion of marital catastrophe, more positively put, of preparation for living and the vocation of marriage. 124 CHAPTER VII RECONCILIATION One of the cases described in the preceding chapter, was that of Mrs. D.D. the English war bride whose husband deserted, leaving her i n care of his parents. When the Family Welfare terminated i t s contact there was a vague suggestion that Mr. and Mrs. D.D. were going to live together again. Despite the harsh treatment Mr. D.D. had meted out to Mrs. D. apparently she s t i l l wanted to live with him. What influences might bring about such a rapprochement? Has family case work anything to offer the husbands and wives who alter-nate between livin g together and separating? Ten families have been selected for this portion of the study, with these questions forming the basis of enquiry.. "Reconciliation" as applied to these cases i s a loose term, used for.want of a better description. It signifies not only mar-riages i n which true reconciliation of partners has taken place, but also those in which there has been resumed no more than the outward appearance of the nuptial state. Affection—Strength of The Wife? The J.Js' were married in Vancouver toward the end of 1944. How long they knew each other before marriage is not indicated. The fact, that the parents of both strenuously objected to the marriage before the J.Js' pledged their troth, would indicate that there must have been a measurable interval between f i r s t meeting and marriage. It was not surprising that there should have been this pre-marital conflict because the family backgrounds differed greatly. Mrs. J.J. had spent most of her twenty-four years on the prairie farm which her Irish-born parents operated none too 125 successfully. Before moving to Vancouver at the beginning of the Second World War the family had lost their property and, for some-time after the reduction of their fortunes, had been subject to poverty heightened by the ignominy of depression r e l i e f . Mr. J . J . , on the other hand, with the exception of his overseas war service, had lived his twenty-five years in Vancouver. His family was reputed to be f a i r l y "stable?1 but this description had been modified by the statement that his mother had possessed "social pretentions." Perhaps i t was the early influence of the socially--aspiring mother that made i t so d i f f i c u l t for him to ask for help when he came to the family agency. The intake worker recorded that he presented "a good, clean-cut appearance" as he diffidently told his i.sJspry .He had l e f t high school, he said, when he had only half-finished i t , i n order to join the navy. After discharge he had been to sea for awhile but the separation from family which this occupation necessitated made i t unpalatable to him. For some time he had been without work of any description. Bewildered, he and his wife saw their debts mount to frightening proportions. They had used Mr. J.J's re-establishment credits for the purchase of furniture and, to supplement this limited purchase, had under-taken the obligation of buying more household equipment to be paid from earnings. How they could not even meet the current living costs which included the $15.00 rental for their suite. Apparently completely discouraged, Mrs. J . J . had taken her leave of Mr. J . J . Her action was incomprehensible to the man who now seemed disappointed in his marriage and who obviously f e l t affronted at the defection of a wife whom he considered socially 126 his inferior. The family case worker made i t plain to Mr. J.J. when he asked to have his wife told that she must return to him, that the family agency could take' no sides in a family quarrel. The wife might have something to say in heroown behalf and might have feelings that Mr. J.J."was at fault. Perhaps the worker could have a talk with Mrs. J.J. to see how she f e l t about their marriage. Mr. J.J. agreed to his wife being interviewed on.this basis. Meanwhile some attention was given to immediate practical issues. Enquiries to the Unemployment Insurance Commission, which were willingly answered, revealed that Mr. J.J. had no entitlement to unemployment insurance benefits. Arrangements were made with the administrators of a military fund for temporary assistance to be granted to Mr. J.Ji so that he could take care of immediate material needs. A check with the Department of Veterans Affairs revealed a very different story from the one he had told to the worker. Mr. J.J. was recorded i n his service career as unstable and given to excessive drinking. He was f i n a l l y discharged from service with a medical diagnosis of "psychopathic inadequate personality." The family case worker found Mrs. J.J. to be thin and p a l l i d -looking, at f i r s t very unresponsive. A well-cared for and healthy baby boy of one year suggested that she must have some positive qualities. The worker moved slowly at Mrs. J.J's pace. In the third interview the pace quickened as Mrs. J.J. became more talkative. Gradually the real Mrs. J.J. became apparent. She admitted that she was very fond of her husband. She seemed to realize his short-comings and was prepared to put up with them despite her recent action in leaving him. Then she admitted that she shared the blame 127 for the marital maladjustment. The worker helped her to say that she had a sex d i f f i c u l t y by reason of which coitus could not be completed. Together the worker and Mrs. J.J. analyzed this ab-normality as a source of conflict between herself and Mr. J.J. Be-ing allowed to talk about It, and. being helped to overcome her sense of guilt for this inadequacy i n such an important area of the marital relationship, enabled Mrs. J.J. to think more clearly about her total situation. She was also referred to a gynaecological c l i n i c for medical counsel and interpretation. The family case worker realized the depth of Mrs. J.J's love for her husband and communicated to the wife her understanding as much by her attitude as by spoken word. The acceptance by the worker of this woman's love for a man who in so many ways was unequal to the demands of l i f e helped to strengthen her resolve to make the marriage successful. Even when Mr. J.J. continued his drinking, and deserted his wife, she did not weaken i n her determination that the marriage would work. Despite the necessity to accept referral to a public agency for financial aid, she appeared stronger at termination of the case than when the worker f i r s t met her. A year after this f i r s t period of service Mrs. J.J. was referred to the family agency by a public health nurse. Although there had been a reunion of husband and wife in the interval, Mr. J.J, was gone again, not only leaving Mrs. J.J. penniless but also weighed with the anxiety of pregnancy. Referral to a prenatal c l i n i c helped meet the immediate need. Mr. J.J. showed the same determination to have the marriage succeed shown during the f i r s t period of service. Mr«j J.J. was 128 interviewed and helped to realize the depth of feeling that his wife had for him, and the meaning that this affection could have in married l i f e . He returned to his wife. Now he has steady employ-ment in the construction industry. There is a good chance that he w i l l be able to contribute to the marriage. At the time that the case record was examined, the J.Js' were s t i l l active with the agency. The social treatment plan embraced "supportive help" to the J.Js 1 for as long as.it would take for them to solidify their marriage. Other Situations Not a l l the cases were as easy to analyze as was that of the J.Js'. Few had the evident strengths that helped this family to re-establish i t s e l f . Not a l l of them permitted of the successful exercising of the family case work techniques. Common to most situations was the fact that the wife l e f t her husband in the f i r s t instance. Circumstances of the disruptions varied greatly i n the six other situations in which the woman took leave of their husbands. Mrs. R.R. came to the bureau at the end of a day in which she had been sent from one agency to another. The strain had increased with each successive referral. By the time she met the family case worker, the fear of an aroused husband who had been violently angry with her at the beginning of the day had reached major proportions. Now, afraid to return home, she was further conflicted by her concern for two l i t t l e g i r l s of pre-school age whom she had l e f t with Mr. R.R. Another woman came to the agency because she no longer f e l t that she could tolorate her husband whose natural instability had been intensified as a result of the rigours of overseas war service. Mrs. M.M. like Mrs. J.J. had an unusual affection for her husband 129 that made her miserable over her d e s e r t i o n . U n l i k e Mrs. J . J . , she h e r s e l f was immature and the task of r e v i t a l i z i n g her;.married l i f e was correspondingly d i f f i c u l t . . Less p a t h e t i c was the case of Mrs. S.S.. She became "so-bored w i t h her surroundings'* In an i s o l a t e d s e c t i o n of the Province where her husband's employment took her, that she s t a r t e d to d r i n k and a f t e r an orgy of some weeks, l e f t her husband, b r i n g i n g her two c h i l d r e n w i t h her to the c i t y . I n t h i s case I t was the husband who wanted .to save the marriage and so fo l l o w e d h i s w i f e to the c i t y . Another young w i f e , Mrs. 0.©.,' r e t u r n e d , supposedly on h o l i d a y , to h e r p a r e n t a l home i n a p r a i r i e c i t y . Apparently her widowed mother was jealous of the daughter;! s supposed married happiness, took over her t h i n k i n g and spoke so con-v i n c i n g l y a g a i n s t the son-in-law that Mrs. 0.0. decided not to r e t u r n to him. Mrs. 0.0. then consulted a lawyer, who on her b e h a l f , wrote to Mr. 0.0. a d v i s i n g that s u i t would be brought f o r j u d i c a l s e p a r a t i o n . A f t e r Mr. 0.0. had proved to the s a t i s f a c t i o n of t h i s lawyer that h i s w i f e had no grounds f o r l a w s u i t and a f t e r she had remained w i t h her mother f o r a considerable time she suddenly decided to come back to him. Mrs. Q.Q. came to the f a m i l y agency a f t e r f i r s t seeking'at a c h i l d r e n ' s agency placement f o r her l i t t l e boy and g i r l , both of them, of pre-school age. The c h i l d r e n , she complained, were " g e t t i n g on her nerves," and the noise which they made around the home was preventing Mr. <4.Q.-, a student veteran, from studying. Although Mrs. Q.Q. accepted r e f e r r a l from the c h i l d r e n ' s agency to the Family Welfare Bureau i n order that she might be helped w i t h her problems, 130 she did not give up her plan of placing the children. She agreed that some people were "born mothers" but she was not one of these. She preferred to work and run a large house which she and Mr. Q.Q. had. bought as a boarding place for university students. Although she stated that Mr. Q.Q. was agreeable to placement she blocked a l l agency attempts to see her husband* Before a plan could be made she placed the children privately. As the boarding home was found satisfactory, the children's agency licensed i t . Mrs. Q.Q. then went to work. She avoided a l l agency contact. Because she did not want case work service i t was arranged that the family agency would..withdraw from the situation and the children's agency enter for the protection of the children. There had not been time to effect transfer before Mr. Q.Q. came to the family agency. He and his wife had separated, sold their house and divided the proceeds of sale. Although -seemingly intelligent and more stable than the wife, Mr. Q.Q. lacked the agressiveness to.-, recover his situation. He described his wife as "jealous, hysterical and a wishful thinker" and said that they had separated after a' quarrel about money. The advice of the psychiatric consultant was sought. He re-ported that Mrs. Q.Q. was unlikely to mature emotionally and that adoption would be best for the children* The"Q.'^s1 "arranged" a divorce. Mr. Q.Q. gained custody of the children. Apparently the psychiatric opinion was not consulted i n this award; and because court action was taken independent of the children's agency, no Immediate steps could be taken toward placement of children. Not long after the divorce, Mrs. Q.Q. returned from a city to which, she stated, she had gone to take treatment for a 131 glandular disorder. A short time later the Q.Qs' decided to try-liv i n g together again, apparently i n common-law relationship. Just as unusual was the situation of Mrs. N.N. a young g i r l who had l e f t her hushand charging cruelty and inadequate support. She had married as a minor without parental consent. When she sought help at the family agency she wanted her marriage to be an-nulled. Later, however, when she thought herself to be,pregnant, she reversed her stand and, while she did not return to her husband, she, at least, accepted the marital status for what advantage i t might give her. She proceeded to the domestic relations court where she laid a charge of non-support against her husband. Mrs. W.W., a British war bride, had no choice other than to leave her husband, having been l i t e r a l l y "kicked out" by him. Im-mediate causes of this violence had been disagreement over the dis-ciplining of the children and the wife's expressed desire to return to England so that she might-see her ageing parents before they died. The worker was able to talk with the husband who, when he discussed his d i f f i c u l t i e s , realized that he was being unreasonable about the disciplining of the children. He began to see, too, that his jealousy of the wife's parents was blinding him to the fact that the woman did not wish to leave him permanently. Two other, marriages give examples of the husband deserting his family. There were constant flare-ups between Mr. and Mrs. M.M. These conflagrations f i r s t had been touched off over a year ago i about a month after the death of an infant daughter. Thereafter, Mr. M.M. had been prone to go off and drink with a man friend. Returning home in a state of intoxication, he would quarrel violently with his wife. Several times he l e f t her for short periods after these quarrels. It might have been assumed that loss of the child 132 set off these escapist actions. But, on the contrary, with the birth of a son, the marital situation deteriorated even more. Mr. P.P. was of an unstable nature and often drank to excess* Mrs. P.P. alleged that he had entered into extra-marital relations, and this allegation had been the cause of more than one quarrel. After one such battle two days before, Mr. P.P. had l e f t Mrs. P.P. When .the wife came to the agency she was overwrought. ' She did not appear to be a very profound person but she was desirous of having a home and obviously was very fond of her husband. It was to please him, she said, that she had borne him a child. On his side, realiz-ing his own limitations, he had thought that a child would help to steady him. Examination of the backgrounds of these cases i s helpful i n understanding the dynamic forces that led to the situations here described. Family Background, Family Histories In most of these ten families the recorded data on family back-ground is not so plentiful as i t was for the J.Js 1. It i s clear, however, that most of these marital partners had known uneven family l i f e . At least three of the husbands had come from homes broken by separation or divorce. Desertion marred the early l i f e of at least two of the other men. This was noticeably so i n the case of the unstable veteran who had been a prisoner of war. Three of the wives had grown up in a similar family context. Apparently few of these people had grown up i n homes with economic advantages. There i s frequent mention i n the records of financial d i f f i c u l t i e s i n the homes of these partners. 133 Cultural and Social Factors It Is of some consequence, perhaps that In terms of rac i a l extraction this was the least homogenous of the groups of families . studied. In seven of the marriages, both partners were of Anglo-Saxon or Celtic origin, Mr. P.P.. was of Russian descent, his wife of French origin. Mr. R.R. was of French-Canadian origin. Mrs. R.R. came from a Polish community i n Canada. The cultural traits of both influenced the course of the marital l i f e . Mrs. N.N. was of Canadian-Indian bloody her husband a Canadian. . In only four cases was the religion noted. This failure to obtain "face sheet Information" which affects the acceptance of referral in a city that supports, non-sectorian, Jewish, and Catholic family agencies i s perhaps less understandable than other ommissions in recording. There i s no certainty as to the religious a f f i l i a t i o n of those for whom this factor was not recorded. In three of the four families for whom religion was noted, i t was Protestant. Only one couple specified the denomination. Mr. P.P. was a non-practicing Catholic. Religion for him, as for the others, seemed to have l i t t l e meaning. l Most of these people hailed fi© m the c i t y . Two of the wives were raised in prairie farms. The difference i n kind of surroundings and the effect on the principals has already been noted in discussing the J.Js'« The contrary influences of urban and rural environment were not so clearly evident In the marriage of the veteran whose ins t a b i l i t y had worsened with incarceration as a prisoner of war. These are some of the influences that moulded these men and women. More specific personal data amplifies the understanding of 134 them as marital partners and parents. The Marriage Partners, Ages With the exception of the R.Rs1 there were no significant differences between ages of men and their wives. Mr. R.R. was thirteen years his wife's senior. This disparity was an Important factor i n the problems of the R.Rs', The age; range was wide, however; for men i t varied from twenty-four to forty yearsj. for women from sixteen to thirty-five-. Obviously, most of these ten cases represented the earlier years of the marriage between young people. Education Educational achievements were recorded for both partners in two cases. In four others the school attainments of the men were given, in two others those of the women. Education varied from grade eight to university credits for the men, and from grade nine to registered nurse for the women. Higher education militated against the success of one marriage; in another i t was a strength. Mr. Q.Qs' absorption i n university study which was not easy for him, contributed to the disruption of his marriage. Mrs. 'D.D. through her nurses' training, and through the natural aptitude which f i t t e d her for that vocation, was able to gain Insight into the marital problem which helped her i n her determination to save her marriage. Occupation and Employment Work histories mostly were erratic showing the least constancy and consistency of a l l the groups of families studied. Six of the husbands had been on active service, three of them overseas. Unquestionably the.overseas experience of two men 155 adversely influenced their emplqyabliity. The war had interrupted Mr. J.J's schooling which, had i t been carried further, might have mitigated, in some measure, the basic, weaknesses of his personality* The experience of battle would have been a further upsetting in-fluence on him. Harsh detention in prisoner-of-war encampment did nothing to improve the personality of Mr. M.M. Occupations were listed for nine of the men. There were no skill e d trades. Only three men, the veteran;: who did not want his war bride to return to England, and the two business propriet-2-e Oirs had been steadily employed before coming to the agency. Both proprietors l e f t their businesses and.took supervised jobs. For the women, only three were listed as having occupations. Two of them had to work at sometime during the period of agency service. Mrs. D.D. the qualified nurse was the only ski l l e d worker. Mobility Rate of geographic mobility did not correspond with the high occupational mobility as might have been expected. The East-West migration represented in four marriages and overseas service were the greatest factors in mobility. Health The general physical health of this selection of families was somewhat better than that of the families in the other groups. In two marriages both husband and wife enjoyed good health; four other men were apparently physically sound. Where physical ailments were present they had an important bearing on the marital problems. A seriously disabling hearing condition reduced the employability of Mr. S.S. The pressure of the .defect at once complicated and simplified his marital problem. While i t did reduce his; employability 136 making the source of family income uncertain, at the same time i t also precluded acceptance of job in isolated areas and so eliminated a grievance of his wife. Leukorrhea intensified the sexual d i f f i c u l t y of Mrs. J.J. and added to the d i f f i c u l t i e s i n effecting an adjustment to her abnormal-ity which would help i n the solution of her conflict with Mr. J.J. Mrs. P.P., too, had a serious physical handicap which struck at the very core of sexual relationship with Mr. P.P. Because of a grave heart condition she could not have more children. The history of miscarriage and gynaecological infections may have accounted, i n some measure, for Mrs. Q.Q's unusual behaviour. The young g i r l who wanted her marriage annulled assented that she had contracted a specific infection from her husband. Laboratory tests did not bear her out in this statement. Neither was i t certain that she was pregnant when she instituted legal action against her husband for support. As i n this case /emotional health in most families was not good. Immaturity and instability often were present although, perhaps, they could not have been diagnosed as ailments. Mr. M.M.* after his experience as a prisoner-of-war had been diagnosed by service medical officers as psycho-neurotic. With the exception of Mr. J.J. who was judged psychopathic by two different authorities, there were no recognized mental illnesses or deficiencies. There i s cause for wondering what kind of marriages people with these backgrounds could make. The Marriages Although there i s relatively l i t t l e detail recorded about the 137 marriages, the information that i s available is important from the points of view of both family case worker and research worker. Circumstances of The Marriages L i t t l e is known about preparation for marriage. In only one case was the length of pre-marital acquaintance recorded. The young g i r l who sought an annulment knew her husband for only one month be-fore marrying him. It i s interesting to note that in two of the most d i f f i c u l t cases the woman had been previously married and divorced. Mrs. T.T. had divorced her f i r s t husband after eight years of marriag and one year before marrying Mr." T.T. There were no children by the f i r s t marriage which had been dissolved by mutual consent of ;both partners. The wife who l e f t her husband because she could not tolerate her surroundings had been twice married. The f i r s t marriage terminated by divorce, l e f t her with the responsibility of caring for a five-year-old son. She frankly admitted that she married the second time under the stress of achieving economic security. Among the nine marriages for which duration was recorded, only two couples had been married more than five years. Both these had been married seven years. Six marriages had not passed their fourth year. Economic and Social Factors In nearly a l l these marriages there were financial d i f f i c u l t i e s . These seemed to be the results of the disturbed lives of the client more than the cause of any marital conflicts. Two of the husbands were without employment when they came into the agency. Two of the men had their own businesses. Mr. R.R. was in partnership, but had to withdraw because of his gambling and drinking detracting from his efficiency. The war-scarred veteran who was so 138 unstable supplemented proceeds from a small neighbourhood business with a sizeable military disability pension. None of the families were in affluence at time of agency contact. Five of the families owned homes, most of them in respectable d i s t r i c t s . The veteran who operated the neighbourhood store owned the premises. His family oc-cupied quarters at the rear. Rented accommodation comprised various types of suites. There were no rented homes. The location of housing in this group would suggest generally better than average social status. In more than one f i l e neighbour-hood approval of the family is recorded.. The Children There were i n these families thirteen children: eight boys and three g i r l s . Ages ranged from a few days to seven years. Only one child, son of a f i r s t marriage (Mrs. S.S., the woman who was bored with her surroundings) was over five years. The vacillations of parents with successive partings and reconciliations might be thought very harmful to children in this age range. Yet there are no behaviour deviations recorded for this group of children, despite the fact that in at least three situations disciplining of the children was a matter of argument. On the basis of the information contained in these f i l e s i t would be unwise to draw any conclusions about the effects of the maritaldi's-harmony on the development of these children other than to say, that no deviant behaviour was manifest during the period of agency service. The gravity of the problems encountered by these families as seen i n terms of family and personal backgrounds, and of the marriages themselves, indicates the need for very skilled use of case work principles in treatment. 139 TREATMENT, The Client It is evident from these wide-ranging examples that emotional in s t a b i l i t y i n one, or both, of the partners i s very commonly a basic cause of disruption. On the other hand, some innate strength i n one of the partners, and strong feelings of affection may operate to bring, about rapproachment. Although, in these cases, i t was most frequently the wife who l e f t the husband In the f i r s t instance, often she was the stronger partner. In effect, the apparent desertion often is apt to be more i n the nature of a tactical retreat from the battle against the problem or problems threatening the marriage. This retreat would be used for the purpose of reconnaisance, exploring the f i e l d In an effort to find resources that would aid the attack. Often at this stage the family case worker is brought in b*. as.: expert counsel on the best plan of attack. In contrast to the other groups of families already studied, the client, and usually the woman, become the spearhead of the attack, actively leading the family case work team. In some instances when this i s not so, i t is the misdirected activity of the woman, taking place as though i n opposition to the case work team, that makes for d i f f i c u l t y i n attempting to overcome the problem. Mrs. J.J.-, Mrs. T.T., Mrs. P.P., and to a lesser degree Mrs. R.R. belonged to the f i r s t order. It w i l l be remembered that Mrs. J.J. despite the psychopathy of her husband, and sexual handicap, deter-mined that her marriage would be firmly established. Her intense feeling of fondness for Mr. J.J. was her best resource in achieving her objective. The family case worker helped her to express this feeling and to understand herself better -so that she could direct her activity toward positive goals. 140 In a like manner, Mrs. T.T's worker helped this wife to release her feelings about her husband's faults i n the seclusion of the inter-viewing office rather than to express her h o s t i l i t y to her husband at home. This acceptance of emotional outbursts of Mrs. T.T. by the worker enabled her to master herself well enough to accept help i n understanding something of the reasons for.Mr. T.T's drinking, and to realize the part her anger played i n the bickering with her husband. Similarly Mrs. P.P. was helped to give vent to her feelings about Mr. P.P's drinking and seeking i l l i c i t feminine companionship, to accept these failings in her spouse and at least to begin to under-stand the causes of these d i f f i c u l t i e s . Despite the fear of Mr. R.R., Mrs. R.R. knew that her conscience would not let her escape the responsibility for her children, or long ignore her own feeling for Mr. R.R. Yet to save her marriage she knew that she must assert herself to her husband. The family case worker s k i l f u l l y used the "supportive" technique of listening sympathetically and reassuring the client with the promise of help at time of future d i f f i c u l t y . In this way, she communicated to Mrs. R.R. the strength necessary to discharge the responsibility of which she was afraid. Her position was not very different from that of Mrs. M.M. whose husband's natural ins t a b i l i t y had increased through the vigours of war service. Undirected leadership functioning i n opposition to, or apart from, the family case work teams, is represented in Mrs, Q.Q.; also in the young g i r l who at f i r s t sought annulment of her marriage. The actions of both could have wrought unsatisfactory .effects not only for themselves but a l l those associated with them. Mrs. Q.Q's early action in placing the children privately was happier in i t s 141 effects on them than It might have been.Finding of foster homes, inspection and licensing of hoarding homes for children, and the placement of children in foster homes and boarding homes generally require exercise of the best s k i l l s of the child care worker and the haphazard methods of placement such as Mrs. Q.CQ. used may result In experiences harmful to the children. I t i s not possible to say whether the fact that this placement proved satisfactory was due to Mrs. Q.Q1s understanding of children's needs or merely attributable to happy accident. Nor is i t possible to gauge how Mrs. Q.Q's latest action in returning to live with her emotionally immature husband w i l l have on either him or their children. Less constructive than the actions of these women were the movements of the wife who l e f t her husband because she was "bored with her surroundings," and the wife who returned to her prairie home, refusing to come back to her husband. The negative qualities of both husband and wife minimized the possibilities of successful resolution of the marital conflicts; and the staff members had to put forth great effort with l i t t l e prospect of achieving success. For good or for bad, the husband who "kicked out" his wife was the stronger partner of his marriage. His capacity for : personal Insight when his conflict was revealed to him in true perspective appeared a major factor in the improvement of his relations with his wife. The Family Case Worker To say that i n many of these situations the client assumed leadership of the family case work team is not to minimize the im-portance of the role of the practitioner. The fact that the clients did assume leadership demanded very subtle use of family case work 142 techniques. - The vi s i t o r who worked with the J.Js', counselled Mrs. J.J. with adroitness that helped her to use her exceptional strengths for the rebuilding of her marriage. The family case worker who helped Mrs. T.T.., immediately con-veyed a sense of the client's worth by showing her common courtesy. She made sure that when an appointment was made for a case work interview the time was convenient for Mrs. T.T. This simple act of viewing Mrs. T.T. as a real person doubtless helped to establish quickly the relationship between vi s i t o r and the client.^ Sympathetic listen-ing on the part of the worker helped Mrs. T.T. talk freely about the "flare-ups" between herself and her husband. The constructive re-sponse which the worker made to this narrative, showing Mrs. T.T. that her problem was understood, helped her to think about the d i f f i c u l t i e s so that she might renew her efforts to make her marriage worthwhile. In some cases the staff members were active beyond rendering support-ive help or interpretation. For instance,: the visitor who interviewed Mrs. R.R. wrote to an elder brother in one of the United States. The brother who had always been very fond of Mrs. R.R., on learning of her plight not only wrote encouragingly to her but forwarded to the family case worker data about Mrs. R.R's background, vAiich was helpful in making a social diagnosis and which, was used i n a personal history when the situation was presented i n psychiatric consultation. The v i s i t o r who helped the P.P's was even more active. She 1. This i s more significant i n the Family Welfare Bureau of Greater Vancouver, than i t might be in some agencies elsewhere. Although the workers do see people by appointment, the routine i s not so highly developed i n some agencies where interviewing is almost exclusively by appointment. 143 made excellent referrals to other agencies i n the community including maternity c l i n i c , the public assistance agency when financial help was needed, and the day nursery when a work plan was being developed and arrangements had to be made for care of the child during the day. Intensive discussion with the shattered war veteran and his wife helped them to meet their d i f f i c u l t i e s . Referral to veteran's hospital for additional treatment of the man's condition.was also well handled. The account of one interview with this couple i l -lustrates the tactfulness of the Interested family case worker. When she called upon them she found them very shaky and miserable after a night of drinking. Accepting their condition without apparent surprise, she quietly withdrew promising to return at a more con-venient time. Even i n those situations in which the clients undertook act-i v i t y that seemed to work against their own interests and which made helping them d i f f i c u l t , family case work was performed with some benefit. Mrs. Q.Q. was not anxious for and apparently not cap-able of accepting agency help. Mr. Q.Q;, on the other hand, sought assistance. Here was another instance of expert use of the telephone. Mr. Q.Q. frequently telephoned the worker who listened well and res-ponded with timely comment. Thus she was;able to interpret to him the need for a substitute home that would.provide affection for his children and also was able to suggest the possibility of securing a boarding home where both he and the children could stay. Sympathetic listening by a family worker helped Mrs. H.H. to express her feelings sufficiently, at least, to hinder impulsive action. Once again, there was evidence of-.professional caution not to give technical advice tha^is the province of another profession:, 1 4 4 as she deferred to legal counsel the intricate mattei/of the validity of her marriage. There was effective family case work i n the instance of the young man-whose wife returned to her prairie home. A good relation-ship was established between the worker and the man. The worker secured valuable co-operation from the social agency in the prairie center to which she wrote requesting that the wife be interviewed. On return of the wife to her husband, a joint interview was arranged . by the family case worker which seemed to have a unifying effect on the couple. Despite the instability of both the woman who could not toler-ate living in an isolated area and her husband, the worker who saw them jointly helped to reduce the tension between them. Wanting them to express themselves fu l l y she controlled the pace of the interview so that confusion would not become worse confounded. That legal knowledge sometimes can be used well was seen i n the case of the W.Ws'y in which the husband did not want his war bride to take a trip to England. The family worker showed that she could interpret law i n the abstract Without depending on legal counsel which is required in situations involving l i t i g a t i o n . Her explanation of guardianship rights to Mrs. W.W. was lucid and helpful to the woman in establishing her position in the marriage. The Community Discussion of these cases has indicated the use made of social resources within the community. Most resources were well used and usually adequate'. Referrals from other social agencies were generally good. One referral was from a client of the Bureau. Mrs. W.W» was brought to the agency by Mrs. T. the wife of the disabled veteran 145 described, i n Chapter VI. The intelligence with which she made the referral undoubtedly helped the W.Ws' to cope with their, problem. Length of Treatment None of the problems disturbing these families was treated on H a short term" basis. F i r s t , treatment was directed to meet the demands of the emergent situations, presented at Intake. Attempts to deal with basic needs of the clints followed. Periods of treat-ment were about as long as in the cases of the separated couples discussed in Chapter VI. Average length of agency contact was 205 days or 6.8 months, and the periods of treatment in individual cases varied from 99 days in the case of the T.Ts' to 520 days for the CCs Mr. and Mrs. J.J. were known to the agency for 410 days during their f i r s t period of contact and the second period of contact with the agency s t i l l active at time' of examining the record, had entered the eighty-fourth day. The case-o-graph i n these cases generally presented a curious im balance. On the l e f t , or analysis, side of the case-chart, the recorded information tended to be clustered about Section II, Per-sonal Adjustment, with the emphasis usually on the portion set aside for the woman. Data on Section I, Background, especially Family Background, was incomplete, and scattered. Section III, Marriage, was heavily weighted under Marriage, Compatibility and Health. On the treatment side of the chart, the Client and Service columns were much more required than that for Community. This confirmation was in keeping with the cause of.these 146 marriages and treatment of the problems affecting the families. There was a concentration on'"the problems associated with the marital adjustment, often to the exclusion or reduced emphasis on Background factors. Significantly, under Marriage and Compatibility, the strong affection of the woman for the husband was repeatedly noted. Most marriages were of comparatively recent date, with the partners being young people s t i l l on the lesser side of thirty years. D i f f i c u l t i e s with children, unlike the other groupings, were not very evident. What data there was indicated that the roots of the trouble in many marriages reach back into the marriages of the parents. Stability of family l i f e , however, was far from unknown to some of these people. The client, and usually the woman, took active leadership of the family case work team, or carried o n a c t i v i t y that represented leadership in opposition to the case work team. The case worker was called upon to exercise the best supportive interpretative and social therapeutic techniques. While treatment was f a i r l y effect-ive, the quality of the problems in this group^being mostly emotion-al^ re-emphasizes the necessity of psychiatrically -orientated train-ing for case workers. Once again the need is shown for a general education of people to meet the problems of social living and to build sound family l i f e . The wealth of information oh these problems committed to case records indicates that the family agency may well have a major part in promoting this education. 147 CHAPTER V I I I PARENT-CHILD RELATIONSHIPS AND CHILD DEVELOPMENT PROBLEMS An unhappy home presents many obstacles to the successful development of children. This truth has been well illustrated in most of the cases discussed in the four chapters which precede this section. I n "The Early Years" i t was seen that even incipient family conflict may threaten the emotional security of children. This was shown in the four cases of parents who asked for place-ment of their children in foster.homes. Because of the strained marital relationships these mothers and fathers f e l t unequal to the task of bringing up their children. The "Advanced Marital Con-f l i c t " in_Chapter V further demonstrated how such d i f f i c u l t i e s i n -crease over a long period. The couples whose time and attention is directed to marital problems can spare l i t t l e thought for parental duties. As a consequence, quite unconsciously they-may neglect their children. Worse s t i l l are the traumatic effects wrought on children by the dissolution of marriage, which, as outlined in Chapter V I I I , manifest themselves inomore extreme behaviour devia-tions, including "withdrawal", hysterical i l l n e s s , excessive destructiveness, and temper tantrums. The influence on child development of the marital relationship involved in the separation of man and wife, followed by rapproachment (described in Chapter VII), was not clearly discernible. The problems associated with the development of these seventy-two children might easily form the subject of this chapter. That fact is further evidence that many of the cases discussed in this 148 study could have been adequately considered under more than one head, and would have f i t t e d easily into several of the_.groupings into which the total case sample was divided. To make for c l a r i t y , however, a wholly different set of ex-amples has been chosen for study in this chapter. Fourteen cases, with twenty-eight children, have been selected for attention. The children, nineteen boys and nine g i r l s , ranged i n ages from birth to sixteen years. Of the boys, eight were of pre-school age, nine between six and twelve, and two adolescent. Of the g i r l s , five were of pre-school age, two between six and twelve years, and three adolescent. Naturally, the d i f f i c u l t i e s of these boys and girl s like their ages, cover a wide variety of developmental problems. DESCRIPTION OF PROBLEMS In Chapter V the Atherton family was described, and also depicted in demonstration of the use that might be made of the case chart. It w i l l be recalled that Sonny, the-three-year old son of the Athertons, exhibited such rampant destructive tendencies that, not only was he a social pariah, but his parents had lost status in the neighbourhood because of his anti-social acts. Miss West, the d i s t r i c t v i s i t o r , over a long period of.treatment, was able to help the Athertons see in what way they themselves were responsible for Sonny's misdemeanors. The intelligence of the parents and their capacity for emotional f l e x i b i l i t y helped them.to gain insight into their part i n their child's d i f f i c u l t i e s , and they were able to make good use of the case work relationship with a visitor who was sympathetic, perspicacious, and able to communicate some of her own personal strength to them. The happy result of this relationship was the Athertons! increased understanding of Sonny's problem as 149. their own. As a consequence, Mr. Atherton gave more attention to his wife, became more active in their home, and both the father and mother devoted more attention and affection to Sonny, The boy in his turn, began to disobey his parents less frequently than had been his wont. In time his anti-social behaviour became modified to the extent that a neighbour invited Sonny to join in play with his own boy. Disobedience and destructiveness were not uncommon in these children. Five-year-old Jerry Casell persistently disobeyed his parents. In and out of their home he destroyed property. Mrs. Casell seemed incapable of controlling him; nor could she deal with his tendency to shed his clothes in public or to use of "f i l t h y language." Jerry could get along with his playmates no better than with adults. In conflict even with himself, he was highly nervous and slept poorly. A tonsilectomy seemed to heighten his nervousness. His singular g i f t was a talent for music. Fifteen year old Frank Voreau seemed completely out-of-hand. His mother showed l i t t l e aptitude for dealing with a "wildness" that took the form of stealing in company with other boys. Her remedy of harsh physical punishment stimulated resentment i n Frank. Aside from the campanionship, i t offered with other boys, which was very satisfying to his gregarious nature, school was as d i f f i c u l t as home for him, because of his limited intelligence, Mrs. Smith complained that sixteen year old Naomi was "defiant", and disrupting the household. Interviews with Naomi revealed that to the normal conflict of adolescence was added confusion over the circumstances of her birth and her place in a family that included the fifteen-year-old g i r l and twelve-year-old boy of her step-father. 150 Jackie MacDonald, aged nine and-a-half years, was a good-look-ing l i t t l e boy, strong, erect, and constantly active. But at home he was stubborn and frequently ran away. Mrs. MacDonald used depriva-tion as a means of punishment. At school, Jackie, although of averag intelligence, was scarcely less happy than at home. He liked his school mates, but hated his teachers. There was a tired look about him, i l l - s u i t e d to such a l i t t l e boy. He found i t d i f f i c u l t to express himself. Although he could not understand the implication of the common-law relationship i n which his mother fived, he had begun to wonder i f Mr. MacDonald were his "real father". Other overt behaviour problems showed themselves among these children. Eight-year-old B i l l y Hughes, small for his age, i n fact the shortest in his class at school, was domineering and "mean" to the smaller children who came under his influence. He had never been strong physically. As a baby, he presented feeding d i f f i c u l t i e s , and then i n succession, he experienced tonsilectomy, c o l i t i s , appen-dectomy, mumps, measles, and whooping caugh. Having received such extra attention as chronic illness requires, he openly resented any favour to his five year old brother, Alfred, who was "mischievous", but"loveable" .• Mrs. Davison came to the Bureau, asking for help i n dealing with seven-year-old Andy, who, she complained* was sadistic and prone to i n f l i e t injury on Max, his five-year-old brother. She mentioned Andy's defective vision as a possible contributing factor to the aberrant behaviour. The case worker soon perceived that the real problem lay with Max, who was given to stealing, lying and -bullying, head-banging, and generally erratic behaviour. That he was obviously-Mrs. Davison's favorite made social treatment d i f f i c u l t 151 Alan, seven-year old son of Mrs. Tanner, was allegedy misbe-having, being found i n the acts of stealing, lying, and truancy. His conduct was what might be expected of. a child who had been i l l -egitimate, subject to the discipline of many relatives, taken into a family i n which the mother promised that he would not become a financial responsibility of the stepfather. The birth of a son to this marriage further increased Alan's insecurity* Frequently deviant behaviour takes a more subtle form. Seven-year-old Larry Ball, for example, was almost consistently selfish, especially with respect to Harry, aged five, and Jesse, aged three years, his half-brothers,the issue of Mr. Ball's second marriage. The younger boys gave expression to their unhappiness through rever-sion to infantile behaviour;. Harry was docile and unable to assoc-iate freely with other children; Jesse had returned to the stage of fecalal soiling and excessive dirtiness. Harry and Jesse both suf-fered from the physical handicap of crossed eyes. L a r r y and Jesse were continuously battling each other. The Edwards were facing a similar problem. Two-year-old Isabel was possessed of an abnormal appetite for food. Not only was she s t i l l not toilet-trained, but she displayed abnormal Interests in the bodily processes of elimination. Mental abnormality posed a problem for the Yorks. Harold, their fourteen year old son by Mr. York's f i r s t marriage, which was, ended by the death of his f i r s t wife, was mentally dull and had to be placed in a special class at school. The second Mrs. York had not been aware of this at the time of her marriage to Harold's father. For a time the d i f f i c u l t y which Mrs. York encountered as she tried to cope with this unpleasant surprise presented a serious 152 threat to the marriage. At the other extreme, the White family possessed a superabund-ance of intelligence. The father was rated in the "exceptionally bright group of intelligence", and the mother was highly intelligent. Four year old Annette.who responded to IQ tests as "very superior", was given to t e l l i n g lies and persistent day-dreaming, A thyroid condition contributed to a high degree of activity. The real problem child, however, was her eight-year-old brother Danny, who was rated in the nnear-genuis" group. His relationships with his family and with the school.were poor. He exhibited negative qualities, being lazy and withdrawing. He resented the birth of his sister, and rivalry ran high between the two children. The unsalutory effects on children of poor family relation-ships are at times more clearly evident than in the above examples. The Stewart and the Mellon family situation confirm this observa-tion. Mr. and Mrs. Stewart, with one baby boy of twelve months of age, had a second child. They were fond of the elder child, but feeling the burden of the support of.a second child, tended to re-ject him, applying for adoption placement of the new-born. The Mellon children were subjected to poor fortune of a different char-acter. A marital quarrel of many years' duration fi n a l l y culminated in Mrs. Mellon's taking leave of her family. Mr. Mellon was l e f t with the job of caring for three children, Charles aged 11 years, Carol aged 9, and Bobby aged 8. Charles seemed to take hold very well, accepting much of the responsibility for his sister and brother; but the younger children both presented a challenge to any adult. Carol behaved negatively, expressing h o s t i l i t y towards most people, stammering, having enuresis, and f a i l i n g in school. Bobby reacted 153 to two serious personal handicaps, of deafness in one ear and blind-ness in one eye, by withdrawing from the company of others to live alone in a dream world. The Parents Brief though these descriptions of child developmental dif-f i c u l t i e s are, they do indicate the important role played by mothers and fathers in the creation of the parent-child relationship which '• so greatly influences the growth of children. Some details of family and personal backgrounds w i l l , therefore, help in understand-ing the d i f f i c u l t i e s of these children. Deviations from the accepted norm of family l i f e varied from poor adjustment of the youngest child in a large family, to a major breakdown eventuating in divorce. It has already been pointed out how the worker on the case used the knowledge that Mrs. Atherton had an unusually close attachment to a brother many years her senior. Not only was this considered In making her diagnosis, but i t was helpful i n interpretation to Mr. Atherton so. that he might better understand his wife and so, maker her lot easier. This in turn would relieve the tension experienced by Sonny. Although Mr. Atherton' father had exhibited ins t a b i l i t y , he also had•sufficient s k i l l and strength of character to build a home that would give his children a good deal of satisfaction as they grew. -These positive elements, along with Mr. Atherton's good intelligence provided strengths for .the worker to use in her treatment plan. A similar quality entered the background of Mrs. Tanner who was an unwed mother before her marriage. The record emphasizes that Mrs. Tanner was a "spoiled" •youngest child of a sizeable family. While there is nothing specific to be found In the f i l e s , there are indications that Mrs. Tanner's 154 mother was not a strong figure. These two facts doubtless entered into the instability which contributed not only to the illegitimacy but also the indecision she showed as to what she should do about placement of Alan*. Successive placements with various members of her large family created i n the child a basic feeling of insecurity i n that he had no idea of his right place in the world. Like Mr.s Atherton, Mr. Tanner had experienced a good family relationship.. This history, plus a natural strength of character enabled him, with the "'••aid, of social case workers who could help relieve the pressures excited by his wife's in s t a b i l i t y , to meet the deep needs of his marriage. The Athertons and Tanners had known happier childhood than the other parents. Relationships between grandparents of these children had been severely strained in at least three instances. Mrs. B a l l who brought to the agency her concern over the regressive behaviour of her children had a neurotic mother who did not get along with her husband. She had preferred to leave home at an early age rather than to li v e in the midst of conflict. As a- result she herself had not enjoyed the opportunity for normal emotional development. Her arrested growth doubtless affected the course of her own marriage. Neither of the Mellons had grown up in'a.healthy environment. Mr. Mellon was known to have been spoiled and overprotected by his parents. Mrs. Mellon's mother had l e f t the father and had led such a loose l i f e that she was suspected of being a prostitute. With such backgrounds i t i s hardly to be wondered that the Mellons could not form a happy marital relationship. Nor i s i t surprising that Mrs. Mellon was such a poor mother that the treatment plan for this situa-tion encompassed the eventual complete withdrawal of the mother from . 1 5 5 the family* The wonder is that Mr. Mellon was able with the support-ive work of the case worker and the practical help offered by home maker service to build a l i f e for his children in which they had an even chance of passing successfully through the stages to emotional maturity. The Cassells had no more enviable background than tii« Mellons. It i s hinted that Mr. Cassell's parents had a very poor relationship and Mrs. Cassell spoke of her unhappy childhood dominated by a strong-willed mother of whom she was s t i l l t e r r i f i e d . This mother had played no small part in the stimulation of Jerry's disobedience and destructiveness. She had looked after Jerry for three years during, the war while Mrs. Mullon worked in a munitions plant. The Insecurity of Isabel Edwards, which she expressed in over-eating, was probably related to the insecurity of her father. Mr. Edwards' parents separated while he was very young and they were later divorced. His mother and a sister appeared to be mentally d u l l . His father, a ci t y o f f i c i a l , although apparently successful i n certain areas was incapable of being a parent. Mrs. Edwards was another person whose parents had been in-competent. As a child she had become known to a children's agency because, i t was alleged, her mother and father neglected her. Death of parents during the childhood of some of these mothers and fathers worked extreme hardships on them. For example, Mrs. MacDonald whose son Jackie had nevercbeensure of- the circumstances of his birth, had not herself known her mother. She had been orphaned while yet of tender years. Both the Stewarts experienced deprived childhoods through deaths of parents. Mr. Stewart, at the age of 12 years, when his mother died, had to take over the care of three 156 brothers. The mother of Mrs. Stewart died at the age of thirty-nine.. Her father remarried. Mrs. Stewart's relationship with her stepmother was unhappy. Most-df the marital partners came of homes of lower economic strata. Mr. Hughes was alone in having known family wealth. His family occupied high social status i n a larger metropolis before the loss of their fortunes. They never recovered from the shock of this catastrophe as they could not adjust to their, new social position. Cultural and Social Factors. With only few exceptions i t was a hemogenous group from the point of view of nationality and ethnic background. Nearly a l l partners were Canadian-born. Most of these families were of Anglo-Saxon or Celtic origin. Two wives were of slavie races. One hus-band and one wife apparently were part Canadian-Indian. In at least one of these people, Mrs. Tanner, who was Slavic-born, either r a c i a l or immigrant influences seemed to bear on the course of the client's l i f e . Part of Mrs. Tanner's problem in adjustment during the process of growing up was that of the whole family accommodating themselves as immigrants to ganada* So far as could be determined a l l partners but one of the men who grew up in a semi-rural area, were urban-bred. In only five situations was the denomination recorded. Religious a f f i l i a t i o n s included United: Church, Catholic, Church of England and Lutheran. But, i n general, religion in this group, as in the others examined, also appeared largely to be a minor consideration. In only two of the eight cases for which i t i s recorded did i t seem to have played a part in the dynamics of growth and marriage* 157 Both of these Situations involved ..change of religion, one from Protestant to Catholic, and one from Catholic to Protestant. Personal Adjustment Factors To understand the qualities of the parent-child relationships, the background factors w i l l have to be considered together with the personal attributes of these mothers and fathers. It w i l l be apparent at once that physical and mental failings are of significance. The parents i n this group belong to higher age rangerthan the other families studied. In the elev.en families for which this factor i s recorded, the age ranged for men from twenty-six to thirty-eight years, and for the women from twenty-five to thirty-five. Considering the age range, the physical health of these parents was relatively good. In four families no somatic disorders were recorded. In five other families, the fathers were i n good health. Ailments of the fathers included: generally impaired health, severe Influenza at time of intake, tuberculosis of the kidneys and debility following excision of a pollinoidai cyst. Three of the mothers suffered from gynaecological disfunctions and disorders associated with pregnancy. Pregnancy of three of the other mothers during the period of agency contact intensified the marital strain which was adversely affecting the development of the children. In addition to these f r a i l i t i e s there were mothers suffering from dermatitis and ulcerous foot, eye, ear and throat trouble, and thyroid d i f f i c u l t y . Physical d i s a b i l i t i e s when present nearly' always affected, the family relationships. I t w i l l be recalled that the respective physical.difficulties of both Mr. and Mrs. Atherton Influenced their- situation. The indifferent health of Mr. Atherton which made 158 him subject to colds and influenza, contributed to his passivity. This negative attitude inhibited a relationship in which the wife required more than the usual support from her husband in f u l f i l l i n g the parental role. Mrs. Atherton 1s uneasiness in marriage was further increased by her fear of pregnancy following the experienc-ing of two miscarriages. The hypochondria of Mrs. Cassell was intensified through the actuality of eye, ear and throat ailments. Thus was fed the narcissism which resulted in her rejection of Jerry* Gynaecological disorders were part of a cluster of personality observations which made i t impossible for Mrs. Mullon to be a real mother. The marital relationship of the Edwards which had never become firmly establish-ed was completely shaken by the refusal of Mrs. Edwards to live with her husband because of his tuberculous condition. The mental dullness of this woman made it-impossible for her to bring up a child by-her-self. Mrs. York as she recovered from a thyroidectomy was able to assume a reasured attitude. that, with the support- of the case worker, helped her meet the problem of dealing with mental retardation of Harold.' The mental backwardness of Harold, of" Mr. York himself and of Mrs. Edwards, constituted a l l the mental health problems of these fourteen families. Although the emotional instability of most of these marital problems was abundantly evident, actual emotional illness was specified i n only five of these cases. The hysteria symptoms of Mrs. Mullon have been noted. The violent temper of Mr. Hughes was diagnosed by psychiatrists as a sympton of a personality disorder. 159 which made i t unusually d i f f i c u l t for this man to adjust to c i v i l i a n l i f e , after military service. Mr. Edwards i n contracting tuberculosi suffered doubly, Psychiatrists early described him as having "an inadequate personality" indicating that i t -<»". was doubtful that he could meet even the ordinary demands of l i f e . The home atmosphere that the Stewarts might provide for their two infants can be best judged from the diagnosis of both parents as possible psychoneurotics. Pew achievements could be expected of people so ill-equipped as were most of these; and the educational attainments, occupational and employment histories of this group of parents hardly betrays this expection. In the five cases for which educational status was recorded, the lowest passed grade was seven, the highest attainment senior matriculation. The infrequent recording of this factor i s i n i t s e l f significant as obviously the attainment must have been insufficient to operate positively i n the family relationship. School achieve-ment when recorded had significance. One indication of Mrs. Atherton mental capacity could be that she. had completed one-half of her senior matriculation. Although Mr. Atherton had only an eighth grade formal education, his intellectual a b i l i t i e s obviously ex-ceeded that range for he took night school courses in refrigeration and lumber-grading. Successful completion of these courses require abil i t y beyond that needed to fin i s h elementary school The high intelligence of Mr. White, which has been observed as an important element in his family situation, could be seen from his attainment of senior matriculation at the early age of fifteen years. Occupational status and employment histories of these cases 160 were generally commensurate with educational achievement. Only six of the men had "skilled" trades. There were only two c l e r i c a l work-ers in this number: Mr. White was one of these exceptions, f i l l i n g a position of considerable.responsibility. Among the "unskilled" workers i t is interesting to note that Mr. Atherton compensated for h i s sparse education by the-full ex-ercise of his mental a b i l i t y which brought him to a supervisory position in a construction industry. The steadiness with which he applied himself for a number of years in one occupation was in . sharp contrast with the actions of other•unskilled labourers who frequently changed occupations. Military service absorbed several employment years of five of the men. In all.these cases i t seemed strongly to influence the later work history and the relationships of these men with their families. Problems of past-discharge re-adjustment to civ-i l i a n l i f e complicated the existence of Mr. Edwards who was deemed to have "an inadequate personality" even before he inlisted. Army l i f e certainly did not benefit Mr. Stewart who was considered as possibly psycho-neurotic. Nor did a term in Auxiliary service make things easier for his wife whose emotional condition had been similarly diagnosed. Even a good service record seemed to work^ against the satisfactory solution of one family situation. Mr. White was so successful in putting his gifts to good use in the army, that he decided to join the permanent force. The result of this decision was largely an escape from family obligation ration-alized as the acceptance of national duty. A good deal of geographical mobility might perhaps have been anticipated. But despite a strong prevalence of neurotic tendencies 161 i n these families and a conspicuous lack of achievement in education and occupation. This type of mobility was practically negligible. The Marriages. Descriptions of the parents In this group of families fre-quently suggest that they were ill-equipped for marriage. Attention to some of the details of the marriage w i l l show the validity of the judgement. .. Circumstances of Marriage. There Is l i t t l e evidence in these cases that there was much thoughtful preparation for wedded l i f e . Specific information is recorded for only two-marriages which were "forced", through i l l e g - -; itimate pregnancy. Preparation of a kind may be said to have taken place for the three parents who had been previously wed. One possible sign of the thoughtlessness with which these parents had entered marriage Is the dearth of information about the., nuptial ceremonies. Marriage before a Catholic Priest in one case i s the only one, for obvious reasons, in which the client recalled this detail. Despite the appearance of lack ofpreparation for family l i f e , these marriages at the time of contact with the Bureau had lasted an average of 6.6 years in the twelve cases for which these facts were recorded. This relatively long term of marriage before partners sought help with their problems seems unfortunate. Such an extended interval permitted development of the troubles often to the point where treatment was extremely d i f f i c u l t . Economic Conditions. Frequently, financial stringency served to heighten the other strains in these families. In seven of the thirteen families for 162 which such data is available the economic condition was c r i t i c a l . The Davisons with a total of. $130 monthly income were the only fam-i l y actually incapable of meeting financial obligations. The other six families suffered because of an inability to manage money, as a result of which they amassed debt which they could not substant-i a l l y reduce. The upper level of Income for those who encountered no f i n -ancial d i f f i c u l t y was probably well in excess of $200 a month. Mr. York shrewdly avoided disclosing the amount of his earnings. Despite the supposed handicap Of retarded intelligence he was able to purchase a comfortable home and to own and operate a handsome automobile. Social andTLiving Conditions. Four of these families owned homes; a f i f t h was purchasing. Among those who rented housing five families had cause to be dis-satisfied because of crowded or other unsanitary conditions. One family, the Edwards, lost the advantage of good rented housing by the woman's poor home management. Mrs. Stewart on the other hand, did her best to compensate for the misery of a crowded three room tenement suite by keeping i t spotlessly clean. L i t t l e of the housing was so d i f f i c u l t as that of the Stewarts and most of these families were able to gain some enjoyment from the home setting i n the neighbourhood contacts. The Hughes family alone is noted as lacking in opportunities for social activity arid as particularly needing the f a c i l i t y for recreation together. Treatment. It is clear from the above description of these mothers and fathers, both as parents and individuals^ that their problems center-ed primarily around the intangible qualities of the family relations 163 or a b i l i t y to li v e together happily. The area of treatment, therefore, should have been delimited by the necessity of dealing primarily with the emotional d i f f i c u l t i e s of the parents rather than by environmental needs. Successful therapy would ideally re-sult i n reduction of emotional strain of the parents and, i n turn, a lessening of the developmental defficulties of their children. Efforts to accomplish such therapy took on the average 1.22 years, per case, exceeding that of any of the other groups studied ranged i n the preceding chapters. The extreme casesJiOm from fifty-three days to 3.8 years. The Family Case Worker. The depth of the.personal problems besetting these parents necessited that the family case worker assume unchallenged leader-ship of the case work team. The intensity of the problems required that the case workers make judicious and refined use of a l l the techniques indigenous to modern social case work. The staff members had'oftento gain the confidence of and help of clients, who, be-cause of their backgrounds, found i t d i f f i c u l t to participate in any s o r t o of relationship. . There had . to be communication from worker to client In extraordinary degree, and a feeling of warmth and interest. The worker had to gauge to what extent the use of Inter-pretation could be effective, when more expression of feeling might be forthcoming from the client. She had to know how to stimulate and to u t i l i z e the expression of emotion that best would relieve the inhibiting tensions in the family relationships. How completely Miss West exercised her craft In helping the Athertons has been illustrated. It w i l l be recalled that she helped Mr. Atherton to understand that Mrs. Atherton, because of 164 early influences in her own l i f e had unusual dependency needs which made i t necessary for him to give to his wife more than.his normal-ly passive attitude toward the home would predispose him to do. The worker who helped the Balls could not use interpretation as did Miss West. The confusion of Mrs. Ball eminating from a childhood marred by marital disagreement between her parents and her own strong guilt feelings made i t very necessary for., her to tttalk i t out". The worker not only gave Mrs. Ball the opportunity to express herself but brought some orderliness to the treatment by insisting on regular scheduled interviews. Mrs. Ball was en-couraged to talk about herself and her background. She carefully helped to arrange a case work interview for Mr. B a l l . The oppor-tunity for Mrs. Ball to talk about her d i f f i c u l t i e s , and the help extended.to Mr. Ball in understanding his wife's d i f f i c u l t i e s eased the strain in the marriage. This done, i t was a matter, of time before the children would begin to grow out of the infant be-haviour to which in their feelings of insecurity they had regressed. One cannot help wonder why. the worker did not seek help from the psy chiatric consultant in her social planning as use of this f a c i l i t y could have given her a better understanding of the dynamics in this situation. The consultant is available at least once in two weeks. The Cassells had a deeply-rooted marital problem. Because they f lacked capacity, for personal insight, the family case worker did not attempt to treat the marital problem but, insead, concentrated on helping the parents deal with Jerry's behaviour problems through discussion of parental attitudes toward the child and by enlisting the aid of some community resources. Direction to a nursery school for Jerry and mothers! club for Mrs. Cassell, brought at least a partial modification of Jerry's behaviour. 165 The family Iworker who was assigned to help Mrs. Vereau and Frank faced a similar problem to that posed in the Cassell house-hold as Mrs. Voreau completely lacked capacity for insight. The therapist concentrated on work with Frank, dissociating herself from the mother. She was able to help ease the school situation by a masterful example of interpretation to the seemingly altra-con-servative and intolerant teacher who had Frank's class. Unlike Mrs. Voreau, Mrs. Smith had some awareness of her part in Naomi's d i f f i c u l t i e s . The worker in this situation was able to help Mrs. Smith to some understanding of her own past, especially as i t related to Naomi's present trouble. The same worker saw Naomi separately affording her the opportunities to vent her feel-ings about her mother and helping her to gain understanding of her mother. Two workers were assigned to the White family. While a woman staff member endeavored to help the parents, especially the father, to discuss feelings and to understand Danny, Mr. Andrews another man worker helped the boy. He identified with Danny, thus helping him to counteract his inclination to withdraw from social contact. He captured much of the lad's feeling about his home, and the new under-standing enabled the parents' worker to show the Whites how they might help their son. Although the efficacy of direct work with young children i s often questioned, the "near genius" rating of intelligence of Danny made such a course very worthwhile. Another good example of helping parents with a young child was the York case. Here the worker was able to encourage Mrs. York to persist in the task which she had undertaken. She Interpreted Harold's limitations to Mrs. York, and to the school which had 166 excellent special teaching f a c i l i t i e s . Additional evidence of what help can he rendered with young children was furnished by the Tanner case. Despite the disadvantage of several changes of workers, Mrs. Tanner was helped .through agency contact to resolve her feelings about the illegitimacy of Alan. She was enabled to make plans for him which lessened his basic sense of insecurity. The settlement with the putative father of the maintenance question so eased the relationship of Mrs. Tanner with her husband as to enhance the quality of the marriage^improving the atmosphere of the home both for Alan and the child which was yet to be born into this family. The Mellon children a l l derived benefit from agency services. Their family case worker helped Mr. Mellon establish e l e g i b i l i t y for v i s i t i n g homemaker service and offered the practical help of budgetting service. With the immediate pressures of household management relieved, and with a mounting confidence in the worker, Mr. Mellon could express his feelings regarding the seeming f u t i l i t y of his marriage. The case worker also helped Mrs.. Mellon to accept the fact that the home was better without her and to direct her energies into channels that would satisfactorily absorb her ar t i s t i c talents. This family has been helped to reconstitute Itself through family agency services and through referral to other community resources. The f a c i l i t i e s of health agencies were particularly neces sary for the physical Improvement of Carol and for the mitigation of the handicaps suffered by Bobby. Although at the time this case was reviewed i t was s t i l l active after 1325 days of contact with the family agency, the condition of the family as a whole, and of each of i t s members, had improved and showed promise of continuing so to do. 167 Resources of the Community. Frequent reference to agencies other than the Family Welfare Bureau in description of these cases has shown that the use of these resources as with the Mellon family, was hardly exceptional. In many of the situations community resources were used in the treat-ment of problems right from the beginning, for in eleven cases refer-r a l was made by a health or welfare agency. In most instances the welfare resources were used with positive values for case work treat-ment. Co-operation of the school authorities was of an unusually high order as witnessed in such cases as the T.Voreau and the Yorks. Public agencies generally provided a high quality of service. The co-operation of Provincial child welfare services played no small part in the helping of the Tanners. It was through these f a c i l i t i e s that the settlement of maintenance for Alan was effected. Psychiatric services, especially in the consultative phase, were lacking in effectiveness, the prime example being seen in the unusual Atherton situation. Miss West actually achieved her success with this family through going counter to the advice given by the psychiatric consultant! Once again neighbourliness appears a s a valuable community resource. The help of a neighbour in caring for Alan earned the physical strain for Mrs. Tanner just at the time when she was the most concerned about her plight. The Client. The activity of the client a s the mate of the family case worker and community resources on the case work team has already been f a i r l y well Indicated. The capacity for emotional growth and personal insight of these parents ranged from the high depress exhibited by .: 168 to the the Athertons^neglibile quality possessed by Mrs. Voreau and Mrs. Edwards. Most of these parents found i t easier to talk about the manifestations of the family relationship disfunction as they appeared in the developmental problems of their children, than to • discuss the marital relationship I t s e l f . As a consequence, generally the outlook was not good for complete amelioration of these d i f f i c u l -ties and a revitalization of the children i n a healthy pattern of existence. The capacity of Mr. Mellon to accept and work for change, and the abil i t y of his wife to withdraw from the family, albeit reluc tently, provided a pleasant exception to -this g enerality. The findings from the study of these fourteen families support conclusions drawn from research in the four other groups of cases and bring out additional propositions. The age range of this group was more advanced than the others. Yet the factors that contributed to disturbance of the family relationships were essentially the same. The proportion of marital partners who had experienced child-hood made unhappy by strife' between their own parents, by economic and emotional deprivation;* was very high. Most of these people entered marriage ill-equipped emotionally for the acceptance of adult responsibility. Their emotional disturbances far exceeded, in seriousness, their mental and physical d i s a b i l i t y . Because of this rampant instability; i t was d i f f i c u l t for them to withstand and recover from the trauma of physical injury and ill n e s s . The educational qualifications and occupational status of these parents, being predominantly low, placed many of them in the lower socio-economic group. Financial stringency accordingly accentuated the emotional strains in these families. Yet in the six families 169 untroubled by pecuniary worries social case work did not seem more successful because of the greater opportunity to concentrate on the purely emotional problems. To say the outlook for the successful development of these children in most situations was poor i s not to say that their problems have not i n some degree been mofified. In only two cases could the situations be said to have deteriorated during the term of agency service. In certain Instances the f a c i l i t i e s of the Family Welfare Bureau, such as v i s i t i n g homemaker service, have been of inestimable value in treatment* The services of the other welfare agencies, the health agencies and the schools in the community usually proved extremely helpful. There i s increasing recognition that the child Is profoundly affected by the relationships between himself and other children, i n the family, and the quality of the attachments and actions of his mother and father. The traditional views of physical neglect of children and of child delinquency as problems to be treated per se i s being supplanted by the concepts of these i l l s as the manisfesta-tion of emotional problems rooted in the family. Study of such problems as portrayed i n this group of families suggests the need for three-fold planning to meet the needs of people at this level. (1) The time seems overdue for development of psychlatrically oriented group-educational programmes to provide education and counsel for family l i v i n g . It i s necessary of course for these to assail the problems on a community-wide basis, and to promote the healthful growth of "normal" people who w i l l have no need of psychiatric services. (2) Secondly, there is need of psychiatric 170 services with personnel competent to treat individuals reouirigtg help with deep emotional d i f f i c u l t i e s , as well as to provide con-sultative f a c i l i t i e s for case workers encountering involved personal problems in their work. The shortage of psychiatrists being what i t i s , the latter course Isperhaps the most Important in terms of provity. (3) Thirdly, the family agency, i t s work increasingly complicated by the necessity of treating intensively emotional d i f f i c u l t i e s of families, and individuals, requires staff trained in understanding the dynamics of human behaviour and in putting this understanding to practical use. 1 7 1 c CHAPTER IX EFFECTIVENESS OF FAMILY CASE WORK The.family case work of the Family Welfare Bureau of Greater Vancouver has been well illustrated i n the preceding chapters. In summarizing the findings in each group of cases and i n drawing conclusions as to the effectiveness of case work, the standards of success used in this study should be kept in mind. Criteria of Success The basic principles of family case work as outlined In Chapter I and the elaboration of these principles in Chapter III, are taken as the c r i t e r i a of achievement. Mary Richmond's classic definition of social case work as "those processes which develop personality through adjustments consciously effected between men and their en-vironment" serves as a guide to any estimate of success of family case work. Likewise, the concern of both Heckman and Hunt i n their, experiments measuring the effectiveness of social case work, with the Importance of easing tension in clients by helping them meet the problems of l i v i n g so that they can continue to function i n society, i s accepted as a primary consideration in defining the aims and objectives of social case work. The success of family case work, i t would seem, should be measured i n terms of achieve-ment i n helping clients and families to deal with the social and personal problems of living, so that they w i l l be able to carry on in "normal" society. The degree of success attending the case work efforts of the Family Welfare Bureau are here subjectively estimated in elementary terms: "ineffective", "neutral","fair"!,.::giiidS"goddM.'rThere is no pretence of s t a t i s t i c a l exactitude in presenting this analysis. 172 Rather, the emphasis is on the narrative account, given in the light o.f;professional knowledge, of what actually happened when., family case, work was applied in the fifty-eight cases under review. Effectiveness Summary Charts Charts I to V, inclusive, in this chapter are merely intended to serve as a guide in summarizing findings, group-by-group. Each chart suggests in what degree work in the group to which i t pertains was effective. The charting of the part played by each of the three members comprising the family case work team i s a continuation of the dissecting, f a c i l i t y employed i n the case-o-graph. Positive (+) and negative (-) symbols are used in these sum-maries to represent the quality of efforts by each member of the family case work team. One positive sign i s indicative of average efforts; a double positive sign suggests unusual efforts. In con-trast to this minimal use of positive symbols, the negative signs are used freely to indicate observable defects in the social case work performance. While the emphasis i s on the negative, this scheme would appear defensible inasmuch as the positive qualities of treatment have been quite f u l l y described, in the chapters on the groups of cases. The intention, here, however is to show, in a rudimentary fashion, the possible reason for success or failure of the case work process. The sequence of signs is not accidental. A positive symbol preceding a negative suggests that the strengths and weaknesses asserted themselves In this order and may give a key to the reason for the outcome of treatment; and vice versa. Blank spaces occur under "Client (M)" when the husband has not been seen during agency contact. Where i t i s known that the husband, although not seen, indirectly derived positive benefit, through 173 C H A R T I S U M M A R Y - E F F E C T I V E N E S S O F F A M I L Y C A S E W O R K G R O U P I A . T H E - E A R L Y Y E A R S CASE : C L I E N T : W O R K E R AND : A G E N C Y : C O M M U N I T Y : E V A L U A T I O N * 1 • .iff: - : + S Ineffective j 2 : P ! : + + : • Neutral : 3 j 1 M; W J + + ' ! + • : Fair : M: ! W + + : + + 5 + + : " J 5 i 1 M; W J + - '• + «^  : + i n • M; Ws • + ; • + ! mm j n > 7 \ M W i + + : + + : + + j + : Good I 8 i M ! w, » + + | + + i +• ! a : M. + . i it • 10 i M - W ; + DEFECTS (b) Community Housing shortage Unemployment Lack of under s tanding by doc tor Lack of co-operation from other agencies Poor referral Ineffectual case conference with children's agency. (a) Client . Emotional immaturity Mental deficiency Inability to use community resources 1 7 4 work with the wife, and so was able to contribute to the betterment of the family situation, the positive symbol i s used. Blanks are provided for recording the participation both man and wife and are so indicated. (M for man; W for wife) Omissions under "Com-munity" may have one of two meanings. Either case work did not advance sufficiently to permit the use of social resources, or the treatment was carried on at the psychotherapeutic level without recourse to f a c i l i t i e s outside of the client or the agency. A query mark is occasionally used under "Evaluation" i f prognosis was so d i f f i c u l t to estimate as to preclude the possibility of gauging the effectiveness of family, case work. The l i s t of defects added to each chart, while not complete, encompassis the principal factors militating against success of the family case work. The Early Years Chart I summarizes the effectiveness of family case work in the cases described in Chapter IV, that is those relative to the early years of marriage of a.relatively young group of people. The conclusion i n that chapter that case work was generally effect-ive in this group i s supported by this composite analysis. It i s significant that in the most successful cases and in the one un-successful case, the positive and negative qualities of client participation in the family case work team are so obvious. The best results occurred in treatment of the As* situation (Case 8 , Chart I) and that of the Ps» (Case 2 ) . Mr. and Mrs. A. were the overseas veteran and his English war bride who required housekeeping service. Their relative maturity, mutual affection, devotion to family and ambition to establish a home were outstanding among 175 this set of families. So too, was the case work of the staff member whose careful "timing", depth of understanding and planful thinking served to augment the strength of the As', even though they had to accept help from the agency. Similarly the Es' despite the embarrassment of an illegitimate pregnancy which precipitated their marriage, had the common strength of good family background which not only steadied them but helped them i n ttheir predicament. The firmness of a case worker who accepted them, gave them "supportive" help i n their hour of c r i s i s and inter-preted their personalities in a degree only commensurate with their capacity for insight, was a major.factor i n marshalling these strengths for a successful resolution of their d i f f i c u l t y . In sharp contrast to these cases, the Js 1 (Case 1) seemingly were so bereft of positive qualities that they could not use case work services. Mrs. J. was unwilling to stay in a marriage when a man other than her husband could offer her the housing which she desired. Mr. J., incapable of seeing his own weaknesses, placed the blame for his d i f f i c u l t y on the housing shortage. In some cases the fine quality of the social case workers' performance redeemed situations to which client and community defects might-have brought disaster. This was true of the Is' (Case 2) who, troubled by their own weaknesses as two immature people with indif-ferent family backgrounds, found d i f f i c u l t y in getting along together, especially in crises resulting from the housing shortage- and reduced employment opportunities. Despite the fact that Mr. I, subsequent to the period of agency activity was convicted for theft-, there i s reason to believe that agency services helped him to carry on in relative sufficiency and that the family might be reconstituted 176 upon his release from imprisonment. -In like manner, the staff member assigned, to the C case (case 5 ) , by acceptance of Mr. C's h o s t i l i t y , and her constructive activity on his behalf, countered in a considerable measure Mr. Is' personal weaknesses and stimulated his strengths to meet the di s a b i l i t i e s caused by a housing d i f f i c u l t y . In accomplishing this she offset the unprofessional bufletting of Mr. G. from agency to agency and the poor referral to the family agency. The family case worker who helped the Es 1 also displayed except-ional a b i l i t y , she found an excellent alliance i n the strength of Mrs. E. the English war bride, who, •loving, her mentally incompetent husband, could accept him to the extent that she waslwilling herself to seek employment that would ease his burden of supporting th© family. Throughout this range of cases, except for isolated instances, family case workers demonstrated a quality of craftsmanship, on a level higher than any achieved i n the other groups of cases. This statement must be qualified by the observation that the problems among this group of families were comparatively simple. Perhaps the most significant aspect of family case work treatment in this group i s that the clientele were relatively young people' whose marriages were recent. The fact that problems were treated in the early stage of development naturally offers most for the potentialities of family case work as a positive, constructive process. 177 CHART I I SUMMARY - EFFECTIVENESS.OP FAMILY CASE WORK GROUP I B. ADVANCED MARITAL CONFLICT CASE CLIENT WORKER AND COMMUNITY AGENCY 1 EVALUATION 1 M | . -w. I - + 4 4 4 ? 2 M - -W 4 • +' I n e f f e c t i v e 3 M l " ' W f + + + 4 N e u t r a l 4 M I . 4 - . -w |- + — + » 5 M + -W f « 4 + n 6 M i + -i | - 4 + + ti 7 M ~ + W 1 + - 4 - 4 ti 8 M + -w 1 + - 4 1 4 4 u 9 M l - + . w | + 4 - 1 + - ti 10 M 1 . * -w | - + + j 4 ti 11 - H I - + W { + + 1 + -• i n 12 M I f ' Wf + I 4 1 ' + " n 13 M T + + .w| - + + 4 4 '| • •' + * .' | F a i r DEFECTS ()a) C l i e n t Lack of i n s i g h t . Emotional Immaturity. R i g i d i t y . Man's f e e l i n g o f s u p e r i o r i t y to woman. I n s t a b i l i t y Poor p a r e n t a l treatment of c h i l d b ehaviour. (b) Case Worker  and Agency (c) Community Premature i n t e r p r e t a t i o n Worker f a i l e d to c l e a r w i t h p s y c h i a t r i s t to whom client'known. N a t i o n a l Employment S e r v i c e unable to supply domestic h e l p . I n t e r f e r e n c e by neighbours.. 178 Advanced Marital Conflict. The second group of cases, described in Chapter V , as the caption indicates, was replete with problems more complex and d i f f i c u l t than those in the f i r s t category. The general overall effectiveness of family case work in these cases, therefore, is significant i n assessing the work of the Bureau. The "community" appeared generally to be a strong member of the family case work team. In this group the resources of the community were used to an unusual extent and in most situations responded well to demands made upon them. Doctors, psychiatrists, lawyers, schools, nursing services, and both private and public social agencies dem--' onstrated a remarkable capacity for understanding the personal and social problems facing these clients, and help was rendered usually In close co-operation with the family case worker. These available community services were used very adroitly by the staff member who helped Mr. T. (Case 10, Chart I ) , the .dis-abled,.veteran, to recover from almost complete helplessness, so that he regained employable status and salvaged his marriage. The worker's unrelenting persistence and the co-operation secured from the veterans hospital and administration and the tuberculosis authority enabled Mr. and Mrs. T., two people with basic personality deficiencies, to succeed in l i f e and stabilize their marriage. In contrast to the Ts', the personality deficiencies, of the Rs' (Case 2,)Cprobably were less grave; yet the facts that they had no ab i l i t y to meet people and no real desire to accept help in their situation not only predluded the possibility of case work treatment, but necessitated withdrawal of the practioner from the situation. 179 In the Ns1 situation the result of casework treatment was questionable, i n that, at termination of agency contact, the wife could not make up her mind.as to whether or not she should continue livin g with her husband who displayed such violent and terrifying behaviour. At some date after the termination of contact, the ef-fectiveness might be gauged by the nature of Mr. N's decision which should have revealed to what extent the case worker helped her un-ravel her feelings and crystallize her thinking. The negative factors in client effort centered around emotional d i f f i c u l t i e s which took the several forms indicated on Chart II and described more f u l l y in Chapter V. In case worker performance there was one glaring error and one incomprehensible omission. The staff member assigned to the Ks' (Case I, Chart II) was altogether too hasty, i n interpreting the significance of Mr. K's family and cultural patterns, doing-so before she had advanced sufficiently in diagnosis to know i f Mrs. K. would have the insight to accept, this knowledge. Even more serious was the omission of the family case worker as-signed to help the woman who was so greatly, concerned about her husband's drinking (Case 4 ) . Although the wife, herself named' a psychiatrist whom she had consulted, the worker did not secure per-mission of Mrs. K. to confer with this.psychiatrist. There i s no indication in the record that the worker even thought of making this inquiry. It i s at least conceivable that, had this staff member consulted the psychiatrist, she might have been able to understand this wife sufficiently to help her. Community weaknesses were evident in several of these situations but are not discussed, being beyond the present study. 180 CHART III SUMMARY ~ EFFECTIVENESS OF FAMILY CASE WORK GROUP I - C. DISSOLUTION OF MARRIAGE CASE CLIENT ' WORKER AND AGENCY COMMUNITY EVALUATION 1 M W - + - + - + :- Ineffective 2 M W i + + tt 3 M W + + I I 4 M W - + - + + + Neutral 5 M w + - + » 6 M w + • - + + + - ~ I I 7 M w + - + I + s + _ - ti 8 M" W + + + - \ + + - Fair 9 M W - + + - + + - if 10 M W - + I + -- + I + w 11 M W 1 + 1 + + 1 + - « DEFECTS (a) Client. Emotional Immaturity Misconduct Not able to use . community resources. Not able to pay fees; •i f could have, might have been able to make use of agency services. (b) Werker And Agsasy. Premature offer of referral to psy-chiatric services. Not able to.form relationship with client. No agency fee system. Abrupt transfer of workers. (c) Community Interference by other persons in the c ommuni ty. No legal grounds for divorce except adultry—this brought woman to falsifying grounds for divorce. 181 Dissolution of Marriage The d i f f i c u l t i e s facing the family case worker, who would try to help the man and wife adjust t o . l i f e during and following.the . breaking of marriage are very real (Chapter V). It i s scarcely surprising, therefore, that the practice of family case work in this group of families met with less success than In any of the other classes. The very factors that make i t d i f f i c u l t for hus-band and wife to get along together, make i t hard, too, for them to meet the worker i n a case work relationship. It i s noticeable in this summary that in two of the three families for whom case work was not effective, .neither husband nor wife could accept agency help. The K.Ks' (Case 7, Chart III) furnish a good il l u s t r a t i o n of this. Mrs. K.K. who would not live In the home and city of her husband, alleging that he was tied to his mother's apron strings, although she came to the agency about not receiving support from her husband, refused to discuss her marital situation with the worker and actually could accept agency contact only on a super-f i c i a l basis. In the L.L. case (Case 9 ) on the other hand, in which the most successful case work among the eleven families was observed, both husband and wife had strength enough to work through the problem to a separation with a f i n a l i t y that would enable them to resume their lives anew, not excessively burdened by ties to the past. The value of the case work in terms of the welfare of the L.Ls' children was even greater than for the parents themselves. Faults that lessened effectiveness were freely distributed among the members of the family case work team. Worker and agency defects would seem to have been too numerous. "Poor timing" violates the basic case work principle of the client's individuality. The 1 8 2 premature offering of referral to the psychiatric services(for the child) i n the G.G. situation, therefore seems hardly excusable. The fact that the agency is unable to give i t s best to a client like Mrs. D.D., (Case 10) who because of financial status and social experience finds i t d i f f i c u l t to accept help.without paying a schedule fee, i s also a matter of v i t a l concern-to agency operation. One community deficiency warrants comment, namely the national disgrace of divorce laws which limit grounds to adultery; these lead to humiliating r ,plays H in which adultery Is simulated, and i s practically the only choice for those who feel that divorce is the one reasonable solution to their marital problems. Mrs. F.F., the war bride who was violently rejected by her husband on her arrival i n Canada, has to suffer this humiliation in effecting what she considered a logical resolution of her d i f f i c u l t y . Efforts to mitigate this condition might well come within the public educa-tion function of the agency which has such a good opportunity to know the e v i l results of such legislation. Reconciliation The rather curious assortment of marriages discussed in Chapter VI was marked by a heterogeneity greater than in any other group of cases considered in this study. The factor most common to these cases, the strength of the woman who wants to maintain her marriage despite the many unhappy influences militating against success, i s as evident in the summary as in the narrative description, four of the wives being particularly active in efforts to solve their problems Interestingly, the success in these cases i s generally above that of any other group. Seemingly would bear some relationships to 183 CHART IV SUMMARY - EFFECTIVENESS OF FAMILY CASE WORK GROUP I D.. RECONCILIATION. CASE • CLIENT WORKER AND AGENCY COMMUNITY EVALUATION 1 M ' W - + - + + - + ? 2 M W — + + ? 3 M W + + + + Neutral 4 M W - + + + + 5 M W - + - + + + ti it? M W - + + + + Fair 7 U w + + + + n 8 M W + + I »» 9 M 1 - + f + + W f - + + - f 1 + « 10 M j + - + w I - + • 1 it • DEFECTS (a) Client Psychopathic inadequate personality. Woman not able to enter into case work relationship Psycho-neurosis Emotional immaturity. (b) Worker and Agency Limitation of time. Premature termination of interview. 184 client participation. • The questionable outcome of case work with two clients is explained by the nery nature of the clients themselves. One of these Mrs. N.N. (Case 2, .Chart IV) was the young g i r l who sought annulment of her marriage. In her record there is no indication of any substantial client activity in the treatment except for participation in the case work relationship at a superficial level. Unless her motivation in going to the domestic relations court were c l a r i f i e d and i t could be shown that she had a sound basis for action and that her decision had been Influenced by her coming to the agency, the effectiveness of the agency service would be doubtful. . In the other doubtful case, Mrs. Q.<Q». (Case 5) divorced her . husband and then apparently returned to live with him in a common-law relationship. Again the motivations was so indiscernible at the time of case-ending' that i t was Improssible to judge what positive benefit, i f any, Mrs. .Q.(QU had derived from her contact with the agency. It i s significant that i n this case the worker made a serious mistake. At the beginning, of service, the staff member, pressed for time, had to terminate and interview hurriedly. There can be no- discounting of the possibility that this episode may have seemed as a "rejection" to Mrs. Q.'Q.., for after that date she was never really able to seek or accept help from the agency. Many of the clients in this'group had personality d i f f i c u l t i e s , that minimized the possibilities of successful treatment. Chief among these were the psychopathic inadequacy of one man and the psycho-neurosis of another. These grav® abnormalities appearing mostly in the husbands made the constructive activities of the wives a l l the more remarkable. 185 CHART V. SUMMARY - EFFECTIVENESS. OF FAMILY CASEWORK ..' . GROUP II. CHILD-PARENT RELATIONSHIPS AND CHILD DEVELOPMENT PROBLEMS CASE . . . j CLIENT , 'WORKER AND AGENCY COMMUNITY EVALUATION 1 M W I - + • • + Ineffective 2 M W - - l + " tt M W - - I * i + ti 4 M W - | + n 5 M W + - l + + Neutral 6 M w - - + - + ti 7 •M W - + + - i + I ' + + i Good 8 M W i • ' + 9 + - tt 9 r i w - + - + j + + + + 1 M _ • 10 M w - + - + i + + 1 " 11 M w - - - + + .+ i + + i " 12 M W .... + + -+•.'. I •. + + I w 13 I w + + I • + i - 1 " 1 14 j u + i + i . + + 1 " DEFECTS: ,^ a) Client Man's undeveloped insight. Oedipal conflict woman unable to meet people (b) Worker (c) Communlty Failed to use Poor attitudes of schools psychiatric services Poor attitudes of doctors when need indicated and harmful actions to client. Psychiatric ' f a c i l i t i e s limited. 186 Parent-Child Relationships And Child-Development Problems » . Of a l l the groups of cases under study, this selection re-presents thermost varied results of family case work. The extremes weri wide, with treatment being "ineffective" i n four cases, "good" i n one, and " f a i r " i n seven. As in the other groups, the key to success or failure is to be found i n the capacity of the staff member to use the positive qualities of the client's personality and i n the strength or weaknesses of the client as seen in his.ability or inabi l i t y to accept and use help offered by the case worker. The course of treatment i n the Atherton situation (Case I, Chart VIII) i s fu l l y described in Chapters III and VIII. It is only necessary here to recall the quality of the therapist's perfor-mance which brought into play the strengths' of this couple to counter their very serious failings, and led to success, despite the in-adequacy of the psychiatric service. In those cases In which the family case work proved "good" client strengths similar to those i n the Atherton family, but of a lesser degree, were present. For in-stance, the success of the Mellon case (Case 9) was largely due to the worker's studied efforts to enable the man realize his capacity for parenthood, and to help the woman withdraw from the family. Success probably would not have " B e e n possible without the availability of a highly efficient housekeeping service, and also the co-operation of the hospital social workers in meeting the medical need of the children. In contrast to these cases, those for whom case work was ineffective usually included- a father and mother with, few, i f any, 187 positive qualities. Mrs. Voreau, (Case 2 ) , for instance, showed neither understanding of her son, nor a real wish to help him. Obvious-ly she was happy i n her own dubious conduct which reflected a personality that must greatly have influenced her son in his der velopment. As noted in Chapter VIII emotional growth arrested by the un-fortunate childhood of these clients was their most common weakness, contributing, in turn, to the urihappiness of their own children. The failings of these clients as parents were not lessened by the frequent lack of understanding of children on the part of professional people in the community such as doctors and teachers. Sometimes, apparently, even the case worker overlooks the importance of using the opportunity to gain the most complete understanding of children. This i s indicated, in one example in which the case worker failed to use Ithe available psychiatric services. CHECKING RESULTS: The Case-Chart. No extravagant claims are made for the case-o-graph, the analytical device used i n the study of these cases. Obviously i t was useful i n dissecting the case records to show the roles played i n social case work by client, worker and agency, and community. It also served to give at a glance a portrayal of the dynamics of family case work operating in specific cases. The r e l i a b i l i t y of the device as a means of measuring the effectiveness of family case work can hardly be. established through use in a single set of cases by one research worker. This can only be. proven by extended use and modification of the instrument in the light of experience. Even the present-study,itself suggests modification. Because the case-chart portrays the personality of 188 both man and wife, the factors of "compatibility" w i l l best be seem by comparison of a l l qualities in each. Section I of Part III there-fore, would appear to be unnecessary. Chart I represents a simple modification of the original; with the space for compatibility factors deleted, the sections below i t relettered, and providing, at the bottom of the chart, space for such information as dates of opening and termination, and evaluation. The r e l i a b i l i t y of the casegram must be further ascertained in terms of the c r i t e r i a , which simply are the best possible application of basic social case work principles to modify the individualysocial situation. The basis of thinking in directing this effort i s that the result of case work treatment indicated by the casegram should correspond with the ability of the client to function as an average citizen after the termination of agency service. This information might be secured by interview of the client arranged specifically for this purpose or from interview of the client, should he return to the agency seeking additional service. Interviewing dependable individuals who meet the client In situations other than the family case work setting, might also prove helpful. Thus., for example discussion with a teacher or a social worker employed by another agency, might e l i c i t the required information. A l l of these methods of checking were used i n a small selection of cases from the research samples. In addition to these methods, there was another check: as some of the cases were s t i l l active when charted they could be re-examined at a later date. 189 Chart YI M W Family & Children A. Family Background B. Social Cultural C. Education D. Group & Employ E. Mobility ft F« Health G. Living <j. G ondi t i ons I I . w M H. Marriage I. Health J. Economic K. Social Status L. Living Conditions M. Children Source of Referral • ~ D a t e of Opening. Previous Contact Date of Closing. 1 9 0 Chart t V j B. S e r v i c e C l i e n t Community. I A. B. C. . -D* E. • F. (*• 1. I I M. I l l H.. I . J . j K. 1 ' L. : 1 M. Summary of Problems. .Evaluation. 191 The Research Interview. There is a vast difference between interviews as used in social case work and social research. The purposes that dictate them are unlike. In social case work the interview i s the basic technique employed in helping people to make social and,personal adjustments. In research the interviewer takes no responsibility for the problems of the client. His objective i s to obtain information that may add to his knowledge of the Individual in some particular phase of social, l i v i n g . Because the social case worker and the social research worker both are concerned with human beings certain interviewing techinques are common to both practices. Ideally, for instance, each i s under the necessity of observing the emotional quality of the interviewee's response to questions, for the feelings of the individal are*:;.important in weighing the significance of the in-formation e l i c i t e d . The social case worker and the" research worker wishing to interview a person who has been treated by case work are both guided by professional e.thics such as the protection of a client's confidence. The "confidentiality" .of the case work relationship i s a fundamental tenet of practice. Thus, when a research worker wishes to interview a client or former client of a social agency he imperils this "confidentiality". The problem which this matter poses seemingly is going to be a major one as research, in social case work advances. At the Vancouver Family Welfare Bureau the right of the research worker to interview a case worker's client was seriously questioned. It was decided that only the case worker who had been active on a case should carry out a research interview. Thus i t was possible to have only one research interview. The apparent outstanding success of the therapist in the Atherton case 192 indicated i t as the logical choice for this research interview. The fact that three years had elapsed since the terminating of agency contact would possibly enhance the value of the interview. Fortunate Miss West was s t i l l on the staff-of the Bureau and agreed with considerable enthusiasm to interview the Athertons. Armed with a carefully-formulated questionnaire, she set out to r e v i s i t the Athertons. Unfortunately she was not able to see Mr. Atherton. Her interview with Mrs. Atherton, however, was inter-esting as i t indicated that the judgment of her work as "good" i s well founded.^ The reply as given by Mrs. Atherton was highly significant in that i t suggested the measure of her benefit from family case work. When she was asked i f she had recommended anybody to the agency, she told Mrs.W. that she was at the moment trying to get a neighbour to go to the agency. This neighbour had adopted the children of her brother and punishing one of them who snored. Mrs. Atherton tried to help the woman understand what was the matter. When Mrs. Atherton could not.persuade her friend to go to the family agency she then tried to get her to use the children's psychiatric service. In t e l l i n g about this, Mrs. Atherton said, W I knew that they {the psychiatric services) would show her that the trouble was with her, not with the child." As Miss West later remarked, ob-viously Mrs. Atherton has continued to use the insight gained through family case work; she said that there were s t i l l minor problems but that "the same principles work". 1. The complete questionnaire used and Miss West's recording of this interview comprise Appendix P. 193 Other Checkings of Results. Among the cases checked "by means other than the research inter-view, the Melions' (Chapter VIII) i s the most significant. Due to delayed recording, i t was possible to chart the case as i t was eight months before the actual date of research. A check was then made with the family case worker. She advised that Mr. Mellon, despite additional misfortunes, had progressed favourably. During the eight months Mr. Mellon had been steadily assuming more responsibility for his children; and the mother had definitely faced up to the. reality that she must withdraw completely from her family. The im-provements in the children had kept pace with the over-all advance-ment. The evaluation of case work as Mgoodtt in this example would appear sound. Eight months was also the length of the interval between clos-ing and re-opening of the Q. case. (Chapter V) in which the husband had f e l t himself superior to his wife and frequently l e f t her to live in an isolated spot. Mrs. Q. apparently wanted no other service In her new contact than to be allowed to talk. She revealed that Mr. Q. had definitely l e f t her after termination of f i r s t con-tact and that she had divorced him. Her adjustment to her new marital status seemed f a i r l y good. Her achievement i n accommoda-. ting herself to her new situation and Mr. Q's defection which had not been forseen by the worker would indicate that the case work had been neutral as evaluated* A l l the other, cases checked are from the group described in Chapter VIII. Two months elapsed between charting the records of the Stewart family and the next interview. During that time the child continued to run away from home and Mr. and Mrs. Stewart continuously battled. These occurrences makes the evaluation of .the case work in • 194 t h i s s i t u a t i o n as " n e u t r a l "seemes unsound* There was a l s o a two-month I n t e r v a l between the c h a r t i n g of the C a s s e l l r e c o r d and the next i n t e r v i e w . Throughout t h i s p e r i o d the f i n a n c i a l needs seemed predominant i n the minds of the C a s s e l l s , and they appeared unable to face the r e a l i t y of a serious m a r i t a l problem. The assessment"neutral" i n t h i s case would seem to be reasonable. I n each of the York and the White s i t u a t i o n s , both a c t i v e at c h a r t i n g , a month elapsed before a check was made. Harold York continued to improve, although he found i t d i f f i c u l t to enter i n t o group a c t i v i t y , and Mrs. York excepted h i s l i m i t a t i o n s and those of her husband w i t h i n c r e a s i n g ease* Mr. White c a r r i e d on w i t h plans f o r d i v o r c e . "Good" seemed to be supported as an e v a l u a t i o n i n both cases, althoughtthe p e r i o d between c h a r t i n g and re-examination i s too short f o r f i n a l judgment. Incomplete as are these attempts to t e s t the e v a l u a t i o n s , they do suggest some of the p r a c t i c a l value of the case chart even though continued a p p l i c a t i o n would be r e q u i r e d before i t could be of resear c h v a l u e . SOME"IMPLICATIONS FOR FAMILY WELFARE BUREAU WORK  The C l i e n t e l e The Socio-economic o r i g i n of the c l i e n t s coming to the Bureau has not been determined. The l a c k of s t a t i s t i c s r e l a t i n g to c l i e n t income aside from those f i g u r e s f o r r e l i e f given by the agency, precludes any accurate estimate of that f a c t o r . I n d i c a t i o n s are, however, that g e n e r a l l y the c l i e n t s are the less-advantaged people i n the community. As i n e v i t a b l y the segment of the community from which the c l i e n t o r i g i n a t e i n f l u e n c e s the k i n d of s e r v i c e s which an agency 195 develops, i t is not surprising that the Bureau renders many services in relation to environmental problems. While relief-giving has been reduced virtually to a minimum, client problems s t i l l include financial planning and budgetary d i f f i c u l t i e s . Employment problems, housing d i f f i c u l t i e s , and concern with health a l l find a considerable place in the work of the agency. At the same time emotional problems occur in an increasing degree. Often environmental hazards adversely affect the family relationships, through the strains they place on members of families. It is seen that a great many clients f a i l to develop emotionally. Arrested emotional growth is harmful to marital and family relation-ships, and i n turn inhibits the development of children. The danger of poor family relationships being passed to the third generation like a physical infection i s altogether too real . Many of the clients of the Family Welfare Bureau are totally unprepared for a l l phases of social living, including both community and family existence. The kind of family situation which seems most d i f f i c u l t for a child i s that in which the marital conflict i s well-advanced, or the marriage is broken. Children are being neglected, "emotionally" i f not physically, by parents who are so pre-occupied with their marital conflicts that they have l i t t l e time for thoughts of anything else. If these families bear any resemblance to the remainder of the population, the outlook for family l i v i n g i s dismal. Nevertheless, not only are they a good deal less typical; i t is worth emphasizing that the majority of the clients considered i n this study showed varying capacities for growth, i f they were but properly stimulated. The accident which has restricted the clientele to one portion 196 of the community i s so. unfortunate as to be almost tragic. The modern family agency liberated from the necessity of meeting economic need can give i t s time and attention to the emotional problems of family l i v i n g . Yet those who, by virtue of the respons-i b i l i t i e s which they have because of their station in l i f e , are like l y to experience, the most acute, needs in this area, and who could perhaps make the best use of this service, are not receiving i t . Probably one of the main reasons for this failure to attract these people is that the aspect of "charity" i s s t i l l associated in many minds with social agencies. As a publicly-supported.agency i t might be expected that the Bureau would serve the community as an educator i n family li v i n g . In this way i t would serve those citizens who are not suffering from acute personal distress which requires individual treatment, but who would benefit by this opportunity of discussing ways and means of strengthening their family l i f e . Case Work Services A family agency should be equipped to help people who' have environmental problems affecting their family well-being and who have problems of relationships within their families. One particular f a c i l i t y of the Family Welfare Bureau has proven of outstanding therapeutic value although predominantly i t i s used for family problems centring around medical and health d i f f i c u l t i e s . This resource is the "Visiting Homemaker Service," which has so well proved i t s e l f , that i t is time to re-evaluate' i t in terms of agency responsibility and function. Two factors, the expense of operation, and the wide acceptance which the service has gained, suggests that the time may be right for assumption by 197 the Provincial Government of responsibility for this as a public service. Perhaps this could be done in co-operation with the training f a c i l i t i e s of the National Employment Service. The fact that there may be no precedent for such action should not be of any moment in such a f i e l d as social work. With the.-.-advanced state of the rapidly expanding welfare services i n British Columbia such ai. transition i s not inconceivable.. Nor would this change have to deny the family agency the use of this resource. On a co-operative basis i t might be well used by the private agency not just in medical-social problems but as a tool of case work in other situations. Psychiatric services available to the agency also seemed to bear some investigation. Consultation does not seem to be benefit-ting the case work practice as i t should, although i t i s altogether probable that shortage of good psychiatrists and c l i n i c s i s a basic reason. Whatever the cause there is need for addition to the staff of more psychiatrically-oriented case workers. The ever-increasing awareness of emotional problems can be met only through adequate, trained staff. While the work as described,generally has been f a i r l y successful, certainly there is room for improvement. The d i f f i c u l t i e s encountered by staff members i n the cases described under "Dissolution" and "Reconciliation" (Chapters VI and VII) are ample evidence of this. An intensified concern with the problems pertaining to child development Is further reason for this need of improvement in staff qualifications. A general f a i l i n g noted in examining these cases is clearly associated with the need for more skilled personnel. Recording 198 frequently i s Incomplete. Often simplest "face sheet" information i s not procured.The securing of such information i s not significant for i t s factual value alone; but the expression that i t calls forth from the client, coloured as i t nearly always is by personal exper-ience, i s important for the purposes of making social diagnosis and formulating treatment plans. Closely related to this need of highly-trained workers is the need to increase .the availability of the agencies services to a l l in the community who desire i t . As long as service i s available to a l l free of charge, for some people i t will, retain i t s "charitable" aspects* Those who are able to pay for service and who are accustom-ed to paying for other services w i l l respect the agency the more i f they can purchase the service. The establishment of a fee service* therefore, i s imperative i f the agency is to serve a l l segments of the community. Operation of a fee service would, of course presume that interviews would be conducted on a scheduled basis. The offering of service on a broader basis than heretoafore seems to be timely for today there i s a growing professional opinion that family,.case work has a constructive as well as a remedial. -of the clients v ' The qualities/described in Chapter IV render substantial support to this opinion. While the primary function of a family agency has always been considered to serve the particular needs of families and individuals, of late years especially, increasing attention has been given to .other- ways in which the agency can foster the advance of family l i f e of the community i t serves. With the first-hand knowledge of family relationships gained from practice, the family agency should be well able to help educate the community-at-large 1 9 9 i n family l i v i n g . Observation of the rapidly growing core of well-trained group workers being graduated from the schools of social work, suggests the possibility of setting up a co-operative program-me, with the family agency supplying the material and a group agency the group leadership. In addition to i t s own programme the agency should give support to other educational efforts in the community which have as their objects the strengthening of family l i f e . This would be in keeping with general policy to encourage and co-operate In a l l efforts to promote family happiness. While i t may be a considerable time before the Bureau has the necessary f a c i l i t i e s in the form of adequately trained personnel this should be kept in mind the possibility of developing in the future a group therapy programme as a complimentary service to the case work and educational programmes* The Community There are always certain environmental factors which impede the course of family l i f e . These include housing needs, slum con-ditions:.^, employment d i f f i c u l t i e s and economic fluctuations. Aside from these major concerns there are community needs affecting family l i f e about which the agency might be able to take some action. Such needs as-improved psychiatric services are plain. Better words can be said for hosiptal and medical f a c i l i t i e s which, as seen i n the cases reviewed in this study, usually are reasonably efficient. With a few exceptions, most other social agencies are helpful to clients and, when called upon contribute to the success of case work treatment. 2 0 0 While deploring the lacks of the community i t would be unfair to ignore the f a c i l i t i e s in the community for happy family l i v i n g . These include special educational features for school children, adult education for their parents, education through the press and the radio. It is only necessary to note such radio programmes as Doorway to Li f e , and the Family Service Assoication of America feature Marriage for Millions to observe how successfully the dynamics of human behaviour and treatment can be portrayed. The encouragement of such activities would seem to be part of the function of a family agency. In twenty-one years of existence the Family Welfare Bureau of Greater Vancouver, British Columbia has represented the conscience this agency of the city in which__/ is situated 7 as i t concerned i t s e l f about the welfare of i t s family. The agency has striven to serve the community through leadership in group action for benefits to families and in serving the individual family through social case work practice. The performance of family case work has been reasonably effective. The agency has the duty of maintaining that same standard through these changing times and can do i t only by securing the best personnel and giving the finest in leadership devoted to the promotion of happy and satisfying family living in the community. 201 APPENDIX A-FORM Al, Family Service Association of America — face sheet FORM A II. Canadian adaptation of face sheet devised by Family Service Association of America. SURNAME CROSS R E F E R E N C E (ALIASES) DATE OPENED C A S E NO. • ht W O M A N * MAID E N N A M ! 1 F A M I L Y S T A T U S ( C H E C K ) •ar.Cp'l | tlnra.Cp'1 | UnnkM'r. | Wld. | Wld'r | D M . | Olv. | Sap. j 8lag. | Oiph. •'•< • D A F R C M T E T O DIST. A D D R E S S LOCATIOh 1 ROOM* R E N T L A N D L O R D O R A O E N T A D D R E S S --FIRST N A M E DA BIRTH LTE DEATH BIRTH P L A C E O C C U P A T I O N O R S C H O O L AVERAGE WAGES D I A G N O S E S - T E S T S P E R M A N E N T D E F E C T S O U T S T A N D I N G C H A R A C T E R I S T I C S MAN .'.MIL. mo.) WOMAK X CHILDREN • ; -O T H E R S I N H O U S E H O L D K I N S H I P A M T . P A I D IN C O U R T R E C O R D D A T E O F W H O M / i t R E L A T I V E S A D D * IESS K N O W N T O E X C H A N G E K I N S H I P T O C H U R C H E S , C H A R I T I E S A N D P E R S O N S I N T E R E S T E D C O N N E C T I O N D A T E R E P O R T F R O M S O C I A L S E R V I C E E X ( S H A N O B -I . RACE OR NAT. O r PARENTS RELIGION DAT CITY I C A M E T PROVING! O C A N . . CITIZEN READ OR WRITE SPEAK* IHOUM MARRIAGE DATE P L A C E -BY WHOM I P R E V I O U S A D D R E S S E S S T A T U S O . T . 8 . L O C A L I T Y R E N T H O W L O N O 1 D A T ! O P L E A V I N G i i 1 , ! t i -E M P L O Y E R S A D D R E S S O P W H O M D A T E S P O S I T I O N S U P T . O R D E P T . W E S C L Y E A R N N O S [ 1 I 1 i : U N I O N S , L O D G E S . B E N E F I T S O C I E T I E S . I N S U R A N C E N A M E O P O R G A N I Z A T I O N M E M B E R P R E M I U M O R D U E S W H E N P A Y A B L E B E N E F I T S : 1 ' • ! 1 1 I N S T I T U T I O N A L C A R E M E M B E R D A T E S R E F E R E N C E S C O N N E C T I O N DATE | • • 1 i ! ! i * • ' • j -i j 1 1 I 1 j Surname Maiden Name Cross R e f A l i a s e s , Prev. Marriage, etc. Date Opened Case No. pi MC UC UM W WR DES DIV SEP SING ORPH pate, Dist. Address Telephone .or Location Rooms Rent Landlord Address < i t V > sFirst Name Date of Birthplace Occupation or Industry School or Grade Military Information Court or Other Data Birth Death imeoa ^Wojran 3Chn 4 <-5 6 «7 a 10 - a 3 Others in Household Kinship Amount Paid i n Marriage Social Service Index Report •• Date t , - Place • -.1 By whom Decree absolute 'Relatives Kinship Address > J Interested Organizations Individuals Agencies No. Employment Record Date 0 Religion Date Came To Naturalized Referred by City Prov. Canada Man' Hbma \TTJ. FACE SHEET No. 7 D I S T R I C T I W O R K E R Y E A R L O C A T I O N N O . O F R O O M S W I T H O T H E R F A M I L Y D A T E O F D A T E O F F I R S T O P E N I N G S O U R C E €>F A P P L I C A T I O N L A S T O P E N I N G C L O S I N G T R A N S F E R R E D D A T E F R O M F A M I L Y S T A T U S S I N G L E C H I L D R E N S E P S M 8 W O R P H E X A C T P A T E O F B I R T H P L A C E O C C U P A T I O N A N D I N D U S T R Y W E E K L Y O R S C H O O L A N D G R A D E O R UNION W H E R E A B O U T S I F A W A Y R E L A T I O N S H I P D A T E C A M E T O N A T U R A L I Z A T I O N D A T E S 1 S T P A P E R S I 2 N D P A P E R S W O M A N S T A T U S F O R F I S C A L Y E A R C A R R I E D O V E R F R O M P R E V I O U S Y E A R . I N T A K E D U R I N G P R E S E N T Y E A R S T A T U S I N C U R R E N T M O N T H A C T I V E - A T A N Y TIME IH M O U T H I N A C T I V E T H R U O U T M O N T H H E E D I N f A T T E N T I O N A C C O R D I N G TO P L A N WAITING C L O S I N G 1 2 a I 2 3 1 2 3 4 9 6 4 5 6 A 5 B 7 6 9 7 8 9 7 8 9 1 0 11 1ft 1 0 I t 1 « 1 0 I I 1 2 R E L I E F S T A T U S I N C U R R E N T M O N T H R E L I E F F R O M A G E N C Y S O L E I N C O M E T H R U O U T M O N T H F R O M A G E N C Y P U B L I C R E L I E F A L S O O T H E R P R I V A T E R E L I E F A L S O I N C O M E A L S O F R O M E A R HI It OS I N C O M E A L S O F R O M O T H E R S O U R C E S N O R E L I E F F R O M A G E N C Y P U B L I C R E L I E F O T H E R P R I V A T E R E L I E F S O L E I N C O M E F R O M E A R R I N G S I N C O M E F R O M OTHER S O U R C E S p * i w f P ct O B P 3 H* ct H H-««4 ca « ^ c+ H W H -<0 o o CO O p OO P H P o P< pr o CO M < 3 CD H O O o *d t J CD § a1 o «4 c+ . h» > O CO P CO o ^ o H * H * g & W O i i 0 CASE WORK PROBLEMS PRESENTED AND SERVICES RENDERED During Present Fiscal Year (Since last opening ior intake during present fiscal year) PROBLEMS (Check for family or designate member of family by number). A. ECONOMIC: . 1. Lack of knowledge of available resources 2. Problems of financial planning and home management caused by lower standards or marginal income 3. Problems of financial planning and home management com-plicated by intellectual or emotional difficulty — 4. Financial need due. to lack of support from members of family 5. Resistance to using available resources 6. Financial need which must be met if case work treatment is to be effective 7. Financial need not met by public agency affecting plan for adjustment SERVICES (Check for family or designate member of family by number). ECONOMIC: Services in relafion fo 1. Helping the client make use of economic resources in the community 2. Helping the client make use of his own economic resources ..... 3. Personality factors affecting management of income .. 4. Financial assistance met directly by the agency 6 ,.-B. EMPLOYMENT: 10. II. 12. 13. 14. 15. 16. 17. Persons with good work history and prospects for work need' ing case work service Persons needing vocational counseling or training Personality factors affecting employability Persons attempting to adjust to job requiring change in employment status Unemployment of head of family affecting family relationships Unemployed persons beyond the current industrial age level 9. — id. — u. 12. EMPLOYMENT: Services in relafion to Helping the client make use of opportunities Training, counseling and preparation for employment Personality factors influencing employment Helping the client understand and accept industrial situations C. FAMILY RELATIONSHIPS: • 18. Difficulties in relationship between husband and wife • 19. Difficulties in relationship between parent and child • 20. Difficulties in relationship between substitute parent and child • 21. Difficulties in relationships among children in the family • 22. Problems related to pregnancy • 23. Absence of parent or substitute parent • 24. Separation from family or relatives • 25. Difficulty in relationship to other relatives • 26. Irregularities in legal status causing fears or conflicts • 27. Actual or potential anti-social behavior affecting family life 28 29. _ . J • 13. 14. • 15. • 16. . 17. • 18. 19. UenUl Physical _ 20. FAMILY RELATIONSHIPS: Helping the client make Services In relafion fo of resources for easing use t t i  the situation Helping the family work out adjustments of living arrangements Training and development of children Personality factors influencing family conflicts Legal procedures affecting family or personal conflicts HEALTH: Services in relation to • 21. • 22. • 23. - 24. 25. • 26. • 27. Helping the client understand the facts and implications of the illness « Helping the client use resources available for treatment Helping the client work out adjustment of living arrangements! Personality factors influenced by illness Helping the client recognize the heed for treatment D. M«nr E. Phys u l leal HEALTH: Ignorance of disease and its implications Illness affecting capacity for social and industrial adjustment Acute or chronic illness creating changes in the family structure. — 33, Acute or chronic illness resulting in removal from the family group Need for readjustment following institutional care Acute or chronic illness or physical incapacity arousing fears or conflicts in the individual or others in the family Resistance to using resources for treatment • 30. 31. 32. 34. 35. SOCIAL AND ENVIRONMENTAL: Services in relation to Helping client use resources within community for correcting situation Interpretation of cultural standards Protecting the interest of children to relieve acute distress Protecting the interest of children in non-voluntary referrals EVALUATION AT CLOSING • 36. 37. • 38. F. SOCIAL AND ENVIRONMENTAL: • 39. School problem involving family situation • 40. Inability to find or use educational or recreational facilities 41. Ignorance of or non-acceptance of established cultural patterns • 42. Changes of residence affecting family adjustment • 43. Problems in relation t'o housing affecting family life 4  L A B C D E F 1. 2. 3. • 4. 5. 6. 7. Problem modified from agency standpoint Problem modified from client's standpoint Problem unmodified because of limitation of case work resources within the agency Problem unmodified because of limitation in community resources Problem unmodified because of limitation in client's capacity Letters A, B, C, etc., refer to general classifications of problems. F.W.A.A. S t a t i s t i c a l C a r d N o . 1A CO © era ( » ' CD p **1 o to c t p>cra P c i -tS. H» N O H* P fci CO "' CD H CO CO o to o 00 H * * 1 C 0 P c t P c t F -CO et H* O P I—1 o o H 2 C J CD < CD H O O o *o 0 CD <L->. pj B O 1 c t o as CO ca O a P ct w o £ s» CO CO HcJ CD O H 4 H •x) O H X CO t> APPENDIX B II Second .Case S t a t i s t i c a l Card. Family Welfare Association of America (1938) 1 i t e 2 O O O DI o 2 2 2 z ~ z o. o £ 2 2 2 2 2 2 E = ' : ; = : £ 2 - 2 2 2 , 2 ' a a *~ fv 0 • • j © to . V £ K) ID » 2 ^ •* "X V H 10 y •x ^ STATUS FOR FIS CARRIED OVER" FROM PREVIOUS INTAKE DURING PRESENT YEAR. : <n mm 3 N w « m u « s " = STATUS FOR FIS CARRIED OVER" FROM PREVIOUS INTAKE DURING PRESENT YEAR. ACTIVE AT ANY TIME IN MONTH INACTIVE THRUOUT MONTH HEED1NC ATTENTION ACCORDING TO PLAN i i M I n i i i =. 1 1 i io n 1.II 1 1 „ i . i i l j i i I Ii ! M i ii ii I u i 1 i TRANSFERRED DATE FROM TO i • K 1 l ! \ TRANSFERRED DATE FROM TO 2 I-ll I fe TRANSFERRED DATE FROM TO OCCUPATIQN AND INDUSTRY OR SCHOOL AND GRADE OR WHEREABOUTS IF AWAY :AME TO I NATURAL If Si fe 111 i OCCUPATIQN AND INDUSTRY OR SCHOOL AND GRADE OR WHEREABOUTS IF AWAY :AME TO I NATURAL i r-2 I \ BIRTHPLACE RELATIONSHIP 1 s s •1 I I • I FAMILY STATUS MC CLC UC UM V 3ATE OF DEATH FAMILY STATUS MC CLC UC UM V h 1 I fe < ! s i FAMILY STATUS MC CLC UC UM V feS I I " L i « 2 « n . o N 5 t 2 » s S S 3 s CASE WORK PROBLEMS PRESENTED AND SERVICES RENDERED During Present Fiscal Year (Since last opening for intake during present fiscal year) PROBLEMS (Check for family or designate member of family by number). A. ECONOMIC: Lack of knowledge of available resources Problems of financial planning and home management caused by lower standards or marginal income Problems of financial planning grid home management com-plicated by. intellectual or emotional difficulty Financial need due to lack of support from members of family Resistance to using available resources Financial need which must be met if case work treatment is to be effective Financial need not met by public agency affecting plan for adjustment 8. 9. EMPLOYMENT: Persons with good work history and prospects for work need-ing case work service Persons needing vocational counseling or training Personality factors affecting employability Persons attempting to adjust to job requiring change in employment status Unemployment of head of family affecting family relationships Unemployed persons beyond the current industrial age level .SERVICES (Check for family or designate member of family by number). ECONOMIC: Services in relation to 1. Helping the client make use of economic resources in tho community 2. Helping the client make use of his own economic resources 3. Personality factors affecting management of income 4. Financial assistance met directly by the agency 5 EMPLOYMENT: Services in relation to — 7. Helping the client make use of opportunities 8. Training, counseling and preparation for employment 9, Personality factors influencing employment 10. Helping the client understand and accept industrial situations i i : 12 -FAMILY RELATIONSHIPS: Services in relation to 13. Helping the .client make use of resources for easing the situation 14. Helping the family work out adjustments of living arrangements 15. Training and development of children 16. Personality factors influencing family conflicts 17. Legal procedures affecting family or personal conflicts - - 18 _ _ : 19 FAMILY RELATIONSHIPS: , _ , Mental Physical Difficulties in relationship between husband and wife Difficulties in relationship between parent and child ~ ~ " Difficulties in relationship between substitute parent and child Difficulties in relationships among children in the family Problems.related to pregnancy Absence of parent or substitute parent Separation from family or relatives Difficulty in relationship to other relatives Irregularities in legal status causing fears or conflicts Actual or potential anti-social behavior affecting family life 21. 22. 23. - 24. 25. 26. HEALTH: Services in relation to Helping the client understand the facts and implications of the illness Helping the client use resources available for treatment Helping the client work out adjustment of living arrangement Personality factors influenced by illness Helping the client recognize the need for treatment SOCIAL AND ENVIRONMENTAL: Services in relation to • 27. Helping client use resources within community for correcting situation * HEALTH: s Ignorance of disease and its implications Illness affecting capacity for social and industrial adjustment Acute or chronic illness creating changes in the family structure. 1 Acute or chronic illness resulting in removal from the family group Need for readjustment following institutional care Acute or chronic illness or physical incapacity arousing fears or conflicts in the individual or others in the family Resistance to using resources for treatment . 28. 29. • 30. 31. 32. Interpretation of cultural standards Protecting the interest of children to relieve acute distress Protecting the interest of children in non-voluntary referrals EVALUATION AT CLOSING SOCIAL AND ENVIRONMENTAL: School problem involving family situation Inability to find or use educational or recreational facilities Ignorance of or non-acceptance of established cultural patterns Changes of residence affecting family adjustment Problems in relation to housing affecting family life A B C D E F 1. 2. 3. 4. 5. 6. 7. Problem modified from agency standpoint Problem modified from client's standpoint Problem unmodified because of limitation of case work resouices within the agency Problem unmodified because of limitation in community resources Problem unmodified because of limitation in client's capacity •Sf-03 CD © H O H) O P <t> > co ca o o H* P Ct H« o V & O P CO •CD 03 ct P ct (-* ca ct H * O O H> P t CD O P O P CO W 00 H H H X td Letters A. B, C, etc., refer to general classifications of problems. P.W.A.A. Statistical Card No. IA ^ " J " APPENDIX B III Case S t a t i s t i c a l Card In Current Use (Front) Family Service Association of America (1948) T E L E P H O N E N O . S O U R C E O F A P P L I C A T I O N A T L A T E S T O P E N I N G D A T E O F L A T E S T C L A S S I F I C A T I O N A T C L O S I N G S T A T U S F O R F I S C A L Y E A R O P E N I N G C L O S I N G o I N T V . 1 I N T V . 2 + I N T V . C A R R I E D O V E R F R O M P R E V I O U S Y E A R I N T A K E D U R I N G C U R R E N T Y E A R : N E W R E O P E N E l 5 F I N A N C I A L A S S I S T A N C E D U R I N G Y E A R F R O M A G E N C Y : Y E S ' N O W O R K E R R E L I G I O N R E S I D E N T Y E S N O Y E S F A M I L Y S T A T U S : M C P U B L I C A S S I S T A N C E : Y E S D I R E C T I N T E R -V I E W S MEMBERS OF HOUSEHOLD D A T E O F B I R T H BIRTHPLACE O C C U P A T I O N , S C H O O L , O R W H E R E A B O U T S I F A W A Y F E E F O R C A S E W O R K S E R V I C E : Y E S C H I L D P L A C E M E N T S T A T U S IN C U R R E N T M O N T H M E M -B E R 10 11 12 S I N G L E C H I L D R E N R E L A T I O N S H I P F . S . A . A . S T A T I S T I C A L C A R D - F O R M 1 i 1 9 4 7 APPENDIX B III Case S t a t i s t i c a l Card In Current Use (B ack) Family Services Association of America (1948) I. PROBLEMS GIVEN INDIVIDUAL CONSIDERATION BY CASEWORKER (during present fiscal year for carried over cases; since last opening for intake) Check 1. FAMILY RELATIONSHIPS a. Marital difficulty b. Parent-child relationships c. Unmarried parenthood d. Other 2. INDIVIDUAL PERSONALITY ADJUSTMENT a. Children (under 13 years) b. Adolescents (13 through 20) c. Adults (21 and over) ; 3. PLANNING FOR SUBSTITUTE CARE OF CHILDREN 4. OLD AGE 5. PHYSICAL ILLNESS OR HANDICAP 6. MENTAL ILLNESS a. Diagnosed b. Suspected 7. INTELLECTUAL RETARDATION a. Diagnosed b. Suspected 8. ECONOMIC 9. EMPLOYMENT (unemployment or underemployment) 10. EDUCATIONAL AND VOCATIONAL ADJUSTMENT 11. RECREATION 12. HOUSING 13. OTHER (specify) ' II. SPECIFIC LACKS OR INADEQUACIES IN COMMUNITY RESOURCES WHICH INTERFERED WITH SERVICE TO FAMILY OR INDIVIDUAL (specify) 1. 2. 3. r'i III. EVALUATION AT CLOSING .1 . Service enabled family or individual to handle situation better 2. Service did not enable family or individual to handle situation better _ t 3. U'.ic&le to evaluate APPENDIX C Assessment Form Used Experimentally By Family Welfare Bureau of Greater Vancouver {April 1947 - April 1948) CODE OF PROBLEMS AT INTAKE. Appropriate numbers to be entered at foot of Daily Registration and Re-opened sli p s , except in tne case of NCMs. Code numbers should be shown in record also. 1. Financial: b). c) I I . Investigation for other agency f 3 g. DBT Emergency situation. Question of e l i g i b i l i t y for public as-sistance, may or may not be considered at this point. Evic-tions may come i n her. Ineligible for public assistance. This w i l l include the following! Awaiting U.I. payments Ineligible for U.I. but classed as employable U.I. benefits inadequate -U.I. benefits exhausted. Earnings of parents inadequate but over r e l i e f scale. Earnings of children inadequate but over r e l i e f scale. Poor planning Income inadequate Public r e l i e f inadequate VII Employment: Catastrophe or i l l n e s s . a) Lack of employment Marriage?• b) Maladjustment "a) Personality Maladjustments c) Underemployment Irregular marital status VIII Environmental: d) e) f) g) b) c) d) b) c) Non-support d) Desertion of husband e) Desertion of Wife f) Absence of mother g) Absence of father, other than desertion. h) Pre-marital problem. i) Divorce or separation III. Child Parent Relationship's: aT Pre-adolescent children Adolescent children Grown sons and daughters Delinquency of child Behaviour problem (other than delinquency) Child Care: a) Temporary care needed i n or out of home-Permanent care needed in or out of home Neglect (actual or potential) Day care or pre-school education Very large family Guardianship'difficulties V. Illegitimacy: a") Unmarried mother b) Married woman VI. Health: ' . T e n t a l handicap (e.g. feeble minded) Physical handicap (e.g. deafness,.crippling) Mental illness (Include epilepsy) IV. b) c) d) e) b) e). f) a) Housing - Bad housing, inab i l i t y to find housing, etc.. Recreation School D i f f i c u l t i e s with relatives or neighbours, e) Cultural conflict. Co IX The Aged: X Immigration and  Citizenship. XI Legal: a) Legal aid. b) Other (except when covered by FC.) " a T b) c) d) e) f) S) Emotional instability (include neurotics, psychopaths) Physical illness Maternity Alcoholism SERVICES RENDERED - 02 & C3. 1. FINANCIAL: - S e r v i c e i n r e l a t i o n to:--. ' ff: a) I n v e s t i g a t i o n f o r other agency. b) F i n a n c i a l a s s i s t a n c e - Agency or T r u s t Funds. c) Other P r i v a t e Funds - Fuel,Fund, VCC, Red Cross Workship, Red C r o s s , Benev. Fund S e a f o r t h s Aux. e t c . , d) A d m i n i s t r a t i o n of C l i e n t ' s Funds. e) R e f e r r a l to p u b l i c department f ) R e f e r r a l to other p r i v a t e agency. g) Budgetting s e r v i c e and h e l p w i t h p l a n n i n g . h) P e r s o n a l i t y f a c t o r s a f f e c t i n g management of income. i ) Supervised.Homemaker (where c l i e n t has not p a i d f u l l c o s t a t time of checking) j) Medi&al s e r v i c e s - where c l i e n t unable to pay f u l l c o s t , k) E x p l o r i n g community r e s o u r c e s . ( * i - Payment of housekeepers from r e l i e f . funds not marked h e r e . Should be shown under l b . and whereveror e l s e a p p r o p r i -ate 4 b. 6e, 9.) 2. MARRIAGE: - S e r v i c e i n r e l a t i o n t o : -a) H e l p i n g the f a m i l y work out adjustments of l i v i n g arrangements. b) P e r s o n a l i t y f a c t o r s i n f l u e n c i n g f a m i l y c o n f l i c t s . c) L e g a l procedure a f f e c t i n g f a m i l y or p e r s o n a l c o n f l i c t s . d) P s y c h i a t r i c . (1) D i r e c t (2) I n d i r e c t - c o n s u l t a t i o n . e) M e d i c a l advise i n r e l a t i o n to marriage r e l a t i o n s h i p . f ) . Support o b t a i n e d . 3. CHILD PARENT RELATIONSHIPS: (Behaviour d i f f i c u l t i e s ) a) Placement of c h i l d - (through own or other agency - i n c l u d e w i t h r e l a t i v e s ) b) Day care of c h i l d - (through own or other agency - i n c l u d e w i t h r e l a t i v e s - i n c l u d e Nursery school) c) P s y c h i a t r i c s e r v i c e (1) D i r e c t (2) I n d i r e c t - c o n s u l t a t i o n . d) L e g a l Procedures. e) R e c r e a t i o n . f ) D i r e c t treatment of c h i l d . g) D i r e c t treatment of parents. 4. CHILD CARE. a) S u p e r v i s e d Homemaker b) Other housekeeper ( i n c l u d e r e l a t i v e s ) c) Placement of c h i l d - i n c l u d i n g w i t h r e l a t i v e s . d) Day care ( a l l k inds) e) R e f e r r a l to p r o t e c t i o n agency. f ) L e g a l Procedures. 5. ILLEGITIMACY: ( S e r v i c e i n r e l a t i o n to) a) M e d i c a l s e r v i c e s b) P s y c h i a t r i c s e r v i c e (1) D i r e c t (2) I n d i r e c t . - c) S e r v i c e i n r e l a t i o n to p e r s o n a l i t y f a c t o r s . . d) L i v i n g arrangements e) L e g a l procedures. 6. HEALTH: ( S e r v i c e s i n r e l a t i o n to:) a) M e d i c a l S e r v i c e s . b) P s y c h i a t r i c S e r v i c e (1) D i r e c t (2) I n d i r e c t . c) P r o f e s s i o n a l N u r s i n g S e r v i c e s - V.O.N, e t c . o d) H o s p i t a l Nursing or boarding home. e) Housekeeper or p r a c t i c a l n urse. f ) H e l p i n g c l i e n t or others i n f a m i l y r e c o g n i z e need f o r treatment. g) H e l p i n g c l i e n t and f a m i l y to understand f a c t s and i m p l i c a t i o n s of the c o n d i t i o n . 7. EMPLOYMENT: (Service In Relation to:) a) Referral to employment services. b) Psychiatric (1) Direct (2) Indirect. c) Exploration of employment situation. d) Personality factors, vocational guidance etc. e) Determination of e l i g i b i l i t y . f) Interpretation to employer. 8 . ENVIRONMENTAL: (Service in relation to:) a) Attempt to social action. b) Referral to housing resource c) Recreation referral d) Consultation with school teacher, Attendance Office or nurse e) Interpretation of school problem with family. f) Interpretation of cultural conflicts. g) Interpretation of d i f f i c u l t i e s with relatives, neighbours, landlords, etc. 9*- THE AGED: (Service i n relation to:) a) Adjustment of living arrangements. b) Housekeeping services. c) Personality factors, clients. d) Personality factors - relatives or others. 10. IMMIGRATION AND CITIZENSHIP: a) Co-operation.with Immigration service. b) Interpretation of situation to client. c) Use of other resources to aid the situation. 11. LEGAL - RP. APPENDIX D RESEARCH INTERVIEW I. Questionnaire And Answers II. Recording of Interview QUESTIONNAIRE AND ANSWERS 1. How long have you known about F. W. B.f •A short time before coming to the agency and then knew more about the children's agency—only vaguely about F.W.B. 2. What d i d you think i t did? (1) Helped destitute families. (2) Helped unmarried mothers-(3) Helped delinquent children. wl'didn't think that i t would deal with problems in a family like ours." 3. How did you come to F.W.B.? Through knowing a friend who had v i s i t s from a children's agency worker. 4. Would you return i f necessary? Certainly! 5 . Have you recommended anybody to the agency and,if so, how? Trying to do this right now. A neighbour is punishing her l i t t l e g i r l for bed-wetting. Mrs. A. tried to explain the ability of the agency.to help understand the problem. When the woman could not accept' this Mrs. A. spoke to her about using a child guidance centre. "I knew they'd li k e l y show her' that the trouble was with her and not with the c h i l d 0 It was obvious that Mrs. A. had continued to use the insight she had gained. She said that there were s t i l l minor problems i n her family but "the same principles s t i l l work" She had joined some outside groups and was also trying her. hand at pencil portrait. "E. West" II RESEARCH INTERVIEW An appointment had been made by telephone and vis. had indicated that she wanted to secure Mrs. A's help i n a project. The v i s i t was made early i n the morning and Mrs. A. was neatly but casually dressed as usual and took vis. to the kitchen to talk, as she. had always done. The general nature of the project was ex-plained to her and the specific questions on the questionnaire were outlined. To the one about whether she would return to the Agency i f she encountered further d i f f i c u l t y , Mrs. A. replied, •'Why, of course!" When asked whether she had'ever recommended anyone to the Agency she replied that she was i n the midst of trying to get one of her neighbours to consult FWB. This neighbour has adopted two children of a relative, and Mrs. A. stated that she punishes one child because she>*gj|jBBJi^<> The l i t t l e g i r l is^made to wash extra dishes and do extra work, i f she happened to*lmJiJm~ the previous night. Mrs. A. seemed quite disturbed by this and'obviously f e l t that her neighbour was behaving in a ridiculous way, but she talked of her with understanding rather than in any s p i r i t of criticism. Mrs. A. said that the l i t t l e g i r l sometimes caused problems because she seemed to be nagged a l l the time. She had asked her neighbour i f she had ever tried making a fuss over her and giving her attention, as most children needed that. Mrs. A. added nShe did not seem to understand what I was talking about". She went.on .to say that she knew her neighbour would change her attitude i f only she could under-stand her situation and see that she was not giving the child a chance at a l l . Mrs. A. became particularly thoughtful at this point and said that although she had recommended the Agency and told the neighbour that the Agency could help her in finding out what the real problem was, she doubted whether her friend was ready for this,-"I don't think she would be able to talk honestly about her feelings, and i f she didn't the worker would not have a chance to help her." To show what she meant about the neighbour's unwillingness to be honest Mrs.. A. told of an incident which showed this. When the neighbour had not responded at a l l to Mrs. A's suggestion that the Agency could help her to find "what the real problem was".Mrs. A. had then talked about going to the Agency so that a psychiatric examination of the g i r l could be held. She laughed and said "I knew that i f she went there they would succeed in showing her that the trouble lay within herself rather than i n the child. Mrs. A. went on to talk about her own family. Jane is doing well at school .and, as usual, canises no trouble anywhere. She. said that Sonny was a b i t slow at school and seemed to have a short span of interest. Vis. noted the affection and understanding i n Mrs. A's voice as she talked of Sonny. There was no longer any trace of tension or of criticism. She said that she was helping him with his writing at night as this had been suggested by the teacher, and' in the middle of a line Sonny would break off and want to t e l l her of. something that had happened, during the day. Mrs. A. said that she would suggest to him that he fini<sh the line and then t e l l her the story. Again, the way in which she told this seemed to indicate that Mrs. A . no longer found i t d i f f i c u l t to be patient. She commen-ted that Sonny had passed Grade 1 last year, although he had not been doing very well. She laughed and said that she had urged the teacher to put him on but realized now that she had made a mistake. Her pride had got i n the. road andjshe had f e l t that her child could not f a i l . She saw now, however, that unless Sonny mastered the work that he was doing he would always lag behind and get discouraged. She was laughing at herself as she said that this year Sonny would f a i l and everybody was going to be very happy about i t . There are s t i l l d i f f i c u l t i e s rregarding the neighbours. Mrs. A . said that for a long time every new comer to the area would be told of how bad Sonny had been and that this was hard on him. Since going to school he had a tendency to make friends in other d i s t r i c t s . Sometimes he would be quite late coming home after school because he had gone to play at the homes of some of these children. Vis. enquired whether Mrs. A. became anxious on such occasions and she said that she did not for she realized that he had to have friends. She did not comment spe-c i f i c a l l y on any worry as to whether Sonny would come directly from the home of his friends to his own home but there seemed to be an implicit trust in the boy. She said that of course he was not free from problems but "the same principles s t i l l work ". With great enthusiasm Mrs. A. ask-ed v i s . whether she had noticed the boat i n the yard. She said i t had been Mr. A's suggestion that they buy the boat in-order to give Sonny outings. They would go up the Sound and land on some islands, and Sonny would clamber over the rocks and y e l l to his heart's content. Mrs. A . said that the boy loved these outings.. Mrs. Ao talked for a U t i l e while about herself and Mr. A . He i s playing in an orchestra and leading a choir and she sometimes gets lonesome as he is out a great deal in the evenings, but knowing how much music means to him she does not want to interfere. As v i s . was about to leave, Mrs. A . said that she would like to show her something. In the living-room above the piano was a beautiful portrait of Brahms. Mrs. A. said that she had done this for her husband and he had been so proud of i t that he had asked her to do some of his other favorite composers. Mrs. A. has been attending recreation class and said that she had enjoyed It very much. She likes the exercise and had enjoyed the weekly meetings with the women. She remarked, however, that she was not going in the display because she was s t i l l too self-conscious to do that type of thing. Just as v i s . was leaving, Mrs. A* commented on how much the service of the Agency had meant to their family. She wondered If she ever needed help again i f she would be able to ask for vis., but v i s . explained that, she was working i n another d i s t r i c t this would not be possible but that-, Mrs. A. would get the same service from any member of the Agency. Mrs. A. said that she realized that but i t would be a b i t awkward having to ex-'' plain everything a l l over again. Vis. realised then that the matter of records had never been discussed with Mrs. A. She explained to her how these records were kept as sometimes there was a change of worker, and went on to talk about how important they were in understanding the s i -tuation clearly. Mrs. A. accepted this very casually and commented that they would make i t easier for families to go back i f there was a record kept..of what had happened. "E. West" APPENDIX E BIBLIOGRAPHY SOCIAL CASE WORK A . Booka Hamilton, Gordon, Theory And P r a c t i c e o f , S o c i a l Case Work, NewwYork, Columbia U n i v e r s i t y P r e s s , 1940 A c l a s s i c a l d e s c r i p t i o n of the nature of s o c i a l case work by the "Dean of S o c i a l Case Workers" Richmond, Mary E., S o c i a l D i a g n o s i s , New York, R u s s e l l S age Foundation,1917. Richmond, Mary E., The Long View, Papers and Addresses s e l e c t e d and e d i t e d w i t h b i o g r a p h i c a l notes by Joanna P. C o l c o r d and Ruth Q.Z. Mann, New York, R u s s e l l Sage Foundation, 1930. Well-chosen s e l e c t i o n that g i v e s Miss Richmond 1s ph i l o s o p h y . The biography i s w e l l - w r i t t e n and w e l l - b a l a n c e d w i t h the documentation. Richmond, Mary E., What Is S o c i a l Case Work, New York, R u s s e l l Sage Foundation, 1922. B. A r t i c l e s A u s t i n , L u c i l l e , "Trends In D i f f e r e n t i a l Treatment I n S o c i a l Case Work", J o u r n a l of S o c i a l Case Work, V o l . XXIX No. 6, June 1948. Pp. 203-211. A paper d e l i v e r e d at the N a t i o n a l Conference of S o c i a l Work, A t l a n t i c C i t y , New J e r s e y , A p r i l 1948. An e x c e l l e n t account of the advance i n s o c i a l case work from environmental treatment to psychotherapy. G a r r e t t e , Annette, "The P r o f e s s i o n a l Base of S o c i a l Case Work", The F a m i l y , V o l . XXVII J u l y , 1946. Pp. 167-174 C l e a r l y d e l i n e a t e d a n a l y s i s of s o c i a l case work. Parker, E a r l N., "Family S o c i a l Work", S o c i a l Work Year Book 1947, New York, R u s s e l l Sage Foundation, 1947 Pp„ • BIBLIOGRAPHY (2) Towle, Charlotte, "Social Case Work", Social Work Year Book 1947, New York, Russell Sage Foundation, 1947 Pp. *77-a-? Towle, Charlotte, "Social Case Work In Modern Society", Social Service Review, June 1946 (Printed Separately) Peerless descriptive analysis of social case war k and i t s relationship to the l i f e of the present day. • FUNCTIONAL APPROACH TO SOCIAL CASE WORK A. Book Taft, Jessie, Family Case Work, Philadelphis, University of Pennsylvania Press, 1944. A compendium of articles about case work from the functional point of view, written by the case work teachers of Pennsylvania School of Social Work. (Leading protagonist of this approach) B. Articles Marcus, Grace F., "Family Case Work In 1948", Journal of Social Case Work, Vol. XXIX, No. 7, July 1948 Pp. 261-279. Pray, Kenneth L., "A Restatement of The Generic Principles of Social Case Work Practice", Journal of  Social Case Work, Vol. XXVIII, No. 8, Oct. 1947. Pp. 283-90. Sytz, Florence, "The Development of Method In Social Case Work", Journal of Social Case Work, Vol. XXIX, No. 3, March 1948. Pp. 83-88 FAMILY WELFARE BUREAU OF GREATER VANCOUVER Documents British Columbia Child Welfare Survey Committee, Vancouver,B.G, Report 1927 Pp. 41-44. Strong, G. F. Early History of The Family Welfare Bureau. . Read at the annual meeting of the Family Welfare Bureau of Greater Vancouver, April 26, 1938. Family Welfare Bureau of Greater Vancouver, Annual Reports 1935, '36, '43, '48. Vancouver, B.C. BIBLIOGRAPHY (3). EVALUATION OF SOCIAL CASE WORK RESULTS REPORTS Dollard, John, and Mowrer, 0. Hobart, "A Method of Measuring Tension In Written Documents", Reprinted from Journal of Abnormal and Social Psychology, Vol. 42, No. 1, January 1947. Hunt, J. McVicker, "Measuring The Effects of Social Case Work, Transactions, New York Academy of Sciences, Series II Vol 9, No. 3 Jan. 1947 Pp. 78-88. Hunt, J. McVicker, "Toward A Measure of Movement In.Social Case Work: A Progress Report" Presented at National Conference of Social Work, Atlantic City, New Jersey, April 1948. Heckman, A. A., and Stone, Allan, "An Analysis of Case Work . Problems In 1032 Families and An Evaluation . of The Services Rendered These Families by Family Service of"St. Paul", St. Paul, Minn. June 1947. Fi r s t report of St. Paul evaluation project. Heckman, A. A., and Stone, Allan, "Forging.New Tools", Survey -Mldmonthly, Vol. LXXXII No..10, Oct. 1947 Pp. 267-70. Heckman, A. A., "Measurement of The Effectiveness of Family Case Work" Paper presented at National Conference of Social Work, Atlantic City, New Jersey, Ap r i l 1948. Schiffman, Frances, and Olsen, Elma, "A Study In Family Case Work" Evanston, I l l i n o i s , Family Welfare Association of Evanston, I l l i n o i s , 1939. 

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